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July 1, 2020June 30, 2021BenefitsEnrollmentGuidePOLKCOUNTY GEORGIA

ShawHankins Acquired by NFPOur benefits broker, ShawHankins, was recently acquired by NFP. NFP is an insuranceindustry leader with more than 5,000 employees and 250 offices across the United States.As one of the largest benefits brokers in the nation, NFP provides their clients with best-inclass products and services. With this acquisition, the ShawHankins name has officially changeto NFP. You will see this new name and branding on your benefit materials. While thecompany name will change, exceptional service remains the priority for theShawHankins/NFP team. The service team, enrollment portal, contact numbers and officelocations has not change. However, they have even greater ability to effectively serveyou. Please contact ShawHankins/NFP with any questions. 800-994-7429Welcome to your new Benefits Enrollment Guide. This guide is your summary of the benefitoptions that are available to eligible employees of the Polk County Board of Commissioners.Each benefit is designed to protect your health and well-being as well as provide valuablefinancial protection.Each section of the Benefits Enrollment Guide is structured to provide you with planhighlights as well as detailed, descriptive instructions to assist you in navigating through theweb-based enrollment portal.While the Benefits Enrollment Guide is an important component in the benefitcommunication process, your dedicated NFP service team continues to provide annualenrollment meetings in addition to being available for questions and concerns regardingbenefits throughout the plan year.Please review the plans contained in the Benefits Enrollment Guide and see how these planscan work for you and your eligible dependents. Your participation in the plans is voluntary.The benefit plans have been chosen to provide a continuation of protection thatcomplements the Polk County Board of Commissioner’s leave policies and retirement plans.The plan year is in effective from July 1, 2020 through June 30, 2021.This Benefits Enrollment Guide is intended for orientation purposes only. It is an abbreviatedoverview of the plan documents. Please refer to the Certificate Booklet (the contract)available from the plan carriers for complete details. Your Certificate Booklet will providedetailed information regarding copayments, coinsurance, deductibles, exclusions and otherbenefits. The certificate booklet will govern should a conflict arise relating to the informationcontained in this summary. This summary does not establish eligibility to participate in orreceive benefits from any benefit plan.NOTICE: If you (and/or your dependents) have Medicare or will becomeeligible for Medicare in the next 12 months, a Federal law gives youmore choices about your prescription drug coverage. Please see page 25for more details.

Table of ContentsTopicPageNew for You and Eligibility4Before you Enroll5How to Enroll6Medical Plan7Wellness Information11Health Reimbursement Arrangement12Dental Plans14Vision Plan16Flexible Spending Account17Basic and Voluntary Life19Short Term Disability21Long Term Disability22Telemedicine23Disclosure Notices25Contacts32This guide describes the benefit plans available to you as an eligible Employee of Polk County Board ofCommissioners. The details of these plans are contained in the official Plan Documents, including some insurancecontracts. This guide is meant only to cover the major points of each plan. It does not contain all the details thatare included in your Summary Plan Descriptions (SPD) (as described by the Employee Retirement Income SecurityAct).If there is ever a question about one of these plans, or if there is a conflict between the information in this guideand the formal language of the Plan Documents, the formal wording in the Plan Documents will govern.Please note the benefits described in this guide may be changed at any time and do not represent a contractualobligation on the part of Polk County Board of Commissioners or NFP.3

New for You / EligibilityNew for 2020-2021 Medical plan will remain with Anthem. The dental plan will be moving to Anthem. The vision plan will continue with Anthem. The telemedicine plan will remain with NewBenefits. The life and disability will remain with UNUM. Please check coverages and rates.EligibilityActive Full Time Employees of Polk County Board of CommissionersEligible dependents are classified as: Your legal spouse who resides in the United States Biological children, Foster child(ren), Step-child(ren) up to age 26 on the medical, dentaland vision. On the life insurance children are covered to age 19 or age 26 if they are afull-time student.Making Changes to Your BenefitsTo make benefit changes as a result of your Life Status Change or Family Status Change asallowed under Section 125 of the Internal Revenue Code, you must:1) Notify Human Resources or NFP within 30 days of the date of the qualifying event.2) Provide proof of your status change event.3) Submit the documentation regarding the event.The Most Common Status Changes: Marriage, divorce, legal separation Birth or adoption Change in your or your spouse’s work status that affects your benefits or an eligibledependent’s benefits Change in health coverage due to your spouse’s annual Open Enrollment period Change in dependent eligibility status Change in eligibility for you or a dependent for Medicaid or Medicare Receipt of a Qualified Medical Child Support Order, or other court order Death of your spouse or covered child4

Before You Enroll – Things to KnowYou are REQUIRED to provide the information and documentation listed below for alldependents and beneficiaries: Name Date of birth Social Security numberHOW TO ENROLLGo to www.polkcountyboc.bswift.com.At this time, make sure to disable your pop-up blocker.At the enrollment website enter your Username and Password. Username is the first letter of your first name, your last name, and the last four digitsof your Social Security number (ex. jdoe0123). Password is the last 4 digits of your Social Security number (ex. 4567).You will then be prompted to create a permanent password. Please go online and make your elections during the Open Enrollment or New HireOrientation period by the deadline provided. Please contact NFP at 800-994-7429 to speak with a benefits consultant if you needassistance with your enrollment.Failure to enroll within the enrollment time period will result in the forfeiture of youreligibility for enrollment until the next annual enrollment period unless you experiencean eligible qualifying event.OPEN ENROLLMENT DEADLINE FOR 2020/2021 BENEFITS is June 4, 2020 at 5:00 p.m.5

How To EnrollTo Begin:1) From the “Home Page” click on the “Enroll Now” link, to begin the election process.2) On the “Personal & Family Page”, verify your information is accurate and “Add” alleligible dependents you wish to cover under any benefits.3) To make a plan selection, select the button beside the newly elected plan. If you arecovering dependents, make sure to “Select” them by checking off next to their nameunder “Select who to cover with this plan.” Then press “Next” at the bottom of thescreen.4) Once you have reviewed and completed your enrollment, click on “I Agree and I amfinished with my enrollment”, then click on “Save My Enrollment”.5) You will now be taken to the final confirmation page to either print or email.Note: The enrollment images within this guide are for illustrative purposes only.6

Base Medical PlanThis plan is provided through Anthem. Please call 855-397-9267 or go online towww.anthem.com to locate a provider in the network. You must select a Primary CarePhysician to coordinate all of your care and obtain referrals to see a specialist.Covered BenefitsIn-Network 5,000 Individual 10,000 FamilyCalendar Year DeductibleCoinsurance80%Lifetime MaximumUnlimitedOut-of-Pocket Calendar Year Maximum(Includes Deductible) 7,150 Individual 14,300 FamilyPrimary Care- 45 copaySpecialist- 50 copay(Referral Required)Office Visits:Preventive Care100%Inpatient Hospital20% After DeductibleOutpatient Hospital20% After DeductibleUrgent Care 60 copayEmergency Room 300 copayAmbulance ServicesMember pays 0%, not subject to deductibleLab, X-ray and Diagnostics20% After DeductibleInpatient-20% After DeductibleOutpatient Office Visit- 45 copay per visitMental Health ServicesTherapy ServicesPhysical and Occupational Therapy(20-visit max combined benefit per year)Speech Therapy (20 visit maximum)Chiropractic Care (20 visit maximum)PrescriptionsTier 1-Retail/Mail OrderTier 2-Retail/Mail OrderTier 3-Retail Mail OrderTier 4-Specialty Drugs-Retail 50 copayment 50 copayment 15 copayment 300 Calendar Year Deductible per member 15/ 30 30/ 60 60/NA20% to a maximum of 3007

Buy Up Medical PlanThis plan is provided through Anthem. Please call 855-397-9267 or go online towww.anthem.com to locate a provider in the network. You must select a Primary CarePhysician to coordinate all your care and obtain referrals to see a specialist.Covered BenefitsIn-Network 5,000 Individual 10,000 FamilyCalendar Year DeductibleCoinsurance90%Lifetime MaximumUnlimitedOut-of-Pocket Calendar Year Maximum(Includes Deductible) 7,150 Individual 14,300 FamilyPrimary Care- 35 copaySpecialist- 40 copay(Referral Required)Office Visits:Preventive Care100%Inpatient Hospital10% After DeductibleOutpatient Hospital10% After DeductibleUrgent Care 60 copayEmergency Room 300 copayAmbulance ServicesMember pays 0%, not subject to deductibleLab, X-ray and Diagnostics10% After DeductibleInpatient-10% After DeductibleOutpatient Office Visit- 35 copay per visitMental Health ServicesTherapy ServicesPhysical and Occupational Therapy(20-visit maximum combined)Speech Therapy (20 visit maximum)Chiropractic Care (20 visit maximum)PrescriptionsTier 1-Retail/Mail OrderTier 2-Retail/Mail OrderTier 3-Retail Mail OrderTier 4-Specialty Drugs-Retail 40 copayment 40 copayment 15 copayment 200 Calendar Year Deductible per member 15/ 30 30/ 60 60/NA20% to a maximum of 3008

Gatekeeper POS Medical PlanThis plan is provided through Anthem. Please call 855-397-9267 or go online to www.anthem.comto locate a provider in the network. You must select a Primary Care Physician to coordinate all yourcare and obtain referrals to see a specialist.Covered BenefitsIn-NetworkOut-of-Network 5,000 Individual 10,000 Family 5,000 Individual 10,000 Family100%60%UnlimitedUnlimited 7,150 Individual 14,300 Family 21,450 Individual 42,900 FamilyPrimary Care- 30 copaySpecialist- 35 copay(Referral Required)40% After Deductible100%40% After DeductibleInpatient ServicesDeductible40% After DeductibleOutpatient Services 200 copay40% After DeductibleUrgent Care 60 copay 60 copay 40%After DeductibleEmergency Room 300 copay 300 copayMember pays 0%,not subject to deductibleMember pays 0%, notsubject to deductibleDeductible40% After DeductibleCalendar Year DeductibleCoinsuranceLifetime MaximumOut-of-Pocket Calendar YearMaximum (IncludesDeductible)Office Visits:Preventive CareAmbulance ServicesLab, X-ray and DiagnosticsMental Health ServicesInpatient- DeductibleOutpatient Office Visit- 30 copay pervisit40% After DeductibleTherapy Services:Physical and OccupationalTherapy (20 visit maximumcombined)Speech Therapy (20 visitmaximum)Chiropractic Care (20 visitmaximum)PrescriptionsTier 1 Retail/Mail OrderTier 2 Retail/Mail OrderTier 3 Retail/Mail OrderTier 4-Specialty Drugs Retail 35 copay 35 copay 15 copay 100 Calendar Year Deductibleper member 15/ 60 30/ 60 60/NA20% to a maximum of 300940% After Deductible

Medical Plan InformationPrescription Drugs – To search for drugs on this list, visithttps://www11.anthem.com/pharmacyinformation/ and select the Essential Drug List.If a member received a brand name drug that falls on Tier 2 or Tier 3 that has a genericequivalent available, the member pays the Tier 1 copay, plus the difference in the cost betweenthe brand drug and generic drug.Preferred Network – Many doctors have more than one office. However, not all the doctors’offices may be in our network. If you don’t see an office on this list, the doctor may not be innetwork for that location. If you have any questions, call Blue Cross Blue Shield for networkdetails. If you need a mental health doctor, please call 855-397-9267.Coinsurance – Your share of the cost of a covered service, calculated as a percentage of theallowed amount for the service.Allowed Amount – The amount the plan pays for covered services is based on the allowedamount. If an out of network provider charges more than the allowed amount, you may have topay the difference.Out-of-Pocket Limit – This is the most you could pay during a coverage period (usually oneyear) for your share of the cost of covered services. This limit helps you plan for your healthcare expenses.Deductible – You must pay all the costs up to the deductible amount before this plan begins topay for covered services you use. The deductible is separate for prescription drugs and does notapply to in network preventive services. Coinsurance and copayments do not count towards thedeductible.Wellness Participation Medical Costs Per Pay PeriodBase HMOMedicalBuy Up HMO MedicalPOS PlanEmployee 34.87 57.45 66.64Employee Spouse 117.70 163.56 177.75Employee Child(ren) 111.69 155.21 168.69Family 158.28 216.73 235.55Payroll DeductionNon-Wellness Participation Medical Costs Per Pay PeriodBase HMOMedicalBuy Up HMO MedicalPOS PlanEmployee 59.87 82.45 91.64Employee Spouse 147.70 193.56 207.75Employee Child(ren) 141.69 185.21 198.69Family 193.28 251.73 270.55Payroll Deduction10

Anthem Wellness InformationWellness IncentivesEligible members include employees, spouses, and covered dependents age 18 and older.Health RewardsEarn rewards by participating in employer-sponsored health and wellness programs. When you completeyour first healthy activity, you will get the Health Rewards card. It is a reloadable card you can useanywhere major credit cards are accepted. As you earn more rewards, they will be automaticallydeposited into your rewards account and available to spend using your Health rewards Card.To register: 1. Log in at anthem.com. 2. Once you are logged in, go to the Health and Wellness section.3. Select Get My Rewards.Earn 50 by completing the Health Assessment.Earn 50 by confirming you are tobacco free (you will need to complete the online certification.Earn 100 by getting an annual wellness exam and flu shot.24/7 NurseLine – Access trained registered nurses any time of the day or night at 800-337-4770.LiveHealth Online – Quick and easy access to a doctor 24/7Have you ever been at work and didn’t feel well? Maybe you had a fever or a sore throat, but you didn’thave time to leave and see your doctor or go to urgent care. Now, with LiveHealth Online, you can see aboard-certified doctor in minutes.Just use your smartphone, tablet or computer with a webcam. It’s so convenient, almost 90% of peoplewho’ve used it feel they saved two hours or more and would use it again in the future. Plus, online visitsusing LiveHealth Online are already part of your Anthem benefits. To start using LiveHealth Online, allyou need to do is sign up at livehealthonline.com or download the app.Sign up for free today and get:1. 24/7 access to doctors. They can assess your condition, provide treatment options and even send aprescription to the pharmacy of your choice, if needed. It’s a great way toget care when yourdoctor isn’t available.2. Medical care when you need it. For things like the flu, a cold, sinus infection, pink eye, rashes, feverand more.3. Convenience. Since there are no appointments or long waits. In fact, most people are connected to adoctor in about 10 minutes or less.Doctors using LiveHealth Online typically charge 49 or less per visit, depending on your health plan.Future Moms ProgramYou can call to speak to a nurse specializing in obstetrics at 800-828-5891 who can answer yourquestions 24/7 and can check your progress.ConditionCareIf you have asthma, diabetes, COPD, heart disease or heart failure, ConditionCare can give you the toolsand resources you need to take charge of your health 24/7. To access the service, call 866-962-0952.11

Health Reimbursement ArrangementThe Health Reimbursement Arrangement (HRA) will be administered by TASC. An HRA is atax-advantaged benefit that allows you to save on the cost of healthcare and have morechoice in your healthcare planning.HRA plans are employer-funded medical reimbursement plans. Polk County sets aside aspecific amount of pre-tax dollars on an annual basis for employees to pay for healthcareexpenses (as defined by your Plan). These contributed funds are available to you tax-free!Employees do not contribute to the HRA Plan.At your open enrollment meeting this year, it was explained that Polk County Board ofCommissioners is actively participating in a Health Reimbursement Arrangement.Polk County Board of Commissioners will reimburse the last 3,500 of the In-Networkdeductible for each eligible family member, for a maximum of 7,000 per covered family.Your HRA is used to cover part of your deductible. You will need to obtain an Explanationof Benefits (EOB) form from your insurance company (this may take a couple of weeks oryou may have access to these online). You will then fax, mail, or upload online your EOBwith your personalized HRA Claim Form to TASC. This assures that you pay the lowernegotiated rate established by your insurance company. You will be reimbursed directlyand need to pay your medical provider. TASC will not pay your medical provider directly.Reimbursement ProcessYou may request reimbursement any time a qualifying expense has been incurred. Theservice related to the expense needs only to have taken place, it need not be paid beforerequesting reimbursement. Simply submit a Request for Reimbursement form along with therequired substantiation to TASC (via online form, fax or mail) for timely processing.Qualified reimbursements are limited to the following: Eligible expenses must be incurred during the Plan Year and pursuant to the Plan Design Eligible Plan Participants must incur the expense; and Expenses must not be previously reimbursed under this or any other benefit Plan orclaimed as an income tax deduction.Once a request is reviewed and approved by TASC, a reimbursement check will be maileddirectly to your home address or processed through your bank (if you elect Direct Deposit).The Plan Contribution limit will be factored in.Run Out Period - The three months following the end of the Plan Year are called the runoutperiod. During this time, you may submit Requests for Reimbursement for expenses fromthe previous Plan Year if you have a positive balance. The plan year runs January 1st toDecember 31st.12

Health Reimbursement ArrangementClaims Submission is efficient and hassle free.Online Request for Reimbursement Instructions.Follow these easy steps:Log in to your online HRA account at www.tasconline.com using your username andpassword. On the left navigation, click File A Claim.1. Select the account to pay from and payee and click Next.2. Click Upload Valid Documentation, click Browse, attach your claim documentation, andclick Submit. You may click View Receipts to verify the correct document wasuploaded. Click Next to complete the upload process.IMPORTANT: Claims submitted without substantiation are not processed untilsubstantiation is received.3. Enter the service start and service end date.NOTE: Each claim line item must be individually entered. Multiple claims submittedas one claim will be denied.4. Enter the claim amount.NOTE: This is the amount that is eligible for reimbursement from the Plan. This is notthe total amount of the claim billed to the insurance carrier.5. Enter the Provider.6. Choose the service Category code and Type from the dropdown lists.7. Enter a Description (this is required for a category of Other or Over-the-Counter).8. Select the Recipient (the person that received the service). If the correct recipient isnot listed, contact your employer to add eligible dependents.9. At this point, you may edit the claim submitted by selecting Update. You may also addanother claim by selecting Add Another and select Submit when finished.10. Upon submission of claims, a confirmation screen will display with the submitted claiminformation.You can also view your Account Summary by clicking on the Accounts tab.If you have issues logging into your account , please contact TASC at (800) 422-4661.NOTE: All Participants are obligated to maintain up-to-date contact information in theironline account; this includes email and mailing addresses, and phone numbers. TASCperiodically sends important Plan notifications (regarding balances, deadlines, and/or PlanChanges). We are not responsible for any consequences resulting from communications notreceived during due to inaccurate contact information.13

Dental PlanThis plan is provided by Anthem. Please call 855-397-9267 or go online to www.anthem.com tolocate a provider in the network.BenefitsBase PlanBuy Up PlanDiagnostic and Preventive (Type 1)Oral evaluationsTeeth cleaning (prophylaxis)Bitewing X-raysIntraoral X-rays100%100%Basic Care (Type 2):Amalgam (silver-colored) FillingFront composite (tooth-colored) FillingBack composite Filling, Covered as CompositesSimple Extractions80%80%Major Services (Type 3):Endodontics (root canal)Periodontics (scaling and root planing)Oral Surgery (surgical extractions)CrownsDenturesBridgesProsthetic Repairs/AdjustmentsNot covered50%Orthodontia (Adult and Child Coverage)Not Covered50%Deductible Amount Per Calendar Year(Deductible applies to all benefits except Diagnostic &Preventive Services and Orthodontic Services) 50 PerIndividual 150 FamilyMax 50 PerIndividual 150 FamilyMax 1,000 1,500NA 1,500 250 350 1,000 1,500Standard Dental Annual Maximum Per EnrolleeOrthodontia Lifetime Maximum Per EnrolleeAnnual Roll-OverMaximum Roll-OverCoverage TierBase PlanBuy Up PlanEmployee Only 7.76 13.90Employee Spouse 16.45 28.21Employee Child(ren) 21.41 33.87Family 29.55 48.1614

Vision Plan InformationVision is provided through Anthem. Please call 855-397-9267 or go online to www.anthem.comto locate a provider in the network.In NetworkOut ofFrequencyBenefitMember CostNetworkRoutine ExamExam with dilation, as necessaryRetinal ImagingContact lens exam(fitting and evaluation)Frames 10 copayUp to 39Up to 42Not coveredUp to 55 forStandard, 10% forpremiumNot CoveredUp to 130, 20% offbalance over 130Up to 45Once everycalendar year 25 25 25Up to 40Up to 60Up to 80Once everycalendarUp to 130 then15% offUp to 105Once everycalendar yearStandard Plastic LensesSingleLined BifocalLined TrifocalContact Lenses(instead of glasses)Once everycalendar yearThis plan covers lenses for your glasses or contact lenses once every 12 months.Savings on items like additional eyewear after your benefits have been used, non-prescription sunglasses,hearing aids and even LASIK laser vision correction surgery are available through a variety of vendors.Just log in at anthem.com, select discounts, then Vision, Hearing & Dental.Some of Anthem’s in-network providers include:Coverage TierPayroll CostEmployee 3.60Employee Spouse 5.76Employee Child(ren) 6.04Family 9.4815

Flexible Spending AccountThis benefit is provided through TASC. (Not offered to new hires.)Advantages of a Flexible Spending Account (FSA) - A valuable pre-tax benefit with innovativeservices!FlexSystem FSA increases your take-home pay by reducing your taxable income. A FlexibleSpending Account (FSA) allows you to save up to 30% on your eligible healthcare expenses everyyear by using pre-tax dollars.Consider how much you spend on healthcare expenses for you and your qualified dependents inone year. Prescription drugs/medications Vaccinations Medical/dental office visit co-pays Eye exams and prescription glasses/lensesWhy not reduce these expenses by using pre-tax dollars instead of after-tax dollars? With risinghealthcare costs, every penny counts! By using pre-tax dollars, you are taxed on a lower grosssalary, thereby saving money that would otherwise be spent on federal, state and FICA taxes, andthereby you increase your take home pay!Employee salary reductions to a medical Flexible Spending Account (FSA) are limited to 2,000 perPlan Year, indexed for inflation. Check with your employer for your Plan’s maximum annualelection amount.Putting money in an FSA is smart and safe! If you have medical FSA funds leftover at the end of thePlan Year and your employer has elected Carryover, you may carryover up to 500 from year toyear with no cost or penalty.Pre-Tax Savings ExampleHow FlexSystem WorksFlexSystem FSA is offered through youremployer and is administered by TASC.When you choose to enroll in aFlexSystem FSA Healthcare, you choosethe dollar amount you want tocontribute to each account based onyour estimated expenses for theupcomingPlanYear.Yourcontributions will be deducted in equalamounts from each paycheck, pre-tax,throughout the Plan Year. The moreyou contribute to these accounts, themore you save by paying less in taxes!Your total Healthcare FSA annualcontribution amount is availableimmediately at the start of the PlanYear.WithoutFSAWithFSA 3,500 3,500Medical/Dental Premiums 0- 125Medical Expenses 0- 75Dependent Care Expenses 0- 400TOTAL: 0- 600Taxable Monthly Income 3,500 2,900Taxes (federal, state, FICA):- 968- 802Out-of-pocket Expenses:- 600 0Monthly Take-home Pay: 1,932 2,098Gross Monthly Pay:Pre-Tax ContributionsNet Increase in Take-Home Pay 166/mo!For illustration only. Actual dollar amounts may vary.16

Flexible Spending AccountReimbursements and the TASC CardAs you incur eligible expenses, simply swipe your TASC Card. The card automatically pays forand substantiates most eligible expenses at the point of purchase. If you do not use the TASCCard to pay for an eligible expense, simply submit a request for reimbursement via theMyTASC Mobile App, online Request for Reimbursement form in MyTASC, text message, fax,or mail.Your reimbursement is deposited in your MyCash account. You can access your MyCashfunds in three ways: (1) swipe your TASC Card at any merchant that accepts major creditcards, (2) withdraw at an ATM using your TASC Card (with PIN), or (3) transfer to a personalbank account from MyTASC.The Flexible Spending Account is provided through TASC/FlexSystem. This plan offers you achoice to contribute pre-tax dollars to pay for certain qualified benefits.You must make a new election for the FSA plan every year. Your current election does notcontinue from year to year.You will be able to roll over up to 500 of unused funds in your Healthcare ReimbursementFSA account to be used for the next plan year. However, it is still important to beconservative in making elections because any unused funds over the 500 threshold left inyour FSA at the close of the plan year are not refundable to you. At the end of the Plan Year,you may allow a Carryover (up to 500) during which participants may carry over a portion oftheir unused medical FSA balance to the next Plan year.At the Plan Year Run Out Period (October 1, 2020), your Roll Over funds will be available foruse for the 2020/2021 plan year.Maximum Annual ContributionPlease see the annual maximum contribution you may be eligible to elect under theFlexible Spending Account.Healthcare Reimbursement: 2,000Available during open enrollment only*Minimum annual contribution is 50 per year.TASC 2302 International Lane Madison, WI 53704-3140 800-422-4661Fax: 608-245-3623 www.tasconline.comFX-4245-09051417

Basic and Voluntary Life InsurancePROVIDED THROUGH UNUMTerm Life Insurance provides valuable financial protection for your family. Polk CountyBoard of Commissioners is pleased to offer 20,000 for all Full Time Employees and 20,000 for Retirees. If you cover your spouse and/or child on the Medical, then you alsoreceive Group Dependent Life at 2,000 for Spouse and 1,000 for eligible Child(ren). Thisis paid for by Polk County Board of Commissioners.You are eligible to enroll in the Voluntary Term Life and AD&D Insurance programunderwritten by UNUM.This enrollment period is an annual opportunity to increase coverage or elect life insurance ifyou do not already have coverage. Your premium will be based on the coverage amount youelect and your age. Premiums will be paid through the convenience of payroll deduction.If you are currently enrolled in the voluntary term life with UNUM, your coverage willautomatically rollover unless you complete a new application changing the coverage.BenefitCoverageYou can purchase coverage in increments of 10,000 up tothe lesser of 500,000- or 5-times Annual Salary.Employee Voluntary Life &AD&DNew Hires: You will have a guarantee issue amount of 150,000- or 5-times Annual Salary.*Late Entrants are subject to Evidence of InsurabilityYou can purchase coverage in increments of 5,000 up to amaximum of 250,000, not to exceed 100% of employee’scoverage.Spouse Voluntary Life &AD&DNew Hires: Spouse will have guarantee issue amount of 25,000*Late Entrants are subject to Evidence of InsurabilityChild(ren) Voluntary Life &AD&DYou can purchase coverage in increments of 2,000 up to amaximum of 10,000 for eligible child(ren) not to exceed100% of employee’s coverage.Child(ren) are covered to age 26.*Late Entrants are subject to Evidence of Insurability* If you do not elect coverage when initially eligible and later elect coverage, you will beconsidered a late entrant. Late entrants will be required to complete an Evidence ofInsurability (EOI) form that is satisfactory to the insurance carrier before the coverage canbecome effective. Additionally, coverage amounts elected over the Guarantee Issueamounts will require EOI that is satisfactory to the insurance carrier before the excess canbecome effecti

Active Full Time Employees of Polk County Board of Commissioners Eligible dependents are classified as: Your legal spouse who resides in the United States Biological children, Foster child(ren), Step-child(ren) up to age 26 on the medical, dental and vision. On the life insurance