Hartford PT - AD&D - Amendatory Rider

Amendatory Rider

 

This rider is attached to all certificates given in connection with The Policy and is effective on The Policy Effective Date.

This rider is intended to amend Your certificate, as indicated below, to comply with the laws of Your state of residence. Only those references to benefits, provisions or terms actually included in Your certificate will affect Your coverage. In addition, any reference made herein to Dependent coverage will only apply if Dependent coverage is provided in Your certificate.

For California residents:

  1. The following is added to the definition of Spouse:
    Spouse will also include an individual who is in a registered domestic partnership with You in accordance with California law. References to Your marriage or divorce will include Your registered domestic partnership or dissolution of Your registered domestic partnership.
  2. The following is added to the definition of Dependent Child(ren):
    Dependent Child(ren) will also include child(ren) of Your California registered domestic partner.

For Indiana residents:
The first paragraph of the Traumatic Brain Injury Benefit is deleted and is replaced by the following:
If You or Your Dependents sustain an Injury that results in a Traumatic Brain Injury within 60 days of the date of accident which:

  1. requires that the injured person be Hospitalized for at least 7 days during the first 60 days following the accident; and
  2. the Traumatic Brain Injury continues for 12 consecutive months;

We will pay a Traumatic Brain Injury Benefit.

For Louisiana residents:

  1. the following will be considered Dependent Child(ren) and are added to the definition of Dependent Child(ren):
    • unmarried Child who is placed in your home pursuant to an adoption placement agreement; executed with a licensed adoption agency (from the date of placement in your home);
    • an unmarried Child who is placed in your home following execution of an act of voluntary surrender (as of the date on which the act of voluntary surrender becomes irrevocable);
    • your unmarried grandchild who is in your legal custody.
  2. The child limiting age is changed to 21 years, or 24 years if a student, if less than such ages.
  3. The following is added to the definition of Dependent Child(ren): “Coverage will be continued for a Child up to age 24 who is deemed to be unable to attend school full-time due to a mental or nervous condition, problem or disorder.”
  4. The following replaces the last sentence of the Dependents definition: “Any person who is in full-time military service cannot be a dependent, unless that person is subsequently called to military service and any required premium is paid.”
  5. The following provision is added:
    Reinstatement after Military Service: Can my coverage be reinstated after return from active military service?
    If:

    1. Your coverage terminates because You enter active military service; and
    2. You are rehired within 12 months of the date You return from active military service;

    then coverage may be reinstated, provided You request such reinstatement within 31 days of the date you return to work.

    The reinstated coverage will:

    1. be the same coverage amounts in force on the date coverage terminated; and
    2. not be subject to any Waiting Period for Coverage, Evidence of Insurability or Pre-existing Conditions Limitations; and
    3. be subject to all the terms and provisions of The Policy.

For Maine residents:

  1. The time period stated in the Notice of Claim provision is changed to 30 days if not already 30 days.
  2. The time period stated in the Claim Forms provision is changed to 15 days if not already 15 days.
  3. The time periods stated in the Sending Proof of Loss provision are changed to 90 days and 1 year if not already 90 days and 1 year, respectively.
  4. The time period stated in the Claim Payment provision is changed to 30 days if not already 30 days.
  5. The dollar amount stated in the Claims to be Paid provision is changed to $2,000 if not already $2,000.
  6. The phrase “In the absence of Insurance Fraud” is deleted from the Misstatements provision.

For Minnesota residents, the definition of Disabled or Total Disability in the Permanent Total Disability Benefit is replaced by the following:
Disabled or Total Disability, for the purpose of this Benefit, means Your or Your Spouse’s:

  1. inability during the first two years of disability to perform the Essential Duties of Your or Your Spouse’s Occupation; and
  2. after that, Your or Your Spouse’s inability to engage in Any Occupation for which you are suited by education, training and experience; or
  3. with respect to a Spouse who is unemployed, his or her inability to engage in the normal and customary activities of a person of like age and gender in good health.

You unemployed Spouse must be:

  1. regularly attended by Physician; and
  2. continuously confined within his or her house or Hospital, provided such house or Hospital confinement will not preclude transportation of Your Spouse to or from a Hospital or Physician’s office for necessary treatment at the direction of his or her Physician.

For Missouri residents, the suicide Exclusion is replaced by the following: “suicide or attempted suicide, while sane”.

For New Hampshire residents:

  1. Item 1 of the definitions of Disabled and Disabled or Disability is replaced by the following:
    1. perfoming any work or occupation for wage or profit for which You are, or become, reasonably qualified by reason of education, training or experience.
  2. Item 3 of the last paragraph of the Sending Proof of Loss provision is deleted.
  3. Item 3 of the Conditions for Qualification provision is replaced by the following:
    3. provide such proof in accordance with the Sending Proof of Loss provision.
  4. The Policy Interpretation provision is deleted.
  5. The time period stated in the definition of Period of Confinement in the Accident Hospital Income Benefit, is changed to 180 days, if less than 180 days.
  6. Item 1 of the definition of Extended Care Facility in the Extended Care Facility Benefit is replaced by the following:
    1. Operates pursuant to law;
  7. The following is added to the Period of Coverage:
    Spouse Continuation: Can coverage be continued for a divorced Spouse?
    If You are legally separated or divorced from Your Spouse, coverage for Your former Spouse may continue under The Policy until the earliest of:

    1. the last day of the third year following the anniversary of a final divorce or legal separation;
    2. the date You remarry;
    3. the date Your former Spouse remarries;
    4. a date specified in the final divorce decree;
    5. the date Your former Spouse fails to pay any premiums that may be due; or
    6. the date You die.

For Oregon residents:

  1. The following is added to the definition of Spouse:
    Spouse will also include an individual who is in a registered domestic partnership with You in accordance with Oregon law. References to Your marriage or divorce will include Your registered domestic partnership or dissolution of Your registered domestic partnership.
  2. The following is added to the definition of Dependent Child(ren):
    Dependent Child(ren) will also include child(ren) of Your Oregon registered domestic partner.

For South Carolina residents:

  1. The time period in the Notice of Claim provision is changed to 20 days, if not already 20 days.
  2. The following is added to the Physical Examinations and Autopsy provision: “Such autopsy must be performed during the period of contestability and must take place in the state of South Carolina.”
  3. Item 2 of the Legal Actions provision is replaced by the following:
    2. 6 years of the date Proof of Loss is required to be furnished according to the terms of The Policy.

For South Dakota residents, the provision titled Policy Interpretation is deleted in its entirety.

For Utah residents:

  1. The following benefits are not available:
    • Anti-Inflation Benefit
    • Therapeutic Counseling Benefit
    • Accidental Death Benefit with Double Indemnity while On a Common Carrier
    • Accidental Death Motor Vehicle Benefit
    • Accidental Death Benefit while in a Covered Accident
    • Accidental Death and Dismemberment: while Actively at Work
    • Double Indemnity while On A Common Carrier
  2. The maximum age for a student, stated in the Child Education Benefit is changed to 26 if not already 26.
  3. The definition of Dependent Child(ren) is amended as follows:
    1. items a and b of item 2 are deleted
    2. the second item 2 is deleted
    3. the maximum age for a child is changed to 26 if not already 26.
  4. The following is added to the first sentence of the Change in Family Status provision:or from the date of placement for adoption with You.
  5. Item 3 of the Sending Proof of Loss provision is deleted in its entirety.
  6. The age references in the Continuation for Dependent Child(ren) with Disabilities provision are changed to 26 if not already 26.

For Vermont residents:

Purpose: Vermont law requires that health insurers offer coverage to parties to a civil union that is equivalent to coverage provided to married persons.

Definitions, Terms, Conditions and Provisions: The definitions, terms, conditions or any other provisions of the policy, contract, certificate and/or riders and endorsements to which this mandatory endorsement is attached are hereby amended and superseded as follows:

  1. Terms that mean or refer to a marital relationship, or that may be construed to mean or refer to a marital relationship, such as “marriage”, “spouse”, “husband”, “wife”, “dependent”, “next of kin”, “relative”, “beneficiary”, “survivor”, “immediate family” and any other such terms, include the relationship created by a civil union established according to Vermont law.
  2. Terms that mean or refer to the inception or dissolution of a marriage, such as “date of marriage”, “divorce decree”, “termination of marriage” and any other such terms include the inception or dissolution of a civil union established according to Vermont law.
  3. Terms that mean or refer to family relationships arising from a marriage, such as “family”, “immediate family”, “dependent”, “children”, “next of kin”, “relative”, “beneficiary”, “survivor” and any other such terms include family relationships created by a civil union established according to Vermont law.
  4. “Dependent” means a spouse, a party to a civil union established according to Vermont law, and a child or children (natural, stepchild, legally adopted or a minor or disabled child who is dependent on the insured for support and maintenance) who is born to or brought to a marriage or to a civil union established according to Vermont law.
  5. “Child or covered child” means a child (natural, step-child, legally adopted or a minor or disabled child who is dependent on the insured for support and maintenance) who is born to or brought to a marriage or to a civil union established according to Vermont law.

CAUTION: FEDERAL LAW RIGHTS MAY OR MAY NOT BE AVAILABLE
Vermont law grants parties to a civil union the same benefits, protections and responsibilities that flow from marriage under state law. However, some or all of the benefits, protections and responsibilities related to health insurance that are available to married persons under federal law may not be available to parties to a civil union. For example, federal law, the Employee Income Retirement Security Act of 1974 known as “ERISA”, controls the employer/employee relationship with regard to determining eligibility for enrollment in private employer health benefit plans. Because of ERISA, Act 91 does not state requirements pertaining to a private employer’s enrollment of a party to a civil union in an ERISA employee welfare benefit plan. However, governmental employers (not federal government) are required to provide health benefits to the dependents of a party to a civil union if the public employer provides health benefits to the dependents of married persons. Federal law also controls group health insurance continuation rights under COBRA for employers with 20 or more employees as well as the Internal Revenue Code treatment of health insurance premiums. As a result, parties to a civil union and their families may or may not have access to certain benefits under this policy, contract, certificate, rider or endorsement that derive from federal law. You are advised to seek expert advice to determine your rights under this contract.

For Virginia residents, any and all references to Domestic Partners are hereby deleted.

For Washington residents:

  1. The Accelerated Benefit is not available.
  2. The provision titled Policy Interpretation is deleted in its entirety.

For Wisconsin residents, the time periods stated in the Claim Appeal provision are removed.

In all other respects, the Policy and certificates remain the same.li