Human Resources: Benefits

Some terms used in General Provisions are defined below. Others may be explained in Words and Phrases.  

Who May Become Insured

If you are an eligible employee, you may insure yourself and persons who quality as your dependents. You become an eligible employee on the later of:

(a)   the date you complete any Waiting Period which applies to you;
(b)   the date you are included in Eligible Class.

The Waiting Period and Eligible Class appear in the Master Schedule.  

Dual Coverage

No person may be insured under the Policy at the same time:
(a)   as an employee of more than one Employer;
(b)   under similar coverages, as both an employee and dependent or as a dependent of more than one employee.

Application For Insurance

To insure yourself and your dependents, you must make application on forms provided for that purpose by the Employer. After one of your dependents becomes insured you need not apply again to insure new dependents.

Right to Require Evidence You or a Dependent is Insurable

Under the following circumstances, Unicare may require that you furnish it evidence which satisfies it the person for whom application is made is insurable:
(a)   if you apply to insure yourself more than 31 days after you become an eligible employee;
(b)   if you apply to insure a dependent more than 31 days after the later of

(1)   the date you become an eligible employee, or
(2)   the date the dependent qualifies as a dependent;

(c)   if you apply to reinstate insurance for yourself and/or your dependents, after such insurance ended because you did not make a required premium contribution.

Evidence required under this provision must be provided at no cost to Unicare.  

When Does Insurance Become Effective

The dates you and your dependents become insured may be determined from (a) or (b) of this provision. But, if you or your dependent fails to meet an applicable requirement described in the provision "Effective Date Requirements" below, the effective date of that person's insurance will be determined from such provision.

(a)   If Unicare does not require evidence that a person is insurable, insurance for that person (you or a dependent) becomes effective as follows:

(1)    For you       On the date you become an eligible employee.
(2)    For a Dependent    On the latest of the following dates:

(A)   the date the dependent qualifies as a dependent provided you made application to insure the dependent, if required to do so for that dependent;
(B)   the date your own insurance becomes effective;
(C)   with respect to dependent life insurance and a child under 15 days of age, the date the child becomes 15 days old.

(b)   If Unicare requires evidence that you or a dependent is insurable, the effective date of such person's insurance is the date such evidence is approved by Unicare at its Home Office.  

Effective Date Requirements

Employees   An employee must be actively at work on the date insurance would otherwise become effective under the provision "When Does Insurance Become Effective". An employee who is not actively at work on such date will not become insured until the date the employee is again actively at work.
Dependents       A dependent must not be disabled on the date insurance would otherwise become effective under such provision. A dependent who is disabled on such date will not become insured until no longer disabled.

A dependent is disabled, if:
(a)   on the date insurance would otherwise become effective under the provision "When Does Insurance Become Effective", the dependent is confined at a hospital, at home or elsewhere and cannot carry on any substantial part of the regular and customary activities of a person of the same age and sex; or

(b)   within 31 days before such date, the dependent was confined at a hospital.

A dependent is no longer disabled upon the earlier of:

(a)   receipt by Unicare of evidence the dependent has made a complete recovery; or

(b)   completion of a period of 31 days during which the dependent was not confined as described above.

In no event will a dependent child be considered disabled at birth.

When Does Insurance End

(a)   Your insurance under each coverage ends on the earliest of:

(1)   the date your employment for purposes of insurance under that coverage ends, as set forth below;
(2)   the end of the period covered by your last contribution to the premium for such coverage;
(3)   the date you cease to be a member of the class or classes eligible for such coverage;
(4)   the date the coverage terminates;
(5)   the date the Policy terminates.

(b)   Employment for insurance purposes ends on the date you cease active work with the employer. But, under the circumstances listed below, you employment, for insurance purposes, will continue until expiration of the time period shown:

(1)   If your salary is on a 12-month payroll basis, and you were insured on the first day of that policy year:

(i)   employment terminates on the last day of the month in which you cease active work, if you completed less than five months active service in that policy year;
(ii)   employment terminates the last day of the month after the month you cease active work, if you have completed five or more months of active service in that policy year, provided a premium deduction is made in the month you ceased active work.

(2)   If your salary is on a 12-month payroll basis, and you were employed and insured after the first day of that policy year, the same time periods apply to you as shown above, except that, if you have paid the required premium contribution for that entire year, your employment terminates on the last day of that policy year.

(3)   If your salary is paid on other than a 12-month payroll basis, and you were insured on the first day of that policy year:

(i)   your employment terminates on the last day of the month in which you cease active work, if you completed less than five months of active service in that policy year;

(ii)   your employment terminates the last day of the month after the month you cease active work, if you have completed five months but less than ten months of active service in that policy year;

(iii)   your employment terminates the last day of the month two months after you cease active work, if ou have completed at least ten months of active service in that policy year.

(4)   If your salary is on other than a 12-month payroll basis, and you were employed and insured after the first day of that policy year, the same time periods apply to you as shown above in item (3), except that, if you have paid the required premium contribution for that entire policy year, your employment terminates on the last day of that policy year.

(5)   If you cease active work as a result of disease, injury, or pregnancy, you may continue all your coverages for the duration of the disability, provided your disability qualifies and has been approved under the Waiver of Premium Benefits provision of Life Insurance for Employees.

(6)   If you cease active work due to a leave of absence, you may continue all your coverages during the leave, but not beyond two years after the leave begins.

(7)   If you cease active work due to retirement, your Employee Life and AD&D will continue through August 31 immediately following your retirement if you have paid your premium contribution for the entire policy year; otherwise, employment terminates as shown in items (1) through (4) above, whichever applies.

Your Employer may end employment earlier than shown above by written notice to Unicare or by any other means.

In no even will employment be deemed to continue as of the date you begin active duty in the armed forces of any state.

(c)   A dependent's insurance under each coverage for dependents ends on the earliest of:

(1)   the date your insurance under the Policy ends;
(2)   the date the dependent cease to qualify as a dependent;
(3)   the end of the period covered by your last contribution to the premium for such coverage;
(4)   the date the dependent begins active duty in the armed forces of any state;
(5)   the date you become inelligible to have dependents insured for that coverage;
(6)   the date the coverage terminates;
(7)   the date the Policy terminates;.

Beneficiary

Your beneficiary is the person or persons designated by you in writing and entered in the insurance records for the Policy. You may changed such designation by written notice to your Employer.

A beneficiary changed becomes effective only when the new designation is entered in such records. But the change then relates back to take effect as of the date you signed the notice, even though you may not be living when the entry is made. any payment of other action by Unicare before the entry is made will not prejudice Unicare.

You do not need the consent of your beneficiary to make a beneficiary change.  

Facility of Payment

If the benficiary is a minor, or for any other reason is not capable of giving a valid release for any payment due, Unicare may, at its option, and until claim is made by the duly appointed guardian of the beneficiary, make such payment to:

(a)   any relative of the beneficiary by blood or marriage; or
(b)   any other person or institution which appears to Unicare to have assumed custody and principal support of the beneficiary.

Such payment(s) may not exceed $50 per month. They must be made for the sole benefit of the beneficiary.

If, with respect to any amount of insurance payable at your death,

(1)   no beneficiary designation is in effect, or
(2)   no designated beneficiary is then living,

Unicare may, at its option, pay such amount to your estate or to any one or more of the following who survive you:

(A)   your wife or husband;
(B)   your children, including adopted or stepchildren;
(C)   your mother or father;
(D)   your brothers or sisters.

The liability of Unicare shall be fully discharged to the extent of payment made under this provision.  

When and to Whom Benefits are Payable

Life Insurance
Claims are paid as described in the Life Insurance provisions.

Other Insurance

Proof of Loss
Written proof of loss for which claim is made must be furnished to Unicare within 90 days after the date of loss.

Proof of loss must cover:

(1)   when and how the loss occurred; (3)   the extent of the loss.

But, failure to furnish such proof within the time limit that applies will not result in denial or reduction of a claim if it shown:

(A)   it was not reasonly possible to provide such proof within the time limit that applies, and
(B)   such proof was provided as soon as reasonably possible.

Benefit Payments
Upon receipt by Unicare of due written proof of loss, benefits under the Policy are paid as follows:

(a)   Benefits for loss of life under Accidental Death and Dismemberment Insurance are paid to your beneficiary or to one or more other persons under terms of the "Facility of Payment" provision above.

        Any other benefit under that insurance is paid to you.

(b)   Benefits to which you are entitled which remain unpaid at your death are paid to your beneficiary, if a designated beneficiary survives you. Otherwise, such benefits are paid under terms of the "Facility of Payment" provision above.  

Autopsy

In case of death, Unicare may require an autopsy where the law does not forbid it to do so.

Legal Action

No legal action or suit to recover on the Policy may be started before 60 days after written proof of loss has been furnished. Further, no such action or suit may be brought more than 3 years after the time such proof must be furnished. But, if either time limit is less than permitted by state law where you reside when the loss occurs, that limit is extended to agree with the smallest limit the law of that state allows.

Assignment

No rights or benefits under the Policy may be assigned without the consent of Unicare.