Long Term Disability Summary Plan Description

SECTION 3 - ELIGIBILITY AND EFFECTIVE DATES (Continued)

What Happens to Your Coverage During a Family and Medical Leave? Your coverage may be continued under this plan for an approved family or medical leave of absence for up to 12 weeks following the date coverage would have terminated, subject to the following: 1. the authorized leave is in writing; 2. the required premium is paid; 3. your benefit level, or the amount of earnings upon which your benefit may be based, will be that in effect on the date before the leave begins; and 4. continuation of coverage will cease immediately if any one of the following events should occur:

a. you return to work; b. this plan terminates; c. you are no longer in an eligible class; d. nonpayment of premium when due by the Sponsor or you; e. your employment terminates.

What Happens if You are Rehired? If you are a former Employee and are re-hired by the Sponsor within 6 months of your termination date, all past periods of Active Employment with the Sponsor will be used in determining your Eligibility Date. If you are a former Employee and are re-hired by the Sponsor more than 6 months after your termination date, you are considered to be a new Employee when determining your Eligibility Date.

Family and Medical Leave/Rehire Eligibility and Effective Dates

ADOC-ELG-7

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