Group Term Life Insurance with Accidental Death &
Dismemberment (AD&D) Insurance for Active Employees
GTL WITH AD&D FOR PUBLIC SCHOOL EMPLOYEES-NH
There are two convenient options to enroll:
1. Enroll with a telephonic Colonial Life benefits counselor.
Ask benefits questions and complete your enrollment by calling:
833-703-1967 Employer Code: 8038317 | Monday-Friday | 7 a.m. to 7 p.m. CT
Benefit confirmation forms can be emailed to you at the conclusion
of the enrollment.
2. Self-enroll online.
Access the enrollment site URL: Harmony.Benselect.com/SoA
Use the following login information:
nLog In: MEMBER ID (This is also your Health ID number.)
nPersonal Identification Number: The last four digits of your
Social Security number and the last two digits of your birth
year (six digits total)
During your online enrollment, you will be prompted to accept or decline
each coverage type, premiums will be displayed for your selections and the
appropriate health questions will be displayed, when applicable. Benefit
confirmation forms can be printed or saved at the conclusion of the enrollment.
Enrollment opportunities:
1. During annual enrollment
2. 60-day new hire eligibility period
3. Within 60 days of a qualifying event,
such as marriage, birth or adoption
How secure is your family’s financial future without you?
If something happened to you, would your family be able to maintain their way of life? How would they cover ongoing
living expenses? Colonial Life’s group term life insurance can help provide financial security for your family.
Employees who are eligible for ARBenefits health insurance are also eligible for Group Term Life with AD&D insurance. Employees
should allow a minimum of 7 business days from their new hire date before accessing the enrollment site or the telephonic enrollment.
This will allow time for employees’ eligibility data to be uploaded into the enrollment platform.
Your basic and optional coverages
* Some districts are not participating in the employer-paid basic group term life with AD&D insurance.
** Employee must elect supplemental group term life with AD&D insurance on themselves in order to elect supplemental group term life with AD&D
insurance for the spouse or dependent child(ren). Eective 1/1/2020, the spouse and/or child supplemental group term life with AD&D benefit amount must be either
equal to or lower than the employee’s supplemental group term life with AD&D benefit amount.
2024 Rates (per $1,000)
Monthly cost of coverage
Supplemental group term life
with AD&D insurance
Age Employee
Under 25
$0.12
25-29
$0.12
30-34
$0.15
35-39
$0.16
40-44
$0.25
45-49
$0.41
50-54
$0.66
55-59
$0.95
60-64
$1.43
65-69
$2.78
70-74
$ 4.53
75+
$ 9.03
Supplemental spouse group term
life with AD&D insurance
All eligible ages
$0.86
Supplemental dependent child
group term life with AD&D
insurance
All eligible ages $0.12
EXCLUSIONS AND LIMITATIONS
Losses Not Covered Under Your Life Insurance Benefit:
Your life insurance benefit does not cover any losses where death is caused by, contributed to by, or results from suicide
occurring within 24 months aer a covered person’s initial eective date of insurance or aer the date any increases or
additional insurance becomes eective, whether sane or insane.
This applies to any amounts of insurance for which you pay all or part of the premium.
This applies to any amount subject to evidence of insurability requirements and we approve the evidence of insurability
form and the amount you applied for at that time.
You will be given credit for any period of time applied toward the satisfaction of the suicide provision, if any, under your
Employer’s prior group life insurance plan.
Losses Not Covered Under the AD&D Insurance Benefit:
Your AD&D benefit does not cover any losses that are caused by, contributed to by, or resulting from:
• an attempt to commit or commission of suicide or intentional self-inflicted injury while sane or insane;
• active participation in a riot;
• an attempt to commit or commission of a felony or engaging in an illegal occupation;
• voluntary use of any drugs, poisonous substance, intoxicant or narcotic, except any drugs taken as prescribed by a
physician and taken as prescribed. Accidental exposure to any poisonous substance will not be excluded;
• the presence of that percentage of alcohol in the covered person’s blood which raises a presumption that the covered
person was under the influence of alcohol. The blood-alcohol level which raises this presumption is governed by the
laws of the state in which the accident occurred;
• disease of the body, mental infirmity or diagnostic, medical or surgical treatment;
• being exposed to war or any act of war, declared or undeclared, or serving in the armed forces of any country or authority.
Losses as a result of acts of terrorism or nuclear release committed by individuals or groups will not be excluded from
coverage unless the covered person who suered the loss committed the act of terrorism or nuclear release; or
• investigational or experimental procedures, surgery, or drugs, including complications arising from having experimental
or investigative procedures, surgeries, or drugs.
Termination
Coverage terminates:
• if the group policy ends;
• the date you no longer meet eligibility requirements;
• the end of the grace period if we do not receive the required premium for your insurance; or
• the date the next premium is due aer you ask us to end your coverage.
If you are no longer eligible for coverage as an active employee, you may be eligible to port your group term life and AD&D
coverage, or you may convert your group term life and AD&D coverage to an individual life insurance policy. Premiums may
be higher than those paid by active employees.
Evidence of Insurability means a statement of medical history which we will use to determine if an applicant is approved for
coverage. Blood profiles and medical examinations, if applicable, will be provided at our expense. Evidence of Insurability is
required for any amount of life insurance over the maximum guaranteed issue amount.
Premium will vary based on plan options and face amount selected.
The eective date of your coverage will be delayed if you are not a member of an eligible class on the coverage eective date.
The coverage will be eective on the date that you return to status as a member of an eligible class. If the certificate covers
your spouse and/or dependent children, their coverage will be eective on the date that you return to status as a member of
an eligible class.
Applicable to policy number GTL1.0-P-AR-SOA and certificate number GTL1.0-C-AR-SOA. This is not an insurance contract
and only the actual policy provisions will control.
Basic group term life with AD&D
insurance
$0.23 per $1,000
Expanded basic group term life
with AD&D insurance
$0.22 per $1,000
GTL WITH AD&D FOR PUBLIC SCHOOL EMPLOYEES-NH 9-23 | NS-935239-3
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC
©2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of
Colonial Life & Accident Insurance Company.
Coverage options Who pays Benefit amount(s)
Basic group term life with
AD&D insurance
Employer or
Employee*
$10,000
You will be automatically enrolled if your district is participating in the Colonial
Life group term life with AD&D insurance oering. A newly eligible employee may
opt-out during the 60-day new hire eligibility period. Health questions are not
asked during the 2024 plan year open enrollment and new hire enrollment.
Expanded basic group term life with
AD&D insurance
Employee
$1,000 increments
up to $40,000
Health questions are not asked during the 2024 plan year open
enrollment and new hire enrollment.
Supplemental employee group term life
with AD&D insurance
Employee
$1,000 increments
up to $250,000
Health questions are not asked during the 2024 plan year open
enrollment and new hire enrollment, for benefit amounts up to $100,000.
Any benefit amount over $100,000 is subject to evidence of insurability.
**Supplemental spouse group term life
with AD&D insurance
Employee
$1,000 increments
up to $50,000
Health questions are not asked during the 2024 plan year open enrollment
and new hire enrollment, for spouse benefit amounts up to $10,000. Any
benefit amount over $10,000 is subject to evidence of insurability.
**Supplemental dependent child group
term life with AD&D insurance
Employee
$1,000 increments
up to $50,000
Health questions are not asked during the 2024 plan year open enrollment
and new hire enrollment, for spouse and coverage up to $10,000. Any
benefit amount over $10,000 is subject to evidence of insurability.
A person may only be insured once under this
plan. Married employees eligible for ARBenefits
life insurance may not be insured both as an
employee and spouse, and a child may only be
insured by one employee.
