HomeMy Public PortalAbout2015 Policy Renewal.tifVILLAGE OF KEY BISCAYNE
Human Resources Department
MEMORANDUM
To: John C. Gilbert, Village Manager
From: Carolyn Greaves
Date: April 10, 2015
Re: Hartford Life Insurance Company Renewal
Our Hartford Life Insurance Statutory AD&D coverage for Firefighter and Law Enforcement Officers
is up for a 2 -year renewal on June 1, 2015. We have had this coverage with Linda Marant, Group
Health Plans, Inc., since the Village began operations..
Under Florida Statute 112.19 and Statute 112.181, all sworn law enforcement officers and firefighters
of the Village must be covered for death benefits. The current 2 year prepaid premium will remain
the same at $9,123.00 even though the Hazards, Benefits and Amounts increased as follows:
1. Accidental Death & Dismemberment in the line of duty
Increased from $ 63,853.79 to $66,041.74
2. Fresh Pursuit Coverage
Increased from $63,853.79 to $66,041.74
3. Unlawful and Intentional Death Coverage
Increased from $192,455.70 to $198,272.66
In the past we have requested quotes from other insurance companies, but most insurers are not
interested in this type of coverage and our premiums have not increased even though the coverage
has increased.
If you approve, please initial the attached Quote and we will return it to Ms. Marant so that coverage
will not lapse.
Group Benefits from The Hartford
April 9, 2015
Linda Marant
Group Health Plans of Florida, Inc.
Re: Village of Key Biscayne
ETB-1 04192
Renewal Date: 06/01/2015
Dear Linda Marant,
THE4.9
HARTFORD
We have prepared a competitive quote based on the renewal information received. Please initial the
appropriate box below, and e-mail or fax it back to my attention.
Note: Once returned, this document will serve as your coverage binder.
Options Premium
2 Years Prepaid Premium: $9,123
Do Not Renew Coverage:
* Proposal and Rates are valid for 60 days.
We appreciate the opportunity to write this coverage for your client. The renewal was rated including the
following benefits:
• C-62 In the Line of Duty Coverage - $66,041.74
• C-64 Fresh Pursuit Coverage- $66,041.74
• C-31 VL 118 Unlawful and Intentional Death Coverage - $198,272.66
Regards,
Jessica Mills, MBA, CPCU
Underwriter —Accident Lines
The Hartford, Group Benefits
Phone: 678-566-4388
jessica. m iI Is(rDthehartford. com
Expertise without equal.
Benefits without burden7'
Hartford Life Group Benefits Division
Business Travel Accident Underwriting
Toll Free 888 560 9632
Facsimile 678 762 0325
Mailing Address: P.O. Box 2250
Alpharetta, GA 30023
"
p = a n _ - - -
Carolyn Greaves
From:
Sent:
To:
Subject:
Attachments:
Importance:
Hi Carolyn,
Linda Marant [Imarant@bellsouth net]
Wednesday, May 13, 2015 11:21 AM
Carolyn Greaves
VILLAGE OF KEY BISCAYNE - The Hartford Policy Renewal 6-1-2015 to 6-1-2017
Village of Key Biscayne - The Hartford - Invoice 21-ETB-104192 INV (2015-2017) pdf, Village
of Key Biscayne - The Hartford Policy 21-ETB-104192 PD (2015-2017).pdf
High
I have attached the renewal documents for The Hartford Policy ETB-104192 for the Village of Key Biscayne for the policy
term June 1, 2015 —June 1, 2017. The Invoice is also attached. Please send the 2 -year pre -paid premium remittance of
$9,123 directly to The Hartford Insurance Company, P. O. Box 7247-0234, Philadelphia, PA 19170-0234.
I thank you and the Village for giving me the opportunity to be of service Please contact me if I may be of further
assistance.
Warmest regards,
Linda
Linda .Marant
GROUP HEALTH PLANS OF FLA., INC.
5870 S W 36`h Terrace
Fort Lauderdale, FL 33312
(954)986-2550
(954)986-2565 - Fax
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY
Hartford Plaza
Hartford, Connecticut
(A stock insurance company)
Will pay benefits according to
the conditions of this
policy.
Policyholder Name: Village of Key Biscayne
Policyholder Address: 88 West McIntyre Street
Key Biscayne, FL 33149
Policy Number: ETB-104192*
Place of Delivery: Key Biscayne, FL
Policy Effective Date: June 1, 2015
Policy Expiration Date: June 1, 2017
TABLE OF CONTENTS
Schedule
Participating Firms (if any)
Contract Provisions
Definitions
Determination of Individual Coverage
Exclusions
Hazards
Benefits
Claims
Riders (if any)
*This policy replaces the prior policy bearing the above number as of the
effective date of this policy.
Signed for the Company
Terence Shields, Secretary Michael Concannon, Executive Vice President
Form 7679 A2
SCHEDULE
ELIGIBLE PERSONS
Class
1
Description
All Sworn Law Enforcement Officers, Dispatchers and Police Department
clerical employees of the Policyholder
2 All Firefighters and Fire Department clerical employees of the
Policyholder
Form 7679 96
BENEFIT DESCRIPTION
AD means Accidental Death Benefit
Loss Period 365 days (not applicable to residents of Pennsylvania)
ADD means Accidental Death and Dismemberment Benefit
Loss Penod 365 days
For residents of Pennsylvania, the 365 days loss period is not applicable for loss of life only
ATD means Accident Total Disability Benefit
Maximum Payment Period 52 weeks
ED means Education Benefit
SPOED means Spouse Education Benefit
DCARE means Day Care Benefit
HAZARDS, BENEFITS, AND AMOUNTS
Class
1
2
Hazard Benefit Amount
C-31 VL118 AD $198,272 66 unlawful & intentional death
ATD $100
DCARE $2,000
ED $2,000
SPOED $2,000
C-62 ADD $66,041 74 in the line of duty
C-64 AD $66,041 74 fresh pursuit
C-31 VL118 AD $198,272 66 unlawful & intentional death
ATD $100
DCARE $2,000
ED $2,000
SPOED $2,000
C-62 ADD $66,041 74 in the line of duty
C-64 AD $66,041 74 fresh pursuit
*The ATD Benefit amount is subject to 80% of salary
Accidental Death and Dismemberment Reduction on and after Age 70 On the date of the Insured Person's attainment of
ages 70, 75, 80, and 85, the Insured Person's amount of Principal Sum will reduce The reduced amount will be
determined by multiplying the Amount of Principal Sum shown in the Schedule and applicable to the Insured Person by
the percentage shown below for his or her attained age
Insured Person's Age Percentage of Principal Sum
Age70-74 65%
Age75-79 45%
Age 80 — 84 30%
Age 85 or over 15%
Insured Persons age 70 or over will not be eligible for a Principal Sum Amount that is more than the Percentage of
Principal Sum shown above for his or her attained age
Form 7679 B7
POLICY PREMIUMS
Premium Not Subject To Audit $9,123
Premium Subject To Audit $0
Total Premium For Policy Period $9,123
Total Premium Payable on Effective Date
Form 7679 B8
POLICY MODIFICATIONS This policy as issued is amended as follows*
1) The definition of injury under this policy is amended to include the following
a) Any occupational condition or impairment of health of a fireman or any law enforcement officer or correctional
officer caused by tuberculosis, heart disease, or hypertension resulting in death shall be presumed to be
accidental, suffered in the line of duty, and to be a covered injury To be entitled to this presumption, the
definitions and requirements of Section 112 18 must be met
b) Any firefighter, paramedic, emergency medical technician, law enforcement officer, or correctional officer who
suffers an occupational condition or impairment of health that is caused by hepatitis, meningococcal meningitis, or
tuberculosis, that requires medical treatment, and that results in death shall be presumed to have been accidental
and to be a covered injury To be entitled to this presumption, the definitions and requirements of Sections
112.181 must be met
c) Any covered firefighter, paramedic, emergency medical technician, law enforcement officer, or correctional officer
who suffers an occupational condition or impairment of health that is caused by exposure to a toxic substance,
adverse results or complications from a smallpox vaccination, or a mental or nervous Injury, that requires medical
treatment, and that results in death shall be presumed to have been accidental and to be a covered Injury To be
entitled to this presumption, the definitions and requirements of Section 112 1815 must be met
2) This policy provides accidental death coverage for police officers and firefighters which is no less restrictive than
benefits specified by Florida statutes 112 19, paragraphs 2) a, b, c, f, and j and 112 191, paragraphs 2) a, b, c and i
This policy provides a Day Care Benefit if
a) We pay a death claim for the unlawful and intentional death of the Insured Person,
b) the Insured Person had a Dependent Child under age 11 at the time of death, and
c) proof of enrollment in a Day Care Program is provided as described below
Payment will be made to the person who has legal physical custody of the dependent child and who has primary
responsibility for the dependent child's expenses Payment will be made in accordance with the Claims provision of the
Policy
Proof of enrollment for each child in a Day Care Program may be in the form of, but will not be limited to, the following
a) a copy of the child's approval enrollment application in a Day Care Program, or
b) canceled check(s) evidencing payment to a Day Care facility or Day Care provider; or
c) a letter from the Day Care facility or Day Care provider stating that the child is attending within 365 days of the
date of the Insured's death
Proof of enrollment must be sent to us prior to the last day of the 12th month on or next following the date of the Insured's
death
One Day Care Benefit payment will be made each year, for a maximum of 2 Day Care Benefit payments, for each
Dependent Child
The Day Care Benefit is the lesser amount of.
a) $2,000 00, or
b) the actual cost charged per year by the Day Care Program
Day Care Program means a program of child care which.
a) is operated in a private home, school or other facility, and
b) provides, and makes a charge for, the care of children, and
c) is licensed as a Day Care center or is operated by a licensed Day Care provider, if such licensing is required by
the state or jurisdiction in which it is located, or
d) if licensing is not required, provides child care on a daily basis for 12 months a year
Child or Children means the Insured's unmarried child, stepchild, legally adopted child, child in the process of adoption or
foster child who is less than age 11 and primarily dependent on the Insured for support and maintenance
This policy provides a Spouse Education Benefit to the Spouse if We pay a death claim for the Insured Person's unlawful
and intentional death
The Insured Person's Spouse, to qualify for this Education Benefit, must enroll in an Occupational Training program within
one year of the date of the Insured Person's death for the purpose of obtaining an independent source of income
The Education Benefit is an amount equal to the lesser of:
a) $2,000 00; or
b) the Expense Incurred for Occupational Training
The expense must be incurred within 3 years of the date of the Insured Person's death
We will pay the Education Benefit due immediately after we receive proof that the Insured Person's Spouse has enrolled
in an Occupational Training program
Occupational Training means any educational, professional, or trade training program which prepares the Insured
Person's Spouse for an occupation for which he or she otherwise would not have been qualified
Expense Incurred means
a) the actual tuition charged, exclusive of room and board, and
b) the actual cost of the materials needed,
or the Occupational Training program.
Spouse means the Insured Person's wife or husband who was not legally separated or divorced from the Insured Person
when he or she died
Form 7679 B10 (FL)2
CONTRACT PROVISIONS
Entire Contract The entire contract between the Policyholder and us consists of this policy, and any papers made a part
of this policy at issue.
Changes No agent has authority to change or waive any part of this policy To be valid, any change or waiver must be in
writing, approved by one of our officers and made a part of this policy
Time Periods All periods begin and end at 12 01 A M , Standard Time at the place where this policy is delivered
Certificates If required by the laws of the state where this policy is delivered, we will give certificates to
a) the Policyholder; or
b) any other person according to a mutual agreement among the other person, the Policyholder and us,
for delivery to Insured Persons The certificates will state the features of this policy which are important to Insured
Persons
Data Furnished by Policyholder The Policyholder
a) with our approval, may keep the records which affect this policy,
b) will give us information from those records, when and in the manner we ask
These records will be open for our inspection at any reasonable time.
Not in Lieu of Worker's Compensation This policy does not satisfy any requirement for worker's compensation insurance
Conformity with State Statutes' On the Policy Effective Date, any part of the policy which is in conflict with a statute of the
state in which the policy is
a) delivered, or
b) issued for delivery,
is hereby amended to agree with the statute's minimum requirements
Cancellation This policy may be cancelled at any time by written notice mailed or delivered by us to the Policyholder or
by the Policyholder to us. If we cancel, we will mail or deliver the notice to the Policyholder at its last address shown in
our records
If we cancel, it becomes effective on the later of
a) the date stated in the notice; or
b) the 31st day after we mail or deliver the notice
If the Policyholder cancels, it becomes effective on the later of
a) the date we receive the notice, or
b) the date stated in the notice
In either event
a) we will promptly return any unearned premium paid, or
b) the Policyholder will promptly pay any earned premium which has not been paid
Any earned or unearned premium will be determined on a pro rata basis
Cancellation will not affect any claim for loss due to an accident which occurs before the effective date of the cancellation
Form 7679 Di
CONTRACT PROVISIONS (Continued)
Policy Period* This Policy becomes effective on the Policy Effective Date and continues in force to the end of the period
for which premium was paid unless cancelled at an earlier date This Policy terminates on the earlier of
a) the Policy Expiration Date unless continued in force in accordance with the Renewal Provision; or
b) the last day of the period for which premium has been paid subject to the Grace Period
The Policy Effective Date and Policy Expiration Date are shown
a) on page 1 for the original Policy Period, and
b) in a Renewal Rider for any Renewal Policy Period.
Renewal We will send the Policyholder a notice of policy renewal The Policy will be renewed if the Policyholder signs
and returns the notice prior to the current Expiration Date If the Policyholder does not receive the notice, the policy may
be renewed if we receive a written request from the Policyholder and a deposit renewal premium of $350 on or before the
current Expiration Date Once we have received the deposit renewal premium, we will request information from the
Policyholder necessary to calculate the actual renewal premium and either return any excess premium or bill the
Policyholder for the remaining unpaid renewal premium
However, in no event will this policy be renewed if
a) we have refused to renew this policy on or before the current Expiration Date;
b) this policy has been cancelled on or before the current Expiration Date; and
c) the Policyholder does not give us, in advance of the current Expiration Date, the information we request
Premium Due Dates Each Premium is due in advance of the date the Schedule states that it is payable If the Schedule
shows an amount for Premium Subject To Audit, the earned premium will be calculated for each date on which the
Policyholder is required to furnish data for determining Units of Exposure If the earned Premium:
a) is greater than the premium paid, the additional premium is payable on the date we notify the Policyholder of the
amount,
b) is less than the premium paid, we will promptly return the unearned portion of the premium paid
Grace Period A Grace Period of 31 days is allowed for payment of each premium due after the initial premium, unless
this policy is cancelled on or before the due date If the Policyholder has returned the notice of renewal prior to the Policy
Expiration Date, a Grace Period of 31 days from the Policy Expiration Date is allowed for payment of the renewal
premium This policy will continue in force during the Grace Period. The Policyholder is liable to us for the payment of
Premium accruing for the period this policy continues in force.
Payment Premiums are to be paid to us by the Policyholder However, they may be paid to us by any other person
according to a mutual agreement among the other person, the Policyholder and us
Change of Premiums We have the nght to change the rate at which Premiums will be calculated for each Policy Period
Form 7679 D2 (Rev -1)
DEFINITIONS
Each term listed, when used in this policy, has the following meaning'
We, us, or our means the insurance company named on page 1
You Your or Insured Person means an Eligible Person while he or she is covered under this policy
Inlury means, and an Insured Person is covered for, bodily injury resulting directly and independently of all other causes
from accident which occurs:
a) while he or she is covered under, and
b) in the manner specified in;
a Hazard applicable to his or her class
Loss resulting from
a) sickness or disease, except a pus -forming infection which occurs through an accidental wound, or
b) medical or surgical treatment of a sickness or disease
is not considered as resulting from injury
Business Trip means a bona fide trip:
a) while on assignment or at the direction of the Policyholder for the purpose of furthering the business of the
Policyholder,
b) which begins when a person leaves his or her residence or place of regular employment, whichever last occurs,
for the purpose of beginning the trip,
c) which ends when he or she returns to his or her residence or place of regular employment, whichever first occurs,
and
d) excluding travel to and from work, bona fide leaves of absence and vacations.
Trip means a trip which
a) begins when a person leaves his or her residence or place of regular employment, whichever last occurs, for the
purpose of beginning the trip, and
b) ends when he or she returns to his or her residence or place of regular employment, whichever first occurs
Passenger means a person who is not
a) the operator or driver, or
b) the pilot, student pilot, or a crewmember,
of a conveyance at the time of accident
Common Carrier means a conveyance operated by a concern, other than the Policyholder, organized and licensed for the
transportation of passengers for hire and operated by an employee of that concern
Form 7679 El
DEFINITIONS
Civil Aircraft means a civil or public aircraft which'
a) has an Airworthiness Certificate,
b) is piloted by a person who has
1) a current pilot certificate with the appropriate aircraft category rating for that aircraft, and
2) a current medical certificate which is appropriate for the operation of that aircraft, and
c) is not operated by the militia, or armed forces of any state, national government or international authority
Scheduled Aircraft means a Civil Aircraft operated by a scheduled airline which
a) is licensed by the FAA for the transportation of passengers for hire, and
b) publishes its flight schedules and fares for regular passenger service
Military Transport Aircraft means a transport aircraft operated by
a) the United States Air Mobility Command (AMC), or
b) a national military air transport service of any country
Policyholder Aircraft means an aircraft which is owned, leased, or operated by or on behalf of the Policyholder
Airworthiness Certificate means a valid and current "Standard Airworthiness Certificate" issued by the FAA
FAA means
a) the Federal Aviation Administration of the United States, or
b) the similar aviation authority for the country of the aircraft's registry, if the country is recognized by the
United States
Extra -Hazardous Aviation Activity means an aircraft while it is being used for one or more of the following activities
Acrobatics or Stunt Flying
Racing or any Endurance Test
Crop Dusting or Seeding
Spraying
Exploration
Pipe or Power Line Inspection
Any Form of Hunting
Bird or Fowl Herding
Form 7679 E2
Aerial Photography or Banner Towing
Any Test or Experiment
Firefighting
Any flight which requires
a) a special permit, or
b) waiver,
from the FAA, even though granted
DETERMINATION OF INDIVIDUAL COVERAGE
Effective Date* Each Eligible Person becomes an Insured Person on the later of
a) the Policy Effective Date, or
b) the date he or she enters a Class of Eligible Persons
Termination Coverage of each Insured Person terminates on the earlier of
a) the date this policy terminates, or
b) the date he or she does not qualify in any Class of Eligible Person
Termination will not affect any claim for loss due to an accident which occurs before the effective date of the termination
The Policyholder's failure to report that a person ceased to qualify in a Class of Eligible Persons will not continue
coverage in that Class beyond the date he or she ceased to qualify.
Hazards and Benefits Determined By Class Each Insured Person is covered under the Hazard and for the Benefits
applicable to the Class in which he or she qualifies:
a) beginning on the date he or she enters the Class, and
b) ending on the date he or she leaves the Class
If an Insured Person qualifies in more than one Class on the date of accident, he or she will be considered to qualify in the
one Class with the largest Benefit Amount.
Form 7679 F1
EXCLUSIONS AND AGGREGATE LIMITATION
Exclusions This policy does not cover any loss resulting from
1) intentionally self-inflicted Injury, suicide or attempted suicide whether sane or insane, (in Missouri, while sane);
2) war or act of war, whether declared or undeclared,
3) Injury sustained while in the armed forces of any country or international authority,
Aggregate Limitation. Not Applicable
Form 7679 G1
HAZARD C-31 V L 118
Unlawful and Intentional Death
While on the Business of the Policyholder
Coverage This Hazard covers death resulting from the unlawful and intentional killing of the Insured Person which occurs
anywhere in the world,
a) in the performance of actual duties, and
b) while on the business of the Policyholder
The term "while on the business of the Policyholder" as used herein means while on assignment by or at the direction of
the Policyholder whether on or off the premises of the Policyholder, for the purpose of furthering the business of the
Policyholder
Refer to the Policy Modifications, Definitions and Exclusions sections for modifications, limitations and exclusions affecting
this coverage
Form 7679 H-31 V L. 118
HAZARD C-62
24 -Hour Coverage
While on the Business of the Policyholder
Coverage This Hazard covers Injury resulting from'
a) an accident, and
b) an accident while the Insured Person is a passenger (but not as a pilot, operator or member of the crew) on,
boarding or alighting from a Civil Aircraft or Military Transport Aircraft, or
c) being struck by an aircraft,
which occurs anywhere in the world while On the Business of the Policyholder
On the Business of the Policyholder means business while on assignment by or at the direction of the Policyholder
whether on or off the premises of the Policyholder for the purpose of furthering the business of the Policyholder
Refer to the Policy Modifications, Definitions and Exclusions sections for modifications, limitations and exclusions affecting
this coverage
Form 7679 H-62
HAZARD C-64
Fresh Pursuit Coverage for
Police Officers and Firefighters
While on the Business of the Policyholder
Coverage This Hazard covers Injury resulting from
a) for law enforcement, correctional, or correctional probation officers results in Accidental Death that occurs
1) as a result of the officer's response to fresh pursuit;
2) as a result of the officer's response to what is reasonably believed to be an emergency,
3) at the scene of a traffic accident to which the officer has responded, or
4) while the officer is enforcing what is reasonably believed to be a traffic law
or ordinance
b) for firefighters, results in Accidental Death as a result of the firefighter's response to what is reasonably believed
to be an emergency involving the protection of life or property
Fresh Pursuit means the pursuit of a person who has committed or is reasonably suspected of having committed a felony,
misdemeanor, traffic infraction or violation of a county or municipal ordinance Fresh Pursuit shall not necessarily imply
instant pursuit, but pursuit without reasonable delay
Refer to the Policy Modifications, Definitions and Exclusions sections for modifications, limitations and exclusions affecting
this coverage
Form 7679 H-64
ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT
If an Insured Person's injury results in any of the following losses within the Loss Period after the date of accident, we will
pay the sum shown opposite the loss
We will not pay more than the Principal Sum for all losses due to the same accident
The Principal Sum and the Loss Period are shown in the Schedule
For Loss of
Life . . ..
Both Hands or Both Feet or Sight of Both Eyes
One Hand and One Foot. .
Speech and Hearing .. . . . . .... .. . .
Either Hand or Foot and Sight of One Eye .
Either Hand or Foot
Sight of One Eye
Speech or Hearing
Thumb and Index Finger of Either Hand
The Principal Sum
The Principal Sum
The Principal Sum
. The Principal Sum
The Principal Sum
One Half The Principal Sum
One Half The Principal Sum
One Half The Principal Sum
One Quarter The Principal Sum
Loss means with regard to
a) hands and feet, actual severance through or above wrist or ankle joints,
b) sight, speech or hearing, entire and irrecoverable loss thereof,
c) thumb and index finger, actual severance through or above the metacarpophalangeal joints
EXPOSURE
Exposure to the elements will be presumed to be injury if
a) it results from the forced landing, stranding, sinking or wrecking of a conveyance in which an Insured Person was
an occupant at the time of the accident, and
b) this policy would have covered injury resulting from the accident
DISAPPEARANCE
An Insured Person will be presumed to have suffered loss of life if
a) his or her body has not been found within one year after the disappearance of a conveyance in which he or she
was an occupant at the time of its disappearance,
b) the disappearance of the conveyance was due to its accidental forced landing, stranding, sinking or wrecking, and
c) this policy would have covered injury resulting from the accident
Form 7679 J1
ACCIDENTAL DEATH BENEFIT
If an Insured Person's injury results in loss of life within the Loss Period after the date of the accident, we will pay the
Principal Sum
The Principal Sum and the Loss Period are shown in the Schedule
DISAPPEARANCE
An Insured Person will be presumed to have suffered loss of life if
a) his or her body has not been found within one year after the disappearance of a conveyance in which he or she
was an occupant at the time of its disappearance,
b) the disappearance of the conveyance was due to its accidental forced landing, stranding, sinking or wrecking, and
c) this policy would have covered injury resulting from the accident
Form 7679 Li
ACCIDENT TOTAL DISABILITY BENEFIT
We will pay the Weekly Benefit for each week of an Insured Person's Total Disability Payment will not exceed the
Maximum Payment Period
Total Disability must
a) result from injury,
b) begin within 30 days after the accident, and
c) require the regular care of a legally qualified physician
For Total Disability of less than one week, one seventh of the Weekly Benefit will be paid per day
The Weekly Benefit and Maximum Payment Period are shown in the Schedule
Total Disability means the Insured Person's inability to perform the duties of his/her occupation for one year and
thereafter unable to perform the substantial duties of any occupation for which he of she is suited by education, training
and experience
Termination of this policy will not affect any benefits payable under this benefit for any accident that occurred while the
Insured Person was covered under this Policy.
Form 7679 M3
EDUCATION BENEFIT
If a Principal Sum is payable under the Accidental Death and Dismemberment Benefit because of the Insured Person's
death, We will pay an Education Benefit to each Student as follows
A Student is a person for whom we receive proof that he or she
a) is your Dependent on the date of your death, and
b) is a full-time post -high school Student in a school for higher learning on the date of the Insured Person's death, or
c) became a full-time post -high school Student in a school for higher learning within 365 days after the Insured Person's
death and was a Student in the 12th grade on the date of the Insured Person's death
He or she is not considered to be a Student after the first to occur of
a) our payment of the 4th Education Benefit to or on behalf of that person, or
b) the end of the 12th consecutive month during which We have not received proof that he or she is a Student
The Education Benefit is an amount equal to the lesser of
a) the Maximum Amount; or
b) the amount determined by applying the Percent to the amount of the Insured Person's Principal Sum.
We will not pay more than one Educational Benefit to any one Student during any one school year
The Education Benefit is payable to each Dependent Child
a) on the date; and
b) for whom,
We receive proof that he or she is a Student
If he or she is a minor, We will pay the benefit to the Student's legal representative
If.
a) a Principal Sum is payable because of the Insured Person's death, and
b) no Dependent Child qualifies as a Student,
we will pay the Minimum Amount due in accordance with the claim provision for payment of benefits for loss of life
The Insured Person's amount of the Principal Sum is determined in the Schedule
The Maximum Amount, Percent of Principal Sum, and Minimum Amount are shown in the Schedule
Form 7679 T1 (FL)
CLAIMS
Notice of Claim The person who has the right to claim benefits (the claimant or beneficiary, or his or her representative)
must give us written notice of a claim within 30 days after a covered loss begins If notice cannot be given within that
time, it must be given as soon as reasonably possible
The notice should include the Insured Person's name and the policy number. Send it to our office in Hartford,
Connecticut, or give it to our agent
Claim Forms When we receive the notice of claim, we will send forms to the claimant for giving us proof of loss The
forms will be sent within 15 days after we receive the notice of claim
If the forms are not received, the claimant will satisfy the proof of loss requirement if a written notice of the occurrence,
character and nature of the loss is sent to us
Proof of Loss Proof of loss must be sent to us in writing within 90 days after.
a) the end of a period of our liability for periodic payment claims, or
b) the date of the loss for all other claims
If the claimant is not able to send it within that time, it may be sent as soon as reasonably possible without affecting the
claim The additional time allowed cannot exceed one year from the date proof of loss is due, unless the claimant is
legally incapacitated
Time of Claim Payment We will pay any daily, weekly or monthly benefit due
a) on a monthly basis, after we receive the proof of loss, while the loss and our liability continue, or
b) immediately after we receive the proof of loss following the end of our liability
We will pay any other benefit due immediately, but not more than 60 days, after we receive the proof of loss
Payment of Claims We will pay any benefit due for loss of the Insured Person's life
a) according to the beneficiary designation in effect at the time of his or her death, otherwise,
b) to the surviving child or children and spouse in equal shares, otherwise
c) to the parents or parent
If there is no survivor in these classes, payment will be made to the Insured Person's estate
All other benefits due and not assigned will be paid to the Insured Person, if living Otherwise, the benefits will be paid
according to the preceding paragraph
Form 7679 Z2 FL Statute
If a benefit due is payable to
a) the Insured Person's estate, or
b) the Insured Person or a beneficiary who is either a minor or not competent to give a valid release for the payment,
we may pay up to $1,000 ($3,000 for residents of Florida) of the benefit due to some other person
The other person will be someone related to the Insured Person or the beneficiary by blood or marriage who we believe is
entitled to the payment We will be relieved of further responsibility to the extent of any payment made in good faith
Appealing Denial of Claims If a claim for benefits is wholly or partially denied, notice of the decision shall be furnished to
the Insured Person within 45 days This written decision will
a) give the specific reason or reasons for denial,
b) make specific reference to policy provisions on which the denial is based,
c) provide a description of any additional information necessary to prepare the claim and an explanation of why it is
necessary,
d) provide an explanation of the review procedure, and
e) state what portions of the claim is being disputed and return the uncontested amount within 60 days
On any denied claim, an Insured Person or his representative may appeal to Us for a full and fair review. The claimant
may
a) request a review upon written application within 60 days of receipt of claim denial,
b) review pertinent documents, and
c) submit issues and comments in writing
We will make a decision no more than 90 days after receipt of the request for review The written decision will include
specific reasons for the decision on which the decision is based
Physical Examinations and Autopsy While a claim is pending we have the right at our expense
a) to have the Insured Person who has a loss examined by a physician when and as often as is reasonably
necessary, and
b) in case of death to make an autopsy, where it is not forbidden by law
Legal Actions You cannot take legal action against us.
a) before 60 days following the date proof of loss is sent to us,
b) after 3 years (6 years for residents of South Carolina) following the date proof of loss is due (for Florida residents,
after the expiration of the applicable statute of limitations following the date proof of loss is due)
Naming a Beneficiary The Insured Person may name a beneficiary or change a revocably named beneficiary by giving
your written request to the Policyholder. His or her request takes effect on the date you execute it, regardless of whether
he or she is living when the Policyholder receives it We will be relieved of further responsibility to the extent of any
payment we made in good faith before the Policyholder received his or her request
Assignment. We will recognize any assignment the Insured Person makes under this policy, provided
a) it is duly executed, and
b) a copy is on file with us
We and the Policyholder assume no responsibility for the validity or effect of an assignment.
Form 7679 Z3