Life Insurance Plan Summary

Benefits for Commonwealthof Massachusetts Employees and Retirees

Effective 7/1/2021

MORETHANMIGHTEXPECT

YOU

Basic Life, Optional Life, and Accidental Death & Dismemberment Insurance

2 Benefits for Commonwealth of Massachusetts Employees and Retirees | Enrolling For Benefits

GCERT2000abo/ee 05/13

Disclaimer:

The information contained in this booklet is a summary of your Life and Accidental Death and Dismemberment (AD&D) policy through the Commonwealth of Massachusetts Group Insurance Commission (GIC) and MetLife. This summary is designed to help you understand your Life and AD&D benefits.

We urge you to read it carefully, share it with your family, and keep it in a safe place. For a detailed version of the benefits described in this booklet, please contact MetLife for a copy of your policy or visit the Life Insurance section of the GIC’s website at Mass.gov/GIC/Lifeinsurance.

All benefits are subject to the terms and conditions of the policy. Policies underwritten by MetLife detail exclusions, limitations, and terms under which the policies may be continued in full or discontinued. If there is any difference between this booklet and the policy, the terms of the policy control your insurance coverage.

The Basic and Optional Life and AD&D insurance described in this booklet is a term policy and has no cash value.

MORETHANMIGHTEXPECT

YOU

Contents

1 | Eligibility and Enrollment for Your Life and AD&D Benefits

Basic Life and AD&D Enrollment _____________ 2Eligibility and Effective Date ________________ 2Optional Life and AD&D Enrollment __________ 3

2 | Life and AD&D - Coverage, Cost, and Claims Filing

Schedule of Benefits ______________________ 4Family Status Change ______________________ 5Enrollee Premium Contributions _____________ 5Death Claims Payment Procedures ___________ 6Method of Claims Payment – Total Control Account _____________________ 7Life Insurance: Accelerated Benefit Option (ABO) ____________________________ 8

3 | AD&D Additional Benefits

Accidental Death & Dismemberment (AD&D) _ 10Presumption of Death __________________ 12Paralysis Benefit _______________________ 12Coma Benefit _________________________ 12Brain Damage Benefit __________________ 12Acts of War or Terror ___________________ 13

When Notice of Claim and Proof of Loss Must Be Given __________________________ 14Physical Examination _____________________ 14Rehabilitation Physical Therapy Benefit _______ 14Felonious Assault Benefit (Robbery and Attempted Robbery) __________ 14Limits and Exclusions to AD&D Benefits _____ 16Be Aware _______________________________ 16Covered Air Travel _______________________ 16Seat Belt Benefit _________________________ 17Airbag Benefit ___________________________ 18

4 | How Your Life Insurance Program Works

Naming Your Beneficiary __________________ 20Assignment of Life Insurance _______________ 21 Waiver of Premium Due to Disability _________ 22Deferred Retirement ______________________ 23Retirement ______________________________ 23Portability Coverage _____________________ 24Conversion Coverage_____________________ 26Cancellation Provisions ___________________ 27

5 | What Other Services Does MetLife Provide?

Will Preparation _________________________ 28Estate Resolution Services (ERS) ____________ 29Grief Counseling (all states except NY) ______ 29Funeral Discounts and Planning Services _____30Beneficiary Claim Assistance ______________30Travel Assistance Services

(Active State Employees Only) _____________ 30Professional Help, Just a Phone Call Away _ 30Emergency Benefits ____________________ 3 1Worldwide Medical Teleconsultation ______ 32Medical Assistance Services _____________ 32Personal Assistance Services ____________ 32

http://Mass.gov/GIC/Lifeinsurance

http://Mass.gov/GIC/Lifeinsurance

32 Benefits for Commonwealth of Massachusetts Employees and Retirees | Enrolling For Benefits

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Basic Life and AD&D Enrollment

New employees’ insurance becomes effective on the first day of the month following the earlier of 60 days or two calendar months of continuous active employment.

Should you decide not to enroll in the Basic Life insurance coverage when you are first eligible, you must wait until the next annual enrollment period. If you enroll at that time, your coverage will be effective on July 1. Active employees and retirees are not required to submit Evidence of Insurability for Basic Life and AD&D insurance.

Eligibility and Effective DateYou are eligible for Basic Life and AD&D insurance as an employee/retiree of the Commonwealth of Massachusetts.

If you’re an employee, you must work at a minimum:• 20 hours in a 40-hour work week or• 18.75 hours per week.

Eligible employees/retirees are further defined under the Massachusetts General Laws in Chapter 32A. Contact information for the Group Insurance Commission is listed at the back of this booklet.

This plan is a two-part program. Part one is Basic Life and Accidental Death & Dismemberment (AD&D), and part two is Optional Life and AD&D. You must first be insured for Basic Life and AD&D before you can choose Optional Life and AD&D coverage.

Eligibility and Enrollment for Your Life and AD&D Benefits

Optional Life and AD&D Enrollment

New EmployeesIn order to enroll in the Optional Life and AD&D insurance program, you must first be enrolled in Basic Life and AD&D insurance. New employees may apply for up to eight times their salary when first eligible. The amount of Optional Life and AD&D insurance you may elect is up to you and is based on a multiple of your annual salary up to a maximum of $1.5 million. In no event can it be more than eight times your annual salary.

Late EnrollmentNew employees who do not apply for Optional Life insurance when first eligible, or do not elect the maximum amount at that time, may at any time during the year enroll or apply to increase their coverage, subject to providing evidence of insurability.

You will need to complete the GIC’s Enrollment/Change Form-1, which you can obtain from your GIC Coordinator and on the GIC’s website https://mygiclink.force.com/ GenerateDocusignPage. MetLife will then send you an email with instructions on how to submit your personal health application (evidence of insurability form) online, or how to obtain a paper application to send in. If your email is not available, MetLife will send a letter with instructions on how to submit your personal health application online. MetLife will notify you of your application’s approval or denial. If approved, the GIC will determine the effective date of coverage.

At RetirementRetirees may elect to keep or reduce their Optional Life insurance in force upon retirement. If at the time of retirement, you cancel or reduce your Optional Life insurance, you may apply to reinstate it up to the amount you carried at the time of retirement, subject to providing evidence of insurability. Before retirement, you should review the amount of your Optional Life insurance coverage and its cost to determine whether it will make economic sense for you to keep it when you retire. Optional Life insurance rates significantly increase when you retire and continue to increase based on your age. See page 6 for rates.

Life Insurance Questions?Contact the Group Insurance Commission at 617-727-2310 or https://www.mass.gov/info-details/ life-insurance-and-accidental-death-dismemberment-add

https://mygiclink.force.com/GenerateDocusignPage

https://mygiclink.force.com/GenerateDocusignPage

https://www.mass.gov/info-details/life-insurance-and-accidental-death-dismemberment-add


54 Benefits for Commonwealth of Massachusetts Employees and Retirees | Benefits, Costs, and Claims Filing

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Schedule of Benefits

Schedule of Benefits

Basic Life and AD&D BenefitsAll Employees and Retirees1

Optional Life and AD&D BenefitsAll Employees and Retirees who have also elected to be insured for Optional Life and AD&D insurance1

$5,000 One to eight times your annual salary (as determined by the GIC), rounded to the next lower multiple of $1,000 if not already an exact multiple thereof, minus $1,000.

-OR

Amounts in $1,000 benefit units to a maximum of one times earnings, rounded to the next lower multiple of $1,000 if not already an exact multiple thereof, minus $1,000.

The total amount of Optional Life insurance chosen is subject to a maximum benefit of $1.5 million based on salary. The total amount of Accidental Death & Dismemberment insurance chosen is subject to a maximum benefit of $1.5 million.

1. AD&D not available if insured has an approved Waiver of Premium.

Life and AD&D - Coverage, Cost, and Claims Filing

Enrollee Premium Contributions

Most of the cost of your Basic Life insurance premium is paid by the Commonwealth. You are responsible for the full premium for any Optional Life insurance you select. Optional Life rates are age-banded and increase as you get older.

Your monthly contribution is deducted from your paycheck or pension one month in advance. If you have selected an amount of Optional Life that is a multiple of your salary (two to eight times), you have elected the Automatic Increase Option, which means that your Optional Life insurance will increase automatically after an increase in your annual salary.

If you are not having payroll or pension deductions made, you must pay your part of the premium directly to the Group Insurance Commission each month. Failure to make the required premium payment by the due date on your GIC billing invoice will result in termination of your Life insurance.

Qualifying Event Required Documentation

Marriage Marriage certificate

Birth or adoption of a child Birth certificate and/or adoption placement letter

Divorce Divorce decree

Death of a spouse Death certificate

5

Family Status Change

Active state employees who have a qualifying family status change during the year may enroll in or increase their coverage without any medical review in an amount up to four times their salary provided that the GIC receives an enrollment form and required documentation within 60 days of the qualifying event. Family status changes include the following events:


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Death Claims Payment Procedures

To File a Claim Contact the GIC at 617-727-2310

The Group Insurance Commission (GIC) wants to process your beneficiary’s claim as soon as possible. A family member or a close friend should contact the GIC and provide the following information:

• A copy of the certified death certificate to initiate the claim.

• A copy of your life insurance certificate or GIC annual benefit statement (if available).

• All beneficiary names, dates of birth, Social Security numbers and addresses.

Calculate Your Optional Life and AD&D Benefit Costs

Active Employees

Monthly rate per $1,000 of coverage

Age Smoker Non-Smoker

Under 35 $0.10 $0.04

35–44 $0.12 $0.0545–49 $0.19 $0.06

50–54 $0.31 $0.13

55–59 $0.49 $0.20

60–64 $0.73 $0.29

65–69 $1.37 $0.67

70 & over $2.49 $1.13

Retired Employees

Monthly rate per $1,000 of coverage

Age Smoker Non-Smoker

Under 70 $1.62 $1.29

70–74 $2.83 $2.1775–79 $7.72 $5.90

80–84 $14.63 $11.16

85–89 $23.17 $17.69

90–94 $32.22 $26.89

95–99 $72.57 $58.72

100 & over $139.14 $112.59

Rates are based on the age of the Insured person and increase as the insured enters each new age category. Rates and/or benefits may be changed on a class basis. In addition, eligibility for non-smoker rates require that the insured has not smoked cigarettes, cigars or a pipe or used chewing tobacco, snuff or a nicotine delivery system during the 12 months before submitting an application for insurance.

* This case illustration is fictitious and for illustrative purposes only.

Example of Monthly Premium Cost Calculation*

Sarah is a 37-year-old active state employee, a smoker and earns $34,700 annually. She has chosen Optional Life insurance in an amount equal to two times her salary. To calculate the cost of her Optional Life and AD&D insurance, she must:

1. Multiply her annual salary by 2 ($69,400);2. Round that amount down to $69,000; and3. Subtract $1,000.

Her Optional Life insurance amount:Sarah’s premium rate is $0.12 per $1,000 of insurance:$68,000 x 0.12 / $1,000Her monthly cost would be $8.16Her annual cost would be $8.16 x 12 mos = $97.92

1. $34,700 X 2 $69,400 2. - 400 3. - 1,000 *$68,000

The GIC will process this information and forward it to MetLife. MetLife will then send a claim package which will include a Claim Form to your beneficiary. Your beneficiary must complete the Claim Form and return it to MetLife with a copy of the death certificate. Your beneficiary will be able to complete the claim submission online or via hard copy. Upon receipt, MetLife will send a claim payment to your beneficiary. This procedure applies for all deaths, regardless of cause. For Accidental Death and Dismemberment, MetLife may request additional information such as police reports and/or any related newspaper or verifiable online articles. Any additional information requested for an AD&D claim must be received by MetLife within 365 days of the date of death.

Method of Claims Payment – Total Control Account

For Immediate Access to Death ProceedsThe Total Control Account® (TCA)1 settlement option provides your loved ones with a safe and convenient way to manage the proceeds of a life or accidental death and dismemberment claim payment of $5,000 or more, backed by the financial strength and claims paying ability of Metropolitan Life Insurance Company.

How the Account WorksThe TCA is a draft account that works like a checking account:

• When your account is open, MetLife will send a package which includes information about the TCA. MetLife pays the full amount owed to you by placing your proceeds into the TCA and providing you a book of drafts. The drafts can be used like checks.

• A single draft can be used to access the entire proceeds or several drafts for smaller amounts (as little as $250). There are no limits on the number of drafts that can be written. Processing time is similar to check processing.

• The TCA can also be conveniently used as a source of funds to pay your bills online or by phone.

• Interest is earned on the money in the TCA account from the date the account is opened.

• MetLife will send an account statement each month when there is activity in the account. If there is no activity, MetLife will send a statement once every three months.

• A beneficiary can be named for the account. MetLife will include a beneficiary form in the package sent when the account is opened.

• There are no monthly maintenance or service fees on the TCA, no charges for making withdrawals or writing drafts, and no cost for ordering additional drafts.

1. The Total Control Account (TCA) is not insured by the Federal Deposit Insurance Corporation or any government agency. The assets backing TCAs are maintained in MetLife’s general account and are subject to MetLife’s creditors.

MetLife bears the investment risk of the assets backing TCAs, and expects to receive a profit. Regardless of the investment experience of such assets, the interest credited to TCAs will never fall below the guaranteed minimum rate. Guarantees are subject to the financial strength and claims paying ability of MetLife.

Each quarter, customers will be mailed a statement showing withdrawals, interest credited, cleared drafts, current interest rate, and any other activity.

Note: interim monthly statements will only be provided upon request or when there are new transactions posted or credited to the customer’s proceeds other than earned interest.


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Life Insurance: Accelerated Benefit Option (ABO)

Accelerated Benefits Option (ABO)If You become Terminally Ill, You have the option to request MetLife to pay ABO Eligible Life Insurance before Your death.1 This is called an accelerated benefit. The request must be made while ABO Eligible Life Insurance is in effect.

Terminally Ill or Terminal Illness means a condition that a Physician certifies will reasonably be expected to result in a drastically limited life span of 12 months or less.

MetLife will pay an accelerated benefit to You if:

• MetLife has received Proof that You are Terminally Ill.

MetLife will only pay an accelerated benefit for each ABO Eligible Life Insurance benefit once.

Proof of Your Terminal IllnessMetLife will require the following for Proof of Your Terminal Illness:

• a completed accelerated benefit claim form;

• a signed Physician’s certification that You are Terminally Ill; and

• an examination by a Physician of MetLife’s choice, at MetLife’s Expense, if MetLife requests it.

You must file an application for the portion of your Amount of Life Insurance to be paid as an accelerated Death Benefit. To apply for this benefit, contact the GIC at 617-727-2310.

Upon Our receipt of Your request to accelerate benefits, MetLife will send You a letter with information about the accelerated benefit payment You requested. The letter will describe the amount of the accelerated benefits MetLife will pay and the amount of Life Insurance remaining after the accelerated benefit is paid.

1. When life expectancy is certified by a physician to be 12 months or less. The Accelerated Benefits Option (ABO) is subject to state availability and regulation. The ABO benefits are intended to qualify for favorable federal tax treatment.

This information was written as a supplement to the marketing of life insurance products. Tax laws relating to accelerated benefits are complex and limitations may apply. You are advised to consult with and rely on an independent tax advisor about your own particular circumstances.

Receipt of ABO benefits may affect your eligibility, or that of your spouse or your family, for public assistance programs such as medical assistance (Medicaid), Temporary Assistance to Needy Families (TANF), Supplementary Social Security Income (SSI) and drug assistance programs. You are advised to consult with social service agencies concerning the effect that receipt of ABO benefits will have on public assistance eligibility for you, your spouse or your family.

This information is written in connection with the promotion or marketing of the matter(s) addressed in this material. The information cannot be used or relied upon for the purpose of avoiding IRS penalties. These materials are not intended to provide tax, accounting or legal advice. As with all matters of a tax or legal nature, you should consult your own tax or legal counsel for advice.

Accelerated Benefit AmountMetLife will pay an accelerated benefit up to 80% for each ABO Eligible Life Insurance benefit in effect for You, subject to the following:

Maximum Accelerated Benefit Amount. The maximum amount MetLife will pay for each ABO Eligible Life Insurance benefit is 80%.

Minimum Accelerated Benefit Amount. The minimum amount MetLife will pay for each ABO Eligible Life Insurance benefit is 25%.

Effect of Payment of an Accelerated BenefitOn Premium for Your Insurance. After MetLife pays the accelerated benefit, any future premium will be waived for Your Life Insurance and Your Accidental Death and Dismemberment Insurance.

On Your Life Insurance at Your Death. The amount of Life Insurance that MetLife will pay at Your death will be decreased by the amount of the accelerated benefit paid by MetLife.

On Your Life Insurance at Conversion. The amount to which You are entitled to convert will be decreased by the amount of the accelerated benefit paid by MetLife.

On Your Accidental Death and Dismemberment Insurance. Payment of an accelerated benefit will not affect Your Accidental Death and Dismemberment Insurance.

Date Your Option to Accelerate Benefits EndsThe accelerated benefit option will end on the earliest of:

• the date the ABO Eligible Life Insurance ends;

• the date You or Your legal representative have accelerated all ABO Eligible Life Insurance benefits.

1110 Benefits for Commonwealth of Massachusetts Employees and Retirees | AD&D Comprehensive Benefits

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Accidental Death & Dismemberment (AD&D)

The Plan also provides the following benefits to you in the event you are injured or die as a result of a covered accident while insured (subject to the exclusions and limitations listed on page 16):

Accidental Death & Dismemberment Benefits

Covered Loss Benefit Amount

Life Full Coverage

AD&D Additional Benefits

Accidental Death & Dismemberment Benefits - Schedule of Benefits

Accidental Dismemberment Benefit Amount

Both Hands or Both Feet or Sight of Both Eyes The Full Amount

One Hand and One Foot The Full Amount

One Hand and Sight of One Eye The Full Amount

One Foot and Sight of One Eye The Full Amount

Speech and Hearing in Both Ears The Full Amount

One Hand or One Foot One-Half of the Full Amount

Sight of One Eye One-Half of the Full Amount

Speech or Hearing in both Ears One-Half of the Full Amount

Thumb and Index Finger of Same Hand One-Quarter of the Full Amount

Quadriplegia The Full Amount

Paraplegia Three-Quarters of the Full Amount

Hemiplegia One-Half of the Full Amount

If You sustain an accidental injury that is the Direct and Sole Cause of a Covered Loss described in the SCHEDULE OF BENEFITS contact the GIC at 617-727-2310 to report the claim. MetLife will send you an accidental death & dismemberment claim package that you should complete and return to MetLife. MetLife will review the claim and, if approved, will pay the insurance in effect on the date of the injury.

Direct and Sole Cause means that the Covered Loss occurs within 12 months of the date of the accidental injury and was a direct result of the accidental injury, independent of other causes.


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Presumption of DeathYou will be presumed to have died as a result of an accidental injury if:

• the aircraft or other vehicle in which You were traveling disappears, sinks, or is wrecked; and

• the body of the person who has disappeared is not found within 1 year of:

– the date the aircraft or other vehicle was scheduled to have arrived at its destination, if traveling in an aircraft or other vehicle operated by a Common Carrier; or

– the date the person is reported missing to the authorities, if traveling in any other aircraft or other vehicle.

Paralysis BenefitIn the event of bodily injuries that occur while you’re insured under the AD&D policy, and paralysis occurs as a result of such injuries within 365 days of the date of the covered accident, this policy will pay benefits as follows:

• Quadriplegia (total paralysis of upper and lower limbs): the full AD&D benefit amount.

• Paraplegia (total paralysis of lower limbs): three-quarters of the AD&D benefit amount.

• Hemiplegia (total paralysis of upper and lower limbs on one side of the body): one half of the full AD&D benefit amount.

Payment of this benefit will reduce or eliminate your total AD&D benefit.

Coma BenefitMetLife will pay the full AD&D benefit to your beneficiary in accordance with your beneficiary designation if you sustain an injury which, independent of all other causes, directly results in your being in a coma. You must be in a coma within 90 days from the date of accident. This benefit will be paid in a lump sum if you have remained continuously in a coma after a Waiting Period of 31 days. A doctor must certify that the coma is permanent and irreversible and the certification must be deemed satisfactory to MetLife. During the Waiting Period for the coma benefit, which is 31 days from the date you become comatose, no coma benefits are payable. The payment will not exceed the maximum amount of your total AD&D benefits.

Brain Damage BenefitMetLife will pay the full amount of your AD&D benefit to your beneficiary, in accordance with your beneficiary designation, if you sustain an injury which, independent of all other causes, directly results in traumatic brain injury causing brain damage.

The benefit will be payable if:

• The brain damage begins within 60 days of the accident and continues for 12 consecutive months.

• A doctor has certified the brain damage is permanent and irreversible at the end of the 12 consecutive months, and the certification must be deemed satisfactory to MetLife.

• The brain damage prevents the injured person from performing all the substantial and material functions and activities of a person of like age and gender in good health.

MetLife will pay this benefit in one lump sum. Payment of this benefit, plus any other benefits payable as a result of the same accident, will not exceed the full AD&D benefit the Insured is eli-gible to receive under this policy. Payment of this benefit will eliminate your total AD&D benefits.

Acts of War or TerrorYour policy will pay Basic Life and AD&D and Optional Life and AD&D for acts of war or terrorism provided you’re insured under the policy and premiums are paid at the time of death.


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Other Claims Procedures

When Notice of Claim and Proof of Loss Must Be Given

An application for dismemberment, paralysis, coma and brain damage benefits must be sent to MetLife. The accident must occur while you are insured under the Plan. You, a family member, or a close friend must contact the GIC to report the accident. MetLife will send you a claim package which you will complete and return to MetLife for processing. Proof of loss must be received within 365 days of the date of loss. The benefit will be paid only if the accident results in one or more losses that occur within 365 days of the date of the accident.

Time Limit on Legal Actions. A legal action on a claim may only be brought against MetLife during a certain period. This period begins 60 days after the date Proof is filed and ends 3 years after the date such Proof is required.

Physical ExaminationWhile an AD&D claim is pending, MetLife, at its expense, has the right to have you examined by a physician of its choice when and as often as it reasonably chooses. In the case of death, MetLife can have an autopsy performed where it is not forbidden by law.

Rehabilitation Physical Therapy BenefitMetLife will pay an additional benefit for rehabilitative physical therapy that is prescribed by your attending doctor if you sustain an injury which causes a covered dismemberment loss. This benefit provides an amount equal to the lesser of:

• The actual expense incurred for a rehabilitative program.

• Ten percent of your full AD&D benefit or a maximum amount of $10,000.

Your AD&D benefit will be increased by 10 percent, up to a maximum of $10,000. The rehabilitation physical therapy benefit is separate from any AD&D benefit which may be payable.

Felonious Assault Benefit (Robbery and Attempted Robbery)MetLife will pay this additional benefit if:

1. We pay a benefit for a loss resulting in Your accidental death, under the Accidental Death and Dismemberment Benefit;

2. We receive Proof that the death was caused by a Felonious Assault (Robbery or Attempted Robbery) committed while You are engaged in the business of your Commonwealth of Massachusetts employer, whether at or away from your place of business;

3. the Felonious Assault (Robbery or Attempted Robbery) must be committed by someone other than You or Your Beneficiary; and

4. this benefit is in effect on the date of the injury.

Felonious Assault (Robbery) means the robbing, stealing or taking by force and violence or by assault (whether or not while armed with a weapon), money or other property which may be the subject of larceny .

Felonious Assault (Attempted Robbery) means any overt act done in the furtherance of robbing, stealing or taking by force and violence or by assault (whether or not while armed with a weapon), money or other property which may be the subject of larceny.

Example

Insured Dies Due to a Felonious Assault (Robbery and Attempted Robbery)

Basic Life $5,000 Optional Life $100,000

Basic Life/AD&D $5,000 Optional Life/AD&D $100,000

Felonious Assault: 3 times Optional AD&D benefit of $100,000 =

$300,000

Total Benefit $10,000 Total Benefit $500,000

Benefit AmountIf the loss results in Your death and that death is the natural and proximate result of a robbery or attempted robbery, We will pay an amount equal to the lesser of:

• 3 times Your Optional Accidental Death and Dismemberment benefit amount; or

• $1,500,000

Benefit PaymentWe will pay this benefit in one sum to Your Beneficiary.


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Limits and Exclusions to AD&D Benefits

MetLife will not pay benefits under this section for any loss caused or contributed to by:

1. physical or mental illness or infirmity, or the diagnosis or treatment of such illness or infirmity;

2. infection, other than infection occurring in an external accidental wound or from food poisoning;

3. suicide or attempted suicide;

4. intentionally self-inflicted injury;

5. the voluntary intake or use by any means of:

• any drug, medication or sedative, unless it is:

– taken or used as prescribed by a Physician; or

– an “over the counter” drug, medication or sedative taken as directed;

– alcohol in combination with any drug, medication, or sedative; or

– poison, gas, or fumes

Be Aware

• The loss must be accidental.

• The total amount paid for any one loss will not exceed the total amount of insurance in force.

• Loss of hand or foot means complete severance at or above the wrist or ankle joint.

• Loss with respect to eyes means total and irrevocable loss of sight.

• Loss with regard to thumb and index finger means actual severance through or above the metacarpophalangeal joints.

• Loss with regard to movement means complete and irrevocable paralysis of such limbs.

Covered Air Travel

The following travel or flight in any type of aircraft is covered:

• Travel or flight as a passenger in a licensed aircraft operated by a licensed pilot on a scheduled passenger service regularly offered between specified airports by a passenger carrier duly licensed by the proper licensing authority.

• Travel or flight as a passenger in a chartered aircraft owned, operated and licensed to a passenger carrier who is licensed to and who offers scheduled, non-charter passenger service regularly, and provided that such chartered aircraft is operated by a licensed pilot during service between specified airports.

• Travel or flight in an aircraft used, leased or operated by the Commonwealth of Massachusetts, in which the employee or retiree is traveling in the performance of his or her duties.

Any other type of travel or flight in an aircraft is not covered.

Seat Belt Benefit

If You die as a result of an accidental injury, MetLife will pay this additional Seat Belt Use benefit if:

1. MetLife pays a benefit for loss of life under the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE section;

2. this benefit is in effect on the date of the injury; and

3. MetLife receives Proof that the deceased person:

• was in an accident while driving or riding as a passenger in a Passenger Car;

• was wearing a Seat Belt which was properly fastened at the time of the accident; and

• died as a result of injuries sustained in the accident.

A police officer investigating the accident must certify that the Seat Belt was properly fastened. A copy of such certification must be submitted to MetLife with the claim for benefits.

Passenger Car means any validly registered four-wheel private passenger car, four-wheel drive vehicle, sports-utility vehicle, pick-up truck, van, motor home, camper or mini-van. It does not include any commercially licensed car, any private car being used for commercial purposes, or any vehicle used for recreational or professional racing.

Seat Belt means any restraint device that:

• meets published United States Government safety standards;

• is properly installed by the car manufacturer; and

• is not altered after the installation.

The term includes any child restraint device that meets the requirements of state law.

Example

Insured Dies in an Accident with Seat Belt



Seat Belt Benefit $1,000Minimum Benefit is $1,000 Maximum Benefit is $25,000

$10,000


Benefit AmountThe Seat Belt benefit is an additional benefit equal to 10% of the Full Amount shown in the SCHEDULE OF BENEFITS. However, the amount MetLife will pay for this benefit will not be less than $1,000 or more than $25,000.

Benefit PaymentFor loss of Your life, MetLife will pay benefits to Your Beneficiary.


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Airbag Benefit

If You die as a result of an accidental injury, MetLife will pay this additional benefit if:

1. MetLife pays a benefit for loss of life under the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE section;

2. this benefit is in effect on the date of the injury; and

3. MetLife receives Proof that the deceased person:

• was in an accident while driving or riding as a passenger in a Passenger Car equipped with an Air Bag(s);

• was riding in a seat protected by an Air Bag;

• was wearing a Seat Belt which was properly fastened at the time of the accident; and

• died as a result of injuries sustained in the accident.

A police officer investigating the accident must certify that the Seat Belt was properly fastened and that the Passenger Car in which the deceased was traveling was equipped with Air Bags. A copy of such certification must be submitted to MetLife with the claim for benefits.

Passenger Car means any validly registered four-wheel private passenger car, four-wheel drive vehicle, sports-utility vehicle, pick-up truck, van, motor home, camper or mini-van. It does not include any commercially licensed car, any private car being used for commercial purposes, or any vehicle used for recreational or professional racing.

Seat Belt means any restraint device that:

• meets published United States government safety standards;



The term includes any child restraint device that meets the requirements of state law.

Air Bag means an inflatable restraint device that:

• meets published United States government safety standards;



Example

Insured Dies in an Accident with Seat Belt and Air Bag



Seat Belt Benefit $1,000Minimum Benefit is $1,000 Maximum Benefit is $25,000

$10,000

Air Bag Basic Life $5,000 Air Bag Optional Life $5,000


Benefit AmountThe Air Bag Benefit is an additional benefit equal to $5,000.

Benefit PaymentFor loss of Your life, MetLife will pay benefits to Your Beneficiary.

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Benefits for Commonwealth of Massachusetts Employees and Retirees | How Your Life Insurance Program Works


How Your Life Insurance Program Works

If you should die while insured under this program, MetLife will pay your beneficiary the entire amount of life insurance in force after the GIC has been notified of the death and MetLife receives all of the required documentation.

Naming Your Beneficiary

When you become insured, you must name someone as your beneficiary to receive your life insurance proceeds. You may name more than one person and determine the proportion each person is to receive. If more than one beneficiary is named, and you do not designate their order or share of payments, the beneficiaries will share equally. The share of a beneficiary who dies before you, or the share of a beneficiary who is disqualified, will pass to any surviving beneficiaries in the order you designated.

The effective date of your beneficiary designee will be the date that the GIC receives the completed beneficiary designation form.

You may change your beneficiary at any time by completing a new GIC life insurance beneficiary designation form and submitting it to the GIC. Active employees should contact the GIC Coordinator at your workplace and retirees should contact the GIC for instructions on how to change your beneficiary designation.

If any beneficiary is a minor, the benefit will be paid to the legal guardian of the minor’s estate.

Beneficiary information is confidential. An insured can confirm his or her beneficiary information by reviewing their annual GIC benefit statement. Beneficiary information is not provided over the phone.

If any person otherwise entitled to payment does not make a claim for payment within one year of the death, payment may be made by order of precedence as if such person had died before the insured.

Assignment of Life Insurance

You may assign Your Life and AD&D Insurance rights and benefits under the Group Policy. The GIC and MetLife will recognize the assignee under such assignment as owner of Your right, title and interest in the Group Policy if:

1. You follow the required rules and regulations of the GIC;

2. a Written form satisfactory to the GIC and MetLife, affirming this assignment, has been completed;

3. the Written form has been Signed by You and the assignee;

4. the Policyholder acknowledges that Your Life Insurance and Accidental Death and Dismemberment Insurance being assigned is in force on the life of the assignor; and

5. the Written form is delivered to the GIC and MetLife for recording.

You may have made an irrevocable assignment under a group policy that the Group Policy replaces. In this case, the GIC and MetLife will recognize the assignee under such assignment as owners of Your right, title and interest under the Group Policy if:

1. a Written form satisfactory to the GIC and MetLife, affirming this assignment, has been completed;

2. the Written form has been Signed by You, the assignee and the Policyholder; and

3. the Written form is delivered to the GIC and MetLife for recording.

To apply for assignment of life insurance, you must contact the GIC for an assignment form. The assignment form must be received and approved by the GIC and MetLife before your insurance can be assigned to another party.

It is important to note that the GIC and MetLife are not responsible for the validity of these assignments.

If you do not name a beneficiary, or if all named beneficiaries do not survive you, or if your named beneficiary is disqualified, your insurance benefit will be paid to the first surviving family member, in the order listed below:

1. Your spouse2. Your child or children3. Your mother or father4. Your sisters or brothers5. Your estate

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Waiver of Premium Due to Disability

If prior to age 60 you become Totally disabled while insured, your Basic and Optional Life insurance may be continued without further premium cost to you.

• You must apply for the Waiver of Premium benefit within two years of your date of disability.

• You must contact the GIC to commence the Waiver of Premium claim process and MetLife will send you a Waiver of Premium claim package which you must complete and return to MetLife. If you are enrolled in the GIC Long Term Disability program and started collecting LTD benefits monthly from MetLife after July 1, 2021, an application for Waiver of Premium will not be required as MetLife will evaluate the medical information supporting your LTD benefit to make a determination regarding your Waiver of Premium eligibility.

Active employees and retirees are eligible to apply for Waiver of Premium for the coverage amount in effect at the time of application. If you qualify for Waiver of Premium, the amount of insurance in effect on the day you applied for Waiver of Premium will be the amount continued under this waiver provision. This amount will not increase.

If your Waiver of Premium was approved prior to May 1, 1983, under state law, your Optional Life insurance benefits will end at age 70. You are then eligible to convert to a non-group policy. The waiver of your Basic Life insurance will remain in force for as long as you continue to remain totally disabled. Upon approval of the Waiver of Premium, your AD&D benefit will be discontinued.

You are disabled when MetLife determines that, due to an injury or sickness:

• You are unable to perform the material duties of your regular job; and

• You are unable to perform any other job for which you are, or could become, fit by education, training, or experience.

The loss of a professional or occupational license or certification does not, in itself, constitute disability.

MetLife may require you to be examined by a doctor, other medical practitioner or vocational expert of its choice. MetLife will pay for this examination. It can require an examination as often as it is reasonable to do so.

If your application for Waiver of Premium is denied or you fail to submit an application for Waiver within the designated two-year period, you may continue the coverage amount in force for you immediately prior to the date you became disabled, provided premiums continue to be paid for such coverage.

Deferred Retirement

A “deferred retiree” is defined as an insured employee who, when ending employment with the Commonwealth, has a right to receive a pension at some future date. Before the pension is received, the employee, for purposes of these life insurance programs, may be considered as if on a leave of absence without pay and may continue his or her insurance program by paying the full cost of the insurance.

Any withdrawal/transfer of monies from a state pension to a pension system not covered by the GIC shall disqualify you from deferred retiree coverage. It is your responsibility to report to the GIC any withdrawal/transfer of monies, so that the GIC can determine if Deferred Retiree Coverage will continue or end.

Retirement

If you retire from service with the Commonwealth and are eligible for a pension, you may continue your Basic and Optional Life insurance at the amount you had at your date of retirement. Your premium for Optional Life insurance will be at the retiree rate. This rate differs from the premium you paid as an active employee. Refer to Monthly Premium Chart on page 6.

An employee thinking of retirement should contact the GIC Coordinator at his or her worksite to obtain GIC retirement forms. It is important to complete these forms before retirement and carefully review the amount of Optional Life insurance coverage and its cost to determine whether it will make economic sense for you to keep it or reduce your amount of coverage.

Be sure to indicate any changes you wish to make on your retirement forms as you will be responsible for the increased premiums if you do not change your coverage amount.

If on or after retirement you terminate or decrease your Optional Life insurance, you may apply for reinstatement up to the amount of Optional Life you had at the time of your retirement if you:

• Submit proof of good health which is satisfactory to MetLife; and

• Forfeit the amount of insurance which has been converted to a non-group policy.

See pages 24-26 for information about portability and conversion options.

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What if You Lose Your Coverage?

Portability1 Coverage

Retirees and those terminating coverage at or above Social Security Normal retirement age are not eligible for the portability option. See https://www.mass.gov/info-details/ life-insurance-and-accidental-death-dismemberment-add for more information.

Active employees under Social Security Normal retirement age who terminate employment or become ineligible due to a reduction in hours may elect to “port” their coverage to a term policy similar to their Group Term Life or Accidental Death & Dismemberment insurance without providing evidence of insurability. This coverage provides more favorable rates than conversion coverage (see page 26).

• if portability is elected and you later become eligible for life insurance under the GIC’s group plan, you must surrender your portable policy.

• You are not eligible for portability if you cancel coverage or if coverage is terminated for non-payment of premium.

If written notice of the option to Port is given within 15 days before or after the date such insurance ends, the Request Period:

• begins on the date the insurance ends, and

• expires 31 days after the date.

If written notice of the option to Port is given more than 15 days after but within 91 days of the date such insurance ends, the Request Period:


• expires 45 days after the date of the notice.

If written notice of the option to Port is not given within 91 days of the date such insurance ends, the Request Period:


• expires at the end of such 91-day period.

Amount of the New CertificateYou may continue your current amount of coverage without providing evidence of insurability: However, at the time of Porting, You may change the amount of Portability Eligible Insurance in the following circumstances:

1. All coverage amounts are subject to applicable state laws. To take advantage of this benefit, coverage of at least $5,000 must be elected.

Your Increase in AmountAt the time of Porting, You may increase the amount of your Life and AD&D Insurance. This may be done in increments of $25,000, up to a maximum ported amount of $2,000,000. To be eligible for this increased amount, You must provide evidence of Your insurability satisfactory to MetLife, at Your expense. If MetLife approves the increase, it will take effect on the date MetLife states in Writing.

Your Decrease in AmountIf MetLife receives a request to decrease an amount of insurance, any such decrease will take place on the date MetLife states in Writing.

Premiums for the New CertificateAll premium payments must be made directly to MetLife. When MetLife issues the new certificate, they will also provide a schedule of premiums and payment instructions.

You are not required to provide evidence of insurability to Port Your existing amount of Life and Accidental Death and Dismemberment Insurance. However, to qualify for a lower premium rate, You may give MetLife, at Your expense, evidence of Your insurability satisfactory to MetLife. If it is determined that the evidence is satisfactory, MetLife will notify You that the lower premium rates will apply to You.

Right to Convert Life Insurance Amounts Not PortedAny amount of Life Insurance not Ported may be converted.

• You are not eligible to apply for portability if you withdraw from GIC coverage.



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Conversion Coverage

If your employment with the Commonwealth ends, you may convert your Group life insurance policy to a non-group policy. The new policy may be on any form then customarily offered by MetLife, excluding term insurance. No medical exam is required.

You are not eligible to apply for conversion if you withdraw from GIC coverage or discontinue paying your premiums.

MetLife will provide you with a conversion application form, instructions, and cost information. If You opt to convert Your life insurance, MetLife must receive a completed conversion application form from You within the Application Period described below.

If You are given Written notice of the option to convert within 15 days before or after the date Your life insurance ends or is reduced, the Application Period begins on the date that such life insurance ends or is reduced and expires 31 days after such date.

If You are given Written notice of the option to convert more than 15 days after the date Your life insurance ends or is reduced, the Application Period begins on the date such life insurance ends or is reduced and expires 15 days from the date of such notice. In no event will the Application Period exceed 91 days from the date Your life insurance ends or is reduced.

General Termination ProvisionsYour insurance under this group plan will expire on the earlier of the following:

• The last day of the month for which your life insurance premium has been paid.

• The date you retire from employment with the Commonwealth, unless you continue your Basic and Optional Life insurance by paying monthly premiums.

• After the GIC determines your date of termination based on receipt of your notice of withdrawal from life insurance.

• The date of termination of the group policy without continuation of your insurance under a successor group policy.

Cancellation Provisions

If you have health insurance through the GIC, you must maintain your Basic Life insurance.

To cancel your Basic and/or Optional Life insurance coverage, you must complete and send the GIC Enrollment/Change Form-1 to the GIC.

Your coverage will be canceled at the end of the month for which contributions are paid. Coverage will be reinstated only with approval by the GIC according to its rules and regulations. If you cancel coverage, there is no option for portability or conversion.

The coverage ends on the last day of the month following the month you leave state service, providing your premiums for that month are paid.

Other Considerations• If your Waiver of Premium was approved prior to May 1, 1983, under state law

your Optional Life insurance benefits will end at age 70.

• Your Accidental Death & Dismemberment coverage will end on the date you are approved for Life Waiver of Premium.

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Benefits for Commonwealth of Massachusetts Employees and Retirees | What Other Services Does MetLife Provide?


Will Preparation1 To help ensure your decisions are carried out

When you enroll for optional term life coverage, you will automatically receive access to Will Preparation Services at no extra cost to you. Both you and your spouse will have unlimited in-person or telephone access to one of MetLife Legal Plans, Inc.’s nationwide network of 18,000+ participating attorneys for preparation of or updating a will, living will or power of attorney.* When you use a participating plan attorney, there will be no charge for the services.* Like life insurance, a carefully prepared will (simple or complex), living will and power of attorney are important.

• A will lets you define your most important decisions, such as who will care for your children or inherit your property.

• A living will ensures your wishes are carried out and protects your loved ones from having to make very difficult and personal medical

decisions by themselves. Also called an “advanced directive,” it is a document authorized by statutes in all states that allows you to provide written instructions regarding use of extraordinary life-support measures and to appoint someone as your proxy or representative to make decisions on maintaining extraordinary life-support if you should become incapacitated and unable to communicate your wishes.

• Powers of attorney allow you to plan ahead by designating someone you know and trust to act on your behalf in the event of unexpected occurrences or if you become incapacitated.

Call 1-800-821-6400 and a Client Service Representative will assist you.* You also have the flexibility of using an attorney who is not participating in

the MetLife Legal Plans, Inc. network and being reimbursed for covered services according to a set fee schedule. In that case, you will be responsible for any attorney’s fees that exceed the reimbursed amount.

What Other Services Does MetLife Provide?

Estate Resolution ServicesSM1 (ERS) Personal service and compassion assistance to help probate your and your spouse’s estates.

MetLife Estate Resolution ServicesSM is available to employees enrolled in optional life and provides probate services in person or over the phone to the representative (executor or administrator) of the deceased employee’s estate and the estate of the employee’s spouse. Estate Resolution Services include preparation of documents and representation at court proceedings needed to transfer the probate assets from the estate to the heirs and completion of correspondence necessary to transfer non-probate assets. ERS covers participating plan attorneys’ fees for telephone and face-to-face consultations or for the administrator or executor to discuss general questions about the probate process.

Grief Counseling (all states except NY)2 To help you, your dependents, and your beneficiaries cope with loss

You, your dependents, and your beneficiaries have access to grief counseling2 sessions and funeral-related concierge services to help cope with a loss — at no extra cost. Grief counseling services provide confidential and professional support during a difficult time to help address personal and funeral planning needs. At your time of need, you and your dependents have 24/7 access to a work/life counselor. You simply call a dedicated 24/7 toll-free number to speak with a licensed professional experienced in helping individuals who have suffered a loss. Sessions can either take place in-person or by phone. You can have up to five face-to-face grief counseling sessions per event to discuss any situation you perceive as a major loss, including but not limited to death, bankruptcy, divorce, terminal illness, or losing a pet.1 In addition, you have access to funeral assistance for locating funeral homes and cemetery options, obtaining funeral cost estimates and comparisons, and more. You can access these services by calling 1-888-319-7819 or log on to www.metlifegc.lifeworks.com (Username: metlifeassist; Password: support).

Download this helpful Funeral Planning Guide at https://www.metlife.com/funeralplanning/funeral-guide/.

1. Will Preparation and MetLife Estate Resolution Services are offered by MetLife Legal Plans, Inc. Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and affiliates, Warwick, Rhode Island. For New York sitused cases, the Will Preparation service is an expanded offering that includes office consultations and telephone advice for certain other legal matters beyond Will Preparation. Tax Planning and preparation of Living Trusts are not covered by the Will Preparation Service. Certain services are not covered by Estate Resolution Services, including matters in which there is a conflict of interest between the executor and any beneficiary or heir and the estate; any disputes with the group policyholder, MetLife and/or any of its affiliates; any disputes involving statutory benefits; will contests or litigation outside probate court; appeals; court costs, filing fees, recording fees, transcripts, witness fees, expenses to a third party, judgments or fines; and frivolous or unethical matters.

2. Grief Counseling and Funeral Assistance services are provided through an agreement with LifeWorks US Inc. LifeWorks is not an affiliate of MetLife, and the services LifeWorks provides are separate and apart from the insurance provided by MetLife. LifeWorks has a nationwide network of over 30,000 counselors. Counselors have master’s or doctoral degrees and are licensed professionals. The Grief Counseling program does not provide support for issues such as: domestic issues, parenting issues, or marital/relationship issues (other than a finalized divorce). For such issues, members should inquire with their human resources department about available company resources. This program is available to insureds, their dependents and beneficiaries who have received a serious medical diagnosis or suffered a loss. Events that may result in a loss are not covered under this program unless and until such loss has occurred. Services are not available in all jurisdictions and are subject to regulatory approval. Not available on all policy forms.

http://www.metlifegc.lifeworks.com

https://www.metlife.com/funeralplanning/funeral-guide/

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Benefits for Commonwealth of Massachusetts Employees and Retirees | What Other Services Does MetLife Provide?


Funeral Discounts and Planning Services1

Ensuring your final wishes are honored

As a MetLife group life policyholder, you and your family may have access to funeral discounts, planning and support to help honor a loved one’s life — at no additional cost to you. Dignity Memorial provides you and your loved ones access to discounts of up to 10% off of funeral, cremation and cemetery services through the largest network of funeral homes and cemeteries in the United States.

When using the Dignity Memorial Network, you have access to convenient planning services — either online at www.finalwishesplanning.com, by phone (1-866-853-0954), or by paper — to help make final wishes easier to manage. You also have access to assistance from compassionate funeral planning experts to help guide you.

Beneficiary Claim Assistance2 For support when beneficiaries need it most

This program is designed to help beneficiaries sort through the details and serious questions about claims and financial needs during a difficult time. MetLife has arranged for financial professionals to be available for assistance in person or by telephone to help with filing life insurance claims, government benefits and help with financial questions.

Travel Assistance Services3 (Active State Employees Only)A Unique AdvantageTo complement your MetLife insurance coverage, you have access to Travel Assistance3 services, a unique program giving you and covered family members4 access to travel assistance professionals at AXA Assistance USA, Inc. when traveling within the U.S. or abroad. They have the expertise to help when you need emergency medical, travel and personal assistance.

Professional Help, Just a Phone Call AwayEveryone wants a stress-free trip, but unforeseen events can happen. The good news is that AXA representatives are there by your side. If there’s an emergency while traveling internationally or domestically,5 with one simple phone call you can access:

• Over 600,000 pre-qualified providers worldwide

• Air and ground ambulance service

• Trained multilingual professionals who can advise and help you quickly in a travel emergency

Emergency BenefitsEmergency medical evacuation services and return of remainsIf medical facilities aren’t available locally, the program will provide resources needed to get you and your covered family members to the nearest medical facility for treatment or back home, if medically necessary. If you or a covered family member passes away while traveling, AXA will transport the remains back and cover the associated costs.

Political and Natural Disaster EvacuationAXA can provide transportation services when the country where eligible participants are located need to be evacuated based on a determination of the US government. In addition, in the event of a Natural Disaster Situation, AXA can coordinate and arrange for the evacuation of eligible participants from a safe departure point to a safe haven.

Dispatch of PhysicianIf the local attending legally qualified physician and AXA cannot adequately assess the member’s need for medical evacuation and transportation, AXA will coordinate, provide and dispatch a physician to assist in the assessment. AXA will provide for a benefit up to $2,500.

Pet RepatriationIf a pet traveling with you is left unattended due to your hospitalization, AXA will coordinate and provide boarding for the pet. If the injury or illness results in an evacuation or repatriation service, AXA will coordinate and provide transportation for the pet to be returned to either home, or to a boarding facility near home. AXA will provide for a benefit up to $2,500.

1. Services and discounts are provided through a member of the Dignity Memorial® Network, a brand name used to identify a network of licensed funeral, cremation and cemetery providers that are affiliates of Service Corporation International (together with its affiliates, “SCI”), 1929 Allen Parkway, Houston, Texas. The online planning site is provided by SCI Shared Resources, LLC. SCI is not affiliated with MetLife, and the services provided by Dignity Memorial members are separate and apart from the insurance provided by MetLife. Not available in some states. SCI offers planning services, expert assistance, and bereavement travel services to anyone regardless of affiliation with MetLife. Discounts through Dignity Memorial’s network of funeral providers have been pre-negotiated. Not available where prohibited by law. If the group policy is issued in an approved state, the discount is available for funeral services held in any state except KY and NY, or where there is no Dignity Memorial presence (AK, MT, ND, SD, and WY). For TN, the funeral services discount is available for “At Need” services only. Not approved in AK, FL, KY, MT, ND, NY and WA.

2. Beneficiary Claim Assistance: MetLife administers the programs, but has arranged for specially-trained third party financial profes-sionals to offer financial education and, upon request, provide personal guidance to employees and former employees of companies providing these programs through MetLife.

3. Travel Assistance services are offered and administered by AXA Assistance USA, Inc. Certain benefits provided under the Travel Assistance program are underwritten by Certain Underwriters at Lloyd’s London (not incorporated) through Lloyd’s Illinois, Inc. Neither AXA Assistance USA Inc. nor the Lloyd’s entities are affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife.

4. You and Covered Family Members means an enrolled employee and their eligible dependents as defined under the group insurance contract issued by MetLife.

5. Traveling more than 100 miles from home.

EXCLUSIONS: The AXA Travel Assistance Program is available for participants in traveling status. Whenever a trip exceeds 120 days, the participant is no longer considered to be in traveling status and is therefore no longer eligible for the services. Also, AXA Assistance USA will not evacuate or repatriate participants without medical authorization; with mild lesions, simple injuries such as sprains, simple fractures or mild sickness which can be treated by local doctors and do not prevent the member from continuing his/her trip or returning home; or with infections under treatment and not yet healed. Benefits will not be paid for any loss or injury that is caused by or is the result from: pregnancy and childbirth except for complications of pregnancy, and mental and nervous disorders unless hospitalized.

Reimbursements for non-medical services such as hotel, restaurant, taxi expenses or baggage loss while traveling are not covered. The maximum benefit per person for costs associated with evacuations, repatriations or the return of mortal remains is US$500,000. Treatment must be authorized and arranged by AXA Assistance’s designated personnel to be eligible for benefits under this program. All services must be provided and arranged by AXA Assistance USA, Inc. No claims for reimbursement will be accepted.

http://www.finalwishesplanning.com

32 Benefits for Commonwealth of Massachusetts Employees and Retirees | What Other Services Does MetLife Provide?


Worldwide Medical Teleconsultation1

If you’re traveling and need medical advice for common and minor illnesses, you and covered family members can have virtual consultations with licensed medical professionals, 24/7 — via mobile device or phone. The DOCTOR PLEASE! App is available at iTunes or Google Play. Create your account and enter the activation code US0620 to schedule a virtual appointment.

Medical Assistance Services• Medical referrals, appointments and hospital admissions

• Critical care monitoring

• Replacement of prescription medication

• Replacement of medical devices

Personal Assistance ServicesAdvice before you travelMake sure you visit AXA’s Travel Assistance website for advice about your visa, passport, inoculations and local customs, as well as 24-hour pre-departure information on weather, currency and plenty more.

Your own conciergeSave time and hassle with our concierge service. Seasoned concierges will take care of all your travel and entertainment arrangements including flights, hotel and dining reservations, general destination and transportation information, city guides and much more. A source of local knowledge on call, whenever you need them, wherever you are.

Pet concierge servicesGet help with locating pet-friendly hotel accommodations, local boarding facilities and assistance with travel arrangements back home for your pets in case of an emergency.

Other Assistance Services Include:

• Local professional referrals

• Help with lost documents or luggage

• Emergency cash/bail assistance

• Mobile phone support

1. Available globally to members in a traveling status. Teleconsultation is not an emergency medical response program. In the event of a medical emergency, you should contact your local emergency medical service. You can receive Teleconsultation services for limited, non-urgent, non-life threating medical conditions; this service is not appropriate for all conditions. Services, including assistance with prescriptions, will be provided if permitted under applicable law. Teleconsultation services are arranged through AXA Assistance USA and Teladoc International.

For information or access to services: Call: Within the U.S.: 1-800-454-3679 | Outside the U.S.: 1-312-935-3783 (collect) Visit: www.metlife.com/travelassist

When accessing services, identify your employer as the GIC.

metlife.com

Life and AD&D coverages are provided under a group insurance policy (Policy Form GPN99 or G2130-S) issued to your employer by MetLife. Life and AD&D coverages under your employer’s plan terminates when your employment ceases, when your Life and AD&D contributions cease, or upon termination of the group insurance policy. Dependent Life coverage will terminate when a dependent no longer qualifies as a dependent. Should your life insurance coverage terminate, for reasons other than non-payment of premium, you may convert it to a MetLife individual permanent policy without providing medical evidence of insurability.

Like most group insurance policies, insurance policies offered by MetLife contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact your benefits administrator or your MetLife Group Representative for costs and complete details.

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0521013823[exp0522][All States][DC,GU,MP,PR,VI] @ 2021 MetLife Services and Solutions, LLC

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