Summary of Beefits HAMPSHIRE COLLEGE All Employees other tha Dea of Faculty ad VP of Fiace ad Admiistratio Basic Term Life, Basic Accidetal Death & Dismembermet, Optioal Term Life, Optioal Depedet Term Life, Optioal Accidetal Death & Dismembermet ad Log Term Disability Issued by The Prudetial Isurace Compay of America Effective: 01/01/2018 Basic Term Life 100% Employer Paid Basic Term Life: You are automatically erolled for 2 times your covered aual earigs to $150,000. If you are termially ill, you ca get a partial paymet of your group life isurace beefit. You ca use this paymet as you see fit. The paymet to your beeficiary will be reduced by the amout you receive with the Accelerated Beefit Optio.* Refer to the pla booklet for details. Paymet of premium ca be waived if you are totally disabled for 9 moths, you are less tha 60 years old whe the disability begis, ad you cotiue to be totally disabled. This waiver termiates at age 65. This provisio may vary by state. Coverage will ed o your termiatio of employmet or as specified i the pla booklet. You may covert your isurace to a idividual life isurace policy issued by the Prudetial Isurace Compay of America. Basic Accidetal Death & Dismembermet 100% Employer Paid Basic AD&D pays you ad your beeficiary a beefit for the loss of life or other ijuries resultig from a covered accidet -- 100% for loss of life ad a lesser percetage for other ijuries. Ijuries covered may iclude loss of sight or speech, paralysis, ad dismembermet of hads or feet. Basic AD&D beefits are paid regardless of other coverages you may have. Basic AD&D: You are automatically erolled for a amout equal to your Basic Term Life coverage amout. * Importat Notice: The acceleratio of life isurace beefits offered uder this certificate are iteded to qualify for favorable tax treatmet uder the Iteral Reveue Code of 1986 (uder IRC Sectio 101(g)). If the acceleratio of life isurace beefits qualify for such favorable treatmet, the beefits will be excludable from your icome ad ot subject to Federal taxatio. Tax laws relatig to acceleratio of life beefits are complex. You are advised to cosult with a qualified tax advisor about circumstaces uder which you could receive acceleratio of life isurace beefits that are excludable from icome uder Federal law. 0308125-00001-00
Optioal Term Life 100% Employee Paid Purchase coverage for 1.0 to 5.0 times your covered aual earigs to a maximum of $500,000. New Hires: If you are ewly eligible, you ca elect a coverage amout up to the Guarateed Issue amout of $150,000, without providig evidece of isurability to The Prudetial Isurace Compay of America. CurretParticipats,Curret Employees who waived coverage i the past or Late Etrats (did ot eroll whe first eligible): Durig the ope erollmet period, you ca elect a coverage amout up to $150,000, without providig evidece of isurability to Prudetial. Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all coverage amouts over the Guarateed Issue amout or if erollig after the ope erollmet period. Curret Employees who were deied coverage i the past: Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all coverage amouts. If termially ill, you ca get a partial paymet of your group term life isurace beefit. You ca use this paymet as you see fit. I the evet of your death, your beeficiary will receive a beefit payout which has bee reduced by the amout you receive. Paymet of premium ca be waived if you are totally disabled for 9 moths, you are less tha 60 years old whe the disability begis, ad you cotiue to be totally disabled. This waiver termiates at age 65. This provisio may vary by state. Refer to the pla booklet for details. Durig future aual erollmet periods, if you erolled whe first eligible, you have ot waived coverage i the past or you have ot bee previously deied coverage, you may select to icrease your curret coverage amout up to a total of 1.0 times your covered aual earigs, ot to exceed $100,000, up to a total coverage amout of the pla maximum, without providig evidece of isurability to Prudetial. Outside of aual erollmet periods, evidece of isurability satisfactory to the Prudetial Isurace Compay of America is required for all icreases i coverage amouts. Upo termiatio of employmet, you (if eligible to port) may choose to cotiue a coverage amout equal to or lower tha your curret beefit amout. Coverage amouts will be subject to maximum of five times your aual earigs or $1 millio, whichever is less.
Spouse / Domestic Parter - Optioal Depedet Term Life 100% Employee Paid Purchase coverage for your spouse i the amouts of $10,000, $30,000, or $50,000. Please ote: The Depedet Term Life Isurace coverage amout o your spouse may ot exceed 50% of your Optioal Term Life coverage amout. New Hires: If your spouse is ewly eligible, you ca elect a coverage amout for your spouse up to the Guarateed Issue amout of $30,000, without providig evidece of isurability to The Prudetial Isurace Compay of America. Curret Spouse Participats, Curret Employees who waived spouse coverage i the past or Late Etrats (did ot eroll whe first eligible): Durig the ope erollmet period, you ca elect a coverage amout for your spouse up to $30,000, without providig evidece of isurability to Prudetial. Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all coverage amouts over the Guarateed Issue amout or if erollig after the ope erollmet period. Curret Employees whose spouse has bee deied coverage i the past: Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all coverage amouts. Upo termiatio of employmet, your spouse (if eligible to port) may choose to cotiue a coverage amout equal to or lower tha your curret beefit amout. Coverage amouts for you ad your spouse will be subject to a maximum of five times your aual earigs or $1 millio, whichever is less. 100% Employee Paid Child - Optioal Depedet Term Life Purchase coverage for $10,000. Please ote: The Optioal Depedet Term Life Isurace coverage amout o your childre may ot exceed 50% of your Optioal Term Life coverage amout. There are o health requiremets for this coverage. Coverage begis from live birth, ad cotiues to age 26. Upo termiatio of employmet, you (if eligible to port) may choose to cotiue a depedet child coverage amout equal to or lower tha your curret beefit amout. Employee - Optioal Accidetal Death & Dismembermet 100% Employee Paid Purchase a Optioal AD&D Isurace coverage amout equal to your Optioal Term Life Isurace coverage amout.
Spouse - Optioal Accidetal Death & Dismembermet 100% Employee Paid Purchase a Optioal AD&D Isurace coverage amout for your spouse equal to your spouses Optioal Depedet Term Life Isurace coverage amout. Log Term Disability 100% Employer Paid Your mothly Log Term Disability beefit will be 60% of your mothly pre-disability earigs, up to the maximum of $7,500, less deductible sources of icome. The miimum mothly beefit is the greater of $100 or 10% of your gross mothly beefit. Deductible sources of icome may iclude beefits from statutory plas, Social Security to you ad your depedets, workers compesatio, uemploymet icome ad other icome. If you meet the defiitio of disability, your beefits will begi 180 days followig a accidetal ijury or sickess. The beefit duratio is up to your ormal retiremet age uder the Social Security Act. However, if you become disabled at or after age 65 beefits are payable accordig to a age-based schedule. Refer to the Booklet-Certificate for details. You are cosidered disabled whe, because of ijury or sickess, you are uder the regular care of a doctor, you are uable to perform the material ad substatial duties of your regular occupatio ad your disability results i a loss of icome of at least 20%. After receivig beefits for 24 moths, you are cosidered disabled whe, due to the same sickess or ijury, you are uable to perform the material ad substatial duties of ay gaiful occupatio for which you are reasoably fitted by educatio, traiig or experiece, ad disability results i a loss of icome of a specified percetage determied by your pla. Disabilities due to metal illess are limited to 24 moths of beefits durig your lifetime. Examples of metal illess iclude schizophreia, depressio, maic depressive or bipolar illess, axiety, somatizatio, substace related disorders (icludig drug ad alcohol abuse), ad/or adjustmet disorders. Disabilities due to metal illess have a combied limited pay period durig your lifetime. LTD beefits will ot be paid for a disability that begis durig the first 12 moths of coverage ad due to a pre-existig coditio. A pre-existig coditio is a ijury or sickess for which you received medical treatmet, cosultatio, diagostic measures, prescribed drugs or medicies, or for which you followed treatmet recommedatios durig the 3 moths prior to your effective date of coverage. This provisio also applies if you did ot cosult a physicia whe a ordiarily prudet perso would have. Durig the first 12 moths of part-time work while disabled, you ca receive full beefits as log as your combied icome ad disability beefits do ot exceed your mothly pre-disability earigs. If you die while collectig disability beefits, a lump sum paymet may be paid to your eligible survivors. You are ot covered for a disability caused by war or ay act of war, declared or udeclared, a itetioally self-iflicted ijury, active participatio i a riot, ad commissio of a crime for which you have bee covicted. Beefits are ot payable for ay period of icarceratio as a result of a covictio. Beefits, exclusios ad provisios may vary by state. Refer to the pla booklet for details. For your coverage to become effective, you must be actively at work o the effective date of the pla. If you apply for a amout that requires satisfactory evidece of isurability to The Prudetial Isurace Compay of America, you must be actively at work o the date of approval for the amout requirig satisfactory evidece of isurability. *Accelerated Death Beefit optio is a feature that is made available to group life isurace participats. It is ot a health, ursig home, or log-term care isurace beefit ad is ot desiged to elimiate the eed for those types of isurace coverage. The death beefit is reduced by the amout of the accelerated death beefit paid. There is o admiistrative fee to accelerate beefits. Receipt of accelerated death beefits may affect eligibility for public assistace ad may be taxable. The federal icome tax treatmet of paymets made uder this rider depeds upo whether the isured is the recipiet of the beefits ad is cosidered "termially ill" or "chroically ill." You may wish to seek professioal tax advice before exercisig this optio.
This policy provides ACCIDENT isurace oly. It does NOT provide basic hospital, basic medical or major medical isurace as defied by the New York Departmet of Fiacial Services. IMPORTANT NOTICE - THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. This policy provides disability icome isurace oly. It does NOT provide basic hospital, basic medical or major medical isurace as defied by the New York Departmet of Fiacial Services. Optioal Term Life, Depedet Term Life, Log Term Disability, Short Term Disability, Accidetal Death & Dismembermet Isurace coverages are issued by The Prudetial Isurace Compay of America, a Prudetial Fiacial compay, Newark, NJ 07102. The Booklet-Certificate cotais all details, icludig ay policy exclusios, limitatios, ad restrictios, which may apply. Cotract Series: 83500 2016 Prudetial Fiacial, Ic. ad its related etities. Prudetial, the Prudetial logo, ad the Rock symbol are service marks of Prudetial Fiacial, Ic. ad its related etities, registered i may jurisdictios worldwide.
Rate Sheet HAMPSHIRE COLLEGE All Employees other tha Dea of Faculty ad VP of Fiace ad Admiistratio Issued by The Prudetial Isurace Compay of America Effective: 01/01/2018 Rates may chage as the isured eters a higher age category. Also, rates may chage if pla experiece requires a chage for all isureds. How much does life isurace cost? The followig steps will show you how to calculate your bi-weekly cost of isurace. Step 1 Eter the amout of Employee coverage you wish to purchase. $ Employee Step 2 Divide the coverage amouts by 1,000. $ Step 3 Step 4 Multiply the dollar amouts i Step 2 by the cost of coverage per $1,000 of coverage, accordig to your age, that youll fid i the chart that follows. This gives you the mothly cost of isurace. To calculate your paycheck deductio, multiply the mothly cost i Step 3 by 12 to get the aual cost ad the divide the aual cost by 26 to get your bi-weekly cost. $ $ TOTAL COST FOR EMPLOYEE $ Implemetatio of the isurace pla(s) will deped o havig a specific percetage of all eligible employees erollig i the pla(s). If this percetage of erollmet level is ot met, these coverage(s) may ot be effective. 0270257
Cost of Optioal Term Life Isurace for You Coverage is available for 1.0 to 5.0 times your covered aual earigs, ot to exceed $500,000. Refer to the Optioal Term Life sectio for evidece of isurability details. Iitial rates based o age as of effective date of your coverage. Rates will chage based o the followig age schedule. Employee's Age Employee Rate < 29 $0.040 30-34 $0.050 35-39 $0.060 40-44 $0.110 45-49 $0.170 50-54 $0.330 55-59 $0.500 60-64 $0.520 65-69 $0.940 70-100 $2.480 A 35 year-old employee elects Example $60,000 of Optioal Term Life for themselves Employee Mothly Cost $3.60 ($60,000 / 1,000 x $0.060) Spouse / Domestic Parter - Optioal Depedet Term Life Bi-Weekly Cost per Coverage Amout Coverage is available i icremets of $10,000 to a maximum of $50,000, ot to exceed 50% of your Optioal Term Life coverage amout. Refer to the Optioal Depedet Term Life sectio for evidece of isurability details. Iitial rates based o age as of effective date of your coverage. Rates will chage based o the followig age schedule. Age $10,000 $30,000 $50,000 0-29 $0.18 $0.55 $0.92 30-34 $0.23 $0.69 $1.15 35-39 $0.28 $0.83 $1.38 40-44 $0.51 $1.52 $2.54 45-49 $0.78 $2.35 $3.92 50-54 $1.52 $4.57 $7.62 55-59 $2.31 $6.92 $11.54 60-64 $2.40 $7.20 $12.00 65-69 $4.34 $13.02 $21.69 70-100 $11.45 $34.34 $57.23 Rates may chage as the isured eters a higher age category. Also, rates may chage if pla experiece requires a chage for all isureds. Spouse / Domestic Parter rate is based o employee's age. Childre - Optioal Depedet Term Life Bi-Weekly Cost per Coverage Amout Oe premium rate covers all eligible childre $10,000 $0.92 Rates may chage if pla experiece requires a chage for all isureds.
Spouse/Domestic Parter - Optioal Accidetal Death & Dismembermet Bi-Weekly Cost per Coverage Amout Your Optioal AD&D coverage amout for your spouse is equal to your spouse's Optioal Depedet Term Life coverage amout. Refer to the Optioal AD&D sectio for evidece of isurability details. $10,000 $30,000 $50,000 $0.08 $0.25 $0.42 Beefits, exclusios ad provisios may vary by state. Refer to the pla booklet for details. For your coverage to become effective, you must be actively at work o the effective date of the pla. If you apply for a amout that requires satisfactory evidece of isurability to The Prudetial Isurace Compay of America, you must be actively at work o the date of approval for the amout requirig satisfactory evidece of isurability. *Accelerated Death Beefit optio is a feature that is made available to group life isurace participats. It is ot a health, ursig home, or log-term care isurace beefit ad is ot desiged to elimiate the eed for those types of isurace coverage. The death beefit is reduced by the amout of the accelerated death beefit paid. There is o admiistrative fee to accelerate beefits. Receipt of accelerated death beefits may affect eligibility for public assistace ad may be taxable. The federal icome tax treatmet of paymets made uder this rider depeds upo whether the isured is the recipiet of the beefits ad is cosidered "termially ill" or "chroically ill." You may wish to seek professioal tax advice before exercisig this optio. This policy provides ACCIDENT isurace oly. It does NOT provide basic hospital, basic medical or major medical isurace as defied by the New York Departmet of Fiacial Services. IMPORTANT NOTICE - THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. Optioal Term Life, Depedet Term Life, Log Term Disability, Short Term Disability, Accidetal Death & Dismembermet Isurace coverages are issued by The Prudetial Isurace Compay of America, a Prudetial Fiacial compay, Newark, NJ 07102. The Booklet-Certificate cotais all details, icludig ay policy exclusios, limitatios, ad restrictios, which may apply. Cotract Series: 83500 2016 Prudetial Fiacial, Ic. ad its related etities. Prudetial, the Prudetial logo, ad the Rock symbol are service marks of Prudetial Fiacial, Ic. ad its related etities, registered i may jurisdictios worldwide. 0270257-00002-00