1 Heo, Wecome to Coonia Vountary Benefits. Thank you for your interest in our Universa Life with the Acceerated Death Benefit for Long Term Care Rider. For detai pease ca Pease eave your name, phone number and a 15 minute preferred time bock for us to contact you to discuss the product. Pease speak ceary. We wi return your ca within 24 hours. You must have access to a computer and the internet for the ca. Again, thank you for choosing Coonia Vountary Benefits. We ook forward to speaking with you. Thank you.
2 Universa Life Insurance Are you prepared for a the changes ife has in store? With Universa Life insurance from The Pau Revere Life Insurance Company, you have the fexibiity you need to protect the ife you re buiding when your needs change, when you set or attain new goas, even when unexpected chaenges arise. What are the advantages of Universa Life Insurance? Offers fexibe premiums and death benefit amounts. Buids cash vaue at current credited interest rates. Provides access to the poicy s cash vaue when needed. Provides a death benefit (to age 100) that can be paid to beneficiaries tax-free. What benefits and features are incuded? Offers two pan design options: eve death benefit (Option A) or increasing death benefit (Option B). Incudes an Acceerated Death Benefit. Aows you to borrow against your poicy s cash vaue or take cash withdrawas from cash vaue if needed. My Coverage Worksheet (For use with your Pau Revere Benefits Counseor) How much coverage do you need? You Spouse Juvenie $ face amount $ face amount $ face amount Option A Option A Option A Option B Option B Option B Seect any optiona riders: Accidenta Death Benefit Rider Universa Life 1000 Additiona Coverage Term Rider Guaranteed Purchase Option Rider Waiver of Monthy Deductions Rider How much wi it cost? Your cost wi vary based on the eve of coverage you seect.
3 Frequenty asked questions about Pau Revere s Universa Life Insurance What s the difference between Option A and Option B? Option A offers a eve death benefit and buids cash vaue at current credited interest rates. Option B offers a death benefit that increases as the poicy s cash vaue increases. What is the Acceerated Death Benefit? If you are diagnosed with a termina iness, you can request up to 75% of the poicy s death benefit, not to exceed $150,000. We deduct a fee ony if you use the benefit, and your death benefit wi then be reduced by the amount you receive. In addition, there may be tax consequences for receiving the acceerated benefit; ask your tax advisor for advice. What spouse coverage options are avaiabe? Two options are avaiabe for spouse coverage at an additiona cost: 1. Spouse Universa Life Poicy: Offers the same fexibe features avaiabe to you whether or not you buy a poicy on yoursef. 2. Spouse Term Life Rider: Add a term rider for your spouse to your poicy, up to a maximum death benefit of $50,000. Choose to convert the term rider ater to a cash vaue poicy without providing proof of good heath if the rider terminates before the spouse s 70 th birthday. What dependent coverage is avaiabe? Two options are avaiabe for dependent coverage at an additiona cost: 1. Universa Life Poicy for each eigibe chid: Purchase a poicy whie chidren are young and premiums are ower whether or not you buy a poicy on yoursef. You may aso increase the coverage when the chid is 18, 21 and 24 without providing proof of good heath. 2. Chidren s Term Life Rider: Add a Chidren s Term Life Rider to cover a of your eigibe dependent chidren with up to $10,000 in coverage each for one premium. You may choose to convert this rider ater to a cash vaue ife insurance poicy without providing proof of the chid s good heath upon your 70 th birthday or the chid s 25 th birthday, whichever comes first. What is the Waiver of Monthy Deduction Benefit in Event of Tota Disabiity Rider? This rider waives a premiums on the universa ife poicy and any riders attached to it if you become totay disabed before your 65 th birthday and you satisfy the six-month eimination period. Your cash vaue wi remain intact and continue to earn interest. Aso, any premiums waived by this rider do not have to be repaid. What is the Accidenta Death Benefit Rider? This rider pays an additiona benefit if you die as a resut of an accidenta bodiy injury before age 70. The benefit doubes if the accidenta bodiy injury occurs whie you are a fare-paying passenger within a pubic conveyance such as a subway or city bus. An additiona 25% of the accidenta death benefit wi be paid shoud the insured die due to an accidenta bodiy injury sustained whie driving or riding in a private passenger vehice and wearing a seat bet. What is the Additiona Coverage Term Rider? This rider adds a 20-year eve term coverage of up to 100 percent of your poicy s death benefit.you may choose to convert the additiona coverage term rider to any new or existing cash vaue ife insurance pan without providing proof of good heath if the universa ife poicy terminates or the additiona coverage term rider terminates. The premiums remain eve for the duration of the rider. What is the Guaranteed Purchase Option Rider? This rider aows you to increase your universa ife coverage without providing proof of good heath at the 2 nd, 5 th and 8 th poicy years or when specified ife events occur. The premium is determined by your age at the time of the increase and amount of insurance you choose. Universa Life 1000 Excusions and Limitations -If the insured commits suicide within two years from the coverage effective date, we wi not pay the death benefit. We wi terminate this poicy and return the premiums paid minus any oans, oan interest and withdrawas to you. We wi not pay any increases in death benefits if the insured commits suicide within two years from the coverage effective date of the increase. Our ony obigation wi be to refund the premiums paid for the increase in the event of suicide. You wi receive a poicy iustration when your poicy is issued. This poicy has excusions, reductions of benefits and terms under which the poicy may be continued in force or discontinued. For costs and compete detais of the coverage, ca or write your benefits counseor or the company. This brochure is appicabe to poicy form UL1000-NY and rider forms R-UL-ACDTH-NY, R-UL-ACR-NY, R-UL-CTR-NY, R-UL-GPO-NY, R-UL-STR-NY, AND R-UL-WOMD-NY. Coonia Vountary Benefits products are underwritten by: The Pau Revere Life Insurance Company, Worcester, MA Administrative office: Coonia Vountary Benefits, 1200 Coonia Life Bouevard, Coumbia, SC coonia-paurevere.com 1/
4 Universa Life Insurance Our Universa Life 1000 pan offers two types of important financia protection in a singe product. The poicy s tax-free death benefit can hep cover fina expenses and provide financia security for a famiy s future expenses, whie optiona riders give empoyees fexibiity to use their death benefit for covered ong-term care expenses. It s a creative coverage soution from an industry eader with 75 years of experience heping America s workers preserve and protect what they ve worked so hard to buid. Fexibe use of death benefit (optiona riders avaiabe at an additiona cost) Long-term care benefit rider draws down the death benefit to hep pay covered ong-term care expenses* Restoration of benefits rider restores the death benefit as it s used for ong-term care caims Attractive underwriting Unimited maximum face amount, subject to underwriting Spouse signature not required for universa ife poicy or Spouse Term Rider with face amounts up to $50,000, except in states that require appicant to sign Exception underwriting avaiabe for quaifying accounts Famiy coverage options Stand-aone poicies avaiabe for spouse, chidren and grandchidren with no empoyee poicy required Spouse Term Rider and Chidren s Term Rider avaiabe on empoyee poicy Competitive features Tobacco-distinct, unisex rates Coverage for broad age ranges, up to 79 Matures at age 100 Buit-in acceerated death benefit due to termina iness Adjustabe death benefit and fexibe premiums Guaranteed 4% interest rate Poicy oans or cash withdrawas avaiabe after first poicy year Optiona riders Additiona Coverage Term Rider Waiver of Monthy Deductions Rider Accidenta Death Benefit Rider Guaranteed Purchase Option Rider CooniaLife.com 2014 Coonia Life & Accident Insurance Company Coonia Life insurance products are underwritten by Coonia Life & Accident Insurance Company, for which Coonia Life is the marketing brand Tak with your Coonia Life representative to earn more about this creative coverage soution. * Known as Comprehensive Long-Term Care Insurance Rider in CA, Long-Term Care Benefit Insurance Rider in FL, Chronic Iness Acceerated Benefit Rider in MA and Long-Term Care Acceerated Death Benefit Rider in PA. Product has excusions and imitations that may affect benefits payabe. Benefits and rider options vary by state and may not be avaiabe in a states. See your Coonia Life benefits representative for compete detais. UNIVERSAL LIFE 1000 Li
5 Eric No Union Coege 807 Union Street Schenectady, NY NYLTC Brokers Brian Johnson Deductions per year: 52 These rates were prepared on 3/2/2016 and are vaid for 90 days. Universa Life 1000 for NY Adut Base Pan Option A, Long Term Care Benefit Non-Tobacco Rates ISSUE AGE $50,000 $75,000 $100,000 $150, $5.83 $8.36 $10.90 $ $9.06 $13.22 $17.36 $ $14.48 $21.35 $28.21 $ $24.52 $36.41 $48.28 $ $44.13 $65.83 $87.52 $ Tobacco Rates ISSUE AGE $50,000 $75,000 $100,000 $150, $7.91 $11.48 $15.06 $ $12.29 $18.06 $23.83 $ $20.02 $29.65 $39.29 $ $33.87 $50.43 $66.98 $ $56.71 $84.69 $ $ Appicabe to poicy forms UL1000-NY and UL1000J-NY Important Notice Regarding Coverage Insurance coverage has excusions and imitations that may affect benefits payabe. For a compete description of benefits, imitations and excusions, pease refer to an outine of coverage, sampe poicy/certificate, proposa description or see your Pau Revere benefits counseor. Coverage type, benefits and rates vary by state. Coverage may not be avaiabe in a states. Rates provided are iustrative and your actua premium may be different depending on your particuar situation and pan choices. Coonia Vountary Benefits products are underwritten by: The Pau Revere Life Insurance Company, Worcester, MA Coonia Life & Accident Insurance Company Page 1 of 1 Underwritten by The Pau Revere Life Insurance Company See page 1 for Important Notice
6 Service guide for poicyhoders This service guide provides easy instructions to hep you access poicy information, fie a caim and contact us. Obtain a caim form Downoad forms from Coonia-PauRevere.com. -OR- Ca Competing the caim form Compete in fu the sections of the caim form that appy to your specific caim. Be sure the information incudes a diagnosis from your doctor aong with medica bis. For disabiity caims, the doctor needs to verify the dates of disabiity and furnish dates of treatment. The empoyer needs to confirm dates you missed from work. Be sure to sign a authorizations as instructed. To ensure prompt processing, sign and return the certification on page three. Then sign, date and return the caims authorization on page seven. Optiona services Page one of the caim form expains optiona services you may seect. You must initia each option you choose. These options aow us to: Reease information to your saes representative, pan administrator or a famiy member. Communicate caims information via eectronic messaging to your home phone number. Send any appicabe caim benefits by overnight deivery and deduct the fee from your caim payment. Submitting your caim Fax the form to Incude your name and Socia Security number on each page of your fax. If you fax the caim, you do not need to mai the origina document to us; keep this for your records. -OR- Mai the competed forms to: P.O. Box , Coumbia, SC Weness caims For weness screenings performed ess than 12 months from the date of your caim fiing, ca For weness screenings performed more than 12 months from the date of your caim fiing, submit a bi showing the date and type of your weness screening and the name and teephone number of the provider who performed the test. Resoving your caim You wi be notified by teephone when we receive information regarding your caim. If you seect the eectronic messaging option, you wi receive a ca once the caim is processed. If your caim is for a sickness or heath condition occurring within the first year, we may need to determine whether you have a pre-existing condition. If we have to contact your doctor and/or request copies of the medica records, it may engthen our processing time. We wi notify you by etter if we need any additiona information from your doctor or any other source(s). We wecome your assistance in encouraging your doctor to provide the needed information as quicky as possibe. Our goa is to provide prompt and accurate caims service. If you woud ike to check the status of your caim, pease ca our automated service ine at Important reminders When maiing the caim form or other information, keep a copy for your records. If you have questions at any point, ca Sign your caim form at the bottom of pages one and three. Read and sign the caims authorization on page seven. We cannot obtain additiona information from your doctor without proper consent. Ongoing caims Tota disabiity benefits provided by your coverage are based on disabiity information submitted on your caim form. Because we cannot pay benefits for time you have not yet missed from work, you may be asked to provide verification of your ongoing disabiity and the dates you are unabe to work. A disabiity dates must be confirmed by your doctor and your empoyer. Incude medica treatment dates on your caim form. Coonia-PauRevere.com
7 Change requests Change of empoyment If you change jobs or take a eave of absence, you may continue your individua coverage at the premium you are currenty paying. To continue your individua coverage, contact your benefits representative or ca our Service Center. Poicy/certificate changes The foowing changes must be requested in writing: Canceations Loans Cash surrenders Withdrawas Ownership changes Beneficiary changes Assignments Fax or mai the competed Request for Service form avaiabe on Coonia-PauRevere.com. Changes made by teephone incude: Name/address Payment method information converting from payro deduction to individua pay Changes and fexibe benefits pans The Interna Revenue Service (IRS) issues reguations that govern fexibe benefits pans. One of the IRS reguations requires empoyers to pace certain imits on when their empoyees can change the eections they make under the pan. If you purchased coverage with pretax doars, you signed an eection form at the time of appication, which stated that the eection wi remain in effect and cannot be revoked or changed during the pan year uness the revocation or new eection is because of a change in status. A change in status is defined as a change in: Lega marita status Number of dependents Empoyment status Abiity to satisfy eigibiity requirements Residence Adoption assistance The eection change must be consistent with the change of status. Taxabiity of benefits If you pay your premiums under a fexibe benefits pan with pretax doars, or if your empoyer pays part or a of your premiums, some of these benefits may be taxabe. If your benefits are taxabe, you may receive a 1099 or W-2 Form from us and/or a W-2 Form from your empoyer that wi incude the amount you shoud report as taxabe income to the IRS. If you have questions about taxabiity of benefits, discuss them with your empoyer, or contact our Service Center and ask to speak to a tax speciaist. Contact us Processing Center P.O. Box Coumbia, SC Teephone Contact Center representatives are avaiabe Monday through Friday, 8 a.m. 8 p.m. EST. Automated service information is avaiabe 24 hours a day, 365 days a year. Check the status of your caim. Fie weness caims. Get answers to other poicy questions. Pease have your Socia Security or poicy number ready when you ca. Spanish-speaking customers Hearing-impaired customers Customers with a Teecommunications Device for the Deaf (TDD) shoud ca Coonia-PauRevere.com 2014 The Pau Revere Life Insurance Company, Worcester, MA Coonia Vountary Benefits insurance products are underwritten by The Pau Revere Life Insurance Company
8 Buit to ast Customer-focused financia stabiity For more than 75 years, we ve heped America s workers preserve and protect the vitay important things they work so hard to buid. We ve done this by aways staying true to our mission, and by pacing our commitment to our customers ahead of everything ese. This ed us to deveop and maintain a stabe, diverse investment portfoio, a history of profitabe growth and a reputation for consistenty strong industry ratings. In other words, we re a company you can trust an industry eader that aways meets our financia obigations and keeps our promises. At-a-gance Vountary benefits provider offering disabiity insurance, ife insurance, accident insurance, cancer insurance, critica iness insurance, denta insurance and hospita confinement indemnity insurance Serving more than 3 miion poicyhoders in 80,000 businesses and organizations Operating in 49 states, the District of Coumbia and Puerto Rico; in New York, simiar products and services, if approved, are underwritten by a Coonia Life affiiate, The Pau Revere Life Insurance Company Approximatey 1,100 empoyees, 8,500 independent saes agents and 6,000 contracted brokers Headquartered in Coumbia, SC, with a operations incuding a customer ca center taking pace there since 1939 Coonia Life operates as a stand-aone business of Unum, a Fortune 500 company and market eader in vountary benefits. The experts agree Coonia Life, with a of Unum s primary subsidiaries 1, consistenty earns strong financia ratings from the four major rating agencies. 2 Agency A.M. Best Company Measures an insurer s financia strength and abiity to meet its ongoing insurance poicy and contract obigations Rating A Exceent Moody s Investors Service Provides opinions of the abiity of insurance companies to punctuay pay senior poicyhoder caims and obigations A 2 Good Standard & Poor s Offers a forward-ooking opinion about the financia security characteristics of an insurance organization with respect to its abiity to pay under its insurance poicies and contracts in accordance with their terms A Strong Fitch Assigns a rating to the insurance company s poicyhoder obigations, incuding assumed reinsurance obigations and contract hoder obigations, and refects the abiity of the insurer to meet these obigations on a timey basis A Strong
9 Investing for ong-term strength Our portfoio is invested across a diverse seection of markets and securities. This heps reduce the effect unexpected events can have on our tota investment program and supports our ong-term strength and growth. Whie investments can have their ups and downs, our portfoio heps ensure that our commitment to our poicyhoders wi stand strong. As of December 31, 2014, our investment portfoio incudes: Since 1939: Faciitating smart, stabe growth We continue to baance our iabiities and assets in ways that support smart, secure and stabe growth. Our practice of investing in quaity securities has resuted in a 16% average compound annua growth rate in statutory assets since the company was founded. Wise management of our assets and iabiities gives us the financia strength to stay true to our word on every poicy and for every poicyhoder. Approximatey 84% invested in bonds 84% BONDS Statutory premiums have grown at an average compound annua growth rate of 14%. 14% PREMIUMS Less than 1% invested in rea estate 1% REAL ESTATE Statutory assets have grown at an average compound annua growth rate of 16%. 16% ASSETS Approximatey 11% invested in commercia mortgages, consistent with the industry average. 3 11% MORTGAGES Tota statutory iabiities have grown at an average compound annua growth rate of 17%. 17% LIABILITIES Long-term profitabe growth In miions 3,000 2,500 2,000 1,500 1,000 Assets Liabiities 2,922 2,355 Learn how we can hep deiver ong-term empoyee benefit soutions for your business. Tak to your Coonia Life benefits representative CooniaLife.com 1 Unum s primary subsidiaries are Unum Life Insurance Company of America, Provident Life and Accident Insurance Company, Provident Life and Casuaty Insurance Company, The Pau Revere Life Insurance Company, Coonia Life & Accident Insurance Company, and First Unum Life Insurance Company. 2 Industry ratings are not a warranty of an insurer s financia strength, current or future abiity to meet its obigations to poicyhoders nor a recommendation of a specific poicy form, contract, rate or caim practice. In addition, industry ratings do not address the suitabiity of a particuar insurance poicy or contract for a specific purpose or purchaser. 3 A.M. Best Company, year-end 2013 Best s Aggregates & Averages 2015 Coonia Life & Accident Insurance Company, Coumbia, SC Coonia Life insurance products are underwritten by Coonia Life & Accident Insurance Company, for which Coonia Life is the marketing brand
10 The Coege Tuition Benefit (CTB) Company Name, Company ID Empoyees now have an added incentive to participate in the Retirement Pan. They earn Tuition Awards that can be used to pay for up to one year of tuition at over 280 private Coeges and Universities across the Nation, that s amost 30% of the Nation s private Coeges and Universities. 60% of the coeges are ranked by US News and word reports as America s Best Coeges. This benefit is being provided to you, by your empoyer, at no cost to you. A you have to do is meet with the Coonia vountary benefits enroer to register a student, and you wi be on your way to reducing the cost of a coege education for your Chidren, Grandchidren, Nieces and Nephew. After your account is set up you wi be abe to register as many students as you wish. Highights of the Coege Tuition Benefit, Each empoyee is registered for 500 SAGE Schoarship Tuition Rewards. Spouses can register for an additiona 500. Empoyees in the Retirement Pan receive an annua 5% Tuition Rewards match of their 401(k)/403(b) account baance. The security of Coonia Workpace Benefits is made avaiabe to empoyees as they are enroed in the SAGE Schoarship Program. To iustrate how the program heps pay for a chid or grandchid s coege education; assume a 12-year od in a famiy where the empoyee has $50,000 in the Retirement pan, assume an annua contribution of $2,000 into the Pan and a hypothetica 7% investment return. (Note: Monies in most Retirement Pans do not have a guaranteed rate of return and may actuay ose vaue). Age Retirement Pan Account Baance 5% Award CTB Schoarship Baance Baance does not accrue interest Award for registering a chid $50,000 2,500 3, $55,500 2,775 5, $61,385 3,069 8, $67,682 3,384 12, $74,420 3,721 15, $81,629 4,081 20,030 In this exampe, if the chid attends a participating SAGE schoo, the tuition wi be reduced by 20,030, with each point being equa to $1. Important Information: You wi receive a wecome emai 10 days from the cose of the enroment. If you do not receive one you must contact You must og on to your account within 6 months after receiving your wecome emai or your benefits may be reduced. To earn credits you must register a student who has not competed 10th grade. Participation does not affect your Retirement account in any way. We just measure against the account baance. The maximum rewards you can use, per registered student, can not exceed one year s tuition at a participating Schoo. The Schoarship credits are hed in your account unti you pedge them to a registered chid - You do not have to seect a coege ahead of time. You do not have to purchase Workpace benefits to participate in The Coege Tuition Benefit. Form: EE022608