Attachment 1B - OGLI Design Plan_Schedule of Benefits.pdf
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- Attached to
- OCC Group Life Insurance (OGLI) Services (RFP)
- Solicitation number
- 2031JW26R00001
About this file
This document is a Schedule of Benefits for a group life insurance policy, detailing multiple insurance coverage options for different employee classes. The policy provides Basic Life Insurance for three employee classes: Senior Executives (with a base benefit of $500,000 and maximum benefit of $600,000), Active Employees (base benefit calculated as 1x basic annual earnings plus $2,000), and Retired Employees (insurance amount equal to coverage before retirement, with a maximum of $300,000). Additionally, the policy offers Supplemental Life Insurance for active employees with a minimum of $25,000 and a maximum of either 5x basic annual earnings or $500,000, and includes Accidental Death and Dismemberment (AD&D) Insurance with coverage ranging from $500,000 for senior executives to a calculated amount for active employees.
The document also outlines Dependent Life Insurance options, with two spouse coverage options (50% or 100% of basic annual earnings) and five different coverage tiers for spouse and children ranging from $5,000/$2,500 to $25,000/$12,500. Estate Resolution Services are included at no additional cost, providing will preparation and probate services through MetLife. The policy includes portability provisions for AD&D insurance, with minimum and maximum portability amounts specified, and details about how portability works if the group policy ends or is amended. Non-medical issue amounts are specified for various insurance types, and an Accelerated Benefit Option allows up to 75% of life insurance to be accessed under certain conditions.
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SCHEDULE OF BENEFITS
GCERT2000
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This schedule shows the benefits that are available under the Group Policy. You and Your Dependents will only be insured for the benefits:
for which You and Your Dependents become and remain eligible;
which You elect, if subject to election; and which are in effect.
The amount of Insurance that We will pay for any insurance to which You make contributions will be decreased by the amount of Your contributions due and unpaid to Us for that insurance.
BENEFIT BENEFIT AMOUNTS AND HIGHLIGHTS
Life Insurance For You
Basic Life Insurance
Basic Life Insurance is NOT Portability Eligible Insurance
Class 1: Senior Executives
Base Benefit Amount for All Senior Executives $500,000
Additional Benefit For Age Additional Benefit Amount
35 and younger ............................................................. $300,000
36 .................................................................................. $270,000
37 .................................................................................. $240,000
38 .................................................................................. $210,000
39 .................................................................................. $180,000
40 .................................................................................. $150,000
41 .................................................................................. $120,000
42 .................................................................................. $90,000
43 .................................................................................. $60,000
44 .................................................................................. $30,000
45 and older .................................................................. No Additional Benefit Amount
Maximum Basic Life Benefit ........................................ $600,000
Non-Medical Issue Amount .......................................... $600,000
Accelerated Benefit Option ............................................... Up to 75% of Your Basic Life amount not to exceed $450,000
ATTACHMENT 1B - OGLI DESIGN PLAN_SCHEDULE OF BENEFITS
SCHEDULE OF BENEFITS (continued) sch 2
Class 2: All Active Employees Other Than Senior Executives
Base Benefit Amount for All Active Employees The sum of an amount equal to 1 times Your Basic Annual Earnings, rounded to the next higher $1,000, plus $2,000
Additional Benefit for Age Additional Benefit Amount
35 and younger............................................................. 1 times Your Base Benefit Amount
36 .................................................................................. 0.9 times Your Base Benefit Amount
37 .................................................................................. 0.8 times Your Base Benefit Amount
38 .................................................................................. 0.7 times Your Base Benefit Amount
39 .................................................................................. 0.6 times Your Base Benefit Amount
40 .................................................................................. 0.5 times Your Base Benefit Amount
41 .................................................................................. 0.4 times Your Base Benefit Amount
42 .................................................................................. 0.3 times Your Base Benefit Amount
43 .................................................................................. 0.2 times Your Base Benefit Amount
44 .................................................................................. 0.1 times Your Base Benefit Amount
45 and older .................................................................. No Additional Base Benefit Amount
Maximum Basic Life Benefit ........................................ $600,000
Non-Medical Issue Amount ......................................... $600,000
Accelerated Benefit Option ............................................... Up to 75% of Your Basic Life amount not to exceed $450,000
Class 3: Retired Employees
For Retirees .................................................................. An amount equal to Your Basic Life Insurance in effect immediately before the date You retire
Maximum Basic Life Benefit ........................................ $300,000
For Retired employees upon attaining age 65, the amount of Your insurance will reduce to 25% of the amount for which You were eligible on the date of Your retirement.
Supplemental Life Insurance
Supplemental Life Insurance is NOT Portability Eligible Insurance
For Active Employees .................................................. An amount, elected by You, which is a multiple of $25,000
Minimum Supplemental Life Benefit ............................ $25,000
Maximum Supplemental Life Benefit ........................... The lesser of 5 times Your Basic Annual Earnings or $500,000 sch 3
Accelerated Benefit Option .......................................... Up to 75% of Your Supplemental Life amount not to exceed $375,000
ESTATE RESOLUTION SERVICES
The following Estate Resolution Services are provided at no additional cost to individuals insured for Group Supplemental Life Insurance coverage as described below. If You are eligible to receive these Estate Resolution Services and You or Your Spouse (for the Will Preparation Service) or You or Your Spouse or a Beneficiary (for the Probate Service) would like to speak with a representative from MetLife Legal Plans or get the name of a Plan Attorney that you can speak with about these Services, please call (800) 821-6400.
THE FOLLOWING APPLIES TO RESIDENTS OF ALL STATES OTHER THAN TEXAS
Will Preparation Service
If You elect Group Supplemental Life Insurance coverage, a Will Preparation Service (the �Service�) will be made available to You, through a MetLife affiliate (the �Affiliate�), while Your Group Supplemental Life Insurance coverage is in effect. This Service will be made available at no cost to You. It enables You to have a will prepared for You and Your Spouse free of charge by attorneys designated by the Affiliate. If You have a will prepared by an attorney not designated by the Affiliate, You must pay for the attorney�s services directly.
Upon Proof of such payment, You will be reimbursed for the attorney�s services in an amount equal to the lesser of the amount You paid for the attorney�s services and the amount customarily reimbursed for such services by the Affiliate.
Probate Service
If You become insured for Group Supplemental Life Insurance coverage and You or Your Spouse die while such Group Supplemental Life Insurance coverage is in effect, a probate benefit (the �Benefit�) will be made available to Your estate in the event of Your death or to Your Spouse's estate in the event of Your Spouse's death. Such benefit will be made available through a MetLife affiliate (�Affiliate�).
The Benefit provides for certain probate services to be made available, free of charge by attorneys designated by the Affiliate. If probate services are provided by an attorney not designated by the Affiliate, the estate of the deceased must pay for those attorney�s services directly. Upon Proof of such payment, the estate of the deceased will be reimbursed for the attorney�s services in an amount equal to the lesser of the amount such estate paid for the attorney�s services and the amount customarily reimbursed for such services by the Affiliate.
This Benefit will be provided at no cost to You and will end on the date Your Group Supplemental Life Insurance coverage ends.
THE FOLLOWING APPLIES TO RESIDENTS OF TEXAS ONLY
Will Preparation Service
If You elect Group Supplemental Life Insurance coverage, a Will Preparation Service (the �Service�) will be made available to You through a MetLife affiliate (the �Affiliate�), as agreed to by the Policyholder and MetLife, while Your Group Supplemental Life Insurance coverage is in effect under this Policy.
Will Preparation Service means a service covering the preparation of wills and codicils for You and Your Spouse. The creation of any testamentary trust is covered. The Will Preparation Service does not include tax planning.
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This Service will be made available at no cost to You. It enables You to have a will prepared for You and Your Spouse free of charge by attorneys designated by the Affiliate. If You have a will prepared by an attorney not designated by the Affiliate, You must pay for the attorney�s services directly. Upon Proof of such payment, You will be reimbursed for the attorney�s services in an amount equal to the lesser of the amount You paid for the attorney�s services and the amount customarily reimbursed for such services by the Affiliate.
Probate Service
If You become insured for Group Supplemental Life Insurance coverage and You or Your Spouse die while such Group Supplemental Life Insurance coverage is in effect, a probate benefit (the �Benefit�) will be made available to Your estate in the event of Your death or to Your Spouse�s estate in the event of Your Spouse�s death. Such benefit will be made available through a MetLife affiliate (�Affiliate�).
The Benefit includes attorney representation and payment of legal fees for the executor or administrator of the estate of the deceased including representation for the preparation of all documents and all of the court proceedings needed to transfer probate assets from the estate of the deceased to applicable heirs; and the completion of correspondence necessary to transfer non-probate assets such as proceeds from insurance policies, joint bank accounts, stock accounts or a house; and associated tax filings.
The Benefit provides for such services to be made available, free of charge by attorneys designated by the Affiliate. If probate services are provided by an attorney not designated by the Affiliate, the estate of the deceased must pay for those attorney�s services directly. Upon Proof of such payment, the estate of the deceased will be reimbursed for the attorney�s services in an amount equal to the lesser of the amount such estate paid for the attorney�s services and the amount customarily reimbursed for such services by the Affiliate.
This Benefit will be provided at no cost to You and will end on the date Your Group Supplemental Life Insurance coverage ends.
GCERT2000 5
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Accidental Death and Dismemberment Insurance (AD&D) For You
Full Amount for AD&D
Accidental Death and Dismemberment Insurance for You is Portability Eligible Insurance
Class 1: Senior Executives
All Senior Executives�������..�����.�..$500,000
Class 2: Active Employees
Class 2 Active Employees ................................... The sum of an amount equal to 1 times Your Basic Annual Earnings, rounded to the next higher $1,000, plus $2,000
Maximum AD&D Benefit .............................................. $500,000
Schedule of Covered Losses for Accidental Death and Dismemberment Insurance
All amounts listed are stated as percentages of the Full Amount.
Covered Losses
Loss of life .................................................................................... 100% Loss of a hand permanently severed at or above the wrist but below the elbow ....................................................... 50% Loss of a foot permanently severed at or above the ankle but below the knee ....................................................... 50% Loss of an arm permanently severed at or above the elbow ....... 75% Loss of a leg permanently severed at or above the knee ............ 75% Loss of sight in one eye ............................................................... 50%
Loss of sight means permanent and uncorrectable loss of sight in the eye. Visual acuity must be 20/200 or worse in the eye or the field of vision must be less than 20 degrees.
Loss of any combination of hand, foot, or sight of one eye, as defined above .............................................................................. 100% Loss of the thumb and index finger of same hand ....................... 25%
Loss of thumb and index finger of same hand means that the thumb and index finger are permanently severed through or above the third joint from the tip of the index finger and the second joint from the tip of the thumb.
Loss of speech and loss of hearing ............................................. 100% Loss of speech or loss of hearing ................................................ 50%
Loss of speech means the entire and irrecoverable loss of speech that continues for 6 consecutive months following the accidental injury.
Loss of hearing means the entire and irrecoverable loss of hearing in both ears that continues for 6 consecutive months following the accidental injury.
GCERT2000 6
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Life Insurance For Your Dependents
Life Insurance for Your Dependents is NOT Portability Eligible Insurance
Class 1 and Class 2: Senior Executives and Active Employees
For Your Spouse Only
Option 1�������������.. An amount equal to 50% of the sum of Your Basic Annual Earnings rounded to the next higher $1,000, plus $2,000
Option 2�������������.. An amount equal to 100% of Your Basic Annual Earnings rounded to the next higher $1,000, plus $2,000
Maximum Dependent Spouse Life Benefit��������������. $300,000
Non Medical Issue Amount�����.. $300,000
For Your Spouse and Child(ren)
Dependent Spouse and Child Spouse Child(ren)
Option 1 $5,000 $2,500
Option 2 $10,000 $5,000
Option 3 $15,000 $7,500
Option 4 $20,000 $10,000
Option 5 $25,000 $12,500
Non Medical Issue Amount $25,000 $12,500
GCERT2000 7
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Portability Eligible AD&D Insurance
AD&D Insurance For You:
Portability Eligible AD&D Insurance For You:
Minimum Portability Eligible AD&D Insurance Amount .................. $10,000
Maximum Portability Eligible AD&D Insurance Amount ................. The lesser of Your total AD&D Insurance in effect on the date You elect to Port or $2,000,000
If Your Portability Eligible Insurance ends due to the end of the Group Policy or the amendment of the Group Policy to end the Portability Eligible Insurance for an eligible class of which You are a member, the maximum amount of insurance that You may Port is the lesser of:
the amount of Your Portability Eligible Insurance that ends under the Group Policy less the amount of AD&D insurance for which You become eligible under any group policy issued to replace this Group Policy; or
$10,000.
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