62-K1 - City of Burleson Proposal - 9.6.18.pdf

Response to Proposal Request

August 20, 2018

Prepared for:

City of Burleson

Burelson, TX on behalf of IPS Advisors

Symetra Group Benefits

BDM-1025 1/16

Table of Contents

Section 1

Section 2

Symetra

Executive Summary……………………..…...…......….…...………………………..…...…......….…...…

Symetra

Financial Proposal……………………..…...…......….…...………………………..…...…......….…...…

1Symetra

Executive Summary

LDM-6237 12/16

GREAT EMPLOYERS OFFER GREAT BENEFITS

From implementation to claims, we deliver a high-quality customer experience to you and your employees at every touch point.

When it comes to your group’s benefits, you deserve a plan that positively impacts the lives of your employees and their families, and enables cost-effective delivery of the right services at the right time.

At Symetra, we strive to give you just that. Our group life and disability income insurance provide important benefits that can make a difference at a critical time in employees’ lives. And to give you the most value for your benefits, we listen to your concerns and work to create a policy that’s right for you, your group and your budget.

It’s all part of our fully integrated approach to claims management—offering you and your employees exceptional service from start to finish.

WITH YOU EVERY STEP OF THE WAY

From implementation to claims, we deliver a high-quality customer experience to you and your employees at every touch point. We’ll be there to guide you and provide the resources you need to successfully manage your plan.

Our implementation managers work closely with you and your broker throughout the entire onboarding process—walking you through policy details, administrative training, reporting needs and more. They’ll provide constant support, communication and transparency to ensure implementation is simple and seamless.

Once your plan is set up, our experienced account managers act as your ongoing contact for the life of your policy. They provide invaluable expertise and can meet with you to address your concerns and find ways to improve your group’s experience.

Our collaborative approach to implementation and account management fosters responsiveness and innovative problem solving to deliver outstanding service to you and your employees.

FULLY INTEGRATED CLAIMS MANAGEMENT

Whether it’s working with employees on disability leave, or helping a beneficiary after the loss of a loved one, our team of claim professionals is committed to helping employees and their families navigate the road to recovery. Your employees will receive empathetic, courteous and prompt service at every interaction.

And with Group Online (GO), our state-of-the-art online processing tool, you have an easy, convenient way to manage life, disability and absence management claims 24/7—significantly easing the burden of administering your group’s absences.

2Symetra

Financial Proposal

Any policy sold and issued in the State of New York is insured and underwritten by First Symetra National Life Insurance Company of New York, a New York-licensed insurer.

Any policy sold and issued in any state other than the State of New York is insured and underwritten by Symetra Life Insurance Company, an Iowa-domiciled insurer that is licensed in all states except New York.

Symetra Group Life and Disability Insurance Proposal

August 20, 2018

Presented to

City of Burleson

Burelson, TX

Presented on behalf of

IPS Advisors

Proposed Contract Effective Date 1/1/2019

Basic Employee Life

Lives Volume Rate per $1,000

Monthly

Premium

Annual

Premium

Basic Employee Life 314 $19,657,500 $0.030 $589.73 $7,076.76

Basic Employee AD&D

Lives Volume Rate per $1,000

Monthly

Premium

Annual

Premium

Basic Employee AD&D 314 $19,657,500 $0.030 $589.73 $7,076.76

Basic Dependent Life

Lives Volume Rate per unit

Monthly

Premium

Annual

Premium

Spouse 178 $1,665,000 $2.000 $356.00 $4,272.00

Child(ren) 178 $832,500 $2.000 $356.00 $4,272.00

*Rates are doubled for Option 2

City of Burleson

Effective 1/1/2019 Proposed Rates

- There are no Basic Employee Life commissions.

- Basic Employee Life Rates are guaranteed for 3 years

- There are no Basic Employee AD&D commissions.

- Basic Employee AD&D Rates are guaranteed for 3 years

- There are no Basic Dependent Life commissions.

- Basic Dependent Life Rates are guaranteed for 3 years.

Prepared by 2

City of Burleson

Effective 1/1/2019 Proposed Rates

Supplemental Employee Life

Age Lives Volume Rate per $1,000

Monthly

Premium

Annual

Premium

< 25 1 $10,000 $0.070 $0.70 $8.40

25 - 29 7 $560,000 $0.070 $39.20 $470.40

30 - 34 22 $2,230,000 $0.080 $178.40 $2,140.80

35 - 39 25 $2,110,000 $0.100 $211.00 $2,532.00

40 - 44 28 $2,790,000 $0.140 $390.60 $4,687.20

45 - 49 28 $2,430,000 $0.220 $534.60 $6,415.20

50 - 54 29 $2,140,000 $0.330 $706.20 $8,474.40

55 - 59 18 $1,130,000 $0.540 $610.20 $7,322.40

60 - 64 11 $830,000 $0.720 $597.60 $7,171.20

65 - 69 0 $0 $1.220 $0.00 $0.00

70 - 74 0 $0 $2.160 $0.00 $0.00

75 + 0 $0 $8.180 $0.00 $0.00

Total 169 $14,230,000 $3,268.50 $39,222.00

Supplemental AD&D

Lives Volume Rate per $1,000

Monthly

Premium

Annual

Premium

Supplemental AD&D 169 $14,230,000 $0.030 $426.90 $5,122.80

Supplemental AD&D Spouse 92 $3,285,000 $0.030 $98.55 $1,182.60

Supplemental AD&D Child 68 $680,000 $0.040 $27.20 $326.40

- There are no Supplemental AD&D commissions.

- There are no Supplemental Employee Life commissions.

- Supplemental Employee Life Rates are guaranteed for 3 years

- Supplemental AD&D Rates are guaranteed for 3 years

Prepared by 3

Proposed Rates

Supplemental Dependent Life

Age Lives Volume Rate per $1,000

Monthly

Premium

Annual

Premium

< 25 1 $5,000 $0.070 $0.35 $4.20

25 - 29 2 $110,000 $0.070 $7.70 $92.40

30 - 34 11 $370,000 $0.080 $29.60 $355.20

35 - 39 12 $565,000 $0.100 $56.50 $678.00

40 - 44 22 $800,000 $0.140 $112.00 $1,344.00

45 - 49 16 $595,000 $0.220 $130.90 $1,570.80

50 - 54 12 $315,000 $0.330 $103.95 $1,247.40

55 - 59 9 $340,000 $0.540 $183.60 $2,203.20

60 - 64 7 $185,000 $0.720 $133.20 $1,598.40

65 - 69 0 $0 $1.220 $0.00 $0.00

70 - 74 0 $0 $2.160 $0.00 $0.00

75 + 0 $0 $8.180 $0.00 $0.00

Spouse Total 92 $3,285,000 $757.80 $9,093.60

Child 68 $680,000 $2.000 $1,360,000.00 $16,320,000.00

Long Term Disability

Lives Volume Rate per $100

Monthly

Premium

Annual

Premium

Long Term Disability 314 $1,630,932 $0.210 $3,424.96 $41,099.52

- There are no Supplemental Dependent Life commissions.

- Supplemental Dependent Life Rates are guaranteed for 3 years

- There are no Long Term Disability commissions.

- Long Term Disability Rates based on $100 of monthly covered payroll

- Long Term Disability Rates are guaranteed for 3 years

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Basic Employee Life and AD&D Insurance

All full-time active employees working minimum of 30 hours per week

Eligibility excludes all temporary and seasonal employees

Basic Employee Life Insurance

Classes: Class 1: All Active Full Time Employees

Waiting Period (months): 1

Benefit Schedule: 1.00 X Annual Earnings

Benefit Maximum: $250,000

Benefit Minimum: $1,000

Guaranteed Issue Amount: $250,000

Disability Provision: Premium Waiver If Disabled Prior To Age 60

Premium Waiver Elimination Period: 6 Months

Disability Duration: To Age 65

Accelerated Death Benefit %: 80%

Accelerated Death Benefit Maximum: $250,000

Terminal Illness Period: 12 Months Or Less

Definition of Earnings: Salary

Rounding Method: Next Higher $1,000

Enhanced No Loss / No Gain: Included

Portability (Life Benefits Only): Included

Portability Maximum: $250,000

Minimum Hour Requirement: 20

Employer Contribution: 100%

Age Reduction: Reduced to - 65% @ age 65, 50% @ age 70, 35% @ age 75

Conversion: Included

Basic Employee AD&D Insurance

Classes: Class 1: All Active Full Time Employees

Benefit Schedule: 1.00 X Annual Earnings

Benefit Maximum: $250,000

Benefit Minimum: $1,000

Guaranteed Issue Amount: Match Maximum Benefit Amount

Coverage Type: 24-hour coverage

Common Carrier Benefit: Included

Definition of Earnings: Salary

Rounding Method: Next Higher $1,000

Enhanced No Loss / No Gain: Included

Minimum Hour Requirement: 20

Employer Contribution: 100%

Age Reduction: Reduced to - 65% @ age 65, 50% @ age 70, 35% @ age 75

Conversion: Not Included

Eligibility:

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Basic Spouse and Dependent Life Insurance

All full-time active employees working minimum of 30 hours per week

Eligibility excludes all temporary and seasonal employees

Provision

Spouse Benefit Schedule: (2 Options) Flat Amount

Spouse Benefit Maximum: $5,000

$10,000

Spouse Guarantee Issue: $5,000

$10,000

Child Benefit Schedule: (2 Options) Flat $2,500

Flat $5,000

Child Guarantee Issue: Match The Benefit Max Quoted

Child Benefit Start Age: 15 Days

Child Benefit End Age: 26

Enhanced No Loss / No Gain: Included

Portability: Included

Conversion: Included

Eligibility:

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Eligibility: All full-time active employees working minimum of 30 hours per week

Eligibility excludes all temporary and seasonal employees

Supplemental Employee Life Insurance

Classes: All Active Full Time Employees

Waiting Period (months): 1

Benefit Schedule: Increments of $10,000

Benefit Maximum: The Lesser of 5 X Annual Earnings Or $300,000

Benefit Minimum: $10,000

Guaranteed Issue Amount: $100,000

Disability Provision: Premium Waiver If Disabled Prior To Age 60

Premium Waiver Elimination Period: 6 Months

Disability Duration: To Age 65

Accelerated Death Benefit %: 80%

Accelerated Death Benefit Maximum: $250,000

Terminal Illness Period: 12 Months Or Less

Definition of Earnings: Salary

Rounding Method: Next Higher $1,000

Enhanced No Loss / No Gain: Included

Portability: Included

Portability Maximum: $250,000

Employee Contribution: 100%

Participation Requirement: 50%

Age Reduction: Reduced to - 65% @ age 65, 50% @ age 70, 35% @ age 75

Suicide Exclusion: 24 Months

Enrollment Type: One Time Modified Open Enrollment 5x

Conversion: Included

Supplemental Employee AD&D Insurance

Classes: All Active Full Time Employees

Benefit Schedule: Increments of $10,000

Benefit Maximum: The Lesser of 5 X Annual Earnings Or $300,000

Benefit Minimum: $10,000

Guaranteed Issue Amount: Match Maximum Benefit Amount

Coverage Type: 24-Hour Coverage

Common Carrier Benefit: Included

Definition of Earnings: Salary

Rounding Method: Next Higher $1,000

Enhanced No Loss / No Gain: Included

Employee Contribution: 100%

Age Reduction: Reduced to - 65% @ age 65, 50% @ age 70, 35% @ age 75

Conversion: Not Included

Portability: Not Included

Supplemental Employee Life and AD&D Insurance

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Supplemental Dependent Life Insurance

All full-time active employees working minimum of 30 hours per week

Eligibility excludes all temporary and seasonal employees

Spouse Benefit Schedule: Increments of $5,000

Spouse Benefit Maximum: Lesser of 50% of the employees life benefit or $150,000

Spouse Guarantee Issue: $25,000

Terminal Illness Period: 12 Months Or Less

Rounding Method: Next Higher $1,000

Enhanced No Loss / No Gain: Included

Spouse Portability: Included

Spouse Portability Maximum: $50,000

Conversion: Included

Child Benefit Schedule: Flat Benefit Amount

Child Benefit Maximum: $10,000

Child Guarantee Issue: Match The Benefit Max Quoted

Child Benefit (Live Birth to Start Age) $250

Benefit Start Age: 15 Days

Benefit End Age: 26

Child Portability: Included

Child Portability Maximum: $10,000

Conversion: Included

Eligibility:

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Group Life Provisions Included in this Proposal

Enhanced No Loss/No Gain

Provided the employee was insured under the prior carrier contract and premiums were being paid on the day preceding our effective date, we will waive the actively at work requirement on a no loss/no gain basis. Coverage will not be deferred if an eligible employee is insured under the prior policy and, although not actively at work on the policy effective date, would otherwise meet the eligibility requirements of the policy period. The amount of insurance will be the lesser of the amount of life insurance and AD&D principal sum in effect under the prior policy or shown in the schedule and reduced by any coverage amount in force, paid or payable under the prior policy.

Right of Conversion

If Life Insurance coverage or any portion of it under The Policy ends for any reason, the insured may have the right to convert the coverage that terminated to an individual conversion policy without providing Evidence of Insurability.

Conversion is not available for:

1. the Accidental Death and Dismemberment Benefits; or

2. any Amount of Life Insurance for which the insured was not eligible under The Policy.

Waiver of Premium

The Waiver of Premium provision allows continuation of life insurance coverage without paying premium if the insured is:

disabled and qualifies for Waiver of Premium. To qualify, an insured must become disabled prior to age 60 and, if approved, premiums will be waived to age 65 as long as the insured remains disabled. If the insured qualifies, the amount of continued coverage:

1. will be the amount in force on the date the insured ceases to be an active employee;

2. will be subject to any reductions provided by The Policy; and

3. will not increase.

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Accidental Loss Of:

Amount of

Principal Sum

Payable:

Life 100%

Both hands or both feet or sight of both eyes 100%

One hand and one foot 100%

Speech and hearing in both ears 100%

Either hand or foot and sight of one eye 100%

Movement of both upper and lower limbs (Quadriplegia) 100%

Movement of both lower limbs (Paraplegia) 75%

Movement of three limbs (Triplegia) 75%

Movement of the upper and lower limbs of one side of the body (Hemiplegia) 50%

Either hand or foot 50%

Sight of one eye 50%

Speech or hearing in both ears 50%

Movement of one limb (Uniplegia) 25%

Thumb and index finger of either hand 25%

Additional Benefits: Percent Maximum

Seatbelt 10.0% $25,000

Airbag 10.0% $25,000

Repatriation 5.0% $5,000

Child Education (payable up to 4 years) 5.0% $5,000

Daycare (payable up to 4 years) 5.0% $5,000

Spouse Education 3.0% $3,000

Exposure and Disappearance Benefit Included

The amount of Principal Sum is shown in the Schedule of Insurance.

City of Burleson

Effective 1/1/2019

Accidental Death & Dismemberment Loss Schedule

If the insured sustains an injury which results in any of the following losses within 365 days of the date of accident, we will pay the injured person’s amount of Principal Sum or a portion of such Principal Sum, as shown opposite the loss after we receive Proof of Loss in accordance with the Proof of Loss provision.

This Benefit will be paid according to the General Provisions of The Policy.

No more than the Principal Sum will be paid to any one person, for all losses due to the same accident.

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Accidental Death & Dismemberment Exclusions

The Policy does not cover any Loss caused or contributed by:

• Intentionally self-inflicted Injury;

• Suicide or attempted suicide, whether sane or insane;

• War or act of war, whether declared or not;

• Injury sustained while on full-time active duty as a member of the armed forces (land, water, air) of any country or international authority except Reserve National Guard Service;

• Injury sustained while On any aircraft except a Civil or Public Aircraft, or Military Transport Aircraft;

• Injury sustained while On any aircraft:

a) as a pilot, crewmember or student pilot;

b) as a flight instructor or examiner;

c) if it is owned, operated or leased by or on behalf of the Policyholder, or any Employer or organization whose eligible persons are covered under The Policy;

d) being used for tests, experimental purposes, stunt flying, racing or endurance tests; or

• Injury sustained while taking drugs, including but not limited to sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless as prescribed by or administered by a Physician;

• Injury sustained while riding or driving in a scheduled race or testing any Motor Vehicle on tracks, speedways or proving grounds;

• Injury sustained while committing or attempting to commit a felony;

• Injury sustained while Intoxicated; or

• Injury sustained while driving while Intoxicated.

Intoxicated means:

1) the blood alcohol content;

2) the results of other means of testing blood alcohol level; or

3) the results of other means of testing other substances;

that meet or exceed the legal presumption of intoxication, or under the influence, under the law of the state where the accident occurred.

Reserve National Guard Service means: You or Your Spouse are:

1) attending or en route to or from any active duty training of less than 60 days;

2) attending or en route to or from a service school of any duration;

3) taking part in any authorized inactive duty training; or

4) taking part as a unit member in a parade or exhibition authorized by official orders.

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Long Term Disability Insurance

All full-time active employees working minimum of 30 hours per week

Eligibility excludes all temporary and seasonal employees

Classes: All Active Full Time Employees

Waiting Period: 1 Months

Benefit Percent: 60%

Maximum Monthly Benefit: $10,000.00

Minimum Monthly Benefit: $100

Elimination Period (Days): 90 Days

Maximum Payment Duration: SSNRA

Definition of Disability: 24 month Own Occ

Partial / Residual: Residual

Own Occ / Any Occ Earnings Test: 99/80%

Return to Work Incentive: 24 months

Integration Method: Direct

Social Security Offset: Family

Pre-Existing Condition Limitation: 3/12

Lump Sum Survivor Benefit: 100% Gross 3 Months

Mental Illness Limitation 24 Months

Substance Abuse Limitation: 24 Months

Special Conditions Limitation: 24 Months

Lifetime / Per Occurrence: Per Lifetime

Indexation: Yes

Worksite Modification: $2,000

Contribution Method: Non Contributory

Employer Contribution Percent: 100%

Employee Assistance Program: Included

Recurrent Disability: 6 Months

Waiver of Premium: Included

Conversion Privilege: Not Included

Eligibility:

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Long Term Disability Provisions Included in this Proposal

Actively at Work:

If you are not in active employment as a result of your injury or a sickness, then your coverage will be effective on the date you return to active employment. This applies to your initial coverage, as well as any increases or additions to coverage occurring after your initial coverage is effective.

Continuity of Coverage:

If you were insured by the prior group insurance plan just before you become eligible for coverage under this plan;

you are in active employment; and you are insured under this plan, then you may be eligible for payments from us under this plan if your disability is due to a pre-existing condition.

In order to receive payments from us, you must meet the pre-existing condition exclusion of this plan;

OR

the prior group insurance plan had the plan stayed in effect.

We will consider the total amount of time you were continuously insured under both the prior group insurance plan and this plan to determine if you satisfy the pre-existing condition exclusion. If you cannot satisfy the pre-existing condition exclusion of either plan then we will not pay you a disability benefit.

We will determine our payments to you using the provisions of this plan, but your monthly payment will not be more than the maximum monthly payment of the prior group insurance plan. Your monthly payments will end on the earlier of the following dates:

the end of the maximum payment duration under this plan;

OR

the date benefits would have ended under the prior group insurance plan if the plan had stayed in effect.

Elimination Period:

The disability benefit payment begins the later of the elimination period listed in the proposal, the date STD payments ends, the date salary continuation ends or the date accumulated sick leave ends. The elimination period is a period of continuous days of disability. The elimination period begins on the first day of your disability.

Disabled/Disability means our determination that your sickness or injury:

During the elimination period, prevents you from performing with reasonable continuity the material and substantial duties of your regular occupation and a reasonable employment option offered to you by the employer and, as a result, you are not working at all, or you are working and the income you are able to earn is less than or equal to

99% of your pre-disability earnings.

During the own occupation period of disability benefits, prevents you from performing with reasonable continuity the material and substantial duties of your regular occupation and a reasonable employment option offered to you by the employer and, as a result, the income you are able to earn is less than or equal to 99% of your pre-disability earnings.

During the any occupation period of disability benefits, prevents you from performing with reasonable continuity the material and substantial duties of any gainful occupation and, as a result, the income you are able to earn is less than or equal to 80% of your pre-disability earnings.

Material and substantial duties are the duties that:

are normally required for the performance of the occupation;

AND

cannot be reasonably omitted or changed.

Integration Method:

Direct - Under direct integration, offsets are subtracted from the Scheduled Monthly Benefit.

Social Security Offset:

Social Security Type - Other income benefit sources include those (due to the employee’s disability or retirement) which are payable to the employee’s spouse, children and dependents.

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Long Term Disability Provisions Included in this Proposal

Return to Work:

12 Months return to work incentive provides insureds with a safety net during the early months of return to employment. Monthly benefits combined with earnings can provide up to 100% of pre-disability earnings

If the insured recovers and returns to work, and the same sickness or injury causes the disability to occur again within the time period specified in our proposal of the date the prior disability ended, Symetra will resume monthly payments if the insured is covered under the policy for the period of temporary recovery

Waiver of Premium:

Premium payments for coverage are suspended for and insured while he/she is receiving disability income payments under this policy

Cost of Living Freeze:

Except for increases in income earned (or received from any form of employment) once other income amounts have been subtracted from the gross monthly disability payment, the insured’s payment will not be further reduced due to a cost of living increase in any other income amounts

Indexed Monthly Earnings:

Indexed pre-disability earnings means your basic monthly earnings in effect just prior to the date your disability began adjusted on the first anniversary of benefit payments and each following anniversary. Each adjustment will be based on the lesser of 10% or the current annual percentage increase in the Consumer Price Index.

Work Place Modification:

Provides a benefit for costs associated with the accommodation of a disabled insured’s workplace

Vocational Rehabilitation:

Provides assistance through services such as testing and training as well as job modification and placement

Social Security Assistance:

Helps an insured obtain Social Security disability benefits

Maximum Benefit Period

Age When Disability Begins - Maximum Payment Duration

Less than Age 60 - To Social Security Normal Retirement Age (SSNRA)

Age 60 - 60 months

Age 61 - 48 months

Age 62 - 42 months

Age 63 - 36 months

Age 64 - 30 months

Age 65 - 24 months

Age 66 - 21 months

Age 67 - 18 months

Age 68 - 15 months

Age 69 and over - 12 months

Social Security Normal Retirement Age (SSNRA) means the age at which you are eligible for Social Security full retirement benefits.

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Long Term Disability Provisions Included in this Proposal

Pre-Existing Condition Limitation:

Pre-existing condition is a sickness or injury:

• for which you received treatment within the three months prior to your effective date of coverage.

Treatment includes:

• consulting with a doctor

• receiving care or services from a doctor or from other medical professionals a doctor recommends you see

• taking prescribed medicines

• being prescribed medicines

• you should have been taking prescribed medicines but chose not to

• receiving diagnostic measures.

Exclusions:

Symetra will not cover a disability if it is due to:

• War, declared or not, or any act of war;

• Intentionally self inflicted injuries or illness, while sane or insane;

• Your active participation in a riot;

• You attempt to commit or your commission of a felony under federal or state law, or your being engaged in an illegal occupation.

• Your service in the armed forces, military reserves or National Guard of any country or International authority, or in a civilian unit serving with such forces

• Cosmetic or reconstructive surgery, except for complications arising from any such surgery or for surgery necessary to correct a deformity caused by accidental injury or sickness;

• An accident resulting from or caused by your operation of a motor vehicle while intoxicated according to the laws of the jurisdiction where the accident occurred; or

• An accident resulting from or caused by your being under the influence of drugs or any controlled substance, unless taken as prescribed by your doctor.

• No benefits are payable for any period of disability during which you are incarcerated in a penal or correctional facility for a period of 30 or more consecutive days or for which you are not under the regular care of a doctor.

• If your professional or occupational license or your certification is suspended, revoked or surrendered, loss of your license or certification, by itself, does not mean you are disabled.

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Qualifications and Deviations

• Symetra reserves the right to review and evaluate changes, deviations and qualifications that we have put forth in our proposal. The coverage being offered is predicated on all of the above information being accurate and correct to the best of the [employer's/prospective client's] knowledge and belief. If any of these conditions are not satisfied, we reserve the right to adjust pricing accordingly, withdraw this proposal from consideration or rescind coverage.

Qualifications:

• This quote assumes a situs state of TX and an SIC of 9111

• Any policy sold and issued in the State of New York is insured and underwritten by First Symetra National Life

Insurance Company of New York, a New York-licensed insurer.

Any policy sold and issued in any state other than the State of New York is insured and underwritten by Symetra

Life Insurance Company, an Iowa-domiciled insurer that is licensed in all states except New York.

• All rates assume a non-participating financial arrangement. Symetra reserves the right to revise the quote if the data provided is not accurate or if the lives or volume change by +/- 10% after initial enrollment.

• Unless otherwise stated, this quote assumes all eligible employees are residents in the United States Citizens and on the U.S. payroll.

• This quote assumes that the employees benefit plan will be governed by ERISA.

• Grace period is 31 days unless regulated by state law.

• By signing the accompanying Application for Group Insurance and providing a binder payment of one month of premium, the applicant accepts the issuance of a group policy according to the terms of this proposal.

• Policies and certificates of insurance will be delivered electronically as PDF attachments. A fee may apply for printing and delivery of paper certificates if requested. You may not modify the electronic certificates in any way, and are responsible for providing current versions of certificates, including amendments, to certificate holders.

• Quote assumes premium billing will be on a self-administered basis.

• Quote excludes temporary, part time and seasonal employees.

• Coverage is subject to exclusions and limitations.

• If applicable law in the state of policy issuance changes, then any provision of this policy which conflicts with the such law will be construed to comply with such law.

• We reserve the right to reprice if any taxes are changed.

• It is Symetra’s intent to match the requested benefits. However, Symetra’s standard policy provisions will apply as our policy is filed and approved in the state where the policy will be issued. If there are employees located in other states, Symetra will need to comply with any extraterritorial requirements of those other states. Some states may require Symetra to file its policy language and may require us to make modifications for the residents of that state.

• A copy of the prior policy must be submitted at the time the case is sold

• A copy of a current billing statement to verify covered lives and volumes is required at time of sale.

• This proposal is not intended as a contract. Policy provisions, exclusions and limitations will be subject to

Symetra Life Insurance Company or First Symetra National Life Insurance Company of New York standard provisions. If there is any conflict between this proposal and a subsequently issued group policy, the policy will prevail. The limitations and exclusions of any policy issued will comply with state insurance laws and regulations as applicable. The agent/broker does not have authority to bind or modify the terms of this offer without prior written approval from Symetra Life Insurance Company of First Symetra national Life Insurance Company of New

York.

• Quote is based on the census presented and actual cost will be based on the data submitted at sold case time.

Should there be any changes in the original data quoted - number of lives, class occupations, salaries, or other pertinent facts - the case will be subject to new underwriting to determine acceptability of the group, the policy provisions and the rate may be changed.

• This offer expires if not accepted within 31 days of the proposed policy effective date.

• The proposal is subject to the approval of the company's board of directors, or a committee thereof, of the related party transaction, if any, that would result from issuance of the policy.

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• A final sold case census is required at time of sale. Census must include lives, classes, and volume by coverage line, and work or home address.

• A copy of a current billing statement to verify the number of covered lives and volumes is required at time of sale.

• By signing the accompanying Application for Group Insurance, the applicant accepts the issuance of a group policy according to the terms of this proposal.

• Rates do not include third party administrator (TPA) or general agent (GA) fees or commissions. The rates will be increased to reflect any additional fees or commissions payable by Symetra other than those noted in this proposal.

• Additional Experience, Billing and/or loss units exceeding Symetra’s standard may be subject to charges.

• This quote is conditional on satisfying Symetra’s concentration of risk requirements. Please provide a list of locations with 500 or more lives, outlining the address and number of lives at the location. Terms of quote are subject to change based on Symetra’s evaluation of concentration of risk information received.

Life Qualifications:

• Proposed rates are contingent on writing all lines including Basic Life, Basic AD&D, and Supplemental Life and

AD&D coverages as a package.

• Symetra requires a list of all employees eligible for life insurance not actively at work. Symetra must review and approve this list before binding coverage.

• Our proposal assumes that we are not grandfathering any employees outside of the plan design. Any employees that have coverage that does not meet our plan design will have their coverage decrease to the closest amount that meets our quoted plans.

• One Time Modified Open Enrollment: Modified Open Enrollments assume coverage can be increased by 5 increment levels without submitting Evidence of Insurability, subject to the Guarantee Issue Limit, during a scheduled annual enrollment period.

Long Term Disability Qualifications:

• Rates assume participation and integration with Social Security, Workers’ Compensation Insurance, Statutory

Disability Plans and any salary continuation programs, if applicable.

• Evidence of insurability/proof of good health is required for applicants who apply for contributory/voluntary coverage more than 31 days after first becoming eligible.

• Employees must be actively at work to become eligible. This policy does not replace or affect requirements for coverage by Workers’ Compensation Insurance or State Disability Insurance.

• Coverage will continue while employees are on FMLA.

• LTD benefits will be reduced by other income amounts, including integration with Family Social Security benefits

• Traditional EOI Enrollment: Traditional EOI enrollments assume scheduled annual enrollment periods and standard Evidence of Insurability requirements will apply meaning EOI is required for all late entrants, increases in coverage and for amounts in excess of the guarantee issue.

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To learn more, visit www.symetra.com.

In New York, visit www.symetra.com/ny.

Symetra Life Insurance Company and First Symetra National Life Insurance Company of New York (collectively, ‘Symetra’) are subsidiaries of Symetra Financial Corporation. Each company is responsible for its own financial obligations. Symetra Life Insurance Company and Symetra Financial Corporation do not solicit business in the state of New York and are not authorized to do so.

Group benefits are insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004.

In New York, group benefits are insured by First Symetra National Life Insurance Company of New York, New York, NY. Mailing address: P.O. Box 34690, Seattle, WA 98124.

Symetra® is a registered service mark of

Symetra Life Insurance Company.

Product availability may vary by state and products are not available in any U.S. territory.

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