Plan Design

What Illnesses are covered under the plan?

PLUS:

And if child coverage is elected, includes for children:

All policies are Guarantee Issue for Employee, Spouse and Child coverage with no Pre-Existing limitation.

Employee must have coverage to elect coverage on the Spouse and/or children.

Elected coverage will reduce to 50% at age 70, but premiums do not change.

The elected lump sum benefit will be paid (up to 2x per benefit) when a covered person has received diagnosis of one of the covered illnesses and the claim is filed.

$100 will be paid annually as a Wellness Benefit when filed,  and is included on Employee & Spouse Policies for wellness checkups.  A $50 Wellness Benefit is payable for Child(ren) for Child Coverage Wellness Checkups (maximum of $300 per year for all children)

Wellness benefit Health screening tests include, but are not limited to:

• Blood test for triglycerides
• Pap smear
• Flexible sigmoidoscopy
• CEA (blood test for colon cancer)
• Bone marrow testing
• Serum cholesterol test for HDL & LDL levels
• Hemoccult stool analysis
• Serum Protein Electrophoresis (myeloma)
• Breast ultrasound
• Chest x-ray
• Mammography
• Colonoscopy
• CA 15-3 (breast cancer)
• Stress test on bicycle or treadmill
• Fasting blood glucose test
• Thermography
• PSA (prostate cancer)

Only one of the above tests needs to be completed to satisfy wellness requirement.

Voya will pay a wellness claim up to 15 months after the date of the wellness screening.

Submit your wellness benefit claim online

Review the Certificate of Coverage for exact plan details, limitations, exclusions and definitions

Definitions

Refer to the Certificate of Coverage for other details and definitions.

Alzheimer’s Disease means a clinically established diagnosis of Alzheimer’s Disease by a psychiatrist or neurologist, resulting in the inability to perform independently 2 or more of the activities of daily living.

Amyotrophic Lateral Sclerosis (ALS) means motor neuron disease, marked by progressive muscular weakness and atrophy with spasticity and hyperreflexia.

Coma means a Coma resulting from a severe traumatic brain injury that results in a continuous state of profound unconsciousness lasting for a period of 14 or more consecutive days. The condition must require intubation for respiratory assistance.

Coronary Artery Bypass means coronary artery disease that has been clinically diagnosed and requires you to undergo a surgical procedure to open a blockage of one or more coronary arteries using venous or arterial grafts. Coronary Artery Bypass does not include balloon angioplasty, placement of intravascular stent, laser relief or other like procedures.

End Stage Renal (Kidney) Failure means chronic, irreversible failure of the kidneys requiring regular hemodialysis or peritoneal dialysis (at least weekly) in order to sustain life or renal transplantation is performed. This definition includes You being placed on the UNOS (United Network for Organ Sharing) list for a renal transplant.

Heart Attack means an acute myocardial infarction (death of an area of heart muscle) that was caused by a blockage of one or more coronary arteries. The medical evidence must be consistent with the diagnosis of heart muscle death. Significant electrocardiogram (EKG) changes must be seen and one or both of the following must confirm the acute myocardial infarction (Heart Attack)

Infectious Disease means a severe infectious disease diagnosed by a Doctor or  expert in that field, that results in you being confined to a Hospital for fourteen (14) or more consecutive days. Examples include but are not limited to:
Polio, Rabies, Meningitis, Lyme’s Disease, Bovine spongiform encephalopathy (Mad Cow Disease), Flesh eating bacteria, Methicillin-resistant Staphylococcus aureus (MRSA), Sepsis, Tuberculosis, Bacterial pneumonia.

Major Organ Failure means a clinical diagnosis of a major organ failure of the liver, both lungs, pancreas, or heart, resulting in you being placed on the UNOS (United Network for Organ Sharing) list for a transplant.

Multiple Sclerosis means unequivocal diagnosis by a consultant neurologist following more than one episode of well-defined neurological symptoms and signs and confirmed by a neurological exam and MRI scan of the brain or spinal fluid analysis. Symptoms must persist for 6 months to ensure that the condition is permanent.

Parkinson’s Disease means a chronic, progressive neurodegenerative disorder characterized by any combination of four cardinal signs: rest tremor, rigidity, bradykinesia and gait disturbance. Diagnosis of Parkinson’s Disease must be made by a psychiatrist or neurologist or another Doctor trained in the diagnosis of Parkinson’s Disease.

Permanent Paralysis means total and permanent loss of the use of two or more limbs (arms or legs or combination) due to accident or sickness for a continuous period of at least 60 days. Permanent Paralysis does not include paralysis as the result of a Stroke. Diagnosis must be made by a licensed Doctor familiar with Permanent Paralysis diagnosis.

Stroke means an acute cerebral event including infarction of brain tissue, cerebral and subarachnoid hemorrhage, cerebral embolism and cerebral thrombosis. The diagnosis of Stroke shall be based on confirmatory neuroimaging studies and evidence of persistent neurological impairment confirmed by a neurologist or a Doctor familiar with the diagnosis of Stroke at least 30 days after the event.

Stroke does not include: Transient ischemic attacks (TIA), Ischemic disorders of the vestibular system, Brain injury related to trauma or infection, Brain injury associated with hypoxia/anoxia or hypotension.