2023 Employee Benefits Booklet - JEFFERSON COUNTY PUBLIC SCHOOLS - JCPS
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JEFFERSON COUNTY
PUBLIC SCHOOLS
2023 Employee Axel Halvarson
Creative Employee Benefits
Benefits Booklet
13117 Eastpoint Park Blvd Site C,
Louisville, KY 40223
Cell: 502-500-6290 Office 502-238-7255
Contents
Welcome Letter............................................................................................................. 3
Disability Insurance....................................................................................................... 4
Cancer Insurance..........................................................................................................10
Accident Insurance.......................................................................................................19
Critical Illness Insurance.............................................................................................. 26
Hospital Confinement Indemnity Insurance................................................................. 31
Policyholder Service Guide ......................................................................................... 38
2
Dear JCPS Employee:
Welcome to the Open Enrollment from Creative Employee Benefits, your local Colonial Life Insurance Team.
Our team has been working with Jefferson County Public Schools for more than 30 years. We take great pride
in working with the JCPS family, and we would like to provide the same benefits to your family as we do for
our own.
You are encouraged to meet with a Colonial Life benefits counselor to discuss your benefits package and
to learn more about voluntary insurance products during the enrollment. You may contact Axel Halvarson
at 502-500-6290 to schedule a 1-to-1 benefits counseling session. If you are unable to meet 1-to1 with
your benefits counselor, you may call Colonial Life at 1-502-238-7255 between 9 a.m. and 5 p.m. to discuss
additional enrollment opportunities.
All products being offered:
• Pay regardless of insurance coverage you may have with another insurance company.
• Pay the insured unless you request otherwise.
• Are portable should you leave your job.
The following insurance plans will be offered during your open enrollment.
Disability Insurance replaces a portion of your income to help make ends meet if you are disabled due to
a covered accident or covered sickness. 60% of salary up to maximum of $6,500, subject to underwriting.
Guaranteed Issue up to $4,000 for 2023.
Cancer Insurance helps offset the out-of-pocket medical and indirect, non-medical expenses related to
cancer that
most medical plans don’t cover. This coverage also provides a benefit for specified cancer-screening tests.
Accident Insurance helps offset the unexpected medical expenses – such as emergency room fees,
deductibles and
co-payments – that can result from a covered accident.
Critical Illness Insurance complements your major medical coverage by providing a lump-sum benefit that
you can use to pay the direct and indirect costs related to a covered critical illness, which can often be
expensive and lengthy. Guarantee Issue may apply up to $20,000.
Hospital Confinement Indemnity Insurance is designed to help you with the rising costs associated with a
covered hospital confinement. Guarantee Issue may apply for new hires up to $1,500.
We encourage you to take some time reviewing the enclosed product information to see where Colonial Life
can help you fill your insurance gaps.
We look forward to working with you in the near future. Please contact us at 502-500-6290 or 502-238-7255
to determine a time that would be best for you.
Sincerely yours,
Creative Employee Benefits
Contact Information:
Axel Halvarson
502-500-6290
Colonial Life
Account Executive
3
Core Benefits - Medical
Disability Insurance
Disability Insurance
4
Individual Short-Term Disability Insurance
You never know when a disability could impact your way of life. Fortunately,
there’s a way to help protect your income. If a covered accident or sickness
prevents you from earning a paycheck, disability insurance can provide a
monthly benefit to help you cover your ongoing expenses.
Can you afford to not protect your income?
You don’t have the same lifestyle expenses as the next person. That’s why you need
disability coverage that can be customized to fit your specific needs.
After calculating your monthly expenses, your benefits counselor can help you
complete the benefits worksheet.
Round to the
MONTHLY EXPENSES
nearest hundred
Rent or mortgage (insurance, minor home repairs) $
Transportation (gas, car, bus, car maintenance and insurance) $
Utilities (cell phone, Wi-Fi, electricity/gas, water) $
Food and household necessities (toiletries, cleaning supplies) $
ColonialLife.com Childcare (daycare, after school care) $
Health (medical needs and prescription drugs) $
Other (gym/fitness, streaming/cable, extracurricular) $
Total monthly expenses (add lines 1–7 together) $
Benefits worksheet
How much coverage do I need?
Monthly benefit amount for off-job accident and off-job sickness: ______________
Choose a monthly benefit amount between $400 and $6,500.*
If your plan includes on-job accident/sickness benefits, the benefit is 50% of the off-job amount.
How long may I receive benefits?
Benefit period: _______ months
The partial disability benefit period is three months.
When may my total disability benefits start?
After an accident: _______ days After a sickness: _______ days
*Subject to income requirements
ISTD3000 BASE
5
Product information
Total disability definition
Totally disabled or total disability means you are: unable to perform the material
and substantial duties of your job, not working at any job, and under the regular
and appropriate care of a physician.
How partial disability works
If you are able to return to work part time after at least 14 days of being paid for a
total disability, you may be able to still receive 50% of your total disability benefit.
Waiver of premium
We will waive your premium payments after 90 consecutive days of a
covered disability.
Geographical limitations
If you are disabled while outside of the United States, Canada or Mexico, you may
receive benefits for up to 60 days before you have to return to the U.S. in order to
continue receiving benefits.
Issue age
Coverage is available from ages 17 to 74.
Keep your coverage
You can keep your coverage to age 75 at no additional cost, even if you change
jobs, as long as you pay your premiums when they are due.
For more information, talk with your benefits counselor.
EXCLUSIONS AND LIMITATIONS
We will not pay benefits for losses that are caused by, contributed to by or occur as the result of: cosmetic surgery,
felonies or illegal occupations, flying, hazardous avocations, intoxicants, narcotics and hallucinogenics, psychiatric or
psychological conditions, racing, semi-professional or professional sports, suicide or injuries which you intentionally
do to yourself, war or armed conflict. We will not pay for losses due to you giving birth within the first nine months
after the coverage effective date of the policy. We will not pay for loss when the disability is a pre-existing condition as
described in the policy.
Pre-existing condition means a sickness or physical condition, whether diagnosed or not, for which you were treated,
had medical testing, or received medical advice within 12 months before the policy coverage effective date shown on the
policy schedule.
After this policy has been in force for 12 months from the policy coverage effective date shown on the policy schedule, we
will pay benefits for any pre-existing condition not excluded by name or specific description if the covered disability began at
least 12 months after the policy coverage effective date and the elimination period has been satisfied.
This information is not intended to be a complete description of the insurance coverage available. The policy or its
provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any
benefits payable. Applicable to policy form ISTD3000-KY and rider form ISTD3000-ADIB-KY. For cost and complete details
of the coverage, call or write your Colonial Life benefits counselor or the company.
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 3-22 | 101629-5-KY
6
Individual Short-Term Disability Insurance
First Day Hospital Benefit
If a disability sent you to the hospital, you would want to get the best
treatment possible. But with hospital costs increasing nearly every year,
paying your bills could be a concern. Even with health insurance, you
could still have out-of-pocket expenses.
The first day hospital benefit from Colonial Life enables you to receive your
disability benefits the first day you are admitted to a hospital. You can use your
benefits to help pay for your medical bills or any other expenses you choose.
How it works
Waiver of elimination period from the first day of hospital confinement
If you select a plan with an elimination period of 30 days or less, you’ll begin
receiving disability benefits from the first day you are confined to a hospital for
For more information,
a total disability due to a covered accident or covered sickness.
talk with your
benefits counselor. Disability benefits will continue even after you are discharged, as long as you
continue to have a covered disability.
Confinement means you are admitted to a hospital and confined as a resident inpatient
(including intensive care) on the advice of a physician.
ColonialLife.com
This information is not intended to be a complete description of the insurance coverage available. The insurance or its
provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any
benefits payable. Applicable to policy form ISTD3000 and rider form ISTD3000-ADIB (including state abbreviations where
used, for example: ISTD3000-TX and ISTD3000-ADIB-TX). For cost and complete details of coverage, call or write your
Colonial Life benefits counselor or the company.
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
ISTD3000 – FIRST DAY HOSPITAL BENEFIT | 9-21 | 101631-3
7
Individual Short-Term Disability Insurance
Psychiatric and Psychological Benefit
Although illnesses and accidents are often associated with disabilities,
mental disorders can also leave you unable to earn an income.
If you’re disabled with a covered mental or nervous condition, disability insurance
from Colonial Life & Accident Insurance Company offers a monthly benefit that can
help provide financial support while you focus on recovery.
Psychiatric and psychological benefit
There is a maximum six-month benefit period limitation for any one
occurrence of a psychiatric or psychological condition. There is a
three-month benefit period limitation if you have a three-month
benefit period.
There is a 24-month cumulative lifetime maximum benefit period
for all psychiatric or psychological conditions. This maximum includes
For more information, a combination of total disability and partial disability occurrences.
talk with your
benefits counselor.
ColonialLife.com
The psychiatric and psychological benefit is only applicable when combined with the ISTD3000 base policy. The exclusions
listed on the ISTD3000 base policy apply, except for the psychiatric or psychological conditions exclusion. For cost and
complete details, talk with your Colonial Life benefits counselor. Applicable to policy form ISTD3000 and rider form
ISTD3000-ADIB (plus state abbreviations where applicable, for example: ISTD3000-TX and ISTD3000-ADIB-TX). Coverage
may vary by state and may not be available in all states. This is not an insurance contract and only the actual policy and
rider provisions will control.
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
ISTD3000 – PSYCHIATRIC AND PSYCHOLOGICAL BENEFIT | 2-20 | 101630-3
8
Jefferson CountyPublic
Jefferson County Public Schools
Schools
3332 NewburgRdRd
3332 Newburg
Louisville, KY
Louisville, KY40218
40218
(502) 485-3011
(502) 485-3011
Deductions per year: 24 These rates were prepared on 6/24/2022 and are valid for 90 days.
Deductions per year: 24 These rates were prepared on 6/24/2022 and are valid for 90 days.
Individual Disability
Individual Disability - ISTD3000
- ISTD3000 for KY forAAAKYRiskAAA
Class
Risk Class Applicable to policy form Individual Disability
l On/Off Job Accident and On/Off Job Sickness with First Day Hospital and Psychiatric and Psychological Condition Applicable to policy form Individual Disability
l On/Off
3 MonthJob Accident
Benefit Period and On/Off Job Sickness with First Day Hospital and Psychiatric and Psychological Condition
3ELIMINATION
Month Benefit Period
PERIOD ISSUE AGE $500* $1,000* $1,500* $2,500* $4,000*
0ELIMINATION PERIOD
days Accident/7 days Sickness ISSUE AGE $9.93 $500*$19.85
17-49 $1,000*
$29.78 $1,500*
$49.63 $2,500*
$79.40 $4,000*
0 days Accident/7 days Sickness 50-64 17-49 $10.83 $9.93 $21.65 $32.48
$19.85 $54.13
$29.78 $86.60
$49.63 $79.40
65-74 50-64 $13.23 $10.83$26.45 $39.68
$21.65 $66.13
$32.48 $105.80
$54.13 $86.60
0 days Accident/14 days Sickness 17-49 $7.90 $15.80 $23.70 $39.50 $63.20
65-74 $13.23 $26.45 $39.68 $66.13 $105.80
50-64 $8.83 $17.65 $26.48 $44.13 $70.60
0 days Accident/14 days Sickness 17-49 $7.90 $15.80 $23.70 $39.50 $63.20
65-74 $10.90 $21.80 $32.70 $54.50 $87.20
*monthly benefit amount 50-64 $8.83 $17.65 $26.48 $44.13 $70.60
6 Month Benefit Period 65-74 $10.90 $21.80 $32.70 $54.50 $87.20
ELIMINATION
*monthly PERIOD
benefit amount ISSUE AGE $500* $1,000* $1,500* $2,500* $4,000*
60Month Benefit Period
days Accident/7 days Sickness 17-49 $12.63 $25.25 $37.88 $63.13 $101.00
ELIMINATION PERIOD ISSUE AGE$14.95 $500*$29.90
50-64 $1,000*
$44.85 $1,500*
$74.75 $2,500*
$119.60 $4,000*
0 days Accident/7 days Sickness 65-74 17-49 $21.25 $12.63$42.50 $63.75
$25.25 $106.25
$37.88 $170.00
$63.13 $101.00
0 days Accident/14 days Sickness 17-49 $9.80 $19.60 $29.40 $49.00 $78.40
50-64 $14.95 $29.90 $44.85 $74.75 $119.60
50-64 $12.30 $24.60 $36.90 $61.50 $98.40
65-74 $21.25 $42.50 $63.75 $106.25 $170.00
65-74 $16.20 $32.40 $48.60 $81.00 $129.60
0 days Accident/14 days Sickness
*monthly benefit amount 17-49 $9.80 $19.60 $29.40 $49.00 $78.40
50-64 $12.30 $24.60 $36.90 $61.50 $98.40
Important Notice 65-74 $16.20 $32.40 $48.60 $81.00 $129.60
Jefferson
Insurance County
coverage
*monthly Publicand
has exclusions
benefit amount Schools
limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to an
outline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage may
3332 Newburg Rd
not be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.
Louisville, KY 40218
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
Important Notice
(502) 485-3011
© 2022 Colonial Life & Accident Insurance Company
Insurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to an
"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.
outline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage may
not be available in all states. Rates provided are illustrative and your actual premium may beAxel
different depending
Halvarson on your particular situation|and
| axel.halvarson@coloniallifesales.com (502)plan choices.
500-6290
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
©Deductions
2022 Colonial perLife
year: 24 Insurance Company
& Accident These rates were prepared on 8/19/2022 and are valid for 90 days.
"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.
Individual Disability - ISTD3000 for KY AAA Risk Class Axel Halvarson |Applicable
axel.halvarson@coloniallifesales.com
to policy form Individual Disability | (502) 500-6290
l Off Job Accident & Off Job Sickness with Psychiatric and Psychological Condition and First Day Hospital
3 Month Benefit Period
ELIMINATION PERIOD ISSUE AGE $500* $1,000* $1,500* $2,500* $4,000*
0 days Accident/7 days Sickness 17-49 $8.30 $16.60 $24.90 $41.50 $66.40
50-64 $9.50 $19.00 $28.50 $47.50 $76.00
65-74 $11.55 $23.10 $34.65 $57.75 $92.40
0 days Accident/14 days Sickness 17-49 $6.50 $13.00 $19.50 $32.50 $52.00
50-64 $7.30 $14.60 $21.90 $36.50 $58.40
65-74 $9.25 $18.50 $27.75 $46.25 $74.00
*monthly benefit amount
6 Month Benefit Period
ELIMINATION PERIOD ISSUE AGE $500* $1,000* $1,500* $2,500* $4,000*
0 days Accident/7 days Sickness 17-49 $10.28 $20.55 $30.83 $51.38 $82.20
50-64 $13.40 $26.80 $40.20 $67.00 $107.20
65-74 $17.43 $34.85 Underwritten
$52.28by Colonial Life & Accident Insurance
$87.13 $139.40Company
Page 1 of 1 See page 1 for Important Notice
0 days Accident/14 days Sickness 17-49 $7.90 $15.80 $23.70 $39.50 $63.20
50-64 $9.88 $19.75 $29.63 $49.38 $79.00
65-74 $13.15 $26.30 $39.45 $65.75 $105.20
*monthly benefit amount
Important Notice
Insurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions,
Underwritten please refer
by Colonial Lifeto&an
Accident Insurance Company
outline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage may
Page 1 of 1 See page 1 for Important Notice
not be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
© 2022 Colonial Life & Accident Insurance Company
"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.
Axel Halvarson | axel.halvarson@coloniallifesales.com | (502) 500-6290
9Cancer Insurance
Cancer Insurance
10Cancer Insurance
How would cancer impact your way of life?
Hopefully, you and your family will never face cancer. If you do, a
financial safety net can help you and your loved ones focus on what
matters most — recovery.
If you were diagnosed with cancer, you could have expenses that
medical insurance doesn’t cover. In addition to your regular, ongoing
bills, you could have indirect treatment and recovery costs, such as
child care and home health care services.
Help in times of need
Cancer coverage from Colonial Life & Accident Insurance Company
can help protect the lifestyle you’ve worked so hard to build. It provides
benefits you can use to help cover:
■ Loss of income
■ Out-of-network treatment
■ Lodging and meals
■ Deductibles and co-pays
CANCER ASSIST
11Paul and Kim were preparing for their second child when they learned Paul had
One family’s journey cancer. They quickly realized their medical insurance wouldn’t cover everything.
Thankfully, Kim’s job enabled her to have a cancer insurance policy on Paul to help
them with expenses.
DOCTOR’S SCREENING SECOND OPINION SURGERY
Wellness benefit Travel expenses Out-of-pocket costs
Paul’s wellness benefit helped pay for the When the couple traveled several hundred miles from The policy’s benefits helped with
screening that discovered his cancer. their home to a top cancer hospital, they used the policy’s deductibles and co-pays related to
lodging and transportation benefits to help with expenses. Paul’s surgery and hospital stay.
For illustrative purposes only
With cancer insurance:
■ Coverage options are available for you
and your eligible dependents.
■ Benefits are payable directly to you, unless
you specify otherwise.
■ Benefits are payable regardless of any
insurance you may have with other companies.
■ You can take coverage with you, even if you
change jobs or retire.
MORE
than 1.8
MILLION
new
cancer cases
are expected to be
diagnosed in 2020.
American Cancer Society, Cancer Facts & Figures, 2020.
12Cancer insurance provides benefits to help with cancer expenses —
from diagnosis to recovery.
TREATMENT RECOVERY
Experimental care Follow-up evaluations
Paul used his plan’s benefits to help pay Paul has been cancer-free for more than four years.
for experimental treatments not covered His cancer policy provides a benefit for periodic scans.
by his medical insurance.
Our cancer insurance offers more than 30 benefits that can help you with costs
that may not be covered by your medical insurance.
Treatment benefits Surgery benefits
(inpatient or outpatient) ■ Surgical procedures
■ Radiation/chemotherapy ■ Anesthesia
■ Anti-nausea medication ■ Reconstructive surgery
■ Medical imaging studies ■ Outpatient surgical center LIFETIME RISK OF
■ Supportive or protective care drugs ■ Prosthetic device/artificial limb DEVELOPING CANCER
and colony stimulating factors IN THE U.S.
■ Second medical opinion Travel benefits
■ Blood/plasma/platelets/ ■ Transportation
immunoglobulins ■ Companion transportation
■ Bone marrow or peripheral stem ■ Lodging
cell donation
■ Bone marrow or peripheral stem Inpatient benefits MEN
cell transplant ■ Hospital confinement 39 out of 100
■ Egg(s) extraction or harvesting/ ■ Private full-time nursing services
sperm collection and storage
■ Skilled nursing care facility
■ Experimental treatment
■ Ambulance
■ Hair/external breast/voice
■ Air ambulance
box prosthesis
■ Home health care services
Additional benefits WOMEN
■ Hospice (initial or daily care) ■ Family care 38 out of 100
■ Cancer vaccine
■ Bone marrow donor screening
■ Skin cancer initial diagnosis American Cancer Society, Cancer Facts & Figures, 2019.
■ Waiver of premium
13Optional riders
For an additional cost, you may have the option of purchasing
additional riders for even more financial protection against cancer.
Talk with your benefits counselor to find out which of these riders
are available for you to purchase.
■ Initial diagnosis of cancer rider — Provides a one-time, lump-sum
benefit for the initial diagnosis of cancer. You may choose a benefit
amount in $1,000 increments between $1,000 and $10,000. If your
dependent child is diagnosed with cancer, this rider can pay two and
ColonialLife.com a half times ($2,500 – $25,000) the chosen benefit amount.
■ Initial diagnosis of cancer progressive payment rider — Provides a
lump-sum payment of $50 for each month the rider has been in force
after the waiting period and before cancer is first diagnosed.
■ Specified disease hospital confinement rider — Provides $300 per day
if you or your covered family members are confined to a hospital for
treatment for one of the 34 specified diseases covered under the rider.
If cancer impacts your life, you should be able to focus on
getting better — not on how you’ll pay your bills. Talk with
your Colonial Life benefits counselor about how cancer
insurance can help provide financial security for you and
your family.
THIS POLICY PROVIDES LIMITED BENEFITS.
WAITING PERIOD
The policy and its riders may have a waiting period. Waiting period means the first 30 days
following the policy’s coverage effective date during which no benefits are payable. If your
cancer has a date of diagnosis before the end of the waiting period, coverage for that cancer
will apply only to losses commencing after the policy has been in force for two years, unless
it is excluded by name or specific description in the policy.
EXCLUSIONS
We will not pay benefits for cancer or skin cancer:
■ If the diagnosis or treatment of cancer is received outside of the territorial limits of the
United States and its possessions; or
■ For other conditions or diseases, except losses due directly from cancer.
Insureds in CA must be covered by comprehensive health insurance before applying for
cancer insurance.
Wellness benefit not available in MI.
This information is not intended to be a complete description of the insurance coverage avail-
able. The policy or its provisions may vary or be unavailable in some states. The policy has
exclusions and limitations which may affect any benefits payable. Applicable to policy form
CanAssist and rider forms R-CanAssistIndx, R-CanAssistProg and R-CanAssistSpDis (including
state abbreviations where applicable, for example: CanAssist-TX). For cost and complete details
of coverage, call or write your Colonial Life benefits counselor or the company.
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 10-21 | 101481-5
14Cancer Insurance
Level 2 Benefits
BENEFIT DESCRIPTION BENEFIT AMOUNT
Cancer insurance helps
provide financial protection Air ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,000 per trip
Transportation to or from a hospital or medical facility [max. of two trips per confinement]
through a variety of benefits.
Ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $250 per trip
These benefits are not only for Transportation to or from a hospital or medical facility [max. of two trips per confinement]
you but also for your covered Anesthesia
Administered during a surgical procedure for cancer treatment
family members. ■ General anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25% of surgical procedures benefit
■ Local anesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30 per procedure
Anti-nausea medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $40 per day administered or
Doctor-prescribed medication for radiation or chemotherapy [$160 monthly max.] per prescription filled
Blood/plasma/platelets/immunoglobulins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150 per day
A transfusion required during cancer treatment [$10,000 calendar year max.]
Bone marrow donor screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50
Testing in connection with being a potential donor [once per lifetime]
Bone marrow or peripheral stem cell donation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500
Receiving another person’s bone marrow or stem cells for a transplant [once per lifetime]
Bone marrow or peripheral stem cell transplant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $4,000 per transplant
Transplant you receive in connection with cancer treatment
[max. of two bone marrow transplant benefits per lifetime]
Cancer vaccine. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50
An FDA-approved vaccine for the prevention of cancer [once per lifetime]
Companion transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0.50 per mile
Companion travels by plane, train or bus to accompany a covered cancer patient more
than 50 miles one way for treatment [up to $1,000 per round trip]
Egg(s) extraction or harvesting/sperm collection and storage
Extracted/harvested or collected before chemotherapy or radiation [once per lifetime]
■ Egg(s) extraction or harvesting/sperm collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $700
■ Egg(s) or sperm storage (cryopreservation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200
Experimental treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $250 per day
Hospital, medical or surgical care for cancer [$12,500 lifetime max.]
Family care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $40 per day
For more information, Inpatient or outpatient treatment for a covered dependent child
[$2,000 calendar year max.]
talk with your
Hair/external breast/voice box prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200 per calendar year
benefits counselor. Prosthesis needed as a direct result of cancer
Home health care services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 per day
Examples include physical therapy, occupational therapy, speech therapy and
audiology; prosthesis and orthopedic appliances; rental or purchase of durable
medical equipment [up to 30 days per calendar year or twice the number of days
hospital confined, whichever is greater]
Hospice (initial or daily care)
An initial, one-time benefit and a daily benefit for treatment [$15,000 lifetime max. for both]
■ Initial hospice care [once per lifetime] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,000
■ Daily hospice care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50 per day
CANCER ASSIST – LEVEL 2
15BENEFIT DESCRIPTION BENEFIT AMOUNT
Hospital confinement
Hospital stay (including intensive care) required for cancer treatment
■ 30 days or less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150 per day
■ 31 days or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 per day
Lodging . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50 per day
Hotel/motel expenses when being treated for cancer more than 50 miles from home
[70-day calendar year max.]
Medical imaging studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $125 per study
Specific studies for cancer treatment [$250 calendar year max.]
Outpatient surgical center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200 per day
Surgery at an outpatient center for cancer treatment [$600 calendar year max.]
Private full-time nursing services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 per day
Services while hospital confined other than those regularly furnished by the hospital
Prosthetic device/artificial limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 per device or limb
A surgical implant needed because of cancer surgery [payable one per site, $3,000 lifetime max.]
Radiation/chemotherapy
Weekly benefit [max. once per week]
■ Injected chemotherapy by medical personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500
■ Radiation delivered by medical personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500
Monthly chemotherapy benefit [max. once per month]
■ Self-injected . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200
■ Pump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200
■ Topical . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200
■ Oral hormonal [1-24 months] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200
■ Oral hormonal [25+ months] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100
■ Oral non-hormonal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200
Reconstructive surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $40 per surgical unit
A surgery to reconstruct anatomic defects that result from cancer treatment
[up to $2,500 per procedure, including 25% for general anesthesia]
ColonialLife.com Second medical opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200
A second physician’s opinion on cancer surgery or treatment [once per lifetime]
Skilled nursing care facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100 per day
Confinement to a covered facility after hospital release [up to the number of days paid for
hospital confinement]
Skin cancer initial diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300
A skin cancer diagnosis while the policy is in force [once per lifetime]
Supportive or protective care drugs and colony stimulating factors . . . . . . . . . . . . . . . . . . . . . . . . . . . $100 per day
Doctor-prescribed drugs to enhance or modify radiation/chemotherapy treatments
[$800 calendar year max.]
Surgical procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50 per surgical unit
Inpatient or outpatient surgery for cancer treatment [$3,000 max. per procedure]
Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0.50 per mile
Travel expenses when being treated for cancer more than 50 miles from home
[up to $1,000 per round trip]
Waiver of premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Is available
No premiums due if the named insured is disabled longer than 90 consecutive days
THIS POLICY PROVIDES LIMITED BENEFITS.
This information is not intended to be a complete description of the insurance coverage available. The policy or its
provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect
any benefits payable. Applicable to policy form CanAssist (including state abbreviations where used, for example:
CanAssist-TX). This chart is not complete without form number 101481. For cost and complete details of coverage,
call or write your Colonial Life benefits counselor or the company.
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 5-21 | 101483-3
16Cancer Insurance
Wellness Benefits
Part one: Cancer wellness/health screening
To encourage early detection,
Provided when one of the tests listed below is performed after the waiting period and while
our cancer insurance offers
the policy is in force. Payable once per calendar year, per covered person.
benefits for wellness and health
screening tests. Cancer wellness tests Health screening tests
■ Bone marrow testing ■ Blood test for triglycerides
■ Breast ultrasound ■ Carotid Doppler
■ CA 15-3 (blood test for breast cancer) ■ Echocardiogram (ECHO)
■ CA 125 (blood test for ovarian cancer) ■ Electrocardiogram (EKG, ECG)
■ CEA (blood test for colon cancer) ■ Fasting blood glucose test
■ Chest X-ray ■ Serum cholesterol test for HDL
■ Colonoscopy and LDL levels
■ Flexible sigmoidoscopy ■ Stress test on a bicycle or treadmill
■ Hemoccult stool analysis
■ Mammography
■ Pap smear
■ PSA (blood test for prostate cancer)
■ Serum protein electrophoresis
(blood test for myeloma)
■ Skin biopsy
■ Thermography
■ ThinPrep pap test
■ Virtual colonoscopy
Part two: Cancer wellness — additional invasive diagnostic
For more information, test or surgical procedure
talk with your
Provided when a doctor performs a diagnostic test or surgical procedure after the waiting
benefits counselor. period as the result of an abnormal result from one of the covered cancer wellness tests in
part one. We will pay the benefit regardless of the test results. Payable once per calendar year,
per covered person.
THIS POLICY PROVIDES LIMITED BENEFITS.
Insureds in MA must be covered by comprehensive health insurance before applying for cancer insurance.
Waiting period means the first 30 days following the policy’s coverage effective date during which no benefits are payable.
This information is not intended to be a complete description of the insurance coverage available. The policy or its
provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any
benefits payable. Applicable to policy form CanAssist (including state abbreviations where used, for example: CanAssist-TX).
For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
CANCER ASSIST WELLNESS | 5-21 | 101486-3
17Jefferson County Public Schools
3332 Newburg Rd
Louisville, KY 40218
(502) 485-3011
Deductions per year: 24 These rates were prepared on 6/24/2022 and are valid for 90 days.
Cancer Assist for KY Applicable to policy form CanAssist
l with $100 Health Screening Benefit
$5,000 Initial Diagnosis Benefit
COVERAGE LEVEL ISSUE AGE NAMED INSURED EMPLOYEE AND SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY
Level 2 17-75 $14.58 $23.18 $14.98 $23.58
Important Notice
Insurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to an
outline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage may
not be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
© 2022 Colonial Life & Accident Insurance Company
"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.
Axel Halvarson | axel.halvarson@coloniallifesales.com | (502) 500-6290
Underwritten by Colonial Life & Accident Insurance Company
Page 1 of 1 See page 1 for Important Notice
18Accident Insurance
Accident Insurance
19Accident Insurance
Preferred Plan
Nobody expects an accident to happen. But if it does, your main focus should
be on recovery, not how you're going to pay your bills. Colonial Life accident
insurance provides benefits directly to use however you like – from medical
costs to everyday expenses. Whether it's a fall or a car accident, your benefits
offer support when you need it.
OUR COVERAGE INCLUDES: Milo was running on the playground when
Benefits payable he tripped and injured his hand.
directly to you
No medical questions URGENT CARE CENTER VISIT
to qualify for coverage Milo went to an urgent care center MILOʼS BENEFITS
Coverage for simple and received immediate care.
and complex injuries With Colonial Life accident benefits, Milo’s
DIAGNOSTIC PROCEDURE parents were able to pay the annual
Benefits payable, The doctor ordered an X-ray deductible and co-payments.
regardless of other and discovered Milo had
insurance fractured his hand. Accident emergency treatment $175
Worldwide coverage LACERATION X-ray $60
Keep coverage no The doctor also found that Milo
Laceration (no stitches) $30
matter where you go had a cut on his hand.
Works alongside your Fracture (hand) $575
health savings account MEDICAL EQUIPMENT
Milo was discharged with a splint. Medical equipment (splint) $40
(HSA)
Accident follow-up treatment
DOCTORʼS OFFICE VISIT $225
(3 visits)
Over the next several weeks,
All of this can help you get he had three follow-up Total: $1,105
back on your feet. appointments with his doctor.
For illustrative purposes only.
Benefit amounts may vary and may not cover all expenses. The policy has exclusions and limitations.
IAC4000 – PREFERRED PLAN
20Olivia was driving to the store
Benefits are per covered person per covered accident unless stated otherwise.
when she got into a car accident.
INITIAL CARE
AMBULANCE AND EMERGENCY Accident emergency treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $175
ROOM VISIT Hospital emergency room, urgent care facility or physician’s office
Olivia arrived by ambulance to the nearest Accidental injury due to an automobile accident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $250
emergency room and received immediate care. Air ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,800
Ambulance – ground or water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300
DIAGNOSTIC PROCEDURES Observation room (up to two days per calendar year) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $225 per day
The doctor ordered an X-ray and discovered X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $60
Olivia had fractured her thigh (femur). He
also ordered a CT scan of her head to check COMMON ACCIDENTAL INJURIES
for brain injury.
Burn (based on size and degree). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500 – $18,000
HOSPITAL ADMISSION, Burn – skin graft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50% of applicable burn benefit
CONFINEMENT AND SURGERY
Coma (lasting for seven or more consecutive days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$17,500
Olivia was admitted to the hospital for surgery Concussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $250
on her leg. She was confined for three days.
Dislocation – separated joint
¾ Non-surgical – repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150 – $3,500
PHYSICAL THERAPY Incomplete dislocation – or dislocation without anesthesia. . . . . . . . . . . . . . . . . . . . 25% of benefit
Examples: elbow: $750 | ankle: $1,500 | knee: $1,750 | hip: $3,500
Olivia had eight sessions of physical therapy to
¾ Surgical – repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 – $7,000
help regain the strength in her leg.
Examples: elbow: $1,500 | ankle: $3,000 | knee: $3,500 | hip: $7,000
Emergency dental work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150 – $400
DOCTORʼS OFFICE VISITS Dental extraction or dental crown, denture or implant
Over the next several weeks, she had six Eye injury – with surgical repair or removal of a foreign object . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $450
follow-up appointments with her doctor. Fracture – complete
¾ Non-surgical – repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $375 – $4,500
OLIVIA'S BENEFITS Chip fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25% of benefit
Examples: hand: $575 | foot: $575 | collarbone: $925 | leg: $1,500
Olivia’s accident benefits helped cover her ¾ Surgical – repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $750 – $9,000
annual deductible and co-payments. Examples: hand: $1,150 | foot: $1,150 | collarbone: $1,850 | leg: $3,000
Ambulance $300 Hearing-loss injuries1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $180
Accidental injury due to an Knee cartilage – torn (with surgical repair) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $900
$250
automobile accident
Laceration (based on repair and length) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30 – $700
Accident emergency treatment $175
Ruptured disc (with surgical repair) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,150
X-ray $60
Tendon/ligament/rotator cuff (with surgical repair)
Medical imaging study (CT) $300 ¾ One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $950 ¾ Two or more . . . . . . . . . . . . . . . . . . . . . . . . $1,900
Hospital admission $1,250
HOSPITAL CARE
Hospital confinement (3 days) $750
Hospital admission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,250
Thigh fracture – femur (surgical) $6,800
Hospital confinement (up to 365 days) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $250 per day
Surgery (exploratory/arthroscopic) $400 Hospital sub-acute intensive care unit confinement (up to 30 days) . . . . . . . . . . . . . . . . . $400 per day
Medical equipment (crutches) $150 Intensive care unit admission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,250
Accident follow-up treatment Intensive care unit confinement (up to 15 days) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500 per day
$450
(6 visits)
Physical therapy (8 days) $400 SURGICAL CARE
Total: $11,285 Blood/plasma/platelets – transfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500
Surgery (based on type of repair and surgery) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 – $2,100
For illustrative purposes only.
Benefit amounts may vary and may not cover all expenses.
The policy has exclusions and limitations.
21TRANSPORTATION & LODGING
Transportation for hospital confinement .............................. . . . . . . . . . . . . . . . . . . . . . . . $900 per round trip
(up to three round trips, 50+ miles from home)
Lodging – companion (up to 30 days) ................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $175 per day
FOLLOW-UP CARE
Accident follow-up treatment – including transportation/telemedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75
(up to six benefits per covered person per covered accident and
up to 12 benefits per covered person per calendar year)
Medical equipment
¾ Tier 1 . . . . . . . . . . . . . . . . . . . . . ............................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $40
Arm sling, cane, medical ring cushion, neck brace or wrist/ankle splint
¾ Tier 2 . . . . . . . . . . . . . . . . . . . . . ............................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150
Bedside commode, cold therapy system (cryotherapy), crutches, leg brace, shower chair,
walker or walking boot
¾ Tier 3 . . . . . . . . . . . . . . . . . . . . . ............................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300
Back brace, body jacket, continuous passive movement (CPM), halo, electric scooter,
hospital bed (including rental), knee scooter, stair lift chair, wheelchair
Medical imaging study – CT, CAT scan, EEG, EMG, MR or MRI........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300
(one per calendar year)
Pain management for epidural anesthesia – non-surgical.......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $150
Post-traumatic stress disorder (PTSD) ................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300
Prosthetic device/artificial limb
¾ One . . . . . . . . . . . . . . . . . . . . . . . . .................. $1,150 ¾ More than one . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,300
¾ Repair/replacement3. . . .............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $575/$1,150
Rehabilitation unit confinement ........................................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $225 per day
(up to 15 days, not to exceed 30 days per calendar year)
Therapy – occupational, physical or speech (up to 10 days)........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50 per day For more information,
talk with your
ACCIDENTAL DISMEMBERMENT benefits counselor.
Accidental dismemberment .............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $750 – $30,000
¾ Loss, loss of use or paralysis – hand, arm, foot, leg, sight of eye
¾ Loss, loss of use – finger, toe, partial dismemberment of finger or toe
Accidental dismemberment due to a catastrophic accident
Named insured, spouse or child ...................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30,0003
¾ Total and irrecoverable loss, loss of use or paralysis – 180-day elimination period
¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination; or
¾ Loss of hearing in both ears, or loss of ability to speak
ACCIDENTAL DEATH
Accidental death
¾ Named insured, spouse ............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $20,000
¾ Child . . . . . . . . . . . . . . . . . . . . . ............................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $10,000
Accidental death common carrier
Examples of common carriers are mass transit trains, buses and planes
¾ Named insured, spouse ............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $80,000
¾ Child . . . . . . . . . . . . . . . . . . . . . . .............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30,000
IAC4000 – PREFERRED PLAN
221 One benefit for each injured ear per covered person per lifetime.
2 One repair or replacement per prosthetic device/artificial limb per covered person per lifetime.
3 Payable once per lifetime per covered person.
HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLE
This plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate.
It may also be offered to employees who do not have HSAs.
ColonialLife.com
THIS POLICY PROVIDES LIMITED BENEFITS.
EXCLUSIONS
We will not pay benefits for losses that are caused by, contributed to by or occur as the result of a covered personʼs
felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness, suicide
or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we will not pay
Accidental Dismemberment Due to Catastrophic Accident benefits for injuries a child sustains during birth, or for injuries
that are the result of intoxication or use of narcotics.
STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONS
KY: Replace "intoxication or use of narcotics" with "intoxication or use of narcotics or hallucinogenics"
This information is not intended to be a complete description of the insurance coverage available. The insurance or its
provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any
benefits payable. Applicable to policy forms IAC4000-CO-R-1, IAC4000-KY-R and IAC4000-NB-OH. For cost and complete
details of coverage, call or write your Colonial Life benefits counselor or the company.
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company. 8-20 | 101776-3-CO-KY-OH
23Accident Insurance
Wellbeing Assistance Standard Benefit
This benefit can help pay for routine preventive tests and services.
Wellbeing assistance standard. . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . $50.00
Payable once per covered person per calendar year; subject to a 30-day waiting period.
Blood test for triglycerides Mammography
Bone marrow testing Pap smear
Breast ultrasound PSA (blood test for prostate cancer)
CA 15-3 (blood test for breast cancer) Serum cholesterol test for HDL and LDL levels
CA 125 (blood test for ovarian cancer) Serum protein electrophoresis
Carotid Doppler (blood test for myeloma)
CEA (blood test for colon cancer) Skin cancer biopsy
Chest X-ray Stress test on a bicycle or treadmill
Colonoscopy Thermography
Echocardiogram (ECHO) ThinPrep pap test
Electrocardiogram (EKG, ECG) Virtual colonoscopy
Fasting blood glucose test
For more information, Flexible sigmoidoscopy
talk with your Hemoccult stool analysis
benefits counselor.
ColonialLife.com
ID, MD, MO, ND: Waiting period does not apply
WV: Includes human papillomavirus screening test
THIS POLICY PROVIDES LIMITED BENEFITS.
This information is not intended to be a complete description of the insurance coverage available. The insurance or its
provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any
benefits payable. Applicable to policy form IAC4000 (including state abbreviations where used, for example: IAC4000-TX).
For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a
registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
IAC4000 – WELLBEING ASSISTANCE STANDARD BENEFIT | 1-21 | 101781-2
24Jefferson County Public Schools
3332 Newburg Rd
Louisville, KY 40218
(502) 485-3011
Deductions per year: 24 These rates were prepared on 6/24/2022 and are valid for 90 days.
Individual Accident (IAC4000) for KY Applicable to Policy Forms IAC4000
l On/Off-Job Accident Coverage, Wellbeing Assistance Standard - $50
BENEFIT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY
Preferred 0-80 $8.97 $15.09 $19.09 $25.21
Important Notice
Insurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to an
outline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage may
not be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
© 2022 Colonial Life & Accident Insurance Company
"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.
Axel Halvarson | axel.halvarson@coloniallifesales.com | (502) 500-6290
Underwritten by Colonial Life & Accident Insurance Company
Page 1 of 1 See page 1 for Important Notice
25Critical Illness Insurance
Critical Illness Insurance
26Specified Critical Illness Insurance
If you’re diagnosed with a covered critical illness, specified critical illness
insurance from Colonial Life can help with your expenses, so you can concentrate
on what’s most important – your treatment, care and recovery.
Face amount: $_______________
Critical illness benefit
This percentage of the face
For the diagnosis of this covered critical illness condition:1
amount is payable:
Heart attack (myocardial infarction) 100%
Stroke 100%
End-stage renal (kidney) failure 100%
Major organ failure 100%
Permanent paralysis due to a covered accident 100%
For more information,
talk with your Coma 100%
benefits counselor.
Blindness 100%
Occupational infectious HIV or occupational
100%
infectious hepatitis B, C or D
Coronary artery bypass graft surgery/disease2 25%
The maximum benefit amount for this policy is 3x the face amount for the named insured for all
covered persons combined. The policy will terminate when the maximum benefit amount for
specified critical illness has been paid.
ColonialLife.com Subsequent diagnosis of a different critical illness3
If you receive a benefit for a specified critical illness, and later you are diagnosed with a different
specified critical illness, the original percentage of the face amount is payable for that particular
specified critical illness.
Subsequent diagnosis of the same critical illness3
If you receive a benefit for a specified critical illness, and later you are diagnosed with the same
specified critical illness, 25% of the original face amount is payable. Critical illness conditions
that do not qualify are: coronary artery bypass graft surgery/disease2 and occupational infectious
HIV or occupational infectious hepatitis B, C or D.
CRITICAL ILLNESS 1.0 WITH SUBSEQUENT DIAGNOSIS
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