LIFE INSURANCE IS VITAL INSURANCE PROTECTION YOUR FAMILY MAY NEED
You certainly understand the importance of having sufficient life insurance. Now, you have the opportunity to make sure you have that protection. Your loved ones will appreciate the assurance this Plan can help provide, with benefits that will help let them go on with less of a financial concern.
Who is Eligible?
Members of the Minnesota Dental Association, in good standing, under age 65, not engaged in active military duty and working full-time (at least 20 hours per week), are eligible to apply for this coverage for themselves, their lawful spouse, under age 65, and their unmarried dependent children ages 14 days to 19 years (25 if a full-time student) (subject to state variations). A dependent spouse of child, who is a member, is eligible for either member or dependent coverage, but not both.
Acceptance into this plan is subject to evidence of insurability as determined by United States Life. Depending on your age, health and the amount of coverage requested, a paramedical exam may be required. If a paramedical exam is required, it will be scheduled at your convenience and at no cost to you.
You can choose benefit amounts ranging from $10,000 to $500,000 in $10,000 increments (but not to exceed five times your basic annual earnings). Spouse benefit amounts can range from $10,000 to $250,000 in $10,000 increments (but not to exceed 50% of your benefit amount). You can choose benefit amounts for each eligible dependent child ranging from $2,500 to $10,000 in $2,500 increments.
At age 65, your benefits will be limited to 35% of the amount in effect on the day before you attain age 65; at age 70, your benefits will be limited to 20% of the amount in effect on the day before you attain age 70; at age 75, our benefits will be limited to 15% of the amount in effect on the day before you attain age 75; and at age 80, your benefits will be limited to 10% of the amount in effect on the day before you attain age 80. On your spouse’s premium due date coinciding with or next following the date your spouse attains age 70, his/her amount of insurance will be reduced to 50% of the amount in effect on the day before he/she attained age 70.
IMPORTANT FEATURES
Waiver of Premium
If, as a result of an injury or sickness, you become totally disabled and unable to perform any work for pay or profit, any premiums that fall due while you are totally disabled, as defined in the policy, will be waived. The total disability must begin prior to age 60 and continue for a minimum of 9 months without interruption. Waiver of premium will end on the date your total disability ends, proof of total disability is not given by you when due; you are not examined when required or you attain age 70.
Conversion Privilege
If your insurance ends for a reason other than non-payment of premium, you may buy an individual policy of life insurance from United States Life without providing evidence of insurability during the conversion period. The amount of the new policy will depend on the reason insurance ends and may be any form then being issued by United States Life which does not provide term insurance or pay dividends. Conversion is also applicable for dependent coverage if a dependent’s life insurance ends.
Accelerated Death Benefits
In the event of a terminal illness, you may request to receive 50% of your life insurance benefit, which must be at least $20,000, up to a maximum of $250,000, less the discount for requesting the benefit, if you are diagnosed with a terminal illness which is expected to result in your death within 12 months and from which you are not expected to recover. The remaining benefit then becomes payable to your beneficiary after your death. All members under age 70 who are insured for life insurance under the group policy for at least 180 consecutive days are eligible for this benefit.
Accelerated death benefits are not payable if you have made an absolute assignment of your life insurance under the group policy, if all or part of your life insurance under the group is to be paid to your child(ren) or former spouse as part of a court approved divorce agreement, if the insurance company does not receive written consent by any irrevocable beneficiary or if the terminal illness is a result of intentional self-inflicted injury or attempted suicide.
Receipt of accelerated death benefits may be taxable. Seek assistance from your personal tax advisor for more information.
Your beneficiary is the person(s) last designated by you in writing, and recorded by, or on behalf of United States Life. You may change your beneficiary designation at any time, unless irrevocable, by written request. You are the automatic beneficiary for your dependent spouse and child(ren)s' insurance, if applying, as described in the Certificate of Insurance. If you wish, you may name another beneficiary for your spouse's coverage.
Effective Date
Your insurance will take effect on the date United States Life approves the request for coverage, provided the initial premium contribution has been paid and satisfactory evidence of insurability has been submitted. You must be actively at work on the date your insurance is to take effect. If you are not, such insurance will take effect on the day you resume such work for 10 consecutive days. Your dependent spouse and children, if applying, must be able to perform the normal activities of a person of like age and sex, with like occupation or retired status on the date their insurance is to take effect. If not, such insurance will take effect on the day they resume such activities. Your dependent spouse and children must also not be hospitalized on the date their insurance is to take effect. If so, insurance will take effect on the day after they are discharged.
MONTHLY PREMIUMS
| Monthly Premium Per $1,000 |
| Member/Employee |
| Age |
Uni-Smoker |
| 0-29 |
$0.07 |
| 30-34 |
$0.08 |
| 35-39 |
$0.11 |
| 40-44 |
$0.17 |
| 45-49 |
$0.30 |
| 50-54 |
$0.49 |
| 55-59 |
$0.81 |
| 60-64 |
$1.01 |
| 65-69 |
$1.74 |
| 70-74 |
$2.84 |
| 75-85 |
$4.37 |
| |
| Spouse |
| Age |
Uni-Smoker |
| 0-29 |
$0.07 |
| 30-34 |
$0.08 |
| 35-39 |
$0.11 |
| 40-44 |
$0.17 |
| 45-49 |
$0.28 |
| 50-54 |
$0.47 |
| 55-59 |
$0.77 |
| 60-64 |
$0.96 |
| 65-69 |
$1.66 |
| 70-74 |
$2.70 |
| 75-85 |
$4.16 |
| Dependent child rate - .20 per $1,000 |
| Monthly Premium Per $10,000 |
| Member/Employee |
| Age |
Uni-Smoker |
| 0-29 |
$0.70 |
| 30-34 |
$0.80 |
| 35-39 |
$1.10 |
| 40-44 |
$1.70 |
| 45-49 |
$3.00 |
| 50-54 |
$4.90 |
| 55-59 |
$8.10 |
| 60-64 |
$10.10 |
| 65-69 |
$17.40 |
| 70-74 |
$28.40 |
| 75-85 |
$43.70 |
| |
| Spouse |
| Age |
Uni-Smoker |
| 0-29 |
$0.70 |
| 30-34 |
$0.80 |
| 35-39 |
$1.10 |
| 40-44 |
$1.70 |
| 45-49 |
$2.80 |
| 50-54 |
$4.70 |
| 55-59 |
$7.70 |
| 60-64 |
$9.60 |
| 65-69 |
$16.60 |
| 70-74 |
$27.00 |
| 75-85 |
$41.60 |
| Dependent child rate - .50 per $2,500 |
Rates are based on your attained age on the effective date of insurance. Rates will change for you and your insured spouse when you enter a new age band. At age 65, your coverage will be limited to 35% of the amount in effect on the day before you attain age 65; 20% at age 70; 15% at age 75; and 10% at age 80. On your spouse’s premium due date coinciding with or next following the date your spouse attains age 70, his/her amount of insurance will be reduced to 50% of the amount in effect on the day before he/she attained age 70. Coverage terminates for you and your spouse, if applying, at age 85.
United States Life reserves the right to change premium rates, but may do so only for all insureds covered under the group policy and with 45 days written notice.
Exclusions and Limitations:
If a person's age, sex or any other data is misstated, the correct data will be used to determine if insurance is in force. If insurance is in force, the premium and/or benefits will be adjusted according to the facts. If a person commits suicide within 2 years from the date his insurance takes effect, United States Life's liability will be limited to the premiums paid, plus interest.
Termination of Coverage
Your insurance can remain in force until age 85, as long as you continue to pay premium contributions when due; the group policy is not terminated or modified by the Policyholder or United States Life to end insurance for the class of insureds to which you belong, and you do not enter active military duty. Insurance for your dependent spouse and children, if insured, will end at the earliest of: the date your insurance ends under the group policy, the date the group policy is changed to end dependents’ life insurance, the date the person ceases to be a dependent, the date premium is not paid for the dependent when due, and with respect to spouses, the date the spouse attains age 85 or the date the spouse enters active military duty.
This plan is underwritten the The United States Life Insurance Company in the City of New York, NAIC No. 70106, domiciled in the state of New York with a principal place of business of 70 Pine Street New York, NY 10270. It is currently authorized to transact business in all states plus DC, except PR. This summary is a brief description of benefits only and is subject to the terms, conditions, exclusions and limitations of Group Policy No. G-610,197, Form No. G-19000. Coverage may vary or may not be available in all states.
The underwriting risks, financial and contractual obligations and support functions associated with products issued by The United States Life Insurance Company in the City of New York (United States Life) are its responsibility.
AG-7671