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.
Accidental death and dismemberment (AD&D insurance)
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.
- Eye injury
- Gunshot wound
- Brain injury
- Loss of sight in at least one eye
- Loss of speech
- Loss of hearing
- Loss of limb
- Loss of thumb or index finger
- 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.
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.
- 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
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 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.
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.
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.
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.
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).
THE VALUE OF A LEGAL PLAN
A legal plan saves costly legal fees and depending on the plan selected provides (full or limited) coverage for:
Home & Residential
Purchase, Sale, Refinancing of primary residence, Tenant dispute, Foreclosure
Financial & Consumer
Document preparation, Consumer dispute, Small claims court representation, Debt collection defense, Pre-litigation activities & trial defense, Tax audits, Bankruptcy (Chapter 7 or 13)
Estate Planning & Wills
Simple will or codicil, Complex will, Living will, Health care power of attorney, Living trust document, Probate of small estate
Auto & Traffic
Traffic defense, License suspension (administrative proceeding), Misdemeanor defense
Separation, Divorce, Name change, Guardianship/Conservatorship, Adoptions, Juvenile court proceedings
Civil litigation defense, Life insurance claims
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.
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
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To learn more call 800-421-3142 or ask your benefit representative at work if this benefit is available.
- 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
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.