Group Term Life and Accidental Death & Dismemberment Benefits

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1 Group Term Life and Accidental Death & Dismemberment Benefits Group Term Life Insurance (GTL) is designed to provide benefits to your designated beneficiary for loss of life. Accidental Death and Dismemberment (ADD) is payable if within 365 days of a covered accident, you suffer loss of life or dismemberment, occurring on or off the job. Note: Additional information about the benefits and features of this plan will be included in the summary of coverage and in the certificate booklet, which you will receive after enrolling Eligibility All Full Time Active Employees Your Life Benefit is 1 times your annual salary to a maximum of $250,000 Your Accidental Death & Dismemberment Benefit is 1 times your annual salary to a maximum of $250,000 Reduction Schedule Coverage amount will reduce according to the following schedule: Age 70: Amount of insurance reduces by 50% of original amount *Benefits terminate at retirement Waiver of Premium The employee s life insurance may continue in force without premium payment while one becomes totally disabled without interruption for at least six (6) months and the total disability begins before age 60 Right of Conversion When the employee s coverage ceases, an employee may convert all or part of their life insurance to an individual life insurance policy. Accelerated Benefit

2 In cases of terminal illness, the accelerated benefit may be paid only once and in one lump sum to the insured before death occurs. The maximum accelerated benefit will be the lesser of: 1. 75% of the insured s life insurance amount; or2. $250,000. Group Short Term Disability Benefits Short Term Disability (STD) is designed to provide partial income replacement should you become disabled as the result of: Injury Illness Pregnancy USAble Life will pay the weekly benefit if you become disabled while insured and are under the regular care of a physician Weekly STD Benefit is 60% of your weekly earnings to a maximum of $2000 per week Elimination Period Accident: Benefits will begin on the 8 th consecutive days of being out of work for any one period of disability Sickness: Benefits will begin on the 8 th consecutive days of being out of work for any one period of disability Benefit Duration Benefits are payable for a maximum of 13 weeks as long as you remained disabled Group Long Term Disability Benefits

3 Long Term Disability (LTD) is designed to provide partial income replacement for you should you become disabled as the result of a covered sickness or injury Monthly LTD Benefit is 60% of your monthly earnings to a maximum of $10,000 per month Your disability benefit may be reduced by deductible sources of income and any earnings you have while disabled. Please see your certificate of coverage for definitions of deductible sources of income. Elimination Period Benefits will begin after 90 consecutive days of being out of work for any one period of disability Definition of Disability 1. During the Elimination Period you are prevented from performing 1 or more of the essential duties of your occupation. 2. For 24 months following the Elimination Period you are prevented from performing 1 or more of the essential duties of your occupation, and as a result your current monthly earnings are less than 80% of your indexed pre disability earnings. 3. After that you are prevented from performing 1 or more of the essential duties of any occupation, and as a result your current monthly earnings are less than 80% of your indexed pre disability earnings. Benefit Duration Your duration of benefits is based on your age when the disability occurs. Your LTD benefits are payable for the period during which you continue to meet the definition of disability up to the Social Security Normal Retirement Age, and may extend further if disabled if age 60 or above and actively employed. Pre Existing Condition Limitation This limitation applies to conditions for which an employee receives medical services in the 3 months prior to the effective date of coverage. No benefits are payable for a disability resulting from such a condition until the employee has been covered for 6 consecutive months with no medical care for the condition, or until the employee has been covered for 12 consecutive months. In addition, the amount of a benefit increase, which results from a change in benefit options, a change of class or a change in the plan, will not be paid for any disability that is due to, contributed to by, or results from a pre existing condition. Mental Nervous and Substance Abuse Limitation Monthly Benefits for a disability due to mental illness or substance abuse will be payable for up to 24 months during a claimant s lifetime unless hospitalized Exclusions

4 Disabilities not covered under this plan include but are not limited to the following: 1. war or any act of war, or while serving in the armed forces of any country or international authority; 2. attempted suicide or intentional self inflicted injury, while sane or insane; or 3. active participation in a riot or insurrection; or 4. voluntary commission of, or attempting to commit, an assault or a felony; or participating in an illegal occupation; or 5. injury occurring while intoxicated; or 6. elective or cosmetic surgery, except for surgery to repair damage to the natural body caused by an injury or treatment of a sickness; or acting as an organ donor. Additional Benefits New Directions Employee Assistance Program and Will Prep In today s world of continuous and competing pressures, Employee Assistance Programs every day are helping employees and their family members identify challenges that might adversely impact their work performance, health and well being. Through counseling, training, management consultation, and interactive website and crisis intervention services, the EAP can help deliver a positive impact on absenteeism, productivity, turnover and healthcare claims costs. The EAP services provided under this arrangement include the following: Employee Tools Dedicated Call Center Toll free number for 24 hour/365 day access Short Term Counseling Up to three face to face sessions per issue for employees and their benefit eligible dependents Legal and Financial Services Referral for face to face or telephone consultation and extensive online resources including interactive will preparation. Family Resource Service Extensive online resources and national Provider Directories for child and elder care services Work Life/Wellness Interactive online resource for emotional and physical health, legal, financial, family life, and personal growth Online Health Risk Assessments Five online tools for employees to determine their health status Contact New Directs at or visit Member Log in Code: SGE3F

5 Travel Assistance Plan Global Emergency Services from Assist America, protecting you whenever you travel with Assist America s array of resources. As part of your company s benefit plan, you can connect with quality medical care whenever they travel 100 miles or more from home, or in another country. The fully paid global emergency services include: Medical Consultation & Referral, Medical Monitoring, Prescription Assistance, Hospital Admission Guarantee, Emergency Medical Evacuation, Compassionate Visit, Care of Minor Children, Medical Repatriation, Return of Mortal Remains, Emergency Trauma Counseling, Legal & Interpreter Referrals, and much more. Visit for information, or call (in U.S.A) or (outside U.S.A.) if assistance is needed. PURINA Care Pet Health Insurance With the purchase of any Indigo or Blue Cross blue Shield Of MA product, we offer discounted pet insurance through Purina Care, a subsidiary of Purina, a trusted name with over 85 years of understanding pets and the people who love them. To get started visit and enter your code (IISPC) or call PURINA Monday through Friday, 8am to 5pm CST. Remember to provide the code (IISPC) to one of the licensed agents, and receive 5% discount for 1 pet or 10% discount for 2 or more pets. This employee benefit summary provides a brief description of the important features of the coverage. This is not the insurance contract, and only the actual issued policy and certificate provisions will control. The policy and certificate set forth in detail the rights and obligations of both you and the insurance company. Group Name will be provided with certificates for distribution to all covered employee. Please read your certificate carefully Indigo Insurance Services, LLC is a subsidiary of Blue Cross and Blue Shield of Massachusetts, Inc. Indigo sells certain products of USAble Life, which is owned in part by Blue Cross and Blue Shield of Massachusetts, Inc. Registered Marks are the property of their respective owners. TM Trademarks are the property of their respective owners Indigo Insurance Services LLC.

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