Overlake Internal Medicine Associates

Transcription

®
Plan now to help Protect you and your family—and
Provide for them through all the stages of your life.
INST-A009690 The Prudential Insurance Company of America
PLAN SMART— Consider Prudential Financial
Why
Prudential?
Affordable, convenient, easy…
tion, we help you make better-informed decisions to
Group insurance is affordable because it’s generally
choose benefits that may protect you and your family.
less expensive than individual coverage. It’s convenient,
Plan
Advantages
because you can purchase it at work. And it’s simple,
Provide for the future.
because you pay for it through easy payroll deductions.
When you help protect your family with group insurance
Group insurance may help you protect your family from
Coverage
Highlights
unexpected death, accidents, and loss of income.
New hires get guaranteed coverage without any
medical exams, too.
Your
Rates
Questions
& Answers
coverage from Prudential, you give yourself the peace
of mind of knowing that you are caring for your loved
ones. With that concern taken care of, you are free to
focus on other important things, like building a better
life for you and your family.
The smart choice for you.
Plan. Protect. Provide. With group insurance
For well over a century, Prudential Financial has helped
from Prudential.
people build their futures. More than 24,000 businesses
count on Prudential to help protect their employees—
and millions of employees count on Prudential to help
protect what is most important to them. In addi-
HELP PROTECT TOMORROW— Meeting Your Needs
Why
Prudential?
Plan
Advantages
Protect the people you love.
It can also help protect your earnings, and make it
What would your family do if you suddenly couldn’t
easier to pay bills like your mortgage or car payments,
provide for them? How would you help protect your
manage education costs or childcare expenses, and
family’s assets?
honor your other financial obligations. You can lighten
Group insurance from Prudential can help you protect
the load and reduce the worries for your loved ones
your assets and your family’s prosperity. Many people
Coverage
Highlights
have company-paid basic insurance coverage, but
these plans may not fully protect you and your family. Voluntary group insurance coverage—a plan you
Your
Rates
choose and pay for—can help give you the extra
protection you want since you choose the type of
protection you need.
Questions
& Answers
Protect your family’s prosperity.
Group insurance can help when finances are probably
the last thing you or your family wants to think about.
if the unexpected happens.
How Much?
Go to our insurance needs calculator to estimate for
yourself how much life insurance coverage you’ll
need to help protect your family.
CHOOSE WISELY—Your Coverage Plan
Why
Prudential?
Choose your protection.
Company-paid insurance plans are a great start in
helping to protect your family’s financial security, but
Plan
Advantages
they may not go far enough. Voluntary group insurance,
which you choose and pay for, is a cost-effective way
to provide an additional level of protection. With
Coverage
Highlights
voluntary group insurance, you can enroll in the coverage
that meets your needs, all at economical group rates,
and pay for it with convenient payroll deductions.
Your
Rates
Your Plan
Click on a link below to review your plan highlights.
Questions
& Answers
➞ OPTIONAL TERM LIFE INSURANCE
➞ DEPENDENT TERM LIFE INSURANCE
Why
Prudential?
Plan
Advantages
Optional Term Life Insurance
Beneficiary Financial Counseling Services: Your
This voluntary employee coverage pays your beneficiary
beneficiary can get personalized, proactive financial
a benefit when you die. You may enroll for this cover-
planning assistance after your death. There is no cost
age at reasonable group rates that are typically lower
for this service, and no obligation to your beneficiary.
than individual rates. With some plans, there is a
Prudential’s Alliance Account ®: Payouts to beneficiaries
reduction in your amount of insurance at certain ages.
Coverage
Highlights
Coverage ends when you leave your current employer,
but you can convert your group insurance plan to an
individual life insurance policy underwritten by The
Your
Rates
Prudential Insurance Company of America (Prudential).
Optional Term Life Insurance has several provisions
that may provide additional protection for you and
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& Answers
your loved ones. For example:
Living Benefit Option*: If you are terminally ill, you
can get a partial payment of your group life insurance
benefit. You can use this payment as you see fit. The
payment to your beneficiary will be reduced by the
amount you receive with the Living Benefit Option.
are deposited into a personalized, interest-bearing
account under the beneficiary’s name. The payout
earns interest from the date the account is opened
and the beneficiary can transfer or withdraw funds
at any time.
Click the links below to see the details of your
plan, and scroll down to see the rates.
YOUR PLAN DETAILS & RATES
*Important Notice: The acceleration of life insurance benefits offered under
this certificate are intended to qualify for favorable tax treatment under
the Internal Revenue Code of 1986. If the acceleration of life insurance
benefits qualify for such favorable treatment, the benefits will be excludable
from your income and not subject to Federal taxation. Tax laws relating to
acceleration of life benefits are complex. You are advised to consult with
a qualified tax advisor about circumstances under which you could receive
acceleration of life insurance benefits that are excludable from income
under Federal law.
Why
Prudential?
Plan
Advantages
Dependent Term Life Insurance
This voluntary group coverage on your spouse and
Click the links below to see the details of your
children pays a benefit to you if your dependent dies.
plan, and scroll down to see the rates.
You can get this coverage at less expensive group
rates. With some plans, there is a reduction in your
spouse’s amount of insurance at certain ages. Coverage
Coverage
Highlights
ends when you leave your current employer, but
your dependent may convert to an individual life insurance policy underwritten by The Prudential Insurance
Your
Rates
Company of America.
If your spouse or dependent child is confined for
medical care or treatment, coverage will begin when
Questions
& Answers
confinement ends. Dependent Term Life Insurance
has a single premium rate that covers all eligible
children. Children do not need to provide evidence
of good health.
YOUR PLAN DETAILS & RATES
SAVE MONEY— Get Economical Rates
Why
Prudential?
Economical Rates
First and foremost, you get this coverage at
economical group rates. You get the buying power
Plan
Advantages
Coverage
Highlights
Your
Rates
Questions
& Answers
of the group–your company–and receive rates
that are typically lower than individual rates.
Convenient Payroll Deductions
The cost of the coverage is conveniently
deducted from your paycheck. This can save
you check-writing time and mailing costs.
Your Cost
You can see the rates online at our enrollment
web site or hear them on our Interactive Voice
Response (IVR) phone system.
ENROLL NOW— Enrollment Made Easy
Why
Prudential?
Plan
Advantages
Coverage
Highlights
We make enrolling in the voluntary group insurance
coverages you select quick and easy. Once you have
reviewed all the information in this document, just
click on the button below to go directly to the enrollment
web site. Follow the instructions below to go through
the web enrollment process or through our Interactive
Voice Response (IVR) system to enroll by phone. You
can switch between these two methods at any time.
Enrolling Online
Your
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Questions
& Answers
1. Once you click the link below, read and follow
the instructions carefully.
2. When prompted for your User ID, use your
Social Security Number (no dashes).
3. When prompted for your Personal Identification
Number (PIN), use your date of birth (MMDDYYYY).
4. Make your selections and review them for accuracy.
5. Submit your selections.
Enrolling by Phone (IVR)
1. Call toll-free 1-866-2SIGNUP (1-866-274-4687).
2. Listen carefully and follow the step-by-step
instructions.
3. When asked for your User ID, use your
Social Security Number, then press #.
4. When asked for your Personal Identification
Number (PIN), use your date of birth (MM/DD/
YYYY), then press #.
5. Make your selections and review them
for accuracy.
6. Submit your selections.
ENROLL ONLINE
LEARN MORE—Your Questions Answered
Why
Prudential?
Plan
Advantages
Coverage
Highlights
Your
Rates
Questions
& Answers
Q. When can I enroll for coverage?
A. Your human resources department or manager will
give you the dates of your enrollment period.
Q. Can I sign up for coverage at any time?
A. Most group programs require you to sign up during
the enrollment period. You may also be able to
sign up if you experience a life event, like a birth,
marriage, divorce, or loss of a loved one. If you
sign up at any other time, you may have to provide
satisfactory evidence of insurability.
Q. Where do I send my forms?
A. Return your forms to your human resources
department or your manager.
Q. Can I drop this coverage at any time?
A. Yes, subject to your employer’s administrative policies.
Q. What is conversion?
A. Conversion allows you to change, or “convert,” your
group term life coverage to an individual life policy
underwritten by The Prudential Insurance Company
of America. You will not be a part of the group plan
and will interact directly with us.
Q. What if I want to change my beneficiary?
A. Your employer can supply you with a beneficiary
change form. Just fill it out and return it to your
human resources department or manager.
Q. What is the difference between a primary and
contingent beneficiary?
A. Your primary beneficiary is the person you designate
to receive your life insurance benefit when you die.
You can name more than one primary beneficiary
and assign a different percentage of your benefit to
each, if you like. If you name a contingent beneficiary,
that person will receive the life insurance benefit
when you die only if any primary beneficiaries are
not living at the time of your death. You can name
more than one contingent beneficiary and assign
different percentages to them, too.
Q. If a medical exam is required, who pays for it?
A. If a medical exam is required during the enrollment
period, we will pay for it. Generally, if you request
coverage after the enrollment period, you must
pay for the medical exam.
Optional Term Life
Coverage Effective November 1, 2003
Enrollment Dates: October 15, 2003 through October 24, 2003
Employee Coverage
♦ Coverage is available in increments of $10,000 to $500,000, not to exceed five times your covered annual
earnings.
♦ New Hires: You can select up to $150,000, without providing satisfactory evidence of good health, if you
apply within 31 days of eligibility.
♦ Current Participants: Your current coverage amount will be continued. Evidence of good health is required
for all increases in coverage amounts.
♦ Current Employees who have waived coverage in the past or have been denied coverage in the
past: Evidence of good health is required for all coverage amounts.
♦ If you are terminally ill, you can get a partial payment of your group life insurance benefit. You can use this
payment as you see fit. The payment to your beneficiary will be reduced by the amount you receive with the
Living Benefit Option. Refer to the plan booklet for details.
♦ Beneficiary Financial Counseling Services provides your beneficiary with personalized, proactive financial
planning assistance after your death. There is no cost for this service, and no obligation to your beneficiary.
♦ Payouts to your beneficiaries are deposited into Prudential Alliance Account ®, a personalized, interestbearing account, under the beneficiary’s name. The payout earns interest from the date the account is
opened and the beneficiary can transfer or withdraw funds at any time.
♦ Payment of premium can be waived if you are totally disabled for 9 months, you are less than 60 years old
when the disability begins, and you continue to be totally disabled. This waiver terminates at age 65. This
provision may vary by state. Refer to the plan booklet for details.
♦ The amount of insurance reduces 35% at age 65 and 50% at age 70.
♦ Coverage will end on your termination of employment or as specified in the plan booklet. You may convert
your insurance to an individual life insurance policy insured by The Prudential Insurance Company of
America or continue your group insurance through a portability provision.
Prudential Securities is a Division of Wachovia Securities, LLC, member NYSE & SIPC. Prudential
Securities is the Administrator of the Prudential Alliance Account Settlement Option, a contractual obligation
of The Prudential Insurance Company of America, a Prudential Financial company, located at 751 Broad
Street, Newark, NJ 07102-3777. Alliance Account balances are not insured by the Federal Deposit
Insurance Corporation (FDIC). Check clearing and processing support are provided by Bank One.
Prudential Securities, Wachovia Securities, and Bank One are not Prudential Financial companies.
INST-A010594
Ed. 4/2003
ECEd.9.2003-0723
Insured by The Prudential Insurance Company of America
Rates Effective: November 1, 2003
Optional Term Life – Biweekly Cost per Coverage Amount – Employee Rates
(Coverage is available in increments of $10,000 to $500,000, not to exceed five times your covered annual earnings. Refer to
the Optional Term Life section for evidence of good health details.)
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000 $100,000 $110,000 $120,000 $130,000
Age
< 25
$0.28
$0.55
$0.83
$1.11
$1.38
$1.66
$1.94
$2.22
$2.49
$2.77
$3.05
$3.32
$3.60
25-29
$0.32
$0.65
$0.97
$1.29
$1.62
$1.94
$2.26
$2.58
$2.91
$3.23
$3.55
$3.88
$4.20
30-34
$0.37
$0.74
$1.11
$1.48
$1.85
$2.22
$2.58
$2.95
$3.32
$3.69
$4.06
$4.43
$4.80
35-39
$0.46
$0.92
$1.38
$1.85
$2.31
$2.77
$3.23
$3.69
$4.15
$4.62
$5.08
$5.54
$6.00
40-44
$0.74
$1.48
$2.22
$2.95
$3.69
$4.43
$5.17
$5.91
$6.65
$7.38
$8.12
$8.86
$9.60
45-49
$1.15
$2.31
$3.46
$4.62
$5.77
$6.92
$8.08
$9.23
$10.38
$11.54
$12.69
$13.85
$15.00
50-54
$2.22
$4.43
$6.65
$8.86
$11.08
$13.29
$15.51
$17.72
$19.94
$22.15
$24.37
$26.58
$28.80
55-59
$4.02
$8.03
$12.05
$16.06
$20.08
$24.09
$28.11
$32.12
$36.14
$40.15
$44.17
$48.18
$52.20
60-64
$5.40
$10.80
$16.20
$21.60
$27.00
$32.40
$37.80
$43.20
$48.60
$54.00
$59.40
$64.80
$70.20
65-69
$9.51
$19.02
$28.52
$38.03
$47.54
$57.05
$66.55
$76.06
$85.57
$95.08
$104.58
$114.09
$123.60
70+
$19.06
$38.12
$57.18
$76.25
$95.31
$114.37
$133.43
$152.49
$171.55
$190.62
$209.68
$228.74
$247.80
$140,000 $150,000 $160,000 $170,000 $180,000 $190,000 $200,000 $250,000 $300,000 $350,000 $400,000 $450,000 $500,000
Age
< 25
$3.88
$4.15
$4.43
$4.71
$4.98
$5.26
$5.54
$6.92
$8.31
$9.69
$11.08
$12.46
$13.85
25-29
$4.52
$4.85
$5.17
$5.49
$5.82
$6.14
$6.46
$8.08
$9.69
$11.31
$12.92
$14.54
$16.15
30-34
$5.17
$5.54
$5.91
$6.28
$6.65
$7.02
$7.38
$9.23
$11.08
$12.92
$14.77
$16.62
$18.46
35-39
$6.46
$6.92
$7.38
$7.85
$8.31
$8.77
$9.23
$11.54
$13.85
$16.15
$18.46
$20.77
$23.08
40-44
$10.34
$11.08
$11.82
$12.55
$13.29
$14.03
$14.77
$18.46
$22.15
$25.85
$29.54
$33.23
$36.92
45-49
$16.15
$17.31
$18.46
$19.62
$20.77
$21.92
$23.08
$28.85
$34.62
$40.38
$46.15
$51.92
$57.69
50-54
$31.02
$33.23
$35.45
$37.66
$39.88
$42.09
$44.31
$55.38
$66.46
$77.54
$88.62
$99.69
$110.77
55-59
$56.22
$60.23
$64.25
$68.26
$72.28
$76.29
$80.31
$100.38
$120.46
$140.54
$160.62
$180.69
$200.77
60-64
$75.60
$81.00
$86.40
$91.80
$97.20
$102.60
$108.00
$135.00
$162.00
$189.00
$216.00
$243.00
$270.00
65-69
$133.11
$142.62
$152.12
$161.63
$171.14
$180.65
$190.15
$237.69
$285.23
$332.77
$380.31
$427.85
$475.38
70+
$266.86
$285.92
$304.98
$324.05
$343.11
$362.17
$381.23
$476.54
$571.85
$667.15
$762.46
$857.77
$953.08
The cost of insurance will depend upon having a specific percentage of all eligible employees enrolling in the plans. If this
enrollment level is not achieved, the cost of these coverages may change from the rates noted here.
Cost of insurance for all coverages, which are deducted from your paycheck, may increase or decrease in the future based
upon the claims experience of participants. All provisions that apply to these coverages are governed by the Certificate.
INST-A010594
Ed. 9.2003-0723
Ed. 4/2003
Dependent Term Life
Coverage Effective November 1, 2003
Enrollment Dates: October 15, 2003 through October 24, 2003
Spouse Coverage
♦ Coverage is available for your spouse in increments of $5,000 to $250,000, not to exceed
50% of your Optional Term Life coverage amount.
♦ New Hires: You may select to enroll your spouse for up to $20,000, without providing
satisfactory evidence of good health, if you enroll your spouse within 31 days of eligibility.
♦ Current Spouse Participants: Your spouse’s current coverage amount will be continued.
Evidence of good health is required for all increases in coverage amounts.
♦ Current Employees who have waived spouse coverage in the past or have been
denied coverage in the past: Evidence of good health is required for all
coverage amounts.
♦ If your spouse is confined for medical care or treatment at home or elsewhere, coverage
will begin when confinement ends.
♦ The amount of insurance reduces 35% at age 65, and 50% at age 70.
♦ Coverage will end on your termination of employment or as specified in the plan booklet.
Insurance may be converted to an individual life insurance policy insured by The Prudential
Insurance Company of America or continue your spouse’s group insurance through a
portability provision.
Child(ren) Coverage
♦ Dependent Term Life coverage has one premium rate that covers all eligible children.
♦ Coverage is available for all your children from live birth in increments of $1,000
to $10,000.
♦ No evidence of good health is required.
♦ If your dependent children are confined for medical care or treatment at home or
elsewhere, coverage will begin when confinement ends.
♦ Coverage begins at live birth and continues to age 19, if unmarried. If the child is
unmarried, dependent on you and a full-time student, coverage continues to age 23.
♦ Coverage will end on your termination of employment or as specified in the plan booklet.
Insurance may be converted to an individual life insurance policy insured by The Prudential
Insurance Company of America or continue your child(ren)’s group insurance through a
portability provision.
INST-A010594
ECEd.9.2003-0723
Ed. 4/2003
Dependent Term Life – Biweekly Cost per Coverage Amount – Spouse Rates**
(Coverage is available for your spouse in increments of $5,000 to $250,000, not to exceed 50% of your Optional Term Life
coverage amount. Refer to the Dependent Term Life section for evidence of good health details.)
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$55,000
$60,000
$65,000
Age
< 25
$0.14
$0.28
$0.42
$0.55
$0.69
$0.83
$0.97
$1.11
$1.25
$1.38
$1.52
$1.66
$1.80
25-29
$0.16
$0.32
$0.48
$0.65
$0.81
$0.97
$1.13
$1.29
$1.45
$1.62
$1.78
$1.94
$2.10
30-34
$0.18
$0.37
$0.55
$0.74
$0.92
$1.11
$1.29
$1.48
$1.66
$1.85
$2.03
$2.22
$2.40
35-39
$0.23
$0.46
$0.69
$0.92
$1.15
$1.38
$1.62
$1.85
$2.08
$2.31
$2.54
$2.77
$3.00
40-44
$0.37
$0.74
$1.11
$1.48
$1.85
$2.22
$2.58
$2.95
$3.32
$3.69
$4.06
$4.43
$4.80
45-49
$0.58
$1.15
$1.73
$2.31
$2.88
$3.46
$4.04
$4.62
$5.19
$5.77
$6.35
$6.92
$7.50
50-54
$1.11
$2.22
$3.32
$4.43
$5.54
$6.65
$7.75
$8.86
$9.97
$11.08
$12.18
$13.29
$14.40
55-59
$2.01
$4.02
$6.02
$8.03
$10.04
$12.05
$14.05
$16.06
$18.07
$20.08
$22.08
$24.09
$26.10
60-64
$2.70
$5.40
$8.10
$10.80
$13.50
$16.20
$18.90
$21.60
$24.30
$27.00
$29.70
$32.40
$35.10
65-69
$4.75
$9.51
$14.26
$19.02
$23.77
$28.52
$33.28
$38.03
$42.78
$47.54
$52.29
$57.05
$61.80
70+
$9.53
$19.06
$28.59
$38.12
$47.65
$57.18
$66.72
$76.25
$85.78
$95.31
$104.84
$114.37
$123.90
$70,000
$75,000
$80,000
$85,000
$90,000
$95,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000
Age
< 25
$1.94
$2.08
$2.22
$2.35
$2.49
$2.63
$2.77
$3.46
$4.15
$4.85
$5.54
$6.23
$6.92
25-29
$2.26
$2.42
$2.58
$2.75
$2.91
$3.07
$3.23
$4.04
$4.85
$5.65
$6.46
$7.27
$8.08
30-34
$2.58
$2.77
$2.95
$3.14
$3.32
$3.51
$3.69
$4.62
$5.54
$6.46
$7.38
$8.31
$9.23
35-39
$3.23
$3.46
$3.69
$3.92
$4.15
$4.38
$4.62
$5.77
$6.92
$8.08
$9.23
$10.38
$11.54
40-44
$5.17
$5.54
$5.91
$6.28
$6.65
$7.02
$7.38
$9.23
$11.08
$12.92
$14.77
$16.62
$18.46
45-49
$8.08
$8.65
$9.23
$9.81
$10.38
$10.96
$11.54
$14.42
$17.31
$20.19
$23.08
$25.96
$28.85
50-54
$15.51
$16.62
$17.72
$18.83
$19.94
$21.05
$22.15
$27.69
$33.23
$38.77
$44.31
$49.85
$55.38
55-59
$28.11
$30.12
$32.12
$34.13
$36.14
$38.15
$40.15
$50.19
$60.23
$70.27
$80.31
$90.35
$100.38
60-64
$37.80
$40.50
$43.20
$45.90
$48.60
$51.30
$54.00
$67.50
$81.00
$94.50
$108.00
$121.50
$135.00
65-69
$66.55
$71.31
$76.06
$80.82
$85.57
$90.32
$95.08
$118.85
$142.62
$166.38
$190.15
$213.92
$237.69
70+
$133.43
$142.96
$152.49
$162.02
$171.55
$181.08
$190.62
$238.27
$285.92
$333.58
$381.23
$428.88
$476.54
**Spouse rate is based on employee’s date of birth.
INST-A010594
Ed. 9.2003-0723 Ed. 4/2003
Dependent Term Life – Biweekly Cost per Coverage Amount – Child(ren) Rates
$1,000
$2,000
$3,000
$4,000
$5,000
$0.07
$0.13
$0.19
$0.26
$0.32
$6,000
$7,000
$8,000
$9,000
$10,000
$0.39
$0.45
$0.52
$0.58
$0.65
The cost of insurance will depend upon having a specific percentage of all eligible employees enrolling in the plans. If this
enrollment level is not achieved, the cost of these coverages may change from the rates noted here.
Cost of insurance for all coverages, which are deducted from your paycheck, may increase or decrease in the future based
upon the claims experience of participants. All provisions that apply to these coverages are governed by the Certificate.
INST-A010594
Ed. 9.2003-0723
Ed. 4/2003

Overlake Internal Medicine Associates

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