Life Insurance Benefit

If you die from any cause while you are insured, the proceeds will be paid to your beneficiary.  The proceeds may be paid in monthly or annual installments or as a lump sum.

Beneficiary

You may name anyone you wish as your beneficiary.  You may change your beneficiary at any time by completing the proper form.  The change will be effective when the I.U.O.E. Local 132 Health and Welfare Fund receives the completed form at its office.

Conversion Privilege

If you are no longer eligible for group life insurance due to your ceasing to belong to an eligible insured class or if you terminate your employment, you may convert that benefit to any form of individual life insurance usually offered by the Insurance Company, except for term.

You will not need a medical examination, but you must complete the application form and send it with the first premium payment to the Insurance Company no later than thirty-one (31) days after your group life insurance has terminated.

The face value of your new policy cannot be more than the amount you had under the group plan.  The rate you pay will depend upon your age (at the nearest birthday to the date of issue of the individual policy) and your class of risk at the time of your conversion.

You may also convert if your life insurance benefits terminate because the policy terminates, or because life insurance benefits for your class terminate.  In this case, however, you must have been covered under the group plan for at least five (5) years.  You may convert the lesser of the following amounts:

• The amount of life insurance you have under this Plan, less any new amount you may have or for which you may become eligible under another group plan within thirty-one (31) days of termination; or
• Two thousand dollars ($2,000)

If you should die during the thirty-one (31) day period after your group life insurance has terminated, the Insurance Company will pay the group life insurance benefits to the last beneficiary you named, whether or not you applied for an individual life insurance policy.

Accidental Death and Dismemberment Benefit
(24 Hour Coverage)

This benefit will be payable if you, while insured, sustain any of the losses mentioned below as a result of purely accidental means.  The loss must take place within ninety (90) days from the date of the accident for the benefits to be payable.  This benefit is in addition to your other benefits under this Plan.

Who Will Receive Benefits

For loss of life, benefits will be paid to the beneficiary you name.  For any other loss, the benefits will be paid to you.

Definitions

• Principal Sum is the benefit amount shown in the Schedule of Benefits.
• Loss of hand or foot means that the limb is severed at or above the wrist or ankle joint.
• Loss of sight means the total and irrecoverable loss of sight.

The Benefits

If you suffer more than one loss in any one accident, no more than the full amount of your benefit will be paid.  The full amount is the principal sum.

Beneficiary

You may name anyone your wish as your beneficiary.  You may change your beneficiary at any time by completing the proper form.  The change will be effective when the form is received by the I.U.O.E. Local 132 Health and Welfare Fund at its office.

Losses that are Not Covered

No benefit is payable under this section if your death or any loss is caused directly or indirectly, in whole or in part, by:

• Bodily or mental illness or disease of any kind;
• Ptomaines or bacterial infection (except infections caused by pyogenic organisms which occur with and through an accidental cut or wound);
• Suicide or intentional self-inflicted injury;
• Participation in the commission of a felony; or
• Any act of war, whether declared or undeclared.

Dependents’ Life Insurance Benefits

Life insurance is provided for your eligible dependents in the amounts shown in the Schedule of Benefits.  If one of your dependents dies, the life insurance proceeds will be payable to you.  However, if you die before your dependent, you dependent’s life insurance proceeds will be payable upon his death to the executor or administrator of the estate or, at the Company’s option, to any one or more of his or her surviving relatives; mother, father, child or children, brothers or sisters.

Effective Date of Dependents’ Life Insurance

Coverage for your dependents starts on the date your coverage starts or, if your coverage is already in effect, on the date he acquires the status of an eligible dependent.

Termination of Dependents’ Life Insurance

The dependents’ life insurance shall terminate on the earliest of the following:

• The date your insurance as an employee terminates;
• The date a change is made in the Plan to terminate dependents’ coverage; or
• The date a dependent is no longer an eligible dependent, as defined above.

Exception:  If your dependents’ life insurance would otherwise terminate due to your death, such dependent will continue to be eligible for the rest of the Benefit Quarter for which you would have been otherwise eligible.

Conversion Privilege

If your dependents’ life insurance terminates because your coverage terminates or because his eligibility terminates, he may convert that benefit to any form of life insurance, except term, usually offered by the Company.

A medical examination will not be required.  However, the application form and the first premium payments must be sent to the Company no later than thirty-one (31) days after the life insurance coverage has terminated.

The face value of the new policy cannot be more than the amount under the group plan.  The rate charged will depend upon your Dependents’ age and class of risk at the time of conversion.

The converted policy will become effective on the thirty-second (32) day following the date his or her life insurance coverage terminated.

Your dependent may also convert if his life insurance benefits terminate because the policy terminates, or because life insurance benefits or dependent status terminates.  In this case, however, he must have been covered under the group plan for at least three (3) years.  He may convert the lesser of the following amounts:

• The amount of life insurance he had under this Plan, less any amount of group life insurance for which he may become eligible under a group plan issued or reinstated within thirty-one (31) days of such termination; or
• Two thousand dollars ($2,000)

If your dependent dies during the thirty-one (31) day period after his group life insurance terminated, the Company will pay the life insurance benefit, as specified in the provision, whether or not your dependent had applied for an individual life insurance conversion policy.

General Provisions

How to Appeal a Life Insurance Claim

If you do not agree with a claim denial, you may request that a review be made of your claim.  The claim denial will tell you the name and address of the person to whom you may send a written request.

You may submit additional information with your request for review.  You may request and receive copies of pertinent documents, although in some cases approval may be needed for the release of confidential information, such as medical records.  You may submit issues and comments in writing.

A decision will be made within sixty (60) days following the date the Insurance Company received your request for review or the date the Insurance Company received all information required of you, whichever date is later.  You will be notified of the decision in writing and you will be given clear and specific reasons for the decision.

Facility of Payment

If you or your Dependent are not legally capable of giving a valid receipt for a benefit payment, the Insurance Company has the right (if there is no legal guardian) to pay the party it believes is entitled to such payment.  Once such a payment is made, the Insurance Company has no further obligation with respect to the amount so paid.  If you name more than one (1) Beneficiary, but do not say how much each Beneficiary should receive, the total amount will be shared equally by all surviving Beneficiaries.  If there is no living Beneficiary when you die, the Insurance Company will make the payment to your spouse; if none, to your children; if none, to your parents; if none, to your brothers and sisters.  However, the Insurance Company has the option to make the payment to your estate.

Examinations

The Insurance Company shall have the right and opportunity through its medical representative to examine any living insured during the pendency of a claim and so often as it may reasonably require.

The Insurance Company shall also have the right to make an autopsy in the case of death, where it is not forbidden by law.

Legal Actions

No action at law or in equity shall be brought to recover on the policy prior to the expiration of sixty (60) days after written Proof of Loss has been furnished.  No action shall be brought after the expiration of three (3) years from the time Proof of Loss is required.

Change of Beneficiary

The right to change of beneficiary is reserved to the insured.  The consent of the beneficiary or beneficiaries is not required for any change in beneficiary requested by the insured.

Conformity with State Laws

Where required by law, limitations will be extended to comply with the minimum requirements of the state in which the insured resides or works.