Group Number: 482733
Heidelberg University
All employees
Here you'll find information about your following employee benefit(s). Be sure to review the
enclosed - it provides everything you need to sign up for your Guardian benefits.
PLAN HIGHLIGHTS
•
•
•
Disability
Critical Illness
Accident
Questions? Concerns?
Helpline (888) 600-1600
Call weekdays, 7:00 AM to 8:30 PM, EST.
And refer to your plan number: 482733
The Guardian Life Insurance Company of America, New York, NY 10004
Welcome
Dear Heidelberg University Employee,
We’re pleased to tell you that Guardian will be our coverage provider this year. We
have chosen Guardian because of its competitive rates, excellent service reputation, and
extensive plan designs.
Margaret Rudolph
Director HR
Heidelberg University
The Guardian Life Insurance Company of America, New York, NY 10004
Heidelberg University
Effective: March 01, 2014
Group Number: 482733
Short-Term Disability Benefit Summary
About Your Benefits:
Your paycheck is your greatest asset. How else would you pay for expenses like your rent or mortgage, food and transportation?
Disability insurance helps replace lost income if you have an accident or illness that prevents you from working. Unfortunately,
disabilities occur more often than you may think. Be prepared and take advantage of an opportunity to help protect your financial
well being. Enroll today!
What Your Benefits Cover:
Short-Term Disability
.
Coverage amount
Choose weekly benefit amount from $200 to $1300. See cost
illustration page for weekly benefit offerings.
Maximum payment period: Maximum length of time you can
receive disability benefits.
26 weeks
Accident benefits begin: The length of time you must be disabled
before benefits begin.
Day 8
Illness benefits begin: The length of time you must be disabled
before benefits begin.
Day 8
Evidence of Insurability: A health statement requiring you to
answer a few medical history questions.
Health Statement may be required
Guarantee Issue: The ‘guarantee’ means you are not required to
answer health questions to qualify for coverage up to and including
the specified amount, when applicant signs up for coverage during the
initial enrollment period.
We Guarantee Issue $1300 in coverage
Minimum work hours/week: Minimum number of hours you must
regularly work each week to be eligible for coverage.
Planholder Determines
Pre-existing conditions: A pre-existing condition includes any
condition/symptom for which you, in the specified time period prior
to coverage in this plan, consulted with a physician, received
treatment, or took prescribed drugs.
3 months look back; 12 months after 2 week limitation
Premium waived if disabled: Premium will not need to be paid
when you are receiving benefits.
Yes
UNDERSTANDING YOUR BENEFITS—DISABILITY (Some information may vary by state)
l
Earnings definition: Your covered salary excludes bonuses and commissions.
3
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
Short-Term Disability Plan Semi-monthly Cost Illustration:
To determine the most appropriate level of coverage, you should consider your current basic monthly expenses. To help you assess
your needs, you can also go to Guardian Anytime and use our Disability Insurance Explorer Tool.
Election Cost Per Age Bracket
35–39 40–44 45–49
< 25
25–29
30–34
50–54
55–59
60+
$17,333 Minimum Annual Salary
$200 Weekly Benefit
$10.42
$10.42
$9.84
$7.50
$7.04
$7.07
$8.05
$10.47
$12.77
$21,667 Minimum Annual Salary
$250
$13.03
$13.03
$12.30
$9.38
$8.80
$8.84
$10.06
$13.09
$15.96
$26,000 Minimum Annual Salary
$300
$15.63
$15.63
$14.76
$11.25
$10.56
$10.61
$12.08
$15.71
$19.16
$30,333 Minimum Annual Salary
$350
$18.24
$18.24
$17.22
$13.13
$12.32
$12.37
$14.09
$18.32
$22.35
$34,667 Minimum Annual Salary
$400
$20.84
$20.84
$19.68
$15.00
$14.08
$14.14
$16.10
$20.94
$25.54
$39,000 Minimum Annual Salary
$450
$23.45
$23.45
$22.14
$16.88
$15.84
$15.91
$18.11
$23.56
$28.73
$43,333 Minimum Annual Salary
$500
$26.05
$26.05
$24.60
$18.75
$17.60
$17.68
$20.13
$26.18
$31.93
$47,667 Minimum Annual Salary
$550
$28.66
$28.66
$27.06
$20.63
$19.36
$19.44
$22.14
$28.79
$35.12
$52,000 Minimum Annual Salary
$600
$31.26
$31.26
$29.52
$22.50
$21.12
$21.21
$24.15
$31.41
$38.31
$56,333 Minimum Annual Salary
$650
$33.87
$33.87
$31.98
$24.38
$22.88
$22.98
$26.16
$34.03
$41.50
$60,667 Minimum Annual Salary
$700
$36.47
$36.47
$34.44
$26.25
$24.64
$24.75
$28.18
$36.65
$44.70
$65,000 Minimum Annual Salary
$750
$39.08
$39.08
$36.90
$28.13
$26.40
$26.51
$30.19
$39.26
$47.89
$69,333 Minimum Annual Salary
$800
$41.68
$41.68
$39.36
$30.00
$28.16
$28.28
$32.20
$41.88
$51.08
$73,667 Minimum Annual Salary
$850
$44.29
$44.29
$41.82
$31.88
$29.92
$30.05
$34.21
$44.50
$54.27
$78,000 Minimum Annual Salary
$900
$46.89
$46.89
$44.28
$33.75
$31.68
$31.82
$36.23
$47.12
$57.47
$82,333 Minimum Annual Salary
$950
$49.50
$49.50
$46.74
$35.63
$33.44
$33.58
$38.24
$49.73
$60.66
$86,667 Minimum Annual Salary
$1,000
$52.10
$52.10
$49.20
$37.50
$35.20
$35.35
$40.25
$52.35
$63.85
$95,333 Minimum Annual Salary
$1,100
$57.31
$57.31
$54.12
$41.25
$38.72
$38.89
$44.28
$57.59
$70.24
$104,000 Minimum Annual Salary
$1,200
$62.52
$62.52
$59.04
$45.00
$42.24
$42.42
$48.30
$62.82
$76.62
$112,667 Minimum Annual Salary
$1,300
$67.73
$67.73
$63.96
$48.75
$45.76
$45.96
$52.33
$68.06
$83.01
*This benefit may not exceed 60% of your weekly salary.
4
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
Manage Your Benefits:
Questions?
Enrolled members and their dependents can access
helpful, secure information about their Guardian benefits at
www.guardiananytime.com
Call the Guardian Helpline (888) 600-1600
Call weekdays, 7:00 AM to 8:30 PM, EST. And refer
to your plan number : 482733
A SUMMARY OF DISABILITY PLAN LIMITATIONS
AND EXCLUSIONS
n
Evidence of Insurability is required on all late enrollees. This coverage will
not be effective until approved by a Guardian underwriter. This proposal is
hedged subject to satisfactory financial evaluation. Please refer to certificate
of coverage for full plan description.
n
You must be working full-time on the effective date of your coverage;
otherwise, your coverage becomes effective after you have completed a
specific waiting period.
n
Employees must be legally working in the United States in order to be
eligible for coverage. Underwriting must approve coverage for employees on
temporary assignment: (a) exceeding one year; or (b) in an area under travel
warning by the US Department of State. Subject to state specific variations.
n
n
For Short-Term Disability coverage, benefits for a disability caused or
contributed to by a pre-existing condition are limited, unless the disability
starts after you have been insured under this plan for a specified period of
time. We do not pay short term disability benefits for any job-related or
on-the-job injury, or conditions for which Workers' Compensation benefits
are payable.
We do not pay benefits for charges relating to a covered person: taking part
in any war or act of war (including service in the armed forces) committing a
felony or taking part in any riot or other civil disorder or intentionally
injuring themselves or attempting suicide while sane or insane. We do not
pay benefits for charges relating to legal intoxication, including but not
limited to the operation of a motor vehicle, and for the voluntary use of any
poison, chemical, prescription or non-prescription drug or controlled
substance unless it has been prescribed by a doctor and is used as
prescribed. We limit the duration of payments for long term disabilities
caused by mental or emotional conditions, or alcohol or drug abuse. We do
not pay benefits during any period in which a covered person is confined to
a correctional facility, an employee is not under the care of a doctor, an
employee is receiving treatment outside of the US or Canada, and the
employee’s loss of earnings is not solely due to disability.
n
This policy provides disability income insurance only. It does not provide
"basic hospital", "basic medical", or "medical" insurance as defined by the
New York State Insurance Department.
n
If this plan is transferred from another insurance carrier, the time an insured
is covered under that plan will count toward satisfying Guardian's
pre-existing condition limitation period. State variations may apply.
n
When applicable, this coverage will integrate with NJ TDB, NY DBL, CA
SDI, RI TDI, Hawaii TDI and Puerto Rico DBA.
Contract #.s GP-1-STD94-1.0 et al; GP-1-STD2K-1.0 et al; ,
GP-1-STD07-1.0 et al.
This handout is for illustration purposes only and is an approximation, premium
amounts may be amended.
5
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
6
Protecting Your Greatest Asset – Your Ability to
Earn an Income
Did You Know?
• Three in 10 workers entering the workforce will become disabled before retiring.(1)
• A disabling injury occurs every three seconds in a public setting and every four seconds in the
home.(2 )
• Nearly half of U.S. employees would discontinue contributions to their retirement accounts in the
event of an illness or disability.(3)
• Disability protection provides income replacement for employees who are unable to work due to
accident or illness.
Statistics show that there’s a good possibility you may become disabled during your lifetime. And with 71% of
Americans living paycheck to paycheck(4), time away from work due to illness or injury can be financially
devastating for many families. That’s because the ability to earn a living is the most significant financial asset most
workers have. You can protect that asset through disability income insurance, which replaces a percentage of predisability income for a specified period of time.
Quick Tips About Buying Disability Protection
• Your workplace is a good place to start: If your employer offers a disability product, consider
enrolling in it. Your employer has done all the work of finding a quality plan, and a workplace benefit
is generally affordable (just a few dollars a month in many cases) and easy to buy. Moreover, you
don’t typically need a medical exam to enroll.
• Having the right amount of protection is important: Everyone’s needs vary. Monthly expenses,
personal savings, and other sources of income should be carefully considered when trying to
determine how much income is necessary to maintain your lifestyle. You may need supplemental
coverage to ensure that you are adequately protected.
• Plan ahead: Visit www.disabilitycanhappen.org and take the “5 questions every worker should ask”
quiz to help understand how prepared you are. It’s also a good idea to complete the income and
expense review and develop an action plan. These tools can help you take responsible action should
the unthinkable happen.
Better Information Leads to Better Choices.
At Guardian, we maintain a strong commitment to enriching the lives of the people we touch. In fact, our benefits
are just the beginning. We are committed to providing industry-leading service and support to ensure that every
customer is satisfied and prepared to make the best possible decisions about their lives, their finances, and their
benefits.
1. Social Security Administration, Fact Sheet 2007.
2. National Safety Council, “Injury Facts”, 2007
3. Guardian Insurance and Behavior—Spotlight on IDI Survey, 2006
4. American Payroll Association, “Getting Paid in America” Survey, 2008
7
8
Short Term Disability Cost Worksheet
Step 1 – Calculate Benefit
Example: Assumes
Annual Salary = $60,000
Benefit % = 60%,
Maximum Benefit = $1000
Column A
Column B
Column C
Annual Salary ÷ 52 =
Weekly Salary
Benefit % x Weekly
Salary = Weekly
Benefit
Does the Weekly Benefit
(Column B) exceed the
Maximum Benefit in the
Example
60% x 1,154 = $692
No
$60,000 ÷ 52 =
$1,154
Calculate your weekly benefit below:
YOU:
Column D
Weekly Benefit
If No, Enter Calculated Weekly
Benefit
(Column B)
If Yes, use the Maximum Benefit
$692
Your weekly benefit
is
Step 2 - Calculate Cost:
To determine your total cost per pay, follow the steps outlined in the example below.
• Please refer to the Short Term Disability Premium Illustration Page to capture the appropriate rate.
• Examples of pay frequency: Semi-Monthly -24 pay periods, Bi-Weekly – 26 pay periods, Weekly – 52 pay periods,
Monthly 12 pay periods
Example: Assumes
24 Pay Periods
Rate
Find your rate on the
STD Cost Illustration
Page
Weekly Benefit
(Step 1 Column D)
Rate x Weekly
Benefit
Divide
by 10 = Monthly
Cost
Multiply by 12 =
Annual Cost
Divide by
Pay Frequency =
Cost per Pay Period
“Sample Rate” .33
$1000
.33 x $692 =
$228.36
$228.36 ÷ 10 =
$22.84
$22.84 x 12 =
$274.08
$274.08 ÷ 24 =
$11.42
Calculate your cost per pay period below:
YOU: Find your rate on the STD Cost
Illustration Page
My rate is
Important information about your Short Term Disability plan: We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including
service in the armed forces); committing a felony or taking part in any riot or other civil disorder; or intentionally injuring themselves or attempting suicide while sane or insane. We
do not pay benefits during any period in which a covered person is confined to a correctional facility, an employee is not under the care of a doctor, and the employee’s loss or
earnings is not solely due to disability. We do not pay benefits for any job-related or on-the-job injury, or conditions for which Workers' Compensation benefits are payable. This
policy provides disability income insurance only. It does not provide “basic hospital,” “basic medical,” “major medical” insurance as defined by the New York State Insurance
Department. Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary
assignment: (a) exceeding 1 year; or (b) in an area under travel warning by the US Department of State, subject to state specific variations.
This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist, your paycheck stub prevails. Your
company has selected Guardian to provide Life coverage to eligible employees according to plan terms, which have been mutually agreed upon. As an eligible employee, you can
purchase this coverage at the group premium levels.
9
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10
Heidelberg University
Effective: March 01, 2014
Group Number: 482733
Critical Illness Benefit Summary
About Your Benefits:
Critical illness insurance covers what medical and disability insurance doesn’t pay for - uncovered medical expenses and non-medical
expenses associated with critical illnesses. Since 9 out of 10 consumers know someone or have a family member who has suffered a
critical illness1, and two-thirds of the costs of cancer are non-medical2, it’s clear that critical illnesses are common, costly, and will
eventually affect virtually every family. When it does, if you don’t have critical illness coverage, you won’t be covered for certain
medical treatments and deductibles, and you won’t get extra money to cover household bills. So, make your selections and enroll in
Guardian Critical Illness today!
1 Guardian Omnibus Study, 2008. 2 American Cancer Society, 2007
What Your Benefits Cover:
CRITICAL ILLNESS
Benefit Amount(s)
CONDITIONS
Employee may choose a lump sum benefit of $5,000 to $25,000 in
$5,000 increments.
PERCENTAGE OF LUMP SUM
st
2nd OCCURRENCE
1 OCCURRENCE
Cancer Type 1 (Invasive)
100%
50%
Heart Attack
100%
50%
Kidney Failure
100%
50%
0%
0%
Stroke
100%
50%
Cancer Type 2 (Non-Invasive)
25%
0%
Coronary Artery Bypass Graft
0%
0%
Organ Transplant
Spouse Benefit
50% of employee's lump sum benefit
Child Benefit- children age 14 days to 23 years (25 if full time
student)
50% of employee's lump sum benefit
Benefit Reductions: Benefits are reduced by a certain percentage as
an employee ages
35% at age 65, 60% at age 70, 75% at age 75, 85% at age 80
Guarantee Issue/
Conditional Issue
Portability: Allows you to take your Critical Illness coverage with
you if you terminate employment.
For a spouse:
15-39
$2,500
40-54
$2,500
55-69
$2,500
For a child: $2,500
and spouses to elect up to $12,500 and Child to elect up to $12,500.
Dependent Guarantee & Conditional Issue amounts are limited to 50%
of the amount purchased by the employee.
An insured may port Critical Illness coverage only after being insured
by this plan for "a state specific amount of time." An insured's ported
certificate ends at age 70.
11
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
CRITICAL ILLNESS
Pre-Existing Condition Limitation: A pre-existing condition
includes any condition for which you, in the specified time period prior
6 months prior, 24 months after
to coverage in this plan, consulted with a physician, received treatment,
or took prescribed drugs.
Total Amount Payable
During your lifetime, this plan will not pay more than 150% of the lump
sum benefit for all critical illnesses combined.
Benefit Waiting Period: We do not pay benefits for a critical illness Cancer:
that occurs during the benefit waiting period.
Non-Cancer:
30 Days
30 Days
12
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
Critical Illness Cost Illustration
To determine the most appropriate level of coverage, you should consider your current basic monthly expenses and
expected financial needs during a critical illness.
Your premium will not increase as you age.
<20
20-24
25-29
Semi-monthly Premiums Displayed
Election Cost Per Age Bracket
30-34
35-39
40-44
45-49
$5,000 Benefit Amount
Employee $5,000
Spouse
$2,500
Child
$2,500
$1.40
$0.70
$0.22
$1.60
$0.80
$0.22
$1.88
$0.94
$0.22
$2.35
$1.18
$0.22
$3.15
$1.58
$0.22
$4.58
$2.29
$0.22
$6.80
$3.40
$0.22
$9.75
$4.88
$0.22
$13.40
$6.70
$0.22
$18.70
$9.35
$0.22
$27.38
$13.69
$0.22
$10,000 Benefit Amount
Employee $10,000
Spouse
$5,000
Child
$5,000
$2.80
$1.40
$0.43
$3.20
$1.60
$0.43
$3.75
$1.88
$0.43
$4.70
$2.35
$0.43
$6.30
$3.15
$0.43
$9.15
$4.58
$0.43
$13.60
$6.80
$0.43
$19.50
$9.75
$0.43
$26.80
$13.40
$0.43
$37.40
$18.70
$0.43
$54.75
$27.38
$0.43
$15,000 Benefit Amount
Employee $15,000
Spouse
$7,500
Child
$7,500
$4.20
$2.10
$0.64
$4.80
$2.40
$0.64
$5.63
$2.82
$0.64
$7.05
$3.53
$0.64
$9.45
$4.73
$0.64
$13.73
$6.87
$0.64
$20.40
$10.20
$0.64
$29.25
$14.63
$0.64
$40.20
$20.10
$0.64
$56.10
$28.05
$0.64
$82.13
$41.07
$0.64
$20,000 Benefit Amount
Employee $20,000
Spouse
$10,000
Child
$10,000
$5.60
$2.80
$0.85
$6.40
$3.20
$0.85
$7.50
$3.75
$0.85
$9.40
$4.70
$0.85
$12.60
$6.30
$0.85
$18.30
$9.15
$0.85
$27.20
$13.60
$0.85
$39.00
$19.50
$0.85
$53.60
$26.80
$0.85
$74.80
$37.40
$0.85
$109.50
$54.75
$0.85
$25,000 Benefit Amount
Employee $25,000
Spouse
$12,500
Child
$12,500
$7.00
$3.50
$1.07
$8.00
$4.00
$1.07
$9.38
$4.69
$1.07
$11.75
$5.88
$1.07
$15.75
$7.88
$1.07
$22.88
$11.44
$1.07
$34.00
$17.00
$1.07
$48.75
$24.38
$1.07
$67.00
$33.50
$1.07
$93.50
$46.75
$1.07
$136.88
$68.44
$1.07
Issue Age
†Benefit
50-54
55-59
60-64
65-99†
reductions may apply. See plan details.
Manage Your Benefits:
Questions?
Enrolled members and their dependents can access
helpful, secure information about their Guardian benefits at
www.guardiananytime.com
Call the Guardian Helpline (888) 600-1600
Call weekdays, 7:00 AM to 8:30 PM, EST. And refer
to your plan number : 482733
13
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
EXCLUSIONS AND LIMITATIONS
A SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS FOR CRITICAL
ILLNESS:
We do not pay benefits for a first ever occurrence of a Critical Illness that
occurs less than 12 months after the first ever occurrence of a different Critical
Illness for which this plan paid benefits. If the insured has exhibited symptoms
or received treatment within the past 24 months for a Critical Illness, we do not
pay benefits for the second ever occurrence of that Critical Illness. We do not
pay benefits for a third or later occurrence of a Critical Illness.
We do not pay benefits for claims relating to a covered person: taking part in
any war or act of war (including service in the armed forces) committing a felony
or taking part in any riot or other civil disorder or intentionally injuring
themselves or attempting suicide while sane or insane.
Employees must be legally working in the United States in order to be eligible
for coverage. Underwriting must approve coverage for employees on temporary
assignment: (a) exceeding 1 year; or (b) in an area under travel warning by the
US Department of State, subject to state specific variations.
If the plan is new (not transferred): During the exclusion period, this Critical
Illness plan does not pay charges relating to a pre-existing condition. If this plan
is transferred from another insurance carrier, the time an insured is covered
under that plan will count toward satisfying Guardian’s pre-existing condition
limitation period. A pre-existing condition includes pregnancy and any
condition for which an employee, in a specified time period prior to coverage in
this plan, consults with a physician, receives treatment, or takes prescribed
drugs. Please refer to the plan documents for specific time periods. State
variations may apply.
Guardian's Critical Illness plan does not provide comprehensive medical
coverage. It is a basic or limited benefit and is not intended to cover all medical
expenses. It does not provide "basic hospital," "basic medical," or "medical"
insurance as defined by the New York State Insurance Department.
Evidence of Insurability is required on all late enrollees and enrollees over age
69 (not applicable in FL). This coverage will not be effective until approved by a
Guardian underwriter.
The policy has exclusions and limitations that may impact the eligibility for or entitlement
to benefits under each covered condition. See your certificate booklet for a full listing of
exclusions & limitations.
If Critical Illness insurance premium is paid for on a pre tax basis, the benefit may be
taxable. Please contact your tax or legal advisor regarding the tax treatment of your
policy benefits.
This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist,
your paycheck stub prevails. Your company has selected Guardian to provide Critical Illness coverage to eligible employees & dependents
according to plan terms which have been mutually agreed upon. As an eligible employee, you can purchase this coverage at the group premium
levels illustrated above.
14
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
How to ensure that an emotionally difficult time is
not also a financially stressful time
The fact is medical problems contributed to over 60% of all bankruptcies in the U.S. in 2007,
even though more than 77% were insured at the start of their bankrupting illness.* When
someone is fighting or recovering from a critical illness such as cancer, heart attack or stroke,
they face a number of medical and non-medical expenses that are not covered by traditional
insurance. It’s hard to anticipate these types of expenses until an illness occurs. Critical Illness
coverage helps to ease the burden of those non-covered expenses.
Critical Illness coverage provides a lump sum benefit payment to a person diagnosed with a
serious illness. The lump sum payment can be used any way you choose. This financial
support supplements medical, disability and life insurance by helping to pay for unforeseen
expenses when a serious illness occurs.
Critical Illness coverage complements other insurance.
Medical Insurance
Fundamental Protection for Medical
Expenses: Coverage for medical
expenses – but not deductibles or
out-of-pocket expenses.
Disability Insurance
Essential in any Financial Plan:
Protection for personal income –
but what if expenses outweigh that
income?
Life Insurance
Fundamental Protection for
Tomorrow: Financial support for
loved ones in the future – but how
do you manage today?
Critical Illness Insurance
Coverage to Fill the Gap: Coverage
for the uninsured expenses that
mount up through treatment and
recovery.
* Medical Bankruptcy in the United States, 2007. Results of a National Study published by the American Journal of Medicine, August 2009, Vol. 122, Issue 8.
Authors David U. Himmelstein, MD, Deborah Thome, PhD, Elizabeth Warren, JD, and Steffie Woolhandler, MD, MPH
15
Q: What type of illness does a person need to be
diagnosed with to get a payment?
A: Guardian Critical Illness plans provide coverage when a
person is diagnosed or experiences (for the first or second
time) the following prevalent health events:
•
•
•
•
•
•
Cancer
Heart attack
Stroke
Major organ transplant
Kidney Failure (end stage renal failure)
Coronary Artery Bypass Graft (CABG)
If a Hospital Admission Benefit is part of your Guardian Critical
Illness plan, you also receive coverage for conditions other
than those listed above. Guardian will provide a benefit
payment for each day you are in the hospital for any illness
other than these covered critical illnesses, for up to 10 days per
plan year.
Q: Who needs this type of coverage?
A: Everyone. Due to rising diagnoses of serious illnesses in
America, the need for Critical Illness coverage is more
important than ever. Many people when faced with the
unexpected expenses of a major illness are forced to tap into
their savings or retirement accounts, take out a second
mortgage or run up high interest credit cards. Guardian Critical
Illness coverage helps protect your financial health as you
recover. It’s an affordable way to make sure an emotionally
difficult time is not financially stressful too.
Q: What’s the best way to purchase it?
A: Your workplace makes it easy for you to enroll in Critical
Illness insurance coverage. Your employer has reviewed
various plans to provide you with a quality plan, at affordable
rates. Plus, you have the convenience of payroll deduction so
you won’t have to worry about making payments.
Many expenses are not covered by
any other insurance.
•
Out-of network medical costs
•
Deductibles
•
Potential loss of spouse’s income for
time off
•
Co-payments for new prescriptions
•
Ongoing bills like mortgages and loans
•
Travel to and from treatment facilities
•
Experimental treatments
•
Child care
•
Elder care
•
Home care nurse
•
Home modifications (such as ramps) to
accommodate disability
•
Overnight accommodations/food/etc.
while away from home to receive
treatment/care
Guardian’s Critical Illness plan does not provide
comprehensive medical coverage. It is a basic or limited
benefit and is not intended to cover all medical expenses. It
does not provide “basic hospital”, “basic medical”, or
“medical” insurance as defined by the New York State
Insurance Department. Product may not be available in all
states. For full plan features, including exclusions and
limitations, please refer to the policy contract. GP-1-CIP-IC07.
The Guardian Life Insurance Company of America, New
York, NY 10004
2011-3365
16
Guardian has made your Critical Illness plan even
better!
The following provisions have been enhanced from what is shown in your enrollment kit:
Total Amount Payable
• Guardian will not pay more than 300% of your lump sum benefit during your lifetime. This was increased
from 150% which is shown in the Plan Details of your enrollment kit.
Exclusions and Limitations
• We do not pay benefits for a first ever occurrence of a critical illness that occurs less than 3 months after
the first ever occurrence of a different critical illness. This time frame is reduced from 12 months shown
in the exclusions section of your enrollment kit.
• If the insured has exhibited symptoms or received treatment (not including routine follow up visits or
preventative medications) within the past 12 months for a critical illness, we do not pay benefits for a
second ever occurrence of that illness. This time frame is reduced from 24 months shown in the
exclusions section of your enrollment kit.
17
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18
Heidelberg University
Effective: March 01, 2014
Group Number: 482733
Accident Benefit Summary
About Your Benefits:
Guardian Accident Insurance empowers you to protect yourself financially. Some things in life are out of your control - having an
accident is one of them. Ensuring you have the right coverage can give you financial confidence, regardless of whether you play it
safe or like to take chances. Guardian Accident Insurance ensures you are covered for specific services and care associated with an
injury. The plan provides you with the financial resources to make getting back to your regular routine as easy as possible.
What Your Benefits Cover:
ACCIDENT
COVERAGE - DETAILS
Your Semi-monthly premium
You and Spouse
$8.27
$12.77
You and Child(ren)
$13.05
You, Spouse and Child(ren)
$17.54
Accident Coverage Type
On and Off Job
Portability - Allows you to take your Accident coverage with you if you terminate
employment. Ported Accident plan terminates at age 70.
Included
ACCIDENTAL DEATH AND DISMEMBERMENT
Benefit Amount(s)
Employee $10,000
Spouse $5,000
Child $5,000
Common Carrier
Quadriplegia, Loss of speech & hearing (both ears),
Loss of Cognitive function: 100% of AD&D
Hemiplegia & Paraplegia: 50% of AD&D
200% of AD&D benefit
Common Disaster
200% of Spouse AD&D benefit
Dismemberment - Hand, Foot, Sight
Single: 50% of AD&D benefit
Multiple: 100% of AD&D benefit
Catastrophic Loss
Dismemberment - Thumb/Index Finger Same Hand, Four Fingers Same Hand, All
Toes Same Foot
Seatbelts and Airbags
25% of AD&D benefit
Reasonable Accommodation to Home or Vehicle
$2,500
Child(ren) Age Limits
Seatbelts: $10,000 & Airbags: $15,000
Children age birth to 26 years (26 if full time student)
FEATURES
Accident Emergency Room Treatment
$150
Accident Follow-Up Visit - Doctor
$25 up to 6 treatments
Air Ambulance
$500
Ambulance
$100
Appliance - Wheelchair, leg or back brace, crutches, walker, walking boot that
extends above the ankle or brace for the neck.
Blood/Plasma/Platelets
$100
$300
19
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
FEATURES (Cont.)
Burns (2nd Degree/3rd Degree)
Burn - Skin Graft
9 sq inches to 18 sq inches: $0/$2,000
18 sq inches to 35 sq inches: $1,000/$4,000
Over 35 sq inches: $3,000/$12,000
50% of burn benefit
Child Organized Sport - Benefit is paid if the covered accident occurred while your
covered child is participating in an organized sport that is governed by an
organization and requires formal registration to participate.
20% increase to child benefits
Coma
$7,500
Concussions
$50
Dislocations
Schedule up to $3,600
Diagnostic Exam (Major)
$100
Emergency Dental Work
$200/Crown, $50/Extraction
Epidural pain management
$100, 2 times per accident
Eye Injury
$200
Family Care
$20/day up to 30 days
Fracture
Schedule up to $4,500
Hospital Admission
$750
Hospital Confinement
$175/day - up to 1 year
Hospital ICU Admission
$1,500
Hospital ICU Confinement
$350/day - up to 15 days
Initial Physician's office/Urgent Care Facility Treatment
$50
Joint Replacement (hip/knee/shoulder)
$1,500/$750/$750
Knee Cartilage
$500
Laceration
Schedule up to $300
Lodging - The hospital must be more than 50 miles from the insured's residence.
Occupational or Physical Therapy
$100/day, up to 30 days for companion hotel stay
$25/day up to 10 days
Prosthetic Device/Artificial Limb
Rehabilitation Unit Confinement
Ruptured Disc With Surgical Repair
Surgery
Surgery - Exploratory or Arthroscopic
Tendon/Ligament/Rotator Cuff
Transportation - Benefit is paid if you have to travel more than 50 miles one way to
receive special treatment at a hospital or facility due to a covered accident.
X - Ray
1: $500
2 or more: $1,000
$150/day up to 15 days
$500
Schedule up to $1,000
Hernia: $125
$150
1: $250
2 or more: $500
$400, 3 times per accident
$20
UNDERSTANDING YOUR BENEFITS:
•
Common Carrier – Benefit is paid if an insured's death occurs due to an accident while riding as a fare-paying passanger in a
public conveyance. If this is paid, we do not pay the Accidental Death benefit.
•
Common Disaster – Benefit is paid if both you & your spouse die in a covered accident or separate covered accidents
within the same 24 hour period.
•
Reasonable Accomodation – Benefit is payable if a modification is required to an insured's place of residence or vehicle due
to an Accidental Dismemberment or Catastrophic loss.
20
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
Manage Your Benefits:
Questions?
Enrolled members and their dependents can access
helpful, secure information about their Guardian benefits at
www.guardiananytime.com
Call the Guardian Helpline (888) 600-1600
Call weekdays, 7:00 AM to 8:30 PM, EST. And refer
to your plan number : 482733
LIMITATIONS AND EXCLUSIONS:
A SUMMARY OF ACCIDENT LIMITATIONS AND EXCLUSIONS:
Employees must be working in the United States in order to be eligible for
coverage. Underwriting must approve coverage for employees on temporary
assignment: (a) exceeding 1 year; or (b) in an area under travel warning by the US
Department of State, subject to state specific variations.
This proposal summarizes the major features of the Guardian Accident benefit
plan. It is not intended to be a complete representation of the proposed plan.
For full plan features, including exclusions and limitations, please refer to your
Policy.
This proposal is hedged subject to satisfactory financial evaluation.
This plan will not pay benefits for any injury caused by or related to: declared or
undeclared war, act of war or armed aggression; taking part in a riot or civil
disorder; or commission of, or attempt to commit a felony; intentionally self
inflicted injury, while sane or insane; suicide, while sane or insane. The covered
person being legally intoxicated. Treatment rendered or hospital confinement
outside the United States or Canada. Travel of flight in any kind of aircraft
including any aircraft owned by or for the employer except as a fare paying
passenger on a common carrier. Participation in any kind of sporting activity for
compensation or profit including coaching or officiating.
Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.
Participation in hang gliding, bungee jumping, sailgliding, parasailing, parakiting,
ballooning, parachuting, and/or skydiving. Injuries to a dependent child received
during the birth. An accident that occurred before the covered person is
covered by this plan. Sickness, disease, mental infirmity or medical or surgical
treatment.
If Accident insurance premium is paid for on a pre tax basis, the benefit may be taxable.
Please contact your tax or legal advisor regarding the tax treatment of your policy benefits.
21
Heidelberg University All employees Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
ADDITIONAL MATERIALS
22
Employee Benefits Hotline (EBH)
Benefit specialists are available to answer questions as you sign up for
your Guardian benefits
Toll-free Phone
1-888-600-1600
Monday-Friday
7:00 a.m. – 8:30 p.m. EST
6:00 a.m. – 7:30 p.m. CST
5:00 a.m. – 6:30 p.m. MST
4:00 a.m. – 5:30 p.m. PST
STEP 1: Ask yourself these questions to determine if you should call
the Employee Benefits Hotline.
If you answer “yes” to any of these questions, prepare to contact the Hotline (go to STEP 2):
• Do I need help completing my enrollment forms?
• Do I have questions about the benefits covered under the plans my employer is offering?
STEP 2: Prepare to contact the Hotline
• Name of the company you work for
• Your company’s group number
STEP 3: Call 888-600-1600 to get answers!
• Press #1 to identify yourself as an employee.
• At the next prompt: Press #0 for all other questions
• Enter your company’s group number
IMPORTANT NOTE: The Employee Benefits Hotline provides pre-enrollment support in over 50 languages!
Once you are enrolled in a plan, you will receive additional information and new toll-free phone numbers.
23
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The Guardian Life Insurance Company of America
Enrollment/Change Form
Page 1 of 4
Plan Administrator: Margaret Rudolph
Midwest Regional Office, P.O. Box 8012,
Appleton, WI 54912-8012
Employer Name:
Please print clearly and mark carefully.
Heidelberg University
Group Plan Number:
q Initial Enrollment
q Family Status Change
q Re-Enrollment
PLEASE CHECK APPROPRIATE BOX
q Increase Amount
Class: All employees
Division:_________________
q Add Employee/Dependents
q Information Change
(Please obtain this from your Employer)
Social Security Number
First, MI, Last Name:
___ ___ ___ - ___ ___ - ___ ___ ___ ___
Address
Email Address:
q Drop/Refuse Coverage
Subtotal Code:____________________
About You:
Gender: q M q F
Benefits Effective:_____________
482733
City
State
Date of Birth (mm-dd-yy): ____ - ____ - ____
Phone: (
Are you married or do you have a spouse? q Yes q No
Do you have children or other dependents? q Yes q No
)
-
Date of marriage/union:____-____-_____
Placement date of adopted child: ____-____-_____
Hours worked per week: _______
About Your Job:
Zip
Job Title:
Work Status:
q Active q Retired q Cobra/State Continuation
Date of full time hire: ____ - ____ - ____
Annual Salary: $____________
About Your Family: Please include the names of the dependents you wish to enroll for coverage. A dependent is a person that you,
as a taxpayer, claim; who relies on you for financial support; and for whom you qualify for a dependency tax exception.
Dependency tax exemptions are subject to IRS rules and regulations. Additional information may be required for non-standard
dependents such as a grandchild, a niece or a nephew.
Spouse (First, MI, Last Name)
Gender
qMqF
Date of Birth (mm-dd-yyyy)
____ - ____ - ____
Child/Dependent 1:
q Add q Drop Gender Date of Birth (mm-dd-yyyy) Status (check all that apply)
____ - ____ - ____ q Student (post high school) q Disabled
qMqF
q Non standard dependent
Child/Dependent 2:
q Add q Drop Gender Date of Birth (mm-dd-yyyy) Status (check all that apply)
____ - ____ - ____ q Student (post high school) q Disabled
qMqF
q Non standard dependent
Child/Dependent 3:
q Add q Drop Gender Date of Birth (mm-dd-yyyy) Status (check all that apply)
____ - ____ - ____ q Student (post high school) q Disabled
qMqF
q Non standard dependent
State of Residence:____________________
Child/Dependent 4:
q Add q Drop Gender Date of Birth (mm-dd-yyyy) Status (check all that apply)
q Student (post high school) q Disabled
qMqF
____ - ____ - ____
q Non standard dependent
State of Residence:____________________
State of Residence:____________________
State of Residence:____________________
CEF2012-OH
Questions? Call the Guardian Helpline (888) 600-1600
www.guardianlife.com
DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER
DATE FORM PUBLISHED: Jan 24, 2014
1
Drop Coverage:
q Drop Employee
Coverage Being Dropped:
q Drop Dependents
The date of withdrawal cannot be prior to the date this form is completed
and signed.
Last Day of Coverage: _____-_____-_____
q Critical Illness
q Employee q Spouse q Child(ren)
q Accident
q Employee q Spouse q Child(ren)
q Short Term Disability
q Termination of Employment q Retirement
Last Day Worked: _____-_____-_____
q Other Event: _____________
Date of Event: _____-_____-_____
I have been offered the above coverage(s) and wish to drop enrollment for the following reasons:
q Covered under another insurance plan
q Other ____________________________________________________
(additional information may be required)
Short-Term Disability (STD) Coverage:
Weekly Benefit
Weekly Benefit
q $200.00
q $250.00
q $300.00
q $350.00
q $400.00
q $450.00
q $500.00
q $550.00
q $600.00
q $650.00
q $700.00
q $750.00
q $800.00
q $850.00
q $900.00
q $950.00
q $1,000.00
q $1,100.00
q $1,200.00
q $1,300.00
This amount may not exceed 60% of your
weekly salary.
q I do not want this coverage.
Critical Illness Coverage:
You must be enrolled to cover your dependents
Employee
Insurance Amount:
q $5,000
q I do not want this coverage.
q $10,000
q $15,000
q $20,000
q $25,000
Spouse
q 50% of the employee's amount
Insurance Amount:
q I do not want this coverage.
Dependent/Child(ren)
q 50% of the employee's amount
Insurance Amount:
q I do not want this coverage.
If you or your dependent spouse or dependents elect Critical illness Coverage, you must answer the following health questions.
Has any proposed insured been diagnosed with or treated for any of the following conditions: cancer, carcinoma in situ, malignant melanoma, any chronic or progressive
disease of heart, kidneys, liver, lungs, pancreas or bone marrow? Or, been advised to have an organ transplant, including bone marrow or stem cell transplant?
Employee q Yes q No
Spouse q Yes q No
Dependent Child (ren) q Yes q No
Has the proposed insured been diagnosed with or treated for: heart attack or heart disease, stroke or transient ischemic attack (TIA), or have you had or been advised to have
bypass surgery, stent insertions, treatment to coronary arteries?
Employee q Yes q No
Spouse q Yes q No
Dependent Child (ren) q Yes q No
Has the proposed insured been diagnosed with or treated for uncontrolled blood pressure (requiring a change in medication or dosage in the past 6 months) or been
diagnosed with or treated for diabetes (except if present only in pregnancy)?
Employee q Yes q No
Spouse q Yes q No
Dependent Child (ren) q Yes q No
IMPORTANT NOTES:
• Based on your plan benefits and age, you may be required to complete an additional evidence of insurability form for Critical Illness.
2
DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER
Guardian Group Plan Number: 482733
Accident Coverage
Please print employee name:
You must be enrolled to cover your dependents.
Your Semi-monthly premium
Check only one box.
Employee Only EE & Spouse
EE &
Dependent/Child(ren)
EE, Spouse &
Dependent/Child(ren)
q $8.27
q $13.05
q $17.54
q $12.77
q I do not want this coverage.
Name your beneficiaries: (Primary beneficiary percentages must total 100%)
Primary Beneficiaries:
Name:
_%
Relationship to Employee:
_
_
Name:
_%
Relationship to Employee:
_
_
Contingent Beneficiary:
__
Relationship to Employee:
_
(In the event the designated beneficiaries are deceased, the contingent beneficiary will receive the benefit. Employer maintains beneficiary information.)
Signature
l
I understand that the premium amounts shown above are estimations and are for illustrative purposes only.
l
Submission of this form does not guarantee coverage. Among other things, coverage is contingent upon underwriting approval and meeting the applicable eligibility
requirements as set forth in the applicable benefit booklet.
l
You must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment (a)
exceeding 1 year; or (b) in an area under travel warning by the US Department of State, subject to state specific variations. You must be legally working in the United
States, or working outside of the United States for a United States based employer in a country or region approved by us.
l
If coverage is waived and you later decide to enroll, late entrant penalties may apply. You may also have to provide, at your own expense, proof of each person's
insurability. Guardian has the right to reject your request.
l
I understand that I must be actively at work or my elected coverage will not take effect until I have met the eligibility requirements (as defined in the benefit booklet.) This
does not apply to eligible retirees.
l
Plan design limitations and exclusions may apply. For complete details of coverage, please refer to your benefit booklet. State limitations may apply.
l
Your coverage will not be effective until approved by a Guardian or its designated underwriter.
l
I hereby apply for the group benefit(s) that I have chosen above.
l
I understand that I must meet eligibility requirements for all coverages that I have chosen above.
l
I agree that my employer may deduct premiums from my pay if they are required for the coverage I have chosen above.
l
I acknowledge and consent to receiving electronic copies of applicable insurance related documents, in lieu of paper copies, to the extent permitted by applicable law. I
may change this election only by providing Guardian thirty (30) day prior written notice.
l
I attest that the information provided above is true and correct to the best of my knowledge.
Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or
deceptive statement is guilty of insurance fraud.
Questions? Call the Guardian Helpline (888) 600-1600
www.guardianlife.com
DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER
3
The state in which you reside may have a specific state fraud warning. Please refer to the attached Fraud Warning Statements page.
The laws of New York require the following statement appear: Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact
material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated
value of the claim for each such violation. (Does not apply to Life Insurance.)
SIGNATURE OF EMPLOYEE X ___________________________________________
DATE ______________________
Enrollment Kit 482733, 0003, EN
Fraud Warning Statements
The laws of several states require the following statements to appear on the enrollment form:
Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for
insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof.
Arizona: For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment
of a loss is guilty of a crime and may be subject to criminal and civil penalties.
California: For your protection California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent claim for the payment of a
loss is guilty of a crime and may be subject to fines and confinement in state prison.
Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to
defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who
knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy
holder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of
Regulatory Agencies.
Connecticut, Iowa, Kansas, Nebraska, Oregon, and Vermont: Any person who knowingly, and with intent to defraud any insurance company or other person, files an
application of insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material
thereto, may be guilty of a fraudulent insurance act, which may be a crime, and may also be subject to civil penalties.
Delaware, Indiana and Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an
insurance policy containing any false, incomplete or misleading information is guilty of a felony.
District of Columbia: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties
include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant.
Florida: Any person knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or application containing any false, incomplete, or
misleading information is guilty of a felony of the third degree.
Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information
or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.
Louisiana and Texas: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit is guilty of a crime and may be subject to fines and
confinement in state prison.
Maine, Tennessee, Virginia and Washington: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of
defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.
Maryland : Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly or willfully presents false information in an
application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
Rhode Island: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly and willfully presents false
information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.
New Hampshire: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or
misleading information is subject to prosecution and punishment for insurance fraud, as provided in N.H. Rev. Stat. Ann. § 638:20
New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.
New Mexico: Any person who knowingly presents a false or fraudulent claim for payment or a loss or benefit or knowingly presents false information in an application for
insurance is guilty of a crime and may be subject to civil fines and criminal penalties or denial of insurance benefits.
Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim
containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act,
which is a crime and subjects such person to criminal and civil penalties.
4