Sponsored by: City of Overland Park Effective date: January 1, 2012

Transcription

1 Group Life Insurance Life and AD&D SUMMARY OF BENEFITS Sponsored by: City of Overland Park Effective date: January 1, 2012 All Full-time Police Officers, Firefighters or EMTs hired on or after January 1, 2011/All Other Full-Time Employees Life Employee Spouse and Dependent Amount Maximum Amount $200,000 Guarantee Issue $200, times Annual Salary rounded to the next higher $1,000 AD&D Employee Spouse Amount 2.5 times Annual Salary rounded to the next higher $1,000 Maximum Amount $200,000 Guarantee Issue $200,000 Reduction Employee Spouse s will reduce: 50% at age 70 s will terminate upon retirement. Additional s See Definitions Page: Accelerated Death Accident Plus Conversion Continuation of Coverage Seat Belt, Airbag, and Common Carrier Eligibility Employee Spouse All full-time active employees working 80 or more hours per pay period in an eligible class are eligible for coverage on the policy effective date. A delayed effective date will apply if the employee is not actively at work. $4,000 Spouse $2,000 Child: 1 day to age 26 s terminate at age 70 Cannot be in a period of limited activity on the day coverage takes effect. EMBARTA CITYOFOVER CIGFM405J /10/26

2 Definitions Accelerated Death Accident Plus AD&D Conversion Guarantee Issue Limited Activity Continuation of Coverage Seat Belt, Airbag, Common Carrier Term Life Additional s BeneficiaryConnect SM TravelConnect SM Accelerated Death provides an option to withdraw a percentage of your life insurance coverage when diagnosed as terminally ill (as defined in the policy). The death benefit will be reduced by the amount withdrawn. To qualify, you have satisfied the Active Work rule and have been covered under this policy for the required amount of time as defined by the policy. Check with your tax advisor or attorney before exercising this option. If loss occurs due to an accident, you may also receive the following Accident Plus benefits: Coma: Pays 5% of your principal sum up to a maximum of $5,000 if you are in a coma as a result of an accident covered under the policy and remain in a coma for 31 continuous days. Plegia: Pays 100% of your principal sum for quadriplegia and 50% of your principal sum for paraplegia and hemiplegia. Plegia must be caused by a covered accident. s are doubled if accident is caused by a common carrier. Repatriation: Pays up to $5,000 for preparation and transportation of your body when the accident occurs more than 150 miles away from home. Death must be the result of a covered accident. Education: As a result of your death, this benefit pays 5% of the principal sum up to a maximum of $5,000 for your eligible dependent s post-secondary education. The benefit is paid for up to four years. Spouse Training: As a result of your death, this benefit pays 5% of your principal sum up to a maximum of $5,000 for your spouse and covers the cost of classes taken to retrain or refresh skills needed for employment. s will be paid for one year and enrollment must occur within 365 days of the covered accident. Child Care: As a result of your death, this benefit pays 5% of your principal sum up to a maximum of $5,000 for expenses paid to a licensed childcare facility for an eligible dependent attending on a regular basis. The benefit will be paid for up to four consecutive years, or until your child s 13th birthday, whichever comes first. Accidental Death and Dismemberment (AD&D) insurance provides specified benefits for a covered accidental bodily injury that directly causes dismemberment (e.g., the loss of a hand, foot, or eye). In the event that death occurs from a covered accident, both the life and the AD&D benefit would be payable. If you terminate your employment or become ineligible for this coverage, you have the option to convert all or part of the amount of coverage in force to an individual life policy on the date of termination without Evidence of Insurability. Conversion election must be made within 31 days of your date of termination. For timely entrants enrolled within 31 days of becoming eligible, the Guarantee Issue amount is available without any Evidence of Insurability requirement. Evidence of Insurability will be required for any amounts above this, for late enrollees or increase in insurance, and it will be provided at your own expense. A period when a spouse or dependent is confined in a health care facility; or, whether confined or not, is unable to perform the regular and usual activities of a healthy person of the same age and sex. If coverage has been in force for at least 12 months, you may continue coverage for a specified period of time after your employment by paying the required premium. Portability is available if you cease employment for a reason other than total disability or retirement. A written application must be made within 31 days of your termination. If you die as a result of a covered auto accident while wearing a seat belt or in a vehicle equipped with an airbag, benefits are payable up to $10,000 or 10% of the principal sum, whichever is less. If loss occurs for you due to an accident while riding as a passenger in a common carrier, benefits will be double the amount that would otherwise apply as outlined in the certificate. Coverage provided to the designated beneficiary upon the death of the insured. Coverage is provided for the time period that you are eligible and premium is paid. There is no cash value associated with this product. Support services for beneficiaries who have experienced a loss. Travel assistance services for employees and eligible dependents traveling more than 100 miles from home. For assistance or additional information Contact Lincoln Financial Group at (800) or log on to NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern Lincoln National Corporation Group Insurance products are issued by The Lincoln National Life Insurance Company (Ft. Wayne, IN), which is not licensed and does not solicit business in New York. In New York, group insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group companies. Product availability and/or features may vary by state. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Each affiliate is solely responsible for its own financial and contractual obligations. «userid» «group_id» «proposal_id» «option_seq» 2011/10/26

3 Group Life Insurance Life and AD&D SUMMARY OF BENEFITS Sponsored by: City of Overland Park Effective date: January 1, 2012 All Full-time Police Officers, Firefighters or EMTs hired prior to January 1, 2011 Life Employee Spouse and Dependent Amount Maximum Amount $350,000 Guarantee Issue $350,000 5 times Annual Salary plus $25,000 rounded to the next higher $1,000 AD&D Employee Spouse Amount 5 times Annual Salary plus $25,000 rounded to the next higher $1,000 Maximum Amount $350,000 Guarantee Issue $350,000 Reduction Employee Spouse s will reduce: 50% at age 70 s will terminate upon retirement. Additional s See Definitions Page: Accelerated Death Accident Plus Conversion Continuation of Coverage Seat Belt, Airbag, and Common Carrier Eligibility Employee Spouse All full-time active employees working 80 or more hours per pay period in an eligible class are eligible for coverage on the policy effective date. A delayed effective date will apply if the employee is not actively at work. $4,000 Spouse $2,000 Child: 1 day to age 26 s terminate at age 70 Cannot be in a period of limited activity on the day coverage takes effect. EMBARTA CITYOFOVER CIGFM405J /10/26

4 Definitions Accelerated Death Accident Plus AD&D Conversion Guarantee Issue Limited Activity Continuation of Coverage Seat Belt, Airbag, Common Carrier Term Life Additional s BeneficiaryConnect SM TravelConnect SM Accelerated Death provides an option to withdraw a percentage of your life insurance coverage when diagnosed as terminally ill (as defined in the policy). The death benefit will be reduced by the amount withdrawn. To qualify, you have satisfied the Active Work rule and have been covered under this policy for the required amount of time as defined by the policy. Check with your tax advisor or attorney before exercising this option. If loss occurs due to an accident, you may also receive the following Accident Plus benefits: Coma: Pays 5% of your principal sum up to a maximum of $5,000 if you are in a coma as a result of an accident covered under the policy and remain in a coma for 31 continuous days. Plegia: Pays 100% of your principal sum for quadriplegia and 50% of your principal sum for paraplegia and hemiplegia. Plegia must be caused by a covered accident. s are doubled if accident is caused by a common carrier. Repatriation: Pays up to $5,000 for preparation and transportation of your body when the accident occurs more than 150 miles away from home. Death must be the result of a covered accident. Education: As a result of your death, this benefit pays 5% of the principal sum up to a maximum of $5,000 for your eligible dependent s post-secondary education. The benefit is paid for up to four years. Spouse Training: As a result of your death, this benefit pays 5% of your principal sum up to a maximum of $5,000 for your spouse and covers the cost of classes taken to retrain or refresh skills needed for employment. s will be paid for one year and enrollment must occur within 365 days of the covered accident. Child Care: As a result of your death, this benefit pays 5% of your principal sum up to a maximum of $5,000 for expenses paid to a licensed childcare facility for an eligible dependent attending on a regular basis. The benefit will be paid for up to four consecutive years, or until your child s 13th birthday, whichever comes first. Accidental Death and Dismemberment (AD&D) insurance provides specified benefits for a covered accidental bodily injury that directly causes dismemberment (e.g., the loss of a hand, foot, or eye). In the event that death occurs from a covered accident, both the life and the AD&D benefit would be payable. If you terminate your employment or become ineligible for this coverage, you have the option to convert all or part of the amount of coverage in force to an individual life policy on the date of termination without Evidence of Insurability. Conversion election must be made within 31 days of your date of termination. For timely entrants enrolled within 31 days of becoming eligible, the Guarantee Issue amount is available without any Evidence of Insurability requirement. Evidence of Insurability will be required for any amounts above this, for late enrollees or increase in insurance, and it will be provided at your own expense. A period when a spouse or dependent is confined in a health care facility; or, whether confined or not, is unable to perform the regular and usual activities of a healthy person of the same age and sex. If coverage has been in force for at least 12 months, you may continue coverage for a specified period of time after your employment by paying the required premium. Portability is available if you cease employment for a reason other than total disability or retirement. A written application must be made within 31 days of your termination. If you die as a result of a covered auto accident while wearing a seat belt or in a vehicle equipped with an airbag, benefits are payable up to $10,000 or 10% of the principal sum, whichever is less. If loss occurs for you due to an accident while riding as a passenger in a common carrier, benefits will be double the amount that would otherwise apply as outlined in the certificate. Coverage provided to the designated beneficiary upon the death of the insured. Coverage is provided for the time period that you are eligible and premium is paid. There is no cash value associated with this product. Support services for beneficiaries who have experienced a loss. Travel assistance services for employees and eligible dependents traveling more than 100 miles from home. For assistance or additional information Contact Lincoln Financial Group at (800) or log on to NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern Lincoln National Corporation Group Insurance products are issued by The Lincoln National Life Insurance Company (Ft. Wayne, IN), which is not licensed and does not solicit business in New York. In New York, group insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group companies. Product availability and/or features may vary by state. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Each affiliate is solely responsible for its own financial and contractual obligations. «userid» «group_id» «proposal_id» «option_seq» 2011/10/26

5 Long-Term Disability Insurance SUMMARY OF BENEFITS Sponsored by: City of Overland Park Effective date: January 1, 2012 All Full-Time Police Officers, Firefighters and Emergency Medical Technicians (EMTs) hired Prior to January 1, 2011 (Closed Class) Long-term disability is intended to protect your income for a long duration after you have depleted shortterm disability or any sick leave your company may offer. Eligibility Maximum Monthly Maximum Duration Own Occupation Period Elimination Period Accumulation of Elimination Days Pre-Existing Condition Waiver of Premium Survivor Income All full-time active employees working 80 or more hours per pay period in an eligible class are eligible for coverage on the policy effective date. 60% of salary up to $3,000 per month Later of Age 65 or Social Security Normal Retirement Age 24 Months, unless employee is actively participating in an Alternative Duty Assignment 90 days, unless employee is actively participating in an Alternative Duty Assignment The number of days you must be disabled prior to collecting disability benefits. You can satisfy the days of your elimination period with either total (off work entirely) or partial (working some hours at your current job) disability. If you are working on a partial basis, you will have 2x the elimination period days to satisfy the total of 90 days. You may not be eligible for benefits if you have received treatment for a condition within the past 3 months until you have been covered under this plan for 12 months. You will not be required to pay premium during any time of approved total or partial disability. A survivor benefit may be paid to your beneficiary if you should die while receiving qualifying disability payments. EmployeeConnect SM Access to an employee assistance program for the employee or an immediate household family member who may be experiencing personal or workplace issues. Limitations Progressive Income Family Care Expense Mental Illness: 24 Months Substance Abuse: 24 Months Specified Illness: 24 Months If you are disabled and have a loss of two or more Activities of Daily Living, you will receive an additional benefit of 10% to a maximum of $5,000. If you have a qualified disability and incur Family Care Expenses, you will be reimbursed for expenses up to $250 for a maximum of 12 months. EMBARTA CITYOFOVER CIKBA964J /10/26

6 Understanding Your s Own Occupation Total Disability Partial Disability Continuation of Disability Duration Reduction Pre-Existing Condition Exclusions Reductions Termination The occupation trade or profession you were employed in prior to your disability as defined by the US DOL Dictionary of Occupational Titles. You are considered totally disabled if, due to an injury or illness, you are unable to perform each of the main duties of your own occupation. Your own occupation is covered for a specific period of time. Following this, the definition of total disability becomes the inability to perform any occupation for which you are reasonably suited based on your experience, education, or training. You are considered partially disabled if you are unable, due to an injury or illness, to perform the main duties of your regular occupation on a full-time basis. Partial Disability benefits may be payable if you are earning at least 20% of the income you earned prior to becoming disabled, but not more than 99%. Partial disability benefits allow you to work and earn income from your employer as well as continue to receive benefits, which may enable you to receive 100% of your income during your time of disability. If you return to work full-time but become disabled from the same disability within six months of returning to work, you will begin receiving benefits again immediately. Your benefit duration may be reduced if you become disabled after age 65. Any sickness or injury for which you have received medical treatment, consultation, care, or services (including diagnostic measures or the taking of prescribed medications) during the specified months prior to the coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full-time basis for the specified months following the coverage effective date. You will not receive benefits in the following circumstances: Your disability is the result of a self-inflicted injury. You are not under the regular care of a doctor when requesting disability benefits. You were involved in a felony commission, act or war, or participation in a riot. You were residing outside of the United States or Canada for more than 12 consecutive months for purposes other than employment with your Employer. Your benefits may be reduced if you are receiving benefits from any of the following sources: Any compulsory benefit act or law (such as state disability plans); Any governmental retirement system earned as a result of working for the current policyholder; Any disability or retirement benefit received under a retirement plan; Any Social Security, or similar plan or act, benefits; Earnings the insured earns or receives from any form of employment. Workers compensation; Salary continuance or employer contributions to an employer sponsored retirement plan. This coverage will terminate when you terminate employment with this policyholder, or at your retirement. For assistance or additional information Contact Lincoln Financial Group at (800) or log on to NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern Lincoln National Corporation Group Insurance products are issued by The Lincoln National Life Insurance Company (Ft. Wayne, IN), which is not licensed and does not solicit business in New York. In New York, group insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group companies. Product availability and/or features may vary by state. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Each affiliate is solely responsible for its own financial and contractual obligations. EMBARTA CITYOFOVER CIKBA964J /10/26

7 Voluntary Short-Term Disability Insurance Specialty Worksite SUMMARY OF BENEFITS Sponsored by: City of Overland Park Effective date: January 1, 2012 Short-term disability is intended to protect your income for a short duration in case you become ill or injured. Eligibility Maximum Weekly Maximum Duration All full-time active employees working 80 or more hours per pay period in an eligible class are eligible for coverage on the policy effective date. 60% of weekly salary up to $1,385 per week Option 1: 11 weeks Option 2: 9 weeks Elimination Period Option 1: Option 2: s begin on: s begin on: 15 th day for an accident 31 st day for an accident 15 th day for an illness 31 st day for an illness *The longer of a)option elected or b)the period of sick leave and/or salary continuance due to Disability Rehabilitation Assistance Survivor Income Pre-Existing Condition Waiver of Premium Employees who participate in an approved rehabilitation program are eligible to receive an additional 5% of benefit. Additionally, approved program costs may be reimbursed. A benefit may be paid to your survivor if you should die while you were eligible to receive benefits under this policy. You may not be eligible for benefits if you have received treatment for a condition within the past 3 months until you have been covered under this plan for 12 months. You will not be required to pay premium during any time of approved total or partial disability. Enrollment Integration of s You are able to take advantage of this coverage now without a health examination. You may not be offered this opportunity again until your annual open enrollment. The benefits from this policy will be reduced by benefits you receive through state disability programs. EMBARTA CITYOFOVER CIGFM405J /10/26

8 Understanding Your s Total Disability Partial Disability Continuation of Disability Pre-Existing Condition Exclusions Reductions Termination You are considered totally disabled if, due to an injury or illness, you are unable to perform each of the main duties of your regular occupation. You are considered partially disabled if you are unable, due to an injury or illness, to perform the main duties of your regular occupation on a full-time basis. Partial Disability benefits may be payable if you are earning at least 20% of the income you earned prior to becoming disabled, but not more than 99%. Partial disability benefits allow you to work and earn income from your employer as well as continue to receive benefits, which may enable you to receive 100% of your income during your time of disability. If you return to work full-time but become disabled from the same disability within two weeks of returning to work, you will begin receiving benefits again immediately. Any sickness or injury for which you have received medical treatment, consultation, care, or services (including diagnostic measures or the taking of prescribed medications) during the specified months prior to the coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full-time basis for the specified months following the coverage effective date. You will not receive benefits in the following circumstances: Your disability is the result of a self-inflicted injury. You are not under the regular care of a doctor when requesting disability benefits. Your disability is covered under a worker s compensation plan and/or is due to a jobrelated sickness or injury. You are receiving payment under a salary continuance or retirement plan sponsored by the group policyholder. Your benefits may be reduced if you are receiving benefits from any of the following sources: Any governmental retirement system earned as a result of working for the current policyholder; Any disability or retirement benefit received under a retirement plan; Any Social Security, or similar plan or act, benefits; Earnings the insured earns or receives from any form of employment; Disability income benefits received under state disability benefit laws. This coverage will terminate when you terminate employment with this policyholder, or at your retirement. For assistance or additional information Contact Lincoln Financial Group at (800) or log on to NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern Lincoln National Corporation Group Insurance products are issued by The Lincoln National Life Insurance Company (Ft. Wayne, IN), which is not licensed and does not solicit business in New York. In New York, group insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group companies. Product availability and/or features may vary by state. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Each affiliate is solely responsible for its own financial and contractual obligations. EMBARTA CITYOFOVER CIGFM405J /10/26

9 Option 1: Semi-Monthly Premium Calculation John Doe is 33 and earns $2,500 per month. $2,500 x = $3.63 Semi-Monthly premium Attained Age Premium Factors < $ x = $ Your Monthly Salary* Premium Factor Your Semi-Monthly Cost *Maximum covered payroll is $10,002 monthly Option 2: Semi-Monthly Premium Calculation John Doe is 33 and earns $2,500 per month. $2,500 x = $2.88 Semi-Monthly premium Attained Age Premium Factors < $ x = $ Your Monthly Salary* Premium Factor Your Semi-Monthly Cost *Maximum covered payroll is $10,002 monthly This is only an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency. «userid» «group_id» «proposal_id» «option_seq» 2011/10/26

10 Voluntary Life Insurance SUMMARY OF BENEFITS Sponsored by: City of Overland Park Effective date: January 1, 2012 Life Employee Spouse Dependent Amount Choice of $10,000 increments Not to exceed 5 times your salary. Employees age 70 and older, maximum benefit is $50,000. Choice of $5,000 increments Employee must elect coverage for spouse to be eligible. Not to exceed 50% of employee elected amount. Minimum Amount $10,000 $5,000 $10,000 Maximum Amount $300,000 $100,000 $10,000 Guarantee Issue for Newly Eligible Employees Guarantee Issue for Current Eligible Employees $300,000 $30,000 $10,000 $10,000 Child: 1 day to age 26 Employee must elect coverage for dependent to be eligible. You or your spouse may elect or increase insurance coverage up to 2 increments on a guaranteed acceptance basis during your company's defined annual enrollment period, provided that you or your spouse have not been previously declined for coverage. Reduction Employee Spouse s will reduce: 50% at age 70 and will terminate upon retirement. Additional s See Definition: Accelerated Death Conversion Portability 50% at employee age 70 s will terminate upon retirement. Eligibility Employee Spouse and Dependents All full-time active employees working 80 or more hours per pay period in an eligible class are eligible for coverage on the policy effective date. A delayed effective date will apply if the employee is not actively at work. Cannot be in a period of limited activity on the day coverage takes effect. EMBARTA CITYOFOVER CIGFM405J /10/26

11 City of Overland Park Employee Semi-Monthly Premium Voluntary Life Premium for sample benefit amounts Employee and Spouse premiums are calculated separately. Refer to Program Specifications for your maximum benefit amounts. s and premium amounts reflect age reductions. $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 Semi- Monthly Rate per $1,000 <35 $.25 $.50 $.75 $1.00 $1.25 $1.50 $1.75 $2.00 $2.25 $ $.30 $.60 $.90 $1.20 $1.50 $1.80 $2.10 $2.40 $2.70 $ $.45 $.90 $1.35 $1.80 $2.25 $2.70 $3.15 $3.60 $4.05 $ $.65 $1.30 $1.95 $2.60 $3.25 $3.90 $4.55 $5.20 $5.85 $ $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $9.90 $ $1.90 $3.80 $5.70 $7.60 $9.50 $11.40 $13.30 $15.20 $17.10 $ $3.25 $6.50 $9.75 $13.00 $16.25 $19.50 $22.75 $26.00 $29.25 $ ** $4.65 $9.30 $13.95 $18.60 $23.25 $27.90 $32.55 $37.20 $41.85 $ $5,000 $10,000 $15,000 $20,000 $25,000 NA NA NA NA NA 70-74** $4.00 $8.00 $12.00 $16.00 $20.00 NA NA NA NA NA.8000 $5,000 $10,000 $15,000 $20,000 $25,000 NA NA NA NA NA 75+** $4.00 $8.00 $12.00 $16.00 $20.00 NA NA NA NA NA.8000 Spouse Semi-Monthly Premium Voluntary Life Premium for sample benefit amounts Employee and Spouse premiums are calculated separately. Spouse premiums will be calculated based on the Employee s age. Refer to Program Specifications for your maximum benefit amounts. s and premium amounts reflect age reductions. $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 Semi- Monthly Rate per $1,000 <35 $.13 $.25 $.38 $.50 $.63 $.75 $.88 $1.00 $1.13 $ $.15 $.30 $.45 $.60 $.75 $.90 $1.05 $1.20 $1.35 $ $.23 $.45 $.68 $.90 $1.13 $1.35 $1.58 $1.80 $2.03 $ $.33 $.65 $.98 $1.30 $1.63 $1.95 $2.28 $2.60 $2.93 $ $.55 $1.10 $1.65 $2.20 $2.75 $3.30 $3.85 $4.40 $4.95 $ $.95 $1.90 $2.85 $3.80 $4.75 $5.70 $6.65 $7.60 $8.55 $ $1.63 $3.25 $4.88 $6.50 $8.13 $9.75 $11.38 $13.00 $14.63 $ ** $2.33 $4.65 $6.98 $9.30 $11.63 $13.95 $16.28 $18.60 $20.93 $ ***PLEASE CONTACT YOUR BENEFIT ADMINISTRATOR FOR ADDITIONAL INFORMATION EXAMPLE: Use this formula to calculate premium for benefit amounts not shown above. This is only an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency. Age Semi-Monthly Rate per in $1,000's Semi-Monthly Cost $1,000 Example X 120 = $3.00 Yours X = Dependent Children Rate = $.40 Semi-Monthly Premium covers all dependent children regardless of the number of children. EMBARTA CITYOFOVER CIGFM405J /10/26

12 Definitions Accelerated Death Conversion Guarantee Issue Limited Activity Portability Term Life Exclusion: Suicide Additional s BeneficiaryConnect SM TravelConnect SM Accelerated Death provides an option to withdraw a percentage of your life insurance coverage when diagnosed as terminally ill (as defined in the policy). The death benefit will be reduced by the amount withdrawn. To qualify, you have satisfied the Active Work rule and have been covered under this policy for the required amount of time as defined by the policy. Check with your tax advisor or attorney before exercising this option. If you terminate your employment or become ineligible for this coverage, you have the option to convert all or part of the amount of coverage in force to an individual life policy on the date of termination without Evidence of Insurability. Conversion election must be made within 31 days of your date of termination. For timely entrants enrolled within 31 days of becoming eligible, the Guarantee Issue amount is available without any Evidence of Insurability requirement. Evidence of Insurability will be required for any amounts above this, for late enrollees or increase in insurance, and it will be provided at your own expense. A period when a spouse or dependent is confined in a health care facility; or, whether confined or not, is unable to perform the regular and usual activities of a healthy person of the same age and sex. If coverage has been in force for at least 12 months, you may continue coverage for a specified period of time after your employment by paying the required premium. Portability is available if you cease employment for a reason other than total disability or retirement. A written application must be made within 31 days of your termination. Coverage provided to the designated beneficiary upon the death of the insured. Coverage is provided for the time period that you are eligible and premium is paid. There is no cash value associated with this product. s will not be paid if the death results from suicide within two years after coverage is effective. May apply if employee contributes toward the premium. Support services for beneficiaries who have experienced a loss. Travel assistance services for employees and eligible dependents traveling more than 100 miles from home. For assistance or additional information Contact Lincoln Financial Group at (800) or log on to NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern Lincoln National Corporation Group Insurance products are issued by The Lincoln National Life Insurance Company (Ft. Wayne, IN), which is not licensed and does not solicit business in New York. In New York, group insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group companies. Product availability and/or features may vary by state. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Each affiliate is solely responsible for its own financial and contractual obligations. EMBARTA CITYOFOVER CIGFM405J /10/26