Group Life Insurance for Employees of the State of Connecticut

medical life insurance logo

Medical Life Insurance Company

(herein called we, us, our)
1220 Huron Road
Cleveland, Ohio 44115-1700

CERTIFICATE

This Plan is underwritten by Medical Life Insurance Company. The benefits and provisions of the group contract which apply to individuals covered under this Plan are described in this Booklet. These benefits and provisions are effective only if you are eligible for the coverage, become covered , and remain covered in accordance with the provisions of the group contract.

If you become covered, this Booklet will become your Certificate of Coverage and will replace and supersede any and all Certificates of Coverage issued to you by the Insurance Company under the group contract.

PLEASE READ CAREFULLY

If you have any questions, please contact the Benefits Administrator at your place of employment or write to us. We will assist you in any way we can to help you understand your benefits.
Secretary President

Group Life Insurance Plan

For Employees of the State of Connecticut

DESCRIPTION OF THE PLAN

The group life insurance plans offered by the State of Connecticut are optional benefits available to eligible employees. This booklet provides information regarding both the "basic" and "supplemental" life insurance plans.

Eligibility

Permanent employees, whether classified or unclassified, full or part-time, will be insured for the basic life insurance plan upon completion of six months of continuous service or nine hundred and fourteen (914) hours of work, whichever is greater, provided a signed enrollment card is on file in the Employee Benefits Unit of the Office of the State Comptroller. However, in the event that an employee is both disabled from a non-occupational illness or injury and away from work on the date the employee would otherwise become insured, the effective date of the insurance will be deferred until the employee returns to an active work schedule for one full day.

Employees not meeting the definition of Section 5-196(20) of the General Statutes of Connecticut, such as seasonal, temporary, intermittent or contractual employees, are ineligible for Group Life Insurance. Provisional employees may be eligible as provided by collective bargaining agreements.

In addition to the basic life insurance plan, an employee may be entitled to supplemental life insurance benefits. Eligibility for such insurance requires participation in the basic life insurance plan and either:

  1. Coverage under a collective bargaining agreement which allows for supplemental life insurance coverage; or
  2. A yearly gross compensation of $45,500 or more as an employee exempt from collective bargaining.

An eligible employee will be entitled to participate in the supplemental life insurance plan on the date the basic life insurance becomes effective or on either April 1 or October 1, whichever first follows the date of eligibility, provided they apply for such insurance and a signed enrollment card is on file in the Employee Benefits Unit of the Office of the State Comptroller. However, in the event the employee is away from work on the date the employee would have become insured, the effective date of the supplemental life insurance will be deferred until the employee returns to an active work schedule for one full day.

Increases in the amounts of supplemental insurance for a participant may be made upon their request, effective April 1 or October 1 of a calendar year provided the additional premium payment has been deducted from the employee's pay.

An employee working for more than one state agency will not be eligible for multiple coverage. The life insurance entitlement for such employee will be based upon the compensation received from the single state agency designated by the Office of the State Comptroller.

Schedule of Life Insurance

An eligible employee is entitled to a basic life insurance amount, as set forth in the "Schedule of Basic Life Insurance" (Page 10), based on the allocation of the position to the compensation schedule in force on the date of eligibility for insurance.

For the purpose of the group life insurance amount, compensation will not include overtime, longevity, shift differential, maintenance or any similar type of payment.

The employee and the State share the cost of the basic life insurance plan. Basic life insurance premium payments will be deducted from the employee's payroll check each payroll period in accordance with the "Schedule of Basic Life Insurance" (Page 10); employee deductions for those paid on any basis not shown on that schedule will be adjusted. The State will pay the balance of the cost of the insurance.

The cost of the supplemental life insurance plan is totally paid by the employee. An eligible employee may elect supplemental life insurance in $5,000 increments to a maximum of $50,000. Supplemental life insurance premium payments will be deducted accordingly from the employee's payroll check each payroll period as provided in the "Schedule of Supplemental Life Insurance" (Page 16).

Increase of Life Insurance

Any increase of basic life insurance warranted by reason of an increase in compensation will automatically become effective either April 1 or October 1, based on salary increments effective on or before those dates, and the premium payment will be adjusted accordingly and deducted from the employee's pay.

Increases in the amount of supplemental insurance may be made on either April 1 or October 1, upon employee request, and the premium payment will be adjusted accordingly and deducted from the employee's pay.

The basic and/or supplemental life insurance of a permanent employee promoted provisionally will be based on the permanent salary rate for the first six months of such promotion. If still provisional after six months of such promotion. If still provisional after six months, such employee will be granted any insurance increase warranted by the salary during the provisional appointment on the next succeeding April 1 or October 1.

Reduction of Life Insurance

In the event an employee's salary is reduced for any reason, the employee may request in writing to have the basic and supplemental life insurance reduced. Such reduction shall become effective on the first of the month next succeeding the receipt of the request by the employee's Agency Personnel/Payroll Officer. A reduction of the amount of basic and supplemental life insurance, however, shall not be required on account of a reduction in compensation.

An employee enrolled in supplemental life insurance based on exemption from collective bargaining, must discontinue such insurance upon a transfer to a position covered by collective bargaining which does not provide for supplemental insurance.

Waiver of Life Insurance

Each employee has the privilege of electing not to be insured, even though eligible for the basic and/or supplemental insurance.

An employee may decide not to participate in the basic life insurance plan, or an employee having such basic life insurance may wish to withdraw from the plan. In either case, the employee should obtain a waiver card from the Agency Personnel/Payroll Officer, which should be completed and promptly returned thereto.

Once having waived participation in the basic life insurance plan, or not enrolled in the supplemental life insurance plan when first eligible, an employee may obtain insurance only after evidence of insurability as determined by Medical Life has been provided. An "Evidence of Insurability" form signed by the employee with an enrollment card should be sent to the Agency Personnel/Payroll Officer for submission to the Employee Benefits Unit of the Office of the State Comptroller.

Leave of Absence

An employee may continue basic and supplemental life insurance during an authorized leave of absence for the reasons listed below, provided the employee continues to make premium payments during such leave:

  1. Educational purposes, military leave, non-occupational illness or injury, one year;
  2. Workers' Compensation (occupational illness or injury), duration of such leave of absence;
  3. Family Leave, in accordance with Section 5-248a of the General Statutes of Connecticut, duration of such leave of absence; or
  4. Other reasons, two months.

If an employee is on leave of absence due to illness resulting from pregnancy, the insurance may continue until she is released by her physician to return to work, but such leave will not extend beyond one year. If the employee continues on leave after such release by her physician, the continuation of the life insurance will be considered in accordance with the type of leave of absence requested.

To insure continuing coverage during a leave of absence, payment of premiums must be made in advance for the periods not covered by payroll deductions. Payments must be made for two months at a time, and submitted by the fifteenth (15th) of the month preceding the two month period to the Agency Payroll Officer.

NO BILLS WILL BE SENT. FAILURE TO MAKE PREMIUM PAYMENTS WILL CAUSE CANCELLATION OF COVERAGE.

Assuming all required payments are made during the leave of absence, an employee must resume payroll deductions immediately upon return to work in order to maintain continuity of coverage. Failure to do so will require evidence of insurability as approved by Medical Life if the employee wishes to rejoin at a later date.

If coverage is cancelled for non-payment during a leave of absence and the employee wishes to participate in the life insurance plan at a later date, evidence of insurability will be required.

Total and Permanent Disability

An employee becoming totally and permanently disabled while insured and before age sixty may apply for a waiver of premium whereby the basic life insurance would continue for the period of such disability, provided the application is approved by Medical Life. Such waiver may take effect no earlier than nine months after the onset of the qualifying disability.

To qualify, Medical Life must determine that the employee:

  1. Is unable to work at said employee's job, any other gainful job, or any reasonable job for which such employee is or may become fitted by education; training or experience;
  2. Has been permanently and totally disabled for at least nine months; and
  3. Has continued to pay monthly premiums.

An employee receiving Workers' Compensation or out of work due to a temporary disability, whether job related or not, is ineligible for the waiver of premium.

An application for a waiver of premium may be obtained by an employee from the Agency Personnel/Payroll Officer. The completed application along with proof of disability must be submitted to the Employee Benefits Unit of the Office of the State Comptroller within twelve (12) months from the employee's last day actively at work. Proof of disability will be requested periodically.

Such waiver of premium applies to the basic life insurance coverage; it is not applicable to the supplemental life insurance. The supplemental life insurance may continue, provided the waiver of premium for the basic life insurance is granted, and further provided the employee has not retired or terminated employment, and the employee continues to pay the premiums.

Should permanent and total disability cease, the employee must notify the Employee Benefits Unit of the Office of the State Comptroller.

Please note that this continuance is subject to change or termination in accordance with the terms of the group contract.

Payment of Life Insurance

The life insurance is payable in event of death from any cause at any time while insured. Payment will be made in a lump sum or installments to the beneficiary or beneficiaries designated. Beneficiaries may be changed by the employee as desired; forms for this purpose are available from the Agency Personnel/Payroll Officer. A retired employee may obtain the necessary beneficiary change form by contacting the Employee Benefits Unit of the office of the State Comptroller.

If the named beneficiary does not survive the employee, or the employee had not designated a beneficiary, Medical Life will pay the amount of insurance:

  1. to the legal spouse; if living; if not,
  2. in equal shares to the then living natural or adopted children, if any; if none,
  3. in equal shares to the father and mother, if living; if not,
  4. in equal shares to the brothers & sisters, if any; if not,
  5. to the estate.

Termination of Employment

An employee who terminates active work for any reason should contact the Employee Benefits Unit of the Office of the State Comptroller, to determine what arrangements, if any, can be made to continue the insurance in force or to exercise any rights under the group policy when insurance terminates.

Retirement

Each insured employee who retires in accordance with any retirement plan for State Employees, will be insured on a reduced basis in accordance with Section 5-257(d) of the General Statutes of Connecticut.

The amount of basic life insurance of an insured employee who retires will be reduced at retirement in accordance with (1) or (2) below depending on the number of years of service, as defined in Section 5-196(25) of the General Statutes of Connecticut:

  1. If the employee has twenty-five years or more of qualifying service, the amount of insurance will be one-half of the amount of insurance for which the employee was insured immediately prior to retirement, but the reduced amount will not be less than $7,500;
  2. If the employee has less than twenty-five years of service, the amount of insurance will be the proportionate amount that such years of service is to twenty-five years rounded off to the nearest hundred dollars of coverage, except that the amount of life insurance of an insured employee who is retired under the hazardous duty provisions of Section 5-173 of the General Statutes of Connecticut will be one-half of the amount of life insurance for which the employee was insured immediately before retirement, regardless of the number of years of service.

In no case shall a retired employee be required to contribute to the cost of any such reduced insurance.

This reduction will become effective at retirement, except that the employee may convert any amount up to the full amount of the reduction in accordance with the following section entitled "Conversion Privilege" by making application directly to Medical Life within thirty-one (31) days after date of retirement. The employee will be covered for the full amount of the policy until expiration of the 31-day conversion period.

Information concerning the conversion privilege may be obtained by contacting the Employee Benefits Unit of the Office of the State Comptroller.

An employee whose basic life insurance is being extended under the section entitled "Total and Permanent Disability" will not be subject to any reduction as a retired employee.

Conversion Privilege

If any of the employee's life insurance ceases because of termination of employment, termination of membership in the class of employees eligible, or State retirement, the amount of life insurance which ceases (or a lesser amount, if desired) may be converted to an individual life insurance policy.

If any of the amount of an employee's life insurance ceases because the group contract terminates as to such coverage or as to the employee's class, the amount that ceases, subject to $2,000 maximum, may be converted to a personal life insurance policy. However:

  1. The amount that can be converted will be less the amount of group life insurance the employee becomes eligible for within 31 days of termination; and
  2. Life insurance as to the employee must have been in force for at least five (5) consecutive years in order to convert.

The individual policy will be a policy of whole life insurance without disability or other supplementary benefits. The premiums for the individual policy will be at Medical Life's customary rate for its form and amount, and the employee's class of risk and closest age on the policy effective date.

If an employee elects to convert, that employee must immediately contact the Employee Benefits Unit of the Office of the State Comptroller.

In order to convert, written application must be received by Medical Life for an individual policy and the first premium must be paid within thirty-one (31) days after cessation of insurance for any of the above reasons. No evidence of insurability will be required. The individual policy will become effective on the day following the thirty-one (31) day period during which conversion is possible.

After an individual policy becomes effective for any person, that policy will be in exchange for all benefits and privileges under the group contract as regards the person involved and the amount that could have been converted.

For conversion privilege at retirement, refer to the section entitled "Retirement."

The insurance described in this booklet will be provided under Medical Life Insurance Company, Policy Number G16993, form ML500.

This booklet is printed for the convenience of employees to help them understand the general provisions of the policy. If there are any discrepancies between this booklet and the Master Policy, the Master Policy shall supersede.

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