Group Universal Life. Summary Plan Description

Transcription

1 Group Universal Life Summary Plan Description December 2014

2 Table of Contents Introduction... 1 For Help and Information... 2 Eligibility and Enrollment... 3 Eligibility... 3 Enrollment... 3 Designating a Beneficiary... 4 Coverage Options Available... 5 Automatic Increase Option... 6 Changing Your Benefits and Options... 6 Terminating Your Participation... 6 Cost of Coverage... 7 The Fund... 7 Waiver of Premium... 7 Claims and Benefit Payment... 8 Legal Proceedings... 8 When Coverage Ends... 9 When Employee Coverage Ends... 9 Conversion Options... 9 Continuation of Coverage During Illness or Injury During a Leave of Absence General Information Your Rights as a Plan Participant Plan Documents Discretionary Authority of Plan Administrator and Claims Administrator No Guarantee of Employment Future of the Plan and Plan Amendment Plan Administration Glossary Prudential Booklet and Certificate of Coverage Attached ii 12/2014 GUL

3 INTRODUCTION The welfare benefit described in this summary is offered to the employees of California Resources Corporation or an affiliated company, as defined in the section Eligibility and Enrollment. This supplement, along with the Group Insurance Certificate booklet (Booklet) provided by The Prudential Insurance Company of America (Prudential) or a successor carrier is your Summary Plan Description (SPD). You should keep and refer to it when you have questions about your Group Universal Life Plan (Plan). In the event that there is a discrepancy between the SPD and the Plan document, the Plan document will control. Any capitalized term not defined in the Glossary of this summary has the meaning ascribed to it in the Booklet that follows. The Plan gives you the opportunity to purchase Group Universal Life (GUL) insurance protection for you and your Spouse and can provide added financial security through the optional accumulation of personal savings that can grow on a tax-free basis. You also may purchase a term life insurance rider on the lives of your Dependents. Unlike CRC s Basic Life Insurance Plan, GUL participation is voluntary. You pay the entire cost for your coverage by enrolling in the Plan and authorizing payroll deductions for your elected coverage amounts. Prudential administers the Plan and handles all transactions regarding your policy(ies). Refer to subsequent issues of California Resources Corporation benefits newsletters on MyInfo at for any material changes to the Plan made after the date of this document. 12/ GUL

4 FOR HELP AND INFORMATION Contact Information Provider: Address: Phone/ Prudential Customer Service P.O. Box 8769 Philadelphia, PA Website: TTD: CRC Benefits Website: MyInfo.crc.com The Prudential secure website was designed to provide detailed information and tools in order to: View available benefit options, Provide you with rate information, Use calculators to determine your insurance needs, and Provide an online beneficiary designation option. If you have any questions, Prudential customer service representatives are available Monday through Friday, 5 a.m. to 5 p.m., Pacific Time). Process your coverage and option change requests, Make arrangements for continuing your GUL coverage when you leave CRC, Assist beneficiaries with filing GUL death claims, and Answer any questions about your GUL benefits. In addition, a summary of the GUL Plan and rates are available on the MyInfo. For addition information or assistance on benefit matters, CRC Benefits. 2 12/2014 GUL

5 ELIGIBILITY AND ENROLLMENT Eligibility You are eligible to participate in the GUL Plan if you are a regular, full-time, nonbargaining hourly or salaried employee of California Resources Corporation or an affiliated company (CRC). For this purpose, affiliated company means any company in which 80 percent or more of the equity interest is owned by California Resources Corporation. Temporary employees and employees of Tidelands Oil Production Company are not eligible to participate. You are considered a full-time employee under the Plan if you regularly are scheduled to work at least 30 hours per week. Generally, you are eligible to participate if you are paid on a U.S. dollar payroll, are designated as eligible to participate by your employer, and do not participate in a similar type of employer-sponsored plan. If you are part of a collective bargaining group, you are eligible to participate in the GUL Plan only if your negotiated bargaining agreement specifically provides for your participation. If you and your Spouse are both employees of CRC, you may not be covered as both an employee and a Spouse under this Plan and only one of you may cover your Dependent children. Enrollment To enroll, you may complete an online application via the Prudential website ( The online application is how you will elect: types of coverage (yourself, spouse, children), the multiples of amounts (as applicable), whether you want to contribute to a Fund, certain other coverage features, and your beneficiary(ies). To enroll your Spouse for coverage, he or she must be under age 70 and not Disabled. GUL coverage will be effective for you and/or your Spouse upon submission and approval by Prudential of a completed application, provided that you enroll within 31 days of when you are first eligible to participate. If you waive participation in the Plan and choose to enroll at a later date, you and/or your Spouse will be required to provide evidence of insurability. You may purchase a term life insurance rider for your Dependents when you enroll in the GUL Plan, as described above. Once you have elected the rider, any new Dependents are automatically covered. If you waive coverage for a Dependent beyond 31 days of the date you are eligible to enroll or beyond 31 days of the date you acquire a new Dependent if you previously were enrolled, your Dependent(s) will be required to provide evidence of insurability before coverage may begin. When 3 12/2014 GUL

6 your Dependents are no longer eligible, you must notify Prudential to remove the rider from your policy. See Additional Provisions for Dependents Term Life Coverage in the attached Prudential Booklet for information regarding conversion options. On the coverage effective date, you must be actively at work in order to be eligible. If you or any family member is not performing normal daily activities on the effective date and/or is confined to any medical facility on that date, the individual s effective date will be delayed until the individual ceases to be confined and/or resumes normal activities. DESIGNATING A BENEFICIARY Prudential maintains the beneficiary information for the GUL Plan. Upon enrollment, you and your Spouse (if participating) will be asked to designate a beneficiary(ies). You may name anyone as your beneficiary(ies), and you may update your beneficiary designation at any time through the Prudential secure website. You may also contact the Prudential Customer Service Center for the beneficiary designation form. You should keep your beneficiary designation current so that if your circumstances change (for example, marriage, divorce or birth of a child), you will have a current beneficiary designation on file with Prudential. Under the Plan, you may designate two types of beneficiaries: Primary Beneficiary: An individual or trust you name to receive your basic life insurance benefit in the event of your death. Contingent Beneficiary: An individual or trust you name to receive your benefit in the event of your death if all of your designated primary beneficiaries die before you. Refer to Beneficiary Rules under General Information in the attached booklet for more information regarding beneficiary designations. 4 12/2014 GUL

7 COVERAGE OPTIONS AVAILABLE Coverage is available for: - Employee Only - Employee and Dependent(s) - Spouse Only - Spouse and Dependent(s) - Employee and Spouse - Employee, Spouse and Dependent(s) Coverage options for employees are based on multiples of Base Earnings rounded up to the next $5,000, with a minimum of $10,000 and a maximum of $2,000,000. During the first 31 days after becoming eligible, you may purchase Guaranteed Issue coverage of one-half, one, or two times your Earnings, to a maximum of $500,000, without providing evidence of insurability. If you elect coverage of three or four times your Earnings or an amount over $500,000, evidence of insurability will be required. You also may purchase coverage for your Spouse of $10,000 or $25,000 without providing evidence of insurability. If you elect to purchase additional Spouse coverage, evidence of insurability will be required. If you elect coverage in excess of the Guaranteed Issue or apply for coverage beyond 31 days after becoming eligible, any necessary forms will be forwarded to you. A health examination may be necessary, at your own expense. You will be contacted directly by Prudential with the results of the underwriting evaluation. If the additional coverage is denied, the Guaranteed Issue will not be affected. Group Universal Life Coverage Options Employee (Salary Multiple) Spouse Child Guaranteed Issue ½, 1 or 2 times Base Earnings, up to $500,000 coverage 3, 4, 5, or 6 times Base Earnings, and coverage over $500,000 $10,000 or $25,000 $10,000 Evidence of insurability required $50,000, $75,000, $100,000 or $150, /2014 GUL

8 Automatic Increase Option The insurance coverage on your life and your premiums will automatically increase without medical evidence on any date to reflect any increase in your salary, not to exceed $2,000,000, unless you decline this Automatic Increase Option in writing. The new coverage amount will be based on your elected salary multiple and rounded up to the next $5,000. Changing Your Benefits and Options You or your Spouse may request to enroll, change your current salary multiple, or increase or decrease coverage at any time, but evidence of insurability may be required. If you experience a Life Event, you can choose to elect or increase your GUL coverage by one times your Base Earnings, within 31 days of the event, without providing evidence of insurability. Refer to Increases and Decreases in the Schedule of Benefits section of the attached booklet for more additional details. Terminating Your Participation You may terminate your participation in the Plan at any time by surrendering your policy. Should you do so, you will be paid the amount in your Fund, less the amounts of any outstanding premiums or loan balances. 6 12/2014 GUL

9 COST OF COVERAGE Premiums for you and your Spouse are based on your age(s) and the amount of insurance selected. Current GUL premium rates are available online at Prudential or MyInfo. The child life insurance rider of $10,000 per child is available for a single monthly premium of one dollar ($1), regardless of how many Dependents are covered. Once you enroll, premiums are paid through after-tax payroll deductions at the end of the month for that month s coverage. Prudential has the right to change premium rates for insurance coverage. Any such change will be disclosed to participants in advance of the effective date of the change. The Fund In addition to making contributions for life insurance benefits, you are eligible to make contributions to your or your Spouse s Fund. To obtain additional information, refer to The Fund in the Universal Life Coverage section of the attached Prudential booklet. Waiver of Premium An extension of coverage and waiver of monthly deductions may be available to you when you are determined to be totally disabled, as described in the Universal Life Coverage section of the attached booklet. 7 12/2014 GUL

10 CLAIMS AND BENEFIT PAYMENT All claims should be reported promptly. In the event of your death, your designated beneficiary should contact your human resources representative or CRC Benefits. Your human resources representative will assist your beneficiary in completing the necessary claim forms and inform your beneficiary of any information, such as a certified copy of the death certificate that may be required. See the attached booklet for more information regarding claim payment and the Accelerated Death Benefit feature of the GUL insurance benefit. Payment of Benefits The amount of any death benefit is equal to the face amount of life insurance plus the amount in the insured person s Fund, less the amount of any outstanding loan balance remaining at the time of payment. See the attached for additional information regarding claim procedures under the Plan and appeals of adverse benefit determination. Legal Proceedings For information regarding Legal Action, refer to Claim Rules in the General Information section in Prudential s Booklet. No action at law or equity shall be brought to recover on the Group Contract or under the Plan until 60 days after the written proof described in Prudential s Booklet is furnished. No action shall be brought more than three years after the end of the time within which proof of loss is required. 8 12/2014 GUL

11 WHEN COVERAGE ENDS When Employee Coverage Ends Your GUL insurance will end at the first to occur of the following: Your employment terminates; The date ending the period for which your last contribution is made; or The coverage described in this Summary Plan Description is terminated under the group contract. Conversion Options In the event that you decide you no longer need your GUL coverage or you are no longer eligible for coverage under the Plan, you have a conversion privilege or may be eligible to purchase paid-up life insurance, as described in the Universal Life Coverage portion of the attached booklet. 9 12/2014 GUL

12 CONTINUATION OF COVERAGE During Illness or Injury If you are unable to work because of illness or injury, your GUL coverage will continue while you are eligible to receive benefits under CRC s Short-Term Disability (STD) Plan, provided you continue to make the required payroll contributions. If you remain disabled beyond your STD period, you may port, or convert, your coverage by making contributions directly to Prudential, as described in the Universal Life Coverage portion of the attached booklet. During a Leave of Absence In some situations, you may continue some or all of your benefits after your coverage normally would end. Following is a summary of two of those situations the Family and Medical Leave Act of 1993 (FMLA) and the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). If you are on an approved leave of absence under FMLA or USERRA, you have several options regarding your Plan participation. You can elect to: Continue your monthly payroll contributions, if you are on a paid leave of absence; Make premium payments directly to the payroll department to be applied to your coverage, if your leave is unpaid; Defer premium payment until your return to work; or Discontinue your GUL policy upon notification to Prudential. Please notify your human resources representative or CRC Benefits of your choice in order to keep your benefit coverage up-to-date. If you defer your premiums, CRC may recover any premiums from you that are made on your behalf. If you elect to discontinue coverage, you may be required to provide evidence of insurability to reinstate coverage upon returning to work /2014 GUL

13 GENERAL INFORMATION Your Rights as a Plan Participant As a participant in this Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). A description of these rights is in the Additional Information section of the attached booklet. Plan Documents This benefit plan description summarizes the main features of the Plan, and is not intended to amend, modify, or expand the Plan provisions. In all cases, the provisions of the Plan document and any applicable contracts control the administration and operation of the Plan. If a conflict exists between a statement in this summary and the provisions of the Plan document or any applicable contracts, the Plan document will govern. Discretionary Authority of Plan Administrator and Claims Administrator In accordance with sections 402 and 503 of Title I of ERISA, the Plan sponsor has designated a Named Fiduciary under the Plan, who has complete authority to review all denied claims for benefits under the Plan. The Plan Administrator has discretionary authority to determine who is eligible for coverage under the Plan and the Claims Administrator has discretionary authority to determine eligibility for benefits under the Plan. In exercising its fiduciary responsibilities, the Named Fiduciary shall have discretionary authority to determine whether and to what extent covered Plan participants are eligible for benefits, and to construe disputed or doubtful Plan terms. The Named Fiduciary shall be deemed to have properly exercised such authority unless it has abused its discretion hereunder by acting arbitrarily and capriciously. No Guarantee of Employment By adopting and maintaining the California Resources Corporation Group Universal Life Plan for certain eligible employees, CRC has not entered into an employment contract with any employee. Nothing contained in the Plan documents or in this summary gives any employee the right to be employed by CRC or to interfere with CRC s right to discharge any employee at any time. Similarly, this Plan does not give CRC the right to require any employee to remain employed by CRC or to interfere with the employee s right to terminate employment with CRC at any time /2014 GUL

14 Future of the Plan and Plan Amendment CRC expects and intends to continue this Plan but does not guarantee any specific level of benefits or the continuation of any benefits during any periods of active employment, inactive employment, disability or retirement. Benefits are provided solely at CRC s discretion. CRC reserves the right, at any time or for any reason, through an action of the Vice President of Compensation and Benefits of California Resources Corporation, to suspend, withdraw, amend, modify, or terminate the Plan (including altering the amount you must pay for any benefit), in whole or in part. In the case of a material change in this description of the Plan, such action will be evidenced by a written announcement to affected individuals /2014 GUL

15 Plan Administration The additional information in this section is provided to you in accordance with the Employee Retirement Income Security Act of 1974 (ERISA) regarding the GUL Plan and the persons who have assumed responsibility for its operation. Plan Name Employer Identification Number Plan Number 507 California Resources Corporation Group Universal Life Plan Plan Administrative Services Provided by CRC Services, LLC Wilshire Boulevard Los Angeles, California Plan Administrator California Resources Employee Benefits Committee Plan Sponsor and CRC Services, LLC Address for Legal Process Wilshire Boulevard for the Plan Los Angeles, California Claims Administrator and Address for Legal Process for the Policy Named Fiduciary The Plan is insured and claims are paid by: Prudential Insurance Company of America 751 Broad Street Newark, New Jersey Prudential Insurance Company of America Plan Year Ends December 31 Plan Type Source of Contributions ERISA Welfare Plan Employee Contributions 13 12/2014 GUL

16 GLOSSARY Following are definitions of the capitalized terms and phrases used throughout this supplement that are not defined in the attached Booklet. Fund An interest earning account to which any contributions above the cost of your life insurance are deposited automatically and from which loans and withdrawals may be made. Dependent Your eligible dependents are your children from live birth to age 26. Your eligible dependents may include your natural children, lawfully adopted children and children placed with you for adoption, and each of your stepchildren, Domestic Partner s children and foster children. The term dependent does not include anyone who is eligible for coverage as an employee of CRC. A covered dependent may be eligible beyond the age limit, if he or she is primarily supported by the employee and incapable of self-sustaining employment because of a mental or physical handicap. Guaranteed Issue The amount of insurance available to you for which you are not required to provide evidence of insurability when you enroll within 31 days of eligibility. Plan Plan means the California Resources Corporation Group Universal Life Plan, and as used in this Summary Plan Description, unless the context otherwise plainly requires, Plan further means the group universal life insurance benefits described here. Also, in this Summary Plan Description, Plan is used interchangeably with GUL Plan. Spouse A spouse is the employee s legal spouse and does not include a spouse who is legally separated from the employee. Spouse does not include any person who is eligible for insurance under the policy as an employee of the employer. Where required by state law, a person with whom the employee has a registered civil union or domestic partnership may be eligible for similar coverage provided to the spouse of an employee /2014 GUL

17 California Resources Corporation Universal Life Coverage

18 Disclosure Notice FOR ARKANSAS RESIDENTS Prudential s Customer Service Office: The Prudential Insurance Company of America P.O. Box 8769 Philadelphia, PA If Prudential fails to provide you with reasonable and adequate service, you may contact: Arkansas Insurance Department Consumer Services Division 1200 West Third Street Little Rock, Arkansas FOR FLORIDA RESIDENTS The benefits of the policy providing your coverage are governed by the law of a state other than Florida. FOR INDIANA RESIDENTS Questions regarding your policy or coverage should be directed to: The Prudential Insurance Company of America (800) If you (a) need the assistance of the governmental agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or State of Indiana Department of Insurance Consumer Services Division 311 West Washington Street, Suite 300 Indianapolis, Indiana Consumer Hotline: (800) ; (317) Complaints can be filed electronically at

19 FOR MARYLAND RESIDENTS The Group Insurance Contract providing coverage under this Certificate was issued in a jurisdiction other than Maryland and may not provide all of the benefits required by Maryland law.

20 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Group Insurance Certificate Prudential certifies that insurance is provided according to the Group Contract for each insured Employee. Your Schedule of Benefits shows the Contract Holder, the Included Employer and the Group Contract Number. Insured Employee: You are eligible to become insured under the Group Contract if: (1) you are in the Covered Classes of the Certificate s Schedule of Benefits; and (2) you meet the requirements in the Certificate s Who Is Eligible section. The When You Become Insured section of the Certificate states how and when you may become insured for the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage. Your insurance will end when the rules in the When Your Insurance Ends section so provide. Beneficiary for Employee Death Benefits: See the Certificate s Beneficiary Rules. Coverage and Amounts: The Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, and the amounts of insurance are described in the Certificate. If you are insured, this Group Insurance Certificate replaces any older certificates issued to you for the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage. All benefits are subject in every way to the entire Group Contract which includes the Group Insurance Certificate. CCT (S-1)

21 Table of Contents GROUP INSURANCE CERTIFICATE... 1 SCHEDULE OF BENEFITS... 3 TABLE OF MAXIMUM RATES... 8 TABLE OF CORRIDOR PERCENTAGES... 9 TABLE OF NET SINGLE PREMIUMS WHO IS ELIGIBLE TO BECOME INSURED WHEN YOU BECOME INSURED DELAY OF EFFECTIVE DATE UNIVERSAL LIFE COVERAGE OPTION TO ACCELERATE PAYMENT OF CERTAIN DEATH BENEFITS UNDER UNIVERSAL LIFE COVERAGE ADDITIONAL PROVISIONS FOR DEPENDENTS TERM LIFE COVERAGE GENERAL INFORMATION WHEN INSURANCE ENDS CTC 1001 ( ) 2

22 Schedule of Benefits Covered Classes: All Employees classified by the Contract Holder as: Class 1: All regular, full-time, non-bargaining hourly or salaried Employees of California Resources Corporation or an affiliated company who are regularly scheduled to work at least 30 hours per week, are designated as eligible to participate, and who do not participate in a similar type of employer-sponsored plan. Temporary employees are not eligible to participate. Represented Employees are eligible to participate only if the collective bargaining agreement specifically provides for participation. Class 2: Retired Employees. Program Date: December 1, This Certificate describes the benefits under the Group Program as of the Program Date. You should know... The Universal Life Coverage in this Certificate, including any of the additional provisions that may be a part of the Universal Life Coverage, is available to you if you are included in the Covered Classes. Only that Coverage and those additional provisions for which you become insured will apply to you. The rules for becoming insured are in this Certificate s When You Become Insured section. There is a Delay of Effective Date section. The rules of that section may delay the start of your insurance. The Delay of Effective Date section also applies to any change, including a change in class, unless otherwise stated. The Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, is described more fully on later pages of this Certificate. Be sure to read those pages carefully. They show when benefits are or are not payable under the Group Contract. They also outline when insurance ends and the conditions, limitations and exclusions that apply to the Coverage. A Definitions section is included in this Certificate. Many of the terms used in this Certificate are defined in that section. The Universal Life Coverage in this Certificate, including any of the additional provisions that may be a part of the Universal Life Coverage, is insured under a Group Contract issued by Prudential. All benefits are subject in every way to the entire Group Contract which includes the Group Insurance Certificate. It alone forms the agreement under which payment of insurance is made. To receive the tax treatment accorded life insurance under federal law, the Universal Life Coverage must meet the definition of life insurance as provided in the Internal Revenue Code, or any successor law. To make sure it qualifies, Prudential reserves the rights: (a) to refuse contributions, in whole or in part; to refuse to make changes to the Coverage; and to decline to make partial withdrawals that could cause it to fail to meet the definition of life insurance; (b) to make distributions to you from your fund; or increase your death benefit to the extent needed to qualify the Universal Life Coverage as life insurance; and (c) to make changes to the Group Contract or Certificates, or both, or to take any action to the extent needed to qualify the Universal Life Coverage as life insurance. CSB 1001 ( ) 3

23 Universal Life Coverage FOR YOU AND YOUR DEPENDENT SPOUSE OR DOMESTIC PARTNER On You under Employee Insurance You may enroll for a Face Amount of Insurance equal to one of the options below. The option for which you enroll will be recorded by Prudential. FACE AMOUNTS OF INSURANCE: Amount For Each Benefit Class: Benefit Classes Face Amount of Insurance All Employees Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7 50% of your annual Earnings*. 100% of your annual Earnings*. 200% of your annual Earnings*. 300% of your annual Earnings*. 400% of your annual Earnings*. 500% of your annual Earnings*. 600% of your annual Earnings*. Maximum Amount: $2,000,000 Minimum Amount: $10,000 The Definitions section explains what Earnings" means. *If this amount is not a multiple of $5,000, it will be rounded to the next higher multiple of $5,000. Guaranteed Issue on Face Amount of Insurance: There is a limit on the amount for which you may be insured without submitting evidence of insurability. This is called the Guaranteed Issue. Guaranteed Issue: The lesser of (1) 200% of your annual Earnings and (2) $500,000. If the face amount of insurance for your Class and age at any time is more than the Guaranteed Issue, you must give evidence of insurability satisfactory to Prudential before the part over the Limit can become effective. This requirement applies: when you first become insured; when your Class changes; if you request an increase in your face amount of insurance; or if the face amount of insurance for your Class is changed by an amendment to the Group Contract. Even if you are insured for an amount over the Limit, you will still have to meet this evidence requirement before any increase in your face amount of insurance can become effective. CSB 1001 ( ) 4

24 Your face amount of insurance will be increased when Prudential decides the evidence is satisfactory and you meet the Active Work Requirement. The Delay of Effective Date section does not apply to this Guaranteed Issue on Face Amount of Insurance provision. The Guaranteed Issue does not apply to any face amount of insurance for which you have provided evidence prior to the Program Date. Automatic Increases and Decreases: Your amount of insurance will be increased or decreased on the date your annual Earnings change. But, if you are not meeting the Active Work Requirement when your amount of insurance would be changed, that change will be deferred until the date you meet that requirement. Increases and Decreases: You may elect to have your face amount of insurance under the Coverage changed within 31 days of a Life Event. You must do this on a form approved by Prudential and agree to make any required contributions. If you request an increase of more than one option, you must give evidence of insurability if you have inforce coverage. If no in-force coverage you can elect up to the lesser of (1) 200% of your annual Earnings and (2) $500,000 without evidence of insurability. That change will become effective on the date Prudential decides the evidence is satisfactory and your insurance is not being delayed under the Delay of Effective Date section. If you request an increase of one option, and your insurance is not being delayed under the Delay of Effective Date section, that change will become effective on the date of your written request. If you request a lower face amount of insurance, that change will become effective on the date of your written request. Any Guaranteed Issue will apply to an increased amount of coverage. The Definitions section explains what Life Event means. Effect of Option to Accelerate Death Benefits Under Universal Life Coverage: When you elect this option, the total amount of Universal Life Coverage otherwise payable on a person s death, including any amount under an extended death benefit, will be reduced by the Terminal Illness Proceeds. Also, any amount a person could otherwise have converted to an individual contract will be reduced by the Terminal Illness Proceeds. Change Date: January 1 of each year. On Your Qualified Dependent Spouse or Domestic Partner under Dependents Insurance You may enroll for a Face Amount of Insurance for your spouse or Domestic Partner equal to one of the options below. The option for which you enroll will be recorded by Prudential. Benefit Class Face Amount of Insurance Spouse or Domestic Partner Option 1 $10,000 Option 2 $25,000 Option 3 $50,000 Option 4 $75,000 Option 5 $100,000 Option 6 $150,000 CSB 1001 ( ) 5

25 Guaranteed Issue on Face Amount of Insurance for Your Spouse or Domestic Partner: There is a limit on the amount for which you may be insured with respect to your spouse or Domestic Partner without submitting evidence of insurability. This is called the Guaranteed Issue. Guaranteed Issue: $25,000. If the face amount of insurance for your spouse or Domestic Partner for your Class at any time is more than the Guaranteed Issue, you must give evidence of insurability for your spouse or Domestic Partner satisfactory to Prudential before the part over the Limit can become effective. This requirement applies: when you first become insured with respect to your spouse or Domestic Partner; when your Class changes; if you request an increase in the face amount of insurance for your spouse or Domestic Partner; or if the face amount of insurance for your spouse or Domestic Partner for your Class is changed by an amendment to the Group Contract. Even if you are insured with respect to your spouse or Domestic Partner for an amount over the Limit, you will still have to meet this evidence requirement for your spouse or Domestic Partner before any increase in the face amount of insurance for your spouse or Domestic Partner can become effective. Your face amount of insurance for your spouse or Domestic Partner will be increased when Prudential decides the evidence is satisfactory and your spouse or Domestic Partner is not confined for medical care or treatment at home or elsewhere. The Delay of Effective Date section does not apply to this Guaranteed Issue on Face Amount of Insurance for Your Spouse or Domestic Partner provision. The Guaranteed Issue does not apply to any face amount of insurance for your spouse or Domestic Partner for which you have provided evidence prior to the Program Date. Increases and Decreases: You may elect to have your face amount of insurance for your spouse or Domestic Partner under the Coverage changed. You must do this on a form approved by Prudential and agree to make any required contributions. If you request an increase of more than one option, your spouse or Domestic Partner must give evidence of insurability. That increase will become effective on the date Prudential decides the evidence is satisfactory and your insurance for your spouse or Domestic Partner is not being delayed under the Delay of Effective Date section. If you request a lower face amount of insurance for your spouse or Domestic Partner, that lower amount will become effective on the date of your written request. Any Guaranteed Issue will apply to an increased amount of coverage. Additional Provisions for Dependents Term Life Coverage FOR YOUR DEPENDENT CHILDREN The amount of insurance is the amount for your Benefit Class. Your Benefit Class is determined by the classification of your dependents as shown in this table. Dependents Classification Amount of Insurance Your children $10,000 CSB 1001 ( ) 6

26 OTHER INFORMATION Contract Holder: TRUSTEE OF THE PRUDENTIAL GROUP LIFE INSURANCE TRUST Group Contract No.: UG-1432 Included Employer: CRC SERVICES, LLC Included Employer's Control No.: Included Employer s Anniversary Date: January 1 of each year, beginning in Cost of Insurance: The Coverage describes the minimum premium contributions required, as well as the additional premium contributions you may make. You will be given additional information concerning the cost of the coverage when you are asked to enroll. Prudential's Address: The Prudential Insurance Company of America 80 Livingston Avenue Roseland, New Jersey WHEN YOU HAVE A CLAIM Each time a claim is made, it should be made without delay. Use a claim form and follow the instructions on the form. If you do not have a claim form, contact Prudential. CSB 1001 ( ) 7

27 Table of Maximum Rates Guaranteed Maximum Monthly Rates per $1,000 of Face Amount of Insurance by Attained Age 200% of 2001 Commissioners Standard Ordinary 80% Male / 20% Female, Composite Ultimate - Age Last Birthday Attained Age COI/1,000 Attained Age COI/1,000 Attained Age COI/1,000 0 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CMR (S-3)

28 Table of Corridor Percentages (For Determining a Person s Insurance Amount) Person s Attained Age Percent Person s Attained Age Percent 0 to % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % CTA (S-1)

29 Table of Net Single Premiums Maximum Rates To Determine Paid-Up Insurance Amounts Calculated at 4%, 2001 Commissioners Standard Ordinary 80% Male / 20% Female Composite Ultimate - Age Last Birthday (Per $1.00 of Insurance Amount) Person s Attained Age Factor Person s Attained Age Factor Person s Attained Age Factor CTA (S-3)

30 Who Is Eligible To Become Insured FOR EMPLOYEE INSURANCE You are eligible for Employee Insurance while: You are a full-time Employee of the Included Employer; and You are in a Covered Class; and You may need to work for the Included Employer for a continuous full-time period before you become eligible for the Coverage. The period must be agreed upon by the Included Employer and Prudential. Your Included Employer will inform you of any such Employment Waiting Period for your class. You are full-time if you are regularly working for the Included Employer at least the number of hours in the Included Employer's normal full-time work week for your class, but not less than 30 hours per week. If you are a partner or proprietor of the Included Employer, that work must be in the conduct of the Included Employer s business. Your class is determined by the Included Employer. This will be done under its rules, on dates it sets. The Included Employer may not discriminate among persons in like situations. You cannot belong to more than one class for insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage. "Class" means Covered Class, Benefit Class or anything related to work, such as position or Earnings, which affects the insurance available. This applies if you are an Employee of more than one subsidiary or affiliate of an Included Employer under the Group Contract: For the insurance, you will be considered an Employee of only one of those subsidiaries or affiliates. Your service with the others will be treated as service with that one. The rules for obtaining Employee Insurance are in the When You Become Insured section. FOR DEPENDENTS INSURANCE You are eligible for Dependents Insurance while: You are eligible for Employee Insurance; and You have a Qualified Dependent. CEL 1001 ( ) 11

31 Qualified Dependents for the Additional Provisions for Dependents Term Life Coverage: Your children less than 26 years old. Your children include your biological children, legally adopted children, children placed with you for adoption prior to legal adoption, and each of your stepchildren, Domestic Partner s children and foster children. A child placed with you for adoption prior to legal adoption is considered your Qualified Dependent from the date of placement for adoption, and is treated as though the child were your newborn child born to you. Qualified Dependent for the Universal Life Coverage: Your spouse or Domestic Partner who is less than age 75. Your Domestic Partner is a person of the same or opposite sex who: (a) you report in an affidavit of domestic partnership satisfactory to Prudential; and (b) is an unmarried adult over the age of 18; and (c) has lived with you for at least 6 consecutive months prior to the person's enrollment in the Program; and (d) has a serious and committed relationship with you; and (e) is not legally married nor a Domestic Partner to anyone else; and (f) is financially interdependent with you; and (g) is not otherwise a Qualified Dependent under the Program. Either a spouse or a Domestic Partner may be a Qualified Dependent under the Program at any one time, but not both at the same time. Exception: Your spouse, Domestic Partner or child is not a Qualified Dependent while: (1) on active duty in the armed forces of any country; or (2) insured for Employee Insurance under the Group Contract. A child will not be considered the Qualified Dependent of more than one Employee. If this would otherwise be the case, the child will be considered the Qualified Dependent of the Employee named in a written agreement of all such Employees filed with the Included Employer. If there is no written agreement, the child will be considered the Qualified Dependent of: (1) the Employee who became insured under the Group Contract with respect to the child, while the child was a Qualified Dependent of only that Employee; and otherwise (2) the Employee who has the longest continuous service with the Included Employer, based on the Included Employer s records. The rules for obtaining Dependents Insurance are in the When You Become Insured Section. CEL 1001 ( ) 12

32 When You Become Insured FOR EMPLOYEE INSURANCE Your Employee Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, will begin on the first day of the month which coincides with or next follows the date on which you meet all of these requirements: You are eligible for Employee Insurance; and You are in a Covered Class for that insurance; and You have met any evidence requirement for the Employee Insurance; and Your insurance is not being delayed under the Delay of Effective Date Section below; and That Coverage is part of the Group Contract; and You have enrolled on a form approved by Prudential and agreed to pay the required contributions. You may enroll for Contributory Insurance within 31 days of when you could first be covered, or within 31 days of a Life Event. At any time, the benefits for which you are insured are those for your class, unless otherwise stated. The Definitions section explains what Life Event means. When evidence is required: In any of these situations, you must give evidence of insurability. This requirement will be met when Prudential decides the evidence is satisfactory. (1) You enroll more than 31 days after you could first be covered. (2) You enroll after any of your insurance under the Group Contract ends because you did not pay a required contribution. (3) You are enrolling for life insurance and have an individual life insurance contract which you obtained by converting your insurance under the Group Contract. (4) You apply to reinstate your Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage. (5) You have not met a previous evidence requirement to become insured under any Prudential group contract covering Employees of the Included Employer. CEL 1001 ( ) 13

33 FOR DEPENDENTS INSURANCE Your Dependents Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, for a person will begin on the first day of the month which coincides with or next follows the date on which the person is a Qualified Dependent and you meet all of these requirements: The person is your Qualified Dependent; and You are in a Covered Class for that insurance; and You are covered for the Employee Insurance under the Universal Life Coverage; and You have met any evidence requirement for that Qualified Dependent; and Your insurance for that Qualified Dependent is not being delayed under the Delay of Effective Date Section; and Dependents Insurance under that Coverage is part of the Group Contract; and You have enrolled on a form approved by Prudential and agreed to pay the required contributions. You may enroll for Contributory Insurance within 31 days of when you could first be covered, or within 31 days of a Life Event. At any time, the Dependents Insurance benefits for which you are insured are those for your class, unless otherwise stated. The Definitions section explains what Life Event means. When evidence is required: In any of these situations, you must give evidence of insurability for a Qualified Dependent spouse or Domestic Partner. This requirement will be met when Prudential decides the evidence is satisfactory. Evidence is not required for a Qualified Dependent child. (1) You enroll for Dependents Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, more than 31 days after you are first eligible for Dependents Insurance. (2) You enroll for Dependents Insurance after any insurance under the Group Contract ends because you did not pay a required contribution. (3) You apply to reinstate the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, for your Qualified Dependents. (4) The Qualified Dependent is a person for whom a previous requirement for evidence of insurability has not been met. The evidence was required for that person to become covered for an insurance, as a dependent or an Employee. That insurance is or was under any Prudential group contract for Employees of the Included Employer. CEL 1001 ( ) 14

34 Delay of Effective Date FOR EMPLOYEE INSURANCE Your Employee Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, will be delayed if you do not meet the Active Work Requirement on the day your insurance would otherwise begin. Instead, it will begin on the day that you meet the Active Work Requirement and other requirements for the insurance. The same delay rule will apply to any change in your insurance that is subject to this section if you do not meet the Active Work Requirement on the day on which that change would take effect. FOR DEPENDENTS INSURANCE If a Qualified Dependent is confined for medical care or treatment, at home or elsewhere, on the day your Dependents Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, for that Qualified Dependent or any change in that insurance that is subject to this section, would take effect, it will not take effect until the Qualified Dependent's final medical release from such confinement. The other requirements for the insurance or change must also be met. Newborn Child Exception for the Additional Provisions for Dependents Term Life Coverage: This section does not apply to a newborn child of yours if the child: (1) is your first Qualified Dependent; or (2) becomes a Qualified Dependent while you are insured for Dependents Insurance under the Additional Provisions for Dependents Term Life Coverage for any other Qualified Dependent. CEL 1001 ( ) 15