City of Charleston
MUGC9452
Mutual
Enrollment Information for:
Voluntary Life
Voluntary Short Term Disability
Voluntary Long Term Disability
Important Benefits Information
Insurance products and services are offered by Mutual of Omaha Insurance Company or one of its affiliates.
Mutual of Omaha Insurance Company, Mutual of Omaha Plaza, Omaha, NE 68175. Mutual of Omaha Insurance
Company is licensed nationwide. Affiliates: United of Omaha Life Insurance Company, Mutual of Omaha
Plaza, Omaha, NE 68175. United of Omaha Life Insurance Company is licensed nationwide, except New York.
Companion Life Insurance Company, 888 Veterans Memorial Highway, Suite 515, Hauppauge, NY 11788.
Companion Life Insurance Company is licensed in New York.
Each company is solely responsible for its own contractual and financial obligations. Products not available in all
states. Some exclusions, limitations and reductions may apply.
United of Omaha Life Insurance Company
A Mutual
of
Omaha Company
The Need for Life Insurance
Life insurance is a simple answer to a very
difficult question: how will my loved ones
manage financially when I die? It’s a subject no
one really wants to think about. But if someone
depends on you financially, it’s one question
you cannot avoid.
Why United of Omaha Life Insurance
Company?
We consistently earn high ratings from leading
independent rating agencies. The company holds an
A+ (Superior)* rating from A.M. Best Company. The
Superior rating is the second highest of 16 ratings
and reflects the organization’s ability to meet the
financial obligations of its policyholders.
income replacement & assets
Annual income your loved ones need now
and in the future (Current income multiplied
by number years needed
–
for example:
$50k x 5 years = $250,000)
$
subtotal (income) = $
final expenses & other debt
Funeral Expenses
$
($15,000 is a reasonable estimate)
Mortgage
$
Credit Card and other debt
$
(Balance, car loans, etc…)
subtotal (debt) = $
educational funds
College costs per person
$
(4 years at Private $118,000/
Public $48,000 institution)
subtotal (education) =
$
total life insurance needed
Income + Debt + Education =
$
total need for life insurance =
$
*As of 10/13
Ratings refer only to the overall financial status of the company, and are not a recommendation of the specific policy provisions, rates
or practices of the insurance company.
Life insurance is underwritten by United of Omaha Life Insurance Company, Mutual of Omaha Plaza, Omaha, NE 68175. Policy form
number 7000GM-U-EZ 2010 or state equivalent (in NC: 7000GM-U-EZ 2010 NC). United of Omaha is licensed nationwide, except
in New York. Some exclusions, limitations and reductions may apply. Please contact United of Omaha Life Insurance Company for
specific product details and policy provisions.
MUGC9445
United 11/13
Protection for Every Stage of Your Life
Whether you’re single, married, have children or
are close to retirement, having life insurance can
help pay benefits to your loved ones after you die.
This could help replace your income and allow
the financial plans you put in place to continue
uninterrupted.
How Much is Enough?
The toughest part about buying life insurance is
determining how much you need. Use the calculator
to the right to determine how much you need.
You can trust United of Omaha
Life Insurance Company for your
financial needs.
For Employees of City of Charleston WV
E
LIGIBILITY
- A
LL
E
LIGIBLE
E
MPLOYEES
EligibilityRequirement
You must be actively at work (able to perform all normal duties of your job) to be
eligible for coverage.
To be eligible for coverage, your dependents must be able to perform normal
activities and not be confined (at home, in a hospital, or in any other care facility).
You must be working a minimum of 2080 hours per year to be eligible for coverage.
You pay 100% of the premium for this coverage through easy payroll deduction.
C
OVERAGE
G
UIDELINES
Employee
Spouse
Child(ren)
Election Options
(All Guarantee Issue)
$10,000
$25,000
$50,000
$100,000
$150,000
$200,000
$10,000
$25,000
$50,000
$5,000
$10,000
Note: Subject to any reductions shown below. For Late Entrants, all coverage amounts will require a health application/evidence of insurability.
BENEFITS
Life Insurance Benefit Amount
Within the coverage guidelines defined above, you select the amount of life insurance
coverage you want.
This plan includes the option to select coverage for your spouse and dependent
child(ren). Children include those 14 days old, up to age 19 (25 if a full-time
student).
Note: In the event of death, the benefit paid will equal the benefit amount after any age reductions less any living
care/accelerated death benefits previously paid under this plan.
Accidental Death &
Dismemberment(AD&D)
Benefit Amount
For you, your spouse and your dependent child(ren): The Principal Sum amount is
equal to the amount of the life insurance benefit.
AD&D coverage is available if you or your dependents are injured or die as a result of
an accident, and the injury or death is independent of sickness and all other causes.
The benefit amount depends on the type of loss incurred, and is either all or a portion
of the Principal Sum.
FEATURES
75% of the amount of the life insurance benefit is available to you if terminally ill, not
to exceed $150,000.
Waiver of Premium
If it is determined that you are totally disabled, your life insurance benefit will
continue without payment of premium, subject to certain conditions.
Annual Benefit Amount
Increase
If you enroll for even the minimum amount of coverage during your initial
enrollment, you have the ability to enroll for additional coverage at your next
enrollment, up to the Guarantee Issue Amount. This feature allows you to secure
additional life insurance protection in the event your needs change (ex. you get
married or have a child).
In addition to basic AD&D benefits, you are protected by the following benefits:
-
Spouse Continuation of - Child Care Center - Child Education
Coverage
-
Seat Belt - Airbag - Spouse Education
-
Repatriation
- Common Carrier
F
EATURES
(C
ONTINUED
)
Portability
The portability feature allows you to continue this insurance for yourself and your
dependents (if applicable) should your employment end, subject to the terms of
eligibility defined in the policy, without having to provide evidence of insurability
(information about your health).
Conversion
If your employment ends, you may apply for an individual life insurance policy from
Mutual of Omaha without having to provide evidence of insurability (information
about your health). You will be responsible for the premium for the coverage.
Note: Additional information about the benefits and features of this plan will be included in the summary of coverage, which you will receive after
enrolling, and in the certificate booklet, available from your employer. Please contact your employer if you have questions prior to enrolling.
AGE REDUCTIONS AND EXCLUSIONS
Your life insurance benefits and guarantee issue amounts are subject to age reductions. At age 65, amounts reduce to 65%.
At age 70+ , amounts reduce to 25%. Spouse coverage terminates at age 70. Coverage terminates at retirement.
Life insurance benefits will not be paid if the insured's death is the result of suicide within two years from the date of issue
(the date coverage begins) of this coverage. If this occurs, the sum of the premiums paid will be returned to the beneficiary.
The same applies for any future increases in coverage under this plan.
Information about the AD&D exclusions for this plan will be included in the summary of coverage, which you will receive
after enrolling.
Please contact your employer if you have questions prior to enrolling.
This information describes some of the features of the benefits plan. Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the
plan's benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this outline, the certificate booklet will prevail.
Benefits availability is subject to final acceptance and approval of the group application by Mutual of Omaha. Term life insurance and accidental death & dismemberment
insurance are underwritten by United of Omaha Life Insurance Company, Mutual of Omaha Plaza, Omaha, Nebraska 68175. United of Omaha Life Insurance Company is
licensed in every state except New York. Term Life Policy Form Number 7000GM-C-EZ-2001. AD&D Policy Form Number 7000M-M-EZ 2001.
To select your benefit amount and calculate your premium, do the following:
1)
Locate the benefit amount you want to select from the top row of the employee premium table. Your benefit amount
must be one of the following options: $10,000; $25,000; $50,000; $100,000; $150,000; $200,000. Refer to the
Coverage Guidelines section for minimums and maximums, if needed.
2)
Find your age bracket in the far left column.
3)
Your premium amount is found in the box where the row (your age) and the column (benefit amount) intersect.
4)
Enter the benefit and premium amounts into their respective areas in the Voluntary Life and AD&D section of your
enrollment form.
Employee Premium Table (12 Payroll Deductions Per Year)
$10,000
$25,000
$50,000
$100,000
$150,000
$200,000
0 - 29
$1.30
$3.27
$6.54
$13.09
$19.63
$26.17
30 - 34
$1.65
$4.07
$8.15
$16.29
$24.44
$32.59
35 - 39
$1.95
$4.88
$9.75
$19.50
$29.25
$39.00
40 - 44
$2.90
$7.30
$14.60
$29.21
$43.81
$58.41
45 - 49
$5.03
$12.55
$25.09
$50.18
$75.27
$100.36
50 - 54
$8.41
$21.02
$42.03
$84.07
$126.10
$168.13
55 - 59
$13.65
$34.15
$68.29
$136.59
$204.88
$273.17
60 - 64
$18.68
$46.65
$93.30
$186.59
$279.89
$373.19
65 - 69
$29.08
$72.69
$145.38
$290.77
$436.15
$581.53
70+
$46.45
$116.13
$232.27
$464.53
$696.80
$929.07
Follow the method described above to select a benefit amount and calculate premiums for optional dependent spouse and/or
child(ren)coverage. Your spouse's rate is based on your age, so find your age bracket in the far left column of the
Spouse Premium Table. Your spouse's premium amo is found in the box where the row (the age) and the column
(benefit amount) intersect. Your spouse's benefit amount must be one of the following options: $10,000; $25,000; $50,000.
Refer to the Coverage Guidelines section for minimums and maximums if needed.
Spouse Premium Table (12 Payroll Deductions Per Year)
$10,000
$25,000
$50,000
0 - 29
$1.30
$3.27
$6.54
30 - 34
$1.65
$4.07
$8.15
35 - 39
$1.95
$4.88
$9.75
40 - 44
$2.90
$7.30
$14.60
45 - 49
$5.03
$12.55
$25.09
50 - 54
$8.41
$21.02
$42.03
55 - 59
$13.65
$34.15
$68.29
60 - 64
$18.68
$46.65
$93.30
65 - 69
$29.08
$72.69
$145.38
All Children Premium Table (12 Payroll
Deductions Per Year)*
$5,000
$10,000
$0.76
$1.52
*Regardless of how many children you have, they are included in the "All Children" premium amounts listed in the table
above.
If you would like to calculate the total premium for your Voluntary Term Life and AD&D benefits (for your own
information), enter the appropriate premium amounts below and add them to obtain a total.
+
+
=
Employee Premium
Spouse Premium
Child(ren) Premium
Total Premium
V
OLUNTARY
T
ERM
L
IFE AND
AD&D C
OVERAGE
S
ELECTION AND
P
REMIUM
C
ALCULATION
Please note that the premium amounts presented below may vary slightly from the amounts provided on your enrollment
form, due to rounding.
United of Omaha Life Insurance Company
A Mutual
of
Omaha Company
The Need for Disability Insurance
Your ability to earn an income may be your most
important asset. Most people wouldn’t think twice about
insuring their home, automobile or health. However,
many do not recognize the need to insure their income.
According to the American Payroll Association, 72% of
American employees live paycheck to paycheck, without
enough savings to cushion a financial blow.
1
Why United of Omaha?
We consistently earn high rating from leading
independent rating agencies. The company holds an
A+ (Superior)* rating from A.M. Best Company. The
Superior rating is the second highest of 16 ratings and
reflects the organization’s ability to meet the financial
obligations of its policyholders.
1
American Payroll Association, “Getting Paid in America” survey, 2010
* As of 2/12. Ratings refer only to the overall financial status of the company, and are not a recommendation of the specific policy
provisions, rates or practices of the insurance company.
Disability insurance underwritten by United of Omaha Life Insurance Company, Mutual of Omaha Plaza, Omaha, NE 68175.
United of Omaha Life Insurance Company is licensed in all states except New York. Policy form: 7000GM-U-EZ 2010 or state
equivalent (In FL: 7000GM-U-EZ 2001 FL 02; In NC: 7000GM-U-EZ 2010 NC).
UGC9273
How Much Do I Need?
A lengthy disability can be devastating, and is more
common than you might think. It can result in a loss
of income, independence and financial security.
Consider how long your savings would pay for:
•
Mortgage or rent
•
Credit cards and other debts
•
Health care
•
Groceries
•
Utilities
•
Car Payments
•
Other transportation
•
Clothing
Easy-To-Understand Protection
•
Elimination Period –
The amount of time you
must
be disabled before benefits begin
•
Benefit Amount –
The amount paid directly to
y
ou for as long as you’re disabled or until you’ve
re
ached the plan’s Maximum Benefit Period
•
Maximum Benefit Period –
The longest period of
time
benefits are payable to you
•
Continuation of Benefits –
Under this feature,
your
disability insurance coverage continues at no
cost
to you while you are receiving benefits
Elimination Period
Disability Benefits
(Days)
(Paid weekly or
monthly)
Amount of time
Benefits Period
you must be
Number of week
s,
disabled
months or years
This information describes some of the features of the benefits plan. Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the
plan's benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this outline, the certificate booklet will prevail.
Benefits availability is subject to final acceptance and approval of the group application by Mutual of Omaha. Short-term disability insurance is underwritten by Mutual of
Omaha Insurance Company or United of Omaha Life Insurance Company. Mutual of Omaha Insurance Company is licensed in all 50 states. United of Omaha Life Insurance
Company is licensed in all states but New York. In New York, Mutual of Omaha Insurance Company underwrites the plan. Policy Form Number 7000GM-MU-EZ 2001.
ELIGIBILITY -
ALL ELIGIBLE EMPLOYEES
Eligibility Requirement
You must be actively at work (able to perform all normal duties of your job) to be
eligible for coverage.
Minimum Work Hours
You must be working a minimum of 2080 hours per year to be eligible for coverage.
Coverage Payment
You pay 100% of the premium for this coverage through easy payroll deduction.
BENEFITS
Benefits Begin (Elimination
Period)
If you become disabled, there is an elimination period before benefits are payable.
Your benefits begin:
▪
On the 31st day of your disabling injury.
▪
On the 31st day of your disabling illness.
Weekly Benefit
Your benefit is equivalent to 60% of your before-tax weekly earnings, not to exceed
the plan's maximum weekly benefit amount.
Maximum Benefit Period
Short-term disability benefits are available for up to 11 weeks .
Maximum Weekly Benefit
$1,000
Minimum Weekly Benefit
$25
DEFINITIONS
Definition of Disability
Disability and disabled mean that because of an injury or illness, a significant change
in your mental or functional abilities has occurred, for which you are prevented from
performing at least one of the material duties of your regular job and are unable to
generate current earnings which exceed 99% of your weekly earnings from your
regular job. You can be totally or partially disabled during the elimination period.
Definition of Weekly Earnings
Weekly earnings for salaried employees is based on your gross annual salary in effect
prior to the onset of disability. Weekly earnings for hourly employees is based on
your average hourly rate of pay in effect prior to the onset of disability. These
earnings are used to determine your benefit in the event of claim. Earnings may
include commissions, bonuses, overtime or differentials.
FEATURES
Partial Disability Benefits
If you become disabled and can work part-time (but not full-time), you may be
eligible for partial disability benefits, which will help supplement your income until
you are able to return to work full-time.
Vocational Rehabilitation
Benefit
If you become disabled and participate in the vocational rehabilitation program,
which offers services that help you return to work and ability, you will be eligible for
a weekly benefit increase of 5%.
Waiver of Premium
The premium for your short-term disability coverage is waived while you are
receiving benefits.
Note: Additional information about the benefits and features of this plan will be included in the summary of coverage, which you will receive after
enrolling, and in the certificate booklet, available from your employer. Please contact your employer if you have questions prior to enrolling.
EXCLUSIONS & LIMITATIONS
Information about the exclusions for this plan will be included in the certificate booklet, available from your employer.
Please contact your employer if you have questions prior to enrolling.
For Employees of City of Charleston WV
Use the rates in the Age/Rate Table to calculate your premium for voluntary Short-term disability coverage in the worksheet
below, using the example as a guide.
Benefit and Premium Calculation Example
This example is for a 42-year-old employee earning $42,000 a year.
A. Enter your annual salary
$42,000.00
B. Enter the Weekly Benefit percentage
60%
C. Multiply "A" times "B"
$25,200.00
D. Divide "C" by 52
$484.62
E. Enter the Maximum Weekly Benefit
$1,000.00
F. Enter the lesser of "D" or "E"; This is your benefit amount
$484.62
G. Divide "F" by $10
$48.46
H. Enter the rate for your age (from the Age/Rate Table)
$.15
I. Multiply "G" times "H"
$7.27
J. Multiply "I" by 12
$87.23
K. Enter the annual pay cycle
12
L. Divide "J" by "K"; This is your premium (cost per paycheck)
$7.27
*
If you are uncertain what your current annual salary is, please consult your employer.
Age/Rate Table
Age Band
Rate
(Per $10 of Weekly Benefit)
0 - 39
$.14
40 - 44
$.15
45 - 49
$.18
50 - 54
$.21
55 - 59
$.29
60 - 64
$.36
65 - 69
$.40
70+
$.44
V
OLUNTARY
S
HORT
-T
ERM
D
ISABILITY
B
ENEFIT AND
P
REMIUM
C
ALCULATION
To enroll for short-term disability coverage:
1) Enter the amount from line "F" in your worksheet into the Voluntary Short-Term Disability Benefit Amount section on
your enrollment form.
2) Enter the amount from line "L" in your worksheet into the Voluntary Short-Term Disability Premium Amount section
on yo
ur enrollment form.
ELIGIBILITY -
ALL ELIGIBLE EMPLOYEES
Eligibility Requirement
You must be actively at work (able to perform all normal duties of your job) to be
eligible for coverage.
Minimum Work Hours
You must be working a minimum of 2080 hours per year to be eligible for coverage.
Coverage Payment
You pay 100% of the premium for this coverage through easy payroll deduction.
BENEFITS
Benefits Begin (Elimination
Period)
If you become disabled, there is an elimination period before benefits are payable.
Your benefits begin 90 days after the onset of your disabling injury or illness.
Monthly Benefit
Your benefit is equivalent to 60% of your before-tax monthly earnings, not to exceed
the plan's maximum monthly benefit amount less other income sources.
Maximum Benefit Period
If you become disabled prior to age 68, benefits are payable for two years. At age 68,
benefits are payable to age 70 for at least one year. At age 69 (and older), benefits are
payable for one year.
Maximum Monthly Benefit
$5,000
Minimum Monthly Benefit
$100 / 15%
DEFINITIONS
Definition of Disability
Disability and disabled mean that because of an injury or illness, a significant change
in your mental or functional abilities has occurred, for which you are:
▪
Prevented from performing at least one of the material duties of your regular
occupation during the first 24 months of disability and after 24 months are unable
to p
erform all of the material duties of any gainful occupation; and
▪
During the first 24 months of disability are unable to generate current earnings
which exceed 99% of your monthly earnings from your regular occupation, and
after 24 m
onths if partially disabled, are unable to generate current earnings which
exceed 85% of yo
ur monthly earnings from any gainful occupation.
You can be totally or partially disabled during the elimination period.
Definition of Monthly Earnings
Monthly earnings for salaried employees is based on your gross annual salary in effect
prior to the onset of disability. Monthly earnings for hourly employees is based
on
your average hourly rate of pay in effect prior to the onset of disability. These
earnings are used to determine your benefit in the event of claim. Earnings may
include commissions, bonuses, overtime or differentials.
FEATURES
Partial Disability Benefits
If you become disabled and can work part-time (but not full-time), you may be
eligible for partial disability benefits, which will help supplement your income until
you are able to return to work full-time.
Vocational Rehabilitation
Benefit
If you become disabled and participate in the vocational rehabilitation program,
which offers services that help you return to work and ability, you will be eligible for
a monthly benefit increase of 5%.
Survivor Benefit
If you pass away while receiving long-term disability benefits, your benefits will be
provided to your beneficiaries for a period of time after your death.
Waiver of Premium
The premium for your long-term disability coverage is waived while you are
receiving benefits.
Alcohol & Drug Abuse
For disabilities related to drug and alcohol abuse, benefits are available for up to 24
months.
Mental Disorders
For disabilities related to mental disorders, benefits are available for up to 24 months.
For Employees of City of Charleston WV
FEATURES (CONTINUED)
Note: Additional information about the benefits and features of this plan will be included in the summary of coverage, which you will receive after
enrolling, and in the certificate booklet, available from your employer. Please contact your employer if you have questions prior to enrolling.
EXCLUSIONS & LIMITATIONS
Pre-existing Conditions
Exclusion
Disabilities that occur during the first 12 months of coverage due to a pre-existing
condition during the 12 months prior to coverage are excluded.
Other Exclusions
Information about other exclusions for this plan will be included in the certificate
booklet, available from your employer. Please contact your employer if you have
questions prior to enrolling.
This information describes some of the features of the benefits plan. Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the
plan's benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this outline, the certificate booklet will prevail.
Benefits availability is subject to final acceptance and approval of the group application by Mutual of Omaha. Long-term disability insurance is underwritten by Mutual of
Omaha Insurance Company or United of Omaha Life Insurance Company. Mutual of Omaha Insurance Company is licensed in all 50 states. United of Omaha Life Insurance
Company is licensed in all states but New York. In New York, Mutual of Omaha Insurance Company underwrites the plan. Policy Form Number 7000GM-MU-EZ 2001.
U
se the rates in the Age/Rate Table to calculate your premium for voluntary long-term disability coverage in the worksheet
below, using the example as a guide.
Age/Rate Table
Age
Rate
(% of payroll)
0 - 29
$.0011
30 - 34
$.0014
35 - 39
$.0018
40 - 44
$.0021
45 - 49
$.0038
50 - 54
$.0056
55 - 59
$.0099
60 - 64
$.0146
65 - 69
$.0153
70+
$.0091
Benefit and Premium Calculation Example
This example is for a 42-year-old employee earning $42,000 a year.
A. Enter your annual salary*
$42,000.00
B. Enter the Monthly Benefit percentage
60%
C. Multiply "A" times "B"
$25,200.00
D. Divide "C" by 12
$2100.00
E. Enter the Maximum Monthly Benefit
$5,000.00
F. Enter the lesser of "D" or "E"; This is your benefit amount
$2,100.00
G. Divide "F" by 60%
$3,500.00
H. Multiply "G" by 12
$42,000.00
I. Enter the rate for your age (from the Age/Rate Table)
$.0021
J. Multiply "H" times "I"
$88.20
K. Enter the annual pay cycle
12
L. Divide "J" by "K"; This is your premium (cost per paycheck)
$7.35
Benefit and Premium Calculation Worksheet
A. Enter your annual salary*
B. Enter the Monthly Benefit percentage
60%
C. Multiply "A" times "B"
D. Divide "C" by 12
E. Enter the Maximum Monthly Benefit
$5,000.00
F. Enter the lesser of "D" or "E"; This is your benefit amount
G. Divide "F" by 60%
H. Multiply "G" by 12
I. Enter the rate for your age (from the Age/Rate Table)
J. Multiply "H" times "I"
K. Enter the annual pay cycle
12
L. Divide "J" by "K"; This is your premium (cost per paycheck)
*If you are uncertain what your current annual salary is, please consult your employer
To enroll for long-term disability coverage:
1) Enter the amount from line "F" in your worksheet into the Voluntary Long-Term Disability Benefit Amount section on
your enrollment form.
2) Enter the amount from line "L" in your worksheet into the Voluntary Long-Term Disability Premium Amount section
on your enrollment form.
VOLUNTARY LONG-TERM DISABILITY BENEFIT AND PREMIUM CALCULATION