Exhibit D - 2025 BVLF Rider (child benefit increase) Hartford.pdf
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- Attached to
- Life and Disability Insurance
- Solicitation number
- 15001-0-2026-BG
- Issued by
- Dane County, Wisconsin
About this file
This is an Amendatory Rider to a life insurance certificate issued by Hartford Life and Accident Insurance Company to the City of Madison, Wisconsin, effective January 1, 2025. The rider modifies the dependent child coverage under Policy GL-033731 to expand eligibility and extend benefits. The rider applies to all full-time active employees, including permanent and limited-term employees working at least 50 percent of a regularly established full-time work week, as well as the Mayor, Municipal Court Judge, and Alders, along with eligible retirees. All covered individuals must be citizens or legal residents of the United States, its territories, or protectorates, excluding temporary, leased, or seasonal employees.
The amendment redefines "Dependent Child(ren)" to include biological children, stepchildren, legally adopted children, and other children related by blood or marriage, extending coverage from live birth through age 25, with continued coverage for children age 26 and older who are disabled. Disabled children must have become disabled before attaining age 26, and proof of disability satisfactory to Hartford Life and Accident Insurance Company is required. All other terms and conditions of the certificate remain unchanged under this rider.
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Text version
Form PA-9394 (10/08) (033731) 7.0
Amendatory Rider
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY
One Hartford Plaza
Hartford, Connecticut 06155 (A stock insurance company)
This rider is attached to a certificate given in connection with Policy number GL-033731, issued to CITY OF MADISON.
This rider becomes effective January 1, 2025.
With respect to:
1) All Full-time Active Employee who are permanent or limited term employees who work at least 50% of a regularly established full-time work week, who are citizens or legal residents of the United States, its territories and protectorates, excluding temporary, leased or seasonal employees;
2) All Full-time Active Employees who are the Mayor, Municipal Court Judge, and Alders, who are citizens or legal residents of the United States, its territories and protectorates, excluding temporary, leased or seasonal employees; and
3) All Full-time Active Employees who are eligible Retirees, who are citizens or legal residents of the United States, its territories and protectorates, excluding temporary, leased or seasonal employees, the Dependent Child(ren) definition shown in the Definitions section of the Life Insurance portion of Your certificate is amended as follows:
Dependent Child(ren) means Your children, stepchildren, legally adopted children; or any other children related to You by blood or marriage provided such children are:
1) from live birth but not yet 26 years; or
2) age 26 or older and disabled. Such children must have become disabled before attaining age 26. You must submit proof, satisfactory to Us, of such children’s disability.
In all other respects the certificate remains the same.
Signed for Hartford Life and Accident Insurance Company
Exhibit D
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Exhibit D
File details come from the government source that posted it. Updated .