Page 35 - 2021 Mid Year Open Enrollment Guide

Critical Illness Coverage Critical Illness Rates

Critical Illness coverage through Voya pays a lump-sum benefit if you are diagnosed with a covered
disease or condition. You can use this money however you like; for example: to help pay for $10,000 CRITICAL ILLNESS
expenses not covered by your medical plan, lost wages, child care, travel, home health care costs or
any of your regular household expenses. WEEKLY PAYROLL DEDUCTIONS BI-WEEKLY PAYROLL DEDUCTIONS
• Guaranteed Issue Coverage (no medical questions)
- Employee: $10,000, $15,000 or $30,000 Employee Only and Employee + Spouse Employee Only and Employee + Spouse
- Spouse: 50% of Team Member benefit Employee + Children Employee + Family Employee + Children Employee + Family
- Child(ren): 25% of Team Member benefit Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco
• Rates are based on your age and the amount of coverage selected and will be shown to you in Under 30 $0.28 $0.46 $0.44 $0.74 Under 30 $0.55 $0.92 $0.88 $1.48
the Dayforce system during enrollment. 30-39 $0.58 $1.25 $0.93 $1.82 30-39 $1.15 $2.49 $1.87 $3.65
• Children are covered at NO COST when you elect employee coverage. Benefits are payable 40-49 $1.45 $3.05 $2.23 $4.63 40-49 $2.91 $6.09 $4.45 $9.25
based on the date of the covered event occurring or the date of diagnosis; Illnesses or 50-59 $3.74 $5.70 $5.70 $8.61 50-59 $7.48 $11.40 $11.40 $17.22
occurrences prior to the effective date of coverage will not be payable events
60-64 $5.77 $8.72 $8.75 $13.14 60-64 $11.54 $17.45 $17.49 $26.28
• $50 annual Wellness Benefit is payable for completing certain wellness screenings such as a 65-69 $5.77 $8.72 $8.75 $13.14 65-69 $11.54 $17.45 $17.49 $26.28
pap test, cholesterol test, mammogram, colonoscopy or stress test (once per year per covered
person); 50% per child to a maximum of $100 for all children. 70+ $8.61 $11.40 $12.98 $17.16 70+ $17.22 $22.80 $25.96 $34.32

BASE MODULE QUALITY OF LIFE MODULE
$15,000 CRITICAL ILLNESS
Heart attack (cardiac arrest is not a heart attack) – 100% Permanent paralysis – 100%
Cancer – 100% Loss of sight, hearing or speech – 100% WEEKLY PAYROLL DEDUCTIONS BI-WEEKLY PAYROLL DEDUCTIONS
Stroke – 100% Coma – 100% Employee Only and Employee + Spouse Employee Only and Employee + Spouse
Employee + Children Employee + Family Employee + Children Employee + Family
Major organ transplant – 100% Multiple sclerosis – 100%
Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco
Coronary artery bypass - 25% Amyotrophic lateral sclerosis (ALS) – 100% Under 30 $0.42 $0.69 $0.66 $1.11 Under 30 $0.83 $1.38 $1.32 $2.22
Carcinoma in situ - 25% Parkinson’s disease – 50% 30-39 $0.87 $1.87 $1.40 $2.73 30-39 $1.73 $3.74 $2.80 $5.47
MAJOR ORGAN MODULE Advanced dementia, including Alzheimer’s disease – 50% 40-49 $2.18 $4.57 $3.34 $6.94 40-49 $4.36 $9.14 $6.68 $13.88
Type I Diabetes - 100% Huntington's disease (Huntington's chorea) - 50% 50-59 $5.61 $8.55 $8.55 $12.91 50-59 $11.22 $17.10 $17.10 $25.82
Severe burns - 100% Muscular dystrophy - 100% 60-64 $8.65 $13.08 $13.12 $19.71 60-64 $17.31 $26.17 $26.24 $39.43
Transient Ischemic attacks (TIA) - 10% Infectious disease - 25% 65-69 $8.65 $13.08 $13.12 $19.71 65-69 $17.31 $26.17 $26.24 $39.43
Ruptured or dissecting aneurysm - 10% Addison's Disease - 10% 70+ $12.91 $17.10 $19.47 $25.74 70+ $25.82 $34.20 $38.94 $51.47
Abdominal aortic aneurysm - 10% Myasthenia gravis - 10%
Thoracic aortic aneurysm - 10% Systemic lupus erythematosus (SLE) - 10% $30,000 CRITICAL ILLNESS
Open heart surgery for valve replacement or repair - 25% Systemic sclerosis (scleroderma) - 10% WEEKLY PAYROLL DEDUCTIONS BI-WEEKLY PAYROLL DEDUCTIONS
Transcatheter heart valve replacement or repair - 10% CHILD DISEASES (100%)
Employee Only and Employee + Spouse Employee Only and Employee + Spouse
Coronary angioplasty - 10% Employee + Children Employee + Family Employee + Children Employee + Family
"Cerebral Palsy; Congenital Birth Defects; Cystic Fibrosis; Down
Implantable (or internal) cardioverter defibrillator (ICD) Syndrome; Gaucher Disease, Type II or III; Infantile Tay Sachs; Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco
placement - 25% Niemann-Pick Disease; Pompe Disease; Type IV Glycogen Storage
Disease; Sickle Cell Anemia; Zellweger Syndrome" Under 30 $0.83 $1.38 $1.32 $2.22 Under 30 $1.66 $2.77 $2.63 $4.43
Pacemaker placement - 10%
30-39 $1.73 $3.74 $2.80 $5.47 30-39 $3.46 $7.48 $5.61 $10.94
ENHANCED CANCER MODULE *This is a summary. Refer to plan document for details 40-49 $4.36 $9.14 $6.68 $13.88 40-49 $8.72 $18.28 $13.36 $27.76
including definitions, plan exclusions and limitations.
Benign brain tumor – 100% 50-59 $11.22 $17.10 $17.10 $25.82 50-59 $22.43 $34.20 $34.20 $51.65
Skin cancer – 10% 60-64 $17.31 $26.17 $26.24 $39.43 60-64 $34.62 $52.34 $52.48 $78.85
Bone marrow transplant – 25% 65-69 $17.31 $26.17 $26.24 $39.43 65-69 $34.62 $52.34 $52.48 $78.85
Stem cell transplant – 25% 70+ $25.82 $34.20 $38.94 $51.47 70+ $51.65 $68.40 $77.88 $102.95

32 • 2021 BUILDERS FIRSTSOURCE MID-YEAR BENEFITS GUIDE 2021 BUILDERS FIRSTSOURCE MID-YEAR BENEFITS GUIDE • 33