Wellness Benefit – Claims Checklist & FAQ

Claims Checklist & FAQ Wellness Bene昀椀t Ready to 昀椀le a claim? Equip yourself with helpful information and documentation before you get started. Information you’ll need: Questions you’ll answer: ☐ Employer or Group name ☐ Date of visit ☐ Group number (optional, but speeds up ☐ Type of screening test the process) ☐ Name of medical provider ☐ Employee name No documentation or forms are generally needed ☐ Employee birthdate for this type of claim. Go the Voya Claims Center and ☐ Employee Social Security number complete the online claim form. ☐ If the claim is for a spouse and/or child, you’ll also need: ☐ Spouse/child’s name ☐ Spouse/child’s birthdate ☐ Spouse/child’s Social Security number What kinds of health screening tests are covered? The Wellness Bene昀椀t provides an annual bene昀椀t payment if you complete a health screening test, whether or not there is any out-of-pocket cost to you. You only need to complete one health screening test, and may only receive a bene昀椀t payment once per year, even if you complete multiple health screening tests. You may also receive a bene昀椀t payment for your spouse and/or children if they are covered for the Wellness Bene昀椀t and complete a health screening test. For a complete description of your available bene昀椀ts, exclusions and limitations, see your certi昀椀cate of coverage and any riders. Health screening tests covered by the Wellness Bene昀椀t include, but are not limited to: • Immunizations • Routine eye exams • Annual physical exams (adults) • Mammography • Routine dental exams • Biometric screenings • Colonoscopy • Bone density screenings • And more ReliaStar LIfe Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY), members of the Voya® family of companies 213330_250007584_03.indd 1213330_250007584_03.indd 1 21/04/2021 17:3521/04/2021 17:35

Additional FAQs Can I receive more than one Wellness Bene昀椀t payment per year? You are limited to one bene昀椀t payment per covered person, per eligible product, per calendar year. A maximum amount payable for all covered children in one calendar year may apply. One health screening can be used to satisfy the requirement for any insurance under which you are also covered by the Wellness Bene昀椀t. For a complete description of your available bene昀椀ts, exclusions and limitations, see your certi昀椀cate of insurance and any riders. Do I need to submit documentation or results related to my screening test? No, you do not need to submit documentation or results. Go to the Voya Claims Center and complete the online claim form with the required information. For a complete description of your available bene昀椀ts, conditions on bene昀椀t determination, exclusions and limitations, see your certi昀椀cate of insurance and any riders. Get started now Start your claim at voya.com/claims You may need to copy/paste "voya.com/claims" into your preferred browser to start the claim process This is intended to be used for information purposes only and does not indicate eligibility for a bene昀椀t. Filing a claim may require any necessary medical records or proof of claim as determined during the review process. This is a summary of bene昀椀ts only. A complete description of bene昀椀ts, limitations, exclusions and termination of coverage will be provided in the certi昀椀cate(s) of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. Insurance products are issued and underwritten by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya® family of companies. Voya Employee Bene昀椀ts is a division of both companies. Product provisions and availability may vary by state or employer’s plan. ©2021 Voya Services Company. All rights reserved. WLT250007584. 1494371 213330-04152021 213330_250007584_03.indd 2213330_250007584_03.indd 2 21/04/2021 17:3521/04/2021 17:35