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Home My WebLink About000299.tiff Long Term & Short Term Disability Basic & Voluntary Term Life Basic & Voluntary AD & D PROPOSAL September 14 , 2017 Prepared For: Weld County Government Requested By : SHIRAZI BENEFITS LLC Proposed Effective Date : January 1 , 2018 This Proposal Valid Until : September 21 , 2017 Underwritten By : Life Insurance Company of North America The information contained in the following response/proposal is confidential and proprietary information of the insurance company making the proposal . It is being provided with the understanding that it will not be used by Weld County Government, its representatives or consultants for any purpose other than the evaluation of the insurance company's proposal in connection with the services sought by Weld County Government. Dissemination of the information contained herein by Weld County Government, its representatives and consultants shall be limited to their respective employees who are directly involved in the evaluation process . Under no circumstances is any of the information contained herein (including excerpts , summaries, extracts and evaluations thereof) to be used , disseminated , disclosed or otherwise communicated to any person or entity other than Weld County Government and its representatives and consultants involved in the evaluation process . 4.10tTogether, all the ways" rt. Ci "Cigna, " "Cigna Group Insurance" and the "Tree of Life" logo are registered service marks , and "Together, all the way. " is a service mark , of Cigna Intellectual Property, Inc. , licensed for the use by Cigna Corporation and its operating subsidiaries . All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation . As used in this proposal , these service marks refer to the insurance company which has issued this proposal . OOO a`19 Weld County Government Long Term Disability Proposal Schedule of Benefits Summary Eligibility All active, Full-Time Employees of the Employer regularly working a minimum of 30 hours per week, and Part-Time Employees working a minimum of 20 hours per week, who are citizens or permanent resident aliens of the United States, and are living and working in the United States. Number of Eligible Employees 1 ,449 Monthly Benefit 60% to $8,000 ($ 13 ,333 maximum payroll) Benefit Waiting Period 180 days or expiration of STD Benefits whichever is greater Definition of Disability 24 Months Own Occupation, any occupation thereafter Definition of Covered Earnings Employee's annual wage or salary excluding bonuses, commissions, overtime pay, and extra compensation. Eligibility Waiting Period 1St of the month following completion of one full pay period COLA Adjustment Percent The lesser of 3% or the annual increase in the Consumer Price Index (CPI-W) during the preceding calendar year COLA Duration Unlimited COLA Waiting Period 12 Months Earnings Test 80/80 AND Plan Type* Non-Contributory Benefits below apply to the foliowth classes: I Accumulated Sick Leave Is Included in Benefit Waiting Period Minimum Benefit Greater of $ 100 or 10% of benefit Maximum Benefit Duration Social Security Normal Retirement Age (SSNRA) Benefit Reduction Schedule Social Security Normal Retirement Age Social Security Integration Type Full Family Other Sources of Income See Disability Contract Features Employer Contribution 100% Survivors Benefits 3 months lump sum following 180 consecutive days of disability. Children are eligible to age 26. Continuation of Insurance Refer to application Pre-Existing Condition Limitation 12 months Prior / 12 months Insured Mental Illness Limitation 24 Month Lifetime Limitation Substance Abuse Limitation 24 Month Lifetime Limitation Chemical Sensitivity No Limitation Subjective Symptom Limitation No Limitation Return to Work Incentive Included Trial Work Days Unlimited Rehabilitation Benefits Included Health and Welfare Deductions Service Excluded Life Assistance Program Excluded For additional descriptions, see Key Definitions and Provisions section below. LONG TERM DISABILITY RATE SUMMARY Coverage Monthly Covered Payroll Monthly Rate per $100 of Monthly Premium Monthly Covered Payroll LTD 7, 1 10,923 $0 . 35 $24,888 Rates are guaranteed for 3 years Rates are only valid if the product is sold as part of this package *This proposal assumes all eligible persons are insured and that premiums are paid on a pre-tax basis. ONG TERM DISABILITY COMMISSION SUMMARY Rates include a Flat 11 % Commission Service Fee 2 % Weld County Government Short Term Disability Proposal Schedule of Benefits Summary Eligibility All active, Full-Time Employees of the Employer regularly working a minimum of 30 hours per week, and Part-Time Employees working a minimum of 20 hours per week, who are citizens or permanent resident aliens of the United States, and are living and working in the United States. Number of Eligible Employees 1 ,449 Weekly Benefit 60% to $2,000 Benefit Waiting Period 30 Days for Accident or expiration of accumulated sick leave whichever is greater 30 Days for Sickness or expiration of accumulated sick leave whichever is greater Definition of Covered Earnings Employee's annual wage or salary excluding bonuses, commissions, overtime pay, and extra compensation. Eligibility Waiting Period 1St of the month following completion of one full pay period Plan Type* Non-Contributory Maximum Duration from Date of 26 Weeks (Includes Benefit Waiting Period) Disability Maximum Weekly Payments 22 Weeks Accident and 22 Weeks Sickness Berit �p av :ar t+ `;the=fadowing classes: Accumulated Sick Leave Is Included in Benefit Waiting Period 1st Day Hospitalization Coverage Not Included Definition of Disability Own Job Earnings Test 80% Minimum Benefit $25 per week Social Security Integration Type Full Family Other Sources of Income See Disability Contract Features Statutory Disability Integration Included as an offset Employer Contribution 100% Continuation of Insurance Refer to application Pre-Existing Condition Limitation None Employer FICA Service Excluded Trial Work Days Unlimited Health and Welfare Deductions Service Excluded Coverage Type Non Occupational For additional descriptions, see Key Definitions and Provisions section below. SHORT TERM DISABILITY RATE SUMMARY Coverage Weekly Gross Benefit Monthly Rate per $10 of Monthly Premium Weekly Gross Benefit STD 985 ,205 $0 . 185 $ 18,226 Rates are guaranteed for 2 years Rates are only valid if the product is sold as part of this package *This proposal assumes all eligible persons are insured and that premiums are paid on a pre-tax basis. SHORT TERM DISABILITY COMMISSION SUMMARY Rates include a Flat 11 % Commission Service Fee 2 % Weld County Government Basic Term Life Proposal Schedule of Benefits Summary Employee Eligibility All active, Full-Time Employees of the Employer regularly working a minimum of 40 hours per week in the United States, who are citizens or permanent resident aliens of the United States and Part-Time Employees working a minimum of 20 hours per week. Employee Eligibility Waiting Period 1 St of the month following completion of one full pay period Number of Eligible Employees 1 ,449 Employee Annual Compensation Employee's annual wage or salary excluding bonuses, commissions, Definition overtime pay, and extra compensation. Employee Basic Life Benefit 3 times Base Annual Earnings rounded to the next higher $ 1 ,000 if not already a multiple thereof, subject to a maximum of $600,000 Employee Guaranteed Issue Amount All coverage amounts are guaranteed issue Employee Minimum Benefit None Domestic Partner / Civil Union State-registered civil unions/domestic partnerships included (state mandate). Coverage Employer-recognized Domestic Partners may optionally be included (definition to be agreed upon). Spouse Life Benefit Flat $5,000 Infant/Child Life Benefit Birth to 6 months: $500 6 months to 26 years : Flat $5 ,000 Dependent Guaranteed Issue Amount Spouse : $5,000 Child: All Guaranteed Issue Employee Benefit Reduction Schedule 65% at age 65, 42% at age 70, 27% at age 75 , 21 %at@ age 80, Benefits Reduce to: 15% at age 85 , 12% at age 90, 9% at age 95 Waiver of Premium with Must become disabled before age 60 Extended Death Benefit 9 month waiting period Benefit provided to age 65 Extended Death Benefit coverage during waiting period, no premiums required during this time Continuation after Waiver Eligibility Life coverage continued for a disabled employee over the age of 60 on a Age Limit continuing premium paying basis for up to 12 months, while policy is in force Continuation of Insurance Refer to application Portability Employee and covered dependents Coverage ends at age 70 Inforce amounts do not require medical underwriting. Increases in coverage are allowed up to plan max with medical underwriting Life Assistance Program Excluded Terminal Illness The lesser of 75% up to $500,000 for Basic benefits Coverage available for employees and spouses if applicable Employer Contribution 100% Beneficiary Services - Comprehensive package of financial, bereavement and legal counseling - Available for benefit payments >= $5,000 BASIC TERM LIFE RATE SUMMARY Coverage Estimated Volume Rate Estimated Monthly Cost Basic Employee Life Employee $254,095 ,820 $0 . 122 per $ 1 ,000 $31 ,762 Basic Dependent Life Basic Family Employee Paid $0 . 710 per family We have separate rates for ported individuals. Rates are guaranteed for 3 years Rates are only valid if the product is sold as part of this package BASIC TERM LIFE COMMISSION SUMMARY Rates include a Flat 11 % Commission Service Fee 2 % Weld County Government Voluntary Term Life Proposal Schedule of Benefits Summary Employee Eligibility All active, Full-Time Employees of the Employer regularly working a minimum of 40 hours per week in the United States, who are citizens or permanent resident aliens of the United States and Part-Time Employees working a minimum of 20 hours per week. Employee Eligibility Waiting Period 1St of the montlfiffilliawimgrRffinpletion of one full pay period Number of Eligible Employees 1 ,449 Employee Annual Compensation Employee's annual wage or salary excluding bonuses, commissions, Definition overtime pay, and extra compensation. Employee Voluntary Life Benefit* Units of $ 1 ,000 to the lesser of 5 times salary or $500,000 Employee Guaranteed Issue Amount $275 ,000 Spouse Eligibility Employees must participate in voluntary plan for dependents to participate Domestic Partner / Civil Union State-registered civil unions/domestic partnerships included (state mandate). Coverage Employer-recognized Domestic Partners may optionally be included (definition to be agreed upon). Spouse Life Benefit Units of $ 1 ,000 to the lesser of $200,000 or 50% of Employee's Voluntary Life Insurance Amount Infant/Child Life Benefit • Birth to 6 months: $500 • 6 months to 26 years : Flat $5 ,000 Dependent Guaranteed Issue Amount • Spouse: $ 100,000 • Child: All Guaranteed Issue Benefits below apply to the following classes: All Initial Enrollment Event Guarantee Issue is available during the Initial Enrollment event fqi rmployees : $275 ,000 pouses : $ 100,000 : $5 ,000 (Child coverage . �wayct� r tee issue) *Any benefit amounts above the case level Guaranteed Issue are subject to full medical underwriting Ongoing Enrollment Event No Annual Enrollment events are available with Guarantee Issue. Evidence f Insurability is required for new enrollees and increases in coverage unless nrollee becomes eligibly for the 1 ' time during tie enrollment periods Life Status Events Full Guarantee Issue is available provided coverage is applied for within 31 days of the Life Status Event. Employee Benefit Reduction Schedule 65% at age 65, 42% at age 70, 27% at age 75 , 21 %at@ age 80, Benefits Reduce to: 15% at age 85, 12% at age 90, 9% at age 95 Waiver of Premium with Must become disabled before age 60 Extended Death Benefit 9 month waiting period Benefit provided to age 65 Extended Death Benefit coverage during waiting period, no premiums required during this time Continuation after Waiver Eligibility Life coverage continued for a disabled employee over the age of 60 on a Age Limit continuing premium paying basis for up to 12 months, while policy is in force Continuation of Insurance Refer to Application Portability Employee and covered dependents Coverage ends at age 70 Inforce amounts do not require medical underwriting. Increases in coverage are allowed up to plan max with medical underwriting Terminal Illness The lesser of 75% up to $500,000 for Voluntary benefits Coverage available for employees and spouses Participation Requirement 30% of eligible employees Suicide Exclusion We do not pay death benefits if insured commits suicide during first two years of coverage This two year suicide exclusion also applies to all later increases in coverage Employee Contribution 100% Beneficiary Services - Comprehensive package of financial, bereavement and legal counseling - Available for benefit payments >= $5,000 Enrollment Communications & - Client-specific brochures & applications Support *We recommend that you consult with your attorney or qualified tax advisor regarding your proposed plan design and the requirements of section 79 of the Internal Revenue Code; in particular, the requirement that any group term life insurance policy must be provided on a basis that precludes individual selection. We cannot provide employers with legal or tax advice. VOLUNTARY TERM LIFE RATE SUMMARY Coverage Premium Rate Voluntary Term Life °y -kph 5 P4 4r.'� ate . Classes 1 - 2 See Step Rates Table below Voluntary Dependent Life Employee & Spouse See Step Rates Table below Child $0. 142 per $ 1 ,000 VOLUNTARY LIFE INSURANCE STEP RATES FOR EMPLOYEE AND SPOUSE Classes 1-2 Age Employee and Spouse Rate per $1 ,000 <20-29 $0 .050 30-34 $0 .080 35 -39 $0 . 090 40-44 $0 . 100 45 -49 $0 . 150 50-54 $0 .230 55 -59 $0 .430 60-64 $0 .660 65 -69 $ 1 .270 70-99 $2 .060 We have separate rates for ported individuals. Rates are guaranteed for 3 years Rates are only valid if the product is sold as part of this package : . : VOLUNTARY TERM LIFE COMMISSION SUMMARY Rates include a Flat 11 % Commission Service Fee 2 % Weld County Government Basic Accident Proposal Schedule of Benefits Summary Eligibility All active, Full-Time Employees of the Employer regularly working a minimum of 40 hours per week in the United States, who are citizens or permanent resident aliens of the United States and Part-Time Employees working a minimum of 20 hours per week. overed Earnings Definition Employee's annual wage or salary excluding bonuses, commissions, overtime pay, and extra compensation. Eligibility Waiting Period of the month following completion of one full pay period Employee Benefit 3 times Base Annual Earnings rounded to the next higher $ 1 ,000 if not already a multiple thereof, subject to a maximum of $600,000 • overage Basic, Employer paid, 24 Hour Accidental Death & Dismemberment Benefits. Other enhancements will be defined in the policy. Loss of Life 100% of the Principal Sum ismemberment oss of Two or More Hands or Feet 100% of the Principal Sum oss of Sight of Both Eyes 100% of the Principal Sum oss of Speech and Hearing (in both ears) 100% of the Principal Sum uadriplegia (Total paralysis of upper and 100% of the Principal Sum lower limbs) araplegia (Total paralysis of both lower or 75% of the Principal Sum oth upper limbs) Hemiplegia (Total paralysis of upper and 50% of the Principal Sum lower limbs on one side of the body) niplegia (Total paralysis of one upper or one 25% of the Principal Sum lower limb) oss of One Hand or Foot 50% of the Principal Sum Loss of Sight in One Eye 50% of the Principal Sum Severance and Reattachment of One Hand or 50% of the Principal Sum oot oss of Speech 50% of the Principal Sum oss of Hearing (in both ears) 50% of the Principal Sum oss of Thumb and Index Finger of the Same 25% of the Principal Sum and oss of all Four Fingers of the Same Hand 25% of the Principal Sum oss of all the Toes of the Same Foot 20% of the Principal Sum 4 / ... oma onthly Benefit 1 % of Principal Sum umber of Monthly Benefits 11 When Payable At the end of each month during which the Covered Person remains comatose ump Sum Benefit 100% of Principal Sum When Payable Be&inning of 12th Month ccidental Death & Dismemberment Schedule of Benefits: We will pay the benefit for any one of the Covered Losses listed in the Schedule of Benefits, if the Covered Person suffers a Covered Loss resulting directly and independently of all ther causes from a Covered Accident within the applicable time period specified in the Schedule of Benefits. If the Covered Person sustains more than one Covered Loss as a result of the same Covered Accident, benefits will be paid for the Covered Loss for which the largest available benefit is payable. If the loss results in death, benefits will only be paid under the Loss of Life benefit provision. Any Loss of Life benefit will be reduced by any paid or payable Accidental Dismemberment benefit. However, if such Accidental Dismemberment benefit equals or exceeds the Loss of Life benefit, no additional benefit will be paid. x n ova e� l' ,i ..:,_ r fir. .� .�. ,.. .:; ', :. ' . ♦ ;; ;.,,♦:'; i .:. ,-. ':. , .;. Coverage <�� to, cover the following circumstances. • Exposure & Disappearance - loss occurs due to exposure; disappearance if not found within one year ,,,, 'Benefitsbelow the following classes: Class 1, Class 2, Class 3, Class4 Benefit Reductions We can help you meet your Age Discrimination in Employment Act (ADEA) responsibilities by extending coverage to all active employees, regardless of age. Benefits reduced for employees based on ages at time of accident according to the following schedule: 65% at age 65, 42% at age 70, 27% at age 75, 21 %at@ age 80, 15% at age 85, 12% at age 90, 9% at age 95 Continuation of Insurance Refer to Application Additional Benefits: Bereavement / Trauma Counseling If bereavement and trauma counseling needed because of a loss (excluding benefits also covered by workers' compensation) 4 sessions, $250 per session maximum of $ 1 ,000 Seatbelt and Airbag Benefit Covered Person dies directly and independently of all other causes from a Covered Accident while wearing a seatbelt and riding in a private passenger automobile. If seatbelt benefit is payable, an additional benefit is provided if Covered Person was also positioned in a seat protected by a properly — functioning and properly deployed Supplemental Restraint System Airbag. Seatbelt: Additional 25% of the principal sum to a maximum of $25,000 Airbag: Additional 10% of the principal sum to a maximum of $5,000 Special Education Benefit I (Child) We will pay the Benefit below for each qualifying Dependent Child of a Covered Person whose death resulted from a Covered Accident, if the child enrolls as a full-time student at an accredited school of higher learning within 365 days from the date of the Covered Accident, continues his education as a full-time student and incurs expenses for tuition, fees, books, room and board, transportation and any other costs payable directly to, or approved and certified by, such school. Additional 5% of Principal Sum, up to a maximum of $5 ,000 per year for up to 4 years If no dependent child qualifies we will pay the following default amount: $ 1 ,000 Spouse Training Reimburse covered Spouse who receives education/training for employment within three years of the covered employee' s death as a result of a loss Additional $3 ,000 Beneficiary Designation Recognize Prior Beneficiary Designations or Pay According to Succession Schedule (if no beneficiary has been designated) „ BASIBASIC ACCIDENT RATE SUMMARY C�✓/ .,"�'�Y,&rerl'R'`9�,<. 2 .:� &iic>c>5ks "r�%a�.d.«,-r...e Number of Eligible Lives : 1 ,532 Coverage Estimated Volume Rate/$1,000 Estimated Monthly Cos Employee Only $266,598,000 $0 .011 $2,933 Premium rates are guaranteed for 36 months provided that the first year premium exceeds $1 ,200. Rate guarantee is subject to all provisions of the policy including the policy's termination provisions. Rates are only valid if the product is sold as part of this package v , BASIC ACCIDENT COMMISSION SUMMARY Rate includes a Flat 11 % Commission Service Fee 2 % Weld County Government Voluntary Accident Proposal Schedule of Benefits Summary Eligibility All active, Full-Time Employees of the Employer regularly working a minimum of 40 hours per week and Part-Time Employees of the Employer working 20 hours per week including Dispatchers who were previously employed by the City of Greeley in the United States, who are citizens or permanent resident aliens of the United States. ) / r / Covered Earnings Definition Employee's annual wage or salary excluding bonuses, commissions, overtime pay, and extra compensation. Eligibility Waiting Period 1St of the month following completion of one full pay period Employee Benefit Units of $ 1 ,000 to the lesser of 5 times salary rounded to the next higher $ 1 ,000 if not already a multiple thereof or $600,000 Coverage Voluntary, Employee paid, 24 Hour Accidental Death & Dismemberment Benefits. Other enhancements will be defined in the policy. Domestic Partner / Civil Union Coverage State-registered civil unions/domestic partnerships included (state mandate). Employer-recognized Domestic Partners may optionally be included (definition to be agreed upon). Loss of Life 100% of the Principal Sum Dismemberment Loss of Two or More Hands or Feet 100% of the Principal Sum Loss of Sight of Both Eyes 100% of the Principal Sum Loss of Speech and Hearing (in both ears) 100% of the Principal Sum Quadriplegia (Total paralysis of upper and 100% of the Principal Sum lower limbs) Paraplegia (Total paralysis of both lower or 75% of the Principal Sum both upper limbs) Hemiplegia (Total paralysis of upper and 50% of the Principal Sum lower limbs on one side of the body) Uniplegia (Total paralysis of one upper or one 25% of the Principal Sum lower limb) Loss of One Hand or Foot 50% of the Principal Sum Loss of Sight in One Eye 50% of the Principal Sum Severance and Reattachment of One Hand or 50% of the Principal Sum Foot Loss of Speech 50% of the Principal Sum Loss of Hearing (in both ears) 50% of the Principal Sum Loss of Thumb and Index Finger of the Same 25% of the Principal Sum Hand Loss of all Four Fingers of the Same Hand 25% of the Principal Sum Loss of all the Toes of the Same Foot 20% of the Principal Sum ... ..,.. .r r .o .. ck ...v. ,._. ..... ,c .. [.... t f f. ,/ .,. r .r .. s: ., r. ..y... .: ;v ,., .:' , r ✓.:..'.. ., ,. .., d ra:/ ..9 ..r. ,"r, rA / ./ ) l / [ .. /.. / r:/ r r r, ,r v. r. _. /: r, 'r%>•%. // ,.rte .T..e.. . ...,:o! ._r ...._ L ... /. „/.. rrF. ) / f .-/ Sr'.,./ .,..✓ . ..,. ... r r....,_ ..(''.. � /. ,. .i. .c � .,_. :,. .... ... .,..... wl :...Y: / .. � � : .///�.. '/l_ '�. n/.. .kf r,A�.. f'.., .Y ..,r „R�. . . ! ._ _,, r ., b / i. ., a ,. ..,a :.. :.., r ., .. ... ... ,.r .... .. ... .. ... ..,>s:. ..," .. .. [. r.. .. ... ..e:.r /.�' ... _S' , : c _. . 1 /r r ..v1`.. 0$4 ]5r " ✓, ..., r.. ,. _.,. r ., r ,..._. r r/r u r .::. ,.. c r_.,_. .. ._ .. a..r:9 ... .., r .. i _ ✓.. <.: x.. .R.. .:./_ .'S' h. / ri .i`/ ., r. ,.. .r / /.. / ,. � ,rr /i _. .7. �.: :,.v / ,/ .N:.:././'r. _. ,,; _,. „ r•.-. r, ,", r `. r, ,, ... .. ,.,.. . . ..,",,.../, <..w r.. ' J,.. .. rr ,.. ,.. ,. e..._r. ..'„_ ,.ri. � / a / c.�/ '? rpr 9..._ 'S q Y Ret‘ T / Re �` yy 9 !I ,. �R:. .,../ d Lt, Coma Monthly Benefit 1 % of Principal Sum Number of Monthly Benefits 11 When Payable At the end of each month during which the Covered Person remains comatose Lump Sum Benefit 100% of Principal Sum When Payable Beginning of 12th Month rr. 5- 1 , Accidental Death & Dismemberment Schedule of Benefits: We will pay the benefit for any one of the Covered Losses listed in the Schedule of Benefits, if the Covered Person suffers a Covered Loss resulting directly and independently of all other causes from a Covered Accident within the applicable time period specified in the Schedule of Benefits. If the Covered Person sustains more than one Covered Loss as a result of the same Covered Accident, benefits will be paid for the Covered Loss for which the largest available benefit is payable. If the loss results in death, benefits will only be paid under the Loss of Life benefit provision. Any Loss of Life benefit will be reduced by any paid or payable Accidental Dismemberment benefit. However, if such Accidental Dismemberment benefit equals or exceeds the Loss of Life benefit, no additional benefit will be paid. ExteImam a cA. we £ "K H .. .,.;. 3•!i. f L..f �l��...:� �,au J. 1 S .. _. 1. .;r: dir aki,coveragei • expanded to cover the !won* circumstances* • Exposure & Disappearance - loss occurs due to exposure; disappearance if not found within one year Family Plan Benefit Based on family members at time of accident: 50% for spouse if no children 40% for spouse if eligible children 10% for children if eligible spouse 15% for children if no spouse Spouse Maximum Principal Sum $300,000 Child Maximum Principal Sum $25,000 Benefit Reductions We can help you meet your Age Discrimination in Employment Act (ADEA) responsibilities by extending coverage to all active employees, regardless of age. Benefits reduced for employees based on ages at time of accident according to the following schedule: 65% at age 65, 42% at age 70, 27% at age 75, 21 %at@ age 80, 15% at age 85, 12% at age 90, 9% at age 95 Continuation of Insurance Refer to application dditional Benefits: Bereavement / Trauma Counseling If bereavement and trauma counseling needed because of a loss (excluding benefits also covered by workers' compensation) 4 sessions, $250 per session maximum of $ 1 ,000 Business Travel Loss occurs while on an employer-approved business trip. Additional 25% of principal sum to $25,000 Seatbelt and Airbag Benefit Covered Person dies directly and independently of all other causes from a Covered Accident while wearing a seatbelt and riding in a private passenger automobile. If seatbelt benefit is payable, an additional benefit is provided if Covered Person was also positioned in a seat protected by a properly — functioning and properly deployed Supplemental Restraint System Airbag. Seatbelt: Additional 25% of the principal sum to a maximum of $25,000 Airbag: Additional 10% of the principal sum to a maximum of $5 ,000 Special Education Benefit I (Child) We will pay the Benefit below for each qualifying Dependent Child of a Covered Person whose death resulted from a Covered Accident, if the child enrolls as a full-time student at an accredited school of higher learning within 365 days from the date of the Covered Accident, continues his education as a full-time student and incurs expenses for tuition, fees, books, room and board, transportation and any other costs payable directly to, or approved and certified by, such school. Additional 5% of Principal Sum, up to a maximum of $5 ,000 per year for up to 4 years If no dependent child qualifies we will pay the following default amount: $ 1 ,000 Spouse Training Reimburse covered Spouse who receives education/training for employment within three years of the covered employee' s death as a result of a loss Additional $3 ,000 Beneficiary Designation Recognize Prior Beneficiary Designations or Pay According to Succession Schedule (if no beneficiary has been designated) VOLUNTARY ACCIDENT RATE SUMMARY Number of Eligible Lives: 1 ,543 Coverage Rate/$1 ,000 Class 1 Employee Only $0 .022 Family $0 .033 Rates are subject to change. Premium rates are guaranteed for 36 months provided that the first year premium exceeds $1 ,200. Rate guarantee is subject to all provisions of the policy including the policy's termination provisions. Rates are only valid if the product is sold as part of this package VOLUNTARY ACCIDENT COMMISSION SUMMARY Rate includes a Flat 11 % Commission Service Fee 2 % Included Cigna Programs and Services* • Identity Theft - provides identity theft prevention and resolution services, including access to personal case managers who provide assistance and guidance as well as education and tools to help prevent identity theft in the future. • CignaWillCenter.com - online access to state-specific legal documentation for wills and powers of attorney, and valuable resources for estate and funeral planning • Healthy Rewards® - provides discounts on a variety of health and wellness products and services. • Cignasurrance® - provides beneficiaries access to a free, interest-bearing account for claim payments of $5 ,000 or more, and support from expert resources in financial, legal, and behavioral health services. Cignassurance counseling, legal or financial assistance programs are not available under policies insured by Cigna Life Insurance Company of New York. • My Secure Advantage TM - offers customers with approved disability claims (and their household members) access to expert "money coaching" for all types of financial challenges. *These programs are NOT insurance and do not provide reimbursement for financial losses. Program availability may vary by plan type and location and is subject to change. Employees are required to pay the entire discounted charge for any discounted products or services available through these programs. Programs are provided through third party vendors who are solely responsible for their products and services. Presented here are only the highlights of these programs. Full terms, conditions and exclusions are contained in the applicable client program description and/or vendor service agreement. •is y,, i c l t�ration �- ua�i Se ` di `and Sim hfiied ,�d�mt�a s � • Dedicated Account Managers to oversee plan design effectiveness; provide ongoing consultative analysis and make recommendations to optimize productivity/minimize costs. • Dedicated Implementation Coordinators to help ensure easy plan setup, answer questions, resolve issues and drive employee awareness and education through marketing and communications. • Dedicated Clinical and Expert Resources which includes over 800 disability claim managers in four offices, 80 medical professionals, 9 medical directors, 35 vocational professionals, 65+ intake specialists and access to over 1 , 100 nurses and 500 doctors representing over 40 clinical specialties. • Comprehensive Reporting and Online Tools to help make informed decisions and manage costs. • Verbal Authorization and Telephonic Intake - Employees calling to report a disability claim can provide authorization to access medical information using a secure, confidential interactive voice response system, which allows for faster disability claim processing. • Pre-disability Vocational Services - help employees with physical/psychological limitations that are at increased risk of a disability get the support they need to stay productive and on the job. • Social Security Advocacy - program offers expert resources to help qualified employees apply and be approved for Social Security Disability Insurance. • Cigna's "Work Wellness" Website http://www.cigna.com/workwellness is an online resource for customers which includes useful information on disability and return to work, general information on family medical leave, managing their particular health condition at work and more. • Cigna's Life Assistance & Work/Life Support Program provides 3 face to face visits to counselors to address emotional issues, as well as online resources and interactive tools. ;✓ <.; - o contract Features. Disability o • Return to Work Incentive Benefit For the first 24 months of the benefits payable - allows an individual through a combination of work earnings and disability benefit, the potential to obtain 100% of pre-disability income. • Use of Trial Work Days Cigna offers an unlimited Number of days an employee can attempt to return to work without extending the elimination period. • Rehabilitation Program Rehabilitation expenses (which can include expenses for medical, education, moving, family care or other) are paid for at Cigna's discretion. No rehabilitation expense cap exists in our contract. • FICA Services Cigna offers three level of service for Employer Paid business - Self-report and pay, FICA reimbursement and FICA match - to accommodate the specific needs of our disability clients. • Integration With Other Income Sources Benefits are Reduced by Amounts Paid by the Following: - Social Security with other government retirement and disability programs - Sick leave or salary continuance paid by the Employer - Mandatory "no fault" auto wage loss - Employer-funded retirement benefits (excludes 401 (k) and supplemental plans) - Franchise or group disability plans - Worker's compensation - Damages for wage loss payable by third parties - Income from employment (subject to return to work incentive) (Government and worker's compensation subject to assumed receipt) • Maximum Benefit Period This is the maximum length of time for which we will pay Disability Benefits to a disabled employee. Benefit payments may end earlier if the employee no longer qualifies under the terms or conditions of this policy. The later of the Employee's SSNRA* or the Maximum Benefit Period listed below. Age at Start of Disability Maximum Benefit Duration age 62 or younger the employee's 65th birthday or the 42nd monthly disability benefit age 63 the 36th monthly disability benefit age 64 the 30th monthly disability benefit age 65 the 24th monthly disability benefit age 66 the 21st monthly disability benefit age 67 the 18th monthly disability benefit age 68 the 15th monthly disability benefit age 69 or older the 12th monthly disability benefit bffe Contract Features • Extended Death Benefit with Waiver of Premium: • We provide up to 12 months of premium-free continued life insurance coverage for disabled employees - even if they're attempting to return to work • We also provide up to 18 months of additional premium-free coverage if the employee is participating in a rehabilitation program. And if the employee is too sick to fully work again, Cigna's life insurance coverage will continue subject to the waiver of premium and continuation provisions quoted • " Linked waiver" Automatically starts the claim process to see if the customer qualifies for Term Life premiums to be waived while they're out on disability (requires Cigna Disability coverage) • Conversion Included • Portability Employees have the option to port their Basic and Voluntary Group Term Life coverage at pooled port rates listed below. Age Rate <20 $0. 153 20-24 $0. 144 25-29 $0. 153 30-34 $0. 177 35-39 $0. 190 40-44 $0.243 45-49 $0.384 50-54 $0.726 55-59 $ 1 .347 60-64 $2.461 65-69 $4.065 Rates for ported insureds are based on the company's pooled experience for ported certificates and are higher than active employee rates. Rates for ported insureds are renewed annually and are not subject to any rate guarantee roposed for active employees. Ported coverage ends at age 70. AD&D Contract Features • AD&D Conversion - available up to age 70; to a maximum of $250,000. Accident Exclusions In addition to any benefit-specific exclusions, benefits will not be paid for any Covered Injury or Covered Loss which, directly or indirectly, in whole or in part, is caused by or results from any of the following unless coverage is specifically provided for by name in the Description of Benefits Section: 1 . intentionally self-inflicted Injury, suicide or any attempt thereat while sane or insane; 2. commission or attempt to commit a felony or an assault; 3 . commission of or active participation in a riot, insurrection or Terrorist Act; 4. declared or undeclared war or act of war; 5 . flight in, boarding or alighting from an Aircraft or any craft designed to fly above the Earth' s surface: a. except as a fare-paying passenger on a regularly scheduled commercial airline; b. being flown by the Covered Person or in which the Covered Person is a member of the crew; c. being used for: i. crop dusting, spraying, seeding, giving flying instruction, receiving flying instruction, firefighting, sky writing, sky diving, hang gliding, pipeline inspection, power line inspection, aerial photography, aerial exploration, racing, endurance tests, stunt, acrobatic flying or ii. any operation that requires a special permit from the FAA, even if it is granted (this does not apply if the permit is required only because of the territory flown over or landed on) d. designed for flight above or beyond the earth' s atmosphere; e. an ultra-light or glider; f. being used for the purpose of parachuting or skydiving; g. being used by any military authority, except an Aircraft used by the Air Mobility Command or its foreign equivalent; 6. Travel in any Aircraft owned, leased or controlled by the Policyholder, Subscriber, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be "controlled" by the Policyholder, Subscriber if the Aircraft may be used as the Policyholder, Subscriber wishes for more than 10 straight days, or more than 15 days in any year; 7. A Covered Accident that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, We will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days; 8 . the Covered Person' s intoxication as determined according to the laws of the jurisdiction in which the Covered Accident occurred; 9. Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage; 10. Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food. PROPOSAL PROVISIONS • This is not a contract.. This proposal outlines some of the important features of the proposed group insurance program. The controlling provisions will be in the group insurance policy, and this proposal is not intended in any way to modify the provisions or their meanings. If you decide to purchase the plan proposed here, we will send you a policy that fully describes all of the provisions of the group disability or term life insurance coverage to which you and Life Insurance Company of North America (Cigna) have agreed. To accept the terms of this proposal, you must notify Cigna of your acceptance by that date, and pay premium equal to the Total Basic Estimated Monthly Cost on the Schedule of Benefits Summary. This proposal may be withdrawn by Cigna at any time before acceptance. • Eligibility Cigna' s eligibility requirements assume that employees are working on a full-time basis, and citizens of the United States, and working in the United States. Part-time, seasonal, temporary, contracted, leased or severed employees are not eligible, unless otherwise noted. • Policy on Rate Changes The rates and fees quoted within the proposal are based on information furnished to Cigna for the purpose of developing a proposal of group insurance. Cigna has assumed that the demographic and plan design information provided will be an accurate representation of your company at the time of implementation. Premium rates are guaranteed as noted in the product schedule of benefits. These rates and the guarantee assume that the number of eligible or insured employees does not change by more than 15% from the date of the census provided. • Policy on Contractual Language Cigna's contract language will be used without modification. Cigna will attempt to match the intent of disclosed policy provisions at the time of quote, but will not duplicate the existing policy language. • Medical Underwriting Status Medical Underwriting Activity Status Reports are sent to the location(s) designated by the employer and are typically distributed on a monthly basis. If online Medical Evidence of Insurability is quoted, Medical Underwriting Activity Reports (reporting status of medically underwritten coverage) are sent electronically to the employer and are typically distributed on a weekly basis. • Producer Compensation Cigna may have entered into, or may enter into, agreements with brokers, under which the insurance company compensates brokers for providing marketplace intelligence and other services intended to enhance the effectiveness of the insurance company's business. Cigna may also invite brokers to participate in events sponsored by the insurance company for the same purposes. Any compensation paid may be based on meeting targets for new business production and persistency, and, if paid, is funded from the insurance company's overhead and is based on the broker's overall book of business with the insurance company. Any such payments are separate from commissions and, if applicable, will be included in ERISA Form 5500, Schedule A information provided by the insurance company. I confirm that I have reviewed the proposal dated 9/ 14/ 17 and find everything to be in order. Julie A;umn Cozad , Chair , Board of iOCT 0 4 2017 Weld er s Name of Representative Signature of Representative Date too at Hello