Union Benefits Trust offers you two types of life insurance. Supplemental life insurance is an additional layer of coverage you may purchase to help financially protect your family if you die.

You may purchase the amount of supplemental coverage you need for yourself and coverage for dependents, up to plan limits. The Trust administers supplemental life insurance for Union-represented State employees through the Prudential Insurance Company of America (Prudential). This policy is group term life insurance that has no cash value.

As an eligible member, you may enroll in the supplemental group term-life insurance program that enables you to purchase life insurance at affordable rates.

Cost Worksheet

The monthly cost for supplemental life insurance for you and your dependents is based on age, amount of coverage you select and whether or not you or your spouse use tobacco products. Print out the worksheet and rate charts below if you would like to figure out what your monthly contributions for supplemental life insurance are likely to be. You should only carry as much insurance as you need. Use this worksheet to help you determine the right amount to select.

Plan Highlights

If you are eligible, you can buy coverage for yourself, as well as your eligible dependents. To elect supplemental life insurance for your dependents, you must be covered under or enrolling in supplemental life insurance for yourself. Dependent coverage is also eligible for portability, or can be converted when you leave State service.

Supplemental life insurance for your spouse is available at $10,000 coverage without evidence of insurability, or $20,000, $30,000 or $40,000 (your choice) with acceptable evidence of insurability. $7,000 coverage for each eligible child at least 14 days old is also available. Your dependents must meet the Trust's eligibility requirements as described in the Eligibility section.

You must choose life insurance amounts for yourself and your spouse in increments of $10,000. Prudential reserves the right to amend your premium by rounding up to the next higher $10,000 or within the maximums, if necessary.

Rates are age-based for you and your spouse. The cost of supplemental life insurance will increase when you or your spouse reach the next age bracket.

Beneficiary Designation

Benefits are paid to your designated beneficiary in the event of your death.

You may name or change your beneficiary at any time by completing a Beneficiary form and mailing it to Prudential. Your change is not effective until the plan receives your documentation.

If you don't name a beneficiary or none of your beneficiaries survives you, equal payment is made to the first of the following: spouse, children, parents, brothers and sisters, your estate. If you elect dependent life coverage, you are automatically the beneficiary of your spouse and children; otherwise the estates of your spouse and children are their beneficiaries, subject to policy provisions.

Accelerated Death Benefits

If you have been diagnosed with a terminal illness and have less than 12 months to live, according to the diagnosis, this benefit allows you to take a cash advance of a portion of your total life insurance benefit. You can request up to 50% of the supplemental life policy amount, up to the $75,000 cap. When combined with basic life insurance, your total accelerated death benefit may not exceed $150,000.

You can purchase coverage in $10,000 increments for yourself (the member) as follows:

1. Without Evidence of Insurability (EOI) • During Open Enrollment If you are purchasing supplemental life for the first time, you may buy up to two times your Basic Annual Earnings or $150,000, whichever is less. Once enrolled, at each subsequent enrollment you may increase your coverage by two times your Basic Annual Earnings (or $150,000, whichever is less), up to six times your Basic Annual Earnings or $500,000, whichever is less. • At Hire As a new employee, you have 90 days from your date of hire to purchase coverage up to three times your Basic Annual Earnings or $150,000, whichever is less.

2. With Evidence of Insurability (EOI) You may buy up to six times your Basic Annual Earnings or $500,000, whichever is less, with evidence of insurability.

When Coverage Begins

Your coverage will begin on the first of the month after your first contribution from your pay, as long as you are actively at work on that day. If you enrolled by the open enrollment deadline, your coverage will likely begin the following July 1 or August 1, depending on when Prudential received and processed your information (which was postmarked by no later than the enrollment deadline). Review your pay information for the "BT 1" deduction to make sure the premiums are being paid (unless they're deducted when you're actively at work, you don't have coverage). If enrolling dependents at the same time as you, their coverage begins the same day as yours, unless they are confined for medical care, in which case coverage would begin the first of the month following the end of their confinement.

Making Changes

You may add or drop dependents' coverage based on family status changes, as shown in the chart in the plan booklet.You can change your smoking status throughout the year by using the supplemental life form.

When Coverage Ends

To cancel your coverage or decrease the amount of your coverage, complete a supplemental life form and submit it to Prudential. Prudential will terminate your coverage once they receive your request; however, since coverage is prepaid, your coverage extends through the end of the month for which the last deduction was taken. In other words, it may be up to three months before you see the premium stopped; you are still required to pay premiums during this time while your coverage is still in force. You may cancel or decrease your coverage anytime during the plan year.

You may also convert or port your plan. To learn more about this, click here.

Limits & Exclusions

SUPPLEMENTAL LIFE for you...

up to six times your Basic Annual Earnings or 500,000, whichever is less.

DEPENDENT LIFE

• Coverage for your spouse up to $40,000 with evidence of insurability or $10,000 coverage without evidence of insurability.
  
  
• $7,000 coverage for each eligible child at least 14 days old.

When a covered member dies a certified copy of the death certificate must be sent to:

Prudential Insurance Company of America
ATTN: Life Claims Supervisor
PO Box 8517
Philadelphia, PA 19176-9802

Please call Prudential if you have questions at 800-778-3827

Benefits are paid to the beneficiary (or beneficiaries) on file.