• Beneficiary change form: http://www.mdc.edu/hr/OnlineForms/Benefits/Beneficiary.pdf
• Enrollment form: http://www.mdc.edu/hr/Benefits/LifeInsurance/Enrollment_Form.pdf
  • Statement of good health required during open enrollment election: http://www.mdc.edu/hr/OnlineForms/Benefits/lifeinsurability.pdf
• Definitions: http://www.mdc.edu/hr/Benefits/LifeInsurance/Definitions.pdf

Benefit Amount
One times annual salary rounded to the next lower hundred, subject to a maximum of $400,000

Your benefit will reduce: 8% every year upon attainment of age 60 up to age 71. Benefit of $1,000 at age 72 and older.

Other benefits included: Conversion privilege, waiver of premium, living benefit, AD&D.

Employee Benefit Amount
One times annual salary rounded to the next lower hundred, subject to a maximum of $400,000. $200,000 guarantee issue for employees under age 60. $30,000 guarantee issue for employees age 60-69 (provided you enroll as a new hire

otherwise you are a late entrant and subject to insurance company approval.)

Your benefit will reduce: 8% every year upon attainment of age 60 up to age 71. Benefit of $1,000 at age 72 and older.

Other benefits included: Conversion privilege, waiver of premium, living benefit, AD&D.

OPEN ENROLLMENT: Satisfactory evidence of insurability is required for all entrants during open enrollment. Health questionnaire must be filled out and submitted to HR Benefits by end of open enrollment period. Effective date will be based on underwriting approval from Lincoln Financial.

Monthly Cost

To calculate your monthly cost, please follow these instructions:

Optional Dependent Life Insurance
(regardless of the number of children)

Flat cost: $3.50 per month. Spouse or Domestic Partner [DP]: half of the employee optional life amount, minimum of $500 & maximum of $15,000. Coverage terminates at spouse / DP age 65. Child(ren): $500 from age 14 days to 6 months, $7,500 from age 6 months to 25 years or marriage, whichever comes first.

Life & Dependent Life Eligibility Requirements:

Please see your certificate for your minimum hour requirements. You must also be a permanent employee and be actively at work* on the coverage effective date.

*Actively at work means the full-time performance of all customary duties of your occupation.

If Spouses and Dependent Children are in a ‘Period of Limited Activity'* their effective date will not take effect until the day after: (1) his or her final discharge from the health care facility; or (2) resuming the normal activities of a healthy person of the same age and sex.

*Period of Limited Activity means a period when a spouse or child is confined in a health care facility; or, whether confined or not, is unable to perform the regular and usual activities of a healthy person of the same age and sex.

SPECIAL NOTE: The above is just a brief summary of benefits and does not constitute a contract. Please refer to your Certificate of Insurance for further information on your Employee Benefits.