BRF Hospital Holdings - LSUHSC Medical Communications Home ...

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Long Term Disability - Mutual of Omaha Eligibility Maximum Monthly Benefit Maximum Benefit Duration Elimination Period Waiver of Premium Survivor Income Benefit You must be actively at work (able to perform all normal duties of your job) to be eligible for coverage. You have the option to elect either 40% or 60% of your monthly covered earnings to a maximum of $12,000 per month. The minimum benefit is $100. Benefits continue to normal social security retirement age while you remain disabled. 90 days - The number of days you must be disabled prior to collecting disability benefits. You will not be required to pay premiums during any time of approved total or partial disability. A 3 months survivor benefit may be paid to your beneficiary if you should die while receiving qualifying disability payments. Disability Partial Disability Continuation of Disability Pre-Existing Condition Benefit Exclusions Benefit Reductions Benefit Termination Portability Disability and disabled mean that because of an injury or illness, a significant change in your mental or functional abilities has occurred, for which you are prevented from performing at least one of the material duties of your regular job and are unable to generate current earnings which exceed 99% of your weekly earnings from your regular job. You can be totally or partially disabled during the elimination period. If you become disabled and can work part time (but not full time), you may be eligible for partial disability benefits, which will help supplement your income until you are able to return to work full time. If you return to work full time but become disabled from the same disability within six months of returning to work, you will begin receiving benefits again immediately. Any sickness or injury for which you have received medical treatment, consultation, care or services (including diagnostic measures or the taking of prescribed medications) during the 3 months prior to the coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full time basis for 12 months following the coverage effective date. You will not receive benefits in the following circumstances: Your disability is the result of a self-inflicted injury You were involved in a felony commission, act of war or participation in a riot * See certificate for full list of exclusions Your benefits may be reduced if you are receiving benefits from any of the following sources: Any compulsory benefit act or law (such as state disability plans) Any governmental retirement system earned as a result of working for the current policyholder Any disability or retirement benefit received under a retirement plan Any Social Security, or similar plan or act, benefits Earnings the insured earns or receives from any form of employment Workers compensation This coverage will terminate when you terminate employment with this policyholder or at your retirement. When you are no longer an eligible employee, you will have 31 days to port coverage, allowing you to continue this insurance until you are 70. Your benefit is based on your Salary. Calculate your Bi-Weekly deduction using the following examples (This example assumes a 40 hour work week): 40% of your Salary 60% of your Salary Hourly Pay Rate 20.00 20.00 Times 40 - weekly payroll 800.00 800.00 Times 52 / 12 3,466.67 3,466.67 Times 40% / 60% - monthly benefit 1,386.67 2,080.00 Times .0136 18.86 28.29 Times 12 / 26 to get your Bi-Weekly Deduction $8.70 $13.06 9 BRF Hospital Holdings 2013 - 2014 Benefits
Critical Illness - HM Life Covered Critical Illnesses Covered Critical Illness Myocardial Infarction (Heart Attack) Percentage of Face amount Covered Critical Illness 100% + Major Organ Transplant 100% Percentage of Face amount Coronary Artery Bypass 25% * End-stage Renal Disease (Kidney Disease) Stroke 100% Loss of Sight, Speech or Hearing 100% 100% * Invasive Cancer 100% + Coma 100% * Carcinoma in Situ 25 % * Paralysis 100% * Skin Cancer 10% * + Benefits paid for Carcinoma in Situ, Skin Cancer and Coronary Artery Bypass Surgery, reduce the benefit payable for subsequently diagnosed Invasive Cancer and Heart Attack, respectively. * Payable once per lifetime. Minimum benefit is $250. Plan Type & Age Guidelines Benefit Options Guarantee Issue Amount Healthy Screening Coverage Pays a lump sum for three types of diagnoses – initial, reoccurrence and additional covered occurrences Employee and Spouse may be covered from ages 18 to 69 years, benefits reduce by 50% at 70 Children up to age 26 Employee - $2,500 up to $100,000; Spouse – Up to 100% of employee amount to a max of $100,000; Children automatically get 25% of employee amount up to $20,000 at no additional cost Employee - $25,000; Spouse - 50% of employee amount $50 - One per covered individual per year. Benefit paid regardless of diagnosis or results of the test. First Occurrence – provides a lump sum payment when a covered critical illness is first diagnosed Reoccurrence – pays when a covered critical illness reoccurs. The reoccurrence must be separated from the initial diagnosis by at least 180 days (365 days treatment - free for cancer) or separated from another reoccurrence by at least 180 days (365 days treatment - free for cancer) Additional Occurrence – pays an additional benefit upon the diagnosis of a covered condition for which benefits previously have not been paid. The diagnosis must be separated from the other critical illness by at least 180 days Continuation of Coverage Employees continuously insured for at least 12 consecutive months under this plan or a prior plan may have the opportunity to continue their coverage. Pre-Existing Condition Limitation Issue Age No benefits will be provided for the first 12 months a person is covered under the policy for conditions for which medical advice or treatment was received or recommended during the 12 month period prior to the effective date of coverage. If elected, your Critical Illness deductions will not change from year to year; your deductions will remain the same throughout the life of your policy. Employee Issue Age Critical Illness Benefit Amounts & Bi-Weekly Deduction $2,500 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $50,000 $75,000 $100,000 18 - 24 $0.47 $0.70 $1.18 $1.65 $2.13 $2.60 $3.07 $4.97 $7.34 $9.55 25 - 29 $0.69 $1.06 $1.80 $2.54 $3.28 $4.02 $4.76 $7.71 $11.40 $14.93 30 - 34 $1.03 $1.61 $2.77 $3.93 $5.09 $6.25 $7.41 $12.05 $17.84 $23.47 35 - 39 $1.58 $2.54 $4.44 $6.35 $8.26 $10.17 $12.07 $19.70 $29.24 $38.61 40 - 44 $2.42 $3.98 $7.08 $10.18 $13.28 $16.39 $19.49 $31.90 $47.41 $62.76 45 - 49 $3.59 $5.99 $10.79 $15.58 $20.38 $25.17 $29.97 $49.15 $73.13 $96.94 50 - 54 $5.17 $8.74 $15.88 $23.03 $30.17 $37.32 $44.46 $73.04 $108.77 $144.32 55 - 59 $6.94 $11.92 $21.89 $31.86 $41.83 $51.80 $61.77 $101.65 $151.49 $201.17 60 - 64 $8.67 $15.09 $27.93 $40.77 $53.61 $66.45 $79.30 $130.66 $194.88 $258.92 65 - 69 $9.20 $16.20 $30.21 $44.21 $58.22 $72.22 $86.23 $142.25 $212.28 $282.15 Guarantee Issue - Employee Only BRF Hospital Holdings 2013 - 2014 Benefits 10
Page 1 and 2: BRF Hospital Holdings Benefit Guide
Page 3 and 4: Table of Contents and Contact Infor
Page 5 and 6: Benefits and Eligibility Qualifying
Page 7 and 8: Medical - BlueCross BlueShield Feat
Page 9 and 10: Vision - AlwaysCare EXAM covered ev
Page 11: Short Term Disability - Mutual of O
Page 15 and 16: Online Enrollment Instructions The

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