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Home My WebLink AboutR-2025-070 Designating Bukaty Companies as Agent and Accepting Certain Employee Insurance Benefits Beginning July 1, 2025 RESOLUTION NO. R-2025-070 A RESOLUTION DESIGNATING AN AGENT AND ACCEPTING CERTAIN EMPLOYEE INSURANCE BENEFITS BEGINNING JULY 1, 2025. 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, 2025; and FURTHER THAT the City will provide its full-time employees with medical insurance coverage options through Blue Cross and Blue Shield of Kansas City, effective July 1, 2025. This renewal represents a 35% increase in premium over the last year. There will be 5 plan options with the City providing an equal contribution to each tier across all options in accordance with the attached plan summaries; and FURTHER THAT the City will provide its full-time employees with dental and vision insurance coverage options through Pacific Life, effective July 1, 2025, all in accordance with the attached plan summaries. This renewal represents a 0% increase in premium over the last year; and FURTHER THAT the City agrees to provide Group Term Life, Voluntary Term Life, 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. This renewal represents a 0% increase in premium over the last year; and FURTHER THAT the City agrees to provide a Voluntary Identify Theft Protection policy from Lifelock all in accordance with the attached plan summaries; and FURTHER THAT the City will partner with Surency to provide administrative management of the Section 125 Flexible Spending Account, the Health Savings Account, and COBRA Administration, effective July 1, 2025. Surency will manage the Health Savings Account with it's banking partner, UMB Bank; 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 6th day of May 2025. Mayor Kathleen L. Rose ATTEST: Robin Kincai ,City Clerk BUKATY COMPANIES Expertise you experience Benefit Proposal Request for:City of Riverside 2950 NW Vivian Road Riverside, MO 64168 Prepared by: Bukaty Companies 4601 Roe Avenue, Suite 100 Leawood, KS 66211 913.345.0440 Benefits Consultant: Jeff Walstrom & Scott Hefner Proposed Effective Date: July 1, 2025 BUKATY COMPANIES Expertise you experience BC BS of KC 6.9% increase rate relief to 3 4.9% increase Cigna-DTQ Aetna-DTQ • • City of Riverside Current vs Renewal Blue0 tor slBlueShle d of KC 61ueCrossoB1ue51e1d of KC Educe Toss/BlueShleld of KC Blueprose.BlueShleld or KC EllueC row AASlueShield of KC Preferred.Care Blue PPO$1000 PCB BNe8aver PPO HSA$3300 PCB BlueSever PPO BSA 54000 BSP Spire Can EPO ASO$1500 BSP HSA Splra Care EPO BENEFITS Pt Memel Cate Blue Nenork eeeee ned Care Blue 1Mwo0 Preferred Care Blue Network Blue Select Plus Meld., Blue Select Plus Nelw0rk 2aeaerA E MrHlwwete MN* n MrhMa.Ne Maw& El Ms... Sour. El ya.e. Men* I l ...v e CALENDAR YEAR DEDUCTIBLE Pe.o.0Pars P.c...Pays Pe.pe0Pars Pa...w8r+ _ •Individual 51,000 $1,000 $3.300 $3.300 S4,000 $4,000 $1,500 N/A $3,300 N/A •F5INIy $3,000 $3.000 56600 56600 $8,000 SB,000 $3,000 N/A $6600 N/A PBV4ICSN OFFICE VISITS S 0T5ER Polk.IPars Paxee0Pars PeupeV Pars Pen..ay. Psqvpeal Pop Pt.ry 0.re Pls..Office VW $30 comm. Deduct.,Co-Insurance Deducl0 Deduct.;Juc1 ;CoDeduct..e Deduct .Co-Insurance Dad Co4.urerce $0 C.f..Se Fec1y Not Covered 650 Co.et SC Ream - NO1 Covered 5perail Physc.0.I.VW $30 001.04. Deduct0b:tp4neunrce Oeducl4b 0.duclob.0.4n4inrw ...Id Co4roumce Dedu...:co-insurenr+ 0.4.0168 Not Covered Ob.. Nel Coveted Ufa.Care Center VW $30 wares. Deductible:eo-Ineunrce Oeduclole Deducl.b;0.4nwnnce Deducliald Co-lmumce Deductible:eo4nwnm Deduct.. Not Corarad Deductible NM Covered Emergency Room Vbil $100 Coped;0.6000Ma $100041pq;Ded0Co'se Deducll0 Deduct. Deduc166,Ge4.unrca 0.ducl16b.CoLrsuretce Deductible Deductible °educable Dad.. Lab Services Deduclob:Co-Pusan. Das.;Co4n.nne Deduct.. Deduct..Co-Insurance Deduct.,eo-Ilrwnrce Deductible,Cp4wtrer. SO Cop,at SC Fxary Net Levered 0.duglbb Not Covered X-Ray Semmes Deduclbld Co4.unnce Deducible,Co-Insurance Oeduct6lo Deductible:Co-Insurance Deftatible,Co-Insure. Deduce.,Co-Insurance S0 Copov al SC Pocky Not Coveted ...Me Not Covers. Mph-Tech RadobaulSent. Deduwee;Co4.urence Deduct.,Ca-Insurance Deduct.. Deduct..,Co-Insurance Deductible,...ran. Deductible;Co-Insurance 00d,Wbb Not Covered Deductible Not Covered Surgery(Physoiere Office) 0eductbb;Co4neurence Deducli06.Co4nwnnce Deaetble Deductible;Co4nwrum 0educliblo,Co Ineu 0-0, Deductible;Cu4nednnce Oeeuelibb Nei Corned Deductible Net Covered Chwpnct,NW/Spml Menpuletone(Lmte I.Auer) Deductible,Co4tnlrnnce Deducloh;Co4neu1Ma Deductible 0.ductb8,Co-Insurance Oedurfble.Lo-lneurenu Deductible;004n.nrce Deductible Sul Covered Deductible Not Covered Imalie VOutpeIienl Mo..Servlms tee., 0.ducti66;0ol.unence Dadselole;Co4nwnne Deduct. Deduct..,Co-Insurance Deduct...COInwnne Deductible;Co4nwnece ...ebb Nel Covered Dedt.ti0le Not Covered Odin Covered Send.,T+wslt Deduct..,GWtlw,.nce Deducible;0o4nmene Deduct.. Deduct..:Co4n.ranee Deductbb;Co-Inwteece 0.ducS0Y;Co-Insurance Deductible Net Covered Deductible Net Covered PLAN CO-INSURANCE,ox.al 80% 50% 100% 80% 80% 60% 100% N/A 100% N/A CALENDAR YEAR OUT.OF-POCKET MAX. Paste.x Pe, PAP:p tnr+ Pane Pays Pewee Pay. (incegaa The De0Mw0,Maul IRX C0pey0) •Indhddual $4,000 $8.000 S3.300 S6.600 $5,500 511,000 $1,500 N/A S3300 N/A •Famry $8,000 I $16,000 $6,600 I 513.200 $11,000 $22,000 $3,000 I N/A S6600 N/A Additional In. ALA Faxes Clem munpy Mem net indurlee ALA raves CMM must.morn turn.. ACA Fans Cahxut.ymenx..wed ACA Tames Cam sus el,maul net mewed AG Tux.LYN must pay amen.net resin. RETAIL PRESCRIPTION DRUGS COPAV ennr Tar 1-$15 cat. TIN 1-515 wpey'50140obe Ow 1-Deducl0le Oct 1-Dot;Coin Tbr I•Ore Cob Ter 1-Dee Cop Tar 1-$15 Copay Tier 1-Not Covers. Tler 1-Deductible TN/I-No1 Covered lanxrs ry a..nu Tier2-$20 ropey Tier 2-$1G cepay,509.ins Rot 1-Deduct.. Tim 2-0.d,Loin Tier 1-Ded;Cob Tier2-Deft Lem Tler1-$5ULopay lam 2-Not Covered Oar 2-Deduct. T1sf1-Mel Coveted Tier 1.5110.pay T.11.1110 ropey.5096win Tim 1-Deduct. Tim 1-0.4,Coln Tier 3-Ded;Coin TO,1-Oaf,Gob Tbr3•Deductible Teri-Not Covered Tier 1-Dodoctble no3-Nut Coveted Tier 4-$N20 cepov Tier 4-$2011 repay 50.01. Tito-0.dumBle Tie14-Dad,Coin TIer4-Dad;Cob Tier -Deft Cob 866910.IRXlnfor.Mon Sec Summery tor eurg0n 0abla Sec Summery fur 0.4rescielon Debtle bee sumnirmo urpnn petals nor Summary,'Other Preset0bon Deals Sae Summary for urgoon0lab COST Cla,e,Rage Updated Rates Carrera Rags R R^^ enewa tr Rates Cue.Rave Renewal Rates Current N Ribs eneweGwentate. Gwent Nee ^• .neural Rate. Empby.OnN 3840,52 $ $694.14 $50369 3 $111]]9 $54240 I $131AB 155142 1 1102.95 1512. IS $5111.29 Empbyae Plus spouse $1611.21 1 $211253 $1,51529 0 12,04.E.49 51,352.35 I $1641.13 $1,451.30 0 stose2S $1,291.39 3 S1,14x.12 Empb6Me MIS Cft$l.l) $1,2.'b.30 1 $1,55224 $1,15357 2 $1,509.55 $1,047.22 $1,413D9 t1134.49 1 11,53000 SOBERS 2 s1,333.18 Emmtply.ePlus Fondly 1 91533,W 3 S2An]B $+.2212e 2 S2328 0 s1ss1S1 E 1ec093.20 $taN1a 0 12xSSm - s1465e2 9 $1Yn.]1 n 1 516,694>1 5x S't 2,s2l.otl S6.set.JJ 10 at],ux 93] L St 222Jt 42]2196 .]5 E6)tt 5: .ttp 00396.00. 5x10.331.96 f53]Ti.25 511J 013.56 12a215t.96 f33'_13G 65 520562'2 5"tli 5.5x 5339.24512 5457.6011.pe hmrease Der reJse over current U.8% 34.914 la.. 31.9, 34.914 IL Correrrr.Mona.Cost ST3,141.1$ Renewal Monthly Cost 599,621.56 Curren0Annue/Coat $119,116.32 Re newelAnual Cost 51.195459.02 reaaeN0Orease over cuvent 35 ADDITIONAL INFORMATION I 1 Ms A an Overmew W Berets only.Men OM summery be connect OTx,0,0 convect all peat __BUKATY COMPANIES Expertise you experience Dental-Pacific Life Rate pass ■ ■ __BUKATY COMPANIES Expertise you experience City of Riverside DENTAL PROGRAM-July 1st 2025 Current/Renewal Current/Renewal Dental Program Rates Pacific Life-Base Pacific Life-Buy-Up Option Option BENEFITS PPO/Premier Non-Network PPO/Premier Non-Network CALENDAR YEAR DEDUCTIBLE Participant Pays Particpant Pays • Individual $50 $50 • Family $150 $150 Plan Pays Plan Pays Reimbursement _ A.DIAGNOSTIC&PREVENTIVE SERVICES 100% 80% 100% 100% B.BASIC SERVICES 80% 60% 80% 80% C.MAJOR SERVICES 50% 40% 60% 50% D.ORTHODONTIC SERVICES 50% 40% 50% 50% CALENDAR YEAR MAXIMUM BENEFIT(A,B&C) $1,500 $2,000 CALENDAR YEAR MAXIMUM BENEFIT(ORTHODONTIA) $1,000 $2,000 COST Count Rates Count Rates Employee Only 21 $22.38 8 $30.28 Employee Plus Spouse 7 $44.74 1 $60.58 Employee Plus Child(ren) 6 $58.98 2 $80.34 Employee Plus Family 19 $86.22 6 $117.30 Estimated Monthly Cost Estimated Annual Cost , , _ . Total Monthly Cost $3,942.52 Total Annual Cost $47,310.24 Dependents covered to age 26 Dependents covered to age 26 Rate Pass Rate Pass This is an Overview of Benefits only,where this summary&the contract differ,the contract will prevail. __BUKATY OMPANIES Expertise you experience Vision-Pacific Life Rate Pass ■ ■ __BUKATY --OMPANIES Expertise you experience City of Riverside VISION -July'I,2025 Current/Renewal Carrier Pacific Life Network 12/12/12 Plan Type BENEFITS Network 1 Non-Network Parthapanl Pays I Plan Allowance VISION EXAM Once every 12 Months $10 Up to$35 FRAMES Plan Allowance Plan Allowance $150 Allowance I $60 STANDARD PLASTIC LENSES Participant Pays Plan Allowance Once every 12 Months Single Vision $25 Copay Up to$40 Bifocal $25 Copay Up to$50 Trifocal $25 Copay Up to$80 Lenticular $25 Copay Up to$80 CONTACT LENSES Participant Pays Plan Allowance Once Every 12 Months-In Lieu Of Frames/Lenses CONTACT LENS FIT&FOLLOW-UP Up to$55 Not Covered Conventional $150 Allowance $104 Allowance Disposable $150 Allowance $104 Allowance Medically Necessary $0 $300 Allowance See Summary of Benefits for more details Counts Monthly Rate Employee Only 29 $6.74 Employee Plus Spouse 10 $12.78 Employee Plus Child(ren) 8 $14.98 Employee Plus Family 21 $21.10 Estimated Monthly Cost $886.20 Estimated Annual Cost $10,634.40 Rate Pass Dependents to age 26 This is an Overview of Benefits only, where this summary&the contract differ, the contract will prevail. __BUKATY COMPANIES Expertise you experience Reliance Matrix All Benefits have a Rate pass ■ 111 K' 4} • __ BUKATY 2OMPANIES Expertise you experience City of Riverside Basic Life/AD&D Current/Renewal BENEr'TS -Employer Provided Reliance Matrix EMPLOYEE BASIC LIFE/AD&D All Eligible Employees:$50,000 35%at age 65,50%at age 70 Age Reductions Occur On Plan Anniversary COST -Employer Provided ESTIMATED VOLUME EMPLOYEE BASIC LIFE $3,915,000 $0 120 Per$1.000 Covered Benefit EMPLOYEE BASIC AD&D $3,915,000 $0.030 Per$1.000 Estimated Monthly Cost $587.25 Estimated Annual Cost $7,047.00 ADDITIONAL INFORMATION Increase/Decrease over current 0% Rate Pass ■ W, __ BUKATY COMPANIES Expertise you experience City of Riverside Voluntary Life AD&D BENEFITS-Employee Paid Reliance M:ztri All Eligible Employees working 30 hours week EMPLOYEE SUPPLEMENTAL LIFE/AD&D Available In$10,000 Increments Maximum$500,000 Guarantee Issue$100,000 Coverage Reduces:35%at age 65;50%at age 70 SPOUSE BASIC LIFE/AD&D Available In$10,000 Increments Maximum$500,000 Guarantee Issue:$20,000 Coverage Reduces By 50% at age 70 CHILD SUPPLEMENT LIFE/AD&D Available In$2,500 Increments Birt up to 6 months:$1,000 6 months-26 years:$10,000 COST-Employee Paid Employee Rate-Rate Per$10.000 Spouse Rate-Rate Per$10,000 25-29 $1.100 $1.100 30-34 $1.480 $1.480 35-39 $1.910 $1.910 40-44 $2.620 $2.620 45-49 $3.710 $3.710 50-54 $5.690 $5.690 55-59 $8.530 $8.530 60-64 $12.200 $12.200 65-69 $20.790 $20.790 70-74 $35.550 $35.550 Employee/Spouse AD&D: $0.20 included in the above rates Childlrent Rate-Rate Per S10.000$1.60 Child Rate Based On Family Unit(Not Per Child) ADDITIONAL INFORMATION Rate Pass This is an Overview of Benefits only, where this summary&the contract differ,the contract will prevail. BUKATY COMPANIES Expertise you experience City of Riverside Short Term Disability BENEFITS - Employer Paid Reliance Standard EMPLOYEE SHORT-TERM DISABILITY All Eligible Employees working 30 hours week Elimination Period Accident: 15th Day Sickness: 15th Day Benefit 60%To$1,000 Maximum Benefit Per Week Maximum Benefit Period 11 Weeks Salary Increase/Decrease Occurs On Plan Anniversary COST - Employee Paid Volume Employee Rate-Rate Per$10 $65,426.51 $0.310 Monthly Premium $2,028.22 Annual Premium $24,338.66 ADDITIONAL INFORMATION Rate Pass !!! ■ __ BUKATY COMPANIES Expertise you experience City of Riverside Long Term Disability Current/Renewal BENEFITS -Employer Provided Reliance Standard EMPLOYEE LONG-TERM DISABILITY Elimination Period 90 Days Benefit 60%To$6,000 Maximum Benefit Per Month Own Occupation Limitation 24 Months Maximum Benefit Period ADEA-B-AGE Mental/Nervous,Substance Abuse Limitation 24 Months Special Conditions Limitation None Social Security Integration Full Family Partial Disability&Recurrent Disability Benefit Included Pre-Existing Conditions Limitation 3/12 Survivor Income Benefit Included Salary Increase/Decrease Occurs On Plan Anniversary COST-Employer Provided VOLUME LONG-TERM DISABILITY $382,785 $0.630 Covered Monthly Payroll Estimated Monthly Cost I $2,411.55 Estimated Annual Cost $28,938.55 ADDITIONAL INFORMATION Rate Pass Plan Highlights Voluntary Group Accident •-�''� I � r ' � Insurance 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 ► Portability to Employee Age 70 accidental death and dismemberment(if included).These benefits ► FMLA/MSLA Continuation are paid directly to the insured and may be used for any reason, ► Newlywed and Newborn Provision from deductibles and prescriptions to transportation and ► 24-Hour Travel Assistance Services childcare. ► 24-Hour Coverage 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 ' RELIANCE STANDARD BUKATY LIFE INSURANCE COMPANY COMPANIES 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. Benefits Low Plan High Plan Ambulance $100 Ground,$500 Air $200 Ground,$1,000 Air Blood,Plasma and Platelets $100 $200 Burns To$800 for 2nd degree burns;To$6,400 for To$2,400 for 2nd degree burns;To$19,200 3rd degree burns;Skin Graft-50%of benefit for 3rd degree burns;Skin Graft-50%of payable for Burns benefit payable for Burns Chiropractic Services(per Visit) $25 per session,6 sessions maximum $25 per session,6 sessions maximum Coma $7,500 $10,000 Concussion $150 $300 Dental Injury $150 for Crown;$50 for Extraction $450 for Crown;$150 for Extraction Diagnostic Exams $250 per CT/MRI scan $300 per CT/MRI scan Dislocation To$2,400 for Non-surgical;To$4,800 for To$3,200 for Non-surgical;To$6,400 for Surgical;Partial-50%of full dislocation; Surgical;Partial-50%of full dislocation; Multiple-200%of highest dislocation benefit Multiple-200%of highest dislocation benefit Emergency Treatment $120 $300 — Epidural Anesthesia Injection(per $100,2 maximum $200,2 maximum Injection) Eye Injury $100 for removal of foreign object,$200 for $200 for removal of foreign object,$400 for surgical repair surgical repair Fractures To$3,125 for Non-surgical;To$6,250 for To$6,250 for Non-surgical;To$12,500 for Surgical repair;Chip fracture:50%of non- Surgical repair;Chip fracture:50%of non- surgical benefit;Multiple fractures:200%of surgical benefit;Multiple fractures:200%of highest sustained fracture highest sustained fracture _ Initial Hospital Admission $1,250 $2,250 Initial Intensive Care Unit(ICU)Hospital $1,250 $2,250 Admission Hospital Confinement(per Day) $300,365 days maximum $450,365 days maximum Intensive Care Unit(ICU)Confinement(per $500,30 days maximum $900,30 days maximum Day) Lacerations To$400 To$600 _ Lodging(per Day) $50 per day up to 30 days if more than 100 $200 per day up to 30 days if more than 100 miles from residence miles from residence Medical Appliances $300 $400 Organized Youth Sports Benefit 25%of the benefit amount 25%of the benefit amount Paralysis $10,000 quadriplegia;$5,000 $50,000 quadriplegia;$25,000 paraplegia/hemiplegia paraplegia/hemiplegia Physical Therapy(per Session) $40,12 sessions maximum $60,12 sessions maximum Physician Visit $50 Initial,$50 Follow-up $100 Initial,$100 Follow-up Prosthesis $250 for one,$500 for two or more $500 for one,$1,000 for two or more Rehabilitation Facility Confinement(per $150,30 days maximum $150,30 days maximum Day) _ Surgery $100 for Exploratory;$300 for Knee Cartilage; $200 for Exploratory;$600 for Knee Cartilage; $1,000 for Abdominal or Thoracic;$500 for $2,000 for Abdominal or Thoracic;$1,000 for Ruptured Disc;to$600 Tendon,Ligament,or Ruptured Disc;to$1,200 Tendon,Ligament,or Rotator cuff Rotator cuff Transportation $300,if more than 100 miles from residence $450,if more than 100 miles from residence X-Rays $100 $200 Wellness(Health Screening)Benefit Low Plan High Plan Wellness(Health Screening) $50 $50 ' 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-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. Plan Highlights Voluntary Group Critical Illness Insurance ;imi' 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, Coverage is 100%Employee Paid. stroke,paralysis and more.These benefits are paid directly to the insured and may be used for any reason,from deductibles and RATES prescriptions to transportation and child care. Age Premium Rate 0-29 $0.58 ELIGIBILITY 30-39 $0.82 40-49 $1.54 All Active Benefit Eligible Employees,except for any person 50-59 $2.94 working on a temporary or seasonal basis. 60-69 $4.29 Dependents:You must be insured for your Dependents to be 70+ $7.61 covered.Dependents are: Child $0.12 ► 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 ' RELIANCE STANDARD ___ BUKATY LIFE INSURANCE COMPANY 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. FEATURES ► Lifetime Maximum Benefit-1000%of Insurance Amount DIAGNOSIS ADULT BENEFIT ► Subsequent Occurrence Benefit—100%of benefit if diagnosed 3 Alzheimer's Disease 25% months or later ► Recurrence Benefit(Same Illness)—100%of benefit if diagnosed 6 Benign Brain Tumor 100% Carcinoma In Situ 50% months or later - ► Portability to employee age 70 Coma 100% ► Wellness(Health Screening)Benefit—$50 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 100% Aneurysm Severe Brain Damage 100% Skin Cancer 5% Stroke 100% DIAGNOSIS CHILD BENEFIT Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Downs'Syndrome 100% Muscular Dystrophy 100% Spina Bifida 100% Type 1 Diabetes 100% ' 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. Plan Highlights Voluntary Group Hospital Indemnity Insurance w .1 Premium Plan COVERAGE BENEFITS Voluntary hospital indemnity insurance provides a range of fixed, Hospital Room&Board Benefits lump-sum daily benefits to help cover costs associated with a hospital admission,including room and board costs.These benefits are paid Room&Board Benefit per Day $100 directly to the insured following a hospitalization that meets the (15 Daily Benefits per Coverage Year)* criteria for benefit payment. Hospital Critical Care Unit Benefits ELIGIBILITY Critical Care Unit Benefits per Day Each Active Full-Time Employee working 20 hours or more per (15 Daily Benefits per Coverage Year) $200 week,except for any person working on a temporary or seasonal Hospital Admission Benefit basis. One Daily Benefit per Coverage Year $1,000 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. Nursery Admission Benefit ► A person may not have coverage as both an Employee and One Daily Benefit per Coverage Year $500 Dependent. Non-Insurance Services FEATURES On-Call Travel Assistance Included ► No pre-existing conditions exclusions ► No deductibles MONTHLY PREMIUM ► Eligible for continuation of coverage Coverage Premium ► Coverage Offered on a Voluntary Basis Employee $ 20.75 ► FMLA/MSLA Continuation Employee&Spouse $ 43.59 ► Portability Employee&Child(ren) $ 30.67 Employee&Family $ 52.52 CONTRIBUTION REQUIREMENTS Coverage is 100%Employee Paid. ' RELIANCE STANDARD BUKATY LIFE INSURANCE COMPANY 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. norton LifeLock Benefit Solutions Are you worried about the health of digital life? $ your We help protect your personal information and finances. Your identity is valuable, regardless of what you own or how much money you make. We help protect your finances by monitoring your personal information for possible identity theft and financial fraud. 0 We provide protection when you connect online. a Everybody is scrolling. How do you know if the ad you see online Ell could take you to a harmful site? — We block thousands of digital threats every minute - even before they can infect your computers, phones, and tablets. 0 We're here to help when you need it. If your identity got stolen, would you know who to call? Or where to turn for support? Our liP lir U.S.-based Restoration Specialists, will personally handle your identity theft case until it's resolved. in ` ■ �• * , Has your personal info been . •"c' exposed in a data breach? t='- ij .4 Try our free Threat Detector tool to 4L) -�r.:�' . uncover potential threats to your identity. norton LifeLock Benefit Solutions Your plan includes these features plus more, easily accessible in your member dashboard: GIB Identity Alerts with Credit Monitoring) ��22Q Parental Control' makes it easy to monitor alerts you if we find potentially fraudulent Lii your child's online activities and view their or suspicious activity surrounding your search history so they stay safer online. personal info including new account opening, credit card usage, and ® Million Dollar Protection"Packagettt data breaches. reimburses stolen funds, personal expenses, and provides coverage for Device Security protects your mobile lawyers and experts up to $1 million each. devices, tablets, and computers from hackers, viruses, malware, vulnerable o Dark Web Monitoring patrols the Dark Web websites, and other online threats. — and notifies you if we find your information, such as your username, password, IP Norton"Secure VPN is a Virtual Private address, or gamer tag. 8 Network (VPN) that helps protect your sensitive information, browsing history, online activities, and webcam. Premier $9.99 Employee Only $18.98 Employee + Family w-- Enroll Now! • i-s Benefit Plans are 60% less -_ than the retail equivalent. — 1— luRLj Many more features are included! To learn more, visit: www.Norton.com/BenefitPremier Already a member?Don't forget to cancel your existing membership just prior to your benefit effective date by calling 800-607-9174. No one can prevent all cybercrime or identity theft. LifeLock does not monitor all transactions at all businesses. 1 Credit features require setup,identity verification and sufficient credit history by TransUnion and/or Equifax.Credit monitoring features may take several days to activate after enrollment. V Norton Parental Control features are not supported on Mac. ttt Reimbursement and Expense Compensation,each with limits of up to E1 million for Benefit Essential,Premier,and Premier Plus,and up to$50,000 for LifeLock Benefit Junior($25,000 reimbursement coverage and$25,000 fraudulent withdrawals).All plans include up to$1 million in coverage for lawyers and experts.Cyber Crime Coverage,if applicable,covers up to$50,000 for covered expenses per Plan.All benefits are issued and covered by third party partners.Policy terms,conditions,and exclusions at:gendigital.com/legal. Copyright 0 2024 Gen Digital Inc.60 E Rio Salado Pkwy STE 1000,Tempe,AZ 85281 NEB19388FL