1 Term Life and Accident Insurance Developed for the Employees of Los Angeles Community College District a 06/12
3 Life Insurance Who Needs Life Insurance? You do. Single or married. Buying your first home or preparing for retirement. Raising children or sending them off to college. No matter where you are in life, insurance should be part of your financial plan. By purchasing this insurance product through your employer, you benefit from: Affordable group rates Convenient payroll deduction Access to knowledgeable service representatives. Who Is Eligible For Coverage? You If you are an active, full-time employee and work at least 20 hours per week for your employer in the United States, excluding employees classified as Seasonal or Temporary, you will be eligible to elect insurance for you and your dependents on the first of the month following the date of hire. Your Spouse* is eligible provided that you apply for and are approved for coverage for yourself. Your Unmarried Children Under age 26, as long as you apply for and are approved for coverage for yourself. One low premium will insure all your eligible children, regardless of the number of children you have. No one may be covered more than once under this plan. If covered as an employee, you can not also be covered as a dependent. * Domestic Partner is defined in the Group Policy. For purposes of this brochure, wherever the term Spouse appears, it shall also include Domestic Partner and Domestic Partners registered under any state which legally recognizes Domestic Partnerships or Civil Unions. Additional information is available from your Benefit Services Representative. How Much Coverage Can You Buy? You You can select life insurance coverage in units of $10,000. The maximum for any employee is the lesser of 5 times your annual salary or $500,000. The guaranteed coverage amount for you is the lesser of 5 times your annual salary or $120,000. Your Spouse You may select coverage for your spouse in units of $5,000 to a maximum of $250,000. The cost of coverage will be based on your age. The guaranteed coverage amount for your spouse is $50,000. Your Unmarried Children You may select coverage for your unmarried children in units of $1,000 to a maximum of $10,000. The maximum benefit for children under six months is $500. The guaranteed coverage amount for your child(ren) is $10,000. Guaranteed Coverage If you and your dependents are eligible and you apply during the initial enrollment period, or within 31 days after you are eligible to elect coverage, you are entitled to choose any of the offered amounts of coverage up to the guaranteed coverage amount, as shown on your application, without having to provide evidence of good health. If you apply for an amount of coverage for yourself or your spouse greater than the guaranteed coverage amount, coverage in excess of the guaranteed coverage amount will not be issued until the insurance company approves acceptable evidence of good health. Evidence of good health may include a paramedical exam or physician s statement. If you apply for coverage for yourself or your spouse more than 31 days from the date you become eligible to elect coverage under this plan, the guaranteed coverage amounts will not apply. Coverage will not be issued until the insurance company approves acceptable evidence of good health. Evidence of good health may include a paramedical exam or physician's statement
4 How Much Your Coverage Will Cost The monthly cost of insurance for you and your spouse will depend on your age and the amount of insurance you wish to purchase. As shown in the following chart, the cost of insurance increases with the age of the insured. Note that at age 65, your benefits are reduced. To calculate your tenthly cost: 1. Find your age group in the following table; 2. Multiply the rate by the number of coverage units you want; 3. Calculate the cost of coverage for your spouse, using your age, then calculate the cost of coverage for your children; 4. Add the premiums for you, your spouse and your children to get your total tenthly cost. Example: Employee (age 28) 25 units x ($250,000) Spouse 20 units x ($100,000) Children 10 units x ($10,000) $.54 per unit = $13.50 $.27 per unit = $5.40 $.185 per unit = $1.85 Total Tenthly Cost $20.75 Employee Age Employee Tenthly Cost per $10,000 Unit Spouse Tenthly Cost per $5,000 Unit Under 30 $.54 $ to to to to to to to to to & over The tenthly cost for children is $.185 per $1,000 of coverage. One premium will insure all your eligible children, regardless of the number of children you have. Costs are subject to change. To calculate your cost, complete this chart: Employee units x $. per unit = $. Spouse units x $. per unit = $. Children units x $.185 per unit = $. Total Tenthly Cost $. Annual Enrollment Period Each year, during your enrollment period, you have the opportunity to enroll in the plan or increase your voluntary coverage. We do require evidence of good health for all new coverage selections
5 How Much Life Insurance Do You Need? We have provided this worksheet to help you calculate how much life insurance you may need for a surviving spouse and dependents. When calculating annual amounts, be sure to multiply the annual income or cost by the number of years you expect to receive that income, or incur that cost. 1. Living Costs Day-to-day Living Expenses (Use 75% of current net income) $ annually x years = $ Child Care Expenses $ annually x years = + Education Funding $ annually x years = + Major Purchases (cars, home repair) $ annually x years = + Estate and Funeral Expenses = + TOTAL LIVING COSTS (A) = $ 2. Available Resources Cash and Savings = $ Retirement Savings (IRA, 401(k), etc.) = + Stocks and Bonds (at current market value) = + Spouse Income (multiply by 60%)* $ annually x years = + Other Assets = + TOTAL AVAILABLE RESOURCES (B) = $ 3. Life Insurance Need TOTAL LIVING COSTS (A) = $ (A) LESS TOTAL AVAILABLE RESOURCES (B) $ (B) EQUALS LIFE INSURANCE NEED = $ Naturally a worksheet like the above is only an aid to determining life insurance needs. It cannot predict all of your expenses, economic conditions, inflation, investment performance or other factors which may alter your needs. For a more accurate plan, you should consider consulting an investment advisor. * Estimate likely spouse income as sole provider. Include your estimate of Social Security benefits to surviving spouse and dependents. The 60% factor above is used to account for taxation so that a net income figure can be derived. Vary this factor if you feel combined federal, state and local taxes, and FICA will be different for your situation Other Benefit Features Accelerated Death Benefit Terminal Illness If you or your spouse is diagnosed by two unaffiliated physicians as terminally ill with a life expectancy of 12 months or less, the accelerated payment benefit for terminal illness provides for up to 80% of the life insurance coverage amount in force up to $400,000, whichever is less, to be paid to the insured. This benefit is payable only once in the insured's lifetime, and will reduce the life insurance death benefit. The terminal illness benefit may be taxable. As with all tax matters, an insured should consult with a personal tax advisor to assess the impact of this benefit. Continuation for Disability for Employees Age 60 or over If your active service ends due to disability, this plan provides a continuation of coverage feature. If you are disabled at age 60 or over, your coverage will continue while you are disabled. This benefit will remain in force until the earliest of the following dates: the date you are no longer disabled, the date the policy terminates, the date you are disabled for 9 consecutive months, or the day after the last period for which premiums are paid. You are considered disabled if, because of injury or sickness, you are unable to perform all the material duties of your Regular Occupation, or you are receiving disability benefits under your Employer s plan. Regular Occupation means your occupation, as routinely performed in the general labor market, at the time your disability begins. Extended Death Benefit with Waiver of Premium Extended Death Benefit If you become Disabled The extended death benefit ensures that if you become disabled prior to age 60, and die before it is determined if you qualify for Waiver of Premium, we will pay the life insurance benefit if you remain disabled during that period. If you qualify for this benefit and have insured your spouse or children, their coverage is also extended. No additional premium payment is required for the extended coverage. You are considered disabled if, because of injury or sickness, you are unable to perform the material duties of your Regular Occupation, or you are receiving disability benefits under your Employer s plan. Regular Occupation means your occupation, as routinely performed in the general labor market, at the time your disability begins. Waiver of Premium If you become totally disabled To make sure you can keep the life insurance protection you need during a difficult period of your life, this plan provides a waiver of premium feature. If you are totally disabled prior to age 60 and can't work for at least 6 months, you won't need to pay premiums for your coverage while you are disabled, provided the insurance company approves you for this benefit. You are considered totally disabled when you are completely unable to engage in any occupation for wage or profit because of injury or sickness. This benefit will remain in force until to age 65, subject to proof of continuing disability each year. If you qualify for this benefit and have insured your spouse or children, the premium for their coverage is also waived.
6 Other Benefit Features, cont d Rehabilitation During a Period of Disability If the insurance company determines that you are a suitable candidate for rehabilitation, the insurance company may require you to participate in an assessment and rehabilitation plan, not to exceed 18 months. A rehabilitation plan may consist of educational, vocational or physical rehabilitation or may include modified work or work on a part-time basis. If you refuse such assistance without good cause (a medical reason preventing participation, in whole or in part, in the rehabilitation plan), insurance under this plan will end. What Is Not Covered The plan will not pay benefits if loss of life is the result of suicide that occurs within the first two years of coverage. When Your Coverage Begins and Ends The date your coverage begins is called its effective date. Your employer will let you know the effective date of your coverage. If you are not actively at work on the effective date of coverage, your coverage will not begin until you return to work. For coverage for your spouse and/or children to be effective, they must not be hospitalized or confined at home under the care of a doctor. Your coverage cannot be terminated as long as you remain eligible, the premium is paid and the group policy remains in force. For your spouse and children, coverage ends when your coverage ends, when their premiums are not paid or when they are no longer eligible. If You Leave Your Employer To help you keep your life insurance coverage during the years when your family needs financial protection, the plan allows you to continue all of your voluntary coverage if you leave your employer. Premiums may change at this time. Just make arrangements to pay your premiums directly to the insurance company after you leave your current employer. Coverage may be continued for you until age 80 and your spouse until age 70. Coverage may also be continued for your children. As long as the group policy remains in force, the option of continuing this coverage is available. Apply Today In order to apply for coverage, you must complete an application form. Be sure to answer all questions accurately, and indicate how much coverage you wish to have. Payroll Deduction You pay your premiums through payroll deduction. The total depends on how much coverage you select, your age and the amount of coverage you buy for your spouse and children. Designating Your Beneficiary Your term life benefit will automatically be paid to the first beneficiary listed below who is living at the time of your death if you do not designate a specific beneficiary: 1) Your Spouse* 2) Your Child(ren) 3) Your Parents 4) Your Siblings 5) Your Estate If you wish to designate different beneficiaries, or to indicate percentages, you may do so on your application. If the listed beneficiary is a trustee or a trust, you will need to indicate the trustee's name, the name of the trust and the date of the trust agreement. The trust document must be presented in order for the claim to be processed. * Benefits will not be paid to your Domestic Partner if he or she is not specifically designated. How Your Claims Are Paid Your employer has all the forms your beneficiary will need and can provide assistance in completing them. Questions? Cigna Group Insurance has courteous, knowledgeable customer service representatives who can assist you with the completion of your enrollment form by calling toll-free anytime from Monday through Friday, 8 a.m. to 6 p.m. Eastern time. Cigna does not have your coverage election information on file. For specific benefit/account inquiries on what is available under your plan, please contact your Health Benefits department. This portion of the plan provides life insurance only. Converting Your Coverage to Permanent Life Insurance If group life insurance coverage is reduced or ends for any reason except nonpayment of premiums, you can convert to an individual policy. No medical certification is needed. To convert coverage, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Family members may convert their coverage as well. Converted policies are subject to certain benefits and limits as outlined in the conversion brochure which may be requested as needed. Premiums may change at this time
7 Accident Insurance Who Needs Personal Accident Insurance? You do. Accident insurance can help you pay expenses if you are seriously injured or killed in a covered accident. This insurance can help ensure that tragedy doesn t take both an emotional and a financial toll on your family. By purchasing this insurance through your employer, you benefit from: Affordable group rates Convenient payroll deduction Who Is Eligible For Coverage? You You are an active, full-time employee and work at least 20 hours per week for your employer in the United States, excluding employees classified as Seasonal or Temporary, you will be eligible to elect insurance for you and your dependents on the first of the month following the date of hire. How Much Coverage Can You Buy? You If you elect voluntary accident insurance, the coverage amount must be equal to your voluntary life insurance benefit in effect under Policy Number FLX , underwritten by Life Insurance Company of North America. Your Monthly Cost The tenthly rate per $1,000 of coverage is $0.017 for the employee. A Valuable Combination of Benefits Personal Accident Insurance helps protect you against losses due to accidents. A covered accident is a sudden, unforeseeable, external event, resulting directly and independently of all other causes, in a covered injury or covered loss that occurs while coverage is in force. To help survivors of severe accidents adjust to new living circumstances, we will pay benefits according to the chart below. If, within 365 days of a covered accident, bodily injuries result in: We will pay this % of the benefit amount: Loss of life, or Total paralysis of upper and lower limbs, or Loss of any combination of two: hands, feet or 100% eyesight, or Loss of speech and hearing in both ears Total paralysis of both lower or upper limbs 75% Total paralysis of upper and lower limbs on one side of the body, or Loss of hand, foot or sight in one eye, or 50% Loss of speech, or Loss of hearing in both ears, or Severance and Reattachment of one hand or foot Total paralysis of one upper or lower limb, or Loss of all four fingers of the same hand, or 25% Loss of thumb and index finger of the same hand Loss of all toes of the same foot 20% Coma 1% If the same accident causes more than one of these losses, we will pay only one amount, but it will be the largest amount that applies. Loss of a hand or foot means complete severance through or above the wrist or ankle joint. Loss of sight means the total, permanent loss of all vision in the eye. Loss of speech means total, permanent and irrecoverable loss of audible communication. Loss of hearing means total and permanent loss of the ability to hear any sound in both ears. Loss of sight, speech and hearing must be irrecoverable by natural, surgical or artificial means. Loss of a thumb and index finger or four fingers, means complete severance through or above the metacarpophalangeal joints (the joints between the fingers and the hand). Paralysis means total loss of use, without severance, of a limb. This loss must be determined by a doctor to be complete and not reversible. Loss of Toes means complete severance through the metatarsalphalangeal joint. Severance means complete and permanent separation and dismemberment of the limb from the body
8 Additional Benefit For Exposure and Disappearance Benefits are payable if you suffer a covered loss due to unavoidable exposure to the elements as a result of a covered accident. If your body is not found within one year of the disappearance, wrecking or sinking of the conveyance in which you were riding, on a trip otherwise covered, it will be presumed that you sustained loss of life as a result of a covered accident. For Comas If you have been in a coma for one full month as a result of a covered accident, we will pay a coma benefit, as shown in A Valuable Combination of Benefits. We will make 11 monthly payments, provided the person remains in a coma during this period. If the person recovers, the payments will stop. If the insured person dies while the monthly coma benefit payments are being made, or if the insured person remains in a coma after the 11 monthly payments have been made, he or she will be entitled to a lump sum payment equal to the full benefit amount. Coma means a profound state of unconsciousness which resulted directly and independently from all other causes from a covered accident, and from which the insured is not likely to be aroused through powerful stimulation. This condition must be diagnosed and treated regularly by a physician. Coma does not mean any state of unconsciousness intentionally induced during the course of treatment of a covered injury unless the state of unconsciousness results from the administration of anesthesia in preparation for surgical treatment of that covered accident. For Brain Damage This plan will pay an additional 100% of the benefit amount, up to a maximum of $500,000, if you suffers brain damage as a result of injuries from a covered accident. The insured person must be hospitalized for treatment of brain damage at least 7 days within the first 60 days following the covered accident. The brain damage must begin within 60 days of the covered accident and continue for 12 consecutive months, and a doctor must determine that, as a result of brain damage, the insured person is permanently, totally disabled at the end of that period. This benefit is payable in one lump sum on the first of the 13 th month following the date of the covered accident if brain damage continues past 12 months. This benefit amount cannot exceed your full benefit amount chosen under How Much Coverage Can You Buy? Brain Damage means physical damage to the brain that results directly and independently of all other causes from a covered accident and causes the insured to be permanently, totally disabled. For Child Care Expenses Personal Accident Insurance pays an additional benefit to help pay for your children s child care expenses. If you die as a result of a covered accident and you have a surviving child under 13 who is enrolled in a licensed child care center at the time of the accident or within 90 days afterward, we will pay a child care center benefit. This benefit will be an annual sum for each child of up to 12% of your benefit amount but not more than $5,000 per year for 4 years or until the child turns 13, whichever occurs first. We will make the payment to the child s surviving custodial parent or legal guardian. Each payment will be made at the end of a 12-month period in which there were documented child care center expenses. Child means your unmarried dependent children who are under age 26. For Traveling on Public Transportation If you are accidentally killed or dismembered while a fare-paying passenger in or being struck by or while getting on or off of public transportation, such as a bus or plane, licensed for hire to carry fare-paying passengers or a transport aircraft operated by the U.S. Air Mobility Command or a similar air transport service of another country, we will increase the benefit amount by 100%, to a maximum of $500,000. For Rehabilitation If you incur rehabilitative expenses within 2 years of the date of a covered loss, we will pay an additional 50% of the benefit amount, to a maximum of $10,000 for each covered accident. Rehabilitative expenses means any medical services, supplies or treatment, or hospital confinement that is necessary for physical rehabilitative training. Rehabilitative training must prepare the insured to return to his/her or any other occupation, be prescribed by and under the care of a doctor and meet the generally accepted standards of medical practice
9 Additional Benefit, cont d For Wearing a Seatbelt and Protection by an Airbag This benefit is payable if an insured person dies as a direct result of injuries sustained in a covered accident while driving or riding in an automobile*, while wearing a properly fastened seatbelt. That person s death benefit will be increased by 100% but not more than $10,000. If the insured person was also positioned in a seat protected by a properly-functioning and properly deployed Supplemental Restraint System ** (Airbag), we will increase that person s death benefit by an additional 100% but not by more than $10,000. Verification of the actual use of the seatbelt and that the supplemental restraint system inflated properly on impact at the time of the accident, must be part of an official report of the accident, or be certified, in writing, by the investigating officer(s) and submitted with the claim. If it is unclear whether the insured had been wearing a seatbelt or that the person was positioned in a seat protected by a properly functioning and properly deployed airbag, the plan will pay a benefit of $1,000. *Automobile means a self-propelled, private passenger motor vehicle with four or more wheels which is of a type both designed and required to be licensed for use on the highways of any state or country. Automobile includes but is not limited to a sedan, station wagon, sport utility vehicle or a motor vehicle of the pickup, van, motor home or camper type. Automobile does not include a mobile home or any motor vehicle which is used in mass or public transit. **Supplemental Restraint System means an airbag that inflates upon impact for added protection to the head and chest areas. For Furthering Education The education benefit can give employees extra peace of mind if their children enroll in a school of higher learning. If you die in a covered accident, we will pay an extra benefit for each child who is enrolled in a school of higher learning or is in the 12 th grade and enrolls within one year of the accident. To help pay expenses, we will increase your benefit amount by 100% (up to $5,000) for each qualifying child. This benefit is payable each year for 4 consecutive years as long as your children continue their education. If there is no qualifying child, we will pay an additional $1,000 to your beneficiary. Child means your unmarried dependent children who are under age 26. For Training for Your Spouse Your spouse will receive educational reimbursement if he or she enrolls, within three years of your death in a covered accident, in an accredited school to gain skills needed for employment. We will pay the actual cost of this education or training program up to 100% of your benefit amount, not to exceed $10,000. Spouse means your lawful spouse under age 99. What Is Not Covered Plan benefits are not payable if an injury or a loss results, directly or indirectly, from or is caused by, self-inflicted injuries or suicide while sane or insane; commission or attempt to commit a felony or an assault; any act of war, declared or undeclared; any active participation in a riot or insurrection; bungee jumping; parachuting; skydiving; parasailing; hang-gliding; sickness, disease, physical or mental impairment, or surgical or medical treatment thereof, or bacterial or viral infection, regardless of how contracted. (This does not include bacterial infection that is the natural and foreseeable result of an accidental external cut or wound or accidental food poisoning.) Benefits are also not payable if the loss occurs while the covered person is voluntarily using any drug, narcotic, poison, gas or fumes except one prescribed by a licensed physician and taken as prescribed; while operating any type of vehicle while under the influence of alcohol (intoxicated is defined by the law of the state in which the covered accident occurred) or any drug, narcotic or other intoxicant including any prescribed drug for which the covered person has been provided a written warning against operating a vehicle while taking it; while the covered person is engaged in the activities of active duty service in the military, navy or air force of any country or international organization (this does not include Reserve or National Guard training, unless it extends beyond 31 days); traveling in an aircraft that is owned, leased or controlled by the sponsoring organization or any of its subsidiaries or affiliates (an aircraft will be deemed to be ''controlled'' by the sponsoring organization if the aircraft may be used as the sponsoring organization wishes for more than 10 straight days, or more than 15 days in any year); flying in, boarding or alighting from an aircraft or any craft designed to fly above the earth s surface, except as a passenger on a regularly scheduled commercial airline; that is: an ultra-light or glider, designed to be used in outerspace; being used by any military authority, except the Air Mobility Command or its foreign equivalent; being flown by the covered person or in which the covered person is a member of the crew; being used for parachuting, hang-gliding, crop dusting, spraying or seeding, giving and receiving flying instruction, fire fighting, sky writing, skydiving, pipeline or power line inspection, aerial photography or exploration, racing or endurance tests, stunts or acrobatic flying, or any operation that requires a special permit from the FAA, even if it is granted (this does not apply if the permit is required only because of the territory flown over or landed on). In addition, benefits will not be paid for services or treatment rendered by a physician, nurse or any other person who is employed or retained by the subscriber or who is providing homeopathic, aroma-therapeutic or herbal therapeutic services, living in the covered person s household or a parent, sibling, spouse or child of the insured
10 When Your Coverage Begins and Ends Current employees can sign up during this enrollment period. New employees have 31 days from the date they become eligible to enroll. Coverage becomes effective on the later of the program s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you are not actively at work, the effective date of your insurance will be deferred until you are actively at work. Your coverage will continue as long as you remain an eligible employee, pay your premium when due and we agree with your employer to continue this group policy. Changing from the Group Plan to Individual Coverage If, before you reach age 70, this group coverage is reduced or ends for any reason except non-payment of premium or age, you can convert to an individual policy. No medical certification is needed. To continue coverage, you must apply for the conversion policy and pay the first premium in effect for your age and occupation within 31 days after your group coverage ends. Converted policies are subject to certain benefits and limits as outlined in your certificate, should you become insured under the plan. Signing Up Is Easy No medical examination is required to apply! Just follow these steps. 1. Choose the benefit amount and coverage options that are right for you. 2. Fill out the accident section of your insurance application and return it to your Health Benefits Department. Don t forget to Use the full name of your beneficiary. For example, use ''Mary Jones Smith'' not ''Mrs. John A. Smith.'' If you have any questions about the plan, please contact your Health Benefits Department. This portion of the plan provides ACCIDENT insurance only. It pays benefits for bodily injury. It does not provide coverage for sickness
12 This information is a brief description of important features of the plan. It is not a contract. Terms and conditions of life insurance coverage are set forth in Group Policy No. FLX , on Policy Form TL , issued in Delaware to the Trustee of the Group Insurance Trust for Employers in the Services Industry. Terms and conditions of accident insurance coverage are set forth in Group Policy No. OK on Policy Form No. GA , issued in Delaware to the Trustee of the Group Insurance Trust for Employers in the Services Industry. The group policy is subject to the laws of the jurisdiction in which it is issued. The availability of this offer may change. Please keep this material as a reference. Coverage is underwritten by Life Insurance Company of North America 1601 Chestnut Street Philadelphia, PA /13 Class 1 Cigna is a registered service mark, and the Tree of Life logo and GO YOU are service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Life Insurance Company of North America, Cigna Life Insurance Company of New York, and Connecticut General Life Insurance Company. All models are used for illustrative purposes only a 06/ Cigna. Some content provided under license.
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