Group Universal Life
Summary Plan Description
12/2014 GUL ii
Table of Contents
Introduction ... 1
For Help and Information ... 2
Eligibility and Enrollment ... 3
Eligibility ... 3
Enrollment ... 3
Designating a Beneficiary ... 4
Coverage Options Available ... 5
Automatic Increase Option ... 6
Changing Your Benefits and Options... 6
Terminating Your Participation ... 6
Cost of Coverage ... 7
The Fund ... 7
Waiver of Premium ... 7
Claims and Benefit Payment ... 8
Legal Proceedings ... 8
When Coverage Ends ... 9
When Employee Coverage Ends ... 9
Conversion Options... 9
Continuation of Coverage ... 10
During Illness or Injury ... 10
During a Leave of Absence ... 10
General Information ... 11
Your Rights as a Plan Participant ... 11
Plan Documents ... 11
Discretionary Authority of Plan Administrator and Claims Administrator ... 11
No Guarantee of Employment ... 11
Future of the Plan and Plan Amendment ... 12
Plan Administration ... 13
12/2014 1 GUL
INTRODUCTION
The welfare benefit described in this summary is offered to the employees of
California Resources Corporation or an affiliated company, as defined in the section
Eligibility and Enrollment. This supplement, along with the Group Insurance
Certificate booklet (Booklet) provided by The Prudential Insurance Company of
America (Prudential) or a successor carrier is your Summary Plan Description (SPD).
You should keep and refer to it when you have questions about your Group Universal
Life Plan (Plan). In the event that there is a discrepancy between the SPD and the
Plan document, the Plan document will control. Any capitalized term not defined in
the Glossary of this summary has the meaning ascribed to it in the Booklet that
follows.
The Plan gives you the opportunity to purchase Group Universal Life (GUL) insurance
protection for you and your Spouse and can provide added financial security through
the optional accumulation of personal savings that can grow on a tax-free basis. You
also may purchase a term life insurance rider on the lives of your Dependents.
Unlike CRC’s Basic Life Insurance Plan, GUL participation is voluntary. You pay the
entire cost for your coverage by enrolling in the Plan and authorizing payroll
deductions for your elected coverage amounts. Prudential administers the Plan and
handles all transactions regarding your policy(ies).
Refer to subsequent issues of California Resources Corporation benefits newsletters
on MyInfo at
https://MyInfo.crc.com
for any material changes to the Plan made after
12/2014 GUL 2
FOR HELP AND INFORMATION
Contact Information
Provider: Address: Phone/Email:
Prudential Customer Service
P.O. Box 8769 Philadelphia , PA 19176-8769 Website: www.prudential.com/CRC 800-562-9874 TTD:800-496-1214
CRC Benefits Website: MyInfo.crc.com Email: [email protected]
The Prudential secure website was designed to provide detailed information and
tools in order to:
View available benefit options,
Provide you with rate information,
Use calculators to determine your insurance needs, and
Provide an online beneficiary designation option.
If you have any questions, Prudential customer service representatives are available
Monday through Friday, 5 a.m. to 5 p.m., Pacific Time).
Process your coverage and option change requests,
Make arrangements for continuing your GUL coverage when you leave CRC,
Assist beneficiaries with filing GUL death claims, and
Answer any questions about your GUL benefits.
12/2014 GUL 3
ELIGIBILITY AND ENROLLMENT
Eligibility
You are eligible to participate in the GUL Plan if you are a regular, full-time,
nonbargaining hourly or salaried employee of California Resources Corporation or an
affiliated company (CRC). For this purpose, “affiliated company” means any company
in which 80 percent or more of the equity interest is owned by California Resources
Corporation. Temporary employees and employees of Tidelands Oil Production
Company are not eligible to participate. You are considered a full-time employee
under the Plan if you regularly are scheduled to work at least 30 hours per week.
Generally, you are eligible to participate if you are paid on a U.S. dollar payroll, are
designated as eligible to participate by your employer, and do not participate in a
similar type of employer-sponsored plan. If you are part of a collective bargaining
group, you are eligible to participate in the GUL Plan only if your negotiated
bargaining agreement specifically provides for your participation.
If you and your Spouse are both employees of CRC, you may not be covered as both
an employee and a Spouse under this Plan and only one of you may cover your
Dependent children.
Enrollment
To enroll, you may complete an online application via the Prudential website
(
www.prudential.com/CRC
). The online application is how you will elect:
types of coverage (yourself, spouse, children),
the multiples of amounts (as applicable),
whether you want to contribute to a Fund,
certain other coverage features, and
your beneficiary(ies).
To enroll your Spouse for coverage, he or she must be under age 70 and not
Disabled.
GUL coverage will be effective for you and/or your Spouse upon submission and
approval by Prudential of a completed application, provided that you enroll within 31
days of when you are first eligible to participate. If you waive participation in the Plan
and choose to enroll at a later date, you and/or your Spouse will be required to
provide evidence of insurability.
You may purchase a term life insurance rider for your Dependents when you enroll in
the GUL Plan, as described above. Once you have elected the rider, any new
12/2014 GUL 4
your Dependents are no longer eligible, you must notify Prudential to remove the
rider from your policy. See Additional Provisions for Dependents Term Life Coverage
in the attached Prudential Booklet for information regarding conversion options.
On the coverage effective date, you must be actively at work in order to be eligible. If
you or any family member is not performing normal daily activities on the effective
date and/or is confined to any medical facility on that date, the individual’s effective
date will be delayed until the individual ceases to be confined and/or resumes
normal activities.
DESIGNATING A BENEFICIARY
Prudential maintains the beneficiary information for the GUL Plan. Upon enrollment,
you and your Spouse (if participating) will be asked to designate a beneficiary(ies).
You may name anyone as your beneficiary(ies), and you may update your beneficiary
designation at any time through the
Prudential
secure website. You may also contact
the Prudential Customer Service Center for the beneficiary designation form.
You should keep your beneficiary designation current so that if your circumstances
change (for example, marriage, divorce or birth of a child), you will have a current
beneficiary designation on file with Prudential.
Under the Plan, you may designate two types of beneficiaries:
Primary Beneficiary: An individual or trust you name to receive your basic life
insurance benefit in the event of your death.
Contingent Beneficiary: An individual or trust you name to receive your benefit
in the event of your death if all of your designated primary beneficiaries die
before you.
12/2014 GUL 5
COVERAGE OPTIONS AVAILABLE
Coverage is available for:
- Employee Only
- Employee and Dependent(s)
- Spouse Only
- Spouse and Dependent(s)
- Employee and Spouse
- Employee, Spouse and Dependent(s)
Coverage options for employees are based on multiples of Base Earnings rounded up
to the next $5,000, with a minimum of $10,000 and a maximum of $2,000,000.
During the first 31 days after becoming eligible, you may purchase Guaranteed Issue
coverage of one-half, one, or two times your Earnings, to a maximum of $500,000,
without providing evidence of insurability. If you elect coverage of three or four times
your Earnings or an amount over $500,000, evidence of insurability will be required.
You also may purchase coverage for your Spouse of $10,000 or $25,000 without
providing evidence of insurability. If you elect to purchase additional Spouse
coverage, evidence of insurability will be required.
If you elect coverage in excess of the Guaranteed Issue or apply for coverage beyond
31 days after becoming eligible, any necessary forms will be forwarded to you. A
health examination may be necessary, at your own expense. You will be contacted
directly by Prudential with the results of the underwriting evaluation. If the additional
coverage is denied, the Guaranteed Issue will not be affected.
Group Universal Life Coverage Options
Employee
(Salary Multiple)
Spouse
Child
Guaranteed Issue
½, 1 or 2 times
Base Earnings,
up to $500,000
coverage
$10,000 or
$25,000
$10,000
Evidence of
insurability required
3, 4, 5, or 6 times
Base Earnings, and
12/2014 GUL 6
Automatic Increase Option
The insurance coverage on your life and your premiums will automatically increase
without medical evidence on any date to reflect any increase in your salary, not to
exceed $2,000,000, unless you decline this “Automatic Increase Option” in writing.
The new coverage amount will be based on your elected salary multiple and rounded
up to the next $5,000.
Changing Your Benefits and Options
You or your Spouse may request to enroll, change your current salary multiple, or
increase or decrease coverage at any time, but evidence of insurability may be
required.
If you experience a Life Event, you can choose to elect or increase your GUL coverage
by one times your Base Earnings, within 31 days of the event, without providing
evidence of insurability. Refer to Increases and Decreases in the Schedule of
Benefits section of the attached booklet for more additional details.
Terminating Your Participation
12/2014 GUL 7
COST OF COVERAGE
Premiums for you and your Spouse are based on your age(s) and the amount of
insurance selected. Current GUL premium rates are available online at
Prudential
or
MyInfo
. The child life insurance rider of $10,000 per child is available for a single
monthly premium of one dollar ($1), regardless of how many Dependents are
covered. Once you enroll, premiums are paid through after-tax payroll deductions at
the end of the month for that month’s coverage.
Prudential has the right to change premium rates for insurance coverage. Any such
change will be disclosed to participants in advance of the effective date of the
change.
The Fund
In addition to making contributions for life insurance benefits, you are eligible to
make contributions to your or your Spouse’s Fund.
To obtain additional information, refer to The Fund in the Universal Life Coverage
section of the attached Prudential booklet.
Waiver of Premium
12/2014 GUL 8
CLAIMS AND BENEFIT PAYMENT
All claims should be reported promptly. In the event of your death, your designated
beneficiary should contact your human resources representative or email
CRC
Benefits
. Your human resources representative will assist your beneficiary in
completing the necessary claim forms and inform your beneficiary of any information,
such as a certified copy of the death certificate that may be required.
See the attached booklet for more information regarding claim payment and the
Accelerated Death Benefit feature of the GUL insurance benefit.
Payment of Benefits
The amount of any death benefit is equal to the face amount of life insurance plus
the amount in the insured person’s Fund, less the amount of any outstanding loan
balance remaining at the time of payment.
See the attached for additional information regarding claim procedures under the
Plan and appeals of adverse benefit determination.
Legal Proceedings
12/2014 GUL 9
WHEN COVERAGE ENDS
When Employee Coverage Ends
Your GUL insurance will end at the first to occur of the following:
Your employment terminates;
The date ending the period for which your last contribution is made; or
The coverage described in this Summary Plan Description is terminated
under the group contract.
Conversion Options
In the event that you decide you no longer need your GUL coverage or you are no
longer eligible for coverage under the Plan, you have a conversion privilege or may be
eligible to purchase paid-up life insurance, as described in the Universal Life
12/2014 GUL 10
CONTINUATION OF COVERAGE
During Illness or Injury
If you are unable to work because of illness or injury, your GUL coverage will continue
while you are eligible to receive benefits under CRC’s Short-Term Disability (STD)
Plan, provided you continue to make the required payroll contributions. If you remain
disabled beyond your STD period, you may ‘port’, or convert, your coverage by making
contributions directly to Prudential, as described in the Universal Life Coverage
portion of the attached booklet.
During a Leave of Absence
In some situations, you may continue some or all of your benefits after your coverage
normally would end. Following is a summary of two of those situations—the Family
and Medical Leave Act of 1993 (FMLA) and the Uniformed Services Employment and
Reemployment Rights Act of 1994 (USERRA).
If you are on an approved leave of absence under FMLA or USERRA, you have several
options regarding your Plan participation. You can elect to:
Continue your monthly payroll contributions, if you are on a paid leave of
absence;
Make premium payments directly to the payroll department to be applied to your
coverage, if your leave is unpaid;
Defer premium payment until your return to work; or
Discontinue your GUL policy upon notification to Prudential.
Please notify your human resources representative or email
CRC Benefits
of your
choice in order to keep your benefit coverage up-to-date. If you defer your
12/2014 GUL 11
GENERAL INFORMATION
Your Rights as a Plan Participant
As a participant in this Plan, you are entitled to certain rights and protections under
the Employee Retirement Income Security Act of 1974 (ERISA). A description of
these rights is in the Additional Information section of the attached booklet.
Plan Documents
This benefit plan description summarizes the main features of the Plan, and is not
intended to amend, modify, or expand the Plan provisions. In all cases, the provisions
of the Plan document and any applicable contracts control the administration and
operation of the Plan. If a conflict exists between a statement in this summary and
the provisions of the Plan document or any applicable contracts, the Plan document
will govern.
Discretionary Authority of Plan Administrator and Claims Administrator
In accordance with sections 402 and 503 of Title I of ERISA, the Plan sponsor has
designated a Named Fiduciary under the Plan, who has complete authority to review
all denied claims for benefits under the Plan. The Plan Administrator has
discretionary authority to determine who is eligible for coverage under the Plan and
the Claims Administrator has discretionary authority to determine eligibility for
benefits under the Plan. In exercising its fiduciary responsibilities, the Named
Fiduciary shall have discretionary authority to determine whether and to what extent
covered Plan participants are eligible for benefits, and to construe disputed or
doubtful Plan terms. The Named Fiduciary shall be deemed to have properly
exercised such authority unless it has abused its discretion hereunder by acting
arbitrarily and capriciously.
No Guarantee of Employment
12/2014 GUL 12
Future of the Plan and Plan Amendment
12/2014 GUL 13
Plan Administration
The additional information in this section is provided to you in accordance with the
Employee Retirement Income Security Act of 1974 (ERISA) regarding the GUL Plan
and the persons who have assumed responsibility for its operation.
Plan Name
California Resources Corporation
Group Universal Life Plan
Employer Identification Number
46-5676989
Plan Number
507
Plan Administrative Services
CRC Services, LLC
Provided by
10889 Wilshire Boulevard
Los Angeles, California 90024
888-848-4754
Plan Administrator
California Resources
Employee Benefits Committee
Plan Sponsor and
CRC Services, LLC
Address for Legal Process
10889 Wilshire Boulevard
for the Plan
Los Angeles, California 90024
888-848-4754
Claims Administrator and
The Plan is insured and claims are paid by:Address for Legal Process
Prudential Insurance Company of
for the Policy
America
751 Broad Street
Newark, New Jersey 07102
Named Fiduciary
Prudential Insurance Company of America
Plan Year Ends
December 31
12/2014 GUL 14
GLOSSARY
Following are definitions of the capitalized terms and phrases used throughout this
supplement that are not defined in the attached Booklet.
Fund
An interest earning account to which any contributions above the cost of your life
insurance are deposited automatically and from which loans and withdrawals may be
made.
Dependent
Your eligible dependents are your children from live birth to age 26. Your eligible
dependents may include your natural children, lawfully adopted children and children
placed with you for adoption, and each of your stepchildren, Domestic Partner’s
children and foster children. The term dependent does not include anyone who is
eligible for coverage as an employee of CRC. A covered dependent may be eligible
beyond the age limit, if he or she is primarily supported by the employee and
incapable of self-sustaining employment because of a mental or physical handicap.
Guaranteed Issue
The amount of insurance available to you for which you are not required to provide
evidence of insurability when you enroll within 31 days of eligibility.
Plan
“Plan” means the California Resources Corporation Group Universal Life Plan, and as
used in this Summary Plan Description, unless the context otherwise plainly requires,
“Plan” further means the group universal life insurance benefits described here.
Also, in this Summary Plan Description, “Plan” is used interchangeably with “GUL
Plan.”
Spouse
A spouse is the employee’s legal spouse and does not include a spouse who is legally
separated from the employee. Spouse does not include any person who is eligible
for insurance under the policy as an employee of the employer.
California Resources
Corporation
Disclosure Notice
FOR ARKANSAS RESIDENTS
Prudential’s Customer Service Office:
The Prudential Insurance Company of America P.O. Box 8769
Philadelphia, PA 19176-8769 1-800-562-9874
If Prudential fails to provide you with reasonable and adequate service, you may contact: Arkansas Insurance Department
Consumer Services Division 1200 West Third Street
Little Rock, Arkansas 72201-1904 1-800-852-5494
FOR FLORIDA RESIDENTS
The benefits of the policy providing your coverage are governed by the law of a state other than Florida.
FOR INDIANA RESIDENTS
Questions regarding your policy or coverage should be directed to: The Prudential Insurance Company of America
(800) 524-0542
If you (a) need the assistance of the governmental agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or e-mail:
State of Indiana Department of Insurance Consumer Services Division
311 West Washington Street, Suite 300 Indianapolis, Indiana 46204
FOR MARYLAND RESIDENTS
96945
CCT 1001 (S-1)
1
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
Group Insurance Certificate
Prudential certifies that insurance is provided according to the Group Contract for each insured Employee. Your Schedule of Benefits shows the Contract Holder, the Included Employer and the Group Contract Number.
Insured Employee: You are eligible to become insured under the Group Contract if: (1) you are in the Covered Classes of the Certificate’s Schedule of Benefits; and (2) you meet the requirements in the Certificate’s Who Is Eligible section.
The When You Become Insured section of the Certificate states how and when you may become insured for the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage. Your insurance will end when the rules in the When Your Insurance Ends section so provide.
Beneficiary for Employee Death Benefits: See the Certificate’s Beneficiary Rules.
Coverage and Amounts: The Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, and the amounts of insurance are described in the Certificate.
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CTC 1001 (51849-5)
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Table of Contents
GROUP INSURANCE CERTIFICATE ... 1
SCHEDULE OF BENEFITS ... 3
TABLE OF MAXIMUM RATES ... 8
TABLE OF CORRIDOR PERCENTAGES ... 9
TABLE OF NET SINGLE PREMIUMS ... 10
WHO IS ELIGIBLE TO BECOME INSURED ... 11
WHEN YOU BECOME INSURED ... 13
DELAY OF EFFECTIVE DATE ... 15
UNIVERSAL LIFE COVERAGE... 16
OPTION TO ACCELERATE PAYMENT OF CERTAIN DEATH BENEFITS UNDER UNIVERSAL LIFE COVERAGE ... 26
ADDITIONAL PROVISIONS FOR DEPENDENTS TERM LIFE COVERAGE ... 29
GENERAL INFORMATION ... 31
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CSB 1001 (51849-5)
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Schedule of Benefits
Covered Classes: All Employees classified by the Contract Holder as:
Class 1: All regular, full-time, non-bargaining hourly or salaried Employees of California Resources Corporation or an affiliated company who are regularly scheduled to work at least 30 hours per week, are designated as eligible to participate, and who do not participate in a similar type of employer-sponsored plan. Temporary employees are not eligible to participate. Represented Employees are eligible to participate only if the collective bargaining agreement specifically provides for participation.
Class 2: Retired Employees.
Program Date: December 1, 2014. This Certificate describes the benefits under the Group Program as of the Program Date.
You should know...
The Universal Life Coverage in this Certificate, including any of the additional provisions that may be a part of the Universal Life Coverage, is available to you if you are included in the Covered Classes. Only that Coverage and those additional provisions for which you become insured will apply to you. The rules for becoming insured are in this Certificate’s When You Become Insured section.
There is a Delay of Effective Date section. The rules of that section may delay the start of your insurance.
The Delay of Effective Date section also applies to any change, including a change in class, unless otherwise stated.
The Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, is described more fully on later pages of this Certificate. Be sure to read those pages carefully. They show when benefits are or are not payable under the Group Contract. They also outline when insurance ends and the conditions, limitations and exclusions that apply to the Coverage.
A Definitions section is included in this Certificate. Many of the terms used in this Certificate are defined in that section.
The Universal Life Coverage in this Certificate, including any of the additional provisions that may be a part of the Universal Life Coverage, is insured under a Group Contract issued by Prudential. All benefits are subject in every way to the entire Group Contract which includes the Group Insurance Certificate. It alone forms the agreement under which payment of insurance is made.
To receive the tax treatment accorded life insurance under federal law, the Universal Life Coverage must meet the definition of life insurance as provided in the Internal Revenue Code, or any
96945
CSB 1001 (51849-5)
4
Universal Life Coverage
FOR YOU AND YOUR DEPENDENT SPOUSE OR DOMESTIC PARTNER
On You under Employee Insurance
You may enroll for a Face Amount of Insurance equal to one of the options below. The option for which you enroll will be recorded by Prudential.
FACE AMOUNTS OF INSURANCE: Amount For Each Benefit Class:
Benefit Classes Face Amount of Insurance
All Employees
Option 1 50% of your annual Earnings*.
Option 2 100% of your annual Earnings*.
Option 3 200% of your annual Earnings*.
Option 4 300% of your annual Earnings*.
Option 5 400% of your annual Earnings*.
Option 6 500% of your annual Earnings*.
Option 7 600% of your annual Earnings*.
Maximum Amount: $2,000,000 Minimum Amount: $10,000
*If this amount is not a multiple of $5,000, it will be rounded to the next higher multiple of $5,000.
The Definitions section explains what “Earnings" means.
Guaranteed Issue on Face Amount of Insurance: There is a limit on the amount for which you may be insured without submitting evidence of insurability. This is called the Guaranteed Issue.
Guaranteed Issue: The lesser of (1) 200% of your annual Earnings and (2) $500,000.
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CSB 1001 (51849-5)
5
Your face amount of insurance will be increased when Prudential decides the evidence is satisfactory and you meet the Active Work Requirement.
The Delay of Effective Date section does not apply to this Guaranteed Issue on Face Amount of Insurance provision.
The Guaranteed Issue does not apply to any face amount of insurance for which you have provided evidence prior to the Program Date.
Automatic Increases and Decreases: Your amount of insurance will be increased or decreased on the date your annual Earnings change. But, if you are not meeting the Active Work Requirement when your amount of insurance would be changed, that change will be deferred until the date you meet that requirement.
Increases and Decreases: You may elect to have your face amount of insurance under the Coverage changed within 31 days of a Life Event. You must do this on a form approved by Prudential and agree to make any required contributions.
If you request an increase of more than one option, you must give evidence of insurability if you have in-force coverage. If no in-in-force coverage you can elect up to the lesser of (1) 200% of your annual Earnings and (2) $500,000 without evidence of insurability. That change will become effective on the date Prudential decides the evidence is satisfactory and your insurance is not being delayed under the Delay of Effective Date section.
If you request an increase of one option, and your insurance is not being delayed under the Delay of Effective Date section, that change will become effective on the date of your written request.
If you request a lower face amount of insurance, that change will become effective on the date of your written request.
Any Guaranteed Issue will apply to an increased amount of coverage. The “Definitions” section explains what “Life Event” means.
Effect of Option to Accelerate Death Benefits Under Universal Life Coverage: When you elect this option, the total amount of Universal Life Coverage otherwise payable on a person’s death, including any amount under an extended death benefit, will be reduced by the Terminal Illness Proceeds. Also, any amount a person could otherwise have converted to an individual contract will be reduced by the Terminal Illness Proceeds.
Change Date: January 1 of each year.
On Your Qualified Dependent Spouse or Domestic Partner under Dependents Insurance
You may enroll for a Face Amount of Insurance for your spouse or Domestic Partner equal to one of the options below. The option for which you enroll will be recorded by Prudential.
Benefit Class Face Amount of Insurance
Spouse or Domestic Partner
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CSB 1001 (51849-5)
6 Guaranteed Issue on Face Amount of Insurance for Your Spouse or Domestic Partner: There is a limit on the amount for which you may be insured with respect to your spouse or Domestic Partner without submitting evidence of insurability. This is called the Guaranteed Issue.
Guaranteed Issue: $25,000.
If the face amount of insurance for your spouse or Domestic Partner for your Class at any time is more than the Guaranteed Issue, you must give evidence of insurability for your spouse or Domestic Partner satisfactory to Prudential before the part over the Limit can become effective. This
requirement applies: when you first become insured with respect to your spouse or Domestic Partner; when your Class changes; if you request an increase in the face amount of insurance for your spouse or Domestic Partner; or if the face amount of insurance for your spouse or Domestic Partner for your Class is changed by an amendment to the Group Contract. Even if you are insured with respect to your spouse or Domestic Partner for an amount over the Limit, you will still have to meet this evidence requirement for your spouse or Domestic Partner before any increase in the face amount of insurance for your spouse or Domestic Partner can become effective.
Your face amount of insurance for your spouse or Domestic Partner will be increased when Prudential decides the evidence is satisfactory and your spouse or Domestic Partner is not confined for medical care or treatment at home or elsewhere.
The Delay of Effective Date section does not apply to this Guaranteed Issue on Face Amount of Insurance for Your Spouse or Domestic Partner provision.
The Guaranteed Issue does not apply to any face amount of insurance for your spouse or Domestic Partner for which you have provided evidence prior to the Program Date.
Increases and Decreases: You may elect to have your face amount of insurance for your spouse or Domestic Partner under the Coverage changed. You must do this on a form approved by Prudential and agree to make any required contributions.
If you request an increase of more than one option, your spouse or Domestic Partner must give evidence of insurability. That increase will become effective on the date Prudential decides the evidence is
satisfactory and your insurance for your spouse or Domestic Partner is not being delayed under the Delay of Effective Date section.
If you request a lower face amount of insurance for your spouse or Domestic Partner, that lower amount will become effective on the date of your written request.
Any Guaranteed Issue will apply to an increased amount of coverage.
Additional Provisions for Dependents Term Life Coverage
FOR YOUR DEPENDENT CHILDREN
The amount of insurance is the amount for your Benefit Class. Your Benefit Class is determined by the classification of your dependents as shown in this table.
Dependents Classification Amount of Insurance
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CSB 1001 (51849-5)
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OTHER INFORMATION
Contract Holder: TRUSTEE OF THE PRUDENTIAL GROUP LIFE INSURANCE TRUST Group Contract No.: UG-1432
Included Employer: CRC SERVICES, LLC Included Employer's Control No.: 51849
Included Employer’s Anniversary Date: January 1 of each year, beginning in 2016.
Cost of Insurance: The Coverage describes the minimum premium contributions required, as well as the additional premium contributions you may make. You will be given additional information concerning the cost of the coverage when you are asked to enroll.
Prudential's Address:
The Prudential Insurance Company of America 80 Livingston Avenue
Roseland, New Jersey 07068
____________________
WHEN YOU HAVE A CLAIM
Each time a claim is made, it should be made without delay. Use a claim form and follow the instructions on the form. If you do not have a claim form, contact Prudential.
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CMR 1005 (S-3)
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Table of Maximum Rates
Guaranteed Maximum Monthly Rates per $1,000 of Face Amount of Insurance
by Attained Age
200% of 2001 Commissioners Standard Ordinary – 80% Male / 20% Female, Composite Ultimate - Age Last Birthday
Attained Age COI/1,000 Attained Age COI/1,000 Attained Age COI/1,000
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CTA 1001 (S-1)
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Table of Corridor Percentages
(For Determining a Person’s Insurance Amount) Person’s
Attained Age Percent
Person’s
Attained Age Percent
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CTA 1007 (S-3)
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Table of Net Single Premiums
Maximum Rates To Determine Paid-Up Insurance Amounts
Calculated at 4%, 2001 Commissioners Standard Ordinary – 80% Male / 20% Female Composite Ultimate - Age Last Birthday
(Per $1.00 of Insurance Amount) Person’s
Attained Age Factor
Person’s
Attained Age Factor
Person’s
Attained Age Factor
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CEL 1001 (51849-5)
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Who Is Eligible To Become Insured
FOR EMPLOYEE INSURANCE
You are eligible for Employee Insurance while:
You are a full-time Employee of the Included Employer; and You are in a Covered Class; and
You may need to work for the Included Employer for a continuous full-time period before you become eligible for the Coverage. The period must be agreed upon by the Included Employer and Prudential. Your Included Employer will inform you of any such Employment Waiting Period for your class.
You are full-time if you are regularly working for the Included Employer at least the number of hours in the Included Employer's normal full-time work week for your class, but not less than 30 hours per week. If you are a partner or proprietor of the Included Employer, that work must be in the conduct of the Included Employer’s business.
Your class is determined by the Included Employer. This will be done under its rules, on dates it sets. The Included Employer may not discriminate among persons in like situations. You cannot belong to more than one class for insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage. "Class" means Covered Class, Benefit Class or anything related to work, such as position or Earnings, which affects the insurance available.
This applies if you are an Employee of more than one subsidiary or affiliate of an Included Employer under the Group Contract: For the insurance, you will be considered an Employee of only one of those subsidiaries or affiliates. Your service with the others will be treated as service with that one.
The rules for obtaining Employee Insurance are in the When You Become Insured section.
FOR DEPENDENTS INSURANCE
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CEL 1001 (51849-5)
12 Qualified Dependents for the Additional Provisions for Dependents Term Life Coverage: Your children less than 26 years old.
Your children include your biological children, legally adopted children, children placed with you for adoption prior to legal adoption, and each of your stepchildren, Domestic Partner’s children and foster children. A child placed with you for adoption prior to legal adoption is considered your Qualified Dependent from the date of placement for adoption, and is treated as though the child were your newborn child born to you.
Qualified Dependent for the Universal Life Coverage: Your spouse or Domestic Partner who is less than age 75.
Your Domestic Partner is a person of the same or opposite sex who:
(a) you report in an affidavit of domestic partnership satisfactory to Prudential; and (b) is an unmarried adult over the age of 18; and
(c) has lived with you for at least 6 consecutive months prior to the person's enrollment in the Program; and
(d) has a serious and committed relationship with you; and
(e) is not legally married nor a Domestic Partner to anyone else; and (f) is financially interdependent with you; and
(g) is not otherwise a Qualified Dependent under the Program.
Either a spouse or a Domestic Partner may be a Qualified Dependent under the Program at any one time, but not both at the same time.
Exception: Your spouse, Domestic Partner or child is not a Qualified Dependent while: (1) on active duty in the armed forces of any country; or
(2) insured for Employee Insurance under the Group Contract.
A child will not be considered the Qualified Dependent of more than one Employee. If this would otherwise be the case, the child will be considered the Qualified Dependent of the Employee named in a written agreement of all such Employees filed with the Included Employer. If there is no written agreement, the child will be considered the Qualified Dependent of:
(1) the Employee who became insured under the Group Contract with respect to the child, while the child was a Qualified Dependent of only that Employee; and otherwise
(2) the Employee who has the longest continuous service with the Included Employer, based on the Included Employer’s records.
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CEL 1001 (51849-5)
13
When You Become Insured
FOR EMPLOYEE INSURANCE
Your Employee Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, will begin on the first day of the month which coincides with or next follows the date on which you meet all of these requirements:
You are eligible for Employee Insurance; and You are in a Covered Class for that insurance; and
You have met any evidence requirement for the Employee Insurance; and
Your insurance is not being delayed under the Delay of Effective Date Section below; and That Coverage is part of the Group Contract; and
You have enrolled on a form approved by Prudential and agreed to pay the required
contributions. You may enroll for Contributory Insurance within 31 days of when you could first be covered, or within 31 days of a Life Event.
At any time, the benefits for which you are insured are those for your class, unless otherwise stated. The “Definitions” section explains what “Life Event” means.
When evidence is required: In any of these situations, you must give evidence of insurability. This requirement will be met when Prudential decides the evidence is satisfactory.
(1) You enroll more than 31 days after you could first be covered.
(2) You enroll after any of your insurance under the Group Contract ends because you did not pay a required contribution.
(3) You are enrolling for life insurance and have an individual life insurance contract which you obtained by converting your insurance under the Group Contract.
(4) You apply to reinstate your Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage.
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CEL 1001 (51849-5)
14
FOR DEPENDENTS INSURANCE
Your Dependents Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, for a person will begin on the first day of the month which coincides with or next follows the date on which the person is a Qualified Dependent and you meet all of these requirements:
The person is your Qualified Dependent; and You are in a Covered Class for that insurance; and
You are covered for the Employee Insurance under the Universal Life Coverage; and You have met any evidence requirement for that Qualified Dependent; and
Your insurance for that Qualified Dependent is not being delayed under the Delay of Effective Date Section; and
Dependents Insurance under that Coverage is part of the Group Contract; and You have enrolled on a form approved by Prudential and agreed to pay the required
contributions. You may enroll for Contributory Insurance within 31 days of when you could first be covered, or within 31 days of a Life Event.
At any time, the Dependents Insurance benefits for which you are insured are those for your class, unless otherwise stated.
The “Definitions” section explains what “Life Event” means.
When evidence is required: In any of these situations, you must give evidence of insurability for a Qualified Dependent spouse or Domestic Partner. This requirement will be met when Prudential decides the evidence is satisfactory. Evidence is not required for a Qualified Dependent child. (1) You enroll for Dependents Insurance under the Universal Life Coverage, including any of the
additional provisions that may be a part of the Universal Life Coverage, more than 31 days after you are first eligible for Dependents Insurance.
(2) You enroll for Dependents Insurance after any insurance under the Group Contract ends because you did not pay a required contribution.
(3) You apply to reinstate the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, for your Qualified Dependents.
(4) The Qualified Dependent is a person for whom a previous requirement for evidence of
96945
CEL 1001 (51849-5)
15
Delay of Effective Date
FOR EMPLOYEE INSURANCE
Your Employee Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, will be delayed if you do not meet the Active Work Requirement on the day your insurance would otherwise begin. Instead, it will begin on the day that you meet the Active Work Requirement and other requirements for the insurance. The same delay rule will apply to any change in your insurance that is subject to this section if you do not meet the Active Work Requirement on the day on which that change would take effect.
FOR DEPENDENTS INSURANCE
If a Qualified Dependent is confined for medical care or treatment, at home or elsewhere, on the day your Dependents Insurance under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, for that Qualified Dependent or any change in that insurance that is subject to this section, would take effect, it will not take effect until the Qualified Dependent's final medical release from such confinement. The other requirements for the insurance or change must also be met.
Newborn Child Exception for the Additional Provisions for Dependents Term Life Coverage: This section does not apply to a newborn child of yours if the child:
(1) is your first Qualified Dependent; or
(2) becomes a Qualified Dependent while you are insured for Dependents Insurance under the Additional Provisions for Dependents Term Life Coverage for any other Qualified Dependent.
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UL R 10006 (51849-5)
16
Universal Life Coverage
FOR YOU AND YOUR DEPENDENT SPOUSE OR DOMESTIC PARTNER
Universal Life Coverage is life insurance which includes one or more of these three parts: face amount of insurance; a fund; and paid-up insurance. To be a Covered Person under the Universal Life Coverage, a person must first have become insured for the face amount of insurance. Under certain conditions, the fund may be applied to provide paid-up insurance. Paid-up insurance continues until death unless surrendered.
A. DEATH
BENEFIT.
If a person dies:
(a) while a Covered Person under the Universal Life Coverage; or (b) while under the extension for the Universal Life Coverage; or
(c) within 31 days after the person’s face amount of insurance under the Universal Life Coverage ends and while the person has the right to convert the face amount of insurance to an individual contract;
a death benefit is payable when Prudential receives written proof of death.
Unless the person’s fund has been used to buy paid-up insurance, the amount of the death benefit is the greater of (1) and (2):
(1) the face amount of insurance plus fund; and
(2) the fund times the percent for the person’s attained age in the Table of Corridor Percentages. If the person’s fund has been used to buy paid-up insurance, the amount of the death benefit is the amount of the paid-up insurance in force on the date of the person’s death.
When a person’s face amount of insurance has ended, the amount of the death benefit includes any amount the person may have under the provisions for Extension of Coverage and Waiver of Monthly Deductions During Total Disability or Conversion Privilege below.
But, the balance and interest for any loan on the person’s fund, due at the person’s death, will be deducted from the death benefit to be paid.
B. FACE AMOUNT OF INSURANCE.
A person's face amount of insurance under the Universal Life Coverage is determined as provided in the Schedule of Benefits.
C. CONTRIBUTIONS
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UL R 10006 (51849-5)
17 Monthly Deductions: Each month, Prudential will make a Monthly Deduction from a person's fund. A Monthly Deduction is equal to the sum of (1), (2) and (3) below:
(1) The amount required to provide the total death benefit minus the fund. But, if the amount of a person's death benefit under Section A above is not determined as the sum of the face amount of insurance plus fund, this item (1) is the amount required to provide the portion of the person's death benefit equal to the total death benefit minus the fund. In no event will this amount be higher than 200% of the applicable amount under the 2001 Commissioners Standard Ordinary Mortality Table 80% Male / 20% Female Composite Ultimate - Age Last Birthday.
(2) The amount required to provide any of the additional provisions that may be a part of the Universal Life Coverage.
(3) The monthly administration fee as set by Prudential from time to time, but not more than $6.00. Contributions in Excess of Monthly Deduction: Each month, contributions toward premiums may be made in an amount in excess of the Monthly Deduction. Prudential will make a fund charge of not more than $2 plus 6% of each such contribution. The balance of such a contribution will remain in the person's fund, subject to the other provisions of the Universal Life Coverage.
Lump Sum Contributions: You may also contribute lump sum amounts toward a person's fund from time to time as you choose, subject to the following. You may not make lump sum contributions: (1) for an amount which would cause a person's fund to reach its limit; or
(2) for an amount less than $100.00.
Prudential will make a fund charge of not more than $2 plus 6% of each such contribution. The balance of such a contribution will remain in the person's fund, subject to the other provisions of the Universal Life Coverage.
Maximum Monthly Contribution: In any event, for all contributions, there is a limit on the amount, per person, which may be contributed each month. That limit is the Maximum Monthly Contribution. The Maximum Monthly Contribution is determined by Prudential, based upon certain factors. Those factors include, but are not limited to, the person's age and contributions which may already have been made to the person's fund. Notice of the amount of your and your spouse's or Domestic
Partner's Maximum Monthly Contribution will be included in the reports provided to you under Section I of the Universal Life Coverage. You may change the amount of the monthly contribution to your fund, or to your fund for your spouse or Domestic Partner and end your contribution or your contribution in excess of the monthly deduction for a person at any time. No contribution may be made after a person's face amount of insurance ends.
To receive the tax treatment accorded to life insurance under the federal law, the Universal Life Coverage must qualify under the Internal Revenue Code or successor law. To make sure the Universal Life Coverage qualifies, Prudential reserves the right: (a) to refuse contributions which would cause the Universal Life Coverage to fail to so qualify; and (b) to make changes in the Universal Life Coverage or to make distributions from a person's fund to the extent needed to continue to qualify the Coverage as life insurance.
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UL R 10006 (51849-5)
18 Grace Period: The grace period starts on the day the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage goes into default and extends to the later of: (a) 60 days after that date; and (b) 30 days from the date Prudential mails you a notice of default. During the grace period, Prudential will accept contributions and make the charges it has set. If the Monthly Deduction is not paid within the grace period, the person's Universal Life
Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, will end at the end of the grace period.
If a Covered Person dies during a grace period, Prudential will deduct any overdue Monthly Deduction from the death benefit.
Reinstatement: If a person's Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, is still in default after the grace period ends, it may be reinstated. To do so, these conditions must be met:
(1) The Group Contract has not ended.
(2) The person’s fund must not have been used to buy paid-up insurance.
(3) You must request reinstatement within three years from the end of the grace period. (4) You have given evidence of the person's insurability that satisfies Prudential.
(5) You pay the amount, if any, needed to bring the person’s fund up to zero as of the date the person’s Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, went into default.
(6) You pay the Monthly Deductions through the end of the grace period.
(7) You pay an amount which is sufficient to keep the person’s Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, in force for at least two months after the date of reinstatement.
If Prudential approves the reinstatement, the reinstatement will be effective on the first day of the month coinciding with or next following the approval date.
D. THE
FUND.
At any time the amount of your fund, or your fund for your spouse or Domestic Partner, is the net amount of:
(1) your contributions under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, received by Prudential; plus
(2) interest; minus
(3) Monthly Deductions; minus
(4) any fund charges, including fees for withdrawals or loans; minus (5) any amounts which have been withdrawn.
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UL R 10006 (51849-5)
19 Withdrawals: You may withdraw all or part of your fund, or your fund for your spouse or Domestic Partner, upon written request, subject to a fee set by Prudential. The fee will not exceed $20. But you may not withdraw that part of the fund equal to the balance of any loan on the fund and the interest charged to it.
If only part of a fund is withdrawn, the amount withdrawn must be at least $200. Prudential may defer a withdrawal for not more than six months.
Loans: You may borrow that part of your fund, or your fund for your spouse or Domestic Partner, equal to (1) minus (2):
(1) 90% of the amount of your fund, or your fund for your spouse or Domestic Partner. (2) one month’s Monthly Deduction.
The loan amount may not be less than $200. Each loan is subject to a fee set by Prudential. The fee will not exceed $20. Prudential may defer a loan for not more than six months.
You can take only one loan per Calendar Year from each fund and can have only one loan in effect at any time from each fund.
Interest on a loan balance will be charged daily at a yearly rate not to exceed 2% plus the rate that interest is credited to the fund. Interest is due: on each anniversary of the Included Employer’s Inclusion Date; when the loan or part of it is paid back; and when the loan becomes due and payable. Interest not paid when due is added to the loan balance.
A loan and the interest charged to it will be due and payable from a person's fund:
(1) when all of the person’s face amount of insurance under the Universal Life Coverage ends; or (2) when the person dies; or
(3) any time the loan balance plus interest charged to it equals the amount of the person's fund. When the amount credited to a person’s fund is reduced to zero because the loan balance plus interest equals the amount of a person's fund, the person's Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, will continue until the date on which Prudential would make the next Monthly Deduction. If, on that date, the amount credited to a person's fund is less than the amount required for that Monthly Deduction, the person’s Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, is in default, and a grace period will begin as described in Section B.
You may pay back all or part of a loan at any time. At your request, a loan may be cancelled, or reduced by no less than $200, by deducting the amount needed from the fund from which it was borrowed.
The balance and interest for any loan due at a person's death will be deducted from the death benefit to be paid.
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UL R 10006 (51849-5)
20
E. PAID-UP
INSURANCE.
Paid-up insurance may be provided under the Universal Life Coverage by using a person's fund to pay the net single premium for that insurance when the person’s face amount of insurance under the Universal Life Coverage ends. But, if paid-up insurance is so provided, all other benefits under the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, will end.
All or part of a person's fund, less the balance and interest due for any loan on the person's fund, may be used to provide the paid-up insurance, subject to both of these rules:
(1) The minimum amount of the person’s fund that may be applied to purchase paid-up insurance is $1,000.
(2) The maximum amount of paid-up insurance that may be purchased is the amount of the person’s death benefit just before the purchase.
Any amount of a person’s fund which exceeds the amount used to provide paid-up insurance will be returned to you in cash.
The net single premium used to provide paid-up insurance will not be more than it would be on the basis of the 2001 Commissioners Standard Ordinary Table 80% Male / 20% Female Composite Ultimate – Age Last Birthday at 4%.
All of a person’s paid-up insurance may be surrendered for its cash value at any time. The cash value will be the net single premium at the person's attained age for the amount of insurance, using the same basis which determined that amount, less a fee set by Prudential. The fee will not exceed $20. Partial surrenders of a person’s paid-up insurance are not permitted. Prudential may defer a surrender for not more than six months.
Paid-up insurance will not end when a person's insurance ends under other rules of the Group Contract. Unless surrendered, it will continue until the person's death.
Premium Refunds: Prudential will determine that part of any premium refund derived from a person's paid-up insurance. That part will be applied to increase the amount of the person's paid-up insurance. That part will not be considered in determining the disposition or effect of premium refunds under any other provision of the Group Contract.
Change in Beneficiary: If you purchase paid-up insurance and you make a Beneficiary change, a Beneficiary change form must be filed with Prudential and not as stated in the Beneficiary Rules.
F. EXTENSION OF COVERAGE AND WAIVER OF MONTHLY DEDUCTIONS
DURING DISABILITY.
If you meet the conditions below:
(1) The Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, will be extended while you are Disabled.
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UL R 10006 (51849-5)
21 The conditions are:
You become Disabled while you are insured for face amount of insurance under the Universal Life Coverage and are not retired.
You are less than age 60 when your Disability starts.
Disability: You are Disabled when you are either Totally Disabled or Partially disabled. You are “Totally Disabled” when as a result of your Sickness or Injury:
(1) you are unable to perform with reasonable continuity the Substantial and Material Acts necessary to pursue your Usual Occupation; and
(2) you are not working in your Usual Occupation.
After 24 months of payments, you are Totally Disabled when, as a result of the same Sickness or Injury, you are unable to engage with reasonable continuity in any occupation in which you could reasonably be expected to perform satisfactorily in light of your age, education, training, experience, station in life, and physical and mental capacity.
You are “Partially Disabled” when: (1) you are not Totally Disabled; and
(2) while actually working in your Usual Occupation, and as a result of your Sickness or Injury, you are unable to earn 80% or more of your Indexed Monthly Earnings.
After 24 months of payments, you are Partially Disabled when: (1) you are not Totally Disabled; and
(2) while actually working in an occupation, and as a result of the same Sickness or Injury, you are unable to engage with reasonable continuity in that or any other occupation in which you could reasonably be expected to perform satisfactorily in light of your age, education, training, experience, station in life, and physical and mental capacity.
Sickness means any disorder of your body or mind, but not an injury; pregnancy including abortion, miscarriage or childbirth.
Injury means physical harm or damage to the body.
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UL R 10006 (51849-5)
22 Usual Occupation means any employment, business, trade or profession and the Substantial and Material Acts of the occupation you were regularly performing for your Employer when the Disability began. Usual Occupation is not necessarily limited to the specific job you performed for your Employer.
Indexed Monthly Earnings means your monthly earnings as adjusted on each July 1 provided you were Disabled for all of the 12 months before that date. Your monthly earnings will be adjusted on that date by the current annual percentage increase in the Consumer Price Index. Your Indexed Monthly Earnings may increase or remain the same, but will never decrease.
The extension ends one year after your Disability started, unless, within that year, you give Prudential written proof that:
(1) You have met the above conditions; and (2) You are still Disabled; and
(3) Your Disability has continued for at least nine months.
Prudential will then further extend the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, for successive one year periods. The first of these periods will start on the date Prudential receives this proof. After that first period, you must give written proof when and as required by Prudential once each year that your Disability continues.
If you or your dependent dies while the Universal Life Coverage, including any of the additional provisions that may be a part of the Universal Life Coverage, is being extended, the death benefit will include the amount of that extension when Prudential receives written proof that:
(1) Your Disability continued until that person's death; and (2) All of the above conditions have been met.
If you or your dependent spouse dies within one year after your Disability started and before you give Prudential proof of Disability, written notice of your or your dependent's death must be given to Prudential within one year after the death.
This extension ends if and when:
(1) Your Disability ends or you reach age 65; or
(2) You fail to furnish any required proof that your Disability continues; or
(3) You fail to submit to a medical exam by Doctors named by Prudential when and as often as Prudential requires. After two full years of this protection, Prudential will not require an exam more than once a year.
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UL R 10006 (51849-5)
23 The amount of a person's face amount of insurance that may be extended is the amount of the person's face amount of insurance on the day Disability began, subject to the provisions of the Schedule of Benefits. But the amount is reduced by any amount payable under any Prudential group life insurance that replaces the Universal Life Coverage for a class of Employees.
Effect of Conversion: An individual contract issued under Section G will be in place of all rights under this Section F.
G. CONVERSION
PRIVILEGE.
If a person’s face amount of insurance under the Universal Life Coverage ends for the reason stated below, the person may convert to an individual life insurance contract. Evidence of insurability is not required. The reason is all face amount of insurance that applies to the person under the Group Contract for the Employee’s class ends by amendment or otherwise. But, on the date it ends the person must have been insured for five years for that insurance (or for that insurance and any other Prudential rider or group contract replaced by that insurance).
Any such conversion is subject to the rest of this Section G.
Availability: A person must apply for the individual contract and pay the first premium by the later of: (1) the thirty-first day after the person’s face amount of insurance ends; and
(2) the fifteenth day after the person has been given written notice of the conversion privilege. But, in no event may insurance be converted to an individual contract if the person does not apply for the individual contract and pay the first premium prior to the ninety-second day after the person’s Face Amount of Insurance ends.
Individual Contract Rules: The individual contract must conform to the following: Amount: Not more than:
(1) the total amount of the person’s insurance under this Universal Life Coverage (face amount of insurance plus fund) just before the face amount of insurance ends; minus
(2) the amount of the person’s fund needed to cancel any loan due; minus
(3) any amount of the person’s paid-up insurance under the Universal Life Coverage purchased by using the person’s fund just after the face amount of insurance ends.
But, if a person converts when extended death protection ends, the amount of that protection applies in place of the face amount of insurance in (1) above.
If the face amount of insurance ends because all face amount of insurance of the Group Contract for your class ends, the total amount of individual insurance which you or your dependent spouse or Domestic Partner may get in place of all life insurance then ending for you or your dependent spouse or Domestic Partner under the Group Contract will not exceed the lesser of the following:
(1) The total amount of all life insurance then ending for that person under the Group Contract reduced by the sum of: (a) the amount of that person’s fund needed to cancel any loan due; (b) the amount of that person’s paid-up insurance; and (c) the amount of group life insurance from any carrier for which that person is or becomes eligible within the next 31 days.
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UL R 10006 (51849-5)
24 Death During Conversion Period: The amount a person has a right to convert to an individual contract is included in the death benefit if the person dies:
(1) Within 31 days after the person's face amount of insurance ends; and
(2) While the person has the right to convert the face amount of insurance to an individual contract. It is included even if the person did not apply for conversion. But it is reduced by the amount of any extended death benefit protection which applies.
Form: Any form of a life insurance contract that:
(1) conforms to Title VII of the Civil Rights Act of 1964, as amended, having no distinction based on sex; and
(2) is one that Prudential usually issues at the age and amount applied for.
This does not include term insurance or a contract with disability or supplementary benefits.
Premium: Based on Prudential's rate as it applies to the form and amount, and to the person's class of risk (other than gender) and age at the time.
Effective Date: The end of the 31 day period after which the person ceases to be insured for the face amount of insurance.
H. SUICIDE
If a Covered Person, whether sane or insane, dies because of suicide, the death benefit under the Universal Life Coverage may be limited. If death because of suicide occurs:
(1) within two years from the date that person became a Covered Person, it is limited to: (a) the sum of the contributions paid; minus
(b) any loan and the interest charged to it; minus
(c) any amounts which have been withdrawn from that person’s fund.
(2) within two years from the date of any increase in that person’s face amount of insurance, the part of the death benefit that would be on account of that increase is limited to the sum of the contributions paid for that increase.
(3) within two years from the date the person’s Universal Life Coverage is reinstated, it is limited to: (a) the sum of the contributions paid since the date of the reinstatement; minus
(b) any loan and the interest charged to it; minus
