Supplemental Life Insurance Benefit Program

Transcription

1 Supplemental Life Insurance Benefit Program o Ordinary Life (Whole Life Insurance) Paid-Up At 65 o Ordinary Life (Whole Life Insurance) Paid for Life o Term Life Insurance Paid-Up At 65 o Term Life Insurance Paid for Life for Employees of CES Member School Districts F4177 R0907

2 About Globe Life A recognized name Since 1951, millions of Americans have entrusted their insurance needs to Globe Life And Accident Insurance Company, and that number is growing every day. Globe has become a tradition in some families, with many second and even some third generation policies. We provide a wide range of affordable supplemental life products and services designed to fit the needs of people from all walks of life. A company you can trust Globe Life has been providing quality supplemental insurance products to state and federal government employees since Our company is rated A+ (Superior) by A.M. Best Company (insurance industry analysts) for overall financial strength. This rating is your assurance that an insurer has the resources to meet claims (rating as of 6/10). We are here for you If you have any questions regarding your policy, your benefits, premiums or claims, please call customer service toll-free weekdays between 7:30 am and 4:30 pm Central Time. One of our courteous customer service representatives will be happy to help you. Optional Supplemental Life Coverage from Globe Life As a CES Member, you have the opportunity to purchase optional Life coverage in addition to employer provided Life benefits. Your rates are locked in now based on your health and your present age. This supplemental coverage stays with you, even if you end your employment with the school district. Frequently Asked Questions About Life Insurance Why do I need Life insurance? Life insurance is an integral part of financial planning. It provides security for loved ones, and ensures financial obligations will be covered in the event of unexpected death. What is supplemental Life insurance? It does not replace, but complements your existing life coverage provided through your employer This optional coverage is made available to help employees meet their individual needs Supplemental Life insurance can be paid for through the convenience of employee payroll deduction Supplemental life coverage is portable it goes with you if you leave or retire. Why should I purchase Globe Life s supplemental Life coverage now? It is a good idea to purchase supplemental Life coverage and secure level premiums now while you are younger and healthier. If you wait until your existing coverage terminates, you will need to apply for new coverage later on. Rates at that time could make life insurance prohibitive because of your age, or your health. How do I purchase Globe Life s supplemental Life coverage? Your agent will be able to help you determine your premiums and complete the required forms for payroll deduction. An application is included in this book. Globe Life And Accident Insurance Company Oklahoma City, OK

3 Ordinary Life (Whole Life Insurance) Enroll now to take advantage of this offer You choose the face amount of life insurance you need to supplement your existing coverage. Family members are eligible for coverage, too No physical or medical exam is required to qualify just answer a few Yes/No health questions* Our supplemental Life coverage is affordable with the convenience of payroll deduction, and no money is needed to buy now When you enroll today, you have the best opportunity to see your cash value grow (subject to policy provisions) and your premiums remain level, regardless of your age or your future health* Your supplemental Life coverage cannot be cancelled as long as premiums are paid on time This supplemental Life coverage is portable it goes with you even if you leave or retire from state government As a CES Member, you have the opportunity to purchase these optional Life coverages from Globe Life And Accident Insurance Company. o Ordinary Life (Whole Life Insurance) Paid-Up At 65 Coverage For Employee & Family Guaranteed Issue Face Amounts* Employee (up to Age 55): $75,000 Spouse (up to Age 55): $25,000 Children (up to Age 23): $7,000 Premiums Remain Level, then Stop at Age 65 when coverage is fully paid up no rate increases ever Graded Benefit available** o Ordinary Life (Whole Life Insurance) Paid for Life Coverage For Employee & Family Guaranteed Issue Face Amounts* Employee (Age 56-80): $30,000 Spouse (Age 56-80): $10,000 Premiums Remain Level for life no rate increases ever Graded Benefit available** o Term Life Insurance Also Available * For those still actively employed subject to certain limitations. Not available to individuals who are HIV positive or terminally ill. If applicant has certain pre-existing medical conditions, policy will be issued with graded benefits. Excess amounts over the Guaranteed Face Amount subject to regular underwriting. ** Graded Benefit: initial policy benefit is 25%; second year 50%; third year 75%; fourth year and thereafter 100%

4 Globe Life And Accident Insurance Company Ordinary Life (Whole Life Insurance) Paid-Up at Age 65 Ordinary Life (Whole Life Insurance) Paid for Life Select the level of supplemental Life coverage you need and can afford, as well as any additional riders you want. Policy benefits Face Amount* Premium Rate Settlement Options Available at claim time. Available Riders Employee: Issue Age 18-55: up to $75,000 Spouse: Issue Age 18-55: up to $25,000 Children: Issue Age 30 days - 23: up to $7,000 Premiums remain level, then stop at Age 65 Death benefit paid in full to the beneficiary; Annuitize the death benefit; Or a combination of both. Issue Age 56-80: up to $30,000 Issue Age 56-80: up to $10,000 Premiums remain level for Life Terminal Illness Accelerated Benefit Rider: Upon proof of terminal illness, insured will receive 50% of the current benefit available prior to death, subject to provisions of the rider. Issue Age 30 days - 55: No additional charge for this rider Issue Age 56-80: No additional charge for this rider Waiver of Premium Disability Rider: Upon proof of the insured s total disability as defined by this rider, the company will waive any premiums due (on standard policy only). Issue Age 15-55: No additional charge for this rider Accidental Death Benefit Rider: This rider pays up to $32,000 for an Accidental Death, subject to policy provisions. This benefit pays in addition to other sums collected under the policy. Issue Age 30 days - 55: $16,000 Face Amount for $0.50 per week; $32,000 Face Amount for $1.00 per week Children s Term to 25 Rider: Upon proof of the insured child s death, policy will pay beneficiary up to $10,000, subject to policy provisions Issue Age 30 days - 23: $10,000 Face Amount for $2.00 per week ** For those still actively employed subject to certain limitations. Not available to individuals who are HIV positive or terminally ill. If applicant has certain preexisting medical conditions, policy will be issued with graded benefits. Excess amounts over the Guaranteed Face Amount subject to regular underwriting. ** Graded Benefit: initial policy benefit is 25%; second year 50%; third year 75%; fourth year and thereafter 100%

5 (Please Print) ENROLLMENT FORM FOR LIFE INSURANCE GLOBE LIFE AND ACCIDENT INSURANCE COMPANY OKLAHOMA CITY, OK 1. Name of Employee as shown on Allotment 2. Residence Address Street City State Zip 3. Social Security 4. Home Tel. Work Tel. 5. Payroll Center City, State, (Dept. Code) ( ) 6. Will the Life insurance applied for replace or change any existing Life insurance or Annuity contract? YES No If yes, list Company name and address 7. Full Name of all Persons Proposed for coverage Beneficiary Sex Birthdates Age Amount Weekly of insurance Premium Plan ADB MM DD YY (Yes / No) a. Empl. b. Spse. a. Empl. c. a. Empl. d. a. Empl. e. a. Empl. f. a. Empl. g. a. Empl. CHILDREN 8. EMPLOYEE'S BENEFICIARY: Spouse OR : IF THE ANSWERS TO QUESTIONS 9., 10.(a), OR 10.(b) ARE YES THE PROPOSED INSURED TO WHOM THE YES ANSWER APPLIES WILL BE ISSUED SUB-STANDARD COVERAGE IF INDIVIDUAL COVERAGE APPLIED FOR. IF THE ANSWER TO QUESTION 10.(c) IS YES, THE PROPOSED INSURED TO WHOM THE YES ANSWER APPLIES IS NOT ELIGIBLE FOR ANY COVERAGE. IF ANY PROPOSED INSURED CHILD ANSWERS YES TO ANY OF THE QUESTIONS, THEY ARE NOT ELIGIBLE FOR COVERAGE UNDER THE CHILD RIDER. YES NO 9. Is any Proposed Insured disabled, confined to a hospital or nursing facility, or does any Proposed Insured require the use of a wheelchair? 10. In the past 5 years has any Proposed Insured ever been medically diagnosed or treated by a physician for: (a) cancer, high blood pressure, coronary artery disease, chronic obstructive lung disease, chronic kidney disease or kidney failure, or any disease or disorder of the heart, brain or liver? (b) muscular disease, mental or nervous disorder, chronic glandular disease or disorder, diabetes, systemic lupus, cystic fibrosis, Down s syndrome, drug or alcohol abuse, had any amputation caused by disease, or been hospitalized for any blood disease or disorder? (c) Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or immune deficiency related disorders or tested positive for antibodies to the HIV virus or been diagnosed with a terminal illness? 11. CHECK APPLICABLE BOX FOR ANY PROPOSED INSURED TO WHOM A YES APPLIES: a. b. c. d. e. f. g. Special Requests Home Office Use Only FOR ANY PROPOSED INSURED WHO APPLIES FOR A FACE AMOUNT WHICH EXCEEDS THE GUARANTEED ISSUE LIMIT OR APPLIES FOR A FACE AMOUNT WHICH, TOGETHER WITH THE FACE AMOUNT IN FORCE WITH THE COMPANY, EXCEEDS THE GUARANTEED ISSUE LIMIT, GIVE DETAILS BELOW OF ANY YES ANSWER ABOVE AND COMPLETE THE FOLLOWING QUESTIONS. 12. Has Proposed Insured, within the past 3 years, engaged in any flying as a pilot or student pilot, or engaged in hazardous sports or activities? (If yes, check applicable box to which person YES answer applies and complete the questionnaire.) a. b. c. d. e. f. g. 13. Has Proposed Insured had any other medical or surgical treatment or advice in the past 5 years not already mentioned? 14. P.I. Line Question Name of Illness or Condition Date of Onset Date of Recovery IF CHILD RIDER IS ISSUED IT WILL BE ATTACHED TO EMPLOYEE S CERTIFICATE Name and Addresses of Attending Physicians, Hospitals or Clinics AGREEMENT: I have read the foregoing questions and represent each answer to be true and complete to the best of my knowledge and belief. The insurance applied for shall not become effective until the certificate is actually issued by the company and the full first premium paid thereon while the proposed insured s health and other conditions remain as described in this enrollment form. Dated at State of this day of To the best of your knowledge as writing agent, is the insurance applied for intended to replace any existing Life insurance or Annuity? YES No Signature of Employee / Proposed Insured I certify that the above medical questions were asked and recorded as given by the Proposed Insured(s). Signature of Spouse Signature of agent who completed enrollment form Signatures(s) of Any Insured Child 18 Years or Older Manager Signatures(s) of Any Insured Child 18 Years or Older Form EGAP(34) MKT

6

7 Term Life Insurance Enroll now to take advantage of this offer You choose the face amount of life insurance you need to supplement your existing coverage. Family members are eligible for coverage, too Our supplemental Life coverage is affordable with the convenience of payroll deduction, and no money is needed to buy now When you enroll today, your premiums remain level regardless of your age or your future health* Your supplemental Life coverage cannot be cancelled as long as premiums are paid on time This supplemental Life coverage is portable it goes with you even if you leave or retire from state government As a CES Member, you have the opportunity to purchase these optional Life coverages from Globe Life And Accident Insurance Company. o Term Life Insurance Paid-Up At 65 Coverage For Employee & Family You choose the Face Amount Premiums Remain Level, then Stop at Age 65 when coverage is fully paid up no rate increases ever Extended Term Insurance (ETI) Benefit of one (1) year for every five (5) years the policy is in force o Term Life Insurance Paid for Life Coverage For Employee & Family You choose the Face Amount Premiums Remain Level for life no rate increases ever Extended Term Insurance (ETI) Benefit of one (1) year for every five (5) years the policy is in force o Ordinary Life (Whole Life Insurance) Also Available * For those still actively employed subject to certain limitations. Not available to individuals who are HIV positive or terminally ill.

8 Globe Life And Accident Insurance Company Term Life Insurance Paid-Up at Age 65 Term Life Insurance Paid for Life Select the level of supplemental Life coverage you need and can afford, as well as any additional riders you want. Policy benefits Face Amount* Premium Rate Settlement Options Available at claim time. Available Riders Employee: Issue Age Issue Age Spouse: Issue Age Issue Age Children: Issue Age 30 days - 23 Premiums remain level, then stop at Age 65 Death benefit paid in full to the beneficiary; Annuitize the death benefit; Or a combination of both. Premiums remain level for Life Terminal Illness Accelerated Benefit Rider: Upon proof of terminal illness, insured will receive 50% of the current benefit available prior to death, subject to provisions of the rider. Issue Age 30 days - 55: No additional charge for this rider Issue Age 56-80: No additional charge for this rider Waiver of Premium Disability Rider: Upon proof of the insured s total disability as defined by this rider, the company will waive any premiums due (on standard policy only). Issue Age 15-55: No additional charge for this rider Accidental Death Benefit Rider: This rider pays up to $32,000 for an Accidental Death, subject to policy provisions. This benefit pays in addition to other sums collected under the policy. Issue Age 30 days - 55: $16,000 Face Amount for $0.50 per week; $32,000 Face Amount for $1.00 per week Children s Term to 25 Rider: Upon proof of the insured child s death, policy will pay beneficiary up to $10,000, subject to policy provisions Issue Age 30 days - 23: $10,000 Face Amount for $2.00 per week ** For those still actively employed subject to certain limitations. Not available to individuals who are HIV positive or terminally ill.

9 (Please Print) Enrollment Form For Life Insurance Globe Life And Accident Insurance Company Oklahoma City, OK 1. Name of Employee as shown on Allotment 2. Residence Address Street City State Zip 3. Social Security 4. Home Tel. Work Tel. 5. Payroll Center City, State, (Dept. Code) ( ) 6. Will the Life insurance applied for replace or change any existing Life insurance or Annuity contract? YES NO If yes, list Company name and address 7. Full Name of all Persons Proposed for coverage Beneficiary Sex C H I L D R E N a. Empl. b. Spse. a c. a d. a e. a f. a g. a 8. Employee's Beneficiary: Spouse or Birthdates Mo. Day Yr. Age Amount of Ins. Weekly Premium Plan ADB (Yes/No) If child rider is issued it will be attached to employee's certificate. If any of the answers to questions 9., 10.(a), 10.(b) or 10.(c) are "Yes" the Proposed Insured to whom the "Yes" answer applies will not be eligible for any coverage.y yes NO 9. Is any Proposed Insured disabled, confined to a hospital or nursing facility, or does any Proposed Insured require the use of a wheelchair? 10. In the past 5 years has any Proposed Insured ever been medically diagnosed or treated by a physician for: (a) cancer, high blood pressure, coronary artery disease, chronic obstructive lung disease, chronic kidney disease or kidney failure, or any disease or disorder of the heart, brain or liver? (b) muscular disease, mental or nervous disorder, chronic glandular disease or disorder, diabetes, systemic lupus, cystic fibrosis, Down's syndrome, drug or alcohol abuse, had any amputation caused by disease, or been hospitalized for any blood disease or disorder? (c) Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or immune deficiency related disorders or tested positive for antibodies to the HIV virus or been diagnosed with a terminal illness? 11. Check applicable box for any Proposed Insured to whom a "Yes" answer applies: a b c d e f g 12. Has Proposed Insured, within the past 3 years, engaged in any flying as a pilot or student pilot, or engaged in hazardous sports or activities? (If yes, check applicable box to which person "Yes" answer applies and complete questionnaire.) a b c d e f g 13. Has Proposed Insured had any other medical or surgical treatment or advice in the past 5 years not already mentioned? 14. P.I. Line Question Name of Illness or Condition Date of Onset Date of Recovery Name & Address of Attending Physicians, Hospitals or Clinics Agreement: I have read the foregoing questions and represent each answer to be true and complete to the best of my knowledge and belief. The Insurance applied for shall not become effective until the Certificate is actually issued by the Company and the full first premium paid thereon while the Proposed Insured's health and other conditions remain as described in this enrollment form. Dated at State of this day of, To the best of your knowledge as writing agent, is the insurance applied for intended to SIGNATURE ON FILE IN HOME OFFICE replace any existing Life insurance or Annuity? YES NO Signature of Employee / Proposed Insured I certify that the above medical questions were asked and recorded as given by the Proposed Insured(s). Signature of Spouse Signature(s) of Any Insured Child 18 Years or Older: Signature of agent who completed enrollment form Manager Form EGA2(03) Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits application or files a claim containing a false or deceptive statement is guilty of insurance fraud. 0507

10 AGENT S REPORT Complete the following questions on any proposed insured whose face amount exceeds the guarantee issue limit (face amount applied for and/or face amount applied for plus face amount in force). First Name Height & Weight Relationship to Premium Payor First Name Height & Weight Relationship to Premium Payor 1. (a) Employee _ (d) (b) (e) (c) (f) 2. Did you personally see proposed insured(s)? yes NO If No, why not? 3. Has medical exam, possible inspection phone interview, or other medical requirement(s) been explained to proposed insured(s)? yes NO 4. Business Telephone Number:. ( ) Business Address: phone number where all non-civil service applicants can be reached: name: name: name: Number: ( ) Number: ( ) Number: ( ) most convenient time/place where proposed insured(s) can be reached by phone: business Residence Time of Day: 5. IMPORTANT - Have you had the separate authorization form signed and attached it to this enrollment form and given the notice of information practices to the employee or enrollee? yes NO FOR USE WITH TERM LIFE ONLY 1. Upon receipt and review of my life insurance certificate, I should pay particular attention to the certificate specifications (which show the face amount of coverage), and the copy of the enrollment form for life insurance. 2. I understand my FEGLI Program provides excellent life insurance coverage and that Globe s Life Insurance program is designed to supplement FEGLI. 3. I realize that my bi-weekly/monthly deduction/payment is:. 4. I fully understand that I am purchasing life insurance from Globe Life and Accident Insurance Company and the government does not endorse or sponsor this life insurance program. WITNESS: Date Signature of Agent Signature of Employee Form EGA2(a) 9/97T MKT

11 GLOBE LIFE AND ACCIDENT INSURANCE COMPANY GLOBE LIFE CENTER OKLAHOMA CITY, OKLAHOMA A Delaware Stock Company TERMINAL ILLNESS ACCELERATED BENEFIT DISCLOSURE AND ACKNOWLEDGEMENT The contract you have applied for contains a Terminal Illness Accelerated Benefit rider. We are required to provide you with this disclosure and obtain your signature, acknowledging your receipt and review of this contract. The Terminal Illness Accelerated Benefit rider on this contract allows the insured to receive a portion of the contract s Death Benefit upon our receiving due proof that the insured has a Terminal Illness. DEFINITION OF TERMINAL ILLNESS: The Insured has been diagnosed with a noncorrectable medical condition that, with reasonable medical certainty, will result in the Insured s death within twelve (12) months from the date on which this benefit is requested. AMOUNT OF THE BENEFIT: The amount of the Accelerated Benefit will be equal to 50% of the Death Benefit less 50% of any outstanding policy loan and loan interest. SAMPLE ILLUSTRATION: The calculation of the Accelerated Benefit Amount and the effects on the remaining contract values are shown in the sample illustration below: CONTRACT DEATH BENEFIT: $ 5,000 CASH VALUE: 1,000 POLICY LOAN: 500 ACCELERATED BENEFIT AMOUNT CALCULATION: $ 5,000 x.50 = $2,500 Gross Amount 500 x.50 = 250 Policy Loan $2,250 Amount Payable CONTRACT VALUES AFTER ACCELERATED BENEFIT PAYMENT: $ 5,000 2,500 = $ 2,500 Death Benefit 1,000 (.50 x 1,000) = 500 Cash Value = 250 Policy Loan THIS FORM IS NOT A CONTRACT. IT IS INTENDED ONLY AS A SUMMARY OF THE RIDER PROVISIONS SHOWN. IN ALL CASES, CONSULT YOUR RIDER FOR FULL DETAILS AND RESTRICTIONS. ANY ACCELERATED BENEFIT PAID UNDER THIS CONTRACT MAY BE TAXABLE. A PERSONAL TAX ADVISOR SHOULD BE CONSULTED. PAYMENT OF ANY ACCELERATED BENEFIT MAY ALSO ADVERSELY AFFECT THE RECIPIENT S ELIGIBILITY FOR MEDICAID AND OTHER GOVERNMENT BENEFITS OR ENTITLEMENTS. I hereby acknowledge receipt of this disclosure form as evidenced by my signature below. Signature of Applicant Date GABR1D1

12 ESD