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HomeMy WebLinkAboutRESPONSE - RFP - P902 BENEFITSExecutive Summary ?3 2rt� SEY 1 fix? x Proposal Compliance Letter MoProposal Checklist ' Plan Design Confirmation Questionnaire Responses • Performance Guarantees Financial Exhibits Items Included with Proposal TABLE OF CONTENTS Benefit Highlights Page Long Term Disability Insurance 4 Eligibility and Effective Dates Employee 7 Termination of Insurance Employee 8 Benefit Provisions Long Term Disability Insurance (LTD) 9 Claim Provisions Notice of Claim 17 Proof of Claim 17 Payment of Claims 18 General Provisions General Provisions 19 Definitions General 20 Long Term Disability 21 93C-LH-TAB Table of Contents Page No. 3 BENEFIT HIGHLIGHTS LONG TERM DISABILITY INSURANCE ELIGIBLE CLASSES All Classified or Unclassified Management Employees working a minimum of 20 hours a week. AMOUNT OF INSURANCE 66.67% (Benefit Percentage) of your Total Monthly Earnings, not to exceed the Maximum Monthly Benefit, less Other Income Benefits. - the Maximum Monthly Benefit is $4,500. Note: your amount of insurance is also subject to reductions for your employment earnings. The Minimum Monthly Benefit is $100 or 10% of your Gross Monthly Benefit, whichever is greater. Elimination Period (The period of time you need to be continuously Totally or Partially Disabled before LTD benefits are payable) 90 days 93C-LH-SCHED Page No. 4 Benefit Highlights BENEFIT HIGHLIGHTS 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. 93C-LH-SCHED Page No. 5 Benefit Highlights BENEFIT HIGHLIGHTS WAITING PERIOD (The period of time you must be employed in an Eligible Class before you can apply for benefits) You are deemed to have completed the Waiting Period on your first day of employment CONTRIBUTIONS The cost of your Long Term Disability Insurance is paid for entirely by your Employer. This is your non-contributory insurance. 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. 93C-LH-SCHED Benefit Highlights Page No. 6 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 - January 1, 1997; or the day after you complete your Waiting Period. When does my insurance start? Your insurance starts on the date you are eligible, 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. 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 on the first day of the calendar month coincident with or next following the date of change, 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 on the first day of the calendar month coincident with or next following the date of change. 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 93C-LH-EELIG Page No. 7 Date of Employee Insurance 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 2 months Leave of Absence - for up to 2 months 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. You may be eligible to continue your insurance coverage pursuant to the Uniformed Services Employment and Reemployment Rights Act (USERRA). You should contact your Employer for more details. Termination of 93C-LH-TERM Page No. 8 Employee Insurance BENEFIT PROVISIONS LONG TERM DISABILITY INCOME INSURANCE 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: 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 from the amount determined in Step 1. Long Term Disability 93C-LH-LTD.2 Page No. 9 Income Insurance BENEFIT PROVISIONS LONG TERM DISABILITY INCOME INSURANCE What is the Partial Disability Benefit formula? To determine your Partial Disability Benefit for the first 24 months of your Partial Disability: 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: (A divided by B) multiplied by C where: 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. Long Term Disability 93C-LH-LTD.2 Page No. 10 Income Insurance BENEFIT PROVISIONS LONG TERM DISABILITY INCOME INSURANCE 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: 1. The amount you are eligible for under: a. Workers' Compensation Law; or b. Occupational Disease Law; or c. Compulsory Benefit Act or Law; or d. 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 benefits you receive under your Employer's Retirement Plan as follows: a. any disability benefits; b. the Employer -paid portion of any retirement benefits. (Disability benefits that reduce your accrued retirement benefit will be treated as a retirement benefit. Retirement benefits do 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. 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. Long Term Disability 93C-LH-LTD.2 Page No. 11 Income Insurance BENEFIT PROVISIONS LONG TERM DISABILITY INCOME INSURANCE 9. Any amount you receive by compromise, settlement or other method as a 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? You must notify Sun Life of the amount of Other Income Benefit when it is approved or adjusted (other than cost of living increases) or if it has been denied on final appeal. Sun Life will make an adjustment to the Net Monthly Benefit when Sun Life receives written notice of the amount of the Other Income Benefit or when it has been denied. Written Notice must be sent within 31 days after receipt of the Other Income Benefit award or denial. If after Sun Life makes an adjustment your Net Monthly Benefit has been underpaid, Sun Life will make a lump sum refund to you of the amount that has been underpaid. If after Sun Life makes an adjustment your Net Monthly Benefit has been overpaid, you must reimburse Sun Life the amount of the overpayment within 31 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. Long Term Disability 93C-LH-LTD.2 Page No. 12 Income Insurance AD (I I'th E-Business E-Business @ Sun Life Assurance Company of Canada The Internet is changing the way the world does For our Group customers, our goal is to continually business. And at Sun Life Assurance Company of provide the most useful and accurate information, 24 Canada, we are energized by the possibilities. hours a day, 7 days a week. And we have reached that As we embrace emerging technologies, we are goal with CustomerLink—our plan sponsor extranet— able to serve our business partners in new and with plans to expand the site in the future. dynamic ways. We are committed to using the Internet to its highest potential to provide access to valuable information and strengthen our relationships. Why? Because we know the importance of E-Business capabilities in today's market. Our E-Business strategy is to continually provide value—added services to our customers and brokers. For Our Customers: CustomerLink However, customers aren't our only business partner who will benefit from our commitment to E- Business. We are also making plans to help our brokers attract, track and retain customers through web -enabled service. Read on to learn more about our current capabilities. But stay tuned. Things are changing all the time. As customers become more technologically sophisticated, they look for newer and faster ways to access plan information. We recognize this demand and are pleased to offer customers on-line access to a variety of information through CustomerLink. CustomerLink is a secured, customized website that allows employers to log onto r 1 www.sunlife-usa.com, enter a password and get instant access to the most up-to- date information regarding their plan. Currently, our customers can conveniently access the following documents and information: In a recentsurvey, 33Xof contracts and Booldets companies polled strongly So customers can quickly and easily access information on their policies, we Woodwith the statement provide their contracts and employee booklets on-line. Links for every that •ebusinaas inMatives are document —for all of a customer's policies —appear p ppear on one screen. When a critical for my comparr/s long customer has a question, he or she simply clicks on the appropriate link to open term succes• A finther SU the document in Adobe Acrobat®. agreed or mildly agreed. --cutter Consortium Finable Forms June 2007 All of our frequently -used forms, such as Beneficiary Designation, Enrollment Forms and Claim Forms, are available on-line for our customers to fill in and print. Customers may also download and distribute these forms to their employees through e-mail or their own intranets. BENEFIT PROVISIONS LONG TERM DISABILITY INCOME INSURANCE 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; - the date Sun Life determines you are able to perform on a full-time basis 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 on a full-time basis all of the material and substantial duties of any occupation for which you are or become reasonably qualified for by education, training or experience, even if you choose not to work. What happens if I return to full-time work and become disabled again? Sun Life will treat this new disability as part of your prior Total or Partial Disability if you returned to work and were Actively at Work for less than: - six months, if due to the same or related causes; - 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 terns 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 Long Tenn Disability 93C-LH-LTD.2 Page No. 13 Income Insurance BENEFIT PROVISIONS LONG TERM DISABILITY INCOME INSURANCE What happens to my LTD benefit if I die? A Survivor Benefit equal to 3 times your last Gross Monthly Benefit is payable in a lump sum to your Eligible Survivor if Sun Life receives satisfactory proof that you died: - after your Total or Partial Disability had continued for 180 or more consecutive days; and - you were eligible to receive 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 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. 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. Benefits will be paid 90 more days if you are still disabled when discharged. - 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. Long Term Disability 93C-LH-LTD.2 Page No. 14 Income Insurance BENEFIT PROVISIONS LONG TERM DISABILITY INCOME INSURANCE 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. any period of Total or Partial Disability due to Chemical and Environmental Illness, unless you are under the continuing care of a Physician providing appropriate treatment by means of examination and testing in accordance with your disabling condition. After you complete your Elimination Period, LTD benefits are payable for 24 months. Benefits after the first 24 months are only payable if you are confined in a Hospital or Institution. any period of your Total or Partial Disability that is due to Chronic Fatigue Illness, unless you are under the continuing care of a Physician providing appropriate treatment by means of examination and testing in accordance with your disabling condition. After you complete your Elimination Period, LTD benefits are payable for 24 months. Benefits after the first 24 months are only payable if you are confined in a Hospital or Institution. any period of your Total or Partial Disability due to Musculoskeletal and Connective Tissue Illness, unless you are under the continuing care of a Physician providing appropriate treatment by means of examination and testing in accordance with your disabling condition. After you complete your Elimination Period, LTD benefits are payable for 24 months. Benefits after the first 24 months are only payable if you are confined in a Hospital or Institution. 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. Long Term Disability 93C-LH-LTD.2 Page No. 15 Income Insurance BENEFIT PROVISIONS LONG TERM DISABILITY INCOME INSURANCE 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 January 1, 1997 you will be insured if: 1. you were insured under the prior insurer's group LTD policy at the time of the transfer; and 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 January 1, 1997. Any benefit payable will be determined as follows: 1. 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 o£ 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. Long Term Disability 93C-LH-LTD.2 Page No. 16 Income Insurance 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 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. 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 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. Proof of Claim includes, but is not limited to, Hospital records; Physician records; Psychiatric records; X-rays, narrative reports, or other diagnostic testing materials as required. 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. 93C-LH-CLAIM.1 Claim Provisions Page No. 17 CLAIM PROVISIONS 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. 93C-LH-CLAIM.1 Claim Provisions Page No. 18 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 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. 93C-LH-GENP General Provisions Page No. 19 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. 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 City of Fort Collins 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. 93C-LH-DEF Definitions Page No. 20 DEFINITIONS These are Long Term Disability Insurance terms you need to know. Chemical and Environmental Illness means an allergy or sensitivity to chemicals or the environment including but not limited to: a)Environmental allergies b)Sick Building Syndrome c)Multiple Chemical Sensitivity Syndrome d)Chronic Toxic Encephalopathy. Chemical and Environmental Illness does not include Asthma or Allergy -induced reactive lung disease. Chronic Fatigue Illness means an Illness that is characterized by a debilitating fatigue in the absence of known medical or psychological conditions, which includes but is not limited to: a)Chronic Fatigue Syndrome as supported by Center for Disease Control Guidelines b)Chronic Fatigue Immunodeficiency Syndrome as supported by Center for Disease Control Guidelines c)Post Viral Syndrome d)Limbic Encephalopathy e)Epstein-Barr virus infection f) Herpes virus type 6 infection g)Myalgic Encephalomyelitis Chronic Fatigue Illness does not include a disorder identified as a(n): a)Neoplastic disorder b)Neurologic disorder c)Endocrine disorder d)Hematologic disorder e)Rheumatologic disorder f) Depression 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. Indexed Total Monthly Earnings means your Total Monthly Earnings prior to the date your Total or Partial Disability began adjusted on the first of the month following 12 calendar months of Partial Disability Benefit payments and each annual anniversary thereafter. Each adjustment to the Indexed Total Monthly Earnings is the lesser of 10% or the current annual percentage increase in the Consumer Price Index for Wage Earners and Clerical Workers as published monthly by the U.S. Department of Labor. Sun Life reserves the right to use some other similar measurement if the Department of Labor changes or stops publishing the Consumer Price Index. 93C-LH-DEF.2 Definitions Page No. 21 DEFINITIONS Maximum Monthly Benefit means the largest amount payable monthly to you. The Maximum Monthly Benefit is shown in the Benefit Highlights. Musculoskeletal and Connective Tissue Illness means a disease or disorder of the neck and back and sprains and strains of joints and adjacent tissues, including but not limited to: a)cervical, thoracic and lumbrosacral back and its surrounding soft tissue b)Carpal Tunnel or repetitive motion syndrome c)Fibromyalgia d)Temporomandibular joint or craniomandibular joint disorder e)Myofascial pain f) Scoliosis that does not require surgery Musculoskeletal and Connective Tissue Illness does not include: a)Hemiated, ruptured or bulging discs with neurological abnormalities that are documented by electromyogram, and computerized tomography or magnetic resonance imaging b)Scoliosis that requires surgery c) Tumors, malignancies, or vascular malformation d)Radiculopathies that are documented by electromyogram e)Spondylolisthesis, grade II or higher f) Myelopathies and myelitis g)Demyelinating diseases h)Traumatic spinal cord necrosis i) Osteopathies j) Rheumatoid or psoriatic arthritis k)Lupus 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 - earning 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 Partial 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. 93C-LH-DEF.2 Definitions Page No. 22 News To keep our customers updated on the latest benefits and human resources news, we offer a daily newsfeed from BenefitsLink®. We also provide the latest news regarding Sun Life Financial and the U.S. Group Division. We are currently inviting all of our customers to sign up and join CustomerLink. Beginning in January 2002, our new customers will join CustomerLink automatically during installation. And this is just the beginning. Going forward, we will provide our customers with even more on-line information and transaction -based capabilities through CustomerLink. saw ( yyy `9ARbsl.MMR ,'.. 7 Y Spending on 6usiness- to-businass(0211) madatplace Infrastructure, such as new technologies and serilm will grow from $2.1 billion in 2000 to $90.9 billion by 2005. lcpnwResearch Jarxwry2t701 The number of US companies billing online will triple to 26% by 2002, and haessse further to 35X by 2004. —Ga►trw Group Febnwry, 2001 DEFINITIONS 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 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. 93C-LH-DEF.2 Definitions Page No. 23 No Text No Text Sun Life of Canada• Wellesley Hills, MA Employee Group Benefits UNDERWRITTEN BY SUN LIFE ASSURANCE COMPANY OF CANADA City of Fort Collins GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE GROUP POLICY NUMBER - 98544 POLICY EFFECTIVE DATE - January 1,1997 POLICY AMENDMENT DATE — August 1, 2003 93C-LH Welcome to Sun Life Assurance Company of Canada ("Sun Life"). Sun Life is pleased to be your Employer's insurance carrier for the benefits provided in the Group Policy. The description of Eligible Classes in the Benefit Highlights will help you determine what benefits apply to you. The booklet is intended to provide a summarized explanation of the current Group Policy Benefits. However, the Group Policy is the Document which forms Sun Life's contract to provide benefits. If the terms of the booklet and the Group Policy differ, the Group Policy will govern. A complete copy of the Group Policy is in the possession of your Employer and is available for your review. In the event of any changes in benefits or Group Policy provisions, you will be provided with a new booklet or a supplement which describes any changes. Possession of this booklet does not necessarily mean you are insured under the Group Policy. The requirements for becoming eligible for insurance and the dates your insurance begins or ceases are explained within this booklet. This booklet uses insurance terms and phrases that are listed in the Definitions Section. For information, call the Sun Life Group Customer Service Center toll free at 1-800-247-6875. 93C-LH TABLE OF CONTENTS Page Benefit Highlights Employee Life and Accidental Death and Dismemberment Insurance.................................................................................... 4 DependentLife Insurance.......................................................................................................................................................... 6 Eligibility and Effective Dates Employee.................................................................................................................................................................................... 8 Dependent.................................................................................................................................................................................10 Termination of Insurance Employee.................................................................................................................................................................................. I I Dependent.................................................................................................................................................................................12 Benefit Provisions LifeInsurance ......................................................................................................................................13 Employee..................................................................................................................................................................................13 Dependent.................................................................................................................................................................................19 Accidental Death and Dismemberment Insurance (AD&D).................................................................................................. 22 Claim Provisions Noticeof Claim........................................................................................................................................................................25 Proofof Claim.......................................................................................................................................................................... 25 Paymentof Claims................................................................................................................................................................... 26 Changein Beneficiary .............................................................................................................................................................. 26 General Provisions GeneralProvisions...................................................................................................................................................................28 Definitions General..................................................................................................................................................................................... 29 EmployeeLife.......................................................................................................................................................................... 31 DependentLife......................................................................................................................................................................... 32 Accidental Death and Dismemberment................................................................................................................................... 33 93C-LH-TAB Table of Contents Page No. 3 BENEFIT HIGHLIGHTS LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE ELIGIBLE CLASSES All Classified, Unclassified Management and Contractual Employees working a minimum of 20 hours a week. BASIC INSURANCE A basic choice of: OPTIONAL INSURANCE LIFE AD&D $10,000 $10,000 or 1 times your Basic An amount equal to Annual Earnings* your amount of Life Insurance in force AMOUNT OF INSURANCE LIFE AD&D 1, 2, or 3 times An amount equal to your Basic Annual your amount of Life Earnings* Insurance in force * rounded to the next higher $1,000, if not already a multiple of $1,000. The Basic Maximum Benefit is $100,000. The Combined Maximum Benefit is your Basic Insurance added to your Optional Insurance or $500,000, whichever is less. The Guaranteed Issue Amount for Basic and Optional Insurance combined is $125,000. Your Amount of Life and Accidental Death and Dismemberment Insurance reduces by 30% when you reach age 65, by 50% when you reach age 70, by 70% when you reach age 75 and by 80% when you reach age 80. Your Life and Accidental Death and Dismemberment Insurance cancels at your retirement. 93C-LH-SCHED Benefit Highlights Page No. 4 BENEFIT HIGHLIGHTS Evidence of Insurability, satisfactory to Sun Life, will be required for any of the following reasons: - you elect Basic Life Insurance only and you later elect Optional Life Insurance; or - you elect an increase in your amount of Optional Life Insurance; or - you elect an amount of Life Insurance over the Guaranteed Issue Amount; or - any future increases which exceed the greater of $20,000 or 15% of your amount of Life Insurance if, after the increase, your total amount of Life Insurance is over your Guaranteed Issue Amount. The increase can be due to a salary change or any other change that increases your amount of Life Insurance. 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. 93C-LH-SCHED Benefit Highlights Page No. 5 BENEFIT HIGHLIGHTS DEPENDENT LIFE INSURANCE ELIGIBLE CLASSES All Classified, Unclassified Management and Contractual Employees working a minimum of 20 hours a week. AMOUNT OF INSURANCE For your Spouse Option 1: $10,000 Option 2: $25,000 Option 3: $50,000 Option 4: $75,000 Option 5: $100,000 For your unmarried Children: Under 15 days NIL 15 days but under 1 year $500 1 year to age 19* Option 1: $5,000 Option 2: $10,000 to age 25 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) The Guaranteed Issue Amount for your Dependent's Life Insurance is $10,000 Evidence of Insurability, satisfactory to Sun Life, will be required for your Dependent for any of the following reasons: you elect no Dependent Life coverage and you later elect Dependent Life Insurance; or - you elect an amount of Dependent Life Insurance in excess of the Guaranteed Issue Amount; or any future increases which exceed the greater of $20,000 or 15% of your Dependent's amount of Life Insurance if, after the increase, your Dependent's amount of Life Insurance is over the Guaranteed Issue Amount. An increase can be due to a salary change or any other change that increases the amount of your Dependent Life Insurance. 93C-LH-SCHED Benefit Highlights Page No. 6 Sun Life Financial'M Executive Summary Sun Life of Canada is pleased to be able to respond to your request for proposal. We have enjoyed our relationship with the City of Fort Collins and hope that it will continue after your market review. We have included in our response information and proposals for Life, AD&D, Supplemental/Optional Life, and Long Term Disability coverages. Our proposal has tried to adhere to all of your requests and specifications. It does not appear that there are any significant requests that we are not currently meeting with our inforce plans. Your coverages through Sun Life are currently in the middle of a two year rate guarantee. Your current rates will be inforce through December 31, 2004. Should the timing of this guarantee become an issue in our ability to retain these coverages with you, we would hope to have the opportunity to review this with you. Sun Life of Canada has made several enhancements to our support and service capabilities since we began our relationship with the City of Fort Collins. Enhancements include online capabilities via CustomerLink and the addition of AssistAmerica to your plan. We are also introducing at this time enhanced online claims status monitoring capabilities for Long Term Disability. You will find this information in Section Eight of the proposal. We look forward to responding to any questions you might have and to a continuance of our relationship with you for many years to come. BENEFIT HIGHLIGHTS WAITING PERIOD (The period of time you must be employed in an Eligible Class before you can apply for benefits) You are deemed to have completed the Waiting Period on your first day of employment CONTRIBUTIONS The cost of your Basic 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, Dependent Life and Optional Accidental Death and Dismemberment Insurance is paid for entirely by you. This is your contributory insurance. 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. 93C-LH-SCHED Benefit Highlights Page No. 7 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: - January 1, 1997; 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 Optional Accidental Death and Dismemberment Insurance, Sun Life must first approve your Evidence of Insurability. Evidence of Insurability is at your own expense. Eligibility and Effective 93C-LH-EELIG Page No. 8 Date of Employee Insurance ELIGIBILITY AND EFFECTIVE DATE OF EMPLOYEE INSURANCE 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 on the first day of the calendar month coincident with or next following the date of change, as long as: - you are 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 salary or age, the decrease will take effect on the first day of the calendar month coincident with or next following the date of change. 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 93C-LH-EELIG Page No. 9 Date of Employee Insurance 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 do I need to apply for Dependent insurance? You must apply for Dependent Life Insurance within 31 days of the date you become eligible for Dependent 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 apply for Dependent Life Insurance. What happens if I do not apply within 31 days? Your Dependent's insurance will start on the date Sun Life approves your Dependent's Evidence of Insurability, if the Dependent is not hospital confined or disabled on that date. Evidence of Insurability is at your expense. Do I need to enroll each Dependent? Yes, you do need to enroll each Dependent before that Dependent can become insured. 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. What happens if I do not want Dependent insurance? You need to sign the Sun Life form refusing your Dependent's insurance. This form is available from your Employer. If you decide later you want Dependent Life Insurance, Sun Life must first approve your Dependent's Evidence of Insurability before your Dependent can become insured. Evidence of Insurability is at your expense. Eligibility and Effective 93C-LH-DELIG Page No. 10 Date of Dependent Insurance 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 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 2 months Leave of Absence - for up to 2 months 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. You may be eligible to continue your insurance coverage pursuant to the Uniformed Services Employment and Reemployment Rights Act (USERRA). You should contact your Employer for more details. Termination of 93C-LH-TERM Page No. 11 Employee Insurance 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; - the date you die. 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. Termination of 93C-LH-DTERM Page No. 12 Dependent Insurance 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 lesser of: 1. your Basic amount of insurance shown in the Benefit Highlights; or 2. the Guaranteed Issue Amount shown in the Benefit Highlights, plus any amount of insurance over your Guaranteed Issue Amount that Sun Life has approved your Evidence of Insurability. 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 Evidence of Insurability requirements, age reductions or terminations shown in the Benefit Highlights. The amount of your Optional Life Insurance is the lesser of 1. your Optional amount of insurance elected as shown in the Benefit Highlights; or 2. the Guaranteed Issue Amount shown in the Benefit Highlights, reduced by your Basic Life Insurance amount, plus any amount of insurance over your Guaranteed Issue Amount that Sun Life has approved your Evidence of Insurability. Your Basic and Optional Life Insurance combined cannot exceed the Combined Maximum Benefit shown in the Benefit Highlights. Your amount of Optional Life Insurance is subject to the Exclusions shown below and any Evidence of Insurability requirements, age reductions or terminations shown in the Benefit Highlights. What are the Exclusions? If your cause of death is suicide: - No amount of Optional Life Insurance is payable if the suicide occurs within 12 months after your Optional Life Insurance starts. Any period of time you were insured for the same amount of Optional Life Insurance under your Employer's prior group life policy will count towards your completion of the 12 months. - No increased or additional amount of your Optional Life Insurance is payable if the suicide occurs within 12 months after your increased or additional amount of Optional Life Insurance starts. - No amount of your Life Insurance over your Guaranteed Issue Amount is payable if the suicide occurs within 12 months after the amount over your Guaranteed Issue Amount starts. 93C-LH-LIFE.1 Employee Life Insurance Page No. 13 BENEFIT PROVISIONS EMPLOYEE LIFE INSURANCE 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. 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; - 90 days after 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 (for Optional Life only); 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. 93C-LH-LIFE.1 Employee Life Insurance Page No. 14 BENEFIT PROVISIONS EMPLOYEE LIFE INSURANCE When am I eligible for an Accelerated Benefit? (Applicable if you were employed on or before January 1, 1997) You are eligible if: - you were Actively at Work on January 1, 1997 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 (Applicable if you were employed after January 1, 1997) 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 Terminally Ill with a life expectancy of 12 months or less; and you are insured for at least $10,000 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 $5,000 or 10% of coverage. If you have received an Accelerated Benefit under the prior insurer's group life policy, you can request up to 75% 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. 93C-LH-LIFE.1 Employee Life Insurance Page No. 15 BENEFIT PROVISIONS EMPLOYEE LIFE INSURANCE 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. 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? 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; or - your changing to a different Eligible Class; or - 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. 93C-LH-LIFE.1 Employee Life Insurance Page No. 16 C,m" Products from ri Life Assurance Company of Canada Experience • Sun Life Assurance Company of Canada was founded in 1871 and began its U.S. operations in 1895. Today, we have worldwide operations in the United States, Canada, United Kingdom, Bermuda, Hong Kong, South America and the Pacific Rim. • U.S. Group Block Size (as of year-end 2001) U.S. covered lives: 3.6 million U.S. business in force (annual premium): $581.1 million U.S. business in force (policies): 13,072 Financial Strength • Total assets under management of $224 billion and shareholders' equity is $4.9 billion. • Sun Life Assurance Company of Canada is rated by these rating agencies for financial strength: A.M. Best: A++ (Superior) for financial strength (first of 16 rating levels) Fitch: AA+ (Very Strong) for financial strength (second of 24 rating levels) Moody's: Aa2 (Excellent) for financial strength (third of 21 rating levels) Standard & Foor's: AA+1(Very Strong) for financial strength (second of 21 rating levels) r With negative outlook Financial information and ratings are current as of June 2002. Group Insurance • Sold first U.S. group life policy in 1924 • Group sales and service offices in 19 cities nationwide • Sun Life Assurance Company of Canada is licensed in 49 states, D.C. and Puerto Rico. Sun Life Insurance and Annuity Company of New York issues Group Life, Medical Stop -Loss, LTD, and STD Advice to Pay Services in New York. For product features, please see reverse side. Sun We Assurance Company of Canada is a member of the Sun Life Financial group of companies. ®2002 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are service marks of Sun Life Assurance Company of Canada Visit us at www.sunlife usa.com. XGRI1004 SLPC 4946 6102 W �e Sun Life Financial' BENEFIT PROVISIONS EMPLOYEE LIFE INSURANCE 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. 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 dismemberment benefits. You do not have to submit Evidence of Insurability to convert to an individual policy. 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. 93C-LH-LIFE.1 Employee Life Insurance Page No. 17 BENEFIT PROVISIONS EMPLOYEE LIFE INSURANCE 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 January 1, 1997 you will be insured if 1. you were insured under the prior insurer's group Life policy at the time of transfer; and 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 Life policy. Any Life benefit payable will be the lesser of. - the Life benefit payable under the Group Policy; or - the Life benefit payable under the prior insurer's group Life policy had it remained in force. All other provisions of Sun Life's Group Policy will apply. 93C-LH-LIFE.1 Employee Life Insurance Page No. 18 BENEFIT PROVISIONS 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 lesser of: 1. the amount of insurance for your Dependent shown in the Benefit Highlights; or 2. the Guaranteed Issue Amount shown in the Benefit Highlights, plus any amount of insurance over your Dependent's Guaranteed Issue Amount that Sun Life has approved your Dependent's Evidence of Insurability. The amount of your Dependent's Life Insurance is subject to any Evidence of Insurability requirements shown in the Benefit Highlights. What is the Conversion Privilege? If your dependent spouse's Life Insurance ceases, your dependent spouse may be able to convert the Life Insurance to an individual policy. When can my dependent spouse convert? Your dependent spouse can convert if all or part of your dependent spouse'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 spouse no longer qualifying as a Dependent. 2. Your dependent spouse can convert if your dependent spouse has been continuously insured for five or more years under Sun Life's Group Life Policy and all or part of your dependent spouse's Life Insurance ceases or reduces due to: - termination of the Dependent Life Insurance Benefit Provision; - termination of the Group Policy; - an amendment to the Group Policy to terminate your Eligible Class. 93C-LH-DLFFE Dependent Life Insurance Page No. 19 BENEFIT PROVISIONS DEPENDENT LIFE INSURANCE What amount of Life Insurance can my dependent spouse convert? The amount of Life Insurance your dependent spouse can convert depends on the reason your dependent spouse's Life Insurance ceased. If your dependent spouse's amount of Life Insurance ceased or reduced for the reasons stated in # 1 "When can my dependent spouse convert?", your dependent spouse can convert up to the amount that ceased or reduced. If your dependent spouse's amount of Life Insurance that ceased is $10,000 or more, the minimum amount of your dependent spouse's individual policy must be $10,000. If your dependent spouse's amount of Life Insurance ceased or reduced for the reasons stated in #2 "When can my dependent spouse convert?", your dependent spouse 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 spouse may become eligible for within 31 days after your dependent spouse's Life Insurance ceased or reduced. How can my dependent spouse convert? You or your dependent spouse 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 spouse's Life Insurance ceases or reduces. This is your dependent spouse's 31 day conversion period. What type of individual policy is available? Your dependent spouse 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 spouse does not have to submit Evidence of Insurability to convert to an individual policy. When does my dependent spouse's individual policy start? If your dependent spouse's application for the individual policy is received and the first premium paid when due, your dependent spouse's individual policy starts on the day after your dependent spouse's 31 day conversion period. What happens if my dependent spouse 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 spouse had applied for an individual policy or had paid the first premium. The death benefit is the amount of Life Insurance your dependent spouse would have been eligible to convert. 93C-LH-DLFFE Dependent Life Insurance Page No. 20 BENEFIT PROVISIONS DEPENDENT LIFE INSURANCE 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 your Dependent is hospital confined or disabled on January 1, 1997 your Dependent will be insured if: 1. your Dependent was insured under the prior insurer's group Life policy at the time of the transfer; and 2. you are a member of an Eligible Class; and 3. premiums for your Dependent are paid up to date; and 4. your Dependent is not receiving or eligible to receive benefits under the prior insurer's group Life policy. Any Life benefit payable will be the lesser of: - the Life benefit payable under the Group Policy; or - the Life benefit payable under the prior insurer's group Life policy had it remained in force. All other provisions of Sun Life's Group Policy will apply. 93C-LH-DLIFE.1 Dependent Life Insurance Page No. 21 BENEFIT PROVISIONS ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE What is my Accidental Death and Dismemberment Benefit? If Sun Life receives written Notice and Proof of Claim that: - you died from an accidental drowning while insured; or - you sustained an Accidental Bodily Injury while insured, which results in your loss of life, sight or limb within 365 days of the date of that Accidental Bodily Injury; 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. Life.........................................................................................................................................................................100% Sightof one eye...................................................................................................................................................... 50% Onelimb.................................................................................................................................................................50% Speech and hearing 100% Speech or bearing 50% Thumb and index finger ofthe same hand.................................................................................................................................................... 25% Quadriplegia...........................................................................................................................................................100% Paraplegia............................................................................................................................................................... 75% Hemiplegia............................................................................................................................................................. 50% The maximum amount of Accidental Death and Dismemberment Benefit payable for your losses resulting from any one accident is 100%. Accidental Death and 93C-LH-AD&D Page No 22 Dismemberment Insurance BENEFIT PROVISIONS ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE 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. Loss of your speech means the total and irrecoverable loss of speech. Loss of your hearing means the total and irrecoverable loss of hearing. Loss of your thumb and index finger means severance through or above the metacarpophalangeal joints. Quadriplegia means the total and permanent paralysis of both your upper and lower limbs. Paraplegia means the total and permanent paralysis of both your lower limbs. Hemiplegia means the total and permanent paralysis of your upper and lower limbs on one side of your body. 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; or - bodily or mental infirmity or disease of any kind, or an infection unless due to an accidental cut or wound; or - your committing or attempting to commit an assault, felony or other illegal act; or - 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. Accidental Death and 93C-LH-AD&D Page No. 23 Dismemberment Insurance BENEFIT PROVISIONS ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE 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 January 1, 1997 you will be insured if. 1. you were insured under the prior insurer's group AD&D policy at the time of transfer; and 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 AD&D policy. Any AD&D benefit payable will be the lesser of: - the AD&D benefit payable under the Group Policy; or - the AD&D benefit payable under the prior insurer's group AD&D policy had it remained in force. All other provisions of Sun Life's Group Policy will apply. Accidental Death and 93C-LH-AD&D.1 Page No. 24 Dismemberment Insurance 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 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 15 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. 93C-LH-CLAIM Claim Provisions Page No. 25 CLAIM PROVISIONS 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. 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. 93C-LH-CLAIM Claim Provisions Page No. 26 F Sun Life Financial SM September 8, 2003 James B. O'Neill H, CPPO, FNIGP Director of Purchasing and Risk Management City of Fort Collins P.O. Box 580 Fort Collins, CO 80522-0580 RE: P902 Benefits — Compliance Letter Dear Jim: The letter is to confirm that our in force Life/AD&D, Supplemental Life and Long Term Disability adheres to the RFP specifications. Best Regards, Todd A.Junker Group Representative CLAIM PROVISIONS 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. 93C-LH-CLAIM Page No. 27 Claim Provisions 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. 93C-LH-GENP General Provisions Page No. 28 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. 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 City of Fort Collins 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. Guaranteed Issue Amount means the maximum amount of insurance available to you or your Dependent without Evidence of Insurability. 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. 93C-LH-DEF Page No. 29 Definitions DEFINITIONS 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. 93C-LH-DEF Page No. 30 Definitions DEFINITIONS 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. Combined Maximum Benefit means the largest amount of insurance available to you under the Group Policy. The Combined 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, 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. 93C-LH-DEF Definitions Page No. 31 DEFINITIONS 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 25 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 he/she depends 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 residing outside the United States, Canada or Mexico. No person may be considered to be a Dependent of more than one Employee. 93C-LH-DEF Page No. 32 Definitions DEFINITIONS 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. 93C-LH-DEF Definitions Page No. 33 No Text No Text Sun Life of Canada• Wellesley Hills, MA CHECKLIST OF ITEMS INCLUDED WITH PROPOSAL Yes No Description of Item Proposal for Group Life Insurance, AD&D and Supplemental Life V Proposal for Group Voluntary Life Proposal for Voluntary Group Life and AD&D �✓ Proposal for Group Long Term Disability �✓ Proposal for Group Dental Proposal for Vision Care Proposal for Transplant Coverage Proposal for Long Term Care Signed Proposal Compliance Letter Signed Plan Design Confirmation Completed and Signed Questionnaire(s) ✓ Dental Network Access Analysis (if applicable) �✓ Vision Network Access Analysis (if applicable) ✓ Copy of your EOB for Dental and/or Vision Services (if applicable) Proposed Implementation Timeline for The City. ✓ Audited Financial Statements and/or Department of Insurance filings for the past two years (Only if requested by The City) �✓ Provider "Report Cards" used to provide feedback on clinical and non -clinical performance measures �✓ Copy of your Policy Assuring Member Satisfaction �✓ Samples of all Standard and Optional Reports you are proposing to provide on an account specific basis ✓ Copy of your Banking Services Agreement ✓ Copy of your Customer Satisfaction Survey Copy of your Administrative Services Agreement or Insurance Contract that will be in effect January 1, 2004 m2Z77=�:==_ City of Fort Collins, RFP 2003 11 Sun1� Life Financial`" Sun Life Assurance Company of Canada Department Addresses & Contact List Denver Group Office General Call Center, 1401 17th Street, Suite 350 One Sun Life Executive Park Denver, CO 80202 Wellesley Hills, MA 02481 Beth Schafer (for general questions) Account Manager (for specific questions) 800-247-6875 303-293-8955, or 800-488-3278 ext 23 beth.e.schafer@sunlife.com Mitch Michener Group Life Claims Denver Group Manager Sun Life Assurance Company of Canada 1401 17th Street, Suite 350 Group Life Claims, SC 3225 Denver, CO 80202 One Sun Life Executive Park 303-293-8955, or 800-488-3278 ext 24 P.O. Box 81100 mitch.michener@sunlife.com Wellesley Hills, MA 02481 Todd Junker Group Life Conversion Senior Sales Representative Sun Life Assurance Company of Canada 1401 17th Street, Suite 350 Group Life Conversion, SC 1219 Denver, CO 80202 One Sun Life Executive Park 303-293-8955, or 800-488-3278 ext 25 Wellesley Hills, MA 02481 todd.ffiunker@sunlife.com Roxanne Lowe Evidence of Insurability Customer Care Manager, Western Region Sun Life Assurance Company of Canada One Sun Life Executive Park Group Life Dept., SC 3227 Wellesley Hills, MA 02481 One Sun Life Executive Park 800-432-1102 x 1859 Wellesley Hills, MA 02481 roxanne.lowe@sunlife.com Group Long Term Disability www.sunlife-usa.com Sun Life Assurance Company of Canada Long Term Disability, SC 3208 Group Forms page: One Sun Life Executive Park http://www.sunlife-usa.com/univ/un8.cfm_ P.O. Box 81830 Wellesley Hills, MA 02481 QUESTIONNAIRE Group Life Insurance, AD&D and Supplemental Life Please refer to plan booklet for current plan provisions. 1. Do you agree to cover without limitation all em ployees/dependents enrolled as of December 31, 2003? 2. Will you agree to replicate each of the current plan's provisions? If not, please list the specific provisions you will not replicate, along with the reason you elect not to replicate the provision(s). If you do not identify those specific provisions you cannot replicate and you are selected as The City's group life vendor, you may be required to make the necessary adjustments in order to achieve replication. Otherwise, your selection may become void. 3. What is your fully insured premium rate for this coverage? Please express your premium quote in terms of cents per covered $1,000 of base annual salary. Premiums must be net of any commissions or broker fees. If you are selected for multiple plans, will you offer discounted premiums? 4. Include samples of claim payment reports, e.g., premiums vs. claims, etc. 5. Is there a toll -free telephone number for employees to call with questions on plan provisions or claim status? 6. What is the average length of time required to resolve fully an employee inquiry? 7. What performance guarantees will you provide? 8. Specify any situations that would result in a claim denial. 9. Please refer to the checklist on page 10 for additional items to submit (e.g., audited financial statements, etc.). City of Fort Collins, RFP 2003 15 City of Fort Collins P902 Group Life Insurance, AD&D and Supplemental Life Questionnaire 1)Yes. 2)Yes, as the incumbent carrier, Sun Life will agree to replicate each of the current plan's provisions. 3)The basic employer paid Life/AD&D is a rate of .20/.04 per $1,000 of basic annual salary. The Supplemental Life has step rates: 0-29 $0.10 30-34 $0.12 35-39 $0.15 40-44 $0.25 45-49 $0.42 50-54 $0.65 55-59 $1.02 60-64 $1.45 65-69 $2.00 70-74 $4.60 4)Sample reports attached. 5) Yes, Sun Life does have a toll -free number for employees to call with questions on plan provisions or claim status. In fact, Sun Life recently implemented the ability to look at claim status on-line. 6)The employee's questions will be addressed within one business day. The length of time required to fully resolve and employee inquiry varies by situation. 7)None 8)A couple situations that would result in claim denial are fraud and no death certificate. 9)This has been addressed on the checklist. QUESTIONNAIRE Group Long Term Disability Please refer to plan booklet for current plan provisions. 1. Will you agree to cover without limitation all employees enrolled as of December 31, 2003? 2. Will you agree to replicate each of the current plan's provisions? If not, please list the specific provisions you will not replicate, along with the reason you elect not to replicate the provision(s). If you do not identify those specific provisions you cannot replicate and you are selected as The City's group LTD vendor, you may be required to make the necessary adjustments in order to achieve replication. Otherwise, your selection may become void. 3. What is your fully insured premium rate for this coverage? Please express your premium rate in terms of cents per $100 of base monthly salary. Premiums must be net of any commissions or broker fees. If you are selected for multiple plans, will you offer discounted premiums? 4. Include samples of claim payment reports, e.g., premiums vs. claims, etc. 5. Is there a toll -free number for employees to call with questions on plan provisions or claim status? What is the average call waiting time? 6. What is the average length of time an employee waits for an inquiry to be answered fully? 7. What performance guarantees will you provide? 8. Specify clearly any conditions and circumstances that would be excluded from coverage. 9. Please refer to the checklist on page 10 for additional items to submit (e.g., audited financial statements, etc.). City of Fort Collins, RFP 2003 13 City of Fort Collins P902 Group Long Term Disability Questionnaire 1)Yes, without limitation, Sun Life Financial will agree to cover all employees enrolled as of December 31, 2003. 2)As the incumbent LTD carrier all plan provision will remain the same 3)Our current in -force rate is .79 per $100 of base monthly salary and will remain in effect until 1/1/2005. 4)See attached sample reports 5)Yes, Sun Life does have a toll -free number for employees to call with questions on plan provisions or claim status. In fact, Sun Life recently implemented the ability to look at claim status on-line. 6)An employee's inquiry will be answered within one business day. 7)None 8)Nothing that is not outlined in the contract. 9)This has been addressed on the checklist. Service Guarantees Life/AD&D: Sun Life Financial does not currently offer a service guarantee for Life Insurance claims Long Term Disability: Due to the inherent complexity of LTD claims we do not offer a service guarantee. Benefit Eligible Employees Volume Rate Basis Current Rate Current Annual Premium Renewal Rate Estimated Renewal Premium Guarantee Renewal Proposal For City of Fort Collins Group Number — 98544 Effective 01/01/2003 Long Term Disability 1,079 $4,327,761 % eligible payroll 0.640% $332,372 0.790% $410,272 24 months Comments: • Your Long Term Disability rate is increasing 23% due to the incurred loss ratio of 128%, compared to target loss ratio of 80%. Please see the enclosed experience exhibit. • Change the Benefit percentage to 60% at a revised rate of .640%. For Sun Life Assurance Company of Canada to process this renewal in a timely manner, please sign this form and return it to me by December 17, 2002. If renewal alternatives are elected, or if there are any changes to the underlying plan's benefit structure, please have the policyholder sign and return this form. Otherwise, your signature as broker is the only signature required. 1 1 Authorized Signature JAMES B. O'NEILL II., CPPO, FNIGP Name (Printed) Underwriter: Brian Lynch v -/02-- Date DIRECTOR OF PURCHASING AND RISK MANAGEMENT Title SLPC7157 7/01 Sun Life Assurance Company of Canada is a member of the Sun Life Financial group of companies. www crmlifa_neo r.m Renewal Proposal For City of Fort Collins Group Number — 98544 Effective 01/01/2003 Benefit Basic Employee Life Basic AD&D Eligible Employees 1,449 1,797 Volume $65,731,928 $95,398,287 Rate Basis per $1,000 volume per $1,000 volume Current Rate $0.170 $0.040 Current Annual Premium $134,093 $45,791 Renewal Rate $0.200 $0.040 Estimated Renewal Premium $157,757 $45,791 Guarantee 24 months 24 months Comments: • Optional Dependent Life rates remain unchanged. • Employee Optional Life rates remain unchanged. • Assist America: offering on the following page. Authorized signature required. • This renewal includes the addition of global travel assistance provided by Assist America for all non - retired employees and their dependents. Assist America's medical and personal emergency assistance is available to employees traveling 100 or more miles away from home. Should an employee or a family member become ill, have an accident or need other assistance covered under the program, with one simple phone call he or she can access proper medical care anywhere in the world. Unless you indicate otherwise, your signature verifies that you have accepted global travel assistance services. For Sun Life Assurance Company of Canada to process this renewal in a timely manner, please sign this form and return it to me by December 17, 2002. If renewal alternatives are elected, or if there are any changes to the underlying plan's benefit structure, please have the policyholder sign and return this form. Otherwise, your signature as broker is the only signature required. Ll:,� V� 0i ; OZ Authorized Signature I Date JAMES R. O'NEILL II. CPPO FNIGP DIRECTOR OF PURCHASING AND RISK MANAGEMENT Name (Printed) Title Underwriter: Brian Lynch SLPC7157 7/01 Sun Life Assurance Company of Canada is a member of the Sun Life Financial group of companies. www.sunlife-usa.com City of Fort Collins Current Supplemental Life Rates: Rates shown are per $1,000 of basic annual salary: Age Rate 0-29 $0.100 30-34 $0.120 35-39 $0.150 40-44 $0.250 45-49 $0.420 50-54 $0.650 55-59 $1.020 60-64 $1.450 65-69 $2.000 70-74 $4.600 Global Travel Assistance A value-added service for our Group Life customers Wo's traveling in America? Just about everyone. Check out the Woo, statistics: * • Overall, American households took 998 million person -trips* in 2000 • Baby boomers (35 to 54 year olds) generated the highest travel volume in the U.S. in 2000 • Mature Americans, aged 55 or older, average the longest stays away from home (4.9 nights, excluding day trips). Conversely, this group also has a higher share of day trips (21%) • One in five trips in the U.S. include children under 18, or 125 million trips in total • Married households represent the largest group of travelers, and take 63% of all trips To provide a valuable service to our Group Life customers, Sun Life Assurance Company of Canada has created a unique partnership with Assist America, the nation's largest provider of global emergency medical travel assistance services through employee benefit plans. Now employees covered by our Group Life insurance can have peace of mind if they become injured or fall ill while traveling. Assist America provides medical and personal assistance to employees traveling 100 miles or more away from home. This protection extends to eligible participants, their spouses and minor dependent children.* * Whether the employee is traveling for business or pleasure, within the U.S. or abroad, with one simple phone call he or she can access proper medical care anywhere in the world. Our global travel assistance services provided by Assist America offer the following: • Medical consultation and evaluation • Medical referrals to English-speaking, west em-trained physicians • Hospital admission guarantee • Critical care monitoring • Emergency medical evacuations • Transportation to return home or to a rehabilitation facility • Transport to join patient (if an in- patient for more than seven days) • Care and transport of unattended minor children • Prescription assistance • Return of mortal remains • Legal and interpreter referrals Assist America has a worldwide network of over 600,000 pre -qualified medical providers. Medical staff is just a phone call away 24 hours a day, 365 days a year. There are no caps, limits or chargebacks for any service Assist America provides. At Sun Life Assurance Company of Canada, we are proud to offer our customers and their employees extra security during their travels. For more information, please contact your Sun Life Financial Group Representative. -Somme: Travel Industry Association of America. A person -trip is one poison traveling 50 miles or more from home, one way. », Excludes spouse business travel SLPC 7892 I1/01 XGRI1267 Sun Life Assurance Company of Canada is a member of the Sum Life Financial group of companies. 02001 Sum life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Sum life Financial and the globe symbol are service marks of Sum We Assurance Company of Canada Visit us at sunlife-usa.com. Life Financial' Employee Group Benefits UNDERWRITTEN BY SUN LIFE ASSURANCE COMPANY OF CANADA City of Fort Collins GROUP LONG TERM DISABILITY INSURANCE GROUP POLICY NUMBER - 98544 POLICY EFFECTIVE DATE - January 1, 1997 POLICY AMENDMENT DATE — August 1, 2003 93C-LH Global Travel Assistance Success Stories �en an accident or illness occurs while traveling away from home, V V employees and their families need timely, quality care. That's why Sun Life Assurance Company of Canada has partnered with Assist America, the nation's largest provider of global medical travel assistance services through employee benefit plans. When covered by our Group Life insurance, employees and family members traveling 100 miles or more away from home can access medical staff 24 hours a day, 365 days a year through services provided by Assist America. The following are examples of how Assist America has assisted those in times of need. A family recently moved to Seattle, Washington, from North Carolina and had not yet established a network of friends and neighbors to rely on in a time of crisis. Shortly after their move, the father was involved in a serious car accident while on business in Denver. After consulting with the treating physician, it was determined that the father would be hospitalized for a lengthy period. Assist America arranged and paid to transport his wife to his bedside. However, the couple had two teenage boys at home, and the wife was concerned about leaving them at home for several weeks. Assist America transported the grandmother from North Carolina to be with the boys so the wife could stay with her husband and focus on this medical situation. When the patient was ready to be discharged, Assist America arranged and paid to transport him and his wife back home. A woman who was six months pregnant went to Cancun, Mexico with her husband. She went into premature labor. Assist America's initial plan was to evacuate her to a medical facility that could provide appropriate treatment. Unfortunately, labor was progressing much too rapidly, so Assist America flew a medical team to her that included a doctor, a neo-natal nurse specialist and respiratory therapist along with the necessary equipment to deliver the baby, including the incubator. Assist America's medical team delivered the baby and evacuated him by private jet ambulance to Miami. There he improved daily, gaining enough weight so that six weeks later, Assist America brought him and his mother back home. While on a ski vacation in Vermont, a covered member fell and sustained a painful hip fracture. The member called Assist America from the hospital and spoke with the medical staff to determine he was in an appropriate medical facility. Throughout his hospital stay, Assist America monitored every aspect of the member's medical care, all the while keeping his family informed of his condition. Once the member's injury had improved and he could be released, Assist America's medical staff assessed the member's condition and determined the most appropriate method to bring him home. Subsequently, Assist America arranged and paid for a ground ambulance to the member's home near Boston, MA. For more information about our global travel assistance services provided by Assist America, please contact your Sun Life Financial Group Representative. SLPC 7894 11/01 XGR/1269 Sun Life Assurance Company of Canada is a member of the Sun Life Financial group of companies. 02001 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Sun Life Financial and the globe symbol are service marks of Sun Life Assurance Company of Canada. Life Financial" Visit us at w .sunlife-usa.com. VVVVVVVVVVVVVVVVVVV Emergency Travel Assistance Success Story Helping an Employee on a Ski Vacation in Colorado We promise a lot to our customers. Every day we make the commitment to listen, to care, to deliver peace of mind. We're doing just that for our customers with the Emergency Travel Assistance service offered with our Group Life product. Take a look at a recent customer experience: An employee of one of our policyholders traveled from her home in Illinois to Colorado to enjoy a ski vacation with family. Unfortunately, while she was there, she fell critically ill. She was rushed to the hospital. Her brother found her Assist America card in her wallet next to her health insurance card. He called Assist America. The Assist America medical coordinator immediately contacted the Colorado hospital to evaluate the facility —which did meet their criteria. The medical coordinator also called the hospital every few days to monitor the employee's status. Assist America even offered to fly one of the employee's teenage daughters out to be with her, but the employee decided it was best that both daughters remain at home. While she was in the hospital, the employee was worried about how to deal with getting back home. Assist America told her not to worry, that they would take care of it After being released from the hospital and convalescing at her brothers home in Colorado, the employee returned to Illinois —with help along the way from Assist America. Saving money for the employee Assist America arranged and paid for everything, including the medical consultation, flight arrangements, a fast -class airline ticket back to Illinois for the employee, and towncar and driver service to provide transport from the airport to the employee s home. Costs for these services reached over $2,000! What is Emergency Travel Assistance? Emergency Travel Assistance is an innovative addition to our Group Life product. We selected a leading vendor, Assist America, to provide emergency medical and personal assistance to covered employees when they need help and are traveling 100 or more miles away from home. There are no caps, limits or chargebacks for any service Assist America provides. Employees and their dependents can call for assistance 24 hours a day, 365 days a year —whether they're on a weekend fishing trip in Maine or a vacation in Europe. Alleviating stress This employee's story shows how important Emergency Travel Assistance is when facing a medical crisis far from home. Assist America helped minimize the stress associated with experiencing an illness on vacation and the physical challenges of traveling while recovering —Assist America even made sure there was a wheelchair for the employee at each airport to make things a little easier. Plus, Assist America eliminated the inconvenience and cost of rearranging flight plans. Without Assist America, the employee would have had to take care of these difficult and expensive tasks alone. Emergency Travel Assistance benefit helps employers and employees by bringing them peace of mind —they know that emergency medical and personal services will be available when they're needed most For more information, please contact your local Sum Life Financial Group Representative. Sun Life Assurance Company of Canada is a member of the Sun life Financial group of wmpanies. ® 2003 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun life Financial and the globe symbol are service marks of Sun Life Assurance Company of Canada. Visit us at .sunlife-usaxom XGR41373 Sun 10437 Life Financial'" 2210 Abr "c Ass is, Al-e r Assist America, formed in 1990, is the nation's largest provider of emergency travel assistance services through employee benefit plans. Although best known for intervening in ' medical emergencies in foreign countries, its programs are designed to respond when any covered employee becomes ill or injured while traveling just 100 miles or more away from home. Next time you or ur fa 'I b yo ml y mem ers are traveling and need medical assistance, remember to use the phone number on the back of your Assist America ID card. Be sure to carry the card with you at all times. One simple phone call puts you in touch with Assist America's highly -trained staff who will ensure your call is handled promptly, and will even coordinate with your medical benefit plan. All services must be provided and arranged by Assist America, No claims for reimbursement will be accepted. ., lenueuld a3f� ung .eJuawle lslssE - saowas aaueJsisSV leatpaW tiva 800-87' 1414 -,.. .. ., Within the united states o„ tdde the unwed state, email: -nad rs'..e ,' 1,,,.. •The holder of this card is a member of Assist America and Is entitled to its medical and personal serYKeS. • Et ports dor de est. tarjeta es hiiembro de Assist America y tiene derecho a los serviclos personates y de, assistene'. medic. de Assist Anrerica. • Le titulaire de cette carte est membre d'Assist America a droit a I'assistauce hied lcal et our services persormels d'Asust Ame i,,, This u not a medical insurance card. All services provided by Assist America. No claims for reimbursement w11 be accepted, \\I.I i Sun Life Financial'"' OKey Benefits 0 Medical Consultation and Evaluation Global Travel Assistance Sun Life Assurance Company of Canada is pleased to offer you global travel assistance services provided by Assist America. You now have access to a unique emergency medical and personal assistance program while traveling, 24 hours a day, 365 days a year. This © service is available to you as part of your enrollment through Sun Life Assurance Company of Canada's Group Life insurance program. Eligible participants have immediate access to doc- tors, hospitals, pharmacies and certain other services when faced with a medical -related emergency while traveling internationally or domestically more than 100 miles away from home. The Assist America Advantage You and your family (whether traveling together or separately) now have access to Assist America's medical travel assistance services. With one simple phone call, you will be connected to a global net- work of: O• Over 600,000 pre -qualified medical providers 4 • Operation Centers with worldwide i response capabilities 4 4 • Air and ground ambulance service providers The Operation Centers are staffed with trained multilingual personnel, including nurses and doctors, to advise and assist you quickly and professionally in a medical emergency. Assist America pays for all of the assistance services it provides. Your call to the Operation Center is evaluated by its medical staff and referred to English-speaking doctors and/or hospitals. Hospital Admission Guarantee Assist America will guarantee hospital admission for you or your dependent if you are outside the United States by validating your health coverage. (On rare occasions, funds may need to be advanced: if so, they need not be repaid until your claim is settled.) Emergency Evacuation Whenever adequate medical facilities are not avail- able locally, Assist America will use whatever mode of transport, equipment and personnel necessary to evacuate you or your family member to the nearest facility capable of providing proper care. Critical Care Monitoring Assist America's team of doctors, nurses and other medically -trained personnel will stay in regular communication with the attending physician and/or hospital and relay information to your family and employer. Medically Supervised Repatriation If you or your dependent requires assistance return- ing home after hospitalization, Assist America will repatriate you, with an escort, if medically necessary. Prescription Assistance Should a member require prescription medication, Assist America will assist the member in filling that prescription. Emergency Message Transmission Assist America will receive and transmit emergency messages. Emergency Trauma Counseling Assist America will provide online telephonic coun- seling and referrals to qualified counselors as needed Transportation to join Patient If you are traveling alone and will be hospitalized for more than seven days, Assist America will provide economy round-trip common carrier transportation to the place of hospitalization for a designated family member or friend. Care for Minor Children If a minor child is left unattended as a result of the accident or illness, Assist America will provide one- way economy transportation, with attendants if required, to the place of residence. Legal and Interpreter Referrals Assist America will refer you to an interpreter or legal personnel, as necessary. Return Mortal Remains In case of death, Assist America will transport and offer every reasonable assistance in legal formalities for the return of mortal remains. Call Assist America when: • You are IN miles or more away from home and require medial assistance • Medical consultation is needed • Medical evacuation may be necessary • You experience local language problems • You require a hospital admission guasartes When you call the Assist America Operation Center, please have the following information: • Your name, telephone number and (if possible) fax number and your relationship to patient • Patient's name, age, sex and reference number • A description of the patient's condition • Name, location and telephone number of hospital, if applicable • Name and telephone number of treating doctor • Where the doctor can be reached now Be sure to fold this card and alrry it in your wallet at all time.. Emergency Medical Travel Assistance Services Please sign card, remove and carry udth you at all times. i01-AA-SUL-100101 Participants Name Sooal Security Number or requested. assist arnerica• Sun Life Financial" Online Claim Status We know employers are looking for convenience, simplicity and better information to manage their benefits plans. At the same time, they want flexible easy -to -use customer service for their employees. At Sun Life Financial, we've made a commitment to listen to our customers, and deliver the solutions they need. Our latest web -enabled innovation is a direct result of that commitment. Introducing Online Claim Status Online Claim Status provides employers with instant access to information about Short Term and Long Term Disability claims through the Internet. And it allows employees who have disability claims to get updated claim status using our web site or our toll -free telephone number. Because our Claim Status system is available 24 hours a day, seven days a week, claim inquiries can be made at the customer's or member's convenience, something that previously was only available during business hours. For Employers One log in provides access to Claim Status ... and all of our other online tools We've seamlessly integrated our new Claim Status system with CustomerLink, our online service center for group benefits customers. LTD, STD and SunAdvisor customers log in like they normally do. ' By selecting the Claims option, they can keep track at each stage of a claim, from initial submission to approval to benefit payments, right through to return -to -work. Customers can sort by date, name and coverage and get a summary view of all claims. Or they can drill down to see details about individual benefit payments including tax withholding. Please note: To protect confidentiality, no medical information of any kind is available through the site. mr0MraNVi n� mrunw[19gS� DE Lm ... am W. D om s... .a O7/b/Am PELL4ffiIRis Lm a. woo 9J.m o6M40m s..wm.a mr�.om ..pro, �� Lm e.w. nm w.m m In Su.,W.e N/A.dID HGNAYFI3Y LlO BM. MM mm B.IYvI.® smpeN m(A(Lpl Stnll$tiNY ty4.5'E LM Bn.G. Wm VM mlPJdm sa. M.n oz� INS. s+ y:5 Lro BM.rn. nm m m Employers can get summary information on their whole group, or detailed status and benefit information on each claim. LL��I Sun Life Financial'" Continued on next page For Members Easy -to -use claim status via the web or over the phone We built our Claim Status system so that plan members can serve themselves, day or night, via the web or by calling our toll -free customer service number. On the web, members will access the system by selecting the Plan Members button on www.sunlife-usa.com and following the on -screen instructions. No matter what their status - approved, pending or dosed - the system displays the most up-to-date payment and claim information and even shows them when to expect their next benefit check. Members view of online claim status. Please note: Our online and telephone claim status systems do not allow access to medical information of any kind. For plan members who prefer to check their claim status over the phone, our interactive voice response system provides access to the same up-to-date information as our web site. Members call one toll -free number, 1-800-247-687S, and follow the prompts for fast, automated service. r(�ools to support our customers. Easy -to -use and secure services for members. 1 Sun Life Financial has made the investment in these dynamic, web -enabled solutions to save our customers time, to make their benefits plans easier to administer, and to enrich their experience. In survey after survey, our customers tell us, these are the things that are important. We've listened. And we've delivered. Sun Life Assurance Company of Canada is a member of the Sun Life Financial group of companies. 02003 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are service marks of Sun Life Assurance Company of Canada. Visit us at w .sunlife-usa.com. XGRI1426 08103 SLPC 11321 11r4i Sun Life Financial" 0 Billing Services Letting employers manage their benefit plan the way they want, right now. We know employers like options - so they can do business the way they want. Here are two new billing options, available to eligible employers beginning April 2003: • online Membership and Billing through our easy -to -use web site, CustomerLink • List Billing that offers member updates by mail or fax Eligible employers can choose the membership and billing option that is best for them. Either way, we provide valuable tools and support to make it easy to do business with us. Note: Not all employers will be eligible for all billing services. Ask your Sun Life Financial Group Representative which services apply. CustomerLink — now with NEW Billing Services CustomerLink is our online resource for streamlined benefits 1 administration, and we've just added NEW Membership and Billing features! Here's what employers will find on /� Vc CustomerLink: \ o � • Add and update members Employers can efficiently manage their plan and save time, by inputting changes when they happen. The helpful screens guide them through the process. • Helpful e-mail alert when the bill is ready Employers don't need to worry about remembering to retrieve their bill. Every month, we'll send an e-mail alert saying, "Your bill is ready" along with a link to view their bill. • View detailed charges Employers who need to verify coverage totals, track costs and stay in -the -know about all of their premium charges will love our detailed online bill. It shows charges by coverage, down to the member level. Or, employers can choose to view a summary bill. • Payment options Employers can mail in their payment or pay by wire transfer, whichever is more convenient. Either way, we provide simple instructions in our comprehensive, online Administrator's Guide. Plus employers get all the highly -rated CustomerLink features like: • Easy -to -use, printable forms, booklets and policies • Specific Sun Life Financial contact information • The popular daily newsfeed, BenefitsLink® Continued on next page Sun Life Financial" List Billing For eligible employers who prefer to receive a paper bill, we'll send J our List Bill in the mail every month. They'll see a summary of charges by coverage and details of all of the changes they've made during the billing period. Employers can fax or mail their monthly membership adds, updates and deletes directly to Sun Life Financial. Sign up today for our new billing options - and find out more about CustomerLink with new online Membership and Billing. * Contact your local Sun Life Financial Group Representative. * Not all employers will be eligible for all billing services. Ask your Sun Life Financial Group Representative which services apply. Sun Life Assurance Company of Canada is a member of the Sun Life Financial group of companies 02003 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are service marks of Sun Life Assurance Company of Canada. Visit us at w .sunlife-usa.com. Sun I XGR11374 Life Financial' 3103 SLPC 10454 Welcome to Sun Life Assurance Company of Canada ("Sun Life"). Sun Life is pleased to be your Employer's insurance carrier for the benefits provided in the Group Policy. The description of Eligible Classes in the Benefit Highlights will help you determine what benefits apply to you. The booklet is intended to provide a summarized explanation of the current Group Policy Benefits. However, the Group Policy is the Document which forms Sun Life's contract to provide benefits. If the terms of the booklet and the Group Policy differ, the Group Policy will govern. A complete copy of the Group Policy is in the possession of your Employer and is available for your review. In the event of any changes in benefits or Group Policy provisions, you will be provided with a new booklet or a supplement which describes any changes. Possession of this booklet does not necessarily mean you are insured under the Group Policy. The requirements for becoming eligible for insurance and the dates your insurance begins or ceases are explained within this booklet. This booklet uses insurance terms and phrases that are listed in the Definitions Section. For information, call the Sun Life Group Customer Service Center toll free at 1-800-247-6875 93C-LH