University Insurance Association Life Insurance

Summary

The University Insurance Association (UIA) Life Insurance plan offers decreasing term life insurance to eligible Unclassified Faculty, Academic Staff and Limited appointees. Coverage is based on an employee's age and ranges from $3,400 - $101,000. There is no coverage available to family members.

In addition to benefits payable in the event of your death, this plan provides the following benefits:

• If you are terminally ill with a life expectancy of 12 months or less, you may receive up to the full amount of your coverage prior to your death.
• Continuation of group policy coverage at retirement, including disability retirement.*
• Conversion of coverage to an individual policy at the end of employment or ineligibility.

*If you terminated employment prior to October 1, 2013, you are eligible to continue coverage regardless of termination reason.

The information provided for this benefit reflects the provisions as of the October 1, 2013 plan year, forward.

Eligibility

Employee

You must meet the following requirements to be eligible for this plan:

• Have an Unclassified Faculty, Academic Staff, or Limited appointment; and
• Meet the minimum monthly salary threshold ($2,643 for the 2013-14 plan year); and
• Are not receiving a Wisconsin Retirement System (WRS) annuity.

These requirements must be met as of October 1st of each year to be eligible.

Dependents

Dependents are not eligible for coverage under this plan.

Enrollment

• If you meet the eligibility criteria for a given year, enrollment is automatic and no application is required.
• Coverage is effective October 1st, provided requirements are met and premium is paid.

Premiums

Benefits are based on your age as of the start of the contract year – October 1st.

The annual premium of $24.00 is deducted from your October earnings. The University of Wisconsin does not contribute toward the premium. If employment starts after October 1st, you must wait until the following year for enrollment.

Schedule of Death Benefits

Age as of 10/1/XX	Amount of Death Benefit	Age as of 10/1/XX	Amount of Death Benefit
Under 28	$101,000	49-51	$22,600
28-30	98,100	52-54	17,200
31-33	90,900	55-57	13,100
34-36	78,900	58-60	10,300
37-39	65,000	61-63	8,200
40-42	50,900	64-66	6,100
43-45	39,100	67-69	4,500
46-48	30,000	70 +	3,400

Eligible employees on a leave of absence, will be billed for the annual premium of $24.00 by the UW Service Center. Premium must be remitted through direct payment or payroll deduction by December 1st or coverage will end as of 9/30 with no option of conversion.

Beneficiary Information

You are strongly encouraged to submit a beneficiary designation directly to Minnesota Life to ensure benefits are paid according to your wishes. Beneficiary designations are effective on date of receipt. If there is no eligible beneficiary, or you do not name one, benefits will be paid in the following order:

• Your surviving spouse or domestic partner, otherwise;
• Your surviving children equally, otherwise;
• Your surviving grandchildren equally, otherwise;
• Your surviving parents equally, otherwise;
• Your surviving siblings equally, otherwise;
• Your estate.

Forms & Publications

• Beneficiary Designation - Complete and submit to Minnesota Life to name who you would like to receive benefits payable upon your death.
• Accelerated Benefit Form - Complete and submit to Minnesota Life if you have a terminal illness with a life expectancy of less than 12 months and want to apply for benefits payable during your lifetime.
• Conversion Form - Complete and submit to Minnesota Life if you want to convert your coverage. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.
• Continuation Form - Contact your benefits office if you need a continuation form.

Plan Administration

The University Insurance Association Life Insurance Plan (group policy #32872-G) is administered by the University Insurance Association Board. The plan is underwritten by the Minnesota Life Insurance Company.