Group Term Life Insurance and AD&D Dearborn National The CityofOklahomaCity provides life insurance to help protect the employee’s family in the event of a death. The employee is also eligible to purchase additional life insurance for himself/herself, and dependent life insurance for a spouse and/or dependent children. Dearborn National is the City’s administrator for Group Term Life and Accidental Death & Dismemberment (AD&D) insurance plan benefits. For existing members, your group term life and AD&D benefits will continue in 2012 without re-enrolling. Dearborn National was founded in Illinois in 1969, when it began providing group life and disability insurance to the people of Illinois. Since then, Dearborn National has expanded its product portfolio to offer products intended to enhance the quality of employee benefit programs while minimizing costs for the employer. Group Term Life and AD&D Insurance coverage is available while you are a full-time employee. Term insurance is payable to a beneficiary only when an insured dies. There are no permanent policy benefits such as cash or loan value. Enrollment/Evidence of Insurability If you or your eligible dependents enroll within 31 days of your eligibility date, you may apply for the $5,500 supplemental coverage and additional coverage of ½, 1 or 2 times your annual salary, up to $500,000 for yourself (base and additional combined) and coverage for your dependents without evidence of insurability. If you apply for coverage for yourself and/or your dependents more than 31 days after your eligibility date, or choose coverage for 3 times your salary, you will be required to furnish evidence of insurability and be approved to qualify for coverage. Basic Life Insurance Coverage The City provides $10,000 in basic life insurance and an additional $1,000 in Accidental Death and Dismemberment insurance at no additional cost. Supplemental Life Insurance Coverage You may purchase an additional $5,500 of supplemental term life insurance. Voluntary Life If you purchase the supplemental life coverage, you may also purchase voluntary life coverage at ½x, 1x, 2x or 3x annual base salary. Life insurance will be rounded to the nearest $1,000, if not already a multiple thereof. Note: Maximum coverage for basic supplemental and voluntary life insurance combined is $500,000. 26 Coverage amounts will reduce according to the following schedule: Age: Insurance Amount Reduces to: 65 65% of original amount 70 40% of original amount 75 25% of original amount Coverage may not be increased after a reduction. Dependent Life Insurance Coverage* You may purchase Voluntary Dependent Life insurance for a qualified dependent spouse and/or child(ren) as follows: Spouse: Spouse coverage may be elected for one of the following amounts: $10,000, $20,000, $40,000, $60,000, $80,000, or $100,000 Child(ren): Age live birth to 6 months - $100 6 months to 23 years - Child coverage may be elected for one of the following amounts: $2,500, $5,000, $7,500, or $10,000 Coverage is available for eligible dependents of active, full-time employees; required documentation must be on file with the EmployeeBenefits Division of the Personnel Department. At initial enrollment opportunity, satisfactory evidence of insurability is only required on spouse dependent life insurance amounts in excess of $20,000. Dearborn National will guarantee issue all other dependent life insurance for both spouse and dependent child(ren). After initial enrollment, satisfactory evidence of insurability is required on all amounts of dependent life insurance. Accidental Death and Dismemberment Coverage (AD&D) The CityofOklahomaCity provides $1,000 of AD&D insurance for each full-time employee. Employees may purchase an additional $5,000 of AD&D coverage. AD&D coverage provides benefits for an accidental death, and for an accidental dismemberment, as defined in the schedule of benefits. Accelerated Benefit If you become terminally ill and are not expected to live more than twelve months, you may request 50 percent of your life insurance amount up to $150,000 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). Waiver of Premium If you become disabled (as defined by your plan) and are no longer able to work, your premium payments will be waived until you are no longer totally disabled or you reach age 65, whichever occurs first. * Dependent coverage is not available for a spouse who also works for the City.
Group Term Life Insurance and AD&D Dearborn National Portability An Employee may elect to continue Voluntary Group Life Insurance under the terms of the Policy by paying premium directly to Dearborn National. The maximum amount of Voluntary Term Life Insurance which may be continued under Portability is the amount of Voluntary Term Life Insurance in force at the time the Portability Benefit is elected plus any life insurance to which an Insured is entitled under the Additional Purchase Option. Limitations and Exclusions Suicide Exclusion Life benefits for additional life coverage will not be paid for deaths caused by suicide in the first 12 months after your effective date of coverage. No increased or additional benefits will be payable for deaths caused by suicide occurring within 12 months after the day such increased or additional insurance is effective. AD&D Benefit Exclusion AD&D benefits will not be paid for losses caused by, contributed by, or resulting from: • Disease of the body, mental infirmity or diagnostic, medical or surgical treatment • Suicide, self-destruction while sane, intentionally self-inflicted injury while sane, or self-inflicted injury while sane • War, declared or undeclared, or any act of war • Active participation in a riot • Attempt to commit or commission of a crime under state or federal law • The voluntary use of any controlled substance. This exclusion does not apply to you if the controlled substance is prescribed for you by a physician • The presence of that percentage of alcohol in your blood, which raises a presumption that you were under the influence of alcohol. The blood alcohol level which raises this presumption is governed by the laws of the state in which the accident occurred. Termination of Coverage Your coverage and your dependents’ coverage under the Summary ofBenefits 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 dependent’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 dependent ceases to be an eligible dependent • For a spouse, the date of divorce or annulment Delayed Effective Date of Coverage 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. Dependent: Insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Exception: infants are insured from live birth. Changes to Coverage At each annual enrollment period or within 31 days of a change in status, you will be given the opportunity to change your coverage. You will be required to provide evidence of insurability and be approved to increase your coverage amounts. Questions If you have any questions about your coverage or how to enroll, please contact Dearborn National at 1-800-778-2281. This plan highlight is a summary provided to help you understand your insurance coverage from Dearborn National. Some provisions may vary or not be available in all states. 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. Disclaimer This information is only a product highlight. The policy has exclusions, limitations, and reduction of benefits and/or terms under which the policy may be continued or discontinued. The policy may be cancelled only during the annual open enrollment period or a qualifying event. The insurer reserves the right to change premium rates, but not more than once in a 12-month period. GROUP POLICY NUMBER: GAE0255-0001 27