GC 3100.31B SECTION 12 - CONTINUITY OF COVERAGE 2005 (LOA/Layoff/IMM) SECTION 12 - CONTINUITY OF COVERAGE This provision applies when coverage under the Group Policy replaces a Participating Unit's Prior Plan of Long Term Disability insurance that terminated on the day before the effective date of the Participating Unit under the Group Policy. This Section will apply only to Persons insured under the Participating Unit's Prior Plan on its termination date. Continuity of Coverage will apply to a Person who would not get full coverage under the Group Policy because of the following situations: 1) failure of the Person to be Actively At Work due to Disability or an approved Leave of Absence or temporary layoff on the effective date of the Participating Unit's coverage under the Group Policy; or 2) a Pre-Existing Condition limitation or exclusion of the Group Policy. BENEFITS FOR A PERSON WHO FAILS TO BE ACTIVELY AT WORK DUE TO DISABILITY The Group Policy will cover, subject to proper premium payments, a Person who: 1) was insured under the Prior Plan on its termination date; and 2) is not Actively At Work due to Disability or an approved Leave of Absence or temporary layoff on the effective date of the Participating Unit's coverage under the Group Policy. Coverage under this provision will begin on the Participating Unit’s effective date under the Group Policy and will continue until the earliest of: 1) the date the Person returns to Active Work; or 2) the end of any period of continuance or extension provided under the Prior Plan; or 3) the date coverage would otherwise end, according to the provisions of the AUL Group Policy. The benefits payable will be the same, as the Prior Plan would have paid, had coverage remained in force, less any amount for which the Prior Plan is liable. This Section of the Continuity of Coverage provision does not establish eligibility for such a Person under the Group Policy. Eligibility can only be met when the Person returns to full-time, Active Work as described in the Eligibility and Individual Effective Date Section. BENEFITS PAYABLE FOR A DISABILITY DUE TO A PRE-EXISTING CONDITION Benefits may be payable for a Disability due to a Pre-Existing Condition for a Person who: 1) was insured by the Prior Plan on its termination date; and 2) has been continuously covered under the AUL Group Policy from the effective date of the Participating Unit’s coverage under the Group Policy through the date the Person’s Disability began. The benefit payable will be determined by applying the Group Policy's Pre-Existing Condition exclusion. If the Injury or Sickness that causes a Person’s Disability is not excluded under the Pre-Existing Condition exclusion, then a Person will be paid the benefits of the Group Policy as selected by the Participating Unit. If the Injury or Sickness that causes a Person's Disability is excluded under the Pre-Existing Condition exclusion of the Group Policy, and such Injury or Sickness is not excluded under the Prior Plan’s Pre-Existing Condition exclusion, giving consideration for continuous time covered under both plans, the Person will be paid the lesser of: 1) the benefits of the Group Policy for the Participating Unit determined without application of the Pre-Existing Condition exclusion; or 2) the benefits of the Prior Plan. If the Injury or Sickness is excluded under the Prior Plan's Pre-Existing Condition exclusion, giving consideration for continuous time covered under both Plans, no benefits will be paid.