Accelerated Death Benefit* Reliance standard benefit: 75% to $500,000 Expected within 12 (*state requirements may apply months to some areas) If other than the above percentage and amount, please describe. Continuation during FMLA Does employee have continued coverage with paid premium during FMLA? (Yes/No) Continuation of Coverage Does the employee have Applicable to GL and VAR only continued coverage with paid premium for a leave of absence? RSL Standard: 12 months Illness or Injury – Any time period that differ or 1 month lay-off or leave of – are different absence Suicide Limitation Applicable to Automatically added on GL only. contributory coverage Suicide Exclusion Applicable to Automatically applicable if the AD&D product only. case has AD&D otherwise N/A Portability Confirm if the Portability provision has been added to this Plan. (Yes or No) RSL Standard: Special Note: As a standard, portability is - available on GL (if included, not available to retirees. If we both life and AD&D coverage must do this, it requires a may be ported, if AD&D is on the filing. policy) - NOT available VAR Supplemental AD&D Benefit Enter the Supplemental Coverage Amount Coverage Amount. List by Class. Options: How is Supplemental AD&D Benefit elected? -AD&D must match what the employee is insured for under the GL - Automatically enrolled for GL amount
Accelerated Death Benefit* (*state requirements may apply to some areas) Reliance standard benefit: 75% to $500,000 Expected within 12 months If other than the above percentage and amount, please describe. Continuation during FMLA Does employee have continued coverage with paid premium during FMLA? (Yes/No) Continuation of Coverage Applicable to GL and VAR only RSL Standard: 12 months – Illness or Injury 1 month – lay-off or leave of absence Does the employee have continued coverage with paid premium for a leave of absence? Any time period that differ or are different Suicide Limitation Applicable to GL only. Automatically added on contributory coverage Suicide Exclusion Applicable to AD&D product only. Automatically applicable if the case has AD&D otherwise N/A Portability RSL Standard: - available on GL (if included, both life and AD&D coverage may be ported, if AD&D is on the policy) - NOT available VAR Confirm if the Portability provision has been added to this Plan. (Yes or No) Special Note: As a standard, portability is not available to retirees. If we must do this, it requires a filing. Supplemental AD&D Benefit Coverage Amount Enter the Supplemental Coverage Amount. List by Class. How is Supplemental AD&D Benefit elected? Options: -AD&D must match what the employee is insured for under the GL - Automatically enrolled for GL amount
COP%20-%20Supp%20Life-%20AD&D-Dep-FINAL082017.docx