Life and Accidental Death and Dismemberment (AD&D) Insurance

Transcription

1 Life and Accidental Death and Dismemberment (AD&D) Insurance This dcument is a Summary Plan Descriptin (SPD), as defined by the Emplyee Retirement Incme Security Act f 1974 (ERISA), f the Tys R Us, Inc. Life and Accidental Death and Dismemberment Insurance Plan. This SPD is a summary f the main features f the Plan in effect as f July 1, Details f the Plan are cntained in the insurance cntract that legally gverns the Plan. If there is any discrepancy between the infrmatin cntained in this dcument and the insurance cntract, the insurance cntract will always gvern. If there are legal rules that require changes that are nt yet written int the cntract, the cntract will be interpreted by the Plan Administratr as including thse legal rules. Please nte that nthing in this dcument is meant t imply a cntract r guarantee f emplyment. Participatin in the Plan des nt preclude Tys R Us, Inc. frm terminating yur emplyment at any time, whether r nt fr cause, with r withut ntice. Please read this dcument carefully and share the infrmatin with yur family. If yu have any questins abut this Plan, please cntact the R Us Benefits Center at This Summary Plan Descriptin supersedes and replaces any previus SPDs yu have received describing the Life and Accidental Death and Dismemberment Insurance Plan. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

2 Cntents Life and Accidental Death and Dismemberment Insurance at a Glance... 3 Basic Life and AD&D Insurance... 3 Supplemental Life and AD&D Insurance... 3 Spuse and Child Life Insurance... 4 Naming a Beneficiary... 5 Evidence f Insurability... 5 When Cverage Changes are Effective... 6 Imputed Incme... 6 Accelerated Benefit... 7 Payment f Benefits... 8 Basic and Supplemental Life Insurance... 8 Cma Benefit... 9 Spuse and Child Life Insurance... 9 Additinal AD&D Insurance Benefits... 9 Seat Belt and Air Bag Benefits... 9 Educatin Benefit (Supplemental AD&D Only) Child Care Benefit (Supplemental AD&D Only) Repatratin f Remains Exclusins If Yu Becme Disabled Claiming Benefits Other Imprtant Infrmatin Terminatin f Cverage Extensin f Cverage Cnversin Privilege Prtability Plan Assignment f Life and AD&D Insurance Glssary f Key Terms Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

3 Life and Accidental Death and Dismemberment Insurance at a Glance Here are the highlights f the Life and Accidental Death and Dismemberment (AD&D) Insurance Plan. Benefits may be subject t certain limits and restrictins. Be sure t review the rest f this Summary Plan Descriptin (SPD) fr a mre cmplete descriptin f Plan benefits. Fr infrmatin abut participatin requirements, see Eligibility and Enrllment; see Administrative and Legal Infrmatin fr hw t file a claim, legal ntices and where t btain additinal infrmatin. Basic Life and AD&D Insurance Basic Life and AD&D Insurance is prvided by the Cmpany, autmatically and at n cst t yu. If yu are a: Yur Basic Life Insurance is: Yur Basic AD&D Insurance is: Management r full-time hurly team member Executive Grade Level F and abve One times yur annual earnings*, up t a maximum benefit f $1,000,000 One times yur annual earnings*, up t a maximum benefit f $1,500,000 One times yur annual earnings*, up t a maximum benefit f $1,000,000 One times yur annual earnings*, up t a maximum benefit f $1,500,000 * If nt a multiple f $1,000, yur annual earnings will be runded t the next higher $1,000. Supplemental Life and AD&D Insurance Benefit: Supplemental Life Insurance Supplemental AD&D Insurance Yu can elect this cverage amunt: Yu can elect cverage f 1, 2, 3, 4 r 5 times yur annual earnings, up t a maximum benefit f $1,500,000. Evidence f Insurability (EOI) may be required fr amunts ver the lesser f 3x annual earnings r $750,000. Yu can elect cverage f 1, 2, 3, 4 r 5 times yur annual earnings, up t a maximum benefit f $1,500,000. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

4 Spuse* and Child Life Insurance Yu can purchase Life Insurance fr yur eligible dependents. Fr yur: Yu can elect this cverage amunt: Spuse r dmestic partner $10,000, $25,000, $50,000, $75,000 r $100,000 Each eligible dependent child $5,000 r $10,000 Cverage fr yur spuse r dmestic partner cannt exceed 100% f yur Basic and Supplemental Life Insurance cmbined. Fr example, if yu have: $50,000 f Basic Life Insurance nly, yu can elect up t $50,000 f Life Insurance fr yur spuse r dmestic partner $50,000 f Basic Life Insurance, plus an additinal $100,000 f Supplemental Life Insurance, yu can elect as much as $100,000 f cverage fr yur spuse r dmestic partner, which is the maximum amunt allwed. If yu elect cverage fr yur spuse r dmestic partner, evidence f insurability (EOI) may be required under certain circumstances. *Spuse Life Insurance includes life insurance fr a Spuse r Dmestic Partner. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

5 Naming a Beneficiary Yu name a beneficiary fr yur Life and AD&D Insurance benefits when yu becme eligible fr cverage. Yu can name anyne yu wish as beneficiary, and can change yur beneficiary designatin at any time (unless yu elect t assign yur Insurance see Assignment f Life and AD&D Insurance). T name r change yur beneficiary, lg n t ibenefitcenter.cm/tysrus r call the R Us Benefits Center at Yu are autmatically the beneficiary fr any Spuse/Dmestic Partner and Child Life Insurance benefits. Evidence f Insurability Evidence f Insurability If yu elect Supplemental r Spuse/Dmestic Partner Life Insurance, yu may be asked t prvide satisfactry evidence f insurability (EOI) t the Insurance cmpany if: During yur initial enrllment: Yu elect Supplemental Life Insurance, and the amunt f cverage yu request exceeds the lesser f three times yur annual earnings r $750,000 (the amunt in excess f three times yur earnings r $750,000 is subject t EOI) r Yu elect Spuse Life Insurance in excess f $25,000. During Annual Enrllment r fllwing a life event yu request a cverage increase f: Mre than ne multiple f salary fr Supplemental Life Insurance r Mre than ne level fr Spuse Life Insurance. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

6 When Cverage Changes are Effective When evidence f insurability is required yur new r increased cverage and yur cntributins fr that cverage begin n the later f the date yu receive written apprval frm the Insurance cmpany r the date the Annual Enrllment increase ges int effect. The amunt f cverage that will remain in frce while pending EOI, will be capped per the fllwing: Supplemental Life Insurance: During yur initial enrllment perid, yu increase t an amunt that exceeds the lesser f three times yur annual earnings r $750,000 yur Supplemental Life cverage will be capped at three times yur earnings r $750,000 (whichever is less). During Annual Enrllment r within 31 days f a qualifying life event by mre than ne times yur annual earnings yur Supplemental Life cverage will be capped at yur previusly elected and apprved amunt r $750,000, whichever is less. Spuse Life Insurance During yur initial enrllment perid Spuse Life Insurance is capped at $25,000 During Annual Enrllment r within 31 days f a qualifying life event, yur Spuse Life Insurance cverage will be capped at yur previusly elected and apprved amunt. If yur annual base pay changes, yur Life and AD&D Insurance will change n the same day yur pay changes. Yu must be actively at wrk n the day yur new r increased cverage is t becme effective. If yu are nt actively at wrk n that day, any change in cverage will becme effective n the first day yu return t active wrk. Imputed Incme As required by the IRS, Cmpany-prvided life insurance ver $50,000 is subject t imputed incme. The effect f imputed incme depends n yur age and the amunt f Cmpany-prvided Basic Life Insurance cverage ver $50,000. Imputed incme is added t yur taxable incme n yur W-2 Frm. T assist yu in determining yur tax liability, yur imputed incme is shwn as Grup Term Life under Other Benefits sectin n yur pay stub. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

7 Accelerated Benefit If a cvered persn (yu, yur spuse/dmestic partner r yur child/dmestic partner s child) is diagnsed as terminally ill i.e., with a life expectancy f 12 mnths r less, r if diagnsed with ne f the fllwing medical cnditins: Amytrphic Lateral Sclersis (Lu s Gehrig s disease); End Stage heart, kidney, liver and/r pancreatic rgan failure and yu are nt a transplant candidate; A medical cnditin requiring artificial life supprt, withut which yu wuld die; r A permanent neurlgical deficit resulting frm a cerebral vascular accident (strke) r a traumatic brain injury which are bth expected t result in life-lng cnfinement in a hspital r skilled nursing facility. yu can elect t receive payment f up t 75% f that cvered persn s Life Insurance benefit, but in n case mre than $500,000. Yu must make this electin in writing, and submit acceptable prf f the diagnsis t the Insurance cmpany. Payment is made t yu in a lump sum. The death benefit payable will be reduced by the full amunt f the accelerated benefit yu receive. Yu can use the prceeds frm the accelerated benefit fr any purpse. Hwever, yu are nt eligible t receive an accelerated benefit if: The cvered persn s Life Insurance has been assigned r Yu are required by law r by a gvernment agency t use the mney t pay ff creditrs, r t qualify fr r keep a gvernment benefit. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

8 Payment f Benefits Basic and Supplemental Life Insurance The full amunt f yur Basic and Supplemental Life Insurance is paid t yur named beneficiary(ies) if yu die frm any cause. Payment will be made in a lump sum. The full amunt f yur Basic and Supplemental AD&D Insurance will be paid t yur beneficiary(ies) in additin t any Basic and Supplemental Life Insurance benefits if yu die as the result f and within 365 days after an accident. Payment will be made in a lump sum. If yu suffer a lss listed belw as the result f and within 365 days after an accident, yu will receive all r a prtin f yur AD&D Insurance as fllws. If Yu Lse*: Yu Receive This Percentage f Yur AD&D Insurance: Sight f bth eyes 100% Speech and hearing in bth ears 100% Bth hands, bth feet, r ne hand and ne ft 100% One hand r ne ft and sight f ne eye 100% Bth hands, bth feet and/r sight f bth eyes 100% Bdily functin due t quadriplegia r 100% Bdily functin due t hemiplegia, r paraplegia 75% One hand r ne ft r sight f ne eye 50% Speech r hearing in ne r bth ears 50% Thumb and index finger f the same hand 25% Bdily functin due t uniplegia 25% If Yu Have: Third degree burns cvering 75% r mre f the cvered persn s bdy Third degree burns cvering 50%-74% f the cvered persn s bdy Yu Receive This Percentage f Yur AD&D Insurance: 100% 50% * Lss f hand r ft means severance at r abve the wrist r ankle. Lss f sight, hearing r speech means a ttal and permanent lss. Lss f thumb and index finger means severance at r abve the pint at which they are attached t the hand. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

9 Cma Benefit The plan will pay a mnthly benefit if yu suffer a bdily injury and are in a cma slely and as a direct result f an accident, if all f the fllwing ccur while cvered by the plan: The bdily injury is caused by a cvered accident; and Yu becme cmatse within 30 days after the accident; and The cma is the direct result f yur accident; and Yu remain cntinually cmatse fr at least 30 days in a rw. Written prf that yu are in a cma must be prvided t Aetna within 60 days after the date yu becme cmatse. The first mnthly benefit will be payable n the first day f the mnth fllwing the date yu have been in a cma fr at least 30 days. The mnthly benefit is payable fr 11 mnths. After yu have been cntinually cmatse fr 12 mnths, the plan will pay the remainder f the principal sum. 5% f yur principal sum per mnth payable fr up t 11 mnths in a rw 45% f yur principal sum if still cmatse in mnth 12. The fllwing prvisins als apply t AD&D Insurance: N mre than 100% f yur cverage will be paid fr all lsses resulting frm ne accident. Expsure t the elements will be cnsidered an accidental bdily injury. Yu will be presumed t have died if yur bdy is nt fund within ne year fllwing yur disappearance, r the sinking, stranding r wrecking f a vehicle in which yu were riding. Spuse and Child Life Insurance Yu are autmatically the beneficiary fr any Spuse and Child Life Insurance benefits. Payment will be made in a lump sum. Additinal AD&D Insurance Benefits In additin t the amunt payable fr yur lss, the Plan may pay the fllwing AD&D benefits. Seat Belt and Air Bag Benefits Yur beneficiary may be eligible fr the seat belt benefit if yu were the driver r passenger in a car invlved in an accident resulting in yur death and yu were wearing a seat belt. If, in additin t wearing yur seat belt, yu were in a seat designed t be prtected by an airbag, the Plan may als pay the air bag benefit. Each benefit (seat belt and air bag) equals the lesser f: 10% f yur Basic and Supplemental AD&D Insurance r $10,000. These benefits are nt payable if the car was engaged in a speed r endurance test, acrbatic r stunt driving, fr any illegal purpse r if the driver f the car was under the influence (DUI). Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

10 Educatin Benefit (Supplemental AD&D Only) If yu have Supplemental AD&D Insurance and yu die as a result f a cvered accident, yur eligible dependents may be eligible fr a tuitin reimbursement benefit, as fllws: Yur spuse r dmestic partner if he/she enrlls in a prfessinal r trade prgram t enhance his r her ability t earn a living within 12 mnths after yur death. Benefits are paid t yur spuse/dmestic partner (r t his r her estate in the event f death). Yur dependent child (r children) under age 23 wh at the time f yur death is enrlled as a full-time cllege r university student r is in the 12 th grade and becmes a full-time cllege r university student within 365 days after yur death. Benefits are paid t the persn r institutin that appears t have assumed main supprt fr the dependent child as determined by the Insurance cmpany. The benefit, which is paid annually fr up t fur cnsecutive years (r up t age 23 fr a dependent child, if earlier), equals the lwest f the fllwing: The actual tuitin charged 5% f yur Supplemental AD&D Insurance r $5,000. Child Care Benefit (Supplemental AD&D Only) This benefit is payable if yu have Supplemental AD&D Insurance and die as a result f a cvered accident, and at the time f yur death yu have a dependent child (r children) under age seven wh is: Enrlled at a child care center r Enrlls within 90 days f yur death. The benefit, which is paid annually fr a maximum f fur years (r until the child reaches age seven, if earlier) equals the lwest f the fllwing: The actual child care cst 5% f yur Supplemental AD&D Insurance r $5,000. Benefits are paid t the persn r institutin that appears t have assumed main supprt fr the dependent child as determined by the Insurance cmpany. Nte: The child care benefit can be paid nly nce fr each eligible child. Repatriatin f Remains The plan pays a benefit f up t $5,000 fr the preparatin and transprtatin f yur bdy t a mrtuary if yu die as a result f an accident mre than 200 miles frm yur principal place f residence. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

11 Exclusins Accidental Death and Dismemberment (AD&D) Insurance des nt cver injury r death resulting frm: Suicide, attempted suicide, r intentinally self-inflicted injuries (whether sane r insane) Bdily r mental infirmity. Illness r the medical r surgical treatment f an illness, whether the lss results directly r indirectly frm the treatment yu received Illness, Ptmaine, r bacterial infectin, unless caused by an infectin which results directly frm the injury r Surgery needed because f the injury. Cmmitting r attempting t cmmit a felny A war r act f war, whether declared r nt (except acts f terrrism) Use f alchl r intxicants r drugs while perating any frm f a mtr vehicle whether r nt registered fr land, air r water use. A mtr vehicle accident will be deemed t be caused by the use f alchl, intxicants r drugs if it is determined that at the time f the accident yu r yur cvered dependent were: -Operating the mtr vehicle while under the influence f alchl at a level which meets r exceeds the level at which intxicatin wuld be presumed under the laws f the state where the accident ccurred, If the accident ccurs utside f the United States, intxicatin will be presumed if the persn s bld alchl level meets r exceeds.08 grams per deciliter; r -Operating the mtr vehicle while under the influence f an intxicant r illegal drug; r -Operating the mtr vehicle while under the influence f a prescriptin drug in excess f the amunt prescribed by the physician; r -Operating the mtr vehicle while under the influence f an ver the cunter medicatin taken in an amunt abve the dsage instructins. Inhalatin f pisnus gases. Intended r accidental cntact with nuclear r atmic energy by explsin and/r release. Ligature strangulatin resulting frm aut-ertic asphyxiatin. Travel in an aircraft, if yu are a pilt r crew member, r if the aircraft is nt intended r licensed fr transprtatin f passengers. If Yu Becme Disabled If yu are receiving disability benefits frm a Cmpany-spnsred LTD Plan, yur Life and AD&D Insurance cntinues while yu are still cnsidered an emplyee, as lng as yu prepay any premiums fr Supplemental cverage. If yur emplyment is terminated, yu will be ffered the ptin t cntinue yur cverage by cnverting it t individual insurance. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

12 Claiming Benefits In case f yur (r yur cvered dependent s) death r ther cvered lss due t an accident yu r yur beneficiary shuld cntact the R Us Benefits Center. The R Us Benefits Center will ntify the Insurance Cmpany f the death and the Insurance Cmpany will send a letter t yu r yur beneficiary explaining the claim prcess. Claims fr AD&D benefits must be submitted t the Insurance cmpany within 90 days after the date f the lss, r as sn as reasnably pssible (Life Insurance claims may be submitted at any time). N benefits can be paid until the frms and necessary prf f lss have been submitted t the Insurance Cmpany. The Insurance Cmpany will make all decisins with respect t the payment f benefits. Other Imprtant Infrmatin Terminatin f Cverage Life and AD&D Insurance stps n the date: Yu (r yur dependent) are n lnger eligible The grup plicy ends Yu fail t timely pay any required cntributins Yur emplyment ends. If yur emplyment ends, the R Us Benefits Center will send yu infrmatin regarding yur ptins t cntinue yur insurance. Cntact the R Us Benefits Center with any questins yu may have. Extensin f Cverage While n an apprved leave f absence, yur Life and AD&D Insurance will cntinue fr up t: Tw years fr salaried exempt, nn-exempt management, and hurly team members classified as management One year fr full-time hurly. While yu are receiving a regular paycheck, any cntributins yu must pay will cntinue t be deducted frm yur pay. If yur pay stps (r is reduced t a pint where cntributins cannt be taken), it is yur respnsibility t cntinue t pay any required cntributins. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

13 Cnversin Privilege Yu can cnvert all r part f yur Basic and Supplemental Life, as well as yur Spuse and/r Child Life Insurance, t an individual life insurance plicy if yur cverage ends because: Yur emplyment ends Yu (r yur dependent) are n lnger eligible The grup plicy is canceled after yu have been cvered fr at least five years. Yu cannt cnvert Supplemental Life r Spuse and Child Life Insurance if it ends because yu stp yur cntributins. AD&D Insurance can be cnverted t an individual plicy when yu cnvert yur Basic and/r Supplemental Life Insurance. Nte: If yur cverage ends because Life Insurance fr all team members in yur emplyment class is cancelled, yu may cnvert nly the amunt f cverage nt being replaced by anther insurance cmpany cntract r $10,000, whichever is less. T cnvert, yu must apply t the Insurance cmpany and pay the first premium within 31 days after yur cverage stps. Evidence f insurability is nt required t cnvert yur cverage. If yu elect t cnvert, yu cannt chse t cntinue cverage thrugh the Prtability Plan unless yu have applied fr the Prtability Plan, and elected t submit evidence f insurability which the Insurance cmpany fails t accept. Yu can als cnvert any amunt f insurance yu had in excess f the Prtability Plan maximum. Prtability Plan If yur Basic, Supplemental r Spuse and Child Life and/r Supplemental AD&D Insurance cverage ends, yu can elect t cntinue yur cverage under the Prtability Plan (a grup term life insurance plan) instead f cnverting yur cverage t an individual plicy. T qualify fr the Prtability Plan, yu must: Be actively at wrk n the day yur cverage ends Be under 98 years ld (under age 19 fr an eligible dependent child; 23 if a full-time student) and Have at least $5,000 f cverage in effect. Yur cvered dependents can cntinue their cverage nly if yu are cntinuing yur cverage. Yu cannt qualify if yur cverage ends because: Or are disabled Yu fail t pay yur cntributins fr cverage The grup plicy is canceled and within 31 days yu becme eligible under a replacement plicy. Yu can cntinue any amunt f insurance up t the amunt f cverage yu had befre it ended up t a maximum f five (5) times yur annual earnings r $1 millin, whichever is less. Yu may chse t cnvert any amunt f insurance ver the Prtability Plan maximum t an individual plicy (see Cnversin). Under the Prtability Plan, benefits reduce at age 65 t 65% f the amunt yu chse t cntinue, at age 70 t 40%, at age 75 t 25% t a minimum f $5,000 and cverage ends at age 99. T cntinue yur cverage, yu must apply t the Insurance cmpany and pay the first premium within 31 days after yur cverage stps. Evidence f insurability is required t cntinue cverage in amunts ver $500,000. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

14 Assignment f Life and AD&D Insurance Yu may make an irrevcable assignment f the ttal amunt f yur Life and/r AD&D Insurance cverage fr any reasn ther than t prvide cllateral fr a lan. Yu can assign Life and AD&D cverage separately; they are nt autmatically assigned tgether. Assignment means yu give up all rights, title and interests bth present and future t this insurance even thugh it is yur life that is insured. The assignment cannt later be revked by yu. The persn t whm yu assign yur insurance has the abslute and cntinuing right t name beneficiaries, cnvert t individual cverage r t exercise any ther privileges which wuld have therwise been available t yu. The persn t whm yu assign yur insurance may becme yur beneficiary, but nly if that persn names themselves as beneficiary. Yu will cntinue t be the beneficiary fr Spuse/Dmestic Partner and/r Child Life Insurance. Because f the varius legal and tax implicatins invlved, yu may wish t cnsult with bth yur lawyer and tax advisr befre taking any such actin. If yu wish t make an assignment, cntact the R Us Benefits Center fr the apprpriate frm and instructins. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

15 Glssary f Key Terms T help yu understand hw the Life and Accidental Death and Dismemberment (AD&D) Insurance Plan wrks, yu shuld familiarize yurself with the fllwing key terms. Annual earnings Fr: Salaried team members is yur annual base pay including annual target bnus if applicable, but excluding cmmissins, ther bnuses, vertime pay r any ther extra cmpensatin r incme received frm ther surces n the day befre a lss ccurs. Hurly team members is yur hurly rate excluding cmmissins, ther bnuses, vertime pay r any ther extra cmpensatin r incme received frm ther surces n the day befre a lss ccurs, times: 2,470 hurs if yu are an hurly nn-exempt team member classified as management 2,080 hurs if yu are a full-time team member 1,196 hurs if yu are a part-time team member. Beneficiary The persn r persns yu designate t receive payment f yur Life and Accidental Death and Dismemberment (AD&D) Insurance benefits. Yu can name anyne as yur beneficiary, and can change yur chice at any time (unless yu elect t assign yur Insurance see Assignment f Life and AD&D Insurance). If yu d nt have a designated beneficiary at the time f yur death, r if yur beneficiary dies befre yu, yur insurance will be paid in a lump sum t the survivrs listed belw in the fllwing rder f pririty: Spuse (excludes dmestic partner) Child(ren) Parent(s) Siblings(s) Yur estate. Cma A state f uncnsciusness frm which yu cannt be awakened, even by pwerful stimulatin, as determined by yur dctr. Cmpany Tys R Us, Inc. Dependent child Yur child under age 23 wh depends n yu fr supprt and lives with yu in a permanent parent-child relatinship. Children include natural r adpted children, stepchildren, yur dmestic partner s children r fster children. The age limit des nt apply t a disabled child wh is mentally r physically incapable f earning a living if the child is cvered under the Plan prir t the date cverage wuld have ended if he r she was nt disabled. Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan

16 Dmestic partner An individual f the same r ppsite sex with whm yu reside, prvided yu and that individual: Are nt s clsely related that marriage wuld therwise be prhibited Are nt legally married t any ther persn and are the sle partners f each ther Have lived tgether fr at least six (6) mnths in the same residence with the intentin f residing tgether permanently Are bth at least 18 years ld and mentally cmpetent t enter int a cntract Are in a cmmitted and mutually exclusive relatinship, jintly respnsible fr each ther s welfare and financial bligatins, and Are registered as dmestic partners pursuant t a dmestic partnership rdinance r law f a state r lcal gvernment, r yu have filed an Affidavit f Dmestic Partnership with the Cmpany. Hemiplegia Ttal and permanent paralysis f the upper and lwer limbs n ne side f the bdy. Imputed incme The value assigned by the IRS t emplyer-prvided life insurance ver $50,000. This value, determined by IRS tables, is added t yur taxable incme n yur W-2 Frm. Tys R Us is required by federal law t withhld FICA taxes n imputed incme each pay perid (shwn as W2GRP in the Special Infrmatin sectin n yur pay stub). Ibenefitscenter.cm A benefits website, where yu can access benefits infrmatin and enrll nline fr Medical (including prescriptin drugs), Dental, Visin, Flexible Spending Accunts, Life Insurance, Accidental Death and Dismemberment Insurance, Spuse and Child Life Insurance, and Lng-Term Disability. The site is available 24 hurs a day, seven days a week. Insurance cmpany Aetna Life Insurance Inc. Paraplegia Ttal and permanent paralysis f bth lwer limbs. Quadriplegia Ttal and permanent paralysis f bth upper and bth lwer limbs. Qualifying life event Circumstances under which the IRS permits yu t make changes t yur pre-tax benefit electins during the curse f the plan year, including: A change in yur legal marital status r dmestic partner status The birth r adptin f a child A dependent s lss f eligibility (because he/she reaches the age limit fr cverage, fr example) Death f a dependent A change in yur spuse s eligibility fr cverage A change in yur emplyment status that affects yur eligibility fr cverage (part-time t full-time r full-time t part-time) A change in yur address r wrk lcatin that affects the plans that are available t yu. R Us Benefits Center Call , Mnday thrugh Friday frm 8:00 a.m. t 8:00 p.m. Eastern Time fr assistance with benefit-related questins. Spuse The individual t whm yu are legally married accrding t civil law in the state r ther jurisdictin in which the ceremny tk place (including a cmmn-law spuse if recgnized by state law in yur state f residence). Uniplegia Paralysis f ne limb Tys R Us, Inc. Life and Accidental Death and Dismemberment (AD&D) Insurance Plan