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This section:
- Outlines the core Life and AD&D insurance coverage
provided by PeaceHealth at no cost to you.
- Explains your options for purchasing additional coverage
for yourself, your spouse, or your dependents.
- Describes the circumstances under which you must provide
proof of good health in order to obtain higher levels of
insurance coverage.
- Explains the procedure for submitting claims.
The Group Life and Accidental Death and Dismemberment
(AD&D) Plan is offered to provide a level of financial
protection for you and your dependents. Life insurance provides
benefits to your beneficiary if you die. Accidental death and
dismemberment insurance provides benefits if you die or are
severely injured in an accident.
Group Life and Accidental Death and Dismemberment (AD&D)
insurance is provided to FlexAbility Benefit Plan members through
MetLife Insurance. This section summarizes information contained
in the group insurance certificate. When there is a dispute
between this summary and the certificate, the certificate will
supersede any provision listed in this summary. To obtain a copy
of the certificate, please contact your local Human Resources
department
Return to Life/AD&D
Table of Contents
Through PeaceHealth, you receive Core Life Insurance at no
cost to you. Your core life insurance benefits are determined by
the job you hold in the company and by your base salary. Under
this plan, if you die, your beneficiary will receive your core
life insurance benefits in a single sum or, if desired, in
installments. The maximum benefit is $50,000.
Core Life Benefit
|
Maximum Benefit
|
Minimum Benefit
|
- 50% of your annual base pay
|
$50,000
|
$5,000
|
Note: Base pay is rounded to the next higher multiple of
$l,000
Core life insurance amounts are reduced beginning at age 70.
| When you are: |
Your core life insurance benefit is: |
| 70 years of age |
65% of the amounts shown in
the table above |
| 75 years of age |
45% of the amounts shown in
the table above |
| 80 years of age |
30% of the amounts shown in
the table above |
Our Life Insurance plan allows you to purchase additional
"optional" insurance, based on your annual base pay, as
shown in the table below. You can purchase as much as 5 times
your annual base pay up to a maximum of $1,000,000.
| Option |
| 1X
annual base pay |
| 2X
annual base pay |
| 3X
annual base pay |
| 4X
annual base pay |
| 5X annual base pay |
| Maximum $1,000,000 |
Note: Base pay is rounded to the next higher multiple of
$l,000
The amounts of your Optional Life Benefit are not
subject to reduction.
Return to Life/AD&D
Table of Contents
Core Life Insurance coverage is also provided for your
dependents in the amount of $1,000 per dependent. Again, this is
provided by PeaceHealth at no cost to you.
If desired, you may purchase additional coverage for your
spouse and dependents, as shown in the table below. Note that you
can purchase increasing levels of coverage for your spouse;
however, the coverage for each dependent remains the same for all
options. Coverage for dependents applies only to children 6
months to 19 years of age (23 years, if a full time student).
Option
|
Spouse
|
Dependents
|
1
|
$5,000
|
$5,000/each
|
2
|
$10,000
|
$5,000/each
|
3
|
$25,000
|
$5,000/each
|
4
|
$50,000
|
$5,000/each
|
Dependent life insurance is in effect only if your personal
insurance is in effect. Your dependents are eligible for
dependent life insurance coverage on the date you become eligible
for life insurance or on the date the person becomes your
dependent, whichever is later. The amount of dependent life
insurance coverage on any one of your dependents cannot be more
than 50 percent of the amount of personal life insurance coverage
you have. Any reduction in your life insurance coverage may
result in a reduction of your dependent coverage as well. Changes
to coverage amounts become effective on the date the change
occurs.
During 2004 Open Enrollment, you have the opportunity to
elect the same level of Life Insurance coverage or increase
coverage for you or your spouse. In some cases, you may need to
provide proof of good health.
Note that new proof of health requirements will take effect
next year.
- You can re-elect Life Insurance coverage in the
amount of 1, 2, or 3 times your base pay with no proof of
good health (Evidence of Insurability.)
- You can newly-elect 1, 2, or 3 times your base pay
with no proof of good health, provided you have not been
hospitalized in the past 90 days. If you have, you must
provide Evidence of Insurability.
- You can newly elect 4 or 5 times your annual base pay. You
must provide Evidence of Insurability.
- New Hires Only: You are first
required to answer whether you have been hospitalized in
the last 90 days.
For Your Spouse
- You can elect Dependent Life Insurance coverage for your
spouse in the amount of $5,000 or $10,000 with no proof
of good health (Evidence of Insurability.)
New hires only: You
are first required to answer whether or not your spouse
has been hospitalized in the last 90 days.
- If you elect coverage in the amount of $25,000, no
Evidence of Insurability is required unless your spouse
has been hospitalized in the past 90 days. If so, you
must provide Evidence of Insurability.
- If you elect coverage in the amount of $50,000, Evidence
of Insurability is required.
Return to Life/AD&D
Table of Contents
If you become terminally ill while insured under this life
insurance plan, you are eligible to receive up to 50 percent of
the benefit while still living. (This also applies to dependent
life insurance.)
A terminal illness is defined as a medical condition that, in
the opinion of a physician, is expected to result in death within
12 months.
To receive this benefit you must:
- Become terminally ill while insured under the life
insurance plan.
- Provide satisfactory proof that you have a terminal
illness and submit to an independent physical
examination, if requested.
- Continue to make premium payments on the full amount of
the life insurance before receiving the accelerated
benefit.
Any benefits received under this provision may be taxable
income and you should consult a personal tax advisor prior to
electing this benefit.
Other requirements may apply. For more information, please
contact your Claims Administrator.
Return to Life/AD&D
Table of Contents
Through PeaceHealth, you receive core AD&D Insurance at no
cost to you. Your core AD&D benefits are determined by your
base salary, as shown in the table below. The maximum benefit you
may receive is $50,000.
Core AD&D Benefit
|
Maximum Benefit
|
Minimum Benefit
|
- 50% of your annual base pay
|
$50,000 |
$5,000 |
Note: Base pay is rounded to the next higher multiple of
$l,000
Under this plan, AD&D benefits are paid to you or your
beneficiary in the event you are injured in an accident resulting
in your death or a permanent loss within one year of the accident
date. The table below lists some of these benefits:
| Loss |
AD&D Benefit |
| Death |
Pays 100% of
coverage |
| Permanent loss of
two hands, feet, or eyes in one accident |
Pays 100% of
coverage |
| Permanent loss of
one hand, foot, or eye |
Pays 50% of coverage |
Permanent loss of hands or feet is defined as severance at or
above the wrists or ankle joints respectively. Permanent loss of
eyes is defined as complete and permanent sight loss. Click here for more detailed
information.
If you die as a result of an accident, your beneficiary would
receive benefits from both the group Life and the AD&D plans.
Beginning at age 70, core AD&D benefits
are reduced on the same schedule as your personal life insurance.
For schedule details, go to Life Insurance.
Return to Life/AD&D
Table of Contents
As with Life Insurance, our AD&D Insurance plan allows you
to purchase additional "optional" insurance, based on
your annual base pay, as shown in the table below. You can
purchase as much as 5 times your annual base pay up to a maximum
of $500,000.
Optional AD&D
Insurance
|
| 1
times your annual base pay |
| 2
times your annual base pay |
| 3
times your annual base pay |
| 4
times your annual base pay |
| 5
times your annual base pay |
Note: Base pay is rounded to the next higher multiple of
$l,000
Return to Life/AD&D
Table of Contents
AD&D Insurance does not cover losses
caused by:
- War or any act of war, whether declared or not
- Suicide, the attempt, or any intentional self-injury,
while sane or insane
- Disease or infection, except pyogenic or septic
infections of accidentally sustained visible wounds
- Injury to you while committing a felony
- Voluntary injection, inhalation, or ingestion of a
substance for purposes other than those prescribed by a
doctor
In the event of a death, send proof of death to your local
Human Resources department within 90 days. Human Resources will
complete the necessary paperwork and file a claim on your behalf.
Benefits are paid in a lump sum unless you have requested and
had approved another method of payment.
Benefits are paid to your designated beneficiary. If no
beneficiary is designated, then benefits are paid according to
this list:
- Your spouse
- Your children
- Your parents
- Your brothers and sisters
- Your estate
If your claim is denied, either in full or in part, and you do
not agree with the reason, submit a letter and supporting
information to Human Resources within 60 days of receiving the
denial.
State why you believe the claim should not have been denied,
providing any supporting data, questions, or comments you think
are appropriate. You will receive a written confirmation that
your appeal is being reviewed. At that time, you may be required
to submit additional documents for the review.
Human Resources will forward your claim to the Claims
Administrator, who will review it give a final decision no later
than 60 days from receipt of your request. If there are any
special circumstances, you will be notified and given the final
decision no later than 120 days from receipt of your request.
MetLife Insurance
Group Life Claims
PO Box 3016
Utica, New York 13504
1-800-638-6420
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Table of Contents
Coverage for both Life and AD&D Insurance ends on the last
day of the month in which you retire or terminate your
employment. If the insurer ends the plan, or your employer ends
the insurance contract, coverage would end on the date the plan
or insurance contract is ended. Dependent insurance coverage
automatically terminates when your personal insurance coverage
terminates.
If you take a leave of absence, coverage automatically
continues while you are on an approved leave if you pay your
premiums. For more information, contact your local Human
Resources department.
If you become totally disabled before age 60 and die within
one year after the disability begins, your life insurance
benefits will be paid to your beneficiary.
If you become totally disabled under the age of 60 and give
satisfactory proof of disability within one year of the start of
the disability, coverage will be extended without premium
beginning with the second year of your continued coverage during
disability. For more information, contact your Human Resources
Department.
If your life insurance ends, you may have the right to convert
this policy to an individual whole life policy. You must apply
for conversion within 31 days of your loss of coverage. Contact
your Human Resources Department to apply.
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Table of Contents
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