Earning for Today and Saving for Tomorrow. Basic Life Insurance Plan. inspiring possibilities

Transcription

1 Earning for Today and Saving for Tomorrow Basic Life Insurance Plan inspiring possibilities

2 In This Summary Certification Page...3 Schedule of Benefits...4 Life Insurance, Accidental Death and Dismemberment (AD&D) Insurance Basic Yearly Earnings Imputed Income Employee s Insurance...5 Eligibility Effective Date of Employee s Insurance Effective Date of Change in Amount of Insurance Termination of Insurance Family and Medical Leave Act of 1993 Continuation of Life Insurance Non-Medical Reasons Sickness or Accidental Injury Life Insurance...7 Employee s Life Insurance Waiver of Life Insurance Premium Disability Benefit Conditions, Notice and Proof of Total Disability Termination of Waiver of Premium Benefit Payments Beneficiary Payment of Proceeds Settlement Options Accelerated Life Benefit AD&D Insurance...10 Accidental Death & Dismemberment (AD&D) Insurance Accidental Death & Dismemberment Exclusions Conversion Right and Portability Options

3 Claim Procedures Submitting a Claim Claim Forms General Provisions...14 Life Insurance Assignment Legal Action Exam and Autopsy Incontestability Age Misstatement Conformity with Law Complaints Definitions

4 Sun Life Assurance Company of Canada (Sun Life) Sun Life Assurance Company of Canada (Sun 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 Plan Sponsor s office. You may look at the Group Policy there. Policyholder: Policy No: Plan Sponsor: Advocate Health Care Network Advocate Health Care Network Your beneficiary is the last beneficiary you named, according to the records on file with the Plan Sponsor s Beneficiary Administrator. You may change your beneficiary any time, according to the terms of the Group Policy. The insurance included in this certificate applies to you only if you are eligible for it and are insured for it. The certificate summarizes and explains the parts of the Group Policy which apply to you. In any case of differences or errors, the Group Policy rules. This certificate replaces any other certificates Sun Life may have given you under the Group Policy. If you have any questions about any of the terms and provisions, please contact the Insurance Administrator at This booklet is not a contract of employment and nothing in the plan gives any associate the right to be retained in the service of Advocate. 3

5 Schedule of Benefits Life Insurance, Accidental Death and Dismemberment (AD&D) Insurance Full-time & Part-time Exempt Employees Class Amount of Life Insurance* Full Amount of AD&D Insurance* Full-time & Part-time Non-Exempt Employees The lesser of: 1 1 / 2 times your Basic Yearly Earnings or $300,000 The lesser of: 1 times your Basic Yearly Earnings or $300,000 The lesser of: 1 1 / 2 times your Basic Yearly Earnings or $300,000 The lesser of: 1 times your Basic Yearly Earnings or $300,000 *Beginning on and after your 65th birthday, Sun Life decreases the amount of your insurance. Sun Life pays a percentage of the amount otherwise payable as follows: From your 65th birthday to age 70, Sun Life pays 65%, From your 70th birthday and after, Sun Life pays 50%. Basic Yearly Earnings The yearly base salary or wage you receive for work done for the Plan Sponsor. It does not include bonuses, commissions or overtime 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. Imputed Income If the amount of your employer-provided life insurance is more than $50,000, the cost of the amount above $50,000 is included in your taxable income each year. This taxable income (sometimes called imputed income) will be shown as earnings on your paycheck so that it can be taxed. 4

6 Employee s Insurance Eligibility The employee is eligible on the day after the employee completes 30 days of continuous service with the Plan Sponsor. The employee must meet the following conditions to become insured: Be eligible for the insurance. Be actively at work. Give to Sun Life evidence of insurability, which it approves, if the employee applies after converting any part of this insurance under the Conversion Right. Effective Date of Employee s Insurance The employee s insurance starts on the latest of the following dates: The date the employee becomes eligible. The date the employee returns to active work if the employee is not actively at work on the date insurance would otherwise start. Effective Date of Change in Amount of Insurance If there is an increase in the amount of your insurance, the increase will take effect on: The effective date of the increase, 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 insurance increases. The nonworking day on which the increase was effective, if you were actively at work on your last scheduled working day before the non-working day. A decrease in the amount of your insurance will take effect on the date of the decrease. Exception: The employee s insurance starts on a nonworking day if the employee was actively at work on the employee s last scheduled working day before the nonworking day. 5

7 Termination of Insurance Your insurance stops on the earliest of the following dates: The last day of the month you are no longer actively at work for the Plan Sponsor. The date you are no longer eligible for insurance under the Group Policy. The date the Group Policy stops. The last day of the month you retire. For AD&D insurance, the date your Life Insurance stops. AD&D Insurance stops at the beginning of the period in which you are eligible to convert your Life Insurance. Sun 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. Continuation of Life Insurance If you are no longer eligible for Insurance because you stop active work your insurance may be continued. Premiums must be paid. Your insurance stops at the end of the period for which your premiums were paid, if the next premium contribution is not paid on time. The length of time your insurance continues depends on the reason you stopped active work. Your continuation of insurance is subject to all other terms of the Group Policy. Non-Medical Reasons If you stop active work because of non-medical leave of absence, temporary layoff, or the Plan Sponsor suspending operations, the Plan Sponsor may continue your Life Insurance to the end of the 18th policy month after the policy month you stop active work. Sickness or Accidental Injury If you stop active work because of sickness or accidental injury, the Plan Sponsor may continue your Life Insurance as long as all required premiums are paid. 6

8 Life Insurance Employee s Life Insurance Sun 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. Sun Life pays the death benefit for all causes of death. Waiver of Life Insurance Premium Disability Benefit Sun Life waives your Life Insurance premium that becomes due while you are totally disabled. The premium will be waived if you satisfy certain conditions. When Sun Life waives a premium, the amount of Life Insurance equals the amount that was in effect when you became totally disabled. That amount will reduce or stop according to the Schedule of Benefits in effect on the date total disability begins. Premiums are waived for Life Insurance only. Premiums are not waived for Accidental Death and Dismemberment Insurance. Conditions, Notice and Proof of Total Disability Sun Life requires written notice of claim and proof of total disability to waive your premium. All of the following conditions must also be met: Total disability must begin before your 60th birthday. You are insured for the Waiver of Life Insurance Premium Disability Benefit on the date you become totally disabled. You must be continuously 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 total disability. All premiums are paid up to the date the total disability is approved by Sun Life. Sun 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 Sun Life notice within one year, your claim may still be considered if you gave Sun Life notice as soon as reasonably possible. Sun Life needs proof of your total disability before any premiums can be waived. Sun Life may require you to have a physical exam by a doctor it chooses. Sun Life pays for that exam. Sun Life may require 2 exams per year after premiums have been waived for 2 full years. When Sun Life approves your proof of total disability, premiums are waived as of the date you became totally disabled. Sun 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 Sun 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 Sun Life proof of total disability when asked. The date you attain age 70. The date your Life Insurance terminates. The date your retire. If Sun Life stops waiving your premiums, your Life Insurance will stay in force only if all of the following conditions are met: The Life Insurance under the Group Policy is still in force. You are eligible for insurance under the Group Policy. Your premium payments are resumed. 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. 7

9 If you apply for and are issued an individual policy under the Conversion Right of the Group Policy, this Waiver of Premium is reduced by the amount of the individual conversion policy. Benefit Payments Sun Life pays the amount of Life Insurance shown for your age and class on the Schedule of Benefits in effect on the date you became totally disabled. Sun Life refunds any premium paid for your Life Insurance after the date your employment with the Plan Sponsor stops. Beneficiary The beneficiary is named to receive the proceeds to be paid at your death. You may name more than one beneficiary. The Plan Sponsor cannot be the beneficiary. You may name, add or change beneficiaries by written request as described below. You may also choose to name a beneficiary that you cannot change without his or her consent. This is an irrevocable beneficiary. You may name, add or change beneficiaries by written request if all of the following conditions are met: Your coverage is in force. You have not assigned the ownership of your insurance. The rights of an assignee are described in the Assignment section. A change will take effect as of the date it is signed but will not affect any payment Sun Life makes or action it takes before receiving your notice. Payment of Proceeds Sun Life pays proceeds to the beneficiary. The death benefit will be paid in a single sum. 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 at the time of your death. In the event a beneficiary is not living at the time of your death, that beneficiary s portion of the death benefit shall be equally distributed to the remaining surviving beneficiaries. If there is no eligible beneficiary or if you did not name one, Sun Life pays the proceeds in the following order: 1. Your lawful spouse or civil union partner (does not include a domestic partner). 2. Your natural and legally adopted children. 3. Your parents. 4. Your siblings. 5. Your estate. Proceeds is the amount of each benefit Sun Life pays when you die or when you request and are eligible for an Accelerated Life Benefit. Sun Life will send a statement with any payment of the Accelerated Life Benefit showing the remaining amount of insurance, if any. To find out more about settlement options, please contact Sun Life. A change will take effect as of the date it is signed but will not affect any payment Sun Life makes or action it takes before receiving your notice. 8

10 Accelerated Life Benefit If you are diagnosed by a physician as terminally ill with a life expectancy of 24 months or less, you may request an Accelerated Life Benefit. You may request a partial Accelerated Benefit or a full Accelerated Benefit. The Accelerated Benefit that will be paid to you will be the death benefit you choose to accelerate, subject to a minimum amount of $10,000. To receive your accelerated life benefit, the following conditions must be met: Your insurance must be in force and all premiums due must be fully paid; You must apply on a form satisfactory to Sun Life. If you are unable to request this benefit yourself, your legal representative may request it for you; You must give evidence that your life expectancy, because of sickness or accident, is 24 months or less. This must include certification by a physician; You must not have assigned the ownership of your insurance; and Your insurance must not have an irrevocable beneficiary. Note: Your amount of life insurance will be reduced or end if you receive an accelerated life benefit. Sun Life may require that you be medically examined at Sun Life s expense to verify your medical condition. If a partial Accelerated Benefit is chosen, coverage will remain in force and premiums will be reduced accordingly. The remaining amount of insurance will be the full amount of insurance minus the amount that was accelerated. If a full Accelerated Benefit is chosen, your coverage will cease. Accelerated Benefits are made available on a voluntary basis only. An Accelerated Benefit is not intended to cause an involuntary reduction of the death benefit ultimately payable to the named beneficiary. Therefore, payment of the death benefit cannot be accelerated if you are required by law to use this option to meet the claims of creditors, whether in bankruptcy or otherwise, or are required by a government agency to use this option in order to apply for, obtain, or keep a government benefit or entitlement. The Accelerated Life Benefit provides for an early payout of death benefits if you have a terminal illness. 9

11 AD&D Insurance Accidental Death & Dismemberment (AD&D) Insurance Sun Life pays this benefit if you lose your life, limb or sight due to an accident. All of the following conditions must be met: You are covered for AD&D Insurance on the date of the accident and on the date of the loss. Loss occurs within 180 days of the date of the accident. The cause of the loss is not excluded. Sun Life pays the benefit shown below if you suffer any of the losses listed. The Full Amount is shown on the Schedule of Benefits. Sun Life pays only one Full Amount while the Group Policy is in effect. If you have a loss for which Sun Life paid 1/2 of the Full Amount, Sun Life pays no more than 1/2 of the Full Amount for the next loss. Life For loss of: Both hands, both feet or sight of both eyes One hand and one foot One hand or one foot and sight of one eye One hand or one foot or sight of one eye The benefit is: Full Amount Full Amount Full Amount Full Amount 1/2 Full Amount Accidental Death & Dismemberment Exclusions Sun Life does not pay benefits for loss directly caused by any of the following: Suicide or intentionally self-inflicted injury, while sane or insane. Physical or mental illness. Injury sustained from any aviation activities, other than riding as a fare-paying passenger and other than riding in a lifesaving medevac or similar medical air transport service. Any armed conflict, whether declared as war or not, involving any country or government. Injury suffered while in the military service for any country or government. Injury which occurs when you commit or attempt to commit a felony. Use of any drug, narcotic or hallucinogenic agent unless prescribed by a doctor. which is illegal. not taken as directed by a doctor or the manufacturer. 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. Sun Life does not pay a benefit for loss of use of the hand or foot. Death benefits are paid to your beneficiary. All other benefits are paid to you. 10

12 Portability Options and Conversion Rights Plan now to protect your loved ones later When it comes to protecting your loved ones, nothing is more important than planning ahead. Life insurance is a great way to provide your loved ones with extra financial protection when you can t be there and they need it most. Accidental Death & Dismemberment (AD&D) insurance can help give you and your family some financial protection in the event of a covered accidental injury or death. Advocate Health Care Network covers you with employer-paid Life and AD&D coverage for as long as you are an eligible Associate or until you retire. With Sun Life, you can apply to take your Life and AD&D coverage with you if you are no longer eligible for coverage because you are changing jobs or are retiring. Solutions for Associates making a career transition It s important to understand the difference between portability and conversion: Portability lets you apply to take (or port ) your group coverage with you after your employment ends as a term life insurance plan that continues for a specific period of time. Porting is available with your Basic Life and AD&D plan and does not require you to answer any medical questions. Conversion allows you to apply to change your coverage to an individual policy that you personally own, while keeping Sun Life as your insurance provider. Our conversion option is available with Basic Life coverage and does not require you to answer any medical questions. Portability Conversion Am I eligible? You are eligible if you: Are 69 years old or younger Are not retiring Do not have an illness or injury with a material impact on life expectancy * Other eligibility and state restrictions may apply You are eligible if you: Are terminating employment or retiring or Are losing group coverage because of age or change of class * Other eligibility and state restrictions may apply What can I take with me? Life and AD&D insurance; you do not have to port AD&D if you do not want to Life insurance How much can I take with me? You may port the same coverage amounts as you had under the Advocate group policy You may convert up to the amount of coverage that is being terminated or reduced What does my coverage turn into? A term life insurance policy that provides coverage until you are age 70 A universal life insurance policy called Sun Universal ProtectorPlus that provides permanent coverage Do I have to pay for coverage? Yes, you will be responsible for paying the premium for ported coverage directly to Sun Life Yes, you are responsible for paying the premium for converted coverage directly to Sun Life 11

13 Portability Conversion Is this a good solution for me? This might be a good option for you if you: want to take advantage of affordable group term rates. do not need a product that has cash value, or are not looking for permanent coverage. This might be a good option for you if you: You leave your job and don t want to provide proof of medical history or applying for a new policy with a different insurance provider. You want your coverage to have cash value. When you convert from a group policy to an individual life insurance policy, your policy grows a cash value based on what you pay into it, and you can borrow against that cash value or take the cash value with you if you no longer want the policy. You need permanent life insurance. Rather than having a policy that lasts a specified number of years, converting to a permanent policy will allow you to receive a pre-specified benefit amount in the event of your death for as long as you continue to pay the premium. How do I apply? If you want to continue your coverage, you must notify Sun Life Financial within 91 days of the termination of your current employment. If you want to continue your coverage, you must notify Sun Life Financial within 31 days of the termination of your current employment or within 15 days after you receive the conversion offer letter.. What if I am not eligible for portability coverage? There are a few reasons why you may be ineligible for portability coverage, including the following: You were not insured for Life before your termination date. You are 70 years old or over. You remain in employment with Advocate, but not at a benefits eligible status. Your insurance is being continued under the waiver of premium provision. You retire or have an injury or sickness that would have a material effect on your life expectancy. 12

14 Claim Procedures Submitting a Claim You or someone on your behalf must send Sun Life written notice of the loss on which your claim will be based. The notice must: Include information to identify you, like your name, address and Plan Sponsor number. Be sent to Sun Life or one of its licensed agents authorized to accept claims. Be sent within 20 days after the loss for which claim is based has occurred or as soon as reasonably possible. Claim Forms Sun Life or its authorized agent will send proof of loss claim forms to you, or to the Plan Sponsor to give to you. Sun Life will send the forms within 15 days after Sun Life receives your notice of claim. You or someone on your behalf must return the completed proof of loss claim forms to Sun Life within 90 days of the loss. Even if you do not receive the forms, written proof of loss must be sent to Sun Life within 90 days after the loss or as soon as reasonably possible. Written proof of loss includes details of how the loss occurred. 13

15 General Provisions Legal Action Legal action may not be taken to receive benefits until 60 days after the date proof of loss is submitted according to the requirements of the Group Policy. Legal action must be taken within 3 years after the date proof of loss must be submitted. If the Policyholder s state requires longer time limits, Sun Life will comply with the state s time limits. Exam and Autopsy For AD&D Insurance, when reasonably necessary, Sun Life may have you examined while a claim is pending under the Group Policy. Sun Life pays for the initial exam. Sun Life may have an autopsy made if you die, if not forbidden by state law. Incontestability Your insurance has a contestable period starting with the effective date of your insurance and continuing for 2 years while you are living. During that 2 years, Sun Life can contest the validity of your insurance because of inaccurate or false information received relating to your insurability. Only statements that are in writing and signed by you can be used to contest the insurance. Conformity with Law If any provision in this certificate is in conflict with the laws of the state governing the Group Policy or this certificate, the provision will be deemed to be amended to conform to such law. Complaints Any complaints about a claim or benefit that may arise under the Group Policy should be sent to Sun Life at the following address: Sun Life Financial P.O. Box 9106 Wellesley Hills, MA You can write the Public Service Division of the Department of Insurance in the State of Illinois at the following address: Consumer Services Section 215 East Monroe Street Springfield, Illinois Age Misstatement If your age has been misstated, the death benefit payable will be that amount to which you are entitled based on your correct age. 14

16 Definitions Accelerated Life Benefit An early payout of the death proceeds if you have a terminal illness. Accident An unexpected, unintended and sudden event which the insured does not foresee. Active Work, Actively at Work The employee is physically present at his or her customary place of employment with the intent and ability of working the scheduled hours and doing the normal duties of his or her job on that day. Basic Yearly Earnings The yearly base salary or wage you receive for work done for the Plan Sponsor. It does not include bonuses, commissions or overtime pay. Employee An active employee residing in the United States who is employed by the Plan Sponsor and is regularly scheduled to work at least 40 hours per pay period. Such employees of companies and affiliates controlled by the Plan Sponsor are included. Group Policy The written group insurance contract between Sun Life and the Policyholder. Sun Life Sun Life Assurance Company of Canada, at its home office in Wellesley Hills, MA. Nonworking Day A day on which the employee is not regularly scheduled to work, including time off for the following: Vacations. Personal holidays. Weekends and holidays. Approved nonmedical leave of absence. Nonworking day does not include time off for any of the following: Medical leave of absence. Temporary layoff. The Plan Sponsor suspending its operations, in part or total. Strike. Plan Sponsor Advocate Health Care Network. Policyholder Advocate Health Care Network. Terminal Illness An injury or sickness which is expected to result in your death within 24 months and from which there is no reasonable chance of recovery. Sun Life or a qualified party chosen by Sun Life will make this determination. Total Disability, Totally Disabled Your inability, due to sickness or accidental injury, to work at any job suited to your education, training or experience. Written, In Writing Signed, dated and received at Sun Life s Home Office in a form Sun Life accepts. You, Your An employee insured for Employee s Insurance under the Group Policy. 15 Advocate Health Care 5/15 MC 1324