Eligibility Requirements:

To enroll in SAMBA’s Group Term Life with AD&D Insurance Plan you must be an active employee of one of the agencies we serve, full-time or part-time. Evidence of insurability is required. Coverage may be carried into retirement, provided you are enrolled in the Plan for at least one year prior to retirement.

Benefits offered by the Plan:

• Accidental Death and Dismemberment (AD&D): This feature provides benefits in the event you are killed or lose your hands, feet, or eyesight as the result of a covered Accidental Injury.

Should you be killed in the Line of Duty, your AD&D benefit increases by 50%. For example, if your base amount is $175,000 your beneficiary would receive an additional $87,500 which when added to your Group Term Life and AD&D is a total of $437,500. The Plan defines “killed in the line of duty” as (1) death results directly from a confrontation between the employee and a hostile element; (2) the confrontation resulting in the employee’s death arises from the employee’s official duties; and (3) at the time of the confrontation, the employee was engaged in an attempt to help protect his/her life or the life of another. SAMBA’s Board of Directors has sole discretion in determining if the death was in the line of duty.

• Accelerated Death Benefit: If you have a Terminal Medical Condition, the Accelerated Death Benefit can make a difficult time a little easier for your family. The Plan can make available up to 75% of the Group Term Life insurance amount, up to a maximum of $250,000. This can be used to help pay medical expenses or begin putting the family’s financial affairs in order. A Terminal Medical Condition is one that, with reasonable medical certainty, will result in death within 12 months and was diagnosed by a physician on or after coverage became effective. This benefit terminates on the earlier of the date this benefit is paid or the date the Policy terminates.

How benefits and rates are determined

Your benefit amount and rate are determined by your job grade when you enroll in the plan. Evidence of insurability is required. When you’re promoted to a higher job grade, you can increase your benefit amount. Plus, if you apply within 12 months of being promoted, and your benefit amount is at your maximum benefit amount allowed in your previous job grade, evidence of insurability is not required.

Your coverage can continue when you retire

Eight options to choose from: When you choose one of the options below, your Group Term Life Insurance and matching AD&D coverage will continue. The amount of your insurance will be based on your age group, but you cannot choose an option which exceeds the amount of Group Term Life Insurance you had immediately prior to retirement. If your insurance needs decrease at any time during retirement, you may select any lower plan option then being offered. Your coverage amount automatically reduces at different age brackets. The reduced amount of insurance takes effect on the date you enter each new age bracket shown below.

Beyond age 70: The Group Term Life Insurance plan coverage ends at age 70. If you wish to continue coverage, SAMBA has made arrangements for you to purchase (under another policy) up to $10,000 of insurance coverage.

Limitations and Exclusions

AD&D Benefits are not payable for any loss which is caused by or results from: suicide or intentionally self-inflicted injury, while sane or insane (for MO residents, while sane); your commission of, or attempt to commit, an assault or felony; bodily or mental infirmity, disease of any kind, or medical or surgical treatment for any such infirmity or disease; your voluntary use (except as prescribed by a Doctor) of: (1) PCP (also known as "Angel Dust"); (2) LSD or other hallucinogens; (3) Cocaine, heroin or other narcotics; (4) Amphetamines or other stimulants; (5) Barbiturates or other sedatives or tranquilizers; or (6) any combination of two or more of these substances; any poison or gas voluntarily taken, administered, absorbed, or inhaled; travel or flight in any kind of military aircraft unless it is operated by the MAC (Military Airlift Command, or its foreign equivalent; travel or flight in, or descent from, any kind of aircraft, aboard which you are giving or receiving any kind of training or instruction, or have any duties whatsoever aboard such aircraft while in flight unless the loss occurs: (a) while you are traveling or flying in or descending from the aircraft during the performance of your official duties as an employee of the Federal Government; or (b) while you are the pilot of the aircraft, if you are considered a pilot by the Federal agency of which you are an employee, whether or not you are piloting that aircraft in connection with the performance of your duties of your employment with the Federal Government; any bacterial infection, except when caused by accidental bodily injury; war, whether or not declared; taking part in an insurrection.

Your Gateway to Additional Coverage

Enrollment in the Group Term Life Insurance Plan also qualifies you to apply for additional coverage under SAMBA’s Dependent Group Term Life Insurance and Supplemental Group Term Life Insurance plans. Click here to download an Enrollment Kit. (This file contains 12 pages and may take several minutes to download to your personal computer.)

Rates effective January 1, 2004

Rates effective January 1, 2004