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EMPLOYEE RESPONSIBILITY CALCULATOR
MEDICAL:
Choose Medical Plan and identify coverage level. Enter premium
DENTAL:
Identify coverage level. Enter cost
VISION:
Identify coverage level. Enter cost
FLEXIBLE SPENDING ACCOUNT:
Add the amount of your contributions
VOLUNTARY LIFE:
See appropriate Premium Rate Table and enter cost
VOLUNTARY STD:
See appropriate Age/Rate Table and enter cost
AFLAC:
Add the amount of your contributions provided by an AFLAC Representative
EMPLOYEE RESPONSIBILITY:
This is the amount you are responsible for and
does not take into account CPI Benefit dollars
A
+B
+C
+D
+E
+F
+G
=H
AFLAC VOLUNTARY PRODUCTS
CPI offers supplemental insurance choices through AFLAC Insurance. Although many medical costs are covered by a person’s
health insurance, these programs are designed to replace lost income, as well as out-of-pocket medical or non-medical expenses
in the event of an injury or illness (expenses such as deductibles, copays, etc.). Some of the important features:
• Cash benefits paid directly to insured.
• Pays regardless of other insurance – there’s no coordination of benefits and pre-certification is not required.
• AFLAC does not use a provider network (insured has freedom of choice).
• If you own more than one plan, AFLAC pays on all policies that apply.
• Rates are stable, and will not increase due to age, change in health, or claims filed.
• No physicals are required, but most plans are subject to health questions.
• Plans are guaranteed renewable for life (disability to age 70).
• Payroll rates may be continued when employment terminates.
Available products include: Accident, Cancer, Hospital Protector and Sickness Indemnity. During open enrollment periods or as
a new hire, you should meet individually with an AFLAC representative to elect these voluntary benefits and/or to review AFLAC
benefits you currently have.
CONTINUATION OF BENEFITS (COBRA)
Upon termination of employment for reasons other than gross misconduct, continuation of qualified benefit coverage is
available for up to 18 months under COBRA (Consolidated Omnibus Budget Reconciliation Act) with the employee assuming all
premium costs. If the employee is disabled, COBRA eligibility is increased to 29 months. Continuation of qualified benefits are
also available for “qualified beneficiaries” up to 36 months when one of the following qualifying events occurs:
• Death of a covered employee
• Divorce or legal separation
• Employee becomes eligible for Medicare
• Dependent child reaches maximum age allowed under group plan
Qualified beneficiaries are those individuals who were covered under the group plan on the day before the qualifying life event;
this could include the employee’s spouse and/or dependent child(ren).
Please note: there are 24 pay periods with benefit deductions.