Page 9 - 2022 Fives Landis Corp Benefit Guide

VOLUNTARY MEDICAL INSURANCE

ELIGIBILITY: COVERAGE SUMMARY:
— You — No medical questions or medical tests
— Your spouse – under age 70 (at the time of enrollment) — Benefits are paid directly to you
— Your children – to age 26 — Do not need to be enrolled in a Fives Health Plan
— Portable – may continue the policy after employment ends
WELLNESS BENEFIT:
(Accident and Critical Illness Insurance) Log on to: presents.voya.com/EBRC/Fives for more
— Benefit payable of $50 for you and spouse each and information
$25 for child(ren) for completing a health screening test.

COMPASS ACCIDENT INSURANCE: COMPASS CRITICAL ILLNESS INSURANCE:
Accident Insurance that helps protect you and your family Critical Illness provides a lump-sum payment if you or a
from the costs of unexpected injuries and events resulting covered family member is diagnosed with a covered
from a covered accident. medical condition and meet the policy and certificate
requirements. Examples include: Cancer, Heart Attack,
Examples of services eligible for benefits: Stroke, Coma, Kidney Failure and certain diseases.
— Hospital and Emergency Care due to an accident (see benefit summary for full details)
— Common Injuries – lacerations, burns, concussion
— Fractures and Dislocations Benefits Payable:
— Surgery, x-rays and physician exams due to the Employee: $10k, $20k or $30k policy
covered accident — Employee must enroll in a minimum $10k policy, then
— An additional 25% benefit if covered accident is the result spouse and/or children may enroll for any level of
of an organized sport activity coverage.
— Includes hospitalization due to a sickness Spouse: $5k, $10k or $15k policy
— Benefits payable vary based on the services provided Child(ren): $5k or $10k policy
due to the covered accident. (see benefit summary for Cost: Employee and Spouse premiums are based on
complete details) age bands. See benefits at a glance.

COMPASS HOSPITAL INSURANCE:
Hospital Confinement pays a benefit if you have a covered Accident Insurance Bi-weekly
hospital, critical care or rehabilitation facility stay. Premium Low High
Employee Only $5.44 $7.52
Benefits are paid for the following: Employee + Spouse $9.77 $13.23
Daily Benefit Amount: Initial Confinement Benefit:
— Low plan: $200 — Low plan: $1,000 Employee + Child(ren) $10.61 $15.82
— High plan: $600 — High plan: $3,000 Family $14.94 $20.53

Hospital Benefit: 1x daily benefit up to 30 days
Critical Care Benefit: 2x daily benefit up to 15 days. Hospital Insurance Bi-weekly
Rehabilitation Facility: .5x daily benefit up to 30 days Premium Low High
Employee Only $9.90 $29.71
Above is a brief summary of the insurance. Refer to
the brochures and certificate of coverage for complete Employee + Spouse $22.94 $68.82
provisions, conditions of benefit determination, Employee + Child(ren) $15.42 $46.25
exclusions and limitations. The Accident, Hospital and
Critical Illness Insurance is issued by ReliaStar Life Insurance Family $28.45 $85.36
Company, a member of the Voya family of companies.
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