Voluntary Benefits MetLife 61

Voluntary Benefits MetLife 61

NEW!!! Group Accident Insurance (Off-the-Job) Accident insurance can help provide you with a cushion to help cover expenses and living costs when you get hurt unexpectedly. While you can count on health insurance to cover medical expenses, it doesn t usually cover indirect costs that can arise with a serious or even not-so-serious injury. You may end up paying out of your own pocket for things like transportation, over-the-counter medicine, day care or sitters and extra help around the house. With accident insurance, the benefits you receive can help take care of these extra expenses and anything else that comes up. With MetLife Accident Insurance you can have peace of mind knowing Coverage is guaranteed issue no evidence of insurability is required Benefits are paid directly to you unless assigned to someone else. Benefits are paid in addition to any other coverage. Coverage is portable and may be continued if the employee leaves the group. Employee or Family coverage available. Plan highlights include* - Accidental Death & Dismemberment Coverage Up to $100,000 Dislocations & Fractures Up to $7,200 Ambulance Accident Physician's Treatment $200 Regular/ $1,000 Air $50 X-Rays Up to $200 Emergency Room Services Up to $200 Hospital Confinement Wellness/Health Screening Benefit $1,000 ($200/day) $50 Monthly Premiums (10 pay periods) Employee Employee Employee & Family Only & Spouse Child(ren) Low Plan $12.07 $24.38 $24.29 $30.53 62

NEW!!! Group Critical Illness Insurance Critical Illness insurance provides a lump sum benefit to help you cover the out-of-pocket expenses associated with a critical illness diagnosis. With MetLife Group Critical Illness Insurance you can have peace of mind knowing - Coverage is guaranteed issue no evidence of insurability is required Benefits are paid directly to you unless assigned. Coverage that supplements your existing medical benefits. Coverage is portable and may be continued if Employee leaves the group. Covered dependents receive 50% of the basic-benefit amount shown in your employer-selected plan, and 100% of the Wellness Benefit. Plan Highlights include* - Plan Design 1 Benefit for Covered Conditions Initial Benefit Recurrence Benefit Alzheimer s disease 100% of Benefit Amount NONE Coronary Artery Bypass Graft 100% of Benefit Amount 50% of Benefit Amount Full Benefit Cancer 100% of Benefit Amount 50% of Benefit Amount Partial Benefit Cancer 25% of Benefit Amount 12.5% of Benefit Amount Heart Attack 100% of Benefit Amount 50% of Benefit Amount Kidney Failure 100% of Benefit Amount NONE Major Organ Transplant 100% of Benefit Amount NONE Stroke 100% of Benefit Amount 50% of Benefit Amount Listed Conditions: Receive 25% of the initial benefit amount for 22 conditions: Addison s disease (adrenal hypofunction); amyotrophic lateral sclerosis (Lou Gehrig s disease); cerebrospinal meningitis (bacterial); cerebral palsy; cystic fibrosis; diphtheria; encephalitis; Huntington s disease (Huntington s chorea); Legionnaire s disease; malaria; multiple sclerosis (definitive diagnosis); muscular dystrophy; myasthenia gravis; necrotizing fasciitis; osteomyelitis; poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic lupus erythematosus (SLE); systemic sclerosis (scleroderma); tetanus; and tuberculosis. A Covered Person may only receive one benefit payment for a Listed Condition in his/her lifetime. Benefit Suspension Period Cancer Recurrence After a covered condition occurs there is a 365 days day Benefit Suspension Period during which most plans do not pay Recurrence benefits. The Benefit Suspension Period does not apply to first occurrences of distinct covered conditions. We will not pay Recurrence benefits for Full Benefit Cancer or Partial Benefit Cancer benefits unless the insured has not been treated nor had symptoms for at least 180 days. Table 63

Other Benefits Health Screening Benefit If a covered person takes one of the screening/prevention measures listed below while such covered person is insured under the certificate MetLife will pay a health screening benefit upon submission of proof that such measure was taken. When MetLife receives such proof, MetLife will review it, and if MetLife approves the claim, MetLife will pay a health screening benefit of $50. The Covered Tests are: physical exam, biopsies for cancer, blood test to determine total cholesterol, blood test to determine triglycerides, bone marrow testing, breast MRI, breast ultrasound, breast sonogram, cancer antigen 15-3 blood test for breast cancer (CA 15-3), cancer antigen 125 blood test for ovarian cancer (CA 125), carcinoembryonic antigen blood test for colon cancer (CEA), carotid Doppler, chest x-rays, clinical testicular exam, colonoscopy, digital rectal exam (DRE), Doppler screening for cancer, Doppler screening for peripheral vascular disease, Echocardiogram, electrocardiogram (EKG), endoscopy, fasting blood glucose test, fasting plasma glucose test, flexible sigmoidoscopy, hemoccult stool specimen, hemoglobin A1C, human papillomavirus (HPV) vaccination, lipid panel, mammogram, oral cancer screening, pap smears or thin prep pap test, prostate-specific antigen (PSA) test, serum cholesterol test to determine LDL and HDL levels, serum protein electrophoresis, skin cancer biopsy, skin cancer screening, skin exam, stress test on bicycle or treadmill, successful completion of smoking cessation program, tests for sexually transmitted infections (STIs), thermography, two hour post-load plasma glucose test, ultrasounds for cancer detection, ultrasound screening of the abdominal aorta for abdominal aortic aneurysms, and virtual colonoscopy. We will only pay one health screening benefit per covered person per calendar year. 64

Monthly Premiums (10 pay periods) 65

NEW!! Group Hospital Indemnity Insurance If unexpected medical needs arise, will your major medical insurance cover enough of the expense? Benefits from a Hospital Indemnity plan can be used to assist you in paying: deductibles, coinsurance, out-of-network costs, etc. Benefits are paid regardless of other coverage and this plan is compatible with Health Savings Accounts. Covered Benefits Benefits Category Subcategory Benefits Accident - Hospital Benefits Accident -Hospital Admission Benefit Accident - Hospital Confinement Benefit Rehab Plan Non- ICU Hospital Admission $1,500 Intensive Care Unit Admission $2,000 Non- ICU Hospital Confinement is payable for up to 31 days per covered person. (starting on $150 day 1) ICU Accident Hospital Confinement is payable for up to 31 days per covered person (starting $400 on day 1). Inpatient Rehabilitation Benefit is payable for up to 15 days per covered person per accident, but not to exceed 30 days per calendar year. $200 Other Benefits Health Screening Health Screening Benefit $50 Sickness - Hospital Non- ICU Hospital Admission $1,000 Admission Benefit Intensive Care Unit Admission $2,000 Non-ICU Sickness Hospital Confinement is payable for up to 31 days per covered person $200 (starting on day 1). Sickness - Hospital Benefits Sickness - Hospital Confinement Benefit ICU Sickness Hospital Confinement is payable for up to 31 days per covered person (starting on day 1). $400 66

Other Benefits Health Screening Benefit Paid one time per calendar year. The covered tests are: annual physical exam, biopsies for cancer, blood test to determine total cholesterol, blood test to determine triglycerides, bone marrow testing, breast MRI, breast ultrasound, breast sonogram, cancer antigen 15-3 blood test for breast cancer (CA 15-3), cancer antigen 125 blood test for ovarian cancer (CA 125), carcinoembryonic antigen blood test for colon cancer (CEA), carotid Doppler, chest x- rays, clinical testicular exam, colonoscopy, digital rectal exam (DRE), Doppler screening for cancer, Doppler screening for peripheral vascular disease, Echocardiogram, electrocardiogram (EKG), endoscopy, fasting blood glucose test, fasting plasma glucose test, flexible sigmoidoscopy, hemoccult stool specimen, hemoglobin A1C, human papillomavirus (HPV) vaccination, lipid panel, mammogram, oral cancer screening, pap smears or thin prep pap test, prostate-specific antigen (PSA) test, serum cholesterol test to determine LDL and HDL levels, serum protein electrophoresis, skin cancer biopsy, skin cancer screening, skin exam, stress test on bicycle or treadmill, successful completion of smoking cessation program, tests for sexually transmitted infections (STIs), thermography, two hour post-load plasma glucose test, ultrasounds for cancer detection, ultrasound screening of the abdominal aorta for abdominal aortic aneurysms, and virtual colonoscopy. Monthly Premiums (10 pay periods) EE EE+SP EE+CH F $23.65 $45.59 $37.04 $62.04 *This is not a complete description of benefits. For a complete description of benefits and policy requirements, please refer to the brochure and certificate of coverage. 67