benefit coverage from allstate benefits · allstate benefits most major medical insurance plans...

FAMILYYou can choose to cover yourself or your entire family

Four reasons you should consider purchasing our coverage

PRICE BENEFITS PAYROLLThe cost of our coverage is affordable

Base policy coverage can be enhanced with rider benefits

Premiums are deducted from your paycheck

Benefit Coverage from

Allstate BenefitsLet our personalized benefit offerings put

you and your family in Good Hands®

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Group Accident, Critical Illness, Universal Life, and Disability Insurance

Are you protected in the event of an accident, critical illness,

loss, or disability?

Offered to the associates of:

Ingles Markets, Inc.

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Even when you live well, accidents happen. Treatment can be vital to recovery, but it can also be expensive. And if an accident keeps you away from work during recovery, the financial worries can grow quickly.

Accident Insurancefrom Allstate Benefits

Benefits are paid to you

Key Features• Guaranteed Issue coverage,

meaning no medical questions to answer

• Coverage available for spouse and child(ren)

• Premiums are affordable and are conveniently payroll deducted

• Coverage can be continued, as long as premiums are paid to Allstate Benefits

Most major medical insurance plans only pay a portion of the bills. Our coverage can help pick up where other insurance leaves off and provide cash to help cover the expenses.

With accident insurance from Allstate Benefits, you can gain the advantage of financial protection, thanks to the cash benefits paid directly to you. You also gain the financial empowerment to seek the treatment needed to get well.

Here’s How It WorksOur coverage pays you cash benefits that correspond with hospital and intensive care confinement. Your plan may also include coverage for a variety of occurrences, such as: dismemberment; dislocation or fracture; ambulance services; physical therapy and more. The cash benefits can be used to help pay for deductibles, treatment, rent and more.

With Allstate Benefits, you can protect your finances against life’s slips and falls.

Are you in Good Hands? You can be.

You choose the benefits to help protect yourself and any family members from accidental injury expenses

CHOOSEYou or a covered family member experience an accidental injury and seek medical attention

USEYou go online and file a claim. The cash benefits are paid to you, to use however you wish

CLAIM

Protection for accidental off-the-job injuries

Nearly three-fourths of medically consulted injuries take place outside of work.13/4Outside

Work1/4 At Work

1National Safety Council, Injury Facts®, 2014 Edition

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BENEFIT AMOUNTSBenefits are paid once per accident unless otherwise noted here or in the Important Information About Coverage.

*Each benefit pays the amount shown. 2Up to amount shown; see Injury Benefit Schedule on page 5. Multiple losses from same injury pay only up to amount shown above.

BASE POLICY BENEFITS PLANInitial Hospital Confinement (Pays once/year) $1,000Daily Hospital Confinement (Pays daily) $200Intensive Care (Pays daily) $400ADDITIONAL RIDERS ADDED TO BASE PLANAccident Treatment and Urgent Care Rider Ambulance Ground $200 Air $600 Accident Physician’s Treatment $100 X-ray $200 Urgent Care $100Dislocation or Fracture Rider2 (Pays up to amount shown on page 5) $4,000Emergency Room Services Rider $200ADDITIONAL RIDERS PLANOutpatient Physician’s Benefit Rider $25Accidental Death*, Dismemberment2,* and Functional Loss2,* Rider $40,000

Common Carrier Accidental Death (fare-paying passenger) $100,000ADDITIONAL BENEFIT ENHANCEMENT RIDER PLANAccident Follow-Up Treatment (Pays daily) $50Lacerations $50Burns < 15% of body surface $100 > 15% or more $500Skin Graft (% of Burns Benefit) 50%Brain Injury Diagnosis $300Computed Tomography (CT) Scan and Magnetic Resonance Imaging (MRI) (Pays once/year) $50Paralysis (Pays once) Paraplegia $7,500 Quadriplegia $15,000Coma with Respiratory Assistance $10,000Open Abdominal or Thoracic Surgery $1,000Tendon, Ligament, Rotator Cuff Surgery $500 or Knee Cartilage Surgery Exploratory $150Ruptured Spinal Disc Surgery $500Eye Surgery $100General Anesthesia $100Blood and Plasma $300Appliance $125Medical Supplies $5Medicine $5Prosthesis 1 device $500 2 or more devices $1,000Physical, Occupational or Speech Therapy (Pays daily) $30Rehabilitation Unit $100Non-Local Transportation $250Family Member Lodging $100Post-Accident Transportation (Pays once/year) $200 Broken Tooth $100Residence/Vehicle Modification $500Pain Management (Epidural Injection) $50Miscellaneous Outpatient Surgery $100

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Benefit amounts for coverage and one occurrence are shown below. INJURY BENEFIT SCHEDULE

Knee joint (except patella). Bone or bones of the foot (except toes). Bone or bones of the hand (except fingers). Pelvis (except coccyx). Skull (except bones of face or nose). Foot (except toes). Hand or wrist (except fingers). Lower jaw (except alveolar process).

EE = Employee; EE + SP = Employee + Spouse; EE + CH = Employee + Child(ren); F = Family

PLAN PREMIUMS

MODE EE EE + SP EE + CH F

Weekly $1.30 $3.01 $3.79 $4.72

COMPLETE DISLOCATION PLAN

Hip joint $4,000

Knee or ankle joint, bone or bones of the foot $1,600

Wrist joint $1,400

Elbow joint $1,200

Shoulder joint $800

Bone or bones of the hand, collarbone $600

Two or more fingers or toes $280

One finger or toe $120

COMPLETE, SIMPLE OR CLOSED FRACTURE PLAN

Hip, thigh (femur), pelvis $4,000

Skull $3,800

Arm, between shoulder and elbow (shaft), shoulder blade (scapula), leg (tibia or fibula) $2,200

Ankle, knee cap (patella), forearm (radius or ulna), collarbone (clavicle) $1,600

Foot, hand or wrist $1,400

Lower jaw $800

Two or more ribs, fingers or toes, bones of face or nose $600

One rib, finger or toe, coccyx $280

LOSS PLAN

Life, hearing, speech, or both eyes, hands, arms, feet, or legs, or one hand or arm and one foot or leg $40,000

One eye, hand, arm, foot, or leg $20,000

One or more entire toes or fingers $4,000

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Group Voluntary Accident (GVAP6)Off-the-Job Accident Insurance Important Information About CoverageProvides details of base policy and rider coverage. Below is a list of base policy and rider benefits available with Group Accident coverage. You will receive a certificate that details the certificate specifications for the coverage you purchased.Group Accident Issue ages are 18 and over if Actively at Work.

Conditions and Limits When an injury results in a covered loss within 180 days unless otherwise stated, from the date of an accident, and is diagnosed by a physician, Allstate Benefits will pay benefits as stated. Treatment must be received in the United States or its territories.

Your EligibilityYour employer decides who is eligible for your group (such as length of service and hours worked each week).

Dependent Eligibility/Termination (a) Coverage may include you, your spouse or domestic partner, and your children. (b) Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent.(c) Spouse coverage ends upon valid decree of divorce or your death.(d) Domestic partner coverage ends upon termination of the domestic partnership or your death.

Conditions, Limitations and Exclusions Affecting Your Benefits

Continuation of CoverageYou may be eligible to continue coverage when coverage under the policy ends.

Exclusions and LimitationsThe Exclusions and Limitations apply to the base policy and the following riders: Accidental Death, Dismemberment and Functional Loss RiderAccident Treatment and Urgent Care RiderBenefit Enhancement RiderDislocation/Fracture RiderEmergency Room Services Rider Benefits are not paid for: (a) injury incurred before the effective date;(b) act of war or active participation in a riot, insurrection or rebellion; (c) suicide or attempt at suicide;(d) intentionally self-inflicted injury or action;(e) any bacterial infection (except pyogenic infections from an accidental cut or wound);(f) participation in aeronautics unless a fare-paying passenger on a licensed common-carrier aircraft;(g) engaging in an illegal occupation or committing or attempting an assault or felony;(h) driving in any race or speed test or testing any vehicle on any racetrack or speedway;(i) hernia, including complications;(j) any injury while under the influence of alcohol or any drug, unless taken as prescribed by a physician;(k) serving as an active member of the Military, Naval, or Air Forces of any country or combination of countries; or(l) an injury that occurred as a result of an on-the-job accident.

When Coverage Ends Coverage under the policy and riders ends on the earliest of: (a) the date the policy or certificate is canceled; (b) the last day of the period for which you made any required contributions;(c) the last day you are in active employment, except as provided under the Temporary Layoff, Leave of Absence, or Family and Medical Leave of Absence provision;(d) the date you are no longer in an eligible class; or(e) the date your class is no longer eligible.

Additional Benefit Enhancement RiderAccident Follow-Up Treatment - Max. 2 treatments/accident. Not paid if Physical, Occupational or Speech Therapy benefit paid.Burns - Other than sunburns.Computed Tomography (CT) Scan and Magnetic Resonance Imaging (MRI) - Treatments must be received within 30 days of accident.Coma with Respiratory Assistance - Payable once/accident.Open Abdominal or Thoracic Surgery; Tendon, Ligament, Rotator Cuff or Knee Cartilage Surgery; Ruptured Spinal Disc Surgery - For each surgical benefit, 2 or more procedures through same entry point are considered 1 operation.General Anesthesia - Payable only if one of the rider Surgery benefits paid.Physical, Occupational or Speech Therapy - Max. 6 days/accident. Includes chiropractic services. Not payable if Accident Follow-Up Treatment benefit paid.Rehabilitation Unit - Per day, max. 30 days confinement, max. 60 days/year. Not paid if Daily Hospital Confinement benefit paid.Non-Local Transportation - Per trip, max. 3 times/accident. More than 50 miles from your home.Family Member Lodging - Payable up to 30 days/accident. Not payable if family member lives within 50 miles of hospital.Post-Accident Transportation - More than 250 miles from your home, by common carrier. Only if Daily Hospital Confinement benefit paid.Residence/Vehicle Modification - Within 365 days after accident. Miscellaneous Outpatient Surgery - Not payable if any other Surgery benefit is paid.

Benefits Specifications (see Benefit Amounts)

Daily Hospital Confinement - Max. 365 days/accident.Intensive Care - Max. 180 days/injury.

Additional RidersDislocation/Fracture Rider - Multiple dislocations or fractures from the same accident are limited to the amount shown in the Base Accident Benefits on page 4.Outpatient Physician’s Benefit Rider - Benefit limited to 2 days/person/year, not to exceed 4 days/year if coverage includes dependents.Accidental Death, Dismemberment and Functional Loss Rider - Multiple dismemberments and functional losses from the same accident are limited to the amount shown in the Base Accident Benefits on page 4.

Outpatient Physician’s Benefit RiderBenefits are not paid for: (a) loss incurred before the effective date;(b) act of war, active participation in a riot, insurrection or rebellion;(c) suicide or attempt at suicide;(d) intentionally self-inflicted injury or action;(e) participation in aeronautics unless a fare-paying passenger on a licensed common-carrier aircraft;(f) engaging in an illegal occupation or committing or attempting an assault or felony;(g) driving in any race or speed test or testing an automobile or any vehicle on any racetrack or speedway;(h) any loss while under the influence of alcohol or any drug, unless taken as prescribed by a physician;(i) serving as an active member of the Military, Naval, or Air Forces of any country or combination of countries; or(j) an injury that occurred as a result of an on-the-job accident.

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No one is ever really prepared for a life-altering critical illness diagnosis. We invite you to put yourself in Good Hands with Critical Illness insurance from Allstate Benefits.

Key Features• Guaranteed Issue coverage,

meaning no medical questions to answer at initial enrollment

• Coverage available for spouse and child(ren)

• Covered dependents receive 50% of your Basic-Benefit Amount

• Benefits paid regardless of any other medical or disability plan coverage

• Premiums are affordable and conveniently payroll deducted

• Coverage may be continued

• 100% of your Basic-Benefit Amount is paid for Advanced Alzheimer’s Disease and Advanced Parkinson’s Disease

The treatment to recovery is vital, but it can also be expensive. Your medical coverage may only cover some of the costs associated with treatment. You’re still responsible for deductibles and coinsurance. If treatment keeps you out of work, the financial worries can grow quickly and stress levels may rise.

Critical Illness coverage helps provide financial support if you are diagnosed with a covered critical illness. With the expense of treatment often high, seeking the treatment you need could seem like a financial burden. When a diagnosis occurs, you need to be focused on getting better and taking control of your health, not stressing over financial worries.

Here’s How It WorksYou choose benefits to protect yourself and any family members if diagnosed with a critical illness. Then, if diagnosed with a covered critical illness, you will receive a cash benefit based on the percentage payable for the condition.

With Allstate Benefits, you gain the power to make treatment decisions without putting your finances at risk.


Every 40 seconds someone in the US has a stroke.3

Every 34 seconds, an American will suffer a heart attack.3

1 min.0 sec. 34 sec. 40 sec.

Critical Illness Insurancefrom Allstate Benefits

Benefits are paid to you

You choose the benefits to protect yourself and any family members if diagnosed with a covered critical illness

CHOOSEYou go to your annual exam, the doctor runs tests, the results come back and you’re diagnosed with a critical illness

USEYou go online and file a claim. The cash benefits are paid to you, to use however you wish

CLAIM

Protection for out-of-pocket expenses upon a positive diagnosis

3 http://www.criticalillnessinsuranceinfo.org/learning-center/critical-illness-coverage-facts.php.

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BENEFIT AMOUNTS†Covered Dependents Receive 50% Of Your Benefit Amount

WEEKLY PREMIUMSPLAN 1 $15,000 Basic Benefit Amount

PLAN 2 $30,000 Basic Benefit Amount

non-tobacco non-tobacco

tobacco tobacco

AGES EE, EE+CH EE+SP, F AGES EE, EE+CH EE+SP, F

AGES EE, EE+CH EE+SP, F AGES EE, EE+CH EE+SP, F

18-2930-3940-4950-5960-6465+

18-2930-3940-4950-5960-6465+

18-2930-3940-4950-5960-6465+

18-2930-3940-4950-5960-6465+

$1.31 $2.11 $2.79 $4.33 $5.67 $8.65 $10.05 $15.23 $13.72 $20.73 $21.43 $32.30

$2.33 $3.64 $5.29 $8.08 $11.04 $16.71 $19.82 $29.87 $27.15 $40.87 $42.58 $64.01

$1.64 $2.60 $3.88 $5.96 $8.67 $13.15 $15.77 $23.81 $21.55 $32.47 $33.11 $49.81

$2.99 $4.62 $7.46 $11.34 $17.05 $25.72 $31.26 $47.03 $42.81 $64.36 $65.93 $99.03

EE = Employee; EE+SP = Employee + Spouse; EE+CH = Employee + Child(ren); F = Family

INITIAL CRITICAL ILLNESS BENEFITS† PLAN 1 PLAN 2

Heart Attack (100%) $15,000 $30,000

Stroke (100%) $15,000 $30,000

Major Organ Transplant (100%) $15,000 $30,000

End Stage Renal Failure (100%) $15,000 $30,000

Coronary Artery Bypass Surgery (25%) $3,750 $7,500

Waiver of Premium (employee only) Yes Yes

CANCER CRITICAL ILLNESS BENEFITS† PLAN 1 PLAN 2

Invasive Cancer (100%) $15,000 $30,000

Carcinoma in Situ (25%) $3,750 $7,500

REOCCURRENCE OF CRITICAL ILLNESS BENEFITS† PLAN 1 PLAN 2Initial Critical Illness Benefit Yes Yes(same amount as Initial Critical Illness Benefit)

Cancer Critical Illness Benefit Yes Yes(same amount as Cancer Critical Illness Benefit)

RIDER BENEFITS PLAN 1 PLAN 2

Supplemental Critical Illness Rider† Advanced Alzheimer’s Disease (100%) $15,000 $30,000 Advanced Parkinson’s Disease (100%) $15,000 $30,000 Benign Brain Tumor (100%) $15,000 $30,000 Coma (100%) $15,000 $30,000 Complete Loss of Hearing (100%) $15,000 $30,000 Complete Loss of Sight (100%) $15,000 $30,000 Complete Loss of Speech (100%) $15,000 $30,000

Paralysis (100%) $15,000 $30,000

Fixed Wellness Rider (per year) $50 $50

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Group Voluntary Critical Illness (GVCIP4)Important Information About Eligibility, Termination and PortabilityProvides details of base policy and rider coverage. Below is a list of base policy and rider benefits available with Group Critical Illness coverage. You will receive a certificate that details the certificate specifications for the coverage you purchased. Group Critical Illness Issue ages are 18 and over, if Actively at Work.

Benefit Specifications (see Benefit Amounts)

INITIAL CRITICAL ILLNESS BENEFITS Heart Attack - Established (old) myocardial infarction and cardiac arrest are not covered.

Stroke - Transient ischemic attacks (TIAs), head injury, chronic cerebrovascular insufficiency and reversible ischemic neurological deficits are not covered.

End Stage Renal Failure - Renal failure caused by traumatic events, including surgical trauma, are not covered.

Major Organ Transplant - Pays either Candidate Benefit if placed on National Transplant List or Surgery Benefit for transplant of heart, lungs, liver, pancreas or kidneys. Surgery Benefit not paid if Candidate Benefit paid; also not paid for mechanical or non-human organs.

Coronary Artery Bypass Surgery - Abdominal aortic bypass, balloon angioplasty, laser embolectomy, atherectomy, stent placement and non-surgical procedures are not covered.

CANCER CRITICAL ILLNESS BENEFITS Invasive Cancer - Carcinoma in situ, non-invasive or metastasized skin cancer, and early prostate cancer are not covered.

Carcinoma In Situ - Other skin malignancies, pre-malignant lesions (such as intraepithelial neoplasia), benign tumors and polyps are not covered.

REOCCURRENCE OF CRITICAL ILLNESS BENEFITS Initial Critical Illness Benefit - Second diagnosis more than 12 months after the first date of diagnosis for which an Initial Critical Illness benefit was paid.

Cancer Critical Illness Benefit - Second diagnosis more than 12 months after the last date treatment was received, for which a Cancer Critical Illness benefit was paid.

ADDITIONAL RIDER BENEFITSSupplemental Critical Illness RiderAdvanced Alzheimer’s Disease* - Must exhibit impaired memory and judgment and be certified unable to perform at least two daily activities7 without adult assistance.

Advanced Parkinson’s Disease* - Must exhibit two or more of the following: muscle rigidity, tremor, or Bradykinesis (slowness in physical and mental responses); and be certified unable to perform at least two daily activities7 without adult assistance.

Benign Brain Tumor* - Tumors of the skull, pituitary adenomas less than 10mm, and germinomas are not covered.

Coma* - Medically-induced coma; coma resulting from alcohol or drug use, and diagnosis of brain death are not covered.

Paralysis* - Permanent loss of muscle function in two or more limbs due to disease or injury. Does not include loss of muscle function limited to fingers or toes.

Fixed Wellness Rider - 24 exams. Once per person, per calendar year.

Conditions and Limits A diagnosis occurring before your coverage begins is not payable; however, a diagnosis of any covered condition after your effective date will be payable. Benefits are subject to all limitations and exclusions. All critical illnesses must meet the definitions and dates of diagnoses stated in the policy and be diagnosed by a physician while coverage is in effect. The date of diagnosis for each illness must be separated by 30 days.

Conditions, Limitations and Exclusions Affecting Your Benefits

ExclusionsBenefits are not paid for: (a) intentionally self-inflicted injury or action; (b) illegal activities or participation in an illegal occupation; (c) suicide while sane, or self-destruction while insane, or any

attempt at either; or (d) being under the influence of alcohol, drugs or narcotics,

unless administered and taken as prescribed by a physician.

Reoccurrence of CancerBenefits are paid for a second diagnosis of cancer that was previously diagnosed before the effective date of coverage if, after the first diagnosis and before the date of the second diagnosis, you are free of any symptoms and treatment of the cancer for the 12 consecutive months immediately preceding the effective date of coverage or any 12 consecutive months thereafter.

When Coverage Ends Coverage under the policy ends on the earliest of: (a) the date the certificate is canceled; (b) the date the policy is canceled; (c) you stop paying your premium; (d) the last day of active employment; (e) you or your class are no longer eligible; (f) a false claim is filed; or(g) when all benefits have been paid under the policy and riders.

Your EligibilityYour employer decides who is eligible for your group (such as length of service and hours worked each week). Issue ages are 18 and over.

Dependent Eligibility/Termination (a) Family members eligible for coverage are your spouse or

domestic partner and children. (b) Coverage for children ends when the child reaches age 26,

unless he or she continues to meet the requirements of an eligible dependent.

(c) Spouse coverage ends upon valid decree of divorce or your death. (d) Domestic partner coverage ends when the domestic partnership

ends or your death.

Continuation of CoverageYou may be able to continue coverage when coverage under the policy ends. Refer to your Certificate of Insurance for details.

7Daily activities include: bathing, dressing, toileting, bladder and bowel continence, transferring and eating.*Benefits paid once per covered person. When all benefits have been used, the coverage terminates.

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A death not only leaves behind loved ones, but also overwhelming financial obligations. And, if you’re like most people, you don’t have enough life insurance to keep your family afloat if an unexpected death occurs. Give yourself and your loved ones a gift of love – put yourself in Good Hands with coverage from Allstate Benefits.

4Facts from LIMRA, September 2014, Life Insurance Awareness Month5Coverage for spouse and child(ren) may be limited to a percentage of the insured’s face amount

Key Features• You choose the death benefit amount to leave behind• Coverage for spouse and children

through a separate certificate or rider5

• Premiums are conveniently payroll deducted • Coverage may continue if you leave your job • Tax benefits, withdrawals and loans are available. However, penalties and taxes may affect your decision

Without a Life Insurance policy, your family may have to tap into their savings, retirement, or 401k to help cover final expenses and everyday living expenses, should a breadwinner die unexpectedly.

Here’s How It WorksYou choose the coverage that’s right for you and your family. With planning, the death benefit can pass to your beneficiaries free from state or federal estate taxes. Consult with your tax advisor for specific information. Then, when life comes to an end, your beneficiary will receive a tax-free death benefit that can be used to help pay for funeral expenses, mortgage payments and more.

With Allstate Benefits, you gain peace of mind knowing your loved ones will receive a financial safety net when you die – think of it as your final gift of love.


50%+ say additional living expenses, such as Internet, cable and cell phone costs prevent them from purchasing life insurance.4

Almost 70% say required cost-of-living expenses are keeping them from buying some or more life insurance.4

Universal Life Insurancefrom Allstate Benefits

Benefits are paid directly toyour designated beneficiary

You choose the death benefit to protect your family members, should you die unexpectedly

CHOOSEUpon death, your loved ones are faced with several personal and financial decisions that can be overwhelming

USEYour beneficiary files a claim. The death benefit is paid directly to your beneficiary

FILE

Provides your beneficiary a lump-sum cash benefit when you die

ABJ23577X-2 Page 10 of 16

ABJ23577X-2 of 16

Benefits

Life: Pays a lump-sum cash benefit when you die.

Base Policy Benefit

Our cash benefits provide greater coverage options because you or your beneficiary get to determine how to use them.

YOUR BENEFICIARY DECIDES how to use the cash benefits

Finances The Accelerated Death Benefit rider can help protect your HSAs, savings, retirement plans and 401ks from being depleted

Travel Your coverage will provide cash benefits to your beneficiary to help with travel related funeral expenses

Home Your beneficiary can use the cash benefits to help pay the mortgage, continue rental payments, or perform needed home repairs

Expenses The lump-sum cash benefit can be used to help pay your family’s living expenses such as bills, electricity and gas

Partial Withdrawals, Surrenders and Non-Qualified Additional Benefit Rider Charges and Loans May Be Subject To Taxes and PenaltiesPartial withdrawals, surrenders, non-qualified additional benefit rider charges and loans from life insurance policies may be subject to ordinary income taxes and possibly an additional 10% federal tax penalty. Outstanding loan balances and withdrawals generally reduce the death benefit and cash value. With proper planning, the death benefit can pass to your beneficiaries free from state or federal estate taxes. Please consult with your tax advisor for specific information.

Life Benefit You may be required to answer health questions at enrollment. Coverage may be available with reduced underwriting through your employer during your initial enrollment period. If you enroll after your initial enrollment period, answers to health questions are required.

Your employer has chosen to include the following rider benefits. The full certificate detailing your coverage will be delivered to you.

Additional Riders‡

Accelerated Death Benefit for Terminal Illness (issue ages: 0-75)

Children’s Term (issue ages: your age 18-65)

‡The riders listed above have exclusions and limitations.

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Like most, unless you know someone who has been disabled, you may not see the value of Disability Insurance. You may think it won’t happen to you, but if it does, you are vulnerable to lost income.

6 Council for Disability Awareness, 2014 Disability Awareness Study

Key Features• You choose the monthly maximum benefit level that meets your needs

• Premiums are affordable and conveniently payroll deducted

• You can take your coverage with you if you leave your job or your employer cancels coverage

An injury or sickness may slow you down, but it won’t slow down your monthly bills. Expenses such as house and car payments, or even daily expenses such as groceries and gas, will still need to be paid. Disability insurance can help replace your lost income and help ensure your finances are not depleted.

Here’s How It WorksYou choose the maximum monthly benefit level that meets your needs. If you are faced with a period of unexpected sickness or off-the-job injury, you will receive cash benefits to use as you see fit. This could include medical treatments, daily living expenses and more.

With Allstate Benefits, you gain the power to make treatment decisions without putting your finances at risk.


57 percent of working Americans have no disability insurance and are therefore vulnerable to losing their income due to an illness or injury6

57%

Disability Insurancefrom Allstate Benefits

Benefits are paid directly to you

You select coverage, which can help protect your income if faced with a disability

CHOOSEYou’re in an accident and suffer a disabling injury. You are unable to work and your paycheck stops

USEYou file a claim online to begin receiving cash benefits each month you are disabled

CLAIM

Provides a monthly benefit if you are disabled and cannot work

ABJ23577X-2 Page 12 of 16

ABJ23577X-2 of 16

Short Term Disability BenefitsBase Policy Benefits

Monthly Benefit: $4,500

Benefit Period: 24 Months

Elimination Periods for Accident: 14/30 Sickness: 14/30

Premium: ______________

Total Disability

Partial Disability

Recurrent Disability

Pregnancy

Waiver of Premium

Long Term Disability BenefitsBase Policy Benefits

Elimination Periods for Accident: 180 Days Sickness: 180 Days

Premium: ______________

Total Disability

Partial Disability

Recurrent Disability

Waiver of Premium

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Group Voluntary Disability (GVD-4000)Short-Term Disability Insurance andLong-Term Disability InsuranceImportant Information About CoverageProvides details of base policy and rider coverage. Below is a list of base policy and rider benefits available with Group Disability coverage. You will receive a certificate that details the certificate specifications for the coverage you purchased. Group Disability Issue ages are 18 and over if Actively at Work.

Benefits Specifications

Total Disability - Pays a benefit for total disability that begins while actively at work. Monthly benefit starts after the Elimination Period has been satisfied. Benefits continue while totally disabled up to the maximum benefit period.

Partial Disability - Pays a benefit when partially disabled from the same sickness or injury, and earnings are 20%-80% of pre-disability earnings. Payments continue while partially disabled up to the length of the benefit period, but not beyond the maximum benefit period.

Recurrent Disability: (1) Short Term Disability only - Pays a benefit when disabled from the same or related cause after performing your regular occupation for 14 consecutive days, without a new waiting period or maximum benefit period. (2) Long Term Disability only - Pays a benefit when disabled from the same or related cause within 6 months of recovery, and it is considered the same disability; you will not be required to satisfy a new Elimination Period. Any disability that occurs after 6 months from the date your prior claim ended will be treated as a new claim.

Pregnancy (Short Term Disability only) - Pays a benefit for total disability due to pregnancy the same as any other total disability.

Waiver of Premium: (1) Short Term Disability only - Pays your premium after monthly disability benefi ts are payable for 90 days in a row, for as long as monthly benefits are payable. (2) Long Term Disability only - No premium payments are required for coverage while you are receiving or were entitled to receive payments under the plan.

Continuation of Coverage - Coverage may continue for up to 24 months as long as you have been insured for at least 12 consecutive months. Must not be retired, disabled, on leave of absence, or covered by any other group disability plan. Subject to the employer’s continuation of the group policy.

How We Calculate Your Monthly Benefit - To calculate your monthly benefit we: (1) Multiply your monthly earnings by 60%. (2) Determine the lesser of item 1 and the maximum monthly benefit amount issued to you. (3) Subtract deductible sources of income from item 2. (4) Pay the greater of item 3 or $100.

Deductible Sources of Income - The amount that you receive, or are eligible to receive, as disability income payments such as state benefit plans, other employee benefits, salary continuation or sick leave, Social Security or other federal benefits. Any others will be listed in your certificate.

Certificate and Rider Exclusions and Limitations(a) Allstate Benefits does not pay benefits for disabilities resulting from: (1) (Short Term Disability only) loss of professional or occupational license or certification; (2) participation in a felony; (3) intentionally self-inflicted injuries; (4) active participation in a riot; (5) committing a crime for which you are convicted under state or federal law; (6) (Short Term Disability only) pre-existing condition; (7) (Short Term Disability only) occupational sickness or injury; (8) war or act of war. (b) We will not pay a benefit for any period of disability during which you are incarcerated. Workers’ Compensation or State Disability Insurance - This coverage does not replace or affect the requirements for coverage by any Workers’ Compensation or state disability insurance.

Pre-Existing Condition LimitationWe do not pay benefits for disability that starts within 12 months of your effective date from a pre-existing condition. You have a pre-existing condition if you received medical treatment, consultation, care or services, including diagnostic measures or took prescribed drugs or medicines in the 12 months prior to the effective date of coverage.

Conditions, Limitations and Exclusions Affecting Your BenefitsWhen Coverage Ends Coverage ends when the policy is canceled; premium payments stop; the last day of active employment, unless coverage is continued through “Temporarily Not Working” provision you or your class is no longer eligible.

Portability PrivilegeCoverage may be continued under the Portability Provision when coverage under the policy ends.

DefinitionsTotal Disability: (1) Short Term Disability only - When, because of sickness or injury, you are unable to perform the material and substantial duties of your own occupation. (2) Long Term Disability only - During the Elimination Period and the first 24 months of benefits, when, because of sickness or injury, you are unable to perform the material and substantial duties of your regular occupation and you are not working in any occupation. After 24 months of benefits, you are considered disabled if you are not working, and due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training, or experience; or working in any occupation and continue to have 20% or more loss in monthly earning due to your sickness or injury.

Partial Disability - You are partially disabled when you have received benefits for total disability for at least one month and then are able to perform some but not all of your duties and continue to have at least a 20% loss in your monthly earnings.

Elimination Period - A period of continuous total disability which must be satisfied before you are eligible to receive benefits.

Regular Occupation (Short Term Disability only) - The occupation you are performing when disability begins.

Maximum Benefit Duration (Long Term Disability only) - Normal Social Security Retirement Age.

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This brochure is for use in the Ingles Markets, Inc. enrollment sitused in: NC

Rev. 1/17. This material is valid as long as information remains current, but in no event later than January 1, 2020.

Group Voluntary Accident benefits provided by policy form GVAP6, or state variations thereof. Rider benefits provided by the following forms or state variations thereof: Accident Treatment and Urgent Care Rider GP6AUC, Dislocation/ Fracture Rider GP6DF, Emergency Room Services Rider GP6ERS, Outpatient Physician’s Benefit Rider GP6OPT, Accidental Death, Dismemberment and Functional Loss Rider GP6ADD, and Benefit Enhancement Rider GP6BE.

Group Voluntary Critical Illness benefits provided by policy form GVCIP4, or state variations thereof. Critical Illness Rider benefits provided by the following rider forms, or state variations thereof: Supplemental Critical Illness Rider GCIP4SR2 and Fixed Wellness Rider GCIP4FWR.

Group Voluntary Short Term Disability benefits provided by insurance policy GVD-4000, or state variations thereof.Group Voluntary Long Term Disability benefits provided by insurance policy GVD-4000, or state variations thereof.

Group Universal Life Insurance benefits provided by policy form GUL22P, or state variations thereof. Rider benefits provided by the following forms or state variations thereof: Accelerated Death Benefit for Terminal Illness GULBR, and Children’s Term GUCTR. It is possible that coverage will expire when either no premiums are paid following the initial premium or subsequent premiums are insufficient to continue coverage.

The Health policies and riders provide Limited Benefit Supplemental Insurance. Critical Illness Insurance policy does not provide benefits for any other sickness or condition. The policies are not Medicare Supplement Policies. If eligible for Medicare, review Medicare Supplement Buyer’s Guide available from Allstate Benefits.

This brochure highlights some features of the policies and riders but is not the insurance contract. For complete details, contact your Allstate Benefits Agent. This is a brief overview of the benefits available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the insurance, including exclusions, restrictions and other provisions are included in the certificates issued.The coverage does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

Access Your Benefits and Claim Filings Accessing your benefit information using MyBenefits has never been easier.

MyBenefits is an easy-to-use website that offers you 24/7 access to important information about your benefits. Plus, you can submit and check your claims (including claim history), request your cash benefit to be direct deposited, make changes to personal information, and more.

Our cash benefits provide you with greater coverage options because you get to determine how to use them.

Finances Can help protect your HSAs, savings, retirement plans and 401ks from being depleted

Travel You can use your cash benefits to help pay for expenses while receiving treatment in another city

Home You can use your cash benefits to help pay the mortgage, continue rental payments, or perform needed home repairs for your after care

Expenses The lump-sum cash benefit can be used to help pay your family’s living expenses such as bills, electricity and gas

YOU DECIDE how to use the cash benefits

Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. ©2017 Allstate Insurance Company. www.allstate.com or allstatebenefits.com

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