Group Basic Life and AD&D Insurance City & County of Denver S T A N D A R D I N S U R A N C E C O M P A N Y
City & County of Denver Group Basic Life and AD&D Insurance WHAT ARE MY BASIC LIFE AND AD&D BENEFITS? For eligible employees who are working less than 80 hours biweekly and whose date of hire is prior to January 1, 2002: The amount of your basic life insurance is equal to 2 times your Annual Earnings, subject to a maximum amount of $75,000. The amount of your basic life insurance is rounded to the next higher multiple of $1,000, if not already a multiple of $1,000. For all eligible full-time employees who are regularly working 80 hours biweekly: The amount of your basic life insurance is equal to 2 times your Annual Earnings, subject to a maximum amount of $100,000. The amount of your basic life insurance is rounded to the next higher multiple of $1,000, if not already a multiple of $1,000. For all eligible part-time employees whose date of hire is on or after January 1, 2002 and regularly working at least 60 hours but less than 80 hours biweekly: The amount of your basic life insurance is equal to 1 1/2 times your Annual Earnings, subject to a maximum amount of $75,000. The amount of your basic life insurance is rounded to the next higher multiple of $1,000, if not already a multiple of $1,000. For all eligible part-time employees whose date of hire is on or after January 1, 2002 and regularly working at least 40 hours but less than 60 hours biweekly: The amount of your basic life insurance is equal to 1 times your Annual Earnings, subject to a maximum amount of $50,000. The amount of your basic life insurance is rounded to the next higher multiple of $1,000, if not already a multiple of $1,000. The amount of your Accidental Death and Dismemberment (AD&D) Insurance is the same as the amount of your Basic Life Insurance. Group Basic Life & AD&D Insurance 1
WHEN ARE BENEFITS PAYABLE? Basic Life Insurance The Basic Life benefit is payable upon receipt of satisfactory written proof of your death while insured under the group policy. AD&D Insurance If you suffer a loss as a direct result of an accident, and satisfy certain requirements, an AD&D benefit will be paid. These requirements are: you must provide satisfactory written proof of loss; the accident must occur while you are insured under the group policy; the loss must occur within 365 days after the date of the accident; the loss must be caused solely and directly by accidental bodily injuries and independently of all other causes. The entire amount of your AD&D Insurance is paid for these losses: Life Loss of both hands or both feet Loss of sight in both eyes Loss of one hand and one foot Loss of one hand or one foot and sight in one eye. One-half of the amount of your AD&D Insurance is paid for these losses: Loss of sight in one eye Loss of one hand or one foot With respect to a hand or foot, loss means actual and permanent severance from the body at or above the wrist or ankle joint. With respect to sight, loss means entire and irrecoverable loss of sight. Note: No more than 100% of the amount of your AD&D Insurance will be paid for all losses resulting from one accident (with the exception of payment of the Seat Belt Benefit). 2 Standard Insurance Company
ARE THERE ANY OTHER BENEFITS? Seat Belt Benefit If you die as a result of an automobile accident, and were wearing an approved seat belt at the time of the accident, your beneficiary will be paid an additional accidental death benefit equal to the amount of the AD&D benefit paid because of loss of life, up to $50,000. Family Benefits Package may provide benefits under the Accidental Death & Dismemberment Insurance coverage in the event of the insured employees accidental death. The family may be eligible for one of more of the following benefits. Surviving children may be eligible for The Higher Education Benefit. This benefit may pay eligible children an annual benefit for up to four consecutive years while attending any accredited college or university. A surviving spouse may be eligible for the Career Adjustment Benefit and/or the Child Care Benefit. The Career Adjustment Benefit makes it possible for a surviving spouse to receive job training skills through a trade-related or professional training program within 36 months following the death of the insured member. Child Care Benefits may be available when a spouse must go to work or obtain job-training for work. Benefits are for all children under age 13 and must be utilized within 36 months following the member s death. Waiver of Premium If you become totally disabled while insured and before your 60th birthday, your Basic Life Insurance may be continued until age 65 while you remain totally disabled without payment of premium. Accelerated Benefit If you have a Qualifying Medical Condition (you are terminally ill, with a life expectancy of less than 12 months), you may have the right to receive during your basic lifetime a portion of your Basic Life Insurance as an Accelerated Benefit. You must have at least $10,000 of Basic Life Insurance in effect to be eligible. You may receive an Accelerated Benefit of up to 75% of your Basic Life Insurance. The minimum Accelerated Benefit is $5,000 or 10% of your Basic Life Insurance whichever is greater. Group Basic Life & AD&D Insurance 3
Right to Convert If your Basic Life Insurance ends or is reduced for any reason, you may have a right to buy an individual policy of permanent basic life insurance without submitting evidence of insurability during the 31-day conversion period. Portability Is available to employees who have been insured for at least one year under the Group Policy. Eligible employees can continue their Group Basic Life Insurance coverage for a maximum of 24-months and may be eligible to convert to an individual policy when portability ends. Repatriation Benefit will pay an additional benefit equal to the lesser of $5,000 or 10% of the amount of the Basic Life Insurance Benefit to transport the deceased employee s remains to a mortuary near their primary place of residence when death occurs more than 200 miles from the employee s place of residence. ARE THERE AGE REDUCTIONS? Your basic life insurance is not subject to reduction because of your age unless your insurance is subject to termination under the Waiver Of Premium provision. ARE THERE ANY EXCLUSIONS? Basic Life Insurance There are no exclusions for Basic Life Insurance. AD&D Insurance No payment will be made for losses caused by: war; suicide or any other intentionally self-inflicted injury, while sane or insane; committing an assault or felony or active participation in a violent disorder or riot; voluntary use or consumption of any poison, chemical compound or drug (unless used in accordance with the directions of a physician); sickness or pregnancy existing at the time of the accident; heart attack or stroke; and medical or surgical treatment for any of the aforementioned items. 4 Standard Insurance Company
WHEN AM I ELIGIBLE? You are eligible on the date you become an active employee of the City and County of Denver (excluding a police or fire employee, but not a sheriff), occupying a permanent position and working at least 20 hours each week. WHEN DOES INSURANCE BECOME EFFECTIVE? Your insurance becomes effective on the date you become eligible, provided you are actively at work on that date. You must also be actively at work before any increase in your insurance will become effective. IS EVIDENCE OF GOOD HEALTH REQUIRED? You are not required to submit evidence of good health to become insured for basic life and AD&D (unless your coverage under the group policy previously ended and you converted the coverage to an individual life insurance policy). WHEN DOES INSURANCE END? Insurance ends when: 1. The group policy terminates. 2. Your employment terminates. 3. You cease to be eligible. 4. You become a full-time member of the armed forces of any country. When you become insured, you will receive a Certificate. Please read it carefully. The Certificate contains a detailed description of the plan, including the exclusions. This is only a brief description of the Basic Life and AD&D Insurance program. The controlling provisions of the Basic Life and AD&D program are in the master group insurance policy, and neither this brochure nor the Certificate may modify those provisions or the insurance in any way. Group Basic Life & AD&D Insurance 5
About this brochure This brochure is written in nontechnical language and is not intended as a complete description of the coverage. The controlling provisions are in the Standard Insurance Company s group policy. This brochure does not modify that document or the insurance in any way. About Standard Insurance company As a national leader in the employee benefits industry, Standard Insurance Company offers quality products and superior customer service to deliver employee benefits solutions to our customers. Founded in 1906, The Standard now serves customers from coast to coast with group and individual disability insurance and retirement plans, and group life and dental insurance. For more information about Standard Insurance Company, visit our Web site at www.standard.com. SI 7648-615855 (11/05) Group Policy 615855 A 6 Standard Insurance Company
Standard Insurance Company 1100 SW Sixth Avenue Portland OR 97204 www.standard.com A subsidiary of StanCorp Financial Group, Inc.