MassMutual Disability Option Summary Plan Description for Career Contract Agents and for General Agents and General Managers Effective January 1, 2015 This Summary Plan Description (SPD), published in September 2015, takes the place of any SPDs and Summaries of Material Modifications (SMMs) previously issued to you describing your benefits. MassMutual Disability Option-Agents September 2015 Page 1 of 33
Table of Contents Disclaimer... 3 Introduction... 4 Contact Information... 5 Short Term Disability (STD) Program For Career Contract Agents... 6 Short Term Disability (STD) Program For General Agents and General Managers... 11 Long Term Disability (LTD) Coverage For Career Contract Agents... 14 Long Term Disability (LTD) Coverage For General Agents and General Managers... 17 Claiming Benefits... 20 Appeals Procedures... 23 About Your Coverage... 25 Plan Information... 28 ERISA Rights... 30 Dictionary Terms... 32 Appendix A: Liberty Life Assurance Company of Boston Certificate... 33 MassMutual Disability Option-Agents September 2015 Page 2 of 33
Disclaimer This Summary Plan Description (SPD) provides details of the disability options available to you through the MassMutual Agents Welfare Benefits Plan. This SPD contains detailed and important information about the Plan; every attempt has been made to communicate this information clearly and in easily understandable terms. This SPD replaces and supersedes all previous SPD versions and Summaries of Material Modifications (SMMs). Benefits are determined under the terms of the Plan in effect at the time you become eligible for the specific benefits. Benefits are based on current laws and regulations, which are subject to change. Massachusetts Mutual Life Insurance Company ( the Company or MassMutual ) reserves the right to modify, revoke, change, suspend or terminate any one or all plans, programs, policies, benefits or services described in this SPD or the underlying Plan documents at any time and from time to time, with or without notice. This SPD does not guarantee any particular benefit. Receipt of this SPD describing the Plan or option for which you are not eligible does not imply that you are eligible. To be eligible to receive benefits from the Plan, you must meet all eligibility requirements of the Plan. In the event of a discrepancy between descriptions in this SPD and information in relevant Plan documents, the Plan documents will govern. Career contract and general agents are independent contractors; provision of benefits does not change that relationship. MassMutual Disability Option-Agents September 2015 Page 3 of 33
Introduction MassMutual provides a disability program to give you continued income if you become sick or Disabled and cannot be in Active Service. Short-Term Disability (STD) benefits precede any Long-Term Disability (LTD) benefits. Both programs are described in this document to illustrate how the programs work together. Career Contract Agents: STD coverage, which is provided at no cost to you if you meet minimum production requirements, replaces 50% of your Basic Weekly Earnings, up to $2,308 per week, before LTD coverage begins. For LTD coverage, the Plan provides you flexibility to choose the coverage that is right for you. You have two LTD options to choose from: Base LTD (also known as LTD 50): Replaces up to 50% of your Basic Monthly Earnings at no cost to you if you meet minimum production requirements (refer to the Production Requirements section and the definition of Basic Monthly Earnings in the Appendix for more information). Buy Up LTD (also known as LTD 70): Replaces up to 70% of your Basic Monthly Earnings; you pay for the cost of this coverage (refer to the Cost of Coverage section for more information). General Agents and General Managers: STD coverages, which are provided at no cost to you, provide a Weekly Benefit (up to $2,308 per week maximum) before LTD benefits begin. For LTD coverage, the Plan provides you flexibility to choose the coverage that is right for you. You have two LTD options to choose from: Base LTD: Provides a flat Monthly Benefit of $10,000, at no cost to you. Buy Up LTD: Provides an additional flat Monthly Benefit ranging from $2,000 to $10,000. Eligibility is based on your agency production (refer to the Eligibility section for more information). You pay for the cost of this additional coverage. The coverage options described here are effective as of January 1, 2015. If your disabling condition occurred before January 1, 2015, your coverage is determined under the provisions in effect when the Disability occurred and you should refer to the SPD that was in place at that time. Liberty Life Assurance Company of Boston (Liberty Mutual), a member of the Liberty Mutual Group, currently administers and issues the policy for, and fully insures, the STD and LTD benefits. A copy of Liberty Mutual s Certificate of Coverage is included with this document. Refer to Appendix A: Liberty Life Assurance Company of Boston Certificate for details of the LTD option. You must satisfy the requirements described in this SPD and the Plan to receive STD and LTD coverage. MassMutual Disability Option-Agents September 2015 Page 4 of 33
Contact Information Resource Website Telephone Liberty Mutual Disability Claims P.O. Box 7211 London, KY 40742-7211 MassMutual Benefits Human Resources Leave Services Unit Producer Services & Operations Performance Excellence-Disability Unit www.mylibertyconnection.com Company ID: Agents Website: https://mmfgonline.massmutual.com Email: DisabilityNotification@MassMutual.com Website: https://benedirect.massmutual.com/irj/portal Email: DisabilityNotification@MassMutual.com 800-713-7384 (claim submission) 888-440-6118 (claim service) 866-662-6448, select prompt for Leave Services 800-767-1000, Ext. 48850 on business days, 8 a.m. to 6 p.m., ET., select prompt for Group Disability Unit MassMutual Disability Option-Agents September 2015 Page 5 of 33
Short Term Disability (STD) Program For Career Contract Agents Eligibility You are eligible for STD coverage if you are a career contract agent: With a valid career agent contract; and Acting in the capacity of sales manager with a career contract and valid sales manager contract. Note: The disability coverage option for general agents and general managers is described in a separate section of this SPD. Ineligible Participants You are not eligible for this coverage if you are: A broker; A retired agent; An agency staff member; An employee of MassMutual or one of its subsidiaries; An eligible agent who did not elect disability coverage; or Otherwise excluded by Plan terms. Production Requirements As a career contract agent, to be eligible for subsidized benefits, each year you must satisfy certain requirements: Agent Type Non-financed career contract agent Financed career contract agent Sales manager/unit sales manager Production Requirements Annual contract minimum requirements Cumulative financing plan validation requirements Annual sales manager compensation plan requirements Production requirements, and information specific to agents receiving disability payments under the STD or LTD options, are updated from time to time and are published in Company memoranda, which can be found on FieldNet. Disability Earnings Your weekly STD benefit is based on your disability earnings, up to the applicable STD maximum. Disability earnings are updated annually, no later than April 1. Prior disability earnings will continue to apply until this annual update. MassMutual Disability Option-Agents September 2015 Page 6 of 33
Disability earnings are defined as follows: If you have at least one full calendar year under a career contract or sales manager agreement with MassMutual: o If you are a non-financed career contract agent, your disability earnings are equal to your prior full calendar year s Aggregated Agent Allowance Weighted Commission Credits (AAA WCCs, as described in Company Memo 2015-006, or its successor) paid by MassMutual. o If you are a sales manager, your disability earnings are equal to your prior full calendar year s AAA WCCs, sales manager production compensation and deferred production compensation paid by MassMutual. o If you are a financed career contract agent, your disability earnings are equal to your prior full calendar year s AAA WCCs paid by MassMutual. If you have less than one full calendar year under a career contract or sales manager agreement with MassMutual: o If you are a non-financed career contract agent or a sales manager, refer to the following table. o If you are a financed career contract agent, your disability earnings through December 31 of your first year under contract are equal to your current year career contract commission requirement. For the first full calendar year under a career contract, your disability earnings remain equal to your current year career contract commission requirement if greater than your actual AAA WCCs. Disability earnings through December 31 of first year under a career contract Disability earnings first full calendar year under a career contract If you do not have prior career agent/sales manager experience Equal to current year career contract commission requirement Equal to the current career contract commission requirement, if greater than your actual AAA WCCs as of the previous December 31 If you do have prior career agent/sales manager experience Equal to the greater of: Your prior non-massmutual calendar year s first year and renewal commissions for life, annuity and disability sales or financial services management income, as determined by MassMutual*; or The current year career contract commission requirement. * You must submit documentation, acceptable to MassMutual, from the prior year reflecting your non-massmutual career agent or financial services management experience. Equal to the greater of: Your prior year s non-massmutual first year and renewal commissions for life, annuity and disability sales or financial services management income as defined by MassMutual, if greater than your actual AAA WCCs as of the previous December 31; or The current year career contract commission requirement, if greater than your actual AAA WCCs as of the previous December 31. MassMutual Disability Option-Agents September 2015 Page 7 of 33
Enrollment If you are a subsidized agent, you are automatically eligible for this coverage subject to Plan terms; no enrollment is necessary. Your coverage is effective as of your career contract endorsement date and there is no cost to you for this coverage. If you are an unsubsidized agent, you pay the full cost of coverage on an After-Tax basis. If you are a corporate agent, you pay the full cost of coverage on an After-Tax basis. The cost of coverage is reviewed annually and is subject to change. If you are responsible for paying the full cost of coverage, the full cost of coverage amount is deducted from your commission voucher. The value of the Company subsidy, if any, is paid through the same voucher and appears as an adjustment. Summary of Benefits The STD Program continues a portion of your income when you cannot work because of Disability. You are considered Disabled if you are unable to perform all of the material and substantial duties of your occupation on an Active Service basis due to Injury or Sickness. Note: Loss of a license for any reason is not considered a total or Partial Disability whatsoever. STD benefits provide 50% of your basic weekly earnings (not to exceed a maximum of $2,308) for up to 26 weeks. You can apply for short-term disability coverage after your 30th consecutive day of disability (fully disabled and not working in any capacity) or 8th day in the case of childbirth. Note: You may participate in Annual Benefits Enrollment while out on STD. However, any increase to your Life Insurance or LTD election will not become effective until you return to active status. As long as you remain disabled, benefits you receive while out on disability are based on the elections you had in place on your last day immediately prior to your disability date. See Appendix A: Liberty Life Assurance Company of Boston Certificate for specific information about this benefit. MassMutual Disability Option-Agents September 2015 Page 8 of 33
Applying for STD Benefits You must apply for STD by contacting Liberty Mutual. The following table summarizes the action steps required for STD to begin and to continue. How to Apply for STD* Who Action When You Keep your general agent informed. At the beginning of your STD and periodically, if a continued absence You You Liberty Mutual You Liberty Mutual You See your Physician or medical-care provider. Provide your Physician s office with a copy of the Liberty Mutual authorization form. Contact Liberty Mutual at 800-713-7384 or online at www.mylibertyconnection.com (Claimant ID: Agents). Be prepared to provide the following information and to respond to any additional questions: Social Security number, address and phone number; Physician s name, phone number and fax number; Last day worked/first day absence due to your Injury/Sickness; Plan Sponsor s name (MassMutual); and General agent s name and phone number. Gives you the claim number and the telephone number of your Liberty Claim Case Manager. Inform your general agent that your claim has been filed. Contacts you (and may contact your Physician) periodically for an update on your condition and the possibility of your return to service. Notify your general agent and Liberty Mutual of return-to-service date. * Failure to follow these steps could delay STD payments. At the beginning of your STD At the beginning of your STD At the time of your initial phone call At the beginning of your STD Throughout your STD period As soon as your return-to-service date is known It is your obligation to submit information needed about your disabling condition including information required to be provided by your Physician as a requirement for benefits and to provide all necessary information requested to Liberty Mutual in support of your claim. STD may be denied if you fail to support your claim. MassMutual Disability Option-Agents September 2015 Page 9 of 33
Applying for STD Benefits due to Maternity How to Apply for Short-Term Disability Maternity* What to do Contact your general agent and inform him/her of your upcoming absence. Provide your Physician s office with a copy of the Liberty Mutual authorization form. Inform Liberty Mutual of the expected due date by using the toll-free number shown on the authorization form (800-713-7384). Contact your Liberty Mutual case manager at 888-440-6118 if your Physician determines you are Disabled or orders a reduced work schedule before your delivery date. Notify Liberty Mutual of delivery. When As soon as you feel comfortable sharing the information but allowing your general agent time to plan for your absence As soon as possible after pregnancy has been confirmed Two weeks before expected due date As soon as you are Disabled or put on reduced work schedule, as ordered by your Physician Within three days after delivery *Failure to follow these steps could delay STD payments. MassMutual Disability Option-Agents September 2015 Page 10 of 33
Short Term Disability (STD) Program For General Agents and General Managers Eligibility You are eligible for STD coverage if you are a: General agent with a valid general agent contract (including a formula general agent); or General manager with a valid employment agreement. Note: The disability coverage options for career contract agents are described in a separate section of this SPD. Ineligible Participants You are not eligible for this coverage if you are: A career contract agent; A broker; A retired agent; An agency staff member; An employee of MassMutual or one of its subsidiaries; or Otherwise excluded by Plan terms. Enrollment You are automatically eligible for this coverage subject to Plan terms; no enrollment is necessary. Your coverage is effective as of your general agent or general manager contract endorsement date and there is no cost to you for this coverage. Summary of Benefits The STD Program continues a portion of your income when you cannot work because of Disability. You are considered Disabled if you are unable to perform all of the material and substantial duties of your occupation on an Active Service basis due to Injury or Sickness. Note: Loss of a license for any reason is not considered a total or Partial Disability, whatsoever. See Appendix A: Liberty Life Assurance Company of Boston Certificate for specific information about this benefit. MassMutual Disability Option-Agents September 2015 Page 11 of 33
Applying for STD Benefits You must apply for STD by contacting Liberty Mutual. The following table summarizes the action steps required for STD to begin and to continue. How to Apply for STD* Who Action When You Keep your agency vice president informed. At the beginning of your STD and periodically, if a continued absence You You Liberty Mutual You Liberty Mutual You See your Physician or medical-care provider. Provide your Physician s office with a copy of the Liberty Mutual authorization form. Contact Liberty Mutual at 800-713-7384 or online at www.mylibertyconnection.com (Claimant ID: Agents). Be prepared to provide the following information and to respond to any additional questions: Social Security number, address and phone number; Physician s name, phone number and fax number; Last day worked/first day absence due to your Injury/Sickness; Plan Sponsor s name (MassMutual); and Agency vice president s name and phone number. Gives you the claim number and the telephone number of your Liberty Claim Case Manager. Inform your agency vice president that your claim has been filed. Contacts you (and may contact your Physician) periodically for an update on your condition and the possibility of your return to service. Notify your agency vice president and Liberty Mutual of return-to-service date. * Failure to follow these steps could delay STD payments. At the beginning of your STD At the beginning of your STD At the time of your initial phone call At the beginning of your STD Throughout your STD period As soon as your return-to-service date is known It is your obligation to submit information needed about your disabling condition including information required to be provided by your Physician as a requirement for benefits and to provide all necessary information requested to Liberty Mutual in support of your claim. STD may be denied if you fail to support your claim. MassMutual Disability Option-Agents September 2015 Page 12 of 33
Applying for STD Benefits due to Maternity How to Apply for Short-Term Disability Maternity* What to do Contact your agency vice president and inform him/her of your upcoming absence. Provide your Physician s office with a copy of the Liberty Mutual authorization form. Inform Liberty Mutual of the expected due date by using the toll-free number shown on the authorization form (800-713-7384). Contact your Liberty Mutual case manager at 888-408-7300 if your Physician determines you are Disabled or orders a reduced work schedule before delivery date. Notify Liberty Mutual of delivery. When As soon as you feel comfortable sharing the information but allowing your agency vice president time to plan for your absence As soon as possible after pregnancy has been confirmed Two weeks before expected due date As soon as you are Disabled or put on reduced work schedule, as ordered by your Physician Within three days after delivery *Failure to follow these steps could delay STD payments. MassMutual Disability Option-Agents September 2015 Page 13 of 33
Long Term Disability (LTD) Coverage For Career Contract Agents Eligibility You are eligible for LTD coverage options if you are a: Career contract agent with a valid career agent contract; or Sales manager with a career contract and valid sales manager agreement. Note: The disability coverage option for general agents and general managers is described in a separate section of this SPD. Ineligible Participants You are not eligible for these coverage options if you are: A broker; A retired agent; An agency staff member; An employee of MassMutual or one of its subsidiaries; An eligible agent who did not elect disability coverage; or Otherwise excluded by Plan terms. Production Requirements As a career contract agent, to be eligible for subsidized benefits, each year you must satisfy certain requirements: Agent Type Non-financed career contract agent Financed career contract agent Sales manager/unit sales manager Production Requirements Annual contract minimum requirements Cumulative financing plan validation requirements Annual sales manager compensation plan requirements Production requirements, and information specific to agents receiving disability payments under the LTD options, are updated from time to time and are published in Company memoranda, which can be found on FieldNet. Summary of Benefits Liberty Mutual manages LTD coverage on an insured basis. If approved, benefit payments will be issued monthly by Liberty Mutual. LTD works in conjunction with the STD Program to provide you with the flexibility to choose a level of income if you become Disabled. The Plan provides you flexibility in choosing the amount of LTD coverage you need at the time of enrollment; you may choose the Base LTD or Buy Up LTD option. For career agents and sales managers, LTD 50 is referenced as Class 1 or Core Plan and LTD 70 is referenced as Class 2 or Buy-up Plan in Appendix A: Liberty Life Assurance Company of Boston Certificate. See Appendix A: Liberty Life Assurance Company of Boston Certificate for specific information about this benefit. MassMutual Disability Option-Agents September 2015 Page 14 of 33
Mid-Year Qualifying Event Any change to your LTD option due to a Mid-Year Qualifying Event must be consistent with and due to the Mid-Year Qualifying Event. If you have a Mid-Year Qualifying Event, you can change your existing level of LTD coverage for instance, you may be able to enroll in Buy Up LTD coverage for the first time. You must make any changes and provide documentation within 30 days of your Mid-Year Qualifying Event (90 days in the case of birth, adoption or placement for adoption; 60 days if you work or reside in Puerto Rico). If Liberty Mutual does not permit a 90-day period (or 60-day period, as applicable), then documentation must be submitted within 30 days. Changes you make due to a Mid-Year Qualifying Event become effective as of the date you make the change. Before July 1, 2015, changes due to a Mid-Year Qualifying Event became effective as of the date of your Mid- Year Qualifying Event. To make changes to your coverage, you must notify Producer Services & Operations and provide documentation within 30 days of the event (90 days in the case of birth, adoption or placement for adoption; 60 days if you work or reside in Puerto Rico). If Liberty Mutual does not permit a 90-day period (or 60-day period, as applicable), then documentation must be submitted within 30 days. See the Family Status Change section in Appendix A: Liberty Life Assurance Company of Boston Certificate for more information. Cost of Coverage In general, Base LTD option coverage is Company paid and you are automatically eligible for this coverage, subject to Plan terms and LTD coverage approval by Liberty Mutual. If you elect Buy Up LTD option coverage, you and the Company pay premiums for coverage. Unsubsidized agents pay the full cost of coverage on an After-Tax basis, for Base and Buy-Up coverage. Your contributions, which are withheld from your commission vouchers, are based on the level of coverage you choose, your agent status (subsidized or unsubsidized) and your Basic Monthly Earnings (see the definition of Basic Monthly Earnings in the Appendix). Additionally, rates for Buy Up LTD coverage may also vary based on your age. Coverage Level Subsidized Agent Unsubsidized Agent LTD 50/Base LTD No cost to you (Company-paid) You pay full cost of coverage on an After-Tax basis LTD 70/Buy Up LTD You contribute toward the cost of coverage on a Before-Tax or After-Tax basis. Before-Tax is the default election if you do not choose to have your contributions deducted on an After-Tax basis. You pay full cost of coverage on an After-Tax basis The cost of LTD coverage is subject to change annually. Corporate Agents Corporate agents contributions for LTD coverage are made on an After-Tax basis. The full coverage amount is deducted from your corporate commission voucher. The value of the Company subsidy, if any, is paid through the same voucher and appears as an adjustment. MassMutual Disability Option-Agents September 2015 Page 15 of 33
Before-Tax Versus After-Tax Contributions Since the Plan is administered at a group level for subsidized and unsubsidized agents, Before-Tax as well as After-Tax contributions are made to the Plan. Therefore, if you become Disabled and receive a benefit from the Plan, all or a portion of this benefit is subject to taxation. If you elect the Buy Up LTD option and are a subsidized agent, you can choose whether your contributions for coverage are deducted from your commission voucher on a Before-Tax or After-Tax basis. When Buy Up LTD benefits are received, the 20% buy-up amount (difference between Base LTD and Buy Up LTD) may be tax-free to you if your contributions were paid on an After-Tax basis. If premiums were paid on a Before-Tax basis, your benefits will be taxable (Note: New Jersey and Puerto Rico do not allow After-Tax contributions, so contributions must be made on a Before-Tax basis). Note: If, during Annual Benefits Enrollment, you switch between Before-Tax and After-Tax for your premiums, the portion of your benefit that is taxable will be based on the percent of premiums paid on a Before- Tax basis over the three years before your Disability. MassMutual Disability Option-Agents September 2015 Page 16 of 33
Long Term Disability (LTD) Coverage For General Agents and General Managers Eligibility You are eligible for LTD coverage options if you are a: General agent with a valid general agent contract (including a formula general agent); or General manager with a valid employment agreement. Note: The disability coverage options for career contract agents are described in a separate section of this SPD. Ineligible Participants You are not eligible for these coverage options if you are: A career contract agent; A broker; A retired agent; An agency staff member; All other employees (non-general managers) of MassMutual or one of its subsidiaries; or Otherwise excluded by Plan terms. Summary of Benefits Liberty Mutual manages LTD coverage on an insured basis. If approved, benefit payments will be issued monthly by Liberty Mutual. LTD works in conjunction with the STD Program to provide you with the flexibility to choose a level of income if you become Disabled. The Plan provides you flexibility in choosing the amount of LTD coverage you need at the time of enrollment; you may choose the Base LTD or Buy Up LTD option. For general agents and general managers, Base LTD is referenced as Class 1 or Core Plan in Appendix A: Liberty Life Assurance Company of Boston Certificate; Buy Up LTD is referenced as Class 2 or Buy-up Plan. Note: You may participate in Annual Benefits Enrollment while out on STD. However, any increase to your Life Insurance or LTD election will not become effective until you return to active status. As long as you remain disabled, benefits you receive while out on disability are based on the elections you had in place on your last day immediately prior to your disability date. See Appendix A: Liberty Life Assurance Company of Boston Certificate for specific information about this benefit. MassMutual Disability Option-Agents September 2015 Page 17 of 33
Benefits Pay/Agency Production Requirements Your benefits pay determines the amount of Buy Up LTD coverage for which you are eligible (refer to the following table). Benefits pay is defined as the rolling three-year average of your agency s First Year Commissions (FYC) for certain Life, Annuity and Disability (LAD) production. This figure is determined annually and is updated no later than April 1. Producer Services & Operations will notify you when your benefits pay is updated. Benefits Pay Monthly Base LTD (Company-paid) Monthly Buy Up LTD (You contribute towards the cost of this coverage) Under $1,000,000 $10,000 $2,000 $12,000 $1,000,000 - $1,999,999 $10,000 $4,000 $14,000 $2,000,000 - $2,999,999 $10,000 $6,000 $16,000 $3,000,000 - $3,999,999 $10,000 $8,000 $18,000 $4,000,000 and over $10,000 $10,000 $20,000 *Less other income offset Total Monthly LTD Coverage* (Base LTD + Buy Up LTD) No matter what your agency s production is, you are eligible for Company-paid Base LTD coverage of $10,000 monthly and Company-paid STD coverage for $2,308 weekly, less benefits from other income. Mid-Year Qualifying Event Any change to your LTD option due to a Mid-Year Qualifying Event must be consistent with and due to the Mid-Year Qualifying Event. If you have a Mid-Year Qualifying Event, you can change your existing level of LTD coverage for instance, you may be able to enroll in Buy-Up LTD coverage for the first time. You must make any changes and provide documentation within 30 days of your Mid-Year Qualifying Event (90 days in the case of birth, adoption or placement for adoption; 60 days if you work or reside in Puerto Rico). If Liberty Mutual does not permit a 90-day period (or 60-day period, as applicable), then documentation must be submitted within 30 days. Changes you make due to a Mid-Year Qualifying Event become effective as of the date you make the change. Before July 1, 2015, changes due to a Mid-Year Qualifying Event became effective as of the date of your Mid- Year Qualifying Event. To make changes to your coverage, you must notify Producer Services & Operations and provide documentation within 30 days of the event (90 days in the case of birth, adoption or placement for adoption; 60 days if you work or reside in Puerto Rico). If Liberty Mutual does not permit a 90-day period (or 60-day period, as applicable), then documentation must be submitted within 30 days. See the Family Status Change section in Appendix A: Liberty Life Assurance Company of Boston Certificate for more information. MassMutual Disability Option-Agents September 2015 Page 18 of 33
Cost of Coverage Base LTD option coverage is Company paid and you are automatically eligible for this coverage subject to Plan terms and LTD coverage approval by Liberty Mutual. If you elect Buy-Up LTD option coverage, you and the Company pay premiums for coverage. You pay for coverage on an After-Tax basis. Your contributions, which are withheld from your general agent voucher or general manager voucher/payroll, are based on the level of coverage you choose and your benefits pay (see the Benefits Pay/Agency Production Requirements section). Additionally, rates for Buy-Up LTD coverage may also vary based on your age. The cost of LTD coverage is subject to change annually. After-Tax Contributions The full value of MassMutual subsidy for STD and Base LTD coverage is included in your taxable income. Since the full value of this subsidy coverage is included in your taxable income and you pay for Buy Up LTD coverage on an After-Tax basis, if you become Disabled and receive a benefit from the Plan, the Buy-Up portion of your benefit is not subject to taxation. MassMutual Disability Option-Agents September 2015 Page 19 of 33
Claiming Benefits Applying for LTD Benefits The following table summarizes the action steps in the LTD process: Who Action When Liberty Mutual Starts the LTD process Approximately midway through the STD period You Provide any information Liberty Mutual may need to determine LTD status As requested by Liberty Mutual and before the end of your STD payment period Liberty Mutual Will inform you and MassMutual of the claim determination Before the end of your STD payment period (if medical documentation is not received, a decision could be delayed until on or after STD transitions to LTD) You may also file your LTD claim directly with Liberty Mutual. Contact Liberty Mutual to report the claim by calling 800-713-7384. Be prepared to provide the following information and to respond to any additional questions: Social Security number, address and phone number; Physician s name and phone number; Last day worked/first day absent due to your Injury/Sickness; Plan Sponsor s name (MassMutual); and General agent s or manager s name and phone number. It is your obligation to submit to periodic review of your disabling condition including examination by a Liberty Mutual consulting Physician as a requirement for benefits and to provide all necessary information requested to Liberty Mutual in support of your claim. LTD benefits may be denied if you fail to support your claim. If your LTD claim is denied, you may file for a review. See the ERISA Rights section in this book for information on reviewing and appealing denied claims. Your Disability Authorization Form A Liberty Mutual disability authorization form is available on the Benefit Forms page of mybenefits. Sign and date a copy of this form and leave it with your Physician or healthcare provider. This allows your healthcare provider to submit documentation to Liberty Mutual regarding your STD and/or LTD claim. Failure to do so may result in your claim being delayed or denied. Filing a Claim You must contact Liberty Mutual to report a claim within 30 calendar days of the date your Injury/Sickness occurred or as soon as reasonably possible. As the Plan s claims fiduciary for LTD Benefits, Liberty Mutual has the right to review and adjudicate LTD and STD claims. MassMutual Disability Option-Agents September 2015 Page 20 of 33
You will be asked to provide your: Name, Social Security number, address and phone number; Physician or healthcare provider s name and phone number; Last day of Active Service/first day absent due to your Injury/Sickness; and Plan Sponsor s name (MassMutual). You will be asked additional questions about yourself, your Physician or healthcare provider and your medical condition. Liberty Mutual will provide you with your claim number and the telephone number for your Liberty Mutual Claim Team. Additionally, at the mid-point of the STD Elimination Period, Liberty Mutual will initiate the LTD process, when applicable. Supply proof of your claim, as requested, to Liberty Mutual. LTD benefits may be denied if you fail to support your claim. Liberty Mutual will inform you of the claim determination. Proof of Your Claim Proof of your claim is medical documentation typically provided by your Physician or healthcare provider stating the: Date the Disability or Partial Disability started; Cause of Disability or Partial Disability; and Degree of Disability or Partial Disability. The proof must be given upon Liberty Mutual s request, on behalf of the Plan Sponsor and at your expense. In determining if you are disabled, Liberty Mutual, on behalf of the Plan Sponsor, will not consider employment factors, including, but not limited to, interpersonal conflict in the workplace, recession, job obsolescence, pay cuts, job sharing and loss of a professional or occupational license or certification. Proof must be provided to Liberty Mutual within 30 calendar days after the end of the Elimination Period. Periodically throughout your STD and/or LTD period, Liberty Mutual may call you and your Physician for an update on your condition and the possibility of your return to service. When proof of regular care of a Physician and continued Disability or Partial Disability is requested, provide this information to Liberty Mutual within 30 days of their request. Notify Liberty Mutual once your return to service date is known. Failure to follow these steps could delay STD/LTD payments. Submitting a Disability Claim: Liberty Mutual s Right of Examination Liberty Mutual, at its own expense, has the right to have you examined as often as reasonably required by a Physician or vocational expert of its choice. MassMutual Disability Option-Agents September 2015 Page 21 of 33
Claim Decision Timeframes If your claim is denied, Liberty Mutual will notify you of the adverse decision within a reasonable period, but not later than 45 days after receiving the claim. This 45-day period may be extended for up to 30 days, if Liberty Mutual: Determines the extension is necessary because of matters beyond the Plan s control; and Notifies you, before the end of the 45-day period, why the extension is needed and the expected decision date. If, before the end of the first 30-day extension, Liberty Mutual determines, due to matters beyond the Plan s control, that a decision cannot be rendered within that extension period, the determination period may be extended for up to an additional 30 days, provided Liberty Mutual notifies you, before the end of the first 30-day extension period, why the extension is needed and of the expected decision date. The notice of extension will explain the: Standards on which benefit entitlement is based; Unresolved issues that prevent a claim decision; and Additional information needed. You have 45 days to provide the information. The claim determination period begins when a claim is filed, without regard to whether all the information necessary to make a claim determination accompanies the filing. If an extension is necessary because you failed to submit necessary information, the days from the date Liberty sends you the extension notice until you respond to the request for additional information are not counted as part of the claim determination period. If Your Claim Is Denied or Reduced If your claim for benefits is denied or reduced, you will be notified in writing of the reason for the denial. The notice will include: The specific reason or reasons for denial with reference to those specific Plan provisions on which the denial is based; A description of any additional material or information necessary to perfect the claim and an explanation of why that material or information is necessary; A description of the Plan s appeals procedures and time frames, including a statement of the claimant s right to bring a civil action under ERISA following an adverse decision on appeal; If applicable, any internal rule, guideline, protocol or other similar criterion relied upon in making the adverse decision, or a statement that such a rule, guideline, protocol or other similar criterion was relied upon and a copy thereof, will be provided free of charge upon request; and If applicable, an explanation of any medically related exclusion or limitation involved in the decision. MassMutual Disability Option-Agents September 2015 Page 22 of 33
Appeals Procedures Appealing a Denied Claim If the decision to deny or reduce the amount of the claim is not explained to your satisfaction or you have additional information that you believe may change the decision, you should follow these steps to try to bring the claim denial to resolution: Contact your Liberty Mutual case manager at 888-440-6118 and request a review of the claim. File a claim appeal by sending a written request to: The Liberty Life Assurance Company of Boston Disability Claims P.O. Box 7211 London, KY 40742-7211 You also have the right to request, free of charge, access to copies of all documents, records and other information relevant to your claim for benefits. The request for the appeal should include: A copy of the denial; Any additional documentation that supports the approval of the claim; and The specific reasons why you think the claim should be reconsidered and approved. The written request for review must be sent within 180 days of receipt of the denial and state the reasons why you feel your claim should not have been denied. Appeals must be in writing and signed and dated. The review will give no deference to the original claim decision, and will not be made by the person(s) who made the initial claim decision. Any medical or vocational experts consulted by the Plan will be identified. Liberty Mutual has 45 days to provide a decision to uphold or overturn the denial. Liberty Mutual may extend this by an additional 45 days (total 90 days) if there are extenuating circumstances. Exception: Send appeals related to Plan eligibility matters (including loss or denial of coverage) within 180 days of loss or denial of coverage to the Claims Review Committee. You will receive written notification from the Claims Review Committee regarding the outcome of your appeal within 30 days from the date your appeal was received. If your appeal to the Claims Review Committee is denied, you may initiate a second-level appeal with the Plan Administrative Committee. Decisions made by the Plan Administrative Committee are final. The Claims Review and Plan Administrative Committees may be contacted at: MassMutual Benefits 1295 State Street, F105 Springfield, MA 01111-0001 Appeal requests may also be submitted to AgentBenefitQuestions@MassMutual.com or via Fax to 413-226-4382. MassMutual Disability Option-Agents September 2015 Page 23 of 33
Legal Action This Plan is governed by ERISA. For ERISA programs, you have the right to bring a civil action under ERISA Section 502(a) if you are not satisfied with the outcome of the appeals procedure. In most instances, you may not initiate a legal action against the Plan until you have completed the appeal processes. No legal action may begin more than one year after the date you have exhausted the Plan s claim and appeal process. You have 180 days from the date the claim was denied to file an appeal. No action may be commenced more than one year after the time requirement has expired. Right of Recovery If for some reason a benefit is paid that is larger than the amount allowed by the Plan, the Plan has a right to recover the excess amount from the person or entity that received it. Liberty Mutual, as this Plan s representative, must produce any instruments or papers necessary to ensure the right of recovery, unless prohibited by law, and present them to the person receiving benefits. Subrogation The Plan reserves the right of subrogation due to a loss. The Plan also reserves all rights to relief under ERISA, including those based in equity. If you incur health care expenses that a third party may be responsible for or contributed to, the Plan will automatically have a lien upon any amount recovered by you from any party. Some examples of situations when this might occur include, but are not limited to, a settlement from an automobile policy related to an automobile accident or a judgment in a lawsuit related to any loss. If your Injury appears to be someone else s fault, benefits otherwise payable under this Plan due to that Injury will not be paid unless you or your representative agrees to: Repay the Company and/or Liberty Mutual for those benefits to the extent that they are for losses for which compensation is paid to you or on behalf of the person at fault; Allow the Company and/or Liberty Mutual a lien on the compensation and to hold the compensation in trust for the Company and/or Liberty Mutual; and Execute and give to the Company and Liberty Mutual any instruments needed to secure the rights under the above items. You or your representative must execute any documents that may be required to allow the Plan to secure its rights (i.e., to recover any amounts to reimburse the Plan for benefits paid). When the third party s liability is determined, the Plan will be reimbursed either the amount actually paid by the Plan or an amount received from the third party, whichever is less. The amount of payments made includes the reasonable cash value of any benefits provided in the form of service. Even if the monetary award you receive is less than the benefit paid by the Plan, the Plan maintains its right to be reimbursed for all medical expenses and attorney s fees incurred by the Plan in pursuit of reimbursement. The Plan s right of recovery extends to any amount paid with respect to, associated with or stemming from the Injury or Illness incurred whether paid directly to you or whether held in trust or constructive trust for the benefit of you. Amounts are recoverable regardless of whether they have been commingled with other assets and may be recovered by the Plan without the need to trace the source of the funds. If you or another third party distributes the funds without regard to the Plan s rights of subrogation or reimbursement, such individual or individuals will be personally liable to the Plan for the amounts distributed. MassMutual Disability Option-Agents September 2015 Page 24 of 33
About Your Coverage If You Do Not Meet Production Requirements For Career Contract Agents If you are an eligible, non-financed career contract agent and do not meet the annual contract minimum requirements, your participation in the Plan can continue until March 31 of the following year, provided your career contract remains active. If you continue to hold a career agent contract, you will be eligible to purchase benefits at unsubsidized rates with After-Tax contributions. Unsubsidized agents can drop or decrease their coverage at any time between April 1 and the end of the year by notifying Producer Services & Operations in writing. These requested changes will be effective the first of the month after Producer Services & Operations receives the written request. An agent may re-qualify for subsidized benefits on a Before-Tax basis if they meet certain production requirements during this calendar year. Once the requirement is met, subsidized benefits will begin the first of the month following qualification. If You Leave the Company Your STD and LTD coverage ends the day your career contract, general agent contract or general manager agreement terminates. If You Retire If you retire from the Company, your STD and LTD coverage ends the day your career contract, general agent contract or general manager agreement terminates. If You Die If you die while covered under STD and LTD, your disability coverage ends the date of your death. Your surviving dependents may be eligible for continuation of coverage for options under the MassMutual Agents Welfare Benefits Plan (for example, medical, dental, vision). Refer to other SPDs (such as medical, dental, vision) for more information. Additionally, if you die while receiving LTD benefits, your Eligible Survivors may receive a lump sum amount equal to three times your last monthly benefit. An eligible survivor is your spouse, if living, otherwise your children under age 25. Payment will be made in equal shares if survivors are your children. Eligible survivors must contact Liberty Mutual at 888-440-6118 and submit a copy of your death certificate to be paid the lump sum amount. If the Company Ends Coverage Although MassMutual does not now intend to terminate the benefits described in this booklet, nevertheless, it reserves the right to modify, revoke, change, suspend or terminate this Plan, policy or benefits described here or in the underlying Plan document at any time or from time to time, with or without notice. This may result in modification or termination of benefits. MassMutual Disability Option-Agents September 2015 Page 25 of 33
When STD Coverage Ends Your STD payments will end on the earliest of the: Date you are no longer Disabled; End of the maximum STD period; Date your career contract, general agent contract or general manager agreement terminates; Date the STD program is terminated or amended to limit eligibility, causing you to become ineligible; Date you are no longer eligible to participate in the Plan; Date your payment for coverage is not made when due (applicable to unsubsidized agents only); or Date you die. The maximum STD period is the period for which STD is payable, if approved, for any Disability. The end of the maximum STD period is the earliest of the: End of the Disability; or Last day of the 22nd consecutive week of Disability (25th consecutive week of Disability for maternity). When the end date of your STD benefit is determined, the final week of your benefit is prorated if your STD benefit does not extend through a full week. The rate is one seventh of your Basic Weekly Earnings per day (Basic Weekly Earnings divided by 7). When LTD Coverage Ends Your LTD coverage ends on the earliest of the: Date your career contract, general agent contract or general manager agreement terminates; Date the LTD plan is terminated or amended to limit eligibility, causing you to become ineligible; End of the maximum benefit period; Date you are no longer eligible to participate in the Plan; Date your payment for coverage is not made when due; Date you are no longer Disabled; or Date you die. How LTD Affects Other MassMutual Benefits Upon Contract Termination Your other benefits may be impacted by LTD and the end of your career contract, general agent contract or general manager agreement: Medical Coverage: You may be eligible to continue medical through the retiree medical plan. See your LTD approval letter, which you will receive when you begin LTD benefits. Life Insurance: You may apply to UniCare for waiver of premium or apply to convert your policy. Refer to the life insurance SPD on FieldNet for more information. Thrift Plan: For career contract agents, contributions stop when your career contract terminates. You may not initiate a Thrift loan. If you have an outstanding Thrift plan loan when you begin LTD, you must repay it within 90 days or it will default, resulting in a taxable distribution. Cash Balance Pension Plan: If you become Disabled and begin receiving LTD benefits, you will receive information about your benefit. You may not change your benefit options during the Annual Benefits Enrollment period while on LTD. MassMutual Disability Option-Agents September 2015 Page 26 of 33
You are not eligible for any other benefits, including, but not limited to: Any additional benefit plans that become available while you are Disabled; Dependent life insurance you may request a right of conversion for group life coverage form to convert your coverage to an individual policy if you want; The dental option; The vision care option; Health Savings Accounts; and Flexible Spending Accounts (FSAs). Social Security Benefits How Social Security Affects Your LTD Benefits If you are eligible to receive Social Security benefits while you are on LTD, generally, you will receive the difference between the scheduled LTD amount payable and the amount you receive from Social Security. In some cases, Social Security awards are made retroactively. When this happens, you must repay the plan the amount it overpaid you. MassMutual LTD benefits are reduced by Social Security benefits received by your spouse or children because of your Disability. If you receive Social Security cost-of-living increases, your disability benefits from MassMutual will not be further reduced to compensate for the increases. Filing for Social Security Disability Benefits The LTD plan requires you to apply for Social Security disability benefits, and you must apply through Liberty Mutual. These benefits are not paid automatically. You may be eligible for these benefits, if approved, when you have been Disabled for five months. Often, LTD recipients are not immediately approved when applying for Social Security disability benefits. Thirdparty representation throughout the application process greatly increases the chances of a Social Security disability award being made. Liberty Mutual provides third-party representation at no cost to you. MassMutual Disability Option-Agents September 2015 Page 27 of 33
Plan Information The information presented in this SPD is intended to comply with the disclosure requirements of the regulations issued by the U.S. Department of Labor under the Employee Retirement Income Security Act (ERISA) of 1974. Plan Name and Number MassMutual Agents Welfare Benefits Plan, 506 Plan Administrator The Plan Administrator is the Plan Administrative Committee, which is appointed by MassMutual s Chief Executive Officer. The Plan Administrative Committee has the authority to control and manage the operations and administration of the Plan. You can reach the Plan Administrative Committee at: Massachusetts Mutual Life Insurance Company MassMutual Benefits 1295 State Street, F105 Springfield, MA 01111-0001 866-662-6448 Plan Sponsor Massachusetts Mutual Life Insurance Company 1295 State Street, F105 Springfield, MA 01111-0001 866-662-6448 Employer Identification Number (EIN) The EIN of Massachusetts Mutual Life Insurance Company is 04-1590850. Plan Year The Plan Year is January 1 through December 31. Agent for Service of Legal Process General Counsel of Massachusetts Mutual Life Insurance Company 1295 State Street Springfield, MA 01111-0001 If legal action is necessary to settle a claim, any action may also be served upon the Plan Administrator. Plan Type and Funding This Plan is a welfare plan providing disability income benefits on an insured basis. Premiums are paid from the general assets of the Company and participant contributions, where applicable. MassMutual Disability Option-Agents September 2015 Page 28 of 33
Claims Administrator The claims administrator is Liberty Mutual, Disability Claims, P.O. Box 7211, London, KY 47402-7211. The claims administrator has full discretion and fiduciary authority to determine claims and appeals arising under this Plan. Type of Administration This Plan is administered by Liberty Life Assurance Company of Boston. Continuation of the Plan Although MassMutual does not now intend to terminate the benefits described in this SPD, nevertheless it reserves the right to modify, revoke, change, suspend or terminate the Plan, policies, benefits or services described here or in the underlying Plan document at any time or from time to time, with or without notice. MassMutual Disability Option-Agents September 2015 Page 29 of 33
ERISA Rights As an LTD Plan participant, you are entitled to certain rights and protections under the Employee Retirement Income Security Act (ERISA) of 1974, as amended. ERISA provides that you are entitled to the rights described in this section. Receive Information about Plan and Benefits You have the right to: Examine, without charge, at the Plan Administrator s office or other specified locations, such as worksites, all documents governing the Plan. These include any insurance contracts and copies of the latest annual report (Form 5500 series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration (EBSA). Obtain, upon written request, copies of documents governing the operation of the Plan. These include any insurance contracts and copies of the latest annual report (Form 5500 series) and current Summary Plan Description. A reasonable charge may be required for the copies. Receive a summary of the Plan s annual financial report (summary annual report), which is required by law to be provided to each member. Prudent Actions by Plan Fiduciaries In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the Plan. The people who operate the Plan, called Plan fiduciaries, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including the Company or any other person, may discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA. Enforce Your Rights If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision (without charge) and to appeal any denial, all within certain time schedules. However, you may not begin any legal action, including proceedings before administrative agencies, until you have followed and exhausted the Plan s claim and appeal procedures. Note: Any legal action must begin within one year from the time proof of claim is required. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of a Plan document or the latest annual report and do not receive it within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the Plan Administrator s control. If you have a claim that is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the Plan s decision or lack thereof, you may file suit in federal court. If you believe that Plan fiduciaries have misused the Plan s money or if you believe that you have been discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees if, for example, it finds your claim is frivolous. MassMutual Disability Option-Agents September 2015 Page 30 of 33
Assistance with Questions If you have any questions about the Plan, you should contact the Plan Administrator. If you have any questions about your rights under ERISA or if you need assistance in getting documents from the Plan Administrator, you should contact the nearest EBSA office or the national office at: Division of Technical Assistance and Inquiries Employee Benefits Security Administration U.S. Department of Labor 200 Constitution Avenue NW Washington, DC 20210 866-444-3272 For more information about your rights and responsibilities under ERISA or for a list of EBSA offices, contact EBSA by visiting their website at www.dol.gov/ebsa. MassMutual Disability Option-Agents September 2015 Page 31 of 33
Dictionary Terms See definitions included in Appendix A: Liberty Life Assurance Company of Boston Certificate. Note: Throughout the Liberty Life Assurance Company of Boston Certificate, the term spouse also refers to an eligible domestic partner. Annual Benefits Enrollment, Benefits Enrollment or Open Enrollment The period each year designated by the Company when you may make changes to your benefit elections. Changes are effective the following January 1. Before-Tax or Pre-Tax Contributions taken before applicable federal, state and/or local taxes are withheld. Effective Date The date coverage begins. Member or Participant A person enrolled in and covered by this Plan. Plan Year The Plan Year is the 12-month period from January 1 to December 31. MassMutual Disability Option-Agents September 2015 Page 32 of 33
Appendix A: Liberty Life Assurance Company of Boston Certificate Note: Appendix numbering restarts with page 1 for Certificate. MassMutual Disability Option-Agents September 2015 Page 33 of 33
DISCLAIMER Sponsor: Massachusetts Mutual Life Insurance Company Policy Number(s): GD3-810-253705-01/GF3-810-253705-01 Date Provided: August 19, 2013 The following certificate(s) are a true copy of the certificate(s) issued under the policy(ies). LIBERTY LIFE ASSURANCE COMPANY OF BOSTON Appendix A: Certificate September 2015 Page 1 of 58
NOTICE OF CHANGE In The Certificate Booklet Issued to Employees of: Massachusetts Mutual Life Insurance Company This Notice is a summary of changes that have been made to your Booklet. These changes are effective on July 25, 2013. Keep this Notice with your Booklet. LIBERTY LIFE ASSURANCE COMPANY OF BOSTON -2- Appendix A: Certificate September 2015 Page 2 of 58
AMENDMENT to be attached to and made a part of the Certificate for Group Plan No. GF3-810-253241-01 issued by LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (Liberty) to Massachusetts Mutual Life Insurance Company (Sponsor) Effective date of this Amendment: July 25, 2013 The attached pages reflect a clarification note regarding agents and Employees. -3- Appendix A: Certificate September 2015 Page 3 of 58
CERTIFICATE OF COVERAGE Liberty Life Assurance Company of Boston (hereinafter referred to as "we", "our" and "us") welcomes your employer as a client. Sponsor: Plan Number: Massachusetts Mutual Life Insurance Company GD3-810-253705-01/GF3-810-253705-01 Effective Date: January 1, 2005 When this plan refers to "you" or "your" it means the Covered Person insured under this plan. This is your Disability Income certificate of coverage as long as you are eligible for insurance and remain insured. A few words about this certificate of coverage... It is written in plain English. A few terms and provisions are written as required by insurance law. PLEASE READ IT CAREFULLY. If you have any questions about any terms and provisions, please contact the Insurance Administrator at your work location or write to us. We will assist you in any way we can to help you understand your benefits. Also, if the terms of your certificate of coverage and the policy differ, the policy will govern. Your coverage may be terminated or modified in whole or in part under the terms and provisions of the policy. Executive Vice President DOC3.08-4- Appendix A: Certificate September 2015 Page 4 of 58