unstructuredio/SCORE-Bench · Datasets at Hugging Face

text stringlengths 0 2.18k
Basic Life $100,000 [] [] + $ ___ - $ ___
Basic AD&D⁴ $100,000 [] [] + $ ___ - $ ___
Supplemental/Optional Life $100,000 [] [] + $ ___ - $ ___
Supplemental/Optional AD&D⁴ $ ___ [] [] + $ ___ - $ ___
Voluntary AD&D⁴ $ ___ [] [] + $ ___ - $ ___
[x] Employee Only [x] Employee + Dependents

Dependent Spouse/Domestic Partner 2,3,5
Dependent Life $25,000 [] [] + $ ___ - $ ___
Dependent AD&D⁴ $ ___ [] [] + $ ___ - $ ___
Voluntary AD&D 4,6 $ ___ [] [] + $ ___ - $ ___

Dependent Child(ren) 3,5
Dependent Life $10,000 [] [] + $ ___ - $ ___
Dependent AD&D⁴ $ ___ [] [] + $ ___ - $ ___
Voluntary AD&D 4,6 $ ___ [] [] + $ ___ - $ ___
--------------------------------------------------- Unstructured Table End
--------------------------------------------------- Unstructured Form End

--------------------------------------------------- Unstructured Caption Begin
¹ Increases in coverage are available annually and must be in $25,000 increments up to $250,000. For a life insurance increase the employee must complete the medical questions and be approved by MetLife. An increase in AD&D coverage only does not require the insured to complete medical questions.

² The maximum amount the employee can continue on a portable basis is $2,000,000. The maximum amount the spouse/domestic partner can continue on a portable basis is $250,000.

³ In order to port coverage for yourself or your dependents, you must have had that coverage under your former plan at the time of your coverage termination.

⁴ AD&D coverage is available without Life Insurance coverage.

⁵ Subject to state limits, the Dependent Spouse/Domestic Partner amount can be greater than the Employee Amount. For Employee and Spouse/Domestic Partner coverage: Spouse/Domestic Partner minimum is $2,500. For Spouse/Domestic Partner only coverage: Spouse/Domestic Partner minimum is $10,000. The Child minimum is $1,000

⁶ Use these fields only when Voluntary AD&D is being requested for the Spouse/Domestic Partner and/or Child because of the death of the Employee or divorce.

NOTE: All coverage amounts are subject to applicable state laws.
--------------------------------------------------- Unstructured Caption End

Please retain a copy of the fully-completed form for your records and return the original to MetLife Customer Service Center. If you have any questions, please call 1-888-252-3607 Monday – Friday between the hours of 8:00 a.m. and 11:00 p. m. (EST).

--------------------------------------------------- Unstructured Page Footer Begin
(Continued on Following Page)
--------------------------------------------------- Unstructured Page Number Block Begin
Page 2 of 3
--------------------------------------------------- Unstructured Page Number Block End
NEWPORT (03/14)
--------------------------------------------------- Unstructured Page Footer End


--------------------------------------------------- Unstructured Page Footer Begin
CONFIDENTIAL - SUBJECT TO PROTECTIVE ORDER
CONFIDENTIAL PROTECTED HEALTH INFORMATION
INSYS-MDL-009095150
Source: https://www.industrydocuments.ucsf.edu/docs/mhky0282
--------------------------------------------------- Unstructured Page Footer End
--------------------------------------------------- Unstructured Plain Text Format 1.0.4
--------------------------------------------------- Unstructured Title Begin
RATE SHEET
--------------------------------------------------- Unstructured Title End
--------------------------------------------------- Unstructured Sub-Title Begin
Schedule of Monthly Portable Group Life and AD&D Insurance Term Rates For Insured and Dependents
--------------------------------------------------- Unstructured Sub-Title End

--------------------------------------------------- Unstructured Image Begin
--------------------------------------------------- Unstructured Sub-Title Begin
TABLE E
CHILD MONTHLY TERM RATES
--------------------------------------------------- Unstructured Sub-Title End
Table E – Sample monthly premium calculation for child(ren) only. An administrative fee will be not charged for the child coverage if you also port your term life insurance. However if only the child(ren) coverage is ported a $3.00 per statement administrative fee will be charged.
--------------------------------------------------- Unstructured Image End

--------------------------------------------------- Unstructured Table Begin
$10,000 ÷ $1,000 = 10 x $0.162 = $1.62
Amount of coverage selected per child ÷ $1,000 = # of units per child x Rate = Monthly premium
--------------------------------------------------- Unstructured Table End
--------------------------------------------------- Unstructured Image Begin
↓
--------------------------------------------------- Unstructured Image End
--------------------------------------------------- Unstructured Table Begin
AGE LIFE DEPENDENT CHILD(REN) RATE COMBINED LIFE & AD&D DEPENDENT CHILD(REN) RATE
N/A $0.162 $0.209
--------------------------------------------------- Unstructured Table End

Please Note: Each child is covered for the same premium regardless of the number of children covered under the certificate. For Instance, using the example above, if you have one child covered for $10,000, the amount of premium per month is $1.62. If you have 5 children, each child is covered for $10,000, but the amount of premium per month is still $1.62. A billing fee may also apply.

--------------------------------------------------- Unstructured Image Begin
--------------------------------------------------- Unstructured Sub-Title Begin
TABLE F
AD&D INSURANCE ONLY MONTHLY TERM RATES
--------------------------------------------------- Unstructured Sub-Title End
Table F – Sample monthly premium calculation of AD&D Premium For Insured Only. An administrative fee will be not charged for AD&D coverage if you also port your term life insurance. However if only AD&D coverage is ported a $3.00 per statement administrative fee will be charged.
--------------------------------------------------- Unstructured Image End

--------------------------------------------------- Unstructured Table Begin
$50,000 ÷ $1,000 = 50 x $0.035 = $1.75
Amount of coverage selected ÷ $1,000 = # of units x Rate = Monthly premium
--------------------------------------------------- Unstructured Table End

--------------------------------------------------- Unstructured Image Begin
↙↘︎
--------------------------------------------------- Unstructured Image End
--------------------------------------------------- Unstructured Caption Begin
AD&D TERM RATES

Basic Life $100,000 [] [] + $ ___ - $ ___

Basic AD&D⁴ $100,000 [] [] + $ ___ - $ ___

Supplemental/Optional Life $100,000 [] [] + $ ___ - $ ___

Supplemental/Optional AD&D⁴ $ ___ [] [] + $ ___ - $ ___

Voluntary AD&D⁴ $ ___ [] [] + $ ___ - $ ___

[x] Employee Only [x] Employee + Dependents

Dependent Spouse/Domestic Partner 2,3,5

Dependent Life $25,000 [] [] + $ ___ - $ ___

Dependent AD&D⁴ $ ___ [] [] + $ ___ - $ ___

Voluntary AD&D 4,6 $ ___ [] [] + $ ___ - $ ___

Dependent Child(ren) 3,5

Dependent Life $10,000 [] [] + $ ___ - $ ___

Dependent AD&D⁴ $ ___ [] [] + $ ___ - $ ___

Voluntary AD&D 4,6 $ ___ [] [] + $ ___ - $ ___

--------------------------------------------------- Unstructured Table End

--------------------------------------------------- Unstructured Form End

--------------------------------------------------- Unstructured Caption Begin

¹ Increases in coverage are available annually and must be in $25,000 increments up to $250,000. For a life insurance increase the employee must complete the medical questions and be approved by MetLife. An increase in AD&D coverage only does not require the insured to complete medical questions.

² The maximum amount the employee can continue on a portable basis is $2,000,000. The maximum amount the spouse/domestic partner can continue on a portable basis is $250,000.

³ In order to port coverage for yourself or your dependents, you must have had that coverage under your former plan at the time of your coverage termination.

⁴ AD&D coverage is available without Life Insurance coverage.

⁵ Subject to state limits, the Dependent Spouse/Domestic Partner amount can be greater than the Employee Amount. For Employee and Spouse/Domestic Partner coverage: Spouse/Domestic Partner minimum is $2,500. For Spouse/Domestic Partner only coverage: Spouse/Domestic Partner minimum is $10,000. The Child minimum is $1,000

⁶ Use these fields only when Voluntary AD&D is being requested for the Spouse/Domestic Partner and/or Child because of the death of the Employee or divorce.

NOTE: All coverage amounts are subject to applicable state laws.

--------------------------------------------------- Unstructured Caption End

Please retain a copy of the fully-completed form for your records and return the original to MetLife Customer Service Center. If you have any questions, please call 1-888-252-3607 Monday – Friday between the hours of 8:00 a.m. and 11:00 p. m. (EST).

--------------------------------------------------- Unstructured Page Footer Begin

(Continued on Following Page)

--------------------------------------------------- Unstructured Page Number Block Begin

Page 2 of 3

--------------------------------------------------- Unstructured Page Number Block End

NEWPORT (03/14)

--------------------------------------------------- Unstructured Page Footer End

--------------------------------------------------- Unstructured Page Footer Begin

CONFIDENTIAL - SUBJECT TO PROTECTIVE ORDER

CONFIDENTIAL PROTECTED HEALTH INFORMATION

INSYS-MDL-009095150

Source: https://www.industrydocuments.ucsf.edu/docs/mhky0282

--------------------------------------------------- Unstructured Page Footer End

--------------------------------------------------- Unstructured Plain Text Format 1.0.4

--------------------------------------------------- Unstructured Title Begin

RATE SHEET

--------------------------------------------------- Unstructured Title End

--------------------------------------------------- Unstructured Sub-Title Begin

Schedule of Monthly Portable Group Life and AD&D Insurance Term Rates For Insured and Dependents

--------------------------------------------------- Unstructured Sub-Title End

--------------------------------------------------- Unstructured Image Begin

--------------------------------------------------- Unstructured Sub-Title Begin

TABLE E

CHILD MONTHLY TERM RATES

--------------------------------------------------- Unstructured Sub-Title End

Table E – Sample monthly premium calculation for child(ren) only. An administrative fee will be not charged for the child coverage if you also port your term life insurance. However if only the child(ren) coverage is ported a $3.00 per statement administrative fee will be charged.

--------------------------------------------------- Unstructured Image End

--------------------------------------------------- Unstructured Table Begin

$10,000 ÷ $1,000 = 10 x $0.162 = $1.62

Amount of coverage selected per child ÷ $1,000 = # of units per child x Rate = Monthly premium

--------------------------------------------------- Unstructured Table End

--------------------------------------------------- Unstructured Image Begin

↓

--------------------------------------------------- Unstructured Image End

--------------------------------------------------- Unstructured Table Begin

AGE LIFE DEPENDENT CHILD(REN) RATE COMBINED LIFE & AD&D DEPENDENT CHILD(REN) RATE

N/A $0.162 $0.209

--------------------------------------------------- Unstructured Table End

Please Note: Each child is covered for the same premium regardless of the number of children covered under the certificate. For Instance, using the example above, if you have one child covered for $10,000, the amount of premium per month is $1.62. If you have 5 children, each child is covered for $10,000, but the amount of premium per month is still $1.62. A billing fee may also apply.

--------------------------------------------------- Unstructured Image Begin

--------------------------------------------------- Unstructured Sub-Title Begin

TABLE F

AD&D INSURANCE ONLY MONTHLY TERM RATES

--------------------------------------------------- Unstructured Sub-Title End

Table F – Sample monthly premium calculation of AD&D Premium For Insured Only. An administrative fee will be not charged for AD&D coverage if you also port your term life insurance. However if only AD&D coverage is ported a $3.00 per statement administrative fee will be charged.

--------------------------------------------------- Unstructured Image End

--------------------------------------------------- Unstructured Table Begin

$50,000 ÷ $1,000 = 50 x $0.035 = $1.75

Amount of coverage selected ÷ $1,000 = # of units x Rate = Monthly premium

--------------------------------------------------- Unstructured Table End

--------------------------------------------------- Unstructured Image Begin

↙↘︎

--------------------------------------------------- Unstructured Image End

--------------------------------------------------- Unstructured Caption Begin

AD&D TERM RATES