STATE OF TENNESSEE

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Member Handbook STATE OF TENNESSEE Employee Basic -erm Li8e Dependent Basic -erm Li8e Basic Accidental Death & Dismemberment (AD&D) Optional Accidental Death & Dismemberment (AD&D) Underwritten By FOR- DEARBORN LIFE INSURANCE COMPANY 1020 31st Street Downers Grove, Illinois 60515 E ective January 1, 2009 Dear State o8 -ennessee Employee: Li8e and Accidental Death & Dismemberment insurance is an important part o8 your overall bene\x4ts package. You and your 8amily should be con\x4dent that these bene\x4ts are provided by a company with a strong reputation in the insurance industry. -his company is Fort Dearborn Li8e Insurance Company (Fort Dearborn Li8e).

Since 1969, we have provided quality products and services to our clients. Fort Dearborn Li8e is rated cA+ d (Superior) by A.M. Best Company, a88irmed November 1, 2007 1 , and cA+ d (Strong) by Standard & Poor 9s 8or 8inancial strength in its most recent report.

We are proud to be the insurance company that provides the State o8 -ennessee 9s Employee Basic -erm Li8e, Dependent Basic -erm Li8e, Basic AD&D and Optional AD&D plan. Tis member handbook outlines these coverages. Please take a moment to learn more about these bene\x4ts made available to you and your 8amily as an employee o8 ... more. less.

the State o8 -ennessee. Sincerely, Anthony F. -rani President and Chie8 Executive O\x2cer Fort Dearborn Li8e 1020 31st Street " Downers Grove, Illinois 60515-5591 " (800) 633-3696 " Fax (630) 824-5418 1 1 A.M. Best Company rates the overall !nancial condition of a company using a scale of A++ (Superior) to F (In Liquidation). TABLE OF CONTENTS Page De\x4nitions ........................................................................................................... 3 Filing a Claim ...................................................................................................... 3 Basic -erm Li8e ................................................................................................... 4 Basic Accidental Death & Dismemberment ................................................... 6 Bene\x4ciary Designation ................................................................................... 10 Reductions ......................................................................................................... 10 Salary Changes .................................................................................................. 10 Extended Bene\x4ts When Employee Becomes Disabled .............................. 11 Continuation Upon -ermination o8 Employment ....................................... 11 Optional Accidental Death & Dismemberment ........................................... 12 E88ective January 1, 2009, Fort Dearborn Li8e will be the insurance company providing 8or the 8ollowing bene8its sponsored by the State o8 -ennessee. I. Employee Basic -erm Li8e II. Dependent Basic -erm Li8e III. Basic Accidental Death & Dismemberment (AD&D) IV. Optional Accidental Death & Dismemberment (AD&D) -his document serves as your certi8ication o8 coverage. It provides a summary o8 your basic term li8e and basic and optional accidental death and dismemberment coverage as a participant in the basic insurance plan 8or employees o8 -ennessee. -he policy is held by the State o8 -ennessee and the Group Master Policy, issued by Fort Dearborn Li8e, establishes all o8 the provisions o8 the coverage. -he policy number is F010990. 2 Te Insurance Handbook , provided to you by Bene\x4ts Administration, describes the insurance options available to you. You should consult the Insurance Handbook 8or eligibility and enrollment requirements. Te Insurance Handbook is available 8rom your agency 9s bene\x4ts coordinator. DEFINITIONS Actively at Work means the employee is on the job per8orming assigned duties 8or a 8ull day. Te actively at work provision and service requirement will be waived 8or employees who are within their eligibility period and are injured while per8orming job related duties and approved by the Claims Division. Base Annual Salary is based on a normal work week, exclusive o8 overtime, bonuses or other special compensation. Dependent 3 Dependent means legal spouse and child(ren) 8rom live birth up to age 24. Dependent child(ren) must be unmarried and 8or the ages o8 19 up to age 24 must be claimed as a dependent on the employee 9s income tax or be a 8ull- time student. Te de\x4nition o8 live birth does not include a time limit but must be speci\x4ed on the birth certi\x4cate. Efective Date o! Coverage 3 Please re8er to your insurance handbook 8or detailed in8ormation regarding the e ective date o8 coverage. Eligibility 3 Te State o8 -ennessee provides, at no cost to the employee, $20,000 o8 basic term li8e and $40,000 o8 basic special accident coverage 8or all eligible employees. For those employees who choose not to elect health coverage, the amount o8 basic li8e coverages remains the same. For those employees who elect health coverage, the amount o8 basic li8e coverages increase as the employee 9s salary increases with premiums 8or coverage above $20,000/$40,000 deducted 8rom the employee 9s paycheck. Te 8ace amount o8 coverage declines at ages above 65. cYou d or cYour d means the insured State employee. FILING A CLAIM Notice o8 a claim under the basic term li8e and the basic or optional accidental death and dismemberment insurance should be made within 20 days o8 the loss. Written proo8 o8 the claim, on claim 8orms satis8actory to Fort Dearborn Li8e, should be \x4led with Bene\x4ts Administration within 90 days o8 the loss. For speci\x4c in8ormation please contact your bene\x4ts coordinator. 3 BASIC TERM LIFE BASIC TERM LIFE EMPLOYEE SCHEDULE OF BENEFITS Employees with Base Annual Earnings o8: Under Age 65 Age 65 but Under 70 Age 70 but Under 75 Age 75 or Over Less than $15,000$ 20,000$13,000$ 9,000$ 6,000 $15,000 but less than $17,500$ 22,000$14,300$ 9,900$ 6,600 $17,500 but less than $20,000$ 25,000$16,250$11,250$ 7,500 $20,000 but less than $22,500$ 30,000$19,500$13,500$ 9,000 $22,500 but less than $25,000$ 33,500$21,775$15,075$10,050 $25,000 but less than $27,500$ 37,000$24,050$16,650$11,100 $27,500 but less than $30,000$ 40,500$26,325$18,225$12,150 $30,000 but less than $32,500$ 44,000$28,600$19,800$13,200 $32,500 but less than $35,000$ 47,500$30,875$21,375$14,250 $35,000 and over$ 50,000$32,500$22,500$15,000 BASIC TERM LIFE DEPENDENT SCHEDULE OF BENEFITS De\x4nition Amount Eligible Dependents o8 Insured who are: Spouse .....................................................................................................$3,000 Each dependent child (!rom live birth) ...........................................$3,000 Basic Term Li!e coverage does not contain any limitations or exclusions !or suicide. 4 BASIC TERM LIFE ADVANCED BENEFIT OPTION I8 you are terminally ill with a diagnosed li8e expectancy o8 no more than nine months, you can request a payment o8 up to 50 percent o8 the scheduled amount o8 your basic term li8e insurance. Tis advanced payment is subject to a minimum withdrawal o8 $5,000 and will reduce the scheduled amount o8 coverage paid to the designated bene\x4ciary. An advanced bene\x4t can only be received once. Te advanced payment will be reported to the Internal Revenue Service, and it may be considered taxable income. Limitations. Tere are some limitations in the program. A bene\x4t will not be paid i8: (1) Te terminal illness resulted 8rom attempted suicide or sel8-in icted injury. (2) Te coverage has been assigned. (3) Te coverage is payable to an irrevocable bene\x4ciary. (4) You are required by law to use this option to meet the claims o8 creditors. (5) You are required by a government agency to use this option in order to get or keep a government bene\x4t or entitlement. 5 BASIC ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) SCHEDULE OF BENEFITS Employees with a Base Annual Earnings o8:Employee Family Coverage Spouse Only (No Children) Spouse and Children Spouse Each Child Less than $15,000$ 40,000$24,000$16,000$ 4,000 $15,000 but less than $17,500$ 44,000$26,000$18,000$ 4,000 $17,500 but less than $20,000$ 50,000$30,000$20,000$ 5,000 $20,000 but less than $22,500$ 60,000$36,000$25,000$ 5,000 $22,500 but less than $25,000$ 67,000$40,000$27,000$ 6,000 $25,000 but less than $27,500$ 74,000$44,000$30,000$ 7,000 $27,500 but less than $30,000$ 81,000$49,000$32,000$ 8,000 $30,000 but less than $32,500$ 88,000$53,000$35,000$ 9,000 $32,500 but less than $35,000$ 95,000$57,000$38,000$ 9,000 $35,000 and over$100,000$60,000$40,000$10,000 6 BASIC ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) TABLE OF LOSSES Tese losses must: (1) Be the result o8 bodily injury caused solely by accident and independent o8 all other causes. (2) Occur within 90 days o8 the date o8 the accident. (3) Be losses 8or which Proo8 o8 Loss is submitted within 180 days o8 the accident. Te amount o8 payment will be determined by the maximum bene\x4t shown 8or this coverage in the Schedule o8 Bene\x4ts. With respect to hands or 8eet, closs d means actual severance at or above wrist or ankle joints; with respect to eyes, permanent and total loss o8 sight; with respect to thumb and index \x4nger, actual severance o8 entire digit at or above joints. No more than 100 percent o8 the maximum bene\x4t will be paid 8or any one accident, no matter how many o8 the above listed losses occur as a result o8 that accident. Accidental Death Both hands or both 8eet Sight o8 both eyes -HE MAXIMUM BENEFI- One hand and one 8oot One hand and sight o8 one eye One 8oot and sight o8 one eye One hand ONE-HALF One 8oot -HE MAXIMUM BENEFI- Sight o8 one eye Tumb and index \x4nger ONE-FOUR-H o8 either hand -HE MAXIMUM BENEFI- 7 BASIC ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) LIMITATIONS Tere are some limitations. A bene\x4t will not be paid i8 the accident results 8rom or is due to: (1) Any disease or in\x4rmity o8 mind or body, and any medical or surgical treatment thereo8. (2) Suicide or attempted suicide, while sane or insane; (3) Any intentionally sel8-in icted injury. (4) War, declared or undeclared war, whether or not you are a member o8 any armed 8orce. (5) Commission o8, participation in, or an attempt to commit an assault or 8elony. (6) Being under the in uence o8 any narcotic, hallucinogen, barbiturate, gas or 8umes, poison or any other controlled substance as de\x4ned in -itle II o8 the Comprehensive Drug Abuse Prevention and Control Act o8 1970, as now or hereafer amended, unless as prescribed by the insured 9s licensed physician. Conviction is not necessary 8or a determination o8 being under the in uence. (7) Intoxication as de\x4ned by the laws o8 the jurisdiction in which the accident occurred. Conviction is not necessary 8or a determination o8 being intoxicated. (8) Active participation in a riot. cRiot d means all 8orms o8 public violence, disorder, or disturbance o8 the public peace, by three or more persons assembled together, whether with or without a common intent and whether or not damage to person or property or unlaw8ul act is the intent or the consequence o8 such disorder. 8 SUPPLEMENTAL BASIC AD&D BENEFITS A supplemental basic accidental death bene\x4t is payable i8 you die as a result o8 an automobile accident 8or which a basic accidental death and dismemberment bene\x4t is paid and you were properly secured by a seatbelt. Te vehicle must have been operated by a licensed driver who was not intoxicated, driving while impaired, or under the in uence o8 certain substances. Te bene\x4t will be the lesser o8: $25,000; the basic accidental death and dismemberment bene\x4t; or $1,000 i8 an o\x2cial police report certi8ying proper seatbelt use is not submitted with the claim. I8 you die as the result o8 an accident that occurs more than 75 miles 8rom your principal residence, a supplemental bene\x4t o8 up to $5,000 8or preparation and transportation o8 the body will be paid. Te accident must quali8y 8or the provision o8 basic accidental death and dismemberment bene\x4ts 8or the repatriation bene\x4t to be provided. 9 BASIC LIFE AND AD&D COVERAGES BENEFICIARY DESIGNATION Bene\x4ts 8or the loss o8 li8e under the basic term li8e and the basic and optional accidental death and dismemberment coverages will be paid to a bene\x4ciary you designate. It is important that you periodically review and update the designation, i8 appropriate. Te bene\x4ciary in8ormation is maintained by the State o8 -ennessee, usually by the agency in which you are employed. Changes in bene\x4ciary take e ect when made by the employee. Te bene\x4ciary 8or all dependent coverage and 8or the dismemberment coverage is the employee. I8 two or more persons are designated bene\x4ciaries and you do not state otherwise, they will share the bene\x4ts equally. I8 one o8 them does not survive you, that share will pass to the surviving bene\x4ciaries. I8 no bene\x4ciary is designated, the bene\x4ts will be paid to your estate. REDUCTIONS Te amount o8 your basic term li8e insurance and the amounts o8 basic accidental death and dismemberment coverage 8or you and your dependent(s) begin to decrease at age 65. Reductions are to 65 percent o8 the scheduled amount at age 65; to 45 percent at age 70; and to 30 percent at age 75. Te amounts o8 optional accidental death and dismemberment coverage do not change as the employee gets older. SALARY CHANGES Changes in coverage based upon salary will become e ective on the \x4rst day o8 October based on your September 1 salary. Changes in coverage based upon age take e ect on the \x4rst day o8 October based upon your age on the prior September 1. 10 BASIC LIFE AND AD&D COVERAGES EXTENDED BENEFITS WHEN EMPLOYEE BECOMES DISABLED I8 you, the employee, become totally and permanently disabled be8ore age 60, and remain disabled 8or nine consecutive months, you may be eligible to continue the basic term li8e coverage on you and your covered dependents until you turn 70. Fort Dearborn Li8e determines whether your disability is considered total and permanent. -o be granted a continuation under the waiver o8 premium provision you must: (1) Apply within 12 months 8ollowing the last day o8 the month 8ollowing end o8 positive pay status. (2) Provide proo8 o8 the disability each year that is satis8actory to Fort Dearborn Li8e. (3) Remain totally disabled. I8 you are under age 70 and become totally disabled, your basic term li8e coverage will continue 8or one year 8rom the last day o8 the month 8ollowing end o8 positive pay status. Any amount payable under the Waiver o8 Premium or one year extension provision will be reduced by the amount o8 a conversion policy. You are not allowed to increase coverage above the level you had as an active employee. Te conversion policy can be surrendered and you would be eligible 8or 8ull coverage under the extension and approved Waiver o8 Premium claim. Tere are no extended bene\x4ts 8or the basic accidental death and dismemberment and optional accidental death and dismemberment coverages. CONTINUATION UPON TERMINATION OF EMPLOYMENT I8 your employee basic term li8e insurance coverage ends because your employment with the State o8 -ennessee ceases, 8or any reason including retirement, or because your class o8 employees is no longer eligible, you will be entitled to enroll in an individual policy o8 li8e insurance o ered by Fort Dearborn Li8e. No evidence o8 insurability will be required. Tis coverage will not be the same as that provided to you as an employee and the premium will be a ected by the 8orm and amount o8 the policy, your age, and the class o8 risk to which you belong. You will receive a notice 8rom Fort Dearborn Li8e concerning your eligibility to continue coverage. Payment o8 premium will be made directly to Fort Dearborn Li8e. Your dependents may exercise a conversion option when they become eligible 8or coverage as well. I8 you die during the 31-day period 8ollowing the termination o8 insurance, Fort Dearborn Li8e will pay the maximum amount o8 li8e insurance 8or which an individual policy could have been issued. 11 OPTIONAL ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) SCHEDULE OF BENEFITS Employees with Base Annual Earnings o8:Employee Family Coverage Spouse Only (No Children) Spouse and Children Spouse Each Child Less than $3,000$ 6,000$ 4,000$ 2,000$ 1,000 $ 3,000 but less than $ 4,000$ 9,000$ 5,000$ 3,000$ 1,000 $ 4,000 but less than $ 5,000$ 12,000$ 7,000$ 4,000$ 2,000 $ 5,000 but less than $ 6,000$ 15,000$ 9,000$ 5,000$ 2,000 $ 6,000 but less than $ 7 000$ 18,000$11,000$ 7,000$ 2,000 $ 7,000 but less than $ 8,000$ 21,000$13,000$ 8,000$ 3,000 $ 8,000 but less than $ 9,000$ 24,000$15,000$10,000$ 3,000 $ 9,000 but less than $10,000$ 27,000$17,000$11,000$ 3,000 $10,000 but less than $12,500$ 32,000$19,000$13,000$ 3,000 $12,500 but less than $15,000$ 38,000$23,000$15,000$ 4,000 $15,000 but less than $17,500$ 44,000$26,000$18,000$ 4,000 $17,500 but less than $20,000$ 50,000$30,000$20,000$ 5,000 $20,000 and over$ 60,000$36,000$25,000$ 5,000 12 OPTIONAL ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) LIMITATIONS Please re8er to Basic Accidental Death and Dismemberment limitations. REDUCTIONS Tere are no age bene\x4t reductions in the Optional Accidental Death and Dismemberment coverage. TABLE OF LOSSES Please re8er to the Basic Accidental Death and Dismemberment -able o8 Losses. TERMINATION OF COVERAGE Please re8er to the Basic Accidental Death and Dismemberment -ermination o8 Coverage provision. BENEFICIARY You may designate a separate bene\x4ciary 8or the Optional Accidental Death and Dismemberment coverage. 13 NOTES 14 F010990

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