Life and AD&D
 

Eligibility and Plan Participation 

ELIGIBILITY
You are eligible for the Life Insurance and Accidental Death and Dismemberment (AD&D) Insurance benefits described in this section if: 

  • you are an active, full-time employee of the Company who is regularly scheduled to work for at least 32 hours per week; or
  • an active, part-time employee of the Company who is regularly scheduled to work for at least 20 (but less than 32) hours per week. 

Exclusions
You are not eligible for the benefits described in this section if you are:

  • a temporary employee;
  • a seasonal employee; or
  • a retired employee.          

COVERAGE FOR YOUR ELIGIBLE DEPENDENTS
You can provide your eligible dependents with: 

  • Optional Employee Term Life Insurance; and/or
  • Voluntary AD&D Insurance. 

Your eligible dependents include: 

  • your spouse;
  • your unmarried dependent children under age 19 (under age 25 if a full-time student);
  • an unmarried dependent child at any age who is incapable of self-support due to a mental or physical handicap; or
  • your domestic partner. 

Definition of “Spouse”: In order to qualify as an eligible dependent, your spouse must be under age 70 and legally married to you in accordance with the laws of the state in which you reside. 

Definition of “Children”: For plan purposes, your children include your legally adopted children, children placed with you for adoption prior to legal adoption, and each of your stepchildren and foster children who depends on you for support and maintenance. A child placed with you for adoption prior to legal adoption is treated as though the child were a newborn child to you. 

Definition of “Domestic Partner”: For plan purposes, a domestic partner is an unmarried adult over the age of 18 (but less than age 70) who has a serious committed relationship with you, and: 

  • shares your permanent residence;
  • has lived with you for at least 12 consecutive months prior to your enrollment in the plan;
  • is financially interdependent with you;
  • has signed a domestic partner declaration with you (if provided for in the jurisdiction where you live);
  • is not legally married to anyone else;
  • has not signed a domestic partnership declaration with anyone else within the last 12 months;
  • is not otherwise covered as a dependent under the plan; and
  • is not a blood relative any closer than would prohibit legal marriage. 

Proof of Domestic Partnership: Human Resources requires that you submit proof of domestic partnership before coverage is approved. You can contact Human Resources for more information concerning this required proof. 

WHEN YOUR COVERAGE BEGINS

The coverage dates for the various types of insurance available to you are shown below. 

Company-paid Basic Life Insurance and Basic Accidental Death and Dismemberment (AD&D) Insurance
Your Company-paid Basic Life Insurance and AD&D Insurance coverage automatically begins as of your first day of work as an active, full-time or part-time employee of the Company. 

Voluntary Insurance
Your coverage under Optional Employee Term Life Insurance and/or Voluntary AD&D Insurance will begin as of your date of hire (or the date on which you become eligible to participate, if later), provided that you enroll within 31 days of the date on which you are first eligible to do so. 

Actively at Work
You must be actively at work on the date your participation begins. You are considered to be “actively at work” if you are performing the duties of your job at the Company’s place of business, or at any other place that the Company’s business requires you to go. If you are not actively at work on the date that your participation would otherwise begin, your participation will be postponed until you are actively at work. 

If you do not enroll for Optional Employee Term Life Insurance and/or Voluntary AD&D Insurance within 31 days of the date on which you are first eligible to do so, you will have to wait until the next annual open enrollment period to enroll, unless you have a Change in Status as described below.

PAYING FOR YOUR BENEFITS
The Company pays the full cost of your Basic Life Insurance and Basic AD&D Insurance coverage. You pay the cost of your Optional Employee Term Life Insurance and/or Voluntary AD&D Insurance through convenient after-tax payroll deduction contributions. 

The cost to you for Optional Employee Term Life Insurance will depend on:          

  • the level of coverage you choose for yourself;
  • your age and smoker status; and
  • whether or not you enroll your eligible dependent(s). 

The cost to you for Voluntary AD&D Insurance will depend on whether you elect coverage for:          

  • yourself only; or
  • yourself and your eligible dependents.          

ANNUAL OPEN ENROLLMENT PERIOD
In the fall of each year, the Company sponsors an open enrollment period. During this period, you can elect to add to, reduce, or cancel your Optional Employee Term Life Insurance and/or Voluntary AD&D Insurance coverage. If you do not make any changes during the applicable annual open enrollment period, your current level of insurance coverage will automatically continue. 

Adding Coverage: Your election to enroll for Optional Employee Term Life Insurance* and/or Voluntary AD&D Insurance coverage during the annual open enrollment period will go into effect on the next January 1 (or the date that the Insurance Company approves your application, if later), provided that you provide any required evidence of insurability that is acceptable to the Insurance Company. See the Optional Employee Term Life Insurance section for an explanation of evidence of insurability. 

*or change the amount of your Optional Employee Term Life Insurance 

Canceling Coverage: If you elect to cancel your Optional Employee Term Life Insurance and/or Voluntary AD&D Insurance coverage during the annual open enrollment period, this cancellation will go into effect on the next January 1. Your coverage cannot be restored until the next annual open enrollment period, unless you have a Change in Status as described below. 

For example, assume that you elect to cancel your Optional Employee Term Life Insurance coverage during the annual open enrollment period. This election will go into effect on January 1. Your coverage cannot be restored until the next annual open enrollment period, unless you have a Change in Status (see below). 

CANCELLING COVERAGE DURING THE YEAR
You may elect to cancel your Optional Employee Term Life Insurance and/or Voluntary AD&D Insurance during the year. This election will go into effect as soon as administratively possible after the date that your cancellation request is received and approved. If you elect to cancel your coverage, you cannot restore it until the next annual open enrollment period, unless you have a Change in Status. 

If you elect to cancel your Optional Employee Term Life Insurance coverage and later decide to add it, you will be required to provide evidence of insurability that is acceptable to the Insurance Company before this election can be approved.

CHANGE IN STATUS
In general, you cannot enroll for Optional Employee Term Life Insurance* and/or Voluntary AD&D Insurance coverage during the year, unless you have a Change in Status. For plan purposes, you are considered to have a Change in Status in the event of: 

  • your marriage or divorce;
  • the death of your spouse, domestic partner, or child;
  • the birth or adoption of a child
  • the employment or termination of employment of your spouse or domestic partner;
  • switching from part-time to full-time employment of your spouse or domestic partner;
  • you, your spouse, or domestic partner taking an unpaid leave of absence; or
  • a change in the employee's, his or her spouse, or domestic partner’s employment status that affects either person’s eligibility for benefits. 

*or change the amount of your Optional Employee Term Life Insurance or Voluntary AD&D Insurance 

Effective Date: Your election to enroll for or increase your Optional Employee Term Life Insurance and/or Voluntary AD&D Insurance coverage will go into effect as of the date of the change*, provided that you make this election within 31 days of the date of the change. 

*or the date that the Insurance Company approves your application, if you are required to provide evidence of insurability that is acceptable to the Insurance Company 

For example, assume that you have Company-paid Basic Life Insurance coverage only, and you get married or choose to cover your eligible domestic partner during the year. In this case, you can elect to cover your spouse or domestic partner for Optional Employee Term Life Insurance. 

If you do not enroll for or increase your Optional Employee Term Life Insurance and/or Voluntary AD&D Insurance coverage within 31 days of the date that a Change in Status occurs, you will have to wait until the next annual open enrollment period.

LAYOFF OR LEAVE OF ABSENCE
You may elect to continue your Optional Employee Term Life Insurance and/or Voluntary AD&D coverage if you are temporarily laid off or go on an unpaid authorized leave of absence for non-FMLA* reasons or are receiving disability pay. The contributions you would otherwise have paid towards the cost of your coverage will be suspended during the first four months of leave. (Please refer to the repayment options described below.) 

You have two options for repayment of your contributions: 

  • You can pay your contributions during your leave via check. Checks should be made payable to “Tufts Health Plan” and mailed to: Benefit Specialist, Tufts Health Plan, 705 Mount Auburn Street, Watertown, MA 02472.
  • You can pay your contributions upon your return to work. You will receive an e-mail from Human Resources informing you of the amount you need to repay. You will be given the option of paying this amount either via Payroll (in one pay period or over a few pay periods) or writing a check for the whole amount.  

If you do not return from your leave of absence, you will be responsible for any benefit contributions you did not make during your leave. Tufts Health Plan will deduct the amount you owe from your last check. If you do not receive a last check, a bill will be sent directly to your home and you will be required to pay the entire amount within 14 calendar days. 

*Family and Medical Leave Act 

Family and Medical (FMLA) Leave: You may elect to continue your Optional Employee Term Life Insurance and/or Voluntary AD&D coverage during an authorized Family and Medical (FMLA) leave of absence. If you are on an unpaid FMLA leave or receiving disability pay, the contributions you would otherwise have paid towards the cost of your coverage will be suspended during the first four months of leave. (Please refer to the repayment options described above). 

You should contact Human Resources for more information concerning the continuation of your benefit coverage during an authorized FMLA leave. 

Military Leave: Reservists who are called to active duty with the Armed Forces of the United States have special benefit continuation and reemployment rights under the law (see Administrative Information). In addition, the federal Family and Medical Leave Act (FMLA) was amended to add two new leave rights related to military service, effective January 16, 2009: 

  • Active Duty Leave: Eligible employees are entitled to up to 12 weeks of leave because of “any qualifying exigency” due to the fact that the spouse, son, daughter, or parent of the employee is on active duty, or has been notified of an impending call to active duty status, in support of a contingency operation.
  • Injured Service Member Leave: An eligible employee who is the spouse, son, daughter, parent, or next of kin of a covered service member who is recovering from a serious illness or injury sustained in the line of duty on active duty is entitled to up to 26 weeks of leave in a single 12-month period to care for the service member. The employee is entitled to a combined total of 26 weeks for all types of FMLA leave in the single 12-month period.