Your employer, Mercedes ISD, has elected Aetna to administer your Employee Supplemental Life & Supplemental Dependent Life benefits. These benefits are available to all employees who are actively at work on the effective date of plan. Below is a summary of the benefits chosen by Mercedes ISD for all eligible employees. This benefit sheet does not bind coverage, nor does it serve as a contract. Detailed Summary Plan Documents will be provided at a later date
Supplemental Life
Employee & Dependant Coverage
/ You may choose to purchase additional coverage for you & your family in the following amounts;§ You, if you are an eligible employee: Increments of $10,000 to a maximum of the lesser of 5 times your annual salary or $500,000.
§ Your spouse: Increments of $5,000 to a maximum of $100,000 (not to exceed 100% of the employee's amount of insurance.)
§ Your children*: $10,000 (not to exceed 100% of the employee's amount of insurance.)
*Your unmarried biological and adopted children between live birth and 25 years. Dependents include children you support and who live with you in a parent/child relationship.
Guarantee Issue Amount
/ You DO NOT need to provide evidence of good health in the following situations:§ If you are currently participating in supplemental life with your company’s current carrier and you do not wish to make any changes.
§ If you are a current participant, you may increase your coverage one increment $10,000. Increases that take you over the guarantee issue amount will require evidence of good health.
NEWLY HIRED EMPLOYEES: You do not need to provide evidence of good health in the following situations:
If you enroll within 31 days of your eligibility date AND do not exceed the guaranteed issue amounts.
Guaranteed issue amounts are as follows:
§ For yourself: $150,000
§ For your spouse: $20,000
§ For each child: $10,000
You DO need to provide evidence of good health for review and approval or denial by Aetna’s underwriters in the following situations:
· If you are a Late Entrant. A Late Entrant is defined as anyone who did not enroll within 31 days of eligibility.
If you enroll for an amount above the guaranteed issue amounts.
Age Reduction Rule
/ Your insurance coverage amount will reduce by 65% of the original amount on the first of the month following your 65th birthday, 60% of the original amount on the first of the month following your 70th birthday & 75% of the original amount on the first of the month following your 75th birthday.Basic and Supplemental Term Life Features
/ Premium Waiver: If you are less than age 60 and have been totally disabled for nine months, you will not have to make premium payments until you recover or reach age 65.Conversion: If you terminate employment, are no longer eligible for coverage, or your coverage reduces due to age, pension or retirement, you have the opportunity to convert your Basic and/or Supplemental Life Insurance to an individual life insurance policy.
Portability: If you leave your current employer for any reason other than disability and you do not exceed age 98 you may take your supplemental term life insurance with you. Aetna will bill you directly. If you are disabled, your coverage is not portable.
Accelerated Death Benefit (ADB): If you have a terminal illness with a life expectancy of no longer than 24 months, your policy will pay—while you’re still alive—75% of your life insurance benefit, with a minimum of $5,000 and a maximum of $500,000. This benefit can help with expenses not covered by your medical plan, pay other bills, enable you to visit relatives and help you get your affairs in order. It pays an advance benefit and ensures that your beneficiary will receive the rest of the life insurance benefit upon your death. The advance benefit may be requested once for either you or your spouse and it is not subject to income tax.
Employee & Spouse Voluntary Life Rates
Age Bands / Rate
Under 20 / $0.060/$1,000
20 to 24 / $0.060/$1,000
25 to 29 / $0.070/$1,000
30 to 34 / $0.090/$1,000
35 to 39 / $0.110/$1,000
40 to 44 / $0.130/$1,000
45 to 49 / $0.180/$1,000
50 to 54 / $0.270/$1,000
55 to 59 / $0.520/$1,000
60 to 64 / $0.760/$1,000
65 to 69 / $1.510/$1,000
70 to 74 / $2.450/$1,000
75 + / $2.450/$1,000
Child Rate / $0.150 / $1,000
/ Voluntary Life Monthly Premium Calculation
Elected Amount ______X rate from table ______/1000(units)= ______Monthly Premium
For example: 40 year old, electing $30,000.
$30,000 X $0.130 / 1000 = $3.90 per month
*This Summary of Benefits explains the general purpose of the insurance described, but in no way changes or affect s the policy as it is actually issued. In the event of any discrepancy between any of these documents and the policy, the terms of the policy apply. Complete coverage information is in the certificate of insurance booklet issued to each insured individual. Please read it carefully and keep it in a safe place with your other important papers.