Plan Overview
ERWA has been active since 1947, and serves the entire DOE Headquarters complex. ERWA has had a long-standing affiliation with the National Employee Services and Recreation Association (NESRA). The purpose of ERWA is to organize, promote, and sponsor those cultural, educational, recreational, social, welfare and related membership activities which accrue benefits to improve employee morale.
All persons who are employed by or on behalf of, or retired from the U.S. Department of Energy are eligible to join ERWA, receive membership benefits and privileges, vote in elections and membership meetings, vote for referenda, hold office, and chair any ERWA committee or function.
Visit the ERWA website
At Last, Real Help For Identity Theft Victims
Up until now, there have been three basic ways to deal with the growing problem of Identity Theft: 1. Credit Monitoring (buy a service or do-it-yourself), 2. Insurance (get reimbursed for monetary losses after the fact), and 3. Caution (taking every prudent step possible to protect your identity). There is of course the most popular option in America – DO NOTHING! Maybe that’s why Identity Theft is the fastest growing crime in America today?
None of these options alone are very effective, and even in combination there’s no way to absolutely prevent ID Theft. Worst of all, none even begin to address the most serious problems victim’s face – the time and frustration of stopping ongoing fraud, and restoring ones good name and credit. Here’s why.
Insurance does nothing to prevent or solve the ongoing problems caused by identity theft. Insurance merely reimburses you for a portion of your losses. According to the FTC the average loss is only $500. Most insurance plans only cover losses above a deductible, usually $200 or more, so for most people there is very little to recover and a lot of extra time and paperwork required filing a claim. When you factor in the yearly premiums, this option becomes even less attractive.
Caution is the most effective of the three tools in the battle against ID Theft and Fraud. No matter how careful you are, a determined identity thief can find a way to get personal information. There are literally hundreds of ways, both legal and illegal, to get access to information about you and your personal information.
So, if there’s no foolproof way to avoid Identity Theft, what’s a person to do?
First let’s look at the most frequent consequence of Identity Theft – the loss of your good name and/or credit rating and the hundreds of hours of your personal time that can be spent trying to correct the problem, along with the emotional trauma involved.
Credit Monitoring is now provided by ID Theft Assist. This addition will help catch any new account activity by someone who has accessed your personal information.
Until the introduction of ID Theft Assist, you were on your own in dealing with these consequences. Sure, some Identity Theft Programs provided “ID Recovery Kits”, but most were little more than Do-It-Yourself manuals with instructions and sample form letters. It was a frustrating “trial and error” process, compounded by the inexperience of the victim and the emotional trauma of the situation.
With the introduction of ID Theft Assist there’s finally a better way to deal with the consequences of Identity Theft. With the cards stacked against you, the victim, only pro-active, dedicated professionals with extensive experience and worldwide resources can bring order to the chaos and restore your security. Here’s a thumbnail description of how the program works when you discover your identity has been compromised.
You simply call our toll free number to report the situation, and authorize us (the program providers - (Worldwide Assistance, Trans Union and Affinity Care) to act on your behalf to correct the problem.
COST: $85.00 per year Single or $95.00 per year Family
OR – Call Mass Benefits for an application – 703-256-7800
The program can do all of the following:
With one phone call ID Theft Assist brings order out of chaos by untangling the red tape and completing the arduous and time consuming tasks you would otherwise have to assume!
ID Theft Assist is truly a pro-active service, stepping into the victim’s shoes and doing everything he/she would otherwise have to do to correct the situation. It’s the first and only true third party assistance service for victims of identity theft that saves time, money and aggravation. This is what sets ID Theft Assist apart from every other product on the market today.
Tuition, books, rent, food, fun...health insurance?
With all the things you have to pay for in college, paying for health insurance is probably last on your list. But what's last on your list could be the first thing to put you at serious financial risk. Think about it - if you're currently without health insurance, just one knee injury could cost you up to $12,000*.
That's why Fortis Health created Student Select - health insurance for college students of all ages. If you are an undergraduate with nine or more credits or a full-time graduate student, and are attending an accredited college or university, you are eligible for Student Select, up to age 63.
Student Select is ideal if you find yourself in one of the following situations
Are you no longer eligible for coverage under your parents' health plan? Many health plans only cover you up to age 19-23, or they require you to have more college credit hours than Student Select.
Does your college or university require coverage but you find the college-sponsored plan inadequate? Many college or university plans offer "bare bones" benefits that may not be enough to give you financial security against large, unexpected expenses.
Do you attend school outside an HMO or PPO region? Restrictions on coverage outside HMO or PPO service areas may leave you with inadequate protection.
Is your current health coverage too expensive? Traditionally, individual major medical plans cost two or three times as much as Student Select. The cost to include a student on an employer's health plan as a dependent can also be very expensive.
* Based on an average 1997 Fortis Health Student Select Claim
Here's How Student Select Works
You choose the deductible that best meets your needs: $250, $500, $1000, $2500
Since this plan is not an HMO or PPO, you pick your doctors and hospitals.
If you change schools, take a semester off or have to leave school, Student Select travels with you. And, because Student Select is guaranteed renewable, you can keep your coverage for as long as it's needed, as long as you pay your premiums.
Benefits are paid as follows:
| FIRST | You pay your calendar year deductible. |
| SECOND |
Once your deductible is satisfied, Fortis pays 80% of the next $10,000 of covered expenses. |
| THEREAFTER | Fortis pays 100% of your remaining covered expenses up to $100,000 for each illness or injury. Your total plan maximum is $1 million. |
Plan Highlights
Up to
$1 million protection, $100,000 per illness or injury
Freedom to choose you own doctors and hospitals
Semi-private room and board
Office visits
Emergency care
Surgery
In-hospital and outpatient services
X-ray and laboratory services
Home health care
Ground or air ambulance service
Medical equipment and supplies
Intensive care
Medical evacuation benefit
Money Back Guarantee!
If you are not 100 percent satisfied with the plan, you may return the contract within 10 days of delivery for a full refund. No questions asked!
Click here to enroll online - www.assuranthealth.com.
The issue of Long-Term Care is one that may affect almost all of us in one way
or another. The costs associated with nursing home and home health care continue
to escalate. Traditional sources of health coverage such as FEHB and Medicare
cover few long-term care expenses.
Even though Congress has passed legislation that provides long-term coverage to federal employees, the insurance plan sponsored by ERWA may provide more comprehensive coverage at a lower cost, and can cover parents and children of Energy employees as well as employees and their spouses.
The ERWA sponsored program
through John Hancock Life provides premium discounts of up to 20% .
BENEFITS ARE AVAILABLE REGARDLESS OF THE TYPE OF CARE YOU NEED:
Home Health Care: Home nursing care by an RN, LPN or LVN, or services provided by home health aids who are certified or employed through qualified home health agencies, physical, respiratory, occupational, or speech therapy, and nutritional counseling, by or under the supervision of qualified home health agency.
Adult Day Care Services: Coverage is provided for licensed facilities with planned daytime activities to relieve the primary caregiver.
Informal Care: This includes help with everyday activities, personal supervision from a skilled or unskilled provider if you are cognitively impaired, and certain services to maintain the home environment.
Assisted Living Facilities/Nursing Home Care: Coverage is provided in qualified assisted living facilities or nursing home.
Nursing Home Care: Coverage
is provided for all levels of nursing home care including skilled, intermediate
and custodial nursing care.
To obtain a proposal (rate quote and benefit outline), complete the information below:
Name:______________________________
Street:______________________________
City, St, Zip__________________________
Sex:_________ Agency: Energy
Date of Birth:________________________
Spouse Date of Birth:__________________
Daytime Phone: (______) _____________
Evening Phone: (______)_____________
Mail your request to:
Mass Benefits Consultants,
Inc.
P.O. Box 828
Annandale, VA 22003-0828
OR
E-mail your request to:
mbc@massbenefits.com
SUPPLEMENTAL RETIREMENT PLAN
The
ERWA Supplemental Health Insurance
Plan (SHIP) Underwritten
by: New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010 SHIP PLAN BENEFITS HOSPITAL
INDEMNITY BENEFITS*: $65
(Red Plan), $125 (White Plan), or $190 (Blue Plan) as per plan selected
by Insured. INTENSIVE CARE BENEFIT*: $65 (Red Plan), $125
(White Plan), or $190 (Blue Plan) as per plan selected by Insured. AT HOME RECUPERATION* $40 (Red Plan), $75
(White Plan), or $115 (Blue Plan) as per plan selected by Insured. Benefit
equal to the number of days of hospital confinement. Benefits are paid
directly to you - in addition to any other medical benefits you may have.
PRE-ADMISSION
TESTING*: $65
(Red Plan), $125 (White Plan), or $190 (Blue Plan) as per plan selected
by Insured. $125 (Red Plan), $250
(White Plan), or $375 (Blue Plan) benefit per session - coverage as per
plan selected by Insured. $65 (Red Plan), $125
(White Plan), or $190 (Blue Plan) as selected by Insured - one benefit
payment per accident. Not available to residents
of: DE, FL, IN, KY, ME, MN, MS, NC, NH, NY, OR, TN, TX, VT, WA. Coverage
terminates for employees and dependents when employee reaches attained age
70. COVERAGE IS GUARANTEED You
are guaranteed to be accepted when you enroll in SHIP no matter what
the condition of your health is. You will NOT be required to take a
physical exam or answer a health questionnaire. As a government employee,
under age 70 and enrolled in a Federal Employee Health Benefit Plan
(FEHB), you are eligible and qualify to enroll for SHIP benefits. PREMIUM CALCULATION All
premiums are based on the member's age at issue and at renewal and is
determined on the immediately preceding December 31, except that if
a person's birthday is December 31, then age is determined as of that
day. Rates increase as the member attains a new age bracket. Premium
rates shown are current and may be changed by New York Life on any premium
due date and on any date on which benefits are changed. Benefits are
subject to change by agreement between New York Life and the policyholder.
Monthly, Quarterly, Semi-Annual and Annual billing available - see following
rate charts. WHEN COVERAGE Insurance
on you and your eligible dependents will take effect on the first of
the month following the date your enrollment form is received and approved
by New York Life, provided the initial premium deposit for insurance
is paid for monthly Check Service or Quarterly Direct Bill, or the first
day of the pay period following the date the first deduction is received
for Bi-Weekly Direct Deposit. You and any person to be insured must
be performing the normal activities of a person in good health of like
age and sex on the later of the date of approval and the premium is
paid. Additional Dependents may be Generally
you must apply for coverage for new dependents. But there is an important
exception: If you have any dependent hospital indemnity insurance in
force, newborn children are automatically covered from birth for 31
days. This coverage will be continued if there is medical insurance
in force on other dependent children. You must inform the SHIP Administrator
in writing of the child's name and date of birth. If there is no dependent
coverage, you must notify the SHIP Administrator within 31 days and
remit the extra premium needed. WHEN COVERAGE ENDS You
may continue your coverage as long as you: remain a member; pay your
premiums when due; don't enter in the armed forces for more than 30
days of active duty; are under age 70; or, the Master Policy is not
terminated or modified to end your coverage. Dependent coverage ends
when they are no longer eligible or when your coverage ends. Definition:
Pre-Existing Condition Conditions
for which an individual consulted a doctor or received any medical services
or supplies, or took any medical, during the 12 months prior to their
effective date of coverage won't be covered until after: 12 consecutive
months have elapsed while insured and during which no treatment, care
or advice was received for that condition; or, if earlier, 24 consecutive
months of coverage under the plan. Definition:
Hospital A
"hospital" is a licensed institution primarily engaged in providing
in-patient medical services. It must have permanent facilities for
diagnosis and surgery, 24-hour nursing by registered nurses and continuous
supervision by one or more doctors. It does not include a convalescent
home, nursing home, rest home, an extended care facility or a place
for the aged. PLAN EXCLUSIONS: Benefits
provided only for confinements, which begin while insured for which
a room and board charge is made, and which are recommended by a doctor
as medically necessary to treat a sickness or accident. Benefits are
not provided for confinements caused by, resulting from or contributed
to by: intentionally self-inflicted injury, while sane or insane (Missouri
while sane); treatment of nervous or mental condition, alcoholism or
drug addiction; injuries resulting from active military service; dental
care, except as a result of injury to sound natural teeth; well-baby
care of a newborn dependent child; treatment or service rendered in
any Hospital or Convalescent Facility owned or operated by the Government
where, in the absence of insurance, there is no legal obligation to
pay (Exclusions may differ in your state. See your Certificate of Insurance
for details); declared or undeclared war or any act of war; pregnancy
(except Complication of Pregnancy, as defined in your certificate of
insurance); expenses incurred or care received outside of the United
States; participating in a crime, illegal activity; or a pre-existing
condition as defined below. ENROLLMENT IS EASY..... You
can give your family the extra protection of SHIP in minutes....... 1.
Complete the Enrollment Form. 2.
Make sure you check which coverage options you want. 3.
Choose your payment option - 4.
Mail the application and payment to: Mass
Benefits Consultants, Inc. YOUR PERSONAL GUARANTEE OF SATISFACTION After
your Enrollment Form has been accepted, you will receive a Certificate of
Insurance describing the Plan's benefits in detail. If you decide, for any reason,
that you do not want to continue coverage, return the Certificate within 30
days. You'll get a full refund, with no questions or obligations. YOUR PLAN ADMINISTRATOR Mass
Benefits Consultants, Inc. (MBC) remains the administrator of the SHIP Plan. ANY QUESTIONS REGARDING THE SHIP PLAN? CALL TOLL-FREE 1-800-221-3083 OR e-mail mbc@massbenefits.com --------------------------------------------------------------------------------- Although
every attempt has been made to verify the accuracy of the information contained
on this website, errors and omissions may occur. This information is a brief
description of important features of the SHIP Hospital Indemnity Plan. It
is not a contract. Terms and conditions of coverage are set forth in group
policy number G-29162-0, on policy form GMR issued to the Government Employees
Voluntary Benefit Trust (GEVBT).
Daily benefits payable for:
Employee, Spouse or Child(ren)
Maximum Benefit Period: 365 days
Daily Benefit
(after hospital confinement)
OUT-PATIENT SURGERY*
ACCIDENT BENEFIT*:
Daily Benefit:
*No Waiting (Elimination) Period except for Pre-Existing Conditions (see
"Definition: Pre-Existing Condition" below).
RED PLAN
BI-WEEKLY RATES
WHITE PLAN
BI-WEEKLY RATES
BLUE PLAN
BI-WEEKLY PLANS
Insured's
Attained Age
MEMBER
ONLY
MEMBER
PLUS 1
MEMBER
PLUS 2 OR
MORE
MEMBER
ONLY
MEMBER
PLUS 1
MEMBER
PLUS 2 OR
MORE
MEMBER
ONLY
MEMBER
PLUS 1
MEMBER
PLUS 2 OR
MORE
Under 40
4.00
7.00
9.00
8.00
14.00
18.00
12.00
21.00
27.00
40-44
5.00
10.00
12.00
10.00
20.00
24.00
15.00
30.00
36.00
45-49
6.00
12.00
14.00
12.00
24.00
28.00
18.00
36.00
42.00
50-54
8.00
14.00
17.00
16.00
28.00
34.00
24.00
42.00
51.00
55-59
9.00
18.00
20.00
18.00
36.00
40.00
27.00
54.00
60.00
60-64
12.00
23.00
25.00
24.00
46.00
50.00
36.00
69.00
75.00
65-69
15.00
28.00
30.00
30.00
56.00
60.00
45.00
84.00
90.00
BECOMES EFFECTIVE
automatically covered:
(Monthly, Quarterly, Semi-Annual and Annual rate charts are linked below.)
P.O. Box 828
Annandale, VA 22003-0828 ENROLLMENT
FORM
DIRECT
DEPOSIT FORM
MONTHLY RATE CHART
QUARTERLY
RATE CHART
SEMI-ANNUAL
RATE CHART
ANNUAL
RATE CHART
CLAIM
FORM
MONTHLY CHECK SERVICE
HIGH-LIMIT ACCIDENTAL DEATH AND DISMEMBERMENT PLAN
Accidents can happen to anyone at any time. No one can foresee when one will occur, but now you can plan against the severe financial loss such a tragedy could bring to you and members of your family.
You may enroll individually or include your spouse and dependent children.
A brief description of the benefits, premium rates and an enrollment form follow. Take this opportunity today to enroll in this important plan to protect yourself and your family's future.
$10,000 to $100,000 - Choose the protection you want........
This Accidental Death and Dismemberment Plan is offered to you, your spouse and dependent children at reasonable, group rates because you are a Federal employee. These benefits are payable for death or dismemberment due to accidents that occur anywhere in the world.
You Are Eligible for up to $100,000 of Coverage
All members under age 70
who are actively at work are eligible for this plan. You select the protection
you want, from $10,000 to $100,000.
You May Select Individual
Coverage or Include Your Spouse
and Dependents in this Plan...
You can include your spouse (husband or wife to age 70) and all dependent, unmarried children to 19 years of age (23 if a full-time student). It costs you much less than similar individual coverage alone. If you select the Family Plan, the benefits are:
a) Your spouse is insured for 50% of the member's full benefit amount.
b) Each unmarried child under 19 (23 if full-time student) is insured for 10% of the member's full benefit amount.
You Are Paid the Benefits Shown Below....
When injuries caused by an accident result in death or dismemberment, within 90 days of an accident, the Accidental Death & Dismemberment Plan pays these benefits.
For loss of:*
| Life | Full Benefit Amount | |
| Both hands or both
feet or sight of both eyes |
Full Benefit Amount | |
| Any combination of
foot, hand or sight of one eye |
Full Benefit Amount | |
| Either hand or foot | One-Half the Full Benefit Amount |
|
| Sight of one eye | One-Half the Full Benefit Amount |
* Loss means: with reference
to hands and feet, actual severance through or above
wrist or ankle joints; with reference to sight, entire and irrecoverable loss
of sight which
cannot be restored by surgical or other means.
Enroll Now at Reasonable Rates
1. Select the total amount of coverage you want from the table below.
2. Fill out the enrollment form.
3. Mail the enrollment form and first annual payment to:
Mass Benefits Consultants, Inc.
P.O. Box 828
Annandale, VA 22003-0828
|
Members
Under Age 65
That Are Actively At Work: Annual Cost: |
||
| Principal Sum | Member Only | Member
& Family |
| $100,000 | $ 58.00 | $ 91.00 |
| $ 90.000 | $ 52.30 | $ 82.00 |
| $ 80.000 | $ 46.60 | $ 73.00 |
| $ 70,000 | $ 40.90 | $ 64.00 |
| $ 60,000 | $ 35.20 | $ 55.00 |
| $ 50,000 | $ 29.50 | $ 46.00 |
| $ 40,000 | $ 23.80 | $ 37.00 |
| $ 30,000 | $ 18.10 | $ 28.00 |
| $ 20,000 | $ 12.40 | $ 19.00 |
| $ 10,000 | $ 6.70 | $ 10.00 |
The above costs include a $1.00 billing fee.
Coverage greater than $50,000 will reduce to $50,000 at Age 65.
Coverage terminates at age 70.
|
Members
That Are Age 65+:
Annual Cost: |
||
| Principal Sum | Member Only | Member
& Family |
| $ 50,000 | $ 43.50 | $ 63.50 |
| $ 40,000 | $ 35.00 | $ 51.00 |
| $ 30,000 | $ 26.50 | $ 38.50 |
| $ 20,000 | $ 18.00 | $ 26.00 |
| $ 10,000 | $ 9.50 | $ 13.50 |
The above costs include
a $1.00 billing fee.
Coverage terminates at age 70.
Important Coverage Information
EFFECTIVE DATE AND TERMINATION
Your coverage goes into effect on the first day of the month following receipt
of your enrollment form and the first annual premium payment. Members must be
actively at work the date insurance is to take effect. If not, insurance will
take effect when the member resumes work. Dependent must not be hospitalized
on the date insurance is to take effect. If hospitalized, insurance will take
effect on the day after being discharged.
Your policy continues in effect up to age 70; or the end of the period for which the last premium has been paid for you; or the date you cease being a member in good standing with a Participating Association; or the premium date coinciding with or next following the date you enter full-time active duty in the armed forces of any country or international organization; or the group policy is terminated.
EXCLUSIONS
No benefits will be paid for any loss that results from or is caused directly,
indirectly, wholly or partly by:
1. suicide; or intentionally self-inflicted injury;
2. insurrection; war or act of war;
3. a physical or mental sickness, or treatment of that sickness;
4. voluntary intake of poison, drugs, gas or fumes, unless taken as prescribed
by a physician;
5. committing a crime, or an attempt to do so;
6. being intoxicated or under the influence of any drug, unless prescribed by
a physician;
7. flight in any type of aircraft. This item applies only to:
This is a brief summary of benefits only and is subject to the terms, conditions and limitations of Group Policy No. G-191,820. Complete details can be found in the Certificate of Insurance, which will be sent to you when your application is approved.
Administered by:
Mass Benefits Consultants, Inc.
P.O. Box 828
Annandale, VA 22003-0828
(800) 221-3083
Underwritten by:
The United States Life Insurance Company
in the City of New York
3600 Route 66, P.O. Box 1580,
Neptune, NJ 00754-1580
United States Life is an
A+ (Superior) by A.M. Best, reflecting the company's superior overall financial
strength and operating performance when compared to A.M. Best's standards.
Although every attempt has been made to verify the accuracy of the information contained on this website, errors and omissions may occur. You will receive a certificate of insurance describing the exact coverage and benefits purchased. This website explains the general purposes of the insurance described, but in no way changes or affects the insurance afforded under the group insurance policy actually issued. All coverage is subject to the actual policy conditions and exclusions
PROFESSIONAL LIABILITY INSURANCE
Especially designed for Federal Employees
Lawsuits against Federal Government employees are increasing at an alarming rate. Members of the public, even fellow workers, can bring personal lawsuits against you. You are at risk whenever you are acting within the scope of your job including:
Away from your desk, you could be exposed to even greater risk of lawsuits from private citizens. Frivolous or not, it could still cost you thousands of dollars.
Federal Law requires that all federal agenciesThe Federal Tort Claims Act states that the government can choose whether or not to defend you. It cannot cover any monetary damages awarded against you personally. Even if the Justice Department refuses to defend you, this plan picks up the full cost of your legal defense and pays covered damages awarded against you (up to the $1 million limit).
This Professional Liability Insurance was specially designed to protect Federal Government employees. You are protected anywhere in the world against losses from lawsuits stemming from the performance of your official federal duties.
In recent years, the number of disciplinary and performance-based actions taken by U.S. government agencies against their own employees, both supervisory and non-supervisory, has risen dramatically. Allegations of discrimination, sexual harassment, civil rights violations, computer and credit card misuse, leave abuse and other offenses can be leveled at the most honest and upright of people. This policy provides experienced federal employment law practitioners for your legal defense with coverage up to $100,000 in attorney fees and related costs. Both administrative and criminal charges against you are covered.
In the event defense of the Insured in any claim or suit is granted by the Department of Justice or its designee, the Insured may, nevertheless request the Company to provide him with an attorney selected by the Company to monitor and oversee the defense being provided by the United States.
ELIGIBILITY
Any full-time employee of the Federal Government working at least 17.5 hours per week is eligible for Professional Liability coverage
DESCRIPTION OF BENEFITS
This plan pays for your defense cost even against groundless or fraudulent suits. This is in addition to your liability limit and is without limitation. There is no deductible, and where allowed by state law, this plan pays punitive damages up to your coverage limit.
JUSTICE DEPARTMENT CONSULTED IN DESIGNING THIS COVERAGE
This program was developed with the advice and consultation of attorneys in the Torts Claims Division of the Justice Department to provide the fullest protection possible for you as a government employee. They work in the field daily and are more acutely aware of your needs than anyone else. You should feel confident knowing this is the only professional liability policy developed with the advice of the Justice Department.
“Course and scope of employment” means an “incident” of any kind or character that has to do with and originates in the work, services, trade or profession of the employee’s federal agency and that is performed by the employee while engaged in or about the furtherance of the affairs or services of that federal agency.
ENROLLMENT
1. Complete and return the enclosed application form with payment in the return envelope provided (payroll deduction must be started by employee – call 1-800-221-3083 for assistance).
2. To pay by credit card, visit our secure website: www.career-guard.com. Complete the on-line application and credit card information.
Coverage will begin on the first day of the month following receipt of the application and payment. (Payroll Deduction Option – Coverage begins on the first day of the pay period that the deduction is made.)
EXCLUSIONS
Coverage under this plan does not apply
a) to any obligation for which the Insured or any carrier as the insurer may be held liable under any workers' compensation, unemployment compensation, disability benefits law, or other similar law;
b) to damages arising out of the willful violation of a penal statue or penal ordinance committed by or with the knowledge or consent of the Insured, or damages arising out of acts of fraud committed by or at the direction of the insured with affirmative dishonesty or actual intent to deceive or defraud;
c) to liability assumed by the Insured under any contract or agreement;
d) to Bodily Injury arising out of the ownership, operation, or the use of any land motor vehicle designed for use principally on public highways, including any machinery or apparatus attached thereto, or any aircraft or watercraft;
e) to Property damage to:
1. Property owned occupied by, or rented to the United States Government or Insured;
2. Property used by the Insured;
3. Property in the care or control of the Insured or as to which the Insured is for any purpose exercising physical control.
f. (1) Bodily Injury, Property Damage, Personal Injury, Advertising Injury or any Administrative Law Proceeding arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of pollutants:
(a) At or from any premises, site or location which is or was at any time owned or occupied by, or rented to or loaned to any Insured;
- At or from any premises, site or location which is or was at any time used by or for any Insured or others for handling, storage, disposal, processing or treatment of waste;
- Which are or were at any time transported, handled, stored, treated disposed of, or processed as waste by or for any Insured or any person or organization for whom may be legally responsible; or
- At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured’s behalf are performing operations;
- if the pollutants are brought on or to the premises, site or location in connection with such operations by such insured, contractor or subcontractor; or
- if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of pollutants
(2) Any loss, cost or expense arising out of any:
- Request, demand or order that any Insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of pollutants;
or
- Claim or Suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any wan responding to, or assessing the effects of pollutants.
Pollutants means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed.
g. (1) Asbestos, asbestos fibers, asbertiform talc or any material and/or substances containing asbestos, asbestos fibers or asbertiform talc or any asbestos related bodily injury, property damage, personal injury, or administrative law proceeding, or exposure to asbestos, asbestos fibers or asbertiform talc in any form, and/or manifestation of any asbestos related bodily injury, including but not limited to asbestosis, mesotheliomia and/or brochogenic carcinoma; or
This article offers a brief description of the Professional Liability Insurance plan. Details can be found in the Certificate of Insurance, which will be available to you upon enrollment.
Although every attempt has been made to verify the accuracy of the information contained on this website, errors and omissions may occur. The Certificate of Insurance describing the exact coverage and benefits purchased will be available upon enrollment. This website explains the general purposes of the insurance described, but in no way changes or affects the insurance afforded under the group insurance policy actually issued. All coverage is subject to the actual policy conditions and exclusions.
Professional Liability Insurance
(All forms are in PDF format. If you cannot
print a form, please call 1-800-221-3083
and we will be glad to mail forms to you.)
Form / Link |
Purpose |
| To participate in the Professional Liability Insurance Plan, an Enrollment Form must be completed, signed and mailed to Mass Benefits Consultants, Inc. The Enrollment Form includes the Bi-Weekly, Quarterly, Semi-Annual, and Annual premium rates. | |
| Complete this form if you want to pay by payroll deduction and your Payroll office processes the form. | |
| Use this information if you want to pay by payroll deduction and you must start the deduction yourself through HR Links or Employee Express online. | |
| When you are ready to submit your request for reimbursement to your agency, complete and mail or fax this form to us. If you pay by Payroll Deduction, please remember that the receipt will reflect the pay periods received. | |
| If you have received notice of an Administrative Hearing or been served with a lawsuit, contact us immediately at 1-800-221-3083 or fax a notice to 703-642-2240. Be sure to include your name and daytime phone number. |
Dept. of Energy employees and their spouses can apply for as much as $250,000 of Term Life Insurance at affordable group rates:
Why Term Life Insurance:
We can sum it up in one word - cost. Term Life offers a considerable advantage over permanent life insurance because term policies provide pure protection at a lower cost during the time your growing family needs it.
Your GEVBP Group Term Life Insurance Plan combines economical group rates with high-limit protection. There are no extras such as cash loans or retirement income value to increase the cost. This is truly a no-frills group plan offering you one of the best life insurance values available.
Apply now and erase the worry and concern for your loved ones' financial future. You will have provided them with a no-nonsense, affordable, term life insurance plan.
Who Can Apply?
Any federal employee, under the age of 75, who is actively at work can apply.
A member must be actively at work on a full-time basis on the date his/her insurance
is to take effect. If he/she is not, such insurance will take effect on the
day the person resumes such work. There are absolutely no restrictions based
on grade level or length of service.
You can also apply for coverage for your spouse and dependent children. Dependents must be able to perform the normal activities of a person of like age, sex or retired status on the date the insurance is to take effect. If not, the insurance will take effect on the day the insured resumes such activities.
How much protection can I get?
You and your spouse can each apply for $50,000 to $250,000 (in $50,000 increments)
(spouse cannot apply for more than the member). A spouse must be able to perform
the normal activities of a person of like age and sex and like occupation or
retired status on the date his insurance is to take effect. If he is not, such
insurance will take effect on the day the person resumes such activities. You
choose how much protection you need. For just $2.00 per quarter, you can insure
ALL of your dependent children. Children ages 6 months to 23 years get $2,500
coverage each; infants age 15 days to 6 months get $500 coverage each. If the
dependent might be hospitalized on the date his insurance is to take effect,
the insurance will take effect on the day after he is discharged.
CHECK THESE VALUABLE FEATURES:
A Living Benefit.
This attractive benefits provision is available to members under the age of
70. If you are terminally ill, as defined by the policy, you may elect to receive
an amount up to 50% (less the discount) of your group life insurance benefit.
The remaining benefit then becomes payable to your beneficiary after your death.
Terminal illness is a medical condition which is expected to result in the insured person's death within 6 months and from which the insured person is not expected to recover. You are eligible for this benefit after a waiting period of 180 consecutive days. Living benefits are subject to certain exclusions which are listed in the Certificate of Insurance. Receipt of living benefits may be taxable. Consult your tax advisor for details. A physician's certification will be required and will be subject to United States Life's review and concurrence.
Affordable group rates.
The buying power of your group makes this insurance affordable.
Automatically renewable
to age 75.
As long as you make your payments on time, and the master policy is in force,
you can keep renewing your insurance. No more medical questions will be asked
after your application is approved. (Benefits are reduced by 50% at age 70;
benefits are terminated upon a member's attainment of age 75 if you are not
actively at work.)
Coverage even if you
change jobs or retire.
As long as you work for the Federal government, or remain a member of GEVBP,
or retire under the Civil Service Retirement Act or FERS, you may keep your
insurance.
INFLATION-GUARD increases.
After 6 full months of coverage, you can choose to increase the amount of your insurance and your spouse's insurance automatically by 10% a year for the next ten years or until the insured attains age 70. If you start with $50,000 of coverage in 2001, you will have $100,000 of coverage in 2011. The maximum amount of coverage that you or your spouse may have, including the Inflation Guard , is $300,000. For example, if you elect $250,000 of coverage in 2002 you'll have the maximum amount of coverage of $300,000 in 2004.
Automatic exchange privileges.
If your insurance ends for a reason other than non-payment of premium , you
may buy an individual policy of permanent life insurance (other than term) from
United States Life during the conversion period without further evidence of
insurability. All applications for conversion must be made within 31 days after
the date the individual becomes entitled to exercise the conversion privilege.
Waiver of Premium.
If an insured member becomes totally disabled prior to age 65, all premiums
after six months of continuous disability will be waived and the insurance will
continue in effect.
Continuation of Insurance
for surviving spouse.
If an insured member dies, the spouse may continue his amount of life insurance
in effect on the date the member died. (Each child will receive $2,500 of coverage.)
The appropriate premium must be paid, except that $10,000 of such amount will
be continued without premium payment. Insurance will continue for two years
following the date of member's death. For example, if your spouse has $60,000
of life insurance, she or he will pay for $50,000 and will get the other $10,000
at no charge.
Quarterly Term Life Rates
(Member or Spouse)
| Current Age | $250,000 | $200,000 | $150,000 | $100,000 | $50,000 |
| Under 30 | 61.00 | 49.00 | 37.00 | 25.00 | 13.00 |
| 30-34 | 63.25 | 50.80 | 38.35 | 25.90 | 13.45 |
| 35-39 | 78.25 | 62.80 | 47.35 | 31.90 | 16.45 |
| 40-44 | 109.00 | 90.44 | 65.80 | 44.20 | 22.60 |
| 45-49 | 170.50 | 136.60 | 102.70 | 68.90 | 34.90 |
| 50-54 | 279.25 | 223.60 | 167.95 | 112.30 | 56.65 |
| 55-59 | 464.50 | 371.80 | 279.10 | 186.40 | 93.70 |
| 60-64 | 878.50 | 703.00 | 527-50 | 352.00 | 176.50 |
| 65-69 | 1,367.75 | 1,086.40 | 815.05 | 543.70 | 272.35 |
| 70-74* | 2,159.50 | 1,727.80 | 1,296.10 | 864.40 | 432.70 |
| 75-79** | 3,346.75 | 2,677.60 | 2,008.45 | 1,339.30 | 670.15 |
CHILDREN: $2.00 per quarter
$500 coverage for infants 15 days to 6 months
$2,500 coverage for children 6 months to 19 years (23 years if full-time student).
* Upon attainment of age
70, benefits will reduce 50%.
** Coverage terminates at age 75 if not actively at work.
Above rates include a $1.00
billing fee.
Notes:
How do I apply?
1. Print and fill out the application. Be sure to sign and date the application/medical
authorization form.
2. Use the table (above)
to decide on coverage and to figure the amount of your payment.
Check the amount of coverage you desire on the application.
3. Mail the signed form and check for your first quarterly payment to:
Mass Benefits Consultants, Inc.
GEVBP Administrator
P.O. Box 828
Annandale, VA 22003-0828
4. Your insurance will become
effective on the first day of the month after your
application is approved and the required premium is paid.
All dependent children (regardless of how many) may be insured for one payment of $2.00 per quarter $2,500 coverage for children 6 months to 19 years (23 years if full-time student) $500 coverage for infants 15 days to 6 months.
Effective Date
Coverage becomes effective on the first day of the month coinciding with, or
immediately following, the date a completed application and any evidence of
insurability required is determined to be satisfactory by United States Life,
and the full premium for the insurance is received.
Benefits and Exclusions
United States Life will pay the amount of your insurance to your beneficiary
if you die from any cause anywhere in the world. The only exclusions are for
misrepresentation of facts on your application and for suicide in the first
two years of the policy. United States Life will pay your beneficiary either
in a lump sum or as installments with interest. They will pay your beneficiary
directly, thus avoiding the delays of probating your will.
Important Notice About
The Medical Information Bureau
Information given in your application may be made available to other insurance
companies to which you make application for life or health insurance coverage
or to which a claim is submitted.
Information regarding your insurability will be treated as confidential except that The United States Life Insurance Company in the City of New York may, however, make a brief report thereon to the Medical Information Bureau, a non-profit membership organization of life insurance companies which operates an information exchange on behalf of its members. Upon request by another member insurance company to which you have applied for life or health insurance coverage or to which a claim is submitted, the Medical Information Bureau will supply such company with the information it may have in its files.
Upon receipt of a request from you, the Bureau will arrange disclosure of any information it may have in your file. If you question the accuracy of the information in the Bureau's file, you may contact the Bureau and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of the Bureau's information office is Post Office Box 105, Essex Station, Boston, Massachusetts 02112, telephone number (617) 426-3660.
The United States Life Insurance Company in the City of New York may also release information in its file to other life insurance companies to whom you may apply for life or health insurance or to whom a claim for benefits may be submitted.
This summary is a brief summary of benefits only and is subject to the terms, conditions and limitations of Group Policy No. G-191,819. Complete details can be found in the Certificate of Insurance, which will be sent to you when your application is approved.
Administered by:
Mass Benefits Consultants, Inc.
P.O. Box 828
Annandale, VA 22003-0828
Call Toll-Free - 1-800-221-3083
Underwritten by:
The United States Life Insurance Company in the City of New York
3600 Route 66
P.O. Box 1580
Neptune, NJ 07754-1580
United States Life is rated
A+ (Superior) by A.M. Best, reflecting the company's superior overall financial
strength and operating performance when compared to A.M. Best's standards.
Although every attempt
has been made to verify the accuracy of the information contained on this website,
errors and omissions may occur. You will receive a certificate of insurance
describing the exact coverage and benefits purchased. This website explains
the general purposes of the insurance described, but in no way changes or affects
the insurance afforded under the group insurance policy actually issued. All
coverage is subject to the actual policy conditions and exclusions.
APPLICATION FOR TERM LIFE INSURANCE
