Frequently Asked Questions – Specific Benefit

For your convenience we have provided a list of answers to common questions about our benefits. Your HR representative may also be able to provide additional information.

What is accident insurance?
Accident insurance protects your hard earned income or retirement savings and helps to pay for out-of-pocket expenses associated with accidental injury such as:

  • Co-pays
  • Deductibles
  • Out-of-pocket costs

Benefits may cover a wide range: doctor visits, accidental death, dismemberment, fractures, initial hospital confinement, emergency room, fractures, intensive care, and more.

Cash benefits are paid directly to you unless assigned.

What is the difference between accident and accidental death and dismemberment (AD&D) insurance?
Accidents tend to happen when you least expect — you can’t plan for them, but you can be prepared. If you want to make sure you are protected in the event of an injury, different types of coverage can come into play, such as accident insurance and accidental death and dismemberment (AD&D) insurance. Although they both cover accidents, they are different. The following are some important points to remember as you decide which one is right for you.

 

Accident insurance

Accidental death and dismemberment (AD&D insurance)

How does it work?

 
Accident insurance will pay a benefit for a wide variety of covered injuries that may or may not be serious over the long-term. 
 
If you experience a covered accident, you could receive a cash benefit according to a benefits schedule. Also, you could receive a cash benefit for emergency room visits. The amount you receive depends on your injury and related treatment.
AD&D insurance provides a payment to your beneficiary if you die in a covered accident or a payment to you if the accident results in a covered loss that causes a permanent impairment. Depending on your plan, you may be able to sign up for an amount of coverage based on your salary — for example, two times your salary — or choose a set dollar amount.

AD&D insurance is often offered with life insurance at an amount that is equal to the life insurance benefit. Only voluntary, AD&D insurance allows independent election of coverage.

What is covered?

 
The following are examples of covered injuries:

  • Fracture
  • Dislocation
  • Eye injury
  • Gunshot wound
  • Paralysis
  • Brain injury
  • Burn
  • Coma
  • Concussion
  • Death
  • Dismemberment

The following are examples of covered losses:

  • Death
  • Quadriplegia
  • Loss of sight in at least one eye
  • Loss of speech
  • Loss of hearing
  • Loss of limb
  • Loss of thumb or index finger

Who can be covered?
 
If you elect coverage for yourself, coverage may also be available to your spouse and dependent children as well.

 
How can I use the benefit?

 
Accident insurance provides a lump sum cash benefit that you can use however you want. Typically, the benefit is used to help with out-of-pocket expenses such as copayments or prescriptions that might not be covered by your health insurance.

 
You or your beneficiaries can spend the money however you see fit.
How much will I receive?

 
If a claim is approved, a check is sent for covered injuries, such as fractures or dislocations. The check can be used for costs related to those injuries, such as fees for emergency room or outpatient visits.
 
The benefit depends on the site and severity of the injury in addition to how the injury was treated and the coverage amount you selected when you enrolled.

 
In the event that a covered accident results in your death, your beneficiary will receive 100% of your AD&D coverage amount. The maximum amount payable for losses resulting from any one accident is 100% of the AD&D coverage amount
Accident insurance and accidental death and dismemberment insurance may be something you don’t want to think about, but they can help you plan for the unexpected so that you and your family have one less thing to worry about in case of an accident. Additionally, in some cases, if you are covered by both products and your claim is approved, both benefits may pay out, in the event the injury qualifies under both insurance policies.
 
Check with your benefits administrator to see if accident insurance or accidental death and dismemberment insurance is available to you as part of your employer’s benefits package.
What is cancer insurance?
The majority of all medical plans do not cover the expenses incurred with the treatment for cancer. Supplemental cancer insurance can be used to help fill these gaps relieving the financial burden. Cancer can strike anyone at anytime regardless of lifestyle, yet too many people lack the cancer insurance coverage they need to help pay the non-medical costs associated with the treatment for cancer:

  • Out-of-pocket expenses
  • Experimental treatment
  • Travel and lodging
  • Childcare
  • Mortgage

Although cancer survival rates have dramatically increased because of modern medical treatment, these treatments are expensive, and together with other related costs, can create a serious financial burden on the family. Will you be prepared to afford the best care available if cancer touches someone in your family?

Plans features available:

  • Guaranteed renewability
  • Choice of cancer coverage type and amount (individual or family) (high or low options)
  • Helps pay for non-medical costs associated with cancer treatment
  • Benefits paid directly to you unless assigned
  • No reduction in benefits regardless of age or number of claims
What is critical illness?
A form of supplemental health insurance, critical illness insurance is a stand-alone, lump-sum product whose benefit payment helps to offset expenses not reimbursed by other types of insurance when a covered person is diagnosed with one of the covered conditions and meets the requirements of the certificate. Critical illness Insurance is not medical insurance.

  • Heart disease* strikes someone in the US about once every 43 seconds and is the number 1 cause of death.
  • Someone has a stroke* about every 40 seconds and is the leading cause of disability.

American Heart Association:  Heart Disease and Stroke Statistics 2017 At A Glance

Covered conditions may be (depending on your plan):

Category 1 incorporates certain cancer-related conditions: full benefit cancer, partial benefit cancer, and bone marrow transplant.

Category 2 incorporates certain heart-related conditions: heart attack, stroke, coronary-artery bypass graft, and heart transplant.

Category 3 incorporates certain other conditions: major organ transplant (other than bone marrow and heart) and kidney failure.

You can use the lump-sum benefit payment in any way you choose:

  • Co-pays
  • Deductibles
  • Out-of-network treatments
  • Childcare
  • Travel to treatment centers
  • Utility payments.

It’s up to you!

What is dental insurance?
Dental insurance covers the following (benefits may vary depending on the plan your employer offers):
Diagnostics and preventive services covered such as:

  • Exams
  • Fluoride treatments
  • Cleanings
  • X-rays

Basic dental services such as:

  • Fillings
  • Simple extractions
  • Repairs of crowns, bridges, dentures etc.
  • Oral surgery
  • General anesthesia for dental surgery

Major dental services such as:

  • Orthodontics
  • Crowns
  • Root canals
  • Denture adjustments

What is disability insurance?
Like most people, you may have a range of financial obligations you’re responsible for, such as rent or a mortgage, utility bills, doctor co-pays, and everyday expenses. If you become disabled due to sickness or injury, you’ll still need to fulfill your commitments and provide for your loved ones. Something as simple as the flu could mean time off from work — and without pay. Disability insurance pays you directly so you can use the money as you need.

How would you…

  • Pay your bills?
  • Make your monthly rent or mortgage loan payments?
  • Buy your groceries?
  • Make your car payments?
  • Provide for your children’s education?
  • Save for retirement?

There are 2 main types of worksite disability insurance:

  1. Short-term disability: pays a benefit to you when out of work due to an illness, injury or childbirth for several weeks up to a year.
  2. Long-term disability: pays a benefit when you are out of work for an extended period of time

What is the difference between accident and disability insurance?
There are many types of insurance out there, and sometimes it is hard to keep them all straight. Two types of coverage that can come into play in the case of injury are accident insurance and disability insurance. Below are some key points to remember for each, how they are different, and how they can work together to protect you and your family.

Accident insurance provides a lump-sum cash benefit to help offset costs associated with a covered injury. This type of policy can help with co-pays for treatments as well as with out-of-pocket expenses paid up front on High Deductible Health Plans (HDHPs). If a claim is approved, a check is sent for covered injuries such as fractures or dislocations and for covered treatments of those injuries, such as emergency room fees or outpatient visits.

Disability insurance (short-term disability and long-term disability) replaces a portion of your income if you are too sick or too hurt to work due to a covered illness or injury. The length of time you may receive short-term disability benefits is usually 13 or 26 weeks. Depending on the severity of your injury or illness, your claim may transition into long-term disability (if you have this coverage). If your disability policy is available through your accident insurance, it means your policy covers disability that occurs specifically due to a covered accident, not sickness.

How these plans work together

These two types of plans are typically independent of one another, meaning you can receive benefits from each and neither amount will be affected. You should, however, check with your benefits administrator to confirm this.

For example, if you fall and break your arm, accident insurance could provide a one-time cash payment to help with co-pays you might incur for treatment. If the broken arm meant that you could not work, you could then file a claim for short-term disability benefits in order to begin receiving weekly replacement income. Although there is a distinct difference between the two types of coverage, they can certainly complement each other in the case of a covered injury.

Hopefully this helps with explaining at least two different but complementary types of insurance. Be sure to ask your benefits administrator if either of these policies is available to you as part of your employer’s benefit package.

What is an Employee Assistance Program?
You may be surprised to learn that you may have access to a wide range of services — such as personal, financial, and legal guidance — through your benefits at work. Like other benefits you can use today that come with insurance protection, you may have access to an EAP — a benefits program to support your holistic health and well-being — just by participating in one of your employer-sponsored insurance products.
 

What kind of services do EAPs offer?

Your EAP may offer a range of services including financial planning, work/life support (e.g., helping you find an apartment), legal advice, and personal counseling — all on a completely confidential basis. These services may be valuable in helping you reach your goals, in facing life’s challenges, or simply in making your life a little easier.

Financial advice and planning

Whether you’re a seasoned investor or new to the world of personal finance, you can likely benefit from speaking with a financial professional. Your EAP may provide some access to a Certified Financial Planner (CFP), Certified Public Accountant (CPA), or other financial expert who can help you plan for long-term financial goals or address any financial challenges that my arise. Whether your goal is to reduce debt, save for college or retirement, create a budget, or get answers to a tax question, working with a financial professional can help move your finances in the right direction.

Legal guidance

There are many situations where legal elements may appear in our lives, for example, a joyous occasion like adoption or a tricky situation with a landlord, and we can benefit from the legal guidance of an attorney who can listen to our situation, determine next steps, and support us through the whole process. Many EAPs offer a telephone consultation with an attorney at no cost to you, and if you decide to use his or her services, you may receive a discount on his or her rate. The advice of an attorney may help make a complicated situation seem easier to manage.

Personal counseling

Life is complex, and sometimes it can be beneficial to have a professional to talk with about the challenges that life presents. A common feature of an EAP is a fixed number of sessions, either in person or over the phone, with a psychologist or trained counselor for you and possibly for others in your immediate family. Since access through your EAP may mean you avoid some sessions with an outside counselor, you may have the extra benefit of avoiding copays and saving the counseling sessions that may be offered by your health insurance plan for future use. Spending time with a counselor may help you get through your challenge faster and get back to feeling like yourself again.

Work/life support

With the demands of work, you may be left wondering how to find the time to address personal responsibilities. If your EAP includes work/life support services, it can help you complete personal tasks by providing you with valuable information on topics like finding an apartment, assessing your elder care needs, finding a daycare provider, assessing the factors of a big consumer purchase, and more. The support of these services can help take some weight off of your shoulders.

Explore your benefits at work to see if you can take advantage of some of the services an EAP offers.

How does a Flexible Spending Account (FSA) work?
Flexible Spending Account (FSA) work?

With an FSA, you determine how much out-of pocket child care and healthcare expenses you have each year, and then you have that amount (divided by the number of payroll periods) automatically set aside from your paycheck. The money is pulled out before taxes are deducted and held in a special account for you. When you start paying healthcare or dependent care expenses, you get reimbursed from your FSA account — and that money never gets taxed. The bottom line: you get more spendable income for paying off credit-card debt, planning a much-needed vacation, saving for retirement, or building up educational funds for your children.

A Flexible Spending Account (FSA) allows you to save up to $2,550 on your eligible healthcare and up to $5000 for dependent care expenses every year by using pretax dollars. Savings can be 25 – 40% depending on your tax bracket on your healthcare expenses!

There are two flexible spending account types:

  1. Healthcare spending account: A healthcare spending account allows you to pay for eligible expenses not covered by your healthcare plan. Some eligible expenses include:
    • Deductibles, co-payments, and co-insurance for medical and dental plans
    • Prescription medications and approved over-the-counter healthcare products
    • Eye exams, glasses, prescription sunglasses, contact lenses and solutions, and LASIK eye surgery

 

  1. Dependent care spending account: A dependent care spending account reimburses you for care provided by eligible caregivers for dependents age 12 and younger, or for a disabled spouse or other dependents whom you claim for tax purposes. A few examples of eligible dependent care expenses:
    • Care provided in your home by an eligible caregiver
    • Care provided outside your home at a qualified day care provider
    • Care provided at a licensed day care facility
    • Summer day camps
    • Before- and after-school programs

What is hospital indemnity insurance?
Hospital indemnity insurance is a type of plan that pays a set amount – per day, per week, per month or per visit – if you are confined in a hospital. Even with major medical insurance, you may still be responsible for co-payments, deductibles, and other out-of-pocket expenses.

Depending on the plan your employer chooses, you can receive payment to cover expenses for:

  • Hospital admission
  • Out-patient surgery
  • In-patient surgery
  • Diagnostic tests
  • ICU
  • Emergency room
  • Rehabilitation services
  • Lodging and transportation costs for you and a companion

Employees, spouses and children can be covered. Whether you are being treated on an out-patient or in-patient basis, this coverage can help you manage your expenses. Check with your Human Resource representative to see if a plan is available.
What is identity theft insurance?
Identity theft is the act of taking someone’s personal information and using it to impersonate a victim, steal from bank accounts, establish phony insurance policies, open unauthorized credit cards, or obtain unauthorized bank loans. Identity theft insurance provides reimbursement to crime victims for:

  • Restoring identity
  • Repairing damaged credit

It generally covers expenses such as: phone bills, lost wages, notary and certified mailing costs, and sometimes attorney fees (with prior consent of the insurer).

What is a legal plan?
What is life insurance?
Life insurance is powerful protection for your loved ones. In the event of your passing life insurance is a guaranteed promise to pay money directly to your beneficiaries. Life insurance helps to pay for:

 

Rent and Mortgage      Retirement       Long-term care with “accelerated death benefit”
Household expenses    Family debt     Education        Final Expense

 

There are 3 basic forms of life insurance:

  1. Term life provides an affordable death benefit for a specific length of time, usually 20 – 30 years. Coverage expires at the end of the term. There are no cash values.
  2. Whole life provides a death benefit plus an investment option where cash values accumulate. The accumulated cash value can be used to borrow against or pay your premium. Your policy is in-force as long as premiums are paid or if a paid-up option is available. Premiums do not change as you grow older.
  3. Universal life provides flexible coverage options where you can change your premiums or coverage amount to meet your current need. This policy can last through retirement and may gain cash value over time. In other words: life coverage that adjusts to your life.

 

Additional features/ riders that may be added to a life policy are:

  • Family coverage
  • Accelerated death benefit
  • Early payouts for terminal illness
  • Long-term care rider
  • Waiver of premium
  • Accidental death benefit

What is long-term care insurance?
Many of us worry about who would take care of us if something happens, and no one wants to be a burden. Long-term care (LTC) is the assistance or supervision you may need when you are not able to do some of the basic activities of daily living (ADL) such as:

  • Bathing
  • Dressing
  • Eating
  • Continence
  • Toileting
  • Moving in and out of bed

A need for long term care may result from:

  • Accidents
  • Illness
  • Advanced aging
  • Stroke
  • Other chronic conditions

Providing long-term care can be time consuming, expensive, and exhausting. Help protect your family and get the information you need to see if long-term care insurance should be a part of your plan.

Genworth 2017 Cost of Care Survey

According to the Genworth 2017 Cost of Care Survey, the annual median cost of long term care services increased an average of 4.5 percent from 2016 to 2017, the second-highest year-over-year increase for nursing homes and home care since the study began in 2004 and nearly three times the 1.7 percent U.S. rate of inflation.

Although the national median cost of receiving care rose considerably across all care options during the last 12 months, the increase was most pronounced for home health aides:

  • Home health aide services, up 6.17% to $21.50/hour
  • Homemaker services, up 4.75% to $21/hour
  • Adult day health care services, up 2.94% to $70/day
  • Assisted living facilities, up 3.36% to $123/day or $3,750/month
  • Semi-private room nursing home care, up 4.44% to $235/day or $7,148/month
  • Private room nursing home care, up 5.50% to $267/day or $8,121/month.

Source: Genworth 2017 Annual Cost of Care Survey

Learn more: https://www.genworth.com/about-us/industry-expertise/cost-of-care.html

What is pet insurance?
Pet Insurance pays, partly or in total, for veterinary treatment of the insured person’s ill or injured pet. Some policies will pay out when the pet dies or if the pet is lost or stolen.
 
As veterinary medicine is increasingly employing expensive medical techniques and drugs, and owners have higher expectations for their pet’s health care and standard of living than previously, the market for pet insurance has increased.
What are student loan repayment programs?
Pierce Insurance offers plans to help employees with Federal Student Loans. The U.S. Department of Education offers many different repayment programs. The savings available vary depending on the loan holder’s personal situation and profession.

We partner with the only company that offers a free Federal Student Loan analysis as well as a customized Benefit Summary including the loan holder’s program options and forecast savings.

To learn more call 800-421-3142 or ask your benefit representative at work if this benefit is available.

What is telemedicine?
In brief, telemedicine is the remote delivery of healthcare services and clinical information using telecommunications technology. This includes a wide array of clinical services using internet, wireless, satellite, and telephone media. You will benefit from reduced medical costs, convenience, and potentially fewer medical complications. Telemedicine has been growing rapidly because it offers four fundamental benefits:

  • Improved access for both the patient and physicians and health facilities
  • Cost efficiencies
  • Improved quality
  • Patient/ employee demand

What is vision insurance?

Vision insurance helps you to maintain good eyesight and healthy eyes, and saves you money while you’re at it. Plans may cover eye exams and materials depending on the plan you have. Depending on your plan, benefits may include:

  • Personalized ID card
  • Comprehensive eye exam
  • Frame allowance
  • Single vision, bifocal, or trifocal lenses
  • Progressive lens upgrade
  • Contact lens allowance
  • Stand-alone contact lens fitting exam
  • Medically necessary contact lenses
  • Discounts on allowance overages and lens options
  • Significant discounts on an unlimited number of additional eyeglasses and contact lens purchases
  • Online contact lenses – great discounts, and in-network
  • LASIK discounts
  • Vision Wellness Program
  • Materials discount

What is a wellness program?

A program intended to improve and promote health and fitness that’s usually offered through the work place, although insurance plans can offer them directly to their enrollees.  The program allows your employer or plan to offer you premium discounts, cash rewards, gym memberships, and other incentives to participate. Some examples of wellness programs include programs to help you stop smoking, diabetes management programs, weight loss programs, and preventative health screenings.