Page 10 - TNJH 2019 Benefits Guide

Required Notices

Genetic Information Non-Discrimination Act (GINA)

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by
GINA from requesting or requiring genetic information of an individual or family member of the individual, except
as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic
information when responding to this request. “Genetic information” as defined by GINA, includes an individual’s
family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or
an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an
individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving
assistive reproductive services. Please do not include any family medical history or any information related to
genetic testing, genetic services, genetic counseling or genetic diseases for which an individual may be at risk.

Life Insurance Conversion

Under the terms of your group life policy, some or all of your insurance coverage may be converted to permanent
insurance. If you are age 76 and above, your only conversion option is for a Single Pay Life Policy. Please carefully
read the provisions in your Booklet-Certificate which describe your conversion privilege, if any.

You should submit your application and first premium within the 31-day period specified in your Booklet-
Certificate. The right to convert to a Cigna Guaranteed Life Insurance policy is guaranteed, provided the terms as
described in your Booklet-Certificate are met.

If you have any questions, call Cigna at (800) 362-4462. When requesting information, please state your date of
birth, your group policy number, and the name of the organization through which your group insurance was
obtained.

Acceptance and negotiation of your conversion premium payment by The Cigna Life Insurance Company is not a
guarantee that an individual conversion policy will be issued as requested on the Conversion Request Form. All
conditions precedent to issue of an individual conversion policy, including, without limitation, confirmation of your
eligibility for conversion coverage, confirmation of the maximum amount of coverage eligible for conversion,
completion of all reasonably required paperwork, and payment of any additional conversion premiums, must be
received by Cigna in a timely manner. A delay in submitting required information, documentation, or additional
premium will not extend the conversion time period specified above.

Your Benefits Guide 10
2019