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HomeMy WebLinkAbout2005 Gehring Group AGENT OF RECORD APPOINTMENT This is to certify that Kurt Gehring is the Agent of Record for the City of Sebastian on employee group insurance and/or health maintenance contracts and is thereby entitled to consultant service fees as might be provided through Florida Combined Insurance Agency, Inc., Blue Cross and Blue Shield of Florida, Inc., Florida Combined Life Insurance Company, Inc. and/or Health Options, Inc., and their other insurance company affiliates, for performing advisory and consultative services while such insurance coverages are in force for our group account. We maintain the right to terminate this Appointment at any time by written notice. Approved this .5/~+ day of #~Jd- , ct:< tJa,j ~ ~ haAL4~ Title ~)~tW--o(!fl~ ltness ~ek~ ~+. Title -11 GEHRING ...4GROUP :illll1I PROFESSIONAL SERVICES July 18, 2005 James Sexton Human Resources Director City of Sebastian 1225 Main Street Sebastian, FL 32958 RE: Hartford Life Insurance Company - Policy No. ETB-110861 Statutory Accidental Death and Dismemberment Insurance Dear Jim: Enclosed please find formal notification amending the City of Sebastian's Statutory Accidental Death and Dismemberment insurance policy with Hartford Life Insurance Company. This amendment adjusts the benefit amount per the Consumer Price Index (CPI) effective July 1, 2005. The adjustment is set forth by the Bureau of Criminal Justice and the State Fire Marshall Office as defined by Statutes 112.19 and 112.191. This benefit adjustment affects all full-time and part-time Sworn Law Enforcement Officers, Bailiffs, and Certified Correctional Officers. There is no additional cost for the increased benefit amount associated with this rider. The policy is scheduled to renew on October 1, 2006. Should you have any questions or concerns, please do not hesitate to contact our office. Sincerely, Christian rgstrom Director - Analytical Services GEHRING GROUP KG/cb/pp Enclosure cc: Shai Francis, Finance Director, City of Sebastian Kris Gehring, Vice President - Account Management, Gehring Group Stephanie Drost, Director - Account Management, Gehring Group U,\;:.j!,'i,[,'-'.']d<htian. ('itv (,rF:mplil.yce nen~rib\07J505 -.f Sexton - Sebastiall f lartf()rd Slat ADD Riderl\ntificati,'n 20()5.d();:; 11505 FAIRCHILD GARDENS AVENUE. SUITE 202 . PALM BEACH GARDENS, FL 33410 PHONE 561.626.6797. FAX 561.626.6970. TOll.FREE 800.244.3696. www.gehringgroup.com -' "' The Gehring Group Attn: Shai Francis 11505 Fairchild Gardens Avenue Suite 202 Palm Beach Gardens, FL 33410 THE HARTFORD July 5, 2005 Group Benefits Re: City of Sebastian Policy Number: ETB-ll0861 Dear Producer, Effective July 1,2005, under HAZARDS. BENEFITS AND AMOUNTS of the above policy, the ADD and AD Benefit Amounts are increased by the Consumer Price Index set forth by the Bureau of Criminal Justice & The State Fire Marshall Office as defined by Statutes 112.19 & 112.191. The adjusted benefit amounts are as follows: HAZARDS. BENEFITS AND AMOUNTS: Class Hazard Benefit Amount 1 C-62 C-64 C-31 VL118 ADD AD AD $53,999.14 in the line of duty $53,999.14 fresh pursuit $161,997.42 unlawful & intentional death This letter is to be attached to and made a part of the above policv. Please send one copy to the Policyholder & keep one for your records. .........--- Should you have any questions regarding this information, please feel free to contact us. We appreciate your continued business. Sincerely, Kasey White Associate Underwriter Ext. 64209 Hartford Life. Two Point Royal Office Building. 4550 North Point Parkway Alpharetta, Georgia 30222. Toll Free (888) 560-9632. Facsimile (678) 762-0325 GEHRING GROUP September 13, 2004 Shai Francis, Director of Finance City of Sebastian 1225 Main Street Sebastian, FL 32958 RE: Hartford Life Insurance Company - Policy No. 21-ETB-110861 Statutory Accidental Death and Dismemberment Insurance Dear Shai: Enclosed please find the above mentioned policy and formal notification amending the City of Sebastian statutory accidental death and dismembem~ent insurance policy with Hartford Life Insurance Company. This amendment adjusts the benefit amount per the Consumer Price Index effective July 1, 2004. The adjustment is set forth by the Bureau of Criminal Justice and the State Fire Marshall Office as defined by Statues 112.19 and 112.191. This benefit adjustment affects all full-time and part-time Sworn Law Enforcement Officers, Bailiffs, Certified Correctional Officers, and Pilots. There is no additional cost for the increase benefit amount associated with this rider. The policy is scheduled to renew on October 1, 2006. Should you have any questions or concems, please do not hesitate to contact our office. Kurt Gehring, P~sident CEO GEHRING GROUP KG/cb cc: Jim Sexton, Director of Human Resources, City of Sebastian Kris Gehring, Vice President - Account Management, Gehring Group Christian Bergstrom, Senior Evaluator, Gehring Group 11505 FAIRCHILD GARDENS AVENUE · SUITE 202 · PALM BEACH GARDENS, FL 33410 PHONE 561.626.6797 · FAX 561.626.6970 · TOLL-FREE 800.244.3696 · www.gehringroup.com August 12, 2004 Shai Francis The Gehring Group 11505 Fairchild Gardens Avenue Suite 202 Palm Beach Gardens, FL 33410 RE: City of Sebastian Florida Statute Policy: 21-ETB-110861 Group Benefits Dear Producer, Effective July 1, 2004, under HAZARDS, BENEFITS AND AMOUNTS of the above policy, the ADD and AD Benefit Amounts are increased by the Consumer Pfice Index set forth by the Bureau of Criminal Justice & The State Fire Marshall Office as defined by Statutes 112.19 & 112.191. The adjusted benefit amounts are as follows: HAZARDS, BENEFITS AND AMOUNTS: Class Hazard Benefit Amount C-62 ADD C-64 AD C-31 VL118 AD $52,375.50 in the line of duty $52,375.50 fresh pursuit $157,126.50 unlawful & intentional death This letter is to be attached to and made a part of the above policy. Please send one copy to the Policyholder & keep one for your records. Should you have any questions regarding this information, please feel free to contact us. We appreciate your continued business. Sincerely, Susan Hartog Associate Underwriter Ext. 64343 Hartford Life · Two Point Royal Office Building * 4550 North Point Parkway Alpharetta, Georgia 30222 * Toll Free (888) 560-9632 * Facsimile (678) 762-0325 ' ~TFORD LIFE AZTDACCIDENT INSUP~%.NCE COMPAI~Y Hartford Plaza Hartford, Connecticut (A stock insurance company) Will pay benefits according to the conditions of this policy. Policyholder Name: City of Sebastian Policyholder Address: 1225 Main Street Sebastian, FL 32958 Policy Number: ETB-110861 Place of Delivery: Sebastian, FL Policy Effective Date: October 01, 2003 Policy Expiration Date: October 01, 2006 TABLE OF CONTENTS Schedule Participating Firms (if any) Contract Provisions Definitions Determination of Individual Coverage Exclusions Hazards Benefits Claims Riders (if any) Signed for the Company Form 7679 A2 (HLA) ELIGIBLE PERSONS: SCHEDULE TFORD Class Description Ail full-time sworn law enforcement officers, reserve, volunteer & auxiliary officers and dispatchers of the Policyholder. Form 7679 B6 SCHEDULE {Eliaibilitv) BENEFIT DESCRIPTION: SCHEDULE ADD means Accidental Death and Dismemberment Benefit Dismemberment Loss Period: 365 days AD means Accidental Death Benefit HAZARDS, BENEFITS AND AMOUNTS: Class Hazard Benefit Amount 1 C-62 ADD $51,662.60 C-64 AD $51,662.60 C-31 VLll8 AD $154,987.80 in the line of duty fresh pursuit unlawful & intentional death AGGREGATE LIMITATION: Not Applicable Christine Hayer Repasy Secretary Form 7679 B7 SCHEDULE (Hazards, Benefits and Amounts) POLICY PREMIUMS: Premium Not Subject To Audit: Premium Subject To Audit: Total Premium For Policy Period: $ 5,721.00 $ none $ 5,721.00 TFORD Total Premium Payable on Effective Date. Three Year Policy Premium: Three Year Prepaid Premium Form 7679 B8 SCHEDULE (Premi~uns) SCHEDULE H~FORD POLICY MODIFICATIONS: This policy as issued is amended as follows: 1) The definition of injury under this policy is amended to include the following: a) Any occupational condition or impairment of health of a fireman caused by tuberculosis, heart disease, or hypertension resulting in death shall be presumed to be accidental, suffered in the line of duty, and to be a covered injury. To be entitled to this presumption, the definitions and requirements of Section 112.18 must be met. b) Any occupational condition or impairment of health of a police officer caused by tuberculosis, hypertension, heart disease, or hardening of the arteries, resulting in death, shall be presumed to be accidental, suffered in the line of duty, and to be a covered injury. To be entitled to this presumption, the definitions and requirements of Section 185.34 must be met. c) Any emergency rescue or public safety worker who suffers an occupational condition or impairment of health that is caused by hepatitis, meningococcal meningitis, or tuberculosis, that requires medical treatment, and that results in death shall be presumed to have been accidental and to be a covered injury. To be entitled to this presumption, the definitions and requirements of Section 112.181 must be met. 2) This policy provides accidental death coverage for police officers and firefighters which is no less restrictive than benefits specified by Florida statutes 112.19, paragraphs 2) a, b, c, f, and j and 112.191, paragraphs 2) a, b, c and i. Form 7679 BI0 SCHEDULE (Modifications) CONTRACT PROVISIONS Tt-i H~SFORD Entire Contract: The entire contract between the Policyholder and us consists of this policy, and any papers made a part of this policy at issue. Chanqes: No agent has authority to change or waive any part of this policy. To be valid, any change or waiver must be in writing, approved by one of our officers and made a part of this policy. Time Periods: Ail periods begin and end at 12:01 A.M., Standard Time at the place where this policy is delivered. Certificates: If required by the laws of the state where this policy is delivered, we will give certificates to: a) the Policyholder; or b) any other person according to a mutual agreement among the other person, the Policyholder and us; for delivery to Insured Persons. The certificates will state the features of this policy which are important to Insured Persons. Data Furnished by Policyholder: The Policyholder: a) with our approval, may keep the records which affect this policy; b) will give us information from those records, when and in the manner we ask. Those records will be open for our inspection at any reasonable time. Not in Lieu of Workers' Compensation: This policy does not satisfy any requirement for workers' compensation insurance. Conformity with State Statutes: On the Policy Effective Date, any part of the policy which is in conflict with a statute of the state in which the policy is: a) delivered; or b) issued for delivery; is hereby amended to agree with the statute's minimum requirements. Cancellation: This policy may be cancelled at any time by written notice mailed or delivered by us to the Policyholder or by the Policyholder to us. If we cancel, we will mail or deliver the notice to the Policyholder at its last address show~ in our records. If we cancel, it becomes effective on the later of: a) the date stated in the notice; or b) the 31st day after we mail or deliver the notice. If the Policyholder cancels, it becomes effective on the later of: a) the date we receive the notice; or b) the date stated in the notice. In either event: a) we will promptly return any unearned premium paid; or b) the Policyholder will promptly pay any earned premium which has not been paid. Any earned or unearned premium will be determined on a pro rata basis. Cancellation will not affect any claim for loss due to an accident which occurs before the effective date of the cancellation. 7679 D1 CONTRACT PROVISIONS CONTRACT PROVISIONS (Continued) Policy Period: This policy becomes effective on the Policy Effective Date and]~r~RD in force to the end of the period for which premium was paid unless cancelled at an earlier date. This policy terminates on the earlier of: a) the Policy Expiration Date unless continued in force in accordance with the Renewal Provision; or b) the last day of the period for which premium has been paid subject to the Grace Period. The Policy Effective Date and Policy Expiration Date are shown: a) on page 1 for the original Policy Period; and b) in a Renewal Rider for any Renewal Policy Period. Renewal: We will send the Policyholder a notice of policy renewal. The policy will be renewed if the Policyholder signs and returns the notice prior to the current Expiration Date. If the Policyholder does not receive the notice, the policy may be renewed if we receive a written request from the Policyholder and a deposit renewal premium of $350 on or before the current Expiration Date. Once we have received the deposit renewal premium, we will request information from the Policyholder necessary to calculate the actual renewal premium and either return any excess premium or bill the Policyholder for the remaining unpaid renewal premium. However, in no event will this policy be renewed if: a) we have refused to renew this policy on or before the current Expiration Date; b) this policy has been cancelled on or before the current Expiration Date; and c) the Policyholder does not give us, in advance of the current Expiration Date, the information we request. Premium Due Dates: Each Premium is due in advance of the date the Schedule states that it is payable. If the Schedule shows an amount for Premium Subject To Audit, the earned premium will be calculated for each date on which the Policyholder is required to furnish data for determining Units of Exposure. If the earned Premium: a) is greater than the premium paid, the additional premium is payable on the date we notify the Policyholder of the amount; b) is less than the premium paid, we will promptly return the unearned portion of the premium paid. Grace Period: A Grace Period of 31 days is allowed for payment of each premium due after the initial premium, unless this policy is cancelled on or before the due date. If the Policyholder has returned the notice of renewal prior to the Policy Expiration Date, a Grace Period of 31 days from the Policy Expiration Date is allowed for payment of the renewal premium. This policy will continue in force during the Grace Period. The Policyholder is liable to us for the payment of Premium accruing for the period this policy continues in force. Payment: Premiums are to be paid to us by the Policyholder. However, they may be paid to us by any other person according to a mutual agreement among the other person, the Policyholder and us. Chanae of Premiums: We have the right to change the rate at which Premiums will be calculated for each Policy Period. Form ?6?9 D2 (Rev.-l) CONTRACT PROVISIONS (Continued) DEFINITIONS Each term listed, when used in this policy, has the following meaning: We, us, or our means the insurance company named on page 1. Insured Person means an Eligible Person while he or she is covered under this policy. Injury means, and an Insured Person is covered for, bodily injury resulting directly and independently of all other causes from accident which occurs: a) while he or she is covered under; and b) in the manner specified in; a Hazard applicable to his or her class. Loss resulting from: a) sickness or disease, except a pus-forming infection which occurs through an accidental wound; or b) medical or surgical treatment of a sickness or disease is not considered as resulting from injury. Business Trip means a bona fide trip: a) while on assignment or at the direction of the Policyholder for the purpose of furthering the business of the Policyholder; b) which begins when a person leaves his or her residence or place of regular employment, whichever last occurs, for the purpose of beginning the trip; c) which ends when he or she returns to his or her residence or place of regular employment, whichever first occurs; and d) excluding travel to and from work, bona fide leaves of absence and vacations. Trip means a trip which: a) begins when a person leaves his or her residence or place of regular employment, whichever last occurs, for the purpose of beginning the trip; and b) ends when he or she returns to his or her residence or place of regular employment, whichever first occurs. Passenq~r means a person who is not: a) the operator or driver; or b) the pilot, student pilot, or a crewmember; of a conveyance at the time of accident. Common Carrier means a conveyance operated by a concern, other than the Policyholder, organized and licensed for the transportation of passengers for hire and operated by an employee of that concern. Christtne Hayer Repasy Secretar) Thomas M. Matra, President Form 7679 ~l DEFINITIONS DEFINITIONS I-L~TFORD civil Aircraft means a civil or public aircraft which: a) has an Airworthiness Certificate; b) is piloted by a person who has: 1) a current pilot certificate with the appropriate aircraft category rating for that aircraft; and 2) a current medical certificate which is appropriate for the operation of that aircraft; and c) is not operated by the militia, or armed forces of any state, national government or international authority. Scheduled Aircraft means a civil Aircraft operated by a scheduled airline which: a) is licensed by the FAA for the transportation of passengers for hire; and b) publishes its flight schedules and fares for regular passenger service. MAC Aircraft means a transport aircraft operated by: a) the Military Airlift Command (MAC) of the United States; or b) the similar air transport service of a country recognized by the United States. Policyholder Aircraft means an aircraft which is owned, leased, or operated by or on behalf of the Policyholder. Airworthiness Certificate means a valid and current "Standard Airworthiness Certificate" issued by the FAA. FAA means: a) the Federal Aviation Administration of the United States; or b) the similar aviation authority for the country of the aircraft's registry, country is recognized by the United States. if the Chnsnne Hayer Repasy Secretary Form 7679 ~2 DEFINITIONS (Continued) Effective Date: Each Eligible Person becomes an Insured Person on the later of: a) the Policy Effective Date; or b) the date he or she enters a Class of Eligible Persons. Termination: Coverage of each Insured Person terminates on the earlier of: a) the date this policy terminates; or b) the date he or she does not qualify in any Class of Eligible Person. Termination will not affect any claim for loss due to an accident which occurs before the effective date of the termination. The Policyholder's failure to report that a person ceased to qualify in a Class of Eligible Persons will not continue coverage in that Class beyond the date he or she ceased to qualify. Hazards and Benefits Determined By Class: Each Insured Person is covered under the Hazard and for the Benefits applicable to the Class in which he or she qualifies: a) beginning on the date he or she enters the Class; and b) ending on the date he or she leaves the Class. If an Insured Person qualifies in more than one Class on the date of accident, he or she will be considered to qualify in the one Class with the largest Benefit Amount. Form 7679 F1 DETERMINATION OF INDIVIDUAL COVERAGE Exclusions: EXCLUSIONS AND AGGREGATE LIMITATION This policy does not cover any loss resulting from: 1. intentionally self-inflicted injury, suicide or attempted suicide, whether sane or insane; 2. war or act of war, whether declared or undeclared; 3. injury sustained while in the armed forces of any country or international authority. Aq~req~te Limitation: Not Applicable Thomas M. Maxca, President 7679 G1 EXCLUSIONS AND AGGREGATE LIMITATION HAZARD C-62 In the Line of Duty Coveraqe While On The Business Of The Policyholder H~TEFoRD Coveraae: This Hazard covers Injury resulting from: a) an accident; and b) an accident while the Insured Person is on, boarding or alighting from a Civil Aircraft or MAC Aircraft; or c) being struck by an aircraft; which occurs anywhere in the world while On the Business of the Policyholder. O__n ~he Business o__f the Policyholder means business while on assignment by or at the direction of the Policyholder whether on or off the premises of the Policyholder for the purpose of furthering the business of the Policyholder. Refer to the Policy Modifications, Definitions, and Exclusions sections for modifications, limitations, and exclusions affecting this coverage. Ckris;~ne Hayer R~p~y, Secmlary Thomas M. Matra, President Form 7679 H-62 HAZARD HAZARD C-64 Fresh Pursuit CoveraGe for Police Officers and FirefiGhters While On The Business Of The PolicYholder CoveraGe: This Hazard covers Injury which: a) for police officers, results in Accidental Death due to a response to a Fresh Pursuit or to the Officer's response to what is reasonably believed to be an emergency; or b) for firefighters, results in Accidental Death due to a response to what is reasonably believed to be an emergency. Fresh Pursuit means the pursuit of a person who has comraitted or is reasonably suspected of having con~itted a felony, misdemeanor, traffic infraction or violation of a county or municipal ordinance. Fresh Pursuit shall not necessarily imply instant pursuit, but pursuit without reasonable delay. Refer to Policy Modifications, Definitions and Exclusions sections for modifications, limitations and exclusions affecting this coverage. Thomas M. Matra, President Form 7679 H-64 HAZARD HAZARD C-31 V.L. 118 Unlawful and Intentional Death While On The Business Of The Policyholder H~TFORD Coverage: This Hazard covers death resulting from the unlawful and intentional killing of the Insured Person which occurs anywhere in the world: a) in the performance of actual duties; and b) while on the business of the Policyholder. The term "while on the business of the Policyholder" as used herein means while on assignment by or at the direction of the Policyholder whether on or off the premises of the Policyholder, for the purpose of furthering the business of the Policyholder. Refer to the Policy Modifications, Definitions and Exclusions sections for modifications, limitations and exclusions affecting this coverage. Christine Hayer Repasy Secretary Form 7679 H-31 V.L. 118 HAZARD ACCIDENTAL DEATH AND DISMEMBEP~MENT BENEFIT If an Insured Person's injury results in any of the following losses, except loss of Life, within the Loss Period after the date of accident, we will pay the sum shown opposite the loss. We will not pay more than the Principal Sum for all losses due to the same accident. The Principal Sum is shown in the Schedule. For Loss of: Life ......................................................... The Principal Sum Both Hands or Both Feet or Sight of Both Eyes ................ The Principal Sum One Hand and One Foot ........................................ The Principal Sum Speech and Hearing ........................................... The Principal Sum Either Hand or Foot and Sight of One Eye ..................... The Principal Sum Either Hand or Foot ................................. One-Half The Principal Sum Sight of One Eye .................................... One-Half The Principal Sum Speech or Hearing ................................... One-Half The Principal Sum Thumb and Index Finger of Either Hand ............ One-Quarter The Principal Sum Loss means with regard to: a) hands and feet, actual severance through or above wrist or ankle joints; b) sight, speech or hearing, entire and irrecoverable loss thereof; c) thumb and index finger, actual severance through or above the metacarpophalangeal joints. EXPOSURE Exposure to the elements will be presumed to be injury if: a) it results from the forced landing, stranding, sinking or wrecking of a conveyance in which an Insured Person was an occupant at the time of the accident; and b) this policy would have covered injury resulting from the accident. DISAPPEARANCE An Insured Person will be presumed to have suffered loss of life if: a) his or her body has not been found within one year after the disappearance of a conveyance in which he or she was an occupant at the time of its disappearance; b) the disappearance of the conveyance was due to its accidental forced landing, stranding, sinking or wrecking; and c) this policy would have covered injury resulting from the accident. Christine Hayer Repasy, Secretarf Fox~ 7679 ACCIDENTAL DEATH AND DISMENBEP~MENT BENEFIT (SH) ACCIDENTAL DEATH BENEFIT H~FORD If an Insured Person's injury results in loss of life, we will pay the Principal Sum shown in the Schedule. DISAPPEARANCE An Insured Person will be presumed to have suffered loss of life if: a) his or her body has not been found within one year after the disappearance of a conveyance in which he or she was an occupant at the time of its disappearance; b) the disappearance of the conveyance was due to its accidental forced landing, stranding, sinking or wrecking; and c) this policy would have covered injury resulting from the accident. Form 7679 L1 ACCIDENTAL DEATH BENEFIT CLAIMS Notice of Claim: The person who has the right to claim benefits (the claimant or beneficiary, or his or her representative) must give us written notice of a claim within 20 days after a covered loss begins. If notice cannot be given within that time, it must be given as soon as reasonably possible. The notice should include the Insured Person's name and the policy number. Send it to our office in Hartford, Connecticut, or give it to our agent. Claim Forms: When we receive the notice of claim, we will send forms to the claimant for giving us proof of loss. The forms will be sent within 15 days after we receive the notice of claim. If the forms are not received, the claimant will satisfy the proof of loss requirement if a written notice of the occurrence, character and nature of the loss is sent to us. Proof of Loss: Proof of loss must be sent to us in writing within 90 days after: a) the end of a period of our liability for periodic payment claims; or b) the date of the loss for all other claims. If the claimant is not able to send it within that time, it may be sent as soon as reasonably possible without affecting the claim. The additional time allowed cannot exceed one year unless the claimant is legally incapacitated. Time of Claim Payment: We will pay any daily, weekly or monthly benefit due: a) on a monthly basis, after we receive the proof of loss, while the loss and our liability continue; or b) immediately after we receive the proof of loss following the end of our liability. We will pay any other benefit due immediately after we receive the proof of loss. Payment of Claims: We will pay any benefit due for loss of the Insured Person's life: a) according to the beneficiary designation in effect at the time of his or her death; otherwise b) to the surviving child or children and spouse in equal shares; otherwise c) to the parents or parent. If there is no survivor in these classes, payment will be made to the Insured Person's estate. Ail other benefits due and not assigned will be paid to the Insured Person, if living. Otherwise, the benefits will be paid according to the preceding paragraph. Form 7679 Z1 CLAIMS CLAIMS (Continued) If a benefit due is payable to: a) the Insured Person's estate; or b) the Insured Person or a beneficiary who is either a minor or not competent to give a valid release for the payment; we may pay up to $1,000 ($3,000 in Florida) of the benefit due to some other person. The other person will be someone related to the Insured Person or the beneficiary by blood or marriage who we believe is entitled to the payment. We will be relieved of further responsibility to the extent of any payment made in good faith. Physical Examinations and Autopsy: While a claim is pending we have the right at our expense: a) to have the Insured Person who has a loss examined by a physician when and as often as is reasonably necessary; and b) in case of death to make an autopsy, where it is not forbidden by law. Lecal Actions: No legal action may be taken against us: a) before 60 days following the date proof of loss is sent to us; b) after 3 years following the date proof of loss is due. Namin~ a Beneficiary: An Insured Person may name a beneficiary or change a revocably named beneficiary by giving his or her Written Request to the Policyholder. His or her request takes effect on the date he or she executes it, regardless of whether he or she is living when the Policyholder receives it. We will be relieved of further responsibility to the extent of any payment we made in good faith before the Policyholder received his or her request. Assicnment: The insurance under this policy is not assignable, but benefits may be assigned in accordance with the Payment of Claims provision of the Claims section of this policy. Form 7679 Z3 CLAIMS (Continued) The Hartford Financial Services Group, Inc is required by law to provide its Policy to its Policyholders. This notice is provided for your information. P~FORD Privacy Policy and Practices of The Hartford Financial Services Group, Inc. and its Affiliates (herein called "we, our, and us") This Privacy Policy applies to our United States Operations We value your trust. We are committed to the responsible: a) management; b) use; and c) protection; of Personal Information. This notice describes how we collect, disclose, and protect Personal Information. We collect Personal Information to: a) service your Transactions with us; and b) support our business functions. We may obtain Personal Information from: a) You; b) your Transactions with us; and c) third parties such as a consumer-reporting agency. Based on the tyl~e of product or service You apply for or get from us, such as: a) your name; b) your address; c) your income; d) your palzment; or e) your credit history; may be gathered from sources such as applications, Transactions, and consumer reports. To serve You and service our business, we may share certain Personal Information. share Personal Information, only as allowed by law, with affiliates such as: a) our insurance companies; b) our employee agents; c) our brokerage firms; and d) our administrators. Personal Information We will As allowed by law, we may share Personal Financial Information with our affiliates to: a) market our products; or b) market our services; to You without providing You with an option to prevent these disclosures. We may also share Personal Information, only as allowed by law, with unaffiliated third parties including: a) independent agents; b) brokerage firms; Form 7679 Z3 CLAIMS {Continued) · c) insurance companies; d) administrators; and e) service providers; who help us serve You and service our business. When allowed by law, we may share certain Personal Financial Information with other unaffiliated third parties who assist us by Derforming services or functions such as: a) taking surveys; b) marketing our products or services; or c) offering financial products or services under a joint agreement between us and one or more financial institutions. We will not sell or share your Personal Financial Information with anyone for purposes unrelated to our business functions without offering You the opportunity to: a) "opt-out;" or b) "opt-in;" as required by law. We only disclose Personal Health Information with: a) your proper written authorization; or b) as otherwise allowed or required by law. Our employees have access to Personal Information in the course of doing their jobs, such as: a) underwriting policies; b) paying claims; c) developing new products; or d) advising customers of our products and services. We use manual and electronic security procedures to maintain: a) the confidentiality; and b) the integrity of; Personal Information that we have. We use these procedures to guard against unauthorized access. Some techniques we use to protect Personal Information include: a) secured files; b) user authentication; c) encryption; d) firewall technology; and e) the use of detection software. We are responsible for and must: a) identify information to be protected; b) provide an adequate level of protection for that data; c) grant access to protected data only to those people who must use it in the performance of their job-related duties. Employees who violate our Privacy Policy will be subject to discipline, which may include ending their emplo!rment with us. At the start of our business relationship, we will give You a copy of our current Privacy Policy. Form 7679 Z3 CLAIMS (Continued) We will also give You a copy of our current Privacy Policy once a year if You continuing business relationship with us. We will continue to follow our Privacy Policy regarding Personal Information even when a business relationship no longer exists between us. As used in this Privacy Notice: Application means your request for our product or service. Personal Financial Information means financial information such as: a) credit history; b) income; c) financial benefits; or d) policy or claim information. Personal Health Information means health information such as: a) your medical records; or b) information about your illness, disability or injury. Personal Information means information that identifies You personally and is not otherwise available to the public. It includes: a) Personal Financial Information; and b) Personal Health Information. Transaction means your business dealings with us, such as: a) your Application; b) your request for us to pay a claim; and c) your request for us to take an action on your account. You means an individual who has given us Personal Information in conjunction with: a) asking about; b) applying for; or c) obtaining; a financial product or service from us if the product or service is used mainly for personal, family, or household purposes. This Privacy Policy is being provided on behalf of the following affiliates of The Hartford Financial Services Group, Inc.: American Maturity Life Insurance Company; Capstone Risk Management, LLC; First State Insurance Company; Hart Life Insurance Company; Hartford Accident & Indemnity Company; Hartford Administrative Services Company; Hartford Casualty Insurance Company; Hartford Equity Sales Company, Inc.; Hartford Fire Insurance Company; Hartford HLS Series Fund II, Inc.; Hartford Insurance Company of Illinois; Hartford Insurance Company of the Midwest; Hartford Insurance Company of the Southeast; Hartford International Life Reassurance Corporation; Hartford Investment Financial Services, LLC; Hartford Investment Management 7679 Z3 CLAIMS IContinued) Company; Hartford Life & Accident Insurance Company; Hartford Life and Annuity Insura~ Company; Hartford Life Insurance Company; Hartford Lloyd's Insurance Company; Ha~t~ Securities Distribution Company, Inc.; Hartford Series Fund, Inc.; Hartford SP~ORD Company; Hartford Underwriters Insurance Company; Hartford-Comprehensive Employee Benefit Service Company; International Corporate Marketing Group, LLC; New England Insurance Company; Nutmeg Insurance Agency, Inc.; Nutmeg Insurance Company; Nutmeg Life Insurance Company; Omni General Agency, Inc.; Omni Indemnity Company; omni Insurance Company; P2P Link, LLC; Pacific Insurance Company, Limited; Planco Financial Services, Inc.; Property and Casualty Insurance Company of Hartford; Sentinel Insurance Company, Ltd.; Servus Life Insurance Company; Specialty Risk Services, Inc.; The Hartford Income Shares Fund, Inc.; The Hartford Mutual Funds II, Inc.; The Hartford Mutual Funds, Inc.; Trumbull Insurance Company; Trumbull Services, L.L.C.; Twin City Fire Insurance Company; Woodbury Financial Services, Inc. Policyholders who have further questions about this Privacy Policy may reach us by calling 1-866-222-4195. ?679 Z3 CLAIMS (Continued)