DOCUMENTS & FORMS

Cigna

• Life & AD&D Benefit Summary - Class 1
• Life & AD&D Benefit Summary - Class 2
• Life & AD&D Benefit Summary - Class 3
• Life & AD&D Benefit Summary - Class 4
• Life & AD&D Benefit Summary - Class 5
• Life Benefit Summary - Class 1
• Life Benefit Summary - Class 2
• Life Benefit Summary - Class 3
• Life Benefit Summary - Class 4
• Life Benefit Summary - Class 5

• Life Certificate Class 1
• Life Certificate Class 2
• Life Certificate Class 3
• Life Certificate Class 4
• Life Certificate Class 5

• AD&D Certificate Class 1
• AD&D Certificate Class 2
• AD&D Certificate Class 3
• AD&D Certificate Class 4
• AD&D Certificate Class 5

• Beneficiary Form

Basic Life and AD&D

Basic Life and Accidental Death & Dismemberment (AD&D) Insurance help provide a foundation of financial protection for family if something happens to you.

What is Group Basic Life Insurance?

Cigna provides an amount of life and AD&D coverage to eligible employees. Group Term Life Insurance pays a benefit to your chosen beneficiary(ies) if you die while you are a member of the group covered by the policy. It doesn’t earn interest and has no cash value but can help protect the financial future of your loved ones.

Group AD&D pays a benefit in addition to your life insurance if you die as the result of a covered accident. It also pays benefits for loss of limb, hearing, speech, sight, and other serious losses resulting from an accident. See your policy documents for details of coverage.

Conversion: If group life insurance coverage is reduced or ends for any reason, except nonpayment of premiums, you can convert to an individual policy. To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Converted policies are subject to certain benefits and limits as outlined in the conversion brochure, which may be requested as needed. Premiums may change at this time.

Accelerated Benefit: If a doctor certifies that an insured individual is terminally ill and not expected to live more than 12 months, the insured may request payment of up to 50% of his/her life insurance amount up to the amount stated, based on your class.

NOTE: The cost of any coverage exceeding $50,000 is considered “imputed income” by the IRS.  Imputed income will be reported on your W-2 form as part of your taxable income. If you wish to avoid imputed income, you may waive coverage over $50,000.

If you waive employer coverage over $50,000 initially, and later decide to change this election, you will need to provide Evidence of Insurability at that time.

For more information about the plan and your coverage, view the documents at left and visit the provider website:

Cigna

• www.mycigna.com
• 1-800-445-0402 (Life AD&D)
• 1-800-858-6843 (LTD)