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.
- 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.
- Out-of-pocket expenses
- Experimental treatment
- Travel and lodging
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?
- 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.
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.
- Out-of-network treatments
- Travel to treatment centers
- Utility payments.
It’s up to you!
- Fluoride treatments
- Simple extractions
- Repairs of crowns, bridges, dentures etc.
- Oral surgery
- General anesthesia for dental surgery
- Root canals
- Denture adjustments
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?
- 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.
- Long-term disability: pays a benefit when you are out of work for an extended period of time
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:
- 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
- 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
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
- Emergency room
- Rehabilitation services
- Lodging and transportation costs for you and a companion
- 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).
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:
- 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.
- 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.
- 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
- Moving in and out of bed
A need for long term care may result from:
- Advanced aging
- 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.
Estimated daily cost for long-term care
- According to the Genworth Financial 2014 Cost of Care Survey, the estimated median annual cost for a nursing home stay was $77,380 per year for a semi-private room. This is about $212 per day.
- The cost for a private room was $87,600 or $240 per day. Assisted living at home can cost more than $41,680 per year or $20.00 per hour for a home healthcare aid. All of these long-term care costs can be considerably higher in larger metropolitan areas.
- The average stay in a nursing home is about 2.5 years, but can vary considerably.
- Improved access for both the patient and physicians and health facilities
- Cost efficiencies
- Improved quality
- Patient/ employee demand
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