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Level Premium Group Term Life Dependents Coverage
Your
NEA INSURANCE BOOKLET and
CERTIFICATE
NEA Members Insurance Trust
A policy of caring
Disclosure Notice
FOR FLORIDA RESIDENTS
The benefits of the policy providing your coverage are governed by the law of a state other than Florida.
FOR INDIANA RESIDENTS
Questions regarding your policy or coverage should be directed to:
The Prudential Insurance Company of America (800) 524-0542
If you (a) need the assistance of the governmental agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or e-mail:
State of Indiana Department of Insurance Consumer Services Division 311 West Washington Street, Suite 300 Indianapolis, Indiana 46204
Consumer Hotline: (800) 622-4461; (317) 232-2395
Complaints can be filed electronically at www.in.gov/idoi.
FOR MARYLAND RESIDENTS
The Group Insurance Contract providing coverage under this Certificate was issued in a jurisdiction other than Maryland and may not provide all of the benefits required by Maryland law.
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THIS NOTICE IS FOR TEXAS RESIDENTS ONLY
IMPORTANT NOTICE
AVISO IMPORTANTE
To obtain information or make a complaint: Para obtener información o para someter una queja:
You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at
Puede comunicarse con el Departamento de Seguros de Texas para obtener información acerca de compañías, coberturas, derechos o quejas al
1-800-252-3439
1-800-252-3439
You may write the Texas Department of Insurance
P.O. Box 149104 Austin, TX 78714-9104
FAX No. (512) 475-1771
Puede escribir al Departamento de Seguros de Texas
P.O. Box 149104 Austin, TX 78714-9104
FAX No. (512) 475-1771
PREMIUM OR CLAIM DISPUTES:
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your premium or about a claim you should contact the PRUDENTIAL first. If the dispute is not resolved, you may contact the Texas Department of Insurance.
Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con LA PRUDENTIAL primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (DST).
ATTACH THIS NOTICE TO YOUR POLICY:
UNA ESTE AVISO A SU POLIZA:
This notice is for information only and does not become a part or condition of the attached document.
Este aviso es sólo para propósito de información y no se convierte en parte o condición del documento adjunto.
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Foreword
We are pleased to present you with this Booklet. It describes the Program of benefits you have selected through the NEA Members Insurance Trust and what you have to do to be covered for these benefits.
We believe this Program provides worthwhile protection for you and your family.
Please read this Booklet carefully. If you have any questions about the Program, we will be happy to answer them.
IMPORTANT NOTICE: This Booklet is an important document and should be kept in a safe place. This Booklet and the Certificate of Coverage made a part of this Booklet together form your Group Insurance Certificate.
RIGHT TO EXAMINE CERTIFICATE RULE
For Newly Insured Members: You may, within thirty (30) days after receiving your Group Insurance Certificate, withdraw your request for coverage under the Group Contract. To do so, make your request in writing and return this Group Insurance Certificate to NEA Insurance Operations, P.O. Box 9389,Des Moines, Iowa 50306-9389. Upon receipt of your request and this Group Insurance Certificate, your coverage under the Group Contract will be deemed void from its effective date. Any payment you made for this insurance will be returned to you
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Table of Contents
FOREWORD ..........................................................................................................................................1
SCHEDULE OF BENEFITS ...................................................................................................................3
WHO IS ELIGIBLE TO BECOME INSURED.........................................................................................4
WHEN YOU BECOME INSURED..........................................................................................................5
DELAY OF EFFECTIVE DATE..............................................................................................................6
DEPENDENTS TERM LIFE COVERAGE .............................................................................................7
OPTION TO ACCELERATE PAYMENT OF DEATH BENEFITS .........................................................9
GENERAL INFORMATION..................................................................................................................12
WHEN YOUR INSURANCE ENDS......................................................................................................18
CERTIFICATE OF COVERAGE ..........................................................................................................21
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Schedule of Benefits
You should know...
• This Booklet and the Certificate of Coverage together form your Group Insurance Certificate. The Coverages in this Booklet are insured under a Group Contract issued by Prudential. All benefits are subject in every way to the entire Group Contract which includes the Group Insurance Certificate. It alone forms the agreement under which payment of insurance is made.
DEPENDENTS TERM LIFE COVERAGE
BENEFIT AMOUNTS:
Amount of Insurance for your Spouse or Domestic Partner: See the Specifications Page.
Effect of Option to Accelerate Payment of Death Benefits: The amount of insurance on a dependent (as determined in the absence of this provision) will be reduced by the amount of any Terminal Illness Proceeds paid under the Option to Accelerate Payment of Death Benefits with respect to the dependent.
OTHER INFORMATION Contract Holder: NEA MEMBERS INSURANCE TRUST
Group Contract No.: G-20400-DC
Program Date: September 5, 2006. This Booklet describes the benefits under the Group Program as of this date. The Program Date is not the same as your Effective Date of Coverage
Cost of Insurance: The insurance in this Booklet is Contributory Insurance. You will be informed of the amount of your Premium payment when you enroll.
Prudential's Address:
The Prudential Insurance Company of America 290 West Mount Pleasant Avenue Livingston, New Jersey 07039
WHEN YOU HAVE A CLAIM Each time a claim is made, it should be made without delay. Use a claim form, and follow the instructions on the form.
If you do not have a claim form, contact:
NEA Insurance Operations
P.O. Box 1737 Des Moines, IA 50306-1737
Toll Free Number
1-800-523-5877
7:00 AM to 8:00 PM Central Time Monday - Friday
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Who is Eligible to Become Insured
FOR DEPENDENTS INSURANCE
You are eligible for Dependents Insurance while:
• You are a Member of the NEA; and
• You are in a Covered Class; and
• You have a Qualified Dependent; and
• You are enrolled for Level Premium Group Term Life-Member Term Life Coverage under the Group Contract.
Your class is determined by the NEA Members Insurance Trust. This will be done under its rules, on dates it sets. The NEA Members Insurance Trust must not discriminate among persons in like situations.
Qualified Dependents:
This is the person for whom you may obtain Dependents Insurance:
• Your spouse or your Domestic Partner under age 66.
Domestic Partner means a person who:
• Is a Registered Domestic Partner. Your Registered Domestic Partner means a person whose domestic partnership with you has been validly registered by the government of the District of Columbia; or
• Is an unmarried adult who cohabits with you in an economically committed and affectional relationship that is meant to be of lasting duration. The Domestic Partner and you must be each other’s sole Domestic Partner; and
• Has cohabited with you in such a relationship for at least 6 consecutive months prior to his or her enrollment in the program; and
• Is anticipated, will continue to cohabit with you in such a relationship.
• Is otherwise not a Qualified Dependent under the Coverage.
You can enroll a Domestic Partner under the Coverage. No Domestic Partner will be eligible while you have a spouse who is or could be covered as a Qualified Dependent. You must notify Prudential within 10 days of the date that a person ceases to be considered your Domestic Partner.
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Exceptions:
Your spouse or Domestic Partner is not your Qualified Dependent while:
(1) On active duty in the armed forces of any country; or
(2) Insured under the Group Contract as a Member for the life coverage.
The rules for obtaining Dependents Insurance are in the When You Become Insured section.
When You Become Insured
FOR DEPENDENTS INSURANCE
Your Dependents Insurance under a Coverage for your spouse or Domestic Partner will begin the first day of the calendar month following the date your enrollment form for the Coverage is approved by Prudential. Approval requires that all of these conditions are met:
• The person is your Qualified Dependent; and
• You are in a Covered Class for that insurance; and
• You have met the evidence requirement for that Qualified Dependent; and
• You are insured for the Member Insurance, if any, under that Coverage. To be insured for a Qualified Dependent under the Dependents Term Life Coverage, you must be insured under a Member Term Life Coverage of the Group Contract.
• Your insurance for that Qualified Dependent is not being delayed under the Delay of Effective Date section below; and
• Dependents Insurance under that Coverage is part of the Group Contract.
You must enroll your Qualified Dependent on a form approved by Prudential and agree to pay the required Premiums.
At any time, the Dependents Insurance benefits for which you are insured are those for your class, unless otherwise stated.
Evidence Requirement: You will be required to provide evidence of insurability for your Qualified Dependent. This requirement will be met when Prudential decides the evidence is satisfactory.
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Delay of Effective Date FOR DEPENDENTS TERM LIFE COVERAGE
A Qualified Dependent may be confined for medical care or treatment, at home or elsewhere. If a Qualified Dependent is so confined on the day that your Dependents Insurance under a Coverage for that Qualified Dependent would take effect, it will not then take effect. The insurance will take effect upon the Qualified Dependent's final medical release from all such confinement. The other requirements for the insurance must also be met.
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Dependents Term Life Coverage
FOR YOUR DEPENDENTS ONLY
A. DEATH BENEFIT WHILE A COVERED PERSON.
If a dependent dies while a Covered Person, the amount of insurance on that dependent under this Coverage is payable when Prudential receives written proof of death. But, all or part of the death benefit is not payable if it is excluded under Section D.
B. DEATH BENEFIT DURING A CONVERSION PERIOD.
A death benefit is payable under this Section B if a dependent dies:
(1) within 31 days after ceasing to be a Covered Person; and
(2) while entitled (under Section C) to a conversion of the insurance under this Coverage to an individual contract.
The amount of the benefit is equal to the amount of Dependents Term Life Coverage which could have been converted. It is payable even if conversion was not applied for. It is payable when Prudential receives written proof of death. But, all or part of the death benefit is not payable if it is excluded under Section D.
C. CONVERSION PRIVILEGE.
This privilege applies if you cease to be insured for the Dependents Term Life Coverage of the Group Contract with respect to a dependent. That dependent may have your insurance on the dependent under this Coverage, which then ends, converted to an individual life insurance contract. Evidence of insurability is not required. However, conversion is not available if the insurance ends for one of these reasons:
(1) You fail to make any required contribution for insurance under the Group Contract.
(2) All Dependents Term Life Coverage of the Group Contract for your class ends by amendment or otherwise. This (2) does not apply if, on the date it ends, you have been insured with respect to the dependent for five years for that insurance (or for that insurance and any Prudential rider or group contract replaced by that insurance).
Any such conversion is subject to the rest of this Section D.
Availability: The individual contract must be applied for and the first premium must be paid by the later of:
(1) the thirty-first day after you cease to be insured for Dependents Term Life Coverage with respect to the dependent; and
(2) the fifteenth day after you have been given written notice of the conversion privilege. But, in no event may you convert the insurance to an individual contract if you do not apply for the contract and pay the first premium prior to the ninety-second day after you cease to be insured for Dependents Term Life Coverage with respect to the dependent.
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Individual Contract Rules: The individual contract must conform to the following:
Amount: Not more than the amount of Dependents Term Life Coverage on the dependent ending under this Coverage. But, if it ends because all the Dependents Term Life Coverage of the Group Contract for your class ends, the total amount of individual insurance which may be obtained in place of all the Dependents Term Life Coverage on the dependent then ending under the Group Contract will not exceed the lesser of the following:
(1) The total amount of all your Dependents Term Life Coverage on the dependent then ending under the Group Contract reduced by the amount of group life insurance from any carrier for which you are or become eligible with respect to the dependent within the next 31 days.
(2) $10,000.
Form: Any form of a life insurance contract that:
(1) conforms to Title VII of the Civil Rights Act of 1964, as amended, having no distinction based on sex; and
(2) is one that Prudential usually issues at the age and amount applied for.
This does not include term insurance or a contract with disability or supplementary benefits.
Premium: Based on Prudential's rate as it applies to the form and amount, and to the dependent's class of risk and age at the time.
Effective Date: The end of the 31 day period after you cease to be insured for Dependents Term Life Coverage with respect to the dependent.
D. SUICIDE EXCLUSION.
If a dependent’s death results from or is caused by suicide, while sane or insane a death benefit is not payable if the dependent dies within two years of the date the dependent became a Covered Person. But, Prudential will refund any premiums paid for the Dependents Term Life Coverage on that dependent.
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Any death benefit provided under a section of this Coverage is payable to you. But, if your dependent continues the insurance under this Coverage after your death, any death benefit provided under a section of this Coverage is payable according to that section and the Beneficiary and Mode of Settlement Rules. (See Continued Coverage after Your Death.)
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Option to Accelerate Payment of Death Benefits
FOR YOUR DEPENDENTS
The following is added to the Dependents Term Life Coverage provision.
Definitions
• Terminally Ill Dependent: A dependent whose life expectancy is 24 months or less.
• Terminal Illness Proceeds: The amount of Dependents Term Life Insurance that you may elect to place under this option. You may elect any amount up to 50% of the amount in force on your dependent’s life on the date Prudential receives the proof that such dependent is a Terminally Ill Dependent. However, the Terminal Illness Proceeds may be reduced if, within 24 months after the date Prudential receives such proof, a reduction on account of age would have applied to the amount of your Dependents Term Life Insurance for that dependent. In that case, the amount of the Terminal Illness Proceeds may not exceed the amount of such Insurance after applying the reduction.
Option: If your dependent becomes a Terminally Ill Dependent while you are insured for that dependent under the Dependents Term Life Insurance provision you may elect to have the Terminal Illness Proceeds placed under this option. That election is subject to the conditions set forth below.
Payment of Terminal Illness Proceeds: If you elect this option, Prudential will pay the Terminal Illness Proceeds you place under this option in one sum when it receives proof that your dependent is a Terminally Ill Dependent.
If you do not want the Terminal Illness Proceeds in one sum, you may elect to have them paid in 24 equal monthly installments. The first monthly payment will be due when Prudential receives proof that your dependent is a Terminally Ill Dependent. The other payments are due on the same day of each later month.
To Whom Payable: The benefits under this provision are payable to you.
Amount Due But Unpaid at Your Dependent’s Death: If you elect monthly installments and your Terminally Ill Dependent dies before all payments have been made, Prudential will pay you in one sum. That sum will be the total of the payments that remain.
Amount Due But Unpaid at Your Death: If you elect monthly installments and you die before all payments have been made, Prudential will pay in one sum an amount equal to the total of the payments that remain. Payment will be made to your spouse or Domestic Partner if living, otherwise to your estate.
Conditions: Your right to be paid under this option is subject to these terms:
(1) You must choose this option in writing in a form that satisfies Prudential.
(2) You must furnish proof that satisfies Prudential that your dependent’s life expectancy is 24 months or less, including certification by a Doctor.
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(3) Your Dependents Term Life Insurance must not be assigned.
(4) Terminal Illness Proceeds will be made available to you on a voluntary basis only. Therefore:
(a) If you are required by law to use this option to meet the claims of creditors, whether in bankruptcy or otherwise, you are not eligible for this benefit.
(b) If you are required by a government agency to use this option in order to apply for, get or keep a government benefit or entitlement, you are not eligible for this benefit.
Effect on Insurance: This benefit is in lieu of the benefits that would have been paid on your dependent’s death with respect to the Terminal Illness Proceeds. When you elect this option, the total amount of Dependents Term Life Insurance otherwise payable on your dependent’s death, will be reduced by the Terminal Illness Proceeds. Also, any amount your dependent could otherwise have converted to an individual contract will be reduced by the Terminal Illness Proceeds.
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Disclosure Notice
Note:
• Any payment made under this option may be taxable. You are advised to seek the help of a professional tax advisor for assistance with any questions that you may have.
• If you elect this option, your eligibility for Medicaid or other government programs may be affected. You are advised to seek the help of a professional legal advisor for assistance with any questions that you may have.
Option to Accelerate Payment of Death Benefits: Your Dependents Term Life plan includes an option to give you flexibility in how your dependent’s life insurance benefits will be paid. If your dependent becomes terminally ill, this option may allow you to have part of your dependent’s life insurance benefits, which would otherwise be paid at your dependent’s death, to be paid in advance to you while your dependent is alive.
Eligibility: To be eligible to elect this option, you must furnish proof satisfactory to Prudential that your dependent’s life expectancy is 24 months or less, including certification by a qualified doctor. Election of this option is also subject to the Conditions below.
Amount of Benefit: The amount to be paid under this option is any amount up to 50% of the amount in force on your dependent’s life on the date Prudential receives the proof that such dependent is a Terminally Ill Dependent. However, the Terminal Illness Proceeds may be reduced if, within 24 months after the date Prudential receives such proof, a reduction on account of age would have applied to the amount of your Dependents Term Life Insurance for that dependent. In that case, the amount of the Terminal Illness Proceeds may not exceed the amount of such Insurance after applying the reduction. You may elect to have the money in one sum or 24 equal monthly payments.
Effect of Option: If you elect this option, the amount of your dependent’s life insurance benefits payable to you on the death of your dependent will be reduced by the advanced payment. Also, if you are contributing for your dependent’s life insurance benefits, the amount of your contribution will be adjusted based on the amount of insurance remaining in force.
Conditions: You cannot elect this option if your dependent’s life insurance benefits are assigned. This option is available to you on a voluntary basis only; you are not eligible for it if (1) you are required to use it to meet the claims of creditors, whether in bankruptcy or otherwise or (2) you are required by a government agency to use it in order to apply for, get or keep a government benefit or entitlement. You can elect this option only once.
Premium for Accelerated Death Benefits: There is no additional charge for this benefit.
Administrative Expense Charge: There is no administrative expense charge to you; the administrative expense charge is paid by the group contract holder.
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General Information
BENEFICIARY RULES
The rules in this section apply to insurance payable on account of your Qualified Dependent’s death, when the Coverage states that they do. But these rules are modified, if there is an assignment, by the Limits on Assignments section.
“Beneficiary” means a person, or an organization, or an institution chosen, on a form approved by Prudential, to receive the insurance benefits.
Your Qualified Dependent has the right to choose a Beneficiary if the dependent continues the dependent’s Coverage after your death.
Your Qualified Dependent may change the Beneficiary at any time without the consent of the present Beneficiary. The Beneficiary change must be filed on a form satisfactory to Prudential. The change will take effect on the date the form is signed. But it will not apply to any amount paid by Prudential before it receives the form.
If there is more than one Beneficiary but the Beneficiary form does not specify their shares, they will share equally. If a Beneficiary dies before your Qualified Dependent, that Beneficiary's interest will end. It will be shared equally by any remaining Beneficiaries, unless the Beneficiary form states otherwise.
Any amount of insurance for which there is no Beneficiary at your Qualified Dependent’s death will be payable to the first of the following: (a) surviving spouse; (b) surviving child(ren) in equal shares; (c) surviving parents in equal shares; (d) surviving siblings in equal shares; (e) estate. This order will apply unless otherwise provided in the Limits on Assignments.
MODE OF SETTLEMENT RULES
The rules in this section apply to Dependents Life Insurance payable on account of your Qualified Dependent’s death, when the Coverage states that they do. But these rules are subject to the Limits on Assignments section.
“Mode of Settlement” means payment other than in one sum.
Dependents Life Insurance is normally paid in one sum. But a Mode of Settlement may be arranged with Prudential for all or part of the insurance, as stated below.
Arrangements for Mode of Settlement: Your Qualified Dependent may arrange a Mode of Settlement by proper written request to Prudential. If, at your Qualified Dependent’s death, no Mode of Settlement has been arranged for an amount of Dependent’s Life Insurance, the Beneficiary and Prudential may then mutually agree on a Mode of Settlement for that amount.
Conditions for Mode of Settlement: The Beneficiary must be a natural person taking in the Beneficiary's own right. If not a natural person, Prudential’s consent is required. A Mode of Settlement will apply to secondary Beneficiaries only if Prudential agrees in writing. Each installment to a person must not be less than $20.00. A change of Beneficiary will void any Mode of Settlement arranged before the change.
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Choice by Beneficiary: A Beneficiary being paid under a Mode of Settlement may, if Prudential agrees, choose (or change the Beneficiary's choice of) a payee or payees to receive, in one sum, any amount which would otherwise be payable to the Beneficiary's estate.
Prudential has prepared information about the modes of settlement available. Contact NEA Insurance Operations, P. O. Box 1737, Des Moines, Iowa 50306-1737 for this information.
INCONTESTABILITY OF LIFE INSURANCE
This limits Prudential's use of a person’s statements in contesting an amount of Life Insurance for which the person is insured. These are statements made to persuade Prudential to accept the person for insurance. They will be considered to be made to the best of the person’s knowledge and belief. These rules apply to each statement:
(1) It will not be used in the contest unless:
(a) It is in a written instrument signed by the person; and
(b) A copy of that instrument is or has been furnished to the person or the person’s Beneficiary.
(2) If it relates to a person’s insurability, it will not be used to contest the validity of insurance which has been in force, before the contest, for at least two years during the person’s lifetime.
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LIMITS ON ASSIGNMENTS
You may assign your insurance under a Coverage. Unless the Schedule of Benefits states otherwise, the following rule applies to assignments: Insurance under any Coverage providing death benefits may be assigned only as a gift assignment. Any rights, benefits or privileges that you have as a Member may be assigned. This includes any right you have to choose a Beneficiary or to convert to another contract of insurance. Prudential will not decide if an assignment does what it is intended to do. Prudential will not be held to know that one has been made unless it or a copy is filed with Prudential.
This paragraph applies only to insurance for which your Qualified Dependent has the right to choose a Beneficiary, when that right has been assigned. If an assigned amount of insurance becomes payable on account of your Qualified Dependent’s death and, at your Qualified Dependent’s death, there is no Beneficiary chosen by the assignee, it will be payable to:
(1) the assignee, if living; or
(2) the estate of the assignee, if the assignee is not living.
It will not be payable as stated in the Beneficiary Rules.
DEFINITIONS
Calendar Year: A year starting January 1.
Contributory Insurance: Contributory Insurance is insurance for which the NEA Members Insurance Trust has the right to require your Premium payments.
Coverage: A set of benefits as described in the Booklet by:
(1) A benefit page labeled as a Coverage in its title.
(2) Any page or pages that continue the same kind of benefits.
(3) A Schedule of Benefits entry and other benefit pages or forms that by their terms apply to that kind of benefits.
Covered Classes: The “Covered Classes” are these Members of the NEA who, according to the administrative records, have elected to participate in any Plan Schedule of the Group Contract: Active, Staff, Substitute, Reserve, Student, Retired and Life Members.
Covered Person under a Coverage: A Member who is insured for Member Insurance under that Coverage; a Qualified Dependent for whom a Member is insured for Dependents Insurance, if any, under that Coverage.
Dependents Insurance: Insurance on the person of a dependent.
Doctor: A licensed practitioner of the healing arts acting within the scope of the license.
Injury: Injury to the body of a Covered Person.
Member: A person who is an Active, Staff, Substitute, Reserve, Student, Retired or Life Member of the NEA.
Member Insurance: Insurance on the person of a Member.
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NEA: The National Education Association of the United States.
Prudential: The Prudential Insurance Company of America.
Sickness: Any disorder of the body or mind of a Covered Person including pregnancy of a Covered Person, abortion, miscarriage, or childbirth, but not including Injury.
You: A Member.
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PAYMENT OF PREMIUMS – GRACE PERIOD
Premiums are to be paid on each Premium Payment Date.
Premium Payment Date: Premiums are to be paid starting with the date you become insured for dependents insurance under the Group Contract. You may elect to pay Premiums monthly, quarterly, semi-annually or annually. The Premium payment basis may be changed at your request.
Period of Insurance under a Coverage: Each period of insurance under a Coverage begins on a Premium Payment Date. Periods of insurance differ by the Premium payment basis chosen. A period is: one calendar month if Premiums are paid on a monthly basis; three consecutive calendar months if Premiums are paid on a quarterly basis; six consecutive calendar months if Premiums are paid on a semi-annual basis; and twelve consecutive calendar months if Premiums are paid annually.
Grace Period: You may pay each Premium after the first within 60 days of the Premium Payment Date without being charged interest. Those days are known as the Grace Period. If you do not pay any Premium by the end of the Grace Period, your dependents Coverage under this Group Insurance Certificate will end when the Grace Period ends. You are liable to pay Premiums for the time your dependents Coverage is in force.
REINSTATEMENT
If your dependents Coverage ends because you did not pay any Premium by the end of its Grace Period, your dependents Coverage may be reinstated. To do so, these conditions must be met:
(1) You must request reinstatement within 120 days of the Premium Payment Date of the first unpaid Premium;
(2) You must pay all overdue Premiums; and
(3) You must give evidence of your Qualified Dependent’s insurability satisfactory to Prudential.
If Prudential approves your request, the reinstatement will be effective on the first day of the month following the date on which all of the conditions are met.
PREMIUM CALCULATIONS
Premiums for the insurance will not increase during the Level Premium Term Period shown on the Specifications Page, unless Premiums change for your Class. During the Level Premium Term Period, Premiums will be based on:
(1) Your Qualified Dependent’s amount of insurance;
(2) Your Qualified Dependent’s age on the Effective Date of Coverage shown on the Specifications Page; and
(3) Your Qualified Dependent’s class of risk (smoker or non-smoker).
When the Level Premium Term Period for your Dependents Term Life Coverage ends, Premiums for your dependents insurance may increase, but not more than once per year. During these annual rate term periods, Premiums will be based on:
(1) Your Qualified Dependent’s amount of insurance;
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(2) Your Qualified Dependent’s age when the Level Premium Term Period ends and as of each subsequent Anniversary of your Effective Date of Coverage; and
(3) The class of risk to which your Qualified Dependent belongs (smoker or non-smoker).
EXCHANGE RULES
When the Level Premium Term Period for your Dependents Term Life Coverage ends, you may keep your dependents insurance under this Group Insurance Certificate in force (as described above), or you may apply to exchange this certificate for a new certificate as described under (1) or (2) below:
(1) If your Qualified Dependent is less than age 56 when the Level Premium Term Period ends, you may apply to exchange this certificate for a new level premium group term life insurance certificate with either a 10 or 20-year level premium term period.
(2) If your Qualified Dependent is age 56 or more but less than age 66 when the Level Premium Term Period ends, you may apply to exchange this certificate for a new level premium group term life insurance certificate with a 10-year level premium term period.
You will not be eligible to exchange the Group Insurance Certificate after your Qualified Dependent reaches age 66.
The rules for the exchange are:
(1) You must request the exchange in writing on a form satisfactory to Prudential at least 3 months prior to the Date of Exchange;
(2) Your dependents Coverage must be in force with all due Premiums paid; and
(3) You must provide evidence of insurability for your Qualified Dependent that is satisfactory to Prudential.
“Date of Exchange” means the Anniversary of your dependents insurance Effective Date of Coverage coinciding with the end of the Level Premium Term Period.
Terms and Conditions of the New Certificate: The amount, premium and effective date will be as stated below.
Amount: The amount may not be more than your Qualified Dependent’s amount of insurance under the Dependents Term Life Coverage of this Group Insurance Certificate or less than the minimum amount of insurance for newly insured dependents on the Date of Exchange.
Premium: The premium will be based on Prudential’s rate as it applies to the amount, your Qualified Dependent’s age and your Qualified Dependent’s class of risk at the time.
Effective Date: The Date of Exchange.
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When Your Insurance Ends
DEPENDENTS INSURANCE
Your Dependents Insurance under a Coverage will end when the first of these occurs:
• Your membership in the Covered Classes for the insurance ends because your membership in the association ends.
• The part of the Group Contract providing the insurance ends.
• Your class is removed from the Covered Classes for the insurance.
• You fail to pay, when due, or by the end of the 31-day Grace Period, any Premium required for an insurance of the Group Contract. But, failure to pay for Dependents Insurance will not cause your Member Insurance to end.
• The insurance is Dependents Insurance under the Level Premium Group Term Life Coverage with and your Member Insurance under the Level Premium Group Term Life Coverage ends.
• You reach age 104.
• You request the end of an insurance in writing.
Your Dependents Insurance for a Qualified Dependent under a Coverage will end when that person ceases to be a Qualified Dependent for that Coverage.
If at any time it is determined that a contribution has been made and Coverage continued after the date an individual ceased to be included in the classes of Members eligible for the insurance described in this Certificate, due to failure on the part of the individual to report to the Insurance Company such cessation of eligibility, such individual’s insurance will be considered to terminate as of the most recent premium due date on which a contribution was made and an amount equal to such contribution shall be refunded to the individual, unless benefits have otherwise become payable under the coverage.
Continued Coverage after Your Death: Your Dependents Insurance under the Dependents Term Life Coverage with Level Premium Term may be continued after your death until the end of your dependent’s Level Premium Term Period. This is subject to the payment, when due, of any Premiums required for the insurance. All other terms of the Group Contract will apply as if you had not died, except that any death benefit provided under a section of the Dependents Term Life Coverage will be paid according to that section and the Beneficiary and Mode of Settlement Rules.
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83500 VTE 5002 (S-1) 19
Vermont Life Insurance Mandatory Civil Union Endorsement
PURPOSE
This endorsement is part of the policy, contract, certificate and/or riders and endorsements to which it is attached and is intended to provide benefits for parties to a civil union. Vermont law requires that insurance contracts and policies offered to married persons and their families be made available to parties to a civil union and their families. In order to receive benefits in accordance with this endorsement, the civil union must have been established in the state of Vermont according to Vermont law.
GENERAL DEFINITIONS, TERMS CONDITIONS AND PROVISIONS
The general definitions, terms, conditions or any other provisions of the policy, contract, certificate and/or riders and endorsements to which this mandatory endorsement is attached are hereby amended and superseded as follows:
Terms that mean or refer to a marital relationship or that may be construed to mean or refer to a marital relationship: such as "marriage", "spouse", "husband", "wife", "dependent", "next of kin", "relative", "beneficiary", "survivor", "immediate family" and any other such terms include the relationship created by a civil union.
Terms that mean or refer to a family relationship arising from a marriage such as "family", "immediate family", "dependent", "children", "next of kin", "relative", "beneficiary", "survivor" and any other such terms include the family relationship created by a civil union.
Terms that mean or refer to the inception or dissolution of a marriage, such as "date of marriage", "divorce decree", "termination of marriage" and any other such terms include the inception or dissolution of a civil union.
"Dependent" means a spouse, a party to a civil union, and/or a child or children (natural, stepchild, legally adopted or a minor who is dependent on the insured for support and maintenance) who is born to or brought to a marriage or to a civil union.
"Child or covered child" means a child (natural, step-child, legally adopted or a minor who is dependent on the insured for support and maintenance) who is born to or brought to a marriage or to a civil union.
CAUTIONARY DISCLOSURE
THIS ENDORSEMENT IS ISSUED TO MEET THE REQUIREMENTS OF VERMONT LAW AS EXPLAINED IN THE "PURPOSE" PARAGRAPH OF THE ENDORSEMENT. THE FEDERAL GOVERNMENT OR ANOTHER STATE GOVERNMENT MAY NOT RECOGNIZE THE BENEFITS GRANTED UNDER THIS ENDORSEMENT. YOU ARE ADVISED TO SEEK EXPERT ADVICE TO DETERMINE YOUR RIGHTS UNDER THIS CONTRACT.
83500 MN 5007 (20400-10) 20
ADDITIONAL PROVISIONS FOR MINNESOTA RESIDENTS
For Minnesota residents, there are additional provisions about your right to convert coverage after your insurance ends.
A. CONVERSION PRIVILEGE
The following provision replaces the conversion provisions in the Dependents Term Life Coverage section of your booklet.
If you cease to be insured for the Dependents Term Life Insurance of the Group Contract for one of the reasons stated below, you may convert all or part of your insurance under this Coverage, which then ends, to an individual life insurance contract. Evidence of insurability is not required. The reasons are:
(1) Your membership ends or you transfer out of a Covered Class.
(2) All term life insurance of the Group Contract for your class ends by amendment or otherwise.
Any such conversion is subject to the rest of this Section.
Availability: You must apply for the individual contract and pay the first premium within 31 days after you cease to be insured for the Dependents Term Life Insurance.
Individual Contract Rules: The individual contract must conform to the following:
Amount: Not more than your Dependents Term Life Insurance under this Coverage when your insurance ends.
Form: Any form of a life insurance contract that:
(1) conforms to Title VII of the Civil Rights Act of 1964, as amended, having no distinction based on sex; and
(2) is one that Prudential usually issues at the age and amount applied for.
This does not include term insurance or a contract with disability or supplementary benefits.
Premium: Based on Prudential's rate as it applies to the form and amount, and to your class of risk and age at the time.
Effective Date: The end of the 31 day period during which you may apply for it.
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83500 BCT 5006 (S-1) 21
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
Certificate of Coverage
Prudential certifies that insurance is provided according to the Group Contract(s) for each Insured Member. Your Booklet's Schedule of Benefits shows the Contract Holder and the Group Contract Number(s).
Insured Member: You are eligible to become insured under the Group Contract if you are in the Covered Classes of the Booklet's Schedule of Benefits and meet the requirements in the Booklet's Who is Eligible section. The When You Become Insured section of the Booklet states how and when you may become insured for each Coverage. Your insurance will end when the rules in the When Your Insurance Ends section so provide. Your Booklet and this Certificate of Coverage together form your Group Insurance Certificate.
Beneficiary for Member Death Benefits: See the Booklet's Beneficiary Rules.
Coverages and Amounts: The available Coverages and the amounts of insurance are described in the Booklet.
If you are insured, your Booklet and this Certificate of Coverage form your Group Insurance Certificate. Together they replace any older booklets and certificates issued to you for the Coverages in the Booklet's Schedule of Benefits. All Benefits are subject in every way to the entire Group Contract which includes the Group Insurance Certificate.
The Prudential Insurance Company of America 751 Broad Street Newark, New Jersey 07102
SPD (20400)
SUMMARY PLAN DESCRIPTION
NEA MEMBERS INSURANCE TRUST
SPD (20400)
INTRODUCTION
The National Education Association (NEA) sponsors a group insurance plan for its members called the “NEA Members Insurance Plan” (“the Plan”). The purpose of the Plan is to provide NEA Members with group insurance benefits in the event of their death, accident, sickness, disability, or other occurrences affecting members and their families. These benefits are funded by one or more group insurance policies acquired and maintained by the trustees of the NEA Members Insurance Trust, the nonprofit entity created as the vehicle through which benefits are provided to NEA members participating in the Plan. Participation for Life Insurance is open to NEA members on a voluntary basis. Participants select the type of coverage they want and pay the entire cost themselves. The NEA does not contribute to the cost of these coverages.
The terms of the Plan are currently contained in a Trust agreement and operating document governing the Plan, in the insurance policies issued to the Trust, in administration agreements between insurance carriers and the Trust, and in resolutions adopted by NEA’s Board of Directors and Executive Committee. The Life program is described in previous pages of this Booklet.
The purpose of this Summary Plan Description is to inform you about the Plan’s structure. This Summary is being furnished to you in compliance with the Employee Retirement Income Security Act of 1974 (ERISA). As a participant in the Plan, you are entitled to certain rights and protections under ERISA. These rights are summarized in this Summary Plan Description.
SPD (20400)
GENERAL INFORMATION Plan name. The plan is generally known as the NEA Member Insurance Plan.
Trust name. The Trust is generally known as the NEA Members Insurance Trust.
Program Name. The Program is generally known as the NEA Level Premium Group Term Life Insurance Plan.
Sponsor. The Plan and Trust are sponsored by the National Education Association of the United States (NEA), 1201 Sixteenth Street, N.W., Washington, D.C. 20036, for its members.
Underwriter. Plan benefits described in previous pages of this booklet are underwritten by: The Prudential Insurance Company of America (Prudential), 290 West Mount Pleasant Avenue, Livingston, New Jersey 07039.
Identification Numbers. NEA has been assigned employer identification number 52-1126682 by the Internal Revenue Service. The Plan number is 520.
Type of Plan. This is an employee welfare benefit plan providing group insurance to participants.
Administration. The Plan is administered by NEA pursuant to resolutions adopted by its Board of Directors and Executive Committee.
Plan Administrator. NEA serves as the administrator of the Plan. Communications concerning any aspect of the Plan should be addressed to NEA Members Insurance Plan, c/o NEA Member Benefits, 1201 Sixteenth Street, N.W., Washington, D.C. 20036. The telephone number of NEA Member Benefits is (800) 637-4636.
Service of Process. If legal action involving the Plan is necessary, legal process may be served upon the Plan Administrator. The person designated as agent for services of legal process is the Plan Administrator, c/o NEA Member Benefits, 1201 Sixteenth Street, N.W., Washington, D.C. 20036.
Trustees. All assets of the Plan, including all insurance policies and reserves, are in a separate tax-exempt trust. A panel of independent trustees is responsible for the financial management of all such assets. The current trustees are Lily Eskelsen (chairperson), Andrea (Chris) Banks, Robert H. Chanin, Judy L. Schaubach and Joann Waller. The trustees may be contacted c/o NEA Member Benefits, 1201 Sixteenth Street, N.W., Washington, D.C. 20036.
Collective Bargaining Agreement. This Trust has not been established and is not being maintained pursuant to the terms of any collective bargaining agreement with any employer.
Plan Eligibility. You are eligible to participate in the Plan if you are an Active, Substitute, Staff, Student, Retired, Reserve, or Life member in good standing.
Program Eligibility. Eligibility is described in the previous pages of this booklet.
Termination of Benefits. You must continue to be a member of the class to which this plan pertains and continue to make any of the premium contributions when due. Failure to do so may result in partial or total loss of your benefits.
Termination and Amendment of Plan or Trust. The NEA and the Trustees reserve the right to modify or terminate the Plan, any Program, or the Trust at any time.
SPD (20400)
CLAIMS
Initial Procedures. If there is a claim for any benefit under the Plan, you or your Beneficiary should notify NEA Insurance Operations, Post Office Box 1737, Des Moines, Iowa 50306-1737. The appropriate claim forms will be sent by return mail accompanied by complete claim instructions. If the claim results from death, a certified copy of the death certificate with the raised seal will be required.
Review of Denied Claims. If a claim for benefits is denied or ignored, in whole or in part, you are entitled to have your claim reviewed by Prudential. You or your authorized representative will receive a written explanation of the reason for the denial. Prudential will send this written notice to you within 90 days. If you are not notified at all within 90 days, this may be considered a claim denial. You then have the right to have Prudential review and reconsider your claim. In order to initiate a review of that claim decision, you must make written request to Prudential. You may then take certain steps to enforce your right to this review process. You may file suit in a state court, or you may file suit in a federal court. The court will decide who should pay the court costs and legal fees. You can obtain further information regarding this review procedure from NEA Member Benefits.
YOUR RIGHTS UNDER ERISA
As a participant in the NEA Members Insurance plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants have the following rights:
• You have the right to examine, without charge, at the offices of NEA Member Benefits Corporation, 900 Clopper Road, Suite 300, Gaithersburg, Maryland 20878, all Plan documents, including insurance contracts (with riders and amendments) with Prudential and the pertinent resolutions adopted by NEA’s Board of Directors and the Executive Committee for the administration of the Plan. You may also examine, without charge, copies of all documents pertaining to the Plan filed by the NEA Members Insurance Trust with the U.S. Department of Labor, such as annual reports and Plan descriptions.
• You have the right to obtain copies of Plan documents and other Plan information upon written request to NEA Member Benefits at the above address. NEA Member Benefits may make a reasonable charge for the copies.
• You are entitled to a summary financial report. If you want a copy of that report, write to NEA Member Benefits at the above address.
In addition to creating rights for you, ERISA imposes duties on NEA, and the Trustees in their operation of the NEA Life Insurance Plan. The NEA and the Trustees are “fiduciaries.” In addition, Prudential is the appropriate named fiduciary for the purposes of the enrollment process, and claims administration settlement, and review of denied claims. The fiduciaries have a duty to operate the Plan prudently and in the interests of you and other Plan participants and beneficiaries. No one can prevent you from obtaining the insurance benefits to which you are properly entitled under the Plan or from exercising your rights under ERISA.
SPD (20400)
If your claim for benefits is denied, in whole or in part, you must receive a written explanation from Prudential of the reason for the denial. You have the right to have Prudential review and reconsider your claim. Under ERISA, there are steps you can take to enforce your rights. For instance, if you request Plan materials to which you are entitled under ERISA and do not receive them within 30 days, you may file suit in Federal court. In such a case, the court may require the Plan Administrator to provide the materials to you and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the Administrator’s control. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are 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 will pay the court costs and legal fees.
If you are successful, the court may order the person you have sued to pay the costs and fees. If you lose, the court may order you to pay the costs and fees (for example, if it finds your claim is frivolous). If you have any questions about the plan or programs provided through the NEA Members Insurance Trust, you should contact NEA Member Benefits. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest Area Office of the Pension and Welfare Benefits Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210.
NOTES
20400, Level Premium Group Term Life, Dependents, Ed. 9-2006, 10