Death and Dismemberment Benefits

INSURED BENEFITS FOR ACTIVE EMPLOYEES

The following benefits are provided through an insurance policy procured by the Trustees from an insurance company. If there is any discrepancy between the following explanation and the provisions of the insurance policy, the provisions of the insurance policy will govern.

Employee Life Insurance

ELIGIBILITY FOR LIFE INSURANCE – Life Insurance is provided only for eligible active employees. Life Insurance is not provided for any employee whose Plan coverage is being continued under COBRA coverage. If you lose coverage under the Plan for any reason, or if your Life Insurance is going to terminate because you start making COBRA self-payments, refer to the section titled “Conversion Privilege”.

PAYMENT OF LIFE INSURANCE – If you die while you are eligible for this benefit, the amount of your Life Insurance shown on the Schedule of Benefits is payable to your beneficiary regardless of the cause of death. (If a person other than your beneficiary pays medical or burial expenses on your behalf, the insurance company may pay up to but not to exceed $2,000 of your Life Insurance to that person upon receipt of acceptable proof of such expense.)

Written notice and proof of your death must be submitted to the Fund Office within 90 days of your death. Your beneficiary will be provided with a form for filing proof of claim as soon as the notice of your death is submitted. Failure to submit the notice and/or proof within the 90-day period will not endanger the claim if it is shown that it was not reasonably possible to submit the notice and/or proof within the required time and that notice and/or proof was submitted as soon as it was reasonably possible.

BENEFICIARY – Be sure that the person you want to receive your Life Insurance has been named as your beneficiary and is on file in the Fund Office. If you name more than one beneficiary and don’t state how much each is to get, the beneficiaries will share equally. If you haven’t named a beneficiary, or if your beneficiary predeceases you, your Life Insurance will be paid to the first of the following successive classes of survivors: your spouse; your children; your parents; your brothers and sisters; or your estate. If there is more than one survivor in the class, the survivors in that class will share equally.

You can change your beneficiary at any time. Just get the proper form from the Fund Office, fill it in and return it to the Fund Office for forwarding to the insurance company. The change of beneficiary will be effective on the date the insurance company receives the change of beneficiary form.

EXTENDED LIFE INSURANCE (Waiver of Premium) – If you become totally disabled and unable to work, your Life Insurance may be continued at no cost to you under the following rules:

1. Your disability must start before your 60th birthday and while you are eligible for Life Insurance, and you must be totally and continuously disabled as a result of injury or sickness which prevents you from engaging in any business, occupation or employment for remuneration or profit.
2. You must provide the insurance company with written proof (“initial proof”) of the facts stated in No. 1 above after you have been totally disabled for at least nine (9) months and before your total disability has lasted for twelve (12) months. If your proof is accepted, your Life Insurance will be continued for 12 months following the insurance company’s receipt of your initial proof.
3. Each year afterwards, during the 3-month period preceding the anniversary date of the insurance company’s receipt of your initial proof, you must provide written proof that you remain totally disabled. If the proof is acceptable, your insurance will be continued for further one-year periods. It is your responsibility to provide this proof within the time limit. No notice or request for proof will be sent to you.
4. When you are no longer totally disabled, or if you fail to comply with the above proof requirements, your Life Insurance will no longer be continued.
5. If you die while covered under this provision, written notice of your death and written proof that your total disability had continued uninterruptedly from the last anniversary of receipt of your initial proof to the date of your death must be provided to the insurance company within one year from the date of your death.

CONVERSION PRIVILEGE – If your Life Insurance is going to terminate because your eligibility for Life Insurance terminates, or because the group insurance policy terminates, you can convert your Life Insurance under this Plan to an individual policy for which you pay the premiums as follows:

• You can convert to any type of individual life insurance policy customarily issued by the insurance company except term insurance, and no medical examination or proof of good health is required.
• Your written application and first premium payment must be made within 31 days after termination of your eligibility for Life Insurance or termination of the group insurance policy. If you die within the 31-day period allowed for conversions, your Life Insurance will be paid even if you haven’t applied for conversion.
• If your eligibility for Life Insurance terminates, you can convert up to but not more than the amount you had under the Plan at the time your eligibility for Life Insurance terminated.
• If the group insurance policy terminates, you can convert up to $10,000 if you have been continuously eligible under the Plan for five or more years. However, the $10,000 will be reduced by any amount of group Life Insurance that you become eligible for under any other group plan within 31 days of the policy termination.

Employee Accidental Death and Dismemberment (AD&D) Insurance

ELIGIBILITY FOR AD&D INSURANCE – AD&D Insurance is provided only for eligible active employees. AD&D Insurance is not provided for any employee whose Plan coverage is being continued under COBRA coverage.

PAYMENT OF BENEFITS – AD&D Insurance benefits are payable if you suffer any of the losses on the Table of Losses below. The loss must result from an accident that occurs to you while you are eligible for AD&D Insurance and must occur within 365 days of the date of the accident.

The full amount of your AD&D Insurance is shown on the Schedule of Benefits. The amount payable for all losses resulting from any one accident cannot exceed this full amount. If you suffer any combination of the losses shown on the Table of Losses as the result of one accident, only one amount (the largest) is payable for all losses.

The amount paid for accidental death (loss of life) is payable to your beneficiary in addition to your Life Insurance benefit. Your beneficiary for loss of life under this benefit is the same as for your Life Insurance. If you change your beneficiary for your Life Insurance, you automatically change your beneficiary for this benefit.

Loss of a hand or foot means dismemberment by severance at or above the wrist or ankle joint. Loss of sight in an eye means total and irrecoverable loss of sight in that eye.

EXCLUSIONS – No AD&D Insurance benefits will be paid for any loss resulting from or caused directly or indirectly or wholly or partly by:

1. Bodily or mental infirmity or disease or illness of any kind.
2. Intentional self-destruction or intentional selfinflicted injury, while sane or insane, or suicide.
3. Participation in the commission of any crime.
4. War or an act of war, or service in any military, naval or air force of any country while such country is engaged in war, or police duty as a member of any military, naval or air organization.

DEPENDENT DEATH AND DISMEMBERMENT BENEFITS (Dependents of Active Employees Only)
The amounts of the Death Benefit and AD&D Benefit for dependents are shown on the Schedule of Benefits. These benefits are self-insured by the Fund; any benefits payable as a result of a dependent’s death or accident will be paid directly to you by the Plan.

If you or the dependent make COBRA self-payments for continued Plan coverage for a dependent, the COBRA coverage does not include continued Death or AD&D Benefits for the dependent.

Dependent Death Benefit
If a covered dependent dies due to any cause, the amount of the dependent’s Death Benefit will be paid to you, the employee.

Dependent AD&D Benefit

PAYMENT OF BENEFITS – The Plan pays benefits as shown below if a dependent suffers any of the losses listed below within 90 days of the accident causing the loss:

1. Accidental Death – If a dependent dies due to an accident, the full amount of the dependent’s AD&D Benefit will be paid to you. This amount is in addition to the dependent’s Death Benefit.
2. Dismemberment – If a dependent suffers any of the following losses, the amount stated will be paid to you:
   • For loss of: two hands or two feet or sight of two eyes, or one foot and sight of one eye, or one hand and sight of one eye, or one hand and one foot, the Plan will pay the full amount of the dependent’s AD&D Benefit.
   • For loss of: one hand, or one foot, or sight of one eye, the Plan will pay one-half of the full amount.

EXCLUSIONS – The exclusions that apply to the employee AD&D Insurance benefit also apply to the dependent AD&D Benefit.

RETIREE DEATH BENEFIT
If you (the eligible retiree) die due to any cause, the amount of the Retiree Death Benefit shown on the Schedule of Benefits will be paid to your beneficiary.

Written notice and proof of your death must be submitted to the Fund Office within 90 days of your death. Your beneficiary will be provided with a form for filing proof of claim as soon as the notice of your death is submitted. Failure to submit the notice and/or proof within the 90-day period will not endanger the claim if it is shown that it was not reasonably possible to submit the notice and/or proof within the required time and that notice and/or proof was submitted as soon as it was reasonably possible.

YOUR BENEFICIARY – The rules governing the naming of your beneficiary are the same as those for active employees.