Earning for Today and Saving for Tomorrow. Optional Life Insurance. inspiring possibilities

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1 Earning for Today and Saving for Tomorrow Optional Life Insurance inspiring possibilities

2 In This Summary Optional Life Insurance Plan Summary...2 Plan Highlights...3 Eligibility...4 For You For Your Eligible Dependents Enrollment...5 Evidence of Insurability Naming a Beneficiary When Coverage Begins Optional Life Insurance...8 For You For Your Spouse or Partner For Your Eligible Dependent Child(ren) Age-Based Coverage Reductions Cost of Coverage...9 Waiver of Premium Benefit Payment Accelerated Life Benefit When Coverage Ends...14 Portability Conversion Right Other Important Information Assignment of Benefits Plan Amendments or Termination Legal Action Autopsy Incontestability Age Misstatement Conformity with the Law Administrative Facts

3 Optional Life Insurance Plan Summary The Advocate Health Care Network (Advocate) Optional Life Insurance Plan offers eligible associates additional financial security for themselves and their eligible dependents in the event of death. If you are an eligible associate, the Optional Life Insurance Plan offers the opportunity to: Purchase additional term life insurance coverage for yourself over and above your Advocate-paid Basic Life Insurance Purchase term life insurance for your eligible dependents Buy this additional insurance at volume discount group rates Continue your coverage when you retire or if you leave Advocate, and Convert your coverage to an individual life policy without providing evidence of insurability. This coverage is provided through a Group Policy with Dearborn National Life Insurance Company (Dearborn National). Advocate Health Care Network is the Policyholder of the Policy and the Policy Number is F If you are eligible for and enrolled in the coverage, this document is your certificate of insurance. It replaces any previous certificate you may have received under the Group Policy. If you have any questions regarding the Optional Life Insurance Plan, call the Advocate Benefits Service Center at ; representatives are available to assist you from 8 am to 6 pm Central Time, Monday through Friday. It is important that you understand the key features of the Optional Life Insurance Plan and how this coverage works. That s why we are providing you this Plan Summary booklet. Keep it handy for future reference. Important! This Plan Summary provides a summary of the Plan details for the Advocate Health Care Network Optional Life Insurance Plan with Dearborn National. If there is a conflict between the Plan Summary and the Policy, the Policy will control. Every effort has been made to accurately describe the terms of the Plan. Advocate reserves the right to amend, modify or terminate the Plan at any time, for any reason. If such change or termination occurs, you will be notified promptly. Nothing in the Plan gives any associate the right to be retained in the service of Advocate or any of its affiliated companies. (Advocate and its affiliated companies are sometimes referred to in this summary as the Advocate Companies.) Any of the Advocate Companies may discharge or discipline an associate at any time. 2

4 Plan Highlights Eligibility You are eligible for coverage under the Optional Life Insurance Plan once you complete 30 days of continuous service as an associate of the Advocate Health Care Network if you meet the plan s other eligibility guidelines. You may also enroll your eligible spouse/partner and child(ren) for coverage. Enrollment You can enroll online at advocatebenefits.com at any time. Life Insurance for You You can purchase life insurance for yourself in any $10,000 increment from $20,000 up to a maximum of $500,000. This life insurance coverage will be in addition to the Advocatepaid Basic Life Insurance coverage you receive as an eligible associate. Life Insurance for Your Eligible Dependents You can purchase life insurance for your spouse/partner in any $10,000 increment you choose from $20,000 up to a maximum of $500,000. If you purchase additional life insurance for yourself or your spouse or partner through this Plan, you can purchase life insurance for your dependent child(ren) in the amount of $10,000 or $20,000 per child, as you choose. Cost of Coverage You pay the cost of any Optional Life Insurance coverage you choose whether for yourself or an eligible dependent based on competitive group insurance rates. This cost will be automatically deducted from your bi-weekly pay. Benefit Payment The Plan pays a benefit to the designated beneficiary(ies) upon your death or the death of your covered spouse or partner, or to you upon the death of a covered child. Portability If you leave Advocate or your benefits eligibility status changes before you reach age 70 you can take your Optional Life Insurance coverage with you. Conversion Right When coverage for you, your spouse/partner or your child(ren) terminates under the group policy, you can convert the applicable coverage to an individual life policy without providing evidence of good health. 3

5 Eligibility For You You are eligible to apply for coverage under Advocate s Optional Life Insurance Plan once you complete 30 days of employment in benefits-eligible status as an Advocate associate and you: Are regularly scheduled to work at least 40 hours per bi-weekly pay period Work in the United States Are actively at work, and Provide satisfactory evidence of insurability, when required (see Evidence of Insurability, page 6). You are considered actively at work if you are physically present at your customary place of employment (or a location to which you are required to travel) and working your regularly scheduled hours, being paid your regular earnings; and are not a temporary or seasonal associate. If you need assistance, contact Advocate Benefits Service Center online at advocatebenefits.com or by phone at Important! You must apply for dependent child coverage within 60 days of the date you become eligible for dependent coverage, otherwise evidence of insurability will be required. For Your Eligible Dependents Once you are eligible, you may apply for coverage under Advocate s Optional Life Insurance Plan for your eligible spouse/partner and/or your eligible dependent child(ren). Your eligible spouse is your legal husband or wife who is at least age 18. Your eligible qualified domestic partner is a person whether of the same or opposite sex who is at least age 18 and with whom you have completed, signed and submitted an Affidavit of Domestic Partnership. For more information about domestic partnership or to print a copy of the Affidavit of Domestic Partnership go to advocatebenefits.com, click on Benefits Information (see Domestic Partners). Your civil union partner, Advocate defines as two unmarried adults of the same or opposite sex who enter into a civil union, as that relationship is legally defined by the state in which they live. Your eligible dependent child(ren) include your child(ren) age 14 days through 25 years who are: Your blood descendants of the first degree or legally adopted child(ren) (including a child living with you during the period of probation) Your stepchild(ren) or foster child(ren) residing in your household Child(ren) for whom you are the legal guardian The term dependent does not include: A child who: is on active military duty, or Does not provide evidence of insurability when requested (or whose evidence of insurability is not accepted) A spouse/partner or dependent child who is eligible for coverage as an Advocate associate, or A parent of yours or your spouse/partner. 4

6 Enrollment If you are eligible and would like to enroll for Optional Life Insurance coverage, follow these simple steps: 1. Determine the amount of coverage you want for yourself, your spouse/partner and/or your dependent child(ren) (see Optional Life Insurance, page 8). 2. Enroll online at advocatebenefits.com. Log in and select Health & Welfare Benefits. Click on Declare Family Status Change and from the drop-down menu, select Life Event Scroll down and select Optional Life and AD&D Change Follow enrollment instructions. About two to three weeks after you enroll you will receive an Optional Life Insurance application packet in the mail. 3. Read the materials in your application packet, then complete and return the necessary forms in the envelope provided to: G. Murphy & Associates 700 E. Diehl, Suite 180 Naperville, IL Note: You must complete the Portable Term Life Enrollment Form. If you provide a Yes answer to any of the health questions on the Portable Term Life Enrollment Form and/or if any other of the situations described under Evidence of Insurability apply (see across) you will also be required to complete the Evidence of Insurability Form. Upon approval of any coverage amount, you will receive a notice from G. Murphy & Associates. Bi-weekly payroll deductions equal to the premium cost for the coverage you choose will begin automatically. Evidence of Insurability Whether or not you will need to provide evidence of insurability will depend on when you enroll for Optional Life Insurance. If you enroll for Optional Life Insurance within 60 days after you first become eligible or at Annual Enrollment and you elect coverage of: Up to $150,000 for yourself you will not have to provide evidence of insurability (based on your responses to the health questions on your Optional Life Insurance application*) More than $150,000 for yourself you will not have to provide evidence of insurability for the first $150,000 of coverage (again, based on your responses to the health questions on your Optional Life Insurance application*), but you will need to provide evidence of insurability before any coverage over $150,000 can take effect. Any amount for a spouse/partner you will have to provide evidence of insurability before this coverage can take effect. * When you apply for coverage, you will need to complete a Portable Term Life Insurance Form which includes a number of health questions; if you respond Yes to one or more of these questions, you will be required to complete the Evidence of Insurability Form. If you enroll for coverage more than 60 days after the date you initially become eligible for this coverage or if you are requesting any increase in existing coverage you will have to complete the entire Optional Life Insurance application and provide evidence of insurability before coverage can take effect for you, your spouse/ partner or dependent child(ren) regardless of the amount of coverage you choose. 5

7 Naming a Beneficiary The beneficiary is the person, persons (more than one beneficiary may be named) or other nonperson entity such as a trust, named to receive the Optional Life Insurance benefit that will be paid out upon the death of a covered individual. When you enroll for Optional Life Insurance for yourself, you must designate a beneficiary for your coverage amount. You may also choose to name a beneficiary that you cannot change without his or her consent an irrevocable beneficiary. In future, you may add or change beneficiaries if: Your coverage is in force Dearborn National has written consent of all irrevocable beneficiaries, and You have not assigned the ownership of your insurance (see Assignment of Benefits, page 18), You can name, add or change your beneficiaries online at advocatebenefits.com; log in and select Health & Welfare Benefits, click on Beneficiary Information. Note: Your beneficiary is the last beneficiary you named, according to the records on file in Dearborn National s Home Office or on file with the Plan Administrator, if applicable. If you choose to purchase coverage for your: Eligible spouse/partner you must designate a beneficiary (or beneficiaries) for your spouse/ partner coverage. Note: Your spouse/partner will be the owner of this coverage if he or she chooses to continue this coverage under the Plan s portability provisions after losing eligibility. As owner of this coverage, your spouse/partner will have the right to designate someone else as beneficiary. Eligible dependent child(ren) you are automatically designated beneficiary for this coverage, unless your spouse/partner owns the dependent child coverage. If the person to whom payment should be made is not living, benefits will be paid to his or her spouse, if living, if not, equal shares to living natural or legally adopted child(ren) if any, if none, equal shares to father and mother if living, if not, equal shares to brothers and sisters if living, otherwise to his or her estate. Additional information including helpful tips and guidelines for making your beneficiary designations is available on the Advocate Benefit webpages. 6

8 When Coverage Begins Optional Life Insurance coverage for you will begin on the first day of the month on or after the latest of the date: You become eligible for coverage You enroll for coverage, or Your coverage is approved when evidence of insurability is required. Note: Insurance requiring evidence of insurability will not be effective until and unless Dearborn National determines that the evidence you submit is satisfactory. If you are not actively at work on the date your coverage is scheduled to begin or, if later, the date any increase or additional coverage that you elect is scheduled to take effect, the effective date of this coverage will be delayed until the date you return to actively-at-work status. Optional Life Insurance coverage for your dependents your spouse/partner and/or your dependent child(ren) will begin on the latest of the date: They become eligible for coverage A dependent (other than a newborn) receives final discharge from any facility for care and treatment of sickness or accidental injury A newborn dependent child attains 14 days of age Coverage is approved, when evidence of insurability is required You apply for coverage for your eligible dependent(s), or Dearborn National receives your premium for dependent coverage. If a dependent whether your spouse/partner or a dependent child is confined to hospital on the date his or her coverage is scheduled to begin or, if later, the date any increase in his or her coverage is scheduled to take effect, the effective date of this coverage will be delayed until the date the dependent is no longer hospital confined. Note: This provision does not apply to a newborn child. 7

9 Optional Life Insurance Your Optional Life Insurance coverage options for yourself, your eligible spouse/partner and/or your eligible dependent child(ren) are outlined below. For You You may elect Optional Life Insurance for yourself in any $10,000 increment from $20,000 up to a maximum of $500,000. This coverage will be in addition to the automatic Basic Life Insurance coverage you have as an eligible Advocate associate. For Your Eligible Spouse/Partner You may elect Optional Life Insurance for your eligible spouse/partner in any $10,000 increment from $20,000 up to a maximum of $500,000. For Your Eligible Dependent Child(ren) You may elect Optional Life Insurance for your eligible dependent child(ren) in the amount of $10,000 or $20,000 per child as you choose. Note: You may choose Optional Life Insurance coverage for your eligible dependent child(ren) only if you first choose Optional Life Insurance coverage for yourself or your spouse/partner. Advocate Benefits Service Center Advocate s automated benefits information resource. You can access it 24 hours a day, every day: Online at advocatebenefits.com. By phone at , Monday Friday, 8 am to 6 pm Representatives are available to assist you by phone from 8 am to 6 pm Central Time, Monday through Friday. Age-Based Coverage Reductions If you continue to work for Advocate beyond age 65, the amount of your Optional Life Insurance coverage will be subject to age-based reductions. Specifically, if you are working for Advocate: From your 65th birthday through age 69 your coverage will be reduced to 65% of the amount of coverage in effect prior to age 65. On or after your 70th birthday your coverage will be reduced to 50% of the amount of coverage in effect prior to age 65. If you have coverage on your spouse/partner, the same reductions will apply to that coverage based on your spouse/partner attaining age 65 or 70. For example: If you have $100,000 in Optional Life Insurance coverage, your coverage amount will reduce to $65,000 (65% of $100,000) on the date you reach age 65 and to $50,000 (50% of $100,000) on the date you reach age 70. Remember: The same type of age-based reduction will apply to any coverage you have chosen for your spouse/partner. 8

10 Cost of Coverage If you choose Optional Life Insurance coverage whether for yourself, your spouse/ partner or your dependent child(ren) you will pay a bi-weekly premium toward the cost of the coverage you choose. Bi-weekly premiums for Optional Life Insurance coverage for you and your eligible spouse/ partner are based on the amount of coverage that you choose and your age (for your own coverage) and the age of your spouse/partner (for your spouse s/partner s coverage). These premiums based on five-year age groups are shown in the Optional Life Insurance Highlights sheet, available on the Advocate Benefits Pages. Note: The only time these rates may increase is when you or your spouse/partner moves into a new age group or if rates are increased for all people insured in a particular age group; your premium will not increase based on any health changes you or your spouse/partner may experience. Bi-weekly premiums for this coverage will be deducted from your pay on an after-tax basis. Note: If you or your spouse/partner becomes totally disabled before reaching age 60, Optional Life Insurance coverage in effect for the disabled party will remain in effect at no cost, subject to proof of disability and approval by Dearborn National. Waiver of Premium Bi-weekly premiums will be waived after you or your spouse/partner have been determined to be totally disabled: If you become totally disabled. In this case, the waiver will apply to the bi-weekly premiums you pay for your Optional Life Insurance coverage and, if you have elected Optional Life Insurance coverage for your dependent child(ren), for that coverage as well. Any premiums you pay for Optional Life Insurance coverage for your spouse/partner will remain in effect. If your spouse or partner becomes totally disabled. In this case, the waiver will apply to the bi-weekly premiums you pay for your spouse s or partner s Optional Life Insurance coverage only. Any premiums you pay for Optional Life Insurance coverage for yourself and/or your dependent child(ren) will remain in effect. The amount of coverage in effect at the time the disability begins will continue; however, this coverage will reduce or stop in accordance with other plan provisions (see Age-Based Coverage Reductions, page 8 and When Coverage Ends, page 14). 9

11 Total disability Total disability means the inability due to sickness or accidental injury to work at any job for wage or profit or any occupation suited to your education, training or experience (or, in the case of a spouse or partner, for wage or profit or any occupation suited to the spouse s or partner s education, training or experience). Dearborn National will require written notice of the claim and proof of disability before premiums will be waived. In addition, the following conditions must be met: Dearborn National must receive the written notice of disability within one year from the date the total disability begins. Note: If you are unable to provide the required proof within one year, your claim may still be considered if you provide notice as soon as reasonably possible. The person who is disabled: Was under age 60 at the time the disability began Was insured for the Waiver of Life Insurance Premium Disability Benefit on the date the disability begins Had in-force coverage at the time he or she suffered the illness or injury that caused the disability Has been continuously totally disabled for at least six consecutive months Has paid all bi-weekly premiums up to the date Dearborn National approves the disability, and Is living and remains totally disabled. When Dearborn National approves the proof of total disability, the applicable waiver of premium for Optional Life Insurance coverage will be retroactive to the date the disability began. The waiver of premiums will end on the earliest of the date: Total disability ends Proof of disability is not provided when requested, or You or your spouse/partner reaches age 70 or retire. If Dearborn National stops waiving your premiums, your Optional Life Insurance coverage will remain in force only if: The Optional Life Insurance under the Group Policy is still in force You are eligible for insurance under the Group Policy, and Payment of bi-weekly premiums is resumed. The amount of Optional Life Insurance coverage that remains in force will be the amount in effect on the date bi-weekly premium payments are resumed. Note: This waiver of premium will not be available if you apply for and are issued an individual policy under the Conversion Right of the Group Policy unless you surrender the individual conversion policy, and your or your spouse s/ partner s disability began while still covered by the Group Policy. If this happens, Dearborn National will refund all premiums paid for the individual conversion policy. To confirm total disability, Dearborn National will require you to obtain initial and continuing proof of total disability; and may request a physical exam at reasonable intervals during the period of total disability. 10

12 Benefit Payment A benefit will be paid to the designated beneficiary(ies) based on the amount of Optional Life Insurance coverage in effect at a covered individual s time of death. Before this benefit will be paid, however, Dearborn National must be provided written proof that the death occurred while this coverage was in force. Optional Life Insurance benefits will be paid in the event of death due to any cause. However, if a covered individual commits suicide while sane or insane within two years of the date: The individual s Optional Life Insurance coverage starts, any premiums paid for the individual s Optional Life Insurance coverage will be refunded; no other death benefit will be paid. A requested increase in the individual s Optional Life Insurance coverage took effect the amount of premiums attributable to the increase will be refunded and Dearborn National will pay a death benefit equal to the Optional Life Insurance coverage in effect prior to the increase; no other benefit payment will be made. Benefits payable to you or to your beneficiary(ies) through this Plan will be paid once Dearborn National receives written notice of the loss on which a claim is based. The notice should include information to identify you or your insured dependent, such as your name, address and the Policy number (F019128) Note: In the event of your death, your beneficiary(ies) can notify the Human Resources Department which will then provide any necessary assistance. Dearborn National or its authorized administrator will send proof of loss claim forms to you after receiving notice of your claim. Completed proof of loss claim forms along with a certified death certificate should be sent to Dearborn National as soon as reasonably possible. Optional Life Insurance benefits are paid in a single lump sum. Where applicable, Dearborn National will pay interest on the death benefit up to the date of payment. Interest will be based on a number of factors including but not limited to the state in which the death certificate was issued, and beneficiary state of residence as required under applicable state law. If there is more than one beneficiary, each will receive an equal share unless you have requested otherwise, in writing. To receive proceeds, a beneficiary must be living at the time of the insured s death. If a beneficiary is not living at the time of the insured s death, that beneficiary s portion of the death benefit will be equally distributed to the remaining beneficiaries. In the event of simultaneous deaths of an insured and a beneficiary, the death benefit will be paid as if the insured survived the beneficiary. 11

13 If there is no surviving beneficiary or if the insured did not name one, the Optional Life benefit will be paid in the following order: To the insured s lawful spouse or civil union partner (does not include a domestic partner) To the insured s natural and legally adopted child(ren) To the insured s parents To the insured s brothers and/or sisters To the insured s estate. References to the insured in the prior two paragraphs mean you or your spouse/partner. You are automatically the beneficiary for dependent child coverage, unless your spouse/ partner owns the dependent child coverage. Your spouse/partner owns the dependent child coverage and is the designated beneficiary for it if he or she owns the spouse/partner coverage and you are not covering the child under your own associate coverage. In either event, if the person to whom payment should be made is not living, benefits will be paid to his or her spouse, if living, if not, equal shares to living natural or legally adopted child(ren) if any, if none, equal shares to father and mother if living, if not, equal shares to brothers and sisters if living otherwise to his or her estate. Accelerated Life Benefit If you or your spouse/partner is diagnosed with a terminal illness, you may request payment under the Plan s accelerated benefit payment provision. You may request a partial accelerated life benefit or a full accelerated life benefit. The accelerated life benefit that will be paid to you will be the death benefit you choose to accelerate, subject to a minimum amount of $10,000. Your amount of life insurance will be reduced or end If you receive an accelerated life benefit. If you request a partial accelerated life benefit, you may reapply for accelerated payment of the remaining amount of insurance at any time, though you may have to provide further evidence of your or your spouse s/partner s eligibility for the benefit. If you move, be sure to update your personal address information with Advocate. If you don t keep your most recent address on file and Advocate can t locate you, benefit payments may be delayed. 12

14 To qualify for payment of an accelerated life benefit: Your coverage must be in force and all premiums due must be fully paid You must apply on a form satisfactory to Dearborn National You must give evidence that your or your spouse s/partner s life expectancy due to illness or injury is 24 months or less, as certified by a physician You must not have assigned the ownership of your insurance, and Your insurance must not have an irrevocable beneficiary. Note: If you are unable to request this benefit yourself, your legal representative may request it for you. If you choose a partial accelerated life benefit, the balance of your coverage will remain in force and your bi-weekly premiums will be adjusted accordingly. If you choose a full accelerated life benefit, your coverage will end and you will no longer have to pay bi-weekly premiums. Note: The benefit paid under this provision may be taxable. If so, you or your beneficiary may incur a tax obligation. As with all tax matters, you or your beneficiary should consult a personal tax advisor to assess the impact of the benefit. Receipt of this benefit may adversely affect your eligibility for Medicaid or other governmental benefits or entitlements. Terminal illness Terminal illness means you have been examined and diagnosed by your doctor as having a medically determined condition which is expected to result in death within 24 months or any medically determined condition which requires your continuous confinement in an eligible institution, if you are expected to remain there until death. An eligible institution includes a hospital, an inpatient hospice facility, or an institution or a distinct part of an institution which is primarily engaged in providing comprehensive skilled nursing services and Is duly licensed by the appropriate governmental authority to provide such services. 13

15 When Coverage Ends Optional Life Insurance coverage will end for you on the earliest of: The last day of the month during which you cease to be an eligible associate at Advocate unless you exercise the portability option The January 1 on or after your 70th birthday if you have exercised the portability option The date Advocate offers a similar life insurance plan through another insurance carrier if you are actively at work on that date The date the Group Policy stops The date coverage of your Eligible Class stops The end of the period for which you paid premiums if you do not make the next premium contribution when due, or The date your Optional Life Insurance coverage stops if you elected the Accelerated Death Benefit. Optional Life Insurance coverage will end for your spouse or partner on the earliest of: The date the Group Policy stops The date your spouse/partner s coverage under your Eligible Class stops The end of the period for which you made your last premium contributions for your spouse s/partner s coverage if you do not make a required contribution when due The date you are no longer eligible under the plan The last day of the month during which your spouse/partner no longer meets the definition of eligible spouse/partner The date your spouse s/partner s coverage is converted under the conversion privilege, or The January 1 on or after your spouse s/ partner s 70th birthday if you or your spouse/partner exercise the portability option. Optional Life Insurance coverage will end for your dependent child(ren) on the earliest of: The date the Group Policy stops The date your dependent child(ren) s coverage under your Eligible Class stops The date your coverage stops The end of the period for which you made your last premium contributions for your dependent child(ren) s coverage if you do not make a required contribution when due The last day of the month during which a dependent child no longer meets the definition of eligible dependent child, or The date your dependent child(ren) s coverage is converted under the conversion privilege. While this Group Policy is in force, you may continue your coverage under the terms and provisions of: The Family and Medical Leave Act of 1993, as amended (FMLA) The Uniformed Services Employment and Reemployment Rights Act (USERRA), or Any applicable state required continuation period. Portability Portability refers to your ability to port (or continue) your Optional Life Insurance coverage if your eligibility for this coverage ends because: You retire or terminate employment with Advocate You become ineligible for insurance due to a change to a non-benefits eligible status with Advocate, or Advocate stops offering Optional Life Insurance coverage and does not replace this Plan with another supplemental life insurance plan. In addition, your spouse/partner may port his or her coverage in the event of divorce or legal separation, dissolution of domestic partnership or your death. 14

16 If you lose eligibility, you will receive a letter describing your right to continue your coverage under this portability provision. Dearborn National must receive your completed portability application no later than 90 days after the date of the letter. When you port your coverage, provisions of your group coverage will continue and conversion right. You can also continue any coverage for your dependent child(ren) that was in effect prior to losing your eligibility for coverage provided you are continuing your own coverage through portability. Note: Once you convert your coverage to an individual policy (see Conversion Right, below), you will no longer be able to exercise this port option. Once you port coverage, you may request a decrease in your coverage amount, but will not be able to request an increase in your coverage amount. When you reach age 65, your coverage will reduce to 65% of the amount in force immediately prior to your 65th birthday. Ported coverage terminates on the January 1 following your 70th birthday. Note: Coverage on a spouse/partner will also reduce to 65% on the spouse s/partner s 65th birthday and terminate on the January 1 following his or her 70th birthday. If you port coverage and then return to active, benefits-eligible employment with Advocate, you will no longer be eligible for ported coverage as you will then be eligible for coverage as an active associate. You must cancel your ported coverage at that time. Conversion Right If any part of your Optional Life Insurance coverage under the Group Policy stops, you may convert this coverage to an individual life insurance policy. This individual policy will be issued without evidence of insurability. The individual policy will be any individual policy offered by Dearborn National for purposes of conversion, except term insurance. The individual policy will not include any additional benefits, such as Waiver of Premium or the Accelerated Life benefits. This conversion right will be available to you if your Optional Life Insurance coverage stops because: You are no longer eligible under the Group Policy Your Optional Life Insurance is changed or terminated because the Group Policy or your Eligible Class is changed or terminated and your coverage under the Group Policy has been in effect for at least five consecutive years The amount of your Optional Life Insurance coverage is reduced, or The premium waiver under the Waiver of Life Insurance Premium Disability Benefits ends and your Optional Life Insurance coverage stops. You, your spouse/partner, or a child of legal age also may apply to convert the Optional Life Insurance coverage in effect for a spouse (or partner) or a dependent child at the time this coverage ends due to: The dependent no longer meeting the definition of dependent Your insurance coverage ending Your death, or The Group Policy or your Eligible Class is changed or terminated and you have had coverage under this Plan in effect for your dependents for at least five consecutive years. 15

17 If life insurance is changed or terminated because the Group Policy or your Eligible Class is changed or terminated, and your life insurance under the Group Policy has been in effect for at least five consecutive years, the amount of life insurance you can convert to an individual policy will be limited to the lesser of: $10,000, or The amount of Optional Life Insurance coverage which ends, minus the amount of other group insurance for which you (or your dependent) become eligible within 31 days after the date Optional Life Insurance coverage stops. If Optional Life Insurance coverage stops for any reason other than the reasons noted previously, the amount of the individual policy may be any amount up to the amount of Optional Life Insurance that stopped. Coverage under the individual policy will take effect 31 days after Optional Life Insurance coverage ends. You will pay premiums to cover the cost of this individual policy; these premiums will be based on the amount of insurance and the covered person s age. If you, your spouse/partner, or your dependent child dies within the 31-day election period, a death benefit will be paid to the beneficiary(ies) in the amount of insurance you were eligible to convert under the Group Policy. This amount will be paid whether or not you have applied or paid premiums for your individual policy; in this case, any premium you have paid toward the cost of your individual policy will be included in the benefit paid to your beneficiary(ies). You must apply for and pay the first premium for an individual policy within 31 days after any part of your Optional Life Insurance coverage stops. If you wish to apply for an individual policy, you must notify Dearborn National in writing; Dearborn National will then provide you a conversion form to complete and return. 16

18 Other Important Information All formal documents relating to the Plan are available for your inspection from the Senior Vice President, Human Resources, Advocate Health Care. Advocate Benefit Services can make arrangements for you to see them during normal business hours. You also may obtain a copy upon the payment of a reasonable fee to cover the cost of reproduction. Your request (in writing) should be sent to: Senior Vice President, Human Resources Advocate Health Care Network 3075 Highland Parkway, Suite 600 Downers Grove, IL Nothing in the Plan gives any associate the right to be retained in the service of Advocate. Nor does it interfere with the right of Advocate to discharge or discipline any associate at any time. Assignment of Benefits If you are an active associate and are paying for your Optional Life Insurance coverage through automatic payroll deductions, you cannot change the owner of your coverage and assignments are not allowed. However, if you have ported your coverage (see Portability, page 14), you can change the owner of your Optional Life Insurance coverage under the Group Policy by sending written notice to Dearborn National. This change is an absolute assignment; you transfer all your rights and duties as owner to the new owner. The new owner can then make any change allowed under the Group Policy. A request for absolute assignment: Does not change the insurance or the beneficiary Applies only if Dearborn National receives your written notice Takes effect from the date the notice was signed, and Does not affect any payment made or action taken before Dearborn National receives your notice. Dearborn National assumes no responsibility for the validity of any assignment. You are responsible to see that the assignment is legal in your state and that it accomplishes the goals that you intend. Plan Amendments or Termination Advocate expects the Optional Life Insurance Plan to continue without change. However, Advocate reserves the right to amend, modify or terminate the Plan at any time for any reason. If material changes are made in the future, you will be told about them in writing. Any changes made to the Plan will not take away any vested amounts already in your accounts. Legal Action Legal action may not be taken to receive benefits until 60 days after the date proof of loss is submitted according to the requirements of the Group Policy. Legal action must be taken within three years after the date proof of loss must be submitted (or within the timeframe specified by the Policyholder s state of residence, if longer). 17

19 Autopsy If you or an insured dependent dies, Dearborn National may have an autopsy performed (unless prohibited under applicable state law). Incontestability Your insurance has a contestable period starting with the effective date of your insurance coverage and continuing for two years while you are living. During that two year period, Dearborn National can contest the validity of your insurance because of inaccurate or false information received relating to you or a dependent s insurability. Only statements that are in writing and signed by you or your dependent can be used to contest the insurance. Age Misstatement If an insured s age has been misstated, the death benefit payable will be that amount to which an insured is entitled based on your correct age. A premium adjustment will be made so that the actual premium required at the correct age is paid. Conformity with the Law If any provision in this certificate is in conflict with the laws of the state governing the Group Policy or this certificate, the provision will be deemed to be amended to conform with the law. 18

20 Administrative Facts Information regarding the administration of your Optional Life Insurance benefits including the Plan Administrator, type of plan and agent for service of legal process is provided below: Items Plan Name Description Advocate Health Care Network Optional Life Insurance Plan Employer Identification Number (EIN) Group Policy Number Type of Plan F Term Life Insurance Plan Year January 1 December 31 Plan Sponsor Plan Administrator Policyholder Agent for Service of Legal Process Advocate Health Care Network 3075 Highland Parkway, Suite 600 Downers Grove, IL Senior Vice President, Human Resources Advocate Health Care Network 3075 Highland Parkway, Suite 600 Downers Grove, IL Advocate Health Care Network Plan Administrator 19 Advocate Health Care 03/15 MC 1399

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