Metlife PolicyCity of Salina
300 West Ash
Salina, KS 67401
January 12, 2018
Group Number:KM 05950251-G
Dear Jennifer Perry:
Thank you again for selecting MetLife as your Group Benefit Carrier.
We are pleased to advise you that the installation of your new coverage(s) with us is now complete!
Enclosed is your MetLife policy, which includes your Application for Group Insurance, and the applicable
certificate(s). Coverage ce rtificates must be distributed to all of your insured employees. If you did no t
choose to receive certificates electronically, they will be shipped separately within the next few days.
Please be advised that the certificates include the MetLife Gramm-Leach-Bliley(GLB) Privacy Notice.
We are pleased to provide you access to our online administrative manual at
.This site provides you the most current and important administration
information such as: required state Life and Health Guaranty Association Notices (to inform you about
state protections in c ase of insurer insolvency), forms, and other helpful tools.
I'd like to remind you that our toll-free Customer Service number, 1-800-275-4638, is available to you and
your employees. Option 2 will allow you, as Administrator, to accomplish a number of se lf-service
functions. For example, among other actions, you can terminate an employees coverage or check your
premium balance or the last payment posted. (You will need your Customer number and Division when
using the toll-free number. These numbers are referenced on your monthly billing statement).
If you are a customer with employees working in the State of Connecticut, please review the CT
Employee Terminations topic found in MetLifes online Administration Manual under the appropriate
coverage sec tion.
We a re committed to ensuring that our customers know how intermediaries are paid. To keep you
informed, we have enclosed a document titled, "I ntermediary and Producer Compensation Notice."
Our goal is to provide you with an exceptional level of consistent and responsive service. Reinforcing our
brand positioning in the marketplace, MetLife is easier, we aim to make you and your employees'
experience with MetLife both productive and pleasant.
Sincerely,
Small Market Customer Service Team
Enclosures: Policy/Certificate
Cc: (Broker)
Metropolitan Life Insurance Company
4150 North Mulberry Drive, Suite 300, Kansas City, MO 64116
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L0817498021\[exp0818\]\[All States\]
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
Metropolitan Life Insurance Company ("MetLife"), a stock company, will pay the benefits specified in the
Exhibits of this policy subject to the terms and provisions of this policy. The Schedule of Exhibits lists
each Exhibit to this policy, to whom it applies and its effective date.
Policyholder:City of Salina
Group Policy No.:KM 05950251-G
EFFECTIVE DATE:
This policy will take effect on January 01, 2018.
POLICY ANNIVERSARIES
Policy anniversaries will be January 01, 2019 and each subs equent January 01.
PREMIUM PAYMENTS
This policy is issued in return for the payment by the Policyholder of required Premiums. Premiums are
payable at the home office of MetLife or to its authorized agent. The first Premium is due on and must be
paid by this policys effective date. Any later Premiums are due monthly in advance on the first day of
each Policy Month. These dates are the Premium Due Dates.
POLICY SITUS
This policy is issued for de livery in and governed by the laws of Kansas.
Signed as of this policys effective date at MetLifes home office in New York, New York.
Jeannette N. Pina
Steven A. Kandarian
Vice President and Secretary
Chairman, President and Chief Executive Offi cer
Signed by Date: 01/12/2018
(A licensed MetLife agent or resident agent as required by law.)
GROUP BASIC TERM LIFE INSURANCE POLICY NON-DIVIDEND PAYING
GPNP99 KM 05950251-G Page 1
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
TABLE OF CONTENTS
Section Page
POLICY FACE PAGE
Effective Date.......................................................................................................................................1
Policy Anniversaries.............................................................................................................................1
Premium Payments..............................................................................................................................1
Policy Situs..........................................................................................................................................1
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Initial Rate(s).......................................................................................................................................6
Frequency o f Premium Payment..........................................................................................................6
Computation of Premium.....................................................................................................................6
Premiums for Changes in Insurance.....................................................................................................6
Right to Change Premium Rates..........................................................................................................7
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Entire Contract.....................................................................................................................................9
Policy Changes o r Waivers..................................................................................................................9
Incontestability: Statements Made by the Policyholder.........................................................................9
Incontestability: Statements Made by Covered Persons......................................................................9
Certificates...........................................................................................................................................9
Assignment........................................................................................................................................10
Information Needed and Policy Administration...................................................................................10
Misstatement of Age..........................................................................................................................10
Non-Dividend Paying.........................................................................................................................10
Conformity with Law...........................................................................................................................10
SCHEDULE OF EXHIBITS SCH/EXHIBITS
EXHIBIT 1: Schedule of Premium Rates ....EXHIBIT1
EXHIBIT 2: Certificate Forms ..........EXHIBIT2
GPNP99 KM 05950251-G Page 3
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
'$/!"!#!+".
As used in this policy, the terms listed below will have the meanings defined below. When defined terms
are used in this policy, they will appear with initial capitalization. The plural use of a term defined in the
singular will share the same meaning.
Cont ribution means the amount the Policyholder may require the Employee to pay towards the total
Premium that MetLife charges for the insurance provided by this policy.
Contributory Insurance means insurance for which the Policyholder may require the Emplo yee to pay at
least part of the Premium.
Covered Person means an Employee and/or a Dependent as set forth in the Exhibit which applies to the
Employee.
Dependent is defined in the Exhibit which applies to the Employee.
Employee is described in the Exh ibit which applies to the Employee.
Employer means the Policyholder shown on page 1.
Noncontributory Insurance means insurance for which the Policyholder may not require the Employee to
pay any part of the Premium.
Policy Anniversary is defined on pag e 1.
Policy Month The first Policy Month will begin on the effective date shown on page 1. Subsequent
Policy Months will begin on the same day of each subsequent calendar month.
Premium means the amount the Policyholder must pay to MetLife for all the insurance provided under this
policy.
Premium Due Date is defined on page 1.
Signed means any symbol or method executed or adopted by a person with the present intention to
authenticate a record, and which is on or transmitted by paper or electronic medi a, and which is consistent
with applicable law.
Written or Writing means a record which is on or transmitted by paper or electronic media, and which is
consistent with applicable law.
GPNP99 KM 05950251-G Page 5
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
.-0$',1$ +/ !".,%("-$
The Schedules of Insurance which apply under t his policy are set forth in the Exhibits.
$1!2!3!1!#) ("' $//$-#!4$ '(#$. +/ !".,%("-$
The Eligibility and Effective Dates of Insurance provisions that apply under this policy are set forth in the
Exhibits.
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The Policyholder will not require an Employee to contribute to the cost of Noncontributory Insurance.
The maximum amount that an Employee may be required to contribute to the cost of Contributory Insurance
will not exceed the Premium charged for the amounts of such insurance.
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Initial Rate(s)
The initial Premium rate(s) are shown in Exhibit 1.
Frequency of Premium Payment
Premiums for this policy will be paid as shown on page 1. MetLife and the Po licyholder may agree that
payment be made in advance every 3, 6, or 12 months.
Computation of Premium
The Premium due on any Premium Due Date is determined by the total amount of insurance provided by
this policy on suc h Premium Due Date, multiplied by the appropriate Premium rate(s) which are then in
effect subject to any Premium adjustments, if applicable.
MetLife may use any reasonable method to compute Premiums due under this policy.
Premiums for Changes in Insuran ce
For insurance that takes effect after the first day of a Policy Month, Premium will be charged from the first
day of the next Policy Month. However, if a policy amendment or evidence of good health is requi red for
such insurance, Premium will be charged as of the date such insurance takes effect.
If this policy ends, or if insurance ends for a class of persons, Premium will be charged to the date
insurance ends. If insurance ends for other reasons, Premium will be charged to the end of the Policy
Month in which insurance ends.
GPNP99 KM 05950251-G Page 6
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
PREMIUM RATES (continued)
Right to Change Premium Rates
MetLife may change Premium rates for changes which materially affect the risk assu med for the
insurance provided by this policy, as follows:
1.when this policy is amended or endorsed;
2.when a class of eligible persons is added to or deleted from this policy for any reason including
corporate restructuring, acquisition, spin-off or simila r situations;
3.when a Policyholder's subsidiary, affiliate, division, branch or other similar entity is added to or
deleted from this policy for any reason including corporate restructuring, acquisition, spin-off or similar
situations;
4.when there is a sig nificant change in the geog raphic distribution of insured Employees;
5.when applicable law requires a change in:
a. the insurance provided by this policy; and/or
b. the class of persons eligible for insurance under this policy; or
6.when a Premium Due Date coincides with or next follows:
a. a change greater than 25% in the number of Covered Persons since the later of the policy
Effective Date and the last date Premium rates were changed; or
b. a change greater than 25% in the amount of insurance p rovided by this policy since the later of
the policy Effective Date and the last date Premium rates were changed.
In addition, MetLife may change Premium rates:
1.except as may be stated in Exhibit 1, on any date on or after the first Policy Anniversary; this will be
done no more frequently than every 12 months and only if MetLife notifies the Policyholder, in Writing,
at least 31 days before such change; and
2.on any other date agreed to by MetLife and the Policyholder.
The new Premium rates will apply on ly to Premiums due on or after the date the rate change takes effect.
2%(-$ *$%!+'
Each Premium due after the effective date of this policy may be paid up to 31 days after its Premium Due
Date. This period is the grace period. The insurance provided by t his policy will stay in effect during this
period. MetLife will notify the Policyholder in Writing that, if the Premium is not paid by the end of the
grace period, this policy will end at the end of the last day of the grace period. If MetLife fails to giv e
Written notice to the Policyholder, this policy will continue in effect until the date such notice is given.
Policyholder's intent to end this policy during the grace period. The Policyholder may notify MetLife in
Writing prior to the end of the grace period of its intent to end this policy before the end of the grace period.
In this case, this policy will end on the later of:
1. the date stated in the notice; or
2. the date MetLife receives the notice.
GPNP99 KM 05950251-G Page 7
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
GRACE PERIOD (continued)
If the Policyhold er replaces this policy with another group insurance policy but does not give MetLife
notice of intent to end this policy, the grace period provisions will apply.
Grace period extensions. MetLife may extend the grace period by giving Written notice to th e
Policyholder. Such notice will state the date this policy will end if the Premium remains unpaid.
Premiums must be paid for a grace period, any extension of such period and any period insurance under
this policy was in effect for which Premium was not p aid.
$"' +/ !".,%("-$ *%+4!'$' 3) #0!. *+1!-)
The Policyholder can end this policy by giving 60 days advance Written notice to MetLife. The policy will end
on the later of:
1. the date stated in the notice; or
2. the date MetLife receives the notic e.
MetLife can end this policy as follows:
1.on the date Premium is not paid when due, subject to the Grace Period provisions; or
2.on any Premium Due Da te, by giving the Policyholder 31 days advance Written notice, if less than:
a.for Life Insurance for Em ployees, 75% of persons eligible under this policy are insured for
Contributory Insurance;
b.for Life Insurance for Dependents, 50% of all eligible Employees with eligible dependents are insured
for Contributory Insurance;
c.100% of persons eligible under th is policy are insured for Noncontributory Insurance; or
d.10 Employees are insured by this policy;
3.on any Premium Due Date, by giving the Policyholder 60 days advance Written notice, if the
Policyholder fails to provide information on a timely basis or per form any obligations required by this
policy or any applicable law; or
4.on any Policy Anniversary by giving the Policyholder 31 days advance Written notice.
This policy will end on the date on which the last certificate in effect under this policy ends.
If this policy ends, all Premiums due must be paid. If MetLife accepts Premium after the date th is policy
ends, such acceptance will not act to reinstate the policy. MetLife will refund any unearned Premium.
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The Policyholder may request to reinstate this policy within one year from the date it ended. The request
must be in Writing an d it must provide MetLife with information that MetLife requires to consider such
request. If MetLife approves the request, the policy will be reinstated on the date stated in Writing by
MetLife.
GPNP99 KM 05950251-G Page 8
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
2$"$%(1 *%+4!.!+".
Entire Contract.The entire contract is made up of the following:
1. this policy, including its Exhibits;
2. the Policyholder's application; and
3. the amendments and endorsements to this policy, if any.
Policy Changes or Waivers. The terms and provisions of this policy may be changed, at any time,
without the consent of the Covered Persons or anyone else with a beneficial interest in it. MetLife will
issue amendments or endorsements to effect such changes. MetLife will only make changes that are
consistent with applicable law. An amendment or endorsement will not affect the insurance provided
under certificates issued before the effective date of the change, unless retroactivity is consistent with
applicable law.
An officer of MetLife must approve in Writing any change or waiver of the terms and provisions of this
policy. A sales representative, or other MetLife employee, who is not an officer of MetLife, does not have
MetLifes authority to approve such changes or wa ivers. A change or waiver will be evidenced by an
amendment Signed by an officer of MetLife and the Policyholder or an endorsement Signed by an officer
of MetLife. A copy of the amendment or endorsement will be provided to the Policyholder for attachment
to this policy.
Incontestability:Statements Made by the Policyholder.Any statement made by the Policyholder will
be considered a representation and not a warranty. MetLife will not use such statemen t to avoid
insurance, reduce benefits or defend a claim unless it is contained in a Written application. MetLife will
not use such statement to contest life insurance after it has been in force for 2 years from its effective
date, or date of last reinst atement, unless the statement is fraudulent.
Incontestability:Statements Made by Covered Persons.Any statement made by a Covered Person
will be considered a representation and not a wa rranty. MetLife will not use such statement to avoid
insurance, reduce benefits or defend a claim unless the following requirements are met:
1. the statement is in a Written application or enrollment form;
2. the Covered Person has Signed the applicat ion or enrollment form; and
3. a copy of the application or enrollment form has been given to the Covered Person or his beneficiary.
MetLife will not use a Covered Persons statements which relate to insurability to contest life insurance after
it has been in force for 2 years during his life, unless the statement is fraudulent. In addition, MetLife will not
use such statements to contest an increase or benefit addition to such insurance after the increase or
benefit has been in force for 2 years during his life, unless the statement is fraudulent.
Certificates. MetLife will issue certificates to the Policyholder for delivery to each Covered Person, as
appropriate. Such certificate will describe the Covered Persons benefits and rights under this
policy."Certificate" includes any of MetLifes insurance riders, notices or other attachments to the
cert ificate.
GPNP99 KM 05950251-G Page 9
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
GENERAL PROVISIONS (continued)
Assignment.The life insurance rights and benefits under this policy are assignable by gift. An Employee
may have made an irrevocable assignment under a group policy that this policy replac es. In this case,
MetLife will recognize the assignee(s) under such assignment as owner(s) of the Employee's right, title
and interest under this policy if:
1. a Written form satisfactory to MetLife, affirming this assignment, has been completed;
2. the Written form has been Signed by the Employer, assignee(s) and Policyholder; and
3. the Written form is delivered to MetLife for recording.
MetLife is not responsible for the validity of an assignment. All other insurance under this policy may not
be assigned prior to a claim for benefits, except as required by law or as permitted by MetLife.
Information Needed and Policy Administration. All information necessary to compute Premiums and
carry out the terms of this policy will be provided by the Policyholder to MetLife. Such information:
·Will be provided in a timely manner and in a format as agreed to by MetLife and the
Policyholder;
·Will be provided, maintained and administered as agreed to in Writing by MetLife and
the Policyholder; and
·If maintained by the Policyholder, may be examined by MetLife at any reasonable
time.
If MetLife or the Policyholder makes a clerical error in keeping or providing the information, the Premium
and/or benefit s will be adjusted as warranted, according to the correct information. An error will not end
insurance validly in effect, nor will it continue insurance validly ended or create insurance coverage where
no coverage existed.
Any act undertaken by the Polic yholder that relates to the insurance provided under this policy must be
consistent with the terms of such insurance and with MetLifes requirements; including but not limited to
the eligibility requirements of the Policyholders plan as set forth in the c ertificates to this policy.
Misstatement of Age. If a Covered Persons age is misstated, the correct age will be used to determine
if insurance is in effect and, as appropriate, adjust the Premium and/or benefits.
Non-Dividend Paying.This policy does not pay dividends.
Conformity with Law. If the terms and provisions of this policy do not conform to any applicable law, this
policy shall be interpreted to so conform.
GPNP99 KM 05950251-G Page 10
as endorsed by GPEND13-05/hh, as endo rsed by GPEND15-04 end ins
SCHEDULE OF EXHIBITS
Exhibit Effective
Number Exhibit Type Applies To Date
1 Schedule of Premium Rates All Covered Persons January 01, 2018
2 Certificate Forms All Covered Persons January 01, 2018
GPNP99 KM 05950251-G
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
SCH/EXHIBITS DATE: January 01, 2018
EXHIBIT 1
SCHEDU LE OF PREMIUM RATES
The initial monthly Premium rates for the insurance provided by this policy are as follows:
Rate Guarantee Period
Subject to the Right to Change Premium Rates provision on page 7, the Premium rates for Life Benefits
will be in effect from January 01, 2018 through December 31, 2020.
Life Benefits for Employees: -$0.140 per $1,000 of Life Benefits in force hereunder.
Certain non-insured grief counseling services are included with non-contributory Basic Life Insurance
coverage and provided at no additional premium. MetLife has arra nged for these services to be provided
to Employees through a third party service provider. MetLife is not responsible for providing or failing to
provide these services nor is it liable for any negligence in the provision of such services by the third pa rty
service provider.
Employees who become insured for MetLife non-contributory Basic Life Insurance under the Group Policy
are eligible to receive discounts of up to 10% off the service providers standard price for certain funeral
services including funeral, cremation and cemetery products and services provided by a third party
national network of funeral and funeral planning providers while such insurance remains in effect.
Employees who become insured for MetLife non-contributory Basic Life Insurance will also have access
to funeral planning resources including funeral planning tools and concierge services provided by the
same national network of providers. MetLife has arranged for these services and discounts to be provided
to Employees and their spouses and children and the parents, grandparents and great-gran dparents of
the Employees and their spo uses for no additional premium.
MetLife is not responsible for providing or failing to provide these services nor is it liable for any
negligence in the provision of such services by th e third party service provider.
Life Benefits for Dependents: $3.084 per Employee insured hereunder for Life Benefits for Dependents.
GPNP99 KM 05950251-G
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
EXHIBIT1 DATE: January 01, 2018
EXHIBIT 2
CERTIFICATE FORMS
Certificate
Number Certificate Form Applies To Effective Date
1 GCERT2000 All Active Full-Time Employees January 01, 2018
Excluding Airport Authority
Employees
2 GCERT2000 All Active Part-Time Employees January 01, 2018
Excluding Airport Authority
Employees
3 GCERT2000 All Active Full-Time Airport January 01, 2018
Authority Employees
GPNP99 KM 05950251-G
as endorsed by GPEND13-05/hh, as endorsed by GPEND15-04 end ins
EXHIBIT2 DATE: January 01, 2018