VOLUNTARY TERM LIFE BENEFITS SUMMARY PLAN DESCRIPTION

Transcription

1 VOLUNTARY TERM LIFE BENEFITS SUMMARY PLAN DESCRIPTION August 1, 2009

2 TABLE OF CONTENTS DEFINITIONS...1 SCHEDULE OF BENEFITS...4 HOW TO FILE A CLAIM FOR BENEFITS...6 ELIGIBILITY...6 GUARANTEED INCREASE BENEFIT...8 CONTINUATION OF INSURANCE AFTER EMPLOYMENT TERMINATES...8 BENEFICIARY...9 DETERMINATION OF BENEFICIARY...9 LIFE BENEFIT...9 ACCELERATED BENEFIT CONVERSION PRIVILEGE WAIVER OF PREMIUM BENEFIT SUICIDE LIMITATION TIC/A/UAS 0809 i

3 The Company provides Voluntary Term Life (VTL) insurance to eligible Employees under Group Policy Number AULtimate VL5F, Participating Unit Number G issued by American United Life Insurance Company, One American Square, P.O. Box 6123, Indianapolis, IN (herein called the Insurance Company). The Plan Administrator for the policy is: TIC International Corporation North Meridian Street, Suite 600 Carmel, IN The policy provides contributory Employee and Dependent VTL insurance (contributory insurance is fully paid for by the Employee). Any information pertaining to benefits, including the information contained herein, is controlled and superseded by the policy. The policy may be amended or terminated by the Company at any time. Employees will be advised of significant changes. To examine the policy, please send a written request, in advance, to the Plan Administrator. Certificate of Insurance: An Employee who becomes insured under the policy will receive a Certificate of Insurance issued by the Insurance Company that summarizes the provisions, limitations and exclusions of the policy. The Certificate of Insurance is subject to the terms of the policy and is not itself a contract for insurance. DEFINITIONS The terms listed below apply to VTL insurance only. If a term's definition is different from its definition in the policy, the definition in the policy shall prevail. Accidental Bodily Injury means an injury occurring as a result of an accident, either directly or indirectly, along with all other related conditions, sustained by an Employee while insured under the policy. Active Work and Actively at Work mean the use of time and energy in the services of the Company at the regular place of business by a person who is physically and mentally capable of performing each of the material and substantial duties of his or her regular job for a minimum of 30 hours per week. This includes time off for vacation, jury duty and funeral leave where the person could otherwise have been at Active Work. This does not include time off as a result of an injury, strike or lockout. Annual Base Salary means the Employee s yearly pay, before taxes, from the Company based on the normal full-time work schedule at the location where the Employee works. It does not include income from commissions, bonuses, or expense accounts. Beneficiary means the person(s) or other entity designated by the Employee on a form satisfactory to the Insurance Company to receive benefits becoming payable under the policy. Child means: 1. Any Child born of the Employee, and 2. Any legally adopted Child of the Employee from the time of placement in the Employee s home with the intent to adopt, and 3. Any stepchild who lives with the Employee, and 4. Any Child for whom the Employee has legal guardianship, and 5. Any Child for whom coverage must be provided in accordance with state law or court order. Company means United Actuarial Services, Inc. UAS

4 DEFINITIONS (continued) Date of Disability means the first day the Employee is not Actively at Work due to Accidental bodily Injury or Sickness that causes Total Disability. Dependent means: 1. An Employee s legal spouse under age 70, and 2. An Employee s unmarried Child from live birth to age 19, if the Child is: a) not eligible for coverage as an Employee, b) not in the armed forces of any country, and c) dependent upon the Employee for principal support or is claimed as a Dependent on the Employee s federal income tax return, and 3. An Employee s unmarried Child to age 25, if the Child is: a) registered in and attending an accredited educational institution on a full-time basis as defined by the institution (NOTE: School vacation periods are considered a part of school attendance on a full-time basis), and b) dependent upon the Employee for principal support or is claimed as a Dependent on the Employee s federal income tax return, and 4. An Employee s unmarried Child who is incapable of self-sustaining employment as a result of mental retardation or physical handicap. The Child must have been incapacitated prior to the age at which insurance would otherwise have terminated due to age. If the Child is not at least age 19, extension of coverage is subject to the Insurance Company receiving written proof of the incapacity not later than 120 days after the Child attains age 19. Proof of continued incapacity will be required not more than once each year thereafter. Dependent Insurance means the insurance provided under the policy for an Employee s Dependent. Elimination Period means a period of nine (9) months beginning on the first day the Employee is not Actively At Work due to a Total Disability. This period may include up to three (3) days of Active Work. Employee means a person who is Actively At Work for the Company on a regular and continuous work schedule of 30 or more hours per week. Employee does not include an individual who is temporarily or seasonally employed by the Company. Evidence of Insurability means written proof, provided without expense to the Insurance Company, of a person s medical history upon which acceptance for insurance will be determined by the Insurance Company. Guaranteed Issue Amount means the amount of insurance that does not require Evidence of Insurability. Initial Enrollment Period means the period ending 31 days after the date the Employee first becomes eligible for insurance under the policy. Late Enrollee means an Employee who did not request insurance during the Initial Enrollment Period. Scheduled Enrollment Period means a recurring period of days stated in the policy during which an Employee may make written application, on an enrollment form acceptable to the Insurance Company, to become covered under the policy or to request a change in coverage amount. Sickness means illness, bodily disorder or disease, pregnancy and any condition classified as a mental disorder in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, as published from time to time, excluding mental retardation. Terminal Condition means an injury or Sickness that, despite appropriate medical care, is reasonably expected to result in the Employee s death within 12 months from the date of payment of an Accelerated Life Benefit, as determined by the Insurance Company. The Insurance Company may require the Employee to be examined by a physician of its choosing. TIC/A/UAS

5 DEFINITIONS (continued) Total Disability and Totally Disabled mean that because of Accidental Bodily Injury or Sickness the Employee cannot engage in any occupation for which he or she is reasonably fitted by training, education, or experience. If the Employee accepts any type of gainful employment, other than in a state-approved rehabilitation program or sheltered workshop, he or she will be considered fitted to that occupation. TIC/A/UAS

6 SCHEDULE OF BENEFITS Classification: All eligible Employees Employee Voluntary Term Life (VTL) Benefits: Life Amount: The Employee may purchase term life insurance in $1,000 increments from a minimum of $20,000 to a maximum of the lesser of: a) $500,000 or b) five (5) times the Employee s Annual Base Salary rounded to the next $10,000. Guaranteed Issue Amount: $100,000* * Amounts requested in excess of the Guaranteed Issue Amount require Evidence of Insurability. Subject to the Insurance Company s approval, excess amounts will be effective on the date named by the Insurance Company. Accelerated Life Benefit: Subject to meeting the terms of the policy, an Employee diagnosed with a Terminal Condition may request payment of an Accelerated Life Benefit equal to either 25% or 50% of the Life Amount. Bi-Weekly Rates per $1,000 of the Employee s Life Amount: Employee s Employee Employee s Employee Age Rate Age Rate Dependent Voluntary Term Life (VTL) Benefits: 0-29 $ $ $ $ $ $ $ $ $ $ Life Amount: Plan 1 Plan 2 Plan 3 Excess Plan Dependent spouse under age 70: $5,000 $10,000 $20,000 50% of Employee s Life Amount Dependent Child 6 months & over: $2,500 $5,000 $10,000 10% of Employee s Life Amount Dependent Child under 6 months: $1,000 $1,000 $1,000 $1,000 Guaranteed Issue Amount: The amounts shown for Plans 1, 2 and 3 are Guaranteed Issue Amounts. Amounts requested under the Excess Plan require Evidence of Insurability. Subject to the Insurance Company s approval, amounts under the Excess Plan will be effective on the date named by the Insurance Company. Accelerated Life Benefit: Subject to meeting the terms of the policy, an Employee whose Dependent spouse has a Terminal Condition, may request payment of an Accelerated Life Benefit equal to 50% of the spouse s amount of insurance. Bi-Weekly Rates Per Dependent Unit: TIC/A/UAS Plan 1 Plan 2 Plan 3 Excess Plan Spouse only: $ $ $ see Excess Plan Rates Child(ren) only: $ $ $ see Excess Plan Rates Family - Spouse & Child(ren): $ $ $ see Excess Plan Rates

7 SCHEDULE OF BENEFITS (continued) Bi-Weekly Excess Plan Rates per $1,000 of Employee s Life Amount: Employee s Spouse Child(ren) Family Employee s Spouse Child(ren) Family Age Rate Rate Rate Age Rate Rate Rate 0-29 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Reduction of Insurance at Age 70: Life Amounts of Employee and Dependent VTL insurance will begin reducing when the Employee attains age 70 as follows (NOTE: Dependent Insurance for the Employee s spouse terminates when the spouse attains age 70): Age When Reduction Occurs... Percentage Remaining From Amount in Effect at Age % % % % 90 and older... 10% TIC/A/UAS

8 HOW TO FILE A CLAIM FOR BENEFITS A claim should be sent to the Insurance Company as soon after a loss as possible. VTL claims must be submitted within three (3) years of loss. Waiver of Premium Benefit claims must be furnished within 12 months of loss. Claims filed after these time limits may still be considered if it is shown that timely submission was not possible. The claim should include a completed claim form and certified death certificate or other appropriate proof of loss. The Insurance Company may also require the Insurance Certificate, medical records, police reports, proofs of employment and other pertinent records. Claim forms may be obtained from the Insurance Company or the Plan Administrator. The Insurance Company, at its expense, may have an autopsy performed. ELIGIBILITY Employee Eligibility: Employees will become eligible for VTL insurance on the date next following completion of 30 days of Active Work. Dependent Eligibility: Contingent on Employee VTL insurance being requested and approved, an Employee s Dependent(s) will be eligible for Dependent Insurance on the latest of: 1. The date the Employee becomes eligible for coverage, or 2. The date the Employee first acquires the Dependent. Enrollment: To become insured, an eligible Employee must give the Plan Administrator a request for coverage on a form satisfactory to the Insurance Company and agree to have the required premium amount deducted from his or her bi-weekly pay. Coverage may only be requested during an Initial or Scheduled Enrollment Period as follows: 1. An Employee may request coverage during the Initial Enrollment Period. Evidence of Insurability is not required unless the amount of insurance requested exceeds the Guaranteed Issue Amount shown in the Schedule of Benefits, or 2. During a Scheduled Enrollment Period: a) an Employee who is a Late Enrollee may request coverage and b) an Employee who has coverage in effect may change the amount of such coverage. Except for increases under the Guaranteed Increase Benefit, coverage requested during a Scheduled Enrollment Period is subject to Evidence of Insurability. A form may be obtained by contacting the Plan Administrator. Effective Date of Employee Insurance: For Employees who are Actively At Work, the effective date for Guaranteed Issue Amounts requested during the Initial Enrollment Period and for increases in coverage provided under the Guaranteed Increase Benefit, is: 1. The date of the request, if that day is the first day of a month, or 2. The first day of the next following month, if the request is made after the first day of a month. For coverage that is subject to Evidence of Insurability, the effective date is the date named by the Insurance Company. If an Employee is not Actively At Work on the date insurance would otherwise be effective, the effective date will be the date of return to full time Active Work. The effective date of a scheduled reduction in coverage is the first day of the month following the reduction. TIC/A/UAS

9 ELIGIBILITY (continued) Effective Date of Dependent Insurance Generally, Dependent Insurance is effective on the date the Employee s VTL insurance becomes effective. If an Employee has Dependent Insurance for a Child, the same amount of coverage will become effective, without Evidence of Insurability, for a newly acquired Dependent Child on the date the Child is acquired. If an Employee has Dependent Insurance for a Child, coverage for a newly acquired Dependent spouse, requested within 31 days of acquiring the spouse, will become effective as follows: 1. The Guaranteed Issue Amount, without Evidence of Insurability, will be effective on the date the spouse was acquired. 2. Amounts in excess of the Guaranteed Issue Amount, subject to Evidence of Insurability acceptable to the Insurance Company, will become effective on the date named by the Insurance Company. Dependent Insurance may be increased during Scheduled Enrollment Periods. All increases in Dependent Insurance are subject to Evidence of Insurability and are not effective until the date named by the Insurance Company. If an eligible Dependent is confined in a facility providing hospital, convalescent or nursing home care on the date coverage for that Dependent would otherwise become effective, the effective date for that Dependent will be the date following the Dependent s final discharge from the facility and the resumption of the usual and customary duties or activities of an individual in good health and of the same age and sex. A change in coverage, will be effective on: a) the date following discharge from the facility and resumption of the usual and customary duties or activities of an individual in good health and of the same age and sex if such date is the first day of the month or b) the first day of the following month if the date determined in a is not the first day of the month. A Dependent will not cease to be confined in the facility if one confinement is followed by another confinement within 72 hours for the same or a related injury or Sickness. Evidence of Insurability: Evidence of Insurability is required if: 1. A request for coverage is made by a Late Enrollee, or 2. A request for coverage is made after insurance was terminated due to a failure to make contributions, or 3. The amount of coverage requested during the Initial Enrollment Period exceeds the Guaranteed Issue Amount shown in the Schedule of Benefits, or 4. The Employee requests an increase in coverage except as allowed under the Guaranteed Increase Benefit, or 5. Coverage under the group policy was previously converted to an individual policy and, while the individual policy remains in force, the person again becomes eligible for the group policy. Any portion of a request for insurance that exceeds the Guaranteed Issue Amount is subject to Evidence of Insurability acceptable to the Insurance Company. If the Insurance Company does not approve the excess portion, the Guaranteed Issue Amount will be effective as set forth in the policy. Termination of Insurance: VTL insurance will terminate on the earliest of the following: 1. The last day of the month in which the Employee requests termination, or 2. The last day of the month for which the last premium was paid, or 3. The last day of the month in which eligibility ceases, or TIC/A/UAS

10 ELIGIBILITY (continued) 4. The last day of the month in which the Employee enters active military service for any country except for temporary duty of 30 days or less, or 5. The date the Employee ceases Active Work except as otherwise provided under the Waiver of Premium or Continuation of Insurance provisions, or 6. The date the policy is terminated, or 7. The date a Waiver of Premium Benefit request is denied, or 8. For a Dependent, the date the Employee s Waiver of Premium Benefit request is approved. GUARANTEED INCREASE BENEFIT At each Scheduled Enrollment Period, insured Employees who meet the following conditions may request, without Evidence of Insurability, additional insurance equal to the greater of: a) 10% of the amount of VTL insurance in force rounded to the next $1,000 or b) $10,000: 1. The Employee must be under age 70, and 2. The Employee must be Actively At Work on the effective date of the increase, and 3. After the increase, the amount in force cannot exceed the policy s maximum benefit, and 4. A claim cannot have been paid under the Accelerated Life Benefit. If in effect, Dependent Insurance that is based on a percentage of the Employee s coverage will also increase without Evidence of Insurability. A Late Enrollee who is accepted for coverage during a Scheduled Enrollment Period will be eligible for the Guaranteed Increase Benefit at the next Scheduled Enrollment Period. Employees may request increases greater than the Guaranteed Increase Benefit, however, such requests are subject to Evidence of Insurability satisfactory to the Insurance Company. If coverage is declined based on unsatisfactory Evidence of Insurability no increases will be allowed under the Guaranteed Increase Benefit until satisfactory Evidence of Insurability is provided. CONTINUATION OF INSURANCE AFTER EMPLOYMENT TERMINATES Subject to the terms of the policy, Employee and Dependent VTL insurance may be continued after employment terminates or the policy is terminated and not replaced by a comparable group policy within 31 days. To continue coverage the Employee must submit written application and the required premium to the Insurance Company within 31 days of the coverage termination date. The Insurance Company reserves the right to charge an administrative fee per billing. Insurance may be continued until the earlier of the date premium payments are discontinued or the attainment of age 70. Limitations: 1. Coverage maintained under the Continuation of Insurance provision will not change due to salary increases, and 2. Dependent Insurance may only be continued if Employee insurance is continued, and 3. The Waiver of Premium Benefit is not included in the continued coverage, and TIC/A/UAS

11 CONTINUATION OF INSURANCE AFTER EMPLOYMENT TERMINATES (continued) 4. Employees who have established permanent residence outside the United States may not continue their coverage. If coverage continued under this provision terminates, it may be converted to an individual policy in accordance with the Conversion Privilege. BENEFICIARY An Employee may designate a Beneficiary on the VTL application form. The designation may name one (1) or more Beneficiaries, establish an order of payment and specify the distribution of proceeds. The application form must be completed and sent to the Plan Administrator within 31 days of the Employee's eligibility date. A Beneficiary designation may be changed at any time by submitting a completed Beneficiary change form to the Plan Administrator. The change will be effective on the date the change form is signed by the Employee, except that, the Insurance Company is not liable if benefits are paid to the previous Beneficiary before the change form is received. DETERMINATION OF BENEFICIARY The Insurance Company will determine how benefits will be distributed in the following order: 1. If more than one (1) Beneficiary is designated and no order of preference is given, than all Beneficiaries who outlive the Employee will share equally. If more than one (1) Beneficiary is listed within the same order of payment and no distribution is specified, then all Beneficiaries will share equally. 2. If there are no named or living Beneficiaries, the Employee s estate is not substantial and there are no statutory requirements to the contrary, payment will be made, at the Insurance Company s option, to a surviving relative. The relatives that will be considered, in descending order of preference, are: a) spouse, b) child(ren), c) parent(s), d) brother(s) and sister(s). 3. The Employee s estate. The Insurance Company, at its option, may pay proceeds up to $2,000 to any person it believes is equitably entitled to payment by reason of having incurred funeral or other expenses incident to the Employee s death. Assignments: Employees may assign their Life insurance ownership rights to any other person or entity except the Company. The assignment must be in a form satisfactory to the Insurance Company. The Insurance Company does not guarantee the validity of any assignment. Collateral assignments are not permitted. LIFE BENEFIT On receipt of satisfactory proof of an insured Employee s death, the Insurance Company will pay the amount of insurance due the Beneficiary. Upon receipt of satisfactory proof of an insured Dependent s death, benefits will be paid: 1. To the Employee, or 2. To the Employee s Beneficiary, if the Employee is not living, or 3. As stated in the Determination of Beneficiary section. The proceeds will be paid in a lump sum unless another payment option was selected by the Employee prior to death or by the Beneficiary. The Insurance Company may be contacted for payment options. TIC/A/UAS

12 ACCELERATED BENEFIT If an Employee or Dependent spouse with VTL coverage is diagnosed with a Terminal Condition, the Employee may request a one (1) time, lump sum Accelerated Life Benefit, payable to the Employee. An Employee with a Terminal Condition may request either 25% or 50% of the Life Amount shown in the Schedule of Benefits. The Accelerated Life Benefit for a Dependent spouse is 50% of the spouse s Life Amount shown in the Schedule of Benefits. In a community property state, the Insurance Company must receive prior written consent from the Employee s spouse, if any, authorizing payment of the benefit. To request an Accelerated Life Benefit, the Employee must provide a completed claim form and any other information that the Insurance Company needs to review the claim. The Insurance Company may require the person with the Terminal Condition to be examined by a physician of its choice. The Life Amount (including the amount which may be converted under the Conversion Privilege) will be reduced by the amount of the Accelerated Life Benefit and an interest charge. The interest charge will equal the 90-day Treasury bill rate on the date the Accelerated Life Benefit was paid. The remaining life insurance will be continued in accordance with the terms and conditions of the policy. Premiums continue to be due and payable on the original Life Amount unless they have been waived under the Waiver of Premium Benefit. An Accelerated Life Benefit will not be paid if: 1. For an Employee with a Terminal Condition: a) an irrevocable Beneficiary has been designated, b) VTL insurance benefits have been assigned or c) all or a portion of the Employee s VTL insurance benefits are to be paid to a former spouse or trustee as part of a divorce decree or property settlement, or child support order, or 2. VTL insurance terminates for the person with the Terminal Condition, or 3. The policy terminates. Payment of an Accelerated Life Benefit may be taxable and/or affect the family s eligibility for public assistance. An Employee should consult with a qualified tax advisor and with social service agencies before requesting an Accelerated Life Benefit. CONVERSION PRIVILEGE VTL insurance may be converted, without Evidence of Insurability, to an individual policy issued by the Insurance Company if it terminates due to: 1. Termination of employment or membership in a class eligible for insurance, or 2. A reduction in the benefit amount, or 3. Disapproval or termination of a Waiver of Premium Benefit, or 4. After five (5) or more years of continuous coverage, termination of the policy or the class under which the Employee is eligible. In addition to the above, a Dependent s insurance may be converted, without Evidence of Insurability if it terminates due to: 1. The Employee s death or disability, or 2. The Dependent Child attaining the limiting age, or 3. Divorce. TIC/A/UAS

13 CONVERSION PRIVILEGE (continued) The conversion policy can be up to the amount of VTL insurance terminated or, with respect to paragraph 1, number 4, above, the smaller of: a) the amount of VTL insurance terminated minus any new group life insurance for which the Employee becomes eligible within 31 days of the date insurance under this policy terminated or b) $10,000. Acceptable written application for conversion and the first premium must be submitted to the Insurance Company within 31 days after the later of the date: 1. Insurance under this policy terminates, or 2. Conversion notification by the Plan Administrator (NOTE: If conversion notification is not received within 15 days of termination of insurance, an additional application period will begin that will end on the earlier of: a) 15 days after notice is received, or b) 60 days from the end of the original 31 day conversion period), or 3. Denial of a Waiver of Premium Benefit request. The conversion policy may be any type of insurance offered by the Insurance Company except term insurance. The premium will be at the Insurance Company's customary rate based on age and class of risk. If death occurs during the conversion application period, the insurance that could have been converted to an individual policy will be paid even if no application for conversion was made. In no event will a death benefit be payable under both the Conversion Privilege and the Waiver of Premium Benefit. The Waiver of Premium Benefit is not available for conversion. If coverage under the group policy is converted to an individual policy that remains in force, Evidence of Insurability is required as a condition of becoming insured again under the group policy. WAIVER OF PREMIUM BENEFIT Upon satisfaction of a nine (9) month Elimination Period the Insurance Company will waive further premium payments for VTL insurance if an Employee becomes Totally Disabled before age 60 and while insured under the policy. The Employee must submit proof of Total Disability, acceptable to the Insurance Company, during the three (3) month period prior to the end of the Elimination Period, and, thereafter, one (1) month prior to the end of each following year of disability. A physician other than the Employee or a member of the Employee s family must certify Total Disability. After two (2) years, the Insurance Company, at its expense, may have the Employee examined by a physician of its choice annually. VTL insurance continued under the Waiver of Premium Benefit will reduce in accordance with the age reduction provision in the Schedule of Benefits and upon any reduction of coverage for the Employee s class. Continuation of Insurance After Employment Terminates or the Conversion Privilege may be elected within 31 days of the date coverage under the Waiver of Premium Benefit is denied or otherwise ceases. Under no circumstances will a death benefit be payable under both the Conversion Privilege and the Waiver of Premium Benefit. Termination of Waiver of Premium Benefit: The Waiver of Premium Benefit will end on the earliest date the following occurs: 1. Unsatisfactory proof of Totally Disabled is submitted, or 2. The Employee accepts employment or is found able to accept employment for which he or she is reasonably fitted by training, education or experience, or 3. The Employee refuses to submit to medical examination, or TIC/A/UAS

14 WAIVER OF PREMIUM BENEFIT (continued) 4. Proof of continuous Total Disability is not submitted annually unless it is not possible to do so, or 5. Attainment of the Social Security Normal Retirement Age per the Social Security Act, as amended, or 6. Retirement. SUICIDE LIMITATION If an Employee or Dependent commits suicide, while sane or insane: 1. Within two (2) years from the effective date of insurance, the benefits payable will be limited to the premiums paid, or 2. Two (2) or more years after the effective date of insurance, but within two (2) years of the effective date of a previously obtained increase in coverage, the benefits payable will be limited to the insurance effective prior to the increase in coverage plus the premiums paid for the increased coverage. TIC/A/UAS