HomeMy WebLinkAboutCORRESPONDENCE - RFP - P682 (2)Sun Life
of Canada'
Sun Life Assurance Company of Canada
Application for Group Insurance
Applicant Organization
Legal Name
City of Fort Collins
Main Address 200 West Mountain Avenue, Suite A
Fort Co11inG. Cnlnradn 90922
City, State & Zip Code
Nature of Business _
Government
Subsidiaries or Affiliates to be Included
Legal Name Address
Nature of Business
Poudre Fire Authority 201 Remington Fort Collins CO 80524 Fire Protection
Downtown Development Authority 201 S. College, Fort Collins, CO 80524 Authority/Govt.
City of Fort o ins Housing Auttiority, W. -'-ltn., kort Collins, ov .
Eligible Employees Eligible Classes: Classified. Unclassified Mgmt., Contractuals
Number of Eligible Employees on the Effective Date: L2t1p Minimum Work Week JQhrs. Are Retirees Eligible? ❑Yes C$No
Waiting Period: Effective 1st of month following 30 consecutive calendar days of emoloymenf.
Specify days or months required for new employees to be eligible for benefits. Current employees who have not satisfied the
waiting period will receive credit for past service to complete the waiting period.
Benefits Requested
Benefit
% of Premium
Paid by Employer
Basic Life
®
100 %
Optional Life
-0
Dependent Life
®
0 %
Basic AD & D
[
inn %
Optional AD & D
®
0 %
Benefit % of Premium
Paid by Employer
Short Term Disability ❑ %
Long Term Disability ® 100 %
Dental
Employee ❑ %
Dependent ❑ %
Effective Date: T u as3r 1, 1997 Amount Paid with this Application: $ 8 , 000
Subject to approval by Sun Life, we will issue a Group Policy with insurance coverage to become effective on the Effective Date.
The Applicant agrees to provide Sun Life with a current census, as of the Effective Date, on all eligible employees and all data on
employees not actively at work. This information is required no sooner than the Effective Date and no later than 15 days after the
Effective Date. Employees not actively at work on the Effective Date will only be insured as required by law or as approved in
writing by Sun Life. This Application will be attached to and is made a part of the Group Policy. l
Countersigned by
(Licensed Resident Agent)
Name and Address of
Agent/Broker Firm
By
, uthorized Signature for pplicant Organization)
U �'i e ��V RD rtetl�J �rn'r,
(Name and itle)
(Place and Date of SignFg—)
State law may require us to notify you that any person who, with intent to defraud or knowing that he is facilitating a fraud against
an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud.
GR 18/354
When does my monthly LTD benefit cease?
Your monthly LTD benefit will cease on the earliest of-
- the date you are no longer Totally or Partially Disabled;
- the date you die;
- the end of your Maximum Benefit Period;
- the date you do not provide proof that you continue to be Totally or Partially
Disabled as requested; or
- the date your current earnings are more than 80% of your Indexed Total Monthly
Earnings;
Officers
- the date Sun Life determines you are able to perform all of the material and
We provide flexible own substantial duties of your own occupation, even if you choose not to work.
occupation periods which
range from the first year of All Other Employees
disability up to age 65.
- the date Sun Life determines you are able to perform all of the material and
substantial duties of your own occupation, even if you choose not to work (this
applies to the first 24 months of Total Disability or to your Partial Disability);
or
- after the first 24 months of Total Disability, the date Sun Life determines you
are able to perform all of the material and substantial duties of any occupation,
even if you choose not to work.
What happens if I return to full-time work and become disabled again?
Our return -to -work policy
encourages employees to Sun Life will treat this new disability as part of your prior Total or Partial Disability if you
return to work as soon as returned to work and were Actively at Work for less than:
possible, thus reducing - six months, if due to the same or related causes;
overall plan experience. - one day, if due to an entirely unrelated cause.
You will not have to complete a new Elimination Period.
Your monthly LTD benefit will be subject to the same terms and conditions as were
applicable to the original Total or Partial Disability.
Your monthly LTD benefit will not continue if:
- you become eligible for benefits under any other group LTD policy; or
- the Group Policy terminates.
If your new disability begins later than the time periods specified, you will need to complete
a new Elimination Period.
A survivor benefit is What happens to my LTD benefit if I die?
available which pays 3 A Survivor Benefit equal to 3 times your last Gross Monthly Benefit is payable in a lump
month's salary in one lump sum to your Eligible Survivor if Sun Life receives satisfactory proof that you died:
sum. - after your Total or Partial Disability had continued for 180 or more consecutive
days; and
Sun Life of Canada Sample Group Disability Booklet Page 18
you had received a monthly LTD benefit.
Who are my Eligible Survivors?
Your spouse, if living, or your children under age 25.
If you do not have an Eligible Survivor, the Survivor Benefit will be payable to your
estate.
What is the Cost of Living Adjustment Benefit?
Sun Life will pay an additional benefit to you to help against increases in costs due to
inflation.
When am I eligible for a Cost of Living Adjustment (COLA) Benefit?
You are eligible for a Cost of Living Adjustment Benefit on the first anniversary of your
Total Disability Benefit payments and each following anniversary thereafter, as long as
you are receiving a Total Disability Benefit.
How is my Cost of Living Adjustment Benefit calculated?
To determine your Cost of Living Adjustment Benefit multiply your Total Disability
monthly LTD benefit by 3%.
Your monthly LTD benefit adjusted by the Cost of Living Adjustment Benefit is not subject
to the Maximum Monthly Benefit.
Your monthly LTD benefit will include any prior years Cost of Living Adjustments.
When does my Cost of Living Adjustment Benefit terminate?
Your Cost of Living Adjustment Benefit will terminate on the earliest of:
- the date you no longer receive Total Disability Benefits; or
- the date you die; or
- the end of your Maximum Benefit Period; or
- the date you do not provide proof that you continue to be Totally Disabled as
requested.
What are the Limitations?
No LTD benefit will be payable to you for any Total or Partial Disability during any of the
following periods:
- any period you are no longer under the regular and continuing care of a Physician
providing appropriate treatment by means of examination and testing in
accordance with your disabling condition.
- any period you do not submit to any medical Examination requested by Sun
Life;
- any period of your Total or Partial Disability that is due to Mental Illness
(mental, nervous, psychological, emotional diseases, or behavioral disorders
of any type), unless you are under the continuing care of a specialist in
psychiatric care.
A COLA Provision is
available. This adjusts
benefit payments annually
to keep pace with inflation.
Limitations and exclusions
prevent misuse of LTD
benefits and help control
costs.
Sun Life of Canada Sample Group Disability Booklet Page 19
Requirements for
professional care help
ensure quality care
and also prevent
fraud.
After you complete your Elimination Period, LTD benefits are payable for 24 months.
Benefits after the first 24 months are payable only if you are confined in a Hospital or
Institution licensed to provide psychiatric treatment.
any period of your Total or Partial Disability that is due to Drug and Alcohol
Illness (an illness which results from the abuse of alcohol, drugs or derivatives),
unless you are actively supervised by a Physician or Rehabilitation Counselor
and are receiving continuing treatment from a rehabilitation center or a
designated institution approved by Sun Life.
After you complete your Elimination Period, LTD benefits are payable for 24
months if, during the Elimination Period you:
become confined in a Hospital or Institution licensed to provide Drug or
Alcohol treatment; or
begin participation in a Drug or Alcohol Rehabilitation Program
acceptable to Sun Life.
Benefits after the first 24 months are payable only if you are confined in a Hospital or
Institution licensed to provide Drug or Alcohol treatment.
any period of your Total or Partial Disability which begins in the first 12 months
after your LTD insurance becomes effective that is caused by, contributed to
by, or resulting from a Pre -Existing Condition unless your Total or Partial
Disability begins after a period of 3 consecutive months after your LTD insurance
becomes effective, during which you have not received medical treatment,
consultation, care or services, including diagnostic measures, or taken
prescribed drugs or medicines.
A Pre -Existing Condition means any Injury or Sickness for which you have received
medical treatment, consultation, care or services, including diagnostic measures, or took
prescribed drugs or medicines within 3 months of the date your LTD insurance becomes
effective.
What are the Exclusions?
No LTD benefit is payable for any Total or Partial Disability that is due to:
- intentionally self-inflicted injuries;
- war, declared or undeclared, or any act of war;
- your active participation in a riot, rebellion or insurrection; or
- your committing or attempting to commit an assault, felony or other illegal
act.
What happens when my Employer transfers Insurance Carriers to Sun Life?
In order to prevent losing your insurance, Sun Life will provide the following coverage.
If you are not Actively at Work on MMDDYY (eg. September 1, 199x) you will be insured
if:
you were insured under the prior insurer's group LTD policy at the time of the
transfer; and
Sun Life of Canada Sample Group Disability Booklet Page 20
2. you are a member of an Eligible Class; and
3. premiums for you are paid up to date; and
4. you are not receiving or eligible to receive benefits under the prior insurer's
group LTD policy.
If you become Totally or Partially Disabled, any LTD benefit payable will be based on the
prior insurer's definition of disability and will not exceed the prior insurer's maximum
monthly benefit. All other provisions of Sun Life's Group Policy will apply.
Are disabilities due to a Pre -Existing Condition covered?
LTD benefits may be payable for a Total or Partial Disability if you:
1. were insured under the prior insurer's group LTD policy at the time of the
transfer; and
2. were Actively at Work and insured on MMDDYY (eg. September 1, 199x).
Any benefit payable will be determined as follows:
if you have satisfied the Pre -Existing Condition Limitation under the Group
Policy, the LTD benefit will be based on the Group Policy's benefit provision.
2 if you cannot satisfy the Group Policy's Pre -Existing Condition Limitation,
the prior insurer's pre-existing condition limitation will be applied.
a. if you have satisfied the prior insurer's pre-existing condition limitation,
considering time insured under both group policies, any benefit payable will
be the lesser of:
i.the LTD benefit payable under the Group Policy; or
ii.the LTD benefit payable under the prior insurer's group LTD policy had
it remained in force.
b if you cannot satisfy the Pre -Existing Condition Limitation of the Group Policy
or that of the prior insurer's group LTD policy, no LTD benefit will be paid.
CLAIM PROVISIONS
How is a claim submitted?
To submit a claim, you or someone on your behalf must send Sun Life written Notice and
Proof of Claim within the time limits specified. Your Employer has the Sun Life Notice
and Proof of Claim forms.
When does written Notice of Claim have to be submitted?
for Short Term Disability -written notice of claim must be given to Sun Life no later
than 30 days after you cease to be Actively at Work.
for Long Term Disability -written notice of claim must be given to Sun Life no later
than 30 days before the end of your Elimination Period or, within 30 days of the termination
of the Group Policy, if earlier.
If notice cannot be given within the applicable time period, Sun Life must be notified as
soon as it is reasonably possible.
Easy steps for claims
submission.
Sun Life's expertise in
claim management allows
us to provide thorough
evaluations in a timely
manner.
Sun Life of Canada Sample Group Disability Booklet Page 21
When Sun Life has received written notice of claim, Sun Life will send the forms for
proof of claim. If the forms are not received within 15 days after written notice of claim
is sent, proof of claim may be sent to Sun Life without waiting to receive the proof of
claim forms.
When does written Proof of Claim have to be submitted?
for Short Term Disability -proof of claim must be given to Sun Life no later than 90 days
after the end of your Elimination Period.
for Long Term Disability -proof of claim must be given to Sun Life no later than 90 days
after the end of your Elimination Period.
If proof cannot be given within these time limits, proof must be given as soon as reasonably
possible. Proof of claim may not be given later than one year after the time proof is
otherwise required unless the individual is legally incompetent.
What is considered Proof of Claim?
Proof of Claim consists of at least the following information:
- what the disability is;
- the date the disability occurred; and
- the cause of the disability.
Sun Life may require as part of the Proof, authorizations to obtain medical and non -medical
information.
Proof of your continued Total or Partial Disability and regular and continuous care by a
Physician must be given to Sun Life within 30 days of the request for proof.
Proof must be satisfactory to Sun Life.
When are benefits payable?
Benefits are payable when Sun Life receives satisfactory Proof of Claim.
Who are benefits payable to?
Survivor Benefits are payable to your Eligible Survivor as defined in the Long Term
Disability Income Benefit Provision.
All other benefits payable during your lifetime are payable to you.
If a benefit is payable to your estate, if you are a minor, or you are not competent, Sun Life
has the right to pay an amount of the benefit up to $5,000 to any of your relatives that Sun
Life considers entitled. If Sun Life pays benefits in good faith to a relative, Sun Life will
not have to pay those benefits again.
GENERAL PROVISIONS
How can statements made in any application for insurance be used?
All statements made in any application are considered representations and not warranties.
No representation by you in applying for insurance under the Group Policy will be used to
reduce or deny a claim unless a copy of your written application for insurance is or has
Sun Life of Canada Sample Group Disability Booklet Page 22
been given to you or to your Beneficiary, if any.
No statement made by you relating to Evidence of Insurability for an initial, increased or
additional amount of insurance, will be used in contesting the validity of that insurance,
after such initial, increased or additional amount of insurance has been in force for a
period of two years during that individual's lifetime. This statement must be contained in
a form signed by that individual.
What happens if facts are misstated?
If relevant facts about you are not accurate:
an equitable adjustment of premium will be made; and
the true facts will be used to determine if and in what amount insurance is
valid under the Group Policy.
If the amount of benefit depends on your age, the benefit will be the amount you would
have been entitled to if your correct age were known.
What are Sun Life's examination rights?
Sun Life, at its own expense, has the right to have any person, whose Injury or Sickness
is the basis of a claim:
examined by a Physician, other health professional or vocational expert of its
choice; and/or
interviewed by an authorized Sun Life representative.
This right may be used as often as reasonably required.
What are the time limits for legal proceedings?
No legal action may start:
until 60 days after Proof of Claim has been given; nor
- more than 3 years after the time Proof of Claim is required.
Do these group benefits affect Workers' Compensation?
The Group Policy is not in lieu of, and does not affect, any requirement for coverage by
Workers' Compensation Insurance.
Can the policyholder act as a Sun Life agent?
For all purposes of the group policy, the policyholder acts on its own behalf or as your
agent. Under no circumstances will the policyholder be deemed a Sun Life agent.
DEFINITIONS
These are some of the general terms you need to know.
Actively at Work means that you perform all the regular duties of your job for a full work
day scheduled by your Employer at your Employer's normal place of business or a site
where your Employer's business requires you to travel.
Clarity of contract
wording helps employers
and employees
understand the benefits.
Sun Life of Canada Sample Group Disability Booklet Page 23
Our contract wording and
definitions are a significant
benefit of our contract. For
instance, by requiring the
disabled employee to be
under the regular care of a
qualified doctor, we help
ansure a high level of care
and thus increase the
chances for early return to
work.
You are considered Actively at Work on any day that is not your regular scheduled work
day (i.e., you are on vacation, layoff or an approved leave of absence) as long as you:
- are not hospital confined; or
- are not disabled due to an injury or sickness; and
- were Actively at Work on your immediately preceding scheduled work day.
You are considered Actively at Work if you usually perform the regular duties of your job
at your home as long as you:
- are not hospital confined; or
- are not disabled due to an injury or sickness; and
- can perform all the regular duties of your job for a full work day and can do so at
your Employer's normal place of business, if required.
Eligibility Date means the date or dates you become eligible for insurance under the
Group Policy. Classes eligible for insurance are shown in the Benefit Highlights.
Employee (You) means a person who is employed by the Employer, working at least the
number of hours shown in the Benefit Highlights, and paid regular earnings.
Employer means Sample LTD and STD and includes any Subsidiary, Affiliated or
Associated company insured under the Group Policy.
Evidence of Insurability means a statement or proof of your medical history upon which
acceptance for insurance will be determined by Sun Life.
Injury means bodily impairment resulting directly from an accident and independently
of all other causes. Any Injury must occur and Disability must begin while you are insured
under the Group Policy.
Physician means an individual who is operating within the scope of his license and is
either:
- licensed to practice medicine and prescribe and administer drugs or to perform
surgery; or
- legally qualified as a medical practitioner and required to be recognized, under the
Group Policy for insurance purposes, according to the insurance regulations of the
governing jurisdiction.
The Physician cannot be you, your spouse or the parents, brothers, sisters or children of
you or your spouse.
Pregnancy means childbirth, miscarriage, abortion or any disease resulting from or
aggravated by the pregnancy.
Sickness means illness, disease or pregnancy. A Disability, because of Sickness, must
begin while you are insured under the Group Policy.
Waiting Period means the continuous length of time immediately before your Eligibility
Date during which you must be employed in an Eligible Class before you can apply for
benefits. Any period of time before the Group Policy Effective Date that you were Actively
at Work for your Employer as a full-time Employee will count towards completion of your
Waiting Period. The Waiting Period is shown in the Benefit Highlights.
Sun Life of Canada Sample Group Disability Booklet Page 24
These are Short Term Disability insurance terms you need to know.
Elimination Period means a period of continuous days of your Total Disability when no
STD Benefit is payable. Your Elimination Period is shown in the Benefit Highlights and
begins on your first day of Total Disability.
Gross Weekly Benefit means your weekly STD benefit before any reduction of Other
Income Benefits.
Maximum Weekly Benefit means the largest amount payable weekly to you. The
Maximum Weekly Benefit is shown in the Benefit Highlights.
Total Disability or Totally Disabled means because of your Injury or Sickness, you are
unable to perform all of the material and substantial duties of your own occupation and
you are not engaged in any occupation for wage or profit.
The loss of your professional or occupational license, or your inability to obtain or qualify
for a license for any reason does not, in itself, constitute Total Disability.
To qualify for benefits, you must satisfy your Elimination Period with the required number
of days of Total Disability.
These are Long Term Disability insurance terms you need to know.
Elimination Period means a period of continuous days of your Total or Partial Disability
when no LTD benefit is payable. Your Elimination Period is shown in the Benefit
Highlights and begins on your first day of Total or Partial Disability.
If you return to work for 15 working days or less during your Elimination Period and
cannot continue working, your Total or Partial Disability will be treated as continuous.
Only those days that you are Totally or Partially Disabled will count toward satisfying
your Elimination Period.
Family Social Security means benefits that are paid by the Federal Social Security Act to
your eligible spouse and/or children as a result of your Total or Partial Disability.
Gross Monthly Benefit means your monthly LTD benefit before any reduction of Other
Income Benefits.
Maximum Monthly Benefit means the largest amount payable monthly to you. The
Maximum Monthly Benefit is shown in the Benefit Highlights.
Partial Disability or Partially Disabled means because of your Injury or Sickness, you
are unable to perform all of the material and substantial duties of your own occupation on
a full-time basis, but you are:
- performing at least one of the material and substantial duties of your own occupation
or another occupation on a part-time or full-time basis; and
- eaming less than 80% of your Total Monthly Earnings due to your same Injury
or Sickness that caused your Total or Partial Disability.
The loss of your professional or occupational license or your inability to obtain or qualify
for a license for any reason does not, in itself, constitute Total Disability.
To qualify for benefits, you must satisfy your Elimination Period with the required number
of days of Total Disability, Partial Disability or a combination of Total or Partial days of
Disability.
Sun Life of Canada Sample Group Disability Booklet Page 25
Retirement Plan means a program which provides retirement benefits to you and is not
funded wholly by your contributions. The term does not include a 401(k) plan, a profit
sharing plan, a thrift plan, an individual retirement account (IRA), a tax sheltered annuity
(TSA), a stock ownership plan, or a nonqualified plan of deferred compensation.
Your Employer's Retirement Plan includes any Retirement Plan which:
- is part of any federal, state, county, municipal or association retirement system; and
- you are eligible for as a result of your employment with your Employer.
Disability Benefit when used with the term Retirement Plan, means a benefit which:
- is payable under. a Retirement Plan due to a disability as defined in that Plan; and
- does not reduce the amount which would have been paid as Retirement Benefits at
your normal retirement age under the Plan if the disability had not occurred.
Social Security means the Federal Social Security Act which provides social insurance
on a national scale.
Total Disability or Totally Disabled means because of your Injury or Sickness, you are
unable to perform all of the material and substantial duties of your own occupation.
The loss of your professional or occupational license or your inability to obtain or qualify
for a license for any reason does not, in itself, constitute Total Disability.
To qualify for benefits, you must satisfy your Elimination Period with the required number
of days of Total Disability, Partial Disability or a combination of Total or Partial days of
Disability.
All Other Employees
Total Disability or Totally Disabled means during your Elimination Period and the next
24 months of your Total Disability, you, because of your Injury or Sickness, are unable to
perform all of the material and substantial duties of your own occupation. After benefits
have been paid to you for 24 months you will continue to be considered Totally Disabled
if you are unable to perform all of the material and substantial duties of any occupation
for which you are or become reasonably qualified for by education, training or experience.
The loss of your professional or occupational license or your inability to obtain or qualify
for a license for any reason does not, in itself, constitute Total Disability.
To qualify for benefits, you must satisfy your Elimination Period with the required number
of days of Total Disability, Partial Disability or a combination of Total or Partial days of
Disability.
Sun Life of Canada Sample Group Disability Booklet Page 26
BENEFIT HIGHLIGHTS
LIFE AND ACCIDENTAL DEATH
AND DISMEMBERMENT INSURANCE
ELIGIBLE CLASSES
All full-time Employees working a minimum of 30 hours a week.
CLASSIFICATION
Class A
Class Al
Class A2
BASIC INSURANCE
Class A
All Employees
All Employees who elect this coverage
All Employees who elect this coverage
OPTIONAL INSURANCE
Class Al
Class A2
AMOUNT OF INSURANCE
LIFE
AD&D
1 times your An amount equal to your
Basic Annual Earnings* amount of Life Insurance in force
LIFE
1 times your
Basic Annual Earnings**
2 times your
Basic Annual Earnings**
AD&D
An amount equal to your
amount of Optional Life
Insurance in force
An amount equal to your
amount of Optional Life
Insurance in force
* rounded to the next higher $1,000, if not already a multiple of $1,000, subject to a Basic
Maximum Benefit of $250,000.
** rounded to the next higher $1,000, if not already a multiple of $1,000, subject to an
Optional Maximum Benefit of $400,000.
Your Amount of Life and Accidental Death and Dismemberment Insurance reduces to
67% when you reach age 70 and to 50% when you reach age 75. Your Life and Accidental
Death and Dismemberment Insurance cancels at your retirement.
Flexibility in plan
design allows life
insurance benefits to
be based on a multiple
of earnings or flat
dollar amount.
Our plans feature high
benefit maximums. We
make life easy for you and
your employees by
providing the amount of
coverage most individuals
want without medical
evidence underwriting.
Sun Life of Canada Sample Group Life Booklet Page 3
LONG TERM DISABILITY INSURANCE
ELIGIBLE CLASSES
All full-time employees working a minimum of 30 hours a week.
AMOUNT OF INSURANCE
60% (Benefit Percentage) of your Total Monthly Earnings, not to exceed the
Maximum Monthly Benefit, less Other Income Benefits.
-the Maximum Monthly Benefit is $5,000.
Note: your amount of insurance is also subject to reductions for your employment earnings.
The Minimum Monthly Benefit is $50.
Elimination Period
(The period of time you need to be continuously Totally or Partially Disabled before LTD
benefits are payable)
6 months, or the end of the Employee's salary continuation period, whichever is
later.
Maximum Benefit Period
(The longest period of time Sun Life will pay you an LTD benefit while you are Totally or
Partially Disabled)
Age at Disability
Less than age 60
60
61
62
63
64
65
66
67
68
69 and over
Total Monthly Earnings -,\
Maximum Benefit Period
To age 65, but not less than 60 months
60 Months
48 Months
42 Months
36 Months
30 Months
24 Months
21 Months
18 Months
15 Months
12 Months
Your basic monthly earnings as reported by your Employer immediately before the first
date your Total or Partial Disability begins. Total Monthly Earnings does not include
commissions, bonuses, overtime pay or any other extra compensation.
We offer Long Term
Disability (LTD) benefit
percentages between 40
and 662/3%. This range
allows employers to create
a valuable employee
benefit at a cost which
meets the employer's
fiscal needs.
Partially replacing
employee wages
encourages employers to
return to work, while still
providing them with
income for fixed expenses.
Sun Life was one of the
first carriers to standardly
provide a zero day
residual feature. This
benefit allows employers
to satisfy the LTD
elimination period while
working part time with a
partial disability. It strongly
encourages employees to
continue working.
Sun Life of Canada Sample Group Disability Booklet Page 5
Evidence of Insurability, satisfactory to Sun Life, will be required for any of the following
Our group life insurance
reasons:
products traditionally do
- you elect Basic Life Insurance only and you later elect Optional Life Insurance; or
not require medical
- you elect an increase in your amount of Optional Life Insurance.
evidence underwriting.
-
Basic Annual Earnings
Your current salary or wage from your Employer. Basic Annual Earnings does not include
commissions, bonuses, overtime pay or any other extra compensation.
DEPENDENT LIFE INSURANCE
ELIGIBLE CLASSES
All full-time Employees working a minimum of 30 hours a week.
AMOUNT OF INSURANCE
For your Spouse $10,000
For your unmarried Children:
Our plans can provide
coverage for children
Under 15 days NONE
from birth and students
up to age 25.
15 days but under 1 year $500
1 year to age 19* $5,000
* to age 23 if your child is an enrolled full-time student and depends on you for 50% or
more of his/her support.
(The amount of insurance for any of your Dependents cannot be more than 50% of your
amount of Life Insurance)
WAITING PERIOD
(The period of time you must be employed in an Eligible Class before you can apply for
benefits)
1 month
CONTRIBUTIONS
The cost of your Basic Life, Dependent Life and Accidental Death and Dismemberment
Insurance is paid for entirely by your Employer. This is your non-contributory insurance.
The cost of your Optional Life and Accidental Death and Dismemberment Insurance is
paid for entirely by you. This is your contributory insurance.
Sun Life of Canada Sample Group Life Booklet Page 4
The following Questions and Answers will help you to better understand your benefits.
Please read them carefully and refer any questions to your Employer or call the Sun
Life Group Service Center toll free at 1-800-247-6875.
ELIGIBILITY AND EFFECTIVE DATE
OF EMPLOYEE INSURANCE
When am I eligible for insurance?
If you are in an Eligible Class shown in the Benefit Highlights, you are eligible on the
later of:
MMDDYY (eg. May 1, 199x); or
the day after you complete your Waiting Period.
When do I need to apply for insurance?
You must apply within 31 days of the date you become eligible.
When does my insurance start?
For non-contributory insurance, your insurance starts on the date you are eligible, if you
are Actively at Work on that date.
For contributory insurance, your insurance starts on the date you apply, if you are Actively
at Work on that date.
What happens if I do not apply within 31 days?
Your insurance will start on the date Sun Life approves your Evidence of Insurability, if
you are Actively at Work on that date. Evidence of Insurability is at your expense.
What if I am not Actively at Work on that date?
If you are not Actively at Work because of injury, sickness, layoff or leave of absence on
the date your insurance would normally start, your insurance will not start until you are
Actively at Work.
What happens if I do not want my insurance?
You need to sign the Sun Life form refusing your insurance. This form is available from
your Employer.
If you decide later you want Optional Life and Accidental Death and Dismemberment
insurance, Sun Life must first approve your Evidence of Insurability. Evidence of
Insurability is at your own expense.
Simple, concise answers
to your employees'
questions.
Important information
about when insurance
starts.
Late entrant
provisions help keep
premiums affordable.
Sun Life of Canada Sample Group Life Booklet Page 5
Termination and
continuation of
employee's coverage.
When do changes in my amount of insurance occur?
If your amount of insurance increases due to a change in your salary or class, your increase
will take effect immediately, as long as:
you afe Actively at Work on that date; and
Evidence of Insurability is not required for the increase in your amount of insurance.
If your amount of insurance decreases due to a change in your age, salary or class, the
decrease will take effect immediately.
If Evidence of Insurability is required for any increase in your amount of insurance, the
increase in your insurance will not start until Sun Life approves the increase, but you
need to be Actively at Work on that date.
If you are not Actively at Work because of injury, sickness, layoff or leave of absence on
the date an increase in your insurance would normally start, the increase in your insurance
will not start until you are Actively at Work.
ELIGIBILITY AND EFFECTIVE DATE
OF DEPENDENT INSURANCE
When am I eligible for Dependent insurance?
If you are in an Eligible Class shown in the Benefit Highlights and you have a Dependent,
you are eligible for Dependent insurance as long as you are insured for Employee Life
insurance.
When does the insurance for my Dependent start?
If your Dependent is not Hospital confined or disabled due to an injury or sickness, the
insurance for your Dependent starts on the date you are eligible for Dependent Life
Insurance.
What if my Dependent is Hospital confined or disabled?
If your Dependent is Hospital confined or disabled due to an injury or sickness on the date
your Dependent's insurance would normally start, your Dependent's insurance will not
start until the Dependent is no longer Hospital confined or the Dependent is no longer
disabled and is able to perform the normal duties of a person of like age and sex.
TERMINATION OF EMPLOYEE INSURANCE
When does my insurance cease?
Your insurance ceases on the earliest of:
- the date the Group Policy terminates;
- the date you are no longer in an Eligible Class;
- the date your class is no longer included for insurance;
- the last day any required premium has been paid for your insurance;
- the date you retire;
- the date you request in writing to terminate your insurance;
- the date you enter active duty in any armed service during a time of war (declared or
undeclared);
- the date your employment terminates; or
- the date you cease to be Actively at Work.
Sun Life of Canada Sample Group Life Booklet Page 6
Are there any conditions under which my insurance can continue?
Yes.
Your insurance will continue during any period the premium for your insurance is waived
under the Group Policy.
If you are on temporary layoff, leave of absence or vacation, your Employer may continue
your insurance by paying the required premium for the length of time specified below.
Layoff - for up to 1 month
Leave of Absence - for up to 1 month
Vacation - for up to 3 months
If you are absent from work due to an injury or sickness, your Employer may continue
your Life insurance, by paying the required premium, for up to 12 months.
If you are "Totally Disabled" you may be eligible for a longer continuation of Life Insurance.
Refer to "What is the Waiver of Premium Provision" in the Life Benefit Section. Please
note you need to apply for continued benefits under the Waiver of Premium Provision
within 12 months after you cease to be Actively at Work.
If your coverage terminates and you are not eligible for any of the described continuations,
you may be eligible for a Conversion Privilege. Refer to the "Conversion Privilege" in
the Life Benefit section. Please note that you need to apply for the conversion and pay the
required premium within 31 days following your termination of insurance.
You may be eligible to continue your insurance pursuant to the Family and Medical Leave
Act of 1993. You should contact your Employer for more details.
TERMINATION OF DEPENDENT INSURANCE
When does my Dependent's insurance cease?
Your Dependent's insurance ceases on the earliest of:
- the date the Group Policy terminates;
- the date you cease to be insured;
- the date you are no longer in an Eligible Class for Dependent Insurance;
- the date the Dependent does not qualify as a Dependent;
- the last day any required premium has been paid for your Dependent's insurance;
- the date you request in writing to terminate your Dependent's insurance;
- the date your Dependent enters active duty in any armed service during a time of war
(declared or undeclared);
- the date you retire; or
- the date you die.
Important Waiver of
Premium information
regarding when an
employee needs to apply
for continued benefits if
totally disabled.
Sun Life of Canada Sample Group Life Booklet Page 7
No elimination period
exists when applying for a
Waiver of Premium. The
industry standard, used
by most other companies,
requires a 6- or 9-month
elimination period.
Our plans can extend the
Waiver of Premium
eligibility to age 65.
Are there any conditions under which my Dependent's insurance can continue?
Yes.
If your Dependent's coverage terminates, your Dependent may be eligible for a Conversion
Privilege. Refer to the "Conversion Privilege" of the Dependent Life Benefit section.
Please note that you or your Dependent need to apply for the conversion and pay the
required premium within 31 days following termination of the Dependent's insurance.
You may be eligible to continue your Dependent's insurance pursuant to the Family and
Medical Leave Act of 1993. You should contact your Employer for more details.
BENEFIT PROVISIONS
EMPLOYEE LIFE INSURANCE
What is the Life Insurance Benefit?
If you die while insured, your Beneficiary will receive the amount of your Life Insurance
in force when Sun Life receives written Notice and Proof of Claim.
What is the amount of my Life Insurance?
The amount of your Basic Life Insurance is the Basic amount of insurance shown in the
Benefit Highlights.
Your Basic Life Insurance cannot exceed the Basic Maximum Benefit shown in the Benefit
Highlights.
Your amount of Basic Life Insurance is subject to any age reductions or terminations
shown in the Benefit Highlights.
The amount of your Optional Life Insurance is your amount of insurance elected as shown
in the Benefit Highlights.
Your Optional Life Insurance cannot exceed the Optional Maximum Benefit shown in the
Benefit Highlights.
Your amount of Optional Life Insurance is subject to any Evidence of Insurability
requirements, age reductions or terminations shown in the Benefit Highlights.
What is the Waiver of Premium Provision?
If you become Totally Disabled while insured, the Waiver of Premium Provision may
continue your Life Insurance without any further payment of premiums by you or your
Employer.
When am I eligible for the Waiver of Premium Provision?
You are eligible if Sun Life receives Notice and Proof of Claim that you became Totally
Disabled:
- while insured; and
- before your 60th birthday; and
- before you retire.
Sun Life of Canada Sample Group Life Booklet Page 8
What is the amount of Life Insurance that is continued under the Waiver of Premium
Provision?
Sun Life will continue the amount of your Life Insurance in force on the last day you were
Actively at Work. This amount is subject to the same reductions or terminations that
would have been applicable had you not become Totally Disabled.
If you have converted your Life Insurance to an individual policy, the continued insurance
will be reduced by that converted amount unless you exchange that individual policy for
a full refund of premiums paid.
When does my Waiver of Premium cease?
Your Waiver of Premium ceases on the earliest of:
- the date you are no longer Totally Disabled;
- the date you do not provide Proof that you continue to be Totally Disabled;
- the date you do not submit to an examination by a Physician of Sun Life's choice;
- the date you are no longer under the regular and continuing care of a Physician
providing appropriate treatment by means of examination and testing in accordance
with your disabling condition;
- the date you reach age 70; or
- the date you retire.
For the purposes of this Waiver of Premium Provision, you are considered retired when
you receive any compensation from a retirement or pension plan of your Employer, or
when you reach age 70, whichever is earlier.
If your Waiver of Premium ceases and you do not return to work with your Employer,
your Life Insurance will terminate. You may be eligible to convert your Life Insurance
under the Conversion Privilege.
What is the Accelerated Benefit?
If Sun Life receives satisfactory Certification that you are Terminally Ill, part of your Life
Insurance may be payable to you while you are still living.
When am I eligible for an Accelerated Benefit?
(Applicable if you were employed on or before MMDDYY (eg. May 1, 199x))
You are eligible if.-
- you were Actively at Work on MMDDYY (eg. May 1, 199x) and have been insured for
Life Insurance for at least 60 days. (This includes any period of time you were insured
under the prior insurer's group life policy); and
Our accelerated benefit
feature is provided at no
additional cost to you,
giving your plan real
added value.
Sun Life of Canada Sample Group Life Booklet Page 9
A living benefit is an
affordable way to help
your employees meet any
financial burdens.
(Applicable if you were employed after MMDDYY (eg. May 1, 199x))
You are eligible if-
- you have been insured for life insurance for at least 60 days; and
(Applicable to All Employees)
- you are certified as Totally and Permanently Disabled; and
- you are insured for at least $20,000 of Life Insurance; and
- you are approved for continuation of your Life Insurance under the Group Policy's
Waiver of Premium provision.
How do I receive an Accelerated Benefit?
You need to submit a written request to Sun Life.
If you have assigned your Life Insurance, named an irrevocable Beneficiary or have a
former spouse named as Beneficiary as part of a divorce decree, you must have a signed
agreement from those parties.
What is the amount of Accelerated Benefit?
You can request up to 50% of the amount of your Life Insurance currently in force. The
maximum amount you can request is $250,000. The minimum amount you may request
is $10,000.
If you have received an Accelerated Benefit under the prior insurer's group life policy,
you can request up to 50% of your Life Insurance currently in force reduced by the amount
of the Accelerated Benefit you have previously received.
How is the Accelerated Benefit paid?
The Accelerated Benefit is paid in a single lump sum amount.
Can I receive more than one Accelerated Benefit?
You may request the Accelerated Benefit only once under Sun Life's Group Policy.
Are there any charges if I request an Accelerated Benefit?
A claims administration fee of up to $150 will be deducted from your Accelerated Benefit.
A 9 month interest charge will also be deducted from your remaining death benefit.
What happens to my Life Insurance if I receive an Accelerated Benefit?
If you have received an Accelerated Benefit from Sun Life or the prior insurer's group life
policy, your Life Insurance will be reduced by an amount equal to the Accelerated Benefit
paid by Sun Life, and the 9 month interest charge and an amount equal to the Accelerated
Benefit paid by the prior insurer's group life policy.
Sun Life of Canada Sample Group Life Booklet Page 10
Some Important Notes about your Accelerated Benefit
Your Accelerated Benefit is not a long term care policy. The amount your Accelerated
Benefit would pay may not be enough to cover nursing home expenses or other bills. You
may use the money received from the Accelerated Benefit for any purpose.
Receipt of your Accelerated Benefit may affect your Medicaid eligibility.
No Accelerated ,Benefit payment will be processed if you are required to request it by a
third party, including any creditor, governmental agency, trustee in bankruptcy or any
other person, or as the result of a court order.
Benefits payable under this provision MAY be taxable. You should consult your tax advisor.
Sun Life does not give tax or legal advice.
What is the Conversion Privilege?
If your Life Insurance ceases, you may be able to convert your Life Insurance to an individual
policy. You need to apply for the Conversion Privilege within 31 days. See question "How
do I convert my Life Insurance?".
When can I convert my Life Insurance?
1. You can convert if all or part of your Life Insurance ceases or reduces due to:
- termination of your employment;
- termination of your membership in an Eligible Class;
- your retirement;
- your reaching a specified age;
- your changing to a different Eligible Class;
- termination of your Waiver of Premium continuation; or
- your continuation period ending during your layoff or leave of absence.
2. You can convert if you have been continuously insured for 5 or more years under Sun
Life's Group Life Policy and all or part of your Life Insurance ceases or reduces due to:
- termination of the Life Insurance Benefit Provision;
- termination of the Group Policy;
- an amendment to the Group Policy to reduce the amount of Life Insurance in your
Eligible Class; or
- an amendment to the Group Policy to terminate your Eligible Class.
What amount of Life Insurance can I convert?
The amount of Life Insurance you can convert depends on the reason your Life Insurance
ceases.
If your amount of Life Insurance ceased or reduced for the reasons stated in #1 "When can
I convert my Life Insurance?", you can convert up to the amount that ceased or reduced. If
your amount of Life Insurance that ceased is $10,000 or more, the minimum amount of
your individual policy must be $10,000.
If your amount of Life Insurance ceased or reduced for the reasons stated in #2 "When can
I convert my Life Insurance?", you can convert up to the lesser of-
- $2,000; or
- the amount that ceased or reduced less any amount of group life insurance you may
become eligible for within 31 days after your Life Insurance ceased or reduced.
Important information
about conversion
privileges.
Sun Life of Canada Sample Group Life Booklet Page 11
How do I convert my Life Insurance?
You convert by applying to Sun Life for an individual policy along with sending
payment of the first premium within 31 days after any part of your Life Insurance
ceases or reduces. This is your 31 day conversion period.
What type of individual policy is available?
You can convert to any plan of whole life insurance available by Sun Life for
conversion. The individual policy will not include any additional benefits such as
disability benefits or accidental death and dismembement benefits.
When does my individual policy start?
If your application for the individual policy is received and the first premium is paid
when due, your individual policy starts on the day after the 31 day conversion period.
What happens if I die during the 31 day conversion period?
If Sun Life receives Notice and Proof of Claim, a death benefit is payable to your Beneficiary,
whether or not you had applied for an individual policy or had paid the first premium.
The death benefit is the amount of Life Insurance you would have been eligible to convert.
DEPENDENT LIFE INSURANCE
What is my Dependent Life Insurance Benefit?
If your Dependent dies while insured, you will receive the amount of your Dependent
Life Insurance in force when Sun Life receives written Notice and Proof of Claim.
What is the amount of my Dependent Life Insurance?
The amount of your Dependent Life Insurance is the amount for your Dependent shown
in the Benefit Highlights.
What is the Conversion Privilege?
If your Dependent's Life Insurance ceases, your Dependent may be able to convert the
Life Insurance to an individual policy.
When can my Dependent convert?
1. Your Dependent can convert if all or part of your Dependent's Life Insurance ceases
or reduces due to:
- termination of your employment;
- termination of your membership in an Eligible Class;
- your retirement;
- your reaching a specified age;
- your changing to a different Eligible Class; or
- your Dependent no longer qualifying as a Dependent.
Sun Life of Canada Sample Group Life Booklet Page 12
2. Your Dependent can convert if your Dependent has been continuously insured for five
or more years under Sun Life's Group Life Policy and all or part of your Dependent's
Life Insurance ceases or reduces due to:
- termination of the Dependent Life Insurance Benefit Provision;
- termination of the Group Policy; or
- an amendment to the Group Policy to terminate your Eligible Class.
What amount of Life Insurance can my Dependent convert?
The amount of Life Insurance your Dependent can convert depends on the reason your
Dependent's Life Insurance ceased.
If your Dependent's amount of Life Insurance ceased or reduced for the reasons stated in
#1 "When can my Dependent convert?", your Dependent can convert up to the amount
that ceased or reduced. If your Dependent's amount of Life Insurance that ceased is
$10,000 or more, the minimum amount of your Dependent's individual policy must be
$10,000.
If your Dependent's amount of Life Insurance ceased or reduced for the reasons stated in
#2 "When can my Dependent convert?", your Dependent can convert up to the lesser of:
- $2,000; or
- the amount that ceased or reduced less any amount of group life insurance your
Dependent may become eligible for within 31 days after your Dependent's Life Insurance
ceased or reduced.
How can my Dependent convert?
You or your Dependent need to apply to Sun Life for an individual policy along with
sending payment of the first premium within 31 days after any part of your Dependent's
Life Insurance ceases or reduces. This is your Dependent's 31 day conversion period.
What type of individual policy is available?
Your Dependent can convert to any plan of whole life insurance available by Sun Life for
conversion. The individual policy will not include any additional benefits such as disability
benefits or accidental death and dismemberment benefits.
Your Dependent does not have to submit Evidence of Insurability to convert to an individual
policy.
When does my Dependent's individual policy start?
If your Dependent's application for the individual policy is received and the first premium
paid when due, your Dependent's individual policy starts on the day after your Dependent's
31 day conversion period.
What happens if my Dependent dies during the 31 day conversion period?
If Sun Life receives Notice and Proof of Claim, a death benefit is payable to you, whether
or not your Dependent had applied for an individual policy or had paid the first premium.
The death benefit is the amount of Life Insurance your Dependent would have been eligible
to convert.
Sun Life of Canada Sample Group Life Booklet Page 13
WAITING PERIOD
(The period of time you must be employed in an Eligible Class before you can apply for
benefits)
1st of the month following 3 months of your continuous employment
CONTRIBUTIONS
The cost of your Long Term Disability Insurance is paid for entirely by your Employer.
This is your non-contributory insurance.
The cost of your Insurance is shared by both you and your Employer. This is your .
contributory insurance.
Sun Life of Canada Sample Group Disability Booklet Page 6
BENEFIT PROVISIONS
ACCIDENTAL DEATH AND DISMEMBERMENT
What is my Accidental Death and Dismemberment Benefit?
If Sun Life receives written Notice and Proof of Claim that:
A significant advantage to
- you died from an accidental drowning while insured; or
our plan is that it allows
- you sustained an Accidental Bodily Injury while insured, which results in your loss
365 days. The industry
of life, sight or limb within 365 days of the date of that Accidental Bodily Injury;
standard is only 90 days.
an Accidental Death and Dismemberment benefit may be payable to you or to your
Beneficiary.
What is the amount of my Accidental Death and Dismemberment Benefit?
Your benefit is a percentage of the amount of Accidental Death and Dismemberment
Insurance in force for your class shown in the Benefit Highlights on the date of your loss.
The following is a list of percentages payable for your applicable loss.
The percentages shown
Life 100%
are standard and can be
adjusted to meet plan
Sight of one eye 50%
needs.
One limb 50%
Speech and hearing loss 75%
Thumb and index finger
loss option 25%
More than one loss
from any one accident 100%
The seat belt option provides for 100% of the AD&D benefit amount or $50,000,
whichever is less, if loss of life occurs as a result of an automobile accident and the
insured was wearing a seat belt at the time of the accident.
Loss of limb means severance of your hand or foot at or above the wrist or ankle joint.
Loss of your sight must be total and irrecoverable.
Any Accidental Death and Dismemberment Benefit payable is subject to the
Exclusions.
What are the Exclusions?
No AD&D benefit will be payable for your loss that is due to or results from:
- suicide while sane or insane, or intentionally self-inflicted injuries;
- bodily or mental infirmity or disease of any kind, or an infection unless due to an
accidental cut or wound;
- your committing or attempting to commit an assault, felony or other illegal act;
- a war (declared or undeclared) or your active duty in any armed service during a
time of war; or
- your active participation in a riot, rebellion, or insurrection.
Sun Life of Canada Sample Group Life Booklet Page 14
CLAIM PROVISIONS
How is a claim submitted?
To submit a claim, you, your insured Dependent or someone on your behalf must send
Sun Life written Notice and Proof of Claim within the time limits specified. Your
Employer has the Sun Life Notice and Proof of Claim forms.
When does written Notice of Claim have to be submitted?
for a Death Claim (accidental or otherwise) -written notice of claim must be given to
Sun Life no later than 30 days after date of death.
for Life Waiver of Premium -written notice of claim must be given to Sun Life no
later than 12 months after you cease to be Actively at Work.
for Accidental Dismemberment -written notice of claim must be given to Sun Life no
later than 12 months after the date of your loss.
If notice cannot be given within the applicable time period, Sun Life must be notified
as soon as it is reasonably possible.
When Sun Life has received written notice of claim, Sun Life will send the forms for
proof of claim. If the forms are not received within 15 days after written notice of
claim is sent, proof of claim may be sent to Sun Life without waiting to receive the
proof of claim forms.
When does written Proof of Claim have to be submitted?
for a Death Claim (accidental or otherwise) -proof of claim must be given to Sun Life
no later than 90 days after date of death.
for Life Waiver of Premium -proof of claim must be given to Sun Life no later than
15 months after you cease to be Actively at Work.
for Accidental Dismemberment -proof of claim must be given to Sun Life no later
than 12 months after the date of your loss.
If proof cannot be given within these time limits, proof must be given as soon as
reasonably possible. Proof of claim may not be given later than one year after the time
proof is otherwise required unless the individual is legally incompetent.
What is considered Proof of Claim?
Proof of Claim consists of at least the following information:
-what the loss or disability is;
-the date the loss or disability occurred; and
-the cause of the loss or disability.
(For example: a Death Claim would include at least the Death Certificate for Proof of
Claim)
Sun Life may require as part of the Proof, authorizations to obtain medical and non-
medical information.
Our claims
representatives are
dedicated to providing
professional service by
being accessible, flexible
and responsive to your
needs.
Sun Life of Canada Sample Group Life Booklet Page 15
An interest -bearing
account with check -
writing privileges is
provided as a service to
each beneficiary. Funds in
the account are
immediately accessible
and can earn interest
while major investment
decisions are considered.
Proof of your continued Total Disability and regular and continuous care by a Physician
must be given to Sun Life within 30 days of the request for proof.
Proof must be satisfactory to Sun Life.
When are benefits payable?
Benefits are payable when Sun Life receives satisfactory Proof of Claim.
Who are benefits payable to?
Benefits payable upon your death are payable to your Beneficiary living at the time
(other than your Employer). Unless you otherwise specify, if more than one Beneficiary
survives you, all surviving Beneficiaries will share equally. If no Beneficiary is alive
on the date of your death, payment will be made to your estate.
All other benefits payable during your lifetime are payable to you.
If a benefit is payable to your estate, if you are a minor, or you are not competent, Sun
Life has the right to pay an amount of the benefit up to $5,000 to any of your relatives
that Sun Life considers entitled. If Sun Life pays benefits in good faith to a relative,
Sun Life will not have to pay those benefits again.
If your Beneficiary is a minor or is not competent, Sun Life has the right to pay up to
$1,000 to the person or institution that appears to have assumed custody and main
support for the minor, until the appointed legal representative makes a formal claim. If
Sun Life pays benefits in good faith to a person or institution, Sun Life will, not have to
pay those benefits again.
Can I change my Beneficiary?
You can change your Beneficiary at any time on the form provided by Sun Life, unless
you have stated your choice of Beneficiary is irrevocable or you have assigned your
interest in your Life Insurance to another person. Any request for change of
Beneficiary must be in a written form and will take effect on the date you sign and file
the change with your Employer. If Sun Life has taken any action or made payment
before receiving notice of that change, your change of Beneficiary will not affect any
action or payment made by Sun Life. The consent of your Beneficiary is not required to
change any Beneficiary.
Can I assign my Life Insurance?
You can transfer ownership of your Life Insurance under the Group Policy by means of
an absolute assignment. You cannot make an absolute assignment to your Employer.
All your rights and duties as owner are transferred to the new owner. The new owner
can make any change the Group Policy allows, such as a change of Beneficiary.
Any assignment must be in a written form and will take effect on the date you sign and
file the assignment with your Employer. If Sun Life has taken any action or made
payment before receiving notice of that change, the assignment will not affect any
action or payment made by Sun Life. Sun Life will not be responsible for the legal, tax
or other effects of any assignment.
Sun Life of Canada Sample Group Life Booklet Page 16
GENERAL PROVISIONS
How can statements made in any application for insurance be used?
All statements made in any application are considered representations and not
warranties. No representation by you in applying for insurance under the Group Policy
will be used to reduce or deny a claim unless a copy of your written application for
insurance is or has been given to you or to your Beneficiary, if any.
No statement made by you or any of your Dependents, relating to Evidence of
Insurability for an initial, increased or additional amount of insurance, will be used in
contesting the validity of that insurance, after such initial, increased or additional
amount of insurance has been in force for a period of two years during that individual's
lifetime. This statement must be contained in a form signed by that individual.
What happens if facts are misstated?
If relevant facts about you or any one of your Dependents are not accurate:
- an equitable adjustment of premium will be made; and
- the true facts will be used to determine if and in what amount insurance is valid
under the Group Policy.
If the amount of benefit depends on your age, the benefit will be the amount you would
have been entitled to if your correct age were known.
What are Sun Life's examination and autopsy rights?
Sun Life, at its own expense, has the right to have any person, whose Injury or
Sickness is the basis of a claim:
- examined by a Physician, other health professional or vocational expert of its
choice; and/or
- interviewed by an authorized Sun Life representative.
This right may be used as often as reasonably required.
Sun Life has the right, in the case of death, to request an autopsy.
What are the time limits for legal proceedings?
No legal action may start:
- until 60 days after Proof of Claim has been given; nor
- more than 3 years after the time Proof of Claim is required.
Do these group benefits affect Workers' Compensation?
The Group Policy is not in lieu of, and does not affect, any requirement for coverage by
Workers' Compensation Insurance.
Can the Policyholder act as a Sun Life agent?
For all purposes of the Group Policy, the policyholder acts on its own behalf or as your
agent. Under no circumstances will the Policyholder be deemed a Sun Life agent.
Sun Life of Canada Sample Group Life Booklet Page 17
Clear definitions eliminate
misunderstandings.
DEFINITIONS
Some general terms you need to know.
Actively at Work means that you perform all the regular duties of your job for a full
work day scheduled by your Employer at your Employer's normal place of business or a
site where your Employer's business requires you to travel.
You are considered Actively at Work on any day that is not your regular scheduled work
day (i.e., you are on vacation, layoff or an approved leave of absence) as long as you:
- are not Hospital confined; or
- are not disabled due to an injury or sickness; and
- were Actively at Work on your immediately preceding scheduled work day.
You are considered Actively at Work if you usually perform the regular duties of your
job at your home as long as you:
- are not Hospital confined; or
- are not disabled due to an injury or sickness; and
- can perform all the regular duties of your job for a full work day and can do so at
your Employer's normal place of business, if required.
Eligibility Date means the date or dates you become eligible for insurance under the
Group Policy. Classes eligible for insurance are shown in the Benefit Highlights.
Employee (You) means a person who is employed by the Employer, working at least
the number of hours shown in the Benefit Highlights, and paid regular earnings.
Employer means Sample Life Policy and includes any Subsidiary, Affiliated or
Associated company insured under the Group Policy.
Evidence of Insurability means a statement or proof of your or your Dependent's
medical history upon which acceptance for insurance will be determined by Sun Life.
Injury means bodily impairment resulting directly from an accident and independently
of all other causes. Any Injury must occur and Disability must begin while you are
insured under the Group Policy.
Physician means an individual who is operating within the scope of his license and is
either:
- licensed to practice medicine and prescribe and administer drugs or to perform
surgery; or
- legally qualified as a medical practitioner and required to be recognized, under the
Group Policy for insurance purposes, according to the insurance regulations of the
governing jurisdiction.
The Physician cannot be you, your spouse or the parents, brothers, sisters or children of
you or your spouse.
Pregnancy means childbirth, miscarriage, abortion or any disease resulting from or
aggravated by the pregnancy.
Sickness means illness, disease or pregnancy. A Disability, because of Sickness, must
begin while you are insured under the Group Policy.
Sun Life of Canada Sample Group Life Booklet Page 18
Waiting Period means the continuous length of time immediately before your
Eligibility Date during which you must be employed in an Eligible Class before you can
apply for benefits. Any period of time before the Group Policy Effective Date that you
were Actively at Work for your Employer as a full-time employee will count towards
completion of your Waiting Period. The Waiting Period is shown in the Benefit
Highlights.
These are life insurance terms you need to know.
Basic Maximum Benefit means the amount of Basic insurance available to you. The
Basic Maximum Benefit is shown in the Benefit Highlights.
Beneficiary means the person (it cannot be your Employer) who is entitled to receive
death benefit proceeds as they become due under the Group Policy. A person becomes
your Beneficiary only if you have named that person on a signed form acceptable to Sun
Life.
Certified or Certification means a written statement made by a Physician, on a form
provided by Sun Life, as to your Terminal Illness.
Optional Maximum Benefit means the amount of Optional insurance available to you.
The Optional Maximum Benefit is shown in the Benefit Highlights.
Retirement for the purposes of your being considered retired means the first of the
following dates to occur:
1. the effective date of your retirement benefits under:
a. any plan of a federal, state, county or municipal or an association retirement
system which you are eligible as a result of your employment with your
Employer;
b. any plan your Employer sponsors; or
c. any plan your Employer makes or has made contributions to.
2. the effective date of your retirement benefits under the Social Security Act or any
similar plan or act. However, if you meet the definition of an Employee Actively
at Work and you are receiving retirement benefits under the Social Security Act or
similar plan or act, you will not be considered retired.
Terminally III or Terminal Illness means your Sickness or physical condition that is
Certified by a Physician to reasonably be expected to result in your death within twelve
months or less.
Total Disability or Totally Disabled means because of your Injury or Sickness, you are
unable to perform the material and substantial duties of any occupation for which you
are or become reasonably qualified for by education, training or experience.
Sun Life of Canada Sample Group Life Booklet Page 19
These are dependent life insurance terms you need to know.
Dependent means your:
- spouse;
- unmarried child from live birth to under age 19;
- unmarried child under age 23 who is an enrolled full-time student and depends on
you for 50% or more of his/her support.
Your unmarried step -child, foster child or adopted child are included as a Dependent if
they depend on you for 50% or more of his/her support and are living with you in a
regular parent -child relationship. A child is considered adopted if in your legal
custody under an interim court order of adoption, whether or not a final adoption order
is ever issued.
Dependent does not include:
- any person who is insured as an Employee; or
- any person residing outside the United States, Canada or Mexico
No person may be considered to be a Dependent of more than one Employee.
This is an Accidental Death and Dismemberment insurance term you need to
know.
Accidental Bodily Injury means bodily harm caused solely by external, violent and
accidental means which is sustained directly and independently of all other causes.
Sun Life of Canada Sample Group Life Booklet Page 20
The following Questions and Answers will help you to better understand your benefits.
Please read them carefully and refer any questions to your Employer or call the Sun Life
Group Service Center toll free at 1-800-247-6875.
ELIGIBILITY AND EFFECTIVE DATE
OF EMPLOYEE INSURANCE
When am I eligible for insurance?
If you are in an Eligible Class shown in the Benefit Highlights, you are eligible on the
later of:
- MMDDYY (eg. September 1, 199x); or
- the day after you complete your Waiting Period.
When does my insurance start?
For non-contributory insurance, your insurance starts on the date you are eligible, if you
are Actively at Work on that date.
For contributory insurance, your insurance starts on the date you apply, if you are Actively
at Work on that date.
What if I am not Actively at Work on that date?
If you are not Actively at Work because of injury, sickness, layoff or leave of absence on
the date your insurance would normally start, your insurance will not start until you are
Actively at Work.
What happens if I do not want my insurance?
You need to sign the Sun Life form refusing your insurance. This form is available from
your Employer.
When do changes in my amount of insurance occur?
If your amount of insurance increases due to a change in your salary, your increase will
take effect immediately, as long as you are Actively at Work on that date.
If your amount of insurance decreases due to a change in your salary, the decrease will
take effect immediately.
If you are not Actively at Work because of injury, sickness, layoff or leave of absence on
the date an increase in your insurance would normally start, the increase in your insurance
will not start until you are Actively at Work.
Simple, concise answers
to your questions.
Sun Life of Canada Sample Group Disability Booklet Page 7
Termination of insurance
is clearly defined.
Insurance coverage can
be provided for extended
vacations and for other
absences.
TERMINATION OF EMPLOYEE INSURANCE
When does my insurance cease?
Your insurance ceases on the earliest of-
- the date the Group Policy terminates;
- the date you are no longer in an Eligible Class;
- the date your class is no longer included for insurance;
- the last day any required premium has been paid for your insurance;
- the date you retire;
- the date you request in writing to terminate your insurance;
- the date you enter active duty in any armed service during a time of war (declared
or undeclared);
- the date your employment terminates;
- the date you cease to be Actively at Work.
Are there any conditions under which my insurance can continue?
Yes.
Your insurance will continue during any Elimination Period or any period the premium
for your insurance is waived under the Group Policy.
If you are on temporary layoff, leave of absence or vacation, your Employer may continue
your insurance by paying the required premium for the length of time specified below.
Layoff - for up to 1 month
Leave of Absence - for up to 1 month
Vacation -for up to 3 months
You may be eligible to continue your insurance pursuant to the Family and Medical Leave
Act of 1993. You should contact your Employer for more details.
Sun Life of Canada Sample Group Disability Booklet Page 8
Our policies are clear and
understandable.
EMPLOYEE INSURANCE - LONG TERM DISABILITY
What is the Long Term Disability Benefit?
Long Term Disability Benefits (LTD) partially replace your income if you become Totally
or Partially Disabled while insured.
When do LTD benefits become payable?
Sun Life will pay a monthly LTD benefit after the end of your Elimination Period, if Sun
Life receives proof that you are:
- Totally or Partially Disabled due to an Injury or Sickness; and
- under the regular and continuing care of a Physician that provides appropriate
treatment by means of examination and testing in accordance with your disabling
condition.
What conditions must be met for LTD benefits to continue?
Sun Life will pay you an LTD benefit, up to the Maximum Benefit Period, if you provide
proof that you continue to be Totally or Partially Disabled and you require the regular and
continuing care of a Physician. You need to provide proof when Sun Life asks for it, but
the proof is at your expense.
How is the LTD benefit calculated?
If you are Totally Disabled, your monthly LTD benefit will be calculated based on the
Total Disability Benefit formula. If you are Partially Disabled, your monthly LTD benefit
will be calculated based on the Partial Disability Benefit formula. You need to provide
Sun Life with proof of your monthly earnings on a quarterly basis. Your monthly LTD
benefit will never be less than your Minimum Monthly Benefit shown in the Benefit
Highlights.
What is the Total Disability Benefit formula?
To determine your Total Disability Benefit:
1. Take the lesser of:
a. your Total Monthly Earnings multiplied by the Benefit Percentage (shown in
the Benefit Highlights); or
b. the Maximum Monthly Benefit (shown in the Benefit Highlights); then
2. Subtract Other Income Benefits form the amount determined in Step 1.
Sun Life of Canada Sample Group Disability Booklet Page 14
What is the Partial Disability Benefit formula?
To determine your Partial Disability Benefit for the first 24 months of your
Partial Disability:
1. calculate the LTD benefit you would receive if you were Totally Disabled;
then
add your earnings from employment plus your income received from Other
Income Benefits to your Total Disability Benefit.
2. if this sum is more than 100% of your Indexed Total Monthly Earnings,
subtract the amount in excess of 100% from your Total Disability Benefit.
This result is your Partial Disability Benefit; or
if the sum is less than 100% of your Indexed Total Monthly Earnings,
your Total Disability Benefit is your Partial Disability Benefit.
A Total Disability Benefit will be paid if you are earning 20% or less of your Indexed
Total Monthly Earnings.
If you continue to be Partially Disabled after 24 months of Partial Disability Benefits,
your Partial Disability Benefit will be recalculated based on the following formula:
where:
(A divided by B) multiplied by C
A = your Indexed Total Monthly Earnings minus your monthly earnings
received from your employment.
B = your Indexed Total Monthly Earnings.
C = your Total Disability Benefit.
A Total Disability Benefit will be paid if you are earning 20% or less of your Indexed
Total Monthly Earnings.
The Partial Disability
Benefit encourages
employees to return to
work. This benefit allows
employees to earn up to
100% of their predisability
income if they return to
work part time. It is
provided at no additional
cost to the employer.
The Partial Disability
Benefit formula equals
A/B x C
A = The income
employees received
before their disability
(adjusted for inflation),
less any wages they
receive now for partial
employment.
B = The income
employees received
before their disability
(adjusted for inflation).
C = The total disability
benefit percentage
chosen by the employer.
Sun Life of Canada Sample Group Disability Booklet Page 15
Other income offsets
prevent overinsurance,
maintain back to work
incentives and control
costs.
What are Other Income Benefits?
Other Income Benefits are those benefits provided or available to you while your monthly
LTD benefit is payable. These Other Income Benefits, other than retirement benefits,
must be provided to you as a result of the same Total or Partial Disability payable under
the Group Policy. Other Income Benefits include:
The amount you are eligible for under:
a. Workers' Compensation Law; or
b. Occupational Disease Law; or
c. Unemployment Compensation Law; or
d. Compulsory Benefit Act or Law; or
e. any other act or law of like intent.
2. The Railroad Retirement Act (including any dependent benefits).
3. Any labor management trustee, union or employee benefit plans that are funded
in whole or in part by your Employer.
4. Any disability income benefits you are eligible for under:
a. any other group insurance plan of your Employer;
b. any governmental retirement system as a result of your job with your
Employer.
5. The Employer -paid portion of benefits you receive under your Employer's
Retirement Plan:
a. any disability benefits;
b. any retirement benefits.
(This applies only if the benefits do not reduce your accrued retirement benefit and does
not include any amount rolled over or transferred to any other retirement plan as defined
in Section 402 of the Internal Revenue Code.)
6. The disability or retirement benefits under the United States Social Security
Act, or any similar plan or act, as follows:
a. Disability benefits you are eligible to receive;
b. Disability benefits your spouse, child or children are eligible to receive
because of your Total or Partial Disability, unless the dependent benefits
are paid directly to your divorced spouse or to your children in custody
of your divorced spouse.
c. Retirement benefits received by you;
d. Retirement benefits your spouse, child or children receive because of
your receipt of retirement benefits, unless the dependent benefits are paid
directly to your divorced spouse or to your children in custody of your
divorced spouse.
If your Total or Partial Disability begins after age 70, your Social Security Retirement
Benefits will not apply if, prior to your Total or Partial Disability, you were already
receiving Social Security Retirement Benefits.
Sun Life of Canada Sample Group Disability Booklet Page 16
7. The amount you receive from any accumulated sick leave.
8. Any formal salary continuation paid to you by your Employer which causes
your monthly LTD benefit, plus Other Income Benefits and any salary
continuation, to be more than 100% of your Total Monthly Earnings. The
amount in excess of 100% of your Total Monthly Earnings will be used as a
reduction.
Any amount you receive by compromise, settlement or other method as
result of a claim for any Other Income Benefit.
Other Income Benefits will include any amount described above which would have been
available to you had you applied for that benefit.
What if I receive payment of Other Income Benefits in a lump sum?
If you receive a lump sum payment for any Other Income Benefits, Sun Life will prorate
the lump sum on a monthly basis over the time period specified for the lump sum payment.
If no time period is stated, the lump sum payment will be prorated on a monthly basis
over your expected lifetime as determined by Sun Life.
What happens if I receive increases in my Other Income Benefits?
After the first deduction for each of your Other Income Benefits, Sun Life will not reduce
your monthly LTD benefit payments due to cost of living increases. This does not apply
to any increase in earnings you receive from employment.
Are any of my Other Income Benefits estimated?
Sun Life will estimate the amount of any Other Income Benefits if they have not yet been
awarded or denied or if they have been denied and are being appealed. This estimate will
be used to reduce the amount of your monthly LTD benefit payments. However, the
estimate will not be used if, within 6 months of becoming Totally or Partially Disabled,
you meet both of the following conditions:
- you have applied for the Other Income Benefits; and
- you complete and sign a Reimbursement Agreement. This Agreement states
that you promise to reimburse Sun Life any overpayment caused by an award
of Other Income Benefits.
What happens when the Other Income Benefits have been awarded or have been
denied?
If Sun Life has reduced your monthly LTD benefit payments by an estimate, a lump sum
refund will be made to you when Sun Life receives written notice that the Other Income
Benefit has been denied.
If the amount of Other Income Benefit is more than what was estimated, you must reimburse
Sun Life the amount of the overpayment within 60 days of the award. Sun Life has the
option to reduce or eliminate your future monthly LTD benefit payments instead of requiring
reimbursement in a lump sum. During the overpayment reimbursement period, the
Minimum Monthly Benefit will not apply.
Other income offsets are
only made on plans which
the employees do not
contribute to.
Sun Life of Canada Sample Group Disability Booklet Page 17