Employee Benefit Solutions Manual for Traditional Group Products

Transcription

1 Employee Benefit Solutions Manual for Traditional Group Products December 1, 2011 UNDERWRITING MANUAL FOR INTERNAL USE ONLY NOT FOR DISTRIBUTION TO THE PUBLIC Policies issued by: American General Life Insurance Company of Delaware American International Life Assurance Company of New York The United States Life Insurance Company in the City of New York

2 Table of Contents Page General Information... 1 The Trusts... 1 Geographic Availability... 1 Eligible Groups... 1 Ineligible Groups... 1 Eligible Employees... 2 Classification of Employees... 3 Employee and Dependent Participation and Contribution... 3 Waiting Peiod... 3 Effective Dates for New Groups... 4 General Underwriting Guidelines... 4 Special Considerations Regarding Non-Profit Groups... 6 Industry Restrictions... 6 Glossary of Insurance Terms... 7 Life and Accidental Death and Dismemberment (AD&D) Insurance Availability Benefit Levels and Schedules Participation Requirements Basic, Supplemental and Voluntary Life and AD&D Eligibility Traditional Life Plan Provisions Traditional AD&D Plan Provisions Additional 2 9 Underwriting Guidelines Supplemental Life Plan Provisions Supplemental AD&D Plan Provisions Additional Supplemental Provisions Voluntary Life Plan Provisions Voluntary AD&D Plan Provisions Voluntary Standalone AD&D Plan Provisions Additional 10+ Underwriting Guidelines Definition of Basic Annual Pay Age Reduction Superimposition Times Rule (New York Cases Only) Waiver of Premium Provision Dependent Life State Limitations for Dependent Life Insurance Domestic Partner Coverage Retiree Coverage for Employee Paid Life Benefits AD&D Benefits Seat Belt Benefit Common Carrier Benefit

3 Table of Contents (continued) Page Accelerated Death Benefit High Maximum Issue Group Life Insurance Medical Underwriting Requirements for Life Amounts Subject to EOI Dental Insurance Introduction Plan Availability Underwriting Guidelines Plan Types Plan Description Commissions Pricing Rate Structure State Availability Grid Employer-Funded Plans Employee-Paid Plans SmileMaker State Restrictions Glossary of Dental Terms Vision Insurance Introduction Plan Designs Available General Information Eligibility Underwriting Guidelines Vision Plan Features Summary Glossary of Vision Terms

4 Table of Contents (continued) Page Short-Term Disability (STD) Insurance Availability Lives Lives Voluntary Short Term Disability Plan Maximum Weekly Benefit Calculation Underwriting Guidelines All Plans Exclusions All Plans Definitions States That Mandate Optional Maternity Benefits for Disability Quoting Procedures Glossary of Disability Terms Long-Term Disability (LTD) Insurance Introduction Requirements Participation Requirements Risk Solution Lives Lives Voluntary Plan Plan Design Options Reinsurance Core Buy-Up Plans Monthly Earnings Quoting Checklists Quoting Procedures Medical Underwriting Requirements for LTD Amounts Subject to EOI General Industry Categories Special Circumstances Underwriting Guidelines Occupational Coding Occupational Classes Unacceptable Occupations (All-Size Groups) SIC Listing Master copy location: GS: C:\Underwriting Manual\Underwriting Manual December 2011 GS: C:\Underwriting Manual\SIC December 2011 Last update: December 1,

5 General Information The Trusts Business written on American General Life Insurance Company of Delaware (AG) or American International Life Assurance Company of New York (AIL) paper is issued via a trust according to product. This is unlike business on The United States Life Insurance Company in the City of New York (USL) paper, in which groups are put into a trust according to their nature of business. The AG/AIL trusts are as follows: G-660,020 (Non-Voluntary LD) G-660,021 (Voluntary LD) G-660,022 (Voluntary STD) G-660,023 (Non-Voluntary STD) G-660,024 (Voluntary LTD) G-660,025 (Non-Voluntary LTD) G-660,026 Dental (Non-Voluntary Indemnity) G-660,027 Dental (Non-Voluntary PPO) G-660,028 (Vision) G-660,029 Dental (Voluntary PPO) G-660,030 Dental (Voluntary Indemnity) G-660,031 Dental (Indemnity plans without major) The USL trusts, for historical purposes, are as follows: Service Industry (SG) Retail Industry (RG) Wholesale Industry (WG) Groups must qualify as employer/employee entities in order to be eligible to purchase coverage, regardless of the issue paper. Final placement into each trust will be determined by the Home Office Group Underwriting Department. Geographic Availability These trusts can be written for all of our products and are available nationwide. The trusts are not available in Puerto Rico or Canada (dual language issue requirements) or the Virgin Islands (not licensed for new business). Eligible Groups In general, most employers are eligible to participate in one of the trusts, but employers in certain industries must be excluded; these are outlined in the industry restriction section. Affiliates, subsidiaries and divisions of a prospective participating employer are eligible for coverage if they engage in related activities. Common ownership of unrelated entities may not qualify. Questions concerning the eligibility of a given employer should be directed to the Home Office Group Underwriting Department. A subsidiary or a division of a company may not be considered for coverage on its own; they would be subject to prior Home Office approval. Subsidiaries and divisions of foreign-based parent companies are acceptable entities. In addition, branch offices of a company may not apply for coverage unless all the branches apply. Ineligible Groups Participation in a trust is not available for any group unless a strict employer/employee relationship is present. For example, unions, welfare funds and membership associations may not participate under any circumstances. 1

6 Eligible Employees To be eligible for insurance, an employee must meet the following criteria: ACTIVE WORK or ACTIVELY AT WORK means that the person performs each duty of his job for full pay. This must be done at the participating employer s place of business or any place to which such business requires him to travel. Business with 50% or more Family content will be required to submit acceptable wage and tax (ineligible for Disability). FULL-TIME means active work and on the participating employer s regular work schedule for the class to which the employee belongs. The work schedule must be at least 30 hours a week (mandatory for STD and LTD). Any other schedule must be called into Underwriting. NOTE: Seasonal businesses, such as landscapers, must provide a letter on company letterhead, signed by an owner, verifying that the business operates year-round. As such, only those employed year-round will be eligible. This verification is mandatory for Disability, and up to the Underwriter s discretion for other coverages. Regardless of coverages sold, it is strongly suggested to furnish this verification upon initial submission of a new case for the most expedient processing. A COMMISSIONED SALESPERSON (or other person paid via 1099) is not normally eligible for benefits under our contract. We will consider a 1099-waged individual to be eligible if they work exclusively for the participating employer. Documentation may be required proving the exclusivity of the work arrangement; namely, a signed statement from an officer, on company letterhead, confirming that the 1099 employee works solely for their place of business, full-time, year-round. The officer cannot be related to the employee. Further payroll documentation may be required at the Underwriter s discretion. Any 1099 earning pay from multiple employers does not fit our description of a full-time, year-round employee. Typically, these employees would not be eligible for STD or LTD unless they earn W-2 wages. In addition, 1099 waged individuals do not earn salary; therefore they would not normally qualify for a salary based Life schedule. A separate schedule is usually developed, and the 1099 should be employed for at least two years when considering a salary-based schedule. Because of the risk of fluctuation in earnings from year-to-year, covering 1099/commissioned salespeople for salary-based schedules is difficult to service and renew. Please contact the Small Group Underwriting area for help in addressing these situations. Groups requesting consideration must conform to all of the previously mentioned requirements, as well as any additional requirements identified by the Underwriter. Job Titles: Job titles for every applicant are mandatory for 2-9 Life and AD+D and all Short Term Disability and Long Term Disability. Dental, Vision and 10+ Life and AD&D coverages do not require job titles unless the group is class distinct. NOTE: THE HOME OFFICE GROUP UNDERWRITING DEPARTMENT MAY REQUEST JOB TITLES, A GROUP EMPLOYER REPORT, INDIVIDUAL EMPLOYEE AUDITS, GROUP PAYROLL REVIEWS AND ELIGIBILITY STATEMENTS IN ORDER TO ELIGIBALIZE AN INDIVIDUAL OR GROUP DEPENDING UPON THE CIRCUMSTANCES OF THE CASE. 2

7 Classification of Employees Employee classifications must be well defined. For example: ACCEPTABLE CLASSES President, Vice Presidents Supervisors, Managers, Assistant Supervisors & Foremen UNACCEPTABLE CLASSES Executives, Principals Management Officers Groups may be written with all employees eligible or with certain classes of employees eligible and certain classes excluded. The designated class or classes must meet standard classification guidelines, namely: The class or classes must be based on conditions pertaining to employment The class or classes must be consistent with normal business judgment or reasoning relative to compensation and fringe benefits provided to employees The first class must include the employer s highest-level personnel (e.g., President) and the subsequent classes must proceed downward through the employer s organization, following its actual hierarchical structure Reverse carve-outs (excluding high-level employees) are typically not allowed due to the risk of adverse selection. In instances where the owners or officers wish to waive out of the plan, the plan will be written as contributory and normal participation rules will apply. For noncontributory plans, Underwriting requires carrier proof that all excluded personnel are covered under another plan, either Individual or Group. If the top class of employees are applying for one coverage but wish to be excluded from another, for example, enrolling for Life but being excluded for Dental, we will consider. To be written, such groups must qualify under all guidelines. Seasonal, part-time and temporary employees will always be excluded. Employee and Dependent Participation and Contribution Non-Contributory: For cases or coverages written on a non-contributory basis (100% employer paid), all eligible employees and, if applicable, all eligible dependents must be insured. Spouses who are separated but not divorced will be considered eligible dependents and must be insured. Contributory: 75-percent employee and dependent participation is required. Refusal of insurance cards must be completed in their entirety for those waiving coverage. Those with Group Coverage elsewhere will be considered as participating in our calculations. Waiting Period Usually, there is no required waiting period for full-time employees to be insured on the effective date. The employer may, however, request a waiting period for these employees. For new employees, the standard waiting period is one month. However, other waiting periods may be selected, such as two months or three months. Waiting periods must be administered in a monthly format. Days or weeks cannot be accommodated. First-of-the-month is only available for plans that bill on the first day of the month. If a waiting period is requested for present employees, all employees who have been employed for at least that length of time are eligible for insurance on the effective date. Dates of hire will be required for all employees. 3

8 Effective Dates for New Groups The group application allows the employer to choose between two options for the effective date of the case: Date Approved or Date Certain For non-takeover cases, it is suggested the Dated Approved option be used. The option, once chosen, may not be changed. Back-dating is never permissible. When we are taking over coverage from another carrier, our effective date must coincide with the termination date of the prior carrier s coverage. A current carrier bill showing a current paid-to-date is required for all takeover coverage. All groups selecting the Date Certain option must be received in underwriting 15 days prior to, or business day next following, of the proposed effective date. Cases received later will be required to change their effective date. If cases are not received within this time-frame, eligibility confirmation and issue may be further delayed. General Underwriting Guidelines It is important to note that while cases may be underwritten without evidence of insurability, this does not imply that all cases will be accepted. Only those cases, which meet the company s underwriting standards, will be accepted and the company does reserve the right to decline or modify any case. Gatekeeper Application Questions If the application has a yes answer to the gatekeeper question the case should not be submitted to the Home Office until a medical Underwriter in Small Group Underwriting is called. This question must be answered for 2-50 Life and 2-9 Disability cases. Consolidated Omnibus Budget Reconciliation Act (COBRA) and State Continues are not exempt from these questions. Takeover groups where we are replacing EXACT coverage are exempt from answering this question. The application must be signed and dated by an officer, proprietor or partner of the company otherwise it will be returned for the appropriate signature and date. The Sales Representative will give information as to the nature of the individual s problem. The Underwriter will determine whether the case can be submitted as is, not submitted at all, or held for further information. If the case is held for further information, the Sales Representative must do the following: Return the deposit check to the group Submit Evidence of Insurability for the person involved, along with a photocopy of the group s application and any other information which would aid a medical decision. Or, employee may furnish complete medical records in lieu of the EOI, which ensures a faster decision. If there is a takeover situation, immediately tell the group to keep their existing coverage When all the information required by the Underwriter has been sent to the Home Office, the Underwriter will notify the Sales Representative whether the case can be submitted 4

9 Retiree Coverage Retiree coverage will only be considered for employer paid Life and Dental benefits only.retiree coverage must be pre-approved by Home Office Underwriting and will only be considered based on the following underwriting rules: Life: See page 26 in the Life section. Available to 10+ enrolled groups. May quote retirees for Life coverage if retiree volume makes up 5% or less than the total volume. Must be take over with proof of a current carrier booklet and bill. Closed class. Dental: Available to 10+enrolled groups. May quote retirees for Dental coverage if retiree enrollment makes up 5% or less than the total enrollment. Must be take over with proof of a current carrier booklet and bill. Closed class. STD; LTD; Vision: No retiree coverage permitted. Takeover Groups For groups previously insured under a group insurance contract immediately preceding the effective date of coverage in regards to any pre-existing exclusion provision, we will give credit for prior coverage. In addition, deductible and coinsurance credit will be provided for dental. Employers of takeover groups must submit their prior carrier bill paid to our proposed effective date regardless of the size of group or coverage elected. For Dental Coverage, a complete copy of the prior carrier s certificate of coverage must be provided in order to determine whether or not takeover will apply. Cases Not Taken Out (NTO) In order to maintain a high service standard in new case issue, it is imperative that all medical and nonmedical requests for additional information be fulfilled promptly. Timely issue of new cases enhances our desirability as a carrier in the marketplace. Cases that cannot or choose not to comply with our underwriting requirements will always exist. These cases will eventually be closed out (NTO). Unfortunately, these cases take valuable time away from the cases that do comply with our requirements. Of course, until the actual time that a case is closed out, there is no way of knowing if that case can be salvaged. Accordingly, all new cases which have been pending in the Underwriting Department for a designated period of time will be reviewed once a week for the purpose of determining whether to continue to pend the case or to advise the group Sales Representative that the file should be closed. The choice to continue to pend or to close out will usually be made as a result of discussion between the Underwriting Department and the Sales Representative. The purpose of the weekly NTO review is to sort out the few cases that will ultimately be closed out. This gives us more time to expedite the cases that will be issued. Refunds of premium deposits for cases NTO'd by Group Underwriting or withdrawn by the applying employer will be made 21 days after the initial premium check is deposited by the Group New Business desk. If the employer requests a refund in less than 21 days, the name and phone number of his bank and his account number must be submitted to the home office. Re-Opened NTO Cases In order to re-open a case that has been "Not Taken Out" the following must occur: Submit all outstanding requirements to the original Underwriter The Underwriter will call to advise whether the case can be approved If it is acceptable, a current effective date will be assigned. We will need an effective date letter confirming the policy effective date. A check must be forwarded to the Underwriter to reopen the file A new policy number will be assigned A message will be forwarded to the appropriate office advising of the approval, policy number and effective date. 5

10 Special Considerations Regarding Non-Profit Groups Non-Profit groups pose an additional risk in that should the group s funding be reduced or eliminated, the Company is put under the added burden of continuing disability or waiver of premium claims without receiving premium in return. Therefore, any Non-Profit in business for less than three years must provide documentation on their company letterhead outlining the following: All sources of funding Percentage of funds received through government channels (we prefer no more than 50%) Full disclosure of long- and short-term revenue projects, if applicable. NOTE: Please refer to page 130 in the LTD section for specific instructions when reviewing a Non-Profit for disability coverage. Underwriting reserves the right to request this documentation on any group, regardless of number of years in business, when needed to mitigate foreseeable risk. NOTE: The Non-Profit letter will not be required for Life, AD&D, Dental and Vision coverages. Industry Restrictions Each coverage in this manual has an industry restriction list to serve as a sales force guide to situations, which should be avoided so that the effectiveness of their efforts and those of our Home Office people can be maximized. Most industries can be written at standard manual rates. However, certain industries present either underwriting or administrative problems, which cannot be solved by normal techniques. Proper underwriting requires that we limit or avoid exposure to situations if: Extra premium is required because of anticipated adverse mortality and morbidity Unusual fluctuations in loss experience are known to occur Administrative costs cannot be properly controlled The Company is likely to be left with unamortized acquisition costs EXAMPLES The work is inherently dangerous and hazardous (examples: logging, miners, long-haul truck drivers and drillers) There is an exposure to working conditions or materials which may cause occupational disease There is a catastrophe hazard (example: professional athletes) The nature of the work is temporary or the coverage as written can be presumed to be temporary The work force is, in general, seasonal or part-time, or excessive turnover can be anticipated The employer commonly contributes a small (or no) percentage towards the cost of insurance and other similar situations where a high degree of selection can be anticipated The employer is experiencing financial hardship There are numerous employees working out of their homes If for any reason, the industry being quoted seems questionable, the Home Office Underwriting Department should be contacted. 6

11 Glossary of Insurance Terms Accelerated Death Benefit An enhancement to the Group Life Insurance that allows insured people to receive a portion of their Group Life insurance benefits if they (1) become terminally ill, (2) are unable to perform one or more Activities of Daily Living (ADL), without standby help, or (3) have a Cognitive Impairment. The benefit may be paid if the insured is unable to perform one or more of the activities of daily living, or have a cognitive impairment, or is terminally ill. If the insured is terminally ill, meaning life expectancy is six months or less from date of application, the insured must provide proof of terminal illness. Proof of Terminal illness must be certified by a physician; proof of other qualifying conditions must also be certified by a physician. Accident An event or occurrence that is sudden, unforeseen and unintended. Active-Work/Actively-at-Work Requirement Under this requirement, coverage will not become effective unless the employee is performing normal duties for the employer at the usual place of employment or at an alternative work site at the direction of the Employer or at a location to which the Employer requires the Insured to travel. Part-time employees who are eligible for group life insurance must be actively at work on a part-time basis. Coverage will not be effective until this requirement is met. Activities of Daily Living Means the following activities. Bathing The ability to wash oneself in either a tub or shower, or by sponge bath; including the tasks of getting into and out of the tub or shower with or without the assistance of equipment. Dressing The ability to put on, take off, and secure all necessary and appropriate items of clothing and any necessary braces or artificial limbs. Toileting The ability to get to and from the toilet, get on and off the toilet, and perform associated personal hygiene with or without the assistance of equipment. Transferring The ability to move in and out of bed, chair, or wheelchair with or without the assistance of equipment. Mobility The ability to walk or wheel on a level surface from one room to another with or without the assistance of equipment. Eating The ability to get nourishment into the body by any means once it has been prepared and made available to one with or without the assistance of equipment. Continence The ability to voluntarily maintain control of bowel and/or bladder function or, in the event of incontinence, the ability to maintain a reasonable level of personal hygiene. Age Discrimination in Employment Act (ADEA) Federal Act, effective 1967, that limits discrimination in plan design based on age. Age Reduction The reduction of benefits when an insured individual reaches a specified age. Basic Life Plan Coverage that provides a payment to a person designated by the employee if the employee dies from any cause. Beneficiary The person who receives the death benefit when an insured dies while covered under an Applicable AG/AIL life benefits plan, or the person who will receive those benefits automatically under the terms of the applicable plan. Employees can designate a primary beneficiary and a contingent (or secondary) beneficiary. The contingent beneficiary will receive the death benefit if the primary beneficiary dies before the employee. Benefit The amount an insurer pays a claimant, assignee or beneficiary under each coverage in the group contract. Census Data, such as age, sex, occupation, earnings, geographic location and dependency status. 7

12 Contributory Contributory coverage requires employee contribution to pay all or part of the cost of the insurance premium. Common Carrier Any land, sea, or air conveyance operated under a license for the transportation of passengers for hire. Covered Classes Group of employees who are eligible for coverage. Death Benefit Full Group Life and AD&D payment that is made when an employee dies. Dependent Child(ren) The Insured s unmarried children, including natural, step, foster or adopted children from the moment of placement in the home of the Insured, under age 19 (or 23 if attending an accredited institution of higher learning on a full-time basis) and primarily dependent on the Insured for support and maintenance. Dependent Group Life Coverage that provides a payment to the employee if a covered dependent dies. Domestic Partner An opposite or same sex partner who has met all of the following requirements: (1) resides with You; (2) shares financial assets and obligations with You; (3) is not related by blood to You to a degree of closeness that would prohibit a legal marriage; (4) is at least the age of consent in the state in which they reside; and (5) neither You or your Domestic Partner is married to anyone else, nor has any other Domestic Partner. Earning Plan Schedule of life insurance under which the insured amount is relative to an individual's salary (example: 2 1/2 times the employee's annual salary). Effective Date Date on which coverage under a policy or for an individual first becomes inforce or effective. Employer Any person who employs others to work for wages or salary and acts in the employees' interests in relation to an employee benefit plan. Can include a group or association of employees acting for an employer in such capacity. Employment Waiting Period The period of continuous, full-time service that must be completed before an employee is eligible for coverage. Also referred to as the service waiting period. Enrollment The process of explaining the proposed group insurance plan to eligible persons and assisting them in properly completing applications for coverage. May also refer to the population covered by an insurance plan. Evidence of Insurability A statement or proof of a person s medical history upon which acceptance for insurance will be determined by the Company. Exclusion Specific condition or circumstance for which the contract does not provide benefits. 8

13 Extended Death Benefit One-year extension of the death benefit during a period of total disability that occurs only if certain conditions are met. Family Coverage Coverage in force under the Policy on an Insured s Eligible Dependents: 1) whom the Insured has elected to cover under the Policy; and (2) for whom premium has been paid. Flat Amount Group Life insurance plans where the amount of insurance is identical for all eligible employees (in a class), regardless of income earning brackets. Also known as a flat plan. Grace Period The 31-day period following the premium due date, during which the premium can be paid without penalty. Group Contract The contract(s) or agreement (s), including any Booklets or Certificates, which govern the benefits and extent of coverage under the group plan. Group Life Insurance Coverage that provides a payment to a person designated by the employee if the employee dies from any cause. Guarantee Issue Amount The amount of insurance that will be issued to an Insured Person without Evidence of Insurability. The Guaranteed Issue Amount for an Insured Person s Life Insurance is shown in the Schedule. Imputed Income The amount an employer plan costs paid for life insurance that are considered employee compensation and reported as income tax liability for the employee. Industry Factor A rate adjustment that takes into account the variances in mortality and morbidity by industry. Inforce Period Time period for which an insurance policy or plan is effective. Injury Bodily injury that is the direct result of an accident occurring while the Policy is in force with respect to the person whose injury is the basis of claim and resulting directly and independently of all other causes in a covered loss. Insured A person who is a member of an Eligible Class and for whom a premium has been paid while covered under the Policy. Late Entrant Employee who did not enroll for contributory coverage within 31 days of eligibility, but later decides to apply for it. The late entrant must furnish Evidence of Insurability at the time of application. Limiting Age Age at which a child of an insured individual can no longer be covered as a dependent. List Billing Home office billing whereby the policyholder receives a monthly bill that lists the insured by product and the amount of premium billed. Medical Evidence see Evidence of Insurability Military The armed land, sea or air force of a nation. 9

14 Multiple of Earnings Plan type where benefit amount are determined by multiplying an employee's annual earnings (excluding overtime pay or bonuses) by a constant. New Issue Business resulting from the sale of coverage to a new client. Non-Contributory Coverage Coverage for which employer pays the entire cost of the employee s group insurance benefits. With this type of plan, all eligible employees must be covered. Non-Medical Limit Maximum amount of life insurance that an individual can apply for without having to submit medical evidence of insurability. Non-Occupational Coverage For a sickness or injury not related to work. Occupational Coverage For a sickness or injury that occurs on the job. Open Enrollment A period of time, usually one month each year, during which eligible employees may elect to change a benefit plan option offered by the employer for a prospective plan year. Depending on the line of coverage, those employees may be subject to some conditional requirement, such a preexisting conditions. Paramilitary An organized, armed force on a military pattern. Physician A licensed practitioner of the healing arts acting within the scope of his or her license, who is not: (a) the Insured Person, (b) an Immediate Family Member, (c) residing with the Insured Person, or (d) retained by the Policyholder. Plan A description of benefits. Policy Anniversary Date The same month and day as the Policy Effective Date in all subsequent years. Portability Provision Provision that gives an insured employee whose employment ends the ability to continue coverage. Usually subject to limitations. Premium The financial payment that is due from the policyholder, usually on a monthly basis. It is intended to provide sufficient funds to cover normal cost of insurance programs and is calculated by multiplying the inforce lives or volume by the premium rate. Prior Plan The Group Life Insurance carried by the Employer on the day before the Policy Effective Date. Proposal A bid made for a group plan in which American General quotes rates for the benefits desired by the prospect. Reinsurance An arrangement where two or more insurance companies share the insurance risk. Rider An attachment to a certificate that indicates that a certificate has been revised to include changes. Roster Billing (see List Billing) Schedule The Schedule of Benefits section of the Policy. Sickness Illness or disease diagnosed by a Physician. Supplemental Life Insurance Contributory life insurance coverage provided in addition to a life plan. A Group Life insurance plan that allows employees to purchase additional amounts of insurance beyond 10

15 those provided under the Basic Life Plan. In order to have Supplemental Life Insurance, there must be an underlying Basic Life Plan. Voluntary Plan 100% employee-paid insurance offered at the worksite as part of the employer s benefit plan. Waiver of Premium Optional feature designed to help disabled employees avoid the financial hardship of life insurance payment during disability. Generally, the employee is totally disabled for a continuous nine-month period, is less than 60 years of age, and is insured under Life insurance Coverage at the time of disability. Coverage is generally extended with no cost of insurance due. War or Insurrection An armed conflict between the military or paramilitary forces of two (2) or more political entities. 11

16 Life and Accidental Death and Dismemberment (AD&D) Insurance Availability AG/AIL group life plans are rated based upon age, gender, and the industry SIC code. If there is a question on the SIC code, Underwriting reserves the right to assign rates based on an accurate code. Plans are available to Groups where an employee/employer relationship exists between those covered by the plan and those using the plan. Groups with a Family content of 50% or greater will require submission of acceptable wage and tax documentation. Groups fewer than 500 lives are manually rated. Groups of 500 lives and over are experience rated. Benefit Levels and Schedules The amount of insurance for each employee must be determined by a formula based on conditions pertaining to employment and not on individual selection. We will issue Life Insurance Plans with flat schedules, salary schedules, occupational schedules or combinations. Participation Requirements If the employees pay all or part of the premium, at least 75% of eligible employees and dependents, (if sold with Dependent Life), must enroll for coverage. If the entire cost of the plan is paid by the employer, all eligible employees and dependents, (if sold with Dependent Life), must enroll for coverage. Basic, Supplemental and Voluntary Life and AD&D Eligibility Basic Life/AD&D must be in effect in order for Supplemental to be available for the employee and eligible dependent(s). If Basic coverage is medically declined, or refused, then the applicant is ineligible for Supplemental coverage (and Voluntary coverage for declinations). When a group purchases Basic and Supplemental together, buying an additional Voluntary plan is strictly prohibited. No exceptions. If a group purchases Basic only (no Supplemental), they may purchase an additional Voluntary plan. Basic Life/AD&D plan provisions follow. Supplemental plan provisions start on page 16. Voluntary plan provisions start on page

17 Traditional Life Plan Provisions (Employer Paid) Plan Schedule Flat Amount Maximum Salary-Based Maximum Minimum Amount Waiver of Premium Accelerated Death Benefit Guarantee Issue Age Reduction Conversion Portability Spouse Maximum Amount (subject to state availability) Up to 5 times salary $50,000 (2-4 enrolled lives) $100,000 (5-9 enrolled lives) Up to $500,000 (10+ enrolled lives) Up to $100,000 (2-4 enrolled lives) Up to $200,000 (5-9 enrolled lives) Up to $500,000 (10+ enrolled lives) $10,000 (standard for all groups) $1,000 to $10,000 (option for all groups) To age 65 (standard 2+ lives) To age 70 (option 10+ lives) Includes terminal illness, or unable to perform one or more ADL, or a cognitive impairment 75% to $250,000 (standard for all groups) 50% to $250,000 (optional for 10+ lives) Virgin $10,000; takeover up to $50,000 (2-4 enrolled lives) (group GI= $10,000; may take over an individual employee amount up to $50,000 based on current carrier list bill) Virgin $75,000; takeover up to $100,000 (5-9 enrolled lives) (group GI= $75,000; may take over an individual employee amount up to $100,000 based on current carrier list bill) Calculation based on group size and participation (10+ enrolled lives) 35% at age 65, 50% at age 70 (standard for all groups) No age reduction (flat plans under $50,000) 50% at age 70 (all groups) 25% at age 70, 50% at age 75 (10+ lives) 8% per year from age 65, 50% at age 70 (10+ lives) 50% at age 75 (10+ lives) Included in all plans May be considered (250+ enrolled lives only and currently inforce) Up to $10,000 (2-9 enrolled employee lives) Up to $50,000 (10+ enrolled employee lives) Child(ren) Maximum Amount Up to $10,000 Spouse Guarantee Issue Domestic Partner Coverage $10,000 (2-9 enrolled employee lives) $20,000 (10+ enrolled employee lives) Optional for all groups where available 13

18 Rate Guarantee Employee Assistance Program (EAP) My Life Values Instant Access Account 24 months (standard for all groups) 12 months (optional for all groups) 36months (optional for 10+ enrolled employee lives) Not available (2-9 enrolled employee lives) Telephonic EAP / online Work/Life services (10+ enrolled) Telephonic EAP / full Work/Life services (10+ enrolled) Face-to-face EAP / full Work.Life services (10+ enrolled) Included (2-9 enrolled employee lives) Not available (10+ enrolled) Included all plans Notes: Employee must enrolled in Basic Life and AD&D for spouse to be eligible for coverage. All Life or AD&D maximums in excess of standard product offerings must be review by Home Office. Any insured receiving approved Life or AD&D amounts over $500,000 Basic or $500,000 Basic and Supplemental or Voluntary combined must be reported to Neptune Life Reinsurance. 14

19 Traditional AD&D Plan Provisions AD&D Amount AD&D Maximum Amount Definition of Loss Airbag and Seatbelt Benefit Loss Due to Exposure and Disappearance Age Reduction/Termination Tier One Provisions (option for 10+ lives) Tier Two Provisions (option for 10+ lives) Spouse and/or child AD&D Same as Traditional Life (standard for all groups) 150% of Traditional Life (10+ enrolled lives) 200% of Traditional Life (10+ enrolled lives) Same as Traditional Life (2-9 enrolled lives) $500,000 (10+ lives) 365 days $10,000 for both Included (all groups) 35% at age 65, terminates at age 70 (2-9 lives) Same as Traditional Life (10+ lives) Repatriation of remains actual cost up to $5,000 Spouse tuition actual cost up to the lesser of 5% employee amount or $5,000 Childcare actual cost up to the lesser of 5% employee amount or $2,500 Child education actual cost up to the lesser of 5% employee amount or $5,000 All of Tier One provisions, plus: Permanent and total disability = 1% of principal amount Paralysis benefits (Quadriplegia 100%; Paraplegia 50%; Hemiplegia 50%; Uniplegia 25%) Common carrier lesser of $250,000 or plan maximum Not available Additional 2-9 Underwriting Guidelines Three times between classes for 2-4 lives; maximum 5 classes Spread between classes may be greater than three times for 5-9 lives, although the maximum may not exceed $100,000 for the top class AD&D terminates at age 70 No retirees Ineligible industries (see page 6) When replacing coverage, we will grandfather amounts, according to the schedule above, with proof from the prior carrier. Underwriting reserves the right to require EOI for any amount over replacement amounts stated above. If Basic coverage is medically declined, or refused, then the applicant is ineligible for Supplemental or Voluntary coverage(s). This applies to both 2-9 and 10+ groups. 15

20 Supplemental Life Plan Provisions Plan Schedule Incremental Plan Maximum Supplemental Amount Up to 5 times salary Increments of $10,000 up to maximum amount Up to $100,000 in $10,000 increments (2-9 enrolled lives) Up to $300,000 in $10,000 increments (10+ enrolled lives) Minimum Supplemental Amount $10,000 Waiver of Premium Accelerated Death Benefit Guarantee Issue (*10 employees must enroll in the Supplemental Life benefit to be eligible for guarantee issue.) Age Reduction Conversion Portability Spouse Supplemental Maximum Amount (state limitations apply) Spouse Increments Children Supplemental Maximum Amount (State limitations apply) Spouse Guarantee Issue Domestic Partner Coverage Must match the Traditional Life option Must match the Traditional Life option Includes terminal illness, or unable to perform one or more ADL, or a cognitive impairment 2-9 eligible lives - None eligible lives 10 enrolled EE s required for GI* Less than 20% participation: $50,000 20% or greater participation: $100, eligible lives 10 enrolled EE s required for GI* Less than 20% participation: $100,000 20% or greater perticpaiton: $150,000 Must match the Traditional Life option Included Excluded (2-9 lives) Available as an option (10+ lives) $10,000 (standard for all groups) Up to $50,000 (2-9 eligible employee lives) Up to $300,000 (10+ eligible employee lives) In $5,000 increments up to spouse maximum amount Up to $10,000 None (2-9 enrolled employee lives in EE Supp.) $20,000 (10+ enrolled employee lives in EE Supp.) Optional for all groups where available 16

21 Supplemental AD&D Plan Provisions AD&D Amount AD&D Maximum Amount Definition of Loss Airbag and Seatbelt Benefit Loss Due to Exposure and Disappearance Age Reduction/Termination Tier One Provisions (option for 10+ lives) Tier Two Provisions (option for 10+ lives) Spouse and/or child AD&D Same as Supplemental Life (standard for all groups) 150% of Supplemental Life (10+ lives) 200% of Supplemental Life (10+ lives) Same as Supplemental Life (2-9 lives) $500,000 (10+ lives) 365 days $10,000 for both Included (all groups) Terminates at age 70 (2-9 lives) Same as Supplemental Life (10+ lives) Repatriation of remains actual cost up to $5,000 Spouse tuition actual cost up to the lesser of 5% employee amount or $5,000 Childcare actual cost up to the lesser of 5% employee amount or $2,500 Child education actual cost up to the lesser of 5% employee amount or $5,000 All of Tier One provisions, plus: Permanent and total disability = 1% of principal amount Paralysis benefits (Quadriplegia 100%; Paraplegia 50%; Hemiplegia 50%; Uniplegia 25%) Common carrier maximum of $250,000 Not available Notes: Supplemental Life coverage is essentially a Voluntary plan written under the umbrella of our Group products. At least one eligible employee must apply and be approved for Supplemental Life in order for the coverage to be written. An applicant cannot be covered for Supplemental Life if his/her Basic application has been refused or declined. No exceptions. For takeover Supplemental amounts, it is allowable, at the Underwriter s discretion, to grandfather existing amounts from the prior carrier. However, a re-enrollment between the date of the sold quote and the effective date of the new plan must be handled with extreme caution in order to mitigate any adverse risk. Evidence of Insurability is required for new additions and for amounts over the guarantee issue and grandfathered amount. Annual Enrollment is allowed only when priced accordingly by a Large Group Proposal Underwriter (usually on Cafeteria-style plans). Therefore, for manually-rated cases, Annual or Open Enrollment is not available. 17

22 Voluntary Life Plan Provisions Plan Schedule Maximum Increments of $10,000, up to 5 times salary The lesser of $300,000 or 5 times salary Minimum Amount $10,000 Waiver of Premium To age 65 Accelerated Death Benefit Guarantee Issue (minimum of 10 employees must be enrolled in order to qualify) Includes terminal illness, or unable to perform one or more ADL, or a cognitive impairment 75% to $250, enrolled lives None eligible lives 10 enrolled and 20% participation: $50, eligible lives 20% or greater participation: $75,000 Less than 20% participation: $50, eligible lives 20% or greater participation: $100,000 Less than 20% participation: $50, eligible lives 20% or greater participation: $150,000 Less than 20% participation: $100,000 Age Reduction 35% at age 65, 50% at age 70 Portability Conversion Spouse Maximum Amount (Subject to state availability) (Employees must enroll) Included Included Up to $200,000 (2-9 eligible employee lives) Up to $300,000 (10+ eligible employee lives) Child(ren) Maximum Amount Up to $10,000 Spouse Guarantee Issue None (2-9) $20,000 (10+ enrolled employees) Spouse Age Reduction Domestic Partner Coverage Rate Guarantee Terminates at age 70 for 2-9 (eligible employee lives) Matches employee s reduction option for 10+ (eligible employee lives*) Optional for all groups where available 24 months (standard for all groups) Note: Voluntary Life may be sold with Employer Paid Group Life. Voluntary Life must be quoted on a separate proposal. Can not offer both Voluntary and Supplement Life with Employer Paid Life. One or the other may be sold. Employee must be enrolled in Voluntary Life for spouse and or child to enroll in Voluntary Life. All Voluntary Life underwriting rules apply. 18

23 Voluntary AD&D Plan Provisions AD&D Amount Same as Voluntary Life AD&D Maximum Amount Lesser of 5x salary and $300,000 Definition of Loss Airbag and Seatbelt Benefit Loss Due to Exposure and Disappearance 365 days $10,000 for both Included Age Reduction/Termination 35% at age 65; Terminates earlier of retirement or age 70 Voluntary Standalone Package Spouse AD&D Child AD+D Plan A, B, or C (see Product Manual for details) Only available on 10+ lives Same amount as employee Voluntary AD&D Not available 19

24 Voluntary Standalone AD&D Plan Provisions Plan A Plan B Plan C Minimum number of employees 10 eligible employees 10 eligible employees 10 eligible employees and 2 enrolled and 2 enrolled and 2 enrolled Employee Amount $25,000 increments to $25,000 increments to $25,000 increments to $250,000 $350,000 $350,000 Spouse Amount 50% of employee 60% of employee 60% of employee principal amount principal amount principal amount Dependent Child(ren) Amount 10% of employee 15% of employee 15% of employee principal amount principal amount principal amount Definition of Loss 365 days 365 days 365 days Exposure and Disappearance Included Included Included Seatbelt Benefit Lesser of $10,000 or Lesser of $10,000 or Lesser of $10,000 or 10% of principal 10% of principal 10% of principal amount amount amount Airbag Benefit Not Included Lesser of $25,000 or 10% of principal amount Lesser of $25,000 or 10% of principal amount Rehabilitation Benefit Not included Lesser of actual cost or $5,000 Lesser of actual cost of $5,000 Common Disaster Benefit Not Included Included Included Daycare Benefit Not included Not included Actual cost to lesser of $5,000 or 5% of principal amount Coma Benefit Not included Not included 1% of principal amount Tuition Not included Not included Actual cost to lesser of $5,000 or 5% of principal amount Child(ren) Additional Indemnity for Dismemberment Not included Not included Double the child amount to $100,000 Travel Assist Included Included Included Instant Access Account Included Included Included Spouse or Child AD&D Not available Not available Not available Note: Can not be quoted next to any other Life or AD&D product. Medical Underwriting Requirements for Life Amounts Subject to EOI. 20

25 Additional 10+ Underwriting Guidelines Non-Medical Maximum Issue Formula (3-Times Rule) The 3-times rule (commonly referred to as Guarantee Issue ) calculation is used to determine the maximum amount (up to $500,000) of life insurance that the Underwriter MAY approve for groups over 10 lives. All maximum issue schedules must adhere to the formula. Amounts, which exceed the following limits for lives, are subject to prior Home Office approval: New Coverage $100,000 Replacement Coverage $150,000 The maximum issue limits are to be determined in accordance with the following formula: 1. Take only the top 10 benefit amounts if on a salary schedule (A) or the top 10 employees relative to a class (B) if on a class schedule. EXAMPLE A EXAMPLE B Number of Employees Salary Number of Employees Class Amounts 1 $100, $150, , , , , , , , , Drop the number of employees from the top salary (A) or class amount (B) to the next highest level. RESULT: EXAMPLE A EXAMPLE B 3 employees at a salary of $75,000 7 employees in Class 2 at $100, Multiply appropriate number of employees by either salary amount (A) or class amount (B). RESULT: EXAMPLE A EXAMPLE B $460,000 $850,000 ( ) ( ) NOTE: ONLY USED 3 EMPLOYEES OUT OF 8 IN CLASS 3 TO OBTAIN THE NECESSARY 10 EMPLOYEES 4. Divide that answer by 10 and multiply answer by 3. RESULT: EXAMPLE A EXAMPLE B Maximum Issue = $138,000 Maximum Issue = $255,000 21

26 Additional Examples The following are examples where literal application of the 3-times rule may either overstate or understate the maximum issue level. If the schedule is salary-based, the top benefits should be considered as equal if the amounts are similar. EXAMPLE C If the top 10 benefits are as follows (zeros omitted): $350 $80 $348 $70 $346 $60 $100 $50 $90 $40 Based on Examples A and B, your 3-times rule calculation would be: = $1, = $ = $459,600 Based on this calculation, it might appear that the group would qualify for the full $350,000 maximum issue. However, in this example, since the top 3 benefits are close, instead of dropping $350 to $348 and performing the calculation, the top 3 benefits should be considered the same, dropped to $100, and the calculation should be done as follows: = $ = $237,000 Based on this result, the case does not qualify for the 350,000 maximum issue. EXAMPLE D Assume the following life schedule has been requested for a law firm. Classification Number of Employees Benefit Lawyers 12 $150,000 All Others 15 $25,000 Based on Examples A and B, by dropping the top benefit to the next highest class, the 3-times rule calculation would be as follows: 10 $25,000 = $250, =$ 75,000 Based on this result, the group would not qualify for a maximum issue of $150,000. However, in this case, $150,000 maximum issue might be considered on the basis of the following reasoning: When there is a lopsided schedule such as the above, and the group s makeup is such that an acceptable carve-out class, (10 or more employees) can be created, the 3-times calculation should be done for each classification. Therefore, in this example, do not drop the class 1 benefit amount, but do the calculation as follows: 10 $150,000 = $1,500, = $450,000, making the $150,000 maximum issue acceptable. 22

27 The maximum issue limits are subject to approval by the Home Office Group Underwriting Department and may be declined or modified where required by underwriting judgment. In addition, any group life plan, which falls into any of the following categories, is subject to Home Office approval: 1. There is an employee age 70 or over covered for $10,000 or more. 2. Retired employees are covered as long as combined retiree benefit volume does not equal or exceed 5% of the groups total benefit volume. (Not available on 2-9 Plans.) Note that retirees are not eligible for AD&D. When approved for Life insurance, they will be added as a closed class. 3. The monthly life rate is in excess of $1.25 per $1,000 (except for cases written with a flat life schedule). 4. Cutback provision is other than 50 percent at age 70, 35 percent at age 65 or 8 percent graded at age Coverage is superimposed over another carrier s plan. 6. Schedules where there are more than 3-times between classes when the top class exceeds $100,000. Definition of Basic Annual Pay The employee s annual salary or wages paid by the employer. Basic Annual Pay does not include bonuses, overtime pay or other special compensation such as commissions, unless Underwriting agrees to cover commissions averaged over the past 24 months. Age Reduction See Glossary (page 7) and Benefits Grid (page 13). Superimposition If any group has group life coverage provided by another insurance carrier or has simultaneously applied for group life coverage from another carrier, we shall consider such cases under the following circumstances: We will superimpose on any and all life coverage provided it is $25,000 or less per policy when the other group life coverage is written with Major Medical or other A & H coverage. In all other situations, we will superimpose only over one other Group Life insurance policy. If the maximum issue under our policy is less than $100,000, then the group can be written with that maximum issue limit. If our maximum issue request is $100,000 or more, than we would use both group life policies to determine our maximum issue limit. In other words, if our normal maximum issue on the case was $200,000 and the other policy provided $75,000, we would reduce our maximum issue limit to $125,

28 5-Times Rule (New York Cases Only) This rule applies only to employers domiciled in New York State. It determines the highest total amount of insurance, which may be offered to any individual. It applies only if there is insurance in excess of the maximum issue amount. The 5-times rule states that the total amount of insurance for any one individual cannot exceed the lowest amount, either A or B. A. 5-times the individual s annual earnings rounded to the next highest $10,000. B. 5-times the average amount of insurance on the 25 individuals with the largest amounts of insurance in force or 5 times the average amount of insurance on the total group if less than 25 lives are insured, exclusive of the individual with the highest amount. If the highest amount in force or applied for is on two or more individuals, only one is eliminated to determine the average. Waiver of Premium Provision Also see Glossary (page 11). To be eligible for the full benefit, a claimant s disability must occur before age 60 and last 9 months Disability is defined as the inability to perform any work for pay or profit Coverage continues until either the claimant is not disabled or reaches age 65, which ever comes first If the claimant is disabled at age 60 or before age 65, coverage will continue until either 1 year elapses, the claimant is not disabled or reaches age 65, which ever comes first Dependent Life Also see Glossary (page 8). Domestic partners may be included in the definition of eligible dependent at the group s request, according to state law. A notarized affidavit is required. The employee must be approved for their Basic Life in order for the spouse or child to apply for Dependent Life or Supplemental Dependent Life benefits. A spouse or child may have Dependent and/or Supplemental Dependent Life benefit with out the employee applying for Supplemental Life. 24

29 State Limitations for Dependent Life Insurance Spouse Limits 50% of the employee s total life volume (total life volume = all basic and all supplemental together) Nebraska Kansas Wyoming Other Spouse Limits Arizona: No more than 100% of the employee s eligible amount California: No more than 100% of the employee s eligible amount Florida: No more than 100% of the employee s eligible amount Hawaii: No more than 100% of the employee s eligible amount Illinois: No more than 100% of the employee s eligible amount Maryland: No more than 100% of the employee s eligible amount New Jersey: No more than 100% of the employee s eligible amount New York: No more than 100% of the employee s eligible amount Rhode Island: No more than 100% of the employee s eligible amount Texas: No more than 100% of the employee s eligible amount Vermont: No more than 100% of the employee s eligible amount Virginia: No more than 100% of the employee s eligible amount Washington: No more than 100% of the employee s eligible amount Child Limits 50% of the employee s total life volume (total life volume = all basic and all supplemental together) Nebraska Kansas Wyoming Other Child Limits Arizona: No more than 100% of the employee s eligible amount California: No more than 100% of the employee s eligible amount Florida: No more than 100% of the employee s eligible amount Hawaii: No more than 100% of the employee s eligible amount Illinois: No more than 100% of the employee s eligible amount Maryland: No more than 100% of the employee s eligible amount New Jersey: No more than 100% of the employee s eligible amount New York: $25,000 limit Rhode Island: No more than 100% of the employee s eligible amount Texas: No more than 100% of the employee s eligible amount Vermont: No more than 100% of the employee s eligible amount Virginia: No more than 100% of the employee s eligible amount Washington: No more than 100% of the employee s eligible amount 25

30 Domestic Partner Coverage Domestic partners may be covered for Dependent Life, subject to underwriting approval. Coverage will be grandfathered in replacement situations where a certificate booklet containing the appropriate definition of dependents can be furnished. Upon underwriting approval, a notarized affidavit is required to determine eligibility. Domestic Partner Coverage may not be available in all states for Dependent Life Insurance. Retiree Coverage for Employer Paid Life Benefits Retiree coverage must be pre-approved by Home Office Underwriting and will only be considered based on the following underwriting rules: Retiree coverage may be considered for employer paid Life benefits only, subject to underwriting approval. Retiree volume must be 5% or less than the total group volume on groups of 100 or less enrolled employees. Retiree volume must be 10% or less than the total group volume on groups more than 100 enrolled employees. Benefit should be take over of small volumes preferably $5,000 or less. Group must have retiree coverage in effect with current carrier. Group must provide a current carrier booklet and list bill clearly identifying current retirees and amounts in force. Benefits will be set up as a closed class as follows: Class # Retirees closed class, Life only Life benefit only; no AD&D; no waiver of premium. AD&D Benefits This employee and Dependent coverage must be written with Life Insurance and is available to groups on a 24-hour basis. It is offered in amounts equal to the Life Insurance amount in force subject to a maximum of $500,000. Higher amounts are available for AD&D when written in conjunction with High Maximum Issue Life. (Retirees are not eligible for AD&D benefits.) Seat Belt Benefit See Benefits Grid (page 14). Common Carrier Benefit Offered under Tier Two AD&D employee only coverage. The amount payable for this additional benefit is the lesser of: (1) $250,000; or (2) 100% of the Insured s Principal Sum. See Glossary (page 8). Accelerated Death Benefit Also see Glossary (page 7) and Benefits Grid (page 15). The benefit may be paid if the insured is unable to perform one or more of the activities of daily living, or has a cognitive impairment, or is terminally ill. If the insured is terminally ill, meaning life expectancy is six months or less from date of application, the insured must provide proof of terminal illness. Proof of Terminal illness must be certified by a physician; proof of other qualifying conditions must also be certified by a physician. 26

31 High Maximum Issue Group Life Insurance over $500,000 High amounts of Group Life Insurance are available to groups having business reasons for such high amounts. Underwriting Considerations Because of the elevated risk that High Maximum Issue Life insurance plans present, we will apply to a heightened degree of scrutiny to requests for HML. Information related to the following will increase the likelihood of an expeditious approval by Underwriting. 1. Detailed and legitimate business reasons for the purchase of large amounts of Group Life insurance. 2. Employee compensation that justifies the high amounts of Life insurance. 3, A solid relationship between the Agent, Broker and American General. 4. The amounts and types of any other Life insurance that the group has either applied for or purchased, with substandard rating information, if applicable. 5. The amounts and types of any other Life insurance that the individuals within the group have either applied for or purchased, with substandard rating information, if applicable. 6. Funding arrangements for the payment of premiums. Information related to the percentage of employer funding (versus employee funding) and which employees will participate is essential. 7. We will pay particular attention to the percentage of employees related by blood or marriage. Family carve-outs will be declined. 8. We will consider whether the group is replacing coverage already in force, or buying the coverage for the first time. We will require a copy of a recent bill containing individual volumes of Life insurance for replacement coverage. Maximum Issue Limits The maximum issue limits are determined by the underwriter. Availability This product is available to groups in their entirety, and executive carve-outs. 27

32 Group Underwriting Requiremenets for Life Amounts Subject to EOI (Employer or Employee-Paid) Face Amount Ages < $50,000 A A A A G $50,001 to $100,000 $100,001 to $200,000 $200,001 to $300,000 $300,001 to $500,000 $500,001 to $1,000,000 $1,000,001 & Over** A A A G G A A G G G C C C* C* C* D E E* E* E* E E* F* F* F* F* F* F* F* F* Notes: A B C D E F G Application Application, full blood profile, urinalysis Application, full blood profile, urinalysis & expanded ID** Application, full blood profile, urinalysis, paramedical exam Application, full blood profile, urinalysis, paramedical exam, EKG Application, full blood profile, urinalysis, MD exam***, EKG Application, Attending Physician Statement (APS) * APS also required for these amounts and ages ** The expanded ID consists of the height and weight, blood pressure readings and the pulse *** The heart section should be completed for all MD exams Additional requirements may be requested at the underwriter s discretion. 28

33 Group Dental Products Introduction Dental coverage is one of the most sought-after employee benefits around and one size doesn t fit all organizations or all employees. With the American General portfolio of dental products, producers can offer just what many employers are looking for: flexibility in plan choices to meet employer s needs and budgets, backed by customer-focused service. Employers can gain a competitive advantage in the ongoing challenge of attracting and retaining quality talent; at the same time, their employees can enjoy quality dental care, plus the convenience of payroll deduction. And of course, producers enhance their ability to meet their client s needs today, tomorrow and for years to come. This section features: Group PPO Dental Plan Group Indemnity Dental Plan Group High-Low Choice Dental Plan Group Scheduled Reimbursement Dental Plan Delta Dental PPO SM (NJ only) Delta Dental Premier (NJ only) Dental products are underwritten by American General Life Insurance Company of Delaware and The United States Life Insurance Company in the City of New York. Plan Availability Dental insurance can be written alone or in conjunction with any of our other Group benefits. Dental products are available to groups of two or more employees. New groups in approved states quoted and administered by Health Plan Services. Renewals and amendments to groups in approved states are administered by Health Plan Services 29

34 Underwriting Guidelines To qualify for Dental insurance, a case must meet the Company s underwriting guidelines. The following special underwriting considerations will also apply to Dental: 1. Ineligible industries: Dental offices. Family businesses with 50% or more family* members require acceptable wage and tax documentation. *Family means spouse, domestic partner, child, parent, grandparent, sister, brother, aunt, uncle, nephew or niece and anyone of a blood relation who have resided together for at least three months at the time coverage is requested. Unions where benefits are subject to labor management negotiations are subject to Home Office approval. 2. Plans may be fully non-contributory (ALL employees and dependents must enroll), partially noncontributory (ALL employees and dependents not covered elsewhere) or fully contributory. Rates will be discounted accordingly for 10+ businesses. If the employer chooses a contributory plan, they must contribute at least 35%, on average, toward the total Dental premium. 3. Job titles are not required unless group is class distinct. 4. On contributory cases, 75% of employees and dependents who are not covered by other group dental insurance must enroll. The participation formula does not include those employees waiving due to coverage elsewhere. For example, in a 25-life group that has 8 employees covered by their spouse, 17 are considered eligible. Therefore, 13 employees need to be enrolled in order to meet the 75% participation requirement. For those waiving coverage the refusal of coverage section (#6) on the group employee enrollment form must be completed. However, waivers are not permissible for non- contributory. If a group previously quoted as non-contributory actually has less than 100% participation, it will be re-rated at 90% to 99% participation level (a 2.5% load will be applied). 4a. Employer sponsored dental groups with at least 10 employees can be considered even if employee and dependent participation levels are below 75% of the total eligible participants. The following premium rate load factors will apply: 61% 74% = % 60% = % 50% = 1.22 The following conditions will also apply to the reduced participation groups you wish to quote: Available to qualified PPO, Indemnity or Schedule Reimbursement groups with at least 10 eligible employees $750, $1,000 or $1,500 non-orthodontia annual maximums only Rates will be adjusted based on the final enrolled census Waiting period waivers are not available NOTE: IF THERE ARE 100+ ENROLLED EMPLOYEES ON THE TAKEOVER PLAN, LARGE GROUP EXPERIENCE UNDERWRITING RULES WILL APPLY. 5. Dental is rated using SIC codes. Dun & Bradstreet reports may be necessary for questionable entities. 30

35 6. Groups must submit the following as evidence of prior coverage to qualify for takeover credit: A certificate showing the Schedule of Benefits and benefit waiting periods for various procedures OR a comparable DHMO plan summary and fee schedule Current carrier bill showing current paid-to-date up to proposed effective date. If the above requirements are not met, takeover benefits will be withheld. Takeover benefits include benefit waiting period credits, credit for calendar-year or plan-year cash deductible and course of treatment coverage for procedures incurred prior to the effective date of this plan. In addition, if the prior plan is not an insured plan offering comparable benefits, Underwriting reserves the right to withhold takeover benefits. 7. Replacement Provision With the prior carrier, we pay for the finalization of treatment for certain charges. We pay if: (1) the covered person was insured by the old plan, and (2) the old plan would have paid the charges. We pay the lesser of: (1) what the old plan would have paid had it remained in force, or (2) what we usually pay. We deduct benefits paid by the old plan under any extension provision. However, we cannot pay for charges incurred more than 90 days after the effective date of our plan. 8. A manual load will be applied to all groups where the average number of enrolled children per employee selecting Family coverage is more than three. The load will be placed on the child portion of the rate, using the factors as per the chart below. Average # of Children Factor >3 and <=4 1.4 >4 and <=5 1.8 >5 and <= For the purposes of this rule, the following shall be considered Family coverages, and a definition of each child portion is shown. Tier Structure Family Coverages Definition of Child Portion 2-Tier EE & Dependents [EE & Dependents rate] [EE-Only rate] 3-Tier EE & 2+ Dependents [EE & 2+ Dependents rate] [EE-Only rate] 4-Tier EE & Children [EE & Children rate] [EE-Only rate] Full-Family [Full-Family rate] [EE & Spouse rate] 9. Eligibility Waiting Periods The waiting periods, which are selected by the group s employer, have no effect on our benefit waiting period guidelines for Basic, Major Orthodontia and SmileMaker services. Our benefit waiting periods begin once an employee is insured under our contract. 31

36 10. Self-Insured Plans (full or partial) The following rules apply to all plans: Lives Takeover is available if the group s self-insured dental is combined with their self-insured medical plan. This is so that we can ensure adequate participation. A description of benefits is required, as well as documentation showing enrollment. Participation rules for Employer-Funded, Employee-Paid and High-Low will apply. 11. Coordination of Benefits will apply to Dental. Benefits will not be paid more than 100% between carriers. 12. Treatment Plan Notice A notice describing the dental services recommended and their cost must be submitted within 20 days of examination whenever the estimated cost of the services is expected to exceed $300. As the policy provides coverage only for the most cost-effective treatment to restore dental health, the Company will either approve the course of treatment recommended or approve a level of payment for the benefits that are available. Compliance with this pre-treatment provision is voluntary; no reduction in benefits will take place solely due to an insured s failure to have the pre-treatment estimate submitted. 13. All Dental benefit additions and enhancements to existing plans must be processed via an amendment. 14. Waiving waiting periods for Basic, Major and Orthodontic Services is available on groups of 5+ lives for an additional load. (loads are approximations) Takeover/Replacement Coverage 7% for present and future 2% for present only Virgin Coverage 21% for present and future 15% for present only 15. Domestic Partner Coverage Available in all states for Dental and Vision coverages. Will be included in the definition of eligible dependent upon written request from the employer. A notarized affidavit is required in order to confirm eligibility. Children of covered domestic partners are also eligible, as long as they meet the requirements of an eligible dependent. For groups sitused in California, Domestic Partner Coverage is mandatory. Affidavit is still required. 2 Employee-Only; Full-Family 3 Employee-Only; Employee + One Dependent; Employee + Two Dependents 4 Employee-Only; Employee + Spouse; Employee + Child(ren); Full-Family 32

37 PLAN TYPES Employer-Funded The following employer-funded plans are available with 2 or more enrolled employees (refer to * and ** for exceptions): - Group PPO Dental - Group Indemnity Dental - Group Scheduled Reimbursement Dental - Group High-Low Choice Dental** - Delta Dental Premier (10-99 enrolled employees required)* - Delta Dental PPO SM (2-99 enrolled employees required)* *Delta Dental is available to groups sitused in New Jersey. **The Group High-Low Choice Dental plan requires 40 percent participation and 25 or more enrolled employees. Employee-Paid The following employee-paid plans are available with 20 percent participation and a minimum of 10 enrolled employees: - Group PPO Dental - Group Indemnity Dental - Group Scheduled Reimbursement Dental PLAN DESCRIPTION Group High-Low Choice Dental Employers can select one high-benefit and one low-benefit plan for their employees. This offering allows more flexibility in meeting the dental and financial needs of employees. Employees can move between plans at each annual benefit renewal without incurring a penalty. Group Scheduled Reimbursement Dental Covers approximately 100 of the top-most-utilized dental procedures paid according to a fee schedule. Cost varies based on the conversion factor and the plan being compared, but schedule plans can be created to be about 50 to 70 percent less than typical PPO and indemnity plans. Group PPO and Group Indemnity Dental Employees are free to visit any dentist. If they choose a provider who participates in our dental network, the provider will accept a negotiated, discounted fee which reduces employees out-ofpocket expense because the provider has agreed not to balance bill. Indemnity plans offer a passive PPO feature. If a network provider is used, employees will receive the negotiated discount on services not covered by their plan, and for services performed even after their maximum benefit has been used. Regular coinsurance and graded coinsurance options are available. - Graded coinsurance options offer two- or three-year lockdown coverage. Coinsurances increase each year, up to a mature level. This feature is valuable to employers looking to retain employees and reward long-term employees. It s also ideal for companies in high-turnover industries, such as retail, since new hires have lower benefit levels. - Graded plans that reach full benefits at year two are priced at approximately the same as standard waiting period plans, with child rates being slightly lower. - Graded plans that reach full benefits at year three are priced at approximately 5 percent less for takeover and 12 percent less for non-takeover cases compared to standard waiting period plans. 33

38 COMMISSIONS Employer-funded There is a graded commission schedule based on premiums for all employer-funded dental plans, regardless of group size. Producers commission grade down from 10 percent and General Agents compensation grades down from 2.5 percent. Employee-paid There is a graded commission schedule based on premiums and first versus future years for all employee-paid dental-plans, regardless of group size. Producers commission grade down from 20 percent in the first year and General Agents compensation grades down from 5 percent in the first year. Bundling Discount A bundling discount applies when employer-funded dental is quoted with an employer-funded life, LTD, STD or Vision plan. The discounting will vary and require verification with current guidelines. This applies on cases with 2 to 99 eligible lives. PRICING Pricing will vary according to different factors and features and is based on a sound actuarial approach. Examples of factors: Area (driven by utilization and charge level by classes to generate composite factor) Plan design Trend (driven by in-network, or out-of-network) Group size Participation loads Industry Contribution level Age/gender Rate guarantee Advantages of pricing factors Better match of premium to risk based on industry information Rating factors better match plan design/risk characteristics to actual claims impact More accurate rates based on employer contribution for employee and dependent More accurate rates based on participation for both employer-funded and employee-paid groups RATE STRUCTURE Tiers must be the same for different options and/or different classes. If a group has vision and dental, tiers must match for both products. Tiers 2 and 3 are available to vision only when it is quoted with dental. Otherwise, only tier 4 is available for vision. Tier Description 2 Employee only, full family 3 Employee only, employee + one dependent, employee + two or more dependents 4 Employee only, employee + spouse, employee + child(ren), full family 34

39 STATE AVAILABILITY GRID Although a plan design may be approved in a particular state, certain features and selections may not be approved and/or available and will reflect accordingly on the proposal system. State Availability PPO Indemnity High-Low Choice Scheduled Reimbursement American General MaxBuilder SmileMaker Alabama Available Approved Approved Approved Approved Approved Approved Alaska Available without PPO Declined Approved Approved 1 Approved Approved Approved Arizona Available Approved Approved Approved Approved Approved Approved Arkansas Available Approved Approved Approved Approved Approved Approved California Available Approved Approved Approved Approved Approved Approved Colorado Available Approved Approved Approved Approved Approved Approved Connecticut Available Approved Approved Approved Approved Approved Approved Delaware Available Approved Approved Approved Approved Approved Approved District of Columbia Available Approved Approved Approved Approved Approved Approved Florida Available Approved Approved Approved Approved Approved Approved Georgia Available Approved Approved Approved Approved Approved Approved Hawaii Available Approved Approved Approved Approved Approved Approved Idaho Available without PPO Declined Approved Approved 1 Approved Approved Approved Illinois Available Approved Approved Approved Approved Approved Approved Indiana Available Approved Approved Approved Approved Approved Approved Iowa Available Approved Approved Approved Approved Approved Approved Kansas Available Approved Approved Approved Approved Approved Approved Kentucky Available Approved Approved Approved Approved Approved Approved Louisiana Available without Approved Approved Approved Approved Approved Pending SmileMaker Maine Available without PPO Declined Approved Approved 1 Approved Approved Approved Maryland Available Approved Approved Approved Approved Approved Approved Massachusetts Available Approved 2 Approved Approved 2 Approved Approved Approved Michigan Available Approved Approved Approved Approved Approved Approved Minnesota Available Approved Approved Approved Approved Approved Approved Mississippi Available Approved Approved Approved Approved Approved Approved Missouri Available Approved Approved Approved Approved Approved Approved Montana Available Approved Approved Approved Approved Approved Approved Nebraska Available Approved Approved Approved Approved Approved Approved Nevada Available Approved Approved Approved Approved Approved Approved New Hampshire Available Approved Approved Approved Approved Approved Approved New Jersey Available Approved Approved Approved Approved Approved Approved New Mexico Available Approved Approved Approved Approved Approved Approved New York Available Approved 2 Approved Approved 2 Approved Approved Approved North Carolina Available Approved Approved Approved Approved Approved Approved North Dakota Available Approved Approved Approved Approved Approved Approved Ohio Available Approved Approved Approved Approved Approved Approved Oklahoma Available Approved Approved Approved Approved Approved Approved Oregon Available Approved Approved Approved Approved Approved Approved Pennsylvania Available Approved 2 Approved Approved 2 Approved Approved Approved Rhode Island Available Approved Approved Approved Approved Approved Approved South Carolina Available Approved Approved Approved Approved Approved Approved South Dakota Available Approved Approved Approved Approved Approved Approved 35

40 State Availability PPO Indemnity High-Low Choice Scheduled Reimbursement American General MaxBuilder SmileMaker Tennessee Available without Approved Approved Approved Approved Approved Pending SmileMaker Texas Available Approved Approved Approved Approved Approved Approved Utah Available Approved Approved Approved Approved Approved Approved Vermont Available Approved Approved Approved Approved Approved Approved Virginia Available Approved Approved Approved Approved Approved Approved Washington Not available Declined Declined Declined Declined Declined Declined West Virginia Available Approved Approved Approved Approved Approved Approved Wisconsin Available Approved Approved Approved Approved Approved Approved Wyoming Available Approved Approved Approved Approved Approved Approved 1 PPO plan not available. High-Low Plans B, D and E not available on proposal system. 2 County restrictions for PPO plan. STATE RESTRICTION/PARAMETERS Massachusetts: PPO not available in Barnstable, Berkshire, Dukes, Franklin, Hampshire, Hampden and Nantucket counties. New York: PPO not available in Allegany, Cattaraugus, Chenango, Clinton, Cortland, Essex, Franklin, Fulton, Genesee, Hamilton, Herkimer, Lewis, Livingston, Madison, Ontario, Orleans, Otsego, Schoharie, Schuyler, Seneca, St. Lawrence, Sullivan, Washington, Wyoming and Yates counties Pennsylvania: PPO not available in Adams, Bedford, Bradford, Cameron, Centre, Elk, Fulton, Huntingdon, Jefferson, McKean, Montour, Potter, Snyder, Susquehanna, Tioga, Union and Warren counties. New Mexico and Pennsylvania: In the event a participating provider cannot be reasonably located, emergency care rendered by a non-participating provider is to be paid as though participating. Texas: There are specific benefit parameters required. Please contact your sales representative if the group is outside of Texas and has employees located in Texas. STATE APPROVALS AT A GLANCE All products and riders available Available without SmileMaker Available without PPO Not Approved 36

41 Employer-Funded Plans UNDERWRITING OFFER FOR EMPLOYER-FUNDED PLANS Employer-funded plans Group PPO Dental Group Indemnity Dental Group Scheduled Reimbursement Dental Group High-Low Choice Dental Eligible employee Actively at work at least 30 hours per week (17 ½ hours for VT) on a full-time basis. Some groups may have a 20- to 30-hour work week requirement, subject to insurance company approval. Eligible dependent children Standard: Birth to under age For FL, NM, OK, TN, to under age For IN, to under age For LA, to under age For ND, to under age For NH, to under age For TX, to under age For UT, to under age 26. To 25 if full-time student. - Not applicable for FL, NH, NM, OK, TN, UT, TX since full-time student status is not required for coverage. - For ND, to 26 if full-time student. - For LA, to 24 if full-time student. A group may also elect from birth to age 26 in any state. Group eligibility Two or more enrolled employees. Orthodontia is available for 10 or more enrolled employees. SmileMaker is available for 25 enrolled employees and 50 percent participation. High-low choice plans: 25 or more enrolled employees and 40 percent of eligible lives. Child-only orthodontia is standard to certain high selections and is subject to the high-low eligibility rule. If the actual enrollment averages more than three children per family unit, we reserve the right to revise quoted rates. Employer contribution for employee coverage Noncontributory plans: 100 percent. Contributory (partially-funded) plans: Minimum of 25 percent of the premium paid. Participation requirement Noncontributory (100 percent employer-funded) plans: 100 percent. Contributory (partially-funded) plans for 2 to 9 groups: At least 75 percent (50 percent dependent participation). Contributory (partially-funded) plans for 10 or more groups: 75 to 99 percent or at least 40 percent if reduced participation (50 percent dependent participation). Continuation of coverage when employment terminates Continuation privilege available to groups of 20 or more enrolled employees. Coverage continuation ceases upon nonpayment of premium or when group policy terminates. Takeover Available Rate guarantee 12 months (standard). 24 months (10 or more enrolled employees). 37

42 UNDERWRITING OFFER FOR EMPLOYER-FUNDED PLANS Out-of-network benefits for PPO plans For MAC plans, benefits are calculated by applying the coinsurance percentage to the maximum allowable charge, less the deductible. For R&C plans, benefits are calculated by applying the coinsurance percentage to the dentist s charge, subject to the reasonable and customary limit, less the deductible. Benefits for Indemnity plans Paid at R&C. Benefits for scheduled reimbursement plans Paid at the lesser of the relative value unit (RVU) multiplied by the selected conversion factor or the actual charge to 100 percent of the scheduled maximum benefit. The scheduled maximum benefit (fee schedule) is derived by multiplying the RVU (an assigned dollar amount) by a conversion factor from 10 to 20. Preventive services may be selected at 100 percent of R&C for 10 or more enrolled. Benefits for high-low plans Low plans can be scheduled reimbursement, indemnity or PPO plans. High plans can be indemnity or PPO. Pretreatment review limit $300 (requested but not required). Standard benefit waiting periods for timely enrollees In takeover cases, credit is applied for time served under a replaced plan for those insured covered under the prior plan and effective on our original effective date. If a PPO or indemnity graded coinsurance plan is selected, there are no standard waiting periods except for orthodontic and SmileMaker services. - Benefit deferrals for timely enrollees are based on coinsurance levels. - Benefit deferrals may be waived for present employees only, so that the last year coinsurance level begins in year one. Waivers require at least 5 enrolled and at least 75 percent participation. - Benefit deferral means that coinsurance percentages begin at the lowest level in the first year of coverage and increase in the second or second and third years. - Standard waiting periods are: - Orthodontic services (if selected): 12 months. - SmileMaker (if selected): 24 months (12 months for NY and OR, 18 months for MT). If a PPO or indemnity coinsurance plan is selected, standard waiting periods may be waived for timely enrollees. - Standard waiting periods may be waived for present employees only or for both present and future employees. Waivers require at least 5 enrolled and at least 75 percent participation. - Standard waiting periods for timely enrollees are: - Preventive services: no waiting period. - Basic services: no waiting period except a 6- month wait for root canal if endo/perio is in Basic. - Major services: 12 months. - Orthodontic services (if selected): 12 months. - SmileMaker (if selected): 24 months (12 months for NY and OR, 18 months for MT). If a scheduled reimbursement plan is selected, there are no standard waiting periods for timely enrollees except for orthodontic services: - Orthodontic services (if selected): 12 months. Waiting period waivers referenced above do not apply to SmileMaker services. 38

43 UNDERWRITING OFFER FOR EMPLOYER-FUNDED PLANS Late entrant waiting periods For PPO and indemnity regular or graded coinsurance plans: - Preventive services: no waiting period. - Fillings: 6 months. - Other Basic services: 12 months. - Major services: 24 months (12 months for NY and OR, 18 months for MT). - Orthodontic services (if selected): 24 months (12 months for NY and OR, 18 months for MT). - SmileMaker (if selected): 24 months (12 months for NY and OR, 18 months for MT). For scheduled reimbursement plans: No waiting periods for non-orthodontic services, however, the maximum benefit during the first 12 months of coverage is $100. Orthodontic services (if selected): 24 months (12 months for NY and OR, 18 months for MT). Charges resulting from an accident while insured are not subject to standard or late entrant waiting periods, provided treatment begins within 90 days of the accident (12 months for NY). Employees or their dependents, who have waived coverage because they had coverage elsewhere, will be able to enroll at any time without late entrant penalties if prior coverage has terminated, provided the person enrolls within 31 days of loss of other coverage. Proof of prior coverage is required with the enrollment form. Open enrollment Available on an exception basis for groups of 25 enrolled lives. Disenrollment Persons who voluntarily terminate coverage may re-enroll provided they have been out of the plan for at least 12 months. Then late entrant waiting periods or penalties as stated above will apply. 39

44 BENEFIT SUMMARY FOR GROUP PPO EMPLOYER-FUNDED PLAN Plan Features Regular Coinsurance Graded Coinsurance Standard waiting periods or Standard waiting periods Deferred benefits deferred benefits Waive standard waiting periods or deferred benefits for Preventive, Basic and Major for present employees. Requires at least 75 percent participation Yes (5 or more enrolled) No (standard) Yes (5 or more enrolled) Waive standard waiting periods or deferred benefits for preventive, basic and major for both present and future employees. Requires at least 75 percent participation Coinsurance selections *10 or more Yes (5 or more enrolled) (standard) No MAC Plans (MAC In and Out) In-Network Out-of-Network 100/80/50 100/80/50 100/90/60* 100/80/50* 100/100/60 100/80/50 R&C Plans (MAC In/R&C Out) In-Network Out-of-Network 100/80/50 90/70/50 100/90/60* 90/70/50* 100/100/60* 90/70/50* 100/90/60 100/80/50 100/100/60 100/80/50 100/80/50 100/80/50 Other* (Custom design in increments of 5 percent. Preventive must be greater than or equal to Basic which must be greater than or equal to Major. Innetwork must be greater than or equal to out-of-network). In-Network Preventive: 80 to 100 Basic: 50 to 100 Major: 0 or 40 to 60 Out-of-Network Preventive: 80 to 100 Basic: 50 to 100 Major: 0 or 40 to 60 Choice of MAC or R&C out-ofnetwork No MAC Plans (MAC In and Out) Year 1 Year 2 Year 3 80/50/10 90/60/25 100/80/50 80/50/25* 90/60/35* 100/80/50* 80/50/25 90/80/50 80/50/35* 90/80/50* R&C Plans (MAC In/R&C Out) Year 1 Year 2 Year 3 80/50/10 90/60/25 100/80/50 80/50/25* 90/60/35* 100/80/50* 80/50/25 90/80/50 80/50/35* 90/80/50* 40

45 BENEFIT SUMMARY FOR GROUP PPO EMPLOYER-FUNDED PLAN Plan Features Regular Coinsurance Graded Coinsurance Out-of-network R&C percentile selections Benefit maximum selections in- and out-of-network * 10 or more ** 51 or more Deductible selections 50 th 60 th 70 th 80 th (standard) 90 th (10 or more option) $500 $750 $1000 (standard) $1250 $1500 $1750 $2000* $2250* $2500** $1000/750* $1500/1250* $1500/1000* $1500/750* $2000/1500* $2000/1250* $2000/1000* $2000/750* $2500/2000** $2500/1500** $2500/1250** $2500/1000** $0 calendar year $25 calendar year $50 calendar year (standard) $75 calendar year $100 calendar year $25 calendar year in-network/$50 calendar year out-of-network $50 calendar year in-network/$75 calendar year out-of-network $100 lifetime (10 or more option) $0 plan year $25 plan year $50 plan year $75 plan year $100 plan year $25 plan year in-network/$50 plan year out-of-network $50 plan year in-network/$75 plan year out-of-network 50 th 60 th 70 th 80 th (standard) 90 th (10 or more option) $500 $750 $1000 (standard) $1250 $1500 $1750 $2000* $2250* $2500** $0 plan year $25 plan year $50 plan year (standard) $75 plan year $100 plan year $25 plan year in-network/$50 plan year out-of-network $50 plan year in-network/$75 plan year out-of-network $100 lifetime (10 or more option) Waive deductible for Preventive services out-ofnetwork (standard = no) Yes (not applicable to $0 deductible) Yes (not applicable to $0 deductible) 41

46 BENEFIT SUMMARY FOR GROUP PPO EMPLOYER-FUNDED PLAN Plan Features Regular Coinsurance Graded Coinsurance Family deductible selections (not applicable to $0 or lifetime deductible) 2 times (10 or more option) 3 times (standard) None None Deductible carry over (standard = no) Reduced premium (standard = no) Sealants (Not available with reduced premium) Choice of endo/perio in Basic or Major (no choice with reduced premium) Composites (white fillings) on posterior teeth (10 or more) under Basic services if selected Implants (10 or more) under Major services if selected TMJ (10 or more) under Major services if selected American General MaxBuilder (standard = yes) Supplemental accident (standard = no) SmileMaker (not available if orthodontia is selected, standard = no) Orthodontia (Not available if SmileMaker is selected, standard = no) Orthodontia or SmileMaker benefit maximum Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes. Yes (10 or more option, not available with $0, plan year or lifetime deductible) Yes Preventive (standard) Basic Basic (standard 10 or more) Major (standard 2 to 9) Yes No (standard) Yes No (standard) Yes No (standard) Yes (10 or more option, requires Major services covered and annual maximum same for in- and out-ofnetwork. Not allowed with 50 th, 60 th or 70 th percentile of R&C. Not available with plan year deductible) No Yes (10 or more option) Yes (25 or more and 50 percent participation, requires Major services covered. Not allowed with 50 th, 60 th or 70 th percentile of R&C) Child (10 or more) Adult/child (10 or more) None Orthodontia SmileMaker $500 $750 $1000 (standard) $1000 (standard) $1250 $1500 $1500 (51 or more) $2000 $2000 (51 or more) Standard: 12 months Waived for present employees only* Waived for present and future employees** 42 No Yes Preventive (standard) Basic Basic (standard 10 or more) Major (standard 2 to 9) Yes No (standard) Yes No (standard) Yes No (standard) No Yes (10 or more option) Yes (25 or more and 50 percent participation, requires Major services covered. Not allowed with 50 th, 60 th or 70 th percentile of R&C) Child (10 or more) Adult/child (10 or more) None Orthodontia SmileMaker $500 $750 $1000 (standard) $1000 (standard) $1250 $1500 $1500 (51 or more) $2000 $2000 (51 or more) Standard: 12 months Waived for present employees only*** Orthodontia waiting period waiver criteria: *Standard waiting period must be waived for Preventive, Basic and Major for present employees only or for present and future employees). **Standard waiting period must be waived for Preventive, Basic and Major for present and future employees. ***Benefit deferral must be waived for Preventive, Basic and Major for present employees only. Refer to State Restriction - PPO pages of product manual for state-specific restrictions in plan design..

47 BENEFIT SUMMARY FOR GROUP INDEMNITY EMPLOYER-FUNDED PLAN Plan Features Regular Coinsurance Graded Coinsurance Standard waiting periods or Standard waiting periods Deferred benefits deferred benefits Waive standard waiting periods or deferred benefits for Preventive, Basic and Major for present employees. Requires at least 75 percent participation Yes (5 or more enrolled) No (standard) Yes (5 or more enrolled) No (standard) Waive standard waiting periods or deferred benefits for Preventive, Basic and Major for both present and future employees. Requires at least 75 percent participation Coinsurance selections * 10 or more Yes (5 or more enrolled) (standard) No R&C 100/80/50 80/80/50* 100/80/0 Other* (Custom design in increments of 5 percent. Preventive must be greater than or equal to Basic which must be greater than or equal to Major). No R&C Year 1 Year 2 Year 3 80/50/10 90/60/25 100/80/50 80/50/25* 90/60/35* 100/80/50* 80/50/25 90/80/50 80/50/35* 90/80/50* R&C percentile selections Benefit maximum selections in- and out-of-network * 10 or more ** 51 or more Deductible selections Waive deductible for Preventive services (standard = no) Preventive: 80 to 100 Basic: 50 to 100 Major: 0 or 40 to th 60 th 70 th 80 th (standard) 90 th $500 $750 $1000 (standard) $1250 $1500 $1750 $2000* $2250* $2500** $0 calendar year $25 calendar year $50 calendar year (standard) $75 calendar year $100 calendar year $100 lifetime (10 or more option) $0 plan year $25 plan year $50 plan year $75 plan year $100 plan year Yes (not applicable to $0 deductible) th 60 th 70 th 80 th (standard) 90 th $500 $750 $1000 (standard) $1250 $1500 $1750 $2000* $2250* $2500** $0 plan year $25 plan year $50 plan year (standard) $75 plan year $100 plan year $100 lifetime (10 or more option) Yes (not applicable to $0 deductible)

48 BENEFIT SUMMARY FOR GROUP INDEMNITY EMPLOYER-FUNDED PLAN Plan Features Regular Coinsurance Graded Coinsurance Family deductible selections (not applicable to $0 or lifetime deductible) Deductible carry over (standard = no) Reduced premium (standard = no) Sealants (not available with reduced premium) Choice of endo/perio in Basic or Major (no choice with reduced premium) Composites (white fillings) on posterior teeth (10 or more) under Basic services if selected Implants (10 or more) under Major services if selected TMJ (10 or more) under Major services if selected American General MaxBuilder (standard = yes) Supplemental accident (standard = no) SmileMaker (Not available if orthodontia is selected, standard = no) Orthodontia (Not available if SmileMaker is selected, standard = no) Orthodontia or SmileMaker benefit maximum Orthodontia waiting period wavier requires at least 75 percent participation and takeover status of yes. 2 times (10 or more option) 3 times (standard) None Yes (10 or more option, not available with $0, plan year or lifetime deductible) Yes Preventive (standard) Basic Basic (standard 10 or more) Major (standard 2 to 9) Yes No (standard) Yes No (standard) Yes No (standard) Yes (10 or more option, requires Major services covered. Not allowed with 50 th, 60 th or 70 th percentile of R&C. Not available with plan year deductible) No Yes (10 or more option) Yes (25 or more and 50 percent participation, requires Major services covered. Not allowed with 50 th, 60 th or 70 th percentile of R&C) Child (10 or more) Adult/child (10 or more) None Orthodontia SmileMaker $500 $750 $1250 $1000 (standard) $1000 (standard) $1500 $1500 (51 or more) $2000 $2000 (51 or more) Standard: 12 months Waived for present employees only* Waived for present and future employees** None No Yes Preventive (standard) Basic Basic (standard 10 or more) Major (standard 2 to 9) Yes No (standard) Yes No (standard) Yes No (standard) No Yes (10 or more option) Yes (25 or more and 50 percent participation, requires Major services covered. Not allowed with 50 th, 60 th or 70 th percentile of R&C) Child (10 or more) Adult/child (10 or more) None Orthodontia SmileMaker $500 $750 $1250 $1000 (standard) $1000 (standard) $1500 $1500 (51 or more) $2000 $2000 (51 or more) Standard: 12 months Waived for present employees only*** Orthodontia waiting period waiver criteria: *Standard waiting period must be waived for Preventive, Basic and Major for present employees only or for present and future employees). **Standard waiting period must be waived for Preventive, Basic and Major for present and future employees. ***Deferred benefit must be waived for Preventive, Basic and Major for present employees only. Refer to State Restriction - Indemnity pages of product manual for state-specific restrictions in plan design. 44

49 BENEFIT SUMMARY FOR GROUP SCHEDULED REIMBURSEMENT EMPLOYER-FUNDED PLAN Plan Features Standard waiting periods and None waiver of waiting periods Conversion factors 10 to percent Preventive at If Preventive at R&C option is selected, then R&C is at 80th R&C (10 or more option) Benefit maximum selections $750 $1000 (standard) $1500 Deductible selections $0 calendar year $25 calendar year $50 calendar year (standard) $75 calendar year $100 calendar year $ 100 lifetime year (10 or more) Waive deductible for If 100 percent Preventive at R&C option is selected, then: Preventive services Yes (10 or more option, not applicable to $0 deductible) No (standard) Family deductible None Deductible carry over Not available Reduced premium Not available Sealants If 100 percent of Preventive at R&C, then sealants covered as Preventive; otherwise, paid at fee schedule Choice of endo/perio in Basic Not applicable; these are paid at fee schedule or Major American General Not available MaxBuilder Supplemental accident Not available SmileMaker Not available Orthodontia Child only (10 or more) (standard = no) Orthodontia benefit maximum $500 $750 $1000 (standard) $1250 $1500 $2000 Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes. Standard: 12 months Waived for present employees only Waived for present and future employees 45

50 BENEFIT SUMMARY FOR GROUP HIGH-LOW CHOICE EMPLOYER-FUNDED PLAN Plan Features High-low plan combinations There are five high-low plan combinations: Plan A Scheduled Reimbursement (Low) / Indemnity (High) Plan B Scheduled Reimbursement (Low)/ PPO (High) Plan C Indemnity (Low) / Indemnity (High) Plan D PPO (Low) / Indemnity (High) Plan E PPO (Low) / PPO (High) Plan category Participation requirements Employer contribution Takeover/non-takeover Employee plan level election Orthodontia eligibility Time served towards waiting periods when switching plans Note: There is one proposal output with two plans and two rates, one group number with different plan ID numbers and one policy reflecting two separate plans Calendar year employer-funded only 25 or more enrolled employees and 40 percent of eligible lives (50 percent dependent participation) Only low plan level is selected on quote Available to takeover and non-takeover groups Employee enrolls (or waives) and elects a plan level. The employee can switch from one plan level to the next at the next annual enrollment. 25 or more enrolled employees and 40 percent of eligible lives. Child-only orthodontia available with certain high plans. Time served towards all waiting periods will be honored from initial enrollment into the plan. Switching from high to low or vice versa at annual re-enrollment does not increase waiting periods Standard features 3 times family deductible Waiting period waivers available (requires at least 75 percent participation) R&C = 80 th percentile Low PPO out-of-network = MAC High PPO out-of-network = R&C Deductible waived for preventive in indemnity plans Deductible waived for preventive in- and out-of-network for high PPO plans Deductible only waived in-network for Preventive in low PPO plans Sealants in Preventive (For scheduled reimbursement plans, sealants are covered at fee schedule unless Preventive is covered at R&C) Endodontics and periodontics are covered in Basic for high plans and in Major for low plans No orthodontia in low plans; some high plans have child only orthodontia; no adult coverage in any plan Features not available Deductible carry-over Reduced Premium Option American General MaxBuilder Supplemental Accident SmileMaker Lifetime deductible Endo/perio buy-up Endo/perio buy-down 90 th percentile R&C Sealants as Basic 46

51 BENEFIT SUMMARY FOR GROUP HIGH-LOW CHOICE EMPLOYER-FUNDED PLAN Plan A A1: Scheduled Reimbursement (Low) Plan A1 A1 A1 A1 Option 1 Low 2 Low 3 Low 4 Low Plan type Scheduled Scheduled Scheduled Scheduled Standard waiting period NA NA NA NA Choice to waive waiting period for present employees (requires 75 NA NA NA NA percent participation) Choice to waive waiting period for both present and future employees NA NA NA NA (requires 75 percent participation) Coinsurance/ conversion factor MAC or R&C percentile NA 100 percent Preventive at 80th R&C NA 100 percent Preventive at 80th R&C Benefit maximum $1,000 $1,000 $1,000 $1,000 Calendar year deductible $100 $100 $50 $50 Deductible is waived for Preventive NA Yes NA Yes Family deductible 3 times 3 times 3 times 3 times Sealants Paid at fee schedule Preventive Paid at fee schedule Preventive Endo/perio Paid at fee schedule Paid at fee schedule Paid at fee schedule Paid at fee schedule Orthodontia covered No No No No Orthodontia maximum NA NA NA NA Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) NA NA NA NA Plan A A2: Indemnity (High) Plan A2 A2 A2 A2 Option 1 High 2 High 3 High 4 High Plan type Indemnity Indemnity Indemnity Indemnity Standard waiting period Yes Yes Yes Yes Choice to waive waiting period for present employees (requires 75 Yes Yes Yes Yes percent participation) Choice to waive waiting period for both present and future employees Yes Yes Yes Yes (requires 75 percent participation) Coinsurance/ conversion factor 80/80/50 100/80/50 100/80/50 100/80/50 MAC or R&C percentile 80 th 80 th 80 th 80 th Benefit maximum $1,000 $1,000 $1,500 $1,500 Calendar year deductible $100 $50 $50 $25 Deductible is waived for Preventive Yes Yes Yes Yes Family deductible 3 times 3 times 3 times 3 times Sealants Preventive Preventive Preventive Preventive Endo/perio Basic Basic Basic Basic Orthodontia covered No No Yes-child Yes-child Orthodontia maximum NA NA $1,000 $1,000 Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) Orthodontia waiting period waiver criteria: NA NA Standard: 12 months Waived for present employees only* Waived for present and future employees** Standard: 12 months Waived for present employees only* Waived for present and future employees** *Standard waiting period must be waived for Preventive, Basic and Major for present employees only or for present and future employees. **Standard waiting period must be waived for Preventive, Basic and Major for present and future employees. 47

52 BENEFIT SUMMARY FOR GROUP HIGH-LOW CHOICE EMPLOYER-FUNDED PLAN Plan B B1: Scheduled Reimbursement (Low) Plan B1 B1 B1 B1 Option 1 Low 2 Low 3 Low 4 Low Plan type Scheduled Scheduled Scheduled Scheduled Standard waiting period NA NA NA NA Choice to waive waiting period for present employees (requires 75 percent participation) NA NA NA NA Choice to waive waiting period for both present and future employees (requires 75 percent NA NA NA NA participation) Coinsurance/ conversion factor MAC or R&C percentile NA 100 percent Preventive at 80th R&C NA 100 percent Preventive at 80th R&C Benefit maximum $1,000 $1,000 $1,000 $1,000 Calendar year deductible $100 $100 $50 $50 Deductible is waived for Preventive (out-of-network for PPO plans) NA Yes NA Yes Family deductible 3 times 3 times 3 times 3 times Sealants Paid at fee Paid at fee Preventive schedule schedule Preventive Endo/perio Paid at fee Paid at fee Paid at fee Paid at fee schedule schedule schedule schedule Orthodontia covered No No No No Orthodontia maximum NA NA NA NA Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) NA NA NA NA Plan B B2: PPO (High) Plan B2 B2 B2 B2 B2 B2 Option 1 High 2 High 3 High 4 High 5 High 6 High Plan type PPO PPO PPO PPO PPO PPO Standard waiting period Yes Yes Yes Yes Yes Yes Choice to waive waiting period for present employees (requires 75 Yes Yes Yes Yes Yes Yes percent participation) Choice to waive waiting period for both present and future employees (requires 75 percent participation) Yes Yes Yes Yes Yes Yes Coinsurance/ conversion factor IN 100/80/50 OON 90/70/50 IN 100/80/50 OON 100/80/50 IN 100/90/60 OON 100/80/50 48 IN 100/90/60 OON 100/80/50 IN 100/80/50 OON 100/80/50 IN 100/100/60 OON 100/80/50 MAC or R&C percentile 80 th out 80 th out 80 th out 80 th out 80 th out 80 th out Benefit maximum $1,000 $1,000 $1,000 $1,500 $1,500 $1,500 Calendar year deductible $50 $50 $50 $50 $50 $25 Deductible is waived for Preventive (out-of-network Yes Yes Yes Yes Yes Yes for PPO plans) Family deductible 3 times 3 times 3 times 3 times 3 times 3 times Sealants Prev Prev Prev Prev Prev Prev Endo/perio Basic Basic Basic Basic Basic Basic Orthodontia covered No No No Yes-child Yes-child Yes-child Orthodontia maximum NA NA NA $1,000 $1,000 $1,000 Orthodontia waiting period. (Waiver requires at least 75 percent participation and takeover status of Yes. NA NA NA Orthodontia waiting period waiver criteria: Standard: 12 months Waived for present employees only* Waived for present and future employees** Standard: 12 months Waived for present employees only* Waived for present and future employees** *Standard waiting period must be waived for Preventive, Basic and Major for present employees only or for present and future employees. **Standard waiting period must be waived for Preventive, Basic and Major for present and future employees. Standard: 12 months Waived for present employees only* Waived for present and future employees**

53 BENEFIT SUMMARY FOR GROUP HIGH-LOW CHOICE EMPLOYER-FUNDED PLAN Plan C C1: Indemnity (Low) Plan C1 C1 C1 C1 Option 1 Low 2 Low 3 Low 4 Low Plan type Indemnity Indemnity Indemnity Indemnity Standard waiting period Yes Yes Yes Yes Choice to waive waiting period for present employees (requires 75 percent participation) Yes Yes Yes Yes Choice to waive waiting period for both present and future employees (requires 75 percent participation) Yes Yes Yes Yes Coinsurance 80/50/0 80/50/50 80/80/50 100/80/50 MAC or R&C percentile 80 th 80 th 80 th 80 th Benefit maximum $1,000 $1,000 $1,000 $1,000 Calendar year deductible $100 $100 $100 $100 Deductible is waived for Preventive Yes Yes Yes Yes Family deductible 3 times 3 times 3 times 3 times Sealants Preventive Preventive Preventive Preventive Endo/perio Major Major Major Major Orthodontia covered No No No No Orthodontia maximum NA NA NA NA Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) NA NA NA NA Plan C C2: Indemnity (High) Plan C2 C2 C2 C2 Option 1 High 2 High 3 High 4 High Plan type Indemnity Indemnity Indemnity Indemnity Standard waiting period Yes Yes Yes Yes Choice to waive waiting period for present employees (requires 75 percent Yes Yes Yes Yes participation) Choice to waive waiting period for both present and future employees (requires 75 Yes Yes Yes Yes percent participation) Coinsurance 100/80/50 100/80/50 100/80/50 100/80/50 MAC or R&C percentile 80 th 80 th 80 th 80 th Benefit maximum $1,000 $1,000 $1,500 $1,500 Calendar year deductible $50 $50 $50 $25 Deductible is waived for Preventive Yes Yes Yes Yes Family deductible 3 times 3 times 3 times 3 times Sealants Preventive Preventive Preventive Preventive Endo/perio Basic Basic Basic Basic Orthodontia covered No Yes Yes No (child-only) (child-only) Orthodontia maximum NA $1,000 NA $1,000 Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) Orthodontia waiting period waiver criteria: NA Standard: 12 months Waived for present employees only* Waived for present and future employees** NA Standard: 12 months Waived for present employees only* Waived for present and future employees** *Standard waiting period must be waived for Preventive, Basic and Major for present employees only or for present and future employees. **Standard waiting period must be waived for Preventive, Basic and Major for present and future employees. 49

54 BENEFIT SUMMARY FOR GROUP HIGH-LOW CHOICE EMPLOYER-FUNDED PLAN Plan D D1: PPO (Low) Plan D1 D1 D1 D1 Option 1 Low 2 Low 3 Low 4 Low Plan type PPO PPO PPO PPO Standard waiting period Yes Yes Yes Yes Choice to waive waiting period for present employees (requires Yes Yes Yes Yes 75 percent participation) Choice to waive waiting period for both present and future employees (requires 75 percent participation) Coinsurance Yes Yes Yes Yes IN 100/80/50 OON 80/50/0 IN 100/80/50 OON 80/50/50 IN 100/80/50 OON 100/80/50 IN 100/80/50 OON 100/80/50 MAC or R&C percentile MAC out MAC out MAC out MAC out Benefit maximum $1,000 $1,000 $1,000 $1,000 Calendar year deductible $100 $100 $100 $50 Deductible is waived for Preventive (out-of-network for PPO plans) No No No No Family deductible 3 times 3 times 3 times 3 times Sealants Preventive Preventive Preventive Preventive Endo/perio Major Major Major Major Orthodontia covered No No No No Orthodontia maximum NA NA NA NA Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) NA NA NA NA Plan D D2: Indemnity (High) Plan D2 D2 D2 D2 Option 1 High 2 High 3 High 4 High Plan type Indemnity Indemnity Indemnity Indemnity Standard waiting period Yes Yes Yes Yes Choice to waive waiting period for present employees (requires 75 percent participation) Yes Yes Yes Yes Choice to waive waiting period for both present and future employees (requires 75 percent participation) Yes Yes Yes Yes Coinsurance 100/80/50 100/80/50 100/80/50 100/80/50 MAC or R&C percentile 80 th 80 th 80 th 80 th Benefit maximum $1,000 $1,000 $1,500 $1,500 Calendar year deductible $50 $50 $50 $25 Deductible is waived for Preventive (out-of-network for PPO plans) Yes Yes Yes Yes Family deductible 3 times 3 times 3 times 3 times Sealants Preventive Preventive Preventiv e Preventive Endo/perio Basic Basic Basic Basic Orthodontia covered No Yes child No Yes child Orthodontia maximum NA $1,000 NA $1,000 Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) Orthodontia waiting period waiver criteria: NA Standard: 12 months Waived for present employees only* Waived for present and future employees** Standard: 12 months Waived for present employees only* Waived for present and future employees** *Standard waiting period must be waived for Preventive, Basic and Major for present employees only or for present and future employees. **Standard waiting period must be waived for Preventive, Basic and Major for present and future employees. 50

55 BENEFIT SUMMARY FOR GROUP HIGH-LOW CHOICE EMPLOYER-FUNDED PLAN Plan E E1: PPO (Low) Plan E1 E1 E1 E1 E1 E1 Option 1 Low 2 Low 3 Low 4 Low 5 Low 6 Low Plan type PPO PPO PPO PPO PPO PPO Standard waiting period Yes Yes Yes Yes Yes Yes Choice to waive waiting period for present employees (requires 75 percent Yes Yes Yes Yes Yes Yes participation) Choice to waive waiting period for both present and future employees (requires 75 percent participation) Coinsurance Yes Yes Yes Yes Yes Yes IN 100/80/50 OON 50/40/0 IN 100/80/50 OON 50/40/0 IN 100/90/60 OON 50/40/0 IN 100/100/60 OON 50/25/0 IN 100/80/50 OON 100/80/50 IN 100/80/50 OON 100/80/50 MAC or R&C percentile MAC out MAC out MAC out MAC out MAC out MAC out Benefit $1,000 in/ $1,000 $1,500 $1,000 maximum $500 out $1,000 $1,000 Calendar year deductible $50 in / $100 out $50 in / $100 out $50 in / $100 out $0 in/ $100 out $100 $50 Deductible is waived for Preventive outof-network No No No No No No Family deductible 3 times 3 times 3 times 3 times 3 times 3 times Sealants Preventive Preventive Preventive Preventive Preventive Preventive Endo/perio Major Major Major Major Major Major Orthodontia covered No No No No No No Orthodontia maximum NA NA NA NA NA NA Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) NA NA NA NA NA NA 51

56 BENEFIT SUMMARY FOR GROUP HIGH-LOW CHOICE EMPLOYER-FUNDED PLAN Plan E E2: PPO (High) Plan E2 E2 E2 E2 E2 E2 E2 E2 Option 1 High 2 High 3 High 4 High 5 High 6 High 7 High 8 High Plan type PPO PPO PPO PPO PPO PPO PPO PPO Standard waiting period Yes Yes Yes Yes Yes Yes Yes Yes Choice to waive waiting period for present employees (requires 75 percent Yes Yes Yes Yes Yes Yes Yes Yes participation) Choice to waive waiting period for both present and future employees (requires 75 percent participation) Coinsurance Yes Yes Yes Yes Yes Yes Yes Yes IN 100/80/50 OON 90/70/50 IN 100/80/50 OON 100/80/50 IN 100/90/60 OON 100/80/50 IN 100/90/60 OON 100/80/50 IN 100/80/50 OON 100/80/50 IN 100/100/60 OON 100/80/50 IN 100/90/60 OON 100/80/50 IN 100/100/60 OON 100/80/50 MAC or R&C percentile 80 th out 80 th out 80 th out 80 th out 80 th out 80 th out 80 th out 80 th out Benefit maximum $1,000 $1,000 $1,000 $1,500 $1,500 $1,500 $2,000 $2,000 Calendar year deductible $50 $50 $50 $50 $50 $25 $50 $25 Deductible is waived for Preventive outof-network Yes Yes Yes Yes Yes Yes Yes Yes Family deductible 3 times 3 times 3 times 3 times 3 times 3 times 3 times 3 times Sealants Preventive Preventive Preventive Preventive Preventive Preventive Preventive Preventive Endo/perio Basic Basic Basic Basic Basic Basic Basic Basic Orthodontia covered No No No Yes child Yes child Yes child Yes child Yes child Orthodontia maximum NA NA NA $1,000 $1,000 $1,000 $1,000 $1,000 Orthodontia waiting period (waiver requires at least 75 percent participation and takeover status of yes) NA NA NA Standard: 12 months Waived for present only* Waived for present and future** Standard: 12 months Waived for present only* Waived for present and future ** Standard: 12 months Waived for present only* Waived for present and future ** Standard: 12 months Waived for present only* Waived for present and future ** Standard: 12 months Waived for present only* Waived for present and future ** Orthodontia waiting period waiver criteria: *Standard waiting period must be waived for Preventive, Basic and Major for present employees only or for present and future employees. **Standard waiting period must be waived for Preventive, Basic and Major for present and future employees. Refer to State Restriction High low pages of Product Manual for state specific restrictions in plan design 52

57 Employee-Paid Plans UNDERWRITING OFFER FOR EMPLOYEE-PAID PLANS Employee-paid plans Group PPO Dental Group Indemnity Dental Group Scheduled Reimbursement Dental Eligible employee Actively at work at least 30 hours per week (17 ½ hours for VT) on a full-time basis. Some groups may have a 20- to 30-hour work week requirement, subject to insurance company approval. Eligible dependent children Standard: Birth to under age For FL, NM, OK, TN, to under age For IN, to under age For LA, to under age For ND, to under age For NH, to under age For TX, to under age For UT, to under age 26. To 25 if full-time student. - Not applicable for FL, NH, NM, OK, TN, UT, TX since full-time student status is not required for coverage. - For ND, to 26 if full-time student. - For LA, to 24 if full-time student. A group may also elect from birth to age 26 in any state. Group eligibility 10 enrolled employees and 20 percent participation. Orthodontia is available for 10 enrolled employees and 20 percent participation. If the actual enrollment averages more than three children per family unit, we reserve the right to revise quoted rates. Employer contribution for employee coverage None (100 percent employee-paid). Participation requirement 20 percent participation with a minimum of 10 enrolled employees. Continuation of coverage when employment terminates Continuation privilege available to groups of 20 or more enrolled employees. Coverage continuation ceases upon nonpayment of premium or when group policy terminates. Takeover Available Rate guarantee 12 months (standard) or 24 months. Out-of-network benefits for PPO plans Benefits for Indemnity plans Paid at R&C. Benefits for scheduled reimbursement plans For MAC plans, benefits are calculated by applying the coinsurance percentage to the maximum allowable charge, less the deductible. For R&C plans, benefits are calculated by applying the coinsurance percentage to the dentist s charge, subject to the reasonable and customary limit, less the deductible. Paid at the lesser of the relative value unit (RVU) multiplied by the selected conversion factor or the actual charge to 100 percent of the scheduled maximum benefit. The scheduled maximum benefit (fee schedule) is derived by multiplying the RVU (an assigned dollar amount) by a conversion factor from 10 to 20. Preventive services may be selected at 100 percent of R&C for 10 or more enrolled. Pretreatment review limit $300 (requested but not required). 53

58 UNDERWRITING OFFER FOR EMPLOYEE-PAID PLANS Standard benefit waiting periods for timely enrollees In takeover cases, credit is applied for time served under a replaced plan for those insured covered under the prior plan and effective on our original effective date. If a PPO or indemnity graded coinsurance plan is selected, there are no waiting periods except for orthodontic services. Benefit deferrals for timely enrollees are based on coinsurance levels. Benefit deferral means that coinsurance percentages begin at the lowest level in the first year of coverage and increase in the last year. Standard waiting periods are: Orthodontic services (if selected): 12 months. If a PPO or indemnity coinsurance plan is selected, standard waiting periods for timely enrollees are: Preventive services: no waiting period. Basic services: no waiting period except a 6-month wait for root canal if endo/perio is in Basic. Major services: 12 months. Orthodontic services (if selected): 12 months. If a scheduled reimbursement plan is selected, there are no waiting periods for timely enrollees, except for orthodontic services: Orthodontic services (if selected): 12 months. Waivers of standard waiting periods is available on an exception basis for takeover groups of 25 eligible lives, a minimum of 50 percent participation. Late entrant waiting periods For PPO and indemnity regular or graded coinsurance plans: Preventive services: no waiting period. Fillings: 6 months. Other Basic services: 12 months. Major services: 24 months (12 months for NY and OR, 18 months for MT). Orthodontic services (if selected): 24 months (12 months for NY and OR, 18 months for MT). For scheduled reimbursement plans: No waiting periods for non orthodontic services, however, the maximum benefit during the first 12 months of coverage is $100. Orthodontic services (if selected): 24 months (12 months for NY and OR, 18 months for MT). Charges resulting from an accident while insured are not subject to standard or late entrant waiting periods, provided treatment begins within 90 days of the accident (12 months for NY). Employees or their dependents, who have waived coverage because they had coverage elsewhere, will be able to enroll at any time without late entrant penalties if prior coverage has terminated, provided the person enrolls within 31 days of loss of other coverage. Proof of prior coverage is required with the enrollment form. Late entrants who decline to enroll at initial eligibility may enroll only at the next annual enrollment following their request to join the plan. Then late entrant waiting periods or penalties as stated above will apply. Open enrollment Available on an exception basis for groups of 50 eligible lives and a minimum of 25 enrolled. Disenrollment Persons who re-enroll after voluntary termination of this coverage may enroll at the next annual enrollment following their request to rejoin the plan, provided they have been out of the plan for at least 12 months. Then late entrant waiting periods or penalties as stated above will apply. 54

59 BENEFIT SUMMARY FOR GROUP PPO EMPLOYEE-PAID PLAN Plan Features Regular Coinsurance Graded Coinsurance Standard waiting periods or Standard waiting periods Deferred benefits deferred benefits Waive standard waiting periods or deferred benefits for Preventive, Basic and Major for present employees No (except on an exception basis for takeover groups of 25 eligible lives and 50 percent participation) Waive standard waiting periods or deferred benefits for preventive, basic and major for both present and future employees Coinsurance selections No (except on an exception basis for takeover groups of 25 eligible lives and 50 percent participation) MAC Plans (MAC In and Out) No (except on an exception basis for takeover groups of 25 eligible lives and 50 percent participation) No MAC Plans (MAC In and Out) In-Network Out-of-Network 100/80/50 100/80/50 100/50/50 100/50/50 R&C Plans (MAC In/R&C Out) In-Network Out-of-Network 100/80/50 100/80/50 100/50/50 100/50/50 Other (Custom design in increments of 5 percent. Preventive must be greater than or equal to Basic which must be greater than or equal to Major. In-network must be greater than or equal to out-of-network) Year 1 Year 2 Year 3 80/50/10 90/60/25 100/80/50 80/50/25 90/60/35 100/80/50 80/50/25 90/80/50 80/50/35 90/80/50 R&C Plans (MAC In/R&C Out) Year 1 Year 2 Year 3 80/50/10 90/60/25 100/80/50 80/50/25 90/60/35 100/80/50 80/50/25 90/80/50 80/50/35 90/80/50 Out-of-network R&C percentile selections In-Network Preventive: 80 to 100 Basic: 50 to 90 Major: 0 or 40 to 60 Out-of-Network Preventive: 80 to 100 Basic: 50 to 80 Major: 0 or 40 to 60 Choice of MAC or R&C out-ofnetwork 50 th 60 th 70 th 80 th (standard) 90 th 50 th 60 th 70 th 80 th (standard) 90 th 55

60 BENEFIT SUMMARY FOR GROUP PPO EMPLOYEE-PAID PLAN Plan Features Regular Coinsurance Graded Coinsurance Benefit maximum selections in- and out-of-network ** 51 or more Deductible selections *Standard calendar year deductible for states that do not allow different deductibles in and out-of-network **Standard plan year deductible for states that do not allow different deductibles in and out-of-network Waive deductible for Preventive services out-ofnetwork (standard = no) $500 $750 $1000 (standard) $1250 $1500 $1750 $2000 $2250 $2500** $1000/750 $1500/1250 $1500/1000 $1500/750 $2000/1500 $2000/1250 $2000/1000 $2000/750 $2500/2000** $2500/1500** $2500/1250** $2500/1000** $2500/750** $0 calendar year $25 calendar year $50 calendar year* $75 calendar year $100 calendar year $25 in-network/ $50 out-of-network calendar year $50 in-network/ $75 out-of-network calendar year (standard for calendar year plans) $0 plan year $25 plan year $50 plan year** $75 plan year $100 plan year $25 in-network/ $50 out-of-network plan year $50 in-network/ $75 out-of-network plan year (standard for plan year plans) $100 lifetime Yes (not applicable to $0 deductible) Family deductible None None Deductible carry over Yes (not available with $0, plan No (standard = no) year or lifetime deductible) Reduced premium (standard = no) Yes Yes $500 $750 $1000 (standard) $1250 $1500 $1750 $2000 $2250 $2500** $0 plan year $25 plan year $50 plan year** $75 plan year $100 plan year $25 in-network/ $50 out-of-network plan year $50 in-network/ $75 out-of-network plan year (standard) $100 lifetime Yes (not applicable to $0 deductible) 56

61 BENEFIT SUMMARY FOR GROUP PPO EMPLOYEE-PAID PLAN Plan Features Regular Coinsurance Graded Coinsurance Sealants (not available with reduced premium) Preventive Basic (standard) Preventive Basic (standard) Choice of endo/perio in Basic or Major (no choice with Basic Major (standard) Basic Major (standard) reduced premium) Simple extractions Basic Basic Oral Surgery American General MaxBuilder (standard = yes) Major (standard) Basic (allowed if simple extractions is in Basic) Major (standard) Not covered Yes (requires Major services covered and annual maximum same for in- and out-of-network. Not allowed with 50 th, 60 th or 70 th percentile of R&C. Not available with plan year deductible) Major (standard) Basic (allowed if simple extractions is in Basic) Major (standard) Not covered No Supplemental accident (standard = no) Orthodontia Orthodontia No Yes Child Adult/Child None Orthodontia $500 $750 $1000 (standard) $1250 $1500 (51 or more) Yes Child Adult/Child None Orthodontia $500 $750 $1000 (standard) $1250 $1500 (51 or more) Refer to State Restriction PPO pages of product manual for state-specific restrictions in plan design 57

62 BENEFIT SUMMARY FOR GROUP INDEMNITY EMPLOYEE-PAID PLAN Plan Features Regular Coinsurance Graded Coinsurance Standard waiting periods or Standard waiting periods Deferred benefits deferred benefits Waive standard waiting periods or deferred benefits for Preventive, Basic and Major for present employees No (except on an exception basis for takeover groups of 25 eligible lives and 50 percent participation) Waive standard waiting periods or deferred benefits for Preventive, Basic and Major for both present and future employees Coinsurance selections No (except on an exception basis for takeover groups of 25 eligible lives and 50 percent participation) R&C No (except on an exception basis for takeover groups of 25 eligible lives and 50 percent participation) No R&C 100/80/50 100/50/50 Other (Custom design in increments of 5 percent. Preventive must be greater than or equal to Basic which must be greater than or equal to Major.) Year 1 Year 2 Year 3 80/50/10 90/60/25 100/80/50 80/50/25 90/60/35 100/80/50 80/50/25 90/80/50 80/50/35 90/80/50 R&C percentile selections Benefit maximum selections ** 51 or more Deductible selections Waive deductible for Preventive services (standard = no) Preventive: 80 to 100 Basic: 50 to 90 Major: 0 or 40 to th 60 th 70 th 80 th (standard) 90 th $500 $750 $1000 (standard) $1250 $1500 $1750 $2000 $2250 $2500** $0 calendar year $25 calendar year $50 calendar year (standard) $75 calendar year $100 calendar year $100 lifetime $0 plan year $25 plan year $50 plan year $75 plan year $100 plan year Yes (not applicable to $0 deductible) Family deductible None None 50 th 60 th 70 th 80 th (standard) 90 th $500 $750 $1000 (standard) $1250 $1500 $1750 $2000 $2250 $2500** $0 plan year $25 plan year $50 plan year (standard) $75 plan year $100 plan year $100 lifetime Yes (not applicable to $0 deductible) 58

63 BENEFIT SUMMARY FOR GROUP INDEMNITY EMPLOYEE-PAID PLAN Plan Features Regular Coinsurance Graded Coinsurance Deductible carry over Yes (not available with $0, plan No (standard = no) year or lifetime deductible) Reduced premium Yes Yes (standard = no) Sealants (not available with reduced premium) Preventive Basic (standard) Preventive Basic (standard) Choice of endo/perio in Basic or Major (no choice with Basic Major (standard) Basic Major (standard) reduced premium) Simple extractions Basic Basic Oral Surgery American General MaxBuilder (standard = yes) Major (standard) Basic (allowed if simple extractions is in Basic) Major (standard) Other Yes (requires Major services covered. Not allowed with 50 th, 60 th or 70 th percentile of R&C. Not available with plan year deductible) Major (standard) Basic (allowed if simple extractions is in Basic) Major (standard) Other No Supplemental accident (standard = no) Orthodontia Orthodontia maximum No Yes Child Adult/Child None Orthodontia $500 $750 $1000 (standard) $1250 $1500 (51 or more) Yes Child Adult/Child None Orthodontia $500 $750 $1000 (standard) $1250 $1500 (51 or more) Refer to State Restriction Indemnity pages of product manual for state-specific restrictions in plan design 59

64 BENEFIT SUMMARY FOR GROUP SCHEDULED REIMBURSEMENT EMPLOYEE-PAID PLAN Plan Features Standard waiting periods and None waiver of waiting periods Conversion factors 10 to percent Preventive at If Preventive at R&C option is selected, then R&C is at 80th R&C Benefit maximum selections $750 $1000 (standard) $1500 Deductible selections $0 calendar year $25 calendar year $50 calendar year (standard) $75 calendar year $100 calendar year $ 100 lifetime year Waive deductible for If 100 percent Preventive at R&C option is selected, then: Preventive services Yes (not applicable to $0 deductible) No (standard) Family deductible None Deductible carry over Not available Reduced premium Not available Sealants If 100 percent of Preventive at R&C, then sealants covered as Preventive; otherwise, paid at fee schedule Choice of endo/perio in Basic Not applicable; these are paid at fee schedule or Major American General Not available MaxBuilder Supplemental accident Not available SmileMaker Not available Orthodontia Child only (standard = no) None Orthodontia benefit maximum $750 $1000 (standard) $1500 (51 or more option) 60

65 Delta Dental of New Jersey Employer-Funded Plans UNDERWRITING OFFER FOR DELTA DENTAL OF NEW JERSEY EMPLOYER-FUNDED PLANS Provisions PPO Panel Premier Panel Eligible employee Actively at work at least 30 hours per week. Some groups may have a 20- to 30-hour work week requirement, subject to insurance company approval Actively at work at least 30 hours per week. Some groups may have a 20- to 30-hour work week requirement, subject to insurance company approval Eligible dependent children From birth to age 19 To age 25 for dependent student (state variations may apply) A group may also elect coverage from birth to age 26 in any state Group eligibility Two to ninety-nine enrolled employees Employer contribution for employee coverage Noncontributory plans: 100 percent Contributory (partially-funded) plans: Minimum of 25 percent of the premium paid Participation requirement Noncontributory (100 percent employer-funded): 100 percent Contributory (partially-funded) plans for 2 to 9 groups: 75 percent of employees and 50 percent of dependents not covered elsewhere Contributory (partially-funded) plans for 10 to 99 groups: the greater of 10 employees or 75 percent of those employees not covered elsewhere From birth to age 19 To age 25 for dependent student (state variations may apply) A group may also elect coverage from birth to age 26 in any state Ten to ninety-nine enrolled employees Noncontributory plans: 100 percent Contributory (partially-funded) plans: Minimum of 25 percent of the premium paid Noncontributory (100 percent employer-funded): 100 percent Contributory (partially-funded) plans: the greater of 10 employees or 75 percent of those employees and 50 percent of dependents not covered elsewhere. Reduced participation to 40 percent available (underwriting exception) Takeover Available Available Rate guarantee 12 months 12 months or 24 months Out-of-network benefits Contracting fee (MAC) R&C (prevailing fee determined by Delta Dental of NJ) Pretreatment review limit $300 $300 Standard benefit waiting periods for timely enrollees on non-takeover groups Standard benefit waiting periods for timely enrollees on takeover groups Waiver of standard waiting Preventive none Basic none Major 12 months Ortho (10 or more) 24 months No waiting periods Available for 5 or more periods Late entrants Open enrollment at anniversary Only allowed with loss of other coverage No waiting periods once enrolled Preventive none Basic none Major 12 months Ortho (10 or more) 24 months No waiting periods Available for 5 or more Open enrollment at anniversary Only allowed with loss of other coverage No waiting periods once enrolled 61

66 Ineligible industries and restrictions Dental offices Unions where benefits are subject to labor management negotiations, are subject to Home Office approval Family business with 50 percent or more family members require acceptable wage and tax documentation Out-of-scope business School boards and municipalities Associations and trusts Existing Delta Dental of New Jersey clients Groups with 100 or more employees Dental offices Unions where benefits are subject to labor management negotiations, are subject to Home Office approval Family business with 50 percent or more family members require acceptable wage and tax documentation School boards and municipalities Associations and trusts Existing Delta Dental of New Jersey clients Groups with 100 or more employees BENEFIT SUMMARY FOR DELTA DENTAL OF NEW JERSEY EMPLOYER-FUNDED PLANS Plan Features PPO (2 to 99) Premier Panel (10 to 99) Deductible $25 $50 Deductible waived for preventive in-network Deductible waived for preventive out-of-network Coinsurance Yes No Annual maximum $1000 $ /80/50 Contracting fee innetwork (MAC) 100/80/50 Contracting fee out-ofnetwork (MAC) Endo/perio Major (static for 2 to 9) Basic (static for 10 or more) Oral surgery Basic Basic Denture repairs Major (static for 2 to 9) Basic Basic (static for 10 or more) Orthodontia 10 or more option Option Orthodontia lifetime maximum $1000 $1500 (51 or more) $0 (51or more) $75 (51 or more) $25 $100 (51 or more) $50 Yes No 100/100/60, 100/90/60, 100/80/50 Contracting fee in-network 90/70/50, 100/80/50 R&C (prevailing fee) out-of-network $1000 $1500 $2000 Basic $1000 $1500 (51 or more) 62

67 General Dental Information SmileMaker (Also known as Supplemental Bundled Benefit) BENEFIT DESCRIPTION Recognizes the demand for cosmetic dentistry and includes implants, labial veneers, teeth-whitening, orthodontia and TJM services. Within each of these categories, only selected procedures are covered. (see list below.) The add-on cost is approximately $8 per employee, $16 per employee and spouse, $24 per employee and child(ren) and $32 per family adjusted up or down for case/risk characteristics such as industry, area and contributions. A buy-up option available to employer-funded PPO and indemnity plans with 25 enrolled lives and 50 percent participation. There is no reduced participation even for large groups. Not available with the scheduled reimbursement and high-low choice plans. Only allowed if there is full coverage of Preventive, Basic and Major and is not available with the 50 th, 60 th or 70 th percentiles of R&C. Not allowed if there is orthodontics in the base plan. Does not accumulate towards the American General MaxBuilder option. STANDARD BENEFITS No deductible. Paid at 50 percent coinsurance. Lifetime maximum of $1,000 (additional options of $1,500 and $2,000 for 51 or more groups). Lifetime maximum is separate from base plan annual maximum. 24-month waiting period. Waiting period waiver is not available. Base plan waiting period waiver does not apply to this benefit. Credit is given for time served under the prior plan. If this option is selected, all four categories must be included. American General MaxBuilder (Also known as Maximum Carry-Forward Benefit) DEFINITIONS OF TERMS Carry-forward threshold means the maximum amount of benefits that a person can use and still be entitled to receive a carry-forward amount. Carry-forward amount means the dollar amount which may be carried over and added to the carryforward account. Carry-forward account means the accrued amount of carry-forward dollars. Carry-forward account limit means the maximum amount that can be accumulated in the carryforward account. Available Base Plan Annual Maximum Carry-Forward Threshold Carry-Forward Amount $500 $250 $125 $500 $750 $375 $200 $750 $1,000 $500 $250 $1,000 $1,250 $625 $325 $1,250 $1,500 $750 $375 $1,250 $1,750 $800 $400 $1,250 $2,000 $850 $425 $1,250 $2,250 $900 $450 $1,250 $2,500 (51+) $950 $475 $1,250 Carry-Forward Account Limit 63

68 DESCRIPTION OF BENEFITS American General MaxBuilder This carry-forward benefit rewards health-conscious employees by allowing them to accumulate a portion of unused calendar-year benefits if certain criteria are met. Depending on takeover/non-takeover plans, waiting period provisions and selected annual maximum, the load is approximately 1.0 to 1.5 percent for employee and employee/spouse tiers and 0.7 to 1.0 percent for employee/child(ren) and family tiers. We will carry over a portion of each person s unused base plan annual maximum up to the carry-forward amount, subject to the carry-forward threshold and the carry-forward account limit. The amount carried over will be saved in a carry-forward account to be used in future years when the member has reached that year s base plan annual maximum. Allows a portion of each member s base plan annual maximum to be carried over and saved in an account to be used in future years after the annual plan maximum has been used. Available with the PPO and indemnity regular coinsurance plans. Not available with the scheduled reimbursement, high-low choice or graded coinsurance plans. Available to virgin and takeover groups. Available to calendar year employee-paid and 10 or more employer-funded groups, with full coverage of Preventive, Basic and Major. Not allowed with 50 th, 60 th or 70 th percentile of R&C. Not available to plan year groups. In order for carry-forward benefits to accrue, the individual must have at least submitted claims for a prophylaxis and oral evaluation during the preceding policy year. (Prophylaxis codes: D1110, D1120, D1201; Oral evaluation codes: D0120, D0150), and must have not exceeded the carry-forward threshold (total paid claims). If the qualifying claims are not submitted within a given benefit period, there will be no carry-forward accrual into the following benefit period. Additionally, any accumulated amount will be removed and the carry-forward account will revert to $0. If the carry-forward threshold has been exceeded, there is no carry-forward accrual for that benefit period. If the carry-forward account limit has been met, there is no additional carry-forward accrual. If a carry forward benefit is warranted, the full carry-forward amount is accrued. The only time a partial carry-forward amount can be added to the carry-forward account is when adding the full amount will exceed the carry-forward account limit. Orthodontic claims or SmileMaker claims are not counted towards the carry-forward threshold. Virgin groups and new entrants joining in October, November or December first become eligible at the beginning of the next calendar year. If there are waiting periods, accrual will begin in January of the year following expiration of the waiting periods and continue to December 31 st. (Refer to illustration below.) Virgin groups and new entrants with an effective date prior to October, become eligible for accrual on their effective date. If there are waiting periods, these must be satisfied before accrual can begin. The first accrual period will be completed on December 31 st of the benefit year in which accrual begun. The next accrual period will begin in January of the following year. (Refer to illustration below.) For takeover groups with waiting periods, credit is given towards time served. If the waiting period is completed in October, November or December, accrual begins the following January. If the waiting period is completed prior to October, accrual begins on the day after the date completed. The claim system will track this benefit on an individual claimant basis. If a takeover account (whether internal or external) has a carry-forward benefit, credit will be given towards time served if there are waiting periods or late entrant penalties. However, any individual American General MaxBuilder accumulation from the prior carrier will be wiped out and a new accumulation will begin following the rules above. Eligibility is established and re-established with receipt of the first claim in the eligible benefit period. Calculation of carry-forward amount is not subject to any cut off date except for normal timely filing requirements. 64

69 If an individual moves from a carry-forward to a non-carry-forward plan, any unused amount in the carry-forward account is forfeited. If an individual moves from a plan with a higher maximum to a plan with a lower maximum, any amount over the lower plan carry-forward account limit is forfeited. Group accumulator reports are available upon group renewal and additionally, once per year. They may be requested from Underwriting. Employees may call the TSC customer service telephone line to access their individual accumulators. Reduced Premium Lessens standard benefits and reduces premiums. Endodontics and periodontics in Major. One exam per year rather than two. Four bitewings per 12 months rather than per 6 months. Adjustments and repairs to dentures, crowns and bridges, tissue conditioning and biopsy moved from Basic to Major. Sealants not covered. Orthodontia Benefit Covered at 50 percent coinsurance level. No deductible. 12 month waiting period. Waiting period waived for time served under prior plan. Waiting period can be waived for employer funded plans if the base plan waiting period is also waived. Supplemental Accident Benefit Pays in addition to all other benefits for dental charges incurred due to an accident. $300 per person. Does not reduce annual maximum. No waiting period to satisfy. Deductible waived. Often secondary to Medical or auto/no fault coverage. 100 percent benefits after Medical. Deductible Carry Over With this benefit, individuals who have met their deductible in the last three months of the previous calendar year benefit period, do not have to meet a new deductible in the new calendar year. 65

70 State Restrictions on Plan Design (These restrictions are programmed into the quote system) PPO PLANS State Restrictions AK PPO plans not available AL Graded coinsurance plans are not available because of coinsurance restrictions Basic cannot be less than 50 percent, Major cannot be less than 40 percent Other coinsurance (customized selection) of zero percent not available AR Waive deductible for Preventive both in and out-of-network In-network coinsurance may not exceed out-of-network by more than 25 percent Out-of-network coinsurance cannot be zero percent unless in-network is also zero percent Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available CT Waive deductible for Preventive both in and out-of-network Coinsurance cannot be less than 50 percent except for graded plans In-network coinsurance may not exceed out-of-network by more than 30 percent Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available FL In and out-of-network should be the same coinsurance or only differ by zero percent to 40 percent In-network verses out-of-network deductible can be the same or up to 2 times more In-network verses out-of-network annual maximum can be the same or differ by 10 to 40 percent Only 80 th and 90 th percentile of R&C allowed For 2 to 51 lives, only 1-year rate guarantee is allowed GA R&C out-of-network plans not available Coinsurance, deductible, annual benefit maximum and waivers must be the same in- and out-of-network Waive deductible for Preventive both in and out-of-network Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available HI In- and out-of-network coinsurance and annual maximum benefit may be the same or differ by no more than 10 to 40 percent Therefore, annual maximum benefit not allowed are: 1500/750, 2000/1000, 2000/750, 2500/1250, 2500/1000, 2500/750, 3000/1500, 3000/1250 ID PPO plans not available LA Coinsurance, deductible, annual benefit maximum and waivers must be the same in- and out-of-network Waive deductible for Preventive in- and out-of-network Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available 66

71 State Restrictions MA MAC out-of-network plans are not available In-network coinsurance or deductible may not exceed out-of-network by more than 20 percent Out-of-network coinsurance may not be zero percent unless in-network is also zero percent Annual maximum benefit must be the same in- and out-of-network Waive deductible for Preventive both in and out-of-network Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available All plans have specific county restrictions no PPO allowed: Barnstable, Berkshire, Dukes, Franklin, Hampshire, Hampden and Nantucket MD Customized (Other) coinsurance plans not available Refer any plan design not on the proposal system to Actuarial to determine if MD rules are met ME PPO plans not available MN In- and out-of-network coinsurance and annual maximum benefit may be the same or differ by no more than 10 to 40 percent Therefore, annual maximum benefit not allowed: 1500/750, 2000/1000, 2000/750, 2500/1250, 2500/1000, 2500/750, 3000/1500, 3000/1250 Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available TMJ services are covered as standard MO Waive deductible for Preventive both in and out-of-network MAC plans must have the same coinsurance, deductible, annual benefit maximum and waivers in- and out-of-network Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available Restriction on R&C plans availability Only choices listed in the proposal system are allowed MS MAC out-of-network Plans are not available Waive deductible for Preventive both in and out-of-network Coinsurance, deductible, annual benefit maximum and waivers must be the same in- and out-of-network Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available MT Waiting periods for timely enrollees and late entrants of greater than 18 months not allowed Only 80 th and 90 th percentile of R&C allowed NC In-network coinsurance or deductible may not exceed out-of-network by more than 30 percent Out-of-network coinsurance or annual benefit maximum cannot be zero percent unless in-network is also zero percent NJ 0 percent coinsurance out-of-network is not allowed In-network and out-of-network coinsurance must be at least 25 percent Coinsurance (F) 100/100/60 in-network, 90/70/50 R&C out-of-network (10+) and (H) 100/100/60 in-network, 100/80/50 R&C out-of-network are not available 67

72 State Restrictions NV MAC out-of-network plans are not available Less than 50 percent coinsurance is not allowed In-network coinsurance may not exceed out-of-network by more than 30 percent Out-of-network deductible, coinsurance and annual benefit maximum may not be zero percent unless in-network is zero percent Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available Graded coinsurance plans are not available since 50 percent is lowest coinsurance allowed Waive deductible for Preventive both in and out-of-network NY Waiting periods for timely enrollees and late entrants of greater than 12 months not allowed All PPO plans have specific county restrictions no PPO in: Allegany, Cattaraugus, Chenango, Clinton, Cortland, Essex, Franklin, Fulton, Genesee, Hamilton, Herkimer, Lewis, Livingston, Madison, Ontario, Orleans, Otsego, Schoharie, Schuyler, Seneca, St. Lawrence, Sullivan, Washington, Wyoming and Yates In- and out-of-network coinsurance and annual maximum benefit may be the same or differ by no more than 10 to 40 percent Therefore, annual maximum benefit not allowed are: 1500/750, 2000/1000, 2000/750, 2500/1250, 2500/1000, 2500/750, 3000/1500, 3000/1250 OH Annual maximum benefit and coinsurance in-network cannot exceed out-ofnetwork by more than 50 percent Therefore, annual maximum benefit not allowed are: 2000/750, 2500/1000, 2500/750, 3000/1250 are not available Out-of-network coinsurance and annual benefit maximum may not be zero percent unless in-network is zero percent Waive deductible for Preventive both in and out-of-network Plan and calendar year deductible of $25 in-network/ $50 out-of-network not available OK Annual benefit maximum and waivers must be the same in- and out-of-network Waive deductible for Preventive both in and out-of-network In-network deductible and coinsurance may not exceed out-of-network by more than 30 percent Out-of-network deductible, coinsurance and annual benefit maximum may not be zero percent unless in-network is zero percent Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available OR Waiting periods for timely enrollees and late entrants of greater than 12 months not allowed In- and out-of-network coinsurance and annual maximum benefit may be the same or differ by no more than 10 to 40 percent Therefore, annual maximum benefit not allowed are: 1500/750, 2000/1000, 2000/750, 2500/1250, 2500/1000, 2500/750, 3000/1500, 3000/1250 PA All PPO plans have specific county restrictions no PPO in: Adams, Bedford, Bradford, Cameron, Centre, Elk, Fulton, Huntingdon, Jefferson, McKean, Montour, Potter, Snyder, Susquehanna, Tioga, Union and Warren 68

73 State Restrictions TX Coinsurance, deductible and annual benefit maximum must be the same in- and out-of-network Plan and calendar year deductible of $25 in-network/ $50 out-of-network and $50 in-network/ $75 out-of-network not available Out-of-network deductible, coinsurance and annual benefit maximum may not be zero percent unless in-network is zero percent Waive deductible for Preventive both in and out-of-network TMJ services are covered as standard VA In- and out-of-network coinsurance and annual maximum benefit may be the same or differ by no more than 10 to 40 percent Therefore annual maximum benefit not allowed are: 1500/750, 2000/1000, 2000/750, 2500/1250, 2500/1000, 2500/750, 3000/1500, 3000/1250 WA PPO plan not approved 69

74 INDEMNITY PLANS State Restrictions CT Coinsurance cannot be less than 50 percent except for graded plans FL Only 80 th and 90 th percentile of R&C allowed For 2 to 51 lives, only 1 year rate guarantee is allowed MT Waiting periods for timely enrollees and late entrants of greater than 18 months not allowed Only 80 th and 90 th percentile of R&C allowed NY Waiting periods for timely enrollees and late entrant of greater than 12 months not allowed OR Waiting periods for timely enrollees and late entrant of greater than 12 months not allowed WA Indemnity Plan not approved HIGH-LOW CHOICE PLANS State Restrictions AK Plan B, Plan D and Plan E not available AL Plan D1, #1, Plan E1, #1-4 not available AR PPO plans waive deductible for Preventive both in- and out-of-network Plan D1, #1, Plan E1, #1-4 not available CT PPO plans waive deductible for Preventive both in- and out-of-network Plan C1, #1, Plan D1, #1, Plan E1, #1-4 not available FL Only 80 th and 90 th percentile of R&C allowed For 2 to 51 lives, only 1 year rate guarantee is allowed Plan D1, #1 and Plan E1, #1,2,3 and 4 not available GA PPO plans waive deductible for Preventive both in- and out-of-network Plan B, Plan E not available Plan D1, #1-2 not available HI Plan D1, #1, Plan E1, #1-4 not available ID Plan B, Plan D and Plan E not available KY Plan D1, #1, Plan E1, #1-4 not available LA PPO plans waive deductible for Preventive both in- and out-of-network Plan D1, #1-2, Plan E1, #1-4 not available Plan B2, #1, 3, 4, 6, Plan E2, #1, 3, 4, 6, 7, 8 not available ME Plan B, Plan D and Plan E not available MD Plan D1, #1, Plan E1, #1-4 not available MA PPO plans waive deductible for Preventive both in- and out-of-network Plan D, Plan E not available PPO county restrictions for Plan B PPO not available: Barnstable, Berkshire, Dukes, Franklin, Hampshire, Hampden and Nantucket MN Plan D1, #1, Plan E1, #1-4 not available MS Plan D, Plan E not available PPO plans waive deductible for Preventive both in- and out-of-network Plan B2, #1,3, 4, 6 not available MO Plan E not available MAC PPO plans waive deductible for Preventive both in- and out-of-network Plan D1, #1, 2 not available Plan B2, # 4, 6 not available MT Waiting periods for timely enrollees and late entrant cannot exceed 18 months NC Plan D1, #1, Plan E1, #1-4 not available NJ Plan D1, #1, Plan E1, #1-4 not available MAC plans are called Contracting fee plans 70

75 State Restrictions NV Plan D, Plan E not available PPO plans waive deductible for Preventive both in- and out-of-network Plan C1, #1 not available NY Waiting periods for timely enrollees and late entrant cannot exceed 12 months PPO county restrictions for Plan B, Plan D, Plan E no PPO in Allegany, Cattaraugus, Chenango, Clinton, Cortland, Essex, Franklin, Fulton, Genesee, Hamilton, Herkimer, Lewis, Livingston, Madison, Ontario, Orleans, Otsego, Schoharie, Schuyler, Seneca, St. Lawrence, Sullivan, Washington, Wyoming and Yates Plan D1, #1, Plan E1, #1-4 not available OH Plan E1, # 1, 2, 3, 4 not available OR Plan D1, #1, Plan E1, #1-4 not available Waiting periods for timely enrollees and late entrant cannot exceed 12 months OK PPO plans waive deductible for Preventive both in- and out-of-network PA PPO county restrictions for Plans B, D and E no PPO in Adams, Bedford, Bradford, Cameron, Centre, Elk, Fulton, Huntingdon, Jefferson, McKean, Montour, Potter, Snyder, Susquehanna, Tioga, Union and Warren TX PPO plans waive deductible for Preventive both in- and out-of-network Plan D1, #1, 2, Plan E1, #1-4 not available Plan E2, #1, 3, 4, 6, 7, 8, Plan B2, #1, 3, 4, 6 not available UT Plan D1, #1, 2, Plan E1, #1-4 not available VA Plan D1, #1, Plan E1, #1-4 not available WA Plans not approved 71

76 Glossary of Dental Terms Abutment A tooth or teeth used to support and anchor a fixed or removable partial denture prosthesis. Acrylic Resins Plastic materials used in the fabrication of denture and crowns and occasionally as a restorative filling material. Acute Condition A disease process of sudden onset, which requires immediate treatment and has a short and relatively severe course. Alloy (see Amalgam) Alveolectomy (Alveoplasty) The shaping of the alveolar ridge of the jawbone by surgical procedures for the removal of bony prominence usually in preparation for the construction of a prosthetic appliance. Amalgam (Silver Filling) A metal alloy consisting of silver, tin, zinc and copper, combined with mercury, and used as a restorative material in operative dentistry. Ancillary Personnel Persons employed by a dentist, such as secretaries, receptionists, bookkeepers, or other clerical workers. This classification does not include dental assistants, dental hygienists, or laboratory technicians (see Auxiliary Personnel). Apical Curettement Surgical removal of diseased material surrounding the apex of a tooth root not involving removal of the root tip. Apicoectomy The surgical removal of the apex of the tooth root. Most often done in conjunction with, or as an adjunct, to root canal therapy. Appliance A device worn by a dental patient during a course of treatment, but not as a substitute or reconstruction of oral or facial structures. For example, space maintainer periodontal splints are appliances. Arch, Dental The curved composite structure of the natural dentition and the residual ridge or the remains thereof after the loss of some or all of the natural teeth. Auxiliary Personnel Persons who assist dentists in the performance of dental services by general usage including chairside assistants, dental hygienists and laboratory technicians, but excludes persons employed solely as secretaries, receptionists, or bookkeepers (see Ancillary Personnel). Bicuspid (Premolar) A tooth with two points or cusps. Normal adult dentition has eight bicuspids (two on each side of the upper and lower jaw). Bicuspids are located between the cuspid and first molar teeth. Biopsy Surgical removal of tissue for microscopic examination primarily for the purpose of diagnosing the possibility of benign or malignant tumors. Bite (see Occlusion) Bitewing Radiograph X-ray A specific type of X-ray picture which shows simultaneously the crowns of upper and lower posterior teeth and a portion of their roots and supporting structures. Generally used to diagnose the presence of dental decay in adjoining tooth surfaces. 72

77 Bridge A replacement for one or more missing or extracted natural teeth or supported and held attachments to restored teeth. Usually not removable. (Sometimes referred to as a fixed partial denture.) Buccal Surface The tooth surface adjacent to the cheek. Calculus Salivary mineral salts and organic matter deposited upon the exposed parts of teeth. (Commonly called tartar.) Cap A nonprofessional's term for jacket. Care The total of diagnostic preventive and restorative services rendered by a licensed dentist. Adequate May denote: o Repair of oral damage and the placing of the mouth in a condition to prevent deterioration o The most desirable treatment for an individual but frequently refers to the substitution of a less costly but satisfactory type of service Comprehensive All dental services indicated for the restoration and maintenance of oral health. Usually excludes dental care solely for cosmetic reasons. Emergency Any dental service required in treating unexpected and urgent conditions, such as acute infection, hemorrhage, toothache or injury Incremental Services initiated at specific intervals of time to specific age groups in order to establish and maintain a state of oral health Initial Services required for dental needs existing at time of enrollment in a plan for dental care or at the beginning of any dental treatment Maintenance Service required to maintain oral health after initial care has been completed Minimal Generally includes only treatment of acute conditions of teeth and gums. Synonym: emergency care. Caries, Dental An infective disease that results in the destruction or decay of tooth substance. Carious Lesion That area of the tooth affected by the caries disease process. Cavities, Dental Destruction of tooth structure. One Surface A carious lesion that involves a single surface of a tooth. Two Surfaces A carious lesion that involves two adjacent tooth surfaces of an individual tooth either the distal and occlusal surfaces (DO) or the mesial and occlusal surfaces (MO) Three Surfaces A carious lesion that involves three tooth surfaces on an individual tooth the mesial, occlusal and distal surfaces (MOD). Chair-Side Assistant One of a group of paradental personnel; specifically an individual who assists the dentist in the performance of dental services. Clasp An integral part of a removable partial denture constructed of metal and used as a stabilizing and retaining device to keep both tooth and denture in passive apposition. Composite Resin A resin restorative material reinforced by a high percentage of inorganic filler. Used primarily to restore anterior teeth. 73

78 Cosmetic Dentistry Any dental service performed primarily to improve appearance. Crown, Artificial A fixed restoration covering the major part of the natural tooth; usually fabricated of gold porcelain or acrylic resin. Crown and Bridge That branch of dental science primarily concerned with the replacementof mission or naturally destroyed teeth or tooth structure by use of permanent non-removable dental prostheses or restorations. Cuspid A tooth with one point or cusp. There are four cuspids in the oral cavity; one on either side in each jaw situated at the angles of the mouth. (Commonly referred to as canine or eye teeth.) Dental Assistant A person who assists with the direct care of dental patients under the supervision of the dentist. The scope of the assistant's responsibilities is influenced by the employer's educational preparation and the regulations of the dental practice Act in the State in which the dental assistant is employed. Dental Auxiliary (see Auxiliary Personnel) Dental Care Resources The personnel facilities, equipment, funds and methodology that make dental services available. Dental Education That specialty of health-service education that deals specifically with the training of an individual to qualify him to practice dentistry. Dental Floss A threadlike material, waxed or un-waxed, used as an aid in cleaning surfaces between the teeth and below the gum line. Dental Health Education That branch of education that attempts to teach individuals and groups about oral health in such a way that results in appropriate health behaviors. Dental History A record of an individual's oral-health experience, including his current health and status. Dental Hygienist A person trained and licensed to perform preventive and therapeutic services under the supervision of a dentist. Dental Lab Technician A person who is essentially concerned with the fabrication of dental appliances or devices on the direct prescription or work order of the licensed practitioner. Dental Plaque (Bacterial Plaque, Mucin Plaque) A sticky substance, which forms on the teeth, that is composed of mucoidal secretions containing bacteria and their products, dead tissue cells and debris. This substance is toxic and is considered important in the initiation and progression of gingivitis (gum inflammation) and destructive periodontal disease. Dentition Natural teeth in the dental arch. Natural teeth are considered collectively in the dental arch and may be primary (deciduous), secondary (permanent) or mixed. Dento-Facial Deformities Disabling abnormalities of the teeth, oral cavity and face; usually congenital in origin. Examples: oral clefts, severe malocclusion. 74

79 Denture An artificial substitute for missing natural teeth and adjacent structures. Complete A dental prosthesis that replaces the lost natural dentition and associated structures of the entire maxilla or mandible Immediate A dental prosthesis constructed for insertion immediately following the extraction of natural teeth Partial An artificial replacement of one or more, but less than all, of the natural teeth and associated structures Fixed A restoration of one or more missing teeth, permanently attached to natural teeth or roots which furnish the primary support to the appliance. (Generally referred to as a bridge.) Removable A prosthetic appliance which artificially replaces missing teeth and associated structures in a partially edentulous law and which can be removed from the mouth and replaced at will Diagnostic Services Procedures such as radiographs, clinical examinations, biopsies, blood tests, study models, and vitality tests that assist the dentist in determining the disease conditions present, and the treatment required. Disclosing Agent A chemical which, when applied to the teeth, allows for the visualization of dental plaque. Distal Surface The tooth surface farthest from the midline of the face, opposite to the mesial surface. Edentulous Without any natural teeth; completely lacking natural teeth. Endodontics The practice of that specialty of dental service concerned with the diagnosis and treatment of diseases of the pulp chamber and pulp canals. Expanded Function Auxiliary A dental assistant or dental hygienist trained to perform under the supervision of the dentist selected intra-oral functions traditionally performed by the dentist. Functions of such auxiliaries are established by the dental practice act of the state in which the expanded function auxiliary is employed. Exposure An opening into the pulp chamber of a tooth. Usually the result of injury or decay, whereby the pulp is brought into contact with the oral environment, including bacteria and saliva. The time that ionization produced by an X-ray machine is permitted to be exposed to the object being radiographed A procedure whereby surgical removal of tissue permits an unerupted tooth to be visible within the oral cavity Extraction The separation and surgical removal of a tooth from its natural state. Filling (see Restoration) Floss (see Dental Floss) Flossing Cleaning the teeth by use of dental floss. Especially indicated for the surfaces between the teeth and below the gum line. 75

80 Fluoridation The adjustment of the fluoride content of a water supply as an aid in decreasing the incidence of dental caries. Foil, Gold Small pellets of gold that are malleted into a cavity preparation to restore the function and shape of the tooth. A type of dental restoration. Fluoride Topical Application The direct application of a fluoride compound (usually sodium fluoride or stannous fluoride) to the crowns of the teeth as a measure for partiality preventing the incidence of dental caries. Application is recommended on a routine basis through childhood and adolescence. Foil, Gold Small pellets of gold that are malleted into a cavity preparation to restore the function and shape of the tooth. A type of dental restoration. Frenectomy (Frenum) Surgical removal of the labial or lingual frenum frena. Labial The band of tissue that passes from the inside of the lip to a point midway between the central incisors. Lingual The band of tissue that passes from under the tongue to the lingual aspect of the midpoint of the lower jaw. Gingiva(e) The fibrous tissue covered by mucous membrane that immediately surrounds a tooth and is continuous with its pericemental ligament (the gums). Impacted Tooth Commonly a tooth embedded in either the soft or the bony tissues of the jaw in such a way that it has not erupted or has erupted only partially. Incisor An anterior tooth with a cutting edge (as opposed to teeth with crushing edges). There are four incisors in the upper jaw and four in the lower jaw (upper right and left central and lateral incisors; lower right and left central and lateral incisors). Inlay A porcelain or gold dental restoration which is inserted into a prepared cavity as a single unit; the restoration is retained by its form and dental cement. Jacket A specific type of crown generally fabricated of porcelain or acrylic resin or a combination of precious metal and porcelain or acrylic resin. Often called a cap. Labial Surface The tooth surface adjacent to the lips. Lingual Surface The tooth surface adjacent to the tongue. Malocclusion Abnormal relationship between the occlusal surfaces of the maxillary and mandibular teeth when they are in contact. Mandible The lower jawbone, the condoles of which articulate on each side with the temporal bones of the skull. Mandibular Pertaining or referring to the mandible. Maxillae The bones of the upper jaw that bear the upper incisor cuspid and molar teeth. Maxillary Pertaining or referring to the maxillae. 76

81 Mesial Surface The tooth surface closest to the midline of the face, opposite to the distal surface. MO (see Cavities) MOD (see Cavities) Molar A grinding tooth. One of the three back teeth on each side of both jaws. Occlusal Pertaining to the contacting or biting surfaces of opposing teeth Pertaining to the masticating surfaces of the posterior teeth (see Cavities) Occlusion The relationship between the occlusal surfaces of the maxillary and mandibular teeth when they are in contact. Operative Dentistry The branch of dentistry primarily concerned with restoring carious diseased or damaged natural teeth to a satisfactory state of health function and esthetics. Oral Examination Those procedures performed by a dentist that aid in making diagnostic conclusions about the oral health of an individual patient. Oral Pathology The branch of dentistry concerned with the study of disease processes of the hard and soft tissues of the oral cavity. Oral Surgery The branch of dentistry concerned with operative procedures in and about the oral cavity and jaws. Orthodontics That specialty of dental science concerned with the diagnosis and treatment of irregularities of the teeth and malocclusion. Palliative Treatment Treatment of pain or discomfort; affording relief from the primary concern of pain, but not necessarily effecting cure. Pedodontics That specialty of dental science concerned with the prevention, detection and treatment of dental disorders in children. Periapical Pertaining to that area of the tooth around the apex (tip) of the root. Periodontal Disease A progressive disorder affecting the structures surrounding and supporting the teeth. Periodontics That specialty of dental science concerned with the prevention and treatment of diseases of the soft and hard tissues supporting the teeth. Pontic An artificial tooth on a bridge or fixed partial denture. It replaces the lost natural tooth, restores its functions, and usually occupies the space previously filled by the natural tooth. Preventive Dentistry The branch of dentistry devoted primarily to averting oral diseases and inhibiting the progress of diseases already present. Some elements of prevention are inherent in all branches of dental practice. 77

82 Primary Dentition The teeth of children. Primary teeth are those of the deciduous dentition which are exfoliated (shed or lost) when the teeth of the secondary dentition (commonly called permanent teeth} erupt. Primary teeth are commonly called milk teeth or baby teeth. Prophylaxis The removal of calculus (tartar, dental plaque) and stains from the teeth by scaling and polishing. Prosthesis An artificial replacement of a lost part of the natural dentition or oral cavity. Prosthetics (see Prosthodontics) Prosthodontics That specialty of dental science concerned primarily with providing artificial replacements for missing natural teeth. Pulp The vital tissue within the tooth containing nerves and blood vessels. Popularly called the nerve. Pulpectomy The complete surgical removal of the pulp of a tooth. A step in root canal therapies. Pulpotomy The partial removal of the pulp of a tooth usually performed on children as a treatment after dental caries or a fracture has penetrated to the pulp. Radiograph The photographic representation of opaque objects produced by the action of ionizing radiation upon a sensitized plate or film (roentgenogram, x-ray). Rebase A process of renting a denture by the replacement of the denture base material without changing the occlusal relations of the teeth. Recall System Any method for periodically reminding patients to return for examination. Rehabilitation (Oral) The complete reconstruction of the masticatory apparatus to as nearly a normal condition as possible, including the replacement of lost teeth and tissue parts and the restoration of esthetics and function. Reline To resurface the tissue side of a denture with new base material to make it fit more accurately. Removable Denture (also see Denture) Prosthetic restoration appliance. Broad terms applied to any partial or complete denture that restores or replaces loss of tooth structure or other oral tissues and can be easily extracted and replaced. Restorative Dentistry (see Operative Dentistry) Ridge Alveolar The bony ridge of the maxilla or mandible that contains the sockets of the teeth. Root Canal The space within the root of a tooth containing pulp tissue and connecting the pulp chamber with the apex of the root. Root Canal Therapy A treatment of a tooth having a damaged pulp. Usually performed by completely removing the pulp, sterilizing the pulp chamber and root canals, and filling these spaces with sealing material. Scaling A dental procedure performed to remove calculus (tartar, soft deposits, plaque) and stains from the teeth. A procedure of prophylaxis. 78

83 Sealant An adhesive material bonded to the tooth surface to retard decay by sheilding the tooth from exposure to the oral environment. Silicate Cement A type of dental restorative material used primarily to restore anterior teeth. Occasionally referred to as synthetic porcelain (a misnomer). Space Maintainer An appliance constructed for the purpose of preventing adjacent and opposing teeth from moving into the space left by teeth lost prematurely. Specialist (Dental) A dental practitioner who limits his practice to a specific branch of dentistry after special education in that branch. The officially recognized dental specialties are endodontics, oral pathology, oral surgery, orthodontics, pedodontics, periodontics, prosthodontics and public health dentistry. Study Model Stone or plaster representations of the teeth and supporting structures used to record stages of jaw development in treatment of malocclusion, as a diagnostic aid in periodontal treatment, and in the design of prosthetic appliances. Supernumerary Tooth A tooth in excess of the regular or normal number. Treatment Plan A series of operations or procedures that are proposed to treat a specific dental disorder or disease, or toward the attainment of a given state of oral health. 79

84 Vision Insurance Introduction Group Vision is a vision product available to groups of two or more employees that utilizes the EyeMed Vision Care network of independent, private practice vision care professionals. Employees decide at time of service if they want to seek care from an in-network or out-of-network provider. Insured employees receiving Vision care from a Vision network provider will enjoy substantial savings. Employees pay less out-of-pocket if they elect to visit an in-network Vision network provider. Plan Designs Available Group Vision has two benefit plan designs, optional at the employer group level: Plan A Frame frequency: 12 months Plan B Frame frequency: 24 months General Information Can be sold as a standalone product. There are no entity restrictions. Self-billed cases are permitted for groups above 100 lives through the Tampa Service Center with approval from Neptune V.P. of Vision. Two-year rate guarantee standard. Groups under 500 lives are manually rated. Groups of 500 lives and above are experience rated. Eligibility Standard participation requirements 75% of those employees and dependents who are not covered by another group insurance plan. To be eligible for coverage, employees must be actively at work at least 30 hours a week on a full time basis. Exceptions to quote down to a 20 hour work week must be pre-approved by HO. Eligible dependents include spouses and any children under the age of 21, full-time students to age 23. Names and dates of birth must be furnished at point of application. Domestic Partner Coverage is available, in all states, at the request of the employer. A notarized affidavit must be supplied in order to determine eligibility. Children of domestic partners are eligible, as long as they meet the definition of a dependent. Underwriting Guidelines Businesses with 50% or more family members require acceptable wage and tax documentation. Job titles are not requred unless setting group up as class destinct. Complete home address for each employee is necessary in order for ID cards to be generated and mailed by EyeMed. Our Voluntary product requires a minimum of 10 eligible employees with no less than 5 enrolled. Otherwise, all other parameters are the same. 80

85 Vision Plan Features Summary Plan Provision Plan Details IN-NETWORK OUT-OF-NETWORK Exam (dilation as necessary) $10 copay <$40 reimbursement standard> *See below for state variations Exam Frequency Annual Same as In-Network plan Frames (any frame available at provider location) $0 copay, $130 allowance; 20% off balance over $130 <$45 reimbursement standard> *See below for state variations Frame Frequency Plan A Annual Plan B Every two years Same as In-Network plan Standard plastic lenses (in lieu of contacts) Single-vision $20 copay Bifocal $20 copay Trifocal $20 copay Lenticular $20 copay Single-vision $40 reimbursement Bifocal $60 reimbursement Trifocal $80 reimbursement Lenticular $80 reimbursement Lens Frequency Annual Same as In-Network plan Other Lens Options You pay: Progressive (add-on to $20 bifocal copay) $65 Premium progressive (add-on to $20 bifocal copay) $65 plus 80% of charge, less $120 allowance UV coating $15 Tint (solid and gradient) $15 Scratch resistance $15 Polycarbonate $40 plus 80% of charge less $120 allowance Anti-reflective $45 N/A Contact Lenses (in lieu of lenses; includes materials only) Conventional $0 copay, $105 allowance; 15% off balance over $105 Disposable $0 copay, $105 allowance; insured covers balance over $105 Medically necessary $0 copay, paid in full Elective- <$80 reimbursement standard> Disposable- <$85 reimbursement standard> Medically necessary- $210 reimbursement *See below for state variations Contact Lens Fit and Follow-up Discount Fee (available after eye exam) Standard (conventional and planned replacement contact lenses): Up to $55 charge to member Premium (all non-standard contact lenses, such as toric, multifocal, etc.): 10% off retail price N/A 81

86 Plan Provision Plan Details IN-NETWORK OUT-OF-NETWORK Laser Vision Correction 15% off retail or 5% off promotional price from U.S. Laser Network N/A Other Services or Add-Ons 20% discount N/A Secondary Discounts Additional discounts up to 40% off a complete pair of eyeglasses and 15% off conventional contact lenses once the funded benefit has been used. N/A Exam (dilation as necessary) $10 copay Standard $45 reimbursement Massachusetts $80 reimbursement Frames (any frame available at provider location) $0 copay $130 allowance 20% off balance over $130 Standard $45 reimbursement Colorado $55 reimbursement Georgia $95 reimbursement Kentucky $55 reimbursement Massachusetts $105 reimbursement Maryland $105 reimbursement Minnesota $65 reimbursement Missouri $95 reimbursement North Carolina $65 reimbursement Contact Lenses (in lieu of lenses; includes materials only) Conventional $0 copay, $105 allowance; 15% off balance over $105 Disposable $0 copay, $105 allowance; insured covers balance over $105 Medically necessary $0 copay, paid in full Elective $80 reimbursement standard Massachusetts $85 reimbursement North Carolina $85 reimbursement Disposable $85 reimbursement standard Maryland $84 reimbursement Medically necessary $210 reimbursement *State specific variations for out-of-network benefits for frames and contacts. Notes: The above Vision benefits are the same for Employer paid and Employee paid plans. 82

87 Glossary of Vision Terms Anti-Reflective Coating A lens coating that allows for more light to pass through the lens, cutting down on glare and distracting reflections. This coating is good for night driving and is also cosmetically appealing because it allows others to see your eyes rather than the light reflecting off the lenses. Copay Amount An insured person s share of costs, paid to the participating provider at the time services are rendered. Copay amounts that apply to the various vision benefits are listed in the benefit schedule. Lenticular Lens Used primarily for post-cataract lenses, a lenticular lens is one in which the power is in the center of the lens but the edge is a portion of plain glass, so it is easily mounted in a frame. Lenticular lenses are designed to reduce the weight and thickness. Ophthalmologist A person who is licensed by the state in which he or she practices as a doctor of medicine or osteopathy and is qualified to practice within the medical specialty of ophthalmology, who is not: 1) the insured person; 2) an immediate family member; 3) retained by the policyholder. Optician A person or business licensed by the state in which services are rendered to manufacture, grind and/or dispense lenses and frames prescribed by either an optometrist or an ophthalmologist, who is not: 1) the insured person; 2) an immediate family member; 3) retained by the policyholder. Participating Provider An ophthalmologist, optician or optometrist who has elected to enter into a contract with the vision benefit manager and who is listed in the participating provider directory. Polycarbonate Lens More durable than regular plastic, polycarbonate lenses are very lightweight. They also have greater impact resistance than any other lens material, making it the lens of choice for sports eyewear, children or active lifestyles. Premium Progressive Lenses Include, but are not limited to, the following trade names: AO Compact, Kodak, Multigressiv, Natural, Outlook, Panamic, and Varilux Comfort. Premium lenses are the highest-grade level of progressive lens based on the most advanced and recent year, make and model of equipment used to develop them. Progressive Lenses Include but are not limited to the following trade names: access, Adaptar, AFMini, Continuous, Vue, Freedom, Sola VIP, Sola XL and True Vision. Standard lenses are the mid-range level of progressive lens based on the year, make and model of equipment used to develop them. Tint A lens add on that reduces the light that enters the eyes. This can be doctor recommended or for fashion purposes. Trifocal Lens A lens having three areas of viewing, each with its own focusing power. usually, the upper power is used for distance vision, the lower power for close vision such as reading, and the middle area for arms length vision. UV Coating An eyeglass lens coating that protects eyes from harmful ultraviolet light. Scratch Resistant Coating A lens coating that helps reduce scratches on the lenses. 83

88 Short-Term Disability (STD) Insurance Availability For groups of 2-9 lives and over 10 lives. All plans are rated based upon age, gender, and the industry SIC code. If there is a question on the SIC code, Underwriting reserves the right to assign rates based on an accurate code. American General Life Companies (American General) reserves the right to revise a quote if data is not accurate or lives/volume group changes by 10%. Weekly STD benefit will be reduced by income from any statutory Disability plan (New York, California, Rhode Island, New Jersey and Hawaii). New York (DBL) and New Jersey (TDB) plans are available. For the other above states, the group must separately purchase any non-occupational short-term disability plan. Short-Term Disability is not available to groups if: The business is conducted in the home of the employer There are known economic problems (Bankruptcy Filings, Layoffs in the last 12 months, etc.) The employees are temporary or seasonal Family* members comprise more than 50% of the employees insured *Family means spouse, domestic partner, child, parent, grandparent, sister, brother, aunt, uncle, nephew or niece and anyone of a blood relation who have resided together for at least three months at the time coverage is requested. Firms are in business less than one year May quote down to one life per class. NOTE: RATES ASSUME PARTICIPATION IN SOCIAL SECURITY AND WORKER S COMPENSATION. UNDERWRITING SHOULD BE CONTACTED PRIOR TO RELEASING A QUOTE ON THESE GROUPS TO CONFIRM RATES AND ELIGIBILITY. 84

89 2-9 Lives STD Employer Funded Plan Features Summary Minimum Group Size Maximum Group Size 2 lives 9 lives Maximum Weekly Benefit $750 standard; up to $1,500 Benefit Percentage Maximum Benefit Period 60% standard; 40%, 50% options, flat amounts 26 weeks standard; 13 weeks option Minimum Weekly Benefit $25 Waiver of Premium No premium is due for employees while receiving STD benefits Elimination Period 7 days injury/7 days sickness standard; other options are 0/7, 7/14, 14/14, 29/29 Definition of Disability During the Elimination Period Executive Carve-Out Maternity Coverage Inability to perform all the material and substantial duties of the regular occupation due to sickness or injury and have a 20% or more loss in indexed monthly earnings. Available (see page 3 for reverse carve-outs) Federally mandated at 15 employed, (must provide maternity) Optional benefit from 2+ employed, (group may request) Mandatory for some states from 2+ employed Pre-Existing Conditions 3/12 standard with or with out maternity; other option 12/12 Partial Disability Other Standard Features Rate Guarantee Included, Proportionate Loss Offsets: Social Security, state compulsory benefits, etc. Partial disability provision 12 months 85

90 10+ Lives STD Employer Funded Plan Features Summary Group Size Maximum Weekly Benefit Benefit Percentage Maximum Benefit Period 10+ lives $2,000 standard; up to $3,000 based on formula results 60% standard; 40%, 50%, 66 2/3%, 70%, flat amounts 26 weeks standard; Options: 13 weeks, 52 weeks, 11 week maximum (intended for 90 day LTD), 24 week maximum (intended for 180 day LTD), Minimum Weekly Benefit $25 Waiver of Premium Elimination Period First Day Hospital Definition of Disability During the Elimination Period Executive Carve-Out Maternity Coverage No premium due for employees while receiving STD benefit 7 days injury/7 days sickness standard other options are 0/7, 7/14, 14/14, 14/29, 29/29 and 12/12 with a 24 week maximum (intended for 180 day LTD) 13/13 with a 11 week maximum (intended for 90 day LTD) No standard Other option: Yes Total Disability: Inability to perform all the material and substantial duties of the regular occupation due to sickness or injury and have a 20% or more loss in indexed monthly earnings. Other option is Zero day Available Included Pre-Existing Conditions None standard; other options are 3/12 and 3/6/12 Partial Disability Rate Guarantee Included, proportionate loss 12 months standard 24 monrth optional 86

91 Voluntary STD Plan 100% Employee Paid Plan Features Summary Minimum Group Size Guarantee Issue (minimum of 10 employees must be enrolled in order to qualify) 2+ lives enrolled 10 Lives enrolled or 25% participation, which ever is greater Maximum Weekly Benefit Benefit Percentage Maximum Benefit Period Minimum Weekly Benefit Waiver of Premium $500; up to $1,000 available for preferred industries 60% standard; 40%, 50% options (Higher percentages may be available at Underwriter discretion.) 26 weeks standard; 13 weeks $25 (state-specific) Included stantard: No premium due for employees while receiving STD benefit Elimination Period 7 days injury/7 days sickness standard; other options are 0/7, 14/14, 29/29 Definition of Disability During the Elimination Period Executive Carve-Out Maternity Coverage Pre-Existing Conditions Evidence of Insurability Rate Guarantee Inability to perform all the material and substantial duties of the regular occupation due to sickness or injury and have a 20% or more loss in indexed monthly earnings. Available Included; optional for some states when less than 15 lives 3/12 standard; 12/12 with maternity Required under 10 lives enrolled, and when participation is less than 25% 12 months Notes: Employees pay 100% of the premium. Rates increase as a new age bracket is entered. 87

92 Maximum Weekly Benefit Calculation We offer a standard maximum weekly benefit of $2,000 for 10+ plans only. Lower amounts are available preferably in increments of $100. Maximum requests over the standard $2,000 and up to $3,000 are determined by using the average of the top three salaries. Maximum requests in excess of $3,000 for groups over 10 lives must be approved by a Home Office Underwriter prior to quoting. EXAMPLE 10+ groups requesting maximums over $2,000 are based on the lesser of: 1. The industry maximum 2. The average of the top three salaries formula EXAMPLE: President $200,000 Vice President $250,000 AVP $100,000 Total $550,000 3 = $183, = $3,526 $3,526 60%* = $2,115 Group is eligible for $2,115 STD maximum *Plan % of Basic Weekly Earnings NOTE: REQUESTS FOR HIGHER MAXIMUMS (ABOVE $3,000) MUST BE APPROVED BY HOME OFFICE UNDERWRITING PRIOR TO QUOTING. 88

93 Underwriting Guidelines All Plans Employees must be actively at work, 30 or more hours per week on a full-time basis. Hourly workweek requests for less than 30 hours are normally not available, regardless of replacement provisions (unless state-mandated) 1099 employees are not eligible for coverage. Please see page 2 for more information regarding commissioned salespersons and 1099 s. Coverage is available on a non-occupational basis only. Twenty-four-hour coverage is not available. Employees must live in the US for coverage For 2-9 groups, the group is subject to the gatekeeper question. Late entrants are subject to Evidence of Insurability. For Voluntary plans, evidence of insurability is required when participation is not met Rate guarantee: One year is standard but a two-year rate guarantee is an available option for groups with over 10 lives insured. For 2-9 groups, two-year rate guarantee is available when sold with other coverages that have multi-year rate guarantees. Contact your sales office or Home Office contact for details. There is a charge for this option, and it will be granted at the discretion of Underwriting. Eligibility: To be eligible for coverage, an employee must be actively at work on the effective date. Participation: Non-contributory cases require 100% of employees to participate. Contributory requires that 75% of eligible employees participate. Note: If a plan is sold on a contributory basis, we must know the contribution percentage Section 125 plans are not eligible. Non-profit and/or social services are subject to home office underwriting approval Exclusions All Plans The group policy does not cover any disability caused by, contributed to by, or resulting from: Loss of professional license, occupational license or certification Intentionally self-inflicted injuries while same or insane Active participation in a riot Attempting to commit a crime, or commission of a crime for which you have been convicted under federal or state law Insurrection, war, declared or undeclared, or any act of war Period of disability during which the insured is incarcerated as a result of a conviction Occupational injuries 89

94 Definitions Also see the Glossary at the end of this section. Disability or Disabled The Company has determined that there has been a change in the employee s functional capacity to work as a result of sickness or injury which began while the employee was covered under the group policy and that: They are unable to perform the material and substantial duties of their regular occupation due to their sickness or injury; and They have a 20% or more loss in weekly earnings due to the same sickness or injury; and During the elimination period they are unable to perform the material and substantial duties due to their sickness or injury; and are not working in any occupation Coordination of Benefits The STD benefit will integrate with benefits from other plans. The STD benefit will be reduced by income received from: The Federal Social Security Act or the Railroad Retirement Act The non-job-related disability cash sickness laws of any state A mandatory state auto reparation or Indemnity act (no-fault auto insurance) Other Group insurance plans Government retirement system Canada or Quebec Pension Plans Disability retirement benefits from the current employer or at the latest of age 62 or normal retirement The Jones Act Third Party Settlements Unemployment Salary continuation or sick leave Franchise disability income plans Any similar plan or act For 2-9: Individual disability income benefits Basic Weekly Earnings The weekly rate of pay from the employer. For partners, the prior year s K-1, W-2, or S-Corp tax statement. The definition does not include bonuses, overtime pay, or other special compensation including commissions. The inclusion of commission will only be considered on 10+ STD at the request of the employer. This must be pre-approved by Underwriting prior to submission. The weekly pay indicated on the enrollment form must reflect the employee s base salary plus the averaged commission received over the past 24 months. 90

95 States that mandate maternity benefits for Disability State Arkansas California Colorado Connecticut Delaware District of Columbia Hawaii Idaho Iowa Kansas Kentucky Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Ohio Oregon Employers Affected All employers Employers with 5 or more employees All employers Employers with 3 or more employees All employers All employers All employers Employers with 5 or more employees All employers Employers with 4 or more employees Employers with 8 or more employees All employers All employers Employers with 6 or more employees All employers All employers Employers with 6 or more employees All employers All employers Employers with 15 or more employees Employers with 6 or more employees All employers Employers with 4 or more employees All employers Employers with 4 or employees All employers 91

96 Pennsylvania Rhode Island Tennessee Vermont Washington Wisconsin Wyoming Employers with 4 or more employees All employers Employers with 8 or more employees Employers with 1 or more employees All employers All employers All employers Note: Maternity benefits may be offered to groups of 2-9 as an option, or for those who currently have it with another carrier and can provide proof with a bill and certificate booklet (for takeover consideration). For groups of 10+, maternity will be offered as a standard benefit. Federal Maternity mandates that any employer who employs 15 or more, including those not eligible (part-time, waivers, carve-outs, etc.), must offer maternity under STD. 92

97 Quoting Procedures 1. Group Information Screen Proposed effective date of coverage Group s proper name, address, nature of business (SIC). Each submitted sold case contains an EMIS/onesource report. Number of Eligible Employees and Number of Insured Employees. A group must have at least 2 insured employees to quote our products. Weekly Hours Worked # of Years in Business Current Insurance Carrier (if known) # of Classes (10+ employees: at least 2 members required in the top class; 2-9 employees: at least one member in top class; all partnership groups must separate the partners into their own class, rated as contributory) 2. Select Products Screen Products are grouped as follows: Employer-Funded Group: Noncontributory and partially contributory coverage we require a minimum participation of 75% if contributory, 100% if noncontributory Employee-Paid Group: 100% Employee Funded Products Employee-Paid Individual Products 3. Census Information Screen The following information may be manually entered or imported from an Excel spreadsheet: Name Age/DOB Sex Salary EE/Family Coverage State ZIP 4. Choose Benefits Screen Select the plan design for the coverages you are quoting. State restrictions may limit some availability. 5. Calculate Rates and Build Proposal Rates and plan design will be displayed, and you may build a proposal that will allow you to , print and save the quote you have created. 93

98 Glossary of Disability Terms Absence Management A program to control absences due to disability with an emphasis on controlling unexplained or excessive absenteeism. Programs with a broader focus (i.e., not limited to disability-related absence) are often referred to as total absence management. Accessibility As required by the Americans with Disabilities Act, removal of barriers that would hinder a person with a disability from entering, functioning, and working within a place of public accommodation. Required restructuring of the facility cannot cause undue hardship for the employer. Accident and Sickness (A&S) Alternative name used by some employers for STD, salary continuation, or sick pay plans. Such plans often have different elimination periods for accidents and for sickness. Accident, Industrial (Occupational) In workers compensation, an unforeseen, unintended event that occurs in the course of an individual s employment and results in an injury or illness. Active Employment Working for an employer on a permanent full-time basis and paid regular earnings and performing the material duties of a regular occupation. An employee must be working the minimum number of hours as specified in the contract and employees work site must be at the employer s usual place of business, an alternative work site at the direction of the employer, for a location to which the job requires the employee to travel. Administrative Services Only (ASO) An arrangement in which an insurer or other organization provides claims administrative services to a benefit plan but does not assume any of the risk or liability. The services are typically for claim processing, but utilization management, case management and quality management contracting and prospective review may also be provided. Age Discrimination in Employment Act (ADEA) A 1976 federal law that prohibits employers with 20 or more employees from discriminating on the basis of age in hiring, job retention, compensation and benefits. ADEA also sets requirements for the duration of employer-provided disability benefits. Appeals Process As mandated by ERISA, a procedure whereby individuals covered by an employersponsored benefit plan can appeal a benefit determination with which they disagree. The appeal must be filed within 180 days of receiving the determination. The employer or its agent (usually an insurance carrier or third-party administrator) must communicate its decision within 45 days of the filing of an appeal. Attending Physician Statement (APS) A report, filled out by the insured s physician documenting current and prior health history. An APS helps the insurance company in the evaluation process of an application or a claim. Basic Monthly Earnings The monthly rate of earnings from the employer in effect immediately prior to the date disability begins. Basic monthly earnings include all earnings before any reductions. It does not include bonuses, overtime pay and extra compensation other than commissions. Benefit Duration The length of time that medical or STD/LTD benefits will be paid to an employee, as specified by the insurance contract or plan design. Federal requirements for benefit duration are contained in the Age Discrimination in Employment Act (ADEA). 94

99 Benefit Integration 1) Reduction of a scheduled benefit by amounts paid or available to an employee from other disability-related sources of income. For STD and LTD plans, other sources could include workers compensation, government disability plans, disability benefits from pension plans, retirement benefits, and Social Security disability benefits, both primary and family. Also known as benefit coordination or offsets. 2) Interdependent administrative and benefit design provisions of STD, LTD, workers compensation, and other paid time-off benefits to achieve cost savings, optimal medical treatment, and return to work. Benefit Percentage Percent of weekly (short-term disability) or monthly (long-term disability) salary that will be replaced. Cafeteria Plan An employee benefit arrangement allowed by Internal Revenue Code Section 125 where employees are allowed to pay for certain employee benefits on a pre-tax rather than an after-tax basis. Disability income insurance is one of those benefits. Also called a flexible spending account. California State Disability Insurance (SDI) Law Mandates a non-occupational, short-term disability plan funded through a tax supported state fund; in effect since Employers may substitute a private, self-insured plan exceeding state fund standards; additional cost is funded by employer, employees, or both. Census Data Information such as date of birth, sex, income, or occupation on persons eligible for or insured by a group policy; used to determine premium rates or benefits. Claim Frequency A measurement of the use of a plan. The number of claims submitted within a given period; may be expressed as a function of payroll size or hours worked. Also known as claim incidence. Claim Lag The time interval between incurred date of claim and its submission to the insurer for payment. Claim Reserve An amount of money set aside by an insurer to cover the total expected future cost of a claim that has been submitted; may change over time with the prognosis of the disability. Claims, Incurred The dollar amount of an insurer s liability at a certain point in time. The sum of paid claims, open claim reserves, and incurred but unreported claim reserves, discounted for interest earnings. Claims, Paid The dollar amount an insurer has actually paid on claims submitted during a certain time period. Cognitive Impairment A deterioration or loss in intellectual capacity resulting from dementia (e.g. Alzheimer s disease) or mental illness. Confidentiality The degree of protection afforded individually identifiable health information. When sharing information and records about an individual, insurers and employers must respect an individual s right to privacy. Continuity of Coverage Under continuity of coverage, a person insured by a prior carrier does not lose coverage solely because of a change in carrier. It affects employees who were not actively at work, due to injury or illness, at the time of the change, as well as employees with pre-existing conditions that would make them ineligible for coverage under the new carrier. Also known as prior service credit, no loss/no gain, takeover provision, and D&R (discontinue and replacement). Conversion Privilege The right of an insured person to replace one policy with another when employment ends without providing evidence of insurability. 95

100 Cost-of-Living Adjustment (COLA) Annual adjustments in benefit amounts based on economic trend analysis. Cost-of-Living Freeze Benefit stipulation that provides that the monthly benefit will not be further reduced due to any cost of living increases payable under other income benefits. Covered Payroll The sum of all employees wages or salaries that are covered by an LTD plan; used as a basis for setting premium rates. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-4) A tool used by the medical and psychological communities to identify and classify behavioral, cognitive, and emotional problems according to a standard numerical coding system of mental disorders. Dictionary of Occupational Titles (DOT) A list of job classifications that specifies job duties; physical, mental, and social demands; and characteristics of each job listed. Maintained and updated by the U.S. Department of Labor as new jobs are created and technologies change. Disability Benefit Amount payable under a group disability (STD or LTD) plan to a covered employee who meets eligibility criteria typically between 50% and 70% of pre-disability income prior to eligibility for STD/LTD. Disability Duration Guidelines Guidelines that describe the duration of different types of disabilities according to diagnosis, symptoms, severity, and occupational factors. Duration guidelines may be used to evaluate disabilities and forecast an expected return-to-work time frame, such as in duration control guidelines. Disability Management Programs that seek to prevent disability, reduce the cost impact of disability, and provide mechanisms to promote maximum functional recovery and return to work. Integrated disability management refers to those programs that are implemented across all disability plans (e.g. STD, LTD, workers compensation, and salary continuation) in addition to, increasingly, group health plans. Disability Pension A pension annuity payable to an eligible employee who becomes disabled before normal retirement age. Disability, Partial A disability that still permits the employee to work part-time or in a limited capacity. Early Intervention Initiation of a variety of case management and return-to-work strategies as soon as possible after the actual or potential disabling incident occurs. This type of intervention involves facilitating communication among all the stakeholders in the case (e.g. employee, physician, supervisor, claims person, case manager, and rehabilitation specialist). Earned Premium That part of the premium for which coverage has already been provided and which the insurer has therefore earned. Earnings Money derived from personal service salary, wages, and commission. The portion of an employee s income put at risk because of disability. Eligibility Date The day on which an employee becomes eligible for insurance coverage. Eligible Survivor In LTD plans, a deceased employee s surviving spouse; if no spouse survives, then the employee s children under a certain age (e.g., 25). 96

101 Elimination Period The number of consecutive days an employee must be disabled before LTD benefits become payable (typically, days). In some plans, employees are allowed to work during the elimination period (see Residual Benefit). Elimination Period, Interruption A period in which an employee with a disability can attempt to return to work without beginning a new elimination period if the attempt is unsuccessful. Also known as trial work period. Employee Retirement Income Security Act (ERISA) A Federal law enacted in 1974 which grants tax incentives to employers who provide healthcare, retirement, pension, life insurance, and disability benefits to their employees while subjecting such benefit plans to a complex set of regulations administered by the Department of Labor. Evidence of Insurability (EOI) Statement of an employee s medical history that will be used to determine if coverage can be approved. EOI is required if an application for coverage is received after the eligibility period (usually more than 31 days after the eligibility date), or if participation levels for a group are not met. Exclusions Causes of disability not covered under disability benefit plans. Typical LTD exclusions are war, insurrection, rebellion, or active participation in a riot; intentionally self-inflicted injuries or attempted suicide; the commission of a felony. Family and Medical Leave Act (FMLA) A 1993 Federal law requiring employers with 50 or more employees to provide eligible workers up to 12 weeks of unpaid leave for birth, adoptions, foster care placement, and serious illnesses of employees and their families. Full-Family Social Security The amount of benefit an insured receives from Social Security for self and family. Full Maternity If an insured employee becomes disabled as a result of a pregnancy or complications, the disability will be covered on the same basis as any other illness. Functional Capacities Analysis An evaluation of an employee or prospective employee s ability to perform the range of activities that are considered essential to job performance. Typically conducted by an occupational or physical therapist. Gainful Occupation An occupation that is, or can be, expected to provide you with an income equal to 60% of your pre-disability income within 12 months of your return to work. Gainful Work The performance of any occupation for wages, remuneration, or profit, for which you are qualified by education, training or experience on a full-time or part-time basis, for the employer or another employer, and which the company approves, and for which the company reserves the right to modify approval in the future. Gross Monthly Benefit The insured s monthly benefit amount before any reduction for other income benefits. Hawaii Temporary Disability Insurance (TDI) Law Mandates a non-occupational, short-term disability plan funded by employers; in effect since Claims must be adjudicated in Hawaii. Employers may substitute a private, insured or self-insured plan at least equal to statutory requirements with the additional cost funded by employer, employees, or both. 97

102 Health Insurance Portability Act of 1996 (HIPAA) Signed into law August 21, 1996, the act is designed to provide portability of health coverage by limiting pre-existing limitations and exclusions in group health insurance plans. It also requires individual insurers to offer coverage without pre-existing limitations to people who have had prior group coverage. Independent Medical Evaluation A medical examination carried out by a physician other than the employee s treating physician. The independent evaluation is used to collect additional medical data or functional capacity information upon which to base benefit payments, make claims decisions and resolve disputes relating to a disability. Indexed Pre-Disability Earnings Insured s basic monthly earnings just prior to the date disability began, which are adjusted each year. Injury A bodily injury that is the direct result of an accident and not related to any other causes that occurred after the effective date of the policy. Integrated benefits A system whereby the claims processing, payment, case management, information management, and return to work functions of sick pay/salary continuance, STD, LTD, and workers compensation are integrated in order to achieve administrative savings and optimal return to work outcomes. The integration is typically achieved through a central administrative function managed by the employer but insurer and TPA-based programs have gained popularity in recent years. Increasingly, group health benefits are also being included in integrated benefit designs. Job Modification The development of medically appropriate ways for employees with disability-related restrictions to perform their regular jobs. Long-Term Disability (LTD) A benefit plan that typically replaces a percentage of an employee s income when that income is lost due to an extended illness and/or injury. After an elimination period (usually days), benefits are payable so long as the employee meets all of the contractual requirements under the policy. The actual number of days or months considered long-term and the duration of payments will vary by insurer. Loss of Earnings By comparing the income earned by an individual before becoming disabled to the income earned after the disability, an insurer determines the amount of benefits to be paid. Most policies require a reduction of at least 20% to qualify for benefits. The amount of benefits paid is determined by the specific policy s definition of disability. Material Duties In LTD plans, the basic and essential requirements of a job. To be considered disabled, employees must be unable to perform material duties, not incidental or insignificant tasks. Maximum Benefit For disability benefits, the maximum dollar amount an insured will receive while disabled. Maximum Benefit Duration The longest period for which employer-sponsored disability benefits will be paid, provided that the employee remains continuously disabled. Typically, the lesser of the number of years until Social Security normal retirement age or the age specified in the plan. Mental Illness Limitation Limit on the period of time (often 24 months) over which LTD benefits will be paid when an employee is disabled as a result of a mental, emotional, or nervous condition that is being treated on an outpatient basis. The limitation does not apply while the individual is confined to a hospital or institution. 98

103 Minimum Monthly (or weekly) Benefit The minimum dollar amount an insured will receive while disabled, after other deductible sources of income are subtracted from the gross benefit. New Jersey Temporary Disability Benefits (TDB) Law mandates a non-occupational, short-term disability plan funded through a tax supported state fund, in effect since Employers may substitute a private, insured or self-insured plan equaling or exceeding state fund standards. Certain existing plans are also permitted as alternatives. New York Disability Benefits Law (DBL) Mandates a non-occupational, short-term disability plan funded by employers, in effect since Employers may substitute a private, insured or self-insured plan equaling or exceeding state benefits; employer, employees, or both fund additional cost. Certain existing plans are also permitted as alternatives. Non-Occupational Plan Any employer-sponsored disability benefit plan that provides income replacement for employees whose disability is not caused by their employment. These plans may also provide for supplements to workers compensation benefits in the event of occupational injuries or illnesses. Occupation Any meaningful work for which an employee is reasonably qualified in terms of training, education and experience. Occupational Injury An injury that occurs in the course of work or a health impairment caused by conditions in the work environment. Offsets (see Benefit Integration) Old Age, Survivors, Disability, and Health Insurance (OASDHI) Benefits provided under the U.S. Social Security program. Omnibus Budget Reconciliation Act (OBRA) of 1993 Federal legislation that limits the amount of compensation that can be paid to employees covered by LTD plans funded through VBA (voluntary employees beneficiary association) trusts. Pre-Disability Earnings The insured s earnings immediately prior to the date disability began; usually excludes overtime pay, bonuses, commissions, and any other extra pay. Also called basic weekly earnings, basic monthly earnings, or covered earnings. Pre-Existing Condition Exclusion Plan provision that excludes or reduces disability benefits for any illness or injury for which an employee received medical treatment or consultation before coverage begins under a disability plan. Primary Integration The LTD benefit is reduced, dollar for dollar, by Social Security benefits paid or payable to the insured because of the worker s disability. This does not include benefits payable to the eligible spouse and/or children. Primary Social Security The amount of benefit an insured receives from Social Security for him or herself. 99

104 Proportionate Loss Partial Disability Benefit A benefit that is paid after the insured has satisfied the elimination period and experienced at least a 20% loss of earnings. This benefit pays the insured a portion of the total disability benefit after a return-to-work based on the percentage of income lost due to the disability. Puerto Rico Disability Benefits (PRDB) Law Mandates a non-occupational, short-term disability plan funded through a tax-supported state fund, in effect since Employers may substitute a private, insured or self-insured plan equaling or exceeding state benefits; additional cost is funded by employer, employees, or both. Railroad Retirement Act Federally administered legislation that provides coverage similar to workers compensation benefits for railway employees. Rate Guarantee Period The length of time after a policy s effective date or renewal date during which premium rates will not be changed, unless the terms of the policy are changed, usually one to three years. Reasonable Accommodation (1) Modification or adjustment to a job application process that enables a qualified applicant with a disability to be considered for the position such qualified applicant desires; or (2) modifications or adjustments to the work environment or to the manner or circumstances under which the position held or desired is customarily performed, that enables qualified individuals with disabilities to perform the essential functions of that position; or (3) modifications or adjustments that enable an employee with a disability to enjoy equal benefits and privileges of employment as are enjoyed by its other similarly situated employees without disabilities. Recurrent Disability A disability which is related to or due to the same cause(s) of a prior disability for which a monthly benefit was payable. Typically, the disability must recur within 6 months (LTD) and 14 days (STD) after returning to work for the insured to be eligible for a resumption of benefits. Reducing Benefit Duration (RBD) A scale that relates the length of time that disability payments will be made to employees ages. For example, employees who became disabled before reaching age 65 are paid benefits only up to that age; employees who become disabled after age 65 receive benefits only for a certain number of years. Regular Job Job that you were performing for your employer on the day before disability began. Regular Occupation The occupation that you are routinely performing when your disability begins. The company will look at your occupation as it is normally performed in the local economy, instead of how the work tasks are performed for a specific employer or at a specific location. Reimbursement Agreement for SSDI In employer-sponsored programs, a written promise by a claimant to reimburse the insurer for any overpayment of disability benefits that may be due to the awarding of SSDI. Reserve Buy-Out A product designed to take over the liability on existing claims of a self-insured LTD plan. The product essentially is a financial agreement between the insurance company and the employer that states the insurer will assume liability for the claims and the employer will pay to the insurer the monies necessary to cover those liabilities. Reserve, Statutory An actuarially determined bookkeeping liability which represents the minimum amount of money an insurer must set aside to meet future claims and obligations, as calculated under the state insurance code. Reserves Accounts created to meet future obligations. 100

105 Residual, Zero-Day In LTD plans, a provision allowing an employee who has been partially disabled to work on a trial basis immediately, while continuing to satisfy the elimination period. Rhode Island Temporary Disability Insurance (TDI) Law Mandates a non-occupational, short-term disability plan funded through a tax-supported state fund; in effect since Employers may not substitute a private plan. Salary Continuation An employer plan that provides a payment to salaried employees during periods of injury and/or illness ranging from several weeks to several months. The benefit amount may be controlled by length of service, job performance, and/or union contracts. This discretionary benefit can be coordinated with workers compensation and other disability benefits so as not to exceed the base salary of the employee. Also often referred to as sick leave. Schedule of Benefits Amount of insurance offered to an insured. Can be a flat benefit or based on a multiple of annual earnings; job classification; or years of service. Self-Insurance A process whereby an employer covers risks by establishing reserves for future losses in lieu of purchasing insurance protection. Also known as self-funding. Short-Term Disability Usually associated with group insurance, this type of insurance pays a weekly income replacement benefit (usually 60%-80%) for disability after a brief elimination period (1-7 days) for a short period of time (typically 3-12 months). Sick Pay An employer paid benefit for periods of illness. The benefit period is usually short, and eligibility is coordinated with other benefits (such as short- and long-term disability) to provide a range of coverage to the employee. Sick pay is usually 100% of earnings, and it can often be banked at the end of the year to allow for accrual. Social Security Disability Insurance (SSDB) A system of federally provided payments to eligible workers (and in some cases their families) when they are unable to continue working because of a disability. Benefits begin with the sixth full month of disability and continue until the individual is capable of substantial gainful activity Social Security Freeze Provides that an insured employee is disabled after the date the Social Security Freeze is effective and becomes entitled to receive a monthly benefit. The monthly benefit cannot be reduced in the future due to any cost-of-living increase in Social Security benefits payable. Social Security Normal Retirement Age (SSNRA) The age at which unreduced Social Security benefits are payable. As defined by a 1983 amendment to the Social Security Act, that age is 65 for individuals born before 1938, 66 for those born from 1938 to 1954, and 67 for those born after Split Classes For rating purposes, the division of a census is called split classes. Different states and different benefits are the two most common reasons for splitting a census. State-Mandated Disability Plans Required minimum STD plans for workers in the states of California, Hawaii, New Jersey, New York, Rhode Island, and the Commonwealth of Puerto Rico. Most plans provide modest coverage (e.g., 50% replacement up to a maximum of $145 a week), with a benefit duration of at least 26 weeks. Supplemental Security Income (SSI) A program of the Social Security Administration that pays monthly benefits to eligible workers with disabilities who fall below a certain asset and income level. Survivor Benefit Amount payable to an employee s eligible survivors following the employee s death due to disability. Payment may be in a lump sum or monthly payments when proof is received that an insured died after the disability continued for 180 consecutive days or more. 101

106 Takeover Provision (see Continuity of Coverage) Taxability of Benefits If disability insurance premiums are paid with after-tax income then the benefits received are tax-free. If disability insurance premiums are paid with pre-tax dollars, or are Employer- Funded, the benefits are subject to tax. Third Party Administrator (TPA) An organization that specializes in processing claims for care by collecting premiums and authorizing payment for services that the physician or hospital provides Sometimes these types of organizations provide other related services such as utilization review, member services, and physician contracting. Transferable Skills Analysis (TSA) An evaluation of an employee who has been disabled to determine employability and job placement potential, and to develop a vocational training plan. Typically, the process involves development of a list of prospective jobs that the individual is capable of performing based on the person s abilities, previous work history, skills, and training as well as their disability-related limitations. Transitional Return-to-Work Program A program to enable employees who have been disabled to return to temporarily modified work. The program coordinates the efforts of physical therapists, physicians, department supervisors, occupational health nurses, and disability management services. Modifications may include job restructuring, assisting devices, workstation modifications, reduced hours, or reassignment to another job. Twenty-Four-Hour Care A program that integrates management, payment, and/or coverages for group health (medical), group disability (STD and LTD), and workers compensation benefits. The objective is to improve services and reduce administrative costs by dissolving the boundaries between occupational and non-occupational benefits. Vocational Rehabilitation A process of developing employment options for an employee with a disability utilizing their remaining capabilities for a different job or career. May include job accommodation, vocational assessment, labor market surveys, developing alternative work plans, retraining, and assistance with job seeking skills. Waiting Period The amount of time an employee must work for the employer before becoming eligible to apply for insurance. This may vary by SIC and by product. Waiver of DI Premium Exemption from premium payment for Disability Insurance during the time the insured is receiving a disability benefit. 102

107 Waiver of Life Premium Exemption from premium payment for Life Insurance during the time the insured is receiving a disability benefit. Typically based on an any OCC definition of disability test after a specific number of months of disability have been satisfied. Work Hardening Structured physical activities either at the work site or at another facility focused on maintaining and improving the physical and psychological capabilities of a disabled employee to return employees to their regular jobs using a reduced schedule or a dedicated facility, in keeping with their medical restrictions. The number of work hours gradually increases as the employee s condition improves. Workers Compensation A system of providing for the cost of medical care and weekly payments to employees injured on the job or to dependents of those killed in industry in which no-fault liability is imposed on the employer. In return, employees are generally prohibited from suing employers, even if the disabling event was due to employer negligence. U.S. government employees, harbor workers, and railroad workers are not covered by state workers compensation laws, but instead by other federally administered laws. Workstation Modifications Customizing tools or equipment (e.g., raising or lowering desks) or making ergonomic changes to enable an employee who has been disabled to return to work or remain safely on the job. 103

108 Long-Term Disability (LTD) Insurance Introduction Long-Term Disability Benefits may be written stand-alone or with any other coverage. Long-Term Disability is designed to replace a reasonable portion of an employee s pre-disability income. In structuring the benefit, it is important that a claimant not receive a higher level of income than his or her after-tax earnings. The percentage of a claimant's pre disability net (after tax) income that is replaced by the net disability benefit is called income replacement. Most LTD plans contain an elimination period of several months, followed by a benefit period of many years. The most popular plans have an elimination period of 90 or 180 days and pay benefits up to age 65 or the normal Social Security retirement age. We will extend payment beyond the age for employees disabled after age 60 in order to comply with ADEA (Age Discrimination in Employment Act) requirements. 2-9 Lives Simplified issue with a gatekeeper question Late entrants to an existing plan will be subject to evidence of insurability 10+ Lives More flexibility for employers Late entrants to an existing plan will be subject to evidence of insurability Voluntary-all sizes Requires a minimum of 10 lives enrolled and 25% participation for Guarantee Issue Note: If under 10 lives enrolling, EOI will be required on all amounts. Late entrants to an existing plan will be subject to evidence of insurability Requirements A variety of factors including the group demographics, plan design, plan funding, and industry, affect the price of LTD plans. Groups are rated through TSC if fewer than 100 lives. Employees must work a minimum of 30 hours per week, and be actively at work on the effective date of coverage, in order to be eligible. Requests for workweek provisions less than 30 hours, regardless of the prior plan s provisions, will not be allowed. 104

109 Participation Requirements If the employees pay part of the premium (contributory), at least 75% of eligible employees must enroll for coverage. If the plan is non-contributory, all eligible, employees must enroll for coverage. However, since we offset with individual disability plans on 2-9, this sized group may be written as non-contributory and allow those covered under an individual plan to waive out of our plan. Substantiating proof, such as a current list bill from the individual carrier, must be provided in order to allow a waiver under these circumstances. If contributory, please submit the following information: Contribution percentage by employee and employer (listed on application). Contributory for rating purposes: The following is a partial list of the types of groups that are considered contributory for rating purposes: Plans where the employer pays part but not all of the premium Partners in a Partnership Partners in a Limited Liability Partnership (LLP) Gross-up Scenarios: This is a practice that involves the employer increasing (or grossing up") employees salaries by the amount of the LTD premium. Then, the LTD premium is deducted from the employees pay to achieve tax-preferred benefit status. May quote down to one employee per class. Risk Selection Businesses in existence less than 2 years are not eligible (spin-off businesses in existence less than 2 years may be eligible with prior Underwriting approval and appropriate financial disclosure). Please have an officer of the company provide, on company letterhead, the start-up revenue, projected revenue and the client base. Businesses based in the home are not eligible. Independent contractors reporting income on IRS form1099 are not eligible Employees may work out of their homes. Titles and occupations should be reviewed for legitamacy. The following are some acceptable occupations: IT consultants, traveling salespeople, etc. Members of the same family* may not comprise more than 50% of the employees insured. o *Family means spouse, domestic partner, child, parent, grandparent, sister, brother, aunt, uncle, nephew or niece and anyone of a blood relation who have resided together for at least three months at the time coverage is requested. Employees whose age, when increased by the waiting period, equals or exceeds age 70, are not eligible, unless business is takeover. Social Services/Non-Profits must be called in to your Underwriting contact prior to quoting. Nonprofit letters are required if company has been is in business less than three years. Please have an officer of the company provide, on company letterhead, all sources of income and funding and the percentage from each source. NOTE: RATES ASSUME WORKER S COMPENSATION AND SOCIAL SECURITY INTEGRATION. GROUPS WHO DO NOT PARTICIPATE IN WORKER S COMP WILL NEED ADJUSTMENTS TO MANUAL RATES. PLEASE CONTACT YOUR HOME OFFICE UNDERWRITER FOR MORE ASSISTANCE. 105

110 2-9 Lives LTD Employer-Funded Plan Features Summary Minimum Group Size Maximum Group Size 2 lives 9 lives Maximum Monthly Benefit Up to $6,000 Benefit Percentage Benefit Duration Minimum Monthly Benefit Waiver of DI Premium Elimination Period Definition of Disability During the Elimination Period 60% standard; 40%, 50% options SSNRA standard; Age 65 (ADEA1) The greater of $100 or 10% of the gross monthly benefit No premium due for employees while receiving LTD benefits 180-day standard (90-day option) Zero-day residual standard Material duties and 20% earnings loss standard. Earnings Test 80/60 Integration Executive Carve-Out Earnings Threshold for Partial Disability Partial Disability Benefit Conversion Privilege Education Benefit Survivor Benefit Maternity Coverage Mental/Nervous, Drug and Alcohol Limit Pre-Existing Condition Exclusion Mandatory Rehabilitation Program Self-Reported Symptoms Limitation COLA Primary and family standard Available (see page 3 for reverse carve-outs) 80% of pre-disability earnings Proportionate Loss Not available Not available Included: 3 times monthly payment after 180 days of disability Covered as any sickness from 2+ lives 24 months of benefits lifetime 3/12, unless mandated by state law Included with Rehab Benefit of 5% for 12 months and children benefits Option: Voluntary Rehab Program 24 months lifetme standard; No limit (none) Not available 106

111 Regular Occupation Period Retrun to Work Incentive Rate Guarantee My Life Values 24 months stnadard Included for 12 months 24 months standard; 12 months option Included 107

112 10+ Lives LTD Employer Funded Plan Features Summary Group Size Maximum Monthly Benefit Benefit Percentage Benefit Duration Minimum Monthly Benefit Waiver of DI Premium Elimination Period Definition of Disability During the Elimination Period Earnings test Integration Earnings Threshold for Partial Disability Partial Disability Benefit Conversion Privilege Education Benefit 10+ lives Up to $10,000 for standard industries 60% standard; 40%, 50%, 66 2/3% options SSNRA standard; to age 65 (ADEA1); 2 years and 5 years The greater of $100 or 10% of the gross monthly benefit No premium due for employees while receiving LTD benefits 180 day standard; 90 day, 365 day available; Greater of: end of 90 day or salary continuation; Greater of: end of 180 day or salary continuation Zero-day residual standard Material duties and 20% earnings loss standard. Material duties or 20% earnings *Optional for standard SICs** 80/60 standard Other option 80/80 (Standard SICs)** Primary and family standard; Primary only or 70% all sources optional 80% of pre-disability earnings Proportionate loss Not included standard; Included optional Not included standard; $100, $200, $300, $400, $500 optional Survivor Benefit 3 times last monthly benefit paid standard; none (option for 10+) Maternity Coverage Mental/Nervous, Drug and Alcohol Limit Pre-Existing Condition Exclusion Mandatory Rehabilitation Program Self-Reported Symptoms Limitation COLA Return to work Incentive Covered as any sickness from 2+ lives 24 months of benefit lifetime 3/12 standard, other options available Included with Rehab Benefit of 5% for 12 months Option: Voluntary Rehab Program Included 24 months; none (no limit) optional Not included standard; 1-3% optional Included for 12 months 108

113 Regular Occupation Period Catastrophic Maximum Capacity Rate Guarantee My Life Values 12 month; 24 month standard Options: 12, 36, 60 months; Unlimited (Standard SICs)** Available as an option Included standard; other option Excluded 24 monhts standard; 12 months optional Not available **Standard SICs only (not available on RQ or high blue collar plans 109

114 Voluntary LTD Plan 100% Employee Paid Plan Features Summary Minimum Group Size Guarantee Issue Maximum Monthly Benefit Benefit Percentage Benefit Duration Minimum Monthly Benefit Waiver of DI Premium Elimination Period Definition of Disability During the Elimination Period Integration Earnings Threshold for Partial Disability Partial Disability Benefit Survivor Benefit Maternity Coverage Mental/Nervous, Drug and Alcohol Limit Pre-Existing Condition Exclusion Rehabilitation Program Mandatory Rehabilitation Program Cost-of-Living Freeze Self-Reported Symptoms Limitation Return to Work Incentive Rate Guarantee 2 lives enrolled 10 lives enrolled and 25% participation Up to $6,000, in $100 increments 60% of indexed monthly earnings standard; 40%, 50% optional SSNRA standard; 2 or 5 years optional The greater of $100 or 10% of the gross monthly benefit No premium due for employees while receiving LTD benefits 180-day standard; 90-day optional Zero-day residual Other sources of income directly offset include Full Family Social Security 80% of pre-disability earnings Proportionate loss 3 times monthly payment after 180 days of disability Covered as any sickness from 2+ lives 24 months of benefit lifetime 12/6/24 standard; 3/12; 6/12; 12/12; 12/24 optional Will rehabilitative benefits, 5% for 12 months With child care expenses, up to $500 per month Included with Rehab Benefit of 5% for 12 months Option: Voluntary Rehab Program Included for all amounts of other income offset Included 24 months; none (no limit) Included for 12 months 24 months standard; 12 months optional 110

115 Plan Design Options Group Size If we are quoting a group employing 10 or more employees, but we are insuring less than 10 employees, the group must purchase the 2-9 plans. Benefit Percentage LTD is designed to replace a reasonable portion of income lost due to a disabling injury or illness. Income is referred to as Indexed Monthly Earnings (IME). Part of the replacement amount is based on the elected benefit percentage. Cost increases as the benefit percentage increases. The same underwriting concerns that apply to our 2-9 Plan also apply to 10+ plans except that sometimes the spread of risk inherent in larger groups mitigates certain risk factors. The following benefit percentages are available: 40% of monthly salary 50% of monthly salary 60% of monthly salary (standard option) 66 2/3%* monthly salary 70%* of monthly salary (for 100+ groups, needs Underwriting approval, and only availableif it is a replacement benefit. See your Home Office Underwriting contact for full details.). *The high replacement ratios inherent in these benefit levels necessitate that we write these plans as noncontributory with Full Family direct integration. In addition, no discounts are available when we quote these benefit levels. Maximum Monthly Benefit We offer a monthly maximum of $10,000 for 10+ plans only; lower amounts (preferably in increments of $1,000) are available. For life groups, the maximum is determined by using the average of the top three salaries. For groups over 50 lives, and standard SICs, a $10,000 benefit is available. Maximums in excess of $10,000 for groups under 50 lives are not available. For groups over 50 lives, contact your Home Office Underwriter. Maximums currently inforce that are over $6,000, the group must still qualify for their requested maximum in order to be eligible for that amount under our plan. Underwriting reserves the right to modify any parameter in order to mitigate our exposure to risk. President $200,000 Vice President $250,000 AVP $100,000 Total $550,000 3 = $183, = $15, $152,277 60%* = $9, *Plan % of Basic Monthly Earnings Each of the top salaries must be capped at $400,000 for purposes of the calculation. To determine top earnings level covered by any given maximum amount, you must divide the maximum by the benefit percentage. For example, a plan providing a benefit of 60% of basic monthly earnings to a maximum of $3,000 would cover monthly salaries to $5,000 ($3,000 divided by.60 = $5,000). The chosen maximum is used to determine the covered payroll of the group. This covered payroll, when multiplied by the rate, determines the monthly cost of the plan. 111

116 Reinsurance Reinsurnace must be obtained by HO for any of the following: Maximums greater than $10,000 Any combination of 3 or more of the following high risk plan features: 1. Contributory 2. COLA 3. Greater than 66 2/3 % benefit 4. Elimination period shorter than 90 days 5. Own Occ 6. Unlimited M & N 7. 70% all source integration 8. Duration greater than SSNRA Waiving of the pre-existing conditions exclusion initially or on a requested increase to the maximum Greater than one million in annual premium Elimination Period The elimination period will influence the cost of the plan (example: shorter elimination periods are the most costly). The elimination period should take into account any Short-Term Disability coverage or salary continuation provided to avoid duplication of benefits. Ideally, we should "dovetail the two. EXAMPLE If Short-Term Disability benefits were provided for up to 13 weeks, then a 90-day elimination period for LTD would be appropriate. Most plans have 90- or 180-day elimination period. Public entities (examples: schools and municipalities) must include elimination period wording to reflect their typically richer and more formal sick leave plans. Their wording should read, days or to the end of the insured s accumulated sick leave, whichever is greater. For schools, the 30-day option is unavailable. Please contact Underwriting for pricing these options as there is often an opportunity to price our plans more competitively due to our mitigated risk. Definitions of Disability Limited Regular Occupation Period This provision provides income protection to insured individuals when they become disabled from their regular occupation for a limited period and from any gainful occupation after that period expires: During the Elimination Period and the Regular Occupation Period, the claimant must be unable to perform the material duties of his or her regular occupation After Elimination Period and following Regular Occupation Period, the claimant must be unable to perform any gainful job for which he or she is reasonably fit by training education or experience and for which he or she could earn 60% or more of his/her pre-disability income Available Regular Occupation Periods: 12 months, 24 months Additional options: 36 months, 60 months, Unlimited* (standard SICs, not available on RQ or BC Plans) *Unlimited Regular Occupation Available only for employees earning in excess of $50,000 in 10+ groups, and subject to SIC code and underwriting review. This is an executive benefit, and is therefore not available to employees who do not meet the outlined criteria. Regular Occupation coverage is extended through the entire benefit duration period. There is never a test of an individual s ability to work at another occupation. 112

117 Core Buy-Up plans Core Buy-up plans need to be rated in Neptune. They are not available to groups less than 100 lives. Definition of Zero-Day Residual The provision allows the employee whom is partially disabled to work on a trial basis immediately, while continuing to satisfy the elimination period. Total disability is never required Earnings threshold to be considered partially disabled is set at 80% of indexed monthly earnings during regular occupation period and 60% of indexed monthly earnings during gainful occupation period. Return-to-Work Incentive Benefit After satisfying the Elimination Period, an insured may work part-time and still be eligible for income replacement of up to 100% of pre disability earnings (between partial earnings and disability income). For the first 12 months, this benefit allows greater earning potential, to incent the individual to continue working to his or her greatest capacity. After 12 months, the partial disability provision switches to that chosen under the plan. Most often, this is the proportionate loss provision. Integration Methods Benefits will be offset by amounts that the insured is eligible for or receives from Other Income Sources. The available integration options are listed below: A. Full Family Direct Offset The LTD benefits are reduced, dollar-for-dollar, by primary and family benefits and all other income benefits related to the disability. Primary and Family is the least expensive integration method and is the most commonly requested and sold LTD integration approach. Example: (PRIMARY & FAMILY): Assumption: 60% of BME to $3,000 Monthly Maximum Benefit Salary: $2,000 per Month Primary & Family Social Security Award: $790 $2,000 Monthly Salary.60 Benefit % = $1,200 Monthly Benefit $1,200 $790 Social Security Award for the Claimant & Family = $ 410 Payable LTD Benefit NOTE: BENEFIT + SOCIAL SECURITY AWARD = 60% OF EARNINGS. B. Primary Direct Offset The LTD benefits are reduced, dollar-for-dollar, by the Primary Insurance Award (PIA) moreover, any other income benefits except for Family Social Security Benefits. Any dependent (Family Social Security) benefits that may be paid are disregarded by the insurer and not used to reduce policy benefits. EXAMPLE (PRIMARY): Assumption: 60% of BME to $2,000 Monthly Maximum Benefit Salary: $2,000 per Month Primary Social Security Award: $650 $2,000 Monthly Salary.60 Benefit % = $1,200 Monthly Benefit $1,200 $650 Social Security Award for the Claimant = $ 550 Payable LTD Benefit NOTE: BENEFIT + SOCIAL SECURITY AWARD = 60% OF EARNINGS. 113

118 C. 70% All Sources Integration This option allows a corridor of other benefits to be paid before any integration occurs. The corridor is usually 10% of the insured s monthly earnings. This approach is intended to provide an upgrade to the Primary and Family benefit. It allows the higher-paid employees to receive a richer benefit. The benefit paid is equal to the least of: The benefit percentage (50 or 60%) of employee s basic monthly earnings with no integration with Other Income Benefits, or 70% of the employee s basic earnings integrated with Other Income Benefits, or The Maximum Monthly Benefit EXAMPLE (PRIMARY): Assumption: 60% of BME to $3,000 Monthly Maximum Benefit Salary: $5,000 per Month Primary & Family Social Security Award: $862 A. 60% of $5,000 BME = $3,000 LTD Benefit B. 70% of $5,000 BME $862 Primary & Family Social Security Award = $2,638 LTD Benefit C. $3,000 LTD Benefit LTD Benefit paid is $2,638 because it is the least of the three calculations. 114

119 Other Income Benefits Other Income Benefits is additional income that a claimant may receive due to their disability or retirement in addition to their LTD benefit. Amounts received from the following are considered deductible sources of income: Worker s compensation law Occupational disease law State compulsory benefit act or law Other Group insurance plans Government retirement system Automobile liability insurance policy Social Security Act Railroad Retirement Act Canada or Quebec pension plans Disability retirement benefits from current employer or at the latest of 62 or normal retirement age The Jones Act (Merchant Marines, etc.) Third party settlements Unemployment Mandatory portion of no-fault motor vehicle plan Salary continuation or sick leave Franchise disability income plans Any similar plan or act For 2-9 Individual Disability Plan Benefits provided to a claimant's dependents because of disability or retirement will be considered for the claimant. NOTE: UNLESS AMERICAN GENERAL IS NOTIFIED TO THE CONTRARY, IT WILL BE ASSUMED THAT THE MAXIMUM FAMILY BENEFIT IS PAID UNDER THESE ACTS OR PLANS. 115

120 Benefit Duration When designing a long-term disability plan, you must determine the maximum length of the benefit period. There are several options to choose from, depending on your client s needs (example: age of the employee population). All options were developed to comply with the Age Discrimination in Employment Act (ADEA). Age 65 (ADEA I) Age At Disability Under 60 Benefit Duration To age 65 but not less than 5 years months months months months months months months months months 69 and over 12 months 116

121 Social Security Normal Retirement Age (SSNRA)-STANDARD Age at which a person qualifies for unreduced Social Security Retirement Benefits. This benefit duration may be slightly longer than Age 65. This option also uses the ADEA I age reduction schedule. SSNRA Benefit Duration Age At Disability Under 60 Benefit Duration To age 65 but not less than 5 years months or to NSSRA, whichever is greater months or to NSSRA, whichever is greater months or to NSSRA, whichever is greater months or to NSSRA, whichever is greater months or to NSSRA, whichever is greater months months months months 69 and over 12 months Other Options Other duration options available include five-year, and two-year. 117

122 Pre-Existing Conditions This means any injury or sickness for which an employee, within the designated number of months before the effective date of coverage under the Group policy, incurred charges, received medical treatment, consultation, care, or services, including diagnostic measures, took prescribed drugs or medicines. The following pre-existing exclusions are subject to state regulations: 3/12 Exclusion (standard) Benefits for disabilities caused by sickness or injury that the employee received treatment for in the three months prior to his effective date of coverage will not be covered unless: o The disability begins more than 12 months after the insured s effective date of coverage. 12/6/24 Exclusion Benefits for disabilities caused by sickness or injury, which the employee received treatment for in the twelve months prior to his effective date of coverage, will not be covered unless: o o The insured was treatment-free for six consecutive months beginning on or after the insured s effective date of coverage; or The disability begins more than 24 months after the insured s effective date of coverage. 3/6/12 Exclusion Benefits for disabilities caused by sickness or injury that the employee received treatment for in the three months prior to his effective date of coverage will not be covered unless: o The insured was treatment-free for six consecutive months beginning on or after the insured s effective date of coverage, or o The disability begins more than 12 months after the insured s effective date of coverage. NOTE: WHEN THE QUOTED GROUP HAS LTD IN FORCE, AND WHEN THEY WANT TO INCREASE THEIR MAXIMUM BY THE GREATER OF 10% OR $1,500, ONLY A 3/6/12 OR 3/12 IS PLACED ON THE INCREASED AMOUNT, EXCEPT IN PENNSYLVANIA. THIS WILL NOT ALLOW ANY PRE- EXISTING ON ANY INCREASE MAXIMUM. Return to Full-Time Work During the Elimination Period The insured can return to full-time work during the elimination period for a specified period without having to begin a new elimination period. The days can be consecutive or intermittent, but they will not count towards satisfaction of the elimination period. Elimination Period More than 90 Days Number of Full-Time Days Allowed 30 days 90 days 15 days 60 days 10 days 30 days 5 days Continuity of Coverage (at Transfer of Coverage) The employee will not lose coverage due to a change in carriers (proof of current coverage will be required at submission). This protects employees who had coverage under the plan we are replacing, during a change in insurance carriers. 118

123 Monthly Earnings Monthly earnings are the monthly compensation from the employer. The monthly earnings definition establishes what earnings will be used to determine both premium and benefits. Our definition of monthly earnings is the monthly compensation from the employer, as noted above. It excludes overtime pay, bonuses, or extra compensation. Commissions may be included and averaged over 24 or 36 months before the disability or the period of employment, whichever is less. If commissions are to be included in the BME definition, the master application must reflect the request. Requests to cover bonus on 10+ plans must be discussed with your Home Office Underwriting contact prior to quote, as this benefit that is not generally available. For partners, the prior year s K-1, W-2, or S-Corp Federal Tax statement will be accepted. Waiting Period The period of employment an employee must satisfy before being eligible for insurance. Cost-of-Living Freeze Once we establish a monthly benefit, we will not further reduce a monthly LTD benefit due to any cost of living increases from other benefit sources. Full Maternity Disability caused by pregnancy or complications of pregnancy is covered as any other sickness. This is standard on all LTD plans from 2+ lives General Exclusions The policy will not cover any disability due to the following: War, declared or undeclared or any act of war Intentionally self-inflicted injuries Active participation in a riot Attempting to commit a crime, or commission of a crime for which the insured has been convicted under state or Federal law Loss of professional license, occupational license or certification Benefits will not be paid while incarcerated Recurrent Disability This allows for the continuation of benefits if an insured returns to work for less than six months and is again disabled by the same or related causes. A new elimination period does not need to be satisfied. The claimant must have been receiving benefits for the disability and must not have become covered under another group policy during the return to work period (continuity of insurance under our plan is required). Mental, Nervous, Drug and Alcohol Limitation/Self Reported Symptoms Limit A disability resulting from mental, nervous, alcoholism or drug abuse illness is limited to 24 months lifetime benefit, unless the patient is hospital confined. A separate 24 month lifetime benefit also standardly applies for all disabilities resulting from self reported symptoms. 119

124 Survivor Benefit If a claimant's disability has lasted for 180 consecutive days or more and he dies, we will pay a survivor benefit. Our standard Survivor Benefit pays a lump sum of 3 times the gross monthly benefit. Waiver of Disability Premium Premium is waived while benefits are payable. Premium is due during the elimination period. Minimum Monthly Benefit The insured, if eligible to receive benefits, will never receive less than the minimum monthly benefit. Options are the following: Greater of $100 or 10% of gross monthly benefit (standard) $50 (10+ only) $100 (10+ only) Rate Guarantee All plans have a standard 2-year rate guarantee. However, 1-year may be available. Cost-of-Living Adjustment (COLA) (Optional for 10+ groups ONLY) This provision is an option for 10+ plans only. We will make a cost of living adjustment after the employee is disabled for the number of years defined in the group policy. The payment will be increased by a defined percent on the anniversary date for a defined number of adjustments such as 5 or 10. COLA is not available with benefit percentages of 66 2/3% or 70%. In addition, it should only be offered on employer-funded plans. This provision is subject to the maximum benefit amount under the plan. Conversion This provision allows insured individuals to convert LTD benefits to group LTD policies at their time of termination. The benefits under conversion plan are as follows: 60% to 2000 max (if 50% plan currently, 50% will remain) $50 minimum benefit 180-day elimination period 2-year RBD Primary and Family integration Any occupation Maternity 3-month survivor benefit Catastrophic Benefit This benefit pays an additional percentage, on top of the regular monthly benefit, to employees who qualify under BOTH the standard definition of disability and the catastrophic definition of disability. The catastrophic definition of disability requires the inability to perform 2 or more ADLs, presence of a cognitive impairment, or diagnosis of a terminal illness. 120

125 Quoting Checklists Please consult the following checklist for each new case, prior to beginning the quote process. Once there is a no response, obtain clearance from a Home Office Underwriter and if all answers are yes, the proposal can be developed and released. Eligible Groups Is this an employer/employee group? Is it a corporation, partnership, or sole proprietorship? Have you confirmed that the group is not an association, trusteeship, joint venture, Taft- Hartley group (union members), a co-op, or affinity group? Has the group been in business for 2 or more years? Are all of the covered employees living and working in the USA? Are all of the employee s eligible to participate in Social Security? Are less than 50% of the covered employees members of the same family? Is the blue-collar content less than 80%? Have you confirmed that there is no coverage on political entities, and/or elected or appointed government officials? Have you confirmed that the employer is not an employee leasing company or PEO? Have you confirmed none of the insureds are members of the clergy or religious order? Eligible Employees Are all of the employee s active full-time 30+ hours per week? Are all part-time, temporary, seasonal workers, elected officials, and contract workers excluded? Are all directors, partners, owners, contractors, consultants to also be covered employees? 121

126 Quoting Procedures 1. Group Information Screen Proposed effective date of coverage Group s proper name, address, nature of business(sic). Each submitted sold case contains an EMIS /onesource report. Number of Eligible Employees and Number of Insured Employees. A group must have at least 2 insured employees to quote our products. Weekly Hours Worked # of Years in Business Current Insurance Carrier (if known) # of Classes (all partnership groups must separate the partners into their own class, rated as contributory) 2. Select Products Screen Products are grouped as follows: Employer-Funded Group: Noncontributory and partially contributory coverage we require a minimum participation of 75% if contributory, 100% if noncontributory Employee-Paid Group: 100% Employee Funded Products Employee-Paid Individual Products 3. Census Information Screen The following information may be manually entered or imported from an Excel spreadsheet: Name Age/DOB Sex Salary Occupation Code (Professional, White, Gray, Skilled or Unskilled) State ZIP 4. Choose Benefits Screen Select the plan design for the coverages you are quoting. State restrictions may limit some availability. 5. Calculate Rates and Build Proposal Rates and plan design will be displayed, and you may build a proposal that will allow you to , print and save the quote you have created. 122

127 Medical Underwriting Requirements for LTD Amounts Subject to EOI (Employer or Employee-Paid) Face Amount Ages < $3,000 A A A I $3,001 to $6,000 $6,001 to $10,000 $10,001 to $20,000 Notes: C C C C + I G G G G + I H H + I H + I H + I A B C D E F G H I Application Application, full blood profile, urinalysis Application, full blood profile, urinalysis & expanded ID** Application, full blood profile, urinalysis, paramedical exam Application, full blood profile, urinalysis, paramedical exam, EKG Application, full blood profile, urinalysis, MD exam***, EKG Application, full blood profile, urinalysis, paramedical exam, financial Application, full blood profile, urinalysis, paramedical exam, EKG, financial Application, Attending Physician Statement (APS)* * APS also required for these amounts and ages ** The expanded ID consists of the height and weight, blood pressure readings and the pulse *** The heart section should be completed for all MD exams Financials: Either prior year s tax return or W2 Additional requirements may be requested at the underwriter s discretion. 123

128 General Industry Categories Standard Industry Solid industry with expectations of reasonably profitable experience. Classify any Standard Industry that has 40% or more "Blue-Collar" content (both Skilled and Unskilled) as a Restricted Quote Industry. Restricted Quote Industry Quotable with one of the plan designs shown below. Benefit Selections Restricted Quote plan design Elimination Period 90 days; 180 days Benefit Percentage 40%; 50%; 60% Maximum Monthly Benefit $6,000 maximum Minimum Monthly Benefit $50; $100; Greater of $100 or 10% of GMB Benefit Duration SSNRA; Age 65 (ADEA); 2 years; 5 years Regular occupation Period 12 months; 24 months Catastrophic Disability Excluded Cost of Living Adjustment Not available Integration Primary and family Pre-existing Condition Limitation 3/12*; 12/6/12; 12/12; 12/24; 3/6/12; 3/3/24; 3/6/24; 6/12; 6/24 (*3/12 not available with 40% or more blue collar content) Earnings Test 80%/60% only Definition of Disability Material duties and 20% earnings loss Decline to Quote: Not eligible for an LTD Quote We have determined that the following types of groups present an unacceptable risk regardless of their industry classification: Groups that do not comply with the statutes of the jurisdiction in which the policy will be issued Groups in which the policyholder cannot or will not assume the necessary contractual responsibility or administrative functions of a group policyholder Firms in financial difficulties Non-employer/employee groups such as health and welfare funds, unions, etc. Blue-collar union employees are not normally eligible for coverage. White-collar union employees will be underwritten, provided they comprise less than 60% of the eligible group (exception: unionized school districts). Underwriting must approve entertainment groups and sports teams Any business that has been in existence for less than two years Any group heavily financed by Federal, state, or local government entities or those which are heavily dependent on the procurement of government contracts (generally 50% or greater) Groups not covered under the Social Security program, unless covered by some other government contracts such as PERS 124

129 Special Circumstance Underwriting Guidelines Insurance Brokerage/Agents We should employ a long eligibility waiting period to minimize the effect of high turnover. Experience has illustrated that high turnover poses an undesirable risk for Disability coverage. Therefore, we would prefer writing eligibility waiting periods for these groups in excess of three months. Foreign Nationals Foreign Nationals employed by a U.S. company and living in the United States are acceptable as long as these employees do not comprise more than 10% of the group. Foreign Nationals employed by a U.S. company and living outside of the United States are unacceptable. As an American General company, however, we can usually cover these individuals through our extensive presence in the overseas employee benefits arena. Contact your American General Group Sales Office for details. Expatriates (U.S. Citizens Working Outside of the United States) Employees working outside the United States are normally not eligible, unless their time overseas is for a designated short period of time (example: six months or less). Similar to our treatment of Foreign Nationals, we can usually cover these individuals through our extensive presence in the overseas employee benefits arena. Contact your American General Group Sales Office for details. Public Employees Retirement System (PERS)/State Teachers Retirement System (STRS) Participants These programs are available to state and municipal employees in lieu of or in addition to Social Security Retirement benefits and not disability coverage are the primary thrust of these programs. Benefits vary by state and municipality. Please contact the American General Large Group Underwriting Unit in Neptune for specific rating instructions that may be applicable for groups over 100 lives Groups Subject To Seasonal Fluctuations (Example: Resorts) Only long-term, full-time employees should be covered and not temporary employees hired during a busy season. To accomplish this, we require a 6-month eligibility waiting period on both present and future employees. Auto Dealers New auto dealers are acceptable, as long as we incorporate certain plan features. These include a maximum 2-year Regular Occupation. For employees, except for management personnel, the definition of earnings for commissions must be an average of the prior 24 months. There must be at least a 90-day waiting period on present employees and at least a 180-day waiting period on future employees. Car salespeople are considered to be blue-collar skilled employees. 125

130 Non-Profit Organizations A nonprofit organization is one that has committed legally not to distribute any net earnings (profits) to individuals with control over it such as members, officers, directors, or trustees however; it may pay them for services rendered and goods provided. Its purpose is usually to serve a public or mutual benefit other than the pursuit or accumulation of profits for owners or investors. Examples of NPO s are: charities, trusts, foundations, When quoting on NPOs, we need to be concerned with three factors: 1. Longevity; 2. Financing; 3. Occupations. 1. Length of time in business: Three Years or less More than three years, but less than 10 years Nonprofit letters are required if company has been is in business less than three years. Please have an officer of the company provide on company letterhead, all sources of income and funding and the percentage from each source. Less scrutiny (i.e. Mix and balance of funding sources not as crucial). Funding letter optional and up to the discretion of the Underwriter. Ten plus years Funding analysis not necessary however up to discretion of Underwriter. 2. Financing The majority of the financing should not be dependent on one source, such as Federal, State, or Local governments. EXAMPLE: Funding comes from a primarily Democratic government. A new party takes over with different views and the funding for this group is cut. A good guideline to follow is that one source should not be responsible for more than 50% of the funding for the NPO. 3. Occupations Full-time, white-collar occupations preferred. Non White Collar occupations may be acceptable. Review of occupations will be used to determine correct SIC for group and acceptable plan design. For these reasons, Non-Profits and Social Services must be called in to your Home Office Underwriting Contact prior to quote. Research sources: NPO portal which includes a search engine. Details include: Mission and Purpose, Historical background, and Tax filing (which includes funding sources). Organizational website Generally greater detail regarding historical information and purpose. Some disclose funding sources. Municipalities Limited Plan Design Same as the Restricted Quote Plan Design, except as noted below. Elimination period has or to end of accumulated sick leave included. Regular benefit durations apply. Special Underwriting Guidelines for Municipalities 10-1,000 lives only Entire systems only No elected officials Police/Firefighters must not comprise more than 20% of the group 126

131 NOTE: THE GUIDELINES PRESENTED IN THIS MANUAL ARE GENERAL AND, UNDER CERTAIN FAVORABLE UNDERWRITING CIRCUMSTANCES, WE WILL GRANT EXCEPTIONS IN ORDER TO UNDERWRITE A DESIRABLE RISK. WHEN IN DOUBT, ALWAYS CONTACT EITHER YOUR REGIONAL SALES OFFICE OR HOME OFFICE UNDERWRITING CONTACT. 127

132 OCCUPATION CODING The various characteristics of occupations have an impact on our expected incidence of Long-Term Disability insurance claims. The most obvious occupational risk cons iteration is the risk of occupational injury or sickness inherent in the duties of a particular occupation. Such hazards can be physical, like a welder working on a high-rise building, or mental, such as a commissioned sales representative who is under constant stress to make sales. The incidence rate of disabilities is generally higher among blue-collar workers than it is for white-collar workers. However, the impact of a claim on a blue-collar worker may not cost as much as for a whitecollar worker because the maximum benefit payable is generally lower. The experience among blue-collar workers is largely traceable to the additional exposure of on-the-job hazards. The blue-collar workers, more often the unskilled ones, usually are involved with routine or repetitive forms of work that may tend to make them less career-oriented and thus apt to take advantage of borderline medical conditions. Therefore, it is important to consider keeping the plan design limited when quoting these risks. Specific Occupational Notes Supervisor/Foreman Sometimes there is difficulty in determining the blue-collar level of a foreman or supervisor. A good rule of thumb is to put the foreman/supervisor one blue-collar level above the employees they supervise. For example, if we are covering a group of employees classified as unskilled blue-collar workers, we should classify their supervisor in the skilled blue-collar category. Occupational Categories Occupational content is based on covered payroll, not number of lives. Professional (White)-Collar White-Collar Gray-Collar Blue-Collar (Skilled) Blue-Collar (Unskilled) 128

133 Occupational Classes For occupations that are not specifically listed below, the individual assigning occupational codes should use their best judgment to select the category that is the closest fit. I. Professional-Collar Includes persons engaged in upper-level business management and professionals. These positions generally require a minimum 4 year college degree and extensive experience in that business or field. The following occupations if annual salary is at least $80,000 (if < $80,000 class as White Collar): Account/Portfolio Manager Accountant/Financial Personnel Actuary Administrator Advertising Agent Architect Computer Programmer Consultant Controller Department Head Engineer - Chemical, Civil, Mechanical, Electrical Executives Financial Analyst Officers of the Company Presidents Vice Presidents 2. White-Collar Includes persons engaged in business management, professionals and most others who work in an office environment. Positions generally require a college degree or experience in that business or field. In addition, strenuous manual labor duties are typically not required in these occupations. Announcer (Radio/TV) Mail Clerk Appraiser/Estimator Manager (in office only) Administrative Assistant Office Manager Artist Officer Buyer/Purchasing Agent Pharmacist Bank Teller Photographer Chaplain/Pastor/Minister Plant Manager Chemist(except maintenance & production) Programmer Computer Operator Psychiatrist/Psychologist Bookkeeper Receptionist Cashier (office only) Sales (office environment) Data Entry Clerk Scientist Designer Secretary Draftsman Stock Broker/Bond Trader Editor Superintendent, white collar Engineer, Radio/TV Supervisor, white collar Executive Teacher/Professor Funeral Director/Mortician Technician (sedentary office duties) Geologist, no field duties Therapist (ex. Phys./Occ./Voc.) Insurance Broker Underwriter Interior Decorator Veterinarian Librarian Word Processor All of the occupations listed in the Professional Class if annual salary is less than $80,

134 3. Grey-Collar Includes employees who are engaged in non-hazardous occupations outside of an office environment, and who need specific skills and extensive training to perform their occupation. These positions may be either salaried or hourly paid They have light or limited manual duties. This occupational category reflects some of the potential for transferability of skills present in white collar occupations. However, the manual duties required in these jobs do result in higher incidence of claim and could limit return to work/rehabilitation opportunities. Assembler (high tech) Attorney Chemist (Maintenance and Production) Computer Technician Construction Superintendent Dispatcher Dental Hygienist/Assistant Dentists Manager (out of office, ex., Fast Food, Retail, Supermarket, Theater Manager) Machine Repair (Office) Medical/Lab/Pharmacy Technician Machine Repair (Office) Physicians/Doctors Paralegal Pilot Reporter Real Estate Agents Sales (outside office environment) Service Representative (in Office/No manual duties) Social Worker Supervisor/Foreman of Skilled Class employees Surgeon Teachers Aide 4. Blue-Collar Skilled Skilled Crafts & Labor: Workers of high level who are required to have a thorough and comprehensive knowledge of the process involved in their work. Jobs in this classification are usually paid on an hourly basis. Duties include physical or manual responsibilities not performed in an office environment. It is not uncommon for there to be some exposure to accidental injury and/or adverse working conditions. Machinist Assembler (not high tech) Auto Body Repair Mechanic Baker Meter reader Barber/Hair Dresser Nurses (LPN, LVN, LGN, RN) Butcher Paramedic/EMT Cabinet Maker Plumber/Pipe fitter Cafeteria/Kitchen Worker Pressman/Printer Carpenter Production Worker Chef Quality Control Inspector Cook Repairman Counter Clerk/ Sales (Retail) Driver (Short Haul) Service Representative (manual duties) Electrician Service Station Manager Engineer, Operating Supervisor/Foreman of unskilled class employees Flight Attendant Surveyor General Contractor Tailor Grocery Clerk Tool Maker/Die Maker Groundskeeper Tool Pusher Installer Tradesmen Kitchen Worker Typesetter Landscaper Welder Machine Repair (Non-office) 130

135 5.-Blue-Collar Unskilled These occupations involve hazardous, stressful, or heavy manual duties, and often require the application of little or no independent judgment. Duties are often elementary and can be learned in a few days or have a high risk of on the job injury. Service employees, with extensive exposure to the public, are included in this category of occupations. Air Traffic Controller Bartender Child Care Worker Dock Worker (Longshoreman, Stevedores) Driller Driver (Bus, Long Haul, Taxi, Delivery) Drywall Installer Entertainment Worker (Actor, Musician) Exterminator Farm/Diary Worker Fireman Fisherman Gardener Gas Station Worker Heavy Equipment Operator Inventory Clerk (manual duties) Janitor/Custodian Laborer Lineman/Cable Worker Logger Maintenance Mason/Tile Layer Messenger Mill Worker Miner Nurses Aide/Orderly Oil Driller Packing/Material Handler Painter Policeman Poultry Plant Processor Quarryman Residential Real Estate Agent/Broker Roofer Sales (outside office environment, ex. Door-to-door) Security Guard Shipping & Receiving Clerk Sport Pro/Coach Steel Worker Stock Clerk Waiter/Waitress Warehouseman/Clerk Window Washer Unacceptable Risks These jobs are usually characterized by six categories of exposure: There is a high risk of accidental injury Examples: Logging, subsurface mining or construction, law enforcement, firefighting, explosives or military service The work may be very physically demanding Examples: Household movers, farm laborers, and professional athletes There is a very high degree of mental stress Example: Air traffic controllers There may be exposure to an adverse and/or dangerous working environment Examples: Hazardous materials handlers, high elevations, exposure to heat, cold or airborne particulate matter The jobs demand that a very high standard of physical fitness be maintained Examples: Pilots, common carriers, police, fire, and professional athletes The skills required are such that a minor injury or impairment may be disabling Examples: Entertainers, musicians, and professional athletes 131

136 Unacceptable Occupations (All-Size Groups) Air Traffic Controller Government Employee (Federal/State) Dock Worker (Longshoremen, Stevedores) Tugboat, Barge, River and Harbor Pilots Natural Resources Worker (Logger, Fisherman, Quarryman, Miner) Entertainment Worker (Actor, Musician) Exterminator Oil Driller Farm/Dairy/Ranch Worker Gas Station Worker Steel Worker Traders on the floor of any stock or commodity Professional Athletes SIC-Standard Industry Code All SIC s must make sense and represent the group s nature of business as close as possible. Job titles should always be reviewed to confirm the recommended SIC. Sources that should be used in verifing an SIC are as follows: EMIS Dunn & Bradstreet Selectory Hoovers Google Job titles Key to abbreviations on SIC chart: S: Standard Mgt. only: Management only PWG only: Professional; White; Grey only DTQ: Decline to quote HO: Home office 132

137 SIC Listing Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Wheat 111 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Rice 112 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Corn 115 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Soybeans 116 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Cash Grains, N.E.C. 119 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Cotton 131 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Tobacco 132 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Sugar Crops 133 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Irish Potatoes 134 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Field Crops (No Cash Grains) 139 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Vegetables and Melons 161 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Berry Crops 171 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Grapes 172 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Tree Nuts 173 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Citrus Fruits 174 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Deciduous Tree Fruits 175 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Fruits and Tree Nuts, N.E.C. 179 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Ornamental Floriculture 181 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Food Crops Grown Under Cover 182 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S General Farms, Primarily Crop 191 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Beef Cattle Feedlots 211 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Beef Cattle (No Feedlots) 212 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Hogs 213 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Sheep and Goats 214 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S General Livestock (No Dairy Poultry) 241 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Dairy Farms 241 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Broiler, Fryer & Roaster Chickens 251 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Chicken Eggs 252 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Turkey & Turkey Eggs 253 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S 133

138 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Poultry Hatcheries 254 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Poultry & Eggs, N.E.C. 259 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Fur-Bearing Animals & Rabbits 271 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Horses & Other Equines 272 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Animal Aquaculture 273 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Animal Specialties, N.E.C. 279 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S General Farms, Primarily Livestock 291 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Soil Preparation Services 711 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Crop Planting, Cultivating & Protection 721 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Crop Harvesting, Primarily by Machine 722 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Crop Preparation Services (No Cotton) 723 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Cotton Ginning 724 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Veterinary Services for Livestock 741 Mgt only PWG only Mgt only S S S S S S Veterinary Services, Animal Specialties 742 S S S S S S S S S Livestock Services (No Specialty) 751 S RQ Mgt only S S S S S S Animal Specialty Services 752 S RQ Mgt only S S S S S S Farm Labor Contractors & Crew Leaders 761 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Farm Management Services 762 Mgt only RQ Mgt only Mgt only Mgt only Mgt only S S S Landscape Planning & Counseling 781 Mgt only RQ Mgt only Mgt only Mgt only Mgt only S S S Lawn & Garden Services 782 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Ornamental Shrub & Tree Services 783 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Timber Tracts 811 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Forest Products 831 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Forestry Services 851 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Finfish 912 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Shellfish 913 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Miscellaneous Marine Products 919 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Fish Hatcheries & Preserves 921 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Hunting, Trapping & Game Propagation 971 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Iron Ores 1011 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Copper Ores 1021 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Lead & Zinc Ores 1031 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ 134

139 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Gold Ores 1041 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Silver Ores 1044 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Ferroalloy Ores (No Vanadium) 1061 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Metal Mining Services 1081 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Uranium/Radium/Vanadium Ores 1094 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Metal Ores, N.E.C Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Bituminous Coal & Lignite SURF 1221 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Bituminous Coal & Lignite UNDGO 1222 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Anthracite Mining 1231 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Coal Mining Services 1241 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only DTQ DTQ DTQ Crude Petroleum & Natural Gas 1311 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Natural Gas Liquids 1321 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Drilling Oil & Gas Wells 1381 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Oil & Gas Field Exploration Services 1382 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Oil & Gas Field Services, N.E.C Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Dimension Stone 1411 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Crushed & Broken Limestone 1422 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Crushed & Broken Granite 1423 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Crushed & Broken Stone, N.E.C Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Construction Sand & Gravel 1442 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Industrial Sand 1446 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Kaolin & Ball Clay 1455 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Clay, Ceramic & Refractory Minerals 1459 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Potash, Soda, & Borate Minerals 1474 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Phosphate Rock 1475 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Chemical & Fertilizer Mineral mining 1479 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Nonmetallic Minerals Services (No Fuel) 1481 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Miscellaneous Nonmetallic Minerals 1499 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only General Contractors Single-Family Houses 1521 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S General Contractors Residential Building 1522 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Operative Builders 1531 S RQ S S S S S S S 135

140 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary General Contractors Industrial/Warehouses 1541 S RQ S S S S S S S General Contractors Non-Residential & Other 1542 S RQ S S S S S S S Highway & Streets (No Elevated Highways) 1611 Mgt only PWG only Mgt only S S S S S S Bridge, Tunnel & Elevated Highways 1622 Mgt only PWG only Mgt only S S S S S S Water Sewer Pipeline Communication & Power 1623 Mgt only PWG only Mgt only S S S S S S Heavy Construction, N.E.C Mgt only PWG only Mgt only S S S S S S Plumbing & Heating 1711 S RQ S S S S S S S Painting, Paper Hanging & Decorating 1721 Mgt only RQ S S S S S S S Electrical Work 1731 S RQ S S S S S S S Masonry, Stone Setting & Other Stonework 1741 Mgt only RQ S S S S S S S Plastering, Drywall, Acoustic & Insulation 1742 Mgt only RQ S S S S S S S Terrazzo, Tile, Marble & Mosaic Work 1743 Mgt only RQ S S S S S S S Carpentering 1751 Mgt only RQ S S S S S S S Floor Laying & Other Floor Work, N.E.C Mgt only RQ S S S S S S S Roofing & Sheet Metal Work 1761 Mgt only RQ S S S S S S S Concrete Work 1771 Mgt only RQ S S S S S S S Water Well Drilling 1781 Mgt only RQ S S S S S S S Structural Steel Erection 1791 Mgt only PWG only Mgt only S S S S S S Glass & Glazing Work 1793 Mgt only PWG only Mgt only S S S S S S Excavating & Foundation Work 1794 Mgt only PWG only Mgt only S S S S S S Wrecking & Demolition Work 1795 Mgt only PWG only Mgt only S S S S S S Installation of Erection Building Equipment 1796 Mgt only PWG only Mgt only S S S S S S Special Trade Contractors, N.E.C Mgt only PWG only Mgt only S S S S S S Meat Packing Plants 2011 Mgt only PW only Mgt only Mgt only Mgt only Mgt only S S S Sausages & Other Prepared Meat Products 2013 Mgt only PW only Mgt only Mgt only Mgt only Mgt only S S S Poultry Slaughtering and Processing 2015 Mgt only PW only Mgt only Mgt only Mgt only Mgt only S S S Creamery Butter 2021 S S S S S S S S S Cheese, Natural & Processed 2022 S S S S S S S S S 136

141 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Condensed & Evaporated Milk 2023 S S S S S S S S S Ice Cream & Frozen Desserts 2024 S S S S S S S S S Fluid Milk 2026 S S S S S S S S S Canned Specialties 2032 S S S S S S S S S Canned Fruits, Vegetables, Preserves 2033 S S S S S S S S S Dried & Dehydrated Fruits, Veggies & Soup 2034 S S S S S S S S S Pickled Fruits, Veggie Sauces & Seasonings 2035 S S S S S S S S S Frozen Fruits, Juices & Vegetables 2037 S S S S S S S S S Frozen Specialties 2038 S S S S S S S S S Flour & Other Grain Mill Products 2041 S S S S S S S S S Cereal Breakfast Foods 2043 S S S S S S S S S Rice Milling 2044 S S S S S S S S S Blended & Prepared Flour 2045 S S S S S S S S S Wet Corn Milling 2046 S S S S S S S S S Dog, Cat & Other Pet Food 2047 S S S S S S S S S Prepared Feeds & Ingredients for Animals 2048 S S S S S S S S S Bread & Bakery Products (No Cookies/Crackers) 2051 S S S S S S S S S Cookies & Crackers 2052 S S S S S S S S S Frozen Bakery Products (No Bread) 2053 S S S S S S S S S Cane Sugar (No Refining) 2061 S S S S S S S S S Cane Sugar Refining 2062 S S S S S S S S S Beet Sugar 2063 S S S S S S S S S Candy & Other Confectionery Products 2064 S S S S S S S S S Chocolate & Cocoa Products 2066 S S S S S S S S S Chewing Gum 2067 S S S S S S S S S Salted & Roasted Nuts & Seeds 2068 S S S S S S S S S Cottonseed Oil Mills 2074 S S S S S S S S S Soybean Oil Mills 2075 S S S S S S S S S Vegetable Oil Mills (No Cottonseed/Corn/Soy) 2076 S S S S S S S S S 137

142 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Animal & Marine Fats & Oils 2077 S S S S S S S S S Shortening, Table Oils, Margarine 2079 S S S S S S S S S Malt Beverages 2082 S S S S S S S S S Malt 2083 S S S S S S S S S Wines, Brandy & Brandy Spirits 2084 S S S S S S S S S Distilled, Rectified & Blended Liquors 2085 S S S S S S S S S Bottled, Canned, Carbonated Drinks 2086 S S S S S S S S S Flavoring extracts & Syrups, N.E.C S S S S S S S S S Canned & Cured Fish & Seafood's 2091 S S S S S S S S S Fresh or Frozen Packaged Fish & Seafood 2092 S S S S S S S S S Roasted Coffee 2095 S S S S S S S S S Potato Chips & Similar Snacks 2096 S S S S S S S S S Manufactured Ice 2097 S S S S S S S S S Macaroni, Spaghetti, Vermicelli & Noodles 2098 S S S S S S S S S Food Preparations N.E.C S S S S S S S S S Cigarettes 2111 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Cigars 2121 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Tobacco, Chewing & Smoking Snuff 2131 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Tobacco Steaming & Re-Drying 2141 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Broad Woven Fabric Mills, Cotton 2211 S RQ S S S S S S S Broad Woven Fabric Mills, Man-Made Fabric 2221 S RQ S S S S S S S Broad Woven Fabric Mills, Including Dyeing 2231 S RQ S S S S S S S Narrow Fabrics & Other Smallware Mills 2241 S RQ S S S S S S S Woman's Full-Length & Knee-High Hosiery 2251 S RQ S S S S S S S Hosiery (No Pantyhose) 2252 S RQ S S S S S S S Knit Outerwear Mills 2253 S RQ S S S S S S S Knit Underwear Mills 2254 S RQ S S S S S S S Circular Knit Fabric Mills 2257 S RQ S S S S S S S Wrap Knit Fabric Mills 2258 S RQ S S S S S S S 138

143 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Knitting Mills, N.E.C S RQ S S S S S S S Finishers of Broad Woven Fabric of Cotton 2261 S RQ S S S S S S S Finishers of Broad Woven Man-Made Fiber 2262 S RQ S S S S S S S Finishers of Textiles, N.E.C S RQ S S S S S S S Carpets and Rugs 2273 S RQ S S S S S S S Yarn Spinning Mills 2281 S RQ S S S S S S S Yarn Texturizing, Throwing, Twisting 2282 S RQ S S S S S S S Thread Mills 2284 S RQ S S S S S S S Coated Fabrics, Non-Rubberized 2295 S RQ S S S S S S S Tire Cord & Fabric 2296 S RQ S S S S S S S Non-Woven Fabrics 2297 S RQ S S S S S S S Cordage & Twine 2298 S RQ S S S S S S S Textile Goods, N.E.C S RQ S S S S S S S Men's, Boys Suits, Coats & Overcoats 2311 S S S S S S S S S Men's, Boys Shirts 2321 S S S S S S S S S Men's, Boys Underwear 2322 S S S S S S S S S Men's, Boys Neckwear 2323 S S S S S S S S S Men's, Boys Sep Pants & Slacks 2325 S S S S S S S S S Men's, Boys Work Clothing 2326 S S S S S S S S S Men's, Boys Clothing, N.E.C S S S S S S S S S Women's, Misses Blouses & Shirts 2331 S S S S S S S S S Women's, Misses Dresses 2335 S S S S S S S S S Women's, Misses Suits, Skirts, Coats 2337 S S S S S S S S S Women's, Misses Outerwear 2339 S S S S S S S S S Women's, Misses Underwear 2341 S S S S S S S S S Corsets & Allied Garments 2342 S S S S S S S S S Hats, Caps, Millinery 2353 S S S S S S S S S Children Dresses, Blouses, Shirts 2361 S S S S S S S S S Children's Outerwear 2369 S S S S S S S S S Fur Goods 2371 S S S S S S S S S Dress & Work Gloves (No Knit /Leather) 2381 S S S S S S S S S 139

144 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Robes & Dressing Gowns 2384 S S S S S S S S S Raincoats & Other Waterproof Garments 2385 S S S S S S S S S Leather & Sheep-Lined Clothing 2386 S S S S S S S S S Apparel Belts 2387 S S S S S S S S S Apparel & Accessories, N.E.C S S S S S S S S S Curtains & Draperies 2391 S S S S S S S S S House Furnishings 2392 S S S S S S S S S Textile Bags 2393 S S S S S S S S S Canvas & Related Products 2394 S S S S S S S S S Pleating, Decorative & Novelty Stitching 2395 S S S S S S S S S Automotive Trimmings & Related Products 2396 S S S S S S S S S Schiffi Machine Embroideries 2397 S S S S S S S S S Fabricated Textile Products 2399 S S S S S S S S S Logging Camps & Contractors 2411 DTQ DTQ DTQ DTQ DTQ DTQ S S S Sawmills & Planing Mills General 2421 DTQ DTQ DTQ DTQ DTQ DTQ S S S Hardwood Dimension & Flooring Mills 2426 DTQ DTQ DTQ Mgt only Mgt only Mgt only S S S Special Products Sawmills, N.E.C DTQ DTQ DTQ Mgt only Mgt only Mgt only S S S Millwork 2431 S S S S S S S S S Wood Kitchen Cabinets 2434 S S S S S S S S S Hardwood Veneer & Plywood 2435 S S S S S S S S S Softwood Veneer & Plywood 2436 S S S S S S S S S Structural Wood Members, N.E.C S S S S S S S S S Nailed & Lock-Corner Wood Boxes 2441 S S S S S S S S S Wood Pallets & Skids 2448 S S S S S S S S S Wood Containers, N.E.C S S S S S S S S S Mobile Homes 2451 S S S S S S S S S Prefabricated Wood Buildings 2452 S S S S S S S S S Wood Preserving 2491 S S S S S S S S S Reconstituted Wood Products 2493 S S S S S S S S S Wood Products, N.E.C S S S S S S S S S Wood Households Furniture (No Upholstery) 2511 S S S S S S S S S 140

145 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Wood Household Furniture, Upholstered 2512 S S S S S S S S S Metal Household Furniture 2514 S S S S S S S S S Mattresses & Bedsprings 2515 S S S S S S S S S Wood TV, Radio, Phonograph, Sewing Cabinets 2517 S S S S S S S S S Household Furniture, N.E.C S S S S S S S S S Wood 2521 S S S S S S S S S Metal Office Furniture 2522 S S S S S S S S S Public Buildings & Related Furniture 2531 S S S S S S S S S Wood Partitions, Shelves, Lockers, Files 2541 S S S S S S S S S Metal Partitions, Shelves, Lockers, Files 2542 S S S S S S S S S Drapery Hardware, Blinds & Shades 2591 S S S S S S S S S Furniture & Fixtures, N.E.C S S S S S S S S S Pulp Mills 2611 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Paper Mills (No Building) 2621 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Paperboard Mills 2631 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Set-Up Paperboard Boxes 2652 S S S S S S S S S Corrugated & Solid Fiber Boxes 2653 S S S S S S S S S Fiber Cans, Tubes, Drums, & Related Prod S S S S S S S S S Sanitary Food Containers 2656 S S S S S S S S S Folding Paperboard Boxes 2657 S S S S S S S S S Coated & Laminated Packaging Paper 2671 S S S S S S S S S Coated & Laminated Packaging Paper, N.E.C S S S S S S S S S Bags Plastic, Laminated & Coated 2673 S S S S S S S S S Bags Uncoated, Paper & Multi-Wall 2674 S S S S S S S S S Die-Cut Paper & Board 2675 S S S S S S S S S Sanitary Paper Products 2676 S S S S S S S S S Envelopes 2677 S S S S S S S S S Stationery Products 2678 S S S S S S S S S Converted Paper Products, N.E.C S S S S S S S S S Newspapers Publishing & Printing 2711 S S S S S S S S S 141

146 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Periodicals Publishing & Printing 2721 S S S S S S S S S Books Publishing & Printing 2731 S S S S S S S S S Book Printing 2732 S S S S S S S S S Miscellaneous Publishing 2741 S S S S S S S S S Printing, Lithographic 2752 S S S S S S S S S Printing, Gravure 2754 S S S S S S S S S Commercial Printing, N.E.C S S S S S S S S S Manifold Business Forms 2761 S S S S S S S S S Greeting Card Publishing 2771 S S S S S S S S S Blankbooks, Looseleaf Binders & Devices 2782 S S S S S S S S S Bookbinding & Related Work 2789 S S S S S S S S S Typesetting 2791 S S S S S S S S S Platemaking Services 2796 S S S S S S S S S Alkalis & Chlorine 2812 Mgt only RQ Mgt only S S S S S S Industrial Gases 2813 Mgt only RQ Mgt only S S S S S S Inorganic Pigments 2816 Mgt only RQ Mgt only S S S S S S Industrial Inorganic Chemical, N.E.C Mgt only RQ Mgt only S S S S S S Plastics, Synthetic Resins, Elastomers 2821 S S S S S S S S S Synthetic Rubber, Vulcanizable Elastomer 2822 S S S S S S S S S Cellulosic Man-Made Fibers 2823 S S S S S S S S S Synthetic Organic Fibers (No Cellulosic) 2824 S S S S S S S S S Medicinal Chemical & Botanical Products 2833 S S S S S S S S S Pharmaceutical Preparations 2834 S S S S S S S S S Diagnostic Substances 2835 S S S S S S S S S Bio Products (No Diagnostic) 2836 S S S S S S S S S Soap & Other Detergents (No Specialty) 2841 S S S S S S S S S Specialty Cleaning, Polishing, Sanitation 2842 S S S S S S S S S Surface Active, Finishing, Sulfon Agents 2843 S S S S S S S S S Perfumes, Cosmetics, Toiletries 2844 S S S S S S S S S Paints, Varnishes, Lacquers, Enamels 2851 S S S S S S S S S 142

147 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Gum & Wood Chemicals 2861 S S S S S S S S S Cyclic Crudes, Dyes, Organic Pigments 2865 S S S S S S S S S Industrial Organic Chemical, N.E.C S S S S S S S S S Nitrogenous Fertilizers 2873 Mgt only PWG only Mgt only S S S S S S Phosphatic Fertilizers 2874 Mgt only PWG only Mgt only S S S S S S Fertilizers, Mixing Only 2875 Mgt only PWG only Mgt only S S S S S S Pesticides & Agricultural Chemicals, N.E.C Mgt only PWG only Mgt only S S S S S S Adhesives & Sealants 2891 Mgt only PWG only Mgt only S S S S S S Explosives 2892 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Printing Inks 2893 S S S S S S S S S Carbon Black 2895 S S S S S S S S S Chemical & Chemical Preparations, N.E.C S S S S S S S S S Petroleum Refining 2911 S S S S S S S S S Paving Mixtures & Blocks 2951 S S S S S S S S S Asphalt Felts & Coating 2952 S S S S S S S S S Lubricating Oils & Greases 2992 S S S S S S S S S Products of Petroleum & Coal, N.E.C S S S S S S S S S Tires & Inner Tubes 3011 S S S S S S S S S Rubber & Plastic Footwear 3021 S S S S S S S S S Rubber & Plastic Hose & Belting 3052 S S S S S S S S S Gaskets, Packing & Sealing Devices 3053 S S S S S S S S S Mech. Rubber Goods 3061 S S S S S S S S S Fabricated Rubber Products, N.E.C S S S S S S S S S Unsupported Plastics Film & Sheet 3081 S S S S S S S S S Unsupported Plastics Profile Shapes 3082 S S S S S S S S S Laminated Plastics Plate & Sheet 3083 S S S S S S S S S Plastic Pipe 3084 S S S S S S S S S Plastic Bottles 3085 S S S S S S S S S Plastics Foam Products 3086 S S S S S S S S S Custom Compounding of Purchased Resins 3087 S S S S S S S S S 143

148 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Plastic Plumbing Fixtures 3088 S S S S S S S S S Plastics Products, N.E.C S S S S S S S S S Leather Tanning & Finishing 3111 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Boot & Shoe Cut Stock & Findings 3131 S S S S S S S S S House Slippers 3142 S S S S S S S S S Men's Footwear (No Athletic) 3143 S S S S S S S S S Women's Footwear (No Athletic) 3144 S S S S S S S S S Footwear (No Rubber), N.E.C S S S S S S S S S Leather Gloves & Mittens 3151 S S S S S S S S S Luggage 3161 S S S S S S S S S Women's Handbags & Purses 3171 S S S S S S S S S Personal Leather Goods (No Purses) 3172 S S S S S S S S S Leather Goods, N.E.C S S S S S S S S S Flat Glass 3211 S S S S S S S S S Glass Containers 3221 S S S S S S S S S Pressed & Blown Glass, N.E.C S S S S S S S S S Glass Products, Made of Purchased Glass 3231 S S S S S S S S S Cement, Hydraulic 3241 S S S S S S S S S Brick & Structural Clay Tile 3251 S S S S S S S S S Ceramic Wall & Floor Tile 3253 S S S S S S S S S Clay Refractories 3255 S S S S S S S S S Structural Clay Products, N.E.C S S S S S S S S S Vitreous China Plumbing, Bathroom Accessories 3261 S S S S S S S S S Vitreous China Table & Kitchen Accessories 3262 S S S S S S S S S Fine Earthenware, Table & Kitchen Articles 3263 S S S S S S S S S Porcelain Electrical Supplies 3264 S S S S S S S S S Pottery Products, N.E.C S S S S S S S S S Concrete Block & Brick 3271 S S S S S S S S S Concrete Products (No Block & Brick) 3272 S S S S S S S S S 144

149 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Ready Mixed Concrete 3273 S S S S S S S S S Lime 3274 S S S S S S S S S Gypsum Products 3275 S S S S S S S S S Cut Stone & Stone Products 3281 S S S S S S S S S Abrasive Products 3291 S S S S S S S S S Asbestos Products 3292 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Minerals & Earths, Treated 3295 Mgt only PWG only Mgt only S S S S S S Mineral Wool 3296 Mgt only PWG only Mgt only S S S S S S Nonclay Refractories 3297 Mgt only PWG only Mgt only S S S S S S Nonmetallic Mineral Products, N.E.C Mgt only PWG only Mgt only S S S S S S Blast Furnaces, Coke Ovens, Steel Works 3312 S S S S S S S S S Electrometallurgical Products 3313 S S S S S S S S S Steel Wire Drawing, Nails & Spikes 3315 S S S S S S S S S Cold-Rolled Steel Sheet, Strip & Bars 3316 S S S S S S S S S Steel Pipe & Tubes 3317 S S S S S S S S S Gray Iron Foundries 3321 S S S S S S S S S Malleable Iron Foundries 3322 S S S S S S S S S Steel Investment Foundries 3324 S S S S S S S S S Steel Foundries, N.E.C S S S S S S S S S Primary Smelting & Refining of Copper 3331 S S S S S S S S S Primary Production of Aluminum 3334 S S S S S S S S S Primary Smelting Nonferrous Metals, N.E.C S S S S S S S S S Secondary Smelting & Refining Nonferrous 3341 S S S S S S S S S Rolling, Drawing & Extruding of Copper 3351 S S S S S S S S S Aluminum Sheet, Plate & Foil 3353 S S S S S S S S S Aluminum Extruded Products 3354 S S S S S S S S S Aluminum Rolling & Drawing, N.E.C S S S S S S S S S Rolling, Drawing, Extruding of Nonferrous 3356 S S S S S S S S S Drawing & Insulating of Nonferrous Wire 3357 S S S S S S S S S 145

150 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Aluminum Die-Castings 3363 S S S S S S S S S Nonferrous Die-Cast (No Aluminum) 3364 S S S S S S S S S Aluminum Foundries 3365 S S S S S S S S S Copper Foundries 3366 S S S S S S S S S Nonferrous Foundries (No Aluminum, Copper) 3369 S S S S S S S S S Metal Heat Treating 3398 S S S S S S S S S Primary Metal Products, N.E.C S S S S S S S S S Metal Cans 3411 S S S S S S S S S Metal Shipping Barrels, Drums, Kegs, Pails 3412 S S S S S S S S S Cutlery 3421 S S S S S S S S S Hand & Edge Tools (No Machine Tools, Saws) 3423 S S S S S S S S S Hand Saws & Saw Blades 3425 S S S S S S S S S Hardware, N.E.C S S S S S S S S S Enameled Iron & Metal Sanitary Ware 3431 S S S S S S S S S Plumbing Fixture Fittings, Trim & Brass 3432 S S S S S S S S S Heating Equipment (No Warm-Air Furnace) 3433 S S S S S S S S S Fabricated Structural Metal 3441 S S S S S S S S S Metal Doors, Sash, Frames, Molding, Trim 3442 S S S S S S S S S Fabricated Plate Work Boiler Shops 3443 S S S S S S S S S Sheet Metal Work 3444 S S S S S S S S S Architectural & Ornamental Metal Work 3446 S S S S S S S S S Prefabricated Metal Buildings & Components 3448 S S S S S S S S S Miscellaneous Metal Work 3449 S S S S S S S S S Screw Machine Products 3451 S S S S S S S S S Bolt, Nuts, Screws, Rivets & Washers 3452 S S S S S S S S S Iron & Steel Forgings 3462 S S S S S S S S S Nonferrous Forgings 3463 S S S S S S S S S Automotive Stampings 3465 S S S S S S S S S 146

151 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Crowns and Closures 3466 S S S S S S S S S Metal Stampings, N.E.C S S S S S S S S S Electroplating, Plating, Anodizing, Coloring 3471 S S S S S S S S S Coating, Engraving & Allied Services, N.E.C S S S S S S S S S Small Arms Ammunition 3482 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Ammunition, Except Small Arms, N.E.C Mgt only PWG only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Mgt only Small Arms 3484 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Ordnance & Accessories, N.E.C Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Industrial Valves 3491 S S S S S S S S S Fluid Power Valves & Hose 3492 S S S S S S S S S Steel Springs (No Wire) 3493 S S S S S S S S S Valves & Pipe Fittings (No Plumbers Goods) 3494 S S S S S S S S S Wire Springs 3495 S S S S S S S S S Miscellaneous Fabricated Wire Products 3496 S S S S S S S S S Metal Foil & Leaf 3497 S S S S S S S S S Fabricated Pipe & Fabricated Pipe Fittings 3498 S S S S S S S S S Fabricated Metal Products, N.E.C S S S S S S S S S Steam, Gas & Hydraulic Turbines Generators 3511 S S S S S S S S S Internal Combustion Engines, N.E.C S S S S S S S S S Farm Machinery & Equipment 3523 S S S S S S S S S Garden Tractors & Lawn Equipment 3524 S S S S S S S S S Mining Machinery & Equipment (No Oil Equipment) 3532 S S S S S S S S S Oil Machinery & Equipment 3533 S S S S S S S S S Elevators & Moving Stairways 3534 S S S S S S S S S Conveyors & Conveying Equipment 3535 S S S S S S S S S Hoists, Industrial Cranes & Monorails 3536 S S S S S S S S S Industrial Trucks, Tractors, Trailers 3537 S S S S S S S S S Machine Tools, Metal Cutting Types 3541 S S S S S S S S S 147

152 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Machine Tools, Metal Forming Types 3542 S S S S S S S S S Industrial Patterns 3543 S S S S S S S S S Special Dies & Tools, Industrial Molds 3544 S S S S S S S S S Machine Tool Accessories & Measuring Device 3545 S S S S S S S S S Power-Driven Hand Tools 3546 S S S S S S S S S Rolling Mill Machinery & Equipment 3547 S S S S S S S S S Welding Apparatus 3548 S S S S S S S S S Metalworking Machinery, N.E.C S S S S S S S S S Textile Machinery 3552 S S S S S S S S S Woodworking Machinery 3553 S S S S S S S S S Paper Industries Machinery 3554 S S S S S S S S S Printing Trades Machinery 3555 S S S S S S S S S Food Prods Machinery 3556 S S S S S S S S S Special Industry Machinery, N.E.C S S S S S S S S S Pumps & Pumping Equipment 3561 S S S S S S S S S Ball & Roller Bearings 3562 S S S S S S S S S Air & Gas Compressors 3563 S S S S S S S S S Blowers & Exhaust Ventilation Fans 3564 S S S S S S S S S Packaging Machinery 3565 S S S S S S S S S Speed Changers, Industrial Drives & Gears 3566 S S S S S S S S S Industrial Process Furnaces & Ovens 3567 S S S S S S S S S Mechanical Power Transmission Equipment, N.E.C S S S S S S S S S General Industrial Machinery & Equipment, N.E.C S S S S S S S S S Electronic Computers 3571 S S S S S S S S S Computer Storage Devices 3572 S S S S S S S S S Computer Terminals 3575 S S S S S S S S S Comp. Peripheral Equipment, N.E.C S S S S S S S S S Calculating & Accounting Equipment 3578 S S S S S S S S S Office Machines, N.E.C S S S S S S S S S 148

153 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Automatic Merchandising Machines 3581 S S S S S S S S S Commercial Laundry, Dry Cleaning Machines 3582 S S S S S S S S S Refrigeration & Heating Equipment 3585 S S S S S S S S S Measuring & Dispensing Pumps 3586 S S S S S S S S S Service Industry Machines, N.E.C S S S S S S S S S Carburetors, Pistons, Rings & Valves 3592 S S S S S S S S S Fluid-Power Cylinders & Actuators 3593 S S S S S S S S S Fluid-Power Pumps & Motors 3594 S S S S S S S S S Scales & Balances (No Laboratory) 3596 S S S S S S S S S Machinery (No Electrical), N.E.C S S S S S S S S S Power Distribution & Specialty Transformer 3612 S S S S S S S S S Switchgear & Switchboard Apparatus 3613 S S S S S S S S S Motor & Generators 3621 S S S S S S S S S Carbon & Graphite Products 3624 S S S S S S S S S Relays & Industrial Controls 3625 S S S S S S S S S Electrical Industrial Appliances, N.E.C S S S S S S S S S Household Cooking Equipment 3631 S S S S S S S S S Household Refrigerators & Freezers 3632 S S S S S S S S S Household Laundry Equipment 3633 S S S S S S S S S Electrical Housewares & Fans 3634 S S S S S S S S S Household Vacuum Cleaners 3635 S S S S S S S S S Household Appliances, N.E.C S S S S S S S S S Electrical Lamps 3641 S S S S S S S S S Current Carrying Wiring Devices 3643 S S S S S S S S S Noncurrent Carrying Wiring Devices 3644 S S S S S S S S S Residential Electric Lighting Fixtures 3645 S S S S S S S S S Commercial, Industrial Electrical Lighting 3646 S S S S S S S S S Vehicular Lighting Equipment 3647 S S S S S S S S S Lighting Equipment, N.E.C S S S S S S S S S Radio & TV Receiving Sets Household 3651 S S S S S S S S S 149

154 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Phonograph Records & Tapes 3652 S S S S S S S S S Telephone & Telegraph Apparatus 3661 S S S S S S S S S Radio & TV Communication Equipment 3663 S S S S S S S S S Communication Equipment, N.E.C S S S S S S S S S Electron Tubes 3671 S S S S S S S S S Printed Circuit Boards 3672 S S S S S S S S S Semiconductors & Related Devices 3674 S S S S S S S S S Electronic Capacitors 3675 S S S S S S S S S Resistors for Electronic Applications 3676 S S S S S S S S S Electronic Coils, Transformers, Inductors 3677 S S S S S S S S S Connectors for Electronic Applications 3678 S S S S S S S S S Electronic Components, N.E.C S S S S S S S S S Storage Batteries 3691 S S S S S S S S S Primary Batteries, Dry & Wet 3692 S S S S S S S S S Equipment for Internal Combustion Engines 3694 S S S S S S S S S Magnetic & Optical Recording Media 3695 S S S S S S S S S Electrical Machinery, Equipment, Supplies, N.E.C S S S S S S S S S Motor Vehicles & Passenger Car Bodies 3711 S S S S S S S S S Truck & Bus Bodies 3713 S S S S S S S S S Motor Vehicle Parts & Accessories 3714 S S S S S S S S S Truck Trailers 3715 S S S S S S S S S Motor Homes 3716 S S S S S S S S S Aircraft 3721 S S S S S S S S S Aircraft Engines & Engine Parts 3724 S S S S S S S S S Aircraft Parts & Auxiliary Equipment, N.E.C S S S S S S S S S Ship Building & Repairing 3731 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Boat Building & Repairing 3732 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Railroad Equipment 3743 S S S S S S S S S Motorcycles, Bicycles & Parts 3751 S S S S S S S S S Guided Missiles & Space Vehicles 3761 S S S S S S S S S 150

155 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Propulsion Units & Parts 3764 S S S S S S S S S Guided Missiles Parts Equipment, N.E.C S S S S S S S S S Travel Trailers & Campers 3792 S S S S S S S S S Tanks & Tank Components 3795 S S S S S S S S S Transportation Equipment, N.E.C S S S S S S S S S Search & Navigation Equipment 3812 S S S S S S S S S Lab Apparatus & Furniture 3821 S S S S S S S S S Automatic Controls for Regulating 3822 S S S S S S S S S Industrial Instruments for Measuring 3823 S S S S S S S S S Totalizing Fluid Meters & Counting Devices 3824 S S S S S S S S S Instruments for Testing Electricity/Signals 3825 S S S S S S S S S Lab Analytical Instruments 3826 S S S S S S S S S Optical Instruments & Lenses 3827 S S S S S S S S S Measuring & Controlling Devices, N.E.C S S S S S S S S S Surgical & Medical Instruments 3841 S S S S S S S S S Orthopedic, Prosthetic Appliances 3842 S S S S S S S S S Dental Equipment & Supplies 3843 S S S S S S S S S X-Ray Apparatus 3844 S S S S S S S S S Electromedical & Electrotherapeutic Apparatus 3845 S S S S S S S S S Photographic Equipment & Supplies 3861 S S S S S S S S S Watches, Clocks, Operated Devices & Parts 3873 S S S S S S S S S Jewelry, Precious Metal 3911 S S S S S S S S S Silverware, Platedware & Stainless 3914 S S S S S S S S S Jewelers Findings & Materials Lapidary 3915 S S S S S S S S S Musical Instruments 3931 S S S S S S S S S Dolls 3942 S S S S S S S S S Games, Toys, Children's Vehicles (No Bikes) 3944 S S S S S S S S S Sporting & Athletic Goods, N.E.C S S S S S S S S S 151

156 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Pens, Mechanical Pencils & Parts 3951 S S S S S S S S S Lead Pencils, Crayons & Artist Materials 3952 S S S S S S S S S Marking Devices 3953 S S S S S S S S S Carbon Paper & Inked Ribbons 3955 S S S S S S S S S Costume Jewelry, Novelties 3961 S S S S S S S S S Fasteners, Buttons, Needles, Pins 3965 S S S S S S S S S Brooms & Brushes 3991 S S S S S S S S S Signs & Advertising Displays 3993 S S S S S S S S S Burial Caskets 3995 S S S S S S S S S Linoleum, Asphalted Floor Coverings, N.E.C S S S S S S S S S Manufacturing Industries, N.E.C S S S S S S S S S Railroad, Line-Haul Operating 4011 Mgt only PWG only Mgt only S S S S S S Switching & Terminal Companies 4013 Mgt only PWG only Mgt only S S S S S S Local & Suburban Transit 4111 Mgt only PWG only Mgt only S S S S S S Local Passenger Transportation, N.E.C Mgt only PWG only Mgt only S S S S S S Taxicabs 4121 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Intercity & Rural Bus Transportation 4131 Mgt only PWG only Mgt only S S S S S S Local Bus Charter Service 4141 Mgt only PWG only Mgt only S S S S S S Bus Charter Service (No Local) 4142 Mgt only PWG only Mgt only S S S S S S School Buses 4151 Mgt only PWG only Mgt only S S S S S S Bus Terminal & Service Facilities 4173 Mgt only PWG only Mgt only S S S S S S Local Trucking Without Storage 4212 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Trucking (No Local) 4213 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Local Trucking with Storage 4214 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Courier Services (No Air) 4215 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Farm Product Warehousing & Storage 4221 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Refrigerated Warehousing 4222 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S General Warehousing & Storage 4225 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Special Warehousing & Storage, N.E.C Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Terminal & Maintenance for Motor Freight 4231 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S U.S. Postal Service 4311 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ 152

157 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Deep-Sea Foreign Transportation, Freight 4412 DTQ DTQ DTQ DTQ DTQ DTQ S S S Deep-Sea Domestic Transportation, Freight 4424 DTQ DTQ DTQ DTQ DTQ DTQ S S S Freight Transportation ON Great Lakes 4432 DTQ DTQ DTQ DTQ DTQ DTQ S S S Water Transportation of Freight, N.E.C DTQ DTQ DTQ DTQ DTQ DTQ S S S Deep Sea Pass Transportation ( No Ferry) 4481 DTQ DTQ DTQ DTQ DTQ DTQ S S S Ferries 4482 DTQ DTQ DTQ DTQ DTQ DTQ S S S Water Passenger Transportation, N.E.C DTQ DTQ DTQ DTQ DTQ DTQ S S S Marine Cargo Handling 4491 DTQ DTQ DTQ DTQ DTQ DTQ S S S Towing & Tugboat Service 4492 DTQ DTQ DTQ DTQ DTQ DTQ S S S Marinas 4493 DTQ DTQ DTQ DTQ DTQ DTQ S S S Water Transportation Service, N.E.C DTQ DTQ DTQ DTQ DTQ DTQ S S S Air Transportation, scheduled 4512 DTQ DTQ DTQ DTQ DTQ DTQ S S S Air Courier Services 4513 DTQ DTQ DTQ DTQ DTQ DTQ S S S Air Transportation (Not Scheduled) 4522 DTQ DTQ DTQ DTQ DTQ DTQ S S S Airports, Fly Fields & Services 4581 DTQ DTQ DTQ DTQ DTQ DTQ S S S Crude Petroleum Pipe Lines 4612 DTQ DTQ DTQ DTQ DTQ DTQ S S S Refined Petroleum Pipe Lines 4613 DTQ DTQ DTQ DTQ DTQ DTQ S S S Pipe Lines, N.E.C DTQ DTQ DTQ DTQ DTQ DTQ S S S Travel Agencies 4724 S S S S S S S S S Tour Operators 4725 DTQ DTQ DTQ DTQ DTQ DTQ S S S Passenger Transportation Arrangements, N.E.C S S S S S S S S S Freight Transportation Arrangements 4731 S S S S S S S S S Rental of Railroad Cars 4741 S S S S S S S S S Packing & Crating 4783 Mgt only PWG only Mgt only S S S S S S Inspection & Fixed Facilities 4785 Mgt only PWG only Mgt only S S S S S S Service Incidental to Transportation N.E.C Mgt only PWG only Mgt only S S S S S S Radiotelephone Communications 4812 S S S S S S S S S Telephone Communications (No Radio) 4813 S S S S S S S S S Telegraph & Other Message Comm S S S S S S S S S 153

158 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Radio Broadcasting (No On-Air Employees) 4832 S S S S S S S S S TV Broadcasting (No On-Air Employees) 4833 S S S S S S S S S Cable & Pay TV Services 4841 S S S S S S S S S Communication Services, N.E.C S S S S S S S S S Electric Companies & Systems 4911 S S S S S S S S S Natural Gas Transmission 4922 S S S S S S S S S Natural Gas Transmission & Distribution 4923 S S S S S S S S S Natural Gas Distribution 4924 S S S S S S S S S Mixed, Manufacturing Gas Production/Distribution 4925 S S S S S S S S S Electric & Other Services Combined 4931 S S S S S S S S S Gas & Other Services Combined 4932 S S S S S S S S S Combination Utilities, N.E.C S S S S S S S S S Water Supply 4941 S S S S S S S S S Sewerage Systems 4952 Mgt only PWG only Mgt only S S S S S S Refuse Systems 4953 Mgt only PWG only Mgt only S S S S S S Sanitary Services, N.E.C Mgt only PWG only Mgt only S S S S S S Steam Supply 4961 S S S S S S S S S Irrigation Systems 4971 S S S S S S S S S Automobiles & Motor Vehicles 5012 S S S S S S S S S Automotive Parts & Supplies 5013 S S S S S S S S S Tires & Tubes 5014 S S S S S S S S S Motor Vehicle Parts, Used 5015 S S S S S S S S S Furniture 5021 S S S S S S S S S Home Furnishings 5023 S S S S S S S S S Lumber, Plywood & Millwork 5031 S S S S S S S S S Brick, Stone, Other Construction Material 5032 S S S S S S S S S Roofing, Siding, Insulation 5033 S S S S S S S S S Construction Materials, N.E.C S S S S S S S S S Photographic Equipment & Supplies 5043 S S S S S S S S S Office Equipment 5044 S S S S S S S S S Computers, Peripherals & Software 5045 S S S S S S S S S 154

159 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Computer Equipment, N.E.C S S S S S S S S S Medical, Dental, Hospital Equipment & Supplies 5047 S S S S S S S S S Ophthalmic Goods 5048 S S S S S S S S S Professional Equipment & Supplies, N.E.C S S S S S S S S S Metal Service Centers & Offices 5051 S S S S S S S S S Coal & Other Minerals & Ores 5052 S S S S S S S S S Electrical/Construction Apparatus & Equipment 5063 S S S S S S S S S Electrical Appliances, TV, Radio Equipment 5064 S S S S S S S S S Electronic Parts & Equipment 5065 S S S S S S S S S Hardware 5072 S S S S S S S S S Plumbing & Heating Equipment & Supplies 5074 S S S S S S S S S Warm-Air Heating & AC Equipment& Supplies 5075 S S S S S S S S S Refrigeration Equipment & Supplies 5078 S S S S S S S S S Construction & Mining Machinery & Equipment 5082 S S S S S S S S S Farm & Garden Machinery & Equipment 5083 S S S S S S S S S Industrial Machinery & Equipment 5084 S S S S S S S S S Industrial Supplies 5085 S S S S S S S S S Service Establishment Equipment & Supplies 5087 S S S S S S S S S Transportation Equipment (No Motor Vehicles) 5088 S S S S S S S S S Sporting & Recreational Goods & Supplies 5091 S S S S S S S S S Toys, Hobby Goods, Supplies 5092 S S S S S S S S S Scrap & Waste Materials 5093 DTQ DTQ DTQ DTQ DTQ DTQ S S S Jewelry, Watches & Other Precious Stone 5094 S S S S S S S S S Durable Goods, N.E.C S S S S S S S S S Printing & Writing Paper 5111 S S S S S S S S S 155

160 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Stationery Supplies 5112 S S S S S S S S S Industrial & Personal Service Paper 5113 S S S S S S S S S Drugs, Proprietaries, Sundries 5122 S S S S S S S S S Piece Goods & Notions 5131 S S S S S S S S S Mens & Boys Clothing & Furnishings 5136 S S S S S S S S S Womens & Childrens Clothing & Accessories 5137 S S S S S S S S S Footwear 5139 S S S S S S S S S Groceries, General Line 5141 S S S S S S S S S Frozen Foods 5142 S S S S S S S S S Dairy Products 5143 S S S S S S S S S Poultry & Poultry Products 5144 S S S S S S S S S Confectionery 5145 S S S S S S S S S Fish & Seafoods 5146 S S S S S S S S S Meats & Meat Products 5147 S S S S S S S S S Fresh Fruits & Vegetables 5148 S S S S S S S S S Groceries & Related Products, N.E.C S S S S S S S S S Grain 5153 S S S S S S S S S Livestock 5154 DTQ DTQ DTQ DTQ DTQ DTQ S S S Farm-Product Raw Materials, N.E.C S S S S S S S S S Plastics Materials & Basic Shapes 5162 S S S S S S S S S Chemical & Allied Products, N.E.C S S S S S S S S S Petroleum Bulk Stations & Terminals 5171 S S S S S S S S S Petroleum Products (No Bulk Stations) 5172 S S S S S S S S S Beer & Ale 5181 S S S S S S S S S Wines & Distilled Alcoholic Beverages 5182 S S S S S S S S S Farm Supplies 5191 S S S S S S S S S Books, Periodicals, Newspapers 5192 S S S S S S S S S Flowers, Florists' Supplies 5193 S S S S S S S S S Tobacco & Tobacco Products 5194 S S S S S S S S S Paints, Varnishes & Supplies 5198 S S S S S S S S S Nondurable Goods, N.E.C S S S S S S S S S 156

161 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Lumber & Other Building Materials 5211 S RQ S S S S S S S Paint, Glass, Wallpaper Stores 5231 S RQ S S S S S S S Hardware Stores 5251 S RQ S S S S S S S Nurseries, Lawn & Garden Supply Stores 5261 S RQ S S S S S S S Mobile Home Dealers 5271 S RQ S S S S S S S Department Stores 5311 S RQ S S S S S S S Variety Stores 5331 S RQ S S S S S S S Miscellaneous General Merchandise Stores 5399 S RQ S S S S S S S Grocery Stores 5411 S RQ S S S S S S S Meat & Fish Markets 5421 S RQ S S S S S S S Fruit & Vegetable Markets 5431 S RQ S S S S S S S Candy, Nut & Confectionery Stores 5441 S RQ S S S S S S S Dairy Products Stores 5451 S RQ S S S S S S S Retail Bakeries 5461 S RQ S S S S S S S Miscellaneous Food Stores 5499 S RQ S S S S S S S Motor Vehicle Dealers, New & Used 5511 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Motor Vehicle Dealers, Used Only 5521 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Auto & Home Supply Stores 5531 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Gasoline Service Stations 5541 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Boat Dealers 5551 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Recreational & Utility Trailers Dealers 5561 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Motorcycle Dealers 5571 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Automotive Dealers, N.E.C Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Men's & Boys Clothing & Furnishings 5611 S S S S S S S S S Women's Ready-To-Wear Stores 5621 S S S S S S S S S Women's Accessories & Specialty 5632 S S S S S S S S S Children's Wear Stores 5641 S S S S S S S S S Family Clothing Stores 5651 S S S S S S S S S Shoe Stores 5661 S S S S S S S S S Miscellaneous Apparel & Accessory Stores 5699 S S S S S S S S S 157

162 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Furniture Stores 5712 S S S S S S S S S Floor Covering Stores 5713 S S S S S S S S S Drapery, Curtain, & Upholstery Stores 5714 S S S S S S S S S Miscellaneous Home Furnishings Stores 5719 S S S S S S S S S Household Appliance Stores 5722 S S S S S S S S S Radio, TV & Electronic Stores 5731 S S S S S S S S S Computer & Software Stores 5734 S S S S S S S S S Re-Record & Pre-Record Tape Stores 5735 S S S S S S S S S Musical Instruments Stores 5736 S S S S S S S S S Eating Places 5812 Mgt only PWG only Mgt only S S S S S S Drinking Place (Alcoholic Beverages) 5813 Mgt only PWG only Mgt only S S S S S S Drug & Proprietary Stores 5912 S S S S S S S S S Liquor Stores 5921 S S S S S S S S S Used Merchandise Stores 5932 S S S S S S DTQ DTQ DTQ Sporting Goods & Bicycle Shops 5941 S S S S S S S S S Book Stores 5942 S S S S S S S S S Stationery Stores 5943 S S S S S S S S S Jewelry Stores 5944 S S S S S S S S S Hobby, Toy & Game Shops 5945 S S S S S S S S S Camera & Photographic Supply Stores 5946 S S S S S S S S S Gift, Novelty & Souvenir Shops 5947 S S S S S S S S S Luggage & Leather Goods Stores 5948 S S S S S S S S S Sewing, Needlework & Piece Goods Stores 5949 S S S S S S S S S Mail Order Houses 5961 S S S S S S S S S Automatic Merchandising Machine Operators 5962 S S S S S S S S S Direct Selling Establishments 5963 S S S S S S S S S Fuel Oil Dealers 5983 S S S S S S S S S Liquefied Petroleum Gas (Bottled) 5984 S S S S S S S S S Fuel Dealers, N.E.C S S S S S S S S S Florists 5992 S S S S S S S S S Cigar Stores & Stands 5993 S S S S S S S S S 158

163 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary News Dealers & Newsstands 5994 S S S S S S S S S Optical Goods Stores 5995 S S S S S S S S S Miscellaneous Retail Stores, N.E.C S S S S S S S S S Federal Reserve Banks 6011 S S S S S S S S S Central Reserve Depositories, N.E.C S S S S S S S S S National Commercial Banks 6021 S S S S S S S S S State Commercial Banks 6022 S S S S S S S S S Commercial Banks, N.E.C S S S S S S S S S Federal Savings Institutions 6035 S S S S S S S S S Savings Institutions (No Federal) 6036 S S S S S S S S S Federal Credit Unions 6061 S S S S S S S S S State Credit Unions 6062 S S S S S S S S S Foreign Bank, Branches & Agencies 6081 S S S S S S S S S Foreign Trade & International Banks 6082 S S S S S S S S S Non-Deposit Trust Facilities 6091 S S S S S S S S S Functions Related to Depository Banking 6099 S S S S S S S S S Federal & Federal-Sponsored Credit 6111 S S S S S S S S S Personal Credit Unions 6141 S S S S S S S S S Short-Term Business Credit Institutions 6153 S S S S S S S S S Miscellaneous Business Credit Institutions 6159 S S S S S S S S S Mortgage Bankers & Loan Correspondents 6162 S S S S S S S S S Loan Brokers 6163 S S S S S S S S S Security Brokers, Dealers, Flotations Companies 6211 DTQ DTQ DTQ S S S S S S Commodity Contracts Brokers & Dealers 6221 DTQ DTQ DTQ S S S S S S Security & Commodity Exchanges 6231 S S S S S S S S S Investment Advice 6282 S S S S S S S S S Security & Commodity Service, N.E.C S S S S S S S S S Life Insurance 6311 S S S S S S S S S Accident & Health Insurance 6321 S S S S S S S S S Hospital & Medical Service Plans 6324 S S S S S S S S S 159

164 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Hire, Marine & Casualty Insurance 6331 S S S S S S S S S Surety Companies 6351 S S S S S S S S S Title Insurance 6361 S S S S S S S S S Pension, Health & Welfare Funds 6371 S S S S S S S S S Insurance Carriers, N.E.C S S S S S S S S S Insurance Agents, Brokers & Services 6411 S S S S S S S S S Operators of Non-Residential Buildings 6512 S S S S S S S S S Operators of Apartment Buildings 6513 DTQ DTQ DTQ S S S S S S Operators of Dwellings (No Apartments) 6514 DTQ DTQ DTQ S S S S S S Operators of Residential Mobile Home Sites 6515 DTQ DTQ DTQ S S S S S S Lessors of Railroad Property 6517 S S S S S S S S S Lessors of Real Property, N.E.C S S S S S S S S S Agents, Brokers, & Managers 6531 S S S S S S S S S Title Abstract Companies 6541 S S S S S S S S S Subdividers & Developers (No Cemeteries) 6552 S S S S S S S S S Cemetery Subdividers & Developers 6553 S S S S S S S S S Bank Holding Companies 6712 S S S S S S S S S Holding Companies, N.E.C S S S S S S S S S Management Investment Companies, Open-End 6722 S S S S S S S S S Investment Offices, N.E.C S S S S S S S S S Educational, Religious, Charitable Trusts 6732 HO HO HO HO HO HO HO HO HO Trusts (No Religious, Charitable, Education) 6733 HO HO HO HO HO HO HO HO HO Oil Royalty Companies 6792 S S S S S S S S S Patent Owners and Lessors 6794 S S S S S S S S S Real Estate Investment Trusts 6798 S S S S S S S S S Investors, N.E.C S S S S S S S S S Hotels, Motels, & Tourist Courts 7011 Mgt only PWG only Mgt only S S S S S S Rooming & Boarding Houses 7021 DTQ DTQ DTQ S S S S S S Sporting & Recreational Camps 7032 DTQ DTQ DTQ S S S S S S 160

165 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Trailering Parks & Camp Sites 7033 Mgt only PWG only Mgt only S S S S S S Organization Hotels Membership 7041 Mgt only PWG only Mgt only S S S S S S Power Laundries, Family & Commercial 7211 Mgt only PWG only Mgt only S S S S S S Garment Pressing, Dry Cleaners 7212 Mgt only PWG only Mgt only S S S S S S Linen Supply 7213 Mgt only PWG only Mgt only S S S S S S Coin-Operated Laundries/Dry Cleaning 7215 Mgt only PWG only Mgt only S S S S S S Dry Cleaning Plants (No Rug Cleaning) 7216 Mgt only PWG only Mgt only S S S S S S Carpet & Upholstery Cleaning 7217 Mgt only PWG only Mgt only S S S S S S Industrial Launders 7218 Mgt only PWG only Mgt only S S S S S S Laundry & Garment Service, N.E.C Mgt only PWG only Mgt only S S S S S S Photographic Studios, Portraits 7221 S S S S S S S S S Beauty Shops 7231 Mgt only RQ Mgt only S S S S S S Barber Shops 7241 Mgt only RQ Mgt only S S S S S S Shoe Repair, Shoe Shine, Hat Cleaning 7251 Mgt only RQ Mgt only S S S S S S General Service & Crematories 7261 S S S S S S S S S Tax Return Preparation Service 7291 S S S S S S S S S Miscellaneous Personal Services, N.E.C Mgt only RQ Mgt only S S S S S S Advertising Agencies 7311 S S S S S S S S S Outdoor Advertising Services 7312 S S S S S S S S S Radio, TV, Publishers Advertising Representative 7313 S S S S S S S S S Advertising, N.E.C S S S S S S S S S Adjustment & Collection Service 7322 S S S S S S S S S Credit Reporting Service 7323 S S S S S S S S S Direct Mail Advertising Services 7331 S S S S S S S S S Photocopying & Duplicating Service 7334 S S S S S S S S S Commercial Photography 7335 S S S S S S S S S Commercial Art & Graphic Design 7336 S S S S S S S S S Secretarial & Court Reporting Service 7338 S S S S S S S S S Disinfecting & Exterminating 7342 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Cleaning & Maintenance, N.E.C Mgt only PWG only Mgt only S S S S S S Medical Equipment Rental 7352 S S S S S S S S S 161

166 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Heavy Construction Equipment 7353 S S S S S S S S S Equipment Rental & Leasing, N.E.C S S S S S S S S S Employment Agencies 7361 S S S S S S S S S Help Supply Services 7363 S S S S S S S S S Computer Programming Services 7371 S S S S S S S S S Computer Programming/Software 7372 S S S S S S S S S Computer Integrated Systems Design 7373 S S S S S S S S S Data Processing Services 7374 S S S S S S S S S Information Retrieval Service 7375 S S S S S S S S S Computer Facilities Management Services 7376 S S S S S S S S S Computer Rental & Leasing 7377 S S S S S S S S S Computer Maintenance & Repair 7378 S S S S S S S S S Computer Related Services, N.E.C S S S S S S S S S Detective & Armored Car Service 7381 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Security Systems Services 7382 S S S S S S S S S News Syndicates 7383 S S S S S S S S S Photofinishing Labs 7384 S S S S S S S S S Business Services, N.E.C S S S S S S S S S Truck Rental & Leasing (No Drivers) 7513 S S S S S S S S S Passenger Car Rental 7514 S S S S S S S S S Passenger Car Leasing 7515 S S S S S S S S S Utility Trailer & Recreational Vehicle Rentals 7519 S S S S S S S S S Automobile Parking 7521 S S S S S S S S S Top & Body Repair & Paint 7532 S S S S S S S S S Auto Exhaust Systems Repair 7533 S S S S S S S S S Tire Retreading & Repair 7534 S S S S S S S S S Automobile Glass Replacement Shops 7536 S S S S S S S S S Automobile Transportation Repair Shops 7537 S S S S S S S S S General Automotive Repair 7538 S S S S S S S S S Automotive Repair Shops, N.E.C S S S S S S S S S Car Washes 7542 S S S S S S S S S 162

167 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Automobile Services (No Repair or Washes) 7549 S S S S S S S S S Radio & TV Repair Shops 7622 S S S S S S S S S Refrigeration & Air Conditioner Service/Repair 7623 S S S S S S S S S Electrical Repair Shops, N.E.C S S S S S S S S S Watch, Clock, Jewelry Repair 7631 S S S S S S S S S Re-Upholstery & Furniture Repair 7641 S S S S S S S S S Welding Repair 7692 S S S S S S S S S Armature Rewinding Shops 7694 S S S S S S S S S Repair Shops & Related Services, N.E.C S S S S S S S S S Motion Picture & Video Production 7812 DTQ DTQ DTQ S S S S S S Services Allied to Motion Picture Production 7819 DTQ DTQ DTQ S S S S S S Motion Picture & Tape Distribution 7822 S S S S S S S S S Services Allied to Motion Picture Distribution 7829 S S S S S S S S S Motion Picture Theaters (No Drive-Ins) 7832 Mgt only PWG only Mgt only S S S S S S Drive-In Theaters 7833 Mgt only PWG only Mgt only S S S S S S Video Tape Rental 7841 Mgt only PWG only Mgt only S S S S S S Dance Halls, Studios and Schools 7911 DTQ DTQ DTQ DTQ DTQ DTQ S S S Theatrical Producers 7922 DTQ DTQ DTQ DTQ DTQ DTQ S S S Bands, Orchestras, Entertainment Groups 7929 DTQ DTQ DTQ DTQ DTQ DTQ S S S Bowling Alleys 7933 DTQ DTQ DTQ DTQ DTQ DTQ S S S Professional Sports Clubs & Promoters 7941 DTQ DTQ DTQ DTQ DTQ DTQ S S S Racing, Including Track Operations 7948 DTQ DTQ DTQ DTQ DTQ DTQ S S S Physical Fitness Facilities 7991 DTQ DTQ DTQ DTQ DTQ DTQ S S S Public Golf Courses 7992 DTQ DTQ DTQ DTQ DTQ DTQ S S S Coin-Operated Amusement Devices 7993 DTQ DTQ DTQ DTQ DTQ DTQ S S S Amusement Parks 7996 DTQ DTQ DTQ DTQ DTQ DTQ S S S Membership Sports & Recreation Clubs 7997 DTQ DTQ DTQ DTQ DTQ DTQ S S S Amusement & Recreation Services, N.E.C DTQ DTQ DTQ DTQ DTQ DTQ S S S 163

168 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary General Medical 8011 S S S S S S S S S Dentists 8021 S S S S S S S S S Osteopaths 8031 S S S S S S S S S Chiropractors 8041 S S S S S S S S S Optometrists 8042 S S S S S S S S S Podiatrists 8043 S S S S S S S S S Offices of Health Practitioners, N.E.C S S S S S S S S S Skilled Nursing Care Facilities 8051 Mgt only PWG only Mgt only S S S S S S Intermediate Care Facilities 8052 Mgt only PWG only Mgt only S S S S S S Nursing & Personal Care Facilities, N.E.C Mgt only PWG only Mgt only S S S S S S General Medical & Surgical Hospitals 8062 Mgt only PWG only Mgt only S S S S S S Psychiatric Hospitals 8063 Mgt only PWG only Mgt only S S S S S S Specialty Hospitals (No Psychiatric) 8069 Mgt only PWG only Mgt only S S S S S S Medical Labs 8071 S S S S S S S S S Dental Labs 8072 S S S S S S S S S Home Health Care Services 8082 Mgt only PWG only Mgt only S S S S S S Kidney Dialysis Centers 8092 S S S S S S S S S Specialty Out-Patient Facilities, N.E.C S S S S S S S S S Health & Allied Services, N.E.C S S S S S S S S S Legal Services 8111 S S S S S S S S S Elementary & Secondary Schools 8211 S S S S S S S S S Colleges, University, & Professional Schools 8221 S S S S S S S S S Junior Colleges & Technical Institutes 8222 S S S S S S S S S Libraries & Information Centers 8231 S S S S S S S S S Data Processing Schools 8243 S S S S S S S S S Business & Secretarial Schools 8244 S S S S S S S S S Vocational Schools (No High School), N.E.C S S S S S S S S S Schools & Educational Services, N.E.C S S S S S S S S S Individual & Family Services 8322 DTQ DTQ DTQ S S S S S S Job Training & Vocational Rehab Mgt only PWG only Mgt only S S S S S S 164

169 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Child Day-Care Services 8351 Mgt only PWG only Mgt only S S S S S S Residential Care 8361 DTQ DTQ DTQ S S S S S S Social Services, N.E.C DTQ DTQ DTQ S S S S S S Museums Only 8412 DTQ S DTQ S S S S S S Botanical & Zoological Garden 8422 DTQ S DTQ S S S S S S Business Associations 8611 S S S S S S S S S Professional Membership Organizations 8621 S S S S S S S S S Labor Unions & Similar Organizations 8631 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Civic, Social & Fraternal Associations 8641 S RQ S S S S S S S Political Organizations 8651 S RQ S S S S S S S Religious Organizations 8661 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Nonprofit Membership Organizations, N.E.C DTQ HO HO HO HO HO S S S Engineering 8711 S S S S S S S S S Architectural 8712 S S S S S S S S S Surveying 8713 S S S S S S S S S Accounting, Auditing, Bookkeeping 8721 S S S S S S S S S Commercial Physical Research 8731 S S S S S S S S S Commercial Nonphysical Research 8732 S S S S S S S S S Noncommercial Research Organizations 8733 S S S S S S S S S Testing Laboratories 8734 S S S S S S S S S Management Services 8741 S S S S S S S S S Management Consulting 8742 S S S S S S S S S Public Relations 8743 S S S S S S S S S Facilities Support 8744 Mgt only PWG only Mgt only Mgt only Mgt only Mgt only S S S Business Consulting, N.E.C S S S S S S S S S Private Households 8811 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Services, N.E.C DTQ DTQ DTQ DTQ DTQ DTQ HO HO HO Executive Offices 9111 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Legislative Bodies 9121 DTQ DTQ DTQ S S S S S S Executive and Legislative Offices Combined 9131 DTQ DTQ DTQ S S S S S S General Government 9199 DTQ DTQ DTQ S S S S S S 165

170 Long Term Disability Short Term Disability LIFE and AD&D Description SIC 2 to Voluntary 2 to Voluntary 2 to Voluntary Courts 9211 DTQ DTQ DTQ S S S S S S Police Protection 9221 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Legal Counsel and Protection 9222 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Correctional Institutions 9223 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Fire Protection 9224 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Public Order & Safety, N.E.C DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ Public Finance, Taxation & Monetary Policy 9311 DTQ DTQ DTQ S S S S S S Administration of Educational Programs 9411 DTQ DTQ DTQ S S S S S S Administration of Public Health Programs 9431 DTQ DTQ DTQ S S S S S S Administration of Social & Manpower Programs 9441 DTQ DTQ DTQ S S S S S S Administration of Veterans Affairs 9451 DTQ DTQ DTQ S S S S S S Air & Water Resource & Solid Waste Management 9511 DTQ DTQ DTQ S S S S S S Land, Mineral, Wildlife & Forest Conservation 9512 DTQ DTQ DTQ S S S S S S Administration of Housing Programs 9531 DTQ DTQ DTQ S S S S S S Administration of Urban Planning, Community, Rural Development 9532 DTQ DTQ DTQ S S S S S S Administration of General Economic Programs 9611 DTQ DTQ DTQ S S S S S S Regulation, Administration of Transportation 9621 DTQ DTQ DTQ S S S S S S Regulation, Administration of Utilities 9631 DTQ DTQ DTQ S S S S S S Regulation, Administration of Agricultural Marketing 9641 DTQ DTQ DTQ S S S S S S Regulation, Miscellaneous Commercial 9651 DTQ DTQ DTQ S S S S S S Space Research 9661 DTQ DTQ DTQ S S S S S S National Security 9711 DTQ DTQ DTQ S S S S S S International Affairs 9721 DTQ DTQ DTQ S S S S S S Non-Classifiable Establishments 9999 DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ DTQ 166

171 Policies issued by: American General Life Insurance Company or Delaware Policy Form Numbers C22438, G-DEN-42000, G-DIS and G-LAD American International Life Assurance Company of New York New York, New York Policy Form Numbers C11657, C11960NY, C22553NY, G-DEN-32000, G-DIS-31000, G-LAD and G-LAD The United States Life Insurance Company in the City of New York New York, New York Policy Form Numbers G American General Life Insurance Company of Delaware, is the marketing name for the insurance companies and affiliates comprising the domestic life operations of American International Group, Inc., including American General Life Insurance Company, American International Life Assurance Company of New York and The United States Life Insurance Company in the City of New York. American General Life Insurance Company insurers offer a broad spectrum of fixed and variable life insurance, annuities and accident and health products to serve the financial and estate planning needs of customers throughout the United States. The underwriting risks, financial and contractual obligations and support functions associated with products issued by American General Life Insurance Company, American International Life Assurance Company of New York and The United States Life Insurance Company in the City of New York are each insurer s own responsibility. American International Life Assurance Company of New York and The United States Life Insurance Company in the City of New York are authorized to do an insurance business in New York. Policies are not available in all states. This is a summary only of products and serviced offered. Actual offerings may vary by group size and are subject to state insurance law, and the benefits/provisions as described may vary due to such law. All products are subject to the terms, conditions, limitations and exclusions of the policy. Please see policy and certificate for details American General Life Insurance Company of Delaware. All rights reserved. 167