Group Additional Life Insurance

Transcription

1 Group Additional Life Insurance Montana Association of Counties Health Care Trust (MACoHCT) Answers To Your Questions About Coverage From Standard Insurance Company Standard Insurance Company Group Additional Life Insurance

2 About This Booklet This booklet is designed to answer some common questions about the group Additional Life insurance coverage offered to the eligible employees in your company. It is not intended to provide a detailed description of the coverage. Features of the coverage may vary by state. In addition to this booklet, refer to the Coverage Highlights for more information about the Additional Life insurance coverage. If coverage becomes effective and you become insured, you will receive a certificate containing a detailed description of the insurance coverage including the definitions, exclusions, limitations, reductions and terminating events. The controlling provisions will be in the group policy. Neither this booklet nor the certificate modify the group policy or the insurance coverage in any way.

3 Group Additional Life Insurance Montana Association of Counties Health Care Trust (MACoHCT) provides a Basic Life and Accidental Death and Dismemberment (AD&D) insurance benefit for active employees and elected officials of participating member groups at no cost to the member or member group. MACoHCT also makes available two other Life/AD&D insurance plans to member groups. Member groups may elect to make coverage available to employees and elected officials under both of these plans. Under Option 1, the member group elects a set amount of coverage for employees and elected officials and pays for coverage. Under Option 2, employees and elected officials choose the amount of additional coverage they need and pay for it themselves. Plan Options FOR ACTIVE EMPLOYEES AND ELECTED OFFICIALS: All eligible employees and elected officials participating in MACoHCT s group medical plan will automatically be covered under Basic Life and AD&D insurance, provided they meet the active work requirement. Member groups may elect to provide coverage for all employees and elected officials under the Option 1 Life and AD&D Plan. Member groups may also wish to make coverage available to their employees and elected officials under Option 2 of the Life and AD&D Plan. Basic Life insurance benefit: $20,000 AD&D insurance benefit: $20,000 Cost: Paid for by MACoHCT for active employees and elected officials. Option 1 The member group elects a multiple of $10,000 to a maximum of $100,000 or $150,000, as determined by the number of eligible employees in the member group. A matching amount of AD&D insurance is included. The member group may also elect to purchase dependent life coverage see Dependent Life Insurance section. Cost: Paid by the member group. Option 2 This coverage is made available by the member group. The employee or elected official may elect any Life Insurance multiple of $10,000, up to $500,000 (not to exceed an amount equal to 4 times the covered person s annual earnings). Option 2 AD&D insurance benefit: Matches the Option 2 Life insurance benefit amount. The employee or elected official may also elect to purchase dependent life coverage See Dependent Life Insurance section. Cost: Covered person pays the cost. Group Additional LIfe Insurance 3

4 Commonly Asked Questions The following information provides details to give you a better understanding of group Life and AD&D insurance available through your participation in MACoHCT. Written in non-technical language, this is not intended as a complete description of the coverage. Who is eligible for this coverage? To become insured, employees and elected officials must meet the eligibility requirements and an active work requirement. An eligible person must be: An active (a) regular permanent employee (including a permanent seasonal employee), regularly scheduled to work at least the minimum number of hours required by the employer for participation under the group policy, and working in a position that is budgeted for not less than.5 FTE (Full Time Equivalency), or (b) an elected official. Not enlisted as a full-time member of the armed forces. Actively at work on the day before the scheduled effective date of insurance. The following are not eligible for coverage: temporary employees, short-term workers, student interns, leased employees, and independent contractors. Will employees and elected officials have to provide information regarding their medical histories? Medical histories (evidence of insurability) are not required to become insured under Basic or Option 1 of Life and AD&D insurance. With respect to coverage under Option 2, coverage will not become effective until evidence of insurability is approved by The Standard in all of the following instances: To become insured for any amount under Option 2, if the application is made more than 60 days after becoming eligible. To become insured for more than $50,000 under Option 2, if the member group has 10 eligible employees or more (and application for coverage is made within 60 days after becoming eligible). To become insured for more than $30,000 under Option 2, if the member group has fewer than 10 eligible employees (and application for coverage is made within 60 days after becoming eligible). For any increase in coverage under Option 2. Evidence of insurability is also required for reinstatement of terminated coverage. 4 Standard Insurance Company

5 Does coverage reduce due to changes in age? Coverage under Basic and Option 1 reduces as follows: Reduces by 35% at age 70, and by 50% at age 75. Coverage under Option 2 reduces as follows: Reduces by 35% at age 65, by 50% at age 70 and by 65% at age 75. Is Life insurance coverage available for spouses and children? Member groups may elect to offer Dependents Life insurance. The amount of Dependents Life insurance for a covered spouse and each eligible child is $10,000. Cost of this coverage may be paid by the member group or the employee or elected official, as determined by the member group. A spouse is a person to whom the employee or elected offi cial is legally married. An eligible child is an child from live birth through age 25, including: natural children, adopted children, stepchildren, and children for whom the employee or elected official has been appointed legal guardian. Disabled children may be eligible for continued coverage beyond the limiting ages Group Additional LIfe Insurance 5

6 How much will the coverage cost? The monthly premium rate for coverage under Option 1 of Life and AD&D is $0.25 per $1,000 of coverage. To calculate monthly premium to be paid by the member group for Option 1 of Life/AD&D coverage: $ $1,000 = x.25 = x = $ Amount of Monthly rate Number of Monthly cost Option 1 eligible employees Option 2 - Use the following rates to determine the monthly premium paid by an active employee or elected official for Life and AD&D coverage under Option 2: Age on January 1 Rate per $1,000 of total coverage Age 29 and under $0.090 Age 30 to 34 $0.100 Age 35 to 39 $0.120 Age 40 to 44 $0.170 Age 45 to 49 $0.260 Age 50 to 54 $0.380 Age 55 to 59 $0.620 Age 60 to 64 $0.710 Age 65 to 69 $1.270 Age 70 to 74 $2.060 Age 75 to 79 $2.800 Age 80 and above $ Standard Insurance Company

7 To calculate an insured person s monthly premium for Option 2 of Life/AD&D coverage: $ $1,000 = x = $ Amount of Premium rate Insured person s Option 2 elected from above chart monthly cost Dependents Life insurance - The monthly premium rate is $2.25 monthly per employee or elected official insured for Dependents Life insurance, regardless of the number of Dependents covered. The covered person or member group pays the premium for this coverage, as determined by the member group. How do employees and elected officials apply for Option 2 Life insurance coverage? To apply for Life and AD&D insurance, an employee or elected official should complete the Enrollment Form in their enrollment packet and submit it to their employer. Application can be made at any time, but if made more than 60 days after becoming eligible, satisfactory evidence of insurability is required to become insured for any amount. Coverage subject to evidence of insurability is not effective until approved by The Standard. How are benefits paid? For amounts less than $25,000, The Standard issues a check to each designated beneficiary. The Standard pays amounts of $25,000 or more to each designated beneficiary by depositing funds into Standard Secure Access a convenient, no fee, interest-bearing draft account. With Standard Secure Access, each beneficiary receives a personalized checkbook and has complete control of the account. Beneficiaries can write checks as needed or for the full amount. This arrangement allows beneficiaries to earn competitive interest rates on their benefits while they take the necessary time to consider financial decisions and evaluate their choices. What happens if an employee or elected official becomes totally disabled and can t work? The Standard will continue the Life insurance under Option 2 without premium payments if the insured person: Becomes totally disabled while insured under the group policy Is under the age of 60 on the date of disability Completes the waiting period of 180 days Provides The Standard with satisfactory proof of total disability The Waiver of Premium provision does not apply to Basic or Option 1 Life insurance, AD&D insurance or Dependents Life insurance. Group Additional LIfe Insurance 7

8 What happens if an employee or elected official becomes terminally ill? Under the Accelerated Benefit provision, an insured person may be eligible to receive up to 75%, or a maximum of $500,000, of Option 2 Life insurance if determined terminally ill, has a life expectancy of less than 12 months and meets other eligibility requirements. The Accelerated Benefit is not available for Basic or Option 1 Life insurance, AD&D insurance or Dependents Life insurance. Proceeds from the Accelerated Benefit may be used as desired whether to cover medical expenses or to maintain quality of life. The amount of Option 2 Life insurance payable at death is reduced by the Accelerated Benefit paid and an interest charge. However, The Standard will pay at least 10% of the original Option 2 coverage amount at that time, even if interest charges on the accelerated amount would have exhausted the remaining benefits over time. Are there any other benefits with Life coverage from The Standard? The Standard pays an additional benefit, the Repatriation Benefit, if an employee or elected official dies more than 200 miles from the primary place of residence. The Standard will reimburse expenses, up to $5,000, incurred to transport the body to a mortuary near the primary place of residence. The Standard policy includes a travel assistance program that provides a full range of 24-hour medical, legal and travel assistance services to insured persons when traveling more than 100 miles from home or in a foreign country. 1 What benefits are paid under Accidental Death and Dismemberment (AD&D) coverage? Matching amounts of AD&D are included under each of the plans. AD&D insurance pays an additional benefi t to the covered person or their benefi ciaries in the event of death or dismemberment as a result of an accident. The amount of this AD&D insurance benefit for loss of life is equal to the amount payable for Life insurance coverage on the date of the accident. The amount of this AD&D insurance benefit for other covered losses is a percentage of the amount payable for Life insurance coverage on the date of the accident, as shown below: Loss: One hand or one foot 50% Sight in one eye 50% Two or more of the losses listed above 100% Percentage Payable: 1 Provided through an agreement with MEDEX Assistance Corporation, which is not affi liated with The Standard. MEDEX Travel Assist is not an insurance product. 8 Standard Insurance Company

9 The loss must occur due to an accident and independently of all other causes, within 365 days after the accident. Loss of life must be evidenced by a certified copy of the death certificate. All other losses must be certified by a physician in the appropriate specialty as determined by The Standard. The AD&D coverage includes the following additional benefits when an AD&D insurance benefit is payable: Seat Belt Benefit. The Seat Belt Benefit provision provides an additional benefit in the event an employee or elected official dies as a result of an automobile accident and was properly wearing and using a seat belt system. Air Bag Benefit. The Air Bag Benefit provides an additional benefit in the event of death as a result of an automobile accident for which a Seat Belt Benefit is payable, if the automobile is equipped with an air bag system which deployed as evidenced by a police accident report, and the deceased was seated in the driver s or passenger s seat intended to be protected by the air bag system. Family Benefits Package. The Family Benefits Package includes the Child Care Benefit, Higher Education Benefit and Career Adjustment Benefit. It provides eligible family members with additional financial help for childcare, college or career training. What are the exclusions? Option 2 Life insurance includes exclusion for death resulting from suicide or other intentionally self-infl icted injury while sane or insane. The amount payable will exclude amounts that have not been continuously in effect for at least two years on the date of death. AD&D insurance benefits are not payable for death or dismemberment caused or contributed to by: War or act of war, declared or undeclared, whether civil or international, and any substantial armed conflict between organized forces of a military nature Suicide or other intentionally self-infl icted injury while sane or insane Committing or attempting to commit an assault or felony, or actively participating in a violent disorder or riot (unless performing official duties) Voluntary use or consumption of any poison, chemical compound, alcohol or drug, unless used or consumed according to the directions of a physician Sickness or pregnancy existing at the time of the accident Heart attack or stroke Medical or surgical treatment for any of the above Group Additional LIfe Insurance 9

10 When does coverage end? Coverage ends automatically on the earliest of the following: The date the last period ends for which a premium was paid for the Life insurance (except for Option 2, if premiums are waived while totally disabled) The date employment terminates or the elected official is no longer active The date Group Life insurance ends under the Basic Plan The date the group policy terminates For Option 2, the date Life insurance terminates under the group policy The date an insured person ceases to be eligible; however, insurance may continue for limited periods under certain circumstances The date the member group ceases to participate under the group policy Dependents Life coverage for spouses and children ends automatically on the earliest of the following: Five months after the date the covered employee or elected official dies The date Group Life insurance ends The date Dependents Life insurance terminates under the group policy The date the last period ends for which a premium was paid for Dependents Life insurance When the dependent ceases to be an eligible dependent For a spouse, the date of divorce For a child who is disabled, 90 days after we mail the employee a request for proof of disability, if proof is not given. 10 Standard Insurance Company

11 AD&D insurance will automatically end on the earliest of the following: The date the corresponding plan of Group Life insurance ends With respect to coverage under Option 2, the date Waiver of Premium begins The date AD&D insurance terminates under the group policy The date the last period ends for which a premium was paid for the AD&D insurance If Life insurance ends or is reduced, may employees convert to an individual policy? If Life insurance from The Standard ends or is reduced for any reason other than failure to pay premiums, an employee may be able to convert the terminated coverage to certain types of individual life insurance policies without providing evidence of insurability. The employee must apply for conversion and pay the required premium within 31 days after group coverage ends or is reduced. AD&D coverage may not be converted under this provision. May employees buy group life coverage after leaving employment? If insurance ends because employment terminates, an employee may be eligible to buy group life insurance from The Standard through the Portability provision, assuming the employee meets the eligibility requirements. The employee must apply to port the coverage and pay the required premium within 31 days after employment terminates. Group Additional LIfe Insurance 11

12 MACoHCT has chosen Standard Insurance Company to provide group Life coverage for participating member groups. The Standard has earned a solid reputation for its quality products, expert resources, superior service, steady growth, innovation and groups and strong financial performance. Founded in 1906, The Standard is a leader in the group disability and life insurance market, while also offering individual disability, group dental and retirement plans for groups and individuals. Standard Insurance Company 1100 SW Sixth Avenue Portland OR GP190-LIFE/S399, GP399-LIFE/TRUST Group Voluntary Life Insurance SI 10391D (7/14)EE