13)
The following Rider form(s) is/are not available:
SICKNESS BENEFITS RIDER
Washington residents:
1) The following has been added to the first paragraph on the first page:
Any conflict between the terms of the Certificate and the Policy will be decided in favor of the Certificate.
2) If the Policy provides coverage/benefits to a Spouse, a Domestic Partner will be afforded the same coverage/benefits provided to a Spouse.
Domestic Partner means any of the following:
1. A person with whom the Employee has a registered domestic partnership under state law which imposes legal obligations on the parties substantially similar to marriage. Such person will continue to be recognized as a Domestic Partner unless and until: (1) the domestic partnership is dissolved under applicable law; or (2) either the Employee or the Domestic Partner marries another person.
All references in the policy to ''Spouse'' shall be changed to read ''Spouse and Domestic Partner'' except as follows:
1. A Domestic Partner shall be deemed eligible to be enrolled for insurance or eligible for Additional Benefits on the latest of:
a. the date of registration under Item 1 of the definition of Domestic Partner; b. the date that the Employee is eligible for insurance under the Policy; or; c. the effective date of this Rider to the Policy.
2. A child of a Domestic Partner may only be eligible to be insured or eligible for Additional Benefits if: a. the child is primarily dependent on the Employee for financial support; b. the Employee has a legal obligation of support of the child; or c. the Employee is the child’s legal guardian.
3) A minimum benefit of $50 for Emergency Care Treatment and Ground Ambulance will be available.
4) A minimum benefit of $25 for Physician Office Visit and Diagnostic Exam will be available.
5) Under the Schedule of Benefits section, the following changes are made:
a) The Fracture benefit is revised to require diagnosis and treatment by a physician within 365 days of a Covered Accident.
b) The Dislocation benefit is revised to require diagnosis and treatment by a physician within 365 days of a Covered Accident.
c) The Intensive Care Unit (ICU) Admission Benefit is not available. ICU admissions will be paid at the Hospital Admission Benefit level.
d) The Sports Accident Benefit is not available.
6) Under the Description of Coverages and Benefits section, the following changes are made:
a) Benefit Conditions time periods is revised to within 365 days of the covered accident throughout.
7) Under the General Definitions section the following changes are made:
62
Made with FlippingBook flipbook maker