Aetna Life Insurance Company

A

Residents of this state who purchase life insurance, annuities, or health and accident insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Arkansas Life and Health Insurance Guaranty Association (“Guaranty Association”). The purpose of the Guaranty Association is to assure that policy and contract owners will be protected, within certain limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of policy owners who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by the member insurers through the Guaranty Association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers’ care in selecting insurance companies that are well-managed and financially stable.

DISCLAIMER

The Arkansas Life and Health Insurance Guaranty Association (“Guaranty Association”) may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in the state. You should not rely on coverage by the Guaranty Association in purchasing an insurance policy or contract.

Coverage is NOT provided for your policy or contract or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as non-guaranteed amounts held in a separate account under a variable life or variable annuity contract.

Insurance companies or their agents are required by law to provide you with this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Guaranty Association to induce you to purchase any kind of insurance policy.

The Arkansas Life and Health Insurance Guaranty Association

C/O The Liquidation Division

1023 West Capitol

Little Rock, Arkansas 72201

Arkansas Insurance Department

1200 West Third Street

Little Rock, Arkansas ###-###-####

The state law that provides for this safety-net is called the Arkansas Life and Health Insurance Guaranty Association Act (“Act”). Below is a brief summary of the Act’s coverages, exclusions and limits. This summary does not cover all provisions of the Act; nor does it in any way change anyone’s rights or obligations under the Act or the rights or obligations of the Guaranty Association.

Generally, individuals will be protected by the Guaranty Association if they live in this state and hold a life, annuity, or health insurance contract or policy, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of policy or contract owners are protected as well, even if they live in another state.

EXCLUSIONS FROM COVERAGE

However, persons owning such policies are NOT protected by the Guaranty Association if:

•       they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state);

•       the insurer was not authorized to do business in this state;

•       their policy or contract was issued by a nonprofit hospital or medical service organization, an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policy or contract owner is subject to future assessments, or by an insurance exchange.

The Guaranty Association also does NOT provide coverage for:

•       Any policy or contract or portion thereof which is not guaranteed by the insurer or for which the owner has assumed the risk, such as non-guaranteed amounts held in a separate account under a variable life or variable annuity contract;

•       Any policy of reinsurance (unless an assumption certificate was issued);

•       Interest rate yields that exceed an average rate;

•       Dividends and voting rights and experience rating credits;

•       Credits given in connection with the administration of a policy by a group contract holder;

•       Employers’ plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them); unallocated annuity contracts (which give rights to group contractholders, not individuals); unallocated annuity contracts issued to/in connection with benefit plans protected under Federal Pension Benefit Corporation (“FPBC”) (whether the FPBC is yet liable or not);

•       Portions of an unallocated annuity contract not owned by a benefit plan or a government lottery (unless the owner is a resident) or issued to a collective investment trust or similar pooled fund offered by a bank or other financial institution);

•       Portions of a policy or contract to the extent assessments required by law for the Guaranty Association are preempted by State or Federal law;

•       Obligations that do not arise under the policy or contract, including claims based on marketing materials or side letters, riders, or other documents which do not meet filing requirements, or claims for policy misrepresentations, or extra-contractual or penalty claims;

•       Contractual agreements establishing the member insurer’s obligations to provide book value accounting guarantees for defined contribution benefit plan participants (by reference to a portfolio of assets owned by a nonaffiliate benefit plan or its trustees).

LIMITS ON AMOUNT OF COVERAGE

A

SUMMARY OF THE LIFE AND HEALTH INSURANCE PROTECTION

ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE

INTRODUCTION

Residents of Colorado who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Life and Health Insurance Protection Association. The purpose of this Association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Association will assess its other member insurance companies for the money to pay the claims of insured persons who live in Colorado and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the Association is limited, however. As noted in the box below, this protection is not a substitute for consumers’ care in selecting companies that are well-managed and financially stable.

IMPORTANT DISCLAIMER

The Life and Health Insurance Protection Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require residency in Colorado. You should not rely on coverage by the Life and Health Insurance Protection Association in selecting an insurance company or in selecting an insurance policy.

Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk.

Insurance companies or their agents are required by law to give or send you this notice. However, insurance companies and their agents are prohibited by law from using the existence of the Association to induce you to purchase any kind of insurance policy.

SUMMARY

The state law that provides for this safety-net coverage is called the Life and Health Insurance Protection Association Act. Below is a brief summary of this law’s coverages, exclusions and limits. This summary does not cover all provisions of the law, nor does it in any way change anyone’s rights or obligations under the act or the rights or obligations of the Association.

COVERAGE

Generally, individuals will be protected by the Life and Health Protection Association if they live in this state and hold a life or health insurance contract, or annuity, or if they hold certificates under a group life or health insurance contract or annuity, issued by a member insurer. The beneficiaries, payees, or assignees of insured persons are protected as well, even if they live in another state. Certain parties to structured settlement annuity contracts may be entitled to coverage benefits as well based on defined circumstances.

EXCLUSIONS FROM COVERAGE

Persons holding such policies or contracts are not protected by this Association if:

•       they are not residents of the State of Colorado, except under certain very specific circumstances;

•       the insurer was not authorized or licensed to do business in Colorado at the time the policy or contract was issued;

•       their policy was issued by a nonprofit hospital or health service corporation, an HMO, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, or by an insurance exchange.

The Association also does not provide coverage for:

•       any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk;

•       any policy of reinsurance (unless an assumption certificate was issued);

•       plans of employers, associations or similar entities to the extent they are self-funded or uninsured (that is, not insured by an insurance company, even if an insurance company administers them);

•       interest rates yields, crediting rate yields or other factors employed in calculating returns, including but not limited to indexes or other external references stated in the policy or contract, that exceed an average rate specified in the Association Act;

•       dividends;

•       experience rating credits;

•       credits given in connection with the administration of a policy or contract;

•       any unallocated annuity;

•       annuity contracts or group annuity certificates used by nonprofit insurance companies to provide retirement benefits for nonprofit educational institutions and their employees;

•       policies, contracts, certificates or subscriber agreements issued by a prepaid dental care plan;

•       sickness and accident insurance when written by a property and casualty insurer as part of an automobile insurance contract;

•       unallocated annuity contracts issued to an employee benefit plan protected under the federal Pension Benefit Guaranty Corporation;

•       policies or contracts issued by an insurer which was insolvent or unable to fulfill its contractual obligations as of July 1, 1991, except for annuity contracts issued by a member insurer which was placed into liquidation between July 1, 1991 and August 31, 1991;

•       policies or contracts covering persons who are not citizens of the United States;

•       any kind of insurance or annuity, the benefits of which are exclusively payable or determined by a separate account required by the terms of such insurance policy or annuity maintained by the insurer or by a separate entity.

LIMITS ON AMOUNT OF COVERAGE

The act also limits the amount the Association is obligated to pay out. The Association cannot pay more than what the insurance company would owe under a policy or contract. Also, for any one insured life, no matter how many policies or contracts were issued by the same company, even if such contracts provided different types of coverages, the Association will pay a maximum of:

•       $ 300,000 in net life insurance death benefits and no more than $ 100,000 in net cash surrender and net cash withdrawal values for life insurance;

•       for health insurance benefits - $ 100,000 for coverages not defined as disability, basic hospital, medical and surgical, or major medical insurance, including any net cash surrender and net cash withdrawal values: $ 300,000 for disability insurance; or $ 500,000 for basic hospital, medical and surgical, or major medical insurance;

•       $ 100,000 in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or

•       with respect to each payee of a structured settlement annuity, $ 100,000 in present value annuity benefits in the aggregate, including net cash surrender and net cash withdrawal values.

The Association shall not be liable to expend more than $ 300,000 in the aggregate, with respect to any one life except that with respect to benefits for basic hospital, medical and surgical and major medical insurance, the aggregate liability of the association shall not exceed $ 500,000 with respect to any one individual.

This Information is Provided By:

A

Policyholder Notice:

To:  

Policyholders with Group Policies Issued in the State of Indiana and Policyholders with an Indiana Business Location

Subject:

The Indiana legislature has passed Senate Bill 211 which provides that persons who believe they have been adversely affected by an unfair claim settlement practice may file a complaint with the Department of Insurance. Senate Bill 211 further requires that insurers must provide a one time written notice of the remedy to each current Indiana policyholder or non-Indiana policyholder with employees in Indiana.

Insurance Department Bulletin No. 63 provides a suggested format for the written notice required by Senate Bill 211.

To comply with this legislation, we have prepared a Complaint Notice of which a copy is attached. We recommend that you inform Indiana insureds of this notice in some manner either by posting the notice on a bulletin board or reproducing a supply for distribution to insureds.

If you have any questions regarding this or the attached notice, please contact the Employee Benefits Representative who services your account or our local Employee Benefits Office.

Public Information/Market Conduct

Indiana Department of Insurance

311 West Washington Street, Suite 300

Indianapolis, IN ###-###-####

SUMMARY OF MISSISSIPPI LIFE AND HEALTH

INSURANCE GUARANTY ASSOCIATION ACT

AND NOTICE CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS

Residents of this state who purchase life insurance, health insurance, or annuities should know that the insurance companies licensed in this state to write these types of insurance are members of the Mississippi Life and Health Insurance Guaranty Association (the “Guaranty Association”). The purpose of the Guaranty Association is to assure that policy and contract owners will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Guaranty Association will assess its other member insurance companies for the money to pay the claims of policy owners who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by the member insurers through the Guaranty Association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers’ care in selecting insurance companies that are well-managed and financially stable.

The Mississippi Life and Health Insurance Guaranty Association

300 North Mart Plaza, Suite 2

Jackson, Mississippi 39206

Mississippi Insurance Department

1804 Walter Sillers Building

Jackson, Mississippi 39205

EXCLUSIONS FROM COVERAGE

•       they are eligible for protection under the laws of another state (this may occur when the insolvent insurer was incorporated in another state whose guaranty association protects insureds who live outside that state);

•       the insurer was not authorized to do business in this state;

•       their policy or contract was issued by a hospital or medical service organization whether profit or nonprofit, a health maintenance organization (HMO), a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or other person that operates on an assessment basis, an insurance exchange, or any similar entity.

The Guaranty Association also does NOT provide coverage for:

•       Any policy or contract or portion thereof which is not guaranteed by the insurer or for which the owner has assumed the risk, such as non-guaranteed amounts held in a separate account under a variable life or variable annuity contract;

•       Any policy or contract of reinsurance, unless an assumption certificates were issued pursuant to the reinsurance policy or contract;

•       Interest rate yields that exceed an average rate;

•       Dividends and voting rights and experience rating credits or payment of any fees or allowances to any person in connection with this service to or administration of the policy or contract;

•       Credits given in connection with the administration of a policy by a group contract holder;

•       Employers’ plans to the extent they are self-funded or uninsured (that is, not insured by an insurance company, even if an insurance company administers them);

•       Unallocated annuity contracts issued to or in connection with benefit plans protected under federal Pension Benefit Guaranty Corporation (“PBGC”) regardless of whether the PBGC has yet become liable to make any payments with respect to the benefit plan;

•       Portions of any unallocated annuity contract not issued to or in connection with a specific employee, union or association of natural persons benefit plan, or a government lottery;

•       Portions of a policy or contract to the extent assessments required by law for the Guaranty Association with respect to the policy or contract are preempted by State or Federal law;

•       Obligations that do not arise under the express written terms of the policy or contract, including claims based on marketing materials, side letters, riders or other documents that were issued by the insurer without meeting applicable policy form filing or approval requirements, or claims for policy misrepresentations, or extra-contractual or penalty or consequential or incidental damages claims;

•       Contractual agreements establishing the member insurer’s obligations to provide book value accounting guarantees for defined contribution benefit plan participants (by reference to a portfolio of assets owned by a nonaffiliate benefit plan or its trustees).

Important Information Regarding Your Insurance

Aetna Life Insurance Company

151 Farmington

Avenue Hartford, CT 06156

1 ###-###-####

Virginia Bureau of Insurance

P.O. Box 1157

Richmond, Virginia 23218

Consumer Service Hotline (Toll Free and Nationwide):

877 ###-###-####

President

Registrar

Aetna Life Insurance Company

151 Farmington Avenue

Hartford, Connecticut 06156

860 ###-###-####

Face
Page

F207079

TX

Eligible Classes

Changes

Special Provisions

The Face Page, Index, this Policy Contents page, and all the provisions of Parts I and II; and

The provisions found in the Certificate(s) listed in this section.

The Certificate(s) included in this policy are as follows:

A “Certificate” consists of a Certificate Base document (“Cert. Base”) and any Summary of Coverage (“SOC”) or Certificate Rider (“Rider”) which may be issued to support or amend the Cert. Base.

Identification

Issue Date

Effective Date

Cert Base 1

SOC 1A

SOC 1B

SOC 1C

Cert Base 2

SOC 2A

Cert Base 3

SOC 3A

Cert Base 4

SOC 4A

SOC 4B

Part-time;

Temporary;

Substitute; or

In a class for which a Certificate is not in this policy.

A reduction will be effective:

On the date the employee requests it under Life Insurance and Accidental Death and Personal Loss Coverage.

On the date of the earnings or status change under all other coverages.

An increase will be effective on the date of the earnings or status change. For any coverage other than Health Expense Coverage, the Active Work Rule must be met. The employee may refuse an increase in Life Insurance or Accidental Death and Personal Loss Coverage. This must be done within 31 days of the date it would have taken effect. If refused, no other increase because of the earnings or status change will be made until the date Aetna gives written consent.

the Rules do not provide a greater amount of Life Insurance than his or her amount under the prior coverage; or

his or her life insurance had not been reduced under the prior coverage due to age or retirement.

As to any Accidental Death and Personal Loss Coverage: Any benefit payable under any prior group accident plan for accidental loss of life, limb, or sight.

As to any Temporary Disability Benefit Coverage: Any benefit payable under any prior group temporary disability plan for loss of time from work.

As to any other benefit section: Any benefit payable under any prior group medical, dental, or other health plan for medical or dental treatment.

are available; or

would be available in the absence of coverage under this policy;

are available; or

would be available in the absence of any coverage under this policy;

An employee shall not be covered for any Accidental Death and Personal Loss Coverage or any Temporary Disability Benefit Coverage unless he or she was covered for a like benefit under the prior coverage on the day before the date the terms of the second preceding paragraph took effect for him or her. If he or she is covered, the amount of Principal Sum and the Weekly Benefit shall be the amount in force for him or her under the like benefit on that date. The Maximum Period of Payment will be the period in effect for him or her under the like benefit on that date.

As to any Major Medical, Comprehensive Medical, or Comprehensive Dental Expense Benefits: If part or all of a covered family member’s Deductible, under any section of his or her prior coverage that provides one or more of these benefits, has been applied against covered expenses incurred by him or her during the 90 day period right before the date his or her coverage goes into effect, his or her Deductible under any Major Medical, Comprehensive Medical, or Comprehensive Dental Expense Benefits for the calendar year in which he or she becomes covered will be reduced by the amount so applied.

0990

ED. 7-73

his or her coverage terminates; or

he or she meets any applicable Active Work Rule.

0990

ED. 7-73

The first “policy month” starts on January 1, 2004

Each subsequent policy month starts on the first of a calendar month

the existence; or

amount;

Maintain a reasonably complete record of such information in electronic or hard copy format, including but not limited to:

evidence of eligibility;

changes to such elections; and

terminations;

for at least seven years or until the final rights and duties under this policy have been resolved; and to make such information available to Aetna upon request.

Obtain from:

the Policyholder; and

each Member Employer:

a “Disclosure of Healthcare Information” authorization in the form currently being used by Aetna in the enrollment process; or such other form as Aetna may reasonably approve.

on Aetna forms; or

such other forms as Aetna may approve.

notify all eligible employees of their right to continue coverage under COBRA and any applicable state law; and

provide notification to each employee within 14 days after termination of coverage, of their conversion right, including:

a description of plans available;

premium rates;

and application forms.

GR-29

11496

ED. 1-02

will make no attempt, whether through differential contributions or otherwise, to encourage or discourage enrollment in the coverages provided by the policy based on health status or risk.

will act so as not to discriminate unfairly between persons in like situations at the time of the action.

with 30 days written notice to the Policyholder; or

by written agreement between Aetna and the Policyholder.

•       The Policyholder has asked for the change and Aetna has agreed to it.

•       The change is needed to correct an error in the policy, including any certificate issued to anyone.

•       The change is needed so that the policy will conform to any law, regulation or ruling of:

a jurisdiction that affects a person covered under this policy; or

the federal government.

•       The change has been initiated by Aetna and is not resulting in either:

a reduction or elimination in benefits or coverage; or

an increase in premium.

that reduces or eliminates benefits or coverage; or

that increases benefits or coverage with a concurrent increase in premium during the policy term, except if the increased benefits or coverage is required by law.

with 30 days written notice to the Policyholder; or

by written agreement between Aetna and the Policyholder.

a copy of the statement is; or

has been furnished to:

the employee; or

his beneficiary; or

the person making the claim.

No statement made by the Policyholder or an employee shall be the basis for:

voiding coverage; or

denying coverage; or

be used in defense of a claim;

unless it is in writing.

No statement made by the Policyholder shall be used to void this policy after it has been in force for 2 years.

No statement made by an eligible employee shall be used in defense to a claim for loss incurred or starting after coverage as to which claim is made has been in effect for 2 years.

on the basis of an examination of the experience of the risk assumed; and

on reasonable assumptions as to:

interest;

mortality; and

expense.

GR-29

1170-2

ED. 7-73

Employee Life Insurance Coverage (Continued)

Premium Per $1,000 of Dependent Term Life Insurance:

Employee Life Insurance Coverage (Continued)

The premium rate may be figured again as of any premium due date only:

By reason of a change in factors bearing on the risk assumed. Aetna must request this.

Once during any continuous 12 month period. The Policyholder must request this and give 60 days notice to Aetna.

Premium Rates

(Continued)

GR-29

11501

ED. 1-02

the date premium charges start or cease; and

the end of the premium-paying period.

Experience; or

a change in factors bearing on the risk assumed.

a significant change in factors bearing a material impact on the risk assumed by Aetna; or

changes in applicable state or federal:

law;

policy;

regulation; or

a judicial decision;

By reason of a change in factors bearing on the risk assumed. This must be requested by Aetna.

Once during any continuous 12 month period. The Policyholder must request this. 60 days advance notice has to be given to Aetna.

The ages of the employees;

The amounts of insurance in force;

The premium rates; and

Any other pertinent factors.

The first day of the policy year in which Aetna receives proof that the refund should be made; or

The date 3 months before Aetna receives proof, if this produces a larger refund.

month; or

partial month;

costs of collecting any unpaid premiums or fees; including reasonable attorney’s fees; and

costs of suit.

determine whether and to what extent employees and beneficiaries are entitled to benefits; and

construe any disputed or doubtful terms of this policy.

policies;

procedures;

rules, and

interpretations;

the creation;

the distribution; and

the final content of:

summary plan descriptions;

summary of material modifications; and

summary annual reports.