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UFCW LOCAL 1776 and
PARTICIPATING EMPLOYERS HEALTH and WELFARE FUND |
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| Life Insurance Benefits |
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The Fund also provides you with life insurance benefits under a policy of insurance with Standard Insurance Company ("Standard"). Your dependents are not covered. The amount of your coverage depends on your length of service. Your service is calculated based on your years of service from your date of hire. Check the chart below for the amount of your insurance coverage. If you are a... Your coverage is... Part-time participant with less than 2 years of service $1,000 Part-time participant with at least 2 but less than 5 years of service $1,500 Part-time participant with at least 5 but less than 10 years of service $2,500 Part-time participant with 10 or more years of service $10,000 If you die from any cause, the amount specified on the chart will be paid to your beneficiary or beneficiaries. You can name one or more beneficiaries and can change beneficiaries at any time. If you do not name a beneficiary, your life insurance is paid in the following order:  Spouse Children Parents Siblings EstateIf You Are Disabled If you are unable to work because of a disability, your coverage under the Fund continues while you are disabled for up to six (6) calendar months beginning with the first month following your last day of work. If you are still not working at the end of the six-month period and are still disabled, your life insurance benefit will terminate. You may, however, be eligible to continue your life insurance under the group policy without payment of premiums if you are totally disabled (called "waiver of premium benefit"). For this purpose, "totally disabled" means that as result of sickness, accidental injury or pregnancy you are unable to perform the material duties of any occupation for which you are reasonably suited by education, training and experience. You should contact the Fund office immediately for more details if you think that you may be eligible for a waiver of premium benefit. Alternatively, you may apply for conversion coverage upon termination of your life insurance coverage, as described below. The amount of your life insurance benefit will be reduced by the amount of death benefits, if any, payable by the Tri-State Pension Fund. Converting Coverage If you leave the bargaining unit, stop working for a participating employer or retire, your life insurance coverage ends. You can, however, submit an application to convert to an individual life insurance policy. You pay the premium for this coverage, which is based on your age at the time your life insurance under the Fund ends. To qualify, you must apply to Standard and pay your premium within 31 days of the date your coverage ends. You will not have to submit evidence of insurability. If you die during the 31-day conversion period, the death benefit will be payable under the group life insurance policy, whether or not you have applied for an individual policy. Notice of right to convert You will receive a written notice of your right to convert to an individual life insurance policy no later than 15 days before the end of the 31-day conversion period. If you do not receive notice, your right to convert will be extended until: (a) 15 days after notice is given, or (b) 60 days after the end of the initial 31 day conversion period, whichever is earlier. However, insurance under the group life insurance policy will never continue beyond the initial 31-day conversion period. Accelerated Benefit If you qualify for waiver of premium benefit (as described above) and give Standard proof that you have a Qualifying Medical Condition ("QMC") while you are insured under the group policy, you may have the right to receive a portion of your insurance as an accelerated benefit. You must have at least $10,000 of insurance in effect to be eligible. A QMC means you have a medically determinable condition that is a result of an illness or injury and that is reasonably expected to result in death within 12 months. Amount of accelerated benefit You may receive an accelerated benefit of up to 75% of your insurance, with certain limitations. The minimum benefit is $5,000 or 10% of your insurance, whichever is greater. The benefit will be paid to you once in your lifetime in a lump sum. If you recover from your QMC after receiving the benefit, you will not be asked for a refund. The accelerated benefit will affect the amount of your remaining life insurance benefit. A benefit payment notice explaining the accelerated benefit and the effect on your remaining insurance will be provided to you with the payment. Your Accidental Death & Dismemberment ("AD&D") insurance is not affected by payment of the accelerated benefit. Exclusions to accelerated benefit No accelerated benefit will be paid if: All or part of your insurance must be paid to your
child(ren), or your former spouse as part of a court approved divorce decree,
separate maintenance agreement, or property settlement agreement. You are married and live in a community property state unless you provide a signed
written consent from your spouse. You have made an assignment of all or part of your insurance unless you
provide a signed written consent from the assignee. You have filed for bankruptcy, unless you provide a written approval
from the Bankruptcy Court for payment of the accelerated benefit. You are required by a government agency to use the accelerated benefit
to apply for, receive, or continue a government benefit or entitlement.
You have previously received an accelerated benefit under the group policy. Other important limitations may apply to an accelerated benefit. You should contact the Fund office for more information. Please note: This life insurance benefit is provided pursuant to a policy of insurance. That policy of insurance is incorporated by reference as if fully set forth herein. If there are any differences between the benefit description set forth in this booklet and the policy of insurance, the policy of insurance prevails. If you wish to review the policy of insurance, please contact the Fund office. |