Group Critical Illness Insurance Certificate

Notwithstanding this paragraph, all dependent coverage remains subject to the Active Service requirements of the Deferred Effective Date provisions of this Policy. 9. For any benefit offered with this Policy that is subject to an Elimination Period, the Elimination Period under this Policy, if applicable, will be waived while the Employee and the Employee's dependents are insured under this Policy if all of the following conditions are met: A. The Covered Loss results from the same or related causes as a Covered Loss for which benefits were payable under the Prior Plan; B. Benefits are not payable for the Covered Loss under the Prior Plan solely because it is not in effect; C. An Elimination Period would not apply to the Covered Loss if the Prior Plan had not ended; D. The Covered Loss occurs within 90 days of the Employee's return to Active Service and the Employee’s and the Employee's dependents' coverage under this Policy is continuous from this Policy’s Effective Date. For purposes of paragraph B, benefits will be determined based on the lesser of: (1) the amount of the benefit under the Prior Plan and any applicable maximums had the Prior Plan remained in force; and (2) those provided by this Policy. If benefits are payable under the Prior Plan for a Covered Loss, no benefits are payable under this Policy.

TERMINATION OF INSURANCE Coverage on a Covered Person will end on the earliest date below: 1. the date this Policy or coverage for a Covered Class is terminated; 2. the date the Subscriber’s participation under this Policy ends.

3. the date the Employee is no longer in Active Service; 4. for a Spouse, the date the Spouse reaches age 100; 5. for a Dependent Child, the date the Dependent Child reaches age 26, unless primarily supported by the Employee and incapable of self-sustaining employment by reason of mental or physical handicap; 6. the date the Employee is no longer in a Covered Class or satisfies eligibility requirements under this Policy; 7. the last day for which premium is paid; 8. with respect to a Spouse or Dependent Child, the date of the death of the covered Employee or the date of divorce from the covered Employee unless the Employee elects to continue coverage, including coverage on any Dependent Child; 9. the date that the plan of benefits under which the Covered Person is covered is terminated. Termination will not affect a claim that arises while coverage was in effect. CONTINUATION OF COVERAGE PROVISIONS 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. Notwithstanding any other provision of this Policy, if an Employee’s Active Service ends due to termination of employment, or any other termination of the employment relationship, coverage will end and Continuation of Coverage under this section will not apply. Continuation for Leave of Absence or Family Medical Leave If an Employee’s Active Service ends due to personal or family medical leave approved timely by the Employer, coverage will continue for up to the Maximum Benefit Period as shown in the Schedule of Benefits . Premiums are required for this coverage and are to be remitted directly to the Subscriber. If an Employee’s Active Service ends due to any other leave of absence approved in writing by the Employer prior to the date the Employee ceases work, coverage will continue up to the Maximum Benefit Period as shown in the Schedule of Benefits . Premiums are required for this coverage and are to be remitted directly to the Subscriber. An approved leave of

23

Made with FlippingBook. PDF to flipbook with ease