• 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, two or three 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. For an employee electing to increase more than one times annual salary, a health questionnaire will be forwarded by The Hartford after open enrollment. Effective date will be based on underwriting approval.

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]: 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.