Frequently Asked Questions - Employee Benefits

If you die or suffer a loss while insured for Life Insurance under the Policy, we will pay the benefit to your Beneficiary according to the terms of the Policy after we receive satisfactory proof of death or loss.

You must apply for the Policy when required, be an Eligible Person, and be a member of the defined Eligible Class.

You may elect optional coverage up to 5 times your annualized earnings rounded to the nearest $1,000, up to a ceiling of $500,000. Additional coverage for your spouse is also available, as covered below.

If you are applying for coverage in excess of the Guaranteed Standard Issue amount, or if you are applying under Late Enrollment, or if you are applying for reinstatement after your coverage has ended, you will be required to provide Evidence of Insurability. We may require you to have a physical examination depending on several factors including the amount of coverage you elect.

Yes, employees pay towards the cost of the insurance premium.

In most states, these policies are portable.  If your Optional Life Insurance ends because your job with the Employer ends, or your job changes so that you are no longer in the Eligible Class, for example, you may continue your Optional coverage by making the election for portability within 31 days from the date your coverage ended.  If you make this election, your continued coverage will be covered by the terms of the Group Life Portability Policy, and the premiums will be at the rate then in force for the group premium rate.  Information is available from your Employer on the benefit features and pricing of this coverage.

Any portion of your coverage that you do not elect for the portability feature may be converted to an individual policy according to the Conversion Privilege.

The Conversion Privilege permits you to keep your Employee Life insurance in the following situations:

  • Your employment ends;
  • You leave the Eligible Class;
  • The Policy ends or there is a change in the Eligible Class, under certain other specified conditions; or
  • Your Policy was being continued because of a disability and the continuation ceases and you have not returned to work as an active employee.

Application must be made within 31 days after the group insurance ends. The converted policy is an individual policy, written on any form we then issue for the amount chosen, except term insurance. Waiver of premium, accidental death, or other optional provisions or riders are not available under the individual policy.

If you become Totally Disabled before age 60 while insured under the Policy, your Employee insurance will be continued without further payment of premium.  You must pay the premiums until your Totally Disability is approved.  To be considered Totally Disabled, you must:

  • Be unable to perform the material duties of your own occupation on a full-time or part-time basis because of an injury or sickness;
  • Not work at all in any occupation; and
  • Be under a physician’s care.

Yes, you may choose to continue your and your spouse’s coverage during a Family and Medical Leave.

If you choose to continue the coverage during the leave, the required contributions must be paid to your Employer, any changes in benefits that occur during the continuation period will apply on the effective date of the change, any Active Work or hospital confinement period will be waived, and the continuation during the Family and Medical Leave will run concurrently with a continuation during any other leave of absence.

If you choose not to continue your coverage, coverage will resume without your providing Evidence of Insurability if you return to work immediately after the Leave ends.

Family and Medical Leave means a leave of absence as defined by the Family and Medical Leave Act of 1993 or any state-mandated family and medical leave act or law.

Yes, in the event of a Terminal Illness expected to result in death within 12 months, you may receive the lesser of 50% of the Life Benefit or $250,000, provided that you have at least $10,000 of life insurance. Because you may have to pay tax on this Living Benefit, you should consult with your tax adviser before requesting this benefit.

You have the option of insuring your spouse’s life for 10%, 20%, 30%, 40% or 50% of the supplemental coverage you elected, rounded to the nearest $1,000, with a ceiling of $250,000.

If you elect coverage in excess of the Guaranteed Standard Issue limit, your spouse may have to provide Evidence of Insurability, part of which may include a physical exam.

In most states, these policies are portable. If your Optional Life Insurance ends because your job with the Employer ends, or your job changes so that you are no longer in the Eligible Class, for example, you may continue your Optional coverage by making the election for portability within 31 days from the date your coverage ended. Any portion of the spousal life insurance benefit may be continued under portability with a minimum of $10,000 coverage to a maximum of the lesser of the plan maximum or a total of $500,000 for all policies with Provident.

Yes, in the event of your spouse’s Terminal Illness expected to result in death within 12 months, you may apply to receive a portion of the life insurance benefit while your spouse is still alive, up to 50% of life benefit with a maximum payment of $125,000, if your spouse has at least $10,000 of life insurance coverage. Because you may have to pay tax on this Living Benefit, you should consult with your tax advisor before requesting this benefit.

You may elect an Accidental Death and Dismemberment (AD&D) policy in amounts of up to five times your annual earnings, rounded to the nearest $1,000, up to a ceiling of $500,000. This coverage is referred to as the Principal Sum. If you suffer a Loss due to Accidental Injury while insured for AD&D, we will pay the benefit to your named Beneficiary.

The AD&D benefit is a percentage of the Principal Sum based on the type of Loss as shown below:

Accidental Loss Of Percentage of Principal Sum
Life 100%
Both hands or both feet or sight of both eyes 100%
One hand and one foot 100%
Either hand or foot and sight of one eye 100%
One hand or one foot 50%
Sight of one eye 50%
Speech and hearing 100%
Paraplegia, quadriplegia, or hemiplegia 100%
Maximum any one accident 100%

The Loss must occur within 365 days of the accident.

Yes, employees pay towards the cost of the insurance premium.

Yes. This Policy includes a Seat Belt Benefit of an additional 10% of the AD&D benefit otherwise payable not exceeding $10,000, for those covered Losses resulting from automobile accidents while wearing a seat belt, subject to certain terms and conditions as described in your Insurance Certificate.

This Policy also provides for an Education Benefit of an additional 5% of the AD&D benefit otherwise payable, to be paid to a Qualified Student, defined as a spouse or child who at the time of your death was a full-time post high school student in a school of higher learning.

Like your Life Insurance policy, this policy is portable in most states. Similarly, the new policy will be governed by the terms of the Group Life Portability Policy, at the rates then in force. This AD&D coverage is not available for conversion to an individual policy

Yes.  You may elect optional coverage of 10%, 20%, 30%, 40% or 50% of the supplemental coverage you elected, rounded to the nearest $1,000, to a ceiling of $250,000.

The benefits follow the same schedule as your own AD&D policy, and also include the Seat Belt benefit. The spousal AD&D policy benefits do not include the Education Benefit, and all benefits will be paid to you, rather than any other named beneficiary. Unlike your own AD&D policy, the spousal coverage is not portable.

Loss is defined as:

  1. Loss of a hand means total severance at or above the wrist;
  2. Loss of a foot means total severance at or above the ankle joint;
  3. Loss of sight, speech, or hearing means the entire and irrevocable loss of the function;
  4. Loss of thumb and index finger means total severance of each at or above the joint closest to the wrist, without loss of the entire hand;
  5. Loss of use of hands or feet means total and irrevocable loss of voluntary movement;
  6. Total paralysis of both arms and legs for quadriplegia;
  7. Total paralysis of both legs for paraplegia;
  8. Total paralysis of the arm and leg on the same side of the body for hemiplegia.
     

Benefits are not paid for Losses caused directly or indirectly, wholly or partly by:

  1. Physical or mental disease, pregnancy, hernia, or ptomaine;
  2. Medical or surgical treatment, except surgical treatment required by the accident and performed within 90 days of the accident;
  3. Infections, except those occurring through a wound at the time of the accident;
  4. Suicide or intentionally self-inflicted injury, whether sane or not;
  5. War or act of war, declared or not, civil or international;
  6. Injury while riding in any aircraft not licensed to carry passengers or not operated by a duly licensed pilot;
  7. Injury while acting as a pilot, student pilot, crew member, flight instructor, or examiner on any aircraft;
  8. Committing, or attempting to commit, an assault, felony or any criminal offense, or active participation in a riot;
  9. Voluntary use of any controlled substance as defined by statute, unless used as directed by a physician;
  10. Operation by the insured of a automobile or boat if at the time of injury, the insured’s blood alcohol concentration exceeded the legal limit; or
  11. Overdose of any medication if not taken as prescribed by a physician.
     

Employee Disability Insurance is designed to provide income replacement to protect you and your family from financial hardship in the event you are unable to work at full capacity due to injury or sickness. The Executive Disability Program is comprised of three elements:

  • Short Term Disability, an elective coverage which commences on the 14th day after the disability and continuing to the 180th day of disability;
  • Long Term Disability, for disability extending over 180 days, that provides eligible executives 60% of their base pay up to a maximum monthly benefit ceiling; and
  • Executive Buy Up, whereby eligible executives may exercise the option of increasing the level of their long-term disability insurance coverage from 60% of their base salary to 80% of their total income, up to a maximum monthly benefit ceiling.

Most Americans have a greater chance of becoming disabled before retirement than of dying. Nearly 15% of the population aged 22-44 is disabled, and of those severely disabled, 54.2% are between the ages of 22-64.1 The employment rates and earning power are reduced substantially among these groups. Advances in modern medicine have resulted in declines in death rates, while chronic long term disability increased over the same period. 48% of all home foreclosures are the result of disability, while only 3% of all foreclosures are related to deaths.2

1 McNeil, J. M. “Americans with Disabilities: 1994-95.” U.S. Department of Commerce Economics and Statistics Administration. P70-61 (August 1997): 2, 3. figure 2. Internet. June 13, 2000. Available: http://www.sipp.census.gov/sipp/pubsmain.htm
2 Housing and Home Finance Agency, U.S. Government

Disability insurance is protection against lost earnings as a result of accident or illness; while health insurance covers direct medical and hospital costs, disability insurance covers the need to protect income to maintain one’s family during the period of recuperation and to sustain additional expenses.  If a disability last longer than 90 days, the average length of the disability is over two years.  Few people have savings sufficient to protect their homes and families’ needs over that period of time in the pre-disability standard of living. 

Average Length of Disability if Disability Lasts Over 90 Days1
Age 25 2.1 years
Age 35 2.8 years
Age 45 3.2 years
Age 55 2.6 years
1 UNUM

You should plan on replacing as much of your net income as possible if you can afford the additional coverage. Although work-related expenses and income taxes may be decreased as a result of the disability, unreimbursed or uninsured medical and rehabilitative expenses can be anticipated to increase. And all the while, the usual basic living expenses and family support needs continue.

The total amount of the benefits you receive cannot exceed approximately 80% of your usual net income, so that you are not encouraged to remain disabled rather than returning to work.

This policy is guaranteed renewable, which means that the insurance carrier may not change your benefits.

Frequently, insurers offer as optional coverage, cost-of-living allowance (COLA) coverage, inflation increase benefit coverage, or an additional purchase benefit, permitting the purchase of additional insurance, subject to financial insurability. Others insurers provide automatic increase benefits, which provide for increases in benefits without annually increases a policy owner’s monthly benefit without evidence of either medical or financial insurability. Check out the various kinds of policies.

Coverage will continue without payment of premiums while monthly benefits are payable.

Built into some policies, available as an option with others, this benefit is called a residual disability benefit, which pays the insured a portion of the total disability benefit after a return to work based on the level of disability, or in some policies, based on the percentage of income lost due to the disability. For example, if after rehabilitation and therapy, you were able to perform some 70% of your job duties, you would be eligible for 30% of your disability benefit.

These are to be distinguished from recovery benefits, which provide for partial payment of benefits after a person has returned to work after a long term disability, until his or her earnings have been restored to pre-disability levels, even though he or she is fully recovered and no longer disabled in any way.

Recovery benefits, featured in some policies, provide for partial payment of benefits after a person has returned to work after a long term disability, until his or her earnings have been restored to pre-disability levels while the insured is re-establishing a client or customer base. This feature is particularly valuable to those engaged in professional practices and to those whose compensation is heavily incentive-based.

Suppose I have a disability that prevents me returning to my former occupation. Must I return to any occupation? Are expenses for rehabilitation covered?

Coverage can vary. Some insurers will permit the insured to choose whether to return to work if he or she cannot return to the former occupation. Additionally, some insurance policies will provide for rehabilitation or retraining expense coverage in addition to the regular benefits, under certain terms and conditions.

Own occupation” refers to the occupation in which you worked at the time of the disability; this term should always be distinguished from “regular occupation, ” which is interpreted to mean the occupation you had at the time of the disabling event until you have received 24 months of benefits due to the same disability—after those 24 months, “regular occupation” means any gainful occupation for which you are reasonably fitted by training, education or experience, whether or not that gainful occupation yields earnings commensurate with pre-disability levels. If you are not employed at the beginning of a disability, regular occupation means any gainful occupation for which you are reasonably fitted by training, education or experience.

If you become disabled during the period of time for which you purchased benefits, you will be covered for the income protection level you elected at the time of the policy purchase. Calculations for residual benefits will be based on your ability to perform those activities that you had been able to do prior to the disabling event.

The answer depends on the source and nature of the funds used to pay the insurance premiums. If you paid for the premiums with after-tax dollars, then you should receive the disability benefits tax-free. If you paid for the premiums with pre-tax dollars, then the benefits are generally taxable to you, as are benefits paid for by your employer. You should consult with your tax advisor about tax treatment of any disability insurance that you have and/or are considering purchasing.

To be eligible for coverage, you must apply under this Policy, and be an Eligible Person of an Eligible Class. The Eligible Class is defined in your Schedule of Insurance; an Eligible Person is:

  • An Employee Actively at Work for the Employer;
  • Regularly scheduled to work at least 30 hours per week;
  • A citizen or legal resident of the United States, its territories, or Canada;
  • Not a temporary or seasonal employee;
  • And not a full-time member of the armed forces of any country.

To be a Covered Person, you must be an Eligible Person, accepted for coverage under the Policy, make premium payments when they become due, complete the Eligibility Waiting Period, and fulfill the Actively at Work requirements and any Evidence of Insurability required.

If you are applying for coverage under Late Enrollment, you are required to provide Evidence of Insurability, which may include a physical examination if required by us, as will be required as well should you apply for reinstatement, or if you were not covered under the prior plan. Evidence of insurability will not be required for employees returning from a Family or Medical Leave.

Your monthly benefit amount is the calculation of your earnings multiplied by the Benefit Percentage (66 2/3rds% of your basic monthly earnings), to a stated maximum, before Benefit Offsets. Benefit Offsets are those amounts to which you are eligible through Workers’ Compensation, any state disability income program, any state unemployment benefit law, and similar programs, as applicable.

Yes. There is a Proportional Return to Work benefit, that restores your earnings to the pre-disability level for the first 24 months after your return to work, and on a formula basis after that time for the duration of the Maximum Benefit Period.

This is an “own occupation” policy, covering disability when you cannot perform the substantial and material duties of the occupation you were routinely performing prior to the disabling event.

If you return temporarily to active work, the allowable period of a temporary return is 12 months, and if you become disabled again within that period, the prior days of disability will apply towards satisfying the elimination period, and your disability will be considered a continuation of the benefit period.

If you die while LTD benefits are payable, the policy provides for a Survivor Benefit Amount as shown in your Schedule of Insurance, presently 6 times the Monthly Benefit Amount, to be paid to your surviving spouse; to your surviving children if you have no surviving spouse; or to your estate if you have no surviving children.

After you have been disabled and received LTD benefits for 12 months, your Monthly Benefit Amount will receive a Cost of Living Adjustment as shown on the Schedule of Insurance on each anniversary of the date LTD benefits began.

The elimination period, or the time you must be disabled, is 90 days. Claims should be filed on the insurer’s forms, and Proof of Loss should be filed within 90 days after the satisfaction of the elimination period.

Your coverage will continue without payment of premiums while LTD Monthly Benefits are payable. Your status as a Covered Person will continue while you are disabled, during any Lay-Off Period or Leave of Absence Period shown in your Schedule of Insurance, during the first six months of a labor dispute or strike, or while you are on a leave of absence under any state or federally mandated family or medical leave act.

Generally, if your age at disability is under 61, benefits will be paid to age 65; at age 61, the duration of benefits is graded according to the information provided in your Schedule of Insurance. However, 24 months of benefits only are provided for those disabilities arising from Mental and Nervous Disorders, or from Drug and Alcohol Disorders. Your Schedule of Insurance describes these limitations in greater detail.

No benefits will be payable for disabilities caused by war or any act of war, declared or undeclared, civil or international, or any substantial armed conflict between organized forces of a military nature; nor during periods of incarceration exceeding 90 days; nor for pre-existing conditions that existed in the three months prior to the effective date of the coverage.

Long term care is the assistance required by an individual who has a chronic illness or disability that leaves him or her unable to care for him- or herself for an extended period of time. Frequently, one receives long term care after one recovers. As much as possible from an accident or illness. Long term care may be provided in a residential care facility (e.g., an assisted living facility, a skilled nursing facility), an adult day care facility, or the individual’s own home. Such care includes both skilled nursing care and custodial care, and may be required by individuals of any age.

A survey of the caregiving members of the National Family Caregivers Association, performed in 1997, revealed the following1:

  • 61% of survey respondents spent 40 or more hours per week in caregiving activities.
  • 87% had been giving care for 3 years or more, and 28% had been giving care for 11 years or more.
  • 25% of caregivers expect to continue in this role for less than 5 more years; 31% expect to continue for five to ten more years; and 44% expect to give care for 11 or more additional years.

According to a study published in June 1997 by the National Alliance for Caregiving, 51.8% of caregivers were employed full-time and 12.3% were employed part-time. Only 35.6% were either retired or not employed.2 Clearly, the demands of caring for a family member will take their toll, no matter how willing you are to provide such care!

1 “Member Survey 1997: A Profile of Caregivers.” National Family Caregiving Association. n.pag. Internet. June 9, 2000. Available: http://www.nfcacares.org.
2 “Family Caregiving in the U.S.: Findings from a National Survey.” n.p.: National Alliance for Caregiving and the American Association of Retired Persons, 1997. 10. Internet. June 9, 2000. Available: http://www.caregiving.org/content/repsprods.asp.

Some of the most significant costs of providing home-based care cannot be measured in dollars; for example, consider the following statistics from the National Alliance for Caregiving1:

  • 25% of all caregivers say that they experience caregiving as emotionally stressful, while 15% report suffering physical or mental health problems as a result of caregiving.
  • 43% of caregivers report that caregiving has left them with less time for other family members than before.
  • 43% report having to give up vacations, hobbies, and other personal activities.
  • 49% of family caregivers who also worked reported having to change their work schedule to provide care (e.g., go in late, leave early, take time off during the work day), and 6% gave up work entirely.

Furthermore, it is estimated that the cost to business of caregiving in terms of lost productivity is between $11.4 and $29 billion per year.2

1 Family Caregiving in the U S.” 23, 22, 22, and 33, respectively.10. Internet.June 9, 2000. Available: http://www.caregiving.org/content/repsprods.asp.
2 “The MetLife Study of Employer Costs for Working Caregivers.” Metropolitan Life Insurance Company, 1997. 7. Internet. June 9, 2000. Available: http://www.caregiving.org/content/repsprods.asp.

Unless you have a net worth in excess of $5 million, chances are you should buy long term care insurance coverage. Costs for long term care can be significant, and statistics show that of 9.3 million Americans receiving assistance with activities of daily living or instrumental activities of daily living, 77% have been receiving care for more than one year and of that number, 29% have been receiving care for more than 5 years.1

By purchasing long term care insurance, you accomplish four key objectives:

  1. You provide yourself with greater control over how and where you will receive care. You are not limited by the options available through Medicaid.
  2. You reduce your dependency on family members, and avoid becoming a burden to them.
  3. You preserve your assets – very important if you will recover from this disability, or if you have a surviving spouse.
  4. You increase the likelihood that all of your needs will for assistance will be met. A government study found that “lacking the necessary assistance with ADLs, approximately one half of those in need experienced a serious negative consequence such as burns from bath water, weight loss, or being chair- or bed-bound.2

1 “Americans with Disabilities: 1994-1995. U.S. Census Bureau. Washington, DC:1997 Table 12. Internet. June 9, 2000. Available: http://www.census.gov/hhes/www/disable/sipp/disab9495/ds94t12.html
2 Health, United States, 1999 with Health and Aging Chartbook.” National Center for Health Statistics. Hyattsville, Maryland. 1999. 60.

A Long Term Care benefit will be paid to you if you become disabled according to the policy schedule. The amount of the monthly payment will depend upon:

  • The Long Term Care plan of coverage you choose;
  • Any options you choose; and
  • The place of residence used for long term care.

Plans of this category are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital, such as in a nursing home, in the community, or in the home.

You are eligible for a monthly benefit if you are assessed as suffering a covered loss of functional capacity and are unable to perform two or more Activities of Daily Living (ADLs) or cognitive impairment. You must be under the regular care of a physician according to the condition.

When you elect the Simple Growth Inflation Protection Option, your coverage will be increased by 5% of your initial amount on the January 1st following your enrollment, and each subsequent January 1st until your total amount of coverage is 200% of your initial coverage.

You may also apply for additional coverage at any time, by completing an Application for Long Term Care Application and providing Evidence of Insurability.

When you apply for additional coverage, with the Simple Growth Inflation Protection Option, your additional coverage will also be increased by 5% of the additional amount each subsequent January 1st.

The Lifetime Maximum Amount is the maximum amount the insurance company will pay you for all the long term care benefits. You have your own Lifetime Maximum Amount. It is shown in the Schedule of Benefits, and may be adjusted to include inflation option increases, if applicable.

To qualify for long term care insurance you must be able to answer “no” to all the following four questions:

  1. Do you use mechanical devices, such as:  a wheelchair, walker, quad cane, crutches, hospital bed, dialysis machine, oxygen, or stairlift?
  2. Do you currently need or receive help in doing any of the following: bathing; eating; dressing; toileting; transferring; maintaining continence?
  3. Do you currently have, or have you ever had a diagnosis for or symptoms of: (a) Alzheimer’s disease, dementia, loss of memory, or organic brain syndrome? Or (b) multiple sclerosis, muscular dystrophy, ALS (Lou Gehrig’s Disease) or Parkinson’s Disease?
  4. Have you been diagnosed or treated by a member of the medical profession for AIDS or the HIV+?

If any of these questions is answered “yes,” coverage is automatically denied.

Beyond these four questions, the long term care insurance application asks approximately 20 questions regarding the applicant’s medical profile and health history. Depending on Unum’s assessment of the applicant’s responses and (possibly) review of a statement from the applicant’s personal physician, coverage may be rated (i.e., premiums may cost more) or coverage may be declined.

No. Medical underwriting is based on your responses to approximately 24 questions regarding your medical profile and health history. In addition, Unum may contact your personal physician to obtain copies of your medical records.

If you are over age 70, you will also be required to complete a personal interview with a representative of the Company. This interview will relate to your medical history and will include a test of cognitive function.

Persons who may be eligible for the plan are active Employees and their family members. An active Employee is a person working on a full-time basis for regularly paid earnings, for a minimum of 30 hours per week, and the Employer’s usual place of business or at a location to which the person is required to travel. Temporary or seasonal employees are not included.

A family member means the spouse of an active Employee, the natural, adoptive or step-parents or grandparents of an active Employee, the natural, adoptive or step-siblings of an active Employee and his or her spouse, or the natural, adoptive, or step-children of an active Employee and his or her spouse. To be eligible for coverage, a family member must be between the ages of 18 and 80.

For Employees: after the Employee has completed the Waiting Period, the Employee may apply for the first 30 days (a period called the First Enrollment Period) without Evidence of Insurability. After the First Enrollment Period, the Employee may apply at any time, with Evidence of Insurability.

For the Employee’s spouse, and for Family Members: the Employee’s spouse and the Family Members may apply any time after the Waiting Period, with Evidence of Insurability.

The appropriate Benefit Election forms are available from your Plan Administrator.

Evidence of Insurability includes the information you supply on the Application for Long Term Care Insurance, and may include proof of your medical history, test results, medical exams, physicians’ statements. The insurance company may also require an insurability assessment, and will use all this information to determine whether to approve or deny an Application.

An insurability assessment means a review done by the insurer or its representative to help to evaluate your cognitive and functional status. It may be by telephone and/or an in-person interview at a location selected by the insurer or its representative.

For active Employees, coverage begins on the latest of the Plan effective date, on the first day of the month that occurs on or after the month in which you became eligible for coverage, or the first day of the month occurring on or after the date you applied for coverage. You will not have coverage if you are absent from work because you are injured, sick, temporarily laid off, or on leave of absence when coverage would ordinarily begin. Coverage will resume when you resume active employment.

For Family Members, coverage commences on the later of the Plan effective date, or on the first day of the month following the date the insurance company approves your Application. Family Members will not have coverage if totally disabled on the date coverage would ordinarily begin. For these purposes, Total Disability is the inability due to injury or sickness, to perform each of the duties or activities of a person of the same age and sex in good health.

  • The date the Summary of Benefits under the Policy ends;
  • The date you no longer are in an Eligible Class;
  • The date your class no longer is included for insurance;
  • The date your total benefit payments equal your Lifetime Maximum Amount;
  • The end of the period for which premiums were last remitted to the insurance company for your coverage;
  • The date you no longer are an active Employee with the company; or
  • You die.

This Group Long Term Care coverage is portable, meaning that you or your authorized representative may elect to continue your coverage on a direct billing basis, and to be paid directly to the insurance company. You may not elect portable coverage if you had chosen to premium payments stopped for your Group coverage. An election for portable coverage must be made within 31 days after the end of the Group coverage. The premium rate schedule and benefit levels will be those in then in force at the time of the election for portability.

Yes. You may apply for changes in coverage at any time, including after election for portable coverage, by completing an Application for Long Term Care which includes Evidence of Insurability.

If you are disabled at the time your coverage would become effective, you will not have coverage until you have resumed active Employment.

If you become disabled and your coverage terminates because of nonpayment of premium, you may request reinstatement of coverage up until five months after the termination date by providing proof that your disability occurred prior to the coverage termination date, and you must pay all unpaid premiums.

Premium payments are waived during the time in which you are receiving benefits and residing in a Long Term Care Facility, in an Assisted Living Facility, or when you are receiving benefits for Total Home Care.

While you continue to have a disability, the Insurer may suggest alternate care designed to help you regain the ability to engage independently in the activities of daily living or to regain cognitive function. Examples may include a rehabilitation program, home modifications for wheelchair access, or certain types of medical equipment or hardware purchases. The terms of such alternate care and the actual expenses will be subject to mutual written agreement, and the Insurer may pay reasonable expenses which are not otherwise payable by Medicare or other insurance. Such alternate care is not mandatory, and if you choose not to accept alternate care, your benefits will continue according to the provisions of your Schedule of Benefits.

The insurer will not cover you for pre-existing conditions. Other exclusions are:

  • Disabilities caused by war, declared or not, or any act of war;
  • Disabilities caused by attempted suicide, whether sane or insane, or other acts of self-destruction;
  • Disabilities caused by commission of a crime for which you have been convicted under state or federal law, or the attempt to commit a crime under state or federal law.
  • Disabilities or confinements when you are outside the United States, its territories or possessions for a period of over 30 days;
  • Any days over 15 days in a calendar year during which you are confined to an acute care facility (acute care is medical care obtained as a result of a sickness or injury requiring immediate medical intervention);
  • Disabilities caused by voluntary use of any controlled substance as defined by law, unless as prescribed by a physician; or • Disabilities caused by psychological or psychiatric conditions which include:
  • Depression;
  • Generalized anxiety disorders;
  • Schizophrenia; or
  • Manic depressive disorders,

whether treated by drugs, counseling, or other forms of therapy. However, the Policy will make payments for conditions that are not psychological or psychiatric in nature, including Alzheimer’s disease, multi-infarct dementia, or Parkinson’s disease.