massmutual disability option summary plan description for

MassMutual Disability Option

Summary Plan Description for Career Contract Agents and

for General Agents and General Managers

Effective January 1, 2010

This Summary Plan Description (SPD), published in August 2010, takes the place of any SPDs and Summaries of Material Modifications (SMMs) previously issued to you describing your benefits.

MassMutual Disability Option-Agents August 2010 of 61

Table of Contents

Disclaimer ..................................................................................................................................................................3 Introduction ................................................................................................................................................................4 Contact Information....................................................................................................................................................5 Short Term Disability (STD) Program – For Career Contract Agents .......................................................................6 Short Term Disability (STD) Program – For Career Contract Agents .......................................................................6 Short Term Disability (STD) Program – For General Agents and General Managers.............................................11 Long Term Disability (LTD) Coverage – For Career Contract Agents ...................................................................14 Long Term Disability (LTD) Coverage – For General Agents and General Managers ...........................................17 Liberty Life Assurance Company of Boston Certificate ..........................................................................................20 Claiming Benefits.....................................................................................................................................................48 Appeals Procedures ..................................................................................................................................................51 About Your Coverage...............................................................................................................................................53 Plan Information.......................................................................................................................................................57 ERISA Rights ...........................................................................................................................................................59 Dictionary Terms......................................................................................................................................................61


Disclaimer

This Summary Plan Description (SPD) provides details of the disability program option available to you through the MassMutual Agents’ Welfare Benefits Plan. This SPD contains detailed and important information about the Plan; every attempt has been made to communicate this information clearly and in easily understandable terms. This SPD replaces and supersedes all previous SPD versions and Summaries of Material Modifications (SMMs).

Benefits are determined under the terms of the Plan in effect at the time you become eligible for the specific benefits. Benefits are based on current laws and regulations, which are subject to change. Massachusetts Mutual Life Insurance Company (“the Company” or “MassMutual”) reserves the right to modify, revoke, change, suspend or terminate any one or all plans, programs, policies, benefits or services described in this SPD or the underlying Plan documents at any time and from time to time, with or without notice. This SPD does not guarantee any particular benefit. Receipt of this SPD describing the Plan or option for which you are not eligible does not imply that you are eligible.

In the event of a discrepancy between descriptions in this SPD and information in relevant Plan documents, the Plan documents will govern. Career contract and general agents are independent contractors; provision of benefits does not change that relationship.


Introduction

MassMutual provides a two-part disability program to give you continued income if you become sick or Disabled and cannot be in Active Service. The Short-Term Disability (STD) Program precedes any Long-Term Disability (LTD) benefits. Both programs are described in this booklet to illustrate how the programs work together.

Career Contract Agents: STD coverage, which is provided at no cost to you if you meet minimum production requirements, replaces 50% of your Basic Weekly Earnings before LTD coverage begins. For LTD coverage, the Plan provides you flexibility to choose the coverage that is right for you. You have two LTD options to choose from: • Base LTD (also known as LTD 50): Replaces up to 50% of your Basic Monthly Earnings. It is provided at

no cost to you if you meet minimum production requirements (refer to the Production Requirements section and the definition of Basic Monthly Earnings for more information).

• Buy Up LTD (also known as LTD 70): Replaces up to 70% of your Basic Monthly Earnings. You pay for the cost of this coverage (refer to the Cost of Coverage section for more information).

General Agents and General Managers: STD coverage, which is provided at no cost to you, provides a Weekly Benefit before LTD benefits begin. For LTD coverage, the Plan provides you flexibility to choose the coverage that is right for you. You have two LTD options to choose from: • Base LTD: Provides a flat Monthly Benefit of $10,000, at no cost to you. • Buy Up LTD: Provides an additional flat Monthly Benefit ranging from $2,000 to $10,000. Eligibility is

based on your agency production (refer to the Eligibility section for more information). You pay for the cost of this coverage.

Liberty Life Assurance Company of Boston (Liberty Mutual), a member of the Liberty Mutual Group, currently administers the STD program and issues the policy and fully insures the LTD option. A copy of Liberty Mutual’s Certificate of Coverage is included with this document. Refer to the Liberty Life Assurance Company of Boston Certificate section for details of the programs.

You must satisfy the requirements described in this SPD to receive STD and LTD coverage.


Contact Information

Resource Web Site Telephone Liberty Mutual Disability Claims P.O. Box 7211 London, KY 40742-7211

www.Mylibertyclaim.com Claimant ID: Agents

800-713-7384 (claim submission) 888-440-6118 (claim service)

MassMutual Benefits Performance Excellence-Disability Unit

Website: https://mmfgonline.massmutual.com E-mail: [email protected] E-mail: [email protected]

866-662-6448, select prompt for Group Disability Unit


http://www.mylibertyclaim.com/

https://mmfgonline.massmutual.com/

mailto:[email protected]

mailto:[email protected]

Short Term Disability (STD) Program – For Career Contract Agents

Eligibility

You are eligible for STD coverage if you are a: • Career contract agent with a valid career agent contract; or • Sales manager with a career contract and valid sales manager addendum.

Note: The disability coverage option for General Agents and General Managers is described in a separate section of this SPD.

Ineligible Participants

You are not eligible for this coverage if you are: • A broker; • A retired agent; • An agency staff member; • An employee of MassMutual or one of its subsidiaries; • An eligible agent who did not elect disability coverage; or • Anyone otherwise excluded by the Plan terms.

Production Requirements

As a career contract agent, to be eligible for subsidized benefits, each year you must satisfy certain requirements: Agent Type Production Requirements Non-financed career contract agent Annual contract minimum requirements Financed career contract agent Cumulative financing plan validation requirements Sales manager/unit sales manager Annual sales manager compensation plan requirements

Production requirements, and information specific to agents receiving disability payments under the STD or LTD options, are updated from time to time and are published in Company memoranda, which can be found on FieldNet.

Disability Earnings

Your weekly STD benefit is based on your disability earnings, up to applicable STD maximum. Disability earnings are updated annually, no later than April 1. MassMutual Benefits will notify you when your disability earnings are updated. Prior disability earnings will continue to apply until this annual update.


Disability earnings are defined as follows: • If you have at least one full calendar year under a career contract or sales manager agreement with

MassMutual: o If you are a non-financed career contract agent, your disability earnings are equal to your prior full

calendar year’s Aggregated Agent Allowance Weighted Commission Credits (AAA WCCs) paid by MassMutual.

o If you are a sales manager, your disability earnings are equal to your prior full calendar year’s AAA WCCs, sales manager production compensation and deferred production compensation paid by MassMutual.

o If you are a financed career contract agent, your disability earnings are equal to your prior full calendar year’s AAA WCCs paid by MassMutual.

• If you have less than one full calendar year under a career contract or sales manager agreement with MassMutual: o If you are a non-financed career contract agent or a sales manager, refer to the following table. o If you are a financed career contract agent, your disability earnings through December 31 of your first

year under contract are equal to your current year career contract commission requirement. For the first full calendar year under a career contract, your disability earnings remain equal to your current year career contract commission requirement if greater than your actual AAA WCCs.

If you do not have prior career agent/sales manager experience

If you do have prior career agent/sales manager experience

Disability earnings through December 31 of first year under a career contract

Equal to current year career contract commission requirement

Equal to the greater of: • Your prior non-MassMutual calendar

year’s first year and renewal commissions for life, annuity, and disability sales or financial services management income, as determined by MassMutual*; or

• The current year career contract commission requirement.

* You must submit documentation, acceptable to MassMutual, from the prior year reflecting your non-MassMutual career agent or financial services management experience.

Disability earnings first full calendar year under a career contract

Equal to the current career contract commission requirement, if greater than your actual AAA WCCs as of the previous December 31

Equal to the greater of: • Your prior year’s non-MassMutual first

year and renewal commissions for life, annuity and disability sales or financial services management income as defined by MassMutual, if greater than your actual AAA WCCs as of the previous December 31; or

• The current year career contract commission requirement, if greater than your actual AAA WCCs as of the previous December 31.


Enrollment

If you are a subsidized agent, you are automatically eligible for this coverage subject to Plan terms; no enrollment is necessary. Your coverage is effective as of your career contract endorsement date and there is no cost to you for this coverage.

If you are an unsubsidized agent, you pay the full cost of coverage on an After-Tax basis.

If you are a corporate agent, you pay the full cost of coverage on an After-Tax basis.

The cost of coverage is reviewed annually and is subject to change. If you pay the cost, the full coverage amount is deducted from your commission voucher. The value of the Company subsidy, if any, is paid through the same voucher and appears as an adjustment.

Summary of Benefits

The STD Program continues a portion of your income when you cannot work because of Disability. You are considered Disabled if you are unable to perform all of the material and substantial duties of your occupation on an Active Service basis due to Injury or Sickness.

Note: Loss of a license for any reason is not considered a total or Partial Disability.

See the Liberty Life Assurance Company of Boston Certificate section for specific information about this benefit.


Applying for STD Benefits

You must apply for STD by contacting Liberty Mutual. The following table summarizes the action steps required for STD to begin and to continue. How to Apply for STD* Who Action When You Keep your general agent informed. At the beginning of your STD and

periodically, if a continued absence You See your Physician or medical-care

provider. Provide your Physician’s office with a copy of the reverse side of your Liberty Mutual wallet card.

At the beginning of your STD

You Call Liberty Mutual to report the claim, using the toll-free number on your wallet card (800-713-7384) or online at www.mylibertyclaim.com (Claimant ID: Agents). Be prepared to provide the information and to respond to any additional questions: • Social Security number, address and

phone number; • Physician’s name and phone number; • Last day worked/first day absence due

to your Injury/Sickness; • Plan Sponsor’s name (MassMutual);

and General a• gent’s name and phone number.


Liberty Mutual r of your Liberty Claim

At the time of your initial phone call Gives you the claim number and the telephone numbeCase Manager.

You eral agent that your claim At the beginning of your STD Inform your genhas been filed.

Liberty Mutual y the

Throughout your STD period Calls you and your Physician periodicallfor an update on your condition and possibility of your return to service.

You erty turn-to-service date.

as your return-to-service date is known

Notify your general agent and LibMutual of re

As soon

* Failure to follow these steps could delay STD payments.

It is your obligation to submit needed information of your disabling condition—including information required to be provided by your Physician —as a requirement for benefits and to provide all necessary informto Liberty Mutual in support of your claim. STD may be denied if you fail to support your claim.

ation requested



Applying for STD Benefits due to Maternity How to Apply for Short-Term Disability Maternity* What to do When Contact your general agent and inform him/her of your upcoming absence.

As soon as you feel comfortable sharing the information but allowing your general agent time to plan for your absence

Provide your Physician’s office with a copy of the reverse side of your Liberty Mutual wallet card.

As soon as possible after pregnancy has been confirmed

Inform Liberty Mutual of the expected due date by using the toll-free number shown on your wallet card (800-713-7384).

Two weeks before expected due date

If your Physician determines you are Disabled or orders a reduced work schedule before delivery date, contact Liberty Mutual at the phone number above.

As soon as you are Disabled or put on reduced work schedule

Notify Liberty Mutual of delivery. Within three days after delivery *Failure to follow these steps could delay STD payments.


Short Term Disability (STD) Program – For General Agents and General Managers

Eligibility

You are eligible for STD coverage if you are a: • General agent with a valid general agent contract (including a formula general agent); or • General Manager with a valid employment agreement.

Note: The disability coverage options for career contract agents are described in a separate section of this SPD.


You are not eligible for the coverage described in this SPD if you are any of the following: • A career contract agent; • A broker; • A retired agent; • An agency staff member; • An employee of MassMutual or one of its subsidiaries; or • Anyone otherwise excluded by the Plan terms.

Enrollment

You are automatically eligible for this coverage subject to Plan terms; no enrollment is necessary. Your coverage is effective as of your general agent contract endorsement date and there is no cost to you for this coverage.

Summary of Benefits

The STD Program continues a portion of your income when you cannot work because of Disability. You are considered Disabled if you are unable to perform all of the material and substantial duties of your occupation on an Active Service basis due to Injury or Sickness.

Note: Loss of a license for any reason is not considered a total or Partial Disability.



Applying for STD Benefits

You must apply for STD by contacting Liberty Mutual. The following table summarizes the action steps required for STD to begin and to continue. How to Apply for STD* Who Action When You Keep your agency vice president informed. At the beginning of your STD and

periodically, if a continued absence You See your Physician or medical-care

provider. Provide your Physician’s office with a copy of the reverse side of your Liberty Mutual wallet card.


You Call Liberty Mutual to report the claim, using the toll-free number on your wallet card (800-713-7384) or online at www.mylibertyclaim.com (Claimant ID: Agents). Be prepared to provide the information and to respond to any additional questions: • Social Security number, address and

phone number; • Physician’s name and phone number; • Last day worked/first day absence due

to your Injury/Sickness; • Plan Sponsor’s name (MassMutual);

and Agency vice pres• ident’s name and phone number.


Liberty Mutual r of your Liberty Claim

At the time of your initial phone call Gives you the claim number and the telephone numbeCase Manager.

You ce president that your At the beginning of your STD Inform your agency viclaim has been filed.

Liberty Mutual y the

Throughout your STD period Calls you and your Physician periodicallfor an update on your condition and possibility of your return to service.

You al of return-to-service date.

as your return-to-service date is known

Notify your agency vice president and Liberty Mutu

As soon

* Failure to follow these steps could delay STD payments.

It is your obligation to submit needed information of your disabling condition—including information required to be provided by your Physician —as a requirement for benefits and to provide all necessary informto Liberty Mutual in support of your claim. STD may be denied if you fail to support your claim.

ation requested



Applying for STD Benefits due to Maternity How to Apply for Short-Term Disability Maternity* What to do When Contact your agency vice president and inform him/her of your upcoming absence.

As soon as you feel comfortable sharing the information

Provide your Physician’s office with a copy of the reverse side of your Liberty Mutual wallet card.

As soon as possible after pregnancy has been confirmed

Inform Liberty Mutual of the expected due date by using the toll-free number shown on your wallet card (800-713-7384).

Two weeks before expected due date

If your Physician determines you are Disabled or orders a reduced work schedule before delivery date, contact Liberty Mutual at the phone number above.

As soon as you are Disabled or put on reduced work schedule

Notify Liberty Mutual of delivery. Within three days after delivery *Failure to follow these steps could delay STD payments.


Long Term Disability (LTD) Coverage – For Career Contract Agents

Eligibility

You are eligible for LTD coverage options if you are a: • Career contract agent with a valid career agent contract; or • Sales manager with a career contract and valid sales manager agreement.

Note: The disability coverage option for General Agents and General Managers is described in a separate section of this SPD.


You are not eligible for these coverage options if you are: • A broker; • A retired agent; • An agency staff member; • An employee of MassMutual or one of its subsidiaries; • An eligible agent who did not elect disability coverage; or • Anyone otherwise excluded by the Plan terms.

Production Requirements

As a career contract agent, to be eligible for subsidized benefits, each year you must satisfy certain requirements: Agent Type Production Requirements Non-financed career contract agent Annual contract minimum requirements Financed career contract agent Cumulative financing plan validation requirements Sales manager/unit sales manager Annual sales manager compensation plan requirements

Production requirements, and information specific to agents receiving disability payments under the LTD options, are updated from time to time and are published in Company memoranda, which can be found on FieldNet.

Summary of Benefits

Liberty Mutual manages LTD coverage on an insured basis. If approved, benefit payments will be issued monthly by Liberty Mutual. LTD works in conjunction with the STD Program to provide you with the flexibility to choose a level of income if you become Disabled.

The Plan provides you flexibility in choosing the amount of LTD coverage you need; you may choose the Base LTD or Buy Up LTD option. For career agents and sales managers, Base LTD is referenced as Class 1 or Core Plan in the Liberty Life Assurance Company of Boston Certificate section; Buy Up LTD is referenced as Class 2 or Buy-up Plan. For general agents and general managers, Base LTD is referenced as Class 1 or Core Plan in the Liberty Life Assurance Company of Boston Certificate section; Buy Up LTD is referenced as Class 2 or Buy-up Plan.



Qualified Change in Status

Any change to your LTD option due to a Qualified Change in Status must be consistent with and because of the Qualified Change in Status. If you have a Qualified Change in Status, you can change your existing level of LTD coverage (e.g., changing from Base LTD to Buy Up LTD coverage) or you may be able to enroll in Buy Up LTD coverage for the first time if you previously waived this coverage. You must make any changes and provide documentation within 30 days of your Qualified Change in Status.

A Qualified Change in Status includes: • A change in the number of your dependents, due to birth, death, adoption, placement for adoption, addition of

a foster child or child for whom you have become a legal guardian; • A change in your legal marital status, such as marriage, the death of a spouse, divorce or legal separation; • Your spouse, domestic partner or dependent gaining or losing employment resulting in a loss of coverage.

Changes you make due to a Qualified Change in Status become effective as of the date of your Qualified Change in Status.

To make changes to your coverage, you must notify MassMutual Benefits and provide documentation within 30 days of the event.

Cost of Coverage

In general, Base LTD option coverage is Company paid and you are automatically eligible for this coverage subject to Plan terms and LTD coverage approval by Liberty Mutual.

If you elect Buy Up LTD option coverage, you and the Company pay premiums for coverage. Contributions are made to the MassMutual Agents’ Health Benefits Trust and trust assets are used to pay benefits, premiums and administrative fees.

Unsubsidized agents pay the full cost of coverage.

Your contributions, which are withheld from your commission vouchers, are based on the level of coverage you choose, your agent status (subsidized or unsubsidized) and your Basic Monthly Earnings (see the definition of Basic Monthly Earnings). Additionally, rates for Buy Up LTD coverage may also vary based on your age. Coverage Level Subsidized Agent Unsubsidized Agent Base LTD No cost to you (Company-paid) You pay full cost of coverage on a After-Tax basis Buy Up LTD You contribute toward the cost of coverage on a

Before-Tax or After-Tax basis. Before-Tax is the default election if you do not choose to have your contributions deducted on an After-Tax basis.

You pay full cost of coverage on a After-Tax basis

The cost of coverage is reviewed annually and is subject to change.

Corporate Agents

Corporate agents’ contributions for LTD coverage are on an After-Tax basis. The full coverage amount is deducted from your corporate commission voucher. The value of the Company subsidy, if any, is paid through the same voucher and appears as an adjustment.


Before-Tax Versus After-Tax Contributions

Since the Plan is administered at a group level for subsidized and unsubsidized agents, Before-Tax as well as After-Tax contributions are made to the Plan. Therefore, if you become Disabled and receive a benefit from the Plan, all or a portion of this benefit is subject to taxation.

If you elect the Buy Up LTD option and are a subsidized agent, you can choose whether your contributions for coverage are deducted from your commission voucher on a Before-Tax or After-Tax basis. When Buy Up LTD benefits are received, the 20% buy-up amount (difference between Base LTD and Buy Up LTD) may be tax-free to you if your contributions were paid on an After-Tax basis. If premiums were paid on a Before-Tax basis, your benefits will be taxable.


Long Term Disability (LTD) Coverage – For General Agents and General Managers

Eligibility

You are eligible for LTD coverage options if you are a: • General agent with a valid general agent contract (including a formula general agent); or • General Manager with a valid employment agreement.

Note: The disability coverage options for career contract agents are described in a separate section of this SPD.


You are not eligible for the coverage described in this SPD if you are any of the following: • A career contract agent; • A broker; • A retired agent; • An agency staff member; • An employee of MassMutual or one of its subsidiaries; or • Anyone otherwise excluded by the Plan terms.

Summary of Benefits

Liberty Mutual manages LTD coverage on an insured basis. If approved, benefit payments will be issued monthly by Liberty Mutual. LTD works in conjunction with the STD Program to provide you with the flexibility to choose a level of income if you become Disabled.

The Plan provides you flexibility in choosing the amount of LTD coverage you need; you may choose the Base LTD or Buy Up LTD option. For career agents and sales managers, Base LTD is referenced as Class 1 or Core Plan in the Liberty Life Assurance Company of Boston Certificate section; Buy Up LTD is referenced as Class 2 or Buy-up Plan. For general agents and general managers, Base LTD is referenced as Class 1 or Core Plan in the Liberty Life Assurance Company of Boston Certificate section; Buy Up LTD is referenced as Class 2 or Buy-up Plan.



Benefits Pay/Agency Production Requirements

Your benefits pay determines the amount of Buy Up LTD coverage for which you are eligible (refer to the following table).

Benefits pay is defined as the rolling three-year average of your agency’s First Year Commissions (FYC) for certain Life, Annuity and Disability (LAD) production. This figure is determined annually and is updated no later than April 1. MassMutual Benefits will notify you when your benefits pay is updated. Benefits Pay Monthly Base LTD

(Company-paid) Monthly Buy Up LTD (You contribute towards the cost of this coverage)

Total Monthly LTD Coverage* (Base LTD + Buy Up LTD)

Under $1,000,000 $10,000 $2,000 $12,000 $1,000,000 - $1,999,999 $10,000 $4,000 $14,000 $2,000,000 - $2,999,999 $10,000 $6,000 $16,000 $3,000,000 - $3,999,999 $10,000 $8,000 $18,000 $4,000,000 and over $10,000 $10,000 $20,000

*Less other income offset

No matter what your agency’s production is, you are eligible for Company-paid Base LTD coverage of $10,000 monthly and Company-paid STD coverage for $2,308 weekly, less benefits from other income.

Qualified Change in Status

Any change to your LTD option due to a Qualified Change in Status must be consistent with and because of the Qualified Change in Status. If you have a Qualified Change in Status, you can change your existing level of LTD coverage (e.g., changing from Base to Buy-Up LTD coverage) or you may be able to enroll in Buy-Up LTD coverage for the first time if you previously waived this coverage. You must make any changes and provide documentation within 30 days of your Qualified Change in Status.

A Qualified Change in Status includes: • A change in the number of your dependents, due to birth, death, adoption, placement for adoption, addition of

a foster child or child for whom you have become a legal guardian; • A change in your legal marital status, such as marriage, the death of a spouse, divorce or legal separation; • Your spouse, domestic partner or dependent gaining or losing employment resulting in a loss of coverage.

Changes you make due to a Qualified Change in Status become effective as of the date of your Qualified Change in Status.

To make changes to your coverage, you must notify MassMutual Benefits and provide documentation within 30 days of the event.


Cost of Coverage

Base LTD option coverage is Company paid and you are automatically eligible for this coverage subject to Plan terms and LTD coverage approval by Liberty Mutual.

If you elect Buy-Up LTD option coverage, you and the Company pay premiums for coverage. You pay for coverage on an After-Tax basis. Contributions are made to the MassMutual Agents’ Health Benefits Trust and trust assets are used to pay benefits, premiums and administrative fees.

Your contributions, which are withheld from your general agent voucher or general manager voucher/payroll, are based on the level of coverage you choose and your benefits pay (see the Benefits Pay/Agency Production Requirements section). Additionally, rates for Buy-Up LTD coverage may also vary based on your age.

The cost of coverage is reviewed annually and is subject to change.

After-Tax Contributions

The full value of MassMutual subsidy for STD and Base LTD coverage is included in your taxable income. Since the full value of this subsidy coverage is included in your taxable income and you pay for Buy Up LTD coverage on an After-Tax basis, if you become Disabled and receive a benefit from the Plan, none of your benefit is subject to taxation.


Liberty Life Assurance Company of Boston Certificate

Note: Throughout this certificate, the term “spouse” also refers to an eligible domestic partner.

DISCLAIMER

Sponsor: Massachusetts Mutual Life Insurance Company

Policy Number(s): GD3-810-253705-01/GF3-810-253705-01

Date Provided: February 10, 2010

The following certificate(s) are a true copy of the certificate(s) issued under the policy(ies).

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON

CERTIFICATE OF COVERAGE

Liberty Life Assurance Company of Boston (hereinafter referred to as “we,” “our” and “us”) welcomes your employer as a client.

Sponsor: Massachusetts Mutual Life Insurance Company

Plan Number: GD3-810-253705-01/GF3-810-253705-01

Effective Date: January 1, 2005

When this plan refers to “you” or “your” it means the Covered Person insured under this plan. This is your Disability Income certificate of coverage as long as you are eligible for insurance and remain insured.

A few words about this certificate of coverage.

It is written in plain English. A few terms and provisions are written as required by insurance law. PLEASE READ IT CAREFULLY. If you have any questions about any terms and provisions, please contact the Insurance Administrator at your work location or write to us. We will assist you in any way we can to help you understand your benefits.

Also, if the terms of your certificate of coverage and the policy differ, the policy will govern. Your coverage may be terminated or modified in whole or in part under the terms and provisions of the policy.

SECTION 1: SCHEDULE OF BENEFITS

ELIGIBLE CLASSES FOR INSURANCE BENEFITS:

(Agents, General Agents, Sales Managers, and General Managers who have a valid General Agent, General Manager, Career Agent or Sales Manager contract)


Short Term Disability Benefits:

Class 1: All Agents who have a valid career agent contract and All Sales Managers who have a valid sales manager agreement

Class 2: All General Agents who have a valid general agent contract and all General Managers who have a valid employment agreement

Long Term Disability Benefits:

Class 1: All Agents who have a valid career agent contract and All Sales Managers who have a valid sales manager agreement participating in the Base Plan

Class 2: All Agents who have a valid career agent contract and All Sales Managers who have a valid sales manager agreement electing the Buy-Up Plan

Class 3: All General Agents who have a valid general agent contract and all General Managers who have a valid employment agreement participating in the Base Plan

Class 4: All General Agents who have a valid general agent contract and all General Managers who have a valid employment agreement electing the Buy-Up Plan

ELIGIBILITY WAITING PERIOD:

1. Present Agents, General Agents, Sales Mangers and General Managers: None

2. New Agents, General Agents, Sales Managers and General Managers: None

COVERED PERSON CONTRIBUTIONS REQUIRED: Subsidized Agents Unsubsidized Agents Short Term Disability Benefits No Yes Long Term Disability Benefits

Classes 1 and 3 – Base Plan Classes 2 and 4 – Buy-Up Plan

No Yes

Yes Yes

SHORT TERM DISABILITY COVERAGE

Elimination Period:

Applicable to Maternity Claims only:

The period for which a benefit is payable will commence as follows:

a. on the 8th day of continuous Disability resulting from Injury; or

b. on the 8th day of continuous Disability resulting from Sickness.

Note: A Covered Person must be Totally Disabled during the Short Term Disability Elimination Period.


Applicable To All Other Claims:

The period for which a benefit is payable will commence as follows:

a. on the 30th day of continuous Disability resulting from Injury; or

b. on the 30th day of continuous Disability resulting from Sickness.

Note: A Covered Person must be Totally Disabled during the Short Term Disability Elimination Period.

Amount Of Insurance Benefits:

Class 1: 50% (Benefit Percentage) of Basic Weekly Earnings not to exceed a Maximum Weekly Benefit of $2,308 less Benefits from Other Income stated in this coverage

Class 2: Flat Weekly Benefit of $2,308 less Benefits from Other Income stated in this coverage

Maximum Benefit Period:

Applicable To Maternity Claims:

The period for which a benefit is payable for any one Disability will end on the earliest of:

a. the end of the Disability; or

b. the end of the 25th week of Disability for which a benefit is payable.

Applicable To All Other Claims:

The period for which a benefit is payable for any one Disability will end on the earliest of:

a. the end of the Disability; or

b. the end of the 22nd week of Disability for which a benefit is payable.

LONG TERM DISABILITY COVERAGE

Your Elimination Period:

The greater of :

a. the end of your Short Term Disability Benefits ; or

b. 180 days.

Note: You must satisfy the Long Term Disability Elimination Period if you are Totally Disabled, or Partially Disabled, or a combination of Totally Disabled or Partially Disabled, during such time.


Your Amount Of Insurance Benefits:

Class 1 - Base Plan: 50% (Benefit Percentage) of Basic Monthly Earnings not to exceed a Maximum Monthly Benefit of $10,000 less Benefits from Other Income as outlined in Section 4

Class 2 - Buy-Up Plan: 70% (Benefit Percentage) of Basic Monthly Earnings not to exceed a Maximum Monthly Benefit of $20,000 less Benefits from Other Income as outlined in Section 4

Class 3 - Base Plan: Flat Monthly Benefit of $10,000 less Benefits from Other Income as outlined in Section 4

Class 4 - Buy-Up Plan: The following Flat Benefit amounts are based on Agency Production:

Agency Production Buy-Up Benefit Amount Base + Buy-Up (Total benefits less benefits form Other Income as outlined in Section 4)

Under $1,000,000 Production $2,000 $12,000 $1,000,000 – $1,999,999 $4,000 $14,000 $2,000,000 – $2,999,999 $6,000 $16,000 $3,000,000 – $3,999,999 $8,000 $18,000 $4,000,000 and over $10,000 $20,000

“Agency Production” will be based on a rolling three-year average of the General Agent’s or General Manager’s agency’s production as determined by the Sponsor. Agency production is measured by first year commissions on sales generated by the agency for MassMutual products in life, annuity and disability lines of business.

Minimum Monthly Benefit

The Minimum Monthly Benefit is $100 or 10% of your gross Monthly Benefit, whichever is greater.

Your Maximum Benefit Period: Age At Disability Maximum Benefit Period Younger than age 60 To age 65 (but not less than 5 years) 60 60 months 61 48 months 62 42 months 63 36 months 64 30 months 65 24 months 66 21 months 67 18 months 68 15 months 69 and older 12 months


Return To Work Benefit

(Applies to both Short Term Disability and Long Term Disability)

Period Of Disability Benefit Period Of Disability Benefit Additional Benefit At least 4 months but less than 5 months Amount equal to 4x the last weekly STD benefit At least 5 months but less than 6 months Amount equal to 8x the last weekly STD benefit 6 months or more Amount equal to 3x the last monthly LTD benefit

SECTION 2: TERMS YOU SHOULD KNOW

In this section, we define some basic terms needed to understand this plan.

“Active Service” means you must be actively at work for the Sponsor:

1. paid compensation; and

2. maintain a valid contract endorsed by the Sponsor; and either perform such work:

a. at the Sponsor’s usual place of business, including agencies; or

b. at a location to which the Sponsor’s business requires you to travel; or

c. at the principal place of service for you, as determined by the Sponsor.

You will be considered actively at work if you held a valid contract on the day immediately preceding:

1. a weekend (except where one or both of these days are scheduled days of work);

2. holidays (except when such holiday is a scheduled workday);

3. any non-scheduled workday;

4. an excused leave of absence (except medical leave for your own disabling condition and lay-off); and

5. an emergency leave of absence (except emergency medical leave for your own disabling condition).

“Administrative Office” means Liberty Life Assurance Company of Boston, 9 Riverside Road, Weston, MA 02493.

“Annual Enrollment Period” or “Enrollment Period” means the period before each policy anniversary so designated by the Sponsor during which you may enroll for coverage under this plan.

“Application” is the document completed by the Sponsor when applying for coverage, it is attached to and is made a part of the policy.


Applicable To Non-Financed Agents With At Least One Full Calendar Year Of Service With The Sponsor:

“Basic Weekly Earnings” (Applicable to Short Term Disability) means your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; divided by 52

“Basic Monthly Earnings” (Applicable to Long Term Disability) means your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; divided by 12.

Note: Earnings are updated once per year no later than April 1. Prior Basic Weekly Earnings and Basic Monthly Earnings continue to apply until the earnings update.

Applicable To Newer Non-Financed Agents (With Less Than One Full Calendar Year Of Service With The Sponsor) Without Prior Career Experience:

“Basic Weekly Earnings” (Applicable to Short Term Disability) means the current year career contract commission requirement for your prior year of contract (and for the first calendar year if greater than actual AAA Weighted Commission Credits, as determined by the Sponsor) divided by 52; thereafter, your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; divided by 52.

“Basic Monthly Earnings” (Applicable to Long Term Disability) means the current year career contract commission requirement for your year of contract (and for the first full calendar year if greater that actual AAA Weighted Commission Credits, as determined by the Sponsor); divided by 12; thereafter, your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor divided by 12.


Applicable To Newer Non-Financed Agents (With Less Than One Full Calendar Year Of Service With The Sponsor) With Prior Career Experience:

“Basic Weekly Earnings” (Applicable to Short Term Disability) means for the first year and renewal commission for the last non-Sponsor calendar year or current year career contract commission requirement for your year of contract (and for the first full calendar year if greater than actual AAA Weighted Commissions Credits, as determined by the Sponsor); divided by 52; thereafter, your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; divided by 52.

“Basic Monthly Earnings” (Applicable to Long Term Disability) means the prior first year and renewal commissions for the last non-Sponsor calendar year or current year career contract commission requirement for your year of contract (and for the first full calendar year if greater than actual AAA Weighted Commission Credits, as determined by the Sponsor); divided by 12; thereafter, your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; divided by 12.



Applicable To Financed Agents:

“Basic Weekly Earnings” (Applicable to Short Term Disability) means the current year career contract commission requirement for your year of contract (and for the first full calendar year if greater than actual AAA Weighted Commission Credits, as determined by the Sponsor); divided by 52; thereafter, your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; divided by 52.

“Basic Monthly Earnings” (Applicable to Long Term Disability) means the current year career contract commission requirement for your year of contract (and for the first full calendar year if greater than actual AAA Weighted Commission Credits, as determined by the Sponsor); divided by 12; thereafter your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; divided by 12.

Note: These definitions apply only during the Financing Period. Earnings are updated once per year no later than April 1. Prior Basic Weekly Earnings and Basic Monthly Earnings continue to apply until earnings updated.

Applicable To Sales Managers With At Least One Full Calendar Year Of Service With The Sponsor:

“Basic weekly Earnings” (applicable to Short Term Disability) Means:

(a.) your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; plus

(b.) Sales Manager Production Compensation paid by the Sponsor; plus

(c.) Sales Manager deferred Production Compensation paid by the Sponsor; divided by 52.

“Basic Monthly Earnings” (applicable to Long Term Disability) means:




Applicable To Sales Managers Without Prior Experience In Life Insurance Sales Or Financial Services Management With Less Than One Full Calendar Year Of Service With The Sponsor:

“Basic Weekly Earnings” (Applicable to Short Term Disability) means for the first year, earnings equal the current year Career Contract commission requirement (and for the first full calendar year if greater than actual AAA Weighted Commission Credits, as determined by the Sponsor); divided by 52; thereafter,



(c.) Sales Manager Deferred Production Compensation paid by the Sponsor; divided by 52.


“Basic Monthly Earnings” (Applicable to Long Term Disability) means for the first year, earnings equal the current year Career Contract commission requirement (and for the first full calendar year if greater than actual AAA Weighted Commission Credits, as determined by the Sponsor); divided by 12; thereafter,

(a.) Your prior full calendar year’s AAA Weighted Commission Credits, as determined by the Sponsor; plus


(c.) Sales Manager Deferred Production Compensation paid by the Sponsor; divided by 12.

Applicable To Sales Managers With Prior Experience In Life Insurance Sales Or Financial Services Management With Less Than One Full Year Of Services With The Sponsor:

“Basic Weekly Earnings” (Applicable to Short Term Disability) means for the first year, and renewal commissions (for Life, Annuity and Disability Sales) or Management Income as determined by the Sponsor for the last non-Sponsor calendar year or current year career contract commission requirement (and for the first full calendar year if greater than actual AAA Weighted Commissioned Credits, as determined by the Sponsor); divided by 52; thereafter,




“Basic Monthly Earnings” (Applicable to Long Term Disability) means the prior first year, and renewal commissions (for Life, Annuity and Disability Sales) or Management Income as determined by the Sponsor for the last non-Sponsor calendar year or current year career contract commission requirement (and for the first full calendar year if greater than actual AAA Weighted Commissioned Credits, as determined by the Sponsor); divided by 12; thereafter,




Note: Earnings are updated once per year no later than April 1. Prior basic Weekly Earnings and Basic Monthly Earnings continue to apply until the earnings update.

“Covered Person,” means a career contract agent of the Sponsor as defined by the IRS Code Section 7701(a)(20) who maintains a valid career contract or a general agent or a general manager insured under this policy.

“Disability” or “Disabled” with respect to Short Term Disability coverage means you are unable to perform all of the material and substantial duties of your occupation on an Active Service basis because of an Injury or Sickness.


“Disability” or “Disabled” with respect to Long Term Disability coverage means:

1. For persons other than pilots, co-pilots, and crew of an aircraft:

i. if you are eligible for the 24 Month Own Occupation Benefit, “Disability” or “Disabled” means during the Elimination Period and the next 24 months of Disability you are unable to perform all of the material and substantial duties of your occupation on an Active Service basis because of an Injury or Sickness; and

ii. after 24 months of benefits have been paid, you are unable to perform, with reasonable continuity, all of the material and substantial duties of your own or any other occupation for which you are or become reasonably fitted by training, education, experience, age and physical and mental capacity.

2. If you are employed as a pilot, co-pilot or crew of an aircraft:

“Disability” or “Disabled” means because of Injury or Sickness you cannot perform the material and substantial duties of any gainful occupation for which you are or become reasonably fitted by training, education, experience, age and physical and mental capacity.

“Disability Benefits,” when used with the term Retirement Plan, means money which:

1. is payable under a Retirement Plan due to Disability as defined in that plan; and

2. does not reduce the amount of money that would have been paid as Retirement Benefits at the normal retirement age under the plan if your Disability had not occurred. (If the payment does cause such a reduction, it will be deemed a Retirement Benefit as defined in this plan.)

“Eligibility Date” means the date you become eligible for insurance under this plan. Eligible Classes are shown in the Schedule of Benefits.

“Eligibility Waiting Period” as shown in the Schedule of Benefits means the continuous length of time you must serve in an eligible class to reach your Eligibility Date.

“Elimination Period” means a period of consecutive days of Disability for which no benefit is payable. Your Elimination Period is shown in the Schedule of Benefits and begins on the first day of your Disability. If you return to work for any 30 or less days during the Elimination Period and cannot continue, Liberty will count only those days you are disabled to satisfy the Elimination Period.

“Family Status Change” means any one of the following events that may occur:

1. your marriage or divorce; or

2. the birth of your child; or

3. the adoption of your child; or

4. the death of your spouse or child; or

5. the loss employment or benefits by your spouse.

“Gross Weekly Benefit” or “Gross Monthly Benefit” means your Weekly or Monthly Benefit before any reduction for Benefits from Other Income.


“Initial Enrollment Period” means one of the following periods during which you may first enroll for coverage under this policy:

1. If you are eligible for insurance on the policy effective date, a period before the policy effective date set by the Sponsor and us.

2. If you become eligible for insurance after the policy effective date, the period that ends 30 days after your eligibility date.

“Injury” means bodily impairment resulting directly from an accident and independently of all other causes. Any Disability that begins more than 60 days after an Injury will be considered a Sickness for the purpose of determining benefits under this plan.

“Monthly Benefit” means the amount payable by Liberty to you if you are Disabled or Partially Disabled. Benefits for Long Term Disability coverage are determined on a monthly basis.

“Partial Disability” or “Partially Disabled” means as a result of the Injury or Sickness, you are:

1. able to perform one or more, but not all, of the material and substantial duties of your occupation or any other occupation on an Active Service or a part-time basis; or

2. able to perform all of the material and substantial duties of your own occupation or any other occupation on a part-time basis.

“Physician” means a person who:

1. is licensed to practice medicine and prescribe and administer drugs or to perform surgery; or

2. is a licensed practitioner of the healing arts in a category specifically favored under the health insurance laws of the State where the policy is delivered and practicing within the terms of his license.

“Physician” does not mean you or your spouse, daughter, son, father, mother, sister or brother.

“Retirement Benefit,” when used with the term Retirement Plan, means money which:

1. is payable under a Retirement Plan either in a lump sum or in the form of periodic payments;

2. does not represent contributions made by you (payments which represent your contributions are deemed to be received over your expected remaining life regardless of when such payments are actually received); and

3. is payable upon:

a. early or normal retirement; or

b. Disability, if the payment does reduce the amount of money that would have been paid under the plan at the normal retirement age.

“Retirement Plan” means a plan which provides Retirement Benefits to you and which is not funded wholly by your contributions. The term shall not include a profit-sharing plan, informal salary continuation plan, registered retirement savings plan, stock ownership plan or a non-qualified plan of deferred compensation.


“Schedule of Benefits” means the section of this plan which shows, among other things, the Eligible Classes, the Eligibility Waiting Period, your Elimination Period, your Amount of Insurance, the Minimum Benefit, and your Maximum Benefit Period.

“Sickness” means illness, disease, pregnancy or complications of pregnancy.

“Sponsor” means the entity to whom the policy is issued.

“Sponsor’s Retirement Plan” is deemed to include any Retirement Plan:

1. that is part of any federal, state, municipal or association retirement system; or

2. for which you are eligible as a result of service with the Sponsor.

“Weekly Benefit” means the amount payable by Liberty to you if you are Disabled or Partially Disabled. Benefits for Short Term Disability coverage are determined on a weekly basis.

SECTION 3: ELIGIBILITY AND EFFECTIVE DATES

Applicable To Short Term Disability

Who Is Eligible For Coverage?

You are Eligible for Coverage if you are in Active Service and in an Eligible Class for Insurance Benefits shown in the Schedule of Benefits.

Your Eligibility Date For Insurance Benefits

If you are in an eligible class, you will qualify for insurance on the later of:

1. this plan’s Effective Date; or

2. the day after you complete the Eligibility Waiting Period shown in the Schedule of Benefits.

Your Effective Date Of Insurance

1. Your insurance will be effective at 12:01 a.m. Standard Time in the governing jurisdiction on the day determined as follows, but only if your Application for insurance is:

a. made with us through your Sponsor; and

b. in a form or format satisfactory to us.

2. You will be insured for non-contributory insurance on your Eligibility Date.

3. You will be insured for contributory insurance on the date you make written Application for insurance on or before the 30th day after your Eligibility Date.

4. Delayed Effective Date for Insurance - The Effective Date of any initial, increased or additional insurance for you will be delayed if you are not in Active Service because of Injury or Sickness. The initial, increased or additional insurance will start on the date you return to Active Service.


Applicable To Long Term Disability

Who Is Eligible For Coverage?

You are Eligible for Coverage if you are in Active Service and in an Eligible Class for Insurance Benefits shown in the Schedule of Benefits.

Your Eligibility Date For Insurance Benefits

If you are in an eligible class, you will qualify for insurance on the later of:

1. this plan’s Effective Date; or

2. the day after you complete the Eligibility Waiting Period shown in the Schedule of Benefits.

Enrollment

You may enroll in or change coverage only during an Initial or Annual Enrollment Period as follows:

1. Initial Enrollment Period

During the Initial Enrollment Period, you may enroll in any one coverage or coverage option shown in the Schedule of Benefits. If you do not choose any coverage or coverage option, you will automatically be enrolled in the Base Plan.

2. Annual Enrollment Period

During each Annual Enrollment Period, you may make any one of the following changes in coverage for the next policy year:

a. a decrease in coverage;

b. an increase in coverage subject to the Pre-Existing Condition Exclusion defined herein; or

c. keep your coverage at the same level.

If you fail to enroll for a change in your coverage option during any Annual Enrollment Period, you will continue to be insured for the same coverage option during the next policy year and no change in that coverage can be made during the next policy year.

3. Family Status Change

When you experience a Family Status change, you may enroll for coverage within 30 days of the date of the Family Status Change. When you experience a Family Status Change, you may:

a. decrease your coverage;

b. increase your coverage without Evidence of Insurability and not subject to the Pre-Existing Condition Exclusion defined herein;

c. keep your coverage at the same level.


You must apply for the change in coverage within 30 days of the date of the Family Status Change. Such changes in coverage must be on account of and consistent with the reason that the change in coverage was permitted.

Your Effective Date Of Insurance

1. Your insurance will be effective at 12:01 a.m. Standard Time in the governing jurisdiction on the day determined as follows, but only if your Application for insurance is:

a. Made with us through your Sponsor; and

b. In a form or format satisfactory to us.

2. For Coverage Applied for During Initial Enrollment Periods

You will become insured for non-contributory insurance on your eligibility date. You will become insured for any other contributory coverage on the later of these dates:

a. Your eligibility date if you enroll before that date; or

b. The date you enroll if you do it on or before the 30th day after your date of eligibility.

If you do not enroll for any contributory coverage on or before the 30th day after your eligibility date, or terminated your insurance while continuing to be eligible, you may not enroll for any contributory coverage until the next Annual Enrollment Period.

3. For Contributory Coverage Applied for During Annual Enrollment Periods, you will be insured for the selected contributory coverage on the first day of the next policy anniversary.

4. For Coverage Applied For Due To A Family Status Change

You will become insured for the selected coverage on the later of the following dates, provided you enroll or apply for the change in coverage before the 30th day following the Family Status Change:

a. the date of the Family Status Change; or

b. the date you enroll or apply for the change in coverage.

5. Delayed Effective Date for Insurance: The Effective Date of any initial, increased or additional insurance will be delayed for an individual if you are not in active Service because of Injury or Sickness. The initial, increased or additional insurance will start on the date the individual returns to Active Service.

What Happens If There Is A Transfer Of Insurance Carriers?

In order to prevent loss of coverage for you because of a transfer of insurance carriers, this plan will provide coverage for you as described in the following.


What Happens If You Are Not In Active Service Due To Injury Or Sickness?

This plan will cover you, subject to premium payments, if you were:

1. insured by the prior carrier at the time of transfer; and

2. not in Active Service due to Injury or Sickness on the Effective Date of the plan.

The benefit payable will be in accordance with the provisions of this plan, less any benefit for which the prior carrier is liable. However, in no event will the benefit payable be greater than that which would have been paid under the prior carrier’s benefit schedule.

What Happens If You Are Disabled Due To A Pre-Existing Condition?

If there is a Pre-Existing Condition Exclusion, a benefit may be payable for a Disability due to a Pre-Existing Condition if you:

1. were insured by the prior carrier at the time of transfer; and

2. were in Active Service and insured under this plan on its Effective Date.

The benefit will be determined as follows:

1. We will apply this plan’s pre-existing condition exclusion. If you qualify for a benefit, you will be paid according to this plan’s benefit schedule.

2. If you cannot satisfy this plan’s pre-existing condition exclusion, the prior carrier’s pre-existing condition exclusion will be applied.

a. If you satisfy the prior carrier’s pre-existing condition exclusion, giving consideration towards continuous time insured under both policies, you will be paid according to this plan’s benefit schedule. However, in no event will the benefit payable be greater than that which would have been paid under the prior carrier’s benefit schedule.

b. If you cannot satisfy the pre-existing condition exclusion of this plan or that of the prior carrier, no benefit will be paid.


SECTION 4: DISABILITY INCOME BENEFITS

SHORT TERM DISABILITY COVERAGE

Disability Benefit

When Is Your Disability Benefit Payable?

When we receive proof that you are Disabled due to Injury or Sickness and require the regular attendance of a Physician, we will pay you a Weekly Benefit after the end of your Elimination Period. The benefit will be paid for the period of your Disability if you give to us proof of continued:

1. Disability; and

2. regular attendance of a Physician.

The proof must be given upon our request and at your expense.

For the purpose of determining Disability, the Injury must occur and your Disability must begin while you are insured for this coverage. In addition, a loss of a license for any reason does not, in itself, constitute Disability.

Your Weekly Benefit will not:

1. exceed your Amount of Insurance; nor

2. be paid for longer than your Maximum Benefit Period.

Your Amount of Insurance and your Maximum Benefit Period are shown in the Schedule of Benefits.

How Is Your Amount Of Disability Weekly Benefit Figured?

To figure your amount of Weekly Benefit:

1. Multiply your Basic Weekly Earnings by the Benefit Percentage shown in the Schedule of Benefits.

2. Take the lesser of:

a. the amount figured in step (1) above; or

b. the Maximum Weekly Benefit shown in the Schedule of Benefits; and then

3. Deduct your Benefits from Other Income, (shown in the Benefits from Other Income provision of this coverage), from this amount.

Partial Disability Benefit

When proof is received that you are Partially Disabled from an Injury or Sickness Liberty will pay a Partial Disability benefit if you give to Liberty upon request and at your expense, proof of continued (a) Partial Disability, and (b) the required regular attendance of a Physician.

To qualify for a Partial Disability Benefit you must be earning less than 80% of your Indexed Pre-Disability Earnings at the time you return to partial employment.


“Partial Disability” or “Partially Disabled” means as a result of the Injury or Sickness, which caused Disability, you are:

1. able to perform one or more, but not all, of the material and substantial duties of your own Occupation or any other occupation on an Active Employment or a part-time basis; or

2. able to perform all of the material and substantial duties of your own Occupation or any other occupation on a part-time basis.

Amount Of Partial Disability Weekly Benefit

If you are eligible for a Partial Disability Benefit according to the terms of this plan, we will pay:

1. 50% of your regular Weekly Benefit as shown in the Schedule of Benefits; or

2. your Basic Weekly Earnings less any Benefits from Other Income, (shown in the Benefits from Other Income provision of this coverage), including any earnings you receive while Partially Disabled.

The Partial Disability Benefit payable will never be more than the Maximum Weekly Benefit shown in the Schedule of Benefits.


If you return to Active Service with the Sponsor on a full-time basis within two weeks after Disability Benefits end, a Return to Work Benefit will be payable as shown in the Schedule of Benefits. To be eligible for the return to Work Benefit, you must

1. have received Disability Benefits for the period shown in the Schedule of Benefits; and

2. return to Active Service on a full-time basis with the Sponsor; and

3. have not received benefits under these provisions for any prior disability while insured under this plan.

Benefits From Other Income

What Are Your Benefits From Other Income?

Your Benefits from Other Income means those benefits shown below:

1. any disability benefits for which you are eligible under Social Security;

2. any other governmental program or coverage required or provided by statute (including any amount attributable to your family).

What Happens If You Receive Any Cost Of Living Increases?

After the first deduction for each of your Benefits from Other Income, your Weekly Benefit will not be further reduced due to any cost of living increases payable under the Benefits from Other Income provision of this coverage.

What Happens If You Receive A Lump Sum Payment?

If you receive Benefits from Other Income that are paid in a lump sum, they will be prorated on a weekly basis over the Maximum Benefit Period.


What Happens If Your Benefit Period Is Less Than A Week?

For any period that a Short Term Disability Benefit is payable that does not extend through a full week, the benefit will be paid on a prorated basis. The rate will be 1/7th per day for such period of Disability.

When Will Your Short Term Disability Benefit Be Discontinued?

Your Weekly Benefit will cease on the earliest of:

1. the date you are no longer Disabled; or

2. the date you die; or

3. the end of your Maximum Benefit Period

Successive Periods Of Disability

What Happens If You Return To Work And Become Disabled Again?

If you return to work and become Disabled again, you may qualify for Successive Periods of Disability. With respect to this coverage, “Successive Periods of Disability” means a Disability which is related or due to the same cause(s) as a prior Disability for which a Weekly Benefit was payable.

A Successive Period of Disability will be treated as part of your prior Disability if, after receiving Disability Benefits under this coverage, you:

1. return to your Own Occupation on an Active Service basis for less than six continuous months; and

2. perform all the Material and Substantial duties of your Own Occupation.

Benefit payments will be subject to the terms of this coverage for your prior Disability.

If you return to your Own Occupation on an Active Service basis for six continuous months or more, the Successive Period of Disability will be treated as a new period of Disability. You must complete another Elimination Period.

If you become eligible for coverage under any other group Short Term Disability coverage, this Successive Period of Disability provision will cease to apply to you.



Disability Benefit

When Is Your Disability Benefit Payable?

When we receive proof that you are Disabled due to Injury or Sickness and require the regular attendance of a Physician, we will pay you a Monthly Benefit after the end of your Elimination Period. The benefit will be paid for the period of your Disability if you give to us proof of continued:

1. Disability; and

2. regular attendance of a Physician.

The proof must be given upon our request and at your expense.

For the purpose of determining Disability, the Injury must occur and your Disability must begin while you are insured for this coverage. In addition, a loss of a license for any reason does not, in itself, constitute Disability.

Your Monthly Benefit will not:

1. exceed your Amount of Insurance; nor

2. be paid for longer than your Maximum Benefit Period.

Your Amount of Insurance and your Maximum Benefit Period are shown in the Schedule of Benefits.

How Is Your Amount Of Disability Monthly Benefit Figured?

To figure your amount of Monthly Benefit:

1. Multiply your Basic Monthly Earnings by the Benefit Percentage shown in the Schedule of Benefits.

2. Take the lesser of:

a. the amount figured in step (1) above; or

b. the Maximum Monthly Benefit shown in the Schedule of Benefits; and then

3. Deduct your Benefits from Other Income, (shown in the Benefits from Other Income provision of this coverage), from this amount.

The Disability Benefit payable will never be less than the Minimum Monthly Benefit shown in the Schedule of Benefits.

Partial Disability Benefit

When Are Benefits Payable Under Our Partial Disability Provision?

When proof is received that you are Partially Disabled because of an Injury or Sickness, you may be eligible to receive a Partial Disability Benefit under Liberty’s Partial Disability provision. To be eligible to receive such benefits, you may be employed in your Own Occupation or another occupation and must satisfy the Elimination Period.


A Monthly Benefit will be paid for the period of Partial Disability if proof is given to Liberty upon request, and at your expense, of continued:

1. Partial Disability; and

2. regular attendance of a Physician..

For the purposes of determining Partial Disability, the Injury must occur and Partial Disability must begin while you are Insured for this coverage. In addition, a loss of a license for any reason does not, in itself, constitute Partial Disability.

Amount Of Partial Disability Benefit

The Monthly Benefit will be calculated as follows.

If you are eligible for a Partial Disability benefit according to the terms of the plan, Liberty will pay 50% of the your regular Monthly Benefit as shown in the Schedule of Benefits less any Benefits from Other Income (shown in the Benefits from Other Income provision of this coverage).

The Monthly Benefit payable will never be less than the Minimum Monthly Benefit shown in the Schedule of Benefits, or more than the Disability Benefit payable under this coverage.


If you return to Active Service with the Sponsor on a full-time basis within two weeks after Disability Benefits end, a Return to Work Benefit will be payable as shown in the Schedule of Benefits. To be eligible for the return to Work Benefit, you must

1. have received Disability Benefits for the period shown in the Schedule of Benefits; and

2. return to Active Service on a full-time basis with the Sponsor; and

3. have not received benefits under these provisions for any prior disability while insured under this plan.

Mental Illness And Alcohol Or Drug Abuse Limitations

What Limitations Will Apply For Mental Illness And Alcohol Or Drug Abuse?

The Benefit for Disability due to Mental Illness and Alcohol or Drug Abuse will not exceed 24 months of Monthly Benefit payments unless you meet one of these situations.

1. You are in a Hospital or Institution for Mental Illness and Alcohol or Drug Abuse at the end of the 24-month period. The Monthly Benefit will be paid during the confinement. If you are still Disabled when you are discharged, the Monthly Benefit will be paid for a recovery period up to 90 days. If you become reconfined during the recovery period for at least 14 days in a row, benefits will be paid for the confinement and another recovery period up to 90 more days.


2. You continue to be Disabled and become confined for the Mental Illness and Alcohol or Drug Abuse:

a. after the 24 month period; and

b. for at least 14 days in a row.

The Monthly Benefit will be payable during the confinement for the Mental Illness and Alcohol or Drug Abuse. The Monthly Benefit will not be payable beyond the Maximum Benefit Period. Benefits are payable for the duration of the confinement.

Benefits are payable for up to 24 months for outpatient treatment.

“Hospital” or “Institution” means a facility licensed to provide care and Treatment for the condition causing your Disability.

“Mental Illness” means mental, nervous or emotional diseases or disorders of any type.

Benefits From Other Income

What Are Your Benefits From Other Income?

Your Benefits from Other Income means those benefits shown below:

1. The amount for which you are eligible under:

a. Workers’ or Workmen’s Compensation Law;

b. occupational disease law;

c. any compulsory benefit act or law; or

d. any other act or law of like intent.

2. The amount of any disability benefits which you are eligible to receive under any governmental retirement system as a result of your job with the Sponsor.

3. The amount of Disability and/or Retirement Benefits under the United States Social Security Act, the Canada Pension Plan, the Quebec Pension Plan, or any similar plan or act, for which:

a. you receive or are eligible for; and

b. your spouse, child or children receive or are eligible for because of your Disability; or

c. your spouse, child or children receive or are eligible

Note: For Agents and Sales Managers, the 20% additional coverage available under the 70% plan will not be reduced from benefits from Other Income. For General Agents and General Managers the additional coverage available under the Buy-Up Plan will not be reduced from Benefits from Other Income.

These Benefits from Other Income, except Retirement Benefits must be payable as a result of the same Disability for which Liberty pays a benefit.


What Happens If You Receive Any Cost Of Living Increases?

After the first deduction for each of your Benefits from Other Income, your Monthly Benefit will not be further reduced due to any cost of living increases payable under the Benefits from Other Income provision of this coverage. This provision does not apply to increases received from any form of service.

What Happens If You Receive A Lump Sum Payment?

If you receive Benefits from Other Income that are paid in a lump sum, they will be prorated on a monthly basis over the period for which the sum is given or the Maximum Benefit Period, whichever is less.

What Happens If Your Benefit Period Is Less Than A Month?

For any period that a Long Term Disability Benefit is payable that does not extend through a full month, the benefit will be paid on a prorated basis. The rate will be 1/30th per day for such period of Disability.

How Can Your Benefit Period Be Extended?

Your Maximum Benefit Period is shown in the Schedule of Benefits. However, the benefit will be extended beyond the end of your Maximum Benefit Period if you attain the age specified in the benefit duration while Disabled and have not received 12 Monthly Benefit payments. In this event, the benefit period will be extended during the continuance of your Disability until 12 monthly payments have been paid.

When Will Your Long Term Disability Benefits Be Discontinued?

Your Monthly Benefit will cease on the earliest of:

1. the date you are no longer Disabled; or

2. the date you die; or

3. the end of your Maximum Benefit Period.

Successive Periods of Disability

What Happens If You Return To Work And Become Disabled Again?

If you return to work and become Disabled again, you may qualify for Successive Periods of Disability. With respect to this coverage, “Successive Periods of Disability” means a Disability which is related or due to the same cause(s) as a prior Disability for which a Monthly Benefit was payable.

A Successive Period of Disability will be treated as part of your prior Disability if, after receiving Disability Benefits under this coverage, you:

1. return to your Own Occupation on an Active Service basis for less than six continuous months; and

2. perform all the material and substantial duties of your Own Occupation.

Benefit payments will be subject to the terms of this coverage for your prior Disability.


If you return to your own occupation on an Active Service basis for six continuous months or more, the Successive Period of Disability will be treated as a new period of Disability. You must complete another Elimination Period.

If you become eligible for coverage under any other group Long Term Disability coverage, this Successive Period of Disability provision will cease to apply to you.

Three Month Survivor Benefit

What Happens To Your Benefit If You Die?

We will pay a lump sum benefit to your Eligible Survivor when proof is received that you died:

1. after your Disability had continued for 180 or more consecutive days; and

2. while receiving a Monthly Benefit.

The lump sum benefit will be an amount equal to three times your Last Monthly Benefit.

“Eligible Survivor” means your spouse, if living, otherwise your children under age 25.

If payment becomes due to your children, payment will be made in equal shares to:

1. the children; or

2. a person named by us to receive payment on your children’s behalf. This payment will be valid and effective against all claims by others representing or claiming to represent your children.

“Last Monthly Benefit” means the Monthly Benefit paid to you immediately prior to your death without any reduction for earnings received from service.

Minimum Indemnity For Accidental Dismemberment And Loss Of Sight

When Is Your Minimum Indemnity Benefit For Accidental Dismemberment And Loss Of Sight Payable?

If Injury results in any of the losses listed in the Schedule below, the Disability Monthly Benefit will be paid to you for the number of monthly payments shown in this Schedule.

The loss must:

1. result from an Injury caused by an accident that occurred while you were insured for this benefit;

2. result from that Injury directly and independently of all other causes; and

3. occur within 100 days after the accident.

If you die before all of these payments have been made, the balance remaining at the time of your death will be paid to your estate.


SCHEDULE For Loss Of Minimum Number of Monthly Payments Sight of both eyes 46 Hands 46 Both feet 46 One hand and one foot 46 One hand and sight of one eye 46 One hand or one foot 23 Sight of one eye 23* Thumb and index finger of either hand 12

The maximum number of monthly payments payable to you for all losses suffered in any one accident shall be limited to that one loss for which the greatest number of monthly payments is provided in the above Schedule.

Loss of hands and feet means loss by severance at or above the wrist or ankle joint. Loss of sight means total and irrecoverable loss of sight. Loss of thumb and index finger means actual severance at or above the knuckles joining each to the hand.

A benefit may be payable for a period in excess of the number of months indicated in the above Schedule provided that you are Disabled.

*Note: The minimum number of payments for loss of sight in one eye has been changed from 15 to 23.

SECTION 5: EXCLUSIONS

GENERAL EXCLUSIONS

What Disabilities Are Not Covered?

This plan will not cover any Disability due to:

1. war, declared or undeclared or any act of war;

2. Intentionally self-inflicted injuries, while sane or insane;

3. active Participation in a Riot;

4. your committing of or the attempting to commit an indictable offense;

5. periods of incarceration;

6. elective cosmetic surgery, unless cosmetic surgery is necessary as a result of injury, illness, deformity or other medically necessary condition, regardless of when such injury, illness, deformity or other medically necessary condition began.


With respect to this provision, Participation shall include promoting, inciting, conspiring to promote or incite, aiding, abetting, and all forms of taking part in, but shall not include actions taken in defense of public or private property, or actions taken in defense of the person of the insured, if such actions of defense are not taken against persons seeking to maintain or restore law and order including, but not limited to police officers and firemen.

With respect to this provision, Riot shall include all forms of public violence, disorder or disturbance of the public peace, by three or more persons assembled together, whether or not acting with a common intent and whether or not damage to persons or property or unlawful act or acts is the intent or the consequence of such disorder.


Pre-Existing Condition Exclusion

What Happens If Your Disability Results From A Pre-Existing Condition?

This policy will not cover any Disability or Partial Disability:

1. that is caused or contributed to by, or results from a Pre-Existing Condition; and

2. that begins in the first 12 months after your Effective Date.

“Pre-Existing Condition” means a condition resulting from an Injury or Sickness for which you are diagnosed or received Treatment within 12 months prior to your Effective Date.

“Treatment” means consultation, care or services provided by a Physician including diagnostic measures and taking prescribed drugs and medicines.

SECTION 6: TERMINATION PROVISIONS

When Will Your Insurance End?

You will cease to be insured on the earliest of the following dates:

1. the date this plan terminates, but without prejudice to any claim originating prior to the time of termination;

2. the date you are no longer in an eligible class;

3. the date your class is no longer included for insurance;

4. the last day for which your required contribution has been made;

5. the end of the commission period following the date service terminates. Cessation of Active Service will be deemed termination of service, except the insurance will be continued for you if you were absent due to Disability during:

a. your Elimination Period; and

b. any period during which premium is being waived.

6. the date you cease Active Service due to a labor dispute, including any strike, work slowdown or lockout.


We reserve the right to review and terminate all classes insured under this plan if any class(es) cease(s) to be covered.

Military Leave Of Absence Under The Uniformed Service Employment And Reemployment Rights Act (USERRA) (Applicable to General Manager Only)

The Sponsor may continue your coverage(s) by paying the required premium, if the Covered Person is given a Military leave of absence. The Covered Person’s coverage will not continue beyond the end of the policy month following 12 months from the date the leave of absence begins.

What Happens If You Leave The Group Or Your Service Ends Because Of A Plant Closing Or Partial Closing? (Applicable to MA Residents Only)

If you leave the group covered by this policy, you will remain insured for a period of 30 days, unless during such period you are entitled to similar benefits.

In addition, if you leave the group covered by this policy because your service is terminated due to plant closing or covered partial closing, you will remain insured under this policy for a period of 90 days, unless during such period you are entitled to similar benefits.

SECTION 7: GENERAL PROVISIONS

How Will Statements Made In Your Application Affect Your Coverage?

In the absence of fraud, all statements made in any signed Application are considered representations and not warranties (absolute guarantees). No representation by the Sponsor in applying for this plan will make it void unless the representation is contained in the signed Application.

Who Has The Authority For Interpretation Of This Plan?

We shall possess the authority, in our sole discretion, to construe the terms of this plan and to determine benefit eligibility hereunder. Our decisions regarding construction of the terms of this plan and benefit eligibility shall be conclusive and binding.

What Happens If Your Age Is Misstated?

If your age has been misstated, an equitable adjustment will be made in the premium. If the amount of the benefit is dependent upon your age, the amount of the benefit will be the amount you would have been entitled to if your correct age were known.

A refund of premium will not be made for a period more than 12 months before the date we are advised of the error.

Who Will Pay Premiums During A Period For Which Benefits Are Payable?

Your premium payments are waived during any period for which benefits are payable. If coverage is to be continued, premium payments may be resumed following a period during which they were waived.


When Can This Plan Be Contested?

The validity of this plan shall not be contested, except for nonpayment of premiums, after it has been in force for two years from the date of issue. The validity of this plan shall not be contested on the basis of a statement made relating to insurability by you after such insurance has been in force for two years during your lifetime, and shall not be contested unless the statement is contained in a written instrument signed by you.

What Happens When There Are Canadian Residents Covered?

If you are domiciled in Canada: (a) premium and benefit amounts will be deemed to be expressed in Canadian currency; (b) plan provisions concerning your rights are subject to applicable provincial statutes; and (c) with respect to benefits, an action under this plan may be brought in any court in the province where you are domiciled.

How Will This Plan Affect Workers’ Compensation?

This plan and the coverages provided are not in lieu of, nor will they affect any requirements for coverage under any Workers’ Compensation Law or other similar law.

When Must We Be Notified Of A Claim?

Notice of your claim must be given to us within 30 days of the date of the loss on which your claim is based, if that is possible. If that is not possible, we must be notified as soon as it is reasonably possible to do so.

When we have the notice of your claim, we will send you our claim forms. If the forms are not received within 15 days after notice of your claim is sent, you can send us proof of claim without waiting for the form.

When Must We Receive Proof Of Claim?

Proof of your claim must be given to us. This must be done no later than 30 days after the end of your Elimination Period.

Failure to furnish such proof within such time shall not invalidate nor reduce any claim if it was not reasonably possible to furnish such proof within such time. Such proof must be furnished as soon as reasonably possible, and in no event, except in the absence of legal capacity of the claimant, later than one year from the time proof is otherwise required.

Proof of your continued Disability or Partial Disability, when applicable, and regular attendance of a Physician must be given to us within 30 days of the request for the proof.

The proof must cover, when applicable:

a. the date your Disability or Partial Disability started;

b. the cause of your Disability or Partial Disability; and

c. the degree of your Disability or Partial Disability.


Proof Of Financial Loss

Liberty has the right to require proof of financial loss. This includes, but is not limited to:

a. statements of pre-disability income;

b. statements of income received from all sources while disabled;

c. evidence that due application has been made for all other available benefits; and

c. tax returns, tax statements, and accountant’s statements; and

e. any other proof Liberty reasonably may require.

Liberty may perform financial audits at its own expense as often as reasonably required. Payments of benefits may be contingent upon the proof of financial loss being satisfactory to Liberty.

When Must Payment Of Claim Be Made?

When we receive satisfactory proof of your claim, the benefit payable under this plan may be paid at least monthly, depending on the coverage for which your claim is made, during any period for which we are liable. Any balance remaining unpaid upon the termination of the period of liability will be paid immediately upon receipt of due written proof.

Who Are Claims Paid To?

The benefit is payable to you. But, if a benefit is payable to your estate, or if you are a minor, or you are not competent, we have the right to pay up to $2,000 to any of your relatives or any other person whom we consider entitled thereto by reason of having incurred expense for your maintenance, medical attendance or burial. If we, in good faith, pay the benefit in such a manner, we will not have to pay such benefit again.

What Are Our Examination Rights?

We, at our own expense, will have the right and opportunity to have you, whose Injury or Sickness is the basis of a claim, examined by a Physician or vocational expert of our choice. This right may be used as often as reasonably required.

What Are Our Rights Of Recovery?

If a benefit overpayment on any claim occurs, it will be required that reimbursement be made to us within 60 days of such overpayment, or we have the right to reduce future benefit payments until such reimbursement is received. We have the right to recover such overpayments from you or your estate.

When Can Legal Proceedings Begin?

You or your authorized representative cannot start any legal action:

1. until 60 days after proof of claim has been given; nor

2. more than one year after the time proof of claim is required.


How Will We Conform With State Statutes?

Any provision of this plan that, on its Effective Date, is in conflict with the statutes of the governing jurisdiction of this plan, is hereby amended to conform to the minimum requirements of such statute.

What Are Our Rights Of Subrogation?

When your Injury appears to be someone else’s fault, benefits otherwise payable under this plan for loss of time as a result of that Injury will not be paid unless you or your legal representative agrees:

1. to repay us for such benefits to the extent they are for losses for which compensation is paid to you by or on behalf of the person at fault;

2. to allow us a lien on such compensation and to hold such compensation in trust for us; and

3. to execute and give to us any instruments needed to secure the rights under the above.

Further, when we have paid benefits to or on your behalf, we will be subrogated to all rights of recovery that you have against the person at fault. These subrogation rights will extend only to recovery of the amount we have paid. You must execute and deliver any instruments needed and do whatever else is necessary to secure those rights to us.


Claiming Benefits

Applying for LTD Benefits

The following table summarizes the action steps in the LTD process: Who Action When Liberty Mutual Starts the LTD process Mid-point through the STD period You Provide any information Liberty Mutual may

need to determine LTD status As requested by Liberty Mutual and before the end of your STD payment period

Liberty Mutual Will inform you and MassMutual of the claim determination

Before the end of your STD payment period (if medical documentation is not received, a decision could be delayed until on or after STD transitions to LTD)

You may also file your LTD claim directly with Liberty Mutual. Contact Liberty Mutual to report the claim, using the toll-free number on your wallet card (800-713-7384). Be prepared to provide this information and to respond to any additional questions: • Social Security number, address and phone number; • Physician’s name and phone number; • Last day worked/first day absent due to your Injury/Sickness; • Plan Sponsor’s name (MassMutual); and • General agent’s (career agents) or agency vice president’s (GAs and GMs) name and phone number.

It is your obligation to submit to periodic review of your disabling condition—including examination by a Liberty Mutual consulting Physician—as a requirement for benefits and to provide all necessary information requested to Liberty Mutual in support of your claim. LTD benefits may be denied if you fail to support your claim.

If your LTD claim is denied, you may file for a review. See the ERISA Rights section in this book for information on reviewing and appealing denied claims.

Your Disability Authorization Form

A Liberty Mutual disability authorization form is available on the Forms page of myBenefits. Sign and date a copy of this form and leave it with your Physician or healthcare provider. This allows your healthcare provider to submit documentation to Liberty Mutual regarding your STD and/or LTD claim. Failure to do so may result in your claim being delayed or denied.


Filing a Claim

You must contact Liberty Mutual to report a claim within 30 calendar days of the date your Injury/Sickness occurred, or as soon as reasonably possible. As the Plan’s claims fiduciary, Liberty Mutual has the right to review and adjudicate claims.

You will be asked to provide your: • Name, Social Security Number, address, and phone number; • Physician or healthcare provider’s name and phone number; • Last day of Active Service/first day absent due to your Injury/Sickness; and • Plan Sponsor’s name (MassMutual).

You will be asked additional questions about yourself, your Physician or healthcare provider and your medical condition. Liberty Mutual will provide you with your claim number and the telephone number for your Liberty Mutual Claim Team.

Additionally, at the mid-point of the STD Elimination Period, Liberty Mutual will initiate the LTD process, when applicable. Supply proof of your claim, as requested, to Liberty Mutual. LTD benefits may be denied if you fail to support your claim. Liberty Mutual will inform you of the claim determination.

Proof of Your Claim

Proof of your claim is medical documentation typically provided by your Physician or healthcare provider stating the: • Date the Disability or Partial Disability started; • Cause of Disability or Partial Disability; and • Degree of Disability or Partial Disability.

Proof must be provided to Liberty Mutual within 30 calendar days after the end of the Elimination Period.

Periodically throughout your STD and/or LTD period, Liberty Mutual will call you and your Physician for an update on your condition and the possibility of your return to service. When proof of regular care of a Physician and continued Disability or Partial Disability is requested, provide this information to Liberty Mutual within 30 days of their request.

Notify Liberty Mutual once your return to service date is known.

Failure to follow these steps could delay STD/LTD payments.

Submitting a Disability Claim: Liberty Mutual’s Right of Examination

Liberty Mutual, at its own expense, has the right to have you examined as often as reasonably required by a Physician or vocational expert of its choice.


Claim Decision Timeframes

If your claim is denied, Liberty Mutual will notify you of the adverse decision within a reasonable period, but not later than 45 days after receiving the claim. This 45-day period may be extended for up to 30 days, if Liberty Mutual: • Determines the extension is necessary because of matters beyond the Plan’s control; and • Notifies you, before the end of the 45-day period, why the extension is needed and the expected decision date.

If, before the end of the first 30-day extension, Liberty Mutual determines, due to matters beyond the Plan’s control, a decision cannot be rendered within that extension period, the determination period may be extended for up to an additional 30 days, provided Liberty Mutual notifies you, before the end of the first 30-day extension period, why the extension is needed and the expected decision date.

The notice of extension will explain the: • Standards on which benefit entitlement is based; • Unresolved issues that prevent a claim decision; and • Additional information needed.

You have 45 days to provide the information.

The claim determination period begins when a claim is filed, without regard to whether all the information necessary to make a claim determination accompanies the filing.

If an extension is necessary because you failed to submit necessary information, the days from the date Liberty sends you the extension notice until you respond to the request for additional information are not counted as part of the claim determination period.

If Your Claim Is Denied or Reduced

If your claim for benefits is denied or reduced, you will be notified in writing of the reason for the denial. The notice will include: • The specific reason or reasons for denial with reference to those specific Plan provisions on which the denial

is based; • A description of any additional material or information necessary to perfect the claim and an explanation of

why that material or information is necessary; • A description of the Plan’s appeals procedures and time frames, including a statement of the claimant’s right

to bring a civil action under ERISA following an adverse decision on appeal; and • If applicable, any internal rule, guideline, protocol, or other similar criterion relied upon in making the

adverse decision, or a statement that such a rule, guideline, protocol, other similar criterion was relied upon and a copy thereof will be provided free of charge upon request.


Appeals Procedures

Appealing a Denied Claim

If the decision to deny or reduce the amount of the claim is not explained to your satisfaction or you have additional information that you believe may change the decision, you should follow these steps to try to bring the claim denial to resolution: • Contact you Liberty Mutual case manager at 888-440-6118 and request a review of the claim. • File a claim appeal by sending a written request to:

The Liberty Life Assurance Company of Boston Disability Claims P.O. Box 7211 London, KY 40742-7211

You also have the right to request, free of charge, access to copies of all documents, records, and other information relevant to your claim for benefits.

The request for the appeal should include: • A copy of the denial; • Any additional documentation that supports the approval of the claim; and • The specific reasons why you think the claim should be reconsidered and approved.

The written request for review must be sent within 180 days of receipt of the denial and state the reasons why you feel your claim should not have been denied. Appeals must be in writing and signed and dated.

Liberty Mutual has 45 days to provide a decision to uphold or overturn the denial. Liberty Mutual may extend this an additional 45 days (total 90 days) if there are extenuating circumstances.

Legal Action

This Plan is governed by ERISA. For ERISA programs, you have the right to bring a civil action under ERISA Section 502(a) if you are not satisfied with the outcome of the appeals procedure. In most instances, you may not initiate a legal action against the Plan until you have completed the appeal processes. If your appeal is expedited, there is no need to complete the process before bringing legal action.

You have 180 days from the date the claim was denied to file an appeal. No action may be commenced more than one year after the time proof is required.

Right of Recovery

If for some reason a benefit is paid that is larger than the amount allowed by the Plan, the Plan has a right to recover the excess amount from the person or agency that received it. Liberty Mutual, as this plan’s representative, must produce any instruments or papers necessary to ensure the right of recovery, unless prohibited by law, and present them to the person receiving benefits.


Subrogation

The Plan reserves the “right of subrogation” in the event of a loss. The Plan also reserves all rights to relief under ERISA, including those based in equity. The Plan may choose to take action to recover the amount of a claim paid to you if the loss was caused by a third party. If your Injury appears to be someone else’s fault, benefits otherwise payable under this program as a result of that Injury will not be paid unless you or your legal representative agree to: • Repay the Company and/or Liberty Mutual for such benefits to the extent they are for losses for which

compensation is paid to you or on behalf of the person at fault; • Allow the Company and/or Liberty Mutual a lien on such compensation and to hold such compensation in

trust for the Company and/or Liberty Mutual; and • Execute and give to the Company and Liberty Mutual any instruments needed to secure the rights under the

above items.

Further, when the Company and/or Liberty Mutual has paid benefits to or on your behalf, the Company and/or Liberty Mutual will be subrogated to all rights of recovery that you have against the person at fault. These subrogation rights will extend only to recovery of the amount the Company and/or Liberty Mutual has paid. You must execute and deliver any instruments needed and do whatever else is necessary to secure those rights to the Company and/or Liberty Mutual.


About Your Coverage

If You Do Not Meet Production Requirements – For Career Contract Agents

If you are an eligible, non-financed career contract agent and do not meet the annual contract minimum requirements, your participation in the Plan can continue until March 31 of the following year (except participation in Flexible Spending Accounts (FSAs), which ends December 31 of the year you did not meet requirements), provided your career contract remains active.

If your career contract is terminated, based on your Plan coverage in place immediately before the date your career contract is terminated, you may: • Elect to continue medical, dental, vision and/or medical FSA coverage options through the Consolidated

Omnibus Budget Reconciliation Act (COBRA); this election must be completed within 60 days of your career contract termination date, or the date on your COBRA paperwork, whichever is later.

• Convert group term life and dependent life insurance to individual coverage; this election must be completed within 31 calendar days of your career contract termination date. Contact MassMutual Benefits to request a conversion form.

If you continue to hold a career agent contract, you will be eligible to purchase benefits at unsubsidized rates with After-Tax contributions. Unsubsidized agents can drop or decrease their coverage at any time between April 1 and the end of the year by notifying MassMutual Benefits in writing. These requested changes will be effective the first of the month after MassMutual Benefits receives the written request.

An agent may re-qualify for subsidized benefits on a Before-Tax basis if they meet certain production requirements during this calendar year. Once the requirement is met, subsidized benefits will begin the first of the month following qualification.

If You Leave the Company

Your STD and LTD coverage ends the day your career contract, general agent contract or general manager agreement terminates.

If You Retire

If you retire from the Company, your STD and LTD coverage ends the day your career contract, general agent contract or general manager agreement terminates.


If You Die

If you die while covered under STD and LTD, your disability coverage ends the date of your death. Your surviving dependents may be eligible for continuation of coverage for options under the MassMutual Agents’ Welfare Benefits Plan (e.g., medical, dental, vision). Refer to other SPDs (e.g., medical, dental, vision) for more information.

Additionally, if you die while receiving LTD benefits, your Eligible Survivors may receive a lump sum amount equal to three times your last monthly benefit. An eligible survivor is your spouse, if living, otherwise your children under age 25. Payment will be made in equal shares if survivors are your children. Eligible survivors must contact Liberty Mutual at 888-440-6118 and submit a copy of your death certificate to be paid the lump sum amount.

If the Company Ends Coverage

Although MassMutual does not now intend to terminate the benefits described in this booklet, nevertheless, it reserves the right to modify, revoke, change, suspend or terminate this Plan, policy, or benefits described here or in the underlying Plan document at any time or from time to time, with or without notice. This may result in modification or termination of benefits.

When Your STD Coverage Ends

Your STD coverage ends on the earliest of the: • Date your Disability ends, as defined by the STD Program; • Last day of the 22nd consecutive week of Disability (25th consecutive week of Disability for maternity

claims); • Date your career contract, general agent contract or general manager agreement terminates; • Date the Company terminates or amends the Plan eliminating coverage; • Date you are no longer eligible to participate in the Plan; • Date your payment for coverage is not made when due (applicable to unsubsidized agents only); or • Date you die.

When the end date of your STD benefit is determined, the final week of your benefit is prorated if your STD benefit does not extend through a full week. The rate is one seventh of your Basic Weekly Earnings per day (Basic Weekly Earnings divided by 7).

When LTD Coverage Ends

Your LTD coverage ends at the earliest of the date: • Your career contract, general agent contract or general manager agre

ting coverage; ement terminates;

• The Company terminates or amends the Plan elimina• You are no longer eligible to participate in the Plan; • Your payment for coverage is not made when due; or • You die.


How LTD Affects Other MassMutual Benefits

Your other benefits may be impacted by LTD and the end of your career contract, general agent contract or general manager agreement: • Medical Coverage: You may be eligible to continue medical through the retiree medical plan. See your LTD

approval letter, which you will receive when you begin LTD benefits. • Life Insurance: You may apply to UniCare for waiver of premium, or apply to convert your policy. Refer to

the life insurance SPD on FieldNet for more information. • Thrift Plan: For career contract agents, contributions stop when your career contract terminates. You may

not initiate a Thrift loan. If you have an outstanding Thrift plan loan when you begin LTD, you must repay it within 90 days or it will default, resulting in a taxable distribution.

• Cash Balance Pension Plan: If you become Disabled and begin receiving LTD benefits, you will receive information about your benefit.

You are not eligible for any other benefits, including but not limited to: • Any additional benefit plans that become available while you are Disabled; • Dependent life insurance—you may request a right of conversion for group life coverage form to convert your

coverage to an individual policy if you want; • The dental option*; and • The vision care option*.

* You may continue dental and vision coverage through COBRA when you are approved for LTD.

State Disability Benefits

State disability benefits are payable to eligible Disabled workers living in California, New York, New Jersey, Hawaii and Rhode Island. The costs and benefits associated with the plans vary from state to state. Call Liberty Mutual for details about how these benefits affect you.

If you are eligible to receive state disability benefits while you are receiving disability benefits from MassMutual, inform Liberty Mutual immediately.

Social Security Benefits

How Social Security Affects Your MassMutual Disability Benefits

If you are eligible to receive Social Security benefits while you are on LTD, generally, you will receive the difference between the scheduled LTD amount payable and the amount you receive from Social Security. In some cases, Social Security awards are made retroactively. When this happens, you must repay the plan the amount it overpaid you.

MassMutual LTD benefits are reduced by Social Security benefits received by your spouse or children because of your Disability. If you receive Social Security cost-of-living increases, your disability benefits from MassMutual will not be further reduced to compensate for the increases.


Filing for Social Security Disability Benefits

The LTD plan requires you to apply for Social Security disability benefits, and you must apply through Liberty Mutual. These benefits are not paid automatically. You may be eligible for these benefits, if approved, when you have been Disabled for five months.

Often, LTD recipients are not immediately approved when applying for Social Security disability benefits. Third-party representation throughout the application process greatly increases the chances of a Social Security disability award being made. Liberty Mutual provides third-party representation at no cost to you.


Plan Information

The information presented in this SPD is intended to comply with the disclosure requirements of the regulations issued by the U.S. Department of Labor under the Employee Retirement Income Security Act (ERISA) of 1974.

Plan Name and Number

MassMutual Agents’ Welfare Benefits Plan, 506

Plan Administrator

The Plan Administrator is the Plan Administrative Committee, which is appointed by MassMutual’s Chief Executive Officer. The Plan Administrative Committee has the authority to control and manage the operations and administration of the Plan. You can reach the Plan Administrative Committee at:

Massachusetts Mutual Life Insurance Company MassMutual Benefits 1295 State Street, F205 Springfield, MA 01111-0001 866-662-6448

Plan Sponsor

Massachusetts Mutual Life Insurance Company 1295 State Street, F205 Springfield, MA 01111-0001 866-662-6448

Employer Identification Number (EIN)

The EIN of Massachusetts Mutual Life Insurance Company is 04-1590850.

Plan Year

The Plan Year is January 1 through December 31.

Agent for Service of Legal Process

General Counsel of Massachusetts Mutual Life Insurance Company 1295 State Street Springfield, MA 01111-0001

If legal action is necessary to settle a claim, any action may also be served upon the Plan Administrator.

Plan Type and Funding

This Plan is a welfare plan providing disability income benefits on an insured basis. Premiums are paid from the general assets of the Company and participant contributions, where applicable.


Claims Administrator

The claims administrator is Liberty Mutual, Disability Claims, P.O. Box 7211, London, KY 47402-7211. The claims administrator has full discretion and fiduciary authority to determine claims and appeals arising under this Plan.

Type of Administration

This Plan is administered by Liberty Life Assurance Company of Boston.

Continuation of the Plan

Although MassMutual does not now intend to terminate the benefits described in this SPD, nevertheless it reserves the right to modify, revoke, change, suspend or terminate the Plan, policies, benefits or services described here or in the underlying Plan document at any time or from time to time, with or without notice.


ERISA Rights

As a Plan participant, you are entitled to certain rights and protections under the Employee Retirement Income Security Act (ERISA) of 1974, as amended. ERISA provides that you are entitled to the rights described in this section.

Receive Information about Plan and Benefits

You have the right to: • Examine, without charge, at the Plan Administrator’s office or other specified locations, such as worksites, all

documents governing the Plan. These include any insurance contracts and copies of the latest annual report (Form 5500 series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration (EBSA).

• Obtain, upon written request, copies of documents governing the operation of the Plan. These include any insurance contracts and copies of the latest annual report (Form 5500 series) and current Summary Plan Description. A reasonable charge may be required for the copies.

• Receive a summary of the Plan’s annual financial report (summary annual report), which is required by law to be provided to each member.

Prudent Actions by Plan Fiduciaries

In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the Plan. The people who operate the Plan, called Plan fiduciaries, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your Company or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

Enforce Your Rights

If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision (without charge) and to appeal any denial, all within certain time schedules. However, you may not begin any legal action, including proceedings before administrative agencies, until you have followed and exhausted the Plan’s claim and appeal procedures. Note: Any legal action must begin within one year from the time proof of claim is required.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of a Plan document or the latest annual report and do not receive it within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the Plan Administrator’s control.

If you have a claim that is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the Plan’s decision or lack thereof, you may file suit in federal court. If you believe that Plan fiduciaries have misused the Plan’s money or if you believe that you have been discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.


Assistance with Questions

If you have any questions about the Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA or if you need assistance in getting documents from the Plan Administrator, you should contact the nearest office of the EBSA or the national office at:

Division of Technical Assistance and Inquiries Employee Benefits Security Administration U.S. Department of Labor 200 Constitution Avenue NW Washington, DC 20210 866-444-3272

For more information about your rights and responsibilities under ERISA or for a list of EBSA offices, contact the EBSA by visiting their Web site at www.dol.gov/ebsa.


http://www.dol.gov/ebsa

Dictionary Terms

See definitions included in certificate.


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Documents