Basic Life and AD&D:
The premium for your coverage is paid by you and your employer.
* All insurance benefits shall terminate upon the employee’s termination of employment.
No medical questions are required for amounts up to for first time applicants in their initial eligibility period.
Basic Life and Accidental Death &
Dismemberment
(AD&D) Benefit Summary
BOSTON MUTUAL LIFE INSURANCE COMPANY – 120 Royall Street • Canton, MA 02021 • www.bostonmutual.com
Policy Series GRTP 04/99 335-3952 3/18
32b
Designed for the Employees of
GUARANTEED ISSUE
COST OF COVERAGE
ELIGIBILITY & BENEFIT FEATURES
REDUCTIONS IN BENEFITS
Accidental Death & Dismemberment: Dismemberment benefits are payable for loss of eyesight or limbs according to the
policy provisions. An additional death benefit is paid if death is the result of a covered accident.
Portability: If you leave your employer prior to age , the coverage is portable for you, your spouse under age and all eligible
dependent children. You may elect to exercise this option in accordance with the provisions as defined by the policy. The coverage
would not include Waiver of Premium or AD&D.
Conversion: Employees have 31 days from the date of termination to convert their basic life insurance to an individual permanent
life insurance policy without evidence of insurability. The premium will be based on Boston Mutual’s usual rate for the insured’s age
on the date of conversion. Coverage will not include Waiver of Premium or AD&D.
Waiver of Premium: If you become totally disabled prior to age 60 and remain totally disabled for the period stated in the policy,
Boston Mutual will continue your insurance without any further payment of premiums subject to the provisions of the contract.
Also Included: Education Benefit, Seat Belt Benefit, and Repatriation of Remains Benefit.
ADDITIONAL FEATURES
Under the AD&D coverage, benefits are not payable for losses caused by or contributed to by: self-inflicted injuries; suicide or
attempted suicide; riot or war; diseases; ptomaine or bacterial infection; drug and/or alcohol abuse; commission of an assault or felony
by an employee; accident while serving on active duty; travel or flight in any aircraft or device which can fly above the earth’s surface
(does not apply to commercial flights); or injury which occurred before the employee was insured by this policy. All exclusion details are
stated in the master policy and certificate which may be reviewed through your benet administrator.
This information is a summary of benefits; this summary is not your certificate nor does it constitute coverage for claim. Any discrepancies
between this summary and the master policy will be resolved by the language issued in the master policy. For complete details of coverage
and availability, please refer to your certificate or contact your benefits administrator.
EXCLUSIONS
Division 1 - Class 1: All eligible active employees working a minimum of 20 hours per week
Your benefit amount does not reduce, even upon retirement.
