LIFE INSURANCE BENEFITS

Transcription

1 LIFE INSURANCE BENEFITS BASIC TERM LIFE INSURANCE Every salaried employee (under age 65) receives $50,000 of life insurance and $50,000 accidental death and dismemberment paid for by Thrifty White Pharmacy. Full time hourly employees (under age 65) will also receive $50,000 of life insurance at Thrifty White Pharmacy s expense. New Employees age 70 and older are limited to $1,000. Life coverage s are reduced at ages 65, 70, 75 and 80. Thrifty White Stores also pays for $5,000 of life insurance on your spouse. VOLUNTARY LIFE INSURANCE & ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) Employee: Only available at time of hire without medical evidence. A full time employee has the option of purchasing additional life insurance coverage. The cost is tiered and increases every 5 years of age. This insurance can be purchased in increments of $25,000, not to exceed the maximum of $200,000. This is a guaranteed issue with no physical or medical records necessary, if enrolled within your initial enrollment period. New employees ages have a maximum guarantee of $10,000 with greater amounts subject to underwriting. New employees 70 and older must be individually underwritten and have no guarantee issue amount. Spouse: Only available at time of hire without medical evidence. Employees electing Voluntary life insurance on themselves may elect up to 50% of their elected amount to a max of $50,000 for a spouse. Example: an employee electing $100,000 on him/her may elect up to $50,000 in coverage on the spouse. This is a guaranteed issue with no physical or medical records necessary, if enrolled within your initial enrollment period. New Spousal coverage is reduced at age 65 and terminates at age 70. Dependent Children: Only available at time of hire without medical evidence. Up to age 23. When the employee elects Voluntary life insurance for themselves, each child may be covered for $5,000 or $10,000. The cost is $.42 or $.83 per pay period and includes all dependent children in the family. (No AD&D on children) PERSONAL ACCIDENT INSURANCE (optional) Accidental death and dismemberment provides benefits in the event a covered employee dies or is dismembered as a result of an accident. This plan allows full time employees to purchase up to $500,000 of coverage with no medical exam needed on themselves. When enrolling themselves, employees may cover their spouse to a maximum of $500,000 and children to $25,000 each, also with no medical exam.. This coverage is very affordable beginning at $.92 per pay check for $50,000 of coverage. Will my benefits reduce due to age? When the covered person reaches age 70, his or her benefits will be reduced to 70% of the benefit amount selected; at age 75, 45%; at age 80, 30% and at age 85, 15%. Coverage for your spouse ends when he or she reaches age 70. These reductions also apply if you elect coverage after age 69. The Voluntary Life Insurance and Personal Accident Insurance DO NOT have an annual open enrollment. If you have any questions regarding enrollment please Jill Seifert at jseifert@thriftywhite.com or contact her at (763) You MUST complete the Benefits Enrollment Application to receive the free Basic Life Insurance on you and your spouse.

2 Group Life Insurance Benefits for all Full-Time Employees of Thrifty White Drug - # A Worldwide Presence Our parent company s operations currently service millions of people in the United States, Canada, the United Kingdom, Hong Kong, the Philippines, Japan, Indonesia, India, China and Bermuda. Benefits All Full-Time Employees working in the United States working 30or more hours per week. Basic Group Term Life Insurance equal to $50,000. Accidental Death and Dismemberment (AD&D) insurance which would pay an additional benefit, up to the amount of your Life benefit, if you suffer a covered loss due to an accident. Benefits are reduced to 65% at age 65, and to 45% at age 70, and 35% at age 75, and 25% at age 80. Coverage is discontinued at termination of employment or retirement. Dependent Life: $5,000 for your spouse. Accelerated Benefits that help offset expenses at a critical time. You may collect a portion of your benefits during your lifetime if you become terminally ill. If you leave Thrifty White Drug, you may be able to convert or port/continue your Group Life coverage to an Individual Life insurance policy. No Cost to You Your employer pays your Group Life and AD&D premium. How to Enroll Basic group term life coverage begins automatically when you meet the eligibility requirements. You ll need to designate beneficiaries for your basic life benefits using our Beneficiary Designation form or Group Enrollment form. Check with your employer for the necessary forms and for additional coverage options that may be available, or find the forms you need online at For Complete Plan Details This highlight flyer is intended to provide an overview of the benefits available from your employer, and is not a complete description of plan provisions. Receipt of this flyer does not certify eligibility for benefits under this plan. Your employer will provide you with the Sun Life Financial Group booklet containing complete plan details. This Overview is preliminary to the issuance of the Policy and booklet certificate. It does not describe the specific benefits under the Policy. Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy F orm Series 93P-LH, 98P-ADD, 02P-STD TDB Policy-2006, 02-SL, 07-SL, and 01C-LH-PT. In New York, group insurance policies are underwritten by Sun Life Insurance and Annuity Company of New York (New York, NY) under Policy F orm Series 93P-LH-NY, 06P-NYDBL, 02P- NYSTD, 98P-ADD-NY, 02-NYSL, 07-NYSL, and 01NYC-LH-PT. Product offerings m ay not be available in all states and m ay vary depending on state laws and regulations Sun Life Assurance Company of Canada, Wellesley Hills, MA All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at e.com/us. SLPC /10 (exp. 06/12) updated 08/10

3 I am an hourly employee, what is my Basic Term Life benefit? Your benefit amount is $50,000. I am a salaried employee, what is my Basic Term Life benefit? Your benefit amount is $50,000. If I, the employee dies from an accident, is there an additional death benefit? Yes, if your Basic Life benefit is $50,000, your beneficiary will receive an additional $50,000 if the death is the direct result of an accident and within 90 days of the accident. What happens to my death benefit at age 65 or older? Employee Less Employee Age Employee Age Employee Age Employee Age Than Age Through through through through 85 $50,000* $32,500 $22,500 $17,500 $12,500 What is my benefit for Accidental Dismemberment? You may receive up to 50% of the death benefit for loss of a hand, foot, sight in one eye and 25% for loss of thumb and index finger of the same hand. What amount do I receive if I first enroll at age 70 or older? Regardless of any of the above reductions, we limit the amount of insurance for which you are eligible if your insurance under this plan starts both: (a) after this plan s effective date; and (b) after you reach age 70. If you provide us with proof of insurability, and we approve it in writing, the amount of your life insurance will be 50% of the amount which otherwise applies to your classification and/or option. But in no event will this reduced amount be less than $1,000. If we do not approve the proof, your insurance amount will be $1,000. Can I list more than one beneficiary? Yes, when completing your Benefits Enrollment Application, list those in the beneficiary section. If married, would my spouse and children be covered under the basic life benefit? Yes, your spouse would be insured for $5,000. No, your children are not eligible. Basic Life Q & A

4 Is there Accidental Death benefit on my spouse? No. If your spouse dies, who would receive the death benefit? You, the employee would receive the benefit should your spouse die. For further information, please contact your Benefits Department or you can contact Sun Life at Basic Life Q & A

5 Optional Life and Voluntary AD&D Insurance Benefits for all Full-Time Employees of Thrifty White Drug - # A Worldwide Presence Our parent company s operations currently service millions of people in the United States, Canada, the United Kingdom, Hong Kong, the Philippines, Japan, Indonesia, India, China and Bermuda. Benefits All Full-Time Employees working in the United States working 30 hours or more per week. For you: An amount between $25,000 and $500,000, in increments of $25,000, not to exceed 5x basic annual earnings. Guaranteed Issue Amount is $200,000 if you are under age 65, $10,000 if age 65-69; $1,000 if age 70 or over. Benefits cease at retirement. For your spouse: An amount between $12,500 and $250,000, in increments of $12,500. Guaranteed Issue Amount is $50,000 if under age 65, $5,000 for ages Spouse Optional Life coverage may not exceed 50% of the employee s coverage. For your dependent child(ren): You can purchase $5,000 or $10,000 for each child up to age 23 years. You must elect Optional Life coverage for yourself in order to cover your spouse and/or children. Features of the Plan Your employer s plan includes Voluntary Accidental Death and Dismemberment (VADD) Insurance which would pay an additional benefit, up to the amount of your Optional Life Employee and Spouse benefit, if you suffer a covered loss due to accident. The plan also includes many special features including Waiver of Premium and Accelerated Benefits. How to Enroll Once you have selected the amount of coverage that s right for you, your spouse and your children, simply fill out the Optional Life enrollment form provided by your employer. Coverage for your spouse and child(ren) is only available if you elect coverage. Be sure to sign, date, and return the form to your employer. Please submit the form to your employer along with any Evidence of Insurability forms that may be required.

6 About Evidence of Insurability Evidence of Insurability also called proof of good health is required if: You decline coverage during your initial eligibility period and then want coverage at a later date; or You apply for Optional Life in excess of the Guaranteed Issue Amount. All late entrants and increases require Evidence of Insurability. Your employer will advise you if you need to submit an Evidence of Insurability application. If so, Sun Life Financial may arrange for you to take a medical exam (at our expense) and/or complete a questionnaire. Coverage will not go into effect until Sun Life Financial approves the application. Cost to You You are responsible for paying the cost of voluntary Life coverage through payroll deduction. Age Reductions Amounts of Life Insurance are reduced at the following ages for: Age Percentage 65 65% 70 45% 75 35% 80 25% For Complete Plan Details This highlight flyer is intended to provide an overview of the benefits available from your employer, and is not a complete description of plan provisions. Receipt of this flyer does not certify eligibility for benefits under this plan. When you become eligible for benefits, your employer will provide you with the Sun Life Financial Group Life booklet containing complete plan details. Exclusions Where allowed by law, if the Employee s cause of death is suicide: No amount of contributory Life or contributory Dependent Life Insurance is payable if the suicide occurs within 24 months after the Employee s Insurance is effective. If there was prior coverage in place, any period of time the Employee was insured for the same amount of Life Insurance under the previous insurer s group Life policy will count towards completion of the 24 months. No increased or additional amount of Life Insurance is payable if the suicide occurs within 24 months after the increased or additional amount of Basic Life Insurance is effective. No amount of Life Insurance in excess of the Guaranteed Issue Amount is payable if the suicide occurs within 24 months after the amount in excess of the Guaranteed Issue Amount is effective.

7 Voluntary Accidental Death or Accidental Dismemberment No Voluntary Accidental Death or Accidental Dismemberment payment will be made for a loss which is due to or results from: Suicide while sane or insane, or intentionally self-inflicted injuries. Bodily or mental infirmity or disease of any kind, or infection unless due to an accidental cut or wound. Committing or attempting to commit an assault, felony or other illegal act. Active participation in a war (declared or undeclared) or active duty in any armed service during a time of war. Active participation in a riot, rebellion, or insurrection. Injury sustained from any aviation activities, other than riding as a fare-paying passenger, if the pilot exclusion applies to the plan. The Insured Person s voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless administered on the advice of a Physician. The Insured Person s operation of any motorized vehicle while intoxicated. Intoxicated means the minimum blood level alcohol required to be considered operating an automobile under the influence of alcohol in the jurisdiction where the accident occurred. For the purpose of this Exclusion, "Motorized Vehicle" includes, but is not limited to, automobiles, motorcycles, boats and snowmobiles. This summary represents a general overview. Limitations and exclusions may vary depending on your specific benefit plan. Please review your booklet for complete information. This Overview is preliminary to the issuance of the Policy and booklet certificate. It does not describe the specific benefits under the Policy. Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy F orm Series 93P-LH, 98P-ADD, 02P-STD TDB Policy-2006, 02-SL, 07-SL, and 01C-LH-PT. In New York, group insurance policies are underwritten by Sun Life Insurance and Annuity Company of New York (New York, NY) under Policy F orm Series 93P-LH-NY, 06P-NYDBL, 02P- NYSTD, 98P-ADD-NY, 02-NYSL, 07-NYSL, and 01NYC-LH-PT. Product offerings m ay not be available in all states and m ay vary depending on state laws and regulations Sun Life Assurance Company of Canada, Wellesley Hills, MA All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at e.com/us. SLPC /10 (exp. 06/12)

8 Employee, Spouse and Child Voluntary Life & AD&D Premium Charts Who qualifies? All Newly Hired Employees or Employees changing from part-time to full-time Is there an Open Enrollment? YES! For the 2013 annual enrollment period ONLY, any eligible employee, even those previously eligible, may purchase Supplemental Employee & Spouse Life up to the guarantee issue amounts indicated above, without providing Evidence of Insurability (EOI). Accidental Death and Dismemberment Benefit (AD&D) is included with all Employee and Spouse Voluntary Life amounts only. (Children are ineligible for AD&D) Age Reductions: All Employee & Spouse coverage amounts reduce to 65% at age 65; 45% at age 70; 35% at age 75 and 25% at age 80. The age reductions are not reflected in the charts below. VOLUNTARY TERM LIFE & AD&D Cost Per Paycheck (26) EMPLOYEE Life & AD&D: Coverage is available in increments of $25,000 to a maximum of $500,000, not to exceed 5x your annual earnings. Guarantee Issue Limits: Under age 65: $200,000; Ages 65-69: $10,000; Ages 70 and over: $1,000 Employee Age $25,000 Plus $25,000 AD&D $50,000 Plus $50,000 AD&D $75,000 Plus $75,000 AD&D $100,000 Plus $100,000 AD&D $125,000 Plus $125,000 AD&D $150,000 Plus $150,000 AD&D $175,000 Plus $175,000 AD&D < 20 $1.12 $2.24 $3.36 $4.48 $5.60 $6.72 $ $1.12 $2.24 $3.36 $4.48 $5.60 $6.72 $ $1.12 $2.24 $3.36 $4.48 $5.60 $6.72 $ $1.34 $2.68 $4.02 $5.35 $6.69 $8.03 $ $1.67 $3.35 $5.02 $6.69 $8.37 $10.04 $ $2.23 $4.45 $6.68 $8.91 $11.13 $13.36 $ $3.22 $6.44 $9.66 $12.88 $16.10 $19.32 $ $4.97 $9.95 $14.92 $19.89 $24.87 $29.84 $ $8.17 $16.34 $24.51 $32.68 $40.85 $49.02 $ $12.46 $24.92 $37.38 $49.85 $62.31 $74.77 $ $22.48 $44.95 $67.43 $89.91 $ $ $ & over $45.70 $91.41 $ $ $ $ $ Employee Age $200,000 Plus $200,000 AD&D $225,000 Plus $225,000 AD&D $250,000 Plus $250,000 AD&D $300,000 Plus $300,000 AD&D $400,000 Plus $400,000 AD&D $500,000 Plus $500,000 AD&D < 20 $8.95 $10.07 $11.19 $13.43 $17.91 $ $8.95 $10.07 $11.19 $13.43 $17.91 $ $8.95 $10.07 $11.19 $13.43 $17.91 $ $10.71 $12.05 $13.38 $16.06 $21.42 $ $13.38 $15.06 $16.73 $20.08 $26.77 $ $17.82 $20.04 $22.27 $26.72 $35.63 $ $25.75 $28.97 $32.19 $38.63 $51.51 $ $39.78 $44.76 $49.73 $59.68 $79.57 $ $65.35 $73.52 $81.69 $98.03 $ $ $99.69 $ $ $ $ $ $ $ $ $ $ $ & over $ $ $ $ $ $ Note: The Employee must enroll to have Spouse or Child(ren) coverage. Eligible coverage options are: Employee only, Employee plus Spouse, Employee plus Children and/or Employee plus Spouse and Child(ren) Voluntary Life & AD&D Premium Chart P a g e 1 Rev 10/2012

9 Employee, Spouse and Child Voluntary Life & AD&D Premium Charts SPOUSE Life & AD&D: Coverage is available increments of $12,500 to a maximum of $250,000; cannot exceed 50% of the Employee s amount. Guarantee Issue Limits: Under age 65: $50,000; Ages 65 and over: $5,000 Employee Age Employee Age $12,500 Plus $12,500 AD&D $125,000 Plus $125,000 AD&D $25,000 Plus $25,000 AD&D $150,000 Plus $150,000 AD&D Child(ren): Life only; NO AD&D. Children s cost per paycheck remains the same whether you have 1 or 20 children. Dependent children are defined as children 14 days to age 23. Child(ren) Life cannot exceed 50% of the Employee s amount. All amounts are GI. $5,000 $10,000 $0.415 $0.831 $37,500 Plus $37,500 AD&D $175,000 Plus $175,000 AD&D $50,000 Plus $50,000 AD&D $200,000 Plus $200,000 AD&D $75,000 Plus $75,000 AD&D $225,000 Plus $225,000 AD&D $100,000 Plus $100,000 AD&D < 20 $0.81 $1.62 $2.42 $3.23 $4.85 $ $0.81 $1.62 $2.42 $3.23 $4.85 $ $0.81 $1.62 $2.42 $3.23 $4.85 $ $0.92 $1.85 $2.77 $3.69 $5.54 $ $1.10 $2.19 $3.29 $4.38 $6.58 $ $1.38 $2.77 $4.15 $5.54 $8.31 $ $1.90 $3.81 $5.71 $7.62 $11.42 $ $2.83 $5.65 $8.48 $11.31 $16.96 $ $4.50 $9.00 $13.50 $18.00 $27.00 $ $6.75 $13.50 $20.25 $27.00 $40.50 $ $12.00 $24.00 $36.00 $48.00 $72.00 $ & over $24.17 $48.35 $72.52 $96.69 $ $ $250,000 Plus $250,000 AD&D < 20 $8.08 $9.69 $11.31 $12.92 $14.54 $ $8.08 $9.69 $11.31 $12.92 $14.54 $ $8.08 $9.69 $11.31 $12.92 $14.54 $ $9.23 $11.08 $12.92 $14.77 $16.62 $ $10.96 $13.15 $15.35 $17.54 $19.73 $ $13.85 $16.62 $19.38 $22.15 $24.92 $ $19.04 $22.85 $26.65 $30.46 $34.27 $ $28.27 $33.92 $39.58 $45.23 $50.88 $ $45.00 $54.00 $63.00 $72.00 $81.00 $ $67.50 $81.00 $94.50 $ $ $ $ $ $ $ $ $ & over $ $ $ $ $ $ TOTAL COST CALCULATOR: Employee: $ Spouse: $ Child(ren): $ Total Cost Per Paycheck $ Step 1: Determine the amount of Voluntary Life & AD&D you want to elect for yourself, spouse and/or child(ren). Step 2: Find the column titled Employee Age on the above cost schedule and find your age bracket. Step 3: From your age bracket, move to the right along that row until you find the column under the Voluntary Life & AD&D amount you will be electing for yourself. (Example: If you are age 52 and want the $150,000 benefit, your cost per paycheck will be $ Repeat Step 2 & 3 for your Spouse (use your age) and see the box above for child(ren), if you are electing coverage for your dependents. Step 4: Add up the costs in the Total Cost Calculator to find what your Total Cost Per Paycheck for Voluntary Life & AD&D will be. Step 5: Complete the Benefits Enrollment Form with your selected choices and send the enrollment form to Jill Seifert in the Benefits Dept. Note: The Employee must enroll to have Spouse or Child(ren) coverage. Eligible coverage options are: Employee only, Employee plus Spouse, Employee plus Children and/or Employee plus Spouse and Child(ren) Voluntary Life & AD&D Premium Chart P a g e 2 Rev 10/2012

10 How long do I have to enroll in voluntary life? You must enroll within 31 days of becoming eligible. Must I be covered under TWS Medica plan to purchase voluntary life? No, voluntary life is independent of medical. Are the rates the same for men and women? Yes, they re the same. What is the amount of life insurance for the employee? The employee can elect from $25,000 to $200,000 (increment of $25,000) guaranteed issue or up to $500,000 with medical evidence. What is the amount of Life Insurance for spouses? Your spouse is eligible for 50% of the employee s amount, in increments of $12,500 to a maximum of $50,000. The spouse s coverage end at age 70. What is the amount of life insurance for children? Dependent Children, age 14 days to age 23 are eligible for $5,000 or $10,000. Newborns to 14 days old are not eligible for benefits. Is there open enrollment for the employee after the initial new hire enrollment period ends? No, there is NO OPEN ENROLLMENT for voluntary life insurance. If an employee does not elect voluntary life during their initial enrollment and later gets married or has children do these events allow the employee new open enrollment for themselves, spouse or children? No. The employee can only receive voluntary life on a guaranteed issue basis at the time of their initial enrollment. If an employee enrolls in the voluntary life and then gets married and has children will these events allow the spouse and children to be added on a guarantee issue basis? Yes, as long as the application is dated and received by Human Resources within 30 days of the qualifying event. Do my benefits reduce with age? Benefits will reduce at age 65 by 35% with an additional reduction of 20% at age 70. At age 75, the benefit would reduce by 10% and 10% at age 80. If your spouse is still covered, their coverage would be determined by the employee s age, not the spouse s age. For further information, please contact your Benefits Department. Voluntary Life Q & A

11 Group Long Term Disability Benefits for all Full-Time Salaried Employees of Thrifty White Drug - # Disability Can Happen to Anyone. Want to know more about your chances of becoming disabled? Sun Life Financial is a founding member of the Council for Disability Awareness. Visit happen.org and find out your Personal Disability Quotient. Benefits Available to all full-time salaried employees working 30 or more hours per week. Covers accidents and sicknesses. Benefits are 60% of monthly earnings up to a maximum of $7,500 per month. Benefits may begin after the elimination period of 90 days of absences due to a covered accident or sickness. Employees must meet the definition of disability as defined in the policy to be eligible for the benefits described here. Benefits are not payable for pre-existing conditions as defined in the policy. Cost to you LTD coverage is contributory, meaning that you are responsible for paying for all or a portion of the cost through payroll deduction. Calculate your monthly cost by dividing your monthly covered earnings by 100 and multiplying the result by the rate $ Follow the example below to determine your monthly cost. Example Monthly Earnings Divided by 100 Multiplied by rate Example cost* $ 3,500 / 100 = 35 x $0.40 $ Your Monthly Earnings Divided by 100 Multiplied by rate Your cost* $ [ ] / 100 = [ ] x $[0.339] $ [ ] *The rate is in effect for January 1, Contact your employer to confirm the portion of the cost for which you will be responsible. How to enroll Fill out the LTD enrollment form provided by your employer. Be sure to sign, date, and return the form to your employer. About Evidence of Insurability Evidence of Insurability also called proof of good health is required if: you decline coverage during your initial eligibility period and then want coverage at a later date. All late entrants and increases require Evidence of Insurability. Your employer will advise you if you need to submit an Evidence of Insurability application. If so, Sun Life Financial may arrange for you to take a medical exam (at our expense) and/or complete a questionnaire. Coverage will not go into effect until Sun Life Financial approves the application.

12 For complete plan details This highlight flyer is intended to provide an overview of the benefits available from your employer and is not a complete description of plan provisions. Receipt of this flyer does not certify eligibility for benefits under this plan. Your employer will provide you with the Sun Life Financial Group booklet containing complete plan details. Limitations Limitations include but are not limited to the list below. Limitations may vary depending on your specific benefit plan. No LTD benefit will be payable for any Total or Partial Disability during any of the following periods: any period the employee is not under the regular and continuing care of a physician providing appropriate treatment and regular examination and testing in accordance with the disabling condition, unless the employee has reached his maximum point of recovery and is still totally or partially disabled any period the employee fails to submit to any medical examination or clinical assessment requested by Sun Life any period the employee is incarcerated Exclusions Exclusions include but are not limited to the list below. Exclusions may vary depending on your specific benefit plan. No LTD benefit will be payable for any Total or Partial Disability that is due to: an intentionally self-inflicted injury, war, declared or undeclared, or any act of war, active participation in a riot, rebellion, or insurrection, or committing or attempting to commit an assault, felony, or other criminal act. This Overview is preliminary to the issuance of the Policy and booklet certificate. It does not describe the specific benefits under the Policy. This policy provides disability incom e insurance only. It does NOT provide basic hospital, basic medical or major m edical insurance as defined by the New York State Insurance Department. Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy F orm Series 93P-LH, 98P-ADD, 02P-STD TDB Policy-2006, 02-SL, 07-SL, and 01C-LH-PT. In New York, group insurance policies are underwritten by Sun Life Insurance and Annuity Company of New York (New York, NY) under Policy F orm Series 93P-LH-NY, 06P-NYDBL, 02P- NYSTD, 98P-ADD-NY, 02-NYSL, 07-NYSL, and 01NYC-LH-PT. Product offerings m ay not be available in all states and m ay vary depending on state laws and regulations Sun Life Assurance Company of Canada, Wellesley Hills, MA All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at e.com/us. XGR/2852 SLPC /10 (exp. 05/12)

13 LONG TERM DISABILITY INSURABLE SALARY DEFINITION Insured Earnings Only your earnings from the employer will be included as insured earnings. We calculate benefit amounts and limits based on the amount of your insured earnings on record with us as of the Redetermination date immediately prior to the start of your disability. See the "Redetermination" section of this plan. Insured earnings includes your contributions deposited into a cash or deferred compensation plan, or salary reduction plan, qualified under IRC Section 401(k), 403(b) or 457. Earnings based on excluded income and employer contributions deposited into such 401(k), 403(b) or 457 plan are excluded. For all covered persons, insured earnings means your rate of monthly earnings, excluding bonuses, commissions, expense accounts, and any other extra compensation, as reported by the plan sponsor. We do not include pay for hours worked or billed over 40 per week. Such earnings are multiplied by This benefit summary is for illustrative purposes. Your Certificate of Coverage will determine your exact benefits. If there is a discrepancy between this benefit summary and your certificate, the certificate prevails. LTD Insurability Salary Definition

14 LONG TERM DISABILITY MAXIMUM PAYMENT PERIOD (AGE 60 AND OVER) Maximum Payment Period The maximum payment period is the longest time that benefits are paid by this plan for your disability. It is determined by the table shown below. But, it may be less than that shown due to the nature of your disability. See "Special Limitations." For a disability starting on or after the employee reaches age 60, the maximum payment period will be determined according to the following table: Age When Disability Starts Maximum Payment Period Age years Age years Age years Age years Age years Age years Age years Age years Age years Age 69 or older year But if an employee whose disability starts after age 60 reaches the end of the maximum payment from this table before he reaches the Social Security Normal Retirement Age, we will extend his maximum payment period until he reaches Social Security Normal Retirement Age. This benefit summary is for illustrative purposes. Your Certificate of Coverage will determine your exact benefits. If there is a discrepancy between this benefit summary and your certificate, the certificate prevails. LTD Max Pymt Period (age 60 & older)

15 LONG TERM DISABILITY MAXIMUM PAYMENT PERIOD (UNDER AGE 60) Maximum Payment Period The maximum payment period is the longest time that benefits are paid by this plan for your disability. It is determined by the table shown below. But, it may be less than that shown due to the nature of your disability. See "Special Limitations." For a disability starting before the employee reaches age 60, the maximum payment period will last until the Social Security Normal Retirement Age as shown in the following table: Employee s Year of Birth Social Security Normal Retirement Age Before and 2 months and 4 months and 6 months and 8 months and 10 months and 2 months and 4 months and 6 months and 8 months and 10 months After This benefit summary is for illustrative purposes. Your Certificate of Coverage will determine your exact benefits. If there is a discrepancy between this benefit summary and your certificate, the certificate prevails. LTD Max Pymt Period (under age 60)

16 LONG TERM DISABILITY PAYMENT REDUCTION Income We Integrate With You may receive, or be entitled to receive, income shown in the list below. We will integrate your gross monthly benefit with such income to determine your monthly benefit from this plan. Commissions received, due to be received, or paid after disability benefits start. This includes vested and nonvested renewal commissions. Disability benefits from any mandated benefit act or law. This includes all temporary disability or state disability benefits required by law. Disability benefits from all group plans of: (1) the plan sponsor; or (2) your employer. This includes payments made by a group life insurance plan due to your disability. This does not include payments made from a group life insurance plan s: (a) accelerated death benefit; or (b) like provision that allows payment of such plan s proceeds due to terminal illness. Disability benefits from any other group plan. Income from a sick leave or salary continuance plan. This applies whether such plan is sponsored on a formal or informal basis. This includes lump sum or recurrent payments of accrued sick leave benefits. Benefits as shown below from: (1) the United States Social Security Act; (2) the Railroad Retirement Act; or (3) any other like U.S. or Canadian plan or act. (a) All disability benefits for which: (i) you are qualified; and (ii) your spouse and children are qualified due to your disability; (b) All unreduced retirement benefits for which: (i) you are qualified; and (ii) your spouse and children are qualified due to your qualification; and (c) all reduced retirement benefits paid to: (i) you; and (ii) your spouse LTD Payment Reduction Page 1 of 2

17 and children due to your receipt of such benefits. We will integrate your gross monthly benefit with such benefits to which your spouse and children are entitled due to your receipt of, or qualification for, disability benefits. We do this without regard to: (a) your marital status; (b) where you live; (c) where your spouse lives; (d) where your child lives; or (e) any custody arrangements made on behalf of your child. Retirement plan retirement benefits funded for your benefit by: (1) the plan sponsor; or (2) your employer. Retirement plan disability benefits. Retirement benefits or retirement plan disability benefits, due to your disability, from any government plan other than those shown above. Disability benefits from any: (1) no-fault motor vehicle coverage; (2) motor vehicle financial responsibility act; or (3) like law. Benefits from: (1) a Workers Compensation law; (2) an occupational disease law; or (3) any other act or law of like intent. This includes: (a) the Jones Act; (b) the Longshoreman s and Harbor Workers Compensation Act; or (c) any Maritime doctrine of Maintenance, Wages or Cure. Disability benefits from any third party when your disability is the result of the negligence or intentional tort liability of that third party. Payment from your employer as part of a termination agreement. We integrate your gross monthly benefit with income shown above that you are entitled to receive without regard to the reason you are entitled to receive it. Our right to reduce your benefit by such income shall not be negated by a transfer of claim liability to a third party. Payment by such third party by law, settlement, judgement, waiver or otherwise shall not negate our right. This benefit summary is for illustrative purposes. Your Certificate of Coverage will determine your exact benefits. If there is a discrepancy between this benefit summary and your certificate, the certificate prevails. LTD Payment Reduction Page 2 of 2

18 LONG TERM DISABILITY PRE EXISTING CONDITIONS Pre-Existing Conditions A pre-existing condition is a sickness or injury, including all related conditions and complications, for which, in the look back period, you: (a) receive advice or treatment from a doctor; (b) take prescribed drugs; or (c) receive other medical care or treatment, including doctor. consultation with a You may have been prescribed drugs by a doctor for a condition to be taken during the look back period. In that case, such condition or a related condition will be considered pre-existing. The "look back period" is the three months before the latest of: (a) the effective date of your insurance under this plan; (b) the effective date of a change that increases the benefits payable by this plan; and (c) the effective date of a change in your benefit election that increases the benefit payable by this plan. A pregnancy that exists on the date your insurance under this plan starts is also a pre-existing condition. No benefits are payable for disability due to a pre-existing condition, unless the disability starts after you complete at least one full day of active work after the date you are insured under this plan for 12 months in a row. You may become disabled due to a pre-existing condition after: (a) a change which provides for an increase in the benefits payable by this plan; or (b) a change in your benefit election which increases the benefit payable by this plan. In this case, your benefit will be limited to the amount that would have been payable had the change not taken place. This limit does not apply if your disability starts after you complete at least one full day of active work after the change has been in force for 12 months in a row. We do not cover any disability that starts before your insurance under this plan. This benefit summary is for illustrative purposes. Your Certificate of Coverage will determine your exact benefits. If there is a discrepancy between this benefit summary and your certificate, the certificate prevails. LTD Pre Existing Conditions

19 LONG TERM DISABILITY RETURNING TO WORK PART TIME Income Earned During Disability Subject to the other terms of this plan, if you are working to your maximum capacity, income earned during disability is treated as shown below while this plan pays benefits. In all cases, your insured earnings are adjusted each year by an indexing factor. See the "Indexing" section of this plan for how this is done. 1. For each of the first 12 months after you return to work, add your gross monthly benefit and your income earned during disability. (a) If the sum is not more than 100% of your insured earnings, we do not reduce your monthly benefit for that month. (b) If the sum is more than 100% of your insured earnings, we reduce your monthly benefit for that month by the amount over 100% of your insured earnings. 2. For each month after 12 months of work while disabled: (a) If your income earned during disability is less than 20% of your insured earnings, we do not reduce your monthly benefit for that month. (b) If your income earned during disability is 20% or more of your insured earnings, we reduce your monthly benefit for that month by 50% of your income earned during disability. Part-Time Earnings Capacity If you are able to work part-time while disabled, but you are not working to your maximum capacity, we adjust the monthly benefit as follows. During the own occupation period, we reduce your monthly benefit by 50% of the income you would currently be able to earn, if working to your maximum capacity, in your own occupation. After the own occupation period, we reduce your monthly benefit by 50% of the income you would currently be able to earn, if working to your maximum capacity, in any gainful occupation. This benefit summary is for illustrative purposes. Your Certificate of Coverage will determine your exact benefits. If there is a discrepancy between this benefit summary and your certificate, the certificate prevails. LTD Returning to Work Part Time

20 LONG TERM DISABILITY SPECIAL LIMITATIONS Special Limitations We limit the maximum payment period, if you are disabled due to a condition listed below. The maximum payment period for all such periods of disability is 24 months. This is a combined maximum for all such conditions and all periods of disability. We limit the maximum payment period for disabilities caused or contributed to by the following conditions. This limitation does not apply to any disability which is due to the covered person being under the influence of a narcotic administered by a doctor. Mental or emotional conditions Drug or alcohol abuse Musculoskeletal and connective tissue disorders including, but not limited to: Sprains or strains of joints and muscles Soft tissue conditions Repetitive motion syndromes or injuries Fibromyalgia Chronic fatigue conditions including, but not limited to: Chronic fatigue syndrome Chronic fatigue immunodeficiency syndrome Epstein-barr syndrome Chemical and environmental sensitivities Headache Chronic pain, myofascial pain Gastro-esophageal reflux disorder Irritable bowel syndrome Vestibular dysfunction, vertigo, dizziness This limitation will not apply to disabilities caused or contributed to by the following conditions: Schizophrenia Dementia Organic brain syndromes Amnesia syndromes Organic delusional or hallucinogenic syndromes Arthritis LTD Special Limitations Page 1 of 2

21 Ruptured intervertebral discs Spinal fractures Osteopathies Spinal tumors, malignancy or vascular malformations Radiculopathies, documented by EMG Spondylolisthesis, Grade II or higher Myelopathies Demyelinating diseases Traumatic spinal cord necrosis No benefits will be paid for disability due to a mental or emotional condition or drug or alcohol abuse if you are not receiving treatment for the cause of the disability from a provider, or in a facility that is: (a) licensed by the state to provide treatment for such condition; and (b) accredited or approved by the Joint Commission on the Accreditation of Health Care Facilities or Medicare. If payments under this plan would end due to the limits in this section, we may extend such payments, as shown below. But, you must meet all of the following conditions: (a) you must be disabled due to a condition named above; (b) you must be an inpatient in a qualified institution because of your disability; and (c) you must have been treated as an inpatient for at least 14 days in a row. In such case, we extend payments until the earliest of: (i) 90 days from the date of your discharge; (ii) the end of this plan s maximum payment period; or (iii) the date your disability ends. The term "qualified institution" means a legally operated hospital or other public or private facility licensed to provide inpatient medical care and treatment for the cause of your disability. If the covered person develops another medical condition while he or she is disabled due to any of the conditions for which we limit payment in this section, any continuing or new disability will be considered due to such conditions until the covered person has fully recovered from such condition(s) and has been released from his or her doctor s care for them. For any other period when the covered person s disability is due to any of the conditions for which we limit payment in this section and any other medical condition, the covered person s disability will be considered due to the other medical condition if the other medical condition would cause the disability, in and of itself. This does not apply to any other medical condition that is a manifestation of the covered person s condition(s) for which we limit payment in this section. This benefit summary is for illustrative purposes. Your Certificate of Coverage will determine your exact benefits. If there is a discrepancy between this benefit summary and your certificate, the certificate prevails. LTD Special Limitations Page 2 of 2