Page 1 of 9 INVENTEC DISTRIBUTION (NA) CORPORATION (#623326) - Full Time Basic and Basic and Voluntary Accidental Death and Personal Loss Coverage (AD&D Ultra ) Coverage Effective Date: 08/01/2016 Your Group Life Insurance Benefits Protecting your greatest asset - your family Am I eligible for coverage? You qualify if you are an active full or part-time employee working at least 30 hours a week. You must be working in an eligible group as defined by your employer. If you are a new hire or have not been previously covered by your employer s plan, you may need to complete a probationary or waiting period of 30 days before your coverage begins. When does my coverage begin? When does coverage become effective?* Do I have to provide proof of good health (EOI) to enroll? When will coverage that requires proof of good health (EOI) begin? Your coverage will begin on the first of the month following 30 days if you are a new hire.* *You must be actively-at-work for your coverage to begin. Other rules may apply. Please review your policy documents for more information. An EOI Form (medical questionnaire) is required to enroll in the Voluntary Life insurance if you are a late applicant during this enrollment period. Coverage will begin after Aetna reviews and approves your EOI. If EOI is not approved, coverage will be limited to any "Guaranteed Issue Amounts" that apply. How much coverage does my Employer provide? Employer Paid - Term Life Your employer pays for a benefit in the amount of: ü You: 1 X times your basic annual earnings rounded to the next higher $1,000 to a maximum of $50,000 Employer Paid - AD&D Ultra Your employer pays for a benefit in the amount of: ü You: 1 X times your basic annual earnings rounded to the next higher $1,000 to a maximum of $50,000 Life insurance provides your loved ones with financial protection if you die. It can help pay your final expenses like funeral and burial; everyday living expenses like mortgage or rent, car payments and groceries; future expenses like college tuition payments. AD&D Ultra provides additional financial protection for the unexpected. AD&D Ultra pays a benefit if you are dismembered as the result of an accident, or an additional benefit to your life insurance benefit if you die as the result of an accident. It will also provide benefits for accidental; loss of eyesight, hearing or speech, loss of a limb, loss of limb use due to paralysis, disfiguring third-degree burns, or coma. Your basic coverage may begin to reduce when you reach a certain age.
Page 2 of 9 Can I buy coverage and how much will it cost? You can buy coverage called Voluntary Life insurance for yourself and your spouse and children. You can purchase Voluntary AD&D Ultra coverage for yourself and your spouse and children. Voluntary Life Coverage You Available Coverage Amounts Increments of $10,000 up to a maximum of $500,000 (not to exceed 5X your salary) Your Spouse Increments of $5,000 up to a maximum of $100,000 Child(ren) Increments of $5,000 up to a maximum of $10,000 Guaranteed Issue Amounts New Hire/Newly Eligible* You 5X Basic Annual Earnings or $200,000, whichever is less Your Spouse $30,000 Child(ren) $10,000 *Available during initial eligibility period. See your policy documents for more information. Employee must buy supplemental life coverage to buy dependent life coverage. Dependent coverage cannot exceed 50% of employee s coverage amount. Child(ren) Eligibility: Birth to Age 26 Spouse rated on Employee's age Monthly Rates for Term Life Insurance (rate per $1,000) Age bands <20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Employee 0.080 0.080 0.080 0.090 0.120 0.210 0.370 0.560 0.830 1.390 2.490 3.530 7.620 Spouse 0.080 0.080 0.080 0.090 0.120 0.210 0.370 0.560 0.830 1.390 2.490 3.530 7.620 Child(ren): $1.000 per $5,000 of coverage
Page 3 of 9 Coverage Coverage Amounts Voluntary AD&D Monthly Rates You Increments of $10,000 up to a Employee rate is $0.040 per $1,000 of coverage. maximum of $500,000 Spouse rate is $0.040 per $1,000 of coverage. Your Increments of $5,000 up to a Spouse maximum of $100,000 Child(ren) rate is $0.040 per $1,000 of coverage. Child(ren) Increments of $5,000 up to a maximum of $10,000 Reductions that apply to Voluntary Life Insurance Your coverage will reduce as you age. Your coverage will reduce as follows: At age 64 your coverage will reduce by 35% of the original amount. At age 70 your coverage will reduce by 60% of the original amount. At age 75 your coverage will reduce by 75% of the original amount. What additional features should I know about? Waiver of Premium Provision for Permanently and Totally Disabled Employees Accelerated Death Benefit Provision AD&D Ultra Features A benefit is paid to your surviving spouse/domestic partner or dependent children if you die in an accident. Conversion If your coverage ends or is reduced, you can convert your term life policy to a Whole Life Policy. If you are unable to work at any reasonable job (any which you are suited to perform due to education, training or experience), you may be eligible to have your life insurance coverage extended at no cost. You may be eligible to receive up to 75% of your (combined basic and voluntary) life insurance coverage if diagnosed with a terminal or serious medical condition. Seatbelt/airbag benefits: If you or your dependent die from a motor vehicle accident while wearing a seatbelt, a benefit is paid. An added benefit is paid if an airbag inflated. Educational benefit: For your spouse and each eligible dependent child under 23. Childcare Benefit: For each dependent child under 13 to help pay for childcare. Repatriation of Mortal Remains: If you or your dependent die in an accident 200 miles or more from home, a benefit will be paid to transport the body to your hometown funeral home. You may convert your basic and/or supplemental coverage into a Whole Life Policy with rates based on your age at that time by paying premiums directly to Aetna. Whole life insurance is generally more expensive than term insurance so a change in your premium may apply. You will have 31 days to convert your coverage without answering any medical questions.
Page 4 of 9 Portability If you leave your employer, you can take your term life plan with you. You have an additional option to conversion. You can continue your basic and/or voluntary life insurance as a term policy by paying premiums directly to Aetna. Term insurance is generally less expensive than Whole Life insurance but your rates will increase as you reach higher age bands. You will have 31 days to convert or port your coverage without answering any medical questions. Aetna Life Essentials Aetna Life Essentials web address: www.aetna.com/aetnalifeessentials/ Legal: Create a will, living will, health care directive or a durable/financial power of attorney. Financial: Financial planning to help your beneficiaries maximize their life/ad&d Ultra payment. Emotional: Master-level social workers provide emotional support in the event of an advanced illness or disabling condition. Physical: Save on gym memberships, fitness equipment, eyeglasses, contact lenses and hearing aids. Funeral Planning and Concierge Services Advisory Assistance to help you and your family make decisions on all funeral-related issues. Planning advice and cost-comparison tools available 24/7 by phone and online. Call 1-800-913-8318 or visit www.everestfuneral.com/aetna (Ask your Human Resources department for your company code.) Premium calculation Calculation: Step 1: Benefit / 1000 = # Units Step 2: # Units x Age-banded Rate = $ Premium Per Month Step 3: Monthly Premium x 12 = Annual Premium / # Pay Periods = $ Payroll Deduction Example: 40 year old, $100,000 Benefit Step 1: Step 2: $100,000 / 1000 = 100 Units 100 x 0.21 (40 year old rate) = $21 Premium Per Month
Page 5 of 9 Age $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $110,000 <20 $0.80 $1.60 $2.40 $3.20 $4.00 $4.80 $5.60 $6.40 $7.20 $8.00 $8.80 20-24 $0.80 $1.60 $2.40 $3.20 $4.00 $4.80 $5.60 $6.40 $7.20 $8.00 $8.80 25-29 $0.80 $1.60 $2.40 $3.20 $4.00 $4.80 $5.60 $6.40 $7.20 $8.00 $8.80 30-34 $0.90 $1.80 $2.70 $3.60 $4.50 $5.40 $6.30 $7.20 $8.10 $9.00 $9.90 35-39 $1.20 $2.40 $3.60 $4.80 $6.00 $7.20 $8.40 $9.60 $10.80 $12.00 $13.20 40-44 $2.10 $4.20 $6.30 $8.40 $10.50 $12.60 $14.70 $16.80 $18.90 $21.00 $23.10 45-49 $3.70 $7.40 $11.10 $14.80 $18.50 $22.20 $25.90 $29.60 $33.30 $37.00 $40.70 50-54 $5.60 $11.20 $16.80 $22.40 $28.00 $33.60 $39.20 $44.80 $50.40 $56.00 $61.60 55-59 $8.30 $16.60 $24.90 $33.20 $41.50 $49.80 $58.10 $66.40 $74.70 $83.00 $91.30 60-64 $13.90 $27.80 $41.70 $55.60 $69.50 $83.40 $97.30 $111.20 $125.10 $139.00 $152.90 65-69 $24.90 $49.80 $74.70 $99.60 $124.50 $149.40 $174.30 $199.20 $224.10 $249.00 $273.90 70-74 $35.30 $70.60 $105.90 $141.20 $176.50 $211.80 $247.10 $282.40 $317.70 $353.00 $388.30 75+ $76.20 $152.40 $228.60 $304.80 $381.00 $457.20 $533.40 $609.60 $685.80 $762.00 $838.20 Age $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000 $190,000 $200,000 $210,000 $220,000 <20 $9.60 $10.40 $11.20 $12.00 $12.80 $13.60 $14.40 $15.20 $16.00 $16.80 $17.60 20-24 $9.60 $10.40 $11.20 $12.00 $12.80 $13.60 $14.40 $15.20 $16.00 $16.80 $17.60 25-29 $9.60 $10.40 $11.20 $12.00 $12.80 $13.60 $14.40 $15.20 $16.00 $16.80 $17.60 30-34 $10.80 $11.70 $12.60 $13.50 $14.40 $15.30 $16.20 $17.10 $18.00 $18.90 $19.80 35-39 $14.40 $15.60 $16.80 $18.00 $19.20 $20.40 $21.60 $22.80 $24.00 $25.20 $26.40 40-44 $25.20 $27.30 $29.40 $31.50 $33.60 $35.70 $37.80 $39.90 $42.00 $44.10 $46.20 45-49 $44.40 $48.10 $51.80 $55.50 $59.20 $62.90 $66.60 $70.30 $74.00 $77.70 $81.40 50-54 $67.20 $72.80 $78.40 $84.00 $89.60 $95.20 $100.80 $106.40 $112.00 $117.60 $123.20 55-59 $99.60 $107.90 $116.20 $124.50 $132.80 $141.10 $149.40 $157.70 $166.00 $174.30 $182.60 60-64 $166.80 $180.70 $194.60 $208.50 $222.40 $236.30 $250.20 $264.10 $278.00 $291.90 $305.80 65-69 $298.80 $323.70 $348.60 $373.50 $398.40 $423.30 $448.20 $473.10 $498.00 $522.90 $547.80 70-74 $423.60 $458.90 $494.20 $529.50 $564.80 $600.10 $635.40 $670.70 $706.00 $741.30 $776.60 75+ $914.40 $990.60 $1,066.80 $1,143.00 $1,219.20 $1,295.40 $1,371.60 $1,447.80 $1,524.00 $1,600.20 $1,676.40
Page 6 of 9 Age $230,000 $240,000 $250,000 $260,000 $270,000 $280,000 $290,000 $300,000 $310,000 $320,000 $330,000 <20 $18.40 $19.20 $20.00 $20.80 $21.60 $22.40 $23.20 $24.00 $24.80 $25.60 $26.40 20-24 $18.40 $19.20 $20.00 $20.80 $21.60 $22.40 $23.20 $24.00 $24.80 $25.60 $26.40 25-29 $18.40 $19.20 $20.00 $20.80 $21.60 $22.40 $23.20 $24.00 $24.80 $25.60 $26.40 30-34 $20.70 $21.60 $22.50 $23.40 $24.30 $25.20 $26.10 $27.00 $27.90 $28.80 $29.70 35-39 $27.60 $28.80 $30.00 $31.20 $32.40 $33.60 $34.80 $36.00 $37.20 $38.40 $39.60 40-44 $48.30 $50.40 $52.50 $54.60 $56.70 $58.80 $60.90 $63.00 $65.10 $67.20 $69.30 45-49 $85.10 $88.80 $92.50 $96.20 $99.90 $103.60 $107.30 $111.00 $114.70 $118.40 $122.10 50-54 $128.80 $134.40 $140.00 $145.60 $151.20 $156.80 $162.40 $168.00 $173.60 $179.20 $184.80 55-59 $190.90 $199.20 $207.50 $215.80 $224.10 $232.40 $240.70 $249.00 $257.30 $265.60 $273.90 60-64 $319.70 $333.60 $347.50 $361.40 $375.30 $389.20 $403.10 $417.00 $430.90 $444.80 $458.70 65-69 $572.70 $597.60 $622.50 $647.40 $672.30 $697.20 $722.10 $747.00 $771.90 $796.80 $821.70 70-74 $811.90 $847.20 $882.50 $917.80 $953.10 $988.40 $1,023.70 $1,059.00 $1,094.30 $1,129.60 $1,164.90 75+ $1,752.60 $1,828.80 $1,905.00 $1,981.20 $2,057.40 $2,133.60 $2,209.80 $2,286.00 $2,362.20 $2,438.40 $2,514.60 Age $340,000 $350,000 $360,000 $370,000 $380,000 $390,000 $400,000 $410,000 $420,000 $430,000 $440,000 <20 $27.20 $28.00 $28.80 $29.60 $30.40 $31.20 $32.00 $32.80 $33.60 $34.40 $35.20 20-24 $27.20 $28.00 $28.80 $29.60 $30.40 $31.20 $32.00 $32.80 $33.60 $34.40 $35.20 25-29 $27.20 $28.00 $28.80 $29.60 $30.40 $31.20 $32.00 $32.80 $33.60 $34.40 $35.20 30-34 $30.60 $31.50 $32.40 $33.30 $34.20 $35.10 $36.00 $36.90 $37.80 $38.70 $39.60 35-39 $40.80 $42.00 $43.20 $44.40 $45.60 $46.80 $48.00 $49.20 $50.40 $51.60 $52.80 40-44 $71.40 $73.50 $75.60 $77.70 $79.80 $81.90 $84.00 $86.10 $88.20 $90.30 $92.40 45-49 $125.80 $129.50 $133.20 $136.90 $140.60 $144.30 $148.00 $151.70 $155.40 $159.10 $162.80 50-54 $190.40 $196.00 $201.60 $207.20 $212.80 $218.40 $224.00 $229.60 $235.20 $240.80 $246.40 55-59 $282.20 $290.50 $298.80 $307.10 $315.40 $323.70 $332.00 $340.30 $348.60 $356.90 $365.20 60-64 $472.60 $486.50 $500.40 $514.30 $528.20 $542.10 $556.00 $569.90 $583.80 $597.70 $611.60 65-69 $846.60 $871.50 $896.40 $921.30 $946.20 $971.10 $996.00 $1,020.90 $1,045.80 $1,070.70 $1,095.60 70-74 $1,200.20 $1,235.50 $1,270.80 $1,306.10 $1,341.40 $1,376.70 $1,412.00 $1,447.30 $1,482.60 $1,517.90 $1,553.20 75+ $2,590.80 $2,667.00 $2,743.20 $2,819.40 $2,895.60 $2,971.80 $3,048.00 $3,124.20 $3,200.40 $3,276.60 $3,352.80
Page 7 of 9 Age $450,000 $460,000 $470,000 $480,000 $490,000 $500,000 <20 $36.00 $36.80 $37.60 $38.40 $39.20 $40.00 20-24 $36.00 $36.80 $37.60 $38.40 $39.20 $40.00 25-29 $36.00 $36.80 $37.60 $38.40 $39.20 $40.00 30-34 $40.50 $41.40 $42.30 $43.20 $44.10 $45.00 35-39 $54.00 $55.20 $56.40 $57.60 $58.80 $60.00 40-44 $94.50 $96.60 $98.70 $100.80 $102.90 $105.00 45-49 $166.50 $170.20 $173.90 $177.60 $181.30 $185.00 50-54 $252.00 $257.60 $263.20 $268.80 $274.40 $280.00 55-59 $373.50 $381.80 $390.10 $398.40 $406.70 $415.00 60-64 $625.50 $639.40 $653.30 $667.20 $681.10 $695.00 65-69 $1,120.50 $1,145.40 $1,170.30 $1,195.20 $1,220.10 $1,245.00 70-74 $1,588.50 $1,623.80 $1,659.10 $1,694.40 $1,729.70 $1,765.00 75+ $3,429.00 $3,505.20 $3,581.40 $3,657.60 $3,733.80 $3,810.00 Spouse Coverage Amounts and Monthly Premiums Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $55,000 <20 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $3.60 $4.00 $4.40 20-24 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $3.60 $4.00 $4.40 25-29 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $3.60 $4.00 $4.40 30-34 $0.45 $0.90 $1.35 $1.80 $2.25 $2.70 $3.15 $3.60 $4.05 $4.50 $4.95 35-39 $0.60 $1.20 $1.80 $2.40 $3.00 $3.60 $4.20 $4.80 $5.40 $6.00 $6.60 40-44 $1.05 $2.10 $3.15 $4.20 $5.25 $6.30 $7.35 $8.40 $9.45 $10.50 $11.55 45-49 $1.85 $3.70 $5.55 $7.40 $9.25 $11.10 $12.95 $14.80 $16.65 $18.50 $20.35 50-54 $2.80 $5.60 $8.40 $11.20 $14.00 $16.80 $19.60 $22.40 $25.20 $28.00 $30.80 55-59 $4.15 $8.30 $12.45 $16.60 $20.75 $24.90 $29.05 $33.20 $37.35 $41.50 $45.65 60-64 $6.95 $13.90 $20.85 $27.80 $34.75 $41.70 $48.65 $55.60 $62.55 $69.50 $76.45 65-69 $12.45 $24.90 $37.35 $49.80 $62.25 $74.70 $87.15 $99.60 $112.05 $124.50 $136.95 70-74 $17.65 $35.30 $52.95 $70.60 $88.25 $105.90 $123.55 $141.20 $158.85 $176.50 $194.15 75+ $38.10 $76.20 $114.30 $152.40 $190.50 $228.60 $266.70 $304.80 $342.90 $381.00 $419.10
Page 8 of 9 Spouse Coverage Amounts and Monthly Premiums Age $60,000 $65,000 $70,000 $75,000 $80,000 $85,000 $90,000 $95,000 $100,000 <20 $4.80 $5.20 $5.60 $6.00 $6.40 $6.80 $7.20 $7.60 $8.00 20-24 $4.80 $5.20 $5.60 $6.00 $6.40 $6.80 $7.20 $7.60 $8.00 25-29 $4.80 $5.20 $5.60 $6.00 $6.40 $6.80 $7.20 $7.60 $8.00 30-34 $5.40 $5.85 $6.30 $6.75 $7.20 $7.65 $8.10 $8.55 $9.00 35-39 $7.20 $7.80 $8.40 $9.00 $9.60 $10.20 $10.80 $11.40 $12.00 40-44 $12.60 $13.65 $14.70 $15.75 $16.80 $17.85 $18.90 $19.95 $21.00 45-49 $22.20 $24.05 $25.90 $27.75 $29.60 $31.45 $33.30 $35.15 $37.00 50-54 $33.60 $36.40 $39.20 $42.00 $44.80 $47.60 $50.40 $53.20 $56.00 55-59 $49.80 $53.95 $58.10 $62.25 $66.40 $70.55 $74.70 $78.85 $83.00 60-64 $83.40 $90.35 $97.30 $104.25 $111.20 $118.15 $125.10 $132.05 $139.00 65-69 $149.40 $161.85 $174.30 $186.75 $199.20 $211.65 $224.10 $236.55 $249.00 70-74 $211.80 $229.45 $247.10 $264.75 $282.40 $300.05 $317.70 $335.35 $353.00 75+ $457.20 $495.30 $533.40 $571.50 $609.60 $647.70 $685.80 $723.90 $762.00 Child(ren) Term Life Child(ren) Coverage Amount and Monthly Premiums Rate $5,000 $10,000 Child(ren) $1.000 $5.00 $10.00 Rate $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 Employee $0.040 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $3.60 Spouse $0.040 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $3.60 Child(ren) $0.040 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $3.60 Rate $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000 Employee $0.040 $4.00 $4.40 $4.80 $5.20 $5.60 $6.00 $6.40 $6.80 $7.20 Spouse $0.040 $4.00 $4.40 $4.80 $5.20 $5.60 $6.00 $6.40 $6.80 $7.20 Child(ren) $0.040 $4.00 $4.40 $4.80 $5.20 $5.60 $6.00 $6.40 $6.80 $7.20
Page 9 of 9 Rate $190,000 $200,000 $210,000 $220,000 $230,000 $240,000 $250,000 $260,000 $270,000 Employee $0.040 $7.60 $8.00 $8.40 $8.80 $9.20 $9.60 $10.00 $10.40 $10.80 Spouse $0.040 $7.60 $8.00 $8.40 $8.80 $9.20 $9.60 $10.00 $10.40 $10.80 Child(ren) $0.040 $7.60 $8.00 $8.40 $8.80 $9.20 $9.60 $10.00 $10.40 $10.80 Rate $280,000 $290,000 $300,000 $310,000 $320,000 $330,000 $340,000 $350,000 $360,000 Employee $0.040 $11.20 $11.60 $12.00 $12.40 $12.80 $13.20 $13.60 $14.00 $14.40 Spouse $0.040 $11.20 $11.60 $12.00 $12.40 $12.80 $13.20 $13.60 $14.00 $14.40 Child(ren) $0.040 $11.20 $11.60 $12.00 $12.40 $12.80 $13.20 $13.60 $14.00 $14.40 Rate $370,000 $380,000 $390,000 $400,000 $410,000 $420,000 $430,000 $440,000 $450,000 Employee $0.040 $14.80 $15.20 $15.60 $16.00 $16.40 $16.80 $17.20 $17.60 $18.00 Spouse $0.040 $14.80 $15.20 $15.60 $16.00 $16.40 $16.80 $17.20 $17.60 $18.00 Child(ren) $0.040 $14.80 $15.20 $15.60 $16.00 $16.40 $16.80 $17.20 $17.60 $18.00 Rate $460,000 $470,000 $480,000 $490,000 $500,000 Employee $0.040 $18.40 $18.80 $19.20 $19.60 $20.00 Spouse $0.040 $18.40 $18.80 $19.20 $19.60 $20.00 Child(ren) $0.040 $18.40 $18.80 $19.20 $19.60 $20.00