5 Star Terms and Conditions
- The Family Protection Plan (FPP) offers a guaranteed level premium to age 121, qualified issued underwriting, and guaranteed death benefit. All at affordable rates, the convenience of payroll deduction, and two unique living benefits: Terminal Illness benefit and Quality of Life Rider.
- Terminal Illness – Pays you 30 percent (25 percent in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months.
- Quality of Life Benefit – Following a diagnosis of either a chronic illness or cognitive impairment, this rider accelerates a portion of the death benefit on a monthly basis – 4 percent – as scheduled by the employer at the group level; up to 75 percent of your benefit, and payable directly to you on a tax favored basis for the following: Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or Permanent sever cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.
- Portability – You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid, in which case the insurance company will simply bill you directly. Coverage can never be cancelled by the insurance company or your employers unless you stop paying premiums.
- Family Protection- You can also purchase coverage for your spouse, children 14 days to 19 years or 26 if full time student.
- Convenience – Premiums are easily taken care of through payroll deduction.
- Easy Application Process – No medical exam required. You simply answer a few health questions.
- Protection you can count on – Within 24 hours after receiving notice of death, an emergency death benefit of 50 percent or $10,000, whichever is less, is mailed to the beneficiary, unless the death is within the 2-year contestability period and/or under investigation.
- This product contains no war or terrorism exclusions.
- Actively at work full time 30 hours for 6 months
- Employee is not required to purchase coverage for other family members to apply.
- Offer to employee, spouse, and dependent is made on a modified qualified issue basis.
- I am eligible to apply for this group level term life insurance coverage as an Employee as defined in the Master Group Policy and described in the Certificate of insurance coverage.
- In the absence of my spouse, I, as Owner, have the appropriate knowledge to answer the questions for my spouse and children. I represent that all statements and answers in this enrollment form are complete, true, and correctly recorded TO THE BEST OF MY KNOWLEDGE AND BELIEF.
- I agree that:
- Upon approval of this enrollment form by 5Star Life Insurance Company (5Star Life), it and the Benefits Summary issued to me will describe the benefits and terms of coverage provided under the Master Group Policy.
- Coverage applied for will not become effective until approved by 5Star Life and is subject to each covered person’s health being as described in this application, and upon receipt of the full first premium, in which case the coverage shall take effect as of the effective date as shown in the Benefits Summary.
- If within 60 days of receipt of all required documentation this application is not approved, it will become void and any premiums paid will be refunded; I will be so notified.
*Note: Within the time limits prescribed by the law of the state where you live, no benefits will be paid, and premiums will be refunded if the insured commits suicide while sane or insane. Refer to your Benefits Summary for coverage details.
- I hereby authorize any licensed physician; medical practitioner; hospital; clinic; insurance company; employer; financial institution; Medical Information Bureau; or Motor Vehicle Administration that may have records of my financial, physical, or mental health condition to give 5Star Life, its authorized representative, and its reinsurers any such information. I understand that this information will be used to determine my eligibility for coverage and that I may revoke this authorization and enrollment form at any time by providing written notice. A photocopy of this authorization shall be as valid as the original. This authorization shall be valid for 24 months from the date below. I acknowledge that I, or my authorized representative is entitled to receive a copy of this authorization.