Group Basic and AD&D Insurance

Eligibility

Each Active Full‐Time Employee of a participating Employer working 30 or more hours per week, except any person working on a temporary or seasonal basis.

Benefit Amount

Basic Life and AD&D: A choice of $15,000 $20,000 or $25,000

Guaranteed Issue

Employee: $25,000

Contribution Requirements

Coverage is employer-paid.

AGE	ORIGINAL BENEFIT REDUCED TO
65	66%
70	50%
75	34%
80	24%

Features

Living Benefit Rider (expressed as Accelerated Death
Benefit in some states and Imminent Death Benefit in PA)
Air Bag Benefit
Conversion Privilege
FMLA/MSLA Continuation
Seat Belt Benefit
Waiver of Premium

Value-Added Services

Bereavement Counseling Service
Travel Assistance Service

FOR ACCIDENTAL LOSS OF:	AMOUNT PAYABLE
Life	100%
Both hands or both feet	100%
Sight of both eyes	100%
One hand and one foot	100%
One hand and sight of one eye	100%
One foot and sight of one eye	100%
Speech and hearing	100%
One hand or one foot	50%
Sight of one eye	50%
Speech or hearing	50%

Exclusions

AD&D Exclusions

AD&D benefits will not be payable for a loss: caused by suicide or intentionally self‐inflicted injuries; caused by or resulting from war or any act of war, declared or undeclared; to which sickness, disease or myocardial infarction, including medical or surgical treatment thereof, is a contributing factor; sustained during an insured’s commission or attempted commission of an assault or felony; to which the insured’s acute or chronic intoxication is a contributing factor; or to which the insured’s voluntary consumption of an illegal or controlled substance or a non‐prescribed narcotic or drug is a contributing factor. For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS‐6422, et al.

Basic Life & AD&D Insurance Premium Table

Plan Holder: Professional Insurance Agents of Wisconsin

Scheduled Benefit: Each eligible employee may elect an amount of insurance shown in the table below. Benefit amounts are reduced according to the age-based reduction chart shown in the Life/AD&D brochure.

Employee Premiums

Determine the age band: Employee age = Employee age at their last birthday.
Select a benefit amount.
Rates change as insured moves from one age bracket to the next

BENEFIT AMOUNT	AGE 18-34	AGE 35-39	AGE 40-44	AGE 45-49	AGE 50-54	AGE 55-59	AGE 60-64	AGE 65-69	AGE 70+
$15,000	$1.80	$2.25	$3.75	$5.55	$8.25	$12.30	$18.00	$32.25	$127.50
$20,000	$2.40	$3.00	$5.00	$7.40	$11.00	$16.40	$24.00	$43.00	$170.00
$25,000	$3.00	$3.75	$6.25	$9.25	$13.75	$20.50	$30.00	$53.75	$212.50