Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D) SUMMARY OF BENEFITS Sponsored by: Pediatric Partners, LLC Life Benefit Employee Spouse Dependent Employee must elect coverage for Spouse or dependents to be eligible. Amount Choice of 10,000 increments Choice of 5,000 increments 14 Days to 6 months: 250 6 months to age 19 (to age 25 if full-time student): 10,000 Newborn children to age 14 days are not eligible for a benefit Minimum Amount 10,000 5,000 10,000 Maximum Amount 500,000, limited to 5 times your annual salary Employees age 70 and older, maximum benefit is 50,000 100,000, limited to 50% of employee amount 10,000 Guarantee Issue for Newly Eligible Employee Current Eligible Employees 100,000 10,000 You or your Spouse may elect or increase insurance coverage equal to 2 benefit levels on a guaranteed acceptance basis during your company's defined annual open enrollment period, provided that you or your Spouse have not been previously declined, withdrawn, or pending for coverage. AD&D Benefit Employee Spouse Amount Benefit Reduction Optional coverage can be purchased by you for additional premium. Benefit amount equal to the life amount elected by you. Employee Same as employee Spouse Benefits will reduce: 35% at age 65; Additional 15% of original amount at age 70; Benefits terminate at retirement 35% at Employee 65 Benefits terminate at Employee's attainment of age 70 or retirement, whichever occurs first. Eligibility Employee Spouse and Dependents Additional Benefits All employees in an eligible class. Cannot be in a period of limited activity on the day coverage takes effect. Accelerated Death Benefit Portability Conversion Seat Belt, Airbag, and Common Carrier 2015 Lincoln National Corporation - PEDPART2-8/15-Employee Choice - Increments- Gen -11/1/2016
Definitions Accelerated Death Benefit AD&D Conversion Guarantee Issue Limited Activity Portability Seat Belt, Airbag, and Common Carrier Term Life Exclusion: Suicide Additional Benefits LifeKeys SM TravelConnect SM Accelerated Death Benefit 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 The death benefit will be reduced by the amount withdrawn.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. 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. This insurance is optional and can be purchased by you and your Spouse. 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 at Social Security Normal 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, additional 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. Benefit provided to the designated beneficiary upon the death of the insured. The benefit is provided for the time period that you are eligible and premium is paid. There is no cash value associated with this product. Benefits will not be paid if the death results from suicide within 1 year after coverage is effective. May apply if employee contributes toward the premium. Online will & testament preparation service, identity theft resources and beneficiary assistance support for all employees and eligible dependents covered under the Group Term Life and/or AD&D policy. 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) 423-2765; reference ID: PEDPART2 www.lincolnfinancial.com 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. Insurance products are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. Not for use in New York.
Employee Premium Life Premium for sample benefit amounts AGE 10,000 20,000 30,000 40,000 50,000 0.0245 <25 0.25 0.49 0.74 0.98 1.23 1.47 1.72 1.96 2.21 2.45 0.0245 25-29 0.25 0.49 0.74 0.98 1.23 1.47 1.72 1.96 2.21 2.45 0.0323 30-34 0.32 0.65 0.97 1.29 1.62 1.94 2.26 2.58 2.91 3.23 0.0485 35-39 0.49 0.97 1.46 1.94 2.43 2.91 3.40 3.88 4.37 4.85 0.0738 40-44 0.74 1.48 2.21 2.95 3.69 4.43 5.17 5.90 6.64 7.38 0.1149 45-49 1.15 2.30 3.45 4.60 5.75 6.89 8.04 9.19 10.34 11.49 0.1694 50-54 1.69 3.39 5.08 6.78 8.47 10.16 11.86 13.55 15.25 16.94 0.3115 55-59 3.12 6.23 9.35 12.46 15.58 18.69 21.81 24.92 28.04 31.15 0.4435 60-64 4.44 8.87 13.31 17.74 22.18 26.61 31.05 35.48 39.92 44.35 0.8400 65-69 6,500 13,000 19,500 26,000 32,500 39,000 45,500 52,000 58,500 65,000 5.46 10.92 16.38 21.84 27.30 32.76 38.22 43.68 49.14 54.60 2.5892 70-74 5,000 10,000 15,000 20,000 25,000 N/A N/A N/A N/A N/A 12.95 25.89 38.84 51.78 64.73 N/A N/A N/A N/A N/A 2.5892 75-79 5,000 10,000 15,000 20,000 25,000 N/A N/A N/A N/A N/A 12.95 25.89 38.84 51.78 64.73 N/A N/A N/A N/A N/A 2.5892 80+ 5,000 10,000 15,000 20,000 25,000 N/A N/A N/A N/A N/A 12.95 25.89 38.84 51.78 64.73 N/A N/A N/A N/A N/A 60,000 70,000 80,000 90,000 100,000 100,000 1,000 X Benefit In 1,000 s = 35 0.0485 X 150 = 7.28 Dependent Children Benefit 10,000 - - - - - - - Rate: 0.92 - - - - - - -
Spouse Premium Life Premium for sample benefit amounts Spouse premiums will be calculated based on the Employee AGE 5,000 10,000 15,000 20,000 25,000 30,000 0.0245 <25 0.12 0.25 0.37 0.49 0.61 0.74 0.86 0.98 1.10 1.23 0.0245 25-29 0.12 0.25 0.37 0.49 0.61 0.74 0.86 0.98 1.10 1.23 0.0323 30-34 0.16 0.32 0.48 0.65 0.81 0.97 1.13 1.29 1.45 1.62 0.0485 35-39 0.24 0.49 0.73 0.97 1.21 1.46 1.70 1.94 2.18 2.43 0.0738 40-44 0.37 0.74 1.11 1.48 1.85 2.21 2.58 2.95 3.32 3.69 0.1149 45-49 0.57 1.15 1.72 2.30 2.87 3.45 4.02 4.60 5.17 5.75 0.1694 50-54 0.85 1.69 2.54 3.39 4.24 5.08 5.93 6.78 7.62 8.47 0.3115 55-59 1.56 3.12 4.67 6.23 7.79 9.35 10.90 12.46 14.02 15.58 0.4435 60-64 2.22 4.44 6.65 8.87 11.09 13.31 15.52 17.74 19.96 22.18 0.8400 65-69 3,250 6,500 9,750 13,000 16,250 19,500 22,750 26,000 29,250 32,500 2.73 5.46 8.19 10.92 13.65 16.38 19.11 21.84 24.57 27.30 2.5892 70-74 - - - - - - - - - - #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 2.5892 75-79 2,500 5,000 7,500 10,000 12,500 15,000 17,500 20,000 22,500 25,000 6.47 12.95 19.42 25.89 32.37 38.84 45.31 51.78 58.26 64.73 2.5892 80-84 2,500 5,000 7,500 10,000 12,500 15,000 17,500 20,000 22,500 25,000 6.47 12.95 19.42 25.89 32.37 38.84 45.31 51.78 58.26 64.73 2.5892 85-89 2,500 5,000 7,500 10,000 12,500 15,000 17,500 20,000 22,500 25,000 6.47 12.95 19.42 25.89 32.37 38.84 45.31 51.78 58.26 64.73 35,000 40,000 45,000 50,000 50,000 1,000 X Benefit In 1,000 s = 35 0.0485 X 75 = 3.64 Dependent Children Benefit 10,000 - - - - - - - Rate: 0.92 - - - - - - -
Employee Premium Life and Accidental Death and Dismemberment Premium for sample benefit amounts AGE 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 100,000 0.0337 <25 0.34 0.67 1.01 1.35 1.69 2.02 2.36 2.70 3.03 3.37 0.0337 25-29 0.34 0.67 1.01 1.35 1.69 2.02 2.36 2.70 3.03 3.37 0.0415 30-34 0.42 0.83 1.25 1.66 2.08 2.49 2.91 3.32 3.74 4.15 0.0577 35-39 0.58 1.15 1.73 2.31 2.89 3.46 4.04 4.62 5.19 5.77 0.0831 40-44 0.83 1.66 2.49 3.32 4.16 4.99 5.82 6.65 7.48 8.31 0.1242 45-49 1.24 2.48 3.73 4.97 6.21 7.45 8.69 9.94 11.18 12.42 0.1786 50-54 1.79 3.57 5.36 7.14 8.93 10.72 12.50 14.29 16.07 17.86 0.3208 55-59 3.21 6.42 9.62 12.83 16.04 19.25 22.46 25.66 28.87 32.08 0.4528 60-64 4.53 9.06 13.58 18.11 22.64 27.17 31.70 36.22 40.75 45.28 0.8492 65-69 6,500 13,000 19,500 26,000 32,500 39,000 45,500 52,000 58,500 65,000 5.52 11.04 16.56 22.08 27.60 33.12 38.64 44.16 49.68 55.20 2.5985 70-74 5,000 10,000 15,000 20,000 25,000 N/A N/A N/A N/A N/A 12.99 25.99 38.98 51.97 64.96 N/A N/A N/A N/A N/A 2.5985 75-79 5,000 10,000 15,000 20,000 25,000 N/A N/A N/A N/A N/A 12.99 25.99 38.98 51.97 64.96 N/A N/A N/A N/A N/A 2.5985 80+ 5,000 10,000 15,000 20,000 25,000 N/A N/A N/A N/A N/A 12.99 25.99 38.98 51.97 64.96 N/A N/A N/A N/A N/A 100,000 1,000 X Benefit In 1,000 s = 35 0.0577 X 150 = 8.66 Dependent Children Benefit 10,000 - - - - - - - Rate: 0.92 - - - - - - -
Spouse Premium Life and Accidental Death and Dismemberment Premium for sample benefit amounts Spouse premiums will be calculated based on the Employee AGE 5,000 10,000 15,000 20,000 25,000 30,000 0.0337 <25 0.17 0.34 0.51 0.67 0.84 1.01 1.18 1.35 1.52 1.69 0.0337 25-29 0.17 0.34 0.51 0.67 0.84 1.01 1.18 1.35 1.52 1.69 0.0415 30-34 0.21 0.42 0.62 0.83 1.04 1.25 1.45 1.66 1.87 2.08 0.0577 35-39 0.29 0.58 0.87 1.15 1.44 1.73 2.02 2.31 2.60 2.89 0.0831 40-44 0.42 0.83 1.25 1.66 2.08 2.49 2.91 3.32 3.74 4.16 0.1242 45-49 0.62 1.24 1.86 2.48 3.11 3.73 4.35 4.97 5.59 6.21 0.1786 50-54 0.89 1.79 2.68 3.57 4.47 5.36 6.25 7.14 8.04 8.93 0.3208 55-59 1.60 3.21 4.81 6.42 8.02 9.62 11.23 12.83 14.44 16.04 0.4528 60-64 2.26 4.53 6.79 9.06 11.32 13.58 15.85 18.11 20.38 22.64 0.8492 65-69 3,250 6,500 9,750 13,000 16,250 19,500 22,750 26,000 29,250 32,500 2.76 5.52 8.28 11.04 13.80 16.56 19.32 22.08 24.84 27.60 2.5985 70-74 - - - - - - - - - - #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 2.5985 75-79 2,500 5,000 7,500 10,000 12,500 15,000 17,500 20,000 22,500 25,000 6.50 12.99 19.49 25.99 32.48 38.98 45.47 51.97 58.47 64.96 2.5985 80-84 2,500 5,000 7,500 10,000 12,500 15,000 17,500 20,000 22,500 25,000 6.50 12.99 19.49 25.99 32.48 38.98 45.47 51.97 58.47 64.96 2.5985 85-89 2,500 5,000 7,500 10,000 12,500 15,000 17,500 20,000 22,500 25,000 6.50 12.99 19.49 25.99 32.48 38.98 45.47 51.97 58.47 64.96 35,000 40,000 45,000 50,000 50,000 1,000 X Benefit In 1,000 s = 35 0.0577 X 75 = 4.33 Dependent Children Benefit 10,000 - - - - - - - Rate: 0.92 - - - - - - -