Return to flip book view
2023-2024 Benefits Guide
____________________________________________thrivesonbalance–balancingprofessionalandpersonalworlds–balancingworkandrest–whilealwaysbalancingcostandvalue.Wealsounderstandthatbalancemustbeindividualized.Whatisrightforonepersonmaynotbeappropriateforanother.Itisourgoaltoofferchoicesallowingyoutotailoryourbenefitsplanspecificallytowhatisbestforyouandyourfamilymembers.YourChoices___ Providesacompletepackageofbenefitsaimedatprovidingflexibleinsuranceprotectionandprogramstomeetyourever-changingneeds.___ sharesthecostofsomebenefitswithyou,whilemakingadditionalbenefitsavailablethatyoupayforifyouchoosetoenroll.Thepartofthebenefitcoststhatyouareresponsibleforwillbeautomaticallydeductedfromyourpaycheck,eitherbeforeorafteryourtaxesarecalculated.BenefitPre-TaxorPostTaxWhopaysthecost?WhydoIpayforsomebenefitswithbefore-taxmoney?Whilenotallbenefitsqualifyforpre-taxcontribution,thereisadefiniteadvantagetopayingforthosethatdo:Takingthemoneyoutbeforeyourtaxesarecalculatedlowerstheamountofyourtaxableincome.Therefore,youpaylessintaxes.HowYourBenefitsWorkFull-timeemployeesareeligibleformostbenefitson_____________________________________ofhire.MakingChangesGenerally,youcanonlychangeyourbenefitschoicesduringtheannualBenefitsEnrollmentPeriod.However,youcanchangeyourbenefitschoicesduringtheyearifyouhavealifeeventchange.Lifeeventchangesincludebutarenotlimitedto:· Marriage· Divorce· Birth,adoption,orplacementforadoptionofaneligiblechild· Deathofyourspouseorcoveredchild· Changeinyouoryourspouse’sworkstatusthatresultsincancellationofyourbenefits· BecomingeligibleforMedicareorMedicaidduringtheyearIfyouhavealifeeventchange,youmustnotifyHumanResourceswithin31daysofthechange(forexample,amarriageorbirthcertificate).Ifyoudo notnotifyHumanResourceswithin31days,youwillhavetowaituntilthenextannualOpenEnrollmentperiodtomakebenefitschangesunlessyouhaveanotherlifeeventchange.Anychangesyoumaketoyourbenefitchoicesmustbedirectlyrelatedtothelifeeventchange.Taggart Motor Co.Taggart Motor Co.Taggart Motor Co.the first day of the month following 60 daysTaggart Motor Co.Pre-Tax Employer SharedPre-Tax Employee PaidPre-Tax Employee PaidPost-Tax Employee PaidHealth InsuranceDental InsuranceVision InsuranceVoluntary Life Insurance
PortabilityIfyouleavethecompany,someofyourbenefitsendandsomeofyourbenefitsareportable.Thismeansyoucantakethemwithyouifyouleave,aslongasyoucontinuetopaythepremiumsyourself.Onceterminated,youwillbenotifiedthroughthemailifanyofyourbenefitsareportable.WhenCoverageEndsBenefitsendonthelastdayofthemonthfollowingterminationorwhenyouceasetomeeteligibilityguidelines. Lookingahead……Nowlet’slookateachbenefitthatmakesupthebenefitsprogram.Inthefollowingpages,you’lllearnmoreaboutthevaluablebenefitsyouremployeroffers.You’llalsoseehowchoosingtherightcombinationofbenefitscanhelpprotectyouandyourfamily’shealth.NOTES:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Continuing Your CoverageUndercertaincircumstances,youmay continue yourhealthcarecoveragewhenitwouldotherwiseend.ThisiscalledCobraappliestotheseplans:· HealthInsurance· DentalInsurance· VisionInsuranceWhencan I continue coverage under____________________?Youand/oryourdependentsareeligibletocontinuehealthcarecoverageunder________________________If coverageislostbecause:· Your employment endsforanyreasonother than“grossmisconduct”.· Yourworkhours are significantlyreduced.· Youdie.· Youbecome entitled toandenrollinMedicarepriortolosingcoverage.· Youdivorceorbecomelegallyseparatedfromyourspouse.· Yourdependentlosesdependentstatus.________________CobraCobraCobraTaggart Motor Co.
OutInDeductible$8,000$4,000Family Deductible$16,000$8,000Coinsurance50%70%Out-Of-Pocket$16,300 ($32,600)$8,150 ($16,300)Office Visit50% After Ded.$25 CopaySpecialty Doctor Office Visit50% After Ded.$75 CopayInpatient Hospital Services50% After Ded.70% After Ded.Preventative Lab & X-Ray50% After Ded.70% After Ded.Advanced Imagining50% After Ded.70% After Ded.Urgent Care50% After Ded.$50 CopayEmergency Room$300 Copay + 70% After Ded.As INNRXNetwork Copay + 30%10/35/75/250PCPEmployees Monthly Rate Employees Weekly Rate Employees Monthly Rate Employees Weekly Rate$106.99Employee Only$26.75$160.57$40.14$544.74Employee + Spouse$136.19$657.25$164.31$465.14Employee + Child(ren)$116.29$566.93$141.73$942.70Employee + Family$235.68$1,108.77$277.19NoPPOP4000i70LX21NavE6000i70LX21HMOIn$6,000$12,00070%$8,150 ($16,300)$25 Copay$75 Copay70% After Ded.70% After Ded.70% After Ded.$50 Copay$300 Copay + 70% After Ded.10/35/75/250YesBase Plan Buy-Up Plan
EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceTaggart Motor CompanyWhat else is included?Pregnancy benefitAn extra cleaning for expecting mothers in their 2nd or 3rd trimester.Wellness benefitsOral cancer screenings for patients 40 and older with high risk factors.Unumdentalcare.comUse unumdentalcare.com to search for providers, manage your benefits and learn about good dental health. Features include easy access to ID Cards, claims history and coverage information.Virtual Dental Visits24/7 dental care for dental emergencies when an in-person visit isn’t an option. Available for active dental members*.Visit unumdentalcare.com and click Virtual Dental Visits to get started. Carryover benefitsMembers who take care of their teeth, but use only part of their annual maximum benefit during a benefit period are rewarded with extra benefits in future years! Carryover benefits will be accrued and stored in the insured’s carryover account to be used in the next benefit year.The limits for this policy/certificate are:Passive PPOCarryover benefit $350Threshold limit $700Carryover account limit$1,250Unum Dental™Dental Insurance can help you pay for dental exams, cleanings and other services.Why is this coverage so valuable?Routine dental care keeps your mouth and whole body healthy.Your plan is backed by Unum’s commitment to excellence in customer service.Personalized website to manage your benefits including claims information, ID cards and more.There’s no waiting period for preventive and basic services.How does it work?Good dental care is critical to your overall well-being. With Unum Dental insurance, you can get the attention your teeth need — at a cost you can afford.Unum Dental allows you to see any dentist you choose. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards. You can find in-network providers at unumdentalcare.com.*Virtual dental visits are a preventiveservice and subject to policy year benefit maximum.
EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceDental carryover benet and how it worksEach benefit year a member must have: • One cleaning, • One regular exam, and • Total dental claims for preventive, basic and major covered procedures paid during the year below the threshold limit. • If all three criteria above are met, a portion of the annual maximum will carry over to the next year.Other Specifications: • Each covered family member receives their own carryover benefit. • Group carryover benefit rider must be in effect for one benefit year before any members can utilize carryover benefits. • A member must be on the plan for a minimum of three months before accruing carryover benefits. • Carryover benefit may be used toward preventive, basic and major covered services only • A member’s carryover account will be eliminated, and the accrued carryover benefits lost if the insured has a break in coverage for any length of time or any reason.Dependent childrenDependent age guidelines vary by state. Please refer to your policy certificate or call our Contact Center at (888) 400-9304.Services not listedIf you expect to require a dental service not included on this brochure, it may still be covered. Please call our Contact Center at (888) 400-9304 to confirm your exact benefits.Alternate treatmentUnum covers the least expensive most commonly used and accepted American Dental Association treatments. Plan members may elect a more expensive treatment, but will be responsible for the cost difference resulting from the more expensive procedure.Coverage details and costsOverview Passive PPOBenefit Year Maximum*$1,500Deductible**$50 in-network and out-of-network Maximum 3 per familyPlan Coinsurance In-network Out-of-NetworkClass A Preventive100% 100%Class B Basic80% 80%Class C Major50% 50%*Applies to Class A, B and C Services, if applicable **Waived for Class A (applies to Class B and C Services) Dental CoveragePassive PPOMonthly cost†You$29.65You and your spouse$58.31You and your children$73.66Family$110.49†Rates guaranteed for 12 months from the effective date.
EN-2026 FOR EMPLOYEES (2-23) Unum | Dental InsuranceCovered Procedures & Waiting PeriodsPassive PPOCLASS A PREVENTIVE SERVICESWaiting Period: None •Routine exams (2 per 12 months) • Prophylaxis (2 per 12 months) – (1 additional cleaning or periodontal maintenance per 12 months, if member is in 2nd or 3rd trimester of pregnancy) • Bitewing x-rays (maximum of 4 films; 1 per 12 months) • Fluoride treatment for children up to age 16 (1 per 12 months) • Sealants for children up to age 16 (permanent molars, 1 per 36 months) • Space Maintainers • Emergency Treatment (1 per 12 months) • Full mouth/panoramic x-rays (1 per 36 months) • Adjunctive pre-diagnostic oral cancer screening (1 per 12 months for ages 40+)CLASS B BASIC SERVICESWaiting Period: None •Simple restorative services (fillings) – Posterior composite restorations • Simple extractions • Oral Surgery (extractions and impacted teeth) • Anesthesia (subject to review, covered with complex oral surgery) • Repair of crown, denture or bridge • Non-Surgical periodontics • Surgical periodontics (gum treatments) • Periodontal maintenance (2 per 12 month in combination with prophylaxis) • Endodontics (root canals)CLASS C MAJOR SERVICESWaiting Period: None •Inlays and onlays • Crowns, bridges, dentures and implantsRefer to your certificate of coverage for the services covered under your plan.
Exclusions and LimitationsThe following dental services are not covered unless stated otherwise in the Certificate of Coverage:• any treatment which is elective or primarily cosmetic in nature and not generally recognized as a generally accepted dental practice by the American Dental Association, as well as any replacement of prior elective or cosmetic restorations;• replacement of a removable device or appliance that is lost, missing or stolen, and for the replacement of removable appliances that have been damaged due to abuse, misuse, or neglect. This may include but not be limited to removable partial dentures or dentures;• replacement of any permanent or removeable device or appliance unless the device or appliance is no longer functional and is older than the limitation in the Schedule of Covered Procedures. This may include but not be limited to bridges, dentures and crowns;• any appliance, service, or procedure performed for the purpose of splinting, to alter vertical dimension or to restore occlusion;• any appliance, service or procedure performed for the purpose of correcting attrition, abrasion, erosion, abfraction, bite registration, or bite analysis;• charges for implants (except noted above), removal of implants, precision or semi-precision attachments, denture duplication, or dentures and any associated surgery, or other customized services or attachments;• services provided for any type of temporomandibular joint (TMJ) dysfunction, muscular, skeletal deficiencies involving TMJ or related structures, myofascial pain.Limitations:• Multiple restorations on one surface are payable as one surface. Multiple surfaces on a single tooth will not be paid as separate restorations. On any given day, more than 8 periapical x-rays or a panoramic film in conjunction with bitewings will be paid as a full mouth radiograph. Pre-estimates are recommended for any treatment expected to exceed $300.Takeover benefits:Takeover benefits apply if we are taking over a comparable benefits plan from another carrier and only if there is no break in coverage between the original plan and the takeover date. Takeover is available to those individuals insured under the employer’s dental plan in effect at the time of the employer’s application. If takeover benefits are included in your benefits, then waiting periods for service will be waived for the individuals currently insured under the employer’s previous plan during the month prior to coverage moving to us. Application of takeover benefits is subject to Underwriting review and approval. New hires with prior-like dental coverage (lapse in coverage must be less than 63 days) will receive takeover credit for the length of time they had with the prior carrier and must provide proof of coverage (including coverage dates) to receive takeover credit (i.e. one page benefit summary, Certificate of Creditable Coverage, etc.). A Network Access plan is available. THIS POLICY PROVIDES LIMITED BENEFITS This brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series Dental 20-GDN or contact your Unum Dental representative. Underwritten by Starmount Life Insurance Company, Baton Rouge, LA.© 2023 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-2026 FOR EMPLOYEES (2-23)unum.com
EN-376255 FOR EMPLOYEES (1-23) Unum | Vision Insurance Taggart Motor CompanyUnum Vision® Powered by EyeMedHow much does it cost? Monthly premiumYou $7.40You and your spouse $14.80You and your children $16.65Family $25.98Plan features:Members have the freedom to choose any provider from EyeMed’s Insight Network. Our network offers the right mix of independent, national retail and regional retail providers like Lens Crafters, Pearle Vision, Target Optical and many more. Members can also purchase glasses and contact lenses online at Glasses.com and ContactsDirect.com.Covered benets:Exam: Each member is entitled to a comprehensive vision exam. An exam co-pay applies and is outlined in the grid at right.Materials: Each member has coverage for covered services and materials. Purchases are subject to benefit frequencies and co-pays. Plan features include: • Frame benefit: You may choose any frame within a provider’s collection, subject to the retail frame allowance listed at right. If the cost is greater than the plan’s benefits, you are responsible for the difference. • Eyeglass lens benefit: Standard plastic (CR-39 Plastic Material) single vision, bifocal, trifocal, and specialty lenses are generally covered after any applicable materials copay. If covered by plan allowance, you are responsible for any cost greater than the plan’s benefit. • Contact lens benefit: Members electing contact lenses instead of eye glass lenses may apply the contact lens allowance to any lenses in the provider’s collection. If the cost is greater than the plan’s benefits, you are responsible for the difference.Laser vision correction: Discounts are available with participating surgery providers across the country (not an insured benefit)EyeMed benets:Vision Care ServicesIn-network Member CostOut-of-network ReimbursementsExam (1 per 12 months)$10 co-pay Up to $40Retinal Imaging BenefitUp to $39 Not coveredStandard Plastic Lenses (1 per 12 months)Single Vision$25 co-pay Up to $30Bifocal$25 co-pay Up to $50Trifocal$25 co-pay Up to $70Lenticular$25 co-pay Up to $70Standard Progressive $90 co-pay Up to $50Premium Progressive LensPremium Progressive Tier 1$110 co-pay Up to $50Premium Progressive Tier 2$120 co-pay Up to $50Premium Progressive Tier 3$135 co-pay Up to $50Premium Progressive Tier 4$90 co-pay (80% of charge less than $120 allowance)Up to $50Lens OptionsPolycarbonate Lenses (under age 19)Covered Up to $32Frames (1 per 24 months)Members may select any frame available$130 allowance Up to $91Contact Lenses (1 per 12 months) In lieu of eyeglass lensesElective$130 allowance Up to $130Non-ElectiveCovered Up to $210Standard Contact Lens Fitting Exam Fee*Up to $40 Not covered*The standard contact lens fitting exam fee applies to a new or existing contact lens user who wears spherical disposable, daily wear, or extended wear lenses only.
EN-376255 FOR EMPLOYEES (1-23) Unum | Vision Insurance Unum Vision Powered by EyeMed members will receive the following discounts on materials at in-network providers only: • 40% off for a complete second pair of glasses. • 20% off non-prescription sunglasses. • 20% off remaining balance beyond plan coverage.Laser Vision Correction NetworkMembership provides access to preferred pricing. Transactions are handled directly between members and providers. Refractive surgery is an elective procedure and may involve potential risks to patients. This is not an insured benefit. Unum cannot and does not guarantee the outcome of any refractive surgical procedure or a total elimination of the need for glasses or contacts. Providers may not be available in all metropolitan areas. Login to www.eyemedvisioncare.com/unum for a list of participating laser vision correction providers.Hearing Savings Plan included at no additional cost to the member!Unum offers a Hearing Savings Plan at no additional cost, to all of its Unum Vision Powered by EyeMed members. Partnering with Amplifon, the Hearing Savings Plan provides: • 40% off hearing exams at thousands of convenient locations nationwide • Discounted set pricing on thousands of hearing aids, including those with the newest, most advanced technology • Low price guarantee – if you find the same product at a lower price elsewhere, Amplifon will beat it by 5% • 60-day hearing aid trial period with no restocking fees • Free batteries for 2 years with initial purchase • 3-year warranty plus loss and damage coverageOther Unum Vision SpecicationsDependent children: Dependent age guidelines vary by state. Please refer to your policy certificate or contact customer service at (855) 652-8686.Services not listed: If you expect to require a vision service not included on this brochure, it may still be covered. Refer to the member portal at www.eyemedvisioncare.com/unum, to confirm your exact benefits. This is a primary vision care benefit and is intended to cover only eye examinations and/or corrective eyewear. Medical or surgical treatment of eye disease or injury is not provided under this plan. Coverage may not exceed the lesser of actual cost of covered services and materials or the limits of the policy.No benets will be paid for services, materials connected with, or charges arising from:Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; Medical and/or surgical treatment of the eye, eyes or supporting structures; services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; any Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear; Plano (non-prescription) lenses; Non-prescription sunglasses; Two pair of glasses in lieu of bifocals; Services or materials provided by any other group benefit plan providing vision care; Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order; Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Member receives a 20% discount on items not covered by the plan at EyeMed In-Network locations. Discount does not apply to EyeMed Provider’s professional services, or contact lenses. Plan discounts cannot be combined with any other discounts or promotional offers. In certain states, members may be required to pay the full retail rate and not the negotiated discount rate with certain participating providers. Please see EyeMed’s online provider locator to determine which participating providers have agreed to the discounted rate. Discounts on vision materials may not be applicable to certain manufacturers’ products EyeMed Vision Care reserves the right to make changes to the products on each tier and the member out-of-pocket costs. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Service and amounts listed above are subject to change at any time. Fees charged by a Provider for services other than a covered benefit must be paid in full by the Insured Person to the Provider. Such fees or materials are not covered under the Policy. Benefit allowances provide no remaining balance for future use within the same Benefit Frequency.A Network Access plan is available.THIS POLICY PROVIDES LIMITED BENEFITSThis brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series VI-2002, VI-2007 and VI-2019 or contact your Unum Vision representative.Vision plans are marketed by Unum and EyeMed, administered by First American Administrators and underwritten by Starmount Life Insurance Company, Baton Rouge, LA.© 2023 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
Unum | Term Life Insurance EN-1976 FOR EMPLOYEES (6-22) Taggart Motor CompanyWho 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 $300,000 in $10,000 increments, up to 3 times your earnings.You can get up to $40,000. This is the amount of coverage you can qualify for with no medical underwriting.Your spouse:Get up to $300,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.Your spouse can get up to $15,000 with no medical underwriting, if eligible (see delayed effective date).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 26th birthday.The maximum benefit for children live birth to 6 months is $1,000.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.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 buy a minimum of $10,000 of coverage now, you can increase your coverage in the future up to $40,000 to meet your growing needs. There would be no medical underwriting to qualify for coverage.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.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.Term Life and Accidental Death & Dismemberment (AD&D) InsuranceWho 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 $300,000 in $10,000 increments, up to 3 times your earnings.You can get up to $40,000. This is the amount of coverage you can qualify for with no medical underwriting.Your spouse:Get up to $300,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.Your spouse can get up to $15,000 with no medical underwriting, if eligible (see delayed effective date).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 26th birthday.The maximum benefit for children live birth to 6 months is $1,000.Who can get Accidental Death & Dismemberment (AD&D) coverage?You:Get up to $300,000 of AD&D coverage for yourself in $10,000 increments to a maximum of 3 times your earnings.Your spouse:Get up to $300,000 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.
Unum | Term Life Insurance EN-1976 FOR EMPLOYEES (6-22) 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. See your plan administrator for your plan effective date. To determine your spouse rate, choose the age the employee will be when coverage becomes effective. See your plan administrator for your plan effective date.)4. Enter your cost.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. Calculate your costs1 2 3 4Employee $______,000 ÷ $1,000 = $________ X $______ = $_______Spouse $______,000 ÷ $1,000 = $________ X $______ = $_______Child $______,000 ÷ $1,000 = $________ X $______ = $_______Total costSpouse monthly ratePer $1,000 of coverageCost$0.100$0.090$0.120$0.170$0.250$0.410$0.630$0.930$1.230$1.580$2.890$9.700Employee monthly rateAgePer $1,000 of coverageCost15-24 $0.10025-29 $0.09030-34 $0.12035-39 $0.17040-44 $0.25045-49 $0.41050-54 $0.63055-59 $0.93060-64 $1.23065-69 $1.58070-74 $2.89075+ $9.700How much coverage can I get?Child monthly rate$0.400 per $1,000 of coverage1. 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. Enter your cost.AD&D monthly ratesCoverage amount RateEmployee per $1,000 of coverage $0.050Spouse per $1,000 of coverage $0.050Child per $1,000 of coverage $0.080AD&D1 2 3 4Employee $______,000 ÷ $1,000 = $________ X $0.050 = $_______Spouse $______,000 ÷ $1,000 = $________ X $0.050 = $_______Child $______,000 ÷ $1,000 = $________ X $0.080 = $_______Total cost
Unum | Term Life Insurance EN-1976 FOR EMPLOYEES (6-22) Exclusions and limitationsActively at workEligible 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.Exclusions and limitationsLife 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 self-inflicted 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 coverageInsurance 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 ReductionCoverage 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 coverageYour 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 coverageIn 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 deathUnum 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.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.