Summary of Benefits RRD
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1 Summary of Beefits RRD All Eligible Employees Basic Term Life, Optioal Term Life, Optioal Depedet Term Life ad Optioal Accidetal Death & Dismembermet Issued by The Prudetial Isurace Compay of America Effective: 01/01/2019 Basic Term Life 100% Employer Paid You are automatically erolled for 1.0 times your covered aual earigs to $125,000. Please refer to your pla certificate(s) to review the required miimum ad maximum coverage amouts allowed. If you are termially ill, you ca get a partial paymet of your group life isurace beefit. You ca use this paymet as you see fit. The paymet to your beeficiary will be reduced by the amout you receive with the Accelerated Beefit Optio.* Refer to the pla booklet for details. Your base amout of isurace is froze based o your earigs at age 65. This amout of isurace reduces to 92% at age 65, to 85% at age 66, to 78% at age 67, to 72% at age 68, to 66% at age 69, to 63% at age 70, to 59% at age 71, to 57% at age 72, to 54% at age 73, to 51% at age 74, to 49% at age 75, to 48% at age 76, to 47% at age 77, to 45% at age 78, to 44% at age 79, ad by a additioal 1% each year at age 80 ad over. Coverage will ed o your termiatio of employmet or as specified i the pla booklet. You may be able to cotiue your term life isurace usig the portability optio, or you may covert your term life isurace to a idividual life isurace policy issued by the Prudetial Isurace Compay of America
2 Optioal Term Life 100% Employee Paid Purchase coverage for 1.0 to 7.0 times your covered aual earigs to a maximum of $2,000,000, of your combied Basic Term Life ad Optioal Term Life coverage amout. New Hires ad Newly Eligible: Get up to the lesser of 3.0 times your covered earigs ot to exceed $500,000 - o medical questios asked - whe erollig whe first eligible i Optioal Group Term Life. Amouts of isurace exceedig 3.0 times your covered earigs or $500,000 require evidece of isurability. Curret Participats: Your curret coverage amout will be cotiued. Durig the 2019 aual erollmet period, you may select to icrease your curret coverage amout up to a total of 1.0 times your covered aual earigs, ot to exceed $500,000, without providig evidece of isurability to Prudetial. If you elect a amout exceedig 1.0 times your covered aual earigs or exceedig $500,000 durig aual erollmet, evidece of isurability will be required. Curret Employees who waived coverage i the past: Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all coverage amouts. If termially ill, you ca get a partial paymet of your group term life isurace beefit. You ca use this paymet as you see fit. I the evet of your death, your beeficiary will receive a beefit payout which has bee reduced by the amout you receive. Coverage will ed o your termiatio of employmet or as specified i the pla booklet. You may be able to cotiue your term life isurace usig the portability optio, or you may covert your term life isurace to a idividual life isurace policy issued by the Prudetial Isurace Compay of America. Spouse / Domestic Parter - Optioal Depedet Term Life 100% Employee Paid Purchase coverage for your spouse for $10,000, or $25,000, or $50,000, or $75,000, or $100,000, or $150,000, or $200,000. New Hires ad Newly Eligible: If your spouse is ewly eligible, you ca elect a coverage amout for your spouse up to the Guarateed Issue amout of $50,000, without providig evidece of isurability to The Prudetial Isurace Compay of America. Curret Spouse Participats: Your spouses curret coverage amout will be cotiued. Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all icreases i coverage amouts. Curret Employees who waived spouse coverage i the past: Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all coverage amouts. Coverage will ed o your termiatio of employmet or as specified i the pla booklet. You may be able to cotiue your term life isurace usig the portability optio, or you may covert your term life isurace to a idividual life isurace policy issued by the Prudetial Isurace Compay of America. 100% Employee Paid Child - Optioal Depedet Term Life Purchase coverage for your childre i icremets of $5,000 up to a maximum of $25,000. There are o health requiremets for this coverage. Coverage begis from live birth, ad cotiues to age 26. Upo termiatio of employmet, you (if eligible to port or covert) may choose to cotiue a depedet child coverage amout equal to or lower tha your curret beefit amout.
3 Optioal Accidetal Death & Dismembermet 100% Employee Paid Employee Coverage: Purchase coverage for 1.0 to 7.0 times your covered aual earigs, to a maximum of $2,000,000 Family: Purchase a coverage amout for your spouse equal to 60% of your Optioal AD&D Isurace coverage amout. Purchase a coverage amout for your child equal to 25% of your Optioal AD&D Isurace coverage amout. The maximum coverage amout for your spouse is $750,000; the maximum coverage amout for your child(re) is $150,000. The coverage icremets that you may elect are based o your froze salary as of age 70. Your elected coverage will be reduced as you age to 65% at age 70, to 45% at age 75, to 30% at age 80, ad to 15% at age 85. For childre, coverage begis from live birth, ad cotiues to age 26. Beefits, exclusios ad provisios may vary by state. Refer to the pla booklet for details. For your coverage to become effective, you must be actively at work o the effective date of the pla. If you apply for a amout that requires satisfactory evidece of isurability to The Prudetial Isurace Compay of America, you must be actively at work o the date of approval for the amout requirig satisfactory evidece of isurability.. *Accelerated Death Beefit optio is a feature that is made available to group life isurace participats. It is ot a health, ursig home, or log-term care isurace beefit ad is ot desiged to elimiate the eed for those types of isurace coverage. The death beefit is reduced by the amout of the accelerated death beefit paid. There is o admiistrative fee to accelerate beefits. Receipt of accelerated death beefits may affect eligibility for public assistace ad may be taxable. The federal icome tax treatmet of paymets made uder this rider depeds upo whether the isured is the recipiet of the beefits ad is cosidered "termially ill" or "chroically ill." You may wish to seek professioal tax advice before exercisig this optio. This coverage is ot health isurace coverage (ofte referred to as Major Medical Coverage ). This type of pla is NOT cosidered miimum essetial coverage uder the Affordable Care Act ad therefore does NOT satisfy the idividual madate that you have health isurace coverage. If you do ot have other health isurace coverage, you may be subject to a federal tax pealty. This policy provides ACCIDENT isurace oly. It does NOT provide basic hospital, basic medical or major medical isurace as defied by the New York Departmet of Fiacial Services. IMPORTANT NOTICE - THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. Group Isurace coverages are issued by The Prudetial Isurace Compay of America, a Prudetial Fiacial compay, Newark, NJ The Booklet-Certificate cotais all details, icludig ay policy exclusios, limitatios, ad restrictios, which may apply. Cotract Series: Prudetial Fiacial, Ic. ad its related etities. Prudetial, the Prudetial logo, the Rock symbol ad Brig Your Challeges are service marks of Prudetial Fiacial, Ic., ad its related etities, registered i may jurisdictios worldwide.
4 Rate Sheet RRD All Eligible Employees Issued by The Prudetial Isurace Compay of America Effective: 01/01/2019 Rates may chage as the isured eters a higher age category. Also, rates may chage if pla experiece requires a chage for all isureds. How much does life isurace cost? The followig steps will show you how to calculate your mothly cost of isurace. Step 1 Eter the amout of Employee coverage you wish to purchase. $ Employee Step 2 Divide the coverage amouts by 1,000. $ Step 3 Multiply the dollar amouts i Step 2 by the cost of coverage per $1,000 of coverage, accordig to your age ad smoker status, that you'll fid i the chart that $ follows. This gives you the mothly cost of isurace. TOTAL COST FOR EMPLOYEE $ Cost of Optioal Term Life Isurace for You Coverage is available for 1.0 to 7.0 times your covered aual earigs, ot to exceed $2,000,000, less your basic term life coverage amout. Refer to the Optioal Term Life sectio for evidece of isurability details. For iitial erollmet oly: Rates are based o the employee's age as of iitial erollmet. For aual erollmet oly: Rates are based o the employee's age as of Jauary 1st of the pla year. Rates will chage based o the followig age schedule.. Employee's Age Employee No-Smoker Rate Employee Smoker Rate < 24 $0.038 $ $0.038 $ $0.038 $ $0.047 $ $0.066 $ $0.124 $ $0.180 $ $0.322 $ $0.483 $ $0.814 $ $1.684 $3.177 Implemetatio of the isurace pla(s) will deped o havig a specific percetage of all eligible employees erollig i the pla(s). If this percetage of erollmet level is ot met, these coverage(s) may ot be effective
5 Example A 35 year-old employee elects $72,500 of Optioal Term Life for themselves Employee Mothly Cost $3.41 ($72,500 / 1,000 x $0.047) Spouse / Domestic Parter - Optioal Depedet Term Life Mothly No-Smoker Cost per Coverage Amout Coverage is available for your spouse for $10,000, or $25,000, or $50,000, or $75,000, or $100,000, or $150,000, or $200,000. Refer to the Optioal Depedet Term Life sectio for evidece of isurability details. For iitial erollmet oly: Spouse/Domestic Parter's rates are based o the spouse/domestic parter's age (if available) or the employee's age as of iitial erollmet. For aual erollmet oly: Rates are based o the spouse/domestic parter's age (if available) or the employee's age as of Jauary 1st of the pla year. Rates will chage based o the followig age schedule: Age $10,000 $25,000 $50,000 $75,000 $100,000 $150,000 $200, $0.38 $0.95 $1.90 $2.85 $3.80 $5.70 $ $0.38 $0.95 $1.90 $2.85 $3.80 $5.70 $ $0.38 $0.95 $1.90 $2.85 $3.80 $5.70 $ $0.47 $1.18 $2.35 $3.53 $4.70 $7.05 $ $0.66 $1.65 $3.30 $4.95 $6.60 $9.90 $ $1.24 $3.10 $6.20 $9.30 $12.40 $18.60 $ $1.80 $4.50 $9.00 $13.50 $18.00 $27.00 $ $3.22 $8.05 $16.10 $24.15 $32.20 $48.30 $ $4.83 $12.08 $24.15 $36.23 $48.30 $72.45 $ $8.14 $20.35 $40.70 $61.05 $81.40 $ $ $16.84 $42.10 $84.20 $ $ $ $ Rates may chage as the isured eters a higher age category. Also, rates may chage if pla experiece requires a chage for all isureds. Spouse / Domestic Parter - Optioal Depedet Term Life Mothly Smoker Cost per Coverage Amout Coverage is available for your spouse for $10,000, or $25,000, or $50,000, or $75,000, or $100,000, or $150,000, or $200,000. Refer to the Optioal Depedet Term Life sectio for evidece of isurability details. For iitial erollmet oly: Spouse/Domestic Parter's rates are based o the spouse/domestic parter's age (if available) or the employee's age as of iitial erollmet. For aual erollmet oly: Rates are based o the spouse/domestic parter's age (if available) or the employee's age as of Jauary 1st of the pla year. Rates will chage based o the followig age schedule: Age $10,000 $25,000 $50,000 $75,000 $100,000 $150,000 $200, $0.76 $1.90 $3.80 $5.70 $7.60 $11.40 $ $0.95 $2.38 $4.75 $7.13 $9.50 $14.25 $ $1.24 $3.10 $6.20 $9.30 $12.40 $18.60 $ $1.42 $3.55 $7.10 $10.65 $14.20 $21.30 $ $1.52 $3.80 $7.60 $11.40 $15.20 $22.80 $ $2.27 $5.68 $11.35 $17.03 $22.70 $34.05 $ $3.50 $8.75 $17.50 $26.25 $35.00 $52.50 $ $6.62 $16.55 $33.10 $49.65 $66.20 $99.30 $ $10.22 $25.55 $51.10 $76.65 $ $ $ $19.76 $49.40 $98.80 $ $ $ $ $31.77 $79.43 $ $ $ $ $635.40
6 Childre - Optioal Depedet Term Life Mothly Cost per Coverage Amout Oe premium rate covers all eligible childre Coverage is available i icremets of $5,000 to a maximum of $25,000. $5,000 $10,000 $15,000 $20,000 $25,000 $0.53 $1.05 $1.58 $2.10 $2.63 Rates may chage if pla experiece requires a chage for all isureds. "How much does this Optioal AD&D isurace cost?" Isured Optioal AD&D* Mothly Cost of Isurace (rates per $1,000 of Coverage) Employee $0.015 Employee & Family $0.024 * This is optioal coverage ad the etire cost of coverage is employee paid. Worksheet for Optioal AD&D (Employee & Family) Follow this worksheet to determie the cost of isurace for you ad your family. 1. Select the desired amout of coverage $ 2. Locate the mothly rate The mothly rate per $1,000 is $ 3. Employee Oly: Divide the selected amout of coverage by $1,000. The multiply the result by the mothly rate to get the mothly cost of isurace. OR Employee ad Family: Divide the selected amout of coverage by $1,000. The multiply the result by the family mothly rate to get the mothly cost of isurace. $ divided by $1,000 is $ multiplied by $ = $ Total mothly cost of isurace = $ $ divided by $1,000 is $ multiplied by $ = $ Total mothly cost of isurace for You/Your Family= $ Total (mothly) cost of isurace = $
7 Beefits, exclusios ad provisios may vary by state. Refer to the pla booklet for details. For your coverage to become effective, you must be actively at work o the effective date of the pla. If you apply for a amout that requires satisfactory evidece of isurability to The Prudetial Isurace Compay of America, you must be actively at work o the date of approval for the amout requirig satisfactory evidece of isurability.. *Accelerated Death Beefit optio is a feature that is made available to group life isurace participats. It is ot a health, ursig home, or log-term care isurace beefit ad is ot desiged to elimiate the eed for those types of isurace coverage. The death beefit is reduced by the amout of the accelerated death beefit paid. There is o admiistrative fee to accelerate beefits. Receipt of accelerated death beefits may affect eligibility for public assistace ad may be taxable. The federal icome tax treatmet of paymets made uder this rider depeds upo whether the isured is the recipiet of the beefits ad is cosidered "termially ill" or "chroically ill." You may wish to seek professioal tax advice before exercisig this optio. This coverage is ot health isurace coverage (ofte referred to as Major Medical Coverage ). This type of pla is NOT cosidered miimum essetial coverage uder the Affordable Care Act ad therefore does NOT satisfy the idividual madate that you have health isurace coverage. If you do ot have other health isurace coverage, you may be subject to a federal tax pealty. This policy provides ACCIDENT isurace oly. It does NOT provide basic hospital, basic medical or major medical isurace as defied by the New York Departmet of Fiacial Services. IMPORTANT NOTICE - THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. Group Isurace coverages are issued by The Prudetial Isurace Compay of America, a Prudetial Fiacial compay, Newark, NJ The Booklet-Certificate cotais all details, icludig ay policy exclusios, limitatios, ad restrictios, which may apply. Cotract Series: Prudetial Fiacial, Ic. ad its related etities. Prudetial, the Prudetial logo, the Rock symbol ad Brig Your Challeges are service marks of Prudetial Fiacial, Ic., ad its related etities, registered i may jurisdictios worldwide.
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