LIFE INSURANCE. Table of Contents. Page i SUMMARY PLAN DESCRIPTION

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1 For this plan year, the plan includes the following provisions, subject to change or discontinuation with or without notice at anytime. This Summary Plan Description presents an overview of your Benefits. In the event of any discrepancy between this Summary Plan Description and the official Plan Document, the Plan Document shall govern. Table of Contents Life Insurance Plans... 1 If the Plans Are Ended or Modified... 1 No Implied Promises... 1 Employee Life Insurance... 1 Overview of Employee Life Insurance Benefits... 1 Who Is Eligible for the Employee Life Insurance Plans?... 2 Employee Life Insurance Options... 2 Reduction of Benefit... 2 Increasing Coverage During Annual Enrollment... 3 Active Work Requirement... 3 Paying for Coverage... 3 Leave of Absence... 3 How Employee Life Insurance Benefits Are Paid... 3 When Employee Life Insurance Benefits Are Not Paid... 4 Designating a Beneficiary... 4 Assigning Policy Ownership... 4 Waiver of Premium... 4 Imputed Income... 5 Accelerated Death Benefit of Employee Life Insurance... 5 Employee Life Insurance Claim Information... 6 When Employee Life Insurance Coverage Ends... 6 Dependent Life Insurance... 7 Eligible Dependents... 7 Incapacitated Children... 8 Qualified Medical Child Support Order (QMCSO)... 8 Overview of Dependent Life Insurance... 9 Dependent Life Insurance Options... 9 Spouse/Domestic Partner Life Insurance Options... 9 Maximum Benefit for Spouse Life Insurance... 9 Child Life Insurance Options Paying for Coverage Leave of Absence Accelerated Death Benefit of Spouse Life Insurance How Dependent Life Insurance Benefits Are Paid When Dependent Life Insurance Coverage Ends Dependent Life Insurance Claim Information Page i

2 Accidental Death & Dismemberment (AD&D) Insurance Who Is Eligible for the AD&D Plan? Eligible Dependents Incapacitated Children Overview of AD&D Insurance AD&D Insurance Options Coverage Choices How AD&D Benefits Are Paid Death Dismemberment Definitions of Loss Exposure and Disappearance Benefit Seat Belt Benefit Hospital Benefit Training Benefit for Your Spouse Education Benefit for Your Children Child Care Center Benefit When AD&D Benefits Are Not Paid Leave of Absence Paying for Coverage AD&D Insurance Claim Information When AD&D Coverage Ends Claim Procedures Page ii

3 Life Insurance Plans The Deluxe life insurance plans help you protect the people who depend on you through the employee life insurance, dependent life insurance, and accidental death & dismemberment insurance (AD&D) plans. These plans give you and your family convenient protection against a variety of events that may occur. The plans are provided through Minnesota Life Insurance Company; an affiliate of Securian Financial Group, Inc. When you join the company - and each year at annual enrollment - you choose the life insurance plan that best fits your needs. Your decision remains in effect for one calendar year, unless you experience a qualified change in status that changes your coverage needs. At that time, you may be able to change your original benefit elections. As an active, full-time or part-time employee regularly scheduled to work 20 or more hours per week, you automatically receive the basic employee life insurance option of 1 x eligible pay. This plan is not available to temporary or seasonal employees or independent contractors. Participation in the optional employee life insurance, dependent life insurance, and accidental death & dismemberment (AD&D) plans is optional. The Deluxe life insurance plans are described in this document. If the Plans Are Ended or Modified Deluxe reserves the right to amend, modify, suspend, or terminate any of its plans at any time, in whole or in part. If material changes that affect you are made in the future, you will be notified. No Implied Promises Nothing in this Web site says or implies that participation in the plans is a guarantee of continued employment with the company. Nor is it a guarantee that the plans or contribution levels will remain unchanged in future years. Employee Life Insurance Life insurance is an important benefit because it can provide the financial security your family needs in the event of your death. By providing this safety net to your family, life insurance can also provide you peace of mind. Overview of Employee Life Insurance Benefits The employee life insurance plan pays a benefit to your beneficiary (or beneficiaries) if you die while you are a Deluxe employee. Optional life insurance is based on the option of life insurance you elect times your eligible pay. Your eligible pay is: Eligible Pay: - Annualized Base Pay Eligible Pay for sales positions in grade Q and below who have 15% - less than 50% pay at risk and receive pay at risk more frequently than 2X per year: - Total Cash Contribution Midpoint Eligible Pay for employees who have 50% - 100% pay at risk: - 12-month total cash compensation lookback on September 1st with a minimum of $25,000 and a maximum of $150,000. If an employee has worked more than 6 months, but less than 12, the lookback will be annualized. An employee will receive a $25,000 benefit until there is a 6-month pay history at the time pay is frozen. Page 1

4 Who Is Eligible for the Employee Life Insurance Plans? You are eligible for Deluxe employee life insurance coverage if you are: An active, full-time employee; or A part-time employee regularly scheduled to work 20 or more hours per week. This does not include seasonal or temporary employees or independent contractors. Check with your Human Resource Representative to determine if you are eligible for this plan. You become eligible for the employee life insurance plans on the first day of the month following your date of hire or when you become otherwise eligible based on your regularly scheduled workweek. You have 31 days to enroll. If you do not enroll within 31 days, you will receive the company-provided 1 x pay, basic employee life insurance coverage. You will not be able to modify your coverage amount until the next annual enrollment period unless you experience a qualified change in status. If you experience a qualified change in status, you must call the Your Benefits Resources Customer Care Center at U-ASK-DLX ( ) within 31 days of the event to request a change in coverage. Employee Life Insurance Options The employee life insurance options are listed below: Basic employee life insurance. Deluxe automatically provides basic employee life insurance to eligible participants equal to: o 1 x eligible pay Optional employee life insurance. You have the choice to purchase optional employee life insurance. You can choose: o 1 x eligible pay o 2 x eligible pay o 3 x eligible pay o 4 x eligible pay o 5 x eligible pay o 6 x eligible pay The maximum combined employee life insurance benefit is $1,250,000. Reduction of Benefit The amount of your basic and optional life insurance benefit once you reach age 65 will be determined by applying the appropriate percentage from the following table to the amount of such benefits in effect on the day before your 65th birthday. Age of Employee Age 65 but less than age 70 Age 70 but less than 75 Age 75 but less than 80 Age 80 or older Benefit Amount 65% of original benefit 45% of original benefit 30% of original benefit 20% of original benefit Page 2

5 Increasing Coverage During Annual Enrollment For optional employee life insurance, you can increase your current coverage one level (for example, from 2 x pay to 3 x pay) without providing evidence of good health as long as the increased benefit amount is less $500,000 basic and optional combined. You will have to provide evidence of insurability if: You increase your employee life benefit by more than one level; You increase your employee life benefit by one level and were previously denied coverage due to failure to provide satisfactory evidence of insurability; You request to be covered under optional employee life insurance after electing no coverage in the prior enrollment period; You increase your employee life benefit over $500,000; or Your total employee life benefit is already greater than $500,000 and your earnings or benefit amount increases $50,000 or more. If evidence of insurability is required, the increased benefit will become available after the evidence of your good health has been approved by Minnesota Life, and you have satisfied the active work requirement. The Your Benefits Resources Customer Care Center will provide you the necessary form if evidence of insurability is needed. If the evidence of insurability is not accepted by Minnesota Life as satisfactory, the requested increase in coverage cannot be made. Active Work Requirement When you elect to increase your coverage, you must be actively at work for one full day in the plan year in which the increase is to be implemented. In the event of a mid-year increase due to a qualified change in status, you must be actively at work on the date when your increase would otherwise become effective, before the increase in coverage can take effect. If you are not actively at work on the date when your increased benefit amount would otherwise become effective, your increased coverage amount will become effective on the first day after you return to active work. Paying for Coverage Deluxe provides you with basic employee life insurance as noncontributory coverage. You can purchase optional employee life insurance using after-tax contributions from your paycheck. Leave of Absence You may be approved to take a medical leave of absence where your life insurance may be continued as long as you pay the monthly premium as billed by the Benefits Resources Center. If you are on a medical leave of absence, insurance cannot be continued beyond the earlier of your retirement date or the attainment of age 65. You may also be approved to take a non-medical leave of absence where your life insurance may be continued as long as you pay the monthly premium as billed by the Benefits Resources Center. If you are on a non-medical leave of absence or a temporary layoff, insurance cannot be continued beyond 12 months from the last day you were actively at work. If you drop life insurance while out on medical or non-medical leave of absence, evidence of insurability is required to receive benefits again. How Employee Life Insurance Benefits Are Paid Page 3

6 Benefits are paid to the beneficiary or beneficiaries you name through Your Benefits Resources. If you do not name a beneficiary, benefits are paid in the following order to one or more of the following persons who are related to you and who survive you: Your lawful spouse; Your natural and legally adopted children; Your parents; Your brother(s) and sister(s); or Your estate. Your beneficiary must be living at the time your life benefit is processed. The life benefit is deposited in an account for the beneficiary to draw out money as needed. When Employee Life Insurance Benefits Are Not Paid Optional employee life insurance benefits are not paid to your beneficiary(ies) if you commit suicide, while sane or insane, within two years from the effective date of your policy. However, your beneficiary(ies) will receive an amount equal to any contributions paid, without interest. If you commit suicide, while sane or insane, more than two years after the effective date of your policy, but within two years from the effective date of any increase in the amount of your optional employee life insurance benefits, that increased amount is not paid to your beneficiary(ies). However, your beneficiary(ies) will receive: An amount equal to all contributions paid for the increased amount, without interest; plus An amount equal to the optional employee life insurance benefits in effect on the day before the effective date of such increased amount. Designating a Beneficiary You must designate a beneficiary (or beneficiaries) to receive benefits if you die. Although you may name any person or persons and may change your designation at any time, this decision requires careful consideration. If you name more than one beneficiary, your benefit amount is distributed equally among your beneficiaries unless you have requested otherwise in writing. The beneficiary (or beneficiaries) you name is the same for your life and AD&D insurance unless you have requested otherwise in writing. To designate or change your beneficiary (or beneficiaries) on your life insurance plan, log on to and enter your beneficiary information. You can also call the Your Benefits Resources Customer Care Center at U-ASK-DLX ( ) to request a beneficiary designation form. Assigning Policy Ownership You can assign the ownership of your employee life insurance to a person or a trustee. When you assign ownership, you no longer control your insurance coverage, although you continue to pay for this coverage (if you have chosen the optional employee life insurance plan). You cannot change the beneficiary or coverage levels. All assignments are irrevocable, which means they are beyond your future control. It is strongly recommended that you consult your tax advisor and/or legal counsel before you make an assignment. To make an assignment, call the Your Benefits Resources Customer Care Center at U-ASK-DLX ( ). Waiver of Premium Page 4

7 If you become totally disabled while your life insurance is in force and you are receiving disability income benefits through the Deluxe long-term disability plan, you are automatically approved for waiver of premium, which will continue employee optional life insurance and dependent life insurance at no cost to you until: You are no longer receiving benefit payments through the Deluxe long-term disability plan; The date you do not give Minnesota Life proof of total disability when required; or Coverage normally ends. To be eligible for the waiver of premium, you must follow these guidelines: You must be actively at work and have coverage on the date you become totally disabled. Only optional life insurance is eligible for waiver of premium if approved by Minnesota Life. You must provide the required proof of your total disability when requested. Imputed Income Certain employer-sponsored benefits, such as group term life insurance, are taxable. Imputed income, which is the dollar value of employee life insurance coverage over $50,000, is considered additional income by the Internal Revenue Service (IRS) and is added to your total compensation reported to the IRS at the end of the year. Depending on your level of life insurance coverage and your tax bracket, this could affect your tax liability. Accelerated Death Benefit of Employee Life Insurance If you become terminally ill and are expected to live less than twelve months, you may request payment under the Plan's accelerated death benefit payment provision. You will choose the amount of accelerated death benefit to be paid subject to a minimum of $10,000 and a maximum of the lesser of 80% of your life insurance benefit amount or $1,250,000. Your life insurance benefit will be reduced by the amount paid to you in accelerated death benefit. If a partial accelerated benefit is chosen, the remaining life insurance benefit must be at least $25,000. If you do not request the full amount that is available to you in accelerated death benefit, you may reapply for the remaining available amount of benefit at any time. You may have to provide further evidence of your eligibility with the additional request. To qualify for payment of an accelerated death benefit: Your coverage must be in force and all premiums due must be fully paid; You must apply in a form satisfactory to Minnesota Life; You must give evidence that your life expectancy - due to illness or injury - is 12 months or less as certified by a physician; You must not have assigned the ownership of your insurance; and Your insurance must not have an irrevocable beneficiary. If you are unable to request this benefit yourself, your legal representative may request it for you. Minnesota Life may require that you be medically examined - at Minnesota Life's expense - to verify your medical condition. If you choose an accelerated death benefit, the balance of your life insurance coverage will remain in force and your premium will be adjusted accordingly. Accelerated death benefits are made available on a voluntary basis only. An accelerated death benefit is not intended to cause an involuntary reduction of the life insurance benefit payment to the named beneficiary. Therefore, payment of the life insurance benefit cannot be accelerated if you are required by law to use this option Page 5

8 to meet the claims of creditors, whether in bankruptcy or otherwise, or are required by a government agency to use this option in order to apply for, obtain, or keep a government benefit or entitlement. A terminal condition is a condition caused by illness or accident which directly results in a life expectancy of twelve months or less. For more information, call the Your Benefits Resources Customer Care Center at U-ASK-DLX ( ). Employee Life Insurance Claim Information If you die, your beneficiaries must contact the Your Benefits Resources Customer Care Center at U-ASK- DLX ( ) to report the death and request a beneficiary claim kit. Your beneficiary or beneficiaries should return the completed claim form along with a certified copy of the death certificate to the address provided on the claim form. When Employee Life Insurance Coverage Ends Your employee life insurance coverage ends on the earliest of the following:the date the policy ends; The date you no longer meet the eligibility requirements; The date the policy is amended so you are no longer eligible; 31 days (the grace period) after the due date of any premium contribution which is not paid; or The last day for which premium contributions have been paid following your written request to cease participation under the policy. You may be eligible to continue to purchase the amount of life insurance coverage you were carrying on your date of termination. After you terminate, you will receive information from Your Benefits Resources (YBR) to port or convert your basic and optional employee life insurance coverage. You will have 31 days from the date in which you terminate to enroll. This is available to all covered, former employees upon termination with the following exceptions. You have: Attained the age of 70; Converted your insurance to an individual life policy; Were not actively at work due to sickness or injury on the date immediately preceding your portability date; Lost eligibility due to termination of the group policy; or Are a resident of Minnesota. Minnesota requires residents to first be offered COBRA-like coverage for 18 months after termination. When the 18 month COBRA-like coverage expires, you will then have the option to port or convert. Minnesota Life will provide Minnesota residents with information on COBRA-like coverage and will administer the monthly billing. If you choose to port or convert, you will have the following choices: To port coverage, continue to hold the employer certificate; or Convert the coverage to an individual policy. Under the portability provisions, the minimum amount of insurance that can be continued is $10,000. The maximum amount that can be continued is the lesser of the amount of coverage in force upon termination or $1,000,000. For a certificate holder who is age 65 or older on his or her portability date, the amount will not be more than $650,000.When you attain age 65, your amount of insurance will reduce to 65% of the amount of insurance in force on the day prior to your attainment of age 65. This insurance will terminate when you attain age 70. Page 6

9 When you convert or port coverage, rates are higher than they are on the Deluxe employee plan. If you continue to hold the employer certificate, your coverage will end on the earliest of the following: The certificate holder's 70th birthday; The date the certificate holder again meets the eligible requirements of the group policy, not including the term of the portability rider; or 31 days after the due date of any premium contribution, which was not made. To request a form to convert or port coverage, call Your Benefits Resources Customer Care Center at U- ASK-DLX ( ). Deluxe reserves the right to amend or terminate any of its plans, at any time without notice to, or the consent of, employees, retirees, or their dependents. Dependent Life Insurance In addition to having life insurance for yourself, it may make sense for you to choose life insurance for your dependents. If you are married, you may need financial help if your spouse/domestic partner dies. If you have children, you may want extra income to help you through the difficult time after the death of a child. You become eligible for dependent life insurance on the first day of the month following your date of hire or when you become otherwise eligible based on your regularly scheduled workweek. You have 31 days to enroll. If you do not enroll within 31 days, you will receive no dependent life coverage. You will not be able to modify your coverage amount until the next annual enrollment period unless you experience a qualified change in status. If you experience a qualified change in status, you must call the Your Benefits Resources Customer Care Center at U-ASK-DLX ( ) within 31 days of the event to request a change in coverage. As an active, full-time or part-time employee regularly scheduled to work 20 or more hours per week, you can enroll in dependent life insurance coverage. This plan is not available to temporary or seasonal employees or independent contractors. Eligible Dependents When you enroll in the dependent life insurance plan, you may cover the following dependents: Your legally married spouse Your domestic partner who, along with you, can establish that all of the following criteria has been met for 12 months: o You are financially interdependent and are jointly responsible for each other s common welfare; and o There is an intent to remain in a committed relationship; and o You share the same living quarters and permanent address; and o You are not so closely related by blood that legal marriage would otherwise be prohibited; and o You are at least 18 years of age and neither of you is married to a third party; and Page 7

10 o you have not been in a different domestic partner relationship or marriage within the last 12 months; and o your current relationship has been in effect for at least 12 months. Your children up to age 26, if they are your: o Biological children; o Legally adopted children; o Stepchildren/domestic partner s children; o Children who are eligible to be claimed on your income tax return and live with you in a parent-child relationship at least 50% of the time; or o Children for whom you are a legal guardian, as defined by a court order or where a court order requires life insurance for the children to be supplied - e.g., through a Qualified Medical Child Support Order (QMCSO). If you gain a new dependent through marriage, the birth of a baby, adoption, or placement for adoption, you must apply for coverage for the new dependent within 31 days following the event. To enroll your new dependent, you can talk with a Your Benefits Resources Customer Care Specialist at U-ASK-DLX ( ) and request a change to your coverage. When you add a dependent, spouse or child, to coverage, YBR will automatically require certification. You will receive a letter requesting documents to certify your dependent s eligibility. Documents include marriage certificates, birth certificates, tax returns. Documents must be provided within 31 days of the enrollment effective date. When documents are received, dependent coverage is activated to the date of eligibility. If documents are not received and approved by the deadline, your dependents will not be eligible for coverage until the next annual enrollment or you have another qualified family status event. If a dependent is hospitalized or confined because of illness or disease on the date his or her insurance would otherwise become effective, his or her effective date will be delayed until he or she is released from such hospitalization or confinement. This does not apply to a newborn child. However, in no event will insurance on a dependent be effective before the insured employee's insurance under the group policy is effective. Incapacitated Children A mentally or physically incapacitated child may continue to be covered beyond the normal age limit. Proof of incapacitation must be submitted to Your Benefits Resources while your child is covered under a Deluxe plan and before your child reaches the normal age limit and periodically thereafter when requested by your service provider. You must provide appropriate confirmation when requested at the time of a claim. Qualified Medical Child Support Order (QMCSO) A Qualified Medical Child Support Order (QMCSO) is a legal order issued by a court or a state agency authorized under state law that mandates that a specified individual must provide a child with one or both of the following: Financial support; or Health coverage. If an employee of Deluxe is ordered to provide life insurance coverage, the order must be sent to: Qualified Order Center Post Office Box 1433 Lincolnshire, IL Here is the process that a QMCSO follows: The Qualified Order Center will review the order and determine if it is qualified. If the order is determined not to be qualified, it will be sent to the employee, beneficiaries, and respective attorney(s) with an explanation of why it does not qualify. Page 8

11 If the order is determined to be qualified, determination letters will be sent to the employee, beneficiaries, and respective attorney(s). The client and attorney(s) then present the QMCSO to the court for certification. The client sets any necessary payroll deductions or changes. The client and attorney(s) send certification to the Qualified Order Center at the address provided in the determination letter. Overview of Dependent Life Insurance If you choose to purchase dependent life insurance coverage, you will receive benefits if your spouse/domestic partner or child dies while covered by the plan. The amount of your benefit is based on the amount of dependent life insurance you elect. You can choose from spouse/domestic partner life insurance and/or child life insurance. Dependent Life Insurance Options Your dependent life insurance coverage includes: Spouse/domestic partner life insurance Child life insurance Spouse/Domestic Partner Life Insurance Options You can cover your spouse or domestic partner at the following levels: $10,000 $25,000 $50,000 $75,000 $100,000 No coverage If you want to initially enroll in spouse/domestic partner coverage of over $50,000 or increase your spouse/domestic partner life insurance coverage by more than one level, by one level if your spouse/domestic partner has previously been denied coverage due to failure to provide satisfactory evidence of insurability, or request coverage after electing no coverage during the previous enrollment period, your spouse/domestic partner is required to provide evidence of good health. The Your Benefits Resources Customer Care Center will provide you the necessary form regarding evidence of good health. An increase in the amount of spouse/domestic partner life insurance benefits will become effective for your spouse/domestic partner on the later of: The date the evidence of good health of your spouse/domestic partner is accepted by Minnesota Life as satisfactory; or The effective date of the benefit coverage; provided you are actively at work on that date. If you are not actively at work on that date, the increase in spouse/domestic partner life benefits will become effective on the date of your return to active work. If the evidence of good health is not accepted by Minnesota Life as satisfactory, the requested increase in coverage cannot be made. Maximum Benefit for Spouse Life Insurance Page 9

12 Your spouse/domestic partner life insurance coverage amount must be less than or equal to 50% of your elected employee life insurance coverage. For example, if you elect $50,000 in employee life insurance coverage, the maximum amount of coverage for your spouse will be $25,000. Child Life Insurance Options You can cover your child(ren) at the following levels: $5,000 $10,000 $15,000 $20,000 $25,000 No coverage Your first eligible newborn child is automatically covered for $5,000 for 31 days from the child s live birth. To continue coverage on the first child, the employee must elect child coverage within those 31 days; otherwise the coverage shall terminate at the end of the 31-day period. If you request child life insurance after electing no coverage during a previous enrollment period, your dependent must provide Minnesota Life with evidence of good health. If the evidence of good health is not accepted by Minnesota Life as satisfactory, the requested coverage cannot be provided. Paying for Coverage You can purchase dependent life insurance coverage for your spouse/domestic partner and children using after-tax contributions from your paycheck. Deluxe does not contribute money or flexible credits toward the purchase of dependent life insurance coverage. Leave of Absence You may be approved to take a medical leave of absence where your dependents life insurance may be continued as long as you pay the monthly premium as billed by the Benefits Resources Center. If you are on a medical leave of absence, dependents insurance cannot be continued beyond the earlier of your retirement date or the attainment of age 65. You may also be approved to take a non-medical leave of absence where your dependents life insurance may be continued as long as you pay the monthly premium as billed by the Benefits Resources Center. If you are on a nonmedical leave of absence or a temporary layoff, dependents insurance cannot be continued beyond 12 months from the last day you were actively at work. If you drop dependents insurance while out on medical or non-medical leave of absence, evidence of insurability is required to receive benefits again. Accelerated Death Benefit of Spouse Life Insurance If your covered dependent spouse/domestic partner becomes terminally ill and is expected to live less than twelve months you may request payment under the Plan's accelerated death benefit payment provision. You will choose the amount of accelerated death benefit to be paid subject to a minimum of $10,000 and a maximum of the lesser of 80% of his or her life insurance benefit amount or $1,250,000. His or her life insurance benefit will be reduced by the amount paid to you in accelerated death benefit. If a partial accelerated benefit is chosen, the remaining life insurance benefit must be at least $25,000. Page 10

13 If you do not request the full amount that is available to you in accelerated death benefit, you may reapply for the remaining available amount of benefit at any time. You may have to provide further evidence of your spouse's eligibility with the additional request. To qualify for payment of an accelerated death benefit: Your dependent s coverage must be in force and all premiums due must be fully paid; You must apply in a form satisfactory to Minnesota Life; You must give evidence that your dependent s life expectancy - due to illness or injury - is 12 months or less as certified by a physician; You must not have assigned the ownership of your dependent s insurance; and Your insurance must not have an irrevocable beneficiary. If you are unable to request this benefit yourself, your legal representative may request it for you. Minnesota Life may require that your dependent be medically examined - at Minnesota Life's expense - to validate your dependent s medical condition. If you choose an accelerated death benefit, the balance of your dependent s life insurance coverage will remain in force and your premium will be adjusted accordingly. Accelerated death benefits are made available on a voluntary basis only. An accelerated death benefit is not intended to cause an involuntary reduction of the life insurance benefit payment to the named beneficiary. Therefore, payment of the life insurance benefit, cannot be accelerated if you or your spouse are required by law to use this option to meet the claims of creditors, whether in bankruptcy or otherwise, or are required by a government agency to use this option in order to apply for, obtain, or keep a government benefit or entitlement. A terminal condition is a condition caused by illness or accident which directly results in a life expectancy of twelve months or less. For more information, call the Your Benefits Resources Customer Care Center at U-ASK-DLX ( ). How Dependent Life Insurance Benefits Are Paid You are automatically the beneficiary for dependent life insurance benefits, so all benefits are paid directly to you. If your dependent dies at the same time as your death occurs or within 24 hours of your death, dependent life benefits will be paid to your estate. When Dependent Life Insurance Coverage Ends Life insurance coverage for your dependents end on the earliest of the following: The date the dependent no longer meets the eligibility requirements; 31 days (the grace period) after the due date of any premium contribution which is not paid; The last day for which premium contributions have been made following your written request that insurance on your eligible dependents be terminated; or The date you are no longer covered under the group policy. You may be eligible to continue to purchase the amount of dependent life insurance coverage you were carrying on your date of termination. Page 11

14 After you terminate, you will receive information from Your Benefits Resources (YBR) to port or convert your dependent life insurance coverage. You will have 31 days from the end of the month in which you terminate to enroll. This is available to all covered, former employees upon termination with the following exceptions: You have attained the age of 70; You converted your dependent s insurance to an individual life policy; Your dependent lost eligibility due to termination of the group policy; You are a resident of Minnesota. Minnesota requires residents to first be offered COBRA-like coverage for 18 months after termination. When the 18 month COBRA-like coverage expires, you will then have the option to port or convert. Minnesota Life will provide Minnesota residents with information on COBRA-like coverage and will administer the monthly billing; or You are not actively at work due to sickness or injury on the date immediately preceding your dependent's portability date. If you choose to port or convert, you will have the following choices: To port coverage, continue to hold the employer certificate; or Convert the coverage to an individual policy. Under the portability provisions, the maximum amount that can be continued for a spouse/domestic partner is the amount of coverage in force upon termination, up to a maximum $100,000. When you convert or port coverage, rates are higher than they are on the Deluxe employee plan. If you continue to hold the employer certificate, your coverage will end on the earliest of the following: The insured s 70th birthday; The date the insured again meets the eligible requirements of the group policy, not including the term of the portability rider; In the case of a dependent child or a spouse/domestic partner who is insured by a rider to your coverage, the date your coverage is no longer being continued under the rider, or the date your spouse/domestic partner or child ceases to be eligible as defined under the terms of the group policy; or 31 days after the due date of any premium contribution this was not made. To request a form to convert or port coverage, call Your Benefits Resources Customer Care Center at U- ASK-DLX ( ). If you are a Minnesota resident and your dependent life insurance coverage is lost due to your death, your covered child exceeds age 26, or spouse coverage is lost due to your divorce, you will not be able to continue coverage through the Deluxe plan for the 18 months. You may however have the right to convert to an individual policy. Deluxe reserves the right to amend or terminate any of its plans at any time without notice to, or the consent of, employees, retirees, or their dependents. Dependent Life Insurance Claim Information If you have dependent life insurance and your spouse/domestic partner or child dies, you must contact the Your Benefits Resources Customer Care Center at U-ASK-DLX ( ) to report the death and obtain a beneficiary claim kit. Return the completed claim form, along with a certified copy of the death certificate, to the address provided in the claim kit. Page 12

15 Accidental Death & Dismemberment (AD&D) Insurance If you die or are injured in an accident, AD&D insurance provides additional financial security for you and your family. Any benefits paid are in addition to the employee life insurance you have through Deluxe. You become eligible for AD&D insurance on the first day of the month following your date of hire or when you become otherwise eligible based on your regularly scheduled workweek. You have 31 days to enroll. If you do not enroll within 31 days, you will receive no AD&D coverage. You will not be able to modify your coverage amount until the next annual enrollment period unless you experience a qualified change in status. If you experience a qualified change in status, you must call the Your Benefits Resources Customer Care Center at U-ASK-DLX ( ) within 31 days of the event to request a change in coverage. Who Is Eligible for the AD&D Plan? You are eligible to elect AD&D insurance if you are: An active, full-time employee; or A part-time employee regularly scheduled to work 20 or more hours per week. This does not include seasonal or temporary employees or independent contractors. Check with your Human Resources Representative to determine if you are eligible for this plan. You may also cover your eligible dependents under the AD&D plan. Eligible Dependents When you enroll in the dependent life insurance plan, you may cover the following dependents: Your legally married spouse Your domestic partner who, along with you, can establish that all of the following criteria has been met for 12 months: o You are financially interdependent and are jointly responsible for each other s common welfare; and o There is an intent to remain in a committed relationship; and o You share the same living quarters and permanent address; and o You are not so closely related by blood that legal marriage would otherwise be prohibited; and o You are at least 18 years of age and neither of you is married to a third party; and o You have not been in a different domestic partner relationship or marriage within the last 12 months; and Your current relationship has been in effect for at least 12 months. Your children up to age 26, if they are your: o Biological children; o Legally adopted children; o Stepchildren/Domestic Partners children; o Children who are eligible to be claimed on your income tax return and live with you in a parent-child relationship at least 50% of the time; or Page 13

16 o Children for whom you are a legal guardian, as defined by a court order or where a court order requires life insurance for the child to be supplied - e.g., through a Qualified Medical Child Support Order (QMCSO). If you gain a new dependent through marriage, the birth of a baby, adoption, or placement for adoption, you must apply for coverage for the new dependent within 31 days following the event. To enroll your new dependent, you can talk with a Your Benefits Resources Customer Care Specialist at U-ASK-DLX ( ) and request a change in your coverage. When you add a dependent, spouse or child, to coverage, YBR will automatically require certification. You will receive a letter requesting documents to certify your dependent s eligibility. Documents include marriage certificates, birth certificates, tax returns. Documents must be provided within 31 days of the enrollment effective date. When documents are received, dependent coverage is activated to the date of eligibility. If documents are not received and approved by the deadline, your dependents will not be eligible for coverage until the next annual enrollment or you have another qualified family status event. Incapacitated Children A mentally or physically incapacitated child may continue to be covered beyond the normal age limit. Proof of incapacitation must be submitted to Your Benefits Resources while your child is covered under a Deluxe plan and before your child reaches the normal age limit and periodically thereafter when requested by your service provider. You must provide appropriate confirmation when requested at the time of a claim. Overview of AD&D Insurance The AD&D plan pays a benefit only if you (or a family member, if covered) die or are injured as a direct result, independent of all other causes, from an accidental injury that is unintended, unexpected, and unforeseen. The injury must occur while your coverage is in force. Death or dismemberment must occur within 365 days after the date of the injury and while your coverage is in force. Your beneficiary (or beneficiaries) receives your coverage amount in addition to any life insurance coverage you may have through Deluxe. If you suffer a physical loss as the result of an accident (for example, you lose a limb or an eye), you will receive a portion of your coverage amount. The benefit coverage amount is adjusted on January 1 of each year. It is based on the option you select and your eligible pay. Your eligible pay is your annualized base salary in effect at the time the wage information is extracted from payroll in the August prior to the January 1 effective date. If you are in a Deluxe sales position, 15 percent or more of your pay is at risk, and you receive at risk pay more frequently then twice a year, your eligible pay is your annualized base salary increased by an at-risk amount. AD&D Insurance Options Your AD&D options are: 1 x eligible pay 2 x eligible pay 3 x eligible pay 4 x eligible pay 5 x eligible pay 6 x eligible pay 7 x eligible pay No coverage If you elect coverage for your spouse/domestic partner and child(ren), the coverage amount for your spouse/domestic partner is equal to 50% of your AD&D benefit subject to a maximum amount of $625,000. If, Page 14

17 however, both you and your dependent spouse/domestic partner die within one year of sustaining bodily injuries in the same accident, or separate accidents occurring within the same 24-hour period, the AD&D benefit that applies to your dependent spouse/domestic partner is increased to equal the amount that applies to you, but not to exceed $500,000. The coverage amount for your child(ren) is equal to the lesser of 20% of your AD&D benefit or $10,000 for each child. Coverage amounts are rounded up to the next higher $1,000, and the maximum benefit is $1,250,000. Coverage Choices Under AD&D insurance, you can choose whom to cover: You only; or You + family. How AD&D Benefits Are Paid AD&D benefits are paid if you or your covered dependents die or are injured in an accident. The amount of the benefit depends on the severity of the injury. Death The full benefit is paid to your beneficiary if you die in an accident. The beneficiary (or beneficiaries) you named for your life insurance coverage is automatically the beneficiary for your AD&D insurance. If you elect coverage for your family, you are automatically the beneficiary if your spouse or child dies or is injured in an accident. If you have no beneficiary on file, benefits are paid in the following order: Your lawful spouse; Your biological and legally adopted children; Your parents; Your brother(s) and sister(s); or Your estate. Dismemberment A portion of your coverage amount is paid to you if you lose a limb, your eyesight, speech, or hearing. If more than one loss occurs in any one accident, the greatest benefit is paid for all injuries. In no event will AD&D benefits payable for the same accident exceed 100% of the coverage amount you elected. For example, if you lose the sight in both eyes and one hand in an accident and you had elected $50,000 coverage, $50,000 is paid to you for your losses, not $75,000. AD&D benefits for death and dismemberment are shown in the chart below. A benefit is paid if: If you lose: Your life Any combination of a hand, a foot, and sight in an eye Speech and hearing Quadriplegia (total paralysis of both upper and lower limbs) Your benefit is: 100% of coverage amount 100% of coverage amount 100% of coverage amount 100% of coverage amount Page 15

18 Paraplegia (total paralysis of both lower limbs) One hand One foot Sight in one eye Speech or hearing in both ears Hemiplegia (total paralysis of upper and lower limbs on one side of the body) Thumb and index finger of the same hand 75% of coverage amount 50% of coverage amount 50% of coverage amount 50% of coverage amount 50% of coverage amount 50% of coverage amount 25% of coverage amount Definitions of Loss Before you can receive personal accident benefits for the loss of a limb, your eyesight, speech, or hearing, the following conditions must apply: Loss of hand means complete severance at or above the wrist joint Loss of foot means complete severance at or above the ankle joint Loss of sight means the eye is entirely blind and no sight can be restored in that eye Loss of hearing means entire and irrecoverable loss which cannot be corrected by medical or artificial means Loss of speech means entire and irrecoverable loss which cannot be corrected by medical or artificial means Loss of thumb and index finger means complete severance of both the thumb and index finger at or above the metacarpophalangeal joints Exposure and Disappearance Benefit Minnesota Life pays 100% of the covered amount for your or your covered dependent s death if either of the following happen: You or your dependent dies from unavoidable exposure to the elements After one year, your or your dependent s body has not been found after the mode of transportation you or your dependent was traveling in: o Disappeared; o Made a forced landing; o Sank; or o Was wrecked. Seat Belt Benefit If you or your covered dependents die from injuries sustained while driving or riding in a private passenger car, and your and your dependent s seat belts were properly fastened, Minnesota Life pays an additional 10% of the covered amount. The amount payable will not exceed $25,000, nor will it be less than $1,000. A "passenger car" means any validly registered four-wheel passenger vehicle. It does not include: Any commercially licensed car; or Page 16

19 A private passenger car that is being used for commercial purposes. A "seat belt" means: Any child restraint device that meets the definition of the state law; or Any other restraint device that: o o o Meets published federal safety standards; Has been installed by the car manufacturer; and Has not been altered after such installation. The investigating officer must certify the correct position of the seat belt, and a copy of the police report must be submitted with the claim. The seat belt benefit is not payable if you or your dependents were driving while under the influence of alcohol or drugs. Hospital Benefit If you or your covered dependents are in the hospital as a result of an accident, Minnesota Life pays an additional 1% of the covered amount (on a monthly basis) during your hospital stay. The amount payable will not exceed $2,500 per month. This benefit is not payable for: The first four days of your hospital confinement; or More than 12 months during a period of hospital confinement. Payments for periods of less than a full month are made on a pro-rata basis. Training Benefit for Your Spouse If you die as a result of an accident, Minnesota Life pays a training benefit to your surviving spouse, equal to the lesser of the actual cost incurred for enrolling for one year or $5,000. The training benefit will only be paid if your spouse is not working for profit on the date of your accident, and if your spouse enrolls as a full-time student in a college, university, or vocational school within 365 following the date of the accident, for purposes of preparing for full-time employment. Education Benefit for Your Children If you die as a result of an accident, Minnesota Life pays an additional 2% of the covered amount, not to exceed $5,000 for each covered dependent who on the date of the accident was enrolled as a full-time student in a college, university, or vocational school above the 12th grade level. The education benefit for covered dependents is payable for a maximum of four consecutive years as long as the dependent remains a full-time student to the child s attainment of age 23. Child Care Center Benefit If you die as a result of an accident, Minnesota Life pays a child care benefit for each covered dependent who: Is age 12 or younger on the date of the accident; and Was enrolled in a child care center on the date of the accident. The annual amount payable is equal to the lesser of: Page 17

20 3% of the covered amount; and The actual amount of child care center costs incurred. The payable amount will not exceed $5,000 per year. The child care center benefit is payable for a maximum of four consecutive years as long as the dependent child remains: Enrolled in a child care center; and 12 years of age or younger. A "child care center" means a facility that: Is operated and licensed according to state law; and Provides care and supervision for children in a group setting on a regular, daily basis. Child care center benefits are paid to the surviving parent. The maximum child care benefit payable under this benefit shall be $50,000 regardless of the number of children who qualify. When AD&D Benefits Are Not Paid AD&D benefits are not paid for death, injuries, or losses resulting from: 1. suicide or attempted suicide, whether sane or insane; or 2. intentionally self-inflicted injury or any attempt at self-inflicted injury, whether sane or insane; or 3. the insured s participation in or attempt to commit a crime or felony; or 4. bodily or mental infirmity, illness or disease; or 5. medical or surgical treatment including diagnostic procedures; or 6. drugs, poisons, gases or fumes, voluntarily taken, administered, absorbed, inhaled, ingested or injected, unless prescribed or administered by a physician; or 7. alcohol, where the insured is legally intoxicated as defined by state law and is operating a motorized vehicle; or 8. bacterial infection, other than infection occurring simultaneously with, and as a result of, the accidental injury; or 9. travel or flight in or on any vehicle used for aerial navigation including getting in, out, on, or off such vehicle, if the insured is: (a) riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; or (b) acting as a pilot or a crew member of any aircraft, unless riding as a passenger; or (c) riding as a passenger in a non-chartered aircraft which is owned, leased, operated, or controlled by the eligible employee s employer; or (d) a student taking a flying lesson, unless riding as a passenger; or (e) hang gliding; or (f) parachuting, except when the insured has to make a parachute jump for self-preservation; or 9. war or any act of war, whether declared or undeclared; or 10. riot or civil insurrection; or 11. service in the military of any nation. Leave of Absence You may be approved to take a medical leave of absence where your AD&D insurance may be continued as long as you pay the monthly premium as billed by the Benefits Resources Center. If you are on a medical leave of absence, AD&D insurance cannot be continued beyond the earlier of your retirement date or the attainment of age 65. Page 18