Service Employees 32BJ North Health Fund

Tri-State Preferred North Summary Plan Description (SPD) >> Life Insurance and Accidental Death & Personal Loss Coverage Benefits

• Life Insurance
  • Schedule of Life Insurance – Employees
  • Age Reduction Rule
  • Dependents: Schedule
  • Accelerated Death Benefit
• Accidental Death and Personal Loss Coverage
  • Schedule of Accidental Death and Personal Loss Coverage – Employees
  • Additional Accidental Death Benefit Maximums
  • Age Reduction Rule

Life Insurance

Your life insurance and accidental death and personal loss coverage benefits are insured by Aetna. Detailed information about your life insurance and accidental death and personal loss coverage, including information about filing claims and appeals, is provided in the booklet provided by Aetna called “Your Group Plan” [click here for the Aetna Summary]  [click here for the full Aetna Booklet]. The Aetna Booklet is included with your SPD materials. If you need an additional copy of the Aetna Booklet, contact Aetna at 1-800-523-5065. The information provided below is only a summary of your schedule of benefits.

Your dependent spouse may also be eligible for benefits under this Plan as a dependent. Please see the Aetna Booklet for additional information regarding dependent spouse coverage.

Schedule of Life Insurance – Employees

Employees: Schedule
Classification		Amount
All Employees		$15,000

Age Reduction Rule

Your Life Insurance amount in force on the day before the first day of the month in which you reach age 65 will be reduced by: 35% at age 65 and 50% at age 70. The reduction will take effect on the first day of the calendar month in which you reach the age specified. No reduction will take place if your Life Insurance has already been reduced because of retirement.

If you become insured during or after the month in which you reach the above ages, your amount of Life Insurance will be the applicable percentage of the amount shown for your classification.

Dependents: Schedule

Dependents: Schedule*
Classification		Amount
Wife or husband		$3,000

* If prior to the Effective Date of this Plan you had the option to elect Dependent Life Insurance under any other group plan sponsored by the Policyholder, whether underwritten by Aetna or not and elected not to do so, dependent spouse Life Insurance in excess of $10,000 under this Plan will not take effect until you submit evidence of that person’s health that is acceptable to Aetna.

Accelerated Death Benefit

Employees
ADB Months:		12
ADB Percentage:		50%
ADB Minimum		The lesser of $50,000 and 25% of the amount of your Life Insurance then in force
ADB Maximum		$7,500

Accidental Death and Personal Loss Coverage

Schedule of Accidental Death and Personal Loss Coverage – Employees

Employees: Schedule
Classification		Principal Sum
All Employees		$3,000

Additional Accidental Death Benefit Maximums

Employees
COMA Benefit Percentage		5% of your full Principal Sum
Passenger Restraint Benefit Maximum		$10,000
Airbag Benefit Maximum Minimum		One half of your Passenger Restraint Benefit
Education Benefit Maximum
for each dependent child		5% of your Principal Sum not to exceed $5,000 per year per child for up to 4 years
for your spouse		5% of your Principal Sum not to exceed $5,000 per year for up to 4 years
Child Care Benefit Maximum
for each child		3% of your Principal Sum not to exceed $2,000 per year per child for up to 4 years

Age Reduction Rule

Your Accidental death and Dismemberment Coverage amount in force on the day before the first day of the month in which you reach age 65 will be reduced by: 35% at age 65 and 50% at age 70. The reduction will take effect on the first day of the calendar month in which you reach the age specified.

If you become insured during or after the month in which you reach the above ages, your amount of Accidental Death and Dismemberment Principal Sum will be the applicable percentage of the amount shown for your classification.