Dearborn National Group Basic & Voluntary Term Life Insurance Effective Date: (pending underwriting approval) Voluntary Term Life Coverage: If you are an existing employee and you are increasing your current coverage amount or if you are applying for coverage the very first time (did not apply when benefit was first offered) you are required to complete a Statement of Health. This applies to your dependents as well. CLASS I - All eligible employees CLASS II - Retirees - $10,000 (Life benefi ts terminate at age 65) BASIC LIFE INSURANCE This insurance is payable for death from any cause to any person you name as benefi ciary. AMOUNT OF BASIC LIFE INSURANCE (no cost to you) Base annual salary times 1 rounded to the next higher $1,000, to a maximum of ACCIDENTAL DEATH & DISMEMBERMENT PRINCIPAL SUM Base annual salary times 1 rounded to the next higher $1,000, to a maximum of AGE REDUCTION Benefi ts reduce* by 35% at age 65 and further reduce by 50% of the original amount at age 70. Life and AD&D benefi ts will terminate if you retire after the attainment of age 65. If you retire prior to age 65, you will transfer to Class II. AD&D benefi ts & Dependent Life benefi ts terminate at retirement. Age reduction also applies to dependent spouse. *There is no age reduction in the Voluntary Plan. AMOUNT OF DEPENDENT LIFE INSURANCE BENEFIT* Spouse $10,000 Child(ren) the age of birth, but less than 6 months $1,000 6 months, but less than 21 years $10,000 (23 years if full-time student) *In no event shall coverage of a dependent exceed 50% of the amount in force under the policy on the life of the insured employee. PLAN SPONSOR Iredell County Government PO Box 788, Statesville, NC 28687 704.878.3056 Page 71
VOLUNTARY LIFE INSURANCE Your employer-sponsored basic life coverage provides important protection for you, but you may need to add to that protection. Now you can...at low group rates and through convenient payroll deductions. To help meet this need, you have the opportunity to elect additional group life insurance under the supplemental portion of your plan to go along with any personal insurance coverage you may have. VOLUNTARY DEPENDENT LIFE INSURANCE Provides coverage on: Your Spouse Unmarried child(ren) between the ages of 15 days and 18 years (up to age 23 if wholly dependent upon you for maintenance and support and if enrolled as a full time student in an accredited school or college). Handicapped children can continue to be covered with no age limit. Children can only be covered by one parent. It is your responsibility to notify Human Resources when a spouse or dependent child is no longer eligible for coverage. (ie. divorce, child no longer full-time college student, etc.) FLEXIBILITY Simply choose the amount of coverage that suits your needs from the selection provided. FEATURES The plan features easy eligibility and simple enrollment procedures. Furthermore, automatic payroll deductions simplify paperwork. This means less bookkeeping for you and no worries about a lapse in coverage due to missed payments. LOW COST Your cost is lower for comparable insurance on an individual basis due to the wholesale economies inherent in group insurance. Additionally, the County absorbs the cost of administering the program which is underwritten by Dearborn National- a leader in the fi eld of group coverage. ELIGIBILITY You are eligible to enroll if you work 30 hours per week required by your employer, and have satisfi ed any waiting period. ENROLLMENT Enrollment is simple -- just fi ll out the enrollment form provided by your employer. Make sure you supply all the required information and return the form to your Benefi ts Department or to a Mark III Benefi ts Counselor (if during Annual Enrollment). That s all. You will be notifi ed as to when coverage starts. BENEFICIARY You have the right to designate the beneficiary of your choice under employee coverage. You are automatically the benefi ciary under Dependent Life. Page 72
WHEN YOUR INSURANCE STARTS If you enroll on or before the day you become eligible, your employer provided insurance becomes effective on the date of your eligibility if you are then actively at work; otherwise, on the day you return to active work. If you have elected Voluntary Employee or Dependent Life Insurance, you will be notifi ed as to when that coverage begins. Anyone electing not to enroll when fi rst eligible or within three months thereafter can enroll later only if evidence of insurability satisfactory to the Insurance Company is provided. TERMINATION OF COVERAGE All insurance under the plan will terminate upon the earlier of retirement, termination of employment, when the plan ceases or when you withdraw from the plan. Nevertheless, if you should die within 31 days thereafter, and you are eligible for conversion or portability, your life insurance will still be paid to your beneficiary. If any of your covered dependents should die within such 31 day period, the amount of Life Insurance on account will be paid to you. FAMILY STATUS CHANGE This provision allows you to increase your coverage by one times your basic annual salary without evidence of insurability within 31 days of the following: Marriage or divorce Death of a spouse or dependent child Birth or adoption of a dependent child Change in employment status for you or your spouse WAIVER OF PREMIUM Your Basic and Voluntary Life coverages include a wavier of premium provision. If an employee is unable to engage in any occupation as a result of injury or sickness for a minimum of 6 months, prior to age 60, premium will be waived for the employee's life insurance benefit until the employee is no longer disabled or reaches age 65, whichever occurs fi rst. Your employee Voluntary Life Insurance may be continued provided you remit the applicable premium to your employer. CONVERSION If your employment terminates while you are covered under the plan, you may purchase without medical evidence of insurability, any individual insurance policy, except a term policy, issued by Dearborn National Life Insurance Company in any amount up to the amount of your life coverage in effect on your date of termination. You must apply for this policy within 31 days after the date your coverage terminates. This privilege applies to Voluntary Life Insurance and Voluntary Dependent Life Insurance as well as to Basic Life Insurance. PORTABILITY Voluntary Life benefi ts are portable upon retirement or termination for the employee and/or his insured spouse. If an insured employee or spouse elects portability, he may also elect to continue Dependent Child(ren)'s coverage. Ported coverage terminates at age 70. Page 73
ACCELERATED BENEFITS OPTION Under this option, if you are diagnosed as having a terminal illness, you may be eligible to receive a portion of your group life benefi ts at such a diffi cult time. Please refer to your Group Certifi cate for details. GROUP POLICY AND CERTIFICATE The insurance briefly described in this folder is subject to the terms and conditions of the Group Policy issued by Dearborn National Life Insurance Company. If you become insured, you will receive a certifi cate outlining your benefi ts under the policy. CLAIMS PROCEDURE Claim forms needed to fi le for benefi ts under the group insurance plan can be obtained from your employer who will also be ready to answer questions about the insurance benefi ts and to assist in fi ling claims. The instructions on the claim form should be followed carefully. This will expedite the processing of the claim. Be sure all questions are answered fully. If there is any question about a claim payment, an explanation can be requested from your employer, who is usually able to provide the necessary information. This is only a brief summary of the life insurance benefits available. Some restrictions may apply. For more specific information about the coverage details, including limitations, exclusions and other requirements, please refer to your certificate booklet or contact your Benefits Department. If you have questions about a Life claim that you have submitted, please call Ft. Dearborn directly at 1.800.348.4512. SCHEDULE OF BENEFITS BASIC LIFE AND AD&D INSURANCE (paid by Iredell County; no cost to you) Base annual salary times 1 rounded to the next higher $1,000, to a maximum of BASIC DEPENDENT RATES - Cost is based on 24 Pay Periods Spouse and Child(ren) - $10,000 coverage- $.90 (for all dependents) VOLUNTARY LIFE INSURANCE Employee: $10,000- $500,000 (in $10,000 increments) Amounts over $100,000 will be fully underwritten and a Statement of Health must be completed. Employees age 70 and over must furnish evidence of insurability for all amounts of coverages. Employees age 60-69 must furnish evidence of insurability for amounts over $20,000. Employees under age 60 may be eligible for waiver of premium if totally disabled. Employees do not have to elect coverage on self to apply for coverage on dependents (Spouse & Child(ren). Page 74
Spouse: $10,000- $500,000 (in $10,000 increments) Amounts over $20,000 will be fully underwritten and a Statement of Health must be completed Spouse to age 70 is guarantee issue $20,000 Spouse who is 70 + years of age will be fully underwritten Spouse coverage can be greater than the Employee coverage Child(ren)*: Choice of $5,000 or $10,000 coverage on each of your eligible children $5,000 coverage- $.50-24 pay periods (no matter how many children) $10,000 coverage- $1.00-24 pay periods (no matter how many children) *If both employee and spouse are employees of the County, only one insured employee may elect life insurance on dependent children. 24 pay periods- Employee & Spouse Voluntary Life Rates (Spouse rates are based on the age of the Spouse, not the Employee) Age < 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Coverage $10,000 000 $0.30 $0.40 $0.45 $0.75 $1.10 $1.80 $2.95 $4.65 $7.45 $11.60 $20.80 vvvvvvvvvvvvv v v $20,000 $0.60 $0.80 $0.90 $1.50 $2.20 $3.60 $5.90 $9.30 $14.90 $23.20 $41.60 $30,000 $0.90 $1.20 $1.35 $2.25 $3.30 $5.40 $8.85 $13.95 $22.35 $34.80 $62.40 $40,000 $1.20 $1.60 $1.80 $3.00 $4.40 $7.20 $11.80 $18.60 $29.80 $46.40 $83.20 $50,000 $1.50 $2.00 $2.25 $3.75 $5.50 $9.00 $14.75 $23.25 $37.25 $58.00 $104.00 $60,000 $1.80 $2.40 $2.70 $4.50 $6.60 $10.80 $17.70 $27.90 $44.70 $69.60 $124.80 $70,000 $2.10 $2.80 $3.15 $5.25 $7.70 $12.60 $20.65 $32.55 $52.15 $81.20 $145.60 $80,000 $2.40 $3.20 $3.60 $6.00 $8.80 $14.40 $23.60 $37.20 $59.60 $92.80 $166.40 $90,000 $2.70 $3.60 $4.05 $6.75 $9.90 $16.20 $26.55 $41.85 $67.05 $104.40 $187.20 $100,000 $3.00 $4.00 $4.50 $7.50 $11.00 $18.00 $29.50 $46.50 $74.50 $116.00 $208.00 $110,000 $3.30 $4.40 $4.95 $8.25 $12.10 $19.80 $32.45 $51.15 $81.95 $127.60 $228.80 $120,000 $3.60 $4.80 $5.40 $9.00 $13.20 $21.60 $35.40 $55.80 $89.40 $139.20 $249.60 $130,000 $3.90 $5.20 $5.85 $9.75 $14.30 $23.40 $38.35 $60.45 $96.85 $150.80 $270.40 $140,000 $4.20 $5.60 $6.30 $10.50 $15.40 $25.20 $41.30 $65.10 $104.30 $162.40 $291.20 $150,000 $4.50 $6.00 $6.75 $11.25 $16.50 $27.00 $44.25 $69.75 $111.75 $174.00 $312.00 Website: www.fdlic.com Page 75