© 2010 Standard Insurance Company

State of New Mexico General Services Department Risk Management Division Policy 645553

2013 Medical Plan Open Enrollment - Affects on Life Insurance

© 2010 Standard Insurance Company

During the 2013 Medical Plan Open Enrollment, eligible members who enroll in a medical plan, will automaticallybe enrolled in the $50,000 Basic Life and $50,000 AD&D without the requirement of completing the Medical History Statement and getting approval by Medical Underwriting, effective 07/01/2013.

If not automatically enrolled, completing the Medical History Statement and getting approval by Medical Underwriting is required for Basic Life and Basic AD&D Insurance if a member enrolls after the initial 31 day eligibility period.

This opportunity to be automatically insured for Basic Life and Basic AD&D does NOT apply to members currently covered under a medical plan.

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Basic Life and Basic AD&D

© 2010 Standard Insurance Company

Spouse/Domestic Partner If the member is enrolled in Basic Life and is adding a

spouse/domestic partner to medical, the member may also insure a spouse/domestic partner for $10,000 without the requirement of completing the Medical History Statement and getting approval by Medical Underwriting, effective 07/01/2013.

Unless enrolled above, completing the Medical History Statement and getting approval by Medical Underwriting is required for spouse/domestic partner Dependent Life Insurance if they are enrolled after the initial 31 day eligibility period.

Children If the member is enrolled in Basic Life and is adding a child(ren)

to medical, the member may also insure the child(ren) for $5,000. Only 1 member may insure the child(ren).

Dependent Life Insurance

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© 2010 Standard Insurance Company

Eligible members may elect Supplemental Life if covered under the Basic Life.

A member may add or increase Supplemental Life after the initial 31 day eligibility period only by completing the Medical History Statement and getting approval by Medical Underwriting.

Supplemental Life is not available for a spouse/domestic partner or children.

*No changes will be allowed to Supplemental Life until after 7/1/2013 for members that became automatically enrolled for Basic Life and Basic AD&D during the 2013 Medical Plan Open Enrollment.

Supplemental Life Insurance*

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© 2010 Standard Insurance Company

Any member or spouse/domestic partner who enrolls after their initial 31 day eligibility period will need to complete the Medical History Statement and send it to Medical Underwriting (not to HR, not to Risk Management). The applicant will be notified of the decision by mail from Medical Underwriting.

Dependent children do not require the Medical History Statement or approval by Medical Underwriting and can be added at any time as long as the member is enrolled in Basic Life.

Enrollment-After The Initial 31 Day Eligibility Period

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© 2010 Standard Insurance Company

Marriage/Affidavit of Domestic Partnership: A new spouse/domestic partner can be added without Medical History approval as long as they are enrolled within 31 days of the date of the marriage/affidavit of domestic partnership.

Loss of Life Benefits Through Employer: The spouse/domestic partner can be added without Medical History approval as long as they are enrolled within 31 days of losing life coverage and they provide proof of having been enrolled in life insurance with their employer. If they did not have prior coverage, they will need to complete the Medical History Statement and wait to be approved by Medical Underwriting.

Qualifying Event

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© 2010 Standard Insurance Company

• Retirement: If the member is eligible for benefits through the NM Retiree Health Care Authority (NMRHCA), with proof of the $50,000 Basic Life and any level of Supplemental Life Insurance, they may enroll up to the maximum $60,000 with NMRHCA. Any Supplemental Life Insurance can continue by Conversion or Portability as a private policy. This needs to be done within 31 days of employment ending. Dependent life can also be taken with you.

• Terminating Employment: The member may Convert their Basic Life and/or apply for Portability of their Supplemental Life if less than age 80 and not disabled. Dependent life can also be taken with you.

• Disability: Any employee out on disability for 180 days or more should be encouraged to complete the Waiver of Premium application. If their application is approved, Standard will pay for the member’s Life Insurance as well as that of their dependents.

Termination of Benefits

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© 2010 Standard Insurance Company

Additional Benefits

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MEDEX® Travel AssistRepatriation BenefitAccelerated Benefit OptionFuneral AssignmentAD&D BenefitsPortability Option (up to age 80 and not disabled)Conversion OptionAirbag BenefitSeatbelt Benefit

© 2010 Standard Insurance Company

Contact Information

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For answers to commonly asked questions, costs, exclusions, limitations and reductions, please review the Additional Life and AD&D Booklet and Certificate of Coverage by visiting:

http://www.standard.com/mybenefits/newmexico_rmd/

Or call

Martha Quintana

Your Local Dedicated Account Manager

888-609-9763, option 4

505-859-4180 office

505-803-8144 cell