Red D Mix Concrete Inc Short Term Disability Insurance How does it work If a covered illness or injury keeps you from working this employer provided Short Term Disability Insurance replaces part of your income while you recover As long as you remain disabled you can receive payments for up to 26 weeks You re generally considered disabled if you re unable to do important parts of your job and your income suffers as a result Why is this coverage so valuable Your employer is paying the cost of this coverage You can use the money however you choose It can help you pay for your rent or mortgage groceries out of pocket medical expenses and more Short Term Disability Insurance pays you a weekly benefit if you have a covered disability that keeps you from working What else is included Cesarean section benefit If you have a Cesarean section you will be considered disabled for a minimum period of eight weeks unless you return to work before the end of the time How much coverage can I get You You are eligible for coverage if you are an active employee in the United States working a minimum of 30 hours per week Cover 60 of your weekly income up to a maximum benefit of 250 per week See the Legal Disclosures for more information Consider your expenses The weekly benefit may be reduced or offset by other sources of income The IRS may require you to pay taxes on certain benefit payments See your tax advisor for details Red D MixUtilities Concrete Inc is paying the cost of this coverage so you don t have to answer health questions Housing Elimination period EP between your This is theGroceries number of days that must pass first day of a covered disability and the day you can begin to Transportation receive your disability benefits Your benefits begin Childwould care Elder careafter 0 days if you become disabled due to an injury and 7 days if you become disabled due to an illness Medical Personal care Benefit duration Education BD The maximum number of weeks you can receive benefits Insurance benefit duration while you re disabled You have a 26 week EN 2045 FOR EMPLOYEES 3 22 Unum Short Term Disability Insurance
Exclusions and Limitations Active employee You are considered in active employment if on the day you apply for coverage you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury sickness temporary layoff or leave of absence on the date that insurance would otherwise become effective Definition of disability You are considered disabled when Unum determines that due to sickness or injury You are limited from performing the material and substantial duties of your regular occupation and you are not working or You are working but you have lost 20 or more in weekly earnings You must be under the regular care of a physician in order to be considered disabled The loss of a professional or occupational license or certification does not in itself constitute disability Unless the policy specifies otherwise as part of the disability claims evaluation process Unum will evaluate your occupation based on how it is normally performed in the national economy not how work is performed for a specific employer at a specific location or in a specific region Deductible sources of income Your disability benefit may be reduced by deductible sources of income and any earnings you have while you are disabled including such items as group disability benefits or other amounts you receive or are entitled to receive Workers compensation or similar occupational benefit laws State compulsory benefit laws Automobile liability insurance policy Motor vehicle insurance policy or plan No fault motor vehicle plan Legal judgments and settlements Salary continuation or sick leave plans if applicable Other group or association disability programs or insurance Social Security or similar governmental programs Exclusions and limitations Benefits will not be paid for disabilities caused by contributed to by or resulting from War declared or undeclared or any act of war Active participation in a riot Intentionally self inflicted injuries Loss of professional license occupational license or certification Commission of a crime for which you have been convicted Any period of disability during which you are incarcerated Any occupational injury or sickness this will not apply to a partner or sole proprietor who cannot be covered by law under workers compensation or any similar law The loss of a professional or occupational license does not in itself constitute disability Termination of coverage Your coverage under the policy ends on the earliest of the following The date the policy or plan is cancelled The date you no longer are in an eligible group The date your eligible group is no longer covered The last day of the period for which you made any required contributions The last day you are in active employment except as provided under the covered layoff or leave of absence provision Unum will provide coverage for a payable claim that occurs while you are covered under the policy or plan This information is not intended to be a complete description of the insurance coverage available The policy or its provisions may vary or be unavailable in some states The policy has exclusions and limitations which may affect any benefits payable For complete details of coverage and availability please refer to Policy Form C FP 1 et al or contact your Unum representative Underwritten by Unum Life Insurance Company of America Portland Maine 2022 Unum Group All rights reserved Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries EN 2045 FOR EMPLOYEES 3 22 Unum Short Term Disability Insurance
Red D Mix Concrete Inc Term Life and Accidental Death Dismemberment AD D Insurance can provide money for your family if you die or are diagnosed with a terminal illness How does it work You choose the amount of coverage that s right for you and you keep coverage for a set period of time or term If you die during that term the money can help your family pay for basic living expenses final arrangements tuition and more Who can get Term Life coverage If you are actively at work at least 30 hours per week you may apply for coverage for You Choose from 10 000 to 500 000 in 10 000 increments up to 5 times your earnings If you previously purchased coverage you can increase it up to 100 000 with no medical underwriting If you previously declined coverage you may have to answer some health questions Your spouse Get up to 500 000 of coverage in 5 000 increments Spouse coverage cannot exceed 100 of the coverage amount you purchase for yourself If you previously purchased coverage for your spouse they can increase their coverage up to 15 000 with no medical underwriting if eligible see delayed effective date If you previously declined spouse coverage some health questions may be required Your children Get up to 10 000 of coverage in 2 000 increments if eligible see delayed effective date One policy covers all of your children until their 19th birthday or until their 26th birthday if they are full time students The maximum benefit for children live birth to 6 months is 1 000 AD D Insurance is also available which pays a benefit if you survive an accident but have certain serious injuries It pays an additional amount if you die from a covered accident Why is this coverage so valuable If you previously purchased coverage you can increase it up to 100 000 to meet your growing needs with no medical underwriting What else is included A Living Benefit If you are diagnosed with a terminal illness with less than 12 months to live you can request 100 of your life insurance benefit up to 250 000 while you are still living This amount will be taken out of the death benefit and may be taxable These benefit payments may adversely affect the recipient s eligibility for Medicaid or other government benefits or entitlements and may be taxable Recipients should consult their tax attorney or advisor before utilizing living benefit payments Who can get Accidental Death Dismemberment AD D coverage You Get up to 500 000 of AD D coverage for yourself in 10 000 increments to a maximum of 5 times your earnings Your spouse Get up to 500 000 of AD D coverage for your spouse in 5 000 increments if eligible see delayed effective date Your children Get up to 10 000 of coverage for your children in 2 000 increments if eligible see delayed effective date No medical underwriting is required for AD D coverage Waiver of premium Your cost may be waived if you are totally disabled for a period of time Portability You may be able to keep coverage if you leave the company retire or change the number of hours you work Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability EN 1976 FOR EMPLOYEES 3 22 605146
Term Life and Accidental Death Dismemberment AD D Insurance How much coverage can I get Calculate your costs 1 Enter the coverage amount you want 2 Divide by the amount shown 3 Multiply by the rate Use the rate table at right to find the rate based on age Choose the age you will be when your coverage becomes effective on 05 01 2022 To determine your spouse rate choose the age the employee will be when coverage becomes effective on 05 01 2022 1 2 Employee ______ 000 10 000 ________ X ______ _______ Spouse ______ 000 5 000 ________ X ______ _______ Child ______ 000 2 000 ________ X ______ _______ 1 Enter the AD D coverage amount you want 2 Divide by the amount shown 3 Multiply by the rate Use the AD D rate table at right to find the rate 4 Total cost Employee monthly rate Age 15 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 75 4 Enter your cost 3 Per 10 000 of coverage Cost 0 850 0 940 1 250 1 860 2 840 4 430 6 520 9 340 12 020 17 100 32 340 99 960 Spouse monthly rate Child monthly rate Per 5 000 of coverage Cost 0 450 0 480 0 650 0 930 1 400 2 180 3 240 4 790 6 630 9 450 17 870 55 240 0 410 per 2 000 of coverage AD D 1 2 3 4 Employee ______ 000 10 000 ________ X 0 680 _______ Spouse ______ 000 5 000 ________ X 0 360 _______ Child ______ 000 2 000 ________ X 0 070 _______ Total cost 4 Enter your cost AD D monthly rates Employee Spouse Child Coverage amount Rate per 10 000 of coverage per 5 000 of coverage per 2 000 of coverage 0 680 0 360 0 070 Billed amount may vary slightly If you apply for coverage above the guaranteed issue amount you may be subject to medical underwriting which may affect your ability to get the larger coverage amount In order to purchase coverage for your dependents you must buy coverage for yourself Coverage amounts cannot exceed 100 of your coverage amounts EN 1976 FOR EMPLOYEES 3 22 605146
Term Life and Accidental Death Dismemberment AD D Insurance Exclusions and limitations Actively at work Eligible employees must be actively at work to apply for coverage Being actively at work means on the day the employee applies for coverage the individual must be working at one of his her company s business locations or the individual must be working at a location where he she is required to represent the company If applying for coverage on a day that is not a scheduled workday the employee will be considered actively at work as of his her last scheduled workday Employees are not considered actively at work if they are on a leave of absence or lay off An unmarried handicapped dependent child who becomes handicapped prior to the child s attainment age of 26 may be eligible for benefits Please see your plan administrator for details on eligibility Employees must be U S citizens or legally authorized to work in the U S to receive coverage Employees must be actively employed in the United States with the Employer to receive coverage Employees must be insured under the plan for spouses and dependents to be eligible for coverage Life Planning Financial Legal Resources services provided by HealthAdvocate are available with select Unum insurance offerings Terms and availability of service are subject to change Service provider does not provide legal advice please consult your attorney for guidance Services are not valid after coverage terminates Please contact your Unum representative for details Unum complies with state civil union and domestic partner laws when applicable Underwritten by Unum Life Insurance Company of America Portland Maine 2022 Unum Group All rights reserved Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries Exclusions and limitations Life insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage The same applies for increased or additional benefits AD D specific exclusions and limitations Accidental death and dismemberment benefits will not be paid for losses caused by contributed to by or resulting from Disease of the body diagnostic medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders DSM Suicide self destruction while sane intentionally self inflicted injury while sane or selfinflicted injury while insane War declared or undeclared or any act of war Active participation in a riot Committing or attempting to commit a crime under state or federal law The voluntary use of any prescription or non prescription drug poison fume or other chemical substance unless used according to the prescription or direction of your or your dependent s doctor This exclusion does not apply to you or your dependent if the chemical substance is ethanol Intoxication Being intoxicated means your or your dependent s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury sickness temporary layoff or leave of absence on the date that insurance would otherwise become effective Delayed Effective Date if your spouse or child has a serious injury sickness or disorder or is confined their coverage may not take effect Payment of premium does not guarantee coverage Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan Age Reduction Coverage amounts for Life and AD D Insurance for you and your dependents will reduce to 65 of the original amount when you reach age 65 and will reduce to 50 of the original amount when you reach age 70 Coverage may not be increased after a reduction Termination of coverage Your coverage and your dependents coverage under the policy ends on the earliest of The date the policy or plan is cancelled The date you no longer are in an eligible group The date your eligible group is no longer covered The last day of the period for which you made any required contributions The last day you are actively employed unless coverage is continued due to a covered layoff leave of absence injury or sickness as described in the certificate of coverage In addition coverage for any one dependent will end on the earliest of The date your coverage under a plan ends The date your dependent ceases to be an eligible dependent For a spouse the date of a divorce or annulment For dependents the date of your death Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan This information is not intended to be a complete description of the insurance coverage available The policy or its provisions may vary or be unavailable in some states The policy has exclusions and limitations which may affect any benefits payable For complete details of coverage and availability please refer to Policy Form C FP 1 et al or contact your Unum representative EN 1976 FOR EMPLOYEES 3 22 605146
Term Life Insurance Enrollment Form Complete this form to enroll Unum Insurance Company 2211 Congress Street Portland Maine 04122 THIS IS NOT AN APPLICATION FOR INSURANCE This is an enrollment form If you already have Unum coverage Please be aware that any new benefit elections on this form will replace all existing elections If you do not wish to make changes you do not need to complete this form Please contact your plan administrator for assistance Red D Mix Concrete Step 1 Complete your personal information First name please print M initial Social Security Number Gender 605146 001 Last name Date of birth mm dd yyyy Street address Apartment City State ZIP code Original hire date Occupation Annual salary Hours worked per week Did you recently become Y N eligible for benefits Have you been rehired Y N by your company Spouse first name please print M initial If so please provide a date mm dd yyyy Last name Date of birth mm dd yyyy Step 2 Choose a coverage amount you may use the worksheet to calculate your cost Remember The coverage amounts you choose for your spouse cannot exceed 100 of the coverage amount you purchase for yourself Term Life Insurance If you previously purchased coverage and are now electing an amount over 100 000 for you or 15 000 for your spouse or if you were previously offered coverage during your initial eligibility period and declined to enroll please complete Evidence of Insurability Ask your Plan Administrator for details Want a different amount Child Coverage amount Coverage amount Coverage amount ____________ 2 000 4 000 6 000 8 000 10 000 Spouse Coverage amount Monthly cost 10 000 30 000 40 000 50 000 70 000 100 000 0 68 2 04 2 72 3 40 4 76 6 80 ____________ 5 000 10 000 15 000 ____________ Employee AE 1185 11 15 Spouse 10 000 30 000 40 000 50 000 70 000 100 000 AD D Insurance Want a different amount Employee Coverage amount Child Monthly cost Coverage amount Monthly cost 0 36 0 72 1 08 2 000 4 000 6 000 8 000 10 000 0 07 0 14 0 21 0 28 0 35 5 000 10 000 15 000 ____________ Continued on back
Step 3 Name your beneficiaries Your primary beneficiary is the person or persons who will receive the benefit payment from your life insurance policy if you were to die The total percent of benefit must not exceed 100 First name please print M initial Last name Relationship parent child friend etc of benefit First name please print M initial Last name Relationship parent child friend etc of benefit First name please print M initial Last name Relationship parent child friend etc of benefit First name please print M initial Last name Relationship parent child friend etc of benefit Your secondary beneficiary would receive the benefit payment from your life insurance policy if a primary beneficiary is no longer living First name please print M initial Last name Relationship parent child friend etc of benefit First name please print M initial Last name Relationship parent child friend etc of benefit First name please print M initial Last name Relationship parent child friend etc of benefit First name please print M initial Last name Relationship parent child friend etc of benefit Step 4 Sign and certify I have read and understand the Exclusions and limitations listed on the Benefit Brochure All statements are true to the best of my knowledge and belief I understand that a copy of this form will be made available to me at my request I authorize my employer to make the necessary deductions from my salary or wages to pay the premium when my insurance becomes effective I understand that my payroll deduction amount will change if my coverage or costs change or if I ve made an error completing this form ___________________________ ___ ___ ______ No I do not want coverage under the Term Life Insurance No I do not want coverage under Accidental Death Dismemberment I understand that if I elect coverage in the future I may need to complete evidence of insurability relative to my health status in order for Unum to determine my eligibility for coverage Signature Date ___________________________ ___ ___ ______ Signature Date Return forms to plan administrator Email ______________________________________________________________________ Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury sickness temporary layoff or leave of absence on the date that insurance would otherwise become effective Delayed Effective Date if your spouse or child has a serious injury sickness or disorder or is confined their coverage may not take effect Payment of premium does not guarantee coverage Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan Exception Infants are insured from live birth Underwritten by Unum Life Insurance Company of America Portland Maine 2019 Unum Group All rights reserved Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries AE 1185 11 15 1064680 1 Note Your email will only be used if you requested a level of coverage above the guaranteed issue amount You will receive a link to answer health questions online