Page 12 - 2019-2020 Country Financial CU Benefit Booklet

Voluntary Term Life and AD&D Summary

Employees who want to supplement their Group Life and AD&D Insurance benefits may purchase voluntary coverage
through Mutual of Omaha for themselves and their dependents. Please Note -In order to elect Voluntary Life Insurance
for a spouse and/or your child(ren), you as the employee must also elect.

Guarantee Issue (GI) Amount: For new hires and/or newly eligible employee(s), the GI amount is 5 times annual salary, up to
$100,000 for yourself; 100% of employee’s benefit up to $25,000 for your spouse; and 100% of employee’s benefit up to $10,000
for your child(ren) without medical underwriting. For any amounts above the Guarantee Issue you MUST complete an Evidence of
Insurability (EOI).
Current Employees: All eligible employees and spouses are able to elect up to two (2) increments ($10,000/$5,000) for a total of
$20,000/$10,000, without having to complete an Evidence of Insurability Form provided the amount does not exceed the GI during this
Open Enrollment only. Dependent Children may elect up to a max of $10,000. Future Open Enrollments will only allow employees that
are currently enrolled in the Voluntary Term Life and AD&D Insurance to elect one (1) increment ($10,000) provided the total amount of
insurance does not exceed your maximum benefit amount. If you and/or your spouse are electing more than GI you both must complete
an Evidence of Insurability (EOI) REGARDLESS OF THE AMOUNT.

Employees hired on or after November 1, 2019: If you and your eligible dependents enroll within 31 days of your initial eligibility date,
you may apply for up to the Guarantee Issue amount without completing an Evidence of Insurability (EOI). For any amounts above the
GI please you MUST complete an Evidence of Insurability (EOI) and return it to HR.
PLEASE NOTE: Failure to provide an Evidence of Insurability Form when required will result in denial of coverage by MOO.
Mutual of Omaha (MOO)

Group #: TBD
(800) 877-5176 / www.mutualofomaha.com

Voluntary Term Life - Employee Benefit: Increments of $10,000 up to 5x annual salary to a maximum of $300,000.
100% Employee Paid Guarantee Issue: $100,000
Rate based on Employee’s age *GI applies only when applicant first becomes eligible*

Benefit: 100% of the employee’s benefit, up to a maximum of $100,000 ($5,000
Voluntary Term Life - Spouse increments)
100% Employee Paid
Rate based on your age, not the Guarantee Issue: $25,000
Spouse’s age *GI applies only when applicant first becomes eligible*
Note: Spouse may not have coverage unless the employee has coverage.

Voluntary Term Life – Child(ren)
100% Employee Paid Benefit: 100% of employee’s benefit, up to $10,000
Flat rate per month regardless of Note: Child(ren) may not have coverage unless the employee has coverage.
number of children to be insured

Benefit Reduction At age 65, amounts reduce to 65%; At age 70, amounts reduce to 50%; Spouse
coverage terminates when the employee reaches age 70.

Portability: Allows you to continue this insurance program for yourself and your
dependents should you leave your employer for any reason, without having to provide
evidence of insurability (information about your health). You will be responsible for the
Additional Benefits premium for the coverage.
Conversion: If your employment ends, you may apply for an individual life
insurance policy from Mutual of Omaha without having to provide evidence of
insurability (information about your health). You will be responsible for the
premium for the coverage.
Note: This is intended to be an easy-to-read comparison (not a contract); the above items are only highlights of this plan.
Additional limitations and exclusions may apply to covered services. For a full description of your coverage, please refer to
your Certificate of Coverage. In the event of any inconsistencies with the insurer’s Certificate, the Certificate will control.
Salus Group © 2019 11