Basic Information:

Employee Death Benefit: 2 x salary
Minimum $18,300
Maximum $50,000
Spouse Death Benefit: $3,000
Dependent Death Benefit: $3,000
Waiver of Premium: Yes, after waiting period
AD&D: Employee only

Seat Restraint Benefits:

If an insured is killed in an auto accident while wearing an approved seat restraint, the death benefit will be adjusted as follows:

Employee

 Basic Death Benefit + $5,000
Spouse Basic Death Benefit + $5,000
Dependent Child 2 Times Basic Death Benefit
 

Who Is Covered:

The employee, legal spouse and unmarried natural and legally adopted children between age 14 days and 26 years are eligible for life benefits.

The eligible employee only is covered under accidental death and dismemberment benefits.

To maintain coverage, payment of premiums is required when applicable.

Proper enrollment is required for each person to be covered.

Beneficiary:

Payment is made to the designated beneficiary on file. In the absence of a beneficiary on file, payment will be made to: (1) widow or widower, (2) surviving children, (3) surviving parents, (4) surviving brothers and sisters, (5) personal representative, in that order, or as ordered by a court.

Death Benefit:

The benefit will be paid to the named beneficiary (or as provided in this policy) upon request of claim form and a certified death certificate or other satisfactory evidence showing that the insured has died.

Amount of Life Insurance:

The amount of term insurance coverage for the employee is two times salary. Coverage for the spouse is $3,000 and dependents are covered at $3,000. Coverage remains constant to age 65. Benefits decrease thereafter as listed below:

Age % of Regular Benefit
Up to age 65 100%
65 78%
66 72%
67 66%
68 60%
69 55%
70 50%
71 46%
72 43%
73 40%
74 37%
75 and over 34%

Termination of Benefits:

Benefits under this program automatically terminate on the earliest of the following:

The date of termination of the policy.

The date of expiration of the period for which the last required premium was paid for the insured, or if the insured is no longer a full-time, salaried employee.

The date the insured enters the armed services of any country for active, full-time duty.

The end of the period for which the last contribution was made if a spouse is no longer married to the insured employee.

The end of the period for which the last contribution was made for a dependent child who turns age 26.

The end of the period for which the last contribution was made for if a dependent child, under age 26, who gets married.

Conversion Privilege:

If coverage for you or your dependents has been terminated, you or your dependents may be eligible for a Conversion Policy.

Accidental Death and Dismemberment Benefits:

Accident or accidental injury means injury that is the direct result of an unpremeditated event of external cause, independent of disease or bodily infirmity or other cause. The benefits for accidental death and dismemberment are:

Life Principle Sum
Two limbs or both eyes or combination Principle Sum
One limb or one eye 1/2 Principle Sum


Accidental Death and Dismemberment Exclusions:

No benefit will be paid for death or dismemberment caused by or resulting from:

Suicide or self-inflicted injury, whether sane or insane.

Travel or flight in an aircraft if the insured is lessee, owner, crew member, trainee or test pilot.

Disease, physical or mental infirmity, medical or surgical treatment, bacterial or other infection, pregnancy, childbirth, or miscarriage.

War or any act of war, whether declared or undeclared.