national life group independent channel e&o program · national life group independent channel...

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If you have questions, please call the CalSurance Customer Care Departmentat (866) 226-9308.

National Life GroupIndependent Channel

E&O Program

National Life GroupIndependent Channel

E&O Program

03272015v6

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*The information obtained from A.M. Best dated November 26, 2014 is not in any way CalSurance Associates’ warranty or guaranty of the financial stability of the insurer in question, and that the information is current only as of the date of the publication.

Top Rated Carrier! The policy is underwritten by Zurich American Insurance Company, which is rated A+, XV by AM Best*.

No cost increase from the 2014-2015 policy year!

Easy online enrollment and instant Certificate issuance!

No Policy Aggregate or Interrelated Claims Limit!

Enroll Today!

www.calsurance.com

Login: NLG Password: VT150

CalSurance Associatesa division of Brown & Brown

Program Insurance Services, Inc.Domiciled in California, California License # 0B02587

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National Life Group – Independent Program Outline of Coverage

This document is a summary of the coverage provided. All statements contained herein are subject to all of the terms, conditions, and exclusions of the actual policy. Please also review the Exclusions document for additional details. A policy can be obtained by calling CalSurance Associates at 866-226-9308.

Page 1 of 2

Policy Period: May 1, 2015 to May 1, 2016 Insurer: Zurich American Insurance Company (a member of the Zurich Financial Services Ltd. and an Admitted Carrier) 2014 A.M. Best's A+ (Superior): XV As of November 26, 2014* *The information obtained from A.M. Best dated November 26, 2014 is not in any way CalSurance Associates’ warranty or guaranty of the financial stability of the insurer in question, and that the information is current only as of the date of publication. Policy Number: EOC 9156498‐01 Risk Purchasing Group Membership: By applying for this insurance, agents are applying for membership in the Financial Sales Professionals Purchasing Group, a group formed and operating pursuant to the Liability Risk Retention Act of 1986 (15 USC 3901et seq.). There is no additional charge for this membership. Limit of Liability (including Defense Costs): Each “Claim”/ Annual Aggregate per “Named Certificate Holder” $1,000,000/$2,000,000

Deductibles: $500 each Claim each Insured for products

of National Life Group $2,500 each Claim each Insured for outside

products

Coverage: Claims Made and Reported coverage for acts, errors, omissions, or Personal Injury arising out of the rendering or failing to render Professional Services for others in the conduct of the Named Certificate Holder’s profession as an Agent, broker or General Agent. Eligible Participants /Named Certificate Holders: The following provided they maintain a contract with National Life Group and not registered with ESI. Independent Agents of National Life Insurance

Company

Agents of Life Insurance Company of the Southwest

Insureds: • Corporation/Partnership/Business Entity • Partners/Officers/Directors/Stockholders • Heirs/Executors/Administrators/Legal

Representatives No additional Limits of Liability are provided to the Insureds listed above. The Limit of Liability shall be that Limit of Liability applicable to the Named Certificate Holder whose wrongful acts gave rise to the Claim or the Named Certificate Holder who is responsible for the wrongful acts of such other Insureds. Claims Administration: Lancer Claims Services, A Division of Brown & Brown Program Insurance Services, Inc. Program Administration: CalSurance Associates, A Division of Brown & Brown Program Insurance Services, Inc. California License Number: 0B02587 Duty to Defend? Yes, to those “Claims” for which coverage applies

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National Life Group – Independent Program Outline of Coverage

This document is a summary of the coverage provided. All statements contained herein are subject to all of the terms, conditions, and exclusions of the actual policy. Please also review the Exclusions document for additional details. A policy can be obtained by calling CalSurance Associates at 866-226-9308.

(4/2/2015) Page 2 of 2

Professional Services: 1. The sale or servicing of:

a. Life Insurance, Accident and Health Insurance, Long‐Term Care Insurance, Disability Income Insurance, and Fixed Annuities or Indexed Annuities;

b. Employee benefit plans funded with those products listed herein in subsection 1.a;

c. Workers’ Compensation Insurance as part of a 24‐hour Accident and Health Insurance Product;

d. Financial planning, advice and consultation solely in connection with any of the products listed in subsection 1;

e. Notary public services; 2. The supervision and training by a General Agent

over the conduct of any Insured. 3. The consultation with participants in an

employee benefit plan in order to explain the provisions of such plan and the handling of day‐to‐day ministerial functions required by such plan, including without limitation, enrollment, record keeping and filing reports with governmental agencies (not including Multiple Employer Welfare Arrangements, 412(i), and 419(e); see Exclusion O.).

Retroactive Date: The earlier of: • The date of inception of the Named Certificate Holder’s continuously maintained contract with National Life Group; or

• The date of the first claims made errors and omissions liability coverage maintained without interruption and for which written proof is provided.

If the Named Certificate Holder elects an effective date other than May 1, 2015 and enrolls with a gap in E&O Coverage, the Retroactive Date will be the date of the first claims made errors and omissions liability coverage maintained without interruption and for which written proof is provided. (i.e. no coverage for errors alleged prior to date of enrollment)

Cancellation of Coverage or Contract Termination: Coverage automatically ceases on the date the Agent’s contract terminates, regardless of the reason for such termination. The Agent will be responsible for any outstanding amount due if termination occurs. Extended Reporting Period (ERP): ERP is provided for one year1 from the date of contract termination for National Life products and 90 days for all other covered products. ERP provides the Agent with the ability to report Claims arising out of Wrongful Acts, which occurred before the date of termination and after the Retroactive Date that are otherwise covered by the Policy. If the Agent’s contract terminates due to retirement, disability, or death, the reporting described above will be extended to two years from contract termination. The following ERP options would then be available for purchase within 60 days of contract termination: • 3 years from contract termination at 200% of

expiring annual premium • 5 years from contract termination at 300% of

expiring annual premium • Unlimited amount of time from contract

termination at 400% of expiring annual premium ERP does not reinstate or increase the Limits of Liability beyond the limits shown on the Certificate of Insurance, nor does it extend the Policy Period. ERP will NOT be provided under the following circumstances: • if other E&O insurance has been purchased to

replace this Policy; or

• if the Agent is insured under any other professional liability insurance policy.

1 If termination resulted from violation of National Life Group policies and procedures, one year ERP will be limited to six months.

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NLG_IndChnl_App_03172015v9

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NATIONAL LIFE GROUP

Independent Channel Enrollment FormClaims Made and Reported Errors and Omissions Coverage

Policy Period: May 1, 2015 to May 1, 2016

CalSurance R

Section 2 - Eligibility InformationPlease complete the following questions. If you are renewing your coverage under the National Life Group sponsored E&O policy, please answer “NO” if there have been no changes to your responses since your prior enrollment:

1. Have you been the subject of disciplinary action by any insurance authority? ____Yes ____ No2. Has any policy or application for E&O insurance or reinsurance on your behalf been declined, canceled, or renewal refused within the last five years? ____Yes ____ No3. Have any E&O claims been made against you within the last ten years? ____Yes ____ No4. Are there any circumstances which may result in any E&O claims being made against you that were (i) not reported under a prior E&O policy; or (ii) not disclosed in a prior application submitted under this program? ____Yes ____ NoIf you answered “YES” to any of the above questions, your enrollment is NOT guaranteed and is subject to review and approval by the sponsor. Please provide an explanation and documentation regarding the facts of your “YES” responses. Please be advised that CalSurance’s receipt of your enrollment form and/or payment does not constitute acceptance of your enrollment in this program. The sponsor reserves the right to deny enrollment.5. Please list any professional services and/or designations used with your clients other than as a life insurance agent, notary public or financial planner (i.e. registered with a broker/dealer, TPA, attorney, CPA, actuary, P&C agent). _____________________________________________________6. Do you carry E&O coverage* for each of the professional services and/or designations listed above? ____Yes ____ No7. If you answered no please list any professional services or designations for which you do not carry E&O coverage. ____________________________

*The E&O policy to which you are applying does NOT provide coverage for professional services other than as a life insurance agent, notary public, and financial planner.

Section 4 - Payment Options (Please select one) Payment in Full by Check: Check made payable to CalSurance Associates for the full premium. - or - ACH Debit – Four Installments: Please return the enrollment form with the attached Debit Pre-Authorization Form along with a voided check. Without a completed Debit Pre- Authorization Form, this enrollment WILL NOT be processed.

For additional payment options, please enroll online at www.calsurance.com Login: NLG Password: VT150

Coverage Questions....Call CalSurance Associates at (866) 226-9308 or email at [email protected]

Instructions..... ALL sections must be completed. Please allow up to ten (10) business days for processing. Incomplete forms will take additional time to process.If you are paying by ACH Debit, fax enrollment form to (800) 607-6875. Return this form along with payment to: CalSurance Associates, PO Box 7048, Orange, CA 92863-7048

Certificates of Insurance....Visit: www.calsurance.com - Certificate Reprint - National Life Group - Independent

Section 5 - Notices and Warranties NOTICE: I must be a currently contracted agent with a National Life Group Company to be eligible for this program. Otherwise, I will not be considered an Insured under this program and no claims made against me will be covered.I warrant that I am currently contracted with National Life Group.NOTICE: This is a claims made and reported policy. If I have knowledge of any claim or incident that could give rise to a claim under the proposed policy and any claim or action arises therefrom, it is excluded from coverage for which this form applies. A potential gap in coverage may occur if I elect an effective date that is not continuous with my prior expiration date and may result in the denial of a claim. I warrant that I have no knowledge of any pending claim or incident that could give rise to a claim under the proposed policy. I acknowledge that the specimen policy and program materials have been delivered to me via www.calsurance.com (Login: NLG Password: VT150) and I have reviewed these documents prior to enrolling in the program. I warrant and represent that the above statements are true and that I have not suppressed or misstated any material facts and I agree that this application shall be the basis of the contract with the company issuing the policy. It is understood that completion of this application does not bind the company to issue or the applicant to purchase the insurance.NOTICE: The premium is fully earned and there is NO return of premium if I decide to cancel for any reason. I have read the above notices and warranties and agree.

Date

Signature

- -

Section 3 - Effective Date and Amount Due

Effective Date of Coverage

* Please refer to the Outline of Coverage for coverage details. Note: Premium is inclusive of a non-refundable administration fee.

Enter amount from RATE TABLE attachedwhich corresponds to the above selection: $

By applying for this insurance, Agents are applying for membership in the Financial Sales Professionals Purchasing Group, a group formed and operating pursuant to the Liability Risk Retention Act of 1986 (15 USC 3901 et seq.). There is no additional charge for membership.

- -

Section 1 - Your Information (Please Print Clearly)

Street Address

First Name M.I. Last Name

Email

City Zip CodeState

Phone Number Fax Number- -- -

CalSurance Associates, a division of Brown & Brown Program Insurance Services, Inc.Domiciled in California, License # 0B02587

NLG Agent Code LSW Agent Code

Coverage Limits Premium

Life Only*

See Reverse for Premium Table

Note: Effective date of coverage cannot be prior to your date of contract with the sponsor.

$1,000,000 each Claim/$2,000,000 Aggregate each Agent$1,000,000 each Claim/$2,000,000 Aggregate each Agent

(MM) (DD) (YYYY)

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NLG_IndChnl_MTMatrix03172015v5 CalSurance Associates, a division of Brown & Brown Program Insurance Services, Inc. Domiciled in California, License # 0B02587

NNAATTIIOONNAALL LLIIFFEE GGRROOUUPP IInnddeeppeennddeenntt CChhaannnneell

RRaattee TTaabbllee

Policy Period: May 1, 2015 to May 1, 2016

Enrollment Month $1,000,000 Each Claim $2,000,000 Aggregate Each Agent

Installment Amounts*

May 2015 $600.00 4 installments of $155.00

June 2015 $556.58 4 installments of $144.15

July 2015 $513.17 3 installments of $176.06

August 2015 $469.75 3 installments of $161.58

September 2015 $426.33 2 installments of $218.17

October 2015 $382.92 2 installments of $196.46

November 2015 $339.50 $339.50 in full

December 2015 $296.08 $296.08 in full

January 2016 $252.67 $252.67 in full

February 2016 $209.25 $209.25 in full

March 2016 $165.83 $165.83 in full

April 2016 $122.42 $122.42 In full

*A $5 fee is included in the installment amounts. Installment dates are upon enrollment, 7/1/15, 9/1/15, and 11/1/15.

Above rates include a non‐refundable administration fee.

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NATIONAL LIFE GROUP Independent Channel

Errors and Omissions Program Debit Pre-Authorization Form

MAY 1, 2015 TO MAY 1, 2016

NLG_INDCHNL_ACH03162015v5 CalSurance Associates, A Division of Brown & Brown Program Insurance Services, Inc Domiciled in California, License # 0B02587

I (we) hereby authorize CalSurance Associates, hereinafter called COMPANY, to initiate electronic debits from my (our) checking account indicated below at the financial institution named below, hereinafter called DEPOSITORY and to debit the same to such account. This authority is to remain in full force and effect until COMPANY and DEPOSITORY have each received written notification from me (or either of us) of its termination in such time as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

I (we) agree that if premiums are not paid on the dates specified below, or in the event the withdrawals are dishonored, coverage shall terminate upon ten (10) days. The agent will be eligible for reinstatement of coverage ONE time only, by paying appropriate premium in addition to a Declined/Non‐Sufficient Fund Fee of $50. Please attach a voided check to the bottom of this form. The Enrollment Form will not be processed if a voided check is not attached. Annual premium will be divided into equal installments. Payments will be processed accordingly. Installments will be taken upon receipt of Enrollment Form, July 1, 2015, September 1, 2015 and November 1, 2015. A $5 processing charge will be added to each installment. I understand that if any of the scheduled installment dates have passed at the time of my enrollment, my premium will be divided between the remaining installment dates.

Name of Financial Institution: Address or Branch: City: State: Zip: Transit / ABA Number: Account Number:

This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and Financial Institution a reasonable opportunity to act on it.

Name: Signature: Date: Signature: Date: (If account requires two signatures)

Please attach a voided check, or photocopy there of applicable to the above account in this space below. (Enrollment will not be processed without it).

2015 May 1

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National Life Group – Independent Program

Exclusions

This document is a summary of the policy exclusions. All statements contained herein are subject to all of the terms, conditions, and exclusions of the actual policy. Please also review the Outline of Coverage for additional details. A copy of the policy can be obtained by calling CalSurance Associates at 866-226-9308.

Page 1 of 3

This Policy does not apply to any "Claim":

A. Arising out of any act, error or omission of the "Insured" committed with dishonest, fraudulent, malicious or knowingly wrongful purpose or intent; however, notwithstanding the foregoing, the "Insured" shall be afforded a defense, subject to the terms of this Policy, until the allegations are subsequently proven by a final adjudication. In such event, the "Insured" shall reimburse the Company for all "Defense Costs" incurred by the Company;

B. Alleging bodily injury, sickness or death of any person, or injury or destruction of any tangible property, including loss of use thereof;

C. Alleging the liability of others assumed by the "Insured" under any contract or agreement unless such liability would have attached to the "Insured" even in the absence of such agreement;

D. By an enterprise which one or more "Insureds" own, operate, control or manage; or any "Claim" by an enterprise which owns, operates, controls or manages an "Insured";

E. Arising out of services performed by the "Insured" as an actuary, accountant, attorney, real estate agent or real estate broker, named fiduciary or third party claims administrator;

F. Arising out of, or contributed to by, any commingling of, or use of client funds;

G. Arising out of, directly or indirectly, the insolvency, receivership, bankruptcy, or inability to pay of any organization in which the "Insured"

1. Has placed or obtained a client's coverage;

2. Has placed a client's funds; or

3. Has recommended a client invest.

However, this exclusion shall not apply if the "Claim" is based upon the insolvency, receivership, liquidation or inability to pay of any insurance company that was rated as A‐ or better by A.M. Best Company at the time the business was placed, obtained or recommended;

H. Arising out of the "Insured's" activities in computer programming or processing if the resulting programs or software are sold or distributed or if a fee is charged for use of such program or software;

I. Made against any "Insured" or the "Additional Insured" by:

1. Any "Insured";

2. Any "Additional Insured";

3. Any "Broker/Dealer";

4. Any other insurance company;

5. Any other insurance agency, brokerage or intermediary;

6. Any person or entities who in the past were, but are not currently, parties to an agent contract with the "Additional Insured"; or

7. Any subsidiary or affiliate of the "Insured", "Additional Insured" or "Named Insured";

J. Arising out of the use of confidential information by an "Insured", including but not limited to such use for the purpose of replacement of coverage;

K. Arising out of the "Insured's" inability or refusal to pay or collect premium, claim or tax monies, including surcharges or assessments of any kind;

L. Arising from, or contributed to by, the placement of client's coverage or funds directly or indirectly with any organization which is not licensed to do business in the state or jurisdiction with authority to regulate such business. However, this exclusion does not apply to any "Claim" arising from or contributed to by the

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Exclusions


(4/2/2015) Page 2 of 4

placement of client's coverage or funds directly or indirectly with any organization which is an eligible surplus lines insurance company in the state or jurisdiction with authority to regulate such business;

M. Arising out of the ownership, formation, operation, administration, advice, referral, recommendation or placement of coverage with any health maintenance organization, preferred provider organization, risk retention group, Multiple Employer Welfare Arrangement, self insurance program or purchasing group;

N. Arising out of or based upon:

1. The Federal Telephone Consumer Protection Act (47 U.S.C. sec 227), Drivers Privacy Protection Act (18 U.S.C. sec. 2721‐2725) or Controlling the Assault of Non‐Solicited Pornography and Marketing Act (15 U.S.C. sec. 7701, et seq.); or

2. Any other federal, state or local statute, regulation or ordinance that imposes liability for the:

a. Unlawful use of telephone, electronic mail, internet, computer, facsimile machine or other communication or transmission device; or

b. Unlawful use, collection, dissemination, disclosure or redisclosure of personal information in any manner by an "Insured" or on behalf of any "Insured";

O. Arising out of the purchase, sale or the giving of advice regarding:

1. Commodities, commodity future contracts, warrants, forward contracts, interest rate swaps or option contracts other than covered call option contracts or auction rate securities;

2. Any security priced under five dollars ($5.00) at the time of purchase;

3. Promissory notes or other non‐securitized evidence of debt;

4. Viatical settlements, life settlements, stranger owned life insurance policies, or any security backed by either viatical, settlements, life settlements or stranger owned life insurance policies;

5. Reverse mortgages or similar transactions in which the present value of a conditional contract is exchanged or sold;

6. ETS pay phones or pay phone investments;

7. "Junk Bonds" or "High Yield Bonds". For the purposes of this exclusion, "Junk Bonds" or "High Yield Bonds" mean bonds which, at the time of purchase or sale were unrated or rated as below investment grade by any rating agency (including but not limited to Moody's rated bonds of Ba or lower or S&P rated bonds of BB or lower);

8. A qualified retirement plan (intended to be a plan) described in Section 412(i) of the Internal Revenue Code of 1986, as amended (the "Code") (prior to the amendments by the Pension Protection Act of 2006) or Section 412(e)(3) of the Code (after the amendments by the Pension Protection Act of 2006) or any successor thereto;

9. A single employer welfare benefit fund (intended to be a welfare benefit fund) described in Section 419(e) of the Internal Revenue Code of 1986, as amended or any successor thereto; or

10. A multiple employer welfare benefit fund (intended to be a welfare benefit fund) described in Section 419(A)(f)(6) of the Internal Revenue Code of 1986, as amended or any successor thereto;

Exclusions O.8, O.9, and O.10 shall not apply if

a) Such plan was funded in whole or in part by coverage issued by national Life Group or was administered through NRPA (National Retirement Plan Advisors, Inc.) or Pentegra Retirement Services; or

b) The agent was previously a National Life Career Agent with a minimum of 15 years of service and has been enrolled in the Independent program for at least three (3) years.

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Exclusions


(4/2/2015) Page 3 of 4

P. Brought by, or on behalf of, the Securities Investor Protection Corporation, or any governmental, quasi‐governmental, regulatory, or self‐regulatory entity, whether directly or indirectly; however, this exclusion shall not apply to any "Claim" by such entity to enforce its rights as a direct customer of the "Insured" or "Additional Insured";

Q. Brought by, or on behalf of, any clearing agency or arising out of any function of any "Insured" or "Additional Insured" as a clearing agency;

R. Arising out of the "Insured's" activities in exercising discretionary authority, management or control over a customer's account;

S. Arising out of or based upon infringement of patent, copyright, trademark, service mark, trade dress, trade secret or trade name, unfair competition or piracy, theft or wrongful taking of concepts including using another's advertising ideas or other intellectual property;

T. For "Personal Injury":

1. Sustained by any "Insured" or "Additional Insured";

2. Caused by or at the direction of the "Insured" with the knowledge that the offense would violate the rights of another and would inflict "Personal Injury";

3. Arising out of oral or written publication of material, if done or at the direction of the "Insured" with knowledge of its falsity;

4. Arising out of an electronic chatroom or bulletin board the "Insured" hosts, owns or over which the "Insured" exercises control; or

5. Arising out of the unauthorized use of another's name or product in the "Insured's" email address, domain name or metatag, or any other similar tactics to mislead another's potential customer;

U. Arising out of alleged discrimination of any kind;

V. Prior to the first effective date of coverage issued to the "Named Certificate Holder", provided no "Insured" had any basis:

1. To believe that any "Insured" had knowledge of any negligent act, error or omission or "Personal Injury";

2. To foresee that any such negligent act, error or omission or "Personal Injury" or any related negligent act, error or omission or "Personal Injury" might reasonably be expected to be the basis of a "Claim";

W. Based upon, arising out of, or attributable to:

1. The actual, alleged or threatened discharge, release, escape, seepage, migration or disposal of "Pollutants" into or on real or personal property, water or the atmosphere; or

2. Any direction or request that the "Insured" tests for, monitors, cleans up, removes, contains, treats, detoxifies or neutralizes "Pollutants", or any voluntary decision to do so.

This pollution exclusion applies whether or not such "Pollutants" have any function in the "Insured's" business, operations, premises, site or location and regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to any "Damages" and "Defense Costs" associated with such "Pollutants"; or

X. Based upon, arising out of, or attributable to the quality of care rendered by, lack of care rendered by, or the alleged malpractice of a participating provider of health‐related services, its employees, physician, or other practitioner, of any Health Maintenance Organization or other Healthcare provider.

Y. Based upon or arising out of any Pension, Profit Sharing, Health and Welfare or other Employee Benefit Plan or Trust sponsored by the “Insured” as an employer;

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Exclusions


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Z. Arising out of the “Insured” making representations, promises or guarantees as to the future value of any investment including but not limited to, representations, promises or guarantees as to interest rates, fluctuations in interest rates, future premium payments or market values (s);

AA. Arising out of or involving investment products partially or totally owned by the “Insured”; or

BB. Arising out of the brokering of structured settlements; however, this exclusion does not apply to any “Claim” arising from or contributing to the sale of annuity products used to fund the structure settlement.

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