Miller MC Inc. dba Larry H. Miller Management Corporation GLUG-283A Revised: December 1, 2014 All eligible employees This Summary of Coverage provides a brief description of some of the terms, conditions, exclusions and limitations of Your employer s Policy. Definitions of capitalized terms in this Summary of Coverage can be found in the Certificate. For a complete description of the terms, conditions, exclusions and limitations of Your employer s Policy, refer to the appropriate section of the Certificate. In the event of a discrepancy between this Summary of Coverage and the Certificate, the Certificate will control. For a copy of the Certificate, contact the group Policyholder or Affiliate or s or Plan Administrator. This Summary of Coverage is not a contract. You are not necessarily entitled to insurance under the Policy because You received this Summary of Coverage. You are only entitled to insurance if You are eligible in accordance with the terms of the Certificate. BENEFITS Life Insurance for You Amount of Life Insurance: $25,000 Reductions Accidental Death and Dismemberment for You Life Insurance for Your Dependent(s) Minimum Work Hours Required Eligibility Waiting Period Note: In the event of death, the benefit paid will equal the benefit amount after any age reductions less any living care benefits previously paid under the Policy. Your Life Insurance will reduce to: 65% at age 65 50% at age 70 35% at age 75 If You are age 65 or older on the day You become insured under the Policy, the reduction will be made in accord with Your attained age. Life Insurance s end on the date of Your retirement. A Principal Sum equal to the amount of Your Life Insurance. If Your Life Insurance has been reduced by the Living s Option, such reduction will not apply to this Accidental Death and Dismemberment Principal Sum. Spouse, any age: $5,000 Child, birth to age 26: $5,000 EMPLOYEE ELIGIBILITY 30 or more hours each week 60 days
Confinement Rule When Insurance Begins When Your Classification or the Amount of Insurance Changes When Your Insurance Ends Dependent means If an eligible Employee is confined due to an Injury or Sickness: in a hospital as an inpatient; in any institution or facility other than a hospital; or at home and under the supervision of a Physician; insurance will begin on the first day of the Policy month which coincides with or follows the day the Employee returns to Active Work. If an eligible Employee is not: confined; and available for work because of an Injury or Sickness; insurance will begin on the first day of the Policy month which coincides with or follows the day the Employee returns to Active Work. An Employee will become insured on the first day of the Policy month that coincides with or follows the day the Employee becomes eligible, provided the Employee is Actively Working on that day. Any change in Your classification, coverage or amount of Your insurance as shown in the Schedule will take effect on the first day of the Policy month which coincides with or follows the day of the change, provided You are Actively Working on that day. If You are not Actively Working on that day, the following conditions will apply: If the change involves an increase in the amount of insurance, the change will not take effect until the first day of the Policy month which coincides with or follows the day You return to Active Work. If the change involves a decrease in the amount of insurance, the change will take effect on the day of the change. Your insurance will end at midnight at the main office of the Policyholder or Affiliate on the earliest of: the day the Policy ends; the day any premium contribution for Your insurance is due and unpaid; the day before You enter the Armed Forces on active duty (except for temporary active duty of two weeks or less); or the last day of the Policy month in which the day You are no longer eligible. You will no longer be eligible when the earliest of the following occurs: You are not in an eligible classification described in the Schedule; Your employment with the Policyholder or Affiliate ends; You are not Actively Employed; or You do not satisfy any other eligibility condition described in the Policy. DEPENDENT ELIGIBILITY Your lawful spouse; Your child who is: natural-born; legally adopted; a stepchild living in Your home; or a child: You are raising as Your own child; who is living in Your home and chiefly dependent on You for support; and for whom You have full parental responsibility and control; all as indicated by evidence acceptable to Us.
Limiting Age When Dependent Insurance Begins Change in the Amount of Dependents Insurance When Dependent Insurance Ends Living s Option For You Layoff or Leave of Absence Continuation of Life Insurance s Due to Total Disability Conversion Privilege Limiting Age means the child s 26th birthday. If We receive an Employee s properly completed and signed enrollment form requesting Dependent insurance and any additional required premium on or within 31 days following the date the Employee becomes eligible, an eligible Dependent will become insured the later of: the day the Employee becomes insured; or the day the Employee acquires the eligible Dependent. If You have a Dependent insured under the Policy, any newly acquired eligible Dependent will be insured automatically, provided We receive Your properly completed and signed enrollment form requesting Dependent insurance within 31 days of acquiring the new Dependent. Any change in the insurance of a Dependent who is confined or disabled (as described in the Confinement/Disability Rule) will not take effect: in the event of an increase in coverage, until such confinement or disability ends; or in the event of a decrease in coverage, on the day of the change. Dependent insurance will end at midnight at the main office of the Policyholder or Affiliate on the earliest of: the day the Policy ends; the day any premium contribution for Dependent insurance is due and unpaid; the day before a Dependent enters the Armed Forces on active duty (except for temporary active duty of two weeks or less); the day Dependent insurance under the Policy ends because of lack of participation; the day Your insurance ends; or the last day of the Policy month in which the Dependent is no longer eligible. FEATURES 75% of the amount of the Life Insurance is available to You if You incur a Terminal Condition, but not to exceed $50,000. Terminal Condition means an Injury or Sickness expected to result in Your death within 12 months and from which there is no reasonable prospect of recovery as determined by Us. Your insurance will continue subject to payment of premium until the last day of the Policy month in which You have been laid off or go on a leave of absence approved by the Policyholder or Affiliate. If You are Totally Disabled, Your Life Insurance s will not end in accordance with the When Your Insurance Ends provision, but will be continued without payment of premium provided: the Total Disability began while You were insured under this Policy; the Total Disability began before You reached age 60; and You have completed Your Disability Elimination Period. If any of your life insurance ends because your employment or membership in a class ends, you may apply for an individual policy of life insurance (called a conversion policy) without giving information about your health.
AD&D BENEFIT SCHEDULE The AD&D is paid if You are Injured as a result of an Accident, and that Injury is independent of Sickness and all other causes. s are paid as indicated below: Loss Life Both Hands Both Feet Entire Sight of Both Eyes One Hand and One Foot One Hand and Entire Sight of One Eye One Foot and Entire Sight of One Eye Speech and Hearing (both ears) Entire Sight of One Eye Speech or Hearing (both ears) One Hand or One Foot Principal Sum One-half Principal Sum Loss of Thumb and Index Finger One-fourth Principal Sum of Same Hand Paralysis Quadriplegia (total Paralysis of both upper and lower limbs) Principal Sum Triplegia (total Paralysis of three Three-quarters Principal Sum limbs) Paraplegia (total Paralysis of both One-half Principal Sum lower limbs) Hemiplegia (total Paralysis of an upper and a lower limb) Uniplegia (total Paralysis of a One-fourth Principal Sum limb) Other s Seat Belt s 10% of the Principal Sum, up to $50,000.
We will not pay for any loss which: is not permanent; AD&D EXCLUSIONS occurs more than 365 days after the Injury; Note: This 365 day limit will not apply if You are in a coma or being kept alive by an artificial support system at the end of the 365 days. does not result from an Accident; is caused by intentional, self-infliction of carbon monoxide poisoning emanating from a motor vehicle; results from injuries You receive in any aircraft other than while riding as a passenger in a commercial aircraft on a regularly scheduled flight; or while: operating; riding as a passenger in; or boarding or leaving; any aircraft while You are Traveling on Business of the Policyholder or Affiliate, provided the aircraft: has a current and valid FAA (Federal Aviation Administration of the United States) standard air worthiness certificate; and is operated by a person holding a current and valid FAA pilot s certificate of rating authorizing him or her to operate the aircraft; results in injuries You receive while riding in any aircraft engaged in: racing; endurance tests; or acrobatic or stunt flying; is caused by You, and is a result of injuries You receive, while under the influence of any Controlled Drug, unless administered on the advice of a Physician; Note: Controlled Drug means any drug having the capacity to affect behavior and regulated by law with regard to possession and use; or is caused by You, and is a result of injuries You receive, while Intoxicated; Note: Intoxicated means Your blood alcohol level at death or dismemberment equals or exceeds the legal limit for operating a motor vehicle in the jurisdiction in which the loss occurs. We do not pay under the Accidental Death and Dismemberment s provisions for: any loss which results, whether the Insured Person is sane or insane, from: an intentionally self-inflicted Injury or Sickness; or suicide or attempted suicide; any loss resulting from the Insured Person s participation in a riot or in the commission of a felony; any loss which results from an act of declared or undeclared war or armed aggression; or any loss: which is incurred while the Insured Person is on active duty or training in the Armed Forces, National Guard or Reserves of any state or country; and for which any governmental body or its agencies are liable. Publication Date: November 18, 2014