Group Term Life Plan

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1 A benefit of your Bar Association membership! Middlesex County Bar Association Group Term Life Plan Affordable Term Life Insurance available to eligible attorneys as a benefit of your membership

2 Middlesex County Bar Association Group Term Life Plan Peace of mind for your family protection for their future No one wants to think about death, but if you avoid planning for it now, could you be forcing your family to abandon the plans you ve dreamed of? The Middlesex County Bar Association Group Term Life Plan with coverage issued by The Prudential Insurance Company of America (Prudential) was designed for a simple purpose: to provide money to help keep your family s hopes and dreams for the future on track following your death. It s money to pay the mortgage, so they can continue to live in the family home; or for the college education they deserve. It can be used for a wedding your daughter will remember all her life, or to help ensure your spouse can retire in comfort. Rates for Term Life are affordable helping to make the decision to apply an easier one. Because Group Term Life isn t a fixed-term plan, the term life coverage you choose is yours to age 75, as long as you continue to pay your contributions even if you change jobs. In other words, you don t have to re-qualify at the end of a term, when a change in your medical condition might make you ineligible for coverage. As your needs increase, you can simply apply for more coverage* up to $1,000,000. And under current IRS rules (section code 101(a)), any death benefit paid is free from income tax. Optional Benefits Depending on your needs, additional options are available under the Plan: Accidental Death & Dismemberment Coverage (AD&D) You have the option to elect additional coverage, up to a maximum of $500,000, that pays a benefit amount if you die by accident. Dependent Child Coverage For $20 a year, you can insure your eligible dependent children with $10,000 of term life insurance. Coverage begins at your child s birth; there is no waiting period and no evidence of insurability is required. The cost is added to your Member Term Life premium. * All coverage is subject to Prudential s approval of satisfactory evidence of insurability.

3 Eligible dependent children from 15 days to six months of age will be insured for $1,000; dependent children between six months and age 19 (age 25 if a full-time student) will be insured for $10,000. Participating attorneys rely on the Group Term Life Plan for the protection they need. Providing that protection to your family could be one of the most important things you ever do for them. This is an important benefit of your Membership don t pass it by Group Term Life Insurance can provide your family with money to keep your plans for the future on track. Plan features such as coverage amounts up to $1 million and affordable rates make the Plan an important benefit. Additionally, money from the Accelerated Death Benefit feature can be used for whatever purpose you wish pay medical costs, pay off your mortgage or take a vacation of a lifetime with your family. Applying for coverage is quick and easy. Simply visit to download a Form. Semi-Annual Rates per $50,000 of Coverage available in $50,000 increments up to $1,000,000 in coverage Age of Participant Male Non- Female Non- Male Female Under 30 $ $ 8.63 $ $ , , Group Term Life Semi-Annual Rates Rates shown are without AD&D (the additional semi-annual cost of AD&D is $12 per $50,000 of coverage). Rates are based on your attained age; will increase as you enter higher age bands, and may be changed on a class-wide basis only. You can never be singled out for a rate increase. A member s life insurance and any optional AD&D insurance reduces at age 65 to 50% of the previous amount and again by 50% at age 70. Insurance coverage terminates at age 75.

4 This is an important benefit of your membership don t pass it by. Term Life Plan Features: For many coverage amounts, no intrusive tests. Just answer a few simple health questions Coverage you can keep An Accelerated Benefit Option feature allows you to receive 50% of your benefit up to $250,000 if terminally ill with a life expectancy of 12 months or less * Questions: Please call , ext. 397, or jtillisch@couchbraunsdorf.com Apply today! To request coverage, go to to download a form. Return your form to: Couch Braunsdorf Insurance, 701 Martinsville Road, P.O. Box 888, Liberty Corner, NJ or fax to Eligibility All association members under the age of 65 are eligible to apply for up to $1 million of Group Term Life Insurance. Covered members may also apply to insure their spouses under age 65. (Spouse coverage may not exceed the lesser of 50% of the member s coverage amount or $250,000.) Please call for information on applying for Spouse coverage. All coverage is subject to Prudential s approval of satisfactory evidence of insurability. Evidence of Insurability Many members will apply for coverage without the need for medical exams or tests. Depending on the amount of coverage applied for, and the medical history disclosed in the application, it may be necessary for Prudential to order a physical exam, a blood test, an ECG, or medical records from your physician. Optional Accidental Death and Dismemberment (AD&D) Insurance AD&D insurance is 24-hour, aroundthe-world accident coverage. AD&D Benefit Schedule Loss % of Principal Sum Life 100% Both Hands or Both Feet 100% Sight in Both Eyes 100% One Hand and One Foot 100% One Hand or One Foot, and Sight of One Eye 100% Speech and Hearing 100% Quadriplegia 100% Paraplegia 75% One Hand or One Foot 50% Sight in One Eye 50% Speech or Hearing 50% The total payment for any accident will not be more than the full amount of the AD&D insurance. Proceeds for loss of life are payable to the beneficiary. Proceeds for other losses are payable to the insured member, if living, otherwise to the beneficiary. The AD&D insurance proceeds are payable in addition to any other insurance, including any life insurance benefit payable under the Plan. The exclusions listed on the back of this brochure apply. AD&D terminates at age 75. Beneficiary The life insurance proceeds are paid to the designated beneficiary. If there is more than one beneficiary, proceeds may be divided into equal or unequal shares. The proceeds are usually paid in a single sum, but as an alternate method of payment, periodic income may be elected, with equal monthly installments of all or part of the proceeds (with interest) paid over a fixed period of time. Several other modes of settlement also are available. One of these may be selected by mutual agreement with Prudential. *Accelerated Death Benefit Option The Group Term Life Plan includes this important feature for insured members diagnosed with a terminal illness, with a life expectancy of 12 months or less. Subject to the terms of the contract, 50% of your coverage amount to a maximum of $250,000 may be payable to you to assist you and your family. The amount payable at death is then reduced by the accelerated benefit amount paid. Please consult with your tax advisor to review any tax implications.

5 Other Provisions When the life insurance terminates A member s life insurance may be continued until the terminating age of 75. Earlier termination will occur: a) at such time the participant is neither a member of a sponsoring Association, b) if the Group Policy terminates, or c) if the member withdraws from the Plan by so electing or by failure to pay the required contributions. (Please refer to certificate for information on dependent coverage termination.) Conversion rights If the Group Term Life Insurance coverage terminates, the member has the privilege of converting the amount to a Prudential individual life insurance policy. The member can get this life insurance protection without taking a medical examination or answering health questions. To convert, a member must apply within the 31-day period after the life insurance terminates, requesting any individual life insurance policy then customarily issued by Prudential except term life insurance (although preliminary term life insurance for up to one year may be included) or a policy containing disability or other supplementary benefits. The converted policy will be effective at the end of the 31-day period, and the premiums will be the same as the member would ordinarily pay on applying for an individual policy at that time. If death occurs within this 31-day period, that amount of life insurance under the Plan, which the member was entitled to convert, will be paid whether or not the member has applied for conversion. If the insurance for a dependent child terminates for any of the reasons stated, all or part of the Dependent Child Coverage may be converted to an individual life insurance policy within 31 days of such termination. No evidence of insurability will be required. Suicide Exclusion If death results from, or caused by, suicide, while sane or insane: (1) A death benefit is not payable if you or your spouse dies within two years of the date you become a Covered Person. But, Prudential will refund any premiums paid for you or on your Spouse Term Life Plan insurance under this Coverage. (2) The amount of any increase in you or your spouse s death benefit is not payable if you or your spouse die within two years of the date of the increase. But, Prudential will refund any premiums paid for that increase. AD&D Exclusions LOSSES NOT COVERED A Loss is not covered if it results from any of these: (1) Suicide or attempted suicide, while sane or insane. (2) Intentionally self-inflicted injuries, or any attempt to inflict such injuries. (3) Sickness, whether the Loss results directly or indirectly from the Sickness. (4) Medical or surgical treatment of Sickness, whether the Loss results directly or indirectly from the treatment. (5) Any infection. But, this does not include: (a) a pyogenic infection resulting from an accidental cut or wound; or (b) a bacterial infection resulting from accidental ingestion of a contaminated substance. (6) War, or any act of war. War means declared or undeclared war and includes resistance to armed aggression. (7) An accident that occurs while the person is serving on full-time active duty for more than 30 days in any armed forces. But this does not include Reserve or National Guard active duty for training. (8) Travel or flight in any vehicle used for aerial navigation. This includes getting in, out, on or off any such vehicle. This (8) applies only if: (a) the person is riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; (b) the person is performing as a pilot or a crew member of any aircraft; or (c) you are riding as a passenger in an aircraft owned, leased or operated by the participating Association. (9) Commission of or attempt to commit a felony. (10) Being legally intoxicated or under the influence of any narcotic unless administered or consumed on the advice of a Doctor. (11) Participation in these hazardous sports: scuba diving; bungee jumping; skydiving; parachuting; hang gliding; or ballooning. Group Life and Disability Income Medical Underwriting NOTICE Thank you for choosing The Prudential Insurance Company of America (Prudential) for your insurance needs. Before we can issue coverage we must review your application/enrollment form. To do this, we need to collect and evaluate personal information about you. This notice is being provided to inform you of certain practices Prudential engages in, and your rights, with regard to your personal information. We would like you to know that: personal information may be collected from persons other than yourself or other individuals, if applicable, proposed for coverage; this personal information as well as other personal or privileged information subsequently collected by us may in certain circumstances be disclosed to third parties without authorization; you have a right of access and correction with respect to personal information we collect about you; and upon request from you, we will provide you with a more detailed notice of our information practices and your rights with respect to such information. Should you wish to receive this notice, please contact: The Prudential Insurance Company of America, Group Medical Underwriting, P.O. Box 8796, Philadelphia, PA Information regarding your insurability will be treated as confidential. We may, however, make a brief report thereon to the MIB, Inc., a not-for-profit membership organization of insurance companies, which operates an information exchange on behalf of its members. If you apply to another MIB member company for life, disability, or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request, will supply such company with the information about you in its file. In addition, upon receipt of a request from you, MIB will arrange disclosure of any information in your file. Please contact MIB at If you question the accuracy of the information in MIB s file, you may contact MIB and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of MIB s information office is 50 Braintree Hill Park, Suite 400, Braintree, Massachusetts Information for consumers about MIB may be obtained on its website at cannot give legal or tax advice. Please consult your tax or financial advisor. The Group Term Life Plan is subject to applicable state laws and regulations. The Prudential Insurance Company of America issues the insurance and is authorized to conduct business in all states, the District of Columbia, Guam, Puerto Rico and the United States Virgin Islands. Principal offices are 751 Broad Street, Newark, NJ , (973) The Plan Agent is Couch Braunsdorf, 701 Martinsville Rd., P.O. Box 888, Liberty Corner, NJ Coverage is made available as long as you maintain your membership in a sponsoring association. The group contract is issued to the Couch Braunsdorf National Trust. This brochure is intended to be a summary of your benefits and may not include all policy provisions, exclusions and limitations. A certificate, with complete policy information, including limitations and exclusions, will be provided. If there is a discrepancy between this document and the certificate issued by Prudential, the terms of the certificate will govern. NAIC 68241; California COA #1179. Contract Series Accelerated Death Benefit option is a feature that is made available to group life insurance participants. It is not a health, nursing home, or long-term care insurance benefit and is not designed to eliminate the need for those types of insurance coverage. The death benefit is reduced by the amount of the accelerated death benefit paid. There is no administrative fee to accelerate benefits. Receipt of accelerated death benefits may affect eligibility for public assistance and may be taxable. The federal income tax treatment of payments made under this rider depends upon whether the insured is the recipient of the benefits and is considered terminally ill. You may wish to seek professional tax advice before exercising this option. Prudential, the Prudential logo and the Rock symbol are service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide. Group Contract Series