Transcript IT’S YOUR CHOICE Financial protection benefits Kellogg Community College Offered by: Connecticut General Life Insurance Company, Life Insurance Company of North America, or Cigna.

IT’S YOUR
CHOICE
Financial protection benefits
Kellogg Community College
Offered by: Connecticut General Life Insurance Company, Life Insurance Company of North America, or Cigna Life Insurance Company of New York
864857
®
You are one of a kind.
And we want to help you live that way.
That’s why we offer coverage
tools
resources that will work for you as an individual
to help you feel more
secure
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These benefits are all about
you
helping you to protect your
income and savings
and giving you what you need
to feel more financially secure.
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WHY CONSIDER FINANCIAL PROTECTION BENEFITS?
• Disability benefits
Short Term
• Accidental injury insurance
• Critical illness insurance
Economical
group rates
Convenient
payroll
deductions
You’ll probably
pay less as an
employee than
you would as an
individual for the
same coverage.
No separate bills to You select the
coverage that
pay or checks to
suits your
write
needs.
• And more
Choice
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disability
benefits
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WHAT IF YOU CAN’T WORK?
DISABILITY
BENEFITS
Disability
benefits are
paid if you are
out of work due
to a covered
disability.
Your ability to earn
a living is a
valuable asset
The average long
term disability claim
lasts more than 30
months.1
About 90% of
disabilities are
caused by illnesses
rather than accidents2
Just over 1 in 4
of today’s 20 year-olds
will become disabled
before they retire3
Is your household
income sufficient to
pay for living and
other expenses in
the event you are
disabled?
1 Gen Re, U.S. Individual DI Risk Management Survey 2011, based on claims closed in 2010
2 Council for Disability Awareness, Long-Term Disability Claims Review, 2012
3 U.S. Social Security Administration, Fact Sheet, February 7, 2013
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SHORT TERM DISABILITY
DISABILITY
BENEFITS
Receive 60% of your salary when you’re out of work because of a
covered disability
14 days until coverage starts
11 weeks of coverage
Benefits start after any sick leave
has been used, or 14 days of
continuous disability, whichever
is longer
If you continue to be disabled,
benefits are subject to a
maximum of 11 weeks
No need to answer medical questions if you enroll
during this initial open enrollment period.
All plans have exclusions and limitations. Please review your Benefit Summary for more
information about what is and is not covered under your plan.
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accident
insurance
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ACCIDENTS HAPPEN
Lives are lost and lives are changed. And if unprotected and unprepared,
the financial impact of an accident can be felt by everyone involved.
ACCIDENT
INSURANCE
Accidents
are the
ER
5th leading
cause of death1
1 in 8
In 2009,
Americans sought
medical treatment
for accidents1
$1,265
average cost of
an emergency
room visit2
1 in 3 children
who play a team
sport is injured
seriously enough
to miss practice
or games.3
Accidents are
the #1 cause
of death
for people
under 411
1 – U.S. Department of Health & Human Services , National Vital Statistics Reports, Vol. 61, No. 6, October 10, 2012
2 – PlosOne, “How much will I get charged for this?,” February 2013
3 – Mickalide AD, Hansen LM. Coaching Our Kids to Fewer Injuries: A Report on Youth Sports Safety. Washington, DC: Safe Kids Worldwide, April 2012.More
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ACCIDENTAL INJURY
ACCIDENT
INSURANCE
Pays a lump sum cash benefit directly to you, or your designee, that can
help pay for any out-of-pocket expenses related to covered accidents.
Examples of covered
injuries may include:*
Covered events
may include:
• Broken bones
• Initial treatment
• Burns
• Emergency room visit
• Torn ligaments
• Hospitalization
• Concussion
• Eye injuries
• Ruptured discs
–
–
Admission (per occurrence)
Confinement (per day)
• Follow-up care
• Cuts requiring stitches
* To receive benefits, the event must meet the terms and definitions of the policy. Waiting periods may apply.
Subject to all other plan exclusions and limitations. See slides 30 and 31 for more information.
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ADDITIONAL FEATURES
• Enhanced Accident – Increases the value of a standard plan by expanding the list of
coverage
• Wellness – Provides annual benefit of $50 for broad range of preventive services
including (but not limited to) office visits, immunizations and health screenings. 30 day
waiting period.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
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• Slips on wet floor
• Injures knee and wrist
meet Sue
ACCIDENT
INSURANCE
PLAN EXAMPLE
Sample expenses NOT covered by major
medical insurance plan
Benefits paid by accidental injury plan
Urgent care copay
$ 100.00
Emergency room visit
Deductible
1,000.00
Dislocated knee
500.00
400.00
Surgery copay
750.00
Fractured wrist
10 physical therapy visits copay
150.00
Follow-up appointment
OUT-OF-POCKET COSTS
2,000.00
10 physical therapy visits
BENEFITS PAID
$ 100.00
50.00
250.00
1,300.00
Sue pays $12.81* monthly for employee
only Accidental Injury coverage.
*Refer to benefit summary for complete exclusions, limitations and premiums
This is an example used for illustrative purposes only and assumes injuries were the direct result of a covered accident.
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critical
illness
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LIFE CHANGING HEALTH EVENT
CRITICAL
ILLNESS
• [More than 13.5 million American have high-deductible health
plans 1]
• [Maximum out-of-pocket expenses for a high-deductible health
plan can reach up to $6,050 a year ($12,100 for families).1]
• [Each year, nearly 1 million Americans have a heart attack and 1.6
million are expected to be diagnosed with cancer. 2, 3]
1 – America's Health Insurance Plans (AHIP), 2012 HSA census.
2 – Heart Disease Foundation. Heart Disease: Scope and Impact., May 3, 2012.
3 – Cancer Facts and Figures 2012, American Cancer Society
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HOW IT HELPS
CRITICAL
ILLNESS
Helps you pay for additional out-of-pocket expenses
from a life changing health event, such as:
• Travel, room and board for medical treatment
• Child care
• Treatment options not covered by traditional insurance
Use the money to pay for everyday household bills that may pile
up due to loss wages
Uncoordinated benefit – Lump sum payment directly to you
It provides financial relief so you can focus on getting better
All plans have exclusions and limitations. Please review your Benefit Summary for more information about what is and is not covered under your plan.
1. See slide 32 for full definitions of each covered condition.
2. If the covered person receives 25% of the benefit, the remaining 75% will be available for a first diagnosis of another covered condition.
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BENEFIT
CRITICAL
ILLNESS
Lump sum benefit is paid upon the diagnosis of a covered
condition – $10,000
During your open enrollment period only, you can elect
$10,000 of coverage without completing a medical questionnaire
30 day benefit waiting period from the coverage effective date
Covered conditions1:
– Invasive Cancer
– Heart Attack
– Stroke
– Renal (Kidney) Failure
– Major Organ Transplant
– ALS (Lou Gehrig’s Disease)
– Blindness
– Paralysis
– Coronary Artery Disease (25%)2
– Carcinoma in Situ (25%)2
All plans have exclusions and limitations. Please review your Benefit Summary for more information about what is and is not covered under your plan.
1. See slide 32 for full definitions of each covered condition.
2. If the covered person receives 25% of the benefit, the remaining 75% will be available for a first diagnosis of another covered condition.
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meet Marco
• 40 years old
• Diagnosis: Heart attack1
CRITICAL
ILLNESS
PLAN EXAMPLE
Sample expenses NOT covered by
traditional medical insurance plan
Critical Illness Plan
Emergency care copay
$ 100.00
Deductible
1,000.00
Coinsurance
2,000.00
Specialist visit copay
Lost wages
OUT-OF-POCKET COSTS
COVERAGE PAID
$10,000.00
Lump sum payment to Marco upon
diagnosis to use as he sees fit
240.00
2,000.00
$5,340.00
Marco pays $5.33* biweekly for Critical
Illness coverage for himself and his spouse
*Refer to benefit summary for complete exclusions, limitations and premiums.
This is an example used for illustrative purposes only.
1. Heart Attack is defined under the policy as a clinical event which has at least 2 of the following: a) chest pain, b) EKG changes, c) biochemical markers of heart
tissue death, that results in permanent functional loss of heart contraction
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ADDITIONAL FEATURES
CRITICAL
ILLNESS
• Additional benefit – Coverage for a different
covered condition (with a 6 month separation and
maximum 1 time additional payment)
• Recurrence benefit – Coverage for an additional
diagnosis
– 12-month separation period
– No lifetime maximum
• Health Screening Benefit – Benefit of $50 per
covered person, per calendar year, for a health
screening or diagnostic test.
– Eligible tests include (but are not limited to)
mammography, chest X-ray, blood tests
– 30 day waiting period
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more
for you
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MORE FOR YOU
Available with your plan*
MORE FOR YOU
• Healthy Rewards® – Discounts of up to 60% on health and wellness products and
services such as weight management, nutrition, fitness, smoking cessation and more
• Identity Theft – Access to personal case managers who give step-by-step assistance
and guidance if your identity is stolen
• Will Preparation & Funeral Planning Services – Online forms and tools to build
state-specific customized wills, powers of attorney, other legal documents,
as well as assistance in funeral planning.
*These programs and services are NOT insurance. Some Cigna Healthy Rewards discount programs are not available in all states, may be discontinued at any time, and you must pay the entire discounted charge. Cigna’s
Identity Theft services are provided under a contract with Europ Assistance USA. Full terms, conditions and exclusions are contained in Cigna’s Identity Theft program service agreement. Will Preparation services are
independently administered by ARAG®. Cigna does not provide legal services and makes no representations or warranties as to the quality of the information on the ARAG website or the services of ARAG. Phone and face-toface counseling sessions must be used within one year of the date the claim is approved. Counseling, legal or financial assistance programs are not available under policies insured by Cigna Life Insurance Company of New York.
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ENROLLMENT
Next steps
MORE FOR YOU
Enroll online at
www.benefits
insight.com
Come speak with us
to learn more today
Please read the summary of benefits, exclusions and limitations for a complete description of the insurance plan along with the premiums.
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The information in this presentation summarizes the highlights of your plan. For a complete list of both covered and not covered services, including benefits required by your
state, see your employer’s group insurance policy, summary plan description or group service agreement – the official plan documents. If there are any differences between
the information in this presentation and the plan documents, the information in the plan documents takes precedence.
Group Universal Life (GUL) insurance plans are offered by Connecticut General Life Insurance Company. Term Life, Accidental Death and Dismemberment, Accidental Injury,
Critical Illness and Disability plans are insured or administered by Life Insurance Company of North America, except in New York, where coverage is provided by Cigna Life
Insurance Company of New York.
“Cigna,” the “Tree of Life” logo, “GO YOU,” “Healthy Rewards” and “Cignassurance” are registered service marks, and “Life Assistance” is a service mark, of Cigna
Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating
subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Life Insurance Company of North America, and
Cigna Life Insurance Company of New York. All models are used for illustrative purposes only.
864857 07/13
© 2013 Cigna. Some content provided under license.
ACCIDENTAL INJURY SAMPLE INJURY DEFINITIONS
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•
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•
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•
Fracture Benefits
Bone broken, within {90} days of accident, as diagnosed by physician and corrected by open (Surgical) or closed
(Non-Surgical) reduction. If more than one fracture, we pay one benefit, whichever is greater.
Small Burns – 2nd or 3rd degree burn covering 20% or less body surface and within {90} days of accident. If 3rd
degree burn benefit is payable, 2nd degree burn benefit for same accident and burned area is not payable. Payable
1 time per accident. Not payable for burns caused from sunburn or if Large Burns benefit is payable.
Large Burns - 2nd or 3rd degree burn covering more than {20}% of body surface and within {90} days of accident. If
3rd degree burn benefit is payable, 2nd degree burn benefit for same accident and burned area is not payable.
Payable 1 time per accident. Not payable for burns caused from sunburn.
Tendon, Ligament, Rotator Cuff, or Knee Surgery – Repair - torn, ruptured, or severed and performed by a
physician within {90}days of accident. Payable {1} time per accident. Not payable if exploratory surgery is performed
with no repair.
Tendon, Ligament, Rotator Cuff, or Knee Surgery – Exploratory – performed by a physician within {90}days of
accident. Payable 1 time per accident.
Concussion - diagnosed within 90 days of accident. Payable 1 time per accident.
Eye Injury Surgery - performed by a physician within {90}of accident. Payable 1 time per accident.
Eye Injury - Removal of Foreign Object - performed by a physician within {90} days of accident. Payable 1 time
per accident. Not payable if Eye Injury Surgery benefit is paid.
Ruptured Disc Surgery – Repair - performed by a physician within {90} days of accident. Payable 1 time per
accident.
Small Lacerations – one or more lacerations, less than or equal to{6} inches long and requires 2 or more sutures
and within {90} days of accident. Multiple lacerations pay maximum {2} times. Payable 1 time per accident.
Large Lacerations - one or more lacerations, more than {6} inches long and requires {2} or more sutures and within
{90} days of accident. Multiple lacerations pay maximum {2}times.
ACCIDENTAL INJURY SAMPLE COVERED CONDITION DEFINITIONS
•
•
•
•
Physician Office Visit – provided by a licensed health care provider within [90] days of accident. Does not include: routine health exams or immunizations
for age 60 and older; mental or nervous disorder visits; visits by surgeon while confined to hospital. Payable [1] X per accident. Not payable with Emergency
Treatment benefit.
Diagnostic Exam – covers x-rays or laboratory studies prescribed by a physician within [90] days of accident. Does not include CT or CAT Scans, MRI,
PET, SPECT or other similar tests. Payable for [1] diagnostic exam per covered accident and payable up to [1] time per [month].
Emergency Care Treatment – in a trauma center or special area of hospital equipped and staffed for emergency care on outpatient basis (not include a
clinic or doctor's office) and within [30] days of accident. Payable [1] time per accident, up to [1] time per month.
Hospitalization Benefits
Hospital meets all of the following: Licensed as hospital pursuant to law; Provides medical care and treatment; under supervision of medical doctor staff; 24hour nursing services by or under supervision of Registered Nurse (R.N.); Major surgical facilities available on premises or prearranged basis; Charges for
services (includes VA hospitals without service charges). Does not include clinic, facility, or unit of hospital for: Rehabilitation, convalescent, custodial,
educational or nursing care; Aged, drug addicts or alcoholics.
Hospital Admission
– Benefit Waiting Period {0} days
– Within {90 days} of accident; inpatient hospital stay required; first admission for accident.
– Payable on day {0}for 1 accident, up to {1} admission per {month}. Not payable for treatment only given in emergency room; outpatient; or re-admission
from same accident.
Hospital Stay
– Benefit Waiting Period {1} day
– Maximum Benefit Period {365} days
– Stay must begin within {90 days} of accident and admitted for at least {23 hours} and/or on an inpatient basis. Payable on day {0}for up to {1} time per
{month}. If payable under Hospital Stay and Initial Intensive Care Unit benefits, only {1} benefit is payable for same accident, whichever is greater. Rehospitalization within {90 days} for same accident is one stay. Re-hospitalization after {90 days} for same accident is as different stay.
Intensive Care Unit Stay
– Benefit Waiting Period {1} day
– Maximum Benefit Period up to {365} days
– Stay must begin within {90 days} of accident and admitted for at least {23 hours} and/or on an inpatient basis in a special area of hospital for treatment
of patients in acute, critical condition; furnished with emergency life-saving equipment and supplies; staffed 24 hours a day by ICU nurses; can monitor
patient's vital signs around-the-clock. Not a recovery room or area used for post-operative or post-anesthesia care. Not payable for hospital
readmission for same accident.
– Payable on day {1}for up to {1} time per {month}. If benefit is payable under Hospital Stay and Initial Intensive Care Unit benefits, only 1 benefit paid for
same accident, whichever is greater. If readmitted within {90 days} for same accident, it counts as one stay. If released for at least {90 days} and
returns for same accident, it counts as different stay.
CRITICAL ILLNESS CONDITION DEFINITIONS
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Invasive Cancer - uncontrolled/abnormal growth or spread of invasive malignant cells (not including skin cancers,
unless metastatic disease develops)
Heart Attack - a clinical event which has at least 2 of the following 3: a) chest pain, b) EKG changes, c) biochemical
markers of heart tissue death, that results in permanent functional loss of heart contraction
Stroke - cerebrovascular event (e.g. cerebral hemorrhage) confirmed by neuroimaging with neurological deficits
lasting 30 days or more (not including TIAs, brain injury from trauma/hypoxia/anoxia or hypotension, or
disease/disorders of the eyes or ears)
Renal (Kidney) Failure - chronic irreversible kidney failure requiring hemodialysis or peritoneal dialysis
Major Organ Transplant - surgical transplant of human-donor organ (liver, lung, pancreas, kidney or heart only)
upon first hospitalized day for surgery (1 benefit payable for multi-organ transplants)
Paralysis - complete and permanent loss of use of 2 or more limbs 100%
Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) - motor neuron disease resulting in muscular weakness
and atrophy
Blindness - irreversible reduction of sight (both eyes) with best corrected single eye visual acuity less than 20/200
(E-Chart) or 6/60 (Metric) or with visual field reduction (both eyes) to 20 degrees or less
Occupational Human Immunodeficiency Virus (Occupational HIV) - HIV infection from accidental exposure to
HIV-contaminated body fluids during normal course of work in your occupation. Incident Report and confirmatory
anti-body test by state certified lab (with negative result) required within 5 days of exposure. Follow-up confirmatory
test (with positive result) required within 90-180 days post-exposure. (Not including infection from IV drug use,
sexual transmission or non-accidental contraction)
Coronary Artery Disease (Surgery) - heart disease/angina requiring Coronary Artery Bypass Surgery, as indicated
by angiographic test results. (Not including angioplasty, stent implants or related procedures)
Carcinoma in Situ - non-invasive malignant tumor (Not including skin cancers – basal or squamous cell carcinoma
or melanoma/melanoma in situ)