Life and AD&D

UnitedHealthcare

ABOUT LIFE AND AD&D

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered. For full plan details, please visit your benefit website: www.mybenefitshub.com/legacypca

EMPLOYEE BENEFITS

Basic Life Coverage A cash benefit to your loved ones in the event of your death provided to eligible employees by your employer. 1 time salary up to $100,000.

Supplemental Life

• Aged Based Voluntary Group Life insurance you elect. • Spouse and Child life available with Employee Election. • Spouse election may not exceed 50% of Employee Amount. • Child(ren) election may not exceed $10,000 per child. • You may not elect coverage for your Spouse if they are already covered as an Employee under this policy. Employee Guaranteed coverage $100,000 Employee Maximum coverage 5 times your annual salary not to exceed $400,000. Employee Minimum coverage $10,000 Spouse Guaranteed coverage $50,000 Spouse Maximum coverage 50% of the employee coverage amount not to exceed $150,000 Spouse Minimum coverage amount $5,000 Guaranteed coverage amount for dependent children 6 months - 26 years $10,000 Paid benefit Limitation for dependent children 4 days - 6 months $500 child age 0 to 14 days, $2500 child age 14 days to 6 months

Optional AD&D coverage amount Equal to the life insurance amount chosen

Voluntary Group Life - per $10,000 in coverage Age Employee Less than 25 $0.63 25-29 $0.63 30-34 $0.78 35-39 $0.88 40-44 $0.98 45-49 $1.37 50-54 $2.05 55-59 $3.23 60-64 $5.58 65-69 $9.78 70-74 $17.12 75+ $17.12 Spouse Rates Based upon Employee's Age Voluntary Group Life - Child(ren) $10,000 in coverage 0-26 $2.28 Supplemental AD&D Per Enrollee Per $10,000 $0.25 Guaranteed Life Amount: Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $100,000 without providing evidence of insurability. If you decline this coverage now and wish to enroll later, evidence of insurability may be required. Actively At Work: You must be actively at work with your employer on the day your coverage takes effect. Benefit Reductions: Coverage amount will reduce by 50% when you reach age 75. Plan Termination: Coverage terminates at employee’s retirement. AD&D Insurance Coverage Amount: Supplemental Life Insurance can be purchased without Supplemental AD&D Insurance, however you cannot purchase Supplemental AD&D Insurance without Supplemental Life Insurance. If you do elect Supplemental AD&D Insurance, the amount elected must not exceed the amount of Supplemental Life elected and approved. This applies to employee, spouse and dependent children. CLAIMS: Please contact your benefit administrator or FBS for assistance in filing a life claim.