Applied Technology Group - 2021 Employee Benefits Guide FINAL

2021 BENEFITS
ENROLLMENT GUIDE
Applied Technology Group, Inc.
Effective 11/1/2021 to 10/31/2022

CONTENTS
04
07
08
10
12
15
18
22
27
29
32
34
35
Benefits Overview
Open Enrollment Instructions
Medical Insurance
Telemedicine / Virtual Visits
Flexible Spending Accounts
Dental & Vision Insurance
Group and Voluntary Life and AD&D Insurance
Short Term & Long Term Disability Insurance
Accident Insurance
Cancer Insurance
Critical Illness Insurance
Hospital Indemnity Insurance
Important Contacts

BENEFITS
OVERVIEW
4

BENEFITS OVERVIEW
ENROLLMENT
You can enroll in benefits or change your elections at the following times:
• 30 days prior to your initial eligibility date (as a newly hired employee)
• During the annual benefits open enrollment period
• Within 30 days of experiencing a qualifying life event
BENEFIT OPTIONS
We offer a comprehensive benefits package consisting of:
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Medical Insurance
Flexible Spending Account
Dental Insurance
Vision Insurance
Group Life and Accidental Death & Dismemberment Insurance
Voluntary Life Insurance
Short Term & Long Term Disability Insurance
Accident Insurance
Cancer Insurance
Critical Illness Insurance
Hospital Indemnity Insurance
5

BENEFITS OVERVIEW
ELIGIBILITY
Full-time employees working at least 30 hours per week are eligible for
benefits on the first of the month following 30 days of employment. Many of
the plans offer coverage for eligible dependents, including:
• Your legal spouse
• Your children to age 26, regardless of student, marital, or tax-dependent
status (including stepchild, legally adopted child, a child placed with you for
adoption, or a child for whom you are the legal guardian)
• Your dependent children over age 26 who are physically or mentally unable
to care for themselves
CHANGING BENEFITS AFTER OPEN ENROLLMENT
You may pay your portion of your select coverages and the Flexible Spending
Accounts on a pre-tax basis. Thus, due to IRS regulations, once you have made
your elections for the plan year, you cannot change your benefits until the next
annual open enrollment period. The only exception is if you experience a
qualifying event, and election changes must be consistent with your life event.
To request a benefits change, notify Human Resources within 30 days of the
qualifying life event. Change requests submitted after 30 days cannot be
accepted. You may need to provide proof of the life event.
Qualifying life events include, but are not limited to:
• Marriage, divorce, or legal separation
• Birth or adoption of an eligible child
• Death of your spouse or covered child
• Change in your spouse’s work status that affects his or her benefits
• Change in your child’s eligibility for benefits
• Qualified Medical Child Support Order
6

ENROLLMENT INSTRUCTIONS
During the Employee Benefits Enrollment process, a representative will cover the extensive benefits
package that Applied Technology Group offers eligible employees, including Medical/Dental/Vision
Insurance, Short-Term and Long-Term Disability Insurance, Group Life and Voluntary Life Insurance,
and so much more!
STEP 4: Before beginning your enrollment process,
please make sure to visit the “Documents” section to
view your plan benefit summaries.
STEP 5: Before beginning your enrollment process, please make sure to visit the “Documents” section to
view your plan benefit summaries.
STEP 6: You are ready to make your benefit elections! Please select the ‘Start Enrollment’ button. The
system will guide you through the process when you select ‘Save & Continue’ on every screen.
Note: IF you are covering a spouse and /or child, please have their full name, DOB, and SSN available.
STEP 7: Click the “Click to Sign” button to complete your enrollment.
STEP 1: Go to the following link to create an account
as an employee:
https://www.employeenavitagor.com/benefits/Login/Re
gistration.aspx
STEP 2: You will be asked for personal identifying
data as well as the following company identifier:
ATGUSA
STEP 3: Write down the username and password you
created for future reference.
If you have any questions please contact your BXSI Account Representative, Rian Baker at
479-271-4380 or rian.baker@bxsi.com.
REMEMBER: Open Enrollment must be completed by the deadline or you
may not be able to enroll yourself and/or your eligible dependents until our next open
enrollment, or a qualifying event occurs.
This summary of benefits is not intended to be a complete description of the terms of Applied Technology Group, Inc. dba ATG USA’s insurance benefit
plans. Please refer to the plan document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document,
rather than by this or any other summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan
and the official document, the official document will prevail. Although Applied Technology Group, Inc. dba ATG USA maintains its benefit plans on an
ongoing basis, Applied Technology Group, Inc. dba ATG USA reserves the right to terminate or amend each plan, in its entirety or in any part at any time.
7

MEDICAL
INSURANCE
8

MEDICAL INSURANCE
CARRIER: Cigna
Plan Option: PPO Plan
Please refer to the official Plan Benefit Summary for additional information on coverage and exclusions.
COVERED BENEFITS
PPO Plan
In-Network
Out-of-Network
Year Deductible
Individual $1,000 $2,000
Family $3,000 $6,000
Out of Pocket Maximum
Individual $2,500 $5,000
Family $5,000 $10,000
Coinsurance (Plan Pays) 80% 60%
Preventive Care Plan pays 100% 40% coinsurance
Physician Services
Primary Care $20 copay 40% after deductible
Virtual Visit $10 copay Not Applicable
Specialist $35 copay 40% after deductible
Urgent Care $50 copay $100 copay
Emergency Room $100 copay $100 copay
Lab / X-Ray
Diagnostic Lab/X-Ray 20% after deductible 40% after deductible
High-Tech Services (MRI, CT, PET) 20% after deductible 40% after deductible
Hospital Services
Inpatient 20% after deductible 40% after deductible
Outpatient 20% after deductible 40% after deductible
Prescription Drugs
Tier 1 $10 copay 20% after deductible
Tier 2 $35 copay 20% after deductible
Tier 3 $60 copay 20% after deductible
MEDICAL RATES COVERAGE LEVEL SEMI-MONTHLY COST (24)
Employee Only $32.26
EE & Spouse $198.70
EE & Child(ren) $147.20
EE & Family $274.39
9

TELEMEDICINE
/VIRTUAL VISITS
10

TELEMEDICINE / VIRTUAL VISITS
When it comes to healthcare, access is
important. You want care that is
convenient, high-quality and low-cost.
But depending on your condition,
going to your personal physician or
an urgent care clinic might not be
your best option. We are proud to
offer telemedicine / virtual visits.
TREATED THROUGH TELEMEDICINE
Allergies
Cold & Flu Symptoms
Cough
Ear Infection
Pink Eye
Prescription Refills
Respiratory Infection
Sinus Problems / Nasal Congestion
Urinary Tract Infection
And more!
NOT TREATED THROUGH TELEMEDICINE
Sprains, broken bones or injuries requiring bandaging
Anything that needs a hands-on exam
Anything that needs a lab test or X-ray
Chronic conditions
Visit
www.myCigna.com or call MDLIVE at 888-726-3171.
COST
$10.00
11

FLEXIBLE
SPENDING
ACCOUNTS
12

FLEXIBLE SPENDING ACCOUNTS
CARRIER: Consolidated Admin Services
Applied Technology Group, Inc. offers two Flexible Spending Account (FSA) options – the
Health Care FSA and the Dependent Care FSA – that allow you to pay for eligible health care
and dependent care expenses with the pre-tax dollars.
Log into your account at www.consolidatedadmin.com to view your account balance(s),
calculate tax savings, view eligible expenses, download forms, view transaction history, and
more.
HEALTH CARE FSA
• Set aside pre-tax money from your paycheck to pay for eligible out-of-pocket expenses, such
as deductibles, copays, and other health-related expenses, that are not paid by the medical,
dental, or vision plans.
• Over-the-counter (OTC) medications are eligible for reimbursement without a prescription.
DEPENDENT CARE FSA
• Set aside pre-tax money from your paycheck for daycare expense to allow you and your
spouse to work or attend school full time.
• Eligible dependents are children under age 13 or a child over 13, spouse, or elderly parent
residing in your house who is physically or mentally unable to care for himself or herself.
• Examples of eligible expenses are daycare facility fees, before and after-school care, and
in-home babysitting fees (income must be reported by your care provider).
HEALTH CARE FSA
$2,750
DEPENDENT CARE FSA
$5,000
$2,500
married filing jointly or
single/head of household
married filing separately
13

FLEXIBLE SPENDING ACCOUNTS
CARRIER: Consolidated Admin Services
HOW DOES AN FSA WORK?
You decide how much to contribute to each FSA on a plan year basis up to the maximum allowable
amounts. Your annual election will be divided by the number of pay periods and deducted evenly on
a pre-tax basis from each paycheck throughout the year.
You will receive a debit card from Consolidated Admin Services, which can be used to pay for eligible
health care expenses at the point of service. If you do not use your debit card or if you have
dependent care expenses to be reimbursed, submit a claim form and a bill or itemized receipt from
the provider to Consolidated Admin Services Keep all receipts in case Consolidated Admin Services
requires you to verify the eligibility of a purchase.
THINGS TO CONSIDER
• Both Health Care and Dependent Care FSA dollars are use it or lose it.
• However, you have an additional two and a half months to incur and be reimbursed for expenses
after the end of the plan year.
• You cannot take income tax deductions for expenses you pay with your FSA(s)
• You cannot stop or change your FSA contribution(s) during the plan year unless you experience a
qualifying life event.
SPECIAL FSA ACCOUNT FEATURES
GRACE PERIOD
The grace period is 2 months
+ 15 days after the end of
the plan year during which
you may incur new expenses
but be reimbursed with last
year’s FSA funds.
ROLLOVER
You have the ability to
roll over up to $500
from one plan year to
the next.
14

DENTAL
& VISION
INSURANCE
15

DENTAL INSURANCE
CARRIER: Delta Dental
● You will pay less out of pocket when you choose an in-network provider.
● Locate an in-network provider at www.deltadentalar.com.
● Be sure to ask for a pre-treatment estimate.
● Out-of-network providers can balance bill, or bill you for the difference between
the provider’s charge and the allowed amount.
DENTAL
ELECTION
SEMI-MONTHLY
COST (24)
Employee Only $2.69
Employee & Spouse $20.33
Employee & Child(ren) $19.98
Employee & Family $40.85
Deductible (per calendar year)
COVERED BENEFITS
PLAN PAYS
$50 per person, 3 per family
Annual Plan Benefit Maximum
Preventive Care
Oral exams, cleanings, X-rays, sealants
Basic Services
Fillings, oral surgery, root canal, simple extractions, space maintainers
Major Services
Periodontics, crowns, inlays, onlays, prosthodontics
$1,000 per covered member
100%
80%
50%
Carryover Benefit $250
Annual Maximum Carryover $1,000
16

VISION INSURANCE
CARRIER: VSP
● You will pay less out of pocket when you choose an in-network provider.
● Locate an in-network provider at www.vsp.com.
● You must submit a claim form for out-of-network expenses.
● LASIK surgery discounts available
VISION
ELECTION
SEMI-MONTHLY
COST (24)
Employee Only $1.10
Employee & Spouse $4.22
Employee & Child(ren) $4.95
Employee & Family $10.63
COVERED BENEFITS
IN-NETWORK
Eye Exam (every 12 months)
$10 copay
Standard Plastic Lenses (every 12 months)
$10 copay
Frames (every 12 months)
$180 allowance
Contact Lenses, in lieu of glasses (every 12 months)
Elective
Medically Necessary
$180 allowance
Plan Pays 100%
*Call Member Services for for out-of-network plan details.
17

GROUP LIFE &
VOLUNTARY LIFE
18

GROUP LIFE INSURANCE
CARRIER: USAble Life
LIFE and ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)
Basic Life and AD&D Insurance are automatically provided to all benefits-eligible employees at
no cost. If you die as a result of an accident, your beneficiary would receive both the Life and the
AD&D benefit.
● Life Insurance Amount: $25,000
● AD&D Amount: Equal to Life Insurance amount
● Benefit Reduction Schedule: 35% at age 65 and 50% at age 70
VOLUNTARY LIFE INSURANCE
CARRIER: USAble Life
WHAT IS VOLUNTARY LIFE INSURANCE? Voluntary Life Insurance is offered
through an employer but is paid by employees.
WHY PURCHASE VOLUNTARY LIFE INSURANCE?
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This type of Life Insurance has limited underwriting required. This allows for people with
health conditions or lifestyles that might otherwise disqualify them to qualify for Life
Insurance.
The group rates are lower than what you could purchase on your own.
You may purchase a policy for your spouse and children.
You may purchase a policy for your spouse and children IF you elect coverage for yourself.
REMINDER
Review your beneficiary designations
19

VOLUNTARY LIFE INSURANCE
CARRIER: USAble Life
Employee
● $10,000 increments to a maximum of the lesser of 5x salary or $500,000
● A minimum benefit of $10,000
● Guarantee Issue Amount: $120,000
● Age Reduction: by 35% at age 65, 50% at age 70
● AD&D amount is 100% of supplemental life benefit amount
Spouse
● $5,000 increments to a maximum of $100,000, not to exceed 50% of employee’s life amount
● A minimum benefit of $5,000
● Guarantee Issue Amount: $30,000
● Age Reduction: by 35% at age 65, 50% at age 70
● AD&D amount is 100% of supplemental life benefit amount
Child(ren)
● Child birth to 6 months old: $1,000
● Child more than 6 months old: $5,000 or $10,000
● Guarantee Issue Amount: $10,000
REMINDER
Review your beneficiary designations
20

VOLUNTARY LIFE INSURANCE
CARRIER: USAble Life
REMINDER
Review your beneficiary designations
21

DISABILITY
INSURANCE
22

SHORT TERM DISABILITY INSURANCE
CARRIER: USAble Life
Short-Term Disability (STD) Insurance is designed to help you meet your financial
needs if you become unable to work due to a non-work related illness or injury.
This is a voluntary plan; employees are responsible for 100% of the cost.
Premiums are calculated as a percentage of your annual base salary.
• Benefit Amount: $10 increment up to the lesser of $1,000 or 60% of base
weekly earnings
• Minimum Benefit Amount: $100
• Elimination Period: 8 days Accident/8 days Illness
• Benefit Durations: up to 26 weeks
• Pre-Existing Condition Waiting Period: 3/12
23

LONG TERM DISABILITY INSURANCE
CARRIER: USAble Life
Long-Term Disability (LTD) Insurance is designed to help you meet your financial
needs during longer disability periods. This is a voluntary plan; employees are
responsible for 100% of the cost. Premiums are calculated as a percentage of
your annual base salary.
• Benefit Amount: $100 increments up to the lesser of $5,000 or 60% of basic
monthly earnings
• Elimination Period: 180 days
• Benefit Duration: Until Social Security Normal Retirement Age
• Pre-Existing Condition Waiting Period: 12/6/24
24

LONG TERM DISABILITY INSURANCE
CARRIER: USAble Life
25

ADDITIONAL
VOLUNTARY
BENEFITS
26

VOLUNTARY ACCIDENT INSURANCE
CARRIER: USAble Life
Accident Insurance supplements your existing medical insurance in case you are have an accident;
medical insurance alone may not be enough to cover your expenses. The plan pays a cash benefit
during the term of your coverage following a covered accident.
COVERAGE & OPTIONS
ACCIDENT TREATMENT BASIC SELECT ULTRA
Physician Office Visit (per visit, up to 2 visits) $125 $150 $225
Emergency Treatment $125 $150 $225
Emergency Dental (crown) $250 $300 $450
Major Diagnostic Exam $200 $240 $360
Lacerations $450 $540 $810
Burns Up to $2,500 Up to $3,000 Up to $4,500
Eye Injury (surgical repair) $200 $240 $360
Brain Injury $500 $600 $900
Dislocation (examples, open)
Hip $2,750 $3,300 $4,950
Knee or Shoulder $600 $720 $1,080
Toe or Finger $125 $150 $225
Fractures (examples, open)
Hip $2,750 $3,300 $4,950
Leg $1,200 $1,440 $2,160
Nose, Heel, or Finger(s) $600 $720 $1,080
HOSPITAL CARE BASIC SELECT ULTRA
Initial Hospitalization $1,000 $1,200 $1,600
Hospital Confinement (per day, up to 365 days) $250 $250 $250
Hospital ICU (per day, up to 15 days) $500 $500 $500
Surgery (reparation of internal injuries) $1,250 $1,500 $2,000
Ambulance (air/ground) $1,250/$200 $1,500/$240 $2,000/$320
Blood, Plasma, Platelets $200 $240 $320
FOLLOW-UP BASIC SELECT ULTRA
Physician Follow-up (per visit, up to 6 visits) $50 $70 $80
Physical Therapy (per visit, up to 6 visits) $100 $140 $160
Rehabilitation Unit (per day, up to 30 days) $125 $175 $200
Appliance (for locomotion) $100 $140 $160
Prosthetic Device (per device, up to 2 devices) $375 $525 $600
Family Lodging (per day, up to 30 days) $100 $150 $175
Transportation (per round trip, up to 5 round trips) $400 $600 $700
Post Transportation $200 $300 $350
27

VOLUNTARY ACCIDENT INSURANCE
CARRIER: USAble Life
COVERAGE & OPTIONS
SURGERY BASIC SELECT ULTRA
Tendon/Ligament $500 $600 $800
Torn Knee (surgical repair) $500 $600 $800
Ruptured Disc $500 $600 $800
Torn Rotator Cuff $500 $600 $800
WELLNESS BENEFIT BASIC SELECT ULTRA
Annual benefit amount $60 $75 $105
OPTIONAL RIDERS
OPTION 1 EMPLOYEE SPOUSE CHILD
Common Carrier Accidental Death $75,000 $75,000 $18,750
Other Accidental Death $50,000 $50,000 $6,250
OPTION 2 EMPLOYEE SPOUSE CHILD
Common Carrier Accidental Death $150,000 $150,000 $37,500
Other Accidental Death $100,000 $100,000 $12,500
This Rider also provides benefits for:
● Accidental Dismemberment
● Child Education
● Paralysis
● Coma
● Child Care Center
● Repatriation
● Spouse’s Training
● Additional benefits if a seatbelt is worn or
airbag deployed at the time of accidental
death
Semi-Monthly Rates
NO RIDERS BASIC SELECT ULTRA
Employee $5.87 $6.93 $8.70
Employee + Spouse $11.20 $26.42 $16.62
1 Parent Family $12.35 $13.21 $18.73
2 Parent Family $17.68 $21.07 $26.65
28

VOLUNTARY CANCER INSURANCE
CARRIER: TransAmerica
Cancer Insurance supplements your existing
medical insurance in case you are diagnosed
with cancer; medical insurance alone may
not be enough to cover your expenses. The
plan pays a cash benefit during the term of
your coverage following a positive diagnosis
of an internal cancer.
WHY PURCHASE CANCER
INSURANCE?
You and your loved ones can rest a little
easier knowing you have protection in place
to help avoid depleting your bank accounts
or taking on additional debt to cover
day-to-day living expenses.
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Help cover medical plan deductibles, co-pays and other out-of-pocket costs
Help cover everyday living expenses such as groceries, rent and mortgage payments
Hire extra help for around the house, such as in-home caregivers
Pay for travel to treatment facilities away from home as well as family visits
Hospital Benefits
Plan Option 1 -
1.00 Units
Plan Option 2 -
1.00 Units
Policy Pays
Hospital Confinement $100 $100 per day of covered confinement
Extended Benefits $200 $200
Attending Physician $20 $20
per day; begins on day 91 of continuous confinement; in
lieu of all other benefits (except surgery and anesthesia)
per day while hospital confined; one visit per 24-hour
period
Inpatient Drugs and Medicines $15 $15 per day while hospital confined
Private Duty Nurse $100 $100
Ambulance $100 $100
Extended Care Facility $100 $100
per day while hospital confined; must be authorized by the
attending physician; cannot be hospital staff or a family
member
for service by a licensed ambulance service for
transportation to a hospital; admittance required
per day; up to the number of days for the prior hospital
stay; admittance must be within 14 days of hospital
discharge
Government or Charity Hospital $100 $100 per day of covered confinement; in lieu of all other benefits
Hospice Care $100 $100
per day of hospice care; 100-day lifetime maximum; not
payable while hospital confined
29

VOLUNTARY CANCER INSURANCE
CARRIER: TransAmerica
Surgery Benefits
Plan Option 1 -
1.00 Units
Plan Option 2 -
5.00 Units
Policy Pays
Inpatient $1,000 $5,000
maximum benefit; actual benefit is determined by the
surgery schedule in the contract; for multiple procedures in
Surgery
same incision only the highest benefit is paid; for multiple
Outpatient $1,500 $7,500 procedures in separate incisions will pay highest benefit
and then 50% for each lesser procedure
Anesthesia 25% 25% of covered surgery benefit
Prosthesis $500 $2,500
maximum benefit; pays actual charges per device requiring
implantation
Hair Prosthesis $50 $250
maximum benefit; pays actual charges for wig to cover hair
loss from cancer treatment
Breast Cancer –
simple or total
$120 $600
mastectomy
Breast Cancer –
$170 $850
radical mastectomy
for reconstructive surgery within 2 years of the initial
Reconstructive
cancer removal; excludes skin cancer and malignant
Surgery Cancers of the
melanoma; benefit not payable if paid under any other
male or female
$170 $850 provision of the policy
genitalia
Cancer of the head,
neck, or oral
$250 $1,250
cancers
Second Surgical Opinion $100 $500 when surgery is prescribed; excludes skin cancer
Ambulatory Surgical Center $150 $750
maximum per day; pays actual charges for outpatient
surgery at an ambulatory surgical center
Skin Cancer
One removal $75 $375
for removal of skin cancer (skin cancer does not include
Per additional
$35 $175 malignant melanoma or mycosis fungoides)
removal
Radiation and Chemotherapy Plan Option 1 - Plan Option 2 -
Benefits
2.00 Units 4.00 Units
Policy Pays
Radiation and Chemotherapy $10,000 $20,000
maximum benefit per 12-month period; pays actual
charges
Associated Radiation & Chemo
Expenses
Blood, Plasma, Blood Components,
Bone Marrow and Stem Cell
Transplant
$500 $1,000
$10,000 $20,000
Associated Blood & Plasma
Expenses $500 $1,000
New or Experimental Treatment $10,000 $20,000
maximum benefit per 12-month period; pays actual
charges for treatment consultations and planning,
adjunctive therapy, radiation management, chemotherapy
administration, physical exams, checkups, and laboratory or
diagnostic tests; transportation and lodging are not
included as associated expenses
maximum benefit per 12-month period; pays actual
charges
maximum benefit per 12-month period; pays actual
charges for administration of blood, plasma and blood
components, transfusions, processing and procurement, or
cross-matching, treatment consultations and planning,
physical exams, checkups, and laboratory or diagnostic
tests; transportation and lodging are not included as
associated expenses
maximum benefit per 12-month period; pays actual
charges for drugs or chemical substances approved by the
FDA for experimental use on humans or surgery or therapy
endorsed by either the NCI or ACS for experimental studies
received in the US or its territories
30

VOLUNTARY CANCER INSURANCE
CARRIER: TransAmerica
Wellness & Non-Medical Benefits
Plan Option 1 -
2.00 Units
Annual Cancer Screening $100 $100
Magnetic Resonance Imaging (MRI)
Scan
$100 $100
Non-Local Transportation Included Included
Family Member Lodging $100 $100
Outpatient Lodging $100 $100
Plan Option 2
Policy Pays
- 2.00 Units
per calendar year for cancer screening tests:
● mammogram pap smear
● flexible sigmoidoscopy prostate-specific antigen test
● chest x-ray
● hemocult stool specimen ultrasound
● CEA CA125
● biopsy thermography colonoscopy serum protein
electrophoresis
● bone marrow testing blood screening
per calendar year for MRI scan used as diagnostic tool for breast
cancer
round-trip charges or private vehicle allowance, up to 750 miles
at $0.40 per mile, when required non-local hospital confinement
is more than 50 miles from residence for an insured person and
an adult immediate family member during confinement; payable
once per confinement
per day (maximum 50 days per 12 month period) for lodging
expenses for an adult immediate family member when non-local
hospital confinement is required
per day (maximum 50 days per 12 month period) for lodging
expenses for an insured person to receive radiation or
chemotherapy on an outpatient basis if not available locally
Physical Therapy & Speech Therapy $50 $50 per treatment; limit one treatment per day
At-Home Nursing $100 $100
per day, up to the number of days of the prior hospital stay when
admitted within 14 days of hospital discharge
Waiver of Premium included included
waives premium for total disability due to cancer after 60
consecutive days of total disability; total disability must begin
prior to the insured person's 70th birthday
Cancer Maintenance Therapy Plan Option 1 - Plan Option 2
Policy Pays
Benefit
1.00 Units - 1.00 Units
● Cancer Suppressive Therapy
● Hematological Drugs
● Anti-Nausea Drugs
$1,000 $1,000 maximum benefit per 12-month period; pays actual charges
● Motility Agents
First Occurrence Rider (Rider Form Plan Option 1 - Plan Option 2
Policy Pays
Ceries CROCC100, 200 or 300) 2.00 Units - 5.00 Units
pays a one-time, lump-sum benefit when an insured person is
initially diagnosed with cancer for the first time ever after the
Initial Diagnosis Benefit $2,000 $5,000
effective date of insurance (except skin cancer), based on a
microscopic examination of fixed tissue or preparations from the
hemic system. Clinical diagnosis is accepted under certain
conditions.
Voluntary Cancer
Rates
ELECTION
PLAN OPTION 1
Semi-Monthly Rate
PLAN OPTION 2
Semi-Monthly Rate
Individual $9.24 $17.67
Single Parent Family $10.69 $19.96
Family $17.04 $31.81
31

VOLUNTARY CRITICAL ILLNESS
INSURANCE
CARRIER: USAble Life
Critical Illness + Cancer Insurance supplements your existing
medical insurance in case you are diagnosed with a covered
condition, like a heart attack, stroke or cancer; medical
insurance alone may not be enough to cover your expenses.
The plan pays a cash benefit during the term of your
coverage following a covered diagnosis.
COVERAGE & OPTIONS
COVERAGE
PERCENTAGE OF POLICY AMOUNT
Cancer Diagnosis 100%
Heart Attack/Stroke 100%
Bone Marrow Transplant 100%
Major Organ Transplant 100%
End-Stage Renal Failure 100%
Burns (third degree, over at least 50% of body) 100%
Specified Diseases: ALS (Lou Gehrig’s Disease); anthrax; Cholera;
Encephalitis; Meningitis; Rocky Mountain Spotted and Typhoid
Fevers; Tuberculosis; Primary Sclerosing Cholangitis (Walter Payton’s
100%
Disease)
Prostate Cancer and/or Carcinoma In Situ 30%
Coronary Artery Bypass Surgery 30%
Alzheimer’s Disease 30%
Angioplasty/Stent 10%
Skin Cancer Diagnosis 10%
Cancer Vaccine
$75 lifetime, one-time payment
Cancer Treatment and Care
$50 month, up to 12 months
WELLNESS BENEFIT
To promote healthier routines, insured can receive an annual payment of $75 for having covered health
screenings and tests, such as a mammogram, Pap test, PSA (Prostate-Specific Antigen) test, and colonoscopy.
OPTIONAL RIDERS
QUALITY OF LIFE BENEFIT
If an illness causes an insured person to be unable to perform two or more of the five Activities of
Daily Living (as defined in the policy) unassisted, the insured will receive a 5% benefit per month up to 20
months while care and assistance is needed.
OCCUPATIONAL HIV BENEFIT
Adds 100% benefit that is payable if an employee contracts HIV on the job. (Not available for spouses or
dependents.) Availability of this benefit is limited to specific occupations and
industries.
32

VOLUNTARY CRITICAL ILLNESS
INSURANCE
CARRIER: USAble Life
EMPLOYEE Non-Tobacco
EMPLOYEE AGE $5,000 $10,000 $15,000 $20,000 $25,000 $50,000
Up to 29 $2.12 $2.86 $3.61 $4.36 $5.10 $8.83
30 - 39 $3.00 $4.58 $6.16 $7.74 $9.32 $17.23
40 - 49 $4.68 $7.85 $11.01 $14.17 $17.33 $33.14
50 - 59 $7.87 $14.01 $20.15 $26.29 $32.42 $63.12
60 - 69 $14.77 $27.41 $40.05 $52.70 $65.34 $128.55
EMPLOYEE Tobacco
EMPLOYEE AGE $5,000 $10,000 $15,000 $20,000 $25,000 $50,000
Up to 29 $3.26 $4.99 $6.71 $8.44 $10.16 $18.78
30 - 39 $5.46 $9.26 $13.05 $16.84 $20.63 $39.58
40 - 49 $9.67 $17.43 $25.18 $32.94 $40.69 $79.46
50 - 59 $17.42 $32.39 $47.37 $62.34 $77.32 $152.19
60 - 69 $32.51 $61.60 $90.68 $119.77 $148.86 $294.31
SPOUSE Non-Tobacco
SPOUSE AGE $5,000 $10,000 $15,000 $20,000 $25,000 $50,000
Up to 29 $2.09 $2.81 $3.53 $4.25 $4.97 $8.57
30 - 39 $2.95 $4.47 $6.00 $7.53 $9.06 $16.69
40 - 49 $4.62 $7.73 $10.84 $13.95 $17.05 $32.59
50 - 59 $7.86 $14.00 $20.14 $26.28 $32.42 $63.11
60 – 69 $14.76 $27.40 $40.05 $52.69 $65.33 $128.54
SPOUSE Tobacco
SPOUSE AGE $5,000 $10,000 $15,000 $20,000 $25,000 $50,000
Up to 29 $3.31 $5.08 $6.86 $8.63 $10.41 $19.28
30 - 39 $5.48 $9.30 $13.11 $16.93 $20.75 $39.83
40 - 49 $9.64 $17.37 $25.10 $32.82 $40.55 $79.19
50 - 59 $17.41 $32.38 $47.36 $62.33 $77.31 $152.18
60 - 69 $32.50 $61.59 $90.68 $119.77 $148.86 $294.30
CHILD(REN)
$5,000 $10,000
$0.65 $1.10
33

VOLUNTARY HOSPITAL INDEMNITY
INSURANCE
CARRIER: USAble Life
Hospital Indemnity Insurance helps protect your
finances if an unexpected hospital stay occurs and
those expenses are not covered by your health plan.
This benefit would pay in addition to any other
coverage(s) you may already have.
HIGHLIGHTS OF BASIC PLAN INCLUDE:
● Hospital Admission (10 per year): $750
● Hospital Confinement (10 per year: $150 per day
● Intensive Care Confinement: $225 per day, up to 15 days
● Ambulance-Air/Ground (3 per year): $750/$120
● Wellness Benefit: $30
BASIC PLAN Semi-Monthly Rates
AGE EMPLOYEE SPOUSE CHILD
Up to 49 $9.21 $9.14 $4.85
50 - 54 $13.45 $13.42 $4.25
55 - 59 $16.09 $15.98 $3.71
60 – 64 $19.79 $19.69 $3.23
HIGHLIGHTS OF ULTRA PLAN INCLUDE:
● Hospital Admission (10 per year): $1,500
● Hospital Confinement (10 per year: $300 per day
● Intensive Care Confinement: $450 per day, up to 15 days
● Ambulance-Air/Ground (3 per year): $1,500/$240
● Wellness Benefit: $30
ULTRA PLAN Semi-Monthly Rates
AGE EMPLOYEE SPOUSE CHILD
Up to 49 $17.91 $17.78 $9.70
50 - 54 $26.39 $26.33 $8.49
55 - 59 $31.67 $31.46 $7.41
60 – 64 $39.08 $38.87 $6.45
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IMPORTANT CONTACTS
BENEFIT CARRIER PHONE WEBSITE
Medical Insurance Cigna 800-997-1654 www.cigna.com
Flexible Spending Account
Consolidated Admin
Services
877-941-5956 www.consolidatedadmin.com
Dental Insurance Delta Dental 800-462-5410 www.deltadentalar.com
Vision Insurance VSP 800-877-7195 www.vsp.com
Group & Voluntary Life and AD&D USAble Life 800-370-5856 www.usablelife.com
Short Term & Long Term Disability
Insurance
USAble Life 800-370-5856 www.usablelife.com
Voluntary Cancer Insurance Transamerica 888-763-7474 www.transamerica.com
Voluntary Accident, Critical Illness &
Hospital Indemnity Insurance
Human Resources
USAble Life 800-370-5856 www.usablelife.com
Shelley Wilson
Danielle Bates
501-492-8640
501-492-8631
swilson@atgusa.com
dbates@atgusa.com
Please contact your
BXS Insurance Account Representative
with any questions!
Rian Baker
479-935-6630
Rian.baker@bxsi.com
35

Applied Technology Group, Inc.
501-492-8612