ESBD_503812_1775238469041_LIFE 1 1 Basic Life.pdf

Basic Dependent Life, Basic Term Life

YOUR

BENEFIT

PLAN

Printed in U.S.A TX v.4

Have a complaint or need help?

If you have a problem with a claim or your premium, call your insurance company first. If you can't work out the issue, the Texas Department of Insurance may be able to help.

Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company. If you don't, you may lose your right to appeal.

Hartford Life and Accident Insurance Company To get information or file a complaint with your insurance company:

Call: Customer Service at 860-547-5000

Toll-free: 1-800-523-2233

Online: https://www.thehartford.com/contact-the-hartford Email: GBD.Customerservice@hartfordlife.com Mail: The Hartford, Group Benefits Division, P.O. Box 2999, Hartford, CT 06104-2999

The Texas Department of Insurance To get help with an insurance question or file a complaint with the state:

Call with a question: 1-800-252-3439

File a complaint: www.tdi.texas.gov Email: ConsumerProtection@tdi.texas.gov Mail: MC 111-1A, P.O. Box 12030, Austin, TX 78711-2030

¿Tiene una queja o necesita ayuda?

Si tiene un problema con una reclamación o con su prima de seguro, llame primero a su compañía de seguros. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar.

Aun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una queja a través del proceso de quejas o de apelaciones de su compañía de seguros. Si no lo hace, podría perder su derecho para apelar.

Hartford Life and Accident Insurance Company Para obtener información o para presentar una queja ante su compañía de seguros:

Llame a: servicio al cliente al 860-547-5000

Teléfono gratuito: 1-800-523-2233

En línea: https://www.thehartford.com/contact-the-hartford Correo electrónico: GBD.Customerservice@hartfordlife.com Dirección postal: The Hartford, Group Benefits Division, P.O. Box 2999, Hartford, CT 06104-2999

El Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con los seguros o para presentar una queja ante el estado:

Llame con sus preguntas al: 1-800-252-3439

Presente una queja en: www.tdi.texas.gov Correo electrónico: ConsumerProtection@tdi.texas.gov Dirección postal: MC 111-1A, P.O. Box 12030, Austin, TX 78711-2030

Maryland

The group insurance policy providing coverage under this certificate was issued in a jurisdiction other than Maryland and may not provide all of the benefits required by Maryland law.

Version: May 2024

State Notices

IMPORTANT INFORMATION FOR RESIDENTS OF CERTAIN STATES: There are state-specific requirements that may change the provisions described in the group insurance certificate. If you live in a state that has such requirements, those requirements will apply to your coverage. State-specific requirements that may apply to your coverage are summarized below. In addition, updated state-specific requirements are published on our website.

You may access the website at www.thehartford.com. If you are unable to access this website, want to receive a printed copy of these requirements, or have any questions or complaints regarding any of these requirements or any aspect of your coverage, please contact your Employee Benefits Manager; or you may contact us as follows:

The Hartford Group Benefits Division, Customer Service P.O. Box 2999 Hartford, CT 06104-2999 1-800-523-2233 https://www.thehartford.com/

If you have a complaint and contacts between you, us, your agent, or another representative have failed to produce a satisfactory solution to the problem, some states require we provide you with additional contact information. If your state requires such disclosure, the contact information is listed below with the other state requirements and notices.

We are providing notice that Hartford Life and Accident Insurance Company is subject to economic and trade sanctions laws and regulations. These laws and regulations, including the laws and regulations administered and enforced by the United States Department of the Treasury’s Office of Foreign Assets Control (“OFAC”), prevent Hartford Life and Accident from providing coverage to, and from paying benefits to, entities and individuals where prohibited by applicable law. In addition, these laws and regulations prohibit certain activities with respect to certain countries.

We have included this information to make you aware of the existence and potential impact of these economic and trade sanctions programs on your benefit program.

The Hartford complies with applicable Federal civil rights laws and does not unlawfully discriminate on the basis of race, color, national origin, age, disability, or sex. The Hartford does not exclude or treat people differently for any reason prohibited by law with respect to their race, color, national origin, age, disability, or sex.

If your policy is governed under the laws of Maryland, any of the benefits, provisions or terms that apply to the state you reside in as shown below will apply only to the extent that such state requirements are more beneficial to you.

Alaska:

1. If notice of Your Conversion Right is not received by You on the date Your or Your Dependent’s coverage terminates, You have 15 days from the date You receive the notice.

2. The Policy Interpretation provision, if shown in the General Provisions section of the Certificate, is not applicable.

3. The Spouse definition will always include domestic partners, civil unions, and any other legal union recognized by state law.

Arizona:

1. NOTICE: The Certificate may not provide all benefits and protections provided by law in Arizona. Please read the Certificate carefully.

Arkansas:

1. NOTICE: You have the right to file a complaint with the Arkansas Insurance Department (AID). You may call AID to request a complaint form at (800) 852-5494 or (501) 371-2640 or write the Department at:

Arkansas Insurance Department 1 Commerce Way, Suite 102 Little Rock, AR 72202

California:

1. The Policy Interpretation provision, if shown in the General Provisions section of the Certificate, does not apply to you. The following requirement applies to you:

Eligibility Determination: How will We determine Your or Your Dependent’s eligibility for benefits?

We, and not Your Employer or plan administrator, have the responsibility to fairly, thoroughly, objectively and timely investigate, evaluate and determine Your or Your Dependent’s eligibility for benefits for any claim You or Your beneficiaries make on The Policy. We will:

1) obtain with Your or Your beneficiaries’ cooperation and authorization if required by law, only such information that is necessary to evaluate Your or Your beneficiaries’ claim and decide whether to accept or deny Your or Your beneficiaries’ claim for benefits. We may obtain this information from Your or Your beneficiaries’ Notice of Claim, submitted proofs of loss, statements, or other materials provided by You or others on Your behalf; or, at Our expense We may obtain necessary information, or have You or Your Dependent’s physically examined when and as often as We may reasonably require while the claim is pending. In addition, and at Your or Your beneficiaries’ option and at Your or Your beneficiaries’ expense, You or Your beneficiaries may provide Us and We will consider any other information, including but not limited to, reports from a Physician or other expert of Your or Your beneficiaries’ choice. You or Your beneficiaries should provide Us with all information that You or Your beneficiaries want Us to consider regarding Your or Your beneficiaries’ claim;

2) As part of Our routine operations, We will apply the terms of The Policy for making decisions, including decisions on eligibility, receipt of benefits and claims or explaining policies, procedures and processes;

3) if We approve Your claim, We will review Our decision to approve Your or Your beneficiaries claim for benefits as often as is reasonably necessary to determine Your or Your Dependent’s continued eligibility for benefits;

4) if We deny Your or Your beneficiaries’ claim, We will explain in writing to You or Your beneficiaries the basis for an adverse determination in accordance with The Policy as described in the provision entitled Claim Denial.

In the event We deny Your or Your beneficiaries’ claim for benefits, in whole or in part, You or Your beneficiaries can appeal the decision to Us. If You or Your beneficiaries choose to appeal Our decision, the process You or Your beneficiaries must follow is set forth in The Policy provision entitled Claim Appeal. If You or Your beneficiaries do not appeal the decision to Us, then the decision will be Our final decision.

2. For Your Questions and Complaints:

State of California Insurance Department Consumer Communications Bureau 300 South Spring Street, South Tower Los Angeles, CA 90013 Toll Free: 1(800) 927-HELP TDD Number: 1(800) 482-4833 Web Address: www.insurance.ca.gov

Colorado:

1. The Suicide provision will only exclude amounts of life insurance in effect within the first year of coverage or within the first year following an increase in coverage.

2. The Dependent Child(ren) definition will always include children related to You by civil union.

3. The Spouse definition will always include civil unions.

4. Entering a civil union, terminating a civil union, the death of a party to a civil union or a party to a civil union losing employment, which results in a loss of group insurance, will all constitute as a Change in Family Status.

5. The Claim Appeal provision will always include the following:

In addition, if a claim for benefits is wholly or partially denied and all administrative remedies have been exhausted, You are entitled to pursue such claim anew, from the beginning, in a court with jurisdiction and entitled to a trial by jury.

Florida:

1. Legal Actions cannot be taken against Us more than 5 years after the date Proof of Loss is required to be furnished according to the terms of The Policy.

2. NOTICE: The benefits of the policy providing you coverage may be governed primarily by the laws of a state other than Florida.

Georgia:

1. NOTICE: The laws of the state of Georgia prohibit insurers from unfairly discriminating against any person based upon his or her status as a victim of family abuse.

Idaho:

1. For Your Questions and Complaints:

Idaho Department of Insurance Consumer Affairs 700 W State Street, 3rd Floor PO Box 83720 Boise, ID 83720-0043 Toll Free: 1-800-721-3272 Web Address: www.DOI.Idaho.gov

Illinois:

1. For Your Questions and Complaints:

Illinois Department of Insurance Consumer Services Station Springfield, Illinois 62767 Consumer Assistance: 1(866) 445-5364 Officer of Consumer Health Insurance: 1(877) 527-9431 Web Address: http://insurance.illinois.gov/

2. In accordance with Illinois law, insurers are required to provide the following NOTICE to applicants of insurance policies issued in Illinois.

STATE OF ILLINOIS

The Religious Freedom Protection and Civil Union Act

Effective June 1, 2011

The Religious Freedom Protection and Civil Union Act (“the Act”) creates a legal relationship between two persons of the same or opposite sex who form a civil union. The Act provides that the parties to a civil union are entitled to the same legal obligations, responsibilities, protections and benefits that are afforded or recognized by the laws of Illinois to spouses. The law further provides that a party to a civil union shall be included in any definition or use of the terms “spouse,” “family,” “immediate family,” “dependent,” “next of kin,” and other terms descriptive of spousal relationships as those terms are used throughout Illinois law. This includes the terms “marriage” or “married,” or variations thereon. Insurance policies are required to provide identical benefits and protections to both civil unions and marriages. If policies of insurance provide coverage for children, the children of civil unions must also be provided coverage. The Act also requires recognition of civil unions or same sex civil unions or marriages legally entered into in other jurisdictions.

For more information regarding the Act, refer to 750 ILCS 75/1 et seq. Examples of the interaction between the Act and existing law can be found in the Illinois Insurance Facts, Civil Unions and Insurance Benefits document available on the Illinois Department of Insurance’s website at http://insurance.illinois.gov/.

Indiana:

1. For Your Questions and Complaints:

Public Information/Market Conduct Indiana Department of Insurance 311 W. Washington St. Suite 300 Indianapolis, IN 46204-2787 1(317) 232-2395

Louisiana:

1. The age limit stated in the Continuation for Dependent Child(ren) with Disabilities provision is increased to 21, if less than 21.

2. The following requirement applies to you:

Reinstatement after Military Service: Can coverage be reinstated after return from active military service?

If Your or Your Dependents’ coverage ends because You or Your Dependents enter active military service, coverage may be reinstated, provided You request such reinstatement upon Your or Your Dependents’ release from active military service.

The reinstated coverage will:

1) be the same coverage amounts in force on the date coverage ended;

2) not be subject to any Eligibility Waiting Period for Coverage or Evidence of Insurability; and

3) be subject to all the terms and provisions of The Policy.

Maine:

1. NOTICE: The laws of the State of Maine require notification of the right to designate a third party to receive notice of cancellation, to change such a designation and, to have the Policy reinstated if the insured suffers from cognitive impairment or functional incapacity and the ground for cancellation was the insured's nonpayment of premium or other lapse or default on the part of the insured.

Within 10 days after a request by an insured, a Third Party Notice Request Form shall be mailed or personally delivered to the insured.

Massachusetts:

1. The definition of Terminal Illness or Terminally Ill shown in the Accelerated Benefit cannot exceed 24 months.

2. NOTICE: As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL or visit the Connector website (www.mahealthconnector.org).

This plan is not intended to provide comprehensive health care coverage and does not meet Minimum Creditable Coverage standards, even if it does include services that are not available in the insured’s other health plans.

If you have questions about this notice, you may contact the Division of Insurance by calling (617) 521- 7794 or visiting its website at www.mass.gov/doi.

Michigan:

1. The Policy Interpretation provision, if shown in the General Provisions section of the Certificate, is not applicable.

Minnesota:

1. You or Your Dependents must be on a documented military leave of absence in order to qualify for the Military

Leave of Absence continuation shown in the Continuation Provisions.

2. If there are 25 or more residents of Minnesota who are covered under The Policy, or there are fewer than 25 residents and those residents constitute 25% or more of the total number of people covered under The Policy, the Lay Off continuation shown in the Continuation Provisions shall not apply to you. The following requirement applies to you:

Minnesota Coverage Continuation: If You are voluntarily or involuntarily terminated or Laid Off by the Employer, You may elect to continue Your Life Insurance coverage (including Dependent Life coverage) by making premium payments to the Employer for the cost of continued coverage. Continued coverage will take effect on the date Your coverage would otherwise have ended and must be elected within 60 days from:

1) the date Your coverage would otherwise terminate; or

2) the date You receive a written notice of Your right to continue coverage from the Employer;

whichever is later.

The amount of premium charged may not exceed 102% of the premium paid for other similarly situated employees who are Actively at Work. The Employer will inform You of:

1) Your right to continue coverage;

2) the amount of premium; and

3) how, where and by when payment must be made.

Upon request, the Employer will provide You Our written verification of the cost of coverage.

Coverage will be continued until the earliest of:

1) the date You are covered under another group policy;

2) the date the required premium is due but not paid; or

3) the last day of the 18th month following the date of termination or Lay Off.

Upon the termination of continued coverage, You may:

1) exercise Your Conversion Right; or

2) continue coverage under a group Portability policy; and

3) qualify for Retiree coverage.

Minnesota law requires that if Your coverage ends because the Employer fails to notify You of Your right to continue coverage or fails to pay the premium after timely receipt, the Employer will be liable for benefit payments to the extent We would have been liable had You still been covered.

3. If the following paragraph appears in the Accelerated Benefit provision, it does not apply to you:

In the event:

1) You are required by law to accelerate benefits to meet the claims of creditors; or

2) if a government agency requires You to apply for benefits to qualify for a government benefit or entitlement;

You will still be required to satisfy all the terms and conditions herein in order to receive an Accelerated Benefit

4. If there are 25 or more residents of Minnesota who are covered under The Policy and those 25 residents constitute 25% or more of the total number of people covered under The Policy, You are not required to be insured under The Policy for a specified period of time in order to exercise the Conversion Right.

Missouri:

1. The period in which You must remain Disabled to qualify for Waiver of Premium cannot exceed 180 days.

2. If Waiver of Premium is approved and You have completed the elimination period, We will retroactively refund to

You, or to Your estate if You have died, any premiums paid during the period You have been continuously Disabled.

3. The Suicide provision will only exclude amounts of life insurance in effect within the first year of coverage or within the first year following an increase in coverage.

Montana:

1. The time period in which You are required to be insured under The Policy in order to exercise the Conversion

Right cannot exceed 3 years.

2. If You are eligible to receive the Felonious Assault Benefit, We will not exclude for losses that result from a

Felonious Assault committed by a member of Your family or a member of the household in which You live.

3. NOTICE: Conformity with Montana statutes: The provisions of the certificate conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which the insured resides on or after the effective date of the certificate.

New Hampshire:

1. Your Spouse may be eligible to continue his or her Life Insurance coverage in the event of divorce or separation as shown in the Spouse Continuation below:

Spouse Continuation: Can coverage for my Spouse be continued in the event of divorce or separation?

If:

1) You are a resident of New Hampshire;

2) You get a divorce or legal separation from a Spouse that is covered under The Policy; and

3) the final decree of divorce or legal separation does not expressly prohibit it;

Your former Spouse may continue his or her coverage.

We must receive Your Spouse's written request and the required premium to continue his or her coverage within 30 days of the final decree of divorce or legal separation.

Solely for the purpose of continuing the coverage, Your Spouse will be considered the insured person. However, Your former Spouse’s coverage will not continue beyond the earliest of:

1) the 3-year anniversary of the final decree of divorce or legal separation;

2) the remarriage of the former Spouse;

3) Your death;

4) an earlier time as provided by the final decree of divorce or legal separation; or

5) a date the coverage would otherwise have ended under the Dependent Termination Provision.

New Mexico:

1. For Your Questions and Complaints:

Office of Superintendent of Insurance Consumer Assistance Bureau

P.O. Box 1689 Santa Fe, NM 87504-1689 1(855) 427-5674

New York:

1. If the definition of Spouse requires the completion of a domestic partner affidavit, the requirement applies to you:

The domestic partner affidavit must be notarized and requires that You and Your domestic partner meet all of the following criteria:

1) you are both legally and mentally competent to consent to contract in the state in which you reside;

2) you are not related by blood in a manner that would bar marriage under laws of the state in which you reside;

3) you have been living together on a continuous basis prior to the date of the application;

4) neither of you have been registered as a member of another domestic partnership within the last six months; and

5) you provide proof of cohabitation (e.g., a driver’s license, tax return or other sufficient proof).

The domestic partner affidavit further requires that You and Your domestic partner provide proof of financial interdependence in the form of at least two of the following:

1) a joint bank account;

2) a joint credit card or charge card;

3) joint obligation on a loan;

4) status as an authorized signatory on the partner’s bank account, credit card or charge card;

5) joint ownership of holdings or investments, residence, real estate other than residence, major items of personal property (e.g., appliances, furniture), or a motor vehicle;

6) listing of both partners as tenants on the lease of the shared residence;

7) shared rental payments of residence (need not be shared 50/50)

8) listing of both partners as tenants on a lease, or shared rental payments, for property other than residence;

9) a common household and shared household expenses (e.g., grocery bills, utility bills, telephone bills, etc.

and need not be shared 50/50);

10) shared household budget for purposes of receiving government benefits;

11) status of one as representative payee for the other’s government benefits;

12) joint responsibility for child care (e.g., school documents, guardianship);

13) shared child-care expenses (e.g., babysitting, day care, school bills, etc. and need not be shared 50/50);

14) execution of wills naming each other as executor and/or beneficiary;

15) designation as beneficiary under the other’s life insurance policy;

16) designation as beneficiary under the other’s retirement benefits account;

17) mutual grant of durable power of attorney;

18) mutual grant of authority to make health care decisions (e.g., health care power of attorney);

19) affidavit by creditor or other individual able to testify to partners’ financial interdependence;

20) other item(s) of proof sufficient to establish economic interdependency under the circumstances of the particular case.

North Carolina:

1. NOTICE: UNDER NORTH CAROLINA GENERAL STATUTE SECTION 58-50-40, NO PERSON,

EMPLOYER, FINANCIAL AGENT, TRUSTEE, OR THIRD PARTY ADMINISTRATOR, WHO IS RESPONSIBLE

FOR THE PAYMENT OF GROUP LIFE INSURANCE, GROUP HEALTH OR GROUP HEALTH PLAN

PREMIUMS, SHALL:

1) CAUSE THE CANCELLATION OR NONRENEWAL OF GROUP LIFE INSURANCE, GROUP HEALTH

INSURANCE, HOSPITAL, MEDICAL, OR DENTAL SERVICE CORPORATION PLAN, MULTIPLE

EMPLOYER WELFARE ARRANGEMENT, OR GROUP HEALTH PLAN COVERAGES AND THE

CONSEQUENTIAL LOSS OF THE COVERAGES OF THE PERSON INSURED, BY WILLFULLY FAILING

TO PAY THOSE PREMIUMS IN ACCORDANCE WITH THE TERMS OF THE INSURANCE OR PLAN

CONTRACT; AND

2) WILLFULLY FAIL TO DELIVER, AT LEAST 45 DAYS BEFORE THE TERMINATION OF THOSE

COVERAGES, TO ALL PERSONS COVERED BY THE GROUP POLICY WRITTEN NOTICE OF THE

PERSON'S INTENTION TO STOP PAYMENT OF PREMIUMS. VIOLATION OF THIS LAW IS A

FELONY. ANY PERSON VIOLATING THIS LAW IS ALSO SUBJECT TO A COURT ORDER

REQUIRING THE PERSON TO COMPENSATE PERSONS INSURED FOR EXPENSES OR LOSSES

INCURRED AS A RESULT OF THE TERMINATION OF THE INSURANCE.

IMPORTANT TERMINATION INFORMATION

YOUR INSURANCE MAY BE CANCELLED BY THE COMPANY. PLEASE READ THE TERMINATION

PROVISION IN THE CERTIFICATE.

THE CERTIFICATE OF INSURANCE PROVIDES COVERAGE UNDER A GROUP MASTER POLICY.

THE CERTIFICATE PROVIDES ALL OF THE BENEFITS MANDATED BY THE NORTH CAROLINA

INSURANCE CODE, BUT YOU MAY NOT RECEIVE ALL OF THE PROTECTIONS PROVIDED BY A POLICY

ISSUED IN NORTH CAROLINA AND GOVERNED BY ALL OF THE LAWS OF NORTH CAROLINA.

North Dakota:

1. The Suicide provision will only exclude amounts of life insurance in effect within the first year of coverage or within the first year following an increase in coverage.

Ohio:

1. Any references to the Accelerated Benefit shall be changed to the Accelerated Death Benefit.

Oregon:

1. The Spouse definition will include Your domestic partner provided You have registered as domestic partners with a government agency or office where such registration is available. You will not be required to provide proof of such registration.

2. The Dependent Child(ren) definition will include children related to You by domestic partnership.

3. The following Jury Duty continuation applies for Employers with 10 or more employees:

Jury Duty: If You are scheduled to serve or are required to serve as a juror, Your coverage may be continued until the last day of Your Jury Duty, provided You:

1) elected to have Your coverage continued; and

2) provided notice of the election to Your Employer in accordance with Your Employer’s notification policy.

Rhode Island:

1. The Policy Interpretation provision, if shown in the General Provisions section of the Certificate, is not applicable.

South Carolina:

1. The dollar amount stated in the third paragraph of the Claims to be Paid provision is changed to $2,000, if greater than $2,000.

2. If the Continuity from a Prior Policy for Disability Extension provision is included in the Certificate and You qualify for continued coverage, Your Amount of Insurance will be the greater of the amount of life insurance and accidental death and dismemberment principal sum that You had under the Prior Policy or the amount shown in the Schedule of Insurance. This Amount of Insurance will be reduced by any coverage amount that is in force, paid or payable under the Prior Policy or that would have been payable under the Prior Policy had timely election been made.

3. If The Policy Terminates or Your Employer ceases to be a Participating Employer and You have been approved for the Waiver of Premium, Your coverage under the terms of this provision will not be affected. Your Dependent coverage will continue for a period of 12 months from the date of Policy termination and will be subject to the terms and conditions of The Policy.

4. If The Policy Terminates or Your Employer ceases to be a Participating Employer and You have been approved for the Disability Extension, Your and Your Dependent’s coverage will be continued for a period of up to 12 months from the date The Policy terminated or Your Employer ceased to be a Participating Employer, as long as premiums are paid when due. Coverage during this period will be subject to the other terms and conditions of the Disability Extension Ceases provision. When this extension period is exhausted, You may be eligible to exercise the Conversion Right for You and Your Dependent’s coverage. Portability Benefits will not be available

South Dakota:

1. The definition of Physician can include You or a person Related to You by blood or marriage in the event that the

Physician is the only one in the area and is acting within the scope of their normal employment.

Texas:

1. The Policy Interpretation provision, if shown in the General Provisions section of the Certificate, is not applicable.

2. NOTICE:

Have a complaint or need help?

If you have a problem with a claim or your premium, call your insurance company first. If you can't work out the issue, the Texas Department of Insurance may be able to help.

Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company. If you don't, you may lose your right to appeal.

Hartford Life and Accident Insurance Company To get information or file a complaint with your insurance company:

Call: Customer Service at 860-547-5000

Toll-free: 1-800-523-2233

Online: https://www.thehartford.com/contact-the-hartford Email: GBD.Customerservice@hartfordlife.com Mail: The Hartford, Group Benefits Division, P.O. Box 2999, Hartford, CT 06104-2999

The Texas Department of Insurance To get help with an insurance question or file a complaint with the state:

Call with a question: 1-800-252-3439

File a complaint: www.tdi.texas.gov Email: ConsumerProtection@tdi.texas.gov Mail: MC 111-1A, P.O. Box 12030, Austin, TX 78711-2030

¿Tiene una queja o necesita ayuda?

Si tiene un problema con una reclamación o con su prima de seguro, llame primero a su compañía de seguros. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar.

Aun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una queja a través del proceso de quejas o de apelaciones de su compañía de seguros. Si no lo hace, podría perder su derecho para apelar.

Hartford Life and Accident Insurance Company Para obtener información o para presentar una queja ante su compañía de seguros:

Llame a: servicio al cliente al 860-547-5000

Teléfono gratuito: 1-800-523-2233

En línea: https://www.thehartford.com/contact-the-hartford Correo electrónico: GBD.Customerservice@hartfordlife.com Dirección postal: The Hartford, Group Benefits Division, P.O. Box 2999, Hartford, CT 06104-2999

El Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con los seguros o para presentar una queja ante el estado:

Llame con sus preguntas al: 1-800-252-3439

Presente una queja en: www.tdi.texas.gov Correo electrónico: ConsumerProtection@tdi.texas.gov Dirección postal: MC 111-1A, P.O. Box 12030, Austin, TX 78711-2030

Utah:

1. We will send Claim Forms within 15 days of receiving a Notice of Claim. If We do not send the forms within 15 days, any other written proof which fully describes the nature and extent of the claim may be submitted.

2. If the Sending Proof of Loss provision provides a timeframe in which proof must be submitted before it affects

Your claim, this time limitation shall not apply to You.

3. When We determine that benefits are payable, We will make Claim Payments within no more than 45 days after

Proof of Loss is received.

4. Any reference to fraud within the Incontestability provision does not apply to You.

5. A Sickness or Injury continuation of at least 6 months must be included in the Continuation Provisions.

Vermont:

1. The following requirement applies:

Purpose: This requirement is intended to provide benefits for parties to a civil union. Vermont law requires that insurance contracts and policies offered to married persons and their families be made available to parties to a civil union and their families. In order to receive benefits in accordance with this requirement, the civil union must have been established in the state of Vermont according to Vermont law.

General Definitions, Terms, Conditions and Provisions: The general definitions, terms, conditions or any other provisions of the policy, contract, certificate and/or riders and endorsements are hereby superseded as follows:

1) Terms that mean or refer to a marital relationship or that may be construed to mean or refer to a marital relationship: such as "marriage", "spouse", "husband", "wife", "dependent", "next of kin", "relative", "beneficiary", "survivor", "immediate family" and any other such terms include the relationship created by a civil union.

2) Terms that mean or refer to a family relationship arising from a marriage such as "family", "immediate family", "dependent", "children", "next of kin", "relative", "beneficiary", "survivor" and any other such terms include the family relationship created by a civil union.

3) Terms that mean or refer to the inception or dissolution of a marriage, such as "date of marriage", "divorce decree", "termination of marriage" and any other such terms include the inception or dissolution of a civil union.

4) "Dependent" means a spouse, a party to a civil union, and/or a child or children (natural, stepchild, legally adopted or a minor who is dependent on the insured for support and maintenance) who is born to or brought to a marriage or to a civil union.

5) "Child or covered child" means a child (natural, step-child, legally adopted or a minor who is dependent on the insured for support and maintenance) who is born to or brought to a marriage or to a civil union.

Cautionary Disclosure: THIS NOTICE IS ISSUED TO MEET THE REQUIREMENTS OF VERMONT LAW AS

EXPLAINED IN THE "PURPOSE" PARAGRAPH OF THE NOTICE. THE FEDERAL GOVERNMENT OR

ANOTHER STATE GOVERNMENT MAY NOT RECOGNIZE THE BENEFITS GRANTED UNDER THIS

NOTICE. YOU ARE ADVISED TO SEEK EXPERT ADVICE TO DETERMINE YOUR RIGHTS UNDER THIS

CONTRACT

2. Interest on a Claim Payment is payable from the date of death until the date payment is made at an interest rate of 6% annually or Our corporate interest rate, whichever is greater.

Virginia:

1. For Your Questions and Complaints:

State Corporation Commission Life and Health Division Bureau of Insurance P.O. Box 1157 Richmond, VA 23218 1(804) 371-9691 (inside Virginia) 1(877) 310-6560 (outside Virginia)

Washington:

1. The following Disputed Diagnosis requirement applies to You:

Disputed Diagnosis: What happens if a dispute occurs over whether I am Terminally Ill or my Dependent is Terminally Ill?

If Your or Your Dependent's attending Physician, and a Physician appointed by Us, disagree on whether You or Your Dependent are Terminally Ill, Our Physician’s opinion will not be binding upon You or Your Dependent. The two parties shall attempt to resolve the matter promptly and amicably. If the disagreement is not resolved, You or Your Dependent have the right to mediation or binding arbitration conducted by a disinterested third party who has no ongoing relationship with either You or Your Dependent or Us. Any such arbitration shall be conducted in accordance with the laws of the State of Washington. As part of the final decision, the arbitrator or mediator shall award the costs of the arbitrator to one party or the other, or may divide the costs equally or otherwise.

2. A Labor Dispute continuation of at least 6 months must be included in the Continuations Provisions.

3. The Dependent Child(ren) definition will always include children related to You by domestic partnership.

4. The definition of Spouse will always include domestic partners.

5. The provision titled Suicide does not apply to you.

Wisconsin:

1. For Your Questions and Complaints:

To request a Complaint Form:

Office of the Commissioner of Insurance Complaints Department P.O. Box 7873 Madison, WI 53707-7873 1(800) 236-8517 (outside of Madison) 1(608) 266-0103 (in Madison)

Form GBD-1100 (10/08) GOV (Rev-1) (TX) (681794) 1.28

Group Term Life Insurance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY

One Hartford Plaza

Hartford, Connecticut 06155 (A stock insurance company)

CERTIFICATE OF INSURANCE

Policyholder: The Texas A&M University System Policy Number: GL-681794 Policy Effective Date: September 1, 2020 Policy Anniversary Date: September 1, 2024

We have issued The Policy to the Policyholder. Our name, the Policyholder's name and the Policy Number are shown above. The provisions of The Policy, which are important to You, are summarized in this certificate consisting of this form and any additional forms which have been made a part of this certificate. This certificate replaces any other certificate We may have given to You earlier under The Policy. The Policy alone is the only contract under which payment will be made.

Any difference between The Policy and this certificate will be settled according to the provisions of The Policy on file with Us at Our home office. The Policy may be inspected at the office of the Policyholder.

Signed for the Company

A note on capitalization in this Certificate:

Capitalization of a term, not normally capitalized according to the rules of standard punctuation, indicates a word or phrase that is a defined term in The Policy or refers to a specific provision contained herein.

Insured: ___________________________________ Amount of Insurance:_________________________ Beneficiary:_________________________________ Certificate Number:___________________________

Form GBD-1100 (10/08) GOV (Rev-1) (TX) (681794) 1.28

Death benefits will be reduced if an Accelerated Benefit is paid.

DISCLOSURE: The acceleration-of-life insurance benefits offered under this certificate may or may not qualify for favorable tax treatment under the Internal Revenue Code. Whether such benefits qualify depends on factors such as the Covered Person’s life expectancy at the time benefits are accelerated or whether the Covered Person uses the benefits to pay for necessary long-term care expenses, such as nursing home care. If the acceleration-of-life insurance benefits qualify for favorable tax treatment, the benefits will be excludable from the Covered Person’s income and not subject to federal taxation. Tax laws relating to acceleration-of-life insurance benefits are complex. The Covered Person is advised to consult with a qualified tax advisor about circumstances under which the Covered Person could receive acceleration-of-life insurance benefits excludable from income under federal law.

DISCLOSURE: Receipt of acceleration-of-life insurance benefits may affect the Covered Person’s spouse, or the Covered Person’s family’s eligibility for public assistance programs such as medical assistance (Medicaid), Aid of Families with Dependent Children (AFDC), supplementary social security income (SSI), and drug assistance programs. The Covered Person is advised to consult with a qualified tax advisor and with social security service agencies concerning how receipt of such payment will affect the Covered Person’s, the Covered Person’s spouse’s, or the Covered Person’s family’s eligibility for public assistance.

TABLE OF CONTENTS

SCHEDULE OF INSURANCE

Cost of Coverage Eligible Class(es) for Coverage Eligibility Waiting Period for Coverage Benefit Amounts

ELIGIBILITY AND ENROLLMENT

Eligible Persons Eligibility for Coverage Enrollment

PERIOD OF COVERAGE

Effective Date Deferred Effective Date Continuity From a Prior Policy Dependent Effective Date Dependent Deferred Effective Date Dependent Continuity From a Prior Policy Termination Continuation Provisions Disability Extension

BENEFITS

Life Insurance Benefit Accelerated Benefit Conversion Right Portability

GENERAL PROVISIONS

DEFINITIONS

GBD-1100 A01 (10/08)

SCHEDULE OF INSURANCE

The benefits described herein are those in effect as of October 1, 2024.

Cost of Coverage:

Non-Contributory Coverage: Basic Life Insurance

Basic Dependent Life Insurance

Eligible Class(es) For Coverage: All Full-time and Part-time Active Employees who are eligible to participate in the Teacher Retirement System of Texas (TRS) or Optional Retirement Program (ORP), graduate student employees or re-employed retirees who are:

1) citizens or legal residents of the United States working in the United States, its territories and protectorates;

2) Expatriates and Third-country Nationals; and

3) citizens or legal residents of Canada, as approved by Us, living and working in Canada;

excluding:

1) temporary, leased or seasonal employees; and

2) any Employee living or working in a country:

a) subject to a sanctions program administered by the United States Treasury Office of Foreign Asset Control; or

b) not meeting our underwriting criteria as determined by Us and accessible to Your Employer on Our

"EmployerView" online informational source.

Expatriate means a citizen or legal resident of the United States living and working on temporary assignment outside the United States, its territories and protectorates.

Third-country National means a person who is a citizen of a country other than the United States who is living and working outside of the country of which he or she is a citizen.

Class 1: Employees with health coverage inside the Texas A&M University System Class 2: Employees with health coverage outside the Texas A&M University System

Full-time Employment: at least 30 hours weekly Part-time Employment: at least 20 hours weekly

You will be considered to have met the Full-time or Part-time Employment requirement if You have worked at least 50% of the required hours over the most recent 4 ½ month period.

Eligibility Waiting Period for Coverage:

None

Life Insurance Benefit

Amount of Life Insurance:

Basic Amount of Life Insurance

Maximum Amount

With respect to Class 1: $7,500

With respect to Class 2: The amount You elect in increments of $1,000, up to a maximum of $50,000.

Dependent Life Insurance Benefit

Basic Amount of Dependent Life Insurance

Maximum Amount

Dependent Children: live birth but under age 26 year(s)

$5,000

Reduction in Amount of Life Insurance We will reduce the Amount of Life Insurance for You and Your Dependents by any Amount of Life Insurance in force, paid or payable:

1) in accordance with the Conversion Right;

2) under the Portability provision; or

3) under the Prior Policy.

GBD-1100 B02 (10/08) (Rev-1) (TX)

ELIGIBILITY AND ENROLLMENT

Eligible Persons: Who is eligible for coverage?

All persons in the class or classes shown in the Schedule of Insurance will be considered Eligible Persons.

GBD-1100 D01 (10/08)

Eligibility for Coverage: When will I become eligible?

You will become eligible for coverage on the latest of:

1) the Policy Effective Date;

2) the date You become a member of an Eligible Class; or

3) the date You complete the Eligibility Waiting Period for Coverage shown in the Schedule of Insurance, if applicable.

GBD-1100 D02 (10/08)

Eligibility for Dependent Coverage: When will I become eligible for Dependent Coverage?

You will become eligible for Dependent coverage on the later of:

1) the date You become insured for employee coverage; or

2) the date You acquire Your first Dependent.

No person may be insured:

1) as a Dependent and an Active Employee; or

2) as a Dependent of more than one Active Employee;

under The Policy.

GBD-1100 D03 (10/08) (Rev-1)

Enrollment: How do I enroll for coverage?

For Non-Contributory Coverage, Your Employer will automatically enroll You and Your Dependents for coverage.

However, You will be required to complete a beneficiary designation form.

GBD-1100 D04 (10/08) (Rev-1)

PERIOD OF COVERAGE

Effective Date: When does my coverage start?

Coverage will start on the date You become eligible.

All Effective Dates of coverage are subject to the Deferred Effective Date provision.

GBD-1100 E01 (10/08)

Deferred Effective Date: When will my effective date for coverage or a change in my coverage be deferred?

If, on the date You are to become covered:

1) under The Policy;

2) for increased benefits; or

3) for a new benefit;

You are not Actively at Work due to a physical or mental condition, such coverage will not start until the date You are Actively at Work.

GBD-1100 E03 (10/08)

Continuity from a Prior Policy: Is there continuity of coverage from a Prior Policy?

Your initial coverage under The Policy will begin, and will not be deferred if, on the day before the Policy Effective Date, You were:

1) insured under the Prior Policy; and

2) Actively at Work or on an authorized family and medical leave;

but on the Policy Effective Date, You were not Actively at Work, and would otherwise meet the Eligibility requirements of The Policy. However, Your Amount of Insurance will be the lesser of the amount of life insurance:

1) You had under the Prior Policy; or

2) shown in the Schedule of Insurance;

reduced by any coverage amount:

1) that is in force, paid or payable under the Prior Policy; or

2) that would have been so payable under the Prior Policy had timely election been made.

Such amount of insurance under this provision is subject to any reductions in The Policy and will not increase.

Coverage provided through this provision ends on the first to occur of:

1) the last day of a period of 12 consecutive months after the Policy Effective Date;

2) the date Your insurance terminates for any reason shown under the Termination provision;

3) the last day You would have been covered under the Prior Policy, had the Prior Policy not terminated; or

4) the date You are Actively at Work.

However, if the coverage provided through this provision ends because You are Actively at Work, You may be covered as an Active Employee under The Policy.

GBD-1100 E05 (10/08) (Rev-1)

Dependent Effective Date: When does Dependent coverage start?

Non-Contributory Coverage will start on the date You become eligible for Dependent coverage.

In no event will Dependent coverage become effective before You become insured.

GBD-1100 E07 (10/08)

Dependent Deferred Effective Date: When will the effective date for Dependent coverage or a change in coverage be deferred?

If, on the date Your Dependent, other than a newborn, is to become covered:

1) under The Policy;

2) for increased benefits; or

3) for a new benefit; and he or she is:

1) confined in a hospital; or

2) Confined Elsewhere;

such coverage will not start until he or she:

1) is discharged from the hospital; or

2) is no longer Confined Elsewhere;

and has engaged in all the normal and customary activities of a person of like age and gender, in good health, for at least 15 consecutive days.

This Deferred Effective Date provision will not apply to disabled children who qualify under the definition of Dependent Child(ren).

Confined Elsewhere means Your Dependent is unable to perform, unaided, the normal functions of daily living, or leave home or other place of residence without assistance.

GBD-1100 E09 (10/08)

Dependent Continuity from a Prior Policy: Is there continuity of coverage from a Prior Policy for my Dependents?

If on the day before the Policy Effective Date, You were covered with respect to Your Dependents under the Prior Policy, the Deferred Effective Date provision will not apply to initial coverage under The Policy for such Dependents. However, the Dependent Amount of Insurance will be the lesser of the amount of life insurance:

1) Your Dependents had under the Prior Policy; or

2) shown in the Schedule of Insurance;

reduced by any coverage amount:

1) that is in force, paid or payable under the Prior Policy; or

2) that would have been so payable under the Prior Policy had timely election been made.

GBD-1100 E11 (10/08)

Termination: When will my coverage end?

Your coverage will end on the earliest of the following:

1) the date The Policy terminates;

2) the last day of the month following the date You are no longer in a class eligible for coverage, or The Policy no longer insures Your class;

3) the last day of the month following the date the premium payment is due but not paid;

4) the last day of the month following the date Your Employer terminates Your employment; or

5) the last day of the month following the date You are no longer Actively at Work;

unless continued in accordance with any one of the Continuation Provisions.

GBD-1100 E17 (10/08)

Dependent Termination: When does coverage for my Dependent end?

Coverage for Your Dependent will end on the earliest to occur of:

1) the date Your coverage ends;

2) the last day of the month following the date the required premium is due but not paid;

3) the last day of the month following the date You are no longer eligible for Dependent coverage;

4) the last day of the month following the date We or the Employer terminate Dependent coverage; or

5) the last day of the month following the date the Dependent no longer meets the definition of Dependent;

unless continued in accordance with the Continuation Provisions.

GBD-1100 E21 (10/08)

Continuation Provisions: Can my coverage and coverage for my Dependents be continued beyond the date it would otherwise terminate?

Coverage can be continued by Your Employer beyond a date shown in the Termination provision, if Your Employer provides a plan of continuation which applies to all employees the same way.

The amount of continued coverage applicable to You or Your Dependents will be the amount of coverage in effect on the date immediately before coverage would otherwise have ended. Continued coverage:

1) is subject to any reductions in The Policy;

2) is subject to payment of premium;

3) may be continued up to the maximum time shown in the provisions; and

4) terminates if The Policy terminates.

In no event will the amount of insurance increase while coverage is continued in accordance with the following provisions.

The Continuation Provisions shown below may not be applied consecutively.

In all other respects, the terms of Your coverage and coverage for Your Dependents remain unchanged.

Leave of Absence: If You are on a documented leave of absence, other than Family and Medical Leave or Military Leave of Absence, Your coverage (including Dependent Life coverage) may be continued for 24 month(s) after the month in which the leave of absence commenced. If the leave terminates prior to the agreed upon date, this continuation will cease immediately.

Military Leave of Absence: If You enter active full-time military service and are granted a military leave of absence in writing, Your coverage (including Dependent Life coverage) may be continued for up to 12 weeks. If the leave ends prior to the agreed upon date, this continuation will cease immediately.

Sickness or Injury: If You are not Actively at Work due to sickness or injury, all of Your coverages (including Dependent Life coverage) may be continued:

1) for a period of 12 consecutive month(s) from the date You were last Actively at Work; or

2) if such absence results in a leave of…