Page 15 - Great Circle 2021 Benefits Guide
P. 15
2021
Great Circle Benefits Enrollment
Critical Illness Accident Coverage
Critical illness coverage is designed to help you offset Accident coverage pays a beneit to you for a speciic
the inancial effects of a catastrophic illness with a covered accident to help you cover the healthcare
lump sum beneit if you or a loved one are diagnosed costs associated with that accident although you may
with a covered critical illness. The critical illness choose to spend your beneit however you would
beneit is based on the amount of coverage in effect like. A full list of covered accidents is available on the
on the date of diagnosis of a critical illness or the myCircle intranet under Beneits. We have included
date treatment is received according to the terms and a short example list in this guide. This coverage does
provisions of the policy. Employees have a maximum not cover work-related accidents and your premium is
beneit of $10,000, and spouses and children have determined when you enroll.
a maximum beneit of $5,000 each. This coverage
is based on age and tobacco usage. See the online Accident Beneit Beneit Amount
enrollment system for rates. Emergency Room $200
Urgent Care $200
Primary Care Physician $75
401(k) Ground Ambulance $400
You are immediately eligible to contribute to your 401(k) Air Ambulance $1,200
$1,500
Hospital Admission
plan. After one year of employment the plan matches up Hospital Coninement (per day) $300
to 6% of your contribution. After your 6th year you are ICU Coninement (per day) $600
100% vested in the matching dollars Great Circle provides. Broken Ankle $1,500
After 10 years of employment, the plan matches 167% of
a 6% contribution or approximately 10%. Broken Wrist $1,500
Broken Finger $200
You will enroll in this plan through the EPIC Retirement Dislocated Shoulder $750
Plan Services website at www.epicrps.com. Request an X-Ray $50
online access form from your HR Coordinator. You can also Physical Therapy (per session) $50
call EPIC at 800.716.3742 for additional guidance. Concussion $200
Coma $5,000
Knee Cartilage (Torn/Exploratory) $750/$200
Lodging (per day) $500
Transportation (per trip) $500
This is not a comprehensive list of your
coverage details. Please see plan documents for
more information.
Coverage Level Per Pay Period
Employee Only $5 .47
Employee + Spouse $8 .61
Employee + Child(ren) $9 .10
Employee + Family $14 .32
15
Great Circle Benefits Enrollment
Critical Illness Accident Coverage
Critical illness coverage is designed to help you offset Accident coverage pays a beneit to you for a speciic
the inancial effects of a catastrophic illness with a covered accident to help you cover the healthcare
lump sum beneit if you or a loved one are diagnosed costs associated with that accident although you may
with a covered critical illness. The critical illness choose to spend your beneit however you would
beneit is based on the amount of coverage in effect like. A full list of covered accidents is available on the
on the date of diagnosis of a critical illness or the myCircle intranet under Beneits. We have included
date treatment is received according to the terms and a short example list in this guide. This coverage does
provisions of the policy. Employees have a maximum not cover work-related accidents and your premium is
beneit of $10,000, and spouses and children have determined when you enroll.
a maximum beneit of $5,000 each. This coverage
is based on age and tobacco usage. See the online Accident Beneit Beneit Amount
enrollment system for rates. Emergency Room $200
Urgent Care $200
Primary Care Physician $75
401(k) Ground Ambulance $400
You are immediately eligible to contribute to your 401(k) Air Ambulance $1,200
$1,500
Hospital Admission
plan. After one year of employment the plan matches up Hospital Coninement (per day) $300
to 6% of your contribution. After your 6th year you are ICU Coninement (per day) $600
100% vested in the matching dollars Great Circle provides. Broken Ankle $1,500
After 10 years of employment, the plan matches 167% of
a 6% contribution or approximately 10%. Broken Wrist $1,500
Broken Finger $200
You will enroll in this plan through the EPIC Retirement Dislocated Shoulder $750
Plan Services website at www.epicrps.com. Request an X-Ray $50
online access form from your HR Coordinator. You can also Physical Therapy (per session) $50
call EPIC at 800.716.3742 for additional guidance. Concussion $200
Coma $5,000
Knee Cartilage (Torn/Exploratory) $750/$200
Lodging (per day) $500
Transportation (per trip) $500
This is not a comprehensive list of your
coverage details. Please see plan documents for
more information.
Coverage Level Per Pay Period
Employee Only $5 .47
Employee + Spouse $8 .61
Employee + Child(ren) $9 .10
Employee + Family $14 .32
15
