Public Employees’ Retirement System - New Jersey

The State Treasurer of New Jersey

Public Employees' Retirement System

Member Term Life Coverage Basic and Optional Plans

Foreword

We are pleased to present you with this Booklet. It describes the Program of benefits we have arranged for you and what you have to do to be covered for these benefits.

We believe this Program provides worthwhile protection for you and your family.

Please read this Booklet carefully. If you have any questions about the Program, we will be happy to answer them.

Insurance Enabling Act - As used in this Certificate, the term "Insurance Enabling Act" means Sections 43:15A-88 through 43:15A-96 of Title 43 of the New Jersey Statutes Annotated. The benefits provided by the Group Contract are equivalent to and in lieu of the death benefits provided by Sections 43:15A-38, 43:15A-41(b), 43:15A-41(c)(2), 43:15A-45(c), 43:15A-46(c), 43:15A-48(c), 43:15A-49(e) and 43:15A-57 of the New Jersey Statues Annotated.

IMPORTANT NOTICE: This Booklet and the Certificate are important documents and should be kept in a safe place. When you become covered under the Program, you will receive a Cover Page to the Certificate. You should attach the Cover Page to this Booklet.

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Table of Contents

FOREWORD ..........................................................................................................................................1 SCHEDULE OF BENEFITS ...................................................................................................................3 WHO IS ELIGIBLE TO BECOME INSURED.........................................................................................6 WHEN YOU BECOME INSURED ..........................................................................................................6 BASIC MEMBER TERM LIFE COVERAGE..........................................................................................7 GENERAL INFORMATION..................................................................................................................10 WHEN YOUR INSURANCE ENDS......................................................................................................14

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Schedule of Benefits

Covered Classes: All eligible active and former Members of the Public Employees' Retirement System of the State of New Jersey as listed below:

Class 1: All Members in active service.

Class 2: Former Members who resigned after having completed 25 years of service, before reaching retirement age and who elected the annuity provided in Section 43:15A-41b. If the Member became insured under the Group Policy on or after July 1, 1971, the Member must have completed 10 years of participation in the retirement system at the time of retirement.

Class 3: Former Members who retired on an ordinary disability retirement allowance or on an accident disability retirement allowance and are less than age 60.

Class 4: Former Members who retired on an ordinary disability retirement allowance or an accident disability retirement allowance and who are age 60 or older.

Class 5: Former Members who retired on an accident disability retirement allowance who at the time of retirement was a Law Enforcement Officer and is not covered under the old age and survivors insurance provisions of Title II of the Federal Social Security Act as a public employee.

Class 6: Former Members who retired on an accident disability retirement allowance who at the time of retirement was a Law Enforcement Officer and who is covered under the old age and survivors insurance provisions of Title II of the Federal Social Security Act as a public employee and is less than age 60.

Class 7: Former Members who retired on an accident disability retirement allowance who at the time of retirement was a Law Enforcement Officer and who is covered under the old age and survivors insurance provisions of Title II of the Federal Social Security Act as a public employee and age 60 or more.

Class 8: Former Members age 60 or more who are receiving a deferred retirement allowance. If the Member became insured under the Group Policy on or after July 1, 1971, the Member must have completed 10 years of participation in the retirement system at the time of retirement.

Class 9: Former Members who are retired on a service retirement allowance. If the Member became insured under the Group Policy on or after July 1, 1971, the Member must have completed 10 years of participation in the retirement system at the time of retirement.

Class 10: Former Members who have been granted a retirement allowance for reasons other than disability who then returned to active service and subsequently retired.

Program Date: July 1, 2004. This Booklet describes the benefits under the Group Program as of the Program Date.

? This Booklet and the Certificate of Coverage together form your Group Insurance Certificate. The Coverages in this Booklet are insured under a Group Contract issued by Prudential. All benefits are subject in every way to the entire Group Contract which includes the Group Insurance Certificate. It alone forms the agreement under which payment of insurance is made.

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? The Contract Holder expects to continue the Group Program indefinitely. But the Contract Holder reserves the right to change or end it at any time. This would change or end the terms of the Group Program in effect at that time for active and retired Members.

BASIC MEMBER TERM LIFE COVERAGE UNDER GROUP CONTRACT G-14800-NJ

BENEFIT AMOUNTS:

Amount For Each Benefit Class:

Benefit Classes

Amount of Insurance*

Class 1 Class 2

1 ? times your Final Compensation 3/16th of your Final Compensation

Class 3 Class 4

1 ? times your Final Compensation 3/16th of your Final Compensation

Class 5

$5,000

Class 6

The greater of $5,000 or 1 ? times your Final Compensation

Class 7 Class 8 Class 9 Class 10

The greater of $5,000 or 3/16th of your Final Compensation

3/16th of your Final Compensation

3/16th of your Final Compensation

An amount equal to your amount of insurance for which you were insured for upon your return to active service but not less than your amount of insurance for which you were eligible for at the time of your former retirement.

*But if you do not wish to become insured for an amount which exceeds $50,000, you may limit your coverage to $50,000 provided you do so in writing on a form satisfactory to Prudential.

The Definitions section explains what "Final Compensation" means.

OPTIONAL MEMBER TERM LIFE COVERAGE UNDER GROUP CONTRACT G-13900-NJ

BENEFIT AMOUNTS:

Amount For Each Benefit Class:

Benefit Classes

Amount of Insurance

Class 1

1 ? times your Final Compensation

The Definitions section explains what "Final Compensation" means.

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