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Other
Benefit Summaries:
MEDICAL
DENTAL
VISION
LIFE
LTD
FLEX
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Life/AD&D Insurance - UNUM Provident
October 1, 2003 - September 30, 2004 |
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Information provided is
in summary format. Any difference between the summary
provided and actual contract will be settled in favor of the
contract.
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Eligibility
|
All
employees covered under WEA Premera Select PPO Plan of
Medical benefits. |
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Coverage
Amounts
|
|
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Actual
Attained Age |
Benefit Amount |
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Less than
35 |
$20,000 |
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35 - 39 |
$16,400 |
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40 - 44 |
$14,000 |
|
45 - 49 |
$12,000 |
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50 - 54 |
$10,400 |
|
55 - 59 |
$9,200 |
|
60 - 64 |
$6,800 |
|
65 - 69 |
$4,600 |
|
70 - 74 |
$3,000 |
|
75 - 79 |
$2,600 |
|
80 and
over |
$2,000 |
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Guarantee Issue Amount |
All |
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Accidental
Death and Dismemberment
|
Same principal sum as
life coverage amount |
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Accelerated
Death Benefit |
Yes, 50% of life
amount if life amount is at least $10,000 |
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Conversion
Privilege |
Yes, if your group
life insurance terminates because your employment
ends, you may be able to convert your coverage to an
individual policy. |
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Waiver
of Premium
|
Yes, if
disability occurs prior to age 65 |
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Coverage
for Dependents
|
None
under this policy |
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