Electronic Certificates (eCert)

• Electronic Documents Authorization Form

If you would like to request authorized electronic certificate delivery, complete the Electronic Document Authorization Form.

If you currently receive your certificates electronically (in a PDF format), you may distribute a certificate to each covered employee electronically. Employees must be able to print a copy of this document if they choose to. If any employees are unable to receive or view their certificates electronically, a printed copy must be provided to each of them.

For policies sitused in California, Florida, or Texas, refer to the face page of the certificate to confirm if an Individualized* Certificate Confirmation Statement is required. The full page template includes: Policyholder (Company Name), Group Policy Number, Employee Name, Coverage Effective Date and the dollar amount of coverage. The dollar amount only needs to be completed for life insurance certificates. The Individualized* Certificate Confirmation Statement will be emailed along with the certificates. Complete the template, then email the template and certificate to the employee.

* “Individualized” means that each certificate shows the name of the employee on the certificate.

Paper Certificates
If you have not signed up for electronic delivery, MetLife will send copies of your group's policy and certificate. Upon receipt, please distribute a certificate to each covered employee.

For policies sitused in California, Florida, or Texas, refer to the face page of the certificate to confirm if individualized* employee labels are required. These labels will be included with the paper certificates. Fill out the label and affix it to each certificate prior to distribution. The label includes: Policyholder (Company Name), Group Policy Number, Employee Name, Coverage Effective Date and the dollar amount of coverage. The dollar amount only needs to be completed for life insurance certificates.

*“Individualized” means that each certificate shows the name of the employee on the certificate.

If you request a plan design change, you will receive new certificates, or the necessary pages to update those certificates you have distributed and those you have in supply. We will provide instructions with any new forms.

For more information, contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638).

The list bill is the most commonly selected bill type. The list bill shows each employee and the amount of premium due for each applicable coverage. Any additions, terminations and changes that occur between billing periods will be reflected on your next invoice after the changes have been made; therefore, please pay premium as billed.

Link to sample of list bill

A completed IRS W9 Form (Request for Taxpayer Identification Number and Certification Form) for MetLife is available. For List billed customer, use this W9 Form.

MetLink and Billing

Access MetLink to accomplish your billing needs. MetLink users can view the following:

• Current bills/invoices
• Billing history
• Payment inquiries

You can also print current bills/invoices, receive email billing notifications, and suppress paper bills. Log into MetLink, and click on the Billing section.

For further help navigating through the MetLink Billing section, access the Resources tab on MetLink to view your customized user guide.

If you are currently not a MetLink user, contact your MetLife Representative or broker.

If You Have Selected The Self-Administered Billing Option

With the self-administered bill option, you are responsible for tracking and reporting additions, terminations and changes that occur between billing periods. The self-administered bill reports premium due for the total number of insured lives for each coverage. You then make the appropriate adjustments in your totals for the month and mail the revised billing statement and premium to MetLife.

Link to sample of self-administered bill

W9 Form for SAP Billed Groups

A completed IRS W9 Form (Request for Taxpayer Identification Number and Certification Form) for MetLife is available. For SAP billed customer, use this W9 Form.

Example Of How To Calculate Basic Life (or Core Life) and Supplemental Life

Basic Life (or Core Life):

Rate per $1,000 of benefits

Life Example: Benefit Amount ($25,000) ÷ $1,000 x Rate (.35) =
Premium Due ($8.75)

Supplemental Life:

Employee's age rate per $1,000 of benefits

Example: Employee's age = 30

Benefit Amount ($20,000) ÷ $1,000 x Rate (.35) = Supplemental Life Premium Due ($7.00)

Age      Rate
30-34   .35
35-39   .40
40-44   .45
45-49   .50
50-54   .55
55-59   .60
60-64   .65

The rates shown are for example purposes only. Contact 1-800-ASK-4-MET (1-800-275-4638) for questions concerning your rates.

How to Read Your Billing Statement

To help you better understand MetLife's billing procedures, sample bill formats are included along with an item-by-item explanation of information it contains. Please contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638) if you have questions about an item or any aspect of our billing process.

MetLife reserves the right to audit your records periodically to ensure the accuracy of premium calculations.

Please note: There is a $25.00 fee for all premium checks returned due to insufficient funds.

Electronic Funds Transfer

• Authorization for Electronic Fund Transfer Form

Electronic Funds Transfer (EFT) provides a new payment option for list billed customers to remit premium electronically from your bank to ours, without the resources and costs associated with requesting and issuing a manual check each month.

You will continue to receive a List Billing statement. The last page will state “Amount To Be Drafted” instead of balance due. The premium will be drafted from your authorized bank account on each bill due date.

To implement the EFT payment option, complete the Authorization for Electronic Fund Transfer Form and attach a copy of a voided business check.

Remit the EFT form and voided check to:

MetLife
Small Market
P.O. Box 14593
Lexington, KY 40512-4593

Or Fax to:

Attn: MetLife-Small Market
Subject: EFT Authorization Form
Fax: 1-888-505-7446

• Notify MetLife in writing. Notification should be sent to MetLife at least 60 days before your specified termination date. The policy will end on the later of the date stated in the notice; or the date MetLife receives the notice.
• Pay all unpaid premiums for the time your policy was in force. If MetLife receives a notice of termination request, all outstanding premiums must be paid in full before your request can be processed.

Please submit all request for termination to:

Fax 1-888-505-7446
Small Market Administration
PO Box 14593
Lexington, KY 40512-4593

• Beneficiary Designation Form
• Enrollment Form (located in Form Finder)
• Statement of Health Form

Note: New Enrollment and Statement of Health Forms are now available. Be sure to download the new forms!

Enrollment of New Employees for Contributory vs. Non-Contributory Coverages

Non-Contributory Coverage means the cost of the coverage is fully paid by the Employer.

• 100% of all eligible Employees must be enrolled.
• Eligible Employees cannot waive non-contributory coverage.

Contributory Coverage means the employee pays all or a portion of the cost of the coverage.

• Employees are not required to enroll for the coverage.

Enrollment of New Employees for Contributory Coverages

Once new employees have met the requirements for coverage, they have 31 days to enroll in your group plan. Employees who do not enroll within this 31-day period are considered late enrollees. Late enrollees may apply for coverage at any time, subject to certain restrictions. Please refer to the Late Enrollments section of this manual for more details. Any employee who chooses to waive coverage must complete the waiving coverage section and sign the Enrollment Form.

For all benefits, except dental, employees must complete a Statement of Health Form for coverage amounts in excess of the non-medical maximum that can be found in the Schedule of Benefits in your Certificate of Insurance.

Employee Declining Coverage
If the employee declined any employee-paid (contributory) coverages, you must obtain an enrollment form from the employee and keep the enrollment form on file.

Enrollment of New Employees for Non-Contributory Coverages

Once new employees have met the requirements for coverage, they have 31 days to enroll in your group plan. All employees are to be covered on the date they are eligible. There are no late enrollments for non-contributory benefits. Enrollments processed after the billing period has ended for the eligibility date will be back-billed on the first available billing after the enrollment has been received and processed. Any employee who chooses to waive coverage must complete the waiving coverage section and sign the Enrollment Form.

The completed Enrollment Form should be sent to MetLife. Keep a copy of each Enrollment Form in your files as evidence that the new employee was given the opportunity to enroll. All requested information is necessary to promptly and accurately enroll your employees.

For all benefits, except dental, employees must complete a Statement of Health Form for coverage amounts in excess of the non-medical maximum that can be found in the Schedule of Benefits in your Certificate of Insurance.

Checking Enrollment Applications

For List Billed Cases: Incomplete or missing information on the Enrollment Form may delay coverage for your employees. Please check to see that all required forms are completed before submitting them to MetLife. Keep a copy of each Enrollment Form for your files.

For Self-Administered Cases: Please check that all required forms are completed and signed. MetLife will use this information to determine eligibility for benefits at the time of claim. Keep these Enrollment Forms in your files for all life coverages except Supplemental Life.  Submit Supplemental Life Enrollment Forms to MetLife.

MetLink and Enrollment

On MetLink you can update employee and dependent eligibility.
You will have the ability to:

• Enroll new employees
• Terminate coverage
• Reinstate coverage
• Add/Change dependent status

For Group enrollment, you can view:

• Enrollment listings
• Plan structure

Log into MetLink and click on the Enrollment Services section.

For further help navigating through the MetLink Enrollment Services section, access the Resources tab on MetLink to view your customized user guide.

If you are currently not a MetLink user, contact your MetLife Representative or broker.

Domestic Partnership

• Domestic Partnership Declaration Form

Domestic Partner means each of two people, one of whom is insured under the Policy, who represent themselves publicly as each other's domestic partner and have satisfied certain conditions set-forth in the Certificate of Insurance. Review your Certificate of Insurance to verify if your plan provides Domestic Partnership benefits. A Domestic Partner can become a qualified dependent for Dental, Life and AD&D if the requirements listed in the Certificate of Insurance are met.

The insured and the declared domestic partner are required to fill out the appropriate Domestic Partnership Form. Retain the form in your files.

For more specific information concerning the Domestic Partnership option, please refer to your group Certificate of Insurance.

For more information, contact Customer Service at 1-800-ASK-4-MET
(1-800-275-4638).

Enrolling Rehired Employees

Any rehired employee should be enrolled as if he or she is a new employee regardless of whether or not this person was previously covered under your group plan. The only exception is if the employee is rehired within six (6) months of the date on which coverage terminated because employment ended.

Any rehired employee returning from the armed services does not have to meet the requirements for coverage of your group plan. Please note on the Enrollment Application that the employee is returning from the armed services and the date he or she returned to full-time employment.

Any rehired employee with coverage under the Portability option will remain covered under Portability until the next renewal date. At the next renewal date, coverage will terminate under Portability and the employee should be re-enrolled under the group Life plan. An employee may not be covered under the Portability Option and the employer's Life plan.

Effective Dates For Absent Employees And Dependents

Individual effective dates for an employee who becomes eligible for benefits after the initial effective date of the employer's plan may be delayed if the employee is out due to injury or sickness on the date that benefits would be effective.

At initial enrollment, eligible employees who are not at work due to injury or sickness on the day benefits would normally become effective, will have benefits delayed until they return to work. Refer to your prior carrier's Certificate of Insurance for the extension of benefits section.

Eligible dependents who are hospital confined, or confined at home under the care of a physician, on the day benefits would normally become effective will have benefits delayed until the day they are no longer confined.

MetLife Center for Special Needs Planning

MetLife Center for Special Needs Planning helps families through the maze of legal and financial complexities in planning for their child’s welfare. Educating families in workshops or evaluating their needs in individual sessions, and is specially qualified to help families develop plans not only to provide for lifetime care but for quality of life. MetLife Center for Special Needs Planning works with families with children or other dependents with special needs and their professional advisors to apprise them of important planning issues and the options available to them. These include:

• Government benefit eligibility requirements for Social Security Income (SSI);
• Medicaid;
• Types of special needs trusts and helping determine which one works best for a particular situation;
• Appropriate financial funding vehicles, including life insurance, to enhance the child's quality of life.

Please contact the Resource Center at 1-877-638-3375 or email at www.metlife.com/specialneeds for additional information.

• Beneficiary Designation Form
• Enrollment Form (located in Form Finder)
• Statement of Health Form

Note: New Enrollment and Statement of Health Forms are now available. Be sure to download the new forms!

Late Employee Enrollments For Contributory Coverage

Employees who do not complete and submit Enrollment Forms during their enrollment period, and employees requesting amounts over the non-medical maximum (found in your Certificate of Insurance) must submit Statement of Health Forms in addition to Enrollment Forms. Coverage is subject to approval by MetLife. Effective dates for approved enrollments are determined by MetLife. Please see your Certificate of Insurance for more details.

If employee and/or dependent coverage was terminated at the employee's request, and the employee wants to re-enroll for coverage, a Statement of Health Form will be required in addition to the Enrollment Form.

Late Dependent Enrollments For Customers With Dependent Coverage

Dependents not added during their enrollment period are subject to the same late enrollment procedures as employees. A Statement of Health Form must be completed and submitted for each late enrolling dependent. Please see your Certificate of Insurance for more details.

Late Enrollments For Non-Contributory Coverage

All employees are to be covered on the date they are eligible. There are no late enrollments for non-contributory benefits.

How to Submit Statement of Health Forms

Employers should treat all information in the Statement of Health Form as confidential. Information should not be discussed with, or disclosed to, others unless such discussion or disclosure is necessary to administer the MetLife coverage.

Review the employee's statement section of the form to ensure that all required questions have been answered and complete the employer section of the form. The original copy should be sent to MetLife, you should keep a copy for your records, and the employee should retain a copy for their records.

The authorization to furnish medical information is incorporated into the employee's statement. If necessary, it allows MetLife to request a medical examination and/or additional information from the employee's or dependent's attending physician for the purpose of underwriting the coverages involved. The signature of the employee who is applying for coverage and the dependent (if over the age of 18 and the information on the statement pertains to that dependent) is always required.

Mail Statement of Health Forms to:

MetLife Statement of Health
P.O. Box 14069
Lexington, KY 40512-4069

Once the completed Statement of Health is received and reviewed by MetLife, the employer will receive notification of approval or declination. If a status has not been received within three weeks of submitting the Statement of Health, contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638). Please do not have the employee call.

The Statement of Health Form may require employees to disclose sensitive medical information about themselves and/or their dependents. This information is used exclusively for determination of insurability. It is not to be used or made available for any other purpose whatsoever.

Checking the status of a Statement of Health (SOH) Form

The SOH Inquiry feature in MetLink will allow you to search the SOH database for an employee or your entire organization’s SOH submissions.

For further help navigating through the MetLink Enrollment Services - View a Statement of Health section, access the Resources tab on MetLink to view your customized user guide.

Log into MetLink and click on the Enrollment Services section.

If you are currently not a MetLink user, contact your MetLife Representative or broker.

• Change Request Form

MetLink and Enrollment Changes

On MetLink you can update employee and dependent eligibility.

You will have the ability to:

• Terminate coverage
• Reinstate coverage
• Add/Change dependent status

Log into MetLink and click on the Enrollment Services section.

For further help navigating through the MetLink Enrollment Services section, access the Resources tab on MetLink to view your customized user guide.

If you are currently not a MetLink user, contact your MetLife Representative or broker.

Examples of Changes in Employee Status

Examples of changes that require notification include:

• Employee has a change in earnings or occupation that affects benefit amounts.
• Employee cancellation of a contributory coverage.
• Employee changes benefit class.
• Employee changes name.
• Employee deletes a dependent or all dependent coverages.
• Employee Divorce or legal separation.
• Death of dependent.
• Death of employee.
• Dependent marries or reaches the limiting age as determined by individual's State requirements (see Certificate of Insurance for details).
• Employee adds a new dependent to existing dependent coverage including marriage, becoming a parent or legal guardian.

MetLife must be notified of any change in employee classification or salary to ensure benefits are properly paid at time of claim. You may indicate the changes on a written list. The listing must include the group name and number, employee's name, effective date of the change and the employee’s Social Security number.

The Change Request Form may be used for all other changes.

The State of Connecticut has passed legislation that allows for a premium credit to be requested following the termination of a covered employee under certain conditions.

Connecticut Public Act No. 09-126 provides employers an election to terminate an employee’s coverage under a group health insurance policy upon termination of employment and to receive a pro rata credit for the employee’s terminated coverage under certain conditions. The law applies to MetLife’s fully insured Dental, Disability, and AD&D plans for members employed in Connecticut. This legislation does not apply to Life plans. The law does not apply where a collective bargaining agreement requires the employer to pay the premium for an employee under the group health insurance policy after the date of such employee’s termination.

When an employee voluntarily terminates employment, or is terminated by his or her employer for reasons other than layoff, the employer may request that the employee’s health insurance coverage be terminated as of the employment termination date and that a credit be applied to their next month’s bill. The amount of this credit will be the pro rata amount of premium for the employee and any dependents for their Dental, Disability, and/or AD&D coverage for the remainder of the month after the date of their termination.

Within 72 hours of employment termination, the employer is obligated to:

1. Notify the employee of the termination of health insurance coverage. To avoid later disputes, it is strongly recommended that the employer notify the employee in writing at the time of the termination of employment. Additionally, please note that it is the employer’s responsibility to remit to the former employee his or her share of any credited or returned premium.
2. Notify the health insurer that it elects to terminate the employee’s health insurance. The employer must provide the employee’s name and other identifying information including date of termination and whether the employee had dependent coverage. This will allow the health insurer to properly process the request.

Please e-mail eligible credit requests to NEService@metlifeservice.com. Requests may also be made by phone by calling the Customer Service Center at 1-800-ASK-4-MET, or by mailing requests to: MetLife NE Service Team, 18205 Crane Nest Drive, 6th Floor, Tampa, FL 33647.

Please note: If all or part of your billing is Self Administered, it is your responsibility to make the appropriate payment adjustment following eligible terminations. Deductions should be for the pro rata amount of premium for the remainder of the month after the termination date, and should be made for Dental, Disability, and AD&D coverage only (not for Life insurance coverage). For example, if an employee has Dental and Life coverage and voluntarily terminates his or her employment on January 25, calculate the cost of six (6) days of Dental coverage (January 26-31) and deduct it from February’s premium payment.

For additional information on this topic, you may visit the State of Connecticut Insurance Department’s website at http://www.ct.gov/cid and look for 2009 BULLETIN HC-73 under the Reference Library. For questions, please contact our Customer Service Center at 1-800-275-4638 or e-mail us at ASK4MET@metlifeservice.com.

Death of an Employee

In the case of death of an employee, all of the deceased employee's dependent(s) coverages must be cancelled. A covered dependent may be eligible for Conversion of Life Benefits to a Personal Policy. Please refer to the Conversion of Coverage section.

Complete a Change Request Form reflecting the date of death as the coverage termination date and submit to MetLife.

Employee Terminations

Examples of employee coverage terminations that require notification include:

• Employee has been terminated.
• Employee no longer meets the definition of an eligible employee under the plan.
• Employee stops making contributions.

Notify MetLife by completing a Change Request Form.

Dependent Terminations For Customers With Dependent Coverage

Examples of dependent terminations: coverage terminates whenever the first of the following occur.

• The employee's coverage terminates.
• A dependent no longer meets the definition of an eligible dependent under the plan.
• An employee stops making contributions for the dependent coverage if the plan is contributory.

An employee's coverage may be continued even though he or she may not be actively at work under the following conditions:

• During a temporary layoff; or
• During an authorized leave of absence.

Continuing coverage in these situations is an option used only when the reasonable expectation exists that the employee will return to work.

To continue coverage, the same contribution must be paid as if the employee was at work. The termination date for any employee continuing coverage under these conditions is the date employment actually terminates. Please indicate the employee's name and the date employment terminated on a Change Request Form.

For more information on the requirements and time periods for this type of coverage to continue, please refer to your Certificate of Insurance.

Layoff Or Leave Of Absence For Customers With Dependent Coverage

If the employee's coverage is being continued because of a layoff or leave of absence, the employee's dependent coverage may also be continued. To continue coverage for dependents under these conditions, the same contribution must be paid as if the employee was at work.

If the employee's coverage terminates, the employee's dependent coverage will also terminate. For more information, please refer to the Certificate of Insurance.

Temporary Layoffs Or Leaves Of Absence

For an employee who has been laid off or who has taken a leave of absence, certain coverages such as Life/AD&D and Dental may be continued as determined by the rules and practices of the employer, however, continuance cannot be longer than 2 months. In the event the leave qualifies under the Family & Medical Leave Act of 1993 (FMLA), the period cannot be longer than 12 weeks following the date the leave of absence began.

Continuation of STD/LTD coverages for such an employee, however, is determined solely by MetLife and not by the employer. Refer to your Certificate of Insurance for any applicable rules.

If the employee does not return to work, submit a Change Request Form noting the date benefits terminate. Refer to your Certificate of Insurance for further information.

Beneficiary Designations

The beneficiary is the person or persons that the employee designates to receive the proceeds of life insurance benefits. The beneficiary maybe a relative or another person is usually an immediate relative (wife, husband, son, daughter, parents, or fiancée). Under certain circumstances such as; if the beneficiary is a minor child, MetLife recommends the employee may wish to consult an attorney. At initial enrollment, the full name and relationship of the beneficiary should be entered on the Enrollment Form. To make changes to a beneficiary designation, the employee should complete the Beneficiary Designation Form.

Examples of beneficiary designations are as follows:

• John F. Doe, husband
• John A. Doe and Mary L. Doe; parents, equally or to the survivor
• Walter John & James Doe, sons, equally to the survivors or survivor
• Jane B. Doe, wife, if living, otherwise Walter Doe, son

First National Bank of Dallas, Texas as Trustee under agreement dated March 1, 1970 (A trustee may only be designated as the beneficiary if there is a written trust agreement. Without a written trust agreement the trust may not be enforceable.)

The employee should complete the Beneficiary Designation Form when changing the originally designated beneficiary. The original Beneficiary Designation Form should remain on file with the employer until a claim is filed.

Absolute Assignment

An absolute assignment is the irrevocable transfer of all right, title and interest in the group certificate from the insured to a new owner, which can be an individual or a trust. Life benefits may be assigned as a gift but, not as collateral. They are generally made to an employee's spouse, adult child, charity, or trust, for example. An employee may not assign group term life benefits to a creditor or employer.

For Individual:

• Absolute Assign Individual Form
• Absolute Assign Individual with Waiver and Consents Form

For Trustee:

• Absolute Assign Trustee Form
• Absolute Assign Trustee with Waiver and Consents Form

For Pursuant to a Viatical Settlement:

• Pursuant to a Viatical Settlement Form
• Pursuant to a Viatical Settlement with Waivers and Consents Form

Continuation of Coverage Forms for Employee and Dependents

Some states allow Continuation of Coverage if the covered employee and/or dependent(s) coverage terminates for certain qualifying events. The employee and/or dependent(s) may be covered under State-specific Continuation of Life Insurance.

For more information, contact Customer Service at 1-800-ASK-4-MET
(1-800-275-4638).

Life Continuation Forms you will need:

• Continuation of Life Insurance Election Form

Disabled Dependent Beyond Limiting Age Due to Handicap

Coverage for handicapped dependent children may be extended beyond the limiting age provided the child is physically or mentally incapable of self-sustaining employment. A Statement of Dependent Eligibility Beyond Limiting Age form must be completed by the employee, the dependent's physician and the employer.

• Statement of Dependent Eligibility for Mental or Physical Handicap

Most policies are renewed annually. Renewal underwriting and pricing typically occur before your group’s anniversary.

About four months before this date, MetLife will contact you to verify the accuracy of the insured data shown on your premium statement according to your records. We ask that you verify this information 90 days prior to your renewal date. If we have not received it, we will follow up with you.

Having a current history of covered insureds facilitates accurate pricing of your coverage

Census Requirements For Self-Administered Billing Option

For cases using the Self-Administered Billing Option MetLife does not maintain employee level data. At the time of renewal, you must provide MetLife with a detailed census of all insureds each year 90 days prior to your renewal date. In addition, provide the percentage of premium contributed by the employer for each line of coverage.

The census must include:

• name and/or Social Security Number;
• date of birth;
• gender;
• occupation (for LTD or STD);
• salary (for LTD, STD or Life);
• class information (eligibility according to the schedule of benefits);
• dependent coverage (indicate participants and whether spouse or child) for all insureds;
• number of hours worked per week (for hourly employees);
• amount of coverage (by line of coverage); and
• total number of employees eligible.

• participants;
• amount of coverage;
• amount or percentage contributed by employer; and
• total number of employees eligible.

Renewal Action Letter

MetLife sends a renewal action letter prior to your group’s anniversary. The letter states the status of your plan and any renewal changes.

Your group plan may terminate if the participation falls below the required participation percentage noted in your insurance policy.

Policy Changes

Changes can be made to your policy or certificate only by MetLife. To request a change to your group policy or certificate, contact your MetLife Representative or Broker.

Once MetLife approves a change, you will receive an acknowledgment letter and, if needed, replacement policy and/or certificate forms.

Examples Of Policy Changes

Examples of policy modifications include changes in:

• Addition of Subsidiary
• Benefit Plan
• Broker Commissions
• Change of Policy Situs State
• Dependent Age Limit
• Earnings Definition
• Employer Contribution Percentage
• Waiting Period

Group Changes

In addition, there are group changes that require notifying your MetLife Representative or Broker.

Examples of group changes include:

• Benefit Administrator or Executive Contact Name Changes
• Group Address Change
• Group Name Change

Form to be available for the insured:

• Will Preparation Pre-enrollment Form
  

When an employee enrolls in Supplemental Life coverage, he or she will have access to Hyatt Legal Plans’ network of 11,000+ participating attorneys for preparing or updating a will at no additional cost to the insured. Once the Supplemental Life coverage becomes effective, the employee will receive information that will allow access to the Will Preparation Service.

Steps for the employee:

Step 1:
Call Hyatt Legal Plans’ toll-free number 1-800-821-6400, and a Client Service Representative will assist the employee in locating a participating plan attorney in their area and provide him/her with a case number.

Step 2:
Call and make an appointment with the participating attorney.

Step 3:
No additional paperwork is necessary if the employee uses a plan attorney. The employee can choose to use a non-network attorney and be reimbursed for covered services according to a set fee schedule.¹

¹ The employee will be responsible for any attorney’s fees that exceed the reimbursed amount.

*Review your group’s certificate to confirm that Will Preparation benefits are included with your Supplemental Life Policy. If not, contact your sales representative or broker to obtain an updated certificate that contains this feature.

Form to be available for the insured:

• Estate Resolution Services Form
  

When an employee enrolls in Supplemental Life coverage, he or she will receive the benefit of MetLife Estate Resolution Services^SM (ERS) at no additional cost.

By participating in MetLife Estate Resolution Services^SM, the participating plan attorney’s fees are covered for the administrator or executor of the employee’s estate for the following probate services*:

• Telephone and office consultations to discuss matters related to probating the insured’s estate;
• Preparation of documents and representation at court proceedings needed to transfer the probate assets from the insured’s estate to heirs;
• The completion of forms and correspondence necessary to transfer non-probate assets such as proceeds from insurance policies, joint bank accounts, stock accounts, or a house; and
• Associated tax filings.

Note: Estate Resolution Services are not available in Puerto Rico.

When the Group Supplemental Life Insurance becomes effective, the insured will automatically become eligible. Beneficiaries receive an explanation of this service with their claim form. All they need to do to access the service is:

• Report the death of the covered participant to MetLife.
• Call a toll-free number and provide a Hyatt Legal Plans’ Client Service Representative the insured’s company name, customer number (if available), and the last 4 digits of the insured’s Social Security number.
• The Client Service Representative will help the beneficiary and/or executor locate a Hyatt plan attorney who will handle all the paperwork. No co-payment is required.
  

Funeral Planning Guide provides an easy-to-use format for the employee to document information for his/her survivors.

Contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638) for contract or benefits questions. For questions regarding how to use the Will Preparation or MetLife Estate Resolution Services^SM contact Hyatt Legal at 1-800-821-6400.

• Life Claim Form - Total Control Account (ex. states CO/FL/LA/MD)
  
• Life Claim Form - Elective Total Control Account
• Life Claim Form - excludes Total Control Account

The Automatic Total Control Account^® (TCA) is the standard Life insurance claim settlement option for all states except policies sitused in Colorado, Florida, Louisiana or Maryland. The settlement must be $5,000 or more in order to qualify for the Total Control Account. The claim payment is made to an interest-bearing account which includes principal and interest. Interest rates for the account are set weekly and are generally higher than the average rate for bank money market accounts.* Account holders have full access to their money and can withdraw all or part of it at any time with no penalty or loss of interest, simply by writing a check. If the payee is a corporation or similar entity, resides in a foreign country or will receive less than $5,000 the payment is generally made with a lump-sum check.

Forms You will Need if your certificate includes MetLife Estate Resolution Services^SM:

These forms should be given to the beneficiary(ies), along with the Life claim form(s):

• Question & Answers for Estate Resolution Services
• Assistance in Probating the Insured’s Estate
  

Claim Form Differences:

• Automatic Total Control Account is the standard claim form for all states except policies sitused in the states of CO, FL, LA or MD (use the elective Total Control Account form).
• Elective Total Control Account can be used by all states and allows the beneficiary the option of a check or a Total Control Account.
• Life Claim form is a form that can be used in all states and does not include Total Control Account information.
  

*Guarantees are based on the financial strength and claims-paying ability of Metropolitan Life Insurance Company (MetLife). Assets backing the Total Control Accounts are maintained in MetLife's general account and are subject to the claims of its creditors. MetLife bears the investment experience of such assets, whether positive or negative. Regardless of the investment experience of such assets, the interest credited to the TCA will never fall below the applicable guaranteed minimum rate. Because MetLife bears the investment experience of the assets backing the Total Control Accounts, it may receive a profit from these assets. The TCA is not insured by the FDIC or any other governmental agency.

Steps For Filing A Life Claim

In the event of a death, provide the beneficiary with a Life Insurance Claim Form. If there is more than one beneficiary, each must be given a separate claim form. If the beneficiary is a minor, documents to support legal guardianship are required.

Requirements

The beneficiary(ies) complete(s) the Life Insurance Claim Form and returns it to the employer with one certified copy of the death certificate.

The employer completes the employer's statement portion of the claim form and attaches a copy of the employee's enrollment form and copies of any beneficiary change forms in the employer's files.

If the death resulted from an accident, the following information should also be provided:

• Copy of the police report
• Copy of the coroner's report
• Newspaper clippings describing the accident
• Eyewitness accounts
• Copy of the investigative report if the accident happened at work.

In instances where the employer has retained the employee's Life Enrollment Form on file, the enrollment form must be submitted at time of claim.

Submit to:

MetLife Life Claims
P.O. Box 6100
Scranton, PA 18505-6100

Getting Claim Assistance

MetLife is available to answer questions regarding group claim procedures. The employee or beneficiary may contact MetLife at 1-800-ASK-4-MET (1-800-275-4638).

Filing A Dependent Life Claim For Customers With Dependent Coverage

When an employee notifies the employer of the death of a dependent, provide the employee with a Life Insurance Claim Form.

Requirements For Submitting a Life Claim when a Covered Dependent Dies

The employee completes the first page of the Life Insurance Claim Form and returns to employer along with a certified copy of the death certificate.

The employer completes the employer's portion of the form and sends the completed claim form and certified copy of the death certificate to:

MetLife Life Claims
P.O. Box 6100
Scranton, PA 18505-6100

Benefit Payments For Life Claims

If the employee designated a settlement option, the claim will be paid in accordance with the option chosen.

If the insured did not designate a settlement option, and the benefit is more than the minimum amount specified in his/her certificate, the benefit will be paid through a guaranteed supplemental contract known as the "Total Control Account Money Market Option" or "TCA". MetLife will send the beneficiary a "Starter Kit", which includes a checkbook and brochures describing this settlement option.

If the employee did not designate a settlement option, and the benefit is less than $5,000, a lump sum check will be used unless the beneficiary requests a longer payment option.

For New Mexico Residents only:

New Mexico Notice of Confidential Abuse Practices
This form permits victims of domestic violence to participate in a location confidentially program as provided under the New Mexico Domestic Abuse Insurance Protection Act.

• New Mexico Domestic Abuse

• Accelerated Benefits Claim Form for Life Expectancy 6 months
• Accelerated Benefits Claim Form for Life Expectancy 12 months
• Accelerated Benefits Claim Form for Life Expectancy 24 months

Requirements For Submitting an Accelerated Benefits Claim

When an insured is medically certified as terminally ill and expected to die within the time frame stated in the Certificate of Insurance, the insured has the option to receive a portion of his/her life insurance benefits to ease the burden of care during his/her final months. See your Certificate of Insurance for details concerning eligibility.

Steps For Filing an Accelerated Benefit Claim

The employee and the attending physician complete the Accelerated Benefits Claim Form and return to you.

The employer then completes the Employer Section of the form.

Submit the completed claim form with copies of the Employee's Enrollment Form, all Beneficiary Designation forms and Statement of Health forms.

New York Requirement For Accelerated Benefit

New York requires that an Accelerated Benefit Option claim must be filed with MetLife within 30 days of the employee receiving the claim form. The employer must insert the date the employee was provided the claim form on the top left hand corner of the claim form and provide the claim form to the employee.

• Life Conversion form

Conversion

The Group Policy provides for the conversion of group life benefits to an individual life policy when group life benefits end. Certain states also allow for the conversion of group life benefits to an individual life policy when group life benefits are reduced. See Certificate of Insurance for details concerning your plan of insurance and the employee's right to obtain a personal policy of life insurance on the life of the employee or their dependent(s).

Requirements For Applying to Convert Life Insurance Coverage

Persons eligible to convert must apply for a conversion policy within the time period specified in their Certificate of Insurance.

Upon termination of group life benefits for an employee and/or covered dependents, complete the Conversion of Life Benefits to Personal Policy Form. Give or mail the original copy to the person eligible to convert as soon as possible after the termination or reduction.

In New Jersey, New York, and South Carolina, upon reduction of group life benefits, complete the above form and send to the person eligible to convert.

The employee should call 1-800-METLIFE (1-800-638-5433) to be advised of the closest local MetLife sales office. That office will provide further instruction for completing a personal life insurance application.

Portability vs. Conversion

• Election of Portable Coverage Form

Portability

If an insured employee's employment or membership in an eligible class ends while eligible life insurance coverage with portability is in force, the employee is eligible to request the portability option. Portability is subject to state availability. Please refer to the Certificate of Insurance for information. With portability, life insurance benefits continue on a self-paid basis where the insured will pay their premiums for their eligible life insurance directly to MetLife.

The employee may continue the same or lesser amount of life insurance coverage they had at the time of coverage termination.  The minimum amount an employee can continue on a portable basis is $20,000, the maximum is generally equal to the Life insurance coverage amount at the time of coverage termination or $1,000,000, whichever is less.

Portability includes features such as the Accelerated Benefits Option and death claims over $5,000 are paid via the Total Control Account^®.

To verify if your plan has the portability option, please refer to your group Certificate of Insurance.

How Portability Works

Portability does not replace any statutory conversion privilege. If the conversion right is exercised, portability is no longer available. See the Certificate of Insurance for details concerning Portability.

If your plan has portability, you must give the employee written notice of the portability option at the time his or her coverage terminates. Benefits may either be ported in full, converted in full, or a combination of the two. The total amount of coverage converted and/or ported cannot exceed the amount of insurance that was in effect prior to coverage termination. 

To request the portability option, the employee must complete, sign and date the Election of Portable Coverage Form. This form must be mailed to MetLife within 31 days after coverage has terminated. No proof of insurability is required.

Requirements For Portability

Upon termination of employee coverage, the employer should confirm that the portability option is available for this employee.  For example, if the terminating employee resides in any state other than the state of issue, there may be a different requirement. Please refer to the Certificate of Insurance for information.

If the portability option is available under your plan and based upon that employee's state of residence, the employer should complete Part A, the Recordkeeper section of the Election of Portable Coverage Form, keep a copy and give the original form to the employee.

The employee mails the original form to:

MetLife Recordkeeping Center
P.O. Box 14401
Lexington, KY 40512-4401

 For additional information or questions regarding portability call:

1-888-252-3607
(Monday – Friday 8:00 a.m. – 8:00 p.m. EST)

MetLife’s Transition Solutions is available to our Group Life customers with 500 or more covered employees as part of our PlanSmart^SM Financial Education Series. The program provides dedicated support from a specially trained network of local financial professionals with MetLife or New England Financial, a MetLife company, to help employers and employees manage the effects of large-scale change as well as day-to-day turnover.

In addition to the outreach from a qualified professional, MetLife may offer a limited record-keeping process for sending standardized letters to your employees, notifying them of their coverage continuation options.

Corporate Transitions
Our team will help alleviate the administrative burden that many employers experience during times of change, including:

• Benefits coordination due to layoffs, merger, acquisition or bankruptcy
• Defined Contribution Plan elimination
• Retiree Group Life elimination

Employee Transitions
A financial professional provides employees with information and assistance to make important, time-sensitive benefit and financial decisions:

• Group Life options
• Lump sum distribution issues
• Retiree or active employee experiencing reduction in benefits
• COBRA alternatives

Value for Employers

• Provides Human resources support from a local professional
• Helps alleviate administrative burdens associated with job and benefit transitions
• Helps reduce questions to Human Resources and benefit professionals

Value for Employees

• Offers one-on-one financial guidance to help meet individual and family financial needs
• Provides a portfolio of financial services and products that helps build financial freedom
• Includes an optional complimentary consultation

• Life Waiver Claim Form
• Life Waiver Claim Form for Long Term Disability and Life Benefits Employee
• Life Waiver Claim Form for Long Term Disability and Life Benefits Employer

Life Only Coverage

• Premium payment must continue for the duration of total disability until the nine-month waiting period is met.
• Approximately 60 days prior to the end of the waiting period, provide claimant with a Statement of Review of Continuance of Life Insurance Protection during Total Disability Form. The form must be completed by claimant and attending physician and forwarded to the employer.
• The employer completes its portion and submits the completed claim form (and any supporting medical information) to MetLife for review of eligibility of Waiver of Premium of Life Insurance.

• Life Waiver Claim Form

Long Term Disability (LTD) and Life Coverages

When an Employee's Life Insurance coverage ends due to total disability, that employee, after satisfying the waiting period requirement, may be entitled to a continuation of his or her Life Insurance coverage without premium payment if there is a Continued Protection (CP) provision in your group certificate. The employer and employee each complete and submit a single claim form to initiate both the LTD and the Life Waiver of Premium claims.

The employer completes the Life Waiver Claim Form for Long Term Disability and Life Benefits Employer. The employee will complete the Life Waiver Claim Form for Long Term Disability and Life Benefits Employee and also provides the Attending Physician Statement form to his/her doctor for completion and submission to MetLife. The employer, employee and doctor mail the forms to the MetLife designated PO Box. Once the forms are received by MetLife, they will be reviewed by LTD and Life Waiver of Premium Case Managers. You will receive letters acknowledging receipt of the claims. Once the Life Waiver of Premium claim is near the end of the waiting period, the claim will be reviewed to determine if a claim decision can be rendered or if additional information needs to be requested.

• Life Waiver Claim Form for Long Term Disability and Life Benefits Employee
• Life Waiver Claim Form for Long Term Disability and Life Benefits Employer

ERISA is an important federal law that governs most benefit plans established and maintained by employers. It imposes among other things certain participant reporting requirements on an employer. As a service to employers, MetLife can include an "ERISA Information" statement with the certificates of insurance issued to a group. This statement, combined with a certificate of insurance, is intended to assist you in meeting ERISA’s requirement to provide a summary plan description (SPD) to participants describing the insurance benefits provided by MetLife under the ERISA plan. If you want the ERISA Information for your plan sent to you, please send a written request to us. Your request must include your MetLife group number, the name, address, and phone number of the plan administrator of your plan, the employer identification number (which may be your Federal Tax Identification Number), and the beginning and end date of your Plan's fiscal year.

NOTE: It is the employer's legal responsibility to comply with any subsequent updates or filings that the law requires. ERISA confers substantial law enforcement responsibilities on the Department of Labor. Non-compliance with the law may result in certain civil or criminal penalties to an employer. We have included some general information about ERISA, however, we urge employers to obtain advice from their own legal and tax advisors concerning any obligations they may have under this law.

What Is ERISA?

ERISA is a federal law that governs most employer established welfare benefit plans (government and church plans are excluded as well as some employee pay all plans).   It is the employer's responsibility to provide certain information to plan participants and the Department of Labor and comply with other requirements.

What types of employer groups are governed by ERISA?

This law generally applies to any employee welfare benefit plan that is established or maintained by:

• Any employer engaged in commerce or in any industry affecting commerce, or
• Any employee organization(s) representing employees engaged in commerce that provides certain benefits to their employees, participants, dependents, or beneficiaries.

Welfare benefit plans may include plans that provide the following types of benefits:

• medical, dental, disability income, or life benefits
• unemployment, vacation or severance benefits
• other types of employer sponsored benefits.

Is there a minimum number of employees below which ERISA does not apply?

No. ERISA governs all welfare benefit plans that have one or more employees, unless they are church or government groups.

What does ERISA require employers to do?

Generally, ERISA requires all employers (or plan administrators as an employer may contract with) to provide participants and beneficiaries with a Summary Plan Description (SPD) describing in understandable terms their rights, benefits and responsibilities under the plan. Employers are also required to furnish participants with a summary of any material changes to the plan or changes to the information contained in the SPD. These documents must be furnished to the Department of Labor on request.

Employers with 100 or more participants must file a Form 5500 annually. Employers with fewer than 100 participants must file Form 5500-C at least every third year and Form 5500-R in the two intervening years.

Where can I obtain additional information about ERISA?

You should contact your legal and tax counsel to advise you about your obligations as an employer under this law. You may also contact The Department of Labor or visit their web site at www.dol.gov for more information.

ERISA Plan Number

Welfare Benefit Plans must start with 501.

• Guaranty Association Notices