a.
employed or retained by the Policyholder;
b. providing homeopathic, aroma-therapeutic or herbal therapeutic services; c. living in the Covered Person’s household; d. a parent, sibling, spouse or child of the Covered Person;
• sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food.
10) Under the Termination of Insurance / Continuation of Insurance Provisions , the following changes are made:
a) Add the following to the Termination of Insurance provision:
For Continuation for Loss of Eligibility, the coverage on a Covered Person will end of the earliest date below:
1. the first of the month following the end of the Maximum Benefit Period stated in the Schedule of Benefits for Loss of Eligibility; 2. the last day of the last period for which premium is paid; 3. the date the Covered Person is considered to reside outside the United States. The Covered Person will be considered to reside outside the United States when the Covered Person has been outside the United States for a total period of 4 months during any 4 consecutive months. 4. for a Spouse and Dependent Child, the date the coverage for the Employee terminates.
b) Under the Continuation of Insurance Provisions section , the following provision is added:
If an Employee is no longer in Active Service, coverage may be continued. The following provisions explain the continuation options available under this Policy. Please see the Schedule of Benefits , to determine the applicability of these benefits on a class level. Premiums are required for this coverage and are to be remitted in accordance with the Payment of Premium provision. Continuation for Loss of Eligibility If an Employee’s coverage ends due to Loss of Eligibility from a qualifying event as defined in this section, coverage will continue up to the Maximum Benefit Period as shown in the Schedule of Benefits . The qualifying event means: 1. loss of employment, including a reduction in hours that results in ineligibility for employer-sponsored coverage; 2. divorce, dissolution, or legal separation of the covered employee from the employee’s spouse or civil union partner; 3. a dependent child ceasing to qualify as a dependent child under the generally applicable requirements of the policy; or 4. death of the covered employee or member. The Provisions of this section will not apply if 1. the deceased person or Employee was not insured under the group policy on the date of the qualifying event; 2. the person is covered by Medicare; 3. the person is covered by any other group insured or uninsured arrangement which provides dental coverage or hospital and medical coverage for individuals in a group and under which the person was not covered immediately prior to such qualifying event, and no preexisting condition exclusion applies.
11) Under the Claim Provision section, the Physical Examination and Autopsy provision is replaced with the following:
We, at Our own expense, have the right and opportunity to examine the Covered Person when and as often as We may reasonably require while a claim is pending and to make an autopsy in case of death unless the law or the Covered Person’s religion forbids it.
12) Under the Accident Disability Rider, under the Termination of Benefits provision, Disability Income Benefits will begin when the Disabled Employee and Disabled Spouse satisfies the definition of Disability/Disabled.
61
Made with FlippingBook flipbook maker