Exhibit_B_Aflac__Brevard_2025.pdf
PDF 5 MB Posted
- Solicitation number
- RFP-1-26-12
- Issued by
- Brevard County, Florida
About this file
This is an Employee Benefits Handbook for Brevard County, Florida for the plan year January 1, 2025 through December 31, 2025, detailing voluntary supplemental health insurance products offered through Aflac via Continental American Insurance Company (CAIC) and administered by Mark III Employee Benefits. The handbook outlines three primary product lines: Aflac Group Accident insurance, Aflac Group Hospital Indemnity insurance, and Aflac Group Critical Illness insurance with cancer coverage. The Group Accident plan provides 24-hour coverage for accidental injuries with benefits ranging from initial treatment ($125-$175 depending on coverage type) to accidental death benefits up to $50,000 for employees. The Hospital Indemnity plan offers cash benefits for hospital admissions, daily confinement, intensive care, and surgical procedures, with low and high benefit options available. The Critical Illness plan covers conditions including cancer, heart attack, stroke, kidney failure, and bone marrow transplant, with face amounts available up to $50,000 for employees and $25,000 for spouses, and dependent children automatically covered at 50% of the primary insured's amount at no additional charge. All plans are available on a post-tax basis with guaranteed-issue coverage options, feature no pre-existing condition limitations or waiting periods, include portability provisions, and offer wellness screening benefits.
Semi-monthly premium rates for the Group Accident plan range from $7.92 for employee-only coverage to $19.14 for family coverage. Hospital Indemnity rates vary by option level, with the low option ranging from $12.12 for employee coverage to $58.66 for family coverage, and the high option ranging from $23.14 to $58.66. Critical Illness premiums are age-based and tobacco-rated, with employee rates ranging from $2.23 to $151.41 semi-monthly depending on age and face amount selected. All three plans are administered through the mymarkiii.com employee benefits portal and mobile app, with claim filing available through the Aflac website or the benefits portal. Eligible employees include those age 18 and older, with spouse coverage available to ages 18-64 and dependent children coverage available for those under age 26. The plans include successor insured benefits allowing surviving spouses to continue coverage upon the primary insured's death, and waiver of premium provisions if the employee becomes totally disabled for 90 days or longer. Employees may enroll during designated open enrollment periods or within 30 days of qualifying life events, with enrollment support available through self-service online platforms or by calling the Mark III Benefits Counselor at 1-833-783-5341.
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EMPLOYEE
BENEFITS
HANDBOOK
January 1, 2025 - December 31, 2025
Provided by:
Read full descriptions and plan details at mymarkiii.com
Table of Contents
All information in this booklet is a brief description of your coverage and is not a contract. Please refer to your policy or certificate for each product for the exact terms and conditions.
Disclaimer ............................................................................................................ Page 2
Important Points ................................................................................................. Page 3
Qualifying Life Events ......................................................................................... Page 4
Welcome to Your Benefits ................................................................................. Page 5
How to Enroll at Open Enrollment .................................................................... Page 6
Employee Benefits Portal ................................................................................... Page 7
MyMark III Mobile App ....................................................................................... Page 8
Filing a Claim ....................................................................................................... Page 9
Aflac Group Accident ........................................................................................ Page 11
Aflac Group Hospital Indemnity ...................................................................... Page 15
Aflac Group Critical Illness ............................................................................... Page 18
Continuation of Benefits .................................................................................. Page 22
Contact Information ......................................................................................... Page 23
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
Important Points ü Your plan year runs from January 1, 2025 to December 31, 2025. This means your benefit elections will take effect January 1, 2025 unless otherwise noted.
ü If you wish to add or make changes to your benefit elections, you have the option of self-enrolling or speaking with a trusted Mark III Benefits Counselor during your scheduled open enrollment.
ü Once the enrollment period is over, you will not be able to make changes unless you experience a qualifying life event as outlined by the IRS.
ü This benefits guide is equipped with mobile-friendly barcodes commonly referred to as QR Codes. Use your smartphone to scan the QR codes to view your benefit summaries.
ü All policy information can be found on your employee benefits portal at https://mymarkiii.com/brevardcountyfl/.
https://mymarkiii.com/brevardcountyfl/
Qualifying Life Events Open 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.” Post-Tax benefits can be changed during the plan year without a QLE. Please contact your Group Contact for information on cancelling post-tax benefits.
Examples of QLEs The following events will open a special 30-day enrollment period from the date of the event, allowing you to make changes to your coverage.
Documentation may be required.
marriage divorce childbirth/ adoption death of a family member loss of parental coverage spouse gains or loses coverage ü Aflac Group Accident ü Aflac Group Hospital Indemnity ü Aflac Group Critical Illness
Post-Tax Benefit Information A “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. Please contact your Group Contact for information on cancelling post-tax benefits.
Pre-Tax Benefit Information A “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 unless you have a qualifying life event (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.
Welcome to Your Benefits!
Mark III Employee Benefits is here to help guide you through the benefits offered by your employer.
This guide is simply a brief summary of benefits offered and does not constitute a policy.
How to Enroll at Open Enrollment Self-Service Enrollment You have the option to self-enroll in your benefits through the online enrollment platform.
Visit the link below to self-enroll.
Self-Enroll Visit: https://mymarkiii.com/brevardcountyfl/enrollment/
Call Center Enrollment Dial the number below to speak with a trusted Mark III Benefits Counselor. They will explain the benefits offered and help get you enrolled.
Call Center: 1 (833) 783-5341 (M – F, 8:00 a.m. – 5:00 p.m. EST)
Employee Benefits Portal Use your smartphone to scan the QR code for quick access to your employee portal page.
Review your benefits guide online, download claim forms, access the online enrollment platform, and much more!
https://mymarkiii.com/brevardcountyfl/enrollment/
Employee Benefits Portal Find details about all of your benefits, download forms, submit claims, ask questions, and more at https://mymarkiii.com/brevardcountyfl/.
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.
MyMark III Mobile App Find details about all of your benefits, download forms, submit claims, ask questions, and more on the MyMark III Mobile App!
ü Benefits Guide ü Product Videos ü Policy Certificates ü Plan Forms ü Contact Info ü Enrollment Info
Your Trusted Benefits Partners at your fingertips!
Search for “MyMark III” to access benefit information on the go!
Available on:
Filing a Claim
Group Aflac Visit https://www.aflacgroupinsurance.com and click on Customer Service and then File a Claim. Choose your claim form and follow the instructions. Complete and upload your HIPAA authorization, claim details and documents, and direct deposit information.
ü Aflac Group Accident Wellness Amount - $60 ü Aflac Group Hospital Indemnity Wellness Amount - $50 ü Aflac Group Critical Illness Wellness Amount - $100 (Employee/Spouse Only)
Employee Benefits Portal Use your smartphone to scan the QR code or visit the link for quick access to your employee portal page. Review your benefits guide online, download claim forms, access the online enrollment platform, and much more!
Visit: https://mymarkiii.com/brevardcountyfl/ https://www.aflacgroupinsurance.com/
STAY
WELL
Voluntary Benefit options that enhance you and your family’s well being.
Group Accident Plan
Plan Features
• Benefits are payable regardless of any other insurance programs.
• Coverage is guaranteed-issue, provided the applicant is eligible for coverage.
• Benefits are available for spouse and/or dependent children.
• There’s no limit on the number of claims an insured can file.
• Premiums are paid by convenient payroll deduction.
Eligibility Issue Ages Employee 18 -69 Spouse 18 -64 Children under age 26 The employee may purchase 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.
Guaranteed-Issue 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.
Portability Coverage may be continued with certain stipulations. See certificate for details.
Benefits Overview Benefit Amount
Initial Treatment (once per accident, within 7 days after the accident, not payable for telemedicine services) Payable when an insured receives initial treatment for a covered accidental injury. This benefit is payable for initial treatment received under the care of a doctor when an insured visits the following:
• Hospital emergency room with X-Ray / without X-Ray
• Urgent care facility with X-Ray / without X-Ray
• Doctor’s office or facility (other than a hospital emergency room or urgent care) with X-Ray / without X-Ray
$175/$125 EE/SP
$125/$75 Child(ren)
Ambulance (within 90 days after the accident) Payable when an insured receives transportation by a professional ambulance service due to a covered accidental injury. $100 Ground | $500 Air
Emergency Room Observation (once per accident, within 7 days after the accident; Each 24 hour period) Payable when an insured receives treatment in a hospital emergency room, and is held in a hospital for observation without being admitted as an inpatient because of a covered accidental injury.
$75 EE/SP
$45 Child(ren)
Blood/Plasma/Platelets (3 times per accident, within 6 months after the accident) Payable for each day that an insured receives blood, plasma or platelets due to a covered accidental injury. $100
Concussion (once per accident, within 6 months after the accident) Payable when an insured is diagnosed by a doctor with a concussion due to a covered accident. $200
Fractures (once per accident, within 90 days after the accident) Payable when an insured fractures a bone because of a covered accident and is treated by a doctor. If the fracture requires open reduction, 200% of the benefit is payable for that bone. For multiple fractures (more than one fracture in one accident), we will pay a maximum of 200% of the benefit amount for the bone fractured that has the highest dollar amount. For a chip fracture (a piece of bone that is completely broken off near a joint), we will pay 25% of the amount for the affected bone. This benefit is not payable for stress fractures.
Up to $3,500 based on a schedule
Dislocations (once per accident, within 90 days after the accident) Payable when an insured dislocates a joint because of a covered accident and is treated by a doctor. If the dislocation requires open reduction, 200% of the benefit for that joint is payable. 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 his certificate and then dislocates the same joint again, it will not be covered by the plan. For multiple dislocations (more than one dislocated joint in one accident), we will pay a maximum of 200% of the benefit amount for the joint dislocated that has the highest dollar amount. For a partial dislocation (joint is not completely separated, including subluxation), we will pay 25% of the amount for the affected joint.
Up to $3,000 based on a schedule
Benefits Overview Benefit Amount Coma (once per accident) Payable when an insured is in a coma lasting 30 days or more as the result of a covered accident. For the purposes of this benefit, Coma means a profound state of unconsciousness caused by a covered accident.
$10,000
Emergency Dental Work (once per accident, within 6 months after the accident) Payable when an insured’s natural teeth are injured as a result of a covered accident.
$50 Extraction $150 Repair with crown
Burns (once per accident, within 6 months after the accident) Payable when an insured is burned in a covered accident and is treated by a doctor. We will pay according to the percentage of body surface burned.
First degree burns are not covered.
Second Degree
• Less than 10% $100
• At least 10% but less than 25% $200
• At least 25% but less than 35% $500
• 35% or more $1,000
Third Degree
• Less than 10% $1,000
• At least 10% but less than 25% $5,000
• At least 25% but less than 35% $10,000
• 35% or more $20,000
Eye Injuries Payable for eye injuries if, because of a covered accident, a doctor removes a foreign body from the eye, with or without anesthesia.
$100
Lacerations (once per accident, within 7 days after the accident) Payable when an insured receives a laceration in a covered accident and the laceration is repaired by a doctor. For multiple lacerations, we will pay a maximum of 200% of the benefit for the largest single laceration requiring stitches. Lacerations requiring stitches (including liquid skin adhesive):
• Over 15 centimeters $400
• 5-15 centimeters $200
• Under 5 centimeters $50
• Lacerations not requiring stitches $25
Outpatient Surgery & Anesthesia (per day / performed in hospital or ambulatory surgical center, within one year after the accident) Payable for each day that, due to a covered accidental injury, an insured has an outpatient surgical procedure performed by a doctor in a hospital or ambulatory surgical center. Surgical procedure does not include laceration repair. If an outpatient surgical procedure is covered under another benefit in the plan, we will pay the higher benefit amount.
$400
Outpatient Surgery & Anesthesia (per day / performed in a doctor’s office, urgent care facility, or emergency room;
maximum of two procedures per accident, within one year of the accident) Payable for each day that, due to a covered accidental injury, an insured has an outpatient surgical procedure performed by a doctor in a doctor’s office, urgent care facility or emergency room. Surgical procedure does not include laceration repair. If an outpatient surgical procedure is covered under another benefit in this plan, we will pay the higher benefit amount.
$50
Inpatient Surgery & Anesthesia (per day / within one year after the accident) Payable for each day that, due to a covered accidental injury, an insured has an inpatient surgical procedure performed by a doctor. The surgery must be performed while the insured is confined to a hospital as an inpatient. If an inpatient surgical procedure is covered under another benefit in the plan, we will pay the higher benefit amount.
$750
Transportation (greater than 100 miles from the insured’s residence, 3 times per accident, within 6 months after the accident) Payable for transportation if, because of a covered accident, an insured is injured and requires doctor-recommended hospital treatment or diagnostic study that is not available in the insured’s resident city.
$300 Plane;
Any ground transportation
Successor Insured Benefit If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time.
Surgical Procedures may include, but are not limited to, surgical repair of: ruptured disc, tendons/ligaments, hernia, rotator cuff, torn knee cartilage, skin grafts, joint replacement, internal injuries requiring open abdominal or thoracic surgery, exploratory surgery (with or without repair), etc., unless otherwise noted due to an accidental injury.
After Care Benefits Overview Benefit Amount Appliances (within 6 months after the accident) Payable if, as a result of an injury received in a covered accident, a doctor advises the insured to use a listed medical appliance as an aid in personal locomotion. Cane, Ankle Brace, Walking Boot, Walker, Crutches, Leg Brace, Cervical Collar, Wheelchair, Knee Scooter, Body Jacket, Back Brace
$100
Hospitalization Benefits Benefit Amount Hospital Admission (once per accident, within 6 months after the accident) Payable when an insured is admitted to a hospital and confined as an inpatient because of a covered accidental injury.
This benefit is not payable for confinement to an observation unit, for emergency room treatment or for outpatient treatment.
$1,000 per confinement
Hospital Confinement (maximum of 365 days per accident, within 6 months after the accident) Payable for each day that an insured is confined to a hospital as an inpatient because of a covered accidental injury. If we pay benefits for confinement and the insured is confined again within 6 months because of the same accidental injury, we will treat this confinement as the same period of confinement. This benefit is payable for only one hospital confinement at a time even if caused by more than one covered accidental injury. This benefit is not payable for confinement to an observation unit or a rehabilitation facility.
$200 per day
Hospital Intensive Care (maximum of 30 days per accident, within 6 months after the accident) Payable for each day an insured is confined in a hospital intensive care unit because of a covered accidental injury. We will pay benefits for only one confinement in a hospital intensive care unit at a time, even if it is caused by more than one covered accidental injury. If we pay benefits for confinement in a hospital intensive care unit and an insured becomes confined to a hospital intensive care unit again within 6 months because of the same accidental injury, we will treat this confinement as the same period of confinement. This benefit is payable in addition to the Hospital Confinement Benefit.
$400 per day
Family Member Lodging (greater than 100 miles from the insured’s residence, maximum of 30 days per accident, within 6 months after the accident) Payable for each night’s lodging in a motel/hotel/rental property for an adult member of the insured’s immediate family.
For this benefit to be payable:
• The insured must be confined to a hospital for treatment of a covered accidental injury;
• The hospital and motel/hotel must be more than 100 miles from the insured’s residence; and
• The treatment must be prescribed by the insured’s treating doctor.
$100 per day
After Care Benefits Overview Benefit Amount Accident Follow-Up Treatment (maximum of 6 per accident, within 6 months after the accident provided initial treatment is within 7 days of the accident) Payable for doctor-prescribed follow-up treatment for injuries received in a covered accident. Follow-up treatments do not include physical, occupational or speech therapy. Chiropractic or acupuncture procedures are also not considered follow-up treatment.
$25
Therapy (maximum of 6 per accident, beginning within 90 days after the accident provided initial treatment is within 7 days after the accident) Payable if because of injuries received in a covered accident, an insured has doctor-prescribed therapy treatment in one of the following categories: physical therapy provided by a licensed physical therapist, occupational therapy provided by a licensed occupational therapist, or speech therapy provided by a licensed speech therapist.
$25
Life Changing Events Benefits Overview Benefit Amount Dismemberment (once per accident, within 6 months after the accident) Payable if an insured loses a hand or foot or experiences loss of sight as the result of a covered accident. Dismemberment means:
• Loss of a hand -The hand is removed at or above the wrist joint;
• Loss of a foot -The foot is removed at or above the ankle;
• Loss of a finger/toe - The finger or toe is removed at or above the joint where it is attached to the hand or foot; or
• Loss of sight - At least 80% of the vision in one eye is lost (such loss of sight must be permanent and irrecoverable).
If the Dismemberment Benefit is paid and the insured later dies as a result of the same covered accident, we will pay the appropriate death benefit (if available), less any amounts paid under this benefit.
Single Loss (the loss of one hand, one foot, or the sight of one eye)
• Employee $12,500
• Spouse $5,000
• Child(ren) $2,500
Double Loss (the loss of both hands, both feet, the sight of both eyes, or a combination of any two)
• Employee $25,000
• Spouse $10,000
• Child(ren) $5,000
Loss of One or More Fingers or Toes
• Employee $1,250
• Spouse $500
• Child(ren) $250
Partial Dismemberment (Includes at Least One Joint of a Finger or a Toe)
• Employee $100
• Spouse $100
• Child(ren) $100
Life Changing Events Benefits Overview Benefit Amount Paralysis (once per accident, diagnosed by a doctor within six months after the accident) Payable if an insured has permanent loss of movement of two or more limbs for more than 90 days (in Utah, 30 days) as the result of a covered accidental injury.
• Paraplegia $5,000
• Quadriplegia $10,000
Prosthesis (once per accident, up to 2 prosthetic devices and one replacement per device per insured)* Payable when an insured receives a prosthetic device, prescribed by a doctor, as a result of a covered accidental injury.
Prosthetic Device/Prosthesis means an artificial device designed to replace a missing part of the body. This benefit is not payable for hearing aids, wigs, or dental aids (to include false teeth), repair or replacement of prosthetic devices* and /or joint replacements.
* We will pay this benefit again once to cover the replacement of a prosthesis for which a benefit has been paid, provided the replacement takes place within three years of the initial benefit payment.
$500
Wellness Rider Benefit Amount
Wellness Benefit (once per calendar year) Payable for wellness tests performed as the result of preventive care, including tests and diagnostic procedures ordered in connection with routine examinations.
$60 First year of certificate and thereafter
Accidental Death Benefits Benefit Amount
Accidental Death Benefit (within 90 days after the accident*) Payable if a covered accidental injury causes the insured to die.
$50,000 Employee $10,000 Spouse $5,000 Child(ren)
Accidental Common-Carrier Death Benefit Payable if the insured:
• Is a fare-paying passenger on a common carrier;
• Is injured in a covered accident; and
• Dies within 90 days* after the covered accident.
*In Oregon and Utah, within 180 days after the accident; in Pennsylvania, there is no limitation on the number of days.
$100,000 Employee $50,000 Spouse
$15,000 Child(ren)
Exceptions & Reductions
PRE-EXISTING CONDITION LIMITATION
PRE-EXISTING CONDITION - Pre-existing Condition means within the 12-month period prior to the Effective Date of this Certificate and attached Riders, as applicable. We will not pay benefits for any loss, injury or total disability which is caused by, contributed to by, or resulting from a pre-existing condition for 12 months after the Effective Date of your Certificate and attached riders, as applicable. A claim for benefits for loss starting after 12 months from the Effective Date of your Certificate and attached riders, as applicable, will not be reduced or denied on the grounds that it is caused by a pre-existing condition.
This certificate may have been issued as a replacement for a Certificate previously issued to you under the Plan. If so, then the pre-existing condition limitation provision of this Certificate applies only to any increase in benefits over the prior Certificate. Any remaining period of pre-existing condition limitation of the prior Certificate would continue to apply to the prior level of benefits.
Exclusions We will not pay benefits for loss caused by pre-existing conditions (except as stated in the previous provision). We will not pay benefits for loss, injury, total disability or death contributed to, caused by, or resulting from:
1. War - participating in war or any act of war, declared or not, or 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.
2. Suicide - committing or attempting to commit suicide, while sane or insane.
3. 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.
4. Self-Inflicted Injuries - injuring or attempting to injure yourself intentionally.
5. Traveling - traveling more than 40 miles outside the territorial limits of the United States, Canada, Mexico, Puerto Rico, the Bahamas, Virgin Islands, Bermuda, and Jamaica, except under the Accidental Common Carrier Death Benefit.
6. Racing - Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.
7. Aviation - operating, learning to operate, serving as a crew member on, or jumping or falling from any aircraft, including those which are not motor-driven.
8. Intoxication - being legally intoxicated, or being under the influence of any narcotic, unless such is taken under the direction of a physician.
9. Illegal Acts - participating or attempting to participate in an illegal activity or working at an illegal job.
10. Sports - participating in any organized sport: professional or semi-professional.
11. Avocations - mountaineering using ropes and/or other equipment, parachuting or hand-gliding.
12. Cosmetic Surgery - having cosmetic surgery or other elective procedures that are not medically necessary or having dental treatment except as a result of covered accident.
Aflac Group Accident Rates
24 Hour Plan Semi-Monthly Rates Employee $7.92
Employee & Spouse $11.97
Employee & Dependent Children $15.09
Family $19.14
Group Hospital Indemnity Plan
Read full descriptions and plan details at mymarkiii.com
Plan Description The Aflac Group Hospital Indemnity plan provides cash benefits directly to you (unless otherwise assigned) that help pay for some of the costs— medical and nonmedical—associated with a covered hospital stay due to a sickness or accidental injury.
Plan Features
• Benefits paid for covered sicknesses and accidents
• Coverage is available for all family members
• Guaranteed-issue coverage is available (which means you may qualify for coverage without answering health questions)
• Premiums paid through convenient payroll deduction
• No pre-existing limitations or waiting period
• Benefits don’t reduce as you get older
• Coverage is portable (with certain stipulations)
• Annual Health Screening Benefit is included
• Benefits are paid regardless of any other medical insurance
Underwriting Guidelines – Guaranteed-Issue Guaranteed-Issue Guaranteed-issue coverage is offered to all eligible applicants during the initial enrollment and for new hires thereafter. At the group’s first and second anniversary, late enrollees are eligible to enroll on a guaranteed-issue basis.
Late Enrollee Eligibility For late enrollees who are not eligible for guaranteed-issue: All applicants are required to answer underwriting questions.
Individual Eligibility Issue Ages:
• Employee: 18+
• Spouse or Domestic Partner: 18+
• Children: Under age 26
Spouse or Domestic Partner Coverage Available To apply for spouse or domestic partner coverage, you must also apply and be issued coverage. Spouse/Domestic Partner-only coverage is not available.
Dependent Children Coverage Available Dependent children under the age of 26 can be covered. To apply for dependent child coverage, you must also apply and be issued coverage. If you do not have dependent child coverage, a newborn/newly adopted child will be automatically covered for 60 days from the date of birth or placement for adoption. To continue coverage beyond 60 days, you must apply for coverage for the child and pay any required premium. Children-only coverage is not available.
Successor Insured Benefit If spouse or domestic partner coverage is in force at the time of the primary insured’s death, the surviving spouse or domestic partner may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time.
Portability Coverage may be continued with certain stipulations. See certificate for complete details.
Waiver of Premium If the employee becomes totally disabled due to a covered sickness or accidental injury, after 90 days of total disability, we will waive premiums for the insured and any covered dependents. As long as the insured remains totally disabled, premium will be waived up to 24 months, subject to the terms of the policy.
Successor Insured Benefit If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time.
Read full descriptions and plan details at mymarkiii.com
Benefits Low High
Hospital Admission (per confinement) – once per covered sickness or accident per calendar year for each insured Payable when an insured is admitted to a hospital and confined as an inpatient because of a covered accidental injury or covered sickness. We will not pay benefits for confinement to an observation unit, or for emergency room treatment or outpatient treatment. We will not pay benefits for admission of a newborn child following his birth; however, we will pay for a newborn’s admission to a Hospital Intensive Care Unit if, following birth, he is confined as an inpatient as a result of a covered accidental injury or covered sickness (including congenital defects, birth abnormalities, and/or premature birth).
$500 $1,500
Hospital Confinement (per day) – maximum of 31 days per confinement for each covered sickness or accident for each insured Payable for each day that an insured is confined to a hospital as an inpatient as the result of a covered accidental injury or covered sickness. If we pay benefits for confinement and the insured becomes confined again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable for only one hospital confinement at a time even if caused by more than one covered accidental injury, more than one covered sickness, or a covered accidental injury and a covered sickness.
$100 $150
Hospital Intensive Care (per day) – maximum of 10 days per confinement for each covered sickness or accident for each insured Payable for each day when an insured is confined in a Hospital Intensive Care Unit because of a covered accidental injury or covered sickness. We will pay benefits for only one confinement in a Hospital's Intensive Care Unit at a time. Once benefits are paid, if an insured becomes confined to a Hospital's Intensive Care Unit again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable in addition to the Hospital Confinement Benefit.
$100 $150
Intermediate Intensive Care Step-Down Unit (per day)- maximum of 10 days per confinement for each covered sickness or accident for each insured Payable for each day when an insured is confined in an Intermediate Intensive Care Step-Down Unit because of a covered accidental injury or covered sickness. We will pay benefits for only one confinement in an Intermediate Intensive Care Step-Down Unit at a time. Once benefits are paid, if an insured becomes confined to a Hospital's Intermediate Intensive Care Step- Down Unit again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable in addition to the Hospital Confinement Benefit.
$50 $75
Hospitalization Benefits
*Residents of Massachusetts are eligible for Hospital Admission, Hospital Confinement only.
Treatment Benefits
Inpatient & Outpatient Surgical Benefits
Benefits Low High
Inpatient Surgery and Anesthesia (performed in hospital or ambulatory surgical center) Payable for each day that, due to a covered accidental injury or sickness, an insured has an inpatient surgical procedure performed by a doctor. The surgery must be performed while the insured is confined to a hospital as an inpatient.
$250 $500
Outpatient Surgery and Anesthesia (performed in a hospital or ambulatory surgical center) Payable for each day that, due to a covered accidental injury or sickness, an insured has an outpatient surgical procedure performed by a doctor in a hospital on an outpatient basis or ambulatory surgical center.
$125 $250
Outpatient Surgery and Anesthesia (performed in a doctor’s office, urgent care facility or emergency room;
maximum of 4 procedures per calendar year for each insured) Payable for each day that, due to a covered accidental injury or sickness, an insured has an outpatient surgical procedure performed by a doctor in a doctor’s office or urgent care facility.
$50 $50
Benefits Low High
Major Diagnostic Exams We will pay the amount shown for each day that, due to a covered accidental injury or covered sickness, an insured requires one of the following exams:
• Computerized Tomography (CT/CAT scan)
• Magnetic Resonance Imaging (MRI)
• Electroencephalography (EEG)
$125 $250
Outpatient Doctor’s Office Visit (maximum of 1 visit per calendar year for each insured) We will pay the amount shown for each day that an insured visits a doctor’s office. This benefit is not payable for visits to a chiropractor’s office.
$50 $50
Read full descriptions and plan details at mymarkiii.com
Limitations & Exclusions (Applies To All Riders Unless Otherwise Noted) Exclusions We will not pay for loss due to:
• War – voluntarily participating in war, any act of war, or military conflicts, declared or undeclared, or voluntarily participating or serving in the military, armed forces, or an auxiliary unit thereto, or contracting with any country or international authority. (We will return the prorated premium for any period not covered by the certificate when the Insured is in such service.) War also includes voluntary participation in an insurrection, riot, civil commotion or civil state of belligerence. War does not include acts of terrorism.
• Suicide – committing or attempting to commit suicide, while sane or insane.
• Self-Inflicted Injuries – injuring or attempting to injure oneself intentionally.
• Racing – riding in or driving any motor-driven vehicle in a race, stunt show or speed test in a professional or semi-professional capacity.
• Illegal Occupation – voluntarily participating in, committing, or attempting to commit a felony or illegal act or activity, or voluntarily working at, or being engaged in, an illegal occupation or job.
• Sports – participating in any organized sport in a professional or semi-professional capacity.
• Custodial Care – this is non-medical care that helps individuals with the basic tasks of everyday life, the preparation of special diets, and the self-administration of medication which does not require the constant attention of medical personnel.
• Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including any resulting complications.
• Services performed by a Family Member.
• Services related to sex or gender change, sterilization, in vitro fertilization, vasectomy or reversal of a vasectomy, or tubal ligation.
• Elective Abortion – an abortion for any reason other than to preserve the life of the person upon whom the abortion is performed.
• Dental Services or Treatment.
• Cosmetic Surgery, except when due to:
§ Reconstructive surgery, when the service is related to or follows surgery resulting from a Covered Accidental Injury or a Covered Sickness or is related to or results from a congenital disease or anomaly of a covered dependent child.
§ Congenital defects in newborns.
Aflac Group Hospital Indemnity Semi-Monthly Rates
Covered Low Option High Option
Employee $12.12 $23.14
Employee + Spouse $24.18 $46.47
Employee + Child(ren) $19.30 $35.33
Family $31.36 $58.66
Group Critical Illness Plan with Cancer
• Benefits are paid directly to you, unless otherwise assigned
• Benefit amounts are available up to $50,000 for employees and up to $25,000 for spouses
• Dependent children are covered at 50% of the primary insured’s amount at no additional charge
• There are no pre-existing condition limitations
• The plan doesn’t have a waiting period for benefits
• Benefits do not reduce as insureds get older
• Coverage is portable, with certain stipulations
• Annual health screening benefit is included
• Premiums are paid through convenient payroll deduction
• Guaranteed-Issue coverage is available (which means you may qualify for coverage without having to answer health questions).
Underwriting Guidelines – Guaranteed- Issue Guaranteed-issue coverage is available for all eligible employees. The following options are available:
Up to $30,000 for employees and up to $15,000 for spouses with no participation requirement.
For employee amounts over $30,000 and spouse amounts over $15,000:
All applicants are required to answer underwriting questions. Employees who would otherwise be declined will be issued the lesser of the amount applied for or the guaranteed-issue limit.
Individual Eligibility Issue Ages:
• Employee 18+
• Spouse 18+
• Children under age 26
Benefit-eligible employees who work at least 30 hours weekly are eligible. If an employee is eligible, his spouse is also eligible to apply for coverage. Dependent children under the age of 26 are automatically covered. Seasonal and temporary workers are not eligible to participate.
Spouse Coverage Available Spouse coverage is available up to 50% of the employee’s face amount, subject to the minimum face amount of $5,000. To apply for spouse coverage, the employee must also apply.
If the employee does not meet the underwriting requirements necessary to participate in the plan, the spouse can still obtain coverage. The spouse would then become the primary insured and be limited to face amounts between $5,000 and $25,000.
Dependent Children Coverage Dependent children under the age of 26 are automatically covered at 50% of the primary insured’s face amount at no additional charge. Children-only coverage is not available.
Waiver of Premium If the employee becomes totally disabled due to a covered critical illness, after 90 days of total disability, we will waive premiums for the insured and any covered dependents. As long as the insured remains totally disabled, premium will be waived up to 24 months, subject to the terms of the policy.
Portability Coverage may be continued with certain stipulations. See certificate for details.
Successor Insured Benefit If spouse coverage is in force at the time of the primary insured’s death, the surviving spouse may elect to continue coverage.
Coverage would continue at the existing spouse face amount and would also include any dependent child coverage in force at the time.
Group Critical Illness Benefits Where applicable, covered conditions must be caused by underlying diseases as defined in the plan.
Plan Features with Cancer
Initial Diagnosis+ An insured may receive up to 100% of his face amount upon the diagnosis of a covered critical illness.
Covered Critical Illnesses and Additional Benefits Percentage of Face Amount/Benefit
Cancer (Internal or Invasive) ++ 100% Heart Attack 100% Major Organ Transplant (25% of this benefit is payable for insureds placed on a transplant list for a major organ transplant) 100%
Kidney Failure (End-Stage Renal Failure) 100% Stroke 100% Bone Marrow Transplant (Stem Cell Transplant) 100% Sudden Cardiac Arrest 100% Non-Invasive Cancer ++ 25% Coronary Artery Bypass Surgery 25% Coma** 100% Severe Burns* 100% Paralysis** 100% Loss of Sight** 100% Loss of Hearing** 100% Loss of Speech** 100% Skin Cancer ++ $250 (once per calendar year/insured)
Benefits will be based on the face amount in effect on the critical illness date of diagnosis.
*This benefit is only payable for burns due to, caused by, and attributed to, a covered accident.
**These benefits are payable for loss due to a covered underlying disease or a covered accident.
Additional Diagnosis + Once benefits have been paid for a covered critical illness, we will pay benefits for each different critical illness when the date of diagnosis is separated by at least 6 consecutive months.
Reoccurrence + Once benefits have been paid for a covered critical illness, benefits are payable for that same critical illness when the date of diagnosis is separated by at least 6 consecutive months.
+ If the claim is for a cancer diagnosis, the insured must be treatment-free from cancer for at least 12 months and must be in complete remission before the date of a subsequent cancer diagnosis.
Health Screening Benefit Benefit Benefit Amount
Health Screening Benefit $100 per calendar year
The Health Screening Benefit is payable once per calendar year for health screening tests performed as the result of preventive care, including tests and diagnostic procedures ordered in connection with routine examinations. This benefit is payable for the covered employee and spouse. This benefit is not paid for dependent children.
Heart Event Rider Surgeries and Procedures Covered Under Plan Percentage of Maximum Benefit
Category 1 - Specified Surgeries of the Heart Coronary Artery Bypass Surgery 75%* Mitral Valve Replacement or Repair 100% Aortic Valve Replacement or Repair 100% Surgical Treatment of Abdominal Aortic Aneurysm 100%
Category 2 – Invasive Procedures and Techniques of the Heart AngioJet Clot Busting 10% Balloon Angioplasty (or Balloon valvuloplasty) 10% Laser Angioplasty 10% Atherectomy 10% Stent Implantation 10% Cardiac Catheterization 10% Automatic Implantable (or Internal) Cardioverter Defibrillator (AICD) 10% Pacemakers 10%
*The 75% benefit available in the rider, combined with the partial benefit available in the certificate, equals a 100% benefit for coronary artery bypass surgery.
with Cancer
Limitations & Exclusions (Applies to all riders unless otherwise noted) Cancer Diagnosis Limitation Benefits are payable for Cancer and/or Non-Invasive Cancer as long as the Insured:
• Is treatment-free from cancer for at least 12 months before the diagnosis date; and
• Is in complete remission prior to the date of a subsequent diagnosis, as evidenced by the absence of all clinical, radiological, biological, and biochemical proof of the presence of the cancer.
Exclusions We will not pay for loss due to any of the following:
• Self-Inflicted Injuries – injuring or attempting to injure oneself intentionally or taking action that causes oneself to become injured.
• Suicide – committing or attempting to commit suicide, while sane or insane.
• Illegal Acts – participating or attempting to participate in an illegal activity or working at an illegal job.
• Participation in Aggressive Conflict of any kind, including:
• War (declared or undeclared) or military conflicts; this does not include terrorism.
• Insurrection or riot.
• Civil commotion or civil state of belligerence.
• Illegal substance abuse, which includes the following:
• Abuse of legally-obtained prescription medication.
• Illegal use of non-prescription drugs.
Diagnosis, treatment, testing, and confinement must be in the United States or its territories.
All benefits under the plan, including benefits for diagnoses, treatment, confinement and covered tests, may be payable only while coverage is in force.
Notices This 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.
Aflac Group Insurance is underwritten by Continental American Insurance Company (CAIC), a proud member of the 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.
EXP (08/24)
Optional Benefits Rider Illnesses Covered Under Plan Percentage of Face Amount Benign Brain Tumor 100%
Advanced Alzheimer’s Disease 25%
Advanced Parkinson’s Disease 25%
Benefits are payable if an insured is diagnosed with one of the conditions listed.
Benefits are payable for the specified surgeries and procedures listed above. Benefits from each category are payable once per calendar year, per insured.
If Category I and Category II procedures are performed at the same time, benefits will be payable only at the highest benefit level and will not exceed the percentage shown above.
Continental American Insurance Company Columbia, South Carolina Toll Free: 800.433.3036
Website: aflacgroupinsurance.com with Cancer
$5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000
18-25 $2.23 $3.06 $3.88 $4.71 $5.53 $6.36 $7.18 $8.01 $8.83 $9.65
26-30 $2.52 $3.63 $4.73 $5.84 $6.95 $8.06 $9.16 $10.27 $11.38 $12.49
31-35 $2.71 $4.02 $5.32 $6.63 $7.93 $9.24 $10.54 $11.85 $13.15 $14.45
36-40 $3.17 $4.93 $6.69 $8.45 $10.21 $11.97 $13.73 $15.49 $17.25 $19.01
41-45 $3.73 $6.04 $8.36 $10.68 $13.00 $15.31 $17.63 $19.95 $22.27 $24.58
46-50 $4.17 $6.92 $9.68 $12.44 $15.19 $17.95 $20.71 $23.46 $26.22 $28.98
51-55 $5.65 $9.89 $14.13 $18.37 $22.61 $26.85 $31.09 $35.33 $39.57 $43.80
56-60 $5.48 $9.55 $13.62 $17.69 $21.76 $25.82 $29.89 $33.96 $38.03 $42.10
61-65 $9.83 $18.24 $26.66 $35.08 $43.49 $51.91 $60.32 $68.74 $77.16 $85.57
66+ $16.41 $31.41 $46.41 $61.41 $76.41 $91.41 $106.41 $121.41 $136.41 $151.41
NON-TOBACCO: Spouse $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25,000
18-25 $2.23 $2.65 $3.06 $3.47 $3.88 $4.30 $4.71 $5.12 $5.53
26-30 $2.52 $3.07 $3.63 $4.18 $4.73 $5.29 $5.84 $6.39 $6.95
31-35 $2.71 $3.37 $4.02 $4.67 $5.32 $5.98 $6.63 $7.28 $7.93
36-40 $3.17 $4.05 $4.93 $5.81 $6.69 $7.57 $8.45 $9.33 $10.21
41-45 $3.73 $4.89 $6.04 $7.20 $8.36 $9.52 $10.68 $11.84 $13.00
46-50 $4.17 $5.54 $6.92 $8.30 $9.68 $11.06 $12.44 $13.81 $15.19
51-55 $5.65 $7.77 $9.89 $12.01 $14.13 $16.25 $18.37 $20.49 $22.61
56-60 $5.48 $7.51 $9.55 $11.58 $13.62 $15.65 $17.69 $19.72 $21.76
61-65 $9.83 $14.03 $18.24 $22.45 $26.66 $30.87 $35.08 $39.28 $43.49
66+ $16.41 $23.91 $31.41 $38.91 $46.41 $53.91 $61.41 $68.91 $76.41
TOBACCO: Employee
TOBACCO: Spouse
Aflac Group Critical Illness w/ Cancer – Semi-Monthly Rates NON-TOBACCO: Employee
$5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25,000 $50,000
18-25 $2.64 $3.87 $5.10 $6.33 $7.57 $8.80 $10.03 $11.26 $12.49 $13.72
26-30 $3.04 $4.67 $6.30 $7.93 $9.55 $11.18 $12.81 $14.44 $16.07 $17.70
31-35 $3.51 $5.60 $7.70 $9.80 $11.89 $13.99 $16.09 $18.19 $20.28 $22.38
36-40 $4.49 $7.57 $10.64 $13.72 $16.80 $19.88 $22.96 $26.03 $29.11 $32.19
41-45 $5.35 $9.29 $13.23 $17.17 $21.11 $25.05 $28.99 $32.93 $36.87 $40.82
46-50 $6.04 $10.67 $15.29 $19.92 $24.55 $29.18 $33.80 $38.43 $43.06 $47.69
51-55 $8.56 $15.71 $22.86 $30.01 $37.16 $44.31 $51.46 $58.61 $65.76 $72.91
56-60 $8.53 $15.64 $22.76 $29.88 $36.99 $44.11 $51.23 $58.34 $65.46 $72.58
61-65 $15.86 $30.30 $44.75 $59.19 $73.64 $88.08 $102.53 $116.97 $131.42 $145.86
66+ $26.81 $52.21 $77.62 $103.02 $128.42 $153.82 $179.22 $204.62 $230.03 $255.43
$5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25,000
18-25 $2.64 $3.26 $3.87 $4.49 $5.10 $5.72 $6.33 $6.95 $7.57
26-30 $3.04 $3.85 $4.67 $5.48 $6.30 $7.11 $7.93 $8.74 $9.55
31-35 $3.51 $4.56 $5.60 $6.65 $7.70 $8.75 $9.80 $10.85 $11.89
36-40 $4.49 $6.03 $7.57 $9.10 $10.64 $12.18 $13.72 $15.26 $16.80
41-45 $5.35 $7.32 $9.29 $11.26 $13.23 $15.20 $17.17 $19.14 $21.11
46-50 $6.04 $8.35 $10.67 $12.98 $15.29 $17.61 $19.92 $22.24 $24.55
51-55 $8.56 $12.13 $15.71 $19.28 $22.86 $26.43 $30.01 $33.58 $37.16
56-60 $8.53 $12.08 $15.64 $19.20 $22.76 $26.32 $29.88 $33.43 $36.99
61-65 $15.86 $23.08 $30.30 $37.52 $44.75 $51.97 $59.19 $66.41 $73.64
66+ $26.81 $39.51 $52.21 $64.91 $77.62 $90.32 $103.02 $115.72 $128.42
Group Aflac If you are no longer employed and would like to keep your current Aflac Group plans in place, you may be able to port your plans. Please visit:
www.aflacgroupinsurance.com, under Customer Service > Service Requests > Continuation of Coverage.
To ensure that your portability (Continuation of Coverage) is handled quickly and accurately, please print the Continuation of Coverage form and then do the following:
• Complete the form in its entirety and sign and date it.
• Verify your rate from your paystub, with your employer/HR department or with your agent.
• If paying by monthly ACH/Bank Draft please email completed forms to
CSCMAIL@aflac.com. This payment option is only available on a monthly basis.
• If paying by check, mail the completed form along with your check to the address noted on the form. This payment option is only available for quarterly, semi-annual or annual payments.
• Submit within 31 days of your termination date.
If you have any questions, please contact Aflac at 1-800-433-3036.
Continuation of Benefits If You Leave Employment http://www.aflacgroupinsurance.com/ mailto:CSCMAIL@aflac.com
Contact Information
Group Aflac Continental American Insurance Company
Post Office Box 84075 Columbus, GA 31993
Phone: 1-800-433-3036 www.aflacgroupinsurance.com
Brevard County Government 2725 Judge Fran Jamieson Way
Viera, FL 32940 Phone: 321-633-2000
Fax: 321-690-6842 www.brevardfl.gov
Mark III Employee Benefits 6525…
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