New York State Group Life Insurance Plan
Information for Management/Confidential Employees and Eligible Officers and Employees of the Legislature and Judiciary
Cost
CalculatorIf You Need Assistance | M/C Life at a Glance | Who is Eligible | Enrollment and When Coverage Begins | Coverage Options | Cost of M/C Life | Beneficiary and Assignment of Benefits | Benefits Under M/C Life | Changes in Status and Age | How to File a Claim | When Coverage Ends | Conversion Rights | Glossary
Metropolitan Life Insurance Company (MetLife), A Stock Company
Certifies that, under and subject to the terms and conditions of the Group Policy issued to the Policyholder, coverage is provided for each enrollee as defined herein.
Each eligible Employee shall become insured on the Employee’s own account and on account of each of the Employee’s eligible Dependents for the coverage described in this Certificate, on the later of May 1, 2003 and the date determined in accordance with the Regulations of the President of the Civil Service Commission.
The procedures required to enroll for an enrollee’s life insurance and accidental death and dismemberment coverage and dependent’s life insurance coverage are set forth in the section called How to Enroll.
The contributory insurance coverages described herein apply to you only if you have requested, are insured and are making the required contributions for the insurance. Dependent coverage applies only if you are eligible for, have requested and are covered for it.
The amounts of coverage available are described in the section called Coverage Options Under the M/C Life Insurance Program.
METROPOLITAN LIFE INSURANCE Company (MetLife)
Robert
H.
Benmosche
Chairman,
President
and
Chief
Executive
Officer
Policyholder:
The
State
of
New
York
Group
Policy
No.
23900-G
Notices
- This certificate is of value to you. It should be kept in a safe place. Your Beneficiary should know where the certificate is kept.
- As soon as your coverage ends, you should consult your agency Employee Benefits Administrator to find out what rights, if any, you may have to continue your protection.
- MetLife’s Home Office is located at 1 Madison Avenue, New York, New York 10010.
No agent has the authority to accept or to waive the required notice or proof of a claim; or to extend the time within which a notice or a proof must be given to MetLife.
Form G.24174
If any prior certificate or certificate rider relating to the coverage set forth herein has been given to the employee, such certificate or certificate rider is void.
The Group Policy
The insurance coverage described on the following pages is subject to the terms and conditions of the Group Policy issued to the State by MetLife.
Disclosure Statement
The insurance evidenced by this certificate provides LIFE INSURANCE and ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department.
If You Need Assistance:
Important Addresses and Telephone Numbers to Keep Your Coverage Up to Date
If you are an active employee and you want information about any aspect of the M/C Life Insurance Program or need assistance in resolving a problem, you should first contact your agency Employee Benefits Administrator. Your agency Employee Benefits Administrator can provide you with the forms that you need. If you work in a field office, contact the person from whom you receive benefits information.
If you are retired, you may write or call the State of New York Department of Civil Service. The Department of Civil Service serves as the Employee Benefits Administrator for retired enrollees in M/C Life.
To file a claim:
Call the State of New York Department of Civil Service Employee Benefits Division at (518) 473-3566
Actives
To change beneficiaries or to change your coverage:
Ask your Employee Benefits Administrator
To purchase a direct-pay conversion policy:
Ask your Employee Benefits Administrator for a form (if you have not already received one); then, look in the yellow pages for local MetLife Representatives
Retirees
To request forms, to change coverage or change beneficiaries, contact:
State of New York Department of Civil Service
Employee Benefits Division
M/C Life Insurance
Alfred E. Smith State Office Bldg.
80 South Swan Street
Albany, New York 12239
(518) 473-3566
Please include your name and Social Security number and a telephone number where you can be reached during the day on all correspondence.
M/C Life and Accidental Death and Dismemberment Coverage for Eligible Employees of New York State at a Glance
THIS
BOOK
DESCRIBES
THE
M/C
LIFE
INSURANCE
PLAN.
THIS
PLAN
IS
AVAILABLE
TO:
- Management/Confidential employees of the Executive Branch of the State of New York and Participating Employers
- Members of the State Legislature and annual employees of the Legislature
- Judges and Justices of the Unified Court System of the State of New York and non-judicial employees of the court system who have been designated Management/Confidential
- Eligible retirees
THE M/C LIFE PLAN OFFERS:
- Group Life Insurance and Accidental Death and Dismemberment Insurance for you
- Group Life Insurance for your eligible dependent(s)
- Competitive rates
- Preferred rates for non-smokers
- Convenient payroll deductions
COVERAGE OPTIONS ARE A FIXED AMOUNT OR A MULTIPLE OF PAY UP TO FIVE TIMES YOUR SALARY.
- A Life Insurance benefit maximum of $500,000
- An Accidental Death and Dismemberment maximum of $250,000
- A Common Carrier Accidental Death maximum of $250,000
- 50% of the amount of your life insurance coverage for your spouse to a maximum of $20,000
- $4,000 Life Insurance coverage for each dependent child
Retirees may continue their M/C Life Insurance coverage by:
- Staying in the program (subject to reductions at age 65 and 70) with either premium pension deductions or direct payments to the Department of Civil Service.
Who Is Eligible
This section explains eligibility requirements under the M/C Life Insurance Program which includes M/C Life Insurance and Accidental Death and Dismemberment Insurance Coverage for you (the enrollee), and, if you choose, dependent life insurance coverage for your spouse and/or your children. Only you, the enrollee, are eligible for Accidental Death and Dismemberment Insurance.
You, the enrollee
To be eligible to enroll in the M/C Life Insurance Program, you must be appointed or elected to a position in New York State government as a:
- Management/Confidential employee of the State or of a Participating Employer; or
- Member or Annual employee of the State Legislature; or
- Judge or Justice of the Unified Court System of the State or a non-judicial employee of the court system who has been designated Management/Confidential.
Your spouse and children
If you elect coverage for yourself, you may also elect life insurance coverage for your spouse only, or your children or both. The following dependents are eligible for life insurance coverage under M/C Life.
Your spouse
Your spouse, including a legally separated spouse, is eligible.
You may cover your spouse as a dependent even if your spouse is enrolled for coverage as an enrollee.
If you are divorced or your marriage has been annulled, your former spouse is not eligible to be a covered dependent under this Plan, even if a court orders you to maintain coverage. You always have the right, however, to make your former spouse the beneficiary of your life insurance coverage. See Beneficiary and Assignment of Benefits.
Your children under age 19
Your unmarried children over 14 days old but less than 19 years of age are eligible. This includes your natural children, legally adopted children and your dependent stepchildren. The signature of the natural parent is required when enrolling a stepchild as a dependent.
No dependent child may be covered by more than one employee in the M/C Life Program.
Your child age 19 or over who is a full-time student
Your unmarried dependent children age 19 or over but under age 25 are eligible if they receive more than half their support from you, are full-time students at an accredited secondary or preparatory school, college or other educational institution and are not eligible for employer group life insurance coverage. They continue to be eligible through the month in which they complete course requirements for graduation. If your child reaches age 19 during a school vacation period, coverage will continue as long as the child is enrolled in an accredited secondary or preparatory school, college or other accredited educational institution and plans to resume classes on a full-time basis at the end of the vacation period.
Disabled dependent(s) age 19 or over
Your unmarried children age 19 or over are eligible provided they are incapable of supporting themselves because of a mental or physical disability acquired before coverage would otherwise have ended.
Dependent child in the military
If your dependent child has life insurance coverage as a dependent student and served in the U.S. Military, you may deduct from your dependent’s age up to four years of full-time military service for purposes of eligibility.
Questions?
If you have any questions concerning eligibility, please contact your agency Employee Benefits Administrator.
Enrollment, Late Enrollment and When Coverage Begins
Enrollment is not automatic | When coverage begins for regular enrollment | When coverage begins for late enrollment
This section explains the date when you and your dependent(s) are eligible for coverage, and when M/C Life coverage begins.
When you first become eligible to enroll
You are eligible to enroll by signing the application:
- the first day you are actively at work (see glossary) and performing the normal duties of your job; and
- the date your class of employees is eligible for coverage under this Plan.
Enrollment is not automatic
You and your dependent(s) will not be covered automatically. If you enroll for M/C Life, you will also receive Accidental Death and Dismemberment coverage. (Only the enrollee is eligible for Accidental Death and Dismemberment coverage.)
If you enroll in M/C Life and you want to cover your eligible dependent(s) for life insurance, you must enroll for dependent coverage.
How to enroll
To enroll for coverage, contact your agency Employee Benefits Administrator.
The request for M/C Life for you and your dependent(s) must be in writing. You must complete Form PS-934 through your agency Employee Benefits Administrator. You must be actively at work on the day you enroll yourself and/or your dependent(s).
If you are on sick leave, leave without pay due to sickness or injury, a pass day, or otherwise not actively at work on the day the enrollment form is signed and dated, the enrollment date for you and your dependent(s) will be the next day you are actively at work.
How to enroll dependents
If you first acquire an eligible dependent after you have enrolled for coverage (with no dependents), dependent insurance will begin on the first day of the payroll period following the payroll period in which you enrolled the dependent if the request is signed within six biweekly payroll periods.
After you have enrolled your first dependent child, subsequent dependents who are born or adopted will be covered effective on the date the person becomes your dependent or on the 15th day after their birth, whichever comes later. It is not necessary for you to file an enrollment form or submit proof of insurability.
When coverage begins for regular enrollment: no medical information required
If you are a new hire or are newly appointed to a position designated as M/C and you enroll yourself (Life Insurance and Accidental Death and Dismemberment) and your eligible dependent(s) (Life Insurance only) within the first six biweekly payroll periods after you become eligible, coverage for you and your dependent(s) will begin on the first day of the payroll period following the payroll period in which you enroll, provided you were actively at work and performing the regular duties of your job on the date you enrolled. This will be considered a regular enrollment. Regular enrollments will not require a statement of health or a medical examination for proof of insurability.
When coverage begins for late enrollment
New
hires
or
employees
newly
designated
as
M/C
who
do
not
enroll
themselves
and
their
dependent(s)
within
the
first
six
biweekly
payroll
periods
of
their
eligibility
will
be
considered
late
enrollees.
They
will
be
required
to
submit
proof
of
insurability
which
will
include
a
Statement
of
Health
(GEF02-1 4/03 Statement of Health HTML version | PDF version(
1.48MB))
and
may
include
a
medical
exam.
In cases of late enrollment, coverage for you and your dependent(s) will become effective on the first day of the payroll period following the date MetLife approves each request for coverage, provided you are actively at work on that day. Otherwise, coverage will take effect on the first day of the payroll period after you return to work.
If MetLife does not accept the Statement of Health for you, no coverage will be available for you or any dependent. If MetLife does not accept a dependent's Statement of Health, no coverage will be available for that person.
If you want to cancel enrollment
To cancel your coverage in the M/C Life Program for you or your dependent(s), contact your agency Employee Benefits Administrator. Your or your dependents' coverage will end on the last day of the payroll period in which the form is signed.
Re-enrollment after cancellation
If your coverage or your dependent's coverage is canceled because you do not pay the required premium while you are off the payroll or because you voluntarily canceled your coverage, you may request, in writing, that you be allowed to re-enroll yourself and eligible dependent(s). Your request will be treated as a late enrollment.
Coverage Options Under the M/C Life Insurance Program
What are the options? | Automatic changes based on salary
What are the options?
When you enroll in the M/C Life Program, you will need to decide which option you want for your own coverage.
You may choose coverage for a fixed amount or for a multiple of salary.
There are important differences between the fixed-amount option and the salary-based option.
If you choose the option which is a multiple of your salary, the amount of your life insurance coverage will change each year if your annual salary changes. Changes in multiples-of-salary coverage (based on your annual salary on September 1st) will occur on the first day of the payroll period beginning on or immediately following the first day of September.
If you choose coverage at a multiple of salary, you do not need to provide evidence of insurability for any automatic increases resulting from salary increases. If you choose a fixed amount of insurance, that amount will stay the same regardless of salary.
Regardless of the option you choose, if, after your initial enrollment, you wish to change your option to a higher multiple of your salary, you must submit proof of insurability satisfactory to MetLife.
The fixed-amount and multiples-of-salary options provide different coverage amounts. Also, the option you choose for your personal coverage affects the benefits payable under the Accidental Death and Dismemberment Program and could affect your spouse's coverage.
Your age is also a factor. Beginning at age 65, decreases are automatic in multiples-of-salary coverage. Be sure to weigh your needs and choose the option that provides the most suitable coverage for you and your family.
No loan or cash values
Regardless of the option you choose, the benefits under the M/C Life Program do not at any time provide paid-up insurance, or loan or cash values.
Coverage for you
You, the enrollee, may select the amount of life insurance coverage and coverage for Accidental Death and Dismemberment Insurance that you carry on yourself from the list of options below.
You may select:
- A fixed amount of $ 5,000 or
$10,000 or
$15,000 or - An amount equal to your annual salary*, or
Two times your annual salary*, or
Three times your annual salary*, or
Four times your annual salary*,or
Five times your annual salary*
*Your annual salary is determined by your employer. If you choose the salary-based option and the amount of insurance is not an even multiple of $1,000, then it is rounded to the next higher multiple of $1,000.
Example: If you choose coverage at two times your annual salary and your current annual salary is $48,180, then two times your annual salary, $96,360, is increased to the next higher $1,000. The amount of your life insurance coverage is $97,000.
Benefit Maximums
When you select coverage at a multiple of salary, the maximum benefit will be determined from the table below:
|
Life
Insurance
|
Accidental
Death
and
Dismemberment
Insurance
|
Common
Carrier
Accidental
Death
Benefit
|
|---|---|---|
|
$500,000
|
$250,000
|
$250,000
|
Automatic changes based on salary
If you have selected coverage equal to a multiple of your salary and your salary increases or decreases or you receive additional coverage because the Benefit Maximums increase, the increase or decrease in life insurance coverage will be automatic.
Any such automatic increase or decrease in life insurance coverage will become effective on the first day of the payroll period coincident with, or next following September 1, provided you are actively at work on that date, otherwise it will take effect on the first day of the payroll period coincident with or next following your return to active work. The coverage is based on your annual salary on September 1.
Examples:
- Your salary is reduced on April 21, 2003. Your coverage will be reduced effective the first day of the payroll period beginning on or following September 1, 2003.
- Your salary is increased on September 1, 2003. Your coverage will be increased effective the first day of the payroll period beginning on or following September 1, 2003.
- Your salary is increased on September 21, 2003. Your coverage would be increased effective the first day of the payroll period beginning on or following September 1, 2004.
Automatic change for your covered spouse
When your insurance coverage changes, your spouse's insurance coverage will continue to equal 50 percent of your coverage or $20,000, whichever is less.
Dependent(s) benefits
You may select life insurance coverage for your dependent(s) from the following table:
Amount of Life Insurance Coverage
Your spouse:
$20,000 or 50 percent of your life insurance coverage, whichever is less
Each of your eligible children:
$4,000
Changes in amounts of coverage that you request
If you request an increase in life insurance coverage, you must give MetLife evidence of your good health. (Requests must be in writing.) If MetLife accepts your evidence of good health as satisfactory, the increased amount will replace your previous selection on the first day of the payroll period following the date of acceptance. If MetLife doesn't accept the evidence of your good health as satisfactory, the increase will not take place.
If you are not actively at work on the date a change in benefits would otherwise take place because of a change in your salary or your request for increased life insurance coverage, the change in benefits will take place on the first day of the payroll period following your return to active work.
If you want to decrease your life insurance coverage
If you request a decrease in your life insurance coverage, the decrease will begin on the first day of the payroll period following the date of your written request. Proof of insurability is not required.
If proof of insurance is not required
The changes will take place on the first day of the payroll period following the date on which you submit your signed application to your agency Employee Benefits Administrator.
Statements which relate to insurability
Any statement you make will be considered a true statement. If it is later discovered that you made an error, your premiums and/or benefits payable to your beneficiary may be adjusted if:
- the statement is contained in a written application you signed, and
- a copy of the application has been furnished to you or to your beneficiary, and
- the insurance coverage has been in force less than two years.
Cost of M/C Life
How you pay
Premiums are based on your age and smoking status. Rate sheets are available from your agency Employee Benefits Administrator.
Premiums will be deducted from your paycheck.
If you go on Leave Without Pay, for continued coverage while you are on leave, you must make payments directly to the Department of Civil Service. If you go on Short Term Disability or Long Term Disability, for continued coverage while you are in this status, you must make payments directly to the Department of Civil Service. If payments are not made for this period and you wish to re-enroll, you will be considered a late enrollee upon return to the payroll.
If you retire, you will receive a billing notice from the Department of Civil Service explaining how you can continue to pay your M/C Life coverage.
Rate changes
Premium rates may change on September 1 based on the overall positive or negative experience of the group.
Premium rates apply in five-year brackets. When your age increases and you move to the next bracket, your rate will go up. This rate increase will take effect on the September 1 coincident with, or next following, the birthday on which your age bracket changes.
If you are a smoker
If you have smoked cigars, cigarettes or a pipe during the 12 months preceding the effective date of your life insurance coverage, you are not eligible for the non-smoker discount.
If you do not smoke
If you have not smoked cigars, cigarettes or a pipe during the 12 months preceding the effective date of your life insurance coverage, you are eligible for a non-smoker discount.
Annual opportunity to change to non-smoker status
You may be eligible to change to non-smoker status in the future. You will become eligible for the discount on September 1 of the year following a 12-month period during which you have not smoked cigars, cigarettes or a pipe. Requests must be made in writing before September 30.
Contact your Employee Benefits Administrator to change your smoker/non-smoker status.
Part-time employees
If you are an M/C employee working part-time or on a reduced schedule and choose to enroll in M/C Life at a multiple of salary, the amount of coverage and the premium are figured on the annual full-time salary.
Waiver of premium
In certain situations, you may be entitled to have your life insurance premium waived. See Waiver of premium for Active Employees.
Keep your coverage up-to-date
Be sure your coverage is up to date so you are paying the correct premium. Should you find that you are paying an incorrect amount, i.e., your dependent child is no longer eligible, contact your agency Employee Benefits Administrator, if you are an active employee or the Department of Civil Service, if you have left the payroll.
Beneficiary and Assignment of Benefits
Your beneficiary
The "beneficiary" is the person or persons whom you choose to receive any benefit payable because of your death.
Once
you
select
the
person
or
persons
you
want
to
name
as
beneficiary,
you
must
complete
the
correct
beneficiary
form
(M/C
Life
Beneficiary
Designation
Form(861KB)) and
submit
it
to
your
agency
Employee
Benefits
Administrator.
You
may
change
the
beneficiary
at
any
time
by
filing
a
new
form.
You
do
not
need
the
consent
of
the
beneficiary
to
make
a
change.
When
the
form
changing
the
beneficiary
is
received,
the
change
will
take
effect
as
of
the
date
you
signed
it.
The
change
of
beneficiary
will
take
effect
even
if
you
are
not
alive
when
it
is
received.
A change of beneficiary will not apply if the form is received after a Life Insurance benefit has been paid by MetLife.
Be sure to keep your beneficiary designation up to date.
Benefits payable to your beneficiary
Upon your death your M/C Life Insurance Benefits will be paid to your beneficiary or beneficiaries of record when a claim is filed. Also, see If you work beyond age 65.
More than one beneficiary
If you have more than one beneficiary, they will share in the benefits equally, unless you have chosen otherwise.
Death of a beneficiary
If you have selected a beneficiary but that person dies before you do, that person's share will be divided equally among your surviving beneficiaries unless you have chosen otherwise.
No beneficiary at your death
If, at your death, you have no beneficiary, the benefits will be paid to your estate. However, MetLife may instead pay all or part of that amount to one or more of the following persons who are related to you and who survive you:
- spouse;
- children;
- parent(s);
- sibling(s).
Payment to any of the above will discharge MetLife's liability for the amount paid.
You are the beneficiary of your dependent(s) coverage
Provided you survive them, you, the employee, are the beneficiary of your spouse's and dependent children's life insurance.
If you die before your spouse or dependent child, the benefits will be paid to the deceased's estate; or MetLife may instead pay all or part of the benefits to one or more of the following persons who are related to that dependent and who survive that dependent:
- children;
- parent(s);
- sibling(s).
Payment to any of the above will discharge MetLife's liability for the amount paid.
Assigning your insurance
You may assign, as a gift, your Life Insurance and your Accidental Death and Dismemberment benefits under this Plan. If you assign the benefits, the person, persons or organization to whom you assign the benefits will, in effect, become the enrollee and will own the right to all benefits. This means that you no longer have any rights regarding your coverage and benefits and this decision cannot be reversed. If you assign your benefits to another, you give that person, persons, or organization the following rights and responsibilities:
- The responsibility to make premium payments required to keep the benefits in force under this Plan;
- The right to change the beneficiary;
- The right to obtain a conversion policy if, for example, your employment is terminated and you are no longer covered under M/C Life. See Conversion Rights for You and Your Dependents(s)
An assignment of benefits will not be valid unless it is:
- submitted on the correct form, and
- accepted in writing by MetLife and the State, and
- filed with MetLife.
You cannot reverse the assignment
Think carefully before you assign your benefits. You may want to discuss it with a lawyer or tax advisor. Once you have completed the forms and they have been accepted and filed, MetLife and the State of New York have no responsibility regarding the validity or the sufficiency of any assignment. You cannot reverse the assignment.
Example: If you assign your coverage and benefits to your spouse and you later get divorced, your former spouse, in effect, owns your life insurance.
You cannot assign your spouse's or children's life insurance benefits.
MetLife and the State of New York assume no obligation or risk regarding your choice of assignment.
Benefits Under the M/C Life Insurance Program and Accidental Death and Dismemberment Insurance Program
Life Insurance Coverage | Accidental Death and Dismemberment Coverage
Life Insurance Coverage
Benefits paid to your beneficiary if you die
If you die while you are covered under the M/C Life Insurance Program, MetLife will pay your beneficiary the amount of M/C Life benefits in effect on the date of your death.
Your beneficiary must file a claim for the payment of the M/C Life benefits. See How to File a Claim for M/C Life Benefits for information on filing claims and deadlines. Also, see Beneficiary and Assignment of Benefits for information on notifying MetLife of your beneficiary.
How the benefit will be paid
MetLife will pay your beneficiary in a lump sum or in installments.
You may arrange to have all or part of your M/C Life Insurance benefit paid under a payment option best suited to the needs of your beneficiary. If you do not specify a payment method at the time you enroll, your beneficiary may choose a settlement option.
Ask your agency Employee Benefits Administrator for details on payment options.
Accidental Death and Dismemberment Coverage
If your death is accidental
If your death is caused by an accident, as described below, the amount of life insurance coverage you have selected, plus an equal amount of Accidental Death and Dismemberment coverage up to the Benefit Maximums, is payable to the beneficiary designated for your M/C Life Insurance. See Benefit Maximums.
Benefits in case of accident
If you are injured in an accident, MetLife will pay Accidental Death and Dismemberment Benefits if:
- the accident occurs while you are covered for Accidental Death and Dismemberment Benefits; and
- that accident is the sole cause of the injury; and
- that injury is the sole cause of a Covered Loss shown below; and
- that loss occurs not more than 90 days after the date of that accident.
If you have coverage that is a multiple of your salary, your Accidental Death and Dismemberment benefit would equal the amount of your Life Insurance benefit up to the Benefit Maximums.
If your death is due to an accident, the combined maximum benefit under this Plan is the amount of Life Insurance, plus the amount of Accidental Death benefit plus the Common Carrier benefit, if the accident occurred while you were a passenger on a common carrier.
Maximum benefit for all losses in each accident
No more than the full amount will be paid for all losses caused by all injuries sustained in one accident. "Full Amount" means the maximum amount of Accidental Death and Dismemberment benefits for which you are covered at the time of the accident.
Common Carrier Benefit
If you are injured while riding in, falling from or otherwise descending from or with the conveyance; and if your accidental death occurs while traveling as a fare-paying passenger on a common carrier (bus, train, scheduled airline, etc.), the amount of the Accidental Death benefit is doubled. A common carrier includes airlines operating regularly scheduled passenger flights over established routes, but excluding all other airlines and flights.
The maximum Common Carrier benefit amount payable is equal to the amount of your Accidental Death and Dismemberment benefit.
Accidental dismemberment
If you are dismembered as the result of an accident, one-half the basic Accidental Death benefit is payable for the loss of one hand, one foot or the sight of one eye, and the full amount of the basic Accidental Death benefit is payable for any combination of these losses from any one accident.
|
Covered Losses (Subject to Exclusions)
|
Benefit Amounts
|
|---|---|
|
Life
|
Full Amount
|
|
A hand (Loss of hand means a loss by severance at or
above the wrist.)
|
One-half of the Full Amount
|
|
A foot (Loss of foot means a loss by severance at or
above the ankle joint.)
|
One-half of the Full Amount
|
|
Sight of an eye (Loss of sight means total and irrecoverable
loss of sight.)
|
One-half of the Full Amount
|
|
Any combination of the above from any one accident
|
Full Amount
|
Accidental death and dismemberment exclusions
Benefits will not be paid under Accidental Death and Dismemberment insurance (including benefits for common carrier coverage) if the loss in any way results from:
- a physical or mental illness, including diagnosis of or treatment for the illness; or
- an infection, unless it is caused by an external wound that can be seen and which was sustained in an accident; or
- suicide or attempted suicide; or
- injuring yourself on purpose; or
- a war, or a warlike action in time of peace, whether or not you are in the armed forces at the time of the loss.
Payment of benefits for losses covered by accident
If, as described above, you lose a limb, eye, etc. in an accident, benefits will be paid when MetLife receives notice and satisfactory proof of that loss. Benefits will be paid directly to you.
Written notice of a claim must be given to MetLife within 20 days after the date of the accident which caused the loss.
Medical examination while a claim is pending
While a claim is pending for dismemberment, MetLife, at its expense, will have the right to have you examined by doctors of their choice when and as often as they reasonably choose.
Proof of death
The benefit will be payable when MetLife receives notice and satisfactory proof of your death. Benefits will be paid to your beneficiary.
Autopsy
If Accidental Death benefits are claimed, MetLife, at its own expense, has the right to require an autopsy if law permits.
Types of payment
Payment of any amount of Accidental Death or Dismemberment benefits (including benefits for common carrier coverage) may be made in installments instead of one sum. You may obtain details on the payment options from your Employee Benefits Administrator.
How Changes in Status and Age Affect Your M/C Life and Accidental Death and Dismemberment Coverage
If you retire | If you work beyond Age 65 | If you become totally disabled | If you go on Leave Without Pay | If you are laid off
If you retire
When you retire you may continue M/C Life Insurance for you and your dependent(s), or you may cancel coverage under this Plan and convert to a Metropolitan individual conversion policy which is not subject to reductions. See Conversions Rights for You and Your Dependent(s).
If you retire and decide to continue coverage under this Plan, the amount of your Life Insurance coverage and your Accidental Death and Dismemberment coverage will be reduced by 35% (but to not less than $15,000) effective on the September 1 coincident with or next following your 65th birthday. Life Insurance coverage will be further reduced to $15,000 on the September 1 coincident with, or next following, your 70th birthday.
Example:
You will be 65 on September 1, 2003. Your Life and Accidental Death and Dismemberment coverage will be reduced by 35% effective September 1, 2003.
Example:
You will be 65 on April 21, 2003. Your Life and Accidental Death and Dismemberment coverage will be reduced by 35% effective September 1, 2003.
Then on the September 1 coincident with or next following your 70th birthday, your Life coverage will be reduced to $15,000.
Example:
You will be 70 on September 1, 2008. Your Life coverage will be reduced to $15,000 effective September 1, 2008.
Example:
You will be 70 on April 21, 2008. Your Life coverage will be reduced to $15,000 effective September 1, 2008.
Your spouse's coverage may be reduced when yours is. It will equal 50% of your coverage or $20,000, whichever is less.
Your Accidental Death and Dismemberment coverage will end on the September 1 coincident with, or next following, your 70th birthday.
If you have selected fixed amounts of insurance ($5,000, $10,000, $15,000) or if you have chosen to be covered at a multiple of your salary that equals $15,000 at retirement, your coverage will not be subject to a reduction.
If you work beyond age 65
If you continue to work beyond age 65 and if your life insurance is more than $15,000, the amount of coverage for you will be reduced effective on the first day of the payroll period which begins or next follows the September 1 coincident, with or next following, the day you reach ages 65, 70, 75 and 80.
On the September 1 after you reach age 65, 70, 75 or 80, your multiples of salary will be reduced as indicated in the table below. Coverage will not be reduced below $15,000. If after the reduction is applied your coverage is not an even $1,000, it will be increased to the next higher $1,000.
|
Enrollee's Age
|
Percentage of Coverage Retained
|
|---|---|
|
65 but less than 70
|
65%
|
|
70 but less than 75
|
45%
|
|
75 but less than 80
|
30%
|
|
80 and over
|
20%
|
Your premiums will be based on the reduced amount of insurance.
Example:
Mary has life insurance equal to five times her salary or $250,000, and she continues to work beyond age 65. (This example does not show possible increases in Mary's salary.) Her coverage after age 65 will be as follows:
|
Age
|
Amount
|
|---|---|
|
65 but less than 70
|
$163,000 ($162,500 increased to next even $1,000
|
|
70 but less than 75
|
$113,000 ($112,500 increased to next even $1,000)
|
|
75 but less than 80
|
$75,000
|
|
80 and over
|
$50,000
|
Note: If you work beyond age 70 and then retire, your coverage will be reduced to $15,000 and your spouse's coverage will be made to equal 50% of your coverage, $7,500.
Reductions to accidental death and disability
On the date of each reduction in life insurance coverage, the amount of your Accidental Death and Dismemberment coverage will be made to equal the reduced amount of Life coverage up to the Maximum Accidental Death and Dismemberment allowable. Accidental Death and Dismemberment Benefits will not be reduced below $15,000. If you retire, Accidental Death and Dismemberment coverage will end on the September 1 following your 70th birthday.
Dependent reductions when you reach 65
When you reach age 65, 70, 75, or 80 and your life insurance is reduced, your spouse's coverage may also be reduced. At no time can your spouse's life insurance benefit be more than 50% of your life insurance benefit.
Premiums will be reduced when coverage is reduced.
Your premiums will be based on the reduced amount of insurance.
You may purchase conversion coverage
Each time your coverage is reduced by 20 percent or more because of age, you may purchase direct-pay conversion coverage, provided you purchased conversion coverage each time it was available to you. Should your spouse's coverage be reduced 20 percent or more, your spouse may also be able to purchase direct-pay conversion coverage. The amount of coverage you may convert will be equal to or, at your option, less than the amount of the reduction. See Dependent reductions when you reach 65.
If you become totally disabled
If you have life insurance coverage and become totally disabled prior to your retirement and before your 60th birthday, and remain totally disabled for nine months or more, life insurance coverage for you, as well as coverage for any enrolled dependent(s) who remain otherwise eligible, will be continued without further cost to you until recovery or death.
Your life insurance coverage can continue provided you:
- remain totally disabled for nine months or more; and
- show proof of your disability satisfactory to MetLife; and
- complete Form MA 8015 Statement of Review for Continuance of Life Insurance to continue your life insurance coverage while totally disabled.
MetLife reserves the right to have you examined by a doctor of their choice to establish proof of your disability.
Waiver of premium for active employees
In certain situations, you may be entitled to have your life insurance premium waived for the duration of your total disability. The amount of the life insurance coverage for which premiums would be waived would be the amount of life insurance coverage you had selected, minus any reduction due to age.
To qualify for a waiver of your life insurance premium, you must meet all of the following requirements:
- you must have been totally disabled as a result of sickness or injury before your retirement and before your 60th birthday; and
- you must have been totally disabled on a continuous basis for a minimum of nine months; and
- you must have kept coverage in effect while you were off the payroll by paying the required cost of your life insurance premium.
Waiver is not automatic
A waiver of premium is not automatic. You must apply for it, and you must continue to pay your life insurance premiums until you are notified that the waiver has been granted. You will receive a refund for any overpayments.
How to apply for a waiver of premium
To apply for a waiver of premium, obtain Form MA 8015, Statement of Review for Continuance of Life Insurance Protection During Total Disability, from your agency Employee Benefits Administrator. After you, your agency Employee Benefits Administrator and your physician have filled in the required information, return the completed form to:
State of New York
Department of Civil Service
Employee Benefits Division
Alfred E. Smith State Office Bldg.
80 South Swan Street
Albany, New York 12239
You must apply during the period in which you meet the eligibility requirements for a waiver; you may not apply after you return to the payroll or vest or retire. The Employee Benefits Division will notify you whether or not your waiver has been granted.
If you are totally disabled and coverage ends
If your life insurance coverage ends and you are totally disabled and then die, benefits may be payable in certain cases. MetLife will pay benefits to your beneficiary if:
- you became totally disabled before your life insurance coverage ended; and
- you were actively at work and less than 60 years old when you became disabled; and
- you continued to be totally disabled after your life insurance coverage ended and until the date of your death, and
- your beneficiary submits the required proof to MetLife.
The proof must be submitted to MetLife within one year, and it must be submitted on the appropriate form in a manner acceptable to them. MetLife is not required to notify your beneficiary to have him/her send the proof. It is the beneficiary's responsibility to contact MetLife. If the proof cannot be provided by the beneficiary within one year, it should be submitted as soon as reasonably possible.
If you die within a year after your life insurance coverage ended and before any proof of your disability has been given, then proof that your total disability continued to the date of your death must be given to MetLife within one year of your death.
If, after your life insurance coverage ended, you purchased an individual conversion policy and you die within one year, a benefit will be paid to your beneficiary under the M/C Life policy, and the premiums for the conversion policy will be reimbursed to the beneficiary if the individual conversion policy is returned to MetLife without any claim. Under no circumstances will benefits be paid under both the conversion policy and the M/C Life policy.
If you go on Leave Without Pay
If you are temporarily removed from the payroll and placed on a Leave Without Pay, you may continue your Life Insurance, Accidental Death and Dismemberment Insurance and Dependent Life Insurance, by making payments directly to the Employee Benefits Division, Department of Civil Service.
If the required payments are not received, your life insurance coverage and coverage for your enrolled dependent(s) will end on the last day of the payroll period for which payment was last made.
If you allow your coverage to lapse when you are on Leave Without Pay, you may apply to reinstate coverage for you and your eligible dependent(s) after you return to the payroll. You will be required to complete a new application and submit evidence of insurability for each person.
If your proof of insurability is satisfactory, coverage for you and your enrolled dependent(s) will take effect on the first day of the payroll period following the date MetLife approves each person for coverage, provided you are actively at work on the date of the approval, otherwise on the first day of the payroll period following your return to work.
If evidence of your good health is not satisfactory to MetLife, you will not be covered for benefits.
If you are laid off
If you are laid off and if you retire, or are eligible to retire as a member of a retirement system administered by New York State (such as the New York State and Local Employees' Retirement System, the New York State Teachers' Retirement System, or the New York State and Local Police and Fire Retirement System) or any of its political subdivisions, you may continue your coverage under M/C Life (see If you retire) or you may convert to an individual policy offered through MetLife. See Conversion Rights for You and Your Dependent(s).
If you are laid off and are not a member of a retirement system administered by New York State or its political subdivisions, but on the date of your separation from service you met the age and service requirements of the retirement plan appropriate for you, you will have the same rights of continuation as the employees listed in the paragraph above. See Conversion Rights for You and Your Dependent(s).
If you are not eligible for retirement as a member of a retirement system administered by New York State or its political subdivision and on the date of your separation from service you do not meet the age and service requirements of the retirement plan appropriate to you, you will not be eligible to continue in the State program but may convert to a standard direct-pay policy with MetLife. See Conversion Rights for You and Your Dependent(s).
You may not convert your Accidental Death and Dismemberment Insurance.
How to File a Claim for M/C Life Benefits
If you die, what your beneficiary must do to file a claim
If you die, your beneficiary must notify your agency Employee Benefits Administrator or the Employee Benefits Division. A claim form will be forwarded promptly.
Send the completed form and a death certificate to the State of New York Department of Civil Service, Employee Benefits Division, M/C Life, Alfred E. Smith State Office Bldg., 80 South Swan Street, Albany, NY 12239.
If a dependent dies
If your dependent dies while covered under the Plan, MetLife will pay the amount of life insurance benefits in effect for that dependent on the date of that dependent's death.
How to file a claim for the death of a dependent
In the event of the death of an enrolled dependent, contact your agency Employee Benefits Administrator if you are an active employee. If you are retired at the time of the dependent's death, contact the State of New York Department of Civil Service, Employee Benefits Division, Alfred E. Smith State Office Bldg., 80 South Swan Street , Albany, NY 12239.
How to file a claim for accidental death or dismemberment
When MetLife receives written notice of a claim, they will furnish forms for filing proof of the claim. If MetLife does not furnish forms within 15 days after you give MetLife notice, you must furnish your own form of proof in writing. Proof must describe the event, the nature and the extent of the cause for which a claim is made and must be satisfactory to MetLife. Written proof of a claim must be given to MetLife not later than 90 days after the date of the loss.
If notice or proof is not given on time, the delay will not cause a claim to be denied or reduced as long as the notice or proof is given as soon as possible.
No lawsuit to obtain benefits may be started until 60 days after proof is given. No lawsuit may be started more than three years after the time proof must be given.
When Coverage Ends
If coverage for you or your dependent(s) ends
Coverage for you and your dependent(s) will end on the date:
- your employment ends or you are no longer in a class which remains eligible for M/C Life,
- the Plan is changed to reduce or end coverage for your class of employment,
- you are no longer receiving coverage under the total disability waiver provided you do not then become eligible to resume coverage under the regular provisions of this Plan.
If coverage for you or your dependent(s) ends as outlined above, coverage will end on the last day of the period for which a contribution is made.
If you do not make a payment for the cost of any coverage, that coverage will end on the last payroll period for which a payment was made, unless you are disabled and have received a waiver of premium.
Coverage for your dependent(s) will end on:
- the date you die,
- the last day of the payroll period in which the dependent no longer qualifies as a dependent.
Under certain circumstances, you and your dependent(s) will have conversion rights. At other times, only your dependent(s) will have conversion rights.
Conversion Rights for You and Your Dependent(s)
Conversion rights for you and your dependent(s)
If your life insurance coverage or the life insurance coverage of your dependent(s) under the M/C Life group plan ends, you and/or your dependent(s) will have the right to purchase an individual conversion policy from your local MetLife representative which will be issued in a form issued by MetLife (example: Whole Life or Universal Life), except term insurance, provided you do so within 31 days of the date your coverage ends. This conversion policy may be preceded by a one-year term policy with premium payable in the insurer's customary mode.
Proof that you or your dependent(s) are insurable will not be required to purchase a conversion policy. The conversion policy will not include Accidental Death and Dismemberment coverage or a total disability waiver.
A 31-day application period
Under certain circumstances, you and your dependent(s) will have conversion rights. At other times, only your dependent(s) will have conversion rights. These instances are outlined below. You or your dependent(s) must apply during the application period.
The 3l-day application period begins on:
for you and your dependent(s),
- the last day of the period for which a contribution is made or the date your employment ends, whichever is later;
- the date you are no longer in a class which remains eligible for M/C Life;
- the date the Plan is changed to reduce or end coverage for your class of employment;
- the date your or your enrolled spouse's coverage is reduced by 20% or more on or after your 65th birthday;
- the date you are no longer receiving coverage under the total disability waiver provided you do not then become eligible to resume coverage under the regular provisions of this Plan.
for your dependent(s) only,
- the date you die,
- the last day of the payroll period in which the dependent no longer qualifies as a dependent. See Who is Eligible.
If you or your dependent(s) die during the application period, a death benefit will be payable to the beneficiary regardless of whether a conversion policy was applied for. The amount of the death benefit will be the highest conversion amount that could have been applied for.
You will be given notice of the application period
In certain situations, if you have kept your agency Employee Benefits Administrator informed of changes in eligibility, you will receive written notice of the application period, and have 31 days to apply for an individual conversion policy.
If you and/or your dependent(s) are not given notice in writing of the right to obtain a conversion policy at least 15 days before or after the first day you/they are eligible to convert, you/they will have additional time in which to apply. If notice is given more than 15 days but less than 90 days after the first day you/they are eligible to convert, you/they will then have up to 45 days from the date you/they are given notice in which to apply. In no event may an individual apply later than the 90th day after the first day of the application period.
It is the responsibility of the enrollee to request conversion forms in situations other than termination, negotiating unit changes and retirement. If the enrollee does not receive notice in the above situations, he or she should ask the agency Employee Benefits Administrator for assistance.
Premium for conversion policies
The premium for your conversion policy will be based on your age and class of risk and the amount purchased. You may not purchase more conversion coverage than you had in the M/C Life program at the time your coverage ended.
Conversion limits after reductions
If you or your dependent(s) are purchasing coverage because your coverage or your dependent's coverage has been reduced, the amount purchased may not be greater than the amount of the reduction in M/C Life coverage.
Conversion limits if you become eligible for other group life insurance coverage
If you and/or your dependent(s) become eligible for life insurance coverage under any group policy within 45 days of the date your coverage under M/C Life ends or is changed so that you and/or your dependent(s) are no longer eligible, the amount of coverage under the new policy will be subtracted from the amount of the individual conversion policy.
Glossary
-
Actively
at
work
means
performing
the
normal
duties
of
your
position
at
your
employer's
place
of
business
or
at
a
location
to
which
your
employer's
business
requires
that
you
travel.
It
includes
any
day
on
which
you
are:
- on vacation; or
- on authorized leave, provided such absence is not due to sickness or injury or Leave Without Pay.
- Annual Employee of the State Legislature means an employee who is employed by the Legislature on an annual payroll as defined by Chapter 867 of the Laws of 1984 subject to regulation by the Department of Civil Service.
- Benefits means an amount paid in case of your death or dismemberment.
- Conversion Policy means a private pay contract between you and MetLife.
- Covered Person means an employee or a dependent with coverage in effect under This Plan.
- Doctor means a person licensed to practice medicine and performing services within the scope of his/her medical license.
- Leave Without Pay means an authorized absence from the payroll.
- Management/Confidential employee means the incumbent of a position determined by the State's Public Employment Relations Board (PERB) to be Management/Confidential. In the case of a Participating Employer (operating as a public authority or public benefit corporation) where PERB has not made such a determination, employees of that employer who are not represented by a recognized or certified employee organization shall be deemed to be in positions designated Management or Confidential and thus eligible for this coverage.
- Member of the State Legislature means a Senator or a member of the Assembly.
- Payroll Period means the two-week payroll interval established by the Policyholder. Normal deductions for premiums pay for the next 14 days of coverage regardless of lag or nonlag status. The date for conversion, retirement or termination is the last day for which contributions are paid.
- State means the State of New York, which is the Policyholder.
- This Plan means Group Policy number 23900-G which Metropolitan Life Insurance Company (MetLife) issued to the State of New York which provides you with life insurance coverage, accidental death and dismemberment coverage and dependent life insurance coverage. The Policyholder provides a form for your use in selecting coverage; an endorsed copy will be returned to you by the Policyholder. Keep it with this certificate.
- Total Disability or Totally Disabled means that because of a sickness or injury prior to retirement:
- You cannot do your job; and
- You cannot do any other job for which you are fit by your education, training or experience.
- You and your means the employee who is a Covered Person for life insurance coverage and accidental death and dismemberment. It does not include a dependent of the employee.