Group Term Life insurance

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1 Group Term Life insurance (518) , ext. 243, or (800) , ext. 243

2 Group Term Life Insurance When it comes to protecting the financial security of your loved ones, nothing is more important than planning ahead. Life insurance provides the extra financial protection when you can t be there and they need it most. The pef membership Benefits program sponsors Group Term Life insurance through sun Life. 1 Take the next step and enroll to protect your loved ones. THE PEF MEMBERSHIP BENEFITS PROGRAM TRUSTEES: susan m. Kent, chair Gustavo santos, Vice chair carlos J. Garcia, secretary Kenneth D. Brynien Tom comanzo THE PEF MEMBERSHIP BENEFITS PROGRAM INTERIM ADMINISTRATOR: Lisa a. pulver 1. Group insurance policies are underwritten by sun Life insurance and annuity company of newyork (newyork, ny) under policy form series 93p-LH-nY, 02p-nYsTD, 98p-aDD-nY, 02-nYsL, 07-nYsL, and 01nYc-LH-pT. GLem-ee-3050 slpc /13 (exp. 01/14)

3 Group Term Life Insurance Contents Group Term Life Insurance...2 eligibility...2 select one of the following options...2 AD&D Benefit...3 accidental Death coverage...3 accidental Dismemberment coverage...3 exclusions...3 Enhancements to AD&D...4 child care Benefit...4 Dependent education Benefit...4 seat Belt Benefit...4 air Bag Benefit...5 common carrier Benefit...5 Bereavement counseling Benefit...5 Enhancements to Dependent Life...5 eligibility...5 Domestic partner coverage...6 Term Life Important Features...7 conversion privilege...7 accelerated Death Benefit...7 retiree coverage...8 General Information...8 effective Dates...8 coverage reductions...8 How to enroll...9 exclusions...9 1

4 Group Term Life Insurance To provide financial resources for your family in the event of your death, life insurance should be an integral part of your financial planning. ELIGIBILITY You may be eligible for Term Life insurance coverage as a dues-paying member of the public employees federation (pef). You may also be eligible for Dependent Life insurance coverage if you are covered for Life insurance under this plan and meet the other requirements described in this brochure. SELECT ONE OF THE FOLLOWING OPTIONS: option a $20,000 option 1 one times Basic annual earnings option 2 Two times Basic annual earnings option 3 Three times Basic annual earnings option 4 four times Basic annual earnings option 5 five times Basic annual earnings earnings are rounded to the next higher $1,000 based on current earnings. maximum: $500,000. Hourly or per Diem employees may only select option a. premiums are based on the member s current age and is a bi-weekly rate. rates are adjusted as you enter a new age bracket. MEMBER LIFE INSURANCE RATE CHART BI-WEEKLY RATE PER $1,000 Member s Age Life and AD&D under 30 $ $ $ $ $ $ $ $ $ $1.463 for example: a member age 43 interested in $20,000 of coverage would pay: $.0855 x 20 = $1.71 bi-weekly, or $44.46 annually. if you have chosen a salary-based option and your annual earnings change for any reason, including promotions to a pef represented position, your insurance will automatically be adjusted on the next available payroll. rates and/or benefits may be changed on a class basis. rates are based on the attained age of the insured person and increase as you enter each new age category. 2

5 AD&D Benefit if you have elected Life insurance coverage for yourself, you are automatically covered for accidental Death and Dismemberment (ad&d) coverage. The accidental Death Benefit is equal to the amount of your Life insurance coverage. ACCIDENTAL DEATH COVERAGE accidental Death coverage, an additional benefit equal to the amount of your Life insurance coverage, will be payable if your death occurs as a direct result of an accidental bodily injury sustained while insured, provided death occurs within 90 days of the accident. ACCIDENTAL DISMEMBERMENT COVERAGE This plan pays a benefit if while insured you suffer a bodily injury caused by an accident and if within 90 days after the accident you lose, as a direct result of the injury, a hand, foot, or eye. The amount payable for any one loss will be equal to one-half the amount of your accidental Death Benefit. You may also be eligible for benefits ranging from 25% to 100% of your accidental Death Benefit for accidental losses that result in paraplegia, quadriplegia, or hemiplegia. However, no more than an amount equal to your full life insurance coverage is payable for all losses resulting from one accident. 1. Loss of a hand or foot means that it is completely cut off at or above the wrist or ankle joint. 2. Loss of an eye means that sight in the eye is completely lost and cannot be recovered or restored. 3. Loss of speech or hearing means that speech or hearing is lost entirely and the Loss cannot be recovered or restored. Hearing must be lost in both ears. 4. Loss of movement of limbs means that movement is completely lost and is irreversible. see your certificate for a complete ad&d benefit schedule. EXCLUSIONS The accidental Death and Dismemberment coverage provides benefits for losses caused by accidents only. Benefits are not payable for disabilities resulting from bodily or mental infirmity, disease, or infection unless from an accident, suicide, or intentionally self-inflicted injury; war or any act of war; participation in a riot; or participation in a felony. 3

6 Enhancements to AD&D if you are eligible for a payment under the ad&d coverage, you may be eligible for one or more of the following enhancements: CHILD CARE BENEFIT if you die, then a child care Benefit may be payable in addition to the accidental Death Benefit. The child care Benefit is payable for each dependent if such dependent is less than age 13 at the time of your death; and if proof of such dependent s enrollment in a licensed child care program is provided. The child care Benefit payable is the lesser of $10,000 or 5% of your accidental Death Benefit. one child care Benefit is payable each year for each dependent who qualifies for child care Benefits. no more than four child care Benefits will be payable for each dependent. payment will be made to the person who has primary responsibility for such dependent s expenses. DEPENDENT EDUCATION BENEFIT if you die, then a Dependent education Benefit may be paid in addition to the accidental Death Benefit. This benefit is payable to each of your dependents who qualifies as a student. please refer to your booklet-certificate to see if your dependents qualify as students. The Dependent child education Benefit payable is the lesser of $5,000; 5% of the accidental Death Benefit; or the actual expense for any one school year. a Dependent spouse/domestic partner is eligible for the lesser of expenses or $5,000 for employment training within 1 year of your death. no more than one Dependent child education Benefit will be payable per student during any one school year. if the student is a minor, payment will be made to the student s legal representative. if no dependent qualifies as a student, then a $1,000 payment will be made in accordance with your beneficiary designation. SEAT BELT BENEFIT if you die from injuries sustained in a motor vehicle accident, a seat Belt Benefit may be paid in addition to the accidental Death Benefit. The seat Belt Benefit payable is the lesser of 10% of the accidental Death Benefit or $25,000. This benefit is payable provided that: a) the death is the result of an automobile accident and b) the individual was wearing a seat belt at the time of the accident, as verified in the police accident report. 4

7 AIR BAG BENEFIT an air Bag Benefit is payable if a seat belt benefit is payable and you were in a seat protected by a supplemental restraining system which inflated on impact. The air Bag Benefit is the lesser of 10% of the accidental Death Benefit or $5,000. COMMON CARRIER BENEFIT if you die while traveling as a fare-paying passenger on a common carrier, a common carrier Benefit may be payable in an amount equal to your accidental Death Benefit. BEREAVEMENT COUNSELING BENEFIT if an accidental Death Benefit is payable, Bereavement counseling Benefits up to $250 per immediate family member up to a maximum $1,000 per family are payable during the 12 months following your death. Enhancements to Dependent Life ELIGIBILITY if you are covered for Life insurance under this plan, you may also apply for Dependent coverage for your spouse/domestic partner and dependent children. You can elect spouse/domestic partner coverage from $20,000 up to $100,000 in the increments noted in the chart below, and $4,000 for your eligible children. under this coverage, a benefit is payable if your dependent dies from any cause while insured. Your dependent child(ren) may be eligible if they are between 15 days and 19 years of age or age 25 if they are attending school on a full-time basis. Dependent Life insurance for your fully handicapped child can be continued past the age of 19; call pef membership Benefits program for clarification. exception: Dependent Life insurance coverage is not available to a dependent in the military service. Please note: Your Dependent Life insurance selection must represent your family status: option D1 for married members/domestic partners. option D2 for unmarried members. 5

8 Enhancements to Dependent Life Option D1 Dependent Life for married members/domestic partners choose spousal/domestic partner coverage of $20,000, $50,000, $75,000, or $100,000, and $4,000 for each eligible dependent child. *premium is based on the member s current age and is a flat bi-weekly rate. in no event can the spouse/domestic partner amount be more than 100% of the member s amount. only the $20,000 option is available in the 120-day new employee open enrollment. Rates and/or benefits may be changed on a class basis. Rates are based on the attained age of the Insured Person and increase as you enter each new age category. Member s Age Bi-weekly Deduction $20,000 $50,000 $75,000 $100,000 under 30 $1.36 $3.40 $5.10 $ DOMESTIC PARTNER COVERAGE The term domestic partner means an individual with whom the member executes a Domestic partner affidavit to establish eligibility. We will use the same criteria currently used by the state of new York to qualify a domestic partner for health insurance benefits. This includes proof that you have been residing together for at least 6 months and documentation of financial interdependence such as a joint bank account, credit card, joint ownership of residence, joint obligation on a loan or mutually granted durable power of attorney. Option D2 Dependent Life for unmarried members. $4,000 for each eligible dependent child Total cost is 26 bi-weekly regardless of age or number of children. 6

9 Term Life Important Features CONVERSION PRIVILEGE The conversion privilege allows you to convert up to the face amount of your group policy to an individual policy from sun Life if your membership with pef terminates or if you are no longer in an eligible class. Your dependents may also convert if your coverage ends as described above or if they no longer meet the definition of dependent. conversion must be requested and the premium paid within 31 days following the end of Life insurance coverage. proof of good health will not be required. if your coverage ends, you will receive information about this option. ACCELERATED DEATH BENEFIT should you or your spouse/domestic partner become diagnosed as terminally ill with a 12-month-or-less life expectancy, this benefit allows an accelerated payment of a portion of the terminally ill person s Life insurance proceeds. Your request cannot exceed 80% of the in force amount of Life insurance, and is subject to a minimum of the greater of: 1. 25% of the in force amount of Life insurance; or 2. $5,000 if amount of insurance is less than $200,000; or 3. $50,000 if amount of insurance is $200,000+; or 4. The accelerated Death Benefit percentage originally selected, multiplied by the amount of Life insurance that would have been in force for you, including any age reductions, at your expected time of death, and a maximum of $500,000. should you or your spouse/domestic partner, if they are covered under this plan, become terminally ill, the funds are paid directly to you or your spouse/domestic partner with no policy restrictions on how they may be used. The remaining benefit is then payable to the beneficiary. Terminally ill or Terminal illness means that an individual or their spouse/domestic partner has a sickness or physical condition that is certified by a physician to reasonably be expected to result in death within 12 months or less. Receipt of accelerated benefits may be taxable. Seek assistance from your personal tax advisor for more information. 7

10 Term Life Important Features RETIREE COVERAGE pef members enrolled in the plan prior to retirement may maintain their Life insurance coverage as a member of the pef retirees. ad&d coverage terminates upon retirement. retirees are eligible to maintain Dependent coverage and are subject to coverage reductions defined under coverage reductions. Benefits reduce to 60% of the amount in force on the first of the month following the month in which an active member attains age 70. if at age 70 you have participated in the plan for at least the 5 continuous years preceding the attainment of age 70 and you are not an active member, your life insurance will be reduced to $20,000 or you may elect a further reduction in benefit to$10,000 or $5,000. if you have not been in the plan for 5 continuous years, your coverage will terminate. General Information EFFECTIVE DATES The effective date of your coverage depends on the date you enroll and whether proof of good health is required. if you: enroll within 120 days after the date you first become eligible to become a member of pef, coverage will automatically be approved for up to 3 times your Basic annual earnings, $20,000 spousal coverage, and $4,000 for each eligible dependent child. coverage that does not require proof of good health will begin the day your enrollment form is received by pef membership Benefits program; or request coverage after the 120-day period you will be required to provide proof of good health, and coverage will begin on the date sun Life approves your application. However, if you re absent from work due to injury or illness on the date coverage would normally begin, your coverage will be deferred until you return to active full-time work. Your coverage will continue for as long as the group policy stays in effect, your premiums are paid, and you remain an eligible member. if you choose to increase your amount of coverage, you ll be required to provide proof of good health that must be approved by sun Life before the increase can take effect. if you are absent from work on the date an increase in coverage would ordinarily begin, the increase will be deferred as described above. COVERAGE REDUCTIONS Benefits reduce to 60% of the amount in force on the first of the month following the month in which an active member attains age 70. if at age 70 you have participated in the plan for at least the 5 continuous years preceding the attainment of age 70 and you are not an active member, your life insurance will be reduced to 8

11 General Information $20,000 or you may elect a further reduction in benefit to$10,000 or $5,000. if you have not been in the plan for 5 continuous years, your coverage will terminate. HOW TO ENROLL complete the Life insurance enrollment form and return it to pef membership Benefits program. if you have been in the ps&t unit for longer than 120 days, or if you are a new employee requesting coverage in excess of 3 times earnings or $20,000 dependent coverage, you will have to complete a evidence of insurability form. enrollment forms can be obtained by calling pef membership Benefits program at (518) , ext. 243 or (800) , ext. 243 or ing a request to EXCLUSIONS no accidental Death or accidental Dismemberment payment will be made for a loss which is due to or results from: suicide or intentionally self-inflicted injuries; or bodily or mental infirmity or disease of any kind, or infection unless due to an accidental cut or wound; or participation in a felony; or active participation in a war (declared or undeclared) or active duty in any armed service during a time of war; or active participation in a riot, rebellion, or insurrection. if the employee s cause of death is suicide: no amount of life insurance is payable if the suicide occurs within 24 months after the employee s life insurance becomes effective. 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 toward completion of the 24 months. complete information on Termination of coverage can be found in the certificate of coverage. IMPORTANT This brochure is intended to provide an explanation of the general purposes of the insurance described, but it does not form a part of the group insurance policy. if any of the terms of this brochure or a certificate differ from the group insurance policy, the policy will govern. 1. Group insurance policies are underwritten by sun Life insurance and annuity company of new York (new York, ny) under policy form series 93p-LH-nY, 02p-nYsTD, 98p-aDD-nY, 02-nYsL, 07- nysl, and 01nYc-LH-pT. 9

12 CONTACT PEF MEMBERSHIP BENEFITS PROGRAM FOR AN UPDATED ENROLLMENT FORM (518) , ext. 243 (800) , ext (518) , ext. 243, or (800) , ext. 243

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