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HomeMy WebLinkAboutRESPONSE - RFP - P682 BENEFITSU City of Loveland Larimer County Platte River Power Authority Poudre School District R-1 Town of Estes Park Presented By: The Segal Company Sun Life of Canada September 1996 7 The amount you receive from any accumulated sick leave 8 Any formal salary continuation paid to you by your Employer which causes your monthly LTD benefit plus Other Income Benefits and any salary continuation to be more than 100% of your Total Monthly Earnings The amount in excess of 100% of your Total Monthly Earnings will be used as a reduction Any amount you receive by compromise settlement or other method as 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 demeV If Sun Life has reduced your monthly LTD benefit payments by an estimate a lump sum refund will be made to you when Sun Life receives written notice that the Other Income Benefit has been denied If the amount of Other Income Benefit is more than what was estimated you must reimburse Sun Life the amount of the overpayment within 60 days of the award Sun Life has the option to reduce or eliminate your future monthly LTD benefit payments instead of requiring reimbursement in a lump sum During the overpayment reimbursement period the Minimum Monthly Benefit will not apply Other income offsets are only made on plans which the employees do not contribute to Sun Life of Canada Sample Group Disability Booklet Page 17 When does my monthly LTD benefit cease" Your monthly LTD benefit will cease on the earliest of the date you are no longer Totally or Partially Disabled the date you die the end of your Maximum Benefit Period the date you do not provide proof that you continue to be Totally or Partially Disabled as requested or the date your current earnings are more than 80% of your Indexed Total Monthly Earnings Officers the date Sun Life determines you are able to perform all of the material and We provide flexible own substantial duties of your own occupation even if you choose not to work occupation periods which range from the first year of All Other Employees disability up to age 66 the date Sun Life determines you are able to perform all of the material and substantial duties of your own occupation even if you choose not to work (this applies to the first 24 months of Total Disability or to your Partial Disability) or after the first 24 months of Total Disability the date Sun Life determines you are able to perform all of the material and substantial duties of any occupation even if you choose not to work What happens if I return to full time work and become disabled agam9 Our return to work policy encourages employees to Sun Life will treat this new disability as part of your prior Total or Partial Disability if you return to work as soon as returned to work and were Actively at Work for less than possible thus reducing six months if due to the same or related causes overall plan experience one day if due to an entirely unrelated cause You will not have to complete a new Elimination Period Your monthly LTD benefit will be subject to the same terms and conditions as were applicable to the original Total or Partial Disability Your monthly LTD benefit will not continue if you become eligible for benefits under any other group LTD policy or the Group Policy terminates If your new disability begins later than the time periods specified you will need to complete a new Elimination Period What happens to my LTD benefit if I die9 A survivor benefit is available which pays 3 A Survivor Benefit equal to 3 times your last Gross Monthly Benefit is payable in a lump months salary in one lump sum to your Eligible Survivor if Sun Life receives satisfactory proof that you died sum after your Total or Partial Disability had continued for 180 or more consecutive days and Sun Life of Canada Sample Group Disability Booklet Page 18 you had received a monthly LTD benefit Who are my Eligible Survivors9 Your spouse if living or your children under age 25 If you do not have an Eligible Survivor the Survivor Benefit will be payable to your estate What is the Cost of Living Adjustment Benefit" Sun Life will pay an additional benefit to you to help against increases in costs due to inflation When am I eligible for a Cost of Living Adjustment (COLA) Benefit" You are eligible for a Cost of Living Adjustment Benefit on the first anniversary of your Total Disability Benefit payments and each following anniversary thereafter as long as you are receiving a Total Disability Benefit How is my Cost of Living Adjustment Benefit calculated9 To determine your Cost of Living Adjustment Benefit multiply your Total Disability monthly LTD benefit by 3% Your monthly LTD benefit adjusted by the Cost of Living Adjustment Benefit is not subject to the Maximum Monthly Benefit Your monthly LTD benefit will include any prior years Cost of Living Adjustments When does my Cost of Living Adjustment Benefit terminate9 Your Cost of Living Adjustment Benefit will terminate on the earliest of the date you no longer receive Total Disability Benefits or the date you die or the end of your Maximum Benefit Period or the date you do not provide proof that you continue to be Totally Disabled as requested What are the Limitations'' No LTD benefit will be payable to you for any Total or Partial Disability during any of the following periods any period you are no longer under the regular and continuing care of a Physician providing appropriate treatment by means of examination and testing in accordance with your disabling condition any period you do not submit to any medical Examination requested by Sun Life any period of your Total or Partial Disability that is due to Mental Illness (mental nervous psychological emotional diseases or behavioral disorders of any type) unless you are under the continuing care of a specialist in psychiatric care A COLA Provision is available This adjusts benefit payments annually to keep pace with inflation Limitations and exclusions prevent misuse of LTD benefits and help control costs Sun Life of Canada Sample Group Disability Booklet Page 19 Requirements for professional care help ensure quality care and also prevent fraud After you complete your Elimination Period LTD benefits are payable for 24 months Benefits after the first 24 months are payable only if you are confined in a Hospital or Institution licensed to provide psychiatric treatment any period of your Total or Partial Disability that is due to Drug and Alcohol Illness (an illness which results from the abuse of alcohol drugs or derivatives) unless you are actively supervised by a Physician or Rehabilitation Counselor and are receiving continuing treatment from a rehabilitation center or a designated institution approved by Sun Life After you complete your Elimination Period LTD benefits are payable for 24 months if during the Elimination Period you become confined in a Hospital or Institution licensed to provide Drug or Alcohol treatment or begin participation in a Drug or Alcohol Rehabilitation Program acceptable to Sun Life Benefits after the first 24 months are payable only if you are confined in a Hospital or Institution licensed to provide Drug or Alcohol treatment any penod of your Total or Partial Disability which begins in the first 12 months after your LTD insurance becomes effective that is caused by contributed to by or resulting from a Pre Existing Condition unless your Total or Partial Disability begins after a period of 3 consecutive months after your LTD insurance becomes effective during which you have not received medical treatment consultation care or services including diagnostic measures or taken prescribed drugs or medicines A Pre Existing Condition means any Injury or Sickness for which you have received medical treatment consultation care or services including diagnostic measures or took prescribed drugs or medicines within 3 months of the date your LTD insurance becomes effective What are the Exclusions9 No LTD benefit is payable for any Total or Partial Disability that is due to intentionally self inflicted mlunes war declared or undeclared or any act of war your active participation in a not rebellion or insurrection or your committing or attempting to commit an assault felony or other illegal act What happens when my Employer transfers Insurance Carriers to Sun Life9 In order to prevent losing your insurance Sun Life will provide the following coverage If you are not Actively at Work on MMDDYY (eg September 1 199x) you will be insured if you were insured under the prior insurer s group LTD policy at the time of the transfer and Sun Life of Canada Sample Group Disability Booklet Page 20 you are a member of an Eligible Class and premiums for you are paid up to date and 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 insurers maximum monthly benefit All other provisions of Sun Life s Group Policy will apply Are disabilities due to a Pre Existing Condition covered9 LTD benefits may be payable for a Total or Partial Disability if you were insured under the prior insurer s group LTD policy at the time of the transfer and were Actively at Work and insured on MMDDYY (eg September 1199x) 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 of 1 the LTD benefit payable under the Group Policy or ii the LTD benefit payable under the prior insurer s group LTD policy had it remained in force b if you cannot satisfy the Pre Existing Condition Limitation of the Group Policy or that of the prior insurer s group LTD policy no LTD benefit will be paid CLAIM PROVISIONS How is a claim submitted9 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 submitted9 for Short Term Disability written notice of claim must be given to Sun Life no later than 30 days after you cease to be Actively at Work for Long Term Disability written notice of claim must be given to Sun Life no later than 30 days before the end of your Elimination Period or within 30 days of the termination of the Group Policy if earlier If notice cannot be given within the applicable time period Sun Life must be notified as soon as it is reasonably possible Easy steps for claims submission Sun Life s expertise in claim management allows us to provide thorough evaluations in a timely manner Sun Life of Canada Sample Group Disability Booklet Page 21 When Sun Life has received written notice of claim Sun Life will send the forms for proof of claim If the forms are not received within 15 days after written notice of claim is sent proof of claim may be sent to Sun Life without waiting to receive the proof of claim forms When does written Proof of Claim have to be submitted'' for Short Term Disability proof of claim must be given to Sun Life no later than 90 days after the end of your Elimination Period for Long Term Disability proof of claim must be given to Sun Life no later than 90 days after the end of your Elimination Period If proof cannot be given within these time limits proof must be given as soon as reasonably possible Proof of claim may not be given later than one year after the time proof is otherwise required unless the individual is legally incompetent What is considered Proof of Claim9 Proof of Claim consists of at least the following information what the disability is the date the disability occurred and the cause of the disability Sun Life may require as part of the Proof authorizations to obtain medical and non medical information Proof of your continued Total or Partial Disability and regular and continuous care by a Physician must be given to Sun Life within 30 days of the request for proof Proof must be satisfactory to Sun Life When are benefits payable9 Benefits are payable when Sun Life receives satisfactory Proof of Claim Who are benefits payable tog 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 tight to pay an amount of the benefit up to $5 000 to any of your relatives that Sun Life considers entitled If Sun Life pays benefits in good faith to a relative Sun Life will not have to pay those benefits again GENERAL PROVISIONS How can statements made in any application for insurance be used9 All statements made in any application are considered representations and not warranties No representation by you in applying for insurance under the Group Policy will be used to reduce or deny a claim unless a copy of your written application for insurance is or has Sun Life of Canada Sample Group Disability Booklet Page 22 been given to you or to your Beneficiary if any No statement made by you relating to Evidence of Insurability for an initial increased or additional amount of insurance will be used in contesting the validity of that insurance after such initial increased or additional amount of insurance has been in force for a period of two years during that individual s lifetime This statement must be contained in a form signed by that individual What happens if facts are misstated? If relevant facts about you are not accurate an equitable adjustment of premium will be made and the true facts will be used to determine if and in what amount insurance is valid under the Group Policy If the amount of benefit depends on your age the benefit will be the amount you would have been entitled to if your correct age were known What are Sun Life's examination rights' Sun Life at its own expense has the right to have any person whose Injury or Sickness is the basis of a claim examined by a Physician other health professional or vocational expert of its choice and/or interviewed by an authorized Sun Life representative This right may be used as often as reasonably required What are the time limits for legal proceedings' No legal action may start until 60 days after Proof of Claim has been given nor more than 3 years after the time Proof of Claim is required Do these group benefits affect Workers' Compensation9 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 agent9 For all purposes of the group policy the policyholder acts on its own behalf or as your agent Under no circumstances will the policyholder be deemed a Sun Life agent DEFINITIONS These are some of the general terms you need to know Actively at Work means that you perform all the regular duties of your job for a full work day scheduled by your Employer at your Employer s normal place of business or a site where your Employer s business requires you to travel Clarity of contract wording helps employers and employees understand the benefits Sun Life of Canada Sample Group Disability Booklet Page 23 Our contract wording and definitions are a significant benefit of our contract For instance by requiring the disabled employee to be under the regular care of a qualified doctor we help _nsure a high level of care and thus increase the chances for early return to work You are considered Actively at Work on any day that is not your regular scheduled work day (i a you are on vacation layoff or an approved leave of absence) as long as you are not hospital confined or are not disabled due to an injury or sickness and were Actively at Work on your immediately preceding scheduled work day You are considered Actively at Work if you usually perform the regular duties of your job at your home as long as you are not hospital confined or are not disabled due to an injury or sickness and can perform all the regular duties of your job for a full work day and can do so at your Employer s normal place of business if required Eligibility Date means the date or dates you become eligible for insurance under the Group Policy Classes eligible for insurance are shown in the Benefit Highlights Employee (You) means a person who is employed by the Employer working at least the number of hours shown in the Benefit Highlights and paid regular earnings Employer means Sample LTD and STD and includes any Subsidiary Affiliated or Associated company insured under the Group Policy Evidence of Insurability means a statement or proof of your medical history upon which acceptance for insurance will be determined by Sun Life Injury means bodily impairment resulting directly from an accident and independently of all other causes Any Injury must occur and Disability must begin while you are insured under the Group Policy Physician means an individual who is operating within the scope of his license and is either licensed to practice medicine and prescribe and administer drugs or to perform surgery or legally qualified as a medical practitioner and required to be recognized under the Group Policy for insurance purposes according to the insurance regulations of the governing jurisdiction The Physician cannot be you your spouse or the parents brothers sisters or children of you or your spouse Pregnancy means childbirth miscarriage abortion or any disease resulting from or aggravated by the pregnancy Sickness means illness disease or pregnancy A Disability because of Sickness must begin while you are insured under the Group Policy Waiting Period means the continuous length of time immediately before your Eligibility Date during which you must be employed in an Eligible Class before you can apply for benefits Any period of time before the Group Policy Effective Date that you were Actively at Work for your Employer as a full time Employee will count towards completion of your Waiting Period The Waiting Period is shown in the Benefit Highlights Sun Life of Canada Sample Group Disability Booklet Page 24 These are Short Term Disability insurance terms you need to know Elimination Period means a period of continuous days of your Total Disability when no STD Benefit is payable Your Elimination Period is shown in the Benefit Highlights and begins on your first day of Total Disability Gross Weekly Benefit means your weekly STD benefit before any reduction of Other Income Benefits Maximum Weekly Benefit means the largest amount payable weekly to you The Maximum Weekly Benefit is shown in the Benefit Highlights Total Disability or Totally Disabled means because of your Injury or Sickness you are unable to perform all of the material and substantial duties of your own occupation and you are not engaged in any occupation for wage or profit The loss of your professional or occupational license or your inability to obtain or qualify for a license for any reason does not in itself constitute Total Disability To qualify for benefits you must satisfy your Elimination Period with the required number of days of Total Disability These are Long Term Disability insurance terms you need to know Elimination Period means a period of continuous days of your Total or Partial Disability when no LTD benefit is payable Your Elimination Period is shown in the Benefit Highlights and begins on your first day of Total or Partial Disability If you return to work for 15 working days or less during your Elimination Period and cannot continue working your Total or Partial Disability will be treated as continuous Only those days that you are Totally or Partially Disabled will count toward satisfying your Elimination Period Family Social Security means benefits that are paid by the Federal Social Security Act to your eligible spouse and/or children as a result of your Total or Partial Disability Gross Monthly Benefit means your monthly LTD benefit before any reduction of Other Income Benefits Maximum Monthly Benefit means the largest amount payable monthly to you The Maximum Monthly Benefit is shown in the Benefit Highlights Partial Disability or Partially Disabled means because of your Injury or Sickness you are unable to perform all of the material and substantial dunes 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 Total Disability To qualify for benefits you must satisfy your Elimination Period with the required number of days of Total Disability Partial Disability or a combination of Total or Partial days of Disability Sun Life of Canada Sample Group Disability Booklet Page 25 Retirement Plan means a program which provides retirement benefits to you and is not funded wholly by your contributions The term does not include a 401(k) plan a profit sharing plan a thrift plan an individual retirement account (IRA) a tax sheltered annuity (TSA) a stock ownership plan or a nonqualified plan of deferred compensation Your Employer s Retirement Plan includes any Retirement Plan which is part of any federal state county municipal or association retirement system and you are eligible for as a result of your employment with your Employer Disability Benefit when used with the term Retirement Plan means a benefit which is payable under a Retirement Plan due to a disability as defined in that Plan and does not reduce the amount which would have been paid as Retirement Benefits at your normal retirement age under the Plan if the disability had not occurred Social Security means the Federal Social Security Act which provides social insurance on a national scale Total Disability or Totally Disabled means because of your Injury or Sickness you are unable to perform all of the material and substantial duties of your own occupation The loss of your professional or occupational license or your inability to obtain or qualify for a license for any reason does not in itself constitute Total Disability To qualify for benefits you must satisfy your Elimination Period with the required number of days of Total Disability Partial Disability or a combination of Total or Partial days of Disability All Other Employees Total Disability or Totally Disabled means during your Elimination Period and the next 24 months of your Total Disability you because of your Injury or Sickness are unable to perform all of the material and substantial duties of your own occupation After benefits have been paid to you for 24 months you will continue to be considered Totally Disabled if you are unable to perform all of the material and substantial duties of any occupation for which you are or become reasonably qualified for by education training or experience The loss of your professional or occupational license or your inability to obtain or qualify for a license for any reason does not in itself constitute Total Disability To qualify for benefits you must satisfy your Elimination Period with the required number of days of Total Disability Partial Disability or a combination of Total or Partial days of Disability Sun Life of Canada Sample Group Disability Booklet Page 26 Sun Life of Canada* Sun Life Assurance Company of Canada Application for Group Insurance Applicant Organization Legal Name Main Address City State & Zip Code Nature of Business Citv of Fort Collins 200 West Mountain Avenue, Suite A Fort Collins, Colorado 80522 Government Subsidianes or Affluites to be Included Legal Name Address Nature of Business Po,idre Fire Authority 201 Remington Fort Collins, CO 80524 Fire Protection Downtown Development Authority 201 S College, Fort Collins, CO 80524 Authority/Gout City of Fort Collins Housing Authority, n , tort Collins, ov Eligible Employees Eligible Classes Classified Unclassified Mgmt Contractuals Number of Eligible Employees on the Effective Date U tin Minunum Work Week. q tus Are Retirees Ehgblev ❑Yes [RNo Waiting Period ctive 1st of month following 30 consecutive calendar days of emD_loymeni Specify days or months required for new employees to be eligible for benefits Current employees who have not satisfied the waiting period will receive credit for past service to complete the waiting period Benefits Requested Benefit % of Premium Paid by Employer Basic Life ® 100 % Optional Life a % Dependent Life ® 0 % Basic AD & D [ t nn % Optional AD & D ® 0 % Benefit % of Premium Paid by Employer Short Term Disability ❑ %n Long Term Disability ® 100 % Dental Employee ❑ % Dependent ❑ % Effective Date T > 1907 Amount Paid with this Application $ 8 , 000 Subject to approval by Sun Life we will issue a Group Policy with insurance coverage to become effective on the Effective Date The Applicant agrees to provide Sun Life with a current census as of the Effective Date on all eligible employees and all data on employees not actively at work. This information is required no sooner than the Effective Date and no later than 15 days after the Effective Date Employees not actively at work on the Effective Date will only be insured as required by law or as approved in writing by Sun Life This Application will be attached to and is made a part of the Group Policy Countersigned by Name and Address of Agent/Broker Firm (Licensed Resident Agent) I for Organization) (Name and Title) �- 6�1Ih�az ign�Jz� State law may require us to notify you that any person who with intent to defraud or knowing that he is facilitating a fraud against an insurer submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud GR 18/354 BENEFIT HIGHLIGHTS LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE ELIGIBLE CLASSES All full time Employees working a minimum of 30 hours a week CLASSIFICATION Class A Class Al Class A2 BASIC INSURANCE Class A All Employees All Employees who elect this coverage All Employees who elect this coverage OPTIONAL INSURANCE Class Al Class A2 AMOUNT OF INSURANCE LIFE AD&D 1 times your An amount equal to your Basic Annual Earnings* amount of Life Insurance in force LIFE 1 tunes your Basic Annual Earnings** AD&D An amount equal to your amount of Optional Life Insurance in force 2 times your An amount equal to your Basic Annual Earnings** amount of Optional Life Insurance in force * rounded to the next higher $1 000 if not already a multiple of $1 000 subject to a Basic Maximum Benefit of $250 000 ** rounded to the next higher $1 000 if not already a multiple of $1 000 subject to an Optional Maximum Benefit of $400 000 Your Amount of Life and Accidental Death and Dismemberment Insurance reduces to 67% when you reach age 70 and to 50% when you reach age 75 Your Life and Accidental Death and Dismemberment Insurance cancels at your retirement Flexibility in plan design allows life insurance benefits to be based on a multiple of earnings or flat dollar amount Our plans feature high benefit maximums We make life easy for you and your employees by providing the amount of coverage most individuals want without medical evidence underwriting Sun Life of Canada Sample Group Life Booklet Page 3 Evidence of Insurability satisfactory to Sun Life will be required for any of the following Our group life insurance reasons products traditionally do you elect Basic Life Insurance only and you later elect Optional Life Insurance or not require medical you elect an increase in your amount of Optional Life Insurance evidence underwriting - Basic Annual Earnings Your current salary or wage from your Employer Basic Annual Earnings does not include commissions bonuses overtime pay or any other extra compensation DEPENDENT LIFE INSURANCE ELIGIBLE CLASSES All full time Employees working a minimum of 30 hours a week AMOUNT OF INSURANCE For your Spouse $10 000 For your unmarred Children Our plans can provide coverage for children Under 15 days NONE from birth and students up to age 25 15 days but under 1 year $500 1 year to age 19* $5 000 * to age 23 if your child is an enrolled full time student and depends on you for 50% or more of his/her support (The amount of insurance for any of your Dependents cannot be more than 50% of your amount of Life Insurance) WAITING PERIOD (The period of time you must be employed in an Eligible Class before you can apply for benefits) 1 month CONTRIBUTIONS The cost of your Basic Life Dependent Life and Accidental Death and Dismemberment Insurance is paid for entirely by your Employer This is your non contributory insurance The cost of your Optional Life and Accidental Death and Dismemberment Insurance is paid for entirely by you This is your contributory insurance Sun Life of Canada Sample Group Life Booklet Page 4 The following Questions and Answers will help you to better understand your benefits Please read them carefully and refer any questions to your Employer or call the Sun Life Group Service Center toll free at 1 800 247 6875 ELIGIBILITY AND EFFECTIVE DATE OF EMPLOYEE INSURANCE When am I eligible for insurance? If you are in an Eligible Class shown in the Benefit Highlights you are eligible on the later of MMDDYY (eg May 1 199x) or the day after you complete your Waiting Period When do I need to apply for insurance9 You must apply within 31 days of the date you become eligible When does my insurance start9 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 days9 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 date9 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 insurance9 You need to sign the Sun Life form refusing your insurance This form is available from your Employer If you decide later you want Optional Life and Accidental Death and Dismemberment insurance Sun Life must first approve your Evidence of Insurability Evidence of Insurability is at your own expense Simple concise answers to your employees questions Important information about when insurance starts Late entrant provisions help keep premiums affordable Sun Life of Canada Sample Group Life Booklet Page 5 Termination and continuation of employees coverage When do changes in my amount of insurance occur9 If your amount of insurance increases due to a change in your salary or class your increase will take effect immediately as long as you afe Actively at Work on that date and Evidence of Insurability is not required for the increase in your amount of insurance If your amount of insurance decreases due to a change in your age salary or class the decrease will take effect immediately If Evidence of Insurability is required for any increase in your amount of insurance the increase in your insurance will not start until Sun Life approves the increase but you need to be Actively at Work on that date If you are not Actively at Work because of injury sickness layoff or leave of absence on the date an increase in your insurance would normally start the increase in your insurance will not start until you are Actively at Work ELIGIBILITY AND EFFECTIVE DATE OF DEPENDENT INSURANCE When am I eligible for Dependent insurance9 If you are in an Eligible Class shown in the Benefit Highlights and you have a Dependent you are eligible for Dependent insurance as long as you are insured for Employee Life insurance When does the insurance for my Dependent start9 If your Dependent is not Hospital confined or disabled due to an injury or sickness the insurance for your Dependent starts on the date you are eligible for Dependent Life Insurance What if my Dependent is Hospital confined or disabled9 If your Dependent is Hospital confined or disabled due to an injury or sickness on the date your Dependents insurance would normally start your Dependents insurance will not start until the Dependent is no longer Hospital confined or the Dependent is no longer disabled and is able to perform the normal duties of a person of like age and sex TERMINATION OF EMPLOYEE INSURANCE When does my insurance cease'' Your insurance ceases on the earliest of the date the Group Policy terminates the date you are no longer in an Eligible Class the date your class is no longer included for insurance the last day any required premium has been paid for your insurance the date you retire the date you request in writing to terminate your insurance the date you enter active duty in any armed service during a time of war (declared or undeclared) the date your employment terminates or the date you cease to be Actively at Work Sun Life of Canada Sample Group Life Booklet Page 6 Are there any conditions under which my insurance can continue' AM Your insurance will continue during any period the premium for your insurance is waived under the Group Policy If you are on temporary layoff leave of absence or vacation your Employer may continue your insurance by paying the required premium for the length of time specified below Layoff for up to 1 month Leave of Absence for up to 1 month Vacation for up to 3 months If you are absent from work due to an injury or sickness your Employer may continue your Life insurance by paying the required premium for up to 12 months If you are Totally Disabled you maybe eligible for a longer continuation of Life Insurance Refer to What is the Waiver of Premium Provision in the Life Benefit Section Please note you need to apply for continued benefits under the Waiver of Premium Provision within 12 months after you cease to be Actively at Work If your coverage terminates and you are not eligible for any of the described continuations you may be eligible for a Conversion Privilege Refer to the Conversion Privilege in the Life Benefit section Please note that you need to apply for the conversion and pay the required premium within 31 days following your termination of insurance You may be eligible to continue your insurance pursuant to the Family and Medical Leave Act of 1993 You should contact your Employer for more details TERMINATION OF DEPENDENT INSURANCE When does my Dependent's insurance cease9 Your Dependent s insurance ceases on the earliest of the date the Group Policy terminates the date you cease to be insured the date you are no longer in an Eligible Class for Dependent Insurance the date the Dependent does not qualify as a Dependent the last day any required premium has been paid for your Dependent s insurance the date you request in writing to terminate your Dependent s insurance the date your Dependent enters active duty in any armed service during a time of war (declared or undeclared) the date you retire or the date you die Important Waiver of Premium information regarding when an employee needs to apply for continued benefits if totally disabled Sun Life of Canada Sample Group Life Booklet Page 7 No elimination period exists when applying for a Waiver of Premium The industry standard used by most other companies requires a 6 or 9 month elimination period Our plans can extend the Waiver of Premium eligibility to age 65 Are there any conditions under which my Dependent's insurance can contmue9 Yes If your Dependent s coverage terminates your Dependent may be eligible for a Conversion Privilege Refer to the Conversion Privilege of the Dependent Life Benefit section Please note that you or your Dependent need to apply for the conversion and pay the required premium within 31 days following termination of the Dependent s insurance You may be eligible to continue your Dependent s insurance pursuant to the Family and Medical Leave Act of 1993 You should contact your Employer for more details BENEFIT PROVISIONS EMPLOYEE LIFE INSURANCE What is the Life Insurance Benefit9 If you die while insured your Beneficiary will receive the amount of your Life Insurance in force when Sun Life receives written Notice and Proof of Claim What is the amount of my Life Insurance' The amount of your Basic Life Insurance is the Basic amount of insurance shown in the Benefit Highlights Your Basic Life Insurance cannot exceed the Basic Maximum Benefit shown in the Benefit Highlights Your amount of Basic Life Insurance is subject to any age reductions or terminations shown in the Benefit Highlights The amount of your Optional Life Insurance is your amount of insurance elected as shown in the Benefit Highlights Your Optional Life Insurance cannot exceed the Optional Maximum Benefit shown in the Benefit Highlights Your amount of Optional Life Insurance is subject to any Evidence of Insurability requirements age reductions or terminations shown in the Benefit Highlights What is the Waiver of Premium Provision? If you become Totally Disabled while insured the Waiver of Premium Provision may continue your Life Insurance without any further payment of premiums by you or your Employer When am I eligible for the Waiver of Premium Provismn9 You are eligible if Sun Life receives Nonce and Proof of Claim that you became Totally Disabled while insured and before your 60th birthday and before you retire Sun Life of Canada Sample Group Life Booklet Page 8 What is the amount of Life Insurance that is continued under the Waiver of Premium Provision Sun Life will continue the amount of your Life Insurance in force on the last day you were Actively at Work This amount is subject to the same reductions or terminations that would have been applicable had you not become Totally Disabled If you have converted your Life Insurance to an individual policy the continued insurance will be reduced by that converted amount unless you exchange that individual policy for a full refund of premiums paid When does my Waiver of Premium cease9 Your Waiver of Premium ceases on the earliest of the date you are no longer Totally Disabled the date you do not provide Proof that you continue to be Totally Disabled the date you do not submit to an examination by a Physician of Sun Life s choice the date you are no longer under the regular and continuing care of a Physician providing appropriate treatment by means of examination and testing in accordance with your disabling condition the date you reach age 70 or the date you retire For the purposes of this Waiver of Premium Provision you are considered retired when you receive any compensation from a retirement or pension plan of your Employer or when you reach age 70 whichever is earlier If your Waiver of Premium ceases and you do not return to work with your Employer your Life Insurance will terminate You may be eligible to convert your Life Insurance under the Conversion Privilege What is the Accelerated Benefit9 If Sun Life receives satisfactory Certification that you are Terminally Ill part of your Life Insurance may be payable to you while you are still living When am I eligible for an Accelerated Benefrt9 (Applicable if you were employed on or before MMDDYY (eg May 1 199x)) You are eligible if you were Actively at Work on MMDDYY (eg May 1 199x) and have been insured for Life Insurance for at least 60 days (This includes any period of time you were insured under the prior insurer s group life policy) and Our accelerated benefit feature is provided at no additional cost to you giving your plan real added value Sun Life of Canada Sample Group Life Booklet Page 9 A living benefit is an affordable way to help your employees meet any financial burdens (Applicable if you were employed after MMDDYY (eg May 1199x)) You are eligible if you have been insured for life insurance for at least 60 days and (Applicable to All Employees) you are certified as Totally and Permanently Disabled and you are insured for at least $20 000 of Life Insurance and you are approved for continuation of your Life Insurance under the Group Policy s Waiver of Premium provision How do I receive an Accelerated Benefit9 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 Benefit9 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 $10000 If you have received an Accelerated Benefit under the prior insurer s group life policy you can request up to 50% of your Life Insurance currently in force reduced by the amount of the Accelerated Benefit you have previously received How is the Accelerated Benefit pard9 The Accelerated Benefit is paid in a single lump sum amount Can I receive more than one Accelerated Benefit9 You may request the Accelerated Benefit only once under Sun Life s Group Policy Are there any charges if I request an Accelerated Benefit9 A claims administration fee of up to $150 will be deducted from your Accelerated Benefit A 9 month interest charge will also be deducted from your remaining death benefit What happens to my Life Insurance if I receive an Accelerated Beneflt9 If you have received an Accelerated Benefit from Sun Life or the prior insurer s group life policy your Life Insurance will be reduced by an amount equal to the Accelerated Benefit paid by Sun Life and the 9 month interest charge and an amount equal to the Accelerated Benefit paid by the prior insurer s group life policy Sun Life of Canada Sample Group Life Booklet Page 10 Some Important Notes about your Accelerated Benefit Your Accelerated Benefit is not a long term care policy The amount your Accelerated Benefit would pay may not be enough to cover nursing home expenses or other bills You may use the money received from the Accelerated Benefit for any purpose Receipt of your Accelerated Benefit may affect your Medicaid eligibility No Accelerated Benefit payment will be processed if you are required to request it by a thud 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 Privdege9 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 Insurance9 When can I convert my Life Insurance9 1 You can convert if all or part of your Life Insurance ceases or reduces due to termination of your employment termination of your membership in an Eligible Class your retirement your reaching a specified age your changing to a different Eligible Class termination of your Waiver of Premium continuation or your continuation period ending during your layoff or leave of absence You can convert if you have been continuously insured for 5 or more years under Sun Life s Group Life Policy and all or part of your Life Insurance ceases or reduces due to termination of the Life Insurance Benefit Provision termination of the Group Policy an amendment to the Group Policy to reduce the amount of Life Insurance in your Eligible Class or an amendment to the Group Policy to terminate your Eligible Class What amount of Life Insurance can I convert9 The amount of Life Insurance you can convert depends on the reason your Life Insurance ceases If your amount of Life Insurance ceased or reduced for the reasons stated in #1 When can I convert my Life Insurance? you can convert up to the amount that ceased or reduced If your amount of Life Insurance that ceased is $10 000 or more the minimum amount of your individual policy must be $10 000 If your amount of Life Insurance ceased or reduced for the reasons stated in #2 When can I convert my Life Insurance? you can convert up to the lesser of $2 000 or the amount that ceased or reduced less any amount of group life insurance you may become eligible for within 31 days after your Life Insurance ceased or reduced Important information about conversion privileges Sun Life of Canada Sample Group Life Booklet Page 1 I 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 available9 You can convert to any plan of whole life insurance available by Sun Life for conversion The individual policy will not include any additional benefits such as disability benefits or accidental death and dismembement benefits When does my individual policy start? If your application for the individual policy is received and the first premium is paid when due your individual policy starts on the day after the 31 day conversion period What happens if I die during the 31 day conversion period, If Sun Life receives Notice and Proof of Claim a death benefit is payable to your Beneficiary whether or not you had applied for an individual policy or had paid the first premium The death benefit is the amount of Life Insurance you would have been eligible to convert DEPENDENT LIFE INSURANCE What is my Dependent Life Insurance Beneft9 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 Insurance9 The amount of your Dependent Life Insurance is the amount for your Dependent shown in the Benefit Highlights What is the Conversion Privilege9 If your Dependent s Life Insurance ceases your Dependent may be able to convert the Life Insurance to an individual policy When can my Dependent convert9 1 Your Dependent can convert if all or part of your Dependent s Life Insurance ceases or reduces due to termination of your employment termination of your membership in an Eligible Class your retirement your reaching a specified age your changing to a different Eligible Class or your Dependent no longer qualifying as a Dependent Sun Life of Canada Sdmple Group Life Booklet Page 12 LONG TERM DISABILITY INSURANCE ELIGIBLE CLASSES All full time employees working a minimum of 30 hours a week AMOUNT OF INSURANCE 60% (Benefit Percentage) of your Total Monthly Earnings not to exceed the Maximum Monthly Benefit less Other Income Benefits the Maximum Monthly Benefit is $5 000 Note your amount of insurance is also subject to reductions for your employment earnings The Minimum Monthly Benefit is $50 Elimination Period (The period of time you need to be continuously Totally or Partially Disabled before LTD benefits are payable) 6 months or the end of the Employee s salary continuation period whichever is later Maximum Benefit Period (The longest period of time Sun Life will pay you an LTD benefit while you are Totally or Partially Disabled) Age at Disability Less than age 60 60 61 62 63 64 65 66 67 68 69 and over Total Monthly Earnings Maximum Benefit Period To age 65 but not less than 60 months 60 Months 48 Months 42 Months 36 Months 30 Months 24 Months 21 Months 18 Months 15 Months 12 Months Your basic monthly earnings as reported by your Employer immediately before the first date your Total or Partial Disability begins Total Monthly Earnings does not include commissions bonuses overture pay or any other extra compensation We offer Long Term Disability (LTD) benefit percentages between 40 and 662/3% This range allows employers to create a valuable employee benefit at a cost which meets the employers fiscal needs Partially replacing employee wages encourages employers to return to work while still providing them with income for fixed expenses Sun Life was one of the first carriers to standardly provide a zero day residual feature This benefit allows employers to satisfy the LTD elimination period while working part time with a partial disability It strongly encourages employees to continue working Sun Life of Canada Sample Group Disability Booklet Page 5 2 Your Dependent can convert if your Dependent has been continuously insured for five or more years under Sun Life s Group Life Policy and all or part of your Dependent s Life Insurance ceases or reduces due to termination of the Dependent Life Insurance Benefit Provision termination of the Group Policy or an amendment to the Group Policy to terminate your Eligible Class What amount of Life Insurance can my Dependent convert9 The amount of Life Insurance your Dependent can convert depends on the reason your Dependent s Life Insurance ceased If your Dependent s amount of Life Insurance ceased or reduced for the reasons stated in #1 When can my Dependent convert9 your Dependent can convert up to the amount that ceased or reduced If your Dependents amount of Life Insurance that ceased is $10 000 or more the minimum amount of your Dependent s individual policy must be $10 000 If your Dependent s amount of Life Insurance ceased or reduced for the reasons stated in #2 When can my Dependent convert? your Dependent can convert up to the lesser of $2 000 or the amount that ceased or reduced less any amount of group life insurance your Dependent may become eligible for within 31 days after your Dependent s Life Insurance ceased or reduced How can my Dependent convert9 You or your Dependent need to apply to Sun Life for an individual policy along with sending payment of the first premium within 31 days after any part of your Dependent s Life Insurance ceases or reduces This is your Dependent s 31 day conversion period What type of individual policy is avadable9 Your Dependent can convert to any plan of whole hfe insurance available by Sun Life for conversion The individual policy will not include any additional benefits such as disability benefits or accidental death and dismemberment benefits Your Dependent does not have to submit Evidence of Insurability to convert to an individual policy When does my Dependent's individual policy star1:9 If your Dependent s application for the individual policy is received and the first premium paid when due your Dependent s individual policy starts on the day after your Dependent s 31 day conversion period What happens if my Dependent dies during the 31 day conversion period9 If Sun Life receives Notice and Proof of Claim a death benefit is payable to you whether or not your Dependent had applied for an individual policy or had paid the first premium The death benefit is the amount of Life Insurance your Dependent would have been eligible to convert Sun Life of Canada Sample Group Life Booklet Page 13 BENEFIT PROVISIONS ACCIDENTAL DEATH AND DISMEMBERMENT What is my Accidental Death and Dismemberment Benefit9 If Sun Life receives written Notice and Proof of Claim that A significant advantage to you died from an accidental drowning while insured or our plan is that it allows you sustained an Accidental Bodily Injury while insured which results in your loss 365 days The industry of life sight or limb within 365 days of the date of that Accidental Bodily Injury standard is only 90 days an Accidental Death and Dismemberment benefit may be payable to you or to your Beneficiary What is the amount of my Accidental Death and Dismemberment Benetit9 Your benefit is a percentage of the amount of Accidental Death and Dismemberment Insurance in force for your class shown in the Benefit Highlights on the date of your loss The following is a list of percentages payable for your applicable loss The percentages shown Life 100% are standard and can be adjusted to meet plan Sight of one eye 50% needs One limb 50% Speech and hearing loss 75% Thumb and index finger loss option 25% More than one loss from any one accident 100% The seat belt option provides for 100% of the AD&D benefit amount or $50 000 whichever is less if loss of life occurs as a result of an automobile accident and the insured was wearing a seat belt at the time of the accident Loss of limb means severance of your hand or foot at or above the wrist or ankle joint Loss of your sight must be total and irrecoverable Any Accidental Death and Dismemberment Benefit payable is subject to the Exclusions What are the Exclusions9 No AD&D benefit will be payable for your loss that is due to or results from suicide while sane or insane or intentionally self inflicted injuries bodily or mental infirmity or disease of any kind or an infection unless due to an accidental cut or wound your commuting or attempting to commit an assault felony or other illegal act a war (declared or undeclared) or your active duty in any armed service during a time of war or your active participation in a not rebellion or insurrection Sun Life of Canada Sample Group Life Booklet Page 14 CLAIM PROVISIONS How is a claim submitted9 To submit a claim you your insured Dependent or someone on your behalf must send Sun Life written Notice and Proof of Claim within the time limits specified Your Employer has the Sun Life Notice and Proof of Claim forms When does written Notice of Claim have to be submitted9 for a Death Claim (accidental or otherwise) written nonce of claim must be given to Sun Life no later than 30 days after date of death for Life Waiver of Premium written nonce 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 submitted9 for a Death Claim (accidental or otherwise) proof of claim must be given to Sun Life no later than 90 days after date of death for Life Waiver of Premium proof of claim must be given to Sun Life no later than 15 months after you cease to be Actively at Work for Accidental Dismemberment proof of claim must be given to Sun Life no later than 12 months after the date of your loss If proof cannot be given within these time limits proof must be given as soon as reasonably possible Proof of claim may not be given later than one year after the time proof is otherwise required unless the individual is legally incompetent What is considered Proof of Claim' Proof of Claim consists of at least the following information what the loss or disability is the date the loss or disability occurred and the cause of the loss or disability (For example a Death Claim would include at least the Death Certificate for Proof of Claim) Sun Life may require as part of the Proof authorizations to obtain medical and non medical information Our claims representatives are dedicated to providing professional service by being accessible flexible and responsive to your needs Sun Life of Canada Sample Group Life Booklet Page 15 An interest bearing account with check writing privileges is provided as a service to each beneficiary Funds in the account are immediately accessible and can earn interest while major investment decisions are considered Proof of your continued Total Disability and regular and continuous care by a Physician must be given to Sun Life within 30 days of the request for proof Proof must be satisfactory to Sun Life When are benefits payable9 Benefits are payable when Sun Life receives satisfactory Proof of Claim Who are benefits payable tog 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 Beneficiary9 You can change your Beneficiary at any time on the form provided by Sun Life unless you have stated your choice of Beneficiary is irrevocable or you have assigned your interest in your Life Insurance to another person Any request for change of Beneficiary must be in a written form and will take effect on the date you sign and file the change with your Employer If Sun Life has taken any action or made payment before receiving notice of that change your change of Beneficiary will not affect any action or payment made by Sun Life The consent of your Beneficiary is not required to change any Beneficiary Can I assign my Life Insurance'' You can transfer ownership of your Life Insurance under the Group Policy by means of an absolute assignment You cannot make an absolute assignment to your Employer All your rights and duties as owner are transferred to the new owner The new owner can make any change the Group Policy allows such as a change of Beneficiary Any assignment must be in a written form and will take effect on the date you sign and file the assignment with your Employer If Sun Life has taken any action or made payment before receiving notice of that change the assignment will not affect any action or payment made by Sun Life Sun Life will not be responsible for the legal tax or other effects of any assignment Sun Life of Canada Sample Group Life Booklet Page 16 GENERAL PROVISIONS How can statements made in any application for insurance be used'' All statements made in any application are considered representations and not warranties No representation by you in applying for insurance under the Group Policy will be used to reduce or deny a claim unless a copy of your written application for insurance is or has been given to you or to your Beneficiary if any No statement made by you or any of your Dependents relating to Evidence of Insurability for an initial increased or additional amount of insurance will be used in contesting the validity of that insurance after such initial increased or additional amount of insurance has been in force for a period of two years during that individual s lifetime This statement must be contained in a form signed by that individual What happens if facts are misstated9 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 tight 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 tight may be used as often as reasonably required Sun Life has the tight 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' Compensation9 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 agent9 For all purposes of the Group Policy the policyholder acts on its own behalf or as your agent Under no circumstances will the Policyholder be deemed a Sun Life agent Sun Life of Canada Sample Group Life Booklet Page 17 Clear definitions eliminate misunderstandings DEFINITIONS Some general terms you need to know Actively at Work means that you perform all the regular duties of your job for a full work day scheduled by your Employer at your Employer s normal place of business or a site where your Employer s business requires you to travel You are considered Actively at Work on any day that is not your regular scheduled work day (i a you are on vacation layoff or an approved leave of absence) as long as you are not Hospital confined or are not disabled due to an injury or sickness and were Actively at Work on your immediately preceding scheduled work day You are considered Actively at Work if you usually perform the regular duties of your job at your home as long as you are not Hospital confined or are not disabled due to an injury or sickness and can perform all the regular duties of your job for a full work day and can do so at your Employer s normal place of business if required Eligibility Date means the date or dates you become eligible for insurance under the Group Policy Classes eligible for insurance are shown in the Benefit Highlights Employee (You) means a person who is employed by the Employer working at least the number of hours shown in the Benefit Highlights and paid regular earnings Employer means Sample Life Policy and includes any Subsidiary Affiliated or Associated company insured under the Group Policy Evidence of Insurability means a statement or proof of your or your Dependent s medical history upon which acceptance for insurance will be determined by Sun Life Injury means bodily impairment resulting directly from an accident and independently of all other causes Any Injury must occur and Disability must begin while you are insured under the Group Policy Physician means an individual who is operating within the scope of his license and is either licensed to practice medicine and prescnbe and administer drugs or to perform surgery or legally qualified as a medical practitioner and required to be recognized under the Group Policy for insurance purposes according to the insurance regulations of the governing jurisdiction The Physician cannot be you your spouse or the parents brothers sisters or children of you or your spouse Pregnancy means childbirth miscarriage abortion or any disease resulting from or aggravated by the pregnancy Sickness means illness disease or pregnancy A Disability because of Sickness must begin while you are insured under the Group Policy Sun Life of Canada Sample Group Life Booklet Page 18 Waiting Period means the continuous length of time immediately before your Eligibility Date during which you must be employed in an Eligible Class before you can apply for benefits Any period of time before the Group Policy Effective Date that you were Actively at Work for your Employer as a full time employee will count towards completion of your Waiting Period The Waiting Period is shown in the Benefit Highlights These are life insurance terms you need to know Basic Maximum Benefit means the amount of Basic insurance available to you The Basic Maximum Benefit is shown in the Benefit Highlights Beneficiary means the person (it cannot be your Employer) who is entitled to receive death benefit proceeds as they become due under the Group Policy A person becomes your Beneficiary only if you have named that person on a signed form acceptable to Sun Life Certified or Certification means a written statement made by a Physician on a form provided by Sun Life as to your Terminal Illness Optional Maximum Benefit means the amount of Optional insurance available to you The Optional Maximum Benefit is shown in the Benefit Highlights Retirement for the purposes of your being considered retired means the first of the following dates to occur 1 the effective date of your retirement benefits under a any plan of a federal state county or municipal or an association retirement system which you are eligible as a result of your employment with your Employer b any plan your Employer sponsors or c any plan your Employer makes or has made contributions to 2 the effective date of your retirement benefits under the Social Security Act or any similar plan or act However if you meet the definition of an Employee Actively at Work and you are receiving retirement benefits under the Social Security Act or similar plan or act you will not be considered retired Terminally II► or Terminal Illness means your Sickness or physical condition that is Certified by a Physician to reasonably be expected to result in your death within twelve months or less Total Disability or Totally Disabled means because of your Injury or Sickness you are unable to perform the material and substantial duties of any occupation for which you are or become reasonably qualified for by education training or experience Sun Life of Canada Sample Group Life Booklet Page 19 These are dependent life insurance terms you need to know Dependent means your spouse unmarred child from live birth to under age 19 unmarred child under age 23 who is an enrolled full time student and depends on you for 50% or more of his/her support Your unmarred step child foster child or adopted child are included as a Dependent if they depend on you for 50% or more of his/her support and are living with you in a regular parent child relationship A child is considered adopted if in your legal custody under an interim court order of adoption whether or not a final adoption order is ever issued Dependent does not include any person who is insured as an Employee or any person residing outside the United States Canada or Mexico No person may be considered to be a Dependent of more than one Employee This is an Accidental Death and Dismemberment insurance term you need to know Accidental Bodily Injury means bodily harm caused solely by external violent and accidental means which is sustained directly and independently of all other causes Sun Life of Canada Sample Group Life Booklet Page 20 WAITING PERIOD (The period of time you must be employed in an Eligible Class before you can apply for benefits) Ist of the month following 3 months of your continuous employment CONTRIBUTIONS The cost of your Long Term Disability Insurance is paid for entirely by your Employer This is your non contributory insurance The cost of your Insurance is shared by both you and your Employer This is your contributory insurance Sun Life of Canada Sample Group Disability Booklet Page 6 The following Questions and Answers will help you to better understand your benefits Please read them carefully and refer any questions to your Employer or call the Sun Life Group Service Center toll free at 1 800 247 6875 ELIGIBILITY AND EFFECTIVE DATE OF EMPLOYEE INSURANCE When am I eligible for insurance'' If you are in an Eligible Class shown in the Benefit Highlights you are eligible on the later of MMDDYY (eg September 1 199x) or the day after you complete your Waiting Period When does my insurance start" For non contributory insurance your insurance starts on the date you are eligible if you are Actively at Work on that date For contributory insurance your insurance starts on the date you apply if you are Actively at Work on that date What if I am not Actively at Work on that date' If you are not Actively at Work because of injury sickness layoff or leave of absence on the date your insurance would normally start your insurance will not start until you are Actively at Work What happens if I do not want my insurance' You need to sign the Sun Life form refusing your insurance This form is available from your Employer When do changes in my amount of insurance occur9 If your amount of insurance increases due to a change in your salary your increase will take effect immediately as long as you are Actively at Work on that date If your amount of insurance decreases due to a change in your salary the decrease will take effect immediately If you are not Actively at Work because of injury sickness layoff or leave of absence on the date an increase in your insurance would normally start the increase in your insurance will not start until you are Actively at Work Simple concise answers to your questions Sun Life of Canada Sample Group Disability Booklet Page 7 Termination of insurance is clearly defined Insurance coverage can be provided for extended vacations and for other absences TERMINATION OF EMPLOYEE INSURANCE When does my insurance cease" Your insurance ceases on the earliest of the date the Group Policy terminates the date you are no longer in an Eligible Class the date your class is no longer included for insurance the last day any required premium has been paid for your insurance the date you retire the date you request in writing to terminate your insurance the date you enter active duty in any armed service during a time of war (declared or undeclared) the date your employment terminates the date you cease to be Actively at Work Are there any conditions under which my insurance can contmue9 Yes Your insurance will continue dunng any Elimination Period or any penod the premium for your insurance is waived under the Group Policy If you are on temporary layoff leave of absence or vacation your Employer may continue your insurance by paying the required premium for the length of time specified below Layoff for up to 1 month Leave of Absence for up to 1 month Vacation for up to 3 months You may be eligible to continue your insurance pursuant to the Family and Medical Leave Act of 1993 You should contact your Employer for more details Sun Life of Canada Sample Group Disability Booklet Page 8 Our policies are clear and understandable EMPLOYEE INSURANCE LONG TERM DISABILITY What is the Long Term Disability Benefit9 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 appropnate treatment by means of examination and testing in accordance with your disabling condition What conditions must be met for LTD benefits to continue" Sun Life will pay you an LTD benefit up to the Maximum Benefit Period if you provide proof that you continue to be Totally or Partially Disabled and you require the regular and continuing care of a Physician You need to provide proof when Sun Life asks for it but the proof is at your expense How is the LTD benefit calculated'' If you are Totally Disabled your monthly LTD benefit will be calculated based on the Total Disability Benefit formula If you are Partially Disabled your monthly LTD benefit will be calculated based on the Partial Disability Benefit formula You need to provide Sun Life with proof of your monthly earnings on a quarterly basis Your monthly LTD benefit will never be less than your Minimum Monthly Benefit shown in the Benefit Highlights What is the Total Disability Benefit formula To determine your Total Disability Benefit 1 Take the lesser of your Total Monthly Earnings multiplied by the Benefit Percentage (shown in the Benefit Highlights) or the Maximum Monthly Benefit (shown in the Benefit Highlights) then 2 Subtract Other Income Benefits form the amount determined in Step 1 Sun Life of Canada Sample Group Disability Booklet Page 14 What is the Partial Disability Benefit formula'' To determine your Partial Disability Benefit for the first 24 months of your Partial Disability 1 calculate the LTD benefit you would receive if you were Totally Disabled then add your earnings from employment plus your income received from Other Income Benefits to your Total Disability Benefit 2 if this sum is more than 100% of your Indexed Total Monthly Earnings subtract the amount in excess of 100% from your Total Disability Benefit This result is your Partial Disability Benefit or if the sum is less than 100% of your Indexed Total Monthly Earnings your Total Disability Benefit is your Partial Disability Benefit A Total Disability Benefit will be paid if you are earning 20% or less of your Indexed Total Monthly Earnings If you continue to be Partially Disabled after 24 months of Partial Disability Benefits your Partial Disability Benefit will be recalculated based on the following formula where (A divided by B) multiplied by C A = your Indexed Total Monthly Earnings minus your monthly earnings received from your employment B = your Indexed Total Monthly Earnings C = your Total Disability Benefit A Total Disability Benefit will be paid if you are earning 20% or less of your Indexed Total Monthly Earnings The Partial Disability Benefit encourages employees to return to work This benefit allows employees to earn up to 100% of their predisabihty income if they return to work part time It is provided at no additional cost to the employer The Partial Disability Benefit formula equals A/B x C A = The income employees received before their disability (adjusted for inflation) less any wages they receive now for partial employment B = The income employees received before their disability (adjusted for inflation) C = The total disability benefit percentage chosen by the employer Sun Life of Canada Sample Group Disability Booklet Page 15 'Dther income offsets prevent overinsurance maintain back to work incentives and control costs What are Other Income Benefits'' Other Income Benefits are those benefits provided or available to you while your monthly LTD benefit is payable These Other Income Benefits other than retirement benefits must be provided to you as a result of the same Total or Partial Disability payable under the Group Policy Other Income Benefits include The amount you are eligible for under a Workers Compensation Law or b Occupational Disease Law or c Unemployment Compensation Law or d Compulsory Benefit Act or Law or e any other act or law of like intent 2 The Railroad Retirement Act (including any dependent benefits) 3 Any labor management trustee union or employee benefit plans that are funded in whole or in part by your Employer 4 Any disability income benefits you are eligible for under a any other group insurance plan of your Employer b any governmental retirement system as a result of your job with your Employer 5 The Employer paid portion of benefits you receive under your Employer s Retirement Plan a any disability benefits b any retirement benefits (This applies only if the benefits do not reduce your accrued retirement benefit and does not include any amount rolled over or transferred to any other retirement plan as defined in Section 402 of the Internal Revenue Code ) 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 Secunty Retirement Benefits will not apply if prior to your Total or Partial Disability you were already receiving Social Security Retirement Benefits Sun Life of Canada Sample Group Disability Booklet Page 16