IQOR 2020 Enrollment Guide

WHAT DOES IT MEAN TO BE DISABLED?
Disability is defined in The Hartford’s certificate with your employer. Due to accidental bodily injury, sickness, mental illness, substance abuse
or pregnancy you are unable to perform the essential duties of your occupation, and as a result, you are earning 20% or less of your pre-
disability weekly earnings or you are able to perform some, but not all, of the essential duties of your occupation and as a result, you are
earning more than 20% but less than 80% (standard) of your pre-disability weekly earnings.
Pre-disability earnings are defined in your policy.
1Injury Facts. National Safety Council. 2015 Edition. P. 37. Web. 30 June 2017.
2Rates and/or benefits may be changed.
Prepare. Protect. Prevail. With The Hartford. ®

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford,
CT. 5962e NS 08/16 © 2016 The Hartford Financial Services Group, Inc. All rights reserved.
This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the
policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual
and the Master Policy as issued to the policyholder. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding
Hartford’s compensation practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

Page 51 of 66

GROUP LONG-TERM DISABILITY INSURANCE
HIGHLIGHTS– Class 2 (Earnings are more than $40,000)

– Class 1 AOS, Inc.
(Earnings
are less A disability can happen to anyone. Long-term disability insurance helps protect your
than paycheck if you’re unable to work for a long period of time after a serious condition, injury
$40,000) or sickness.

Just over 1 in 4 of To learn more about Long-Term Disability insurance,
today’s 20 year-olds will visit thehartford.com/employeebenefits
become disabled before

they retire (age 67).1

COVERAGE INFORMATION

COVERAGE BENEFIT MAXIMUM MINIMUM BENEFIT BENEFIT DURATION
LEVEL PERCENTAGE STARTS
(BASED ON MONTHLY Disabled before: Age 63
(PERCENT OF YOUR INCOME LOSS BEFORE (ELIMINATION Benefit duration: As long as you are disabled
EARNINGS) THE DEDUCTION OF PERIOD) Benefit duration maximum: The greater of
OTHER INCOME BENEFITS) your Social Security Normal Retirement Age
or 4 years
Core 50% $7,300 Disabled before: Age 63
$8,800 Benefit duration: As long as you are disabled
The greater of $100 or 10% of After 90 days Benefit duration maximum: The greater of
the benefit disabled your Social Security Normal Retirement Age
or 4 years
Buy-Up 60%

PREMIUMS

See the Premium Worksheet.2

ASKED & ANSWERED
WHO IS ELIGIBLE?
You are eligible if you are an active full time employee whose annual earnings are $40,000 or more and work at least 30 hours per week on
a regularly scheduled basis.

AM I GUARANTEED COVERAGE?
If this is the first time you are eligible to elect coverage, evidence of insurability is not required.

If you did not elect coverage the first time it was offered to you, evidence of insurability is required to elect coverage. 2

This coverage is subject to a pre-existing condition exclusion, which is detailed on the Limitations & Exclusions sheet.

HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE?
Premium is provided on the Premium Worksheet.

Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t
have to worry about writing a check or missing a payment.

WHEN CAN I ENROLL?
Your employer will automatically enroll you for core coverage.

You may enroll in buy-up coverage during any scheduled enrollment period, or within 31 days of the date you have a change in family status.

Page 52 of 66

WHEN DOES THIS INSURANCE BEGIN?
Insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect
coverage).
You must be actively at work with your employer on the day your coverage takes effect.
WHEN DOES THIS INSURANCE END?
This insurance will end when you no longer satisfy the applicable eligibility conditions, premium is unpaid, you leave your employer, or the
coverage is no longer offered.
WHAT DOES IT MEAN TO BE DISABLED?
Disability is defined in The Hartford’s certificate with your employer.
Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy
or other medical condition covered by the insurance, and as a result, your current monthly earnings are less than 80% of your pre-disability
earnings. Once you have been disabled for 2 years following the elimination period, you must be prevented from performing one or more of
the essential duties of any occupation and as a result, your current monthly earnings are less than or equal to 60% of your pre-disability
earnings.
Pre-disability earnings are defined in your policy.
1U.S. Social Security Administration Fact Sheet. Web. 30 June 2017 https://www.ssa.gov/news/press/factsheets/basicfact-alt.pdf
2Rates and/or benefits may be changed.
3The Long Term Disability policy contains a Pre-Existing Condition Exclusion. Please refer to the certificate for more information on exclusions and limitations, such as Pre-Existing Conditions.
Prepare. Protect. Prevail. With The Hartford. ®

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is
Hartford, CT. 5962e NS 08/16 © 2016 The Hartford Financial Services Group, Inc. All rights reserved.
This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the
policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual
and the Master Policy as issued to the policyholder. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding
Hartford’s compensation practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

Page 53 of 66

Premium Worksheet Class 2 (Earnings more than $40,000)

Rates and/or benefits can change.

VOLUNTARY SHORT TERM DISABILITY INSURANCE
Bi-weekly Premium Amount (Cost per Pay Period – 26/Year)QQ2

To calculate your bi-weekly premium amount, use the following formula.

÷ 52 = x 70% = ÷ 10 = x $0.0923 =
Rate Premium Amount
Your Annual Your Weekly Weekly Benefit Max
Earnings Earnings = $2,000

5962e NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

VOLUNTARY LONG TERM DISABILITY INSURANCE
Bi-weekly Premium Amount (Cost per Pay Period – 26/Year)QQ5.2

To calculate your bi-weekly premium amount, use the following formula.

÷ 12 = ÷ 100 = x $0.1062 =
Rate Premium Amount
Your Annual Earnings Your Monthly Earnings
Maximum = $176,000

5962e NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

Prepare. Protect. Prevail. With The Hartford. ®

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT.

This document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy
apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the
policyholder.

PAGE 1 OF 1 CREATION DATE: 8/7/2019
AOS IQOR GLOBAL SERVICES, INC./00097949
Page 54 of 66

Page 55 of 66

BASIC TERM LIFE and ACCIDENTAL DEATH & DISMEMBERMENT
INSURANCE HIGHLIGHTS– Class 2 (Earnings are more than $40,000)

Approximately 50 million AOS, Inc.
households recognize
they need more life The group term Life and Accidental Death and Dismemberment (AD&D) insurance
available through your employer gives extra protection that you and your family may
insurance (40 percent of need. Life and AD&D insurance offers financial protection by providing you coverage in
households).1 case of an untimely death or an accident that destroys your income-earning ability. Life
benefits are disbursed to your beneficiaries in a lump sum in the event of your death.

To learn more about Life and AD&D insurance,
visit thehartford.com/employeebenefits

COVERAGE INFORMATION

APPLICANT LIFE COVERAGE AD&D COVERAGE
AD&D: Included
Employee Benefit2: 1 times earnings
Maximum: $500,000

AD&D BENEFITS – PERCENT OF COVERAGE AMOUNT PER ACCIDENT
Covered accidents or death can occur up to 365 days after the accident. The total benefit for all losses due to the same accident will not
exceed 100% of your coverage amount.

LOSS FROM ACCIDENT COVERAGE

Life 100%
Both Hands or Both Feet or Sight of Both Eyes 100%
One Hand and One Foot 100%
Speech and Hearing in Both Ears 100%
Either Hand or Foot and Sight of One Eye 100%
Movement of Both Upper and Lower Limbs (Quadriplegia) 100%
Movement of Both Lower Limbs (Paraplegia) 75%
Movement of Three Limbs (Triplegia) 75%
Movement of the Upper and Lower Limbs of One Side of the Body (Hemiplegia) 50%
Either Hand or Foot 50%
Sight of One Eye 50%
Speech or Hearing in Both Ears 50%
Movement of One Limb (Uniplegia) 25%
Thumb and Index Finger of Either Hand 25%

PREMIUMS

Your employer pays 100% of the premium for your coverage.3

ASKED & ANSWERED

WHO IS ELIGIBLE?
You are eligible if you are an active full time employee whose annual earnings are $40,000 or more and work at least 30 hours per
week on a regularly scheduled basis.

2



Page 56 of 66

AM I GUARANTEED COVERAGE?
This insurance is guaranteed issue coverage - it is available without having to provide information about your health.
AD&D is available without having to provide information about your health.
HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE?
Your employer pays 100% of the premium for your (employee) coverage.2
WHEN CAN I ENROLL?
Your employer will automatically enroll you for this coverage. If you have not already done so, you must designate a beneficiary.
WHEN DOES THIS INSURANCE BEGIN?
This insurance will become effective for you on the date you become eligible.
You must be actively at work with your employer on the day your coverage takes effect.
WHEN DOES THIS INSURANCE END?
This insurance will end when you no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer are
actively working, you leave your employer, or the coverage is no longer offered.
CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP?
Yes, you can take this life coverage with you. Coverage may be continued for you under a group portability certificate or an
individual conversion life certificate. The specific terms and qualifying events for conversion and portability are described in the
certificate. Conversion and portability are not available for AD&D coverage.

1LIMRA, Facts About Life 2016. Web. 30 June 2017. <https://www.limra.com/uploadedFiles/limra.com/LIMRA_Root/Posts/PR/_Media/PDFs/Facts-of-Life-
2016.pdf> 3Rates and/or benefits may be changed.
Prepare. Protect. Prevail. With The Hartford. ®

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford,
CT. 5962a and 5962b NS 08/16 © 2016 The Hartford Financial Services Group, Inc. All rights reserved.
This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy,
the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the
Master Policy as issued to the policyholder. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding Hartford’s
compensation practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Life Form Series includes GBD-1000, GBD-1100, or state equivalent.

Page 57 of 66

LIMITATIONS & EXCLUSIONS

This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of
the certificate can be obtained from your employer.

GROUP LIFE INSURANCE
GENERAL LIMITATIONS AND EXCLUSIONS

 35% @ 65, 55% of Orig @ 70, and 75% of Orig @ 75*
 You must be a citizen or legal resident of the United States, its territories and protectorates.

5962a NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Life Form Series includes GBD-1000, GBD-1100, or state equivalent.

GROUP ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE
GENERAL LIMITATIONS AND EXCLUSIONS

 35% @ 65, 55% of Orig @ 70, and 75% of Orig @ 75*
 This insurance does not cover losses caused by:

 Sickness; disease; or any treatment for either
 Any infection, except certain ones caused by an accidental cut or wound
 Intentionally self-inflicted injury, suicide or suicide attempt
 War or act of war, whether declared or not
 Injury sustained while in the armed forces of any country or international authority
 Injury sustained on aircraft in certain circumstances
 Taking prescription or illegal drugs unless prescribed by or administered by a licensed physician
 Injury sustained while riding, driving, or testing any motor vehicle for racing
 Injury sustained while committing or attempting to commit a felony
 Injury sustained while driving while intoxicated
 You must be a citizen or legal resident of the United States, its territories and protectorates.
DEFINITIONS
 Loss means, with regard to hands and feet, actual severance through or above wrist or ankle joints; with regard to sight, speech or hearing, entire and irrecoverable loss thereof;
with regard to thumb and index finger, actual severance through or above the metacarpophalangeal joints; with regard to movement, complete and irreversible paralysis of such
limbs.
 Injury means bodily injury resulting directly from an accident, independent of all other causes, which occurs while you have coverage. 5962c
NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Accident Form Series includes GBD-1000, GBD-1300, or state equivalent.

GROUP SHORT TERM DISABILITY INSURANCE
LIMITATIONS AND EXCLUSIONS
GENERAL EXCLUSIONS
 You must be under the regular care of a physician to receive benefits.
 You cannot receive disability insurance benefit payments for disabilities that are caused or contributed to by:
 War or act of war (declared or not)
 The commission of, or attempt to commit a felony
 An intentionally self-inflicted injury
 Your being engaged in an illegal occupation
 Sickness or injury for which workers' compensation benefits are paid, or may be paid, if duly claimed
 Sickness or injury sustained as a result of doing any work for pay or profit for another employer, including self-employment
OFFSETS
Your benefit payments will be reduced by other income you receive or are eligible to receive due to your disability, such as:
  Social Security disability insurance (please see next section for exceptions)

 Other employer-based insurance coverage you may have
 Unemployment benefits
 Settlements or judgments for income loss
 Retirement benefits that your employer fully or partially pays for (such as a pension plan)
Your benefit payments will not be reduced by certain kinds of other income, such as:
 Retirement benefits if you were already receiving them before you became disabled

 Retirement benefits that are funded by your after-tax contributions your personal savings, investments, IRAs or Keoghs profit-sharing
 Most personal disability policies
 Social Security cost-of-living increases

This example is for purposes of illustrating the effect of the benefit reductions and is not intended to reflect the situation of a particular claimant under the Policy:

Insured’s weekly [Pre-Disability Earnings/Basic weekly Pay] $1,000
Short term disability benefits percentage x 60%
Unreduced maximum benefit $600
Less Social Security disability benefit per week - $300
Less state disability income benefit per week - $100
Total amount of short term disability benefit per week $200
This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York Department of Financial Services.
5962e NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

GROUP LONG TERM DISABILITY INSURANCE
LIMITATIONS AND EXCLUSIONS
GENERAL EXCLUSIONS

 You must be under the regular care of a physician to receive benefits.
 You cannot receive disability insurance benefit payments for disabilities that are caused or contributed to by:

 War or act of war (declared or not)
 The commission of, or attempt to commit a felony
 An intentionally self-inflicted injury
 Your being engaged in an illegal occupation
PRE-EXISTING CONDITIONS

Page 58 of 66

 Your insurance excludes the benefits you can receive for pre-existing conditions. In general, if you were diagnosed or received care for a condition before the effective date of your
certificate, you will be covered for a disability due to that condition only if:
 You have not received treatment for your condition for 6 months before the effective date of your insurance, or
 You have been insured under this coverage for 12 months prior to your disability commencing, so you can receive benefits even if you're receiving treatment, or
 You have already satisfied the pre-existing condition requirement of your previous insurer

LIMITATIONS
OFFSETS

 Your benefit payments will be reduced by other income you receive or are eligible to receive due to your disability, such as:
 Social Security disability insurance (please see next section for exceptions)
 Workers’ compensation
 Other employer-based insurance coverage you may have
 Unemployment benefits
 Settlements or judgments for income loss
 Retirement benefits that your employer fully or partially pays for (such as a pension plan)

 Your benefit payments will not be reduced by certain kinds of other income, such as:
 Retirement benefits if you were already receiving them before you became disabled
 Retirement benefits that are funded by your after-tax contributions your personal savings, investments, IRAs or Keoghs profit-sharing
 Most personal disability policies
 Social Security cost-of-living increases

This example is for purposes of illustrating the effect of the benefit reductions and is not intended to reflect the situation of a particular claimant under the Policy:
Insured’s monthly [Pre-Disability Earnings/Basic Monthly Pay] $3,000
Long term disability benefits percentage x 60%
Unreduced maximum benefit $1,800
Less Social Security disability benefit per month - $900
Less state disability income benefit per month - $300
Total amount of long term disability benefit per month $600
This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York Department of Financial Services.
5962d NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.
Prepare. Protect. Prevail. With The Hartford. ®
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is
Hartford, CT.
This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document
and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured
individual and the Master Policy as issued to the policyholder.

Page 59 of 66

VOLUNTARY GROUP TERM LIFE and ACCIDENTAL DEATH &
DISMEMBERMENTINSURANCE BENEFIT HIGHLIGHTS

Approximately 50 million AOS, Inc.
households recognize
they need more life The group term Life and Accidental Death and Dismemberment (AD&D) insurance
available through your employer is a smart, affordable way to purchase the extra
insurance (40 percent of protection that you and your family may need. Life and AD&D insurance offers financial
households).1 protection by providing you coverage in case of an untimely death or an accident that
destroys your income-earning ability. Life benefits are disbursed to your beneficiaries in a
lump sum in the event of your death.

To learn more about Life and AD&D insurance, visit
thehartford.com/employeebenefits

COVERAGE INFORMATION

APPLICANT LIFE COVERAGE AD&D COVERAGE
AD&D: Included
Employee Benefit2: Increments of $10,000 AD&D: Included
Spouse Maximum: the lesser of 5x earnings or $500,000
Benefit2: Increments of $10,000.
Maximum: the lesser of 100% of your supplemental coverage or $250,000

Child(ren) Benefit: $20,000 AD&D: Not Included

p y[

AD&D BENEFITS – PERCENT OF COVERAGE AMOUNT PER ACCIDENT

Covered accidents or death can occur up to 365 days after the accident. The total benefit for all losses due to the same accident will not exceed
100% of your coverage amount.

LOSS FROM ACCIDENT COVERAGE

Life 100%
%RWK +DQGV RU %RWK )HHW RU 6LJKW RI %RWK (\HV 100%
2QH +DQG DQG 2QH )RRW 100%
Speech and Hearing in Both Ears 100%
(LWKHU +DQG RU )RRW DQG 6LJKW RI 2QH (\H 100%
Movement of Both Upper and Lower Limbs (Quadriplegia) 100%
Movement of Both Lower Limbs (Paraplegia) 75%
Movement of Three Limbs (Triplegia) 75%
Movement of the Upper and Lower Limbs of One Side of the Body (Hemiplegia) 50%
(LWKHU +DQG RU )RRW 50%
Sight of One Eye 50%
Speech or Hearing in Both Ears 50%
Movement of One Limb (Uniplegia) 25%
7KXPE DQG ,QGH[ )LQJHU RI (LWKHU +DQG 25%

235% @ 65, 55% of Orig @ 70, and 75% of Orig @ 75*

PAGE 1 OF 4

Page 60 of 66

Premium Worksheet

Rates and/or benefits can change. Rates are based on the employee’s age and increase as you enter each new age category.

VOLUNTARY TERM LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) INSURANCE
Bi-weekly Premium Amount (Cost per Pay Period – 26/Year)QQ20, 23, 24 26x, 27, 29x

Benefit Under 25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
$10.25 $27.69
$10,000 $0.42 $0.42 $0.51 $0.65 $0.69 $1.20 $2.35 $3.28 $4.43 $6.09 $20.49 $55.38
$30.74 $83.08
$20,000 $0.83 $0.83 $1.02 $1.29 $1.38 $2.40 $4.71 $6.55 $8.86 $12.18 $40.98 $110.77
$51.23 $138.46
$30,000 $1.25 $1.25 $1.52 $1.94 $2.08 $3.60 $7.06 $9.83 $13.29 $18.28 $61.48 $166.15
$71.72 $193.85
$40,000 $1.66 $1.66 $2.03 $2.58 $2.77 $4.80 $9.42 $13.11 $17.72 $24.37 $81.97 $221.54
$92.22 $249.23
$50,000 $2.08 $2.08 $2.54 $3.23 $3.46 $6.00 $11.77 $16.38 $22.15 $30.46 $102.46 $276.92
$112.71 $304.62
$60,000 $2.49 $2.49 $3.05 $3.88 $4.15 $7.20 $14.12 $19.66 $26.58 $36.55 $122.95 $332.31
$133.20 $360.00
$70,000 $2.91 $2.91 $3.55 $4.52 $4.85 $8.40 $16.48 $22.94 $31.02 $42.65 $143.45 $387.69
$153.69 $415.38
$80,000 $3.32 $3.32 $4.06 $5.17 $5.54 $9.60 $18.83 $26.22 $35.45 $48.74 $163.94 $443.08
$174.18 $470.77
$90,000 $3.74 $3.74 $4.57 $5.82 $6.23 $10.80 $21.18 $29.49 $39.88 $54.83 $184.43 $498.46
$194.68 $526.15
$100,000 $4.15 $4.15 $5.08 $6.46 $6.92 $12.00 $23.54 $32.77 $44.31 $60.92 $204.92 $553.85
$215.17 $581.54
$110,000 $4.57 $4.57 $5.58 $7.11 $7.62 $13.20 $25.89 $36.05 $48.74 $67.02 $225.42 $609.23
$235.66 $636.92
$120,000 $4.98 $4.98 $6.09 $7.75 $8.31 $14.40 $28.25 $39.32 $53.17 $73.11 $245.91 $664.62
$256.15 $692.31
$130,000 $5.40 $5.40 $6.60 $8.40 $9.00 $15.60 $30.60 $42.60 $57.60 $79.20 $266.40 $720.00
$276.65 $747.69
$140,000 $5.82 $5.82 $7.11 $9.05 $9.69 $16.80 $32.95 $45.88 $62.03 $85.29 $286.89 $775.38
$297.14 $803.08
$150,000 $6.23 $6.23 $7.62 $9.69 $10.38 $18.00 $35.31 $49.15 $66.46 $91.38 $307.38 $830.77
$317.63 $858.46
$160,000 $6.65 $6.65 $8.12 $10.34 $11.08 $19.20 $37.66 $52.43 $70.89 $97.48 $327.88 $886.15
$338.12 $913.85
$170,000 $7.06 $7.06 $8.63 $10.98 $11.77 $20.40 $40.02 $55.71 $75.32 $103.57 $348.37 $941.54
$358.62 $969.23
$180,000 $7.48 $7.48 $9.14 $11.63 $12.46 $21.60 $42.37 $58.98 $79.75 $109.66 $368.86 $996.92
$379.11 $1,024.62
$190,000 $7.89 $7.89 $9.65 $12.28 $13.15 $22.80 $44.72 $62.26 $84.18 $115.75 $389.35 $1,052.31
$399.60 $1,080.00
$200,000 $8.31 $8.31 $10.15 $12.92 $13.85 $24.00 $47.08 $65.54 $88.62 $121.85 $409.85 $1,107.69
$420.09 $1,135.38
$210,000 $8.72 $8.72 $10.66 $13.57 $14.54 $25.20 $49.43 $68.82 $93.05 $127.94 $430.34 $1,163.08
$440.58 $1,190.77
$220,000 $9.14 $9.14 $11.17 $14.22 $15.23 $26.40 $51.78 $72.09 $97.48 $134.03 $450.83 $1,218.46
$461.08 $1,246.15
$230,000 $9.55 $9.55 $11.68 $14.86 $15.92 $27.60 $54.14 $75.37 $101.91 $140.12

$240,000 $9.97 $9.97 $12.18 $15.51 $16.62 $28.80 $56.49 $78.65 $106.34 $146.22

$250,000 $10.38 $10.38 $12.69 $16.15 $17.31 $30.00 $58.85 $81.92 $110.77 $152.31

$260,000 $10.80 $10.80 $13.20 $16.80 $18.00 $31.20 $61.20 $85.20 $115.20 $158.40

$270,000 $11.22 $11.22 $13.71 $17.45 $18.69 $32.40 $63.55 $88.48 $119.63 $164.49

$280,000 $11.63 $11.63 $14.22 $18.09 $19.38 $33.60 $65.91 $91.75 $124.06 $170.58

$290,000 $12.05 $12.05 $14.72 $18.74 $20.08 $34.80 $68.26 $95.03 $128.49 $176.68

$300,000 $12.46 $12.46 $15.23 $19.38 $20.77 $36.00 $70.62 $98.31 $132.92 $182.77

$310,000 $12.88 $12.88 $15.74 $20.03 $21.46 $37.20 $72.97 $101.58 $137.35 $188.86

$320,000 $13.29 $13.29 $16.25 $20.68 $22.15 $38.40 $75.32 $104.86 $141.78 $194.95

$330,000 $13.71 $13.71 $16.75 $21.32 $22.85 $39.60 $77.68 $108.14 $146.22 $201.05

$340,000 $14.12 $14.12 $17.26 $21.97 $23.54 $40.80 $80.03 $111.42 $150.65 $207.14

$350,000 $14.54 $14.54 $17.77 $22.62 $24.23 $42.00 $82.38 $114.69 $155.08 $213.23

$360,000 $14.95 $14.95 $18.28 $23.26 $24.92 $43.20 $84.74 $117.97 $159.51 $219.32

$370,000 $15.37 $15.37 $18.78 $23.91 $25.62 $44.40 $87.09 $121.25 $163.94 $225.42

$380,000 $15.78 $15.78 $19.29 $24.55 $26.31 $45.60 $89.45 $124.52 $168.37 $231.51

$390,000 $16.20 $16.20 $19.80 $25.20 $27.00 $46.80 $91.80 $127.80 $172.80 $237.60

$400,000 $16.62 $16.62 $20.31 $25.85 $27.69 $48.00 $94.15 $131.08 $177.23 $243.69

$410,000 $17.03 $17.03 $20.82 $26.49 $28.38 $49.20 $96.51 $134.35 $181.66 $249.78

$420,000 $17.45 $17.45 $21.32 $27.14 $29.08 $50.40 $98.86 $137.63 $186.09 $255.88

$430,000 $17.86 $17.86 $21.83 $27.78 $29.77 $51.60 $101.22 $140.91 $190.52 $261.97

$440,000 $18.28 $18.28 $22.34 $28.43 $30.46 $52.80 $103.57 $144.18 $194.95 $268.06

$450,000 $18.69 $18.69 $22.85 $29.08 $31.15 $54.00 $105.92 $147.46 $199.38 $274.15

PAGE 1 OF 2 CREATION DATE: 8/7/2019
AOS IQOR GLOBAL SERVICES, INC./00097924
Page 61 of 66

$460,000 $19.11 $19.11 $23.35 $29.72 $31.85 $55.20 $108.28 $150.74 $203.82 $280.25 $471.32 $1,273.85
$470,000 $19.52 $19.52 $23.86 $30.37 $32.54 $56.40 $110.63 $154.02 $208.25 $286.34 $481.57 $1,301.54
$480,000 $19.94 $19.94 $24.37 $31.02 $33.23 $57.60 $112.98 $157.29 $212.68 $292.43 $491.82 $1,329.23
$490,000 $20.35 $20.35 $24.88 $31.66 $33.92 $58.80 $115.34 $160.57 $217.11 $298.52 $502.06 $1,356.92
$500,000 $20.77 $20.77 $25.38 $32.31 $34.62 $60.00 $117.69 $163.85 $221.54 $304.62 $512.31 $1,384.62

SPOUSE VOLUNTARY TERM LIFE LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) INSURANCE

Bi-weekly Premium Amount (Cost per Pay Period – 26/Year)

Age Under 25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
$27.69
$10,000 $0.42 $0.42 $0.51 $0.65 $0.69 $1.20 $2.35 $3.28 $4.43 $6.09 $10.25 $55.38
$83.08
$20,000 $0.83 $0.83 $1.02 $1.29 $1.38 $2.40 $4.71 $6.55 $8.86 $12.18 $20.49 $110.77
$138.46
$30,000 $1.25 $1.25 $1.52 $1.94 $2.08 $3.60 $7.06 $9.83 $13.29 $18.28 $30.74 $166.15
$193.85
$40,000 $1.66 $1.66 $2.03 $2.58 $2.77 $4.80 $9.42 $13.11 $17.72 $24.37 $40.98 $221.54
$249.23
$50,000 $2.08 $2.08 $2.54 $3.23 $3.46 $6.00 $11.77 $16.38 $22.15 $30.46 $51.23 $276.92
$304.62
$60,000 $2.49 $2.49 $3.05 $3.88 $4.15 $7.20 $14.12 $19.66 $26.58 $36.55 $61.48 $332.31
$360.00
$70,000 $2.91 $2.91 $3.55 $4.52 $4.85 $8.40 $16.48 $22.94 $31.02 $42.65 $71.72 $387.69
$415.38
$80,000 $3.32 $3.32 $4.06 $5.17 $5.54 $9.60 $18.83 $26.22 $35.45 $48.74 $81.97 $443.08
$470.77
$90,000 $3.74 $3.74 $4.57 $5.82 $6.23 $10.80 $21.18 $29.49 $39.88 $54.83 $92.22 $498.46
$526.15
$100,000 $4.15 $4.15 $5.08 $6.46 $6.92 $12.00 $23.54 $32.77 $44.31 $60.92 $102.46 $553.85
$581.54
$110,000 $4.57 $4.57 $5.58 $7.11 $7.62 $13.20 $25.89 $36.05 $48.74 $67.02 $112.71 $609.23
$636.92
$120,000 $4.98 $4.98 $6.09 $7.75 $8.31 $14.40 $28.25 $39.32 $53.17 $73.11 $122.95 $664.62
$692.31
$130,000 $5.40 $5.40 $6.60 $8.40 $9.00 $15.60 $30.60 $42.60 $57.60 $79.20 $133.20

$140,000 $5.82 $5.82 $7.11 $9.05 $9.69 $16.80 $32.95 $45.88 $62.03 $85.29 $143.45

$150,000 $6.23 $6.23 $7.62 $9.69 $10.38 $18.00 $35.31 $49.15 $66.46 $91.38 $153.69

$160,000 $6.65 $6.65 $8.12 $10.34 $11.08 $19.20 $37.66 $52.43 $70.89 $97.48 $163.94

$170,000 $7.06 $7.06 $8.63 $10.98 $11.77 $20.40 $40.02 $55.71 $75.32 $103.57 $174.18

$180,000 $7.48 $7.48 $9.14 $11.63 $12.46 $21.60 $42.37 $58.98 $79.75 $109.66 $184.43

$190,000 $7.89 $7.89 $9.65 $12.28 $13.15 $22.80 $44.72 $62.26 $84.18 $115.75 $194.68

$200,000 $8.31 $8.31 $10.15 $12.92 $13.85 $24.00 $47.08 $65.54 $88.62 $121.85 $204.92

$210,000 $8.72 $8.72 $10.66 $13.57 $14.54 $25.20 $49.43 $68.82 $93.05 $127.94 $215.17

$220,000 $9.14 $9.14 $11.17 $14.22 $15.23 $26.40 $51.78 $72.09 $97.48 $134.03 $225.42

$230,000 $9.55 $9.55 $11.68 $14.86 $15.92 $27.60 $54.14 $75.37 $101.91 $140.12 $235.66

$240,000 $9.97 $9.97 $12.18 $15.51 $16.62 $28.80 $56.49 $78.65 $106.34 $146.22 $245.91

$250,000 $10.38 $10.38 $12.69 $16.15 $17.31 $30.00 $58.85 $81.92 $110.77 $152.31 $256.15

CHILD(REN) VOLUNTARY TERM LIFE INSURANCE
Bi-weekly Premium Amount (Cost per Pay Period – 26/Year)QQ89

Benefit Amount Cost For Each Child x Number of Covered Children = Cost For All Children
x =
$20,000 $1.38

5962a NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Life Form Series includes GBD-1000, GBD-1100, or state equivalent.

Prepare. Protect. Prevail. With The Hartford. ®

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT.

This document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy
apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the
policyholder.

PAGE 2 OF 2 CREATION DATE: 8/7/2019
AOS IQOR GLOBAL SERVICES, INC./00097924
Page 62 of 66

PREMIUMS

See the Life Premium Worksheet.3

ASKED & ANSWERED

WHO IS ELIGIBLE?
You are eligible if you are an active full time employee who works at least 30 hours per week on a regularly scheduled basis.
Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26.
AM I GUARANTEED COVERAGE?
If you are currently participating in this coverage you may increase your current coverage by 2 times your annual earnings, not to
exceed $150,000, without providing evidence of insurability. If you are electing coverage for the first time, you may elect coverage in
the amount of 2 times your annual earnings, not to exceed $150,000, without providing evidence of insurability. Additional coverage
amounts will require evidence of insurability that is satisfactory to The Hartford before the excess can become effective.
If you are currently participating in this coverage you may increase your spouse's current coverage by $20,000, not to exceed $30,000
without providing evidence of insurability. If you are electing coverage for the first time, you may elect coverage in the amount of
$20,000. Additional coverage amounts will require your spouse to provide evidence of insurability that is satisfactory to The Hartford
before the excess can become effective.
This insurance is guaranteed issue coverage – it is available without having to provide information about your child(ren)’s health.
AD&D is available without having to provide information about your or your family’s health.
HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE?
Premiums are provided on the Life Premium Worksheet. You have a choice of coverage amounts. You may elect insurance for you
only, or for you and your dependent(s).
Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you
don’t have to worry about writing a check or missing a payment.
WHEN CAN I ENROLL?
You may enroll from 7/1/2019 to 7/15/2019.
WHEN DOES THIS INSURANCE BEGIN?
The effective date of this coverage is 8/1/2019.
You must be actively at work with your employer on the day your coverage takes effect.
Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility), unless
already insured with the prior carrier.
WHEN DOES THIS INSURANCE END?
This insurance will end when you (or your dependent(s)) no longer satisfy the applicable eligibility conditions, premium is unpaid, or
the coverage is no longer offered.
CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP?
Yes, you can take this life coverage with you. Coverage may be continued for you and your dependent(s) under a group portability
certificate or an individual conversion life certificate. Your spouse may also continue insurance in certain circumstances. The specific
terms and qualifying events for conversion and portability are described in the certificate.Conversion and portability are not available
for AD&D coverage.

1LIMRA, Facts About Life 2016. Web. 30 June 2017. <https://www.limra.com/uploadedFiles/limra.com/LIMRA_Root/Posts/PR/_Media/PDFs/Facts-of-Life-2016.pdf>
3Rates and/or benefits may be changed. Rates are based on the age of the insured person and increase on the policy anniversary date on or following your birthday as you enter each new age
category.
Prepare. Protect. Prevail. With The Hartford. ®
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford,
CT. 5962a and 5962b NS 08/16 © 2016 The Hartford Financial Services Group, Inc. All rights reserved.
This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy,
the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master
Policy as issued to the policyholder. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding Hartford’s compensation
practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Life Form Series includes GBD-1000, GBD-1100, or state equivalent.

Page 63 of 66

LIMITATIONS & EXCLUSIONS

This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of
the certificate can be obtained from your employer.
GROUP LIFE INSURANCE
GENERAL LIMITATIONS AND EXCLUSIONS

•35% @ 65, 55% of Orig @ 70, and 75% of Orig @ 75*
•A benefit will not be paid if death occurs by suicide within two years (or as allowed by state law) of purchasing this coverage.
•You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates.
DEPENDENT LIMITATIONS AND EXCLUSIONS
•Coverage may only be elected for dependents when you elect and are approved for coverage for yourself.
•Coverage may not be elected for a dependent who has employee coverage under this certificate.
•Coverage may not be elected for a dependent who is in active full-time military service.
•Child(ren) may only be covered as a dependent of one employee.
•Infants may receive a reduced benefit prior to the age of six months.
5962a NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Life Form Series includes GBD-1000, GBD-1100, or state equivalent.
GROUP ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE
GENERAL LIMITATIONS AND EXCLUSIONS
•35% @ 65, 55% of Orig @ 70, and 75% of Orig @ 75*
•This insurance does not cover losses caused by:

• Sickness; disease; or any treatment for either
• Any infection, except certain ones caused by an accidental cut or wound
• Intentionally self-inflicted injury, suicide or suicide attempt
• War or act of war, whether declared or not
• Injury sustained while in the armed forces of any country or international authority
• Injury sustained on aircraft in certain circumstances
• Taking prescription or illegal drugs unless prescribed by or administered by a licensed physician
• Injury sustained while riding, driving, or testing any motor vehicle for racing
• Injury sustained while committing or attempting to commit a felony
• Injury sustained while driving while intoxicated
•You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates.
DEPENDENT LIMITATIONS AND EXCLUSIONS
•Coverage may only be elected for dependents when you elect and are approved for coverage for yourself.
•Coverage may not be elected for a dependent who has employee coverage under this certificate.
•Child(ren) may only be covered as a dependent of one employee.
DEFINITIONS
•Loss means, with regard to hands and feet, actual severance through or above wrist or ankle joints; with regard to sight, speech or hearing, entire and irrecoverable loss thereof; with
regard to thumb and index finger, actual severance through or above the metacarpophalangeal joints; with regard to movement, complete and irreversible paralysis of such limbs.
•Injury means bodily injury resulting directly from an accident, independent of all other causes, which occurs while you or your dependent(s) have coverage.
5962c NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Accident Form Series includes GBD-1000, GBD-1300, or state equivalent.
Prepare. Protect. Prevail. With The Hartford. ®
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is
Hartford, CT.
This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy,
the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master
Policy as issued to the policyholder.

Page 64 of 66

CONTACT INFORMATION

CONTACT INFORMATION

Questions regarding any of this information can be directed to:

USI Southwest, Inc.

Marlene Cisneros

915 534-9455
[email protected]

Micah Harrison

915 373-0366

[email protected]

Mandy Jones
254-751-0156
[email protected]

Page 65 of 66

Prepared on behalf of AOS Inc. by USI Insurance Services

This brochure summarizes the benefit plans that are available to AOS, Inc. eligible employees and their
dependents. Official plan documents, policies and certificates of insurance contain the details, conditions, maximum
benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict,
the official documents prevail. These documents are available upon request through the Human Resources
Department. Information provided in this brochure is not a guarantee of benefits.

Page 66 of 66