Exhibit_C6-_-Securian_Term_Life_Policy_Amendment.pdf
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- Attached to
- RFP 25-02 Life Insurance Benefit Plans
- Solicitation number
- 0000036099
- Issued by
- San Bernardino County, California
About this file
This document is a group term life insurance policy amendment for the Superior Court of California, County of San Bernardino, issued by Minnesota Life Insurance Company (a Securian Company). The policy covers various employee classes including exempt groups, supervisory staff, court commissioners, support services, court reporters, professionals, and interpreters. The amendments modify life insurance benefit amounts for different employee classes, with incremental increases ranging from $25,000 to $50,000 across multiple effective dates between 2016 and 2017.
The policy provides basic life insurance, grandfathered optional life insurance, and supplemental life insurance with varying coverage amounts based on employee classification. Employees can elect supplemental life insurance up to a maximum of $700,000, with guaranteed issue amounts of $250,000. The policy includes provisions for portability, accelerated benefits, and a waiver of premium for totally and permanently disabled employees under age 65. Premium contributions are noncontributory for basic insurance and contributory for optional and supplemental insurance, with coverage subject to actively at work requirements and specific eligibility conditions.
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33849-G/7 Policy Amendment Minnesota Life 1
Group Term Life Policy Amendment #7
Minnesota Life Insurance Company - A Securian Company 400 Robert Street North • St. Paul, Minnesota 55101-2098
To be attached to and made a part of Group Policy No. 33849-G issued by Minnesota Life Insurance Company to Superior Court of California, County of San Bernardino. This amendment is effective as of July 1, 2017. Continued payment of premiums shall constitute acceptance of the conditions stated in this amendment.
As a correction to Amendment #2, the coverage for Class 10 – Interpreters which increased to $35,000 as of July 1, 2017, had a asterisk missing from the Employee Term Life Benefit Schedule noting this change. As a result, the Employee Term Life Benefit Schedule on the Group Policy Specifications Page is amended to read:
Basic Life Insurance
Eligible Class Number Eligible Class Name
Insurance Amount:
Job Share (Bi-weekly)
Insurance Amount:
Full-Time (Regular position budgeted for 40 Hours or More, Bi-weekly)
1 Exempt Groups A & B N/A $75,000
2 Supervisory N/A $40,000*
3 Superior Court Commissioner and CEO N/A $75,000
4 Support Services N/A $25,000**
5 Exempt Groups C & D (includes former class #5)
N/A $60,000
8 Official Court Reporter N/A $25,000**
9 Professional (includes former class #7)
N/A $40,000*
10 Interpreters N/A $25,000** 11 Contract Employees Contract Specific Contract Specific
*Will increase to $50,000 January 1, 2017 **Will increase to $35,000 July 1, 2017
Agreed to by Minnesota Life Insurance Company this 11th day of July 2022.
By ___________________________________
CAS
Vice President and Actuary
F. MHC-50062 A
GROUP POLICY SPECIFICATIONS PAGE
GENERAL INFORMATION
POLICYHOLDER:
Superior Court of California, County of San Bernardino
POLICY NUMBER: 33849-G
ASSOCIATED COMPANIES:
All subsidiaries and affiliates reported to Minnesota Life by the policyholder for inclusion in the policy.
POLICY SITUS:
State of California
POLICY EFFECTIVE DATE:
August 1, 2010. This specifications page represents the plan in effect as of January 1, 2020 as revised July 11, 2022.
POLICY ANNIVERSARY DATE:
August 1 of each year beginning August 1, 2011
PREMIUM DUE DATE(S):
The first day of each month.
ELIGIBLE GROUP:
The group is composed of all employees of the policyholder and its associated companies scheduled to work in regular positions, and elected officials, who are in the Eligible Classes below. All references to “employee” shall include an elected official, unless the context requires otherwise.
MINIMUM PARTICIPATION
REQUIREMENT:
There is no minimum participation requirement under this policy.
ENROLLMENT PERIOD:
Not applicable for noncontributory insurance; 31 days from the first day of eligibility for contributory insurance.
WAITING PERIOD: For basic life: The first day of the pay period following the pay period in which the employee works and receives pay for one-half plus one of the regularly scheduled hours.
For grandfathered optional life: None
For supplemental life: The first day of the pay period following the time requirements established in the employee’s Memorandum of Understanding (MOU), Exempt Compensation Plan, salary ordinance or contract.
MINIMUM HOURS
PER WEEK REQUIRED:
40 hours per pay period
F. MHC-50062 B
PLAN OF INSURANCE
EMPLOYEE TERM LIFE BENEFIT SCHEDULE
Eligible Class Number Eligible Class Name
Insurance Amount:
Job Share (Bi-weekly)
Insurance Amount:
Full-Time (Regular position budgeted for 40 Hours or More, Bi-weekly)
1 Exempt Groups A & B N/A $75,000
2 Supervisory N/A $40,000*
3 Superior Court Commissioner and CEO N/A $75,000
4 Support Services N/A $25,000**
5 Exempt Groups C & D
(includes former class #5)
N/A $60,000
8 Official Court Reporter N/A $25,000**
9 Professional
(includes former class #7)
N/A $40,000*
10 Interpreters N/A $25,000** 11 Contract Employees Contract Specific Contract Specific
Grandfathered Optional Life Insurance
Eligible Employees Insurance Amount Elected Superior Court Judges (Appointed or Elected before 11/04/1994) who were covered for grandfathered optional life coverage on July 31, 2009 under a prior policy.
$50,000
Supplemental Life Insurance
Employees whose Memorandum of Understanding (MOU), Exempt Compensation Plan, salary ordinance or contract states they are eligible.
An amount elected by the employee, in an increment of $10,000, subject to a maximum of $700,000.
GENERAL PROVISIONS FOR EMPLOYEE INSURANCE
AGE REDUCTIONS:
(Grandfathered Optional and Supplemental Life Only)
The amount of grandfathered optional and supplemental insurance on an employee age 70 or older shall be a percentage of the amount otherwise provided by the plan of insurance applicable to such employee in accordance with the following table:
Age of Employee 70 – 74 75 – 79
80 and over
Amount of Optional/Supplemental Insurance
65% 45% 30%
Reduced amounts will be rounded to the next higher multiple of $10,000 if not already a multiple thereof. Age reductions will apply the first day of the month next following an insured employee’s applicable birthday.
F. MHC-50062 C
RETIREMENT REDUCTIONS: All insurance terminates at retirement, except as provided for under the portability provision.
CONTRIBUTORY/NONCONTRIBUTORY: Basic insurance is noncontributory insurance; grandfathered optional and supplemental insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an employee can receive without evidence of insurability when first eligible under the plan provided enrollment is made within the enrollment period. The amounts are as follows:
For basic insurance: All basic insurance is guaranteed issue.
For grandfathered optional insurance: All grandfathered optional insurance is guaranteed issue.
For supplemental insurance: $250,000
EVIDENCE OF INSURABILITY: Evidence of insurability is required for an amount of insurance greater than the guaranteed issue amount.
EFFECTIVE DATE OF INCREASES
AND DECREASES DUE TO CHANGE
IN ELIGIBLE CLASS:
The date of the change in eligible class. All increases are subject to the actively at work requirement.
DEPENDENTS BENEFIT SCHEDULE
DEPENDENTS TERM LIFE INSURANCE:
An employee does not need to be insured for supplemental life insurance to elect dependents life insurance.
The amount of insurance on a dependent may not exceed 100% of the total amount of insurance the employee has in force on himself/herself.
Spouse Life Insurance
Eligible Class Amount of Spouse Life Insurance
All Employees An amount elected by the employee, in an increment of $10,000, subject to a maximum of $200,000
Child Life Insurance
Eligible Class Amount of Child Life Insurance
All Employees An amount elected by the employee, in an increment of $5,000, subject to a maximum of $20,000.
An employee’s first eligible newborn child is automatically covered for $5,000 for 31 days from the child’s live birth. To continue coverage on the first child, the employee must elect child coverage within those 31 days; otherwise the coverage shall terminate at the end of the 31-day period.
F. MHC-50062 D
GENERAL PROVISIONS FOR DEPENDENTS INSURANCE
SPOUSE AGE REDUCTIONS: The amount of insurance on an insured spouse age 70 or older shall be a percentage of the amount otherwise provided by the plan of insurance applicable to such spouse in accordance with the following table:
Age of Spouse
75 – 79
80 and over
Amount of Spouse Insurance 65%
Age reductions will apply the first day of the month following an insured spouse’s applicable birthday.
CONTRIBUTORY/NONCONTRIBUTORY: Dependents insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an eligible dependent can receive without evidence of insurability when first eligible under the plan provided enrollment is made within the enrollment period*. The amounts are as follows:
For spouse insurance: $20,000 For child insurance: $20,000
*As an exception, evidence of insurability is never required of a child, but enrollment opportunities are limited to a period of initial eligibility, annual enrollment, or within 31 days of a qualified status change.
EVIDENCE OF INSURABILITY: Evidence of insurability is required as stated in the policy and for an amount of insurance greater than the guaranteed issue amount.
EFFECT OF EMPLOYEE’S RETIREMENT: All dependents insurance terminates upon the employee’s retirement except as provided under the portability provision.
ADDITIONAL INFORMATION
SUICIDE EXCLUSION FOR LIFE
INSURANCE:
The suicide exclusion described in the policy applies to grandfathered optional, supplemental and spouse life insurance. It does not apply to basic or child life insurance.
WAIVER OF PREMIUM APPLICATION: Applies to contributory and noncontributory employee insurance.
REINSTATEMENT PERIOD: There is no reinstatement under this policy. An employee who loses eligibility and later again becomes eligible shall be treated the same as an employee who is first eligible under the plan.
F. MHC-50062 E
ONE-TIME ANNUAL ENROLLMENT:
(Effective January 1, 2018)
During the policyholders 2018 annual enrollment, the following election changes can be made without providing evidence of insurability:
• An employee may elect spouse life insurance up to the guaranteed issue amount of $20,000.
• An employee may elect any amount of child life insurance, up to the plan maximum of $20,000.
Coverage will be effective on January 1, 2018 following the enrollment, subject to the actively at work requirement for the employee and the hospitalization/confinement clause for the dependent.
(Effective January 1, 2019)
During the policyholders 2019 annual enrollment, the following election
Coverage will be effective on January 1, 2019 following the enrollment, (Effective January 1, 2020)
During the policyholders 2020 annual enrollment, the following election
Coverage will be effective on January 1, 2020 following the enrollment, ANNUAL ENROLLMENTS: During the policyholder’s annual open enrollment, the following election changes can be made:
• An employee may make changes to his or her supplemental life elections, however elections that exceed $250,000 for supplemental life insurance when combined with the amount, if any of Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy 55052-G, will require evidence of insurability.
• Electing spouse life insurance requires evidence of insurability.
Coverage will go into effect on January 1 following the annual enrollment for coverage that does not require evidence of insurability, or on the date we approve evidence of insurability if later. Increases in coverage are subject to the actively at work requirement for employees and the hospitalization/confinement clause for dependents.
F. MHC-50062 F
QUALIFIED STATUS CHANGES: An employee who experiences a Qualified Status Change as determined by the policyholder may make the following election changes, provided enrollment is made within 31 days of the status change event:
supplemental life insurance when combined with the amount, if any, of Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy 55052-G, will require evidence of insurability.
• Electing spouse life insurance requires evidence of insurability.
Coverage will be effective on the date of the election, or on the date we approve evidence of insurability if later. Increases in coverage are
Qualified Status Change shall be as defined by IRC Section 125. The change in plan must be consistent with the change in status.
RIDER(S) TO THE GROUP POLICY
Accelerated Benefits Dependents Benefits Portability Waiver of Premium
33849-G/6 Policy Amendment Minnesota Life 1
Group Term Life Policy Amendment #6
To be attached to and made a part of Group Policy No. 33849-G issued by Minnesota Life Insurance Company to Superior Court of California, County of San Bernardino. This amendment is effective as of January 1, 2018. Continued
The Term Life Insurance Portability Rider is amended to include the minimum and maximum amounts of insurance a dependent is eligible to port. As a result of this change the Group Policy Specifications Page and the Term Life Insurance Portability Policy Rider are replaced with the attached Group Policy Specifications Page and Term Life Insurance Portability Policy Rider.
Agreed to by Minnesota Life Insurance Company this 14th day of April 2020.
SEM
January 1, 2020 as revised on April 14, 2020.
WAITING PERIOD: For basic life: The first day of the pay period following the pay period in which the employee works and receives pay for one-half plus one of the regularly scheduled hours.
For grandfathered optional life: None
For supplemental life: The first day of the pay period following the time
Class Number Eligible Class Name
Insurance Amount:
Job Share (Bi-weekly)
Insurance Amount:
Full-Time (Regular position budgeted for 40 Hours or More, Bi-weekly)
1 Exempt Groups A & B N/A $75,000
2 Supervisory N/A $40,000*
3 Superior Court Commissioner and CEO N/A $75,000
4 Support Services N/A $25,000**
5 Exempt Groups C & D
(includes former class #5)
N/A $60,000
8 Official Court Reporter N/A $25,000**
9 Professional
(includes former class #7)
N/A $40,000*
10 Interpreters N/A $25,000* 11 Contract Employees Contract Specific Contract Specific
Elected Superior Court Judges (Appointed or Elected before 11/04/1994) who were covered for grandfathered optional life coverage
Employees whose Memorandum of Understanding (MOU), Exempt Compensation Plan, salary ordinance or contract states they are eligible.
An amount elected by the employee, in an
(Grandfathered Optional and Supplemental Life Only)
The amount of grandfathered optional and supplemental insurance on an employee age 70 or older shall be a percentage of the amount
75 – 79
80 and over
Amount of Optional/Supplemental Insurance
65%
CONTRIBUTORY/NONCONTRIBUTORY: Basic insurance is noncontributory insurance; grandfathered optional and supplemental insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an employee can receive without evidence of insurability when first eligible under the insurance is guaranteed issue.
For supplemental insurance: $250,000
EVIDENCE OF INSURABILITY: Evidence of insurability is required for an amount of insurance greater than the guaranteed issue amount.
EFFECTIVE DATE OF INCREASES
AND DECREASES DUE TO CHANGE
IN ELIGIBLE CLASS:
An employee does not need to be insured for supplemental life insurance to elect dependents life insurance.
The amount of insurance on a dependent may not exceed 100% of the total amount of insurance the employee has in to a maximum of $20,000.
An employee’s first eligible newborn child is automatically covered for $5,000 for 31 days from the child’s live birth. To continue coverage on the first child, the employee must elect child coverage within those 31
75 – 79
80 and over
Amount of Spouse Insurance 65%
CONTRIBUTORY/NONCONTRIBUTORY: Dependents insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an eligible dependent can receive without evidence of insurability when first eligible
*As an exception, evidence of insurability is never required of a child, but
INSURANCE:
The suicide exclusion described in the policy applies to grandfathered supplemental life insurance when combined with the amount, if any of Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy 55052-G, will require evidence of insurability.
• Electing spouse life insurance requires evidence of insurability.
we approve evidence of insurability if later. Increases in coverage are supplemental life insurance when combined with the amount, if any, of Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy 55052-G, will require evidence of insurability.
• Electing spouse life insurance requires evidence of insurability.
MHC-96-13214 Minnesota Life 1
EdF70682 Rev 4-2020
Term Life Insurance Portability Policy Rider
General Information
This rider is issued in consideration of the required premium and amends the group policy to which it is attached. This rider is subject to every term, condition, exclusion, limitation and provision of the group policy unless otherwise expressly provided for herein.
What does this rider provide?
This rider provides for continuation of group life insurance for insureds who no longer meet the eligibility requirements of the group policy except as provided for herein.
To continue coverage under the provisions of this rider, an eligible insured must make a written request and make the first premium contribution within 31 days after insurance provided by the group policy would otherwise terminate.
Evidence of insurability will not be required. Coverage provided by this rider will then be deemed effective retroactive to the beginning of the 31-day period. This date is considered to be the insured’s portability date and the insured is then considered to have portability status.
Who is eligible to continue insurance under this rider?
A certificate holder is eligible to continue insurance under this rider if he or she, except as provided by this rider, no longer meets the eligibility requirements of the group policy due to any of the following:
(1) the employee terminates employment, including retirement; or
(2) the employee is no longer in a class eligible for insurance or is on a leave or layoff; or
(3) a class or group of employees insured under the policy is no longer considered eligible and there is no successor plan for that class or group.
Successor plan means an insurance policy or policies provided by us or another insurer that replaces insurance provided under this policy.
The certificate holder will not be eligible to request coverage under this rider if he or she:
(1) has attained the age of 70; or
(2) has converted his or her insurance to an individual life policy under the terms of the group policy’s conversion right section; or
(3) was not actively at work due to sickness or injury on the day immediately preceding his or her portability date; or
(4) loses eligibility due to termination of the group policy.
What insurance can be continued under this rider?
Basic and supplemental life insurance may be continued under this rider. If the certificate holder elects to continue his or her own coverage according to the provisions of this rider, he or she may also elect to continue contributory insurance for any other individual insured under his or her certificate. The certificate holder may also continue coverage under all supplements to such certificate by which he or she was insured immediately preceding his or her portability date, except for the Term Life Waiver of Premium Certificate Supplement, which shall terminate upon porting
The amount of insurance continued under this rider for any individual will be subject to any applicable state law or regulation relating to allowable amounts of insurance.
What is the minimum amount of insurance that can be continued under this rider?
The minimum amount of insurance that can be continued on the life of an insured is $10,000 for an employee or $1,000 on each dependent.
What is the maximum amount of insurance that can be continued under this rider?
The maximum amount of insurance that can be continued under this rider is the amount of insurance that was in force on the insured’s portability date, but not more than $500,000 for the employee or $100,000 for a spouse/registered domestic partner. However, if the insured is age 65 or older on the insured’s portability date, the amount will not be more than 65% of the amount of insurance that was in force on the insured’s portability date, to a maximum of $325,000 for the employee or $65,000 for a spouse/registered domestic partner.
Will the amount of insurance continued under this rider change?
Yes. On the first day of the month following the date an insured attains age 65, the amount of insurance on his or her life continued under this rider will reduce to 65% of the amount of insurance in force on the day prior to his or her attainment of age 65. Insurance terminates at age 70.
Can a certificate holder request a change in his or her amount of insurance continued under this rider?
Yes. The certificate holder may elect to reduce the amount of insurance provided under his or her certificate.
The remaining amount of insurance on the life of a certificate holder must be at least $10,000.
MHC-96-13214 Minnesota Life 2
EdF70682 Rev 4-2020
The amount of insurance continued under this rider will never increase.
How will premium contributions be paid?
Premium contributions will be paid directly to us by the certificate holder on a monthly, quarterly, semi-annual, or annual basis and will be subject to an administrative charge per billing period. We may adjust the amount of the charge, but not more often than once per year.
Can the premium rate change?
Yes. The premium rate may increase on the portability date. The premium rate may also increase in the future but will not change more often than once per year.
Can insurance continued under this rider be converted to a policy of individual insurance?
Yes. At any time after insurance has been continued under the provisions of this rider, it may be converted to a policy of individual insurance with Minnesota Life. All other conditions and provisions of the conversion right section of the group policy to which this rider is attached will apply.
What happens if a certificate holder again becomes eligible under the group policy?
If a certificate holder who is continuing coverage under the provisions of this rider again meets the eligibility requirements of the group policy, not including the terms of this rider, he or she shall no longer be considered to have portability status. Insurance for that certificate holder may be provided only under the terms of the group policy, not including this rider, unless and until he or she no longer meets the eligibility requirements of the group policy and again returns to portability status as provided for herein.
What happens to insurance provided under this rider when the group policy terminates?
Anything in the group policy notwithstanding, termination of the group policy by the policyholder or us will not terminate life insurance then in force for any person under the terms of this rider. The group policy will be deemed to remain in force solely for the purpose of continuing such insurance, but without further obligation of the policyholder.
Any insurance continued under the terms of this rider will remain in force until terminated by the provisions of the section entitled “When will insurance continued under this rider terminate?”.
No individual may elect coverage under this rider on or after the date of termination of the group policy.
When will insurance continued under this rider terminate?
Insurance continued under this rider will terminate on the earliest of the following:
(1) the insured’s 70th birthday; or
(2) the date the insured again meets the eligibility requirements of the group policy, not including the terms of this rider; or
(3) in the case of a dependent child or a spouse/registered domestic partner who is insured by a rider to the certificate holder’s coverage, the date the certificate holder’s coverage is no longer being continued under this rider, or the date the certificate holder’s spouse/registered domestic partner or child ceases to be eligible as defined under the terms of the group policy; or
(4) 31 days after the due date of any premium contribution which is not made.
Secretary President
33849-G/5 Policy Amendment Minnesota Life 1
Group Term Life Policy Amendment #5
Minnesota Life Insurance Company - A Securian Company 400 Robert Street North • St. Paul, Minnesota 55101-2098
To be attached to and made a part of Group Policy No. 33849-G issued by Minnesota Life Insurance Company to Superior Court of California, County of San Bernardino. This amendment is effective as of the dates shown below.
Continued payment of premiums shall constitute acceptance of the conditions stated in this amendment.
Effective January 1, 2019:
1. A one-time open enrollment is added to the policy to allow an employee to elect spouse life insurance in the amount of $20,000 guaranteed issue.
Effective January 1, 2020:
1. The spouse term life insurance plan maximum is increased to $200,000. As a result of this change the Group Policy Specifications Page is replaced with the attached Group Policy Specifications Page dated effective January 1, 2020.
2. A one-time open enrollment is added to the policy to allow an employee to elect spouse life insurance in the amount of $20,000 guaranteed issue.
Agreed to by Minnesota Life Insurance Company this 11th day of December 2019.
By ___________________________________
January 1, 2020.
WAITING PERIOD: For basic life: The first day of the pay period following the pay period in which the employee works and receives pay for one-half plus one of the regularly scheduled hours.
For grandfathered optional life: None
For supplemental life: The first day of the pay period following the time
Eligible Class Number Eligible Class Name
Insurance Amount:
Job Share (Bi-weekly)
Insurance Amount:
Full-Time (Regular position budgeted for 40 Hours or More, Bi-weekly)
1 Exempt Groups A & B N/A $75,000
2 Supervisory N/A $40,000*
3 Superior Court Commissioner and CEO N/A $75,000
4 Support Services N/A $25,000**
5 Exempt Groups C & D
(includes former class #5)
N/A $60,000
8 Official Court Reporter N/A $25,000**
9 Professional
(includes former class #7)
N/A $40,000*
10 Interpreters N/A $25,000* 11 Contract Employees Contract Specific Contract Specific
Elected Superior Court Judges (Appointed or Elected before 11/04/1994) who were covered for grandfathered optional life coverage
Employees whose Memorandum of Understanding (MOU), Exempt Compensation Plan, salary ordinance or contract states they are eligible.
An amount elected by the employee, in an
(Grandfathered Optional and Supplemental Life Only)
The amount of grandfathered optional and supplemental insurance on an employee age 70 or older shall be a percentage of the amount
75 – 79
80 and over
Amount of Optional/Supplemental Insurance
65%
CONTRIBUTORY/NONCONTRIBUTORY: Basic insurance is noncontributory insurance; grandfathered optional and supplemental insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an employee can receive without evidence of insurability when first eligible under the insurance is guaranteed issue.
For supplemental insurance: $250,000
EVIDENCE OF INSURABILITY: Evidence of insurability is required for an amount of insurance greater than the guaranteed issue amount.
EFFECTIVE DATE OF INCREASES
AND DECREASES DUE TO CHANGE
IN ELIGIBLE CLASS:
An employee does not need to be insured for supplemental life insurance to elect dependents life insurance.
The amount of insurance on a dependent may not exceed 100% of the total amount of insurance the employee has in to a maximum of $20,000.
An employee’s first eligible newborn child is automatically covered for $5,000 for 31 days from the child’s live birth. To continue coverage on the first child, the employee must elect child coverage within those 31
75 – 79
80 and over
Amount of Spouse Insurance 65%
CONTRIBUTORY/NONCONTRIBUTORY: Dependents insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an eligible dependent can receive without evidence of insurability when first eligible
*As an exception, evidence of insurability is never required of a child, but
INSURANCE:
The suicide exclusion described in the policy applies to grandfathered supplemental life insurance when combined with the amount, if any of Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy 55052-G, will require evidence of insurability.
• Electing spouse life insurance requires evidence of insurability.
we approve evidence of insurability if later. Increases in coverage are supplemental life insurance when combined with the amount, if any, of Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy 55052-G, will require evidence of insurability.
• Electing spouse life insurance requires evidence of insurability.
33849-G/4 Policy Amendment Minnesota Life 1
Group Term Life Policy Amendment #4 Minnesota Life Insurance Company - A Securian Company 400 Robert Street North • St. Paul, Minnesota 55101-2098
To be attached to and made a part of Group Policy No. 33849-G issued by Minnesota Life Insurance Company to Superior Court of California, County of San Bernardino. This amendment is effective as of October 1, 2019. Continued payment of premiums shall constitute acceptance of the conditions stated in this amendment.
The Implementation Credit Rider EdF94351 is added to the policy.
Agreed to by Minnesota Life Insurance Company this 23rd day of October, 2019.
By ___________________________________
JS
18-32543 Minnesota Life 1 EdF94351 10-2019
Implementation Credit Policy Rider Minnesota Life Insurance Company 400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information This rider is subject to every term, condition, exclusion, limitation and provision of the group policy unless otherwise expressly provided for herein.
What does this rider provide?
This rider provides for an additional benefit to offset the direct and indirect costs that you incur in connection with the insurance coverage offered under the group policy issued by Minnesota Life.
What is the amount of the implementation credit?
The implementation credit is in an amount equal to the lesser of:
(1) $25,000; or
(2) the direct or indirect costs you incur in connection with the insurance coverage offered under the group policy, provided that such costs are incurred no later than December 31, 2020.
When will the implementation credit be payable?
We will pay the implementation credit after you have submitted to us reasonably detailed documentation evidencing the cost you incurred in connection with the insurance coverage offered under the group policy. Such documentation must be sent to us no later than June 30, 2021.
To whom will we pay the implementation credit?
We will pay the implementation credit to you or to an entity you have named to receive it.
Termination When does this rider terminate?
This rider terminates upon the earlier of:
(1) the date the group policy to which it is attached terminates; or
(2) the date requested by you to cancel this rider for your plan.
33849-G/3 Policy Amendment Minnesota Life 1
Group Term Life Policy Amendment #3
To be attached to and made a part of Group Policy No. 33849-G issued by Minnesota Life Insurance Company to Superior Court of California, County of San Bernardino. This amendment is effective as of the dates shown below.
Continued payment of premiums shall constitute acceptance of the conditions stated in this amendment.
Effective April 28, 2016
The minimum hours per week requirement is changed to 40 per pay period.
Effective January 1, 2018
Spouse/Registered Domestic Partner and Child life insurance is added to the policy.
The following forms are modified as a result of these changes:
The Group Policy Specifications Page is replaced with the attached Group Policy Specifications Page dated effective January 1, 2018.
The Accelerated Benefits Policy Rider EdF70641 is replaced with the attached Accelerated Benefits Policy Rider EdF70641 Rev 11-2017.
The Term Life Insurance Portability Policy Rider EdF70683 is replaced with the attached Term Life Insurance Portability Policy Rider EdF70683 Rev 11-2017.
The Dependents Term Life Insurance Policy Rider EdF90581 11-2017 is added to the policy.
Agreed to by Minnesota Life Insurance Company this 20th day of November, 2017.
January 1, 2018.
WAITING PERIOD: For basic life: The first day of the pay period following the pay period in which the employee works and receives pay for one-half plus one of the regularly scheduled hours.
For grandfathered optional life: None
For supplemental life: The first day of the pay period following the time
Class Number Eligible Class Name
Insurance Amount:
Job Share (Bi-weekly)
Insurance Amount:
Full-Time (Regular position budgeted for 40 Hours or More, Bi-weekly)
1 Exempt Groups A & B N/A $75,000
2 Supervisory N/A $40,000*
3 Superior Court Commissioner and CEO N/A $75,000
4 Support Services N/A $25,000**
5 Exempt Groups C & D
(includes former class #5)
N/A $60,000
8 Official Court Reporter N/A $25,000**
9 Professional
(includes former class #7)
N/A $40,000*
10 Interpreters N/A $25,000* 11 Contract Employees Contract Specific Contract Specific
Elected Superior Court Judges (Appointed or Elected before 11/04/1994) who were covered for grandfathered optional life coverage
Employees whose Memorandum of Understanding (MOU), Exempt Compensation Plan, salary ordinance or contract states they are eligible.
An amount elected by the employee, in an
(Grandfathered Optional and Supplemental Life Only)
The amount of grandfathered optional and supplemental insurance on an employee age 70 or older shall be a percentage of the amount
75 – 79
80 and over
Amount of Optional/Supplemental Insurance
65%
CONTRIBUTORY/NONCONTRIBUTORY: Basic insurance is noncontributory insurance; grandfathered optional and supplemental insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an employee can receive without evidence of insurability when first eligible under the insurance is guaranteed issue.
For supplemental insurance: $250,000
EVIDENCE OF INSURABILITY: Evidence of insurability is required for an amount of insurance greater than the guaranteed issue amount.
EFFECTIVE DATE OF INCREASES
AND DECREASES DUE TO CHANGE
IN ELIGIBLE CLASS:
An employee does not need to be insured for supplemental life insurance to elect dependents life insurance.
The amount of insurance on a dependent may not exceed 100% of the total amount of insurance the employee has in to a maximum of $100,000 to a maximum of $20,000.
An employee’s first eligible newborn child is automatically covered for $5,000 for 31 days from the child’s live birth. To continue coverage on the first child, the employee must elect child coverage within those 31
SPOUSE AGE REDUCTIONS: The amount of insurance on an insured spouse age 65 or older shall be
75 – 79
80 and over
Amount of Spouse Insurance 65%
CONTRIBUTORY/NONCONTRIBUTORY: Dependents insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an eligible dependent can receive without evidence of insurability when first eligible
*As an exception, evidence of insurability is never required of a child, but
EFFECT OF EMPLOYEE’S RETIREMENT: All dependents insurance terminates upon the employee’s retirement except as provided under the portability provision.
ADDITIONAL INFORMATION
SUICIDE EXCLUSION FOR LIFE
INSURANCE:
The suicide exclusion described in the policy applies to grandfathered
An employee may elect spouse life insurance up to the
An employee may elect any amount of child life insurance, up to
An employee may make changes to his or her supplemental life supplemental life insurance when combined with the amount, if any of Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy 55052-G, will require evidence of insurability.
Electing spouse life insurance requires evidence of insurability.
we approve evidence of insurability if later. Increases in coverage are
An employee may make changes to his or her supplemental life supplemental life insurance when combined with the amount, if any, of Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy 55052-G, will require evidence of insurability.
Electing spouse life insurance requires evidence of insurability.
MHC-96-13186 Minnesota Life 1
EdF90581 11-2017
Dependents Term Life Insurance Policy Rider
General Information
This rider is issued in consideration of the required premium and amends the group policy to which it is attached. The rider is subject to every term, condition, exclusion, limitation, and provision of the group policy unless otherwise expressly provided for herein. Any Accidental Death and Dismemberment coverage provided by a rider to the group policy will not apply to dependents coverage provided by this rider.
What does this rider provide?
This rider provides insurance on the lives of the insured employee’s eligible dependents.
What members of the insured employee’s family are eligible for insurance under this rider?
The following members of the insured employee’s family are eligible for insurance under this rider:
(1) the insured employee’s lawful spouse who is not legally separated from the insured or the employee’s registered domestic partner, who is not eligible for insurance as an employee under the policy; and
(2) the insured employee’s natural children, stepchildren, legally adopted children and foster children. Children are eligible from live birth (stillborn and unborn children are not eligible) to the attainment of age 26. Children age 26 or older are eligible if they are physically or mentally disabled, were insured under the group policy and disabled prior to age 26 and are financially dependent on the employee for more than one-half of their support and maintenance.
A registered domestic partner is an individual who is in registered domestic partnership with the employee in accordance with California Law.
If both parents of a child qualify as eligible employees under the group policy, the child shall be considered a dependent of only one parent for purposes of this rider. If any child qualifies as an eligible employee under the group policy, he or she is not eligible to be insured as a dependent child.
Any dependent child who, subsequent to the effective date of the insured employee’s child life insurance, meets the requirements of this provision will become insured on the date he or she so qualifies.
When will we require evidence of insurability?
Evidence of insurability will be required if:
(1) the specifications page attached to the group policy states that evidence of insurability is required; or
(2) the insurance is contributory and the employee does not enroll for coverage under this rider within the enrollment period shown on the specifications page attached to the group policy; or
(3) dependents insurance for which the employee previously enrolled did not go into effect or was terminated because the employee failed to make a required premium contribution; or
(4) during a previous period of eligibility, the employee failed to submit evidence of insurability that was required for a dependent or that which was submitted was not satisfactory to us; or
(5) the dependent is insured by an individual policy issued under the terms of the conversion right of this rider.
When does insurance on a dependent become effective?
Insurance on a dependent becomes effective on the date when all of the following conditions have been met:
(1) the dependent meets all eligibility requirements;
and
(2) if required, the insured employee applies for dependents coverage on forms which are approved by us; and
(3) we are satisfied with the dependent’s evidence of insurability, if we require evidence; and
(4) we receive the required premium.
If a dependent is hospitalized or confined because of illness or disease on the date his or her insurance would otherwise become effective, his or her effective date shall be delayed until he or she is released from such hospitalization or confinement. This does not apply to a newborn child. However, in no event will insurance on a dependent be effective before the insured employee’s insurance under the group policy is effective.
Death Benefit
What is the amount of life insurance on each insured dependent?
The amount of life insurance on each insured dependent is shown on the specifications page attached to the group policy.
MHC-96-13186 Minnesota Life 2
EdF90581 11-2017
To whom will we pay the death benefit?
The death benefit payable under this rider will be paid to the insured employee if living, otherwise to his or her estate.
Termination
When does an insured dependent’s coverage under this rider terminate?
An insured dependent’s coverage ends on the earliest of the following:
(1) the date the dependent no longer meets the eligibility requirements; or
(2) 31 days (the grace period) after the due date of any premium contribution which is not paid; or
(3) the last day for which premium contributions have been made following an employee’s written request that insurance on his or her eligible dependents be terminated; or
(4) the date the employee is no longer covered under the group policy.
The employee must notify us or the employer when a dependent is no longer eligible for coverage under this rider so that premiums may be discontinued. All premiums paid for dependents who are no longer eligible for coverage under this rider will be refunded without any payment of claim.
When does this rider terminate?
This rider will terminate on the earlier of:
(1) the date we receive a written request to cancel this rider; or
(2) the date the group policy is terminated.
Additional Information
What is the conversion right under this rider?
If an insured dependent’s coverage under this rider terminates because he or she is no longer eligible, or because of the death of the insured employee, or because of termination or amendment of this rider, the insurance may be converted to a policy of individual insurance with Minnesota Life.
Conversion may be requested by the insured employee, an insured dependent of legal capacity, or the insured dependent’s guardian, if applicable. All other conditions and provisions of the conversion right section of the group policy to which this rider is attached will apply.
Does the Waiver of Premium rider to the group policy apply to insured dependents?
The Waiver of Premium rider to the group policy will not apply to disabilities for dependents covered under this rider.
However, if, due to the insured employee’s disability, his or her insurance is continued in force without further payment of premiums due to the Waiver of Premium rider to the group policy, any dependents insurance provided by this rider shall also continue in force without further payment of premiums until the dependent’s eligibility terminates or until the insured employee’s insurance is no longer continued in force due to the Waiver of Premium rider to the group policy.
This provision is not applicable if the dependent’s insurance has been converted under the conversion right section of this rider, unless the converted policy is surrendered without claim except for refund of premiums.
33849-G/2 Policy Amendment Minnesota Life 1
Group Term Life Policy Amendment #2
Minnesota Life Insurance Company - A Securian Company 400 Robert Street North • St. Paul, Minnesota 55101-2098
To be attached to and made a part of Group Policy No. 33849-G issued by Minnesota Life Insurance Company to Superior Court of California, County of San Bernardino. This amendment is effective as of the dates indicated below.
Continued payment of premiums shall constitute acceptance of the conditions stated in this amendment.
Effective June 25, 2016:
1. The amount of basic life insurance for Class 4 is increased to $25,000.
2. The amount of basic life insurance for Class 8 is increased to $25,000.
3. The amount of basic life insurance for Class 10 is increased to $25,000.
Effective January 1, 2017:
1. The amount of basic life insurance for Class 2 is increased to $50,000.
2. The amount of basic life insurance for Class 9 is increased to $50,000.
Effective July 1, 2017:
1. The amount of basic life insurance for Class 4 is increased to $35,000.
2. The amount of basic life insurance for Class 8 is increased to $35,000.
3. The amount of basic life insurance for Class 10 is increased to $35,000.
As a result of these changes, the Group Policy Specifications Page effective February 6, 2016 is replaced with the attached Group Policy Specifications Page effective June 25, 2016.
Agreed to by Minnesota Life Insurance Company this 15th day of December, 2016.
By ___________________________________
LL
Superior Court of California, County of San
Bernardino
POLICY NO.: 33849-G
June 25, 2016.
companies scheduled to work in regular positions, and elected officials, who are in the
Eligible Classes below. All references to “employee” shall include an elected official, unless the context requires otherwise.
Not applicable for noncontributory insurance; 31 days from the first day of eligibility for contributory insurance.
WAITING PERIOD: For basic life: The first day of the pay period following the pay period in which the employee works and receives pay for one-half plus one of the regularly scheduled hours.
For grandfathered optional life: None
For supplemental life: The first day of the pay period following the time requirements established in the employee’s Memorandum of Understanding (MOU), Exempt
Compensation Plan, salary ordinance or contract.
40 hours per pay period for basic life and grandfathered optional life, 41 hours per pay period for supplemental life.
Class Number Eligible Class Name
Insurance Amount:
Job Share (Bi-weekly)
Insurance Amount:
Full-Time (Regular position budgeted for 40 Hours or More, Bi-weekly)
1 Exempt Groups A & B N/A $75,000
2 Supervisory N/A $40,000*
3 Superior Court Commissioner and CEO N/A $75,000
4 Support Services
N/A $25,000**
Class
Number Eligible Class Name
Insurance Amount:
Job Share (Bi-weekly)
Insurance Amount:
Full-Time (Regular position budgeted for 40 Hours or More, Bi-weekly)
5 Exempt Groups C & D
(includes former class #5)
N/A $60,000
8 Official Court Reporter N/A $25,000**
9 Professional
(includes former class #7)
N/A $40,000*
10 Interpreters N/A $25,000*
11 Contract Employees Contract Specific Contract Specific
Number Eligible Class Name
Insurance Amount:
1 Elected Superior Court Judges (Appointed or Elected before 11/04/1994) who were covered for grandfathered optional life coverage on July 31, 2009 under a prior policy.
1 Employees whose Memorandum of Understanding (MOU), Exempt Compensation Plan, salary ordinance or contract states they are eligible.
An amount elected by the employee, in an
(Grandfathered Optional and Supplemental Life Only)
The amount of grandfathered optional and supplemental insurance on an employee age 70 or older shall be a percentage of the amount otherwise provided by the plan of insurance applicable to such employee in accordance with the following table:
75 – 79
80 and over
Amount of Supplemental Insurance
65%
Reduced amounts will be rounded to the next higher multiple of $10,000 if not already a multiple thereof.
CONTRIBUTORY/NONCONTRIBUTORY: Basic insurance is noncontributory insurance; grandfathered optional and supplemental insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT: Guaranteed issue is the maximum amount of insurance an employee can receive without evidence of insurability when first eligible under the plan provided enrollment is made within the enrollment period. The amounts are as follows:
For grandfathered optional insurance: All grandfathered optional insurance is guaranteed issue.
For supplemental insurance: $250,000
EVIDENCE OF INSURABILITY: Evidence of insurability is required for an amount of insurance greater than the guaranteed issue amount.
EFFECTIVE DATE OF INCREASES
AND DECREASES DUE TO CHANGE
IN ELIGIBLE CLASS:
The date of the change in eligible class. All increases are subject to the actively at work requirement.
INSURANCE:
The suicide exclusion described in the policy applies to grandfathered optional and supplemental life insurance. It does not apply to basic life insurance.
REINSTATEMENT PERIOD: There is no reinstatement under this policy. An employee who loses eligibility and later again becomes eligible shall be treated the same as an employee who is first eligible under the plan.
ELECTION CHANGES:
An employee may make changes to his or her supplemental life election only at annual open enrollment or within 31 days of a Qualified Status Change.
Evidence of insurability will be required for elections of supplemental life insurance that exceed $250,000 when combined with the amount, if any, of
Variable Group Universal Life (VGUL) coverage under Minnesota Life Policy
No. 55052-G.
Qualified Status Change shall be as defined by IRC Section 125. The change in plan must be consistent with the change in status.
33849-G/1 Policy Amendment Minnesota Life 1
Group Term Life Policy Amendment #1
To be attached to and made a part of Group Policy No. 33849-G issued by Minnesota Life Insurance Company to Superior Court of California, County of San Bernardino. This amendment is effective as of February 6, 2016. Continued
1. Basic life insurance has increased for eligible classes as follows:
Class 1 has increased to $75,000 Class 2 has increased to $40,000 Class 3 has increased to $75,000 Class 5 has increased to $60,000 Class 9 has increased to $40,000
2. Class 6 has been removed from the policy and no longer exists.
3. Employees from Class 7 have moved to Class 9 and Class 7 no longer exists.
4. Class names have changed for classes 1, 5 and 9. As a result, these new class names are as follows:
Class 1: Exempt Groups A & B Class 5: Exempt Groups C & D (includes former class 5) Class 9: Professional (includes former class 7)
5. The section noted as Insurance Amount: Scheduled Hours of 40 to 60 (Bi-weekly) for classes 5 through
11 under the Employee Term Life Benefit Schedule on the Group Policy Specifications Page has changed to match the title of classes 1 through 4, Insurance Amount: Job Share (Bi-weekly). Any applicable benefit amount for all classes will now be under the section entitled: Insurance Amount: Job Share (Bi-weekly).
6. The section noted as Insurance Amount: Full-time (Scheduled 41 hour or more, Bi-weekly) under the
Employee Term Life Benefit Schedule on the Group Policy Specifications Page for classes 1 through 4 and the section noted as Insurance Amount: Scheduled Hours of 61 to 80 (Bi-weekly) for classes 5 through 11 has changed to Insurance Amount: Full-Time (Regular position budgeted for 40 hours or more, Bi-weekly) for all classes.
As a result of these changes, the Group Policy Specifications Page with…
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