MetLife Voluntary Life Insurance Certificate
GCR19-07 Metropolitan Life Insurance Company 200 Park Avenue, New York, New York 10166 CERTIFICATE RIDER Group Policy No.: TM 05384468-G Employer: Buckingham Browne and Nichols School Effective Date: June 1, 2023 The Certificate is changed as shown below: The Certificate is revised to add the following: “ How We Will Pay Benefits Unless the Beneficiary requests payment by check, when the Certificate states that We will pay benefits in “one sum”, “lump sum”, or a “single sum”, We may pay the full benefit amount: 1. by check; 2. by establishing an account that earns interest and provides the Beneficiary with immediate access to the full benefit amount; or 3. by any other method that provides the Beneficiary with immediate access to the full benefit amount. Other modes of payment may be available upon request. For details, call Our toll free number shown on the Certificate Face Page.” This rider is to be attached to and made a part of the Certificate.
GCERT2000 fp 1 All Active Full-Time Employees RV 6/16/2023 Metropolitan Life Insurance Company 200 Park Avenue, New York, New York 10166-0188 CERTIFICATE OF INSURANCE Metropolitan Life Insurance Company ("MetLife"), a stock company, certifies that You are insured for the benefits described in this certificate, subject to the provisions of this certificate. This certificate is issued to You under the Group Policy and it includes the terms and provisions of the Group Policy that describe Your insurance. PLEASE READ THIS CERTIFICATE CAREFULLY. This certificate is part of the Group Policy. The Group Policy is a contract between MetLife and the Employer and may be changed or ended without Your consent or notice to You. Employer: Buckingham Browne and Nichols School Group Policy Number: TM 05384468 - G Type of Insurance: Supplemental Term Life Insurance MetLife Toll Free Number(s): For General Information 1-800-275-4638 THIS CERTIFICATE ONLY DESCRIBES LIFE INSURANCE. FOR CALIFORNIA RESIDENTS: REVIEW THIS CERTIFICATE CAREFULLY. IF YOU ARE 65 OR OLDER ON YOUR EFFECTIVE DATE OF THIS CERTIFICATE, YOU MAY RETURN IT TO US WITHIN 30 DAYS FROM THE DATE YOU RECEIVE IT AND WE WILL REFUND ANY PREMIUM YOU PAID. IN THIS CASE, THIS CERTIFICATE WILL BE CONSIDERED TO NEVER HAVE BEEN ISSUED. THE BENEFITS OF THE POLICY PROVIDING YOUR COVERAGE ARE GOVERNED PRIMARILY BY THE LAW OF A STATE OTHER THAN FLORIDA. For Idaho Residents: TEN DAY RIGHT TO EXAMINE CERTIFICATE: You may return the certificate to Us within 10 days from the date You receive it. If You return it within the 10 day period, the certificate will be considered never to have been issued. We will refund any premium paid after We receive Your notice of cancellation. THE GROUP INSURANCE POLICY PROVIDING COVERAGE UNDER THIS CERTIFICATE WAS ISSUED IN A JURISDICTION OTHER THAN MARYLAND AND MAY NOT PROVIDE ALL THE BENEFITS REQUIRED BY MARYLAND LAW. For Residents of North Dakota: If you are not satisfied with your Certificate, You may return it to Us within 20 days after You receive it, unless a claim has previously been received by Us under Your Certificate. We will refund within 30 days of our receipt of the returned Certificate any Premium that has been paid and the Certificate will then be considered to have never been issued. You should be aware that, if you elect to return the Certificate for a refund of premiums, losses which otherwise would have been covered under your Certificate will not be covered. For New Hampshire Residents: 30 Day Right to Examine Certificate. Please read this Certificate. You may return the Certificate to Us within 30 days from the date You receive it. If you return it within the 30 day period, the Certificate will be considered never to have been issued and We will refund any premium paid for insurance under this Certificate.
GCERT2000 fp 2 All Active Full-Time Employees RV 6/16/2023 WE ARE REQUIRED BY STATE LAW TO INCLUDE THE NOTICE(S) WHICH APPEAR ON THIS PAGE AND IN THE NOTICE(S) SECTION WHICH FOLLOWS THIS PAGE. PLEASE READ THE(SE) NOTICE(S) CAREFULLY.
NOTICE FOR RESIDENTS OF TEXAS GCERT-TX-NOTICE 2020 3 Have a complaint or need help? If you have a problem with a claim or your premium, call your insurance company or HMO first. If you can't work out the issue, the Texas Department of Insurance may be able to help. Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company or HMO. If you don't, you may lose your right to appeal. Metropolitan Life Insurance Company To get information or file a complaint with your insurance company or HMO: Call: Corporate Consumer Relations Department at 1-800-438-6388 Toll-free: 1-800-438-6388 Email: [email protected] Mail: Metropolitan Life Insurance Company 700 Quaker Lane 2nd Floor Warwick, RI 02886 The Texas Department of Insurance To get help with an insurance question or file a complaint with the state: Call with a question: 1-800-252-3439 File a complaint: www.tdi.texas.gov Email: [email protected] Mail: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 ¿Tiene una queja o necesita ayuda? Si tiene un problema con una reclamación o con su prima de seguro, llame primero a su compañía de seguros o HMO. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar. Aun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una queja a través del proceso de quejas o de apelaciones de su compañía de seguros o HMO. Si no lo hace, podría perder su derecho para apelar. Metropolitan Life Insurance Company Para obtener información o para presentar una queja ante su compañía de seguros o HMO: Llame a: Departamento de Relaciones Corporativas del Consumidor al 1-800-438-6388
GCERT-TX-NOTICE 2020 4 Teléfono gratuito: 1-800-438-6388 Correo electrónico: [email protected] Dirección postal: Metropolitan Life Insurance Company 700 Quaker Lane 2nd Floor Warwick, RI 02886 El Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con los seguros o para presentar una queja ante el estado: Llame con sus preguntas al: 1-800-252-3439 Presente una queja en: www.tdi.texas.gov Correo electrónico: [email protected] Dirección postal: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091
NOTICE FOR RESIDENTS OF TEXAS GCERT2000 5 notice/tx/abo LIFE INSURANCE: ACCELERATED BENEFIT OPTION (ABO) The laws of the state of Texas mandate that the terms “ Terminally Ill” and “Terminal Illness” when used in the LIFE INSURANCE: ACCELERATED BENEFIT OPTION (ABO) FOR YOU provisions mean that due to injury or sickness, You expected to die within 24 months of the date You request payment of an Accelerated Benefit.
NOTICE FOR RESIDENTS OF ALL STATES GCERT2000 6 notice/abo/nw LIFE INSURANCE BENEFITS WILL BE REDUCED IF AN ACCELERATED BENEFIT IS PAID DISCLOSURE : The Life Insurance accelerated benefit offered under this certificate is intended to qualify for favorable tax treatment under the Internal Revenue Code of 1986. If this benefit qualifies for such favorable tax treatment, the benefit will be excludable from Your income and not subject to federal taxation. Tax laws relating to accelerated benefits are complex. You are advised to consult with a qualified tax advisor about circumstances under which You could receive an accelerated benefit excludable from income under federal law. DISCLOSURE: Receipt of an accelerated benefit may affect Your, Your Spouse’s or Your family’s eligibility for public assistance programs such as Medical Assistance (Medicaid), Aid to Families with Dependent Children (AFDC), Supplementary Social Security Income (SSI), and drug assistance programs. You are advised to consult with a qualified tax advisor and with social service agencies concerning how receipt of such payment will affect Your, Your Spouse’s and Your family’s eligibility for public assistance.
NOTICE FOR RESIDENTS OF ARKANSAS GCERT2000 7 notice/ar If You have a question concerning Your coverage or a claim, first contact the Policyholder or group account administrator. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page. Policyholders have the right to file a complaint with the Arkansas Insurance Department (AID). You may call AID to request a complaint form at (800) 852-5494 or (501) 371-2640 or write the Department at: Arkansas Insurance Department Consumer Services Division 1 Commerce Way, Suite 102 Little Rock, Arkansas 72202
NOTICE FOR RESIDENTS OF CALIFORNIA GCERT2000 8 notice/ca IMPORTANT NOTICE TO OBTAIN ADDITIONAL INFORMATION, OR TO MAKE A COMPLAINT, CONTACT THE POLICYHOLDER OR METLIFE AT: METROPOLITAN LIFE INSURANCE COMPANY ATTN: CONSUMER RELATIONS DEPARTMENT 500 SCHOOLHOUSE ROAD JOHNSTOWN, PA 15904 1-800-438-6388 IF, AFTER CONTACTING THE POLICYHOLDER AND/OR METLIFE, YOU FEEL THAT A SATISFACTORY SOLUTION HAS NOT BEEN REACHED, YOU MAY FILE A COMPLAINT WITH THE CALIFORNIA DEPARTMENT OF INSURANCE DEPARTMENT AT: DEPARTMENT OF INSURANCE CONSUMER SERVICES 300 SOUTH SPRING STREET LOS ANGELES, CA 90013 WEBSITE: http://www.insurance.ca.gov/ 1-800-927-4357 (within California) 1-213-897-8921 (outside California)
NOTICE FOR RESIDENTS OF CALIFORNIA GCERT2000 9 notice/ca If Your certificate includes an exclusion for the voluntary intake or use by any means of any drug, medication or sedative, unless it is taken or used as prescribed by a Physician (or a similar exclusion), We will adjudicate your claim as follows: We will exclude any Covered Loss as a consequence of being under the influence of any intoxicant or controlled substance unless administered on the advice of a Physician.
NOTICE FOR RESIDENTS OF GEORGIA GCERT2000 10 notice/ga IMPORTANT NOTICE The laws of the state of Georgia prohibit insurers from unfairly discriminating against any person based upon his or her status as a victim of family violence.
NOTICE FOR RESIDENTS OF IDAHO GCERT2000 11 notice/id If You have a question concerning Your coverage or a claim, first contact the Employer. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page. If You are still concerned after contacting both the Employer and MetLife, You should feel free to contact: Idaho Department of Insurance Consumer Affairs 700 West State Street, 3 rd Floor PO Box 83720 Boise, Idaho 83720-0043 1-800-721-3272 or www.DOI.Idaho.gov
NOTICE FOR RESIDENTS OF ILLINOIS GCERT2000 12 notice/il IMPORTANT NOTICE To make a complaint to MetLife, You may write to: MetLife 200 Park Avenue New York, New York 10166 The address of the Illinois Department of Insurance is: Illinois Department of Insurance Public Services Division Springfield, Illinois 62767
NOTICE FOR RESIDENTS OF INDIANA GCERT2000 13 notice/in Questions regarding your policy or coverage should be directed to: Metropolitan Life Insurance Company 1-800-275-4638 If you (a) need the assistance of the government agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or email: State of Indiana Department of Insurance Consumer Services Division 311 West Washington Street, Suite 300 Indianapolis, Indiana 46204 Consumer Hotline: (800) 622-4461; (317) 232-2395 Complaint can be filed electronically at www.in.gov/idoi
NOTICE FOR RESIDENTS OF MISSOURI GCERT2000 14 notice/mo LIFE INSURANCE GENERAL PROVISIONS If You reside in Missouri the suicide provision is as follows: Suicide If You commit suicide within 1 year from the date Life Insurance for You takes effect, We will not pay such insurance and Our liability will be limited as follows: · any premium paid by You will be returned to the Beneficiary. · any premium paid by the Policyholder will be returned to the Policyholder. If You commit suicide within 1 year from the date an increase in Your Life Insurance takes effect, We will pay to the Beneficiary the amount of Insurance in effect on the day before the increase. Any premium You paid for the increase will be returned to the Beneficiary. Any premium paid by the Policyholder for the increase will be returned to the Policyholder.
NOTICE FOR RESIDENTS OF NORTH DAKOTA GCERT2000 notice/nd 15 GENERAL PROVISIONS If You reside in North Dakota the suicide provision is as follows: Suicide If You commit suicide within 1 year from the date Life Insurance for You takes effect, We will not pay such insurance and Our liability will be limited as follows: · any premium paid by You will be returned to the Beneficiary. · any premium paid by the Policyholder will be returned to the Policyholder. If You commit suicide within 1 year from the date an increase in Your Life Insurance takes effect, We will pay to the Beneficiary the amount of Insurance in effect on the day before the increase. Any premium You paid for the increase will be returned to the Beneficiary. Any premium paid by the Policyholder for the increase will be returned to the Policyholder.
NOTICE FOR RESIDENTS OF TEXAS GCERT2000 16 notice/tx/wc THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.
NOTICE FOR RESIDENTS OF UTAH GTY-NOTICE-UT-0710 17 Notice of Protection Provided by Utah Life and Health Insurance Guaranty Association This notice provides a brief summary of the Utah Life and Health Insurance Guaranty Association (“the Association”) and the protection it provides for policyholders. This safety net was created under Utah law, which determines who and what is covered and the amounts of coverage. The Association was established to provide protection in the unlikely event that your life, health, or annuity insurance company becomes financially unable to meet its obligations and is taken over by its insurance regulatory agency. If this should happen, the Association will typically arrange to continue coverage and pay claims, in accordance with Utah law, with funding from assessments paid by other insurance companies. The basic protections provided by the Association are: · Life Insurance o $500,000 in death benefits o $200,000 in cash surrender or withdrawal values · Health Insurance o $500,000 in hospital, medical and surgical insurance benefits o $500,000 in long-term care insurance benefits o $500,000 in disability income insurance benefits o $500,000 in other types of health insurance benefits · Annuities o $250,000 in withdrawal and cash values The maximum amount of protection for each individual, regardless of the number of policies or contracts, is $500,000. Special rules may apply with regard to hospital, medical and surgical insurance benefits. Note: Certain policies and contracts may not be covered or fully covered. For example, coverage does not extend to any portion of a policy or contract that the insurer does not guarantee, such as certain investment additions to the account value of a variable life insurance policy or a variable annuity contract. Coverage is conditioned on residency in this state and there are substantial limitations and exclusions. For a complete description of coverage, consult Utah Code, Title 3 lA, Chapter 28. Insurance companies and agents are prohibited by Utah law to use the existence of the Association or its coverage to encourage you to purchase insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between Utah law and this notice, Utah law will control. To learn more about the above protections, as well as protections relating to group contracts or retirement plans, please visit the Association's website at www.utlifega.org or contact: Utah Life and Health Insurance Guaranty Assoc. Utah Insurance Department 60 East South Temple, Suite 500 3110 State Office Building Salt Lake City UT 84111 Salt Lake City UT 84114-6901 (801) 320-9955 (801) 538-3800 A written complaint about misuse of this Notice or the improper use of the existence of the Association may be filed with the Utah Insurance Department at the above address. ce
NOTICE FOR RESIDENTS OF VIRGINIA GCERT2000 18 notice/va IMPORTANT INFORMATION REGARDING YOUR INSURANCE In the event You need to contact someone about this insurance for any reason please contact Your agent. If no agent was involved in the sale of this insurance, or if You have additional questions You may contact the insurance company issuing this insurance at the following address and telephone number: MetLife 200 Park Avenue New York, New York 10166 Attn: Corporate Consumer Relations Department To phone in a claim related question, You may call Claims Customer Service at: 1-800-275-4638 If You have been unable to contact or obtain satisfaction from the company or the agent, You may contact the Virginia State Corporation Commission’s Bureau of Insurance at: Bureau of Insurance Life and Health Division P.O. Box 1157 Richmond, VA 23218-1157 1-804-371-9691 - phone 1-877-310-6560 - toll-free 1-804-371-9944 – fax www.scc.virginia.gov - web address [email protected] - email Written correspondence is preferable so that a record of Your inquiry is maintained. When contacting Your agent, company or the Bureau of Insurance, have Your policy number available.
CIVIL UNION NOTICE FOR RESIDENTS OF VERMONT GCERT2000 notice/vt 19 Vermont law provides that the following definitions apply to your certificate: ● Terms that mean or refer to a marital relationship, or that may be construed to mean or refer to a marital relationship, such as "marriage," "spouse," "husband," "wife," "dependent," "next of kin," "relative," "beneficiary," "survivor," "immediate family" and any other such terms include the relationship created by a Civil Union established according to Vermont law. ● Terms that mean or refer to the inception or dissolution of a marriage, such as "date of marriage," "divorce decree," "termination of marriage" and any other such terms include the inception or dissolution of a Civil Union established according to Vermont law. ● Terms that mean or refer to family relationships arising from a marriage, such as "family," "immediate family," "dependent," "children," "next of kin," "relative," "beneficiary," "survivor" and any other such terms include family relationships created by a Civil Union established according to Vermont law. ● "Dependent" includes a spouse, a party to a Civil Union established according to Vermont law, and a child or children (natural, step-child, legally adopted or a minor or disabled child who is dependent on the insured for support and maintenance) who is born to or brought to a marriage or to a Civil Union established according to Vermont law. ● "Child" includes a child (natural, stepchild, legally adopted or a minor or disabled child who is dependent on the insured for support and maintenance) who is born to or brought to a marriage or to a Civil Union established according to Vermont law. ● “Civil Union” means a civil union established pursuant to Act 91 of the 2000 Vermont Legislative Session, entitled “Act Relating to Civil Unions”. All references in this notice to Civil Unions are limited to Civil Unions in which the parties are residents of Vermont. If dependent insurance for a spouse and/or child is not provided under your certificate, such insurance is not added by virtue of this notice. For purposes of dependent insurance, any person who meets the definition of “dependent” as set forth in this notice is required to meet all other applicable requirements in order to qualify for such insurance. This notice does not limit any definitions or terms included in your certificate. It broadens definitions and terms only to the extent required by Vermont law. DISCLOSURE: Vermont law grants parties to a Civil Union the same benefits, protections and responsibilities that flow from marriage under state law. However, some or all of the benefits, protections and responsibilities related to life and health insurance that are available to married persons under federal law may not be available to parties to a Civil Union. For example, a federal law, the Employee Retirement Income Security Act of 1974 known as “ERISA”, controls the employer/employee relationship with regard to determining eligibility for enrollment in private employer benefit plans. Because of ERISA, Act 91 does not state requirements pertaining to a private employer’s enrollment of a party to a Civil Union in an ERISA employee benefit plan. However, governmental employers (not federal government) are required to provide life and health benefits to the dependents of a party to a Civil Union if the public employer provides such benefits to dependents of married persons. Federal law also controls group health insurance continuation rights under “COBRA” for employers with 20 or more employees as well as the Internal Revenue Code treatment of insurance premiums. As a result, parties to a Civil Union and their families may or may not have access to certain benefits under this notice and the certificate to which it is attached that derive from federal law. You are advised to seek expert advice to determine your rights under this notice and the certificate to which it is attached.
NOTICE FOR RESIDENTS OF THE STATE OF WASHINGTON GCERT2000 20 notice/wa Washington law provides that the following apply to Your certificate: Wherever the term " Spouse " appears in this certificate it shall, unless otherwise specified, be read to include Your Domestic Partner. Domestic Partner means each of two people, one of whom is an Employee of the Employer, who have registered as each other’s domestic partner, civil union partner or reciprocal beneficiary with a government agency where such registration is available. Wherever the term "step-child" appears in this certificate it shall be read to include the children of Your Domestic Partner.
NOTICE FOR RESIDENTS OF WASHINGTON GCERT2000 notice/wa1 21 LIFE INSURANCE GENERAL PROVISIONS The suicide provision is not applicable to residents of Washington.
GCERT2000 notice/wa 22 NOTICE FOR RESIDENTS OF WASHINGTON This non-insurance benefit does not constitute an insurance funded prearrangement contract, pursuant to RCW 18.39.255. Employees who become insured for MetLife Supplemental Life Insurance under the Group Policy are eligible to receive discounts of up to 10% off the service provider’s standard price for certain funeral services including funeral, cremation and cemetery products and services provided by a third party national network of funeral and funeral planning providers while such insurance remains in effect. Employees who become insured for MetLife Supplemental Life Insurance will also have access to funeral planning resources including funeral planning tools and concierge services provided by the same national network of providers. MetLife has arranged for these services and discounts to be provided to Employees and their spouses for no additional premium. MetLife is not responsible for providing or failing to provide these services nor is it liable for any negligence in the provision of such services by the third party service provider. The discounts and planning services are not available in all jurisdictions and are subject to regulatory approval. A Digital Estate Planning Platform is included with Supplemental Life Insurance at no additional cost. MetLife has arranged for this Platform to be provided by MetLife Legal Plans, Inc., a MetLife affiliate. The Platform will be made available to Employees and their Spouses so they can create estate planning documents through legalplans.com/estateplanning.
NOTICE FOR RESIDENTS OF WEST VIRGINIA GCERT2000 23 notice/wv FREE LOOK PERIOD: If You are not satisfied with Your certificate, You may return it to Us within 10 days after You receive it, unless a claim has previously been received by Us under Your certificate. We will refund within 10 days of our receipt of the returned certificate any Premium that has been paid and the certificate will then be considered to have never been issued. You should be aware that, if You elect to return the certificate for a refund of premiums, losses which otherwise would have been covered under Your certificate will not be covered.
NOTICE FOR RESIDENTS OF WISCONSIN GCERT2000 notice/wi 24 KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS PROBLEMS WITH YOUR INSURANCE? - If you are having problems with your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve your problem. MetLife Attn: Corporate Consumer Relations Department 200 Park Avenue New York, NY 10166-0188 1-800-638-5433 You can also contact the OFFICE OF THE COMMISSIONER OF INSURANCE , a state agency which enforces Wisconsin’s insurance laws, and file a complaint. You can contact the OFFICE OF THE COMMISSIONER OF INSURANCE by contacting: Office of the Commissioner of Insurance Complaints Department P.O. Box 7873 Madison, WI 53707-7873 1-800-236-8517 outside of Madison or 608-266-0103 in Madison.
TABLE OF CONTENTS GCERT2000 toc 25 Section Page CERTIFICATE FACE PAGE ............................................................................................................................... 1 NOTICES ............................................................................................................................................................ 3 SCHEDULE OF BENEFITS .............................................................................................................................. 26 DEFINITIONS .................................................................................................................................................... 29 ELIGIBILITY PROVISIONS: INSURANCE FOR YOU ...................................................................................... 31 Eligible Classes ............................................................................................................................................. 31 Date You Are Eligible For Insurance ............................................................................................................. 31 Enrollment Process ........................................................................................................................................ 31 Date Your Insurance Takes Effect ................................................................................................................. 31 Date Your Insurance Ends ............................................................................................................................. 34 SPECIAL RULES FOR GROUPS PREVIOUSLY COVERED UNDER OTHER GROUP LIFE INSURANCE . 35 CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT .................................................................... 37 For Family And Medical Leave ...................................................................................................................... 37 At Your Option: Portability ............................................................................................................................. 37 At The Employer's Option .............................................................................................................................. 38 EVIDENCE OF INSURABILITY ........................................................................................................................ 40 LIFE INSURANCE: FOR YOU .......................................................................................................................... 42 LIFE INSURANCE: ACCELERATED BENEFIT OPTION (ABO) FOR YOU ..................................................... 43 LIFE INSURANCE: CONVERSION OPTION FOR YOU .................................................................................. 45 ELIGIBILITY FOR CONTINUATION OF CERTAIN INSURANCE WHILE YOU ARE TOTALLY DISABLED ... 47 FILING A CLAIM ............................................................................................................................................... 49 GENERAL PROVISIONS .................................................................................................................................. 50 Assignment .................................................................................................................................................... 50 Beneficiary ..................................................................................................................................................... 50 Suicide ........................................................................................................................................................... 50 Entire Contract ............................................................................................................................................... 51 Incontestability: Statements Made By You .................................................................................................... 51 Misstatement of Age ...................................................................................................................................... 51 Conformity with Law ...................................................................................................................................... 51 Autopsy .......................................................................................................................................................... 51
SCHEDULE OF BENEFITS GCERT2000 26 sch This schedule shows the benefits that are available under the Group Policy. You will only be insured for the benefits: ● for which You become and remain eligible, and ● which You elect, if subject to election; and ● which are in effect. The amount of Insurance that We will pay will be decreased by the amount of any contributions due and unpaid to Us for that insurance. BENEFIT BENEFIT AMOUNT AND HIGHLIGHTS Life Insurance For You Supplemental Life Insurance (if elected by You) Supplemental Life Insurance for You is Portability Eligible Insurance For All Active Full-Time Employees .......................................... An amount, elected by You, which is a multiple of $10,000. Maximum Supplemental Life Benefit ........................................ The lesser of 5 times Your Basic Annual Earnings or $300,000 . Non-Medical Issue Amount ...................................................... $120,000 Accelerated Benefit Option ....................................................... Up to 80% of Your Supplemental Life amount not to exceed $500,000. ESTATE RESOLUTION SERVICES The following Estate Resolution Services are provided at no additional cost to individuals insured for Group Supplemental Life Insurance coverage as described below. If You are eligible to receive these Estate Resolution Services and You or Your Spouse (for the Will Preparation Service) or You or a Beneficiary (for the Probate Service) would like to speak with a representative from MetLife Legal Services or get the name of a Plan Attorney that you can speak with about these Services please call (800) 821-6400. THE FOLLOWING APPLIES TO RESIDENTS OF ALL STATES OTHER THAN TEXAS Will Preparation Service If You elect Group Supplemental Life Insurance coverage a will preparation service (the “Service”) will be made available to You, through a MetLife affiliate (the “Affiliate”), while Your Group Supplemental Life Insurance coverage is in effect. This Service will be made available at no cost to You. It enables You to have a will prepared for You and Your Spouse free of charge by attorneys designated by the Affiliate. If You have a will prepared by an attorney not designated by the Affiliate, You must pay for the attorney’s services directly. Upon Proof of such payment, You will be reimbursed for the attorney’s services in an amount equal to the lesser of the amount You paid for the attorney’s services and the amount customarily reimbursed for such services by the Affiliate.
SCHEDULE OF BENEFITS (continued) GCERT2000 27 sch Probate Service If You become insured for Group Supplemental Life Insurance coverage and You or Your Spouse die while such Group Supplemental Life Insurance coverage is in effect, a probate benefit (the “Benefit”) will be made available to Your estate in the event of Your death or to Your Spouse's estate in the event of Your Spouse's death. Such benefit will be made available through a MetLife affiliate (“Affiliate”). The Benefit includes attorney representation and payment of legal fees for the executor or administrator of the estate of the deceased, including representation for the preparation of all documents and all of the court proceedings needed to transfer probate assets from the estate of the deceased to applicable heirs; and the completion of correspondence necessary to transfer non-probate assets such as proceeds from insurance policies, joint bank accounts, stock accounts or a house; and associated tax filings. The Benefit provides for such probate services to be made available, free of charge by attorneys designated by the Affiliate. If probate services are provided by an attorney not designated by the Affiliate, the estate of the deceased must pay for those attorney’s services directly. Upon Proof of such payment, the estate of the deceased will be reimbursed for the attorney’s services in an amount equal to the lesser of the amount such estate paid for the attorney’s services and the amount customarily reimbursed for such services by the Affiliate. This Benefit will be provided at no cost to You and will end on the date Your Group Supplemental Life Insurance coverage ends. THE FOLLOWING APPLIES TO RESIDENTS OF TEXAS ONLY Will Preparation Service If You elect Group Supplemental Life Insurance coverage, a Will Preparation Service (the “Service”) will be made available to You through a MetLife affiliate (the “Affiliate”), as agreed to by the Policyholder and the Affiliate, while Your Group Supplemental Life Insurance coverage is in effect under this Policy. Will Preparation Service means a service covering the preparation of wills and codicils for You and Your Spouse. The creation of any testamentary trust is covered. The Will Preparation Service does not include tax planning. This Service will be made available at no cost to You. It enables You to have a will prepared for You and Your Spouse free of charge by attorneys designated by the Affiliate. If You have a will prepared by an attorney not designated by the Affiliate, You must pay for the attorney’s services directly. Upon Proof of such payment, You will be reimbursed for the attorney’s services in an amount equal to the lesser of the amount You paid for the attorney’s services and the amount customarily reimbursed for such services by the Affiliate. Probate Service If You become insured for Group Supplemental Life Insurance coverage and You or Your Spouse die while such Group Supplemental Life Insurance coverage is in effect, a probate benefit (the “Benefit”) will be made available to Your estate in the event of Your death or to Your Spouse’s estate in the event of Your Spouse’s death. Such benefit will be made available through a MetLife affiliate (“Affiliate”). The Benefit includes attorney representation and payment of legal fees for the executor or administrator of the estate of the deceased including representation for the preparation of all documents and all of the court proceedings needed to transfer probate assets from the estate of the deceased to applicable heirs; and the completion of correspondence necessary to transfer non-probate assets such as proceeds from insurance policies, joint bank accounts, stock accounts or a house; and associated tax filings. The Benefit provides for such services to be made available, free of charge by attorneys designated by the Affiliate. If probate services are provided by an attorney not designated by the Affiliate, the estate of the deceased must pay for those attorney’s services directly. Upon Proof of such payment, the estate of the deceased will be reimbursed for the attorney’s services in an amount equal to the lesser of the amount such estate paid for the attorney’s services and the amount customarily reimbursed for such services by the Affiliate.
SCHEDULE OF BENEFITS (continued) GCERT2000 28 sch This Benefit will be provided at no cost to You and will end on the date Your Group Supplemental Life Insurance coverage ends. Portability Eligible Life Insurance Life Insurance For You: Portability Eligible Life Insurance For You: Supplemental Life Insurance: Minimum Portability Eligible Life Insurance Amount.................. $10,000 Maximum Portability Eligible Life Insurance Amount................. The lesser of Your total Life Insurance in effect on the date You elect to Port or $2,000,000. If Your Portability Eligible Insurance ends due to the end of the Group Policy or the amendment of the Group Policy to end the Portability Eligible Insurance for an eligible class of which You are a member, the maximum amount of insurance that You may Port is the lesser of: ● the amount of Your Portability Eligible Insurance that ends under the Group Policy less the amount of Life insurance for which You become eligible under any group policy issued to replace this Group Policy; or ● $10,000.
DEFINITIONS GCERT2000 29 def As used in this certificate, the terms listed below will have the meanings set forth below. When defined terms are used in this certificate, they will appear with initial capitalization. The plural use of a term defined in the singular will share the same meaning. Actively at Work or Active Work means that You are performing all of the usual and customary duties of Your job on a Full-Time basis. This must be done at: ● the Employer’s place of business; ● an alternate place approved by the Employer; or ● a location to which the Employer’s business requires You to travel. You will be deemed to be Actively at Work during weekends or -approved vacations, holidays or business closures if You were Actively at Work on the last scheduled work day preceding such time off. Basic Annual Earnings means Your gross annual rate of pay as determined by Your Employer, excluding overtime and other extra pay. Beneficiary means the person(s) to whom We will pay insurance as determined in accordance with the General Provisions section. Contributory Insurance means insurance for which the Employer requires You to pay any part of the premium. Full-Time means Active Work on the ’s regular work schedule for the class of employees to which You belong. The work schedule must be at least 20 hours a week. Full-Time does not include temporary or seasonal employees. Hospital means a facility which is licensed as such in the jurisdiction in which it is located and : ● provides a broad range of medical and surgical services on a 24 hour a day basis for injured and sick persons by or under the supervision of a staff of Physicians; and ● provides a broad range of nursing care on a 24 hour a day basis by or under the direction of a registered professional nurse. Hospitalized means: ● admission for inpatient care in a Hospital; ● receipt of care in the following: ● a hospice facility; or ● an intermediate care facility; or ● a long term care facility; or ● receipt of the following treatment, wherever performed: ● chemotherapy; or ● radiation therapy; or ● dialysis. Noncontributory Insurance means insurance for which the Employer does not require You to pay any part of the premium . Physician means: ● a person licensed to practice medicine in the jurisdiction where such services are performed; or ● any other person whose services, according to applicable law, must be treated as Physician's services for purposes of the Group Policy. Each such person must be licensed in the jurisdiction where the service is performed and must act within the scope of that license. Such person must also be certified and/or registered if required by such jurisdiction.
DEFINITIONS (continued) GCERT2000 30 def The term does not include : ● You; ● Your Spouse; or ● any member of Your immediate family including Your and/or Your spouse’s parents; children (natural, step or adopted); siblings; grandparents; or grandchildren. Proof means Written evidence satisfactory to Us that a person has satisfied the conditions and requirements for any benefit described in this certificate. When a claim is made for any benefit described in this certificate, Proof must establish: · the nature and extent of the loss or condition; · Our obligation to pay the claim; and · the claimant’s right to receive payment. Proof must be provided at the claimant’s expense. Sickness means illness, disease or pregnancy, including complications of pregnancy. Signed means any symbol or method executed or adopted by a person with the present intention to authenticate a record, which is on or transmitted by paper or electronic media which is acceptable to Us and consistent with applicable law. Spouse means Your lawful Spouse. The term does not include any person who: ● is on active duty in the military of any country or international authority; however, active duty for this purpose does not include weekend or summer training for the reserve forces of the United States, including the National Guard; or ● is insured under the Group Policy as an employee. We , Us and Our mean MetLife. Written or Writing means a record which is on or transmitted by paper or electronic media which is acceptable to Us and consistent with applicable law. You and Your mean an employee who is insured under the Group Policy for the insurance described in this certificate.
ELIGIBILITY PROVISIONS: INSURANCE FOR YOU GCERT2000 31 e/ee ELIGIBLE CLASS(ES) All Active Full-Time Employees DATE YOU ARE ELIGIBLE FOR INSURANCE You may only become eligible for the insurance available for Your class as shown in the SCHEDULE OF BENEFITS . All Active Full-Time Employees Supplemental Life Insurance If You are in an eligible class on June 01, 2023, You will be eligible for insurance on that date. If You enter an eligible class after June 01, 2023, You will be eligible for insurance on the date You enter that class. Waiting Period means the period of continuous membership in an eligible class that You must wait before You become eligible for insurance. This period begins on the date You enter an eligible class and ends on the date You complete the period(s) specified. ENROLLMENT PROCESS If You are eligible for insurance, You may enroll for such insurance by completing the required form. In addition, You must give evidence of Your insurability satisfactory to Us at Your expense if You are required to do so under the section entitled EVIDENCE OF INSURABILITY. If you enroll for Contributory Insurance, You must also give the Employer written permission to deduct premiums from Your pay for such insurance. You will be notified by the Employer how much You will be required to contribute. If Your Employer establishes an annual enrollment period for Life Insurance, You may enroll for Life Insurance only when You are first eligible or during an annual enrollment period or If You have a Qualifying Event. You should contact the Employer for more information regarding the annual enrollment period. DATE YOUR INSURANCE TAKES EFFECT Rules for Noncontributory Insurance When You complete the enrollment process for Noncontributory Insurance, such insurance will take effect as follows: ● if You are not required to give evidence of Your insurability, such insurance will take effect on the date You become eligible, provided You are Actively at Work on that date; or ● if You are required to give evidence of Your insurability and We determine that You are insurable, such insurance will take effect on the date We state in Writing, provided You are Actively at Work on that date. If You are not Actively at Work on the date the Noncontributory Insurance benefit would otherwise take effect, the insurance will take effect on the day You resume Active Work. Rules for Contributory Insurance If You request Contributory Insurance before the date You become eligible for such insurance, such insurance will take effect as follows: ● if You are not required to give evidence of Your insurability, such insurance will take effect on the date You become eligible, provided You are Actively at Work on that date. ● if You are required to give evidence of Your insurability and We determine that You are insurable, such insurance will take effect on the date We state in Writing, provided You are Actively at Work on that date. If You request Contributory Insurance within 12 months of the date You become eligible for such insurance, or
ELIGIBILITY PROVISIONS: INSURANCE FOR YOU (continued) GCERT2000 32 e/ee during the Employer’s next annual enrollment period, whichever occurs first , such insurance will take effect as follows: ● if You are not required to give evidence of Your insurability, such insurance will take effect on the later of: ● the date You become eligible for such insurance; and ● the date You enroll provided You are Actively at Work on that date. ● if You are required to give evidence of Your insurability and We determine that You are insurable, such insurance will take effect on the date We state in Writing, provided You are Actively at Work on that date. ● If You request Contributory Insurance more than 12 months after the date You become eligible for such insurance or after the first annual enrollment period for which You may enroll, whichever occurs first , You must give such evidence at Your expense. If We determine that You are insurable, such insurance will take effect on the date We state in Writing, if You are Actively at Work on that date. If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work. See the DEFINITIONS section of this certificate for a complete list of Contributory Insurance benefits. For Supplemental Life Insurance When You become eligible under the plan, You may choose an option for Supplemental Life Insurance. Each year You can choose the amount and types of benefits for Supplemental Life Insurance subject to the following rules. You will be able to enroll by completing the required form in Writing. You must also give the Employer written permission to deduct the contribution from Your pay. The Employer will notify You of the amount You will be required to contribute. Enrollment During Annual Enrollment Periods For Supplemental Life Insurance Only If You choose an option which does not require You to give evidence of Your insurability, the insurance will take effect on the first day of the month following the annual enrollment period, provided You are Actively at Work on that day . If You choose an option which requires You to give evidence of Your insurability under the section entitled EVIDENCE OF INSURABILITY and We determine that You are insurable, the insurance will take effect on the date We state in Writing, provided You are Actively at Work on that date. · if We do not approve Your evidence of insurability, or You do not submit evidence of insurability, the insurance will not take effect. · if You are required to give evidence of insurability under the section entitled EVIDENCE OF INSURABILITY for a portion of the insurance: · the portion of the insurance that is not subject to evidence of insurability will take effect on the date of Your request. · if We approve Your evidence of insurability, the portion of the insurance that is subject to evidence of insurability will take effect on the date We state in Writing. If We do not approve Your evidence of insurability or You do not submit evidence of insurability, the portion of the insurance that is subject to evidence of insurability will not take effect. If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work. Increase in Insurance
ELIGIBILITY PROVISIONS: INSURANCE FOR YOU (continued) GCERT2000 33 e/ee An increase in insurance due to a change in class of employee, an increase in Your earnings, or a requested increase in insurance will take effect as follows: ● if You are required to give evidence of insurability for the entire increase and We approve Your evidence of insurability, the increase will take effect on the date We state in Writing. If We do not approve Your evidence of insurability, or You do not submit evidence of insurability, the increase in insurance will not take effect. ● if You are required to give evidence of insurability for a portion of the increase: ● the portion of the increase that is not subject to evidence of insurability will take effect on the date of Your request or the date of the increase in Your earnings. ● if We approve Your evidence of insurability, the portion of the increase that is subject to evidence of insurability will take effect on the date We state in Writing. If We do not approve Your evidence of insurability or You do not submit evidence of insurability, the increase in insurance will not take effect. ● if You are not required to give evidence of insurability, the increase will take effect on the date of Your request or the date of the increase in Your earnings. You must be Actively at Work on that date. If You are not Actively at Work on the date the increase would otherwise take effect, the increase will take effect on the day You resume Active Work. For Contributory Insurance to take effect, in addition to having been Actively at Work on the date the insurance is to take effect, You must also have been Actively at Work for at least 20 hours during the 7 calendar days preceding that date. Decrease in Insurance A decrease in insurance due to a change in class of employee or a decrease in Your earnings will take effect on the date of change. If You make a Written application to decrease Your insurance, that decrease will take effect as of the date of Your application. Enrollment Due to a Qualifying Event You may enroll for insurance for which You are eligible or change the amount of Your insurance between annual enrollment periods only if You have a Qualifying Event. If You have a Qualifying Event, You will have 12 months from the date of that change or the Employer’s next annual enrollment period following the date of that change to make a request, whichever occurs first . This request must be consistent with the nature of the Qualifying Event. The insurance enrolled for or changes to Your insurance made as a result of a Qualifying Event will take effect on the day after the date of Your request, if You are Actively at Work on that date. If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work.
ELIGIBILITY PROVISIONS: INSURANCE FOR YOU (continued) GCERT2000 34 e/ee Qualifying Event includes: Ÿ marriage; or Ÿ the birth, adoption or placement for adoption of a dependent child; or Ÿ divorce, legal separation or annulment; or Ÿ the death of a dependent; or Ÿ You previously did not enroll for life coverage for You or Your dependent because You had other group coverage, but that coverage has ceased due to loss of eligibility for the other group coverage; or Ÿ Your dependent's ceasing to qualify as a dependent under this insurance or under other group coverage. DATE YOUR INSURANCE ENDS Your insurance will end on the earliest of: 1. the date the Group Policy ends; 2 . the date insurance ends for Your class; 3 . the end of the period for which the last premium has been paid for You; or 4. for Supplemental Life Insurance, the date in which Your employment ends; Your employment will end if You cease to be Actively at Work in any eligible class, except as stated in the section entitled CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT; or 5 . for Supplemental Life Insurance, the date in which You retire in accordance with the Employer’s retirement plan. Please refer to the section entitled ELIGIBILITY FOR CONTINUATION OF CERTAIN INSURANCE WHILE YOU ARE TOTALLY DISABLED for information concerning continuation of Your Life Insurance if insurance ends while You are Totally Disabled. Please refer to the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU for information concerning the option to convert to an individual policy of life insurance if Your Life Insurance ends.
SPECIAL RULES FOR GROUPS PREVIOUSLY COVERED UNDER OTHER GROUP LIFE INSURANCE GCERT2000 35 tog/life The following rules will apply if the Life Insurance under this Group Policy replaces other group Life insurance provided to You by the Employer. Prior Plan means the group life insurance underwritten by another insurer and provided to You by the Employer on the day before the Replacement Date. Replacement Date means the effective date of the Life Insurance under this Group Policy. Rules if You were Covered Under the Prior Plan on the Day Before the Replacement Date: 1. Actively at Work on the Replacement Date - If You were covered under the Prior Plan on the day before the Replacement Date and You are Actively at Work in an eligible class on the Replacement Date, You will be insured under this Group Policy for an amount of Life Insurance referred to as Active Employee Coverage. The amount of the Active Employee Coverage on the Replacement Date will be the amount of Life Insurance described in the SCHEDULE OF BENEFITS. 2. Not Actively at Work on the Replacement Date - If You were covered under the Prior Plan on the day before the Replacement Date and You are not Actively at Work on the Replacement Date, but You would otherwise be a member of an eligible class if You were Actively at Work on the Replacement Date, You will be insured under this Group Policy for an amount of Life Insurance referred to as Transition Coverage. T he amount of the Transition Coverage on the Replacement Date will be the lesser of: ● the amount of group life insurance in effect under the Prior Plan, and ● the amount of Life Insurance available under this Group Policy for the eligible class to which You belong. While Transition Coverage is in effect, the amount of coverage will continue to be determined in accordance with the provisions of the plan used to determine the amount of Transition Coverage on the Replacement Date. If You are not Actively at Work on the Replacement Date due to a disability, Transition Coverage will remain in effect on and after the Replacement Date until the earliest of: ● the date You return to Active Work as a member of an eligible class, at which time Active Employee Coverage will supersede the Transition Coverage; ● the date Life Insurance would otherwise end in accordance with the terms and conditions of this certificate; ● the date on which Your life insurance under the Prior Plan would have ended for any reason other than the Prior Plan ending; ● the date You are approved for extension of life insurance without premium payment under the terms of Prior Plan; and ● if the Prior Plan provided for extension of life insurance without premium payment during a period of disability, the last day of the 12-month period following the Replacement Date.
SPECIAL RULES FOR GROUPS PREVIOUSLY COVERED UNDER OTHER GROUP LIFE INSURANCE (continued) GCERT2000 36 tog/life In any other case where You are not Actively at Work on the Replacement Date, Transition Coverage will remain in effect on and after the Replacement Date until the earliest of: ● the date You return to Active Work as a member of an eligible class, at which time Active Employee Coverage will supersede the Transition Coverage; and ● the date Life Insurance would otherwise end in accordance with the terms and conditions of this certificate. Rules if You were NOT Covered Under the Prior Plan on the Day Before the Replacement Date: 1. You will be eligible for the Life Insurance under this Group Policy when You meet the eligibility requirements for such insurance as described in ELIGIBILITY PROVISIONS: INSURANCE FOR YOU; and 2. We will credit any time accumulated toward any eligibility waiting period under the Prior Plan to the satisfaction of any eligibility Waiting Period required to be met under this Life Insurance.
CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT GCERT2000 37 coi-np FOR FAMILY AND MEDICAL LEAVE Certain leaves of absence may qualify for continuation of insurance under the Family and Medical Leave Act of 1993 (FMLA), or other legally mandated leave of absence or similar laws. Please contact the Employer for information regarding such legally mandated leave of absence laws. AT YOUR OPTION: PORTABILITY For Supplemental Life Insurance If Your Portability Eligible Insurance ends for any of the reasons stated below, You have the option to continue that insurance under another group policy in accordance with the conditions and requirements of this section. This is referred to as Porting. Evidence of Your insurability will not be required. For purposes of this subsection the term “Portability Eligible Insurance” refers to Your Supplemental Life benefits for which the Portability Eligible Insurance is shown as available in the SCHEDULE OF BENEFITS. When Porting is an Option Porting may only be exercised by a request in Writing during the Request Period specified below. If You choose not to Port, Life Insurance benefits may be converted in accordance with the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU. 1 . You may choose to Port if Portability Eligible Insurance ends while You are Actively at Work or on an approved leave of absence because: · You retired from active service with the Employer; or · Your employment ends, due to a reason other than retirement; or · You cease to be in a class that is eligible for such insurance; or · The Policy is amended to end the Portability Eligible Insurance, unless such insurance is replaced by similar insurance under another group insurance policy issued to the Policyholder or its successor; or · This Policy has ended, unless such insurance is replaced by similar insurance under another group insurance policy issued to the Policyholder or its successor. 2 . You may choose to Port the reduced amount of insurance if Your Portability Eligible Insurance is reduced due to: · Your age; or · An amendment to the Plan which affects the amount of insurance for Your class. · the person making the request resides in a jurisdiction that permits this Portability feature. Request Period For You to Port, We must receive a completed request form within the Request Period as described below. If written notice of the option to Port is given within 15 days before or after the date such insurance ends, the Request Period: · begins on the date the insurance ends, and · expires 31 days after the date. If written notice of the option to Port is given more than 15 days after but within 90 days of the date such insurance ends, the Request Period: · begins on the date the insurance ends, and · expires 45 days after the date of the notice.
CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT (continued) GCERT2000 38 coi-np If written notice of the option to Port is not given within 91 days of the date such insurance ends, the Request Period: · begins on the date the insurance ends, and · expires at the end of such 91 day period. Amount of the New Certificate The amount of Ported Insurance for You that may be continued is shown in the SCHEDULE OF BENEFITS. However, at the time of Porting You may change the amount of Portability Eligible Insurance in the following circumstances: Your Increase in Amount For Portability Eligible Life Insurance At the time of Porting, You may increase the amount of Your Portability Eligible Life Insurance. This may be done in increments of $25,000, up to a maximum ported amount of $2,000,000. To be eligible for this increased amount, You must provide evidence of Your insurability satisfactory to us, at Your expense. If We approve the increase, it will take effect on the date We state in Writing. Your Decrease in Amount If We receive a request to decrease an amount of insurance, any such decrease will take place on the date We state in Writing. Premiums for the New Certificate All premium payments must be made directly to Us. When We issue the new certificate, We will also provide a schedule of premiums and payment instructions. You are not required to provide evidence of insurability to Port Your existing amount of Portability Eligible Supplemental Life. However, to qualify for a lower premium rate, You may give us, at Your expense, evidence of Your insurability satisfactory to Us. If We determine that the evidence satisfies Us, We will notify You that the lower premium rates will apply to You. Right to Convert Life Insurance Amounts Not Ported Any amount of Life Insurance not Ported under this subsection may be converted under the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU. If You Die Within 31 Days of the Date Portability Eligible Life Insurance Ends If You die within 31 days of the date Portability Eligible Life Insurance ends and an application to Port is not received by Us during such period, We will determine whether Your life insurance qualifies for payment. This determination will be made in accordance with the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU. If You are Totally Disabled on the Date Your Employment Ends. If You are Totally Disabled on the date Your employment ends and You elect to continue Portability Eligible Insurance as provided in this subsection, You may at a later date become approved for continuation of insurance under the section entitled ELIGIBILITY FOR CONTINUATION OF CERTAIN INSURANCE WHILE YOU ARE TOTALLY DISABLED . If You are so approved, all insurance continued under this subsection or any new certificate provided under this subsection will end and We will return any premium paid by You for such insurance. AT THE EMPLOYER’S OPTION
CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT (continued) GCERT2000 39 coi-np The Employer has elected to continue insurance by paying premiums for employees who cease Active Work in an eligible class for any of the reasons specified below. You will be notified by the Employer how much You will be required to contribute. Insurance will continue for the following periods: 1. for the period You cease Active Work in an eligible class due to injury or Sickness, up to 9 months; 2. for the period You cease Active Work in an eligible class due to part-time work, layoff or strike, up to 2 months; 3. for the period You cease Active Work in an eligible class due to any other Employer approved leave of absence, up to 2 months. 4. for the period You cease Active Work in an eligible class due to any Employer approved leave of absence because of a call-up to active military service, up to 24 months. At the end of any of the continuation periods listed above, Your insurance will be affected as follows: ● if You resume Active Work in an eligible class at this time, You will continue to be insured under the Group Policy; ● if You do not resume Active Work in an eligible class at this time, Your employment will be considered to end and Your insurance will end in accordance with the DATE YOUR INSURANCE ENDS subsection of the section entitled ELIGIBILITY PROVISIONS: INSURANCE FOR YOU. Option to Convert In addition to the Continuation of Insurance options described above, You may have the right to convert to a policy of individual life insurance. We urge You to read the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU.
EVIDENCE OF INSURABILITY GCERT2000 40 eoi We require evidence of insurability satisfactory to Us as follows: 1 . In order to become covered for an amount of Supplemental Life Insurance greater than the Non-Medical Issue Amount as shown in the SCHEDULE OF BENEFITS. If You do not give Us evidence of Your insurability, or if such evidence of insurability is not accepted by Us as satisfactory, the amount of Your Supplemental Life Insurance will be limited to the Non-Medical Issue Amount. 2 . If You make a request during an annual enrollment period to increase the amount of Your Supplemental Life Insurance to an option which is more than one level above Your current amount of Supplemental Life Insurance. If You do not give Us evidence of insurability or the evidence of insurability is not accepted by Us as satisfactory, the amount of Your Supplemental Life Insurance may still increase under the following conditions; ● if Your current level of Supplemental Life Insurance is below the Non-Medical Issue Amount and the option one level higher is also below the Non-Medical Issue Amount, Your Supplemental Life Insurance will be increased to the option one level higher than Your current level. ● if Your current level of Supplemental Life Insurance is below the Non-Medical Issue Amount and the option one level higher is above the Non-Medical Issue Amount, Your Supplemental Life Insurance will be increased to the Non-Medical Issue Amount. If Your current level of Supplemental Life Insurance is above the Non-Medical Issue Amount and You do not give Us evidence of insurability or the evidence of insurability is not accepted by Us as satisfactory, Your Supplemental Life Insurance will not be increased. The Non-Medical Issue Amount is shown in the SCHEDULE OF BENEFITS. 3 . If You make a request during an annual enrollment period to increase the amount of Your Supplemental Life Insurance to an option which is one level above Your current amount of Supplemental Life Insurance and the requested amount is more than the Non-Medical Issue Amount as shown in the SCHEDULE OF BENEFITS. If Your current amount is at or below the Non-Medical Issue Amount and You do not give Us evidence of insurability or the evidence of insurability is not accepted by Us as satisfactory, the amount of Your Supplemental Life Insurance will be limited to the Non-Medical Issue Amount. 4 . If You make a request to increase the amount of Your Supplemental Life Insurance. If You do not give Us evidence of insurability or the evidence of insurability is not accepted by Us as satisfactory, the amount of Your Supplemental Life Insurance will not be increased. 5. When You make a late request for Supplemental Life Insurance. A late request is one made more than 12 months after You become eligible or after the Employer’s next annual enrollment period, whichever occurs first. If You do not give Us evidence of insurability or the evidence of insurability is not accepted by Us as satisfactory, You will not be covered for Supplemental Life Insurance. 6 . In the case of transferred business, if You did not elect coverage under the prior plan for which You were eligible. If You do not give Us evidence of insurability or the evidence of insurability is not accepted by Us as satisfactory, You will not be covered for Supplemental Life Insurance.
EVIDENCE OF INSURABILITY (continued) GCERT2000 41 eoi The evidence of insurability is to be given at Your expense.
LIFE INSURANCE: FOR YOU GCERT2000 42 l/ee If You die, Proof of Your death must be sent to Us. When We receive such Proof with the claim, We will review the claim and if We approve it, will pay the Beneficiary the Life Insurance in effect on the date of Your death. PAYMENT OPTIONS We will pay the Life Insurance in one sum. Other modes of payment may be available upon request. For details, call Our toll free number shown on the Certificate Face Page.
LIFE INSURANCE: ACCELERATED BENEFIT OPTION (ABO) FOR YOU GCERT2000 abo/ee 10/04 43 For purposes of this section, the term “ABO Eligible Life Insurance” refers to each of Your Life Insurance benefits for which the Accelerated Benefit Option is shown as available in the Schedule of Benefits. If You become Terminally Ill, You or Your legal representative have the option to request Us to pay ABO Eligible Life Insurance before Your death. This is called an accelerated benefit. The request must be made while ABO Eligible Life Insurance is in effect. Terminally Ill or Terminal Illness means that due to injury or sickness, You are expected to die within 12 months. Requirements For Payment of an Accelerated Benefit Subject to the conditions and requirements of this section, We will pay an accelerated benefit to You or Your legal representative if: ● the amount of each ABO Eligible Life Insurance benefit to be accelerated equals or exceeds $20,000; and ● the ABO Eligible Life Insurance to be accelerated has not been assigned; and ● We have received Proof that You are Terminally Ill. We will only pay an accelerated benefit for each ABO Eligible Life Insurance benefit once. Proof of Your Terminal Illness We will require the following Proof of Your Terminal Illness: ● a completed accelerated benefit claim form; ● a signed Physician’s certification that You are Terminally Ill; and ● an examination by a Physician of Our choice, at Our expense, if We request it. You or Your legal representative should contact the Employer to obtain a claim form and information regarding the accelerated benefit. Upon Our receipt of Your request to accelerate benefits, We will send You a letter with information about the accelerated benefit payment You requested. Our letter will describe the amount of the accelerated benefits We will pay and the amount of Life Insurance remaining after the accelerated benefit is paid. Accelerated Benefit Amount We will pay an accelerated benefit up to the percentage shown in the SCHEDULE OF BENEFITS for each ABO Eligible Life Insurance benefit in effect for You, subject to the following: Maximum accelerated benefit amount. The maximum amount We will pay for each ABO Eligible Life Insurance benefit is shown in the SCHEDULE OF BENEFITS . Scheduled reduction of an ABO Eligible Life Insurance Benefit. If an ABO Eligible Life Insurance benefit is scheduled to reduce within the 12 month period after the date You or Your legal representative request an accelerated benefit, We will calculate the accelerated benefit using the amount of such ABO Eligible Life Insurance that will be in effect immediately after the reduction(s) scheduled for such period. Scheduled end of ABO Eligible Life Insurance Benefit. If an ABO Eligible Life Insurance benefit is scheduled to end within 12 months after the date You or Your legal representative request an accelerated benefit, We will not pay an accelerated benefit for such ABO Eligible Life Insurance benefit. Previous conversion of an ABO Eligible Life Insurance Benefit. We will not pay an accelerated benefit for any amount of ABO Eligible Life Insurance which You previously converted under the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU . We will pay the accelerated benefit in one sum unless You or Your legal representative select another payment mode.
LIFE INSURANCE: ACCELERATED BENEFIT OPTION (ABO) FOR YOU (continued) GCERT2000 abo/ee 10/04 44 Effect of Payment of an Accelerated Benefit On premium for Your Life Insurance. After We pay the accelerated benefit, any premium You are required to pay will be based upon the amount of Your Life Insurance remaining after the accelerated benefit is paid. On Your Life Insurance at Your death . The amount of Life Insurance that We will pay at Your death will be decreased by: ● the amount of the accelerated benefit paid by Us. On Your Life Insurance at conversion . The amount to which You are entitled to convert under the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU, will be decreased by: ● the amount of the accelerated benefit paid by Us. Date Your Option to Accelerate Benefits Ends The accelerated benefit option will end on the earliest of: ● the date ABO Eligible Life Insurance ends; ● the date You or Your legal representative assign all ABO Eligible Life Insurance; or ● the date You or Your legal representative have accelerated all ABO Eligible Life Insurance benefits.
LIFE INSURANCE: CONVERSION OPTION FOR YOU GCERT2000 45 co/l/ee If Your Life Insurance ends or is reduced for any of the reasons stated below, You have the option to buy an individual policy of life insurance (“new policy”) from Us during the Application Period in accordance with the conditions and requirements of this section. This is referred to as the “option to convert”. Evidence of Your insurability will not be required. When You Will Have the Option to Convert You will have the option to convert when: ● Your Life Insurance ends because: ● You cease to be in an eligible class; or ● Your employment ends; or ● the Group Policy ends provided You have been insured for Life Insurance for at least 5 years; or ● the Group Policy is amended to end Life Insurance for an eligible class of which You are a member, provided You have been insured for Life Insurance for at least 5 years; or ● Your Life Insurance is reduced: ● on or after the date You attain age 60 in any increment or series of increments aggregating 20% or more of the amount of Your Life Insurance in effect before the first reduction due to Your age; ● because You change from one eligible class to another; or ● due to an amendment of the Group Policy. If You opt not to convert a reduction in the amount of Your Life Insurance as described above, You will not have the option to convert that amount at a later date. A reduction in the amount of Your Life Insurance as a result of the payment of an accelerated benefit will not give rise to a right to convert under this section. Application Period If You opt to convert Your Life Insurance for any of the reasons stated above, We must receive a completed conversion application form from You within the Application Period described below. If You are given Written notice of the option to convert within 15 days before or after the date Your Life Insurance ends or is reduced, the Application Period begins on the date that such Life Insurance ends or is reduced and expires 31 days after such date. If You are given Written notice of the option to convert more than 15 days after but within 90 days of the date Your Life Insurance ends or is reduced, the Application Period begins on the date such Life Insurance ends or is reduced and expires 15 days from the date of such notice. In no event will the Application Period exceed 91 days from the date Your Life Insurance ends or is reduced. Option Conditions The option to convert is subject to these conditions: 1 . Our receipt within the Application Period of: ● Your Written application for the new policy; and ● the premium due for such new policy; 2 . The premium rates for the new policy will be based on: ● Our rates then in use; ● the form and amount of insurance; ● Your class of risk; and ● Your attained age when Your Life Insurance ends or is reduced; 3 . the new policy may be on any form then customarily offered by Us excluding term insurance;
LIFE INSURANCE: CONVERSION OPTION FOR YOU (continued) GCERT2000 46 co/l/ee 4 . the new policy will be issued without an accidental death and dismemberment benefit, a continuation benefit, an accelerated benefit option, a waiver of premium benefit or any other rider or additional benefit; and 5 . the new policy will take effect on the 32 nd day after the date Your Life Insurance ends or is reduced; this will be the case regardless of the duration of the Application Period. Maximum Amount of the New Policy If Your Life Insurance ends due to the end of the Group Policy or the amendment of the Group Policy to end Life Insurance for an eligible class of which You are a member, the maximum amount of insurance that You may elect for the new policy is the lesser of: ● the amount of Your Life Insurance that ends under the Group Policy less the amount of life insurance for which You become eligible under any group policy within 31 days after the date insurance ends under the Group Policy; or ● $2,000 If Your Life Insurance ends for any other reason, the maximum amount of insurance that You may elect for the new policy is the amount of Your Life Insurance that ends under the Group Policy. If You Die Within 31 Days After Your Life Insurance Ends or is reduced If You die within 31 days after Your Life Insurance ends or is reduced by an amount You are entitled to convert, Proof of Your death must be sent to Us. When We receive such Proof with the claim, We will review the claim and if We approve it will pay the Beneficiary the amount of Life Insurance You were entitled to convert. Effect of Previous Conversion If You obtained a new policy through this conversion option and Your Life Insurance is later continued under the section entitled ELIGIBILITY FOR CONTINUATION OF CERTAIN INSURANCE WHILE YOU ARE TOTALLY DISABLED. We will only pay Your Life Insurance under such section if the new policy is returned to Us. If the new policy is returned to us, We will refund to Your estate the premium paid for such policy without interest, less any debt incurred under such policy. If the new policy is not returned to Us, We will only pay the life insurance in effect under such new policy. We will not pay insurance under both the Group Policy and the new policy.
ELIGIBILITY FOR CONTINUATION OF CERTAIN INSURANCE WHILE YOU ARE TOTALLY DISABLED GCERT2000 47 cp/all If You become Totally Disabled while You are insured for Continuation Eligible Insurance under this policy, You may qualify to continue certain insurance under this section. If continued, premium payment will not be required. We will determine if You qualify for this continuation after We receive Proof that You have satisfied the conditions of this section. Total Disability must start before You attain age 60 and while You are insured for Continuation Eligible Insurance. Your Total Disability must continue without interruption from the date You became Totally Disabled through the end of the Continuation Waiting Period. DEFINITIONS For the purpose of this section, “Continuation Eligible Insurance” means Your · Supplemental Life Insurance; to the extent that such insurance was in effect for You on the date Your Total Disability began. Continuation Eligible Insurance does not include Life Insurance amounts accelerated under the section entitled LIFE INSURANCE: ACCELERATED BENEFIT OPTION FOR YOU. Continuation Waiting Period means the period which starts on the date You become Totally Disabled and ends 9 consecutive months later. Total Disability or Totally Disabled means, for purposes of this section, that due to an injury or sickness: · You are unable to perform the material and substantial duties of Your regular job; and · You are unable to perform any other job for which You are fit by education, training or experience. TOTAL DISABILITY AND PROOF REQUIREMENTS If You become disabled You should contact Us as soon as reasonably possible. After the Continuation Waiting Period ends, You must send Us Proof that You were Totally Disabled with no interruption throughout the Continuation Waiting Period. You must do this within the time frame specified in the section entitled FILING A CLAIM. As part of such Proof, We may choose a Physician to examine You to verify that You are Totally Disabled. We will pay for the exam. After We receive and review Your Proof, We will determine if You qualify. We will notify You in writing of Our decision. To verify that You continue to be Totally Disabled without interruption, We may require from time to time that You send Us Proof that You continue to be Totally Disabled. We will not ask for Proof more than once each year. IF YOU DIE DURING CONTINUATION If You die during the continuation, Proof of the death must be sent to Us. In addition to the Proof which is otherwise required for the insurance, the Proof must show that Your Total Disability continued with no interruption from the date We informed You that the continuation was approved until the date of the death. When We receive such Proof with the claim, We will review the claim and if We approve it, will pay any benefit payable under the insurance continued under this section.
ELIGIBILITY FOR CONTINUATION OF CERTAIN INSURANCE WHILE YOU ARE TOTALLY DISABLED GCERT2000 48 cp/all EFFECT OF PREVIOUS CONVERSION If You converted any portion of Your Continuation Eligible Life Insurance to an individual policy, We will only pay the life insurance under this section if the individual policy is returned to Us. If it is returned to Us, We will refund to Your estate the premiums paid for such policy without interest, less any debt incurred under such policy. If such individual policy is not returned to Us, We will pay the life insurance in effect under the individual policy. We will not pay insurance under both the Group Policy and the individual policy. EFFECT OF PREVIOUS ELECTION TO PORT COVERAGE If You ported any portion of Your Continuation Eligible Insurance to a certificate under another policy, We will only pay insurance under this section if the other policy’s certificate is surrendered to Us. If it is returned to Us, We will refund to Your estate the premiums paid under such policy without interest. If that certificate is not returned to Us, We will pay any insurance which applies under the other policy’s certificate. We will not pay insurance under both this Group Policy and the other policy. DATE CONTINUATION ENDS The Continuation Eligible Insurance continued under this section may be continued in a reduced amount on account of Your age or the payment of accelerated benefits and will end at the earliest of: 1. the date You die; 2. the date Your Total Disability ends; 3. the date You do not give Us Proof of Total Disability, as required; 4. the date You refuse to be examined by Our Physician, as required; 5 . if You become Totally Disabled before age 60, the date You reach age 65. Option To Convert Your Continuation Eligible Life Insurance When a continuation under this section ends, You may buy an individual policy of life insurance from Us. The details of this option are described in the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU. For the purpose of that section, the end of this continuation will be considered the end of Your employment. You may not use the conversion option described in those sections if before the end of the Application Period for conversion You return to Active Work in an eligible class and become insured under the Group Policy. You will not be able to convert any of Your Continuation Eligible Life Insurance which You have already converted to an individual policy. Option To Port Your Continuation Eligible Insurance When a continuation under this section ends, You may elect to port to a different policy the insurance which has been continued under this section. The details of this option are described in the At Your Option: Portability subsection of the CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT section. For the purpose of that section, the end of this continuation will be considered the end of Your employment. You may not use the portability option described in that section if before the end of the Portability Request Period, You return to Active Work in an eligible class and become insured under the Group Policy. You will not be able to port any of Your Continuation Eligible Insurance which You have already converted to an individual policy.
FILING A CLAIM GCERT2000 49 claim 10/04 The Employer should have a supply of claim forms. Obtain a claim form from the Employer and fill it out carefully. Return the completed claim form with the required Proof to the Employer. The Employer will certify Your insurance under the Group Policy and send the certified claim form and Proof to Us. When we receive the claim form and Proof We will review the claim and, if We approve it, We will pay benefits subject to the terms and provisions of this certificate and the Group Policy. CLAIMS FOR LIFE INSURANCE BENEFITS When a claimant files a claim for Life Insurance benefits , Proof should be sent to Us as soon as is reasonably possible after the death of an insured.
GENERAL PROVISIONS GCERT2000 50 gp 10/04 Assignment You may assign Your Life Insurance rights and benefits under the Group Policy as a gift or as a viatical assignment. We will recognize the assignee(s) under such assignment as owner(s) of Your right, title and interest in the Group Policy if: 1. a Written form satisfactory to Us, affirming this assignment, has been completed; 2. the Written form has been Signed by You and the assignee(s); 3. the Employer acknowledges that the Life Insurance being assigned is in force on the life of the assignor; and 4. the Written form is delivered to Us for recording. Viatical assignments may only be made after Your Life Insurance has been in effect under this certificate for 2 years. However, you may make a viatical assignment before the end of the 2 year period if you are Terminally Ill. Terminally Ill means that You are expected to die within 6 months. As Proof of Your Terminal Illness You or Your legal representative must send Us a signed Physician’s certification that You are Terminally Ill. We may also request an exam by a Physician of Our choice, at Our expense. Beneficiary You may designate a Beneficiary in Your application or enrollment form. You may change Your Beneficiary at any time. To do so, You must send a Signed and dated, Written request to the Employer using a form satisfactory to Us. Your Written request to change the Beneficiary must be sent to the Employer within 30 days of the date You Sign such request. You do not need the Beneficiary’s consent to make a change. When We receive the change, it will take effect as of the date You Signed it. The change will not apply to any payment made in good faith by Us before the change request was recorded. If two or more Beneficiaries are designated and their shares are not specified, they will share the insurance equally. If there is no Beneficiary designated or no surviving designated Beneficiary at Your death, We may determine the Beneficiary to be one or more of the following who survive You: 1. Your Spouse; 2. Your child(ren); 3. Your parent(s); or 4. Your siblings(s) · Instead of making payment to any of the above, we may pay Your estate. Any payment made in good faith will discharge our liability to the extent of such payment. If a Beneficiary or payee is a minor or incompetent to receive payment, We will pay that person’s guardian. Suicide (See notice page for residents of Missouri) For Supplemental Life If You commit suicide within 2 years from the date Life Insurance for You takes effect, We will not pay such insurance and Our liability will be limited as follows: · any premium paid by You will be returned to the Beneficiary. · any premium paid by the Employer will be returned to the Employer. If You commit suicide 2 years from the date an increase in Your Life Insurance takes effect, We will pay to the Beneficiary the amount of insurance in effect on the day before the increase. Any premium You paid for the
GENERAL PROVISIONS (continued) GCERT2000 51 gp 10/04 increase will be returned to the Beneficiary. Any premium paid by the Employer for the increase will be returned to the Employer. Entire Contract Your insurance is provided under a contract of group insurance with the Employer. The entire contract with the Employer is made up of the following: 1. the Group Policy and its Exhibits, which include the certificate(s); 2. the Employer's application ; and 3. any amendments and/or endorsements to the Group Policy. Incontestability: Statements Made by You Any statement made by You will be considered a representation and not a warranty. We will not use such statement to avoid insurance, reduce benefits or defend a claim unless the following requirements are met: 1. the statement is in a Written application or enrollment form; 2. You have Signed the application or enrollment form; and 3. a copy of the application or enrollment form has been given to You or Your Beneficiary. We will not use Your statements which relate to insurability to contest life insurance after it has been in force for 2 years during Your life. In addition, We will not use such statements to contest an increase or benefit addition to such insurance after the increase or benefit has been in force for 2 years during Your life. Misstatement of Age If Your age is misstated, the correct age will be used to determine if insurance is in effect and, as appropriate, We will adjust the benefits and/or premiums. Conformity with Law If the terms and provisions of this certificate do not conform to any applicable law, this certificate shall be interpreted to so conform. Autopsy Subject to Your religious practices or beliefs, We have the right to make a reasonable request for an autopsy where permitted by law. Any such request will set forth the reasons We are requesting the autopsy.
THIS IS THE END OF THE CERTIFICATE. THE FOLLOWING IS ADDITIONAL INFORMATION
CPN-Initial Enr/SOH and SBR (08/21) Page 1 Delaware American Life Insurance Company MetLife Health Plans, Inc. MetLife Legal Plans, Inc. MetLife Legal Plans of Florida, Inc. Metropolitan General Insurance Company Metropolitan Life Insurance Company Metropolitan Tower Life Insurance Company SafeGuard Health Plans, Inc. SafeHealth Life Insurance Company Our Privacy Notice We know that you buy our products and services because you trust us. This notice explains how we protect your privacy and treat your personal information. It applies to current and former customers. “Personal information” as used here means anything we know about you personally. SECTION 1: Plan Sponsors and Group Insurance Contract Holders This privacy notice is for individuals who apply for or obtain our products and services under an employee benefit plan, group insurance or annuity contract, or as an executive benefit. In this notice, “you” refers to these individuals. SECTION 2: Protecting Your Information We take important steps to protect your personal information. We treat it as confidential. We tell our employees to take care in handling it. We limit access to those who need it to perform their jobs. Our outside service providers must also protect it, and use it only to meet our business needs. We also take steps to protect our systems from unauthorized access. We comply with all laws that apply to us. SECTION 3: Collecting Your Information We typically collect your name, address, age, and other relevant information. We may also collect information about any business you have with us, our affiliates, or other companies. Our affiliates include life insurers, a legal plans company and a securities broker-dealer. In the future, we may also have affiliates in other businesses. SECTION 4: How We Get Your Information We get your personal information mostly from you. We may also use outside sources to help ensure our records are correct and complete. These sources may include consumer reporting agencies, employers, other financial institutions, adult relatives, and others. These sources may give us reports or share what they know with others. We don’t control the accuracy of information outside sources give us. If you want to make any changes to information we receive from others about you, you must contact those sources. We may ask for medical information. The Authorization that you sign when you request insurance permits these sources to tell us about you. We may also, at our expense: · Ask for a medical exam · Ask for blood and urine tests · Ask health care providers to give us health data, including information about alcohol or drug abuse We may also ask a consumer reporting agency for a “consumer report” about you (or anyone else to be insured). Consumer reports may tell us about a lot of things, including information about: · Reputation · Driving record · Finances · Work and work history · Hobbies and dangerous activities The information may be kept by the consumer reporting agency and later given to others as permitted by law. The agency will give you a copy of the report it provides to us, if you ask the agency and can provide adequate identification. If you write to us and we have asked for a consumer report about you, we will tell you so and give you the name, address and phone number of the consumer reporting agency. Another source of information is MIB, Inc. (“MIB”). It is a not-for-profit membership organization of insurance companies which operates an information exchange on behalf of its Members. We, or our reinsurers, may make a brief report to MIB. If you apply to another MIB Member company for life or health insurance coverage, or a claim for benefits is submitted, MIB, upon request, will supply such company with the information in its file. Upon receipt of a request from you MIB will arrange disclosure of any information it may have in your file. Please contact MIB at 866-692-6901. If you question the accuracy of information in MIB’s
CPN-Initial Enr/SOH and SBR (08/21) Page 2 file, you may contact MIB and seek a correction in accordance with the procedures set forth in the federal Fair Credit Reporting Act. You may do so by writing to MIB, Inc., 50 Braintree Hill, Suite 400, Braintree, MA 02184- 8734 or go to MIB website at www.mib.com . SECTION 5: Using Your Information We collect your personal information to help us decide if you’re eligible for our products or services. We may also need it to verify identities to help deter fraud, money laundering, or other crimes. How we use this information depends on what products and services you have or want from us. It also depends on what laws apply to those products and services. For example, we may also use your information to: · administer your products and services · process claims and other transactions · perform business research · confirm or correct your information · market new products to you · help us run our business · comply with applicable laws SECTION 6: Sharing Your Information With Others We may share your personal information with others with your consent, by agreement, or as permitted or required by law. We may share your personal information without your consent if permitted or required by law. For example, we may share your information with businesses hired to carry out services for us. We may also share it with our affiliated or unaffiliated business partners through joint marketing agreements. In those situations, we share your information to jointly offer you products and services or have others offer you products and services we endorse or sponsor. Before sharing your information with any affiliate or joint marketing partner for their own marketing purposes, however, we will first notify you and give you an opportunity to opt out. Other reasons we may share your information include: doing what a court, law enforcement, or government agency requires us to do (for example, complying with search warrants or subpoenas) telling another company what we know about you if we are selling or merging any part of our business giving information to a governmental agency so it can decide if you are eligible for public benefits giving your information to someone with a legal interest in your assets (for example, a creditor with a lien on your account) giving your information to your health care provider having a peer review organization evaluate your information, if you have health coverage with us those listed in our “Using Your Information” section above SECTION 7: HIPAA We will not share your health information with any other company – even one of our affiliates – for their own marketing purposes. The Health Insurance Portability and Accountability Act (“HIPAA”) protects your information if you request or purchase dental, vision, long-term care and/or medical insurance from us. HIPAA limits our ability to use and disclose the information that we obtain as a result of your request or purchase of insurance. Information about your rights under HIPAA will be provided to you with any dental, vision, long- term care or medical coverage issued to you. You may obtain a copy of our HIPAA Privacy Notice by visiting our website at www.MetLife.com . For additional information about your rights under HIPAA; or to have a HIPAA Privacy Notice mailed to you, contact us at [email protected] , or call us at telephone number (212) 578-0299. SECTION 8: Accessing and Correcting Your Information You may ask us for a copy of the personal information we have about you. We will provide it as long as it is reasonably locatable and retrievable. You must make your request in writing listing the account or policy numbers with the information you want to access. For legal reasons, we may not show you privileged information relating to a claim or lawsuit, unless required by law.
CPN-Initial Enr/SOH and SBR (08/21) Page 3 If you tell us that what we know about you is incorrect, we will review it. If we agree, we will update our records. Otherwise, you may dispute our findings in writing, and we will include your statement whenever we give your disputed information to anyone outside MetLife. SECTION 9: Questions We want you to understand how we protect your privacy. If you have any questions or want more information about this notice, please contact us. A detailed notice shall be furnished to you upon request. When you write, include your name, address, and policy or account number. Send privacy questions to : MetLife Privacy Office P. O. Box 489 Warwick, RI 02887-9954 [email protected] We may revise this privacy notice. If we make any material changes, we will notify you as required by law. We provide this privacy notice to you on behalf of the MetLife companies listed at the top of the first page.
LEGAL SERVICES INSURANCE
MG WP-ERS 20 CERT 1 Wills, ERS Metropolitan General Insurance Company 700 Quaker Lane, Warwick, RI 02886 Legal Services Plan Certificate of Coverage Wills and Estate Resolution Services This Legal Services Plan is insured by Metropolitan General Insurance Company; a Rhode Island company with its principal place of business at 700 Quaker Lane, Warwick, Rhode Island, 02886. Administrative services are provided under the policy by MetLife Legal Plans, Inc. (“MetLife Legal Plans”), a Delaware Corporation and an affiliate of Metropolitan General Insurance Company. Any reference to MetLife Legal Plans is as the Administrator. This certificate certifies that if You are an Eligible Employee, You are insured for the Covered Legal Services described in this certificate, subject to the provisions of this certificate. This certificate is issued under the Group Legal Services Policy and includes the terms and provisions of the Group Legal Services Policy that describe this insurance. Please read this certificate carefully. Name and Address of Policyholder: Buckingham Browne and Nichols School 80 Gerrys Landing Rd CAMBRIDGE, MA 02138 Group Policy Effective Date: June 1, 2023 Contacting MetLife Legal Plans MetLife Legal Plans, Inc. may be contacted by phone or mail as follows: Phone: 1-800-821-6400 Mail: 1111 Superior Avenue Cleveland, OH 44114-2507 Definitions Covered Legal Services means the following services: Estate Resolution Services - Certain probate services to be made available to Your or Your Spouse’s estate upon Your or Your Spouse’s death, respectively. These services provide representation and payment of legal fees for the executor or administrator of Your or Your Spouse’s estate and include all court proceedings needed to transfer probate assets from Your or Your Spouse’s estate to Your or Your Spouse’s heirs, respectively; the correspondence necessary to transfer non-probate assets such as proceeds from insurance policies, joint bank accounts, stock accounts or a house; and associated tax filings. The service also includes telephone and office consultations with beneficiaries related to probating the covered estate. Will Preparation - A service covering the preparation of wills, codicils, living wills and powers of attorney (when You or Your Spouse are granting the power) for You or Your Spouse. The creation of any testamentary trust is covered. The service does not include tax planning. Eligible Employee means each employee who is insured under the Policyholder's plan of group supplemental life insurance with Metropolitan Life Insurance Company (MetLife). Legal Services Plan or Plan means the group policy to provide insurance for Covered Legal Services. Metropolitan means Metropolitan General Insurance Company.
MG WP-ERS 20 CERT 2 Wills, ERS Plan Attorney means an attorney who has contracted with Metropolitan or the Administrator to provide Covered Legal Services. Spouse means Your lawful Spouse or Qualified Domestic Partner or Civil Union Partner. Qualified Domestic Partner or Civil Union Partner means a person who qualifies for coverage (a) as a domestic partner or civil union partner under another employee benefit provided by the Policyholder or (b) as required by applicable law We, Us and Our means MetLife Legal Plans, Inc. You and Your means an Eligible Employee. How the Group Legal Services Plan Works To use the Group Legal Services Plan for Will Preparation, You can call MetLife Legal Plans. You should be prepared to identify Yourself as a participant in the Will Preparation Service Plan. To use the Group Legal Services Plan for Estate Resolution Services, the executor or administrator of Your or Your deceased Spouse’s estate should call MetLife Legal Plans and be prepared to identify themselves as the executor or administrator of the deceased’s estate. In either situation when calling MetLife Legal Plans, the Client Service Representative who answers the call will: make an initial determination of whether and to what extent the matter is covered; give a case number (a new case number will be needed for each new matter); give the telephone number(s) and location of the nearest Plan Attorney(s); and answer questions about the Plan. A Plan Attorney or a non-Plan Attorney may be used. If a Plan Attorney is used, the Plan Attorney will provide the Covered Legal Services described above. If a non-Plan Attorney is used, the plan member, executor or administrator of the estate must notify MetLife Legal Plans. MetLife Legal Plans will send a claim form and informational material including a Non-Plan Attorney Fee Schedule. After the matter is finished, the claim form must be completed and returned to MetLife Legal Plans with the attorney’s final bill. Within 60 days of MetLife Legal Plans' receipt of the completed claim form and final bill, MetLife Legal Plans will pay the claimant an amount equal to the lesser of the amount the claimant paid for the attorney’s services and the amount stated in the Non-Plan Attorney Fee Schedule. The plan member, administrator or executor will be responsible for making payment to the non-Plan Attorney for any expenses or costs and/or fees incurred in excess of the amount paid by MetLife Legal Plans. If a claim is denied in whole or in part, MetLife Legal Plans may be asked to provide a written statement with the reason(s) for the denial and with information as to the steps that need to be taken to appeal the denial.
MG WP-ERS 20 CERT 3 Wills, ERS Exclusions Excluded services are those legal services that are not provided under the plan. No services can be provided for the following matters: Matters in which there is a conflict of interest between Your or Your Spouse’s estate and the Policyholder; Matters in which there is a conflict of interest between the executor, administrator, any beneficiary or heir and the deceased’s estate; Any employment-related matter, including Policyholder or statutory benefits; Any dispute with the Policyholder, MetLife and affiliates and Plan Attorneys; Will Contests or litigation outside Probate Court; Appeals; Costs, expenses to a third party or fines; or Frivolous or unethical matters. Requirements for Coverage All Eligible Employees are participants in the Plan. Because this is a Non-Contributory Plan, You do not need to contribute to the cost of coverage. You will be a participant in the Plan on the later of the Group Policy Effective Date or the date You become an Eligible Employee. How Insurance Coverage Ends Your insurance coverage will end upon the first of the following to occur: ● the date the Group Legal Services Policy ends, or ● the last day of the month in which a person cease to be an Eligible Employee. Other Important Information Plan Attorneys may not request or accept additional compensation for providing Covered Legal Services, except for expenses or payments required to be made to third parties. Complaints regarding the conduct of an attorney who provides Covered Legal Services under the Plan may be made to the state bar association. If, at any time, a question or concern arises about the Covered Legal Services received, please call MetLife Legal Plans, Inc. MetLife Legal Plans and Metropolitan will work hard to fix the problem. A Legal Plan Member Survey form is available upon request. This form will be used by MetLife to help evaluate and improve services. This form can be faxed to MetLife using the number shown on the form. The use of the Covered Person’s name is optional. You have the right to complain to the Board of Bar Overseers concerning attorney conduct in the providing of legal services. Complaint procedures and information regarding the process can be obtained from the Office of the Bar Counsel at 99 High Street, Boston, MA 02110, telephone: 617-728-8750. Any dispute or controversy arising between an insurer or sponsor and any attorney, insured, or member, or any person whose insurance certificate contract or membership certificate has been canceled or to whom an insurer or sponsor has refused to issue an insurance certificate contract or membership certificate or between any attorney and an insured or member may, within 30 days after such dispute or controversy arises, make written request to the Massachusetts Division of Insurance commissioner for a hearing thereon. The commissioner or the commissioner’s designee shall hear such party or parties within 30 days after receipt of such request and shall give not less than 15 days written notice of the time and place of the hearing. Such hearing shall be an adjudicatory hearing as defined in MA Gen L ch 30A § 1. Within 30 days after such hearing the commissioner or the commissioner’s designee shall issue a decision thereon. Such hearing may be requested from the Consumer Section of the Division of Insurance at 1000 Washington Street, Suite 810, Boston, MA 02118 through its website, www.mass.gov/doi . Nothing contained in this certificate is intended to interfere with freedom of choice in the selection of an attorney or with the attorney-client relationship.
THIS IS THE END OF THE LEGAL SERVICES INSURANCE CERTIFICATE.