Leon County Benefit Booklet

Leon County Benefit Booklet

Board of County Commissioners Clerk of Courts

Supervisor of Elections

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Board of County Commissioners

Clerk of Courts Supervisor of Elections

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Welcome to your Employee Benefits!

This Benefit Booklet describes the many benefits that are

available to you as an eligible Leon County employee. These

benefits are an important part of your compensation package.

You are encouraged to read this booklet, which provides a brief

summary of your benefits. Keep this Benefits Booklet for

reference throughout the year. Should you have any questions

concerning the benefits or eligibility described in this booklet,

refer to the insurance certificates, policies, or other benefit

brochures provided to you.

If you have further questions, please contact your

Human Resources office:

Board of County Commissioners at 606-2400

Supervisor of Elections at 606-8613

Clerk of Courts at 577-4230

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TABLE OF CONTENTS

Benefits Summary

HIPPA Notice

Service Directory

Monthly Premiums

Medical Insurance

Medicare Drug Coverage

Dental Insurance

Vision Insurance

Term Life Insurance

Long Term Disability

Legal Services

Long Term Care

Colonial Supplemental Insurance

5

8

13

14

15

23

25

27

28

30

31

33

36

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Benefits Summary The following is a brief summary of the Benefits that are available at Leon County: Eligibility:

All regular full- time employees Leon County Board of County Commissioners and Supervisor of Elections regular

part-time employees who have been employed for at least two years are eligible only for health insurance and participation in the Colonial Insurance programs.

Part time employees with less than 2 years of service & OPS employees are not eligible to participate

Pre-Tax Advantage: Medical, dental & vision premiums deducted from your pay can be made from pre-tax dollars. This means that the premiums deducted from your paycheck are before Federal taxes and Social Security taxes are withheld. That’s a tax savings for you. Pre-tax payments allowed under the IRS regulations do not allow you to change your coverage during the year except for certain change in status events.

Benefit Options Medical

You can choose to participate in Capital Health Plan or United Healthcare. If you are a regular full time or eligible part time employee, you can also choose to

Opt-Out of medical insurance coverage if you can provide proof that you have medical insurance coverage elsewhere. You can receive $300 per month in a payment for opting out of coverage. This is taxable income to you. If a husband & wife both work for Leon County, they are not eligible for the Opt-Out Program.

Dental

You can choose to participate in one of 2 Managed Care Plans (DHMO) which requires you to use a dentist from a Network of Participating Dentists or you can choose to participate in 2 Preferred Provider Plan (PPO) which allows you to obtain services from a Network of Participating Dentists or from any Dentist.

Vision

This plan provides for coverage for eye exams, glasses, lenses & frames. You can choose to have your eye care provided by a Network Doctor (which provides you the least out-of-pocket expenses) or a Non-Network Doctor.

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Group Term Life Insurance Basic Life

Leon County pays for basic term life insurance coverage in an amount equal to your annual salary if you are a Career Service or Executive Support Employee or an amount of two times your annual salary if you are in Executive or Senior Management.

Supplemental Life

You can purchase additional life insurance in the amount of two times your annual earnings if you are a Career Service or Executive Support Employee or one times your annual salary if you are in Executive or Senior Management.

You will need to complete an “Evidence of Insurability” form & approval is subject to the underwriting requirements of the insurance company. You could be declined coverage.

Dependent Life

You can apply for coverage for your spouse and/or dependent children You can choose from the following coverage amounts:

Spouse: $20,000 $10,000 $5,000

Children: $ 5,000 $ 2,500 $1,500 You will need to complete an “Evidence of Insurability” form & approval is

subject to the underwriting requirements of the insurance company. Your spouse & or children could be declined coverage.

Long Term Disability Insurance ( Leon County Board and Supervisor of Elections )

You can apply for coverage that could pay you 60% of pay up to age 65 after you have been disabled for 90 days.

You will need to complete an “Evidence of Insurability” form & approval is subject to the underwriting requirements of the insurance company. You could be declined coverage.

Flexible Reimbursement Accounts

You can choose to participate in this program which allows you to pay for certain health care & dependent care expenses through payroll deduction with pre-tax dollars.

You can contribute a maximum of $5,000 to the health care account and $5,000 to the dependent care account.

Careful planning of expenses is essential because IRS regulations require that participants forfeit any money left in the account at the end of the year.

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Voluntary Plans Opportunity to participate in ARAG-Legal Plan which provides coverage for

legal services that you may need. Opportunity to apply for coverage with Colonial Life which provides

insurance coverage for: Cancer, Intensive Care, Accident & Disability & Hospital Indemnity; or for Long Term Care Insurance with Blue Cross/Blue Shield. You may need to provide “Evidence of Insurability” & approval of your application is subject to the underwriting requirements of the Insurance Company. You could be declined coverage.

Opportunity to enroll in limited additional Life Insurance with Reliance Standard Life without Evidence of Insurability.

Retirement (Contact Human Resources for information)

Automatic participation in the Florida Retirement System. No contributions are required. You can choose to participate in the Pension Plan or the Investment Plan

Opportunity for you to save for retirement through payroll deduction with pre-tax dollars in Deferred Compensation Plans through VALIC, ICMA or NACO. You can choose to participate any time during the year.

Other Benefits Available (Contact Human Resources for information)

Sick Leave Pool (BOCC) Tuition Assistance Employee Assistance Program (EAP) and Mediation Program (BOCC & Clerk) Florida PrePaid College Savings Program Annual & Sick Leave Accruals Volunteer Service-Project Lead (BOCC) Parking (Cost deducted Pre-Tax)

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LEON COUNTY BOARD OF COUNTY COMMISSIONERS,

CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS

Notice of Privacy Practices (NPP)

LEON COUNTY FLEXIBLE BENEFITS PLAN NOTICE OF PRIVACY PRACTICES

This Notice is effective January 1, 2005

This notice will describe how medical information about you may be used and disclosed and how you can get access to this information.

PLEASE REVIEW IT CAREFULLY

If you have any questions about this Notice, or you would like to make a request concerning your rights, please contact the Privacy Officer through the Leon County Human Resources Division. This Notice applies to all records about your health care that we complete or have access to and relate to your eligibility or method of payment for such care.

OUR RESPONSIBILITIES

This privacy notice will tell you about the lawful ways in which we may use and disclose your Protected Health Information (PHI). It also describes your rights and the responsibilities we have regarding the use and disclosure of your PHI. PHI is information that may identify you (including your name, address, and social security number), that relates to your past, present, or future physical or mental health condition, your health care services, and payment for your health care services. Leon County Human Resources Division is required by law to maintain the security and privacy of your PHI and to provide you with this Notice of our Privacy Practices and legal duties. We are required to follow the terms of this Notice. We reserve the right to change the terms of this notice and to make any new provisions effective to the entire PHI that we maintain about you. If we revise this notice, we will provide you with a revised notice upon request. We will also make any revised Notice available in our reception area and on our website at http://www.co.leon.fl.us/ .

USES and DISCLOSURES of PHI

To comply with the law only the individual’s "Minimum and Necessary" PHI will be used or disclosed to accomplish the intended purpose of the use, disclosure, or request. It is the Leon County Human Resources Division policy to limit the use or disclosure of an individual’s PHI on a "need to know" basis. The following categories describe some of the different ways we may use and disclose your PHI.

Payment:

We may use and disclose your PHI for payment activities. For example, we may use and disclose your PHI to process and pay your bill for health care services, when your health care provider requests information regarding your eligibility for coverage under our health plan, or in reviewing the medical necessity of the treatment you received, or in coordinating payment with other insurance carriers or facilities, or in coordinating reimbursement under our Flexible Benefits Plan.

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CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS Business Associates:

We may disclose your PHI to third party "business associates" that perform various services for us.

Individuals Involved in Your Care:

We may use and disclose your PHI to a family member or other person’s you identify involved in your care. We will disclose only PHI relevant to that person’s involvement in your care or payment for your care. We may use and disclose your PHI for locating and notifying a family member, a personal representative, or another person responsible for your care. If you are unable to agree or object to this disclosure, we may disclose such information as we deem is in your best interest based on our professional judgment.

State of Florida Monitors and Other Auditors:

We may disclose your PHI to State of Florida monitors and other auditors determining our compliance with the law, other state and federal regulations, and Generally Accepted Accounting Procedures.

Research:

We may use and disclose your PHI for research purposes in certain limited circumstances.

Required By Law: We will disclose your PHI as required by federal or state law including:

Military and National Security. We may disclose your PHI to authorized federal officials for conducting national security and intelligence activities who have appropriate authorization in writing citing the relevant Law, U.S. Code, Code of Federal Regulations,

Florida Statute, and / or Florida Administrative Code. We may also be required to disclose your PHI to authorized members of the Armed Forces for activities deemed necessary, and described and justified in writing by appropriate military authorities.

Public Health. We may disclose your PHI for public health activities. For example, we may disclose your PHI when necessary to prevent a serious threat to you or others health and safety. Public health activities generally include: (1) to prevent or control disease,

injury or disability; (2) to report births and deaths; (3) to report child abuse or neglect; (4) to report reactions to medications or problems with products; (5) to notify people of recalls of products they may be using; (6) to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and (7) to notify the appropriate government authority if we believe the individual has been the victim of abuse, neglect, or domestic violence.

Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law such as audits, investigations, inspections, and licensure. Government oversight agencies include those agencies that oversee government benefit

programs, government regulatory programs, and civil rights laws.

Legal Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding to the extent expressly authorized by a court or administrative order. We may disclose your PHI in response to a subpoena, discovery request, or other

lawful process, but only if efforts have been made to tell you or your attorney representative about the request or to obtain an order protecting the information requested.

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CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS

Law Enforcement. We may disclose your PHI to law enforcement officials for law enforcement, including: (1) in response to a court order, subpoena, warrant, summons, or similar process; (2) to identify or locate a suspect, fugitive, material witness, or missing

person; (3) pertaining to a victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct that occurs on our premises; and (6) in emergency circumstances to report a crime, the location of the crime or victims, or the identity , description, or location of the person who committed the crime.

Coroners, Medical Examiners, and Funeral Directors. We may disclose your PHI to a coroner or medical examiner for purposes of identifying a deceased person or determine cause of death. We may also disclose your PHI to a funeral director, as authorized by

law, in order for the director to carry out assigned duties.

Inmates. If you are an inmate of a correctional institution, we may disclose your PHI to the correctional institution or law enforcement official holding you in custody in order for:

(1) the institution to provide you with health care; (2) your health and safety and the health and safety of others; or (3) the safety and security of the correctional institution.

OTHER USES and DISCLOSURE OF YOUR PHI

Other disclosures of your PHI not covered by this notice or laws that apply to our use and disclosure will be made only with your written authorization. You may revoke your authorization, in writing, at anytime. If you revoke your authorization we will no longer use or disclose your PHI for the reasons covered by your written authorization. We are unable to take back any use or disclosure that has already been made with your authorization or that has been made as described in this notice.

YOUR RIGHTS

The following is a description of your rights with respect to your Protected Health Information.

Right to a Request A Restriction. You have the right to request a restriction on certain uses and disclosures of your PHI, including that for treatment, payment, or health care operations. You also have the right to request a restriction on the disclosure of your

information to individuals involved in your care or payment for your care. Leon County Human Resources Division will give serious consideration to your request but is not required to agree to any such restrictions. If we do agree, we will comply with the restriction unless the information is needed under exceptional circumstances. If we are unable to notify you of these exceptional circumstances prior to the fact, we will notify you of those circumstances as soon as reasonably possible. To request a restriction please contact the Privacy Officer. Your request must specify (1) the information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.

Right to Access, Inspect, And Copy. You have the right to access, inspect, and obtain a copy of your PHI that may be used to make decisions about your health care benefits. This includes your medical and billing records, but may not include information that is

subject to laws that prohibit access. We may deny your request to access, inspect, and copy in certain limited circumstances. If you are denied access, you may request that the

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CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS denial be reviewed. A licensed health care provider chosen by us will review your request and denial. The person performing this request will not be the person who denied your initial request. We will comply with the outcome of that review. To inspect and copy your PHI, please contact the Privacy Officer. A fee may be charged for the cost of copying, mailing, or other supplies associated with your request.

Right to Amend - If you believe any of your information in our possession is inaccurate you may request, in writing, that we amend or correct the information that you believe to be erroneous. To request an amendment, contact the Privacy Officer. You will be

required to provide a reason that supports your request. We may deny your request if you ask us to amend information that: (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of the Protected Health Information kept by or for us; (3) is not part of the information which you would be permitted to inspect or copy; or (4) is accurate and complete. If we deny your request you may submit a short statement of dispute, which will be included in any future disclosure of your information.

Right to an Accounting of Disclosures. You have the right to receive an accounting of disclosures of your PHI. This is a list of the disclosures of your PHI that we made to others. The list does not include disclosures made: (1) for treatment, payment and any

other health plan operations; (2) to you; (3) that are incidental disclosures; (4) in accordance with an authorization; (5) for national security or intelligence purposes; and (6) to correctional institutions or law enforcement officials for the provision of health care, safety of individual, other inmates, and officers and employees. To request an accounting contact the Privacy Officer. You may request an accounting for disclosure made up to 6 years before the date of your request but not for disclosures made before January 1, 2005. The first accounting you request within a 12-month period will be free. For additional accountings, we may charge you the cost of providing the list. We will notify you of the fee before any costs are incurred.

Right to Confidential Communications. You have the right to request that you receive communication of your Protected Health Information in a certain time or manner (for example, by e-mail rather than by regular mail, or never by telephone). For example, you

may ask that we only contact you at work or by U.S. Mail. We must agree to your request as long as it would not be disruptive to our operations to do so. You must make any such request in writing, addressed to our Privacy Officer. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may request a paper copy by contacting the Privacy Officer. In addition, you may obtain a copy of this notice on the Leon County website: http://www.co.leon.fl.us/

COMPLAINTS

If you believe your privacy rights have been violated, please send your complaint, in writing, to the Privacy Officer. All complaints will be resolved in a timely manner. If we cannot resolve your concern, you have the right to file a written complaint with the Secretary of the United States Department of Health and Human Services. You will not be retaliated against in any way for filing a complaint.

If you would like to discuss the privacy of your Protected Health Information in detail, or if you have any concerns, please feel free to contact the Privacy Officer. For additional information please visit the Leon County website at: http://www.co.leon.fl.us/ or the Leon County Human

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CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS Human Resources Division contact person at:

315 South Calhoun Street, Tallahassee, Florida 32301

Leon County Board of County Commissioners

Suite 502

850-487-2220

Clerk of Courts

Suite 450

850-577-4230

Supervisor of Elections

Suite 110

850-606-8613

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Service Directory

For all service related issues please call:

Brown & Brown, Inc 3520 Thomasville Rd. Suite 500

Tallahassee, FL 32309 850.656.3747

Fringe Benefits Management Company

3101 Sessions Road Tallahassee, FL 32303

800.342.8017

LEON COUNTY BOARD OF COUNTY COMMISSIONERS LEON COUNTY CLERK OF COURTS MEDICAL MEDICAL

Capital Health Plan 850.383.3311

Capital Health Plan 850.383.3311

United Healthcare 1.800.411.1147


DENTAL DENTAL CompBenefits 1.800.342.5209

CompBenefits 1800.342.5209



VISION VISION Vision Care 1.800.865.3676

Vision Care 1.800.865.3676

TERM LIFE INSURANCE TERM LIFE INSURANCE Florida Combined Life 1.800.333.3256

Florida Combined Life 1800.333.3256

Reliance Standard Life 1.800.644.1103

Reliance Standard Life 1.800.644.1103

LONG TERM DISABILITY LONG TERM DISABILITY Michael J. Milton North Florida Insurance Service, Inc. 4356 Lafayette St. Marianna, FL 32446 1.800.652.5032

Michael J. Milton North Florida Insurance Service, Inc. 4356 Lafayette St. Marianna, FL 32446 1.800.652.5032

LONG TERM CARE LONG TERM CARE Blue Cross/Blue Shield 1.888.202.3393

Blue Cross/Blue Shield 1.888.202.3393

LEGAL ARAG Group 1.800.523.5299

LEGAL ARAG Group 1.800.523.5299

Supplemental Products Colonial Supplemental Insurance 850.962.2600 850.962.2500

Supplemental Products Colonial Supplemental Insurance 850.962.2600 850.962.2500

AFLAC (Brown & Brown, Inc.) 850.656.3747

Flexible Spending Account, Medical Reimbursement Account, Dependent Daycare

Flexible Spending Account, Medical Reimbursement Account, Dependent Daycare

Fringe Benefits Management Company 3101 Sessions Road Tallahassee, FL 32303 Customer Service: 800.342.8017

Fringe Benefits Management Company 3101 Sessions Road Tallahassee, FL 32303 Customer Service: 800.342.8017

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2008 EMPLOYEE CONTRIBUTIONS PER PAY CHECK

Your employee contributions are deducted from your paycheck 24 times per year. The rates below reflect what you would

pay for your benefits each paycheck. Coverage Type Employee Employee + 1 Family Only Dependent MEDICAL PLANS Capital Health Plan $15.56 $32.21 $41.23 United $20.31 $42.04 $53.82 Full Time Employees (If both spouses employed by LCBCC or by LCBCC and a Constitutional Office, then no

employee contribution required for Family coverage ) Part Time Employees Capital Health Plan $15.56 $237.36 $357.81 United $20.31 $310.07 $467.14 DENTAL PLANS CompBenefits DHMO (Managed Care) $10.55 $17.86 $28.15 Advantage $7.62 $14.78 $24.50 PPO (Preferred Provider) $12.67 $24.21 $40.18 United PPO Plan $15.42 $30.57 $54.23 VISIONCARE PLAN $2.99 $8.55 SUPPLEMENTAL TERM LIFE INSURANCE $0.43 cents per thousand dollars of coverage DEPENDENT LIFE Coverage Type INSURANCE Spouse Children Premium $20,000 $5,000 $3.12 $10,000 $2,500 $1.58 $ 5,000 $1,500 $0.86 LONG TERM Monthly rates are based on age and $100 of pay. DISABILITY Age Band Rate 29 or less $0.46 30-34 $0.60 35-39 $0.67 40-44 $0.97 45-49 $1.20 50-54 $1.73 55-59 $2.56 60-64 $3.31 65 or over $3.38

ARAG LEGAL PLAN $8.75

Colonial Voluntary Plans Rates are based on the type of Plan. Contact Colonial Representative for plans and rates.

*Please contact a Brown & Brown Representative for information on Reliance Standard Life Voluntary Group Life and Blue Cross Blue Shield Long Term Care plan and rates.

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Der

mat

olog

y$1

0/vi

sit;

limit

of 5

vis

its/y

ear

No

limits

; thi

s on

ly a

pplie

s to

H

MO

's w

here

ref

erra

ls a

re r

equi

red

O

B/G

YN

Exa

m$1

0/vi

sit f

or w

ell w

oman

exa

m$1

0/vi

sit f

or w

ell w

oman

exa

m

V

isio

n S

cree

ning

$10/

visi

t for

rou

tine

eye

exam

s$1

0/vi

sit f

or r

outin

e ey

e ex

ams

(g

lass

es &

con

tact

lens

es n

ot c

over

ed)

P

odia

try

$10/

visi

t; $1

0/vi

sit;

whe

n m

edic

ally

nec

essa

ryw

hen

med

ical

ly n

eces

sary

S

pine

& B

ack

Dis

orde

r T

reat

men

t$1

0/vi

sit;

$10/

visi

t; fo

r ac

ute

& d

iagn

ostic

con

ditio

nsfo

r ac

ute

& d

iagn

ostic

con

ditio

nsD

IAB

ET

ES

TR

EA

TM

EN

T

In P

hysi

cian

Offi

ce$1

0/vi

sit;

$10/

visi

t;se

e m

embe

r ha

ndbo

ok fo

r de

tails

see

mem

ber

hand

book

for

deta

ilsIN

-HO

SP

ITA

L S

ER

VIC

ES

S

emi-P

rivat

e R

oom

& B

oard

No

Cha

rge

No

Cha

rge

A

ncill

ary

& P

rofe

ssio

nal S

ervi

ces

No

Cha

rge

No

Cha

rge

M

edic

al S

ervi

ces

No

Cha

rge

No

Cha

rge

A

nest

hesi

aN

o C

harg

eN

o C

harg

e

M

ater

nity

(P

re &

Pos

t Car

e)N

o C

harg

eN

o C

harg

e

D

iagn

ostic

Ser

vice

sN

o C

harg

eN

o C

harg

e

In

tens

ive

Cor

onar

y C

are

No

Cha

rge;

No

Cha

rge

whe

n m

edic

ally

nec

essa

ry

S

urgi

cal P

roce

dure

sN

o C

harg

e;N

o C

harg

esu

bjec

t to

appr

oval

- 19 -

CA

PIT

AL

HE

AL

TH

PL

AN

UN

ITE

D H

EA

LT

H C

AR

E

Ope

ratin

g &

Rec

over

y R

oom

No

Cha

rge

No

Cha

rge

A

cute

& C

hron

ic D

ialy

sis

No

Cha

rge

No

Cha

rge

D

rugs

, Med

icat

ions

& R

adio

ther

apy

No

Cha

rge

No

Cha

rge

S

peci

alty

Car

e &

Con

sulta

nts

No

Cha

rge;

No

Cha

rge

whe

n m

edic

ally

nec

essa

ry

S

peci

al D

uty

Nur

sing

No

Cha

rge;

No

Cha

rge

whe

n m

edic

ally

nec

essa

ry

OU

TP

AT

IEN

T H

OS

PIT

AL

SE

RV

ICE

S

Out

patie

nt S

urge

ryN

o C

harg

eN

o C

harg

e

R

adio

logy

& D

iagn

ostic

Tes

ting

Mam

mog

ram

No

Cha

rge

No

Cha

rge

Rou

tine:

Che

st x

-ray

, EK

G, e

tcN

o C

harg

eN

o C

harg

e

Spe

cial

ized

: Ultr

asou

nd, E

EG

,N

o C

harg

e; $

10 c

opay

N

o C

harg

e; $

10 c

opay

al

lerg

y te

stin

g, e

tc.

for

alle

rgy

test

ing

for

alle

rgy

test

ing

Ext

ensi

ve: C

at s

can,

MR

I, et

c.N

o C

harg

e;N

o C

harg

e;m

ay r

equi

re p

rior

auth

oriz

atio

nm

ay r

equi

re p

rior

auth

oriz

atio

n

La

b W

ork

No

Cha

rge

No

Cha

rge

C

hem

othe

rapy

No

Cha

rge

No

Cha

rge

D

ialy

sis

Ser

vice

sN

o C

harg

eN

o C

harg

e

S

hort

Ter

m T

hera

py

O

ccup

atio

nal,

Phy

sica

l, S

peec

h,$1

0/vi

sit;

for

cond

ition

s$1

0/vi

sit;

for

cond

ition

s

In

hala

tion

sub

ject

to s

igni

fican

t s

ubje

ct to

sig

nific

ant

impr

ovem

ent i

n 62

day

sim

prov

emen

t in

62 d

ays

- 20 -

CA

PIT

AL

HE

AL

TH

PL

AN

UN

ITE

D H

EA

LT

H C

AR

E

EM

ER

GE

NC

Y C

AR

E S

ER

VIC

ES

H

ospi

tal E

R R

oom

$100

/epi

sode

, wai

ved

if ad

mitt

ed$1

00/e

piso

de, w

aive

d if

adm

itted

P

hysi

cian

Cha

rges

Incl

uded

in a

bove

$10

0 co

pay

Incl

uded

in a

bove

$10

0 co

pay

U

gent

Car

e F

acili

ty$1

5/vi

sit

$15/

visi

t

EX

TE

ND

ED

CA

RE

SE

RV

ICE

S

Ski

lled

Nur

sing

Fac

ility

No

Cha

rge;

No

Cha

rge;

u

p to

60

days

per

adm

issi

on u

p to

60

days

per

adm

issi

on

H

ospi

ce C

are

No

Cha

rge

No

Cha

rge

H

ome

Hea

lth C

are

No

Cha

rge

No

Cha

rge

ME

NT

AL

HE

AL

TH

In

patie

nt F

acili

tyN

o C

harg

e; u

p to

31

days

/yea

rN

o C

harg

e; u

p to

30

days

/yea

r

O

utpa

tient

Fac

ility

& P

hysi

cian

Offi

ce$2

0/vi

sit;

up to

20

visi

ts/y

ear

$20/

visi

t; up

to 2

0 vi

sits

/yea

r

D

ay T

reat

men

t Fac

ility

Not

Cov

ered

Not

Cov

ered

P

artia

l Hos

pita

lizat

ion

No

Cha

rge;

2 d

ays

of p

artia

l N

o C

harg

e; 2

day

s of

par

tial

hosp

italiz

atio

n co

unts

as

1 da

yho

spita

lizat

ion

coun

ts a

s 1

day

tow

ards

men

tal/n

ervo

us b

enef

itto

war

ds m

enta

l/ner

vous

ben

efit

SU

BS

TA

NC

E A

BU

SE

In

patie

nt F

acili

tyN

o C

harg

e; d

etox

ifica

tion

only

No

Cha

rge;

det

oxifi

catio

n on

ly

Out

patie

nt F

acili

ty$2

0/vi

sit;

up to

20

visi

ts/y

ear

$20/

visi

t; up

to 2

0 vi

sits

/yea

r (C

ombi

ned

with

men

tal h

ealth

(C

ombi

ned

with

men

tal h

ealth

ou

tpat

ient

vis

its)

outp

atie

nt v

isits

)N

o C

harg

e fo

r di

agno

stic

med

ical

N

o C

harg

e fo

r di

agno

stic

med

ical

tr

eatm

ent f

or d

rugs

and

trea

tmen

t for

dru

gs a

ndal

coho

l det

oxifi

catio

nal

coho

l det

oxifi

catio

n

- 21 -

CA

PIT

AL

HE

AL

TH

PL

AN

UN

ITE

D H

EA

LT

H C

AR

E

OT

HE

R S

ER

VIC

ES

D

ME

No

Cha

rge;

up

to

No

Cha

rge;

up

to

$2,5

00 p

er m

embe

r pe

r ye

ar$2

,500

per

mem

ber

per

cale

ndar

yea

r

P

rost

hetic

sN

o C

harg

eN

o C

harg

e; $

2500

per

cal

enda

r ye

ar

O

rtho

tics

Not

Cov

ered

Not

Cov

ered

T

MJ/

Ort

hogn

atic

No

Cha

rge;

Not

Cov

ered

whe

n m

edic

ally

nec

essa

ry

O

rgan

Tra

nspl

ants

No

Cha

rge;

sub

ject

to li

mita

tions

No

Cha

rge;

sub

ject

to li

mita

tions

A

mbu

lanc

eN

o C

harg

e; w

hen

med

ical

y N

o C

harg

ene

cess

ary

M

edic

al S

uppl

ies

No

Cha

rge;

whe

n pa

rt o

fN

o C

harg

e;m

edic

al tr

eatm

ent

whe

n pa

rt o

f med

ical

trea

tmen

t

S

teril

izat

ion

Ser

vice

sN

o C

harg

e; s

urgi

cal s

teril

izat

ion

No

Cha

rge;

sur

gica

l ste

riliz

atio

n in

clud

ing

tuba

l lig

atio

ns a

nd in

clud

ing

tuba

l lig

atio

ns a

ndva

sect

omie

sva

sect

omie

s

F

ertil

ity S

ervi

ces

$10/

visi

t; $2

,000

Life

time

Max

$10/

visi

t; fa

mily

pla

nnin

g se

rvic

es

othe

r th

an th

ose

serv

ices

othe

r th

an th

ose

serv

ices

spec

ifica

lly d

escr

ibed

in th

e sp

ecifi

cally

des

crib

ed in

the

Cov

ered

Ser

vice

s se

ctio

n of

the

Cov

ered

Ser

vice

s se

ctio

n of

the

Mem

ber

Han

dboo

k ar

e ex

clud

edM

embe

r H

andb

ook

are

excl

uded

In

fert

ility

Ser

vice

s$1

0 fo

r en

dom

etria

l bio

psy,

$1

0 fo

r en

dom

etria

l bio

psy,

sp

erm

cou

nt &

sp

erm

cou

nt &

hy

ster

osal

ping

ogra

phy

hyst

eros

alpi

ngog

raph

y

- 22 -

CA

PIT

AL

HE

AL

TH

PL

AN

UN

ITE

D H

EA

LT

H C

AR

EP

RE

SC

RIP

TIO

N D

RU

GS

(fo

r 30

day

su

pp

ly)

G

ener

ic$7

$7

Pre

ferr

ed B

rand

$20

$20

N

on-P

refe

rred

Bra

nd$3

5$3

5

Mai

l Ord

erC

o-pa

ys in

boo

klet

New

em

ploy

ees

wis

hing

to e

nrol

l in

med

ical

insu

ranc

e m

ust s

ubm

it an

enr

ollm

ent a

pplic

atio

n w

ithin

30

days

of e

mpl

oym

ent.

It m

ay b

e ne

cess

ary

to c

onta

ct th

e ph

ysic

ian'

s of

fice

befo

re m

akin

g yo

ur s

elec

tion

in C

HP

to d

eter

min

e if

the

phys

icia

n is

acc

eptin

gne

w p

atie

nts.

Em

ploy

ees

who

hav

e m

edic

al in

sura

nce

thro

ugh

anot

her

plan

out

side

of L

CB

CC

may

ele

ct to

par

ticip

ate

in th

e M

edic

al In

sura

nce

Op

t-O

ut P

rogr

aman

d re

ceiv

e $3

00/m

onth

. E

mpl

oyee

s m

ust p

rovi

de w

ritte

n pr

oof o

f oth

er m

edic

al c

over

age,

with

in 3

0 da

ys o

f em

ploy

men

t, in

ord

er to

par

ticip

ate.

SP

EC

IAL

NO

TIC

ES

:D

EC

LIN

ING

EN

RO

LL

ME

NT

IN T

HE

ME

DIC

AL

PL

AN

If yo

u ar

e de

clin

ing

enro

llmen

t for

you

rsel

f or

your

dep

ende

nts

beca

use

of o

ther

med

ical

insu

ranc

e co

vera

ge, y

ou m

ay in

the

futu

re b

e ab

le to

enr

oll

your

self

of y

our

depe

nden

ts in

one

of t

he m

edic

al p

lans

, pro

vide

d th

at y

ou r

eque

st e

nrol

lmen

t with

in 3

1 da

ys a

fter

your

cov

erag

e en

ds.

In a

dditi

on, i

f you

hav

e a

new

dep

ende

nt a

s a

resu

lt of

mar

riage

, birt

h, a

dopt

ion/

plac

emen

t for

ado

ptio

n, y

ou m

ay b

e ab

le to

enr

oll y

ours

elf &

your

dep

ende

nts,

pro

vide

d th

at y

ou r

eque

st e

nrol

lmen

t with

in 3

1 da

ys a

fter

the

mar

riage

, birt

h, a

dopt

ion/

plac

emen

t for

ado

ptio

n.

WO

ME

N'S

HE

AL

TH

& C

AN

CE

R R

IGH

TS

AC

T O

F 1

998

Mas

tect

omie

s &

rel

ated

rec

onst

ruct

ive

surg

ery

are

cove

red

bene

fits

for

mem

bers

in th

e m

edic

al p

lans

. T

his

incl

udes

bot

h re

cons

truc

tion

of th

e br

east

on w

hich

sur

gery

was

per

form

ed a

s w

ell a

s su

rger

y &

rec

onst

ruct

ion

of th

e ot

her

brea

st to

pro

duce

a s

ymm

etric

al a

ppea

ranc

e. C

ove

rage

is a

lso

avai

labl

e fo

r br

east

pro

sthe

sis

& fo

r th

e ph

ysic

al c

ompl

icat

ions

of m

aste

ctom

y, in

clud

ing

lym

phed

emas

.

- 23 -

-

16 -

Imp

ort

ant

No

tice

fro

m L

eon

Co

un

ty A

bo

ut

Yo

ur

Pre

scri

pti

on

Dru

g C

ove

rag

e an

d M

edic

are

Ple

ase

read

th

is n

oti

ce c

aref

ully

an

d k

eep

it w

her

e yo

u c

an f

ind

it. T

his

no

tice

has

info

rmat

ion

ab

ou

t yo

ur

curr

ent

pre

scri

pti

on

dru

g c

ove

rag

e w

ith

Leo

n C

ou

nty

an

d a

bo

ut

you

r o

pti

on

s u

nd

er M

edic

are’

s p

resc

rip

tio

n d

rug

co

vera

ge.

T

his

in

form

atio

n c

an h

elp

yo

u d

ecid

e w

het

her

or

no

t yo

u w

ant

to j

oin

a M

edic

are

dru

g p

lan

. In

form

atio

n a

bo

ut

wh

ere

you

can

get

hel

p t

o m

ake

dec

isio

ns

abo

ut

you

r p

resc

rip

tio

n d

rug

co

vera

ge

is a

t th

e en

d

of

this

no

tice

. 1.

M

edic

are

pre

scri

pti

on

dru

g c

ove

rag

e b

ecam

e av

aila

ble

in

200

6 to

eve

ryo

ne

wit

h M

edic

are.

Yo

u c

an g

et t

his

co

vera

ge

if y

ou

jo

in a

Med

icar

e P

resc

rip

tio

n D

rug

Pla

n o

r jo

in a

Med

icar

e A

dva

nta

ge

Pla

n (

like

an H

MO

or

PP

O)

that

off

ers

pre

scri

pti

on

dru

g c

ove

rag

e. A

ll M

edic

are

dru

g p

lan

s p

rovi

de

at l

east

a s

tan

dar

d l

evel

of

cove

rag

e se

t b

y M

edic

are.

So

me

pla

ns

may

als

o o

ffer

mo

re c

ove

rag

e fo

r a

hig

her

mo

nth

ly p

rem

ium

.

2.

Leo

n C

ou

nty

has

det

erm

ined

th

at t

he

pre

scri

pti

on

dru

g c

ove

rag

e o

ffer

ed b

y th

e L

eon

Co

un

ty m

edic

al

insu

ran

ce v

end

ors

(C

apit

al H

ealt

h P

lan

an

d U

nit

ed)

is,

on

ave

rag

e fo

r al

l p

lan

par

tici

pan

ts,

exp

ecte

d t

o p

ay

ou

t as

mu

ch a

s st

and

ard

Med

icar

e p

resc

rip

tio

n d

rug

co

vera

ge

pay

s an

d is

co

nsi

der

ed C

red

itab

le C

ove

rag

e.

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

__

Bec

ause

yo

ur

exis

tin

g c

ove

rag

e is

, o

n a

vera

ge,

at

leas

t as

go

od

as

stan

dar

d M

edic

are

pre

scri

pti

on

dru

g

cove

rag

e, y

ou

can

kee

p t

his

co

vera

ge

and

no

t p

ay a

hig

her

pre

miu

m (

a p

enal

ty)

if y

ou

lat

er d

ecid

e to

jo

in a

M

edic

are

dru

g p

lan

. Y

ou c

an j

oin

a M

edic

are

drug

pla

n w

hen

you

first

bec

ome

elig

ible

for

Med

icar

e an

d ea

ch y

ear

from

Nov

embe

r 15

th

thro

ugh

Dec

embe

r 31

st.

Thi

s m

ay m

ean

that

you

may

hav

e to

wai

t to

join

a M

edic

are

drug

pla

n an

d th

at y

ou m

ay p

ay a

hi

gher

pre

miu

m (

a pe

nalty

) if

you

join

late

r.

You

may

pay

tha

t hi

gher

pre

miu

m (

a pe

nalty

) as

long

as

you

have

Med

icar

e pr

escr

iptio

n dr

ug c

over

age.

H

owev

er, i

f you

lose

cre

dita

ble

pres

crip

tion

drug

cov

erag

e, th

roug

h no

faul

t of y

our

own,

you

w

ill b

e el

igib

le f

or a

six

ty (

60)

day

Spe

cial

Enr

ollm

ent

Per

iod

(SE

P)

beca

use

you

lost

cre

dita

ble

cove

rage

to

join

a P

art

D

plan

. I

n ad

ditio

n, if

you

lose

or

deci

de t

o le

ave

empl

oyer

/uni

on s

pons

ored

cov

erag

e; y

ou w

ill b

e el

igib

le t

o jo

in a

Par

t D

pl

an a

t th

at t

ime

usin

g an

Em

ploy

er G

roup

Spe

cial

Enr

ollm

ent

Per

iod.

Y

ou s

houl

d co

mpa

re y

our

curr

ent

cove

rage

, in

clud

ing

whi

ch d

rugs

are

cov

ered

at

wha

t co

st,

with

the

cov

erag

e an

d co

sts

of t

he p

lans

offe

ring

Med

icar

e pr

escr

iptio

n dr

ug c

over

age

in y

our

area

.

If y

ou

dec

ide

to j

oin

a M

edic

are

dru

g p

lan

, yo

ur

Leo

n C

ou

nty

co

vera

ge

will

be

affe

cted

. S

ee b

elo

w f

or

mo

re

info

rmat

ion

ab

ou

t w

hat

hap

pen

s to

yo

ur

curr

ent

cove

rag

e if

yo

u jo

in a

Med

icar

e d

rug

pla

n.

If yo

u en

roll

in a

Med

icar

e pr

escr

iptio

n dr

ug p

lan,

you

and

you

r de

pend

ents

will

no

long

er b

e el

igib

le f

or L

eon

Cou

nty’

s re

tiree

med

ical

or

pres

crip

tion

drug

cov

erag

e an

d yo

u w

ill n

ot b

e ab

le t

o ha

ve t

hat

cove

rage

rei

nsta

ted

if yo

u la

ter

dise

nrol

l fro

m t

he M

edic

are

pres

crip

tion

dru

g pl

an.

Bef

ore

you

deci

de t

o en

roll

in a

Med

icar

e pr

escr

iptio

n dr

ug p

lan,

you

sh

ould

com

pare

you

r Le

on C

ount

y m

edic

al p

lan

optio

ns—

incl

udin

g w

hich

dru

gs a

re c

over

ed—

with

the

cove

rage

and

cos

t of

the

plan

s of

ferin

g M

edic

are

med

ical

and

pre

scrip

tion

drug

cov

erag

e in

you

r ar

ea.

- 24 -

-

17 -

If y

ou

do

dec

ide

to j

oin

a M

edic

are

dru

g p

lan

an

d d

rop

yo

ur

Leo

n C

ou

nty

pre

scri

pti

on

dru

g c

ove

rag

e, b

e aw

are

that

yo

u a

nd

yo

ur

dep

end

ents

may

no

t b

e ab

le t

o g

et t

his

co

vera

ge

bac

k.

You

sho

uld

also

kno

w t

hat

if yo

u dr

op o

r lo

se y

our

cove

rage

with

Leo

n C

ount

y an

d do

n’t

join

a M

edic

are

drug

pla

n w

ithin

63

con

tinuo

us d

ays

afte

r yo

ur c

urre

nt c

over

age

ends

, yo

u m

ay p

ay a

hig

her

prem

ium

(a

pena

lty)

to jo

in a

Med

icar

e dr

ug

plan

late

r.

If yo

u go

63

cont

inuo

us d

ays

or l

onge

r w

ithou

t pr

escr

iptio

n dr

ug c

over

age

that

’s a

t le

ast

as g

ood

as M

edic

are’

s pr

escr

iptio

n dr

ug c

over

age,

you

r m

onth

ly p

rem

ium

may

go

up b

y at

leas

t 1%

of

the

base

ben

efic

iary

pre

miu

m p

er m

onth

fo

r ev

ery

mon

th t

hat

you

did

not

have

tha

t co

vera

ge.

For

exa

mpl

e, i

f yo

u go

nin

etee

n m

onth

s w

ithou

t co

vera

ge,

your

pr

emiu

m m

ay c

onsi

sten

tly b

e at

lea

st 1

9% h

ighe

r th

an t

he b

ase

bene

ficia

ry p

rem

ium

. Y

ou m

ay h

ave

to p

ay t

his

high

er

prem

ium

(a

pena

lty)

as lo

ng a

s yo

u ha

ve M

edic

are

pres

crip

tion

drug

cov

erag

e. In

add

ition

, you

may

hav

e to

wai

t unt

il th

e fo

llow

ing

Nov

embe

r to

join

. F

or m

ore

info

rmat

ion

abou

t thi

s no

tice

or y

our

curr

ent p

resc

ript

ion

drug

cov

erag

e…

Con

tact

the

per

son

liste

d be

low

for

fur

ther

info

rmat

ion.

N

OT

E:

You

’ll g

et t

his

notic

e ea

ch y

ear.

You

will

als

o ge

t it

befo

re

the

next

per

iod

you

can

join

a M

edic

are

drug

pla

n, a

nd i

f th

is c

over

age

thro

ugh

Leon

Cou

nty

chan

ges.

You

als

o m

ay

requ

est a

cop

y.

For

mor

e in

form

atio

n ab

out y

our

optio

ns u

nder

Med

icar

e pr

escr

iptio

n dr

ug c

over

age…

M

ore

deta

iled

info

rmat

ion

abou

t M

edic

are

plan

s th

at o

ffer

pres

crip

tion

drug

cov

erag

e is

in

the

“Med

icar

e &

You

” ha

ndbo

ok.

You

’ll g

et a

cop

y of

the

han

dboo

k in

the

mai

l eve

ry y

ear

from

Med

icar

e.

You

may

als

o be

con

tact

ed d

irect

ly

by M

edic

are

drug

pla

ns.

For

mor

e in

form

atio

n ab

out M

edic

are

pres

crip

tion

drug

cov

erag

e:

V

isit

ww

w.m

edic

are.

gov

Cal

l you

r S

tate

Hea

lth In

sura

nce

Ass

ista

nce

Pro

gram

(se

e th

e in

side

bac

k co

ver

of y

our

copy

of t

he “

Med

icar

e &

Y

ou”

hand

book

for

thei

r te

leph

one

num

ber)

for

pers

onal

ized

hel

p,

C

all 1

-800

-ME

DIC

AR

E (

1-80

0-63

3-42

27).

TT

Y u

sers

sho

uld

call

1-87

7-48

6-20

48.

If yo

u ha

ve l

imite

d in

com

e an

d re

sour

ces,

ext

ra h

elp

payi

ng f

or M

edic

are

pres

crip

tion

drug

cov

erag

e is

ava

ilabl

e. F

or

info

rmat

ion

abou

t th

is e

xtra

hel

p, v

isit

Soc

ial

Sec

urity

on

the

web

at

ww

w.s

ocia

lsec

urity

.gov

, or

cal

l th

em a

t 1-

800-

772-

1213

(T

TY

1-8

00-3

25-0

778)

. R

emem

ber

: K

eep

th

is C

red

itab

le C

ove

rag

e n

oti

ce.

If y

ou

dec

ide

to jo

in o

ne

of

the

Med

icar

e d

rug

pla

ns,

yo

u m

ay

be

req

uir

ed t

o p

rovi

de

a co

py

of

this

no

tice

wh

en y

ou

join

to

sh

ow

wh

eth

er o

r n

ot

you

hav

e m

ain

tain

ed c

red

itab

le

cove

rag

e an

d w

het

her

or

no

t yo

u a

re r

equ

ired

to

pay

a h

igh

er p

rem

ium

(a

pen

alty

).

D

ate:

11

/01/

07

N

ame

of E

ntity

/Sen

der:

Le

on C

ount

y

Con

tact

--P

ositi

on/O

ffice

: E

rnie

Poi

rier(

BO

CC

)/S

haro

n F

erre

ll(C

lerk

of C

ourt

s)/C

indy

Kel

ly (

Sup

ervi

sor

of E

lect

ions

)

A

ddre

ss:

315

S. C

alho

un S

t., T

alla

hass

ee, F

L 32

301

S

uite

502

(B

OC

C),

Sui

te 4

50 (

Cle

rk o

f Cou

rts)

, Sui

te 1

10(S

uper

viso

r of

Ele

ctio

ns)

P

hone

Num

bers

: (8

50)

- 60

6-24

17 (

BO

CC

), 5

77-4

230

(Cle

rk o

f Cou

rts)

, 606

-861

3 (S

uper

viso

r of

Ele

ctio

ns)

DH

MO

Pla

nA

dva

nta

ge

Pla

nC

S150

AV

N1

In N

etw

ork

Out

of N

etw

ork

Co

pa

yme

ntC

op

aym

ent

Reim

bur

sem

ent

Reim

bur

sem

ent

9430

Offi

ce V

isit

(Nor

mal

Hou

rs)

$5.0

0$0

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120

Per

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al e

valu

atio

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o C

harg

eN

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harg

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mite

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valu

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harg

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harg

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ompr

ehen

sive

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l eva

luat

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No

Cha

rge

No

Cha

rge

210

Intr

aora

l-com

plet

e se

ries

(incl

udin

g bi

tew

ings

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ms

No

Cha

rge

No

Cha

rge

330

Pan

oram

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lm

No

Cha

rge

No

Cha

rge

1110

Pro

phyl

axis

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lt (o

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x m

onth

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mon

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No

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rge

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1203

Top

ical

app

licat

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of fl

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p to

16

year

s of

age

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o C

harg

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harg

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1351

Sea

lant

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toot

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0.00

No

Cha

rge

2140

Am

alga

m-o

ne s

urfa

ce, p

rimar

y or

per

man

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No

Cha

rge

$24.

0021

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mal

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per

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No

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0023

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ed c

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site

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sur

face

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erio

r $3

5.00

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0023

31R

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ed c

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site

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o su

rfac

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nter

ior

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in-b

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com

posi

te-o

ne s

urfa

ce, p

oste

rior

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8.00

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Cro

wn-

porc

elai

n fu

sed

to h

igh

nobl

e m

etal

$2

80.0

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to $

125

per

unit

for

high

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ble

met

al$4

66.0

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olar

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al$2

50.0

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calin

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lani

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per

quad

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exp

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hodo

ntic

trea

tmen

t of t

he tr

ansi

tiona

l/ado

lesc

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entit

ion.

Chi

ldre

n up

to

19 y

ears

of a

ge; u

p to

24

mon

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of r

outin

e or

thod

ontic

trea

tmen

t for

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ss I

& C

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time

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thre

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ched

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Th

is s

ched

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ten

ded

fo

r co

mp

aris

on

pu

rpo

ses

on

ly.

Th

e b

enef

its

for

each

pla

n w

ill b

e d

eter

min

ed b

y th

e co

ntr

act.

Fo

r a

com

ple

te li

stin

g o

f b

enef

its

and

exc

lusi

on

s an

d li

mit

atio

ns,

ple

ase

refe

ren

ce t

he

cert

ific

ate

of

cove

rag

e.

Typ

e I

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iag

nost

ic &

Pre

vent

ive

Se

rvic

es

Typ

e II

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asi

c S

erv

ice

s

Typ

e II

I - M

ajo

r Se

rvic

es

(12

mo

nth

wa

iting

pe

riod

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me

se

rve

d o

n th

e e

mp

loye

r's im

me

dia

tley

pre

ce

din

g g

roup

de

nta

l pla

n m

ay

be

cre

dite

d to

wa

rds

this

wa

iting

pe

riod

.)

Par

ticip

atin

g P

rovi

ders

will

red

uce

thei

r fe

es b

y 25

%.

Not

Cov

ered

.

80%

of P

PO

Pro

vide

r's fe

e80

% o

f PP

O S

ched

ule;

bal

ance

bill

ing

appl

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50%

of P

PO

Pro

vide

r's fe

e50

% o

f PP

O S

ched

ule;

bal

ance

bill

ing

appl

icab

le

No

clai

m fo

rms

to fi

le; n

o an

nual

m

axim

um b

enef

its;

no

wai

ting

perio

ds,

no c

alen

dar

year

ded

uctib

les

No

clai

m fo

rms

to fi

le; n

o an

nual

m

axim

um b

enef

its;

no

wai

ting

perio

ds,

no c

alen

dar

year

ded

uctib

les

Wit

h t

he

CS

150

pla

n, i

n o

rder

to

rec

eive

ben

efit

s yo

u m

ust

co

nta

ct t

he

den

tal o

ffic

e yo

u h

ave

sele

cted

. W

ith

th

e A

dva

nta

ge

pla

n, n

o p

rese

lect

ion

of

den

tist

is r

equ

ired

, yo

u m

ay b

e tr

eate

d b

y an

y d

enti

st w

ith

in t

he

net

wo

rk.

Wit

h b

oth

th

e C

S15

0 an

d A

dva

nta

ge

Pla

ns,

co

pay

men

ts a

nd

ben

efit

s ar

e av

aila

ble

wit

h n

etw

ork

pro

vid

ers

on

ly.

2008

SU

MM

AR

Y O

F C

OM

PB

EN

EF

ITS

DE

NT

AL

OP

TIO

NS

100%

of P

PO

Pro

vide

r's fe

e10

0% o

f PP

O S

ched

ule;

bal

ance

bill

ing

appl

icab

le

PPO

EP7

00 P

lan

Parti

al L

istin

g o

f Co

vere

d S

erv

ice

s

- 26 -

In

and

Out

of

Net

wor

k

I

n an

d O

ut o

f N

etw

ork

N

on-O

rtho

dont

ics

Ort

hodo

ntic

s In

divi

dual

Ann

ual D

educ

tible

$5

0

Fam

ily A

nnua

l Ded

uctib

le

$150

Max

imum

(co

mbi

ned

for

both

In-

Net

wor

k an

d O

ut-o

f-N

etw

ork

serv

ices

) $1

500

per

pers

on p

er c

alen

dar

year

$1

000

per

pers

on p

er li

fetim

e

In-N

etw

ork

Out

-of-

Net

wor

k A

nnua

l ded

uctib

le a

pplie

s to

pre

vent

ativ

e an

d di

agno

stic

se

rvic

es

No

No

For

new

enr

olle

es, t

here

will

be

a w

aitin

g pe

riod

of:

E

mpl

oyee

s al

read

y en

rolle

d in

den

tal w

ill b

e gi

ven

prio

r cr

edit

12 m

onth

s fo

r M

ajor

12

Mon

ths

for

Maj

or

12

mon

ths

for

Ort

ho

12 m

onth

s fo

r O

rtho

O

rtho

dont

ic e

ligib

ility

req

uire

men

t C

hild

up

to a

ge 1

9 C

hild

up

to a

ge 1

9

C

over

ed S

ervi

ces

In-

Net

wor

k

O

ut-o

f-N

etw

ork

Pre

vent

ativ

e an

d D

iagn

osti

c D

enta

l Ser

vice

s Pe

riod

ic O

ral E

xam

inat

ions

10

0%

100%

B

itew

ing

X-r

ays

100%

10

0%

Com

plet

e Se

ries

or

Pano

rex

X-r

ays

100%

10

0%

Den

tal P

roph

ylax

is (

Cle

anin

gs)

100%

10

0%

Fluo

ride

Tre

atm

ents

10

0%

100%

Se

alan

ts

100%

10

0%

Bas

ic D

enta

l Ser

vice

s A

mal

gam

Res

tora

tions

(Fi

lling

s)

80%

80

%

Com

posi

te R

esin

(Fi

lling

s)

80%

80

%

Spac

e M

aint

aine

rs

80%

80

%

Sim

ple

Ext

ract

ion

80%

80

%

Surg

ical

Ext

ract

ion

incl

udin

g im

pact

ed W

isdo

m T

eeth

80

%

80%

Gen

eral

Ane

sthe

sia

80%

80

%

Palli

ativ

e T

reat

men

t (R

elie

f of

Pai

n)

80%

80

%

Roo

t Can

al T

reat

men

t 80

%

80%

R

oot P

lani

ng

80%

80

%

Peri

odon

tal S

urge

ry

80%

80

%

Maj

or D

enta

l Ser

vice

s

C

row

ns

50%

50

%

Fixe

d B

ridg

es

50%

50

%

Full

Den

ture

s 50

%

50%

In

lays

and

Onl

ays

50%

50

%

Part

ial D

entu

res

50%

50

%

Rec

emen

t Bri

dges

, Cro

wns

, Inl

ays

50%

50

%

Rel

inin

g D

entu

res

50%

50

%

Rep

airs

to F

ull D

entu

res,

Par

tial D

entu

res,

Bri

dges

50

%

50%

O

rtho

dont

ic S

ervi

ces

Dia

gnos

e or

cor

rect

mis

alig

nmen

t of

the

teet

h or

bite

in

clud

ing

Phas

e I

and

Phas

e II

50

%

50%

*The

in-n

etw

ork

perc

enta

ge o

f be

nefi

ts is

bas

ed o

n th

e di

scou

nted

fee

neg

otia

ted

with

the

prov

ider

. **

The

out

-of-

netw

ork

perc

enta

ge o

f be

nefi

ts is

pai

d at

85th

per

cent

ile o

f th

e us

ual a

nd c

usto

mar

y ra

tes

prev

ailin

g in

the

geog

raph

ic a

rea

in w

hich

the

expe

nses

are

incu

rred

.

SUM

MA

RY

OF

UN

ITE

D H

EA

LT

HC

AR

E’S

DE

NT

AL

OP

TIO

NS

- 27 - -

21 -

N

ET

WO

RK

DO

CT

OR

N

ON

-NE

TW

OR

K D

OC

TO

R

BE

NE

FIT

S

Eye

Exa

ms

$10

copa

y; th

en p

aid

in fu

ll $3

5 al

low

ance

E

xam

eve

ry 1

2 m

onth

s

L

ense

s (p

er p

air)

$1

5 co

pay;

then

pai

d in

full

See

bel

ow

Lens

es e

very

12

mon

ths

Sin

gle

$2

5 al

low

ance

Bifo

cal

$4

0 al

low

ance

Trif

ocal

$60

allo

wan

ce

Le

ntic

al

$1

00 a

llow

ance

Co

nta

ct L

ense

s

Ele

ctiv

e (e

xam

+ le

nses

) $1

0 co

pay

for

exam

and

$10

5 al

low

ance

for

lens

es (

incl

udin

g fit

ting,

fo

llow

up

exam

and

lens

es)

$35

allo

wan

ce fo

r ex

am a

nd $

105

allo

wan

ce fo

r le

nses

(in

clud

ing

fittin

g,

follo

w u

p ex

am, a

nd le

nses

)

Thi

s al

low

ance

is p

aid

with

the

sam

e fr

eque

ncy

as le

nses

. T

he p

lan

prov

ides

an

allo

wan

ce fo

r co

ntac

ts in

stea

d of

le

nses

and

fram

es.

Med

ical

ly N

eces

sary

$1

5 co

pay;

then

pai

d in

full

$210

allo

wan

ce

Prio

r au

thor

izat

ion

is r

equi

red

for

Med

ical

ly N

eces

sary

con

tact

lens

es a

s in

dica

ted

in th

e C

ertif

icat

e of

Cov

erag

e.

Fra

me

$15

copa

y; th

en p

aid

in fu

ll $4

0 al

low

ance

E

very

24

mon

ths.

The

pla

n co

vers

fram

es

base

d on

the

man

ufac

ture

rs w

hole

sale

pr

ice.

Pric

e of

cov

ered

fram

es m

ay v

ary

amon

g pl

an d

octo

rs, t

houg

h th

e va

lue

of

your

cov

ered

fram

e st

ays

the

sam

e. Y

ou

may

be

requ

ired

to p

ay e

xtra

onl

y if

you

choo

se a

fram

e th

at e

xcee

ds th

e co

vere

d w

hole

sale

pric

e.

LA

SIK

Pro

ced

ure

s T

he p

lan

has

cont

ract

ed w

ith m

any

of

the

fines

t LA

SIK

faci

litie

s an

d ey

e do

ctor

s to

offe

r th

is p

roce

dure

at

subs

tant

ially

red

uced

fees

. T

he

netw

ork

of L

AS

IK c

ente

rs fe

atur

es a

ll T

LC L

aser

Cen

ter

(TLC

Vis

ion)

fa

cilit

ies

as w

ell a

s m

any

of th

e le

adin

g in

depe

nden

t cen

ters

in th

e co

untr

y.

No

bene

fit a

vaila

ble

To

rece

ive

$180

0 re

duce

d fe

e, m

embe

r m

ust u

se th

e La

ser

Cen

ter’s

faci

litie

s.

Mem

ber

rece

ives

a 1

0% d

isco

unt f

or

usin

g ou

t of n

etw

ork

doct

ors,

with

the

max

imum

allo

wab

le a

mou

nt $

1800

.

Ou

t o

f S

tate

Ser

vice

s T

hrou

gh N

atio

nwid

e ne

twor

k S

ame

bene

fits

In-n

etw

ork

serv

ices

are

ava

ilabl

e th

roug

h a

natio

nwid

e ne

twor

k of

par

ticip

atin

g do

ctor

s. I

f pla

n m

embe

rs tr

avel

or

mov

e to

ano

ther

sta

te, t

heir

plan

goe

s w

ith

them

. T

hey

can

sim

ply

requ

est a

list

of

Mem

ber

Doc

tors

for

that

are

a al

ong

with

a

bene

fit fo

rm, a

nd a

s lo

ng a

s th

ey a

re

elig

ible

, the

y w

ill r

ecei

ve th

e sa

me

bene

fits

as th

ey w

ould

in th

eir

hom

e st

ate.

The

am

ount

s sh

own

are

max

imum

ben

efits

. The

act

ual b

enef

it am

ount

the

plan

will

rei

mbu

rse

to a

pla

n m

embe

r fo

r no

n-ne

twor

k do

ctor

s w

ill b

e th

e le

ast o

f: th

e m

axim

um s

how

n in

the

sche

dule

; the

am

ount

act

ually

cha

rged

; or

the

amou

nt a

doc

tor

usua

lly c

harg

es a

priv

ate

patie

nt.

The

ava

ilabi

lity

of s

ervi

ces

unde

r th

e no

n-ne

twor

k re

imbu

rsem

ent s

ched

ule

is s

ubje

ct

to th

e sa

me

time

limits

and

cop

aym

ents

as

thos

e fo

r ne

twor

k se

rvic

es.

The

pla

n pa

ys n

on-n

etw

ork

bene

fits

in p

lace

of s

ervi

ces

from

a n

etw

ork

doct

or.

- 28 -

-

22 -

T

ER

M L

IFE

IN

SU

RA

NC

E

FLO

RID

A C

OM

BIN

ED

LIF

E

B

AS

IC L

IFE

S

UPPLE

ME

NT

AL L

IFE

D

EPE

ND

EN

T L

IFE

E

LIG

IBIL

ITY

Fu

ll T

ime

Em

plo

yee

Fu

ll T

ime

Em

plo

yee

Fu

ll T

ime

Em

plo

yee

WA

ITIN

G P

ER

IOD

1

st D

ay

of t

he

Mon

th

1

st D

ay

of t

he

Mon

th

1

st D

ay

of t

he

Mon

th

FO

R N

EW

HIR

ES

Fol

low

ing

Date

of

Hir

e Fol

low

ing

Rec

eipt

of

Fol

low

ing

Rec

eipt

of

A

pplica

tion

(M

ust

su

bm

it

Applica

tion

(M

ust

su

bm

it

A

pplica

tion

wit

hin

30 d

ays

of

A

pplica

tion

wit

hin

30 d

ays

of

D

ate

of

hir

e)

date

of

hir

e)

WA

ITIN

G P

ER

IOD

1

st D

ay

of t

he

Mon

th

1

st D

ay

of t

he

Mon

th

FO

R C

UR

RE

NT

Fol

low

ing

Evi

den

ce o

f

Fol

low

ing

Evi

den

ce o

f E

MPLO

YE

ES

Insu

rabilit

y A

ppro

val by

Insu

rabilit

y A

ppro

val by

In

sura

nce

Com

pan

y

Insu

ran

ce C

ompan

y W

HO

PA

YS

FO

R

Leo

n C

oun

ty

Em

plo

yee

Em

plo

yee

TH

E P

LA

N

CO

VE

RA

GE

AM

OU

NT

E

XE

CU

TIV

E &

2 x

Basi

c A

nn

ual S

ala

ry

1 x

Basi

c A

nn

ual S

ala

ry

Opti

ons:

S

R. M

AN

AG

EM

EN

T

S

pou

se a

nd D

epen

den

ts

$20,0

00 a

nd $

5,0

00

Applies

to

Boa

rd a

nd S

uper

viso

r of

Ele

ctio

n o

nly

$10,0

00 a

nd $

2,5

00

$ 5

,000 a

nd $

1,5

00

E

XE

CU

TIV

E S

UPPT

.

1 x

Basi

c A

nn

ual S

ala

ry

1 o

r 2 x

Basi

c A

nn

ual S

ala

ry

O

pti

ons:

&

CA

RE

ER

SE

RVIC

E

S

pou

se a

nd D

epen

den

ts

$20,0

00 a

nd $

5,0

00

$10,0

00 a

nd $

2,5

00

$ 5

,000 a

nd $

1,5

00

AD

DIT

ION

AL I

NFO

RM

AT

ION

M

axi

mu

m c

over

age

am

oun

t is

$250,0

00 f

or B

asi

c an

d S

upple

men

tal Life

Insu

ran

ce

C

over

age

am

oun

t re

du

ces

to 6

5%

at

Age

65

D

epen

den

t Life

Insu

ran

ce a

mou

nt

can

not

exc

eed 5

0%

of

the

emplo

yee’

s B

asi

c an

d S

upple

men

tal life

com

bin

ed a

mou

nts

In

sura

nce

pro

vided

by

Flo

rida C

ombin

ed L

ife

Insu

ran

ce C

ompan

y

C

omple

te b

enef

it p

rovi

sion

s are

ava

ilable

in

th

e m

ast

er c

ontr

act

an

d c

erti

fica

te o

f life

in

sura

nce

cov

erage

.

- 29 -

-

23 -

TE

RM

LIF

E I

NS

UR

AN

CE

R

ELIA

NC

E S

TA

ND

AR

D L

IFE

S

UPPLE

ME

NT

AL L

IFE

DE

PE

ND

EN

T L

IFE

E

LIG

IBIL

ITY

A

ny

emplo

yee

wor

kin

g 30

A

ny

emplo

yee

wor

kin

g 30

Or

mor

e h

ours

O

r m

ore

hou

rs

WA

ITIN

G P

ER

IOD

1st D

ay

of t

he

Mon

th

1st D

ay

of t

he

Mon

th

FO

R N

EW

HIR

ES

Fol

low

ing

Date

of

Hir

e

W

AIT

ING

PE

RIO

D

1

st d

ay

of t

he

mon

th f

ollo

win

g

1

st d

ay

of t

he

mon

th f

ollo

win

g

FO

R C

UR

RE

NT

rece

ipt

of a

pplica

tion

rece

ipt

of a

pplica

tion

E

MPLO

YE

ES

WH

O P

AYS

FO

R

E

mplo

yee

Em

plo

yee

T

HE

PLA

N

CO

VE

RA

GE

AM

OU

NT

E

mplo

yee

S

pou

se

Opti

on o

f $10,

000 t

o $500,

000 in

in

crem

ents

of

$10,0

00

Opti

on o

f $10,

000 t

o $500,

000 in

in

crem

ents

of

$10,0

00

Gu

ara

nte

e Is

sue

am

oun

t u

nder

Age

60-

$100,0

00

Gu

ara

nte

e Is

sue

Am

oun

t u

nder

Age

60 -

$40,0

00

Gu

ara

nte

e Is

sue

Am

oun

t A

ge 6

0 t

o 70 -

$10,0

00

subje

ct t

o em

plo

yee

cove

rage

of

at

least

$50,0

00

C

hildre

n

C

over

age

opti

ons

1

2

3

4

14 d

ays

up t

o 6 m

onth

s

$1000

$1000

$1000

$1000

6 m

onth

s u

p t

o age

20*

$2500

$5000

$7500

$

10,0

00

*

26 if

Fu

ll-T

ime

Stu

den

t

A

DD

ITIO

NA

L I

NFO

RM

AT

ION

C

hoi

ces

of lif

e in

sura

nce

in

in

crem

ents

of

$1

0,0

00

to

$5

00

,00

0

D

epen

den

t C

over

age

Ava

ilab

le

G

ua

ran

teed

Acc

epta

nce

Am

oun

ts f

or E

mp

loy

ee,

Sp

ouse

an

d D

epen

den

t C

hild

ren

Gu

ara

nte

e Is

sue

for

Em

plo

yee

s u

nd

er a

ge 6

0 is

$1

00

,00

0

G

ua

ran

tee

Issu

e fo

r E

mp

loy

ees

age

60

to

70

is

$1

0,0

00

Gu

ara

nte

e Is

sue

for

Sp

ouse

un

der

age

60

is

$4

0,0

00

, p

rovi

ded

th

e em

plo

yee

ap

plie

s fo

r a

t le

ast

$5

0,0

00

No

Med

ica

l E

vid

ence

is

requ

ired

on

dep

end

ent

child

ren

Lib

era

l C

onve

rsio

n a

nd

Por

tab

ility

Pro

visi

ons

Liv

ing

Ben

efit

- 30 -

LONG T

ERM

DIS

ABIL

ITY

UNUM

PROVI

DENT

ELI

GIB

ILIT

Y

Al

l ful

l tim

e em

ploy

ees

wor

king

30

hour

s or

mor

e pe

r w

eek

WAIT

ING P

ERIO

D

1s

t of t

he m

onth

coi

ncid

ing

with

or

next

follo

win

g 30

con

secu

tive

days

of e

mpl

oym

ent

FO

R N

EW

HIR

ES

WHO P

AYS

FOR

Em

ploy

ee

THE P

LAN

BENEFI

T PE

RCE

NTA

GE

60%

to

a m

axim

um o

f $60

00 a

mon

th

M

AXIM

UM

BENEFI

T PE

RIO

D

TO

AG

E 6

5 DEFI

NIT

ION O

F BM

E

Cur

rent

bas

e m

onth

ly s

alar

y

DEFI

NIT

ION O

F DIS

ABIL

ITY

Your

ow

n oc

cupa

tion

for

two

year

s, a

ny o

ccup

atio

n th

erea

fter

ELI

MIN

ATI

ON P

ERIO

D

3 M

onth

s

PRE-E

XIS

TING C

ONDIT

ION P

ERIO

D

The

3 m

onth

s pr

ior

to y

our

cove

rage

effe

ctiv

e da

te

PRE-E

XIS

TING C

ONDIT

ION E

XCL

USI

ON P

ERIO

D

The

first

12

mon

ths

as a

cov

ered

per

son

ADDIT

IONAL

INFO

RM

ATI

ON

Indi

vidu

al G

uara

ntee

d Ren

ewab

ility

Pol

icy

Ear

ning

s m

eans

bas

e m

onth

ly s

alar

y bu

t ex

clud

es b

onus

es, o

vert

ime

pay,

and

any

oth

er e

xtra

com

pens

atio

n re

ceiv

ed fr

om the

Em

ploy

er.

- 31 -

28

UA_Workbook_Copy_0504

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Specific document preparation

Specific document review (up to four pages)

Standard will preparation including testamentary support trusts for minor children, durable powers of attorney, health care powers of attorney, living wills, advanced health care directives

In-Office Legal Benefits For situations like your underage

child getting in trouble with the law

or uncontested divorce, sometimes

only face-to-face counsel from an

attorney will do. UltimateAdvisor

can protect your world by

providing attorney representation to

help resolve a number of legal

issues. Benefits include:

Standard will preparation

Complex will

reimbursement (partial)

Codicil (amendment to a

will)

Living will

Power of attorney IRS audit protection

reimbursements (partial)

IRS collection defense reimbursements

Court adoption proceedings

Divorce, legal separation or annulment (Uncontested)

Divorce, legal separation or annulment (Contested – up to 15 hours paid) Plus ARAG contract rate for any additional hours needed

Guardianship or conservatorship – Uncontested and contested

Name change proceedings

Juvenile court proceedings

Loss of driving privilege (except DWI)

Review of documents

Preparation of final contract

Attendance at closing

Preparation and review of deeds and mortgages

Preparation and review of promissory notes and affidavits

Preparation and review of a lease contract (lessee only)

Enforcement of tenants rights for primary residence (lessee only)

Enforcement of personal property rights

Representation in disputes regarding the transfer of personal property

Tenant eviction defense for primary residence (lessee only)

Consumer protection

Consumer debt collection

Criminal misdemeanor

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Reduced Fee Benefit

Reduced Fee Attorney Network - If you have a legal issue that is not covered by your plan, a Reduced Fee Network Attorney will provide a rate of 25% off for personal legal needs such as representation and other legal issues for most non-covered, non-excluded matters.

Reduced Contingency Fees – A Network Attorney will represent you under a contingent fee arrangement. The fee paid to the attorney is based on the success of your case and is a percentage of the amount of money rewarded. The contingent fee cannot exceed 25% of the amount awarded before or after trial, or cannot exceed 30% of the amount successfully resolved only after an appeal.

Value-Added Services Financial Planning To Enrich Your Life

Unlimited toll-free confidential telephone access to an experienced and objective financial planner for advice and

personal planning reports

Unlimited access to an interactive financial planning Web site that includes calculators, a library of content, planning

resources and more

Online financial information record keeper and financial modeling tools

Identity Theft Protection Explain what identity theft is and how to prevent it Provide you assistance from our Identity Theft Case Managers who will walk you through the recovery

process Assist you in finding available legal assistance from our network of attorneys Provide an identity theft victim action kit

Immigration Assistance If you are required to utilize the United States Immigration Process, UltimateAdvisor will help you by: Providing toll-free access to an Immigration Case Manager who can give information on the immigration

process Providing access to In-Office Network Attorneys at a reduced fee for covered matters

How To Enroll Enrolling in UltimateAdvisor is easy. Just fill out an enrollment form in your HR office and your premium is payroll deducted!

For more information on UltimateAdvisor: Visit http://members.ARAGgroup.com/sglcp to view detailed information on plan benefits, how to use the plan and

FAQs.

Talk to an ARAG Customer Care Counselor toll-free from 7 a.m. to 7 p.m. Central time, Monday through Friday at 800-247-4184.

E-mail an ARAG Customer Care Counselor at [email protected].

Insurance products are underwritten by ARAG® Insurance Company of Des Moines, Iowa or GuideOne® Mutual Insurance Company of West Des Moines, Iowa or GuideOne Specialty Mutual Insurance Of West Des Moines Iowa. Additional services may be provided by ARAG LLC, ARAG Services LLC, or Advisory Communication Systems Inc. Some products are only available through membership in the ARAG Association LC. This document is for illustrative purposes only and is not a contract. For terms, benefits or exclusions, visit our web site or call our toll-free number.

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SUPPLEMENTAL PRODUCTS

ACCIDENT

CANCER SECURITY COVERAGE

DISABILITY INCOME COVERAGE

CRITICAL ILLNESS

HOSPITAL CONFINEMENT

LIFE INSURANCE

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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.

Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.

Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.

Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance

companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates

Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period

Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.

Policies have exclusions and limitations that may affect benefits payable.

For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.

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The need for cancer insurance is very real. According to statistics, in the U.S., men have a one-in-two

lifetime risk of developing cancer, and for women the risk is one in three.* Everybody knows somebody

who has had cancer, and this disease affects all age groups.

As serious as the threat of cancer may be, new and improved treatments are being introduced, and studies

are showing that regular screening tests can detect some cancers in the early stages. But with high

technology come high costs. The American Cancer Society reports that cancer costs Americans more than

$107 billion.* And much of that amount is considered indirect or hidden costs not covered by major

medical plans.

Colonial's cancer insurance can help. It helps you deal with the financial problems that may be associated with cancer detection and treatment. Plus, your Colonial cancer policy is designed for you:

4 Levels of Coverage 3 Optional Riders

Initial Diagnosis Rider – Pays $1,000 to $5,000 Progressive Payment Rider – Builds $50 Per Month & Pays At Time of Diagnosis Specified Disease Rider – Pays Up To $125,000 During Lifetime

Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance companies. The coverage is portable; you can take it with you if you change jobs or retire. Guaranteed

Renewable. Key Features and Benefits of Colonial’s most updated cancer plan addresses the changing needs of insureds by staying abreast of changing treatment trends.

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Chances are you know someone who has faced a critical illness, so you know the physical and emotional drain such an illness can impose. But have you thought about the financial problems a critical illness can bring? Fortunately, the odds of surviving a critical illness are in your favor, but would you be prepared for the many expenses that can accompany a critical illness, such as coinsurance, deductibles, caregivers, special medical equipment, household renovations and extra living expenses? Colonial's Critical Illness insurance can help. It pays a lump-sum benefit upon diagnosis of a covered

critical illness for you to use where it’s needed most. Face amount for Employee up to $50,000 and up to

$30,000 for Spouse. Colonial pays 100 percent of the policy’s face amount for the following conditions,

unless otherwise specified:

Cancer (if purchased) Heart attack (myocardial infarction) Stroke Major organ transplant (surgery required) End stage renal (kidney) failure Coronary artery bypass surgery (payable once at 25 percent of face amount) Carcinoma in situ (payable if cancer coverage is purchased at 25 percent of policy’s face amount)

Plus, your Colonial Critical Illness policy is designed for you:

Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance companies. The coverage is portable; you can take it with you if you change jobs or retire. Compliments Major Medical coverage, pays deductibles and coinsurance; replaces lost income;

benefits can be sued for travel to any treatment center or for childcare and unexpected household expenses, etc. No survival period required.

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Your income is the financial security that helps protect your family and lifestyle. But if a serious accident or illness suddenly stopped your income, how would you get by? Do you have other sources of income? If you were unable to work, would you be able to continue covering everyday living expenses? Colonial's Short-Term Disability Insurance can help. It replaces a portion of your income if you become

disabled because of a covered illness or injury.

Elimination Period (accident/sickness) Benefit Periods 0/7, 7/7, 0/14, 14/14 3, 6, 12 and 24 months 0/30, 30/30 6, 12, and 24 months 60/60, 90/90 12 and 24 months 180/180 24 months

Plus, your Colonial Short-Term Disability policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance companies. You may choose the amount of disability benefits to meet your needs, subject to income. The coverage is portable; you can take it with you if you change jobs or retire.

The Colonial Advantage

“Your Job” definition for Total Disability. Partial Disability available if insured returns to his job or any other job working less than 20 hours per

week, after being paid disability for at least one month. Partial disability pays up to 3 months at 50% of Total Disability benefit.

Worldwide Coverage Waiver of Premium after 90 continuous days of disability. Guaranteed Renewable to age 70. Up to $5,000 in monthly benefits. An optional Health Screening Rider that pays $50/calendar year is available at an additional cost.

HELP PROTECT YOUR INCOME WITH COLONIAL’S SHORT-TERM DISABILITY INSURANCE. FIND OUT MORE WITH YOUR COLONIAL REPRESENTATIVE:

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The materials contained in this booklet do not constitute an insurance

certificate or policy. The information provided is intended only as a

summary to assist in the selection of benefits. Final determination of

benefits, exact terms, and exclusions of coverage for each benefit plan are

contained in certificates of insurance issued by the participating insurance

companies. Leon County Board of County Commissioners, Clerk of Courts,

and Supervisor of Elections reserve the right to amend, reduce, or terminate

the plans described in this booklet at any time.

The materials contained in this booklet do not constitute an insurance

certificate or policy. The information provided is intended only as a

summary to assist in the selection of benefits. Final determination of

benefit, exact terms and exclusions of coverage for each benefit plan are

contained in certificates of insurance issued by the participating insurance

companies. Leon County Board of County Commissioners, Clerk of Courts

and Supervisor of Elections reserves the right to amend, reduce or

terminate the plans described in this booklet at any time.