Eligibility All permanent employees in subscribing group working 20 hours or more per week Regarding your eligibility, we may require proof of good health and will rely on answers given on your application to determine if coverage can be issued. Regardless of your health at the time of application, if coverage is approved and issued, claims incurred while coverage is in force will be subject to all terms of the Policy including any Pre-Existing Condition limitation. When Coverage Begins Certificates will become effective on the requested effective date following the date we approve the application, provided you are on active employment and premium has been paid. Physician Expense Benefit Injury - $150.00 per Injury If you need personal treatment by a Physician due to an Injury, we will pay the amount shown above provided no other claim has been paid under the Policy. You are not required to miss one full day of work in order to receive the Injury benefit. This benefit will be limited to 8 payments per calendar year. Accidental Death Benefit A lump sum of $50,000 will be paid to your designated beneficiary if you die as the direct result of an injury within 90 days after the injury. Survivor Benefit An eligible survivor will be paid a lump sum benefit equal to 3 times the Disability Payment if, on the date of your death: the Disability had continued for 90 or more consecutive days and you were receiving or were entitled to receive payments under the Policy. If there are no eligible survivors, no payment will be made. Donor Benefit If you are disabled as a result of being an organ or tissue donor, we will pay your benefit as any other sickness under the terms of the plan. If You Are Disabled Due to a Covered Disability and Not Working We will pay the Disability Benefit described in the Schedule. No disability payment will be provided for any period in which you are not under the regular and appropriate care of a physician. Disability means that you are unable to perform the material and substantial duties of your regular occupation. Return To Work Incentives: Disabled and Working If you are disabled and working, you may be eligible to continue to receive a percentage of your disability payment in addition to your disability earnings. If your disability earnings exceed 80% of your monthly compensation, payments will stop and your claim will end. • Worksite Accommodation As a part of our claims evaluation process, if worksite modifications may assist your return to work, we will evaluate your claim for appropriate action. Pre-Existing Condition Limitation No Disability Benefit will be payable if Disability is caused by or resulting from a Pre-Existing Condition and begins before you have been continuously covered under the Policy for 12 months. This provision will not apply if you have: received no treatment and received no diagnosis or advice from a Physician, for 12 consecutive months for such condition(s). This limitation will not apply to a Disability resulting from a Pre-Existing Condition that begins after you have been continuously covered under the Policy for 12 months. Any increase in benefits will be subject to this pre-existing condition limitation. A new pre-existing condition period must be satisfied with respect to any increase applied for and approved by us. Pre-existing condition means a disease, Injury, Sickness, physical condition or mental illness for which you: received treatment or received a diagnosis or advice from a physician, during the 12 month period immediately before your effective date of coverage. The term pre-existing condition will also include conditions which are related to such disease, injury, sickness, physical condition, or mental illness. Exclusions The Policy does not cover any loss, fatal or non-fatal, resulting from: • Intentionally self-inflicted injury while sane or insane. • An act of war, declared or undeclared. • Injury sustained or Sickness contracted while in the service of the armed forces of any country. • Committing a felony. • Penal incarceration. We will not pay benefits for Disability or any other loss during any period for which you are incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer. • Injury or Sickness arising out of and in the course of any occupation for wage or profit or for which you are entitled to Workers’ Compensation. The term “entitled to Workers’ Compensation” shall also include Workers’ Compensation claim settlements that occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which you are entitled to Workers’ Compensation benefits. Your coverage may be continued for up to 1 year during a leave of absence approved in writing by your employer. Coverage will continue as long as the group policy remains in force, the premiums are paid and you remain eligible for the coverage under the policy. Your coverage will end when you no longer qualify as an insured, you retire, you are not on active employment, or your employment terminates. Your coverage can be terminated or premiums may be increased on any premium due date with 31 days advance notice. Policy Provisions and Plan Features