Advance Insurance Company of Kansas is a subsidiary of Blue Cross and Blue Shield of Kansas. Advance Insurance Company is the provider of life insurance for Crawford County employees.

Effective Date
The life insurance policy through Advance Insurance Company becomes effective for employees the first day of the month, following the 30 day waiting period.

Schedule of Insurance
The life insurance policy through Advance Insurance Company is for $10,000 for all active, eligible persons.  The amount of the life insurance policy will be reduced by 35%, for a new amount of $6500 for an insured person who attains age 65.  The amount will reduce an additional 25% of the original $10,000, for a new amount of $4000 at age 70.  The insurance policy will be reduced further by 15% of the original amount, for a new amount of $2500, when the individual reaches age 75.  The policy will terminate when the insured retires.

Payments to Beneficiary
At the death of the insured, the amount of the insured’s insurance will be paid to the named beneficiary who survives the insured.  If no named beneficiary survives the insured, payment will be made in equal shares to the first surviving class of the following classes of successive preference beneficiaries:

*surviving spouse
*surviving children born to or legally adopted by the insured
*surviving parents
*surviving brothers or sisters
*executors or administrators of the insured’s estate in accordance with Advance Insurance Company’s Facility of Payment section

Facility of Payment
If any benefit under this policy becomes payable, but no designated beneficiary is then living, Advance Insurance Company - at its option – pay a sum not exceeding $250 to any person appearing to Advance Insurance Company that is equitably entitled by reason of having incurred funeral or other expenses incident to the last illness or the death of the insured.

Naming a Beneficiary
An insured’s beneficiary is designated at enrollment.  Only the insured or the insured’s assignee may change the beneficiary. A new beneficiary may be named by filing a written notice of the change with Advance Insurance Company.  The following tips are offered for naming a beneficiary:

The primary beneficiary is the person who will receive the death benefit upon the death of the insured.  The contingent beneficiary will receive the death benefit only if the primary benefit is deceased.
If the primary is living, all proceeds will be paid to that person.  If you wish the proceeds to be divided among more than one person, each person must be named on the appropriate line, whether it is the primary or contingent.  Be sure to give the percent each person is to receive if it is not to be divided equally. Advance requires that individuals name a primary beneficiary; naming a contingent beneficiary is optional.  It is recommended to name both the primary and contingent beneficiary.  If the primary is deceased and no contingent is named payment of the death claim could be delayed, and possibly settled in court.
* List all relationships with beneficiaries.
* Use full names – not initials – to list beneficiaries.  This makes settlements much easier.
* If children are named as beneficiaries, provide the full name and relationship of each child named. Payment cannot be made to children under the age of 18.  Advance can only pay benefits to a court appointed conservator or guardian.
* Charities or churches are acceptable beneficiaries as long as you provide Advance with the legal name and address of such.
Individuals cannot name themselves as the beneficiary.  Individuals can name their estate, trust, or last will.  When individuals name their trust or will as beneficiary, Advance will need the name and date of such.
* To change a beneficiary, use the Request for Change form.
* For any other beneficiary that may be unusual, please contact your legal counsel.

Death Benefit
Upon receipt of satisfactory proof of an insured’s death, Advance Insurance Company will pay a lump sum death benefit equal to the amount of Life Insurance, which is in effect on the date of death.

Conversion Policy
An individual life policy, known as a conversion policy, may be purchased from Advance Insurance Company without evidence of insurability if all or part of the policy is terminated, for any reason except, termination or amendment of the policy or insured’s request for termination insurance.  To purchase a conversion policy, application and payment of the first premium must be made within 31 days after the life insurance is terminated.

Any policy issued under the General Conversion Privilege will:
Be in an amount not to exceed the amount of the life insurance which was terminated, less the amount of any group life insurance for which the person becomes eligible within 31 days after insurance terminates
Be on any form (except term) then issued by Advance Insurance Company at the age and amount for which application is made
Be issued at the insured’s age at nearest birthday
Be issued without disability or other supplemental benefits
Require premiums based on the class of risk to which the insured then belongs.

A conversion policy may also be purchased from Advance Insurance Company if:
all or part of the life insurance terminates due to amendment or termination of the policy
the insured has been covered continuously under the policy for at least five years.

When applying for a conversion policy under the Conversion Privilege, an insured must name a beneficiary.  If the beneficiary named for the conversion policy is other than the one named under this policy, the application for the conversion policy will be treated as a written notice of change of beneficiary.

Contact Information
Advance Insurance Company of Kansas
1133 S. W. Topeka Boulevard
Topeka, KS 66629-0001
Telephone: toll free 1-800-530-5989 or (785) 273-9804
Web site http://www.advanceinsurance.com

Please refer any remaining questions to the Plan Administrator:
Jenna Pucci
Director of Human Resources
Crawford County Clerk’s Office
PO Box 249
Girard, KS 66743
Telephone: (620) 724-6117
E-Mail: jpucci@ckt.net