Exhibit E - 2025 BVLF Rider (dependent children) 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 and accident insurance certificate issued by Hartford Life and Accident Insurance Company to the City of Madison, Wisconsin, effective January 1, 2025. The rider modifies the definition of "Dependent Child(ren)" under Policy number GL-033731 to expand coverage eligibility. 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, provided they are citizens or legal residents of the United States. Eligible Retirees are also included. The contract term begins January 1, 2025.
Under the amended rider, dependent children are defined as biological children, stepchildren, legally adopted children, or children related by blood or marriage who are either from live birth but not yet 26 years of age, or age 26 or older if disabled. Disabled children must have become disabled before attaining age 26, and proof of disability satisfactory to Hartford Life and Accident Insurance Company must be submitted. The rider excludes temporary, leased, or seasonal employees from coverage eligibility. The modification expands dependent coverage to include adult disabled children, providing extended protection beyond the standard age limitation.
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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 E
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Exhibit E
File details come from the government source that posted it. Updated .