ASSOCIATE BENEFITS GUIDE 2019 - AMITA Health
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2019
ASSOCIATE BENEFITS GUIDE
Welcome to the AMITA Health Benefits Program
AMITA Health is committed to maintaining a positive and productive work environment – one that is dedicated to
providing the utmost quality care to those we serve in our community.
To accomplish our mission, it takes the special talent of many competent and highly-skilled people.
To succeed in a competitive healthcare market, AMITA Health strives to employ only the most capable
and dedicated associates at all levels, which includes providing a generous associates benefits program.
Please review the enclosed associate benefits documents and retain them for your personal files.
Feel free to contact us if you have any further questions.
Sincerely,
AMITA Health Benefits Department
This Benefits material briefly describe the excellent benefits program that is available as part of employment with AMITA Health. This information is not a contract.
Any of the benefits, policies or procedures may be changed as the organization requires, and nothing contained in this material shall be construed as creating an
expressed or implied obligation or contract on the part of the AMITA Health.
2 Benefits Guide 2019
Table of Contents
Overview and How to Enroll .................................................................... 4
Dependent Documentation ..................................................................... 5
Qualifying Life Events ............................................................................. 6
Paid Time Off .......................................................................................... 7
Medical Plan ........................................................................................... 8
Prescription Drug Coverage .................................................................. 11
Dental Plan ........................................................................................... 12
Vision Plan ............................................................................................ 15
Benefit Plan Premiums - Health, Dental and Vision ............................... 17
Flexible Spending Accounts .................................................................. 18
Basic Life and Voluntary Life / AD&D .................................................... 20
Short Term Disability Plan ..................................................................... 23
Long Term Disability Plan ...................................................................... 24
Permanent Life Insurance with Long Term Care .................................... 25
Accident Insurance ............................................................................... 26
Critical Illness Insurance ....................................................................... 27
Employee Assistance Program ............................................................. 29
Legal Plan ............................................................................................. 30
Retirement ............................................................................................ 31
Diabetes Management .......................................................................... 34
Commuter Benefits ............................................................................... 35
Additional Benefits ................................................................................ 39
Vendor Contact Listing .......................................................................... 40
Mobile Applications ............................................................................... 41
Important Notices .................................................................................. 42
Benefits Guide 2019 3
Overview
In today’s changing world, your benefits are an
increasingly valuable part of your total pay. AMITA
Health knows how important having the right
benefits are to you and your family.
We are pleased to offer you a wide range of bene- Various documents will help in certifying your
fit plan features and choices. The benefit plan year dependents. To see a complete list of acceptable
begins January 1 and ends December 31. documents please refer to page 5 of this guide.
Whether you’re single or have a family, you’ll find
plans here to suit your unique needs. You will be
Provide copies of the documents – not originals as
able to customize a package of benefits to meet
these will not be returned to you.
those needs–with an opportunity annually to
change your selections as your needs change. If you are submitting a copy of your most recent
Federal Tax Return, please submit the first page
This booklet will help you learn more about your
only which shows your dependents (you may hide
choices, so you can make educated decisions
social security numbers and income by blacking
when you enroll.
out).
WHO’S ELIGIBLE We only accept government Issued documents
such as marriage license, birth certificate, or court
You are eligible to enroll in benefits if you are a full- ordered documents.
time or part-time associate regularly scheduled to
work a minimum of 20 hours per week. These documents are due within 31 days from
your hire date or status change date.
Temporary associates or those working fewer than
20 hours per week are not eligible. Please submit documents with a cover sheet with
your name, associate ID number and contact tele-
Your eligible dependents include: phone number to:
OVERVIEW
• Your spouse
• Your children up to age 26 (including natural
children, stepchildren, or adopted children)
• Your disabled children of any age, provided they
became disabled before age 26 and while
covered by the plan
You may be asked to provide proof of eligibility. If
you cannot provide the requested documentation,
your dependent coverage will be terminated.
ENROLLING IN OUR BENEFIT PLANS
All associates must enroll through Benefit Express on-line through their secure website: www.amitahealthbenefits.com
within 31 days from date of hire or qualified life event.
You will need your 8-digit associate ID number found in iAMITA > rAMITA > My Information > Associate Id
number and the social security numbers for all dependents you plan to add.
Associates who fail to enroll within 31 days from date of hire, or qualified life event must wait until next
enrollment period.
Hint: The website can only be entered through Internet Explorer not through Google.
4 Benefits Guide 2019
Dependent Documentation
DEPENDENT DOCUMENTATION GUIDE
DEPENDENT TYPE AGE DOCUMENTATION REQUIREMENTS
• Government Issued Marriage Certificate and last year filed Federal Tax
Return OR
• Government Issued Marriage Certificate and Proof of Joint Ownership
Legal Spouse NA
Issued in last 6 months OR
• Government Issued Marriage Certificate ONLY (if married in current
calendar year).
Age 0 up
Biological Child • Government Issued Birth Certificate ONLY.
to 26
• Government Issued Birth Certificate AND
Disabled Biological Child Over 26 • Completed disabled child certification form (must be medically certified
by a physician as disabled).
Age 0 up • Government issued Birth Certificate AND
Step-Child
DEPENDENT DOCUMENTATION
to 26 • Associate’s Government issued Marriage Certificate.
• Government issued Birth Certificate AND
• Associate’s Government issued Marriage Certificate AND
Disabled Step-Child Over 26
• Completed disabled child certification form (must be medically certified
by a physician as disabled).
Age 0 up • Adoption Placement Agreement and Petition for Adoption ONLY OR
Adopted Child
to 26 • Adoption Certificate ONLY.
• Adoption Certificate AND
Disabled Adopted Child Over 26 • Completed disabled child certification form (must be medically certified
by a physician as disabled).
Age 0 up • Government Issued Birth Certificate AND
Legal Ward
to 26 • Court Ordered Document of Legal Custody.
• Government Issued Birth Certificate AND
• Court Ordered Document of Legal Custody AND
Disabled Legal Ward Over 26
• Completed disabled child certification form (must be medically certified
by a physician as disabled).
Qualified Medical Child Age 0 up • Qualified Medical Child Support Order ONLY. Must be ordered for the
Support Order to 26 associate or spouse.
Benefits Guide 2019 5
Qualifying Life Events
The annual open enrollment period is the only time you can change benefit plans or add/drop dependents during
a plan year, unless you experience a qualifying family status change. A qualifying event to change benefits during
the plan year is defined as a change in your status due to:
• New employment
• Marriage
• Birth or adoption of a child(ren)
• Death of an immediate family member
• Divorce
• Loss or gain of insurance coverage by your spouse’s employer-sponsored coverage
• Unpaid leave of absence by you or your spouse
• Ineligibility of a dependent
• Termination of employment
To change your benefit elections, you must notify AMITA Health Benefits Department within 31 days of the quali-
fying event triggering the need for the change. For example, if you were married September 3, you would need to
notify the AMITA Health Benefits Department (within 31 days of the marriage).
QUALIFYING LIFE EVENTS
YOUR BENEFIT CHOICES
AMITA Health provides a wide variety of benefits. Some are provided automatically at no cost to you. Other
benefits are available if you elect them. Review the guide in detail to see which benefits you need to create a
successful program designed to meet your needs and, if applicable, the needs of your family.
6 Benefits Guide 2019Paid Time Off
Paid Time Off (PTO)
PTO is available to all Full-Time and Part-Time associates who are regularly scheduled to work 40 hours or
more per pay period. Associates are eligible to use PTO for any supervisor-approved reason, including
vacations, personal business or illness.
Paid Time Off (PTO) Accrual
Non-exempt (hourly) associates PTO is accrued based on hours worked in a pay period (not to exceed 80 hours
for this purpose). The amount associates may earn will depend on their job classification, length of service,
and hours worked in a pay period (with exception of premium hours, e.g., call pay, stand-by pay, etc.). Current
Associates may accumulate up to a maximum of 320 hours. PTO accruals will cease until the accumulated PTO
falls below the maximum.
PTO Accrual Schedule for Non-exempt (hourly) (cap at 320 hours)
Completed Years of Service
Years (Months per Year) Hours Per Year* Days Per Year* Accrual Per Hour Paid
0-1 (0-11.9) 128 16 0.061538
2-3 (12-35.9) 136 17 0.065385
4-5 (36-59.9) 152 19 0.073077
6-8 (60-95.9) 168 21 0.080769
9-11 (96-131.9) 192 24 0.092308
12-15 (132-179.9) 200 25 0.096154
16+ (180+) 216 27 0.103846
PAID TIME OFF
Example to Pro-rate: If you work 72 hours a pay period and your year of service is 1 year
0.0161538 (hourly accrual rate) x 72 pp hours = 4.43 x 26 (pay periods/year) = 115.20 (annual hours)
Paid Time Off (PTO) Front Loaded Plan
Annual Front-Loaded PTO will be awarded to exempt (salaried) associates and available for use at the
beginning of each year. During pay period one of each year, 27 days of non-accrued PTO will be advanced
into the associate’s bank (prorated based on FTE). Unused PTO hours are forfeited following the last pay
period of the year.
Legal/Observed Holidays
Legal Holidays are available to all Full-Time and Part-Time associates. New Year’s Day, Martin Luther King Day,
Good Friday, Memorial Day, July 4th, Labor Day, Thanksgiving Day and Christmas Day. These holidays are in
addition to PTO. All associates required to work on a recognized holiday will have those holiday hours added to
his/her PTO bank. Those holiday hours will then be available to use as any other PTO hours.
Benefits Guide 2019 7Medical Plan
Eligibility
All full-time or part-time benefit eligible associates may elect coverage. Eligible dependents include your legal spouse,
and children up to the date in which they turn age 26. Any unmarried child of any age with a mental or physical
handicap or disability who is incapable of self-support is eligible provided they became disabled before age 26 and
while covered by the plan.
Coverage Levels
You can choose from four levels of coverage:
• Associate Only
• Associate + Spouse
• Associate + Child(ren)
• Family
Coverage Begins
If you enroll in this plan, coverage is effective the 1st of the month following 30 days of employment.
Coverage Ends
Coverage ends on the last day of employment or when you cease to be an eligible associate. Dependents
terminate on the day of their 26th birthday. Please see the Medical Plan book for additional instances when
coverage ends.
AMITA Health Medical Plan
AMITA Health will offer associates a Preferred Provider Organization (PPO) plan administered by Automated Benefit
Services (ABS) and it consists of the BlueCross BlueShield’s national provider network. PPO plans allow associates to
seek services from the provider of their choice.
The AMITA Health Medical Plan is a ‘tiered’ network with three tiers: (1) * SmartHealth Network consisting of AMITA
MEDICAL PLAN
Health (Adventist Midwest Health, Alexian Brothers and Presence Health), Ascension and Adventist Health System
facilities and contracted providers; (2) BlueCross BlueShield National Provider Network; and (3) Out of Network –
facilities and providers not contracted with BlueCross BlueShield National Provider Network. You and your family
members will experience a significantly higher level of benefits when receiving your care from an AMITA provider. If
you choose to seek care outside of AMITA Health, you will have access to BlueCross BlueShield’s national provider
network.
8 Benefits Guide 2019Certain services may require satisfying a deductible. Once the deductible is satisfied by the member, the plan will begin
paying a portion of your remaining charges known as co-insurance. AMITA Health PPO plan provides associates financial
security by placing an out-of-pocket limit on an associate’s health care expenses.
Associates are free to seek services from the provider of their choice, however, associates’ out-of-pocket expenses will be
significantly lower when services are received from an AMITA Health provider.
Health Benefits Subsidy is offered to Full-Time associates at the time of the annual open enrollment or initial enrollment
for benefits (New hire or from PRN to Full-time benefits eligible status). The Health Benefits Subsidy is designed to assist
associates who may not have affordable access to healthcare. The subsidy provides a discount of:
• 25%, 50%, 75% or 100% on associate bi-weekly deductions for coverage on the SmartHealth PPO plan.
• 50% or 100% on deductibles, coinsurance and maximum out-of-pocket costs for covered expenses under the
SmarthHealth PPO medical plan for care that you and covered dependents receive in the PPO Plan Tier 1 Network.
(The discount does not apply to co -payments)
• The subsidy also includes reduced pharmacy copays for associates who qualify for all levels of the subsidy.
Associates have 31 days to apply from the initial enrollment period or by the deadline provided during the annual open
enrollment period.
For more information about the Health Benefits Subsidy and how to apply, please visit iAMITA > Departments > Human
Resources > Benefits > Health Plan Subsidy or www.amitahealthbenefits.com.
Please review both the schedule of benefits below as well as your bi-weekly premiums on www.amitahealthbenefits.com.
MEDICAL PLAN
Deductible: The amount you owe before insurance or plan begins to pay.
Co-insurance: Once the deductible is met, this is the share of the costs of a covered service for which the member
is responsible. It is a percent (%) of the allowed amount of the service.
Co-payment: This is a fixed amount you pay for a covered service. This amount can vary depending on the service
received. The co-pay may or may not count toward the deductible.
Network Providers: These are facilities, providers, and suppliers who have a contract to deliver services under the
network, which is managed by the insurer.
Out-of-Pocket Maximum: This is the most the enrolled associate will pay during the year before the plan begins to
pay 100% of the allowed amount.
Precertification: A decision by the plan that a service, treatment, prescription drug or durable medical equipment
is medically necessary.
Benefits Guide 2019 92019 Schedule of Benefit
Benefits Tier 1 AMITA Network Tier 2 National Tier 3
Network (BCBS) Out-of-Network*
Claims questions, benefit questions, eligibility Contact ABS Customer Service at (844) 659-2519
Find a doctor View provider directory at www.mysmarthealth.org
All eligible expenses apply towards all deductibles and out-of-pocket maximums.
Deductible
• Individual $300 $1,000 $2,000
• Family $600 $2,000 $4,000
Coinsurance
• Plan Pays 90% after 70% after National 50% after OON Deductible
AMITA Network Deductible Network Deductible
• You Pay 10% coinsurance after 30% after National Network 50% after OON Deductible
AMITA Network Deductible Deductible
Total Out-Of-Pocket Maximum (Deductible plus coinsurance and copays) Medical Out of Pocket
• Individual $4,000 $5,850 $0
• Family $8,000 $11,700 $0
Rx Out of Pocket
• Individual $1,500 $1,500 N/A
• Family $3,000 $3,000 N/A
Lifetime Maximum Unlimited
Services AMITA Network National Network Out-of-Network*
Preventive Service
50% coinsurance after
Annual Routine Physical, Well Baby/Child Care, Routine Immunizations, Annual $0 $0
OON Deductible
Gynecological Exam/Annual Mammogram, Screening Colonoscopy
Outpatient/Diagnostic Services
30% coinsurance after
• Diagnostic Infertility Testing, Physical/Occupational/Speech Therapy (Annual 10% coinsurance after 50% coinsurance after
National Network
Maximum - 60 Visits), Lab, Pathology, Radiation and Chemotherapy, AMITA Network Deductible OON Deductible
Deductible
Radiology, Outpatient Surgery
High Tech Radiology MRI, PET Scan, MRA Pre-Certification Required Pre-Certification Required 30% Pre-Certification Required
10% coinsurance after coinsurance after National 50% coinsurance after OON
AMITA Network Deductible Network Deductible Deductible
• Dialysis 10% coinsurance after 30% coinsurance after 50% coinsurance after OON
AMITA Network Deductible National Network Deductible Deductible
Office Visits
50% aft 50% coinsurance after
Primary Care (Family Practice/General Internal $15 Copay $30 Copay
OON Deductible er Deductible
Medicine/Pediatrics)
MEDICAL PLAN
• Specialist (Including OB/GYN) 50% coinsurance after OON
$35 Copay $50 Copay
Deductible
• Pre/Postnatal Care 50% coinsurance after OON
$15 Copay $30 Copay
Deductible
• Chiropractic Office Visit (Annual maximum - 60 visits) 50% coinsurance after OON
$15 Copay $30 Copay
Ancillary services are subject to deductible/coinsurance Deductible
Mental Health 50% coinsurance after OON
$15 Copay $30 Copay
• Individual Therapy/Group Therapy Deductible
• Inpatient Admission/Partial Day Treatment, Intensive 10% coinsurance after 30% coinsurance after AMITA 50% coinsurance after OON
Outpatient Therapy AMITA Network Deductible Network Deductible Deductible
Substance Abuse 50% coinsurance after OON
$15 Copay $30 Copay
• Individual Therapy/Group Therapy Deductible
• Intensive Outpatient Therapy, Acute Inpatient Care 10% coinsurance after 30% coinsurance after AMITA 50% coinsurance after OON
AMITA Network Deductible Network Deductible Deductible
Emergency Care
$150 Copay $150 Copay $150 Copay
• ER Visit
• Urgent Care 50% coinsurance after OON
$35 Copay $50 Copay
Deductible
• Ambulance 10% coinsurance after 10% coinsurance after AMITA 10% coinsurance after AMITA
AMITA Network Deductible Network Deductible Network Deductible
• Medical Transfer/Transport (non-emergent) Pre-Certification Pre-Certification Pre-Certified
Required Required Required
Inpatient Services
• Per Admission
• Room and Board Pre-Certification Required Pre-Certification Required 30% Pre-Certification Required
• Ancillary Services 10% coinsurance after coinsurance after National 50% coinsurance after OON
• Surgery AMITA Network Deductible Network Deductible Deductible
• Anesthesia
• Physician Charges
• Emergency Room Admission 10% coinsurance after 30% coinsurance after
50% after OON Deductible
AMITA Network Deductible National Network Deductible
• Extended Care Facility (Annual maximum - 120 days) 10% coinsurance after 30% coinsurance after
50% after OON Deductible
AMITA Network Deductible National Network Deductible
10 Benefits Guide 2019Other Services Pre-Certification Required Pre-Certification Required 30%
Pre-Certification Required
• Durable Medical Equipment (DME) 10% coinsurance after coinsurance after National
50% after Deductible
AMITA Network Deductible Network Deductible
• Prosthetics & Orthotics (P&O) 10% coinsurance after 30% coinsurance after Nation- 50% coinsurance after OON
AMITA Network Deductible al Network Deductible Deductible
• Foot Orthotics - 2 pairs every 3 years 50% coinsurance after 50% coinsurance after OON
50% after Network Deductible
AMITA Network Deductible Deductible
• Hearing Aid (3-year maximum - $2,000) 10% coinsurance after 30% coinsurance after Nation- 50% coinsurance after OON
AMITA Network Deductible al Network Deductible Deductible
• Home Health Care (Annual maximum - 100 visits) 10% coinsurance after 30% coinsurance after Nation- 50% coinsurance after OON
AMITA Network Deductible al Network Deductible Deductible
• Hospice 10% coinsurance after 30% coinsurance after Nation- 50% coinsurance after OON
AMITA Network Deductible al Network Deductible Deductible
• Allergy Testing & Treatment 10% coinsurance after 30% coinsurance after Nation- 50% coinsurance after OON
AMITA Network Deductible al Network Deductible Deductible
• Bariatric Surgery Pre-Certification Required Pre-Certification Required 30%
Pre-Certification Required
10% coinsurance after coinsurance after National
50% after OON Deductible
AMITA Network Deductible Network Deductible
• Organ/Bone Marrow/Other Transplants Pre-Certification Required Pre-Certification Required 30%
Pre-Certification Required
10% coinsurance after coinsurance after National
50% after OON Deductible
AMITA Network Deductible Network Deductible
• Wellness/Disease Management
• Diabetic Education 50% coinsurance after OON
$0 $0
Deductible
• Smoking Cessation Intervention (Counseling)
This is a brief summary of benefits, which are subject to change. In the case of a conflict between this summary and the official Summary Plan Description, the language in the Summary Plan Description will prevail. For further details about plan benefits, please contact Cus-
tomer Service at the number shown on the back of your ID card. Network Description: Tier 1 represents the AMITA network, which is comprised of participating AMITA providers and facilities, as well as the broader Ascension AMITA network. Your out-of-pocket costs will always
be lower when utilizing a AMITA provider. Tier 2 represents BCBS participating providers. Members should make every effort to utilize a BCBS provider whenever a AMITA provider is not available in their area. Contraceptive Coverage: The U.S. Department of Health and Human
Services, the Department of Labor and the Internal Revenue Service have jointly released final regulations regarding women’s preventive services under the Affordable Care Act (“ACA”). The ACA requires group health plans to provide coverage for “contraceptive services” as part
PRESCRIPTION DRUG COVERAGE
of an array of women’s preventive services that must be included in health plans without cost sharing to covered participants. AMALX-MED-300 AMADV-MED-300
Prescription Drug Coverage
Associates enrolled in the Medical Plan automatically receive the Prescription Drug Coverage benefit which is managed
through Cigna. Members will receive their own Pharmacy ID card in addition to their Medical ID cards. For a complete
listing of medications covered you may go to www.myCigna.com.
Use of AMITA in-house pharmacies may reduce your medication expense and you can only receive a 90 Day Supply
through our in-house pharmacies. Certain medications require approval from Cigna before they’re covered by the
plan. If you are not sure a medication requires approval, please check on-line or call the toll-free number on the back
of your Cigna ID card. In these cases, if your doctor feels that an alternative medication isn’t right for you, he or she
can ask Cigna to consider approving coverage of your medication.
Prescription Drug Coverage
In-House Pharmacies Retail Pharmacies Out-of-Network*
Individual MOOP (Rx) $1,500 $1,500 N/A
Family MOOP (Rx) $3,000 $3,000 N/A
Generic $5 $10 N/A
Preferred Brand 85% 75% N/A
($25 Min / $50 Max) ($40 Min / $80 Max)
PHARMACY
Non-Preferred Brand 80% 75% N/A
($50 Min / $100 Max) ($80 Min / $160 Max)
Generic - 90 Day Supply $10 N/A N/A
Preferred Brand - 90 Day Supply 85% N/A N/A
($50 Min / $100 Max)
Non-Preferred - 90 Day Supply 80% ($100 Min / $200 N/A N/A
Max)
Specialty Rx - 30 Day Supply 85% ($50 Min / $100 75% N/A
Max) ($80 Min / $160 Max)
*Please note: 90-day supplies must be filled by the AMITA Health In-House Pharmacies. Prescription drugs classified as Specialty medications may only be filled up to a 30-day supply through an AMITA Health In-House pharmacy or Cigna
Home Delivery. One 30-day supply grace fill is allowed at retail.
Benefits Guide 2019 11Dental PPO
Eligibility
All full-time or part-time benefit eligible associates may elect coverage. Eligible dependents include your legal
spouse, and children up to the date in which they turn age 26. Any unmarried child of any age with a mental or
physical handicap or disability who is incapable of self-support is eligible provided they became disabled before
age 26 and while covered by the plan.
Coverage Levels
You can choose from four levels of coverage:
• Associate Only
• Associate + Spouse
• Associate + Child(ren)
• Family
When Coverage Begins
If you enroll in this plan, coverage is effective the 1st of the month following 30 days of employment.
When Coverage Ends
Coverage ends on the last day of employment or when you cease to be an eligible associate. Dependents
terminate on the day of their 26th birthday. Please see the Dental Plan book for additional instances when
coverage ends.
AMITA Health Dental Plan
AMITA Health provides you with a choice of 2 dental PPO plans through Delta Dental the “High” and “Low” Plan.
DENTAL PLAN
With the Delta Dental Preferred Provider Organization (PPO) plans, you have the freedom to visit any licensed net-
work or non-network Dentist for covered services. You do not have to designate a primary care dentist. Plus, you
can visit any dental specialist for covered benefits up to an annual limit without waiting for prior approval from the
plan. You will generally save on the cost of covered dental care when you use a dentist who participates in the PPO
network.
Search Delta Dental’s online dentist directory at www.deltadentalil.com
AMITA Health is part of the Delta Dental PPO Plus Premier Network– meaning you can go to any dentist
in the PPO or Premier Network
The PPO toll free number is 800-323-1743
12 Benefits Guide 2019AMITA Health - Adventist Midwest Health #11510
AMITA Health - Alexian Brothers Health System #11506
AMITA Health – Presence Health #11506
DENTAL PLAN HIGHLIGHTS
HIGH PLAN
Annual Deductible (applies to Basic and Major Services Only) $50/person; $150/family
Annual Maximum $1,500/person
Enhanced Benefits Program Your plan provides additional cleanings and/or
applications of topical fluoride to people with
specific health conditions that put them at risk
for oral health disease.
Lifetime Orthodontic Maximum $1,500/person
Delta Dental Delta Dental Non-
PPO Network Premier® Network
Dentist Network Dentist Dentist
PREVENTIVE/DIAGNOSTIC SERVICES
Not subject to annual maximum
• Routine exams (twice per benefit year)
• Dental prophylaxis (twice per benefit year)
• X-rays (bitewings-twice per benefit year; full mouth-every three years)
100%* 100%** 100%***
• Fluoride treatments (once per benefit year to age 19)
• Space maintainers (once per lifetime to age 14)
• Sealants (to age 16)
• Periodontal maintenance
• Emergency exams and palliative treatment
BASIC SERVICES
• Amalgam and composite resin (anterior) fillings
• Posterior composites (tooth colored fillings on back teeth)
• Non-surgical Periodontics
• Surgical Periodontics
80%* 80%** 80%***
• Endodontics
DENTAL PLAN
• Oral surgery – simple extractions
• Oral surgery – surgical extractions including general anesthesia
• IV sedation
• Denture repairs
MAJOR RESTORATIVE SERVICES
• Implants
50%* 50%** 50%***
• Cast restorations – crowns, onlays, post and core
• Prosthodontics – bridges, partial dentures and complete
ORTHODONTICS-dependents to age 26 and Adults
50%* 50%** 50%***
Treatment necessary for proper alignment of teeth
No TMJ Coverage 0% 0% 0%
*Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network
dentists cannot charge you for costs exceeding the PPO fee. **Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual
fee) or Delta Dental’s maximum plan allowance. Premier dentists may not charge you for costs exceeding the maximum plan allowance. ***Non-network dentists
(non-Delta Dental PPO/non-Delta Dental Premier) do not agree to accept Delta Dental’s allowed fees as payment in full; payment is based on the lesser of the
submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. These dentists can charge you for costs exceeding the maximum plan allowance.
Benefits Guide 2019 13AMITA Health - Adventist Midwest Health #11510
AMITA Health - Alexian Brothers Health System #11506
AMITA Health – Presence Health #11506
DENTAL PLAN HIGHLIGHTS
LOW PLAN
Annual Deductible (applies to Basic and Major Services Only) $75/person; $225/family
Annual Maximum $1,000/person
Enhanced Benefits Program Your plan provides additional cleanings and/or
applications of topical fluoride to people with spe-
cific health conditions that put them at risk for oral
health disease.
Lifetime Orthodontic Maximum $1,000/person
Delta Dental Delta Dental Non-Network
PPO Network Premier® Dentist
Dentist Network Dentist
PREVENTIVE/DIAGNOSTIC SERVICES
Not subject to annual maximum
• Routine exams (twice per benefit year)
• Dental prophylaxis (twice per benefit year)
• X-rays (bitewings-twice per benefit year; full mouth-every three years)
100%* 100%** 100%***
• Fluoride treatments (once per benefit year to age 19)
• Space maintainers (once per lifetime to age 14)
• Sealants (to age 16)
• Periodontal maintenance
• Emergency exams and palliative treatment
BASIC SERVICES
• Amalgam and composite resin (anterior) fillings
• Posterior composites (tooth colored fillings on back teeth)
• Non-surgical Periodontics
• Surgical Periodontics
60%* 60%** 60%***
• Endodontics
DENTAL PLAN
• Oral surgery – simple extractions
• Oral surgery – surgical extractions including general anesthesia
• IV sedation
• Denture repairs
MAJOR RESTORATIVE SERVICES
• Implants
50%* 50%** 50%***
• Cast restorations – crowns, onlays, post and core
• Prosthodontics – bridges, partial dentures and complete
ORTHODONTICS-dependents to age 26 and Adults
50%* 50%** 50%***
Treatment necessary for proper alignment of teeth
No TMJ Coverage 0% 0% 0%
*Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network
dentists cannot charge you for costs exceeding the PPO fee. **Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual
fee) or Delta Dental’s maximum plan allowance. Premier dentists may not charge you for costs exceeding the maximum plan allowance. ***Non-network dentists
(non-Delta Dental PPO/non-Delta Dental Premier) do not agree to accept Delta Dental’s allowed fees as payment in full; payment is based on the lesser of the
submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. These dentists can charge you for costs exceeding the maximum plan allowance.
14 Benefits Guide 2019Vision Plan
Eligibility
All full-time or part-time benefit eligible associates may elect coverage. Eligible dependents include your legal spouse,
and children up to the date in which they turn age 26. Any unmarried child of any age with a mental or physical
handicap or disability who is incapable of self-support is eligible provided they became disabled before age 26 and
while covered by the plan.
Coverage Levels
You can choose from four levels of coverage:
• Associate Only
• Associate + Spouse
• Associate + Child(ren)
• Family
When Coverage Begins
If you enroll in this plan, coverage is effective the 1st of the month following 30 days of employment.
When Coverage Ends
Coverage ends on the last day of employment or when you cease to be an eligible associate. Dependents
terminate on the day of their 26th birthday. Please see the Vision Plan book for additional instances when
coverage ends.
AMITA Health Vision Plan
AMITA Health vision benefits are administered by Vision Service Plan (VSP). You can go to any eye care professional
you choose but if you use a VSP network provider you’ll pay less.
VISION PLAN
To use your VSP benefit:
• Create an account at www.vsp.com to review your benefits.
• To find a doctor who is right for you, visit www.vsp.com or call 1-800-877-7195
• At your appointment, tell your provider you have VSP. There is no ID card necessary. If you’d like a card
as a reference, you can print one on www.vsp.com.
• That is it! There are no claim forms to complete when you see a VSP provider.
Convenient online shopping! Eyeconic is an online eyewear store for VSP members.
You can visit Eyeconic to purchase eyewear or contact lenses with your VSP insurance – in-network.
Visit www.eyeconic.com and connect your VSP account to the Eyeconic store.
Benefits Guide 2019 15Benefit Description Copay Frequency
Your Coverage with a VSP Provider
Well Vision Exam • Focuses on your eyes and overall wellness $10 Every 12 months
Prescription Glasses $15 See frame and
lenses
Frame • $160 allowance for a wide selection of frames Included in Every 12 months
• $180 allowance for featured frame brands Prescription Glasses
• 20% savings on the amount over your allowance
• $90 Costco® frame allowance
Lenses • Single vision, lined bifocal, and lined trifocal Included in Every 12 months
lenses Prescription Glasses
• Polycarbonate lenses for dependent children
Lens Enhancements • Scratch Resistant Coating $0 Every 12 months
• Standard progressive lenses $55
• Premium progressive lenses $95-105
• Custom progressive lenses $150-$175
• Average savings of 20-25% on other lens
enhancements
Contacts •$160 allowance for contacts; copay does not apply Up to $50 Every 12 months
(instead of glasses) • Contact lens exam (fitting and evaluation)
Diabetic Eyecare Plus • Services related to diabetic eye disease, $20 As needed
Program glaucoma and age-related macular degeneration
(AMD). Retinal screening for eligible members
with diabetes. Limitations and coordination with
medical coverage may apply. Ask your VSP
doctor for details.
Extra Savings Glasses and Sunglasses
• Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details.
• 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP
VISION PLAN
provider within 12 months of your last WellVision Exam.
Retinal Screening
• No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam
Laser Vision Correction
• Average 15% off the regular price or 5% off the promotional price; discounts only available from
contracted facilities
Your Coverage with Out-of-Network Providers
Get the most out of your benefits and greater savings with a VSP network doctor. Your coverage with out-of-network providers will
be less or you’ll receive a lower level of benefits. Visit vsp.com for plan details.
Exam ................................... up to $45 Lined Bifocal Lenses ........................ up to $50 Progressive Lenses ........................... up to $50
Frame ..................................up to $70 Lined Trifocal Lenses ........................ up to $65 Contacts ................................................ up to $105
Single Vision Lenses ......... up to $30
Coverage with a participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information is subject to change. In the
event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may
vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.
16 Benefits Guide 2019AMITA 2019 Bi-Weekly Benefit Rates
MEDICAL RATES - Bi Weekly – Non-Wellness
Salary Banding Associate Associate + Associate + Family
Spouse Children
$0-$14.42 $64.31 $130.28 $122.03 $188.00
Full-TIme $14.43-$28.85 $71.58 $149.19 $139.49 $217.10
Non-wellness
$28.86-$48.08 $76.43 $161.81 $151.13 $236.51
Rates
$48.09+ $81.28 $174.42 $162.78 $255.91
Part-TIme Associate $123.75 $228.45 $206.30 $336.17
Non-wellness
Rates
AMITA 2019 BI-WEEKLY BENEFIT RATES
DENTAL RATES - Bi Weekly
Associate Associate + Associate + Family
Spouse Children
Full-Time Rates - Low Plan $4.46 $8.92 $10.85 $16.83
Part-Time Rates - Low Plan $12.76 $25.52 $31.06 $48.17
Full -Time Rates - High Plan $5.47 $10.95 $13.29 $20.61
Part- Time Rates - High Plan $15.66 $31.32 $38.02 $58.98
VISION RATES - Bi Weekly
Associate Associate + Associate + Family
Spouse Children
$4.08 $6.54 $6.68 $10.77
Benefits Guide 2019 17Flexible Spending Accounts
Eligibility Dependent Daycare Flexible Spending Account:
All full-time or part-time benefit eligible associates may Estimate your eligible expenses for dependent day care
elect coverage. Eligible dependents include your legal while you work, or other dependent care expenses. The
spouse, and children up to the date in which they turn maximum you may elect is based on your tax filing status:
age 26. Any unmarried child of any age with a mental
$5,000 (if you are single or married and filing a joint
or physical handicap or disability who is incapable of
return) or $2,500 (if you are married and filing a separate
self-support is eligible provided they became disabled
return).
before age 26 and while covered by the plan.
• Pay for eligible dependent care expenses out of your
Coverage Begins own pocket and submit a claim for reimbursement,
with a copy of any necessary documents (receipts,
You must enroll in a Flexible Spending Account (FSA) etc.) to ConnectYourCare at the address listed on the
during your enrollment window to have an FSA, which claim form.
is effective the 1st of the month following 30 days of
employment, or during each open enrollment for the • ConnectYourCare will direct deposit your
first day of the new benefit year. reimbursement into your designated account within
24-48 hours after processing your claim (Monday -
As part of the wide range of choices the AMITA benefits
FLEXIBLE SPENDING ACCOUNTS
Friday) provided you have a balance. Otherwise,
program offers, you may also elect to set up a Flexible your claim will be processed once a contribution
Spending Account to help save income taxes on is received.
predict- able eligible health and/or dependent care
expenses. Make your elections:
You may choose to set up either or both: • During Open Enrollment or any enrollment period
after you become eligible; or
• A Health Care Flexible Spending Account
• In the event of a qualifying life status change.
• A Dependent Daycare Flexible Spending Account
HOW A FLEXIBLE SPENDING HEALTH CARE FLEXIBLE SPENDING
ACCOUNT WORKS ACCOUNT QUALIFYING EXPENSES
Health Care Flexible Spending Account: Any health care expenses qualifying under the Internal
Revenue Code for income tax purposes also qualify for
Estimate how much you expect to spend on eligible
reimbursement through the Health Care Flexible Spend-
health care expenses for the plan year (January 1, 2019
ing Account. If you use the account for these expenses,
through December 31, 2019). Consider medical, dental,
you cannot take an income tax deduction as well.
vision, and hearing expenses not covered by the benefit
plans, such as copays and deductibles, as well as other
eligible expenses. The maximum contribution you may
elect is $2,650 per plan year. The minimum is $120 per
plan year.
• Pay for eligible health care expenses out of your own
pocket and submit a claim for reimbursement, with
a copy of any necessary documents (receipts,
explanation of benefits, etc.) to the ConnectYourCare
at the address listed on the claim form.
• Pay using a VISA payment card. Automatically records
purchase online and no need to pay upfront and wait
for reimbursement.
18 Benefits Guide 2019Flexible Spending Accounts
Eligible expenses include, but are not limited to: General Plan Rules
• Deductibles, coinsurance, and copays – for medical, The Internal Revenue Service imposes the following rules
dental, pharmacy, and vision care; and regulations on pre-tax Flexible Spending Accounts:
• Amounts you pay in excess of plan limitations for • You lose any money left in your account at the end of the
allowed charges; plan year, so decide carefully how much to contribute
when you enroll each year. However, there is a 90-day
• Amounts in excess of annual or lifetime benefit grace period after the end of the plan year to submit
maximums; eligible health care and dependent daycare expenses
incurred during the plan year.
• Expenses not covered or not fully covered by your
plan; and • You may be eligible for a Federal Child and Dependent
Daycare Tax Credit and/or to deduct certain health care
• Certain over-the-counter medications if prescribed expenses on your tax return. Be sure to talk to a tax
by a physician. advisor to see whether the tax credits and deductions
or the Flexible Spending Accounts are the best choice
for you.
DEPENDENT DAYCARE FLEXIBLE SPENDING • For the Health Care Flexible Spending Account, you can
FLEXIBLE SPENDING ACCOUNTS
ACCOUNT QUALIFYING EXPENSES be reimbursed up to the full amount you elect to
contribute for the plan year even if funds are not yet
Any expenses qualifying for a Federal Child and Dependent
deposited into your account. However, you can only be
Daycare Tax Credit for income tax purposes also qualify for
reimbursed up to the amount deposited into your
reimbursement through the Dependent Daycare Flexible
Dependent Daycare Flexible Spending Account at the
Spending Account.
time of your claim.
If you use the account to reimburse yourself for eligible
expenses, you cannot take the Federal Tax Credit for the • You cannot use money in your Health Care Flexible
same expenses. Eligible expenses include those services Spending Account to be reimbursed for dependent day
provided inside or outside your home while you work by care expenses, and you cannot use money in your
Dependent Daycare Flexible Spending Account to be
anyone other than your spouse or your dependents to care
for eligible dependent children (under age 13) or depen- reimbursed for health care expenses. You also cannot
dents who are physically or mentally unable to care for transfer money from one account to the other.
themselves for whom you contribute more than half of their
support. • Flexible spending accounts (medical) allow $500 per
• Flexible Spending Accounts (medical) allow $500 per
year to be rolled over.
Benefits Guide 2019 19Basic and Voluntary Life / AD&D
BASIC LIFE
Eligibility
All full-time and part-time benefit eligible associates are provided employer paid Basic Life/AD&D coverage at
1x annual earnings to a maximum of $1,000,000. Associates are automatically enrolled in Basic Life and AD&D.
AMITA Health provides this benefit at no cost to the Associate. The Prudential Insurance Company of America
provides this insurance.
When Coverage Begins
Coverage is effective the 1st of the month following 30 days of employment.
When Coverage Ends
Coverage will end at the termination of your employment. You may convert your insurance to an individual life
insurance policy issued by the Prudential Insurance Company of America. Please see the Life Plan book for
additional instances when coverage ends.
Basic Life – Key Provisions
• If you are terminally ill, you can get a partial payment of your group life insurance benefit. You can use this
payment as you see fit. The payment to your beneficiary will be reduced by the amount you receive with the
Accelerated Benefit Option.
LIFE - BASIC AND AD&D
• Payment of premium can be waived if you are totally disabled for 6 months, you are less than 60 years old when
disability begins, and you continue to be totally disabled. The waiver terminates at normal social
security retirement age. This provision may vary by state.
• Coverage will be reduced as you age – 50% at age 70.
Please refer to the Life plan summary plan description for more information.
Basic Accidental Death & Dismemberment – Key Provisions
• Basic AD&D pays you and your beneficiary a benefit for loss of life or other injuries resulting from a covered
accident. 100% is paid for loss of life. A lesser percentage is paid for other injuries such as loss of sight or
speech, paralysis, and dismemberment of hands or feet.
• Basic AD&D benefits are paid regardless of other coverages you may have.
• You are automatically enrolled for an amount equal to your Basic Life coverage amount.
20 Benefits Guide 2019VOLUNTARY LIFE
Eligibility
All full-time and part-time benefit eligible associates may purchase voluntary employee optional life coverage for
1.0 to 7.0 times your covered annual earnings up to a maximum of $2,500,000. You must elect voluntary life insurance
at enrollment. Rates for this insurance are determined by your use of tobacco, which is self-reported. Premiums are
deducted on an after tax basis from your paycheck.
When Coverage Begins
Coverage is effective the 1st of the month following 30 days of employment.
When Coverage Ends
Coverage will end at the termination of your employment. You may port (continue) your group coverage in an
amount equal to or lower than your current benefit amount. Coverage amounts will be subject to maximum of five
times your annual earnings or $1 million, whichever is less. Please see the Life Plan book for additional
instances when coverage ends.
Voluntary Employee Optional Life – (100% Associate Paid)
• Enrollment at time of hire. You can elect a coverage up to the Guaranteed Issue amount of up to the lesser
of 2.0 times your covered annual earnings or $750,000, without providing evidence of insurability to The Prudential
Insurance Company of America. If you enroll in voluntary life any other time outside your hire date or increase your
amount of coverage at open enrollment, you will be required provide evidence of insurability.
LIFE - BASIC AND AD&D
• If you are terminally ill, you can get a partial payment of your group life insurance benefit. You can use this payment
as you see fit. In the event of your death, your beneficiary will receive a benefit payout which has been reduced by
the amount you receive.
• Payment of premium can be waived if you are totally disabled for 6 months, you are less than 60 years old when
disability begins, and you continue to be totally disabled. The waiver terminates at social security retirement age.
This provision may vary by state.
• Coverage will be reduced as you age – 50% at age 70.
.
Benefits Guide 2019 21Spouse - Dependent Life (100% Associate Paid)
Spouse Term Life AD&D
Eligibility May purchase only if Associate elects Voluntary May purchase only if Associate elects Voluntary
Life. AD&D.
Coverage and Limits 1. Coverage amount cannot be greater than 50% Purchase a coverage amount equal to 65% of
of the Associate Voluntary coverage amount. the Associate Voluntary AD&D coverage with a
maximum of $1 Million.
2. May elect $10K to $250K in $25K increments.
Evidence of Insurability At time of hire may elect up to 25K without EOI. There are no health requirements.
If increased or elected any other time, EOI will be
required.
Age Reduction 50% at age 70 50% at age 70
Portability Coverage will end at the termination of your May be ported only if Associate coverage is
employment. You may port (continue) your ported.
group coverage in an amount equal to or lower
than your current benefit amount only if Asso-
ciate average is ported. Coverage amounts will
be subject to maximum of five times your annual
earnings or $1 million, whichever is less.
Child Dependent Life (100% Associate Paid)
Child(ren) Term Life AD&D
LIFE - BASIC AND AD&D
Eligibility May purchase only if Associate elects Voluntary May purchase only if Associate elects Voluntary
Life. Coverage may begin from live birth and con- AD&D. Coverage may begin from live birth and
tinues to age 26. continues to age 26.
Coverage and Limits 1. Coverage amount cannot be greater than 50% Purchase a coverage amount equal to 25% of
of the Associate Voluntary coverage amount. the Associate Voluntary AD&D coverage with a
maximum of $75K.
2. May elect either $5K or $10K for each child.
Evidence of Insurability There are no health requirements. There are no health requirements.
Portability Coverage will end at the termination of your May be ported only if Associate coverage is
employment. You may port (continue) your group ported.
coverage in an amount equal to or lower than the
current coverage level only if Associate average is
ported.
Voluntary Optional Accidental Death & Dismemberment (100% Associate Paid)
Eligibility
All full-time and part-time benefit eligible Associates may purchase coverage for 1.0 to 10.0 times annual earnings to a
maximum of $2,500,000. Premiums are deducted on an after tax basis from your paycheck.
When Coverage Begins and Ends
Coverage is effective the 1st of the month following 30 days of employment. Coverage ends on the last day
of employment.
Voluntary Accidental Death & Dismemberment – Key Provisions
• There are no health requirements for this coverage
• Coverage will be reduced as you age – 50% at age 70.
22 Benefits Guide 2019Short-Term Disability
Eligibility
Short-Term Disability (STD) is available to Full-Time and Part-Time benefit eligible associates who are
regularly scheduled 40 hours per pay period.
When Coverage Begins
Coverage is effective the 1st of the month following 30 days of employment.
When Coverage Ends
Coverage ends on the last day of employment or when you cease to be an eligible associate. Please see the
Short Term Disability Plan book for additional instances when coverage ends.
Benefits of the STD Plan
• Full-time associates: There is no cost to you. You are automatically enrolled in this employer paid benefit.
• Part-time associates: Have the option to purchase this coverage and pay 100% of the premium after tax.
• You can have coverage without providing proof of good health.
• This plan provides a benefit for disability, illness or injury that is not work-related, including pregnancy.
• Your plan also includes Rehabilitation benefits that provide services and support targeted at helping you return
to active work.
SHORT-TERM DISABILITY
Pre-existing Condition
STD benefits will not be paid for a disability that begins within 3 months of your coverage effective date and due
to a pre-existing condition. A pre-existing condition is an injury or sickness for which you received medical
treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for which you followed
treatment recommendations during the 12 months prior to your effective date of coverage.
Coverage Waiting Period Elimination Period Benefit Duration
Full-time 1st of the month following 14 Calendar days of an 70% of pre-disability weekly 24 weeks
30 days of employment injury or illness earnings, not exceeding
maximum of to $2,500
Part-time 1st of the month following 14 Calendar days of an 60% of pre-disability weekly 24 weeks
30 days of employment injury or illness earnings, not exceeding
maximum of to $2,500
Benefits Guide 2019 23Long-Term Disability
Eligibility
Long-Term Disability (LTD) is provided at no charge to all Full-time associates only who are regularly scheduled to work
72 hours or more per pay period.
When Coverage Begins
Coverage is effective the 1st of the month following 30 days of employment.
When Coverage Ends
Coverage ends on the last day of employment or when you cease to be an eligible associate. Please see the
Long Term Disability Plan book for additional instances when coverage ends.
Benefits of the LTD Plan
• Your monthly LTD will be 50% of their monthly pre-disability earnings, up to a maximum of $15,000.
• Provides coverage for on–and-off-the-job accidents.
• Benefits are payable directly to you to be spent any way you choose.
• Pays in addition to any other coverage you may have.
• Benefits may be reduced if receiving other income benefits
• Benefits will not be paid for a disability that begins within 12 months of your coverage effective date and is due to
a pre-existing condition unless you were treatment free for 3 consecutive months after the coverage effective date.
LONG-TERM DISABILITY
• Fast and accurate claims service.
Coverage Waiting Period Elimination Period Benefit Duration
CORE LTD 1st of the month following 180 calendar days 50% up to $15K monthly Later of age 65 or
Employer 30 days of employment Social Security Normal
paid Retirement Age
BUY-UP LTD 1st of the month following 180 calendar days 70% up to $15K monthly Later of age 65 or
Associate 30 days of employment Social Security Normal
paid Retirement Age
24 Benefits Guide 2019Voluntary Permanent Whole Life
Eligibility
Voluntary Permanent Whole Life Insurance is an associate paid benefit available to all associates
that work over 20 hours per week.
To supplement your Basic Life AD&D insurance provided by AMITA Health, you may purchase
additional life insurance coverage for yourself, your spouse and dependent children through
Voya.
Voluntary Permanent Life insurance provides a financial benefit that your family can depend on and getting it at work
is easier, more convenient and more affordable than doing it on your own. If you have financial dependents- a spouse,
children or aging parents, having life insurance is a responsible and smart decision. Premiums never increase due to an
increase in age and the coverage is fully portable.
Accelerated Life Benefit Included: A lump sum benefit is paid to you if you are diagnosed with a terminal condition,
as defined by the plan
VOLUNTARY PERMANENT WHOLE LIFE
Medical Evidence of Insurability (EOI) is required
if you enroll at a later date, including future Open Enrollments.
Associate Coverage
• Coverage is available for you in $10,000 increments up to $100,000.
• No medical questions asked, if you enroll when initially offered the coverage unless you elect over the guarantee
issue amount.
Spouse Coverage
• Coverage is available for you in $5,000 increments to up $25,000.
• Associates and spouses must elect coverage prior to reaching age 70.
Child(ren) Coverage
• Term Life Insurance
• No medical questions asked, if you enroll in up to the guarantee issue amount when initially offered
the coverage. $5,000-$10,000, 15 days - 24 years.
Associate 15-50 Up to $100,000 ($10,000 increments)
51-65 Up to $50,000 ($10,000 increments)
66-70 Up to $30,000 ($10,000 increments)
Spouse 15-65 Up to $25,000 ($5,000 increments)*
66-70 $5,000 or $10,000*
Dependent Child 15 days-24 years $5,000 or $10,000*
*Spouses and Children are limited to 50% of the Associate face amount for amounts in excess of $5,000
For more information regarding Voluntary Permanent Whole Life Insurance, please call Voya at 1-800-537-5024
or visit www.voya.com
Benefits Guide 2019 25You can also read
