How the Plan Works
You are eligible for critical illness and mammography benefits if you are covered by a Company-sponsored medical plan or other group medical plan.
This plan is closed to new enrollments. If you were enrolled in the plan on December 31, 2020, your coverage will continue through payroll deduction until you cancel your coverage. To cancel your coverage, call UNUM directly at 800-635-5597.
All benefits will be paid in a lump sum to you. If a dependent child is insured by two employees and makes a claim, you choose whose benefits to use. Unum will only pay benefits under one parent's coverage.
Unum will pay benefits for the critical illnesses listed under What's Covered if:
- The date of diagnosis is at least 30 days after your coverage is in force (this 30-day period is the plan's benefit waiting period)
- The benefit claim is medically unrelated to any previously paid critical illness benefit for the same person
- It has been 90 days or more since the last claim
- Benefits would not otherwise be denied due to plan limitations or exclusions, or failure to meet conditions as required by Unum
Taxation of Benefits
Voluntary critical illness and wellness benefits are not taxable to you.
Pre-Existing Conditions
Unum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of a pre-existing condition or any medical or surgical treatment for that condition for which the date of diagnosis is in the first 12 months after your coverage effective date. However, pre-existing conditions are covered if diagnosis occurs after the insured person has been covered by the plan for 12 months.
For purposes of this plan, a pre-existing condition is defined as a sickness or injury, or symptoms of a sickness or injury, whether diagnosed or not, for which a person received any of the following during the 12 months just prior to his or her coverage effective date:
- Medical treatment
- Consultation
- Care or services, including diagnostic measures
- A prescription for medicine
A pre-existing condition can also be a sickness or injury, or symptoms of a sickness or injury, whether diagnosed or not, for which an ordinarily prudent person would have consulted a health care provider during the 12 months just prior to the his or her coverage effective date.
The pre-existing condition will apply to any new or increased coverage.
The pre-existing condition limitation does not apply for dependent children who are born or adopted while you are covered under this policy, and who are continuously covered from the date of birth or adoption.
You can change coverage for you or your spouse/domestic partner during the annual enrollment period. Evidence of Insurability is required for any additional coverage. Additional coverage will begin at 12:01 a.m. on the later of:
- The first day of the month following the end of the annual enrollment period; or
- The first of the month following the date Unum approves your proof of good health.
Any additional coverage will be subject to a new pre-existing condition limitation and a new benefit waiting period.
A decrease in coverage will begin at 12:01 a.m. on the first of the month following the date you provide notification to the Benefits Department.
Coverage changes will not affect a claim that occurs before the effective date of the change.
If you are absent from work on the date your change in coverage would normally begin due to injury or sickness any coverage changes will begin on the date you return to active employment.
Any changes to your coverage will affect your dependent children's coverage.
For You
If you choose to cancel your coverage under the policy, your coverage ends on the first of the month following the date you provide notification to the Benefits Department.
Otherwise, your coverage ends on the earliest of the:
- Date this policy is cancelled
- Date you are no longer in an eligible group
- Date your eligible group is no longer covered
- Date of your death;—last day of the period for which You made any required contributions
- Last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness
Coverage on your dependent children ends on the earliest of the date your coverage under the policy ends or the date a dependent child no longer meets the definition of dependent children.
Unum will provide coverage for a payable claim which occurs while you are covered under this plan.
For Your Spouse/Domestic Partner
If you choose to cancel coverage for your spouse/domestic partner under the policy, coverage ends on the first of the month following the date you provide notification to your employer.
Otherwise, spouse coverage under the policy ends on the earliest of the:
- Date this policy is cancelled
- Date you no longer are in an eligible group
- Date your eligible group is no longer covered
- Date of your death
- Last day of the period for which you made any required contributions
- Last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness
- Date your coverage under the policy ends
- Date your spouse no longer meets the definition of spouse
- Date of divorce or annulment.
Unum will provide coverage for a payable claim which occurs while your spouse is covered under the policy.
For You
If your employment with the Company ends or you are no longer in an eligible group, you may have the right to apply to continue coverage under the policy for yourself, your spouse if covered, and your eligible children. You must apply for coverage under this portability provision and pay the first premium within 31 days after your employment ends or you are no longer eligible.
You can't apply for continuing coverage if the policy is already cancelled or closed to new enrollments or if it is changed to exclude the group of employees to which you belong.
Your continuing coverage will be the same as when you were employed or eligible for coverage. Future changes to the policy will not apply to you. Even if Unum cancels this coverage or closes it for new enrollments, your policy will remain in effect, except as follows:
- You may decrease, but not increase, the amount of your critical illness coverage
- Premiums will be billed directly to you
- Initial premium rates will be based on the portability rates in effect at the time you apply to continue your coverage
- Unum can change premium rates at any time upon 31 days notice to you, so long as the change is not due to any change in your age or health or the age or health of your spouse or your eligible children.
Your continuing coverage will end on the earlier of the following:
- You don't pay the required premium within the 31 day grace period
- The date you die, unless your spouse applies for continuing coverage
- Unum cancels this benefit for any reason upon 31 days notice
Once continuing coverage is cancelled, it cannot be reinstated.
For Your Spouse/Domestic Partner
If you die, divorce, or terminate your domestic partnership, your spouse/domestic partner may have the right to continue family coverage, including eligible dependent children, under this policy. Your spouse/domestic partner must apply for continuing coverage and pay the first premium within 31 days after the date of your death, divorce, or termination of domestic partnership.
If you die and your spouse/domestic partner applies to continue coverage, any eligible dependent children also will be covered. Critical illness coverage for eligible children will be provided at 25% of your spouse/domestic partner's critical illness face amount.
Continued coverage is not available if your spouse/domestic partner was not insured under this policy on the date of your death or divorce.
Coverage for your spouse/domestic partner will be the same as when he or she was an eligible participant. Future changes to the policy will not apply. Even if Unum cancels this coverage or closes it for new enrollments, the policy will remain in effect, except as follows:
- Your spouse/domestic partner may decrease, but not increase, the amount of critical illness coverage,
- Premiums will be billed directly to your spouse/domestic partner
- Initial premium rates will be based on the portability rates in effect at the time continued coverage is requested
- Unum can change premium rates at any time upon 31 days notice, so long as the change is not due to any change in age or health.
Continued coverage for your spouse/domestic partner and children will end on the earlier of the following:
- Your spouse/domestic partner doesn't pay the required premium within the 31 day grace period
- The date your spouse/domestic partner dies, unless your spouse applies for continuing coverage
- Unum cancels this benefit for any reason upon 31 days notice
Once continuing coverage is cancelled, it cannot be reinstated.