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1.
INTRODUCTION
The City of Glendale (City) is soliciting Requests for Proposals from qualified firms experienced
in basic life, accidental death and dismemberment insurance, optional life, accidental death
and dismemberment and commuter insurance for employees and grandfathered retirees. The
awarded vendor shall match the employee’s current plan design (see Attachments 2, 3, and 4,
attached separately), available to all regular-status full and part-time employees who work a
minimum of 20 or more hours per week. It is the intent of the City to require Offerors to provide
coverage on a no loss basis to all employees, retirees, and their dependents that are currently
covered under the plan commencing July 1, 2024.
2.
BACKGROUND AND OBJECTIVES
The current City program covers approximately 2,200 employee lives, (See Attachment 10,
attached separately for a complete census of eligible employees and retirees). New employees
scheduled to work at least 30 hours per week become eligible for benefits on the first of the
month following 30 days of employment. Employees hired on the 1st, 2nd, or 3rd of the month
are eligible for benefits on the first of the following month. Part-time employees scheduled to
work 20 to 29 hours per week become eligible for benefits on the 1st of the month following
five (5) months of employment. Terminated employee’s coverage is cancelled at the end of the
month in which they last worked.
Late entrants are allowed benefits as stipulated under HIPAA guidelines.
The City “Grandfathered” its existing retirees in the Retiree Life. Benefits for Retirees expire
when the retiree attains age 70. However, the city may reintroduce retiree coverage and offer
basic life to future retirees.
The City anticipates conducting open enrollment in late April and early May 2024; however,
actual dates have not been set. Benefits will be effective July 1, 2024.
The City pays bills on a self-accounting basis. All monies are paid on the 15th of the month and
are based on the enrollment on the 1st of the prior month. Adjustments are not made for partial
months. Therefore, the City requires the payment grace period to be a minimum of 60 days
from the due date.
Exhibit A
Table 1. Current Plan Summary:
Contract Year:
July 1 – June 30
Waiting Period:
Regular status Employees scheduled to work at
least 30 hours per week become eligible for
benefits on the first of the month following 30 days
of employment. Employees hired on the 1st, 2nd, or
3rd of the month are eligible for benefits on the first
of the following month.
Regular status Employees scheduled to work 20 –
29 hours per week become eligible for benefits on
the 1st of the month following six (6) months of
employment.
Basic Life/AD&D Coverage Amount:
All City Managers
We are requesting.
2x Basic Annual Earnings (rounded to the next
higher $1,000, if not already a multiple of $1,000)
The Basic Maximum Benefit is $500,000
All Regular Status Active Employees
1x Basic Annual Earnings (rounded to the next
higher $1,000, if not already a multiple of $1,000)
The Basic Maximum Benefit is $300,000.
Retirees (Life Only)
1x Basic Annual Earnings (rounded to the next
higher $1,000, if not already a multiple of $1,000)
plus an additional $1,000.
The Basic Maximum Benefit is $100,000.
Terminates at age 70.
Basic Dependent Life Insurance:
Spouse Life Insurance Amount
$1,000
Child Life Insurance Amount
$1,000 – to age 26
$100 – Age 15 days but under 6 months of age.
$0 – Under 15 days old.
Optional Life Insurance
Employee Optional Life
Spouse Optional Life
Dependent Optional Life
Increments of $50,000 not to exceed $500,000. GI
is $200,000
Increments of $25,000 not to exceed $100,000.
GI is $50,000
$5,000 benefit
Exhibit A
Table 2. Current Premium Rates
Premiums (Includes Waiver of Premium):
•
Employer Paid Life Insurance:
•
Group Term Life
$.065 per $1,000 of coverage/month
•
Group AD&D
$.015 per $1,000 of coverage/month
•
Dependent Life
$.28 per Employee with Dependents/month
•
Employee Paid Optional Life Insurance:
•
Employee Optional Rates
<29
30 – 34
35 – 39
40 – 44
45 – 49
50 – 54
55 – 59
60 – 64
65 – 69
70+
$
$
$
$
$
$
$
$
$
$
.060
.080
.090
.150
.240
.420
.690
1.020
1.520
2.370
•
Employee Optional AD&D
$ .020
•
Spouse Optional Rates
<29
30 – 34
35 – 39
40 – 44
45 – 49
50 – 54
55 – 59
60 – 64
65 – 69
$
$
$
$
$
$
$
$
$
.060
.080
.090
.150
.240
.420
.690
1.020
1.520
•
Child(ren) Optional Rates
$ .760 per enrolled employee
The City pays bills on a self-billing basis. All monies are paid at the end of the month and are
based upon the enrollment on the 1st of the same month. Adjustments are not made for partial
months. Therefore, the City requires the payment grace period be a minimum of 60 days from
the due date.
The current carrier is The Standard for Life and AD&D and The Hartford for Commuter Life.
Current coverage expires June 30, 2024, as detailed in Attachments 1, 5, 6, 7, 8, and 9,
attached separately.
Eligibility and Participation
All employees of the City of Glendale meeting the following criteria are eligible to participate
in the Plan:
Exhibit A
•
Employed by the City;
•
Meet the eligibility requirements established by City as an Employee with a minimum of
20 hours worked per week.
**Temporary Employees are not eligible for coverage under the plan.
Eligible Dependents
Dependent means an Employee’s:
•
Spouse
•
Child, including stepchild, foster child, or adopted child, from live birth to underage 26;
•
A child is considered adopted if he is in the legal custody of the Employee under an interim
court order of adoption, whether a final adoption order is ever issued.
Retirees
“Grandfathered” retirees will continue to participate in the Plan at an amount of 1 times the
Employee’s Basic Annual Earnings on the day prior to his retirement plus an additional $1,000
to a maximum benefit of $100,000. Retirees are only eligible for Basic Life only.
•
Round to the nearest $1000, if not already a multiple of $1,000 plus $1,000.
•
Not eligible for AD&D
Waiting Period
•
All eligible full-time employees hired on the 1st, 2nd, or 3rd day of the month. First of the
month following date of employment.
•
All other eligible full-time employees.
First of the month following 30 days of employment.
•
All eligible part-time employees.
First of the month following 180 days of employment.
3.
SCOPE OF WORK
It is the City’s desire to engage a community partner to provide services at city-owned facilities
that meet or exceed the following program objectives and create a focus on measuring for
success. Responses to this RFP should clearly demonstrate how the Offeror intends to
accomplish and measure successful outcomes of the program objectives.
General Services - Contractor shall:
•
Provide Basic and Optional Life and Accidental Death & Dismemberment (AD&D)
insurance and Commuter Life.
Exhibit A
•
Guarantee initial rates and contract terms at minimum effective July 1, 2024, through
June 30, 2026.
•
Provide claims experience for actives and retirees by employee, dependent spouse, and
dependent child(ren) at minimum every six months.
•
Provide final renewal rates, costs, and underwriting projections to the City at least 180
days prior to the contract anniversary date.
•
Agree to provide coverage on a “no loss” basis for all participants enrolled in the current
plan.
•
Not include commissions in the rates submitted unless included in the carrier’s filing
with the State. Any proposal that includes payment of commissions or any other form
of remuneration shall be deemed non-responsive unless fully disclosed and approved by
the City. If commissions or fees are included in the filed rates and cannot be removed
from the rates provided, the level of commissions included in the proposed rates must
be disclosed and noted.
•
Comply with all HIPAA Privacy Rule Regulations where applicable.
•
Provide all Plan Certificates and Summary Benefit Booklets, and other customized
communications (i.e. payroll stuffers, etc.) at no additional charge.
•
Provide any professional service representatives the City requires to understand,
analyze, and/or plan for any plan changes including but not limited to general account
servicing, underwriting- actuarial, clinical, and/or operational support.
•
Maintain all pertinent claim records for up to seven (7) years including claim records,
individual case review and notes, and any member inquiry records as prudent business
practice and provisions dictate.
•
Process Life and Accidental Death and Dismemberment insurance claims accurately
and timely.
•
Rates provided shall be based on current rates.
•
Sign the Business Associate Amendment as written and attached to this proposal as
Attachment 11, attached separately.
4.
TERM
The term of the resultant contract shall be for a one (1) year initial term. The City may,
at its option and upon mutual agreement with the Bidder(s), extend the term of this
agreement for an additional four (4) years.
5.
OPTION TO EXTEND
Based on satisfactory Bidder performance, the City, may at its option and upon mutual
Exhibit A
agreement with the Bidder, extend the term of this agreement for an additional four (4)
years renewable on an annual basis. Bidder shall be notified in writing by the City
Materials Manager of the City's intention to extend the contract period at least ninety
(90) calendar days prior to the expiration of the original contract period.
6.
HOW WE CHOOSE
6.1
SCORING RESPONSES
The evaluation criteria are weighted in accordance with the Submission
Requirements. Your response will be rated as follows:
•
20% Experience and qualifications
•
30% Method of Approach
•
30% Insurance Offering
•
20% Cost
6.2
LENGTH OF CONTRACT: The City will award for an initial one (1) year with four
(4) additional one-year renewal options.
6.3
EVALUATION PANEL: Submittals will be evaluated by a panel based on the
stated criteria and are responsible for selecting the proposal that is most
advantageous to the City.
6.4
PANEL CONTACT: Offerors shall have no exclusive meetings, conversations or
communications with an individual evaluation panel member on any aspect of
the RFP, after submittal.
6.5
INTERVIEWS: City may ask some or all Offerors to participate in an interview at
any point during the evaluation process but is not required to do so. Information
gathered in an interview will be used by the panel to make a selection. Offeror is
responsible for any costs incurred to participate in an interview.
6.6
ADDITIONAL INVESTIGATIONS: City may conduct additional investigations
needed to determine the competence or financial stability of any Offeror.
6.7
BEST AND FINAL OFFERS: City may request best and final offers and will
determine the scope and subject of any best and final request.
6.8
PROPOSAL EVALUATION: City reserves the right to secure additional
information from the Offeror in various forms and to award based on submitted
information.
7.
NOTICE OF INTENT TO AWARD AND PROTEST PERIOD: Information about the
recommended award for this solicitation will be posted here and will be available
immediately after the City has completed its evaluation process. Questions regarding
the notice of intent to award must be directed to the listed Procurement Officer
immediately. Any protest must be submitted to the Procurement Administrator no later
Exhibit A
than seven (7) calendar days from the date of posting on the Internet. Information and
instructions on how to file a protest can be found here.
8.
WITHDRAWAL OF PROPOSAL: Offeror may withdraw a submitted proposal at any time
prior to the specified solicitation due date and time through the City’s online bidding
system. Withdrawals must be made by the Offeror or designated representative listed
on the proposal. Telephonic or oral withdrawals cannot be accepted.
9.
OFFER ERRORS OMISSIONS AND CORRECTIONS: City will not be responsible for any
offeror errors or omissions. Any corrections shall be submitted through the City’s online
bidding system prior to due date and time of the RFP. No corrections will be permitted
after the offers have been opened.
10.
COMPETITIVE NEGOTIATIONS: City may negotiate with multiple Offerors at the same
time. Negotiations may result in changing the conditions, terms, or price of the
proposed contract for the benefit of the City unless prohibited herein. All Offerors shall
be treated fairly and equally while conducting negotiations and the City is prohibited
from disclosing any information submitted by competing Offerors. Entering into
negotiations does not constitute a contract award or confer any rights to Offerors. The
City may formally terminate negotiations and enter into concurrent or exclusive
negotiations with the next most qualified Offeror/s if it is in the City’s best interest to
do so.
11.
NO CONTACT, NO INFLUENCE DURING THE RFP PROCESS: City is conducting a
competitive RFP process for the contract, free from improper influence or lobbying.
There shall be no contact concerning this RFP from Offerors submitting a Proposal with
any member of the City Council, RFP Evaluation Committee Members, or anyone
connected with the process for or on behalf of the City. Contact includes direct or
indirect contact by the Offeror, its employees, attorneys, lobbyists, surrogates, etc. in
an attempt to influence the RFP process.
From the time the RFP is issued until the expiration of the protest period or the
resolution of any protest, whichever is later (the “Silent”), Offerors, directly or indirectly
through others, are restricted from attempting to influence in any manner the decision
making process through, including but not limited to, the use of paid media; contacting
or lobbying the City Council or City Manager or any other City employee (other than
Material Management employees); the use of any media for the purpose of influencing
the outcome; or in any other way that could be construed to influence any part of the
decision-making process about this RFP. This provision shall not prohibit an Offeror
from petitioning an elected official or engaging in any other protected first amendment
activity after the protest period has run or any protest has been resolved, whichever is
later.
Violation of this provision will cause the proposal or offer of the Offeror to be found in
violation and to be rejected.
Exhibit A
12.
PROPRIETARY INFORMATION Offeror shall clearly mark any proprietary information
contained in its bid with the words “Proprietary Information.” Offeror shall not mark any
Solicitation Form as proprietary. Pricing data shall not be considered proprietary.
Marking all, or nearly all, of a bid as proprietary may result in rejection of the bid.
Offerors acknowledge that the City is required by law to make certain records available
for public inspection. In the event that the City receives a request for disclosure of
Proprietary Information by any person, court, agency or administrative body, or
otherwise has a reasonable belief that it is obligated to disclose the Proprietary
Information to any such person or authority, the City will provide Offeror with prompt
written notice so that Offeror may seek a protective order or other appropriate remedy.
The Offeror, by submission of materials marked Proprietary Information, acknowledges
and agrees that the City will have no obligation to advocate for non-disclosure in any
forum or any liability to the Offeror in the event that the City must legally disclose the
Proprietary Information.
13.
SUBMISSION CHECKLIST
This section provides an overview of the submission instructions including a checklist to
aid in the submission of complete proposals. Offerors shall complete the fillable
“RESPONSE WORKBOOK” attachment and submit as their proposal.
Vendors are strongly advised to read this section in its entirety and complete the
checklist to avoid disqualification. Please note that the City will NOT be able to consider
proposals that are submitted late or that do not follow these guidelines.
The Offeror shall bear all costs associated with submitting the proposal, including
proposal preparation, site visitation or any travel connected with submission of the
proposal. The City shall have no liability whatsoever for such costs.
Checklist for Submitting Proposal
Complete (✓)
Submission Requirements
OFFER SHEET (Response Workbook)
Offeror Name
Offeror Address
1. EXPERIENCE AND QUALIFICATIONS
2. METHOD OF APPROACH
3. INSURANCE OFFERING
3.1 Claims & Administration
3.2 Plan Design
3.3 Insurance Financials
3.4 Basic Life
3.5 Optional Life
Exhibit A
3.6 Dependent Life
3.7 AD & D
3.8 Commuter Life
4. COST (Must be submitted in a separate electronic file)
(1 question)
COMPLETED PRICING WORKBOOK
ADDENDUM RESPONSES (if applicable)
Return of Offer
•
Electronic copies of all "SUBMISSION REQUIREMENTS” listed
above. Pricing Workbook must be submitted separately from
the rest of the proposal.
14.
SUBMISSION REQUIREMENTS
The proposal is every element of your response to this RFP. For this proposal, you must
provide a completed OFFER SHEET in addition to answering the questions identified in
the REQUIRED RESPONSES. (see Response Workbook)
Responses must be numbered to correspond to the question numbers to aid in the
evaluation process; failure to do so may result in disqualification.
Should your offer contain any PROPRIETARY INFORMATION you must clearly mark that
information with the words “Proprietary Information.” Only information contained in your
response questions may be marked as such, information on the OFFER SHEET or
PRICING SHEET (if applicable) are not considered proprietary.
Offerors acknowledge that the City is required by law to make certain records available
for public inspection. By submitting any materials marked as Proprietary Information,
Offeror acknowledges and agrees that the City will have no obligation to advocate for
non-disclosure in any forum or any liability to the Offeror if the City must legally disclose
the Proprietary Information.
Helpful Hints:
•
Answer each question completely, your answers will be the only basis on which
your proposal is scored.
•
Do not unnecessarily elaborate, keep your response complete and effective.
•
Do not provide general answers or reference to sales literature.
•
Only when applicable attach and reference supporting documents.
Exhibit A
EXHIBIT 1: SPECIAL NOTICES
By signing on the Offer/Bid page, solicitation Addendum(a), or cover letter accompanying the
submittal documents, Offerors are certifying that they understand the following notices and
agree to comply with all required terms and conditions.
1.
RETURN OF OFFER
The Offeror shall submit required proposal responses electronically in Vendor Self
Service (VSS).
Offeror is required to register in VSS prior to submitting a proposal if they have not
already registered.
https://glendaleazvendors.munisselfservice.com/Vendors/default.aspx
Guide to Register as a new vendor:
https://www.glendaleaz.com/your_government/city_finances/procurement/vendor_s
elf_service___v_s_s_ (This is a PDF document “Vendor Registration Instructions” at
the bottom of page.)
a.
The Offeror shall complete all sections of the solicitation in the format given and
the spaces provided. Proposals that do not conform to the above format may
be rejected.
b.
The Offeror shall bear all costs associated with submitting the proposal,
including proposal preparation, site visitation or any travel connected with
submission of the proposal. The City shall have no liability whatsoever for such
costs.
2.
PRE-OFFER CONFERENCE
A Pre-Offer meeting will be held on the time and at the location shown on page 1 of
this document. Attendance is not required. Copies of the Request for Proposal (RFP)
will NOT be available.
The purpose of the conference will be to clarify the contents of the solicitation to
prevent any misunderstanding of the City of Glendale’s position. Any doubt as to the
requirements of the solicitation or any apparent omission or discrepancy should be
presented to the City at the conference. The City will determine the appropriate action
necessary, if any, and issue a written amendment to the solicitation if required. Oral
statements or instructions will not constitute an amendment to the solicitation.
3.
NO CONTACT, NO INFLUENCE DURING THE RFP PROCESS
The City is conducting a competitive RFP process for the contract, free from improper
influence or lobbying. There shall be no contact concerning this RFP from Offerors
submitting a Proposal with any member of the City Council, RFP Evaluation Committee
Members, or anyone connected with the process for or on behalf of the City. Contact
includes direct or indirect contact by the Offeror, its employees, attorneys, lobbyists,
surrogates, etc. in an attempt to influence the RFP process.
From the time the RFP is issued until the expiration of the protest period or the
resolution of any protest, whichever is later (the “Silent Period”), Offerors, directly or
indirectly through others, are restricted from attempting to influence in any manner the
decision making process through, including but not limited to, the use of paid media;
Exhibit A
contacting or lobbying the City Council or City Manager or any other City employee
(other than Procurement employees); the use of any media for the purpose of influencing
the outcome; or in any other way that could be construed to influence any part of the
decision-making process about this RFP. This provision shall not prohibit an Offeror
from petitioning an elected official or engaging in any other protected first amendment
activity after the protest period has run or any protest has been resolved, whichever is
later.
Violation of this provision will cause the proposal or offer of the Offeror to be found in
violation and to be rejected.
4.
CONFLICT OF INTEREST
Contractor shall disclose the following: 1) the name(s) and position(s) of each
Contractor’s employee or subcontractor that participated in the preparation of the
submittal or who will be involved, directly or indirectly, with performing the contract, if
awarded; 2) the name(s) of any City of Glendale employee who is a relative of persons
identified pursuant to No. 1; 3) the name(s) and position(s) of Contractor’s personnel
that have a financial or proprietary interest in the contract; 4) the name(s) of any City
of Glendale employee who is a relative of persons identified pursuant to No. 3.
Providing such disclosure will not necessarily disqualify a Contractor. Failure to disclose
the requested information or any potential conflict of interest pursuant to A.R.S. § 38-
511 et seq. may result in rejection of the proposal or bid or any contract being void or
terminated.
For purposes of this provision, the following definitions apply:
i.
“Employee” means all persons who are employed on a full-time, part-time or
contract basis by the City of Glendale.
ii.
“Relative” means the spouse, child, child’s child, parent, grandparent, brother or
sister of the whole or half blood and their spouses and the parent, brother, sister
or child of a spouse.
5.
INQUIRIES
Any question related to the Request for Proposal shall be directed to the Procurement
Officer whose name appears above. An Offeror shall not contact or ask questions of the
department for whom the requirement is being procured. The Procurement Officer may
require any and all questions be submitted in writing. Offerors are encouraged to submit
written questions via electronic mail or facsimile, no later than FIVE days prior to the
proposal due date. Any correspondence related to a solicitation should refer to the
appropriate Request for Proposal number, page and paragraph number. An envelope
containing questions should be identified as such; otherwise, it may not be opened until
after the official proposal due date and time. Oral interpretations or clarifications will
be without legal effect. Only questions answered by a formal written amendment to the
Request for Proposal will be binding.
6.
SPECIAL TERMS AND CONDITIONS
Additional terms and conditions specific to the provision of the services referenced will
be negotiated with the successful bidder for inclusion in the contract.
7.
PUBLIC RECORD REQUIREMENTS
Offeror acknowledges that the City is a public agency and must comply with all Public
Exhibit A
Records laws and proposals submitted become the property of the City and are subject
to public disclosure requirements in accordance with Arizona Public Records Law. Any
portion of the proposal that the offeror deems confidential or proprietary must be clearly
labeled as such. Labeling material does not automatically preclude the material from
public disclosure, as the City is required to make an appropriate determination as to
the confidentiality of the material in accordance with Arizona Public Records Law. It is
the offeror’s sole responsibility and cost to take action, including legal actions, to
protect such material. Price is not confidential and will not be withheld.
8.
PERMITS AND LICENSES
It is the offeror’s sole responsibility to determine and secure any and all licenses and
permits the contractor needs to operate the facility, from any regulatory body having
jurisdiction related to the services being provided. Such costs are the exclusive
responsibility of the operator, operator must also ensure appropriate licensing of any
sub-contractors, operator shall notify the City in writing within two (2) working days of
any suspension, revocation or renewal.
9.
NO COLLUSION OR ANTI-COMPETITIVE PRACTICES
The submission of the offer did not involve collusion, and without any agreement,
understanding or planned common course of action with, any other vendor of materials,
supplies, equipment or services described in the invitation to bid, designed to limit
independent bidding or competition or other anti-competitive practices.
10.
NON-DISCRIMINATION
Contractor agrees not to discriminate against any employee or applicant for
employment on the basis of race, color, religion, sex, national origin, age, marital status,
sexual orientation, gender identity or expression, genetic characteristics, familial status,
U.S. military veteran status or any disability. Contractor will require any Sub-contractor
to by bound to the same requirements as stated within this section. Contractor, and on
behalf of any subcontractors, warrants compliance with this section.
11.
NO CONSIDERATIONS
The Contractor has not given, offered to give, nor intends to give at any time hereafter,
any economic opportunity, future employment, gift, loan, gratuity, special discount, trip,
favor, meal or service to a public servant in connection with the submitted offer.
12.
AUTHORIZED AGENT
The individual signing the submittal is an authorized agent and has the authority to
bind the Offeror to the proposal and subsequent contract if awarded.
13.
KEY PERSONNEL
If awarded, Offeror shall assign a specific individual as the key point of contact for the
management of the contract, subject to specific notification requirements to be included
in the final contract.
14.
SITE INSPECTION
It is the responsibility of the Offeror to become familiar with any conditions which may
affect the performance and cost of providing the service and this submission will serve
as evidence that the Offeror did, in fact, make a site inspection and is aware of all
conditions.
Exhibit A
EXHIBIT 2: SPECIAL TERMS AND CONDITIONS
By signing on the Offer/Bid page, solicitation Addendum(a), or cover letter accompanying the
submittal documents, Offerors are certifying that they understand the following notices and
agree to comply with all required terms and conditions. The following terms are found on the
City’s Website and are applicable to Request for Proposal: Standard Terms and Conditions
1.
TYPE OF AWARDS
The City reserves the right to make multiple awards or to award by individual line items,
by group of line items, or to make an aggregate award, whichever is deemed most
advantageous to the City. If the City determines that an aggregate award to one offeror
is not in the City's best interest, "all or none" offers shall be rejected.
2.
ALTERNATE OFFERS
Offers submitted as alternates, or on the basis of exceptions to specific conditions of
purchase and/or required specifications, must be submitted as an attachment
referencing the specific paragraph number(s) and adequately defining the alternate or
exception submitted. Detailed product brochures and/or technical literature, suitable
for evaluation, must be submitted with the offer. If no exceptions are taken, City will
expect and require complete compliance with the specifications and all Conditions of
Purchase.
3.
EFFECTIVE PERIOD OF OFFER Offers shall be valid for a minimum of 120 days following
the deadline for submitting offers. If an award is not made during that period, all offers
shall be automatically extended for another 120 days. Offers will be automatically
renewed until the solicitation is either canceled, an award is made, or proper Notice is
given to the Procurement Officer of Offeror’s intent to withdraw its offer. Offers may only
be withdrawn by submitting Notice at least 15 days before the expiration of the then
current 120-day period.
4.
PAYMENT TERMS If payment terms are not indicated, terms of NET 30 days shall be
applied by the City. Payment terms to apply after receipt of invoice or final acceptance
of the products/services, whichever is later. Payment terms offering less than 20 days
for payment will not be considered.
5.
UNIT PRICE TO PREVAIL In the event of a price disparity between the unit and extended
price, the unit price shall prevail unless judged obviously in error by the City.
6.
OFFER ERRORS OMISSIONS AND CORRECTIONS The City will not be responsible for
any offeror errors or omissions. All prices and notations shall be written in ink or typed.
Changes or corrections made on the offer form must be initialed in ink by the individual
signing the offer. No corrections will be permitted after the offers have been opened.
7.
BRAND NAME REFERENCES AND TECHNICAL SPECIFICATIONS Brand names or
manufacturer's references shall be construed as a quality or performance level and does
not indicate the item cited is mandatory. Technical specifications define the acceptable
standard.
Exhibit A
8.
RESTRICTIVE OFFER PROVISIONS If specifications preclude an otherwise qualified
offeror from submitting an offer, a written request for modification must be received by
the Buyer at least seven (7) calendar days prior to the proposal due date. All offerors
will be notified by a written addendum to the solicitation of any approved changes.
9.
DEFAULT In case of default by the contractor, the City may, by written notice, cancel
this contract and repurchase from another source and may recover the excess costs by
(1) deduction from an unpaid balance due; (2) collection against the bid and/or
performance bond; or (3) a combination of the aforementioned remedies or other
remedies as provided by law.
10.
TERMINATION FOR CONVENIENCE The City reserves the right to terminate any order
or contract upon thirty days written notice. The City will be responsible only for those
standard items which have been delivered and accepted. If the items are unique and not
saleable or useable for any other application, the City will reimburse the Seller for actual
labor, material, and burden costs, plus a profit not to exceed 8%. Title to all materials,
work-in-process, and completed but undelivered goods will pass to the City after costs
are claimed and allowed.
11.
SUB-CONTRACTING The contract or any portion thereof, shall not be sub-contracted
without the prior written approval of the Materials Manager. No such approval will be
construed as making the City a party of or to such sub-contract or subjecting the City
to liability of any kind to any sub-contractor. No sub-contract shall, under any
circumstances, relieve the contractor of liability and obligation under this contract; and
despite any such subletting the City shall deal through the contractor. Sub-contractors
will be dealt with as workmen and representatives of the contractor.
12.
SAFETY DATA SHEETS (SDS). Contractor is to supply SDS) in accordance with Federal
requirements for The Globally Harmonized System of Classification and Labeling of
Chemicals (GHS). Contractor entering the City workplace with hazardous materials will
supply the City with a Safety Data Sheets (SDS) covering those particular products the
contractor may expose City employees or the general public to while working at the site.
13.
GENERAL INDEMNIFICATION: Contractor shall indemnify, defend, save and hold
harmless the City of Glendale and its officers, officials, agents, and employees
(hereinafter referred to as “Indemnitee”) from and against any and all claims, actions,
liabilities, damages, losses, or expenses (including court costs, attorneys’ fees, and
costs of claim processing, investigation and litigation) (hereinafter referred to as
“Claims”) for bodily injury or personal injury (including death), or loss or damage to
tangible or intangible property caused, or alleged to be caused, in whole or in part, by
the negligent or willful acts or omissions of Contractor or any of its owners, officers,
directors, agents, employees or subcontractors. This indemnity includes any claim or
amount arising out of or recovered under the Workers’ Compensation Law or arising out
of the failure of such Contractor to conform to any Federal, State or local law, statute,
ordinance, rule, regulation or court decree. It is the specific intention of the parties that
the Indemnitee shall, in all instances, except for Claims arising solely from the negligent
or willful acts or omissions of the Indemnitee, be indemnified by Contractor from and
Exhibit A
against any and all claims. It is agreed that Contractor will be responsible for primary
loss investigation, defense and judgment costs where this indemnification is applicable.
In consideration of the award of this contract, the Contractor agrees to waive all rights
of subrogation against the City, its officers, officials, agents, and employees for losses
arising from the work performed by the Contractor for the City.
14.
RESPONSIBILITY FOR COMPLIANCE WITH LEGAL REQUIREMENTS The offeror's
products, services, and facilities shall be in full compliance with all applicable Federal,
State, and local health, environmental, and safety laws, regulations, standards, and
ordinances, regardless of whether or not they are referred to by the City.
15.
RESPONSIBILITY FOR CORRECTION It is agreed that the offeror shall be fully
responsible for making any correction, replacement, or modification necessary for
specification or legal compliance. In the event of a call back, Offeror agrees to give the
City first priority. Offeror agrees that if the product or service offered does not comply
with the written specification, the Materials Manager has the right to cancel the sale at
any time with full refund within thirty (30) calendar days after notice of noncompliance
and offeror further agrees to be fully responsible for any consequential damages
suffered by the City.
16.
WARRANTY Unless otherwise specified, all items shall be guaranteed for a minimum
period of one year against defects in material and workmanship. During the period, if a
defect should occur, that item shall be repaired or replaced by the Seller at no obligation
to the City, except where it be shown that the defect was caused by misuse and not by
faulty manufacture. The offeror expressly warrants all items to be new, free from defects
in design, materials, and workmanship, and to be fit and sufficient for their intended
purpose. Any sample submitted shall create an expressed warranty that the whole of
the goods shall conform to the sample or model.
17.
REJECTION OF OFFERS The City reserves the right to reject any or all offers, or any
part thereof; to accept any offer or any part thereof; or to waive any informalities when
it is deemed to be in the City's best interest.
18.
DELAY IN EXERCISING CONTRACT REMEDY Failure or delay by the City to exercise
any right, power, or privilege shall not be deemed a waiver thereof.
19.
TAX EXEMPTION The City is not exempt from paying Federal Excise Taxes and will
furnish an exemption certificate upon request.
20.
ORDER OF PRECEDENCE In the event of conflict, the following precedence shall prevail:
(1) Special Terms and Conditions incorporated by attachment; (2) Special Terms and
Conditions; (3) Drawings and Specifications; (4) referenced documents; and (5) the
Standard Terms and Conditions.
21.
CHANGES The City reserves the right to make changes in any of the following: (a)
specifications; (b) methods of shipment; (c) place of delivery; (d) time of delivery; (e)
quantities. If any change causes an increase or decrease in the cost of or the time
Exhibit A
required for performance, an equitable adjustment may be made in the price or delivery
schedule, or both. Any claim for adjustment shall be deemed waived unless asserted in
writing within thirty days from receipt of the change. Price increases or extensions of
delivery time shall not be binding on the City unless in writing and approved by the
Materials Manager prior to the institution of the change.
22.
PRICE ADJUSTMENTS Price adjustments shall be addressed a minimum of Ninety (90)
days prior to the contract renewal date, shall be in writing and include supportive
justification for the proposed increase. Supportive justification means that the request
shall include detailed information and calculations that make it clear how the claimed
increase has an impact on the contract unit prices. The requested price increase must
be based upon a cost increase that was clearly unpredictable at the time of the offer
and can be shown to directly affect price of the item concerned. The rate increase shall
only be considered at time of contract extension. The City will review the request and
shall determine if the increase shall be granted or if an alternate option is in the best
interest of the City. The price increase adjustment, if approved, will be effective and
executed via a contract amendment.
23.
LATE SUBMISSION OF CLAIM The City will not honor any invoices or claims which are
tendered one year after the last item of the account accrued.
24.
PROTEST OF AWARD Any person who has an objection to the awarding of a solicitation
by the City, pursuant to competitive solicitation procedures, shall lodge that protest, in
writing, with the Materials Manager. The protest should specifically identify the
objection to the award, pursuant to the formal purchase procedure. The protest must
be submitted no later than seven (7) calendar days after the notice of intent to award is
posted
on
the City's
Procurement
Internet
home
page
at
https://www.glendaleaz.com/your_government/city_finances/procurement/notice_of_
intent_to_award. Untimely protests will not be considered.
25.
REMEDIES City shall have, in addition to the remedies provided herein, all remedies
afforded by the Uniform Commercial Code as adopted by the State of Arizona.
Contractor shall have, subject to the limitation imposed by the terms of this agreement,
all remedies afforded by the Uniform Commercial Code as adopted by the State of
Arizona.
26.
ASSIGNMENT Neither an order nor monies due thereunder shall be assigned in whole
or in part without the City's prior written consent.
27.
ADDENDA Any change to the proposal will be in the form of a numbered addendum
issued by the Procurement Division. The addendum will be furnished to all who received
the proposal. The City will not be responsible for any oral or written instructions made
by any employees, officers, contracted consultant or agent of the City in regard to the
proposal. The City will not be responsible for offerors adjusting their offer based on oral
or written instructions.
Exhibit A
28.
SPECIAL ACCOMMODATIONS Please contact Procurement at 930-2862 at least 3 days
prior to the meeting for special accommodation. Hearing impaired persons, please use
the Arizona Relay Service (1-800-367-8939).
29.
OFFER IDENTIFICATION The City is not responsible for the pre-opening of, post-opening
of, or the failure to open, an offer not properly addressed or identified.
30.
OFFER TABULATION An electronic copy of the scoring may be requested by e-mailing
the Procurement office at procurement@glendaleaz.com and referencing the proposal
title and number. The information will be available for distribution when the City has
completed its evaluation process of the offers received.
31.
LIABILITY Except for the sole negligence of the City, its officers, managers, employees,
or agents, Contractor shall be liable to the City for any physical damage to City property
or for the death of, or personal injury to, City personnel arising out of Contractor's
occupancy, maintenance, repair, replacement, installation and/or any other work
performed pursuant to the contract. Contractor agrees to indemnify, defend and hold
the City harmless from any claim or loss arising from such damage or injury.
32.
OSHA GUIDELINES The contractor shall be familiar with and operate within the
guidelines set forth by the Occupational Safety and Health Act.
33.
PATENTS Seller agrees to defend City at seller's own expense, in all suit, actions, or
proceedings in which City is made a defendant for actual or alleged infringement of any
United States of America or foreign letters patent resulting from City’s use of the goods
purchased as a result of this RFP. Seller further agrees to pay and discharge any and
all judgments or decrees, which may be rendered in any such suit, action or proceedings
against City. Seller agrees to indemnify and hold harmless the City from any and all
license, royalty and proprietary fees or costs, including legal costs, which may arise out
of City’s purchase and use of goods supplied by the seller. It is expressly agreed by
seller, that these covenants are irrevocable and perpetual.
34.
VENDOR PERFORMANCE Prior offeror performance in regard to product, service, or
representation of/from the offeror may be used in evaluation of this offer. Unsatisfactory
performance to the City may be considered sufficient grounds for rejection of this offer.
No offer will be awarded to any offeror who is in default on any contract with the City.
35.
PERFORMANCE SURETY REQUIREMENTS The performance sureties shall be in the
form of a bond, cashier's check, certified check or money order. Personal or company
checks are not acceptable unless certified. Letters of credit are not acceptable.
Individual sureties are not acceptable.
PERFORMANCE SURETY The successful proposer shall, at the time of entering into
the contract, furnish a performance surety in the form of a bond, money order or
certified or cashier's check, in the amount of 10 percent of the contract amount
guaranteeing the faithful performance of the contract by the proposer.
Exhibit A
If a bond is submitted, it shall be written on the form provided by the City as an
attachment to the proposal documents. The attorney-in-fact who executes the bond
on behalf of the surety shall affix to the bond a certified and current copy of the
power of attorney. The bond must be written by a surety with a Best Rating no less
than an A and must be authorized and licensed to do business in this State by the
Arizona Department of Insurance. Individual sureties and letters
of credit are not
acceptable.
36.
FUND APPROPRIATION CONTINGENCY The contractor and the City recognize that the
continuation of any contract after the close of any given fiscal year of the City; which
ends on June 30, shall be subject to the approval of the budget of the City providing the
contract item is an expenditure therein. The City does not guarantee that the budget
item will be actually adopted, as it is the determination of the City Council at the time
of the adoption of the budget.
37.
NOTIFICATION OF AWARD The successful offeror(s) will be notified that their offer has
been accepted by the City Council as recommended for award.
38.
NON-EXCLUSIVITY The City, in its sole discretion, reserves the right to request the
materials or services set forth herein from other sources when deemed necessary and
appropriate. No exclusive rights are included in this Agreement.
39.
PROHIBITIONS - Contractor, and on behalf any subcontractor, certifies, to the extent
applicable under A.R.S. §§ 35-391 et seq and 35-393 et seq, that neither has
"scrutinized" business operations, as defined in the proceeding statutes, in the countries
of Sudan or Iran.
40.
IMMIGRATION LAW COMPLIANCE Contractor, and on behalf any subcontractor,
warrants, to the extent applicable under A.R.S. § 41-4401, compliance with all federal
immigration laws and regulations that relate to their employees as well as compliance
with A.R.S. § 23-214(A) which requires registration and participation with the E-Verify
Program. Any breach of warranty described above is considered a material breach of
this Agreement and is subject to penalties up to and including termination of this
Agreement. City of Glendale (“City”) retains the legal right to inspect the papers of
Contractor or subcontractor employee who performs work under this Agreement to
ensure that Contractor or any subcontractor is compliant with the warranty described
above. City may conduct random inspections, and upon request of the City, Contractor
shall provide copies of papers and records demonstrating continued compliance with
the warranty described above. Contractor agrees to keep papers and records available
for inspection by the City during normal business hours and will cooperate with City in
exercise of its statutory duties and not deny access to its business premises or
applicable
papers
or
records
for
the
purposes
of
enforcement
of
this
Section. Contractor agrees to incorporate into any subcontracts under this Agreement
the same obligations imposed upon itself and expressly accrue those obligations directly
to the benefit of the City. Contractor also agrees to require any subcontractor to
Exhibit A
incorporate into each of its own subcontracts under this Agreement the same obligations
above and expressly accrue those obligations to the benefit of the City. Contractor’s
warranty and obligations under this Section I to the City is continuing throughout the
term of this Agreement or until such time as the City determines, in its sole discretion,
that Arizona law has been modified in that compliance with this section is no longer a
requirement. The “E-Verify Program” above means the employment verification
program administered by the United States Department of Homeland Security, the
Social Security Administration, or any successor program.
41.
CONTRACT ADMINISTRATOR The staff member identified as the Contract Administrator
for a solicitation serves as the liaison between Procurement, the city and the successful
contractor. The Contract Administrator manages the contract, overseeing the daily
operations, scheduling, performance and compliance of the agreement by all
parties. The Contract Administrator is responsible for:
a.
Establishing and maintaining records and documentation
b.
Monitoring the contractor’s performance
c.
Handling issues and disputes
d.
Exercising extension options
e.
Initiating contract modifications
f.
Initiating rebids or new solicitations
42.
FORCE MAJEURE
a.
Except for payment of sums due, neither party shall be liable to the other nor
deemed in default under this contract if and to the extent that such party’s
performance of this Contract is prevented by reason of force majeure. The term
“force majeure” means an occurrence that is beyond the control of the part
affected and occurs without its fault or negligence. Without limiting the foregoing,
force majeure includes acts of God; acts of the public enemy; war; riots; strikes;
mobilization; labor disputes; civil disorders, fire; flood; lockouts; injunctions-
interventions-acts; or failures or refusals to act by government authority; and other
similar occurrences beyond the control of the party declaring force majeure which
such party is unable to prevent by exercising reasonable diligence.
b.
Force majeure shall not include the following circumstances:
i.
Late delivery of equipment or materials caused by congestion at a
manufacturer’s plant or elsewhere, or an oversold condition of the market.
ii.
Late performance by a subcontractor unless the delay arises out of a force
majeure occurrence in accordance with this force majeure term and
condition; or
iii.
Inability of either the Contractor or any subcontractor to acquire or
maintain any required insurance, bonds, licenses or permits.
Exhibit A
43.
SUSPENSION AND DEBARMENT. (APPLIES TO ALL PURCHASES.)
a.
This contract is a covered transaction for purposes of 2 CFR pt. 180 and 2 CFR
pt. 3000. As such, the Contractor is required to verify that none of Contractor’s
principals (defined at 2 CFR § 180.995) or its affiliates (defined at 2 CFR §
180.905) are excluded (defined at 2 CFR § 180.940) or disqualified (defined at
2 CFR § 180.935).
b.
The Contractor must comply with 2 CFR pt. 180, subpart C and 2 CFR pt. 3000,
subpart C, and must include a requirement to comply with these regulations in
any lower tier covered transaction it enters into.
c.
This certification is a material representation of fact relied upon by the City of
Glendale. If it is later determined that the contractor did not comply with 2 CFR
pt. 180, subpart C and 2 CFR pt. 3000, subpart C, in addition to remedies
available to the City, the Federal Government may pursue available remedies,
including but not limited to suspension and/or debarment.
d.
The Contractor agrees to comply with the requirements of 2 CFR pt. 180, subpart
C and 2 CFR pt. 3000, subpart C while this offer is valid and throughout the
period of any contract that may arise from this offer. The Contractor further
agrees to include a provision requiring such compliance in its lower tier covered
transactions.
Exhibit A
EXHIBIT 3: INSURANCE REQUIREMENTS
By signing on the Offer/Bid page, solicitation addenda, or cover letter accompanying the submittal
documents, Offerors are certifying that they understand the following notices and agree to comply with
all required terms and conditions.
1)
INSURANCE REQUIREMENTS. Offeror shall procure and maintain until all their
obligations have been discharged, insurance against claims for injury to persons or
damage to property that may arise from or in connection with this Solicitation. The
insurance requirements herein are minimum requirements for this Solicitation and in
no way limit the indemnity covenants contained herein. The City of Glendale in no way
warrants that the minimum limits contained herein is sufficient to protect the OFFEROR
from liabilities that might arise. Offeror is free to purchase such additional insurance
as Offeror determines necessary.
a)
Minimum Scope and Limits of Insurance: Offeror shall provide coverage with
limits of liability not less than those stated below.
i)
Commercial General Liability – Occurrence Form
Policy shall include bodily injury, property damage, personal and
advertising injury and broad form contractual liability coverage.
General Aggregate
$2,000,000
Products – Completed Operations Aggregate
$1,000,000
Personal and Advertising Injury
$1,000,000
Each Occurrence
$1,000,000
(1)
The policy shall be endorsed to include the following additional
insured language: “The City of Glendale, and its departments,
officers, officials, agents, employees and volunteers shall be
named as additional insureds with respect to liability arising out
of the solicitation. Such additional insured shall be covered to the
full limits of liability purchased by the OFFEROR, even if those
limits of liability are in excess of those required herein.
(2)
Policy shall contain a waiver of subrogation endorsement in favor
of the “City of Glendale, and its departments, officers, officials,
agents, employees and volunteers”. This provision applies
regardless of whether or not the City of Glendale has received a
waiver of subrogation endorsement from the insurer.
ii)
Business Automobile Liability – (if driving is not a part of the scope of
work, excluding driving from the place of business and to the City
departments, this coverage can be eliminated.)
Bodily Injury and Property Damage for any owned, hired, and/or non-
owned vehicles used in the performance of this Agreement. Combined
Single Limit (CSL) $1,000,000.
Exhibit A
(1)
The policy shall be endorsed to include the following additional
insured language: “The City of Glendale and its departments,
officers, officials, agents, employees and volunteers shall be named
as additional insureds with respect to liability arising out of the
activities performed by or on behalf of the Offeror, involving
automobiles owned, licensed, hired or borrowed by the OFFEROR."
Such additional insured shall be covered to the full limits of liability
purchased by the Offeror, even if those limits of liability are in
excess of those required by this license.
(2)
Policy shall contain a waiver of subrogation endorsement in favor
of the “City of Glendale, and its departments, officers, officials,
agents, employees and volunteers” for losses arising from work
performed by or on behalf of the Offeror. This provision applies
regardless of whether or not the City of Glendale has received a
waiver of subrogation endorsement from the insurer.
iii)
Worker's Compensation and Employers' Liability
Workers' Compensation Statutory
Employers' Liability
Each Accident
$1,000,000
Disease – Each Employee $1,000,000
Disease – Policy Limit
$1,000,000
(1)
Policy shall contain a waiver of subrogation endorsement in favor
of the “City of Glendale, and its departments, officers, officials,
agents, employees and volunteers” for losses arising from
OFFEROR activities. This provision applies regardless of whether
or not the City of Glendale has received a waiver of subrogation
endorsement from the insurer.
The Department shall be endorsed (Blanket Endorsements are not
acceptable) as a Loss Payee as our interest may appear.
iv)
Professional Liability (Errors & Omissions) – no less than $2,000,000 per
occurrence or claim, $4,000,000 aggregate. Should include coverage for Plan
administration and fiduciary administrative duties. Full description of the E&O
Coverage provided.
Errors & Omissions are written as Claims Made Policies. If any of the policies
provide coverage on a claims-made basis the following shall apply:
(1)
The Retroactive Date must be shown and must be before the date of the
contract or the beginning of contract work.
(2)
Insurance must be maintained, and evidence of insurance must be
provided for at least five (5) years after completion of the contract of
work.
Exhibit A
(3)
If coverage is canceled or non-renewed, and not replaced with another
claims-made policy form with a Retroactive Date prior to the contract
effective date, the Consultant must purchase “extended reporting”
coverage for a minimum of five (5) years after completion of contract work
v)
Additional Insurance Requirements: The policies shall include, or be endorsed
to include the following provisions:
(1)
Policies shall stipulate that the insurance afforded by the organization
shall be primary insurance and that any insurance carried by the City of
Glendale shall be excess and not contributory insurance.
(2) Coverage provided by the organization shall not be limited to the liability
assumed under the indemnification provisions of the license or contract.
(3) If the Vendor maintains broader coverage and/or higher limits than the
minimum shown, the City requires and shall be entitled to the broader
coverage and/or the higher limits maintained by the Vendor. Any available
insurance proceeds in excess of the specified minimum of insurance and
coverage shall be available to the City.
(4) Vendor shall require and verify that all subcontractors (subconsultants)
maintain insurance meeting all the requirements stated herein, and
Vendor shall ensure that City is an additional insured on insurance
required from subcontractors (subconsultants).
(5) If the Vendor is awarded the solicitation, the Vendor shall furnish the City
with original Certificates of Insurance including all required amendatory
endorsements before the work begins. However, failure to obtain the
required documents prior to the work beginning shall not waive the
Vendor’s obligation to provide them. The City reserves the right to require
complete, certified copies of all required insurance policies including
endorsements required by these specifications, at any time.
Exhibit A
ATTACHMENT 1 - ADDITIONAL LIFE COVERAGE HIGHLIGHTS
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ATTACHMENT 2 - EMPLOYEE BENEFITS BOOKLET – CITY MANAGER
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ATTACHMENT 3 - EMPLOYEE BENEFITS BOOKLET – ALL OTHER
MEMBERS, OTHER THAN CITY MANAGER
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ATTACHMENT 4 - EMPLOYEE BENEFITS BOOKLET - RETIRED
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ATTACHMENT 5 - COMMUTER LIFE POLICY
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ATTACHMENT 6 - LIFE CERTIFICATE
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ATTACHMENT 7 – LIFE EXPERIENCE (BASIC)
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ATTACHMENT 8 - LIFE EXPERIENCE (EMPLOYEE)
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ATTACHMENT 9 – LIFE EXPERIENCE (SPOUSE)
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ATTACHMENT 10 – LIFE CENSUS CITY OF GLENDALE
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ATTACHMENT 11 – BUSINESS ASSOCIATE AGREEMENT
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Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
City of Glendale
Life, AD&D Insurance and
Commuter Life
PROPOSAL
April 11, 2024
RFP #24-45
Katie Degelmann
kdegelmann@ochsinc.com
651-303-6854 (Cell) ● 651-665-3789 (Office) ● 800-392-7295 (Fax)
Ochs, Inc., A Securian Company
400 Robert Street North, Suite 1880
St. Paul, Minnesota 55101-7734
TABLE OF CONTENTS
Technical Proposal
Section 1
a)
Cover Letter
b)
Roles and Responsibilities
c)
Strength in Numbers
d)
Value Adds
Section 2 - Method of Approach
a)
Plan Enhancements
b)
Plan Design
Section 3 - Forms
a)
Submission Checklist
b)
Attachment 11 - Business Associate
Amendment
c)
Addendum 1 4-1-24
d)
Addendum 2 4-5-24
Section 4 - Questionnaires
a)
Response Workbook
1)
Organizational Chart
2)
Sample Policy and Riders
3)
Katie Degelmann Biography
4)
Emily Watters Biography
5)
Cory Claeson Biography
6)
Gao Vang Biography
7)
Implementation Timeline
8)
Sample Reports
9)
Sample Certificate
b)
Scope of Work
c)
Administration
d)
Experience and Qualifications
e)
Claims
Cost Proposal
a)
Pricing Workbook
b)
Proposed Rates
c)
Performance Guarantees
Exhibit A
Ochs, Inc.
A Securian Financial Company
400 Robert Street North, Suite 1880
St. Paul, MN 55101
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
April 11, 2024
City of Glendale
Submitted Via Munis Self Service
Re: RFP 24-45 - Life, AD&D Insurance and Commuter Life
Hello,
On behalf of our best-in-class insurance carrier, Securian Financial, we are pleased to present our
Life/AD&D Insurance proposal. To provide streamlined customer service, Ochs serves as the main
point of contact between clients and the insurance carrier. We specialize in working with small to mid-
sized public employers and developed The Municipal Pool© to give groups of your size similar
purchasing power as large employers. For additional details please see the “Roles and
Responsibilities” and “Strength in Numbers” flyers included.
Municipal Pool members receive strength in numbers including:
Competitive rates
Enhanced plan designs
Better rate stability
Favorable rate guarantees
Proposed financial offer
Basic Life/AD&D - A pricing structure designed for plan stability and financial viability
Voluntary Life/AD&D - A pricing structure designed for plan stability and financial viability
Life plan enhancements (see our “Plan Enhancements” document for complete list)
$12,500 Implementation credit included
Increased employee voluntary life maximum from $500,000 to $750,000 and increased newly hired
guaranteed issue (no medical questions) amount from $200,000 to $300,000
Increased spouse voluntary life maximum from $100,000 to $250,000
Increased child voluntary life maximum and guaranteed issue (no medical questions) amount from
$5,000 to $20,000
Surveys reveal that our clients are extremely satisfied with the exceptional service we provide. You can
count on our Pool insurance carrier, Securian Financial, as a trusted partner, along with Ochs who will
serve as your main point of contact to simplify implementation and the ongoing enrollment and
administration processes.
Sincerely,
Katie Degelmann, Senior Regional Sales Vice President, Western Region
P: 651-303-6854; E: kdegelmann@ochsinc.com
Exhibit A
More value. More choice. More support.
Life and AD&D insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, A New York authorized insurer. Minnesota
Life is not an authorized New York insurer and does not do insurance business in New York. Both companies are headquartered in St. Paul, MN. Product availability and
features may vary by state. Each insurance company is solely responsible for the financial obligations under the policies or contracts it issues.
Securian Financial is the marketing name for Securian Financial Group, Inc., and its subsidiaries. Minnesota Life Insurance Company, Securian Life Insurance
Company and Ochs, Inc. are subsidiaries of Securian Financial Group, Inc.
Ochs, Inc., A Securian Financial Company • ochs@ochsinc.com • 651-665-3789 • 800-392-7295 • www.ochsinc.com
DOFU 02-2023
2423165
Working together - Ochs works alongside a best-in-class Life and AD&D insurance
carrier to offer comprehensive, innovative and customized employee benefit plans.
LIFE/AD&D Insurance
• Contracts and Certificates
• Authorized Signatures
• Claims Adjudication
SECURIAN FINANCIAL
• Selects and endorses ideal
benefit plan for employees
• Promotes benefits
education and enrollment
YOUR GROUP
ROLES AND RESPONSIBILITIES
Independent rating agengies and comdex ranking as of 1-2022 and client satisfaction survey July 2022.
OCHS
Serves as the main point of contact to deliver streamlined service:
Product, pricing, and rate stability advantages
Streamlined implementations and service solutions
Exceptional customer service and timely problem resolution
Customized marketing materials and employee communications
Exhibit A
More value. More choice. More support.
THE MUNICIPAL POOL®
Members experience STRENGTH in numbers
• Cities & Counties
• Higher Education & School Districts
• Public Hospitals
• Public Airports, Transit, & Port Authorities
• Public Utilities & more
POOL MEMBERS
Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, a New York authorized insurer. Minnesota Life is not an authorized New York insurer and
does not do insurance business in New York. Both companies are headquartered in St. Paul, MN. Product availability and features may vary by state. Each insurer is solely responsible for the financial
obligations under the policies or contracts it issues. Securian Financial is the marketing name for Securian Financial Group, Inc., and its subsidiaries. Minnesota Life Insurance Company and Securian
Life Insurance Company are subsidiaries of Securian Financial Group, Inc.
Disability Insurance is issued by Madison National Life Insurance Company, Inc. National Insurance Services provides some administrative services for products issued by Madison National Life
Insurance Company, Inc.
F88781-2 DOFU 1-2024 (Rev. 1-2024)
3341764
Ochs, Inc. A Securian Financial Company
400 Robert Street North, Suite 1880, St. Paul, MN 55101
©2022 Ochs, Inc. All rights reserved
PRODUCTS & SERVICES
Established in 1943, Ochs brings expertise
to public employers and their benefit
advisors across the country. To learn more
about our products & services or to submit
a Request for Proposal, Contact Ochs:
1-800-392-7295
ochs@ochsinc.com
The Municipal Pool brings hundreds of small to mid-sized public employers
together to share the benefits of one large group. Ochs’ Pool members receive:
Short & Long Term Disability through Madison National
Customized marketing and communications
The Ochs Resource Center
Unlimited professional support, no cost training & online
resources - saving employers thousands of dollars
Group Life and AD&D through Securian Financial
Competitive rates
Enhanced plan designs
Favorable rate guarantees
Better rate stability
806
public
employers
256,200
eligible
employees
Ochs developed and is the exclusive
administrator of THE MUNICIPAL POOL.
What began with two public employers in 1955,
has grown to include more than:
(as of January 2024)
Exhibit A
Job descripton builders to help with finding new
hires as well as updating current employee positions
EASY ACCESS AND USER FRIENDLY RESOURCES INCLUDE:
A state-specific employee handbook building
tool, online training courses, and benchmarking
tools
Unlimited answers to your Human Resources &
employment law, benefits law, and cyber security questions
A simple cyber assessment to identify an
organization’s risks along with the immediate
steps to take to address them
ACA reporting and OSHA log tools to help track
key compliance requirements
Live and recorded webinars on cyber security, risk
management and health plan compliance, many
with CE credits for Human Resources personnel
Proactive state law / regulation updates based
on each user’s selected preferences
Questions - Contact Ochs: 800-392-7295
Vetted resources available for ongoing and
additional cyber protection and breach
support
Human Resources &
Administrative Staff have
access to valuable tools,
training, and support -
SAVING employers time
and money!
OCHS RESOURCE CENTER
At no additional cost we provide our clients unlimited access to a secure portal,
helping staff members tackle challenges and find solutions more easily.
NO COST
TRAINING
Phishing testing and
online training available
for staff and
employees
+
+
ONLINE
RESOURCES
Job description builder,
employee handbook
builder, forms,
posters, etc.
UNLIMITED
SUPPORT
Specific, documented,
and confidential
answers to
questions
More value. More choice. More support.
Exhibit A
©2022 Ochs, Inc. (Rev. 05-23)
Emergency & Disaster Resources for Employers
When disaster strikes and disrupts your organization, employers often need fast and easy
access to the right resources to take action and address employee questions. The emergency
and disaster center can help you with critical decisions including terminations, layoffs, furloughs,
benefits, temporary leaves of absence, rehiring/return to work, remote workforces, cyber
exposures, and more.
What Clients Are Saying About the Ochs Resource Center
“ This is phenomenal. WOW! I cannot believe we have access to all of this. What a lifesaver. The posters I
can print out. No more spending time looking all over Google for them or wasting money on the big ones.
This is all overwhelming but in a good way. So many resources and tools that are going to be so helpful. I’m
sorry if I sound overly excited, but you have no idea what this is going to do for me. Knowledge is power. ”
HR Training Coordinator, Florida
“ This is a resourceful site. I can see myself coming here for all of the forms and
documents we need. Especially that online training. I do have need HRCI credits, the
webinars will be helpful as well. ”
HR/Assistant City Manager, FL
“ This looks straightforward and easy to use. I like that. There is so much information here and in one
spot. We have an IT department. I am going to show them this to see if they want access to the Cyber and
Website Accessibility. We are in the process of doing our handbook, loving this. Thank you for showing and
going over the online training with me. I am going to start assigning that out today. ”
HR Public Relations Coordinator, Ohio
800-392-7295
ochs@ochsinc.com
Questions? Contact Ochs:
Learn More
Online training
Job description builder
Employee handbook builder
State posters and notices
Compliance checklists
State law / regulation
Cyber security help
Popular Resources
Click Here
Watch a short
video:
Exhibit A
Automatic access to
Lifestyle Benefits
Your employer’s group insurance programs help protect your
financial wellness. And you and your family can rely on a suite
of additional tools, support, guidance and services to help make
life a little easier.
There is no additional fee or enrollment for these resources. Just access the
services you need, whenever you need them. Lifestyle Benefits are automatically
available to active U.S. employees insured with Securian Financial. Your spouse
and insurance-eligible children can also use these resources, even if they’re not
covered under the insurance program.
Lifestyle Benefits available to you include:
• Legal, Financial and Grief Resources
• Travel Assistance
• Legacy Planning Resources
• Beneficiary Financial Coaching
Lifestyle Benefits
Products issued by: Minnesota Life Insurance Company or
Securian Life Insurance Company
Exhibit A
Legal, Financial and Grief resources
from TELUS Health
Professional services for a variety of needs - from legal matters and financial
situations to coping with loss - through comprehensive web and mobile
resources, as well as consultations
Legal: Includes resources such as will prep templates - and a free, 30-minute
consultation per issue, by phone or in an attorney’s office (additional services
available at 25 percent discount)
Funeral planning: Resources to make funeral arrangements, including a final
wishes and funeral planning form and guidebooks, as well as a 10 percent
discount on prearrangements and immediate-need end-of-life services
Financial: Includes telephone consults or 45-minute counseling session per issue
on many topics — from budget analysis to tax planning. Includes online access
to a financial fitness assessment
Grief support: Access master’s-level consultants by phone for any stage of grief
and referrals for loss support
Well-being: Includes a total well-being index with personalized
recommendations for lifestyle changes, access to online self-guided programs
to help with anxiety, depression and stress, as well as personalized fitness
journeys based on personal goals
Travel Assistance
from RedpointWTP LLC
24/7 online, pre-trip resources and support for emergency travel assistance
and other services when traveling 50+ miles from home
Pre-trip planning and trip support: Passport, visa, immunization and currency
conversion information
Medical evacuation services: Pre-hospital and rental vehicle assistance,
transportation to nearest appropriate medical facility once hospitalized,
mortal remains repatriation, return of dependent children/pets, family member
visitation, and travel companion transport
Security evacuation services: Transfer to nearest safe area, ID theft support
and assistance replacing lost/stolen luggage
How to access:
LifeBenefits.com/travel
U.S./Canada:
1-855-516-5433
All other locations:
1-415-484-4677
How to access:
LifeBenefits.com/Lfg
username: lfg
password: resources
1-877-849-6034
Exhibit A
PREPARE
PROTECT
SECURE
securian.com
400 Robert Street North, St. Paul, MN 55101-2098
©2023 Securian Financial Group, Inc. All rights reserved.
F97548-3 10-2023 DOFU 10-2023
3146498
Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, a New York authorized insurer.
Minnesota Life is not an authorized New York insurer and does not do insurance business in New York. Both companies are headquartered
in St. Paul, MN. Product availability and features may vary by state. Each insurer is solely responsible for the financial obligations under the
policies or contracts it issues.
Services provided by TELUS Health, PricewaterhouseCoopers LLP and RedpointWTP LLC are their sole responsibility. The services are not
affiliated with Securian Financial or its group contracts and may be discontinued at any time. Certain terms, conditions and restrictions
may apply when utilizing the services. To learn more, visit the appropriate website.
Securian Financial is the marketing name for Securian Financial Group, Inc., and its subsidiaries. Minnesota Life Insurance Company and
Securian Life Insurance Company are subsidiaries of Securian Financial Group, Inc.
Legacy Planning Resources
from Securian Financial
Online information and resources to help with multiple aspects of legacy
planning — from end-of-life and funeral planning, final arrangements, directives
and survivor assistance
Funeral concierge: Allows for coverage verification and direct payment to a
funeral home so services can be provided before insurance payment is made
Express Assignment™: Same-day funeral home assignment service reduces
concern about paying funeral expenses by working with the funeral home or
lending agency
Beneficiary Financial Coaching
from Pricewaterhouse-Coopers LLP
Independent, objective and free financial coaching program for beneficiaries
Dedicated financial coaching: Telephone access to a coach for a specified
period to help with financial decisions related to estate, insurance, investment,
retirement and tax planning following the death of a loved one
Survivor guide workbooks: Resources focused on specific planning stages to
help make decisions on critical financial and legal matters less overwhelming
How to access:
Beneficiaries receiving
$25,000 or more will be
invited to take advantage
of this program when
the life insurance claim is
paid. Telephone financial
guidance provided to
beneficiaries receiving
$100,000+.
How to access:
securian.com/legacy
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
Plan Enhancements
We understand how valuable employee benefits are to you and your employees. In support of this, we have identified
several plan enhancements to enrich your life insurance program. In addition to matching the requested plan design, our
life insurance proposal offers plan enhancements at no cost beyond the premium paid. You have the flexibility to choose
any, or all, of the following enhancements:
Implementation Credit
We are able to provide an implementation credit to City of Glendale of up to $12,500. We will pay the credit after receiving
reasonably detailed invoices from the City evidencing the costs the City incurred in connection with the insurance
coverage offered. We can pay the credit to either the City or a third party as the City directs. The insurance policy issued
to the City will include a rider with additional details regarding the timeframes associated with incurring costs and
requesting payment.
Increased Supplemental Life Maximum for Employee
We propose increasing the supplemental life maximum from $500,000 to $750,000 to help keep pace with increasing
salaries and insurance needs. The guaranteed issue limit will be increased from $200,000 to $300,000 for newly eligible
employees.
Increased Supplemental Life Maximum for Spouse
We propose increasing the supplemental spouse life maximum from $100,000 to $250,000, not to exceed 100% of
employee’s basic and supplemental amount combined. Employees do not need to be enrolled in supplemental life to elect
spouse supplemental life coverage.
Increased Supplemental Life Maximum and Guarantee Issue for Child
We propose increasing the supplemental child life maximum from $5,000 to $20,000, not to exceed 100% of employee’s
basic and supplemental amount combined. The guaranteed issue limit will be increased from $5,000 to $20,000 for newly
eligible children. Employees do not need to be enrolled in supplemental life to elect child supplemental life coverage.
Spouse and Child Life Without Employee Supplemental Life
Our proposal includes the ability for employees to elect spouse and child supplemental life coverage without having, or
enrolling in, supplemental life themselves.
Remove Age Reductions for Supplemental Life
We propose removing the supplemental life age reductions from the plan design. Because this plan will be part of The
Municipal Pool, age reductions can be removed.
First Eligible Newborn Child Benefit
Our proposal includes a benefit to be paid if an employee's first eligible newborn child dies within 31 days of birth
but prior to the employee enrolling for child life coverage.
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
Annual Open Enrollment for Child Life
Our proposal includes a special guaranteed issue opportunity for child(ren) during the initial enrollment period, as well as
each year during the annual enrollment period. One low monthly premium covers all eligible dependent children in the
family up to the maximum child life benefit amount.
Accelerated Death Benefit
We offer one of the most competitive and flexible accelerated death benefit provisions in the market. Terminally ill
insureds with a life expectancy of 12 months or less can accelerate up to 100% of their combined basic and supplemental
insurance – to a maximum of $1,000,000. The minimum face amount eligible to be accelerated is $10,000. We do not
discount the benefit amount for early payment of the claim. This provision has no impact to the premium rates.
Exhibit A
City of Glendale
Group Term Life and AD&D Insurance
PLAN DESIGN
Date:
Effective Date:
April 11, 2024
July 1, 2024
Presented by:
Ochs, Inc., A Securian Financial Company
Underwritten by:
Securian Life Insurance Company
City of Glendale
©2022 Ochs, Inc. All rights reserved.
Version 1.4
2
Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
PLAN DETAILS
Group Term Life and AD&D Insurance
Funding
Class
Non-Contributory / Contributory
Classes 1 and 2:
Employer Paid
•
Basic Term Life and AD&D
Employee Paid
•
Supplemental Term Life and AD&D
•
Dependent Term Life Package
•
Spouse Term Life
•
Child Term Life
Class 3:
Employer Paid
•
Basic Term Life
City of Glendale
©2022 Ochs, Inc. All rights reserved.
Version 1.4
3
Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
BASIC TERM LIFE
Plan Design Description
Benefit Summary
Class
Amount
Class 1: All City Managers
2x Basic Annual Earnings (rounded to the next higher $1,000, if not already a
multiple of $1,000), subject to a maximum of $500,000
Class 2: All Regular Status
Active Employees
1x Basic Annual Earnings (rounded to the next higher $1,000, if not already a
multiple of $1,000), subject to a maximum of $300,000
Class 3: Retirees
Amount in force prior to retirement, subject to a maximum of $100,000
Basic Life Age Reduction Schedule
Class
Age
Reduces to
Classes 1 and 2
70
65%
75
45%
80
30%
Class 3
70
Terminates
Guaranteed Issue (GI) and EOI Requirements
Summary
Amount
Current Insureds
•
All coverage is grandfathered and guaranteed
•
Salary Increases: Coverage increases due to salary changes are guaranteed
to the plan maximum
New Employees
All coverage is guaranteed for new employees
Accidental Death and Dismemberment (AD&D)
Summary
Amount
Benefit
Matches life amount for death with benefit schedule for dismemberment;
includes the following additional benefits:
• Line of Duty - Principal sum increases by 100% up to $100,000
• Airbag - Lesser of 10% or $10,000
• Seatbelt - Lesser of 20% or $20,000
• Child Care - Lesser of actual cost, 3% or $3,000 for four (4) years
• Child Education - Lesser of actual cost, 5% or $5,000 for four (4) years
• Occupation Related Benefit - Lesser of 10% or $10,000
• Public Transportation - Lesser of 10% or $10,000
• Repatriation - Lesser of actual cost or $5,000
• Spouse Education - Lesser of actual cost, 5% or $5,000 for four (4) years
City of Glendale
©2022 Ochs, Inc. All rights reserved.
Version 1.4
4
Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
AD&D Dismemberment
Schedule of Benefits
(member is defined as hand,
foot, or eye)
Loss
Benefit
Life
100%
Two or more members
100%
Quadriplegia
100%
Speech and hearing
100%
Paraplegia
75%
One member
50%
Speech
50%
Hearing
50%
Hemiplegia
50%
Thumb & index finger of same hand
25%
Basic Dependent Package
Benefit Summary
Summary
Amount
Benefit
Spouse: $1,000*
Child: $1,000*
*not to exceed 100% of employee’s basic and supplemental amount
combined.
Guaranteed Issue (GI) and EOI Requirements
Summary
Requirement
Current Insureds
All coverage is grandfathered and guaranteed
New Employees
All coverage is guaranteed for new employees if elected within 31 days of
initial eligibility
Future Annual Enrollment
Not applicable
Qualified Status Change
All coverage is guaranteed
Outside of GI opportunities
Not applicable
Additional Plan Benefits
Benefit
Definition
Waiver of Premium
Premiums waived for active employees disabled prior to age 60 and continues
until the earlier of retirement, recovery, or age 65; provision includes a six (6)
month elimination period and is not available with ported coverage.
Accelerated Death Benefit
Allows terminally ill insureds with a life expectancy of 12 months or less to
accelerate up to 100% of the face amount up to $1,000,000 (Basic and
Supplemental combined).
Portability
Allows insureds to continue coverage if they terminate employment or retire.
Conversion
Allows insureds to convert terminated coverage to an individual life insurance
policy.
City of Glendale
©2022 Ochs, Inc. All rights reserved.
Version 1.4
5
Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
SUPPLEMENTAL TERM LIFE
Supplemental Employee Life
Benefit Summary
Summary
Amount
Benefit
$10,000 increments to a maximum of $750,000
Age Reductions
None
Guaranteed Issue (GI) and EOI Requirements
Summary
Requirement
Current Insureds
All coverage is grandfathered and guaranteed
Initial Enrollment
Option 1: $100,000 is guaranteed, up to the maximum guarantee issue of $300,000
if elected during one-time enrollment period (GI limit includes coverage currently in
force)
Option 2: $200,000 is guaranteed, up to the maximum guarantee issue of $200,000
if elected during one-time enrollment period (GI limit includes coverage currently in
force)
New Employees
Option 1: $300,000 is guaranteed for new employees if elected within 31 days of
initial eligibility
Option 2: $200,000 is guaranteed for new employees if elected within 31 days of
initial eligibility
Future Annual Enrollment
Electing or increasing coverage requires EOI
Qualified Status Change
Electing or increasing coverage requires EOI
Outside of GI opportunities
Electing or increasing coverage requires EOI
Accidental Death and Dismemberment (AD&D)
Summary
Amount
Benefit
Matches life amount for death with benefit schedule for dismemberment; includes
the following additional benefits:
•
Airbag - Lesser of 10% or $10,000
•
Seatbelt - Lesser of 20% or $20,000
•
Child Care - Lesser of actual cost, 3% or $3,000 for four (4) years
•
Child Education - Lesser of actual cost, 5% or $5,000 for four (4) years
•
Occupation Related Benefit - Lesser of 10% or $10,000
•
Public Transportation - Lesser of 10% or $10,000
•
Repatriation - Lesser of actual cost or $5,000
•
Spouse Education - Lesser of actual cost, 5% or $5,000 for four (4) years
Dismemberment Schedule of Benefits Matches Basic AD&D Schedule
City of Glendale
©2022 Ochs, Inc. All rights reserved.
Version 1.4
6
Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
Additional Plan Benefits
Benefit
Definition
Waiver of Premium
Available for employees disabled prior to age 60 and continues until retirement,
recovery, or age 65; provision includes six (6) month elimination period and is not
available with ported coverage.
Accelerated Death Benefit
Allows terminally ill insureds with a life expectancy of 12 months or less to
accelerate up to 100% of the face amount up to $1,000,000 (Basic and
Supplemental combined).
Portability
Allows insureds to continue coverage if they terminate employment or retire.
Conversion
Allows insureds to convert terminated coverage to an individual life insurance
policy.
City of Glendale
©2022 Ochs, Inc. All rights reserved.
Version 1.4
7
Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
DEPENDENT TERM LIFE
Dependent Eligibility
Class
Definition
Spouse
•
A spouse is not eligible if they are also eligible for employee coverage
Children
•
Live birth to 26 years; or physically or mentally disabled and incapable of self-
support prior to attaining age 26
•
A child may only be covered by one parent
•
If an employee's first eligible newborn child dies within 31 days of birth but prior
to the employee enrolling for child life coverage, a benefit will be paid
Supplemental Spouse Life
Benefit Summary
Summary
Amount
Benefit
$10,000 increments to a maximum of $250,000, not to exceed 100% of employee’s
basic and supplemental amount combined.
Elect coverage even if employee does not have supplemental life themselves.
Age Reductions
None
Guaranteed Issue (GI) and EOI Requirements
Summary
Requirement
Current Insureds
All coverage is grandfathered and guaranteed
Initial Enrollment
Electing or increasing coverage requires EOI
New Employees
$50,000 is guaranteed for new employees if elected within 31 days of initial
eligibility
Future Annual Enrollment
Electing or increasing coverage requires EOI
Qualified Status Change
$50,000 is guaranteed if elected within 31 days of Qualified Status Change
Outside of GI opportunities
Electing or increasing coverage requires EOI
City of Glendale
©2022 Ochs, Inc. All rights reserved.
Version 1.4
8
Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
Supplemental Child Life
Benefit Summary
Summary
Amount
Benefit
$10,000, $15,000 or $20,000, not to exceed 100% of employee’s basic and
supplemental amount combined.
Elect coverage even if employee does not have supplemental life themselves.
Guaranteed Issue (GI) and EOI Requirements
Summary
Requirement
Current Insureds
All coverage is grandfathered and guaranteed
One-time Open Enrollment
All coverage is guaranteed if elected within 31 days of initial eligibility
New Employees
All coverage is guaranteed for new employees if elected within 31 days of
initial eligibility
Future Annual Enrollment
All coverage is guaranteed at each annual enrollment
Qualified Status Change
All coverage is guaranteed if elected within 31 days of Qualified Status Change
Outside of GI opportunities
Electing or increasing coverage requires EOI
Additional Plan Benefits
Benefit
Definition
Waiver of Premium
If an employee's premium is being waived under the Waiver of Premium provision,
premiums for dependent coverage(s) the employee had as an active insured will be
continued and waived as well.
Accelerated Death Benefit
Allows terminally ill insureds with a life expectancy of 12 months or less to
accelerate up to 100% of the face amount up to $1,000,000 (Basic and
Supplemental combined).
Portability
Allows spouse and children to continue coverage if employee terminates
employment or retires.
Conversion
Allows insureds to convert terminated coverage to an individual life insurance
policy.
City of Glendale
©2022 Ochs, Inc. All rights reserved.
Version 1.4
9
Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
DEFINITIONS AND GUARANTEED ISSUE (GI) LIMITS
Category
Guaranteed Issue Limits*
Current Insureds
All employees in a benefit eligible class on
the effective date of this policy and their
dependents
All current Basic coverage amounts are guaranteed and carried
over without providing evidence of insurability (EOI)
•
Employee: Supplemental amount in force prior to policy
effective date
•
Spouse: amount in force prior to policy effective date
•
Child: amount in force prior to policy effective date
•
Dependent Package: amount in force prior to policy effective
date
Initial Enrollment
•
Employee:
•
Option 1: $100,000 is guaranteed, up to the maximum
guarantee issue of $300,000 if elected during one-time
enrollment period (GI limit includes coverage currently in
force)
•
Option 2: $200,000 is guaranteed, up to the maximum
guarantee issue of $200,000 if elected during one-time
enrollment period (GI limit includes coverage currently in
force)
•
Spouse: Electing or increasing coverage requires EOI
•
Child: All coverage is guaranteed at each annual enrollment
Future Annual Enrollment
Benefit eligible employees and their
dependents
•
Employee: Electing or increasing coverage requires EOI
•
Spouse: Electing or increasing coverage requires EOI
•
Child: All coverage is guaranteed at each annual enrollment
New Employees
All employees who first become benefit
eligible after the effective date of this policy
and their dependents
Coverage is guaranteed up to the GI limits if elected within the 31-
day new employee enrollment period
•
Employee:
•
Option 1: $300,000 is guaranteed for new employees if
elected within 31 days of initial eligibility
•
Option 2: $200,000 is guaranteed for new employees if
elected within 31 days of initial eligibility
•
Spouse: $50,000 is guaranteed
•
Child: All coverage is guaranteed
•
Dependent Package: All coverage is guaranteed
Qualified Status Change (QSC)
Dependents who become benefit eligible
after the effective date of this policy (i.e.
marriage, birth, adoption). QSC are
determined by the employer
Coverage is guaranteed up to the GI limits if elected within 31 days
of a qualifying status change
•
Employee: Not applicable
•
Spouse: $50,000 is guaranteed
•
Child: All coverage is guaranteed
•
Dependent Package: All coverage is guaranteed
Outside of GI opportunities: Electing or increasing coverage requires Evidence of Insurability
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Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
*GI limits include coverage currently in force
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Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
PROPOSAL TERMS AND CONDITIONS
• Quote is valid for 120 days and is based on census data submitted. If actual enrollment or plan design differs
materially, we reserve the right to review and modify the rates as necessary.
• Individuals may be covered only once under the group policy. Employees cannot also be insured as a spouse or child,
a child can only be insured by one parent, and an individual cannot be insured as both an ex-employee and a current
employee.
• All increases are subject to the actively at work provision in the policy.
• Non-participating (Fully pooled): The policyholder remits premiums at the stated rate. The policyholder will not
receive any experience refunds.
• Our proposal assumes that all lives will be transferred according to the chart below and that coverage will be provided
on a no loss/no gain basis. Because the current plan has a waiver of premium provision, those eligible under that
provision will continue to be insured by the prior carrier. Others will be insured by Securian.
Status of Employee on Effective Date
Responsible Party
Disabled and on approved waiver of premium
Incumbent Carrier
Disabled and not yet approved waiver of premium
Incumbent Carrier/ Securian *
Disabled and satisfying elimination period
Incumbent Carrier/ Securian *
Absent due to disabling ailment
Incumbent Carrier/ Securian *
Absent due to non-disabling ailment
Securian
On vacation
Securian
On non-medical leave of absence
Securian
On excused absence (funeral, etc.)
Securian
At work
Securian
*Our proposal assumes that employees on approved waiver of premium on the effective date will stay with the incumbent carrier under
the current waiver of premium provision. If an employee is absent due to disability but not yet eligible or approved for waiver of
premium, we recommend that premiums be paid to Securian. If the employee returns to work or otherwise does not satisfy the
requirements for approved waiver of premium, Securian will be responsible for the ongoing life insurance coverage. If the employee
remains disabled and satisfies the requirements for a waiver of premium claim, the claim should be filed with the incumbent carrier.
Similarly, if the employee dies while totally disabled but before satisfying the waiting period for a waiver of premium claim, the death
claim should be filed with the incumbent carrier. In any event, either Securian or the incumbent carrier will provide coverage for
every insured employee.
• We relied on information provided with the initial RFP and subsequent information after the RFP release to develop
our proposal. If any information was incorrect or incomplete we reserve the right to review and adjust rates.
• We reserve the right to review the appropriateness of the rates at any time in the event of plan design changes,
modifications to the definition of eligible employees, or significant demographic changes in the group. We define
significant changes to mean a change in the volume within a coverage or across coverages of more than 15%.
Actives and retirees are considered independent coverages. The baseline for calculating the total change in volume
will be the volume provided in the RFP
• Issued policies will comply with applicable state insurance laws and coverage restrictions or limits may apply.
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Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
• Securian Financial Group is licensed to do business in the United States and our proposal covers employees working
in the U.S. and U.S. citizens working abroad as expatriates. We’re happy to discuss solutions for your non-U.S.
citizens working outside the U.S. to meet the changing benefits needs of a global workforce.
• If selected as a finalist, Securian Financial Group's legal counsel will review the specifics of any sample contract,
service agreement, or terms & conditions language and provide a list of items to discuss with client’s legal counsel.
We have found that this process can be completed efficiently and result in a mutually agreeable contract.
• It is the employer's obligation to determine the applicability of and compliance with any ERISA or DOL rules. Under
Department of Labor rules, certain employee-pay-all group plans may not be subject to ERISA rules. However, the
employer should consult counsel to determine if this plan falls within the exemption.
Termination
Term Life
Terminates at earlier of retirement (unless eligible for retiree benefits), loss of
eligibility, or termination of employment
Life Exclusions
Basic
No exclusions
Supplemental
Suicide exclusion applies. This exclusion limits our liability to an amount equal to the
premiums paid for an insured if the insured, whether sane or insane, dies by suicide
within two years of the effective date of his or her insurance. For existing amounts
transferred to our policy, the time insurance was in force under the prior policy(ies) will
count toward this two year limitation.
Ridered AD&D Exclusions (subject to situs state exclusions)
In no event will we pay the accidental death or dismemberment benefit where the insured’s death or dismemberment is
caused directly or indirectly by, results from, or where there is a contribution from, any of the following:
• Self-inflicted injury or self-destruction, whether sane or insane; or
• Suicide or attempted suicide, whether sane or insane; or
• The insured’s participation in or attempt to commit a crime, assault, felony, or any illegal activity, regardless of any legal
proceedings, or the absence of any legal proceedings, thereto; or
• Bodily or mental infirmity, illness or disease; or
• The use of alcohol, drugs, medications, poisons, gases, fumes or other substances taken, absorbed, inhaled, ingested
or injected, unless taken upon the advice of a licensed physician in the verifiable prescribed manner and dosage; or
• Motor vehicle collision or accident where the insured is the operator of the motor vehicle and this insured’s blood alcohol
level meets or exceeds the level at which intoxication is defined in the state where the collision or accident occurred,
regardless of any legal proceedings, or the absence of any legal proceedings, thereto; or
• Infection, other than infection occurring simultaneously with, and as a direct result of, the accidental injury; or
• Medical or surgical treatment or diagnostic procedures or any resulting complications; or
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Ochs, Inc., A Securian Financial Company
Underwritten by Securian Life Insurance Company
• Travel in or descent from any aircraft, except as a fare-paying passenger on a regularly scheduled commercial flight on
a licensed passenger aircraft carrier; or
• War or any act of war, whether declared or undeclared; or
• Service in the military of any nation.
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file:///T:/Proposals%20-%20RFP%20Documents/Organizational%20Charts/2024%20Org%20Charts%20updated/Group%20Division%20Organizational%20Chart%20-%2...
Exhibit A
Group Term Life Insurance Policy
Securian Life Insurance Company • A Stock Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
POLICYHOLDER:
ABC Company
POLICY NUMBER:
12345-G
POLICY SITUS:
This policy was issued and delivered in STATE .
POLICY EFFECTIVE DATE:
January 1, 2016
POLICY ANNIVERSARY DATE:
January 1 of each year beginning January 1, 2017
POLICY PREMIUM DUE DATE(S):
The first day of each month
Read Your Policy Carefully
This policy was issued to the policyholder on the effective
date shown above. We promise to pay the benefits
provided by this policy, subject to its conditions,
limitations, and exceptions. We make this promise and
issue this policy in consideration of the application for this
policy and the payment of the premiums.
Signed for Securian Life Insurance Company at St. Paul,
Minnesota on the effective date.
Secretary
President
TABLE OF CONTENTS
Definitions .......................................................................... 3
General Information .......................................................... 3
Premiums .......................................................................... 3
Termination ........................................................................ 4
Additional Information ........................................................ 4
GROUP TERM LIFE INSURANCE POLICY • NONPARTICIPATING
SAMPLE
Exhibit A
Certificates of Insurance Schedule
The following Certificates of Insurance and Certificate Endorsements (if any) are attached to and made a part of this
policy:
Certificate Title
Certificate Form Number
Applies To
Revision Date
All Salaried Employees
Certificate of Insurance
14-31701
Salaried employees
January 1, 2015
All Hourly Employees
Certificate of Insurance
14-31701
Hourly employees
January 1, 2015
Certificate Endorsement
Title
Certificate Endorsement
Form Number
Applies To
Revision Date
Executives
12345-G/1
Executive employees
January 1, 2015
Exhibit A
Definitions
associated company
Any company which is a subsidiary or affiliate of the
policyholder which is designated by the policyholder and
agreed to by us to participate under this policy.
contributory insurance
Insurance for which an employee is required to make
premium contributions.
noncontributory insurance
Insurance for which an employee is not required to make
premium contributions.
policyholder
The owner of the group policy as shown on the first page
of this policy.
we, our, us
Securian Life Insurance Company.
you, your
The policyholder.
General Information
What is your agreement with us?
This policy and your application contain the entire
insurance contract between you and us. Any statements
you make will, in the absence of fraud, be considered
representations and not warranties. Also, any statement
that you make will not be used to void this policy, nor will
it be used in our defense if we refuse to pay a claim,
unless the statement is contained in your application.
No change or waiver of any provisions of this policy, or
any certificate issued under it, will be valid unless made in
writing by us and signed by our president, a vice-
president, our secretary, or an assistant secretary. No
agent or other person has the authority to change or
waive any provisions of this policy, or of any certificate
issued under it.
Are employees of associated companies eligible for
insurance under this policy?
Yes. Employees of associated companies may be
eligible for insurance under this policy. You represent
any associated company in all transactions pertaining to
this policy. Your acts or omissions and every notice given
by us to you shall be binding on every associated
company. When an associated company ceases its
participation under the policy, the policy shall be
considered to be terminated for all employees of the
associated company. All provisions related to the policy
terminating will apply to such employees.
Can this policy be amended?
Yes. The insured's consent is not required to amend this
policy or any certificates issued under it. Any amendment
will be without prejudice to any claim for benefits incurred
prior to the effective date of the amendment.
Premiums
When and how often are premiums due?
Unless we have agreed to some other premium payment
procedure, premiums for this policy are remitted to us
monthly. Premiums are due on the premium due date as
shown on the first page of this policy. We apply premiums
consecutively to keep the insurance in force.
Premium contributions for contributory insurance are to be
paid to you. The premium contributions by insureds for
contributory insurance should be remitted to us as due
along with the premiums payable for noncontributory
insurance.
How is the premium determined?
The premium will be the premium rate multiplied by the
number of $1,000 units of insurance in force on the date
premiums are due. The premium may also be computed
by any other method on which you and we agree.
We may change the premium rate:
(1) on any premium due date following the expiration
of any rate guarantee period; or
(2) on any premium due date following the date that
the amount of insurance in force for any one
coverage changes by more than 15% from that
which was used to determine the current rates
(active employee coverage and retiree coverage
are considered separate coverages, as are basic
life, supplemental life, spouse life, child life and
AD&D); or
(3) anytime the policy terms are amended.
What factors do we consider when premium is
changed?
If premium is changed, the change will be based upon
future estimated or emerging experience, which factors
include: interest rates, mortality, taxes, our expenses and
profit considerations.
Can a premium be paid after the date it is due?
Yes. This policy has a 31-day grace period. If a premium
is not paid on or before the date it is due, that premium
may be paid during the 31-day period following the due
date. The insurance under this policy will remain in effect
during the 31-day grace period.
Exhibit A
Can the premium be adjusted?
Yes. An adjustment will be made to the premium on each
due date for insurance which was effective or terminated
before the most recent due date, but not reflected in prior
premium payments, so that the correct premium is paid.
Termination
When does this group policy terminate?
You may terminate this group policy by giving us 31 days
prior written notice. We reserve the right to terminate this
policy on the earlier of the following to occur:
(1) 31 days (the grace period) after the due date of
any premiums which are not paid; or
(2) 31 days after we provide you with notice of our
intent to terminate this policy.
Additional Information
Are you required to maintain records?
Yes. You are required to maintain adequate records of
any information necessary for us to administer this policy.
We will have reasonable access to such records in order
to administer the policy.
If an administration or clerical error is made in keeping
records on or administering the insurance under this
policy, it will not affect otherwise valid insurance. A
clerical or administrative error, however, does not
continue insurance which is otherwise stopped, make
insurance effective when it should not have been or
change the amount of insurance provided by the
provisions of this policy and no claim shall be paid on
amounts put into effect as a result of a past clerical or
administrative error. If an error causes a change in
premium payment, a fair adjustment will be made.
Will a certificate of insurance be provided for each
insured?
Yes. We will provide you with a certificate of insurance for
delivery to each insured. The certificate will include
information regarding the principal provisions of his or her
coverage.
Are you our agent?
No. For all purposes of this policy, neither you, an
associated company, nor any administrator you appoint is
our agent. We will not be liable for any of your acts or
omissions or those of an associated company or
administrator.
Will the provisions of this policy conform with state
law?
Yes. If any provision in this policy, or in the certificates
issued under this policy, is in conflict with the laws of the
state governing the policy or the certificates, the provision
will be deemed to be amended to conform to such laws.
Does ownership of this policy entitle you to
membership in Securian Life Insurance Company’s
parent company?
No. The ultimate parent company of Securian Life
Insurance Company is a mutual insurance holding
company. This policy does not entitle you to any holding
company membership rights.
Exhibit A
Employee Group Term Life Certificate of Insurance
Securian Life Insurance Company • A Stock Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
POLICYHOLDER: ABC Company
POLICY NUMBER: 12345-G
Read Your Certificate Carefully
If you meet the eligibility and enrollment requirements
herein, you are insured under the group policy shown on
the specifications page. This certificate summarizes the
principal provisions of the
group policy that affect you. The provisions summarized
in this certificate are subject in every respect to the group
policy. You may examine the group policy at the principal
office of the policyholder during regular working hours.
Secretary
President
TABLE OF CONTENTS
Definitions .......................................................................... 2
General Information .......................................................... 2
Premiums .......................................................................... 3
Death Benefit..................................................................... 4
Termination ........................................................................ 4
Conversion Right ............................................................... 4
Additional Information ........................................................ 5
GROUP TERM LIFE CERTIFICATE OF INSURANCE
Exhibit A
Certificate Specifications Page
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
GENERAL INFORMATION
POLICYHOLDER:
The ABC Company
POLICY NUMBER:
12345-G
ASSOCIATED COMPANIES:
All subsidiaries and affiliates reported to Securian Life by the
policyholder for inclusion in the policy.
POLICY SITUS:
The policy was issued and delivered in STATE.
POLICY EFFECTIVE DATE:
January 1, 2016.
This certificate and/or certificate specifications page replaces any and all certificates and/or certificate
specifications pages previously issued to you under the group policy. Please replace any certificate and/or
certificate specifications page previously issued to you with this new certificate and/or specifications page.
GROUP:
The group is composed of all active employees of the policyholder and
its associated companies working in the United States in the following
classes:
Class 1
All Salaried Employees
Class 2
All Hourly Employees
NO DOUBLE COVERAGE:
A person cannot be covered under more than one class. A person
cannot be covered as both an active employee and a retiree. Any
person who is eligible as an employee or retiree under the policy, or
insured under the portability provisions, is not eligible as a dependent.
Only one person can insure an eligible dependent child.
ENROLLMENT PERIOD:
Not applicable for noncontributory insurance; 31 days from the first day
of eligibility for contributory insurance
WAITING PERIOD:
The period commencing with the employee’s date of employment and
ending with the first day of the month next following or coinciding with
the employee’s completion of 90 days of continuous employment
MINIMUM HOURS
PER WEEK REQUIRED:
30 hours per week
PLAN OF INSURANCE
EMPLOYEE BENEFIT SCHEDULE
EMPLOYEE TERM LIFE INSURANCE:
Basic Life Insurance
Eligible Class
Amount of Basic Life Insurance
Class 1
One times annual earnings, rounded to the next higher $1,000 if not
already a multiple thereof, subject to a minimum of $10,000 and a
maximum of $500,000.*
Class 2
$50,000
Exhibit A
Supplemental Life Insurance
An amount elected by the employee from the following options:
Eligible Class
Amount of Supplemental Life Insurance
Classes 1 and 2
One, two, three or four times annual earnings, multiplied and then
rounded to the next higher $1,000 if not already a multiple thereof,
subject to a minimum of $10,000 and a maximum of $500,000.*
*The combined amount of basic and supplemental insurance for an employee shall not exceed $500,000.
EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE:
Basic and Supplemental Insurance
Eligible Class
Amount of Basic and Supplemental AD&D Insurance
Classes 1 and 2
An amount equal to the amount of basic and supplemental life insurance
for which the employee is insured under the group policy.
GENERAL PROVISIONS FOR EMPLOYEE INSURANCE
AGE REDUCTIONS:
The amount of insurance on an employee age 65 or older shall be a
percentage of the amount otherwise provided by the plan of insurance
applicable to such employee in accordance with the following table:
Age of Employee
65 - 69
70 - 74
75 and over
Amount of Insurance
65%
50%
25%
Age reductions will apply the first day of the month following an insured
employee's 65th, 70th, and 75th birthdays.
RETIREMENT REDUCTIONS:
All insurance terminates at retirement, except as provided for under the
portability provision.
CONTRIBUTORY/NONCONTRIBUTORY:
Basic insurance is noncontributory insurance; supplemental insurance is
contributory insurance.
GUARANTEED ISSUE AMOUNT:
The guaranteed issue is the maximum amount of insurance an
employee can receive without evidence of insurability when first eligible
under the plan provided enrollment is made within the enrollment period.
The amounts are as follows:
For basic insurance:
All basic insurance is guaranteed issue.
For supplemental
insurance:
The lesser of two times annual earnings or $250,000.
NOTE: For an employee who was covered for supplemental life
under the employer’s plan immediately prior to the policy effective
date shown above, the guaranteed issue for supplemental life is
the amount of supplemental life in force under that prior plan
immediately prior to the policy effective date.
Exhibit A
EFFECTIVE DATE OF INCREASES
AND DECREASES DUE TO CHANGE
IN ELIGIBLE CLASS OR EARNINGS:
Increases and decreases due to a change in eligible class or earnings
will become effective the date of the change in eligible class or earnings.
Evidence of insurability will not be required for an increase in insurance
due solely to an increase in earnings. All increases are subject to the
actively at work requirement. NOTE: An employee whose amount of
supplemental insurance is limited to the guaranteed amount of $250,000
due to being declined any amount of insurance by us under the group
policy is not insured for a multiple of earnings plan, but rather is insured
for the frozen amount of $250,000 and therefore will not receive an
increase in supplemental insurance due to salary increases.
DEPENDENTS BENEFIT SCHEDULE
DEPENDENTS TERM LIFE INSURANCE:
An employee must be insured for supplemental life insurance in order to be insured for dependents life insurance.
Spouse/Domestic Partner Life Insurance
Eligible Class
Amount of Spouse/Domestic Partner Life Insurance
All Employees
An amount elected by the employee, in an increment of $10,000, subject
to a maximum of $200,000
Child Life Insurance
Eligible Class
Amount of Child Life Insurance
All Employees
$5,000 or $10,000, as elected by the employee
GENERAL PROVISIONS FOR DEPENDENTS INSURANCE
SPOUSE/DOMESTIC PARTNER AGE
REDUCTIONS:
The amount of insurance on an insured spouse/domestic partner age 65
or older shall be a percentage of the amount otherwise provided by the
plan of insurance applicable to such spouse/domestic partner in
accordance with the following table:
Age of Spouse/DP Amount of Insurance
65 – 69 65%
70 – 74 50%
75 and over 25%
Age reductions will apply the first day of the month following an insured
spouse’s 65th, 70th, and 75th birthdays.
CONTRIBUTORY/NONCONTRIBUTORY:
Dependents insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT:
The guaranteed issue is the maximum amount of insurance an eligible
dependent can receive without evidence of insurability when first eligible
under the plan provided enrollment is made within the enrollment period.
The amounts are as follows:
For spouse/domestic partner insurance: $50,000
For child insurance: $10,000
NOTE: For employees with eligible dependents immediately prior to the
policy effective date, the guaranteed issue amount is equal to the
amount of dependents insurance for which they were insured under the
prior group policy immediately prior to the policy effective date.
EFFECT OF EMPLOYEE’S RETIREMENT:
All dependents insurance terminates upon the employee’s retirement
except as provided under the portability provision.
Exhibit A
ADDITIONAL INFORMATION
WAIVER OF PREMIUM APPLICATION:
Applies to contributory and noncontributory employee insurance.
EVIDENCE OF INSURABILITY:
Evidence of insurability satisfactory to us will be required:
•
In order for a newly eligible employee to become insured for an
amount of insurance greater than the guaranteed issue amount.
If such evidence of insurability is not provided or is not
satisfactory to us, the employee will be insured for the
guaranteed issue amount.
•
In order for a newly eligible spouse/domestic partner to become
insured for an amount of insurance greater than the guaranteed
issue amount. If such evidence of insurability is not provided or
is not satisfactory to us, the spouse/domestic partner will be
insured for the guaranteed issue amount.
•
At Qualified Status Change or annual open enrollment, a
request that exceeds the amounts indicated below as not
requiring evidence of insurability.
•
At Qualified Status Change or annual open enrollment, if the
insured has previously been declined any insurance amount by
us due to evidence of insurability being found unsatisfactory.
•
At Qualified Status Change if the change is not in the list below
in the “Certain Qualified Status Changes” section.
CERTIFICATE SUPPLEMENTS (found later in this document):
Accelerated Benefits
Accidental Death and Dismemberment
Dependents Term Life
Portability
Waiver of Premium
Exhibit A
Definitions
application
Your application for insurance under the group policy and,
if required, your evidence of insurability application.
associated company
Any company which is a subsidiary or affiliate of the
policyholder which is designated by the policyholder and
agreed to by us to participate under the group policy.
contributory insurance
Insurance for which you are required to make premium
contributions.
earnings
Your basic rate of compensation not including
commissions, overtime or premium pay, bonuses, or any
other additional compensation.
employee
An individual who is employed by the policyholder or by an
associated company. A sole proprietor will be considered
the employee of the proprietorship. A partner in a
partnership will be considered an employee so long as the
partner’s principal work is the conduct of the partnership’s
business. The term employee does not include temporary
employees or corporate directors who are not otherwise
employees.
employer
The policyholder or any designated associated
companies.
evidence of insurability
Evidence satisfactory to us of the good health of the
prospective insured and any other underwriting
information we require.
insured
A person who is eligible for and becomes insured
according to the terms of this certificate, including any
person insured by supplement to this certificate.
non-work day
A day on which you are not regularly scheduled to work,
including scheduled time off for vacations, personal
holidays, weekends and holidays, and approved leaves of
absence for non-medical reasons.
Non-work day does not include time off for medical leave
of absence, temporary layoff, employer suspension of
operations in total or in part, strike, and any time off due to
sickness or injury including sick days, short-term disability,
or long-term disability.
noncontributory insurance
Insurance for which you are not required to make premium
contributions.
policyholder
The owner of the group policy as shown on the
specifications page.
waiting period
The period, if any, of continuous employment with the
employer required prior to becoming eligible for coverage
under this certificate. The waiting period is shown on the
specifications page. You are not eligible until the first day
following the waiting period.
we, our, us
Securian Life Insurance Company.
you, your
An insured employee.
General Information
What is your agreement with us?
If you meet the eligibility and enrollment requirements, you
are insured under the group policy shown on the
specifications page. Your application as defined under
this certificate is a part of this certificate. This certificate
summarizes the principal provisions of the group policy
that affect your life insurance coverage. The provisions
summarized in this certificate are subject in every respect
to the group policy.
Any statements made in your application as defined in this
certificate will, in the absence of fraud, be considered
representations and not warranties. Also, any statement
made will not be used to void your insurance nor defend
against a claim unless the statement is contained in the
application.
Can this certificate be amended?
Yes. We retain the right to amend this certificate at any
time without your consent. Any amendment will be
without prejudice to any claim incurred for benefits prior to
the date of the amendment.
Who is eligible for insurance?
You are eligible if you:
(1) are a member of the eligible group and of an
eligible class as shown on the specifications page;
and
(2) work for the employer for at least the number of
hours per week shown as the minimum hours per
week requirement on the specifications page; and
(3) have satisfied the waiting period as shown on the
specifications page; and
Exhibit A
(4) meet the actively at work requirement as shown in
the section entitled “What is the actively at work
requirement?”.
Are employees of associated companies eligible for
insurance under the group policy?
Yes. Employees of associated companies may be eligible
for insurance under the group policy. The policyholder
represents any associated company in all transactions
pertaining to the group policy. The policyholder’s acts or
omissions and every notice given by us to the policyholder
shall be binding on every associated company. When an
associated company ceases its participation under the
policy, the policy shall be considered to be terminated for
all employees of the associated company. All provisions
related to the policy terminating will apply to such
employees.
Are retired employees eligible for insurance?
If the policyholder’s plan of insurance, as reflected in the
specifications page, does not specifically provide
insurance for retired employees, a retired employee shall
not be eligible to become insured, nor have his or her
insurance continued. If the policyholder’s plan of
insurance specifically provides insurance for retired
employees, the minimum hours per week and actively at
work requirements will not apply to such persons.
What is the actively at work requirement?
To be eligible to become insured or to receive an increase
in the amount of insurance, you must be actively at work,
fully performing your customary duties for your regularly
scheduled number of hours at the employer’s normal
place of business, or at other places the employer’s
business requires you to travel.
If you are not working due to illness or injury you do not
meet the actively at work requirement. If you are receiving
sick pay, short-term disability benefits or long-term
disability benefits, you do not meet the actively at work
requirement.
If you are not actively at work on the date coverage would
otherwise begin, or on the date an increase in your
amount of insurance would otherwise be effective, you will
not be eligible for the coverage or increase until you return
to active work. However, if the absence is on a non-work
day, coverage will not be delayed provided you were
actively at work on the work day immediately preceding
the non-work day.
Except as otherwise provided for in this certificate, you are
eligible to continue to be insured only while you remain
actively at work.
Any insurance or increase in insurance which is elected or
put in force while you are not actively at work will not be
eligible for claim payment. You will receive a refund of
premium for any contributory insurance for which you
were not eligible.
When will we require evidence of insurability?
The specifications page describes when evidence of
insurability is required.
When does insurance become effective?
Insurance becomes effective on the date that all of the
following conditions have been met:
(1) you meet all eligibility requirements; and
(2) for contributory insurance, you apply for the
insurance in accordance with the application
methods agreed upon by the policyholder and us;
and
(3) we are satisfied with your evidence of insurability,
if we require evidence.
Can your coverage be continued during sickness,
injury, leave of absence or temporary layoff?
Yes. Insurance may be continued on an insured
employee who is not actively at work due to sickness,
injury, leave of absence or temporary layoff, subject to the
employer's practices and procedures, including the
employer's limits on the length of continuation allowed for
the type of absence. Continuation is contingent upon
continued premium payment and is subject to the
following maximum time frames:
(1) if you are on non-medical leave of absence or
temporary layoff, insurance cannot be continued
beyond 12 months from the last day you were
actively at work.
(2) if you are on a medical leave of absence,
insurance cannot be continued beyond the later of
12 months from the last day you were actively at
work or attained age 65.
Coverage during a leave of absence and upon return from
a leave of absence shall meet all state and federal
requirements. The above limits will be expanded if
necessary in order to meet such requirements.
Premiums
When and how often are your premium contributions
due?
Unless the policyholder and we have agreed to some
other premium payment procedure, any premium
contributions you are required to make for contributory
insurance are to be paid by you to the policyholder on a
regular, periodic basis. We apply premiums consecutively
to keep the insurance in force.
How is the premium determined?
The premium will be the applicable premium rate
multiplied by the number of $1,000 units of insurance in
force on the date premiums are due. The premium may
also be computed by any other method on which the
policyholder and we agree.
Exhibit A
Premium rates are subject to change according to the
provisions of the group policy.
Death Benefit
What is the amount of the death benefit?
The amount of the death benefit is equal to the amount of
insurance for which you are insured, based on the plan of
insurance applicable to your class as described on the
specifications page, and your elections.
Can you request a change in the amount of your
contributory insurance?
Yes. The specifications page describes when changes
can be requested, when evidence of insurability will be
required for such changes, and when the changes will
become effective.
When will the death benefit be payable?
We will pay the death benefit upon receipt at our home
office of written proof satisfactory to us as to both
substance and form that you died while insured under this
certificate. All payments by us are payable from our home
office. The death benefit will be paid in a single sum or by
any other method agreeable to us and the beneficiary.
To whom will we pay the death benefit?
We will pay the death benefit to the beneficiary or
beneficiaries. You name a beneficiary to receive the
death benefit to be paid at your death. You may name
one or more beneficiaries. You can change the
beneficiary designation at any time, provided all of the
following are true:
(1) your coverage is in force; and
(2) we have written consent of all irrevocable
beneficiaries; and
(3) you have not assigned the ownership of your
insurance.
A beneficiary designation must be made in writing or by
any other method made available under the plan. Any
beneficiary designation shall take effect as of the date it is
signed, but will not affect any payment we make or action
we take before receiving the designation.
You may also choose to name a beneficiary that you
cannot change without the beneficiary’s consent. This is
called an irrevocable beneficiary.
If there is more than one beneficiary, each will receive an
equal share, unless you have requested another method
in your beneficiary designation. To receive the death
benefit, a beneficiary must be living at the time of your
death. In the event a beneficiary is not living at the time of
your death, that beneficiary’s portion of the death benefit
shall be equally distributed to the remaining surviving
beneficiaries. In the event of the simultaneous deaths of
you and a beneficiary, the death benefit will be paid as if
you survived the beneficiary.
If there is no eligible beneficiary, or if you do not name
one, we will pay the death benefit to:
(1) your lawful spouse if living; otherwise
(2) your natural or legally adopted child (children) in
equal shares, if living; otherwise
(3) your parents in equal shares, if living; otherwise
(4) your estate.
Termination
When does your coverage terminate?
Your coverage ends on the earliest of the following:
(1) the date the group policy ends; or
(2) the date you no longer meet the eligibility
requirements; or
(3) the date the group policy is amended so you are
no longer eligible; or
(4) 31 days (the grace period) after the due date of
any premium contribution which is not paid; or
(5) the last day for which premium contributions have
been paid following your written request to cease
participation under this certificate.
Can your insurance be reinstated after termination?
Yes. When your coverage terminates because you are no
longer eligible, and you become eligible again within three
months after the date your coverage under this certificate
terminated, your prior coverage may be reinstated, without
evidence of insurability. If you die prior to our receipt of
your reinstatement application and the required premium,
no benefit will be paid.
When does the group policy terminate?
The policyholder may terminate the group policy by giving
us 31 days prior written notice. We reserve the right to
terminate the group policy on the earlier of the following to
occur:
(1) 31 days (the grace period) after the due date of
any premiums which are not paid; or
(2) 31 days after we provide the policyholder with
notice of our intent to terminate the group policy.
Conversion Right
What is the conversion right?
You may be able to convert this insurance to a new
individual life insurance policy if all or part of your life
insurance under the group policy terminates due to the
reasons listed below.
What is the full conversion right?
You may convert up to the full amount of terminated
insurance if termination occurs because of termination of
employment or of membership in the class or classes
eligible for coverage.
Exhibit A
What is the limited conversion right?
Limited conversion is available if, after you have been
insured for at least five years, insurance is terminated
because:
(1) the group policy is terminated; or
(2) the group policy is changed, by amendment or
otherwise, to reduce or terminate your insurance.
For a limited conversion, you may convert an amount up
to the lesser of:
(1) $10,000; and
(2) the amount of life insurance which terminated
minus any amount of group life insurance for
which you become eligible under any group policy
issued or reinstated by us or any other carrier
within 31 days of the date your insurance
terminated under the group policy.
When is conversion not available?
Neither the full conversion right nor the limited conversion
right is available if your coverage under the group policy
terminates due to failure to make, when due, required
premium contributions.
To what type of policy may you convert?
Under both the full conversion right and the limited
conversion right, you may convert your insurance to any
type of individual policy of life insurance then customarily
issued by us for purposes of conversion, except term
insurance. The individual policy will not include any
supplemental benefits, including, but not limited to, any
disability benefits or accidental death and dismemberment
benefits.
How do you convert your insurance?
You convert your insurance by applying for an individual
policy and paying the first premium within 31 days after
the date your group insurance terminates. No evidence of
insurability will be required.
How is the premium for the individual policy
determined?
The premium for the individual policy is based upon the
individual policy type, risk class, coverage amount and
your age on the date of conversion.
When is the individual policy effective?
The individual policy takes effect 31 days after the group
insurance provided under the group policy terminates.
What happens if you die within 31 days of when your
group insurance terminates?
If you die within 31 days of when your group insurance
terminates, and meet the conversion eligibility
requirements, we will pay a death benefit regardless of
whether or not an application for coverage under an
individual policy has been submitted. The death benefit
will be the amount of insurance you would have been
eligible to convert under the terms of the conversion right
section. If you have completed a conversion application,
we will pay the beneficiary designated on the conversion
application. If you have not completed a conversion
application, we will pay the beneficiary under your group
insurance coverage.
We will return any premium you paid for an individual
policy converted from this group insurance to your
beneficiary as described above. In no event will we be
liable under both the group policy and the individual policy.
Additional Information
What if your age has been misstated?
If your age has been misstated, the death benefit payable
will be that amount to which you are entitled based on
your correct age. A premium adjustment from any benefit
payable will be made so that the actual premium required
at your correct age is paid. If your correct age is such that
no benefit is payable, you will receive a refund of premium
for the period your eligibility would have ended.
Is there any cash value to this coverage?
No. This is term life insurance and it does not build cash
value.
What is the suicide limitation?
If you, whether sane or insane, commit suicide within two
years from the effective date of any contributory life
insurance, our liability with respect to that coverage will be
limited to an amount equal to the premiums paid for the
coverage.
If there has been an increase in your amount of
contributory life insurance for which you were required to
apply or for which we required evidence of insurability,
and if you die by suicide within two years of the effective
date of the increase, our liability with respect to that
increase will be limited to the premiums paid and
attributable to such increase.
Can your insurance coverage be contested?
Yes. If you die, or sustain a loss under one of your
certificate supplements, within two years of your original
effective date of coverage or increase in coverage, we will
verify the accuracy of the information provided by you
during the application process. If we discover a material
misrepresentation, your coverage will be rescinded and an
otherwise valid claim will be denied. This two year period
can be extended for fraud or as otherwise allowed by law.
Any statements you make in your application as defined
under this certificate will, in the absence of fraud, be
considered representations and not warranties. Also, any
statement you make will not be used to void your
insurance, nor defend against a claim, unless the
statement is contained in the application.
Exhibit A
Who is the owner of this coverage?
Unless assigned otherwise, you, the insured employee,
are the owner of all coverage provided under your
certificate. Only the owner has the right to exercise
ownership rights under the certificate, including but not
limited to naming or changing a beneficiary, changing the
amount of insurance, assigning any or all ownership
rights, converting coverage to an individual policy and
terminating the coverage.
Can your insurance be assigned?
Yes. However, we will not be bound by an assignment of
the certificate or of any interest in it unless it is made as a
written instrument, and you file the original instrument or a
certified copy with us at our home office, and we send you
an acknowledged copy.
We are not responsible for the validity of any assignment.
You are responsible for ensuring that the assignment is
legal in your state and that it accomplishes your intended
goals. If a claim is based on an assignment, we may
require proof of interest of the claimant. A valid
assignment will take precedence over any claim of a
beneficiary.
Can a change in ownership for a certificate be
requested?
Yes. A change in ownership is a type of assignment. All
provisions for assignments apply to ownership changes.
Is the policyholder required to maintain records?
Yes. The policyholder is required to maintain adequate
records of any information necessary for us to administer
the group policy, and shall provide access to such records
when required for us to administer the policy.
If an administrative or clerical error is made in keeping
records on or administering the insurance under the group
policy, it will not affect otherwise valid insurance. A clerical
or administrative error, however, does not continue
insurance which is otherwise stopped, make insurance
effective when it should not have been or change the
amount of insurance provided by the provisions of the
policy and no claim shall be paid on amounts put into
effect as a result of a past clerical or administrative error.
If an error causes a change in premium payment, a fair
adjustment will be made.
Will the provisions of this certificate conform with
state law?
Yes. If any provision in this certificate, or in the provisions
of the group policy, is in conflict with the laws of the state
governing the certificates or the group policy, the provision
will be deemed to be amended to conform to such laws.
What is the policy interpretation right and authority?
The following applies only when the administration of the
policy is governed by the Employee Retirement Income
Security Act (ERISA), 29 U.S.C. 1001 et seq.:
Securian Life has the exclusive right and authority, in its
sole discretion, to interpret the group policy and decide all
matters arising thereunder. Securian Life's exercise of that
authority shall be conclusive and binding on all persons
unless it can be shown that the determination was
arbitrary and capricious.
Exhibit A
Accelerated Benefits
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
Benefits received under this Accelerated Benefits
Certificate Supplement may be taxable. You should
seek assistance from a personal tax advisor prior to
requesting an accelerated payment of death benefits.
General Information
This supplement is subject to every term, condition,
exclusion, limitation, and provision of the certificate unless
otherwise expressly provided for herein.
What does this supplement provide?
This supplement provides for the accelerated payment of
either the full or a partial amount of an insured’s death
benefit provided under your certificate. If an insured has a
terminal condition as defined in this supplement, you may
request an accelerated payment of the applicable death
benefit. An accelerated payment will not include any
accidental death or dismemberment benefit payable under
an Accidental Death and Dismemberment Certificate
Supplement. You must give notice of claim while living
and while your life insurance coverage is in force to be
eligible for consideration of an accelerated benefit.
What is a terminal condition?
A terminal condition is a condition caused by sickness or
accident which directly results in a life expectancy of 12
months or less. We must be given medical evidence in
substance and in form that satisfies us that the insured
has a terminal condition. That evidence must include
certification by a physician. For purposes of this
supplement, a physician is an individual who is licensed to
practice medicine or treat illness in the state in which
treatment is received. The physician cannot be you or
your spouse, children, parents, grandparents,
grandchildren, brothers or sisters; or the spouse of any
such individuals.
Accelerated Benefit
Who may request an accelerated payment of the death
benefit?
You may request an accelerated payment of the insurance
on your life or on the life of a spouse or dependent child
insured under your certificate.
When can an accelerated benefit be requested?
An accelerated benefit can be requested any time,
provided the following conditions are met:
(1) the insurance is in force and all premiums due are
fully paid; and
(2) you have not assigned and are the sole owner of
the certificate; and
(3) the certificate does not have an irrevocable
beneficiary.
Is there a minimum or maximum death benefit eligible
for an accelerated benefit?
Yes. The minimum death benefit to be eligible for an
accelerated benefit under this supplement is $10,000.
The maximum death benefit that can be accelerated is
$1,000,000.
Is a partial accelerated benefit available?
Yes. You may choose to accelerate only a portion of an
insured’s death benefit, providing the remaining amount of
insurance is at least $25,000. This is called a partial
accelerated benefit.
You may reapply for the payment of the remaining amount
of insurance at any time. However, the total amount of the
death benefit for all accelerated benefit payments for an
insured cannot exceed $1,000,000. We may ask for
further evidence satisfactory to us in substance and in
form that the insured meets all requirements for the
accelerated benefit.
When will we pay an accelerated benefit?
We will pay an accelerated benefit upon receipt at our
home office of written proof satisfactory to us in substance
and in form that the insured meets the requirements
herein.
The accelerated benefit will be paid in a single sum or by
any other method agreeable to you and us.
To whom will we pay accelerated benefits?
We will pay the accelerated benefit to you unless you
validly assign it otherwise. If you die before we issue
payment of an accelerated benefit to you, we will pay the
life insurance benefits to your life insurance beneficiary(s).
What is the effect on the insured’s coverage of the
receipt of an accelerated benefit?
If you elect to accelerate the full amount of an insured’s
death benefit, the insured’s coverage and all other
benefits under the certificate and any certificate
supplements for that insured will end. If it is your death
benefit being accelerated, any dependent life insurance
will terminate, though it may be converted to a policy of
individual life insurance according to the conversion right
section of the certificate.
If a partial accelerated benefit is chosen, coverage will
remain in force and premiums will be reduced accordingly.
The remaining amount of insurance under the certificate
will be the full amount of insurance minus the amount of
insurance that was accelerated.
Exhibit A
Termination
When does an insured’s coverage under this
supplement terminate?
An insured’s accelerated benefits coverage terminates on
the earliest of:
(1) the date the insured is no longer insured for life
insurance under the certificate; or
(2) the date the accelerated benefits coverage is
terminated for the policyholder’s plan; or
(3) the date the group policy is terminated.
Additional Information
Is the request for an accelerated benefit voluntary?
Yes. An accelerated benefit will be made available on a
voluntary basis only. An accelerated benefit under this
supplement is not intended to cause an involuntary
reduction of the death benefit ultimately payable to the
beneficiary. Therefore, an accelerated benefit is not
available if you:
(1) are required by law to use this option to meet the
claims of creditors, whether in bankruptcy or
otherwise; or
(2) are required by a government agency to use this
option in order to apply for, obtain, or keep a
government benefit or entitlement.
Do we have the right to obtain independent medical
verification?
Yes. Although you are responsible for submitting proof
satisfactory to us that you meet the requirements for the
accelerated benefit, we do retain the right to have an
insured medically examined at our expense to verify the
insured’s medical condition. We may do this as often as
reasonably required while an accelerated benefit is being
considered or paid.
Secretary
President
Exhibit A
Accidental Death and Dismemberment
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is issued in consideration of
the required premium and is subject to every term,
condition, exclusion, limitation, and provision of the
certificate unless otherwise expressly provided for herein.
Coverage under this supplement will not be included in
any insurance issued under the conversion right section of
the certificate.
What does this supplement provide?
This supplement provides accidental death and
dismemberment coverage subject to all terms, conditions,
and exclusions herein.
Who is eligible for insurance under this supplement?
An employee who is insured under the provisions
applicable to life insurance coverage under the group
policy is eligible for insurance under this supplement. In
addition, an employee may elect coverage for his or her
spouse and/or dependent child(ren) who are insured
under the Dependents Term Life Insurance Certificate
Supplement attached to the certificate. All references to
an insured in this supplement shall include dependents.
All provisions of this supplement applicable to an “insured”
shall apply to an insured dependent.
When does insurance under this supplement become
effective?
Insurance becomes effective on the date that all of the
following conditions have been met:
(1) the insured meets all eligibility requirements; and
(2) for contributory coverage, application is made in
accordance with the application methods agreed
upon by the policyholder and us.
For an insured employee who has existing dependent
coverage inforce, any newly acquired dependent who
meets the requirements will automatically become insured
when he or she becomes eligible unless additional
premium is required for the newly eligible dependent, in
which case coverage will become effective as described
above.
If a dependent is hospitalized or confined because of
illness or disease on the date his or her insurance would
otherwise become effective, his or her effective date shall
be delayed until he or she is released from such
hospitalization or confinement. This provision shall not
apply to a newborn child. However, in no event will
insurance on a dependent be effective before the
employee’s insurance under the group policy is effective.
Accidental Death and Dismemberment
(AD&D) Benefit
What does accidental death or dismemberment by
accidental injury mean?
Accidental death and dismemberment coverage is limited
coverage. This means this coverage will provide benefits
only when your loss, death or dismemberment results,
directly and independently from all other causes, from an
accidental bodily injury which was unintended, unexpected
and unforeseen. The bodily injury must be evidenced by a
visible contusion or wound, except in the case of accidental
drowning. The bodily injury must be the sole cause of your
death or dismemberment. The injury and accidental loss,
death or dismemberment must occur while your coverage
is in force. Your loss, death or dismemberment must occur
within 180 days after the date of the accidental injury. In no
event will we pay the accidental death or dismemberment
benefit where your accident, injury, loss, death or
dismemberment is caused directly or indirectly by, results
in whole or in part from or during, or there is contribution
from, any of the following:
(1) self-inflicted injury, self-destruction, or
autoeroticism, whether sane or insane; or
(2) suicide or attempted suicide, whether sane or
insane; or
(3) your participation in, or attempt to commit, a crime,
assault, felony, or any illegal activity, regardless of
any legal proceedings thereto; or
(4) bodily or mental infirmity, illness or disease; or
(5) the use of alcohol; or
(6) the use of prescription drugs, non-prescription
drugs, illegal drugs, medications, poisons, gases,
fumes or other substances taken, absorbed,
inhaled, ingested or injected; or
(7) motor vehicle collision or accident where you are
the operator of the motor vehicle and your blood
alcohol level meets or exceeds the level at which
intoxication is defined in the state where the
collision or accident occurred, regardless of any
legal proceedings thereto; or
(8) infection, other than infection occurring
simultaneously with, and as a direct and
independent result of, the accidental injury; or
(9) medical or surgical treatment or diagnostic
procedures or any resulting complications,
including complications from medical
misadventure; or
(10) travel in or descent from any aircraft, except as a
fare-paying passenger on a regularly scheduled
commercial flight on a licensed passenger aircraft
carrier; or
(11) war or any act of war, whether declared or
undeclared.
Exhibit A
What is the amount of the accidental death and
dismemberment benefit?
The amount of the benefit shall be a percentage of the
amount of insurance shown on the specifications page.
The percentage is determined by the type of loss as
shown in the following table:
PERCENT OF
TYPE OF LOSS
AMOUNT OF INSURANCE
Life .............................................................................. 100%
Both Hands or Both Feet ............................................ 100%
Sight of Both Eyes ...................................................... 100%
Speech and Hearing in Both Ears .............................. 100%
One Hand and One Foot ............................................ 100%
One Foot and Sight of One Eye ................................. 100%
One Hand and Sight of One Eye................................ 100%
Sight of One Eye .......................................................... 50%
One Hand or One Foot ................................................. 50%
Loss of hands or feet means complete severance at or
above the wrist or ankle joints. Loss of sight, speech, or
hearing means the entire and irrecoverable loss of sight,
speech, or hearing which cannot be corrected by medical
or surgical treatment or by artificial means.
Under no circumstance will more than one payment be
made for the loss of the same limb, eye, hand, foot, sight,
speech, or hearing if one payment has already been made
for that loss.
Benefits may be paid for more than one accidental loss
but the total amount of AD&D insurance payable under
this supplement for any one accident, not including any
amount paid according to the terms of the Additional
Benefits section of this supplement, will never exceed the
full amount of an insured’s AD&D insurance.
When will the accidental death and dismemberment
benefit be payable?
We will pay the AD&D benefit upon receipt at our home
office of written proof satisfactory to us as to both
substance and form that you died or suffered
dismemberment as a result of an accidental injury. All
payments by us are payable from our home office. The
benefit will be paid in a single sum or by any other method
agreeable to us and the beneficiary.
To whom do we pay the benefit?
In the case of your accidental death, we will pay the
accidental death benefit to the person or persons entitled
to receive your death benefit under the terms of the group
policy. The benefit for other losses sustained by you will
be paid to you, if living, otherwise to your estate.
A dependent’s AD&D benefit will be paid to you, if living,
otherwise to your estate.
Additional Benefits
Unless stated otherwise, additional benefits are payable to
the same person or persons who receive the AD&D
benefits. Additional benefits are paid in addition to any
AD&D benefits described in the Accidental Death and
Dismemberment section, unless otherwise stated. All
provisions of this supplement, including but not limited to
the exclusions and requirements listed under the “What
does accidental death or dismemberment by accidental
injury mean?” section, shall apply to these additional
benefits.
Air Bag Benefit
What is the air bag benefit?
If an insured dies or suffers a covered dismemberment as a
result of a covered accident which occurs while he or she is
driving or riding in a private passenger car, we will pay an
additional AD&D benefit equal to the lesser of $10,000 or
10% of the insured’s amount of AD&D insurance.
In order to be eligible for this benefit, the following must
apply:
(1) the seat in which the insured was seated was
equipped with a properly installed airbag at the
time of the accident; and
(2) the private passenger car is equipped with
seatbelts; and
(3) a seatbelt was in proper use by the insured at the
time of the accident as certified in the official
accident report or by the investigating officer; and
(4) at the time of the accident, the driver of the private
passenger car was a licensed driver and was not
intoxicated, impaired, or under the influence of
alcohol or drugs.
Airbag means a passive restraint device in a vehicle which
inflates upon collision to protect an individual from injury or
death.
Seatbelt means a properly installed seatbelt (or child
restraint if the insured is a child), lap and shoulder restraint,
or other restraint approved by the National Highway Traffic
Safety Administration or any successor governmental
agency. A private passenger car means a validly
registered four-wheeled private passenger car or
policyholder-owned car, jeep, pickup truck or van, including
a sport utility vehicle (SUV), that is not licensed
commercially or being used for racing, or acrobatic or stunt
driving.
Seatbelt Benefit
What is the seatbelt benefit?
If an insured dies or suffers a covered dismemberment as a
result of a covered accident which occurs while he or she is
driving or riding in a private passenger car, we will pay an
additional AD&D benefit equal to the lesser of:
(1) $10,000; or
(2) 10% of the insured’s amount of AD&D insurance.
Exhibit A
In order to be eligible for this benefit, the following must
apply:
(1) the private passenger car was equipped with
seatbelts; and
(2) a seatbelt was in proper use by the insured at the
time of the accident as certified in the official
accident report or by the investigating officer; and
(3) at the time of the accident, the driver of the private
passenger car was a licensed driver and was not
intoxicated, impaired, or under the influence of
alcohol or drugs.
Termination
When does an insured’s coverage under this
supplement terminate?
An insured’s coverage ends on the earliest of:
(1) the date you are no longer covered for life
insurance under the group policy; or
(2) the insured’s 70th birthday; or
(3) for an insured dependent, the date the dependent
no longer meets the eligibility requirements; or
(4) for an insured dependent, the date the dependent
is no longer covered for life insurance under the
group policy; or
(5) 31 days (the grace period) after the due date of
any premium contribution which is not paid; or
(6) the date this supplement terminates.
When does this supplement terminate?
This supplement will terminate on the earlier of:
(1) the date requested by the policyholder to cancel
the Accidental Death and Dismemberment
coverage for its plan; or
(2) the date the group policy is terminated.
Additional Information
Can insurance under this supplement be converted to
a policy of individual insurance upon termination?
No. Coverage under this supplement will not be included in
any insurance issued under the conversion right section of
the certificate.
Secretary
President
Exhibit A
Dependents Term Life Insurance
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is issued in consideration of
the required premium and is subject to every term,
condition, exclusion, limitation, and provision of your
certificate unless otherwise expressly provided for herein.
What does this supplement provide?
This supplement provides insurance on the lives of your
eligible dependents.
What members of your family are eligible for
insurance under this supplement?
The following members of your family are eligible for
insurance under this supplement:
(1) your lawful spouse who is not legally separated
from you, your civil union partner, or your
registered domestic partner, as recognized under
the laws of the jurisdiction of celebration; and
(2) your or your spouse’s natural, legally adopted or
stepchildren who are less than 26 years old. An
adopted child includes a child legally placed for
adoption with you. Eligibility begins at live birth
(stillborn or unborn children are not eligible).
A person who is eligible as an employee or retiree under
the policy, or insured under the portability provisions, is
not eligible as a dependent. Only one person can insure
an eligible dependent child.
Any dependent who, subsequent to the effective date of
your dependents term life insurance, meets the eligibility
requirements of this supplement will become insured on
the date he or she so qualifies, provided no additional
premium is required and the dependent is not hospitalized
or confined because of illness or disease (except in the
case of a newborn). If additional premium is required, the
insurance for that dependent will be effective under the
same conditions which would apply if you were newly
becoming eligible for dependents term life insurance
under this supplement. If the dependent is hospitalized or
confined because of illness or disease on the date his or
her insurance would otherwise become effective, his or
her effective date shall be delayed until he or she is
released from such hospitalization or confinement (except
in the case of a newborn).
When will we require evidence of insurability?
The specification page describes when evidence of
insurability will be required.
When does insurance on a dependent become
effective?
Insurance on a dependent becomes effective on the date
when all of the following conditions have been met:
(1) the dependent meets all eligibility requirements;
and
(2) for contributory coverage, you apply for
dependents coverage in accordance with the
application methods agreed upon by the
policyholder and us; and
(3) we are satisfied with the dependent’s evidence of
insurability, if we require evidence.
If a dependent is hospitalized or confined because of
illness or disease on the date his or her insurance would
otherwise become effective, his or her effective date shall
be delayed until he or she is released from such
hospitalization or confinement. This does not apply to a
newborn child. However, in no event will insurance on a
dependent be effective before your insurance is effective.
Death Benefit
What is the amount of life insurance on each insured
dependent?
The amount of life insurance on each insured dependent
is shown on the specifications page.
To whom will we pay the death benefit?
The death benefit payable under this supplement will be
paid to you if living, otherwise to your estate.
Termination
When does an insured dependent’s coverage under
this supplement terminate?
An insured dependent’s coverage ends on the earliest of
the following:
(1) the date the dependent no longer meets the
eligibility requirements; or
(2) 31 days (the grace period) after the due date of
any premium contribution which is not paid; or
(3) the last day for which premium contributions have
been made following your written request that
insurance on your eligible dependents be
terminated; or
(4) the date you are no longer covered under the
group policy; or
(5) the date this supplement terminates.
When does this supplement terminate?
This supplement will terminate on the earlier of:
(1) the date requested by the policyholder to cancel
the Dependents Term Life coverage for its plan; or
(2) the date the group policy is terminated.
Exhibit A
Additional Information
What is the conversion right under this supplement?
If an insured dependent’s coverage under this supplement
terminates because he or she is no longer eligible, or
because of your death, or because of termination or
amendment of this supplement, the insurance may be
converted to a policy of individual insurance with us.
Conversion may be requested by you, an insured
dependent of legal capacity, or the insured dependent’s
guardian, if applicable. All other conditions and provisions
of the conversion right section of your certificate to which
this supplement is attached will apply.
What is the suicide limitation?
If an insured dependent, whether sane or insane, commits
suicide within two years from the effective date of any
contributory life insurance, our liability with respect to that
coverage will be limited to an amount equal to the
premiums paid for the coverage.
If there has been an increase in an insured dependent’s
amount of contributory life insurance for which you were
required to apply or for which we required evidence of
insurability, and if the dependent dies by suicide within two
years of the effective date of the increase, our liability with
respect to that increase will be limited to the premiums
paid and attributable to such increase.
The suicide exclusion does not apply to an insured child.
Does the Waiver of Premium supplement to your
certificate apply to insured dependents?
The Waiver of Premium supplement to your certificate will
not apply to disabilities for dependents covered under this
supplement.
However, if, due to your disability, your insurance is
continued in force without further payment of premiums
due to the Waiver of Premium supplement, any
dependents insurance provided by this supplement shall
also continue in force without further payment of
premiums until the dependent’s eligibility terminates or
until your insurance is no longer continued in force due to
the Waiver of Premium supplement.
This provision is not applicable if the dependent’s
insurance has been converted under the conversion right
section of this supplement, unless the converted policy is
surrendered without claim except for refund of premiums.
Secretary
President
Exhibit A
Portability
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is issued in consideration of
the required premium and is subject to every term,
condition, exclusion, limitation and provision of the
certificate unless otherwise expressly provided for herein.
What does this supplement provide?
This supplement provides for continuation of insurance if
an insured no longer meets the eligibility requirements of
the certificate, except as provided for herein.
To continue insurance, the insured must make a written
request and make the first premium payment within 31
days after insurance provided by the group policy would
otherwise terminate. Evidence of insurability will not be
required. Coverage provided by this supplement will be
effective the date we receive the completed application.
This date is considered to be the insured’s portability date
and the insured is then considered to have portability
status.
Who is eligible to continue insurance under this
supplement?
An insured employee is eligible to continue group life
insurance under the terms of this supplement if he or she
no longer meets the eligibility requirements of the
certificate due to any of the following:
(1) the employee terminates employment, including
retirement; or
(2) the employee is no longer in a class eligible for
insurance or is on a leave or layoff; or
(3) a class or group of employees insured under the
policy is no longer considered eligible and there is
no successor plan for that class or group.
Successor plan means an insurance policy or
policies provided by us or another insurer that
replaces insurance provided under this policy.
An insured will not be eligible to request coverage under
this supplement if he or she:
(1) has attained the age of 70; or
(2) has converted his or her insurance to an individual
life policy under the terms of the certificate’s
conversion right section; or
(3) is an employee and was not actively at work due
to sickness or injury on the date immediately
preceding his or her portability date; or
(4) loses eligibility due to termination of the group
policy.
Can insurance that is lost due to moving from one
eligible class to another be ported?
No, with one exception: if an employee moves from an
active class to a retiree class, he or she can port the
amount of insurance lost due to the change in class,
subject to all the provisions of this supplement.
What insurance can be continued under this
supplement?
Only contributory insurance may be continued under this
supplement. If an employee elects to continue his or her
own coverage according to the provisions of this
supplement, he or she may also elect to continue
contributory insurance for any dependent insured under
his or her certificate.
An insured may also continue coverage under all
certificate supplements which apply to his or her
contributory insurance and by which he or she was
insured immediately preceding his or her portability date,
except the Waiver of Premium Certificate Supplement,
which shall terminate upon porting.
Is there a minimum amount of insurance that can be
continued under this supplement?
Yes. The minimum amount of insurance that can be
continued on an employee’s life under this supplement is
$10,000. The minimum for dependents life is $1,000.
Is there a maximum amount of insurance that can be
continued under this supplement?
Yes. The maximum amount of insurance that can be
continued under this supplement is the amount of
insurance that was in force on the insured’s portability
date, but not more than $300,000 for an employee or
$150,000 for a spouse. However, for an insured age 65 or
older on his or her portability date, the amount will not be
more than $195,000 for an employee or $97,500 for a
spouse.
Will the amount of insurance continued under this
supplement change?
Yes. On the first day of the month following the date an
insured attains age 65, the amount of insurance on his or
her life continued under this supplement will reduce to
65% of the amount of insurance in force on the day prior
to attainment of age 65. Insurance terminates at age 70.
Can an insured request a change in the amount of
insurance continued under this supplement?
Yes. An insured may elect to reduce the amount of
insurance on his or her life, subject to the minimum
amount. The amount of insurance continued under this
supplement will never increase.
Exhibit A
How will premium contributions be paid?
Premium contributions will be paid directly to us on a
monthly, quarterly, semi-annual, or annual basis and will
be subject to an administrative charge per billing period.
We may adjust the amount of the charge, but not more
often than once per year.
Can the premium rate change?
Yes. The premium rate may increase on the portability
date. The premium rate may also increase in the future.
Can insurance continued under this supplement be
converted to a policy of individual insurance?
Yes. At any time after insurance has been continued
under the provisions of this supplement, but not beyond
31 days after coverage terminates under the provisions of
this supplement, it may be converted to a policy of
individual insurance with us. All other conditions and
provisions of the conversion right section of the certificate
to which this supplement is attached will apply. Coverage
cannot be continued under both this supplement and the
conversion privilege.
What happens if an insured again becomes eligible
under the certificate?
If an insured is continuing coverage under the terms of
this supplement, and again meets the eligibility
requirements of the certificate, the insured shall no longer
be considered to have portability status, ported coverage
will terminate and only one death benefit will be paid
under the coverage. Insurance may be continued only
under the terms of the certificate, not including this
supplement unless and until the insured no longer meets
the eligibility requirements of the certificate and again
return to portability status as provided for herein.
What happens to insurance provided under this
supplement when the group policy terminates?
Anything in the group policy notwithstanding, termination
of the group policy will not terminate life insurance then in
force for any person under the terms of this supplement.
The group policy will be deemed to remain in force solely
for the purpose of continuing such insurance, but without
further obligation of the policyholder.
Any insurance continued under the terms of this
supplement will remain in force until terminated by the
provisions of the section entitled “When will insurance
continued under this supplement terminate?”.
No individual may elect coverage under this supplement
on or after the date of termination of the group policy.
When will insurance continued under this supplement
terminate?
Insurance being continued under this supplement will
terminate on the earliest of the following:
(1) the insured’s 70th birthday; or
(2) the date the insured again meets the eligibility
requirements of the certificate, not including the
terms of this supplement; or
(3) in the case of a dependent child or a spouse who
is insured by a supplement to the employee’s
certificate, the date the employee’s coverage is no
longer being continued under this supplement or
the date the spouse or child ceases to be eligible
as defined under the terms of the certificate; or
(4) 31 days after the due date of any premium
contribution which is not made; or
(5) the date an insured requests to terminate his or
coverage being continued under this supplement.
Secretary
President
Exhibit A
Waiver of Premium
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is subject to every term,
condition, exclusion, limitation, and provision of your
certificate unless otherwise expressly provided for herein.
Coverage under this supplement will not be included in
any insurance issued under the conversion right section of
your certificate.
The specifications page indicates to what insurance this
supplement applies. This supplement does not apply to
you if you have portability status.
What does this supplement provide?
This supplement provides for waiver of premium if you
become totally and permanently disabled, as defined
herein, while under age 60. Upon approval of proof of
such disability, your insurance, including all supplements
to your certificate which were in force on the date of the
onset of your disability, will be continued in force without
payment of premiums during the uninterrupted
continuance of the total and permanent disability.
What is total disability?
Total disability is a disability which occurs while your
insurance is in force and which results from an accidental
injury or an illness that continuously prevents you from
engaging in any occupation for which you are reasonably
suited by education, training, or experience on a full or
part time basis. You must be under the care of a licensed
physician. The licensed physician cannot be you or a
member of your immediate family. For purposes of this
supplement, your immediate family consists of your
spouse, children, parents, grandparents, grandchildren,
brothers and sisters, and their spouses.
What is permanent disability?
Permanent disability is a total disability which has existed
continuously for at least nine months.
Are there any limitations?
Yes. Insurance will not be continued if your disability
results from intentionally self-inflicted injury, participation
in or any attempt to commit a crime, or war or any act of
war, whether declared or undeclared.
What if you convert your group life insurance to a
policy of individual insurance prior to the approval of
your disability claim?
If your coverage has been converted in accordance with
the conversion right section of your certificate, benefits
under this supplement will apply only if the converted
policy is surrendered without claim, except for refund of
premiums. You cannot have coverage under both policies
and only one death benefit will be available.
What will be considered due proof of total and
permanent disability?
You must furnish evidence satisfactory to us as to both
substance and form that your disability:
(1) commenced while your insurance under your
certificate was in force; and
(2) meets the definition of total disability; and
(3) commenced before your 60th birthday; and
(4) was continuous for nine months or more.
We will, from time to time, also require additional proof
satisfactory to us that you continue to be totally and
permanently disabled. After you have provided at your
expense the requested claim forms and records, we may
also require that you submit to one or more medical
examinations at our expense.
If you die within one year of the date of onset of your total
disability, your beneficiary may claim benefits under this
supplement even if your premium payments were
discontinued and you had not submitted due proof
satisfactory to us of your total disability or you were
continuously disabled for less than nine months. Your
beneficiary must submit due proof satisfactory to us that
your total disability, which began before premium
payments on your behalf were discontinued and before
your 60th birthday, continued without interruption until
your death.
When must we be notified of your disability or death?
We must receive written notice at our home office of your
total disability within one year of the date of onset of such
disability. However, failure to give notice within the time
provided will not invalidate the claim if it is shown that
notice was given as soon as reasonably possible.
We must receive written notice at our home office within
one year of death that you died during a period of
continuance provided by this supplement. Proof must be
furnished that you continued to be totally disabled during
the entire period of continuance until death. If such notice
and proof are not provided within the required time frame,
there shall be no liability for any payment under this
supplement. However, failure to give notice within the time
provided will not invalidate the claim if it is shown that
notice was given as soon as reasonably possible.
What is the amount of insurance to be continued
without payment of premium under this supplement?
The amount of insurance continued without payment of
premium shall be the amount of insurance that was in
force on the date of onset of total disability.
If the group policy provides for reductions in amounts of
insurance based on age or retirement, such reductions
shall apply to your insurance while disabled.
Exhibit A
How long will insurance be continued without
payment of premium?
If you become totally and permanently disabled, insurance
will be continued, without payment of premium, until the
earliest of:
(1) your 65th birthday; or
(2) the date you retire; or
(3) the date you recover so that you are no longer
totally and permanently disabled; or
(4) the date you fail to furnish proof of continued
disability when requested or you refuse to submit
to a required medical examination.
What happens to your insurance when the waiver of
premium benefit ends?
When the benefits under this supplement end according to
the provisions of the section entitled “How long will
insurance be continued without payment of premium?,”
the following will apply:
(1) If you are then eligible for coverage under your
certificate, your insurance may be continued
under your certificate provided that premiums are
paid. The first such premium payment must be
made within 31 days of the date the waiver of
premium benefit ends.
(2) If you are no longer eligible for coverage under
your certificate, you may convert coverage to an
individual policy, as provided for under the
conversion right section of your certificate.
Your insurance will end unless, within 31 days of the date
benefits under this supplement end, premium payments
on your behalf are resumed or you apply to convert your
coverage.
Termination
When does your coverage under this supplement
terminate?
Your waiver of premium coverage terminates on the
earliest of:
(1) the date you are no longer insured for life
insurance covered by this supplement; or
(2) the date requested by the policyholder to cancel
the Waiver of Premium coverage for its plan; or
(3) the date the group policy is terminated.
Insurance being continued without further payment of
premiums in accordance with the provisions of this
supplement will not end due solely to the termination of
the Waiver of Premium coverage or of the group policy.
Secretary
President
Exhibit A
Securian Life Insurance Company • A Stock Company
400 Robert Street North • St Paul, Minnesota 55101-2098
GROUP TERM LIFE CERTIFICATE OF INSURANCE
Exhibit A
Securian Life Insurance Company • A Stock Company
400 Robert Street North • St Paul, Minnesota 55101-2098
GROUP TERM LIFE INSURANCE POLICY • NONPARTICIPATING
Exhibit A
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
KATIE DEGELMANN
Senior Regional Sales Vice President, Western Region
Ochs, Inc.
400 Robert Street North, Suite 1880
St. Paul, MN 55101-2025
651-665-3789 / 800-392-7295
kdegelmann@ochsinc.com
Key Responsibilities
Sales and service of group insurance products for employer
sponsored plans
Build and maintain strong relationships with clients and their
benefit advisors
Experience with Ochs, Inc.
10 years
Insurance Industry Experience
17 years
Credentials
Life & Health Insurance License
MN License Number: 40038386
Education
University of Wisconsin, Eau Claire
Bachelor of Arts
Previous Experience
Invesco
o
Account Executive, Retail Broker Distribution
Allianz
o
Regional Vice President
o
Strategic Accounts Manager
o
Internal Wholesaler
Exhibit A
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
EMILY WATTERS
Senior Manager, Implementation and Client Success
Ochs, Inc.
400 Robert Street North, Suite 1880
St. Paul, MN 55101-2025
651-665-3789 / 800-392-7295
ewatters@ochsinc.com
Key Responsibilities
Responsible for managing the overall implementation process for
all lines of coverage
Serves as an implementation coordinator for new lines of coverage,
working closely with clients and their benefit advisors
Specializes in groups that are part of The Municipal Pool and
provides expertise to employers and employees covering a vast
number of topics regarding group benefit plans.
Experience with Ochs, Inc.:
17 years
Insurance Industry Experience
17 years
Credentials
Life & Health Insurance License
MN License Number: 40208838
Education
University of Wisconsin – La Crosse
Bachelor’s Degree, Political Science
Bachelor’s Degree, Public Administration
Previous Experience
SuperValu
o
Human Resources Technician
Exhibit A
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
CORY CLAESON
Manager, Client Accounts
Ochs, Inc.
400 Robert Street North, Suite 1880
St. Paul, MN 55101-2025
651-665-3789 / 800-392-7295
cclaeson@ochsinc.com
Key Responsibilities
Account Management and Client Relations
Lead Ochs Account Management Team
Support and service of group insurance products for employer
sponsored plans
Build and maintain strong relationships with clients and their
benefit advisors
Experience with Ochs, Inc.
1 year
Insurance Industry Experience
10 years
Credentials:
Life & Health Insurance License
MN License Number: 40886326
Education:
University of Minnesota - Duluth
B.A., Communication
Previous Experience
Securian Financial
o
Supervisor, Customer Benefit Payments
o
Sr. Product Analyst
o
Group Insurance Technology Coordinator
o
Client Implementation Assistant
Exhibit A
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
GAO VANG
Senior Client Success Representative
Ochs, Inc.
400 Robert Street North, Suite 1880
St. Paul, MN 55101-2025
651-665-3789 / 800-392-7295
gvang@ochsinc.com
Key Responsibilities
Responsible for providing customer service support to clients and
their employees regarding group benefits, enrollment, and billing.
Provides assistance to clients during their annual enrollment period.
Day to day contact for assigned clients.
Experience with Ochs, Inc.
4 years
Insurance Industry Experience
9 years
Credentials
Life & Health Insurance License
MN License Number: 40622991
Education
St. Paul College
Previous Experience
Securian Financial
o
Client Service Coordinator
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
Implementation Timeline
At Ochs, we specialize in working closely with clients and their benefit advisors to develop implementation
strategies that work best for them. A dedicated Implementation Coordinator from Ochs will be assigned to
lead the transition process, along with a team of experts from technology; enrollment; administration; billing;
underwriting and claims.
The transition and implementation process below will be customized to meet the client’s needs.
When
Action
May 2024
Client Awards Contract for the Insurance Plan
Following the plan
award date
– May –
Plan and Administrative Questions
Ochs Implementation Coordinator provides our Coverage Administration Details (CAD) document to complete
Client returns by the date requested (prior to the implementation conference call)
Following Client’s
completion of the
CAD
– May –
Implementation Meeting (45 – 60 minutes)
Ochs Implementation Coordinator initiates a conference call to discuss the plan and answer questions
Review sold plan design and documents for signature
Identify key contacts; outlining roles and responsibilities
Brief overview of billing, marketing, administration, and certificates
Following the
Implementation
Meeting
– May –
Conference Call with TPA (15 – 20 minutes) – If applicable –
Prior to the initial open enrollment, Ochs’ Client Services Representative will call the TPA to discuss
Guaranteed Issue (GI) rules and plan design set– up for the benefits enrollment system
Acceptable enrollment form/Evidence of Insurability (EOI) submission process
Prior to the
enrollment period
– May –
Enrollment Materials
Ochs creates customized marketing and enrollment forms at no additional cost
Ochs sends drafts to the client for review and approval
Upon approval, Ochs sends finalized electronic materials, along with GI/EOI form completion guidelines
Brief call between Ochs and client to review understanding of GI and EOI rules
After call with client, Ochs will print and ship enrollment packets requested
Prior to the
effective date
– May –
Administration
Ochs will send an Administration Kit to the client which includes all necessary forms and documents to
administer the plan, including New Employee enrollment materials
Ochs will send an Access Agreement for our secure online site LifeBenefitsExtra (LBE) – client returns signed
form to have access to view EOI status, run reports, and submit claims electronically
May or within 60
days of the
conference call or
CAD return
Policy and Certificates
Ochs will send the certificate drafts to the client to review
Ochs will send an Access Agreement for our secure online site LifeBenefitsExtra (LBE) – client returns signed
form to have access to view EOI status, run reports, and submit claims electronically
Prior to the first
payment
– June –
Bill Remittance and Forms Processing Discussion (20 – 30 minutes)
Prior to the first premium payment, Ochs’ Client Services Rep. will meet with the client to review the billing process;
remittance procedures; and recap the Enrollment and EOI forms submission process
Ochs will send client GI guidelines, how to complete forms, on– line billing walk– through, Admin. Kit for review
July 1, 2024
Effective Date of the Insurance Plan
Exhibit A
Claim Reports attached include:
•
Claims Status Report
•
EOI Status Report
•
Financial Experience Report
•
Participation Trends Report
•
Summary of Incurred Claims Report
0i0 secur1an
FINANCIAL
Exhibit A
0i0 secur1an
LifeBenefitsExtra
FINANCIAL
HOME
Search
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Claims snapshot
12/29/2018 through 01/0lt/2019
Showing l to L, of L, entries
Deceased
or
claimant•
DOE,
ELIZABETH
JONES, SUSAN
SMITH, JUDY
SMYTH, JOSEPH
Deceased or
claimant Social
Security number ;
xxx-xx-xxxx
xxx-xx-xxxx
xxx-xx-xxxx
xxx-xx-xxxx
Claim
number;
1328888
1399999
1348888
1349999
Plan Support
Coverage
type;
Basic Life
Basic Life
Basic Life
Basic Life
[
Status
...
T
Claim
Paid
Claim
Paid
Claim
Paid
Claim
Paid
All
Effective
date;
01/04/20XX
01/03/20XX
01/04/20XX
01/03/20XX
Contact us
John Doe
Log out
New
Employer;
055887 -
DIVISION 3
040335
DIVISION I
055887 -
DIVISION 3
030208 -
DIVISION 2
Finalized
Amount
paid;
52,530.75
587,822.33
$54,602.88
$47,466.78
This status hos been changed since the lost dote in your snapshot and does not match the current status. You can view the current status of the claim by selecting the
deceosed/cloimanrs name.
0 Not seeing the information you need? Create your own custom report with our Report builder. Create report >
Exhibit A
Exhibit A
FINANCIAL EXPERIENCE REPORT
Client Name
January 1, 2019 through December 31, 2019
Policy Number: 00000
Submitted by
©2020 Securian Financial Group, Inc. All rights reserved.
Exhibit A
Financial Experience Report - Sample
Client Name
Earned
Incurred
Coverage
Premium
Claims
Active Basic Life
$0
$0
0.0%
Retiree Basic Life
0
0
0.0%
Supplemental Life
0
0
0.0%
Supplemental Spouse Life
0
0
0.0%
Supplemental Child Life
0
0
0.0%
Total Life Coverages
$0
$0
0.0%
Active Basic AD&D
$0
$0
0.0%
Employee Voluntary AD&D
0
0
0.0%
Family Voluntary AD&D
0
0
0.0%
Total AD&D Coverages
$0
$0
0.0%
Notes:
Incurred Claims =
Paid Claims + Interest
+ Current Reported Life Reserve - Prior Reported Life Reserve
+ Current Reported Waiver Reserve - Prior Reported Waiver Reserve
+ Current Waiver IBNR Reserve - Prior Waiver IBNR Reserve
+ Conversion Charges
Experience by Coverage
For the Period January 1, 2019 through December 31, 2019
Incurred
Loss Ratio
© 2020 All Rights Reserved
1
Exhibit A
Financial Experience Report - Sample
Paid
Paid
Month
Premium
Claims
January 2017
$0.00
$0.00
February 2017
0.00
0.00
March 2017
0.00
0.00
April 2017
0.00
0.00
May 2017
0.00
0.00
June 2017
0.00
0.00
July 2017
0.00
0.00
August 2017
0.00
0.00
September 2017
0.00
0.00
October 2017
0.00
0.00
November 2017
0.00
0.00
December 2017
0.00
0.00
Total
0.00
0.00
Change in Life Reserves
0.00
0.00
Conversion Charges
0.00
0.00
Earned Premium
Incurred Claims
Total Active Basic Life
$0.00
$0.00
Active Basic Life Experience by Month
For the Period January 1, 2019 through December 31, 2019
© 2020 All Rights Reserved
2
Client Name
Exhibit A
Financial Experience Report - Sample
Average Paid
Number of
Average Age
Coverage
Claim Amount *
Paid Claims
at Claim
Active Basic Life
$0
0
0
Retiree Basic Life
0
0
0
Supplemental Life
0
0
0
Supplemental Spouse Life
0
0
0
Supplemental Child Life
0
0
0
Active Basic AD&D
0
0
0
Employee Voluntary AD&D
0
0
0
Family Voluntary AD&D
0
0
0
*The Average Paid Claim Amount is the average face amount of insurance for claims which had a final
claim payment in the reporting period.
Claim Statistics by Coverage
For the Period January 1, 2019 through December 31, 2019
Based on the Number of Paid Claims in the Period
© 2020 All Rights Reserved
3
Client Name
Exhibit A
Financial Experience Report
Client Name
Based on the Number of Paid Claims in the Period
Cause of death is considered private, non-public information in many governmental jurisdictions. Please take
steps to protect this information and prevent its disclosure. This confidential information may not be shared
with your general employee population and should be carefully protected by you.
Cause of Death Report
For the Period January 1, 2019 through December 31, 2019
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Percent
Client Name
Minnesota Life
Total Count: 106
© 2020 All Rights Reserved
4
Exhibit A
Financial Experience Report - Sample
Total
%
SL %
Total
%
SL %
Total
%
SL %
Total
%
SL %
Total
%
SL %
All other accidents
0
0.0%
15.2%
1
14.3%
19.0%
0
0.0%
17.1%
2
8.7%
10.5%
1
2.3%
8.2%
Cancer & tumor
0
0.0%
7.5%
0
0.0%
8.2%
3
20.0%
18.5%
2
8.7%
27.3%
15
34.1%
32.8%
Heart disease & disorders
0
0.0%
9.6%
2
28.6%
10.1%
3
20.0%
14.7%
2
8.7%
17.8%
10
22.7%
19.1%
Homicide
0
0.0%
8.1%
1
14.3%
7.0%
0
0.0%
5.2%
1
4.3%
1.3%
0
0.0%
2.2%
Liver & kidney disease
0
0.0%
1.3%
0
0.0%
0.6%
0
0.0%
0.0%
2
8.7%
2.6%
2
4.5%
5.4%
Lung Disorders
0
0.0%
5.5%
0
0.0%
3.2%
2
13.3%
5.7%
1
4.3%
7.2%
1
2.3%
4.1%
Motor vehicle accidents
4
80.0%
19.4%
2
28.6%
21.5%
2
13.3%
12.3%
5
21.7%
5.3%
2
4.5%
5.4%
Other diseases & disorders
0
0.0%
18.7%
0
0.0%
11.4%
0
0.0%
9.5%
4
17.4%
11.8%
7
15.9%
10.3%
Stroke
0
0.0%
0.3%
0
0.0%
0.6%
0
0.0%
1.4%
0
0.0%
1.3%
1
2.3%
2.8%
Suicide
1
20.0%
13.4%
1
14.3%
16.5%
5
33.3%
13.3%
4
17.4%
12.2%
5
11.4%
8.8%
Unknown
0
0.0%
1.0%
0
0.0%
1.9%
0
0.0%
2.4%
0
0.0%
2.6%
0
0.0%
0.7%
Totals
5 100.0% 100.0%
7 100.0% 100.0%
15 100.0% 100.0%
23 100.0% 100.0%
44 100.0% 100.0%
Total
%
SL %
Total
%
SL %
Total
%
SL %
Total
%
SL %
Total
%
SL %
All other accidents
3
4.2%
5.5%
5
3.8%
3.4%
7
3.3%
2.8%
7
1.9%
2.4%
26
2.9%
4.8%
Cancer & tumor
29
40.3%
35.4%
56
42.1%
40.5%
78
36.3%
40.2%
151
40.1%
40.7%
334
37.5%
36.3%
Heart disease & disorders
14
19.4%
23.2%
26
19.5%
23.5%
50
23.3%
22.8%
98
26.0%
24.3%
205
23.0%
21.9%
Homicide
0
0.0%
0.4%
3
2.3%
0.5%
0
0.0%
0.2%
2
0.5%
0.2%
7
0.8%
1.1%
Liver & kidney disease
3
4.2%
3.5%
7
5.3%
5.5%
13
6.0%
6.9%
23
6.1%
6.1%
50
5.6%
5.4%
Lung Disorders
4
5.6%
5.4%
8
6.0%
5.1%
16
7.4%
7.7%
27
7.2%
8.5%
59
6.6%
6.9%
Motor vehicle accidents
3
4.2%
4.2%
2
1.5%
2.5%
3
1.4%
1.5%
6
1.6%
1.1%
29
3.3%
3.7%
Other diseases & disorders
9
12.5%
12.4%
16
12.0%
10.6%
34
15.8%
11.7%
46
12.2%
11.9%
116
13.0%
12.0%
Stroke
3
4.2%
2.8%
4
3.0%
2.7%
6
2.8%
2.4%
9
2.4%
2.6%
23
2.6%
2.4%
Suicide
4
5.6%
6.1%
5
3.8%
4.4%
3
1.4%
2.7%
7
1.9%
1.3%
35
3.9%
4.5%
Unknown
0
0.0%
1.1%
1
0.8%
1.3%
5
2.3%
1.1%
1
0.3%
0.8%
7
0.8%
1.1%
Totals
72 100.0% 100.0%
133 100.0% 100.0%
215 100.0% 100.0%
377 100.0% 100.0%
891 100.0% 100.0%
Total
%
SL %
Total
%
SL %
Total
%
SL %
Total
%
SL %
Total
%
SL %
All other accidents
8
1.7%
1.2%
6
1.1%
1.2%
4
0.7%
1.7%
14
1.8%
1.6%
4
0.6%
1.6%
Cancer & tumor
187
39.2%
37.0%
175
32.0%
33.9%
134
23.3%
27.1%
164
21.1%
21.4%
100
14.6%
15.2%
Heart disease & disorders
121
25.4%
26.3%
121
22.1%
25.8%
167
29.0%
27.0%
197
25.3%
27.4%
187
27.3%
30.2%
Homicide
1
0.2%
0.1%
0
0.0%
0.1%
0
0.0%
0.0%
0
0.0%
0.0%
0
0.0%
0.0%
Liver & kidney disease
26
5.5%
5.9%
39
7.1%
5.4%
36
6.3%
5.8%
39
5.0%
4.8%
34
5.0%
5.1%
Lung Disorders
44
9.2%
11.8%
68
12.4%
13.7%
85
14.8%
15.5%
127
16.3%
16.7%
117
17.1%
16.4%
Motor vehicle accidents
4
0.8%
0.7%
4
0.7%
0.4%
1
0.2%
0.3%
5
0.6%
0.3%
1
0.1%
0.3%
Other diseases & disorders
66
13.8%
12.5%
93
17.0%
14.2%
115
20.0%
16.7%
187
24.0%
21.8%
202
29.4%
25.5%
Stroke
14
2.9%
2.9%
30
5.5%
3.7%
30
5.2%
4.8%
40
5.1%
5.0%
36
5.2%
4.9%
Suicide
4
0.8%
0.8%
6
1.1%
0.8%
3
0.5%
0.5%
3
0.4%
0.3%
2
0.3%
0.1%
Unknown
2
0.4%
0.8%
5
0.9%
0.7%
1
0.2%
0.6%
3
0.4%
0.7%
3
0.4%
0.6%
Totals
477 100.0% 100.0%
547 100.0% 100.0%
576 100.0% 100.0%
779 100.0% 100.0%
686 100.0% 100.0%
Total
%
SL %
Total
%
SL %
Total
%
SL %
Total
%
SL %
Total
%
SL %
All other accidents
9
1.8%
2.0%
2
1.0%
2.9%
1
2.7%
1.6%
0
0.0%
5.3%
48
1.3%
1.6%
Cancer & tumor
49
9.9%
9.5%
14
7.1%
6.9%
2
5.4%
6.6%
0
0.0%
5.3%
825
21.7%
22.8%
Heart disease & disorders
140
28.2%
32.3%
54
27.4%
34.3%
14
37.8%
35.5%
0
0.0%
26.3%
1001
26.4%
28.5%
Homicide
0
0.0%
0.0%
0
0.0%
0.0%
0
0.0%
0.0%
0
0.0%
0.0%
1
0.0%
0.0%
Liver & kidney disease
24
4.8%
4.8%
8
4.1%
4.2%
0
0.0%
3.3%
0
0.0%
0.0%
206
5.4%
5.2%
Lung Disorders
63
12.7%
14.8%
34
17.3%
14.8%
8
21.6%
15.3%
0
0.0%
15.8%
546
14.4%
15.0%
Motor vehicle accidents
0
0.0%
0.1%
2
1.0%
0.0%
0
0.0%
0.0%
0
0.0%
0.0%
17
0.4%
0.3%
Other diseases & disorders
178
35.8%
30.0%
67
34.0%
30.2%
12
32.4%
33.3%
2 100.0%
47.4%
922
24.3%
20.8%
Stroke
31
6.2%
5.8%
15
7.6%
5.7%
0
0.0%
3.3%
0
0.0%
0.0%
196
5.2%
4.6%
Suicide
0
0.0%
0.2%
1
0.5%
0.0%
0
0.0%
0.0%
0
0.0%
0.0%
19
0.5%
0.4%
Unknown
3
0.6%
0.5%
0
0.0%
1.0%
0
0.0%
1.1%
0
0.0%
0.0%
17
0.4%
0.7%
Totals
497 100.0% 100.0%
197 100.0% 100.0%
37 100.0% 100.0%
2 100.0% 100.0%
3798 100.0% 100.0%
Death Claims Cause Analysis by Age Band
For the Period January 1, 2019 through December 31, 2019
Cause
<25
25 - 29
30 - 34
35 - 39
40 - 44
85 - 89
Cause
45 - 49
50 - 54
55 - 59
60 - 64
<65 Total
Cause
65 - 69
70 - 74
75 - 79
80 - 84
Cause
90 - 94
95 - 99
100 - 104
105+
65+ Total
© 2020 All Rights Reserved
5
Client Name
Exhibit A
APPENDIX
Exhibit A
Financial Experience Report - Sample
(+)
(+)
(+)
(-)
(+)
(-)
(+)
(-)
(+)
Insurance
Interest
Current
Prior
Current
Prior
Current
Prior
Conversion
Incurred
Coverage
Amount Paid
Paid
Reserve
Reserve
Reserve
Reserve
Reserve
Reserve
Charge
Claims
Active Basic Life
$0.00
$0.00
$0.00
$0.00
$0
$0
$0
$0
$0
$0
Retiree Basic Life
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Supplemental Life
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Supplemental Spouse Life
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Supplemental Child Life
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Active Basic AD&D
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Employee Voluntary AD&D
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Family Voluntary AD&D
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Total
$0.00
$0.00
$0.00
$0.00
$0
$0
$0
$0
$0
$0
Life Claims
Waiver of Premium
Reported Reserves
Reported Reserves
IBNR
Summary of Incurred Claims
For the Period January 1, 2019 through December 31, 2019
© 2020 All Rights Reserved
A1
Client Name
Exhibit A
Financial Experience Report - Sample
Age at
Date of
Date Notice
Insurance
Interest
Current
Prior
Incurred
Name
Death
Gender
Death
Received
Date Paid
Amount Paid
Paid
Reserve
Reserve
Claims
Name 1
$
0.00
$
0.00
$
0.00
$
0.00
$
0.00
Name 2
0.00
0.00
0.00
0.00
0.00
Name 3
0.00
0.00
0.00
0.00
0.00
Name 4
0.00
0.00
0.00
0.00
0.00
Name 5
0.00
0.00
0.00
0.00
0.00
Name 6
0.00
0.00
0.00
0.00
0.00
6 Total Claims
$
0.00
$
0.00
$
0.00
$
0.00
$
0.00
Active Basic Life Claims Experience
For the Period January 1, 2019 through December 31, 2019
Death Claims
© 2020 All Rights Reserved
A2
Client Name
Exhibit A
Exhibit A
Financial Experience Report - Sample
Client Name
(+)
(+)
(+)
(-)
(+)
(-)
(+)
(-)
(+)
Insurance
Interest
Current
Prior
Current
Prior
Current
Prior
Conversion
Incurred
Coverage
Amount Paid
Paid
Reserve
Reserve
Reserve
Reserve
Reserve
Reserve
Charge
Claims
Active Basic Life
$0.00
$0.00
$0.00
$0.00
$0
$0
$0
$0
$0
$0
Retiree Basic Life
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Supplemental Life
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Supplemental Spouse Life
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Supplemental Child Life
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Active Basic AD&D
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Employee Voluntary AD&D
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Family Voluntary AD&D
0.00
0.00
0.00
0.00
0
0
0
0
0
0
Total
$0.00
$0.00
$0.00
$0.00
$0
$0
$0
$0
$0
$0
Life Claims
Waiver of Premium
Reported Reserves
Reported Reserves
IBNR
Summary of Incurred Claims
For the Period January 1, 2019 through December 31, 2019
© 2020 All Rights Reserved
A1
Exhibit A
Financial Experience Report - Sample
Client Name
Age at
Date of
Date Notice
Insurance
Interest
Current
Prior
Incurred
Name
Death
Gender
Death
Received
Date Paid
Amount Paid
Paid
Reserve
Reserve
Claims
Name 1
$
0.00
$
0.00
$
0.00
$
0.00
$
0.00
Name 2
0.00
0.00
0.00
0.00
0.00
Name 3
0.00
0.00
0.00
0.00
0.00
Name 4
0.00
0.00
0.00
0.00
0.00
Name 5
0.00
0.00
0.00
0.00
0.00
Name 6
0.00
0.00
0.00
0.00
0.00
6 Total Claims
$
0.00
$
0.00
$
0.00
$
0.00
$
0.00
Active Basic Life Claims Experience
For the Period January 1, 2019 through December 31, 2019
Death Claims
© 2020 All Rights Reserved
A2
Exhibit A
Group Term Life Insurance Policy
Securian Life Insurance Company • A Stock Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
POLICYHOLDER:
ABC Company
POLICY NUMBER:
12345-G
POLICY SITUS:
This policy was issued and delivered in STATE .
POLICY EFFECTIVE DATE:
January 1, 2016
POLICY ANNIVERSARY DATE:
January 1 of each year beginning January 1, 2017
POLICY PREMIUM DUE DATE(S):
The first day of each month
Read Your Policy Carefully
This policy was issued to the policyholder on the effective
date shown above. We promise to pay the benefits
provided by this policy, subject to its conditions,
limitations, and exceptions. We make this promise and
issue this policy in consideration of the application for this
policy and the payment of the premiums.
Signed for Securian Life Insurance Company at St. Paul,
Minnesota on the effective date.
Secretary
President
TABLE OF CONTENTS
Definitions .......................................................................... 3
General Information .......................................................... 3
Premiums .......................................................................... 3
Termination ........................................................................ 4
Additional Information ........................................................ 4
GROUP TERM LIFE INSURANCE POLICY • NONPARTICIPATING
SAMPLE
Exhibit A
Certificates of Insurance Schedule
The following Certificates of Insurance and Certificate Endorsements (if any) are attached to and made a part of this
policy:
Certificate Title
Certificate Form Number
Applies To
Revision Date
All Salaried Employees
Certificate of Insurance
14-31701
Salaried employees
January 1, 2015
All Hourly Employees
Certificate of Insurance
14-31701
Hourly employees
January 1, 2015
Certificate Endorsement
Title
Certificate Endorsement
Form Number
Applies To
Revision Date
Executives
12345-G/1
Executive employees
January 1, 2015
Exhibit A
Definitions
associated company
Any company which is a subsidiary or affiliate of the
policyholder which is designated by the policyholder and
agreed to by us to participate under this policy.
contributory insurance
Insurance for which an employee is required to make
premium contributions.
noncontributory insurance
Insurance for which an employee is not required to make
premium contributions.
policyholder
The owner of the group policy as shown on the first page
of this policy.
we, our, us
Securian Life Insurance Company.
you, your
The policyholder.
General Information
What is your agreement with us?
This policy and your application contain the entire
insurance contract between you and us. Any statements
you make will, in the absence of fraud, be considered
representations and not warranties. Also, any statement
that you make will not be used to void this policy, nor will
it be used in our defense if we refuse to pay a claim,
unless the statement is contained in your application.
No change or waiver of any provisions of this policy, or
any certificate issued under it, will be valid unless made in
writing by us and signed by our president, a vice-
president, our secretary, or an assistant secretary. No
agent or other person has the authority to change or
waive any provisions of this policy, or of any certificate
issued under it.
Are employees of associated companies eligible for
insurance under this policy?
Yes. Employees of associated companies may be
eligible for insurance under this policy. You represent
any associated company in all transactions pertaining to
this policy. Your acts or omissions and every notice given
by us to you shall be binding on every associated
company. When an associated company ceases its
participation under the policy, the policy shall be
considered to be terminated for all employees of the
associated company. All provisions related to the policy
terminating will apply to such employees.
Can this policy be amended?
Yes. The insured's consent is not required to amend this
policy or any certificates issued under it. Any amendment
will be without prejudice to any claim for benefits incurred
prior to the effective date of the amendment.
Premiums
When and how often are premiums due?
Unless we have agreed to some other premium payment
procedure, premiums for this policy are remitted to us
monthly. Premiums are due on the premium due date as
shown on the first page of this policy. We apply premiums
consecutively to keep the insurance in force.
Premium contributions for contributory insurance are to be
paid to you. The premium contributions by insureds for
contributory insurance should be remitted to us as due
along with the premiums payable for noncontributory
insurance.
How is the premium determined?
The premium will be the premium rate multiplied by the
number of $1,000 units of insurance in force on the date
premiums are due. The premium may also be computed
by any other method on which you and we agree.
We may change the premium rate:
(1) on any premium due date following the expiration
of any rate guarantee period; or
(2) on any premium due date following the date that
the amount of insurance in force for any one
coverage changes by more than 15% from that
which was used to determine the current rates
(active employee coverage and retiree coverage
are considered separate coverages, as are basic
life, supplemental life, spouse life, child life and
AD&D); or
(3) anytime the policy terms are amended.
What factors do we consider when premium is
changed?
If premium is changed, the change will be based upon
future estimated or emerging experience, which factors
include: interest rates, mortality, taxes, our expenses and
profit considerations.
Can a premium be paid after the date it is due?
Yes. This policy has a 31-day grace period. If a premium
is not paid on or before the date it is due, that premium
may be paid during the 31-day period following the due
date. The insurance under this policy will remain in effect
during the 31-day grace period.
Exhibit A
Can the premium be adjusted?
Yes. An adjustment will be made to the premium on each
due date for insurance which was effective or terminated
before the most recent due date, but not reflected in prior
premium payments, so that the correct premium is paid.
Termination
When does this group policy terminate?
You may terminate this group policy by giving us 31 days
prior written notice. We reserve the right to terminate this
policy on the earlier of the following to occur:
(1) 31 days (the grace period) after the due date of
any premiums which are not paid; or
(2) 31 days after we provide you with notice of our
intent to terminate this policy.
Additional Information
Are you required to maintain records?
Yes. You are required to maintain adequate records of
any information necessary for us to administer this policy.
We will have reasonable access to such records in order
to administer the policy.
If an administration or clerical error is made in keeping
records on or administering the insurance under this
policy, it will not affect otherwise valid insurance. A
clerical or administrative error, however, does not
continue insurance which is otherwise stopped, make
insurance effective when it should not have been or
change the amount of insurance provided by the
provisions of this policy and no claim shall be paid on
amounts put into effect as a result of a past clerical or
administrative error. If an error causes a change in
premium payment, a fair adjustment will be made.
Will a certificate of insurance be provided for each
insured?
Yes. We will provide you with a certificate of insurance for
delivery to each insured. The certificate will include
information regarding the principal provisions of his or her
coverage.
Are you our agent?
No. For all purposes of this policy, neither you, an
associated company, nor any administrator you appoint is
our agent. We will not be liable for any of your acts or
omissions or those of an associated company or
administrator.
Will the provisions of this policy conform with state
law?
Yes. If any provision in this policy, or in the certificates
issued under this policy, is in conflict with the laws of the
state governing the policy or the certificates, the provision
will be deemed to be amended to conform to such laws.
Does ownership of this policy entitle you to
membership in Securian Life Insurance Company’s
parent company?
No. The ultimate parent company of Securian Life
Insurance Company is a mutual insurance holding
company. This policy does not entitle you to any holding
company membership rights.
Exhibit A
Employee Group Term Life Certificate of Insurance
Securian Life Insurance Company • A Stock Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
POLICYHOLDER: ABC Company
POLICY NUMBER: 12345-G
Read Your Certificate Carefully
If you meet the eligibility and enrollment requirements
herein, you are insured under the group policy shown on
the specifications page. This certificate summarizes the
principal provisions of the
group policy that affect you. The provisions summarized
in this certificate are subject in every respect to the group
policy. You may examine the group policy at the principal
office of the policyholder during regular working hours.
Secretary
President
TABLE OF CONTENTS
Definitions .......................................................................... 2
General Information .......................................................... 2
Premiums .......................................................................... 3
Death Benefit..................................................................... 4
Termination ........................................................................ 4
Conversion Right ............................................................... 4
Additional Information ........................................................ 5
GROUP TERM LIFE CERTIFICATE OF INSURANCE
Exhibit A
Certificate Specifications Page
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
GENERAL INFORMATION
POLICYHOLDER:
The ABC Company
POLICY NUMBER:
12345-G
ASSOCIATED COMPANIES:
All subsidiaries and affiliates reported to Securian Life by the
policyholder for inclusion in the policy.
POLICY SITUS:
The policy was issued and delivered in STATE.
POLICY EFFECTIVE DATE:
January 1, 2016.
This certificate and/or certificate specifications page replaces any and all certificates and/or certificate
specifications pages previously issued to you under the group policy. Please replace any certificate and/or
certificate specifications page previously issued to you with this new certificate and/or specifications page.
GROUP:
The group is composed of all active employees of the policyholder and
its associated companies working in the United States in the following
classes:
Class 1
All Salaried Employees
Class 2
All Hourly Employees
NO DOUBLE COVERAGE:
A person cannot be covered under more than one class. A person
cannot be covered as both an active employee and a retiree. Any
person who is eligible as an employee or retiree under the policy, or
insured under the portability provisions, is not eligible as a dependent.
Only one person can insure an eligible dependent child.
ENROLLMENT PERIOD:
Not applicable for noncontributory insurance; 31 days from the first day
of eligibility for contributory insurance
WAITING PERIOD:
The period commencing with the employee’s date of employment and
ending with the first day of the month next following or coinciding with
the employee’s completion of 90 days of continuous employment
MINIMUM HOURS
PER WEEK REQUIRED:
30 hours per week
PLAN OF INSURANCE
EMPLOYEE BENEFIT SCHEDULE
EMPLOYEE TERM LIFE INSURANCE:
Basic Life Insurance
Eligible Class
Amount of Basic Life Insurance
Class 1
One times annual earnings, rounded to the next higher $1,000 if not
already a multiple thereof, subject to a minimum of $10,000 and a
maximum of $500,000.*
Class 2
$50,000
Exhibit A
Supplemental Life Insurance
An amount elected by the employee from the following options:
Eligible Class
Amount of Supplemental Life Insurance
Classes 1 and 2
One, two, three or four times annual earnings, multiplied and then
rounded to the next higher $1,000 if not already a multiple thereof,
subject to a minimum of $10,000 and a maximum of $500,000.*
*The combined amount of basic and supplemental insurance for an employee shall not exceed $500,000.
EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE:
Basic and Supplemental Insurance
Eligible Class
Amount of Basic and Supplemental AD&D Insurance
Classes 1 and 2
An amount equal to the amount of basic and supplemental life insurance
for which the employee is insured under the group policy.
GENERAL PROVISIONS FOR EMPLOYEE INSURANCE
AGE REDUCTIONS:
The amount of insurance on an employee age 65 or older shall be a
percentage of the amount otherwise provided by the plan of insurance
applicable to such employee in accordance with the following table:
Age of Employee
65 - 69
70 - 74
75 and over
Amount of Insurance
65%
50%
25%
Age reductions will apply the first day of the month following an insured
employee's 65th, 70th, and 75th birthdays.
RETIREMENT REDUCTIONS:
All insurance terminates at retirement, except as provided for under the
portability provision.
CONTRIBUTORY/NONCONTRIBUTORY:
Basic insurance is noncontributory insurance; supplemental insurance is
contributory insurance.
GUARANTEED ISSUE AMOUNT:
The guaranteed issue is the maximum amount of insurance an
employee can receive without evidence of insurability when first eligible
under the plan provided enrollment is made within the enrollment period.
The amounts are as follows:
For basic insurance:
All basic insurance is guaranteed issue.
For supplemental
insurance:
The lesser of two times annual earnings or $250,000.
NOTE: For an employee who was covered for supplemental life
under the employer’s plan immediately prior to the policy effective
date shown above, the guaranteed issue for supplemental life is
the amount of supplemental life in force under that prior plan
immediately prior to the policy effective date.
Exhibit A
EFFECTIVE DATE OF INCREASES
AND DECREASES DUE TO CHANGE
IN ELIGIBLE CLASS OR EARNINGS:
Increases and decreases due to a change in eligible class or earnings
will become effective the date of the change in eligible class or earnings.
Evidence of insurability will not be required for an increase in insurance
due solely to an increase in earnings. All increases are subject to the
actively at work requirement. NOTE: An employee whose amount of
supplemental insurance is limited to the guaranteed amount of $250,000
due to being declined any amount of insurance by us under the group
policy is not insured for a multiple of earnings plan, but rather is insured
for the frozen amount of $250,000 and therefore will not receive an
increase in supplemental insurance due to salary increases.
DEPENDENTS BENEFIT SCHEDULE
DEPENDENTS TERM LIFE INSURANCE:
An employee must be insured for supplemental life insurance in order to be insured for dependents life insurance.
Spouse/Domestic Partner Life Insurance
Eligible Class
Amount of Spouse/Domestic Partner Life Insurance
All Employees
An amount elected by the employee, in an increment of $10,000, subject
to a maximum of $200,000
Child Life Insurance
Eligible Class
Amount of Child Life Insurance
All Employees
$5,000 or $10,000, as elected by the employee
GENERAL PROVISIONS FOR DEPENDENTS INSURANCE
SPOUSE/DOMESTIC PARTNER AGE
REDUCTIONS:
The amount of insurance on an insured spouse/domestic partner age 65
or older shall be a percentage of the amount otherwise provided by the
plan of insurance applicable to such spouse/domestic partner in
accordance with the following table:
Age of Spouse/DP Amount of Insurance
65 – 69 65%
70 – 74 50%
75 and over 25%
Age reductions will apply the first day of the month following an insured
spouse’s 65th, 70th, and 75th birthdays.
CONTRIBUTORY/NONCONTRIBUTORY:
Dependents insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT:
The guaranteed issue is the maximum amount of insurance an eligible
dependent can receive without evidence of insurability when first eligible
under the plan provided enrollment is made within the enrollment period.
The amounts are as follows:
For spouse/domestic partner insurance: $50,000
For child insurance: $10,000
NOTE: For employees with eligible dependents immediately prior to the
policy effective date, the guaranteed issue amount is equal to the
amount of dependents insurance for which they were insured under the
prior group policy immediately prior to the policy effective date.
EFFECT OF EMPLOYEE’S RETIREMENT:
All dependents insurance terminates upon the employee’s retirement
except as provided under the portability provision.
Exhibit A
ADDITIONAL INFORMATION
WAIVER OF PREMIUM APPLICATION:
Applies to contributory and noncontributory employee insurance.
EVIDENCE OF INSURABILITY:
Evidence of insurability satisfactory to us will be required:
•
In order for a newly eligible employee to become insured for an
amount of insurance greater than the guaranteed issue amount.
If such evidence of insurability is not provided or is not
satisfactory to us, the employee will be insured for the
guaranteed issue amount.
•
In order for a newly eligible spouse/domestic partner to become
insured for an amount of insurance greater than the guaranteed
issue amount. If such evidence of insurability is not provided or
is not satisfactory to us, the spouse/domestic partner will be
insured for the guaranteed issue amount.
•
At Qualified Status Change or annual open enrollment, a
request that exceeds the amounts indicated below as not
requiring evidence of insurability.
•
At Qualified Status Change or annual open enrollment, if the
insured has previously been declined any insurance amount by
us due to evidence of insurability being found unsatisfactory.
•
At Qualified Status Change if the change is not in the list below
in the “Certain Qualified Status Changes” section.
CERTIFICATE SUPPLEMENTS (found later in this document):
Accelerated Benefits
Accidental Death and Dismemberment
Dependents Term Life
Portability
Waiver of Premium
Exhibit A
Definitions
application
Your application for insurance under the group policy and,
if required, your evidence of insurability application.
associated company
Any company which is a subsidiary or affiliate of the
policyholder which is designated by the policyholder and
agreed to by us to participate under the group policy.
contributory insurance
Insurance for which you are required to make premium
contributions.
earnings
Your basic rate of compensation not including
commissions, overtime or premium pay, bonuses, or any
other additional compensation.
employee
An individual who is employed by the policyholder or by an
associated company. A sole proprietor will be considered
the employee of the proprietorship. A partner in a
partnership will be considered an employee so long as the
partner’s principal work is the conduct of the partnership’s
business. The term employee does not include temporary
employees or corporate directors who are not otherwise
employees.
employer
The policyholder or any designated associated
companies.
evidence of insurability
Evidence satisfactory to us of the good health of the
prospective insured and any other underwriting
information we require.
insured
A person who is eligible for and becomes insured
according to the terms of this certificate, including any
person insured by supplement to this certificate.
non-work day
A day on which you are not regularly scheduled to work,
including scheduled time off for vacations, personal
holidays, weekends and holidays, and approved leaves of
absence for non-medical reasons.
Non-work day does not include time off for medical leave
of absence, temporary layoff, employer suspension of
operations in total or in part, strike, and any time off due to
sickness or injury including sick days, short-term disability,
or long-term disability.
noncontributory insurance
Insurance for which you are not required to make premium
contributions.
policyholder
The owner of the group policy as shown on the
specifications page.
waiting period
The period, if any, of continuous employment with the
employer required prior to becoming eligible for coverage
under this certificate. The waiting period is shown on the
specifications page. You are not eligible until the first day
following the waiting period.
we, our, us
Securian Life Insurance Company.
you, your
An insured employee.
General Information
What is your agreement with us?
If you meet the eligibility and enrollment requirements, you
are insured under the group policy shown on the
specifications page. Your application as defined under
this certificate is a part of this certificate. This certificate
summarizes the principal provisions of the group policy
that affect your life insurance coverage. The provisions
summarized in this certificate are subject in every respect
to the group policy.
Any statements made in your application as defined in this
certificate will, in the absence of fraud, be considered
representations and not warranties. Also, any statement
made will not be used to void your insurance nor defend
against a claim unless the statement is contained in the
application.
Can this certificate be amended?
Yes. We retain the right to amend this certificate at any
time without your consent. Any amendment will be
without prejudice to any claim incurred for benefits prior to
the date of the amendment.
Who is eligible for insurance?
You are eligible if you:
(1) are a member of the eligible group and of an
eligible class as shown on the specifications page;
and
(2) work for the employer for at least the number of
hours per week shown as the minimum hours per
week requirement on the specifications page; and
(3) have satisfied the waiting period as shown on the
specifications page; and
Exhibit A
(4) meet the actively at work requirement as shown in
the section entitled “What is the actively at work
requirement?”.
Are employees of associated companies eligible for
insurance under the group policy?
Yes. Employees of associated companies may be eligible
for insurance under the group policy. The policyholder
represents any associated company in all transactions
pertaining to the group policy. The policyholder’s acts or
omissions and every notice given by us to the policyholder
shall be binding on every associated company. When an
associated company ceases its participation under the
policy, the policy shall be considered to be terminated for
all employees of the associated company. All provisions
related to the policy terminating will apply to such
employees.
Are retired employees eligible for insurance?
If the policyholder’s plan of insurance, as reflected in the
specifications page, does not specifically provide
insurance for retired employees, a retired employee shall
not be eligible to become insured, nor have his or her
insurance continued. If the policyholder’s plan of
insurance specifically provides insurance for retired
employees, the minimum hours per week and actively at
work requirements will not apply to such persons.
What is the actively at work requirement?
To be eligible to become insured or to receive an increase
in the amount of insurance, you must be actively at work,
fully performing your customary duties for your regularly
scheduled number of hours at the employer’s normal
place of business, or at other places the employer’s
business requires you to travel.
If you are not working due to illness or injury you do not
meet the actively at work requirement. If you are receiving
sick pay, short-term disability benefits or long-term
disability benefits, you do not meet the actively at work
requirement.
If you are not actively at work on the date coverage would
otherwise begin, or on the date an increase in your
amount of insurance would otherwise be effective, you will
not be eligible for the coverage or increase until you return
to active work. However, if the absence is on a non-work
day, coverage will not be delayed provided you were
actively at work on the work day immediately preceding
the non-work day.
Except as otherwise provided for in this certificate, you are
eligible to continue to be insured only while you remain
actively at work.
Any insurance or increase in insurance which is elected or
put in force while you are not actively at work will not be
eligible for claim payment. You will receive a refund of
premium for any contributory insurance for which you
were not eligible.
When will we require evidence of insurability?
The specifications page describes when evidence of
insurability is required.
When does insurance become effective?
Insurance becomes effective on the date that all of the
following conditions have been met:
(1) you meet all eligibility requirements; and
(2) for contributory insurance, you apply for the
insurance in accordance with the application
methods agreed upon by the policyholder and us;
and
(3) we are satisfied with your evidence of insurability,
if we require evidence.
Can your coverage be continued during sickness,
injury, leave of absence or temporary layoff?
Yes. Insurance may be continued on an insured
employee who is not actively at work due to sickness,
injury, leave of absence or temporary layoff, subject to the
employer's practices and procedures, including the
employer's limits on the length of continuation allowed for
the type of absence. Continuation is contingent upon
continued premium payment and is subject to the
following maximum time frames:
(1) if you are on non-medical leave of absence or
temporary layoff, insurance cannot be continued
beyond 12 months from the last day you were
actively at work.
(2) if you are on a medical leave of absence,
insurance cannot be continued beyond the later of
12 months from the last day you were actively at
work or attained age 65.
Coverage during a leave of absence and upon return from
a leave of absence shall meet all state and federal
requirements. The above limits will be expanded if
necessary in order to meet such requirements.
Premiums
When and how often are your premium contributions
due?
Unless the policyholder and we have agreed to some
other premium payment procedure, any premium
contributions you are required to make for contributory
insurance are to be paid by you to the policyholder on a
regular, periodic basis. We apply premiums consecutively
to keep the insurance in force.
How is the premium determined?
The premium will be the applicable premium rate
multiplied by the number of $1,000 units of insurance in
force on the date premiums are due. The premium may
also be computed by any other method on which the
policyholder and we agree.
Exhibit A
Premium rates are subject to change according to the
provisions of the group policy.
Death Benefit
What is the amount of the death benefit?
The amount of the death benefit is equal to the amount of
insurance for which you are insured, based on the plan of
insurance applicable to your class as described on the
specifications page, and your elections.
Can you request a change in the amount of your
contributory insurance?
Yes. The specifications page describes when changes
can be requested, when evidence of insurability will be
required for such changes, and when the changes will
become effective.
When will the death benefit be payable?
We will pay the death benefit upon receipt at our home
office of written proof satisfactory to us as to both
substance and form that you died while insured under this
certificate. All payments by us are payable from our home
office. The death benefit will be paid in a single sum or by
any other method agreeable to us and the beneficiary.
To whom will we pay the death benefit?
We will pay the death benefit to the beneficiary or
beneficiaries. You name a beneficiary to receive the
death benefit to be paid at your death. You may name
one or more beneficiaries. You can change the
beneficiary designation at any time, provided all of the
following are true:
(1) your coverage is in force; and
(2) we have written consent of all irrevocable
beneficiaries; and
(3) you have not assigned the ownership of your
insurance.
A beneficiary designation must be made in writing or by
any other method made available under the plan. Any
beneficiary designation shall take effect as of the date it is
signed, but will not affect any payment we make or action
we take before receiving the designation.
You may also choose to name a beneficiary that you
cannot change without the beneficiary’s consent. This is
called an irrevocable beneficiary.
If there is more than one beneficiary, each will receive an
equal share, unless you have requested another method
in your beneficiary designation. To receive the death
benefit, a beneficiary must be living at the time of your
death. In the event a beneficiary is not living at the time of
your death, that beneficiary’s portion of the death benefit
shall be equally distributed to the remaining surviving
beneficiaries. In the event of the simultaneous deaths of
you and a beneficiary, the death benefit will be paid as if
you survived the beneficiary.
If there is no eligible beneficiary, or if you do not name
one, we will pay the death benefit to:
(1) your lawful spouse if living; otherwise
(2) your natural or legally adopted child (children) in
equal shares, if living; otherwise
(3) your parents in equal shares, if living; otherwise
(4) your estate.
Termination
When does your coverage terminate?
Your coverage ends on the earliest of the following:
(1) the date the group policy ends; or
(2) the date you no longer meet the eligibility
requirements; or
(3) the date the group policy is amended so you are
no longer eligible; or
(4) 31 days (the grace period) after the due date of
any premium contribution which is not paid; or
(5) the last day for which premium contributions have
been paid following your written request to cease
participation under this certificate.
Can your insurance be reinstated after termination?
Yes. When your coverage terminates because you are no
longer eligible, and you become eligible again within three
months after the date your coverage under this certificate
terminated, your prior coverage may be reinstated, without
evidence of insurability. If you die prior to our receipt of
your reinstatement application and the required premium,
no benefit will be paid.
When does the group policy terminate?
The policyholder may terminate the group policy by giving
us 31 days prior written notice. We reserve the right to
terminate the group policy on the earlier of the following to
occur:
(1) 31 days (the grace period) after the due date of
any premiums which are not paid; or
(2) 31 days after we provide the policyholder with
notice of our intent to terminate the group policy.
Conversion Right
What is the conversion right?
You may be able to convert this insurance to a new
individual life insurance policy if all or part of your life
insurance under the group policy terminates due to the
reasons listed below.
What is the full conversion right?
You may convert up to the full amount of terminated
insurance if termination occurs because of termination of
employment or of membership in the class or classes
eligible for coverage.
Exhibit A
What is the limited conversion right?
Limited conversion is available if, after you have been
insured for at least five years, insurance is terminated
because:
(1) the group policy is terminated; or
(2) the group policy is changed, by amendment or
otherwise, to reduce or terminate your insurance.
For a limited conversion, you may convert an amount up
to the lesser of:
(1) $10,000; and
(2) the amount of life insurance which terminated
minus any amount of group life insurance for
which you become eligible under any group policy
issued or reinstated by us or any other carrier
within 31 days of the date your insurance
terminated under the group policy.
When is conversion not available?
Neither the full conversion right nor the limited conversion
right is available if your coverage under the group policy
terminates due to failure to make, when due, required
premium contributions.
To what type of policy may you convert?
Under both the full conversion right and the limited
conversion right, you may convert your insurance to any
type of individual policy of life insurance then customarily
issued by us for purposes of conversion, except term
insurance. The individual policy will not include any
supplemental benefits, including, but not limited to, any
disability benefits or accidental death and dismemberment
benefits.
How do you convert your insurance?
You convert your insurance by applying for an individual
policy and paying the first premium within 31 days after
the date your group insurance terminates. No evidence of
insurability will be required.
How is the premium for the individual policy
determined?
The premium for the individual policy is based upon the
individual policy type, risk class, coverage amount and
your age on the date of conversion.
When is the individual policy effective?
The individual policy takes effect 31 days after the group
insurance provided under the group policy terminates.
What happens if you die within 31 days of when your
group insurance terminates?
If you die within 31 days of when your group insurance
terminates, and meet the conversion eligibility
requirements, we will pay a death benefit regardless of
whether or not an application for coverage under an
individual policy has been submitted. The death benefit
will be the amount of insurance you would have been
eligible to convert under the terms of the conversion right
section. If you have completed a conversion application,
we will pay the beneficiary designated on the conversion
application. If you have not completed a conversion
application, we will pay the beneficiary under your group
insurance coverage.
We will return any premium you paid for an individual
policy converted from this group insurance to your
beneficiary as described above. In no event will we be
liable under both the group policy and the individual policy.
Additional Information
What if your age has been misstated?
If your age has been misstated, the death benefit payable
will be that amount to which you are entitled based on
your correct age. A premium adjustment from any benefit
payable will be made so that the actual premium required
at your correct age is paid. If your correct age is such that
no benefit is payable, you will receive a refund of premium
for the period your eligibility would have ended.
Is there any cash value to this coverage?
No. This is term life insurance and it does not build cash
value.
What is the suicide limitation?
If you, whether sane or insane, commit suicide within two
years from the effective date of any contributory life
insurance, our liability with respect to that coverage will be
limited to an amount equal to the premiums paid for the
coverage.
If there has been an increase in your amount of
contributory life insurance for which you were required to
apply or for which we required evidence of insurability,
and if you die by suicide within two years of the effective
date of the increase, our liability with respect to that
increase will be limited to the premiums paid and
attributable to such increase.
Can your insurance coverage be contested?
Yes. If you die, or sustain a loss under one of your
certificate supplements, within two years of your original
effective date of coverage or increase in coverage, we will
verify the accuracy of the information provided by you
during the application process. If we discover a material
misrepresentation, your coverage will be rescinded and an
otherwise valid claim will be denied. This two year period
can be extended for fraud or as otherwise allowed by law.
Any statements you make in your application as defined
under this certificate will, in the absence of fraud, be
considered representations and not warranties. Also, any
statement you make will not be used to void your
insurance, nor defend against a claim, unless the
statement is contained in the application.
Exhibit A
Who is the owner of this coverage?
Unless assigned otherwise, you, the insured employee,
are the owner of all coverage provided under your
certificate. Only the owner has the right to exercise
ownership rights under the certificate, including but not
limited to naming or changing a beneficiary, changing the
amount of insurance, assigning any or all ownership
rights, converting coverage to an individual policy and
terminating the coverage.
Can your insurance be assigned?
Yes. However, we will not be bound by an assignment of
the certificate or of any interest in it unless it is made as a
written instrument, and you file the original instrument or a
certified copy with us at our home office, and we send you
an acknowledged copy.
We are not responsible for the validity of any assignment.
You are responsible for ensuring that the assignment is
legal in your state and that it accomplishes your intended
goals. If a claim is based on an assignment, we may
require proof of interest of the claimant. A valid
assignment will take precedence over any claim of a
beneficiary.
Can a change in ownership for a certificate be
requested?
Yes. A change in ownership is a type of assignment. All
provisions for assignments apply to ownership changes.
Is the policyholder required to maintain records?
Yes. The policyholder is required to maintain adequate
records of any information necessary for us to administer
the group policy, and shall provide access to such records
when required for us to administer the policy.
If an administrative or clerical error is made in keeping
records on or administering the insurance under the group
policy, it will not affect otherwise valid insurance. A clerical
or administrative error, however, does not continue
insurance which is otherwise stopped, make insurance
effective when it should not have been or change the
amount of insurance provided by the provisions of the
policy and no claim shall be paid on amounts put into
effect as a result of a past clerical or administrative error.
If an error causes a change in premium payment, a fair
adjustment will be made.
Will the provisions of this certificate conform with
state law?
Yes. If any provision in this certificate, or in the provisions
of the group policy, is in conflict with the laws of the state
governing the certificates or the group policy, the provision
will be deemed to be amended to conform to such laws.
What is the policy interpretation right and authority?
The following applies only when the administration of the
policy is governed by the Employee Retirement Income
Security Act (ERISA), 29 U.S.C. 1001 et seq.:
Securian Life has the exclusive right and authority, in its
sole discretion, to interpret the group policy and decide all
matters arising thereunder. Securian Life's exercise of that
authority shall be conclusive and binding on all persons
unless it can be shown that the determination was
arbitrary and capricious.
Exhibit A
Accelerated Benefits
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
Benefits received under this Accelerated Benefits
Certificate Supplement may be taxable. You should
seek assistance from a personal tax advisor prior to
requesting an accelerated payment of death benefits.
General Information
This supplement is subject to every term, condition,
exclusion, limitation, and provision of the certificate unless
otherwise expressly provided for herein.
What does this supplement provide?
This supplement provides for the accelerated payment of
either the full or a partial amount of an insured’s death
benefit provided under your certificate. If an insured has a
terminal condition as defined in this supplement, you may
request an accelerated payment of the applicable death
benefit. An accelerated payment will not include any
accidental death or dismemberment benefit payable under
an Accidental Death and Dismemberment Certificate
Supplement. You must give notice of claim while living
and while your life insurance coverage is in force to be
eligible for consideration of an accelerated benefit.
What is a terminal condition?
A terminal condition is a condition caused by sickness or
accident which directly results in a life expectancy of 12
months or less. We must be given medical evidence in
substance and in form that satisfies us that the insured
has a terminal condition. That evidence must include
certification by a physician. For purposes of this
supplement, a physician is an individual who is licensed to
practice medicine or treat illness in the state in which
treatment is received. The physician cannot be you or
your spouse, children, parents, grandparents,
grandchildren, brothers or sisters; or the spouse of any
such individuals.
Accelerated Benefit
Who may request an accelerated payment of the death
benefit?
You may request an accelerated payment of the insurance
on your life or on the life of a spouse or dependent child
insured under your certificate.
When can an accelerated benefit be requested?
An accelerated benefit can be requested any time,
provided the following conditions are met:
(1) the insurance is in force and all premiums due are
fully paid; and
(2) you have not assigned and are the sole owner of
the certificate; and
(3) the certificate does not have an irrevocable
beneficiary.
Is there a minimum or maximum death benefit eligible
for an accelerated benefit?
Yes. The minimum death benefit to be eligible for an
accelerated benefit under this supplement is $10,000.
The maximum death benefit that can be accelerated is
$1,000,000.
Is a partial accelerated benefit available?
Yes. You may choose to accelerate only a portion of an
insured’s death benefit, providing the remaining amount of
insurance is at least $25,000. This is called a partial
accelerated benefit.
You may reapply for the payment of the remaining amount
of insurance at any time. However, the total amount of the
death benefit for all accelerated benefit payments for an
insured cannot exceed $1,000,000. We may ask for
further evidence satisfactory to us in substance and in
form that the insured meets all requirements for the
accelerated benefit.
When will we pay an accelerated benefit?
We will pay an accelerated benefit upon receipt at our
home office of written proof satisfactory to us in substance
and in form that the insured meets the requirements
herein.
The accelerated benefit will be paid in a single sum or by
any other method agreeable to you and us.
To whom will we pay accelerated benefits?
We will pay the accelerated benefit to you unless you
validly assign it otherwise. If you die before we issue
payment of an accelerated benefit to you, we will pay the
life insurance benefits to your life insurance beneficiary(s).
What is the effect on the insured’s coverage of the
receipt of an accelerated benefit?
If you elect to accelerate the full amount of an insured’s
death benefit, the insured’s coverage and all other
benefits under the certificate and any certificate
supplements for that insured will end. If it is your death
benefit being accelerated, any dependent life insurance
will terminate, though it may be converted to a policy of
individual life insurance according to the conversion right
section of the certificate.
If a partial accelerated benefit is chosen, coverage will
remain in force and premiums will be reduced accordingly.
The remaining amount of insurance under the certificate
will be the full amount of insurance minus the amount of
insurance that was accelerated.
Exhibit A
Termination
When does an insured’s coverage under this
supplement terminate?
An insured’s accelerated benefits coverage terminates on
the earliest of:
(1) the date the insured is no longer insured for life
insurance under the certificate; or
(2) the date the accelerated benefits coverage is
terminated for the policyholder’s plan; or
(3) the date the group policy is terminated.
Additional Information
Is the request for an accelerated benefit voluntary?
Yes. An accelerated benefit will be made available on a
voluntary basis only. An accelerated benefit under this
supplement is not intended to cause an involuntary
reduction of the death benefit ultimately payable to the
beneficiary. Therefore, an accelerated benefit is not
available if you:
(1) are required by law to use this option to meet the
claims of creditors, whether in bankruptcy or
otherwise; or
(2) are required by a government agency to use this
option in order to apply for, obtain, or keep a
government benefit or entitlement.
Do we have the right to obtain independent medical
verification?
Yes. Although you are responsible for submitting proof
satisfactory to us that you meet the requirements for the
accelerated benefit, we do retain the right to have an
insured medically examined at our expense to verify the
insured’s medical condition. We may do this as often as
reasonably required while an accelerated benefit is being
considered or paid.
Secretary
President
Exhibit A
Accidental Death and Dismemberment
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is issued in consideration of
the required premium and is subject to every term,
condition, exclusion, limitation, and provision of the
certificate unless otherwise expressly provided for herein.
Coverage under this supplement will not be included in
any insurance issued under the conversion right section of
the certificate.
What does this supplement provide?
This supplement provides accidental death and
dismemberment coverage subject to all terms, conditions,
and exclusions herein.
Who is eligible for insurance under this supplement?
An employee who is insured under the provisions
applicable to life insurance coverage under the group
policy is eligible for insurance under this supplement. In
addition, an employee may elect coverage for his or her
spouse and/or dependent child(ren) who are insured
under the Dependents Term Life Insurance Certificate
Supplement attached to the certificate. All references to
an insured in this supplement shall include dependents.
All provisions of this supplement applicable to an “insured”
shall apply to an insured dependent.
When does insurance under this supplement become
effective?
Insurance becomes effective on the date that all of the
following conditions have been met:
(1) the insured meets all eligibility requirements; and
(2) for contributory coverage, application is made in
accordance with the application methods agreed
upon by the policyholder and us.
For an insured employee who has existing dependent
coverage inforce, any newly acquired dependent who
meets the requirements will automatically become insured
when he or she becomes eligible unless additional
premium is required for the newly eligible dependent, in
which case coverage will become effective as described
above.
If a dependent is hospitalized or confined because of
illness or disease on the date his or her insurance would
otherwise become effective, his or her effective date shall
be delayed until he or she is released from such
hospitalization or confinement. This provision shall not
apply to a newborn child. However, in no event will
insurance on a dependent be effective before the
employee’s insurance under the group policy is effective.
Accidental Death and Dismemberment
(AD&D) Benefit
What does accidental death or dismemberment by
accidental injury mean?
Accidental death and dismemberment coverage is limited
coverage. This means this coverage will provide benefits
only when your loss, death or dismemberment results,
directly and independently from all other causes, from an
accidental bodily injury which was unintended, unexpected
and unforeseen. The bodily injury must be evidenced by a
visible contusion or wound, except in the case of accidental
drowning. The bodily injury must be the sole cause of your
death or dismemberment. The injury and accidental loss,
death or dismemberment must occur while your coverage
is in force. Your loss, death or dismemberment must occur
within 180 days after the date of the accidental injury. In no
event will we pay the accidental death or dismemberment
benefit where your accident, injury, loss, death or
dismemberment is caused directly or indirectly by, results
in whole or in part from or during, or there is contribution
from, any of the following:
(1) self-inflicted injury, self-destruction, or
autoeroticism, whether sane or insane; or
(2) suicide or attempted suicide, whether sane or
insane; or
(3) your participation in, or attempt to commit, a crime,
assault, felony, or any illegal activity, regardless of
any legal proceedings thereto; or
(4) bodily or mental infirmity, illness or disease; or
(5) the use of alcohol; or
(6) the use of prescription drugs, non-prescription
drugs, illegal drugs, medications, poisons, gases,
fumes or other substances taken, absorbed,
inhaled, ingested or injected; or
(7) motor vehicle collision or accident where you are
the operator of the motor vehicle and your blood
alcohol level meets or exceeds the level at which
intoxication is defined in the state where the
collision or accident occurred, regardless of any
legal proceedings thereto; or
(8) infection, other than infection occurring
simultaneously with, and as a direct and
independent result of, the accidental injury; or
(9) medical or surgical treatment or diagnostic
procedures or any resulting complications,
including complications from medical
misadventure; or
(10) travel in or descent from any aircraft, except as a
fare-paying passenger on a regularly scheduled
commercial flight on a licensed passenger aircraft
carrier; or
(11) war or any act of war, whether declared or
undeclared.
Exhibit A
What is the amount of the accidental death and
dismemberment benefit?
The amount of the benefit shall be a percentage of the
amount of insurance shown on the specifications page.
The percentage is determined by the type of loss as
shown in the following table:
PERCENT OF
TYPE OF LOSS
AMOUNT OF INSURANCE
Life .............................................................................. 100%
Both Hands or Both Feet ............................................ 100%
Sight of Both Eyes ...................................................... 100%
Speech and Hearing in Both Ears .............................. 100%
One Hand and One Foot ............................................ 100%
One Foot and Sight of One Eye ................................. 100%
One Hand and Sight of One Eye................................ 100%
Sight of One Eye .......................................................... 50%
One Hand or One Foot ................................................. 50%
Loss of hands or feet means complete severance at or
above the wrist or ankle joints. Loss of sight, speech, or
hearing means the entire and irrecoverable loss of sight,
speech, or hearing which cannot be corrected by medical
or surgical treatment or by artificial means.
Under no circumstance will more than one payment be
made for the loss of the same limb, eye, hand, foot, sight,
speech, or hearing if one payment has already been made
for that loss.
Benefits may be paid for more than one accidental loss
but the total amount of AD&D insurance payable under
this supplement for any one accident, not including any
amount paid according to the terms of the Additional
Benefits section of this supplement, will never exceed the
full amount of an insured’s AD&D insurance.
When will the accidental death and dismemberment
benefit be payable?
We will pay the AD&D benefit upon receipt at our home
office of written proof satisfactory to us as to both
substance and form that you died or suffered
dismemberment as a result of an accidental injury. All
payments by us are payable from our home office. The
benefit will be paid in a single sum or by any other method
agreeable to us and the beneficiary.
To whom do we pay the benefit?
In the case of your accidental death, we will pay the
accidental death benefit to the person or persons entitled
to receive your death benefit under the terms of the group
policy. The benefit for other losses sustained by you will
be paid to you, if living, otherwise to your estate.
A dependent’s AD&D benefit will be paid to you, if living,
otherwise to your estate.
Additional Benefits
Unless stated otherwise, additional benefits are payable to
the same person or persons who receive the AD&D
benefits. Additional benefits are paid in addition to any
AD&D benefits described in the Accidental Death and
Dismemberment section, unless otherwise stated. All
provisions of this supplement, including but not limited to
the exclusions and requirements listed under the “What
does accidental death or dismemberment by accidental
injury mean?” section, shall apply to these additional
benefits.
Air Bag Benefit
What is the air bag benefit?
If an insured dies or suffers a covered dismemberment as a
result of a covered accident which occurs while he or she is
driving or riding in a private passenger car, we will pay an
additional AD&D benefit equal to the lesser of $10,000 or
10% of the insured’s amount of AD&D insurance.
In order to be eligible for this benefit, the following must
apply:
(1) the seat in which the insured was seated was
equipped with a properly installed airbag at the
time of the accident; and
(2) the private passenger car is equipped with
seatbelts; and
(3) a seatbelt was in proper use by the insured at the
time of the accident as certified in the official
accident report or by the investigating officer; and
(4) at the time of the accident, the driver of the private
passenger car was a licensed driver and was not
intoxicated, impaired, or under the influence of
alcohol or drugs.
Airbag means a passive restraint device in a vehicle which
inflates upon collision to protect an individual from injury or
death.
Seatbelt means a properly installed seatbelt (or child
restraint if the insured is a child), lap and shoulder restraint,
or other restraint approved by the National Highway Traffic
Safety Administration or any successor governmental
agency. A private passenger car means a validly
registered four-wheeled private passenger car or
policyholder-owned car, jeep, pickup truck or van, including
a sport utility vehicle (SUV), that is not licensed
commercially or being used for racing, or acrobatic or stunt
driving.
Seatbelt Benefit
What is the seatbelt benefit?
If an insured dies or suffers a covered dismemberment as a
result of a covered accident which occurs while he or she is
driving or riding in a private passenger car, we will pay an
additional AD&D benefit equal to the lesser of:
(1) $10,000; or
(2) 10% of the insured’s amount of AD&D insurance.
Exhibit A
In order to be eligible for this benefit, the following must
apply:
(1) the private passenger car was equipped with
seatbelts; and
(2) a seatbelt was in proper use by the insured at the
time of the accident as certified in the official
accident report or by the investigating officer; and
(3) at the time of the accident, the driver of the private
passenger car was a licensed driver and was not
intoxicated, impaired, or under the influence of
alcohol or drugs.
Termination
When does an insured’s coverage under this
supplement terminate?
An insured’s coverage ends on the earliest of:
(1) the date you are no longer covered for life
insurance under the group policy; or
(2) the insured’s 70th birthday; or
(3) for an insured dependent, the date the dependent
no longer meets the eligibility requirements; or
(4) for an insured dependent, the date the dependent
is no longer covered for life insurance under the
group policy; or
(5) 31 days (the grace period) after the due date of
any premium contribution which is not paid; or
(6) the date this supplement terminates.
When does this supplement terminate?
This supplement will terminate on the earlier of:
(1) the date requested by the policyholder to cancel
the Accidental Death and Dismemberment
coverage for its plan; or
(2) the date the group policy is terminated.
Additional Information
Can insurance under this supplement be converted to
a policy of individual insurance upon termination?
No. Coverage under this supplement will not be included in
any insurance issued under the conversion right section of
the certificate.
Secretary
President
Exhibit A
Dependents Term Life Insurance
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is issued in consideration of
the required premium and is subject to every term,
condition, exclusion, limitation, and provision of your
certificate unless otherwise expressly provided for herein.
What does this supplement provide?
This supplement provides insurance on the lives of your
eligible dependents.
What members of your family are eligible for
insurance under this supplement?
The following members of your family are eligible for
insurance under this supplement:
(1) your lawful spouse who is not legally separated
from you, your civil union partner, or your
registered domestic partner, as recognized under
the laws of the jurisdiction of celebration; and
(2) your or your spouse’s natural, legally adopted or
stepchildren who are less than 26 years old. An
adopted child includes a child legally placed for
adoption with you. Eligibility begins at live birth
(stillborn or unborn children are not eligible).
A person who is eligible as an employee or retiree under
the policy, or insured under the portability provisions, is
not eligible as a dependent. Only one person can insure
an eligible dependent child.
Any dependent who, subsequent to the effective date of
your dependents term life insurance, meets the eligibility
requirements of this supplement will become insured on
the date he or she so qualifies, provided no additional
premium is required and the dependent is not hospitalized
or confined because of illness or disease (except in the
case of a newborn). If additional premium is required, the
insurance for that dependent will be effective under the
same conditions which would apply if you were newly
becoming eligible for dependents term life insurance
under this supplement. If the dependent is hospitalized or
confined because of illness or disease on the date his or
her insurance would otherwise become effective, his or
her effective date shall be delayed until he or she is
released from such hospitalization or confinement (except
in the case of a newborn).
When will we require evidence of insurability?
The specification page describes when evidence of
insurability will be required.
When does insurance on a dependent become
effective?
Insurance on a dependent becomes effective on the date
when all of the following conditions have been met:
(1) the dependent meets all eligibility requirements;
and
(2) for contributory coverage, you apply for
dependents coverage in accordance with the
application methods agreed upon by the
policyholder and us; and
(3) we are satisfied with the dependent’s evidence of
insurability, if we require evidence.
If a dependent is hospitalized or confined because of
illness or disease on the date his or her insurance would
otherwise become effective, his or her effective date shall
be delayed until he or she is released from such
hospitalization or confinement. This does not apply to a
newborn child. However, in no event will insurance on a
dependent be effective before your insurance is effective.
Death Benefit
What is the amount of life insurance on each insured
dependent?
The amount of life insurance on each insured dependent
is shown on the specifications page.
To whom will we pay the death benefit?
The death benefit payable under this supplement will be
paid to you if living, otherwise to your estate.
Termination
When does an insured dependent’s coverage under
this supplement terminate?
An insured dependent’s coverage ends on the earliest of
the following:
(1) the date the dependent no longer meets the
eligibility requirements; or
(2) 31 days (the grace period) after the due date of
any premium contribution which is not paid; or
(3) the last day for which premium contributions have
been made following your written request that
insurance on your eligible dependents be
terminated; or
(4) the date you are no longer covered under the
group policy; or
(5) the date this supplement terminates.
When does this supplement terminate?
This supplement will terminate on the earlier of:
(1) the date requested by the policyholder to cancel
the Dependents Term Life coverage for its plan; or
(2) the date the group policy is terminated.
Exhibit A
Additional Information
What is the conversion right under this supplement?
If an insured dependent’s coverage under this supplement
terminates because he or she is no longer eligible, or
because of your death, or because of termination or
amendment of this supplement, the insurance may be
converted to a policy of individual insurance with us.
Conversion may be requested by you, an insured
dependent of legal capacity, or the insured dependent’s
guardian, if applicable. All other conditions and provisions
of the conversion right section of your certificate to which
this supplement is attached will apply.
What is the suicide limitation?
If an insured dependent, whether sane or insane, commits
suicide within two years from the effective date of any
contributory life insurance, our liability with respect to that
coverage will be limited to an amount equal to the
premiums paid for the coverage.
If there has been an increase in an insured dependent’s
amount of contributory life insurance for which you were
required to apply or for which we required evidence of
insurability, and if the dependent dies by suicide within two
years of the effective date of the increase, our liability with
respect to that increase will be limited to the premiums
paid and attributable to such increase.
The suicide exclusion does not apply to an insured child.
Does the Waiver of Premium supplement to your
certificate apply to insured dependents?
The Waiver of Premium supplement to your certificate will
not apply to disabilities for dependents covered under this
supplement.
However, if, due to your disability, your insurance is
continued in force without further payment of premiums
due to the Waiver of Premium supplement, any
dependents insurance provided by this supplement shall
also continue in force without further payment of
premiums until the dependent’s eligibility terminates or
until your insurance is no longer continued in force due to
the Waiver of Premium supplement.
This provision is not applicable if the dependent’s
insurance has been converted under the conversion right
section of this supplement, unless the converted policy is
surrendered without claim except for refund of premiums.
Secretary
President
Exhibit A
Portability
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is issued in consideration of
the required premium and is subject to every term,
condition, exclusion, limitation and provision of the
certificate unless otherwise expressly provided for herein.
What does this supplement provide?
This supplement provides for continuation of insurance if
an insured no longer meets the eligibility requirements of
the certificate, except as provided for herein.
To continue insurance, the insured must make a written
request and make the first premium payment within 31
days after insurance provided by the group policy would
otherwise terminate. Evidence of insurability will not be
required. Coverage provided by this supplement will be
effective the date we receive the completed application.
This date is considered to be the insured’s portability date
and the insured is then considered to have portability
status.
Who is eligible to continue insurance under this
supplement?
An insured employee is eligible to continue group life
insurance under the terms of this supplement if he or she
no longer meets the eligibility requirements of the
certificate due to any of the following:
(1) the employee terminates employment, including
retirement; or
(2) the employee is no longer in a class eligible for
insurance or is on a leave or layoff; or
(3) a class or group of employees insured under the
policy is no longer considered eligible and there is
no successor plan for that class or group.
Successor plan means an insurance policy or
policies provided by us or another insurer that
replaces insurance provided under this policy.
An insured will not be eligible to request coverage under
this supplement if he or she:
(1) has attained the age of 70; or
(2) has converted his or her insurance to an individual
life policy under the terms of the certificate’s
conversion right section; or
(3) is an employee and was not actively at work due
to sickness or injury on the date immediately
preceding his or her portability date; or
(4) loses eligibility due to termination of the group
policy.
Can insurance that is lost due to moving from one
eligible class to another be ported?
No, with one exception: if an employee moves from an
active class to a retiree class, he or she can port the
amount of insurance lost due to the change in class,
subject to all the provisions of this supplement.
What insurance can be continued under this
supplement?
Only contributory insurance may be continued under this
supplement. If an employee elects to continue his or her
own coverage according to the provisions of this
supplement, he or she may also elect to continue
contributory insurance for any dependent insured under
his or her certificate.
An insured may also continue coverage under all
certificate supplements which apply to his or her
contributory insurance and by which he or she was
insured immediately preceding his or her portability date,
except the Waiver of Premium Certificate Supplement,
which shall terminate upon porting.
Is there a minimum amount of insurance that can be
continued under this supplement?
Yes. The minimum amount of insurance that can be
continued on an employee’s life under this supplement is
$10,000. The minimum for dependents life is $1,000.
Is there a maximum amount of insurance that can be
continued under this supplement?
Yes. The maximum amount of insurance that can be
continued under this supplement is the amount of
insurance that was in force on the insured’s portability
date, but not more than $300,000 for an employee or
$150,000 for a spouse. However, for an insured age 65 or
older on his or her portability date, the amount will not be
more than $195,000 for an employee or $97,500 for a
spouse.
Will the amount of insurance continued under this
supplement change?
Yes. On the first day of the month following the date an
insured attains age 65, the amount of insurance on his or
her life continued under this supplement will reduce to
65% of the amount of insurance in force on the day prior
to attainment of age 65. Insurance terminates at age 70.
Can an insured request a change in the amount of
insurance continued under this supplement?
Yes. An insured may elect to reduce the amount of
insurance on his or her life, subject to the minimum
amount. The amount of insurance continued under this
supplement will never increase.
Exhibit A
How will premium contributions be paid?
Premium contributions will be paid directly to us on a
monthly, quarterly, semi-annual, or annual basis and will
be subject to an administrative charge per billing period.
We may adjust the amount of the charge, but not more
often than once per year.
Can the premium rate change?
Yes. The premium rate may increase on the portability
date. The premium rate may also increase in the future.
Can insurance continued under this supplement be
converted to a policy of individual insurance?
Yes. At any time after insurance has been continued
under the provisions of this supplement, but not beyond
31 days after coverage terminates under the provisions of
this supplement, it may be converted to a policy of
individual insurance with us. All other conditions and
provisions of the conversion right section of the certificate
to which this supplement is attached will apply. Coverage
cannot be continued under both this supplement and the
conversion privilege.
What happens if an insured again becomes eligible
under the certificate?
If an insured is continuing coverage under the terms of
this supplement, and again meets the eligibility
requirements of the certificate, the insured shall no longer
be considered to have portability status, ported coverage
will terminate and only one death benefit will be paid
under the coverage. Insurance may be continued only
under the terms of the certificate, not including this
supplement unless and until the insured no longer meets
the eligibility requirements of the certificate and again
return to portability status as provided for herein.
What happens to insurance provided under this
supplement when the group policy terminates?
Anything in the group policy notwithstanding, termination
of the group policy will not terminate life insurance then in
force for any person under the terms of this supplement.
The group policy will be deemed to remain in force solely
for the purpose of continuing such insurance, but without
further obligation of the policyholder.
Any insurance continued under the terms of this
supplement will remain in force until terminated by the
provisions of the section entitled “When will insurance
continued under this supplement terminate?”.
No individual may elect coverage under this supplement
on or after the date of termination of the group policy.
When will insurance continued under this supplement
terminate?
Insurance being continued under this supplement will
terminate on the earliest of the following:
(1) the insured’s 70th birthday; or
(2) the date the insured again meets the eligibility
requirements of the certificate, not including the
terms of this supplement; or
(3) in the case of a dependent child or a spouse who
is insured by a supplement to the employee’s
certificate, the date the employee’s coverage is no
longer being continued under this supplement or
the date the spouse or child ceases to be eligible
as defined under the terms of the certificate; or
(4) 31 days after the due date of any premium
contribution which is not made; or
(5) the date an insured requests to terminate his or
coverage being continued under this supplement.
Secretary
President
Exhibit A
Waiver of Premium
Certificate Supplement
Securian Life Insurance Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is subject to every term,
condition, exclusion, limitation, and provision of your
certificate unless otherwise expressly provided for herein.
Coverage under this supplement will not be included in
any insurance issued under the conversion right section of
your certificate.
The specifications page indicates to what insurance this
supplement applies. This supplement does not apply to
you if you have portability status.
What does this supplement provide?
This supplement provides for waiver of premium if you
become totally and permanently disabled, as defined
herein, while under age 60. Upon approval of proof of
such disability, your insurance, including all supplements
to your certificate which were in force on the date of the
onset of your disability, will be continued in force without
payment of premiums during the uninterrupted
continuance of the total and permanent disability.
What is total disability?
Total disability is a disability which occurs while your
insurance is in force and which results from an accidental
injury or an illness that continuously prevents you from
engaging in any occupation for which you are reasonably
suited by education, training, or experience on a full or
part time basis. You must be under the care of a licensed
physician. The licensed physician cannot be you or a
member of your immediate family. For purposes of this
supplement, your immediate family consists of your
spouse, children, parents, grandparents, grandchildren,
brothers and sisters, and their spouses.
What is permanent disability?
Permanent disability is a total disability which has existed
continuously for at least nine months.
Are there any limitations?
Yes. Insurance will not be continued if your disability
results from intentionally self-inflicted injury, participation
in or any attempt to commit a crime, or war or any act of
war, whether declared or undeclared.
What if you convert your group life insurance to a
policy of individual insurance prior to the approval of
your disability claim?
If your coverage has been converted in accordance with
the conversion right section of your certificate, benefits
under this supplement will apply only if the converted
policy is surrendered without claim, except for refund of
premiums. You cannot have coverage under both policies
and only one death benefit will be available.
What will be considered due proof of total and
permanent disability?
You must furnish evidence satisfactory to us as to both
substance and form that your disability:
(1) commenced while your insurance under your
certificate was in force; and
(2) meets the definition of total disability; and
(3) commenced before your 60th birthday; and
(4) was continuous for nine months or more.
We will, from time to time, also require additional proof
satisfactory to us that you continue to be totally and
permanently disabled. After you have provided at your
expense the requested claim forms and records, we may
also require that you submit to one or more medical
examinations at our expense.
If you die within one year of the date of onset of your total
disability, your beneficiary may claim benefits under this
supplement even if your premium payments were
discontinued and you had not submitted due proof
satisfactory to us of your total disability or you were
continuously disabled for less than nine months. Your
beneficiary must submit due proof satisfactory to us that
your total disability, which began before premium
payments on your behalf were discontinued and before
your 60th birthday, continued without interruption until
your death.
When must we be notified of your disability or death?
We must receive written notice at our home office of your
total disability within one year of the date of onset of such
disability. However, failure to give notice within the time
provided will not invalidate the claim if it is shown that
notice was given as soon as reasonably possible.
We must receive written notice at our home office within
one year of death that you died during a period of
continuance provided by this supplement. Proof must be
furnished that you continued to be totally disabled during
the entire period of continuance until death. If such notice
and proof are not provided within the required time frame,
there shall be no liability for any payment under this
supplement. However, failure to give notice within the time
provided will not invalidate the claim if it is shown that
notice was given as soon as reasonably possible.
What is the amount of insurance to be continued
without payment of premium under this supplement?
The amount of insurance continued without payment of
premium shall be the amount of insurance that was in
force on the date of onset of total disability.
If the group policy provides for reductions in amounts of
insurance based on age or retirement, such reductions
shall apply to your insurance while disabled.
Exhibit A
How long will insurance be continued without
payment of premium?
If you become totally and permanently disabled, insurance
will be continued, without payment of premium, until the
earliest of:
(1) your 65th birthday; or
(2) the date you retire; or
(3) the date you recover so that you are no longer
totally and permanently disabled; or
(4) the date you fail to furnish proof of continued
disability when requested or you refuse to submit
to a required medical examination.
What happens to your insurance when the waiver of
premium benefit ends?
When the benefits under this supplement end according to
the provisions of the section entitled “How long will
insurance be continued without payment of premium?,”
the following will apply:
(1) If you are then eligible for coverage under your
certificate, your insurance may be continued
under your certificate provided that premiums are
paid. The first such premium payment must be
made within 31 days of the date the waiver of
premium benefit ends.
(2) If you are no longer eligible for coverage under
your certificate, you may convert coverage to an
individual policy, as provided for under the
conversion right section of your certificate.
Your insurance will end unless, within 31 days of the date
benefits under this supplement end, premium payments
on your behalf are resumed or you apply to convert your
coverage.
Termination
When does your coverage under this supplement
terminate?
Your waiver of premium coverage terminates on the
earliest of:
(1) the date you are no longer insured for life
insurance covered by this supplement; or
(2) the date requested by the policyholder to cancel
the Waiver of Premium coverage for its plan; or
(3) the date the group policy is terminated.
Insurance being continued without further payment of
premiums in accordance with the provisions of this
supplement will not end due solely to the termination of
the Waiver of Premium coverage or of the group policy.
Secretary
President
Exhibit A
Securian Life Insurance Company • A Stock Company
400 Robert Street North • St Paul, Minnesota 55101-2098
GROUP TERM LIFE CERTIFICATE OF INSURANCE
Exhibit A
Securian Life Insurance Company • A Stock Company
400 Robert Street North • St Paul, Minnesota 55101-2098
GROUP TERM LIFE INSURANCE POLICY • NONPARTICIPATING
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
CITY OF GLENDALE
Procurement Division
5970 West Brown Street,
LIFE, AD&D INSURANCE AND COMMUTER LIFE
Suite 210
Glendale, Arizona 85302
3.
SCOPE OF WORK
It is the City’s desire to engage a community partner to provide services at city-owned facilities that
meet or exceed the following program objectives and create a focus on measuring for success.
Responses to this RFP should clearly demonstrate how the Offeror intends to accomplish and measure
successful outcomes of the program objectives.
General Services - Contractor shall:
Provide Basic and Optional Life and Accidental Death & Dismemberment (AD&D) insurance and
Commuter Life.
Our proposal includes Basic Life and AD&D, and Optional Life and AD&D. Our proposal
does not include Commuter Life.
Guarantee initial rates and contract terms at minimum effective July 1, 2024, through June 30, 2026.
Confirmed. Our proposed rates are guaranteed for three years effective July 1, 2024
Provide claims experience for actives and retirees by employee, dependent spouse, and dependent
child(ren) at minimum every six months.
By using our customized LifeBenefitsExtra site, you will be able to create claims or
underwriting reports specific to its needs by selecting criteria from the Report Builder
screen. Once the request is submitted, the report displays immediately and can be
printed or saved as a .pdf or Excel file. Additionally, subscriptions can be created to run
reports. This one time setup allows reports to be automatically emailed to you as often
as requested.
Customized claims reports can be built by sorting data for a specified time frame
by class, location, or division; by claim type (e.g. life, AD&D, or accelerated death
benefit); or coverage type (e.g. basic, optional, or dependent coverage).
Underwriting reports can provide data for a specified time frame sorted by class,
location, or division; by claim type (e.g. life, AD&D, or accelerated death benefit);
or coverage type (e.g. basic, optional, or dependent coverage).
Provide final renewal rates, costs, and underwriting projections to the City at least 180 days prior to
the contract anniversary date.
Confirmed.
Agree to provide coverage on a “no loss” basis for all participants enrolled in the current plan.
Confirmed. We waive the actively-at-work requirement at initial transition and
grandfather all coverage on a no-loss/no-gain basis as outlined in the chart below. We
also waive our standard confinement restriction for dependent life coverage for
currently insured dependents.
Status of Employee on the Effective Date
Responsible Party
Disabled and on approved waiver of premium
Incumbent Carrier
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
CITY OF GLENDALE
Procurement Division
5970 West Brown Street,
LIFE, AD&D INSURANCE AND COMMUTER LIFE
Suite 210
Glendale, Arizona 85302
Disabled and not yet approved waiver of premium
Incumbent Carrier*
Disabled and satisfying elimination period
Incumbent Carrier*
Absent due to disabling ailment
Incumbent Carrier*
Absent due to nondisabling ailment
Securian Financial
On vacation
Securian Financial
On non-medical leave of absence
Securian Financial
On excused absence (funeral, etc.)
Securian Financial
At work
Securian Financial
*Assumes that employees on approved waiver of premium on the effective date stays with the incumbent
carrier under the current waiver of premium provision. Any employees absent due to disability as of the
plan transition date may remain the liability of the incumbent carrier under the waiver of premium
provision. If the employee remains disabled and satisfies the requirements for a waiver of premium claim,
the claim should be filed with the incumbent carrier. Similarly, if the employee dies while disabled but
before satisfying the elimination period for a waiver of premium claim, the death claim should be filed
with the incumbent carrier. If the employee returns to work or otherwise does not satisfy the requirements
for approved waiver of premium (e.g. not disabled, over age), Securian Financial is responsible for the
ongoing life insurance coverage in accordance with plan provisions. In any event, either Securian
Financial or the incumbent carrier provides coverage for every insured employee.
Not include commissions in the rates submitted unless included in the carrier’s filing with the State.
Any proposal that includes payment of commissions or any other form of remuneration
shall be deemed non-responsive unless fully disclosed and approved by the City. If
commissions or fees are included in the filed rates and cannot be removed from the rates provided, the
level of commissions included in the proposed rates must be disclosed and noted.
Confirmed.
Comply with all HIPAA Privacy Rule Regulations where applicable.
HIPAA regulations specifically exclude life insurance coverages; therefore, do not affect
our group term plan. With that said, we do take our customers’ privacy very seriously and
are in full compliance with the Gramm-Leach-Bliley Act. We also employ privacy specialists
who ensure all reasonable safeguards are being taken to protect private information.
Provide all Plan Certificates and Summary Benefit Booklets, and other customized communications (i.e.
payroll stuffers, etc.) at no additional charge.
Confirmed.
Provide any professional service representatives the City requires to understand, analyze, and/or plan
for any plan changes including but not limited to general account servicing, underwriting- actuarial,
clinical, and/or operational support.
Confirmed. To ensure satisfaction in Ochs’ handling of your needs, we use multiple
approaches which have earned us 97% satisfaction rating from our clients who would
recommend Ochs to other organizations.
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
CITY OF GLENDALE
Procurement Division
5970 West Brown Street,
LIFE, AD&D INSURANCE AND COMMUTER LIFE
Suite 210
Glendale, Arizona 85302
To ensure we are meeting our client’s needs, we have several touch points throughout
the year, including:
Annual service visit from the Account Manager
Attendance at open enrollments meetings and discussions with human resources
(HR) and Benefits Department
Phone calls and email check-ins, at least 3 times during the year
Available for day-to-day assistance as needed
Annual satisfaction survey
Additionally, when requested, we provide benefit plan reviews for newly hired HR and
benefits personnel.
Maintain all pertinent claim records for up to seven (7) years including claim records, individual case
review and notes, and any member inquiry records as prudent business practice and provisions dictate.
Records are maintained for the life of the policy plus ten years.
We allow policyholders the opportunity to inspect plan administrative and claim records
and procedures any time they have a need or desire to verify information related to the
insurance plan. Please note that some claim information, as well as medical
information, is considered confidential for the individual involved and cannot be
released to the City without written permission from the individual.
The correct retention process for each type of document is regularly reviewed and
carefully determined by the legal research of an outside consultant. We do not have a
publicly available policy to provide.
Process Life and Accidental Death and Dismemberment insurance claims accurately and timely.
Confirmed.
Rates provided shall be based on current rates.
Confirmed.
Sign the Business Associate Amendment as written and attached to this proposal as Attachment 11,
attached separately.
We will be happy to review your contract/service agreement if we are selected as a
finalist. Securian Financial’s legal counsel will review and provide edits to discuss with
the City’s legal counsel. We have found that this process results in the efficient
development of a mutually agreeable contract.
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
Administration
Account Management
Account services for the plan will be provided by Ochs Inc., a Securian Company. Specializing in
employee benefit plans, Ochs has been a key part of Securian’s group life success since 1943. We
provide insurance to municipalities and school districts through an insurance pooling arrangement
branded The Municipal Pool. Ochs has been the exclusive administrator of The Municipal Pool since
its inception in 1955 and to date, there are 806 public employers with over 256,200 lives realizing the
cost advantages and financial stability of purchasing their employee life insurance programs through
The Municipal Pool.
We provide customized marketing and plan communication services at no additional charge to provide
complete support. We also provide robust tools and resources to educate employers and employees
about their benefit plans. We can also attend meetings in person. We would be happy to visit with you
and discuss your needs further when we are chosen as a finalist.
Solution highlights include:
Detailed-electronic plan summaries, forms, and handouts available in hard copy at no additional cost
Engaging-online educational videos
Informative needs calculators
Fun trinkets and raffle prizes
Benefit plan overviews ready-to-go in PowerPoint
Customized and virtual presentation including a Q&A session
Annual personalized employee benefit statements and enrollment packets available in hard copy
at no additional cost
Katie Degelmann, Senior Regional Sales Vice President, Western Region at Ochs will be
a key player in the success of the plan. Katie will be the first point of contact with your
organization, will work with you through the award process, and will initiate
implementation. Katie, a graduate of the University of Wisconsin - Eau Claire, has been
with Ochs for ten years and in the industry for 17 years.
Emily Watters, Senior Manager, Implementation & Client Success at Ochs will manage a
centralized implementation team of subject matter experts to ensure a simplified and
flexible transition process for you and will be the primary contact for the duration of the
implementation. Emily, a graduate of the University of Wisconsin - LaCrosse, has been
with Ochs and in the industry for 17 years.
Cory Claeson, Manager - Account Services at Ochs will assume account management
on an ongoing basis. Cory be involved in your implementation and afterward, will be the
primary contact for service matters and management of the plan. He will also work closely
with our team of dedicated experts from claims, technology, enrollment, and
administration to ensure that your plan runs smoothly. Cory, a graduate of the University
of Minnesota - Duluth, has been with Ochs for one year and in the industry for ten years.
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
Gao Vang, Senior Client Success Representative at Ochs will provide exemplary service
and is responsible for providing customer service support to clients and their employees
regarding group benefits, enrollment, and billing, assistance to clients during their annual
enrollment period, and day to day contact for her assigned clients. Gao, a graduate of St.
Paul College, has been with Ochs for four years and in the industry for nine years.
Value Adds
At no additional cost, our proposal includes the following services:
Ochs Resource Center is an embedded EMPLOYER benefit, at NO additional cost:
o
Unlimited answers to your HR (Human Resources), benefits law
o
Employee Training courses for Sexual Harassment Prevention, HIPAA Privacy, and
Cyber Risk Management
o
Employee Handbook and Policy Builder
o
Live and on demand webinars with HRCI credits
o
Forms, Posters, Articles, What Are You Doing Today Tool, and More
Lifestyle Benefits, a suite of self-service resources that help employees address specific issues
such as financial counseling, travel assistance, or will preparation, among other offerings. This
is available at no charge with our proposed Life Insurance coverage.
o
Legal, Financial and Grief Resources from LifeWorks by Morneau Shepell: Whether it is
creating a will or advice on a legal matter, getting a handle on financial security, or
struggling to cope with the loss of a loved one - get the professional support you need.
Resources include templates to create a will and other key legacy documents,
complimentary 30-minute face-to-face consultation with an attorney, unlimited telephone
consultation with attorneys and counselors, and much more.
o
Travel Assistance Services from RedpointWTP LLC: While traveling 100 or more miles
from home, you have access to pre-trip planning and emergency services. These include
medical relocation and medical or security evacuation, assistance replacing lost or stolen
luggage or other critical items, repatriation of mortal remains and much more.
o
Beneficiary Financial Counseling from PricewaterhouseCoopers LLP: Beneficiaries
receiving $25,000 or more will be invited to access professional guidance to help them
make sound financial decisions regarding their policy proceeds. Resources include
assessment, workbooks, newsletter, website and more. Access information is provided
with claims payment.
o
Legacy Planning Resources from Securian Financial: This website provides self-help
tools for getting a person’s affairs in order in advance as well as for dealing with the loss
of a loved one. In addition to the online tools and resources available, funeral concierge
service allows for coverage verification and direct payment to the funeral home so that
services can be provided before the insurance settlement becomes available.
Securian and Ochs understand the importance of a strong ongoing and proactive work plan to ensure
we meet your needs. We have been insuring group clients since 1917. We provide more than 21 million
people with nearly $1.2 trillion of insurance protection and have over $97.8 billion in assets under
management. Our most recent A.M. Best rating is A+ (Superior), last affirmed on 11/30/23. We have
been insuring group clients since 1917. We currently have $1.179 trillion of group life insurance in force
and $3.06 billion of group life insurance annual premium covering 10.82 million lives which includes
1,014 public sector clients with 2.7 million lives and 15 state plans with 2.1 million lives.
Customer Service
Human Resources and Payroll staff as well as plan members can reach us toll free at 800-392-7295.
We are available Monday through Friday 8 am to 4:30 pm Central Time. You can also email us at
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
ochs@ochsinc.com. You can call us at 800-392-7295 or, for claim specific questions, you can call 877-
494-8401. You will also be provided with direct contact info for your Claims Examiner. For underwriting
specific questions, call 651-665-7092. These call centers are staffed with customer service
representatives from 7 am to 7 pm Central Time. Additionally, online claims status is available to benefit
staff 24 hours a day, 7 days a week, with information updated daily. Life insurance claims are processed
in Saint Paul, Minnesota.
Additionally, we will also provide our secure online website. This technology provides benefits staff fast,
easy access to plan information and services including:
•
eClaims, our online claim submission site allows you to submit claims online. We will also accept
a faxed or attached copy of the death certificate
•
24/7 access to claims and underwriting information, updated daily
•
Ability to create customized claims and EOI reports instantly online with Report Builder
•
Plan specific forms
We establish different levels of accessibility to accommodate your organizational structure (e.g.,
different levels for the central staff and branch representatives). Information will be updated daily, and
sorting capabilities offer additional flexibility in viewing this information.
Underwriting
We use a simplified underwriting approach, with requirements tailored to the level of risk, for amounts
above the guaranteed issue limit, and coverage applied for outside an eligibility period. Our goal is to
enable most individuals to become insured while appropriately screening unacceptable risks to
minimize anti-selection.
Applicants are asked to provide their height, weight, and answer three general health questions. Our
underwriters take into consideration this information and any additional information obtained that may
include prescription history, digital medical and laboratory data reports, a report from the Medical
Information Bureau, and the amount of coverage requested in determining if more information is needed to
assess insurability. Most of the applications we receive are approved without asking for further information.
Continuity of Coverage
We waive the actively-at-work requirement at initial transition and grandfather all coverage on a no-
loss/no-gain basis as outlined in the chart below. We also waive our standard confinement restriction
for dependent life coverage for currently insured dependents.
Status of Employee on the Effective Date
Responsible Party
Disabled and on approved waiver of premium
Incumbent Carrier
Disabled and not yet approved waiver of premium
Incumbent Carrier*
Disabled and satisfying elimination period
Incumbent Carrier*
Absent due to disabling ailment
Incumbent Carrier*
Absent due to nondisabling ailment
Securian Financial
On vacation
Securian Financial
On non-medical leave of absence
Securian Financial
On excused absence (funeral, etc.)
Securian Financial
At work
Securian Financial
*Assumes that employees on approved waiver of premium on the effective date stays with the incumbent carrier under the current
waiver of premium provision. Any employees absent due to disability as of the plan transition date may remain the liability of the
incumbent carrier under the waiver of premium provision. If the employee remains disabled and satisfies the requirements for a
waiver of premium claim, the claim should be filed with the incumbent carrier. Similarly, if the employee dies while disabled but
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
before satisfying the elimination period for a waiver of premium claim, the death claim should be filed with the incumbent carrier.
If the employee returns to work or otherwise does not satisfy the requirements for approved waiver of premium (e.g. not disabled,
over age), Securian Financial is responsible for the ongoing life insurance coverage in accordance with plan provisions. In any
event, either Securian Financial or the incumbent carrier provides coverage for every insured employee.
Claims
We offer a simple claims process. Claims can be submitted online, fax, mail, or by telephone.
Our Life Claims Experience highlights include:
Cash Advance
Ability to issue a partial benefit to a beneficiary
Up to $25,000 without a death certificate or claim form
Express Assignment
Same-day funeral home assignment
Funeral home or lending agency reimbursement for final expenses
Securian works directly with the funeral home or lending agency
Fast Track
Claims $100,000 and under*
No death certificate
Expedited and high touch handling
*Under some circumstances a death certificate or other additional information may be needed.
Upon receipt of all necessary claim documents, examiners make claim payout determination within 3.92
days on average. (Statistics reflect entire group insurance business of Minnesota Life Insurance Company
and Securian Life Insurance Company.) 99% of survey clients are satisfied with our group claims process.
(Securian Financial Customer and Channel Partner Insights, Service Scorecard, December 2021.)
Reporting
By using our customized LifeBenefitsExtra site, you will be able to create claims or underwriting reports
specific to its needs by selecting criteria from the Report Builder screen. Once the request is submitted,
the report displays immediately and can be printed or saved as a .pdf or Excel file. Additionally,
subscriptions can be created to run reports. This one-time setup allows reports to be automatically
emailed to you as often as requested.
Customized claims reports can be built by sorting data for a specified time frame by class,
location, or division; by claim type (e.g. life, AD&D, or accelerated death benefit); or coverage
type (e.g. basic, optional, or dependent coverage).
Underwriting reports can provide data for a specified time frame sorted by class, location, or
division; by claim type (e.g. life, AD&D, or accelerated death benefit); or coverage type (e.g.
basic, optional, or dependent coverage).
Additional ad hoc reports can be provided as requested at no additional charge. We welcome additional
discussions regarding your reporting needs.
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
Statement of Qualifications
Securian Financial Group, Inc. is the parent company for our underwriters, Minnesota Life Insurance
Company and Securian Life Insurance Company. We are a Minnesota Corporation founded in 1880
and providing a full range of financial products for individuals and businesses including insurance,
investments, and retirement solutions. We have 2,968 employees and are in Saint Paul, Minnesota.
We provide more than 21 million people with nearly $1.2 trillion of insurance protection and have over
$97.8 billion in assets under management. Our most recent A.M. Best rating is A+ (Superior), last
affirmed on 11/30/23. We have been insuring group clients since 1917. We currently have $1.179 trillion
of group life insurance in force and $3.06 billion of group life insurance annual premium covering 10.82
million lives which includes 1,014 public sector clients with 2.7 million lives and 15 state plans with 2.1
million lives.
Securian will provide the exceptional service we are consistently known for.
Ochs will be responsible for the account services of your plan. Securian and Ochs understand the
importance of a strong ongoing and proactive work plan to ensure we meet your needs.
Exhibit A
Life and AD&D Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, affiliates of Securian Financial Group, Inc.
©2024 Ochs, Inc. All rights reserved.
Ochs, Inc.
A Securian Financial Company
Claims Process
We offer a simple claims process. Claims can be submitted online, fax, mail, or by telephone.
Our Life Claims Experience highlights include:
Cash Advance
Ability to issue a partial benefit to a beneficiary
Up to $25,000 without a death certificate or claim form
Express Assignment
Same-day funeral home assignment
Funeral home or lending agency reimbursement for final expenses
Securian works directly with the funeral home or lending agency
Fast Track
Claims $100,000 and under*
No death certificate
Expedited and high touch handling
*Under some circumstances a death certificate or other additional information may be needed.
Upon receipt of all necessary claim documents, examiners make claim payout determination within 3.92
days on average. (Statistics reflect entire group insurance business of Minnesota Life Insurance Company
and Securian Life Insurance Company.) 99% of survey clients are satisfied with our group claims process.
(Securian Financial Customer and Channel Partner Insights, Service Scorecard, December 2021.)
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
CITY OF GLENDALE
Procurement Division 5970
West Brown Street,
LIFE, AD&D INSURANCE AND COMMUTER LIFE
Suite 210
Glendale, Arizona 85302
12.
SUBMISSION CHECKLIST
This section provides an overview of the submission instructions including a checklist to aid in
the submission of complete proposals. Offerors shall complete the fillable “RESPONSE
WORKBOOK” attachment and submit as their proposal.
Vendors are strongly advised to read this section in its entirety and complete the checklist to
avoid disqualification. Please note that the City will NOT be able to consider proposals that are
submitted late or that do not follow these guidelines.
The Offeror shall bear all costs associated with submitting the proposal, including proposal
preparation, site visitation or any travel connected with submission of the proposal. The
City shall have no liability whatsoever for such costs.
Checklist for Submitting Proposal
Complete ()
Submission Requirements
OFFER SHEET (Response Workbook)
Offeror Name: Securian Life Insurance Company
Offeror Address: 400 Robert Street North St. Paul, MN 55101
1. EXPERIENCE AND QUALIFICATIONS
2. METHOD OF APPROACH
3.
INSURANCE OFFERING
3.1
Claims & Administration
3.2
Plan Design
3.3
Insurance Financials
3.4
Basic Life
3.5 Optional Life
3.6
Dependent Life
3.7
AD & D
3.8
Commuter Life
4. COST (Must be submitted in a separate electronic file) (1 question)
COMPLETED PRICING WORKBOOK
ADDENDUM RESPONSES (if applicable)
Return of Offer
Electronic copies of all "SUBMISSION REQUIREMENTS” listed above.
Pricing Workbook must be submitted separately from the rest of the
proposal.
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
LIFE, AD&D INSURANCE AND COMMUTER LIFE
ATTACHMENTS 1 THROUGH 11
CITY OF GLENDALE
Procurement Department
5970 West Brown Street,
Suite 210
Glendale, Arizona 85302
ATTACHMENT 11 – BUSINESS ASSOCIATE AGREEMENT
11th April 24
Securian Life Insurance Company
*Solicitation Number:
RFP 24-45
*
Mar. 20, 2024
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
LIFE, AD&D INSURANCE AND COMMUTER LIFE
ATTACHMENTS 1 THROUGH 11
CITY OF GLENDALE
Procurement Department
5970 West Brown Street,
Suite 210
Glendale, Arizona 85302
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
LIFE, AD&D INSURANCE AND COMMUTER LIFE
ATTACHMENTS 1 THROUGH 11
CITY OF GLENDALE
Procurement Department
5970 West Brown Street,
Suite 210
Glendale, Arizona 85302
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
LIFE, AD&D INSURANCE AND COMMUTER LIFE
ATTACHMENTS 1 THROUGH 11
CITY OF GLENDALE
Procurement Department
5970 West Brown Street,
Suite 210
Glendale, Arizona 85302
Exhibit A
City of Glendale
Solicitation Number: RFP 24-45 / 42400061
LIFE, AD&D INSURANCE AND COMMUTER LIFE
ATTACHMENTS 1 THROUGH 11
CITY OF GLENDALE
Procurement Department
5970 West Brown Street,
Suite 210
Glendale, Arizona 85302
Securian Life Insurance Company
Kyle Strese, 2nd Vice President and Actuary
Securian Life Insurance Company’s group life and AD&D products are excluded from the definition
of “health plan” under HIPAA, and therefore HIPAA is not applicable to the products or services that
are the subject of this plan. Because HIPAA regulations exclude life insurance coverages, we do not
enter into Business Associate Agreements. With that said, we take our customers’ privacy very
seriously and are in full compliance with the Gramm-Leach-Bliley Act and have privacy specialists
who assure all reasonable safeguards are being taken to protect private information.
Exhibit A