May 1, 2019 –April 30, 2020 Employee Benefits Guide

May 1, 2019 – April 30, 2020

Employee Benefits Guide

Read full descriptions and plan details at mymarkiii.com

If you wish to add or make changes to your insurance coverage(s), please consult a Mark III BenefitsRepresentative during your scheduled enrollment period. You will not be able to make any changesonce the enrollment period is over unless you experience a qualified event outlined by the IRS (i.e.,

marriage, divorce, birth of a child, etc.). If you should experience a qualified event, you have 30 days fromthe date of the event to make any changes.

All information in this booklet is a brief description of your coverage and is not a contract. Please refer toyour policy or certificate for each product for the exact terms and conditions.

Table of ContentsDisclaimer .................................................................................... Page 2

Important Points for 2019 ......................................................... Page 3

What’s New or Changing? .......................................................... Page 4

Qualifying Life Events ................................................................. Page 5

Pre-Tax vs. Post-Tax .................................................................... Page 6

How to Enroll ............................................................................... Page 7

View Your Benefits ...................................................................... Page 8

FBA Flexible Spending Account ............................................... Page 10

Ameritas Dental ........................................................................ Page 13

Superior Vision .......................................................................... Page 15

Aflac Group Accident ................................................................ Page 18

MetLife Cancer .......................................................................... Page 23

AUL Short-Term Disability ........................................................ Page 27

AUL Long-Term Disability ......................................................... Page 28

MetLife Term Life ...................................................................... Page 29

Texas Life Whole Life ................................................................ Page 31

Continuation of Benefits .......................................................... Page 38

Contact Information ................................................................. Page 40

Benefits Available for Retirees ................................................ Page 41

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This guide is a brief summary of benefits

offered to your group and does not

constitute a policy.

Your employer may amend the benefits

program at any time. Your Summary Plan

Description (SPD) will contain the actual

detailed provisions of your benefits. The

SPD will be available at mymarkiii.com

If there are any discrepancies between the

information in this guide and the SPD, the

language in the SPD will always prevail.

DISCLAIMER

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Important Points for 2019 - 2020• Your plan year runs from May 1, 2019 to April 30, 2020.

This means your benefit elections will take effect May 1, 2019.

• If you wish to add or make changes to your benefit elections, please consult with a Mark III Benefits Representative during your scheduled enrollment period.

• Once the enrollment period is over, you will not be able to make changes unless you experience a qualified life event as outlined by the IRS.

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What’s New or Changing?Before making your benefit elections, review this guide. It’s important that you correctly enroll in the coverage that is right for you and your family. If you wish to add or make changes to your insurance coverage(s), please consult with a Benefits Representative during your scheduled enrollment period.

• MetLife Cancer Plan replaced Humana Cancer Plan from last year. No change in Benefits, Rates and Administrator will remain the same.

• Ameritas Dental rates have increased slightly. Please see below for rate change.

Current RatesEmployee working 30 or more hours per weekEmployee Only $0 (no cost to you)

Employee & Family $65.00

Employee working 20 – 29 hours per weekEmployee Only $29.00


New RatesEmployee working 30 or more hours per weekEmployee Only $0 (no cost to you)




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Qualifying Life EventsOpen Enrollment selections are generally locked for the plan year, but certain exceptions called Qualifying Life Events (QLEs) can grant you a special enrollment period in which to make midyear changes. You are permitted to change benefit elections if you have a “change in status” and you make an election change that is consistent with the “change in status.”

Examples of QLEsThe following events will open a special 30-day enrollment period from the date of

the event, allowing you to make changes to your coverage.

marriage divorce childbirth/adoption

death of a family

member

loss of parental coverage

spouse gains or loses coverage

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I’m here to help guide you through the benefits offered by your employer. If you have any questions regarding your benefits, please feel free to contact me at:

Pre-TaxA “pre-tax basis” means that the money you pay towards the cost of coverage comes out of your salary before you pay any taxes on it. By choosing this option, you reduce your taxable income, therefore reducing the taxes you owe. If you choose this option, you cannot drop coverage until the next annual enrollment period or until you have a qualifying change in your status (i.e. birth of a child, divorce, separation, reduction in hours, etc.).If your premiums are deducted on a pre-tax basis, any benefits received under the plan could be treated as taxable income.

Post-TaxA “post-tax basis” means that the money you pay towards the cost of coverage comes out of your salary after you pay taxes. Although you do not get any savings from taxes, you have the flexibility of dropping your coverage at any time. If your employer allows, you may also enroll any time during the year but, depending on the plan, you may be subject to waiting periods for pre-existing conditions, or you may have to furnish Evidence of Insurability (EOI).

vs.

Pre-Tax Plans Offered: Post-Tax Plans Offered:

• FBA Flexible Spending Account

• Ameritas Dental

• Superior Vision

• Aflac Group Accident

• MetLife Cancer & Specified Disease

• AUL Short-Term Disability

• AUL Long-Term Disability

• MetLife Optional Term Life

• Texas Life Whole Life

As stated in the disclaimer, this guide is simply a brief summary of benefits offered and does not constitute a policy. Before we review benefits offered, let’s look at the difference in pre-tax vs post-tax benefits.

Sherry McCormick

(800) 532-1044 (toll-free)

(704) 365-4280 x306

[email protected]

Hi, Asheboro City Schools Employee!

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How to Enroll

On-SiteOur non-commissioned, salaried Benefits Counselors are available to meet with employees like yourself, on-site to explain the benefits offered and help you enroll.

No matter what your schedule holds or which location you work, we have multiple ways to enroll or elect changes to your benefits.

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View Your BenefitsFind details about all of your benefits, download forms, submit claims, ask questions, and more at mymarkiii.com.

ü Benefits Guide

ü Product Videos

ü Policy Certificates

ü Plan Forms

ü Contact Info

ü Enrollment Info

Available 24/7* from any internet enabled device for your convenience.

*-As with all technology, due to technical difficulties beyond our control there may be small windows of time the benefits website is down. In the case of outage, plan information can always be requested from your HR office or Mark III Employee Benefits

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COREBENEFITSFSA, Dental, & Vision options to keep you and your family healthy.

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Flexible Spending Account


Flexible Spending Accounts (FSAs) allow you to pay certain healthcare and dependent care expenses with pre-tax money. (The key to the Flexible Benefit Plan is that your eligible expenses are paid for with Tax Free Dollars!) You will not pay any federal, state or social security taxes on funds placed in the Plan. You will save, approximately, $27.65 to $37.65 on every $100 you place in the Plan. The amount of your savings will depend on your federal tax bracket.

There are 2 types of FSAs:• A Health Care FSA: With this account, you can pay for your out of pocket health care expenses for

yourself, your spouse and all of your tax dependents for healthcare services that are incurred during your plan year and while an active participant. Eligible expenses are those incurred “for the diagnosis, cure, mitigation, treatment, or prevention of dis-ease, or for the purpose of affecting any structure or function of the body. “ This is a broad definition that lends itself to creativity.• Minimum Contribution: $240• Maximum Contribution: $2,700

• A Dependent Care FSA The Day Care/Aged Adult Care FSA allows you to pay for day care expenses for your qualified dependent/child with pre-tax dollars. Eligible Day Care/Aged Adult Care expenses are those you must pay for the care of an eligible dependent so that you and your spouse can work. Eligible dependents, as revised under Section 152 of the Code by the Working Families Tax Act of 2005, are defined as either dependent children or dependent relatives that you claim as dependents on your taxes. Refer to the Employee Guide for more details.• Minimum Contribution: $0• Maximum Contribution: $5,000

Examples of Expenses• Acupuncture• Surgery• Prescription Eyeglasses• Contact Lens & supplies• Eye Exams/Laser Eye Surgery• Physician• Ambulance• Psychiatrist• Psychologist• Anesthetist

• Hospital• Chiropractor• Laboratory• Fertility• Physicals• Oxygen• Physical Therapy• Hearing Aids• Prescriptions• Au Pair

• Nannies• Before & After Care• Day Camps• Babysitters• Daycare for Elderly Dependent• Nursery school• Sick Child Center• Licensed Day Care Center

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Benefits Debit CardThe Benefit Card can be used as a direct payment method for eligible expenses incurred at approved service providers and merchants. Using your card allows you instant access to your funds with no out of pocket expense. Benefits Cards are available upon request of the account holder for dependents over the age of 18. Please keep all your itemized receipts. Flexible Benefit Administrators, Inc. may re-quest documentation to substantiate Benefits Card transactions to determine eligibility of an expense. Please contact Flexible Benefit Administrators, Inc. to order additional cards.

How the Flexible Benefit Plan Works

By taking advantage of the Flexible Benefit Plan this employee was able to increase his/her spendable income by $154.84 every month! This means an annual tax savings of $1,858.08. Remember, with the FLEXIBLE BENEFIT PLAN, the better you plan the more you save!

Without FSA With FSA

Gross Monthly Income $2,500.00 $2,500.00

Eligible Pre-Tax employer medical insurance $0.00 $200.00

Eligible Pre-Tax medical expenses $0.00 $60.00

Eligible Pre-Tax dependent child care expenses $0.00 $300.00

Taxable Income $2,500.00 $1,940.00

Federal Tax (15%) $375.00 $291.00

State Tax (5.75%) $125.00 $97.00

FICA Tax (7.65%) $191.25 $148.41

After-Tax employer medical insurance $200.00 $0.00

After-Tax medical expenses $60.00 $0.00

After-Tax dependent child care expenses $300.00 $0.00

Monthly Spendable Income $1,248.75 $1,403.59

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Health Care FSA Contributions• Minimum Contribution: $240• Maximum Contribution: $2,700

Dependent Care Contributions• Minimum Contribution: $0• Maximum Contribution: $5,000

Forfeiting FundsPlan carefully! Unused funds will be forfeited back to your employer as governed by the IRS’s “use-it-or-lose-it” rule. Your employer has elected to add the $500 roll-over provision to the Medical FSA. Please see the Employee Guide for more info.

Follow the simple steps below to establish your secure user account. 1. Visit https://fba.wealthcareportal.com/ and click the new user link.2. You will be directed to the registration page. 3. Follow the prompt to create your account.

• User name• Password• Name• Email• Employee ID (Your SSN, no spaces/dashes)• Registration ID

• Employer ID (FBAASHS) or your Benefits Card Number4. Once completed, please proceed to your account.

If you are having difficulty creating your user account or you have forgotten your password to an existing account, please contact us at 800-437-3539 or [email protected]

All claims must be incurred between May 1, 2019-April 30,2020.

You have 90 days to submit claims for reimbursement after the plan year ends

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Dental Plan


Proper dental care is important and taking care of your oral health is an investment in your overall well-being. Your coverage is provided by Ameritas and it covers preventative, basic, and major dental procedures.

Ameritas Dental PlanA $50 In-Network and a $100 Out-of-Network, per individual for Type 2 (Basic) and/or Type 3 (Major) procedures (3 times family limit). After the date that 3 members of a family have each satisfied their individual deductible, the entire deductible or any remaining portion of the deductible for any family member will be waived for the rest of that calendar year.

ProceduresType 1 – Preventative &

DiagnosticType 2 – Basic Procedures Type 3 – Major Procedures

Routine Exam (2 per benefit period)

Sealants (under 17) Endodontics (root canal)Periodontics (gum disease)

Bitewing X-rays (2 per benefit period)

Restorative Amalgams & Resin (excluding inlays & crowns)

Crowns – Stainless Steel (age 19 & over)

Cleaning (2 per benefit period) Anesthesia (allowed when cutting procedure performed)

Repair & recement Crowns

Fluoride for Children (under age 19)

Denture Repair Prosthodontics – fixed pontics or abutments

Space Maintainers Full Mouth & other X-rays Crowns – Restorative

Limited Exams Oral Surgery – Complex & Simple Extractions

Prosthodontics – removable dentures, partials

• Type 1 – Preventive & Diagnostic• Benefits are payable at 100% U&C*. No deductible applies.

• Type 2 – Basic Procedures• Benefits are payable at 80% U&C*. $50 deductible In-Network. $100 deductible Out-of-Network.

• Type 3 – Major Procedures• Benefits are payable at 50% U&C*. $50 deductible In-Network. $100 deductible Out-of-Network.

• Orthodontia – Adult & Child(ren)• Benefits paid at 50% U&C* with a $1,000 lifetime maximum. No deductible applies.

*Usual & Customary charge

This is a brief product overview only. The plans have limitations and exclusions that affect benefits payable. Refer to the plan for complete details, limitations and exclusions.

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Dental Plan


Annual Maximum Benefit• Type 1, Type 2, and Type 3 Procedures - $1,000 per calendar year per person.• Orthodontia Procedures - $1,000 Lifetime per person.

Late EntrantWe strongly encourage you and/or your dependents to sign up for coverage when you are initially eligible. If you choose to enroll after initially declined, you and/or your eligible dependents will be considered a Late Entrant. Covered expenses will not include and benefits will not be payable in the first 12 months that a person is insured if the person is a Late Entrant; except for evaluations, prophylaxis (cleanings), and fluoride application. After 12 months, you will have access to all of the plan's benefits.

Dental Network InformationTo find a provider, visit www.ameritas.comand select FIND A PROVIDER, then DENTAL. Enter your criteria to search by locations or for a specific dentist or practice.

If you have any questions about PPO or the plan, please call:Ameritas Group Claims Department at 800-487-5553

Or, visit the Ameritas website at:www.AmeritasGroup.com

Monthly RatesEmployee working 30 or more hours per weekEmployee Only $0 (no cost to you)




Pre-TreatmentThough not required, it is strongly recommended that you have your dental provider submit a pre-treatment prior to having any dental services or procedures you deem expensive (ex. crown). This allows you to understand your benefits and plan accordingly. Ameritas will review the information and provide a detailed response back to you and your provider so that you can understand the claim determination based upon your policy contract.

Eligible Dependents• Your Spouse• Children up to age 26

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Vision Plan


A routine eye exam is important not only for correcting vision problems, but for maintaining healthy eyes and overall health wellness. Superior Vision eye care providers are trained to treat for and diagnose a variety of health issues, not just eye problems. Take the time to get to know your vision plan and start experiencing healthy eyes and healthy living.

Superior VisionSuperior Vision provides primary vision care benefits including eye examinations, prescription eyewear, and contact lenses through a broad-based provider network consisting of ophthalmologists, optometrists, and opticians. The plan also contracts with a large number of national and regional optometric chain locations.

Co-Pays: Comprehensive Eye Exam $10Materials $15Contact Lens Fitting $35

Frequency In-Network Non-Network

Comprehensive Exam (by Ophthalmologist) 12 Months Covered in Full Up to $44.00

Comprehensive Exam (by Optometrist) 12 Months Covered in Full Up to $39.00

Lenses (Standard) per pair

Single VisionBifocalTrifocalLenticular

12 Months Covered in FullCovered in FullCovered in FullCovered in Full

Up to $34.00Up to $48.00Up to $64.00Up to $88.00

Contact Lenses (per pair)Medically NecessaryCosmetic (Elective)

12 Months Covered in FullUp to $120.00

Up to $210.00Up to $100.00

Contact Lense FittingStandardSpecialty

12 Months Covered in FullUp to $50.00

Not CoveredNot Covered

Frames (Standard) 24 Months Up to $100.00 Up to $50.00

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Vision Plan


Superior Vision Discount FeaturesLook for providers in the Provider Directory who accepts discounts; please verify their discounts prior to service.

Superior Vision Monthly Rates

Employee Only $9.90

Employee + Family $24.86

Discounts on Covered Materials

Frames 20% off amount over allowance

Lens 20% off retail

Progressives 20% off amount over retail lined trifocal lens, including lens options

Superior Vision also offers discounts on an unlimited number of materials after the member has exhausted their covered benefit.

Discounts on Non-Covered Exam & Materials

Exams, Frames, and prescription lenses 30% off retail

Lens options, contacts, other prescription materials 20% off retail

Disposable contact lenses 10% off retail

Refractive SurgerySuperior Vision has a nationwide network of refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 20%-50%, and are the best possible discounts available to Superior Vision.

Eligible Dependents• Your Spouse• Children up to age 26

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STAYWELLVoluntary Benefit Options that enhance your and your family’s well being.

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Accident Plan


Accidents may happen as a fact of life. An accident insurance plan can help with unexpected expenses. Aflac Group Accident can pay a benefit based on the injury you sustain and the various treatments and/or services received, regardless of what is covered by your medical insurance. For details of payouts for treatments & services, please review your certificate or detailed SBC on the benefits microsite.

Plan Features• Benefits are payable regardless of any other insurance programs.• Coverage is guaranteed-issue, provided the applicant is eligible for coverage.• Benefits for both inpatient and outpatient treatment of covered accidents.• Available for spouse and/or dependent children.• No limit to the number of claims an insured can file.• Premiums are paid by convenient payroll deduction.• Immediate effective date – Coverage will be effective the date the employee signs the

application.• 24-Hour Coverage• Includes an Accidental Death & Dismemberment Benefit (within 90 days)• Coverage is guaranteed-issue, provided the applicants are eligible for coverage.

Enrollments take place once each 12 month period. Late enrollees cannot enroll outside of an annual enrollment period.

• Plan is portable with certain stipulations. See certificate for details.• This is a brief product overview only. The plans have limitations and exclusions that

affect benefits payable. Refer to the plan for complete details, limitations, and exclusions.

Eligibility• Employee at least age 18• Spouse at least age 18• Children under age 26

The employee may purchase Accident Plus coverage for his spouse and/or dependent children. The spouse and dependent children cannot participate if the employee is not eligible for coverage or elects not to participate.

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Accident Plan



Complete Fracture Closed Reduction Benefits Employee Spouse/Children

Hip/Thigh $4,500 $4,000

Vertebrae $4,050 $3,600

Pelvis $3,600 $3,200

Skull (Depressed) $3,375 $3,000

Leg $2,700 $2,400

Forearm/Hand/Wrist $2,250 $2,000

Foot/Ankle/Knee Cap $2,250 $2,000

Shoulder Blade/Collar Bone $1,800 $1,600

Lower Jaw (mandible) $1,800 $1,600

Skull (Simple) $1,575 $1,400

Upper Arm/Upper Jaw $1,575 $1,400

Facial Bones (Except teeth) $1,350 $1,200

Vertebral Processes $900 $800

Coccyx/Rib/Finger/Toe $360 $320

If the fracture requires open reduction, we will pay 150% of the amount shown.

A fracture is a break in a bone that can be seen by X-ray. If a bone is fractured in a covered accident, and it is diagnosed and treated by a doctor within 90 days after the accident, we will pay the appropriate amount shown. Multiple fractures refer to more than one fracture requiring either open or closed reduction. If multiple fractures occur in any one covered accident, we will pay the appropriate amounts shown for each fracture. However, we will pay no more than 150% of the benefit amount for the fractured bone which has the highest dollar amount. Chip fracture refers to a piece of bone that is completely broken off near a joint. If a doctor diagnoses the fracture as a chip fracture, we will pay 10% of the amount shown for the affected bone. The maximum amount payable for the Fracture Benefit per covered accident is 150% the benefit amount for the fractured bone that has the higher dollar amount.

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Accident Plan



Complete Dislocations Employee Closed Reductions

Spouse/Children Closed Reductions

Hip $4,000 $3,000

Knee (not kneecap) $2,600 $1,950

Shoulder $2,000 $1,500

Foot/Ankle $1,600 $1,200

Hand $1,400 $1,050

Lower Jaw $1,200 $900

Wrist $1,000 $750

Elbow $800 $600

Finger/Toe $320 $240

If the dislocation requires open reduction, we will pay 150% of the amount shown. Dislocation refers to a completely separated joint. If a joint is dislocated in a covered accident, and it is diagnosed and treated by a doctor within 90 days after the accident, we will pay the amount shown. We will pay benefits only for the first dislocation of a joint. We will not pay for recurring dislocations of the same joint. If the insured dislocated a joint before the effective date of the certificate and then dislocates the same joint again, it will not be covered by this plan. Multiple dislocations refer to more than one dislocation requiring either open or closed reduction in any one covered accident. For each covered dislocation, we will pay the amounts shown. However, we will pay no more than 150% of the benefit amount for the dislocated joint that has the higher dollar amount. Partial dislocation is one in which the joint is not completely separated. If a doctor diagnoses and treats the accidental injury as a partial dislocation, we will pay 25% of the amount shown in the benefit schedule for the affected joint. The maximum amount payable for the Dislocation Benefit per covered accident is 150% of the benefit amount for the dislocated joint that has the higher dollar amount. If you have both fracture and dislocation in the same covered accident, we will pay for both. However, we will pay no more than 150% the benefit amount for the fractured bone or dislocated joint that has the higher dollar amount.

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Accident Plan


BenefitParalysis – Quadriplegia (lasting 90 days or more & diagnosed by physician within 90 days) $10,000

Paralysis – Paraplegia (lasting 90 days or more & diagnosed by physician within 90 days) $5,000

Lacerations up to 2” long (treatment/repair within 14 days) $50

Lacerations 2” – 6 “ long (treatment/repair within 14 days) $200

Lacerations more than 6” long (treatment/repair within 14 days) $400

Lacerations not requiring stitches (treatment/repair within 14 days) $25

*Medical Fees for each accident – Employee or Spouse $125

*Medical Fees for each accident – Children $75

**Emergency Room Treatment – Employee or Spouse $125

**Emergency Room Treatment – Children $75

**Emergency Room Observation – Employee or Spouse $75

**Emergency Room Observation – Employee or Spouse $45

+Accident Follow-Up Treatment $25

++Physical Therapy – Up to six treatments per covered accident $25

Air Ambulance (within 90 days after covered accident) $500

Ambulance (within 90 days after covered accident) $100

Wellness Benefit (per 12 month period) $60

Hospital Admission – Confined for at least 24 hours within 6 months after the accident date $1,000

+*Hospital Confinement (per day) $200

Additional Benefits (Limitations and Exclusions Apply)

*Initial treatment from doctor within 14 days after the accident**Initial treatment within 14 days after the covered accident: only payable once per 24 hour period & only once per covered accident+Up to six treatments (one per day) per covered accident, per insured for follow-up treatment; initial treatment within 14 days of accident++Initial treatment within 14 days of the covered accident; must begin within 30 days after the covered accident or discharge from the hospital & must take place within six months of the covered accident. This benefit is not payable for the same visit that the Accident Follow-Up Treatment Benefit is paid. +*Confined for at least 24 hours within 90 days after the accident date; max period is 365 days.

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Accident Plan


Covered RatesEmployee Only $16.20

Employee + Spouse $23.16

Employee + Dependent Child(ren) $30.90

Employee, Spouse, + Dependent Child(ren) $37.86

Monthly Rates

NoticesThis booklet is a brief description of coverage, not a contract. Read your certificate carefully for exact plan language, terms,and conditions.

If this coverage will replace any existing individual policy, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy.

Notice to Consumer: The coverages provided by Continental American Insurance Company (CAIC) represent supplemental benefits only. They do not constitute comprehensive health insurance coverage and do not satisfy the requirement of minimum essential coverage under the Affordable Care Act. CAIC coverage is not intended to replace or be issued in lieu of major medical coverage. It is designed to supplement a major medical program.

Continental American Insurance Company (CAIC), a proud member of Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands.

Continental American Insurance Company, Columbia, South Carolina.

AGC1900372 IV (2/19)

Limitations & ExclusionsWe will not pay benefits for injury, total disability or death contributed to, caused by, or resulting from:• War - participating in war or any act of war, declared or not; participating in the armed forces of, or contracting with, any

country or international authority. We will return the prorated premium for any period not covered by this certificate when you are in such service. This does not include terrorism.

• Suicide – committing or attempting to commit suicide, while sane or insane. • Sickness – having any disease or bodily/mental illness or degenerative process. We also will not pay benefits for any related

medical/surgical treatment or diagnostic procedures for such illness. This exclusion does not exclude an accidental death from a bacterial infection resulting from an accidental injury.

• Self-Inflicted Injuries – injuring or attempting to injure yourself intentionally. • Racing – riding in or driving any motor-driven vehicle in a race, stunt show, or speed test. • Intoxication - being legally intoxicated, or being under the influence of any narcotic, unless taken under the direction of a

Doctor. Legally intoxicated means that condition as defined by the law of the jurisdiction in which the accident occurred.)• Illegal Acts – participating or attempting to participate in an illegal activity, or working at an illegal job. • Sports – participating in any organized sport – professional or semi-professional.• Cosmetic Surgery – having cosmetic surgery or other elective procedures that are not medically necessary or having dental

treatment except as a result of a covered accident.

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Cancer Plan


With the rates of cancer increasing, cancer treatment can lead to unexpected expenses to add to your financial burden. Cancer coverage fills in the gaps your medical insurance doesn’t cover. Benefits are paid directly to you and can be used for a variety of purposes.

Plan Features• Donor Benefits • Portable (take your coverage with you)• Wellness Benefits • Pays regardless of other coverage• Many Benefits have No Lifetime Maximum • In & Out of Hospital Benefits• Covers certain Lodging & Transportation

Benefit Benefit Amounts

Wellness Benefit Up to $100 per calendar year

Positive Diagnosis Test Up to $300 per calendar year

First Diagnosis Benefit $0 - $5000 depending on chosen option

Second & Third Surgical Opinions Incurred expenses

Non-Local Transportation Actual billed charges by a common carrier or $0.50 per mile if personal vehicle used

Adult Companion Lodging & Transportation Up to $75 per day for lodging, $0.50 per mile if personal vehicle used.

Ambulance Incurred expenses

Surgery Up to $3,000

Donor Benefit Bone Marrow & Stem Cell Transplant

$200 medical expense, actual billed charges for round trip coach fare or $0.50 per mile for personal vehicle, actual billed charges up to $50 per day for lodging and meal expense.

Benefits

Pre-Existing Condition LimitationDuring the first 12 months of a Covered Person’s insurance, losses incurred for Pre-Existing Conditions are not covered. During the first 12 months following the date a Covered Person makes a change in coverage that increases his or her benefits, the increase will not be paid for Pre-Existing Conditions. After this 12 month period, however, benefits for such conditions will be payable unless specifically excluded from coverage. This 12 month period is measured from the Certificate Effective Date for each Covered Person.

23

Cancer Plan



Bone Marrow & Stem Cell Transplant Incurred expenses up to a combined lifetime maximum of $15,000

Anesthesia

Up to 25% of the surgical benefit paid. $100 maximum per Covered Person for anesthesia in connection with skin Cancer that is not malignant melanoma.

Ambulatory Surgical Center $250 per day

Drugs & Medicines Up to $25 per day, $600 per calendar year

Outpatient Anti-Nausea Drugs Up to $250 per calendar year

Radiation, Radioactive Isotopes Therapy, Chemotherapy, or Immunotherapy

Incurred expenses up to $2,500 per month (options 1 & 2)Incurred expenses up to $5,000 per month (options 3 & 4)

Miscellaneous Diagnostic Charges Incurred expenses up to a lifetime maximum of $10,000

Self-Administered Drugs Incurred expenses up to $4,000 per month

Colony Stimulating Factors Incurred expenses up to $500 per month

Blood, Plasma, & Platelets Incurred expenses up to $200 per day

Physician’s Attendance Up to $35 per day

Private Duty Nursing Service Up to $100 per day

National Cancer Institute Designated Comprehensive Treatment Center Evaluation/Consultation

Actual billed charges limited to a lifetime maximum up to $750 for evaluation. Actual billed charges limited to a lifetime maximum up to $350 for transportation and lodging.

Breast Prothesis Incurred expenses

Artificial Limb or Prosthesis Up to $1,500 lifetime maximum per amputation

Benefits (continued)

24

Cancer Plan



Physical or Speech Therapy Up to $35 per session

Extended Benefits $300 per day

Extended Care Facility Up to $50 per day

At Home Nursing Up to $100 per day

New or Experimental Treatment Up to $7,500 per calendar year

Hospice Care Up to $50 per day

Government or Charity Hospital $200 per day

Hairpiece Incurred expenses up to a lifetime maximum of $150

Rental or Purchase of Durable Goods Incurred expenses up to $1,500 per calendar year

Waiver of Premium After 60 days

Hospital Confinement $100 per day

Benefits (continued)

Other Specified Diseases Covered• Addison’s Disease• Scarlet Fever• Multiple Sclerosis• Cystic Fibrosis• Tay-Sachs Disease• Myasthenia Gravis• Encephalitis• Epilepsy• Osteomyelitis• Hansen’s Disease• Tularemia

• Rabies• Lupus Erythematosus• Undulant Fever• Rheumatic Fever• Malaria• Meningitis• Amyotrophic Lateral Sclerosis• Sickle Cell Anemia• Muscular Dystrophy• Diphtheria• Tetanus

• Niemann-Pick Disease• Toxic Epidermal Necrolysis• Tuberculosis• Poliomyelitis• Legionnaire’s Disease• Typhoid Fever• Reye’s Syndrome• Lyme Disease• Whipple’s Disease• Rocky Mountain Spotted Fever

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Cancer Plan


Benefit Option 1 Option 2 Option 3 Option 4

Hospital Confinement $100 $100 $100 $100

Surgical $3,000 $3,000 $3,000 $3,000

Radiation/Chemotherapy per month $2,500 $2,500 $5,000 $5,000

First Diagnosis $0 $2,500 $0 $5,000

Colony Stimulating Factors per month $500 $500 $500 $500

Wellness $100 $100 $100 $100

Intensive Care Rider $0 $325 $0 $625

Variable Benefit Elections

Coverage Tier Option 1 Option 2 Option 3 Option 4

Employee $17.65 $23.38 $19.63 $30.89

Employee + Spouse $35.57 $47.60 $39.44 $62.87

Employee + Child(ren) $25.19 $33.20 $27.64 $43.36

Employee, Spouse, + Dependent Child(ren) $43.10 $57.43 $47.45 $75.34

Monthly Rates

26

Short-Term Disability Plan


You insure your home, car, and other valuable possessions, so why not also protect what pays for all of those things? Your income. Without it, think about how your mortgage/rent, groceries, or credit card bills would get paid. That’s where disability insurance can help.

Plan Features• Choose to insure up to 70% of covered basic monthly earnings to a maximum monthly

benefit of $2,000. The minimum benefit is $500.• 7 day elimination period for sickness and 0 for injury• Benefit duration if continually disabled is 13 weeks• 24 hour coverage on or off the job• 3/12 Pre-Existing Condition Exclusion• Maternity coverage subject to applicable pre-existing condition exclusion• Recurrent disability. If you resume work for 30 consecutive workdays, additional

disability is considered a new period.• Annual enrollment for $500-$1000 without medical questions.• Portability: Once an employee is on the AUL disability plan for 3 consecutive months, you

may be eligible to port your coverage for one year at the same rate without evidence of insurability. You have 31 days from your date of termination to apply for portability by calling 800-553-5318. The Portability Privilege is not available to any Person that retires (when the Person receives payment from any Employer’s Retirement Plan as recognition of past services or has concluded his/her working career)

Monthly Benefit

Monthly Premium

$500 $10.36

$600 $12.43

$700 $14.50

$800 $16.57

$900 $18.64

$1,000 $20.71

Monthly Premium (13 Weeks)Monthly Benefit

Monthly Premium

$1,100 $22.78

$1,200 $24.85

$1,300 $26.92

$1,400 $28.99

$1,500 $31.07

$1,600 $33.14

Monthly Benefit

Monthly Premium

$1,700 $35.21

$1,800 $37.28

$1,900 $39.35

$2,000 $41.42

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Long-Term Disability Plan


• Choose to insure up to 60% of covered basic monthly earnings to a maximum monthly benefit of $2,000 in $500 increments. Minimum benefit is $500.

• 90 day elimination period for sickness or injury• Benefit duration of up to 5 years if disabled prior to age 61• 24 hour coverage on or off the job• 3/12 Pre-Existing Condition Exclusion• Annual enrollment for $500-$1000 without medical questions.• Portability: Once an employee is on the AUL disability plan for 3 consecutive months, you

may be eligible to port your coverage for one year at the same rate without evidence of insurability. You have 31 days from your date of termination to apply for portability by calling 800-553-5318. The Portability Privilege is not available to any Person that retires (when the Person receives payment from any Employer’s Retirement Plan as recognition of past services or has concluded his/her working career)

Monthly Benefit Monthly Deduction

$500 $8.15

$1,000 $16.30

$1,500 $24.45

$2,000 $32.60

Monthly Premiums

This information is provided as a Benefit Outline. It is not a part of the insurance policy and does not change or extend American United Life Insurance Company’s liability under the

group Policy. Employers may receive either a group Policy or a Certificate of Insurance containing a detailed description of the insurance coverage under the group Policy. If there are any discrepancies between this information and the group Policy, the Policy will prevail. OneAmerica® is the marketing name for American United Life Insurance Company (AUL) ®,

a One America company. Products issued and underwritten by AUL.

You insure your home, car, and other valuable possessions, so why not also protect what pays for all of those things? Your income. Without it, think about how your mortgage/rent, groceries, or credit card bills would get paid. That’s where disability insurance can help. Long Term Disability kicks in after 90 consecutive days out of work for a sickness or injury.

Plan Features

28

Term Life Plan


Your optional term life coverage provides important protection for you. This coverage is available to you at low group rates and with convenient payroll deductions. To help meet this need, you have the opportunity to elect and pay for additional group life insurance to go along with any other life insurance coverage you may have.

Overview of Benefits Offered• Optional Employee Life Insurance: You have the opportunity to elect additional group life

insurance through payroll deduction.

• Optional Dependent Life Insurance: Provides coverage on your Spouse, Child(ren) from 15 days of age to age 19 (to age 23 if wholly dependent upon you for maintenance and support if full-time student in an accredited school or college.) Handicapped children can continue to be covered with no age limit as long as child is covered prior to 19 or to age 23 if full-time student. It is your responsibility to notify payroll in writing when a dependent is ineligible for coverage.

• Accelerated Life Benefit Option: Under this option, if you are diagnosed as having terminal illness, you may be eligible to receive a portion of your group life benefits at such a difficult time. Please refer to your Group Certificate for details.

Schedule of Benefits• Optional Employee Life Insurance: Your choice of the following amounts: $100,000, $50,000,

$40,000, $30,000, $20,000, or $10,000• Guaranteed issue coverage up to $100,000 if elected when first eligible.

• Optional Dependent Life Insurance: Your choice of either spouse only coverage, child(ren) only coverage, or family coverage in the amount of:• $10,000 for your spouse• Spouse coverage is based off employees age• Spouse coverage terminates at age 70• $5,000 on each of your eligible children 6 months and up• $500 on each of your eligible children age 15 days to 6 months

Optional Dependent Life Insurance is available only to those eligible employees who are insured for Employee Optional Life Insurance. If both husband and wife are employees of Asheboro City Schools, only one can cover the dependent children.

29

Term Life Plan


Age $10,000 $20,000 $30,000 $40,000 $50,000 $100,000

<30 $0.60 $1.20 $1.80 $2.40 $3.00 $6.00

30 - 34 $0.80 $1.60 $2.40 $3.20 $4.00 $8.00

35 - 39 $0.90 $1.80 $2.70 $3.60 $4.50 $9.00

40 - 44 $1.10 $2.20 $3.30 $4.40 $5.50 $11.00

45 - 49 $1.70 $3.40 $5.10 $6.80 $8.50 $17.00

50 - 54 $2.50 $5.00 $7.50 $10.00 $12.50 $25.00

55 - 59 $4.30 $8.60 $12.90 $17.20 $21.50 $43.00

60 - 64 $7.20 $14.40 $21.60 $28.80 $36.00 $72.00

65 - 69 $13.60 $27.20 $40.80 $54.40 $68.00 $136.00

70+ $22.00 $44.00 $66.00 $88.00 $110.00 $220.00

Monthly Cost

Optional Dependent Life InsuranceFamily Coverage $6.60

Spouse only Coverage $5.60

Child(ren) Only Coverage $1.00

30

Whole Life Plan


Whole Life Insurance is an ideal complement to any group term or optional term life insurance your employer might provide. Texas Life’s SOLUTIONS 121 is the life insurance you keep, even if you change jobs or retire as long as you pay premiums. It will help protect your family today, and more importantly tomorrow. And, you won’t have to pay for it after age 65 (or 20 years or if you purchased the policy after age 46), because it’s guaranteed to be paid up.

Common Issue Date: June 1, 2019

Plan Features• Permanent and yours to keep when you change jobs or retire• Non-participating Whole Life (no dividends)• Guaranteed death benefit• Guaranteed paid-up insurance at age 65, or 20 years if you purchased the policy after age 45• If you’re actively at work the day you enroll, you can qualify for basic amounts with no additional

underwriting• Rates shown include Accelerated Death Benefit for Chronic Illness• Rates shown include Waiver of Premium for ages 17-59• If you desire more coverage, you may qualify by answering just four health questions.1• Coverage available for spouse, children, and grandchildren. 2

Age Face Amount Monthly Premium Non-Tobacco

Monthly Premium Tobacco Paid-Up Age

20 $50,000 $32.50 $40.00 65

25 $50,000 $37.00 $46.50 65

30 $50,000 $45.50 $57.00 65

35 $50,000 $58.00 $73.50 65

40 $50,000 $78.00 $98.00 65

45 $50,000 $106.50 $137.50 65

Sample Rates

1- Coverage will depend on the answer to these questions2- Coverage not available on children in WA or on grandchildren in WA and MD. In MD, child must reside with the applicant to be eligible for coverage.Policy Form ICC11-WLOTO-NI-11 or Form Series WLOTO-NI-11.18M113-C 1078 R0219 (exp1020)

31

Whole Life Plan


32

Whole Life Plan


33

Whole Life Plan


34

Whole Life Plan


35

Whole Life Plan


36

Whole Life Plan


37

Continuation of Benefits


If you leave employment

Flexible Benefit Administrators Healthcare Spending Account

If you have a positive balance (payroll deductions are greater than theamount you have received in reimbursement) in your Healthcare Flexible Spending Account at the time of your termination, you may continue participation in the Plan for the remainder of the Plan year through COBRA. If you prefer to terminate your participation and contribution to the Plan, any balance in your account on the date of termination will be forfeited if claims were not incurred prior to the date of termination. For information about continuing your Healthcare Flexible Spending Account, you may contact IMS at 800-426-8739. Interactive Medical Systems is the COBRA Administrator.

Ameritas Dental Plan

Under the dental plan, you and your covered dependents are eligibleto continue dental coverage through COBRA according to the following “qualifying events". If you and your dependents are enrolled in the dental plan, you will be eligible to continue coverage for a specified period through COBRA even after you leave employment. In addition, while covered under the plan, if you should die, become divorced or legally separated, or become eligible for Medicare, your covered dependents may be eligible to continue dental coverage through COBRA. Also, while you are covered under the plan,your covered children who no longer qualify as an eligible dependent may continue coverage through COBRA. Examples of an ineligible dependent would be when your child graduates from college, or turns 24 years old. Should you have any questions you can contact IMS at 800-426-8739. Interactive Medical Systems is the COBRA Administrator.

Superior Vision

Under the Superior Vision plan, you and your covered dependents areeligible to continue vision coverage through COBRA according to thefollowing “qualifying events”. If you and your dependents are enrolled in the vision plan, you will be eligible to continue coverage through COBRA after you leave employment for a specified period. In addition, while covered under the plan, if you should die, become divorced or legally separated, or become eligible for Medicare, your covered dependents may be eligible to continue vision coverage through COBRA. Also, while you are covered under the plan, your covered children who no longer qualify as an eligible dependent may continue coverage through COBRA. Examples of an ineligible dependentwould be when your child graduates from college, or turns 24 yearsold. You will receive notification from Interactive Medical Systems(IMS) with premium and continuation options shortly following yourtermination of employment or you may call them at: 800-426-8739.

38

Continuation of Benefits


If you leave employment

MetLIfe Cancer PlanYou may continue your Cancer Plan by having the premiumcurrently deducted from your paycheck drafted from your bank accountor billed to your home. For more information, contact Bay Bridge Administrators at 800-845-7519.

Aflac Group Accident Plan

You may continue your Aflac Accident by having the premiums currentlydeducted from your paycheck drafted from your bank account or billed toyour home. For more information, contact Aflac/CAIC at 800-433-3036.

AUL Disability Plans

Once an employee is on one of the AUL disability plans for 3 months,you may port the coverage for one year at the same cost withoutevidence of insurability. You have 30 days from your date of terminationto contact AUL to port your coverage by calling 800-553-5318.

MetLife Group Term Life

Conversion: If your employment terminates while you are coveredunder the plan or when you are approved for long-term disability, youmay purchase without medical evidence of insurability, any individualinsurance policy. You must apply for conversion within 31 days afterthe date your coverage terminates. This applies to Optional Life andDependent Life. Portability: If you terminate employment, the portability provision allows you to take your optional life coverage with you, subject to the following provisions:• You must apply for coverage with 31 days from the date your life

coverage terminates.• You must be ACTIVELY at work prior to employment termination.• You may only port up to your current coverage amount. You

cannot increase or add dependents.Your employer will advise MetLife of your termination and MetLife willin turn, contact you directly to assist with the conversion/portabilityprocess, and advise you of your options. If you do not convert or port your group term life insurance, coverage will terminate.Contact MetLife Term Life at 1-800-638-6420.

Texas Life Whole Life Insurance

When you leave employment, you may continue your Whole Lifecoverage by having the premiums that are currently deducted from yourpaycheck billed to your home address or drafted from your bank account.You may do that by contacting Texas Life at: (800) 283-9233 prompt #2.

39

Contact Information


Flexible Benefit Administrators1-800-437-FLEX (1-800-437-3539)

Fax: (757) 431-1155

[email protected]

Https://fba.wealthcareportal.com

Aflac(CAIC a proud member of the Aflac family of insurers)

Columbia, South Carolina

Customer Service

800-433-3036

Aflacgroupinsurance.com

MetLife CancerBay Bridge Administrators

PO Box 161690

Austin, TX 78716

1-800-845-7519

American United Life (AUL)One AmericaClaims Toll-Free Number

855-517-6365

Customer Service

800-553-5318

Texas Life Insurance CompanyPO Box 830

Waco, TX 76703-0830

800-283-9233

www.texaslife.com

Superior Vision1-800-507-3800

Fax: 916-852-2277

Ameritas DentalCall Center: 1-800-487-5553

www.ameritas.com

MetLife Term Life1-800-638-6420

40

Benefits Available for Retirees


MetLife Dental and Superior Vision Insurance Plans for Retirees of State or Local Government Offered Through North Carolina Retired Governmental Employees’ Association, Inc.

With over 54,000 members, the North Carolina Retired Governmental Employees’ Association is the largest single group representing retirees before the N.C. General Assembly, the Retirement Systems Boards of Trustees, and the State Health Plan trustees. For retirees or future retirees of state or local governments in North Carolina (including teachers, legislators, National Guard, and judicial), NCRGEA is your voice for sustaining and increasing your benefits after retirement.

Additionally, there are many benefits included with membership at no additional cost ($10,000 AD&D Insurance, bimonthly newsletter, weekly electronic legislative updates while the General Assembly is in session, a toll-free number to call for information and assistance, hearing assistance and vision care discount programs, and free district meetings).

The Association also offers optional MetLife Dental Insurance and Superior Vision Insurance plans for our members. Those premiums are conveniently deducted from your retirement benefit check monthly. Please contact us at NCRGEA, PO Box 10561, Raleigh, NC 27605, 1-800-356-1190, or go to our website, www.ncrgea.com, for further information.

41

NOTES


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Arranged and Enrolled by Mark III Brokerage, Inc.

114 E. Unaka Ave.Johnson City, TN 37601

(800) 532-1044(704) 365-4280

Feb-19

View additional benefits information or download forms at:mymarkiii.com

Documents

May 1, 2019 –April 30, 2020 Employee Benefits Guide