ESBD_398114_1740251753055_City of Waco RFP Marketing and Questionnaire.xlsx

Front Cover Request for Proposal #

* Life & AD&D

* Supplemental Life & AD&D

* LTD

*STD

City of Waco

Prepared by: Lockton Companies

Questionnaire

QUESTIONNAIRE

If requested or required, affirm that you are amenable to single case filing.

Life/AD&D: y/n STD: y/n LTD: y/n

What is the minimum participation requirement for the Long Term Disability?

Life Plan Design

Commissions, Bonuses, Overtime pay, any other extra compensation will be averaged for the lesser of:

a. the 12 full calendar month period of Your employment with Your Employer just prior to the date of Loss, or

b. the period of actual employment with Your Employer Basic Life Benefit 1x AnnualEarnings to a maximum of $50,000 rounded to the next higher $1,000, but not less $10,000 prior to any applied reductions

*On the day you are retired by the Employer, your amount of insurance is limited to $2,500

Minimum Covered Life Insurance Amount: $15,000 Maximum ADB Payment: $500,000 Minimum ADB Payment: $7,500

Amounts from $10,000 to $20,000 in increments of $10,000: age 6 months to 26 years

Minimum Covered Life Insurance Amount: $15,000 Maximum ADB Payment: $500,000 Minimum ADB Payment: $7,500

Retiree Life

Class 3: All Eligible Retirees Basic Life Benefit Class 2: Amounts currently on file Class 3: $2,500 Age Reduction Class 2: Basic Group Term Life benefits reduce to $2,500 of the original amount at age 70 Class 3: None

Class 4: Closed Class - All Eligible Retirees with Grandfathered $3,500 Voluntary Life Plan Supplemental Life Benefit - Employee Class 3: $5,000 Class 4: $3,500 Guarantee Issue Amount - Employee Class 3: $5,000 Class 4: Benefit amounts may be subject to Guarantee Issue limits based on participation levels as determind by Us. Any Guaranteed Issue Limits established are only available during Your group's initial enrollment and for new employees who have met the Eligibility requirements. Employees must enroll within 31 days of their eligibility date to qualify for any established Guarantee Issue.

ADD Plan Design (2)

Commissions, Bonuses, Overtime pay, any other extra compensation will be averaged for the lesser of:

a. the 12 full calendar month period of Your employment with Your Employer just prior to the date of Loss, or

b. the period of actual employment with Your Employer Basic AD&D Benefit 1x AnnualEarnings to a maximum of $50,000 rounded to the next higher $1,000, but not less $10,000 prior to any applied reductions

*On the day you are retired by the Employer, your amount of insurance is limited to $2,500

Miles Limitation: at least 75 miles

If the required certification is not available and if it is unclear whether You were properly wearing a Seat Belt, then We will pay an additional benefit of $1,000.

Dissapearance: 100% Child Care Benefit (Birth - 13 years) For each child Benefit Amount: 1% of Employee Coverage Amount to a maximum of $2,000 per year Maximum Benefit Duration: 4 Years We will pay this benefit once a year, at the end of a 12-month period in which there are documented Day Care Center expenses, for not more the Maximum Day Care Benefit Duration, as set forth in the Schedule of Benefits, or until the child's 13th birthday, whichever happens first. If at the time of the Accident, coverage for a Dependent Child is in force, but there is no Dependent child who qualifies, we will pay an additional benefit of $1,500 to Your designated beneficiary.

Child Education Benefit Benefit Amount: 3% of Employee Coverage Amount, to a maximum of $3,000 per year Maximum Benefit Duration: Benefit payable for a maximum of 4 Years Eligible Dependents: Age live birth to age 25 years Special Child Education Benefit: We will pay a Child Education Benefit in the amount of $1,000 Spouse Education Benefit Benefit Amount: $2,500 The benefit is paid annually for the cost of covered expenses incurred within 36 months of Your death.

Amounts from $10,000 to $20,000 in increments of $10,000: age 6 months to 26 years Supplemental AD&D Benefit - Employee Only Employee Only:

Option 1: 1x annual salary to a maximum of $100,000 rounded to the next higher $1,000 but not less than $10,000 prior to any applied reductions.

Option 2: 2x annual salary to a maximum of $200,000 rounded to the next higher $1,000 but not less than $10,000 prior to any applied reductions.

Option 3: Incremental selection from $10,000 to $300,000 in increments of $10,000 rounded to the next higher $1,000 but not less than $10,000 prior to any applied reductions Supplemental AD&D Benefit - Family Plan Family Plan:

Option 1: 1x annual salary to a maximum of $100,000 rounded to the next higher $1,000 but not less than $10,000 prior to any applied reductions.

Option 2: 2x annual salary to a maximum of $200,000 rounded to the next higher $1,000 but not less than $10,000 prior to any applied reductions.

Option 3: Incremental selection from $10,000 to $300,000 in increments of $10,000 rounded to the next higher $1,000 but not less than $10,000 prior to any applied reductions.

Spouse Only: 100% Spouse w/Children: 100% Child Only: 10% Child w/Spouse: 10% Age Reduction 35% at age 70 60% at age 75 75% at age 80 85% at age 85 90% at age 90

Dissapearance: 100%

STD Plan Design

Commissions, Bonuses, Overtime pay or any other extra compensation will be averaged for the lesser of:

a. the 12 full calendar month period of Your employment with Your Employer just prior to the date Disability begins; or

b. the period of actual employment with Your Employer

Total Disability: means that due to Injury or Sickness the employee is unable to perform all of the material and substantial duties of the employee's regular occupation, and the emplouee's disability earnings, if any, are than the percentage (20%) of the employee's pre-disability weekly earnings.

LTD Plan Design

Commissions, Bonuses, Overtime pay or any other extra compensation will be averaged for the lesser of:

a. the 12 full calendar month period of Your employment with Your Employer just prior to the date Disability begins; or

b. the period of actual employment with Your Employer

Day Care Expense Benefit: Day Care Expenses mean monthly expenses, up to $350 per child per month, to a maximum total benefit of $1,000.00 per month Rehabilitation: The Rehabilitation Benefit pays 5% of Your Gross LTD Monthly Benefit to a maximum of $500 per month subject to the maximum Monthly Benefit as shown in the Schedule of Benefits Worksite Modification Benefit: When this occurs, We will reimburse the Policyholder for the cost of the modification, up to the greater of $1,500 or 2 times Your Last Monthly Benefit Rehabilitation Incentive Income (RII): 12 months Day Care Expense Benefit: to $350 per child per month, to a maximum total benefit of $1,000.00 per month Vocational Rehabilitation Service:

Rehabilitation services are available when We determine that these services are reasonably required to assist in returning You to Gainful Employment. Vocational rehabilitation services might include but are not limited to one or more of the following:

1. job modification;

2. job retraining;

3. job placement;

4. other activities This document is intended to merely highlight or summarize certain aspects of the employer’s benefit program(s). It is not a summary plan description (SPD) or an official plan document. Your rights and obligations under the program(s) are set forth in the official plan documents. All statements in this summary are subject to the terms of the official plan documents, as interpreted by the appropriate plan fiduciary. In the case of an ambiguity or outright conflict between a provision in this summary and a provision in the plan documents, the terms of the plan documents control. The employer reserves the right to review, change, or terminate the plan, or any benefits under it, for any reason, at any time and without advance notice to any person.

Basic Life_AD&D Rates

Notes:

Commissions

Retiree Life Rates

Notes:

Commissions

Active Retiree Supplemental Lif

Supp Life_AD&D Rates

STD Rates

LTD Rates