Fill and Sign the Tx Custody Form

benefits Farmers® agents’ group program 2011 Enrollment Guide Contact List For any benefit questions or concerns, please contact us by phone or web. Benefit Resource Phone Website Farmers Agents Benefits Call Center n  dd A New Participant Profile A n  erminate Participant Benefits T n  eneral Coverage Questions G 877-862-1237 www.farmersagentsbenefits.com Aetna Medical Plans Member Services (Policy #810111) n Aetna Managed Choice (POS) n Aetna Open Choice (PPO) n Aetna PPO High Deductible Health Plans (HDHP) n Aetna Traditional Choice Indemnity n Aetna Indemnity High Deductible Health Plan (HDHP) 888-257-0403 www.aetna.com/docfind/custom/ farmersagents/ 800-227-5720 800-238-6279 866-782-2779 www.aetna.com/aetnarxhomedelivery 877-238-6200 www.aetna.com/docfind/custom/ farmersagents/ 800-880-1800 www.safeguard.net 800-877-7195 www.vsp.com Aetna Pharmacy n Mail Order/Home Delivery n Pharmacy Unitº n Specialty Pharmacy Dental Plans n Aetna DMO Dental Plan (Policy #810111) n Aetna PPO/Indemnity Plan (Policy #810111) n Aetna Out-of-Area Indemnity Dental Plan (Policy #810111) n Safeguard DMO Plan (Group #142143) Vision Service Plan (VSP) (Policy #00109034) MetLife Life Insurance (Policy #110031-1G) n  edical Underwriting & Claims Office M n  onversion Unit C n  ortability Unit P 800-638-6420 (prompts 1 & 2) 877-275-6387 866-492-6983 MetLife AD&D Insurance (Policy #110031-1-G) n  asic & Supplemental (Claims) B 800-638-6420 (prompt 2) MetLife Long Term Disability (LTD) (Policy #110031-1-G) n General LTD Questions Hotline/Claims Office n Claim Form Request n ELTD or BOE Hotline (Unum) 888-463-2002 323-932-3904 800-347-8081 Employee Assistance Plan (MHN, Inc.) 800-511-3920 Travel Assistance and Identity Theft Program (AXA Assistance USA, Inc.) 800-454-3679 Agents’ Errors & Omissions (Policy #CAP0016497 02) n Report Claims (Lancer) n General Coverage Questions (CalSurance) n  equest Certificates R (www.farmersagentsbenefits.com) 800-821-0540 866-893-1023 Deferred Compensation Plan (Mullin TBG) n Inquiries/Request Information n Continuum Advisory Service Farmers Agents’ Benefits Dept n Change Home Address n Change Status/Position www.members.mhn.com (access code: metlife2) 800-487-0042 888-866-8242 323-932-3904 877-771-1360 (fax) www.farmersagentsbenefits.com Table of Contents Your Farmers Agents’ Group Benefits Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Medical Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The Dental Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 The Vision Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Life and AD&D Insurance Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Disability Insurance Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Errors and Omissions Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 The Farmers Agency Force Deferred Compensation Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Fidelity Bond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Enrolling in Your Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 How to Add an Employee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 How to Terminate an Employee’s Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 How to Provide a Rate Quote (Benefits Pricing Model) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Qualified Status Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Continuing Your Benefits When Coverage Ends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Eligibility for Benefit Continuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 COBRA Continuation Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 This brochure highlights the main features of the Farmers® Agents’ Group Benefits Program. It is intended to help you choose the benefit programs that are best for you. This brochure does not include all plan rules and details. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be any inconsistencies between this brochure and the legal plan documents, the plan documents are the final authority. Farmers reserves the right to change or discontinue its benefit plans at any time. eligibility Eligibility All agents, district managers, reserve district managers (RDM), reserve field managers (RFM), district manager training and administrative assistants (DMTAA), district life specialists (DLS), district commercial specialists (DCS), agency producers (AP) and office employees are eligible for the benefits program as soon as their status becomes full-time. Office employees of district managers and agents are eligible for medical, dental, vision and life insurance coverage on the first day of the month following 30 days of full-time employment (20 hours or more per week). For example, those with a March 1 hire date are eligible on April 1. If hired on March 2, the eligibility date is May 1. Your Eligible Dependents Your Farmers® Agents’ Group Benefits Program The Farmers® Agents’ Group Benefits Program consists of many plans that, together, provide valuable protection for you and your family. Your benefits program includes plans that help pay for medical, dental, and vision expenses, provide income if you’re ill or injured and unable to work, and provide financial security for your family in case you die or are seriously injured in an accident. This brochure has been developed to serve as a guide for enrolling in the Farmers Agents’ Group Benefits Program. Your enrollment guide provides information about the benefit programs available to you and how to enroll in them. If you want more detailed information about the individual plans, you can request a summary plan description (SPD) directly from the Farmers Agents’ Benefits Department. You may also access the SPDs online at www.farmersagentsbenefits.com after you have enrolled. This brochure is merely an overview of the benefit plans available through the Program. Please refer to the carrier-specific SPD for coverage details. 1 Dependents that may be covered are your spouse, registered domestic partner, and eligible children as described below: n A natural child n  n adopted child (including a child from the A date of placement with adopting parents until the legal adoption) n  stepchild (including the child of a A domestic partner) n  foster child A WHO CAN I CALL? We have contracted with a third-party, Aliquant, to provide you the convenience of having one place to call for most of your benefit needs. The Farmers Agents’ Benefits Call Center at 877-862-1237 can answer questions about: n Enrollment process n Status of your enrollment n Eligibility n COBRA coverage and administration n Continuation coverage See the Contact List on the inside front cover of this guide for other important phone numbers. n  handicapped child dependent who exceeds A the maximum age. Proof that the covered dependent is fully handicapped must be submitted to the carrier no later than 31 days after the date the child reaches the maximum age. For more information on what constitutes a handicapped child, please refer to your SPD. Note: Coverage will not be extended to the spouse or child(ren) of an adult child for any available plans. For the Aetna medical and dental plans and the Vision Service Plan (VSP) An adult child may be covered to age 26, and does not need to be a full-time student, does not need to receive at least 50% of support from you, does not need to be unmarried, and does not need to reside with you. benefit plan for which the child is eligible. If the participant is a resident of Ohio but the dependent child is not, the child must also be a full-time student at an accredited public or private institution of higher learning in order to be eligible for coverage to age 28. For MetLife Life Insurance and the Safeguard Dental Plan An adult child may be covered to age 26, provided they are unmarried, supported by you, and not employed on a full-time basis. The child does not need to be a full-time student. Special note for Ohio residents: If the participant and the dependent child are residents of Ohio, the child may be covered to age 28 provided they are unmarried and not employed by an employer that offers a health Agreement to Participate If you select medical, dental, or vision coverage, you must participate in the plan for the entire year unless you experience a qualified status change. Position Plans For Which You Are Eligible Agents, District Managers, Reserve District Managers (RDM), Reserve Field Managers (RFM), District Manager Training and Administrative Assistants (DMTAA), District Life Specialists (DLS), and District Commercial Specialists (DCS) Medical, dental, vision, life, accidental death and dismemberment (AD&D), supplemental AD&D, long-term disability (LTD), Enhanced LTD Plan*, E&O*, and Business Overhead Expense Plan (BOE)* Agency Producers (APs) Medical, dental, vision, life, AD&D, and supplemental AD&D Office Employees Medical, dental, vision, life, AD&D, and supplemental AD&D Reserve Agents Fidelity Bond only * Available only for DMs and Agents. 2 medical plans The Medical Plans n  n out-of-area indemnity plan, called Aetna A The medical plan coverage available to you depends on where you live. If you elect coverage, you must participate in the plan until the end of the plan year, unless you experience a qualified status change. There are five types of coverage available through Aetna: n  point-of-service plan, called Aetna Managed A Choice Point-of-Service (POS) Plan, with a deductible of $750 individual/$2,250 family in-network and $1,500 individual/$4,500 family out-of-network. n  preferred provider organization (PPO) plan, A called Aetna Open Choice PPO Plan, with a deductible of $750 individual/$2,250 family in-network and $2,000 individual/$6,000 family out-of-network. n  choice of three Aetna high deductible A health plans (HDHPs): —  DHP High Option deductibles are H $1,250 individual/$2,500 family —  DHP Medium Option deductibles are H $2,500 individual/$5,000 family in-network; $3,000 individual/$6,000 family out-ofnetwork —  DHP Low Option deductibles are H $5,000 individual/$10,000 family in-network; $6,000 individual/$12,000 family out-ofnetwork n  n out-of-area high deductible health plan, A called Aetna Indemnity HDHP, with an individual deductible of $2,500 and a family deductible of $5,000. Traditional Choice Indemnity Plan, with a deductible of $2,000 individual/$4,000 family. Read more about each of the medical options on the next pages. If you live in a ZIP code area served by the Aetna Managed Choice POS Plan, you can enroll in that plan, the Aetna PPO HDHP or the Aetna Open Choice PPO Plan. If you live in the Aetna Open Choice PPO Plan service area, you can enroll in that plan or the Aetna PPO HDHP. It is your responsibility to ensure that network providers are available in your ZIP code before choosing a plan that provides in-network benefits. For those participants who do not have access to an Aetna POS or PPO network, you may enroll in an Aetna Traditional Choice Indemnity Plan or the Aetna Indemnity HDHP. For those eligible for Medicare If you are an active participant and are enrolled in an Aetna medical plan, your Aetna medical coverage is primary and Medicare is secondary. If you are a continuee who is 65 years and older, and enrolled in an Aetna medical plan, Medicare is primary and Aetna medical coverage is secondary. There is no pre-existing condition exclusion associated with any of the medical plans. Manage Your Health and Your Healthcare Aetna offers important resources to help you and your family achieve a healthier lifestyle, enjoy improved health and manage existing health conditions. Be sure to take advantage of the following Aetna programs: n Online Health Assessments to alert you to health risks and opportunities for improvement  n Quit Tobacco program, including individual counseling, and nicotine replacement therapy  n Health information, research and support tools to make informed decisions  3 To find out more, call Aetna Member Services at 888-257-0403 or log on to www.aetna.com Here are the features of the medical plans. Aetna Managed Choice Point-of-Service (POS) Plan* Under a point-of-service plan, you may elect to seek care either through your primary care physician (PCP) and receive in-network benefits or see any doctor you wish (out-of-network) and receive reduced benefits. You decide to seek care through the network or outside of the network each time you or your covered dependents need medical care. You receive higher benefits when you see a network physician. Enrolling in the Plan You must live in a ZIP code area served by the Aetna Managed Choice POS Plan to enroll in this medical plan. Please contact the Farmers Agents’ Benefits Call Center at 877-862-1237 to confirm whether your home ZIP code is serviced by the Aetna Managed Choice POS Plan. If you live in a ZIP code area served by the Aetna Managed Choice POS Plan, you may enroll in the Aetna Managed Choice POS Plan, the Aetna PPO HDHP or the Aetna Open Choice PPO Plan. With Internet access, you can use DocFind®, the Aetna online provider directory on the Aetna website www.aetna.com/docfind/custom/ farmersagents/, to find Aetna Managed Choice POS participating physicians, hospitals, and other providers in your area. Physicians can be located by geographic location, medical specialty, or hospital affiliation. If you do not have access to a computer, you may call Aetna at 888-257-0403 for assistance or to receive a provider directory by mail. If you have dependents who do not reside with you, but live in another Aetna Managed Choice POS Plan area, you can enroll them in the Aetna Managed Choice POS Plan. If you have dependents who do not reside with you and they live in an area where an Aetna Managed Choice POS Plan network is not available, you can enroll them in the Aetna Traditional Choice Plan. It is your responsibility to write to the Farmers Agents’ Benefits Department to alert them of this matter. Be sure *  pecial Note For Texas Members: S Texas does not require you to select a primary care physician (PCP) to coordinate your medical care. Therefore, when care is required, as long as you select a participating provider in the Open Choice PPO network, you will receive the in-network level of benefits. The POS Plan in Texas is known as the “Open Choice PPO Plus Plan” and all contracted physicians and facilities are listed in DocFind® under the Open Choice PPO product. 4 to indicate your dependents’ full names, their dates of birth, Social Security numbers, their new home address, and their guardian’s full name. Aetna will keep this information and pay your dependents’ claims accordingly. Your cost for health care coverage will not change. You will continue to pay for your dependents under the Aetna Managed Choice POS Plan. Out-of-Network Benefits If you receive medical care out-of-network or if your care is not authorized by your PCP, benefits generally are paid at 70% after an annual deductible of $1,500 per person/$4,500 per family. Females age 13 and older may elect a primary care physician, as well as an obstetrician/ gynecologist (OB/GYN) who is in the same medical group as their PCP. When you receive treatment from an out-ofnetwork provider, you must complete your own claim form, which you can obtain by calling Aetna at 888-257-0403. Completed claim forms should be sent for processing to the address listed on the form. In-Network Benefits Identification Card To receive in-network benefits, you and your family members must each select a primary care physician (PCP) from the Aetna Managed Choice POS provider directory. Your PCP will coordinate all of your medical care, including referrals to specialists and inpatient hospital authorizations, if necessary. If you receive in-network care from your PCP, benefits generally are paid at 90% to 100% after an annual deductible of $750 per person/$2,250 per family. Office visits are covered at 100% after a $25 co-pay for PCP ($40 co-pay for specialist); a deductible does not apply. In-network preventive care is covered at 100%; a deductible does not apply. When you receive treatment from an Aetna Managed Choice POS Plan network provider or hospital, no claim forms are required. 5 When you enroll in the Aetna Managed Choice POS Plan, you will receive two identification cards that cover you and your dependents (up to five names can be printed on one Family ID Card). Additional cards can be obtained by calling Aetna at 888-257-0403. The cards will verify your eligibility for coverage and list the names and telephone numbers of your PCPs. See the chart on page 9 for a partial listing of benefits under the POS Plan. Aetna Open Choice Preferred Provider (PPO) Plan The Aetna Open Choice PPO Plan gives you the freedom to choose the doctor or hospital you want to see for covered services. You may use a doctor or hospital in the Aetna PPO provider network, or you may use any doctor, hospital, or licensed provider of your choice. You do not have to select a primary care physician (PCP) to direct your care when you enroll in the Open Choice PPO Plan. You will, however, receive higher benefits when you use participating Aetna PPO providers. You will need to file a claim form to receive benefits when you receive services from an outof-network provider. You should submit your claims to Aetna at the address shown on the claim form. Enrolling in the Plan You may enroll in the Aetna Open Choice PPO Plan if you live in a ZIP code area that is served by the Aetna PPO network. With Internet access, you can use DocFind®, the Aetna online provider directory on the Aetna website www.aetna.com/docfind/custom/ farmersagents/, to find Aetna PPO physicians, hospitals, and other participating providers in your area. Physicians can be located by geographic location, medical specialty, or hospital affiliation. If you do not have access to a computer, you may call Aetna at 888-257-0403 for assistance or to receive a provider directory by mail. PPO Plan Benefits Under the PPO Plan, there is an annual deductible of $750 individual/$2,250 family for innetwork services, or $2,000 individual/$6,000 family for out-of-network services. Eligible charges for in-network services generally are covered at 80% after you satisfy the $750 deductible. However, in-network preventive care is covered at 100% without a deductible. The plan will cover eligible charges at 100% after you satisfy the deductible and pay $2,500 in out-of-pocket expenses for eligible charges during the calendar year. Out-of-network services generally are covered at 60% after you satisfy the $2,000 deductible, and then will cover eligible charges at 100% after you pay the deductible and $8,000 in additional out-of-pocket expenses for eligible charges during the calendar year. See the chart on page 9 for a partial listing of benefits under the PPO plan. 6 Aetna PPO High Deductible Health Plan (HDHP) The HDHP allows you to select care from in-network and out-of-network providers each time you or a covered dependent needs medical care. You do not need to select a primary care physician (PCP) to direct your care. You will receive reduced benefits when you seek care from out-of-network providers. Note that you will need to file a claim to receive benefits from an out-of-network provider. You should submit your claims to the address shown on the Aetna claim form. The Aetna HDHP features a high annual deductible for those wishing to minimize their monthly premium. Participation in the HDHP allows you to set up a Health Savings Account (HSA) so that you may pay for expenses that qualify for the plan deductible on a taxadvantaged basis. See more information on HSAs on the next page. Depending on where you live, you may have the choice between three Aetna HDHP options: the HDHP High Option plan, the HDHP Medium Option plan, and the HDHP Low Option plan. The options have different deductibles, out-ofpocket maximums and benefits levels. Enrolling in the Plan You must live in a ZIP code area served by the Aetna PPO network to enroll in an HDHP Plan. (See page 11 for information on an HDHP option if you do not live in the network area). Please contact the Farmers Agents’ Benefits Call Center at 877-862-1237 to confirm whether your home ZIP code is served by either of those networks. With Internet access you can use DocFind®, the Aetna online provider directory on the Aetna website www.aetna.com/docfind/custom/ farmersagents/, to find Aetna network providers in your area. Physicians can be located by geographic area, medical specialty, or hospital affiliation. If you do not have access to a computer, you may call Aetna at 888-257-0403 for assistance or to receive a provider directory by mail. 7 If you enroll in an Aetna HDHP, you may set up a Health Savings Account (HSA) through an outside financial institution. An HSA is not currently offered through the Farmers Agents’ Group Benefits Program. Plan Benefits After satisfying the plan’s annual deductible, you pay a percentage of most eligible expenses, up to your annual out-of-pocket maximum. The HDHP High Option plan, the HDHP Medium Option plan and the HDHP Low Option plan have different deductibles, out-ofpocket maximums and benefits levels. Note that eligible in-network preventive care expenses such as routine physical exams and immunizations are covered at 100% without a deductible, subject to the plan’s limitations on frequency. Well-child exams and immunizations, gynecological care, mammograms, digital rectal/ prostate specific antigen test for males age 40 and over and colorectal cancer screening for members age 50 and over are considered preventive care by the HDHP; see the SPD for details. Prescription drug benefits are covered only after the deductible is met. You should be aware that using out-of-network providers result in significantly reduced benefits. The percentage of covered expenses you pay as well as the annual deductible, count toward your out-of-pocket maximum. Once you pay the out-of-pocket maximum, the plan will pay 100% of covered charges. See the chart on page 10 for a partial listing of benefits under the three HDHP options. Health Savings Accounts n  ome nursing services S If you enroll in an HDHP, you may want to set up a Health Savings Account (HSA). This account will allow you to make tax-deductible contributions each year up to the Plan’s annual deductible amount. HSAs are available through independent institutions; Farmers does not sponsor an HSA. n  earing aids H You may use HSA funds for qualified medical expenses. Typical qualified expenses are listed below: n  edical plan deductibles M n  iagnostic services not covered by the plan D n  ental care, including braces D n  ASIK eye surgery and contact lenses L n  heel chairs W n  rgan transplants O n  ver-the-counter drugs, if prescribed by O a doctor A complete list of qualified expenses can be found on the Aetna website, www.aetna.com, or by requesting IRS Publications 502 by calling the IRS at 800-829-3676 or visiting their website at www.irs.gov and clicking on “Forms and Publications.” You never lose your HSA account balance. Your account balance remains available until you use it for qualified expenses. 8 Medical Plan Comparisons Aetna Managed Choice POS Plan Aetna Open Choice PPO Plan Benefit Provisions In-Network1 Out-of-Network In-Network Out-of-Network Deductible per calendar year (once the family deductible has been met, all family members will be considered as having met their deductible for the remainder of the calendar year) $750 individual $2,250 family $1,500 individual $4,500 family $750 individual $2,250 family $2,000 individual $6,000 family Coinsurance 90% after deductible 70% after deductible 80% after deductible2 60% after deductible2 Coinsurance (Out-of-Pocket) Limit per calendar year (does not include deductible) $4,000 individual $8,000 family3 $15,000 individual $30,000 family3 $2,500 per individual $8,000 per individual Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Preventive Care (routine exams/immunizations, subject to plan guidelines; see SPD for details) 100%, deductible waived 70% after deductible 100%, deductible waived 60% after deductible Inpatient Hospital (includes physician’s services) 90% after deductible 70% after individual/ family deductible and inpatient confinement deductible 80% after individual/ family deductible and inpatient confinement deductible 60% after individual/ family deductible and inpatient confinement deductible Inpatient per Confinement Deductible None $100 $100 $300 Routine Maternity Care n Initial office visits n Inpatient hospital 100% after $25 copay 90% after deductible 70% after deductible 70% after individual/ family deductible and inpatient confinement deductible 100% after $25 copay 80% after individual/ family deductible and inpatient confinement deductible 60% after deductible 60% after individual/ family deductible and inpatient confinement deductible Prescription Drugs4,5 Retail (30-day supply) n Generic n Formulary Brand Name n Non-Formulary Brand Name Mail order (31-day to 90-day supply) n Generic n Formulary Brand Name n Non-Formulary Brand Name You pay 30% ($40 min/$80 max) You pay 30% ($60 min/$120 max) You pay 50% ($90 min/$180 max) Not covered You pay 30% ($40 min/$80 max) You pay 30% ($60 min/$120 max) You pay 50% ($90 min/$180 max) Not covered You pay 30% ($120 min/$240 max) You pay 30% ($180 min/$360 max) You pay 50% ($270 min/$540 max) You pay 30% ($120 min/$240 max) You pay 30% ($180 min/$360 max) You pay 50% ($270 min/$540 max) Emergency Room for a bona fide emergency 100% after $100 copay; waived if admitted 100% after $100 copay; waived if admitted 80% after deductible 80% after deductible Outpatient Surgery Expenses 90% after deductible 70% after deductible 80% after deductible 60% after deductible Diagnostic X-ray & Lab (other than physician’s office) 90% after deductible 70% after deductible 80% after deductible 60% after deductible Primary Care Physician Office Visit 100% after $25 copay 70% after deductible 100% after $25 copay 60% after deductible Specialist’s Office Visit 100% after $40 copay 70% after deductible 100% after $40 copay 60% after deductible 1 n Texas, this plan is known as “Open Choice PPO Plus Plan.” I 2  0% coverage for services not available within the network. Includes services such as Skilled Nursing Facility, Private Duty Nursing, Home Health Care, Hospice, DME, etc. 8 9 3  nce the family coinsurance limit is met, all family members will be considered as having met their coinsurance for the remainder of the calendar year. O HDHP High Option In-Network Out-of-Network HDHP Medium Option HDHP Low Option In-Network Out-of-Network In-Network Out-of-Network $1,250 individual $2,500 family* *If two or more participants are enrolled in this plan, only the family deductible applies. $2,500 individual $5,000 family $3,000 individual $6,000 family $5,000 individual $10,000 family $6,000 individual $12,000 family 90% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible $2,500 individual $5,000 family* *If two or more participants are enrolled in this plan, only the family deductible applies. $3,500 individual $7,000 family $4,250 individual $8,500 family $5,950 individual $11,900 family $7,500 individual $15,000 family Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited 100%, deductible waived 70% after deductible 100%, deductible waived 60% after deductible 100%, deductible waived 60% after deductible 90% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible None None None None None None 90% after deductible 90% after deductible 70% after deductible 70% after deductible 80% after deductible 80% after deductible 60% after deductible 60% after deductible 80% after deductible 80% after deductible 60% after deductible 60% after deductible You pay 30% ($20 min/$40 max)* You pay 30% ($40 min/$80 max)* You pay 50% ($70 min/$140 max)* You pay 30%* You pay 30% ($20 min/$40 max)* You pay 30% ($40 min/$80 max)* You pay 50% ($70 min/$140 max)* You pay 30%* You pay 30% ($20 min/$40 max)* You pay 30% ($40 min/$80 max)* You pay 50% ($70 min/$140 max)* You pay 30%* You pay 30% ($60 min/$120 max)* You pay 30% ($120 min/$240 max)* You pay 50% ($210 min/$420 max)* Not applicable You pay 30% ($60 min/$120 max)* You pay 30% ($120 min/$240 max)* You pay 50% ($210 min/$420 max)* Not applicable You pay 30% ($60 min/$120 max)* You pay 30% ($120 min/$240 max)* You pay 50% ($210 min/$420 max)* Not applicable *after deductible *after deductible *after deductible *after deductible *after deductible *after deductible 90% after deductible 90% after deductible 80% after deductible 80% after deductible 80% after deductible 80% after deductible 90% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible 90% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible 90% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible 90% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible 70% after deductible You pay 30%* You pay 50%* You pay 30%* You pay 50%* You pay 30%* You pay 50%* 4 f a generic drug is available and a brand-name drug is dispensed without your doctor indicating “dispense as written” on the prescription, you must pay the difference in cost between the I generic and brand name drug, plus the copayment. 5  fter two refills of a maintenance prescription, you must use the mail service in order to have plan coverage for the drug. A The terms of your benefit plans are governed by legal documents. Please refer to your Aetna SPD for more details and plan limitations. 10 Aetna Traditional Choice Indemnity Plan (Out-of-Area Plan) Aetna Indemnity High Deductible Health Plan (HDHP) Out-of-Area The Aetna Traditional Choice Indemnity Plan is an out-of area plan for those participants who do not live in an area served by the Aetna POS or PPO networks. With an indemnity plan, you may use the doctor, hospital, or licensed provider of your choice. The Indemnity HDHP is available to those who wish to take advantage of a High Deductible Health Plan, but who do not live in a ZIP code serviced by the Aetna PPO or POS networks. You will need to file a claim form to receive benefits. You should submit your claims to Aetna at the address shown on the claim form. Plan Benefits The Out-of-Area Plan has an annual deductible of $2,000 individual/$4,000 family. This plan covers eligible charges at 80% after you satisfy the deductible. After you pay $8,000 per individual in out-of-pocket expenses for eligible expenses during the calendar year, the plan covers eligible charges at 100% except for prescription copays. You may seek care from a doctor, hospital or licensed provider of your choice. The Aetna Indemnity HDHP features a high annual deductible for those wishing to minimize their folio deductions. Participation in the HDHP allows you to set up a Health Savings Account (HSA) so that you may pay for expenses that qualify for the plan deductible on a tax-advantaged basis. See more information on HSAs on page 8. Enrolling in the Plan If you do not live in a ZIP code area served by the Aetna PPO or POS network, you may enroll in the Indemnity HDHP. Please contact the Farmers Agents’ Benefits Call Center at 877-862-1237 to confirm whether your home ZIP code is served by either of those networks. Plan Benefits After satisfying the plan’s annual deductible ($2,500 individual/$5,000 family), you pay 20% of most eligible expenses, up to your annual out-of-pocket maximum ($3,500 individual/$7,000 family). Note that eligible preventive care expenses are covered at 100% without a deductible. Prescription drug benefits are covered only after the deductible is met. The percentage of covered expenses you pay as well as the annual deductible, count toward your out-of-pocket maximum. Once you pay the out-of-pocket maximum, the plan will pay 100% of covered charges. See the chart on the next page for a partial listing of benefits under the two Out-of-Area plans. 11 Out-of-Area Medical Plan Options Benefit Provisions Aetna Traditional Choice Indemnity Plan Aetna Indemnity HDHP Deductible per calendar year (once the family deductible has been met, all family members will be considered as having met their deductible for the remainder of the calendar year) $2,000 individual $4,000 family $2,500 individual $5,000 family Coinsurance 80% after deductible 80% after deductible Coinsurance (Out-of-Pocket) Limit per calendar year; does not include deductible $8,000 individual None for family $3,500 individual $7,000 family Lifetime Maximum Unlimited Unlimited Inpatient Hospital (includes physician’s services) 80% after deductible 80% after deductible Preventive Care (routine exams/immunizations, subject to plan guidelines; see SPD for details) 100%, deductible waived 100%, deductible waived Emergency Room for bona fide emergency 80% after deductible 80% after deductible Routine Maternity Care n Office Visit n Inpatient Hospital 80% after deductible 80% after deductible 80% after deductible 80% after deductible Prescription Drugs1,2 Retail (30-day supply) n Generic n Formulary Brand Name n Non-Formulary Brand Name You pay 30% ($20 min/$40 max) You pay 30% ($40 min/$80 max) You pay 50% ($70 min/$140 max) You pay 30% ($20 min/$40 max)* You pay 30% ($40 min/$80 max)* You pay 50% ($70 min/$140 max)* Mail order (31-90 day supply) n Generic n Formulary Brand Name n Non-Formulary Brand Name You pay 30% ($60 min/$120 max) You pay 30% ($120 min/$240 max) You pay 50% ($210 min/$420 max) You pay 30% ($60 min/$120 max)* You pay 30% ($120 min/$240 max)* You pay 50% ($210 min/$420 max)* *after deductible Outpatient Surgery Expenses 80% after deductible 80% after deductible Diagnostic X-ray & Lab (other than physician’s office) 80% after deductible 80% after deductible Physician’s Office Visit 80% after deductible 80% after deductible 1 f a generic drug is available and a brand-name drug is dispensed without your doctor indicating “dispense as written” on the prescription, you must pay the I difference in cost between the generic and brand name drug, plus the copayment. 2  fter two refills of a maintenance prescription, you must use the mail service in order to have plan coverage for the drug. A The terms of your benefit plans are governed by legal documents. Please refer to your Aetna SPD for more details and plan limitations. 12 Prescription Drug Coverage You receive prescription drug coverage with each of the medical plan options. The amount you pay depends on whether the drug is a generic, brand name drug on the “formulary” list, or a brand name drug not on the formulary list. You should also know that if you are taking a “maintenance” drug for more than two 30-day fills, you must use the mail service in order to have coverage for the drug. See the chart on pages 9 and 10 to see the amount you pay for each category of prescription drug. You can obtain a copy of the formulary list or get more information on the mail service online at www.aetna.com/docfind/custom/ farmersagents/ or by calling 800-227-5720 Generic Drugs Generic drugs can save you money. They are proven by the Food and Drug Administration (FDA) to be safe and effective. Generic drugs have the same active ingredients, dosage, safety, strength, quality and performance as their brand name counterparts. Not all brand name drugs have generic equivalents since the patent on a brand name drug must expire before a generic equivalent can be produced; most drug patents are protected for 17 years. Important: A prescription for a brand name drug will automatically be filled with a generic drug (if available), unless your doctor writes “Dispense as Written” on the prescription for a brand name drug. If the doctor does not include that instruction and you insist on a brand name drug, you will pay the difference between the cost of the generic and the brand as well as the coinsurance amount. 13 Formulary Drugs A formulary is a preferred drug list containing both generic and brand name drugs commonly prescribed by physicians. To be on the Aetna formulary list, drugs must be FDA approved and proven safe and effective. Non-formulary refers to any prescription drug, brand name or generic, that does not appear on the formulary drug list. Non-Formulary Brand refers to brand name prescription drugs that do not appear on the formulary list. Non-Formulary Brand drugs are available at the Non-Formulary Brand pharmacy copay level. Mail Order Drugs The Aetna Rx Home Delivery prescription drug service offers a convenient and cost-effective way to obtain your longer-term (maintenance) prescriptions. Mail order generally provides a three-month (90 day) supply for three times the monthly cost. (If you are in Arkansas or Alabama, there is no copay difference between retail and mail order.) Important: You must use the mail service after two 30-day refills of the prescription at your local pharmacy (original 30 days plus one 30 day refill) to receive plan benefits for the drug. Infusion and injectable therapies that are administered in your doctor’s office are supplied by Aetna Specialty Pharmacy. Your doctor can fax new prescriptions to 866-329-2779 or mail them to Aetna Specialty Pharmacy, 503 Sunport Lane, Orlando, FL 32809. You or your doctor may call 866-782-2779 for more information. dental plans The Dental Plans The Aetna DMO Prepaid Dental Plan and SafeGuard Dental Plan are known as “dental maintenance organizations” or DMOs. That means that dental benefits are provided only if you see a dentist from the plan’s panel of participating dentists. To select an Aetna participating dentist, use DocFind® on www.aetna.com/docfind/custom/farmersagents/ or call Aetna Dental Customer Service toll-free at 877-238-6200. For a SafeGuard participating dentist, visit www.safeguard.net or call SafeGuard Customer Service toll-free at 800-635-4238. If you elect coverage, you must participate in the plan until the end of the year unless you experience a qualified status change. There are two types of dental plans to choose from if you live in an area served by their networks, and an out-of-area plan if you live outside those network areas: n  etna DMO Dental Plan (a prepaid dental A plan). If you live in California, you also have the option to choose coverage under the SafeGuard Dental Plan, a DMO dental plan, or n  etna PPO/Indemnity Dental Plan, which A Aetna DMO Prepaid Dental Plan and SafeGuard Dental Plan allows you to receive dental care from innetwork or out-of-network dentists. n  etna Out-of-Area Indemnity Dental Plan, A which is available if you live outside of the network service areas for the Aetna DMO or PPO/Indemnity Dental Plans; you may use any dentist. It is your responsibility to determine if you live in a plan’s network area before you choose coverage under that plan. Under both the Aetna DMO Prepaid Dental Plan and the SafeGuard Dental Plan, you can select a different dental provider for each family member you enroll. Dental benefits are payable only if you seek care from a participating network dentist. Here is a partial list of services covered by the Aetna DMO Prepaid Dental Plan and the SafeGuard Dental Plan. Aetna DMO Prepaid Dental Plan Safeguard Dental Plan (Only available in California) Calendar Year Deductible N/A N/A Calendar Year Maximum N/A N/A 100% after $5 office visit copay 100% after $5 office visit copay $10 – $35 $70 – $340 $11 – $100 $30 – $300 $10 – $80 $105 – $275 $0 – $130 $38 – $300 $180 – $220 $275 – $350 $165 – $225 $210 – $300 100% after $2,000 copay** 100% after $2,195 copay** N/A N/A Service Preventive Care (oral exams, cleanings, x-rays) Basic Treatment* Fillings Root Canals Extractions Periodontics n n n n Major Procedures* n Inlays/crowns n Dentures Orthodontia (children & adults) Waiting Period for Major Procedures * Dentist determines the amount you pay for services ** Includes copays for screening exam, diagnostic records, treatment, and retention. The terms of your benefit plans are governed by legal documents. Please refer to your Aetna or Safeguard SPD for more details and plan limitations. 14 To indicate which dentist you have chosen, fill in his/her name and code number on the enrollment form. The dentist that you choose will provide routine care — checkups, cleanings, etc. — and refer you to a specialist, if necessary. If you would like to change the dentist that you have selected, you may call the dental plan’s toll-free number and give them the new dentist’s code number. This toll-free number is listed on your dental I.D. card. You do not have to file a claim for dental expenses; all you have to do is pay the dentist the copayment for the dental service at the time you receive treatment. PLEASE NOTE: Orthodontia is not covered under the Aetna PPO/Indemnity Dental Plan. Most diagnostic and preventive services are covered at 100% after you pay the office visit copayment. For other services, you pay a copayment directly to the participating dentist. The amount depends on the procedure performed. The SPD tells you the specific copayment for each service. Aetna PPO/Indemnity Dental Plan The Aetna PPO/Indemnity Dental Plan is a dualoption plan. This means that you can receive your dental care from any dentist you choose. However, you can reduce your out-of-pocket dental expenses if you use a provider in the Aetna PPO dental network. Both plans cover diagnostic and preventive care, including full-mouth x-rays, office visits, and cleanings. Also covered are basic services such as fillings, crowns, periodontal (gum) treatments, root canals, dentures, and oral surgery. Both the Aetna DMO and SafeGuard plans provide limited orthodontia coverage for children and adults. The plan pays a higher level of benefits for in-network dental services. In addition, Aetna network dentists are paid for services based on reduced negotiated fees. The chart below is a partial list of services covered by the Aetna PPO/Indemnity Dental Plan. Aetna PPO/Indemnity Dental Plan Service In-Network Out-of-Network Out-of-Area Texas* Calendar Year Deductible $75 individual $225 family $75 individual $225 family Calendar Year Maximum $1,000 per person $1,000 per person Preventive Care (oral exams, cleanings, x-rays) 100% 90% 100% Basic Treatment (fillings, extractions, periodontics) 80% 60% 80% Major Procedures (inlays, crowns, fixed bridgework, dentures, general anesthesia) 50% 50% 50% Not covered Not covered Not covered None None None Orthodontia Waiting Period for Major Procedures * The state of Texas does not allow for an active dental PPO plan. The terms of your benefit plans are governed by legal documents. Please refer to your Aetna SPD for more details and plan limitations. 15 When you use a dentist outside the Aetna dental network, you may receive a balance bill, as the plan only covers benefits up to the usual and prevailing charge limits in your area. You will also have to file a claim. The plan covers preventive, basic, and major services. After you pay a $75 calendar year deductible per person, $225 per family, the plan pays a calendar year maximum of $1,000 for covered services. Aetna Out-of-Area Indemnity Dental Plan If you live outside of the network area that serves the Aetna DMO or Aetna PPO/Indemnity Dental Plans, dental coverage is offered under the Aetna Out-of-Area Indemnity Dental Plan. You may use any licensed dental provider. The chart below is a partial list of services covered by the Aetna Out-of-Area Indemnity Dental Plan. Aetna Out-of-Area Indemnity Dental Plan Service Any Provider Calendar Year Deductible $75 individual $225 family Calendar Year Maximum $1,000 per person Preventive Care (oral exams, cleanings, x-rays) 100% Basic Treatment (fillings, extractions, periodontics) 80% Major Procedures (inlays, crowns, fixed bridgework, dentures, general anesthesia) 50% Orthodontia Waiting Period for Major Procedures Not covered None The terms of your benefit plans are governed by legal documents. Please refer to your Aetna SPD for more details and plan limitations. 16 vision plan The Vision Plan You can receive coverage for annual eye examinations and the purchase of eyeglasses or contact lenses through Vision Service Plan (VSP). If you elect vision coverage, you must participate in the plan until the end of the plan year, unless you experience a qualified status change. VSP Open Access provides the flexibility for members to use VSP Vision Care benefits at any location, including specialty optical boutiques or retail chains. While 95% of members choose a VSP Preferred Provider for the enhanced benefits, the plan also includes a generous open access schedule. VSP offers members discounts on laser vision correction surgery to correct such visual acuity problems as nearsightedness, farsightedness and even astigmatism. For more details, visit VSP’s new Laser VisionCareSM home page through www.vsp.com or call 888-354-4434. Finding a VSP Provider VSP offers different ways to help you find a participating doctor in your area, or to verify that your current provider is a VSP doctor. You should always call a doctor to confirm participation in the VSP network. If you require assistance in locating a VSP doctor, use one of the following methods: To find a VSP provider on the web: n Go to the VSP website at www.vsp.com n Find the “Members & Consumers” section n  ollow the directions to register as a site user, F or fill in your UserID and password n Select the “Find a VSP Doctor” tab You can search for a VSP doctor by entering your ZIP code or a doctor’s specific address or last name. Either option provides you with a geographical map and doctor’s office location and contact information. 17 VSP also offers an automated member service system accessible via a toll-free number. You just call 800-VSP-7195 (877-7195), and you can: n Enter a doctor’s telephone number to verify  the office’s participation in VSP’s network n  ocate a doctor by a ZIP code and obtain a L doctor’s location information and telephone number n  equest a list of VSP participating doctors R that will be mailed to you n If you need additional assistance, a customer  service department representative is available. When you need vision care contact VSP directly by using one of the methods described above. Then, call a VSP participating doctor to schedule an appointment. You’ll need to identify yourself as a VSP member and a participant in the Farmers Agents’ Group Benefits Program and provide your Social Security number. After you’ve scheduled your appointment, the VSP participating doctor will contact VSP to verify your eligibility and plan coverage. You will not receive a VSP ID card. The following is a chart showing benefits for both VSP and non-VSP providers. Benefit VSP Provider Non-VSP Provider Annual Copay $25 $25 Examination once per calendar year 100% Plan pays up to $50 Plan pays up to $120 100% of VSP-approved fees Plan pays up to $70 Plan pays: Up to $50/pair Up to $75/pair Up to $100/pair Up to $120 100% Plan pays up to $105 Plan pays up to $210 $20 copay N/A Eyeglasses1 n Frame every 2 calendar years n Lenses once per calendar year - Single Vision - Bifocal - Trifocal 1 VSP provides 20% off additional complete pairs of glasses (lenses and frames) and non-prescription sunglasses; includes non-covered lens options. If you order the additional eyeglasses/sunglasses from the same VSP provider on the same day as your WellVision Exam, the discount is 30%. Contact lenses2 once per calendar year (in lieu of frame and lenses) n Elective n Medically necessary 2 VSP provides a 15% off cost of contact lens examination (evaluation and fitting). This discount does not apply to the contact lens materials. New and current soft contact lens wearers may qualify for a program that includes a contact lens evaluation and initial supply of lenses with discounts on 65% of lenses on the market. Diabetic Eyecare Program (for those with Type 1 diabetes) The terms of your benefit plans are governed by legal documents. Please refer to your VSP SPD for more details and plan limitations. What’s Not Covered n Blended lenses The plan does not include coverage for professional services or materials connected with: n  ontact lenses (if purchased in addition to frames C n Orthoptics or vision training and any  You may incur additional charges if you chose cosmetic options not covered under the plan, such as: and lenses in the same service plan year) associated supplemental testing n Oversize lenses n Plano lenses (non-prescription) n  hotochromic or tinted lenses other than P n Two pairs of glasses in lieu of bifocals Pink 1 or 2 n Coated or laminated lenses n Progressive multifocal lenses n  frame that costs more than the plan allowance A n Certain limitations on low vision care n Cosmetic lenses n Optional cosmetic processes n UV protected lenses n Lenses and frames furnished under this  program that are lost or broken will not be replaced, except at normal intervals when services are otherwise available n Medical or surgical treatment of the eyes  n A ny eye examination or any corrective eye  wear required as a condition of your job n Corrective vision services, treatments, and  materials of an experimental nature 18 life and AD&D Life and AD&D Insurance Plans These plans provide life insurance and accidental death and dismemberment (AD&D) insurance for you and your family. Life and AD&D insurance is underwritten by our carrier, MetLife. The amount of life and accidental death and dismemberment (AD&D) insurance you may buy depends on your position. When you buy life insurance, you are automatically covered by an equal amount of AD&D insurance. You can enroll yourself and your dependents in the Life and supplemental AD&D Farmers agents’ plans within 31 days of your initial eligibility. If you don’t enroll within 31 days of your initial eligibility date, you’ll need to complete an Evidence of Insurability form and it is subject to approval by the insurance carrier. Basic Group Life and AD&D Insurance Agents or District Managers n  ife insurance: $50,000 first year; after first year, able to L Reserve District Managers, Reserve Field Managers, DMTAAs, DLSs, DCSs, or APs n Life insurance: $50,000  n AD&D: Equal to life insurance coverage  increase amount in $50,000 increments up to $1,200,000, not to exceed 8 times annual commissions. Maximum benefit is the lesser of $1,200,000 or 8 times annual commissions n AD&D: Equal to life insurance coverage n See Evidence of Insurability rules under “Basic Life and AD&D  Insurance Plan” heading Eligible family members of Agents, District Managers, Reserve District Managers, Reserve Field Managers, DMTAAs, DLSs, DCSs, and APs Family life insurance: n $25,000 for spouse n  5,000 for each child from birth to age 26* $ n  D&D: Equal to life insurance coverage A Office Employees n  ife insurance: $25,000 L n  D&D: Equal to life insurance coverage A Eligible family members of office employees n $12,500 for spouse n  1,500 for each child from birth to age 26* $ n  D&D: Equal to life insurance coverage A Supplemental AD&D Insurance Agents or District Managers, Reserve District Managers, Reserve Field Managers, DMTAAs, DLSs, DCSs, APs, or Office Employees $50,000 to $300,000 in multiples of $50,000 Eligible family members of Agents, District Managers, Reserve District Managers, Reserve Field Managers, DMTAAs, DLSs, DCSs, APs, and Office Employees Family AD&D insurance: n Equal to your coverage for spouse n 10% of your coverage to a maximum of $30,000 for each child The terms of your benefit plans are governed by legal documents. Please refer to your MetLife SPD for more details and plan limitations. * Provided they are unmarried, supported by you and not employed on a full-time basis. 19 plans MetLife Basic Life and AD&D Insurance Plan Coverage Options During the first year that you are eligible for coverage as an agent or district manager, you may elect a maximum benefit of $50,000 if you request this coverage within 31 days after you become eligible. After your first year, you will be eligible to elect insurance coverage of more than $50,000, based on your prior year’s earnings (maximum of $500,000 without evidence of insurability) only if you enroll within 31 days of your first anniversary. If you apply for more than $500,000, you must complete a MetLife Evidence of Insurability Form and/or carrier approval for the requested amount must be granted. MetLife will notify you of its decision regarding your request.* THE Accelerated BENEFIT OPTION: Under MetLife’s Accelerated Benefit Option, if you become terminally ill (as determined by the plan), you may be eligible to receive a portion of your group life insurance benefits while you are still living. Benefits not paid in advance will remain with the plan and will be payable to your beneficiary. If you’re an agent or district manager, you can increase your life insurance amounts at anytime after you’ve been enrolled in the plan for 12 months. After your first year as an agent or district manager, you will be eligible to elect insurance coverage of more than $50,000, based on your prior year’s earnings (maximum of $500,000 without evidence of insurability) only if you enroll within 31 days of your first anniversary.* All other classes are eligible for the amounts of coverage indicated on page 19. If you want to change the amount of your life insurance, call the Farmers Agents’ Benefits Call Center for information. You may be required to submit evidence of insurability. You may also be required to submit medical evidence at your expense. Covering Your Family You can select life insurance for your spouse or child(ren) only if you elect life insurance for yourself. For spouse coverage, life and AD&D insurance terminates at age 70. The termination of coverage will occur on the January 1 following your spouse’s 70th birthday. Spouse and child(ren) benefits will also terminate upon the death of the active or former agent or district manager. The monthly cost for child life insurance is a flat rate, regardless of the number of children that you cover. Additional Benefits When you enroll for life and AD&D insurance, you are automatically covered for an additional 100% of AD&D insurance if your death is caused by an accident while riding in a common carrier. The AD&D benefit is payable in addition to life benefits. If you die in a covered accident while driving or riding in a private passenger car and you were properly using a seat belt, an additional 10% of the principal sum of AD&D coverage is payable (not to exceed $25,000). Evidence of Insurability If you do not return the Evidence of Insurability form, depending on what you have requested, you will be prevented from increasing your amount of coverage until the form is received and approved. However, if you do not apply for benefits within the first 31 days of eligibility and do not return the Evidence of Insurability form, then you will not have coverage until that form has been submitted and approved. *  you apply for any increase after the 31-day window following your first year anniversary, you must complete a MetLife Evidence of Insurability form for any If request, and carrier approval for the requested amount must be granted. Your increase request can be made in $50,000 increments up to a maximum request of $1,200,000, and is subject to a limit of eight times your prior year’s annual net commissions. MetLife will notify you of its decision regarding your request. 20 AD&D Insurance Submitting a Claim This insurance is payable for loss of limb, eyesight, speech, hearing, life, or paralysis caused by an accident. The full amount is paid for loss of life, total and irreversible paralysis of all four limbs, and loss of speech and hearing. A percentage of the full amount is paid for loss of limb, eyesight, speech, or hearing and loss of the thumb and index finger of the same hand. Contact the Farmers Agents’ Benefits Department if you need to submit a life insurance claim. If the Farmers Agents’ Benefits Department is not notified of a claim, premiums will continue to be charged. In most cases, basic life insurance claims should be processed by the carrier within 10 days after receipt of all required paperwork. Total Disability Benefits Portability You are eligible to continue the amount of your group life insurance without premium payment if you become totally disabled under the “extended death benefits during total disability” provision of the plan. Portability is a feature available with your life insurance and AD&D benefits. If you are eligible and you choose to port your coverage when you leave Farmers, you can continue group coverage at your own expense. This group insurance is administered through MetLife, and the premium is submitted directly to MetLife on a monthly basis. You can continue this same amount or a lesser amount of coverage that you Coverage continued under the “extended death benefits during total disability” provision is subject to reductions. 21 had with Farmers, but coverage cannot exceed $1,000,000, nor can it go below $20,000. The application period for portable term coverage is 31 days from the date of termination of benefits. You must elect portable coverage in order for your dependents to elect portable coverage. Michigan residents can port a maximum of $173,400, and portability coverage reduces by 50% at age 70 and terminates at age 80. In the event of your death, your spouse is eligible to port up to age 70 and dependent children are eligible to port until age 26, provided they are unmarried, supported by you, and not employed on a full-time basis. In addition, if you elect benefit continuation coverage, you cannot port your coverage (only continue or convert coverage). Converting Life Insurance You may convert the amounts of life insurance you lose when you leave Farmers to an individual whole life insurance policy by purchasing the policy at standard rates from MetLife. You will not have to submit evidence of insurability if you choose to convert your coverage. However, you must apply for conversion within 31 days of when your coverage ends, or else you will not be eligible for conversion. You will receive a conversion notice from the Farmers Agents’ Benefits Call Center when you leave Farmers. Travel Assistance Participants in MetLife’s AD&D plan automatically receive the emergency travel assistance program, provided by AXA Assistance USA. This plan provides professional assistance for travelers (including spouse/registered domestic partner and eligible dependents) who are traveling on business or pleasure almost any where in the world and at least 100 miles or more from home. AXA’s Travel Assistance program provides a wide range of services through a network of highly qualified professionals who are multilingual and board-certified physicians. Some of the services available include assistance 24 hours a day for medical emergencies, emergency prescription services, evacuation, return of mortal remains, care for minor children, legal and interpreter referrals, as well as assistance to locate lost luggage. Will Preparation Service Participants in MetLife’s AD&D plan are automatically eligible for the Will Preparation Service provided by Hyatt Legal Plans, a MetLife company. Fees for a participating attorney to prepare or update a will for you and your spouse are fully covered, including telephone and office consultations. If you use a non-network attorney, you will receive reimbursement for eligible services up to a set dollar amount. To find out more, call the Hyatt Legal Plans’ toll free number at 800-821-6400. Identity Theft Program Participants in MetLife’s AD&D plan are automatically covered by Identity Theft Solutions, provided by AXA Assistance USA. This no-cost service provides you and your dependents with assistance in obtaining free credit reports, educational materials on identity theft and help placing “fraud alerts” with credit bureaus, as well as 24/7 access to case managers. Case managers can provide assistance with taking inventory of lost or stolen items and directing you to the appropriate contacts for resolution. They will help you with police and credit reports, contacting credit or fraud departments, government agencies and local law enforcement, as well as filing complaints with the Federal Trade Commission. 22 disability MetLife Supplemental AD&D Insurance This insurance is payable for loss of limb, eyesight, speech, hearing, life, or paralysis caused by an accident. The full amount is paid for loss of life, total and irreversible paralysis of all four limbs, and loss of speech and hearing. A percentage of the full amount is paid for loss of limb, eyesight, speech, or hearing and loss of the thumb and index finger of the same hand. You may purchase MetLife Supplemental AD&D insurance whether or not you buy group life and AD&D insurance. Coverage Options You can elect from $50,000 to $300,000 of supplemental AD&D coverage in multiples of $50,000. You also can elect to cover your spouse for an equal amount and your children for 10% of your insurance amount, to a maximum of $30,000 per child. Your spouse's coverage terminates at the end of the calendar year in which he or she reaches age 70. Submitting a Claim When filing a claim for Supplemental AD&D insurance, you need to complete a separate claim form (other than the one for life insurance). You can obtain the form from the Farmers Agents’ Benefits Department. What the Supplemental AD&D Plan Does Not Cover The Supplemental AD&D Insurance Plan does not cover certain types of losses, including those associated with the following: n  ntentionally self-inflicted injury while sane I or insane, suicide, or attempted suicide n  isease of the body, bodily or mental D infirmity, or any bacterial infection other than bacterial infection due directly to an accidental cut or wound n  ar or any act of war, declared or undeclared W These are not the only exclusions under this plan. For information on other limitations and exclusions, and for more details on those listed here, please review the SPD. 23 Disability Insurance Plans MetLife Long-Term Disability (LTD) Insurance Plan LTD provides a monthly benefit if you become disabled. You have the option to choose a 90-day or 180-day elimination period. If you currently have coverage, you can change your coverage by applying for a different option only during the annual enrollment period. Note: Elimination period means the period of your disability during which MetLife does not pay benefits. The elimination period begins on the date that you become medically disabled and continues for either 90 or 180 days, depending on the plan you have selected. A 3/12 pre-existing condition clause will apply. Participants who have previously waived coverage will be subject to evidence of insurability restriction