Coverage Highlights Multnomah County Policy # 285369 Please read carefully the following description of your Unum Lifestyle Term Life insurance plan. Your Plan Eligibility Eligibility Date for Application Under Guaranteed Issue Provision All active full-time employees working at least 20 hours each week and their eligible spouse/domestic partner. New Employees: Eligibility date is the first of the month coincident with or next following the date of hire in an eligible group. Example: Hired 7/11 31 day period begins 8/1 application must be submitted by 8/31 to qualify for Guaranteed Issue coverage. New Spouse/Domestic Partner: Due to Marriage: Application must be submitted within 31 days of marriage date to qualify for Guaranteed Issue coverage. Due to Domestic Partnership when registered under Multnomah County s Domestic Partner Registry: Application must be submitted within 31 days of registry date to qualify for Guaranteed Issue coverage. Due to Domestic Partnership based on Shared Domicile (Employee must wait 6 months before applying for Domestic Partner Eligibility): Application must be submitted within 31 days after 6 month waiting period in order to qualify for Guaranteed Issue coverage. Example: Shared domicile begins 3/17. County employee must wait 6 months to enroll Domestic Partner. End of 6 month waiting period (9/17) begins the 31 day enrollment period for Guaranteed Issue life insurance. Application must be submitted by 10/17 to qualify for Guaranteed Issue coverage. Coverage Amounts lifestyle Your Term Life coverage options are: Employee: Up to $300,000 in increments of $10,000 Minimum coverage required is $30,000. Spouse/Domestic Partner: Up to $300,000 in increments of $10,000 Minimum coverage required is $30,000. *You cannot be covered as both a spouse/domestic partner and an employee. Coverage amount(s) will reduce according to the following schedule: Age 70-74 75-79 80-84 85-89 90-94 95 or over Coverage may not be increased after a reduction. Insurance Amount Reduced to: 65% of original amount 45% of original amount 30% of original amount 20% of original amount 15% of original amount 10% of original amount ADR1879-2001
Guarantee Issue Lifestyle - Reenrollment Term Life Coverage Rates Lifestyle Life Term Life Insurance New Employees: If you enroll within 31 days of your eligibility date (see above), you may apply for any amount of coverage up to $100,000 for yourself and any amount of coverage up to $30,000 for your spouse/domestic partner. Any coverage over the Guarantee Issue amount(s) will be subject to evidence of insurability. If you do not enroll within 31 days of your eligibility date, you can apply for coverage at any time and will be required to furnish evidence of insurability for the entire amount of coverage. If you enroll within 31 days of your eligibility date, and later, wish to increase your coverage, you may apply to increase your coverage, with evidence of insurability, at anytime during the year. Current Employees: If you are enrolled in the plan and wish to increase your coverage, you may apply to increase your coverage, with evidence of insurability, at anytime during the year. If you are not currently enrolled in the plan, you may apply for coverage at any time and will be required to furnish evidence of insurability for any amount of coverage. New Spouse or New Domestic Partner: If new spouse/domestic partner submits application within 31 days of their eligibility date (see above), you may enroll your new spouse/domestic partner in coverage up to the Guaranteed Issue amount $30,000. Any coverage over the Guarantee Issue amount(s) will be subject to evidence of insurability. If new spouse/domestic partner does not enroll within 31 days of their eligibility date, you can apply for coverage at any time and will be required to furnish evidence of insurability for the entire amount of coverage. If spouse/domestic partner enrolls within 31 days of their eligibility date, and later, wishes to increase coverage, you may apply to increase the coverage, with evidence of insurability, at anytime during the year. Rates shown are your Monthly deduction: Age Band Employee per $10,000-24 $.60 25-29 $.60 30-34 $.80 35-39 $.90 40-44 $1.35 45-49 $2.70 50-54 $4.40 55-59 $7.20 60-64 $11.50 65-69 $17.50 70-74 $20.60 75+ $20.60 Spouse/Domestic Partner per $10,000 $.60 $.60 $.80 $.90 $1.35 $2.70 $4.40 $7.20 $11.50 $17.50 $20.60 $20.60 NOTE: Your rate will increase as you age and move to the next age band. Insurance Age Your rate is based on your current age as of the plan anniversary date of July 1 st. For example if you were born February, 1960 you would be 47 for purposes of determining your monthly premium for the 2007 (beginning 7/1/07) plan year. If you were born September, 1960 you would be 46 for purposes of determining your monthly premium for the 2007 plan year. For premium purposes you will age one year each July 1 st.
Life Insurance Needs Worksheet 1) How long do you wish to provide financial support for your family? 2) How much would your family need for housing expenses-to pay off the mortgage or continue the rent? (number of months times monthly housing expense) 3) How much would your children pay for their education? 4) How much would your family need to pay for all other installment debt-car payments, credit cards, personal loans? (number of months times monthly installment debt) 5) How much would your family need to meet ongoing expenses-food utilities, daycare? (number of months times average monthly expenses Total: 6) Subtract the amount of any coverage you already have in place Consider this amount of Life Insurance months $ + + + = - $ To calculate your cost, complete the following by selecting your coverage amount and rate (based on your current age). Term Life Calculation C overage Amount Monthly Worksheet Increment Rate Cost Employee $ $10,000 x $ = $ Spouse/Domestic Partner $ $ 10,000 x $ = $ Total Monthly Cost = $ Additional Benefits Survivor Financial Counseling Services Portability This personalized financial counseling service provides expert, objective financial counseling to survivors and terminally ill employees at no cost to them. This service is also extended to employees upon the death or terminal illness of their covered spouse/domestic partner. The financial counselors, all highly trained attorneys, help develop strategies needed to protect resources, preserve current lifestyles, and build future security. At no time will the counselor offer or sell any product or service. If you retire, reduce your hours or leave your employer, you can take this coverage with you according to the terms outlined in the contract. However, if you have a medical condition which has a material effect on life expectancy, you will be ineligible to port your coverage.
Accelerated Benefit Waiver of Premium Retained Asset Account If you become terminally ill and are not expected to live more than twelve months, you may request up to 50% of your life insurance amount up to $750,000, without fees or present value adjustments. A doctor must certify your condition in order to qualify for this benefit. Upon your death, the remaining benefit will be paid to your designated beneficiary(ies). This feature also applies to your covered spouse/domestic partner If you, as the employee, become disabled (as defined by your plan) and are no longer able to work, both your and your spouse/domestic partners optional life insurance premium payments may be waived during your period of disability. Benefits of $10,000 or more are paid through the Unum Retained Asset Account. This interest bearing account will be established in the beneficiary's name. He or she can then write a check for the full amount or for $250 or more, as needed. Limitations/Exclusions/ Termination of Coverage Suicide Exclusion Termination of Coverage Life benefits will not be paid for deaths caused by suicide in the first twenty-four months after your effective date of coverage. No increased or additional benefits will be payable for deaths caused by suicide occurring within 24 months after the day such increased or additional insurance is effective. Your coverage and your spouse/domestic partner's coverage under the Summary of Benefits ends on the earliest of: The date the policy or plan is cancelled; The date you no longer are in an eligible group; The date your eligible group is no longer covered; The last day of the period for which you made any required contributions; The last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage; For spouse/domestic partner's coverage, the date of your death. In addition, coverage for any one dependent will end on the earliest of: The date your coverage under a plan ends; The date your spouse/domestic partner ceases to be an eligible dependent; For a spouse, the date of divorce or annulment. Unum will provide coverage for a payable claim which occurs while you and your spouse/domestic partner are covered under the policy or plan. Next Steps How to Apply All employees: If you apply for coverage after your effective date, or if you choose coverage over the guarantee issue amount, you will need to complete a medical questionnaire which you can get from your Plan Administrator. You may also be required to take certain medical tests at Unum s expense (Unum will notify you if tests are required).
Delayed Effective Date of Coverage Questions Employee: Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Spouse/Domestic Partner: Insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that, as a result of an injury, a sickness or a disorder, your dependent is confined in a hospital or similar institution; is unable to perform two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a sickness; is cognitively impaired; or has a life threatening condition. If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator. This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Details may differ from state to state. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. Travel assistance services are provided exclusively by Assist America, Inc. The services are subject to availability and may be withdrawn by Unum without prior notice. Survivor financial counseling services are provided exclusively by The Ayco Company, L.P. The services are subject to availability and may be withdrawn by Unum without prior notice. Underwritten by: Unum Life Insurance Company of America, 2211 Congress Street, Portland, Maine 04122, www.unum.com Unum is the marketing brand of Unum Corporation s insuring subsidiaries. 2001 Unum Corporation. The name and logo combination is a servicemark of Unum Corporation. All rights reserved.