NORTHERN NEW ENGLAND BENEFIT TRUST LIFE INSURANCE ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE

Transcription

1 NORTHERN NEW ENGLAND BENEFIT TRUST LIFE INSURANCE ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE

2 LIFE INSURANCE ACCIDENTAL DEATH AND DISMEMBERMENT INTRODUCTION Life Insurance and Accidental Death & Dismemberment (AD&D) benefits are part of the health and welfare benefits provided by Northern New England Benefit Trust (Trust) to you as a covered employee of Anheuser-Busch, LLC (Company). You and any of your covered dependents will be eligible to receive Life Insurance Benefits and you also will be eligible for AD&D benefits as long as you remain a covered Member with the Trust based on contributions made to the Trust by the Company. Life and AD&D benefits are insured. The Trust is the Contract Holder with the Group Insurer. This document is a summary of the Life and AD&D benefit program. You may request a copy of the Certificate which is the Group Insurance Contract between the Trust and the Group Insurer. Life Insurance Benefit BENEFIT SCHEDULE All Active Members... $100,000 Spouse... $ 50,000* Child... $ 10,000** Accidental Death and Dismemberment Benefit All Active Members... $100,000 * Benefit will be paid to a Domestic Partner who is covered under the health and welfare plans administered by the Trust. ** To be eligible for a benefit, a covered child must be between the ages of 7 days and 19 years or 23 years if the child is a full-time student carrying 12 or more credit hours per enrollment period (or the full-time equivalent).

3 HOW DOES LIFE INSURANCE WORK? Life insurance provides a benefit to you or your family members in the event of a death. Life insurance benefits for you as an active Member will be paid to the beneficiary you select. Beneficiaries must be listed on the Life Insurance Beneficiary Form, which is included in the enrollment package and available online. Life insurance benefits for your spouse, covered domestic partner or child will be paid automatically to you as the Member. You can request a copy of the beneficiary designation form at any time from the Trust. You can change your beneficiary by submitting the completed form to the Trust or by completing the form online. A change in beneficiary becomes effective on the date you sign the form. Beneficiary Fast Facts You may choose anyone to be the beneficiary for your life/accidental death benefit; however this person s name must be on file with the Trust in order to be valid. Keep your beneficiary designation up to date: To make any changes, contact the Trust. For a spouse, covered domestic partner or child, you as the Member is automatically the beneficiary. To File a Claim In the event of your death, your spouse, child(ren) or other beneficiary must provide an original copy of the death certificate to the Trust and apply for the life insurance benefit. In the event of the death of a covered dependent, you as the Member must provide an original copy of the death certificate to the Trust and apply for the life insurance benefit. WHAT DOES CONVERSION MEAN? If your eligibility for coverage under the Trust ends for any reason, you may convert your insurance to an individual life insurance policy through the Trust s Group Insurer. You will not be able, however, to get AD&D coverage on an individual policy nor will you be able to purchase term insurance from the Group Insurer. If you lose coverage under the Trust due to the group life plan ending; or group life coverage being dropped from the group plan you will have the right to convert your life insurance. Your spouse, covered domestic partner and children will also have that right if they were insured under the plan as well.

4 You will be able to convert to an individual policy that provides a benefit equal to the lesser of $10,000 or an amount equal to the amount of your terminated group policy less the amount of any new group life coverage you obtain, within thirty-one (31) days of your loss of coverage under The Trust. You will have thirty-one (31) days to apply for a converted policy and to pay the premium due following the date you lose coverage under the Trust. Provided however, that if you do not receive from the Trust notice of your right to convert to an individual policy within fifteen (15) days from the date your coverage under the Trust ends, you will have an additional fifteen (15) days, to apply and pay for individual coverage, calculated from the date you receive notice from the Trust of your right to convert. If you should die within the thirty-one (31) day conversion period, the amount of insurance you would have been allowed to convert will be paid to your beneficiary, even if you had not yet sent in your application. Premiums for a converted policy depend on your age and risk class. However, you will not be required to furnish any evidence of insurability to obtain your converted policy. OPTION TO ACCELERATE PAYMENT OF DEATH BENEFITS If you become terminally ill as defined below while covered by the Trust, you will have an option to accelerate payment of a portion of your death benefit. You may elect to receive not less than $5,000 but no more than $50,000 of your $100,000 death benefit. You will be considered terminally ill within the meaning of this option if your life expectancy is 12 months or less. If you elect this option, the Group Insurer will pay the proceeds you place under this option in one sum when it receives proof that you are terminally ill. If you do not want the proceeds in one sum, you may elect to have them paid in 12 equal monthly installments. The first monthly payment will be due when the Group Insurer receives proof that you are terminally ill. The other payments are due on the same day of each later month. To Whom Payable: The benefits under this provision are payable to you. Amount Due But Unpaid at Your Death: If you elect monthly installments and you die before all payments have been made, the Group Insurer will pay your Beneficiary or Beneficiaries determined under the Beneficiary Rules in one sum. That sum will be the total of the payments that remain. Conditions: Your right to be paid under this option is subject to these terms: (1) You must choose this option in writing in a form that satisfies the Group Insurer.

5 (2) You must furnish proof that satisfies the Group Insurer that your life expectancy is 12 months or less, including certification by a Doctor. (3) Your death benefit must not be assigned. (4) Terminal illness proceeds will be made available to you on a voluntary basis only. Therefore: in (a) If you are required by law to use this option to meet the claims of creditors, whether bankruptcy or otherwise, you are not eligible for this benefit. (b) If you are required by a government agency to use this option in order to apply for, get or keep a government benefit or entitlement, you are not eligible for this benefit. Effect on Insurance: This benefit is in lieu of the benefits that would have been paid on your death with respect to the terminal illness proceeds. When you elect this option, your $100,000 death benefit will be reduced by the amount paid to you under this option. Also, any amount you could otherwise have converted to an individual contract will be reduced by the terminal illness proceeds. EXTENDED DEATH BENEFIT AND WAIVER OF PREMIUMS DURING TOTAL AND PERMANENT DISABILITY If you become Totally and Permanently Disabled as defined below, your death benefit protection will be extended even though you are no longer covered by other benefits by the Trust if: (1) You become Totally and Permanently Disable while you are covered for other benefits by the Trust; (2) You are less than age 60 when your Total and Permanent Disability starts; and (3) Your Total and Permanent Disability has continued for at least 180 consecutive days. You are Totally and Permanently Disabled for purposes of these extended benefits when, due to sickness, injury or both: (a) (b) You are not able to perform the material and substantial duties of your job during the first 12 months of disability; and thereafter You are not able to perform the material and substantial duties of any gainful job for which you are suited by education, training or experience. To be eligible for the extended death benefit you must submit to the Group Insurer a written notice of claim for the extension and written proof of your Total and Permanent Disability within 36 months from the date your disability begins. If adequate proof of disability is provided, the Group Insurer will extend your death benefit protection for successive one year periods. The first of these periods will start on the date the

6 Group Insurer receives this proof. After that first period, you must give written proof when and as required by the Group Insurer once each year that your disability continues. If you die while your death benefit protection is being extended, the Extended Death Benefit is payable when the Group Insurer receives written proof that: (1) Your Total and Permanent Disability continued until your death; and (2) All of the above conditions have been met. If you die within one year after your Total and Permanent Disability started and before you give the Group Insurer proof of Total and Permanent Disability, written notice of your death must be given to the Group Insurer within one year after your death. Your Extended Death Benefit will be payable to your Beneficiary if: (1) Your Total and Permanent Disability had not lasted at least 180 consecutive days; or (2) The required proof had not yet been received by the Group Insurer. Your extension protection ends if and when: (1) Your Total and Permanent Disability ends; or (2) You reach age 65; or (3) You start to work at any gainful job; or (4) You do not give the Group Insurer any written proof that your Total and Permanent Disability continues within 31 days of the request sent by the Group Insurer to your last address shown on the Group Insurer s records; or (5) You fail to submit to a medical exam by Doctors named by the Group Insurer within 31 days of the request sent by the Group Insurer to your last address shown on the Group Insurer s records. After two full years of this protection, the Group Insurer will not require an exam or proof more than once a year. If your extension protection ends after you have given the first proof of continued Total and Permanent Disability, you will be eligible to convert to an individual life insurance policy as described above as if your employment had then ceased. But this does not apply if you become eligible for life insurance under any group policy within 31 days after this protection ends. WHAT IS ACCIDENTAL DEATH & DISMEMBERMENT COVERAGE? Accidental Death & Dismemberment (AD&D) coverage is available only for you as the active Member. AD&D provides a benefit to your beneficiary in addition to your life insurance benefit in the event of your accidental death. AD&D coverage also provides benefits for the loss of:

7 1. Accidental Loss of Life: 100% of your coverage amount (200% of your coverage amount, if the accident causing death occurs while riding in or on or getting into or out of a common carrier operated under license for transportation of passengers for hire) 2. Accidental Loss of Speech and Hearing: 100% of your coverage amount 3. Accidental Loss of Speech and one hand, foot or Sight of One Eye: 100% of your coverage amount 4. Accidental Loss of Hearing and one hand, foot or Sight of One Eye: 100% of your coverage amount 5. Accidental Loss of both hands or both feet: 100% of your coverage amount 6. Accidental Loss of Sight of Both Eyes: 100% of your coverage amount 7. Accidental Loss of One Hand and One Foot: 100% of your coverage amount 8. Accidental Loss of One Hand and Sight of One Eye: 100% of your coverage amount 9. Accidental Loss of One Foot and Sight of One Eye: 100% of your coverage amount 10. Accidental Loss of One Hand or One Foot: 50% of your coverage amount 11. Accidental Loss of Sight in One Eye: 50% of your coverage amount 12. Accidental Loss of Speech or Hearing: 50% of your coverage amount 13. Accidental Loss of Thumb and Index Finger of same hand: 25% of your coverage amount 14. Accidental Loss of Use of Both Arms and Both Legs: 100% of your coverage amount 15. Accidental Loss of Use of Both Arms or Both Legs: 75% of your coverage amount 16. Accidental Loss of Use of One Arm and One Leg: 75% of your coverage amount 17. Accidental Loss of Use of One Arm or One Leg: 50% of your coverage amount 18. Accidental Loss of Use of Both Hands or Both Feet: 50% of your coverage amount 19. Accidental Loss of Use of One Hand and One Foot: 50% of your coverage amount 20. Accidental Loss of Use of One Hand or One Foot: 25% of your coverage amount Benefit will not be paid if death/injury is caused: 1. by willful self-injury, suicide or attempted suicide 2. by sickness, disease, mental infirmity, medical or surgical treatment 3. while taking part in a riot or other civil disorder, or in the commission of or an attempt to commit a felony

8 4. by travel on any type of aircraft if you are an instructor or crew member or have any duties at all on the aircraft 5. by war or act of war 6. while you are in the military (includes serving on active Reserve and Guard duty) 7. while you are a driver in a motor vehicle accident, if you do not hold a current and valid driver s license 8. by legal intoxication; this includes, but is not limited to, your operation of a motor vehicle 9. by voluntary use of a controlled substance, unless: (a) it was prescribed for you by a doctor; and (b) it was used as prescribed In no event will your benefit payment be more than the total of all the losses you suffer in any one accident.