Proprietary 8-23 BENEFITS ENROLLMENT GUIDE 2024 Choose the coverage that’s right for you
Proprietary 8-23 Benefit Resource Phone Website Farmers® Agent Benefits Call Center n Add A New Participant Profile n Terminate Participant Benefits n General Coverage Questions 877.862.1237 www.farmersagentsbenefits.com MetLife Life and AD&D Insurance (Policy #110031-1-G) n Medical Underwriting & Claims Office n Conversion Unit n Portability Unit 800.638.6420 (prompts 1 & 2) 877.275.6387 866.492.6983 www.mybenefits.metlife.com MetLife Legal n Will Preparation/Digital Estate Planning & Will Preparation/Estate Resolution Services/Online Will prep 800.821.6400 www.legalplans.com/employeebenefit-services-will-preparation/ Online Will prep: https://www.willscenter.com www.legalplans.com/estate planning MetLife Long-term Disability (LTD) (Policy #110031-1-G) n General LTD Questions Hotline/Claims Office n Claim Form Request 800.438.6388 800.432.6761 www.metlife.com Unum n Enhanced LTD (ELTD) or Business Overhead Expense (BOE) Hotline n ELTD or BOE Claim 800.633.7490 800.633.7490 www.unum.com/claims MetLife Agent Assistance Program (Services through TELUS Health 888.319.7819 https://metlifeeap.lifeworks.com (user name: metlifeeap password: eap) Travel Assistance and Identity Theft Program (AXA Assistance USA, Inc.) 800.454.3679 www.metlife.com/travelassist (Login: axa password: travelassist) Dental Plans n Aetna Dental Plans (Policy #810111 and #176692) n MetLife Safeguard DHMO Plan (SG-185, Group #142143) 877.238.6200 800.880.1800 www.aetna.com/docfind/custom/ farmersagents Superior Vision by MetLife 833.393.5433 www.mybenefits.metlife.com Supplemental Plans n Critical Illness Insurance (CII) Plan n Metlife Hospital Plan n Accident Plan MetLife Accident & Health Claims: 866-626-3705 Service Center Hours 8 am - 8 pm ET M-F Claim submission: visit mybenefits.metlife.com Agent Errors & Omissions n Report Claims (Lancer) n General Coverage Questions (CalSurance) n Request Certificates 800.821.0540 866.893.1023 www.calsurance.com Deferred Compensation Plan (Empower) n Inquiries/Request Information 800.487.0042 www.farmersagentsbenefits.com See page 27 COBRA n HealthEquity 866.747.0039 www.mybenefits.wageworks.com Farmers Agent Benefits Dept. n Change Status/Position agentbenefits@farmersinsurance.com 800.432.6761 877.771.1360 (fax) www.farmersagentsbenefits.com CONTACT LIST For any benefit questions or concerns, please use the contact information below.
Proprietary 8-23 TABLE OF CONTENTS Farmers® AgentGroupBenefitsProgram. . . . . . . . . . . . . . . . . . . . . . 1 Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 LifeandAD&DInsurancePlans...........................3 DisabilityInsurancePlans.............................8 TheDentalPlans................................13 TheVisionPlan.................................17 CriticalIllnessInsurance(CII)Plan . . . . . . . . . . . . . . . . . . . . . . . . .19 HospitalPlan..................................21 AccidentPlan..................................22 ErrorsandOmissionsInsurance . . . . . . . . . . . . . . . . . . . . . . . . . .23 The Farmers Agency Force Deferred Compensation Plan . . . . . . . . . . . . . . . 27 Fidelity Bond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 EnrollinginBenefits...............................32 HowtoAddaStaffMember...........................34 How to Terminate a Staff Member’s Benefits . . . . . . . . . . . . . . . . . . . . 35 How to Get a Rate Quote (New Participant Modeler) . . . . . . . . . . . . . . . . .35 QualifiedStatusChange.............................36 COBRAContinuationCoverage. . . . . . . . . . . . . . . . . . . . . . . . . .38 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 IMPORTANT — PLEASE READ This brochure highlights the main features of the Farmers® Agent Group Benefits Program. This brochure does not include all plan rules and details. The terms of the benefit plans are governed by legal documents, including insurance contracts. Should there be any inconsistencies between this brochure and the legal plan documents, the plan documents govern. We reserve the right to change or discontinue benefit plans at any time. The dental, vision, life, and disability plans are ERISA plans filed as a Multiple Employer Welfare Arrangement (MEWA). Farmers agents are a group of independent employers providing benefit options for their own employees. The dental, vision, life, long term disability, critical illness, hospital, accident and deferred compensation plans are all voluntary. Participants may pick and choose the benefit plans that suit their insurance needs.
Proprietary 8-22 FARMERS® AGENT GROUP BENEFITS PROGRAM The Farmers® Agent Group Benefits Program consists of many plans that, together, offer valuable coverage for you and your family. The benefits program includes plans that help pay for dental, and vision expenses, provide income if you’re ill or injured and unable to work, and provide financial support for your family in case you die or are seriously injured in an accident. This document has been developed to serve as a guide for enrolling in the Farmers Agent Group Benefits Program. It provides information about the benefit programs available to you and how to enroll in them. If you want more detailed information about the individual plans, you can request a summary plan description (SPD) directly from the Farmers Agent Benefits Department. You may also access the SPDs online at www.farmersagentsbenefits.com. This guide is merely an overview of the benefit plans available through the program. Please refer to the carrier-specific SPD for additional coverage details. ELIGIBILITY All participants (agents, district managers and staff members of agents and district managers) are eligible for benefits on the first day of the month following 30 days of full-time appointment (20 hours or more per week). For example, those with a March 1 appointment date are eligible on April 1. If the appointment date is March 2, the eligibility date is May 1. The 30-day waiting period does not apply to E&O coverage. Newly appointed agents and district managers will be automatically enrolled in the Errors & Omissions Level 1 Coverage with limits of liability of $1,000,000 each claim/$2,000,000 annual aggregate. Your eligible dependents Dependents that may be covered are your spouse, registered domestic partner, and eligible children as described below: n A natural child n An adopted child (including a child from the date of placement with adopting parents until the legal adoption) n A stepchild (including the child of a domestic partner) n A foster child n A disabled child dependent who exceeds the maximum age. Proof that the covered dependent is fully disabled must be submitted to the carrier no later than 31 days after the date the child reaches the maximum age. For more information on what constitutes a disabled child, please refer to your SPD. Note: Coverage will not be extended to the spouse or child(ren) of an adult child for any available plans. 1 WHO CAN I CALL? The Farmers Agent Benefits Call Center, at 877.862.1237, can answer questions about: n The enrollment process n The status of your enrollment n Eligibility n COBRA coverage and administration n Continuation coverage See the Contact List on the inside front cover of this guide for other important phone numbers. eligibility
Proprietary 8-23 2 For the Aetna dental plans An adult child may be covered to age 26, and does not need to be a full-time student, does not need to be unmarried, and does not need to reside with you. Eligibility guidelines may vary by state. Position Plans for Which You Are Eligible Agents and District Managers MetLife Hospital Plan, Critical Illness Insurance (CII), Accident Plan, dental, vision, life and AD&D, voluntary AD&D, long-term disability (LTD), Enhanced LTD, Errors and Omissions, and Fidelity Bond Staff Members of Agent and District Managers MetLife Hospital Plan, Critical Illness Insurance (CII), Accident Plan, dental, vision, life and AD&D, and voluntary AD&D Reserve Agents Errors and Omissions and Fidelity Bond AGREEMENT TO PARTICIPATE If you select dental, vision, group life, long-term disability (LTD), the MetLife Hospital Plan, Accident Plan or Critical Illness Insurance coverage, you must participate in the plan for the entire year unless you experience a qualified status change. For MetLife Life Insurance and the Safeguard Dental Plan An adult child may be covered to age 26, provided they are unmarried, supported by you, and not employed on a full-time basis. The child does not need to be a full-time student.
Proprietary 8-23 LIFE AND AD&D INSURANCE PLANS These plans provide life insurance and accidental death and dismemberment (AD&D) insurance for you and your family. Life and AD&D insurance is underwritten by MetLife. If you elect coverage, you must participate in the plan until the end of the plan year, unless you experience a qualified status change. The amount of life and accidental death and dismemberment (AD&D) insurance you may buy depends on your position. You can enroll yourself and your dependents in the Life and voluntary AD&D plans within 31 days of your initial eligibility. If agents and district managers don’t enroll within 31 days of your initial eligibility date, you’ll need to complete an Evidence of Insurability form and it is subject to approval by the insurance carrier. 3 life and AD&D When you buy life insurance, you are automatically covered by an equal amount of AD&D insurance. Voluntary AD&D Insurance Classification Amounts Agents, District Managers and Staff Members of Agents and District Managers n $50,000 up to $300,000 maximum in increments of $50,000 Eligible Dependents of Agents, District Managers and Staff Members of Agents and District Managers Family AD&D insurance: n Equal to your coverage for your spouse n 10% of your coverage to a maximum of $30,000 for each child The terms of your benefit plans are governed by legal documents. Please refer to your MetLife SPD for more details and plan limitations. Note: All life insurance coverage ends for spouse/domestic partner at the end of the year of 70th birthday. All life insurance coverage ends for child(ren) at the end of the month of 26th birthday. Basic Group Life and AD&D Insurance Classification Amounts Agents and District Managers First Year Options: (flat amounts): n $50,000 n $100,000 n $150,000 n $200,000 n $250,000 1-Yr Anniversary Options: n $50,000 increments up to $1,200,000, not to exceed eight times annual commissions. The maximum benefit is the lesser of $1,200,000 or eight times annual commissions. AD&D: Equal to life insurance coverage Eligible Dependents of Agents and District Managers and Eligible Dependents of Staff Members of Agents and District Managers Spouse/Domestic Partner: n $12,500 n $25,000 n $50,000 n $100,000 Child: n $10,000 AD&D: Equal to life insurance coverage Staff Members of Agents and District Managers $25,000 up to $250,000 maximum in increments of $25,000 Certain age restrictions apply to staff members AD&D: Equal to life insurance coverage See Evidence of Insurability rules under the “Basic Life and AD&D Insurance Plan” heading.
Proprietary 8-23 4 MetLife Basic Life and AD&D Insurance Plan Coverage options for agents and district managers During the first year that you are eligible for coverage as an agent or district manager, you may elect benefit options of $50,000, $100,000, $150,000, $200,000 or $250,000 if you request this coverage within 31 days after you become eligible. On your first year anniversary, you will be able to elect insurance coverage in $50,000 increments, up to $1,200,000, not to exceed 8 times annual commission. The amount available to enroll without providing evidence of insurability is dependent on your age. If you apply for more than the level provided for your age, you must complete a MetLife Evidence of Insurability form and carrier approval for the amount over the indicated level must be granted.* All other classes are eligible for the amounts of coverage indicated on page 6. Evidence of insurability is required for any amounts above $150,000 when initially eligible. All amounts and increases require evidence of insurability after the initial enrollment opportunity. If you want to change the amount of your life insurance, call the Farmers Agent Benefits Call Center for information. You may be required to submit evidence of insurability. You may also be required to submit medical evidence at your expense. Covering your family You can select life insurance for your spouse or child(ren) only if you elect life insurance for yourself. If you elect any amount or increase your spouse coverage after you are initially eligible, evidence of insurability is required. For spouse coverage, life and AD&D insurance terminates at age 70 and dependent children are eligible until age 26. The termination of coverage will occur on the January 1 following your spouse’s 70th birthday. Dependent children life and AD&D coverage will terminate on the first of the month following your child’s birthday month. Spouse and child(ren) benefits will also terminate upon the death of the active or former agent or district manager. The monthly cost for child life insurance is a flat rate, regardless of the number of children that you cover. Additional benefits When you enroll for life and AD&D insurance, you are automatically covered for an additional 100% of AD&D insurance if your death is caused by an accident while riding in a common carrier. The AD&D benefit is payable in addition to life benefits. If you die in a covered accident while driving or riding in a private passenger car and you were properly using a seat belt, an additional 10% of the principal sum of AD&D coverage is payable (not to exceed $25,000). Evidence of insurability If you do not return the Evidence of Insurability form, depending on what you have requested, you will be prevented from increasing your amount of coverage until the form is received and approved. Also, if you do not apply for benefits within the first 31 days of eligibility and do not return the Evidence of Insurability form, then you will not have coverage until that form has been submitted and approved. Group life coverage may be reduced depending on fluctuating annual commissions. Agent and district manager commissions are reviewed annually. Group Life coverage and premium may be reduced to avoid exceeding 8x annual commission. * If you apply for any increase after the 31-day window following your first-year anniversary, you must complete a MetLife Evidence of Insurability form for any request, and carrier approval for the requested amount must be granted. Your increase request can be made in $50,000 increments, up to a maximum request of $1,200,000, and is subject to a limit of eight times your prior year’s annual net commissions. MetLife will notify you of its decision regarding your request. plans
Proprietary 8-22 AD&D insurance This insurance is payable for loss of limb, eyesight, speech, hearing, life, or paralysis caused by an accident. The full amount is paid for loss of life, total and irreversible paralysis of all four limbs, brain damage, and loss of speech and hearing. A percentage of the full amount is paid for loss of limb, eyesight, speech, or hearing and loss of the thumb and index finger of the same hand. Total disability benefits You are eligible to continue the amount of your group life insurance without premium payment if you become totally disabled under the “extended death benefits during total disability” provision of the plan. To port coverage, you must do so within 31 days of being disabled. Upon termination of appointment or work for an agent or district manager, the death benefit is extended for one year as long as coverage was in force on the date disability occurs. If the participant was covered less than a year, the death benefit is extended for the length of time coverage was in force. Premium is waived. Disability must occur before age 60. The extension ends 12 months from the termination of coverage. The 31-day portability option is available when coverage terminates. Note, portability conversion is not available at the end of the extension period. n DM & agents, total disability must start before the participant attains age of 65. n Staff of agents or DMs, total disability must start before staff member attains age of 60. Upon Termination of employment, death benefit is extended for one year as long as coverage was in force on date disability occurs. If the employee was covered less than a year, death benefit is extended for length coverage was in force. Premium is waived. Disability must occur before age 60. Extension ends 12 months from termination of coverage. The 31 day portability option is available only when coverage terminates. Note, portability conversion is not available at the end of the extension period. n DM & Agents — total disability must start before Agent attains age of 65. n Staff of Agents — total disability must start before Agent attains age of 60. Submitting a claim Contact the Farmers Agent Benefits Department if you need to submit a life insurance claim. If the Farmers Agent Benefits Department is not notified of a claim, premiums will continue to be charged. In most cases, basic life insurance claims should be processed by the carrier within 10 business days after receipt of all required paperwork. Portability Portability is a feature available with your life insurance and AD&D benefits. If you are eligible and you choose to port your coverage when you leave, you can continue group coverage at your 5
Proprietary 8-23 6 own expense. This group insurance is administered through MetLife, and the premium must be submitted directly to MetLife on a monthly basis. You can continue this same amount or a lesser amount of coverage, but coverage cannot exceed $2,000,000, or go below $10,000. The application period for portable term coverage is 31 days from the date of termination of benefits. You must elect portable coverage in order for your dependents to elect portable coverage. Michigan residents can port a maximum of $173,400, and portability coverage reduces by 50% at age 70 and terminates at age 100. In the event of your death, your spouse is eligible to port up to age 70 and dependent children are eligible to port until age 26, provided they are not employed on a full-time basis. Converting life insurance You may convert the amounts of life insurance you lose when you leave to an individual whole life insurance policy by purchasing the policy at standard rates from Mass Mutual. If you have questions, you can arrange a meeting with a local Barnum Financial Group professional by calling 877.275.6387 Monday - Friday, 9:00 a.m. to 6:00 p.m. (ET). You will not have to submit evidence of insurability if you choose to convert your coverage. However, you must apply for conversion within 31 days of when your coverage ends, or else you will not be eligible for conversion. You will receive a conversion notice from MetLife when you leave. Travel assistance Participants in MetLife’s AD&D plan automatically receive the emergency travel assistance program, provided by AXA Assistance USA. This plan provides professional assistance for travelers (including a spouse/registered domestic partner and eligible dependents) who are traveling on business or pleasure almost anywhere in the world and at least 100 miles or more from home. You can learn more by contacting AXA at 800.454.3679. AXA’s Travel Assistance program provides a wide range of services through a network of highly qualified professionals who are multilingual and board-certified physicians. Some of the services available include assistance 24 hours a day for medical emergencies, emergency prescription services, evacuation, return of mortal remains, care for minor children, legal and interpreter referrals, as well as assistance to locate lost luggage. Will preparation service Participants in MetLife’s Basic Life plans are automatically eligible for the Will Preparation Service provided by MetLife Legal Plans, a MetLife company. Fees for a participating attorney to prepare or update a will for you and your spouse are fully covered, including telephone and office consultations. If you use a nonnetwork attorney, you will receive reimbursement for eligible services up to a set dollar amount. To find out more, call the MetLife Legal Plans’ toll-free number at 800.821.6400. THE ACCELERATED BENEFIT OPTION: Under MetLife’s Accelerated Benefit Option, if you become terminally ill (as determined by the plan), you may be eligible to receive a portion of your group life insurance benefits while you are still living. Benefits not paid in advance will remain with the plan and will be payable to your beneficiary.
Proprietary 8-23 Identity theft program Participants in MetLife’s AD&D plan automatically receive Identity Theft Solutions coverage, provided by AXA Assistance USA. This service is available at no additional cost and provides you and your dependents with assistance in obtaining free credit reports, educational materials on identity theft and help placing “fraud alerts” with credit bureaus, as well as 24/7 access to case managers. Case managers can provide assistance with taking inventory of lost or stolen items and directing you to the appropriate contacts for resolution. They will help you with police and credit reports, contacting credit or fraud departments, government agencies and local law enforcement, as well as filing complaints with the Federal Trade Commission. MetLife Voluntary AD&D Insurance This insurance is payable for loss of limb, eyesight, speech, hearing, life, or paralysis caused by an accident. The full amount is paid for loss of life, total and irreversible paralysis of all four limbs, brain damage, and loss of speech and hearing. A percentage of the full amount is paid for loss of limb, eyesight, speech, or hearing and loss of the thumb and index finger of the same hand. You may purchase MetLife Voluntary AD&D insurance whether or not you buy group life and AD&D insurance. Coverage options You can elect from $50,000 to $300,000 of voluntary AD&D coverage in multiples of $50,000. You also can elect to cover your spouse for an equal amount and your children for 10% of your insurance amount, to a maximum of $30,000 per child. Your spouse’s coverage terminates at the end of the calendar year in which he or she reaches age 70. A child may be covered until age 26. Submitting a claim Contact the Farmers Agent Benefits Department if you need to file a Voluntary AD&D insurance claim. What the AD&D Plans do not cover AD&D insurance plans do not cover certain types of losses, including those associated with the following: n Intentionally self-inflicted injury while sane or insane, suicide, or attempted suicide n Disease of the body, bodily or mental infirmity, or any bacterial infection other than bacterial infection due directly to an accidental cut or wound n War or any act of war, declared or undeclared These are not the only exclusions under these plans. For information on other limitations and exclusions, and for more details on those listed here, please review the SPD. 7
Proprietary 8-23 8 DISABILITY INSURANCE PLANS MetLife Long-Term Disability (LTD) Insurance Plan The LTD plan provides a monthly benefit if you become disabled. If you are an agent or district manager, you will have the option to enroll in the MetLife LTD Insurance Plan. If you elect coverage, you must participate in the plan until the end of the plan year, unless you experience a qualified status event. Participants who have previously waived coverage will be subject to restrictions and the 3/12 pre-existing condition clause described in the box below. You are disabled when MetLife determines that you are unable to perform with reasonable continuity the Substantial and Material Acts necessary to pursue your Usual Occupation in the usual and customary way and you have a 20% or more loss in your monthly new business commissions due to the same sickness. After your elimination period of 180 days plus the following 24 months of continuous disability, you are disabled when MetLife determines that, due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fit by education, training or experience. Note: Elimination period means the period of your disability during which MetLife does not pay benefits. The elimination period begins on the date that you become medically disabled and continues for 180 days. Your monthly LTD benefit is 60% of your new business commissions. The highest benefit payable is $15,000 per month. LTD coverage does not require an “evidence of insurability” form, if you enroll within 31 days of becoming eligible. If you wish to enroll at any time after that, you will need to complete the form, and it is subject to approval by the insurance carrier. disability plans
Proprietary 8-22 Pre-existing condition clause Coverage under the LTD plan is subject to a 3/12 preexisting condition clause. This means that a pre-existing condition review will be conducted if you submit an LTD claim within the first 12 months of your coverage effective date. If it is determined that you received care, treatment, or consultation for the disabling condition within the three months prior to the effective date of your coverage, then this condition will not be covered under the policy. Benefits limitation In addition, benefit coverage for disabilities due to mental illness, alcoholism, drug abuse, neuromusculoskeletal/Soft Tissue Disorder and Chronic Fatigue Syndrome is limited to a maximum of two years, unless the patient is confined to a hospital. Benefits are not paid for disabilities resulting from intentionally self-inflicted injuries, active participation in a riot, loss of a professional license or certification, or commission of a crime for which you have been convicted under state or federal law. Your plan will not cover a disability due to war, declared or undeclared, or any act of war. Your LTD benefit will be reduced by any disability benefits you receive or are eligible to receive, including workers’ compensation, federal or state benefits, Social Security, other group disability plans, and by new business commissions and any service fees you receive from any Farmers carrier. Work incentive benefit For the first 12 months of being disabled and receiving a disability payment, your monthly disability payment will not be reduced as long as your new business commissions plus the gross disability payment do not exceed 100% of your pre-disability monthly new business commissions. The length of time LTD benefits can be paid depends on your age when you become disabled, as shown in the chart below. 9 Your Age at Disability Maximum Benefit Period Less than age 60 To age 65 Age 60 60 months Age 61 48 months Age 62 42 months Age 63 36 months Age 64 30 months Age 65 24 months Age 66 21 months Age 67 18 months Age 68 15 months Age 69 and over 12 months WHAT IS A PRE-EXISTING CONDITION? You have a pre-existing condition if: n You received medical treatment, care, or services for a diagnosed condition or took prescribed medication for a diagnosed condition in the three months immediately prior to the effective date of coverage; and n The Disability caused or substantially contributed to by the condition begins in the first 12 consecutive months after the effective date of coverage.
10 A family survivor benefit pays your spouse, registered domestic partner or children a lump-sum benefit equal to six months of your gross disability payment following your death. This benefit is payable if your disability had continued for at least six months prior to your death, and you were receiving or were entitled to receive payments under the plan. Agent Assistance Program All agents and district managers have access to the Agent Assistance Program regardless of enrollment in the MetLife LTD Plan. All of us, at one time or another, experience problems that are difficult to handle. MetLife provides trained and experienced counselors that can help you identify and resolve your problems and those of any family member in a professional, confidential manner. Some of the issues the MetLife Agent Assistance Program can help you with include stress, financial issues, parenting, legal concerns, workplace issues, childcare, elder care, alcohol and/or drug abuse, communication skills and other matters of concern. You and the members of your household are allowed up to five counseling sessions per incident per year and services can be received in any of three ways — by calling the Agent Assistance Program’s toll-free number, by making an appointment with an Agent Assistance Program counselor or by visiting the Agent Assistance Program’s website at metlifeeap.lifeworks.com, username: metlifeeap and password: eap. The program is available 24 hours a day, 7 days a week, 365 days a year through Agent Assistance Program toll-free number 888.319.7819. Terminal illness benefit If you become terminally ill while you are disabled and are not expected to live more than 12 months, you may be eligible for a terminal illness benefit. The terminal illness benefit increases your monthly disability payment to 80 percent of the first $25,000 of your pre-disability commissions for a maximum of 12 consecutive monthly payments. You also may elect to receive a single lump-sum benefit. You or your legal representative must send MetLife a signed physician’s certification documenting your terminal illness. In addition, MetLife may request an examination by a physician of their choice, at their expense.
Proprietary 8-22 11 Porting long-term disability insurance You can port your long-term disability insurance to an individual policy if you have been insured for at least 12 consecutive months under the Long-Term Disability Plan available through the Farmers Agent Group Benefits Program and your coverage ends for any reason except for the following: n You are or become insured under another group long-term disability plan within 31 days after your appointment agreement ends, n You are disabled under the terms of the plan, n You recover from a disability and do not reinstate your appointment agreement, or n Your coverage under the plan ends because: — The plan is cancelled, — The plan is changed to exclude the group of participants to which you belong, — You are no longer in an eligible group, — You end your working career or retire and receive payment from any retirement plan, or — You fail to pay the required premium under this plan. To continue coverage as an individual, you must apply in writing and pay your first premium within 31 days after your group coverage ends. Unum Enhanced Long-Term Disability Plan Your group Long-Term Disability (LTD) policy insures 60% of your new business income to a maximum of $15,000 a month ($180,000 a year). The individual Enhanced Long-Term Disability Plan (also referred to as the Individual Disability Insurance (IDI) with Guaranteed Long Term Care (LTC) Exchange Option) enables those who financially qualify to cover up to 60% of total insurable income up to $7,500 per month without evidence of insurability when first eligible to enroll. Amounts greater than $7,500 a month and/or any applications submitted outside of the newly eligible enrollment process will require evidence of insurability up to an overall monthly maximum of $15,000. In addition to the increased income replacement, plan will also pay an additional 40% income replacement (up to $12,500 a month) for a disability that is catastrophic in nature. In total, this could result in a 100% income replacement. Also, between the ages of 60 and 70, the entire individual plan can be converted to a Long-Term Care policy without medical evidence of insurability.
Evidence of insurability (EOI) If you currently have an individual Enhanced Long-Term Disability Plan and qualify for additional coverage, the enhanced plan will increase your coverage up to a total of $7,500 a month without medical evidence of insurability. Amounts greater than $7,500 a month will require evidence of insurability up to an overall monthly maximum of $15,000. If you were previously eligible for this coverage and did not choose to enroll, all elected amounts are subject to evidence of insurability. This evidence consists of a copy of your most recent Schedule C’s and a completed medical questionnaire. In some cases, to assist in issuing a policy, an Attending Physician Statement from your primary physician may be ordered from the insurance carrier as well. If evidence is required, once your selections are received by the Farmers Agent Benefits Department, any required forms and instructions for completing these forms will be sent to you automatically. If you do not return the EOI form, you will not have coverage under the requested plan until the insurance company receives the form and approves your application for coverage. 12 The Farmers Agent Benefits Call Center can also tell you if you must complete an EOI form. Refer to the appropriate benefit sections in this booklet for more information. Note: If you qualify for the Enhanced Long-Term Disability Plan based on your Form 1099 income, you will receive a communication with enrollment instructions from the Farmers Agents Benefits Department at the next annual enrollment opportunity. Also, the Enhanced Long-Term Disability Plan is independent of the group disability plan. Converting enhanced disability The Enhanced Long-Term Disability Plan is fully portable. Once you are no longer part of the Farmers Agent Group Benefits Program, you will receive notification from Unum on your options of continuing coverage. Proprietary 8-23
Proprietary 8-22 13 THE DENTAL PLANS The dental plans offer comprehensive dental coverage. If you elect coverage, you must participate in the plan until the end of the plan year unless you experience a qualified status change. There are three types of dental plans to choose from if you live in the network areas: n Aetna DMO Dental Plan (a prepaid dental plan). If you live in California, you also have the option to choose coverage under the MetLife SafeGuard Dental Plan, a DMO dental plan. n Aetna PPO Dental Plans (Low Option and High Option), which allow you to receive dental care from in-network or out-of-network dentists. n Aetna Out-of-Area PPO Dental Plans, which are available if you live outside of the network service areas for the Aetna DMO or PPO Dental Plans; you may use any dentist. It is your responsibility to determine if you live in a plan’s network area before you choose coverage under that plan. dental plans The Aetna DMO Prepaid Dental Plan and MetLife SafeGuard Dental Plan are known as “dental maintenance organizations” or DMOs. That means that dental benefits are provided only if you see a dentist from the plan’s panel of participating dentists. To select an Aetna participating dentist, visit www.aetna.com/docfind/custom/ farmersagents or call Aetna Dental Customer Service toll-free at 877.238.6200. For a MetLife SafeGuard participating dentist, visit www.metlife.com/mybenefits or call MetLife SafeGuard Customer Service toll-free at 800.880.1800.
Proprietary 8-23 14 Service Aetna DMO Prepaid Dental Plan MetLife Safeguard Dental Plan (Only available in California) Calendar Year Deductible N/A N/A Calendar Year Maximum N/A N/A Preventive Care (oral exams, cleanings, x-rays) 100% after $5 office visit copay 100% after $5 office visit copay Basic Treatment* n Fillings n Root Canals n Extractions n Periodontics $10 – $35 $70 – $340 $11 – $100 $27 – $300 $10 – $80 $105 – $275 $0 – $130 $38 – $300 Major Procedures* n Inlays/crowns n Dentures $180 – $220 $275 – $350 $165 – $185 $210 – $225 Orthodontia (children & adults) 100% after $2,000 copay** 100% after $1,695 copay** Waiting Period for Major Procedures N/A N/A * The dentist determines the amount you pay for services . You must have a referral from your PCD in order to receive coverage for any services a specialist dentist provides. ** This includes copays for screening exams, diagnostic records, treatment, and retention. Members do not need a referral from their PCD for orthodontic services. The terms of your benefit plans are governed by legal documents. Please refer to your Aetna or MetLife Safeguard SPD for more details and plan limitations. Here is a partial list of services covered by the Aetna DMO Prepaid Dental Plan and the MetLife SafeGuard Dental Plan. Aetna DMO Prepaid Dental Plan and MetLife SafeGuard Dental Plan Under both the Aetna DMO Prepaid Dental Plan and the MetLife SafeGuard Dental Plan, you can select a different dental provider for each family member you enroll. Dental benefits are payable only if you seek care from a participating network dentist. If you are electing the Aetna DMO Prepaid Dental Plan or MetLife Safeguard Dental Plan, enter the Primary Care Dentist (PCD) code and name on the “Primary Care Physician Information” page when completing your online enrollment. You will need to enter this information for yourself and each dependent. The dentist that you choose will provide routine care — checkups, cleanings, etc. — and refer you to a specialist, if necessary. If you would like to change the dentist that you have selected, you may call the dental plan’s toll-free number and give them the new dentist’s code number. This toll-free number is listed on your dental I.D. card. Most diagnostic and preventive services are covered at 100% after you pay the office visit copayment. For other services, you pay a copayment directly to the participating dentist. The amount depends on the procedure performed. The SPD tells you the specific copayment for each service. Both plans cover diagnostic and preventive care, including full-mouth x-rays, office visits, and cleanings. Also covered are basic services such as fillings, crowns, periodontal (gum) treatments, root canals, dentures, and oral surgery. Both the Aetna DMO Prepaid Dental Plan and MetLife SafeGuard Plan provide limited orthodontia coverage for children and adults. You do not have to file a claim for dental expenses; all you have to do is pay the dentist the copayment for the dental service at the time you receive treatment.
Proprietary 8-23 15 Aetna PPO Dental Plans The Aetna PPO Dental Plans are dual-option plans. This means that you can receive your dental care from any dentist you choose. However, you can reduce your out-of-pocket dental expenses if you use a provider in the Aetna PPO dental network. There are two PPO options, the High Option (which offers higher benefits) and the Low Option. Both plans pay a higher level of benefits for in-network dental services. In addition, Aetna network dentists are paid for services based on reduced negotiated fees. When you use a dentist outside the Aetna dental network, you may receive a balance bill, as the plan only covers benefits up to the recognized charge limits in your area. You will also have to file a claim. The plans cover preventive, basic, and major services. In addition, the High Option offers orthodontia coverage. After you pay a calendar year deductible, each option pays a calendar year maximum for covered services. The chart below is a partial list of services covered by the Aetna PPO Dental Plans. Aetna PPO Dental Plans Services Low Option PPO Dental* High Option PPO Dental* In-Network Out-of-Network In-Network Out-of-Network Calendar Year Deductible $75 individual $225 family $50 individual $150 family $75 individual $225 family Calendar Year Maximum $1,000 per person $2,000 per person $1,000 per person Preventive Care (oral exams, cleanings, bitewing or full series of x-rays) 100% Deductible waived 90% Deductible waived 100% Deductible waived 90% Deductible waived Basic Treatment (fillings, simple extractions, non-surgical periodontics) 80% 60% 80% 60% Major Procedures (inlays, crowns, fixed bridgework, dentures, general anesthesia) 50% 50% 50% 50% Orthodontia Not covered Not covered Adult and Children: 50% up to $1,000 Orthodontia Lifetime Maximum Waiting Period for Major Procedures None None None None * The state of Texas does not allow for an active dental PPO plan. The Texas Dental PPO plans have same in-network and out-of-network benefits. The benefit coverage level can vary based on the nature of the services. The terms of your benefit plans are governed by legal documents. Please refer to your Aetna SPD for more details and plan limitations.
Proprietary 8-22 Aetna Out-of-Area PPO Dental Plan If you live outside of the network area that serves the Aetna DMO or Aetna PPO Dental Plans, dental coverage is offered under the Aetna Out-of-Area PPO Dental Plan. You may use any licensed dental provider. The Plan does not participate in any dental networks. 16 The chart below is a partial list of services covered by the Aetna Out-of-Area PPO Dental Plans. Aetna Out-of-Area PPO Dental Plans Service Low Option PPO Any Provider High Option PPO Any Provider Calendar Year Deductible $75 individual $225 family $50 individual $150 family Calendar Year Maximum $1,000 per person $2,000 per person Preventive Care (oral exams, cleanings, bitewing or full series of x-rays) 100% Deductible waived 100% Deductible waived Basic Treatment (fillings, simple extractions, non-surgical periodontics) 80% 80% Major Procedures (inlays, crowns, fixed bridgework, dentures, general anesthesia) 50% 50% Orthodontia Not covered Adults and Children: 50% up to $1,000 lifetime Orthodontia maximum Waiting Period for Major Procedures None None The benefit coverage level can vary based on the nature of the services. The terms of your benefit plans are governed by legal documents. Please refer to your Aetna SPD for more details and plan limitations.
Proprietary 8-23 17 THE VISION PLAN You can receive coverage for annual eye examinations and the purchase of eyeglasses or contact lenses through the Superior Vision Network offered by the Superior Vision by MetLife vision program. The plan has two options: the High Option and the Low Option as compared in the chart on the next page. If you elect vision coverage, you must participate in the plan until the end of the plan year, unless you experience a qualified status change. The Superior Vision by MetLife plan (Vision Plan) Open Access provides the flexibility for members to use Vision Care benefits at any location, including specialty optical boutiques or retail chains. While 95% of members choose a Vision Plan Preferred Provider for the enhanced benefits, the plan also includes a generous open access schedule. The Vision Plan offers members discounts on laser vision correction surgery to correct such visual acuity problems as nearsightedness, farsightedness and even astigmatism. For more details, visit www.mybenefits.metlife.com or call 833.393.5433. Finding a Vision Plan provider The Vision Plan offers different ways to help you find a participating provider in your area, or to verify that your current provider is a Vision Plan participant. You should always call a provider to confirm participation in the network. If you require assistance in locating a network provider, use one of the following methods: To find a Vision Plan provider on the web: n Go to www.mybenefits.metlife.com. n Either log in or register. n Type “Farmers Agent Group Benefits Program” as your organization and select “Next”. n Under Vision Benefits, enter your Zip Code and select “Find”. You can search for a Vision Plan provider by entering your ZIP Code or a provider’s specific address or last name. Either option provides you with a geographical map and doctor’s office location and contact information. The Superior Vision by MetLife Plan also offers an automated member service system accessible via a toll-free number. You just call 833.393.5433, and you can: n Enter a provider’s telephone number to verify the office’s participation in the Vision Plan’s network. n Locate a provider by a ZIP Code and obtain a provider’s location information and telephone number. n Request a list of the Vision Plan’s participating providers be mailed to you. n Receive additional assistance from a customer service department representative. vision plan Superior Vision by MetLife offers one of the largest provider networks in the industry, composed of independent eye care professionals and the most retail chains, with more than 146,000 access points across the United States. Find a Plan network provider at www.metlife.com/vision. Download a claim form at www.metlife.com/mybenefits. For general questions, go to www.metlife.com/mybenefits or call 833.393.5433. HEARING AID DISCOUNTS The Superior Vision by MetLife Plan offers members discounts through the Hearing Network on services, hearing aids and accessories. These discounts should be verified prior to service as they are not available in all locations.
Proprietary 8-23 18 Exclusions n Plano lenses (lenses with refractive correction of less than ± .50 diopter) n Two pairs of glasses instead of bifocals n Refitting of contact lenses after the initial (90-day) fitting period See the Benefits Certificate of Coverage on the Empyrean website for additional details. The following is a chart showing coverage with a Superior Network Provider. Visit www.mybenefits.metlife.com for details if you plan to see a provider other than a network provider. Coverage with a participating retail chain may be different. Once your benefit is effective, visit www.mybenefits.metlife.com for details. In the event of a conflict between this information and the applicable contract with the Vision Plan, the terms of the contract will prevail. Benefits may vary by location. The terms of your benefit plans are governed by legal documents. Refer to your Vision Plan SPD for more details and plan limitations. Benefit In-Network Low Option High Option Comprehensive Eye Exam $25 copay; every calendar year $25 copay; every calendar year Contact Lens Exam $30 copay; every calendar year $30 copay; every calendar year Lasik Benefits* Yes Yes Hearing Benefits* Yes Yes Eyeglass Lenses n Single Vision n Bifocal n Trifocal n Lenticular Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Eyeglass Frames n Retail frame n Enhanced frame Every other calendar year $180 allowance $205 allowance Every calendar year $200 allowance $225 allowance Elective Contact Lenses $180 allowance in lieu of eyeglasses $200 allowance in lieu of eyeglasses Necessary Contact Lenses Covered in full Covered in full Lens Options* n Anti-reflective coating – Standard – Premium – Ultra – Ultimate n Polycarbonate lenses n Tints n Progressive lenses – Standard – Premium – Ultra – Ultimate n UV coating n Polarized lenses n Scratch coating Member Out of Pocket Cost $50 $70 $85 $120 $40 adults/$0 children Solid tints $15; Gradient tints $18 Covered in full $110 $150 $225 $12 $75 $15 Member Out of Pocket Cost Covered in full $70 $85 $120 $40 adults/$0 children Solid tints $15; Gradient tints $18 Covered in full $110 $150 $225 Covered in full $75 $15 * Not available at all locations; verify coverage prior to service.
19 Proprietary 8-22 supplemental CRITICAL ILLNESS INSURANCE (CII) Even if you have comprehensive medical insurance, there are still expenses associated with a critical illness that many medical plans are not designed to pay, such as copays, deductibles, out-of-network treatments, childcare, mortgage and utility payments. Critical Illness Insurance provides you with a lump-sum payment that can be used for any purpose in the event you or a covered family member is diagnosed with a covered condition. Covered conditions CII provides you with a lump-sum payment in the event a Covered Family Member is diagnosed with one of the following medical conditions (as they are defined by the group certificate): n Full Benefit Cancer n Partial Benefit Cancer n Heart Attack n Stroke n Coronary Artery Bypass Graft n Kidney Failure n Alzheimer’s Disease n 22 Listed Conditions A Major Organ Transplant Benefit is also included, as well as an annual health screening benefit. Enrollment Enrollment is guaranteed provided you are actively at work. There is no waiting period required for this coverage. To elect CII for yourself and your dependents, log on to www.farmersagentsbenefits.com. Plan benefits You may elect coverage with an Initial Benefit Amount of $10,000, $20,000 or $30,000 of CII for yourself, spouse/domestic partner and/or dependent child(ren). Your Initial Benefit provides a lump-sum payment upon the first diagnosis of a Covered Condition. A Recurrence Benefit is paid when a covered person is diagnosed with another occurrence of the same covered condition for which an Initial Benefit was previously paid. The maximum amount that you can receive through your CII plan for an Initial Benefit and Recurrence Benefit is called the Total Benefit (lifetime benefit) and is five times the amount of your Initial Benefit. This means that you can receive multiple Initial Benefit and Recurrence Benefit payments until you reach the maximum (see the payment example below). In addition to the Total Benefit amount, the plan pays: n An additional lump-sum payment of 100% of your Initial Benefit Amount in the event of a covered Major Organ Transplant. n An annual health screening benefit of $100 per calendar year for taking all of the eligible screening/prevention measures.
Proprietary 8-22 20 plans PAYMENT EXAMPLE The example below illustrates an individual who elected an Initial Benefit Amount of $10,000 and has a Total Benefit of five times the Initial Benefit Amount, or $50,000 (lifetime benefit). The Total Benefit paid is $30,000, leaving a $20,000 benefit remaining for any future Recurrence or Initial Benefit payments. Illness – Covered Condition Payment Total Benefit Remaining Heart Attack – first diagnosis Initial Benefit payment of $10,000 or 100% $40,000 Heart Attack – second diagnosis, two years later Recurrence Benefit payment of $10,000 or 100% $30,000 Kidney Failure – first diagnosis, three years later Initial Benefit payment of $10,000 or 100% $20,000 Plan exclusions and limitations CII is a limited group policy. Like most group accident and health insurance policies, CII policies contain certain exclusions, limitations and terms for keeping them in force. There is a pre-existing condition exclusion and there is a Benefit Suspension Period between Recurrences. A more detailed description of the benefits, limitations, and exclusions applicable to you can be found in the Disclosure Statement or Outline of Coverage/Disclosure Document available at the time of enrollment. Please review the notes and guidelines of the plan when applying, as there may be plan variances based on state residence.
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