GapAssistSupplemental coverage to help with unexpected medical costs

Product Guide

✔ Accident

✔ Critical illness

✔ Inpatient hospital

BDM-1035 7/17

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While high-deductible major medical plans can be less expensive in terms of premium, they often result in coverage gaps and can leave employees facing significant out-of-pocket costs. That’s where supplemental coverage—like GapAssist—can help.

GapAssist is a package of accident, critical illness and inpatient hospital benefits that offers an added layer of financial protection to help insureds with unexpected medical costs.

Three GapAssist plan designs —Base, Classic and Premier—are available. Each offers the same core coverage but the benefit amounts vary. You may choose to offer just one plan or any combination of the three based on the needs of your group.

Plan options

Base Classic Premier

Accident $1,000 Per accident,

up to 3 occurrences per calendar year

$2,500 Per accident,

up to 3 occurrences per calendar year

$5,000 Per accident,

up to 3 occurrences per calendar year

Critical Illness

$5,000 First diagnosis after the policy is in effect

$10,000 First diagnosis after the policy is in effect

$15,000 First diagnosis after the policy is in effect

Inpatient Hospital

$200 Per day, up to 5 days per calendar year

$300 Per day, up to 5 days per calendar year

$400 Per day, up to 5 days per calendar year

Finding ways to offer valuable health care benefits while managing expenses can be challenging.

According to a recent survey, 63 million adults in 2016 reported not getting needed care because of cost.1

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GapAssist highlights✔ You choose which plans to offer

✔ HSA-compatible benefits

✔ Guaranteed issue—no medical underwriting

✔ No co-pays, coinsurance or deductibles

✔ Voluntary or employer-paid

✔ No required networks or preferred provider lists

✔ No coordination—benefits paid regardless of any other coverage

Who’s eligible?GapAssist is available to employees, their spouse and dependent child(ren). Premium is tiered based on who is enrolled:

• Employee only• Employee and dependent child(ren)• Employee and spouse• Family

Participation requirementGapAssist plans have minimum participation requirements. Contact your Symetra Life Insurance Company representative for details.

Benefits play a significant role in your ability to build and retain a quality workforce. GapAssist provides first-dollar benefits for your employees while helping to keep your health care budget in check.

47% of Americans “can’t pay for an unexpected $400 expense through savings or credit cards without selling something or borrowing money.”2

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Accident coverage

GapAssist’s accident coverage is designed to help with costs for eligible services and supplies related to an accident that occurs while insureds are covered under the policy.* Benefits will be paid for covered medical, dental, surgical, inpatient hospital, X-ray and lab, and inpatient prescription drug expenses up to the stated benefit amount.

Highlights✔ Covers up to three accidents per calendar year.

✔ Benefits are paid for eligible expenses such as emergency room visits, tests, physician’s fees, and more.

✔ Eligible expenses must be incurred within 52 weeks from the date of the accident with the first expense incurred within 60 days of that date.

How it works

If eligible expenses exceed the selected dollar amount, the full benefit will be paid and employees are responsible for any remaining balance. However, if eligible expenses are lower than the selected amount, benefits are paid only up to the actual billed amount.

Example 2Eligible incurred expenses are less than coverage amount

Example 1 Eligible incurred expenses exceed coverage amount

Here are two examples of how benefits would be paid on a benefit amount of $2,500 per accident occurrence:

Total expenses $3,070

Benefits paid = $2,500

Out-of-pocket costs = $570

Total expenses $1,455

Benefits paid = $1,455

Out-of-pocket costs = $0

Benefit options

Base Classic Premier

Up to Up to Up to$1,000

per accident

$2,500per accident

$5,000per accident

* Unless covered by workers’ compensation or similar law.

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Critical illness coverage

Critical illness coverage is designed to help with those costs not covered by a major medical policy, such as co-pays, transportation, child care and other expenses that can add financial pressure to an already stressful situation.

How it works

Upon the diagnosis of a covered critical illness after the policy is in effect, insureds will receive a lump-sum benefit amount that can be used in any way they choose. The payment will be equal to the benefit amount selected multiplied by the percentage for that covered condition (as shown in the table below).

Covered conditions are grouped into three benefit categories and will pay up to 100% per category. If the diagnosed critical illness does not qualify for the full benefit amount (in other words, the percentage is less than 100%), participants could receive an additional lump-sum benefit upon diagnosis of a different type of critical illness within the same category up to the 100% maximum. Benefits in different categories are subject to a separation period of 12 months between diagnoses.3

Covered critical illness conditions3Percentage of benefit amount paid*

Category 1 • Invasive cancer 100%

• Minor cancer 25%

Category 2 • Heart attack • Stroke 100%

• Coronary artery disease needing surgery or angioplasty 25%

Category 3 • Coma due to accident • End-stage renal disease• Loss of hearing** • Loss of sight** • Loss of speech**

• Major organ failure• Occupational HIV infection• Paralysis due to accident• Severe burns

100%

* The benefit amount reduces by 50% starting at age 70.** Due to accident or specified disease.

Benefit options

$5,000 $10,000 $15,000 Base Classic Premier

Spouse $2,500Child(ren) $1,250

Spouse $5,000Child(ren) $2,500

Spouse $5,000Child(ren) $3,750

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Fixed-payment inpatient hospital coverage

GapAssist’s hospital benefit is designed to help with costs associated with a hospital stay. The benefit also applies to care received in an intensive care unit, or in a substance abuse, mental health or nursing facility. Each facility has a per-day benefit with a calendar year maximum.

How it works

Benefits are paid for eligible services and supplies received in a hospital or authorized facility beginning on the first day of a covered stay lasting at least 24 hours. Benefits for ICU, substance abuse, mental health and nursing facility stays are dependent on the inpatient hospital benefit amount selected (as shown in the table below).

Benefit options

Hospital stay Base:

$200

Classic:

$300

Premier:

$400

Per day, 5 days per calendar year (pcy)

ICU $400 $600 $800 Per day, 5 days pcy

Substance abuse facility $200 $300 $400 Per day, 5 days pcy

Mental health facility $100 $150 $200 Per day, 5 days pcy

Nursing facilityPaid only if following a covered hospital stay of at least three consecutive days and the insured is under age 65.

$100 $150 $200 Per day, 60 consecutive days per stay maximum

A typical charge for a one-day inpatient hospital stay is around $2,100. Most high-deductible plans cover 80% or less of that amount and only after the deductible is met.4

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Service that makes a difference

In-house administration

Implementation, billing, claims processing and benefit payments are all handled in-house by our customer service team. Insureds receive one ID card and have a single point of contact should they have questions or require additional information about their coverage.

Customer Service Hours: 6:30 a.m. to 5 p.m., CT Monday through Friday

Toll-free: 1-800-497-3699 Fax: (715) 682-5919 symsba@symetra.com

Enrollment

Most employees enroll during the annual enrollment period. If an individual does not elect coverage at this time, he/she may have to wait until the next annual enrollment period to sign up.

Anyone hired after annual enrollment has 31 days from the date of hire to elect coverage. Once this eligibility period has passed, they may have to wait until the next annual enrollment period to elect benefits.

Symetra is available to help make your enrollment successful by providing materials, at no additional charge, to help educate employees on their options and the benefits of signing up.

We’re proud of our service and claims records. Our customers tell us that one of the reasons they renew with us year after year is the responsive and personable service they receive from Symetra.

GapAssist insurance policies are not a replacement for a major medical policy or other comprehensive coverage and do not satisfy the minimum essential coverage requirements of the Affordable Care Act. Critical illness and fixed-payment inpatient hospital coverages are designed to provide benefits at a preselected, fixed dollar amount. Coverage may be subject to exclusions, limitations, reductions, and termination of benefit provisions. For costs and complete details of the coverage, contact your Symetra representative. GapAssist policies are insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, and are not available in all U.S. states or any U.S. territory. GapAssist is comprised of and filed as Fixed-Payment Indemnity, Group Accident and Critical Illness insurance policies. Fixed-Payment Indemnity, Group Accident and Critical Illness policies are available on a standalone basis, although pricing may vary. Coverage is provided under generic policy form numbers SBC-01505, SBC-00535 and LGC-10011. 1 The Commonwealth Fund 2016 Biennial Health Insurance Survey.2 Hunter Schwartz, Washington Post, June 8, 2015.3 May vary by state.4 Source: 1999-2014 AHA Annual Survey, Copyright 2015 by Health Forum, LLC, an affiliate of the American Hospital

Association. Special data request, 2015. Available at http://www.ahaonlinestore.com.

Symetra Life Insurance Company 777 108th Avenue NE, Suite 1200 Bellevue, WA 98004-5135www.symetra.com Symetra® is a registered service mark of Symetra Life Insurance Company.

For more information about GapAssist, contact your Symetra representative.