All eligible active employees working or more hours per week, their spouse, unmarried children ages 14 days to 19 years (25 if
a full time student), and handicapped children over the age of 19 are eligible for coverage.
Dependent cover
age is available only if the employee elects coverage. Dependents may not be insured if they are confined to a medical facility.
If the employee is not actively at work on the effective date of coverage, the insurance will become effective on the date of the employee’s return
to active employment.
The premium for your coverage is paid by you.
Issue Age pricing means that your rates (and your spouse’s if applicable) do not change with age.
After the initial rate guarantee period, the employer is subject to an annual review and possible rate changes.
Employee and spouse coverage reduces upon the attainment of age and
periodically thereafter in accordance with the following
schedule:
to % of the original benefit at age
to % of the original benefit at age
to % of the original benefit at age
Dependent children coverage terminates upon notice that all dependent children are no longer eligible. All insurance benefits shall terminate
upon the employee’s retirement or termination of employment.
see other side
No medical underwriting will be required unless you apply for coverage over the Guaranteed Issue amount, apply beyond the initial
31 day eligibility period, or have been previously declined coverage by Boston Mutual.
Guaranteed Issue Amounts
AGE EMPLOYEE SPOUSE
All life insurance coverage for dependent children is guaranteed issue if applied for during the initial 31 day eligibility period.
, sold in increments of
, sold in increments of
. Coverage cannot exceed times base annual salary.
. Coverage cannot exceed % of employee coverage
Employ
ee coverage maximum of
Spouse coverage maximum of
amount elected.
Child coverage: Age 14 days to 1 year:
Age 1 to 19 years: (age 25 for full-time students)
A spouse or child who is also an employee cannot be insured as a dependent. If both spouses are insured as employees of the same group, their
children can be insured as dependents of one spouse only.
Voluntary Term Life and Accidental Death &
Dismemberment Benefit Summary
(Issue Age Pricing)
BOSTON MUTUAL LIFE INSURANCE COMPANY – 120 Royall Street • Canton, MA 02021 • www.bostonmutual.com
Policy Series GRTP 04/99 335-3946 3/18
32b
Designed for the Employees of
GUARANTEED ISSUE
COST OF COVERAGE
ELIGIBILITY & BENEFIT FEATURES
REDUCTIONS IN BENEFITS
