Life, Accident and Critical Illness Insurance Programs

Transcription

1 Life, Accident and Critical Illness Insurance Programs

2 Important Notice This Summary Plan Description (SPD) booklet, including any subsequent related Summaries of Material Modifications (SMMs), is intended to help you understand the main features of the Life, Accident and Critical Illness Insurance Programs applicable to eligible Employees, and to provide information regarding your benefits. If you need assistance in reading this booklet, please call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. This SPD booklet, including any subsequent related SMMs, constitutes the latest SPD booklet of the Life, Accident and Critical Illness Insurance Programs of The Prudential Welfare Benefits Plan. The Prudential Welfare Benefits Plan also covers other classes of Employees as described in other SPD booklets that cover those specific Employee populations. This SPD booklet, including any subsequent related SMMs, is not a substitute for the official Plan Document(s), which governs the operation of the Program. All terms and conditions of the Program, including your eligibility and any benefits, will be determined pursuant to and are governed by the provisions of the applicable Plan Document(s). If there is any discrepancy between the information in this SPD booklet, including any subsequent related SMMs, or in any other Prudential materials relating to the Program and the actual Plan Document(s), or if there is a conflict between information discussed by anyone acting on Prudential s behalf and the actual Plan Document(s), the Plan Document(s) as interpreted by the applicable Plan Administrator in its sole discretion will always govern. Prudential may, in its sole discretion, modify, amend, suspend or terminate any and all of its HR policies, programs, plans and benefits, including those described in this SPD booklet, including any subsequent related SMMs, in whole or in part, at any time, without notice to or consent of any participant, employee or former employee to the extent permissible under applicable law. Nothing contained in this SPD booklet, including any subsequent related SMMs, is intended to constitute or create a contract of employment, nor shall it constitute or create the right to remain associated with or in the employ of Prudential for any particular period of time. In addition, no oral or written statements made by anyone acting on Prudential s behalf are intended to create the right to remain associated with or in the employ of Prudential for any particular period of time. Employment with Prudential is employment-at-will. This means that either you or Prudential may terminate the employment relationship at any time, with or without cause or notice. Enrollment and Election Changes The Prudential Benefits Center website (at is your primary resource when you need to enroll for coverage under the Life, Accident and Critical Illness Insurance Programs or make changes to your elections. When you process your enrollment or election changes through the Prudential Benefits Center website, you will look there to find the instructions and guidance you will need for completing the process and confirming your enrollment or changes. If you have any questions as to whether you are properly completing your transaction, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Prudential Benefits Center Representatives are available to assist you between 8 a.m. and 6 p.m. Eastern time, Monday through Friday, except on holidays. For the hearing-impaired, please contact your local relay service. Life, Accident and Critical Illness Insurance Programs Page i

3 Inside You Will Find How to Contact the Prudential Benefits Center... 1 Online Access... 1 Via the Internet... 1 Via the Prudential Intranet... 1 Telephone Access... 1 Mail Access... 1 Terms and Conditions... 2 Introduction to the Life, Accident and Critical Illness Insurance Programs... 3 Core Company-Provided Benefits... 3 Voluntary Benefits... 4 Survivor Benefits Life Insurance Program (Frozen Effective January 1, 2001)... 6 Joining the Program... 7 Who Is Eligible... 7 Who Is Not Eligible... 7 Important Notice Regarding Civil Union Partnership... 8 Cost of Coverage... 8 After-Tax Contributions... 8 When You Are Eligible to Enroll... 8 How to Enroll... 9 For Core Company-Provided Coverage... 9 For Voluntary Coverage... 9 Enrollment and Election Changes When Coverage Takes Effect For Core Company-Provided Coverage For Voluntary Coverage GUL Insurance Dependent Term Life Insurance Supplemental AD&D Insurance Critical Illness Insurance Changes in Your Eligible Earnings Beneficiaries Beneficiary for Dependent Term Life Insurance Beneficiary for Survivor Benefits Life Insurance Beneficiary for Dependent Coverage Under Supplemental AD&D Insurance and BTA Insurance Beneficiary for Critical Illness Insurance Basic Group Life Insurance...15 Cost of Coverage Coverage Amount Imputed Income When Benefits Are Paid Life, Accident and Critical Illness Insurance Programs Page ii

4 Option to Accelerate Payment of Death Benefits How Benefits Are Paid If You Take a Leave of Absence Unpaid Leave of Absence Paid Leave of Absence If You Are Disabled Waiver of Premium If You Reach Age 70 as an Active Employee If You Retire If Your Employment Ends Group Universal Life Insurance and the Group Universal Life Insurance Cash Accumulation Fund...20 Group Universal Life Insurance Cost of Coverage After-Tax Contributions Coverage Amount Evidence of Good Health When You Will Be Required to Show Evidence of Good Health When You Are Not Required to Provide Evidence of Good Health Group Universal Life Insurance Cash Accumulation Fund Modified Endowment Contract Section 1035 Exchange How to Access Your GUL Fund Paid-Up Insurance Annual Statements When Benefits Are Paid Option to Accelerate Payment of Death Benefits How Benefits Are Paid Continuation Conversion If You Take a Leave of Absence Unpaid Leave of Absence Paid Leave of Absence If You Are Disabled Waiver of Premium If You Retire If Your Employment Ends Dependent Term Life Insurance...28 Your Eligible Dependents Enrolling and Adding Eligible Dependents Restrictions on Eligibility Important Notice Regarding Civil Union Partnership Cost of Coverage Life, Accident and Critical Illness Insurance Programs Page iii

5 After-Tax Contributions Coverage Amount Evidence of Good Health When an Eligible Dependent Ceases to Be Covered When Benefits Are Paid How Benefits Are Paid Portability If You Take a Leave of Absence Unpaid Leave of Absence Paid Leave of Absence If You Are Disabled If You Retire If Your Employment Ends Survivor Benefits Life Insurance...34 Cost of Coverage After-Tax Contributions Coverage Amount Qualified Family Members Adding Qualified Family Members When Benefits Are Paid How Benefits Are Paid Spouse Benefit Children Benefit If You Take a Leave of Absence Unpaid Leave of Absence Paid Leave of Absence If You Are Disabled Waiver of Premium If You Reach Age 65 as an Active Employee If You Retire If Your Employment Ends Basic Accidental Death and Dismemberment Insurance...40 Cost of Coverage Coverage Amount Additional Seat Belt and Air Bag Benefits Specified Aircraft Coverage Exclusions When Benefits Are Paid How Benefits Are Paid If You Take a Leave of Absence Unpaid Leave of Absence Paid Leave of Absence Life, Accident and Critical Illness Insurance Programs Page iv

6 If You Are Disabled If You Reach Age 70 as an Active Employee If You Retire If Your Employment Ends Supplemental Accidental Death and Dismemberment Insurance...45 Your Eligible Dependents Enrolling and Adding Eligible Dependents Restrictions on Eligibility Important Notice Regarding Civil Union Partnership Cost of Coverage After-Tax Contributions Coverage Amount Additional Seat Belt and Air Bag Benefits Specified Aircraft Coverage Additional Benefits Monthly Medical Premium Benefit Common Disaster Benefit Day Care Expense Benefit Child Tuition Reimbursement Benefit Spouse or Domestic Partner Tuition Reimbursement Benefit Dependent Child Loss Benefit Continued Accident Insurance After Your Death Exclusions Evidence of Good Health When Benefits Are Paid How Benefits Are Paid If You Take a Leave of Absence Unpaid Leave of Absence Paid Leave of Absence If You Are Disabled If You Retire If Your Employment Ends Business Travel Accident Insurance...53 Cost of Coverage Coverage Amount Qualified Eligible Dependent Coverage Important Notice Regarding Civil Union Partnership Business Travel Coverage War Risk Coverage Hijacking Coverage Commuting to and from Work Due to a Transit Difficulty Felonious Assault Life, Accident and Critical Illness Insurance Programs Page v

7 Specified Aircraft Coverage Additional Benefits Seat Belt and Air Bag Benefit Additional Benefit for Family Relocation and Accompaniment Home Alteration and Vehicle Modification Benefit Monthly Rehabilitation Expense Benefit Bereavement and Trauma Counseling Benefit Monthly Medical Premium Benefit Emergency or Disaster Response Team Member Benefit Common Carrier Benefit Day Care Expense Benefit Child Tuition Reimbursement Benefit Spouse or Domestic Partner Tuition Reimbursement Benefit Exclusions When Benefits Are Paid How Benefits Are Paid If You Take a Leave of Absence If You Are Disabled If You Retire If Your Employment Ends Critical Illness Insurance...60 Qualified Eligible Dependent Important Notice Regarding Civil Union Partnership Enrolling a Qualified Eligible Dependent Restrictions on Eligibility Cost of Coverage After-Tax Contributions Coverage Amount Evidence of Good Health When You Are Not Required to Provide Evidence of Good Health Benefits First Occurrence Benefit Amount Payable Reoccurrence Benefit Amount Payable Lifetime Maximum Benefit Critical Illnesses or Procedures Not Covered Pre-Existing Condition Limitations Effect of a Pre-Existing Condition on a Benefit Increase Physical Exam When Benefits Are Paid When Coverage Ends If You Take a Leave of Absence Unpaid Leave of Absence Life, Accident and Critical Illness Insurance Programs Page vi

8 Paid Leave of Absence If You Are Disabled If You Retire If Your Employment Ends Continuation of Coverage Claims and Appeals Procedures...69 Claim for Benefits Making a Claim for a Benefit How to File a Claim for Benefits Proof of Loss What Information to Include in a Claim When to File a Claim Time Frame for Claim Determinations Notice of Adverse Benefit Determination Appeal of an Adverse Benefit Determination Appeals Procedures When You Can Expect a Response Notice of Adverse Benefit Determination on Appeal Voluntary Level of Appeal Non-Benefit Claims Enrollment and Eligibility Claims Other Non-Benefit Claims Appeal of an Adverse Determination of a Non-Benefit Claim Legal Action Life Events...77 Family and Medical Leave Act Uniformed Services Employment and Reemployment Rights Act Other Important Information...80 Converting to an Individual Policy A Prudential Alliance Account Tax Considerations Assignment of Benefits Administrative Information...82 Plan Administration Plan Name and Number Plan Administrator Plan Sponsor Employer Identification Number Plan Year Funding, Payment and Claims of Program Benefits Trustee Information Insurance Issuers and Administrators Life, Accident and Critical Illness Insurance Programs Page vii

9 Plan Amendment or Termination Service of Legal Process If You Do Not Have Access to the Prudential Benefits Center Website Your Rights Prudent Actions by Plan Fiduciaries Assistance with Your Questions Glossary...87 Life, Accident and Critical Illness Insurance Programs Page viii

10 How to Contact the Prudential Benefits Center Throughout this SPD booklet, you will see references to the Prudential Benefits Center, which is your primary resource for information about most of your Prudential benefits. You can reach the Prudential Benefits Center online, by telephone or by mail. Online Access Through the Prudential Benefits Center website, you can: Find information about your benefits; Access benefits forms you may need; In most cases, process a change in your benefit elections; Get information on how to contact insurers and service providers; Find links to carrier websites and online provider directories; and the Prudential Benefits Center by clicking on the Contact Us link. You can also use the online chat feature on the Prudential Benefits Center website to get in touch with a Prudential Benefits Center Representative who can answer your questions about navigating the site or general questions about your benefits. From the home page on the Prudential Benefits Center website, click the Web Chat icon. Prudential Benefits Center Representatives are available between 8 a.m. and 6 p.m. Eastern time, Monday through Friday, except on holidays. The Prudential Benefits Center website is available via the Internet and the Prudential intranet. Via the Internet Log on to to access the Prudential Benefits Center website 24 hours a day, 7 days a week. Via the Prudential Intranet To access the Prudential Benefits Center website through the Prudential intranet, click on the Prudential Benefits Center link under Quick Links. If you do not have a computer or Internet access, follow the instructions in this section for contacting the Prudential Benefits Center by telephone or by mail. Telephone Access You can call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Prudential Benefits Center Representatives are available to assist you between 8 a.m. and 6 p.m. Eastern time, Monday through Friday, except on holidays. For the hearing-impaired, please contact your local relay service. Mail Access The mailing address for filing claims related to Program enrollment and eligibility is: Prudential Benefits Center Claims and Appeals Management (CAM) P.O. Box 1407 Lincolnshire, IL Life, Accident and Critical Illness Insurance Programs Page 1

11 The mailing address for submitting written proof of a child s disability and for submitting written proof of loss is: Prudential Benefits Center P.O. Box Charlotte, NC Terms and Conditions When you use the Prudential Benefits Center website (at and the Prudential Interactive Voice Response (IVR) systems, you are agreeing to use them under the terms and conditions prescribed by the Company. These terms and conditions are maintained on the Prudential Benefits Center website for easy reference. Or, to obtain a copy, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Life, Accident and Critical Illness Insurance Programs Page 2

12 Introduction to the Life, Accident and Critical Illness Insurance Programs Throughout this SPD booklet, you will see terms whose first letters are capitalized. When you see these terms, you can check the Glossary at the back for detailed definitions and how the definitions apply to the benefits described in the SPD booklet. Prudential s Life, Accident and Critical Illness Insurance Programs can help you plan for the uncertainties of the future by providing valuable benefits if you die, are seriously injured in an accident or experience a critical illness. These Programs are governed by the terms of The Prudential Welfare Benefits Plan. Core Company-Provided Benefits The Company provides a core level of life and accident coverage. You are automatically enrolled in this coverage and you are not required to make a contribution for these benefits. Basic Group Life Insurance: Pays your Beneficiary(ies) a benefit equal to one times your Eligible Earnings, up to a maximum benefit of $300,000 upon your death. You may elect to cap the amount of your Basic Group Life Insurance benefit at $50,000 to avoid Imputed Income. (See the Imputed Income section for more information.) Basic Accidental Death and Dismemberment (AD&D) Insurance: Pays a benefit of one times your Eligible Earnings, up to a maximum benefit of $300,000 to your Beneficiary(ies) if you die as the result of an accident. Basic AD&D Insurance coverage amounts of $50,000 and over will not be subject to Imputed Income. If you sustain certain serious accident-related injuries, Basic AD&D Insurance pays the full benefit amount or a percentage of your benefit amount, based on the Basic AD&D Schedule of Benefits (see the Basic AD&D Schedule of Benefits section) Business Travel Accident (BTA) Insurance: Pays a benefit of up to 10 times your Eligible Earnings, up to a maximum benefit of $1,000,000 if you die or are injured as the result of an accident while traveling on Company business. It also provides a benefit for the injury or death of a Spouse, Qualified Adult (that is, a Domestic Partner or an Extended Family Member) or Dependent Child traveling with you. Life, Accident and Critical Illness Insurance Programs Page 3

13 Voluntary Benefits If you want more insurance than what is offered through the core Company-provided coverages or you want Critical Illness Insurance coverage, you may enroll in voluntary coverages offered by Prudential. If you elect to enroll in one of the following voluntary coverages, you pay the full Cost of coverage. Group Universal Life (GUL) Insurance: Pays your Beneficiary(ies) a life insurance benefit of one to nine times your Eligible Earnings (based on your election), up to a maximum benefit of $3,000,000 if you die. You also have the option of contributing additional amounts to the Group Universal Life Insurance Cash Accumulation Fund (GUL Fund). The amount in your GUL Fund is added to your GUL Insurance benefit if you die. The maximum benefit for this coverage is separate from the maximum benefit applicable to Basic Group Life Insurance coverage. Supplemental Accidental Death & Dismemberment (AD&D) Insurance: Pays a benefit of one to nine times your Eligible Earnings (based on your election), up to a maximum benefit of $2,000,000 if you die as the result of an accident. It pays the full amount or a percentage of your coverage if you sustain certain serious accident-related injuries. (See the Supplemental AD&D Schedule of Benefits section.) The maximum benefit for this coverage is separate from the maximum benefit applicable to Basic AD&D coverage. You may also elect: Spouse/Domestic Partner coverage in multiples of $50,000, up to a maximum coverage amount of $500,000; or Dependent Child coverage in the amount of $10,000, $25,000, $50,000 or $75,000 for each Dependent Child. This coverage pays benefits to you if one of your covered Eligible Dependents dies as the result of an accident or sustains certain serious, accident-related injuries. Please note: If you would like to elect this coverage, you must elect Supplemental AD&D coverage for yourself. The Spouse/Domestic Partner coverage amount you elect cannot exceed the amount for which you are covered under Basic and Supplemental AD&D Insurance combined. Similarly, the coverage amount you elect for your Dependent Child(ren) also cannot exceed the amount for which you are covered under Basic and Supplemental AD&D Insurance combined. Dependent Term Life Insurance: Provides a benefit payable to you if one of your covered Eligible Dependents dies. The maximum benefit for Spouse/Domestic Partner coverage is $250,000 (chosen as a flat $10,000 or a multiple of $25,000). Note that the benefit cannot exceed 50% of the amount for which you are covered under the Basic Life Insurance Program and the GUL Insurance Program combined. The benefit for each Dependent Child age 14 days or older, but less than age 19, is $10,000. Life, Accident and Critical Illness Insurance Programs Page 4

14 Critical Illness Insurance: Critical Illness Insurance provides a lump-sum benefit payment upon diagnosis of a covered critical illness and benefit proceeds may be used to pay for any type of expense. Critical Illness benefits are payable when you or a covered Spouse/Domestic Partner is diagnosed with a critical illness and the diagnosis occurs during the person s lifetime while covered. Pre-existing coverage limitations apply. Critical Illness Insurance is available to: You, up to a maximum coverage amount of $100,000 (in increments of $20,000), subject to evidence of good health. You must enroll and coverage must be effective prior to your attainment of age 65; however, once coverage is issued, it will not end based on age; and Your Spouse/Domestic Partner, up to a maximum coverage amount of $50,000 (in increments of $10,000), subject to evidence of good health, if you elect coverage for yourself. You must enroll your Spouse/Domestic Partner and coverage must be effective prior to your Spouse/Domestic Partner s attainment of age 65; however, once coverage is issued, it will not end based on age. Your Spouse/Domestic Partner coverage cannot be more than 50% of your coverage amount. Please note: If you would like to elect this coverage, you must review the Critical Illness Insurance Outline of Coverage and be enrolled in either a Prudential-sponsored medical program or have other medical coverage, such as through a Spouse s or Domestic Partner s health plan. When enrolling for coverage, you must attest that you received and reviewed the Critical Illness Insurance Outline of Coverage and you and your Spouse/Domestic Partner have Prudentialsponsored or other medical coverage. Otherwise, enrollment will not be permitted. To participate in any of these coverages, you must enroll within the 31-day period on and following your first day of employment or a Change in Status. (See the Qualified Changes in Status booklet for more information.) If you do not enroll within the 31-day period and you later want to enroll, you may be required to submit satisfactory evidence of good health to the insurance carrier. (See the Evidence of Good Health section under the specific insurance section for more information.) For Basic Group Life Insurance, Basic AD&D Insurance, Group Universal Life (GUL) Insurance and your Employee coverage under BTA Insurance and Supplemental AD&D Insurance, you must also name your Beneficiary(ies). If no Beneficiary is named, any death benefits will be payable in the following successive order: Surviving Spouse or Domestic Partner; Surviving child(ren), in equal shares; Surviving parent(s), in equal shares; Surviving sibling(s), in equal shares; or Your estate. You can enroll in the programs and designate your Beneficiary(ies) by visiting the Prudential Benefits Center website (at This does not apply to Dependent Term Life Insurance, Survivor Benefits Life Insurance and Critical Illness Insurance. You can disenroll from any of your voluntary life, accident and critical illness coverages at any time by calling the Prudential Benefits Center. If you do not have access to a computer or the Internet or if you need more information about enrolling or disenrolling for voluntary coverage, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Life, Accident and Critical Illness Insurance Programs Page 5

15 Survivor Benefits Life Insurance Program (Frozen Effective January 1, 2001) Effective January 1, 2001, no Employee may newly enroll in the Survivor Benefits Life Insurance Program. You may continue this coverage only if you were participating as of December 31, 2000, provided that you have been continuously covered since that date. You pay the full Cost of coverage. The Survivor Benefits Life Insurance Program pays a monthly benefit to your Spouse (20% of your monthly Eligible Earnings, up to a maximum benefit of $2,500 per month) and/or Dependent Children (10% of your monthly Eligible Earnings, up to a maximum benefit of $1,250 per month) after your death. Whether you have one Dependent Child or many Dependent Children, the total benefit for all Dependent Children is 10% of your monthly Eligible Earnings, up to the maximum benefit, divided equally among all designated Dependent Children. Life, Accident and Critical Illness Insurance Programs Page 6

16 Joining the Program Who Is Eligible You are eligible to participate in the Life, Accident and Critical Illness Insurance Programs described in this SPD booklet if you are: A Full-Time Employee; A Part-Time Employee who is scheduled to work at least 20 hours per week, other than a part-time field force marketing assistant; or An Agency Distribution Financial Professional. Please note: For Critical Illness Coverage, to be eligible you must be under age 65 at the time you enroll and obtain coverage. If you would like to elect this coverage, you must review the Critical Illness Insurance Outline of Coverage and be enrolled in either a Prudential-sponsored medical program or have other medical coverage, such as through a Spouse s or Domestic Partner s health plan. When enrolling for coverage, you must attest that you received and reviewed the Critical Illness Insurance Outline of Coverage and you and your Spouse/Domestic Partner have Prudential-sponsored or other medical coverage. Otherwise, enrollment will not be permitted. Your Spouse or Qualified Adult (that is, a Domestic Partner or an Extended Family Member) and your Dependent Child(ren) are also covered under the Business Travel Accident (BTA) Insurance Program when traveling with you on Company business. Retirees are eligible to participate in some insurance coverages. (See the If You Retire section under the specific insurance sections for more information.) Who Is Not Eligible You are not eligible to participate in the Life, Accident and Critical Illness Insurance Programs described in this SPD booklet if you are: Included in a collective bargaining unit, unless the collective bargaining agreement specifically provides for participation in the Life, Accident and Critical Illness Insurance Programs; An Employee of a non-participating Affiliate; An International Employee; A Retired Employee, except as otherwise noted; A temporary or occasional Employee; An Agency Distribution Financial Professional Emeritus, Agent Emeritus, Premier Retired Representative or Retired Representative; An individual service provider compensated through an employee leasing company, temporary employment agency or other third-party agency; An individual who would be treated as an employee solely by reason of such individual being treated as either part of an affiliated service group or a leased employee under the Internal Revenue Code and regulations; An independent contractor (other than an Agency Distribution Financial Professional); A person retained on a monthly fee or per diem basis; An examining physician or other person rendering services solely on the basis of fees; A person working under the direction of real estate management firms or other contractors; A part-time field force marketing assistant; Life, Accident and Critical Illness Insurance Programs Page 7

17 A student intern hired or re-hired on or after June 1, 2007; An Agency Distribution Probationary Financial Professional hired on or after September 1, 2008, and who participates in a development program within Agency Distribution pursuant to an employment agreement for a period of time that is not expected to exceed 26 weeks; or Any other person who performs services for Prudential but is not treated by Prudential as an Employee for federal tax purposes. Refer to the Plan Document for a complete listing of the classes of Employees who are ineligible to participate in the Life, Accident and Critical Illness Insurance Programs. If you would like to request a Plan Document, you should write to the Plan Administrator at the address shown in the Plan Administrator section. Important Notice Regarding Civil Union Partnership Certain states have passed legislation that requires insurers to provide equal benefit coverage for civil union partners, if spousal coverage is provided through an employer s group insurance plan. Civil union partners under a validly established civil union partnership under a state or foreign jurisdiction may be eligible for some of these programs. For more details regarding civil union partner eligibility requirements for these Programs, please contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Cost of Coverage Prudential pays the full Cost for the following core coverages: Basic Group Life Insurance; Basic AD&D Insurance; and BTA Insurance. If you elect to purchase voluntary coverage through GUL, Supplemental AD&D, Dependent Term Life and/or Critical Illness Insurance, you pay the full Cost of coverage. If you were covered under the Survivor Benefits Life Insurance Program as of December 31, 2000, and chose to continue that coverage, you pay the full Cost of coverage, if applicable. After-Tax Contributions Your Cost for any voluntary coverage you elect to purchase is paid on an After-Tax basis, usually through automatic payroll deductions. After-Tax means a portion of your income that is deducted from your pay after any applicable federal, state and local income taxes and Social Security taxes have been withheld, that you contribute to a plan or program or use to pay all or a portion of the Cost of coverage for certain programs. Your deducted pay will still be part of your taxable income. When You Are Eligible to Enroll You are eligible to enroll in the Life, Accident and Critical Illness Insurance Programs as of your first day of employment. Life, Accident and Critical Illness Insurance Programs Page 8

18 How to Enroll For Core Company-Provided Coverage Prudential automatically enrolls you in the core Company-provided coverage on your first day of employment. You do not have to enroll to participate in these coverages; however, you will have to designate your Beneficiary(ies). (See the Beneficiaries section for more information.) For Voluntary Coverage If you want more insurance coverage than the core Company-provided coverage, you may elect to enroll in one or more of the following types of voluntary coverage at any time: GUL Insurance; Supplemental AD&D Insurance; Dependent Term Life Insurance; and Critical Illness Insurance. You can enroll in the programs and designate your Beneficiary(ies) by visiting the Prudential Benefits Center website (at (See the Beneficiaries section for more information.) You also may be required to provide satisfactory evidence of good health to the insurance carrier before your coverage takes effect for GUL Insurance, Dependent Term Life Insurance or Critical Illness Insurance. (See the Evidence of Good Health section under the Group Universal Life Insurance and the Group Universal Life Insurance Cash Accumulation Fund, Dependent Term Life Insurance and Critical Illness Insurance sections for more information.) You can disenroll from any of your voluntary Life, Accident or Critical Illness Insurance coverages at any time by calling the Prudential Benefits Center. If you do not have access to a computer or the Internet or if you need more information to enroll or disenroll from any of your voluntary Life, Accident or Critical Illness Insurance coverages, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Prior to becoming enrolled in the GUL Insurance Program, you may elect to exchange the amount in your group universal life cash accumulation fund and your Basis in the Certificate from the group universal life cash accumulation fund you had with a previous employer for an equivalent amount in the GUL Fund provided by Prudential. An exchange will not become effective unless: The exchange is initiated before your enrollment in the GUL Insurance Program; The group universal life cash accumulation fund program of your former employer is compatible with the GUL Fund of Prudential as determined by the insurer; The exchange qualifies under Section 1035 of the Internal Revenue Code; and You satisfy all enrollment and evidence of good health requirements and any other criteria as may be established by the Administrative Committee. Life, Accident and Critical Illness Insurance Programs Page 9

19 Enrollment and Election Changes The Prudential Benefits Center website (at is your primary resource when you need to enroll for coverage under the Life, Accident and Critical Illness Insurance Programs or make changes to your elections. When you process your enrollment or election changes through the Prudential Benefits Center website, you will look there to find the instructions and guidance you will need for completing the process and confirming your enrollment or changes. If you have any questions as to whether you are properly completing your transaction, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. When Coverage Takes Effect You must be Actively at Work for changes in coverage amounts to take effect. This includes changes resulting from an increase or decrease in your Eligible Earnings. If you are not Actively at Work on the date your coverage changes are scheduled to take effect, coverage will begin on the day you return to active work. In addition, evidence of good health, if applicable, must be approved before coverage changes become effective. For Core Company-Provided Coverage Core Company-provided coverage takes effect on your first day of employment. For Voluntary Coverage GUL Insurance GUL Insurance coverage equal to one to three times your Eligible Earnings takes effect on your first day of employment if you make your election within the 31-day period on and following your first day of employment or, if you enroll at any other time, the date your coverage is approved by the insurance carrier. GUL Insurance coverage equal to four to nine times your Eligible Earnings, which requires you to provide evidence of good health, takes effect on the date your coverage is approved by the insurance carrier. For example, if you elect GUL Insurance coverage in the amount of six times your Eligible Earnings within the 31-day period on and following your first day of employment, your coverage for one to three times your Eligible Earnings will take effect on your first day of employment. The remaining coverage you elected (four to six times your Eligible Earnings) will take effect on the date your coverage is approved by the insurance carrier. If you make your GUL Insurance coverage election (of any coverage level) after the initial 31-day period or at any other time, you will be required to provide evidence of good health to the insurance carrier. Your coverage will take effect on the date your coverage is approved by the insurance carrier. See the Evidence of Good Health section for more information about situations in which you will be required to provide evidence of good health. If you elect GUL Insurance coverage during the Annual Enrollment Period, coverage takes effect the later of: January 1 of the following Calendar Year; or The date your coverage is approved by the insurance carrier. Life, Accident and Critical Illness Insurance Programs Page 10

20 Dependent Term Life Insurance Dependent Term Life Insurance coverage for a Spouse or Domestic Partner in the amount of $25,000 or less takes effect on your first day of employment if you make your election within the 31-day period on and following your first day of employment or, if you enroll at any other time, the date coverage is approved by the insurance carrier. Dependent Term Life Insurance coverage in an amount above $25,000, which requires your Spouse or Domestic Partner to provide evidence of good health to the insurance carrier, takes effect on the date coverage is approved by the insurance carrier. For example, if you elect coverage in the amount of $50,000 within the 31-day period on and following your first day of employment, coverage in the amount of $25,000 will take effect on your first day of employment. The remaining coverage you elected (the additional $25,000) will take effect on the date your Spouse s or Domestic Partner s coverage is approved by the insurance carrier. If you make your Dependent Term Life Insurance coverage election (of any coverage level) after the initial 31-day period, you will be required to provide evidence of good health to the insurance carrier. Coverage will take effect on the later of: The date your coverage is approved by the insurance carrier; or The day your Eligible Dependent is no longer confined for medical treatment at home or elsewhere (unless a hospital confinement is related to the birth of a Dependent Child). See the Evidence of Good Health section for more information about situations in which you will be required to provide evidence of good health. Dependent Term Life Insurance coverage for children takes effect on your first day of employment if you make your election within the 31-day period on and following your first day of employment or on the date that you make your election at any other time. Child coverage does not require evidence of good health. If you elect Dependent Term Life Insurance coverage for a Spouse or Domestic Partner during the Annual Enrollment Period, coverage takes effect the later of: January 1 of the following Calendar Year; or The date your coverage is approved by the insurance carrier. If you elect Dependent Term Life Insurance coverage for children during the Annual Enrollment Period, coverage takes effect on January 1 of the following Calendar Year. Supplemental AD&D Insurance If you elect Supplemental AD&D Insurance during the Annual Enrollment Period, coverage takes effect on January 1 of the following Calendar Year. Otherwise, Supplemental AD&D Insurance coverage elected during the year takes effect on the date that you make your election. Evidence of good health is not required. Critical Illness Insurance Critical Illness Insurance coverage for you in the amount of $20,000 takes effect on your first day of employment if you make your election within the 31-day period on and following your first day of employment or on the date of enrollment if you make your election within the 31-day period on and following a Change in Status Event. Critical Illness Insurance coverage for your Spouse/Domestic Partner in the amount of $10,000 takes effect on your first day of employment if you make your election within the 31-day period on and following your first day of employment or on the date of enrollment if you make your election within the 31-day period on and following a Change in Status Event. Life, Accident and Critical Illness Insurance Programs Page 11

21 Critical Illness Insurance coverage in an amount above $20,000 for you or $10,000 for your Spouse/Domestic Partner requires you and/or your Spouse/Domestic Partner to provide evidence of good health to the insurance carrier and will take effect on the date coverage is approved by the insurance carrier. For example, if you elect coverage in the amount of $40,000 within the 31-day period on and following your first day of employment, coverage in the amount of $20,000 will take effect on your first day of employment. The remaining coverage you elected (the additional $20,000) will take effect on the date your coverage is approved by the insurance carrier. If you make a Critical Illness coverage election (of any coverage level) after the initial 31-day period or after the 31-day period following a Change in Status, you and/or your Spouse/Domestic Partner will be required to provide evidence of good health to the insurance carrier. Coverage will take effect on the later of: The date coverage is approved by the insurance carrier; The day you are Actively at Work; or The day your Spouse/Domestic Partner is not confined at home or in a medical facility for medical care or treatment. See the Evidence of Good Health section for more information about situations in which you will be required to provide evidence of good health. If you elect Critical Illness Insurance coverage for yourself and/or your Spouse/Domestic Partner during the Annual Enrollment Period, coverage takes effect the later of: January 1 of the following Calendar Year; or The date coverage is approved by the insurance carrier. Changes in Your Eligible Earnings Your Life and Accident Insurance coverage will be adjusted automatically to reflect any increases or decreases in your Eligible Earnings. You must be Actively at Work for changes in coverage amounts to take effect. This includes changes resulting from an increase or decrease in your Eligible Earnings. If you are not Actively at Work on the date your coverage changes are scheduled to take effect, coverage will begin on the day you return to active work. In addition, evidence of good health, if applicable, must be approved before coverage changes become effective. Your contributions for GUL Insurance, Survivor Benefits Life Insurance and Supplemental AD&D Insurance coverage also will be adjusted automatically to reflect changes in your Eligible Earnings. If your combined amount of Basic Group Life Insurance and GUL Insurance coverage increases as the result of an increase in your Eligible Earnings, you may be eligible for additional Spouse/Domestic Partner coverage under the Dependent Term Life Insurance Program. If you wish to increase your Spouse/Domestic Partner coverage under the Dependent Term Life Insurance Program, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. You will need to provide evidence of good health if you increase your Spouse/Domestic Partner coverage under the Dependent Term Life Insurance Program. When you call the Prudential Benefits Center to increase your Spouse s/domestic Partner s coverage, a Prudential Benefits Center Representative will help you with the process for providing evidence of good health. Once the new coverage amount is approved, your records will be updated accordingly. Life, Accident and Critical Illness Insurance Programs Page 12

22 Agency Distribution Sales Professionals, Agency Distribution Field Management and Non-Retail Sales Professionals Only: Your Eligible Earnings for all coverages under the Life and Accident Insurance Programs (also known as your Annual Benefits Base Rate) will be redetermined annually, around April 1. Coverage amounts and your contributions will be adjusted to reflect changes in your Eligible Earnings. Beneficiaries All of the Life and Accident Insurance Programs (except Dependent Term Life Insurance, Survivor Benefits Life Insurance and Critical Illness Insurance) provide you with the opportunity to elect a Beneficiary. You may have made this election when you enrolled or first became eligible for coverage. To change or designate your Beneficiary or to determine your current Beneficiary designation if you have already added your Beneficiary designation on the Prudential Benefits Center website, log on to the Prudential Benefits Center website (at select Beneficiaries under My Profile. If you have general questions regarding the process for designating Beneficiaries or you have not made your Beneficiary designation on the Prudential Benefits Center website (for example, if you made your Beneficiary designation via paper forms) and would like to determine your current Beneficiary designation, you may call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. You may name any individual(s) or legal entity you wish as your Beneficiary for the benefits provided by these coverages, except for Dependent Term Life Insurance, Survivor Benefits Life Insurance and Critical Illness Insurance, as noted below. You may also elect more than one person to be your Beneficiary for a program. If you want more than one Beneficiary for a Program, you must indicate the percentage of your benefit you would like each named Beneficiary to receive; otherwise, benefits will be distributed equally among all of your named Beneficiaries. The Beneficiary you designated for your Basic Group Life Insurance will also be your Beneficiary for your Basic Accidental Death and Dismemberment Insurance and Supplemental Accidental Death and Dismemberment Insurance, unless you name another Beneficiary. If no Beneficiary is named, any death benefits will be payable in the following successive order: Surviving Spouse or Domestic Partner; Surviving child(ren), in equal shares; Surviving parent(s), in equal shares; Surviving sibling(s), in equal shares; or Estate. Generally, you may change your Beneficiary at any time. Your changes will take effect as of the date you complete the change on the Prudential Benefits Center website. If you do not have access to a computer or the Internet or if you need more information, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Beneficiary for Dependent Term Life Insurance You, the Employee, are the Beneficiary for any Dependent Term Life Insurance benefits that are paid. If you predecease your Eligible Dependent, the death benefit is payable to your Eligible Dependent s estate or, at the option of the insurance carrier, to your Eligible Dependent s then-living Spouse, Domestic Partner, mother, father, children and/or siblings. Life, Accident and Critical Illness Insurance Programs Page 13

23 Beneficiary for Survivor Benefits Life Insurance You may continue this coverage only if you were participating as of December 31, 2000, provided that you have been continuously covered since that date. Only your Spouse and/or covered children can be Beneficiaries under Survivor Benefits Life Insurance. If you are enrolled in: Spouse only coverage or in Spouse and child(ren) coverage, benefits payable to your qualified family members are paid to your Spouse; or Child(ren) only coverage, benefits will be paid in equal shares to each of your Dependent Children or their guardian(s). See the Adding Qualified Family Members section for more information about who qualifies as Eligible Dependents for this coverage. Beneficiary for Dependent Coverage Under Supplemental AD&D Insurance and BTA Insurance You, the Employee, are the Beneficiary for dependent coverage under Supplemental AD&D Insurance and BTA Insurance. If you predecease your covered Eligible Dependent, the death benefit is payable to your covered Eligible Dependent s estate or, at the option of the insurance carrier, to your covered Eligible Dependent s then-living Spouse, Domestic Partner, mother, father, children and/or siblings. Beneficiary for Critical Illness Insurance There is no Beneficiary for the Critical Illness Insurance Program coverage. Any benefits under the program will be paid to you, the Employee, as applicable. If you are not living when the benefit is to be paid, the benefit that is unpaid at the time of death will be payable to the first of the following: Surviving Spouse or Domestic Partner; Surviving child(ren), in equal shares; Surviving parents, in equal shares; Surviving siblings in equal shares; or Estate. If you have assigned the insurance, benefits will be paid to the assignee. Life, Accident and Critical Illness Insurance Programs Page 14

24 Basic Group Life Insurance Basic Group Life Insurance pays your Beneficiary(ies) a benefit in the event of your death. Cost of Coverage Basic Group Life Insurance is a core coverage. Prudential pays the full Cost of coverage for you. Coverage Amount Your Basic Group Life Insurance coverage is equal to one times your Eligible Earnings, up to a maximum benefit of $300,000. Your coverage amount will be adjusted to reflect any increases or decreases in your Eligible Earnings. (See the Changes in Your Eligible Earnings section for more information.) Please note: If you are a Home Office or field office Employee and transfer to become an Agency Distribution Sales Professional, Agency Distribution Field Manager or a Non-Retail Sales Professional or vice versa, the amount of your Basic Group Life Insurance coverage may be adjusted. For more information on how your coverage amount will be affected in this case, contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. You may elect to cap the amount of your Basic Group Life Insurance coverage at $50,000 to avoid Imputed Income. The election to cap your coverage is irrevocable for the Calendar Year during which you elect the coverage cap. (See the Imputed Income section for more information.) You will have to wait until the next Annual Enrollment Period to change your election, unless you experience a Change in Status, such as your marriage or the birth, adoption or placement for adoption of a child. If you experience a Change in Status, you can change your election to cap your benefit as long as you submit the notification of this change within the 31-day period on and following the date of the Change in Status. Imputed Income Company-paid life insurance in excess of $50,000 may affect your income taxes. The Internal Revenue Service (IRS) has established age-related rates it believes are appropriate to determine the value of Company-paid life insurance. This value can result in Imputed Income that becomes part of your taxable income. Since Prudential pays the full Cost of your Basic Group Life Insurance coverage, the value of any coverage above $50,000 will be reported on your Form W-2 Wage and Tax Statement as taxable Imputed Income. Your W-2 form will also reflect the Imputed Income for Social Security tax purposes. For example, as of 2014, if you are 45 years old and have Basic Group Life coverage of $60,000, your Imputed Income is equal to the value of $10,000 of coverage ($60,000 - $50,000), or $18 per year, as determined by IRS age-related rates. When Benefits Are Paid Benefits under Basic Group Life Insurance are payable to your designated Beneficiary(ies) upon your death. Your Beneficiary(ies) will be required to provide written evidence of your death. (See the How to File a Claim for Benefits section for more information.) Option to Accelerate Payment of Death Benefits If you are diagnosed as terminally ill with six months or less to live, you may accelerate the payment of benefits with the option to accelerate payment of death benefits. If you elect this option, you may receive terminal illness proceeds of up to 90% of the amount of coverage in effect on the date the insurance carrier receives evidence that you are terminally ill. You may receive terminal illness proceeds either as a lump sum or in six equal monthly installments. All payments above $5,000 will be made via a Prudential Alliance Account. (See the A Prudential Alliance Account section for more information.) The Internal Revenue Service (IRS) may consider the payment of terminal illness proceeds to be taxable income. Any remaining balance of the benefit will be payable to your Beneficiary(ies) upon your death. Life, Accident and Critical Illness Insurance Programs Page 15

25 The terminal illness proceeds may be reduced if, within six months after the date the insurance carrier receives proof that you are terminally ill, a reduction in your benefit amount due to your age would have applied to the amount of your Basic Group Life Insurance. (See the If You Reach Age 70 as an Active Employee section for more information.) The option to accelerate payment of death benefits will not be available if you have assigned your coverage. (See the Assignment of Benefits section for more information.) In addition, since this benefit is available only on a voluntary basis, it may not be used to meet a requirement by law to pay the claims of creditors or a requirement by a government agency to apply for, obtain or keep a government benefit. You may elect the option to accelerate payment of death benefits only once during your lifetime. For more information about the option to accelerate payment of death benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. How Benefits Are Paid Basic Group Life Insurance benefits of $5,000 or more are deposited into a Prudential Alliance Account in the name of the Beneficiary(ies) that you have designated, unless you pre-select an optional method of payment. You should keep in mind that if you pre-select an optional form of payment, your Beneficiary(ies) will not be allowed to change the payment method at a later date. Payments of less than $5,000 are paid in a lump sum. (See the A Prudential Alliance Account section for more information.) If You Take a Leave of Absence Unpaid Leave of Absence If you take an unpaid leave of absence, your coverage under Basic Group Life Insurance will continue automatically at no Cost to you while you are on leave up to a period of six months. If you are still on leave at the end of the six-month period, your Basic Group Life Insurance will end. When coverage ends, you may convert lost coverage, without evidence of good health, to an individual policy at your own cost. You must apply and pay the first premium before the later of: 31 days after the date your coverage ends; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends. See the Converting to an Individual Policy section for more information. If your death occurs within the time period during which you are entitled to convert your coverage under the Basic Group Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. If you are planning to take an unpaid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Paid Leave of Absence If you take a paid leave of absence, your coverage under Basic Group Life Insurance will continue automatically while you are on your leave. If you are planning to take a paid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Life, Accident and Critical Illness Insurance Programs Page 16

26 If You Are Disabled If you become Totally Disabled and are receiving benefits from the Short Term Disability (STD) Program*, your coverage will continue and your coverage amount will be frozen. If your STD benefits are exhausted, your coverage terminates, unless you meet the requirements of the waiver of premium provision, as outlined in the section that follows. * For Full-Time Employees who are not eligible for STD benefits, you will continue to be eligible for active Employee Basic Group Life Insurance coverage for up to six weeks. After six weeks, your coverage may continue if you have been approved for a leave of absence. Waiver of Premium If you continue to be Totally Disabled for six consecutive months, your Basic Group Life Insurance may be continued at no Cost under the waiver of premium provision. To qualify, your disability must have begun prior to age 65 and you must remain Totally Disabled for more than six consecutive months. You must provide written proof of your Total Disability to the insurance carrier after six months of disability but prior to 12 months of disability. Thereafter, you must provide written proof annually, as required by the insurance carrier, that your Total Disability continues. If you should die prior to submitting proof of your Total Disability, your Beneficiary(ies) may provide written proof to the insurance carrier upon the submission of a claim for death benefits. (See the How to File a Claim for Benefits section for more information.) While coverage is continued under the waiver of premium provision, you may elect to cap the amount of your Basic Group Life Insurance coverage at $50,000 to avoid Imputed Income. The election to cap your coverage is irrevocable and can be made at any time. (See the Imputed Income section for more information.) Your coverage will continue until you are no longer Totally Disabled. If you remain eligible for coverage at age 70, your coverage will begin to reduce by 20% per year. This reduction will continue until you reach the minimum benefit of $10,000. If you elected to cap your coverage at $50,000, your coverage will begin to reduce once annual reductions to your pre-age 70 amount of coverage would, in the absence of the cap, have reached $50,000 or less. When your coverage terminates or reduces as a result of a reduction beginning at age 70, you may convert any lost coverage, without evidence of good health, to an individual policy at your own cost. You must apply and pay the first premium before the later of: 31 days after the date your coverage ends or is reduced; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends or is reduced. See the Converting to an Individual Policy section for more information. If your death occurs within the time period during which you are entitled to convert coverage under the Basic Group Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. Life, Accident and Critical Illness Insurance Programs Page 17

27 If You Reach Age 70 as an Active Employee If you remain an active Employee after reaching age 70, your coverage will begin to reduce as of the January 1 after you reach age 70. Coverage will continue to reduce each Calendar Year until it reaches the minimum benefit of $10,000. If you elected to cap your coverage at $50,000, your coverage will begin to reduce once annual reductions to your pre-age 70 amount of coverage, in the absence of the cap, reach $50,000 or less. The reduced amount will be a percentage of your pre-age 70 amount, as the following table illustrates: Your Age as of January 1 Coverage Amount 70 80% of your eligible pre-age 70 amount 71 60% of your eligible pre-age 70 amount 72 40% of your eligible pre-age 70 amount 73 20% of your eligible pre-age 70 amount 74 $10,000 You have the option to convert your coverage, without evidence of good health, to an individual policy at your own cost. You must apply and pay the first premium before the later of: 31 days after the date your coverage ends or is reduced; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends or is reduced. See the Converting to an Individual Policy section for more information. If your death occurs within the time period during which you are entitled to convert your coverage under the Basic Group Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. If You Retire If you Retire, your coverage ends on your last date of employment with Prudential. You may continue Basic Group Life Insurance coverage if, at the time you Retire, you meet the terms of The Prudential Welfare Benefits Plan, including if you: Have 10 or more years of Vesting Service (as defined under The Prudential Merged Retirement Plan [the Retirement Plan ] and including any additional periods of Vesting Service granted under The Prudential Welfare Benefits Plan for the purpose of eligibility); and Either: Have attained the first day of the month coinciding with or next following your 55th birthday; or Are considered a Retired participant under the terms of The Prudential Traditional Retirement Plan (a component of the Retirement Plan). If you meet the above requirements, your coverage will continue and will be immediately reduced to $10,000. You have the option to convert your lost coverage, without evidence of good health, to an individual policy at your own cost. You must apply and pay the first premium before the later of: 31 days after the date your coverage ends or is reduced; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends or is reduced. Life, Accident and Critical Illness Insurance Programs Page 18

28 See the Converting to an Individual Policy section for more information. If your death occurs within the time period during which you are entitled to convert your coverage under the Basic Group Life Insurance Program, benefits will be payable as if your coverage had not reduced. These benefits are payable even if you did not apply for conversion. If Your Employment Ends If your employment with Prudential ends before you Retire, your coverage ends on your last date of employment with Prudential. You have the right to convert all or part of your coverage to an individual policy at your own expense, without evidence of good health, provided you do so before the later of: 31 days after your coverage ends; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends. See the Converting to an Individual Policy section for more information. If your death occurs within the time period during which you are entitled to convert your coverage under the Basic Group Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. If your coverage ends because all Basic Group Life Insurance for your class ends, the total amount of individual insurance will not exceed the lesser of the following: The total amount of all your life insurance then ending under the Group Contract reduced by the amount of group life insurance from any carrier for which you are or become eligible within the next 31 days; or $10,000. If your amount of Basic Group Life Insurance under this coverage is reduced, the total amount of individual insurance will not be more than the amount of the reduction. For Minnesota residents only: You may continue Basic Group Life Insurance coverage in an amount equal to the amount of insurance in effect on the day your employment with Prudential ends by completing the appropriate Prudential form. You have until the date 60 days after the later of: The date your coverage ends; or The date you receive the letter to make your election. Coverage may be continued until the earliest of any of the following events: 18 months from the date your employment with Prudential ends; The date you cease to pay any required payments to continue group life insurance; or The date you become covered under any other group life insurance plan. To continue coverage, contact the Prudential Group Life Services Division at and follow the prompts to speak with a representative. Life, Accident and Critical Illness Insurance Programs Page 19

29 Group Universal Life Insurance and the Group Universal Life Insurance Cash Accumulation Fund Group Universal Life Insurance If you want more life insurance coverage than your Basic Group Life Insurance provides, you may purchase voluntary Group Universal Life (GUL) Insurance coverage. One of the special features of GUL Insurance is that it offers you life insurance coverage as well as a cash accumulation option through the Group Universal Life Insurance Cash Accumulation Fund (GUL Fund). (See the Group Universal Life Insurance Cash Accumulation Fund section for more information.) You may enroll in GUL Insurance at any time. To do so, you must select a coverage amount and authorize contributions by visiting the Prudential Benefits Center website (at You may also designate a Beneficiary(ies) on the Prudential Benefits Center website. (See the Beneficiaries section for more information.) If you do not have access to a computer or the Internet or if you need more information, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Coverage amounts may be subject to evidence of good health that is satisfactory to the insurance carrier. If evidence of good health is required, your coverage will take effect following approval by the insurance carrier. (See the Evidence of Good Health section for more information.) Cost of Coverage GUL Insurance is a voluntary coverage. You pay the full Cost of coverage. Your contribution amount is based on your age, the amount of coverage you choose and your Eligible Earnings. This means that your contribution will be adjusted as your Eligible Earnings change and as you get older, based on five-year age brackets. To determine your contribution amount, visit the Prudential Benefits Center website (at If you do not have access to a computer or the Internet or if you need more information, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. After-Tax Contributions Your Cost for GUL Insurance coverage is paid on an After-Tax basis, usually through automatic payroll deductions. After-Tax means a portion of your income that is deducted from your pay after any applicable federal, state and local income and Social Security taxes have been withheld, that you contribute to a plan or program or use to pay all or a portion of the Cost of coverage for certain programs. Your deducted pay will still be part of your taxable income. Coverage Amount You may purchase GUL Insurance coverage of one to nine times your Eligible Earnings, up to a maximum benefit of $3,000,000. Your coverage amount will be adjusted to reflect any increases or decreases in your Eligible Earnings. (See Changes in Your Eligible Earnings for more information.) You may increase or decrease your GUL Insurance coverage at any time. If you increase your coverage, you may be required to provide satisfactory evidence of good health to the insurance carrier before the higher coverage amount takes effect. (See the Evidence of Good Health in the following section for more information.) Life, Accident and Critical Illness Insurance Programs Page 20

30 If you experience a job classification change that results in a corresponding salary decrease, you may enroll for GUL Insurance coverage or elect to have your GUL Insurance coverage increased by an amount equal to the reduction in your combined Basic Group Life Insurance and GUL Insurance coverages resulting from your job classification change, without having to provide evidence of good health. However, your enrollment or election must take place within 31 days from the date of the change in job classification. Otherwise, evidence of good health will be required. (See the Evidence of Good Health below for more information.) Evidence of Good Health When you enroll in GUL Insurance, you may be required to provide evidence of good health that is satisfactory to the insurance carrier. When you make your election on the Prudential Benefits Center website, if your election requires you to provide evidence of good health, you will be prompted to provide the evidence of good health through the online process. In some cases, you may be required to provide additional information, in which case a form will be provided to you as you complete the process online. You will need to complete, sign and mail the form to the address indicated on the form, if applicable. When You Will Be Required to Show Evidence of Good Health You will be required to provide evidence of good health to the insurance carrier if you: Are a new hire and enroll for GUL Insurance coverage of more than three times (in other words, coverage equal to four to nine times) your Eligible Earnings within the 31-day period on and following your first day of employment with Prudential; Have a Change in Status and enroll for GUL Insurance coverage equal to more than three times (in other words, coverage equal to four to nine times) your Eligible Earnings within the 31-day period on and following your Change in Status. A Change in Status includes your marriage, divorce or the birth, adoption or placement for adoption of a child; Delay initial enrollment for more than 31 days after your first day of employment with Prudential or after you first become eligible due to a Change in Status and enroll for any amount of coverage; Wish to enroll after any part of the insurance under the group contract ends because you did not pay a required contribution; Elect to increase the amount of your GUL Insurance coverage; or Previously converted all or part of your GUL Insurance coverage to an individual policy, continue to maintain that individual policy and wish to again enroll in GUL Insurance coverage. When You Are Not Required to Provide Evidence of Good Health You will not be required to provide evidence of good health to the insurance carrier if you: Are a new hire and enroll for coverage equal to one, two or three times your Eligible Earnings within the 31-day period on and following your first day of employment with Prudential; Enroll for coverage equal to one, two or three times your Eligible Earnings within the 31-day period on and following a Change in Status; or Elect to decrease your coverage. Life, Accident and Critical Illness Insurance Programs Page 21

31 Group Universal Life Insurance Cash Accumulation Fund If you are enrolled in GUL Insurance, you may also participate in the Group Universal Life Insurance Cash Accumulation Fund (GUL Fund). The GUL Fund is designed to provide extra protection by building cash value that is tax-deferred. Participation in the GUL Fund is voluntary. You may enroll for GUL Insurance and choose not to participate in the GUL Fund. Your GUL Fund earns tax-deferred interest. Each year the insurance company will announce an interest rate. The minimum interest rate is 4% per year. Because the applicable annual interest rate may change from year to year, prior years contributions you may have made will earn interest at the current year s interest rate. You may contribute to your account in two ways. Deposits through regular payroll deductions of at least $10 a month, up to 10 times the monthly Cost of your GUL Insurance. You can change your deductions at any time. If you have enrolled for a coverage amount that requires evidence of good health, such that for a period of time your coverage is limited to the Guaranteed Issue amount, then your maximum contribution to the GUL Fund will be limited as well. When you are approved for a higher amount of GUL Insurance, you may then increase your GUL Fund contributions as well. Your GUL Fund contributions are made on an After-Tax basis. After-Tax means a portion of your income that is deducted from your pay after any applicable federal, state and local income taxes and Social Security taxes have been withheld, that you contribute to a plan or program or use to pay all or a portion of the Cost of coverage for certain programs. Your deducted pay will still be part of your taxable income; or Lump-sum contributions. You may not make lump-sum contributions if you have an amount of Paid-Up Insurance under this coverage, if the amount of the lump-sum contribution would cause your GUL Fund to reach its limit or if your coverage is being continued as described under Waiver of Premium. For additional information regarding contributions to your GUL Fund, contact the Prudential Group Life Services Division at Modified Endowment Contract Note that if your cash contribution exceeds certain limits and your GUL Insurance coverage becomes a Modified Endowment Contract (MEC), as determined by the IRS, different tax rules and, in some cases, penalties apply for lifetime distributions, such as loans, withdrawals and assignments. An MEC can result from premium payments or from a reduction in coverage (such as the purchase of Paid-Up Insurance). If this applies to you, the insurance carrier will notify you in writing of your status and advise you of your current options (if any) and by when you must respond. Section 1035 Exchange If you are newly enrolling in the GUL Insurance Program and are currently enrolled in a similar program through another insurance carrier, you may be eligible to exchange the amount of your GUL Fund and the Basis in the Certificate from your current insurance program to the Prudential GUL Insurance Program. (This is often referred to as a Section 1035 exchange, referring to the relevant Internal Revenue Code provision.) To make an exchange, you must meet certain rules and regulations and you must initiate the exchange prior to enrolling in the Prudential GUL Insurance Program. For more information about exchanging funds, contact the Prudential Group Life Services Division at Life, Accident and Critical Illness Insurance Programs Page 22

32 How to Access Your GUL Fund The GUL Fund allows you easy access to your money for any reason. You can withdraw all or a portion of your GUL Fund or take a loan on your GUL Fund. Outstanding loans will accrue interest at the current GUL Fund crediting rate plus 1.5% per Calendar Year. The following restrictions also will apply: Withdrawals: You may withdraw a minimum of $100 and up to a maximum of the available GUL Fund balance (minus other outstanding loans and loan interest charges); and Loans: You may borrow from your GUL Fund, up to the amount of your GUL Fund balance, minus any outstanding loans and loan interest charges and one month s contribution for the insurance. You may borrow from your GUL Fund after you have been contributing to it for one year on a weekly, bi-weekly or monthly basis. In general, GUL Fund loans are not taxable. However, withdrawals are taxable to the extent they exceed the Basis in the Certificate. Loans outstanding at certificate lapse or surrender prior to the death of the insured will cause immediate taxation to the extent of gain in the certificate. Different tax rules apply to certificates that are classified as MECs. (See the Modified Endowment Contract section for more information.) Paid-Up Insurance The GUL Fund features an additional benefit Paid-Up Insurance. Paid-Up Insurance may be purchased when: Your GUL Fund reaches its limit through contributions (other than lump-sum contributions); Your term life insurance coverage ends; or The extended death benefit ends. When your GUL Fund reaches its limit through contributions (other than lump-sum contributions), 30% of the GUL Fund will be used to purchase Paid-Up Insurance. However, this will not be done if the amount then left in your GUL Fund would be less than the balance of any loan on your GUL Fund and the interest charged to it. If that would be the case, 30% of your GUL Fund will be used to reduce the loan balance. Paid-Up Insurance may be surrendered for its cash value at any time. If you have questions about Paid-Up Insurance or would like to surrender your Paid-Up Insurance policy, contact the Prudential Group Life Services Division at Annual Statements In the second quarter of each Calendar Year, if you have a balance of at least $10 in your GUL Fund, you will receive a statement that describes your GUL Fund activity for the preceding Calendar Year. When Benefits Are Paid Benefits under the GUL Insurance Program are payable to your designated Beneficiary(ies) upon your death. Your Beneficiary(ies) will be required to provide written evidence of your death. (See the How to File a Claim for Benefits section for more information). Life, Accident and Critical Illness Insurance Programs Page 23

33 Option to Accelerate Payment of Death Benefits If you are diagnosed as terminally ill with six months or less to live, you may accelerate the payment of benefits with the option to accelerate payment of death benefits. If you elect this option, you may receive terminal illness proceeds of up to 90% of the amount of coverage in effect, plus up to 90% of the available balance in your GUL Fund, on the date the insurance carrier receives evidence that you are terminally ill. You may receive the terminal illness proceeds either as a lump sum or in six equal monthly installments. All payments above $5,000 will be made via a Prudential Alliance Account. (See the A Prudential Alliance Account section for more information.) The IRS may consider the payment of this benefit to be taxable income. Any remaining balance of the benefit will be payable to your Beneficiary(ies) upon your death. The option to accelerate payment of death benefits will not be available if you have assigned your coverage. (See the Assignment of Benefits section for more information.) In addition, since this benefit is available only on a voluntary basis, it may not be used to meet a requirement by law to pay the claims of creditors or a requirement by a government agency to apply for, obtain or keep a government benefit. You may elect the option to accelerate payment of death benefits only once during your lifetime. For more information about the option to accelerate payment of death benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. How Benefits Are Paid The GUL Insurance benefit will equal the sum of your GUL Insurance and Paid-Up Life Insurance coverage, plus any amount in your GUL Fund. The total benefit will be reduced by any balance and interest due for any outstanding loans against the GUL Fund. Benefits of $5,000 or more are deposited into a Prudential Alliance Account, in the name of the Beneficiary(ies) that you have designated, unless you pre-select an optional method of payment. You should keep in mind that if you pre-select an optional form of payment, your Beneficiary(ies) will not be allowed to change the payment method at a later date. Payments of less than $5,000 are paid in a lump sum. (See the A Prudential Alliance Account section for more information.) Continuation Continuation is a feature that allows you to continue participation in GUL Insurance coverage after you end your employment with Prudential or Retire at the same coverage amount that was in force when your coverage ended. As a Retiree, your continuation rates are the same as those in force for active Employees. However, if you are not a Retiree, your continuation rates as a terminated Employee are different (generally higher) than those that were in force while you were an active Employee. Through continuation, you may continue your coverage, provided that: You apply for continued coverage within 31 days after the end of the pay period during which your employment with Prudential ends; and You continue to pay the required premiums. Once ported, your coverage may be maintained on a direct billing basis until you are age 100. If you elect to continue your coverage through the continuation feature, you will be unable to exercise your conversion rights. However, you may exercise your conversion rights if the group contract ends or you attain age 100. If you previously ported your GUL Insurance coverage when your employment with Prudential ended, you may keep the amount of ported coverage after you are re-hired. However, if upon rehire or at any time after rehire as an active Employee, you make a new GUL Insurance election, your ported GUL Insurance coverage will end. Life, Accident and Critical Illness Insurance Programs Page 24

34 For general information about porting coverage, contact the Prudential Group Life Services Division at To obtain a continuation notice, contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Conversion Conversion is a feature that allows you to convert your coverage under a group policy into an individual life insurance contract. You may convert all or part of your lost coverage without evidence of good health. If you elect to convert your lost coverage through the conversion feature, you will be unable to exercise your continuation rights. To convert lost coverage, you must notify the insurance carrier of your intent to do so and pay the required contributions before the later of: 31 days after the date your coverage ends; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends. For more information about converting coverage, contact the Prudential Group Life Conversion Unit at (See the Converting to an Individual Policy section for more information.) To obtain a conversion notice, contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If your death occurs within the time period during which you are entitled to convert your coverage under the GUL Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. If your coverage ends because all GUL Insurance for your class ends, the total amount of individual insurance will not exceed the lesser of the following: The total amount of all your life insurance then ending under the Group Contract reduced by the amount of group life insurance from any carrier for which you are or become eligible within the next 31 days; or $10,000. If You Take a Leave of Absence Unpaid Leave of Absence If you take an unpaid leave of absence, your coverage under GUL Insurance will continue automatically at your existing coverage level while you are on leave up to a period of six months, provided you make the required payments. A bill will be mailed to your home each month. Benefits will continue automatically during an unpaid leave unless you notify the Prudential Benefits Center to terminate your benefits while on leave. Payments are due within 30 days of the specified due date. GUL Fund contributions will not be included on your direct bill and will require you to make separate lump sum contributions. If you are still on leave at the end of the six-month period or if you fail to pay any required premiums, your GUL Insurance will end. When coverage ends, you may elect to continue the coverage through the continuation or conversion features. If you have a GUL Fund balance and your GUL Insurance coverage ends, the available GUL Fund balance is returned to you minus any outstanding loans or interest or it may be used to purchase Paid-Up Insurance. If your death occurs within the time period during which you are entitled to convert your coverage under the GUL Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. Life, Accident and Critical Illness Insurance Programs Page 25

35 If you are planning to take an unpaid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Paid Leave of Absence If you take a paid leave of absence, your coverage under GUL Insurance will continue while you are on leave. Benefits will automatically continue during your paid leave and you will continue to make contributions through payroll deductions. If you are planning to take a paid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If You Are Disabled If you become Totally Disabled and are receiving benefits from the Short Term Disability (STD) Program*, your coverage will continue and your coverage amount will be frozen, provided you continue paying contributions. If your STD benefits are exhausted, your coverage terminates, unless you meet the requirements of the waiver of premium provision as outlined in the section that follows. Upon termination of coverage, you may elect to continue this voluntary coverage through either the continuation or conversion feature. (See the Continuation and Converting to an Individual Policy sections for more information.) * For Full-Time Employees who are not eligible for STD benefits, you will continue to be eligible for active Employee GUL Insurance coverage for up to six weeks. After six weeks, your coverage may continue if you have been approved for a leave of absence. Waiver of Premium If you continue to be Totally Disabled for six consecutive months, your GUL Insurance may be continued at no Cost to you under the waiver of premium provision. To qualify, your disability must have begun prior to age 60 and you must remain Totally Disabled for more than six consecutive months. You must provide written proof to the insurance carrier after six months of disability but prior to 12 months of disability. Thereafter, you must provide written proof annually, as required by the insurance carrier, that your Total Disability continues. Coverage may continue under the waiver of premium provision until age 65 provided you are continuously Totally Disabled. If you should die prior to submitting proof of your Total Disability, your Beneficiary(ies) may provide written proof of your disability to the insurance carrier upon the submission of a claim for death benefits. (See the How to File a Claim for Benefits section for more information.) When your protection under the waiver of premium provision ends, you may elect to continue your GUL Insurance coverage through the continuation or conversion feature. (See the Continuation and Converting to an Individual Policy sections for more information.) If You Retire If you Retire, your GUL Insurance coverage ends on the last day of the pay period in which your employment with Prudential ended. When coverage ends, you may elect to continue coverage through the continuation or conversion feature. (See the Continuation and Converting to an Individual Policy sections for more information.) If you have a GUL Fund balance and your GUL Insurance coverage ends, the available GUL Fund balance is returned to you, minus any outstanding loans or interest or it may be used to purchase Paid-Up Insurance. Life, Accident and Critical Illness Insurance Programs Page 26

36 If Your Employment Ends If your employment with Prudential ends before you Retire, your GUL Insurance coverage ends on the last day of the pay period in which your employment with Prudential ended. When coverage ends, you may elect to continue coverage through the continuation or conversion feature. (See the Continuation and Converting to an Individual Policy sections for more information.) If you have a GUL Fund balance and your GUL Insurance coverage ends, the available GUL Fund balance is returned to you minus any outstanding loans or it may be used to purchase Paid-Up Insurance. Life, Accident and Critical Illness Insurance Programs Page 27

37 Dependent Term Life Insurance Dependent Term Life Insurance provides a benefit if one of your Eligible Dependents, as described below, dies from any cause. You are the Beneficiary for any benefits payable under this Program. Coverage ends on the date you no longer have an Eligible Dependent. Your Eligible Dependents You may elect Dependent Term Life Insurance coverage for your Eligible Dependents. Please note: Your Eligible Dependents are eligible for coverage if they meet the criteria summarized below and described in detail in the Glossary definitions of Spouse, Domestic Partner, Dependent Child(ren), Qualifying Child or Qualifying Relative. See the Glossary for more information. Your qualified Eligible Dependents are: Your Spouse or Domestic Partner; and Your Dependent Child(ren) (as defined in the Glossary) who generally are your natural children, your adopted children, children placed with you for adoption, your stepchildren and your unmarried grandchildren and children living in your home for whom you are the legal guardian, if: At age 14 days or older but under age 19, they are unmarried and Substantially Dependent on you; Between the ages of 19 and 24, they are unmarried, Substantially Dependent on you and attending school on a full-time basis; or At age 19 or older, they are unmarried, incapable of sustaining employment due to a mental or physical disability and Substantially Dependent on you (this must be a continuation of coverage that was in effect prior to exceeding the above age limit). Your Dependent Child must, in addition to falling into one of the above categories, remain continuously covered and qualify and continue to qualify as your Qualifying Child or Qualifying Relative under Section 152 of the Code, without regard to the requirement that the child has gross income less than the exemption amount (the income limitation ) or whether your child has dependents. Enrolling and Adding Eligible Dependents You may enroll in Dependent Term Life Insurance at any time. If you acquire an Eligible Dependent through marriage, eligibility of a Domestic Partner under the Program, birth, adoption or placement for adoption, you can enroll that Eligible Dependent for coverage within the 31-day period on and following the Change in Status without providing evidence of good health. However, if you are already enrolled in Dependent Term Life Insurance and you acquire another Dependent Child through marriage, birth, adoption or placement for adoption, this dependent will be automatically added for coverage. You do not have to enroll him/her for coverage. Life, Accident and Critical Illness Insurance Programs Page 28

38 Restrictions on Eligibility Your Spouse or Domestic Partner or Dependent Child is not considered an Eligible Dependent if he/she: Is on active duty in the armed forces of any country; Is covered as an active Employee or Retiree under any term life insurance benefits coverage under the Program; or Is covered under the waiver of premium provision of any Employee term life coverage under the Program. A child will not be considered the Dependent Child of more than one Prudential Employee. The child will be considered the Dependent Child of the Employee named in a written agreement between the Employees and filed with the Prudential Benefits Center. If there is no written agreement, the child will be considered the Dependent Child of the Employee who: Became covered under Dependent Term Life Insurance while the child was a Dependent Child of only the Employee; or Has the longest Continuous Service with the Company and its Affiliated Companies. Extended Family Members are not eligible for coverage. Important Notice Regarding Civil Union Partnership Certain states have passed legislation that requires insurers to provide equal benefit coverage for civil union partners, if spousal coverage is provided through an employer s group insurance plan. Civil union partners under a validly established civil union partnership under a state or foreign jurisdiction may be eligible for some of these programs. For more details regarding civil union partner eligibility requirements for these Programs, please contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Cost of Coverage Dependent Term Life Insurance is a voluntary coverage. You pay the full Cost of coverage. Coverage rates are based on the following factors: The coverage level you elect (Spouse/Domestic Partner, Dependent Child(ren) or both); The coverage amount you elect for your Spouse or Domestic Partner; and The age of your Spouse or Domestic Partner. To determine your coverage rate, visit the Prudential Benefits Center website (at If you do not have access to a computer or the Internet or if you need more information, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. After-Tax Contributions Your Cost for coverage is paid on an After-Tax basis, usually through automatic payroll deductions. After-Tax means a portion of your income that is deducted from your pay after any applicable federal, state and local income taxes and Social Security taxes have been withheld, that you contribute to a plan or program or use to pay all or a portion of the Cost of coverage for certain programs. Your deducted pay will still be part of your taxable income. Life, Accident and Critical Illness Insurance Programs Page 29

39 Coverage Amount If one of your covered Eligible Dependents dies, you will receive benefits as follows: Dependent Life Schedule of Benefits Covered Dependent Spouse or Domestic Partner Maximum Benefit A coverage amount you choose: A multiple of $25,000, up to a maximum of $250,000*; or A flat $10,000. Each Dependent Child $10,000 * The Spouse/Domestic Partner coverage you elect cannot exceed 50% of the amount of your coverage under the Basic Life and GUL Insurance Programs combined. If 50% of your coverage amount is not a multiple of $25,000, the Spouse/Domestic Partner coverage amount will be rounded up to the next $25,000 increment. Evidence of Good Health You may elect to enroll for coverage at any time. Evidence of good health is not required for coverage amounts of $25,000 or less if you enroll for coverage: Within the 31-day period on and following the date you are first eligible for coverage; or Within the 31-day period on and following your marriage, the date your Domestic Partner becomes eligible under the Program or the birth or adoption of a child. For amounts above $25,000 or for any amount elected outside of the time frames noted above, you must supply evidence of good health for your Spouse or Domestic Partner that is satisfactory to the insurance carrier. Currently, the insurance carrier does not require evidence of good health for Dependent Children. When you make your election on the Prudential Benefits Center website, if your election requires you to provide evidence of good health, you will be prompted to provide the evidence of good health through the online process. In some cases you may be required to provide additional information, in which case a form will be provided to you as you complete the process online. You will need to complete, sign and mail the form to the address indicated on the form, if applicable. When an Eligible Dependent Ceases to Be Covered When an Eligible Dependent ceases to meet the eligibility requirements, coverage may be continued via the conversion or portability provisions by the former Eligible Dependent only. (See the Portability and Converting to an Individual Policy sections for more information.) If your coverage ends because all Dependent Term Life Insurance for your class ends, the total amount of individual insurance will not exceed the lesser of the following: The total amount of all your Dependent Term Life Insurance then ending under the Group Contract reduced by the amount of group life insurance from any carrier for which you are or become eligible with respect to the dependent within the next 31 days; or $10,000. When Benefits Are Paid Benefits under Dependent Term Life Insurance are payable at the death of a covered Eligible Dependent. You are the Beneficiary for any benefits payable under this Program. You will be required to provide written evidence of your Eligible Dependent s death. Life, Accident and Critical Illness Insurance Programs Page 30

40 How Benefits Are Paid Benefits of $5,000 or more are deposited into a Prudential Alliance Account, in your name, unless you pre-select an optional method of payment. Payments of less than $5,000 are paid as a lump sum. (See the A Prudential Alliance Account section for more information.) Portability Portability is a feature that allows your Spouse, Domestic Partner and Dependent Child(ren) to continue Dependent Term Life Insurance coverage after coverage would have otherwise terminated (i.e., due to a divorce, your death or your termination of employment with Prudential). Please note: Portability is not permitted when coverage ends due to the following: You fail to make the required contributions; You Retire; or You become insured by another group life insurance program within 31 days of the date coverage for all Employees ends. Portability rates are different (generally higher) than those that were in force while you were an active Employee. Portability under the Dependent Term Life Insurance Program is permitted for Spouses or Domestic Partners, as long as the Spouse or Domestic Partner is not confined for medical care or treatment on the day before your Dependent Term Life Insurance coverage ends. Once ported, Spouse or Domestic Partner coverage may be maintained on a direct billing basis until the Spouse or Domestic Partner is age 80. You may also port coverage for your Dependent Child (even if you do not port Spouse or Domestic Partner coverage), as long as the Dependent Child is not confined for medical care or treatment on the day before your Dependent Term Life Insurance coverage ends. Once ported, Dependent Child coverage may be maintained on a direct billing basis until the child is age 19, or age 23 if enrolled in school as a full-time student, and wholly depends on you for support and maintenance. Note: In the event of your death, coverage for your Dependent Child(ren) will be portable only along with Spouse or Domestic Partner coverage. Coverage will continue until the applicable age provided that: Coverage is applied for by the longer of 31 days after your Dependent Term Life Insurance coverage ends or the number of days during which you have the right to convert your Basic Life Insurance to an individual life insurance contract or in the case of death or divorce the number of days in which your Spouse or Domestic Partner has the right to convert the Dependent Term Life Insurance to an individual life insurance contract; and Required premiums continue to be paid. If you previously ported your Dependent Term Life Insurance coverage for your Eligible Dependents when your employment with Prudential ended, you may keep the amount of ported coverage after you are re-hired. However, if upon rehire or at any time after rehire as an active Employee, you make a new Dependent Term Life Insurance election for your Eligible Dependents, your ported Dependent Term Life Insurance coverage will end. Coverage continued through the portability feature cannot also be converted. However, if your Spouse, Domestic Partner or Dependent Child(ren) continues coverage through the portability feature and the ported coverage ends, coverage may then be converted. Conversion is not available when coverage ends due to coverage voluntarily lapsing because of non-payment. Life, Accident and Critical Illness Insurance Programs Page 31

41 For general information about porting coverage or if you are a Minnesota resident, contact the Prudential Group Life Services Division at To obtain a portability notice, contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If You Take a Leave of Absence Unpaid Leave of Absence If you take an unpaid leave of absence, your coverage under Dependent Term Life Insurance will continue automatically while you are on leave up to a period of six months, provided you make the required payments. Benefits will continue automatically during an unpaid leave unless you notify the Prudential Benefits Center to terminate your benefits while on leave. If you continue coverage, a bill will be mailed to your home address on a monthly basis. Payments are due within 30 days of the specified due date. If you are still on leave at the end of the six-month period or if you fail to pay any required premiums, your Dependent Term Life Insurance will end. When coverage ends, your Eligible Dependents may elect to continue their coverage, without evidence of good health, through either the portability or the conversion feature. (See the Portability and Converting to an Individual Policy sections for more information.) If your Eligible Dependent s death occurs within the time period during which you are entitled to convert the dependent s coverage under the Dependent Term Life Insurance Program, benefits will be payable as if the coverage had not terminated. These benefits are payable even if you did not apply for conversion. If you are planning to take an unpaid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Paid Leave of Absence If you take a paid leave of absence, your coverage under Dependent Term Life Insurance will continue while you are on leave. Benefits will automatically continue during your paid leave and you will continue to make contributions through payroll deductions. If you are planning to take a paid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If You Are Disabled If you become Totally Disabled and are receiving benefits from the STD Program*, your coverage will continue and your coverage amount will be frozen, provided you continue paying contributions. If your STD benefits are exhausted, your coverage terminates. When coverage ends, your Eligible Dependents may elect to continue their coverage, without evidence of good health, through either the portability or the conversion feature. (See the Portability and Converting to an Individual Policy sections for more information.) * For Full-Time Employees who are not eligible for STD benefits, you will continue to be eligible for active Employee Dependent Term Life Insurance coverage for up to six weeks. After six weeks, your coverage may continue if you have been approved for a leave of absence. If your Eligible Dependent s death occurs within the time period during which you are entitled to convert the dependent s coverage your coverage under the Dependent Term Life Insurance Program benefits will be payable as if the coverage had not terminated. These benefits are payable even if you did not apply for conversion. Life, Accident and Critical Illness Insurance Programs Page 32

42 If You Retire If you Retire, your Eligible Dependent s coverage ends on the last day of the pay period in which your employment with Prudential ended. When coverage ends, your Eligible Dependents may convert their coverage to an individual policy, without evidence of good health, through the conversion feature. (See the Converting to an Individual Policy section for more information.) If your Eligible Dependent s death occurs within the time period during which you are entitled to convert the dependent s coverage under the Dependent Term Life Insurance Program, benefits will be payable as if the coverage had not terminated. These benefits are payable even if you did not apply for conversion. If Your Employment Ends If your employment with Prudential ends before you Retire, your Eligible Dependent s coverage ends on the last day of the pay period in which your employment with Prudential ended. Your Eligible Dependents may elect to continue their coverage, without evidence of good health, through either the portability or the conversion feature. (See the Portability and Converting to an Individual Policy sections for more information.) If your Eligible Dependent s death occurs within the time period during which you are entitled to convert the dependent s coverage under the Dependent Term Life Insurance Program, benefits will be payable as if the coverage had not terminated. These benefits are payable even if you did not apply for conversion. If your coverage ends because all Dependent Term Life Insurance for your class ends, the total amount of individual insurance will not exceed the lesser of the following: The total amount of all your Dependent Term Life Insurance then ending under the Group Contract reduced by the amount of group life insurance from any carrier for which you are or become eligible with respect to the dependent within the next 31 days; or $10,000. For Minnesota residents only: You may continue Dependent Term Life Insurance coverage in an amount equal to the amount of insurance in effect on the day your employment with Prudential ends by completing the appropriate Prudential form. You have until the date 60 days after the later of: The date your coverage ends; or The date you receive the letter to make your election. Coverage may be continued until the earliest of any of the following events: 18 months from the date your employment with Prudential ends; The date you cease to pay any required payments to continue Dependent Term Life Insurance; or The date you become covered under any other dependent term life insurance plan. To continue coverage, contact the Prudential Group Life Services Division at and follow the prompts to speak with a representative. Life, Accident and Critical Illness Insurance Programs Page 33

43 Survivor Benefits Life Insurance Survivor Benefits Life Insurance provides your qualified family members with monthly income if you die from any cause. Effective January 1, 2001, no Employee may newly enroll in Survivor Benefits Life Insurance. You may continue this coverage only if you were participating as of December 31, 2000, and provided that you have been continuously enrolled in the coverage for all periods on and after January 1, If you are not currently enrolled for this coverage, it is not available to you. Cost of Coverage Survivor Benefits Life Insurance is a voluntary coverage. You pay the full Cost of coverage for Survivor Benefits Life Insurance, if applicable. Your Cost is based on your age and your Eligible Earnings (up to a maximum of $12,500 per month). To determine your coverage rate, visit the Prudential Benefits Center website (at If you do not have access to a computer or the Internet or if you need more information, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Your contributions will be adjusted to reflect any increases or decreases in your Eligible Earnings. (See the Changes in Your Eligible Earnings section for more information.) Contributions for your Spouse s benefit stop when you reach age 58. Contributions for your Dependent Children s benefit stop when your youngest Dependent Child reaches age 23. After-Tax Contributions Your Cost for coverage is paid on an After-Tax basis through automatic payroll deductions, if applicable. After-Tax means a portion of your income that is deducted from your pay after any applicable federal, state and local income taxes and Social Security taxes have been withheld, that you contribute to a plan or program or use to pay all or a portion of the Cost of coverage for certain programs. Your deducted pay will still be part of your taxable income. Coverage Amount Your qualified family members will receive a monthly benefit based on a percentage of your monthly Eligible Earnings, up to a maximum of $12,500 per month. Any Eligible Earnings over $12,500 per month will not be considered when calculating survivor benefits. Your coverage amount will be adjusted to reflect any increases or decreases in your Eligible Earnings. (See the Changes in Your Eligible Earnings section for more information.) If you die, your qualified family members will receive the following benefits: Spouse benefit: 20% of your monthly Eligible Earnings, up to a maximum benefit of $2,500 per month; Children benefit: 10% of your monthly Eligible Earnings, up to a maximum benefit of $1,250 per month; or Spouse and children benefit combined: 30% of your monthly Eligible Earnings, up to a maximum benefit of $3,750 per month. The children benefit is a total of 10% of your monthly Eligible Earnings (subject to the maximum benefit), regardless of the number of eligible children you have. For example, if your monthly Eligible Earnings are equal to $2,500, the total monthly benefit payable to your qualified family members would be as follows: Spouse: $500 per month (20% of $2,500); Children: $250 per month (10% of $2,500) divided equally among all designated children; or Spouse and children combined: $750 per month (30% of $2,500). Life, Accident and Critical Illness Insurance Programs Page 34

44 If your qualified family members change either before or after your death, the monthly benefit will be adjusted accordingly. Qualified Family Members Your qualified family members may include: Your Spouse under age 65; and Your children under age 23 (including legally adopted children and stepchildren who are wholly dependent on you for their support and maintenance) or unmarried children age 23 or older who are mentally or physically disabled. Prudential must receive proof of the child s disability within 31 days after the child reaches age 23. You may submit written proof of the child s disability to the Prudential Benefits Center at: Prudential Benefits Center P.O. Box Charlotte, NC Adding Qualified Family Members You can add additional qualified family members for Survivor Benefits Life Insurance coverage if you meet all of the following conditions: You are already enrolled for coverage and have remained continuously enrolled for all periods on and after January 1, 2001; You are under age 65; and You experience a Change in Status, such as your marriage and/or the birth, adoption or placement for adoption of a child. If you are already enrolled for a: Spouse benefit, you can enroll an eligible child at any time without evidence of good health; or Children benefit, you can enroll an eligible Spouse within 31 days of your marriage, without evidence of good health. After the 31-day period, evidence of good health is required to add a Spouse. Once you reach age 65, you cannot enroll any additional dependents (including your Spouse or child). In the event of divorce, Spouse coverage ends. To report the addition of a qualified family member, complete the certification process on the Prudential Benefits Center website (at If you do not have access to a computer or the Internet or if you need more information, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. When Benefits Are Paid Benefits are paid upon the insurance carrier s receipt of written evidence of your death if you are survived by one or more qualified family members. The first payment is payable as of the date of your death; subsequent payments are payable on the first day of each month. If you are not survived by one or more qualified family members, no benefits will be paid. (See the How to File a Claim for Benefits section for more information.) Life, Accident and Critical Illness Insurance Programs Page 35

45 How Benefits Are Paid Spouse Benefit The Spouse benefit will be paid to your Spouse and will continue until the later of: The first day of the month in which your Spouse reaches age 65; or The first day of the month in which you would have reached age 65. However, in either case, when your Spouse dies, all payments stop. Children Benefit The children benefit will be paid to your widow or widower on behalf of your Eligible Dependent Child(ren). If you are not survived by your Spouse or if you are divorced, the children benefit will be paid in equal shares to your Eligible Dependent Child(ren) or to their legal guardian if the Dependent Child(ren) are minors. If no guardian has been appointed, the children benefit may be paid to the person or institution that has assumed custody and support of the child(ren) (but only up to a maximum of $250 per month) until a legal guardian is appointed. The children benefit will continue to be paid to your Eligible Dependent Child(ren) until the first day of the month following the date your youngest child reaches age 23. However, if you have an unmarried child age 23 or older who is mentally or physically disabled, the children benefit will continue as long as he/she remains unmarried and disabled. If You Take a Leave of Absence Unpaid Leave of Absence If you take an unpaid leave of absence, your coverage under Survivor Benefits Life Insurance will continue automatically while you are on leave up to a period of six months, provided you make the required payments. Benefits will continue automatically during an unpaid leave unless you notify the Prudential Benefits Center to terminate your benefits while on leave. If you continue coverage, a bill will be mailed to your home address on a monthly basis. Payments are due within 30 days of the specified due date. If you are still on leave at the end of the six-month period or if you fail to pay any required premiums, your Survivor Benefits Life Insurance will end. When coverage ends, you may convert your lost coverage, without evidence of good health, to an individual policy at your own cost. You must apply and pay the first premium before the later of: 31 days after the date coverage ends; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends. See the Converting to an Individual Policy section for more information. If your death occurs within the time period during which you are entitled to convert your coverage under the Survivor Benefits Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. If you are planning to take an unpaid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Life, Accident and Critical Illness Insurance Programs Page 36

46 Paid Leave of Absence If you take a paid leave of absence, your coverage under Survivor Benefits Life Insurance will continue while you are on leave. Benefits will automatically continue during your paid leave and you will continue to make contributions through payroll deductions. If you are planning to take a paid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If You Are Disabled If you become Totally Disabled and are receiving benefits from the Short Term Disability (STD) Program*, your coverage will continue and your coverage amount will be frozen, provided you continue paying contributions. If your STD benefits are exhausted, your coverage terminates. Upon termination of coverage, you may elect to continue this voluntary coverage through the conversion feature. (See the Converting to an Individual Policy section for more information.) * For Full-Time Employees who are not eligible for STD benefits, you will continue to be eligible for active Employee Survivor Benefits Life Insurance coverage for up to six weeks. After six weeks, your coverage may continue if you have been approved for a leave of absence. Waiver of Premium If you continue to be Totally Disabled for six consecutive months, your Survivor Benefits Life Insurance may be continued at no Cost under the waiver of premium provision. To qualify, your disability must have begun prior to age 65 and you must remain Totally Disabled for more than six consecutive months. You must provide written proof of your Total Disability to the insurance carrier after six months of disability but prior to 12 months of disability. Thereafter, you must provide written proof annually, as required by the insurance carrier, that your Total Disability continues. If you should die prior to submitting proof of your disability, your Beneficiary(ies) may provide written proof to the insurance carrier upon the submission of a claim for death benefits. (See the How to File a Claim for Benefits section for more information.) If your death occurs within the time period during which you are entitled to convert your coverage under the Survivor Benefits Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. If You Reach Age 65 as an Active Employee Spouse coverage ends when you reach age 65 unless your Spouse was under age 65, in which case the coverage would continue until your Spouse attained age 65. Generally, your children coverage s will continue until your youngest child reaches age 23, unless the child is unmarried and mentally or physically disabled. You cannot enroll additional family members after you reach age 65. When coverage ends, you may convert your lost Employee coverage, without evidence of good health, to an individual policy at your own cost. You must apply and pay the first premium before the later of: 31 days after you cease to be insured for Survivor Benefits Life Insurance coverage; and 15 days after you receive notice of conversion, but no more than 91 days after the date coverage ends. See the Converting to an Individual Policy section for more information. If your death occurs within the time period during which you are entitled to convert your coverage under the Survivor Benefits Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. Life, Accident and Critical Illness Insurance Programs Page 37

47 If You Retire If you Retire, your coverage ends on the last day of the pay period in which your employment with Prudential ended. You may continue Survivor Benefits Life Insurance coverage if, at the time you Retire, you meet the terms of The Prudential Welfare Benefits Plan, including if you: Have 10 or more years of Vesting Service (as defined under the Retirement Plan and including any additional periods of Vesting Service granted under The Prudential Welfare Benefits Plan for the purpose of eligibility); and Either: Have attained the first day of the month coinciding with or next following your 55th birthday; or Are considered a Retired participant under the terms of The Prudential Traditional Retirement Plan (a component of the Retirement Plan). If you meet the above criteria, your Spouse coverage ends when you reach age 65 unless your Spouse was under age 65, in which case the coverage would continue until your Spouse attained age 65. Generally, your children coverage will continue until your youngest child reaches age 23, unless the child is unmarried and mentally or physically disabled. You cannot enroll additional family members after you reach age 65. When coverage ends, you may convert your lost Employee coverage, without evidence of good health, to an individual policy at your own cost. You must apply and pay the first premium before the later of: 31 days after you cease to be insured for Survivor Benefits Life Insurance coverage; and 15 days after you receive notice of conversion, but no more than 91 days after the date coverage ends. See the Converting to an Individual Policy section for more information. If your death occurs within the time period during which you are entitled to convert your coverage under the Survivor Benefits Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. If Your Employment Ends If your employment with Prudential ends before you Retire, your coverage ends on the last day of the pay period in which your employment with Prudential ended. You have the right to convert your coverage, without evidence of good health, to an individual policy at your own cost. You must apply and pay the first premium before the later of: 31 days after the date your coverage ends; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends. See the Converting to an Individual Policy section for more information. If your death occurs within the time during which you are entitled to convert your coverage under the Survivor Benefits Life Insurance Program, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. Life, Accident and Critical Illness Insurance Programs Page 38

48 For Minnesota residents only: You may continue Survivor Benefits Life Insurance coverage in an amount equal to the amount of insurance in effect on the day your employment with Prudential ends by completing the appropriate Prudential form. You have until the date 60 days after the later of: The date your coverage ends; or The date you receive the letter to make your election. Coverage may be continued until the earliest of any of the following events: 18 months from the date your employment with Prudential ends; The date you cease to pay any required payments to continue Survivor Benefits Life Insurance; or The date you become covered under any other survivor benefits life insurance plan. To continue coverage, contact the Prudential Group Life Services Division at and follow the prompts to speak with a representative. Life, Accident and Critical Illness Insurance Programs Page 39

49 Basic Accidental Death and Dismemberment Insurance Basic Accidental Death and Dismemberment (AD&D) Insurance pays a benefit if you die or suffer a serious injury due to an accident either on or off the job. You or your Beneficiary may receive this benefit in addition to any other life insurance benefit that you or your Beneficiary is eligible to receive. You are enrolled automatically, but you must designate a Beneficiary if you want to name a Beneficiary other than the Beneficiary designated for your Basic Group Life Insurance. (See the Beneficiaries section for more information.) Cost of Coverage Basic AD&D Insurance is a core coverage. Prudential pays the full Cost of coverage for you. Coverage Amount If you die as the result of an accident, the Basic AD&D Insurance coverage pays your Beneficiary a benefit of one times your Eligible Earnings (provided you are not yet age 70), up to a maximum benefit of $300,000. (If you are age 70 or older at the time of your death, your Beneficiary will receive a benefit equal to your reduced coverage amount, as explained under If You Reach Age 70 as an Active Employee. ) It will pay you the full amount or a percentage of your coverage if, due to an accidental injury, you lose your life, a limb, your eyesight, speech or hearing, or if you become quadriplegic, paraplegic or hemiplegic, based on the seriousness of the loss. Your coverage amount will be adjusted to reflect any increases or decreases in your Eligible Earnings. (See the Changes in Your Eligible Earnings section for more information.) Basic AD&D Insurance coverage amounts of $50,000 or over will not be subject to taxable Imputed Income. If you suffer one of the following losses within 90 days of a covered accident (or within 365 days in the case of quadriplegia, paraplegia or hemiplegia), you or your Beneficiary(ies) will receive Basic AD&D benefits as the following table illustrates: Basic AD&D Schedule of Benefits Type of Loss Benefit Payable (up to a maximum of $300,000) Life; both hands; both feet; sight in both eyes; one hand and one foot; one hand or one foot and the sight in one eye; speech and hearing in both ears; quadriplegia Paraplegia Hemiplegia; one hand; one foot; sight in one eye; speech; hearing in both ears; hearing in one ear Thumb and index finger of the same hand Full amount (100%) of your coverage amount at the time of the accident, up to the maximum Three-quarters (75%) of your coverage amount at the time of the accident, up to the maximum One-half (50%) of your coverage amount at the time of the accident, up to the maximum One-quarter (25%) of your coverage amount at the time of the accident, up to the maximum Life, Accident and Critical Illness Insurance Programs Page 40

50 Basic AD&D Schedule of Benefits Loss means the following in reference to: A hand or foot complete severance at or above the wrist or ankle Sight total and permanent loss of sight Speech total and permanent loss of speech Hearing in both ears total and permanent loss of hearing in both ears Hearing in one ear the total and permanent loss of hearing in one ear Quadriplegia complete and irreversible paralysis of both upper and both lower limbs Paraplegia complete and irreversible paralysis of both lower limbs Hemiplegia complete and irreversible paralysis of the upper and lower limbs on one side of the body A thumb and index finger (same hand) a severance through or above the metacarpophalangeal joint Note: If you suffer more than one type of loss as a result of a single accident, the maximum benefit payable is equal to the coverage amount. Benefits for an accidental loss that results from a covered accident will be paid only once, even if more than one hazard or covered risk applies. New York residents: This policy provides ACCIDENT insurance only. It does not provide basic hospital, basic medical or major medical insurance, as defined by the New York State Insurance Department. IMPORTANT: This policy does not provide coverage for sickness. Additional Seat Belt and Air Bag Benefits If you are wearing a seat belt and/or traveling in an automobile with an air bag system at the time of the accident and you die, the Program pays the following additional benefits: 10% of your coverage amount, up to $10,000, if you are wearing a seat belt in the manner prescribed by the vehicle s manufacturer at the time of the accident; and 10% of your coverage amount, up to $10,000, if you are wearing a seat belt in the manner prescribed by the vehicle s manufacturer at the time of the accident and sitting in a seat that is protected with an air bag system at the time of the accident and a properly functioning air bag was deployed. Both the seat belt and air bag must meet published federal safety standards, be installed by the automobile manufacturer and not be altered since the installation. Actual use of the seat belt and air bag at the time of the injury must be verified in an official report of the accident or be certified in writing by the investigating official. The loss is not covered under this additional benefit if it results from driving or riding in a vehicle used in a race or a speed or endurance test, for acrobatic or stunt driving or for any illegal purpose. Specified Aircraft Coverage You are covered while you are on an Authorized Business Trip for boarding, leaving or riding as a pilot, crew member (including flight attendants) or passenger in a Prudential-specified aircraft. You are also covered if you are struck by a Prudential-specified aircraft. Specified aircraft means any aircraft that is owned, operated, controlled or leased by, or on behalf of, Prudential and is on file with Prudential. Specified aircraft also means new and substitute aircraft. Life, Accident and Critical Illness Insurance Programs Page 41

51 Exclusions Basic AD&D Insurance benefits are not payable for losses or death caused by: Suicide or attempted suicide while sane or insane; Intentional or attempted self-inflicted injury; Sickness or disease; Medical or surgical treatment of sickness or disease whether the loss results directly or indirectly from the treatment; Any bacterial or viral infection (however, benefits are payable in the case of a pyogenic infection resulting from an accidental cut or wound or a bacterial infection resulting from accidental ingestion of a contaminated substance); Taking part in any insurrection; War or any act of war (war means declared or undeclared war and includes resistance to armed aggression); An accident that occurs while you are serving on full-time active duty for more than 30 days in any armed forces (not including Reserve or National Guard active duty for training); Travel or flight in any vehicle used for aerial navigation (including getting into, out of, on or off any such vehicle) if you are: A passenger in any aircraft not intended or licensed for passenger transportation; Acting as a pilot or crew member (including flight attendants) of any aircraft, except as specified by the Specified Aircraft Coverage provision in the previous section; A passenger in an aircraft owned, operated, controlled or leased by, or on behalf of, Prudential or any of its subsidiaries or Affiliates, except as provided in the Specified Aircraft Coverage provision in the previous section; or Commission of, or attempt to commit, an assault or a felony; Being legally intoxicated or under the influence of any narcotic unless administered or consumed on the advice of a Doctor; or Participation in these hazardous sports: scuba diving, bungee jumping, skydiving, parachuting, hang gliding, paragliding, paramotoring, parascending or ballooning. When Benefits Are Paid The benefit for loss of limbs, sight, hearing or speech, or for quadriplegia, paraplegia or hemiplegia will be paid when the insurance carrier receives written evidence that the loss resulted from a covered accident occurring while you were insured. The benefit for loss of life is payable upon your accidental death. Your Beneficiary(ies) will be required to provide written evidence of your death. See the How to File a Claim for Benefits section for more information. Life, Accident and Critical Illness Insurance Programs Page 42

52 How Benefits Are Paid If an accidental injury results in the loss of limbs, sight, hearing or speech, or in quadriplegia, hemiplegia or paraplegia, a lump sum benefit will be paid to you via a Prudential Alliance Account. (See the A Prudential Alliance Account section for more information.) If you die as a result of an accident, a death benefit of $5,000 or more will generally be deposited into a Prudential Alliance Account, in the name of the Beneficiary(ies) you have designated, unless you pre-select an optional method of payment. You should keep in mind that if you pre-select an optional form of payment, your Beneficiary(ies) will not be allowed to change the payment method at a later date. A benefit of less than $5,000 will be paid to your Beneficiary(ies) in a lump sum. (See the A Prudential Alliance Account section for more information.) If You Take a Leave of Absence Unpaid Leave of Absence If you take an unpaid leave of absence, your coverage under Basic AD&D Insurance will continue automatically while you are on leave up to a period of six months. If you are still on leave at the end of the six-month period, your Basic AD&D Insurance will end. When coverage ends, you may not convert lost coverage to an individual policy. If you are planning to take an unpaid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Paid Leave of Absence If you take a paid leave of absence, your coverage under Basic AD&D Insurance will continue while you are on leave. Benefits will automatically continue during your paid leave. If you are planning to take a paid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If You Are Disabled If you become Totally Disabled and are receiving benefits from the STD Program*, your coverage will continue and your coverage amount will be frozen. If your STD benefits are exhausted, your coverage ends. When coverage ends, you cannot convert this coverage to an individual policy. * For Full-Time Employees who are not eligible for STD benefits, you will continue to be eligible for active Employee Basic AD&D Insurance coverage for up to six weeks. After six weeks, your coverage may continue if you have been approved for a leave of absence. If You Reach Age 70 as an Active Employee If you remain an active Employee after reaching age 70, your coverage will begin to reduce as of the January 1 after you reach age 70. Coverage will continue to reduce each Calendar Year until it reaches the minimum benefit of $10,000. The reduced amount will be a percentage of your pre-age 70 amount, as the following table illustrates: Your Age as of January 1 Coverage Amount 70 80% of your pre-age 70 amount 71 60% of your pre-age 70 amount 72 40% of your pre-age 70 amount 73 20% of your pre-age 70 amount 74 $10,000 Life, Accident and Critical Illness Insurance Programs Page 43

53 If You Retire If you Retire, your coverage ends on your last date of employment with Prudential. However, if you are placed on a paid terminal leave of absence preceding your last day of employment, coverage ends on the last day you were Actively at Work before the start of the paid terminal leave. When coverage ends, you cannot convert it to an individual policy. If Your Employment Ends If your employment with Prudential ends before you Retire, your coverage ends on your last date of employment with Prudential. However, if you are placed on a paid terminal leave of absence preceding your last day of employment, coverage ends on the last day you were Actively at Work before the start of the paid terminal leave. When coverage ends, you cannot convert it to an individual policy. Life, Accident and Critical Illness Insurance Programs Page 44

54 Supplemental Accidental Death and Dismemberment Insurance Supplemental Accidental Death and Dismemberment (AD&D) Insurance can supplement your Basic AD&D Insurance. It pays a benefit to your Beneficiary(ies) if you die or to you if you suffer a serious injury due to an accident either on or off the job. Supplemental AD&D benefits are paid in addition to Basic AD&D benefits. You may also elect coverage for your Spouse/Domestic Partner and/or Dependent Children. This coverage pays benefits to you if one of your covered Eligible Dependents dies or sustains certain serious injuries due to an accident. Note: If you would like to elect Supplemental AD&D Insurance coverage for your Eligible Dependents, you must first elect Supplemental AD&D Insurance coverage for yourself. For benefits paid in the event of your death, you must designate a Beneficiary if you want to name a Beneficiary other than the Beneficiary designated for your Basic Group Life Insurance. (See the Beneficiaries section for more information.) You are the Beneficiary for benefits paid if one of your covered Eligible Dependents dies or suffers a covered injury. Your Eligible Dependents You may elect Supplemental AD&D Insurance coverage for your Eligible Dependents. Please note: Your Eligible Dependents are eligible for coverage if they meet the criteria summarized below and described in detail in the Glossary definitions of Spouse, Domestic Partner, Dependent Child(ren), Qualifying Child or Qualifying Relative. See the Glossary for more information. Your qualified Eligible Dependents are: Your Spouse or Domestic Partner; and Your Dependent Child(ren) (as defined in the Glossary) who generally are your natural children, your adopted children, children placed with you for adoption, your stepchildren and your unmarried grandchildren and children living in your home for whom you are the legal guardian, if: From birth but under age 19, they are unmarried and Substantially Dependent on you; Between the ages of 19 and 24, they are unmarried, Substantially Dependent on you and attending school on a full-time basis; or At age 19 or older, they are unmarried, incapable of sustaining employment due to a mental or physical disability and Substantially Dependent on you (this must be a continuation of coverage that was in effect prior to exceeding the above age limit). Your Dependent Child must, in addition to falling into one of the above categories, remain continuously covered and qualify and continue to qualify as your Qualifying Child or Qualifying Relative under Section 152 of the Code, without regard to the requirement that the child has gross income less than the exemption amount (the income limitation ) or whether your child has dependents. Enrolling and Adding Eligible Dependents You may enroll yourself or your Eligible Dependents in Supplemental AD&D Insurance at any time. Life, Accident and Critical Illness Insurance Programs Page 45

55 Restrictions on Eligibility Your Spouse or Domestic Partner or Dependent Child is not considered an Eligible Dependent if he/she: Is on active duty in the armed forces of any country; or Is covered as an active Employee or Retiree under any life insurance term benefits coverage under the Program. A child will not be considered the Dependent Child of more than one Prudential Employee. The child will be considered the Dependent Child of the Employee named in a written agreement between the Employees and filed with the Prudential Benefits Center. If there is no written agreement, the child will be considered the Dependent Child of the Employee who: Became covered under Supplemental AD&D Insurance while the child was a Dependent Child of only the Employee; or Has the longest Continuous Service with the Company and its Affiliated Companies. Extended Family Members are not eligible for coverage. Important Notice Regarding Civil Union Partnership Certain states have passed legislation that requires insurers to provide equal benefit coverage for civil union partners, if spousal coverage is provided through an employer s group insurance plan. Civil union partners under a validly established civil union partnership under a state or foreign jurisdiction may be eligible for some of these programs. For more details regarding civil union partner eligibility requirements for these Programs, please contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Cost of Coverage Supplemental AD&D Insurance is a voluntary coverage. You pay the full Cost of coverage. Your contributions for Employee coverage are based on the amount of coverage you choose and on your Eligible Earnings. Your contribution will be adjusted as your Eligible Earnings change. (See the Changes in Your Eligible Earnings section for more information.) The Cost to cover your Eligible Dependents is based on the following factors: The coverage level you elect (Spouse/Domestic Partner, Dependent Child(ren) or both); and The coverage amount you elect for your Spouse or Domestic Partner. To determine your coverage rate, visit the Prudential Benefits Center website (at If you do not have access to a computer or the Internet or if you need more information, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. After-Tax Contributions Your Cost for coverage is paid on an After-Tax basis, usually through automatic payroll deductions. After-Tax means a portion of your income that is deducted from your pay after any applicable federal, state and local income taxes and Social Security taxes have been withheld, that you contribute to a plan or program or use to pay all or a portion of the Cost of coverage for certain programs. Your deducted pay will still be part of your taxable income. Life, Accident and Critical Illness Insurance Programs Page 46

56 Coverage Amount You may elect coverage for yourself in an amount from one to nine times your Eligible Earnings, up to a maximum benefit of $2,000,000. Your coverage amount will be adjusted to reflect any increases or decreases in your Eligible Earnings. (See the Changes in Your Eligible Earnings section for more information.) Benefits are paid in addition to Basic AD&D benefits. (There is also no connection between your Supplemental AD&D Insurance coverage and your Group Universal Life (GUL) Insurance coverage.) Supplemental AD&D coverage pays your Beneficiary(ies) the full amount of your coverage if you die as the result of an accident. It will pay you the full amount or a percentage of your coverage if, due to an accidental injury, you lose a limb, your eyesight, speech or hearing, or if you become quadriplegic, paraplegic or hemiplegic, based on the seriousness of the loss. You may elect Supplemental AD&D coverage for your Eligible Dependents as follows: Covered Dependent Spouse or Domestic Partner Full Coverage Amount* You may elect coverage in $50,000 increments, up to a maximum coverage amount of $500,000. Dependent Child(ren) You may elect a coverage amount of $10,000, $25,000, $50,000 or $75,000. * The Spouse/Domestic Partner coverage amount you elect cannot exceed the amount for which you are covered under Basic and Supplemental AD&D Insurance combined. The coverage amount you elect for your Dependent Children also cannot exceed the amount for which you are covered under Basic and Supplemental AD&D Insurance combined. When you cover your Eligible Dependents, Supplemental AD&D coverage pays you the full amount of your coverage if your covered dependent dies as the result of an accident. It will pay you a percentage of the full coverage amount if, due to an accidental injury, your covered dependent loses a limb, eyesight, speech or hearing, or if he/she becomes quadriplegic, paraplegic or hemiplegic, based on the seriousness of the loss. If you or your covered Eligible Dependents suffers one of the following losses within 90 days of a covered accident (or within 365 days in the case of quadriplegia, paraplegia or hemiplegia), Supplemental AD&D benefits will be payable as described in the following table: Supplemental AD&D Schedule of Benefits Type of Loss Life; both hands; both feet; sight in both eyes; one hand and one foot; one hand or one foot and the sight in one eye; speech and hearing in both ears; quadriplegia Paraplegia Hemiplegia; one hand; one foot; sight in one eye; speech; hearing in both ears; hearing in one ear Thumb and index finger of the same hand Benefit Payable Full amount (100%) of the elected coverage amount at the time of the accident, up to the maximum Three-quarters (75%) of the elected coverage amount at the time of the accident, up to the maximum One-half (50%) of the elected coverage amount at the time of the accident, up to the maximum One-quarter (25%) of the elected coverage amount at the time of the accident, up to the maximum Life, Accident and Critical Illness Insurance Programs Page 47

57 Supplemental AD&D Schedule of Benefits Type of Loss Benefit Payable Loss means the following in reference to: A hand or foot complete severance at or above the wrist or ankle Sight total and permanent loss of sight Speech total and permanent loss of speech Hearing in both ears the total and permanent loss of hearing in both ears Hearing in one ear the total and permanent loss of hearing in one ear Quadriplegia complete and irreversible paralysis of both upper and both lower limbs Paraplegia complete and irreversible paralysis of both lower limbs Hemiplegia complete and irreversible paralysis of the upper and lower limbs on one side of the body A thumb and index finger (same hand a severance through or above the metacarpophalangeal joint Note: If you or your covered Eligible Dependent suffers more than one type of loss as a result of a single accident, the maximum benefit payable is the full coverage amount. Benefits for an accidental loss that results from a covered accident will be paid only once, even if more than one hazard or covered risk applies. New York residents: This policy provides ACCIDENT insurance only. It does not provide basic hospital, basic medical or major medical insurance, as defined by the New York State Insurance Department. IMPORTANT: This policy does not provide coverage for sickness. Additional Seat Belt and Air Bag Benefits If a covered person is wearing a seat belt and/or traveling in an automobile with an air bag system at the time of the accident and dies, the Program pays the following additional benefits: 10% of the elected coverage amount, up to $10,000, if the person was wearing a seat belt in the manner prescribed by the vehicle s manufacturer at the time of the accident; and 10% of the elected coverage amount, up to $10,000, if the person was wearing a seat belt in the manner prescribed by the vehicle s manufacturer at the time of the accident and sitting in a seat that was protected with an air bag system at the time of the accident and a properly functioning air bag was deployed. Both the seat belt and air bag must meet published federal safety standards, be installed by the automobile manufacturer and not be altered since the installation. Actual use of the seat belt and air bag at the time of the injury must be verified in an official report of the accident or be certified in writing by the investigating official. The loss is not covered under this additional benefit if it results from driving or riding in a vehicle used for a race or a speed or endurance test, for acrobatic or stunt driving or for any illegal purpose. Specified Aircraft Coverage You are covered while you are on an Authorized Business Trip while boarding, leaving or riding as a pilot, crew member (including flight attendants) or passenger in a Prudential-specified aircraft. You are also covered if you are struck by a Prudential-specified aircraft. Specified aircraft means any aircraft that is owned, operated, controlled or leased by, or on behalf of, Prudential and is on file with Prudential. Specified aircraft also means new and substitute aircraft. Life, Accident and Critical Illness Insurance Programs Page 48

58 Additional Benefits The following program features are available if coverage is elected for Eligible Dependents. Monthly Medical Premium Benefit The Program will pay an additional monthly benefit to help you pay your monthly medical premiums for COBRA continuation coverage if you choose to continue your Prudential Medical Program coverage beyond the time it would normally end because you are on a leave of absence. The leave of absence must be due to an accidental injury that resulted in a covered loss within 365 days of the accident. The amount of the monthly benefit will be equal to the least of the COBRA medical premium amount, 5% of the coverage amount and $500. The benefit will be paid monthly until the earliest of the following events: Your continued Prudential Medical Program coverage ends; You become covered under any other group medical plan; or The benefit has been paid for 24 consecutive months. Common Disaster Benefit If both you and your covered Spouse/Domestic Partner die as a result of a common accident (or separate accidents that occur within 24 hours of each other) and you have surviving Dependent Children on the date of the accident, then an additional benefit will be payable. The benefit amount will be the lesser of: The difference between your coverage amount and $500,000; and The difference between your Spouse s/domestic Partner s coverage amount and $500,000. Day Care Expense Benefit The Program will pay a benefit for day care expenses of a covered Dependent Child under the age of 13 if you or your covered Spouse/Domestic Partner dies in a covered accident. The annual benefit is the least of the actual cost charged by the Child Care Center per year, 5% of your coverage amount and $5,000 a year, up to four consecutive years or until the child reaches age 13, if earlier. The benefit applies only if the child is under the age of 13 and is enrolled in a licensed or certified Child Care Center on the date of your or your Spouse s/domestic Partner s death or enrolls within 90 days of that date. In the event of your death, the benefit is paid to your surviving Spouse/Domestic Partner or to the child s legal guardian. Child Tuition Reimbursement Benefit The Program will pay a tuition reimbursement benefit for a covered Dependent Child upon your or your covered Spouse/Domestic Partner s death in a covered accident. An annual payment for up to four years is payable for a covered Dependent Child who is less than age 24 and a full-time student in an institution of higher learning. The annual benefit is the least of the actual tuition (excluding room and board), 5% of your coverage amount and $5,000 a year. This benefit applies once and applies only if the child was enrolled in an institution of higher learning or is in high school and enrolls within 365 days of your death. In the event of your death, if the child is under age, according to state law, the benefit is paid to the person or institution that appears to have assumed main support of the child. Spouse or Domestic Partner Tuition Reimbursement Benefit If you die in a covered accident, the Program provides a tuition reimbursement benefit, payable for one year, for a professional or trade program to help your surviving Spouse/Domestic Partner prepare for work. To be eligible for this benefit, your Spouse or Domestic Partner must be covered under the Program at the time of your death. The benefit is the least of the actual tuition, 5% of your coverage amount and $5,000. Enrollment in that program must occur within 30 months of your death. Life, Accident and Critical Illness Insurance Programs Page 49

59 Dependent Child Loss Benefit If a covered Dependent Child suffers a covered dismemberment or paralysis, the Program provides a benefit equal to the amount payable for that child s loss. If the child sustains more than one loss from the same accident, the benefit amount will be equal to the lesser of 200% of the one largest amount to which the child is entitled and $150,000. The benefit is not payable if the child dies within 90 days of the accident. Continued Accident Insurance After Your Death If you suffer an accidental loss of life for which benefits are payable under this Program, your covered dependents Supplemental AD&D Insurance will be continued until the earliest of the following events: 12 months from the date of your death; Your Spouse or Domestic Partner remarries; or Your Dependent Child no longer qualifies for coverage. No premiums are required for the continued coverage. Exclusions Supplemental AD&D benefits are not payable for losses or death caused by: Suicide or attempted suicide while sane or insane; Intentionally self-inflicted injuries or any attempt to inflict such injuries; Sickness, whether the loss results directly or indirectly from the sickness; Medical or surgical treatment of sickness, whether the loss results directly or indirectly from the treatment; Any bacterial or viral infection (however, benefits are payable in the case of a pyogenic infection resulting from an accidental cut or wound or a bacterial infection resulting from accidental ingestion of a contaminated substance); Taking part in any insurrection; War or any act of war (war means declared or undeclared war and includes resistance to armed aggression); An accident that occurs while you are serving on full-time active duty for more than 30 days in any armed forces (not including Reserve or National Guard active duty for training); Travel or flight in any vehicle used for aerial navigation (including getting into, out of, on or off any such vehicle), except as provided by any hazard provision, if you are: A passenger in any aircraft not intended or licensed for passenger transportation; Acting as a pilot or crew member (including flight attendants) of any aircraft, except as provided by the Specified Aircraft Coverage provision in the previous section; or A passenger in an aircraft owned, operated, controlled or leased by, or on behalf of, Prudential or any of its subsidiaries or Affiliates, except as provided by the Specified Aircraft Coverage provision in the previous section; Commission, or attempt to commit, an assault or felony; Being legally intoxicated or under the influence of any narcotic unless administered or consumed on the advice of a Doctor; or Participation in these hazardous sports: scuba diving, bungee jumping, skydiving, parachuting, hang gliding, paragliding, paramotoring, parascending or ballooning. Life, Accident and Critical Illness Insurance Programs Page 50

60 Evidence of Good Health Evidence of good health is not required for any Supplemental AD&D Insurance coverage amount. When Benefits Are Paid The benefit for loss of limbs, sight, hearing or speech or for quadriplegia, paraplegia or hemiplegia will be paid when the insurance carrier receives written evidence that the loss resulted from a covered accident occurring while you or your covered Eligible Dependent was insured. The benefit for loss of life is payable upon the accidental death of you or your covered Eligible Dependent. You (or your Beneficiary) will be required to provide written evidence of the death. See the How to File a Claim for Benefits section for more information. How Benefits Are Paid You are the Beneficiary for all benefits payable under this Program, except benefits paid in the event of your death. If an accidental injury to you or your covered Eligible Dependents results in the loss of limbs, sight, hearing or speech, or in quadriplegia, hemiplegia or paraplegia, a lump-sum benefit will be paid to you via a Prudential Alliance Account. If a covered Eligible Dependent dies as a result of an accident, a death benefit of $5,000 or more will be deposited into a Prudential Alliance Account in your name, unless you pre-select an optional method of payment. A benefit of less than $5,000 will be paid to you in a lump sum. (See the A Prudential Alliance Account section for more information.) If you die as a result of an accident, a death benefit of $5,000 or more will generally be deposited into a Prudential Alliance Account in the name of the Beneficiary(ies) you have designated, unless you pre-select an optional method of payment. You should keep in mind that if you pre-select an optional form of payment, your Beneficiary(ies) will not be allowed to change the payment method at a later date. A benefit of less than $5,000 will be paid to your Beneficiary(ies) in a lump sum. (See the A Prudential Alliance Account section for more information.) If You Take a Leave of Absence Unpaid Leave of Absence If you take an unpaid leave of absence, your coverage under Supplemental AD&D Insurance will continue automatically while you are on leave up to a period of six months, provided you make the required payments. Coverage will continue automatically during an unpaid leave unless you notify the Prudential Benefits Center to terminate your benefits while on leave. If you continue coverage, a bill will be mailed to your home address on a monthly basis. Payments are due within 30 days of the specified due date. If you are still on leave at the end of the six-month period or if you fail to pay any required premiums, your Supplemental AD&D Insurance will end. When coverage ends, you may not convert lost coverage to an individual policy. If you are planning to take an unpaid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Paid Leave of Absence If you take a paid leave of absence, your coverage under Supplemental AD&D Insurance will continue while you are on leave. Coverage will automatically continue during your paid leave and you will continue to make contributions through payroll deductions. If you are planning to take a paid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Life, Accident and Critical Illness Insurance Programs Page 51

61 If You Are Disabled If you become Totally Disabled and are receiving benefits from the STD Program*, your coverage will continue and your coverage amount will be frozen, provided you continue paying contributions. Coverage will end when your STD benefits are exhausted. When coverage ends, you cannot convert it to an individual policy. * For Full-Time Employees who are not eligible for STD benefits, you will continue to be eligible for active Employee Supplemental AD&D Insurance coverage for up to six weeks. After six weeks, your coverage may continue if you have been approved for a leave of absence. If You Retire If you Retire, your coverage ends on the last day of the pay period in which your employment with Prudential ended. When coverage ends, you cannot convert it to an individual policy. If Your Employment Ends If your employment with Prudential ends before you Retire, your coverage ends on the last day of the pay period in which your employment with Prudential ended. When coverage ends, it cannot be converted to an individual policy. Life, Accident and Critical Illness Insurance Programs Page 52

62 Business Travel Accident Insurance Business Travel Accident (BTA) Insurance pays a benefit if you die or are injured due to an accident while traveling on Company business or if your Spouse, Qualified Adult (that is, a Domestic Partner or an Extended Family Member) and/or your Dependent Child dies or is injured while traveling with you on Company business. You are enrolled automatically under this coverage, but you must designate a Beneficiary if you want to name a Beneficiary other than the Beneficiary designated for your Basic Group Life Insurance. (See the Beneficiaries section for more information.) Cost of Coverage BTA Insurance is a core coverage. Prudential pays the full Cost of coverage for you. Coverage Amount The benefit is determined based on your Eligible Earnings and the type of loss you, your Spouse or a Qualified Adult and/or your Dependent Child experiences within one year of a covered accident. If you die as the result of a covered accident, BTA Insurance pays the full coverage amount, which is equal to ten times your Eligible Earnings, rounded to the next higher multiple of $1,000, up to a maximum benefit of $1 million. For certain cases of serious injury, the Program pays a percentage of your full coverage amount, as shown in BTA Schedule of Benefits on the following page. Your coverage amount will be adjusted to reflect any increases or decreases in your Eligible Earnings. (See the Changes in Your Eligible Earnings section for more information.) Qualified Eligible Dependent Coverage Your Spouse or a Qualified Adult (that is, a Domestic Partner or an Extended Family Member) and/or your Dependent Child(ren) are covered under BTA Insurance if they join you on a Relocation Trip or accompany you on an Authorized Business Trip. You cannot cover a Qualified Adult under this Program if you are also covering a Spouse. Benefits payable for your Spouse or a Qualified Adult are shown in the BTA Schedule of Benefits chart. If you wish to cover a Qualified Adult under BTA Insurance, you must complete the Qualified Adult certification process on the Prudential Benefits Center website (at If you do not have access to a computer or the Internet or if you need more information, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Important Notice Regarding Civil Union Partnership Certain states have passed legislation that requires insurers to provide equal benefit coverage for civil union partners, if spousal coverage is provided through an employer s group insurance plan. Civil union partners under a validly established civil union partnership under a state or foreign jurisdiction may be eligible for some of these programs. For more details regarding civil union partner eligibility requirements for these Programs, please contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Life, Accident and Critical Illness Insurance Programs Page 53

63 BTA Schedule of Benefits Covered Person Employee Full Coverage Amount The full coverage amount is 10 times Eligible Earnings, rounded to the next higher multiple of $1,000, up to a maximum benefit of $1 million Spouse or Qualified Adult The full coverage amount is $100,000 Dependent Child(ren) The full coverage amount is $50,000 Type of Loss Life; both hands; both feet; sight in both eyes; one hand and one foot; one hand or one foot and sight in one eye; speech and hearing in both ears; quadriplegia Paraplegia One hand; one foot; sight in one eye; speech; hearing in both ears; hemiplegia Thumb and index finger of same hand; hearing in one ear; uniplegia Coma Benefit Payable 100% of the full coverage amount Three-quarters (75%) of the full coverage amount One-half (50%) of the full coverage amount One-quarter (25%) of the full coverage amount 1% of the full coverage amount per month, up to 100 months, for each month that you remain in a coma resulting from a covered accident. The coma must begin within 365 days of the accident, continue for 31 consecutive days and be total, continuous and permanent at the end of that 31-day period. Benefits will begin at the end of the 31-day period. Benefits will be paid even if the group contract ends or you cease to be a covered person. Loss means the following in reference to: A hand or foot complete severance at or above the wrist or ankle Sight total and permanent loss of sight Speech total and permanent loss of speech Hearing in both ears the total and permanent loss of hearing in both ears Hearing in one ear the total and permanent loss of hearing in one ear Quadriplegia complete and irreversible paralysis of both upper and both lower limbs Paraplegia complete and irreversible paralysis of both lower limbs Hemiplegia complete and irreversible paralysis of the upper and lower limbs on one side of the body Uniplegia complete and irreversible paralysis of one limb A thumb and index finger (same hand) a severance through or above the metacarpophalangeal joint Coma a profound state of unconsciousness from which the person cannot be aroused Note: If you suffer more than one type of loss arising out of a single accident, the total amount payable is equal to your full coverage amount. If more than one covered person dies or suffers a loss as a result of the same covered felonious assault accident, aircraft accident or other accident that is not due to felonious assault, the Program limits the total amount payable to all Beneficiaries or covered Employees. The aggregate amount the Program will pay is $5 million for a covered felonious assault accident, $30 million for an aircraft accident or $20 million for any other accident that is not due to felonious assault. The benefit amount payable would be prorated among the Beneficiaries or covered Employees. For exposure and disappearance, the Program will pay your full coverage amount if loss of life occurs as a result of exposure to the elements or if you cannot be found within one year of the disappearance, stranding, sinking or wrecking of any vehicle in which the covered person was an occupant. Life, Accident and Critical Illness Insurance Programs Page 54

64 New York residents: This policy provides ACCIDENT insurance only. It does not provide basic hospital, basic medical or major medical insurance, as defined by the New York State Insurance Department. Important: This policy does not provide coverage for sickness. Business Travel Coverage Business travel begins with the actual start of the trip, regardless of whether the trip starts at your home, workplace or otherwise. Business travel ends when you arrive at your home or workplace, which ever happens first. Business travel does not include commuting between your home and workplace, vacations or leaves of absence. War Risk Coverage The Program provides for benefits to be paid if you suffer a loss that results from war or acts of war while traveling on Company business. If you travel to a War Risk Country, you must provide advance notice or you will not be covered. Currently, War Risk Country is defined as Afghanistan or Iraq; however, this may change in the future. At least five days before traveling to a War Risk Country, you must provide the Prudential Benefits Center the following for each covered person who is traveling: Name of the War Risk Country the person will be traveling to; Period of time the person will be in the identified country; Principal amounts of insurance; and Purpose of travel (state if the travel involves any military involvement). You may notify the Prudential Benefits Center by calling PRU-EASY ( ) and following the prompts for Health and Welfare benefits. The Program does not cover acts of war that occur in the United States or your country of permanent residence. Hijacking Coverage The Program pays a benefit if, while on an Authorized Business Trip for Prudential, you suffer a loss as the result of a hijacking that occurs while you were getting into, out of, on or off or riding as a passenger, in any air, land or water vehicle, except a private automobile. This does not include hijacking that occurs while you are performing, learning to perform or instructing others to perform as a pilot, operator or crew member in any aircraft. Commuting to and from Work Due to a Transit Difficulty The Program pays a benefit if you suffer a loss while commuting to and from work due to a transit difficulty. A transit difficulty is the discontinuance of service of public transportation due to a strike, work stoppage, power failure or public disaster requiring you to pursue other options for commuting, such as using your personal automobile. Felonious Assault The Program will pay a benefit if you suffer a loss due to a physical attack because of your employment and while you are working for Prudential. Specified Aircraft Coverage You are covered while you are on an Authorized Business Trip while boarding, leaving or riding as a pilot, crew member (including flight attendants) or passenger in a Prudential-specified aircraft. You are also covered if you are struck by a Prudential-specified aircraft. Specified aircraft means any aircraft that is owned, operated, controlled or leased by, or on behalf of, Prudential and is on file with Prudential. Specified aircraft also means new and substitute aircraft. Life, Accident and Critical Illness Insurance Programs Page 55

65 Additional Benefits Seat Belt and Air Bag Benefit If a covered person dies in an automobile accident, the Program will pay the following additional benefits: 10% of the elected coverage amount, up to $25,000, if the person was wearing a seat belt in the manner prescribed by the vehicle s manufacturer at the time of the accident; and 10% of the elected coverage amount, up to $25,000, if the person was wearing a seat belt in the manner prescribed by the vehicle s manufacturer at the time of the accident and sitting in a seat that is protected with an air bag system at the time of the accident. Both the seat belt and air bag must meet published federal safety standards, be installed by the automobile manufacturer and not be altered since the installation. Actual use of the seat belt and air bag at the time of the injury must be verified in an official report of the accident or be certified in writing by the investigating official. Additional Benefit for Family Relocation and Accompaniment Coverage is provided for family relocation and accompaniment while your Spouse or Qualified Adult and/or your Dependent Child(ren) are with you or on the way to join you on a Relocation Trip or while accompanying you on an Authorized Business Trip. For your Spouse or Qualified Adult, the amount payable is $100,000. For each Dependent Child, the amount payable is $50,000. Home Alteration and Vehicle Modification Benefit If a covered person suffers a loss that requires home alteration or vehicle modification, an additional one-time benefit will be payable. The benefit amount will be the lesser of: The actual cost charged for the alteration or modification; 10% of your full coverage amount; or $25,000. Monthly Rehabilitation Expense Benefit The Program will pay an additional benefit if, within 180 days of an accidental injury, a Doctor determines that rehabilitation is medically necessary to help you return to the normal activities of a person of the same age and gender. The benefit amount will be the lesser of 10% of the coverage amount or $500. The benefit will be paid monthly until: A Doctor determines that you no longer need rehabilitation; You fail to furnish any required proof of a continuing need for rehabilitation; You fail to submit to a medical exam by Doctors named by Prudential Group Life Services, at Prudential Group Life Services expense, when and as often as Prudential Group Life Services requires; or The benefit has been paid for 36 months. Bereavement and Trauma Counseling Benefit If a covered person needs bereavement and trauma counseling because you, your Spouse or Qualified Adult or your Dependent Child suffered a loss, the Program will pay an additional benefit. The bereavement and trauma counseling sessions must be held within one year after the date of the accident causing the loss. The benefit will be lesser of the actual charge for counseling sessions or $150 per session, for up to 50 sessions per covered person. Life, Accident and Critical Illness Insurance Programs Page 56

66 Monthly Medical Premium Benefit The Program will pay an additional monthly benefit to help you pay your medical premiums for COBRA continuation coverage if you choose to continue your Prudential Medical Program coverage beyond the time it would normally end because you are on a leave of absence. The leave of absence must be due to an accidental injury that resulted in a covered loss within 365 days of the accident. The benefit amount will be the lesser of 5% of the coverage amount or $500. The benefit will be paid monthly until the first of these to occur: Your continued Prudential Medical Program coverage ends; You become covered under any other group medical plan; or The benefit has been paid for 24 consecutive months. Emergency or Disaster Response Team Member Benefit If you are a member of a Prudential emergency response team and you suffer a loss due to an accident that occurs while you are responding to an emergency, the Program will pay an additional benefit. The benefit amount will be the lesser of: 10% of the benefit amount; and $25,000. Common Carrier Benefit If you die as a result of boarding, leaving or riding as a passenger on a common carrier or as a result of being struck by a common carrier, the Program will pay an additional benefit. The additional benefit will be the lesser of: 10% of the coverage amount; or $10,000. A common carrier is any: Air, land or water vehicle operated under a license for the transportation of passengers for hire, including a shuttle bus, tram or other vehicle used to transport people within an airport, as well as a chartered aircraft that is not owned, operated, controlled or leased by or on behalf of the Company or its customers; or Aircraft operated by the Military Air Transport Service (MATS) of the United States or by a similar military air transport service of any duly constituted governmental authority of any other recognized country. Day Care Expense Benefit If you die in a covered accident, the Program will pay a benefit for day care expenses of a Dependent Child under the age of seven. The annual benefit is the least of the actual cost charged by the Child Care Center per year, 5% of your coverage amount and $5,000 a year, up to four consecutive years or until the child reaches age seven, if earlier. The benefit applies only if the child is under the age of seven and enrolled in a licensed or certified Child Care Center on the date of your death or within 90 days of that date. The benefit is paid to your Beneficiary. Life, Accident and Critical Illness Insurance Programs Page 57

67 Child Tuition Reimbursement Benefit If you die in a covered accident, the Program will pay a tuition reimbursement benefit for a Dependent Child. An annual payment for up to four years is payable for a covered Dependent Child who is less than age 25 and a full-time student in an institution of higher learning. The annual benefit is the least of the actual tuition (excluding room and board), 10% of your coverage amount and $10,000 a year. This benefit applies only if the child was enrolled in an institution of higher learning or is in high school and enrolls within 365 days of your death. In the event of your death, the benefit is paid to your Beneficiary or to the child s legal guardian if the child is under age, according to state law. Spouse or Domestic Partner Tuition Reimbursement Benefit If you die in a covered accident, the Program provides a tuition reimbursement benefit for a professional or trade program to help your surviving Spouse or Domestic Partner prepare for work. The benefit is the least of the actual tuition, 5% of your coverage amount and $5,000. Enrollment in that program must occur within 12 months of your death. Exclusions This policy does not cover any loss caused by, contributed to or resulting from: Suicide or attempted suicide, while sane or insane; Intentionally self-inflicted injuries or any attempt to inflict such injuries; Sickness, whether the loss results directly or indirectly from the sickness; Medical or surgical treatment of sickness, whether the loss results directly or indirectly from the treatment; Any bacterial or viral infection (however, benefits are payable in the case of a pyogenic infection resulting from an accidental cut or wound or a bacterial infection resulting from accidental ingestion of a contaminated substance); Taking part in any insurrection; War or any act of war, except as provided by the War Risk Hazard provision (war means declared or undeclared war and includes resistance to armed aggression); An accident that occurs while you are serving on full-time active duty for more than 30 days in any armed forces (not including Reserve or National Guard active duty for training); Travel or flight in any vehicle used for aerial navigation (includes getting into, out of, on or off any such vehicle), except as provided by any hazard provision, if you are: A passenger in any aircraft not intended or licensed for passenger transportation; Acting as a pilot or a crew member (including flight attendants) of any aircraft, except as provided by the Specified Aircraft Coverage provision in the previous section; or A passenger in an aircraft owned, operated, controlled or leased by, or on behalf of, Prudential or any of its subsidiaries or Affiliates, except as provided by the Specified Aircraft Coverage provision in the previous section; Commission of, or attempt to commit, an assault or a felony; or Being legally intoxicated or under the influence of any narcotic unless administered or consumed on the advice of a Doctor. Life, Accident and Critical Illness Insurance Programs Page 58

68 When Benefits Are Paid If you (and/or your Spouse or Qualified Adult and/or your Dependent Child) are injured, the benefit will be paid when the insurance carrier receives written evidence that the injury occurred while traveling on Company business. The benefit for loss of life is payable upon death. Your Beneficiary will be required to provide written evidence of your death and, if applicable, the death of your Spouse or Qualified Adult and/or your Dependent Child and written evidence that the deaths occurred as a result of an accident while traveling on Company business. See the How to File a Claim for Benefits section for more information. How Benefits Are Paid If an accidental injury to you or your covered Eligible Dependents results in the loss of limbs, sight, hearing or speech, a lump-sum benefit will be paid to you via a Prudential Alliance Account. If a covered Eligible Dependent dies as a result of an accident, a death benefit of $5,000 or more will be deposited into a Prudential Alliance Account in your name, unless you pre-select an optional method of payment. A benefit of less than $5,000 will be paid to you in a lump sum. (See the A Prudential Alliance Account section for more information.) If you die as a result of an accident, a death benefit of $5,000 or more will generally be deposited into a Prudential Alliance Account, in the name of the Beneficiary(ies) you have designated, unless you pre-select an optional method of payment. You should keep in mind that if you pre-select an optional form of payment, your Beneficiary(ies) will not be allowed to change the payment method at a later date. A benefit of less than $5,000 will be paid to your Beneficiary(ies) in a lump sum. (See the A Prudential Alliance Account section for more information.) If You Take a Leave of Absence During a paid or unpaid leave of absence, this core coverage ends. When coverage ends, you cannot convert it to an individual policy. If You Are Disabled If you become Totally Disabled, coverage will end. When coverage ends, you cannot convert it to an individual policy. If You Retire If you Retire, your coverage ends on your last date of employment with Prudential. However, if you are placed on a paid terminal leave of absence preceding your last day of employment, coverage ends on the last day you were Actively at Work before the start of the paid terminal leave. When coverage ends, you cannot convert it to an individual policy. If Your Employment Ends If your employment with Prudential ends before you Retire, your coverage ends on your last date of employment with Prudential. However, if you are placed on a paid terminal leave of absence preceding your last day of employment, coverage ends on the last day you were Actively at Work before the start of the paid terminal leave. When coverage ends, you cannot convert it to an individual policy. Life, Accident and Critical Illness Insurance Programs Page 59

69 Critical Illness Insurance Critical Illness Insurance provides a lump-sum benefit payment upon diagnosis of covered Critical Illnesses and procedures and benefit proceeds may be used to pay for any type of expense. Critical Illness benefits are payable when you or a covered Spouse or Domestic Partner is diagnosed with a critical illness for the first time and the diagnosis occurs during the person s lifetime, while covered. Pre-existing condition limitations apply. Note: If you would like to elect this coverage, you must review the Critical Illness Insurance Outline of Coverage and be enrolled in either a Prudential-sponsored medical program or have other medical coverage, such as through a Spouse s or Domestic Partner s health plan. You may only enroll yourself for coverage prior to attainment of age 65. In addition, you may only enroll a qualified Eligible Dependent prior to his/her attainment of age 65. Coverage must begin for you and your qualified Eligible Dependent prior to age 65, however, once coverage is in effect, it will not end based on age. When enrolling for coverage, you must attest that you received and reviewed the Critical Illness Insurance Outline of Coverage and you and your Spouse/Domestic Partner have Prudential-sponsored or other medical coverage. Otherwise, enrollment will not be permitted. Qualified Eligible Dependent Critical Illness Insurance is available to your qualified Eligible Dependent if you enroll yourself for coverage. For Critical Illness Insurance, your qualified Eligible Dependent is your Spouse or Domestic Partner who is under age 65 at the time of enrollment and when coverage becomes effective. Important Notice Regarding Civil Union Partnership Certain states have passed legislation that requires insurers to provide equal benefit coverage for civil union partners, if spousal coverage is provided through an employer s group insurance plan. Civil union partners under a validly established civil union partnership under a state or foreign jurisdiction may be eligible for some of these programs. For more details regarding civil union partner eligibility requirements for these Programs, please contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Enrolling a Qualified Eligible Dependent You may enroll a qualified Eligible Dependent at any time. If you acquire a qualified Eligible Dependent through marriage or eligibility of a Domestic Partner under the Program, you can enroll that qualified Eligible Dependent for coverage within the 31-day period on and following the Change in Status without providing evidence of good health, up to $10,000. (See the Qualified Changes in Status booklet for more information.) Restrictions on Eligibility Your Spouse or Domestic Partner is not considered a qualified Eligible Dependent if he/she: Is on active duty in the armed forces of any country; or Is eligible for coverage as an active Employee under the Program. Cost of Coverage Critical Illness Insurance is a voluntary coverage. You pay the full Cost of coverage if elected. Your Cost is based on your age and the amount of coverage you elect. To determine your coverage rate, visit the Prudential Benefits Center website (at Life, Accident and Critical Illness Insurance Programs Page 60

70 After-Tax Contributions Your Cost for coverage is paid on an After-Tax basis through automatic payroll deductions, if applicable. After-Tax means a portion of your income that is deducted from your pay after any applicable Federal, state and local income taxes and Social Security taxes have been withheld, that you contribute to a plan or program or use to pay all or a portion of the Cost of coverage for certain programs. Your deducted pay will still be part of your taxable income. Coverage Amount If you elect coverage for yourself, you may also elect coverage for your qualified Eligible Dependent. Coverage amounts available are as follows: Employee Qualified Eligible Dependent Insurance Amount Any multiple of $20,000 Any multiple of $10,000* Minimum Amount $20,000 $10,000 Maximum Amount $100,000 $50,000 * The amount of insurance on your Spouse/Domestic Partner cannot be more than 50% of the amount of your benefit. Lifetime Maximum Benefit: No more than the Lifetime Maximum Benefit will be paid for all of your Critical Illnesses or Procedures. The Lifetime Maximum Benefit is 200% of your or your qualified Eligible Dependent s insurance amount, as shown above. Evidence of Good Health You may elect to enroll for coverage at any time. When you enroll in Critical Illness Insurance, you may be required to provide evidence of good health that is satisfactory to the insurance carrier. When you make your election on the Prudential Benefits Center website, if your election requires you to provide evidence of good health, you will be prompted to provide the evidence of good health through the online process. In some cases, you may be required to provide additional information, in which case a form will be provided to you after you complete the process online. You will need to complete, sign and mail the form to the address indicated on the form, if applicable. If evidence of good health is required, your coverage will take effect following approval by the insurance carrier. When You Are Not Required to Provide Evidence of Good Health You will not be required to provide evidence of good health to the insurance carrier if you: Are a new hire and enroll yourself for coverage of $20,000 or your dependent for coverage of $10,000 within 31 days on and following your first day of employment with Prudential; Enroll yourself for coverage of $20,000 or your dependent for coverage of $10,000 within 31 days of a Change in Status; or Elect to decrease your and/or your dependent s coverage. Change in Status or Change in Status Event means any of the following: Your marriage, divorce, legal separation or annulment; Your establishment or dissolution of a civil union; Your becoming or ceasing to be a Domestic Partner; The birth, adoption or placement for adoption of your child; Life, Accident and Critical Illness Insurance Programs Page 61

71 A change in the number of your qualified Eligible Dependents; and A change in your or your qualified Eligible Dependent s employment status (including a change in worksite or change in place of residence) if it causes you or your dependent to gain or lose eligibility for group coverage. Benefits Critical Illness Insurance provides benefits upon the first occurrence of the following illnesses and procedures for you and/or your qualified Eligible Dependent when you are covered under the Program: Alzheimer s Disease, which is the permanent and significant loss of cognitive ability. This does not include any other type of dementia. Medical evidence of a definite clinical diagnosis of Alzheimer s disease by a neurologist, psychiatrist or geriatrician is required. Benign Brain Tumor, which is a non-malignant tumor or cyst that is one centimeter or greater in size and located in the brain, cranial nerves or meninges within the skull. This does not include tumors of the pituitary gland or tumors of blood vessels known as angiomas or aneurysms. Medical evidence of a definite diagnosis of a benign brain tumor by a Doctor is required. Blindness, which is the permanent and irreversible loss of sight in both eyes to the extent that even when tested with the use of visual aids, vision is measured at 20/400 or worse in the better eye using a Snellen eye chart. Being legally blind may not qualify as a valid claim. Medical evidence of a definite diagnosis of blindness by a Doctor is required. Cancer in Situ (partial benefit), which is one of the following conditions that meets the TNM Staging classification and other qualifications specified below: Carcinoma in situ classified as TisN0M0, provided that surgery, radiotherapy or chemotherapy has been determined to be medically necessary by a Doctor who is board certified in the medical specialty that is appropriate for the type of carcinoma in situ involved; Malignant tumors classified as T1N0M0 or greater that are treated by endoscopic procedures alone; Malignant melanomas classified as T1N0M0, for which a pathology report shows maximum thickness less than or equal to 1.0 millimeters using the Breslow method of determining tumor thickness; and Tumors of the prostate classified as T1bN0M0 or T1cN0M0, provided that they are treated with a prostatectomy or radiotherapy. Medical evidence of a definite diagnosis of cancer in situ by a Doctor is required. When pathological diagnosis is required and the pathological diagnosis is medically inappropriate or life threatening, a clinical diagnosis will be accepted instead. Coma, which is a state of unconsciousness with no reaction to external stimuli or internal needs that requires the use of life support systems and results in permanent neurological deficit with persistent clinical symptoms continuously for at least 96 hours. This does not include: Coma due to either alcohol or drug abuse; Persistent vegetative state; or Medically-induced coma. Medical evidence of a definite diagnosis of coma by a Doctor is required. Life, Accident and Critical Illness Insurance Programs Page 62

72 Coronary Artery Obstruction, which is the narrowing or blockage of one or more coronary arteries that, on the advice of a cardiologist or cardiovascular surgeon, requires coronary artery bypass surgery. Coronary artery bypass surgery requires media sternotomy (surgery to divide the breastbone) and corrects the narrowing or blockage of the coronary arteries with by-pass grafts. Deafness, which is the permanent and irreversible loss of hearing in both ears to the extent that the loss is greater than 70 decibels across all frequencies in both ears using a pure tone audiogram. Medical evidence of a definite diagnosis of deafness by a Doctor is required. Heart Attack, which is the death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction: New characteristic electrocardiographic changes; Characteristic rise of cardiac enzymes or troponins recorded at the following levels of higher troponin T>1.0ng/ml, AccuTnl>0.5ng/ml.; and The evidence must show a definite acute myocardial infarction. This does not include: Heart attack that occurs during a surgical procedure; Other acute coronary syndromes, including but not limited to angina; or Heart attack sustained or contracted as a consequence of intoxication or being under the influence of any narcotic unless administered or consumed on the advice of a Doctor. Medical evidence of a definite diagnosis of heart attack by a cardiologist is required. Heart Valve Malfunction, which is when one or more heart valves that, on the advice of a cardiologist or cardiovascular surgeon, require open-heart surgery to replace or repair the heart valve(s). Open-heart surgery requires median sternotomy (surgery to divide the breastbone). Invasive Cancer (full benefit), which is any malignant tumor positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumor includes leukemia, lymphoma, sarcoma and multiple myeloma. This does not include: Cancers that are histologically classified as pre-malignant, non-invasive, cancer in situ, borderline malignancy or low potential malignancy; Tumors of the prostate unless histologically classified as having a Gleason score of 7 or greater or having progressed to at least clinical TNM classification T2N0M0; Chronic lymphocytic leukemia unless histologically classified as having progressed to at least Rai Stage II or above; Skin cancer other than malignant melanoma; or Malignant melanomas classified as T1N0M0, for which a pathology report shows maximum thickness less than or equal to 1.0 millimeters using the Breslow method of determining tumor thickness. Medical evidence of a definite diagnosis of invasive cancer by a Doctor is required. When pathological diagnosis is required and the pathological diagnosis is medically inappropriate or life threatening, a clinical diagnosis will be accepted instead. Life, Accident and Critical Illness Insurance Programs Page 63

73 Major Organ Transplant, which is the undergoing as a recipient of a human-to-human transplant of bone marrow or of a complete heart, kidney, liver, lung or pancreas or inclusion on the Organ Procurement and Transplantation Network waiting list for such a procedure. This does not include the transplant of any other organs, parts of organs, stem cells, tissues or cells. Simultaneous transplant of multiple organs is considered a single organ transplant for determining benefits under Critical Illness Insurance. Occupational HIV Infection, which is infection with Human Immunodeficiency Virus (HIV) from accidental injury during the course of your normal occupation, which exposed you to HIV contaminated body fluids. The accidental injury leading to the infection must have occurred after the effective date of your coverage. Proof of claim for occupational HIV infection must show: You sustained a documented occupational exposure to HIV contaminated body fluids; You were not HIV positive prior to the date of occupational exposure; and A definite diagnosis of occupational HIV infection made by an infectious disease specialist. Occupational HIV infection does not include HIV infection that has occurred due to non-accidental injury including, but not limited to, sexual transmission and intravenous (IV) drug use. Parkinson s Disease, which is permanent clinical impairment of motor function with associated tremor, rigidity of movement and postural instability. Medical evidence of a definite diagnosis of Parkinson s disease by a neurologist is required. Renal (kidney) Failure, which is chronic and end stage (irreversible) failure of both kidneys to function, the result of which is the need for regular dialysis for a period of at least three months. This does not include renal failure due to diabetes mellitus or hypertension. Medical evidence of a definite diagnosis of renal failure by a Doctor is required. Stroke, which is the death of brain tissue due to inadequate blood supply or hemorrhage within the skull resulting in a permanent and significant neurological deficit with persistent clinical symptoms. This does not include Transient Ischemic Attacks (TIA). Medical evidence of a definite diagnosis of stroke by a neurologist is required. Terminal Illness, which is advanced or rapidly progressing incurable illness where your life expectancy is six months or less. Terminal illness does not include any other Critical Illness or Procedure covered under this Program. Certification by a Doctor that your life expectancy is six months or less and supporting medical evidence are required. First Occurrence Benefit Amount Payable The first occurrence of a critical illness is the date that you or your qualified Eligible Dependent is diagnosed with the critical illness for the first time while covered under the Program. For a critical procedure, the first occurrence is the date that you or your qualified Eligible Dependent has the critical procedure for the first time while covered under the Program. Life, Accident and Critical Illness Insurance Programs Page 64

74 The amount payable for the first occurrence of a Critical Illness or Procedure depends on the type of Critical Illness or Procedure as shown below. All benefits are subject to the Lifetime Maximum Benefit below. Critical Illness or Procedure Percent of Coverage Amount Payable Alzheimer s Disease 100% Heart Attack 100% Invasive Cancer (full benefit) 100% Major Organ Transplant 100% Renal (kidney) Failure 100% Stroke 100% Benign Brain Tumor 25% Blindness 25% Cancer in Situ (partial benefit) 25% Coma 25% Coronary Artery Obstruction 25% Deafness 25% Heart Valve Malfunction 25% Occupational HIV Infection 25% Parkinson s Disease 25% Terminal Illness 25% Reoccurrence Benefit Amount Payable The amount payable for a reoccurrence of a Critical Illness or Procedure is 50% of the amount paid for the first occurrence. All benefits are subject to the Lifetime Maximum Benefit below. The reoccurrence of a Critical Illness or Procedure means: You or your qualified Eligible Dependent is positively diagnosed by a Doctor as having an additional occurrence or reoccurrence of the Critical Illness or Procedure for which a benefit was paid under this Program; and The date of the diagnosis of the additional occurrence or reoccurrence is more than 180 days after the date of prior benefit payment. Lifetime Maximum Benefit No more than the Lifetime Maximum Benefit will be paid for all of your Critical Illnesses or Procedures. The Lifetime Maximum Benefit is 200% of your or your qualified Eligible Dependent s insured amount. Critical Illnesses or Procedures Not Covered A Critical Illness or Procedure is not covered if it is caused by, contributed to by or resulting from, directly or indirectly, any of the following: Attempted suicide, while sane or insane. Intentionally self-inflicted injuries or any attempt to inflict such injuries. War or any act of war (war means declared or undeclared war and includes resistance to armed aggression). Life, Accident and Critical Illness Insurance Programs Page 65

75 Travel or flight in any vehicle used for aerial navigation. This includes getting in, out, on or off any such vehicle. This does not apply if the person is riding as a fare paying passenger in a licensed aircraft provided by a common carrier and operating between definitely established airports. Commission of a crime for which you have been convicted under state or federal law. Being under the influence of alcohol or alcohol intoxication, as defined by the laws of the jurisdiction in which the Critical Illness or Procedure occurred. Conviction is not required for a determination of being intoxicated. Being under the influence of or taking any narcotic unless prescribed by and administered in accordance with the advice of your Doctor. Pre-Existing Condition Limitations A Critical Illness or Procedure is not covered if it is caused by, contributed to by or resulting from a pre-existing condition. You have a pre-existing condition if both: You received medical treatment, consultation, care or services, including diagnostic measures (testing) from a Doctor or took prescribed drugs or medicines or followed treatment recommendation in the six months just prior to your coverage under this Program or the date an increase in your benefits would otherwise be available; and Your Critical Illness or Procedure begins within six months of the date your coverage under the Program becomes effective. Effect of a Pre-Existing Condition on a Benefit Increase If there is an increase in your or your qualified Eligible Dependent s benefits due to an amendment or your enrollment in another option, a benefit limit applies if your Critical Illness or Procedure is due to a pre-existing condition. Benefits will be limited to the benefits you had on the day before the increase if your Critical Illness or Procedure begins within six months of the date any increase in coverage becomes effective. Physical Exam Prudential, at its own expense, has the right to examine the person for whom a claim is made. Prudential may do this when and as often as is reasonable while a claim is pending. When Benefits Are Paid Benefits are paid when Prudential receives satisfactory written proof of claim. Use a claim form and follow the instructions on the form. You must give Prudential written proof of claim within 20 days of the date of a loss. The proof must cover the occurrence, character and extent of your claim and must be provided within 90 days of the date the: Critical illness is first diagnosed; or Critical procedure is performed. A claim will not be considered valid unless the proof is provided within this time limit. However, it may not be reasonably possible to do so. In that case, the claim will still be considered valid if the proof is furnished as soon as reasonably possible. Life, Accident and Critical Illness Insurance Programs Page 66

76 Any benefit will be paid to you. However, if you are not living, benefits that are unpaid at the time of death will be paid to the first of the following: Surviving Spouse, Domestic Partner or civil union partner; Surviving child(ren), in equal shares; Surviving parents, in equal shares; Surviving siblings, in equal shares; or Estate. If you or your covered dependent has assigned your benefits, benefits will be paid to the assignee. You may assign your benefits on forms satisfactory to Prudential. Benefits may be assigned only as a gift assignment. Any rights, benefits or privileges that you have as an Employee may be assigned. This includes any right you have to continue coverage under the Program. Prudential will not decide if an assignment does what it is intended to do. Prudential will not be held to know that an assignment has been made unless it or a copy is filed with Prudential. When Coverage Ends Your and/or your qualified Eligible Dependent s coverage ends on the first of the following: At the end of the pay period in which your employment with Prudential ends or you Retire or are otherwise no longer eligible for coverage. You reach your Lifetime Maximum Benefit. You die. The date you fail to pay, when due, any required contribution for your coverage. Your qualified Eligible Dependent s coverage ends on the first of the following: Your coverage ends. Your qualified Eligible Dependent reaches his/her Lifetime Maximum Benefit. Your dependent ceases to be a qualified Eligible Dependent. If You Take a Leave of Absence Unpaid Leave of Absence If you take an unpaid leave of absence, your Critical Illness Insurance coverage will continue automatically while you are on leave, up to a period of six months, provided you make the required payments. Coverage will continue automatically during an unpaid leave unless you notify the Prudential Benefits Center to terminate your benefits while on leave. If you continue coverage, a bill will be mailed to your home address on a monthly basis. Payments are due within 30 days of the specified due date. If you are still on leave at the end of the six-month period or if you fail to pay any required premiums, your Critical Illness Insurance will end. When coverage ends, you may not convert lost coverage to an individual policy. If you are planning to take an unpaid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Paid Leave of Absence If you take a paid leave of absence, your coverage under Critical Illness Insurance will continue while you are on leave. Coverage will automatically continue during your paid leave and you will continue to make contributions through payroll deductions. Life, Accident and Critical Illness Insurance Programs Page 67

77 If you are planning to take a paid leave of absence and have questions about your Health and Welfare benefits, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If You Are Disabled If you become Totally Disabled and are receiving benefits from the STD Program*, your coverage will continue and your coverage amount will be frozen, provided you continue paying contributions. Coverage will end when your STD benefits are exhausted. * For Full-Time Employees who are not eligible for STD benefits, you will continue to be eligible for active Critical Illness Insurance coverage for up to six weeks. After six weeks, your coverage may continue if you have been approved for a leave of absence. If You Retire If you Retire, your coverage ends on the last day of the pay period in which your employment with Prudential ends. If Your Employment Ends If your employment with Prudential ends before you Retire, your coverage ends on the last day of the pay period in which your employment with Prudential ended. Continuation of Coverage When Critical Illness Insurance coverage ends, you may elect to continue coverage for you and your qualified Eligible Dependent if all of these conditions are met: Coverage for you and your qualified Eligible Dependent would have ended because: Your employment ended for a reason other than gross misconduct; or Your work hours were reduced. You have been continuously insured under the Program for at least 12 months just before the date your employment ended or your work hours were reduced. Coverage that may be continued is that which you had on the date your employment ended or your work hours were reduced. To continue lost coverage, you must notify the insurance carrier of your intent to do so and pay the required contributions. You must apply and pay the first premium before the later of: 31 days after the date your coverage ends; or 15 days after you receive notice informing you of your right to continue coverage, but no more than 91 days after the date your coverage ends or is reduced. In no event may an election be made if you do not apply for continuation of coverage and pay the first payment prior to the 92nd day after you cease to be covered. If this is done, coverage will be continued from the date it would have ended until the first of the following: The date 36 months from the date employment ended or work hours were reduced. If you fail to make any payment required for continued coverage, the end of the period for which you have made the required payments. The date you become covered under any other group critical illness insurance plan. Your and/or your qualified Eligible Dependent s coverage amount cannot be more than the coverage amount was when coverage would have ended. You may not increase your or your dependent s coverage amount. Life, Accident and Critical Illness Insurance Programs Page 68

78 Claims and Appeals Procedures You, or any person you choose to represent you, must follow the claims and appeals review procedures outlined in this section before taking action in any other forum regarding a claim under the Plan. The Plan Administrator or its delegate will process any writing that is identified as a claim for benefits (either by the claimant or, if the writing is not specific, by the Plan Administrator) under the claims and appeals procedures outlined in this section. If your claim is not identified as a claim for benefits, the Plan Administrator or its delegate will treat your writing or communication as a claim under the Non-Benefit Claims procedures. Enrollment and eligibility claims will be identified as Non-Benefit Claims and will be processed under the Non-Benefit Claims procedures unless they are part of a claim for life insurance benefits. For example, if you file a claim for benefits that is denied because you are not eligible to participate in the Plan, your claim will be considered a claim for benefits and will follow the procedures outlined in the Claim for Benefits section. For all enrollment and eligibility claims, including those considered a claim for benefits, the Prudential Benefits Center is the Claims Administrator and the Administrative Committee is the Claims Fiduciary. If your claim for benefits is denied, it will be considered an Adverse Benefit Determination. An Adverse Benefit Determination is any denial, reduction or termination of a benefit, or a failure to provide or make a payment. You have the right to appeal any Adverse Benefit Determination under the procedures described below. A claim will be considered approved only if approval is communicated to you in writing. If you do not receive a response to any claim within the applicable time period, you may proceed with an appeal under the procedures described in the Appeal of an Adverse Benefit Determination section. Claim for Benefits Making a Claim for a Benefit When you apply for or request a benefit in any manner, this will generally constitute a claim. The information in this section will tell you exactly how to file for a benefit under the Plan. There are times when a phone call to the Claims Administrator questioning why you are not covered or how to apply for a benefit can constitute a claim. The Claims Administrator can always give you more information on how to request or apply for a benefit. How to File a Claim for Benefits To make a claim for a death benefit (including benefits payable under the waiver of premium provision) or dismemberment benefit, to make a claim for a Critical Illness Insurance benefit, to elect the option to accelerate payment of death benefits or to pre-select optional payment methods, you and/or your Beneficiary(ies) should complete any applicable claim form and follow the instructions on the form. You need to file these forms in a timely manner, according to the time restrictions that apply to each Program. Claim forms for all coverages, except Critical Illness Insurance coverage, are available on the Prudential Benefits Center website (at or by calling the Prudential Benefits Center at PRU-EASY ( ) and following the prompts for Death Claims for death benefit claims or Health and Welfare benefits for all other claims. For Critical Illness Insurance coverage, claims forms are available by calling Prudential Group Insurance at For the hearing impaired, please contact your local relay service. Life, Accident and Critical Illness Insurance Programs Page 69

79 Proof of Loss For Basic Accidental Death & Dismemberment (AD&D) and Supplemental AD&D Insurance Only: You must provide the Prudential Group Life Services Division with written proof of the loss for which your claim is being made. The proof must cover the occurrence, character and extent of the loss and be furnished within 90 days of the date of loss, unless this is not possible. Claims must be received no later than one year from the date of loss, unless the insurance carrier provides for a later date. A claim will not be considered valid unless proof is furnished within these time limits. However, it may not be reasonably possible to do so. In that case, the claim will still be considered valid if the proof is furnished as soon as reasonably possible. To claim death benefits, a certified copy of the death certificate must be provided. To claim dismemberment benefits, evidence of a covered loss will be required. You may submit written proof of loss to the Prudential Group Life Services Division at: The Prudential Insurance Company of America Group Life Claims Division P.O. Box 8517 Philadelphia, PA For Critical Illness Insurance: You must provide the Prudential Group Life Services Division with written proof of the loss for which your claim is being made within 20 days of the date of the loss. The proof must cover the occurrence, character and extent of the loss and be furnished within 90 days of the date of the Critical Illness is first diagnosed or the Critical Procedure is performed, unless this is not possible. A claim will not be considered valid unless proof is furnished within these time limits. However, it may not be reasonably possible to do so. In that case, the claim will still be considered valid if the proof is furnished as soon as reasonably possible. You may submit written proof of loss to the Prudential Group Life Services Division at: The Prudential Insurance Company of America c/o Transaction Applications Group, Inc. as Third Party Administrator P.O. Box Lincoln, NE Phone: Secure Fax: For All Other Coverages: Proof of loss should be submitted to the Prudential Benefits Center within a reasonable period of time following the death of the covered individual. To claim death benefits, your Beneficiary(ies) must provide a certified copy of the death certificate. You may submit written proof of loss to the Prudential Benefits Center at: Prudential Benefits Center P.O. Box Charlotte, NC You may contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Life, Accident and Critical Illness Insurance Programs Page 70

80 What Information to Include in a Claim Your claim should state your name, address, the specific basis for your claim and any additional materials you wish to present. Call the Prudential Benefits Center for more information. You may contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Death Claims for death benefit claims or Health and Welfare benefits for all other claims. Benefits under each ERISA-governed plan will be paid only if the applicable Claims Fiduciary decides in its sole discretion that the claimant is entitled to them. When to File a Claim The best time to file a claim for benefits is as soon as possible after the circumstances creating the claim take place (for example, injury, illness). You are entitled to file a claim for benefits to which you believe you are entitled. For all coverages, you have up to one year from the date your claim arose to submit a claim, except Basic Group Life and Group Universal Life (GUL) death claims, which have no time limit for submission, and Critical Illness Insurance coverage, for which you must submit a claim within 90 days of the event. A claim will be presumed to have arisen when you have actual or constructive knowledge of the events giving rise to the claim. Time Frame for Claim Determinations If you receive an Adverse Benefit Determination (that is, any denial, reduction, or termination of a benefit, or a failure to provide or make a payment), the Claims Administrator will notify you of the adverse determination within a reasonable period of time, but not later than 45 days after receiving the claim. This 45-day period may be extended for up to 30 days, if the Claims Administrator both determines the extension is necessary due to matters beyond the control of the Plan, and notifies you, before the initial 45-day period expires, of the reason(s) requiring the extension of time and the date by which the Claims Administrator expects to render a decision. If, prior to the end of the first 30-day extension period, the Claims Administrator again determines that, due to matters beyond the control of the Plan, a decision cannot be rendered within that extension period, the determination period may be extended for up to an additional 30 days. In such case, the Claims Administrator must notify you, before the first 30-day extension period expires, of the reason(s) requiring the extension of time and the date by which the Claims Administrator expects to render a decision. All extension notices you receive regarding your benefits must specifically explain: The standards on which entitlement to a benefit is based; The unresolved issues that prevent a decision on the claim; and The additional information needed to resolve those issues. You have 45 days to provide the specified additional information. In the event that an extension is necessary because you did not submit the necessary information, the time frame for making a benefit determination is tolled (that is, stopped) from the date the Claims Administrator sends you the extension notification until the date you respond to the request for additional information. In no event will a determination on a life insurance claim be rendered more than 180 days after the date your claim was received. Notice of Adverse Benefit Determination The written notice of your Adverse Benefit Determination (that is, any denial, reduction or termination of a benefit, or a failure to provide or make a payment) will include the following: The specific reason(s) for the Adverse Benefit Determination; Reference to the specific provisions of The Prudential Welfare Benefits Plan on which the Adverse Benefit Determination is based; A description of any additional material or information necessary for you to complete or support your claim and an explanation of why that material or information is necessary; Life, Accident and Critical Illness Insurance Programs Page 71

81 A description of or a copy of the Plan s appeal procedures and time limits applicable to such procedures, including a statement of your right to bring a civil action under Section 502(a) of ERISA, after you have completed all mandatory appeals under the Program; and If the Adverse Benefit Determination was based on a medical necessity or experimental treatment or similar exclusion or limit, either an explanation of the scientific or clinical judgment for the adverse determination, applying the terms of The Prudential Welfare Benefits Plan to your medical circumstances, or a statement that such explanation will be provided free of charge upon request. Appeal of an Adverse Benefit Determination The Program offers one level of mandatory appeal. This means that before you can bring a civil action under ERISA, you must first complete the mandatory level of appeal. If your claim is adversely determined after you have completed the mandatory level of appeal, the Program provides for a voluntary level of appeal. You are not required to go through this voluntary level of appeal before you bring a civil action, but you may avail yourself of it if you want. The following time frames apply under each level of appeal. You, or your authorized representative, have 180 days following the receipt of a notification of an Adverse Benefit Determination to appeal the determination. To appeal an Adverse Benefit Determination, you should contact: For Coverage Other Than Critical Illness Insurance: Via regular mail: The Prudential Insurance Company of America Group Life Claims Division P.O. Box 8517 Philadelphia, PA Via overnight delivery: The Prudential Insurance Company of America Group Life Claims Division 2101 Welsh Road Dresher, PA For claims and appeals information, call For Critical Illness Insurance: The Prudential Insurance Company of America c/o Transaction Applications Group, Inc. as Third Party Administrator P.O. Box Lincoln, NE Phone: Secure Fax: Life, Accident and Critical Illness Insurance Programs Page 72

82 Appeals Procedures You have the right to: Submit written comments, documents, records and other information relating to the claim for benefits; Request, free of charge, reasonable access to, and copies of all documents, records and other information relevant to your claim for benefits. For this purpose, a document, record, or other information is treated as relevant to your claim if it: Was relied upon in making the benefit determination; Was submitted, considered, or generated in the course of making the benefit determination, regardless of whether such document, record or other information was relied upon in making the benefit determination; Demonstrates compliance with the administrative processes and safeguards required in making the benefit determination; and A review that takes into account all comments, documents, records, and other information submitted by you relating to the claim, regardless of whether such information was submitted or considered in the initial benefit determination. When You Can Expect a Response The Claims Administrator must notify you of the Program s benefit determination on review within a reasonable period of time, but not later than 45 days after receipt of your request for review, unless the Claims Administrator determines that special circumstances require an extension of time. If an extension of time is required, the period may be extended for an additional 45 days as long as a written notice of the extension is sent to you before the end of the initial 45-day period. The notice of the extension must indicate the special circumstances and the date by which the Claims Administrator expects to render the determination on review. In the event an extension is necessary because you did not submit the necessary information, the time frame for making a benefit determination on review is tolled (that is, stopped) from the date the Claims Administrator sends you the extension notification until the date you respond to the request for additional information. Notice of Adverse Benefit Determination on Appeal The Claims Administrator s notice of an Adverse Benefit Determination on appeal will contain all of the following information: The specific reason(s) for the Adverse Benefit Determination; Reference to the specific provisions of The Prudential Welfare Benefits Plan on which the Adverse Benefit Determination is based; A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim; and A statement describing any voluntary appeal procedures offered by the Program and your right to obtain the information about such procedures, and a statement of your right to bring an action under Section 502(a) of ERISA, following the denial of your claim after you have completed all mandatory appeals under the Program. Life, Accident and Critical Illness Insurance Programs Page 73

83 Voluntary Level of Appeal If the decision to deny benefits is upheld after your mandatory level of appeal, you may file a voluntary second appeal. You are entitled to receive upon request, sufficient information to make a decision about filing this appeal. The same time frame for the first appeal will apply to the second voluntary appeal. After completing the first mandatory level of appeal, you may also file a lawsuit under the Employee Retirement Income Security Act (ERISA). ERISA allows you to file suit for policy benefits and reasonable attorney s fees. Your decision on whether to file a second voluntary appeal will not affect your rights to sue under ERISA. For Coverage Other Than Critical Illness Insurance: To file a voluntary second appeal, you should contact: Via regular mail: The Prudential Insurance Company of America Group Life Claims Division P.O. Box 8517 Philadelphia, PA Via overnight delivery: The Prudential Insurance Company of America Group Life Claims Division 2101 Welsh Road Dresher, PA For claims and appeals information, call For Critical Illness Insurance: The Prudential Insurance Company of America c/o Transaction Applications Group, Inc. as Third Party Administrator P.O. Box Lincoln, NE Phone: Secure Fax: Non-Benefit Claims Enrollment and Eligibility Claims If you have questions regarding a Program enrollment or eligibility claim (for example, if you missed an opportunity to enroll for GUL Insurance without Evidence of Insurability upon hire or if you dispute eligibility for one of the Group Life, Accident and Critical Illness Insurance Programs), please contact the Prudential Benefits Center. You may contact the Prudential Benefits Center by calling PRU-EASY ( ) and following the prompts for Health and Welfare benefits. If you and the Prudential Benefits Center are not able to resolve your issue, the Prudential Benefits Center can provide you with a Claim Initiation Form. You may complete this form or submit written notice with the specific basis for your claim and send it to Claims and Appeals Management (CAM) at the following address: Prudential Benefits Center Claims and Appeals Management (CAM) P.O. Box 1407 Lincolnshire, IL Life, Accident and Critical Illness Insurance Programs Page 74

84 Your claim will be considered as soon as practicable following its receipt. Notice of an adverse determination will be provided no later than 90 days after receipt of the claim. If the Prudential Benefits Center determines that special circumstances require an extension of time for processing the claim, written notice will be furnished prior to the end of the 90-day period. Such extension will not exceed 180 days after the date your claim was received. If you have followed the required procedures and you receive an adverse determination, you may appeal the decision by following the steps described in the Appeal of an Adverse Determination of a Non-Benefit Claim section. For all enrollment and eligibility claims, the Prudential Benefits Center is the Claims Administrator and the Administrative Committee is the Claims Fiduciary. Other Non-Benefit Claims To make a claim under the Plan, other than for a claim for benefits (see the Claim for Benefits section), or for enrollment and eligibility claims (see the Enrollment and Eligibility Claims section), you must send your request in writing to: Administrative Committee The Prudential Insurance Company of America Employee Benefits Department 751 Broad Street, 18th Floor Newark, NJ Your claim should state your name, address, the specific basis for your claim and any additional materials you wish to present. Your claim will be considered by the Administrative Committee or its delegate as soon as practicable following its receipt. Notice of an adverse determination will be provided no later than 90 days after receipt of the claim. If the Plan Administrator or its delegate determines that special circumstances require an extension of time for processing the claim, written notice will be furnished prior to the end of the 90-day period. Such extension will not exceed 180 days after the date your claim was received. Appeal of an Adverse Determination of a Non-Benefit Claim If you have followed the required procedures and you receive an adverse determination, you may appeal the decision by making a request in writing within 60 days after you receive notice of the adverse determination. Appeals must be sent to the Administrative Committee or its delegate, in this case the Appeals Committee, at the address in the Other Non-Benefit Claims section. Your appeal will be considered by the Appeals Committee as soon as practicable. Notice of an adverse determination of your appeal will be provided no later than 60 days after receipt of the appeal. If the Appeals Committee determines that special circumstances require an extension of time for processing the appeal, written notice will be furnished prior to the end of the 60-day period. Such extension will not exceed 120 days after the date your request to appeal your adverse determination was received. The Administrative Committee, as Plan Administrator, may appoint itself, one or more of its number, or any other person or persons whether or not connected with Prudential to review a claim. The ultimate decision of the Administrative Committee or its delegate is final and binding. Claims under the Plan will be granted only if the Plan Fiduciary or its delegate decides, in its sole discretion, that they should be granted. For more information, you may call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Life, Accident and Critical Illness Insurance Programs Page 75

85 Legal Action All the facts and circumstances of your case will be thoroughly reviewed. If you have completed all of the required claims and appeals procedures (see the Claims and Appeals Procedures section) and your appeal is given an Adverse Benefit Determination, you have the right to bring legal action if you believe the adverse determination is incorrect and was decided in an arbitrary and capricious manner. Any suit or legal action initiated by you must be brought no later than three years (for AD&D and Critical Illness Insurance claims only, otherwise there is no time limit) following a final decision on your claim (including the decision on any appeal of your claim). This time period for bringing a suit or legal action applies in all forums. Life, Accident and Critical Illness Insurance Programs Page 76

86 Life Events Family and Medical Leave Act All Employees who have at least one year of service and have worked at least 1,000 hours (excluding any unpaid leave, any disability absences and any designated FMLA absences during that period) during the 12 months prior to commencing a leave are eligible for unpaid leave under the Federal Family and Medical Leave Act of 1993 (FMLA). Eligible Employees may take an unpaid leave of absence, up to 12 weeks in a single 12-month period (measured backward from the date an Employee uses any FMLA leave), under the following circumstances: To care for the Employee s child (as defined by applicable law) after birth, or placement for adoption or foster care; To care for the Employee s Spouse, child or parent (as defined by applicable law) with a serious health condition; To care for the Employee s child who is 18 years of age or older with a serious health condition, but is incapable of self-care because of a mental or physical disability (as defined by applicable law), regardless of when the disability commenced; For the Employee s own serious health condition that renders the Employee unable to perform the essential functions of the Employee s job; or For qualifying exigency leave when: The Employee s Spouse, child or parent is a member of a regular component of the United States Armed Forces (i.e., is a military member) and is deployed to a foreign country; or The family member belongs to the National Guard or Reserves and is called to military duty in support of a contingency operation. Qualifying exigencies may include: attending certain military events; arranging for alternative childcare for the military member s child; addressing certain financial and legal arrangements arising from the military member s covered active duty; attending counseling for the Employee, the military member or the military member s child when the need for the counseling arises from the military member s covered active duty; attending post-deployment reintegration briefings and handling other situations arising out of the military member s deployment; spending up to 15 calendar days with a military member who is on Rest and Recuperation leave during covered active duty; and addressing certain activities related to the care of the military member s parent who is incapable of self-care, such as arranging for alternative parental care, providing care on a non-routine, urgent basis, admitting the parent to a new care facility or attending meetings with staff at a care facility. Life, Accident and Critical Illness Insurance Programs Page 77

87 The Company also provides a special leave entitlement that permits eligible Employees who are the Spouse, son, daughter, parent or next of kin of a covered service member (as defined by applicable law) to take up to 26 weeks of leave to care for a covered service member during a single 12-month period (measured forward from the date the leave is first taken). A covered service member is a: Current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of active duty (or had a serious injury or illness that existed before the beginning of the member s active duty and was aggravated by service in the line of duty while on active duty in the Armed Forces) that may render the service member medically unfit to perform his/her duties for which the service member is undergoing medical treatment, recuperation or therapy; or is in outpatient status; or is on the temporary disability retired list; or Veteran who is undergoing medical treatment, recuperation or therapy, for a serious injury or illness that was incurred in the line of active duty (or had a serious injury or illness that existed before the beginning of the member s active duty and was aggravated by service in the line of duty while on active duty in the Armed Forces) and who was a member of the Armed Forces, including a member of the National Guard or Reserves, at any time during the period of five years preceding the date on which the veteran undergoes that medical treatment, recuperation or therapy. The 26-week leave available to eligible Employees to care for a covered service member is not in addition to the 12-week leave allotment available for other types of FMLA leave. Thus, if an Employee takes leave for any other reason permitted by the FMLA, the leave will be deducted from the 26-week allotment during that year. Certain state statutes may provide additional leave rights and coverage. For complete information regarding your FMLA leave rights and responsibilities, as well as your family and medical leave rights and obligations in the specific state in which you work, contact your local Human Resources Consultant or refer to the Human Resources Policies Lotus Notes database under the Quick Links tab on Prudential s intranet site, PRU Today. During your FMLA leave, if you are covered under the Program, the Company will continue your coverage for up to six months under the same terms and conditions as you would have received if you had not taken the leave provided that, during the leave, you continue to make any Employee contributions that you normally would make if you were actually working. Benefits will automatically continue during an FMLA leave unless you notify the Prudential Benefits Center within 31 days of the first day of your leave to terminate your benefits while on leave. If you continue coverage, a bill for the active Cost for the Program will be mailed to your home address on a monthly basis. Payments are due within 30 days of the specified due date. GUL Fund contributions will not be included on your direct bill and will require you to make separate lumpsum contributions. If you fail to pay your contributions for the Program by the date shown on your bill, your coverage will end. If you are planning to take an FMLA leave of absence and have questions about your benefits during your absence call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If you are planning to take an FMLA leave of absence and have questions regarding FMLA, call the Prudential FMLA Services Unit at PRU-EASY ( ) and follow the prompts for Disability and Leaves. Life, Accident and Critical Illness Insurance Programs Page 78

88 Uniformed Services Employment and Reemployment Rights Act The Uniformed Services Employment and Reemployment Rights Act (USERRA) provides certain protections and reemployment rights to Employees who are absent from work due to service in the Armed Forces, Army National Guard or Air National Guard (collectively, uniformed service). If, as a result of service in the uniformed service, you take a leave from work, generally, your absence will be designated as an authorized, unpaid leave. During this leave, you will be treated in the same manner as other Employees who are on an unpaid leave. Life, Accident and Critical Illness Insurance Programs Page 79

89 Other Important Information Converting to an Individual Policy When your coverage under the Program ends, you may convert your lost Basic Group Life Insurance, Group Universal Life (GUL) Insurance, Dependent Term Life Insurance or Survivor Benefits Life Insurance coverage to an individual life insurance contract. You may also convert reduced amounts of insurance, including any reduction related to your Retirement or attainment of age 70 while an active Employee. An election to convert this insurance must be made by the owner of the policy. Therefore, if ownership of your policy has been transferred via an assignment, the current owner of the policy has the right to make this election. (See the Assignment of Benefits section for more information.) To convert lost coverage, you must notify the insurance carrier of your intent to do so and pay the required contributions. You must apply and pay the first premium before the later of: 31 days after the date your coverage ends or is reduced; or 15 days after you receive notice of conversion, but no more than 91 days after the date your coverage ends or is reduced. For more information about converting coverage, contact the Prudential Group Life Conversion Unit at To obtain a conversion notice, contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If your death occurs within the time period during which you are entitled to convert your coverage, benefits will be payable as if your coverage had not terminated. These benefits are payable even if you did not apply for conversion. For Dependent Term Life Insurance Only: Coverage under the Dependent Term Life Insurance Program can only be converted by the Eligible Dependent. Critical Illness Insurance cannot be converted, but may be continued for a period after coverage ends. See the Critical Illness Insurance s Continuation of Coverage section for more information. A Prudential Alliance Account Life and Accident Insurance Program benefits (except Survivor Benefits Life Insurance and Critical Illness Insurance) of $5,000 or more will be deposited automatically into a personal interest-bearing account called a Prudential Alliance Account *. * The Bank of New York Mellon is the Administrator of the Prudential Alliance Account Settlement Option, a contractual obligation of The Prudential Insurance Company of America, located at 751 Broad Street, Newark, NJ Draft clearing and processing support is provided The Bank of New York Mellon. Alliance Account balances are not insured by the Federal Deposit Insurance Corporation (FDIC). The Bank of New York Mellon is not a Prudential Financial company. However, your Beneficiary(ies) may elect to have all or part of any benefit (except benefits for Survivor Benefits Life Insurance and Critical Illness Insurance) paid through other payout options. If you pre-select an optional form of payout, your Beneficiary(ies) will not be allowed to change the payout method at a later date. In the event of an option to accelerate payment of death benefits claim, the proceeds will be deposited into a Prudential Alliance Account in your name. A Prudential Alliance Account is not available for payouts less than $5,000, for payouts to individuals residing outside the United States and its territories and for certain other payouts. These will be paid in a single lump-sum check. Life, Accident and Critical Illness Insurance Programs Page 80

90 A Prudential Alliance Account is an interest-bearing account. The purpose of the account is to provide a safe, accessible place to keep life insurance benefits paid from a Prudential policy until your Beneficiary(ies) is able to finalize all important financial decisions. The account offers immediate access to policy benefits with drafts ( checks ) that are mailed to your Beneficiary(ies) as soon as the claim is processed. There is no charge for account maintenance and the account offers unlimited free checks. Due to regulatory guidance, some death claims may require that the Beneficiary provide affirmative election of the Prudential Alliance Account via the claim form Beneficiary statement. Tax Considerations Company-paid life insurance in excess of $50,000 may affect your income taxes. The Internal Revenue Service (IRS) has established age-related rates it believes are appropriate to determine the value of company-paid life insurance coverage. This value can result in Imputed Income that becomes part of your taxable income. For example, Prudential pays the full Cost of your Basic Group Life Insurance coverage, so if you have coverage exceeding $50,000, the value of your coverage over $50,000 is taxable. No Imputed Income is generated for coverage less than $50,000. Imputed Income will be reported for tax purposes, and you will receive tax forms reflecting this Imputed Income, if applicable. Assignment of Benefits The Programs summarized in this SPD booklet are used exclusively to provide benefits to you and, in some cases, to your Eligible Dependents. You may assign ownership of your Life and Accident Insurance benefits with the insurance carrier s written consent. You cannot assign ownership of your Critical Illness Insurance benefits. Call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits for more information. Life, Accident and Critical Illness Insurance Programs Page 81

91 Administrative Information This Life, Accident and Critical Illness Insurance Program SPD booklet is intended to describe the specific provisions of the Life, Accident and Critical Illness Insurance Programs available to eligible Employees of Prudential under The Prudential Welfare Benefits Plan. In addition to knowing these provisions, you need to be aware of important administrative details, including what steps you may take if you believe that a claim has been wrongfully denied. You also need to know about your legal rights as a participant in the Programs under the Employee Retirement Income Security Act of 1974, as amended (ERISA). This SPD booklet constitutes the Summary Plan Description of the Life, Accident and Critical Illness Insurance Programs of The Prudential Welfare Benefits Plan effective as of January 1, 2015, and provides important information about your rights under ERISA. Terms and phrases used in this booklet are intended to have the meanings ascribed to them in the Plan Document. If there is any difference between the information contained in this booklet and the Plan Document, the Plan Document, as interpreted by the Plan Administrator (in its sole discretion), always will govern. If there are legal rules that require changes not yet written into the Plan Document, the Plan Document will be interpreted by the Plan Administrator (in its sole discretion) as including those legal rules. This SPD booklet should in no way be considered a substitute for the Plan Document, which governs the operation of the Programs. If you have any questions regarding this SPD booklet, please visit the Prudential Benefits Center website (at or, if you do not have access to a computer or the Internet or you need more information, you may call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Important Information for Residents of Certain States: There are state-specific requirements that may change the provisions under the coverage(s) described in this SPD booklet. If you live in a state that has such requirements, those requirements will apply to your coverage(s) and are made part of your Group Insurance Certificate. Prudential has a website that describes these state-specific requirements (you may access the website at When you access the website, you will be asked to enter your state of residence and your access code. Your access code is If you are unable to access this website, if you want to receive a printed copy of these requirements or if you have any questions, call Prudential Group Life Services Division at For Critical Illness Insurance, call Plan Administration Plan Name and Number The Life, Accident and Critical Illness Insurance Programs are components of The Prudential Welfare Benefits Plan. Plan Name Plan Number Type of Plan Plan Administrator The Prudential Welfare Benefits Plan 501 Welfare (Group Life, Accident and Critical Illness Insurance) Administrative Committee Life, Accident and Critical Illness Insurance Programs Page 82

92 Plan Administrator The Plan Administrator for the Life, Accident and Critical Illness Insurance Programs is the Administrative Committee, which is responsible for plan administration matters under the Life, Accident and Critical Illness Insurance Programs. The address for the Plan Administrator is: Administrative Committee The Prudential Insurance Company of America Employee Benefits Department 751 Broad Street, 18th Floor Newark, NJ Telephone: Plan Sponsor The Plan Sponsor for the Programs described in this SPD booklet is: The Prudential Insurance Company of America Prudential Plaza 751 Broad Street Newark, NJ Telephone: A complete list of Participating Employers may be obtained by participants and Qualified or Eligible Dependents upon written request to the Plan Administrator, and is available for examination, without charge, by participants and Qualified or Eligible Dependents at the Plan Administrator s office. You may make a written request to the Plan Administrator for information as to whether a particular employer participates in the Programs and, if so, the employer s address. Employer Identification Number The Company s employer identification number assigned by the Internal Revenue Service is Plan Year The Plan Year is the 12-month period used for maintaining the Programs financial records. The official Plan Year for the Programs is January 1 through December 31 of each Calendar Year. Funding, Payment and Claims of Program Benefits The Life, Accident and Critical Illness Insurance Programs are components of The Prudential Welfare Benefits Plan and benefits are funded by a combination of insurance, employer payments, trust funds and participant contributions, where applicable. Trustee Information Assets under The Prudential Welfare Benefits Plan are held both in trusts and pursuant to insurance contracts issued by The Prudential Insurance Company of America. The Trustee of the trusts for the benefit of The Prudential Welfare Benefits Plan is: Prudential Trust Company 30 Scranton Office Park Mailstop 330 Scranton, PA Telephone: Life, Accident and Critical Illness Insurance Programs Page 83

93 Insurance Issuers and Administrators The following lists the insurance companies and their roles in providing benefits under the Programs. Insurance refers to the contract providing a full guarantee by the provider. Program Providers Provider Roles* Basic Group Life Insurance Group Universal Life Insurance Dependent Term Life Insurance Basic Accidental Death and Dismemberment Insurance Business Travel Accident Insurance Supplemental Accidental Death and Dismemberment Insurance Survivor Benefits Life Insurance Critical Illness Insurance * Notes: The Prudential Insurance Company of America 751 Broad Street Newark, NJ Insurance Claims Administrator Claims Fiduciary The Administrative Committee has delegated Group Insurance as the Claims Administrator and Claims Fiduciary; and For Program enrollment and eligibility claims, the Prudential Benefits Center is the Claims Administrator and the Administrative Committee is the Claims Fiduciary. Plan Amendment or Termination The Company has reserved the right in its sole discretion, subject to applicable law, to amend, modify, suspend or terminate The Prudential Welfare Benefits Plan, including, but not limited to, the benefits discussed in this SPD booklet, in whole or in part. Any such action would be taken in writing and maintained with the records of The Prudential Welfare Benefits Plan. Plan amendment, modification, suspension or termination may be made for any reason, and at any time. Such amendments may be made retroactive if necessary to meet statutory requirements or for any other appropriate reason as determined by the Company in its sole discretion. If The Prudential Welfare Benefits Plan is terminated, you may be allowed to convert certain coverages to individual policies. These coverages are: Basic Group Life Insurance, GUL Insurance, Dependent Term Life Insurance and Survivor Benefits Life Insurance. Conversion is also allowed for these coverages upon elimination of any one of these from The Prudential Welfare Benefits Plan. If you were continuously covered under a coverage for at least five years, you may convert your coverage to an individual policy. The amount allowed to be converted is the amount of your coverage reduced for any group insurance, including coverage from another carrier, provided within the conversion period of plan or provision termination and cannot be greater than $10,000. Upon termination of The Prudential Welfare Benefits Plan, Prudential will determine in accordance with applicable law, how the remaining assets of The Prudential Welfare Benefits Plan will be distributed. The Plan Document for The Prudential Welfare Benefits Plan describes the procedures for amending or terminating the Plan and who may make amendments. Life, Accident and Critical Illness Insurance Programs Page 84

94 Service of Legal Process Most questions about the Program benefits may be resolved by calling the Prudential Benefits Center at PRU-EASY ( ) and following the prompts for Health and Welfare benefits, or by completing the claims and appeals process. (See the Claims and Appeals Procedures section for more information.) However, if, after you have completed all of the claims and appeals procedures described in this SPD booklet, you feel you need to take legal action to resolve a question governing your benefits or your claim, then you may contact the agent for service of legal process in a timely manner at the following address: The Prudential Insurance Company of America Vice President, Employee Benefits Employee Benefits Department 751 Broad Street, 18th Floor Newark, NJ Telephone: Legal papers may also be served in a timely manner on The Prudential Welfare Benefits Plan Administrative Committee or the respective Plan Trustee, if any. Any suit or legal action must be brought by you no later than three years following a final decision on your claim for benefits. If You Do Not Have Access to the Prudential Benefits Center Website Throughout this SPD booklet there are references to accessing the Prudential Benefits Center website (at If you do not have access to a computer or the Internet or if you need more information, you may call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Your Rights As a participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974, as amended (ERISA). ERISA provides that all ERISA-governed plan participants are entitled to: Receive information about the Plan, including: Examine, without charge, at the Plan Administrator s office and at other specified locations, such as worksites, all documents governing the Plan. This includes insurance contracts, collective bargaining agreements and a copy of the latest annual report (Form 5500 series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration; Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan including insurance contracts, collective bargaining agreements and the latest annual report (Form 5500 series) and the updated SPD. The Plan Administrator may make reasonable charges for the copies; and Receive a summary of the Plan s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. Life, Accident and Critical Illness Insurance Programs Page 85

95 Enforce your rights: If your claim for a benefit is denied or ignored, in whole or in part, you have the right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce these rights. For instance: If you request a copy of the Plan Document or the latest annual report from the Plan Administrator and do not receive it within 30 days, you may file suit in a Federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator; If you have a claim for benefits that is denied (or ignored), in whole or in part, you may file suit in a state or Federal court, after you complete (or if your claim is ignored, have attempted to complete) all of the claims and appeals procedures. (See the Claims and Appeals Procedures section); and If it should happen that Plan Fiduciaries misuse the Plan s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court, after you complete all of the claims and appeals procedures. (See the Claims and Appeals Procedures section.) The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees if, for example, it finds your claim is frivolous. Prudent Actions by Plan Fiduciaries In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of employee benefit plans. The people who operate the Plan, called fiduciaries of the Plan, have a duty to do so prudently and in the interests of all participants and Beneficiaries. No one, including your employer, your union (if applicable), or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA. Assistance with Your Questions If you have any questions about the Plan, contact the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or contact: Division of Technical Assistance and Inquiries Employee Benefits Security Administration U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC EBSA ( ) You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration at Life, Accident and Critical Illness Insurance Programs Page 86

96 Glossary In this section, you will find definitions for some of the terms used in this SPD booklet. If you need more help understanding a certain term, call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Actively at Work Actively at Work means that you are working at Prudential to perform the normal duties of your occupation. Adverse Benefit Determination An Adverse Benefit Determination is any denial, reduction or termination of a benefit, or a failure to provide or make a payment. You have the right to appeal any Adverse Benefit Determination under the claims and appeals procedures described in this SPD booklet. Affiliate or Affiliated Company Affiliated Company means any corporation that is a member of a controlled group of corporations, which includes the Company, any trade or business that is under common control with the Company, any organization included in the same affiliated service group as the Company, and any other entity required to be aggregated with the Company pursuant to regulations promulgated under Section 414(o) of the Internal Revenue Code. Any such entity will be treated as an Affiliated Company only for the period while it is a member of the controlled group or considered to be in such common control group. After-Tax After-Tax basis, contributions or dollars means that a portion of your income is deducted from your pay after any applicable Federal, state and local income taxes, and Social Security taxes have been withheld and contributed by you to a plan or program or used to pay all or a portion of the Cost of coverage for certain plans or programs. Your deducted pay will still be part of your taxable income. Agency Distribution Financial Professional An Agency Distribution Financial Professional is a full-time life insurance salesperson as defined under Internal Revenue Code Section 3121(d)(3)(B) and the regulations prescribed there under, including an associate under any of the following contracts: Senior Life Representative, Statutory Agent Agreement, Agency Distribution Financial Professional Agreement or Career Special Agent. Agency Distribution Financial Professional Associate An Agency Distribution Financial Professional Associate is a common law Employee participating in a two-year developmental program within Agency Distribution. Agency Distribution Sales Professionals Agency Distribution Sales Professionals are Employees and full-time life insurance salespeople who are independent contractors, but who are considered employees under the Internal Revenue Code (generally referred to as Agency Distribution Financial Professionals), who are: Agency Distribution Financial Professionals; or Agency Distribution Financial Professional Associates. Life, Accident and Critical Illness Insurance Programs Page 87

97 Annual Benefits Base Rate For Agency Distribution Sales Professionals, Agency Distribution Field Management and Non-Retail Sales Professionals Only: Each year around April 1, the amount of Eligible Earnings (the Annual Benefits Base Rate) used for calculating Basic Group Life, Accidental Death & Dismemberment, Group Universal Life, Survivor Benefits Life Insurance, Short Term Disability, Long Term Disability and Optional Long Term Disability is adjusted. If your annual benefitable earnings (as determined under The Prudential Merged Retirement Plan) would increase your insurance coverage, then the amounts of these insurance coverages will increase. Otherwise, your insurance coverage(s) will be based on the greater of the previous year s benefitable earnings or the average of your annual benefitable earnings for the three preceding Calendar Years (or as many Calendar Years of earnings you have if less than three). If you are not Actively at Work when your insurance coverage(s) would normally be increased or decreased because of a change in Eligible Earnings, the adjustment will be deferred until you return to active part-time or full-time work. Annual Enrollment Period The Annual Enrollment Period is your opportunity to review your current benefits coverages and then re-enroll or make desired changes for the next Calendar Year. Start and end dates of the Annual Enrollment Period are announced each year by the Administrative Committee. Authorized Business Trip An Authorized Business Trip is a trip that Prudential authorizes you to take for the purpose of furthering its business. An Authorized Business Trip: Starts when you leave your residence or regular place of employment, whichever is later; and Ends when you return to your residence or regular place of employment, whichever is earlier. The term Authorized Business Trip does not include commuting to and from work, vacations or leaves of absence. Basis in the Certificate The Basis in the Certificate is an amount equal to all contributions made for the Cost of GUL Insurance plus all contributions made to the Group Universal Life Insurance Cash Accumulation Fund (GUL Fund). Beneficiary/Beneficiaries Your Beneficiary(ies) is the person(s) or legal entity you name under procedures prescribed by the Program or insurance contract to receive benefits that are payable if you die while covered under an applicable Prudential benefits plan or program, or who will receive those benefits automatically under the terms of the applicable plan or program. You may make different Beneficiary designations for different plans or programs. Calendar Year A Calendar Year begins January 1 and ends December 31. Change in Status or Change in Status Event An event upon which you may enroll or change your election for Life, Accident and Critical Illness Insurance benefits. Changes in Status generally include, but are not limited to: Your marriage, divorce, legal separation or annulment; A Qualified Adult (Domestic Partner or Extended Family Member) becoming eligible for coverage; and Birth, adoption or placement for adoption of a child. Life, Accident and Critical Illness Insurance Programs Page 88

98 Child Care Center For purposes of Business Travel Accident (BTA) and Supplemental Accidental Death and Dismemberment (AD&D) Insurance, a Child Care Center is a facility or individual that: Operates pursuant to law, if locally required; Is not a family member; and Primarily provides care and supervision for children in a group setting on a regular, daily basis. Claims Administrator The Claims Administrator is the entity designated to handle the requests for payment of benefits under the various plans and programs. In some instances, this entity may also be designated to handle appeals for denied benefits. The Claims Administrator is Group Insurance, a division of The Prudential Insurance Company of America. The Claims Administrator for Program enrollment and eligibility claims is the Prudential Benefits Center and the Administrative Committee or its delegate is the Claims Fiduciary. Claims Fiduciary The Claims Fiduciary is the Fiduciary for all actions involving the payment of benefits under an ERISA Plan. The Administrative Committee has delegated Group Insurance as the Claims Fiduciary for the Life, Accident and Critical Illness Insurance Programs. The Administrative Committee or its delegate is the Claims Fiduciary for Program enrollment, eligibility and Non-Benefit Claims. Company The Company is The Prudential Insurance Company of America. Continuous Service A period of Continuous Service as such term is defined in the Retirement Plan. (See the Retirement Plan SPD booklet for more information.) Cost Cost of benefits or coverages refers to the charges determined by Prudential, using the best tools available, to estimate the total amount that will be expended for your benefits during the Calendar Year. If the program is self-insured (rather than provided through an actual insurance policy with a premium), the actual expenditures for the Calendar Year may be higher or lower than the determined charge, depending on the Calendar Year. Any amount charged to a participant will be based solely on the original estimated charge, not the actual expenditures. Depending on the benefit, this Cost may be borne by the participant directly, by Prudential directly or indirectly from a plan fund, such as a Contractual Special Reserve (CSR), established with contributions from Prudential or by a combination of these sources. Critical Illnesses or Procedures Critical Illnesses or Procedures are the following illnesses or procedures for which a benefit may be paid under the Critical Illness Insurance Program, as each is defined by the insurance company providing the benefit: Alzheimer s disease, benign brain tumor, blindness, cancer in situ, coma, coronary artery obstruction, deafness, heart attack, heart valve malfunction, invasive cancer, major organ transplant, occupational HIV infection, Parkinson s disease, renal (kidney) failure, stroke and terminal illness. Life, Accident and Critical Illness Insurance Programs Page 89

99 Dependent Child(ren) For Dependent Term Life Insurance, Supplemental AD&D Insurance and BTA Insurance, Dependent Child(ren) are individuals who both qualify as a Qualifying Child or Qualifying Relative under the Internal Revenue Code (as limited below), and who qualify under one of the following categories: Your unmarried Dependent Children age 14 days or older (from birth for Supplemental AD&D Insurance) but under age 19 who are Substantially Dependent on you. Your Dependent Children are: Your natural children; Your adopted children; Children placed with you for adoption; Children who are living in your home for whom you are the legal guardian and for whom you receive no monetary compensation from a state or county agency; Your stepchildren (your Spouse must be the legal custodial parent); and Your unmarried grandchildren age 14 days or older but under age 19 when: Your child the parent or stepparent (who has legal custody) of the grandchild meets the definition of a Dependent Child, and is covered under the Program (your child cannot be covered as an Extended Family Member if the grandchild is to be covered as a Dependent Child); and Your grandchild is living in your household or is a full-time student at an Educational Institution. Your unmarried Dependent Children (as previously described) continue to qualify between the ages of 19 and 24 if they: Are attending school on a full-time basis; Are Substantially Dependent on you; and Participated in the Dependent Term Life Insurance Program at the time they attained age 19 or participated in a different dependent term life insurance program at the time they attained age 19 and remained continuously covered until the loss of that other coverage and the children became participants within 31 days of the loss of the other coverage. Coverage is continued without regard to whether: Your Spouse continues to have legal custody of a stepchild; Your unmarried Dependent Child continues to have legal custody of your grandchild; You have a legal obligation of support in the case of legally adopted children or children placed for adoption; or The child continues to live in your home or you continue to have legal responsibility under an order of guardianship. You must certify or re-certify Dependent Children between the ages of 19 and 24 as full-time students each ear during the Annual Enrollment Period. If you do not (re-)certify full-time students during the Annual Enrollment Period, their coverage will end December 31 of the year in which you did not complete the (re-)certification, or the end of the pay period during which the Dependent Child reaches age 24, if earlier. Life, Accident and Critical Illness Insurance Programs Page 90

100 You must certify Dependent Children who reach age 19 mid-year as full-time students on the Prudential Benefits Center website (at or by calling the Prudential Benefits Center at PRU-EASY ( ) and following the prompts for Health and Welfare benefits. Coverage for Dependent Children who reach age 24 mid-year will be terminated at the end of the pay period during which the Dependent Child reaches age 24. Coverage for Dependent Children who remain Substantially Dependent on you after ceasing to be full-time students mid-year will be terminated at the earlier of the following dates: The end of the Calendar Year during which the Dependent Child ceases to be a full-time student; or The end of the pay period during which the Dependent Child reaches age 24. Your unmarried Dependent Children (as previously described) age 19 or older who are incapable of sustaining self-supporting employment due to a mental or physical disability, if: Such children participated in the Dependent Term Life Insurance Program at the time they attained age 19 (this must be a continuation of coverage that was in effect prior to exceeding the above age limit); The children participated in a different dependent term life insurance program at the time they attained age 19 and remained continuously covered until the loss of that other coverage and the children became participants within 31 days of the loss of the other coverage; You are a newly hired Employee whose child met these requirements other than the age limits and became a participant within 31 days of your date of hire; or At the time of your marriage your Spouse s child was already disabled and over age 19 and such child became a participant within 31 days of the date of your marriage. For a Dependent Child meeting this definition, you may continue that child s coverage as long as your child remains continuously covered, is Substantially Dependent on you and the child remains incapacitated and unmarried. If you wish to enroll a Dependent Child who meets this definition, you may do so by calling the Prudential Benefits Center at PRU-EASY ( ) and following the prompts for Health and Welfare benefits. You will be required to furnish medical evidence of the Dependent Child s disability upon request from your Program carrier. Your Child Must Be Your Qualifying Child or Qualifying Relative Your Dependent Child must, in addition to falling into one of the above categories, qualify and continue to qualify as your Qualifying Child or Qualifying Relative under Code Section 152, without regard to the requirement that the child has gross income less than the exemption amount (the income limitation) or whether your child has dependents. See the definitions of Qualifying Child and Qualifying Relative in the Glossary for more information. Doctor A Doctor is a licensed practitioner of the healing arts within the scope of the license. The Claims Administrator will not recognize any relative including, but not limited to, you, your Spouse, civil union partner or Domestic Partner or a child, brother, sister or parent of you or your Spouse, civil union partner or Domestic Partner as a Doctor for a claim that you send. Life, Accident and Critical Illness Insurance Programs Page 91

101 Domestic Partner To meet the eligibility requirements of a same-sex or opposite-sex Domestic Partner under the Program, your Domestic Partner must: Be age 18 or older; Have lived with you for at least six months and remain a member of your household during the period of coverage; Be and have been in a serious and committed relationship with you for at least six months; Be Financially Interdependent with you; Not be related to you in any way that would prohibit legal marriage (laws vary from state to state); Not be legally married to, or a Domestic Partner of, anyone else; and Not otherwise be eligible for coverage under the Plan (for example, as a Prudential Employee). To enroll your Domestic Partner, you must follow the Domestic Partner certification process on the Prudential Benefits Center website (at or, if you do not have access to a computer or the Internet or if you need more information, you may call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare benefits. Educational Institution An Educational Institution is an institution that maintains a regular faculty and curriculum, including primary and secondary schools, colleges, universities and technical and mechanical schools. The term does not include non-educational institutions, on-the-job-training schools and correspondence schools. Eligible Dependents For Dependent Term Life Insurance and Supplemental AD&D Insurance, Eligible Dependents are your: Spouse or Domestic Partner; and Your Dependent Child(ren). For Critical Illness Insurance, Eligible Dependents are your Spouse, Domestic Partner or civil union partner. Eligible Earnings Your Eligible Earnings for Life and Accident Insurance Programs coverage amounts and any required contributions are defined as your current salary. Bonuses, overtime pay and all other benefits are not included. For Part-Time Employees, scheduled hours (not the hours you actually worked in any period) are used to determine Eligible Earnings. For Agency Distribution Sales Professionals, Agency Distribution Field Management and Non-Retail Sales Professionals Only: Your Eligible Earnings for Life and Accident Insurance Programs coverage amounts and any required contributions are defined as your Annual Benefits Base Rate. Life, Accident and Critical Illness Insurance Programs Page 92

102 Employee Generally, any person who is categorized as an Employee on the books and records of the Company or any Affiliate, or is compensated as an Agency Distribution Financial Professional by the Company or any Affiliate, will be considered an Employee for the purposes of this Plan. The term Employee never includes any individual who is associated with the Company or any Affiliate as: An Agency Distribution Financial Professional Emeritus, Agent Emeritus, Premier Retired Representative, Retired Representative or Retired Financial Professional; An independent contractor (other than an Agency Distribution Financial Professional); A service provider compensated through an employee leasing company, temporary employment agency or other third-party agency; An individual who would be treated as an employee solely by reason of such individual being treated as either part of an affiliated service group or a leased employee under the Internal Revenue Code and regulations; or Any other individual who performs services for the Company or an Affiliate but is not treated as an Employee for Federal tax purposes at the time the individual renders services. Refer to the Plan Documents for a complete listing of the classes of Employees who are ineligible to participate in the Program. See also the Who Is Not Eligible section in this SPD booklet. ERISA ERISA is the Employee Retirement Income Security Act of 1974, as amended, which is the Federal statute governing private pension and welfare plans. Extended Family Member To meet the eligibility requirements of an Extended Family Member under a Program, your Extended Family Member must meet all of the following criteria: Be age 18 or older, but not have reached the first day of the month in which he/she attains Medicare eligibility. In situations where the Extended Family Member is not eligible for Medicare (for example, a non-u.s. citizen), eligibility ends at either the end of the month during which he/she attains age 65 (for all birth dates that do not fall on the first of a month) or on the date he/she attains age 65 (for all birth dates that fall on the first of a month); Meet the definition of a Qualifying Relative as defined in Internal Revenue Code Section 152 (without regard to the requirement that the child have gross income less than the exemption amount or whether the Extended Family Member has dependents or has filed a joint return with his/her Spouse) during the period of coverage (including, but not limited to, being Substantially Dependent upon you); Have lived with you for at least six months and remain a member of your household during the period of coverage; Not otherwise be eligible for coverage under The Prudential Welfare Benefits Plan or The Prudential Retiree Welfare Benefits Plan Medical Program (for example, as a Prudential Employee); Be related to you as follows: mother, father, grandmother, grandfather, stepmother, stepfather, mother-in-law, father-in-law, brother, sister, stepbrother, stepsister, niece, nephew, aunt, uncle, son, daughter, stepson, stepdaughter, son-in-law, daughter-in-law, brother-in-law or sister-in-law, or any person (other than your Spouse) who, for that Calendar Year, lives with you and is a member of your household; Life, Accident and Critical Illness Insurance Programs Page 93

103 Not file a joint return for Federal income tax purposes; and Be a citizen or resident of the United States, Canada or Mexico. To enroll your Extended Family Member, you must follow the Extended Family Member certification process on the Prudential Benefits Center website (at If you wish to change an existing dependent s relationship type, such as if you wish to enroll an existing Qualified Dependent (for example, a child) as an Extended Family Member or, if you do not have access to a computer or the Internet or if you need more information, you may call the Prudential Benefits Center at PRU-EASY ( ) and follow the prompts for Health and Welfare Fiduciary A Fiduciary is one who exercises discretion on behalf of an ERISA plan and its participants in the management or disposition of ERISA plan assets or ERISA plan administration and/or one who renders investment advice for a fee with respect to ERISA plan assets. Financially Interdependent A requirement for Domestic Partner eligibility, Financially Interdependent means that you and your Domestic Partner share the cost of food and housing. You both do not have to contribute equally or jointly for each of these expenses as long as you are both responsible for such costs. Full-Time Employee A Full-Time Employee is an Employee who is regularly (not on a temporary basis) working for Prudential at least the number of hours in Prudential s normal full-time work week for the class of Employees to which the Employee belongs, but not less than 30 hours per week for purposes of benefits eligibility. Guaranteed Issue The Guaranteed Issue is an amount of insurance that can be obtained without providing evidence of good health to the insurance carrier. Imputed Income Imputed Income is the value of certain benefits you receive from Prudential that is considered income to you under current Federal and state tax laws. This may include the value of any Prudential-paid life insurance coverage in excess of $50,000 and the value of Domestic Partner medical, dental and/or vision coverage. The Imputed Income amount is determined as prescribed under the Internal Revenue Code and/or state tax laws. In some states, Imputed Income may include the value of health care coverage for a same-sex Spouse. Internal Revenue Code The Internal Revenue Code of 1986, as amended, is the Federal statute governing taxes and certain benefits plans and programs. International Employee An International Employee means an Employee or retiree who is not or was not an Employee of a Participating Employer operating in the United States of America, and is or was compensated for services rendered for an Affiliate in currency other than currency of the United States of America and paid from a payroll system other than that used by a Participating Employer to pay Employees in the United States of America. Lifetime Maximum Benefit Lifetime Maximum Benefit means the maximum amount payable for all of a covered person s Critical Illnesses or Procedures. The Lifetime Maximum Benefit for a covered person is 200% of the covered person s amount of insurance under the Critical Illness Insurance Program. Life, Accident and Critical Illness Insurance Programs Page 94

104 Non-Benefit Claim A Non-Benefit Claim means any claim other than a claim for benefits. Unless they are part of a claim for benefits, eligibility and enrollment claims are considered Non-Benefit Claims. Paid-Up Insurance Paid-Up Insurance means life insurance coverage that remains in effect for the rest of your life with no further contributions due. Part-Time Employee A Part-Time Employee is an Employee who is regularly (not on a temporary basis) working for Prudential less than the number of hours in Prudential s normal full-time work week for the class of Employees to which the Employee belongs and regularly scheduled to work at least the number of hours per week that is required for eligibility for the applicable plan or program, if any. (Part-Time Employees do not include part-time field force marketing assistants.) Plan Administrator Generally, the Plan Administrator is the entity that has overall responsibility for administration of a benefits plan or program, including interpreting the Plan Documents, establishing procedures, recordkeeping and filing all necessary reports regarding the benefits plan or program and publishing and distributing communication materials. The Plan Administrator is the Administrative Committee. Plan Document(s) The Plan Documents are the written documents describing all the benefits and limitations pertaining to a particular employee benefits plan or program. Plan Sponsor The Plan Sponsor is the employer establishing a benefits plan or program for its eligible participants and/or beneficiaries. The Prudential Insurance Company of America is the Plan Sponsor for all the plans and programs described in this SPD booklet. Plan Trustee The Plan Trustee is the person or entity that holds title to and administers certain of the assets of certain benefits plans or programs for the benefit of participants and beneficiaries. The Plan Trustee for each of the ERISA benefits plans and programs is listed in the Administrative Information section in the SPD booklets. Plan Year The Plan Year is the period used for all plan administration accounting and reporting. The Plan Year for each of the benefits plans or programs is the Calendar Year, beginning each January 1 and ending the following December 31. Prudential The term Prudential refers to The Prudential Insurance Company of America and its Participating Affiliates. The Prudential Welfare Benefits Plan (or Plan) The Prudential Welfare Benefits Plan is an employee benefits plan established by the Company to provide various health and welfare benefits for participants. Benefits provided under the Plan include Medical, Dental, Vision, Disability, Life Insurance, Long Term Care and Group Legal. Retiree Medical, Retiree Dental and Retiree Vision benefits were provided under the Plan through March 30, Life, Accident and Critical Illness Insurance Programs Page 95

105 The Prudential Retiree Welfare Benefits Plan was established by the Company effective January 1, 2014, to provide various retiree health and welfare benefits previously provided under The Prudential Welfare Benefits Plan; specifically, the Retiree Medical Savings Account effective January 1, 2014, and Retiree Medical, Retiree Dental and Retiree Vision benefits effective March 31, Qualified Adult A Qualified Adult is a person who meets certain eligibility requirements for a program and is not your Spouse. A Qualified Adult is a Domestic Partner or Extended Family Member, as defined in this Glossary. Prior to January 1, 2014, the term Qualified Adult also included individuals who would have been considered a Qualified Same-Sex Spouse for an insured program provided under the Plan if the insured program was subject to state laws, including civil union partnership laws, that required the Plan to offer equal coverage for a participant s same-sex spouse whenever the Plan provided spousal coverage. Qualifying Child A Qualifying Child is defined under Internal Revenue Code Section 152(a)(l) without regard to the requirement that the child have gross income less than the exemption amount or whether the Dependent Child has dependents. Subject to Internal Revenue Code Section 152, a Qualifying Child generally includes, among others, an individual who: Is your child or stepchild or a descendant of your child or stepchild; Has the same principal place of abode as you do for more than one-half of the Calendar Year; Is younger than you and: Has not attained age 19 as of the close of the Calendar Year; Is a student who has not attained age 24 as of the close of the Calendar Year; or Is permanently and totally disabled at any time during the Calendar Year; and Has not provided more than one-half of his/her own support for the Calendar Year; and Has not filed a joint return with his/her Spouse for the Calendar Year. If you and one or more other individuals could otherwise claim a child as a Qualifying Child, the following applies: If both you and the other individual are parents of the child, then the child would be your Qualifying Child if you are the parent with whom the child resided the longest; or if the child resided with both parents for the same amount of time, if you are the parent with the highest adjusted gross income; If only one of the individuals is the parent of the child, then the child would be the Qualifying Child of that parent; If the parents of the child can claim the child as a Qualifying Child for purposes of Section 152, but do not do so, then the child may be claimed by you as your Qualifying Child only if you have adjusted gross income higher than any other person who could claim the child; or If neither parent could claim the child, the child will be your Qualifying Child only if you are the individual with the highest adjusted gross income. Life, Accident and Critical Illness Insurance Programs Page 96

106 Qualifying Relative Under the Plan, a Qualifying Relative is defined under Internal Revenue Code Section 152(a)(2) without regard to the requirement that the child have gross income less than the exemption amount or whether the Dependent Child has dependents. Subject to Code Section 152, a Qualifying Relative is generally an individual: Who is related to you as follows: your child or a descendant of your child, your mother, father, grandmother, grandfather, stepmother, stepfather, mother-in-law, father-in-law, brother, sister, stepbrother, stepsister, niece, nephew, aunt, uncle, son, daughter, stepson, stepdaughter, son-in-law, daughter-in-law, brother-in-law or sister-in-law, or any person (other than your Spouse) who, for that Calendar Year, has the same principal place of abode as you do and is a member of your household; For whom you provide over one-half the individual s support for the Calendar Year or otherwise satisfy the special exception related to multiple support agreements under Code Section 152(d)(3); and Who is not your Qualifying Child or any other individual s Qualifying Child for the Calendar Year. Relocation Trip A trip due to your relocation, at the request and expense of Prudential that: Begins when you leave your former place of residence for the purpose of relocating to a new residence; and Ends when you arrive at the new residence. A Relocation Trip does not include any period of time during which you take a personal trip or vacation. Retire/Retiree Retire/Retiree are terms used to indicate that you have become eligible for benefits under the Prudential Retiree Medical Program, the Retiree Dental Program, the Retiree Life Insurance Program and the Retiree Vision Program. You may be eligible for these benefits at the time your employment with Prudential ends if you meet the terms of The Prudential Welfare Benefits Plan and/or The Prudential Retiree Welfare Benefits Plan, including if you: Have ten or more years of Vesting Service (as defined under the Retirement Plan, and including any additional periods of Vesting Service granted under The Prudential Welfare Benefits Plan and or The Prudential Retiree Welfare Benefits Plan, as applicable, for the purpose of eligibility); and Either: Have attained the first day of the month coinciding with or next following your 55th birthday; or Are considered a Retired Participant under the terms of The Prudential Traditional Retirement Plan (a component of the Retirement Plan). Retirement Plan Retirement Plan refers to The Prudential Merged Retirement Plan, which is a defined benefit pension plan. It was first adopted in 1941, and has been amended over the years. The Retirement Plan consists of The Prudential Traditional Retirement Plan Document Component One (referred to as the Traditional Pension Formula), the Prudential Securities Incorporated Cash Balance Pension Plan Document Component Two (the PSI Plan), and the Prudential Cash Balance Pension Plan Document Component Three (referred to as the Cash Balance Formula). Life, Accident and Critical Illness Insurance Programs Page 97

107 Spouse Spouse, whether capitalized or lowercase, means the person to whom a participant is legally married (whether the same or opposite sex) under the laws of any U.S. or foreign jurisdiction having the authority to sanction marriages. Substantially Dependent To be considered Substantially Dependent, your Dependent Children must receive more than one-half of their maintenance and support from you or your Spouse, as defined by the Internal Revenue Code Section 152. Totally Disabled You will be considered Totally Disabled for life and accident insurance coverage if you are receiving Short Term Disability (STD) benefits when due to sickness or accidental Injury, both of these are true: You are not able to perform, for wage or profit, the material and substantial duties of your occupation; and You are not able to perform, for wage or profit, the material and substantial duties of any job for which you are reasonably fitted by your education, training or experience, and you are not working at any job for wage or profit. This applies after 12 months of Total Disability. But, if you are receiving Long Term Disability (LTD) benefits, this 12-month period will be extended until the end of the initial duration described in the LTD coverage. Vesting Service Vesting Service is determined in accordance with the Retirement Plan (and including any additional periods of Vesting Service granted under The Prudential Welfare Benefits Plan and/or The Prudential Retiree Welfare Benefits Plan, as applicable, for the purpose of eligibility). Generally, your Vesting Service includes time worked and certain approved or authorized time away from work, including vacations, holidays, sick days and certain time away on a paid or unpaid leave of absence. You receive credit for Vesting Service beginning with your first day of employment with the Company and its Affiliates and ending on the date your employment with the Company and its Affiliates ends. (See the Retirement Plan SPD booklet for more details.) War Risk Country For the purposes of Business Travel Accident Insurance coverage, War Risk Country is currently defined as Afghanistan or Iraq. This definition is subject to change. Life, Accident and Critical Illness Insurance Programs Page 98

108 2015 The Prudential Insurance Company of America 751 Broad Street, Newark, NJ ALL RIGHTS RESERVED. ORD Ed. 01/2015