Williams v. Colgate Palmolive Company et alMOTION TO DISMISS FOR FAILURE TO STATE A CLAIM , MOTION to Strike Jury DemandW.D. Ky.July 6, 2017IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF KENTUCKY LOUISVILLE DIVISION MOTION TO DISMISS PLAINTIFF’S COMPLAINT AND TO STRIKE DEMAND FOR JURY TRIAL PURSUANT TO ERISA Defendant Aetna Life Insurance Company (“Aetna” or “Defendant”) respectfully moves this Court to dismiss Plaintiff’s Complaint under Rule 12(b)(6) of the Federal Rules of Civil Procedure and to strike Plaintiff’s jury demand under Rules 12(f) and 39(a)(2) of the Federal Rules of Civil Procedure. In support of this motion, Aetna relies on its Memorandum in Support of Motion to Dismiss Plaintiff’s Complaint and to Strike Demand for Jury Trial, contemporaneously filed with this motion. These materials establish that Plaintiff’s state-law claims are preempted by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq., as amended (“ERISA”); that she has not properly alleged CONNIE S. WILLIAMS, individually and as Executrix of the Estate of John W. Williams, Deceased, Plaintiff, v. COLGATE-PALMOLIVE COMPANY and AETNA LIFE INSURANCE COMPANY, Defendants. Case No. 3:17-cv-00309-DJH-CHL Case 3:17-cv-00309-DJH-CHL Document 15 Filed 07/06/17 Page 1 of 3 PageID #: 54 2 the remaining cause of action against Aetna under ERISA; and that Plaintiff is not entitled to a jury trial under ERISA. Respectfully submitted this 6th day of July 2017. Respectfully submitted by, /s/ William B. Wahlheim, Jr. William B. Wahlheim, Jr. Grace R. Murphy [Pro hac vice motions to be filed] Attorneys for Defendant Aetna Life Insurance Company OF COUNSEL: MAYNARD, COOPER & GALE, P.C. 2400 Regions/Harbert Plaza 1901 Sixth Avenue North Birmingham, AL 35203-2602 Telephone: (205) 254-1000 Facsimile: (205) 254-1999 wwahlheim@maynardcooper.com Case 3:17-cv-00309-DJH-CHL Document 15 Filed 07/06/17 Page 2 of 3 PageID #: 55 3 CERTIFICATE OF SERVICE I hereby certify that a copy of the above and foregoing has been filed with the Court on this the 6th day of July 2017, via the CM/ECF system which will serve a copy upon the following counsel of record: Harold W. Thomas Rebecca D. Northup THOMAS, DODSON & WOLFORD, PLLC 9200 Shelbyville Road, Suite 611 Louisville, KY 40222 (502) 426-1700 hal@tdwattorneys.com Rebecca@tdwattorneys.com Counsel for Plaintiff Eric P. Mathisen OGLETREET, DEAKINS, NASH, SMOAK & STEWART, P.C. 56 S. Washington, St., Suite 302 Valparaiso, IN 46383 Counsel for Aetna Life Douglas C. Ballantine Christopher E. Schaefer STOLL KEENON OGDEN PLLC 2000 PNC Plaza 500 West Jefferson Street Louisville, KY 40202 Counsel for Colgate-Palmolive Company /s/ William B. Wahlheim, Jr. OF COUNSEL Case 3:17-cv-00309-DJH-CHL Document 15 Filed 07/06/17 Page 3 of 3 PageID #: 56 IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF KENTUCKY LOUISVILLE DIVISION MEMORANDUM OF LAW IN SUPPORT OF DEFENDANT’S MOTION TO DISMISS PLAINTIFF’S COMPLAINT AND TO STRIKE DEMAND FOR JURY TRIAL PURSUANT TO ERISA Defendant Aetna Life Insurance Company (“Aetna” or “Defendant”), pursuant to Rules 8, 12(b)(6), 12(f), and 39(a)(2) of the Federal Rules of Civil Procedure, submits the following memorandum of law in support of its contemporaneously filed Motion to Dismiss Plaintiff’s Complaint and to Strike Demand for Jury Trial. INTRODUCTION On April 24, 2017, Plaintiff instituted her Complaint in the Circuit Court of Jefferson County, Kentucky. (See ECF doc. 1-2). Pursuant to 28 U.S.C. § 1331, This case was subsequently removed to the United States District Court for the CONNIE S. WILLIAMS, individually and as Executrix of the Estate of John W. Williams, Deceased, Plaintiff, v. COLGATE-PALMOLIVE COMPANY and AETNA LIFE INSURANCE COMPANY, Defendants. Case No. 3:17-cv-00309- DJH-CHL Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 1 of 13 PageID #: 57 2 Western District of Kentucky on the basis of preemption by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq., as amended (“ERISA”). (Doc. 1). In her Complaint, Plaintiff alleges that, as representative of the estate of John W. Williams (“Decedent”) and beneficiary of the life insurance policy at issue, she is entitled to benefits under Group Policy GP-654092 (the “Policy”) issued to Colgate-Palmolive (“Colgate”) by Aetna to insure the life insurance component of Colgate’s employee welfare benefit plan (the “Plan”). (See ECF doc. 1-2 at 3-4 (¶¶ 1-4, 7)). A true and correct copy of the Policy and the applicable Certificate-Booklet are attached hereto as Exhibit A. The Plan is an employer-sponsored plan governed by ERISA. See 29 U.S.C. § 1002(1) (“The terms “employee welfare benefit plan” and “welfare plan” mean any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) . . . benefits in the event of . . . disability . . . .”). Plaintiff’s claim seeks benefits allegedly due under the ERISA-governed Policy, along with statutory penalties under ERISA. (See ECF doc. 1-2 at 8-10 (¶ 23) and “Wherefore” clause, subsections (a) and (c))). Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 2 of 13 PageID #: 58 3 In her Complaint, Plaintiff alleges that “Defendants” cancelled coverage without authorization and without notifying her or the Decedent. (See ECF doc. 1-2 at 7 (¶¶ 17, 19, 21)). Plaintiff contends that the cancellation is actionable through a number of common law theories, specifically breach of contract, breach of common law fiduciary duties, as well as breach of ERISA fiduciary duties and for promissory estoppel. (See ECF doc. 1-2 at 6-9 (¶¶ 16-26)). In connection with her claims, Plaintiff seeks benefits in the full amount of the Policy minus the “unwithheld” premiums, interest, and attorney’s fees. (See ECF doc. 1-2 at 9-10 (“Wherefore” paragraph)). Despite her common law and statutory theories of recovery, Plaintiff’s claims unequivocally seek benefits under, and arise out of the administration of, the Plan—which she tacitly acknowledges by asserting a breach of ERISA fiduciary duties claim for the same conduct—and thus her claim is due to be dismissed due to complete preemption under ERISA. Furthermore, under ERISA, Plaintiff is not entitled to a jury trial and her jury demand is due to be dismissed. ARGUMENT I. LEGAL STANDARD. Although Rule 8(a) of the Federal Rules of Civil Procedure does not require “detailed factual allegations,” the United States Supreme Court has held that “labels and conclusions” or a “formulaic recitation of the elements of a cause of Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 3 of 13 PageID #: 59 4 action will not do.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007)). Rather, to survive a motion to dismiss, “a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” Id. (quoting Twombly, 550 U.S. at 570). In other words, a pleading must contain sufficient “factual content t[o] allow[] the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Iqbal, 556 U.S. at 678. Thus, although the allegations of a complaint generally must be taken as true when ruling on a motion to dismiss, the Court need not accept “conclusory allegations or unwarranted factual inferences.” Directv, Inc. v. Treesh, 487 F. 3d 471, 476 (6th Cir. 2007). Typically, a court reviewing a motion to dismiss under Rule 12(b)(6) of the Federal Rules of Civil Procedure is limited to the four corners of the complaint. See Weiner v. Klais & Co. Inc., 108 F. 3d 86, 89 (6th Cir. 1997). However, a district court may consider documents attached to a motion to dismiss without converting the motion into a motion for summary judgment where, as here, the documents (such as the Policy) are referred to in the Complaint and central to Plaintiff’s claims. Id. Under Rule 12(f), “[t]he court may strike from a pleading an insufficient defense or any redundant, immaterial, impertinent, or scandalous matter,” and, Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 4 of 13 PageID #: 60 5 under Rule 39(a)(2), designates an action as a non-jury action where it “finds that on some or all of those issues there is no federal right to a jury trial.” II. PLAINTIFF’S STATE-LAW CLAIMS ARE PREEMPTED AND SHOULD BE DISMISSED. Plaintiff’s Complaint alleges state-law claims for breach of contract, breach of common law fiduciary duty, and promissory estoppel1 for conduct related to the administration of an ERISA Plan. (ECF doc. 1-2 at 6-7 (¶¶ 16-19), 9 (¶¶ 24-26)). Although Plaintiff seeks to recover benefits and enforce rights through state-law claims, the well-pleaded complaint rule is qualified by the doctrine of complete preemption. See Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58 (1987); Aetna Health Inc. v. Davila, 542 U.S. 200 (2004). In Davila, the Supreme Court stated that “any state-law cause of action that duplicates, supplements, or supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy exclusive and is therefore pre-empted.” 542 U.S. at 209. The Court then set out the following test: [I]f an individual brings suit complaining of a denial of coverage for medical care, where the individual is entitled to such coverage only because of the terms of an ERISA-regulated employee benefit plan, and where no legal duty (state or federal) independent of ERISA or the plan terms is violated, then the suit falls within the scope of ERISA § 502(a)(1)(B). In other words, if an 1 Count IV, asserting a claim of promissory estoppel, appears to be alleged only against Defendant Colgate, (see ECF doc. 1-2 at 9 (¶ 26)), but such a claim is completely preempted by ERISA and thus Aetna moves to dismiss it to the extent it could be argued to apply to Aetna. Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 5 of 13 PageID #: 61 6 individual, at some point in time, could have brought his claim under ERISA § 502(a)(1)(B), and where there is no other independent legal duty that is implicated by a defendant’s actions, then the individual’s cause of action is completely pre-empted by ERISA § 502(a)(1)(B). Davila, 542 U.S. at 210 (emphasis added). In the present case, Plaintiff expressly seeks to recover benefits and enforce rights to which she is allegedly entitled under an ERISA-governed Policy and Plan. (See ECF doc. 1-2 at 6-10 (¶¶ 17, 19, 23(a), 26, and “Wherefore” clause, subsection (a)); Exhibit “A”). Such allegations directly concern Plan benefits and coverage under the Plan that fall squarely within the scope of ERISA. Moreover, there is no separate legal duty supporting Plaintiff’s claims. Plaintiff’s claims arise under an ERISA-governed Plan as her state-law claims directly relate to the allegedly improper handling of her coverage under the Policy and Plan. See, e.g., Cromwell v. Equicor-Equitable HCA Corp., 944 F. 2d 1272, 1276 (6th Cir. 1991) (holding state-law claim of breach of contract based on denial of benefits was “at the very heart of issues within ERISA’s exclusive regulation”); Smith v. Provident Bank, 170 F.3d 609, 614 (6th Cir. 1999) (“A claim for breach of fiduciary duty against the fiduciary of an ERISA plan necessarily presents a federal question. Thus, [the plaintiff’s] state-law fiduciary duty claim is not only preempted but also provides federal subject-matter jurisdiction.”); Weaver v. Prudential Ins. Co. of Am., 763 F. Supp. 2d 930, 936 (M.D. Tenn. 2010) (“Plaintiffs’ claims, although Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 6 of 13 PageID #: 62 7 characterized as state-law causes of action for promissory estoppel, negligence, and breach of fiduciary duty, all seek to recover the proceeds of the ERISA- governed group life-insurance policy and are therefore completely preempted by ERISA.”). In other words, the duty upon which Plaintiff’s claims are based did not arise independently of the Plan. Accordingly, both prongs of the Davila test for complete preemption are met in this case. As explained above, Plaintiff’s Complaint sets forth causes of action pursuant to the common law and statutory law of the Commonwealth of Kentucky, and such state laws are completely preempted and barred by the provisions of ERISA. Accordingly, these claims are due to be dismissed or affirmatively re- characterized as an ERISA cause of action through an Amended Complaint. III. PLAINTIFF’S CLAIM FOR BREACH OF ERISA FIDUCIARY DUTIES DOES NOT SUFFICIENTLY ALLEGE A CLAIM AGAINST AETNA UNDER THE FEDERAL PLEADING STANDARD Plaintiff’s allegations against Aetna for breach of ERISA fiduciary duties is based solely on a conclusory statement that “the Defendants” breached their “respective fiduciary duties” under ERISA “as the result of Defendants’ cancellation” of coverage “without authorization from or notice to” Plaintiff or Decedent. (ECF doc. 1-2 at 7 (¶ 21)) (citing 29 U.S.C. § 1104). The only factual allegation in the Complaint that so much as mentions Aetna is that Plaintiff contacted Aetna by phone and was referred back to Colgate after being informed Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 7 of 13 PageID #: 63 8 that “Aetna’s records showed that it had never received an ‘Evidence of Insurability Form’ from Colgate.” (Id. at 5 (¶ 10)). These allegations do not contain sufficient “factual content t[o] allow[] the court to draw the reasonable inference that the defendant is liable for the misconduct alleged,” Iqbal, 556 U.S. at 678. For purposes of the claim against Aetna, the “misconduct alleged” must be the breach of fiduciary duties imposed upon Aetna by ERISA. Section 1104 of ERISA, to which Plaintiff cites, requires that fiduciaries discharge their duties with respect to a plan “solely in the interest of the participants and beneficiaries and,” among other things, “(D) in accordance with the documents and instruments governing the plan . . . .” 29 U.S.C. § 1104(a)(1). An allegation that Aetna informed Plaintiff that it had not received a particular form in no way establishes the breach of any duty. Otherwise, Plaintiff has only alleged that the Policy “had been cancelled” and that “Defendants” cancelled coverage “without authorization from or notice to” Plaintiff and Decedent, (ECF doc. 1-2 at 5 (¶ 11), 7 (¶ 21)). Critically, the Complaint contains no factual allegations that Aetna cancelled the Policy or coverage, and there are no allegations to support the implication that authorization from Plaintiff and Decedent was required for cancellation or that Aetna had a duty to notify Plaintiff or Decedent of any cancellation. Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 8 of 13 PageID #: 64 9 For example, under the terms of the Policy, coverage terminates automatically, among other reasons, at “[t]he end of a 31 day period following the date the required premium contribution for the coverage is due and not made . . . .” (Exhibit A at 92). Similarly, the Policy terminates automatically “[i]f the premiums and any fees are not paid by the Premium Due Date and before the end of the Grace Period.” (Exhibit A at 79). Neither of these events requires authorization from Plaintiff or Decedent to terminate coverage. Further, under the terms of the Policy, the Policyholder has the duty to notify employees of the termination of the Policy and their rights to continue coverage, not Aetna. (See Exhibit A at 67). Plaintiff’s allegations do not establish to any reasonable degree, and certainly not to the federal pleading standard, that there was an ERISA- imposed fiduciary duty that Aetna violated. Under the Policy and Plan, as well as the ERISA statute, the defendants and other fiduciaries have different and distinct roles and duties. Plaintiff cannot simply and conveniently lump the defendants all together and call it a day because doing so does not provide the defendants with notice of the basis for the claims against them or give the Court sufficient grounds to draw the reasonable inference that a specific defendant is liable for the misconduct alleged. See, e.g., Banks v. Bosch Rexroth Corp., No. 5:12-345-DCR, 2014 WL 868118, at *7 (E.D. Ky. Mar. 5, 2014) (dismissing claims that failed “to provide notice regarding which specific Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 9 of 13 PageID #: 65 10 defendant is liable for which count” and listed “each defendant . . . in each count with no mention of his individual role or action”); Caudle v. Life Ins. Co. of N. Am., 33 F. Supp. 3d 1288, 1294-95 (N.D. Ala. 2014) (dismissing claims as failing to validly state claims where they were “silent about [the defendant’s] specific actions or inactions” and as failing to satisfy Rule 8 obligations where they “simply lump[ed] all [the defendants] together . . . in an unacceptable shotgun format”). Plaintiff’s claim against Aetna for breach of ERISA fiduciary duty is due to be dismissed for failure to sufficiently state a claim under the Federal pleading rules. IV. PLAINTIFF IS NOT ENTITLED TO A JURY TRIAL UNDER ERISA Plaintiff’s Complaint also demands a “Trial by jury.” (See ECF doc. 1-2 at 10 (“Wherefore” clause, subsection (e))). Such demand is due to be stricken, however, as the Sixth Circuit has routinely and consistently held that there is no right to a jury trial in an action under 29 U.S.C. § 1132. See, e.g., Bair v. Gen. Motors Corp., 895 F.2d 1094, 1096 (6th Cir. 1990) (striking plaintiff’s demand for a jury trial from her complaint seeking retirement benefits on the grounds that an ERISA claim is equitable in nature and is therefore is not eligible for a jury trial); Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 616 (6th Cir. 1998) (affirming that a claimant seeking benefits under 29 U.S.C. § 1132 is not entitled to a jury trial); Johnson v. Décor Fabrics, Inc., 250 F.R.D. 323, 331-332 (M.D. Tenn. Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 10 of 13 PageID #: 66 11 2008) (granting defendants’ motion to strike plaintiffs’ jury demand and explaining that “[s]ince the court has found that the plaintiffs’ causes of action fall under either § 1132(a)(1)(B) or § 1132(a)(3) for purposes of complete preemption, there is no right to a jury trial.”). Accordingly, Plaintiff is not entitled to a jury trial, and her jury demand should be stricken from her Complaint. CONCLUSION WHEREFORE, PREMISES CONSIDERED, Defendant Aetna Life Insurance Company respectfully requests that this Court (i) dismiss Plaintiff’s state-law claims pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure, as such claims are preempted and foreclosed by ERISA; (ii) dismiss Plaintiff’s breach of ERISA fiduciary duties claim against Aetna pursuant to Rules 8 and 12(b)(6) for failure to sufficiently allege a claim under the federal pleading standard; and (iii) strike Plaintiff’s demand for a jury trial under Rules 12(f) and 39(a)(2), as Plaintiff is not entitled to a jury trial under ERISA. Respectfully submitted this 6th day of July 2017. Respectfully submitted by, /s/ William B. Wahlheim, Jr. William B. Wahlheim, Jr. Grace R. Murphy [Pro hac vice motions to be filed] Attorneys for Defendant Aetna Life Insurance Company Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 11 of 13 PageID #: 67 12 OF COUNSEL: MAYNARD, COOPER & GALE, P.C. 2400 Regions/Harbert Plaza 1901 Sixth Avenue North Birmingham, AL 35203-2602 Telephone: (205) 254-1000 Facsimile: (205) 254-1999 wwahlheim@maynardcooper.com Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 12 of 13 PageID #: 68 13 CERTIFICATE OF SERVICE I hereby certify that a copy of the above and foregoing has been filed with the Court on this the 6th day of July 2017, via the CM/ECF system which will serve a copy upon the following counsel of record: Harold W. Thomas Rebecca D. Northup THOMAS, DODSON & WOLFORD, PLLC 9200 Shelbyville Road, Suite 611 Louisville, KY 40222 (502) 426-1700 hal@tdwattorneys.com Rebecca@tdwattorneys.com Counsel for Plaintiff Eric P. Mathisen OGLETREET, DEAKINS, NASH, SMOAK & STEWART, P.C. 56 S. Washington, St., Suite 302 Valparaiso, IN 46383 Counsel for Aetna Life Douglas C. Ballantine Christopher E. Schaefer STOLL KEENON OGDEN PLLC 2000 PNC Plaza 500 West Jefferson Street Louisville, KY 40202 Counsel for Colgate-Palmolive Company /s/ William B. Wahlheim, Jr. OF COUNSEL Case 3:17-cv-00309-DJH-CHL Document 15-1 Filed 07/06/17 Page 13 of 13 PageID #: 69 Exhibit A Policy and Certificate-Booklet Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 1 of 131 PageID #: 70 Arkansas Aetna Life Insurance Company A LIMITATIONS AND EXCLUSIONS UNDER THE ARKANSAS LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT Residents of this state who purchase life insurance, annuities, or health and accident insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Arkansas Life and Health Insurance Guaranty Association (“Guaranty Association”). The purpose of the Guaranty Association is to assure that policy and contract owners will be protected, within certain limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of policy owners who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by the member insurers through the Guaranty Association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting insurance companies that are well-managed and financially stable. DISCLAIMER The Arkansas Life and Health Insurance Guaranty Association (“Guaranty Association”) may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in the state. You should not rely on coverage by the Guaranty Association in purchasing an insurance policy or contract. Coverage is NOT provided for your policy or contract or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as non-guaranteed amounts held in a separate account under a variable life or variable annuity contract. Insurance companies or their agents are required by law to provide you with this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Guaranty Association to induce you to purchase any kind of insurance policy. The Arkansas Life and Health Insurance Guaranty Association C/0 The Liquidation Division 1023 West Capitol Little Rock, Arkansas 72201 Arkansas Insurance Department 1200 West Third Street Little Rock, Arkansas 72201-1904 The state law that provides for this safety-net is called the Arkansas Life and Health Insurance Guaranty Association Act (“Act”). Below is a brief summary of the Act’s coverages, exclusions and limits. This summary does not cover all provisions of the Act; nor does it in any way change anyone's rights or obligations under the Act or the rights or obligations of the Guaranty Association. COVERAGE Generally, individuals will be protected by the Guaranty Association if they live in this state and hold a life, annuity, or health insurance contract or policy, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of policy or contract owners are protected as well, even if they live in another state. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 2 of 131 PageID #: 71 Arkansas EXCLUSIONS FROM COVERAGE However, persons owning such policies are NOT protected by the Guaranty Association if: they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); the insurer was not authorized to do business in this state; their policy or contract was issued by a nonprofit hospital or medical service organization, an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policy or contract owner is subject to future assessments, or by an insurance exchange. The Guaranty Association also does NOT provide coverage for: Any policy or contract or portion thereof which is not guaranteed by the insurer or for which the individual has assumed the risk, such as non-guaranteed amounts held in a separate account under a variable life or variable annuity contract; Any policy of reinsurance (unless an assumption certificate was issued); Interest rate yields that exceed an average rate; Dividends and voting rights and experience rating credits; Credits given in connection with the administration of a policy by a group contract holder; Employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); unallocated annuity contracts (which give rights to group contractholders, not individuals); unallocated annuity contracts issued to/in connection with benefit plans protected under Federal Pension Benefit Corporation (“FPBC”) (whether the FPBC is yet liable or not); Portions of an unallocated annuity contract not owned by a benefit plan or a government lottery (unless the owner is a resident) or issued to a collective investment trust or similar pooled fund offered by a bank or other financial institution); Portions of a policy or contract to the extent assessments required by law for the Guaranty Association are preempted by State or Federal law; Obligations that do not arise under the policy or contract, including claims based on marketing materials or side letters, riders, or other documents which do not meet filing requirements, or claims for policy misrepresentations, or extra- contractual or penalty claims; Contractual agreements establishing the member insurer’s obligations to provide book value accounting guarantees for defined contribution benefit plan participants (by reference to a portfolio of assets owned by a nonaffiliate benefit plan or its trustees). LIMITS ON AMOUNT OF COVERAGE The Act also limits the amount the Guaranty Association is obligated to cover: The Guaranty Association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one insured life, the Guaranty Association will pay a maximum of $ 300,000--no matter how many policies and contracts there were with the same company, even if they provided different types of coverages. Within this overall $ 300,000 limit, the Association will not pay more than $ 300,000 in health insurance benefits, $ 300,000 in present value of annuity benefits, or $ 300,000 in life insurance death benefits or net cash surrender values--again, no matter how many policies and contracts there were with the same company, and no matter how many different types of coverages. There is a $ 1,000,000 limit with respect to any contract holder for unallocated annuity benefits, irrespective of the number of contracts held by the contract holder. These are limitations for which the Guaranty Association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 3 of 131 PageID #: 72 California Aetna Life Insurance Company A CALIFORNIA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT SUMMARY DOCUMENT AND DISCLAIMER Residents of California who purchase life and health insurance and annuities should know that the insurance companies licensed in this state to write these types of insurance are members of the California Life and Health Insurance Guaranty Association (“CLHIGA”). The purpose of this Association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided through the Association is not unlimited, as noted in the box below, and is not a substitute for consumers' care in selecting insurers. DISCLAIMER The California Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Guaranty Association to induce you to purchase any kind of insurance policy. Policyholders with additional questions should first contact their insurer or agent or may then contact: California Life and Health Insurance Guaranty Association P.O. Box 16860 Beverly Hills, CA 90209 or Consumer Service Division California Department of Insurance 300 South Spring Street Los Angeles, CA 90013 Below is a brief summary of this law's coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the Act or the rights or obligations of the Association. COVERAGE Generally, individuals will be protected by the California Life and Health Insurance Guaranty Association if they live in this state and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 4 of 131 PageID #: 73 California EXCLUSIONS FROM COVERAGE However, persons holding such policies are not protected by this Guaranty Association if: • Their insurer was not authorized to do business in this state when it issued the policy or contract; • Their policy was issued by a health care service plan (HMO), Blue Cross, Blue Shield, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society; • They are eligible for protection under the laws of another state. This may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state. The Guaranty Association also does not provide coverage for: • Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which guaranty rights to group contract holders, not individuals; • Employer and association plans, to the extent they are self-funded or uninsured; • Synthetic guaranteed interest contracts; • Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; • Any policy of reinsurance unless an assumption certificate was issued; • Interest rate yields that exceed an average rate; • Any portion of a contract that provides dividends or experience rating credits. LIMITS ON AMOUNT OF COVERAGE The Act limits the Association to pay benefits as follows: LIFE AND ANNUITY BENEFITS • 80% of what the life insurance company would owe under a life policy or annuity contract up to $ 100,000 in cash surrender values, $ 100,000 in present value of annuities, or $ 250,000 in life insurance death benefits. • A maximum of $ 250,000 for any one insured life no matter how many policies and contracts there were with the same company, even if the policies provided different types of coverages. HEALTH BENEFITS • A maximum of $ 200,000 of the contractual obligations that the health insurance company would owe were it not insolvent. The maximum may increase or decrease annually based upon changes in the health care cost component of the consumer price index. PREMIUM SURCHARGE Member insurers are required to recoup assessments paid to the Association by way of a surcharge on premiums charged for health insurance policies to which the Act applies. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 5 of 131 PageID #: 74 Colorado Aetna Life Insurance Company A COLORADO NOTICE SUMMARY OF THE LIFE AND HEALTH INSURANCE PROTECTION ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS INTRODUCTION Residents of Colorado who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Life and Health Insurance Protection Association. The purpose of this Association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in Colorado and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the Association is limited, however. As noted in the box below, this protection is not a substitute for consumers’ care in selecting companies that are well-managed and financially stable. IMPORTANT DISCLAIMER The Life and Health Insurance Protection Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require residency in Colorado. You should not rely on coverage by the Life and Health Insurance Protection Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Association to induce you to purchase any kind of insurance policy. SUMMARY The state law that provides for this safety-net coverage is called the Life and Health Insurance Protection Association Act. Below is a brief summary of this law’s coverages, exclusions and limits. This summary does not cover all provisions of the law, nor does it in any way change anyone’s rights or obligations under the act or the rights or obligations of the Association. COVERAGE Generally, individuals will be protected by the Life and Health Protection Association if they live in this state and hold a life or health insurance contract, or annuity, or if they hold certificates under a group life or health insurance contract or annuity, issued by a member insurer. The beneficiaries, payees, or assignees of insured persons are protected as well, even if they live in another state. Certain parties to structured settlement annuity contracts may be entitled to coverage benefits as well based on defined circumstances. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 6 of 131 PageID #: 75 Colorado EXCLUSIONS FROM COVERAGE Persons holding such policies or contracts are not protected by this Association if: they are not residents of the State of Colorado, except under certain very specific circumstances; the insurer was not authorized or licensed to do business in Colorado at the time the policy or contract was issued; their policy was issued by a nonprofit hospital or health service corporation, an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, or by an insurance exchange. The Association also does not provide coverage for: any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk; any policy of reinsurance (unless an assumption certificate was issued); plans of employers, associations or similar entities to the extent they are self-funded or uninsured (that is, not insured by an insurance company, even if an insurance company administers them); interest rates yields, crediting rate yields or other factors employed in calculating returns, including but not limited to indexes or other external references stated in the policy or contract, that exceed an average rate specified in the Association Act; dividends; experience rating credits; credits given in connection with the administration of a policy or contract; any unallocated annuity; annuity contracts or group annuity certificates used by nonprofit insurance companies to provide retirement benefits for nonprofit educational institutions and their employees; policies, contracts, certificates or subscriber agreements issued by a prepaid dental care plan; sickness and accident insurance when written by a property and casualty insurer as part of an automobile insurance contract; unallocated annuity contracts issued to an employee benefit plan protected under the federal Pension Benefit Guaranty Corporation; policies or contracts issued by an insurer which was insolvent or unable to fulfill its contractual obligations as of July 1, 1991, except for annuity contracts issued by a member insurer which was placed into liquidation between July 1, 1991 and August 31, 1991; policies or contracts covering persons who are not citizens of the United States; any kind of insurance or annuity, the benefits of which are exclusively payable or determined by a separate account required by the terms of such insurance policy or annuity maintained by the insurer or by a separate entity. LIMITS ON AMOUNT OF COVERAGE The act also limits the amount the Association is obligated to pay out. The Association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one insured life, no matter how many policies or contracts were issued by the same company, even if such contracts provided different types of coverages, the Association will pay a maximum of: $ 300,000 in net life insurance death benefits and no more than $ 100,000 in net cash surrender and net cash withdrawal values for life insurance; for health insurance benefits - $ 100,000 for coverages not defined as disability, basic hospital, medical and surgical, or major medical insurance, including any net cash surrender and net cash withdrawal values: $ 300,000 for disability insurance; or $ 500,000 for basic hospital, medical and surgical, or major medical insurance; $ 100,000 in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or with respect to each payee of a structured settlement annuity, $ 100,000 in present value annuity benefits in the aggregate, including net cash surrender and net cash withdrawal values. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 7 of 131 PageID #: 76 Colorado The Association shall not be liable to expend more than $ 300,000 in the aggregate, with respect to any one life except that with respect to benefits for basic hospital, medical and surgical and major medical insurance, the aggregate liability of the association shall not exceed $ 500,000 with respect to any one individual. This Information is Provided By: Life and Health Insurance Protection Association Colorado Division of Insurance P.O. Box 480025 1560 Broadway, Suite 850 Denver, CO 80248-0025 Denver, CO 80202 (303) 292-5022 (303) 894-7499 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 8 of 131 PageID #: 77 Hawaii Aetna Life Insurance Company A NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE HAWAII LIFE AND DISABILITY INSURANCE GUARANTY ASSOCIATION ACT Residents of Hawaii who purchase life insurance, annuities or disability insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Hawaii Life and Disability Insurance Guaranty Association. The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the Guaranty Association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. DISCLAIMER The Hawaii Life and Disability Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in Hawaii. You should not rely on coverage by the Hawaii Life and Disability Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Guaranty Association to induce you to purchase any kind of insurance policy. The Hawaii Life and Disability Insurance Guaranty Association P.O. Box 4068 Honolulu, Hawaii 96812 Department of Commerce & Consumer Affairs Insurance Division P.O. Box 3614 Honolulu, Hawaii 96811 The state law that provides for this safety-net coverage is called the Hawaii Life and Disability Insurance Guaranty Association Act. Below is a brief summary of this law's coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the act or the rights or obligations of the Guaranty Association. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 9 of 131 PageID #: 78 Hawaii COVERAGE Generally, individuals will be protected by the Hawaii Life and Disability Insurance Guaranty Association if they live in this state and hold a life or disability insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state. EXCLUSIONS FROM COVERAGE However, persons holding such policies are not protected by the Guaranty Association if: • they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); or • the insurer was not a member insurer of the Guaranty Association. A nonprofit hospital or medical service organization (the "Blues"), an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, or an insurance exchange are examples of nonmember insurers. The Guaranty Association also does not provide coverage for: • any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; • any policy of reinsurance (unless an assumption certificate was issued); • interest rate yields that exceed an average rate; • dividends; • credits given in connection with the administration of a policy by a group contract holder; • employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); • unallocated annuity contracts (which give rights to group contractholders, not individuals). LIMITS ON AMOUNT OF COVERAGE The act also limits the amount the Guaranty Association is obligated to pay out: The Guaranty Association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one insured life, the Guaranty Association will pay a maximum of $ 300,000--no matter how many policies and contracts there were with the same company, even if they provided different types of coverages. Within this overall $ 300,000 limit, the Association will not pay more than $ 100,000 in cash surrender values, $ 100,000 in disability insurance benefits, $ 100,000 in present value of annuities, or $ 300,000 in life insurance death benefits --again, no matter how many policies and contracts there were with the same company, and no matter how many different types of coverages. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 10 of 131 PageID #: 79 Idaho Aetna Life Insurance Company A SUMMARY OF THE IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS Revised July, 2005 Residents of Idaho who purchase life insurance, annuities or health/disability insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Idaho Life and Health Insurance Guaranty Association. The purpose of the Association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Association will assess its other member insurance companies for money to pay the claims of insured persons who reside in Idaho and, in some cases, to keep coverage in force. However, the protection provided by these insurers through the Association is limited and is not a substitute for consumers' care in selecting insurance companies that are well-managed and financially stable. The Idaho Life and Health Insurance Guaranty Association Act provides a safety net for certain purchasers of insurance. Below is a brief summary of the Act's coverage, exclusions and limitations. This summary does not cover all provisions of the Idaho Life and Health Insurance Guaranty Association Act, nor does it in any way change anyone's legal rights or obligations under the Act including the legal rights or obligations of the Association. COVERAGE Generally, individuals will be protected by the Association if they live in Idaho and own a life or health/disability insurance policy, an annuity contract, or if they are an insured certificate holder under a group life or health insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of covered policies may be protected as well, even if they live in another state. EXCLUSIONS FROM COVERAGE However, persons holding such policies or contracts are not protected by the Association if: • They are eligible for protection under the laws of another state. • The insurer was not authorized to do business in Idaho. • The policy was issued by a reciprocal insurer, mutual benefit association, fraternal benefit society, hospital and medical service corporation, limited managed care plan, or self-funded health care plan. The Association also does not provide coverage for: • Any policy or contract or any portion of any policy or contract under which the risk is borne by the policyholder. • Any policy of reinsurance. • Interest rate yields that exceed an average rate. • Unallocated annuity contracts (any annuity not issued to and owned by an individual). LIMITS ON AMOUNT OF COVERAGE The Act also limits the amount the Association is obligated to pay out. The Association cannot pay out more than what the insurance company would owe under a policy or contract. Furthermore, the amounts the Association is authorized to pay are limited as follows: • Not more than $ 100,000 of net cash surrender or net cash withdrawal values under a life insurance, health/disability insurance, or annuity policy or contract. • Not more than $ 300,000 of claims or benefit payments under a health/disability policy. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 11 of 131 PageID #: 80 Idaho • Not more than $ 300,000 of death benefits under a life insurance policy. • Not more than $ 300,000 of annuity benefit payments under a contract for which periodic annuity payments have begun to be paid, if the annuitization period chosen was the annuitant's lifetime or a period certain of 10 years or longer; otherwise $ 100,000 of annuity benefit payments. • However, in no event will the Association be obligated to cover more than $ 300,000 in the aggregate for all benefits for any one life. IMPORTANT DISCLAIMER The Idaho Life and Health Insurance Guaranty Association does not provide coverage for all types of policies. In addition, coverage may be subject to substantial limitations or exclusions, and require continued residency in Idaho. You should not rely on coverage by the Idaho Life and Health Insurance Guaranty Association in selecting an insurance company or an insurance policy. Coverage is not provided by the Idaho Life and Health Insurance Guaranty Association for your policy or contract or any portion of it that is not guaranteed by the insurer or for which the risk is borne by you - the policyholder. Insurance companies and their agents are prohibited by law from using the existence of the Association for the purpose of sales, solicitation or inducement to purchase any kind of insurance policy. This Summary does not cover all provisions of the Idaho Life and Health Insurance Guaranty Association Act, nor does it in any way change your legal rights or obligations or the Association's legal rights or obligations which are defined by and set forth under the Act. Idaho Life & Health Insurance Guarantee Association 8324 Northview, Suite 104 Boise, Idaho 83704 208-378-9510 www.idlifega.org Idaho Department of Insurance 700 West State Street P.O. Box 83720 Boise, Idaho 83720-0043 208-334-4250 1-800-721-3272 www.doi.idaho.gov Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 12 of 131 PageID #: 81 Illinois Aetna Life Insurance Company A ILLINOIS LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION LAW Residents of Illinois who purchase health insurance, life insurance, and annuities should know that the insurance companies licensed in Illinois to write these types of insurance are members of the Illinois Life and Health Insurance Guaranty Association. The purpose of this Guaranty Association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the covered claims of policyholders that live in Illinois (and their payees, beneficiaries, and assignees) and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the Guaranty Association is not unlimited, however, as noted below. ILLINOIS LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION DISCLAIMER The Illinois Life and Health Insurance Guaranty Association provides coverage of claims under some types of policies if the insurer becomes impaired or insolvent. COVERAGE MAY NOT BE AVAILABLE FOR YOUR POLICY. Even if coverage is provided, there are substantial limitations and exclusions. Coverage is generally conditioned on continued residence in Illinois. Other conditions may also preclude coverage. You should not rely on availability of coverage under the Life and Health Insurance Guaranty Association Law when selecting an insurer. Your insurer and agent are prohibited by law from using the existence of the Association or its coverage to sell you an insurance policy. The Illinois Life and Health Insurance Guaranty Association or the Illinois Department of Insurance will respond to any questions you may have which are not answered by this document. Policyholders with additional questions may contact: Illinois Life and Health Insurance Guaranty Association 8420 West Bryn Mawr Avenue Chicago, Illinois 60631 (312) 714-8050 Illinois Department of Insurance 320 West Washington Street 4 th Floor Springfield, Illinois 62767 (217) 782-4515 SUMMARY OF GENERAL PURPOSES AND CURRENT LIMITATIONS OF COVERAGE The Illinois law that provides for this safety-net coverage is called the Illinois Life and Health Insurance Guaranty Association Law ("Law") (215 ILCS 5/531.01, et seq.). The following contains a brief summary of the Law's coverages, exclusions and limits. This summary does not cover all provisions; nor does it in any way change anyone's rights or obligations under the Law or the rights or obligations of the Guaranty Association. If you have obtained this document from an agent in connection with the purchase of a policy, you should be aware that its delivery to you does not guarantee that your policy is covered by the Guaranty Association. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 13 of 131 PageID #: 82 Illinois A) Coverage: The Illinois Life and Health Insurance Guaranty Association provides coverage to policyholders that reside in Illinois for insurance issued by members of the Guaranty Association, including: 1) life insurance, health insurance, and annuity contracts; 2) life, health or annuity certificates under direct group policies or contracts; 3) unallocated annuity contracts; and 4) contracts to furnish health care services and subscription certificates for medical or health care services issued by certain licensed entities. The beneficiaries, payees, or assignees of such persons are also protected, even if they live in another state. B) Exclusions from Coverage: 1) The Guaranty association does not provide coverage for: a) any policy or portion of a policy for which the individual has assumed the risk; b) any policy of reinsurance (unless an assumption certificate was issued); c) interest rate guarantees which exceed certain statutory limitations; d) certain unallocated annuity contracts issued to an employee benefit plan protected under the Pension Benefit Guaranty Corporation and any portion of a contract which is not issued to or in connection with a specific employee, union or association of natural persons benefit plan or government lottery; e) any portion of a variable life insurance or variable annuity contract not guaranteed by an insurer; or f) any stop loss insurance. 2) In addition, persons are not protected by the Guaranty Association if: a) the Illinois Director of insurance determines that, in the case of an insurer which is not domiciled in Illinois, the insurer's home state provides substantially similar protection to Illinois residents which will be provided in a timely manner; or b) their policy was issued by an organization which is not a member insurer of the Association. C) Limits on Amount of Coverage: 1) The Law also limits the amount the Illinois Life and Health Insurance Guaranty Association is obligated to pay. The Guaranty Association's liability is limited to the lesser of either: a) the contractual obligations for which the insurer is liable or for which the insurer would have been liable if it were not an impaired or insolvent insurer, or b) with respect to any one life, regardless of the number of policies, contracts, or certificates: i) in the case of life insurance, $ 300,000 in death benefits but not more than $ 100,000 in net cash surrender or withdrawal values; ii) in the case of health insurance, $ 300,000 in health insurance benefits, including net cash surrender or withdrawal values; and iii) with respect to annuities, $ 100,000 in the present value of annuity benefits, including net cash surrender or withdrawal values, and $ 100,000 in the present value of annuity benefits for individuals participating in certain government retirement plans covered by an unallocated annuity contract. The limit for coverage of unallocated annuity contracts other than those issued to certain governmental retirement plans is $ 5,000,000 in benefits per contract holder, regardless of the number of contracts. However, in no extent is the Guaranty Association liable for more than $ 300,000 with respect to any one individual. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 14 of 131 PageID #: 83 Kansas Aetna Life Insurance Company A GENERAL PURPOSES AND LIMITATIONS OF THE KANSAS LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION K.S.A. 40-3001, et. Seq. DISCLAIMER The Kansas Life and Health Insurance Guaranty Association may not provide coverage for all or a portion of this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and is dependent upon continued resident in Kansas. Therefore, you should not rely upon coverage by the Kansas Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Insurance companies and their agents are prohibited by law from using the existence of the Kansas Life and Health Insurance Guaranty Association in selling you any form of an insurance policy, or to induce you to purchase any form of an insurance policy. Either the Kansas Life and Health Insurance Guaranty Association or the Kansas Insurance Department will respond to any questions you have regarding this document. The Kansas Life and Health Insurance Guaranty Association 2909 SW Maureen Lane Topeka, KS 66614-5335 The Kansas Insurance Department 420 Southwest 9 th Street Topeka, KS 66612-1678 This is a summary of the basic provisions of the Kansas Life and Health Insurance Guaranty Association Act. It is only a summary, and does not provide an in depth analysis of that act. Nothing in this summary modifies the rights of persons who are protected by the act, or the rights or duties of the association. The purpose of the Kansas Life and Health Insurance Guaranty Association Act is to protect certain individuals who purchase life insurance, annuities or health insurance in Kansas. The act provides for the establishment of a funding mechanism to pay benefits or provide insurance coverage to individuals when a life or health insurance company is unable to meet its obligations by reason of insolvency or financial impairment. However, not all individuals with a right to recover under life or health insurance policies are protected by the act. An individual is only provided protection when: 1. the individual, regardless of where they reside, except for nonresident certificate holders under group policies or contracts, is the beneficiary, assignee or payee of a covered policy or contract holder, 2. the individual policy or contract holder is a resident of the state of Kansas, 3. the individual is not a resident of the state of Kansas, but only with respect to an annuity contract which has been awarded pursuant to a judgment or settlement agreement in a medical malpractice liability action, 4. the individual is not a resident of the state of Kansas, but only under all of the following conditions: a. the impaired or insolvent insurer was a Kansas domestic insurer; and b. the insurer never had a license to do business in the state in which the individual resides; and c. the state in which the individual resides has an association similar to this state's; and d. the individual is not eligible for coverage by the association of the state in which the individual resides. Additionally, the association may not provide coverage for the entire amount the individual expects to receive from the policy. The association does not provide coverage for any portion of the policy where the individual has assumed the risk, Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 15 of 131 PageID #: 84 Kansas for any policy of reinsurance, for interest rates that exceed a specified average rate, for employers' plans that are self funded, for parts of plans that provide dividends or credits in connection with the administration of the policy, for policies sold by companies not authorized to do business in Kansas, or for any unallocated annuity contract. Also, the association will not provide coverage where any guaranty protection is provided to the individual under the laws of the insolvent or impaired insurer's state of domicile. The act also limits the amount the association is obligated to pay individuals on various policies. The association does not pay more than the amount of the contractual obligation of the insurance company. Regardless of the number of policies or contracts the association is not obligated to pay amounts over $ 300,000 in life insurance death benefits; $ 100,000 in net cash surrender and net cash withdrawal values for life insurance, $ 100,000 in health insurance benefits, including any net cash surrender and net cash withdrawal values, $ 100,000 in the present value of annuity benefits, including net cash surrender and net cash withdrawal values, unless the annuity contract is awarded pursuant to a judgment or settlement agreement in a medical malpractice liability action; or more than $ 300,000 in the aggregate for the above coverage’s with respect to any one life. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 16 of 131 PageID #: 85 Louisiana Aetna Life Insurance Company A SUMMARY OF THE LOUISIANA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS Residents of Louisiana who purchase life insurance, annuities, or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Louisiana Life and Health Insurance Guaranty Association. The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state, and in some cases, to keep coverage in force. However, the valuable extra protection provided by these insurers through the Guaranty Association is limited. As noted in the disclaimer below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. DISCLAIMER The Louisiana Life and Health Insurance Guaranty Association provides coverage of claims under some types of policies if the insurer becomes impaired or insolvent. COVERAGE MAY NOT BE AVAILABLE FOR YOUR POLICY. Even if coverage is provided, there are significant limits and exclusions. Coverage is always conditioned upon residence in this state. Other conditions may also preclude coverage. Insurance companies and insurance agents are prohibited by law from using the existence of the association or its coverage to sell you an insurance policy. You should not rely on the availability of coverage under the Louisiana Life and Health Insurance Guaranty Association when selecting an insurer. The Louisiana Life and Health Insurance Guaranty Association or the Department of Insurance will respond to any questions you may have which are not answered by this document. LLHIGA Department of Insurance P.O. Drawer 44126 P.O. Box 94212 Baton Rouge, LA 70804 Baton Rouge, LA 70804-9214 The state law that provides for this safety-net coverage is called the Louisiana Life and Health Insurance Guaranty Association Act. The following is a brief summary of this law’s coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change any person's rights or obligations under the Act or the rights or obligations of the Guaranty Association. COVERAGE Generally, individuals will be protected by the Life and Health Insurance Guaranty Association if they live in this state and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by an insurer authorized to conduct business in Louisiana. The beneficiaries, payees or assignees of insured persons are protected as well even if they live in another state. EXCLUSIONS FROM COVERAGE 1. However, persons owning such policies are not protected by this association if: a. they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose Guaranty Association protects insureds who live outside that state); b. the insurer was not authorized to do business in this state; Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 17 of 131 PageID #: 86 Louisiana c. their policy was issued by a nonprofit hospital or medical service organization (the "Blues"), an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, or by an insurance exchange. 2. The association also does not provide coverage for: a. any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; b. any policy of reinsurance (unless an assumption certificate was issued); c. interest rate yields that exceed an average rate; d. dividends; e. credits given in connection with the administration of a policy by a group contract holder; f. employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); g. unallocated annuity contracts (which give rights to group contractholders, not individuals); unless qualified under § 403(b) of the Internal Revenue Code, except that, even if qualified under § 403(b), unallocated annuities issued to employee benefit plans protected by the Federal Pension Benefit Guaranty Corporation are not covered. LIMITS ON AMOUNT OF COVERAGE The act also limits the amount the association is obligated to pay out. The association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one insured life, the association will pay a maximum of $ 300,000, no matter how many policies and contracts there were with the same company, even if they provided different types of coverage. Within this overall $ 300,000 limit, the association will not pay more than $ 100,000 in cash surrender values, $ 100,000 in health insurance benefits, $ 100,000 in present value of annuities, or $ 300,000 in life insurance death benefits. Again, no matter how many policies and contracts there were with the same company, and no matter how many different types of coverages. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 18 of 131 PageID #: 87 Maryland Aetna Life Insurance Company A MARYLAND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE LIFE AND HEALTH INSURANCE GUARANTY CORPORATION SUBTITLE Residents of this State who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this State to write these types of insurance are members of the Maryland Life and Health Insurance Guaranty Corporation. The purpose of this is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the guaranty corporation will assess its other member insurance companies for the money to pay the claims of insured persons who live in this State and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the guaranty corporation is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. The Maryland Life and Health Insurance Guaranty Corporation may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in Maryland. You should not rely on coverage by the Maryland Life and Health Insurance Guaranty Corporation in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the guaranty corporation to induce you to purchase any kind of insurance policy. The Maryland Life and Health Insurance Guaranty Corporation 9199 Reistertown Road P.O. Box 671 -- Suite 216C Owings Mills, Maryland 21117 (410) 998-3907 The State law that provides for this safety-net is called the Life and Health Insurance Guaranty Corporation. The Corporation is not a department or unit of the State of Maryland and the liabilities or debts of the Life and Health Insurance Guaranty Corporation are not liabilities or debts of the State of Maryland. Following is a brief summary of this law’s coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the law or the rights or obligations of the guaranty corporation. COVERAGE Generally, individuals will be protected by the Life and Health Guaranty Corporation if they live in this State and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state. EXCLUSIONS FROM COVERAGE However, persons owning such policies are not protected by this corporation if: • they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); • the insurer was not authorized to do business in this State; Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 19 of 131 PageID #: 88 Maryland • their policy was issued by a Health Maintenance Organization, a fraternal benefit society, a mandatory State pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessment, or by an insurance exchange. The corporation also does not provide coverage for: • any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; • any policy of reinsurance, unless assumption certificates have been issued); • interest rate yields that exceed an average rate; • any portion of a policy or contract to the extent that it provides dividends; • credits given in connection with the administration of a policy by a group contract holder; • employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); • unallocated annuity contracts (which give rights to group contractholders, not individuals). LIMITS ON AMOUNT OF COVERAGE The statute also limits the amount the corporation is obligated to pay. The corporation cannot pay more than the amount the insurance company would owe under a policy or contract. Also, with respect to any one insured life, regardless of the number of policies or contracts with the member insurer, the corporation will pay a maximum of: • $ 300,000 in life insurance death benefits, but will not pay more than $100,000 in life insurance cash surrender values; • $ 300,000 in health insurance benefits, including any net cash surrender and net cash withdrawal values; and • $ 100,000 in the present value of annuity benefits, including any net cash surrender and net cash withdrawal values. These amounts are the maximums, no matter how many policies and contracts the insured has with the member company. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 20 of 131 PageID #: 89 Minnesota Aetna Life Insurance Company 151 Farmington Avenue Hartford, CT 06156 A NOTICE CONCERNING POLICYHOLDER RIGHTS IN AN INSOLVENCY UNDER THE MINNESOTA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION LAW If the insurer that issued your life, annuity, or health insurance policy becomes impaired or insolvent, you are entitled to compensation for your policy from the assets of that insurer. The amount you recover will depend on the financial condition of the insurer. In addition, residents of Minnesota who purchase life insurance, annuities, or health insurance from insurance companies authorized to do business in Minnesota are protected, SUBJECT TO LIMITS AND EXCLUSIONS, in the event the insurer becomes financially impaired or insolvent. This protection is provided by the Minnesota Life and Health Insurance Guaranty Association. MINNESOTA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION 4640 West 77 th Street, Suite 342 Edina, Minnesota 55435 (612) 831-1908 The maximum amount the guaranty association will pay for all policies issued on one life by the same insurer is limited to $ 300,000. Subject to this $ 300,000 limit, the guaranty association will pay up to $ 300,000 in life insurance death benefits, $ 100,000 in net cash surrender and net cash withdrawal values for life insurance, $ 300,000 in health insurance benefits, including any net cash surrender and net cash withdrawal values, $ 100,000 in annuity net cash surrender and net cash withdrawal values, $ 300,000 in present value of annuity benefits for annuities which are part of a structured settlement or for annuities in regard to which periodic annuity benefits, for a period of not less than the annuitant's lifetime or for a period certain of not less than ten years, have begun to be paid on or before the date of impairment or insolvency, or if no coverage limit has been specified for a covered policy or benefit, the coverage limit shall be $ 300,000 in present value. Unallocated annuity contracts issued to retirement plans, other than defined benefit plans, established under section 401, 403(b), or 457 of the Internal Revenue Code of 1986, [FN1] as amended through December 31, 1992, are covered up to $ 100,000 in net cash surrender and net cash withdrawal values, for Minnesota residents covered by the plan provided, however, that the association shall not be responsible for more than $ 7,500,000 in claims from all Minnesota residents covered by the plan. If total claims exceed $ 7,500,000, the $ 7,500,000 shall be prorated among all claimants. These are the maximum claim amounts. Coverage by the guaranty association is also subject to other substantial limitations and exclusions and requires continued residency in Minnesota. If your claim exceeds the guaranty association's limits, you may still recover a part or all of that amount from the proceeds of the liquidation of the insolvent insurer, if any exist. Funds to pay claims may not be immediately available. The guaranty association assesses insurers licensed to sell life and health insurance in Minnesota after the insolvency occurs. Claims are paid from this assessment. THE COVERAGE PROVIDED BY THE GUARANTY ASSOCIATION IS NOT A SUBSTITUTE FOR USING CARE IN SELECTING INSURANCE COMPANIES THAT ARE WELL MANAGED AND FINANCIALLY STABLE. IN SELECTING AN INSURANCE COMPANY OR POLICY, YOU SHOULD NOT RELY ON COVERAGE BY THE GUARANTY ASSOCIATION. THIS NOTICE IS REQUIRED BY MINNESOTA STATE LAW TO ADVISE POLICYHOLDERS OF LIFE, ANNUITY, OR HEALTH INSURANCE POLICIES OF THEIR RIGHTS IN THE EVENT THEIR INSURANCE CARRIER BECOMES FINANCIALLY INSOLVENT. THIS NOTICE IN NO WAY IMPLIES THAT THE COMPANY CURRENTLY HAS ANY TYPE OF FINANCIAL PROBLEMS. ALL LIFE, ANNUITY, AND HEALTH INSURANCE POLICIES ARE REQUIRED TO PROVIDE THIS NOTICE. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 21 of 131 PageID #: 90 Missouri Aetna Life Insurance Company A MISSOURI NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT Residents of this state who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Missouri Life and Health Insurance Guaranty Association. The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the guaranty association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the guaranty association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. The Missouri Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in Missouri. You should not rely on coverage by the Missouri Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their insurance producers are required by law to give or send you this notice. However, insurance companies and their insurance producers are prohibited by law from using the existence of the guaranty association to induce you to purchase any kind of insurance policy. YOU MAY CONTACT EITHER THE ASSOCIATION OR THE MISSOURI DEPARTMENT OF INSURANCE AT THE FOLLOWING ADDRESSES SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE. The Missouri Life and Health Insurance Guaranty Association 520 Dix Road, Suite D Jefferson City, MO 65109 Missouri Insurance Department P.O. Box 690 Jefferson City, MO 65109 The state law that provides for this safety-net is called the Missouri Life and Health Insurance Guaranty Association Act. Below is a brief summary of this law’s coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the Act or the rights or obligations of the guaranty association. Generally, persons will be covered if they live in this state, and hold a life or health insurance contract or annuity, or a certificate under a group policy or contract. However, not all individuals with a right to recover under life or health insurance policies or annuities are protected by the Act. A person is not protected when: 1. The person is eligible for protection under the laws of another state; 2. The person purchased the insurance from a company that was not authorized to do business in this state; 3. The policy is issued by an organization which is not a member insurer of the association; or 4. The person does not live in this state, except under limited circumstances. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 22 of 131 PageID #: 91 Missouri Additionally, the Association may not provide coverage for the entire amount a person expects to receive from the policy. The Association does not provide coverage for any portion of the policy where the person has assumed the risk, for any policy of reinsurance (unless an assumption certificate was issued), for interest rates that exceed a specified average rate, for employers' plans that are self-funded, for parts of plans that provide dividends or credits in connection with the administration of policy, or for unallocated annuity contracts (which are generally issued to pension plan trustees). The Act also limits the amount the Association is obligated to pay persons on various policies. The Association does not pay more than the amount of the contractual obligation of the insurance company. The Association does not have to pay more than three hundred thousand dollars ($ 300,000) in death benefits for any one life regardless of the number of policies that insure that life. The Association does not have to pay amounts over one hundred thousand dollars ($ 100,000) in cash surrender or withdrawal benefits on one life regardless of the number of policies insuring that individual. For health insurance benefits, the Association is not obligated to pay over one hundred thousand dollars ($ 100,000) including net cash surrender and withdrawal benefits. On an annuity contract, the Association is not liable for over one hundred thousand dollars ($ 100,000) in present value. Finally, the Association is never obligated to pay more than a total of three hundred thousand dollars ($ 300,000) for any one insured for any combination of insurance benefits. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 23 of 131 PageID #: 92 Mississippi Aetna Life Insurance Company A SUMMARY OF MISSISSIPPI LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS Residents of this state who purchase life insurance, health insurance, or annuities should know that the insurance companies licensed in this state to write these types of insurance are members of the Mississippi Life and Health Insurance Guaranty Association (the “Guaranty Association”). The purpose of the Guaranty Association is to assure that policy and contract owners will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of policy owners who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by the member insurers through the Guaranty Association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting insurance companies that are well-managed and financially stable. DISCLAIMER The Mississippi Life and Health Insurance Guaranty Association (the “Guaranty Association”) may not provide coverage for this policy. If coverage is provided, it will be subject to substantial limitations and exclusions, and require continued residency in this state. You should not rely on coverage by the Guaranty Association when selecting an insurer. Coverage is NOT provided for your policy or contract or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as non-guaranteed amounts held in a separate account under a variable life or variable annuity contract. Insurance companies or their agents are required by law to provide you with this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Guaranty Association for the purpose of sales, solicitation, or inducement to purchase any form of insurance. You may contact either the Guaranty Association or the Mississippi Insurance Department at the following addresses if you should have any questions regarding this notice. The Mississippi Life and Health Insurance Guaranty Association 300 North Mart Plaza, Suite 2 Jackson, Mississippi 39206 Mississippi Insurance Department 1804 Walter Sillers Building Jackson, Mississippi 39205 The state law that provides for this safety-net coverage is called the Mississippi Life and Health Insurance Guaranty Association Act (the “Act”). Below is a brief summary of the Act’s coverages, exclusions and limits. This summary does not cover all provisions of the Act; nor does it in any way change anyone's rights or obligations under the Act or the rights or obligations of the Guaranty Association. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 24 of 131 PageID #: 93 Mississippi COVERAGE Generally, individuals will be protected by the Guaranty Association if they live in this state and hold a life, or health insurance contract or policy, or an annuity contract or policy, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of policy or contract owners are protected as well, even if they live in another state. EXCLUSIONS FROM COVERAGE However, persons owning such policies are NOT protected by the Guaranty Association if: they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); the insurer was not authorized to do business in this state; their policy or contract was issued by a hospital or medical service organization whether profit or nonprofit, a health maintenance organization (HMO), a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or other person that operates on an assessment basis, an insurance exchange, or any similar entity. The Guaranty Association also does NOT provide coverage for: Any policy or contract or portion thereof which is not guaranteed by the insurer or for which the owner has assumed the risk, such as non-guaranteed amounts held in a separate account under a variable life or variable annuity contract; Any policy or contract of reinsurance, unless an assumption certificates were issued pursuant to the reinsurance policy or contract; Interest rate yields that exceed an average rate; Dividends and voting rights and experience rating credits or payment of any fees or allowances to any person in connection with this service to or administration of the policy or contract; Credits given in connection with the administration of a policy by a group contract holder; Employers' plans to the extent they are self-funded or uninsured (that is, not insured by an insurance company, even if an insurance company administers them); Unallocated annuity contracts issued to or in connection with benefit plans protected under federal Pension Benefit Guaranty Corporation (“PBGC”) regardless of whether the PBGC has yet become liable to make any payments with respect to the benefit plan; Portions of any unallocated annuity contract not issued to or in connection with a specific employee, union or association of natural persons benefit plan, or a government lottery; Portions of a policy or contract to the extent assessments required by law for the Guaranty Association with respect to the policy or contract are preempted by State or Federal law; Obligations that do not arise under the express written terms of the policy or contract, including claims based on marketing materials, side letters, riders or other documents that were issued by the insurer without meeting applicable policy form filing or approval requirements, or claims for policy misrepresentations, or extra-contractual or penalty or consequential or incidental damages claims; Contractual agreements establishing the member insurer’s obligations to provide book value accounting guarantees for defined contribution benefit plan participants (by reference to a portfolio of assets owned by a nonaffiliate benefit plan or its trustees). Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 25 of 131 PageID #: 94 Mississippi LIMITS ON AMOUNT OF COVERAGE The Act also limits the amount the Guaranty Association is obligated to cover. The Guaranty Association cannot pay more than what the insurance company would owe under a policy or contract. Also, with respect to any one life, regardless of the number of policies or contracts, the maximum obligation of the Guaranty Association is $ 300,000 in benefits except with respect to benefits for basic hospital, medical and surgical insurance and major medical insurance in which case the aggregate liability of the Guaranty Association is $ 500,000. Within these overall limits, the Guaranty Association will not pay more than $ 300,000 in life insurance death benefits, $ 100,000 in net cash surrender and net cash withdrawal values, $ 300,000 for disability insurance benefits, $ 500,000 for basic hospital, medical and surgical insurance or major medical insurance benefits, $ 100,000 in present value of annuity benefits, including net cash surrender and net cash withdrawal values – again, no matter how many policies and contracts there were with the same company, and no matter how many different types of coverages. There is a $ 5,000,000 limit with respect to any contract owner for unallocated annuity benefits, irrespective of the number of contracts with respect to the contract owner or plan sponsor. These are limitations for which the Guaranty Association is obligated before taking into account either its subrogation and assignment rights or to the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 26 of 131 PageID #: 95 New Hampshire Aetna Life Insurance Company A MONTANA NOTICE The Montana Life and Health Insurance Guaranty Association may or may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and also require continued residency in Montana. You should not rely on coverage by the Montana Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. COVERAGE IS NOT PROVIDED BY THE MONTANA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION FOR YOUR POLICY OR CONTRACT OR ANY PORTION OF IT UNDER WHICH THE RISK IS BORNE BY YOU, THE POLICYHOLDER. Insurance companies or their producers are required by law to give or send you this notice. However, insurance companies and their producers are prohibited by law from using the existence of the Association to induce you to purchase any kind of insurance policy. This information is provided by: Montana Life and Health Insurance Guaranty Association P.O. Box 541 Helena, Montana 59624 1-877-678-1048 State of Montana Department of Insurance 840 Helena Avenue Helena, Montana 59601 (406) 444-2040 1-800-332-6148 Aetna Life Insurance Company A SUMMARY OF THE 1996 NEW HAMPSHIRE LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT (RSA 408-B) AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS Residents of New Hampshire who purchase life insurance, health insurance, and annuities should know that the insurance companies licensed in New Hampshire to write these types of insurance are members of the New Hampshire Life and Health Insurance Guaranty Association. The purpose of this Association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Association will assess its other member insurance companies for the money to pay the claims of policyholders who live in New Hampshire and, in some cases, to keep coverage in force. This protection is not a substitute for consumers' care in selecting companies that are well managed and financially stable. The valuable extra protection provided by these insurers through the Guaranty Association is not unlimited, however, as noted below. IMPORTANT DISCLAIMER Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 27 of 131 PageID #: 96 New Hampshire The New Hampshire Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in New Hampshire. Other conditions may preclude coverage. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to provide you with this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Association to induce you to purchase any kind of insurance policy. This information is provided by: New Hampshire Life and Health Insurance Guaranty Association 47 Hall Street, Suite 2 Concord, NH 03301 (603) 226-9114 New Hampshire Department of Insurance 56 Old Suncook Road Concord, NH 03301 (603) 271-2261 SUMMARY: The 1996 state law that provides for this safety-net coverage is called the New Hampshire Life and Health Insurance Guaranty Association Act. Below is a brief summary of this law’s coverage, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the Act or the rights or obligations of the Association. COVERAGE: Generally, individuals will be protected by the New Hampshire Life and Health Insurance Guaranty Association if they live in this state and hold a life or health insurance policy or an annuity contract, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, assignees or payees of insured persons are protected as well, even if they live in another state. Coverage provided under this Act may be different from coverage provided prior to 1996, as coverage is determined by the governing Act in effect on the date that the Association becomes obligated. EXCLUSIONS FROM COVERAGE: Persons holding such policies or contracts are NOT protected by this Association if: • they are not residents of the state of New Hampshire, except under certain very specific circumstances; • they are eligible for protection under the laws of another state; • their policy was issued by a nonprofit hospital or medical service organization, an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or an entity that operates on an assessment basis, an insurance exchange, or any entity similar to any of the above. The Association also does NOT provide coverage for: • any policy or portion of a policy or contract not guaranteed by the insurer or under which the risk is borne by the policy holder or contract holder; • any policy or contract of reinsurance, unless assumption certificates have been issued; • interest rate guarantees that exceed certain statutory limitations; • any plan or program of an employer, association, or similar entity to provide life, health, or annuity benefits to its employees or members to the extent that the plan or program is self-funded or uninsured, including, but not limited to, benefits payable by an employer, association, or similar entity; • dividends, experience rating credits, or fees for services in connection with this policy; • any policy or contract issued in this state by an insurer at a time when it was not licensed or authorized to do business in New Hampshire; Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 28 of 131 PageID #: 97 New Hampshire • any unallocated annuity contract issued to an employee benefit plan protected under the federal Pension Benefit Guaranty Corporation; • any portion of any unallocated annuity contract which is not issued to or in connection with a specific employee, union, or association of natural persons benefit plan or a government lottery; • any portion of a policy or contract to the extent that the required assessments are preempted by federal or state law. LIMITS ON AMOUNT OF COVERAGE: The Act also limits the amount the Association is obligated to pay: The Association cannot pay more than what the insurance company would owe under a policy or contract. With respect to any one life, the Association will pay a maximum of $ 300,000--no matter how many policies and contracts there were with the same company, even if they provided different types of coverages. Within this overall $ 300,000 limit, the Association will not pay more than $ 100,000 in cash surrender values, $ 100,000 in health insurance benefits, $ 100,000 in present value of annuities, or $ 300,000 in life insurance death benefits. With respect to any one contract holder of an unallocated annuity contract, not including a governmental retirement plan established under Section 401, 403(b) or 457 of the U.S. Internal Revenue code, the Association will pay a maximum of $ 5,000,000 in benefits, irrespective of the number of such contracts held by that contract holder. ADDITIONAL INFORMATION: Policyholders should contact the New Hampshire Insurance Department with questions they may have with regard to concerns about their rights under the Act and procedures for filing a complaint to allege a violation of the Act. Policyholders may contact the New Hampshire Insurance Department for sources of information about the financial condition of insurers. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 29 of 131 PageID #: 98 New Jersey Aetna Life Insurance Company A NEW JERSEY LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT Residents of New Jersey who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the New Jersey Life and Health Insurance Guaranty Association. The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the Guaranty Association is not unlimited, however. And, as noted below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. DISCLAIMER The New Jersey Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in New Jersey. You should not rely on coverage by the New Jersey Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the guaranty association to induce you to purchase any kind of insurance policy. The New Jersey Life and Health Insurance Guaranty Association One Gateway Center 9 th Floor Newark, NJ 07102 State of New Jersey Department of Insurance 20 West State Street CN-325 Trenton, NJ 08625 The state law that provides for this safety-net coverage is called the New Jersey Life and Health Insurance Guaranty Association Act, N.J.S.A. 17B:32A-1, et seq, (the "Act"). COVERAGE The following is a brief summary of this law’s coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the act or the rights or obligations of the guaranty association. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 30 of 131 PageID #: 99 New Jersey Generally, individuals will be protected by the Life and Health Insurance Guaranty Association if they live in New Jersey and hold a life, health insurance or long-term care insurance contract, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state. EXCLUSIONS FROM COVERAGE However, persons owning such policies are not protected by this association if: • they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); • the insurer was not authorized to do business in this state; • the policy was issued by an organization which is not a member of the New Jersey Life and Health Insurance Guaranty Association. The Association also does not provide coverage for: • any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; • any policy of reinsurance (unless an assumption certificate was issued); • interest rate yields that exceed an average rate as more fully described in Section 3 of the Act; • dividends; • credits given in connection with the administration of a policy by a group contract holder; • employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them). LIMITATIONS OF COVERAGE The act also limits the amount the Association is obligated to pay out. The Association cannot pay more than what the insurance company would owe under a policy or contract. With respect to any one insured individual, regardless of the number of policies or contracts, the Association will pay not more than $ 500,000 in life insurance death benefits and present value annuity benefits, including net cash surrender and net cash withdrawal values. Within this overall limit, the Association will not pay more than $ 100,000 in cash surrender values for annuity benefits, $ 500,000 in life insurance death benefits or $ 500,000 in present value of annuities--again no matter how many policies and contracts there were with the same company, and no matter how many different types of coverages. The Association will not pay more than $ 2,000,000 in benefits to any one contractholder under any one unallocated annuity contract. There are no limits on the benefits the Association will pay with respect to any one group, blanket or individual accident and health insurance policy. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 31 of 131 PageID #: 100 Nevada Aetna Life Insurance Company A NEVADA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT SUMMARY DOCUMENT Residents of Nevada who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Nevada Life and Health Insurance Guaranty Association (Guaranty Association). The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association assesses its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the Guaranty Association is not unlimited, however, and, as noted below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. The Nevada Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations and exclusions, and require continued residency in Nevada. A person should not rely on coverage by the Nevada Life and Health Insurance Guaranty Association when selecting an insurance company or when selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the Insurer or for which the policyholder has assumed the risk, such as a variable contract sold by prospectus. Insurance companies are required by law to deliver this notice to you. However, insurance companies and their agents are prohibited by law from using the existence of the guaranty association for sales, solicitation or to induce the purchase of any kind of insurance policy. The state law that provides for this safety-net coverage is called the Nevada Life and Health Insurance Guaranty Association Act. Below is a brief summary of this law’s coverage, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the act or the rights or obligations of the Guaranty Association. Anyone may obtain additional information or file a complaint with the Commissioner of Insurance, at the address listed below, to allege a violation of any provision of the Nevada Life and Health Insurance Guaranty Association Act. The Nevada Life and Health Insurance Guaranty Association P.O. Box 3302 Reno, Nevada 89505 Commissioner of Insurance, State of Nevada Department of Business and Industry, Division of Insurance 788 Fairview Drive, Suite 300 Carson City, Nevada 89701-5491 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 32 of 131 PageID #: 101 Nevada COVERAGE Generally, individuals will be protected by the Nevada Life and Health Insurance Guaranty Association if they live in this state and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well even if they live in another state. EXCLUSIONS FROM COVERAGE However, persons holding such policies are not protected by this Association if: • they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside the state); • the insurer was not authorized to do business in this state; • their policy was issued by a nonprofit hospital or medical service organization (the "Blues"), a health maintenance organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, or by an insurance exchange. The Association also does not provide coverage for: • any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; • interest rate yields that exceed an average rate; • dividends; • credits given in connection with the administration of a policy by a group contract holder; • employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); • unallocated annuity contracts (which give rights to group contractholders, not individuals). LIMITS ON AMOUNT OF COVERAGE The act also limits the amount the Association is obligated to pay. The Association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one insured life, the Association will pay a maximum of $ 300,000, regardless of how many policies and contracts there were with the same company, and even if they provided different types of coverage. Within this overall $ 300,000 limit, the Association will not pay more than $ 100,000 in cash surrender values, $ 100,000 in present value of annuities, or $ 300,000 in life insurance death benefits. Again, no matter how many policies and contracts there were with the same company, and no matter how many different types of coverage. With respect to health insurance for any one natural person, the Association will not pay more than: 1) $ 100,000 for coverage other than disability insurance, basic hospital, medical and surgical insurance or major medical insurance, including any net cash surrender or withdrawal; 2) $ 300,000 for disability insurance; or 3) $ 500,000 for basic hospital, medical and surgical insurance or major medical insurance. With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries of the payee if deceased, the Association will not pay more than $ 100,000 in present value of benefits from the annuity in the aggregate, including any net cash for surrender or withdrawal. With respect to any one life or person, in no event will the Association be obligated to cover more than: 1) an aggregate of $ 300,000 in benefits, excluding benefits for basic hospital, medical and surgical insurance or major medical insurance; or 2) an aggregate of $ 500,000 in benefits, including benefits for basic hospital, medical and surgical insurance or major medical insurance. With respect to one owner of several nongroup policies of life insurance, whether the owner is a natural person or an organization and whether the persons insured are officers, managers, employees or other persons, the Association will not pay more than $ 5,000,000 in benefits, regardless of the number of policies and contracts held by the owner. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 33 of 131 PageID #: 102 Ohio Aetna Life Insurance Company A OHIO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION DISCLAIMER AND NOT COVERED FORM The Ohio Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in Ohio. You should not rely on coverage by the Ohio Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. You should check with your insurance company representative to determine if you are only covered in part or not covered at all. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the guaranty association to induce you to purchase any kind of insurance policy. Ohio Life and Health Insurance Guaranty Association 1840 Mackenzie Drive Columbus, Ohio 43220 Ohio Department of Insurance 2100 Stella Court Columbus, Ohio 43266-0566 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 34 of 131 PageID #: 103 Oklahoma Aetna Life Insurance Company A NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE OKLAHOMA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT Residents of Oklahoma who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Oklahoma Life and Health Insurance Guaranty Association. The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the Guaranty Association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. The Oklahoma Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in Oklahoma. You should not rely on coverage by the Oklahoma Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the guaranty association to induce you to purchase any kind of insurance policy. The Oklahoma Life and Health Insurance Guaranty Association 201 Robert S. Kerr, Suite 600 Oklahoma City, Oklahoma 73102 Oklahoma Department of Insurance P.O. Box 53408 Oklahoma City, Oklahoma 73152-3408 The state law that provides for this safety-net coverage is called the Oklahoma Life and Health Insurance Guaranty Association Act. Below is a brief summary of this law’s coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the act or the rights or obligations of the guaranty association. COVERAGE Generally, individuals will be protected by the Life and Health Insurance Guaranty Association if they live in this state and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 35 of 131 PageID #: 104 Oklahoma EXCLUSIONS FROM COVERAGE However, persons owning such policies are not protected by this Association if: • they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); • the insurer was not authorized to do business in this state; • their policy was issued by an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, or by an insurance exchange. The Association also does not provide coverage for: • any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; • any policy of reinsurance (unless an assumption certificate was issued); • interest rate yields that exceed an average rate; • dividends; • credits given in connection with the administration of a policy by a group contract holder; • employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); • unallocated annuity contracts (which give rights to group contractholders, not individuals). LIMITS ON AMOUNT OF COVERAGE The act also limits the amount the Association is obligated to pay out: The Association cannot pay more than what the insurance company would owe under a policy or contract. Also, for one insured life, the Association will pay a maximum of $ 300,000--no matter how many policies and contracts there were with the same company, even if they provided different types of coverages. Within this overall $ 300,000 limit, the Association will not pay more than $ 100,000 in cash surrender values, $ 300,000 in health insurance benefits, $ 300,000 in present value of annuities, or $ 300,000 in life insurance death benefits - again, no matter how many policies and contracts there were with the same company, and no matter how many different types of coverages. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 36 of 131 PageID #: 105 Rhode Island Aetna Life Insurance Company A SUMMARY COVERAGE, LIMITATIONS AND EXCLUSIONS UNDER RHODE ISLAND LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT (“Act”) A resident of Rhode Island who purchases life insurance, annuities, or accident and health insurance should know that an insurance company licensed in Rhode Island to write these types of insurance is a member of the Rhode Island Life and Health Insurance Guaranty Association (“Association”). The purpose of the Association is to assure that a policyholder will be protected within the statutory limits, if a member insurer becomes financially unable to meet its obligations. If this should happen, the Association will, within the statutory limits, pay the claims of insured persons who live in this state, and, in some cases, keep coverage in force. However, the protection provided through the Association is not unlimited. This protection is not a substitute for your care in selecting a company that is well managed and financially stable. IMPORTANT DISCLAIMER RHODE ISLAND LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION 235 PROMENADE STREET, PROVIDENCE, RI 02908 TEL (401) 273-2921 The Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in Rhode Island. You should not rely on coverage by the Association in selecting an insurance company or an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus or self funded plans. Insurance companies or their agents are required by law to give or send you this summary. However, they are prohibited by law from using the existence of the Association to induce you to purchase any kind of insurance policy. Should you seek information as to the financial condition of any insurer or should you have any complaint as to an insurer’s violation of the Act, you may contact the Division of Insurance at the address listed below. RHODE ISLAND DIVISION OF INSURANCE 222 Richmond Street, Providence, RI 02903 TEL (401) 222-2223 The full text of the state law that provides for this safety net coverage, Rhode Island Life and Health Insurance Guaranty Association Act, (“the Act”), can be found beginning at R.I. Gen. Laws §27-34.3-1. A brief summary of the Act is provided below. This summary does not cover all provisions of the law, nor does it in any way change your rights or obligations or those of the Association under the Act. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 37 of 131 PageID #: 106 Rhode Island COVERAGE: Generally, individuals will be protected by the Association if the individual lives in Rhode Island and: Holds a life or health insurance contract or annuity contract; or is insured under a group insurance contract issued by a member insurer. The beneficiaries, payees, or assignees of insured persons are protected as well, even if they live elsewhere. EXCLUSIONS FROM COVERAGE: The Association does NOT protect a person holding a policy if: • the individual is eligible for protection under a similar law of another state; • the insurer was not authorized to do business in this state; • the policy is issued by an organization that is not a member of the Association; • the policy was issued by a nonprofit hospital or medical service organization (such as, the “Blues”), an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments or by an insurance exchange. The Association does not provide coverage for: • a policy or portion of a policy not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; a policy of reinsurance (unless an assumption certificate was issued); • interest rate yields that exceed a rate specified by statute; • dividends; • credits given in connection with the administration of a policy by a group contract holder; • an employer’s plan to the extent that it is self-funded (that is, not insured by an insurance company, even if an insurance company administrators the plan); • an unallocated annuity contract issued to an employee benefit plan protected under the United States Pension Benefit Guaranty Corporation; • that part of an unallocated annuity contract not issued to a specific employee, union, association of natural persons benefit plan, or a government lottery; • certain contracts which establish benefits by reference to a portfolio of assets not owned by the insurer; • any portion of a policy or contract to the extent that the required assessments are preempted by federal or state law; • an obligation that does not arise under the express written terms of the policy or contract issued by the insurer. LIMITATIONS ON COVERAGE: The Act limits the amount the Association is obligated to pay. The Association cannot pay more than what the insurer would have owed under a policy or contract. Also, for any one insured life, no matter how many policies or contracts were in force with the same insurer, the Association will pay no more than: • $ 300,000 in net life insurance death benefits and no more than $100,000 in net cash surrender and net cash withdrawal values for life insurance; • $ 100,000 for health insurance benefits, coverages not defined as disability, basic hospital, medical, and surgical, or major medical insurance, including any net cash surrender and net cash withdrawal values; • $ 300,000 for disability insurance; • $ 500,000 for basic hospital, medical, and surgical or major medical insurance; • $ 100,000 in the present value of annuity benefits, including net cash surrender and net cash withdrawal value; • $ 100,000 in present value per payee with respect to a structured settlement annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values; • $ 100,000, in the aggregate, of the present value of annuity benefits, including net cash surrender and net cash withdrawal values, with respect to an individual participating in a governmental retirement plan established under 26 U.S.C. §§401, 403(b), or 457 and covered by an unallocated annuity contract, or to a beneficiary of the individual if the individual is deceased; • $ 5,000,000 in unallocated annuity contract benefits, irrespective of the number of contracts with respect to the contract owner or plan sponsor whose plan owns, directly or in trust, one or more unallocated annuity contracts. Note to benefit plan trustees or other holders of unallocated annuities (GICs, DACs, etc.) covered by the Act: for unallocated annuities that fund governmental retirement plans under sections 401(k), 403(b), or 457 of the Internal Revenue Code, the limit is $ 100,000 in present value of annuity benefits including net cash surrender and net cash withdrawal per participating individual. In no event shall the Association be liable to spend more than $ 300,000 in the aggregate per individual except hospital insurance up to $ 500,000 per individual. For covered unallocated annuities that fund other plans, a special limit of $ 5,000,000 applies to each contract holder, regardless of the number of contracts held with the same company or number of persons covered. In all cases, the contract limits also apply. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 38 of 131 PageID #: 107 Rhode Island These general statements as to Limitations on Coverage are only summaries of the law. The actual limitations are set forth in R.I. Gen. Laws §27-34.3-3. This information is provided by: The Association and by the Division of Insurance, whose respective addresses are provided in the Important Disclaimer, above. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 39 of 131 PageID #: 108 Tennessee Aetna Life Insurance Company A NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE TENNESSEE LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT Residents of Tennessee who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Tennessee Life and Health Insurance Guaranty Association. The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the guaranty association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the guaranty association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. The state law that provides for this safety-net coverage is called the Tennessee Life and Health Insurance Guaranty Association Act. The following is a brief summary of this law’s coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the act or the rights or obligations of the guaranty association. COVERAGE Generally, individuals will be protected by the life and health guaranty association if they live in this state and hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by an insurer authorized to conduct business in Tennessee. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state. EXCLUSIONS FROM COVERAGE However, persons holding such policies are not protected by this association if: (1) they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); (2) the insurer was not authorized to do business in this state; (3) their policy was issued by an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, or by an insurance exchange. The association also does not provide coverage for: (1) any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; (2) any policy of reinsurance (unless an assumption certificate was issued); (3) interest rate yields that exceed an average rate; (4) dividends; (5) credits given in connection with the administration of a policy by a group contractholder; (6) employers' plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 40 of 131 PageID #: 109 Tennessee (7) unallocated annuity contracts (which give rights to group contractholders, not individuals), unless qualified under Section 403(b) of the Internal Revenue Code, except that, even if qualified under Section 403(b), unallocated annuities issued to employee benefit plans protected by the federal Pension Benefit Guaranty Corporation are not covered. LIMITS ON AMOUNT OF COVERAGE The act also limits the amount the association is obligated to pay out: The association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one insured life, the association will pay a maximum of $ 300,000 no matter how many policies and contracts there were with the same company, even if they provided different types of coverage. Within this overall $ 300,000 limit, the association will not pay more than $ 100,000 in cash surrender values, $ 100,000 in health insurance benefits, $ 100,000 in present value of annuities, or $ 300,000 in life insurance death benefits -- again, regardless of the number of policies and contracts there were with the same company, and no matter how many different types of coverages. The Tennessee Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in Tennessee. You should not rely on coverage by the Tennessee Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the guaranty association to induce you to purchase any kind of insurance policy. TENNESSEE LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION 1200 FIRST UNION TOWER 150 4 TH AVENUE NORTH NASHVILLE, TENNESSEE 37219-2433 TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE 500 JAMES ROBERTSON PARKWAY NASHVILLE, TENNESSEE 37243 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 41 of 131 PageID #: 110 Texas Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 42 of 131 PageID #: 111 Texas Aetna Life Insurance Company A TEXAS LIFE, ACCIDENT, HEALTH & HOSPITAL SERVICE INSURANCE GUARANTY ASSOCIATION IMPORTANT INFORMATION ABOUT COVERAGE UNDER THE TEXAS LIFE, ACCIDENT, HEALTH AND HOSPITAL SERVICE INSURANCE GUARANTY ASSOCIATION (For insurers declared insolvent or impaired on or after September 1, 2005) Texas law establishes a system, administered by the Texas Life, Accident, Health and Hospital Service Insurance Guaranty Association (the "Association"), to protect Texas policyholders if their life or health insurance company fails. Only the policyholders of insurance companies which are members of the Association are eligible for this protection which is subject to the terms, limitations, and conditions of the Association law. (The law is found in the Texas Insurance Code, Article 21.28-D.) It is possible that the Association may not cover your policy in full or in part due to statutory limitations. Eligibility for Protection by the Association When a member insurance company is found to be insolvent and placed under an order of liquidation by a court or designated as impaired by the Texas Commissioner of Insurance, the Association provides coverage to policyholders who are: • Residents of Texas at the time (irrespective of the policyholder's residency at policy issue) • Residents of other states, ONLY if the following conditions are met: 1. The policyholder has a policy with a company domiciled in Texas; 2. The policyholder's state of residence has a similar guaranty association; and 3. The policyholder is not eligible for coverage by the guaranty association of the policyholder's state of residence. Limits of Protection by Association Accident, Accident and Health, or Health Insurance: • For each individual covered under one or more policies; up to a total of $500,000 for basic hospital, medical-surgical, and major medical insurance, $300,000 for disability or long term care insurance, and $200,000 for other types of health insurance. Life Insurance: • Net cash surrender value or net cash withdrawal value up to a total of $100,000 under one or more policies on any one life; or • Death benefits up to a total of $300,000 under one or more policies on any one life; or • Total benefits up to a total of $5,000,000 to any owner of multiple non-group life policies. Individual Annuities: • Present value of benefits up to a total of $100,000 under one or more contracts on any one life. Group Annuities: • Present value of allocated benefits up to a total of $100,000 on any one life; or • Present value of unallocated benefits up to a total of $5,000,000 for one contractholder regardless of the number of contracts. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 43 of 131 PageID #: 112 Texas Aggregate Limit: • $300,000 on any one life with the exception of the $500,000 health insurance limit, the $5,000,000 multiple owner life insurance limit, and the $5,000,000 unallocated group annuity limit. Insurance companies and agents are prohibited by law from using the existence of the Association for the purpose of sales, solicitation, or inducement to purchase any form of insurance. When you are selecting an insurance company, you should not rely on Association coverage. Texas Life, Accident, Health Texas Department of and Hospital Service Insurance Insurance Guaranty P.O. Box 149104 Association Austin, Texas 78714-9104 6504 Bridge Point Parkway 800-252-3439 Suite 450 www.tdi.state.tx.us Austin, Texas 78730 800-982-6362 or www.txlifega.org Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 44 of 131 PageID #: 113 Utah Aetna Life Insurance Company A UTAH LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION NOTICE TO POLICYHOLDERS Insurance companies licensed to sell life insurance, health insurance, or annuities in the State of Utah are required by law to be members of an organization called the Utah Life and Health Insurance Guaranty Association ("ULHIGA"). If an insurance company that is licensed to sell insurance in Utah becomes insolvent (bankrupt), and is unable to pay claims to its policyholders, the law requires ULHIGA to pay some of the insurance company's claims. The purpose of this notice is to briefly describe some of the benefits and limitations provided to Utah insureds by ULHIGA. PEOPLE ENTITLED TO COVERAGE • You must be a Utah resident. • You must have insurance coverage under an individual or group policy. POLICIES COVERED ULHIGA provides coverage for certain life, health and annuity insurance policies. EXCLUSIONS AND LIMTATIONS Several kinds of insurance policies are specifically excluded from coverage. There are also a number of limitations to coverage. The following are not covered by ULHIGA: • Coverage through an HMO. • Coverage by insurance companies not licensed in Utah. • Self-funded and self-insured coverage provided by an employer that is only administered by an insurance company. • Policies protected by another state's guaranty association. • Policies where the policyholder bears the risk under the policy. • Re-insurance contracts. • Annuity policies that are not issued to and owned by an individual, unless the annuity policy is issued to a pension benefit plan that is covered. • Policies issued to pension benefit plans protected by the Federal Pension Benefit Guaranty Corporation. • Policies issued to entities that are not members of ULHIGA, including health plans, fraternal benefit societies, state pooling plans and mutual assessment companies. LIMITS ON AMOUNT OF COVERAGE Caps are placed on the amount ULHIGA will pay. These caps apply even if you are insured by more than one policy issued by the insolvent company. The maximum ULHIGA will pay is the amount of your coverage or $500,000 -- whichever is lower. Other caps also apply: • $ 200,000 in net cash surrender values. • $ 500,000 in life insurance death benefits (including cash surrender values). • $ 500,000 in health insurance benefits. • $ 200,000 in annuity benefits -- if the annuity is issued to and owned by an individual or the annuity is issued to a pension plan covering government employees. • $ 5,000,000 in annuity benefits to the contract holder of annuities issued to pension plans covered by the law. (Other limitations apply). Interest rates on some policies may be adjusted downward. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 45 of 131 PageID #: 114 Utah DISCLAIMER PLEASE READ CAREFULLY: COVERAGE FROM ULHIGA MAY BE UNAVAILABLE UNDER THS POLICY, OR, IF AVAILABLE, IT MAY BE SUBJECT TO SUBSTANTIAL LIMITATIONS OR EXCLUSIONS. THE DESCRIPTION OF COVERAGES CONTAINED IN THIS DOCUMENT IS AN OVERVIEW. IT IS NOT A COMPLETE DESCRIPTION. YOU CANNOT RELY ON THIS DOCUMENT AS A DESCRIPTION OF COVERAGE. FOR A COMPLETE DESCRIPTION OF COVERAGE, CONSULT THE UTAH CODE, TITLE 31A, CHAPTER 28. COVERAGE IS CONDITIONED ON CONTINUED RESIDENCY IN THE STATE OF UTAH. THE PROTECTION THAT MAY BE PROVIDED BY ULHIGA IS NOT A SUBSTITUTE FOR CONSUMERS' CARE IN SELECTING AN INSURANCE COMPANY THAT IS WELL-MANAGED AND FINANCIALLY STABLE. INSURANCE COMPANIES AND INSURANCE AGENTS ARE REQUIRED BY LAW TO GIVE YOU THIS NOTICE. THE LAW DOES, HOWEVER, PROHIBIT THEM FROM USING THE EXISTENCE OF ULHIGA AS AN INDUCEMENT TO SELL YOU INSURANCE. THE ADDRESS OF ULHIGA, AND THE INSURANCE DEPARTMENT ARE PROVIDED BELOW. Utah Life and Health Insurance Guaranty Association 955 E. Pioneer Road Draper, Utah 84020 Utah Insurance Department State Office Building Room 3110 Salt Lake City, Utah 84114 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 46 of 131 PageID #: 115 Washington Aetna Life Insurance Company A THE WASHINGTON LIFE AND DISABILITY INSURANCE GUARANTY ASSOCIATION PREFACE This notice briefly describes the coverage provided through the Washington Life & Disability Insurance Guaranty Association ("Association"). This Association is a nonprofit unincorporated legal entity created by the Washington Life and Disability Insurance Guaranty Association Act, Chapter 48.32A RCW ("Act"), under the laws of 1971 and 2001. Every life and disability insurance company authorized to do business in Washington is a member of the Association. A Board of Directors ("Board"), composed of representatives from member insurers, and the Insurance Commissioner, ex officio, oversee the operation of the Association. The expenses of the Association are paid by assessments against each member insurer. Persons covered by the Act are not charged for the expenses of the Association or the protection provided under the Act. Coverage is provided for certain life and disability insurance. However, the Association does not cover all such insurance. Coverage that is provided is subject to the limitations and exclusions provided by the Act. The purpose of this notice is to help you understand the general nature and the conditions of the protection provided under the Act. It is only a summary, however, and if you have specific questions that are not discussed here you may contact either the Association or the Office of the Insurance Commissioner. Washington Life and Disability Insurance Guaranty Association P.O. Box 50303 Bellevue, WA 98015 425-562-3128 Company Supervision Division Office of the Insurance Commissioner P.O. Box 40259 Olympia, WA 98504-0259 360-407-0535 WHAT INSURANCE POLICIES ARE COVERED UNDER THE ACT? The Act applies to life insurance policies, disability insurance policies, and annuity contracts issued by an insurance company authorized to do business in Washington. The term "disability insurance", as used in the Act, includes not only disability income insurance, but also policies commonly referred to as "health insurance". Together, all of these policies and contracts are sometimes referred to as "covered policies", a term used in this notice. ARE THERE POLICIES OR INSURERS NOT COVERED BY THE ACT? The Act specifically excludes certain types of policies or portions of policies, including, but not limited to: The portion of a policy not guaranteed by the insurer; the portion of a policy to the extent the interest rate or crediting rate exceeds the limits in the Act; policies of reinsurance, unless assumption certificates have been issued; policies issued in Washington by an insurer at a time when the insurer was not licensed or did not have a certificate of authority; policies issued to a self-insured plan or program; certain unallocated employee benefit plan annuities protected by federal law; and unallocated annuity contracts not issued to or in connection with a benefit plan or a government lottery. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 47 of 131 PageID #: 116 Washington The Act also does not apply to policies or contracts issued by health care service contractors, health maintenance organizations, fraternal benefit societies, mandatory state pooling plans, mutual assessment companies, insurance exchanges, or an organization that has a certificate or license limited to issuance of certain charitable gift annuities. WHO IS PROTECTED UNDER THE ACT? You are covered by the Act if you are an owner of or certificate holder under a policy or contract (other than an unallocated annuity contract or structured settlement annuity), and: • You are a Washington resident; or • You are not a Washington resident, but only if: the insurer is domiciled in Washington; there is an association similar to the Washington Association in your state of residency; and you are not covered in your state of residency, because the insurer was not licensed in that state; or • You are a beneficiary, assignee, or payee of one of the above, regardless of where you reside (except for nonresident certificate holders under group policies). Owners of unallocated annuity contracts are covered if the contract was issued to or in connection with a specific benefit plan whose plan sponsor has its principal place of business in Washington, or the contract was issued to or in connection with a government lottery and the owner is a Washington resident. A payee under a structured settlement annuity (or beneficiary of a deceased payee) is also covered, if the payee is a Washington resident, or the payee is not a Washington resident, but the contract owner is a resident; or the insurer that issued the annuity is domiciled in Washington and coverage is not available in the state in which the payee resides. Residency is determined at the time of entry of an order of rehabilitation, conservation or liquidation against the insurer. If you move to another state and reside there when such an order is entered, you may still have protection under the law of that state. You should contact the insurance department in your new state of residence to find out about guaranty act protection there. HOW DOES THE ASSOCIATION PROTECT COVERED PERSONS AGAINST LOSS? After an order of rehabilitation, conservation or liquidation is entered against a company, the Association begins its work of carrying out the purpose of the Act, which is to assure the performance of insurance obligations of that company. The Association is authorized to carry out its duties by working with insurance companies in good standing to assume or take over the covered policies. Often this is the best solution for covered persons because the insurance policy or annuity contract remains in force rather than being terminated. The Association also has the authority to collect the funds necessary to provide protection to covered persons against losses on their covered policies. WHERE DOES THE ASSOCIATION GET THE MONEY TO PROVIDE THIS PROTECTION? The Association is authorized to collect money from all life and disability insurance companies doing business in Washington. The funds collected from an assessment are used to pay claims to covered persons and/or to fund the assumption of covered policies by another insurer. DOES THE ASSOCIATION PAY OUT THE MONEY IT COLLECTS RIGHT AWAY OR DO COVERED PERSONS HAVE TO WAIT? The earliest that the Association can make an assessment for covered policies issued by a company is after an order of rehabilitation, conservation or liquidation has been entered against the company, and a reasonable estimate of the amount of money needed can be made. Insurance companies receiving an assessment notice must make their payments within thirty days. Because it takes time for an action to be commenced against a financially impaired insurer, for a Court to issue an order, and for funds to be collected to satisfy the obligations of that insurer, some delay, hopefully short, is unavoidable before payments can be made. Although it is impossible to predict how long this process will take in any given case, an average time period of twelve to eighteen months is not unusual. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 48 of 131 PageID #: 117 Washington When necessary, the Association may borrow money to make payments more promptly, particularly in cases that will take an unusual amount of time to be resolved. WHAT IS THE AMOUNT OF PROTECTION PROVIDED BY THE ACT? The Act provides the following maximum amounts of protection: Life Insurance Death Benefits ..................................................................................................................................... $ 500,000 Disability Benefits…. .................................................................................................................................................. $ 500,000 Present Value of Individual Annuities ......................................................................................................................... $ 500,000 Unallocated Annuity Contracts, other than certain government retirement plans (limit is per contract owner or plan sponsor) ........................................................................................................................ .$ 5,000,000 Government Retirement Plans established under Internal Revenue Code sections 401, 403(b), or 457 (limit is per participant) ....................................................................................................................... $ 100,000 This protection becomes effective at the time of entry of a Court order of rehabilitation, conservation or liquidation against the insurer. Of course, if the amount owed under the contract or policy is less than the maximum benefit under the Act, the covered person will be entitled to protection only up to the actual amount owed. Furthermore, the maximum protection available to each covered person remains the same, regardless of the number of contracts through which he or she has a claim. IF A HUSBAND AND WIFE EACH OWN A COVERED POLICY, IS THE PROTECTION UNDER THE ACT PROVIDED TO EACH OF THEM? Yes. As long as the residency requirements are met, both would be entitled to the protection provided by the Act, up to the maximum amount. WHY DOESN'T MY INSURANCE COMPANY ADVERTISE THE FACT THAT ITS POLICIES AND CONTRACTS ARE PROTECTED UNDER THE ACT? Under Washington law, insurance companies are prohibited from advertising that their policies or contracts may be covered under the Act. You should not rely on coverage under the Act when selecting an insurance company. WHY HASN'T MY AGENT TOLD ME ABOUT THE GUARANTY ACT? Your insurance agent is subject to the same prohibitions as your insurance company. As a representative of the company, an agent must exercise great care when soliciting business and consequently will generally not discuss the subject of a guaranty act with clients. WHO SHOULD I CONTACT IF I BELIEVE THERE HAS BEEN A VIOLATION OF THE ACT? You should contact the Association if you believe your rights have been violated under the Act. If you are dissatisfied with the actions of the Association, you may also contact the Office of the Insurance Commissioner. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 49 of 131 PageID #: 118 Washington CONCLUSION This notice has been prepared by the Washington Life and Disability Insurance Guaranty Association. Its purpose is to inform the public in a general way of the protections that are available in this state on insurance policies and annuity contracts issued by companies authorized to do business in Washington. The Association does not, by the notice, endorse any company or its products, but rather seeks to address some of the concerns that you may have regarding the security of insurance policies and annuity contracts. For more information or answers to specific questions you may contact the Washington Life and Disability Insurance Guaranty Association or the Washington Department of Insurance, whose address and telephone number are shown in the Preface. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 50 of 131 PageID #: 119 West Virginia Aetna Life Insurance Company A NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS UNDER THE WEST VIRIGNIA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT Residents of West Virginia who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the West Virginia Life and Health Insurance Guaranty Association. The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the Guaranty Association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable. The West Virginia Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in West Virginia. You should not rely on coverage by the West Virginia Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. For a complete description of coverage, consult Article 26A, Chapter 33 of the West Virginia Code. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk. Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Guaranty Association to induce you to purchase any kind of insurance policy. The Guaranty Association or the West Virginia Insurance Commission will respond to questions you may have which are not answered by this document. Policyholders with additional questions may contact: West Virginia Life and Health Insurance Guaranty Association P.O. Box 816 Huntington, West Virginia 25712 West Virginia Insurance Commissioner Consumer Services Division 2019 Washington Street, East P.O. Box 50540 Charleston, West Virginia 25305-0540 (304) 558-3386 Toll Free 1-800-642-9004 TDD 1-800-435-7381 The state law that provides for this safety-net coverage is called the West Virginia Life and Health Insurance Guaranty Association Act. Below is a brief summary of this law's coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the act or the rights or obligations of the Guaranty Association. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 51 of 131 PageID #: 120 West Virginia Generally, individuals will be protected by the West Virginia Life and Health Insurance Guaranty Association if they live in West Virginia and hold a life or health insurance contract, annuity contract, unallocated annuity contract, or if they are insured under a group life, health or annuity insurance contract, issued by a member insurer. Member insurer also includes non-profit service corporations and health care corporations. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in another state. EXCLUSIONS FROM COVERAGE However, persons holding such policies are not protected by this association if: • they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state); • the insurer was not authorized to do business in this state; • the policy was issued at a time when the insurer was not licensed or authorized to do business in the state; • their policy was issued by an HMO, a fraternal benefit society, mandatory state pooling plan, a mutual protective association or similar plan in which the policyholder is subject to future assessments, an insurance exchange, or an entity similar to the above. The association also does not provide coverage for: • any policy or portion of a policy which is not guaranteed by the insurer or for which the individual or contract holder has assumed the risk; • any policy of reinsurance (unless an assumption certificate was issued); • interest rate yields that exceed an average rate; • dividends; • credits given in connection with the administration of a policy by a group contract holder; • employer or association plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them) or uninsured, including: i. multiple employer welfare arrangement; ii. minimum premium group insurance plan; iii. stop loss group insurance plan; or iv. administrative services only contract. • any unallocated annuity contract issued to an employee benefit plan protected under the federal pension guaranty corporation; • any portion of any unallocated contract which is not issued to or in connection with a specific employee, union or association's benefit plan or a governmental lottery. LIMITS ON AMOUNT OF COVERAGE The act also limits the amount the Guaranty Association is obligated to pay out: The association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one insured life, the association will pay a maximum of $ 300,000--no matter how many policies and contracts there were with the same company, even if they provided different types of coverages. Within this overall $ 300,000 limit, the association will not pay more than $ 100,000 in cash surrender values, $ 100,000 in health insurance benefits, $ 100,000 in present value of annuities, or $ 300,000 in life insurance death benefits --again, no matter how many policies and contracts there were with the same company, and no matter how many different types of coverages. Note to benefit plan trustees or other holders of unallocated annuities (GICs, DACs, etc.) covered by the act: for unallocated annuities that fund governmental retirement plans under sections 401(k), 403(b) or 457 of the Internal Revenue Code, the limit is $ 150,000 in present value of annuity benefits including net cash surrender and net cash withdrawal per participating individual. In no event shall the association be liable to spend more than $ 300,000 in the aggregate per individual; for covered unallocated annuities that fund other plans, a special limit of $ 1,000,000 applies to each contract holder, regardless of the number of contracts held with the same company or number of persons covered. In all cases, of course, the contract limits also apply. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 52 of 131 PageID #: 121 A Policyholder No. 654092 Group Life and Accident Insurance Policy a contract between Aetna Life Insurance Company (A Stock Company herein called Aetna) and Colgate-Palmolive Company (Policyholder) Policy Number: GP-654092 Date of issue: October 18, 2006 To take effect: January 1, 2006 Policy delivered in: Delaware This policy will be construed in line with the law of the jurisdiction in which it is delivered. Based on timely premium payments by the Policyholder, Aetna agrees with the Policyholder, to pay benefits in line with the policy terms. The duties and the rights of all persons will be based solely on policy terms. This policy is non-participating. Signed at Aetna's Home Office in Hartford, Connecticut on the date of issue. President Aetna Life Insurance Company 151 Farmington Avenue GR-29 Hartford, Connecticut 06156 Face Page ED. 8-87 860-273-0123 207974 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 53 of 131 PageID #: 122 Index Policy Contents Part I Eligible Classes Changes Special Provisions Part II Policyholder and Insurance Company Matters GR-29 0040 ED. 7-73 Page 9000 F208015 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 54 of 131 PageID #: 123 Policy Contents This policy consists of: The Face Page, Index, this Policy Contents page, and all the provisions of Parts I and II; and The provisions found in the Certificate(s) listed in this section. The words "you" or "your" in any Certificate included in this policy, will refer to a covered Employee. The Certificate(s) included in this policy are as follows: A "Certificate" consists of a Certificate Base document ("Cert. Base") and any Summary of Coverage ("SOC") or Certificate Rider ("Rider") which may be issued to support or amend the Cert. Base. Identification Issue Date Effective Date Eligible Group and/or Type of Coverage Cert Base: 1 SOC: 1A August 28, 2006 August 28, 2006 January 1, 2006 January 1, 2006 Grandfathered Employees Life Plan LG Cert Base: 2 SOC: 2A SOC: 2B SOC: 2C SOC: 2D August 28, 2006 August 28, 2006 August 28, 2006 August 28, 2006 August 28, 2006 January 1, 2006 January 1, 2006 January 1, 2006 January 1, 2006 January 1, 2006 Retiree Life Plan LS Class R1 Class R2 Class R3 Class R4 Cert Base: 3 SOC: 3A SOC: 3B August 28, 2006 August 28, 2006 August 28, 2006 January 1, 2006 January 1, 2006 January 1, 2006 Life and AD&PL, Plans LB & LS Bargaining Employees Non-Bargaining Employees GR-29 1508 ED. 10-96 Page 9010 T-205478 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 55 of 131 PageID #: 124 Part I Eligible Classes All classes of employees of a Member Employer are eligible except those who are: Part-time; Temporary; Substitute; or In a class for which a Certificate is not in this policy. An employee is eligible only for the coverages shown in the Certificate which applies to his class. If a Member Employer is a partnership or proprietorship, each of its natural-person partners, or the proprietor, will be deemed to be an employee. This applies only if the person is working on a mostly full-time basis for the Employer. GR-29 0150 ED. 7-73 Page 9050 205823 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 56 of 131 PageID #: 125 Change In Amounts Employee Coverage (Contributory) Earnings or Status Change If, at any time, the employee's rate of earnings or status changes so as to warrant an amount of contributory coverage other than that for which the employee is then covered, the amount of his or her coverage will be changed as follows: A reduction will be effective: On the date the employee requests it under Life Insurance and Accidental Death and Personal Loss Coverage. On the date of the earnings or status change under all other coverages. An increase will be effective on the date of the earnings or status change. For any coverage other than Health Expense Coverage, the Active Work Rule must be met. The employee may refuse an increase in Life Insurance or Accidental Death and Personal Loss Coverage. This must be done within 31 days of the date it would have taken effect. If refused, no other increase because of the earnings or status change will be made until the date Aetna gives written consent. Schedule or Benefit Level Change If, at any time, any schedule or the level of any benefit is changed so as to warrant an amount of contributory coverage other than that for which the employee is then covered, the amount of coverage will be changed to the new amount. For any coverage other than Health Expense Coverage, an increase will be subject to the Active Work Rule. The employee may refuse an increase in Life Insurance and Accidental Death and Personal Loss Coverage. This must be done within 31 days of the date it would have taken effect. If the employee later elects the increase, it will be made on the date Aetna gives written consent. GR-29 0190 ED. 7-73 Page 9060 F207815 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 57 of 131 PageID #: 126 Change In Amounts (Continued) Employee Coverage (Contributory) (Continued) All Changes A retroactive change in an employee's rate of earnings or status will not result in a retroactive change in coverage. Any change in coverage will be effective on the date the change in earnings or status is made. This section will not apply to any reductions due to reaching a stated age or due to retirement. Employee Coverage (Non-Contributory) Earnings, Status, Schedule, or Benefit Level Change If, for any reason and at any time, the employee's rate of earnings, or the employee's status, or any schedule, or the level of any benefit is changed so as to warrant an amount of non-contributory coverage other than that for which the employee is then covered, the amount of his or her coverage will be changed to the new amount. For any coverage other than Health Expense Coverage, an increase will be subject to the Active Work Rule. A retroactive change in an employee's rate of earnings or status will not result in a retroactive change in coverage. Any change in coverage will be effective on the date the change in earnings or status is made. This section will not apply to any reductions due to reaching a stated age or due to retirement. GR-29 0190 ED. 7-73 Page 9062 205328 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 58 of 131 PageID #: 127 Change In Amounts (Continued) Dependent Coverage Status, Schedule, or Benefit Level Change If, for any reason and at any time, a dependent's status, any schedule, or the level of any benefit for a dependent is changed so as to warrant an amount of coverage for a dependent other than that then in force, the amount of a dependent's coverage will be changed to the new amount. GR-29 0190 ED. 7-96 Page 9065 207726 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 59 of 131 PageID #: 128 Other Changes Employee Coverage Change in Eligibility Date An increase in any required period of service will apply only to an employee who enters service on or after the effective date of the increase. A decrease in any required period of service will permit an employee to become eligible on the effective date of the decrease if he or she then has worked the new period of service. Otherwise he or she is eligible on the date he or she completes it. Change in Age Reduction Rule If an Age Reduction Rule is changed and an employee is eligible for an increase in coverage due to such change, such increase shall be effective only if Aetna gives its written consent. Employee And Dependent Coverage Addition or Deletion of a Benefit Except as set forth in the next paragraph, if any benefit becomes applicable to an employee or a dependent who is already covered under the policy, that person will be eligible for that benefit right away. Coverage will be effective in line with the Effective Date provisions. For any coverage other than Health Expense Coverage, this includes the Active Work Rule. If any benefit no longer applies to an employee or a dependent, coverage for that benefit will stop right away for that person. GR-29 0190 ED. 7-73 Page 9070 205241 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 60 of 131 PageID #: 129 Special Provisions Active Work Rule This Active Work Rule does not apply to any Health Expense Coverage. If the employee is ill or injured and away from work on the date any of his or her Employee Coverage (or any increase in such coverage) would become effective, the effective date of coverage (or increase) will be held up until the date he or she goes back to work for one full day. GR-29 0170 ED. 8-96 Page 9072 205573 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 61 of 131 PageID #: 130 Special Provisions (Continued) Effect of Prior Coverage - Transferred Business If the coverage of any family member under one or more benefit sections replaces any prior coverage in effect for the member, the rules below will apply. "Prior Coverage" is any plan of group life insurance or group accident and health benefits coverage carried or sponsored by a Member Employer or its predecessor. It was provided by any carrier other than Aetna (i.e., transferred business). It has been replaced as a whole or in part, as to the class of employees of which the employee is a member, by coverage under one or more benefit sections of this policy. Any such plan will be "prior coverage" whether provided by group insurance or by any other arrangement of group coverage. As to Life Insurance If an employee or his or her beneficiary becomes entitled to claim under the prior life insurance coverage, his or her Life Insurance under this policy will be canceled. This will take place as of the date it took effect. Any premiums paid for his or her Life Insurance under this policy will be refunded to the Policyholder. By mutual agreement between Aetna and the Policyholder, the Active Work Rule will, on the day after the date the employee's prior life insurance coverage terminates, not apply to any employee whose name is given to Aetna by that day. The amount of his or her life insurance will be the amount in effect under the prior coverage on the day before he or she becomes insured for Life Insurance under this policy. Any Age Reduction Rule or Retirement Rule will apply to the employee if: the Rules do not provide a greater amount of Life Insurance than his or her amount under the prior coverage; or his or her life insurance had not been reduced under the prior coverage due to age or retirement. If the employee does not return to active work within 12 months from the date Life Insurance goes into effect, Life Insurance will cease at the end of such 12 month period. This will happen unless such employee is eligible as a permanently and totally disabled employee under the terms of Special Provisions for Permanently and Totally Disabled Employees. GR-29 2079 ED. 4-78 Page 9074 F205530D Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 62 of 131 PageID #: 131 Special Provisions (Continued) Effect of Prior Coverage - Transferred Business (Continued) The Policyholder shall make a payment to Aetna for each employee to whom this provision applies. It shall be an amount equal to 100% of the employee's Life Insurance, as to an employee who dies while this provision applies to the employee. This payment shall be made on the first day of the fifth month after the end of the policy year which follows the date of the death of the employee while this provision applies to him or her. As to Accident and Health Benefits A "like benefit" of the prior coverage means: As to any Accidental Death and Personal Loss Coverage: Any benefit payable under any prior group accident plan for accidental loss of life, limb, or sight. As to any Temporary Disability Benefit Coverage: Any benefit payable under any prior group temporary disability plan for loss of time from work. As to any other benefit section: Any benefit payable under any prior group medical, dental, or other health plan for medical or dental treatment. Any applicable Active Work Rule be waived on the day right after the date the employee's coverage under the prior coverage terminated. Any Employee Coverage or Dependent Coverage which becomes effective under the terms of this section will not be in effect and benefits will not be available as to a disease or injury for which benefits: are available; or would be available in the absence of coverage under this policy; under any extension of benefits provision of the prior coverage until the end of the period for which such benefits: are available; or would be available in the absence of any coverage under this policy; under such extension of benefits. GR-29 2080 ED. 7-96 Page 9075 F207795 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 63 of 131 PageID #: 132 Special Provisions (Continued) Effect of Prior Coverage - Transferred Business (Continued) As to each family member to whom the 2 prior paragraphs apply: An employee shall not be covered for any Accidental Death and Personal Loss Coverage or any Temporary Disability Benefit Coverage unless he or she was covered for a like benefit under the prior coverage on the day before the date the terms of the second preceding paragraph took effect for him or her. If he or she is covered, the amount of Principal Sum and the Weekly Benefit shall be the amount in force for him or her under the like benefit on that date. The Maximum Period of Payment will be the period in effect for him or her under the like benefit on that date. As to any Major Medical, Comprehensive Medical, or Comprehensive Dental Expense Benefits: If part or all of a covered family member's Deductible, under any section of his or her prior coverage that provides one or more of these benefits, has been applied against covered expenses incurred by him or her during the 90 day period right before the date his or her coverage goes into effect, his or her Deductible under any Major Medical, Comprehensive Medical, or Comprehensive Dental Expense Benefits for the calendar year in which he or she becomes covered will be reduced by the amount so applied. GR-29 0990 ED. 7-73 Page 9076 F207802 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 64 of 131 PageID #: 133 Special Provisions (Continued) Effect of Prior Coverage - Transferred Business (Continued) No benefits will be payable under this policy with respect to any expenses which are covered in whole or in part under any extension of benefits under the prior coverage because of total disability. The Policyholder will be liable for the premium required by Aetna for the terms of this provision to apply to the covered family member. Coverage under this provision will continue only for the period of time agreed to by Aetna and the Policyholder. This provision will terminate as to an employee if: his or her coverage terminates; or he or she meets any applicable Active Work Rule. If he or she stays insured or again becomes eligible, this policy will apply to him or her as though this provision were not included. GR-29 0990 ED. 7-73 Page 9077 F205541C Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 65 of 131 PageID #: 134 Part II Policyholder and Insurance Company Matters Declarations The first "policy month" starts on January 1, 2006 Each subsequent policy month starts on the first of a calendar month. The first "policy year" starts on January 1, 2006 and ends on December 31, 2006. Each subsequent policy year starts on January 1. It ends on December 31. Member Employers Member Employers are those employers which are included under this policy by written agreement between the Policyholder and Aetna. An employer may be a Member Employer if not against the law of the jurisdiction in which this policy is delivered. The Policyholder may act for all Member Employers in all policy matters. Each such act, or agreement made between Aetna and the Policyholder, or notice given by one to the other will be binding on all the Employers. Clerical Error A clerical error in keeping records; or a delay in making an entry; will not alone decide if insurance is valid. An equitable adjustment in premiums will be made when the error or delay is found. If the clerical error affects: the existence; or amount; of insurance, the facts as determined by Aetna will be used to decide if insurance is in force and its amount. Misstatements If any fact as to a person to whom the insurance relates is found to have been misstated, a fair change in premiums will be made. If the misstatement affects the existence or amount of insurance, the true facts will be used to decide if insurance is in force and its amount. GR-29 1150, 1150-1 ED. 1-02 Page 9080 205242 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 66 of 131 PageID #: 135 Policyholder and Insurance Company Matters (Continued) Duties of the Policyholder The Policyholder and each Member Employer must give Aetna such information as Aetna may reasonably require to administer this policy and must agree to: Maintain a reasonably complete record of such information in electronic or hard copy format, including but not limited to: evidence of eligibility; changes to such elections; and terminations; for at least seven years or until the final rights and duties under this policy have been resolved; and to make such information available to Aetna upon request. The information shall be provided when requested: on Aetna forms; or such other forms as Aetna may approve. All data which may have a bearing on insurance or premiums will be open for Aetna to inspect while this policy is in force. The Policyholder must notify employees of the termination of the policy in compliance with all applicable laws. However, Aetna reserves the right to notify employees of termination of the policy for any reason, including non-payment of premium. The Policyholder shall provide written notice to employees of their rights upon termination of coverage. The Policyholder must: notify all eligible employees of their right to continue coverage under any applicable state law; and provide notification to each employee within 15 days after termination of coverage, of their conversion right, including: a description of plans available; premium rates; and application forms. GR-29 11496 ED. 1-02 Page 9085 209413 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 67 of 131 PageID #: 136 Policyholder and Insurance Company Matters (Continued) Non-Discrimination In the management of this policy, the Policyholder and the Member Employers: will make no attempt, whether through differential contributions or otherwise, to encourage or discourage enrollment in the coverages provided by the policy based on health status or risk. will act so as not to discriminate unfairly between persons in like situations at the time of the action. Aetna can rely on such action. It will not have to probe into the details. Certificates Aetna will provide the Policyholder with either a supply of paper copies or electronic certificates. The Policyholder shall distribute or otherwise make the certificates available to each insured employee. The insurance in force will be set forth. Statements as to whom benefits are payable will appear. Any applicable Conversion Privilege will also be described. Policy Changes This policy may be amended by Aetna: with 30 days written notice to the Policyholder; or by written agreement between Aetna and the Policyholder. The consent of any employee or other person is not needed. All agreements made by Aetna are signed by one of its executive officers. No other person can change or waive any of the policy terms or make any agreement binding Aetna. The Policyholder will not have to give written agreement of a change in the policy if: • The Policyholder has asked for the change and Aetna has agreed to it. • The change is needed to correct an error in the policy, including any certificate issued to anyone. • The change is needed so that the policy will conform to any law, regulation or ruling of: a jurisdiction that affects a person covered under this policy; or the federal government. The change has been initiated by Aetna and is not resulting in either: a reduction or elimination in benefits or coverage; or an increase in premium. GR-29 1160-1, 1160-2, 1160-3 ED. 1-02 Page 9090 205243 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 68 of 131 PageID #: 137 Policyholder and Insurance Company Matters (Continued) Policy Changes (Continued) The Policyholder will have to give written agreement of a change in the policy: that reduces or eliminates benefits or coverage; or that increases benefits or coverage with a concurrent increase in premium during the policy term, except if the increased benefits or coverage is required by law. Payment of the applicable premium after notice of the proposed changes will be deemed to constitute the Policyholder’s written agreement of those changes on behalf of all persons covered under this policy. This policy shall be deemed to be automatically amended to conform with the provisions of applicable laws and regulations. GR-29 1160-1, 1160-2, 1160-3 ED. 1-02 Page 9090.1 205243 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 69 of 131 PageID #: 138 Policyholder and Insurance Company Matters (Continued) Contract This policy and application of the Policyholder are the entire contract. A copy of the application is attached. All statements made by the Policyholder or an employee shall be deemed representations and not warranties. No written statement made by an employee shall be used by Aetna in a contest unless: a copy of the statement is; or has been furnished to: the employee; or his beneficiary; or the person making the claim. Aetna's failure to implement or insist upon compliance with any provision of this policy at any given time or times, shall not constitute a waiver of Aetna's right to implement; or insist upon compliance with that provision at any other time or times. This includes, but is not limited to, the payment of premiums. This applies whether or not the circumstances are the same. Life Insurance - Incontestability The validity of this policy shall not be contested, except for non-payment of premiums, after it has been in force for 2 years. No statement made by an employee about his insurability shall be used by Aetna in contesting the validity of the insurance as to which such statement was made if the insurance has been in force prior to the contest for 2 years during the employee's lifetime nor unless such statement is contained in a written form signed by him. Accident and Health Coverage Statements Except as to a fraudulent misstatement or issues concerning premiums due: No statement made by the Policyholder or an employee shall be the basis for: voiding coverage; or denying coverage; or be used in defense of a claim; unless it is in writing. No statement made by the Policyholder shall be used to void this policy after it has been in force for 2 years. No statement made by an eligible employee shall be used in defense to a claim for loss incurred or starting after coverage as to which claim is made has been in effect for 2 years. GR-29 9020-1, 9020-2 ED. 1-02 Page 9100 208053 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 70 of 131 PageID #: 139 Policyholder and Insurance Company Matters (Continued) Premium Rates GR-29 1170 ED. 7-73 Page 9110 205245 Redacted as Confidential Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 71 of 131 PageID #: 140 Policyholder and Insurance Company Matters (Continued) Premium Rates (Continued) GR-29 1170-2 ED. 7-73 Page 9120 T-208057 Redacted as Confidential Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 72 of 131 PageID #: 141 1170-2 ED. 7-73 Page 9120.1 T-208057 Redacted as Confidential Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 73 of 131 PageID #: 142 Policyholder and Insurance Company Matters (Continued) Premium Rates (Continued) GR-29 1180 ED. 10-96 Page 9140 206638 Redacted as Confidential Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 74 of 131 PageID #: 143 Policyholder and Insurance Company Matters (Continued) Premium Rates (Continued) GR-29 1190 ED. 1-02 Page 9150 T-208149 Redacted as Confidential Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 75 of 131 PageID #: 144 Policyholder and Insurance Company Matters (Continued) Fees In addition to the premium, Aetna may charge: An installation fee upon: initial installation of coverage; or any significant change in installation, including but not limited to: a substantial change in the number or composition of persons insured under this policy; or a change in the method of reporting eligibility to Aetna. A billing fee with each monthly premium bill. The billing fee may include a fee for the recovery of any surcharges for amounts paid through: credit card; debit card; or other similar means. A reinstatement fee if any or all coverage is terminated and later reinstated under this policy. A conversion fee applied to each covered person electing conversion coverage. The conversion fee may be charged monthly based upon the number of covered persons electing conversion coverage during the previous month. GR-29 11501 ED. 1-02 Page 9152 207909 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 76 of 131 PageID #: 145 Policyholder and Insurance Company Matters (Continued) Premiums Due - Experience Rating The premium due under this policy on any premium due date will be the sum of the premium charges for the coverages then provided under this policy. If premiums are payable monthly, any insurance becoming effective will be charged for from the first day of the policy month on or right after the date the insurance takes effect. Premium charges for insurance which ceases will cease as of the first day of the policy month on; or right after the date the insurance terminates. If premiums are payable less often than monthly, premium charges or credits for a fraction of a premium-paying period will be made on a pro rata basis for the number of policy months between: the date premium charges start or cease; and the end of the premium-paying period. If this policy is changed to provide more coverage to take effect on a date other than the first day of a premium-paying period, a pro rata premium for the coverage will be due and payable on that date. It will cover the period then starting and ending right before the start of the next premium-paying period. The premium charges will be figured at the premium rates shown before. Aetna may change them due to: Experience; or a change in factors bearing on the risk assumed. Each change shall be made by written notice to the Policyholder by Aetna. No experience reduction or increase in premium rates shall become effective less than 12 months after the effective date of the group policy unless there is: a significant change in factors bearing a material impact on the risk assumed by Aetna; or changes in applicable state or federal: law; policy; regulation; or a judicial decision; GR-29 1195-1, 1195-2 ED. 1-02 Page 9160 207893 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 77 of 131 PageID #: 146 Policyholder and Insurance Company Matters (Continued) Premiums Due - Experience Rating (Continued) having a material impact on the cost of providing the coverages then provided under this group policy. As used here, “group policy” shall be deemed to include any group policy previously issued by Aetna that has been replaced in whole or in part by this policy. The Employee Life Insurance section of this policy sets forth the way in which the premium rates for such coverage will be figured. The premium charges for any other coverage under this policy may be refigured, as of a premium due date, only: By reason of a change in factors bearing on the risk assumed. This must be requested by Aetna. Once during any continuous 12 month period. The Policyholder must request this. 60 days advance notice has to be given to Aetna. They will be refigured using: The ages of the employees; The amounts of insurance in force; The premium rates; and Any other pertinent factors. All facts will be taken into account as of the date of the refiguring. GR-29 1195-1, 1195-2 ED. 1-02 Page 9160.1 207893 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 78 of 131 PageID #: 147 Policyholder and Insurance Company Matters (Continued) Premiums Due - Experience Rating (Continued) At the end of a policy year, Aetna may declare an experience credit. The amount of each credit Aetna declares will be returned to the Policyholder. Upon request by the Policyholder, part or all of it will be applied against the payment of premiums or in any other manner as may be agreed to by the Policyholder and Aetna. If the sum of employee contributions which have been made for group insurance exceeds the sum of premiums which have been paid for group insurance (after giving effect to any experience credits), the excess will be applied by the Policyholder for the sole benefit of employees. Aetna will not have to see to the use of such excess. Instead of figuring premiums as described above, premiums may be figured in any way approved by Aetna that comes up with about the same amount of premiums. Aetna will not have to refund any premium for a period prior to: The first day of the policy year in which Aetna receives proof that the refund should be made; or The date 3 months before Aetna receives proof, if this produces a larger refund. This applies even if the premium was paid in error. Premium and Fees Due Payment of Premiums and Fees The Policyholder will pay premiums and fees in advance. They may be paid at Aetna's Home Office or to its authorized agent. A premium is due to be paid on the first day of each policy month. The Policyholder may change the number of premium payments as of a premium due date. This needs Aetna's written consent. Aetna may accept a partial payment of premium without waiving its right to collect the entire amount due. If the premiums and any fees are not paid by the Premium Due Date and before the end of the Grace Period, this policy will automatically terminate when the Grace Period ends. Aetna will require the Policyholder to pay interest on the total premium amount and any fees overdue after the Premium Due Date including the premiums due for the Grace Period. The interest rate will be 1 1/2% per month for each: month; or partial month; the balance remains unpaid. Aetna may recover from the Policyholder: costs of collecting any unpaid premiums or fees; including reasonable attorney’s fees; and costs of suit. GR-29W 1198-1, 11500, 11502 ED. 1-02 Page 9170 208133 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 79 of 131 PageID #: 148 Policyholder and Insurance Company Matters (Continued) Retroactive Adjustments Aetna may, at its discretion, make retroactive adjustments to the Policyholder’s billings for the termination of employees not posted to previous billings. However, the Policyholder may only receive a maximum of 1 month’s credit for employee terminations that occurred more than 30 days before the date the Policyholder notified Aetna of the termination. Aetna may reduce any such credits by the amount of any payments Aetna may have made on behalf of such employees before Aetna was informed their coverage had been terminated. Retroactive additions will be made at Aetna’s discretion based upon eligibility guidelines stated in the certificate, and are subject to the payment of all applicable premiums. Grace Period A grace period of 31 days after the due date will be allowed the Policyholder for the payment of each premium and fee. If premiums and fees are not paid by the end of the Grace Period, the policy will automatically terminate at the end of the Grace Period. GR-29W 1198-1, 11500, 11502 ED. 1-02 Page 9170.1 208133 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 80 of 131 PageID #: 149 Policyholder and Insurance Company Matters (Continued) Discontinuance of Policy The Policyholder may terminate this policy as to any or all coverage of all or any class of employees of any one or more Member Employers. A Member Employer may terminate this policy as to any or all coverage of all or any class of its employees. Aetna must be given written notice. The notice must state when such termination shall occur. It must be a date after the notice. It shall not be effective during a period for which a premium has been paid to Aetna as to the coverage. Aetna may terminate this policy as to any or all coverage, other than Health Expense Coverage, which includes: Comprehensive Medical Expense Coverage; Major Medical Expense Coverage; Prescription Drug Expense Coverage; and Hospital Expense Benefit; but does not include: Comprehensive Dental Expense Coverage; and Comprehensive Vision Expense Coverage; of all or any class of employees or dependents of any one or more Member Employers by giving written notice of when it will terminate. The date shall not be earlier than 31 days after the date of the notice unless it is agreed to by the Policyholder and Aetna. This right to terminate shall be in accordance with the Grace Period and Payment of Premiums and Fees provisions and is subject to the terms of any laws or regulations. Comprehensive Medical Expense Coverage; Major Medical; Prescription Drug Expense Coverage; Hospital Expense Benefit may be terminated by Aetna as follows: When the premium for the employees’ coverage has not been paid. This right to terminate shall be in accordance with the Grace Period and Payment of Premiums and Fees provisions and is subject to the terms of any laws or regulations. When the Policyholder ceases to meet the requirements for a group as defined under applicable state law or regulation. GR-29 1210-1, 1210-2, 1210-3 ED. 1-02 Page 9180 205931 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 81 of 131 PageID #: 150 Policyholder and Insurance Company Matters (Continued) Discontinuance of Policy (Continued) When the Policyholder fails to meet Aetna’s contribution or participation requirements. Aetna may request: certification of the Policyholder’s compliance with Aetna’s participation and contribution requirements; and certification of group status; prior to renewal. Aetna may exercise its right to non-renew if such certification is not provided. When the Policyholder fails, without good cause, to perform in good faith its obligations under this policy including an act or practice that constitutes fraud or intentional misrepresentation of a material fact relevant to the coverage provided under this policy. In accordance with any applicable state or federal law, rule or regulation. When Aetna decides to discontinue offering: a particular type of group health expense coverage; or all its group health expense coverage in the state the policy is issued; provided all group health expense coverages issued or delivered for issuance in such state are discontinued and not renewed. Except if Aetna discontinues offering a type of group health expense coverage, Aetna will give the Policyholder advance written notice of when it will terminate the policy. The date shall not be earlier than 31 days after the date of the notice unless it is agreed to by the Policyholder and Aetna. If Aetna discontinues offering a particular type of group health expense coverage, it shall: provide written notice to each affected employer, (and all covered employees and dependents), of the discontinuance within 90 days before such plans discontinue; offer each affected employer the option, on a guaranteed issue basis; to purchase any other group health benefit plan currently being offered in that market; and act uniformly without regard to the claims experience of the affected employers; or any health status-related factor relating to any covered employee or dependent who may become eligible for coverage. If Aetna discontinues offering all its group health expense coverages, it shall provide written notice to each affected employer, (and all covered employees and dependents), of the discontinuance at least 180 days before such discontinuance. GR-29 1210-1, 1210-2, 1210-3 ED. 1-02 Page 9180.1 205931 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 82 of 131 PageID #: 151 Policyholder and Insurance Company Matters (Continued) Discontinuance of Policy (Continued) If: This policy terminates as to any of the employees of a Member Employer; and Premiums and fees have not been paid for the period this policy; or any coverage included was in force for those employees; then the Policyholder and the Employer shall be jointly and severally liable to Aetna for the unpaid premiums and fees, including those due for the grace period. Employees shall also remain liable for employee cost sharing and other required contributions to coverage for any period of time the policy is in force during the Grace Period. Aetna may request from the Policyholder, a written indication of their intention to renew or non-renew a policy at any time during the final three months of any policy year. If the Policyholder fails to reply to such request: within two weeks of their receipt of the request; or 15 days prior to the renewal date; whichever is later; then upon Aetna’s written notice to the Policyholder, all or a part of the policy shall be deemed to terminate automatically as of the end of the policy year. Similarly, upon Aetna’s written confirmation to the Policyholder, Aetna may accept an oral indication by: the Policyholder; or its agent or broker; of intent to non-renew as the Policyholder’s notice of termination of all or a part of the policy effective as of the end of the policy year. Aetna may charge the Policyholder a reinstatement fee if any or all coverage is terminated; and later reinstated under this policy. GR-29 1210-1, 1210-2, 1210-3 ED. 1-02 Page 9180.2 205931 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 83 of 131 PageID #: 152 Policyholder and Insurance Company Matters (Continued) Life Insurance Portability Anything in this section to the contrary notwithstanding: Termination of this policy by the Policyholder or Aetna will not terminate Life Insurance then in force for any person under the terms of the Life Insurance Portability section. This policy will be deemed to remain in force solely for the purpose of continuing such Life Insurance, but without further obligation of the Policyholder hereunder. Any Life Insurance continued by the terms of this paragraph will remain in force until terminated under the terms of the Life Insurance Portability section. No other person may elect coverage under the Life Insurance Portability section on or after the date of termination by the Policyholder or Aetna, except a person who elects it in accordance with the terms of said section. GR-29 11009 ED. 11-94 Page 9182 F207563 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 84 of 131 PageID #: 153 Policyholder and Insurance Company Matters (Continued) ERISA Matters Under Section 503 of Title 1 of the Employee Retirement Income Security Act of 1974, as amended (ERISA), Aetna is a fiduciary. It has complete authority to review all denied claims for benefits under this policy. In exercising such fiduciary responsibility, Aetna shall have discretionary authority to: determine whether and to what extent employees and beneficiaries are entitled to benefits; and construe any disputed or doubtful terms of this policy. Aetna shall be deemed to have properly exercised such authority. It must not abuse its discretion by acting arbitrarily and capriciously. Aetna has the right to adopt reasonable: policies; procedures; rules, and interpretations; of this policy to promote orderly and efficient administration. The Policyholder shall be responsible for making reports and disclosures required by ERISA, including: the creation; the distribution; and the final content of: summary plan descriptions; summary of material modifications; and summary annual reports. GR-29 9020-3 ED. 1-02 Page 9190 207840 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 85 of 131 PageID #: 154 Life and AD&PL Colgate-Palmolive Company Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 86 of 131 PageID #: 155 Table of Contents Summary of Coverage ................................................................................................................ Issued With Your Booklet Your Group Coverage Plan .................................................................................. 1 Life Insurance ....................................................................................................... 2 Accidental Death and Personal Loss Coverage .................................................... 6 Traumatic Brain Injury Benefit.......................................................................................................................................... 12 Effect Of Benefits Under Other Plans ................................................................ 14 Effect of Prior Coverage - Transferred Business ............................................ 14 General Information About Your Coverage ....................................................... 15 Glossary .............................................................................................................. 20 (Defines the Terms Shown in Bold Type in the Text of This Document.) Note: The codes appearing throughout the document is text required by the Department of Insurance. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 87 of 131 PageID #: 156 GR-9 1 Your Group Coverage Plan This Plan is underwritten by the Aetna Life Insurance Company, of Hartford, Connecticut (called Aetna). The benefits and main points of the group contract for persons covered under this Plan are set forth in this Booklet. They are effective only while you are covered under the group contract. If you become covered, this Booklet will become your Certificate of Coverage. It replaces and supersedes all Certificates issued to you by Aetna under the group contract. President Group Policy: GP-654092 Cert. Base: 3 Issue Date: August 28, 2006 Effective Date: January 1, 2006 This Certificate may be an electronic version of the Certificate on file with your Employer and Aetna Life Insurance Company. In case of any discrepancy between an electronic version and the printed copy which is part of the group insurance contract issued by Aetna Life Insurance Company, or in case of any legal action, the terms set forth in such group insurance contract will prevail. To obtain a printed copy of this Certificate, please contact your Employer. 0020 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 88 of 131 PageID #: 157 GR-9 2 Life Insurance This Plan will pay as a Life Insurance benefit the amount of Life Insurance in force for you if you die from any cause while insured. You name your beneficiary. You may change your choice at any time. 0420 Accelerated Death Benefit If, while covered under this Plan for Life Insurance: • you become terminally ill; or • your spouse becomes terminally ill; you may request that Aetna pay an Accelerated Death Benefit (herein called ADB). Upon Aetna's approval of any such request, Aetna will pay to you the amount of ADB; subject to all of the following terms. A person is terminally ill if the person: • suffers from an incurable, progressive, and medically recognized disease or condition; and • to a reasonable medical probability and based on a generally accepted prognostic protocol, will not survive more than the ADB Months beyond the date of the request for an ADB. You may request an ADB on your own behalf or on behalf of your spouse at any time by completing an Aetna Request For Accelerated Death Benefit Form and submitting it to Aetna. The request must include the statement of a currently licensed United States physician that: • you are terminally ill; or • your spouse is terminally ill. The physician's statement must include: • all medical test results; • laboratory reports; and • any other information on which the statement is based, including the generally accepted prognostic protocol used by the physician to determine your expected remaining life span. Your request for an ADB must state the amount of the benefit requested. You may request as an ADB up to the ADB Percentage of the amount of Life Insurance then in force for the person for whom you are making the request; but in no event may the requested amount of ADB be equal to: • less than the ADB Minimum; or • more than the ADB Maximum. You may request an ADB under this Plan: • only once on your own behalf; and • only once on behalf of any one spouse. If, by assignment or otherwise, someone other than you is the owner of your Life Insurance Coverage or the Life Insurance Coverage of your spouse, an ADB will not be available under this Plan for or on behalf of such person. If, during the ADB Months following the date of your request for an ADB, the amount of your Life Insurance would reduce due to the attainment of a specified age or retirement, the ADB amount will be calculated by multiplying the percentage that you have requested by the amount of Life Insurance that would remain in effect after any reduction. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 89 of 131 PageID #: 158 GR-9 3 The amount of ADB payable to you will be reduced by an interest charge equal to the sum of daily interest that would have accrued on such amount during ADB Months which begins on the date the ADB is paid. The interest rate used to calculate the interest charge will not exceed the current yield on 90-day United States Treasury bills on the date the ADB payment is requested. When your request for an ADB on your own behalf or on behalf of your spouse has been approved, the amount of Life Insurance then in force for such person will be reduced by the amount of ADB that would have been payable in the absence of any interest charge. Any person whose amount of Life Insurance has been so reduced, will not be entitled to the Conversion of Life Insurance for the amount of Life Insurance that ceases because of the reduction by the amount of the ADB. In considering your request for an ADB, Aetna may require you or your spouse, at Aetna's expense, to submit to an independent medical exam by a physician chosen by Aetna. Aetna may suspend its review of a request for an ADB until the exam has been completed and the results submitted to Aetna. Aetna may refuse your request for an ADB if: • prior to Aetna's receipt of approval of the request: the group contract terminates as to your Eligible Class (even though all or part of your Life Insurance Coverage or the Life Insurance Coverage of your spouse continues for any reason); or the entire amount of Life Insurance of the person for whom request is made ceases under the group contract for any reason; or • prior to payment of the ADB, the person for whom request is made dies. Upon approval by Aetna, the amount of ADB will be paid to you in a lump sum. To the extent allowed by law: • any ADB paid to you is exempt from any legal or equitable process for your debts or the debts of your spouse; and • you will not be required to request an ADB in order to satisfy claims of creditors. 7611, 7612, 7613, 7612-1 Life Insurance For Your Dependents An amount of life insurance is payable to you if one of your dependents dies while insured. If you are not living at the time of payment, it will be made to your executors or administrators. At Aetna's option, it may be paid to your wife or husband. The following dependents are not eligible: • Those in full-time active military service. • Children who are not born alive. 0480 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 90 of 131 PageID #: 159 GR-9 4 Life Insurance Portability The terms of this provision apply only to an amount of Life Insurance which is fully contributory (i.e., you pay the total cost) and which: • for you, is at least $ 5,000; • for your spouse, is at least $ 1,000; and • for your dependent child, is at least $ 1,000. In no event, however, will the terms of this provision apply: • to you if you are in an Eligible Class for which Life Insurance coverage under the group contract is terminated and replaced by like coverage under another policy; • to you if you are in an Eligible Class for which coverage under the group contract is terminated because your Employer has gone out of business; and • to any amount of a person's Life Insurance that has been converted to an individual life policy in accordance with this Plan's Conversion of Life Insurance provision. This Plan's Conversion of Life Insurance provision does not apply to any amount of a person's Life Insurance for which a person elects coverage under this provision, but may be available for: • any amount of a person's Life Insurance to which the terms of this provision do not apply; • any amount of a person's Life Insurance to which the terms of this provision apply, but for which you do not elect coverage under this provision; or • any amount of a person's Life Insurance in force under this provision that ceases because of age. Your Life Insurance If your Life Insurance coverage ceases because your employment ceases or you are no longer in a class eligible for Life Insurance coverage, you may elect coverage under this provision; provided however, that: • the amount of your Life Insurance will be determined in accordance with the Amount of Insurance section of this provision; • on the date of the change to portability status, your age will not exceed the Eligibility Age; and • on the day your coverage ceases you are not ill or injured and away from work. Life Insurance For Your Dependents If Life Insurance coverage for a dependent ceases because your employment ceases or you are no longer in a class eligible for Dependent Life Insurance, you may elect coverage under this provision for the amount of insurance that is subject to this provision, but only if: • you elect coverage for yourself under this provision; and • on the date of the change to portability status, the dependent's age will not exceed the applicable Eligibility Age. 11005 Eligibility Age The Eligibility Age is: • for you, 98; • for your dependent spouse, 64; and • for your dependent child, the age which is one year younger than the age at which he or she will cease to meet the Plan's definition of dependent. General Information Concerning Portability In order to elect coverage for a person under this provision, written request must be made and the first premium contribution must be paid within 31 days after insurance ceases. Coverage will become effective at the end of the 31 day period during which election of coverage is possible. Such date is a person's "Portability Date". All of the terms and conditions of this Plan that apply to Life Insurance coverage apply to coverage continued under this provision except as otherwise stated in this provision. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 91 of 131 PageID #: 160 GR-9 5 Amount of Insurance The amount of a person's Life Insurance will be limited to the lesser of: the amount of insurance that was in force for the person on the day before his or her eligibility for coverage under this provision; and the amounts shown below: • $ 500,000 as to you; • $ 25,000 as to your spouse; and • $ 5,000 as to your dependent child. It will not increase; as to coverage for your spouse and dependent child, it will not decrease. However, as to coverage for you only, you may elect an amount of Life Insurance under this provision that is less than the amount as determined above; provided that: • the amount is an amount of Life Insurance available under this Plan for your classification; • such decrease may take effect only on your Portability Date; • such decreased amount may not be an amount that is less than the amount in force under this provision for your spouse or dependent child; and • such decreased amount may not be an amount in relation to the amount for your spouse or dependent child that is not permitted by any applicable law. On the January 1, next following the date you reach age 65, your Life Insurance amount will be reduced by 35%. Thereafter, the amount of your Life Insurance will be reduced by 60% at age 70, and, by 75% at age 75, but not below $ 5,000. 11006 Permanent and Total Disability Feature For you only, insurance under this provision may be extended in accordance with the terms of this Plan's Permanent and Total Disability Feature. However: You are permanently and totally disabled only if disease or injury stops you from working at any reasonable job, as defined in the Permanent and Total Disability Feature. Any insurance extended under this feature will cease on the first anniversary of your Portability Date next following the date you reach age 65. 11007 Accelerated Death Benefit In no event will the terms of the Accelerated Death Benefit provision apply to Life Insurance in force under this provision. 11007 Premium Contributions The rate of premium contribution will change for any insurance in force for a person under this provision on the person's Portability Date. The rate of premium contribution is subject to another change on the next January 1 and on each January 1 thereafter. Premium contributions will be paid directly to Aetna and will be subject to a direct billing charge. The amount of the charge may be adjusted by Aetna, but not more than once a year. Termination of Coverage A person's Life Insurance in force under the terms of this provision will cease on the first to occur of: • The end of a 31 day period following the date the required premium contribution for the coverage is due and not made. • The date of your death. • The first anniversary of your Portability Date next following the date you reach age 99. • As to coverage for your spouse, the first anniversary of his or her Portability Date next following the date your spouse reaches age 65. • As to coverage for your dependent child, the first anniversary of his or her Portability Date next following the date such person reaches his or her Eligibility Age. • As to coverage for your spouse or your dependent child, the date such person is no longer a defined dependent. 11007 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 92 of 131 PageID #: 161 GR-9 6 Accidental Death and Personal Loss Coverage This Plan pays a benefit if, while insured, a person suffers a bodily injury caused by an accident; and if, within 365 days after the accident and as a direct result of the injury, he or she loses: • His or her life. • A hand, by actual severance at or above the wrist joint. • A foot, by actual severance at or above the ankle joint. • An eye, involving irrecoverable and complete loss of sight in the eye. • His or her speech or hearing; the loss must be total and deemed permanent. • The thumb and index finger of the same hand, by actual severance of entire digit. Loss of thumb and index finger means complete severance through or above the metacarpophalangeal joint of both digits. A total loss of speech or hearing will be deemed permanent if the loss has been present for 12 consecutive months, unless an attending physician states otherwise. Loss of life due to exposure to natural or chemical elements will be deemed to be accidental if the exposure was a direct result of an accident. If: • a person disappears as a direct result of the accidental disappearance, wrecking, or sinking of the conveyance in which he or she was an occupant; and • there is no contrary evidence about the circumstances of the disappearance within one year of the accident; the disappearance will be deemed an accidental death. This Plan also pays a benefit if, while insured, a person suffers a bodily injury in an accident and if, as a direct result of the accident, suffers a full thickness third degree burn caused by direct contact with a chemical, fire, steam, water or heat (except sunburns) or, within 30 days after the accident and as a direct result of the injury, he or she is stricken with one of the following forms of paralysis: • Quadriplegia - the entire and irrecoverable paralysis of both upper and lower limbs. • Paraplegia - the entire and irrecoverable paralysis of both lower limbs. • Hemiplegia - the entire and irrecoverable paralysis of the upper and lower limbs on one side of the body. • Uniplegia - the entire and irrecoverable paralysis of one limb. A limb means the entire arm or leg. The Principal Sum for loss of a dependent's life is payable to you. The following dependents are not eligible: • Those in full-time active military service. • Those age 65 or over. • Children who are not born alive. 11037 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 93 of 131 PageID #: 162 GR-9 7 Benefit The full Principal Sum is payable for loss of life. The full Principal Sum is payable for loss of both hands, both feet, or both eyes. The full Principal Sum is payable for loss of both hearing and speech. The full Principal Sum is payable for quadriplegia. The full Principal sum is payable for third degree burns covering 75% or more of the body. Half the Principal Sum is payable for loss of either hearing or speech. Half the Principal Sum is payable for loss of a hand, loss of a foot, or loss of an eye. The full Principal Sum is payable for paraplegia or for hemiplegia. Half the Principal Sum is payable for third degree burns covering 50% to 74% of the body. One quarter of the Principal Sum is payable for loss of the thumb and index finger of the same hand. One quarter of the Principal Sum is payable for uniplegia. No more than the full Principal Sum is payable for all losses listed above resulting from one accident. 11038 Total Disability Benefit If you become totally disabled as defined below because of an accident of the type covered by this benefit section and that disability is continuous from the date of the accident until your death, Aetna will pay your beneficiary the amount of your Principal Sum if all of the following are true: • You are not able to work at your own job. • You are not able to work at any other job for pay or profit. • You are under age 60 at the time of the accident. • You die while this group policy is in effect. • Your Employer continues to make premium payments for your coverage. If a death benefit is payable, it will be reduced by any other benefit which is payable under this benefit section because of the same accident. Written notice of your death must be given to Aetna at its Home Office within 12 months of your death. If it is not given, Aetna will not have to pay this benefit. 11038 Additional Accidental Death Benefits The following benefits will be payable if, while insured, a person suffers a bodily injury caused by an accident and if, within 365 days after the accident, he or she suffers a loss of life solely and as a direct result of the accident. 11039 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 94 of 131 PageID #: 163 GR-9 8 Coma Benefit If, while insured, a person suffers a bodily injury caused by an accident and if, within 30 days after the accident, he or she becomes comatose solely and as a direct result of the accident, Aetna will pay a monthly benefit provided the person is continually comatose for at least 30 consecutive days. Proof that the person is comatose must be submitted to Aetna no later than 60 days after the date he or she becomes comatose. The first monthly benefit will be payable on the first day of the month following the date he or she has been continually comatose for at least 30 days. The monthly benefit is the Coma Benefit Percentage less any benefit amount paid or payable under this benefit section for any loss the covered person suffers as a direct result of a bodily injury caused by the same accident. The monthly benefit is payable for 11 months. The full Principal Sum less any benefit amount paid or payable under this benefit section because of the same accident will be payable after the covered person has been continually comatose for 12 months. No more than the full Principal Sum is payable for all losses resulting from the same accident. The monthly benefit is payable for as long as the coma continues, until the earliest to occur of: failure to have any required exam; failure to give proof that the coma continues; the date the full Principal Sum is paid under this benefit section; the date the covered person is no longer comatose, by death, recovery, or any other change of condition, as certified by a physician; or termination of the group policy. Aetna will have the right to require proof of the continuation of the coma. Aetna, at its own expense, also has the right to examine the covered person while the coma continues. Aetna will not request an exam or proof more often than twice in a 12 month period. A physician’s certification will be required before the final payment is made. Your dependent’s monthly benefit is payable to you. Your monthly benefit is payable to your named beneficiary. No benefit will be payable if: no named beneficiary survives you; or no beneficiary has been named; and no immediate family member to whom the benefit may be paid, at Aetna’s discretion, survives you. Immediate family members are: your spouse, your children, your parents, and your brothers and sisters. If the monthly payments are less than $20 each, the payments will be paid in one lump sum on the first day of the month following the date the covered person has been continually comatose for 12 months. 11246 Passenger Restraint and Airbag Benefit If a covered loss of life occurs solely and as a direct result of an accident involving a motor vehicle while the person: • is an occupant of the motor vehicle; and • at the time of the accident, is properly using a passenger restraint; and • if the driver has, at the time of the accident, a valid driver's license; a Passenger Restraint Benefit will be payable. If an airbag is also activated as a result of the same accident, an Airbag Benefit will be payable if the motor vehicle’s airbag system is not effective in helping save the person’s life it was designed to protect. Verification of the actual use of the passenger restraint and activation of the airbag system, if applicable, at the time of the loss must be part of an official report of the accident or certified, in writing, by investigating officer(s). No Airbag Benefit will be payable unless a Passenger Restraint Benefit is paid. 11040 Education Benefit Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 95 of 131 PageID #: 164 GR-9 9 Education Benefit for Your Dependent Child If you or your covered dependent spouse suffer a loss of life solely and as a direct result of an accident, an Education Benefit is payable on behalf of each Dependent Child as defined below. The Education Benefit will be payable in annual installments until the earliest to occur of: four years from the date of your or your spouse's death; or the date no dependent qualifies as a Dependent Child, as defined below; or the date that satisfactory proof of dependent eligibility status is not provided to Aetna within 30 days of a request for it; or discontinuance of the group policy. The first Education Benefit will be paid when: you or your covered dependent spouse's Principal Sum becomes payable; and Aetna receives written proof that the Dependent Child is attending school on a regular basis. If you and your covered dependent spouse both suffer a loss of life as a result of the same accident, only one Education Benefit, based on your Principal Sum, is payable. Education Benefits will be paid on each anniversary of the first Education Benefit, provided Aetna receives written proof that the Dependent Child is attending school on a regular basis. A Dependent Child means a child who is: your biological child; or your adopted child; or your stepchild; or any other child you support that lives with you in a parent-child relationship; and, for the purposes of this benefit, is an unmarried, full-time student and is attending school, up to and including the 12th grade of high school; or is under the age of 23, and attending college or trade school on a regular basis at the time of your or your spouse’s death; or enrolls in college or trade school within 365 days of your or your spouse’s death. The Education Benefit will be payable to the Dependent Child if that child has attained the age of majority. Otherwise, the Education Benefit will be payable to the guardian of the estate of the minor, or to the Custodian under the Uniform Transfer to Minors Act, or an adult caretaker, when permitted under applicable state law. Education Benefit for Your Spouse An Education Benefit will be paid to your surviving spouse for costs incurred, as a result of your death, towards employment training if your spouse has enrolled for the purpose of obtaining or supplementing an independent source of income. Written proof of your spouse's enrollment in an employment training program must be received within 365 days of your death. The Education Benefit will be payable in annual installments until the earliest to occur of: one year from the date of your death; or the date that satisfactory proof of dependent eligibility status is not provided to Aetna within 30 days of a request for it; or discontinuance of the group policy. The first Education Benefit will be paid when: your Principal Sum becomes payable; and Aetna receives written proof that your spouse is enrolled in an employment training program. Education Benefits will be paid on each anniversary of the first Education Benefit provided Aetna receives written proof that your dependent spouse is enrolled in an employment training program. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 96 of 131 PageID #: 165 GR-9 10 The Education Benefit will be payable to your surviving spouse, regardless of beneficiary for your Life Insurance amount. 11041, 11042 Child Care Benefit If you or your covered dependent spouse suffer a loss of life solely and as a direct result of an accident, a Child Care Benefit may be payable with respect to any Dependent Child as defined below. If the Dependent Child is enrolled in a legally licensed child care center, the Child Care Benefit is payable in annual installments until the earliest to occur of: four years from the date of you or your spouse's death; or the date no dependent qualifies as a Dependent Child, as defined below; or the date that satisfactory proof of dependent eligibility status is not provided to Aetna within 30 days of a request for it; or discontinuance of the group policy. If you and your covered dependent spouse suffer a loss of life as a result of the same accident, only one Child Care Benefit will be payable based on your Principal Sum. The first Child Care Benefit will be paid when: you or your spouse's Principal Sum becomes payable; and Aetna receives written proof that the Dependent Child is enrolled in a legally licensed child care center. Child Care Benefits will be paid on each anniversary of the first Child Care Benefit, provided Aetna receives written proof that the Dependent Child is attending a legally licensed child care center. For purposes of this benefit, a Dependent Child means a child who is under age 13 and is enrolled in a legally licensed child care center on the date of the accident or subsequently enrolled in a legally licensed child care center within 90 calendar days from the date of the accident and is either: your biological child; or your adopted child; or your stepchild; or any other child you support who lives with you in a parent-child relationship. The Child Care Benefit will be payable to the guardian of the estate of the minor, or to the Custodian under the Uniform Transfer to Minors Act, or an adult caretaker, when permitted under applicable state law. 11043 Repatriation of Remains Benefit This Plan pays a Repatriation of Remains Benefit for the preparation and transportation of a person's body to a mortuary if, as a direct result of an accident for which a benefit is payable under this section, he or she suffers loss of life while outside a 200 mile radius from his or her principal place of residence. 11046 Spouse Common Accident Benefit If you and your covered dependent spouse suffer a loss of life within 30 days of each other as a result of the same accident and your spouse's Life Insurance amount under this policy is less than $200,000, a Spouse Common Accident Benefit will be paid equal to the difference between your covered dependent spouse's Principal Sum and your Principal Sum, up to the Spouse Common Accident Benefit Maximum. This Benefit will be paid, in equal shares, to your surviving children who are under the age of 23, regardless of the beneficiary for your spouse's Life Insurance amount. If, however, there are no surviving children under the age of 23, only your covered dependent spouse's Principal Sum will be paid. For the purpose of this benefit, your surviving children include: your biological children; or your adopted children; or your stepchildren; or any other child you support who lives with you in a parent-child relationship. 11044 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 97 of 131 PageID #: 166 GR-9 11 Medical Coverage Funding Benefit If, while insured and within 365 days after an accident you or your spouse suffer a covered loss of life solely and as a direct result of an accident, a Medical Coverage Funding Benefit will be payable on behalf of your surviving dependents if both of the following are true: • your dependent enrolls for medical coverage through your Employer in accordance with the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) or State law; and • your dependent incurs out-of-pocket expenses to continue medical coverage. Aetna, at its discretion, may pay the benefit in a lump sum if the total value is less than $ 250. Otherwise, the Medical Coverage Funding Benefit will be payable annually until the earlier to occur of: • 3 years after your death; or • the death of the last surviving eligible dependent; or • discontinuance of the group policy. The benefit will be payable to the surviving spouse, if any. If you are not survived by a spouse, the benefit will be payable to your surviving dependent child or children. If a benefit is payable to a surviving dependent child or children, and that dependent child has not attained the age of majority, the Medical Coverage Funding Benefit will be payable to the guardian of the estate of the minor or to the Custodian under the Uniform Transfer to Minors Act, or adult caretaker, when permitted under applicable state law. Written proof that out-of-pocket expenses were incurred for continued medical coverage must be received by Aetna. 11535 Monthly Hospital Benefit If, while insured, and within 365 days of an accident, and as a direct result of an accident; you are confined in a hospital or convalescent facility for at least 30 successive days as a result of the accident, a Monthly Hospital Benefit will be payable. The first Monthly Hospital Benefit will be payable after you have been confined in a hospital or convalescent facility for a period of 30 successive days. Subsequent monthly benefits will be paid on the basis of 1/30 th of the monthly benefit for each day of confinement. The Monthly Hospital Benefit will be payable during a period of confinement until the earliest to occur of: • The date you are discharged from the hospital or convalescent facility; or • The date 12 monthly payments have been made; or • Discontinuance of the group policy. If a confinement for which a benefit is payable under this benefit ends, but reoccurs within 14 days of discharge due to the same accident, it will be considered the same period of confinement. Monthly Hospital Benefits will continue to be paid as if there is no break in the confinement. If the confinement reoccurs after 14 days, it will be considered a new period of confinement and benefits will not be payable until after you have completed a stay of 30 successive days. A period of confinement must begin while you are insured for Accidental Death and Personal Loss Coverage. Written proof that you were confined for at least 30 successive days must be submitted to Aetna. If you are unable to submit proof because you are incapacitated, proof may be submitted by a person acting on your behalf. In order for Aetna to pay this benefit on a monthly basis, written proof must be submitted to Aetna within 30 days of each successive period of 30 days of confinement. If it is not possible to submit proof as required, the benefit will still be payable if proof is furnished to Aetna in writing within 90 days of discharge from the hospital or convalescent facility. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 98 of 131 PageID #: 167 GR-9 (654092 N.V.) 92905 12 Traumatic Brain Injury Benefit If, while insured, and as a direct result of an accident, you suffer permanent and irreversible brain damage causing the complete inability to perform all the functions and activities normal to daily living, you may be eligible for a Traumatic Brain Injury Benefit equal to 100% of your Principal Sum. You must meet all of the following to be eligible: the injury requires hospitalization for at least 5 consecutive days. the injury manifests itself within 30 days of the accident. the injury persists for 12 consecutive months from the date of the accident causing the injury. the injury prevents you from performing all activities normal to daily living. Activities normal to daily living include: bathing: Washing oneself by a sponge bath; or washing oneself in either a tub or shower, including the task of getting into and out of the tub or shower. transferring: Moving into our out of a bed, chair or wheelchair. dressing: Putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs. toileting: Getting to and from the toilet, getting on and off the toilet and associated personal hygiene. continence: The ability to maintain control of bowel and bladder functions; and when unable to maintain control of bowel and bladder functions, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag). eating: Feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table), or by a feeding tube or intravenously. “Eating” does not include shopping for food or preparing food for consumption. Proof of the injury must be received by Aetna at its Home Office within 90 days of meeting the above conditions. If proof is not received within 90 days, you will not be eligible for this benefit. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 99 of 131 PageID #: 168 GR-9 13 Limitations This coverage is only for losses caused by accidents. No benefits are payable for a loss caused or contributed to by: • A bodily or mental infirmity. • A disease, ptomaine, or bacterial infection.* • Medical or surgical treatment.* • Suicide or attempted suicide (while sane or insane). • An intentionally self-inflicted injury. • A war or any act of war (declared or not declared). • Voluntary inhalation of poisonous gases. • Commission of or attempt to commit a criminal act. • Use of alcohol, intoxicants, or drugs, except as prescribed by a physician. An accident in which the blood alcohol level of the operator of a motor vehicle meets or exceeds the level at which intoxication would be presumed under the law of the state where the accident occurred shall be deemed to be caused by the use of alcohol. • Intended or accidental contact with nuclear or atomic energy by explosion and/or release. • Air or space travel. This does not apply if a person is a passenger, with no duties at all, on an aircraft being used only to carry passengers (with or without cargo). * These do not apply if the loss is caused by: • An infection which results directly from the injury. • Surgery needed because of the injury. The injury must not be one which is excluded by the terms of this section. 11047 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 100 of 131 PageID #: 169 GR-9 14 Effect Of Benefits Under Other Plans 5030 Effect of Prior Coverage - Transferred Business If the coverage of any person under any part of this Plan replaces any prior coverage of the person, the rules below apply to that part. "Prior coverage" is any plan of group coverage that has been replaced by coverage under part or all of this Plan; it must have been sponsored by your Employer (i.e., transferred business). The replacement can be complete or in part for the Eligible Class to which you belong. Any such plan is prior coverage if provided by another group contract or any benefit section of this Plan. A person's Life Insurance under this Plan replaces and supersedes any prior life insurance. It will be in exchange for everything under the prior life insurance. If you or your beneficiary become entitled to claim under the prior life insurance, your Life Insurance under this Plan will be canceled. This will be done as of its effective date. Any premiums paid for your Life Insurance under this Plan will be returned to your Employer. The mode of settlement you chose and the beneficiary you named under a prior Aetna life insurance plan will apply to this Plan. This can be changed according to the terms of this Plan. Coverage under any other section of this Plan will be in exchange for all privileges and benefits provided under any like prior coverage. Any benefits provided under such prior coverage may reduce benefits payable under this Plan. The beneficiary you named under a prior Aetna accidental death and dismemberment coverage plan will apply to this Plan. This can be changed according to the terms of this Plan. 6051 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 101 of 131 PageID #: 170 GR-9 15 General Information About Your Coverage Termination of Coverage Coverage under this Plan terminates at the first to occur of: When employment ceases. When the group contract terminates as to the coverage. When you are no longer in an Eligible Class. (This may apply to all or part of your coverage.) When you fail to make any required contribution. Your Employer will notify Aetna of the date your employment ceases for the purposes of termination of coverage under this Plan. This date will be either the date you cease active work or the day before the next premium due date following the date you cease active work. Your Employer will use the same rule for all employees. If you are not at work on this date due to one of the following, employment may be deemed to continue up to the limits shown below. If you are not at work due to disease or injury: For Life Insurance, your employment will be continued for up to 6 months from the start of the absence. It may be further continued until stopped by your Employer but not beyond 12 months from the start of the absence. For all other coverage, your employment may be continued until stopped by your Employer but not beyond 12 months from the start of the absence. If you are eligible as a permanently and totally disabled employee under the terms of the Eligibility section, your employment may be deemed to continue for Life Insurance while you remain eligible under that section. If you are not at work due to temporary lay-off or leave of absence, your employment may continue until stopped by your Employer, but not beyond the end of the policy month after the policy month in which the absence started. The term "policy month" is defined elsewhere in the group contract. See your Employer for this definition. The Summary of Coverage may show an Eligible Class of retired employees. If you are in that class, your employment may be deemed to continue: for any coverage shown in the Retirement Eligibility section; and subject to any limits shown in that section. If no Eligible Class of retired employees is shown, there is no coverage for retired employees. In figuring when employment will stop for the purposes of termination of any coverage, Aetna will rely upon your Employer to notify Aetna. This can be done by telling Aetna or by stopping premium payments. Your employment may be deemed to continue beyond any limits shown above if Aetna and your Employer so agree in writing. If you cease active work, ask your Employer if any coverage can be continued. Dependents Coverage Only A dependent's coverage will terminate at the first to occur of: Termination of all dependents' coverage under the group contract. When a dependent becomes covered as an employee. When such person is no longer a defined dependent. When your coverage terminates. 6080 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 102 of 131 PageID #: 171 GR-9 16 Handicapped Dependent Children Life Insurance and Accidental Death and Personal Loss Coverage for your fully handicapped dependent child may be continued past the maximum age for a dependent child. However, such coverage may not be continued if the child has been issued a personal life conversion policy. 11048 Your child is fully handicapped if: he or she is not able to earn his or her own living because of mental retardation or a physical handicap which started prior to the date he or she reaches the maximum age for dependent children; and he or she depends chiefly on you for support and maintenance. Proof that your child is fully handicapped must be submitted to Aetna no later than 31 days after the date your child reaches the maximum age. Coverage will cease on the first to occur of: Cessation of the handicap. Failure to give proof that the handicap continues. Failure to have any required exam. Termination of Dependent Coverage as to your child for any reason other than reaching the maximum age. Aetna will have the right to require proof of the continuation of the handicap. Aetna also has the right to examine your child as often as needed while the handicap continues at its own expense. An exam will not be required more often than once each year after 2 years from the date your child reached the maximum age. 11048 Conversion of Life Insurance Your Life Insurance If any of your Life Insurance ceases because your employment ceases or you are no longer in a class eligible for such insurance, or because of age, pension or retirement, the amount of insurance which ceases (or a lesser amount if desired) may be converted to an individual life insurance policy. Your Dependents' Life Insurance If any of your Dependents' Life Insurance ceases because: • your employment ceases; • you are no longer in a class eligible for such insurance; • the dependent ceases to be a dependent; • of a reduction in the dependent's life insurance for any reason; or • you die; the amount of insurance which ceases for each dependent (or lesser amounts, if desired) may be converted to individual life insurance policies. 6200, 6205 General Information Concerning The Conversion Privilege The converted policy may be any kind of individual policy then customarily being issued by Aetna for the amount being converted and for the individual's age (nearest birthday) on the date it will be issued, except a term policy or one with disability or other supplementary benefits. When Life Insurance ceases because that part of the group contract discontinues as to your employee class, and insurance on the life of the person has been in force under the group contract for at least 5 years in a row prior to such discontinuance, the amount that ceases less the amount of any group life insurance for which the person becomes eligible within 31 days of discontinuance may be converted to an individual policy. The maximum amount that can be converted by each person in any event is $ 10,000. In order to convert, written application must be made for an individual policy and the first premium must be paid on it within 31 days after cessation of insurance for any of the above reasons. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 103 of 131 PageID #: 172 GR-9 17 No evidence of insurability will be required. The individual policy will become effective at the end of the 31 day period during which conversion is possible. The premiums for the converted policy will be at Aetna's then customary rates for the same policy issued to any other person of the same class of risk and age at the time the converted policy is to become effective. After an individual policy becomes effective for any person, that policy will be in exchange for all benefits and privileges under the group contract as regards the person involved and the amount that could have been converted. Life Insurance After Termination In most cases a person can apply for an individual policy under the Conversion Privilege within 31 days after his or her Life Insurance ceases. If a person dies during this 31 days and before the individual policy goes into effect, the amount payable under the group contract is limited to the maximum that could have been converted. This limit applies even if he or she has not applied for or paid the first premium on the individual policy. 6210, 6160 Legal Action (Does not apply to Life Insurance) No legal action can be brought to recover under any benefit after 3 years from the deadline for filing claims. Aetna will not try to reduce or deny a benefit payment on the grounds that a condition existed before a person's coverage went into effect, if the loss occurs more than 2 years from the date coverage commenced. This will not apply to conditions excluded from coverage on the date of the loss. 6470-1 Additional Provisions The following additional provisions apply to your coverage. • You cannot receive multiple coverage under this Plan because you are connected with more than one Employer. • In the event of a misstatement of any fact affecting your coverage under this Plan, the true facts will be used to determine the coverage in force. This document describes the main features of this Plan. Additional provisions are described elsewhere in the group contract. If you have any questions about the terms of this Plan or about the proper payment of benefits, you may obtain more information from your Employer or, if you prefer, from the Home Office of Aetna. Your Employer hopes to continue this Plan indefinitely but, as with all group plans, this Plan may be changed or discontinued with respect to all or any class of employees. 6470 Assignments Life Insurance may be assigned only with Aetna's written consent and only if you assign all ownership as a gift. If you wish to do this, an assignment form must be completed by you. Then send 3 copies to Aetna's Home Office to be approved. See your Employer for details. Neither your Employer nor Aetna guarantees or assumes any obligation concerning any assignment. All other coverage may be assigned only with the written consent of Aetna. Claims of Creditors If allowed by law, Life Insurance and Accidental Death and Personal Loss Coverage benefits are exempt from legal or equitable process for your debts. This also applies to the debts of your beneficiary. Beneficiaries You may name or change your beneficiary by filing written request at your Employer's headquarters or at Aetna's Home Office. Ask your Employer for the forms. The naming or any change will take effect as of the date you execute the request. Aetna will be fully discharged of its duties as to any payment made by it before your request is received at its Home Office. Any amount payable to a beneficiary will be paid to those you name. Unless you state to the contrary, if more than one beneficiary is named, they will share on equal terms. If a named beneficiary dies before you, his or her share will be payable in equal shares to any other named beneficiaries who survive you. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 104 of 131 PageID #: 173 GR-9 18 If no named beneficiary survives you or if no beneficiary has been named, payment will be made as follows to those who survive you: • Your spouse, if any. • If there is no spouse, in equal shares to your children. • If there is no spouse or child, to your parents, equally or to the survivor. • If there is no spouse, child, or parent, in equal shares to your brothers and sisters. • If none of the above survives, to your executors or administrators. 6430, 6400, 6475 Reporting of Claims A claim must be submitted to Aetna in writing. It must give proof of the nature and extent of the loss. Your Employer has claim forms. 6320 All claims should be reported promptly. The deadline for filing a claim for any benefits is 90 days after the date of the loss causing the claim. The deadline does not apply to Life Insurance. 6320 If, through no fault of your own, you are not able to meet the deadline for filing claim, your claim will still be accepted if you file as soon as possible. Unless you are legally incapacitated, late claims will not be covered if they are filed more than one year after the deadline. 6320 Payment of Benefits 6350, 9265 Benefits will be paid as soon as the necessary proof to support the claim is received. For all benefits except any Temporary Disability Benefit, written proof must be provided. Any death benefit for your loss of life will be paid in one lump sum and in accordance with the beneficiary designation. 6350, 9265 All other benefits are payable to you. 6350, 9265 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 105 of 131 PageID #: 174 GR-9 19 For New Jersey Employees: Any unpaid balance will be paid within 30 days of receipt by Aetna of the due written proof. 7693 For All Other Employees: Any unpaid balance will be paid within 30 days of receipt by Aetna of the due written proof. This paragraph does not apply to Life Insurance. 7693 If your beneficiary is a minor or, in Aetna’s opinion, legally unable to give a valid release for payment of any Life Insurance benefit, the benefit will be payable to the guardian of the estate of the minor, or to the Custodian under the Uniform Transfer to Minors Act, or an adult caretaker, when permitted under applicable state law. 6350, 9265 Aetna may pay up to $ 1,000 of any other benefit to any of your relatives whom it believes fairly entitled to it. This can be done if the benefit is payable to you and you are a minor or not able to give a valid release. It can also be done if a benefit is payable to your estate. 6350, 9265 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 106 of 131 PageID #: 175 GR-9 20 Glossary The following definitions of certain words and phrases will help you understand the benefits to which the definitions apply. Some definitions which apply only to a specific benefit appear in the benefit section. If a definition appears in a benefit section and also appears in the Glossary, the definition in the benefit section will apply in lieu of the definition in the Glossary. 9990 Airbag An airbag is: • an unaltered airbag installed by the manufacturer of the motor vehicle; or • an airbag: provided by the manufacturer of the motor vehicle; and installed by an authorized motor vehicle dealer. Coma This means the condition of being comatose. Comatose This means a profound state of unconsciousness from which the person cannot be aroused to consciousness, even by powerful stimulation, as certified by a physician. Legally Licensed Child Care Center This is a facility which is duly licensed, certified, or accredited by the jurisdiction in which it is located to provide child care and is operating in compliance with applicable laws and regulations of the jurisdiction. Motor Vehicle This is a vehicle that is a registered and licensed vehicle and is: • a passenger land vehicle of pleasure design which includes autos, vans, four-wheel drive vehicles, and self-propelled motor homes; or • a truck of commercial design. For purposes of the Passenger Restraint and Airbag Benefit only, the following will not be considered to be a motor vehicle: • a motor vehicle which has been altered and no longer meets the licensing and registration requirements; or • a motorcycle; or • an "ATV" All Terrain Vehicle; or • a military vehicle; or • a vehicle while being used for farming or racing or any other type of competitive event. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 107 of 131 PageID #: 176 GR-9 21 Passenger Restraint This is a restraint that is: • an unaltered seat belt or lap and shoulder restraint installed by the manufacturer of the motor vehicle; or • a seat belt or lap and shoulder restraint; provided by the manufacturer of the motor vehicle; and installed by an authorized motor vehicle dealer; and • any child restraint device which is properly secured in the motor vehicle and meets the definition of the law of the state in which the motor vehicle is licensed and registered. Third Degree Burn A third-degree burn or a full thickness burn is the most severe of the three burns extending near or to the bone. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 108 of 131 PageID #: 177 Confidentiality Notice Confidentiality Notice Aetna considers personal information to be confidential and has policies and procedures in place to protect it against unlawful use and disclosure. By "personal information," we mean information that relates to a member's physical or mental health or condition, the provision of health care to the member, or payment for the provision of health care or disability or life benefits to the member. Personal information does not include publicly available information or information that is available or reported in a summarized or aggregate fashion but does not identify the member. When necessary or appropriate for your care or treatment, the operation of our health, disability or life insurance plans, or other related activities, we use personal information internally, share it with our affiliates, and disclose it to health care providers (doctors, dentists, pharmacies, hospitals and other caregivers), payors (health care provider organizations, employers who sponsor self-funded health plans or who share responsibility for the payment of benefits, and others who may be financially responsible for payment for the services or benefits you receive under your plan), other insurers, third party administrators, vendors, consultants, government authorities, and their respective agents. These parties are required to keep personal information confidential as provided by applicable law. Some of the ways in which personal information is used include claim payment; utilization review and management; coordination of care and benefits; preventive health, early detection, vocational rehabilitation and disease and case management; quality assessment and improvement activities; auditing and anti-fraud activities; performance measurement and outcomes assessment; health, disability and life claims analysis and reporting; health services, disability and life research; data and information systems management; compliance with legal and regulatory requirements; formulary management; litigation proceedings; transfer of policies or contracts to and from other insurers, HMOs and third party administrators; underwriting activities; and due diligence activities in connection with the purchase or sale of some or all of our business. We consider these activities key for the operation of our health, disability and life plans. To the extent permitted by law, we use and disclose personal information as provided above without member consent. However, we recognize that many members do not want to receive unsolicited marketing materials unrelated to their health, disability and life benefits. We do not disclose personal information for these marketing purposes unless the member consents. We also have policies addressing circumstances in which members are unable to give consent. To obtain a copy of our Notice of Information Practices, which describes in greater detail our practices concerning use and disclosure of personal information, please call 1-866-825-6944 or visit our Internet site at www.aetna.com. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 109 of 131 PageID #: 178 Continuation of Coverage During an Approved Leave of Absence Granted to Comply With Federal Law This continuation of coverage section applies only for the period of any approved family or medical leave (approved FMLA leave) required by Family and Medical Leave Act of 1993 (FMLA). If your Employer grants you an approved FMLA leave for a period in excess of the period required by FMLA, any continuation of coverage during that excess period will be subject to prior written agreement between Aetna and your Employer. If your Employer grants you an approved FMLA leave in accordance with FMLA, your Employer may allow you to continue coverage for which you are covered under the group contract on the day before the approved FMLA leave starts. This includes coverage for your eligible dependents. At the time you request the leave, you must agree to make any contributions required by your Employer to continue coverage. Your Employer must continue to make premium payments. If any coverage your Employer allows you to continue has reduction rules applicable by reason of age or retirement, the coverage will be subject to such rules while you are on FMLA leave. Coverage will not be continued beyond the first to occur of: • The date you are required to make any contribution and you fail to do so. • The date your Employer determines your approved FMLA leave is terminated. • The date the coverage involved discontinues as to your eligible class. Any coverage being continued for a dependent will not be continued beyond the date it would otherwise terminate. If the group contract provides continuation of coverage (for example, upon termination of employment), you (or your eligible dependents) may be eligible for such continuation on the date your Employer determines your approved FMLA leave is terminated or the date of the event for which the continuation is available. If you acquire a new dependent while your coverage is continued during an approved FMLA leave, the dependent will be eligible for the continued coverage on the same terms as would be applicable if you were actively at work, not on an approved FMLA leave. If you return to work for your Employer following the date your Employer determines the approved FMLA leave is terminated, your coverage under the group contract will be in force as though you had continued in active employment rather than going on an approved FMLA leave provided you make request for such coverage within 31 days of the date your Employer determines the approved FMLA leave to be terminated. If you do not make such request within 31 days, coverage will again be effective under the group contract only if and when Aetna gives its written consent. If any coverage being continued terminates because your Employer determines the approved FMLA leave is terminated, any Conversion Privilege will be available on the same terms as though your employment had terminated on the date your Employer determines the approved FMLA leave is terminated. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 110 of 131 PageID #: 179 Claim Procedures Your booklet-certificate contains information on reporting claims. Claim forms may be obtained at your place of employment. These forms tell you how and when to file a claim. Note: If applicable state law requires the Plan to take action on a claim or appeal within a shorter timeframe, the shorter period will apply. You may file claims for Plan benefits, and appeal adverse claim decisions, either yourself or through an authorized representative. An "authorized representative" means your legal spouse or adult child, or a person you authorize, in writing, to act on your behalf. In addition, the Plan will recognize a court order giving a person authority to submit claims on your behalf. Filing Life Claims under the Plan You will be notified of an adverse benefit determination not later than 90 days after the Plan's receipt of the claim. This time period may be extended up to an additional 90 days due to special circumstances. In that case, you will be notified of the extension before the end of the initial 90-day period. Notice of the extension will explain the special circumstances requiring the extension and the date by which a decision is expected. Filing Premium Waiver, DBO or DBO-AID Claims under the Plan You will be notified of an adverse benefit determination not later than 45 days after the Plan's receipt of the claim. This time period may be extended up to an additional 30 days due to circumstances outside the Plan's control. In that case, you will be notified of the extension before the end of the initial 45-day period. If a decision cannot be made within this 30 day extension period due to circumstances outside the Plan's control, the time period may be extended up to an additional 30 days, in which case you will be notified before the end of the first 30 day extension period. Notice of the extension will explain the special circumstances requiring the extension and the date by which a decision is expected. If your claim is denied in whole or in part, you will receive a written notice of the denial from Aetna Life Insurance Company. The notice will explain the reason for the denial and the review procedure. Filing an Appeal of an Adverse Benefit Determination Life Claims You may request a review of the denied claim. You will have 60 days following receipt of an adverse benefit decision to appeal the decision. The request must be submitted, in writing, and include your reasons for requesting the review. Submit your request to the office of the Aetna Life Insurance Company to which you submitted your initial request for benefit payment. You will be notified of the decision not later than 60 days after the appeal is received. If an extension of time for processing the appeal is needed, the time period may be extended up to an additional 60 days, in which case you will be notified prior to the end of the first 60 day period. The notice will indicate the special circumstances requiring an extension and the date by which a decision is expected. Premium Waiver, DBO or DBO-AID Claims You may request a review of the denied claim. You will have 180 days following receipt of an adverse benefit decision to appeal the decision. The request must be submitted, in writing, and include your reasons for requesting the review. Submit your request to the office of the Aetna Life Insurance Company to which you submitted your initial request for benefit payment. You will be notified of the decision not later than 45 days after the appeal is received. If an extension of time for processing the appeal is needed, the time period may be extended up to an additional 45 days, in which case you will be notified prior to the end of the first 45 day period. The notice will indicate the special circumstances requiring an extension and the date by which a decision is expected. You may submit written comments, documents, records and other information relating to your claim, whether or not the comments, records or information were submitted in connection with the initial claim. You may also request that the Plan provide you, free of charge, copies of all documents, records, and other information relevant to the claim. Assistance with Your Questions If you have any questions about your Plan, you should contact the Plan Sponsor. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 111 of 131 PageID #: 180 A Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 112 of 131 PageID #: 181 IMPORTANT NOTICE To obtain information or make a complaint: AVISO IMPORTANTE Para obtener información o para someter una queja: You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights, or complaints at: 1-800-252-3439 You may write the Texas Department of Insurance at: Texas Department of Insurance P.O. Box 149104 Austin, TX 78714-9104 FAX No. (512) 475-1771 Premium or Claim Disputes: Should you have a dispute concerning your premium or about a claim you should contact Aetna first. If the dispute is not resolved you may contact the Texas Department of Insurance. Notice: This notice is for information only and does not become a part or condition of your Certificate. Puede comunicarse con el Departamento de Seguros de Texas para obtener información acerca de compañías, coberturas, derechos, o quejas llamando al: 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas: Texas Department of Insurance P.O. Box 149104 Austin, TX 78714-9104 FAX No. (512) 475-1771 Disputas Sobre Primas o Reclamaciones: Si surge una disputa concerniente a su prima o a una reclamación, debe comunicarse con Aetna primero. Si no se resuelve la disputa puede comunicarse con el Departamento de Seguros de Texas. Aviso: Este aviso es sólo para propósito de información y no se convierte en una parte o condición de su Folleto. You may call Aetna's toll-free telephone number for information or to make a complaint at: 1-888-982-7227 Usted puede llamar al siguiente número de teléfono gratuito de Aetna para obtener información o para presentar una queja: 1-888-982-7227 You may write to Aetna at: Aetna Life Insurance Company Attn: Health Law Department 151 Farmington Avenue Hartford, Connecticut 06156 Usted puede escribir a Aetna: Aetna Life Insurance Company Attn: Health Law Department 151 Farmington Avenue Hartford, Connecticut 06156 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 113 of 131 PageID #: 182 Notice to Policyholders and Certificate Holders Questions regarding your policy or coverage should be directed to: Aetna Life Insurance Company Contact Number: 1-866-825-6944. If you (a) need the assistance of the governmental agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone, or email: Indiana Department of Insurance Consumer Services Division 311 West Washington Street, Suite 300 Indianapolis, IN 46204 Consumer Hotline: (800) 622-4461; (317) 232-2395 Complaints can be filed electronically at www.in.gov/idoi. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 114 of 131 PageID #: 183 Arizona Employees: NOTICE: THIS CERTIFICATE OF INSURANCE MAY NOT PROVIDE ALL BENEFITS AND PROTECTIONS PROVIDED BY LAW IN ARIZONA. PLEASE READ THIS CERTIFICATE CAREFULLY. New Hampshire Employees: Aetna shall not be liable for death, injury incurred or disease contracted, as a result of a person's commission of, or attempt to commit, a felony. Aetna shall not be liable for death, injury incurred or disease contracted while a person was engaged in an illegal occupation. North Dakota Employees: Notice Concerning Your Right to Review Your Life Insurance If you review the Life Insurance described in this Booklet-Certificate and are not satisfied with the coverage for any reason, you will have 20 days from the date you received the Booklet-Certificate to request a full refund of your contribution towards the cost of the insurance. Ohio Employees: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE OR SHE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. West Virginia Employees: NOTICE: If you are not satisfied with the coverage under this Plan, you may return this booklet-certificate to your Employer within 10 days of receipt. If you return the booklet-certificate, your coverage (and the coverage for any of your dependents who are covered) will then be terminated under this Plan. If you have not incurred any claims under this Plan, either with respect to yourself or any of your dependents, any required contributions you made for coverage before the date of such termination will be returned to you. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 115 of 131 PageID #: 184 GR-9 0030-0120 1 Summary of Coverage Employer: Colgate-Palmolive Company Group Policy: GP-654092 SOC: 3B Issue Date: August 28, 2006 Effective Date: January 1, 2006 The benefits shown in this Summary of Coverage are available for you and your eligible dependents. This Summary of Coverage may be an electronic version of the Summary of Coverage on file with your Employer and Aetna Life Insurance Company. In case of any discrepancy between an electronic version and the printed copy which is part of the group insurance contract issued by Aetna Life Insurance Company, or in case of any legal action, the terms set forth in such group insurance contract will prevail. To obtain a printed copy of this Summary of Coverage, please contact your Employer. Eligibility Employees You are in an Eligible Class if you are a regular full-time non-bargaining employee or a part time non-bargaining employee who works a continuous schedule and works more than 17.5 hours and less than 35 hours a week in a position which has an established job description and salary grade, of an Employer participating in this Plan and not an employee who is in a class for which a separate Summary of Coverage has been designated for the coverages described in this Summary of Coverage. Your Eligibility Date, if you are then in an Eligible Class, is the Effective Date of this Plan. Otherwise, it is the first day of the calendar month coinciding with or next following the date you complete a probationary period of 1 full month of continuous service for your Employer or, if later, the date you enter the Eligible Class. Dependents You may cover your: • wife or husband; and • unmarried children who are under 23 years of age. Your children include: • Your biological children. • Your adopted children. • Your stepchildren. • Any other child you support who lives with you in a parent-child relationship. No person may be covered both as an employee and dependent and no person may be covered as a dependent of more than one employee. Eligibility For Life Insurance if you are Disabled If you become disabled before you retire, the same life insurance plan that is offered to active employees continues automatically for up to six months while you are receiving benefits under the Short Term Disability Plan. If you become eligible for and receive benefits under the Long Term Disability Plan before you retire, your coverage under the Life Insurance Plan will continue for a specified period of time, as shown in the following chart, provided that you make the required contributions to purchase the coverage. All contributions will be made on an after-tax basis. Non-Bargaining Employees Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 116 of 131 PageID #: 185 GR-9 0030-0120 2 How Long Life Insurance Coverage Will Continue If Age at Onset of Short Term disability is Credited Years of Service at Onset of Short Term Disability Less Than 40 40 but Less Than 50 50 and Over Less than five years 2 years 3 years 5 years Five years but less than 15 years 3 years 5 years 10 years 15 years but less than 25 years 5 years 10 years 15 years 25 years or more 10 years 15 years to retirement Enrollment Procedure You will be required to enroll in a manner determined by Aetna and your Employer. This will allow your Employer to deduct your contributions from your pay for Supplemental Life Insurance, Supplemental Dependents Life Insurance, Supplemental Accidental Death and Personal Loss Coverage and Supplemental Dependents Accidental Death and Personal Loss Coverage. Your Basic Life Insurance, Dependents Basic Life, Basic Accidental Death and Personal Loss Coverage and Dependents Accidental Death and Personal Loss Coverage is paid 100% by your Employer. Be sure to enroll within 31 days of your Eligibility Date. Your contributions toward the cost of this coverage will e deducted from your pay and are subject to change. The rate of any required contributions will be determined by your Employer. See your Employer for details Effective Date of Coverage Employees Your coverage will take effect on the later to occur of: • your Eligibility Date; and • the date you return your signed form. If you don't sign and return your form within 31 days of your Eligibility Date, coverage will not take effect until you submit evidence of good health that is acceptable to Aetna. Active Work Rule: If you happen to be ill or injured and away from work on the date your coverage would take effect, the coverage will not take effect until you return to full-time work for one full day. This rule also applies to an increase in your coverage. Dependents Coverage for your dependents will take effect on the date yours takes effect if, by then, you have enrolled for dependent coverage. You are not in an Eligible Class for Dependent Life Insurance coverage if you do not enroll for Supplemental Life Insurance. You should report any new dependents. This may affect your contributions. If you don't do so within 31 days of any dependent's eligibility date, evidence of his or her good health that is acceptable to Aetna will be required. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 117 of 131 PageID #: 186 GR-9 0030-0120 3 Life Insurance Schedule of Life Insurance Non-Bargaining Employees Basic Schedule Classification Amount Option 1 50% of your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 2 100% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 3 150% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Members of the Board $ 50,000 Supplemental Schedule* Classification Amount Option 1 50% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 2 100% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 3 150% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 118 of 131 PageID #: 187 GR-9 0030-0120 4 Option 4 200% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 5 250% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 6 300% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 7 350% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 8 400% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 9 450% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 10 500% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 11 550% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 119 of 131 PageID #: 188 GR-9 0030-0120 5 Option 12 600% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 13 650% of your your highest recognized hourly earnings to date, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Your overall combined maximum for Basic Life Insurance and Supplemental Life Insurance is $2,500,000. * If prior to the Effective Date of this Plan you had the option to elect Supplemental Life Insurance under any other group plan sponsored by the Policyholder, whether underwritten by Aetna or not and elected not to do so, Supplemental Life Insurance under this Plan will not take effect until you submit evidence of good health that is acceptable to Aetna. You may elect coverage under any one of the available options shown above for Supplemental Life Insurance. Once you have made a selection, if you wish to choose a different option, your Employer will provide you with information on when and how you can make that change. Evidence Requirements If, while insured: • you elect to increase your Life Insurance by more than one level or multiple of your basic annual earnings; or • you elect to increase your Life Insurance by any amount after you have applied for an Accelerated Death Benefit; you can become insured for the new amount only if you submit evidence of good health to Aetna and such evidence is approved by Aetna. This applies even if Aetna has approved evidence of your good health in the past. If you do not or did not elect Life Insurance within 31 days of the date you were first eligible to elect Life Insurance, whether under this Plan or any other group plan sponsored by the Policyholder, coverage under this Plan will not take effect until you submit evidence of good health to Aetna. If Evidence of Insurability is not acceptable to Aetna, you will not be eligible for coverage under this Plan. Dependents Basic Schedule* Classification Amount Spouse $ 7,500 Unmarried child(ren), under 23 years of age $ 5,000 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 120 of 131 PageID #: 189 GR-9 0030-0120 6 Supplemental Schedule* Classification Amount Spouse Option 2 $ 25,000 Option 3 $ 50,000 Option 4 $ 100,000 Option 5 $ 150,000 Option 6 $ 200,000 Unmarried child(ren), under 23 years of age Option 2 $ 15,000 Option 3 $ 15,000 Option 4 $ 20,000 Option 5 $ 20,000 Option 6 $ 20,000 * If prior to the Effective Date of this Plan you had the option to elect Dependent Life Insurance under any other group plan sponsored by the Policyholder, whether underwritten by Aetna or not and elected not to do so, dependent spouse Life Insurance and dependent child Life Insurance in excess of $10,000 under this Plan will not take effect until you submit evidence of that person's health that is acceptable to Aetna. Evidence Requirements If: you request Life Insurance coverage for a dependent within 31 days of the date you are first eligible to elect coverage for that dependent; and you are eligible for an amount of Life Insurance in excess of $ 50,000 for your spouse or $ 20,000 for your child; you can become insured with respect to that dependent for an amount in excess of the above limits only if you submit evidence of that dependent's good health to Aetna and such evidence is approved by Aetna. If you request Life Insurance coverage for a dependent spouse more than 31 days after the date you are first eligible to elect coverage for that dependent spouse, whether under this Plan or any other group plan sponsored by the Policyholder, you can become insured with respect to that dependent spouse only if you submit evidence of that dependent's good health to Aetna and such evidence is approved by Aetna. If you request Life Insurance coverage for a dependent child more than 31 days after the date you are first eligible to elect coverage for that dependent child, whether under this Plan or any other group plan sponsored by the Policyholder, you can become insured with respect to that dependent child without having to submit evidence of good health to Aetna provided the amount is not more than $ 20,000. To become insured for an amount over $ 20,000 you must submit evidence of that dependent child's good health to Aetna and such evidence must be approved by Aetna. If the evidence of good health is not approved by Aetna, you can still become insured with respect to that dependent child for an amount not to exceed $ 10,000. If, while insured for dependent coverage under this Plan, you first become eligible for an amount of Life Insurance in excess of $ 50,000 for your spouse or $ 20,000 for your child, you can become insured with respect to that dependent for an amount in excess of the above limits only if you submit evidence of that dependent's good health to Aetna and such evidence is approved by Aetna. Thereafter, when eligible, you may increase your dependent coverage by one additional increment of up to $ 25,000 without having to submit evidence of good health to Aetna. If you elect to increase coverage by more than one increment or if the incremental increase is more than $ 25,000, evidence of good health will be required. This applies even if Aetna has approved evidence of your dependent's good health in the past. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 121 of 131 PageID #: 190 GR-9 0030-0120 7 Accelerated Death Benefit Employees and Dependents (Combined Basic and Supplemental Amounts) ADB Months: 12 ADB Percentage: 75% ADB Minimum: $ 5,000 ADB Maximum: $ 500,000 For Texas Employees: Death benefits will be reduced if an accelerated death benefit is paid. At the time an accelerated death benefit is paid, a statement will be sent to you specifying the amount of benefits paid, the effect of the benefit on other certificate benefits, future charges and premiums. The Accelerated Death Benefits (ADB) offered under this certificate are intended to qualify for favorable tax treatment under the Internal Revenue Code of 1986. If the ADB qualify for such favorable tax treatment, the benefits will be excludable from your income and not subject to federal taxation. Tax laws relating to ADB are complex. You are advised to consult with a qualified tax advisor about circumstances under which you could receive ADB excludable from income under federal law. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 122 of 131 PageID #: 191 GR-9 0030-0120 8 Accidental Death and Personal Loss Coverage Schedule of Accidental Death and Personal Loss Coverage Non-Bargaining Employees Basic Schedule Classification Amount Option 1 50% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 2 100% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 3 150% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Supplemental Schedule Classification Amount Option 1 50% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 2 100% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 3 150% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 123 of 131 PageID #: 192 GR-9 0030-0120 9 Option 4 200% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 5 250% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 6 300% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 7 350% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 8 400% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 9 450% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 10 500% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 11 550% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 124 of 131 PageID #: 193 GR-9 0030-0120 10 Option 12 600% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Option 13 650% of your basic annual earnings, as determined by your Employer, rounded to the next higher $ 1,000, if not an integral multiple of $ 1,000. Maximum: $ 2,500,000 Minimum: $ 1,000 Your overall combined maximum for Basic Accidental Death and Personal Loss and Supplemental Accidental Death and Personal Loss is $2,500.000. You may elect coverage under any one of the available options shown above for Supplemental Accidental Death and Personal Loss Coverage. Once you have made a selection, if you wish to choose a different option, your Employer will provide you with information on when and how you can make that change. Dependents Basic Schedule Classification Amount Spouse $ 7,500 Unmarried child(ren), under 23 years of age $ 5,000 Supplemental Schedule* Classification Amount Spouse Option 2 $ 25,000 Option 3 $ 50,000 Option 4 $ 100,000 Option 5 $ 150,000 Option 6 $ 200,000 Unmarried child(ren), under 23 years of age Option 2 $ 15,000 Option 3 $ 15,000 Option 4 $ 20,000 Option 5 $ 20,000 Option 6 $ 20,000 * The amount of the person's Principal Sum will be based on the amount of coverage in-force on the date of the accident, not the amount of coverage that may be in-force at the time of the loss. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 125 of 131 PageID #: 194 GR-9 0030-0120 11 Additional Accidental Death Benefit Maximums Employees and Dependents Coma Benefit Percentage 5% of your full Principal Sum** Education Benefit Maximum for each dependent child 10% of your Principal Sum not to exceed $ 25,000 one time benefit payable over 4 years for your spouse 10% of your Principal Sum not to exceed $ 20,000 up to 1 year Passenger Restraint Benefit Maximum for you $ 15,000* for each covered dependent The lesser of $ 15,000 and your covered dependent's Principal Sum** Airbag Benefit Maximum $ 10,000 Child Care Benefit Maximum for each child 5% of your Principal Sum** not to exceed $ 7,500 per year per child for up to 4 years Traumatic Brain Injury Benefit Percentage 100% of your full Principal Sum** Repatriation of Remains Benefit Maximum $ 5,000* Spouse Common Accident Benefit Maximum $ 200,000 * This benefit maximum is payable only once, even if the person is covered for both Basic and Supplemental Accidental Death and Personal Loss Coverage at the time of the loss. ** With respect to a dependent, the amount of the person's Principal Sum will be based on the amount of coverage in-force on the date of the accident, not the amount of coverage that may be in-force at the time of the loss. Accidental Death and Personal Loss Benefit Enhancement Maximums Medical Coverage Funding Benefit The Medical Coverage Funding Benefit is the lesser of: $ 300 per month not to exceed $ 3,600 per year up to 3 years, or the actual out-of-pocket expenses your dependents incur annually for medical coverage continuation. Monthly Hospital Benefit The Monthly Hospital Benefit is: $ 2,500 per month up to 12 months not to exceed the $ 30,000 maximum. * With respect to a dependent, the amount of the person's Principal Sum will be based on the amount of coverage in-force on the date of the accident, not the amount of coverage that may be in-force at the time of the loss. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 126 of 131 PageID #: 195 GR-9 0030-0120 12 Adjustment Rule If, for any reason, a person is entitled to a different amount of coverage, coverage will be adjusted as provided elsewhere in the group contract, except that an increase is subject to any Active Work Rule described in Effective Date of Coverage section of this Summary of Coverage. Benefits for claims incurred after the date the adjustment becomes effective are payable in accordance with the revised plan provisions. In other words, there are no vested rights to benefits based upon provisions of this Plan in effect prior to the date of any adjustment. Disclosure The accident coverage provides benefits for losses for accidental bodily injury. The accident and health insurance evidenced by this Booklet-Certificate provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical as defined by the New York State Insurance Department. IMPORTANT NOTICE - THE GROUP POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. General This Summary of Coverage replaces any Summary of Coverage previously in effect under the group contract. Requests for amounts of coverage other than those to which you are entitled in accordance with this Summary of Coverage cannot be accepted. The insurance described in this Booklet-Certificate will be provided under Aetna Life Insurance Company policy form GR-29. KEEP THIS SUMMARY OF COVERAGE WITH YOUR BOOKLET-CERTIFICATE Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 127 of 131 PageID #: 196 THE BENEFITS OF THE POLICY PROVIDING YOUR COVERAGE ARE GOVERNED PRIMARILY BY THE LAW OF A STATE OTHER THAN FLORIDA Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 128 of 131 PageID #: 197 Additional Information Provided by Aetna Life Insurance Company Inquiry Procedure The plan of benefits described in the Booklet-Certificate is underwritten by: Aetna Life Insurance Company (Aetna) 151 Farmington Avenue Hartford, Connecticut 06156 Telephone: (860) 273-0123 If you have questions about benefits or coverage under this plan, call Aetna at the number shown above. If you have a problem that you have been unable to resolve to your satisfaction after contacting Aetna, you should contact the Consumer Service Division of the Department of Insurance at: 300 South Spring Street Los Angeles, CA 90013 Telephone: 1-800-927-4357 or 213-897-8921 You should contact the Bureau only after contacting Aetna at the numbers or address shown above. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 129 of 131 PageID #: 198 Additional Information Provided by Colgate-Palmolive Company The following information is provided to you in accordance with the Employee Retirement Income Security Act of 1974 (ERISA). It is not a part of your booklet-certificate. Your Plan Administrator has determined that this information together with the information contained in your booklet-certificate is the Summary Plan Description required by ERISA. In furnishing this information, Aetna is acting on behalf of your Plan Administrator who remains responsible for complying with the ERISA reporting rules and regulations on a timely and accurate basis. Employer Identification Number: 13-1815595 Plan Number: 527 Veba, 506 Non-Veba Type of Plan: Employee Welfare Plan Type of Administration: Group Insurance Policy with: Aetna Life Insurance Company 151 Farmington Avenue Hartford, CT 06156 Plan Administrator: Colgate-Palmolive Company 300 Park Avenue New York, NY 10022 212-310-3718 Agent For Service of Legal Process: Colgate-Palmolive Company 300 Park Avenue New York, NY 10022 212-310-3718 End of Plan Year: December 31 Source of Contributions: Employee and Employer Procedure for Amending the Plan: The Employer may amend the Plan from time to time by a written instrument signed by Director of Global Benefits. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 130 of 131 PageID #: 199 ERISA Rights As a participant in the group insurance plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974. ERISA provides that all plan participants shall be entitled to: Receive Information about Your Plan and Benefits Examine, without charge, at the Plan Administrator’s office and at other specified locations, such as worksites and union halls, all documents governing the Plan, including insurance contracts, collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) that is filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts, collective bargaining agreements, and copies of the latest annual report (Form 5500 Series), and an updated Summary Plan Description. The Administrator may make a reasonable charge for the copies. Receive a summary of the Plan’s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. Receive a copy of the procedures used by the Plan for determining a qualified domestic relations order (QDRO) or a qualified medical child support order (QMCSO). Prudent Actions by Plan Fiduciaries In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in your interest and that of other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA. Enforce Your Rights If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA there are steps you can take to enforce the above rights. For instance, if you request materials from the Plan and do not receive them within 30 days you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay up to $ 110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the Plan's decision or lack thereof concerning the status of a domestic relations order or a medical child support order, you may file suit in a federal court. If it should happen that plan fiduciaries misuse the Plan's money or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous. Assistance with Your Questions If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, you should contact: • the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory; or • the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. Case 3:17-cv-00309-DJH-CHL Document 15-2 Filed 07/06/17 Page 131 of 131 PageID #: 200 IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF KENTUCKY LOUISVILLE DIVISION ORDER Defendant Aetna Life Insurance Company (“Aetna” or “Defendant”) filed its Motion to Dismiss Plaintiff’s Complaint and to Strike Demand for Jury Trial. Having reviewed the motion and all pleadings submitted in connection therewith, the Court finds, as a matter of law, that Plaintiff cannot maintain her claims for common law breach of contract, breach of common law fiduciary duties, and promissory estoppel because they are preempted by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq., as amended (“ERISA”). Her demand for a trial by jury are similarly foreclosed. Further, she has failed to meet her burden under Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009), and Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007), to sufficiently plead a cause of action CONNIE S. WILLIAMS, individually and as Executrix of the Estate of John W. Williams, Deceased, Plaintiff, v. COLGATE-PALMOLIVE COMPANY and AETNA LIFE INSURANCE COMPANY, Defendants. Case No. 3:17-cv-00309-DJH-CHL Case 3:17-cv-00309-DJH-CHL Document 15-3 Filed 07/06/17 Page 1 of 3 PageID #: 201 2 against Aetna for violations of its fiduciary duties under ERISA. It is, therefore, ORDERED: I. Defendant’s Motion to Dismiss Plaintiff’s Complaint is GRANTED. All of the state-law claims alleged in Plaintiff’s Complaint are hereby dismissed without prejudice as preempted, and Plaintiff’s Count III asserting breach of ERISA fiduciary duties is dismissed without prejudice as against Aetna. II. Defendant’s Motion to Strike Demand for Jury Trial is GRANTED, and Plaintiff’s demand for a jury trial is STRICKEN from the Complaint. The Clerk is DIRECTED to designate this action as NON-JURY. ________________________________ UNITED STATES DISTRICT JUDGE Case 3:17-cv-00309-DJH-CHL Document 15-3 Filed 07/06/17 Page 2 of 3 PageID #: 202 3 Copies to: William B. Wahlheim, Jr. wwahlheim@maynardcooper.com Harold W. Thomas Rebecca D. Northup THOMAS, DODSON & WOLFORD, PLLC 9200 Shelbyville Road, Suite 611 Louisville, KY 40222 Eric P. Mathisen OGLETREET, DEAKINS, NASH, SMOAK & STEWART, P.C. 56 S. Washington, St., Suite 302 Valparaiso, IN 46383 Douglas C. Ballantine Christopher E. Schaefer STOLL KEENON OGDEN PLLC 2000 PNC Plaza 500 West Jefferson Street Louisville, KY 40202 Case 3:17-cv-00309-DJH-CHL Document 15-3 Filed 07/06/17 Page 3 of 3 PageID #: 203
