Group Term Life Insurance Certificate Booklet Checklist

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1 Group Term Life Insurance Certificate Booklet Checklist ReliaStar Life Insurance Company Policyholder Number GAT Policyholder Name University System of New Hampshire Please review your booklet draft to ensure that we have accurately reflected your benefits. Pay special attention to the following sections of your booklet. Please return comments within 30 days. Schedule of Benefits section Amounts of insurance Benefit percentages Maximum benefit amounts Reduction schedule Employee s Insurance section Eligibility section (top of the page) Date of change section Termination section Continuation of Insurance section AD&D Insurance Definitions Employee definition

2 University System of New Hampshire Dunlap Center 25 Concord Road Durham, NH TO OUR FACULTY/STAFF: All of us appreciate the protection and security insurance provides. The certificate describes the benefits that are available to you. We urge you to read it carefully. Benefits are provided through a group policy issued to University System of New Hampshire by ReliaStar Life Insurance Company. University System of New Hampshire

3 ReliaStar Life Insurance Company 20 Washington Avenue South, Minneapolis, MN NOTICE TO CALIFORNIA POLICYHOLDERS/CERTIFICATEHOLDERS KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS If you have a question about your policy, if you need assistance with a problem, or if you have questions about a claim, you may write to us at the above address or call You will need to provide your policy number with any communication. If you do not reach a satisfactory resolution after having discussions with us, or our agent or representative, or both, you may contact the following unit within the Department of Insurance that deals with consumer affairs: California Department of Insurance Consumer Communications Bureau 300 South Spring Street, South Tower Los Angeles, California Outside Los Angeles: HELP ( ) Los Angeles: (213) R-08247a 4/04

4 ReliaStar Life Insurance Company CERTIFICATE BOOKLET RIDER Applicable to Montana Residents The CLAIM PROCEDURES section of your group life insurance certificate is revised to add the following provision: Benefit Payments Benefits under the Group Policy are paid when proof of loss is received. For Life Insurance, benefits payable due to death will be paid within 60 days of the date ReliaStar Life receives proof of death. If payment is made after the first 30 days, ReliaStar Life will include interest from the 30th day until the date of payment. The interest rate will equal the greater of the following The discount rate on 90-day commercial paper in effect at the federal reserve bank in the ninth federal reserve district on the date proof of death is received. ReliaStar Life s minimum interest rate payable on death claims on the date proof of death is received. The GENERAL PROVISIONS section of your group life insurance certificate is revised to add the following provisions: The Group Policy also has a 2 year contestable period starting from the Effective Date of the Group Policy. After the Group Policy has been in force for 2 years from the Effective Date, ReliaStar Life can not contest the validity of the Group Policy except for nonpayment of premium. Grace Period If a premium is not paid by its due date, ReliaStar Life allows 31 days from the due date in which to pay it. ReliaStar Life calls this the grace period. Full payment must be received by the 31st day. If ReliaStar Life receives payment during the grace period, coverage under the Group Policy stays in force. If ReliaStar Life receives written notice of termination during the grace period, premium payment is required for any period that coverage under the Group Policy was in force during the grace period. Representations Not Warranties A copy of the Policyholder s application, if any, is attached to the Group Policy. Unless fraudulent, all statements made by the Policyholder or by you are considered representations and not warranties. No statement can be used to void the Group Policy or be used in ReliaStar Life s defense if ReliaStar Life refuses to pay a claim, unless a copy of the statement is furnished to the Policyholder, you or your beneficiary, as applicable. Misstatement of Age If your (or your dependent s, if your certificate includes Dependent s Life Insurance) age is misstated, ReliaStar Life adjusts the premium according to the correct age. The amount of insurance provided is not affected. Conformity with Montana Statutes The provisions of this certificate conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which you reside on or after the effective date of your coverage under the Group Policy. R-08187a 1 of 2

5 The CONVERSION RIGHTS section of your group life insurance certificate for you (and your insured dependents, if your certificate includes Dependent s Life Insurance) is revised as indicated below. Under Conditions for Conversion, the condition related to change, cancellation or termination of the Group Policy is replaced by the following: The Group Policy is changed or cancelled, and your Life Insurance under the Group Policy has been in effect for at least 3 years in a row. The following provision is added: If you or your insured dependent are not given written notice of this conversion right within 16 days after any part of this insurance stops, you or your insured dependent will have more time to apply and pay the first premium for the individual policy. This additional time period will end 15 days after you or your insured dependent are given written notice of this conversion right. In no event will the additional time period extend for more than 91 days after any part of your Life Insurance or Dependent s Life Insurance stops. The provision entitled Amount of Conversion Coverage is replaced by the following: Amount of Conversion Coverage If your or your insured dependent s Life Insurance is changed or cancelled because the Group Policy is changed or cancelled, and your Life Insurance under the Group Policy has been in effect for at least 3 years in a row, the amount of the individual policy is limited to the lesser of $10,000, or the amount of your or your insured dependent s Life Insurance which stops, minus the amount of other group insurance for which you or your insured dependent become eligible within 31 days of the date your or your insured dependent s insurance stops. If your or your insured dependent s Life Insurance stops for any reason other than the above, the amount of your or your insured dependent s individual policy may be any amount up to the amount of your or your or your insured dependent s Life Insurance that stopped. R-08187a 2 of 2

6 ReliaStar Life Insurance Company BENEFICIARY DESIGNATION MAY NOT APPLY IN THE EVENT OF ANNULMENT OR DIVORCE Under Virginia law (Virginia Code Section ), a revocable beneficiary designation in a policy owned by one spouse that names the other spouse as beneficiary becomes void upon the entry of a decree of annulment or divorce, and the death benefit prevented from passing to a former spouse will be paid as if the former spouse had predeceased the decedent. In the event of annulment or divorce proceedings, and if it is the intent of the parties that the beneficiary designation of the former spouse is to continue, you are advised to make certain that one of the following courses of action is taken prior to the entry of a decree of annulment or divorce: Change the beneficiary designation to make it irrevocable. Change the ownership of the policy or contract. Execute a separate written agreement stating the intention of both parties that the beneficiary designation is to remain in effect beyond the date of entry of the decree of annulment or divorce. Make certain that the decree of annulment or divorce contains a provision stating that the beneficiary designation is not to be revoked pursuant to Section R-08176

7 California Life and Health Insurance Guarantee Association Act Summary Document and Disclaimer ReliaStar Life Insurance Company Residents of California who purchase life and health insurance and annuities should know that the insurance companies licensed in this state to write these types of insurance are members of the California Life and Health Insurance Guarantee Association ( CLHIGA ). The purpose of this Association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guarantee Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided through the Association is not unlimited, as noted in the box below, and is not a substitute for consumers care in selecting insurers. The California Life and Health Insurance Guarantee Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Guarantee Association to induce you to purchase any kind of insurance policy. Policyholders with additional questions should first contact their insurer or agent or may then contact: California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau P.O. Box or 300 South Spring Street, South Tower Beverly Hills, CA Los Angeles, CA Below is a brief summary of this law s coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone s rights or obligations under the Act or the rights or obligations of the Association. COVERAGE Generally, individuals will be protected by the California Life and Health Insurance Guarantee Association if they live in this state and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state. (please turn over) R-08222a

8 EXCLUSIONS FROM COVERAGE However, persons holding such policies are not protected by this Guarantee Association if: Their insurer was not authorized to do business in this state when it issued the policy or contract; Their policy was issued by a health care service plan (HMO, Blue Cross, Blue Shield), a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society; They are eligible for protection under the laws of another state. This may occur when the insolvent insurer was incorporated in another state whose guarantee association protects insureds who live outside that state. The Guarantee Association also does not provide coverage for: Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which guarantee rights to group contract holders, not individuals; Employer and association plans, to the extent they are self-funded or uninsured; Synthetic guaranteed interest contracts; Any policy or any portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; Any policy of reinsurance unless an assumption certificate was issued; Interest rate yields that exceed an average rate; Any portion of a contract that provides dividends or experience rating credits. LIMITS ON AMOUNTS OF COVERAGE The Act limits the Association to pay benefits as follows: LIFE AND ANNUITY BENEFITS 80% of what the life insurance company would owe under a life policy or annuity contract up to $100,000 in cash surrender values, $100,000 in present value of annuities, or $250,000 in life insurance death benefits. A maximum of $250,000 for any one insured life no matter how many policies and contracts there were with the same company, even if the policies provided different types of coverages. HEALTH BENEFITS A maximum of $200,000 of the contractual obligations that the health insurance company would owe were it not insolvent. The maximum may increase or decrease annually based upon changes in the health care cost component of the consumer price index. PREMIUM SURCHARGE Member insurers are required to recoup assessments paid to the Association by way of a surcharge on premiums charged for health insurance policies to which the Act applies. R-08222a

9 CONTENTS CERTIFICATION PAGE SCHEDULE OF BENEFITS Life Insurance, Accidental Death and Dismemberment (AD&D) Insurance EMPLOYEE'S INSURANCE LIFE INSURANCE Waiver of Life Insurance Premium Disability Benefit Applicable only to Options C & D Accelerated Life Benefit Accidental Death & Dismemberment (AD&D) Insurance CONVERSION RIGHTS CLAIM PROCEDURES FOR YOUR LIFE AND AD&D BENEFITS GENERAL PROVISIONS DEFINITIONS B ( ) Class I i

10 RELIASTAR LIFE INSURANCE COMPANY Minneapolis, Minnesota ReliaStar Life Insurance Company (ReliaStar Life) certifies that it has issued the Group Policy listed below to the Policyholder. All benefits are controlled by the terms and conditions of the Group Policy. The Group Policy is on file in the Policyholder's office. You may look at the Group Policy there. Group Policy Number GAT Policyholder University System of New Hampshire Your beneficiary is the last beneficiary you named, according to the records on file in ReliaStar Life's Home Office or on file with the Plan Administrator, if applicable. You may change your beneficiary any time, according to the terms of the Group Policy. The certificate summarizes and explains the parts of the Group Policy which apply to you. This certificate is not an insurance policy. In any case of differences or errors, the Group Policy rules. This certificate replaces any other certificates ReliaStar Life may have given you under the Group Policy. Registrar 1

11 SCHEDULE OF BENEFITS Life Insurance, Accidental Death and Dismemberment (AD&D) Insurance Class Amount of Life Insurance* Full Amount of AD&D Insurance* All Eligible Employees of the University System of New Hampshire who are employed in a fulltime status position working 75% or more of a normal work schedule Option A - $10,000 $10,000 plus $25,000 Option B - Option C - Option D - An amount equal to 1.5 times your Regular Budgeted Salary An amount equal to 3 times your Regular Budgeted Salary An amount equal to 4.5 times your Regular Budgeted Salary An amount equal to 1.5 times your Regular Budgeted Salary plus $25,000 An amount equal to 3 times your Regular Budgeted Salary, plus $25,000 An amount equal to 4.5 times your Regular Budgeted Salary, plus $25,000 Maximum Benefit... $1,500,000 Minimum Benefit... $10,000 Note: If an option for coverage is not elected at your initial enrollment, you will be enrolled in Option B. If you elect Option A or B, your coverage is paid for by your Employer. If you elect Option C or D, your coverage in excess of 1.5 times your Regular Budgeted Salary is paid for by you. *For those Employees who elected Option B, C, or D, your amount of insurance will decrease to 50% on the next payroll date that follows your 70th birthday. The reduced amount will be rounded to the next higher $500 multiple unless the amount equals a multiple of $500. Regular Budgeted Salary the yearly salary or wage you receive for work done for USNH. It does not include bonuses, commissions, overtime or supplemental pay. To determine benefits, your amount of insurance is rounded to the next higher $1,000 multiple unless the amount equals a multiple of $1,000. Accelerated Life Benefit This benefit is equal to 50% of your amount of Life Insurance in force, or $300,000, whichever is less. Accelerated Benefits may be taxable. If so, you or your Beneficiary may incur a tax obligation. As with all tax matters, you should consult your personal tax advisor to assess the impact of the Benefit. 2

12 EMPLOYEE'S INSURANCE Eligibility You are eligible on the later of the following dates: The Group Policy's Effective Date, January 1, The first day of the month on or after the date you begin eligible service with the USNH, if you apply for coverage within 30 days. The first day of the month following enrollment if you apply within 31 to 60 days of your date of hire. You must meet the following conditions to become insured: Be eligible for the insurance. Be actively at work. Apply for the insurance within 60 days of the date of initial eligibility. If you do not apply within 60 days you will automatically be enrolled in Option B, the first of the following month. Effective Date of Employee's Insurance Your insurance starts on the latest of the following dates: The date you become eligible. The date you return to active work if you are not actively at work on the date insurance would otherwise start. Exception: Your insurance starts on a nonworking day if you were actively at work on your last scheduled working day before the nonworking day. The date you apply for insurance for all four levels of coverage. Effective Date of Change in Amount of Insurance You may change to the next higher level of benefits only during annual enrollment periods, unless you experience a qualifying change in family status. If you elect to change to the next higher level of benefits, during an annual enrollment period the change in the amount of your insurance will be effective on The first of January on or after the date of the increase, if you are actively at work on the date of the increase. The date you return to active work if you are not actively at work on the first of January on or after the date of the increase. The first of January on or after the date of the increase, if the first of January is a nonworking day and you were actively at work on your last scheduled working day before the nonworking day. If: You experience a qualifying change in family status and elect to change plans between annual enrollment periods, or your amount of insurance increases due to an increase in your regular budgeted salary. The change in the amount of your insurance will be effective on The date your option election or regular budgeted salary change, if you are actively at work on that date, The date you return to active work, if you are not actively at work on the date your option election or regular budgeted salary change, or The date your option election or regular budgeted salary change, if that date is a nonworking day and you were actively at work on your last scheduled working day before the nonworking day. The amount of your insurance decreases on the date of change in your class or regular budgeted salary change. If you elect to decrease your insurance during an annual enrollment period, the decrease will take effect on the first of January on or after the date of the elected decrease. 3

13 EMPLOYEE'S INSURANCE Qualified Changes in Family Status The following events are considered to be qualified changes in family status: Marriage or divorce. Death of your dependent. Birth or adoption of a child. Termination or commencement of employment by your spouse. Change in your employment status from full-time to part-time or vice versa or taking an unpaid leave of absence. Cessation or commencement of your insurance due to changes in your employment class or status; or Cessation or commencement of your or your spouse's insurance due to changes in the policy which applies to your spouse's class of employees. Only benefit changes which are consistent with the change in family status are permitted. You must notify USNH of your change in family status and complete a new enrollment election within 30 days after the qualifying event. Termination of Insurance Your insurance stops on one of the following dates: The date you were last actively at work for USNH. The date you are no longer eligible for insurance under the Group Policy. The date the Group Policy stops. The end of the period for which you paid premiums, if you do not make the next required premium contribution when due. The date you retire. Exception: If you are an early retiree age 55 or older with 15 or more years of service, the date your retirement ends, as determined by USNH. For Accelerated Life Benefit, the date your Life Insurance stops. The Accelerated Life Benefit stops at the beginning of the period in which you are eligible to convert your Life Insurance. For AD&D Insurance, the date your Life Insurance stops or the date Life Insurance premiums are waived under the Waiver of Life Insurance Premium Disability Benefit. AD&D Insurance stops at the beginning of the period in which you are eligible to convert your Life Insurance. ReliaStar Life stops providing a specific benefit to you on the date that benefit is no longer provided under the Group Policy. Family and Medical Leave Act of 1993 Certain employers are subject to the FMLA. If you have a leave from active work certified by your employer, then for purposes of eligibility and termination of coverage you will be considered to be actively at work. Your coverage will remain in force so long as you continue to meet the requirements as set forth in the FMLA. 4

14 EMPLOYEE'S INSURANCE Continuation of Life Insurance If you are no longer eligible for Life Insurance because you stop active work, the USNH may continue your insurance. Premiums must be paid. Your continuation of insurance is subject to all other terms of the Group Policy. The length of time your insurance continues depends on the reason you stop active work. During a Labor Dispute If you stop active work due to a labor dispute, your continuation of insurance stops on the earliest of the following dates: The end of the period for which your premiums were paid, if the next premium contribution is not paid on time. The date the Group Policy stops. The date you start work for pay or profit with any employer. The end of the 6 month period following the date you stop active work. Total Disability Applicable only to Options A & B If you stop active work due to a total disability and are no longer eligible for insurance, your continuation of insurance will be determined by ReliaStar Life (see definition section on page 14 for "Total Disability, Totally Disabled") and will stop on the earliest of the following dates: The end of the period for which your premiums were paid, if the next premium contribution is not paid on time. The date the Group Policy stops. The date you are no longer totally disabled, as determined by ReliaStar Life. The date you do not provide proof of total disability when asked. If you are less than age 61 when you become totally disabled, you should contact your Employer to determine how long your Life Benefits will continue. If you are age 61 or older when you become totally disabled, the last day of the benefit period listed below in the following table: Age at disability Maximum Benefit Period 61 but less than months 62 but less than months 63 but less than months 64 but less than months 65 but less than months 66 but less than months 67 but less than months 68 but less than months 69 but less than months 70 and over months Total Disability Applicable only to Options C & D If you stop active work due to a total disability and are no longer eligible for insurance, insurance under Options C and D is continued in accordance with the Waiver of Life Insurance Premium Disability Benefit provisions outlined on pages 6 and 7. Reinstatement ReliaStar Life will reinstate your insurance if you stop work and then return to work. You will be eligible for insurance on the date you return to active work with USNH, subject to the eligibility of employees insurance provisions. 5

15 LIFE INSURANCE Employee's Life Insurance ReliaStar Life pays a death benefit to your beneficiary if written proof is received that you have died while this insurance is in force. The death benefit is the amount of Life Insurance for your class shown on the Schedule of Benefits in effect on the date of your death. ReliaStar Life pays the death benefit for all causes of death. However, for the employee paid options C & D, if you commit suicide, while sane or insane, within 2 years of the date your insurance starts, ReliaStar Life will refund the amount of premiums paid by the Employee under options C & D instead of paying a death benefit. Beneficiary The beneficiary is named to receive the proceeds to be paid at your death. You may name more than one beneficiary. USNH cannot be the beneficiary. You may name, add or change beneficiaries by written request (including on MyUSNHBenefits.net) to your Employer at anytime. A change will take effect as of the date it is signed but will not affect any payment ReliaStar Life makes or action it takes before receiving your notice. Payment of Proceeds ReliaStar Life pays proceeds to the beneficiary. If there is more than one beneficiary, each receives an equal share, unless you have requested otherwise, in writing. To receive proceeds, a beneficiary must be living on the earlier of the following dates: The date ReliaStar Life receives proof of your death. The tenth day after your death. If there is no eligible beneficiary or if you did not name one, ReliaStar Life pays the proceeds in the following order: 1. Your spouse. 2. Your natural and adopted children. 3. Your parents. 4. Your siblings. 5. Your estate. The person must be living on the tenth day after your death. Settlement Options Settlement options are alternative ways of paying the proceeds under the Group Policy. Proceeds is the amount of each benefit ReliaStar Life pays when you die or when you request and are eligible for the Accelerated Life Benefit. ReliaStar Life will send a statement with any periodic payment of the Accelerated Life Benefit showing the new in force amount of insurance. To find out more about settlement options, please contact ReliaStar Life. Waiver of Life Insurance Premium Disability Benefit Applicable only to Options C & D ReliaStar Life waives the Employee paid portion of your Life Insurance premium that becomes due after you have been determined by ReliaStar Life to be totally disabled. The premium will be waived if you satisfy certain conditions. When ReliaStar Life waives a premium, the amount of Life Insurance equals the amount above the employer paid 1.5 times portion that would have been provided if you had not become totally disabled. That amount will reduce or stop according to the Schedule of Benefits in effect on the date total disability begins. When ReliaStar Life waives a premium it includes Life Insurance, Accelerated Life Benefit, and Waiver of Premium. It does not include AD&D Insurance, or any other benefits as elected under this certificate which were effective at the time of disability. 6

16 LIFE INSURANCE Conditions, Notice and Proof of Total Disability ReliaStar Life requires written notice of claim and proof of total disability to waive your premium. All of the following conditions must also be met: You are insured for the Waiver of Life Insurance Premium Disability Benefit on the date you become totally disabled. You must be totally disabled for at least 6 months. You continue to be totally disabled. Your insurance is in force when you suffer the sickness or accidental injury causing the total disability. All premiums are paid up to the date the Waiver of Premium is approved by ReliaStar Life. ReliaStar Life needs written notice of claim before it waives any premium. This notice must be received while you are living, while you are totally disabled, and within one year from the date total disability begins. If you cannot give ReliaStar Life notice within one year, your claim may still be considered if you show you gave ReliaStar Life notice as soon as reasonably possible. ReliaStar Life needs proof of your total disability before any premiums can be waived. ReliaStar Life may require you to have a physical exam by a doctor it chooses. ReliaStar Life pays for that exam. ReliaStar Life can only require one exam a year after premiums have been waived for 2 full years. When ReliaStar Life approves your proof of total disability, premiums are waived as of the sixth month following the date you became totally disabled. ReliaStar Life refunds any premium paid for the period during which premiums are not required to be paid under the Waiver of Life Insurance Premium Disability Benefit. Termination of Waiver of Premium ReliaStar Life stops waiving premiums on the earliest of the following dates: The date you are no longer totally disabled. The date you do not give ReliaStar Life proof of total disability when asked. If you are less than age 61 when you become totally disabled, you should contact your Employer to determine how long your Life Benefits will continue. If you are age 61 or older when you become totally disabled, the last day of the benefit period listed below in the following table: Age at disability Maximum Benefit Period 61 but less than months 62 but less than months 63 but less than months 64 but less than months 65 but less than months 66 but less than months 67 but less than months 68 but less than months 69 but less than months 70 and over months The amount of Life Insurance that stays in force will be the amount shown on the Schedule of Benefits in effect on the date your premium payments are resumed. If ReliaStar Life stops waiving your premiums, your Life Insurance will terminate. If you buy an individual policy under the Conversion Right of the Group Policy during the first year of your total disability, your Life Insurance may be restored. ReliaStar Life will cancel the individual policy as of its issue date if within 12 months of the date you become totally disabled you file a claim under this provision and ReliaStar Life approves it, and surrender the individual policy without claim, except for refund of premium. When ReliaStar Life cancels your individual policy, ReliaStar Life refunds all premiums paid for the individual policy. 7

17 LIFE INSURANCE restores your Life Insurance under the Group Policy. retains the beneficiary named under the individual policy as beneficiary under the Group Policy, unless you ask ReliaStar Life to change the beneficiary in writing. Accelerated Life Benefit NOTE: YOUR AMOUNT OF LIFE INSURANCE WILL BE REDUCED IF YOU RECEIVE AN ACCEL- ERATED LIFE BENEFIT. Accelerated Life Benefit proceeds is the amount ReliaStar Life pays to you or your legal representative while you are living when it has been determined that you have a terminal condition. The Accelerated Life Benefit proceeds are paid only once. The Accelerated Life Benefit is the amount shown on the Schedule of Benefits in effect on the date you apply for Accelerated Life Benefit proceeds. You will not be able to increase your Life Insurance benefit after the time you apply for the Accelerated Life Benefit, unless it is determined that you are ineligible to receive Accelerated Life Benefit proceeds and also eligible for the increase. To receive the Accelerated Life Benefit, all of the following conditions must be met. You must: request this benefit in writing while you are living. If you are unable to request this benefit yourself, your legal representative may request it for you. be insured for Life Insurance benefits under this Group Policy. provide to ReliaStar Life a doctor's statement which gives the diagnosis of your medical condition; and states that because of the nature and severity of such condition, your life expectancy is no more than 12 months. ReliaStar Life may require that you be examined by a doctor of its choosing. If ReliaStar Life requires this, ReliaStar Life pays for the exam. Accelerated Life Benefit Exclusions ReliaStar Life does not pay benefits for a terminal condition if any of the following apply: any required Accelerated Life Benefit premium or Life Insurance premium is due and unpaid. the terminal condition is directly or indirectly caused by attempted suicide or intentionally self-inflicted injury, whether sane or insane. the terminal condition is directly or indirectly caused by any event occurring while you are in violation of criminal law. Effects on Coverage When ReliaStar Life pays out this benefit, your coverage is affected in the following ways: Your total available Life Insurance benefit equals your amount of Life Insurance shown on the Schedule of Benefits at the time your application for the Accelerated Life Benefit is approved. Your Life Insurance benefit is reduced by the Accelerated Life Benefit proceeds paid out under this provision. Your Life Insurance benefit amount which you may convert is reduced by the Accelerated Life Benefit proceeds paid out under this provision. You will not be able to increase your Life Insurance benefit after ReliaStar Life approves you to receive the Accelerated Life Benefit. Your premium is based upon the Life Insurance benefit amount in force prior to any proceeds paid under this Accelerated Life Benefit provision. Such premium must be paid, unless waived, to keep the Life Insurance coverage in force. Your remaining Life Insurance benefit is subject to future age reductions. You will not be able to reinstate your coverage to its full amount in the event of a recovery from a terminal condition. Your receipt of Accelerated Life Benefit proceeds does not affect your Accidental Death and Dismemberment Insurance. Thus, if you should die in an accident after receiving Accelerated Life Benefit Proceeds, the amount of your Accidental Death and Dismemberment Insurance will not be affected. 8

18 LIFE INSURANCE Accidental Death & Dismemberment (AD&D) Insurance ReliaStar Life pays this benefit if you suffer a covered loss due to a covered accident. All of the following conditions must be met: You are covered for AD&D Insurance on the date of the accident. Loss occurs within 1 year of the date of the accident. The cause of the loss is not excluded. ReliaStar Life pays the benefit shown below if you suffer any of the losses listed. The Full Amount is shown on the Schedule of Benefits. ReliaStar Life pays only one Full Amount while the Group Policy is in effect. If you have a loss for which ReliaStar Life paid 1/2 of the Full Amount, ReliaStar Life pays no more than 1/2 of the Full Amount for the next loss. For: The benefit is: Loss of life... Full Amount Loss of both hands, both feet or sight of both eyes... Full Amount Loss of one hand and one foot... Full Amount Loss of speech and hearing in both ears... Full Amount Loss of one hand or one foot and sight of one eye... Full Amount Loss of one hand or one foot or sight of one eye... 1/2 Full Amount Loss of speech... 1/2 Full Amount Loss of hearing in both ears... 1/2 Full Amount Loss of thumb and index finger of same hand... 1/4 Full Amount Uniplegia... 1/4 Full Amount Quadriplegia... Full Amount Paraplegia... 1/2 Full Amount Hemiplegia... 1/2 Full Amount Loss of hands or feet means loss by being permanently, physically severed at or above the wrist or ankle. Loss of sight means total and permanent loss of sight. Loss of speech and hearing means total and permanent loss of speech and hearing. Loss of thumb and index finger means loss by being permanently, physically, entirely severed. Uniplegia means paralysis of one limb. Quadriplegia means total paralysis of all four limbs. Paraplegia means total paralysis of both lower limbs. Hemiplegia means paralysis of one arm and one leg on the same side of the body. Paralysis means loss of use, without severance, of a limb. Paralysis must be determined by competent medical authority to be permanent, complete and irreversible. ReliaStar Life does not pay a benefit for loss of use of the hand or foot or thumb and index finger. Death benefits are paid to your beneficiary. All other benefits are paid to you. 9

19 LIFE INSURANCE Accidental Death & Dismemberment (AD&D) Insurance continued Safe Driver Benefit ReliaStar Life pays a Safe Driver benefit in addition to the AD&D benefit and subject to the exclusions listed below if you were: killed due to an automobile accident, and wearing a properly fastened safety belt at the time of the accident. An additional amount will be paid if you were also driving in or riding in an automobile equipped with a factory installed airbag that operated properly upon impact. For loss of: The benefit is: Life (with safety belt only)... An additional 10% of Full Amount of AD&D Insurance up to a maximum of $25,000 and a minimum of $1,000 Life (with safety belt and airbag)... An additional 15% of Full Amount of AD&D Insurance up to a maximum of $40,000 and a minimum of $1,000 Automobile means any validly registered four-wheel private passenger car. It does not include any commercially licensed car or a private passenger car which is being used for commercial purposes. Safety belt means a passenger restraint system properly installed in the vehicle in which you were riding. Airbag means an additional restraint system which inflates for added protection to the head and chest areas. ReliaStar Life will not pay the Safe Driver benefit if you were driving while under the influence of alcohol or drugs. Safe Driver benefits are paid to your beneficiary. Accidental Death and Dismemberment Exclusions ReliaStar Life does not pay benefits for loss directly or indirectly caused by any of the following: An accident occurring before the Effective Date of the Group Policy. Suicide or intentionally self-inflicted injury. Physical or mental illness. Riding in or descending from an aircraft as a pilot or crew member. Any armed conflict, whether declared as war or not, involving any country or government. An accident which occurs while in the military service for any country or government, except the United States National Guard. An accident which occurs when you commit or attempt to commit a crime. Use of any drug or medicine, unless taken on the advice of a doctor. Driving a vehicle while intoxicated as defined by the laws of the jurisdiction in which the vehicle was being operated. 10

20 CONVERSION RIGHTS Life Insurance You may convert this insurance to an individual life insurance policy if any part of your Life Insurance under the Group Policy stops. Proof of good health is not required. Conditions for Conversion You may convert this Life Insurance if it stops for any of the following reasons: You are no longer actively at work. You are no longer eligible for Employee's Insurance under the Group Policy. The Group Policy is changed or cancelled and your Life Insurance under the Group Policy has been in effect for at least 5 years in a row. Premium is no longer being waived under the Waiver of Life Insurance Premium Disability Benefit and your Group Life Insurance stops. ReliaStar Life will provide you with 15 days written notice if and when the Group Policy terminates. For New Hampshire residents. If you are not given notice, in writing, of the Right to Obtain a Personal Policy of Life Insurance on Your Own Life at least 15 days before the end of the Application Period, you will have additional time in which to apply. You will then have 15 days from the date you are given the notice in which to apply. You may convert this insurance by applying and paying the first premium for an individual policy within 31 days after any part of your insurance stops. ReliaStar Life or USNH must be notified. ReliaStar Life will supply you with a conversion form to complete and return. The 31 day period may be extended if you do not receive notice of the right to convert within 15 days after the Group Policy terminates. ReliaStar Life extends the period for conversion to 15 days following the date you receive written notice. Type of Converted Policy You may purchase any individual nonparticipating policy offered by ReliaStar Life, except term insurance. The new policy must provide for a level amount of insurance and have premiums at least equal to those of ReliaStar Life's whole life plan with the lowest premium. If your previous coverage included additional benefits such as disability, Accidental Death and Dismemberment Insurance, Waiver of Premium or the Accelerated Life Benefit, the new insurance will not include these benefits. The new policy may contain a suicide provision. Any time that you satisfied under the Group Policy's suicide period will be credited toward satisfying the new policy's period. Amount of Conversion Coverage If you have been covered under the Group Policy for at least 5 years and your life Insurance is terminated because coverage for all active employees under the Group Policy is terminated, the amount of the individual policy is limited to the lesser of: the amount of your Life Insurance that stops, minus the amount of other group insurance for which you become eligible within 31 days of the date your insurance stops, or $10,000. If your Life Insurance stops for any reason, the amount of your individual policy may be any amount up to the amount of your Life Insurance that stopped. Effective Date The new policy takes effect 31 days after the part of your Life Insurance being converted stops. If you die within the 31-day period allowed for making application to convert, ReliaStar Life will pay a death benefit to your beneficiary in the amount you were entitled to convert. ReliaStar Life will pay the amount whether or not application was made. ReliaStar Life will return any premium paid for the individual policy to your beneficiary named under the Group Policy. Premiums Premiums for the new policy are based on your age on the date of conversion. 11

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