Period of Coverage
When does my coverage start?
Coverage will start on the 1st day of the month following the month You become eligible. All Effective Dates of coverage are subject to the Deferred Effective Date provision.
Deferred Effective Date
When will my effective date for coverage or a change in my coverage be deferred?
If, on the date You are to become covered:
- under The Policy;
- for increased benefits; or
- for a new benefit;
You are not Actively at Work due to a physical or mental condition, such coverage will not start until the date You are Actively at Work.
Continuity from a Prior Policy
Is there Continuity of Coverage from a Prior Policy?
Your initial coverage under The Policy will begin, and will not be deferred if on the day before the Policy Effective Date, You were insured under the Prior Policy, but on the Policy Effective Date, You were not Actively at Work, and would otherwise meet the Eligibility requirements of The Policy. However, Your Amount of Insurance will be the amount of accidental death and
dismemberment principal sum:
- You had under the Prior Policy; or
- shown in the Schedule of Insurance;
reduced by any coverage amount:
- that is in force, paid or payable under the Prior Policy; or
- that would have been so payable under the Prior Policy had timely election been made.
Such amount of insurance under this provision is subject to any reductions in The Policy and will not increase.
Coverage provided through this provision ends on the first to occur of:
- the last day of a period of 12 consecutive months after the Policy Effective Date;
- the date Your insurance terminates for any reason shown under the Termination provision;
- the last day You would have been covered under the Prior Policy, had the Prior Policy not terminated; or
- the date You are Actively at Work.
However, if the coverage provided through this provision ends because You are Actively at Work, You may be covered as an Active Employee under The Policy.
When will my coverage end?
Your coverage will end on the earliest of the following:
- the date The Policy terminates;
- the date You are no longer in a class eligible for coverage, or The Policy no longer insures Your class;
- the date the premium payment is due but not paid;
- the date Your Employer terminates Your employment;
- the date You are no longer Actively at Work; or
- the last day of the insurance period Your combined credited and excess hours do not qualify You for the next insurance period, except that you may continue Your insurance as determined within Your collective bargaining agreement.
Can my coverage be continued beyond the date it would otherwise terminate?
Coverage can be continued by Your Employer beyond a date shown in the Termination provision, if Your Employer provides a plan of continuation which applies to all employees the same way. Coverage may not be continued under more than one Continuation Provision.
The amount of continued coverage applicable to You will be the amount of coverage in effect on the date immediately before coverage would otherwise have ended. Continued coverage:
- is subject to any reductions in The Policy;
- is subject to payment of premium;
- may be continued up to the maximum time shown in the provisions; and
- terminates if The Policy terminates.
In no event will the amount of insurance increase while coverage is continued in accordance with the following provisions. There are no provisions which apply to The Policy. In all other respects, the terms of Your coverage remain unchanged.
Waiver of Premium
Does coverage continue if I am Disabled?
Waiver of Premium is a provision which allows You to continue Your Accidental Death and Dismemberment Insurance coverage without paying premium, while You are Disabled and qualify for Waiver of Premium.
If You qualify for Waiver of Premium, the amount of continued coverage:
- will be the amount in force on the date You cease to be an Active Employee;
- will be subject to any reductions provided by The Policy; and
- will not increase.
What does Disabled mean?
Disabled means You are wholly and continuously prevented from performing any work or occupation for wage or profit, for which You are reasonably qualified or trained, as a result of injury or sickness.
If You are in an occupation that requires You to maintain a license, Your failure to pass a physical examination required to maintain that license does not alone mean that You are disabled.
Conditions for Qualification
What conditions must I satisfy before I qualify for this provision?
To qualify for Waiver of Premium You must:
- be covered under The Policy and be under age 60 when You become Disabled;
- be Disabled and provide Proof of Loss that You have been Disabled for 9 consecutive month(s), starting on the date You were last Actively at Work; and
- provide such proof within one year of the date You became Disabled.
Refund of Premium
Will premiums be refunded if I am Disabled?
When You are approved for Waiver of Premium, We will refund to You, or to Your estate if You have died, any premiums paid during the period You have been continuously Disabled.
When Premiums are Waived
When will premiums be waived?
If We approve Waiver of Premium, We will notify You of the date We will begin to waive premium. In any case, We will not waive premiums for the first 9 month(s) You are Disabled. We have the right to:
- require Proof of Loss that You are Disabled; and
- have You examined at reasonable intervals during the first 2 years after receiving initial Proof of Loss, but not more than once a year after that.
If You fail to submit any required Proof of Loss or refuse to be examined as required by Us, then Waiver of Premium ceases. However, if We deny Your application for Waiver of Premium, You may be eligible to convert coverage in accordance with the Conversion Right.
If You cease to be Disabled and return to work for a total of 5 days or less during the first 9 month(s) that You are Disabled, the 9 month(s) waiting period will not be interrupted. Except for the 5 days or less that You worked, You must be Disabled by the same condition for the total 9 month(s) period. If You return to work for more than 5 days, You must satisfy a new waiting period.
When will Waiver of Premium cease?
We will waive premium payments and continue Your coverage, while You remain Disabled, until the date You attain Normal Retirement Age if Disabled prior to age 60.
What happens when Waiver of Premium ceases?
When the Waiver of Premium ceases:
- if You return to work in an Eligible Class, as an Active Employee, then You may again be eligible for coverage for Yourself as long as premiums are paid when due; or
- if You do not return to work in an Eligible Class, coverage will end and You may be eligible to exercise the Conversion Right for You if You do so within the time limits described in such provision. The Amount of Accidental Death and Dismemberment Insurance that may be converted will be subject to the terms and conditions of the Conversion Right.
Effect of Policy Termination
What happens to the Waiver of Premium if The Policy terminates?
If The Policy terminates before You qualify for Waiver of Premium:
- You may be eligible to exercise the Conversion Right, provided You do so within the time limits described in such provision; and
- You may still be approved for Waiver of Premium if You qualify.
If The Policy terminates after You qualify for Waiver of Premium, Your coverage under the terms of this provision will not be affected.
Exercise of Conversion Right
What happens to the Waiver of Premium Provision if I convert my coverage?
If You exercise Your right under the Conversion Right, this Waiver of Premium provision will automatically terminate.
However, You may still be eligible for this Waiver of Premium provision, if, within 12 months of conversion of Your coverage to an individual policy:
- You fulfill all the conditions of the Waiver of Premium provision; and
- You surrender the individual policy and all benefits and payments under the individual policy except for any refund of premiums.
If my coverage under The Policy ends, do I have a right to conversion?
If You cease to be covered under The Policy because You cease to be eligible for coverage and:
- The Policy has not terminated; and
- You have paid any required premium;
You have a Conversion Right as provided below.
The Conversion Right allows You to request coverage under a conversion policy from the Insurer, without giving medical evidence of insurability, to cover Yourself on the date Your coverage ceases.
Insurer, as used for this Conversion Right, means Us or another insurance company which has agreed with Us to issue converted policies according to this conversion right.
- give the Insurer a written request for the converted policy; and
- pay the Insurer the initial premium;
within 31 days after You cease to be covered under The Policy.
The Conversion Right will provide a converted policy that:
- will have the provisions, limitations and exclusions on the form the Insurer is issuing for this purpose at conversion;
- will provide coverage on a twenty four hour a day basis;
- will provide benefits for Accidental Death and Dismemberment alone;
- will take effect on the date You cease to be covered under The Policy;
- may exclude any condition excluded by The Policy;
- will not pay for any loss covered by The Policy;
- will provide a Principal Sum for You which will be:
- the amount of Your Principal Sum under The Policy on the date of conversion, rounded to the nearest $1,000, subject to a minimum of $25,000.00 and a maximum of $25,000.00, if You are under age 70;
- $25,000.00, if You are age 70 or older but less than age 75; or
- $12,500.00, if You are age 75 or older;
- will have premiums based on the Insurer’s rates in effect for new applicants of Your class and age at conversion.
Reinstatement after Military Service
Can my coverage be reinstated after return from active military service?
- Your coverage terminates because You enter active military service; and
- 2) You are rehired within 12 months of the date Your coverage terminated;
then coverage for You may be reinstated, provided You request such reinstatement within 31 days of the date You return to work.
The reinstated coverage will be the same coverage amounts in force on the date coverage terminated and will be subject to all the terms and provisions of The Policy.