Group Term Life Insurance Certificate
For Active Employees and Retirees
State of
Michigan
Employee Group Term Life Certificate of Insurance
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
Effective August 1, 2023, as revised on October 12, 2023
Read Your Certificate Carefully
You are insured under the group policy identified on the
specifications page, for benefits described in this
certificate, subject to all provisions of this certificate. This
certificate is issued to you under the group policy and it
includes the terms and provisions of the group policy that
describe your insurance. This certificate is an important
TABLE OF CONTENTS
Definitions ............................................................................2
General Information ............................................................2
Death Benefit.......................................................................3
document and should be kept in a safe place. This
certificate replaces any previous certificates issued to you
under the group policy.
This certificate is a part of the group policy. The group
policy is a contract between Minnesota Life and the
policyholder and may be changed or ended without your
consent or notice to you.
Secretary President
Termination..........................................................................3
Conversion Right.................................................................4
Additional Information .........................................................5
GROUP TERM LIFE CERTIFICATE OF INSURANCE
08-31075 Minnesota Life 1
EdF89427 Rev 10-2023
CERTIFICATE SPECIFICATIONS PAGE
GENERAL INFORMATION
POLICYHOLDER:
State of Michigan
POLICY NO.:
33667-G
PROGRAM DATE:
October 1, 2008. This certificate describes the benefits under the group policy as of the
program date. This Specifications page represents the plan of insurance in effect as of
August 1, 2023, as revised on October 12, 2023.
GROUP:
The group is composed of the following:
1. Any active employee in the category of classified State service with an appointment
of at least 720 hours duration, but excluding employees with non-career
appointments and those working less than 40% of full time.
2. Any active official or active unclassified employee of the State who has been
approved for coverage by the Civil Service Commission.
3. Any retired employee or official who was insured under Policy No. 33667-G, or any
policy replaced by Policy No. 33667-G, just prior to entry into a State Retirement
System.
4. A Wayne County employee who:
(a) was a State Judicial Council employee on October 1, 1996 and whose
employment was transferred to the Recorder’s Court on October 1, 1996; and
(b) whose employer subsequently became the Wayne County Clerk’s Office;
will be considered to be an eligible employee under this policy. Coverage under this
policy shall terminate at such time as employment with the Wayne County Clerk’s
Office terminates, unless the employee retires, at which time the amount of coverage
will be subject to the retiree reduction schedule.
CONTRIBUTORY/
Employee term life insurance and accidental duty death insurance is noncontributory
NONCONTRIBUTORY:
insurance, except as noted in the certificate for those on layoff or leave of absence.
Dependents insurance is contributory insurance except for dependents insurance for
retirees, which is noncontributory insurance.
CHANGES IN BASIC
Your insurance amount will automatically be adjusted whenever your basic annual salary
ANNUAL SALARY:
changes. Increases in insurance amounts are subject to the actively at work requirement.
PLAN OF INSURANCE
EMPLOYEE TERM LIFE INSURANCE
Eligible Class
Amount of Insurance
All eligible active employees other
Two times your basic annual salary, the result rounded to the next higher $1,000 if not
than physicians represented by the
already a multiple thereof, with a minimum of $10,000 and a maximum of $200,000.
UAW
Or, if you select the Reduced Benefit Plan:
One times your basic annual salary, rounded to the next higher $1,000 if not already a
multiple thereof, with a minimum of $10,000 and a maximum of $50,000.
F.68901 A Rev 10-2023
All eligible active physicians
Two times your basic annual salary, the result rounded to the next higher $1,000 if not
represented by the UAW
already a multiple thereof, with a minimum of $10,000 and no maximum.
Or, if you select the Reduced Benefit Plan:
One times your basic annual salary, rounded to the next higher $1,000 if not already a
multiple thereof, with a minimum of $10,000 and a maximum of $50,000.
All eligible retirees
25% of your life insurance in force immediately prior to retirement. This amount is
rounded to the next higher $100, provided you retired after July 1, 1974.
EMPLOYEE ACCIDENTAL DUTY DEATH INSURANCE
Eligible Class
Amount of Insurance
All eligible active employees other
$100,000
than Michigan State Employees
Association (MSEA) bargaining
employees
All eligible active Michigan State
$150,000
Employees Association (MSEA)
bargaining employees
DEPENDENTS TERM LIFE INSURANCE
Eligible Class
Amount of Insurance
All eligible active employees
Plan F:
Spouse:
Children:
$1,500
$1,000
All eligible active employees
Plan G:
Spouse:
Children:
$5,000
$2,500
All eligible active employees
Plan H:
Spouse:
Children:
$10,000
$5,000
All eligible active employees
Plan K:
Spouse:
Children:
$25,000
$10,000
All eligible active employees
Plan L:
Spouse:
Children:
None
$10,000
All eligible active employees
Plan M:
Spouse:
Children:
$50,000
$15,000
All eligible active employees
Plan N:
Spouse:
Children:
None
$15,000
All eligible retired employees*
Spouse
Children:
$1,000
$1,000
*A retiree must have been insured for Plan F, G, H, K or L, M, N immediately prior to retirement in order to be eligible for the
retiree dependents plan.
F.68901 B Rev 10-2023
Definitions
application
Your application for insurance under the group policy.
associated employer
Any employer which is designated by the policyholder and
agreed to by us to participate under the group policy.
When an associated employer ceases its participation
under the policy, the policy shall be considered to be
terminated for all employees of the associated employer.
All provisions related to the policy terminating will apply to
such employees.
basic annual salary
For Fire Crash/Rescue Officers for the Department of
Military Affairs: basic hourly rate times 2,740.5.
For all other employees: basic hourly rate times 2088.
contributory insurance
Insurance for which you are required to make premium
contributions.
employee
An individual who is employed by the policyholder or by an
associated employer.
employer
The policyholder or any designated associated employer.
insured
A person who is eligible for and becomes insured
according to the terms of this certificate, including any
supplements to this certificate.
non-work day
A day on which you are not regularly scheduled to work,
including scheduled time off for vacations, personal
holidays, weekends and holidays, and approved leaves of
absence for non-medical reasons.
Non-work day does not include time off for medical leave
of absence, temporary layoff, employer suspension of
operations in total or in part and any time off due to
sickness or injury including sick days, short-term disability,
or long term disability.
noncontributory insurance
Insurance for which you are not required to make premium
contributions.
pay status
The period of time during which you receive your earnings
because you are actively employed or using accumulated
leave time.
policyholder, State
State of Michigan.
specifications page
The outline which summarizes your coverage under the
policyholder’s plan of insurance. The specifications page
is located at the front of this booklet.
we, our, us
Minnesota Life Insurance Company.
you, your, certificate holder
An insured employee.
General Information
What is your agreement with us?
You are insured under the group policy identified on the
specifications page, subject to all provisions of this
certificate.
Your application is deemed a part of this certificate. Any
statements made in your application will, in the absence of
fraud, be considered representations and not warranties.
Also, any statement made will not be used to void your
insurance nor defend against a claim unless the statement
is contained in the application attached to your certificate.
Can this certificate be amended?
Yes. This certificate may be amended if the policyholder
and we agree to the change. Any amendment will be
without prejudice to any claim incurred for benefits prior to
the effective date of the amendment.
Who is eligible for insurance?
You are eligible if you:
(1) are a member of the group and of an eligible class
as defined in the specifications page; and
(2) meet the actively at work requirement as shown in
the section entitled “What is the actively at work
requirement?”.
Are retired employees eligible for insurance?
Yes. Retired employees are eligible as described in the
specifications page. The actively at work requirement
does not apply to a retired employee
What is the actively at work requirement?
To be eligible to become insured or to receive an increase
in the amount of insurance, you must be actively at work
performing your customary duties at the employer’s
normal place of business, or at other places the
employer’s business requires you to travel.
If you are not actively at work on the date coverage would
otherwise begin, or on the date an increase in your
08-31075 Minnesota Life 2
EdF89427 Rev 10-2023
amount of insurance would otherwise be effective, you will
not be eligible for the coverage or increase until you return
to active work. However, if the absence is on a non-work
day, coverage will not be delayed provided you were
actively at work on the work day immediately preceding
the non-work day.
Except as otherwise provided for in this certificate, you are
eligible to continue to be insured only while you remain
actively at work.
When does insurance become effective?
Insurance becomes effective on the date you meet all
eligibility requirements.
Death Benefit
What is the amount of the death benefit?
The amount of the death benefit is the amount of
insurance shown on the specifications page.
When will the death benefit be payable?
We will pay the death benefit upon receipt at our home
office of written proof satisfactory to us that you died while
insured under this certificate. All payments by us are
payable from our home office. The death benefit will be
paid in a single sum or by any other method agreeable to
us and the beneficiary.
Payment of the death benefit will extinguish our liability
under the certificate for which the death benefit has been
paid.
What are the proof of death requirements?
Your beneficiary or representative must request a death
claim be submitted by the MI HR Service Center* or the
Office of Retirement Services. This request should be
made as soon as reasonably possible.
You must notify the MI HR Service Center* or the Office of
Retirement Services as SOON as possible, but not later
than one year after death. Death claims submitted outside
of one year will not be accepted.
To whom will we pay the death benefit?
We will pay the death benefit to the beneficiary or
beneficiaries. You should designate a beneficiary or
beneficiaries when you first enroll under the plan. You
can change your beneficiary designation at any time,
provided all of the following are true:
(1) your coverage is in force; and
(2) we have written consent of all irrevocable
beneficiaries; and
(3) you have not assigned the ownership of your
insurance.
*Legislative, Judicial, House, Senate, or Auditor General
employees should contact their respective Human
Resource Office.
A beneficiary designation must be made in writing or by
any other method made available under the plan. Any
beneficiary designation shall take effect as of the date it is
signed, but will not affect any payment we make or action
we take before receiving the designation.
You may also choose to name a beneficiary that you
cannot change without the beneficiary’s consent. This is
called an irrevocable beneficiary.
If there is more than one beneficiary, each will receive an
equal share, unless you have requested another method
in your beneficiary designation. To receive the death
benefit, a beneficiary must be living at the time of your
death. In the event a beneficiary is not living at the time of
your death, that beneficiary’s portion of the death benefit
shall be equally distributed to the remaining surviving
beneficiaries. In the event of the simultaneous deaths of
you and a beneficiary, the death benefit will be paid as if
you survived the beneficiary.
If you designate your spouse as a beneficiary and
subsequently get divorced, that beneficiary designation is
automatically declared null and void as of the date of the
divorce. If you want your ex-spouse to be a beneficiary,
you must file a new beneficiary designation stating your
ex-spouse as beneficiary.
If there is no eligible beneficiary, or if you do not name
one, we will pay the death benefit to:
(1) your lawful spouse, if living; otherwise
(2) your natural or legally adopted child (children) in
equal shares, if living; otherwise
(3) your parents in equal shares, if living; otherwise
(4) your siblings in equal shares, if living; otherwise
(5) your estate.
Termination
When does your coverage terminate?
Your coverage ends at midnight on the earliest of:
(1) the last day of the pay period in which you are no
longer eligible; or
(2) the last day of the pay period in which you are no
longer approved for coverage by the Civil Service
Commission; or
(3) the day before you enter the Armed Forces on
full-time active duty (except for active duty of two
weeks or less); or
(4) the date the group policy is terminated; or
(5) the day you terminate pay status with the State; or
(6) the day you enter deferred retirement.
Your pay status will be considered terminated if we are so
notified by the Civil Service Commission or if the State
stops submitting premium for you.
If a lapse in coverage occurs between the date you
separate from employment and the date you begin
receiving retirement benefits, you are not eligible to again
08-31075 Minnesota Life 3
EdF89427 Rev 10-2023
be covered for life insurance, unless you return to State
employment.
Can your coverage be continued during a leave of
absence or layoff?
Yes. You may continue your life insurance coverage
during a leave of absence or layoff for up to 12 or 36
months respectively. You must agree to pay the
premiums in accordance with the State’s direct billing
system.
You will receive an application for continuation of
insurance which must be completed and submitted within
60 days from the day you are no longer in pay status.
Can your coverage be continued during total
disability?
If you become totally disabled for any reason prior to age
65, your life insurance will be continued while you remain
in pay status. Thereafter, your active life insurance will be
continued at no cost to you if you are declared totally
disabled upon presentation of satisfactory evidence of
total disability to Civil Service, which is defined as
receiving benefits from one of the following:
(1) The State’s Long Term Disability Plan; or
(2) Social Security Disability coverage; or
(3) Workers Compensation Insurance; or
(4) The State’s Duty or Non-Duty Disability
Retirement Plan.
If you become totally disabled prior to age 65, your
amount of insurance being continued will be the amount in
force on the day you became disabled. If you are still
totally disabled on your 65th birthday, you will be
considered retired and your life insurance amount will be
reduced to 25% of the coverage in force on the day before
you became disabled, and any dependents insurance you
have will be reduced to the retiree dependent plan.
If you become totally disabled as described above on or
after age 65, your life insurance will be continued at no
cost to you at 25% of the coverage in force on the day you
became disabled. If you have dependents insurance, it
will reduce to the retiree dependents plan.
Conversion Right
What is the conversion right?
You may convert this insurance to a new individual life
insurance policy if all or part of your life insurance under
the group policy terminates.
What is the full conversion right?
You may convert up to the full amount of terminated
insurance if termination occurs because your eligible
employment ends or because you enter a class with a
lower amount of insurance.
What is the limited conversion right?
Limited conversion is available if, after you have been
insured for at least three years, insurance is terminated
because:
(1) the group policy is terminated; or
(2) the class of employees to which you belong is no
longer eligible under the policy.
For a limited conversion, you may convert an amount up
to the lesser of:
(1) $3,000; and
(2) the amount of life insurance which terminated
minus any amount of group life insurance for
which you become eligible under any group policy
issued or reinstated by us or any other carrier
within 31 days of the date your insurance
terminated under the group policy.
When is conversion not available?
Neither the full conversion right nor the limited conversion
right is available if your coverage under the group policy
terminates due to failure to make, when due, required
premium contributions.
To what type of policy may you convert?
Under both the full conversion right and the limited
conversion right, you may convert your insurance to any
type of individual policy of life insurance then customarily
issued by us for purposes of conversion, except term
insurance. The individual policy will not include any
disability or other supplemental benefits.
How do you convert your insurance?
You convert your insurance by applying for an individual
policy and paying the first premium within 31 days after
your group insurance terminates. No evidence of
insurability will be required. Call Minnesota Life at 866-
365-2374 if you have questions or need a conversion
application sent to you.
How is the premium for the individual policy
determined?
We base the premium for the individual policy on the plan
of insurance, your age, and the class of risk to which you
belong on the date of the conversion.
When is the individual policy effective?
The individual policy takes effect 31 days after the group
insurance provided under the group policy terminates.
What happens if you die during the 31-day period
allowed for conversion?
If you die during the 31-day period allowed for conversion,
we will pay a death benefit regardless of whether or not an
application for coverage under an individual policy has
been submitted. The death benefit will be the amount of
08-31075 Minnesota Life 4
EdF89427 Rev 10-2023
insurance you would have been eligible to convert under
the terms of the conversion right section.
We will return any premium you paid for an individual
policy to your beneficiary named under the group policy.
In no event will we be liable under both the group policy
and the individual policy.
Additional Information
What if your age has been misstated?
If your age has been misstated, the death benefit payable
will be that amount to which you are entitled based on
your correct age. A premium adjustment will be made so
that the actual premium required at your correct age is
paid.
When does your insurance become incontestable?
Except for employee, retiree and dependent eligibility
determinations or the non-payment of premiums, after
your insurance has been in force during your lifetime for
two years from the effective date of your coverage, we
cannot contest your coverage. However, if there has been
an increase in the amount of insurance for which you were
required to apply, then, to the extent of the increase, any
loss which occurs within two years of the effective date of
the increase will be contestable.
Any statements you make in your application as defined
under this certificate will, in the absence of fraud, be
considered representations and not warranties. Also, any
statement you make will not be used to void your
insurance, nor defend against a claim, unless the
statement is contained in your application.
Who is the owner of this coverage?
Unless assigned otherwise, you, the insured employee,
are the owner of the coverage provided under this
certificate. Only the owner has the right to exercise
ownership rights under the certificate, including but not
limited to naming or changing a beneficiary, electing
conversion to an individual policy, electing to change or
cancel contributory insurance or assigning any or all
ownership rights.
Can your insurance be assigned?
Yes. However, we will not be bound by an assignment of
a certificate or of any interest in such certificate unless the
assignment is made in writing or through any other
method made available under the plan and we send the
owner an acknowledgement of the assignment.
We are not responsible for the validity of any assignment.
You are responsible for ensuring that the assignment is
legal in your state and that it accomplishes your intended
goals. If a claim is based on an assignment, we may
require proof of interest of the claimant.
Can a change of ownership for a certificate be
requested?
Yes. A change of ownership is a type of assignment. All
provisions for assignments apply to ownership changes.
Is the policyholder required to maintain records?
Yes. The policyholder is required to maintain adequate
records of any information necessary for us to administer
this certificate. We can have access to the records at any
reasonable time agreed upon by the policyholder and us.
If a clerical error is made in keeping records on the
insurance under the group policy, it will not affect
otherwise valid insurance. A clerical error does not
continue insurance which is otherwise stopped. If an error
causes a change in premium payment, we will make a fair
adjustment.
Will the provisions of this certificate conform with
state law?
Yes. If any provision in this certificate, or in the provisions
of the group policy, is in conflict with the laws of the state
governing the certificates or the group policy, the provision
will be deemed to be amended to conform to such laws.
08-31075 Minnesota Life 5
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Accidental Duty Death Benefit
Certificate Supplement
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is subject to every term,
condition, exclusion, limitation, and provision of your
certificate unless otherwise expressly provided for herein.
Coverage under this supplement will not be included in
any insurance issued under the conversion right section of
your certificate.
What does this supplement provide?
This supplement provides a benefit for your accidental
death which occurs as a result of an accidental injury that
occurs while performing the duties of your employment
with the policyholder or a participating employer.
Accidental Duty Death Benefit
What does accidental duty death mean?
Accidental duty death as used in this supplement means
that your death results, directly and independently of all
other causes, from an accidental injury which is
unintended, unexpected, and unforeseen, and which
occurs while you are performing the duties of your
employment with the policyholder or a participating
employer.
The injury must occur while your coverage under this
supplement is in force. Your death must occur within 180
days after the date of the injury.
In no event will we pay the accidental duty death benefit
where your death results from or is caused directly or
indirectly by any of the following:
(
1) s
uicide or attempted suicide, whether sane
or
i
nsane;
or
(2) w
ar or any act of war, whether declare
d or
undec
lared;
or
(3) i
ntentionally self-inflicted injuries;
or
(4) an
accident while traveling between your wor
k
station and home, either as a pedestrian or in a
pr
ivate automobile, common carrier, carpool
or
v
anpool (whether private or State sponsored)
,
unl
ess you are in official travel status
.
(5) an i
llness, including a heart attack or strok
e,
ex
cept for an illness which directly results from
a
c
overed occupational accident
.
W
hat is the amount of the accidental duty death
benefit?
The amount of the benefit is shown on the specifications
page.
When will the accidental duty death benefit be
payable?
We will pay the accidental duty death benefit upon receipt
at our home office of written proof satisfactory to us that
you died as a result of an accidental injury while
performing the duties of your employment with the
policyholder or a participating employer. All payments by
us are payable from our home office. The benefit will be
paid in a single sum or by any other method agreeable to
us and the beneficiary.
To whom do we pay the benefit?
We pay the accidental duty death benefit to the person or
persons entitled to receive the life insurance benefit under
the terms of your certificate, unless you have named a
different beneficiary for this coverage. All provisions of the
certificate related to beneficiary designation will apply to a
designation under this coverage.
Termination
When does your coverage under this supplement
terminate?
Your coverage ends on the earliest of:
(
1) t
he date you are no longer covered for lif
e
i
nsurance under the group policy; or
:
(1) t
he date the Accidental Duty Death Benefi
t
Certificate Supplement is terminated from the
gr
oup policy;
or
(2) t
he date the group policy is terminat
ed.
Additional Information
Do we have the right to obtain independent medical
verification?
Yes. Where not prohibited by law, we reserve the right to
require and pay for an autopsy.
Secretary President
08-31076 Minnesota Life 1
Dependent Term Life Insurance
Certificate Supplement
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
General Information
This certificate supplement is issued in consideration of
the required premium and is subject to every term,
condition, exclusion, limitation, and provision of your
certificate unless otherwise expressly provided for herein.
What does this supplement provide?
This supplement provides insurance on the lives of your
eligible dependents.
What members of your family are eligible for
insurance under this supplement?
The following members of your family are eligible for
insurance under this supplement:
(1) your lawful spouse; and
(2) your children by birth, legal adoption, or legal
guardianship, who have attained the age of 14 days
but have not attained the age of 23 years, who are
unmarried and who are dependent upon you for at
least 50% of their support; and
(3) any other unmarried children who have attained the
age of 14 days but have not attained the age of 23
years, who live with you and are dependent upon you
for at least 50% of their support.
The following are not eligible for dependents insurance:
(1) your divorced spouse or any married child; or
(2) a child who has been legally adopted by another
person (insurance ends on the date custody is
assumed by the adoptive parents); or
(3) anyone eligible for insurance as an employee or
retiree; or
(4) a spouse or child who is in the armed forces of any
country, except for active duty of two weeks or less; or
(5) a child less than 14 days old or a child 23 years old or
older, except for an incapacitated child as described
elsewhere in this supplement.
If both parents of a child qualify as eligible employees
under the group policy, the child shall be considered a
dependent of only one parent for purposes of this
supplement.
Any dependent who, subsequent to the effective date of
this supplement, meets the requirements of this provision
will become insured on the date he or she so qualifies.
Can coverage be continued for an incapacitated
child?
Yes. Insurance for a mentally or physically incapacitated
child who attains age 23 while insured under this
supplement may be continued if the child:
(1) is chiefly dependent upon you for support; and
(2) is not capable of self-sustaining employment.
The insurance will continue only if you provide proof of the
child’s incapacity:
(1) no later than 31 days prior to the child’s attainment of
age 23; and
(2) thereafter as may be required, but not more often than
once every two years.
If your enrolled dependent is an incapacitated child, your
coverage for the child will automatically continue at and
beyond age 23 as long as he or she became incapacitated
prior to age 23, continues to be incapacitated, and
provided coverage does not terminate for any other
reason.
Contact the MI HR Service Center* or the Office of
Retirement Services for additional information. You may
be periodically asked for proof that your child remains
incapacitated.
When does insurance on a dependent become
effective?
In order to insure your eligible dependents, you must
request the coverage in the manner made available by the
policyholder, and agree to pay the necessary premium
contribution . If the MI HR Service Center* receives the
request and any applicable supporting documentation
within 31 days from the day you become employed in an
eligible position, your dependents insurance will take
effect the beginning of the following pay period after
you’ve requested the enrollment through the MI HR
Service Center*.
If you waive coverage for your dependents during your
initial enrollment period, you may enroll for dependents
coverage only during a subsequent annual insurance
open enrollment.
However, if you do not have a dependent when you are
first eligible for employee life insurance, the MI HR Service
Center* must receive your request no later than 31 days
from the date you first acquire an eligible dependent.
*Legislative, Judicial, House, Senate, or Auditor General
employees should contact their respective Human
Resource Office.
08-31077 Minnesota Life 1
Ed89428 Rev 7-2017
Death Benefit
What is the amount of life insurance on each insured
dependent?
The amount of life insurance on each insured dependent
is shown on the specifications page.
To whom will we pay the death benefit?
The death benefit payable under this supplement will be
paid to:
(
1) y
ou, if living; otherwis
e
(2) y
our lawful spouse, if living; otherwis
e
(3) y
our natural or legally adopted child (children) in equa
l
s
hares, if living; otherwise
(
4) t
he estate of the last survivor of the abov
e.
Termination
When does an insured dependent’s coverage under
this supplement terminate?
An insured dependent’s coverage ends at midnight on the
earliest of:
(
1) t
he day before the dependent no longer meets t
he
el
igibility requirements. In the case of divorce, th
e
dat
e of the divorce;
or
(2) t
he date a premium contribution for dependent
s
i
nsurance is due and unpaid;
or
(3) t
he date the policy is terminated;
or
(4) t
he date the Dependents Term Life Insuranc
e
Certificate Supplement is terminated from the group
pol
icy;
or
(5) t
he day before a dependent enters the armed forc
es
on f
ull-time active duty, except for active duty of tw
o
w
eeks’ duration or less;
or
(6) t
he date you are no longer covered under the gro
up
pol
icy, except that retiree dependents life insuranc
e
m
ay be continued after your death if you wer
e
c
overed as a retiree and surviving dependent
s
continue to receive a pension benefit after your death.
Additional Information
What is the spouse conversion right under this
supplement?
If an insured spouse’s coverage under this supplement
terminates because of your death or because your
employment ends, your spouse may convert the insurance
to a policy of individual insurance with Minnesota Life.
All other conditions and provisions of the conversion right
section of your certificate to which this supplement is
attached will apply to a spouse converting his or her
coverage.
Secretary President
08-31077 Minnesota Life 2
Ed89428 Rev 7-2017
Accelerated Benefits
Certificate Supplement
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North • St. Paul, Minnesota 55101-2098
Benefits received under this Accelerated Benefits
Certificate Supplement may be taxable. You should seek
assistance from a personal tax advisor prior to requesting
an accelerated payment of death benefits.
General Information
This certificate supplement is subject to every term,
condition, exclusion, limitation, and provision of your
certificate unless otherwise expressly provided for herein.
What does this supplement provide?
This supplement provides for the accelerated payment of
either the full or a partial amount of an insured’s death
benefit provided under your certificate. If an insured has a
terminal condition as defined in this supplement, you may
request an accelerated payment of the applicable death
benefit.
What is a terminal condition?
A terminal condition is a condition caused by sickness or
accident which directly results in a life expectancy of 12
months or less. We must be given medical evidence that
satisfies us that you have a terminal condition. That
evidence must include certification by a physician. For
purposes of this supplement, a physician is an individual
who is licensed to practice medicine or treat illness in the
state in which treatment is received. The physician cannot
be you or your spouse, children, parents, grandparents,
grandchildren, brothers or sisters, or the spouse of any
such individuals.
Accelerated Benefit
Who may request an accelerated payment of the death
benefit?
You may request an accelerated payment of the insurance
on your life or on the life of a spouse or dependent child
insured under your certificate.
When can an accelerated benefit be requested?
An accelerated benefit can be requested any time,
provided the following conditions are met:
(1) the insurance is in force and all premiums due are
fully paid; and
(2) you are the sole owner of the certificate; and
(3) the certificate does not have an irrevocable
beneficiary; and
(4) application is made in writing or through any other
method made available by us under the group
policy and in a form which is satisfactory to us.
Is there a minimum or maximum death benefit eligible
for an accelerated benefit?
Yes. The minimum death benefit to be eligible for an
accelerated benefit under this supplement is $10,000.
There is no maximum death benefit that can be
accelerated.
Is a partial accelerated benefit available?
Yes. You may choose to accelerate only a portion of an
insured’s death benefit, providing the remaining amount of
insurance is at least $25,000. This is called a partial
accelerated benefit.
You may reapply for the payment of the remaining amount
of insurance at any time. However, we may ask for further
satisfactory evidence that the insured meets all
requirements for the accelerated benefit.
When will we pay an accelerated benefit?
We will pay an accelerated benefit upon receipt at our
home office of written proof satisfactory to us that you
meet the requirements herein.
The accelerated benefit will be paid in a single sum or by
any other method agreeable to you and us.
To whom will we pay accelerated benefits?
We will pay the accelerated benefit to you unless you
validly assign it otherwise.
What is the effect on the insured’s coverage of the
receipt of an accelerated benefit?
If you elect to accelerate the full amount of an insured’s
death benefit, the insured’s coverage and all other
benefits under the certificate and any certificate
supplements for that insured will end. If it is your death
benefit being accelerated, any spouse or child life
insurance will terminate, though spouse coverage may be
converted to a policy of individual life insurance according
to the conversion right section of the certificate.
If a partial accelerated benefit is chosen, coverage will
remain in force and premiums will be reduced accordingly.
The remaining amount of insurance under your certificate
will be the full amount of insurance minus the amount of
insurance that was accelerated.
08-31078 Minnesota Life 1
Termination
When does an insured’s coverage under this
supplement terminate?
An insured’s Accelerated Benefits coverage terminates on
the earliest of:
(
1) t
he date the insured is no longer insured for lif
e
insurance under the certificate; or
(2) the date the Accelerated Benefits Certificate
S
upplement is terminated from the group policy
;
or
(3) t
he date the group policy is terminat
ed.
Additional Information
Is the request for an accelerated benefit voluntary?
Yes. An accelerated benefit will be made available on a
voluntary basis only. An accelerated benefit under this
supplement is not intended to cause an involuntary
reduction of the death benefit ultimately payable to the
beneficiary. Therefore, an accelerated benefit is not
available if you:
(1) are required by law to use this option to meet the
c
laims of creditors, whether in bankruptcy
or
ot
herwise;
or
(2) ar
e required by a government agency to use thi
s
opt
ion in order to apply for, obtain, or k
eep a
government benefit or entitlement.
D
o we have the right to obtain independent medical
verification?
Yes. We retain the right to have you medically examined
at our expense to verify your medical condition. We may
do this as often as reasonably required while an
accelerated benefit is being considered or paid.
Secretary President
08-31078 Minnesota Life 2
Minnesota Life Insurance Company
A Securian Company
Group Insurance
www.lifebenefits.com
400 Robert Street North, St. Paul, MN 55101-2098
©2008 Securian Financial Group, Inc. All rights reserved.
Qu
estions?
For claims information, call
1-877-867-5781.
For conversion information, call
1-866-365-2374.
F64094-1 9-2008
A03377-0908 Coverage is offered under group policy form series 08-31074.
