Exhibit 10(j)
PROVIDENT
LIFE &
ACCIDENT
INSURANCE
COMPANY
(Herein
called the Provident)
_________________________________________________________________
_____________
Based on the request for this Policy (herein called the Plan)
made by
NORTHROP GRUMMAN CORPORATION
0000 Xxxxxxx Xxxx Xxxx
Xxx Xxxxxxx, Xxxxxxxxxx 00000-2199
(herein called the Policyholder)
and based on the payment of the premium when due, the Provident
agrees to pay the benefits as provided on the following pages.
This Plan becomes effective at 12:01 A.M. Standard Time at the
Policyholder's Address on the Effective Date shown below. The
Plan will terminate at 12:00 Midnight on the Expiration Date
shown below or as shown in Section VII - Termination of the Plan.
All matter printed or written by the Provident on the following
pages forms a part of this Plan as if recited over the signatures
below.
This Plan is delivered in and, to the extent permitted by Federal
Law, is governed by the laws of the Jurisdiction shown below.
This Plan is subject to the Employee Retirement Income Security
Act of 1974 (ERISA). The general Plan information and a statement
of the Rights of Plan participants are found at the end of this
document.
In witness whereof the Provident has caused this Plan to be
executed at its Home Office in Chattanooga, Tennessee on March
10, 1995.
Secretary President and Chief
Executive Officer
Approved by Countersigned by
Vice President-Legislative and Industry Affairs
Licensed Resident Agent
GROUP POLICY NUMBER GTA-1561
EFFECTIVE DATE July 1, 1995
EXPIRATION DATE July 1, 1998
JURISDICTION California
COVERAGE PROVIDED Group Accident Insurance
NON-PARTICIPATING
GROUP POLICY
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A-1
TABLE OF CONTENTS
SECTION I SCHEDULE OF BENEFITS
SECTION II DEFINITIONS
SECTION III ELIGIBILITY AND TERMINATION OF COVERAGE
SECTION IV BENEFIT PROVISION
SECTION V CLAIM PAYMENTS
SECTION VI PREMIUMS
SECTION VII TERMINATION OF THE PLAN
SECTION VIII GENERAL PROVISIONS
SECTION IX ERISA STATEMENT OF RIGHTS AND
INFORMATION
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SECTION I - SCHEDULE OF BENEFITS
The following Employees are eligible for coverage:
Class Hazard Description of Class
I 17, 17T The Chairman of the Board.
20, 26, 28
II 17, 17T All full-time Employees, who
are Executive Classes 1, 2,
20, 26, 28 3 and 4, and who are:
(a) permanent resident aliens of the
United States of
America; or
(b) citizens of the United States of
America whether
employed within or without the
United States of
America.
III 17, 17T All full-time Employees, who
are Executive Class 5, and
20, 26, 28 who are:
(a) permanent resident aliens of the
United States of
America; or
(b) citizens of the United States of
America whether
employed within or without the
United States of
America.
IV 17, 17T All full-time Employees, who
are Executive Class 6, and
20, 26, 28 who are:
(a) permanent resident aliens of the
United States of
America; or
(b) citizens of the United States of
America whether
employed within or without the
United States of
America.
V 17, 17T All full-time Employees, not
included in Classes I, II, III or
20, 26, 28 VI, who are:
(a) permanent resident aliens of the
United States of
America; or
(b) citizens of the United States of
America whether
employed within or without the
United States of
America.
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SECTION I - SCHEDULE OF BENEFITS
ACCIDENTAL DEATH, DISMEMBERMENT AND PLEGIA INSURANCE
Class Principal Sum
I $1,000,000.
II An amount equal to six (6) times Base
Annual Earnings,
subject to a maximum of $1,000,000.
III An amount equal to four (4) times Base
Annual Earnings,
subject to a maximum of $1,000,000.
IV $100,000.
V $ 25,000.
Premium Calculation: A monthly premium of $0.0217 per $1,000
of Principal Sum.
SECTION II - DEFINITIONS
Injury - Accidental bodily injury which: (i) is direct and
independent of any other cause; and (ii) requires treatment by a
legally qualified physician or surgeon.
Exposure - Being exposed to the elements following the
disappearance, forced landing, stranding, sinking or wrecking of
a vehicle. Exposure will be deemed an accidental bodily injury.
Disappearance - Not finding the body within one year after the
disappearance, forced landing, stranding, sinking or wrecking of
a vehicle. Disappearance will be deemed loss of life.
Subsidiary - Any corporation wholly owned by Northrop Grumman
Corporation, or any corporation that Northrop Grumman Corporation
owns 50% or more of the outstanding voting stock, including the
wholly owned or 50% owned corporations of such corporations.
The Plan applies only to the Policyholder as constituted on the
Effective Date of the Plan. Coverage will be extended to
Employees of acquired companies or corporations, provided:
1. the Policyholder gives the Provident:
(i) the names of any newly acquired company or
corporation; and
(ii) all underwriting data required to enable the
Provident to determine
any additional premium due.
2. coverage for any newly acquired company or corporation
will begin on the date acquired and continue for 60
days;
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SECTION II - DEFINITIONS (continued)
3. coverage will end 60 days after the date a new company
or corporation is acquired if:
(i) all underwriting data is not furnished; or
(ii) any additional premium is not paid. The
Policyholder will remain liable for
payment of premiums for the period coverage was
available.
SECTION III - ELIGIBILITY AND TERMINATION OF COVERAGE
When Coverage Begins
If an Employee is in an eligible Class, he or she will be covered
when he or she has completed:
(a) a full day of Active Work on that date; or
(b) a full day of Active Work on his or her last regularly
scheduled work day.
If an Employee does not meet the requirements of (a) and (b)
above, the coverage will become effective on the date he or she
returns to Active Work.
Active Work means performing his or her regular duties for a full
work day for the Policyholder.
When Coverage Ends
An Employee's coverage will end the sooner of:
(a) the date the Plan ends;
(b) the date ending the period for which his or her last
contribution is made,
if he or she is required to pay a part of the cost of
the Plan; or
(c) the date he or she is no longer a member of an eligible
Class, subject to the
following:
(i) for an Approved Medical Leave, coverage may be
continued
for up to two years;
(ii) for an Approved Personal or Educational Leave,
coverage may
be continued for up to one month; or
(iii) for an Approved Family Leave, coverage may be
continued for
up to four months.
For coverage to continue during an Approved Leave, the
required contributions for
coverage under the Plan must continue to be made on the
behalf of the Employee.
Termination of coverage will not affect any claim for loss that
begins before termination.
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D-2, D-3
SECTION IV - BENEFIT PROVISION
Accidental Death, Dismemberment and Plegia Insurance
Benefit Provision
The Provident will pay a benefit for loss due to an Injury to an
Employee from a Hazard described on a following page as shown in
the table below. The loss must occur within 365 days after the
date of the accident. The Employee must be covered under the
Plan on the date of the accident.
The benefit is called the Principal Sum and it is shown in the
Schedule of Benefits.
The benefit for loss of life will be paid to the named
beneficiary. All other benefits will be
paid to the Employee.
Table of Losses
For Loss of:
Life.............................................................
......................... 100% of the Principal Sum
Both Hands or Both Feet or Sight of Both
Eyes................. 100% of the Principal Sum
One Hand and One
Foot...................................................... 100%
of the Principal Sum
Speech and Hearing of Both
Ears........................................ 100% of the
Principal Sum
Either Hand or Foot and Sight of One
Eye.......................... 100% of the Principal Sum
Quadriplegia.....................................................
.................... 100% of the Principal Sum
Speech or Hearing of Both
Ears............................................ 85% of the
Principal Sum
Either Hand or
Foot.............................................................
.. 75% of the Principal Sum
Paraplegia.......................................................
....................... 75% of the Principal Sum
Hemiplegia.......................................................
...................... 75% of the Principal Sum
Sight of One
Eye..............................................................
...... 60% of the Principal Sum
Hearing of One
Ear..............................................................
.. 25% of the Principal Sum
Thumb and Index Finger of Same
Hand................................ 25% of the Principal Sum
Maximum-All Losses-Any One
Accident.......................................... 100% of the
Principal Sum
Loss shall mean the:
(i) loss of a hand by total severance at or above the
wrist;
(ii) loss of a foot by total severance at or above the
ankle;
(iii) complete and total loss to the sight of an eye;
(iv) complete and total loss of speech;
(v) complete and total loss of hearing;
(vi) loss of thumb and index finger by total severance at or
above the knuckles;
(vii) total paralysis of both arms and legs for
Quadriplegia;
(viii) total paralysis of both legs for Paraplegia; or
(ix) total paralysis of the arm and leg on the same side of
the body for Hemiplegia.
Paralysis shall mean the total loss of the use of an arm or leg.
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SECTION IV - BENEFIT PROVISION
HAZARD 17
War Risk Accident Protection
Coverage applies only to a person who is in a Class to which this
Hazard applies.
Description of Hazards
Coverage will apply to an Injury sustained by an Employee when
caused by or resulting from declared or undeclared war or any act
thereof occurring anywhere in the world, excluding the Employee's
country of domicile or residence.
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F-17
SECTION IV - BENEFIT PROVISION
HAZARD 17T
Terrorism and Terrorist Acts Accident Protection
Coverage applies only to a person who is in a Class to which this
Hazard applies.
Description of Hazards
Coverage will apply to an Injury sustained by an Employee when
caused by or resulting from Terrorism or a Terrorist Act anywhere
in the world to the extent that coverage for such Terrorism or
Terrorist Act is not provided elsewhere under the Policy.
Definitions
The term "Terrorism" means the systematic use of violence by a
group or groups in order to intimidate or coerce a population of
government into granting the political demands of the group.
The term "Terrorist Act" means any act which is intended to cause
Injury or damage to persons or property carried out by an
individual or group who systematically use terror as a means of
intimidation or coercion.
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F-17T
SECTION IV - BENEFIT PROVISION
HAZARD 20
24-Hour All Risk Accident Protection - Business and Pleasure
Coverage applies only to a person who is in a Class to which this
Hazard applies.
Description of Hazards
Coverage will apply to an Injury sustained by an Employee
anywhere in the world.
Coverage will also apply to an Injury sustained by an Employee
while riding as a passenger, pilot, operator or member of the
crew in or on, boarding or alighting from, or by being struck or
run down by any aircraft piloted by a licensed pilot.
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F-20
SECTION IV- BENEFIT PROVISION
HAZARD 26
Private Passenger Automobile Seat Belt Accident Protection
Business and Pleasure
Coverage applies only to a person who is in a Class to which this
Hazard applies.
Description of Coverage
The Provident will pay an additional benefit of $5,000 for loss
of life due to Injury as described below.
Coverage will apply to an Injury sustained by an Employee while
operating or riding as a passenger in a private passenger
automobile provided the Employee was wearing a properly fastened
seat belt at the time of the accident.
Seat Belt means a properly installed seat belt, lap and shoulder
restraint, child restraint or other restraint approved the
National Highway Traffic Safety Administration.
No Benefit is payable if the Employee was under the influence of
alcohol or drugs.
Seat belt usage must be verified by:
(i) a doctor;
(ii) a coroner;
(iii) a police officer; or
(iv) any other person of competent authority.
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F-26
SECTION IV - BENEFIT PROVISION
HAZARD 28
Aircraft Sky-Jacking and Air Piracy Accident Protection
Business and Pleasure
Coverage applies only to a person who is in a Class to which this
Hazard applies.
Description of Hazards
Coverage will apply to an Injury sustained by an Employee
resulting from an aircraft "sky-jacking" or an act of "air
piracy" while riding as a passenger, pilot, operator or member of
the crew, in or on, boarding or alighting from any aircraft.
Definition
The term "sky-jacking" and "air piracy" means any illegal, non-
governmental, forceful commandeering of an aircraft.
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F-28
SECTION IV - BENEFIT PROVISION
Beneficiary
An Employee may name anyone as his or her beneficiary. The
Employee must file the name or names on a form approved by the
Provident.
An Employee may change his or her beneficiary at any time by
giving notice in writing. The effective date of the change is
the date the request is signed. However, the Provident is not
liable for any amount paid before the request is received.
If an Employee names more than one beneficiary, they will share
equally unless he or she provides otherwise.
If a beneficiary dies before an Employee, his or her share will
be paid equally to the surviving beneficiaries, unless the
Employee states otherwise. Any amount for which a beneficiary is
not named will be paid to the Employee's estate.
General Exclusions
Benefits are not paid for any loss caused by or resulting from:
(a) suicide or self-inflicted Injury, whether sane or not (in
Missouri, while sane);
(b) bacterial infections, except those which occur with a cut or
wound at the time of the accident;
(c) any kind of disease;
(d) medical or surgical treatment (except surgical treatment
required by the accident);
(e) war or any act of war;
(f) Injury sustained while in any of the armed forces (land, sea
or air) of any country or international authority except
while on temporary domestic National Guard or Reserve
duty for less than 30 days; or
(g) Injury sustained while an Employee is riding in, boarding or
alighting from an aircraft
other than as provided under a Hazard described on a
preceding page.
SECTION V - CLAIM PAYMENTS
Notice of Claim
Written notice of a claim must be given within 20 days after the
loss, or as soon as possible. The notice must be given to the
Provident or an authorized agent with information identifying the
Employee.
Claim Forms
When a notice of claim is received, the Provident will provide
claim forms for the filing of proofs of loss. If such forms are
not sent within 15 days, an Employee will have met the proof of
loss requirement if he or she gives the Provident a written
statement of the nature and extent of the loss within the time
fixed in this Plan.
Proofs of Loss
Written proof must be given to the Provident within 90 days after
the date of loss. However, a claim will still be considered if
it was not possible to furnish proof within this time and the
proof was furnished as soon as possible. Except in the absence
of legal capacity, in no event will a loss be considered if proof
for that loss is furnished more than 2 years after the date the
loss was incurred.
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G-1,H-1
SECTION V - CLAIM PAYMENTS (continued)
Time of Payment of Claims
All benefits provided by the Plan will be paid upon receipt of
proof of loss.
Payment of Claims
Any benefits paid for loss of life will be paid as follows:
(1) to the beneficiary or beneficiaries designated in writing by
the Employee, otherwise;
(2) to the beneficiary or beneficiaries designated in writing by
the Employee under the Group Life Insurance policy issued
to the Policyholder, otherwise;
(3) to the Employee's widow or widower, if surviving the covered
person, otherwise;
(4) to the Employee's surviving child or children, in equal
shares, otherwise;
(5) to the Employee's parents in equal shares, or the surviving
parent, otherwise;
(6) to the Employee's surviving brothers and sisters in equal
shares, or the survivors of them, otherwise; or
(7) to the Employee's estate.
Physical Examination and Autopsy
The Provident will have the right to examine any person as often
as it may require and to perform an autopsy where not forbidden
by law. This will be at the expense of the Provident.
Legal Actions
No action may be brought to recover under the Plan until 60 days
after proof of loss has been given. No action can be brought
after 3 years from the date written proof of loss was required to
be furnished.
SECTION VI - PREMIUMS
Premium Payments
The first premium for coverage under the Plan is due on the
effective date. After that, premiums are due as shown under
Premium Calculation - Schedule of Benefits.
Premiums can be paid to the Provident's Home Office, or to an
authorized agent of the Provident. Each premium paid continues
the Plan in force until the Expiration date, except as shown
under Grace Period.
When asked, the Provident will consider changing the way in which
premium payments are made.
Grace Period
A period of 31 days, without interest, is allowed for paying any
premium other than the first one. The Plan will remain in force
during the Grace Period, unless the Provident has been advised in
writing that the Plan is to cease prior to the end of the Grace
Period. If any premium is not paid before the Grace Period ends,
the Plan will cease. However, the Policyholder will be liable
for all premiums not paid. In addition, a pro rata premium will
be due for the time the Plan was in force during the Grace
Period.
F-66503
H-1,J-1
SECTION VII - TERMINATION OF THE PLAN
The Plan will cease if the Policyholder fails to pay the premium
before the end of the Grace Period.
After the end of the first Plan year, the Provident or the
Policyholder has the right to cancel the Plan on the day prior to
the date any premium is due by giving 31 days written notice.
SECTION VIII - GENERAL PROVISIONS
Entire Contract
The entire contract consists of:
(1) the Plan; and
(2) the Attached Amendments and request, if any.
All statements made by the Policyholder or by the Employees are
true and complete to the best of the knowledge and belief of the
persons making them. No statement will be used in any contest
unless:
(a) the statement is in writing; and
(b) a copy of the statement is given to the Employee or to his
or her beneficiary.
Agreements
All agreements made by the Provident must be signed by an
executive officer. No agent may modify or waive any of the terms
of the Plan. An endorsement or amendment changing this Plan must
be signed by an executive officer of the Provident.
Incontestability
There will be no contest of the Plan, except for failure to pay
the premium, after it has been in force for 2 years from its date
of issue. There will be no contest of an Employee's coverage
after it has been in force, during the lifetime of the Employee,
for 2 years from the date of coverage.
Data Required
The Policyholder will furnish all information and proofs which
the Provident may reasonably require with regard to the Plan.
Clerical Error
Clerical error by the Policyholder will not end coverage or
continue terminated coverage. In the event of such clerical
error, a premium adjustment will be made. However, such
adjustment will not be made beyond the preceding renewal date of
the Plan.
Individual Certificates
The Provident, if required by law, will give the Policyholder a
certificate for each Employee. The certificate will set forth:
(1) the Employee's coverage;
(2) to whom benefits will be paid; and
(3) the rights and privileges under the Plan.
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J-1,K-1,L-1
SECTION IX - THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974
(ERISA)
STATEMENT OF RIGHTS AND INFORMATION
HOW TO FILE A CLAIM
If you should suffer a loss covered by the Policy, either you or
your beneficiary should contact the plan administrator to obtain
claim forms. Read the instructions on these forms carefully and
be sure that all the questions are answered. Remember to include
any required attachments when you return the completed forms.
After your claim has been processed you will be notified in
writing if any additional information is required or if any
benefits are denied in whole or in part.
YOUR RIGHT TO APPEAL
If you have any questions about a claim payment, call or write
the plan administrator. If your claim has been denied in whole
or in part and you do not agree, you should write, within 60
days, to the claim office which advised you of the denial. Be
sure you state why you believe the claim should not have been
denied, and submit any data you think is appropriate. Your
appeal will be reviewed by the office that processed your claim.
Any appeal that cannot be resolved by that office will be
forwarded to the insurance company's home office for review and
final decision. The party hearing the appeal has the
discretionary authority to interpret the Plan and the Policy and
to determine eligibility for benefits. You will be notified of
the final decision within 60 days after the date of your appeal
unless there are special circumstances in which case you will be
notified within 120 days.
NAME OF PLAN
Group Accident Plan for Employees of Northrop Grumman
Corporation.
PLAN ADMINISTRATOR
Employee Welfare Benefits Committee
Northrop Grumman Corporation
0000 Xxxxxxx Xxxx Xxxx
Xxx Xxxxxxx, Xxxxxxxxxx 00000-0000
(000) 000-0000
PLAN IDENTIFICATION
Employer Identification No. 00-0000000
Plan No. 501
TYPE OF ADMINISTRATION
Contract administration. All benefits provided by Group Policy
Number GTA-1561 issued to the Plan sponsor by Provident Life &
Accident Insurance Company. You may inspect this Policy and the
annual report filed with the U.S. Department of Labor at the
Corporate Office of Northrop Grumman Corporation.
FUNDING
All payments to support the Plan are made by Northrop Grumman
Corporation.
END OF BENEFIT PLAN YEAR
June 30th.
END OF ERISA PLAN YEAR
December 31st.
DESIGNATED AGENT FOR SERVICE OF LEGAL PROCESS
Legal process may be made upon the plan administrator at the
address above.
F-66503
ERISA-1
YOUR ERISA RIGHTS
As a participant in this plan, you are entitled to certain rights
and protections under the Employee Retirement Income Security Act
of 1974 (ERISA). XXXXX provides that all plan participants shall
be entitled to:
1) Examine, without charge, at the plan administrator's
office, all plan documents,
including insurance contracts and copies of all
documents filed by the plan with the U.S.
Department of Labor, such as detailed annual reports
and plan descriptions.
2) Obtain copies of all plan documents and other plan
information upon written request to the
administrator. The administrator may make a reasonable charge
for the copies.
3) Receive a summary of the plan's annual financial
report. The plan administrator is required by law
to furnish each participant with a copy of this summary annual
report.
In addition to creating rights for plan participants, XXXXX
imposes duties upon the people who are responsible for the
operation of this plan. The people who operate your plan, called
"fiduciaries" of the plan, have a duty to do so prudently and in
the interest of you and the other plan participants and
beneficiaries.
No one, including your employer or any other person, may fire you
or otherwise discriminate against you in any way to prevent you
from obtaining a welfare benefit or exercising your rights under
ERISA.
If your claim for welfare benefit is denied in whole or in part,
you must receive a written explanation of the reason for the
denial. You have the right to have your plan reviewed and
reconsider your claim.
Under ERISA, there are steps you can take to enforce the above
rights. For instance, if you request materials from the plan and
do not receive them within 30 days, you may file suit in a
federal court. In such case, the court may require the plan
administrator to provide the materials and pay you up to $100 a
day until you receive the materials, unless the materials were
not sent because of reasons beyond the control of the
administrator. If you have a claim for benefits which is denied
or ignored, in whole or in part, you may file suit in a state or
federal court. If it should happen that plan "fiduciaries" misuse
the plan's money, or if you are discriminated against for
asserting your rights, you may seek assistance from the U.S.
Department of Labor, or you may file suit in federal court. The
court will decide who should pay court costs and legal fees. If
you are successful, the court may order the person you have sued
to pay these costs and fees. If you lose, the court may order
you to pay these costs and fees, for example, if it finds your
claim is frivolous. If you have any questions about your plan,
you should contact the plan administrator.
The right is reserved in the Plan for the Plan Sponsor to
terminate, suspend, withdraw, amend or modify the Plan, covering
any active employee, or current retiree or future retiree, in
whole or in part at any time. Any such change or termination in
benefits (i) will be based solely on the decision of the Plan
Sponsor and (ii) may apply to all active employees, current
retirees or future retirees, as either separate groups or as one
group. This is subject to the applicable provisions of the Plan.
If you have any questions about this statement or about your
rights under XXXXX, you should contact the nearest office of the
U.S. Labor-Management Services Administration, Department of
Labor.
F-66503
ERISA-2
