Benefits Chart

Below is a full listing of the benefits for each plan.

This Income Insurance Protection Plan Works For You!

Eligibility

All members (and spouses) who are under age 60, who are actively at work 30 or more hours per week.

Cost of Living Adjustment (COLA)

After the waiting period and one complete calendar year of total disability, the net monthly benefit is increased 3%. Should the total disability continue, benefit increases will take effect on each subsequent anniversary for a maximum of five increases.

Waiver of Premium

If you become totally disabled, as defined by the group policy, and receive monthly benefits for 6 consecutive months, the premium payment may be waived for as long as the insured is disabled (provided the required proof is given). When the insured stops receiving monthly benefits, premiums must again be paid when due.

Partial Disability Benefit

This helps you to rebuild your income as you return to full-time employment. The partial disability benefit helps provide continuing support for a claimant attempting a return to work, up to the Benefit Duration Period selected. A claimant will be considered partially disabled if he cannot perform the material duties of his regular job, but can perform at least one of these duties on a part-time basis; or at least one, but not all of these duties on a full-time basis.

This benefit is payable until the claimant is able to earn 80% of pre-disability income. The claimant must have been totally disabled throughout the elimination period. The Partial disability benefit equals the total disability benefit less 50% of the claimant°s partial earnings.

Survivor Income Benefit

For insureds under age 55, family will receive 60% of insured earnings for 1 year. Benefit is payable if the Insured is receiving Disability Income at time of death. For insureds age 55 or over, pays 60% of insured earnings for eight months.

Duration of Benefits

Benefits are paid depending on the plan chosen. If total disability begins before age 60, benefits are paid for 2 years for Plan 1, 5 years for Plan 2, or to age 65 for Plan 3, as elected. If total disability begins between ages 60 and 67, benefits are paid for 2 years, and up to age 70 if disability begins on age 68 or 69, regardless of plan selected.

All benefits will end on the date:

1. The member fails to give required proof of continuing total disability;
2. The member’s total disability ends;
3. The member attains age 70;
4. The maximum benefit period ends; or
5. The member dies.

If the group policy ends while totally disabled, this will not act to end the maximum benefit period.

Notice of Insurance Information Practices

To properly underwrite and administer your application for insurance coverage, we must collect certain information concerning your insurability. You are our most important source of information, but we may also contact other sources such as medical professionals and institutions, employers and other insurance companies. While all information regarding your insurability will be treated as confidential, in some situations, and in compliance with applicable law, we may disclose necessary items of information to third parties without your specific authorization.

INVESTIGATIVE CONSUMER REPORTS

As part of our procedure for processing your application, an investigative consumer report may be prepared by an outside insurance reporting organization. Personal information may be collected from others regarding your general reputation and lifestyle. If an interview is conducted with someone other than you, we will inform you of your right to be interviewed in connection with the preparation of the investigative consumer report. You have the right to send a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

PERSONAL HISTORY INTERVIEW

To provide you, our client, with the best possible service, we may also conduct what we call a personal history interview. This is a phone call placed from our underwriting office. Its purpose is to make sure that the application information is complete. Our interviewers are trained to conduct their calls in a friendly, professional manner. The nature of the information discussed is always treated as personal and confidential and will only be used to assess your eligibility for insurance.

MEDICAL INFORMATION BUREAU (MIB) PRE-NOTICE

Information regarding your insurability will be treated as confidential. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may, however, make a brief report thereon to the MIB, Inc., formerly known as Medical Information Bureau, a not-for-profit membership organization of insurance companies, which operates an information exchange on behalf of its members. If you apply to another MIB member company for life or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request, will supply such company, with the information about you in its file. Upon receipt of a request from you, MIB will arrange disclosure of any information in your file. Please contact MIB at (866) 692-6901 (TTY (866) 346-3642). If you question the accuracy of the information in MIB's file, you may contact MIB and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of MIB's information office is 50 Braintree Hill Park, Suite 400, Braintree, Massachusetts 02184-8734. Hartford Life Insurance Company, Hartford Life and Accident Insurance Company , or their reinsurers, may also release information from their files to other insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Information for consumers about MIB may be obtained on its website at www.mib.com.

ACCESS, CORRECTION AND DISCLOSURE

You can obtain access to personal information about you contained in our policy files by sending us a written request. You may also request any necessary corrections, amendments or deletion of any information in our files which you believe to be inaccurate or irrelevant. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may release information in their files to other life insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Also, please be advised that personal and confidential information collected by us may, in certain circumstances, be disclosed to third parties without authorization. A notice providing further description of the circumstances under which information about you may be disclosed and the types of persons and organizations to whom it may be disclosed will be sent to you upon your written request. If you desire further information or access to your personal information, please send your written request to: Hartford Life Insurance Company or Hartford Life and Accident Insurance Company, 200 Hopmeadow St., Simsbury, CT 06089.

The Hartford is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.                 PA-9369

Coverage is not currently available to California and New York residents.

GBD-1000 A (AGP-5825) & GBD-1000 A (AGP-5824)

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Underwritten by Hartford Life and Accident Insurance Company, Simsbury, CT 06089

The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company

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