Life Insurance Summary Plan Description

Printable Version of Life Insurance Summary Plan Description

We are pleased to present you with this document. It describes the Program of benefits we have arranged for you and what you have to do to be covered for these benefits.

We believe this Program provides worthwhile protection for you and your family.

Please read this document carefully. If you have any questions about the Program, we will be happy to answer them.

IMPORTANT INFORMATION FOR RESIDENTS OF CERTAIN STATES: There are state-specific requirements that may change the provisions under the Coverage(s) described in this Group Insurance Certificate. If you live in a state that has such requirements, those requirements will apply to your Coverage(s) and are made a part of your Group Insurance Certificate. Prudential has a website that describes these state-specific requirements. You may access the website at www.prudential.com/etonline. When you access the website, you will be asked to enter your state of residence and your Access Code. Your Access Code is 50757.

If you are unable to access this website, want to receive a printed copy of these requirements or have any questions, call Prudential at 1-866-439-9026.

Covered Classes: The “Covered Classes" are these Employees of the Contract Holder (and its Associated Companies): As listed below:

For Basic Employee Term Life Coverage: 1) All Full-time Active Employees other than those classified by the Contract Holder as Class II; 2) all Employees classified by the Contract Holder as Full-time Active Employees in the Retirement Transition Program; 3) all Full-time Employees classified by the Contract Holder as those who are hired by Rochester Institute of Technology on or after July 1, 2013 and 4) Employees classified as Part-time active Employees.

For Optional Employee Term Life Coverage and Optional Dependents Term Life Coverage: All Full-time Active Employees other than those classified by the Contract Holder as Class II; all Employees classified by the Contract Holder as Full-time Active Employees in the Retirement Transition Program; and Employees classified as Part-time active Employees.

Program Date: January 1, 2019. This Booklet describes the benefits under the Group Program as of the Program Date.

• This Booklet and the Certificate of Coverage together form your Group Insurance Certificate. The Coverages in this Booklet are insured under a Group Contract issued by Prudential. All benefits are subject in every way to the entire Group Contract which includes the Group Insurance Certificate. It alone forms the agreement under which payment of insurance is made.

Basic Employee Term Life Insurance

Benefit Amounts:

* But if you do not wish to become insured for an amount that exceeds $50,000, you may limit your coverage to $50,000 provided you do so in writing on a form satisfactory to Prudential. If you later decide to increase you Amount of Insurance to 2 times your annual Earnings as described above, you must give evidence of insurability. The amount of your insurance will be increased when Prudential decides the evidence is satisfactory and you meet the Active Work Requirement.

The Definitions section explains what “Earnings" means.

Amount Limit Due to Age: When you are age 70 or more, your amount of insurance is limited. It is the Limited Percent (for that Age) of the amount for which you would then be insured if there were no limitation. Each Age and the Limited Percent for that Age are shown below.

The Limited Percent for an Age takes effect on the day you become insured if you are then that Age. Otherwise, each Limited Percent for an Age takes effect on the first January 1 that occurs while you are that Age.

The Delay of Effective Date section does not apply to this Amount Limit Due to Age provision.

Effect of Option to Accelerate Payment of Death Benefits: Your amount of insurance (as determined in the absence of this provision) will be reduced by the amount of any Terminal Illness Proceeds paid under the Option to Accelerate Payment of Death Benefits.

Optional Employee Term Life Insurance

You may enroll for one of the options below. The option for which you enroll will be recorded by your Employer and reported to Prudential.

Benefit Amounts:

*If this amount is not a multiple of $1,000, it will be rounded to the next higher multiple of $1,000.

The Definitions section explains what “Earnings" means.

Non-Medical Limit on Amount of Insurance: There is a limit on the amount for which you may be insured without submitting evidence of insurability. This is called the Non-medical Limit.

If the amount of insurance for your Class and age at any time is more than the Non-medical Limit, you must give evidence of insurability satisfactory to Prudential before the part over the Limit can become effective.

This requirement applies: when you first become insured; when your Class changes; if you request an increase in your Amount of Insurance; or if the amount for your Class is changed by an amendment to the Group Contract. Even if you are insured for an amount over the Limit, you will still have to meet this evidence requirement before any increase in your amount of insurance can become effective. The amount of your insurance will be increased to the amount for your Class and age when Prudential decides the evidence is satisfactory and you meet the Active Work Requirement.

Non-medical Limit: The lesser of (1) 2 times your annual Earnings and (2) $375,000. If the Amount Limit for this Coverage applies at any time to your amount of insurance, that Limit will also apply to the Non-medical Limit as if it were an amount of insurance.

The Delay of Effective Date section does not apply to this Non-medical Limit on Amount of Insurance provision.

Note: The Non-medical Limit does not apply to any amount of insurance for which you were insured under another group contract providing employee term life coverage for Employees of the Employer on the day prior to the Program Date.

Increases and Decreases other than during the Annual Enrollment Period: You may elect to have your amount of insurance under the Coverage changed within 31 days of a Life Event. You must do this on a form approved by Prudential and agree to make any required contributions.

If you request an increase, you must give evidence of insurability. The amount of your insurance will be increased when Prudential decides the evidence is satisfactory and you meet the Active Work Requirement.

If you request a decrease, the amount of your insurance will be decreased on the date of your written request.

The Definitions section explains what “Life Event” means.

Changing Plans at Annual Enrollment: may enroll for Optional Employee Term Life Coverage or you may elect to have your amount of insurance under the Coverage changed during the Annual Enrollment Period. You must do this on a form approved by Prudential and agree to make any required contributions.

You must give evidence of insurability if: (a) you enroll more than 31 days after you first could have; or (b) if you request an increase of more than one option. Changes will become effective on the date designated by the Employer. But a new enrollment or an increase, which are subject to evidence, will be effective on the date Prudential decides the evidence is satisfactory, if this date is later. The Delay of Effective Date section applies to all changes except decreases.

Any Non-medical Limit will apply to an increased amount of coverage.

The Definitions section explains what "Annual Enrollment Period" means.

Amount Limit Due to Age: When you are age 70 or more, your amount of insurance is limited. It is the Limited Percent (for that Age) of the amount for which you would then be insured if there were no limitation. Each Age and the Limited Percent for that Age are shown below.

The Limited Percent for an Age takes effect on the day you become insured if you are then that Age. Otherwise, each Limited Percent for an Age takes effect on the first January 1 that occurs while you are that Age.

The Delay of Effective Date section does not apply to this Amount Limit Due to Age provision.

Effect of Option to Accelerate Payment of Death Benefits: Your amount of insurance (as determined in the absence of this provision) will be reduced by the amount of any Terminal Illness Proceeds paid under the Option to Accelerate Payment of Death Benefits.

Optional Dependents Term Life Insurance

The amount of insurance is the amount for your Benefit Class. You may enroll your Qualified Dependents for the plan shown below. If you may choose the amount of insurance or if there are options from which to select, the amount for which you enroll will be recorded by your Employer and reported to Prudential. Your Benefit Class is determined by the classification of your dependents and the amount for which you enroll as shown in this table:

Your Spouse or domestic partner:

*If this amount is not a multiple of $1,000, it will be rounded to the next higher multiple of $1,000.

Your Children – not available with spouse or Domestic Partner Option 1 Coverage:

**The amount of insurance on a dependent spouse or Domestic Partner will not exceed 100% of the amount for which you are insured under the Basic and Optional Employee Term Life Coverages.

The Definitions section explains what "Earnings" means.

Non-medical Limit on Amount of Insurance for Your Spouse or Domestic Partner: There is a limit on the amount for which your spouse or Domestic Partner may be insured without submitting evidence of insurability. This is called the Non-medical Limit.

If you elect an amount of Dependents Term Life Coverage for your spouse or Domestic Partner above the Non-medical Limit, you must give evidence of insurability for your spouse or Domestic Partner satisfactory to Prudential before the part over the Limit can become effective. The amount of your spouse's or Domestic Partner's insurance will be increased when Prudential decides the evidence is satisfactory and your spouse or Domestic Partner is not home or hospital confined for medical care or treatment. This requirement applies: when your spouse or Domestic Partner first becomes insured, or if you elect to have your spouse's or Domestic Partner's amount of Dependents Term Life Coverage increased.

Non-medical Limit: $25,000. If the Amount Limit for this Coverage applies at any time to your spouse's or Domestic Partner's amount of insurance, that Limit will also apply to the Non-medical Limit as if it were an amount of insurance.

The Delay of Effective Date section does not apply to this Non-medical Limit on Amount of Insurance for Your Spouse or Domestic Partner provision.

Increases and Decreases: You may elect to have the amount of insurance on your dependents changed within 31 days of a Life Event. You must do this on a form approved by Prudential and agree to make any required contributions.

If you request an increase in the amount of insurance on your spouse or Domestic Partner, you must give evidence of insurability for your spouse or Domestic Partner. The amount of insurance on your spouse or Domestic Partner will be increased when Prudential decides the evidence is satisfactory and your spouse or Domestic Partner is not home or hospital confined for medical care or treatment.

If you request an increase in the amount of insurance on a dependent child, the amount of insurance on that child will be increased on the date of your written request or, if later, when that child is not home or hospital confined for medical care or treatment. Evidence of insurability is not required for an increase in the amount of insurance on a child.

If you request a decrease in the amount of insurance on a dependent, the amount of insurance on that dependent will be decreased on the date of your written request.

The Definitions section explains what "Earnings" means.

Amount Limit Due to Age: When you are age 70 or more, your spouse's or Domestic Partner's amount of insurance is limited. It is the Limited Percent (for that Age) of the amount for which your spouse or Domestic Partner would then be insured if there were no limitation. Each Age and the Limited Percent for that Age are shown below.

The Limited Percent for an Age takes effect on the day you become insured if you are then that Age. Otherwise, each Limited Percent for an Age takes effect on the first January 1 that occurs while you are that Age.

The Delay of Effective Date section does not apply to this Amount Limit Due to Age provision.

Effect of Option to Accelerate Payment of Death Benefits for your Spouse or Domestic Partner: The amount of insurance (as determined in the absence of this provision) will be reduced by the amount of any Terminal Illness Proceeds paid under the Option to Accelerate Payment of Death Benefits with respect to the dependent.

When You Have a Claim

Each time a claim is made, it should be made without delay. Use a claim form, and follow the instructions on the form.

If you do not have a claim form, contact your Employer.

For Employee Insurance

You are eligible for employee insurance while:

• You are a full time Employee of the Employer; and
• You are in a Covered Class; and
• You have completed the Employment Waiting Period, if any. You may need to work for the Employer for a continuous full-time period before you become eligible for the Coverage. The period must be agreed upon by the Employer and Prudential. Your Employer will inform you of any such Employment Waiting Period for your class.

For all Full-time Employees, you are benefit eligible if you are scheduled to work for your Employer at least 1500 hours per year. If you are a partner or proprietor of the Employer, that work must be in the conduct of the Employer's business.

For all Employees classified as Part-time Employees, you are benefit eligible if you are scheduled to work for your Employer 750 hours or more per year. If you are a partner or proprietor of the Employer, that work must be in the conduct of the Employer's business.

For all Employees classified as Retirement Transition Employees, you are benefit eligible if you are scheduled to work for your Employer 750 hours or more per year. If you are a partner or proprietor of the Employer, that work must be in the conduct of the Employer's business.

Your class is determined by the Contract Holder. This will be done under its rules, on dates it sets. The Contract Holder must not discriminate among persons in like situations. You cannot belong to more than one class for insurance on each basis, Contributory or Non-contributory Insurance, under a Coverage. “Class" means Covered Class, Benefit Class or anything related to work, such as position or Earnings, which affects the insurance available.

This applies if you are an Employee of more than one subsidiary or affiliate of an employer included under the Group Contract: For the insurance, you will be considered an Employee of only one of those subsidiaries or affiliates. Your service with the others will be treated as service with that one.

The rules for obtaining Employee Insurance are in the When You Become Insured section.

For Dependent's Insurance

You are eligible for Dependents Insurance while:

• You are eligible for Employee Insurance; and
• You have a Qualified Dependent.

Qualified Dependents:

These are the persons for whom you may obtain Dependents Insurance:

• Your Spouse or Domestic Partner.
  • Your Domestic Partner is a person of the opposite sex who:
    1. you report in an affidavit of domestic partnership satisfactory to Prudential; and
    2. is in a single dedicated, serious and committed relationship with you of at least 12 months; and
    3. has shared a single permanent residence with you for at least 12 consecutive months prior to the person's enrollment in the Program; and
    4. is an unmarried adult 18 or older; and
    5. is not related to you by blood or a degree of closeness that would prohibit marriage in the law of the state in which you reside; and
    6. is mentally competent to consent to contract; and
    7. is not married to another person under statutory or common law nor in a domestic partnership with another person; and
    8. is financially interdependent with you; and
    9. is not otherwise a Qualified Dependent under the Program.
    Either a spouse or a Domestic Partner may be a Qualified Dependent under the Program at any one time, but not both at the same time.

  • Your unmarried children from live birth to 26 years old.

    Your children include your legally adopted children, children placed with you for adoption prior to legal adoption, and your Domestic Partner’s children who depend on you for support and maintenance. A child placed with you for adoption prior to legal adoption is considered your Qualified Dependent from the date of placement for adoption, and is treated as though the child were a newborn child born to you. Your children also include each of your stepchildren, who depends on you for support and maintenance.

Exceptions:

Your spouse, Domestic Partner or child is not your Qualified Dependent while:

1. on active duty in the armed forces of any country; and
2. insured under any Employee Term Life Coverage of the Group Contract; or
3. the spouse, Domestic Partner or child has protection under any Employee Term Life Coverage of the Group Contract after the spouse's, Domestic Partner's or child's insurance under that Coverage ends.

A child will not be considered the Qualified Dependent of more than one Employee. If this would otherwise be the case, the child will be considered the Qualified Dependent of the Employee named in a written agreement of all such Employees filed with the Contract Holder. If there is no written agreement, the child will be considered the Qualified Dependent of:

1. the Employee who became insured under the Group Contract with respect to the child, while the child was a Qualified Dependent of only that Employee; and otherwise
2. the Employee who has the longest continuous service with the Employer, based on the Contract Holder's records.

The rules for obtaining Dependents Insurance are in the When You Become Insured section.

For Employee Insurance

Your Employee Insurance under a Coverage will begin the first day on which:

• You have enrolled, if the Coverage is Contributory; and
• You are eligible for Employee Insurance; and
• You are in a Covered Class for that insurance; and
• You have met any evidence requirement for Employee Insurance; and
• Your insurance is not being delayed under the Delay of Effective Date section below; and
• That Coverage is part of the Group Contract.

For Contributory Insurance, you must enroll on a form approved by Prudential and agree to pay the required contributions. You may enroll for Contributory Insurance within 31 days of when you could first be covered, or within 31 days of a Life Event. Your Employer will tell you whether contributions are required and the amount of any contribution when you enroll.

At any time, the benefits for which you are insured are those for your class, unless otherwise stated.

The Definitions section explains what “Life Event” means.

When evidence is required: In any of these situations, you must give evidence of insurability. This requirement will be met when Prudential decides the evidence is satisfactory.

1. For Contributory Insurance, you enroll more than 31 days after you could first be covered.
2. You enroll after any of your insurance under the Group Contract ends because you did not pay a required contribution.
3. You wish to become insured for life insurance and have an individual life insurance contract which you obtained by converting your insurance under a Coverage of the Group Contract.
4. You have not met a previous evidence requirement to become insured under any Prudential group contract covering Employees of the Employer.

For Dependents Insurance

Your Dependents Insurance under a Coverage for a person will begin the first day on which all of these conditions are met:

• You have enrolled for Dependents Insurance under the Coverage, if the Coverage is Contributory.
• The person is your Qualified Dependent.
• You are in a Covered Class for that insurance.
• To be insured for a Qualified Dependent under the Dependents Term Life Coverage, Full-time Active Employees in the Retirement Transition Program must be insured under an Employee Term Life Coverage of the Group Contract.
• To be insured for a Qualified Dependent under the Dependents Term Life Coverage, Part-time Active Employees must be insured under the Optional Employee Term Life Coverage of the Group Contract.
• You have met any evidence requirement for that Qualified Dependent.
• Your insurance for that Qualified Dependent is not being delayed under the Delay of Effective Date section below.
• Dependents Insurance under that Coverage is part of the Group Contract.

For Contributory Insurance, you must enroll on a form approved by Prudential and agree to pay the required contributions. You may enroll for Contributory Insurance within 31 days of when you could first be covered, or within 31 days of a Life Event. Your Employer will tell you whether contributions are required and the amount of any contribution when you enroll.

At any time, the Dependents Insurance benefits for which you are insured are those for your class, unless otherwise stated.

The Definitions section explains what “Life Event” means.

When evidence is required: In any of these situations, you must give evidence of insurability for a Qualified Dependent spouse or Domestic Partner. This requirement will be met when Prudential decides the evidence is satisfactory. Evidence is not required for a Qualified Dependent child.

1. For Contributory Insurance, you enroll for Dependents Insurance under a Coverage more than 31 days after you are first eligible for Dependents Insurance.
2. You enroll for Dependents Insurance after any insurance under the Group Contract ends because you did not pay a required contribution.
3. The Qualified Dependent is a person for whom a previous requirement for evidence of insurability has not been met. The evidence was required for that person to become covered for an insurance, as a dependent or an Employee. That insurance is or was under any Prudential group contract for Employees of the Employer.

Change in Family Status: It is important that you inform the Employer promptly when you first acquire a Qualified Dependent. You should also inform the Employer if your Dependents Insurance status changes from one to another of these categories:

• No Qualified Dependents.
• Qualified Dependent Spouse or Domestic Partner only.
• Qualified Dependent Spouse or Domestic Partner and Children.
• Qualified Dependent Children only.

If you are insured under a Coverage for one or more children, you need not report additional children.

Forms are available for reporting these changes.

For Employee Insurance

Your Employee Insurance under a Coverage will be delayed if you do not meet the Active Work Requirement on the day your insurance would otherwise begin. Instead, it will begin on the first day you meet the Active Work Requirement and the other requirements for the insurance. The same delay rule will apply to any change in your insurance that is subject to this section. If you do not meet the Active Work Requirement on the day that change would take effect, it will take effect on the first day you meet that requirement.

For Dependents Term Life Coverage

A Qualified Dependent may be confined for medical care or treatment, at home or elsewhere. If a Qualified Dependent is so confined on the day that your Dependents Insurance under a Coverage for that Qualified Dependent, or any change in that insurance that is subject to this section, would take effect, it will not then take effect. The insurance or change will take effect upon the Qualified Dependent's final medical release from all such confinement. The other requirements for the insurance or change must also be met.

Newborn Child Exception: This section does not apply to a child of yours if the child is born to you, becomes your Qualified Dependent at birth, and either:

1. is your first Qualified Dependent; or
2. becomes a Qualified Dependent while you are insured for Dependents Insurance under that Coverage for any other Qualified Dependent.

Also, this section does not apply to any age increase in the amount of insurance for a child under the Dependents Term Life Coverage.

For You Only

A. Death Benefit While a Covered Person.

If you die while a Covered Person, the amount of your Employee Term Life Insurance under this Coverage is payable when Prudential receives written proof of death.

B. Death Benefit During Conversion Period.

A death benefit is payable under this Section B if you die:

1. within 31 days after you cease to be a Covered Person or within 31 days after the date your amount of Employee Term Life Insurance under this Coverage is reduced; and
2. while entitled (under Section C) to convert all or part of your Employee Term Life Insurance under this Coverage to an individual contract; and
3. before you make satisfactory application for the individual contract.

The amount of the benefit is equal to the amount of Employee Term Life Insurance under this Coverage you were entitled to convert. It is payable when Prudential receives written proof of death.

C. Conversion Privilege.

If you cease to be insured for all or part of the Employee Term Life Insurance of the Group Contract for one of the reasons stated below, you may convert your insurance under this Coverage, which then ends, to an individual life insurance contract. Evidence of insurability is not required. The reasons are:

1. Your employment ends, you transfer out of a Covered Class or the amount of your insurance is reduced by reason of age, retirement, change in Covered Class, or an amendment to the Group Contract that reduces the benefits for your class.
2. All term life insurance of the Group Contract for your class ends by amendment or otherwise.

All term life insurance of the Group Contract for your class ends by amendment or otherwise.

Availability: The individual contract must be applied for and the first premium must be paid according to the following rules:

1. If you have been given written notice of the conversion privilege within 15 days before or after you cease to be insured for all or part of the Employee Term Life Insurance, you must apply for the individual contract and pay the first premium within 31 days after you cease to be insured for that coverage.
2. If you have been given written notice of the conversion privilege more than 15 days but less than 90 days after you cease to be insured for all or part of the Employee Term Life Insurance, you must apply for the individual contract and pay the first premium within 45 days after you have been given the notice.
3. If you have not been given written notice of the conversion privilege within 90 days after you cease to be insured for all or part of the Employee Term Life Insurance, the time allowed for you to apply for the individual contract and pay the first premium ends at the end of the 90 days.

Individual Contract Rules: The individual contract must conform to the following:

Amount: If you cease to be insured for all of the Employee Term Life Insurance under this Coverage, the amount of individual insurance may not be more than your amount of insurance under this Coverage when your insurance ends. But, if your Employee Term Life Insurance under this Coverage ends because all term life insurance of the Group Contract ends, the total amount of individual insurance which you may get in place of all your life insurance then ending under the Group Contract will not exceed the total amount of all your life insurance then ending under the Group Contract reduced by the amount of group life insurance from any carrier for which you are or become eligible within the next 45 days.

If your amount of Employee Term Life Insurance under this Coverage is reduced, the amount of individual insurance may not be more than the amount of the reduction.

Form and Premium: You are entitled to any individual contract customarily issued by Prudential. Evidence of insurability is not required.

The premium will be calculated based on your class of risk under the Group Contract and the form and amount of the contract at your then attained age. The premium will have no distinction based on your sex.

Subject to the exceptions below, the individual contract does not include term insurance or a contract with waiver of premium, accelerated death benefits or accidental death and dismemberment benefits.

1. The contract may be issued, at your request, with preliminary term insurance that lasts for one year starting with its effective date.
2. If your insurance ends because your employment ends due to your total and permanent disability, any individual insurance contract customarily issued by Prudential, including term insurance, may be issued at your request.

Effective Date: The day you cease to be insured for the Employee Term Life Insurance or your amount of such insurance is reduced.

Any death benefit provided under a section of this Coverage is payable according to that section and the Beneficiary and Mode of Settlement Rules.

For You Only

A. Death Benefit While a Covered Person.

If you die while a Covered Person, the amount of your Employee Term Life Insurance under this Coverage is payable when Prudential receives written proof of death. But, all or part of the death benefit is not payable if it is excluded under Section D.

B. Death Benefit During Conversion Period.

A death benefit is payable under this Section B if you die:

1. after you cease to be a Covered Person or after the date your amount of Employee Term Life Insurance under this Coverage is reduced; and
2. while entitled (under Section C) to convert all or part of your Employee Term Life Insurance under this Coverage to an individual contract; and
3. before you make a satisfactory applicataion for the individual contract.

The amount of the benefit is equal to the amount of Employee Term Life Insurance under this Coverage you were entitled to convert. It is payable when Prudential receives written proof of death. But, all or part of the death benefit is not payable if it is excluded under Section D.

C. Conversion Privilege.

If you cease to be insured for all or part of the Employee Term Life Insurance of the Group Contract for one of the reasons stated below, you may convert your insurance under this Coverage, which then ends, to an individual life insurance contract. Evidence of insurability is not required. The reasons are:

• Your employment ends, you transfer out of a Covered Class or the amount of your insurance is reduced by reason of age, retirement, change in Covered Class, or an amendment to the Group Contract that reduces the benefits for your class.
• All term life insurance of the Group Contract for your class ends by amendment or otherwise.

Any such conversion is subject to the rest of this Section C.

Availability: The individual contract must be applied for and the first premium must be paid according to the following rules:

1. If you have been given written notice of the conversion privilege within 15 days before or after you cease to be insured for all or part of the Employee Term Life Insurance, you must apply for the individual contract and pay the first premium within 31 days after you cease to be insured for that coverage.
2. If you have been given written notice of the conversion privilege more than 15 days but less than 90 days after you cease to be insured for all or part of the Employee Term Life Insurance, you must apply for the individual contract and pay the first premium within 45 days after you have been given the notice.
3. If you have not been given written notice of the conversion privilege within 90 days after you cease to be insured for all or part of the Employee Term Life Insurance, the time allowed for you to apply for the individual contract and pay the first premium ends at the end of the 90 days.

Individual Contract Rules: The individual contract must conform to the following:

Amount: If you cease to be insured for all of the Employee Term Life Insurance under this Coverage, the amount of individual insurance may not be more than your amount of insurance under this Coverage when your insurance ends. But, if your Employee Term Life Insurance under this Coverage ends because all term life insurance of the Group Contract ends, the total amount of individual insurance which you may get in place of all your life insurance then ending under the Group Contract will not exceed the total amount of all your life insurance then ending under the Group Contract reduced by the amount of group life insurance from any carrier for which you are or become eligible within the next 45 days.

If your amount of Employee Term Life Insurance under this Coverage is reduced, the amount of individual insurance may not be more than the amount of the reduction.

Form and Premium: You are entitled to any individual contract customarily issued by Prudential. Evidence of insurability is not required.

The premium will be calculated based on your class of risk under the Group Contract and the form and amount of the contract at your then attained age. The premium will have no distinction based on your sex.

Subject to the exceptions below, the individual contract does not include term insurance or a contract with waiver of premium, accelerated death benefits or accidental death and dismemberment benefits.

• The contract may be issued, at your request, with preliminary term insurance that lasts for one year starting with its effective date.
• If your insurance ends because your employment ends due to your total and permanent disability, any individual insurance contract customarily issued by Prudential, including term insurance, may be issued at your request.

Effective Date: The day you cease to be insured for the Employee Term Life Insurance or your amount of such insurance is reduced.

D. Suicide Exclusion.

If your death results from or is caused by suicide:

1. The term insurance death benefit is not payable if you die because of suicide within two years of the date you became a Covered Person. But, Prudential will refund any premiums paid for your Employee Term Life Insurance under this Coverage.
2. The amount of any applied for increase in your death benefit is not payable if you die because of suicide within two years of the date of the increase. But, Prudential will refund any premiums paid for that increase.

Any death benefit provided under a section of this Coverage is payable according to that section and the Beneficiary and Mode of Settlement Rules.

Notes:

1. Receipt of accelerated death benefits may affect eligibility for public assistance programs and may be taxable.
2. If you elect this option, you will not be charged an administrative fee, and the Terminal Illness Proceeds described below will not be discounted.

The following is added to the Employee Term Life Coverage provision:

Definitions:

• Terminally Ill Employee: An employee whose life expectancy is 12 months or less.
• Terminal Illness Proceeds: The amount of Employee Term Life Insurance that you may elect to place under this option. The Terminal Illness Proceeds are equal to 90% of the amount in force on your life on the date Prudential receives the proof that you are a Terminally Ill Employee, but not more than $500,000. But, you may elect a smaller amount that is not less than the Minimum Election Amount. The Minimum Election Amount is the lesser of 25% of the amount in force on your life on the date Prudential receives the proof that you are a Terminally Ill Employee and $50,000.
• The Terminal Illness Proceeds may be reduced if, within 12 months after the date Prudential receives such proof, a reduction on account of age would have applied to the amount of your Employee Term Life Insurance. In that case, the amount of the Terminal Illness Proceeds may not exceed the amount of such Insurance after applying the reduction.

Options: If you become a Terminally Ill Employee while insured under the Employee Term Life Insurance provision or while your death benefit protection is being extended under the Employee Term Life Coverage provision, you may elect to have the Terminal Illness Proceeds placed under this option. That election is subject to the conditions set forth below.

Payment of Terminal Illness Proceeds: If you elect this option, Prudential will pay the Terminal Illness Proceeds you place under this option in one sum when it receives proof that you are a Terminally Ill Employee.

To Whom Payable: The benefits under this provision are payable to you.

Conditions: Your right to be paid under this option is subject to these terms:

1. You must choose this option in writing in a form that satisfies Prudential.
2. You must furnish proof that satisfies Prudential that your life expectancy is 12 months or less, including certification by a Doctor.
3. Your Employee Term Life Insurance must not be assigned.
4. Terminal Illness Proceeds will be made available to you on a voluntary basis only. Therefore:
   • If you are required by law to use this option to meet the claims of creditors, whether in bankruptcy or otherwise, you are not eligible for this benefit.
   • If you are required by a government agency to use this option in order to apply for, get or keep a government benefit or entitlement, you are not eligible for this benefit.

Effect on Insurance: This benefit is in lieu of the benefits that would have been paid on your death with respect to the Terminal Illness Proceeds. When you elect this option, the total amount of Employee Term Life Insurance otherwise payable on your death, including any amount under an extended death benefit, will be reduced by the Terminal Illness Proceeds. Also, you may not convert any amount of Employee Term Life Insurance which ends because it is paid under this option.

Effect on Contributions: The amount of your contribution, if any, will be adjusted based on the amount of your Employee Term Life Coverage remaining in force.

This right applies to the Employee Term Life Coverage under the Group Contract.

It describes when and how you may become covered for similar coverage under the Portability Plan when your Employee Term Life Coverage under the Group Contract ends. The terms and conditions of the Portability Plan will not be the same as those under this Group Contract. The amount of insurance available under the Portability Plan may not be the same as the amount under this Group Contract.

Right to Apply for Coverage Under the Portability Plan

A right under this section is subject to the rest of these provisions.

You will have the right to apply for term life coverage under the Portability Plan if you meet all of these tests:

1. Your Employee Term Life Coverage ends for any reason other than:
   • your failure to pay, when due, any contribution required for it; or
   • the end of the Coverage for all Employees when such Coverage is replaced by group life insurance from any carrier for which you are or become eligible within the next 45 days.
2. You are less than age 80.
3. Your Amount of Insurance is at least $20,000 under the Employee Term Life Coverage on the day your insurance ends.

Portability Application Period

You have the right to apply for coverage under the Portability Plan during the Portability Application Period.

The Portability Application Period is the 31 day period after your Employee Term Life Coverage ends, subject to the following exceptions:

1. If you have been given written notice of the right to elect coverage under the Portability Plan more than 15 days but less than 90 days after you cease to be insured for the Employee Term Life Coverage, the Portability Application Period is the 45 day period after you have been given such notice.
2. If you have not been given written notice of the right to elect coverage under the Portability Plan within 90 days after you cease to be insured for the Employee Term Life Coverage, the Portability Application Period is the 90 day period after your Employee Term Life Coverage ends.

Effect of Conversion Period.

The right to elect coverage under the Portability Plan is provided in lieu of the conversion privilege described in the Employee Term Life Coverage, except as follows:

1. You may convert your amount of insurance under the Employee Term Life Coverage in excess of any applicable maximum for term life coverage under the Portability Plan.
2. You will have a conversion privilege under the Portability Plan. The conversion privilege under the Portability Plan will be described in your certificate of coverage for the Portability Plan.

If you elect to convert all of your insurance under the Employee Term Life Coverage to an individual contract, you may not elect to apply for coverage under the Portability Plan.

If, during the Portability Application Period, you apply for coverage under the Portability Plan and then elect to convert all of your insurance under the Employee Term Life Coverage to an individual contract, your coverage under the Portability Plan will not become effective.

The right to elect coverage under the Portability Plan does not affect your coverage under the Death Benefit During Conversion Period provision of the Employee Term Life Coverage.

Terms and Conditions of the Portability Plan

The terms and conditions of that coverage will not be the same as the Employee Term Life Coverage under the Group Contract. The form, amount, first premium, and effective date will be as stated below.

Form: The form of term life coverage that Prudential then makes available under the Portability Plan.

Amount: Not more than your amount of insurance under the Employee Term Life Coverage when your insurance ends. The maximum amount of term life insurance under the Portability Plan is the lesser of 5 times your annual Earnings and $1,000,000.

First Premium: The first premium is due to Prudential by the later of the end of the Portability Application Period and 31 days from receipt of the first bill.

Effective Date: The day you cease to be insured for the Employee Term Life Insurance.

For Your Dependents Only

A. Death Benefit While a Covered Person.

If a dependent dies while a Covered Person, the amount of insurance on that dependent under this Coverage is payable when Prudential receives written proof of death. But, all or part of the death benefit is not payable if it is excluded under Section D.

B. Death Benefit During a Conversion Period.

A death benefit is payable under this Section B if a dependent dies:

1. after ceasing to be a Covered Person or after the date the amount of insurance for which you are insured under this Coverage with respect to a dependent is reduced; and
2. while entitled (under Section C) to a conversion of all or part of the insurance under this Coverage to an individual contract; and
3. before satisfactory application for the individual contract is made.

The amount of the benefit is equal to the amount of Dependents Term Life Coverage which could have been converted. It is payable when Prudential receives written proof of death. But, all or part of the death benefit is not payable if it is excluded under Section D.

C. Conversion Privilege.

This privilege applies if you cease to be insured for all or part of the Dependents Term Life Coverage of the Group Contract with respect to a dependent for any reason, except failure to make any required contribution for insurance under the Group Contract. It also applies if your amount of insurance under this Coverage with respect to a dependent is reduced by reason of age, your retirement, change in Covered Class, the end of your membership in a Covered Class, or an amendment to the Group Contract that changes the benefits for your class. That dependent may have your insurance on the dependent under this Coverage, which then ends, converted to an individual life insurance contract.

Any such conversion is subject to the rest of this Section C.

Availability: The conversion privilege will be available to you, except that it will be available:

1. upon your death, to your surviving spouse or Domestic Partner with respect to such spouse or Domestic Partner and children for whom you are insured under the Coverage at your death; and
2. upon your divorce or annulment or your Domestic Partner ceasing to be a Qualified Dependent, to your spouse or Domestic Partner or former spouse or Domestic Partner; and
3. to your child or other dependent child when that child reaches the age limit in the definition of Qualified Dependent; and
4. to any other dependent who ceases to be a Qualified Dependent.

The individual contract must be applied for and the first premium must be paid according to the following rules:

1. If written notice of the conversion privilege has been given within 15 days before or after you cease to be insured for the Dependents Term Life Coverage with respect to the dependent or the amount of such insurance is reduced, the individual contract must be applied for and the first premium must be paid within 31 days after you cease to be insured for that Coverage or the amount of such insurance is reduced.
2. If written notice of the conversion privilege has been given more than 15 days but less than 90 days after you cease to be insured for the Dependents Term Life Coverage with respect to the dependent or the amount of such insurance is reduced, the individual contract must be applied and the first premium must be paid within 45 days after the notice has been given.
3. If written notice of the conversion privilege has not been given within 90 days after you cease to be insured for the Dependents Term Life Coverage with respect to the dependent or the amount of such insurance is reduced, the time allowed to apply for the individual contract and pay the first premium ends at the end of the 90 days.

Individual Contract Rules: The individual contract must conform to the following:

Amount: If you cease to be insured for the Dependents Term Life Coverage with respect to a dependent, not more than the amount of such insurance ending under this Coverage. But, if it ends because all the Dependents Term Life Coverage of the Group Contract ends, the total amount of individual insurance which may be obtained in place of all the Dependents Term Life Coverage on the dependent then ending under the Group Contract will not exceed the lesser of the total amount of all your Dependents Term Life Coverage on the dependent then ending under the Group Contract reduced by the amount of group life insurance from any carrier for which you are or become eligible with respect to the dependent within the next 45 days.

If your amount of insurance under this Coverage on a dependent is reduced, not more than the amount of the reduction.

Form and Premium: Any individual contract customarily issued by Prudential. Evidence of insurability is not required.

The premium will be calculated based on the dependent's class or risk under the Group Contract and the form and amount of the contract at the dependent's then attained age. The premium will have no distinction based on the dependent's sex.

Subject to the exceptions below, the individual contract does not include term insurance or a contract with waiver of premium, accelerated death benefits or accidental death and dismemberment benefits.

1. The contract may be issued with preliminary term insurance that lasts for one year starting with its effective date.
2. If your insurance on a dependent under this Coverage ends because your employment ends due to your total and permanent disability, any individual insurance contract customarily issued by Prudential, including term insurance, may be issued.

Effective Date: The day you cease to be insured for Dependents Term Life Coverage with respect to the dependent or the amount of such insurance is reduced.

D. Suicide Exclusion

If a dependent’s death results from or is caused by suicide:

1. A death benefit is not payable if the dependent dies within two years of the date the dependent became a Covered Person. But, Prudential will refund any premiums paid for the Dependents Term Life Coverage on that dependent.
2. The amount of any applied for increase in the death benefit with respect to the dependent is not payable if the dependent dies within two years of the date of the increase. But, Prudential will refund any premiums paid for that increase.

Any death benefit provided under a section of this Coverage is payable to you. If you are not living at the death of a dependent*, the death benefit is payable to the dependent's estate or, at Prudential's option, to any one or more of these surviving relatives of the dependent: wife; husband; mother; father; children; brothers; sisters.

*If you and a dependent die in the same event and it cannot be determined who died first, the insurance will be payable as if that dependent died before you.

For Your Dependents

Notes:

1. Receipt of accelerated death benefits may affect eligibility for public assistance programs and may be taxable.
2. If you elect this option, you will not be charged an administrative fee, and the Terminal Illness Proceeds described below will not be discounted.

The following is added to the Dependents Term Life Coverage provision:

Definitions:

• Terminally Ill Dependent: A dependent spouse or Domestic Partner whose life expectancy is 12 months or less.
• Terminal Illness Proceeds: The amount of Dependents Term Life Insurance that you may elect to place under this option. The Terminal Illness Proceeds are equal to 50% of the amount in force on your dependent’s life on the date Prudential receives the proof that your dependent is a Terminally Ill Dependent, but not more than $100,000.

However, the Terminal Illness Proceeds may be reduced if, within 12 months after the date Prudential receives such proof, a reduction on account of age would have applied to the amount of your Dependents Term Life Insurance for that dependent. In that case, the amount of the Terminal Illness Proceeds may not exceed the amount of such Insurance after applying the reduction.

Option: If your dependent becomes a Terminally Ill Dependent while insured under the Dependents Term Life Insurance provision, or while the dependent’s death benefit protection is being extended under the Dependents Term Life Insurance provision, you may elect to have the Terminal Illness Proceeds placed under this option. That election is subject to the conditions set forth below.

Payment of Terminal Illness Proceeds: If you elect this option, Prudential will pay the Terminal Illness Proceeds you place under this option in one sum when it receives proof that your dependent is a Terminally Ill Dependent.

To Whom Payable: The benefits under this provision are payable to you.

Conditions: Your right to be paid under this option is subject to these terms:

1. You must choose this option in writing in a form that satisfies Prudential.
2. You must furnish proof that satisfies Prudential that your dependent’s life expectancy is 12 months or less, including certification by a Doctor.
3. Your Dependents Term Life Insurance must not be assigned.
4. Terminal Illness Proceeds will be made available to you on a voluntary basis only. Therefore:
   • If you are required by law to use this option to meet the claims of creditors, whether in bankruptcy or otherwise, you are not eligible for this benefit.
   • If you are required by a government agency to use this option in order to apply for, get or keep a government benefit or entitlement, you are not eligible for this benefit.

Effect on Insurance: This benefit is in lieu of the benefits that would have been paid on your dependent’s death with respect to the Terminal Illness Proceeds. When you elect this option, the total amount of Dependents Term Life Insurance otherwise payable on your dependent’s death, including any amount under an extended death benefit, will be reduced by the Terminal Illness Proceeds. Also, you may not convert any amount of Dependents Term Life Insurance which ends because it is paid under this option.

Effect on Contributions: The amount of your contribution, if any, will be adjusted based on the amount of your Dependents Term Life Coverage remaining in force.

This right applies to the Optional Dependents Term Life Coverage under the Group Contract.

It describes when and how your Qualified Dependents may become covered for similar coverage under the Portability Plan when your Optional Dependents Term Life Coverage under the Group Contract ends. The terms and conditions of the Portability Plan will not be the same as those under this Group Contract. The amount of insurance available under the Portability Plan may not be the same as the amount under this Group Contract.

Right to Apply for Coverage Under the Portability Plan.

A right under this section is subject to the rest of these provisions.

You will have the right to apply for dependents term life coverage under the Portability Plan for a Qualified Dependent if all of these tests are met:

1. The Optional Dependents Term Life Coverage on the dependent ends because your Employee Term Life Coverage ends for any reason other than:
   1. your failure to pay, when due, any contribution required for it; or
   2. the end of the Employee Term Life Coverage for all Employees when such Coverage is replaced by group life insurance from any carrier for which you are or become eligible within the next 45 days.
2. You apply and become covered for term life coverage under the Portability Plan.
3. With respect to a dependent spouse or Domestic Partner, that spouse or Domestic Partner is less than age 80.
4. With respect to a dependent child, that child is less than age 26.
5. The dependent is covered for Optional Dependents Term Life Coverage on the day your Employee Term Life Coverage ends.
6. The dependent is not confined for medical care or treatment, at home or elsewhere on the day your Employee Term Life Coverage ends.

If you die, your spouse or Domestic Partner will have the right to apply for term life coverage under the Portability Plan if that spouse or Domestic Partner meets all of the tests in (3), (5) and (6) above.

If you die, your spouse or Domestic Partner will also have the right to apply for dependents term life coverage under the Portability Plan for a Qualified Dependent child if:

1. that spouse or Domestic Partner applies and becomes covered under the Portability Plan; and
2. that child meets all of the tests in (4), (5) and (6) above.

If you divorce or your Domestic Partner ceases to be a Qualified Dependent, your spouse or Domestic Partner will have the right to apply for term life coverage under the Portability Plan if:

1. the Optional Dependents Term Life Coverage on your spouse or Domestic Partner ends due to divorce or your Domestic Partner ceasing to be a Qualified Dependent; and
2. that spouse or Domestic Partner is less than age 80; and
3. that spouse or Domestic Partner is not confined for medical care or treatment, at home or elsewhere on the day the Optional Dependents Term Life Coverage on that spouse or Domestic Partner ends.

Portability Application Period

You have the right to apply for dependents term life coverage under the Portability Plan for your dependents during the Portability Application Period. In the case of your death or divorce or your Domestic Partner ceasing to be a Qualified Dependent, your spouse or Domestic Partner has the right to apply for coverage under the Portability Plan during the Portability Application Period.

The Portability Application Period is the 31 day period after the Optional Dependents Term Life Coverage with respect to the dependent ends, subject to the following exceptions:

1. If written notice of the right to elect coverage under the Portability Plan is given more than 15 days but less than 90 days after the Optional Dependents Term Life Coverage with respect to the dependent ends, the Portability Application Period is the 45 day period after such notice has been given.
2. If written notice of the right to elect coverage under the Portability Plan is not given within 90 days after the Optional Dependents Term Life Coverage with respect to the dependent ends, the Portability Application Period is the 90 day period after such coverage ends.

Effect of Conversion Privilege

The right to elect coverage under the Portability Plan is provided in lieu of the conversion privilege described in the Optional Dependents Term Life Coverage, except as follows:

• If a dependent’s amount of insurance under the Optional Dependents Term Life Coverage exceeds any applicable maximum, the dependent may convert the amount in excess of that maximum.
• Your dependent will have a conversion privilege under the Portability Plan. The conversion privilege under the Portability Plan will be described in the certificate of coverage for the Portability Plan.

If a dependent elects to convert all of the insurance under the Optional Dependents Term Life Coverage to an individual contract, you or, in the case of your death or divorce or your Domestic Partner ceasing to be a Qualified Dependent, your spouse or Domestic Partner may not elect to apply for coverage under the Portability Plan for that dependent.

If, during the Portability Application Period, you or, in the case of your death or divorce or your Domestic Partner ceasing to be a Qualified Dependent, your spouse or Domestic Partner applies for coverage under the Portability Plan for a dependent and that dependent then elects to convert all of the insurance under the Optional Dependents Term Life Coverage to an individual contract, that dependent’s coverage under the Portability Plan will not become effective.

The right to elect coverage under the Portability Plan does not affect a dependent’s coverage under the Death Benefit During a Conversion Period provision of the Optional Dependents Term Life Coverage.

Terms and Conditions of the Portability Plan

The terms and conditions of that coverage will not be the same as those under the Group Contract. The form, amount, first premium, and effective date will be as stated below.

Form: The form of dependents term life coverage that Prudential then makes available under the Portability Plan.

Amount: Not more than the amount of insurance on the dependent under the Optional Dependents Term Life Coverage when that insurance ends. For each dependent, the maximum amount of dependents term life insurance under the Portability Plan is the lesser of 5 times your annual Earnings and $1,000,000.

First Premium: The first premium is due to Prudential by the later of the end of the Portability Application Period and 31 days from receipt of the first bill.

Effective Date: The day you cease to be insured for Dependents Term Life Coverage with respect to the dependent.

Beneficiary Rules

The rules in this section apply to insurance payable on account of your death, when the Coverage states that they do. But these rules are modified by any burial expenses rule in the Schedule of Benefits and, if there is an assignment, by the following sections: Limits on Assignments; and Effect of Gift Assignment of Rights of Group Life Insurance Under Another Group Contract.

“Beneficiary" means a person chosen, on a form approved by Prudential, to receive the insurance benefits.

You have the right to choose a Beneficiary.

If there is a Beneficiary for the insurance, it is payable to that Beneficiary. Any amount of insurance for which there is no Beneficiary at your death will be payable to the first of the following: your (a) surviving spouse; (b) surviving child(ren) in equal shares; (c) surviving parents in equal shares; (d) surviving siblings in equal shares; (e) estate. This order will apply unless otherwise provided in the Limits on Assignments.

You may change the Beneficiary at any time without the consent of the present Beneficiary. The Beneficiary change form must be filed through the Contract Holder. The change will take effect on the date the form is signed. But it will not apply to any amount paid by Prudential before it receives the form.

If there is more than one Beneficiary but the Beneficiary form does not specify their shares, they will share equally. If a Beneficiary dies before you, that Beneficiary's interest will end. It will be shared equally by any remaining Beneficiaries, unless the Beneficiary form states otherwise.

Mode of Settlement Rules.

The rules in this section apply to Life Insurance payable on account of a Covered Person’s death. But these rules are subject to the Limits on Assignments and Effect of Gift Assignment of Rights of Group Life Insurance Under Another Group Contract sections.

Life Insurance is normally paid to the Beneficiary in one sum. Subject to applicable law, where the amount of the benefit meets Prudential's current minimum requirement, payment in one sum will be made by establishing a retained asset account in the Beneficiary’s name, unless the Beneficiary elects another settlement or payment option available at the time of claim, and the benefit distribution will be deemed complete when the account is established. The retained asset account is an interest- bearing draft account backed by the financial strength of Prudential. Funds are held in Prudential’s general account or elsewhere as Prudential may direct and an account in the Beneficiary’s name is credited interest at a rate set by Prudential’s discretion, subject to a minimum rate that will change no more than once every 90 days on advance notice to the Beneficiary. The Beneficiary is provided a draftbook and has immediate access to the entire amount by writing drafts for any amount up to the account balance. The retained asset account is not a bank account and is not insured by the Federal Deposit Insurance Corporation; it is a contractual undertaking between Prudential and the Beneficiary. Further information about the account is provided at the time of claim. Prudential may at its discretion provide other forms of payment in one sum. But another mode of settlement may be arranged with Prudential for all or part of the insurance, as stated below.

Arrangements for Mode of Settlement: You may arrange a mode of settlement by proper written request to Prudential.

If, at a Covered Person’s death, no mode of settlement has been arranged for an amount of the person’s Life Insurance, the Beneficiary and Prudential may then mutually agree on a mode of settlement for that amount.

Conditions for Mode of Settlement: The Beneficiary must be a natural person taking in the Beneficiary's own right. A mode of settlement will apply to secondary Beneficiaries only if Prudential agrees in writing. Each installment to a person must not be less than $20.00. A change of Beneficiary will void any mode of settlement arranged before the change.

Choice by Beneficiary: A Beneficiary being paid under a mode of settlement may, if Prudential agrees, choose (or change the Beneficiary's choice of) a payee or payees to receive, in one sum, any amount which would otherwise be payable to the Beneficiary's estate.

Prudential has prepared information about the modes of settlement available. Ask the Contract Holder for this.

Incontestability of Life Insurance

This limits Prudential's use of a person's statements in contesting an amount of Life Insurance for which the person is insured. These are statements made to persuade Prudential to accept the person for insurance. They will be considered to be made to the best of the person's knowledge and belief. These rules apply to each statement:

1. It will not be used in the contest unless:
   1. It is in a written instrument signed by the person and
   2. A copy of that instrument is or has been furnished to the person or to the person's Beneficiary.
2. If it relates to the person's insurability, it will not be used to contest the validity of insurance which has been in force, before the contest, for at least two years during the person's lifetime.

Limits on Assignments

You may assign your insurance under a Coverage. Any rights, benefits or privileges that you have as an Employee may be assigned without restriction. This includes any right you have to choose a Beneficiary or to convert to another contract of insurance. Prudential will not decide if an assignment does what it is intended to do. Prudential will not be held to know that one has been made unless it or a copy is filed with Prudential through the Contract Holder.

This paragraph applies only to insurance for which you have the right to choose a Beneficiary, when that right has been assigned. If an assigned amount of insurance becomes payable on account of your death and, on the date of your death, there is no Beneficiary chosen by the assignee, it will be payable to:

1. the assignee, if living; or
2. the estate of the assignee, if the assignee is not living.

It will not be payable as stated in the Beneficiary Rules.

Effect of Gift Assignment of Rights of Groups Life Insurance Under Another Group Contract.

This Section applies to all Coverages providing Employee death benefits.

If you are eligible for insurance under the Group Contract on the Group Contract’s effective date you will have no rights, benefits or privileges under any such Coverage if, on the day before that date, all the following were true:

1. You were insured for group life insurance under another group contract. That contract was issued by Prudential or another insurance carrier to cover Employees of the Employer.
2. Your group life insurance under the other group contract ended.
3. An irrevocable and absolute gift assignment made by you was in effect. It was made before the other contract ended. That assignment was of all your rights, benefits and privileges of the group life insurance under the other group contract. Those rights were owned by the assignee or the assignee’s successor.

The owner of those rights of the group life insurance under the other group contract on the day before this Group Contract’s effective date will be the owner of the rights, benefits, and privileges you would have had under a Coverage if this section did not apply. This includes, but is not limited to, any right of assignment you would have had under the Limits on Assignments section above. The term “assignee” as used in that section includes such an owner.

The term “group life insurance”, as used above, means only group life insurance provided under a group contract in effect on the day before the date the Employer became included under the Group Contract.

Definitions

Active Work Requirement: A requirement that you be actively at work on a full time basis at the Employer's place of business or at any other place that the Employer's business requires you to go. You are considered actively at work during a normal vacation if you were actively at work on your last regularly scheduled workday.

Annual Enrollment Period: There is a period each year during which you may enroll for Coverage or request a change in Coverage for the following Calendar Year. The Contract Holder will notify you of when this Annual Enrollment Period begins and ends.

Calendar Year: A year starting January 1.

Contributory Insurance, Non-contributory Insurance: Contributory Insurance is insurance for which the Contract Holder has the right to and may require your direct contribution to the cost of coverage. Non-contributory Insurance premiums are paid by the Contract Holder, usually without direct contribution from you. The rate for Non-contributory insurance may be determined, or in some cases, reduced, in part, based on your contributions for contributory insurance or other benefits offered to you under the Contract Holder benefit plan.

Coverage: A part of the Booklet consisting of:

1. A benefit page labeled as a Coverage in its title.
2. Any page or pages that continue the same kind of benefits.
3. A Schedule of Benefits entry and other benefit pages or forms that by their terms apply to that kind of benefits.

Covered Person under a Coverage: An Employee who is insured for Employee Insurance under that Coverage; a Qualified Dependent for whom an Employee is insured for Dependents Insurance, if any, under that Coverage.

Dependents Insurance: Insurance on the person of a dependent.

Doctor: A licensed practitioner of the healing arts acting within the scope of the license.

Earnings: This is the gross amount of money paid to you by the Employer in cash for performing the duties required of your job, determined as of January 1 of each year. Bonuses, overtime pay, Earnings for more than 40 hours per week, and all other benefits are not included.

Employee: A person employed by the Employer; a proprietor or partner of the Employer. The term also applies to that person for any rights after insurance ends.

Employee Insurance: Insurance on the person of an Employee.

The Employer: Collectively, all employers included under the Group Contract.

Injury: Injury to the body of a Covered Person.

Life Event: Any of the following which constitute a change in family status:

1. your marriage or divorce;
2. becoming or ceasing to be a Domestic Partner;
3. the death of your Spouse, Domestic Partner, or child;
4. the birth or adoption of your child;
5. employment or termination of employment of your Spouse or Domestic Partner;
6. switching from part-time to full-time Employee status (or vice versa) by you or your Spouse or Domestic Partner;
7. you or your Spouse or Domestic Partner taking an unpaid leave of absence;
8. a significant change in your health coverage that is attributable to your Spouse’s or Domestic Partner's employment.

Prudential: The Prudential Insurance Company of America.

Sickness: Any disorder of the body or mind of a Covered Person, but not an Injury; Sickness also includes pregnancy of a Covered Person, including abortion, miscarriage or childbirth.

You: An Employee.

Employee and Dependents Insurance

Your Employee Insurance under a Coverage or your Dependents Insurance under a Coverage will end when the first of these occurs:

• You are no longer in the Covered Classes for the insurance because your employment ends (see below) or because your class changes.
• Your class is removed from the Covered Classes for the insurance.
• The part of the Group Contract providing the insurance ends.
• You make a written request to the Contract Holder to end your Employee or Dependents Insurance under a Coverage.
• You fail to pay, when due, any contribution required for an insurance of the Group Contract. But, failure to contribute will not cause Non-Contributory Insurance to end, and failure to contribute for Dependents Insurance will not cause your Employee Insurance to end.
• The Insurance is Dependents Insurance under the Dependents Term Life Coverage and your Employee Insurance under the Employee Term Life Coverage ends.

Your Dependents Insurance for a Qualified Dependent under a Coverage will end when that person ceases to be a Qualified Dependent for that Coverage. (See Continued Coverage for an Incapacitated Child below.)

End of Employment: For insurance purposes, your employment will end when you are no longer a full-time Employee actively at work for the Employer. But, under the terms of the Group Contract, the Contract Holder may consider you as still employed in the Covered Classes during certain types of absences from full-time work. This is subject to any time limits or other conditions stated in the Group Contract.

If you stop active full-time work for any reason, you should contact the Employer at once to determine what arrangements, if any, have been made to continue any of your insurance.

Continued Coverage for an Incapacitated Child: This applies to the Dependents Insurance you have for a child. The insurance for the child will not end on the date the age limit in the definition of Qualified Dependent is reached if both of these are true:

1. The child is then mentally or physically incapable of earning a living. Prudential must receive proof of this within the next 31 days.
2. The child otherwise meets the definition of Qualified Dependent.

If these conditions are met, the age limit will not cause the child to stop being a Qualified Dependent under that Coverage. This will apply as long as the child remains so incapacitated.

The Certificate of Coverage and the following Additional Information (together, the Booklet), are intended to comply with the disclosure requirements of the regulations issued by the U.S. Department of Labor under the Employee Retirement Income Security Act (ERISA) of 1974. ERISA requires that your employer provide you with a "Summary Plan Description" which describes the plan and informs you of your rights under it. Information about eligibility rules, benefits amounts, benefit limitations, and exclusions from coverage is contained in the Certificate of Coverage. The following Additional Information about your plan is provided at the request of your Employer/Plan Sponsor.

*Service of legal process may also be made upon the plan administrator at the address above.

Plan Sponsor’s Designation of Prudential As Claims Administrator

It is the Plan Sponsor’s intention and direction that The Prudential Insurance Company of America as Claims Administrator has the sole discretion to interpret the terms of the plan, to make factual findings, and to determine eligibility for benefits. The Plan Sponsor has determined that benefits are payable under the plan only if The Prudential Insurance Company of America, in its sole discretion, determines that they are due. The decision of the Claims Administrator shall not be overturned unless arbitrary and capricious. *

* This paragraph does not apply to residents of AK, AR, CA, CO, DC, IL, KY, MD, ME, MI, NJ, NY, OR, PR, RI, SD, TX, VT, WA

Plan Sponsor, Policyholder and Employer not Agents of Prudential

The Group Contract underwritten by The Prudential Insurance Company of America provides insured benefits under your Employer/Policyholder/Plan Sponsor's ERISA plan(s). For all purposes associated with the plan or the Group Contract under which The Prudential Insurance Company of America provides benefits, the Employer/Policyholder/Plan Sponsor acts on its own behalf or as an agent of its employees. Under no circumstances will the Employer/Policyholder/Plan Sponsor be deemed the agent of The Prudential Insurance Company of America, absent a written authorization of such status executed between the Employer/Policyholder/Plan Sponsor and The Prudential Insurance Company of America. Nothing in these documents shall, of themselves, be deemed to be such a written authorization.

Allocation of Contributions

The insurance benefit coverages described in this Booklet are being offered to you under a single ERISA plan. Coverages described as non-contributory or as being paid entirely by the Employer/Policyholder/Plan Sponsor (if any) are those paid for directly by the Employer/Policyholder/Plan Sponsor such that you have no out of pocket expense for such coverages. However, the premium rate that the Employer/Policyholder/Plan Sponsor pays for insurance coverage offered to you under the Plan may be determined, or in some cases, reduced, in part, based on your contributions for other coverages or other benefits offered under the Plan. When this occurs, your contributions for one benefit coverage may cover some or all of the costs or plan expenses for another benefit coverage offered to you under the Plan.

Loss of Benefits

You must continue to be a member of a class of eligible employees or beneficiaries to which the plan pertains and continue to make any contributions or payments that are due, including those you agreed to when you enrolled for coverage. Failure to make required contributions may result in partial or total loss of your benefits.

Plan Sponsor May Amend or Terminate the Plan at any Time

It is intended that this plan will be continued for an indefinite period of time. But, the Plan Sponsor reserves the right to change or terminate the plan at any time. This Booklet elsewhere describes your rights upon termination of the plan.

1. Determination of Benefits.

Prudential shall notify you of the claim determination within 45 days of the receipt of your claim. This period may be extended by 30 days if such an extension is necessary due to matters beyond the control of the plan. A written notice of the extension, the reason for the extension and the date by which the plan expects to decide your claim, shall be furnished to you within the initial 45-day period. This period may be extended for an additional 30 days beyond the original 30-day extension if necessary due to matters beyond the control of the plan. A written notice of the additional extension, the reason for the additional extension and the date by which the plan expects to decide on your claim, shall be furnished to you within the first 30-day extension period if an additional extension of time is needed. However, if a period of time is extended due to your failure to submit information necessary to decide the claim, the period for making the benefit determination by Prudential will be tolled (i.e., suspended) from the date on which the notification of the extension is sent to you until the date on which you respond to the request for additional information.

If your claim for benefits is denied, in whole or in part, you or your authorized representative will receive a written notice from Prudential of your denial. The notice will include:

1. the specific reason(s) for the denial, which will include a discussion of the decision describing, if applicable, the basis for disagreeing with or not following (i) the views of your treating providers, (ii) the views of medical or vocational experts whose advice was obtained on behalf of the plan in connection with your adverse benefit determination, without regard to whether the advice was relied upon in making the benefit determination, and (iii) an award of Social Security Administration disability benefits,
2. references to the specific plan provisions on which the benefit determination was based,
3. a description of any additional material or information necessary for you to perfect a claim and an explanation of why such information is necessary,
4. a statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits,
5. a description of Prudential’s appeals procedures and applicable time limits, including a statement of your right to bring a civil action under section 502(a) of ERISA following your appeals,
6. a statement that, if an adverse benefit determination is based on a medical necessity or experimental treatment or similar exclusion or limit, an explanation of the scientific or clinical judgment for the determination will be provided free of charge upon written request, and
7. copies of any internal rules or guidelines relied upon in making this determination, if applicable.

2. Appeals of Adverse Determination

If your claim for benefits is denied, you or your representative may appeal your denied claim in writing to Prudential within 180 days of the receipt of the written notice of denial or 180 days from the date such claim is deemed denied. Similarly, if Prudential does not decide your claim within the time described in Section 1 above, you may appeal, although you are not required to do so. You may submit with your appeal any written comments, documents, records and any other information relating to your claim. Upon your request, you will also have access to, and the right to obtain copies of, all documents, records and information relevant to your claim free of charge.

A full review of the information in the claim file and any new information submitted to support the appeal will be conducted by Prudential, utilizing individuals not involved in the initial benefit determination. This review will not afford any deference to the initial benefit determination.

Prudential shall make a determination on your appeal within 45 days of the receipt of your appeal request. This period may be extended by up to an additional 45 days if Prudential determines that special circumstances require an extension of time. A written notice of the extension, the reason for the extension and the date that Prudential expects to render a decision shall be furnished to you within the initial 45-day period. However, if the period of time is extended due to your failure to submit information necessary to decide the appeal, the period for making the benefit determination will be tolled (i.e., suspended) from the date on which the notification of the extension is sent to you until the date on which you respond to the request for additional information.

Prudential will provide you, free of charge and prior to any adverse decision on appeal, with any new or additional evidence that is considered by Prudential in connection with the claim (including evidence that may be the basis for denial as well as any evidence that may support granting the claim), and any new or additional rationale that will form the basis for the Prudential’s decision on appeal. Any such evidence will be provided as soon as possible and sufficiently in advance of the date on which the notice of adverse benefit determination must be provided in order to give you a reasonable opportunity to respond prior to that date.

If the appeal is denied in whole or in part, you will receive a written notification from Prudential of the denial. The notice will include:

1. the specific reason(s) for the adverse determination, which will include a discussion of the decision describing, if applicable, the basis for disagreeing with or not following (i) the views of your treating providers, (ii) the views of medical or vocational experts whose advice was obtained on behalf of the plan in connection with your adverse benefit determination, without regard to whether the advice was relied upon in making the benefit determination, and (iii) an award of Social Security Administration disability benefits,
2. references to the specific plan provisions on which the determination was based,
3. a statement that you are entitled to receive upon request and free of charge reasonable access to, and make copies of, all records, documents and other information relevant to your benefit claim upon request,
4. a description of Prudential’s review procedures and applicable time limits,
5. a statement that if an adverse benefit determination is based on a medical necessity or experimental treatment or similar exclusion or limit, an explanation of the scientific or clinical judgment for the determination will be provided free of charge upon written request,
6. copies of internal rules or guidelines relied upon in making this determination, if applicable and
7. a statement describing any appeals procedures offered by the plan, and your right to bring a civil suit under ERISA.

If a decision on appeal is not furnished to you within the time frames mentioned above, the claim shall be deemed denied on appeal.

If the appeal of your benefit claim is denied, you or your representative may make a second, voluntary appeal of your denial in writing to Prudential within 180 days of the receipt of the written notice of denial or 180 days from the date such claim is deemed denied. Similarly, if Prudential does not decide your appeal within the time described in Section 1 above, you may appeal again, although you are not required to do so. You may submit with your second appeal any written comments, documents, records and any other information relating to your claim. Upon your request, you will also have access to, and the right to obtain copies of, all documents, records and information relevant to your claim free of charge.

Prudential shall make a determination on your second claim appeal within 45 days of the receipt of your appeal request. This period may be extended by up to an additional 45 days if Prudential determines that special circumstances require an extension of time. A written notice of the extension, the reason for the extension and the date by which Prudential expects to render a decision shall be furnished to you within the initial 45-day period. However, if the period of time is extended due to your failure to submit information necessary to decide the appeal, the period for making the benefit determination will be tolled from the date on which the notification of the extension is sent to you until the date on which you respond to the request for additional information.

Your decision to submit a benefit dispute to this voluntary second level of appeal has no effect on your right to any other benefits under this plan. If you elect to initiate a lawsuit without submitting to a second level of appeal, the plan waives any right to assert that you failed to exhaust administrative remedies. If you elect to submit the dispute to the second level of appeal, the plan agrees that any statute of limitations or other defense based on timeliness is tolled during the time that the appeal is pending.

If the claim on appeal is denied in whole or in part for a second time, you will receive a written notification from Prudential of the denial. The notice will be written in a manner calculated to be understood by the applicant and shall include the same information that was included in the first adverse determination letter. If a decision on appeal is not furnished to you within the time frames mentioned above, the claim shall be deemed denied on appeal.

Time Limit To File Suit

If your claim for benefits and any required appeals are denied (or not decided within the time periods discussed above), you may file suit as discussed below. If you elect to file suit, you should do so as soon as possible. However, you must file suit no later than three years after proof of your claim was first due as explained elsewhere in this Booklet, regardless of whether your claim is still pending in the claim or appeal process.

As a participant in this plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA), as amended. ERISA provides that all plan participants shall be entitled to:

Receive information about your plan benefits

• Examine, without charge, at the plan administrator’s office and at other specified locations, such as worksites and union halls, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.
• Obtain, upon written request to the plan administrator, copies of documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The plan administrator may make a reasonable charge for the copies.
• Receive a summary of the plan’s annual financial report. The plan administrator is required by law to furnish each participant with a copy of this summary annual report.

Prudent Actions by Plan Fiduciaries

In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called “fiduciaries” of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including the Plan Sponsor, your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

Enforce Your Rights

If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the plan administrator to provide the materials and pay you a fine that accrues on a daily basis (based on amounts set by the Department of Labor, and subject to a cap) from the time the materials were due to you until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. If it should happen that plan fiduciaries misuse the plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

If you have any questions about your plan, you should contact the plan administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, DC 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.