Roanoke Bar Association

Basic Life Insurance 

Amount of Life Insurance* $25,000
All Members who become insured on or after February 5, 1988**

Supplemental Life Insurance

Amount of Life Insurance* $25,000
All Members who become insured on or after February 5, 1988**

*Your amount of insurance will decrease to 50% on the policy anniversary date on or after your 65th
birthday.
**All eligible members who became insured under the Plan prior to February 5, 1988 will remain
covered under the existing schedules.

Member's Insurance

Eligibility

The member is eligible on the later of the following dates:

• The Group Policy's Effective Date.
• The date the member becomes a member of the Policyholder.

The member must meet the following conditions to become insured:

• Be eligible for the insurance.
• Be actively performing the normal duties of your occupation.
• Be at least age 18 and under age 60 on the date of application.
• Give to ReliaStar Life proof of good health it accepts, with or without expense to ReliaStar Life as
  applicable, if requested.

Effective Date of Member's Insurance

The Member's Insurance starts on the fifth day of the first month on or after the later of the following
dates:

• ReliaStar Life approves your proof of good health;
• Your premium is received;
• You become eligible for insurance; or
• You apply for insurance, if proof of good health is not required.

Effective Date of Change in Amount of Insurance

If there is an increase in the amount of your insurance, the increase will take effect on the fifth day of
the month on or next following the date of the increase.
If there is a decrease in the amount of your insurance, the decrease will take effect on the fifth day of
the month on or next following the date of the decrease.

Termination of Insurance

Your insurance stops on the earliest of the following dates:

• The last day of the month during which you are no longer eligible for insurance under the Group
  Policy.
• The date the Group Policy stops.
• The end of the period for which you paid premiums, if you do not make the next required premium
  contribution when due.

ReliaStar Life stops providing a specific benefit to you on the date that benefit is no longer provided
under the Group Policy.

Member's Insurance

ReliaStar Life pays a death benefit to your beneficiary if written proof is received that you have died
while this insurance is in force. The death benefit is the amount of Life Insurance shown on the
Schedule of Benefits in effect on the date of your death.

Waiver of Life Insurance Premium Disability Benefit

ReliaStar Life waives your Life Insurance premium that becomes due while you are totally disabled. The
premium will be waived if you satisfy certain conditions. When ReliaStar Life waives a premium, the
amount of Life Insurance equals the amount that would have been provided if you had not become
totally disabled. That amount will reduce or stop according to the Schedule of Benefits in effect on the
date total disability begins.
When ReliaStar Life waives a premium it includes Life Insurance, Waiver of Premium, and any other
benefits as elected under this certificate which were effective at the time of disability.

Conditions, Notice and Proof of Total Disability

ReliaStar Life requires written notice of claim and proof of total disability to waive your premium. All of
the following conditions must also be met:

• Total disability must begin before your 60th birthday.
• You are insured for the Waiver of Life Insurance Premium Disability Benefit on the date you become
  totally disabled.
• You must be continuously totally disabled for at least six months.
• You continue to be totally disabled.
• Your insurance is in force when you suffer the sickness or accidental injury causing the total disability.
• All premiums are paid up to the date total disability begins.

ReliaStar Life needs written notice of claim before it waives any premium. This notice must be
received –

• while you are living,
• while you are totally disabled, and
• within one year from the date total disability begins. If you cannot give ReliaStar Life notice within one year, your claim is still valid if you show you gave ReliaStar Life notice as soon as reasonably possible.

ReliaStar Life needs proof of your total disability before any premiums can be waived. ReliaStar Life
may require you to have a physical exam by a doctor it chooses. ReliaStar Life pays for that exam.
ReliaStar Life can only require one exam a year after premiums have been waived for 2 full years.
When ReliaStar Life approves your proof of total disability, premiums are waived as of the sixth month
following the date you became totally disabled. ReliaStar Life refunds to you any premium paid for the
period during which premiums are not required to be paid under the Waiver of Life Insurance Premium
Disability Benefit.

Termination of Waiver of Premium

ReliaStar Life stops waiving premiums on the earliest of the following dates:

• The date you are no longer totally disabled.
• The date you do not give ReliaStar Life proof of total disability when asked.
• The date your Life Insurance terminates according to the Schedule of Benefits.

If ReliaStar Life stops waiving your premiums, your Life Insurance will stay in force only if all of the
following conditions are met:

• The Life Insurance under the Group Policy is still in force.
• You are eligible for insurance under the Group Policy.
• Your premium payments are resumed.

The amount of Life Insurance that stays in force will be the amount shown on the Schedule of Benefits
in effect on the date your premium payments are resumed.

If you apply for and are issued an individual policy under the Conversion Right of the Group Policy, this
Waiver of Premium is not available unless you surrender the individual conversion policy to ReliaStar
Life and this disability commenced while you were insured under the Group Policy. ReliaStar Life will
then refund all premiums paid for the individual conversion policy.

Beneficiary
The beneficiary is named to receive the proceeds to be paid at your death. You may name more than
one beneficiary.
You may name, add or change beneficiaries by written request as described below.
You may name, add or change beneficiaries by written request if all of the following conditions are met:

• Your coverage is in force.
• You have not assigned the ownership of your insurance. The rights of an assignee are described in
  the Assignment section.

All requests are subject to the approval of ReliaStar Life. A change will take effect as of the date it is
signed but will not affect any payment ReliaStar Life makes or action it takes before receiving your
notice.
Payment of Proceeds
ReliaStar Life pays proceeds to the beneficiary. If there is more than one beneficiary, each receives an
equal share, unless you have requested otherwise, in writing. To receive proceeds, a beneficiary must
be living on the earlier of the following dates:

• The date ReliaStar Life receives proof of your death.
• The tenth day after your death.

If there is no eligible beneficiary or if you did not name one, ReliaStar Life pays the proceeds in the
following order:
1. Your spouse.
2. Your children.
3. Your parents.
4. Your estate.
The person must be living on the tenth day after your death.

Settlement Options
Settlement options are alternative ways of paying the proceeds under the Group Policy. Proceeds is the
amount of each benefit ReliaStar Life pays when you die. To find out more about settlement options,
please contact ReliaStar Life. 

CONVERSION RIGHTS

Life Insurance
You may convert this insurance to an individual life insurance policy if any part of your Life Insurance
under the Group Policy stops. Proof of good health is not required.
Conditions for Conversion
You may convert this Life Insurance if it stops for any of the following reasons:

• You are no longer eligible for insurance under the Group Policy.
• The Group Policy is changed or cancelled and your Life Insurance under the Group Policy has been
  in effect for at least five years in a row.
• The amount of Life Insurance is reduced.
• Premium is no longer being waived under the Waiver of Life Insurance Premium Disability Benefit and
  your group Life Insurance stops.

You must apply for and pay the first premium for an individual policy within 31 days after any part of
your insurance stops.
ReliaStar Life must be notified in writing, and will supply you with a conversion form to complete and
return.
Type of Converted Policy
You may purchase any individual, non-term nonparticipating policy offered by ReliaStar Life. The new
insurance will not include a Waiver of Premium benefit unless Waiver of Premium is offered by us under
the conversion policy and proof of good health is provided.
Amount of Conversion Coverage
If your Life Insurance is changed or cancelled because the Group Policy is changed or cancelled, and
your Life Insurance under the Group Policy has been in effect for at least five years in a row, the
amount of the individual policy is limited to the lesser of –

• $5,000, or
• the amount of Life Insurance which stops, minus the amount of other group insurance for which you
  become eligible within 31 days of the date your insurance stops.

If your Life Insurance stops for any reason other than the above, the amount of your individual policy
may be any amount up to the amount of your Life Insurance that stopped.
Effective Date
The new policy takes effect 31 days after the part of your Life Insurance being converted stops.
If you die within the 31-day period allowed for making application to convert, ReliaStar Life will pay the
death benefit to your beneficiary in the amount you were entitled to convert. ReliaStar Life will pay the
amount whether or not application was made. ReliaStar Life will return any premium paid for the individual policy to your beneficiary named under the Group Policy.
Premiums
Premiums for the new policy are based on your age on the date of conversion.

CLAIM PROCEDURES

Submitting a Claim
You or someone on your behalf must send ReliaStar Life written notice of the loss on which your claim
will be based. The notice must –

• include information to identify you, like your name, address and Group Policy number.
• be sent to ReliaStar Life or one of its licensed agents authorized to accept claims.
• be sent within 20 days after the loss for which claim is based has occurred or as soon as reasonably
  possible.

Claim Forms
ReliaStar Life or its authorized agent will send proof of loss claim forms to you or to the Policyholder to
give to you. ReliaStar Life will send the forms within 15 days after ReliaStar Life receives your notice of
claim.
You or someone on your behalf must return the completed proof of loss claim forms to ReliaStar Life
within 90 days of the loss. Even if you do not receive the forms, written proof of loss must be sent to
ReliaStar Life within 90 days after the loss or as soon as reasonably possible.
Written proof of loss includes details of how the loss occurred. It also includes copies of itemized
doctor, hospital and prescription drug bills or receipts.

GENERAL PROVISIONS

Life Insurance Assignment
You can change the owner of your Life Insurance under the Group Policy by sending ReliaStar Life
written notice. This change is an absolute assignment. You transfer all your rights and duties as owner
to the new owner. The new owner can then make any change the Group Policy allows. A request for an
absolute assignment –

• does not change the insurance or the beneficiary.
• applies only if ReliaStar Life receives your notice.
• takes effect from the date signed.
• does not affect any payment ReliaStar Life makes or action ReliaStar Life takes before receiving your
  notice.

ReliaStar Life assumes no responsibility for the validity of any assignment. You are responsible to see
that the assignment is legal in your state and that it accomplishes the goals that you intend.
A collateral assignment is not allowed.
Legal Action
Legal action may not be taken to receive benefits until 60 days after the date proof of loss is submitted
according to the requirements of the Group Policy. Legal action must be taken within 3 years after the
date proof of loss must be submitted.
If the Policyholder's state requires longer time limits, ReliaStar Life will comply with the state's time
limits.
Incontestability
Your insurance has a contestable period starting with the effective date of your insurance and continuing for 2 years while you are living. During that 2 years, ReliaStar Life can contest the validity of your insurance because of inaccurate or false information received relating to your insurability. Only statements that are in writing and signed by you can be used to contest the insurance.

DEFINITIONS

Active Work, Actively at Work – the employee is physically present at his or her customary place of
employment with the intent and ability of working the scheduled hours and doing the normal duties of
his or her job on that day.
Group Policy – the written group insurance contract between ReliaStar Life and the Policyholder.
Member –

• active member – a member who is engaged in the practice of law, either privately or for an institution using his services as a lawyer, within the state of Virginia.
• associate member –
  • Retired lawyers or judges who were previous active members of an association.
  • Law students attending a state accredited law school full-time and under age 30.

ReliaStar Life – ReliaStar Life Insurance Company, at its Home Office in Minneapolis, Minnesota.
Total Disability, Totally Disabled – your inability, due to sickness or accidental injury, to work at any
job suited to your education, training or experience.
Written, In Writing – signed, dated and received at ReliaStar Life's Home Office in a form ReliaStar
Life accepts.
You, Your – a person insured for Member's Insurance under the Group Policy.