Document:

EX-10.23

 

Confidential Treatment

Exhibit 10.23

PORTIONS OF THIS EXHIBIT HAVE BEEN OMITTED AND FILED SEPARATELY WITH THE
SECRETARY OF THE COMMISSION PURSUANT TO REGISTRANT’S APPLICATION OBJECTING TO
DISCLOSURE AND REQUESTING CONFIDENTIAL TREATMENT UNDER RULE 406. THE OMITTED
PORTIONS HAVE BEEN MARKED WITH BRACKETS.

HEALTH BENEFITS AGREEMENT

FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY,

UNION PLANTERS CORPORATION

AND

STRATEGIC OUTSOURCING, INC.

Effective Date: March 1, 2004

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 2 of 13

FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY

HEALTH BENEFITS AGREEMENT

TABLE OF CONTENTS

	 	 	 	 	 
	SECTION

	 	I
	 	TERMS OF AGREEMENT
	 
	 	 	 	 
	SECTION

	 	II
	 	PRODUCTS
	 
	 	 	 	 
	SECTION

	 	III
	 	RATES
	 
	 	 	 	 
	SECTION

	 	IV
	 	MODIFICATION OF ADMINISTRATION FEES AND INSURANCE PREMIUM RATES
	 
	 	 	 	 
	SECTION

	 	V
	 	THE OFFERING OF FHLHIC PRODUCTS
	 
	 	 	 	 
	SECTION

	 	VI
	 	GROUP REPORTING REQUIREMENTS
	 
	 	 	 	 
	SECTION

	 	VII
	 	FHLHIC REPORTING REQUIREMENTS
	 
	 	 	 	 
	SECTION

	 	VIII
	 	ADMINISTRATIVE POLICIES
	 
	 	 	 	 
	SECTION

	 	IX
	 	RENEWAL
	 
	 	 	 	 
	SECTION

	 	X
	 	EXTENSION
	 
	 	 	 	 
	SECTION

	 	XI
	 	GENERAL
	 
	 	 	 	 
	SECTION

	 	XII
	 	TERMINATION

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 3 of 13

AGREEMENT TO PROVIDE

COMPREHENSIVE HEALTH BENEFITS

          This is an Agreement (hereinafter “Agreement”) between First Health Life & Health
Insurance Company, located at 3200 Highland Avenue, Downers Grove, Illinois 60515 (hereinafter
referred to as “FHLHIC”), Union Planters Corporation, located at 6200 Poplar Avenue, Memphis,
Tennessee 38119 (“UPC”) and Strategic Outsourcing, Inc. located at 5260 Parkway Plaza Boulevard,
Fourteen Parkway Plaza, Suite 140, Charlotte, North Carolina 28217 (“SOI”). FHLHIC, UPC and SOI
may be individually referred to herein as a “party” or collectively referred to herein as the
“parties.”

	 	 	WHEREAS, SOI requests FHLHIC to provide health insurance products (hereinafter referred to
as the “Products”) to SOI’s client group employees and SOI’s corporate employees
(hereinafter collectively referred to as “Covered Employee(s)”) as part of its operation as
a professional employer organization;

and
	 
	 	 	WHEREAS, FHLHIC agrees to provide health insurance products to Covered Employees; and
	 
	 	 	WHEREAS, each of the parties to this Agreement seeks to set forth, in writing, the terms and
conditions

of this Agreement;
	 
	 	 	THEREFORE, the parties agree as follows:
	 
	I.	 	Term of the Agreement
	 
	 	 	This Agreement between the parties is for the period beginning March 1, 2004 (the effective
date) and shall end on February 28, 2009 (the termination date), and will renew
automatically for one year terms, unless otherwise terminated or revised in accordance with
the provisions of this Agreement.
	 
	II.	 	Products

	 	A.	 	FHLHIC will offer a large group preferred provider option (the “Benefits
Contract”), to be administered in a manner compliant with state insurance laws in the
states of California, North Carolina, South Carolina and Texas, as applicable, as
determined by the residence of Covered Employees. In addition, FHLHIC may administer
other mutually agreed upon health benefit options
in a manner compliant with state insurance laws in the states of California, North
Carolina, South Carolina and Texas, as applicable, as determined by the residence of
Covered Employees.
	 
	 	B.	 	The Benefits Contract is offered on a minimum premium insured basis (i.e., this
is not a plan of self-insurance).

	III.	 	Administration Fees and Premium Rates

	 	A.	 	The Administration Fees and Insurance Premium Rates are described in Schedule
A.
	 
	 	B.	 	The Administration Fees and Insurance Premium Rates in Schedule A are valid for
the period of March 1, 2004 through February 28, 2005, subject to CPI increases at each
subsequent annual coverage period.

 

 

					
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	 	C.	 	FHLHIC will provide SOI with a 120-day renewal notice for the approaching annual
coverage period, including: (a) the actual CPI increase for the Administration Fees and
Insurance Premium Rates set forth in Schedule A for the subsequent annual coverage
period; and (b) any required increase in the amount of the irrevocable letter of credit
for the subsequent annual coverage period. The parties acknowledge that increases in
the amount of the irrevocable letter of credit will be either: (i) connected to the
amount of reserves that are statutorily required by the state of Texas for Covered
Employees; or (ii) as determined by FHLHIC. Notwithstanding the foregoing, FHLHIC
reserves the right to require SOI to contribute additional amounts of money to the
irrevocable letter of credit based upon other factors such as SOI’s financial viability
and SOI’s claims experience. FHLHIC, in its sole discretion, will determine such
additional amounts of money that SOI must contribute to the irrevocable letter of
credit.
	 
	 	D.	 	Notwithstanding Section III.C above, FHLHIC may require an increase in the
irrevocable letter of credit at any time by giving 30 days advance written notice if
the number of Covered Employees exceeds 2,250. The parties acknowledge that increases
in the amount of the irrevocable letter of credit will be either: (a) connected to the
amount of reserves that are statutorily required by the state of Texas for Covered
Employees; or (b) as determined by FHLHIC. Notwithstanding the foregoing, FHLHIC
reserves the right to require SOI to contribute additional amounts of money to the
irrevocable letter of credit based upon other factors such as SOI’s financial viability
and SOI’s claims experience. FHLHIC, in its sole discretion, will determine such
additional amounts of money that SOI must contribute to the irrevocable letter of
credit.

	IV.	 	Modification of Administration Fees and Insurance Premium Rates
	 
	 	 	Administration Fees and Insurance Premium Rates for the term of this Agreement will remain
in effect, as set forth in Schedule A, provided there is no material change to the
Product(s) or any other risk factors1, as determined by FHLHIC. In the
event there is a change in the total enrollment of 15% or greater during any 90 day period,
FHLHIC reserves the right to review the prospective client group’s experience data. At that
time, FHLHIC will review the in-force Administration Fees and Insurance Premium Rates and
modify them to compensate for changes in the risk factors. In the event a modification is
required due to a single large group of 300 or more Covered Employees the method for such
modification, such as separate contract, or a change in the fees and rates on all plans
under this contract, will be as mutually agreed to by the parties.
	 
	 	 	In the event a modification is required, the modified Administration Fees and Insurance
Premium Rates will be set forth and presented to SOI on a revised Schedule A within 30 days.
All other provisions of this Agreement shall remain in effect without modification.
	 
	V.	 	The Offering of FHLHIC Products

	 	A.	 	FHLHIC and SOI agree that SOI will offer the FHLHIC Products exclusively to its
Covered Employees in California, North Carolina, South Carolina and Texas. No other
SOI sponsored major medical health plan will be offered to Covered Employees in the
above states during the term of this Agreement.
	 
	 	B.	 	SOI will make the Product(s) available to its Covered Employees in the
following manner:

 

			
	1	 	  Risk factors include age, sex, worker
classification, diagnosis, claims experience, or any other demographics of the
Covered Employees or the employees requested to be covered by this Agreement.

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 5 of 13

	 	1.	 	SOI will conduct one open enrollment per year. The open enrollment period
shall not exceed 30 days in duration.
	 
	 	2.	 	FHLHIC’s marketing materials including price, product
designs, network information, and other pertinent information will be
available to SOI to make the selection of the Product(s) available to its
Covered Employees. FHLHIC, in consultation with SOI, shall determine the
appropriate quantity of marketing materials to make available to SOI.
	 
	 	3.	 	An open enrollment will be conducted for 30 days and will
commence approximately 60-90 days before the annual coverage period begins, or
as mutually agreed to by the parties.
	 
	 	4.	 	Individual client groups of SOI will be required to maintain
75% participation and 50% contribution (of the single rate) for their Covered
Employees. SOI will monitor compliance with these requirements and, upon
request by FHLHIC, will provide copies of the monitoring reports to FHLHIC.

	 	C.	 	The Insurance Premium Rates are subject to change with 30 days notice, in the
event premium taxes are assessed on premium exceeding the Insurance Premium Rates. Any
increase in Insurance Premium Rates based upon the foregoing will be limited to the
amount of the actual increase assessed to FHLHIC and relating to the plan.

	VI.	 	Group Reporting Requirements

	 	A.	 	SOI will provide FHLHIC with the necessary reports to ensure compliance with
participation and contribution requirements described in Section V above. These
reports will be provided as requested by FHLHIC.
	 
	 	B.	 	SOI will provide to FHLHIC the industry classification codes (SIC) of the
enrolled client groups as requested by FHLHIC.
	 
	 	C.	 	SOI will provide to FHLHIC enrollment data by county, or other such information
that may be required to adequately evaluate risk and develop appropriate rates, as
requested by FHLHIC.
	 
	 	D.	 	SOI will provide to FHLHIC, as requested by FHLHIC, business practice
information related to the following:

	 	•	 	client acquisition process
	 
	 	•	 	client contracting
	 
	 	•	 	monitoring of participation levels and contribution levels
	 
	 	•	 	business plans
	 
	 	•	 	financial statements
	 
	 	•	 	benefits administration process including enrollment,
premium remittance and reconciliation and new client/Covered Employee
orientation

	VII.	 	FHLHIC Reporting Requirements
	 
	 	 	FHLHIC will provide SOI with its standard monthly utilization reports as requested by SOI in
their role as Plan Administrator. Based on the originally executed Business Associate
Agreement, FHLHIC will provide the following data elements to SOI via monthly diskette.
Covered Employee number, coverage

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 6 of 13

	 	 	code, zip code, state, county, patient, first and last name, DOB, sex code, paid date,
service date, claim type, charge allowed and paid amount.

	VIII.	 	Administrative Policies

	 	A.	 	Enrollment Methodology
	 
	 	 	 	SOI’s human resource staff will enroll each new client group’s Covered Employees via
SOI’s Individual Application. Individual Applications will be provided to SOI’s
Corporate Office for entry. SOI will provide FHLHIC with daily electronic transfer of
full file enrollment data. Enrollment transfers will be processed the night of receipt
as long as the file is transferred prior to 2:00 p.m. Files received after this time
will process the next business day.
	 
	 	B.	 	Identification Cards
	 
	 	 	 	SOI will prepare the identification cards for Covered Employees. Identification cards
prepared by SOI must be reviewed and approved, in writing, by FHLHIC prior to
distribution to Covered Employees, such approval will not be unreasonably withheld.
	 
	 	C.	 	Terminations
	 
	 	 	 	Terminations are removed on the date of termination. If a Covered Employee terminates
during the 1st — 15th of the month, zero (0) premium is paid. If
a Covered Employee terminates during the 15th — 30th of the
month, a full month’s premium is paid to FHLHIC.
	 
	 	D.	 	Billing Process:

	 	1.	 	On March 1, 2004, SOI shall provide FHLHIC an irrevocable
Letter of Credit (“LOC”) and Claims Fund (as defined below) solely in favor of
FHLHIC in the amount set forth in Schedule A. Such LOC shall be available to
FHLHIC, in the event any obligation of SOI under this Agreement is not, in the
opinion of FHLHIC, fully satisfied on a timely basis by SOI. Such LOC must be
acceptable to FHLHIC, and must be for a term which exceeds six (6) months
beyond the term of this Agreement. Additional irrevocable LOC’s which are
acceptable to FHLHIC must be provided to FHLHIC by SOI after quarterly review
of the continued adequacy of the amount of the LOC and/or prior to any
extension of this Agreement. Each such additional LOC must have a term which
extends six (6) months beyond the extended term of this Agreement. In the
event the LOC terminates or expires, then SOI will replace the LOC with no gap
in coverage. “Claims Fund” means the predetermined amount paid by SOI to
FHLHIC to be held for the benefit of claims incurred by SOI. Each year during
the Agreement, FHLHIC may modify the Claims Fund upon giving SOI at least
thirty (30) days written notice prior to March 1st. Such
modification of the Claims Fund will not exceed 11/2 months of expected claims
as determined by FHLHIC. Notwithstanding anything to the contrary in this
Section VIII.D.1, FHLHIC may modify the Claims Fund at any time if the number
of Covered Employees increases by ten percent (10%) or more.

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 7 of 13

	 	2.	 	Administration Fees and Insurance Premium

	 	a.	 	SOI agrees to pay FHLHIC, each month, an
Administrative Fee and Insurance Premium. The Administrative Fees and
Insurance Premium Rates applicable to this Agreement are set forth in
Schedule A, which is hereby, incorporated by reference into and made a
part of this Agreement.
	 
	 	b.	 	These Administrative Fees and Insurance Premium Rates
will be applied to the number of contracts covered at the beginning of
each month and will not be prorated. The due date, for purposes of this
section, is the tenth day of each calendar month. SOI agrees to pay to
FHLHIC, each month, the Administrative Fee and the Insurance Premium, in
full, by the due date.
	 
	 	c.	 	SOI’s monthly invoice for Administrative Fees and
Insurance Premium will be generated on the 1st day of each
month and either Secure E-mailed or Federal Expressed to SOI’s Corporate
Office. The invoice will provide a list of each enrolled Covered
Employee’s social security number, coverage type and rate by division for
insureds reported to FHLHIC and processed by the 1st of each month. The
due date will be the 10th of each month.
	 
	 	 	 	SOI/Division Mapping Structure is as follows:
	 
	 	 	 	     California, North Carolina, South Carolina and Texas.
	 
	 	 	 	Each month’s invoice is due and payable on the 10th of the month. A 10
day grace period will be administered. If full premium payment is not
received by FHLHIC by the end of this grace period, this Agreement will be
immediately canceled for nonpayment of premium.
	 
	 	d.	 	Payment received after ten (10) days after the due
date is considered late and subject to a daily late payment charge of
..00038 times the amount of overdue Administrative Fees and/or Insurance
Premium, or the maximum amount permitted by law, if less.

	 	3.	 	Paid Claims Liability

	 	a.	 	SOI agrees that the LOC and the Claims Fund which are
described in Section VIII.D.l. above are available for all Claims (as
defined below) paid by FHLHIC in accordance with this Agreement, the
Benefits Contract and the applicable provider agreements. “Claims”
includes physician incentives, pharmacy, physician, hospital, other
fee-for- service claims expenditures, and fees paid to contracted entities
necessary to the performance of this Agreement.
	 
	 	b.	 	At the end of each month, FHLHIC will provide SOI
with a detailed printout of the previous month’s Claims payments in its
standard report format.
	 
	 	c.	 	Each business day, SOI will remit funds to FHLHIC or
permit FHLHIC to withdraw funds in an amount equal to the checks issued
for payment of Claims in accordance with

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 8 of 13

	 	 	 	the Agreement or the Benefits Contract. Funding will continue as long as
Claims are eligible for payment under the plans.

	 	d.	 	FHLHIC will adjudicate all Claims incurred during the
term of this Agreement. For purposes of this Agreement, the date of an
incurred claim is the date the particular service was rendered or the
supply was furnished. After the effective date of termination of this
Agreement, SOI will continue to provide FHLHIC with funds to pay claims
incurred prior to the termination date or due to any benefit extension
provision of the Benefits Contract.
	 
	 	e.	 	Payment received after ten (10) days after the due
date is considered late and subject to a daily late payment charge of
..00038 times the amount overdue.

	 	4.	 	UPC acknowledges and agrees that it is the guarantor of the
financial obligations of SOI under this Agreement.

	 	E.	Retroactive Terminations (Max 60 days)

	 	 	Retroactive terminations will not be accepted past 60 days from the actual
termination date. FHLHIC will provide premium credits for these retroactive
terminations up to but not exceeding 60 days. For example, FHLHIC receives a
request on March 31st to terminate a Covered Employee’s coverage
effective December 31st. FHLHIC will terminate the Covered Employee’s
coverage effective January 31st and collect premium for the month of
January. Reports will reflect the actual termination date.

	 	F.	Retroactive Additions

	 	 	Retroactive additions will not be accepted past 60 days from the actual effective
date. FHLHIC will bill full premium payment for retroactive additions.

	 	G.	Eligibility

	 	 	FHLHIC and SOI have agreed upon 90 days waiting period. The applicable waiting
period will be determined by SOI.

	 	H.	Membership Forms

	 	1.	 	SOI Individual Insurance/Membership

	 	 	 	Each Covered Employee applying for coverage must complete an Individual Application.

	 	2.	 	Covered Employee Status Change Form

	 	 	 	Any Covered Employee status change, i.e., marriage, divorce, addition of newborns,
etc. will require completion of a Covered Employee Status Change form. The change
data must be received by FHLHIC as follows:

	 	 	 	Marriage — within 60 days of event

Divorce — within 60 days of event

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 9 of 13

	 	 	 	Newborn — within 60 days of event

	 	 	 	If changes are not submitted within the specified time frames, the Covered Employee must
wait until the next annual open enrollment to make changes except under HIPAA
requirements for special enrollment.
	 
	 	I.	 	COBRA
	 
	 	 	 	SOI will retain sole responsibility for COBRA administration as evidenced by the signing
of the attached Exhibit A, COBRA Waiver.
	 
	 	J.	 	Health Insurance Portability and Accountability Act (HIPAA) Pre-Ex Compliance
	 
	 	 	 	SOI has elected electronic enrollment and therefore, SOI retains accountability for
calculating and reporting to the Covered Employee and FHLHIC, the amount of creditable
time to be applied to satisfy the pre-existing exclusion limitation.

	IX.	 	Renewal
	 
	 	 	This Agreement shall automatically renew/extend for a one year period, after the termination
date. Either party may elect not to renew this Agreement and in that event shall give
written notice to the other party at least ninety (90) days prior to the expiration of the
then current term. Renewal rates will be provided to SOI at least one hundred twenty (120)
days prior to the expiration of the then current term. The proposed Administrative Fees and
Insurance Premium Rates provided to SOI will apply for the renewal period.
	 
	X.	 	Extension
	 
	 	 	In the event an agreement cannot be reached or no action is taken on FHLHIC’s annual rate
adjustment, either party may elect not to renew provided that said party shall give written
notice to the other party of its intent not to extend this Agreement at least ninety (90)
days prior to the applicable Anniversary Date. In the event SOI needs additional time to
secure a new agreement, FHLHIC agrees to extend the then current agreement at the FHLHIC
proposed Administrative Fees and Insurance Premium Rates for the renewal period, for a
period not to exceed six (6) months beyond the effective termination/expiration date for
then current term.
	 
	XI.	 	Termination

	 	A.	 	This Agreement may be terminated by written notice thereof given by SOI to
FHLHIC if any one of the following occurs:

	 	1.	 	Failure of FHLHIC to meet any material covenant, agreement,
or obligation provided for in this Agreement if it has not commenced to cure
any such default within 20 days and has not cured such default within 90 days
after written notice thereof to FHLHIC by SOI. FHLHIC acknowledges that
termination of this Agreement for material breach is not SOIs sole and
exclusive remedy.

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 10 of 13

	 	2.	 	FHLHIC becomes insolvent or is adjudicated as a bankrupt entity, or its
business comes into possession or control, even temporarily, of any trustee in
bankruptcy, or a receiver is appointed for it, or it makes a general
assignment for the benefit of creditors. If any of these events occurs: (a)
no interest in this Agreement may be deemed an asset of creditors; (b) no
interest in this Agreement may be deemed an asset or liability of FHLHIC; and
(c) no interest in this Agreement may pass by the operation of law without the
consent of SOI.

	 	B.	 	This Agreement may be terminated by written notice thereof given by FHLHIC to
SOI and UPC if any one of the following occurs:

	 	1.	 	Failure of SOI and/or UPC to meet any material covenant,
agreement, or obligation provided for in this Agreement if it has not
commenced to cure any such default within twenty (20) days and has not cured
such default within ninety (90) days after written notice thereof to SOI and
UPC by FHLHIC. SOI and UPC acknowledge that termination of this Agreement for
material breach is not FHLHIC’s sole and exclusive remedy.
	 
	 	2.	 	Failure of SOI and/or UPC to make payment under this
Agreement when due, and if payment is not made within twenty (20) days
following written notice of non-payment sent by FHLHIC to SOI and UPC.
	 
	 	3.	 	Termination of the agreement between SOI, UPC, First Health
Group Corp. and First Health Benefits Administrators Corp.
	 
	 	4.	 	Failure of SOI to properly fund a benefits account or
otherwise provide for allowed claims within ten (10) days following written
notice of inadequate funding sent by FHLHIC to SOI. Such accounts will be
established, maintained and reconciled by SOI, which will be responsible for
any applicable account fees and will ensure that the accounts contain
sufficient funds at all times for the continuous and timely payment of claims
processed by FHLHIC. In those states where FHLHIC pays for claims, FHLHIC
will own the accounts. If FHLHIC determines that the accounts do not contain
sufficient funds, FHLHIC may so notify SOI and immediately suspend further
performance of services under this Agreement pending termination under this
Section.
	 
	 	5.	 	SOI and/or UPC become insolvent, or is adjudicated as a
bankrupt entity, or its business comes into possession or control, even
temporarily, of any trustee in bankruptcy, or a receiver is appointed for it,
or it makes a general assignment for the benefit of creditors. If any of
these events occurs: (a) no interest in this Agreement may be deemed an asset
of creditors: (b) no interest in this Agreement may be deemed an asset or
liability of SOI and/or UPC; and (c) no interest in this Agreement may pass by
operation of law without the consent of FHLHIC.

	 	C.	 	Upon the effective date of the termination of this Agreement, in whole or in
part, as applicable:

	 	1.	 	If FHLHIC owes SOI any moneys due to an adjustment, FHLHIC
will pay SOI the balance of any amount due SOI, less any amount SOI owes
FHLHIC, within 30 days of the completion of any adjustment calculation; or (b)
if SOI owes FHLHIC any moneys, SOI will pay FHLHIC the balance of any amount
due FHLHIC, less any amount FHLHIC owes SOI, within 30 days of the termination
of this Agreement or, if applicable, the completion of any

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 11 of 13

	 	 	 	adjustment calculation. Moneys not so paid under the terms of this Agreement
will accrue interest at a rate of 1.5% per month or, if less, the maximum
amount permitted by law until such obligations are satisfied.

	 	2.	 	Upon termination, SOI further agrees that any accounts owned
by FHLHIC for the benefit of SOI’s Covered Employees will: (a) be used to
continue to pay the claims incurred prior to the termination date of the
contract; and (b) contain funds, subject to the current funding arrangement,
sufficient to ensure payment for all checks written by FHLHIC on behalf of SOI
and its Covered Employees pursuant to this Agreement, and such account will
remain active after the termination of this Agreement for the time period
necessary to ensure such payment. In those states where FHLHIC pays for
claims, FHLHIC will own such accounts.
	 
	 	3.	 	SOI will immediately cease to represent that FHLHIC is its
provider of the health benefits services terminated and will cease to use the
respective FHLHIC’s documents, systems, logos, service marks, trademarks,
trade names, methods and techniques in any form.
	 
	 	4.	 	Any plan records may be delivered to SOI in the format in
which they are maintained by FHLHIC.

	XII.	 	Confidentiality of Information

	 	A.	 	The parties agree that all Confidential Information (as defined below) of each
party may not be disclosed, except as provided below, without the express written
approval of the other party. Further, Confidential Information may be disclosed only
to those persons who need to know, and only to the extent necessary, in order to carry
out the terms of this Agreement. Confidential Information may not be used in any way
not specifically allowed under this Agreement, including in each party’s own business,
whether or not competitive with the other party. Each party will notify the others of
any loss or accidental or unauthorized disclosure of Confidential Information.
“Confidential Information” means any non-public proprietary information, including, but
not limited to, the terms of this Agreement, information about fees, computer software,
business procedures and manuals, data review criteria, and information provided by SOI
to FHLHIC pursuant to Section VI of this Agreement. For purposes of this Agreement,
Confidential Information does not include: (a) information publicly available by means
other than wrongful disclosure or lawfully obtained from third parties without any
confidentiality obligations; (b) information which is required by law or by a
government agency to be disclosed by a party, provided that such party immediately
notifies the other party of the requirements for such disclosure and reasonably
cooperates in obtaining any protective order desired by the other party with regard to
such information; (c) information independently developed by the other party; or (d)
information provided to the other party with the intention that it be published,
disseminated, released or distributed by such other party to Covered Employees or to
the general public.
	 
	 	B.	 	The parties recognize that no remedy of law may be adequate to compensate a
party for a breach of the provisions of this Section; therefore, all parties agree that
a party may seek temporary and permanent injunctive relief against the breaching party,
in addition to all other remedies which either is otherwise entitled, and this Section
in no way limits such other remedies of the parties. Such temporary or permanent
injunctive relief may be granted without bond which each party does hereby waive.

 

 

					
	FHLHIC- 2004
	 	 
	 	Page 12 of 13

	XIII.	 	General

	 	A.	 	Inconsistencies

	 	 	 	If the provisions of this Agreement are, in any way, inconsistent with the
provisions of the Products, then the provisions of the Agreement shall prevail, and
the other provisions shall be deemed modified but only to the extent necessary to
implement the intent of the parties herein.

	 	B.	 	Survival

	 	 	 	The rights and obligations of the parties, as set forth herein, shall survive the
termination of this Agreement to the extent necessary to effectuate the intent of
the parties as expressed herein.

	 	C.	 	Waiver of Breach

	 	 	 	The failure by either party, at any time, to enforce or to require the strict
adherence to any provision of this Agreement shall not be deemed to be a waiver of
such provision or any other provision of this Agreement.

	 	D.	 	Governing Law

	 	 	 	This Agreement, and the rights of the parties hereunder, shall be construed
according to the laws of the State of Illinois.

	 	E.	 	Severance

	 	 	 	In the event any provision of this Agreement is deemed to be invalid or
unenforceable, all other provisions shall remain in full force and effect.

	 	F.	 	Amendment

	 	 	 	This Agreement may be amended at any time upon mutual written agreement of the
parties, except that FHLHIC may make changes necessary to comply with state and
federal laws. In the event such changes are necessary, FHLHIC will provide
appropriate written notice to SOI and UPC.

	 	G.	 	Entire Agreement

	 	 	 	This Agreement, which includes the Schedules, Individual Applications for Group
Insurance, Group Application(s) for coverage, and the Products, which are hereby
incorporated by reference, constitute the entire Agreement between SOI, UPC and
FHLHIC. Any prior agreements, promises, or representations, either oral or written,
relating to the subject matter of this Agreement, and not expressly set forth in
this Agreement, are of no force or effect.

	 	H.	 	Notices

	 	 	 	Any notice, required or permitted under this Agreement, shall be deemed given if
hand delivered or if mailed by United States mail, or an overnight mail service
(e.g. Federal Express), postage

 

 

					
	FHLHIC — 2004
	 	 
	 	Page 13 of 13

	 	 	 	prepaid, to the applicable address as set forth above or to such other address as a
party may designate, in writing, to the other party. Such notice shall be deemed
effective as of the date so deposited or delivered.

	 	I.	 	Provider Networks
	 
	 	 	 	FHLHIC’s health care provider networks are subject to change and may be modified at any
time during the term of this Agreement without notice to or consent of SOI or UPC.

IN WITNESS WHEREOF the parties have executed this Agreement as of the 1st day of March,
2004 by their duly authorized officers for and on behalf of said entity.

	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	First Health Life & Health Insurance Company
	 

	 	 
	 	 	 	 	 	 	 	 	 	 
	  /s/ Sharon Bradel	 	 	 	Signature:	 	  /s/ Jane Hannabach	 	 
	 	 	 	 	 	 	 	 	 	 	 
	  Witness	 	 	 	Print Name:	 	  Jane Hannabach	 	 
	 

	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	Title:	 	  President	 	 
	 	 	 	 	 	 	 	 	 
	 	 	 	 	Date:	 	  11/1/04	 	 
	 	 	 	 	 	 	 	 	 

	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	Strategic Outsourcing, Inc.
	 

	 	 
	 	 	 	 	 	 	 	 	 	 
	/s/ Sarah M. Smith	 	 	 	Signature:	 	  /s/ Carl Guidice	 	 
	 	 	 	 	 	 	 	 	 	 	 
	  Witness	 	 	 	Print Name:	 	  Carl Guidice	 	 
	 

	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	Title:	 	  Chief Operating Officer	 	 
	 	 	 	 	 	 	 	 	 
	 	 	 	 	Date:	 	  10/25/04	 	 
	 	 	 	 	 	 	 	 	 

	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	Union Planters Corporation
	 

	 	 
	 	 	 	 	 	 	 	 	 	 
	/s/ Sarah M. Smith	 	 	 	Signature:	 	  /s/ Carl Guidice	 	 
	 	 	 	 	 	 	 	 	 	 	 
	Witness	 	 	 	Print Name:	 	  Carl Guidice	 	 
	 

	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	Title:	 	  Divisional CEO	 	 
	 	 	 	 	 	 	 	 	 
	 	 	 	 	Date:	 	  10/25/04	 	 
	 	 	 	 	 	 	 	 	 

 

 

					
	FHLHIC- 2004
	 	 
	 	Schedule A

Schedule A

	 	 	 
	Fees:
	 	 
	 
	 	 
	Initial Implementation Fee:

	 	$[     ] (includes California, North Carolina, South Carolina and
Texas)
	 
	 	 
	Insurance Premium:

	 	$[     ] per Covered Employee per Month, with annual CPI increases
	 
	 	 
	Minimum Insurance Premium:

	 	1,500 Covered Employees or $[     ] Per Month, with annual CPI

Increases
	 
	 	 
	Irrevocable Letter of Credit:

	 	$[     ], adjusted at the end of the term or if number of Covered
Employees meets or exceeds 2,250
	 
	 	 
	Additional State Implementation:

	 	$[     ], at FHLHIC’s discretion
	 
	 	 
	State Assessments:

	 	All per member per month state assessments will be passed
through to SOI.
	 
	 	 
	Claims Fund:

	 	$[     ] (this amount may be modified as specified in Section
VIII.D.1. of the Agreement)

 

 

					
	FHLHIC- 2004
	 	 
	 	Exhibit A

EXHIBIT A

COBRA WAIVER

SOI hereby acknowledges and agrees that it is: (1) retaining sole responsibility for COBRA

administration; and (2) waiving FHLHIC’s offer to provide COBRA administration services.

IN WITNESS WHEREOF, the parties have executed this COBRA Waiver as of the 1st day of

March, 2004 by their duly authorized officers for and on behalf of said entity.

	 	 	 	 	 
	Strategic Outsourcing, Inc.	 	 
	By:

	 	  /s/ Carl Guidice	 	 
	 

	 	 	 	 
	Name:

	 	  Carl Guidice	 	 
	 

	 	 	 	 
	Title:

	 	  Chief Operating Officer
	 	 
	 

	 	 	 	 
	Date:

	 	  10/25/04	 	 
	 

	 	 	 	 

 

 

FIRST AMENDMENT TO THE

HEALTH BENEFITS AGREEMENT

DATED MARCH 1, 2004

BY AND BETWEEN

FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY,

UNION PLANTERS CORPORATION

AND

STRATEGIC OUTSOURCING, INC.

THIS FIRST AMENDMENT (the “Amendment”) is entered into as of June 1, 2004 (the “Effective Date”),
between First Health Life & Health Insurance Company (“FHLHIC”), Union Planters Corporation (“UPC”)
and Strategic Outsourcing, Inc. (“SOI”). FHLHIC, UPC and SOI may be individually referred to
herein as a “party” or collectively referred to herein as the “parties.”

WHEREAS, FHLHIC, UPC and SOI previously entered into that certain Health Benefits Agreement dated
March 1, 2004 (the “Agreement”), under which the FHLHIC provides certain health insurance products
(hereinafter referred to as the “Products”) to SOI’s client group employees and SOI’s corporate
employees (hereinafter collectively referred to as “Covered Employee(s)”) as part of SOI’s
operation as a professional employer organization; and

WHEREAS, FHLHIC, UPC and SOI desire to amend the Agreement to: (i) add Nevada as one of the states
in which FHLHIC will provide Products to Covered Employees; and (ii) include FHLHIC’s fees for
providing such Products to Covered Employees in the state of Nevada.

NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth herein and in the
Agreement, the parties agree as follows:

	1.	 	Section II.A of the Agreement is hereby deleted in its entirety and replaced with the
following:

	 	A.	 	FHLHIC will offer a large group preferred provider option (the “Benefits
Contract”), to
be administered in a manner compliant with state insurance laws in the states of
California, Nevada, North Carolina, South Carolina and Texas, as applicable, as
determined by the residence of Covered Employees. In addition, FHLHIC may
administer other mutually agreed upon health benefit options in a manner compliant with
state insurance laws in the states of California, Nevada, North Carolina, South Carolina
and Texas, as applicable, as determined by the residence of Covered Employees.

	2.	 	Section V.A of the Agreement is hereby deleted in its entirety and replaced with the
following:

	 	A.	 	FHLHIC and SOI agree that SOI will offer the FHLHIC Products exclusively to its
Covered Employees in California, Nevada, North Carolina, South Carolina and Texas.
No other SOI sponsored major medical health plan will be offered to Covered Employees
in the above states during the term of this Agreement.

	3.	 	The fourth sentence in Section VIII.D.2.c. of the Agreement is hereby deleted in its entirety
and replaced with the following:
	 
	 	 	SOI/Division Mapping Structure is as follows:
	 
	 	 	     California, Nevada, North Carolina, South Carolina and Texas.

 

 

					
	Union Planters Corporation/SOI — First Amendment
	 	Page 2 of 3

	4.	 	The following shall be added to the end of Schedule A of the Agreement:

Nevada Implementation Fee:    $[     ]
	 
	5.	 	The parties ratify and affirm the Agreement and agree that it is in full force as modified by
this Amendment. This Amendment will prevail in the event of a conflict between it and the
Agreement.

IN WITNESS WHEREOF, the duly authorized officers for and on behalf of the parties have executed

this Amendment as of the Effective Date.

	 	 	 	 	 	 	 
	 	 	 	 	First Health Life & Health Insurance Company
	 
	  /s/ Sharon Bradel

	 	 	 	By:
	 	  /s/ Jane Hannabach
	 

	 	 	 	 	 	 
	  Witness

	 	 	 	Name:
	 	  Jane Hannabach
	 

	 	 	 	 	 	 
	 

	 	 	 	Title:
	 	  President
	 

	 	 	 	 	 	 
	 

	 	 	 	Date:
	 	  11/1/04
	 

	 	 	 	 	 	 

	 	 	 	 	 	 	 
	 	 	 	 	Strategic Outsourcing, Inc.
	 
	/s/ Sarah M. Smith

	 	 	 	By:
	 	  /s/ Carl Guidice
	 

	 	 	 	 	 	 
	  Witness

	 	 	 	Name:
	 	  Carl Guidice
	 

	 	 	 	 	 	 
	 

	 	 	 	Title:
	 	  Chief Operating Officer
	 

	 	 	 	 	 	 
	 

	 	 	 	Date:
	 	  10/25/04
	 

	 	 	 	 	 	 

	 	 	 	 	 	 	 
	 	 	 	 	Union Planters Corporation
	 
	/s/ Sarah M. Smith

	 	 	 	By:
	 	  /s/ Carl Guidice
	 

	 	 	 	 	 	 
	Witness

	 	 	 	Name:
	 	  Carl Guidice
	 

	 	 	 	 	 	 
	 

	 	 	 	Title:
	 	  Divisional CEO
	 

	 	 	 	 	 	 
	 

	 	 	 	Date:
	 	  10/25/04
	 

	 	 	 	 	 	 

 

 

SECOND AMENDMENT TO THE

HEALTH BENEFITS AGREEMENT

DATED MARCH 1, 2004

BY AND BETWEEN

FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY,

REGIONS FINANCIAL CORP. (FORMERLY UNION PLANTERS CORPORATION)

AND

STRATEGIC OUTSOURCING, INC.

THIS SECOND AMENDMENT (the “Amendment”) is entered into as of March 1, 2005 (the “Effective
Date”), between First Health Life & Health Insurance Company (“FHLHIC”), Regions Financial Corp.
(Formerly, Union Planters Corporation (“RFC”) and Strategic Outsourcing, Inc. (“SOI”). FHLHIC, RFC
and SOI may be individually referred to herein as a “party” or collectively referred to herein as
the “parties.”

WHEREAS, FHLHIC, RFC and SOI previously entered into that certain Health Benefits Agreement
dated March 1, 2004 (the “Agreement”), under which the FHLHIC provides certain health insurance
products (hereinafter referred to as the “Products”) to SOI’s client group employees and SOI’s
corporate employees (hereinafter collectively referred to as “Covered Employee(s)”) as part of SOI’s
operation as a professional employer organization; and

WHEREAS, FHLHIC, RFC and SOI desire to amend the Agreement to: (i) add Virginia as one of the
states in which FHLHIC will provide Products to Covered Employees; (ii) include FHLHIC’s fees for
providing such Products to Covered Employees in the state of Virginia; (iii) add dental coverage
for Virginia and Nevada; and (iv) include FHLHIC’s fees for providing dental coverage to Covered
Employees in these states;

NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth herein and in

the Agreement, the parties agree as follows:

	1.	 	Section II.A of the Agreement is hereby deleted in its entirety and replaced with the
following:

	 	A.	 	FHLHIC will offer a large group preferred provider option (the “Benefits
Contract”), to be administered in a manner compliant with state insurance laws in the states of
California, Nevada, North Carolina, South Carolina, Texas and Virginia, as applicable,
as determined by the residence of Covered Employees. In addition, FHLHIC may
administer other mutually agreed upon health benefit options in a manner compliant with
state insurance laws in the states of California, Nevada, North Carolina, South
Carolina, Texas and Virginia, as applicable, as determined by the residence of Covered Employees.

	2.	 	Section V.A of the Agreement is hereby deleted in its entirety and replaced with the
following:

	 	A.	 	FHLHIC and SOI agree that SOI will offer the FHLHIC Products exclusively to its
Covered Employees in California, Nevada, North Carolina, South Carolina, Texas and
Virginia. No other SOI sponsored major medical health plan will be offered to Covered
Employees in the above states during the term of this Agreement, except the following
HMO plans may be offered: Kaiser HMO of California in California; Coventry HMO of
GA; and Humana Medicare Advantage Plan to Medicare eligible employees.

 

 

					
	Union Planters Corporation/SOI — First Amendment
	 	Page 2 of 3

	3.	 	The fourth sentence in Section VIII.D.2.c of the Agreement is hereby deleted in its entirety
and replaced with the following:
	 
	 	 	SOI/Division Mapping Structure is as follows:
	 
	 	 	     California, Nevada, North Carolina, South Carolina, Texas and Virginia.
	 
	4.	 	Schedule A of the Agreement shall be amended as follows:

	 	 	The Irrevocable Letter of Credit is hereby deleted and replaced with the following:

	 	 	 	 	 
	 

	 	Irrevocable Letter(s) of Credit:
	 	$[     ], adjusted annually or if the number of covered
lives meets or exceeds 2,500 by more than 10%.

	 	 	The following is added at the end of Schedule A:

	 	 	 	 	 
	 

	 	Virginia Implementation Fee:
	 	$[     ]
	 
	 	 	 	 
	 

	 	Dental Insurance Premium:
	 	$[     ] per Covered Employee per Month, with annual CPI increases

	5.	 	The parties ratify and affirm the Agreement and agree that it is in full force as modified by
this Amendment. This Amendment will prevail in the event of a conflict between it and the
Agreement.

IN WITNESS WHEREOF, the duly authorized officers for and on behalf of the parties have executed

this Amendment as of the Effective Date.

	 	 	 	 	 	 	 
	 	 	 	 	First Health Life & Health Insurance Company
	 
	  /s/ Sharon Bradel

	 	 	 	By:
	 	  /s/ Karyn Glogowski
	 

	 	 	 	 	 	 
	  Witness

	 	 	 	Name:
	 	  Karyn Glogowski
	 

	 	 	 	 	 	 
	 

	 	 	 	Title:
	 	  Vice President
	 

	 	 	 	 	 	 
	 

	 	 	 	Date:
	 	  11/1/05
	 

	 	 	 	 	 	 

	 	 	 	 	 	 	 
	 	 	 	 	Strategic Outsourcing, Inc.
	 
	/s/ Sarah M. Smith

	 	 	 	By:
	 	  /s/ Carl Guidice
	 

	 	 	 	 	 	 
	  Witness

	 	 	 	Name:
	 	  Carl Guidice
	 

	 	 	 	 	 	 
	 

	 	 	 	Title:
	 	  Chief Operating Officer
	 

	 	 	 	 	 	 
	 

	 	 	 	Date:
	 	  10/12/05
	 

	 	 	 	 	 	 

 

 

					
	Union Planters Corporation/SOI — First Amendment
	 	Page 3 of 3

	 	 	 	 	 	 	 
	 	 	 	 	Union Planters Corporation
	 
	/s/ Sarah M. Smith

	 	 	 	By:
	 	  /s/ Carl Guidice
	 

	 	 	 	 	 	 
	Witness

	 	 	 	Name:
	 	  Carl Guidice
	 

	 	 	 	 	 	 
	 

	 	 	 	Title:
	 	  Divisional CEO
	 

	 	 	 	 	 	 
	 

	 	 	 	Date:
	 	  10/12/05EX-10.24

 

Confidential Treatment

Exhibit 10.24

PORTIONS OF THIS EXHIBIT HAVE BEEN OMITTED AND FILED SEPARATELY WITH THE
SECRETARY OF THE COMMISSION PURSUANT TO REGISTRANT’S APPLICATION OBJECTING TO
DISCLOSURE AND REQUESTING CONFIDENTIAL TREATMENT UNDER RULE 406. THE OMITTED
PORTIONS HAVE BEEN MARKED WITH BRACKETS.

Policyholder No. 811357

Group Accident and Health

Insurance Policy

a contract between

Aetna Life Insurance Company

(A Stock Company herein called Aetna)

and

Strategic Outsourcing Inc.

(Policyholder)

	 	 	 
	Policy Number:

	 	GP-811357
	 
	 	 
	Date of issue:

	 	March 1, 2007
	 
	 	 
	To take effect:

	 	March 1, 2007
	 
	 	 
	Policy delivered in:

	 	Florida

This policy will be construed in line with the law of the jurisdiction in which it is
delivered.

Based on timely premium payments by the Policyholder, Aetna agrees with the Policyholder, to
pay benefits in line with the policy terms.

The duties and the rights of all persons will be based solely on policy terms. This policy is
non-participating.

Signed at Aetna’s Home Office in Hartford, Connecticut on the date of issue

	 	 	 
		 	 
	Ronald A. Williams	 	 
	Chairman, Chief Executive Officer, and President
	 	 

	 	 	 	 	 
	GR-29

	 	Aetna Life Insurance Company
	 	Face Page
	ED. 8-87

	 	151 Farmington Avenue
	 	207976
	 

	 	Hartford, Connecticut 06156	 	 
	 

	 	860-273-0123	 	 

 

 

Index

 

Policy Contents

Part I

     Eligible Classes

     Changes

     Special Provisions

Part II

     Policyholder and Insurance Company Matters

	 	 	 	 	 
	GR-29
	 	 	 	 
	0040
	 	 	 	 
	ED. 7-73

	 	Page 9000
	 	F208015

 

 

Policy Contents

 

This policy consists of:

     The Face Page, Index, this Policy Contents page, and all the provisions of Parts I and II; and

     The provisions found in the Certificate(s) listed in this section.

The words “you” or “your” in any Certificate included in this policy, will refer to a covered
Employee,

The Certificate(s) included in this policy are as follows;

     A “Certificate” consists of a Certificate Base document (“Cert. Base”) and any Summary of
Coverage (“SOC”) or
Certificate Rider (“Rider”) which may be issued to support or amend the Cert. Base.

	 	 	 	 	 	 	 
	 	 	 	 	 	 	Eligible Group and/or
	Identification	 	Issue Date	 	Effective Date	 	Type of Coverage
	 
	 	 	 	 	 	 
	Cert. Base: 1

	 	April 1, 2007
	 	March 1, 2007
	 	OA MC
	SOC: 1A

	 	April 1, 2007
	 	March 1, 2007
	 	OA MC 500
	SOC: IB

	 	April 1, 2007
	 	March 1, 2007
	 	OA MC 1000
	 
	 	 	 	 	 	 
	Cert. Book: 2

	 	April 1, 2007
	 	March 1, 2007
	 	HDHP 1500
	SOC: 2A

	 	April 1, 2007
	 	March 1, 2007
	 	HOHP 1500
	 
	 	 	 	 	 	 
	Cert. Book: 3

	 	April 1, 2007
	 	March 1, 2007
	 	Open Choice
	SOC: 3A

	 	April 1, 2007
	 	March 1, 2007
	 	Open Choice 1000
	SOC: 3B

	 	April 1, 2007
	 	March 1, 2007
	 	Open Choice 500
	 
	 	 	 	 	 	 
	Rider 1

	 	April 1, 2007
	 	March 1, 2007
	 	New York ET
	Rider 2

	 	April 1, 2007
	 	March 1, 2007
	 	Connecticut ET
	Rider 3

	 	April 1, 2007
	 	March 1, 2007
	 	New Jersey ET
	Rider 4

	 	April 1, 2007
	 	March 1, 2007
	 	Arizona ET
	Rider 5

	 	April 1, 2007
	 	March 1, 2007
	 	California ET
	Rider 6

	 	April 1, 2007
	 	March 1, 2007
	 	Texas ET
	Rider 7

	 	April 1, 2007
	 	March 1, 2007
	 	South Carolina ET
	Rider 8

	 	April 1, 2007
	 	March 1, 2007
	 	North Carolina ET
	Rider 9

	 	April 1, 2007
	 	March 1, 2007
	 	Alabama ET
	Rider 10

	 	April 1, 2007
	 	March 1, 2007
	 	Arkansas ET
	Rider 11

	 	April 1, 2007
	 	March 1, 2007
	 	Colorado ET
	Rider 12

	 	April 1, 2007
	 	March 1, 2007
	 	Georgia ET
	Rider 13

	 	April 1, 2007
	 	March 1, 2007
	 	Iowa ET
	Rider 14

	 	April 1, 2007
	 	March 1, 2007
	 	Illinois ET
	Rider 15

	 	April 1, 2007
	 	March 1, 2007
	 	Indiana ET
	Rider 16

	 	April 1, 2007
	 	March 1, 2007
	 	Massachusetts ET
	Rider 17

	 	April 1, 2007
	 	March 1, 2007
	 	Maryland ET
	Rider 18

	 	April 1, 2007
	 	March 1, 2007
	 	Missouri ET

	 	 	 	 	 
	GR-29
	 	 	 	 
	1508
	 	 	 	 
	ED. 10-96

	 	Page 9010
	 	205478

 

 

	 	 	 	 	 	 	 
	 	 	 	 	 	 	Eligible Group and/or
	Identification	 	Issue Date	 	Effective Date	 	Type of Coverage
	 
	 	 	 	 	 	 
	Rider 19

	 	April 1, 2007
	 	March 1, 2007
	 	Mississippi ET
	Rider 20

	 	April 1, 2007
	 	March 1, 2007
	 	Ohio ET
	Rider 21

	 	April 1, 2007
	 	March 1, 2007
	 	Oklahoma ET
	Rider 22

	 	April 1, 2007
	 	March 1, 2007
	 	Pennsylvania ET
	Rider 23

	 	April 1, 2007
	 	March 1, 2007
	 	Tennessee ET
	Rider 24

	 	April 1, 2007
	 	March 1, 2007
	 	Virginia ET
	Rider 25

	 	April 1, 2007
	 	March 1, 2007
	 	Kentucky ET
	Rider 26

	 	April 1, 2007
	 	March 1, 2007
	 	Louisiana ET
	Rider 27

	 	April 1, 2007
	 	March 1, 2007
	 	Nevada ET
	Rider 28

	 	April 1, 2007
	 	March 1, 2007
	 	New Hampshire ET
	Rider 29

	 	April 1, 2007
	 	March 1, 2007
	 	New Mexico ET
	Rider 30

	 	April 1, 2007
	 	March 1, 2007
	 	Maine ET
	Rider 31

	 	April 1, 2007
	 	March 1, 2007
	 	South Dakota ET

	 	 	 	 	 
	GR-29W
	 	 	 	 
	1508
	 	 	 	 
	ED. 6-86

	 	Page 9010.1
	 	208246

 

 

Part I

 

Eligible Classes

All classes of employees of a Member Employer are eligible except those who are:

     Part-time;

     Temporary;

     Substitute; or

     In a class for which a Certificate is not in this policy.

An employee is eligible only for the coverages shown in the Certificate which applies to his
class.

If a Member Employer is a partnership or proprietorship, each of its natural-person partners,
or the proprietor, will be deemed to be an employee. This applies only if the person is
working on a mostly full-time basis for the Employer.

	 	 	 	 	 
	GR-29
	 	 	 	 
	0150
	 	 	 	 
	ED. 7-73

	 	Page 9050
	 	205823

 

 

Change in Amounts

Employee Coverage

Earnings, Status, Schedule, or Benefit Level Change

If, for any reason and at any time, the employee’s rate of earnings, or the employee’s
status, or any schedule, or the level of any benefit is changed, the amount of his or her
coverage will be changed to the new amount.

A retroactive change in an employee’s rate of earnings or status will not result in a
retroactive change in coverage. Any change in coverage will be effective on the date the
change in earnings or status is made.

	 	 	 	 	 
	GR-29
	 	 	 	 
	0190
	 	 	 	 
	ED. 7-96

	 	Page 9060
	 	F207664

 

 

Change In Amounts (Continued)

Dependent Coverage

Status, Schedule, or Benefit Level Change

If, for any reason and at any time, a dependent’s status, any schedule, or the level of any
benefit for a dependent is changed so as to warrant an amount of coverage for a dependent
other than that then in force, the amount of a dependent’s coverage will be changed to the new
amount.

	 	 	 	 	 
	GR-29
	 	 	 	 
	0190
	 	 	 	 
	ED. 7-96

	 	Page 9065
	 	207726

 

 

Other Changes

Employee Coverage

Change in Eligibility Date

An increase in any required period of service will apply only to an employee who enters
service on or after the effective date of the increase. A decrease in any required period of
service will permit an employee to become eligible on the effective date of the decrease if he
or she then has worked the new period of service. Otherwise he or she is eligible on the date
he or she completes it.

Change in Age Reduction Rule

If an Age Reduction Rule is changed and an employee is eligible for an increase in coverage
due to such change, such increase shall be effective only if Aetna gives its written consent.

Employee And Dependent Coverage

Addition or Deletion of a Benefit

Except as set forth in the next paragraph, if any benefit becomes applicable to an employee
or a dependent who is already covered under the policy, that person will be eligible for that
benefit right away. Coverage will be effective in line with the Effective Date provisions.

If any benefit no longer applies to an employee or a dependent, coverage for that benefit will
stop right away for that person.

	 	 	 	 	 
	GR-29
	 	 	 	 
	0190
	 	 	 	 
	ED. 7-96

	 	Page 9070
	 	F207644A

 

 

Special Provisions

Effect of Prior Coverage — Transferred Business

If the coverage of any family member under one or more benefit sections replaces any prior
coverage in effect for the
member, the rules below will apply.

“Prior Coverage” is any plan of group health benefits coverage carried or sponsored by a Member
Employer or its predecessor. It was provided by any carrier other than Aetna (i.e.,
transferred business). It has been replaced as a whole or in part, as to the class of employees
of which the employee is a member, by coverage under one or more benefit sections of this
policy. Any such plan shall be “prior coverage” whether provided by group insurance or by any
other arrangement of group coverage.

A “like benefit” of the prior coverage means:

     Any benefit payable under any prior group medical, dental, or other health plan for medical or
dental treatment.

As to any Major Medical, Comprehensive Medical, or Comprehensive Dental Expense Benefits:

If part or all of a covered family member’s Deductible, under any section of his or her prior
coverage that provides one or more of these benefits, has been applied against covered
expenses incurred by him or her during the 90 day period right before the date his or her
coverage goes into effect, his or her Deductible under any Major Medical, Comprehensive
Medical, or Comprehensive Dental Expense Benefits for the calendar year in which he or she
becomes covered will be reduced by the amount so applied.

If such benefit has a Personal Payment Limit or a Family Payment Limit and any section of the
prior coverage had a
similar limit and any expenses were applied against those similar limits during the calendar
year in which the family member’s coverage goes into effect, the Personal Payment Limit and
the Family Payment Limit under any Major Medical, Comprehensive Medical, or Comprehensive
Dental Expense Benefits for the calendar year in which he or she becomes covered will be
reduced by the amount so applied.

	 	 	 	 	 
	GR-29
	 	 	 	 
	0990

	 	 	 	209457
	ED. 7-73

	 	Page 9074
	 	FL

 

 

Special Provisions (Continued)

Effect of Prior Coverage — Transferred Business (Continued)

If the family member had, during the calendar year in which his or her coverage goes into
effect, reached any Personal Payment Limit or Family Payment Limit under the prior coverage,
any higher limits under this policy will not apply to the family member until the calendar year
following the calendar year in which his or her coverage goes into effect.

	 	 	 	 	 
	GR-29
	 	 	 	 
	0990

	 	 	 	F207847
	ED. 7-73

	 	Page 9075
	 	FL

 

 

Special Provisions (Continued)

Effect of Prior Coverage — Transferred Business (Continued)

Any Employee Coverage or Dependent Coverage which becomes effective under the terms of this
section will not be in effect and benefits will not be available as to a disease or injury for
which benefits:

are available; or

would be available in the absence of coverage under this policy;

under any extension of benefits provision of the prior coverage until the end of the period for
which such benefits:

are available; or

would be available in the absence of any coverage under this policy;

under such extension of benefits.

As to each family member to whom the 2 prior paragraphs apply:

	 	 	 	 	 
	GR-29
	 	 	 	 
	0990

	 	 	 	209459
	ED. 7-96

	 	Page 9076.1
	 	FL

 

 

Special Provisions (Continued)

Effect of Prior Coverage — Transferred Business (Continued)

No benefits will be payable under this policy with respect to any expenses which are
covered in whole or in part under any extension of benefits under the prior coverage because of
total disability.

The Policyholder will be liable for the premium required by Aetna for the terms of this
provision to apply to the covered family member.

Coverage under this provision will continue only for the period of time agreed to by Aetna and
the Policyholder.

This provision will terminate as to an employee if his or her coverage terminates.

If he or she stays insured or again becomes eligible, this policy will apply to him or her as
though this provision were not included.

	 	 	 	 	 
	GR-29
	 	 	 	 
	0990
	 	 	 	 
	ED. 7-73

	 	Page 9077
	 	209428

 

 

Part II

Policyholder and Insurance Company Matters

Declarations

The first “policy month” starts on March 1, 2007.

Each subsequent policy month starts on the first
of a calendar month.

The first “policy year” starts on March 1, 2007
and ends on February 28, 2008.

Each subsequent policy year starts on March 1.
It ends on February 28.

Member Employers

Member Employers are those employers which are included under this policy by written
agreement between the Policyholder and Aetna.

An employer may be a Member Employer if not against the law of the jurisdiction in which this
policy is delivered.

The Policyholder may act for all Member Employers in all policy matters. Each such act, or
agreement made between Aetna and the Policyholder, or notice given by one to the other will be
binding on ail the Employers.

Clerical Error

A clerical error in keeping records; or a delay in making an entry; will not alone decide
if insurance is valid. An equitable adjustment in premiums will be made when the error or
delay is found. If the clerical error affects:

the existence; or

amount:

of insurance, the facts as determined by Aetna will be used to decide if insurance is in force
and its amount.

Misstatements

If any fact as to a person to whom the insurance relates is found to have been misstated, a
fair change in premiums will be made. If the misstatement affects the existence or amount of
insurance, the true facts will be used to decide if insurance is in force and its amount.

	 	 	 	 	 
	GR-29
	 	 	 	 
	1150,1150-1
	 	 	 	 
	ED. 1-02

	 	Page 9080
	 	205333

 

 

Policyholder and Insurance Company Matters (Continued)

Duties of the Policyholder

The Policyholder and each Member Employer must give Aetna such information as Aetna may
reasonably require to administer this policy and must agree to:

Maintain a reasonably complete record of such information in electronic or hard copy format,
including but not limited to:

evidence of eligibility;

changes to such elections; and

terminations;

for at least seven years or until the final rights and duties under this policy have been
resolved; and to make such
information available to Aetna upon request.

Obtain from:

the Policyholder; and

each Member Employer.

a “Disclosure of Healthcare Information” authorization in the form currently being used by
Aetna in the enrollment
process; or such other form as Aetna may reasonably approve.

The information shall be provided when requested:

on Aetna forms; or

such other forms as Aetna may approve.

All data which may have a bearing on insurance or premiums will be open for Aetna to inspect
while this policy is in force.

The Policyholder must notify employees of the termination of the policy in compliance with all
applicable laws. However, Aetna reserves the right to notify employees of termination of the
policy for any reason, including non-payment of premium. The Policyholder shall provide
written notice to employees of their rights upon termination of coverage.

The Policyholder must:

notify all eligible employees of their right to continue coverage under COBRA and any
applicable state law; and

provide notification to each employee within 15 days after termination of coverage, of their
conversion right, including:

a description of plans available;

premium rates;

and application forms.

	 	 	 	 	 
	GR-29
	 	 	 	 
	11496
	 	 	 	 
	ED. 1-02

	 	Page 9085
	 	207919

 

 

Policyholder and Insurance Company Matters (Continued)

Non-Discrimination

In the management of this policy, the Policyholder and the Member Employers:

will make no attempt, whether through differential contributions or otherwise, to encourage or
discourage enrollment in the coverages provided by the policy based on health status or risk.

will act so as not to discriminate unfairly between persons in like situations at the time of
the action.

Aetna can rely on such action. It will not have to probe into the details.

Certificates

Aetna will provide the Policyholder with either a supply of paper copies or electronic
certificates. The Policyholder shall distribute or otherwise make the certificates available
to each insured employee. The insurance in force will be set forth. Statements as to whom
benefits are payable will appear. Any applicable Conversion Privilege will also be described.

Policy Changes

This policy may be amended by Aetna:

with 30 days written notice to the Policyholder; or

by written agreement between Aetna and the Policyholder.

The consent of any employee or other person is not needed. All agreements made by Aetna are
signed by one of its executive officers. No other person can change or waive any of the policy
terms or make any agreement binding Aetna.

The Policyholder will not have to give written agreement of a change in the policy if:

	•	 	The Policyholder has asked for the change and Aetna has agreed to it.
	•	 	The change is needed to correct an error in the policy, including any certificate issued to
anyone.
	•	 	The change is needed so that the policy will conform to any law, regulation or ruling of:

a jurisdiction that affects a person covered under this policy; or

the federal government.

	•	 	The change has been initiated by Aetna and is not resulting in either:

a reduction or elimination in benefits or coverage; or

an increase in premium.

	 	 	 	 	 
	GR-29
	 	 	 	 
	1160-1, 1160-2, 1160-3
	 	 	 	 
	ED. 1-02

	 	Page 9090
	 	205243

 

 

Policyholder and Insurance Company Matters (Continued)

Policy Changes (Continued)

The Policyholder will have to give written agreement of a change in the policy:

that reduces or eliminates benefits or coverage; or

that increases benefits or coverage with a concurrent increase in premium during the policy
term, except if the increased benefits or coverage is required by law.

Payment of the applicable premium after notice of the proposed changes will be deemed to
constitute the Policyholder’s written agreement of those changes on behalf of all persons
covered under this policy.

This policy shall be deemed to be automatically amended to conform with the provisions of
applicable laws and regulations.

	 	 	 	 	 
	GR-29
	 	 	 	 
	1160-1, 1160-2, 1160-3
	 	 	 	 
	ED. 1-02

	 	Page 9090.1
	 	205243

 

 

Policyholder and Insurance Company Matters (Continued)

Contract

This policy and application of the Policyholder are the entire contract. A copy of the
application is attached. All statements made by the Policyholder or an employee shall be
deemed representations and not warranties. No written statement made by an employee shall be
used by Aetna in a contest unless:

a copy of the statement is; or

has been furnished to:

the employee; or

his beneficiary; or

the person making the claim.

Aetna’s failure to implement or insist upon compliance with any provision of this policy at any
given time or times, shall not constitute a waiver of Aetna’s right to implement; or insist
upon compliance with that provision at any other time or times. This includes, but is not
limited to, the payment of premiums. This applies whether or not the circumstances are the
same.

Accident and Health Coverage Statements

Except as to a fraudulent misstatement or issues concerning premiums due:

No statement made by the Policyholder or an employee shall be the basis for:

voiding coverage; or

denying coverage; or

be used in defense of a claim;

unless it is in writing.

No statement made by the Policyholder shall be used to void this policy after it has been in
force for 2 years.

No statement made by an eligible employee shall be used in defense to a claim for loss
incurred or starting after coverage as to which claim is made has been in effect for 2
years.

	 	 	 	 	 
	GR-29
	 	 	 	 
	1165, 9020
	 	 	 	 
	ED. 1-02

	 	Page 9100
	 	208055

 

 

Policyholder and Insurance Company Matters (Continued)

Independent Contractor Relationships

Participating providers (Preferred Care Providers) are not agents or employees of Aetna.
Aetna is not an agent or an employee of any Preferred Care Provider. The relationship between
Aetna and Preferred Care Providers is that of independent contractors.

Preferred Care Providers are solely responsible for their health services. Aetna makes no
express or implied warranties or representations concerning the:

qualifications;

continued participation; or

quality of services of any:

physician;

dentist;

hospital; or

other Preferred Care Provider.

A provider’s participation may be terminated at any time. This may be done with no advance
notice given to the
Policyholder or employees.

	 	 	 	 	 
	GR-29
	 	 	 	 
	11498
	 	 	 	 
	ED. 1-02

	 	Page 9105
	 	207913

 

 

Policyholder and Insurance Company Matters (Continued)

Premium Rates (Continued)

Other Accident and Health Benefits

The premium rates for accident and health coverage are as follows. They can be changed as
shown below. The premium rates are for a period of one month.

The current premium rates for all of the Accident and Health Coverages provided under this
policy are on record with both Aetna and the Policyholder.

Premium Per Employee

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Dependent Coverage
	 
	 	 	Employee	 	Employee	 	Employee	 	Family
	 	 	Coverage	 	and Spouse	 	and	 	 
	 	 	 	 	 	 	Child(ren)	 	 
	National Rates — MC POS 500 90%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Super Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Proposed Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Non-Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	High Risk Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	National Rates — MC POS 1000 80%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Super Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Proposed Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Non-Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	High Risk Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	National Rates — PPO 500 90%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Super Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Proposed Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Non-Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	High Risk Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	National Rates — HDHP1500 100%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Super Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Proposed Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	Non-Preferred Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 
	High Risk Rates
	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 	 	$	[___]	 

	 	 	 	 	 
	GR-29
	 	 	 	 
	1190
	 	 	 	 
	ED. 1-02

	 	Page 9150
	 	208149

 

 

Policyholder and Insurance Company Matters (Continued)

Fees

In addition to the premium, Aetna may charge;

An installation fee upon:

initial installation of coverage; or

any significant change in installation, including but not limited to:

a substantial change in the number or composition of persons insured under this policy; or

a change in the method of reporting eligibility to Aetna.

A billing fee with each monthly premium bill. The billing fee may include a fee for the
recovery of any surcharges for amounts paid through:

credit card;

debit card; or

other similar means.

A reinstatement fee if any or all coverage is terminated and later reinstated under this
policy.

A conversion fee applied to each covered person electing conversion coverage. The conversion
fee may be charged monthly. This fee is based upon the number of covered persons electing
conversion coverage during the previous month.

	 	 	 	 	 
	GR-29
	 	 	 	 
	11501

	 	 	 	209610
	ED. 1-02

	 	Page 9152
	 	FL
	 
	 	 	 	 
	05/06
	 	 	 	 

 

 

Policyholder and Insurance Company Matters (Continued)

Premiums Due — Experience Rating

The premium due under this policy on any premium due date will be the sum of the premium
charges for the coverages then provided under this policy.

If premiums are payable monthly, any insurance becoming effective will be charged for from the
first day of the policy month on or right after the date the insurance takes effect. Premium
charges for insurance which ceases will cease as of the first day of the policy month on; or
right after the date the insurance terminates. If premiums are payable less often than monthly,
premium charges or credits for a fraction of a premium-paying period will be made on a pro rata
basis for the number of policy months between:

the date premium charges start or cease; and

the end of the premium-paying period.

If this policy is changed to provide more coverage to take effect on a date other than the
first day of a premium-paying period, a pro rata premium for the coverage will be due and
payable on that date. It will cover the period then starting and ending right before the start
of the next premium-paying period.

The premium charges will be figured at the premium rates shown before. Aetna may change them
due to:

Experience; or

a change in factors bearing on the risk assumed.

Each change shall be made by written notice to the Policyholder by Aetna.

No experience reduction or increase in premium rates shall become effective less than 12 months
after the effective date of the group policy unless there is:

a significant change in factors bearing a material impact on the risk assumed by Aetna; or

changes in applicable state or federal:

law;

policy;

regulation; or

a judicial decision;

	 	 	 	 	 
	GR-29
	 	 	 	 
	1195-1, 1195-2
	 	 	 	 
	ED. 1-02

	 	Page 9160
	 	209202

 

 

Policyholder and Insurance Company Matters (Continued)

Premiums Due — Experience Rating (Continued)

having a material impact on the cost of providing the coverages then provided under this
group policy. As used here, “group policy” shall be deemed to include any group policy
previously issued by Aetna that has been replaced in whole or in part by this policy.

The premium charges for any coverage under this policy may be refigured, as of a premium due
date, only:

By reason of a change in factors bearing on the risk assumed. This must be requested by Aetna.

Once during any continuous 12 month period. The Policyholder must request this. 60 days
advance notice has to be given to Aetna.

They will be refigured using:

The ages of the employees;

The amounts of insurance in force;

The premium rates; and

Any other pertinent factors.

All facts will be taken into account as of the date of the refiguring.

	 	 	 	 	 
	GR-29
	 	 	 	 
	1195-1, 1195-2
	 	 	 	 
	ED. 1-02

	 	Page 9160.1
	 	209202

 

 

Policyholder and Insurance Company Matters (Continued)

Premiums Due — Experience Rating (Continued)

At the end of a policy year, Aetna may declare an experience credit. The amount of each
credit Aetna declares will be returned to the Policyholder. Upon request by the Policyholder,
part or all of it will be applied against the payment of premiums or in any other manner as may
be agreed to by the Policyholder and Aetna.

If the sum of employee contributions which have been made for group insurance exceeds the sum
of premiums which have been paid for group insurance (after giving effect to any experience
credits), the excess will be applied by the Policyholder for the sole benefit of employees.
Aetna will not have to see to the use of such excess.

Instead of figuring premiums as described above, premiums may be figured in any way approved by
Aetna that comes up with about the same amount of premiums.

Aetna will not have to refund any premium for a period prior to:

The first day of the policy year in which Aetna receives proof that the refund should be made;
or

The date 3 months before Aetna receives proof, if this produces a larger refund.

This applies even if the premium was paid in error.

Payment of Premiums and Fees

The Policyholder will pay premiums and fees in advance. They may be paid at Aetna’s Home
Office or to its authorized agent.

A premium is due to be paid on the first day of each policy month.

The Policyholder may change the number of premium payments as of a premium due date. This
needs Aetna’s written consent.

Aetna may accept a partial payment of premium without waiving its right to collect the entire
amount due.

If the premiums and any fees are not paid by the Premium Due Date and before the end of the
Grace Period, this policy will automatically terminate when the Grace Period ends. Aetna will
require the Policyholder to pay interest on the total premium amount and any fees overdue after
the Premium Due Date including the premiums due for the Grace Period. The interest rate will
be 1 1/2% per month for each:

month; or

partial month;

the balance remains unpaid. Aetna may recover from the Policyholder:

costs of collecting any unpaid premiums or fees; including reasonable attorney’s fees; and

costs of suit.

	 	 	 	 	 
	GR-29
	 	 	 	 
	11500, 11502

	 	 	 	208105
	ED. 1-02

	 	Page 9170
	 	FL

 

 

Policyholder and Insurance Company Matters (Continued)

Retroactive Adjustments

Aetna may, at its discretion, make retroactive adjustments to the Policyholder’s billings
for the termination of employees not posted to previous billings. However, the Policyholder
may only receive a maximum of 1 month’s credit for employee terminations that occurred more
than 30 days before the date the Policyholder notified Aetna of the termination. Aetna may
reduce any such credits by the amount of any payments Aetna may have made on behalf of such
employees before Aetna was informed their coverage had been terminated. Retroactive additions
will be made at Aetna’s discretion based upon eligibility guidelines stated in the certificate,
and are subject to the payment of all applicable premiums.

Grace Period

A grace period of 31 days after the due date will be allowed the Policyholder for the
payment of each premium and fee. If premiums are not paid by the end of the Grace Period, the
policy will automatically terminate at the end of the Grace Period.

	 	 	 	 	 
	GR-29
	 	 	 	 
	11500, 11502

	 	 	 	208105
	ED. 1-02

	 	Page 9170.1
	 	FL

 

 

Policyholder and Insurance Company Matters (Continued)

Discontinuance of Policy

The Policyholder may terminate this policy as to any or all coverage of all or any class of
employees of any one or more Member Employers. A Member Employer may terminate this policy as
to any or all coverage of all or any class of its employees. Aetna must be given written
notice. The notice must state when such termination shall occur. It must be a date after the
notice. It shall not be effective during a period for which a premium has been paid to Aetna
as to the coverage.

Aetna may terminate this policy as to any or all coverage, other than Health Expense Coverage,
which includes:

Comprehensive Medical Expense Coverage;

Major Medical Expense Coverage;

Prescription Drug Expense Coverage; and

Hospital Expense Benefit;

but does not include:

Comprehensive Dental Expense Coverage; and

Comprehensive Vision Expense Coverage;

of all or any class of employees or dependents of any one or more Member Employers by giving
written notice of when it will terminate. The date shall not be earlier than 31 days after the
date of the notice unless it is agreed to by the Policyholder and Aetna. This right to
terminate shall be in accordance with the Grace Period and Payment of Premiums provisions and
is subject to the terms of any laws or regulations.

Comprehensive Medical Expense Coverage; Major Medical; Prescription Drug Expense Coverage;
Hospital Expense Benefit may be terminated by Aetna as follows:

When the premium for the employees’ coverage has not been paid. This right to terminate shall
be in accordance with the Grace Period and Payment of Premiums provisions and is subject to
the terms of any laws or regulations.

When the Policyholder ceases to meet the requirements for a group as defined under applicable
state law or regulation.

When the Policyholder fails to meet Aetna’s contribution or participation requirements. Aetna
may request:

	 	 	 	 	 
	GR-29
	 	 	 	 
	1210-1, 1210-2, 1210-3

	 	 	 	207900
	ED. 1-02

	 	Page 9180
	 	FL

 

 

Policyholder and Insurance Company Matters (Continued)

Discontinuance of Policy (Continued)

certification of the Policyholder’s compliance with Aetna’s participation and contribution
requirements; and

certification of group status;

prior to renewal. Aetna may exercise its right to non-renew if such certification is not
provided.

When the Policyholder fails, without good cause, to perform in good faith its obligations under
this policy including an act or practice that constitutes fraud or
intentional misrepresentation of a material fact relevant to the coverage provided under this
policy.

In accordance with any applicable state or federal law, rule or regulation.

When Aetna decides to discontinue offering:

a particular type of group health expense coverage; or

all its group health expense coverage in the state the policy is issued; provided all group health
expense coverages issued or delivered for issuance in such state are discontinued and not renewed.

Except if Aetna discontinues offering a type of group health expense coverage, Aetna will give
the Policyholder advance written notice of when it will terminate the policy. The date shall
not be earlier than 45 days after the date of the notice
unless it is agreed to by the Policyholder and Aetna.

If Aetna discontinues offering a particular type of group health expense coverage, it shall:

provide written notice to each affected employer, (and all covered employees and dependents),
of the discontinuance within 90 days before such plans discontinue;

offer each affected employer the option, on a guaranteed issue basis; to purchase any other
group health benefit plan currently being offered in that market; and

act uniformly without regard to the claims experience of the affected employers; or any health
status-related factor relating to any covered employee or dependent who may become eligible
for coverage.

If Aetna discontinues offering all its group health expense coverages, it shall provide written
notice to the Florida Department of Insurance and to each affected employer, (and all covered
employees and dependents), of the discontinuance at least 180 days before such discontinuance.

	 	 	 	 	 
	GR-29
	 	 	 	 
	1210-1, 1210-2, 1210-3

	 	 	 	207900
	ED. 1-02

	 	Page 9180.1
	 	FL

 

 

Policyholder and Insurance Company Matters (Continued)

Discontinuance of Policy (Continued)

If:

This policy terminates as to any of the employees of a Member Employer; and

Premiums have not been paid for the period this policy; or any coverage included was in force
for those employees;

then the Policyholder and the Employer shall be jointly and severally liable to Aetna for the
unpaid premiums including those due for the grace period. Employees shall also remain liable
for employee cost sharing and other required contributions to coverage for any period of time
the policy is in force during the Grace Period.

Aetna may request from the Policyholder, a written indication of their intention to renew or
non-renew a policy at any time during the final three months of any policy year. If the
Policyholder fails to reply to such request:

within two weeks of their receipt of the request; or

15 days prior to the renewal date;

whichever is later; then upon Aetna’s written 45 day advance termination notice to the
Policyholder, all or a part of the policy shall be deemed to terminate automatically as of the
end of the policy year. Similarly, upon Aetna’s written confirmation to the Policyholder, Aetna
may accept an oral indication by:

the Policyholder; or

its agent or broker;

of intent to non-renew as the Policyholder’s notice of termination of all or a part of the
policy effective as of the end of the policy year.

	 	 	 	 	 
	GR-29
	 	 	 	 
	1210-1, 1210-2, 1210-3

	 	 	 	207900
	ED. 1-02

	 	Page 9180.2
	 	FL

 

 

Policyholder and Insurance Company Matters (Continued)

ERISA Matters

Under Section 503 of Title 1 of the Employee Retirement Income Security Act of 1974, as
amended (ERISA), Aetna is a fiduciary. It has complete authority to review all denied claims
for benefits under this policy. This includes, but is not limited to, the denial of
certification of the medical necessity of hospital or medical treatment. In exercising such
fiduciary responsibility, Aetna shall have discretionary authority to:

determine whether and to what extent employees and beneficiaries are entitled to benefits; and

construe any disputed or doubtful terms of this policy.

Aetna shall be deemed to have properly exercised such authority. It must not abuse its
discretion by acting arbitrarily and capriciously. Aetna has the right to adopt reasonable:

policies;

procedures;

rules, and

interpretations;

of this policy to promote orderly and efficient administration.

The Policyholder shall be responsible for making reports and disclosures required by ERISA,
including:

the creation;

the distribution; and

the final content of:

summary plan descriptions;

summary of material modifications; and

summary annual reports.

	 	 	 	 	 
	GR-29
	 	 	 	 
	9020-3
	 	 	 	 
	ED. 1-02

	 	Page 9190
	 	207366

 

 

Aetna Life Insurance Company

LIMITATIONS AND EXCLUSIONS UNDER THE ARKANSAS

LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION ACT

Residents of this state who purchase life insurance, annuities, or health and accident
insurance should know that the insurance companies licensed in this state to write these types
of insurance are members of the Arkansas Life and Health Insurance Guaranty Association
(“Guaranty Association”). The purpose of the Guaranty Association is to assure that policy and
contract owners will be protected, within certain limits, in the unlikely event that a member
insurer becomes financially unable to meet its obligations. If this should happen, the
Guaranty Association will assess its other member insurance companies for the money to pay the
claims of policy owners who live in this state and, in some cases, to keep coverage in force.
The valuable extra protection provided by the member insurers through the Guaranty Association
is not unlimited, however. And, as noted in the box below, this protection is not a substitute
for consumers’ care in selecting insurance companies that are well-managed and financially
stable.

DISCLAIMER

The Arkansas Life and Health Insurance Guaranty Association (“Guaranty
Association”) may not provide coverage for this policy. If coverage is
provided, it may be subject to substantial limitations or exclusions, and
require continued residency in the state. You should not rely on coverage by
the Guaranty Association in purchasing an insurance policy or contract.

Coverage is NOT provided for your policy or contract or any portion of it that
is not guaranteed by the insurer or for which you have assumed the risk, such
as non-guaranteed amounts held in a separate account under a variable life or
variable annuity contract.

Insurance companies or their agents are required by law to provide you with
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the Guaranty Association to induce you to
purchase any kind of insurance policy.

The Arkansas Life and Health Insurance Guaranty Association

C/0 The Liquidation Division

1023 West Capitol

Little Rock, Arkansas 72201

Arkansas Insurance Department

1200 West Third Street

Little Rock, Arkansas 72201-1904

The state law that provides for this safety-net is called the Arkansas Life and Health
Insurance Guaranty Association Act (“Act”). Below is a brief summary of the Act’s coverages,
exclusions and limits. This summary does not cover all provisions of the Act; nor does it in
any way change anyone’s rights or obligations under the Act or the rights or obligations of the
Guaranty Association.

COVERAGE

Generally, individuals will be protected by the Guaranty Association if they live in this state
and hold a life, annuity, or health insurance contract or policy, or if they are insured under
a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees
of policy or contract owners are protected as well, even if they live in another state.

Arkansas

 

 

EXCLUSIONS FROM COVERAGE

However, persons owning such policies are NOT protected by the Guaranty Association if:

	•	 	they are eligible for protection under the laws of another state (this may occur when
the insolvent insurer was incorporated in another state whose guaranty association
protects insureds who live outside that state);
	•	 	the insurer was not authorized to do business in this state;
	•	 	their policy or contract was issued by a nonprofit hospital or medical service
organization, an HMO, a fraternal benefit society, a mandatory state pooling plan, a
mutual assessment company or similar plan in which the policy or contract owner is subject
to future assessments, or by an insurance exchange.

The Guaranty Association also does NOT provide coverage for:

	•	 	Any policy or contract or portion thereof which is not guaranteed by the insurer or for
which the individual has assumed the risk, such as non-guaranteed amounts held in a
separate account under a variable life or variable annuity contract;
	•	 	Any policy of reinsurance (unless an assumption certificate was issued);
	•	 	Interest rate yields that exceed an average rate;
	•	 	Dividends and voting rights and experience rating credits;
	•	 	Credits given in connection with the administration of a policy, by a group contract
holder;
	•	 	Employers’ plans to the extent they are self-funded (that is, not insured by an
insurance company, even if an insurance company administers them); unallocated annuity
contracts (which give rights to group contractholders, not individuals); unallocated
annuity contracts issued to/in connection with benefit plans protected under Federal
Pension Benefit Corporation (“FPBC”) (whether the FPBC is yet liable or not);
	•	 	Portions of an unallocated annuity contract not owned by a benefit plan or a government
lottery (unless the owner is a resident) or issued to a collective investment trust or
similar pooled fund offered by a bank or other financial institution);
	•	 	Portions of a policy or contract to the extent assessments required by law for the
Guaranty Association are preempted by State or Federal law;
	•	 	Obligations that do not arise under the policy or contract, including claims based on
marketing materials or side letters, riders, or other documents which do not meet filing
requirements, or claims for policy misrepresentations, or extra-contractual or penalty
claims;
	•	 	Contractual agreements establishing the member insurer’s obligations to provide book
value accounting guarantees for defined contribution benefit plan participants (by
reference to a portfolio of assets owned by a nonaffiliate benefit plan or its trustees).

LIMITS ON AMOUNT OF COVERAGE

The Act also limits the amount the Guaranty Association is obligated to cover: The Guaranty
Association cannot pay more than what the insurance company would owe under a policy or
contract. Also, for any one insured life, the Guaranty Association will pay a maximum of $
300,000—no matter how many policies and contracts there were with the same company, even if
they provided different types of coverages. Within this overall $ 300,000 limit, the
Association will not
pay more than $ 300,000 in health insurance benefits, $ 300,000 in present value of annuity
benefits, or $ 300,000 in life insurance death benefits or net cash surrender values-again,
no matter how many policies and contracts there were with the same company, and no matter how
many different types of coverages. There is a $ 1,000,000 limit with respect to any
contract holder for unallocated annuity benefits, irrespective of the number of contracts held
by the contract holder. These are limitations for which the Guaranty Association is obligated
before taking into account either its subrogation and assignment rights or the extent to which
those benefits could be provided out of the assets of the impaired or insolvent insurer.

Arkansas

 

 

Aetna Life Insurance Company

COLORADO NOTICE

SUMMARY OF THE LIFE AND HEALTH INSURANCE PROTECTION ASSOCIATION ACT AND NOTICE

CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS

INTRODUCTION

Residents of Colorado who purchase life insurance, annuities or health insurance should know
that the insurance companies licensed in this state to write these types of insurance are
members of the Life and Health Insurance Protection Association. The purpose of this
Association is to assure that policyholders will be protected, within limits, in the unlikely
event that a member insurer becomes financially unable to meet its obligations. If this should
happen, the Association will assess its
other member insurance companies for the money to pay the claims of insured persons who live in
Colorado and, in some cases, to keep coverage in force. The valuable extra protection provided
by these insurers through the Association is limited, however. As noted in the box below, this
protection is not a substitute for consumers’ care in selecting companies that are well-managed
and financially stable.

IMPORTANT DISCLAIMER

The Life and Health Insurance Protection Association may not provide coverage
for this policy. If coverage is provided, it may be subject to substantial
limitations or exclusions, and require residency in Colorado. You should not
rely on coverage by the Life and Health Insurance Protection Association in
selecting an insurance company or in selecting an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not
guaranteed by the insurer or for which you have assumed the risk.

Insurance companies or their agents are required by law to give or send you
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the Association to induce you to purchase any
kind of insurance policy.

SUMMARY

The state law that provides for this safety-net coverage is called the Life and Health
Insurance Protection Association Act. Below is a brief summary of this law’s coverages,
exclusions and limits. This summary does not cover all provisions of the law, nor does it in
any way change anyone’s rights or obligations under the act or the rights or obligations of the
Association.

COVERAGE

Generally, individuals will be protected by the Life and Health Protection Association if they
live in this state and hold a life or health insurance contract, or annuity, or if they hold
certificates under a group life or health insurance contract or annuity, issued by a member
insurer. The beneficiaries, payees, or assignees of insured persons are protected as well,
even if they live in another state. Certain parties to structured settlement annuity contracts
may be entitled to coverage benefits as well based on defined circumstances.

Colorado

 

 

EXCLUSIONS FROM COVERAGE

Persons holding such policies or contracts are not protected by this Association if:

	•	 	they are not residents of the State of Colorado, except under certain very specific
circumstances;
	•	 	the insurer was not authorized or licensed to do business in Colorado at the time the
policy or contract was issued;
	•	 	their policy was issued by a nonprofit hospital or health service corporation, an HMO,
a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company
or similar plan in which the policyholder is subject to future assessments, or by an
insurance exchange.

The Association also does not provide coverage for:

	•	 	any policy or portion of a policy which is not guaranteed by the insurer or for which
the individual has assumed the risk;
	•	 	any policy of reinsurance (unless an assumption certificate was issued);
	•	 	plans of employers, associations or similar entities to the extent they are self-funded
or uninsured (that is, not insured by an insurance company, even if an insurance company
administers them);
	•	 	interest rates yields, crediting rate yields or other factors employed in calculating
returns, including but not limited to indexes or other external references stated in the
policy or contract, that exceed an average rate specified in the Association Act;
	•	 	dividends;
	•	 	experience rating credits;
	•	 	credits given in connection with the administration of a policy or contract;
	•	 	any unallocated annuity;
	•	 	annuity contracts or group annuity certificates used by nonprofit insurance companies
to provide retirement benefits for nonprofit educational institutions and their employees;
	•	 	policies, contracts, certificates or subscriber agreements issued by a prepaid dental
care plan;
	•	 	sickness and accident insurance when written by a property and casualty insurer as part
of an automobile insurance contract;
	•	 	unallocated annuity contracts issued to an employee benefit plan protected under the
federal Pension Benefit Guaranty Corporation;
	•	 	policies or contracts issued by an insurer which was insolvent or unable to fulfill its
contractual obligations as of July 1, 1991, except for annuity contracts issued by a
member insurer which was placed into liquidation between July 1, 1991 and August 31,1991;
	•	 	policies or contracts covering persons who are not citizens of the United States;
	•	 	any kind of insurance or annuity, the benefits of which are exclusively payable or
determined by a separate account
required by the terms of such insurance policy or annuity maintained by the insurer or by a
separate entity.

LIMITS ON AMOUNT OF COVERAGE

The act also limits the amount the Association is obligated to pay out. The Association cannot
pay more than what the
insurance company would owe under a policy or contract. Also, for any one insured life, no
matter how many policies or contracts were issued by the same company, even if such contracts
provided different types of coverages, the Association will pay a maximum of:

	•	 	$ 300,000 in net life insurance death benefits and no more than $ 100,000 in net
cash surrender and net cash withdrawal values for life insurance;
	•	 	for health insurance benefits — $ 100,000 for coverages not defined as disability,
basic hospital, medical and surgical, or major medical insurance, including any net cash
surrender and net cash withdrawal values: $ 300,000 for disability insurance; or $
500,000 for basic hospital, medical and surgical, or major medical insurance;
	•	 	$ 100,000 in the present value of annuity benefits, including net cash surrender and
net cash withdrawal values; or
	•	 	with respect to each payee of a structured settlement annuity, $ 100,000 in present
value annuity benefits in the aggregate, including net cash surrender and net cash
withdrawal values.

Colorado

 

 

The Association shall not be liable to expend more than $ 300,000 in the aggregate, with
respect to any one life except that with respect to benefits for basic hospital, medical and
surgical and major medical insurance, the aggregate liability of the association shall not
exceed $ 500,000 with respect to any one individual.

This Information is Provided By:

	 	 	 
	Life and Health Insurance Protection Association

	 	Colorado Division of Insurance
	P.O. Box 480025

	 	1560 Broadway, Suite 850
	Denver, CO 80248-0025

	 	Denver, CO 80202
	(303) 292-5022

	 	(303) 894-7499

Colorado

 

 

Aetna Life Insurance Company

ILLINOIS

LIFE AND HEALTH INSURANCE GUARANTY

ASSOCIATION LAW

Residents of Illinois who purchase health insurance, life insurance, and annuities should know
that the insurance companies licensed in Illinois to write these types of insurance are members
of the Illinois Life and Health Insurance Guaranty Association. The purpose of this Guaranty
Association is to assure that policyholders will be protected, within limits, in the unlikely
event that a member insurer becomes financially unable to meet its obligations. If this should
happen, the Guaranty Association will assess its other member insurance companies for the money
to pay the covered claims of policyholders that live in Illinois (and their payees,
beneficiaries, and assignees) and, in some cases, to keep coverage in force. The valuable
extra protection provided by these insurers through the Guaranty Association is not unlimited,
however, as noted below.

ILLINOIS LIFE

AND HEALTH INSURANCE GUARANTY ASSOCIATION

DISCLAIMER

The Illinois Life and Health Insurance Guaranty Association provides coverage
of claims under some types of policies if the insurer becomes impaired or
insolvent. COVERAGE MAY NOT BE AVAILABLE FOR YOUR POLICY. Even if coverage is
provided, there are substantial limitations and exclusions. Coverage is
generally conditioned on continued residence in Illinois. Other conditions may
also preclude coverage.

You should not rely on availability of coverage under the Life and Health
Insurance Guaranty Association Law when selecting an insurer. Your insurer and
agent are prohibited by law from using the existence of the Association or its
coverage to sell you an insurance policy.

The Illinois Life and Health Insurance Guaranty Association or the Illinois
Department of Insurance will respond to any questions you may have which are
not answered by this document. Policyholders with additional questions may
contact:

Illinois Life and Health Insurance Guaranty Association

8420 West Bryn Mawr Avenue

Chicago, Illinois 60631

(312) 714-8050

Illinois Department of Insurance

320 West Washington Street 4th Floor

Springfield, Illinois 62767

(217) 782-4515

SUMMARY OF GENERAL PURPOSES AND CURRENT LIMITATIONS OF COVERAGE

The Illinois law that provides for this safety-net coverage is called the Illinois Life and
Health Insurance Guaranty Association Law (“Law”) (215 ILCS 5/531.01, et seq.). The following
contains a brief summary of the Law’s coverages, exclusions and limits. This summary does not
cover all provisions; nor does it in any way change anyone’s rights or obligations under the
Law or the rights or obligations of the Guaranty Association. If you have obtained this
document from an agent in connection with the purchase of a policy, you should be aware that
its delivery to you does not guarantee that your policy is covered by the Guaranty Association.

Illinois

 

 

	A)	 	Coverage:
	 
	 	 	The Illinois Life and Health Insurance Guaranty Association provides coverage to policyholders
that reside in Illinois for insurance issued by members of the Guaranty Association, including:

	 	1)	 	life insurance, health insurance, and annuity contracts;
	 	2)	 	life, health or annuity certificates under direct group policies or contracts;
	 	3)	 	unallocated annuity contracts; and
	 	4)	 	contracts to furnish health care services and subscription certificates for
medical or health care services issued by certain licensed entities. The
beneficiaries, payees, or assignees of such persons are also protected, even if they
live in another state.

	B)	 	Exclusions from Coverage:

	 	1)	 	The Guaranty association does not provide coverage for:

	 	a)	 	any policy or portion of a policy for which the individual has assumed the
risk;
	 	b)	 	any policy of reinsurance (unless an assumption certificate was issued);
	 	c)	 	interest rate guarantees which exceed certain statutory limitations;
	 	d)	 	certain unallocated annuity contracts issued to an employee benefit plan
protected under the Pension Benefit Guaranty Corporation and any portion of a
contract which is not issued to or in connection with a specific employee, union or
association of natural persons benefit plan or government lottery;
	 	e)	 	any portion of a variable life insurance or variable annuity contract not
guaranteed by an insurer; or
	 	f)	 	any stop loss insurance.

	 	2)	 	In addition, persons are not protected by the Guaranty Association if:

	 	a)	 	the Illinois Director of insurance determines that, in the case of an insurer
which is not domiciled in Illinois, the insurer’s home state provides substantially
similar protection to Illinois residents which will be provided in a timely manner;
or
	 	b)	 	their policy was issued by an organization which is not a member insurer of
the Association.

	C)	 	Limits on Amount of Coverage:

	 	1)	 	The Law also limits the amount the Illinois Life and Health Insurance Guaranty
Association is obligated to pay. The Guaranty Association’s liability is limited to
the lesser of either:

	 	a)	 	the contractual obligations for which the insurer is liable or for which the
insurer would have been liable if it were not an impaired or insolvent insurer, or
	 	b)	 	with respect to any one life, regardless of the number of policies,
contracts, or certificates:

	 	i)	 	the case of life insurance, $ 300,000 in death benefits but not more
than $ 100,000 in net cash surrender or withdrawal values;
	 	ii)	 	in the case of health insurance, $ 300,000 in health insurance
benefits, including net cash surrender or withdrawal values; and
	 	iii)	 	with respect to annuities, $ 100,000 in the present value of annuity
benefits, including net cash surrender or withdrawal values, and $ 100,000 in
the present value of annuity benefits for individuals participating in certain
government retirement plans covered by an unallocated annuity contract. The
limit for coverage of unallocated annuity contracts other than those issued to
certain governmental retirement plans is
$ 5,000,000 in benefits per contract holder, regardless of the number of contracts.

However, in no extent is the Guaranty Association liable for more than $ 300,000 with
respect to any one individual.

Illinois

 

 

Aetna Life Insurance Company

SUMMARY OF THE LOUISIANA LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION ACT AND NOTICE CONCERNING

COVERAGE LIMITATIONS AND EXCLUSIONS

Residents of Louisiana who purchase life insurance, annuities, or health insurance should know
that the insurance companies licensed in this state to write these types of insurance are
members of the Louisiana Life and Health Insurance Guaranty Association. The purpose of this
association is to assure that policyholders will be protected, within limits, in the unlikely
event that a member insurer becomes financially unable to meet its obligations. If this should
happen, the Guaranty Association will assess its other member insurance companies for the money
to pay the claims of insured persons who live in this state, and in some cases, to keep
coverage in force. However, the valuable extra protection provided by these insurers through
the Guaranty Association is limited. As noted in the disclaimer below, this protection is not
a substitute for consumers’ care in selecting companies that are well-managed and financially
stable.

DISCLAIMER

The Louisiana Life and Health Insurance Guaranty Association provides
coverage of claims under some types of policies if the insurer becomes
impaired or insolvent. COVERAGE MAY NOT BE AVAILABLE FOR YOUR POLICY. Even
if coverage is provided, there are significant limits and exclusions.
Coverage is always conditioned upon residence in this state. Other
conditions may also preclude coverage.

Insurance companies and insurance agents are prohibited by law from using
the existence of the association or its coverage to sell you an insurance
policy.

You should not rely on the availability of coverage under the Louisiana
Life and Health Insurance Guaranty Association when selecting an insurer.

The Louisiana Life and Health Insurance Guaranty Association or the
Department of Insurance will respond to any questions you may have which
are not answered by this document.

	 	 	 
	LLHIGA

	 	Department of Insurance
	P.O. Drawer 44126

	 	P.O. Box 94212
	Baton Rouge, LA 70804

	 	Baton Rouge, LA 70804-9214

The state law that provides for this safety-net coverage is called the Louisiana Life and
Health Insurance Guaranty Association Act. The following is a brief summary of this law’s
coverages, exclusions and limits. This summary does not cover all provisions of the law; nor
does it in any way change any person’s rights or obligations under the Act or the rights or
obligations of the Guaranty Association.

COVERAGE

Generally, individuals will be protected by the Life and Health Insurance Guaranty Association
if they live in this state and hold a life or health insurance contract, or an annuity, or if
they are insured under a group insurance contract, issued by an insurer authorized to conduct
business in Louisiana. The beneficiaries, payees or assignees of insured persons are protected
as well even if they live in another state.

EXCLUSIONS FROM COVERAGE

	1.	 	However, persons owning such policies are not protected by this association if:

	 	a.	 	they are eligible for protection under the laws of another state (this may occur
when the insolvent insurer was incorporated in another state whose Guaranty Association
protects insureds who live outside that state);
	 	b.	 	the insurer was not authorized to do business in this state;

Louisiana

 

 

	 	c.	 	their policy was issued by a nonprofit hospital or medical service organization (the
“Blues”), an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual
assessment company or similar plan in which the policyholder is subject to future
assessments, or by an insurance exchange.

	2.	 	The association also does not provide coverage for:

	 	a.	 	any policy or portion of a policy which is not guaranteed by the insurer or for
which the individual has assumed the risk, such as a variable contract sold by
prospectus;
	 	b.	 	any policy of reinsurance (unless an assumption certificate was issued);
	 	c.	 	interest rate yields that exceed an average rate;
	 	d.	 	dividends;
	 	e.	 	credits given in connection with the administration of a policy by a group contract
holder;
	 	f.	 	employers’ plans to the extent they are self-funded (that is, not insured by an
insurance company, even if an
insurance company administers them);
	 	g.	 	unallocated annuity contracts (which give rights to group contractholders, not
individuals); unless qualified under § 403(b) of the Internal Revenue Code, except
that, even if qualified under § 403(b), unallocated annuities issued to employee
benefit plans protected by the Federal Pension Benefit Guaranty Corporation are not
covered.

LIMITS ON AMOUNT OF COVERAGE

The act also limits the amount the association is obligated to pay out. The association cannot
pay more than what the insurance company would owe under a policy or contract. Also, for any
one insured life, the association will pay a maximum of $ 300,000, no matter how many
policies and contracts there were with the same company, even if they provided different types
of coverage. Within this overall $ 300,000 limit, the association will not pay more than $
100,000 in cash surrender values, $ 100,000 in health insurance benefits, $ 100,000 in
present value of annuities, or $ 300,000 in life insurance death benefits. Again, no matter
how many policies and contracts there were with the same company, and no matter how many
different types of coverages.

Louisiana

 

 

Aetna Life Insurance Company

MARYLAND NOTICE CONCERNING

COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE

LIFE AND HEALTH INSURANCE GUARANTY CORPORATION SUBTITLE

Residents of this State who purchase life insurance, annuities or health insurance should know
that the insurance companies licensed in this State to write these types of insurance are
members of the Maryland Life and Health Insurance Guaranty Corporation. The purpose of this is
to assure that policyholders will be protected, within limits, in the unlikely event that a
member insurer becomes financially unable to meet its obligations. If this should happen, the
guaranty corporation will assess its other member insurance companies for the money to pay the
claims of insured persons who live in this State and, in some cases, to keep coverage in force.
The valuable extra protection provided by these insurers through the guaranty corporation is
not unlimited, however. And, as noted in the box below, this protection is not a substitute
for consumers’ care in selecting companies that are well-managed and financially stable.

The Maryland Life and Health Insurance Guaranty Corporation may not provide coverage for this
policy. If coverage is provided, it may be subject to substantial limitations or exclusions,
and require continued residency in Maryland. You should not rely on coverage by the Maryland
Life and Health Insurance Guaranty Corporation in selecting an insurance company or in
selecting an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the
insurer or for which you have assumed the risk, such as a variable contract sold by prospectus.

Insurance companies or their insurance producers are required by law to give or send you this
notice. However, insurance companies and their insurance producers are prohibited by law from
using the existence of the guaranty corporation to induce you to purchase any kind of insurance
policy.

The Maryland Life and Health Insurance

Guaranty Corporation

9199 Reistertown Road

P.O. Box 671t — Suite 216C

Owings Mills, Maryland 21117

(410) 998-3907

The State law that provides for this safety-net is called the Life and Health Insurance
Guaranty Corporation.

The Corporation is not a department or unit of the State of Maryland and the liabilities or
debts of the Life and Health Insurance Guaranty Corporation are not liabilities or debts of the
State of Maryland.

Following is a brief summary of this law’s coverages, exclusions and limits. This summary does
not cover all provisions of the law; nor does it in any way change anyone’s rights or
obligations under the law or the rights or obligations of the guaranty corporation.

COVERAGE

Generally, individuals will be protected by the Life and Health Guaranty Corporation if
they live in this State and hold a life or health insurance contract, or an annuity, or if they
are insured under a group insurance contract, issued by a member insurer. The beneficiaries,
payees or assignees of insured persons are protected as well, even if they live in another
state.

EXCLUSIONS FROM COVERAGE

However, persons owning such policies are not protected by this corporation if:

	•	 	they are eligible for protection under the laws of another state (this may occur when
the insolvent insurer was incorporated in another state whose guaranty association
protects insureds who live outside that state);
	•	 	the insurer was not authorized to do business in this State;

Maryland

 

 

	•	 	their policy was issued by a Health Maintenance Organization, a fraternal benefit
society, a mandatory State pooling plan, a mutual assessment company or similar plan in
which the policyholder is subject to future assessment, or by an insurance exchange.

The corporation also does not provide coverage for:

	•	 	any policy or portion of a policy which is not guaranteed by the insurer or for which
the individual has assumed the risk, such as a variable contract sold by prospectus;
	•	 	any policy of reinsurance, unless assumption certificates have been issued);
	•	 	interest rate yields that exceed an average rate;
	•	 	any portion of a policy or contract to the extent that it provides dividends;
	•	 	credits given in connection with the administration of a policy by a group contract
holder;
	•	 	employers’ plans to the extent they are self-funded (that is, not insured by an
insurance company, even if an insurance company administers them);
	•	 	unallocated annuity contracts (which give rights to group contractholders, not
individuals).

LIMITS ON AMOUNT OF COVERAGE

The statute also limits the amount the corporation is obligated to pay. The corporation
cannot pay more than the amount the insurance company would owe under a policy or contract.
Also, with respect to any one insured life, regardless of the number of policies or contracts
with the member insurer, the corporation will pay a maximum of:

	•	 	$ 300,000 in life insurance death benefits, but will not pay more than $ 100,000 in
life insurance cash surrender values;
	•	 	$ 300,000 in health insurance benefits, including any net cash surrender and net cash
withdrawal values; and
	•	 	$ 100,000 in the present value of annuity benefits, including any net cash surrender
and net cash withdrawal values.

These amounts are the maximums, no matter how many policies and contracts the insured has with
the member company.

Maryland

 

 

Aetna Life Insurance Company

MISSOURI NOTICE CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS UNDER THE LIFE AND

HEALTH INSURANCE GUARANTY CORPORATION SUBTITLE

Residents of this state who purchase life insurance, annuities or health insurance should know
that the insurance companies licensed in this state to write these types of insurance are
members of the Missouri Life and Health Insurance Guaranty Association. The purpose of this
association is to assure that policyholders will be protected, within limits, in the unlikely
event that a member insurer becomes financially unable to meet its obligations. If this should
happen, the guaranty association will assess its other member insurance companies for the money
to pay the claims of insured persons who live in this state and, in some cases, to keep
coverage in force. The valuable extra protection provided by these insurers through the
guaranty association is not unlimited, however. And, as noted in the box below, this
protection is not a substitute for consumers’ care in selecting companies that are well-managed
and financially stable.

The Missouri Life and Health Insurance Guaranty Association may not provide
coverage for this policy. If coverage is provided, it may be subject to
substantial limitations or exclusions, and require continued residency in
Missouri. You should not rely on coverage by the Missouri Life and Health
Insurance Guaranty Association in selecting an insurance company or in
selecting an insurance policy. Coverage is NOT provided for your policy or any
portion of it that is not guaranteed by the insurer or for which you have
assumed the risk, such as a variable contract sold by prospectus. Insurance
companies or their insurance producers are required by law to give or send you
this notice. However, insurance companies and their insurance producers are
prohibited by law from using the existence of the guaranty association to
induce you to purchase any kind of insurance policy. YOU MAY CONTACT EITHER
THE ASSOCIATION OR THE MISSOURI DEPARTMENT OF INSURANCE AT THE FOLLOWING
ADDRESSES SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE.

The Missouri Life and Health Insurance Guaranty Association

520 Dix Road, Suite D

Jefferson City, MO 65109

Missouri Insurance Department

P.O. Box 690

Jefferson City, MO 65109

The state law that provides for this safety-net is called the Missouri Life and Health
Insurance Guaranty Association Act. Below is a brief summary of this law’s coverages,
exclusions and limits. This summary does not coyer all provisions of the law; nor does it in
any way change anyone’s rights or obligations under the Act or the rights or obligations of the
guaranty association.

Generally, persons will be covered if they live in this state, and hold a life or health
insurance contract or annuity, or a certificate under a group policy or contract. However, not
all individuals with a right to recover under life or health insurance policies or annuities
are protected by the Act. A person is not protected when:

	1.	 	The person is eligible for protection under the laws of another state;
	2.	 	The person purchased the insurance from a company that was not authorized to do business in
this state;
	3.	 	The policy is issued by an organization which is not a member insurer of the association; or
	4.	 	The person does not live in this state, except under limited circumstances.

Missouri

 

 

Additionally, the Association may not provide coverage for the entire amount a person expects
to receive from the policy. The Association does not provide coverage for any portion of the
policy where the person has assumed the risk, for any policy of reinsurance (unless an
assumption certificate was issued), for interest rates that exceed a specified average rate,
for employers’ plans that are self-funded, for parts of plans that provide dividends or credits
in connection with the administration of policy, or for unallocated annuity contracts (which
are generally issued to pension plan trustees). The Act also limits the amount the Association
is obligated to pay persons on various policies. The Association does not pay more than the
amount of the contractual obligation of the insurance company. The Association does not have
to pay more than three hundred thousand dollars ($ 300,000) in death benefits for any one life
regardless of the number of policies that insure that life. The Association does not have to
pay amounts over one hundred thousand dollars ($ 100,000) in cash surrender or withdrawal
benefits on one life regardless of the number of policies insuring that individual. For health
insurance benefits, the Association is not obligated to pay over one hundred thousand dollars
($ 100,000) including net cash surrender and withdrawal benefits. On an annuity contract, the
Association is not liable for over one hundred thousand dollars ($ 100,000) in present value.
Finally, the Association is never obligated to pay more than a total of three hundred thousand
dollars
($ 300,000) for any one insured for any combination of insurance benefits.

Missouri

 

 

Aetna Life Insurance Company

SUMMARY OF MISSISSIPPI LIFE AND HEALTH

INSURANCE GUARANTY ASSOCIATION ACT

AND NOTICE CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS

Residents of this state who purchase life insurance, health insurance, or annuities should
know that the insurance companies licensed in this state to write these types of insurance are
members of the Mississippi Life and Health Insurance Guaranty Association (the “Guaranty
Association”). The purpose of the Guaranty Association is to assure that policy and contract
owners will be protected, within limits, in the unlikely event that a member insurer becomes
financially unable to meet its obligations. If this should happen, the Guaranty Association
will assess its other member insurance companies for the money to pay the claims of policy
owners who live in this state and, in some cases, to keep coverage in force. The valuable
extra protection provided by the member insurers through the Guaranty Association is not
unlimited, however. And, as noted in the box below, this protection is not a substitute for
consumers’ care in selecting insurance companies that are well-managed and financially stable.

DISCLAIMER

The Mississippi Life and Health Insurance Guaranty Association (the “Guaranty
Association”) may not provide coverage for this policy. If coverage is
provided, it will be subject to substantial limitations and exclusions, and
require continued residency in this state. You should not rely on coverage by
the Guaranty Association when selecting an insurer.

Coverage is NOT provided for your policy or contract or any portion of it that
is not guaranteed by the insurer or for which you have assumed the risk, such
as non-guaranteed amounts held in a separate account under a variable life or
variable annuity contract.

Insurance companies or their agents are required by law to provide you with
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the Guaranty Association for the purpose of
sales, solicitation, or inducement to purchase any form of insurance. You may
contact either the Guaranty Association or the Mississippi Insurance Department
at the following addresses if you should have any questions regarding this
notice.

The Mississippi Life and Health Insurance Guaranty Association

300 North Mart Plaza, Suite 2

Jackson, Mississippi 39206

Mississippi Insurance Department

1804 Walter Sillers Building

Jackson, Mississippi 39205

The state law that provides for this safety-net coverage is called the Mississippi Life and
Health Insurance Guaranty Association Act (the “Act”). Below is a brief summary of the Act’s
coverages, exclusions and limits. This summary does not cover all provisions of the Act; nor
does it in any way change anyone’s rights or obligations under the Act or the rights or
obligations of the Guaranty Association.

Mississippi

 

 

COVERAGE

Generally, individuals will be protected by the Guaranty Association if they live in this
state and hold a life, or health insurance contract or policy, or an annuity contract or
policy, or if they are insured under a group insurance contract, issued by a member insurer.
The beneficiaries, payees or assignees of policy or contract owners are protected as well, even
if they live in another state.

EXCLUSIONS FROM COVERAGE

However, persons owning such policies are NOT protected by the Guaranty Association if:

	•	 	they are eligible for protection under the laws of another state (this may occur when
the insolvent insurer was incorporated in another state whose guaranty association
protects insureds who live outside that state);
	•	 	the insurer was not authorized to do business in this state;
	•	 	their policy or contract was issued by a hospital or medical service organization
whether profit or nonprofit, a health maintenance organization (HMO), a fraternal benefit
society, a mandatory state pooling plan, a mutual assessment company or other person that
operates on an assessment basis, an insurance exchange, or any similar entity,

The Guaranty Association also does NOT provide coverage for:

	•	 	Any policy or contract or portion thereof which is not guaranteed by the insurer or for
which the owner has assumed the risk, such as non-guaranteed amounts held in a separate
account under a variable life or variable annuity contract;
	•	 	Any policy or contract of reinsurance, unless an assumption certificates were issued
pursuant to the reinsurance policy or contract;
	•	 	Interest rate yields that exceed an average rate;
	•	 	Dividends and voting rights and experience rating credits or payment of any fees or
allowances to any person in connection with this service to or administration of the
policy or contract;
	•	 	Credits given in connection with the administration of a policy by a group contract
holder;
	•	 	Employers’ plans to the extent they are self-funded or uninsured (that is, not insured
by an insurance company, even if an insurance company administers them);
	•	 	Unallocated annuity contracts issued to or in connection with benefit plans protected
under federal Pension Benefit Guaranty Corporation (“PBGC”) regardless of whether the PBGC
has yet become liable to make any payments with respect to the benefit plan;
	•	 	Portions of any unallocated annuity contract not issued to or in connection with a
specific employee, union or association of natural persons benefit plan, or a government
lottery;
	•	 	Portions of a policy or contract to the extent assessments required by law for the
Guaranty Association with respect to the policy or contract are preempted by State or
Federal law;
	•	 	Obligations that do not arise under the express written terms of the policy or
contract, including claims based on marketing materials, side letters, riders or other
documents that were issued by the insurer without meeting applicable policy form filing or
approval requirements, or claims for policy misrepresentations, or extra-contractual or
penalty or consequential or incidental damages claims;
	•	 	Contractual agreements establishing the member insurer’s obligations to provide book
value accounting guarantees for defined contribution benefit plan participants (by
reference to a portfolio of assets owned by a nonaffiliate benefit plan or its trustees).

Mississippi

 

 

LIMITS ON AMOUNT OF COVERAGE

The Act also limits the amount the Guaranty Association is obligated to cover. The
Guaranty Association cannot pay more than what the insurance company would owe under a policy
or contract. Also, with respect to any one life, regardless of the number of policies or
contracts, the maximum obligation of the Guaranty Association is $ 300,000 in benefits
except with respect to benefits for basic hospital, medical and surgical insurance and major
medical insurance in which case the aggregate liability of the Guaranty Association is $
500,000. Within these overall limits, the Guaranty Association will not pay more than $300,000
in life insurance death benefits, $ 100,000 in net cash surrender and net cash withdrawal
values, $ 300,000 for disability insurance benefits, $ 500,000 for basic hospital, medical and
surgical insurance or major medical insurance benefits, $ 100,000 in present value of annuity
benefits, including net cash surrender and net cash withdrawal values — again, no matter how
many policies and contracts there were with the same company, and no matter how many different
types of coverages. There is a $ 5,000,000 limit with respect to any contract owner for
unallocated annuity benefits, irrespective of the number of contracts with respect to the
contract owner or plan sponsor. These are limitations for which the Guaranty Association is
obligated before taking into account either its subrogation and assignment rights or to the
extent to which those benefits could be provided out of the assets of the impaired or insolvent
insurer.

Mississippi

 

 

Aetna Life Insurance Company

NOTICE CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS UNDER THE NORTH CAROLINA

LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT

Residents of this state who purchase life insurance, annuities or health insurance should know
that the insurance companies licensed in this state to write these types of insurance are
members of the North Carolina Life and Health Insurance Guaranty Association. The purpose of
this association is to assure that policyholder will be protected, within limits, in the
unlikely event that a member insurer becomes financially unable to meet its obligations. If
this should happen, the guaranty association will assess its other member insurance companies
for the money to pay the claims of the insured persons who live in this state and, in some
cases, to keep coverage in force. The valuable extra protection provided by these insurers
through the guaranty association is not unlimited, however. And, as noted in the box below,
this protection is not a substitute for consumers’ care in selecting companies that are
well-managed and financially stable.

The North Carolina Life and Health Insurance Guaranty Association may not
provide coverage for this policy. If coverage is provided, it may be subject
to substantial limitations or exclusions, and require continued residency in
North Carolina. You should not rely on coverage by the North Carolina Life and
Health Guaranty Association in selecting an insurance company or in selecting
an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not
guaranteed by the insurer or for which you have assumed the risk, such as a
variable contract sold by prospectus.

Insurance companies or their agents are required by law to give or send you
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the guaranty association to induce you to
purchase any kind of insurance policy.

The North Carolina Life and Health Insurance Guaranty Association

Post Office Box 10218

Raleigh, North Carolina 27605-0218

North Carolina Department of Insurance, Consumer Division

Post Office Box 26387

Raleigh, North Carolina 27611

The state law that provides for this safety-net coverage is called the North Carolina Life and
Health Insurance Guaranty Association Act. Below is a brief summary of this law’s coverages,
exclusions and limits. This summary does not cover all provisions of the law; nor does it in
any way change anyone’s rights or obligations under the act or the rights or obligations of the
guaranty association.

COVERAGE

Generally, individuals will be protected by the life and health guaranty association if
they live in this state and hold a life or health insurance contract, or an annuity, or if they
are insured under a group insurance contract, issued by a member insurer. The beneficiaries,
payees or assignees of insured persons are protected as well, even if they live in another
state.

EXCLUSIONS FROM COVERAGE

However, persons owning such policies are not protected by the association if:

	•	 	They are eligible for protection under the laws of another state (this may occur when
the insolvent insurer was incorporated in another state whose guaranty association
protects insureds who live outside that state);
	•	 	The insurer was not authorized to do business in this state;

North Carolina

 

 

	•	 	Their policy was issued by an HMO, a fraternal benefit society, a mandatory state pooling
plan, a mutual assessment company or similar plan in which the policyholder is subject to
future assessments, or by an insurance exchange.

The association also does not provide coverage for:

	•	 	Any policy or portion of a policy which is not guaranteed by the insurer or for which
the individual has assumed the risk, such as a variable contract sold by prospectus;
	•	 	Any policy of reinsurance (unless an assumption certificate was issued);
	•	 	Interest rate yields that exceed the average rate specified in the law;
	•	 	Dividends;
	•	 	Experience or other credits given in connection with the administration of a policy by
a group contractholder;
	•	 	Employers’ plans to the extent they are self-funded (that is, not insured by an
insurance company, even if an insurance company administers them);
	•	 	Unallocated annuity contracts (which give rights to group contractholders, not
individuals), unless they fund a government lottery or a benefit plan of an employer,
association or union, except that unallocated annuities issued to employee benefit plans
protected by the Federal Pension Benefit Guaranty Corporation are not covered.

LIMITS ON AMOUNT OF COVERAGE

The act also limits the amount the association is obligated to pay out: The association
cannot pay more than what the insurance company would owe under a policy or contract. Also,
for one individual, the association will pay a maximum of
$ 300,000—no matter how many policies and contracts there were with the same company, even if
they provided different types of coverages. For any one group holder of an unallocated annuity
contract, the association will pay a maximum of
$ 5,000,000.

North Carolina

 

 

Aetna Life Insurance Company

SUMMARY OF THE 1996 NEW HAMPSHIRE LIFE AND HEALTH

INSURANCE GUARANTY ASSOCIATION ACT (RSA 408-B)

AND

NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS

Residents of New Hampshire who purchase life insurance, health insurance, and annuities should
know that the insurance companies licensed in New Hampshire to write these types of insurance
are members of the New Hampshire Life and Health Insurance Guaranty Association. The purpose
of this Association is to assure that policyholders will be protected, within limits, in the
unlikely event that a member insurer becomes financially unable to meet its obligations. If
this should happen, the Association will assess its other member insurance companies for the
money to pay the claims of policyholders who live in New Hampshire and, in some cases, to keep
coverage m force. This protection is not a substitute for consumers’ care in selecting
companies that are well managed and financially stable. The valuable extra protection provided
by these insurers through the Guaranty Association is not unlimited, however, as noted below.

IMPORTANT DISCLAIMER

The New Hampshire Life and Health Insurance Guaranty Association may not
provide coverage for this policy. If coverage is provided, it may be subject
to substantial limitations or exclusions, and require continued residency in
New Hampshire. Other conditions may preclude coverage.

Coverage is NOT provided for your policy or any portion of it that is not
guaranteed by the insurer or for which you have assumed the risk, such as a
variable contract sold by prospectus.

Insurance companies or their agents are required by law to provide you with
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the Association to induce you to purchase any
kind of insurance policy.

This information is provided by:

New Hampshire Life and Health Insurance Guaranty Association

47 Hall Street, Suite 2

Concord, NH 03301

(603) 226-9114

New Hampshire Department of Insurance

56 Old Suncook Road

Concord, NH 03301

(603) 271-2261

SUMMARY:

The 1996 state law that provides for this safety-net coverage is called the New Hampshire
Life and Health Insurance Guaranty Association Act. Below is a brief summary of this law’s
coverage, exclusions and limits. This summary does not cover all provisions of the law; nor
does it in any way change anyone’s rights or obligations under the Act or the rights or
obligations of the Association.

COVERAGE:

Generally, individuals will be protected by the New Hampshire Life and Health Insurance
Guaranty Association if they live in this state and hold a life or health insurance policy or
an annuity contract, or if they are insured under a group insurance contract, issued by a
member insurer. The beneficiaries, assignees or payees of insured persons are protected as
well, even if they live in another state.

New Hampshire

 

 

Coverage provided under this Act may be different from coverage provided prior to 1996, as
coverage is determined by the governing Act in effect on the date that the Association becomes
obligated,

EXCLUSIONS FROM COVERAGE:

Persons holding such policies or contracts are NOT protected by this Association if:

	•	 	they are not residents of the state of New Hampshire, except under certain very
specific circumstances;
	•	 	they are eligible for protection under the laws of another state;
	•	 	their policy was issued by a nonprofit hospital or medical service organization, an
HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment
company or an entity that operates on an assessment basis, an insurance exchange, or any
entity similar to any of the above.

The Association also does NOT provide coverage for:

	•	 	any policy or portion of a policy or contract not guaranteed by the insurer or under
which the risk is borne by the policy holder or contract holder;
	•	 	any policy or contract of reinsurance, unless assumption certificates have been issued;
	•	 	interest rate guarantees that exceed certain statutory limitations;
	•	 	any plan or program of an employer, association, or similar entity to provide life,
health, or annuity benefits to its employees or members to the extent that the plan or
program is self-funded or uninsured, including, but not limited to, benefits payable by an
employer, association, or similar entity;
	•	 	dividends, experience rating credits, or fees for services in connection with this
policy;
	•	 	any policy or contract issued in this state by an insurer at a time when it was not
licensed or authorized to do business in New Hampshire;
	•	 	any unallocated annuity contract issued to an employee benefit plan protected under the
federal Pension Benefit Guaranty Corporation;
	•	 	any portion of any unallocated annuity contract which is not issued to or in connection
with a specific employee, union, or association of natural persons benefit plan or a
government lottery;
	•	 	any portion of a policy or contract to the extent that the required assessments are
preempted by federal or state law.

LIMITS ON AMOUNT OF COVERAGE:

The Act also limits the amount the Association is obligated to pay: The Association cannot
pay more than what the insurance company would owe under a policy or contract.

With respect to any one life, the Association will pay a maximum of $ 300,000 — no matter
how many policies and contracts there were with the same company, even if they provided
different types of coverages. Within this overall $ 300,000 limit, the Association will not
pay more than $ 100,000 in cash surrender values, $ 100,000 in health insurance benefits, $
100,000 in present value of annuities, or $ 300,000 in life insurance death benefits.

With respect to any one contract holder of an unallocated annuity contract, not including a
governmental retirement plan established under Section 401, 403(b) or 457 of the U.S. Internal
Revenue code, the Association will pay a maximum of
$ 5,000,000 in benefits, irrespective of the number of such contracts held by that contract
holder.

ADDITIONAL INFORMATION;

Policyholders should contact the New Hampshire Insurance Department with questions they may
have with regard to concerns about their rights under the Act and procedures for filing a
complaint to allege a violation of the Act.

Policyholders may contact the New Hampshire Insurance Department for sources of information
about the financial condition of insurers.

New Hampshire

 

 

Aetna Life Insurance Company

NEW JERSEY LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION ACT

Residents of New Jersey who purchase life insurance, annuities or health insurance should know
that the insurance companies licensed in this state to write these types of insurance are
members of the New Jersey Life and Health Insurance Guaranty Association.

The purpose of this association is to assure that policyholders will be protected, within
limits, in the unlikely event that a member insurer becomes financially unable to meet its
obligations. If this should happen, the Guaranty Association will assess its other member
insurance companies for the money to pay the claims of insured persons who live in this state
and, in some cases, to keep coverage in force.

The valuable extra protection provided by these insurers through the Guaranty Association is
not unlimited, however. And, as noted below, this protection is not a substitute for
consumers’ care in selecting companies that are well-managed and financially stable.

DISCLAIMER

The New Jersey Life and Health Insurance Guaranty Association may not provide
coverage for this policy. If coverage is provided, it may be subject to
substantial limitations or exclusions, and require continued residency in New
Jersey. You should not rely on coverage by the New Jersey Life and Health
Insurance Guaranty Association in selecting an insurance company or in
selecting an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not
guaranteed by the insurer or for which you have assumed the risk, such as a
variable contract sold by prospectus.

Insurance companies or their agents are required by law to give or send you
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the guaranty association to induce you to
purchase any kind of insurance policy.

The New Jersey Life and Health Insurance Guaranty Association

One Gateway Center

9th Floor

Newark, NJ 07102

State of New Jersey

Department of Insurance

20 West State Street

CN-325

Trenton, NJ 08625

The state law that provides for this safety-net coverage is called the New Jersey Life and
Health Insurance Guaranty Association Act, N.J.S.A. 17B:32A-1, et seq, (the “Act”).

COVERAGE

The following is a brief summary of this law’s coverages, exclusions and limits. This
summary does not cover all provisions of the law; nor does it in any way change anyone’s rights
or obligations under the act or the rights or obligations of the guaranty association.

New Jersey

 

 

Generally, individuals will be protected by the Life and Health Insurance Guaranty Association
if they live in New Jersey and hold a life, health insurance or long-term care insurance
contract, or if they are insured under a group insurance contract, issued by a member insurer.

The beneficiaries, payees or assignees of insured persons are protected as well, even if they
live in another state.

EXCLUSIONS FROM COVERAGE

However, persons owning such policies are not protected by this association if:

	•	 	they are eligible for protection under the laws of another state (this may occur when
the insolvent insurer was incorporated in another state whose guaranty association
protects insureds who live outside that state);
	•	 	the insurer was not authorized to do business in this state;
	•	 	the policy was issued by an organization which is not a member of the New Jersey Life
and Health Insurance Guaranty Association.

The Association also does not provide coverage for:

	•	 	any policy or portion of a policy which is not guaranteed by the insurer or for which
the individual has assumed the risk, such as a variable contract sold by prospectus;
	•	 	any policy of reinsurance (unless an assumption certificate was issued);.
	•	 	interest rate yields that exceed an average rate as more fully described in Section 3
of the Act;
	•	 	dividends;
	•	 	credits given in connection with the administration of a policy by a group
contract holder;
	•	 	employers’ plans to the extent they are self-funded (that is, not insured by an
insurance company, even if an insurance company administers them).

LIMITATIONS OF COVERAGE

The act also limits the amount the Association is obligated to pay out. The Association
cannot pay more than what the insurance company would owe under a policy or contract

With respect to any one insured individual, regardless of the number of policies or contracts,
the Association will pay not more than $500,000 in life insurance death benefits and present
value annuity benefits, including net cash surrender and net cash withdrawal values. Within
this overall limit, the Association will not pay more than $100,000 in cash surrender values
for annuity benefits, $500,000 in life insurance death benefits or $500,000 in present value of
annuities—again no matter how many policies and contracts there were with the same company,
and no matter how many different types of coverages.

The Association will not pay more than $2,000,000 in benefits to any one contract holder under
any one unallocated annuity contract,

There are no limits on the benefits the Association will pay with respect to any one group,
blanket or individual accident and health insurance policy.

New Jersey

 

 

Aetna Life Insurance Company

NEVADA LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION ACT SUMMARY DOCUMENT

Residents of Nevada who purchase life insurance, annuities or health insurance should know that
the insurance companies licensed in this state to write these types of insurance are members of
the Nevada Life and Health Insurance Guaranty Association (Guaranty Association). The purpose
of this association is to assure that policyholders will be protected, within limits, in the
unlikely event that a member insurer becomes financially unable to meet its obligations. If
this should happen, the Guaranty Association assesses its other member insurance companies for
the money to pay the claims of insured persons who live in this state and, in some cases, to
keep coverage in force. The valuable extra protection provided by these insurers through the
Guaranty Association is not unlimited, however, and, as noted below, this protection is not a
substitute for consumers’ care in selecting companies that are well-managed and financially
stable.

The Nevada Life and Health Insurance Guaranty Association may not provide coverage for this
policy. If coverage is provided, it may be subject to substantial limitations and exclusions,
and require continued residency in Nevada. A person should not rely on coverage by the Nevada
Life and Health Insurance Guaranty Association when selecting an insurance company or when
selecting an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the
Insurer or for which the policyholder has assumed the risk, such as a variable contract sold by
prospectus.

Insurance companies are required by law to deliver this notice to you. However, insurance
companies and their agents are prohibited by law from using the existence of the guaranty
association for sales, solicitation or to induce the purchase of any kind of insurance policy.

The state law that provides for this safety-net coverage is called the Nevada Life and Health
Insurance Guaranty Association Act. Below is a brief summary of this law’s coverage,
exclusions and limits. This summary does not cover all provisions of the law; nor does it in
any way change anyone’s rights or obligations under the act or the rights or obligations of the
Guaranty Association. Anyone may obtain additional information or file a complaint with the
Commissioner of insurance, at the address listed below, to allege a violation of any provision
of the Nevada Life and Health Insurance Guaranty Association Act.

The Nevada Life and Health Insurance Guaranty Association

P.O. Box 3302

Reno, Nevada 89505

Commissioner of Insurance, State of Nevada

Department of Business and Industry, Division of Insurance

788 Fairview Drive, Suite 300

Carson City, Nevada 89701-5491

Nevada

 

 

COVERAGE

Generally, individuals will be protected by the Nevada Life and Health Insurance Guaranty
Association if they live in this state and hold a life or health insurance contract, or an
annuity, or if they are insured under a group insurance contract issued by a member insurer.
The beneficiaries, payees or assignees of insured persons are protected as well even if they
live in another state.

EXCLUSIONS FROM COVERAGE

However, persons holding such policies are not protected by this Association if:

	•	 	they are eligible for protection under the laws of another state (this may occur when
the insolvent insurer was incorporated in another state whose guaranty association
protects insureds who live outside the state);
	•	 	the insurer was not authorized to do business in this state;
	•	 	their policy was issued by a nonprofit hospital or medical service organization (the
“Blues”), a health maintenance organization, a fraternal benefit society, a mandatory
state pooling plan, a mutual assessment company or similar plan in which the policyholder
is subject to future assessments, or by an insurance exchange.

The Association also does not provide coverage for:

	•	 	any policy or portion of a policy which is not guaranteed by the insurer or for which
the individual has assumed the risk, such as a variable contract sold by prospectus;
	•	 	interest rate yields that exceed an average rate;
	•	 	dividends;
	•	 	credits given in connection with the administration of a policy by a group contract
holder;
	•	 	employers’ plans to the extent they are self-funded (that is, not insured by an
insurance company, even if an insurance company administers them);
	•	 	unallocated annuity contracts (which give rights to group contractholders, not
individuals).

LIMITS ON AMOUNT OF COVERAGE

The act also limits the amount the Association is obligated to pay. The Association cannot
pay more than what the insurance company would owe under a policy or contract. Also, for any
one insured life, the Association will pay a maximum of $300,000, regardless of how many
policies and contracts there were with the same company, and even if they provided different
types of coverage. Within this overall $300,000 limit, the Association will not pay more than
$100,000 in cash surrender values, $100,000 in present value of annuities, or $300,000 in life
insurance death benefits. Again, no matter how many policies and contracts there were with the
same company, and no matter how many different types of coverage.

With respect to health insurance for any one natural person, the Association will not pay more
than: 1) $100,000 for coverage other than disability insurance, basic hospital, medical and
surgical insurance or major medical insurance, including any net cash surrender or withdrawal;
2) $300,000 for disability insurance; or 3) $500,000 for basic hospital, medical and surgical
insurance or major medical insurance.

With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries
of the payee if deceased, the Association will not pay more than $100,000 in present value of
benefits from the annuity in the aggregate, including any net cash for surrender or withdrawal.

With respect to any one life or person, in no event will the Association be obligated to cover
more than: 1) an aggregate of $300,000 in benefits, excluding benefits for basic hospital,
medical and surgical insurance or major medical insurance; or 2) an aggregate of $500,000 in
benefits, including benefits for basic hospital, medical and surgical insurance or major
medical insurance.

With respect to one owner of several nongroup policies of life insurance, whether the owner is
a natural person or an organization and whether the persons insured are officers, managers,
employees or other persons, the Association will not pay more than $5,000,000 in benefits,
regardless of the number of policies and contracts held by the owner.

Nevada

 

 

Aetna Life Insurance Company

OHIO LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION

DISCLAIMER AND NOT COVERED FORM

The Ohio Life and Health Insurance Guaranty Association may not provide coverage for this
policy. If coverage is provided, it may be subject to substantial limitations or exclusions,
and require continued residency in Ohio. You should not rely on coverage by the Ohio Life and
Health Insurance Guaranty Association in selecting an insurance company or in selecting an
insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the
insurer or for which you have assumed the risk, such as a variable contract sold by prospectus.
You should check with your insurance company representative to determine if you are only
covered in part or not covered at all.

Insurance companies or their agents are required by law to give or send you this notice.
However, insurance companies and their agents are prohibited by law from using the existence of
the guaranty association to induce you to purchase any kind of insurance policy.

Ohio Life and Health Insurance Guaranty Association

1840 Mackenzie Drive

Columbus, Ohio 43220

Ohio Department of Insurance

2100 Stella Court

Columbus, Ohio 43266-0566

Ohio

 

 

Aetna Life Insurance Company

NOTICE CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS UNDER THE

OKLAHOMA LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION ACT

Residents of Oklahoma who purchase life insurance, annuities or health insurance should know
that the insurance companies licensed in this state to write these types of insurance are
members of the Oklahoma Life and Health Insurance Guaranty Association. The purpose of this
association is to assure that policyholders will be protected, within limits, in the unlikely
event that a member insurer becomes financially unable to meet its obligations. If this should
happen, the Guaranty Association will assess its other member insurance companies for the money
to pay the claims of insured persons who live in this state and, in some cases, to keep
coverage in force. The valuable extra protection provided by these insurers through the
Guaranty Association is not unlimited, however. And, as noted in the box below, this
protection is not a substitute for consumers’ care in selecting companies that are well-managed
and financially stable.

The Oklahoma Life and Health Insurance Guaranty Association may not provide
coverage for this policy. If coverage is provided, it may be subject to
substantial limitations or exclusions, and require continued residency in
Oklahoma. You should not rely on coverage by the Oklahoma Life and Health
Insurance Guaranty Association in selecting an insurance company or in
selecting an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not
guaranteed by the insurer or for which you have assumed the risk, such as a
variable contract sold by prospectus.

Insurance companies or their agents are required by law to give or send you
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the guaranty association to induce you to
purchase any kind of insurance policy.

The Oklahoma Life and Health Insurance Guaranty Association

201 Robert S. Kerr, Suite 600

Oklahoma City, Oklahoma 73102

Oklahoma Department of Insurance

P.O. Box 53408

Oklahoma City, Oklahoma 73152-3408

The state law that provides for this safety-net coverage is called the Oklahoma Life and Health
Insurance Guaranty Association Act. Below is a brief summary of this law’s coverages,
exclusions and limits. This summary does not cover all provisions of the law; nor does it in
any way change anyone’s rights or obligations under the act or the rights or obligations of the
guaranty association.

COVERAGE

Generally, individuals will be protected by the Life and Health Insurance Guaranty
Association if they live in this state and hold a life or health insurance contract, or an
annuity, or if they are insured under a group insurance contract, issued by a member insurer.
The beneficiaries, payees or assignees of insured persons are protected as well, even if they
live in another state.

Oklahoma

 

 

EXCLUSIONS FROM COVERAGE

However, persons owning such policies are not protected by this Association if:

	•	 	they are eligible for protection under the laws of another state (this may occur when
the insolvent insurer was incorporated in another state whose guaranty association
protects insureds who live outside that state);
	•	 	the insurer was not authorized to do business in this state;
	•	 	their policy was issued by an HMO, a fraternal benefit society, a mandatory state
pooling plan, a mutual assessment company or similar plan in which the policyholder is
subject to future assessments, or by an insurance exchange.

The Association also does not provide coverage for:

	•	 	any policy or portion of a policy which is not guaranteed by the insurer or for which
the individual has assumed the risk, such as a variable contract sold by prospectus;
	•	 	any policy of reinsurance (unless an assumption certificate was issued);
	•	 	interest rate yields that exceed an average rate;
	•	 	dividends;
	•	 	credits given in connection with the administration of a policy by a group contract
holder;
	•	 	employers’ plans to the extent they are self-funded (that is, not insured by an
insurance company, even if an insurance company administers them);
	•	 	unallocated annuity contracts (which give rights to group contractholders, not
individuals).

LIMITS ON AMOUNT OF COVERAGE

The act also limits the amount the Association is obligated to pay out: The Association
cannot pay more than what the insurance company would owe under a policy or contract. Also,
for one insured life, the Association will pay a maximum of $ 300,000—no matter how many
policies and contracts there were with the same company, even if they provided different types
of coverages. Within this overall $300,000 limit, the Association will not pay more than
$100,000 in cash surrender values, $ 300,000 in health insurance benefits, $300,000 in present
value of annuities, or $300,000 in life insurance death benefits — again, no matter how many
policies and contracts there were with the same company, and no matter how many different types
of coverages.

Oklahoma

 

 

Aetna Life Insurance Company

NOTICE CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS UNDER

THE SOUTH DAKOTA LIFE AND

HEALTH INSURANCE GUARANTY

ASSOCIATION ACT

Residents of South Dakota who purchase life insurance, annuities or health insurance should
know that the insurance companies licensed in this state to write these types of insurance are
members of the South Dakota Life and Health Insurance Guaranty Association. The purpose of
this association is to assure that policyholders will be protected, within limits, in the
unlikely event that a member insurer becomes financially unable to meet its obligations. If
this should happen, the Guaranty Association will assess its other member insurance companies
for the money to pay the claims of insured persons who live in this state and, m some cases, to
keep coverage in force. The valuable extra protection provided by these insurers through the
Guaranty Association is not unlimited, however. And, as noted in the box below, this
protection is not a substitute for consumers’ care in selecting companies that are well-managed
and financially stable.

The Guaranty Association does not provide coverage for all types of life, health, or annuity
benefits, and the Guaranty Association may not provide coverage for this policy. If coverage
is provided, it may be subject to substantial limitations or exclusions, and require continued
residency in South Dakota. You should not rely on coverage by the South Dakota Life and Health
Insurance Guaranty Association in selecting an insurance company or in selecting an insurance
policy.

Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the
insurer or for which you have assumed the risk, such as a variable contract sold by prospectus.

Insurance companies or their agents are required by law to give or send you this notice.
However, insurance companies and their agents are prohibited by law from using the existence of
the Guaranty Association for the purpose of sales, solicitation or inducement to purchase any
kind of insurance policy.

The South Dakota Life and Health Insurance Guaranty Association

Charles D. Gullickson, Executive Director

206 West 14th Street

Sioux Falls, South Dakota 57104

Tel. (605) 336-0177

www.sdlifega.org

South Dakota Division of Insurance

500 East Capitol, Pierre, South Dakota 57501-5070

Tel. (605) 773-3563

www.state.sd.us/dcr/insurance

The state law that provides for this safety-net coverage is called the South Dakota Life and
Health Insurance Guaranty Association Act. Below is a brief summary of this law’s coverages,
exclusions and limits. This summary does not coverall provisions of the law; nor does it in any
way change anyone’s rights or obligations under the act or the rights or obligations of the
Guaranty Association.

South Dakota

 

 

COVERAGE

Generally, individuals will be protected by the Guaranty Association if they live in this
state and hold a life or health insurance contract, or an annuity, or if they are an insured
certificateholder under a group insurance contract issued by a member insurer. The
beneficiaries, payees or assignees of insured persons are protected as well even if they live
in another state. Coverage is also provided by the Guaranty Association to persons eligible to
receive payment under structured settlement annuities who are residents of this state and,
under certain conditions, such persons even if they are not a resident of this state.

EXCLUSIONS FROM COVERAGE

However, persons holding such policies are not protected by the Guaranty
Association if:

	•	 	they are eligible for protection under the laws of another state (this may occur when
the insolvent insurer was incorporated in another state whose guaranty association
protects insureds who live outside that state);
	•	 	the insurer was not authorized to do business in this state;
	•	 	their policy was issued by an HMO a fraternal benefit society, a mandatory state
pooling plan, a mutual assessment company or similar plan in which die policyholder is
subject to future assessments, or by an insurance exchange.

The Guaranty Association also does not provide coverage for:

	•	 	any policy or portion of a policy which is not guaranteed by the insurer or for which
the individual has assumed the risk, such as a variable contract sold by prospectus;
	•	 	claims based on marketing materials or other documents which are not approved policy
forms, claims based on misrepresentations of policy benefits, and other extra-contractual
claims;
	•	 	any policy of reinsurance (unless an assumption certificate was issued);
	•	 	interest rate yields that exceed an average rate specified by statute;
	•	 	dividends;
	•	 	credits given in connection with the administration of a policy by a group contract
holder;
	•	 	employers’ plans to the extent they are self-funded (that is, not insured by an
insurance company, even if an insurance company administers them);
	•	 	unallocated annuity contracts (which give rights to group contractholders, not
individuals);
	•	 	certain contracts which establish benefits by reference to a portfolio of assets not
owned by the insurer.

LIMITS ON AMOUNT OF COVERAGE

The Guaranty Association in no event will pay more than what the insurance company would
owe under a policy or contract. In addition, state law limits the amount of benefits the
guaranty association will pay for any one insured life, and no matter how many policies or
contracts there are with the same company, as follows: (i) for life insurance, not more than
$300,000 in death benefits and not more than $100,000 in net cash surrender and net cash
withdrawal values; (ii) for health insurance, not more than $500,000 for basic hospital,
medical and surgical insurance, not more than $300,000 for disability insurance, and not more
than $100,000 for other types of health insurance; and (iii) for annuities, not more than
$100,000 in the present value of annuity benefits, including net cash surrender and net cash
withdrawal values. However, in no event will the Guaranty Association be obligated to cover
more than an aggregate of $300,000 in benefits with respect to any one life except with respect
to benefits for basic hospital, medical and surgical insurance, for which the aggregate
liability of the guaranty association may not exceed $500,000. These general statements of the
limits on coverage are only summaries and the actual limitations are set forth in South Dakota
law.

ADDITIONAL INFORMATION

The statutes which govern the Guaranty Association are contained in SDCL Chapter 58-29C.
Additional information about the Guaranty Association may be found at www.sdlifega.org,
which contains a link to SDCL Chapter 58-29C.

Information about the financial condition of insurers is available from a variety of sources,
including financial rating agencies such as AM Best Company, Fitch Inc., Moody’s Investors
Service, Inc., and Standard Sc Poor’s. Additional information about financial rating agencies
may be obtained by clicking on “Insurance Related Links” on the website of the South Dakota
Division of Insurance at www.state.sd. us/dcr/insurance.

The Guaranty Association is subject to supervision and regulation by the director of the South
Dakota Division of Insurance. Persons who desire to file a complaint to allege a violation of
the statutes governing the Guaranty Association may contact the Division of Insurance. State
law provides that any suit against the Guaranty Association shall be brought in Hughes County,
South Dakota.

South Dakota

 

 

Aetna Life Insurance Company

NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS

UNDER THE TENNESSEE LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION ACT

Residents of Tennessee who purchase life insurance, annuities or health insurance should know
that the insurance companies licensed in this state to write these types of insurance are
members of the Tennessee Life and Health Insurance Guaranty Association. The purpose of this
association is to assure that policyholders will be protected, within limits, in the unlikely
event that a member insurer becomes financially unable to meet its obligations. If this should
happen, the guaranty association will assess its other member insurance companies for the money
to pay the claims of insured persons who live in this state and, in some cases, to keep
coverage in force. The valuable extra protection provided by these insurers through the
guaranty association is not unlimited, however. And, as noted in the box below, this
protection is not a substitute for consumers’ care m selecting companies that are well-managed
and financially stable.

The state law that provides for this safety-net coverage is called the Tennessee Life and
Health Insurance Guaranty Association Act The following is a brief summary of this law’s
coverages, exclusions and limits. This summary does not cover all provisions of the law; nor
does it in any way change anyone’s rights or obligations under the act or the rights or
obligations of the guaranty association.

COVERAGE

Generally, individuals will be protected by the life and health guaranty association if they live in this
state and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance
contract, issued by an insurer authorized to conduct business in Tennessee. The beneficiaries, payees or
assignees of insured persons are protected as well, even if they live in another state.

EXCLUSIONS FROM COVERAGE

However, persons holding such policies are not protected by this association if:

	(1)	 	they are eligible for protection under the laws of another state (this may occur when the insolvent insurer
was
incorporated in another state whose guaranty association protects insureds who live outside that state);
	 
	(2)	 	the insurer was not authorized to do business in this state;
	 
	(3)	 	their policy was issued by an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual
assessment company or similar plan in which the policyholder is subject to future assessments, or by an insurance
exchange.

The association also does not provide coverage for:

	(1)	 	any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has
assumed the risk,
such as a variable contract sold by prospectus;
	 
	(2)	 	any policy of reinsurance (unless an assumption certificate was issued);
	 
	(3)	 	interest rate yields that exceed an average rate;
	 
	(4)	 	dividends;
	 
	(5)	 	credits given in connection with the administration of a policy by a group contractholder;
	 
	(6)	 	employers’ plans to the extent they are self-funded (that is. not insured by an insurance company, even if an
insurance company administers them);

Tennessee

 

 

	(7)	 	unallocated annuity contracts (which give rights to group contractholders,
not individuals), unless qualified under Section 403(b) of the Internal Revenue
Code, except that, even if qualified under Section 403(b), unallocated
annuities issued to employee benefit plans protected by the federal Pension
Benefit Guaranty Corporation are not covered.

LIMITS ON AMOUNT OF COVERAGE

The act also limits the amount the association is obligated to pay out:
The association cannot pay more than what the insurance company would owe under
a policy or contract. Also, for any one insured life, the association will pay
a maximum
of $300,000 no matter how many policies and contracts there were with the same
company, even if they provided different types of coverage. Within this
overall $300,000 limit, the association will not pay more than $100,000 in cash
surrender values, $100,000 in health insurance benefits, $100,000 in present
value of annuities, or $300,000 in life insurance death benefits — again,
regardless of the number of policies and contracts there were with the same
company, and no matter how many different types of coverages.

The Tennessee Life and Health Insurance Guaranty Association may not provide
coverage for this policy. If coverage is provided, it may be subject to
substantial limitations or exclusions, and require continued residency in
Tennessee. You should not rely on coverage by the Tennessee Life and Health
Insurance Guaranty Association in selecting an insurance company or in
selecting an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not
guaranteed by the insurer or for which you have assumed the risk, such as a
variable contract sold by prospectus.

Insurance companies or their agents are required by law to give or send you
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the guaranty association to induce you to
purchase any kind of insurance policy.

TENNESSEE LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION

1200 FIRST UNION TOWER 150 4TH AVENUE

NORTH NASHVILLE, TENNESSEE 37219-2433

TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE

500 JAMES ROBERTSON PARKWAY

NASHVILLE, TENNESSEE 37243

 

NOTICE

Residents of this state who purchase life insurance, annuities or health
insurance should know that the insurance companies licensed in this state to
write these types of insurance are members of the Tennessee Life and Health
Guaranty Association. The purpose of this association is to assure that
policyholders will be protected, within limits, in the unlikely event that a
member insurer becomes financially unable to meet its obligations. If this
should happen, the Guaranty Association will assess its other member insurance
companies for the money to pay the claims of insured persons who live in this
state and, in some cases, to keep coverage in force. The valuable extra
protection provided by these insurers through the Guaranty Association is not
unlimited, however, and is not available at all for some policies.

COVERAGE IS NOT PROVIDED FOR YOUR POLICY OR ANY PORTION OF IT THAT IS NOT
GUARANTEED BY THE INSURER OR FOR WHICH YOU HAVE ASSUMED THE RISK, SUCH AS A
VARIABLE CONTRACT SOLD BY PROSPECTUS.

Tennessee

 

 

Insurance companies or their agents are required by law to give or send you
this notice. However, insurance companies and their agents are prohibited by
law from using the existence of the Guaranty Association to induce you to
purchase any kind of insurance policy.

TENNESSEE LIFE AND HEALTH INSURANCE

GUARANTY ASSOCIATION

1200 FIRST UNION TOWER 150 4TH AVENUE

NORTH NASHVILLE, TENNESSEE 37219-2433

TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE

500 JAMES ROBERTSON PARKWAY

NASHVILLE, TENNESSEE 37243

Tennessee

 

 

Aetna Life Insurance Company

TEXAS LIFE, ACCIDENT, HEALTH & HOSPITAL SERVICE

INSURANCE GUARANTY ASSOCIATION

IMPORTANT INFORMATION ABOUT COVERAGE UNDER THE TEXAS

LIFE, ACCIDENT, HEALTH AND HOSPITAL SERVICE INSURANCE

GUARANTY ASSOCIATION

(For insurers declared insolvent or impaired on or after September 1, 2005)

Texas law establishes a system, administered by the Texas Life, Accident, Health and Hospital
Service Insurance Guaranty Association (the “Association”), to protect Texas policyholders if
their life or health insurance company fails. Only the policyholders of insurance companies
which are members of the Association are eligible for this protection which is subject to the
terms, limitations, and conditions of the Association law. (The law is found in the Texas
Insurance Code, Article 21.28-D.)

It is possible that the Association may not cover your policy in full or in part due to
statutory limitations,

Eligibility for Protection by the Association

When a member insurance company is found to be insolvent and placed under an order of
liquidation by a court or designated as impaired by the Texas Commissioner of Insurance, the
Association provides coverage to policyholders who are:

	•	 	Residents of Texas at the time (irrespective of the policyholder’s residency at policy
issue)
	•	 	Residents of other states, ONLY if the following conditions are met:
	 
	1.	 	The policyholder has a policy with a company domiciled in Texas;
	 
	2.	 	The policyholder’s state of residence has a similar guaranty association; and
	 
	3.	 	The policyholder is not eligible for coverage by the guaranty association of the
policyholder’s stale of residence.

Limits of Protection by Association

Accident, Accident and Health, or Health Insurance:

	•	 	For each individual covered under one or more policies; up to a total of $500,000 for
basic hospital, medical-surgical, and major medical insurance, $300,000 for disability or
long term care insurance, and $200,000 for other types of health insurance.

Life Insurance:

	•	 	Net cash surrender value or net cash withdrawal value up to a total of $100,000
under one or more policies on any one life;
	 	 	or
	•	 	Death benefits up to a total of $300,000 under one or more policies on any one life; or
	•	 	Total benefits up to a total of $5,000,000 to any owner of multiple non-group life
policies.

Individual Annuities:

	•	 	Present value of benefits up to a total of $100,000 under one or more contracts on
any one life.

Group Annuities:

	•	 	Present value of allocated benefits up to a total of $100,000 on any one life; or

Texas

 

 

	•	 	Present value of unallocated benefits up to a total of $5,000,000 for one contractholder
regardless of the number of contracts.

Aggregate Limit:

	•	 	$300,000 on any one life with the exception of the $500,000 health insurance limit,
the $5,000,000 multiple owner life insurance limit, and the $5,000,000 unallocated group
annuity limit,

Insurance companies and agents are prohibited by law from using the existence of the
Association for the purpose of sales, solicitation, or inducement to purchase any form of
insurance. When you are selecting an insurance company, you should not rely on Association
coverage.

	 	 	 
	Texas Life, Accident, Health

	 	Texas Department of
	and Hospital Service

	 	Insurance
	Insurance Guaranty

	 	P.O. Box 149104
	Association

	 	Austin, Texas 78714-9104
	6504 Bridge Point Parkway

	 	800-252-3439
	Suite 450

	 	www.tdi.state.tx.us
	Austin, Texas 78730
	 	 
	800-982-6362 or
	 	 
	www.txlifega.org
	 	 

Texas

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