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Home My WebLink AboutR-2023-051 Designating an Agent and Accepting Certain Insurance BenefitsRESOLUTION NO. R-2023-51 A RESOLUTION DESIGNATING AN AGENT AND ACCEPTING CERTAIN INSURANCE BENEFITS BEGINNING JULY 1, 2023. BE IT RESOLVED BY THE BOARD OF ALDERMEN OF THE CITY OF RIVERSIDE, MISSOURI AS FOLLOWS: THAT the City of Riverside designates Bukaty Companies as its broker/agency of record for employee insurance benefits beginning July 1, 2023; and FURTHER THAT the City accepts the 0% rate increase from United Healthcare for the City's health and vision plans and a 2.5% rate increase from United Healthcare for the City's dental plan, all in accordance with the attached plan summaries; and FURTHER THAT the City agrees to provide Voluntary Short -Term Disability, Long -Term Disability, Hospital Indemnity, Critical Illness, and Accident polices from Reliance Standard all in accordance with the attached plan summaries; and FURTHER THAT the City agrees to provide a Voluntary Identify Theft Protection policy from Identity Force all in accordance with the attached plan summaries; and FURTHER THAT the Mayor, the City Administrator, Human Resources Manager, and other appropriate City officials are hereby authorized to take any and all actions as may be deemed necessary or convenient to carry out and comply with the intent of the Resolution and to execute and deliver for and on behalf of the City all certificates, instruments, agreements, and other documents as may be necessary or convenient to perform all matters herein authorized. PASSED AND ADOPTED by the Board of Aldermen of the City of Riverside, Missouri, the 5th day of May 2023. Ma or Kathleen L. Rose ATTE 4. t Robin. Kincaid, City Clerk ■BUKATY COMPANIES Expertise you experience City of Riverside Current Renewal UNITED HEALTHCARE UNITED HEALTHCARE UNITED HEALTHCARE UNITED HEALTHCARE vs. BW8T (Premier) Rx Plan: IU BWBW I Premier) Rx Plan: IU BTKN IHSA) RK Plan: H9-HSA DFLU (HSA) Rx Plan: H9-HSA Current/Renewal CurmnVRenewal Current Renewal -NEW PLAN BENEFITS Cholce Plus Nework Choke Plus Network Choice Plus Nelwork Cholc. PI.. Network NNwerk NamNerwe•k Network Nan-Neevod Nuworh Non-N,elwerk Nelwor. NonNeaverh Pan.rowN Pav+ PwxrowN vat• CALENDAR YEAR DEDUCTIBLE P Pwe wr• • Individual $1,000 $5.000 $2.000 $10,000 Pan<o.+t Pay+ SZ500 $5,000 f5,000 f10.000 PwN..ne Pare $2,800 $5,000 $7,000 55.000 S6p00 $10,000 a+icowN Par• • Family $5 fi00 $10.000 PHYSICIAN OFFICE VISITS a OTHER arnr xpars Primary Gre Phy.cwn Ol/i-Nutr$50 $ge 19/S25 Copay Datludible, G-Inurerce $0 vtler ape tYf30 GOay Detlucbbk. Co-Irwaarce Oedlcnbk, Lo-Iravarce DeWchbk, Co-bwverce Ixalctmk. co-Iray.rrs Dedltbbk. Co-Invarce Speaatisl Phywaan01fiuvol mpry Detlwbbk, Co4-- $60-pay Deducbbk, Co -insane Dedle6bk. Co-lnw.— DWIctW Co-k-- Dductbh, C.4-. rce DWucllbk. C,4—n- Urped CareC.Ner Nwl copayhvit D.dletibk: G-1— $50 wpayMsd Oadlstibl. Ce4ns... Dci c bt., Co -(matte Deducbbic Co-lnavance DdmtblaCo-Invarce De —bic Co-lnwaneEm q,p Reom Nut +tled 6 min I visit S250 copay+ded B win l wal $250 - pay+ded Acolnl wait $250 wpay+ dad S can 1—.1 Dedmtbk, Co-im— Dmimbbk: Co-lnsane Dedwtible. Co-I—m. Dedrebble, Co4mvarce Lab Serve.. 100°S Deductible; Ce-Inwarre 100% Dedwtibl. C.4—no. 100% Oedmtibk, Co Il—e 1DO% Deductbk: LoJnvarce %-Ray Services 100% ON=bla, C.-Insane 100% D"mhbk. La-Inure-e 100% Deductibk, G-Invent. 100% Dedwtibk. Ca-Inwance Hqp Tech R.diokpical Service. O.d.bble, Co-1— Deductible: Co4nsw.— Deductible: Co-Inwence Deductbi, Co -I —me Deductibk: Co-1—me Deductible, Co-k.vance Ded—bk. Co-Inwance Dedmtible, Co -(nuance Swpery (Physlnen Office) Deductible, Co4—m. Dedwbble, G-(matte Ndmtible. C,Am,,me Dedwbbl. Co-lnurarce DNombbk. Co-lnwnse Detllshbk; C.4—me Ded—W. Co-Invarce Dedwhbk. Co-lnvarce Ch11Prad11VluVSP1nI kbnpll.banlLimib May Apply) Oed.bble, Co-I—m. D d-liblc Co4—na Dedw:hble, C.4-..— Dedv:ubkCodreurane Ded.hbk, Co-Inwance DedW,bk. Co-Irevane Deductible. Co-I—m. Dedimbble Co4now— InpalurU04pabM Hospul Service. tc.rcal Deductible, Co-Insanw D.tludlbl., G4-- Deductible. Co-Inwaree 0ed ,bl. C.4—me Dedmi,bk: CoJra— Dedstibk, Co -Inverse Deductibl,. Co-Inv.nce Dedmbble Co-Irwwance Other Co—d So-..lCarciell Dedwtibk, Co4nsarca Detludlbl., Co4nwnce 80% sox Pa ro>7r Per+ D.du Yibl., C.-lm re Deducbble Co-lrwaance Box sox PenropwN Pw+ Dedlehbk, Co-lnwarce 0e ,bk. Co-kwwarce Dedwtibl.. Co-Inwarre Dedletlbk. Co-Inwaree Sox W% v.Mw•n�var+ PUN C04NSURANCE,—"j 80% sox CALENDAR YEAR OUT-OF-POCKET MAX. PwzpwN van (Includes Tne DaWcfible, Medcal B RX Copays) • Individual $4,000 510,000 $6.000 510.W0 $12,000 S2L1,000 IS— 570.000 SS.fi00 510,000 S1 t,200 S2(1,000 • Family 58,000 $20,000 511,200 570,fxlo Additional Into: RETAIL PRESCRIPTION DRUGS COPAY Nr Orow-Pares«c.ewrvww• Twr1-515 mpry Twr1-fl5wpey Twr1-fly wpay Tler1-S15mpay Tiert-Ded+510-pry Tiar 1-Ded+$10-Pay Twr 14).d+$10-Pay Tler1-Gd+S10 Lowy cardsvmm.r vewwua Tkr 2-SAD mpay Tier 2-f40 mpay Tier2-340 wpaY TIer2-UG Pay Tier' -Dad+ 35 cops S Y Ter2-Ded +335 mpay Tkr2-Oetl•f]O wpaY tier'-Ded *f35 copay Ter 3-S75-pay Tier3-f75 c,pay Tier3-S75 copay Tier3-575 mpry Tier3-Oed+$50 copay Tier3-Ded+S50 mpay Tmr3-Detl+f50 mpay TIer 3-Ded+f50 copay Additi.nl R%Iltlormation COST ewr.d a..... e.rr.d Aanww f:ewe CwnM Cew. .emw.l Emplov—Only S678.94 9 $678.94 $626.46 1 S628.46 22 S494.18 22 $494,18 Einpkye. Phi. One $1,575.14 0 S1,575.14 Ill 453.39 1 S1A53.39 12 f1,146450 12 $1,146.50 Erlployn Plus FamNy $1,866.68 2 $1,866,68 $1,72139 2 $1,7224M 18 f1,3511470 18 $14358.70 Esti—d Monthly C-1 $9,843.82 $9,843.82 $5,524.63 $5,524,63 $49.OS6.56 $49pS6.56 Esurlssled Annual Cost $118,125,84 $118,125.84 $66.295.56 $65.295.56 SSSS038.72 $589,038.72 Incre WDern..e Over Currant 0% 0% 0% CurIaN--ly Coer al AN Plane $64.455.01 A:MWaI MPiNhly C.er of All Plan+ $64,455.01 Cwwd A —A Coe101 All Plan S773,460.12 Re�wwal annual Caet of AN Plane S773,460.12 Ircrnee/Oacwaee Over Curanl 0% ADDITIONAL INFORMATION AuT...e Ck.wnarr py dwnr. rrNale4rew ACA T..., caw. moraytram. nr.NNdad ACA Ten. C—mrm.0wm,,M eN:Aead ACA Tana CY nww gyrMrn, raw nc.a.d NONE Th. N - 0ver+rw offl—Afa o*. W— a. eunm. y M. cpnkacf dt1 r. ft eor &.t"pnv.i. City of Riverside • t Carrier Plan Type BENEFITS CALENDAR YEAR DEDUCTIBLE Individual Family A. DIAGNOSTIC & PREVENTIVE SERVICES B. BASIC SERVICES C. MAJOR SERVICES D. ORTHODONTIC SERVICES CALENDAR YEAR MAXIMUM BENEFIT 1A B, & CI ORTHODONTIC LIFETIME MAXIMUM to) COST Empbyee Only Empbyee + Spouse Empbyee + Child(uml Employ"Plus Family Esfimated Monthly Coat Estimated Annual Cost nerea.elDeerease Over Current Total Current Montly Coat $3,573.68 Tore; Currant Annual Cost $42,884.10 United Health Care United Healthcare P1138 P1138 Network Non-Nobrork Network Non-IMework $50 $50 $150 S150 100% aa. n.r, 60% 100% ar• a0% 00% so% e0X Sax 50% 40% 50% 40% 50% SOX 50% 50% $1,Soo $1, 500 $1.000 $1.000 COUNTS COUNTS 25 521.83 25 522.31 8 I $43.86 8 f44.75 10 557.54 10 $Se.98 25 $84.13 25 386.23 S3.573.68 $3.663.05 $42,684.16 $43.956.60 0.0% 2.5% Dependent. b age 28 Dependent. b age 26 United Healthcare Delta Dental Missouri P4887 Network: Options PPO 30 Network. Deltal Denta PPO Network Non -Network Network Non-Nalwork S50 • $50 $150 $150 100% n 100% 100 % m 80% 80% 80% 80% 60% 50% 50% 50% 50% 50% sox so% 50% $2.000 $1, 500 $2,000 $1, 000 COUNTS 25 $30.29 COUNTS 25 524.31 a SeO.se 8 f49.85 10 $80.34 10 657.43 25 $117,31 25 $89.48 $4,978.04 $3,519.36 $59.735.4e $46,632.20 39.3% 8.9% 2% Bundling discount It wl Dena Dental Vl.bn Dependents to age 26 lhpendant. to age 26 NBUKATY COMPANIES Expertise you experience Network Non -Network �SSOPm S150 100% 11% 80% fi0% 50% 40% 50% 40% $1,500 $1,000 COUNTS 25 132.30 8 $64. 50 10 I $85.90 25 $122.70 $6.290.00 $83,000.00 43.3% Dependent. to age 28 ■ 0 0 EBUKATY COMPANIES Expertise you experience City of Riverside Current/Renewal•� . • a Carrier United Healthcare Delta Denta Missouri BCBS of KC Network S1106 12/12124 Dynamic Select Plus 130 Plan 12112124 Blue Vue 10/150 12112112 Plan Type .. ._ _. . __ _.... .. ... ..... ..,.. ._. BENEFITS Net—,* Non -Network Network Non -Network Network Non Network Pan,cipant Pays Plan Allowance Panlopant Pays Men Allowance Participant P.Y. M-Allowance VISION EXAM Once every 12 Months $10 Up to $40 $10 Up to $40 $10 Up to $30 FRAMES Plan Allowance Men Allowance Plan Allowance Plen Allowance Men, Allowance Men Allowance S 130 Allowance $45 $130 Allowance II 112 $130 Allowance I $45 STANDARD PLASTIC LENSES Participant Pays Men Allowance Paniopenf Pays Plan Allowance Participaw Pays Plan Allowance Once every 12 Months Single Vision $25 Copay Up to $40 $25 Copay Up to $20 $25 Copay Up to $25 Bifocal $25 Copay Up to $60 $25 Copay Up to $40 $25 Copay Up to $40 Trifocal $25 Copay Up to $80 $25 Copay Up to $60 $25 Copay Up to $55 Lenticular $25 Copay $25 Copay Up to $100 $25 Copay Up to $55 CONTACT LENSES Participant Peys Plan Allowance Rvf,i ipent P.Y. Plan Allowance Participant Pays Plan Allowance Once Every 12 Months - In Lieu Of Frameskarises CONTACT LENS FIT & FOLLOW-UP Up to $60 Not Covered Up to $30 Not Covered Up to $55 Not Covered Conventional $150 Allowance $100 Allowance $130 Allowance $78 Allowance $150 Allowance $120 Allowance Disposable $150 Allowance $100 Allowance $130 Allowance $78 Allowance $150 Allowance $120 Allowance Medically Necessary $0 $210 Allowance $0 1 $250 Allowance $0 $210 Allowance See Summery of Benefits for more defeils See Summery of Benefits for morn deteAs See Summary of Benefits for more details COST Counts Monthly Rate Counts Monthly Rate Counts Monthly Rate Employee Only 24 $6.14 24 $4.83 24 $6.99 Employee Plus Spouse 6 $11.65 6 $9.05 6 $12.58 Employee Plus Child(ren) 9 $13.66 9 $10.27 9 $12.93 Employee Plus Family 23 $19.24 23 $14.97 23 $24.47 Estimated Monthly Cost $702.72 $606.96 $922.42 Estimated Annual Cost $9, 392.64 $7,283.52 $11.U69.04 Increase/Decrease Over Current 0 % -22.46 % 17.85% 2% bundling discount wl Dental De endents to a e 26 De endents to a e 26 De endents to a e 26 This is an Overview of Benefits only, where this summary B the contract differ, the contract will prevail N City of Riverside BENEFITS - Employer Paid EMPLOYEE SHORT-TERM DISABILITY Elimination Period Benefit Maximum Benefit Period COST - Employee Paid Volume $51,510.81 Monthly Premium ADDITIONAL INFORMATION Reliance Standard All Eligible Employees working 30 hours week Accident: 15th Day Sickness: 15th Day 60% To $1,000 Maximum Benefit Per Week 11 Weeks Salary Increase/Decrease Occurs On Plan Anniversary Employee Rate - Rate Per $10 $0.310 $1,596.84 2 year rate guarantee EBUKATY COMPANIES Expertise you experience BUKATY COMPANIES Expertise you experience City of Riverside BENEFITS - Employer Provided EMPLOYEE LONG-TERM DISABILITY Elimination Period Benefit Own Occupation Limitation Maximum Benefit Period Mental/Nervous, Substance Abuse Limitation Special Conditions Limitation Social Security Integration Partial Disability & Recurrent Disability Benefit Pre -Existing Conditions Limitation Survivor Income Benefit COST - Employer Provided VOLUME LONG-TERM DISABILITY $391,725 Covered Monthly Payroll Estimated Monthly Cost Estimated Annual Cost ADDITIONAL INFORMATION 3 es--„-------„„'s s �� s�„ss�sssss�33��r" 3 [LLiL F - u F _ a 1 u 1 w 9 1, 1 a u a a a d m u u 9 0 00 E N U > - o 9 x o D y Z Un m v 6 Y 80 O OC O Y Z O B N n g N N N W q M O D D N u a u O a z - ^ O w w m 0 ❑ a n m R gR - n _= a S M- e o a a O O N« N N M N N N N N » Z I 2 0 4 0 «« « «« H N M M N I N N« N«« O w Zj n 8' N M N M N ' N M M X1, M M w 1 <' Accident Insurance COVERAGE Voluntary accident insurance provides a range of fixed, lump -sum FEATURES benefits for injuries resulting from a covered accident, or for accidental death and dismemberment (if included). These benefits are paid directly to the insured and may be used for any reason, from deductibles and prescriptions to transportation and childcare. ELIGIBILITY All Active Benefit Eligible Employees, except for any person working on a temporary or seasonal basis. Dependents: You must be insured for your Dependents to be covered. Dependents are: ► Your legal spouse or domestic partner. Spouse must be under age 70 at date of application. ► Your dependent children from birth to 26 years. ► A person may not have coverage as both an Employee and Dependent. BENEFIT AMOUNT See Full Schedule of Benefits on next page CONTRIBUTION REQUIREMENTS Coverage is 100% Employee Paid. MONTHLY PREMIUM Coverage Low Plan High Plan Employee $ 10.33 $ 17.70 Employee and Spouse $ 17.73 $ 29.43 Employee & Children $ 18.44 $ 31.31 Employee & Family $ 25.63 $ 42.60 ► Portability to Employee Age 70 ► FMLA/MSLA Continuation ► Newlywed and Newborn Provision ► 24-Hour Travel Assistance Services ► 24-Hour Coverage RELIANCE STANDARD BUKATY ILIFE INSURANCE COMPANY ECOMPANIES This Plan Highlight is not a completed escription of the insurance coverage. Insurance is provided under group policy form LRS-9547, etal. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. Ambulance $100 Ground, $500 Air Blood, Plasma and Platelets $100 Burns To $800 for 2nd degree burns; To $6,400 for 3rd degree burns; Skin Graft - 50% of benefit payable for Burns Chiropractic Services (per Visit) � $25 per session, 6 sessions maximum Coma $7,500 Concussion $150 Dental Injury $150 for Crown; $50 for Extraction Diagnostic Exams $250 per CT/MRI scan Dislocation To $2,400 for Non -surgical; To $4,800 for Surgical; Partial - 50% of full dislocation; Multiple - 200% of highest dislocation benefit Emergency Treatment $120 Epidural Anesthesia Injection (per $100, 2 maximum Injection) Eye Injury Fractures Initial Hospital Admission Initial Intensive Care Unit (ICU) Hospital Admission Hospital Confinement (per Day) Intensive Care Unit (ICU) Confinement (per Day) Lacerations Lodging (per Day) Medical Appliances Organized Youth Sports Benefit Paralysis Physical Therapy (per Session) Physician Visit Prosthesis Rehabilitation Facility Confinement (per Day) Surgery Transportation X-Rays Wellness (Health Screening) (RELIANCE STANDARD LIFE INSURANCE COMPANY $100 for removal of foreign object, $200 for surgical repair To $3,125 for Non -surgical; To $6,250 for Surgical repair; Chip fracture: 50% of non- surgical benefit; Multiple fractures: 200% of highest sustained fracture $1,250 $1,250 $300, 365 days maximum $500, 30 days maximum To $400 $50 per day up to 30 days if more than 100 miles from residence $300 25% of the benefit amount $10,000 quadriplegia; $5,000 paraplegia/hemiplegia $40, 12 sessions maximum $50 Initial, $50 Follow-up $250 for one, $500 for two or more $150, 30 days maximum $100 for Exploratory; $300 for Knee Cartilage; $1,000 for Abdominal or Thoracic; $500 for Ruptured Disc; to $600 Tendon, Ligament, or Rotator cuff $300, if more than 100 miles from residence $50 $200 Ground, $1,000 Air $200 To $2,400 for 2nd degree burns; To $19,200 for 3rd degree burns; Skin Graft - 50% of benefit payable for Burns $25 per session, 6 sessions maximum $10,000 $300 _ $450 for Crown; $150 for Extraction $300 per CT/MRI scan To $3,200 for Non -surgical; To $6,400 for Surgical; Partial - 50% of full dislocation; Multiple - 200% of highest dislocation benefit $300 $200, 2 maximum $200 for removal of foreign object, $400 for surgical repair To $6,250 for Non -surgical; To $12,500 for Surgical repair; Chip fracture: 50% of non- surgical benefit; Multiple fractures: 200% of highest sustained fracture $2,250 $2,250 $450, 365 days maximum $900, 30 days maximum To $600 _ $200 per day up to 30 days if more than 100 miles from residence $400 25% of the benefit amount $50,000 quadriplegia; $25,000 paraplegia/hemiplegia $60, 12 sessions maximum $100 Initial, $100 Follow-up $500 for one, $1,000 for two or more $150, 30 days maximum $200 for Exploratory; $600 for Knee Cartilage; $2,000 for Abdominal or Thoracic; $1,000 for Ruptured Disc; to $1,200 Tendon, Ligament, or Rotator cuff $450, if more than 100 miles from residence $50 www.reliancestandard.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9547, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. Bukaty Shelf Plan COVERAGE Voluntary critical illness insurance provides a fixed, lump- sum benefit CONTRIBUTION REQUIREMENTS upon diagnosis of a critical illness, which can include heart attack, stroke, paralysis and more. These benefits are paid directly to the insured and may be used for any reason, from deductibles and prescriptions to transportation and child care. ELIGIBILITY All Active Benefit Eligible Employees, except for any person working on a temporary or seasonal basis. Dependents: You must be insured for your Dependents to be covered. Dependents are: ► Your legal spouse or your domestic partner. Spouse must be under age 70 at date of application. Coverage terminates at age 75. ► Your dependent children from birth to 26 years. ► A person may not have coverage as both an Employee and Dependent. BENEFIT AMOUNT Employee: Choose from a benefit of $5,000 to a maximum of $20,000 in $5,000 increments. Spouse: Choose from a benefit of $5,000 to a maximum of $20,000 in $5,000 increments, not to exceed 100% of approved employee amount. Child(ren): 50% of approved employee amount up to a maximum of $10,000. GUARANTEED ISSUE Employee: $20,000 Spouse: $20,000 Child(ren): $10,000 Coverage is 100% Employee Paid. RATES Age Premium Rate 0-29 $0.58 30-39 $0.82 40-49 $1.54 50-59 $2.94 60-69 $4.29 TO + $7.61 Child $0.12 (RELIANCE STANDARD BUKATY LIFE INSURANCE COMPANY ECOMPANIES This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9537, eta]. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. FEATURES DIAGNOSIS ADULT Alzheimer's Disease 25% Benign Brain Tumor 100% Carcinoma In Situ 50% Coma 100% Coronary Disease 50% Heart Attack 100% Life Threatening Cancer 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Major Organ Failure 100% Motor Neuron Disease (ALS) 100% Multiple Sclerosis 50% Occupational Hepatitis 100% Occupational HIV 100% Paralysis 100% Parkinson's Disease 25% Ruptured Cerebral, Carotid or Aortic Aneurysm 100% Severe Brain Damage 100% Skin Cancer 5% Stroke DIAGNOSIS CHILD Cerebral Palsy 100% BENEFIT 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Downs' Syndrome 100% Muscular Dystrophy 100% Spina Bifida 100% Type 1 Diabetes 100% ► Lifetime Maximum Benefit —1000% of Insurance Amount ► Subsequent Occurrence Benefit — 100% of benefit if diagnosed 3 months or later ► Recurrence Benefit (Same Illness) —100% of benefit if diagnosed 6 months or later ► Portability to employee age 70 ► Wellness (Health Screening) Benefit — $So (RELIANCE STANDARD LIFE INSURANCE COMPANY www.reliancestandard.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9537, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. Plans Highlights Economy Plan COVERAGE Voluntary hospital indemnity insurance provides a range of fixed, lump -sum daily benefits to help cover costs associated with a hospital admission, including room and board costs. These benefits are paid directly to the insured following a hospitalization that meets the criteria for benefit payment. ELIGIBILITY Each Active Full -Time Employee working 20 hours or more per week, except for any person working on a temporary or seasonal basis. Dependents: You must be insured for your Dependents to be covered. Dependents are: ► Your legal spouse or domestic partner. Spouse must be under age 70 at date of application. ► Your dependent children from birth to 26 years. ► A person may not have coverage as both an Employee and Dependent. FEATURES ► No pre-existing conditions exclusions ► No deductibles ► Eligible for continuation of coverage ► Coverage Offered on a Voluntary Basis ► FMLA / MSLA Continuation ► Portability CONTRIBUTION REQUIREMENTS Coverage is 100% Employee Paid. BENEFITS Hospital Room & Board Room & Board Benefit per Day $100 (15 Daily Benefits per Coverage Year)* Critical Care Unit Benefits per Day $200 (15 Daily Benefits per Coverage Year)Hospital Admission Benefit One Daily Benefit per Coverage Year $500 One Daily Benefit per Coverage Year On -Call Travel Assistance MONTHLY PREMIUM $250 Included Coverage Premium Employee $ 11.29 Employee & Spouse $ 24.78 Employee & Child(ren) $ 18.43 Employee & Family $ 29.86 RELIANCE STANDARD BUKATY ILIFE INSURANCE COMPANY ECOMPANIES This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9537, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. Premium Plan COVERAGE BENEFITS Voluntary hospital indemnity insurance provides a range of fixed, lump -sum daily benefits to help cover costs associated with a hospitalI Hospital Room & Board Benefits admission, including room and board costs. These benefits are paid Room & Board Benefit per Day directly to the insured following a hospitalization that meets the (15 Daily Benefits per Coverage Year)* criteria for benefit payment ELIGIBILITY Each Active Full -Time Employee working 20 hours or more per week, except for any person working on a temporary or seasonal basis. Dependents: You must be insured for your Dependents to be covered. Dependents are: ► Your legal spouse or domestic partner. Spouse must be under age 70 at date of application. ► Your dependent children from birth to 26 years. ► A person may not have coverage as both an Employee and Dependent. FEATURES ► No pre-existing conditions exclusions ► No deductibles ► Eligible for continuation of coverage ► Coverage Offered on a Voluntary Basis ► FMLA / MSLA Continuation ► Portability CONTRIBUTION REQUIREMENTS Coverage is 100% Employee Paid. (RELIANCE STANDARD LIFE INSURANCE COMPANY Critical Care Unit Benefits per Day (15 Daily Benefits per Coverage Year) One Daily Benefit per Coverage Year One Daily Benefit per Coverage Year On -Call Travel Assistance MONTHLY PREMIUM $100 $200 $1,000 $500 Included Coverage Premium Employee $ 20.75 Employee & Spouse $ 43.59 Employee & Child(ren) $ 30.67 Employee & Family $ 52.52 EBUKATY COMPANIES This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-9537, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state. ABOUT SONTIO KBUKATY -OMPANIES Employee Benefit Plans Etpertise you experience - Plan Premium THEFT PROTECTION Financial Account Takeover Monitoring • Mobile Attack Control • Secure My Network (VPN) • Online PC Protection Tools • Password Manager • BreachlQ' • Bank and Credit Card Activity Alerts • Identity Vault and Secure Storage • Auto On Monitoring • Advanced Fraud Monitoring (Instant Inquiry Alerts) • Change of Address Monitoring • Court Records Monitoring • Fraud Alert Reminders • Dark Web Monitoring • Compromised Credentials Alerts • Sex Offender Notification • Social Media Activity Alerts (Adult and Child) • Data Breach Notification • Identity Threat Alerts • Junk Mail Opt Out • Smart SSN Tracker (SSN Monitoring) • Medical ID Fraud Protection • Mobile App (iOS and Android) • Two Factor Authentication • Lost Wallet Assistance • Child Monitoring (SSN and Dark Web) • 401(k), HSA & Investment Account Activity Alerts • CREDIT MONITORING Credit Report Assistance • Credit Freeze and Lock Assistance (Adult and Child) • Credit Report Monitoring (Daily) 3 Credit Bureaus Credit Report and Score (Quarterly) 3 Credit Bureaus Credit Score Simulator • Credit Score Tracker (Monthly) • RESTORATION SERVICES Ransomware Expense Reimbursement $25,000 Social Engineering Expense Reimbursement $25,000 Cyberbullying Expense Reimbursement $25,000 Senior Fraud Resolution (Insurance Included with Family Plan) • White Glove Restoration • Pre-existing Identity Theft Restoration • Deceased Family Member Fraud Remediation' • Identity Theft Insurance $2,000,000 Stolen Funds Replacement • Any Financial Account Covered • *Deceased Family Member Fraud Remediation I Available for adults a' eligible dependents enrolled in an active IdentityForce 'r. 'I i -`" r ,.rrh.,, d.3rh Employee Only: $9.49 Employee + Family: $17.49 Sontiq is an Intelligent Identity Security company arming businesses and consumers with award -winning products built to protect what matters most. Sontiq's brands, IdentityForce, Cyberscout, and EZShield, provide a full range of identity monitoring, restoration, and response products and services that empower customers to be less vulnerable to the financial and emotional consequences of identity theft and cybercrimes. Learn more at www.sontiq.com or engage with us on Twitter, Facebook, Linkedln, or YouTube.