Summary of Beefits THE SCRIPPS RESEARCH INSTITUTE All Active Full Time Beefit Eligible Employees Workig i Califoria Basic Term Life, Basic Accidetal Death & Dismembermet, Buy-Up Term Life, Buy-Up Depedet Term Life, Buy-Up AD&D ad Log Term Disability Issued by The Prudetial Isurace Compay of America Effective: 01/01/2018 Basic Term Life 100% Employer Paid Optio 1: You are automatically erolled for 2.0 times your covered aual earigs to $1,500,000. Optio 2: You ca elect ot to receive Basic Term Life coverage i excess of $50,000, i which case you will ot have imputed icome. 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 6 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 be reduced as you age - by 35% at age 65 ad 50% at age 70. 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 2.0 times your covered aual earigs to $1,500,000. 0308125-00001-00
Buy-Up Term Life 100% Employee Paid Purchase coverage for 1.0 times your covered aual earigs to a combied Basic Term Life ad Buy-Up Term Life maximum of $1,500,000. The miimum amout is $10,000. New Hires: If you are ewly eligible, you ca elect coverage up to the Guarateed Issue amout of $1,000,000, without providig evidece of isurability to The Prudetial Isurace Compay of America. Curret Participats: Your curret coverage amout will be cotiued. Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all icreases i coverage amouts. Curret Employees who were deied coverage i the past, Curret Employees who waived coverage i the past or Late Etrats (did ot eroll whe first eligible): 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 6 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. Coverage will be reduced as you age - by 35% at age 65 ad 50% at age 70. 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. Buy-Up Depedet Term Life 100% Employee Paid Purchase coverage for your spouse/domestic parter for $5,000 ad for each of your childre for $5,000, ot to exceed 100% of your Optioal Term Life coverage amout. New Hires: Get up to $5,000 for both your spouse ad childre - o medical questios asked - whe erollig whe first eligible i Optioal Depedet Group Term Life. Curret Spouse ad Childre Participats: Your spouse ad childres curret coverage amout will be cotiued. Curret Employees whose spouse has bee deied coverage i the past, Curret Employees who waived spouse coverage i the past or Late Etrats (did ot eroll whe first eligible): Evidece of isurability satisfactory to The Prudetial Isurace Compay of America is required for all spouse coverage amouts. Coverage will be reduced as you age - by 35% at age 65 ad 50% at age 70. Child coverage begis from live birth, ad cotiues to age 26.
Employee - Buy-Up AD&D 100% Employee Paid Purchase a Buy-Up AD&D Isurace coverage amout equal to your Buy-Up Term Life Isurace coverage amout. The miimum amout is $10,000. This amout caot exceed a combied Basic AD&D ad Buy-Up AD&D maximum of $1,500,000. Coverage will be reduced as you age - by 35% at age 65 ad 50% at age 70. Log Term Disability 100% Employer Paid Your mothly Log Term Disability beefit will be the lesser of 70% of your pre-disability earigs, reduced by deductible sources of icome or 60% of your mothly pre-disability earigs, ot reduced by deductible sources of icome, up to the pla maximum of $20,000. 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 90 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 totally disabled whe you are ot workig at your usual occupatio ad, as a result of your sickess or ijury you are uable to perform with reasoable cotiuity the substatial ad material acts ecessary to pursue your usual occupatio. You are cosidered partially disabled while actually workig i your usual occupatio ad as a result of your sickess or ijury, you are uable to ear 80% or more of your idexed mothly earigs. After receivig beefits for 24 moths, you are cosidered totally disabled whe, as a result of the same sickess or ijury, you are uable to egage with reasoable cotiuity i ay occupatio i which you could reasoably be expected to perform satisfactorily i light of your age, educatio, traiig, experiece, statio i life, ad physical ad metal capacity. You are cosidered partially disabled after 24 moths of paymets while actually workig i a occupatio, ad as a result of the same sickess or ijury, you are uable to egage with reasoable cotiuity i that or ay other occupatio i which you could reasoably be expected to perform satisfactorily i light of your age, educatio, traiig, experiece, statio i life ad physical ad metal capacity. Disabilities primarily 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. LTD beefits will ot be paid for a disability that begis durig the first 12 moths of coverage ad is caused by or substatially cotributed to by a pre-existig coditio. A pre-existig coditio is a diagosed coditio for which you received medical treatmet, care or services or took prescribed medicatio i the 3 moths just prior to your effective date. This provisio also applies to udiagosed coditios uder very limited circumstaces as outlied i your Booklet-Certificate. Durig the first 24 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 feloy 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. 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 THE SCRIPPS RESEARCH INSTITUTE All Active Full Time Beefit Eligible Employees Workig i Califoria Issued by The Prudetial Isurace Compay of America Effective: 01/01/2018 How much does life isurace cost? The followig steps will show you how to calculate your mothly 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 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. TOTAL COST FOR EMPLOYEE $ $ Cost of Buy-Up Term Life Isurace for You Coverage is available for 1.0 times your covered aual earigs to a combied Basic Term Life ad Buy-Up Term Life maximum of $1,500,000. The miimum amout is $10,000. Refer to the Buy-Up 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 < 24 $0.030 25-29 $0.040 30-34 $0.050 35-39 $0.080 40-44 $0.100 45-49 $0.150 50-54 $0.230 55-59 $0.430 60-64 $0.660 65-69 $1.130 70-100 $2.060 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
Example A 35 year-old employee elects $100,000 of Buy-Up Term Life for themselves Employee Mothly Cost $8.00 ($100,000 / 1,000 x $0.080) Mothly Cost of Buy-Up Depedet Term Life Spouse: $5,000/Childre: $5,000 $2.50 Rates may chage if pla experiece requires a chage for all isureds. "How much does this Buy-Up AD&D isurace cost?" Isured Buy-Up AD&D* Mothly Cost of Isurace (rates per $1,000 of Coverage) Employee $0.015 * This is optioal coverage ad the etire cost of coverage is employee paid. Worksheet for Buy-Up AD&D (Employee) Follow this worksheet to determie the cost of isurace for you. 1. Select the desired amout of coverage $ 2. Locate the mothly rate The mothly rate per $1,000 is $ 3. Divide the selected amout of coverage by $1,000. The multiply the result by the mothly rate to get the mothly cost of isurace. $ divided by $1,000 is $ multiplied by $ = $ Total Mothly Cost of Isurace = $ Total (mothly) cost of isurace = $ 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. 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
Last Name First Name Middle Iitial Social Security No. 1 Basic Term Life, Basic AD&D, Buy-Up Term Life, Buy-Up AD&D- Primary Beeficiary Desigatio 2 Basic Term Life, Basic AD&D, Buy-Up Term Life, Buy-Up AD&D- Cotiget Beeficiary Desigatio 1 2 Page 1 of 2 Beeficiary Desigatio - THE SCRIPPS RESEARCH INSTITUTE Cotrol # 00179
Page 2 of 2 The above beeficiary desigatio oly applies to: Basic Term Life, Basic AD&D, Buy-Up Term Life, Buy-Up AD&D Employee Sigature Date (mm/dd/yyyy) If you have ay questios, please see Huma Resources for details. Group Term Life ad Disability coverages are issued by The Prudetial Isurace Compay of America, a Prudetial Fiacial compay, Newark, NJ 07102. Life Claims: 800-524-0542, Disability Support: 800-842-1718. This brochure is iteded to be a summary of your beefits ad does ot iclude all pla provisios, exclusios ad limitatios. Please refer to the Booklet-Certificate, which is made a part of the Group Cotract, for all pla details, icludig ay exclusios, limitatios ad restrictios which may apply. If there is a discrepacy betwee this documet ad the Booklet-Certificate/Group Cotract issued by The Prudetial Isurace Compay of America, the Group Cotract will gover. Cotract provisios may vary by state. Cotract Series:83500. Califoria COA # 1179 NAIC #68241 2013 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. GL.2005.289 Ed. 04.2015 ECEd.10.2017-24947 Exp. 04.2019