Individual and Family Group Term Life Insurance
PROTECT YOUR
FAMILY AND
YOUR WAY
OF LIFE
Board of Regents of the
University of Wisconsin System
Underwritten by
Minnesota Life Insurance Company
Policy number 32871-G
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ENROLL FOR INDIVIDUAL AND FAMILY GROUP TERM LIFE
How?
.
1. Read this brochure to familiarize yourself with the
plan.
2. Complete the application form or enroll through
e-Benefits if available. You can obtain an
application from your institution’s benefits office or
at www.uwsa.edu/ohrwd/benefits/life/if/app.pdf.
3. You must enroll through e-Benefits or deliver the
application to your institution’s benefits office
within 30 days of your eligibility begin date.
4. The certificate of insurance that represents the
plan provisions is available at:
www.uwsa.edu/ohrwd/benefits/life/if/cert.pdf.
If you are unable to access the certificate online,
contact your benefits office for a paper copy.
Please review the certificate and retain it in a
safe place.
When can I enroll?
• New employees may enroll within 30 days of
their initial employment begin date, or Wisconsin
Retirement System (WRS) coverage begin date.
If you are married, in a domestic partnership
or have an eligible dependent child(ren) when
you initially enroll in coverage, you may enroll
your family members when you first enroll in
coverage as an employee. Coverage will be
effective the first day of the calendar month
on or after your benefits office receives your
application. Coverage amounts you elect within
these 30 days are guaranteed, regardless of your
medical history.
• Graduate Assistants, Employees-in-Training,
Short-Term Academic Staff and other
employees covered by the Graduate Assistant
benefits package who did not elect coverage
when initially eligible under the Graduate
Assistant benefits package have another
opportunity to elect coverage if/when the
employee later becomes benefits eligible in a
position covered by the Wisconsin Retirement
System (WRS). The employee must elect
coverage within 30 days of the WRS coverage
begin date.
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• A UW employee who is either married to
another UW employee or who has established
a domestic partnership for benefits purposes
with another UW employee cannot be insured
as both an employee and a spouse/domestic
partner on another UW employee’s plan. Child
coverage can also only be covered under one
parent’s plan.
• You may add a spouse to your coverage within
30 days of marriage.
• You may add a domestic partner to your
coverage within 30 days of first establishing
a domestic partnership with your domestic
partner for employee benefit purposes.
• You may add child coverage within 30 days of
having an eligible child to cover for the first time.
Please note that if you get married or establish
a domestic partnership and your new spouse/
domestic partner has children, these children are
considered “eligible children” under the plan and
you may add child coverage within 30 days of
the marriage/domestic partnership begin date
provided you do not have any children eligible
for coverage prior to the marriage/domestic
partnership. If you already have child coverage
in place, any eligible children of your spouse/
domestic partner are automatically covered.
• Employees who are enrolled in coverage at the
beginning of the annual increase option period
may elect additional coverage for themselves
and insured family members without providing
proof of good health.
• At any time you may apply for coverage
or increase your coverage level beyond the
amounts that are guaranteed (as identified
above), by providing proof of good health. This
applies to yourself and your family members.
You can obtain a Medical Evidence of Insurability
form from your benefits office or at
www.uwsa.edu/ohrwd/benefits/life/if/eoi.pdf.
Acceptance and enrollment is not guaranteed
when you apply for coverage through Medical
Evidence of Insurability so it is recommended
that you enroll in coverage during your regular
enrollment periods.
GROUP TERM LIFE INSURANCE
Why Group Term Life?
Eligibility
You may elect coverage under the Individual
and Family Group Term Life insurance plan for
yourself, your spouse or domestic partner and
your dependent children under age 25. Term life
insurance is a great way to provide a foundation of
financial protection for your family.
Employees of the University of Wisconsin System
who are eligible for participation in the State of
Wisconsin group health insurance program may
elect coverage under this plan. If an employee
is covered as a spouse/domestic partner under
another UW employee’s plan, the employee may
enroll in coverage as an employee or be covered
as a spouse/domestic partner under the spouse’s
or domestic partner’s plan – an employee cannot
have coverage under more than one person’s
plan. Likewise, if an employee is covered as a child
under a parent’s plan, the employee may enroll in
employee coverage but is ineligible for coverage
as a child under the parent’s plan. Wisconsin
Retirement System retirees are not eligible to
participate.
Your Group Term Life insurance program from the
Board of Regents of the University of Wisconsin
System has the following features:
• Flexible amounts of insurance coverage give
you the ability to choose your level of protection.
• Guaranteed coverage amounts for new
employees, as well as guaranteed annual
increase options for employees already enrolled
in the plan.
• Convenient payroll deductions of premiums.
• Tax-free death benefit paid to the beneficiary(s).
• Conversion of your coverage. If you leave
the University of Wisconsin System, you can
continue your coverage by converting to an
individual policy without providing proof of
good health. Premiums may be higher than for
those paid by active employees.
Effective date of insurance
You have 30 days from your employment begin
date or Wisconsin Retirement System (WRS) start
date to enroll. Coverage is effective on the first
of the month on or following the receipt of your
application by your institution’s benefits office.
You will have an annual opportunity to increase
your coverage level. This increased coverage will be
effective on January 1 following the annual increase
option period.
If you apply for coverage through Evidence of
Insurability, coverage will be effective the first
of the month following the approval of your
application.
How much coverage can I apply for?
Additional coverage available
during Annual Increase period
Enrollment and coverage level
increases applied for through
Evidence of Insurability
$5,000, $10,000, $15,000
or $20,000
$5,000, $10,000, $15,000 or $20,000
$5,000 increments
(up to $300,000 maximum)
(up to $300,000 maximum)
Your Spouse/Domestic
Partner
$5,000 or $10,000
$5,000 or $10,000
$5,000 increments
(up to $150,000 maximum or employee
coverage amount, whichever is less)
(up to $150,000 maximum or employee
coverage amount, whichever is less)
Your children
$2,500 or $5,000
$2,500
$2,500 increments
(up to $25,000 maximum or employee
coverage amount, whichever is less)
(up to $25,000 maximum or employee
coverage amount, whichever is less)
You (employee) may
purchase insurance for
Yourself
When you are hired
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How much does life insurance cost?
Your monthly insurance premium and your spouse
or domestic partner premiums are based upon your
age and amount of coverage you elect. Premiums
for children are based only on the insurance amount
and are not based on age. All of your children will
be insured for the same amount of insurance and
all will be insured for just one monthly premium.
Below is a chart outlining the “per $1,000 of
coverage” premium rates for employee and spouse/
domestic partner coverage. The premiums for
the levels of child coverage are calculated for
you. Pre‑calculated premiums for coverage levels
available to new employees are available on the
following page.
Determining your age for premium
purposes
Your age is based on your age as of January 1st of
the coverage year. For example, your premium in
2014 is based on your age as of January 1, 2014.
Monthly Individual and Family Group Life insurance premiums
(Spouse/domestic partner premium based on employee’s age)
Employee’s age
Employee coverage
(per $1,000 of coverage)
Spouse/Domestic Partner
coverage
(per $1,000 of coverage)
Child coverage
($0.070 per $1,000 of coverage)
Total premium listed below
Under 28
$0.023
$0.036
$2,500
$0.18
28-30
0.025
0.040
$5,000
$0.35
31-33
0.032
0.050
$7,500
$0.53
34-36
0.037
0.059
$10,000
$0.70
37-39
0.045
0.072
$12,500
$0.88
40-42
0.068
0.108
$15,000
$1.05
43-45
0.108
0.171
$17,500
$1.23
46-48
0.130
0.207
$20,000
$1.40
49-51
0.181
0.288
$22,500
$1.58
52-54
0.232
0.369
$25,000
$1.75
55-57
0.323
0.513
58-60
0.403
0.621
61-63
0.556
0.774
64-66
0.799
1.080
67-69
1.117
1.503
70-72
1.724
2.331
73 and over
2.466
3.330
Employee and spouse/domestic partner rates increase with age and all rates are subject to change.
Example for coverage effective in 2014
A new employee elects $20,000 of life insurance for herself, $10,000 for her domestic partner and
$5,000 for her child. Employee’s date of birth is August 1, 1969. Coverage is effective July 1, 2014.
Employee’s age on January 1, 2014: Age 44 – Her insurance premium is based on the 43-45 age band.
1. T o determine the premium for $20,000 of employee coverage, multiply the premium listed in the Employee
Coverage 43-45 age band by 20.
$0.108 x 20 = $2.16
2. T o determine the premium for $10,000 of domestic partner coverage, multiply the premium listed in the Spouse/
Domestic Partner Coverage 43-45 age band by 10 (premium is based on the employees age).
$0.171 x 10 = $1.71
3. T o determine the premium for $5,000 of child coverage, refer to the appropriate coverage and premium level in
the child coverage premium chart above.
$0.35
Total Monthly Premium
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$4.22
Pre-calculated monthly premiums for coverage levels available to new employees
(Spouse/domestic partner premium based on employee’s age)
Employee’s
Age
Spouse/Domestic Partner
coverage
Employee Coverage
$20,000
$15,000
$10,000
$5,000
$10,000
$5,000
Under 28
$0.46
$0.35
$0.23
$0.12
$0.36
$0.18
28-30
0.50
0.38
0.25
0.13
0.40
0.20
31-33
0.64
0.48
0.32
0.16
0.50
0.25
34-36
0.74
0.56
0.37
0.19
0.59
0.30
37-39
0.90
0.68
0.45
0.23
0.72
0.36
40-42
1.36
1.02
0.68
0.34
1.08
0.54
43-45
2.16
1.62
1.08
0.54
1.71
0.86
46-48
2.60
1.95
1.30
0.65
2.07
1.04
49-51
3.62
2.72
1.81
0.91
2.88
1.44
52-54
4.64
3.48
2.32
1.16
3.69
1.85
55-57
6.46
4.85
3.23
1.62
5.13
2.57
58-60
8.06
6.05
4.03
2.02
6.21
3.11
61-63
11.12
8.34
5.56
2.78
7.74
3.87
64-66
15.98
11.99
7.99
4.00
10.80
5.40
67-69
22.34
16.76
11.17
5.59
15.03
7.52
70-72
34.48
25.86
17.24
8.62
23.31
11.66
73 and over
49.32
36.99
24.66
12.33
33.30
16.65
Child Coverage
($0.070 per $1,000 of coverage)
Total Premium Listed Below
$2,500
$5,000
$0.18
0.35
Employee and spouse/domestic partner rates increase with age and all rates are subject to change.
F o r N ew s
Employee
Calculating your premium
You can use the chart above to determine your total monthly premium.
1.
Enter the year that coverage will be effective:
2.
Enter your age as of January 1 of the year in which coverage will be effective:
(Your premium will be based on your age as of January 1 of each year)
For the next section, please refer to the coverage tables above
3.
Find Selected Employee Coverage Level
Enter premium:
4.
Find Selected Spouse/Domestic Partner Coverage Level
Enter premium:
5.
Find Selected Child Coverage Level
Enter premium:
Add All Premiums to Determine Total Monthly Premium
Total Premium:
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How much life insurance do I need?
When choosing the amount of coverage that’s right for you and your family, it is important to think about
the amount of money your family would need to maintain their lifestyle during your working career if
your income were not included. How much would your family need to live comfortably without depleting
existing assets and compromising short- and long-term plans?
When answering the following questions, keep in mind how many years it will be until your children are
financially independent, as well as when you plan to retire. You may also visit Minnesota Life’s online
insurance needs calculator to help determine how much life insurance you may beed at
lifebenefits.com/insuranceneeds.
Insurance Needs Calculator
A. For how many years do you plan to provide financial support to your family? (Think about the number of years your children or elderly parents will
depend on you for financial support.)
B.
years
Multiply your answer by 12 to get the number of months
you wish to provide for your family.
months
C. Enter the number from “B” in the white boxes below.
Calculation
1. How much a month would your family need for mortgage or rent?
$
x
=$
OR
You can substitute estimated total amount for above.$
2. How much a month would your family need to pay for all other
debt — car payment, credit cards or personal loan payments?
$
x
=$
OR
You can substitute estimated total amount for above. $
3. How much a month would your family need to meet ongoing
expenses — food, utilities, day care, elder care, etc.
$
x
=$
OR
You can substitute estimated total amount for above. $
4. Estimate the total cost of your children’s education ($10,000
for public, $20,000 for private — per-year cost). $
5. Add lines 1-4 together and write total here. $
6. Estimate the amount of personal savings, life insurance or other
assets you already have in place, plus any Social Security benefit
you anticipate leaving to your family. $
Subtract line 6 total from line 5 total and put that number here. Based on the information you provided, this is the recommended amount of life insurance.
Use this amount when setting up your life insurance plan or to obtain a quote for life insurance.$
Remember, your individual financial situation may require more or less insurance.
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How will I pay for this coverage?
Your premiums will be collected through
convenient payroll deduction by the University
of Wisconsin System. If you are on some type of
unpaid leave such as a personal/medical leave
of absence or a seasonal work break, you may
continue your insurance by submitting the monthly
premium to your benefits office before the first
of each month during your leave. Employees
who have academic year appointments who
are expected to return to work the following
semester will have additional premium deductions
taken from paychecks through summer prepays
coverage active over the summer months.
What happens if I do not pay my
premium while on a leave of absence
or during a seasonal or academic year
work break?
If you do not continue to pay your premium during
your leave or work break, your coverage will end.
You will have the opportunity to reapply for the
same level of coverage that you carried prior
to your leave or work break by submitting an
application within 30 days of your return to work.
If you are going on military leave, consult your
benefits office.
How do I choose a beneficiary?
Designating a beneficiary for your life insurance lets
you determine who receives the death benefit. You
may choose any beneficiary and may change the
designation at any time by filing a signed beneficiary
change form. The entire death benefit received by
your beneficiary is income tax-free. If you do not
choose a beneficiary, benefits will be paid according
to the following plan default:
1. The insured’s spouse or domestic partner, if
living; otherwise;
2. The insured’s surviving children equally,
otherwise;
3. The insured’s surviving grandchildren equally,
otherwise;
4. The insured’s surviving parents equally,
otherwise;
5. The insured’s surviving siblings equally,
otherwise;
6. The insured’s estate.
Death benefits payable under spouse/domestic
partner or child coverage are payable to the
insured employee or the employee’s estate.
A beneficiary form is available at your institution’s
benefits office or at www.uwsa.edu/ohrwd/
benefits/life/if/.
Additional benefits for no extra cost
• Accelerated death benefit gives you access to
your life insurance benefit when you need it. If you
are diagnosed as terminally ill and are expected to
live 12 or fewer months, you may elect to receive
up to 100 percent of your life insurance during
your lifetime. If you elect to accelerate the benefit,
the benefit paid upon your death will be reduced
accordingly. Your insured spouse/domestic partner
or insured dependent children are eligible for the
accelerated benefit. IMPORTANT: If employee
coverage is fully accelerated, spouse/domestic
partner and dependent child coverage ends.
• No premiums to pay in the event of disability.
If you become totally disabled (for more than
six months) before age 60, your premiums will
be waived until you are no longer disabled or
until you reach age 65. You will not be able to
increase your coverage until you have returned
to work.
• Convert coverage if you become ineligible
for coverage or terminate employment. You
can continue the life insurance protection on
yourself, your spouse/domestic partner and your
eligible dependent children, by converting the
group term plan to an individual life insurance
policy. If you die, the coverage for your spouse
or domestic partner and eligible child(ren) may
be converted to an individual policy.
A conversion application and the first premium
for coverage must be submitted within 31 days
after the group coverage ends. In addition, your
dependent children may convert up to five times
their coverage amount at age 25, provided you
remain eligible for coverage under this plan.
Premiums may be higher than for those paid by
active employees.
For more information on conversion, see your
certificate. You can obtain a conversion brochure
from your institution’s benefits office or at
www.uwsa.edu/ohrwd/benefits/life/if/.
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What if I have a claim?
Minnesota Life is committed to providing superior
service to you and your family. Our goal is to
process all claims promptly, fairly and courteously.
Most claims are processed in five to ten business
days of receipt of the necessary claim information.
If you or your family wishes to present a claim,
please contact your institution’s benefits office for
specific instructions. You may also call Minnesota
Life concerning the status of a claim.
About Minnesota Life
Minnesota Life is one of the country’s
largest group life insurers. We understand
the important role we play in the financial
well-being of the five million employees
we insure nationwide, and we will remain
financially strong so we can be there when
you need us most.
We are considered among the highest
rated group life insurance companies by the
independent rating agencies that analyze the
financial soundness and claims-paying
ability of insurance companies. For more
information about the rating agencies and to
see where our ratings rank compared to other
companies’ ratings, please visit
www.securian.com/ratings.
Based on insurance in force, A.M. Best Group Life Statistical Study,
2007-2011.
Information in this brochure is intended as a general guide to the insurance coverage. If there are any differences between this brochure and the policy or certificate, the
policy or certificate will govern.
Coverage offered under policy form number 03-30540.
The University of Wisconsin System does not discriminate on the basis of disability in the provision of programs, services or employment. If you need this printed material
interpreted or in another form, or if you need assistance using this service, please contact us at (608) 263-4375.
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Minnesota Life Insurance Company
A Securian Company
Group Insurance – Madison Office
P.O. Box 259708, Madison, WI 53725-9708
1-866-295-8690 • 608-277-8665 Fax • www.LifeBenefits.com
©2013 Securian Financial Group, Inc. All rights reserved.
F59114 Rev 9-2013 UWS1302
A03249-0913