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Your brokeris: <br />Basic Term Life <br />PROPOSAL I Prepared for I Mayfield Village <br />IMPORTANT NOTES <br />Rates Notes <br />Rates for contributory plans assume a minimum of 75% Participation of eligible employees. <br />Rates for non-contributory plans assume a minimum of 100% participation of eligible employees. <br />Life rate valid for life oniy coverage. <br />Benefit Detail Notes <br />Waiver; must be disabled prior to age 60. Total Disability is required. <br />Future entranfs age 70 and over are Gmited to $1,000 of life insurance without evidence of insurability. <br />Biood and/or urine testing is required for underwritten life insurance amounts of $100,000 or greater. <br />Portability: ceases on attainment oF age 70. <br />A SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS <br />Life Plan <br />Email: <br />Denny Stusek <br />BGS Associates LLC <br />32901 Station Street <br />5uite 206 <br />Solon, OH 44139 <br />dstusek@basassociates.cum <br />X You must be working full-time on the effective date of yaur coverage; otherwise, your coverage becomes effective afteryou have completed <br />a specific waiting period, <br />X A person is ADL-disabled if he or she is (a) physically unable to perform two or more ADLs without continuous physical assistance; or (b) <br />cogniGvely impalred, and requires verbal cueing to protect Fiunselflherself or others. ADLs are bathing, dressing, toileting, transferring, <br />continence, and eafing, <br />X Accelerated Life Benefit is not paid to an employee under the fdlowing circumstances: one who is required by law to use lhe benefit to pay <br />creditors; is required by court order to pay ihe benefit to another person; is required by a govemment agency to use the payment to receive a <br />govemment 6enefit; or loses his or her group coverage before an accelerated benefit is paid. <br />X Evidence of Insurability is required on all late enrollees_ <br />X This coverage will not be effecfive unGl approved by a Guardian underwriter. <br />X This proposal is hedged subject to satisfactory financial evaluation. <br />X Please refer to policy booklet for full plan description. <br />X Employees must be legally working in the United States in order to be eligible for coverage. Underwridng must approve caverage for <br />employees on temporary assignment (a) exceeding 1 year; or (b) in an area under travel waming by the US Department of State, subject to <br />state specific variations, <br />Accidental Death and Dismemberment Plan <br />X W e pay no Accidental Death and Dismemberment benefits for an insured where deaih or dismemberment occurs: <br />¦ As the result of a disease or a bodily infirmity. , <br />¦ Through intentional self-injury. ¦ By declared or undeclared urar or act of war or artned aggression, w while a member of any armed force. May vary by state. <br />¦ W hile driving without a valid drivers Gcense. <br />¦ W hile legally intoxicated. <br />¦ W hile participating in civil disorder or commiffing a felony. <br />¦ Traveling on any type of aircraft while having any duGes on that aircraft. <br />¦ While voluntarily using a non-prescription controlled substance. • <br />Rates and premiums are based on the employee data submitted. Final rates and premiumsare based on the plan and <br />employee/dependent data provided on the eneollment forms. <br />(o <br />GUARDIAN' <br />The Guardian Life Insurance Company of America, New York, NY