Income Protection. Archdiocese of St. Louis Policy# Supplemental Life Insurance. Administration Guide for Supplemental Life Insurance :

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1 Income Protection Supplemental Life Insurance Administration Guide for Supplemental Life Insurance : Archdiocese of St. Louis Policy# Eligibility Enrollment Period All full-time active employees working 1,000 or more hours per year are eligible for coverage on their date of hire. Spouse coverage is available only if the employee has elected coverage and is subject to 50% of the employee amount. Child coverage is available for child from the age of 14 days to 25 th birthday regardless of student status provided the employee is enrolled and approved for coverage. All employees should complete an enrollment form electing to participate in the benefit. Employee enrolling after the 31 day period will be required to provide evidence of insurability for any amount of coverage. Effective Date Benefit Amount Coverage will be effective on the later of: The employee s date of hire provided they enrolled within 31 days of their date of hire The date the employee signs their enrollment form provided they enrolled within 31 days of their date of hire The date Hartford approves their Personal Health Application Benefit amounts are as follows: Employees coverage - Increments of $10,000 to a maximum of $300,000 Spouse coverage Increments of $5,000 to a maximum of $150,000 subject to 50% of the employee s approved amount of coverage. Child coverage Increments of $5,000 to a maximum of $15,000 Guaranteed Issue Amount Employee - $100,000 Spouse - $25,000 Child - $15,000 Employees enrolling within 31 days of their date of hire are guaranteed up to the Guaranteed Issue Amount (GIA). Amounts over the guaranteed issue amount require the employee and/or spouse to complete a Hartford Personal Health Application and be approved for coverage. Reductions Due To Age Employee and Spouse benefits will reduce to 65% at age 70, to 45% at age 75 and to 30% at age 80 based on the employee s age. These reductions will automatically appear on July 1 bill following the employee s birthday. Family Status Changes Employees can also elect coverage for a spouse or child if they have a family status change. Family status changes include marriage, divorce, birth, adoption or legal guardian of a child, spouse dies or spouse is no longer employed and looses benefits.

2 Accelerated Death Benefit Waiver of Premium Premiums Termination of Coverage Conversion and Portability If an employee or dependent is diagnosed as terminally ill with a life expectancy of 12 months or less, they may be eligible to receive payment of a portion of their life insurance. The remaining amount of the life insurance would be paid to their beneficiary upon death. They will need to complete the Hartford Accelerated Death Benefit form. Employees who are totally disabled and not working may continue their life insurance past the 12 month period if they are approved for waiver of premium. To be eligible, they need to be under the age of 60 at the time of the disability and be disabled for at least 6 months. Employees will need to complete the Hartford Waiver of Premium form and be approved for coverage prior to the end of the 12 month period in order to continue their life insurance past the 12 month period. Monthly rates are based on the employee s age as of their effective date of coverage and will increase on July 1 of each year following the date the employee moves to the next age band. Spouse coverage is based on employee s age. Child cost is based on a unit cost and not per child. The employee s cost for child coverage is the same regardless of the number of children they have enrolled. Employee & Spouse Monthly Rates per $1,000 of Benefit Age Hartford < Child(ren) 1.00 per $5,000 Employee Coverage will end on the earlier of 1) the date the employee is no longer eligible or 2) the employee s last day work. Dependent coverage will end on the date the dependent is no longer eligible for coverage. Coverage may be continued by the employee and/or dependent provided they enroll for Conversion or Portability. Coverage may also continue under one of the following continuation provisions provided premium is paid during this time. Military Leave 12 weeks Sickness or Injury 12 months Family Medical Leave 12 weeks Conversion - Employees and Dependent may convert the supplemental life insurance to an individual policy by completing the Notice of Continuing Coverage form, if they enroll for conversion with 31 days of the date their coverage ends. Premiums are based on their age at the time of conversion. Portability Employees may elect Portability, if their coverage is terminating prior to their Social Security Normal Retirement Age. This option allows the employee to continue all or a portion of their and their dependent Supplemental Life Insurance coverage under a separate Portability term policy. To elect Portability, they must complete the Notice of Continuing Coverage form to apply and pay the premium within 31 days of the termination of their Supplemental Life Insurance. Evidence of Insurability will not be required. Portability is not available to dependent children who have reached the limiting age of 25. Employees can contact Hartford s Conversion and Portability Department at to obtain additional information.

3 STEPS INVOLVED IN ADMINISTRATION OF VOLUNTARY TERM LIFE INSURANCE 1. When an employee is first hired, give the employee a Hartford Life Enrollment-Change form and Hartford Life benefit booklet. 2. Instruct the employee that he/she has 31 days to elect or waive this coverage. After 31 days, evidence of insurability will be required for benefits. Ask that the employee complete the Hartford Life Enrollment-Change Form and name a beneficiary, if they are electing life insurance. 3. Once an employee has enrolled for this coverage, add the employee to the voluntary billing by logging onto the Hartford Employerview Website ( and adding the employee s information using the Participant Administration button located to the left of the screen and arrange for their payroll deduction with your payroll administrator. This is an age related billing, not salary related. Insert $1 when enrolling in the Participant Administration section. Questions regarding User Name and Password access to Employerview should be directed to Anne Hager at Important Billing Notes: Hartford bills for full months only and does not do any partial month billing. The payroll deduction amount should apply to the guaranteed issue amount only. Once the employee has been approved for amounts over the guaranteed issue amount, the payroll deduction should be increased to the total amount approved by Hartford. The bill will automatically update to the new benefit amount on the first of the month following the date of the approval. 4. Your monthly bill from Hartford will list the employees with their approved benefit amounts and monthly premium amounts. The monthly bill should be carefully reviewed each month for accuracy. The employee s name will appear in bold text if any changes were made from the previous month. 5. Questions regarding billing and enrollment can be directed to Hartford s Customer Service department at In the event of a death claim, employee with a terminal illness or a disability lasting 6 months or longer, contact Linda Lenz (314) at Hartford for the appropriate forms. 7. An employee can cancel their employee, spouse, and/or child coverage at any time. If the employee decides to cancel his/her coverage, the employee must complete and sign a new Hartford Enrollment-Change Form requesting to cancel coverage. Once the form is completed, you can terminate the employee from the billing by updating the employee s information on the Employerview website or notifying Hartford at the fax number or address provided above. Premium is required to the end of the month following termination. Any overpayments will be credited on your next monthly bill. If cancellation is due to termination, provide employee with Conversion and Portability information.

4 Your Administration and Billing Responsibilities You play an important role in the administration of your policy. Your responsibilities include: Ensuring that all eligible employees apply appropriately and timely for coverage. Managing the Employerview Website for your Participant Administration, (adds, terms and changes). Keeping accurate records on plan enrollment, census information, and coverage levels to aid in the preparation of your billing statements. Maintaining all Enrollment Forms, Beneficiary Change forms and other important plan records in your office. Determining when an applicant needs to submit a Personal Health Application and completing the Employer s section of the application. Notifying employees of their Conversion, Portability and Waiver of Premium rights in a timely manner, if applicable. Review the electronic monthly billing statement each month, and pay the premium requested no later than 60 days from statement.

5 Hartford Contact Information Primary Contact: Hartford Life Customer Service Phone: (800) Secondary Contact: Conversions & Portability: Medical Underwriting Enrollment Changes Billing & Premiums: Linda Lenz Account Manager 1401 Brentwood St. Louis, MO Hartford Administration Conversion & Portability Unit P.O. Box Cleveland, OH Medical Underwriting Unit P.O. Box 2999 Hartford, CT Hartford Employerview website, or fax number Lockbox Philadelphia, PA Overnight Address: The Hartford Lockbox N. Independence Mall East Philadelphia, PA Phone: (314) Fax: (860) Phone: (877) Fax: (440) Phone: (800) Fax: (860) Website: Fax: For or Fax, be sure to include: policy number # billing id number from bill effective date of change Phone: (888) Fax: (860)