Mid-America Apartments, L.P.
Your Group Life and Accidental Death and Dismemberment Plan
Policy No. 972765 011
Underwritten by Unum Life Insurance Company of America
1/8/2025
Unum Life Insurance Company of America 2211 Congress Street Portland, ME 04122 (877) 225-2712 services.unum.com
________________________________________________________________________________ Group Life and Accidental Death and Dismemberment Insurance Certificate of Coverage ________________________________________________________________________________ Policyholder: Mid-America Apartments, L.P. Policy Number: 972765 011 Policy Effective Date: January 1, 2025 Policy Anniversary: January 1 Governing Jurisdiction: Tennessee This Certificate of Coverage (the "certificate") is issued to you under the policy which is a contract between us and the Policyholder. If the provisions of this certificate conflict with the provisions of the policy, the provisions of the policy will govern. The policy is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable, the laws of other states and the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments. This certificate includes an Accelerated Death Benefit. The Life Benefit will be reduced if an Accelerated Death Benefit is paid. Accelerated Death Benefits may be taxable. You should consult a tax advisor about the tax status of any Accelerated Death Benefit payment. This certificate provides benefits under a non-participating policy. This certificate contains proof of loss requirements, limitations, exclusions, and other provisions that may reduce benefits or prevent an Insured from receiving benefits under this certificate. Please read your certificate carefully and keep it in a safe place. All references to defined terms, provision titles, and section headings have been capitalized. If you have any questions about provisions of this certificate, please contact your Employer, or you may contact us at (877) 225-2712 Monday through Friday 8 a.m. to 8 p.m. Eastern Standard Time.
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 1
Unum Life Insurance Company of America
Table of Contents
Life Highlights ....................................................................................................................................................................... 4 Eligible Group(s)...............................................................................................................................................................4 Paying for Coverage.........................................................................................................................................................4 Coverage Amounts...........................................................................................................................................................4 Coverage Reductions Due to an Insured's Age...............................................................................................................5 Life Benefit Amount .........................................................................................................................................................5 Certificate Riders .............................................................................................................................................................5 Life Details ............................................................................................................................................................................. 6 Death Benefit....................................................................................................................................................................6 Accelerated Death Benefit................................................................................................................................................6 Life Details | Exclusions and Limitations ........................................................................................................................... 8 Life Details | Other Features ................................................................................................................................................ 9 Accidental Death and Dismemberment Highlights ......................................................................................................... 11 Eligible Group(s).............................................................................................................................................................11 Paying for Coverage.......................................................................................................................................................11 Coverage Amounts.........................................................................................................................................................11 Coverage Reductions Due to an Insured's Age.............................................................................................................12 Accidental Death and Dismemberment (AD&D) Benefit Amount ..................................................................................12 Certificate Riders ...........................................................................................................................................................12 Accidental Death and Dismemberment Schedule of Benefits........................................................................................13 Additional Benefits under Accidental Death and Dismemberment.................................................................................13 Accidental Death and Dismemberment Details ............................................................................................................... 14 Accidental Death and Dismemberment Benefits............................................................................................................14 Additional Benefits under Accidental Death and Dismemberment.................................................................................15 Accidental Death and Dismemberment Details | Exclusions and Limitations .............................................................. 19 Continuity of Coverage ...................................................................................................................................................... 20 Waiver of Premium ............................................................................................................................................................. 22 Start of Coverage ................................................................................................................................................................ 25 End of Coverage ................................................................................................................................................................. 29
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 2
Unum Life Insurance Company of America
Table of Contents
Claim Provisions ................................................................................................................................................................. 31 General Provisions ............................................................................................................................................................. 35 Glossary .............................................................................................................................................................................. 37
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 3
Unum Life Insurance Company of America
Life Highlights
Life insurance provides protection against financial loss resulting from death. This section includes highlights of an Insured's coverage. Please refer to the Life Details for further information on the benefits available. Eligible Group(s) Full-Time Employees in Active Employment working a minimum of 30 hours per week.
Paying for Coverage
For You Basic Coverage Your Employer must make premium contributions for your coverage. Additional Coverage You must make premium contributions for your coverage. For your Spouse Additional Coverage You must make premium contributions for your Spouse's coverage. For your Children Additional Coverage You must make premium contributions for your Children's coverage.
Coverage Amounts
The following Coverage Amounts are available to you, your Spouse, and your Children. Basic Coverage For you 1 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, with a minimum of $50,000, to a maximum of $500,000 Additional Coverage For you Option A: 1 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 Option B: 2 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 Option C: 3 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 Option D: 4 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 Option E: 5 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 For your Spouse A minimum of $5,000 to a maximum of $250,000, in $5,000 increments For your Children A minimum of $5,000 to a maximum of $15,000, in $5,000 increments Coverage Amounts for your Spouse and Children will not be more than 50% of your Coverage Amount. Coverage Amounts may be subject to Evidence of Insurability Requirements. Please refer to the Start of Coverage section of this certificate for any enrollment rules, Evidence of Insurability Requirements, and effective dates of coverage.
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 4
Unum Life Insurance Company of America
Life Highlights
Coverage Reductions Due to an Insured's Age
Applies to Basic Coverage Only Your life insurance coverage will reduce as follows: - on the Policy Anniversary following the date you reach age 70, your life insurance coverage will reduce to 65%; - on the Policy Anniversary following the date you reach age 75, your life insurance coverage will reduce to 50%. There will be no further age reductions as of the Policy Anniversary following your 75th birthday. If you are subject to any life insurance coverage reductions due to your age when you apply or become eligible for life insurance coverage, your coverage will immediately reduce on the Coverage Effective Date according to the percentages shown above. Any life insurance coverage with a Coverage Effective Date after coverage reductions begin will be immediately reduced according to the attained ages noted in this provision. Once your first reduction has occurred, you may not increase your life insurance coverage. Your life insurance coverage can reduce below the minimum benefit specified in this certificate. Applies to Additional Coverage Only Your life insurance coverage will reduce as follows: - on the Policy Anniversary following the date you reach age 70, your life insurance coverage will reduce to 65%; - on the Policy Anniversary following the date you reach age 75, your life insurance coverage will reduce to 50%. Your Spouse's life insurance coverage will reduce as follows: - on the Policy Anniversary following the date your Spouse reaches age 70, your Spouse's life insurance coverage will reduce to 65%; - on the Policy Anniversary following the date your Spouse reaches age 75, your Spouse's life insurance coverage will reduce to 50%. There will be no further age reductions as of the Policy Anniversary following your or your Spouse's 75th birthday. If you or your Spouse are subject to any life insurance coverage reductions due to your or your Spouse's age when you or your Spouse apply or become eligible for life insurance coverage, your or your Spouse's coverage will immediately reduce on the Coverage Effective Date according to the percentages shown above. Any life insurance coverage with a Coverage Effective Date after coverage reductions begin will be immediately reduced according to the attained ages noted in this provision. Once your or your Spouse's first reduction has occurred, you may not increase your or your Spouse's life insurance coverage. Your life insurance coverage can reduce below the minimum benefit specified in this certificate. The Life Benefit Amount is the total amount of life insurance coverage for which an Insured is covered under the policy subject to all the provisions of this certificate.
Life Benefit Amount Certificate Riders
The following riders are attached to this certificate. Portability of Life and Accidental Death and Dismemberment Insurance Value Added Services Rider
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Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 5
Unum Life Insurance Company of America
Life Details
The information in this section provides details about the benefits that may be payable, any applicable Exclusions and Limitations, and Other Features included in an Insured's coverage. Benefits will only be payable for an Insured's death that occurs on or after the Insured's Coverage Effective Date. Death Benefit We will pay an Insured's Life Benefit Amount, in accordance with the provisions of this certificate, if an Insured dies. Accelerated Death Benefit This benefit provides an advance payment of an Insured's Death Benefit if the Insured becomes Terminally Ill or has a Terminal Illness. For purposes of this benefit, Terminally Ill or Terminal Illness is a medical condition: - from which an Insured is not expected to recover; and - which is expected to result in the Insured's death within 12 months.
Benefits received under this Accelerated Death Benefit may be taxable. You should seek assistance from a personal tax advisor prior to requesting an accelerated payment of death benefits. Accelerated Death Benefit Limitations No Accelerated Death Benefit will be paid: - if any required premium is due and unpaid; - if the Insured is not Terminally Ill at the time you apply for the Accelerated Death Benefit for an Insured; - without the Written consent of the assignee if you have assigned your rights under this certificate; - without the Written consent of the beneficiary if you have named an irrevocable beneficiary; - if a government agency requires you to use this benefit to apply for, obtain, or otherwise keep a government benefit or entitlement; - if you are required by law to use this benefit to meet the claims of creditors, whether in bankruptcy or otherwise. Accelerated Death Benefit Amount The amount you may receive is up to 50% of the Insured's Life Benefit Amount. The maximum amount is the lesser of: - the maximum benefit available under this certificate; or - $750,000. If an Insured's life insurance coverage is scheduled to reduce within 12 months of the date application for this benefit is received by us, the amount of life insurance coverage that can be accelerated will be limited to the amount that would be available after such reduction takes place. Payment of an Accelerated Death Benefit The Accelerated Death Benefit will be payable one time in a lump sum to you, after we receive proof of an Insured's Terminal Illness and benefit eligibility. If you have assigned your rights under this certificate to an assignee or made an irrevocable beneficiary designation before benefits are payable, we must receive Written consent on a form acceptable to us that the assignee or irrevocable beneficiary has agreed to the accelerated benefit payment on your behalf. If an Insured dies before we issue an Accelerated Death Benefit payment, no Accelerated Death Benefit will be paid. Instead, we will pay the Death Benefit in accordance with the provisions of this certificate. Effect of the Accelerated Death Benefit payment on other benefit provisions An Insured's Death Benefit will be reduced by any amount paid under the Accelerated
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Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 6
Unum Life Insurance Company of America
Life Details
Death Benefit provision. Payment of an Accelerated Death Benefit for one Insured will not reduce any other Insured's life insurance coverage and will not reduce accidental death and dismemberment insurance coverage. Any Life Benefit Amount that would be continued under a disability continuation provision or that may be available under Conversion will be reduced by the amount of the Accelerated Death Benefit paid. The remaining Life Benefit Amount will be paid in accordance with the provisions of this certificate. Upon request to accelerate an Insured's Death Benefit and upon the payment of the Accelerated Death Benefit, we will provide a statement to the Insured and any assignee of record or irrevocable beneficiary of record demonstrating the effect of the acceleration on the Insured's Death Benefit. Upon payment of the Accelerated Death Benefit, the certificate will remain in force, unless coverage terminates. Premium payments must continue to be paid on the full amount of an Insured's life insurance coverage in force prior to the payment of the Insured's Accelerated Death Benefit unless the Insured is approved to have life premium waived in accordance with the Waiver of Premium section of this certificate. Applying for an Accelerated Death Benefit This replaces the Filing a Claim provision in the Claim Provisions section of this certificate. If there are any questions on how to file a claim, please contact us or your Employer. Starting a Claim Notice of a claim may be provided in Writing, online at: services.unum.com, or by contacting us directly at 1-800-635-5597. Completed claim forms may be submitted online or sent to us by mail, or fax: Mailing Address: The Benefits Center P.O. Box 100158 Columbia, South Carolina 29202-3158 Fax: (800) 447-2498 Proof of Loss Proof of Loss must be sent to us no later than 90 days after the date the claim is filed for an Accelerated Death Benefit. If it is not reasonably possible to provide Proof of Loss within this time period, it will not affect a Payable Claim if it is provided within one year, unless the Insured lacks the legal capacity to do so. In no event can Proof of Loss be submitted after the expiration of the time limit for commencing Legal Action as stated in this certificate, even if the failure to provide Proof of Loss is due to a lack of legal capacity or if state law provides an exception to the one year time period. Proof of Loss provided at your or your authorized representative's expense, must include, but not be limited to the following: - satisfactory Written proof from the Insured's Physician certifying that the Insured is Terminally Ill; and - the appropriate documentation of your financial records, including but not limited to, Earnings and income tax returns. If the Proof of Loss is not complete, we will request additional information.
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 7
Unum Life Insurance Company of America
Life Details | Exclusions and Limitations
This certificate is subject to all Exclusions in this section, unless stated otherwise in a specific provision. Exclusions This certificate does not cover any losses where death is caused by, contributed to by, or occurs as a result of suicide occurring within 24 months after: - an Insured's initial Coverage Effective Date; and - the date any increases or additional life insurance coverage becomes effective for an Insured.
This exclusion will apply to any life coverage for which you pay all or part of the premium. This exclusion will also apply to any life coverage that has been approved by us that is subject to the Evidence of Insurability Requirements. An Insured will be given credit towards the satisfaction of the time period of 24 months for any amount of time satisfied while coverage was effective under your Employer's prior group life insurance policy.
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Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 8
Unum Life Insurance Company of America
Life Details | Other Features
Conversion
Conversion rights provide an Insured the option to convert group life insurance coverage to any type of individual level premium whole life plan(s) in use by Unum or another insurance company which has agreed to issue conversion policies according to this conversion right. Please refer to the provisions below for additional details. Right to Convert You may convert all or part of an Insured's life insurance coverage to an individual level premium whole life policy without submitting Evidence of Insurability when an Insured's life insurance coverage reduces or ends due to a Qualifying Event. For purposes of this provision, Qualifying Event means: - you cease to be in an Eligible Group; - your employment ends; - your continuation of coverage, if any, ends; - your portability coverage, if any, ends; - the group policy ends; - the policy is changed to end life insurance for the Eligible Group to which you belong; or - your life insurance coverage is reduced: - on or after you reach a certain age; - on or after your Spouse or Child reaches a certain age; - because you change from one eligible class to another; - due to a change made by the Employer to the policy. Your Spouse may convert their life insurance coverage if it ends because your Spouse no longer meets the definition of a Spouse. Your Children may convert their life insurance coverage if it ends because your Children no longer meet the definition of Children. Life insurance coverage for any Insured cannot be converted if coverage was terminated due to non-payment of premium. Applying for Conversion - because you change from one eligible class to another; - due to a change made by the Employer to the policy; or - your Spouse or Children's life insurance coverage is reduced: You must apply to convert coverage within the Conversion Application Period. The first premium payment for converted coverage is due at the time you submit the conversion application. For purposes of this provision, Conversion Application Period means the 31 day period after the date of any Qualifying Event. Applications for conversion, which include cost information, are available from the Employer, from us, or online at services.unum.com . Notice of Right to Convert Your Employer must notify you of your Right to Convert all or part of an Insured's life insurance coverage within 15 days from the end of the Conversion Application Period. If your Employer does not notify you within those 15 days, the time allowed for you to exercise an Insured's Right to Convert will be extended for 15 days from the date you are notified. In no event will the time allowed for you to exercise an Insured's Right to Convert be extended beyond 60 days from the end of the Conversion Application Period. Life Insurance Coverage that can be Converted Except as limited under Limits on Right to Convert, the maximum amounts that you can convert may not exceed the Insured's life insurance coverage lost under this certificate
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Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 9
Unum Life Insurance Company of America
Life Details | Other Features
less the amount of any life insurance coverage that the Insured is or becomes eligible for under the same or any other group policy during the Conversion Application Period. You may convert a lower amount of life insurance coverage for an Insured. Conversion is not available for any amount of life insurance for which an Insured was not eligible for or covered for under this certificate. Conversion is also not available for coverage which is being continued: - in accordance with the Waiver of Premium section of this certificate; - under the Portability Rider; or - in accordance with the continuation provisions found in the End of Coverage section of this certificate until such coverage ends. Coverage available for Conversion does not include the following services and benefits included in or with your certificate: - Accelerated Death Benefits; - Accidental Death and Dismemberment Benefits; - Additional Services, including but not limited to, Employee Assistance Programs, Travel Assist, and Life Planning Financial and Legal Resources; or - Waiver of Premium. If you convert to an individual life policy, then return to work, and, again, become covered under this certificate, you are not eligible to convert to an individual life policy again. However, you do not need to surrender your individual life policy when you return to work. Limits on Right to Convert If your Insurance ends because of cancellation or changes to the policy, the following will apply: You may convert a limited amount of life insurance coverage for an Insured, if the Insured has been covered under the Employer's group policy with us for at least five (5) years. The maximum amount you have the right to convert is the lesser of: - $10,000; or - the Insured's life insurance coverage under this certificate less any amounts that become available under any other group life policy offered by the Employer within 31 days after the date the policy is cancelled. Death During the Conversion Application Period If an Insured dies during the Conversion Application Period, we will pay a benefit equal to the maximum amount the Insured was entitled to convert under the terms of this certificate. If application and Premium payment has been made for an individual life conversion policy, any Premiums paid for the individual life conversion policy will be refunded. In no event will we be liable to pay a death benefit under both the group policy and the individual life conversion policy. Premiums for Converted Insurance Premiums for the converted life insurance coverage will be based on: - the Insured's then attained age on the effective date of the individual life policy; - the type and amount of insurance to be converted; - our customary rates in use at that time; and - the class of risk to which the Insured belongs. If premium payment has been made, the individual life policy will be effective at the end of the Conversion Application Period.
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 10
Unum Life Insurance Company of America
Accidental Death and Dismemberment Highlights
Accidental death and dismemberment (AD&D) insurance provides financial protection by paying a benefit in the event of a Covered Loss. This section includes highlights of an Insured's coverage. Please refer to the Accidental Death and Dismemberment Details for further information on the benefits available. Eligible Group(s) Full-Time Employees in Active Employment working a minimum of 30 hours per week.
Paying for Coverage
For you Basic Coverage Your Employer must make premium contributions for your coverage. Additional Coverage You must make premium contributions for your coverage. For your Spouse Additional Coverage You must make premium contributions for your Spouse's coverage. For your Children Additional Coverage You must make premium contributions for your Children's coverage.
Coverage Amounts
The following Coverage Amounts are available to you, your Spouse, and your Children. Basic Coverage For you 1 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, with a minimum of $50,000, to a maximum of $500,000 Additional Coverage For you Option A: 1 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 Option B: 2 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 Option C: 3 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 Option D: 4 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 Option E: 5 x your annual Earnings rounded to the next higher $1,000 if not already an exact multiple thereof, to a maximum of $500,000 For your Spouse A minimum of $5,000 to a maximum of $250,000, in $5,000 increments For your Children A minimum of $5,000 to a maximum of $15,000, in $5,000 increments Coverage Amounts for your Spouse and Children will not be more than 50% of your Coverage Amount. Please refer to the Start of Coverage section of this certificate for any enrollment rules, and effective dates of coverage.
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 11
Unum Life Insurance Company of America
Accidental Death and Dismemberment Highlights
Coverage Reductions Due to an Insured's Age
Applies to Basic Coverage Only Your AD&D insurance coverage will reduce as follows: - on the Policy Anniversary following the date you reach age 70, your AD&D insurance coverage will reduce to 65%; - on the Policy Anniversary following the date you reach age 75, your AD&D insurance coverage will reduce to 50%. There will be no further age reductions as of the Policy Anniversary following your 75th birthday. If you are subject to any AD&D insurance coverage reductions due to your age when you apply or become eligible for AD&D insurance coverage, your coverage will immediately reduce on the Coverage Effective Date according to the percentages shown above. Any AD&D insurance coverage with a Coverage Effective Date after coverage reductions begin will be immediately reduced according to the attained ages noted in this provision. Once your first reduction has occurred, you may not increase your AD&D insurance coverage. Your AD&D insurance coverage can reduce below the minimum benefit specified in this certificate. Applies to Additional Coverage Only Your AD&D insurance coverage will reduce as follows: - on the Policy Anniversary following the date you reach age 70, your AD&D insurance coverage will reduce to 65%; - on the Policy Anniversary following the date you reach age 75, your AD&D insurance coverage will reduce to 50%. Your Spouse`s AD&D insurance coverage will reduce as follows: - on the Policy Anniversary following the date your Spouse reaches age 70, your Spouse`s AD&D insurance coverage will reduce to 65%; - on the Policy Anniversary following the date your Spouse reaches age 75, your Spouse's AD&D insurance coverage will reduce to 50%. There will be no further age reductions as of the Policy Anniversary following your or your Spouse`s 75th birthday. If you or your Spouse are subject to any AD&D insurance coverage reductions due to your or your Spouse's age when you or your Spouse apply or become eligible for AD&D insurance coverage, your or your Spouse's coverage will immediately reduce on the Coverage Effective Date according to the percentages shown above. Any AD&D insurance coverage with a Coverage Effective Date after coverage reductions begin will be immediately reduced according to the attained ages noted in this provision. Once your or your Spouse's first reduction has occurred, you may not increase your or your Spouse's AD&D insurance coverage. Your AD&D insurance coverage can reduce below the minimum benefit specified in this certificate. The AD&D Benefit Amount is the total amount of accidental death and dismemberment insurance coverage for which an Insured is covered under the policy subject to all the provisions of this certificate.
Accidental Death and Dismemberment (AD&D) Benefit Amount
Certificate Riders
The following riders are attached to this certificate. Portability of Life and Accidental Death and Dismemberment Insurance
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Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 12
Unum Life Insurance Company of America
Accidental Death and Dismemberment Highlights
Value Added Services Rider
Accidental Death and Dismemberment Schedule of Benefits The benefits an Insured may receive for a Payable Claim are listed in the Schedule of Benefits. Please refer to the Accidental Death and Dismemberment Details for additional information. Covered Loss Percentage of an Insured's AD&D Benefit Amount Accidental Death Benefit 100% Accidental Dismemberment and Loss of Use Benefit Both Hands 100% Both Feet 100% Sight in Both Eyes 100% One Hand and One Foot 100% One Foot and Sight in One Eye 100% One Hand and Sight in One Eye 100% Speech and Hearing 100% One Hand or One Foot 50% Sight in One Eye 50% Speech or Hearing 50% Thumb and Index Finger of the same Hand 25% All Toes on One Foot 25% Big Toe on One Foot 10% Coma Benefit 1%
Additional Benefits under Accidental Death and Dismemberment
Education Benefit Exposure and Disappearance Benefit Helmet Benefit Repatriation Benefit Seatbelt(s) and Airbag Benefit Spouse Education Benefit
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 13
Unum Life Insurance Company of America
Accidental Death and Dismemberment Details
The information in this section provides details about the benefits that may be payable, and any applicable Exclusions and Limitations included in an Insured`s coverage. Benefits will only be payable for an Insured's Covered Loss resulting from Injuries sustained in an Accident that occurs on or after the Insured's Coverage Effective Date. Accidental Death and Dismemberment Benefits The most we will pay for any combination of Covered Losses from any one Accident is 100% of an Insured's AD&D Benefit Amount. Accidental Death Benefit Benefit Description We will pay the corresponding amount shown in the Schedule of Benefits if, due to Injuries sustained in an Accident, an Insured dies. The Accidental Death must be within 365 days of the Accident. Benefit Duration This benefit is payable once per Insured. Accidental Benefit Description We will pay the corresponding amount shown in the Schedule of Benefits if, due to Injuries sustained in an Accident, an Insured suffers an Accidental Dismemberment and Loss of Use. The Accidental Dismemberment and Loss of Use must occur within 365 days from the date of the Accident. For purposes of this benefit, the following meet the Benefit Description of Accidental Dismemberment and Loss of Use: Dismemberment and Loss of Use Benefit
- for the dismemberment of a foot, all of the foot is cut off at or above the ankle joint; - for the dismemberment of a hand, all four fingers are cut off at or above the knuckles joining each to the hand; - for the dismemberment of a thumb and index finger, all of the thumb and index finger are cut off at or above the joint closest to the wrist; - for the dismemberment of all toes on one foot or the big toe on one foot, the toes are cut off at or above the point at which they are attached to the foot; - for the loss of hearing, the ability to hear is a total and irrecoverable loss in both ears; - for the loss of sight in one eye, the eye must be totally blind, and no sight can be restored in that eye; - for the loss of sight in both eyes: - the sight in the better eye is reduced to a best corrected visual acuity of 20/200 or less (Snellen or E-Chart Acuity); or - the sight in the better eye has a visual field that is less than 20°; and - the Insured was not previously legally blind; - for the loss of speech, the ability to speak is a total and irrecoverable loss. If an Insured sustains multiple Accidental Dismemberments and Losses of Use in a single Accident, we will pay for each Accidental Dismemberment and Loss of Use but will pay no more than 100% of the Insured's AD&D Benefit Amount. Benefit Duration This benefit is payable once per Insured per Accident. Benefit Description We will pay the corresponding amount shown in the Schedule of Benefits if, due to Injuries sustained in an Accident, an Insured is in a Coma for a period of 31 or more consecutive days. A Physician must confirm the Coma began within 365 days of the Accident.
Coma Benefit
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Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 14
Unum Life Insurance Company of America
Accidental Death and Dismemberment Details
The Coma must begin within 31 days of the Accident. No benefits are payable for the first 31 days that the Insured is in a Coma.
For purposes of this benefit, Coma means a state of deep and total unconsciousness from which the comatose person cannot be aroused. A medically induced Coma does not meet the Benefit Description of a Coma. Benefit Duration This benefit is payable for up to 100 months per Accident. Additional Benefits under Accidental Death and Dismemberment Benefit Description This benefit may be payable on behalf of each Child if, due to Injuries sustained in an Accident, you or your Spouse dies. The following conditions also apply: Your Child must be: - enrolled as a full-time student in an accredited post-secondary institution of higher learning beyond the 12th grade level; or - at the 12th grade level and enrolled as a full-time student in an accredited post- secondary institution of higher learning beyond the 12th grade level within 365 days following the date of your or your Spouse's death. We must receive proof, at your or your authorized representative's expense, which includes, but is not limited to the following: - the date of enrollment for your Child in an accredited post-secondary institution of higher learning; - the name of the institution; and - the list of courses and the number of credit hours for the current academic year. Your or your Spouse's death must occur within 365 days from the date of the Accident. Benefits are payable to your Child or your Child's legal representative. This benefit provides a lump sum payment of 10% of your or your Spouse's AD&D Benefit Amount, to a maximum of $10,000 per academic year. The Education Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Education Benefit to be paid, your or your Spouse's Accidental Death Benefit must be paid first. Benefit Duration The Education Benefit for each Child has: - a total lifetime maximum of $100,000; - a maximum amount of benefit payments of 4 per lifetime; and - a maximum benefit period of no more than 6 years from the date the first benefit payment has been made. The Education Benefit will end for each Child on the earliest of the following dates: - the date your Child fails to furnish proof as required by us; - the date your Child no longer qualifies as a Child for any reason except your death; or - the end of the maximum benefit period.
Education Benefit
Exposure and Disappearance Benefit
Benefit Description Exposure
If an Insured is unavoidably exposed to the elements as the result of an Accident and suffers a Covered Loss, benefits will be payable in accordance with the Accidental Death and Dismemberment Schedule of Benefits.
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 15
Unum Life Insurance Company of America
Accidental Death and Dismemberment Details
The Covered Loss must occur within 365 days from the date of the Accident. Disappearance If an Insured's body cannot be located within 365 days after the Insured's disappearance, due to a forced landing, stranding, or wrecking of any Common Carrier in which the Insured was riding at the time of the Accident, the Insured will be presumed to have died in the Accident. Benefits will be payable for Accidental Death in accordance with the Accidental Death and Dismemberment Schedule of Benefits. The most we will pay for any combination of Covered Losses from any one Accident is 100% of an Insured's AD&D Benefit Amount. Benefit Duration This benefit is payable once per Insured per Accident. Benefit Description This benefit may be payable if an Insured dies due to Injuries sustained in a Motorcycle Accident and all the following are met: - the Insured was operating or riding as a passenger on a Motorcycle when the Accident occurred; - the Insured was wearing a Helmet that was properly fastened at the time of the Accident; - if the Insured was operating the Motorcycle, the Insured must have held a valid driver's license appropriate for the Motorcycle; and - the use of a Helmet is certified in the official report of the Accident, or by the investigating officer. A copy of the police Accident report must be submitted with the claim. The Insured's death must occur within 365 days from the date of the Accident. For purposes of this benefit: Helmet means protective headgear that meets or exceeds the standard established by the SNELL Memorial Foundation Standard M-95 or M2000, the American National Standards Institute specification Z 09.1, or the United States Department of Transportation's Federal Motor Vehicle Safety Standard No.218. Motorcycle means a motorized vehicle registered for use on public roads. If certification is not available, and it is clear that the Insured was properly wearing a Helmet, then we will pay an amount equal to 10% of the Insured's AD&D Benefit Amount to a maximum of $25,000. However, if such certification is not available, and it is unclear whether the Insured was properly wearing a Helmet, then we will pay a fixed benefit of $1,000. The Helmet Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Helmet Benefit to be paid, the Insured's Accidental Death Benefit must be paid first. Benefit Duration This benefit is payable once per Insured. Benefit Description This benefit may be payable for the preparation and transportation of the Insured's body to a chosen mortuary, when an Insured's death occurs more than 100 miles away from the Insured's principle place of residence due to an Injury sustained in an Accident. Benefits are payable to the beneficiary or whomever paid the actual cost incurred. From all Unum group life and accidental death and dismemberment insurance policies combined we will pay a lump sum payment up to a maximum of $10,000 not to exceed the actual expenses incurred for the preparation and transportation of the Insured's body
Helmet Benefit
Repatriation Benefit
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Group Life and Accidental Death and Dismemberment Certificate
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Unum Life Insurance Company of America
Accidental Death and Dismemberment Details
to a mortuary. The Repatriation Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Repatriation Benefit to be paid, the Insured's Accidental Death Benefit must be paid first. Benefit Duration This benefit is payable once per Insured. Benefit Description This benefit may be payable if, due to Injuries sustained in an Accident, an Insured dies while driving or riding in a Private Passenger Car, provided: - the Private Passenger Car is equipped with seatbelt(s); - the seatbelt(s) were in actual use and properly fastened at the time of the Accident; and - the position of the seatbelt(s) are certified in the official report of the Accident, or by the investigating officer. A copy of the police Accident report must be submitted with the claim. If certification is not available, and it is clear that an Insured was properly wearing seatbelt(s), then we will pay an amount equal to 10% of the Insured's AD&D Benefit Amount to a maximum of $25,000. However, if such certification is not available, and it is unclear whether an Insured was properly wearing seatbelt(s), then we will pay a fixed benefit of $1,000. We will only pay the Seatbelt Benefit for the death of a minor Child if the Child is correctly strapped and fastened in the appropriate seat for the Child's age and weight as defined by state or federal guidelines. The seatbelt device must also be approved by the state or federal government for the Child's age and weight. An automatic harness seatbelt will not be considered properly fastened unless a lap belt is also used. No benefit will be paid if the Insured is the driver of the Private Passenger Car and does not hold a current and valid driver's license. The Seatbelt(s) Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Seatbelt(s) Benefit to be paid, the Insured's Accidental Death Benefit must be paid first. Benefit Duration This benefit is payable once per Insured. Benefit Description This benefit may be payable in addition to the Seatbelt Benefit if, due to Injuries sustained in an Accident, an Insured dies while driving or riding in a Private Passenger Car, provided: - the Private Passenger Car is equipped with an airbag for the seat in which the Insured is seated; and - the seatbelt(s) must be in actual use and properly fastened at the time of the Accident. This benefit will pay an amount equal to 5% of the Insured's AD&D Benefit Amount to a maximum of $5,000. However, if we can verify that the airbag(s) had been disengaged prior to the Accident, no benefit will be payable. The Air Bag Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Air Bag Benefit to be paid, the Insured's Seatbelt(s) Benefit and Accidental Death Benefit must be paid first. Benefit Duration
Seatbelt(s) Benefit
Air Bag Benefit
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Group Life and Accidental Death and Dismemberment Certificate
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Unum Life Insurance Company of America
Accidental Death and Dismemberment Details
This benefit is payable once per Insured.
Spouse Education Benefit
Benefit Description This benefit may be payable on behalf of your Spouse if, due to Injuries sustained in an Accident, you die. The following conditions also apply: Your Spouse must be enrolled and incur costs for a post-secondary, professional or trade school program within 365 days of your death. Benefits are payable to your Spouse for actual costs incurred for their enrollment. From all Unum group life and accidental death and dismemberment insurance policies combined, we will pay an amount equal to 10% of your AD&D Benefit Amount to a maximum of $20,000, not to exceed the actual amount paid for actual costs incurred for enrollment. The Spouse Education Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Spouse Education Benefit to be paid, your Accidental Death Benefit must be paid first. Benefit Duration This benefit is payable once.
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Group Life and Accidental Death and Dismemberment Certificate
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Unum Life Insurance Company of America
Accidental Death and Dismemberment Details | Exclusions and Limitations
This certificate is subject to all Exclusions in this section, unless stated otherwise in a specific provision. Exclusions We will not pay benefits for any Covered Loss that is caused by, contributed to by, or occurs as a result of any of the following: - committing or attempting to commit a felony; - being engaged in an illegal occupation; - being engaged in an illegal activity;
- injuring oneself intentionally or attempting or committing suicide, whether sane or not; - active participation in a riot, insurrection, or terrorist activity. This does not include Injury as an innocent bystander, or Injury for self-defense; - being Intoxicated; - voluntary use of or treatment for voluntary use of any prescription or non-prescription drug, poison, fume, or other chemical or controlled substance unless taken as directed by the manufacturer, or as prescribed or directed by the Insured's Physician; - Mental or Nervous Disorders; - disease or infirmity of mind or body, or medical or surgical treatment for such disease or infirmity; - war or any act of war, whether declared or undeclared.
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Group Life and Accidental Death and Dismemberment Certificate
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Unum Life Insurance Company of America
Continuity of Coverage
Continuity of Coverage will protect you, your Spouse, and your Children from having a lapse in group term life and accidental death and dismemberment insurance when your Employer changes insurance carriers to Unum from another insurance company. Continuity of Coverage also applies when your coverage changes from another carrier to Unum because the Employer merged with your prior employer or acquired your prior employer in whole or in part. As used in this section, the following terms are defined as follows: - Prior Policy means your Employer's prior group term life and accidental death and dismemberment insurance policy under which you, your Spouse, and your Children were insured on the day before the effective date of the Unum policy; and - Prior Plan Benefits means the group term life and accidental death and dismemberment benefits that would have been paid to you, your Spouse, or your Children under the Prior Policy had that Prior Policy remained in force and you, your Spouse, and your Children had continued to be insured. Coverage Effective Date
You are In Active Employment on the Policy Effective Date or on the Date your Eligible Group is First Covered
Basic Coverage You will be insured under the Unum policy for the amount you had in force with the Prior Policy, provided you: - were covered under the Prior Policy on the day before the effective date of the Unum policy or on the date your Eligible Group is first covered due to the Employer merging with or acquiring your prior employer; and - on the Unum Policy Effective Date or on the date your Eligible Group is first covered due to the Employer merging with or acquiring your prior employer, you are in Active Employment in an Eligible Group and satisfy any other eligibility requirements under the Unum policy. If you were covered by the Prior Policy, you may increase or decrease coverage for you subject to the Coverage Amounts available during an initial Enrollment Period. Evidence of Insurability is required for any increases in coverage. If you were not covered by the Prior Policy, you may apply for any Coverage Amounts available during an initial Enrollment Period. Evidence of Insurability is required for all life Coverage Amounts. Additional Coverage You, your Spouse, and your Children will be insured under the Unum policy for the amount you, your Spouse, and your Children had in force with the Prior Policy, provided you, your Spouse, and your Children: - were covered under the Prior Policy on the day before the effective date of the Unum policy or on the date your Eligible Group is first covered due to the Employer merging with or acquiring your prior employer; and - on the Unum Policy Effective Date or on the date your Eligible Group is first covered due to the Employer merging with or acquiring your prior employer, you are in Active Employment in an Eligible Group and satisfy any other eligibility requirements under the Unum policy. If you were covered by the Prior Policy, you may increase or decrease coverage for an Insured subject to the Coverage Amounts available during an initial Enrollment Period. Evidence of Insurability is required for any increases in coverage. If you were not covered by the Prior Policy, you may apply for any Coverage Amounts available during an initial Enrollment Period. Evidence of Insurability is required for all life Coverage Amounts. Due to Injury or Sickness We will provide limited coverage under the Unum policy for you, your Spouse, and your
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Group Life and Accidental Death and Dismemberment Certificate
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Unum Life Insurance Company of America
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