CommonwealthofMassachusettsGroup
InsuranceCommission
YourGroupLongTermDisabilityPlan
PolicyNo. 123741011
PolicyNo. 125514011
PolicyNo. 125515011
PolicyNo. 125516011
UnderwrittenbyUnumLifeInsuranceCompanyofAmerica
3/31/2017
CERTIFICATEOFCOVERAGE
UnumLifeInsuranceCompanyofAmerica(referredtoasUnum)welcomesyouasaclient.
Thisisyourcertificateofcoverageaslongasyouareeligibleforcoverageandyoubecomeinsured.Youwillwanttoreaditcarefullyandkeepitinasafeplace.
UnumhaswrittenyourcertificateofcoverageinplainEnglish.However,afewtermsandprovisionsarewrittenasrequiredbyinsurancelaw. Ifyouhaveanyquestionsaboutanyofthetermsandprovisions,pleaseconsultUnum'sclaimspayingoffice.Unumwillassistyouinanywaytohelpyouunderstandyourbenefits.
Ifthetermsandprovisionsofthecertificateofcoverage(issuedtoyou)aredifferentfromthepolicy(issuedtothepolicyholder),thepolicywillgovern. Yourcoveragemaybecancelledorchangedinwholeorinpartunderthetermsandprovisionsofthepolicy.
ThepolicyisdeliveredinandisgovernedbythelawsofthegoverningjurisdictionandtotheextentapplicablebytheEmployeeRetirementIncomeSecurityActof1974(ERISA)andanyamendments.Whenmakingabenefitdeterminationunderthepolicy,Unumhasdiscretionaryauthoritytodetermineyoureligibilityforbenefitsandtointerpretthetermsandprovisionsofthepolicy.
Forpurposesofeffectivedatesandendingdatesunderthegrouppolicy,alldaysbeginat12:01a.m.andendat12:00midnightatthePolicyholder'saddress.
UnumLifeInsuranceCompanyofAmerica
2211CongressStreet
Portland,Maine04122
CC.FP-1CC.FP-1 (7/1/2017)REV1
TABLEOFCONTENTS
BENEFITSATAGLANCE...... B@G-LTD-1
LONGTERMDISABILITYPLAN...... B@G-LTD-1
CLAIMINFORMATION...... LTD-CLM-1
LONGTERMDISABILITY...... LTD-CLM-1
GENERALPROVISIONS...... EMPLOYEE-1
LONGTERMDISABILITY...... LTD-BEN-1
BENEFITINFORMATION...... LTD-BEN-1
OTHERBENEFITFEATURES...... LTD-OTR-1
OTHERSERVICES...... SERVICES-1
GLOSSARY...... GLOSSARY-1
TOC-1(7/1/2017)REV2
BENEFITSATAGLANCE
LONGTERMDISABILITYPLAN
Thislongtermdisabilityplanprovidesfinancialprotectionforyoubypayingaportionofyourincomewhileyouaredisabled. Theamountyoureceiveisbasedontheamountyouearnedbeforeyourdisabilitybegan.Insomecases,youcanreceivedisabilitypaymentsevenifyouworkwhileyouaredisabled.
AlltermsboldedaredefinedintheGLOSSARYsection.
EMPLOYER'SORIGINALPLANEFFECTIVEDATE:July1,2007
POLICYNUMBER:Refertothefrontcoverofthecertificate
ELIGIBLEGROUP(S)ANDMINIMUMHOURSREQUIREMENT:
Allfull-timeandhalf-timeemployeeswhoworkatleast183/4hoursina371/2hourworkweekor20hoursina40hourworkweekandwhoareinactiveemploymentintheUnitedStateswiththeEmployerandwhoarenotcoveredunderanyotherGroupUnumLongTermDisabilitypolicywiththePolicyholder
WAITINGPERIOD:
ForemployeesinaneligiblegrouponorbeforeJuly1,2007:Thefirstofthemonthfollowingtwofullcalendarmonthsor60daysofcontinuousactiveemployment,whicheverissooner
ForemployeesinaneligiblegroupafterJuly1,2007:Thefirstofthemonthfollowingtwofullcalendarmonthsor60daysofcontinuousactiveemployment,whicheverissooner
REHIRE:
IfyouremploymentendsandyouarerehiredwhilemaintainingbenefitsunderthePolicyholder'sCOBRAplan,yourpreviousworkwhileinaneligiblegroupwillapplytowardsthewaitingperiod.Ifyourwaitingperiodhasbeensatisfied,youwillbeeligibletoenrollforcoverageonthefirstofthemonthfollowingyourrehiredate. Allotherpolicyprovisionsapply.
WHOPAYSFORTHECOVERAGE:
Youpaythecostofyourcoverage.
ELIMINATIONPERIOD:
90days
Benefitsbeginthedayaftertheeliminationperiodiscompleted.
MONTHLYBENEFIT:
55%ofmonthlyearningstoamaximumbenefitof$10,000permonth.
Yourpaymentmaybereducedbydeductiblesourcesofincomeanddisabilityearnings.Somedisabilitiesmaynotbecoveredormayhavelimitedcoverageunderthisplan.
MINIMUMBENEFIT:
Theminimummonthlypaymentisthegreaterof:
- $100;or
- 10%ofyourgrossdisabilitypayment.
Unummayapplythisamounttowardanoutstandingoverpayment.
B@G-LTD-1(7/1/2017)REV3
MAXIMUMPERIODOFPAYMENT:
AgeatDisabilityMaximumPeriodofPayment
LessthanAge62ToAge65
Age62 42monthsAge63 36monthsAge64 30monthsAge65 24monthsAge66 21monthsAge67 18monthsAge68 15monthsAge69orolder 12months
Nopremiumpaymentsarerequiredforyourcoveragewhileyouarereceivingpaymentsunderthisplan.Premiumpaymentisrequiredwhileyouaresatisfyingyoureliminationperiod.
REHABILITATIONANDRETURNTOWORKASSISTANCEBENEFIT:
10%ofyourgrossdisabilitypaymenttoamaximumbenefitof$1,000permonth.
Inaddition,wewillmakemonthlypaymentstoyoufor3monthsfollowingthedateyourdisabilityendsifwedetermineyouarenolongerdisabledwhile:
- youareparticipatingintheRehabilitationandReturntoWorkAssistanceprogram;and
- youarenotabletofindemployment.
DEPENDENTCAREEXPENSEBENEFIT:
WhileyouareparticipatinginUnum'sRehabilitationandReturntoWorkAssistanceprogram,youmayreceivepaymentstocovercertaindependentcareexpenseslimitedtothefollowing
amounts:
DependentCareExpenseBenefitAmount:$350permonth,perdependent
DependentCareExpenseMaximumBenefitAmount: $1,000permonthforalleligibledependentcareexpensescombined
TOTALBENEFITCAP(alsofoundonLTD-BEN-2):
Thetotalbenefitpayabletoyouonamonthlybasis(includingallbenefitsprovidedunderthisplan)willnotexceed100%ofyourmonthlyearnings. However,ifyouareparticipatinginUnum'sRehabilitationandReturntoWorkAssistanceprogram,thetotalbenefitpayabletoyouonamonthlybasis(includingallbenefitsprovidedunderthisplan)willnotexceed110%ofyourmonthlyearnings.
OTHERFEATURES:
ContinuityofCoverage
DisabilityPlus(CatastrophicBenefit)MinimumBenefit
Pre-Existing:6/6/12
SurvivorBenefit
Theaboveitemsareonlyhighlightsofthisplan.Forafulldescriptionofyourcoverage,continuereadingyourcertificateofcoveragesection.
Theplanincludesenrollment,riskmanagementandothersupportservicesrelatedtoyourEmployer's
BenefitProgram.
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CLAIMINFORMATIONLONGTERMDISABILITY
WHENDOYOUNOTIFYUNUMOFACLAIM?
Weencourageyoutonotifyusofyourclaimassoonaspossiblesothataclaimdecisioncanbemadeinatimelymanner.Youmustprovidetelephonicorwrittennoticeofaclaimwithin30daysofthedateyourdisabilitybegins.Inadditiontonotifyingusoftheclaim,wemustreceiveproofofyourclaim.
ImportantInformationAboutProofofYourClaim
IFYOUDONOTGIVEUSPROOFOFYOURCLAIMWITHIN180DAYSOFTHEDATEYOURDISABILITYBEGINS,YOURCLAIMMAYBEDENIEDFORLATEFILING.
YoumustsendUnumacompletesetofclaimformsnolaterthan180daysafterthedateyourdisabilitybegins.Unumcanonlyreviewyourclaimifitreceivesa
completesetofclaimforms.ProvidingUnumcompletedclaimformsconstitutesfilingandinitialproofofyourclaim.IfitisnotpossibletosendUnumthisinitialproofofyourclaimwithin180daysofthedateyourdisabilitybegins,youmustsendittoUnumassoonasitispossibletodoso,butinnoeventmorethan18monthsafterthedateyourdisabilitybegins.Ifyouhavebeendisabledformorethan18months,Unumwillonlyreviewyourclaimifyouwerepreventedfromfilingtheclaimbyyourlegalincapacity.
YoucanreportaclaimandrequestasetofclaimformsfromUnumbycalling(877)
226-8620.IfyoudonotreceivetheclaimformsfromUnumwithin15daysofyourrequest,donotwait.Youcanobtaintheclaimformsonlineat
HOWDOYOUFILEACLAIM?
YouandyourEmployermustfilloutyourownsectionsoftheclaimformandthengiveittoyourattendingphysician.YourphysicianshouldfillouthisorhersectionoftheformandsenditdirectlytoUnum.
WHATINFORMATIONISNEEDEDASPROOFOFYOURCLAIM?
Yourproofofclaim,providedatyourexpense,mustshow:
- thatyouareundertheregularcareofaphysician;
- theappropriatedocumentationofyourmonthlyearnings;
- thedateyourdisabilitybegan;
- thecauseofyourdisability;
- theextentofyourdisability,includingrestrictionsandlimitationspreventingyoufromperformingyourregularoccupation;and
- thenameandaddressofanyhospitalorinstitutionwhereyoureceivedtreatment,includingallattendingphysicians.
Wemayrequestthatyousendproofofcontinuingdisabilityindicatingthatyouareundertheregularcareofaphysician. Thisproof,providedatyourexpense,mustbereceivedwithin45daysofarequestbyus.
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Insomecases,youwillberequiredtogiveUnumauthorizationtoobtainadditionalmedicalinformationandtoprovidenon-medicalinformationaspartofyourproofofclaim,orproofofcontinuingdisability.Unumwilldenyyourclaim,orstopsendingyoupayments,iftheappropriateinformationisnotsubmitted.
TOWHOMWILLUNUMMAKEPAYMENTS?
Unumwillmakepaymentstoyou.
WHATHAPPENSIFUNUMOVERPAYSYOURCLAIM?
Unumhastherighttorecoveranyoverpaymentsdueto:
- fraud;
- anyerrorUnummakesinprocessingaclaim;and
- yourreceiptofdeductiblesourcesofincome.
Youmustreimburseusinfull.Wewilldeterminethemethodbywhichtherepaymentistobemade.
Unumwillnotrecovermoremoneythantheamountwepaidyou.
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GENERALPROVISIONS
WHATISTHECERTIFICATEOFCOVERAGE?
ThiscertificateofcoverageisawrittenstatementpreparedbyUnumandmayincludeattachments.Ittellsyou:
- thecoverageforwhichyoumaybeentitled;
- towhomUnumwillmakeapayment;and
- thelimitations,exclusionsandrequirementsthatapplywithinaplan.
WHENAREYOUELIGIBLEFORCOVERAGE?
IfyouareworkingforyourEmployerinaneligiblegroup,thedateyouareeligibleforcoverageisthelaterof:
- theplaneffectivedate;or
- thedayafteryoucompleteyourwaitingperiod.
WHENDOESYOURCOVERAGEBEGIN?
EmployeeseligibleforcoveragepriortoJuly1,2007
Youpay100%ofthecostofyourcoverage. Youwillbecoveredat12:01a.m.onthelatestof:
- thedateyouareeligibleforcoverage,ifyouapplyforinsurancebeforethatdateandhadbeencoveredunderyourEmployer'spriorcarrierplanatanytimepriortoJuly1,2007,andhadnotbeenpreviouslydeclinedwithevidenceofinsurability;or
- theOctober1,2007followingthedateyouapplyforinsurancepriortoJuly1,
2007,andhadnotbeencoveredunderyourEmployer'spriorcarrierplanjustpriortoJuly1,2007,andhadnotbeenpreviouslydeclinedwithevidenceofinsurability;or
- theOctober1,2007followingthedateyouapplyforinsurancepriortoJuly1,
2007,ifUnumapprovesyourevidenceofinsurabilityhadyoubeenpreviouslydeclinedbyyourEmployer'spriorcarrierplanandUnumapprovesyourapplicationpriortoOctober1,2007;or
- beyondOctober1,2007,uponUnum'sapprovaldateshouldyouapplyforinsurancepriortoJuly1,2007,andtheapprovalofyourevidenceofinsurability,forwhateverreason,isafterOctober1,2007hadyoubeenpreviouslydeclinedbyyourEmployer'spriorcarrierplan.
EmployeesfirsteligibleforcoverageonorafterJuly1,2007
Youpay100%ofthecostofyourcoverage. Youwillbecoveredat12:01a.m.onthelatestof:
- thedateyouareeligibleforcoverage,ifyouapplyforinsuranceonorbeforethatdate;
- thedateyouapplyforinsurance,ifyouapplywithin31daysafteryoureligibilitydate;or
- thedateUnumapprovesyourapplication,ifevidenceofinsurabilityisrequired.
AllEmployees
Evidenceofinsurabilityisrequiredifyou:
EMPLOYEE-1(7/1/2017)REV7
- arealateapplicant,whichmeansyouapplyforcoveragemorethan31daysafterthedateyouareeligibleforcoverage;or
- voluntarilycancelledordeclinedyourcoverageandarereapplying.
AnevidenceofinsurabilityformwillberequestedbyyourEmployerandmaileddirectlytoyoufromUnum.
WILLMYPOLICYPREMIUMPAYMENTSCHANGE?
PremiumpaymentsaresubjecttochangeandallnegotiationswillbehandledsolelythroughUnumandthePolicyholder.
ASANEWAPPLICANT,WHATIFYOUAREABSENTFROMWORKONTHEDATEYOURCOVERAGEWOULDNORMALLYBEGIN?
Ifyouareabsentfromworkduetoinjury,sicknessorapprovedleaveofabsence,yourcoveragewillbeginonthedateyoureturntoactiveemployment.
ONCEYOURCOVERAGEBEGINS,WHATHAPPENSIFYOUARETEMPORARILYNOTWORKING?
Ifyouareonanapprovedleaveofabsence(includingamilitaryleave),andifpremiumispaid,youwillbecoveredforupto12monthsfollowingthedateyourapprovedleaveofabsencebegins.
Allpolicyprovisions(includingexclusionsandlimitations)whileonanapprovedleaveofabsencewillapply.
ONCEYOURCOVERAGEBEGINS,WHATHAPPENSIFYOUARENOTWORKINGDUETOAPLANTCLOSING?
Ifyouarenotworkingduetoaplantclosing(asdefinedinSection71AofChapter
151AoftheMassachusettsInsuranceStatutes),andifpremiumispaid,youwillbecoveredupto90daysfromthedateyouwerenolongerinactiveemployment.Ifyoubecomecoveredunderanyothergroupdisabilityplan,yourcoverageunderthispolicyorplanwillend.
WHENWILLCHANGESTOYOURCOVERAGETAKEEFFECT?
Anychangeincoverage:
a.duetoachangeinmonthlyearningswilltakeeffectonthelaterof:
- thefirstdayofthesecondmonthfollowingthechange;or
- whenthePolicyholdercanmaketheapplicablepayrolldeduction.
b.duetoaplanchangewilltakeeffectimmediately.
Anydecreaseincoveragewillnotaffectapayableclaimthatoccurspriortothedecrease.
Youmustbeinactiveemploymentoronacoveredapprovedleaveofabsence. Ifyouarenotinactiveemploymentduetoinjuryorsickness,anyincrease,decrease
EMPLOYEE-2(7/1/2017)REV8
oradditionalcoverageduetoachangeinitemsa.orb.willbeginonthedateyoureturntoactiveemployment.
WHENDOESYOURCOVERAGEEND?
Yourcoverageunderthepolicyoraplanendsontheearliestof:
- thedatethepolicyoraplaniscancelled;
- thedateyounolongerareinaneligiblegroup;
- thedateyoureligiblegroupisnolongercovered;
- thelastdayoftheperiodforwhichyoumadeanyrequiredcontributions;or
- thelastdayyouareinactiveemploymentexceptasprovidedunderthecoveredapprovedleaveofabsenceandplantclosingprovisions,orasnotedbelow.
Ifyouendemployment,coveragewillbeextendedfor31days. Butifyoubecomeeligibleforanyothergroupdisabilityinsuranceoranyotherarrangement,thisextensionofcoveragewillend.
Unumwillprovidecoverageforapayableclaimwhichoccurswhileyouarecoveredunderthepolicyorplan.
WHATARETHETIMELIMITSFORLEGALPROCEEDINGS?
Youcanstartlegalactionregardingyourclaim60daysafterproofofclaimhasbeengivenandupto3yearsfromthetimeproofofclaimisrequired.
HOWCANSTATEMENTSMADEINYOURAPPLICATIONFORTHISCOVERAGEBEUSED?
UnumconsidersanystatementsyouoryourEmployermakeinasignedapplicationforcoveragearepresentationandnotawarranty.IfanyofthestatementsyouoryourEmployermakearenotcompleteand/ornottrueatthetimetheyaremade,wecan:
- reduceordenyanyclaim;or
- cancelyourcoveragefromtheoriginaleffectivedate.
Wewilluseonlystatementsmadeinasignedapplicationasabasisfordoingthis.NostatementoftheEmployerwillbeusedtovoidthePolicyafterithasbeeninforcefor2years,exceptinthecaseoffraud.
IftheEmployergivesusinformationaboutyouthatisincorrect,wewill:
- usethefactstodecidewhetheryouhavecoverageundertheplanandinwhatamounts;and
- makeafairadjustmentofthepremium.
HOWWILLUNUMHANDLEINSURANCEFRAUD?
UnumwantstoensureyouandyourEmployerdonotincuradditionalinsurancecostsasaresultoftheunderminingeffectsofinsurancefraud.Unumpromisestofocusonallmeansnecessarytosupportfrauddetection,investigation,andprosecution.
EMPLOYEE-3(7/1/2017)REV9
Itisacrimeifyouknowingly,andwithintenttoinjure,defraudordeceiveUnum,orprovideanyinformation,includingfilingaclaim,thatcontainsanyfalse,incompleteormisleadinginformation.Theseactions,aswellasprovidingfalsematerialinformation,willresultindenialofyourclaim,andaresubjecttoprosecutionandpunishmenttothefullextentunderstateand/orfederallaw;includingbutnotlimitedto,fines,denialorterminationofinsurancebenefits,recoveryofanyamountspaid,civildamages,criminalprosecutionandconfinementinstateprison.Unumwillpursueallappropriatelegalremediesintheeventofinsurancefraud.
DOESTHEPOLICYREPLACEORAFFECTANYWORKERS'COMPENSATIONORSTATEDISABILITYINSURANCE?
Thepolicydoesnotreplaceoraffecttherequirementsforcoveragebyanyworkers'compensationorstatedisabilityinsurance.
DOESYOUREMPLOYERACTASYOURAGENTORUNUM'SAGENT?
Forpurposesofthepolicy,yourEmployeractsonitsownbehalforasyouragent.UndernocircumstanceswillyourEmployerbedeemedtheagentofUnum,norwillUnumbedeemedanagentofyourEmployer.
EMPLOYEE-4(7/1/2017)REV10
LONGTERMDISABILITYBENEFITINFORMATION
HOWDOESUNUMDEFINEDISABILITY?
YouaredisabledwhenUnumdeterminesthat:
- youarelimitedfromperformingthematerialandsubstantialdutiesofyour
regularoccupationduetoyoursicknessorinjury;and
- youhavea20%ormorelossinyourindexedmonthlyearningsduetothesamesicknessorinjury.
After24monthsofdisabilitypayments,youaredisabledwhenUnumdeterminesthatduetothesamesicknessorinjury,youareunabletoperformthedutiesofanygainfuloccupationforwhichyouarereasonablyfittedbyeducation,trainingorexperience.
Youmustbeundertheregularcareofaphysicianforyourdisabilityinordertobeconsidereddisabled.
Thelossofaprofessionaloroccupationallicenseorcertificationdoesnot,initself,constitutedisability.
Wemayrequireyoutobeexaminedbyaphysician,othermedicalpractitionerand/orvocationalexpertofourchoice.Unumwillpayforthisexamination.Wecanrequireanexaminationasoftenasitisreasonabletodoso.WemayalsorequireyoutobeinterviewedbyanauthorizedUnumRepresentative.
INDEXEDMONTHLYEARNINGSmeansyourmonthlyearningsadjustedoneachanniversaryofbenefitpaymentsbythelesserof10%orthecurrentannualpercentageincreaseintheConsumerPriceIndex.Yourindexedmonthlyearningsmayincreaseorremainthesame,butwillneverdecrease.
TheConsumerPriceIndex(CPI-U)ispublishedbytheU.S.DepartmentofLabor.UnumreservestherighttousesomeothersimilarmeasurementiftheDepartmentofLaborchangesorstopspublishingtheCPI-U.
Indexingisonlyusedasafactorinthedeterminationofthepercentageoflostearningswhileyouaredisabledandworkingandinthedeterminationofgainfuloccupation.
HOWLONGMUSTYOUBEDISABLEDBEFOREYOUAREELIGIBLETORECEIVEBENEFITS?
Youmustbecontinuouslydisabledthroughyoureliminationperiod.Theeliminationperiodbeginsonthedayyoubecomedisabled. Unumwilltreatyourdisabilityascontinuousifyourdisabilitystopsfor45daysorlessduringtheeliminationperiod.Thedaysthatyouarenotdisabledwillnotcounttowardyoureliminationperiod.Anyincreasesyoumayreceiveinyourmonthlyearningsduringapossiblereturntoworkperiodwillnotbetakenintoconsiderationwhen
determiningyourmonthlybenefit.
LTD-BEN-1(7/1/2017)REV11
Youreliminationperiodis90days.
CANYOUSATISFYYOURELIMINATIONPERIODIFYOUAREWORKING?
Yes.Ifyouareworkingwhileyouaredisabled,thedaysyouaredisabledwillcounttowardyoureliminationperiod.
WHENWILLYOUBEGINTORECEIVEPAYMENTS?
Youwillbegintoreceivepaymentswhenweapproveyourclaim,providingtheeliminationperiodhasbeenmetandyouaredisabled. WewillsendyouapaymentmonthlyforanyperiodforwhichUnumisliable.Ifyouaredisabledforlessthan1month,wewillsendyou1/30thofyourpaymentforeachdayofdisability.
HOWMUCHWILLUNUMPAYYOUIFYOUAREDISABLED?
Wewillfollowthisprocesstofigureyourpayment:
1.Multiplyyourmonthlyearningsby55%.
2.Themaximummonthlybenefitis$10,000.
3.ComparetheanswerfromItem1withthemaximummonthlybenefit.Thelesserofthesetwoamountsisyourgrossdisabilitypayment.
4.Subtractfromyourgrossdisabilitypaymentanydeductiblesourcesofincome.
Yourmonthlypaymentisthegreaterof:
- theamountfiguredinItem4;or
- $100;or
- 10%ofyourgrossdisabilitypayment.
WILLUNUMEVERPAYMORETHAN100%OFMONTHLYEARNINGS?(TOTALBENEFITCAPALSOFOUNDONB@G-LTD-2)
Thetotalbenefitpayabletoyouonamonthlybasis(includingallbenefitsprovidedunderthisplan)willnotexceed100%ofyourmonthlyearnings.However,ifyouareparticipatinginUnum'sRehabilitationandReturntoWorkAssistanceprogram,thetotalbenefitpayabletoyouonamonthlybasis(includingallbenefitsprovidedunderthisplan)willnotexceed110%ofyourmonthlyearnings.
WHATAREYOURMONTHLYEARNINGS?
"MonthlyEarnings"meansthemonthlywageorsalarythatyouwerereceivingfromyourEmployeronthedateofdisability.Itincludes:
1.employeecontributionsmadethroughasalaryreductionagreementwithyourEmployertoanIRCSection401(k),403(b),501(c)(3),457deferredcompensationplan,oranyotherqualifiedornon-qualifiedemployeeRetirementPlanordeferredcompensationarrangement;and
2.amountscontributedtoyourfringebenefitsaccordingtoasalaryreductionarrangementunderanIRCSection125plan.
Itdoesnotincludecommissions,bonuses,overtimepay,shiftdifferential,orretroactivesalaryadjustmentswhilereceivingdisabilitybenefitsunderthisplanor
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yourEmployer'scontributiononyourbehalftoaretirementplanordeferredcompensationarrangement;oranyotherextracompensation.
WHATWILLWEUSEFORMONTHLYEARNINGSIFYOUBECOMEDISABLEDDURINGACOVEREDAPPROVEDLEAVEOFABSENCE?
Ifyoubecomedisabledwhileyouareonacoveredapprovedleaveofabsence,wewilluseyourmonthlyearningsfromyourEmployerineffectjustpriortothedateyourabsencebegins.
HOWMUCHWILLUNUMPAYYOUIFYOUAREDISABLEDANDWORKING?
Wewillsendyouthemonthlypaymentifyouaredisabledandyourmonthlydisabilityearnings,ifany,arelessthan20%ofyourindexedmonthlyearnings,duetothesamesicknessorinjury.
Ifyouaredisabledandyourmonthlydisabilityearningsarefrom20%through80%ofyourindexedmonthlyearnings,duetothesamesicknessorinjury,Unumwillfigureyourpaymentasfollows:
Duringthefirst12monthsofpayments,whileworking,yourmonthlypaymentwillnotbereducedaslongasdisabilityearningsplusthegrossdisabilitypaymentdoesnotexceed100%ofindexedmonthlyearnings.
1.Addyourmonthlydisabilityearningstoyourgrossdisabilitypayment.
2.ComparetheanswerinItem1toyourindexedmonthlyearnings.
IftheanswerfromItem1islessthanorequalto100%ofyourindexedmonthlyearnings,Unumwillnotfurtherreduceyourmonthlypayment.
IftheanswerfromItem1ismorethan100%ofyourindexedmonthlyearnings,Unumwillsubtracttheamountover100%fromyourmonthlypayment.
After12monthsofpayments,whileworking,youwillreceivepaymentsbasedonthepercentageofincomeyouarelosingduetoyourdisability.
1.Subtractyourdisabilityearningsfromyourindexedmonthlyearnings.
2.DividetheanswerinItem1byyourindexedmonthlyearnings.Thisisyourpercentageoflostearnings.
3.MultiplyyourmonthlypaymentbytheanswerinItem2.
ThisistheamountUnumwillpayyoueachmonth.
Unummayrequireyoutosendproofofyourmonthlydisabilityearningsatleastquarterly.Wewilladjustyourpaymentbasedonyourquarterlydisabilityearnings.
Aspartofyourproofofdisabilityearnings,wecanrequirethatyousendusappropriatefinancialrecordswhichwebelievearenecessarytosubstantiateyourincome.
Aftertheeliminationperiod,ifyouaredisabledforlessthan1month,wewillsendyou1/30ofyourpaymentforeachdayofdisability.
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HOWCANWEPROTECTYOUIFYOURDISABILITYEARNINGSFLUCTUATE?
Ifyourdisabilityearningsroutinelyfluctuatewidelyfrommonthtomonth,Unummayaverageyourdisabilityearningsoverthemostrecent3monthstodetermineifyourclaimshouldcontinue.
IfUnumaveragesyourdisabilityearnings,wewillnotterminateyourclaimunlesstheaverageofyourdisabilityearningsfromthelast3monthsexceeds80%ofindexedmonthlyearnings.
Wewillnotpayyouforanymonthduringwhichdisabilityearningsexceed80%ofindexedmonthlyearnings.
WHATAREDEDUCTIBLESOURCESOFINCOME?(Offsets)
Unumwillsubtractfromyourgrossdisabilitypaymentthefollowingdeductiblesourcesofincome:
1. Theamountthatyoureceiveorareentitledtoreceiveunder:
- aworkers'compensationlaw.
- anoccupationaldiseaselaw.
- theRailroadRetirementAct.
- anyotheractorlawwithsimilarintent.
2. Theamountthatyoureceiveorareentitledtoreceiveasdisabilityincomepaymentsunderany:
- statecompulsorybenefitactorlaw.
- automobileliabilityinsurancepolicy.
- othergroupinsuranceplan.
3. Theamountthatyou,yourspouseandyourchildrenreceiveorareentitledtoreceiveasdisabilitypaymentsbecauseofyourdisabilityunder:
- theUnitedStatesSocialSecurityAct.
- theCanadaPensionPlan.
- theQuebecPensionPlan.
- anysimilarplanoract.
4. Theamountthatyoureceiveasretirementpaymentsortheamountyourspouseandchildrenreceiveasretirementpaymentsbecauseyouarereceivingretirementpaymentsunder:
- theUnitedStatesSocialSecurityAct.
- theCanadaPensionPlan.
- theQuebecPensionPlan.
- anysimilarplanoract.
5. TheamountthatyoureceiveasdisabilityincomepaymentsunderanygovernmentalretirementplanorsystemasaresultofyourjobwithyourEmployer,suchas,anyPublicEmployeeRetirementSystemPlan,anyStateTeacher'sRetirementSystemPlan,oranyplanprovidedasanalternative.
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Disabilitypaymentsunderagovernmentalretirementplanorsystemwillbethosebenefitswhicharepaidduetodisabilityanddonotreducetheretirementbenefitwhichwouldhavebeenpaidifthedisabilityhadnotoccurred.
6. Theamountthatyou:
- voluntarilyelecttoreceiveasretirementpaymentsunderyourEmployer'sretirementplan.
- receiveasretirementpaymentswhenyoureachthelaterofage62ornormalretirementage,asdefinedinyourEmployer'sretirementplan.
RetirementpaymentswillbethosebenefitswhicharebasedonyourEmployer'scontributiontotheretirementplan. Disabilitybenefitswhichreducetheretirementbenefitundertheplanwillalsobeconsideredasaretirementbenefit.
Regardlessofhowtheretirementfundsfromtheretirementplanaredistributed,UnumwillconsideryourandyourEmployer'scontributionstobedistributedsimultaneouslythroughoutyourlifetime.
Amountsreceiveddonotincludeamountsrolledoverortransferredtoany
eligibleretirementplan. UnumwillusethedefinitionofeligibleretirementplanasdefinedinSection402oftheInternalRevenueCodeincludinganyfutureamendmentswhichaffectthedefinition.
7. TheamountthatyoureceiveunderTitle46,UnitedStatesCodeSection688(TheJonesAct).
8. Theamountthatyoureceiveunderthemandatoryportionofany"nofault"motorvehicleplan.
9. Theamountthatyoureceiveunderasalarycontinuation,accumulatedsickleave,orvacationpayplan.
10.Theamountyoureceivefromamilitarypensionanddisabilityincomeplans.Withtheexceptionofretirementpayments,Unumwillonlysubtractdeductible
sourcesofincomewhicharepayableasaresultofthesamedisability.
WewillnotreduceyourpaymentbyyourSocialSecurityretirementincomeifyourdisabilitybeginsafterage65andyouwerealreadyreceivingSocialSecurityretirementpayments.
WHATARENOTDEDUCTIBLESOURCESOFINCOME?(Offsets)
Unumwillnotsubtractfromyourgrossdisabilitypaymentincomeyoureceivefrom,butnotlimitedto,thefollowing:
- 401(k)and403(b)plans
- profitsharingplans
- thriftplans
- taxshelteredannuities
- stockownershipplans
- non-qualifiedplansofdeferredcompensation
- pensionplansforpartners
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- creditdisabilityinsurance
- franchisedisabilityincomeplans
- aretirementplanfromanotherEmployer
- individualretirementaccounts(IRA)
- individualdisabilityincomeplans
WHATIFSUBTRACTINGDEDUCTIBLESOURCESOFINCOMERESULTSINAZEROBENEFIT?(MinimumBenefit)
Theminimummonthlypaymentisthegreaterof:
- $100;or
- 10%ofyourgrossdisabilitypayment.
Unummayapplythisamounttowardanoutstandingoverpayment.
WHATHAPPENSWHENYOURECEIVEACOSTOFLIVINGINCREASEFROMDEDUCTIBLESOURCESOFINCOME?
OnceUnumhassubtractedanydeductiblesourceofincomefromyourgrossdisabilitypayment,Unumwillnotfurtherreduceyourpaymentduetoacostoflivingincreasefromthatsource.
WHATIFUNUMDETERMINESYOUMAYQUALIFYFORDEDUCTIBLEINCOMEBENEFITS?
WhenwedeterminethatyoumayqualifyforbenefitsunderItem(s)1,2and3inthedeductiblesourcesofincomesection,wewillestimateyourentitlementtothesebenefits.Wecanreduceyourpaymentbytheestimatedamountsifsuchbenefits:
- havenotbeenawarded;and
- havenotbeendenied;or
- havebeendeniedandthedenialisbeingappealed.
YourLongTermDisabilitypaymentwillNOTbereducedbytheestimatedamountifyou:
- applyforthedisabilitypaymentsunderItem(s)1,2and3inthedeductiblesourcesofincomesectionandappealyourdenialtoalladministrativelevelsUnumfeels
arenecessary;and
- signUnum'spaymentoptionform.Thisformstatesthatyoupromisetopayusanyoverpaymentcausedbyanaward.
Ifyourpaymenthasbeenreducedbyanestimatedamount,yourpaymentwillbeadjustedwhenwereceiveproof:
- oftheamountawarded;or
- thatbenefitshavebeendeniedandallappealsUnumfeelsarenecessaryhavebeencompleted.Inthiscase,alumpsumrefundoftheestimatedamountwillbemadetoyou.
Ifyoureceivealumpsumpaymentfromanydeductiblesourcesofincome,thelumpsumwillbepro-ratedonamonthlybasisoverthetimeperiodforwhichthesumwasgiven.Ifnotimeperiodisstated,wewilluseareasonableone.
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HOWLONGWILLUNUMCONTINUETOSENDYOUPAYMENTS?
Unumwillsendyouapaymenteachmonthuptothemaximumperiodofpayment.Yourmaximumperiodofpaymentisbasedonyourageatdisabilityasfollows:
AgeatDisabilityMaximumPeriodofPayment
LessthanAge62ToAge65
Age62 42monthsAge63 36monthsAge64 30monthsAge65 24monthsAge66 21monthsAge67 18monthsAge68 15monthsAge69orolder 12months
WHENWILLPAYMENTSSTOP?
Wewillstopsendingyoupaymentsandyourclaimwillendontheearliestofthefollowing:
- duringthefirst24monthsofpayments,whenyouareabletoworkinyourregularoccupationonapart-timebasisbutyouchoosenotto;
- after24monthsofpayments,whenyouareabletoworkinanygainfuloccupationonapart-timebasisbutyouchoosenotto;
- ifyouareworkingandyourmonthlydisabilityearningsexceed80%ofyourindexedmonthlyearnings,thedateyourearningsexceed80%;
- theendofthemaximumperiodofpayment;
- thedateyouarenolongerdisabledunderthetermsoftheplan,unlessyouareeligibletoreceivebenefitsunderUnum'sRehabilitationandReturntoWorkAssistanceprogram;
- thedateyoufailtosubmitproofofcontinuingdisability;
- after12monthsofpaymentsifyouareconsideredtoresideoutsidetheUnitedStatesorCanada.YouwillbeconsideredtoresideoutsidethesecountrieswhenyouhavebeenoutsidetheUnitedStatesorCanadaforatotalperiodof6monthsormoreduringany12consecutivemonthsofbenefits;
- thedateyoudie.
WHATDISABILITIESHAVEADEFINEDPAYPERIODUNDERYOURPLAN?
Disabilitiesduetomentalillnesshaveamaximumpayperiodofupto36monthspereachoccurrenceduetothesamesicknessorinjury;however,paymentswillcontinueifoneorbothofthefollowingoccurs:
1.Ifyouareadmittedforparticipationinapartialordaytreatmentprograminahospitalorinstitutionlicensedtoprovidecareandtreatmentforamentalillnessduetoapsychiatricorpsychologicalconditionforatleast5hoursperdayandatleast4daysperweek.
2.Ifyouareconfinedtoahospitalorinstitutionlicensedtoprovidecareandtreatmentforamentalillnessduetoapsychiatricorpsychologicalcondition.
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Unumwillcontinuetosendyoupaymentsforthedurationofyouradmissionand/orconfinement.
Ifyoubecomereconfinedatanytimeduringtherecoveryperiodandremainconfined,Unumwillsendpaymentsduringthatadditionalconfinement.
Thelifetimecumulativemaximumbenefitperiodforalldisabilitiesduetoalcoholismordrugabuse(substanceabuseordependency)is36months.Only36monthsofbenefitswillbepaidforanycombinationofsuchdisabilitiesevenifthedisabilities:
- arenotcontinuous;and
- arenotrelated.
Unumwillcontinuetosendyoupaymentsbeyondthe36monthperiodifyoumeetoneorbothoftheseconditions:
1.Ifyouareconfinedtoahospitalorinstitutionlicensedtoprovidecareandtreatmentforamentalillnessduetoapsychiatricorpsychologicalconditionattheendofthe36monthperiod,Unumwillcontinuetosendyoupaymentsduringyourconfinement.
Thecostofthetreatmentprogrammustbebornebyyou,oranothergroupplan
ofyourEmployer(suchasagrouphealthplanorEmployeeAssistanceProgram)
ifoneisavailableandcoversthistypeoftreatment.
Ifyoubecomereconfinedatanytimeduringtherecoveryperiodandremainconfined,Unumwillsendpaymentsduringthatadditionalconfinement.
2.Innoeventwillmonthlypaymentsbeissuedbeyondtheearliestof:
- 36months;or
- themaximumperiodofpayment;or
- thedateyourefusetoparticipateinanappropriate,availabletreatmentprogram,orthedateyouleavethetreatmentprogrampriortocompletion;or
- thedateyoucompletetheinitialtreatmentplan,exclusiveofanyaftercareorfollow-upservices.
Unumwillnotapplythementalillnesslimitationtodementiaifitisaresultof:
- stroke;
- trauma;
- viralinfection;
- Alzheimer'sdisease;or
- otherconditionsnotlistedwhicharenotusuallytreatedbyamentalhealthproviderorotherqualifiedproviderusingpsychotherapy,psychotropicdrugs,orothersimilarmethodsoftreatment.
WHATDISABILITIESARENOTCOVEREDUNDERYOURPLAN?
Yourplandoesnotcoveranydisabilitiescausedby,contributedtoby,orresultingfromyour:
- intentionallyself-inflictedinjuries.
- activeparticipationinariot.
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- lossofaprofessionallicense,occupationallicenseorcertification.
- attempttocommitorcommissionofacrime.
- commissionofacrimeforwhichyouhavebeenconvicted.
- pre-existingcondition(see"WHATISAPRE-EXISTINGCONDITION?"below).
Yourplanwillnotcoveradisabilityduetowar,declaredorundeclared,oranyactofwar.
Unumwillnotpayabenefitforanyperiodofdisabilityduringwhichyouareincarceratediftheperiodofconfinementexceeds30days.
WHATISAPRE-EXISTINGCONDITION?
Youhaveapre-existingconditionif:
- youreceivedmedicaltreatment,consultation,careorservicesincludingdiagnosticmeasures,ortookprescribeddrugsormedicinesinthe6monthsjustpriortoyoureffectivedateofcoverage;and
- thedisabilitybeginsinthefirst12monthsafteryoureffectivedateofcoverageunlessyouhavebeentreatmentfreefor6consecutivemonthsafteryoureffectivedateofcoverage.
WHATHAPPENSIFYOURETURNTOWORKFULLTIMEWITHTHEPOLICYHOLDERANDYOURDISABILITYOCCURSAGAIN?
Ifyouhavearecurrentdisabilitywhileyourcoverageisinforceunderthepolicy,Unumwilltreatyourdisabilityaspartofyourpriorclaimandyouwillnothavetocompleteanothereliminationperiodif:
- yourpriorclaimendedwhenyoureturnedtoworkforyourEmployerandyourearningsfromyourEmployerexceeded80%ofyourmonthlyearnings;
- youwerecontinuouslyinsuredundertheplanfortheperiodbetweentheendofyourpriorclaimandyourrecurrentdisability;and
- yourrecurrentdisabilityoccurswithin6monthsfromtheendofyourpriorclaim.
Yourrecurrentdisabilitywillbesubjecttothesametermsoftheplanasyourpriorclaimandwillbetreatedasacontinuationofthatdisability.
Anydisabilitywhichoccursafter6monthsfromthedateyourpriorclaimendedwillbetreatedasanewclaim.Thenewclaimwillbesubjecttoallofthepolicyprovisions,includingtheeliminationperiod.
Ifyoubecomeentitledtopaymentsunderanyothergrouplongtermdisabilityplan,youwillnotbeeligibleforpaymentsundertheUnumplan.
RECURRENTDISABILITYmeansadisabilitywhichis:
- causedbyaworseninginyourcondition;and
- duetothesamecause(s)asyourpriordisabilityforwhichUnummadeaLong
TermDisabilitypayment.
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WHATHAPPENSIFYOURETURNTOWORKFULLTIMEFORANEMPLOYEROTHERTHANTHEPOLICYHOLDERANDYOURDISABILITYOCCURSAGAIN?
Ifyouhavearecurrentdisability,Unumwilltreatyourdisabilityaspartofyourpriorclaimandyouwillnothavetocompleteanothereliminationperiodif:
- youwerecontinuouslyworkingfulltimefortheperiodbetweentheendofyourpriorclaimandyourrecurrentdisability;and
- yourrecurrentdisabilityoccurswithin6monthsfromtheendofyourpriorclaim.
However,youwillhavetocompleteanothereliminationperiodifyourrecurrentdisabilityoccursmorethan6monthsandlessthan12monthsaftertheendofyourpriorclaim.
Yourrecurrentdisabilitywillbesubjecttothesametermsoftheplanasyourpriorclaimandwillbetreatedasacontinuationofthatdisability.
Ifyoubecomeentitledtopaymentsunderanyothergrouplongtermdisabilityplan,youwillnotbeeligibleforpaymentsundertheUnumplan.
Unumwillnotcoverarecurrentdisabilitythatoccursmorethan12monthsaftertheendofyourpriorclaimundertheplan.
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LONGTERMDISABILITYOTHERBENEFITFEATURESSURVIVORBENEFIT
WHATBENEFITSWILLBEPROVIDEDTOYOUORYOURFAMILYIFYOUDIEORARETERMINALLYILL?(SurvivorBenefit)
WhenUnumreceivesproofthatyouhavedied,wewillpayyoureligiblesurvivoralumpsumbenefitequalto3monthsofyournetdisabilitypaymentif,onthedateofyourdeath:
- yourdisabilityhadcontinuedfor90ormoreconsecutivedaysandyouhadsatisfiedtheeliminationperiod;and
- youwerereceivingorwereentitledtoreceivepaymentsundertheplan.
Ifyouhavenoeligiblesurvivors,paymentwillbemadetoyourestate,unlessthereisnone.Inthiscase,nopaymentwillbemade.
However,wewillfirstapplythesurvivorbenefittoanyoverpaymentwhichmayexistonyourclaim.
Youmayreceiveyour3monthsurvivorbenefitpriortoyourdeathifyouhavebeendiagnosedasterminallyill.
Wewillpayyoualumpsumamountequalto3monthsofyournetdisabilitypaymentif:
- youhavebeendiagnosedwithaterminalillnessorcondition;
- yourlifeexpectancyhasbeenreducedtolessthan12months;and
- youarereceivingmonthlypayments.
Yourrighttoexercisethisoptionandreceivepaymentissubjecttothefollowing:
- youmustmakethiselectioninwritingtoUnum;and
- yourphysicianmustcertifyinwritingthatyouhaveaterminalillnessorconditionandyourlifeexpectancyhasbeenreducedtolessthan12months.
Thisbenefitisavailabletoyouonavoluntarybasisandwillonlybepayableonce.
Ifyouelecttoreceivethisbenefitpriortoyourdeath,no3monthsurvivorbenefitwillbepayableuponyourdeath.
CONTINUITYOFCOVERAGE
WHATIFYOUARENOTINACTIVEEMPLOYMENTWHENYOUREMPLOYERCHANGESINSURANCECARRIERSTOUNUM?(ContinuityofCoverage)
Whentheplanbecomeseffective,Unumwillprovidecoverageforyouif:
- youarenotinactiveemploymentbecauseofasickness,injuryoracoveredapprovedleaveofabsenceorFMLAasdefinedinthepriorpolicy;and
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- youwerecoveredbythepriorpolicy.
Yourcoverageissubjecttopaymentofpremium.
Yourpaymentwillbelimitedtotheamountthatwouldhavebeenpaidbythepriorcarrier.Unumwillreduceyourpaymentbyanyamountforwhichyourpriorcarrierisliable.
WHATIFYOUHAVEADISABILITYDUETOAPRE-EXISTINGCONDITIONWHENYOUREMPLOYERCHANGESINSURANCECARRIERSTOUNUM?(ContinuityofCoverage)
Unummaysendapaymentifyourdisabilityresultsfromapre-existingconditionif,youwere:
- inactiveemploymentandinsuredundertheplanonitseffectivedate;and
- insuredbythepriorpolicyatthetimeofchange.
Inordertoreceiveapaymentyoumustsatisfythepre-existingconditionprovisionunder:
1.theUnumplan;or
2.thepriorcarrier'splan,ifbenefitswouldhavebeenpaidhadthatpolicyremainedinforce.
IfyoudonotsatisfyItem1or2above,Unumwillnotmakeanypayments.
IfyousatisfyItem1,wewilldetermineyourpaymentsaccordingtotheUnumplanprovisions.
IfyouonlysatisfyItem2,wewilladministeryourclaimaccordingtotheUnumplanprovisions.However,yourpaymentwillbethelesserof:
a.themonthlybenefitthatwouldhavebeenpayableunderthetermsofthepriorplanifithadremainedinforce;or
b.themonthlypaymentundertheUnumplan.
Yourbenefitswillendontheearlierofthefollowingdates:
1.theendofthemaximumbenefitperiodundertheplan;or
2.thedatebenefitswouldhaveendedunderthepriorplanifithadremainedinforce.
REHABILITATIONANDRETURNTOWORK
HOWCANUNUM'SREHABILITATIONANDRETURNTOWORKASSISTANCEPROGRAMHELPYOURETURNTOWORK?
UnumhasavocationalRehabilitationandReturntoWorkAssistanceprogramavailabletoassistyouinreturningtowork.Wewilldeterminewhetheryouareeligibleforthisprogram,atoursolediscretion. Inordertobeeligiblefor
rehabilitationservicesandbenefits,youmustbemedicallyabletoengageinareturntoworkprogram.
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YourclaimfilewillbereviewedbyoneofUnum'srehabilitationprofessionalstodetermineifarehabilitationprogrammighthelpyoureturntogainfulemployment.Asyourfileisreviewed,medicalandvocationalinformationwillbeanalyzedtodetermineanappropriatereturntoworkprogram.
Wewillmakethefinaldeterminationofyoureligibilityforparticipationintheprogram.
WewillprovideyouwithawrittenRehabilitationandReturntoWorkAssistanceplandevelopedspecificallyforyou.
Therehabilitationprogrammayincludeatoursolediscretion,butisnotlimitedto,thefollowingservicesandbenefits:
- coordinationwithyourEmployertoassistyoutoreturntowork;
- adaptiveequipmentorjobaccommodationstoallowyoutowork;
- vocationalevaluationtodeterminehowyourdisabilitymayimpactyouremploymentoptions;
- jobplacementservices;
- resumepreparation;
- jobseekingskillstraining;or
- educationandretrainingexpensesforanewoccupation.
WHATADDITIONALBENEFITSWILLUNUMPAYWHILEYOUPARTICIPATEINAREHABILITATIONANDRETURNTOWORKASSISTANCEPROGRAM?
Wewillpayanadditionaldisabilitybenefitof10%ofyourgrossdisabilitypaymenttoamaximumbenefitof$1,000permonth.
ThisbenefitisnotsubjecttopolicyprovisionswhichwouldotherwiseincreaseorreducethebenefitamountsuchasDeductibleSourcesofIncome.However,theTotalBenefitCap(foundonB@G-LTD-2andLTD-BEN-2)willapply.
Inaddition,wewillmakemonthlypaymentstoyoufor3monthsfollowingthedateyourdisabilityendsifwedetermineyouarenolongerdisabledwhile:
- youareparticipatingintheRehabilitationandReturntoWorkAssistanceprogram;
and
- youarenotabletofindemployment.
Thisbenefitpaymentmaybepaidinalumpsum.
WHENWILLREHABILITATIONANDRETURNTOWORKASSISTANCEBENEFITSEND?
BenefitsfortheRehabilitationandReturntoWorkAssistanceprogramwillendontheearliestofthefollowingdates:
- thedateUnumdeterminesthatyouarenolongereligibletoparticipateinUnum's
RehabilitationandReturntoWorkAssistanceprogram;or
- anyotherdateonwhichmonthlypaymentswouldstopinaccordancewiththisplan.
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WHATADDITIONALBENEFITISAVAILABLEFORDEPENDENTCAREEXPENSESTOENABLEYOUTOPARTICIPATEINUNUM'SREHABILITATIONANDRETURNTOWORKASSISTANCEPROGRAM?
WhileyouareparticipatinginUnum'sRehabilitationandReturntoWorkAssistanceprogram,wewillpayaDependentCareExpenseBenefitwhenyouaredisabledandyou:
1.areincurringexpensestoprovidecareforachildundertheageof15;and/or
2.startincurringexpensestoprovidecareforachildage15orolderorafamilymemberwhoneedspersonalcareassistance.
ThepaymentoftheDependentCareExpenseBenefitwillbeginimmediatelyafteryoustartUnum'sRehabilitationandReturntoWorkAssistanceprogram.
OurpaymentoftheDependentCareExpenseBenefitwill:
1.be$350permonth,perdependent;and
2.notexceed$1,000permonthforalldependentcareexpensescombined.
Toreceivethisbenefit,youmustprovidesatisfactoryproofthatyouareincurringexpensesthatentitleyoutotheDependentCareExpenseBenefit.
DependentCareExpenseBenefitswillendontheearlierofthefollowing:
1.thedateyouarenolongerincurringexpensesforyourdependent;
2.thedateyounolongerparticipateinUnum'sRehabilitationandReturntoWork
Assistanceprogram;or
3.anyotherdatepaymentswouldstopinaccordancewiththisplan.
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DISABILITYPLUSRIDER(CATASTROPHICBENEFIT)
WHENWILLYOUBEELIGIBLETORECEIVEDISABILITYPLUSBENEFITS?
YouaredisabledunderthisriderwhenUnumdeterminesthatduetosicknessorinjury:
- youlosetheabilitytosafelyandcompletelyperform2activitiesofdailyliving
withoutanotherperson'sassistanceorverbalcueing;or
- youhaveadeteriorationorlossinintellectualcapacityandneedanotherperson'sassistanceorverbalcueingforyourprotectionorfortheprotectionofothers.
WewillpayamonthlyDisabilityPlusbenefittoyouwhenwereceiveproofthatyouaredisabledunderthisriderandarereceivingmonthlypaymentsundertheLTDplan.DisabilityPlusbenefitswillbeginattheendoftheeliminationperiodshownintheLTDplan.
WHOISELIGIBLEFORDISABILITYPLUSCOVERAGE?
YoumustbeinsuredundertheUnumLongTermDisability(LTD)plantobeeligiblefortheadditionaldisabilitycoveragedescribedinthisRider.AllofthepolicydefinitionsapplytothecoverageaswellaspolicyprovisionsspecifiedinthisRider.
WHENWILLTHISCOVERAGEBECOMEEFFECTIVE?
YouwillbecomeinsuredforDisabilityPluscoverageonthelaterof:
- theeffectivedateofthisRider;or
- youreffectivedateundertheLTDplan.
DisabilityPluscoveragewillcontinueaslongastheRiderisineffectandyouareinsuredundertheLTDplan.
HOWMUCHWILLUNUMPAYIFYOUAREDISABLED?
TheDisabilityPlusbenefitis10%ofmonthlyearningstoamaximummonthlybenefitofthelesseroftheLTDplanmaximummonthlybenefitor$5,000.
Thisbenefitisnotsubjecttopolicyprovisions,exceptfortheTotalBenefitCap(foundonB@G-LTD-2andLTD-BEN-2),whichwouldotherwiseincreaseorreducethebenefitamountsuchasDeductibleSourcesofIncome.
WHATEXCLUSIONSANDLIMITATIONSAPPLYTODISABILITYPLUS?
AllofthepolicyprovisionsthatexcludeorlimitcoveragewillapplytothisDisability
PlusRider.
Youwillnotreceivethisbenefitforalossresultingfromoneofthefollowingconditions,ifthelossexistsontheeffectivedateofyourcoverageunderthisrider:
- alossoftheabilitytosafelyandcompletelyperformanyactivitiesofdailylivingwithoutanotherperson'sassistanceorverbalcueing;and/or
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- adeteriorationorlossinintellectualcapacityandneedforanotherperson'sassistanceorverbalcueingforyourprotectionorfortheprotectionofothers.
WHATCLAIMSINFORMATIONISNEEDEDFORDISABILITYPLUS?
TheLTDclaiminformationsectionunderthepolicyappliestoDisabilityPluscoverage.Wemayaskyoutobeexamined,atourexpense,byaphysicianand/orothermedicalpractitionerofourchoice.Wemayalsorequireaninterviewwithyou.
WHENWILLDISABILITYPLUSBENEFITPAYMENTSEND?
Benefitpaymentswillendontheearliestofthefollowingdates:
- thedateyouarenolongerdisabledundertheRider;
- thedateyoubecomeineligibleformonthlypaymentsundertheLTDplan;
- theendofthemaximumperiodofpaymentshownintheLTDplan;or
- thedateyoudie.
NosurvivorbenefitsarepayablefortheDisabilityPluscoverage.
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OTHERSERVICES
TheseservicesarealsoavailablefromusaspartofyourUnumLongTermDisabilityplan.
HOWCANUNUMHELPYOUREMPLOYERIDENTIFYANDPROVIDEWORKSITEMODIFICATION?
AworksitemodificationmightbewhatisneededtoallowyoutoperformthematerialandsubstantialdutiesofyourregularoccupationwithyourEmployer.OneofourdesignatedprofessionalswillassistyouandyourEmployertoidentifyamodificationweagreeislikelytohelpyouremainatworkorreturntowork.Thisagreementwillbeinwritingandmustbesignedbyyou,yourAgencyHeadandUnum.
Whenthisoccurs,UnumwillreimburseyourEmployerforthecostofthemodification,uptothegreaterof:
- $1,500;or
- theequivalentof2monthsofyourmonthlybenefit.
Thisbenefitisavailabletoyouonaonetimeonlybasis.
HOWCANUNUM'SSOCIALSECURITYCLAIMANTADVOCACYPROGRAMASSISTYOUWITHOBTAININGSOCIALSECURITYDISABILITYBENEFITS?
InordertobeeligibleforassistancefromUnum'sSocialSecurityclaimantadvocacyprogram,youmustbereceivingmonthlypaymentsfromus.Unumcanprovideexpertadviceregardingyourclaimandassistyouwithyourapplicationorappeal.
ReceivingSocialSecuritybenefitsmayenable:
- youtoreceiveMedicareafter24monthsofdisabilitypayments;
- youtoprotectyourretirementbenefits;and
- yourfamilytobeeligibleforSocialSecuritybenefits.
WecanassistyouinobtainingSocialSecuritydisabilitybenefitsby:
- helpingyoufindappropriatelegalrepresentation;
- obtainingmedicalandvocationalevidence;and
- reimbursingpre-approvedcasemanagementexpenses.
SERVICES-1(7/1/2017)REV27
GLOSSARY
ACTIVEEMPLOYMENTmeansyouareworkingforyourEmployerforearningsthatarepaidregularlyandthatyouareperformingthematerialandsubstantialdutiesofyourregularoccupation.YoumustbeworkingatleasttheminimumnumberofhoursasdescribedintheBenefitsataGlancesectionunderEligibleGroup(s)ineachplan.
Youworksitemustbe:
- yourEmployer'susualplaceofbusiness;
- analternativeworksiteatthedirectionofyourEmployer,includingyourhome;or
- alocationtowhichyourjobrequiresyoutotravel.
Vacationisconsideredactiveemployment.Temporaryworkersareexcludedfromcoverage.
Seasonalworkersareexcludedfromcoverage,unlesstheyareactivelyatworkfor180daysofcontinuousemploymentormore.TheyaretheneligibletoapplyforcoveragewiththeEmployer.
ACTIVITIESOFDAILYLIVINGmean:
- Bathing-theabilitytowashyourselfeitherinthetuborshowerorbyspongebathwithorwithoutequipmentoradaptivedevices.
- Dressing-theabilitytoputonandtakeoffallgarmentsandmedicallynecessarybracesorartificiallimbsusuallyworn.
- Toileting-theabilitytogettoandfromandonandoffthetoilet,tomaintainareasonablelevelofpersonalhygiene,andtocareforclothing.
- Transferring-theabilitytomoveinandoutofachairorbedwithorwithoutequipmentsuchascanes,quadcanes,walkers,crutchesorgrabbarsorothersupportdevicesincludingmechanicalormotorizeddevices.
- Continence-theabilitytoeither:
- voluntarilycontrolbowelandbladderfunction;or
- ifincontinent,beabletomaintainareasonablelevelofpersonalhygiene.
- Eating-theabilitytogetnourishmentintothebody.
APPROVEDLEAVEOFABSENCEmeansyouaretemporarilyabsentfromactiveemploymentforaperiodoftimethathasbeenagreedtoinadvanceinwritingbyyourEmployer.
Yourvacationtime,atemporarylayoff,astrike/lock-out,oranyperiodofdisabilityisnotconsideredanapprovedleaveofabsence.
DEDUCTIBLESOURCESOFINCOMEmeansincomefromdeductiblesourceslistedintheplanwhichyoureceiveorareentitledtoreceivewhileyouaredisabled.This
incomewillbesubtractedfromyourgrossdisabilitypayment.
DEPENDENTmeans:
- yourchild(ren)undertheageof15;and
- yourchild(ren)age15oroverorafamilymemberwhorequirespersonalcareassistance.
GLOSSARY-1(7/1/2017)REV28
DISABILITYEARNINGSmeanstheearningswhichyoureceivewhileyouaredisabledandworking,plustheearningsyoucouldreceiveifyouwereworkingtoyourmaximumcapacity.
ELIMINATIONPERIODmeansaperiodofcontinuousdisabilitywhichmustbesatisfiedbeforeyouareeligibletoreceivebenefitsfromUnum.
EMPLOYEEmeansapersonwhoisinactiveemploymentintheUnitedStateswiththe
Employer.
EMPLOYERmeanstheCommonwealthofMassachusettsandincludesanyagenciesandgovernmentalorquasi-governmentalentitiesonfilewiththeGroupInsuranceCommission,andnamedinthepolicy.
EVIDENCEOFINSURABILITYmeansastatementofyourmedicalhistorywhichUnumwillusetodetermineifyouareapprovedforcoverage. Evidenceofinsurabilitywillbe
atUnum'sexpense.
GAINFULOCCUPATIONmeansanoccupationthatisorcanbeexpectedtoprovideyouwithanincomewithin12monthsofyourreturntowork,thatexceeds:
80%ofyourindexedmonthlyearnings,ifyouareworking;or
60%ofyourindexedmonthlyearnings,ifyouarenotworking.
GRACEPERIODmeanstheperiodoftimefollowingthepremiumduedateduringwhichpremiumpaymentmaybemadebythePolicyholder.
GROSSDISABILITYPAYMENTmeansthebenefitamountbeforeUnumsubtractsdeductiblesourcesofincomeanddisabilityearnings.
HOSPITALORINSTITUTIONmeansanaccreditedfacilitylicensedtoprovidecareandtreatmentfortheconditioncausingyourdisability.
INDEXEDMONTHLYEARNINGSmeansyourmonthlyearningsadjustedoneachanniversaryofbenefitpaymentsbythelesserof10%orthecurrentannualpercentageincreaseintheConsumerPriceIndex. Yourindexedmonthlyearningsmayincreaseorremainthesame,butwillneverdecrease.
TheConsumerPriceIndex(CPI-U)ispublishedbytheU.S.DepartmentofLabor.UnumreservestherighttousesomeothersimilarmeasurementiftheDepartmentofLaborchangesorstopspublishingtheCPI-U.
Indexingisonlyusedasafactorinthedeterminationofthepercentageoflostearningswhileyouaredisabledandworkingandinthedeterminationofgainfuloccupation.
INJURYmeansabodilyinjurythatisthedirectresultofanaccidentandnotrelatedtoanyothercause.Disabilitymustbeginwhileyouarecoveredundertheplan.
INSUREDmeansanypersoncoveredunderaplan.
LAW,PLANORACTmeanstheoriginalenactmentsofthelaw,planoractandallamendments.
LIMITEDmeanswhatyoucannotorareunabletodo.
GLOSSARY-2(7/1/2017)REV29
MATERIALANDSUBSTANTIALDUTIESmeansdutiesthat:
- arenormallyrequiredfortheperformanceofyourregularoccupation;and
- cannotbereasonablyomittedormodified.
MAXIMUMCAPACITYmeans,basedonyourrestrictionsandlimitations:
- duringthefirst24monthsofdisability,thegreatestextentofworkyouareabletodoinyourregularoccupation,thatisreasonablyavailable.
- beyond24monthsofdisability,thegreatestextentofworkyouareabletodoinanyoccupation,thatisreasonablyavailable,forwhichyouarereasonablyfittedbyeducation,trainingorexperience.
MAXIMUMPERIODOFPAYMENTmeansthelongestperiodoftimeUnumwillmakepaymentstoyouforanyoneperiodofdisability.
MENTALILLNESSmeansapsychiatricorpsychologicalconditionclassifiedintheDiagnosticandStatisticalManualofMentalHealthDisorders(DSM),publishedbytheAmericanPsychiatricAssociation,mostcurrentasofthestartofadisability.Suchdisordersinclude,butarenotlimitedto,psychotic,emotionalorbehavioraldisorders,ordisordersrelatabletostressortosubstanceabuseordependency.IftheDSMisdiscontinuedorreplaced,thesedisorderswillbethoseclassifiedinthediagnosticmanualthenusedbytheAmericanPsychiatricAssociationasofthestartofadisability.
MONTHLYBENEFITmeansthetotalbenefitamountforwhichanemployeeisinsuredunderthisplansubjecttothemaximumbenefit.
MONTHLYEARNINGSmeansyourgrossmonthlyincomefromyourEmployerasdefinedintheplan.
MONTHLYPAYMENTmeansyourpaymentafteranydeductiblesourcesofincomehavebeensubtractedfromyourgrossdisabilitypayment.
NETDISABILITYPAYMENTmeansthegrossdisabilitybenefitamountimmediatelypriortoyourdeathreducedbyanydeductiblesourcesofincomebutnotdisabilityearnings.
PART-TIMEBASISmeanstheabilitytoworkandearnbetween20%and80%ofyourindexedmonthlyearnings.
PAYABLECLAIMmeansaclaimforwhichUnumisliableunderthetermsofthepolicy.
PHYSICIANmeans:
- apersonperformingtasksthatarewithinthelimitsofhisorhermedicallicense;and
- apersonwhoislicensedtopracticemedicineandprescribeandadministerdrugsortoperformsurgery;or
- apersonwithadoctoraldegreeinPsychology(Ph.D.orPsy.D.)whoseprimarypracticeistreatingpatients;or
- apersonwhoisalegallyqualifiedmedicalpractitioneraccordingtothelawsandregulationsofthegoverningjurisdiction.
GLOSSARY-3(7/1/2017)REV30
Unumwillnotrecognizeyou,oryourspouse,children,parentsorsiblingsasaphysicianforaclaimthatyousendtous.
PLANmeansalineofcoverageunderthepolicy.
PRE-EXISTINGCONDITIONmeansaconditionforwhichyoureceivedmedicaltreatment,consultation,careorservicesincludingdiagnosticmeasures,ortookprescribeddrugsormedicinesforyourconditionduringthegivenperiodoftimeasstatedintheplan.
RECURRENTDISABILITYmeansadisabilitywhichis:
- causedbyaworseninginyourcondition;and
- duetothesamecause(s)asyourpriordisabilityforwhichUnummadeaLongTerm
Disabilitypayment.
REGULARCAREmeans:
- youpersonallyvisitaphysicianasfrequentlyasismedicallyrequired,accordingtogenerallyacceptedmedicalstandards,toeffectivelymanageandtreatyourdisablingcondition(s);and
- youarereceivingthemostappropriatetreatmentandcarewhichconformswithgenerallyacceptedmedicalstandards,foryourdisablingcondition(s)byaphysicianwhosespecialtyorexperienceisthemostappropriateforyourdisablingcondition(s),accordingtogenerallyacceptedmedicalstandards.
REGULAROCCUPATIONmeanstheoccupationyouareroutinelyperformingwhenyourdisabilitybegins.Unumwilllookatyouroccupationasitisnormallyperformedinthenationaleconomy,insteadofhowtheworktasksareperformedforaspecificemployerorataspecificlocation.
RETIREMENTPLANmeansadefinedcontributionplanordefinedbenefitplan.Theseareplanswhichprovideretirementbenefitstoemployeesandarenotfundedentirelybyemployeecontributions. RetirementPlanincludesbutisnotlimitedtoanyplanwhichispartofanyfederal,state,county,municipalorassociationretirementsystem.
SALARYCONTINUATION,ACCUMULATEDSICKLEAVEORVACATIONPAYmeanscontinuedpaymentstoyoubyyourEmployerofallorpartofyourmonthlyearnings,afteryoubecomedisabledasdefinedbythePolicy.ThiscontinuedpaymentmustbepartofanestablishedplanmaintainedbyyourEmployerforthebenefitofallemployeescoveredunderthePolicy.Salarycontinuation,accumulatedsickleaveorvacationpaydoesnotincludecompensationpaidtoyoubyyourEmployerforworkyouactuallyperformafteryourdisabilitybegins. Suchcompensationisconsidereddisabilityearnings,andwouldbetakenintoaccountincalculatingyourmonthlypayment.
SICKNESSmeansanillnessordisease.Disabilitymustbeginwhileyouarecoveredundertheplan.
SURVIVOR,ELIGIBLEmeansyourspouse,ifliving;otherwiseyourchildrenunderage
25equally.
TREATMENTFREEmeansyouhavenotreceivedmedicaltreatment,consultation,careorservicesincludingdiagnosticmeasures,ortakenprescribeddrugsormedicinesforthepre-existingcondition.
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WAITINGPERIODmeansthecontinuousperiodoftime(shownineachplan)thatyoumustbeinactiveemploymentinaneligiblegroupbeforeyouareeligibleforcoverageunderaplan.
WE,USandOURmeansUnumLifeInsuranceCompanyofAmerica.
YOUmeansanemployeewhoiseligibleforUnumcoverage.
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AdditionalClaimandAppealInformation
COMMONWEALTHOFMASSACHUSETTS
ThefollowingitemsconstitutethePlan:theadditionalinformationcontainedinthisdocument,thepolicy,includingyourcertificateofcoverage,andanyadditionalsummaryplandescriptioninformationprovidedbythePlanAdministrator.Benefit
determinationsarecontrolledexclusivelybythepolicy,yourcertificateofcoverage,andtheinformationinthisdocument.
HOWTOFILEACLAIM
Ifyouwishtofileaclaimforbenefits,youshouldfollowtheclaimproceduresdescribedinyourinsurancecertificate.Tocompleteyourclaimfiling,Unummustreceivetheclaiminformationitrequestsfromyou(oryourauthorizedrepresentative),yourattendingphysicianandyourEmployer.Ifyouoryourauthorizedrepresentativehasanyquestionsaboutwhattodo,youoryourauthorizedrepresentativeshouldcontactUnumdirectly.
CLAIMSPROCEDURES
Unumwillgiveyounoticeofthedecisionnolaterthan45daysaftertheclaimisfiled. Thistimeperiodmaybeextendedtwiceby30daysifUnumbothdeterminesthatsuchanextensionisnecessaryduetomattersbeyondthecontrolofthePlanandnotifiesyouofthecircumstancesrequiringtheextensionoftimeandthedatebywhichUnumexpectstorenderadecision.Ifsuchanextensionisnecessaryduetoyourfailuretosubmittheinformationnecessarytodecidetheclaim,thenoticeofextensionwillspecificallydescribetherequiredinformation,andyouwillbeaffordedatleast45dayswithinwhichtoprovidethespecifiedinformation.Ifyoudelivertherequestedinformationwithinthetimespecified,any30dayextensionperiodwillbeginafteryouhaveprovidedthatinformation.Ifyoufailtodelivertherequestedinformationwithinthetimespecified,Unummaydecideyourclaimwithoutthatinformation.
Ifyourclaimforbenefitsiswhollyorpartiallydenied,thenoticeofadversebenefitdeterminationunderthePlanwill:
- statethespecificreason(s)forthedetermination;
- referencespecificPlanprovision(s)onwhichthedeterminationisbased;
- describeadditionalmaterialorinformationnecessarytocompletetheclaimandwhysuchinformationisnecessary;
- describePlanproceduresandtimelimitsforappealingthedetermination,andyourrighttoobtaininformationaboutthoseprocedures;and
- discloseanyinternalrule,guidelines,protocolorsimilarcriterionreliedoninmakingtheadversedetermination(orstatethatsuchinformationwillbeprovidedfreeofchargeuponrequest).
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Noticeofthedeterminationmaybeprovidedinwrittenorelectronicform.Electronicnoticeswillbeprovidedinaformthatcomplieswithanyapplicablelegalrequirements.
APPEALPROCEDURES
Youhave180daysfromthereceiptofnoticeofanadversebenefitdeterminationtofileanappeal.Requestsforappealsshouldbesenttotheaddressspecifiedintheclaimdenial.Adecisiononreviewwillbemadenotlaterthan45daysfollowingreceiptofthewrittenrequestforreview.IfUnumdeterminesthatspecialcircumstancesrequireanextensionoftimeforadecisiononreview,thereviewperiodmaybeextendedbyanadditional45days(90daysintotal).Unumwillnotifyyouinwritingifanadditional45dayextensionisneeded.
Ifanextensionisnecessaryduetoyourfailuretosubmittheinformationnecessarytodecidetheappeal,thenoticeofextensionwillspecificallydescribetherequiredinformation,andyouwillbeaffordedatleast45daystoprovidethespecifiedinformation.Ifyoudelivertherequestedinformationwithinthetimespecified,the45dayextensionoftheappealperiodwillbeginafteryouhaveprovidedthatinformation.Ifyoufailtodelivertherequestedinformationwithinthetimespecified,Unummaydecideyourappealwithoutthatinformation.
Youwillhavetheopportunitytosubmitwrittencomments,documents,orotherinformationinsupportofyourappeal.YouwillhaveaccesstoallrelevantdocumentsasdefinedbyapplicableU.S.DepartmentofLaborregulations
applicabletoERISAplans.Thereviewoftheadversebenefitdeterminationwilltakeintoaccountallnewinformation,whetherornotpresentedoravailableattheinitialdetermination.Nodeferencewillbeaffordedtotheinitialdetermination.
ThereviewwillbeconductedbyUnumandwillbemadebyapersondifferentfromthepersonwhomadetheinitialdeterminationandsuchpersonwillnotbetheoriginaldecisionmaker'ssubordinate.Inthecaseofaclaimdeniedonthegroundsofamedicaljudgment,Unumwillconsultwithahealthprofessionalwithappropriatetrainingandexperience. Thehealthcareprofessionalwhoisconsultedonappealwillnotbetheindividualwhowasconsultedduringtheinitialdeterminationorasubordinate.IftheadviceofamedicalorvocationalexpertwasobtainedbythePlaninconnectionwiththedenialofyourclaim,Unumwillprovideyouwiththenamesofeachsuchexpert,regardlessofwhethertheadvicewasreliedupon.
Anoticethatyourrequestonappealisdeniedwillcontainthefollowinginformation:
- thespecificreason(s)forthedetermination;
- areferencetothespecificPlanprovision(s)onwhichthedeterminationisbased;
- astatementdisclosinganyinternalrule,guidelines,protocolorsimilarcriterionreliedoninmakingtheadversedetermination(orastatementthatsuchinformationwillbeprovidedfreeofchargeuponrequest);
- thestatementthatyouareentitledtoreceiveuponrequest,andwithoutcharge,reasonableaccesstoorcopiesofalldocuments,recordsorotherinformationrelevanttothedetermination;and
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- thestatementthat"Youoryourplanmayhaveothervoluntaryalternativedisputeresolutionoptions,suchasmediation.OnewaytofindoutwhatmaybeavailableistocontactyourStateinsuranceregulatoryagency".
Noticeofthedeterminationmaybeprovidedinwrittenorelectronicform.Electronicnoticeswillbeprovidedinaformthatcomplieswithanyapplicablelegalrequirements.
Unlesstherearespecialcircumstances,thisadministrativeappealprocessmustbecompletedbeforeyoubeginanylegalactionregardingyourclaim.
OTHERRIGHTS
Unum,foritselfandasclaimsfiduciaryforthePlan,isentitledtolegalandequitablerelieftoenforceitsrighttorecoveranybenefitoverpaymentscausedbyyourreceiptofdisabilityearningsordeductiblesourcesofincomefromathirdparty.Thisrightofrecoveryisenforceableeveniftheamountyoureceivefromthethirdpartyislessthantheactuallosssufferedbyyoubutwillnotexceedthebenefitspaidyouunderthepolicy.UnumandthePlanhaveanequitablelienoversuchsourcesofincomeuntilanybenefitoverpaymentshavebeenrecoveredinfull.
DISCRETIONARYACTS
ThePlan,actingthroughthePlanAdministrator,delegatestoUnumanditsaffiliateUnumGroupdiscretionaryauthoritytomakebenefitdeterminationsunderthePlan.UnumandUnumGroupmayactdirectlyorthroughtheiremployeesandagentsorfurtherdelegatetheirauthoritythroughcontracts,lettersorotherdocumentationorprocedurestootheraffiliates,personsorentities.Benefitdeterminationsincludedeterminingeligibilityforbenefitsandtheamountofanybenefits,resolvingfactualdisputes,andinterpretingandenforcingtheprovisionsofthePlan.AllbenefitdeterminationsmustbereasonableandbasedonthetermsofthePlanandthefactsandcircumstancesofeachclaim.
OnceyouaredeemedtohaveexhaustedyourappealrightsunderthePlan,youhavetherighttoseekcourtreviewofanybenefitdeterminationswithwhichyoudisagree.Thecourtwilldeterminethestandardofreviewitwillapplyinevaluatingthosedecisions.
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