Life Short Term Disability

Transcription

1 a lifetie of coitent c o p a n i o n b u s i n e s s plan f o r groups of 2 t h r o u g h 9 e p l o y e e s Life Short Ter Disability

2 Approxiately 30% of all people age 35 to 65 will becoe disabled for at least 90 days. It is estiated that one in seven can expect to becoe disabled for five years or ore. 1 Beginning at age 35, you have a chance of being unable to work for ore than three onths before you turn age Many eployees, however, are unprepared Short Ter Disability Copanion Life s Short Ter Disability (STD) coverage provides the solution... a source of incoe for eployees who can t work because of sickness or injury. STD coverage replaces 60% of an eployee s weekly earnings up to a axiu of $750 per week. Benefits begin on the first day if the disability resulted fro an accident, or the eighth day if caused by illness. Benefits continue for 13 or 26 weeks as chosen by the eployer. If the disability recurs ore than 30 consecutive days after the eployee returns to active fulltie work, a new benefit period begins. STD benefits are payable for disabilities resulting fro non-occupational accidents or illnesses only. Additional Benefits Maternity Coverage: Benefits for disability due to aternity are covered as any other illness and begin on the eighth day. Pre-Existing Conditions Liitations There are no pre-existing condition liitations. Percent of Earnings Plan All eployees receive an aount of STD benefit equal to 60% of their weekly earnings rounded to the next $1, to a axiu not to exceed $750 per week. Refer to saple preiu calculation exaple below: for the financial devastation a disability causes. short ter disability onthly rate table 13-Week Benefit (Cost per $10 of Benefit) 26-Week Benefit (Cost per $10 of Benefit) Age Male Feale Male Feale Under age & Older exaple: three-person eployer group chooses 13-week benefit Eployee Sex Age Earnings Weekly STD Benefit Weekly Nuber 1 F 25 $400 X 60% = $240 Nuber 2 M 34 $500 X 60% = $300 Nuber 3 M 48 $650 X 60% = $390 onthly cost Eployee STD Benefit Weekly Rate Fro Table STD Preiu Monthly Preiu Nuber 1 $ = 24 X.69 = $16.56 Nuber 2 $ = 30 X.37 = $11.10 Nuber 3 $ = 39 X.55 = $21.45 Total Monthly Preiu $49.11 Billing Fee: A onthly billing fee of $10 will be included for the eployer group. 1 Health Insurance Association of Aerica, The New York Ties, February Society of Actuaries, Money Magazine, April 2000

3 Group Ter Life, AD&D Group Ter Life and AD&D continues to be one of the ost iportant and best values of all eployee benefits. For any eployees, group ter life insurance is the only life insurance they have. Copanion Life s Group Ter Life and AD&D provides eployees with a iniu life aount of $10,000 and a axiu life aount of $100,000. AD&D benefits are equal to the aount of life benefits. The full AD&D benefit is payable for the following losses if such loss is the result of an accident: loss of life, loss of both hands or both feet, loss of sight in both eyes, loss of a hand and a foot, loss of a hand or a foot and the sight in one eye. Half of the AD&D benefit is payable for the following losses if such loss is the result of an accident: loss of a hand, loss of a foot, loss of sight in one eye. Benefits for Life and AD&D reduce to 65% of the original aount at age 65 and terinate at age 70, or at retireent, if earlier. Additional Benefits Extended death benefit: The death benefit will be paid if the person dies while totally disabled. The disability ust begin while the person was both insured under this plan and under age 60, be continuous until death, and begin within 12 onths of the date of death. Conversion privilege: Eployees ay convert to an individual life policy within 31 days of leaving active eployent. No evidence of insurability will be required. Coverage: 24 hour coverage. Dependent life (optional): Dependent life insurance provides coverage for an eployee s spouse and children. Spouse life aount $10,000. Children, 6 onths to 19 years, life aount $5,000. Children, 14 days to 6 onths, life aount $200. Once elected, the plan autoatically covers additional dependents as they becoe eligible. group ter life and ad&d onthly preiu Age at Last Birthday $10,000 $15,000 $25,000 $50,000 $75,000 $100,000 Under age * Benefits Terinate at Age 70 * Life Benefit reduced at age 65 to 65% of original aount. Preiu shown is for the reduced benefit aount. Dependent Life $10,000 on spouse, $5,000 on children, $200 on children 14 days to 6 onths. Cost $10 per onth per faily. Choose fro two different plan designs Flat Aount Plan All eployees receive one of the following flat aounts of Life and AD&D:.$10,000 $15,000.$25,000 $50,000.$75,000 $100,000 Class Plan All eployees ust be placed in a clearly defined class according to condition of eployent. The life aount for the highest class cannot exceed $100,000 and cannot be ore than two and a half ties the life aount for the next lower class. Aounts ust be in increents of $10,000 only. Eployer Eligibility Eployers eeting these requireents are eligible for coverage: Two to nine eligible eployees No ore than 50% of the group related by blood or arriage, unless special consideration is given by underwriting In business at least one year

4 Copanion Life Insurance Copany has specialized in group benefits for ore than 35 years. We ve earned an A.M. Best Rating of A+ (Superior). We ve earned these high arks due to our fiscal strength, investent practices and sound anageent. Now, we want to earn your trust by giving you the highest level of service and responsiveness possible. for a proposal, contact Copanion Life Insurance Copany Group Marketing P.O. Box Colubia, SC phone fax web site General Inforation Eployee Eligibility Eployees eeting all these requireents are eligible for coverage: 30 days of continuous service with the eployer Full-tie eployent (i.e., working 30 or ore hours per week) Work 15 of the 20 working days prior to the effective date of coverage Actively at work on the effective date of coverage Participation If the eployer pays the entire cost 100% participation is required. If the eployees contribute to the cost eployer is required to contribute a iniu of 25%. If Dependent Life is selected, 100% of those eployees with eligible dependents ust enroll. Nuber of Eployees Participation Required Effective Coverage is effective on the first or the 15th of the onth following approval of the group s application by Copanion Life. Evidence of Insurability Evidence of insurability is not required for STD. evidence of insurability nuber of eligible lives life and ad&d std 2-4 Aounts in excess of $25,000 No Evidence of Insurability Required 5-9 Aounts in excess of $50,000 No Evidence of Insurability Required Even though one or ore eployees ay be declined coverage for edical reasons, the eployer unit ay be accepted provided at least two eployees are approved for coverage. This is a general outline of covered benefits and does not include all the benefits, liitations and exclusions of the policy. Please see your certificate for details. Policy For #GP-1000 firs ineligible for life, ad&d, dependent life and short ter disability Auseent Enterprises Auto Wreckers, Junkyards Bail Bondsan, Repossession Barber and Beauty Shops Bars, Night Clubs Building Wreckers Car Wash Businesses Charitable Groups Dance Halls and Studios Drug and Alcohol Rehabilitation Entertainent Groups Explosives Industry Fire and Police Departents Florists Garbage Collectors and Scavengers Guard or Watchen Services Hatcheries Independent Contractors Liquor Stores Logging and Sawills Massage Parlors Mining, Quarrying and Drilling Operations Motorcycle Sales and Services Parking Lots Private Households Taxi Copanies firs engaged in the following activities are only eligible for life, ad&d, and dependent life (not eligible for short ter disability) Abulance Services Asbestos Products Auto and Body Repair Auto Dealers Bus Copanies Doctors and Dentists Dry Cleaners and Laundries Eployee Leasing Firs Fars and Ranches Gas Stations and Garages Governent-Funded Groups Health and Sports Clubs Hoe Health Service Hotels and Motels Janitorial and Building Maintenance Lawn and Tree Services Movers Nursing Hoes Petroleu Bulk Stations Public Transportation Copanies Pulp and Paper Mills Religious Groups Restaurants and Bars Scrap Iron Dealers Social Service Groups Union Groups Video Rental Firs A Lifetie Of Coitent Rev. 06/10

5 EMPLOYER INFORMATION EMPLOYER PARTICIPATION APPLICATION FOR THE JOINT EMPLOYER GROUP INSURANCE TRUST Fir Nae Address City State Zip Telephone ( ) Fir Contact (person to contact concerning coverages) Type of Business (i.e., sole proprietorship, partnership, corporation, etc). # Full-tie Eployees in Fir: # Full-tie Eployees Enrolled: Effective Requested: SIC Code or Nature of Business: (The fir s effective date will be the first or the 15th of the onth following written acceptance by Copanion Life Insurance Copany.) How any years in this business? How any years in this location? Tax I.D. Nuber Will this insurance replace existing insurance? Nae of existing carrier Which coverages are being replaced? Life and AD&D STD Life and AD&D Flat Aount Plan $10,000 $15,000 $25,000 $50,000 $75,000 $100,000 Class Plan Life and AD&D Class Description Aount 1 $ 2 $ 3 $ Percent of preiu paid by eployer % (A iniu of 25% is required.) Dependent Life Yes No Spouse: $10,000 Children: $5,000 Children: 14 days - 6 onths: $200 Initial Enrollent One onth Other Benefit Period Waiting Period Future Eployees One onth Other STD Percent of Earnings 60% to a axiu benefit of (select one): $750/week 13 weeks 26 weeks Benefits Begin: First Day (Accident) $ /week Eighth Day (Illness) Percent of preiu paid by eployer % (A iniu of 25% is required.) Life and AD&D Total Dependent Life Total STD Total Total Monthly Monthly Preiu Monthly Preiu Monthly Preiu $10.00 per onth Preiu $ + $ + $ + Adinistration Fee = $ Are any of the persons to be covered retired, currently hospitalized, disabled or on any extension of benefits? Yes No (If yes, give details.) FRAUD WARNING (Not Applicable in AZ, FL, MD, OR, VA): Any person who knowingly and with intent to defraud any insurance copany or other person files an application for insurance or a stateent of clai containing any aterially false inforation or conceals for the purpose of isleading, inforation concerning any fact aterial thereto coits (in TX, ay be coitting) a fraudulent insurance act, which is a crie and subjects (in KS, which ay be deterined by a court of law to be a crie which subjects) such person to criinal and civil penalties. FRAUD WARNING (FL only): Any person who knowingly and with intent to injure, defraud or deceive any insurer files a stateent of clai or an application containing any false, incoplete or isleading inforation is guilty of a felony of the third degree. Participation Agreeent (adinistered and underwritten by Copanion Life Insurance Copany) The Participant does hereby apply for Group Insurance Benefits as set forth in the above Eployer Participation Application for the Joint Eployer Group Insurance Trust and subscribes to the Agreeent and Declaration of Trust. Nae of Trust: Joint Eployer Group Insurance Trust It is understood and agreed by the undersigned that the Trustee is not an insurer, nor does he have any obligation under any policy of insurance and that all clais for and benefits provided by insurance being applied for herein shall be ade to and payable by the Insurance Copanies issuing group policy(ies) to the Trustees, but only to the extent and in strict accordance with the provisions of such policy. The Trust agreeent and the group policy(ies) held by the Trustee are available for inspection during regular business hours by the Participant at the office of the Adinistrator, Copanion Life Insurance Copany, located at 7909 Parklane Road, Suite 200, Colubia, SC The undersigned eployer agrees that coverage shall not coence until this application has been approved by Copanion Life Insurance Copany and notice of approval has been transitted to us. As naed eployer, I understand that I should not cancel any existing coverage until notified that this application has been accepted by Copanion Life. Signature of Applicant Signature of Agent/Broker Printed Nae FOR HOME OFFICE USE Accepted by Adinistrator Effective: By: Rev. 12/07