We will pay the Death Benefit to Your Beneficiary upon receipt of proof of death of the Insured while covered under this Certificate. The Death Benefit will decrease by 50% at the later of age 70 or 10 years after the Certificate Effective Date. The Death Benefit, including any reduction in Death Benefit, is shown on the Certificate Schedule.
If the Insured commits suicide, while sane or insane, within one year from the Certificate Effective Date, and while this coverage is in force, We will not pay the Death Benefit and payment will be limited to the total amount of premiums paid for this coverage.
If the Certificate Lapses during the Vesting Period, Your Certificate will terminate with no value. After this Certificate satisfies the Vesting Period shown on the Certificate Schedule, if any premium remains unpaid after the grace period, this Certificate may be continued under one of the following options:
Option 1: Reduced Paid-Up Term Insurance
This Certificate may be continued from the due date of the unpaid premium as Reduced Paid-Up Term Insurance for the amount of benefit shown on the Schedule of Guaranteed Nonforfeiture Benefits. If the coverage Lapses after the Vesting Period, Reduced Paid-Up Term Insurance coverage will remain in force until Attained Age 121. The amount of Reduced Paid-Up Term Insurance will be proportionally reduced if accelerated benefits were paid as a Terminal Illness Accelerated Death Benefit prior to Lapsing.
Option 2: Extended Term Insurance
This Certificate may be continued from the due date of the unpaid premium as Extended Term Insurance. The amount of Extended Term Insurance will be the amount of Death Benefit in force at the time of Lapse. The Death Benefit will decrease by 50% at Attained Age 70 if the Extended Term Insurance period extends to Attained Age 70. Extended Term Insurance will be continued for the duration shown on the Schedule of Guaranteed Nonforfeiture Benefits. If the term will extend beyond Attained Age 100, Reduced Paid-up Term Insurance will be purchased instead. The table of Extended Term Insurance is shown on the Certificate Schedule.
The above Nonforfeiture Options are subject to the following conditions:
Disclosure Notice: Your Death Benefit will be reduced if You receive a Terminal Illness Accelerated Death Benefit. Receipt of this benefit may be taxable. As with all tax matters, You should consult Your personal tax advisor to assess the impact of this benefit. Trustmark Insurance Company has no responsibility for any tax consequences of any benefits paid under this provision. Receipt of a Terminal Illness Accelerated Death Benefit may affect Your eligibility for Medicaid or other governmental benefits or entitlements.
We will pay the Terminal Illness Accelerated Death Benefit when the Insured is diagnosed as Terminally III, subject to all of the following conditions:
The amount of the Terminal Illness Accelerated Death Benefit will be:
The Terminal Illness Accelerated Death Benefit is payable only once.
On the date the Terminal Illness Accelerated Death Benefit is paid, the Death Benefit, Face Amount, and Reduced Paid-Up Term Insurance will be reduced by the same percentage of Death Benefit that was accelerated for the Terminal Illness Accelerated Death Benefit payment.
Premium payable for the Certificate and any riders, will be waived and coverage will remain in force for 24 months immediately following the date the Terminal Illness Accelerated Death Benefit is paid or until the Insured's death, whichever occurs first. If the Insured survives beyond 24 months, a proportionately reduced premium will be due to continue coverage for the remaining Face Amount.
The Terminal Illness Accelerated Death Benefit will be paid upon receipt of proof that the Conditions for Payment have been met. Such proof should include a claim form that We will furnish upon request. We will require the consent of any irrevocable Beneficiary. We also have the right to require that You be examined, at Our expense, by a Physician or other medical professional designated by Us.
The Terminal Illness Accelerated Death Benefit will be paid to You, unless otherwise assigned. If We receive notice that the Insured died prior to payment, benefits will be paid under the Death Benefit provision. We shall be discharged from liability to the extent of any payment made in good faith under this provision.
| Prior to Accelerated Death Benefit Payment | Following Accelerated Death Benefit Payment | |
|---|---|---|
| Face Amount | $ 50,000 | $ 25,000 |
| Death Benefit | $ 50,000 | $ 25,000 |
| Reduced Paid Up Term Insurance | $ 5,000 | $ 2,500 |
| Available Death Benefit | $ 50,000 | $ 25,000 |
| Administrative Fee | $ 250 | |
| Accelerated Death Benefit | $ 24,750 |
This demonstration is based on example Certificate values. Please refer to the Schedule for Your specific Face Amount, Death Benefit and Reduced Paid Up Term Insurance values provided by this Certificate.
All premium must be paid to Us at Our home office. All premium is payable in advance.
The initial premium is due on the Certificate Effective Date. If the initial premium is not paid, there will be no coverage provided under this Certificate. Subsequent premium is payable monthly or according to the premium payable frequency established by the Participating Employer. Failure to pay premium when due shall result in termination of coverage as of such due date, subject to the grace period.
If a payment of any premium is dishonored for insufficient funds, a reasonable service charge shall be charged to You. A dishonored payment shall be considered a failure to pay premium.
On payment of a claim under this Certificate, any premium then due and unpaid may be deducted therefrom.
If written notice of termination has not been received from You, a grace period of 31 days will be allowed for premium payments due after the initial premium. Coverage shall remain in force during the grace period. If any premium is unpaid at the end of the grace period, coverage shall automatically terminate retroactively to the last day for which premium has been paid.
If You do not pay the premium due by the end of the grace period, the coverage will Lapse. You may have Nonforfeiture Options as described in the Life Insurance Benefit Provisions section.
Coverage may be reinstated while the Insured is alive, at any time within 30 days after the date of Lapse without submitting additional Evidence of Insurability, if all past due premiums are paid.
Reinstatements that are more than 30 days but less than 5 years after the date of Lapse can be made, but must include Evidence of Insurability. All past due premiums are due before the Certificate is reinstated, in addition to interest in the amount of 6% compounded annually. This amount of past due premiums is calculated for the coverage period from the last unpaid due date to the date of reinstatement.
The Active Employee who signed the application is the original Owner of this Certificate unless someone else is shown as Owner in the application. Ownership may be changed in accordance with the Change of Owner or Beneficiary provision. During the Insured's lifetime, the Owner may exercise every right this Certificate gives or We allow. If the Owner and the Insured are not the same person, and the Owner dies during the lifetime of the Insured, the Insured will become the Owner. The Insured must notify us if the Owner dies. All changes are subject to any endorsement on this Certificate limiting such rights.
The Beneficiary named in the application, or later changed by the Insured, will receive the Death Benefit upon the death of the Insured after approval of the claim. Unless You have stated otherwise, if any Beneficiary dies before the Insured, that Beneficiary's interest will pass to any other Beneficiaries according to their respective interest. If no Beneficiary survives the Insured, the Death Benefit will be paid to the Insured's estate.
You may change the Owner or the Beneficiary at any time during the lifetime of the Insured, unless the previous designation provides otherwise. Change in ownership is limited to the Insured person. To change the Owner or Beneficiary, send a written request to Us in a form acceptable to Us. The change will go into effect when We have recorded the change. However, after the change is recorded, it will be deemed effective as of the date of Your written request for change. The change will be subject to any payment made or action taken by Us before the request is recorded.
If We cannot determine whether a Beneficiary or the Insured died first in a common disaster, We will assume that the Beneficiary died first. The Death Benefit will be paid on this basis unless an Endorsement to this Certificate provides otherwise.
Your coverage is not assignable and Your benefits are not assignable. A change in ownership to an Insured person is not considered an assignment for purposes of this Certificate and is subject to the Change of Owner or Beneficiary provision.
Once We receive the required proof of loss and have approved Your claim, any benefits due under this Certificate will be paid within 30 days. Proof of loss shall be sent to Us at PO Box 2906, Clinton, IA, 52733-2906 or through our online claims site at TrustmarkVB.com or our current online claims site at the time of claim. If We approve the claim, We shall pay the benefits subject to the terms of the Certificate.
We have the right, at Our expense, to obtain Your medical records to investigate a claim. We have the right to have an autopsy performed, at Our expense, unless prohibited by applicable state law.
Insurance for eligible persons is provided under a contract of group insurance with the Policyholder. The Policy, the Participation Agreement, the Certificates, applications, any riders or Endorsements and any attached papers shall constitute the entire contract. No change to the Policy or this Certificate shall be valid until approved by an executive officer of the Company. No agent or Participating Employer has authority to change the Policy or this Certificate or waive any of its provisions. Any changes are subject to the laws of the governing jurisdiction.
We rely on the statements made in the application for coverage described in this Certificate and application for any reinstatements. These statements are considered representations and not warranties. No statement may be used in defense of a claim under this Certificate unless it is in such applications, signed by You and a copy has been furnished to You or Your Beneficiary.
We will not contest payment of benefits after this Certificate has been in force during the Insured's lifetime for two (2) years from the Certificate Effective Date. We will not contest payment of benefits which were reinstated after this Certificate has been in force during the Insured's lifetime for two years from the date of such reinstatement.
If there is a misstatement of age or tobacco use in the application, all benefits and other amounts payable, including the Face Amount, will be adjusted. The adjustment will reflect the benefits and amount that would have been purchased for the premium listed on the Certificate Schedule at the correct Issue Age and tobacco use status.
For purposes of this section, tobacco includes, but is not limited to, cigarettes and all forms of heated tobacco and all forms of smokeless tobacco.
If We make any payment or Certificate changes in good faith, relying on Our records, or evidence supplied to Us, Our duty will be fully discharged. We reserve the right, at any time, to correct any errors in this Certificate.
No legal action may be brought against Us within 60 days after written proof of loss has been sent to Us. No such action may be brought more than 2 years from the time written proof of loss is required to be given.
We have the right to recover any overpayments made on Your claim due to fraud or an error the Company makes in processing Your claim.
We will notify You or Your Beneficiary, if applicable, in writing, of any overpayments made under this coverage. We have the right to recover any overpayments made in full. We will determine the method by which the repayment is to be made, including the application of future benefits payable under this Certificate or attached rider to the overpayment balance. We will not recover more money than the amount We paid.
If any provision of this Certificate and any attachments is in conflict with the laws that govern this Certificate and any attachments, the provision will be deemed to be amended to conform with such laws.
While Your coverage is in force, We may, either directly or through a third-party service provider, provide You with access to chronic care support, independent living-related resources and other goods and services to support health or financial well-being. These services may be discontinued by Us at any time and are subject to change. While Trustmark has arranged these goods, services and/or third party service provider discounts, the third party service providers are liable to the applicants/Insureds/enrollees for the provision of such goods and/or services. Trustmark is not responsible for the provision of such goods and/or services, nor are We liable for the failure of the provisions of the same. Further, Trustmark is not liable to the applicants/Insureds/enrollees for the negligent provision of such goods and/or services by third party service providers.
Activities of Daily Living
Any of the following basic human functional abilities used to measure the Insured's impairment due to Chronic Illness:
Adult Day Care
Medical or nonmedical care on a less than 24-hour basis, provided in an Adult Day Care Center outside the residence, for persons of 6 or more in need of personal services, supervision, protection, or assistance in sustaining daily needs, including eating, bathing, dressing, transferring, toileting, and taking medications.
Adult Day Care Center
A facility which provides Adult Day Care and meets all of the following requirements:
Assisted Living Facility
A facility that provides a combination of housing and personalized health care in a professionally managed group-living environment designed to respond to the individual needs of persons who require assistance with Activities of Daily Living. This type of facility is specifically designed to promote maximum independence and dignity in the most residential and homelike setting possible. It may be all or part of a building that houses a few or several hundred persons, or a distinct part of a residential campus.
Chronic Illness or Chronically Ill
An Insured who has been certified by a Licensed Health Care Practitioner as:
Certification by the Licensed Health Care Practitioner of the Chronically Ill Insured must occur at least once every 12 months.
Elimination Period
The first 90 days of Professional Caregiving or Family Caregiving for which no benefits are payable. The Elimination Period only needs to be satisfied once.
Family Caregiving
Unpaid, Substantial Assistance provided in the Insured's or caregiver's home to assist the Insured with Chronic Illness when:
Home Health Care
Medical and nonmedical services provided by a Home Health Care Agency to Chronically Ill persons in their residences.
Home Health Care Agency
An entity which provides care and services at the Insured's home or other residence, is primarily engaged in providing Home Health Care services under policies and procedures established by a group of professionals, including at least one Licensed Health Care Practitioner and one nurse, and:
Hospice Services
Outpatient services not paid by Medicare, that are designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease or condition, and to provide supportive care to the primary caregiver and the family. Care may be provided by a skilled or unskilled person under a Plan of Care or a multidisciplinary team under medical direction.
Hospital
A facility which:
Intermediate Care Facility
A licensed health facility that provides inpatient care to ambulatory or non-ambulatory patients who have recurring need and need supportive care, but who do not require availability of continuous Skilled Nursing Care.
Licensed Health Care Practitioner
Any doctor of medicine or osteopathy authorized to practice medicine and surgery in the state where such action is performed, and any registered professional nurse, licensed social worker, or other individual who meets such requirements as may be prescribed by the Secretary of the Treasury.
Long-Term Care Facility
A Skilled Nursing Facility, an Intermediate Care Facility, or a Residential Care Facility. Long-Term Care Facility does NOT mean:
Medicare
The "Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as then constituted or later amended," or Title 1, Part I of Public Law 89-97, as enacted by the 89th Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof.
Plan of Care
A written description of the Insured's needs and the type, frequency, providers, and cost of all formal and informal services required by the Insured, which is prepared and signed by a Licensed Health Care Practitioner.
Pre-existing Condition
A condition, including a condition not diagnosed or identified, for which symptoms existed within 6 months before the effective date of this Rider, or for which medical advice or treatment was recommended by or received from a Licensed Health Care Practitioner or other member of the medical profession within 6 months before the effective date of this Rider.
Professional Caregiving
Care provided by any of the following to assist the Insured with Chronic Illness:
The following conditions must be satisfied:
Residential Care Facility
A facility which:
Residential Nursing Care
Care designed mainly to help a person in the Activities of Daily Living which does not require the continuous attention of trained medical or paramedical personnel. Such care may involve:
Such care must be provided in a Residential Care Facility.
Severe Cognitive Impairment
Deterioration or loss of intellectual capacity as measured by clinical evidence and standardized tests which measure impairment in the areas of:
The deterioration or loss must:
Skilled Nursing Care
Active nursing care and/or restorative rehabilitation services given to treat an unstable health condition. For such Skilled Nursing Care:
Skilled Nursing Facility
A place which:
Substantial Assistance
Physical assistance without which the Insured would be unable to perform the Activities of Daily Living.
Substantial Supervision
Continual supervision (which may include cuing by verbal prompting, gestures, or other demonstrations) by another person that is necessary to protect the Severely Cognitively Impaired Insured from threats to their health or safety (such as may result from wandering).
For benefits to be payable, You must:
Benefits begin after You have received Professional Caregiving or Family Caregiving services for 90 days. No benefits are payable for the Elimination Period.
If You are Chronically Ill and receiving fewer than 8 days per month of either Professional Caregiving or Family Caregiving, but are receiving 8 days per month or more of Professional Caregiving and Family Caregiving combined, the Family Caregiving benefit will be paid.
If You are receiving Professional Caregiving, Your monthly Long-Term Care Accelerated Death Benefit amount is 6% of the Face Amount at the end of the Elimination Period.
If You are receiving Family Caregiving, Your monthly Long-Term Care Accelerated Death Benefit amount is 2% of the Face Amount at the end of the Elimination Period.
If You are receiving both Professional Caregiving and Family Caregiving, only one benefit will be paid. The benefit paid will be the greater of the two benefits.
The total sum of monthly payments under this provision may not exceed 100% of the Face Amount at the end of the Elimination Period.
If the Terminal Illness Accelerated Death Benefit is paid after We have started paying Your Long-Term Care Accelerated Death Benefit, any remaining Long-Term Care Accelerated Death Benefit payments will be recalculated based on Your remaining Face Amount. The total sum of the Terminal Illness Accelerated Death Benefit and monthly payments under the Long-Term Care Accelerated Death Benefit may not exceed 100% of the Face Amount at the end of the Elimination Period.
On the date the Long-Term Care Accelerated Death Benefit is paid, the Death Benefit, Face Amount, and Reduced Paid-Up Term Insurance will be reduced by the same percentage of Face Amount that was accelerated for the Long-Term Care Accelerated Death Benefit payment.
Premium payable for the Certificate and any Riders will be waived as long as monthly Long-Term Care Accelerated Death Benefit payments continue. Coverage will remain in force for the period of time for which the monthly payments are made. When the Long-Term Care Accelerated Death Benefit claim ends and the Face Amount is reduced, a proportionately reduced premium will be due to continue coverage for the remaining Face Amount.
100% of the following Certificate values will be restored under this benefit:
The above Certificate values will be restored while this benefit, the Certificate, and the Long-Term Care Accelerated Death Benefit are in force. The restored Certificate values shall equal 100% of the amount of the Certificate values which were reduced due to the benefits that were paid under the Long-Term Care Accelerated Death Benefit. At no point will the Death Benefit exceed the amount shown on the Schedule of Guaranteed Death Benefits for Your Attained Age.
The initial restoration shall be made following the first month for which benefits are paid under the Long-Term Care Accelerated Death Benefit. Subsequent restoration shall be made on a monthly basis coinciding with the payment of benefits under the Long-Term Care Accelerated Death Benefit. The aggregate amount of the restored Certificate values shall, at no time, exceed 100% of the aggregate reduction in the Certificate values for benefits paid under the Long-Term Care Accelerated Death Benefit.
Benefit Restoration will terminate at the earliest of:
After the Long-Term Care Accelerated Death Benefit has been exhausted and if You still meet the Eligibility for the Payment of Benefits, We will increase the Face Amount by the monthly amount You qualify for under the Long-Term Care Accelerated Death Benefit and then accelerate the same amount to You. We will continue to do so each month that You remain eligible. The total sum of monthly payments under this provision may not exceed 100% of the Face Amount at the end of the Elimination Period.
The terms, conditions, exclusions and limitations of the Long-Term Care Accelerated Death Benefit govern the payment of extended benefits under this provision, with the exception of the impacts to the Death Benefit and the Reduced Paid-Up Term Insurance.
If the Terminal Illness Accelerated Death Benefit is paid after We have started paying Your Long-Term Care Accelerated Death Benefit, any remaining Extension of Long-Term Care Accelerated Death Benefit payments will be recalculated based on Your remaining Face Amount.
The Extension of Long-Term Care Accelerated Death Benefit will terminate at the earliest of:
This Rider does not pay benefits for care that is related to or arising from any of the following:
This Rider does not pay benefits due to a Pre-existing Condition when Your inability to perform Activities of Daily Living or Your Severe Cognitive Impairment starts before or during the first 6 months after the effective date of this Rider.
The initial premium is due on the effective date of this Rider. If the initial premium is not paid, there will be no coverage provided under this Rider. Subsequent premium is payable monthly or according to the premium payable frequency established by the Participating Employer. Failure to pay premium when due shall result in termination of coverage as of such due date, subject to the Grace Period.
If written notice of termination has not been received from You, a Grace Period of 31 days will be allowed for premium payments due after the initial premium. Coverage shall remain in force during the Grace Period. If any premium is unpaid at the end of the Grace Period, coverage shall automatically terminate retroactively to the last day for which premium has been paid.
If You do not pay the premium due by the end of the Grace Period, the coverage will Lapse.
If this Rider terminates for nonpayment of premium and the cause is due to Your Severe Cognitive Impairment or loss of functional capacity, this Rider may be reinstated without Evidence of Insurability within five (5) months after the date of termination. You or any designated addressee must demonstrate to Us that failure to pay the premium was unintentional and due to Your Severe Cognitive Impairment or loss of functional capacity. Reinstatement is subject to the payment of past due premiums during which period the Certificate will continue in force if the demonstration of Severe Cognitive Impairment or loss of functional capacity is made.
If this Rider is reinstated under these conditions, the Certificate will also be reinstated. All past due premiums are due before the Certificate and Rider are reinstated. This amount of past due premiums is calculated for the coverage period from the last unpaid due date to the date of reinstatement.
If You Lapse for any reason other than the above, reinstatement is governed by the Reinstatement provision in the Certificate.
We must receive notice of claim within 30 days after a covered loss starts or as soon thereafter as reasonably possible. Notice shall be sent to Us at PO Box 2906, Clinton, IA, 52733-2906 or through our online claims site at TrustmarkVB.com or our current online claims site at the time of claim.
If requested by You, We will send You forms for filing Proof of Loss. If these forms are not sent to You within 15 days, You will meet the Proof of Loss requirement by giving Us a written statement of the nature and extent of the loss within the time limit stated in the Proof of Loss provision.
Written proof must be given within 90 days after such loss or as soon thereafter as reasonably possible. Proof of Loss shall be sent to Us at PO Box 2906, Clinton, IA, 52733-2906 or through our online claims site at TrustmarkVB.com or our current online claims site at the time of claim. We will not reduce or deny the claim for this reason, if the proof is submitted as soon as reasonably possible. When this Rider provides payment for continuing loss, written Proof of Loss must be completed and returned to Us within 90 days after the end of each period for which We owe You benefits. Except for absence of legal capacity, no claim for benefits will be accepted after 1 year from the time specified. Proof of Loss refers to all documentation necessary to support a claim.
After We receive written Proof of Loss and process Your claim, We will pay any benefits due under this Rider. Benefits will be paid to You. Any accrued benefits unpaid at Your death will be paid to Your Beneficiary.
Once We have received the required Proof of Loss and approved Your claim, any benefits due under this Rider will be paid within 30 days.
If a claim under this Rider is denied, upon written request, We will provide You with a written explanation of the reasons for the denial and make available all information directly related to the denial.
If You wish to file an appeal regarding an adverse claim decision, You must send a written request to Us, along with any additional supporting information, within 120 days of receiving notification of Our claim decision. We will complete Our review of Your appeal within 30 days of receipt of all information needed to make a final determination. If Our original determination is upheld upon appeal, the notice of the appeal decision shall describe any additional appeal rights offered by Us.
This Rider will terminate at 12:01 a.m. standard time at Your home on the earliest of the following:
This Rider is noncancellable, meaning We may not cancel, reduce coverage or increase premiums due under this Rider.
Once payment of Your claim has begun, We will continue to pay Your continuous claim as long as You qualify, subject to the Eligibility for the Payment of Benefits and the maximum lifetime benefit, even if Your Certificate is terminated.
We have the right to have You examined, at Our expense, by a Licensed Health Care Practitioner as often as reasonably necessary.
We rely on the statements made in the application for coverage described in this Rider and application for any reinstatements. These statements are considered representations and not warranties. No statement may be used in defense of a claim under this Rider unless it is in such applications, signed by You and a copy has been furnished to You or Your Beneficiary.
We will not contest payment of benefits after this Rider has been in force during Your lifetime for two (2) years from the effective date of this Rider. We will not contest payment of benefits which were reinstated after this Rider has been in force during Your lifetime for two years from the date of such reinstatement.