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Home My WebLink AboutR-2025-070 Designating Bukaty Companies as Agent and Accepting Certain Employee Insurance Benefits Beginning July 1, 2025RESOLUTION 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. /s/ Kathleen L. Rose Mayor Kathleen L. Rose ATTEST: /s/ Robin Kincaid Robin Kincaid, 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 36.9% increase rate relief to 34.9% increase Cigna-DTQ Aetna-DTQ City of Riverside Current vs Renewal BENEFITS CALENDAR YEAR DEDUCTIBLE • Individual • Foray P NVSCMN OFFICE Vain 4OD ER Pr.. Den Plle.ron ORiu VW Specaht Phy.clen OP. Vale Ur9e4 C. Canter VW Emergency Room Vail Lab Services X45ry servo. Mob Tech Radoopul 5ervow Surgery (PM... Office) Ch,mpxt4N4N5pw1 Manipuhfona(Lmle 7 App6) Inp.IbnVO2petienl NaepWservbalh.r..l OMer Cove. 6enow r0.wdr P LAN CO4N8URANCEroe.wl CALENDAR YEAR OUTOF-POCKET MAD. amours The DMc4O6, Merle 4RXLap.yoJ • Individual • Family Additional lora: RETAIL PRESCRIPTION DRUGS COPAV 001.10 Sun., demobs Addbioml. Information COST amplevae so* Enno4at* we spouse E... Mrs Ch..) Empty.. Plus Family Increase Decrease over curreef Commit Monthly Cost 673,1140.114 Curr.nt Annual Cost $816,100.32 increaseiDecrease over cunent ADDITIONAL INFORMATION BlueCrosslBlue3hleld of KC Preened -Care Blue PPO 81000 BlueCrosslBlueShleld of KC PCB BNesaver PPO NSA $3300 Preferred Care Moe WNbre N.rw. E Ne.a.e..ra Prefenetl Cara Blue Hew. lbw. P.w.,. $3.300 n n Nee.Nen..e Pays 33.300 P.lew.eP.r• 81,000 31,000 53,000 33,000 56600 56600 Paa.wr-P.r. $30 cambia $30 copryNW 330 coprrNW 3100 Cepry; Ded.CDwa Deducible; 0.4nurence Deducible; fn4nunnce 0.ductbb; Co4murence Deductible; De4murence 0.eutble; Ca -Insurance Deductbb; Co-1m m. Deductiialo Ca -Insurance DMuctBY: CWnaorarcs Deduct. Cc4nsurerce Deducterb. Co-Ineuneme 1100031W; D.e.0.bw Dabble; Ci4neurence Deducible; Co -Insurance 0.euct.le; Ca -Insurance Deduct. Co -bum. 061.16le; Co-lneunme Deducible; Co-Ineunro Deducible. Co4nsunma abb.,. Deducible Deducible Deducible 0.ducl2b Deduct. Deductible 0.euti.le Deductible Deductible Deducible Deduct. 0.du4166; Co4neuranoe Deducl.Y.W4neunrw Oeduclilpb; Co4neunrru Deduct 8 Deductible. Cu0eunme Deductible) Co Insurance Deductible; Co -Insurance Deductible; Co-Inbar. Deducible; Co -Insurance Deduct.; Co -Insurance Deducible; Co4nsuraro BO% 50% 100% B0% Paste... 84,000 . 88,000 P.r:a 33.300 inn 56.600 $8,000 $16,000 $6,600 313. 200 ACA Faxes Ow f rm. pay Pam not ondurlad ALA rases Crory burp. mern norm.. Tor 1-315 copay Dar 2-570 mpey Der 3.3110mpry Tier4.1200 mpry Sus Summary, Tier 1-s15 mpry.5014cowe Tier 2-sl0 mpry. 505mine Dor 3-8110 co.. 5096mins Der 4-$20O capry. 50%mlm rgon Cab.. Tler 1-Deducible Tor 2-Deducible Teri - Deduct . Tbr4 -Deductible See Summery for Ter 1-Ode; Coin Der 2-Dee; Coin DP 3-DM, Coln Dal 4-Ded; Coin enrgon Debris Cum. Rohs Updated Rates 3040.51 0 SOM.12 Curran Rohs Renewal ales SOO2A9 2 R 307325 3111124 3211T56 $+,SID20 0 50,W0.44 31,230.30 1 31,60T24 $1.18]ST 2 31,500.65 s12320] 3 12.47124 31.72420 2 32.326.00 516,690,67 52352100 1200396.U4 5270.324.96 34.0 % 55.981.44 594128E 583772.2E 5113 U1456 34.85 Renewal Monthly Cost 599,521.65 Renewal Annual Cost 11.195459.02 35% TM.le an o wweware.ens only. eberebib summery Ore connxt dra, ere contract aNpeal BlueCros,lBlueShleld oe KC PCB Blue2aver PPO NSA 34000 Preferred Care Blue Networ4 N.ne.rt El Nann.lw.a P.wwem $4,000 Para $4,000 SB,000 SB,000 w0M+r Deduct.. Co-lrwurarce Dbl.. Co4murame Deductible; Co4mur.rwe D 3,0-7*e: Co -Insurance Deductbls:Co-lrrsunrce Deductible) Co -Insurance Ded*866, Cebu..Deducible) 0.du2bb: Cn4neumce Deductible: Cobsunma Deduct.) Co -Insurance Deducible; Co -Insurance Pays Deductible: Co4neurnce Deductbb: Co4n.ur.n.. Dbl... Co4neurem [bd..Ns; Co -Insurance Ded.bh, Ca -Insurance Deductible: Ca4mur.rce Ca-Insune rc Deductible: Co -Insurance Deeurbble; Ce4nsure ce Deductible; Co -Insurance Deducts.) Co -Insurance 80% 60% P.N74Pga 55,500 311,000 $11,000 $22,000 aca nom Clam mop Kent not...* nar1-[lea Cob Der 2-Den; Cob Teri -Ded; Cow Tier 4- Deb Coin See Summery for OtnorPub ner1-Oed: Cob Der 2-Ded; Con Teri - Odd; Cob 1.4-Ded: Cow oron Debts Current Robs Renewal Rates Ss43A0 3731.36 s1,3sT.]5 1 51,044.13 0734722 $1,473D9 51501,04 a 32,003.20 320.179.33 n s219.74 S242151 ,9a S326636.99 3695 BlueeroaelBlueShleld or KC BSP Spire Can EPO ASO $1500 Blue Select Plus Net'AerD, Nana.. El N.nlee* p.m, $1,500 WA S3,000 N/A Pw.rpwarPay. so Capry al40 Fspy 0.dutibe Deductible Deductible SO Copry et SC.... SO Co. et SC F*CMV Do .WO* Deew4sle Deeuclible D.du4i06 Deducible Nov Cove0 Not Covered Not Covered 0.ductble Net Cover. Not Covered Nol Covered 41M Covered Nol Covered Not Covered Nal Covered 700% WA $1,500 n N/A $3,000 WA ACP rase. Cnnm,.rm e.m mat ma.. Tbr,$15 Comae Der 2-300 Co. Der 3•Deductible tea Summarrbr Othar Dar 1-Not Covered Tbr2-Not Covered Tier 3-Not Cove. Prase eta Deals Currant Bates Renewal Rates 156702 1 1122.96 31,451.30 0 31,a90am 31134.40 1 1123040 61,161.16 0 3226506 St 722.31 32 32296 520 667 72 C27875.52 34.05 BlueC rosslll6eShield of KC BSP HSA Spiral Care EPO Blue Select Plus NetworNonMown $3,300 $6 600 360 Copry ei BC Fc0Bly Detectible Deductible Deducible Deductible Dedutible Deductible Deductible Deductible 0.drctibh 100% WA N/A .1 Cowry NM Caw. Nal Covered Deepdbb Not cpe.. Not Covered Not Covered Not Cove. Not Cove. Not Cove. Not Covered N/A 33.300 36.600 N/A N/A AG rum Clan, must pa nem mambo. Tier 1-0.dmibb Der 3-Deducible Tbr2-0.4uctble See Summary for omer T. 1-Not Cove. Der 1- Nal Cove. Ter ] - Nit Cove. ^noon Delete Currant Nibs $572.44 1e eeevml Rates 3801.20 57261.39 ] 31,742.47 SOWN 2 S1,333.72 61,465.02 31211.31 26t11 S.•e 1.4 S339.20512 S457, bell 34.05 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 [table with three columns, first is Dental Program Rates, second is Pacific Life-Base, third is Pacific Life-Buy-Up] [column 1] Dental Program Rates BENEFITS CALENDAR YEAR DEDUCTIBLE • Individual • Family Reimbursement A. DIAGNOSTIC & PREVENTIVE SERVICES B. BASIC SERVICES C. MAJOR SERVICES D. ORTHODONTIC SERVICES CALENDAR YEAR MAXIMUM BENEFIT (A, B & C) CALENDAR YEAR MAXIMUM BENEFIT (ORTHODONTIA) COST Employee Only Employee Plus Spouse Employee Plus Child(ren) Employee Plus Family Estimated Monthly Cost Estimated Annual Cost Total Monthly Cost $3,942.52 Total Annual Cost $47,510.24 [column 2] Pacific Life -Base Option PPO/Premier | Non -Network Participant Pays • Individual $50 • Family $150 Plan Pays Reimbursement A. DIAGNOSTIC & PREVENTIVE SERVICES 100% 80% B. BASIC SERVICES 80% 60% C. MAJOR SERVICES 50% 40% D. ORTHODONTIC SERVICES 50% 40% CALENDAR YEAR MAXIMUM BENEFIT (A, B & C) $1,500 CALENDAR YEAR MAXIMUM BENEFIT (ORTHODONTIA) $1,000 COST Count | Rates Employee Only 21 $22.38 Employee Plus Spouse 7 $44.74 Employee Plus Child(ren) 6 $58.98 Employee Plus Family 19 $86.22 Estimated Monthly Cost $2,775.22 Estimated Annual Cost $33,302.64 Dependents covered to age 26 Rate Pass [column 3] Pacific Life-Buy-Up Option PPO/Premier | Non-Network Participant Pays CALENDAR YEAR DEDUCTIBLE • Individual $50 • Family $150 Plan Pays Reimbursement A. DIAGNOSTIC & PREVENTIVE SERVICES 100% 100% B. BASIC SERVICES 80% 80% C. MAJOR SERVICES 60% 50% D. ORTHODONTIC SERVICES 50% 50% CALENDAR YEAR MAXIMUM BENEFIT (A, B & C) $2,000 CALENDAR YEAR MAXIMUM BENEFIT (ORTHODONTIA) $2,000 COST Count | Rates Employee Only 8 $30.28 Employee Plus Spouse 1 $60.58 Employee Plus Child(ren) 2 $80.34 Employee Plus Family 6 $117.30 Estimated Monthly Cost $1,167.30 Estimated Annual Cost $14,007.60 Dependents covered to age 26 Rate Pass This is an Overview of Benefits only, where this summary & the contract differ, the contract will prevail. BUKATY COMPANIES Expertise you experience Vision -Pacific Life Rate Pass City of Riverside VISION - July 1, 2025 Carrier Network Plan Type BENEFITS VISION EXAM Once every 12 Months FRAMES STANDARD PLASTIC LENSES Once every 12 Months Single Vision Bifocal Trifocal Lenticular CONTACT LENSES Once Every 12 Months - In Lieu Of Frames/Lenses CONTACT LENS FIT & FOLLOW-UP Conventional Disposable Medically Necessary Employee Only Employee Plus Spouse Employee Plus Child(ren) Employee Plus Family Estimated Monthly Cost Estimated Annual Cost BUKATY COMPANIES Expertise you experience Current/Renewal Pacific Life F y,.ytr.rl i„t,,i+i 12112/12 Network 1 Non -Network ,Participant Pays $10 Plan Allowance $150 Allowance Participant Pays $25 Copay $25 Copay $25 Copay $25 Copay Participant Pays Up to $55 $150 Allowance $150 Allowance $0 See Summary of Benefits Counts 29 Plan Allowance Up to $35 Plan Allowance $60 Plan Allowance Up to $40 Up to $50 Up to $80 Up to $80 Plan Allowance Not Covered $104 Allowance $104 Allowance $300 Allowance for more details Monthly Rate $6.74 10 $12.78 8 $14.98 21 $21.10 $886.20 $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 City of Riverside Basic Life / AD&D BENEr'TS - Employer Provided EMPLOYEE BASIC LIFE/AD&D COST - Employer Provided EMPLOYEE BASIC LIFE Per $1.000 ESTIMATED VOLUME $3,915,000 Covered Benefit EMPLOYEE BASIC AD&D Per $1,000 $3,915,000 Estimated Monthly Cost Estimated Annual Cost ADDITIONAL INFORMATION Increase/Decrease over current __BUKATY .2OMPANIES Expertise you experience Current/Renewal Reliance Matrix All Eligible Employees: $50,000 35% at age 65. 50% at age 70 Age Reductions Occur On Plan Anniversary $0 120 $0 030 $587.25 $7,047.00 0% Rate Pass IIMP 41.1P City of Riverside Voluntary Life AD&D " BENEFITS - Employee Paid EMPLOYEE SUPPLEMENTAL LIFE/AD&D SPOUSE BASIC LIFE/AD&D CHILD SUPPLEMENT LIFE/AD&D , Current/Renewal Reliance M:ztr,, All Eligible Employees working 30 hours week Available In $10,000 Increments Maximum $500,000 Guarantee Issue $100,000 Coverage Reduces: 35% at age 65; 50% at age 70 Available In $10,000 Increments Maximum $500,000 Guarantee Issue: $20,000 Coverage Reduces By 50% at age 70 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 Childtrent Rate - Rate Per S10.000 51.60 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 EMPLOYEE SHORT-TERM DISABILITY Elimination Period Benefit Maximum Benefit Period COST - Employee Paid Volume $65,426.51 Monthly Premium Annual Premium ADDITIONAL INFORMATION __BUKATY COMPANIES Expertise you experience 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 $2,028.22 $24,338.66 Rate Pass e ■ City of Riverside Long Term Disability 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 LONG-TERM DISABILITY VOLUME $382,785 Covered Monthly Payroll Estimated Monthly Cost Estimated Annual Cost ADDITIONAL INFORMATION BUKATY COMPANIES Expertise you experience Current/Renewal Reliance Standard 90 Days 60% To $6,000 Maximum Benefit Per Month 24 Months ADEA-B-AGE 24 Months None Full Family Included 3/12 Included Salary Increase/Decrease Occurs On Plan Anniversary $0.630 $2,411.55 $28,938.55 Rate Pass Plan Highlights Voluntary Group Accident Insurance Accident Insurance COVERAGE Voluntary accident insurance provides a range of fixed, lump -sum 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 ILIFE INSURANCE COMPANY RELIANCE STANDARD FEATURES ► Portability to Employee Age 70 ► FMLA/MSLA Continuation ► Newlywed and Newborn Provision ► 24-Hour Travel Assistance Services ► 24-Hour Coverage 7 BUKATY 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 Blood, Plasma and Platelets Burns Chiropractic Services (per Visit) Coma Concussion Dental Injury Diagnostic Exams Dislocation Emergency Treatment Epidural Anesthesia Injection (per 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 $100 Ground, $500 Air $100 To $800 for 2nd degree burns; To $6,400 for 3rd degree burns; Skin Graft - 50% of benefit payable for Burns $25 per session, 6 sessions maximum $7,500 $150 $150 for Crown; $50 for Extraction $250 per CT/MRI scan To $2,400 for Non -surgical; To $4,800 for Surgical; Partial - 50% of full dislocation; Multiple - 200% of highest dislocation benefit $120 $100, 2 maximum $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 5300, if more than 100 miles from residence $100 $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 $200 Wellness (Health Screening) Benefit Low Plan High Plan Wellness (Health Screening) ILIFE INSURANCE COMPANY RELIANCE STANDARD $50 $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. Plan Highlights Voluntary Group Critical Illness Insurance 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 40-49 $$0.82 1.82 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 TO + $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 ILIFE INSURANCE COMPANY RELIANCE STANDARD BUKATY 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 DIAGNOSIS ADULT Alzheimer's Disease BENEFIT 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 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% ILIFE INSURANCE COMPANY RELIANCE STANDARD ► 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 — $50 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 Premium 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. ILIFE INSURANCE COMPANY RELIANCE STANDARD BENEFITS Hospital Room & Board Benefits Room & Board Benefit per Day (15 Daily Benefits per Coverage Year)* $100 Hospital Critical Care Unit Benefits Critical Care Unit Benefits per Day (15 Daily Benefits per Coverage Year) $200 Hospital Admission Benefit One Daily Benefit per Coverage Year $1,000 Nursery Admission Benefit One Daily Benefit per Coverage Year $500 Non -Insurance Services On -Call Travel Assistance MONTHLY PREMIUM Included Coverage Premium Employee $ 20.75 Employee & Spouse $ 43.59 Employee & Child(ren) $ 30.67 Employee & Family $ 52.52 BUKATY 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. v norton LifeLock Benefit Solutions Are you worried about the health of your digital life? $ o 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. We provide protection when you connect online. Everybody is scrolling. How do you know if the ad you see online 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. Co 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 U.S.-based Restoration Specialists, will personally handle your identity theft case until it's resolved. Has your personal info been exposed in a data breach? Try our free Threat Detector tool to uncover potential threats to your identity. norton LifeLock Benefit Solutions Your plan includes these features plus more, easily accessible in your member dashboard: Identity Alerts with Credit Monitoring' alerts you if we find potentially fraudulent or suspicious activity surrounding your personal info including new account opening, credit card usage, and data breaches. Device Security protects your mobile devices, tablets, and computers from hackers, viruses, malware, vulnerable websites, and other online threats. Norton" Secure VPN is a Virtual Private 8 Network (VPN) that helps protect your sensitive information, browsing history, online activities, and webcam. Premier $9.99 Employee Only $18.98 Employee + Family Enroll Now! Benefit Plans are 60% less than the retail equivalent. URL Os5 LJ Parental Control" makes it easy to monitor your child's online activities and view their search history so they stay safer online. Million Dollar Protection" Packagettt reimburses stolen funds, personal expenses, and provides coverage for lawyers and experts up to $1 million each. Dark Web Monitoring patrols the Dark Web and notifies you if we find your information, such as your username, password, IP address, or gamer tag. 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 $1 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