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2021 Capital Accounting Booklet 2021 Flipbook PDF
2021 Capital Accounting Booklet 2021
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Capital Accounting 2021 Benefits Booklet
An Overview of the benefits provided by Capital Accounting that can help you enjoy increased well being and financial security.
Plan Year January 1,2021 thru December 31,2021 Prepared by Arizona Benefit Consultants for Capital Accounting
Revolution Health Plans: THE GALAXY SERIES
DIAMOND
EVIDENCE-BASED MEDICINE COMBINED WITH THE FLEXIBILITY OF A PATIENT SPECIFIC QUALITY CARE NETWORK Say goodbye to massive books of network providers and generic search engine results that lack advice, direction or any measure of quality and performance! Instead, present your healthcare needs to our team and receive real help, including patient advocacy and an Evidence-Based treatment plan. We will provide you with a fully coordinated plan and direct you to the best Guided Network providers in your area for the most appropriate care when you need it most... just Call the Nurse. Evidence-Based Medicine means that the course of treatment you receive has been scientifically tested, reviewed by medical peers, and confirmed to be safe and effective for a given condition. There is always risk involved in medical treatment, but with Evidence-Based Medicine, experience, data and the power of numbers guide best practices.
THIS INITIATIVE’S GOAL IS TO PROVIDE THE RIGHT PATIENT, WITH THE RIGHT CARE, AT THE RIGHT TIME, IN THE RIGHT PLACE, AND ALL AT THE RIGHT PRICE!
Schedule of Benefits
Guided Network benefits are those directed by your nurse (or basic routine care via your PHCS Provider). Care provided outside of or contradictory to your nurse’s direction is considered Out of Network.
Guided Network
Out-of-Network
Ask the nurse and follow the Guided Network directions to better health care.
When care is found Out of Network the Deductible and 20% Coinsurance applies.*
Covered in Full
Deductible & 20% Coinsurance
Covered in Full
Covered in Full
Covered in Full
Deductible & 20% Coinsurance
Covered in Full
Deductible & 20% Coinsurance
Preventive Care Under PPACA | Charges for preventive care as per PPACA on the effective date of the plan provide for certain benefits to be paid absent of cost sharing.
TeleMedicine Professional Outpatient Office Visits | These charges are billed by the physician for time spent with the patient. Office visits do not include charges for diagnostic, surgical or medical procedures performed by the physician or for diagnostic services billed separately.
Office Based Diagnostic Tests, Labs & X-Ray | Includes diagnostic tests performed in a physician’s office and billed by such physician or a freestanding non-hospital billed facility only.
Outpatient Surgical, Diagnostic, & Therapeutic Procedure Services Facility Charges
Covered in Full Covered in Full
Vision | Annual Eye Exam Only. Any optometrist; member must submit claim for reimbursement.
Covered in Full
Deductible & 20% Coinsurance
Covered in Full
Deductible & 20% Coinsurance
Covered in Full Covered in Full Covered in Full
Deductible & 20% Coinsurance Deductible & 20% Coinsurance Deductible & 20% Coinsurance
Covered in Full Covered in Full
Deductible & 20% Coinsurance Deductible & 20% Coinsurance
Deductible Waived
$3,000 per Individual $6,000 per Family
$2,500 Individual or Family
$6,000 per Individual $12,000 per Family
Inpatient Hospitalization Medical Services & Facility Anesthesiologist & Surgeon Fees Mental Health & Substance Use Disorder Skilled Nursing Facilities
Covered in Full Covered in Full Covered in Full Covered in Full
Deductible & 20% Coinsurance Deductible & 20% Coinsurance Deductible & 20% Coinsurance Deductible & 20% Coinsurance
Home Health Care
Covered in Full
Deductible & 20% Coinsurance
Hospice Care
Covered in Full
Deductible & 20% Coinsurance
Durable Medical Equipment
Covered in Full
Deductible & 20% Coinsurance
Prescription Benefits Tier 1 Tier 2 Tier 3 Tier 4
No Deductible $0 Copay $20 Copay $75 Copay $150 Copay
All Prescription Benefits are administered through the Pharmacy Manager as indicated in the “Guided Network” column to the left.
Short Term Rehabilitation Services | Physical, chiropractic, speech and occupational therapy. (Includes therapies performed in a provider’s office or other non-hospital billed facility only).
Deductible & 20% Coinsurance Deductible & 20% Coinsurance
Emergency Services | ER copayment waived if admitted; $250 penalty for non-emergency use of a hospital emergency room.
Hospital Emergency Room Urgent Care/Physician (see professional office visit above) Ambulance Allergy Treatment Testing & Injections Serum Plan Year Deductible | Copays do not apply to deductibles. Out-of-Pocket Maximum | When through Guided Network, Only Copays Apply
* Out of Network Reimbursements are subject to Maximum Allowable Charges (MAC). Balance billing may apply.
RevHP20-04 | Galaxy 01 | Pg 1
Revolution Health Plans: THE GALAXY SERIES
Four Important Questions DO I NEED TO USE A SPECIFIC NETWORK OF MEDICAL PROVIDERS? You do have a designated network of care providers for certain out-patient services. But for anything beyond a routine well visit, for the best benefits, we ask that you first Call the Nurse. By communicating with the nurse, your care coordinator, you will receive valuable direction toward care, provider selection, and facilities when needed. Your nurse will guide you to a PHCS Practitioner and Ancillary network provider whenever possible for physician, lab, and other health care needs. Your access through this network does not include acute care hospitals. If you need care beyond that network of providers, your nurse will work with you to find the best providers in your area to receive your care in the most appropriate facility and with the best quality of providers. WHAT HAPPENS IF MY NETWORK DOCTOR REFERS ME TO ANOTHER PROVIDER THAT IS NOT IN THE NETWORK? Any time that your physician refers you to care beyond your routine well visit, you will Call the Nurse. Your nurse will coordinate finding you the most appropriate physician, location, and care plan for your medical needs and will assure that you get the very best benefits from your plan. If you go directly to providers without the direction of your nurse coordinator, you will receive out of network benefits which will be considerably higher cost for you. WHAT IF I NEED TO GO IN THE HOSPITAL OR OTHER HEALTH CARE FACILITY? It is very important to note that all hospitals are not the same, and no hospital is the best at everything. The most important thing to do is Call the Nurse. Your nurse care coordinator will be sure to work with all of the parts of your health plan to help navigate you to the most appropriate care, with quality providers, in facilities well suited for the care you need. It is vital that all hospital, facility, and surgical visits are coordinated with the Plan by calling the nurse. Many facilities will need to work with your care coordinator to maximize your benefits and provide quality care. To prevent your care from being treated as out-of-network care which would have radically higher costs for you... Call the Nurse! WHAT IF I HAVE AN EMERGENCY? In an emergency the choice is pretty simple. If the problem is serious enough that you should call an ambulance, then do not hesitate, otherwise ask the nurse! It is important especially in times of crisis that you find direction to the nearest appropriate medical provider. So call 911 or Call the Nurse. By Calling the Nurse, you will find support and direction from a medical professional at a time when you need it most. With professional guidance from your care coordinator you will also preserve the highest level of benefits possible! If you find yourself in a situation where you just can’t Call the Nurse, then call or have a family member or friend call as soon as the situation allows. WHAT IF I DON’T CALL THE NURSE OR CALL THE NURSE AND MAKE A DIFFERENT DECISION BUT STILL SEE A NETWORK PROVIDER? If you do not Call the Nurse for direction, or you make care decisions contrary to the provided options, then your benefits will be deemed to be Out-of-Network rather than Guided Network. In that case, if you happen to see a Provider that is in the Network you will be receive benefits based on the Out-of-Network schedule but you will not be expected to pay the provider more than the agreed upon charges.
Provider Search 1. In your browser, type www.phcs.com. This will bring you to the Multiplan website provider search page. 2. Click the green “Select Network” button on the left side of the page. If you arrow back and get redirected to the Multiplan home page, you will find this green “Select Network” button at the top right side of the page. From there, the directions are the same. 3. Select the “PHCS,” option on the list. 4. Select the “Practitioner and Ancillary” option on the list. 5. Update zip code selected as necessary. Search by specialty is suggested. Search by provider name, if you know first and last and correct spelling, otherwise, it will not find results. After searching via specialty, you may use the filters on the left to narrow your search to any specifics you desire, IE. Language, gender, mile radius (default is 20), wait time for visit, etc. 6. For additional assistance, call Multiplan/PHCS Provider Search Customer Service 866-680-7427. * Out of Network Reimbursements are subject to Maximum Allowable Charges (MAC). Balance billing may apply.
RevHP20-04 | Galaxy 01 | Pg 2
Capital Accounting PC ALL ELIGIBLE EMPLOYEES Group Number: 00582591
Customer Service (888) 600-1600 Monday to Friday | 8am to 8:30pm ET
Welcome to
Workplace benefits Everyone deserves a Guardian Every day, Guardian gives 26 million Americans the security they deserve through our insurance and wealth management products and services. We’ve partnered with your organization to offer you a range of employee benefits. Inside this pack, you’ll find the plans your employer thinks you might benefit from.
Your coverage options Dental insurance
Taking care of teeth and overall health
Vision insurance
Looking after your eyesight and related health issues
Life insurance
Protecting your family's financial future
Ready to enroll? Only you know what’s right for you and your family. Which is why you can choose from a range of plans to pick the best fit. Whatever you pick, you’re in good hands. We’ve been delivering on our promises for over 150 years, and we’re looking forward to doing the same for you too.
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Read through this information.
2
Choose the benefits you’d like to take.
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Follow your employer’s instructions to complete the enrollment process. © Copyright 2020 The Guardian Life Insurance Company of America This document is a summary of the major features of the insurance coverage that's been agreed to with your employer – it isn't your contract.
Watch our video Learn how dental insurance can protect your long-term health.
Dental insurance Taking care of your teeth is about more than just covering cavities and cleanings. It also means accounting for more expensive dental work, and your overall health.
Staying healthy
With dental insurance, routine preventive care can lead to better overall health. And you’ll be able to save money if any extensive dental work is required.
Oral health is about more than just teeth and gums. It’s also essential for a range of other health and wellbeing reasons:
Who is it for?
Cardiovascular disease: Some research suggests that heart disease, clogged arteries, and infections may be linked to inflammation and infections from oral bacteria.
Everyone should have access to great dental coverage, which is why we offer comprehensive plans that are available through employers as part of your benefit offerings.
What does it cover? Dental insurance helps to protect your overall oral care. That includes services like preventive cleanings, x-rays, restorative services like fillings, and other more serious forms of oral surgery if you ever need them.
Why should I consider it? Poor oral health isn’t just aesthetic, it’s also been linked to conditions including diabetes, heart disease, and strokes. So, while brushing and flossing every day can help keep your teeth clean, nothing should replace regular visits to the dentist.
Joe visits his dentist for a routine dental cleaning, to take care of his teeth as well as his overall health.
Osteoporosis: Weak and brittle bones may be linked to tooth loss. Diabetes: Research shows that people with gum disease find it more difficult to control their blood sugar levels. Alzheimer’s disease: Tooth loss before the age of 35 may be a risk factor for Alzheimer’s disease.
All information contained here is from the Mayo Clinic, Oral Health: A Window to Your Overall Health, www.mayoclinic.com. 2018. You will receive these benefits if you meet the conditions listed in the policy.
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/2020 3 ALL ELIGIBLE EMPLOYEES Group number: 00582591 2020-104309 (07/22)
Your dental coverage PPO plan, you can visit any dentist; but you pay less out-of-pocket when you choose a PPO dentist. Out-of-network benefits are limited to our PPO fee schedule. Your Dental Plan
PPO
Your Network is
DentalGuard Preferred
Calendar year deductible
In-Network $50
Individual Family limit Waived for Charges covered for you (co-insurance) Preventive Care Basic Care Major Care Orthodontia Annual Maximum Benefit Maximum Rollover Rollover Threshold Rollover Amount Rollover In-network Amount Rollover Account Limit Lifetime Orthodontia Maximum Dependent Age Limits
Out-of-Network $50 3 per family Preventive Preventive In-Network Out-of-Network 100% 80% 80% 70% 50% 40% Not Covered (applies to all levels) $1500
$1500 Yes $700 $350 $500 $1250 Not Applicable 26
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America CAPITAL ACCOUNTING PC Your benefits as of 12/10/2020 4 ALL ELIGIBLE EMPLOYEES Group number: 00582591
Your dental coverage A Sample of Services Covered by Your Plan:
PPO Plan pays (on average) In-network Out-of-network Preventive Care
Basic Care
Major Care
Cleaning (prophylaxis) Frequency: Fluoride Treatments Limits: Oral Exams Sealants (per tooth) X-rays
100%
100% 100% 100%
Anesthesia* Fillings‡
80% 80%
70% 70%
Perio Surgery Periodontal Maintenance Frequency:
80% 80%
70% 70% 2 in 12 months
100%
80% 2 in 12 Months 80% Under Age 19 80% 80% 80%
Repair & Maintenance of Crowns, Bridges & Dentures Root Canal Scaling & Root Planing (per quadrant) Simple Extractions Surgical Extractions
80%
70%
80% 80% 80% 80%
70% 70% 70% 70%
Bridges and Dentures Dental Implants Inlays, Onlays, Veneers** Single Crowns
50% 50% 50% 50%
40% 40% 40% 40%
This is only a partial list of dental services. Your certificate of benefits will show exactly what is covered and excluded. **For PPO and or Indemnity members, Crowns, Inlays, Onlays and Labial Veneers are covered only when needed because of decay or injury or other pathology when the tooth cannot be restored with amalgam or composite filing material. When Orthodontia coverage is for "Child(ren)" only, the orthodontic appliance must be placed prior to the age limit set by your plan; If full-time status is required by your plan in order to remain insured after a certain age; then orthodontic maintenance may continue as long as full-time student status is maintained. If Orthodontia coverage is for "Adults and Child(ren)" this limitation does not apply. *General Anesthesia – restrictions apply. ‡For PPO and or Indemnity members, Fillings – restrictions may apply to composite fillings.
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/20 5 ALL ELIGIBLE EMPLOYEES Group number: 00582591
Your dental coverage Manage Your Benefits:
Need Assistance?
Go to www.GuardianAnytime.com to access secure information about your Guardian benefits including access to an image of your ID Card. Your on-line account will be set up within 30 days after your plan effective date..
Call the Guardian Helpline (888) 600-1600, weekdays, 8:00 AM to 8:30 PM, EST. Refer to your member ID (social security number) and your plan number: 00582591 Please call the Guardian Helpline if you need to use your benefits within 30 days of plan effective date. Please note, self-serve options over the phone or online at Guardian Anytime are not available until the case is fully implemented, please wait to speak to a live agent when calling the Guardian Helpline.
Find A Dentist: Visit www.GuardianAnytime.com Click on “Find A Provider”; You will need to know your plan, which can be found on the first page of your dental benefit summary.
EXCLUSIONS AND LIMITATIONS n Important Information about Guardian’s DentalGuard Indemnity and
DentalGuard Preferred Network PPO plans: This policy provides dental insurance only. Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. The plan does not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments (unless they are expressly provided for), any treatments to the extent benefits are payable by any other payor or for which no charge is made, prosthetic devices unless certain conditions are met, and services ancillary to surgical treatment. The plan limits benefits for diagnostic
consultations and for preventive, restorative, endodontic, periodontic, and prosthodontic services. The services, exclusions and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. Contract # GP-1-DG2000 et al. n PPO and or Indemnity Special Limitation: Teeth lost or missing before a covered person becomes insured by this plan. A covered person may have one or more congenitally missing teeth or have lost one or more teeth before he became insured by this plan. We won’t pay for a prosthetic device which replaces such teeth unless the device also replaces one or more natural teeth lost or extracted after the covered person became insured by this plan. R3-DG2000
DentalGuard Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage. This policy provides DENTAL insurance only. Policy Form # GP-1-DG2000, et al, GP-1-DEN-16
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/20 6 ALL ELIGIBLE EMPLOYEES Group number: 00582591
Oral Health Rewards Program Regular visits to the dentist can help prevent and detect the early signs of serious diseases. That’s why Guardian’s Maximum Rollover Oral Health Rewards Program encourages and rewards members who visit the dentist, by rolling over part of your unused annual maximum into a Maximum Rollover Account (MRA). This can be used in future years if your plan’s annual maximum is reached.
Automatic rollover Submit a claim (without exceeding the paid claims threshold of a benefit year), and Guardian will roll over a portion of your unused annual dental maximum.
How maximum rollover works* Depending on a plan’s annual maximum, if claims made for a certain year don’t reach a specified threshold, then the set maximum rollover amount can be rolled over. Plan annual maximum**
Threshold
Maximum rollover amount
In-network only rollover amount
Maximum rollover account limit
$1,500 Maximumclaims reimbursèment
$700 Claims amount that determines rollover eligibility
$350 Additional dollars added to a plan’s annual maximum for future years
$500 Additional dollars added if only in-network providers were used during the benefit year
$1,250 The limit that cannot be exceeded within the maximum rollover account
* This example has been created for illustrative purposes only. ** If a plan has a different annual maximum for PPO benefits vs. non-PPO benefits, ($1500 PPO/$1000 non-PPO for example) the non-PPO maximum determines the Maximum Rollover plan. May not be available in all states. Guardian’s Dental Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage. Information provided in this communication is for informational purposes only. Dental Policy Form No. GP-1-DEN-16. GUARDIAN® is a registered service mark of The Guardian Life Insurance Company of America ® ©Copyright 2019 The Guardian Life Insurance Company of America.
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America guardianlife.com © Copyright 2020 The Guardian Life Insurance Company of America 2020-105050 (07/22)
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Watch our video How vision insurance can help you see clearly as you get older.
Vision insurance Vision insurance helps protect the health of your eyes by providing coverage for benefits that often aren’t covered by regular medical insurance. Protecting your eyesight means allowing for routine visits to the optometrist for eye exams, as well as coverage for glasses and contacts. Make sure your eyes remain in great shape at any age – no matter how much time you spend staring at digital screens.
20/20 coverage David notices that his vision is deteriorating. He goes in for an eye exam, and is diagnosed with myopia, which means he needs glasses.
Average cost of vision exam: $171 Average cost of frames and lenses: $350 Total cost: $521
Who is it for? Even if you have perfect eyesight, it’s important to have regular eye exams to make sure you’re still seeing clearly. Most of us may eventually need vision correction, which is why we offer vision insurance to cover some of the costs.
With a Vision policy from Guardian, David pays just $10 for his eye exam. After $25 in copay, his lenses are fully covered, and he pays $96 for his frames.
What does it cover?
David’s total out-of-pocket expense is $131, saving him $390.
Vision insurance covers benefits not typically included in medical insurance plans. It covers things like routine eye exams, allowances towards the purchase of eyeglasses and contact lenses, as well as discounts on corrective Lasik surgery.
Why should I consider it? Regular eye exams can detect more than failing eyesight, they can also pick up diseases like glaucoma and diabetes. Vision problems are one of the most prevalent disabilities in the United States, making vision insurance especially useful for anyone who regularly needs to purchase eyeglasses or contacts, or anyone who simply wants to help protect their eyesight and general health.
This example is for illustrative purposes only. Your plan’s coverage may vary. See your plan’s information on the following pages for specific amounts and details.
You will receive these benefits if you meet the conditions listed in the policy.
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/2020 9 ALL ELIGIBLE EMPLOYEES Group number: 00582591 2020-104313 (07/22)
Your vision coverage Option 1: Significant out-of-pocket savings available with your Full Feature plan by visiting one of Davis Vision's network locations including retail centers such as Costco®, Wal-Mart®, JCPenney®, Target®, Sam’s Club®, Pearle®, Visionworks®. You can also use your network benefits online at Visionworks®.com, glasses®.com, or 1800contacts®.com. Your Vision Plan
Full Feature - Designer
Your Network is
Davis Vision
Your Semi-monthly premium
$ 4.51
You and Spouse/Domestic partner
$ 7.59
You and Child(ren)
$ 7.74
You, Spouse/Domestic partner and Child(ren)
$ 12.25
Copay Exams Copay
$ 20
Materials Copay (waived for elective contact lenses)
$ 20
Sample of Covered Services
You pay (after copay if applicable): In-network
Out-of-network
Eye Exams
$0
Amount over $50
Single Vision Lenses
$0
Amount over $48
Lined Bifocal Lenses
$0
Amount over $67
Lined Trifocal Lenses
$0
Amount over $86
Lenticular Lenses
$0
Amount over $126
Frames
80% of amount over $150*²
Amount over $48
Contact Lenses (Elective and conventional)
85% of amount over $150*
Amount over $105
Contact Lenses (Planned replacement and disposable)
85% of amount over $150*
Amount over $105
Contact Lenses (Medically Necessary)
$0
Amount over $210
Cosmetic Extras
Avg. 40-60% off retail price
No discounts
Glasses (Additional pair of frames and lenses)
Courtesy discount from most providers
No discounts
Laser Correction Surgery Discount
Up to 25% off the usual charge or 5% No discounts off promotional price
Service Frequencies Exams
Every calendar year
Lenses (for glasses or contact lenses)‡‡
Every calendar year
Frames
Every calendar year
Network discounts (glasses and contact lens professional service)
Applies to first purchase & courtesy discount from most providers on subsequent purchases.
Dependent Age Limits
26 Visit www.GuardianAnytime.com and click on “Find a Provider” This is only a partial list of vision services. Your certificate of benefits will show exactly what is covered and excluded.
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/2020 10 ALL ELIGIBLE EMPLOYEES Group number: 00582591
Your vision coverage Davis • ‡‡Benefit includes coverage for glasses or contact lenses, not both. • Contact lenses from Davis Vision's Collection are available at most private practice locations with Full Feature and Materials Only plans. Contacts from the collection are covered in full including fitting and evaluation, in excess of the plan's materials copay. Elective contacts that are not part of the Collection are covered up to the plan's elective contact lens allowance and the materials copay is waived.
• *Additional discounts are not available at all private practice locations. Costco, Walmart, Sam’s Club, glasses.com, and 1800contacts.com do not allow additional discounts.
• For Davis Vision, complete eyeglasses must be purchased at one time from one provider. For example, if a member purchases only lenses, he or she cannot
purchase frames later in the same benefit period. The member is not eligible for new vision materials until the next benefit period. Only charges for an initial purchase can be used toward the material allowance. Any unused balance remaining after the initial purchase cannot be banked for future use.
• 2Extra $50 at Visionworks stores and at Visionworks.com. • Davis Vision offers 2,000 College Tuition Benefit Rewards, which are administered by SAGE CTB, LLC.
EXCLUSIONS AND LIMITATIONS Important Information: This policy provides vision care limited benefits health insurance only. It does not provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. Coverage is limited to those charges that are necessary for a routine vision examination. Co-pays apply. The plan does not pay for: orthoptics or vision training and any associated supplemental testing; medical or surgical treatment of the eye; and eye examination or corrective eyewear required by an employer as a condition of employment; replacement of lenses and frames that are furnished under this plan, which are lost or broken (except at normal intervals when services are otherwise available or a warranty exists). The plan limits benefits for blended lenses, oversized lenses, photochromic lenses, tinted lenses, progressive multifocal lenses, coated or laminated lenses, a frame that exceeds plan allowance, cosmetic lenses; U-V protected lenses and optional cosmetic processes.
The services, exclusions and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. Contract #GP-1-DAVIS-05-VIS et al. Laser Correction Surgery: Up to 25% off for vision laser surgery. Laser surgery is not an insured benefit. The surgery is available at a discounted fee. The covered person must pay the entire discounted fee. In addition, the laser surgery discount may not be available in all states.
Guardian’s Vision Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. This policy provides vision care limited benefits health insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. Plan documents are the final arbiter of coverage. Policy Form # GP-1-GVSN-17
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/2020 11 ALL ELIGIBLE EMPLOYEES Group number: 00582591
Watch our video How life insurance protects families and covers critical costs.
Life insurance If something happens to you, life insurance can help your family reduce financial stress. Life insurance helps protect your family’s finances by providing a cash benefit if you pass away. This ensures that they’ll be financially supported, and can cover important things from bills to funeral costs. With life policies, you can get affordable life insurance protection for a set period of time.
Who is it for?
Preparing and planning Jorge’s never considered purchasing life insurance, but after being offered it through work, he decides it’s a smart way to protect his family.
Jorge has a mortgage, and because his wife is helping to take care of her mother, she only works part-time. In addition, his daughter is about to start college.
Everyone’s life insurance needs are different, depending on their family situation. That’s why group life insurance through an employer is an easier and more affordable option than individual life insurance.
Jorge looks at how his family would be affected by losing him.
What does it cover?
Average mortgage debt: $202,000
Life insurance protects your loved ones by providing a benefit (which is usually tax-exempt) if you pass away.
Average cost of college: $17,000 $44,000
Why should I consider it?
Average household credit card debt: $8,500
Life insurance is about more than just covering expenses. Depending on your circumstances, it could take your family years to recover from the loss of your income.
With life insurance, Jorge can make sure that part of these costs are covered if something happens to him.
With a life insurance benefit, your family will have extra money to cover mortgage and rent payments, legal or medical fees, childcare, tuition, and any outstanding debts.
Guardian, its subsidiaries, agents, and employees do not provide tax, legal, or accounting advice. Consult your tax, legal, or accounting professional regarding your individual situation.
Average funeral cost: $9,000
This example is for illustrative purposes only. Your plan’s coverage may vary. See your plan’s information on the following pages for specific amounts and details.
You will receive these benefits if you meet the conditions listed in the policy.
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/2020 13 ALL ELIGIBLE EMPLOYEES Group number: 00582591 2020-104318 (07/22)
Your life coverage BASIC LIFE Employee Benefit
Your employer provides $15,000 Basic Term Life coverage for all full time employees.
Accidental Death and Dismemberment
Your Basic Life coverage includes Enhanced Accidental Death and Dismemberment coverage.
Guarantee Issue: The ‘guarantee’ means you are not required to answer health questions to qualify for coverage up to and including the specified amount, when you sign up for coverage during the initial enrollment period.
Guarantee Issue coverage up to $15,000 per employee
Premiums
Covered by your company if you meet eligibility requirements
Portability: Allows you to take coverage with you if you terminate employment.
Yes, with age and other restrictions
Conversion: Allows you to continue your coverage after your group plan has terminated.
Yes, with restrictions; see certificate of benefits
Waiver of Premiums: Premium will not need to be paid if you are totally disabled.
For employees disabled prior to age 60, with premiums waived until age 65, if conditions are met
Benefit Reductions: Benefits are reduced by a certain percentage as an employee ages.
35% at age 65, 50% at age 70
Subject to coverage limits
LIMITATIONS AND EXCLUSIONS:
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/2020 14 ALL ELIGIBLE EMPLOYEES Group number: 00582591
Your life coverage A SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS FOR LIFE AND AD&D COVERAGE: You must be working full-time on the effective date of your coverage; otherwise, your coverage becomes effective after you have completed a specific waiting period. Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment: (a) exceeding one year; or (b) in an area under travel warning by the US Department of State. Subject to state specific variations. Evidence of Insurability is required on all late enrollees. This coverage will not be effective until approved by a Guardian underwriter. This proposal is hedged subject to satisfactory financial evaluation. Please refer to certificate of coverage for full plan description.
undeclared act of war or armed aggression; while a member of any armed force (May vary by state); while driving a motor vehicle without a current, valid driver’s license; by legal intoxication; or by voluntarily using a non-prescription controlled substance. Contract #GP-1-R-ADCL1-00 et al. We won't pay more than 100% of the Insurance amount for all losses due to the same accident, except as stated. The loss must occur within a specific period of time of the accident. Please see contract for specific definition; definition of loss may vary depending on the benefit payable. GP-1-R-LB-90 Enhanced AD&D: A loss may be defined as death, quadriplegia, loss of speech and hearing, loss of cognitive function, comatose state in excess of one month, hemiplegia or paraplegia. The loss must occur within a specific period of time of the accident. Please see contract for specific definition; definition of loss may vary depending on the benefit payable.
For AD&D: We pay no benefits for any loss caused: by willful self-injury; sickness, disease or medical treatment; by participating in a civil disorder or committing a felony; Traveling on any type of aircraft while having duties er on that aircraft; by declared or
Guardian Group Life Insurance underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage. Policy Form # GP-1-LIFE-15
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefits as of 12/10/2020 15 ALL ELIGIBLE EMPLOYEES Group number: 00582591
Watch our video How Guardian can help with college tuition.
College Tuition Benefit Program Get closer to your college savings goals by earning valuable rewards that can help you pay for a loved one’s tuition. Paying for college is one of the most significant financial goals families face. That can mean decades of saving, but Guardian is able to help. Our College Tuition Benefit Program gives you reward-based points when you sign up for a plan – helping you save and reduce the cost of tuition.
How it works
Every reward point equals $1 off the cost of full tuition
To set up your SAGE Scholars Tuition Rewards account, you’ll need a few personal details.
User ID Your Guardian Group Plan Number Password Guardian There are two important deadlines that must be met to utilize rewards points:
You’ll earn 2,000 points annually, per line of qualifying Guardian coverage purchased*
Every student on your account starts with 500 reward points
Tuition Reward points can be used at over 400+ four-year undergraduate colleges and universities across the U.S. that are in the SAGE network. Plus, Guardian dental members earn an extra 2,500 points after the fourth year.
This service is only available if you purchase qualifying lines of coverage. See your plan administrator for more details. *
How to sign up
Except for Guardian Davis Vision Plan Rewards, which are provided by Davis Vision.
The Tuition Rewards program is provided by SAGE CTB, LLC. Guardian does not provide any services related to this program. SAGE CTB, LLC is not a subsidiary or an affiliate of Guardian. Guardian reserves the right to discontinue the College Tuition Benefit program at any time without notice. The College Tuition Benefit is not an insurance benefit and may not be available in all states. Group insurance coverage is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states.
1. Adding Students and Pledging Tuition Rewards: Students must be registered by the member by August 31 of the year when the student begins 12th grade. The last day for pledging earned Tuition Rewards to a student is August 31 of the year the student begins 12th grade. This is also the last day for a student to earn any Student Tuition Rewards from any source. 2. Submitting Student Tuition Rewards to member schools: Using the college and university list available in the member’s account, the member must submit a Tuition Rewards statement to any member school(s) a registered student applies to within ten days of the application being submitted.
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America © Copyright 2020 The Guardian Life Insurance Company of America
16 2020-104974 (07/22)
Employee Assistance Program We all need a little support every now and then.
How to access
Guardian’s Employee Assistance Program gives you and your family members access to confidential personal support, across everything from stress management and nutrition to handling legal or financial issues.
To access the WorkLifeMatters Employee Assistance Program, you’ll need a few personal details.
Visit ibhworklife.com
The services available include consultations with experts, as well as access to resources and discounts designed to help you in a variety of different ways.
User ID Matters
How it can help
Password wlm70101
Consultative services are available to provide direct support and assistance
Work/life assistance that can help you save money and balance commitments
Access legal and financial assistance and resources – including WillPrep Services
For more information or support, you can reach out by phoning 1800 386 7055. The team is available 24 hours a day, 7 days a week1.
This service is only available if you purchase qualifying lines of coverage. See your plan administrator for more details. WorkLifeMatters Program services are provided by Integrated Behavioral Health, Inc., and its contractors. Guardian does not provide any part of WorkLifeMatters program services. Guardian is not responsible or liable for care or advice given by any provider or resource under the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide the actual terms, services, limitations and exclusions. Guardian and IBH reserve the right to discontinue the WorkLifeMatters program at any time without notice. Legal services provided through WorkLifeMatters will not be provided in connection with or preparation for any action against Guardian, IBH, or your employer. WorkLifeMatters Program is not an insurance benefit and may not be available in all states. Office hours: Monday-Friday 6 a.m.–5 p.m. PST.
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GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America © Copyright 2020 The Guardian Life Insurance Company of America
18 2020-105962 (03/21)
Our commitment to you Please read the documentation referenced below carefully. The notices are intended to provide you important information about our insurance offerings and to protect your interests. Certain ones are required by law. the
Important information Notice Informing Individuals about Nondiscrimination and Accessibility Requirements Guardian notice stating that it complies with applicable Federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, sex, or actual or perceived gender identity. The notice provides contact information for filing a nondiscrimination grievance. It also provides contact information for access to free aids and services by disabled people to assist in communications with Guardian. Visit https://www.guardiananytime.com/notice48 to read more.
No Cost Language Services Guardian provides language assistance in multiple languages for members who have limited English proficiency. Visit https://www.guardiananytime.com/notice46 to read more.
Vision insurance Guardian's HIPAA Notice of Privacy Practices The notice describes how health information about you may be used and disclosed and how you can access this information. Visit https://www.guardiananytime.com/notice50 to read more. the man
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Capital Accounting PC Your benefit as of 12/10/2020 19 ALL ELIGIBLE EMPLOYEES Group number: 00582591