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Assurity Life Insurance Company Group Term Life Certificate (Peace of Mind)
Policyholder: Nelnet Business Solutions Inc./FACTS Management Company
201 S 13th Street, Suite 301
Lincoln, Nebraska 68508
Policy Number: G70001
This Certificate is a part of the Policy that is a legal contract between the group Policyholder and Us (Assurity Life Insurance Company, a stock company), and may be amended, changed or terminated without Your consent or notice to You. Any difference between the Policy and this Certificate will be settled according to the provisions of the Policy.
This Certificate replaces any certificate previously issued under the Policy.
Class I All Members electing the Peace of Mind Plan
MAXIMUM BENEFIT AMOUNTS
Class I Peace of Mind $30,000
Beneficiary means the Educational Institution identified on each FACTS Tuition Payment Agreement for the current school year.
Certificate means this document that describes the benefits, terms, conditions, exclusions and limitations of the insurance provided under the Policy.
Educational Institution means an elementary school, middle school, secondary school or college that has entered into a contract with the Policyholder for management of the school’s periodic tuition payment program.
FACTS Tuition Payment Agreement means the agreement between You and the Policyholder authorizing the Policyholder to process tuition payments.
Member means a person who:
— has signed, or is the Spouse of a person who has signed, the FACTS Tuition Payment Agreement under which tuition payments are outstanding for the current school year; and
— is under the age of 70 on the later of the day insurance is elected or the FACTS Tuition Payment Agreement is signed.
Policy means the group master policy issued to the Policyholder by Us.
Proceeds means the amount payable upon the death of an Insured Person.
Spouse means the person to whom You are legally married, or Your domestic partner, civil union partner or
equivalent, as recognized and allowed by federal law, or by state law in Your state of residence. A spouse may include Your domestic or civil union partner or equivalent if:
— You submit to the Policyholder a written declaration of partnership signed by You and Your partner in a form acceptable to Us;
— You submit evidence acceptable to Us that all applicable requirements of the state, city and/or county in which You reside regarding the establishment of a domestic or civil union partnership have been met; or
— You and Your partner satisfy the Policyholder’s requirements for such partnership.
We, Us, Our mean Assurity Life Insurance Company.
You, Your, Insured Person mean the Member who is insured under this Certificate.
Date a Person’s Insurance Takes Effect
You will become covered on the date (a) You sign the FACTS Tuition Payment Agreement and (b) You enroll for insurance.
Date an Insured Person’s Insurance Ends
Insurance coverage under this Certificate will terminate on the earliest of the following:
— the date that the last scheduled tuition payment for the current FACTS Tuition Payment Agreement is due;
— the date written notice to terminate the Certificate is received, unless the notice specifies a later date;
— the date the Policy terminates;
— the day an individual is no longer eligible for insurance under the Policy; or
— the day of the Insured Person’s death.
The Policyholder has the sole responsibility to notify the Insured Person of such termination.
Payment of Proceeds
If the Insured Person dies while this Certificate is in force and all provisions have been met, Proceeds will be paid to the Beneficiary. Payment will be made in a lump sum after receiving due proof of loss.
Proceeds are equal to the outstanding tuition balance owed to the Educational Institution identified on each FACTS Tuition Payment Agreement that You have signed for the current school year. Proceeds will not include any tuition payments that are in arrears (past due). In no event will the Proceeds payable for each FACTS Tuition Payment Agreement be more than the Maximum Benefit Amount.
Proceeds are payable only once for each FACTS Tuition Payment Agreement.
If it is found that We paid more benefits than We should have paid under the Policy due to fraud, misrepresentation or error, We will have the right to a refund from the recipient of benefits.
The recipient of benefits must reimburse Us in full. We will determine the method by which the repayment is to be made.
Notice of Claim
Written notice of claim must be given to:
Nelnet Business Solutions Inc./FACTS Management Company
121 S 13th Street, Suite 201
Lincoln, NE 68508 (402) 466-1063
When the notice of claim is received, the form(s), if any, and instructions for filing a claim will be sent to the claimant.
Proof of Loss
Satisfactory proof of loss must be submitted which may consist of a copy of the Insured Person’s certified death certificate or other lawful evidence providing equivalent information and any other necessary documentation.
Time of Payment of Claim
Benefits covered by this Certificate will be paid after written proof of loss is received and all other provisions herein are met.
Prior to filing any lawsuit against Us, an appeal must be submitted in writing within 60 days after receipt of Our denial decision. We will provide written notice of Our decision on appeal.
Conformity with State and Federal Law
The laws of the federal government and the state in which the Insured Person resides on the Certificate issue date apply. If the Policy or this Certificate conflicts with the laws of the federal government or the state in which the Insured Person resides on the Certificate issue date, it is considered changed to meet those
laws. The change will be to the law’s minimum requirement.
Duty of Cooperation
The claimant shall reasonably cooperate during any investigation or adjudication of a claim. This cooperation shall include providing information We request.
Entire Contract; Changes
The entire contract consists of the Policy and this Certificate, which includes any riders, endorsements, amendments or any other papers We have attached. All statements made on the application by the Policyholder or by any Insured Person shall be deemed representations and not warranties. No change in the Policy or this Certificate will be effective until approved by one of Our officers and unless such approval is endorsed and attached to the Policy or this Certificate. No sales representative has authority to change the Policy or this Certificate or to waive any of its provisions.
Misstatement of Age
If the age of an Insured Person has been misstated and according to the correct age the coverage provided would not have become effective, Our only liability during that period shall be limited to a refund of premiums paid for such period.
GROUP TERM LIFE CERTIFICATE Nonparticipating
READ THIS CERTIFICATE CAREFULLY!
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