Employee Group Universal Life, Spouse/ Eligible Same-Gender Domestic Partner Group Universal Life, Children Dependent Term Life and Optional Accidental Death and Dismemberment (AD&D) Issued by The Prudential Insurance Company of America Employee Group Universal Life Prudential s Group Universal Life (GUL) plan for employees of Unisys offers you the opportunity to purchase affordable life insurance protection and build cash value by making additional contributions to a cash accumulation fund that earns tax-deferred interest at competitive rates. You can make those additional contributions either through payroll deductions or by lump sum deposits. Face Amount of Insurance Medical Evidence Requirements Cash Accumulation Fund 1 Loans 1 You may enroll for a face amount of insurance for one to eight times your annual base pay, not to exceed $4,000,000. During your initial eligibility period, you may enroll for one, two or three times your annual base pay, up to $500,000, without providing any evidence of insurability. After your initial eligibility period, evidence of insurability satisfactory to Prudential, may be required for all coverage amounts. In addition to regular payroll deductions, you may make lump sum contributions to the cash accumulation fund. The minimum lump sum contribution amount is $100. You may take loans from your cash accumulation fund. The minimum loan is $200 and the maximum loan is 90% of your available fund balance (minus any loans and loan interest and minus an amount equal to the next month s deduction). The loan interest charged is generally set at 2% above the interest being credited to your cash accumulation fund. You cannot take more than one loan per calendar year, and you may not have more than one outstanding loan at any time. Withdrawals 1 You may make withdrawals from your cash accumulation fund. The minimum withdrawal is $200 and the maximum withdrawal is the balance in your cash accumulation fund (minus any outstanding loan and loan interest). IFS-A093645 Ed.8/2005 ECEd.10.2008-0040 1
Accelerated Benefit Option 2 Continuation of Coverage If you are an active employee and provide proof, satisfactory to Prudential, that you or your spouse are terminally ill with a life expectancy of 6 months or less, you may elect to receive 75% up to $250,000, of the applicable GUL face amount of insurance while still living. (Certain conditions apply, please refer to your Certificate for details.) You may also receive up to of any applicable cash value (minus any outstanding loan and loan interest). The death benefit payable to the beneficiary will be reduced by any benefits paid under the Accelerated Benefit Option 2. This benefit is available once in a lifetime and is payable in a lump sum. You may continue your GUL insurance at group rates under the Continuation of Coverage Option if: Your employment terminates for any reason. You are no longer covered by the master contract Coverage for your class is ended, and is not replaced by another GUL plan. Continuation of coverage will begin on the first of the month following the date of notification of termination. Continuation rates will be provided at time of termination. Face Amount of Insurance Spouse/Eligible Same-Gender Domestic Partner Group Universal Life You may enroll your spouse/eligible same-gender domestic partner for a face amount of insurance in $10,000 increments to a maximum of $100,000. Medical Evidence Requirements Continuation of Coverage Additional Plan Provisions You may select to enroll your spouse/eligible same-gender domestic partner for coverage up to $20,000, without providing evidence of insurability satisfactory to The Prudential Insurance Company of America, if you enroll your spouse when first eligible. After your spouse s initial eligibility period, proof of good health will be required. You may continue your spouse s/eligible same-gender domestic partner s GUL coverage if coverage terminates for any reason other than non-payment of premium. In the event of your death or divorce, your spouse/eligible same-gender domestic partner and children may continue their coverage by paying premiums directly to Prudential. Please refer to Continuation of Coverage in the Employee section for more details. Spouse/eligible same-gender domestic partner GUL coverage has the same features as employee GUL coverage regarding the following plan provisions: Cash Accumulation Fund 1 Loans 1 Withdrawals 1 Accelerated Benefit Option 2 Children Dependent Term Life Coverage Amounts Coverage of $10,000 is available for all of your eligible dependent children from 14 days to age 19, 23 if full time student.. Evidence of insurability satisfactory to The Prudential Insurance Company of America is not required. If your dependent children are confined for medical care or treatment at home or elsewhere, coverage will begin when confinement ends. Continuation of Coverage You may continue your children s Dependent Term Life coverage provided that you choose to continue your own coverage. Please refer to Continuation of Coverage in the Employee section above for more details. 2
Face Amount of Insurance Benefits Optional Accidental Death & Dismemberment If you have enrolled for GUL coverage for yourself or your spouse/eligible samegender domestic partner you may choose to enroll for Optional AD&D coverage. Your Optional AD&D coverage amount will match the Group Universal Life coverage amount you ve elected. Benefits are paid at certain percentages of your coverage amount for specific accidental losses, as indicated in the chart below. Not more than of your coverage amount is payable for all losses due to the same accident. Life Sight in both eyes Both hands or both feet One hand & one foot Sight in one eye & one hand or one foot Speech & hearing in both ears Quadriplegia Paraplegia Hemiplegia One hand or one foot Sight in one eye Speech Hearing in both ears Thumb & index finger on the same hand 75% 25% Seat Belt Benefit Air Bag Benefit Additional Benefits Optional AD&D Exclusions The plan pays an additional benefit of 10% of your coverage amount, up to a maximum of $10,000, if you are in a covered accident and meet plan requirements, including use of a seat belt. The plan pays an additional benefit of 10% of your coverage amount, up to a maximum of $10,000, if you are in a covered accident and meet plan requirements, including deployment of an airbag. Spouse Tuition Reimbursement Benefit Child(ren) Tuition Reimbursement Benefit Day Care Expense Benefit A loss is not covered if it results from suicide or attempted suicide; intentionally self-inflicted injuries or an attempt at same; sickness; medical or surgical treatment of sickness; certain bacterial or viral infections (unless the infection was the result of an accidental injury or bacterial infection which results from the accidental ingestion of contaminated substances); act of war; certain full-time military duty; commission of, or attempt to commit a felony; legal intoxication or drug use; certain travel or flight in a vehicle used for aerial navigation (This provision may vary by state. Refer to the plan booklet for details). 1 Cash Accumulation Fund, Loans, and Withdrawals: Please note, if your cash contribution exceeds certain limits and your GUL coverage becomes a Modified Endowment Contract (MEC), different tax rules and, in some cases, penalties apply for lifetime distributions such as loans, withdrawals, and assignments including distributions made in the two years prior to becoming a MEC. A MEC can result from premium payments or from a reduction in coverage (such as the purchase of paid-up life insurance). If this applies to you, Prudential will notify you in writing of your status and advise you of your current options (if any) and by when you must respond. Loans and withdrawals can reduce policy values and may have tax consequences. Prudential is not authorized to give tax advice. Please consult your tax advisor. 2 Accelerated Benefit Option Important Notice: The acceleration of life insurance benefits offered under this certificate are intended to qualify for favorable tax treatment under the Internal Revenue Code of 1986 (under IRC Section 101(g)). If the acceleration of life insurance benefits qualify for such favorable treatment, the benefits will be excludable from your income and not subject to Federal taxation. Tax laws relating to acceleration of life benefits are complex. You are advised to consult with a qualified tax advisor about circumstances under which you could receive acceleration of life insurance benefits that are excludable from income under Federal law. 3
For your coverage to become effective, you must be actively at work during the enrollment period and on the effective date of the plan. If you apply for an amount that requires satisfactory evidence of insurability to The Prudential Insurance Company of America, you must be actively at work on the date of approval for the amount requiring satisfactory evidence of insurability. Refer to the plan booklet for details. All benefit features may not be available in all states. Group Universal Life coverage and Dependent Term Life coverage are issued by The Prudential Insurance Company of America, 751 Broad Street, Newark, NJ 07102. GUL Customer Service: 800-562-9874 and Life Claims: 1-800-524-0542. This is intended to be a summary of your benefits and does not include all plan provisions, exclusions, and limitations. A Booklet-Certificate, with complete plan information, including limitations and exclusions, will be provided. If there is a discrepancy between this document and the Booklet-Certificate issued by Prudential, the terms of the Booklet-Certificate will govern. Contract provisions may vary by state (Contract Series: 96945 and 83500). Prudential Financial is a registered service mark of The Prudential Insurance Company of America, Newark, NJ and its affiliates. 4
R A T E S H E E T Unisys Rates Effective: January 1, 2009 Group Universal Life* (Employee, Spouse/eligible same-gender domestic partner **) Age (Initial rates based on age as of effective date of your coverage. After that, rates based on your age each January 1. Rates will change based on the following age schedule.) Monthly Rate Non -Tobacco User Employee Rates per $1,000 Monthly Rate Tobacco User Employee Monthly Rate Non-Tobacco User Spouse/eligible same-gender domestic Monthly Rate Tobacco User Spouse/eligible same-gender domestic partner ** partner** 17-24 $0.022 $0.036 $0.022 $0.036 25-29 $0.022 $0.043 $0.022 $0.043 30-34 $0.019 $0.050 $0.019 $0.050 35-39 $0.029 $0.057 $0.029 $0.057 40-44 $0.037 $0.065 $0.037 $0.065 45-49 $0.065 $0.102 $0.065 $0.102 50-54 $0.100 $0.168 $0.100 $0.168 55-59 $0.186 $0.251 $0.186 $0.251 60-64 $0.298 $0.396 $0.298 $0.396 65-69 $0.415 $0.538 $0.415 $0.538 70 $0.645 $0.825 $0.645 $0.825 71 $0.695 $0.899 $0.695 $0.899 72 $0.760 $0.975 $0.760 $0.975 73 $0.839 $1.075 $0.839 $1.075 74 $0.932 $1.190 $0.932 $1.190 75 $1.025 $1.304 $1.025 $1.304 76 $1.125 $1.444 $1.125 $1.444 77 $1.247 $1.593 $1.247 $1.593 78 $1.356 $1.733 $1.356 $1.733 79 $1.482 $1.896 $1.482 $1.896 80 $1.621 $2.073 $1.621 $2.073 81 $1.770 $2.269 $1.770 $2.269 82 $1.933 $2.474 $1.933 $2.474 83 $2.129 $2.725 $2.129 $2.725 84 $2.329 $2.982 $2.329 $2.982 85 $2.553 $3.266 $2.553 $3.266 86 $2.786 $3.569 $2.786 $3.569 87 $3.033 $3.885 $3.033 $3.885 88 $3.201 $4.095 $3.201 $4.095 89 $3.452 $4.421 $3.452 $4.421 90 $3.722 $4.766 $3.722 $4.766 91 $4.016 $5.139 $4.016 $5.139 92 $4.454 $5.702 $4.454 $5.702 93 $4.747 $6.075 $4.747 $6.075 94 $5.302 $6.788 $5.302 $6.788 *This is optional coverage and the entire cost of coverage is employee paid. ** Spouse/eligible same-gender domestic partner s rate s based on spouse s age. IFS-A093645 Ed.12/2007 ECEd.9.2008-0037
R A T E S H E E T Unisys Rates Effective: January 1, 2009 Dependent Term Life* (Children - Regardless of the number of children) Coverage Amount Monthly Cost of Insurance $ 10,000 $0.054 Optional AD&D* Insured Monthly Cost of Insurance (Rates per $1,000 of Coverage) Employee $0.017 $0.017 Spouse/eligible same-gender domestic partner For rates not listed, contact Prudential's Customer Service Center at 800-562-9874. Effective January 1, 2009 to January 1, 2010, the certificate fund interest rate is 4.5%. *This is optional coverage and the entire cost of coverage is employee paid. Rates may change as the insured enters a higher age category, also rates may change if plan experience requires a change for all insureds. Please refer to the Booklet-Certificate for all plan details, including any exclusions, limitations and restrictions which may apply. Group Universal Life, Dependent Term Life and Optional AD&D coverages are underwritten by The Prudential Insurance Company of America, 751 Broad Street, Newark, New Jersey 07102, GUL/GVUL 1-800-562-9874, Life Claims: 1-800-524-0542. Contract provisions may vary by state. Contract Series: 83500 & 96945. Prudential Financial and the Rock Logo are registered service marks of The Prudential Insurance Company of America, Newark, NJ, and affiliates. 2