Supplemental Life Insurance Plan

Benefits for You

If you are covered by the Basic Life plan, you may elect Supplemental Life coverage in $10,000 increments ($10,000, $20,000, $30,000 and so on) up to five (5) times your base annual earnings or $1 million, whichever is less.

Base Annual Earnings

Life and AD&D benefit amounts are based on your base annual earnings, which are:

• For Full-time hourly employees, current hourly wage times 2,080 hours
• For Part-time hourly employees, current hourly wage times 1,560 hours
• For salaried employees, current annual pay

Base annual earnings do not include any extra compensation such as overtime pay or bonuses.

Benefits for Your Family

If you elect Supplemental Life for yourself, you also may enroll your family. You may enroll your spouse or domestic partner only; your children only; or your spouse or domestic partner and your children.

• For your spouse or domestic partner, you may elect coverage in $10,000 increments, up to 50% of your Supplemental Life benefit amount or $300,000, whichever is less.
• For your children, you may purchase $5,000 coverage for each dependent child.

Evidence of Insurability (EOI)

You will be required to provide Unum with Evidence of Insurability in the following circumstances:

• To elect more than “guaranteed amounts” of Supplemental Life Insurance at any time, including initial Enrollment, Annual Open Enrollment, or following a mid-year change in status. For you, the guaranteed amount is $300,000. For your Spouse or Domestic Partner, it is $150,000.
• If you have previously declined insurance for yourself or your family member, to enroll yourself of family member at a later time even during Annual Open Enrollment.
• To increase your current Supplemental Life Insurance during Annual Open Enrollment or following a mid-year change in status by more than $20,000 or current coverage for your Spouse of Domestic Partner by more than $10,000.

When EOI is required, an application will be sent to your home address within 30 days after you make your election through the online or telephone enrollment system. There are two ways to complete an Evidence of Insurability application:

• Complete the paper application and return it to:
  

  Unum
  Customer Account Services
  PO Box 9783-5083
  Portland ME 04104
  Fax: 1-207-575-0745

• Use the information on the paper application to complete and submit an on-line Evidence of Insurability form. Click here to complete the on-line Evidence of Insurability process.

You must complete your Evidence Insurability application and submit it to Unum within 30 days of the date the application was sent.