This Policy is issued on a non-contributory
basis. Employee's coverage will become effective on:
Elimination Period: The first 90 days of the disability period.
Coverage terminates upon the earlier of age sixty-five (65) or retirement.
DEFINITIONS
ACTIVE WORK or ACTIVELY AT WORK means the use of time and energy in the services of UCAR:
- (1)
- At the regular place of employment.
- (2)
- By an Employee who:
- (a)
- Is physically capable; and
- (b)
- Is mentally capable;
- of performing each of the main duties of his or
her regular job.
- (3)
- On a regular full-time basis.
If an Employee was actively at work, as defined
above, on his or her last regular working day, then he or she
shall be deemed to be actively at work:
- (1)
- On each day of a paid vacation; or
- (2)
- On a regular non-working day;
on which he or she is not disabled.
DISABILITY and DISABLED mean that because of injury or sickness:
- (1)
- the insured cannot perform each of the
material duties of his regular occupation; and
- (2)
- after benefits have been paid for 24 months, the insured cannot
perform each of the material duties of any gainful occupation for which he is reasonably
fitted by training, education or experience.
"PHYSICIAN" means a legally qualified physician; except that with respect to a period
of total disability, or any portion thereof, during which total
disability is caused by any condition other than a medically
determinable physical impairment, "physician" shall mean a legally qualified physician
who either specializes in the practice of psychiatric medicine or has, by reason of
training or experience a specialized competency in the field of psychiatric medicine
sufficient to render the necessary evaluation and treatment of mental illness.
"MONTHLY RATE OF BASIC EARNINGS" means as to any period of total disability:
- (1)
- With respect to any Employee or other than an Employee specified in
item (2) below, the sum of items (a) and (b) below:
- (a)
- the Employee's monthly rate of earnings in effect for the last complete payroll
period immediately preceding the commencement of the period of total disability, exclusive
of bonuses, overtime pay, and other extra compensation;
- (b)
- the average excess monthly earnings, if any, over (a) above on account of
piece-work during the three (3) month period immediately preceding the commencement of the
period of total disability.
- (2)
- With respect to an Employee who is classified by his or her Employer as an
executive and who is eligible for payment under an incentive bonus plan, the sum of
items (a) and (b) below:
- (a)
- the monthly rate of earnings in effect for the last complete payroll
period immediately preceding the commencement of the period of total disability, exclusive
of bonuses, overtime pay, and other extra compensation.
- (b)
- the average monthly bonus for the (2) calendar years (ending December 31)
immediately preceding the commencement of the period of total disability.
A Retroactive change in an Employee's rate of earnings shall be deemed to be effective on the date of
the determination of the change in the rate of earnings.
"ELIGIBILITY DATE" for any Employee means the date that the Employee first becomes
eligible for insurance under this Policy.
"ELIGIBLE SURVIVOR" means the Insured Employee's spouse, if living, otherwise the Insured Employee's children
who are under age twenty-three (23).
"ELIMINATION PERIOD" means a period of consecutive days of total disability for which no
benefit is payable. The elimination period begins on the first
day of total disability. For accumulating the elimination period
the following will apply:
- (1)
- If total disability stops during the elimination period for not more than 14
days then the total disability will be treated as continuous.
- (2)
- Days that the Insured Employee is not totally disabled will not count toward
the elimination period.
"EMPLOYEE" means an actively at work Employee who has not yet attained the age of
sixty-five (65) and who is regularly working for UCAR at least
seventeen and one-half (17 1/2) hours per week during the regular work week.
"INJURY" means accidental bodily injury resulting independently
of all other causes.
"INSURED EMPLOYEE" means an Employee whose insurance is in force under the terms of this
Policy.
"NON-CONTRIBUTORY INSURANCE" means insurance for which the Insured Employee pays none of the
premium.
"PRE-EXISTING CONDITION" means a sickness or injury for which the Insured Employee:
- (1)
- Got medical treatment or consultation;
- (2)
- Had medical care or service(s);
- (3)
- Had diagnostic test(s); or
- (4)
- Took prescribed drug(s) or medicine(s);
within ninety (90) days prior to the Employee's effective date of coverage.
"RECURRENT DISABILITY" means a disability which is contributed to by the same cause(s) or is the
result of the cause(s) of a prior disability for which a monthly benefit was payable.
"REHABILITATIVE EMPLOYMENT" means work in any gainful occupation for which the Insured Employee is
reasonably fitted by training, education, or experience.
"RETIREMENT PLAN" means:
- (1)
- A defined benefit plan; or
- (2)
- A defined contribution plan; or
- (3)
- A profit sharing plan (unless it is in addition to (1) or (2));
Which:
- (a)
- If provided wholly or in part by employer deposits; and
- (b)
- Is for the benefit of the Insured Employee.
It does not mean:
- (a)
- A thrift plan; or
- (b)
- A deferred compensation plan.
"SOCIAL SECURITY" means the United State Social Security Act or any similar law, plan, or at
of any other jurisdiction including the initial enactment and all amendments.
"TOTAL INSURED PAYROLL" is the total amount of basic monthly earnings for which all Employees are
insured under this Policy.
"WAITING PERIOD" is the period of the time that a person must be employed before being
eligible for insurance under this Policy.
"HOSPITAL" means an institution or subdivision thereof which either:
- (1)
- meets fully every one of the following tests:
- (a)
- if is primarily and continuously engaged in providing, for compensation from
its patients and on an in-patient basis, a full range of diagnostic and therapeutic
facilities for the surgical and medical diagnosis, treatment, and care of injured and
sick persons by or under the supervision of a staff of physicians;
- (b)
- it continuously provides twenty-four (24) hour a day nursing service by or under
the supervision of Registered Graduate Nurses (R.N.);
- (c)
- it is not, other than incidentally, a place for rest, a place for the aged, a
place for drug addicts, a place for alcoholics or custodial care, and extended care
facility or nursing home; or
-
(2)
- provides services directed wholly or chiefly to patients who collectively
have conditions related either by a specialty field of medicine or by a specific category
of disease and which meets fully every one of the tests enumerated above except that
complete surgical services are not provided, bu only for periods of confinement during
which the patient is under regular therapeutic treatment by a physician for the injury or
disease involved.
"MEDICALLY DETERMINABLE PHYSICAL IMPAIRMENT" shall mean a physical impairment which results from anatomical or
physiological abnormalities which are exclusively organic and
non-psychiatric in nature and which are demonstrable by medically
acceptable clinical and laboratory diagnostic techniques.
- INSURING PROVISIONS
When proof is received by the Insurance Company
that an Insured Employee is totally disabled as the result of a
passive war risk injury and requires the regular attendance of a
legally qualified physician, the Insurance Company will pay a
monthly benefit to the Insured Employee after completion of the
Elimination Period. This monthly benefit will be paid as long as
total disability continues provided that proof of continued total
disability is submitted, at the Insured Employee's
expense, to the Insurance Company upon request. However, the
monthly benefit will not exceed the Insured Employee's
amount of insurance, nor will it be payable for longer than the
maximum benefit duration. The amount of insurance and the maximum
benefit duration are shown in the Schedule of Benefits.
If other income benefits are payable for a
given monthly period, the amount of monthly benefit payable
under this Policy for the given monthly period shall be an amount
equal to the excess, if any, of:
- (i)
- 60% of the Employee's monthly rate of basic earnings over;
- (ii)
- the amount of other income benefits payable for the given monthly period.
In no event shall the amount of monthly benefit under this Policy exceed the amount
listed for each Class in the Schedule of Benefits to a maximum of 60% of each Employee's
monthly compensation.
OTHER INCOME BENEFITS: Other income benefits are those benefits below which apply to
the Insured Employee, or to the Insured Employee's spouse, child or children, as
indicated. These other income benefits, except for retirement benefits, are benefits
resulting form the same disability for which a monthly benefit is payable under this
Policy.
Other income benefits, referred to above, shall include the following:
- (1)
- Income received from any employer or from any occupation for compensation or
profit (other than in connection with an approved rehabilitation program).
- (2)
- Disability, retirement, or unemployment benefits required or provided for under
any law of a government - for example:
- (a)
- unemployment compensation benefits;
- (b)
- temporary or permanent, partial or total, disability benefits under any
worker's compensation law or any other similar law, which are intended to compensate the
worker for any one or more of the following:
- (i)
- loss of past and future wages,
- (ii)
- impairment of earning capacity or diminished ability to compete in the open
labor market, and
- (iii)
- any degree of permanent impairment of loss of bodily function or capacity;
- (c)
- no-fault wage replacement benefits;
- (d)
- statutory disability benefits;
- (e)
- benefits under the law of any government relating to the social security of
the Employee.
- (3)
- Disability, retirement, or unemployment benefits provided under any group insurance
or pension plan or any other arrangement of coverage for individuals in a group (whether on
an insured or uninsured basis).
- (4)
- Distributions from any profit sharing plan provided such distributions are not paid
as a lump sum benefit. However, benefits from the Employer's Profit Sharing Plan are not
included as other income.
Benefits payable to the Employee or to his spouse, children, and dependents by reason o the Employee's
disability or retirement shall be included as other income benefits.
For the Purposes of determining other income benefits:
- (1)
- Any single sum payment made in settlement of a claim for workers compensation
benefits:
- (a)
- will be considered to include disability benefits of 50% of the total amount of
such single sum payment, whether such payment is or is not the result of a compromise,
award or judgment, unless there exists in the terms of the compromise, award, or judgment (or
in the record of the proceeding resulting in such payment) evidence satisfactory to the
Insurance Company that a greater or lesser percentage should be applied; and
- (b)
- the amount so determined will be allocated by the Insurance Company, in
equal amounts, to a 60 month period which shall commence:
- (i)
- on the same date as the period with respect to which the single sum payment is
made, or
- (ii)
- on the date on which the single sum payment is made if the compromise, award,
or judgment does not allocate the single sum payment to any specific period.
- (2)
- Any other single sum payment (including any periodic payments which the
individual could have elected to receive in any single sum) shall also, be allocate in its
entirety by the Insurance Company, in equal amounts, to 60 monthly periods, and my
also be allocated retroactively by the Insurance Company if received pursuant to a
retroactive award.
- (3)
- The Insurance Company shall have the right to allocate any other periodic
payments or an amount which represents an accumulation of past due periodic payments to
monthly periods and to make such allocation retroactively when such payments are received
pursuant to a retroactive award.
LUMP SUM PAYMENTS: If other income benefits are paid in a lump sum, the sum shall be
spread on a monthly basis over the period of time for which the sum is given. If no
period of time is stated, the sum will be spread on a monthly basis over
the time the Insurance Company expects the Insured Employee to live.
TERMINATION OF THE PERIOD OF TOTAL DISABILITY:
The period of total disability shall be deemed to terminate on the earliest of the following:
- (1)
- The date the Insured Employee ceases to be totally disabled;
- (2)
- The date the Insured Employee dies;
- (3)
- The effective date that the Insured Employee receives retirement benefits under
employer's retirement plan as a result of the Employee's voluntary election to
receive such benefits; or
- (4)
- completion of the benefit duration;
- (5)
- As of any date on which the total disability is caused by any condition other
than a medically determinable physical impairment, unless the Insurance Company has
received satisfactory proof that the Employee is then confined in a hospital for
treatment of such condition, in which event, the Employee shall continue to be eligible
for income benefits during such confinement.
For the purpose of above item (5):
Any reference to confinement in a hospital shall mean twenty-four (24) hours a day
confinement in a hospital on an inpatient basis and shall not include any day on which the
Employee is on temporary leave from a hospital.
In no event shall the Employee be eligible for income benefits beyond the date the
period of total disability would terminate in accordance with the above provisions.
RECURRENT DISABILITY: Any two separate periods of total disability which arise from the
same or related causes and which are separated by less than three (3) months shall be
considered as one period of total disability, except that the earlier of such separate
periods shall not be taken into account if at the beginning of such earlier period the
Employee was not insured under this Policy.
Having combined two (2) separate periods into a single period, this rule may be applied
successively to any further separate period of total disability, provided such
further separate period of total disability also arises from the same or related causes
and is not separated from the last preceding such period by more than three (3) months.
REHABILITATIVE EMPLOYMENT: If after benefits have commenced to be payable, the Employee,
while remaining totally incapacitated from returning to the occupation in which he or she
was engaged immediately prior to his or her becoming so incapacitated, becomes, in the
opinion of a medical advisor, (appointed by both the physician of the Employee and the
physician of the insurance company), able to return to work for which the Employee is
reasonably fitted by training, education or experience, the benefit shall continue to be
paid only in proportion to the loss of earnings to e expected if the Employee
engaged in such other occupation.
If after benefits have commenced to be payable, the Employee engages in an occupation
other than that in which he or she was engaged immediately prior to his or her becoming
disabled because he or she is totally unable owing to such incapacity to return to such
former occupation, and such change of occupation results in a loss of earnings, the
benefit shall continue to be paid and reduced by the amount corresponding to
the proportion of earnings lost.
No benefit shall be payable under the two preceding paragraphs in respect of:
- a.
- any period subsequent to the termination date of the disability, or
- b.
- beyond a benefit period of 24 continuous months.
GENERAL EXCLUSION: No insurance is afforded under this Policy -
- (a)
- as to a period of total disability commencing during the first twelve
(12) months of the Employee's current period of insurance under this Policy if the
disability is caused or contributed to by, or is a consequence of a pre-existing
condition; or
- (b)
- as to a disability due to intentionally self-inflicted injuries (whether
sane or insane); or
- (c)
- as to a disability resulting from the commission by the Employee of, or an attempt by the
Employee to commit, an assault, battery, felony, or other criminal act; or
- (d)
- as to a disability due to war or any act of war (whether war is declared or not) while the
Employee is enlisted for active service connected with war; or
- (e)
- as to a disability due to warlike operations, insurrection, rebellion, or participation in
a riot or civil commotion in which the Employee takes active part; or
- (f)
- as to a disability due to war or acts of war, declared or undeclared, while in
the United States, Algeria, former Yugoslavia, except Slovenia, North Korea, Rwanda, Iran
and Iraq and the Insured Person's country of residence, except as follows:
An Insured Person's disability due to non-active involvement (passive war risk) as a
result of war or act of war, declared or undeclared in areas other than those countries
listed above, will be covered.
Coverage is limited to trips made on behalf of UCAR, excluding commuting to and from
work and vacation.
- (g)
- as to a disability which is caused or contributed to by chronic alcoholism, or
by the use of narcotics, barbiturates, or hallucinogenic substances; or
- (h)
- as to a disability which is caused or contributed to by any condition other than
a medically determinable physical impairment, unless the Employee is confined in a hospital
for treatment of such condition.
EXTENSION OF BENEFITS: If an Employee's insurance terminates during a period of total
disability which commenced while such insurance was in force, any benefits
otherwise provided under this Policy shall continue to be
available during the continuance of such period of total
disability, but not beyond twelve (12) months after the date this
Policy is discontinued with respect to the class of Employees of
which the Employee was a member on the date his or her period of
total disability commenced.
EFFECTIVE DATE OF INITIAL INSURANCE FOR
EMPLOYEES WHO ARE NOT ACTIVELY AT WORK:
Insurance for any Employee will not become
effective on a date that the Employee is not actively at work
because of sickness or injury. In this event, insurance will
become effective on the first day that the employee is actively
at work in an eligible class.
EFFECTIVE DATE OF POLICY CHANGES FOR INSURED
EMPLOYEES WHO ARE NOT ACTIVELY AT WORK: Policy changes to the
employer's plan of insurance will not apply to any Insured
Employee who is not actively at work because of sickness or
injury. In this event, Policy changes will become effective on
the first day that the Employee is actively at work in an
eligible class.
TERMINATION OF EMPLOYEE'S INSURANCE:
The insurance of any Employee under this Policy shall terminate
at the earliest time specified below:
- (a)
- Upon discontinuance of this Policy;
- (b)
- Immediately when the Employee's employment with a Participant Employer in the
Classes of Employees eligible for insurance terminates. Cessation of active work by an
Employee shall be deemed to be termination of his or her employment, except that:
- (i)
- in the case of an absence from active work because of injury, his or her
employment may, for the purposes of insurance
under this Policy, be deemed to continue until
terminated by his or her Participant Employer but
in no case beyond twelve (12) months from the
date such absence from active work started, or
- (ii)
- in the case of absence from active work because of temporary lay-off or
leave of absence, his or her employment shall, for the purposes of insurance under this
Policy, be deemed to terminate on the Employee's last full day of active
work prior to the commencement of the lay-off or leave of absence.
- In the case of any continuation of insurance in accordance with the foregoing
item (I), the insurance under this Policy for such Employee shall automatically cease on
the date of such termination of his or her employment by his or her Participant Employer,
as evidenced to the Insurance Company by UCAR, whether by notification or by cessation of
premium payment on account of such Employee's insurance hereunder.
- (c)
- The end of the calendar month in which the Employee attains the age of
sixty-four (64) years and six (6) months;
- (d)
- The date the Employee becomes a resident of the United States;
- (e)
- As to a period of total disability which is caused by any condition other than
a medically determinable physical impairment, the date the Employee
ceases to be confined in a hospital for the treatment of such condition.
CLAIM FORMS:
The Insurance Company will send the Insured Employee claim forms within fifteen (15)
days after notice of claim is received. If the Insurance Company does not send the
forms within fifteen (15) days, the Insured Employee can send to the Insurance Company
written proof of disability. Th Insurance company will also periodically send the Insured
Employee additional claim forms. The initial claim form or proof must show:
- (1)
- The date disability started;
- (2)
- The cause of disability; and
- (3)
- How serious the disability is.
The initial claim form or proof must be:
- (1)
- Signed by a physician; and
- (2)
- Sent to the Insurance Company within ninety (90) days of the end of the
Elimination Period.
Subsequent claim forms must be sent to the Insurance Company within thirty (30) days
after they are received by the Insured Employee.
The Insured Employee cannot start any legal action:
- (1)
- Within sixty (60) days after the claim form or proof is sent; nor
- (2)
- More than three (3) years after the claim form or proof is due.
PAYMENT OF CLAIMS: Subject to written proof of loss, all accrued benefits for loss for
which this Policy provides periodic payment will be paid monthly to the Insured
Employee. Any balance remaining unpaid upon the termination of the period of liability
will be paid on a pro-rata basis.
If any benefit under this Policy becomes payable to:
- (1)
- The estate of the Insured Employee;
- (2)
- An Insured Employee who is a minor; or
- (3)
- An Insured Employee who is not competent to give a valid release;
then the Insurance Company may pay the benefit up to an amount not to exceed $1,000 to:
- (1)
- Any relative by blood; or
- (2)
- Any person related by marriage;
who I deemed by the Insurance Company to be equitably entitled. Any payment made by
the Insurance Company in good faith under this provision will fully discharge the
Insurance Company to the extent of the payment.
EXAMINATION: The Insurance Company, at its own expense, has the right to have a
claimant examined:
- (1)
- Physically;
- (2)
- Psychologically; and
- (3)
- Psychiatrically;
to determine the existence of any total disability which is the basis for a claim. This
right may be used:
- (1)
- As other as it is reasonably required;
- (2)
- While a claim is pending.
GENERAL PROVISIONS
INDIVIDUAL CERTIFICATE. The Insurance Company
will issue to UCAR for delivery to each insured Employee an
individual Certificate. This Certificate will in no way void any
of terms and conditions of this Policy but will set forth in
summary form the insurance protection to which the Employee is
entitled (including any changes in the benefits resulting from a
change in age of the insured Employee), to whom benefits are
payable and the terms and conditions of the Conversion Privilege.
NOTICE OF CLAIM. Written notice of claim must be given to the Insurance Company within
30 days after the occurrence of the event of which the claim is based.
Written notice of claim given by or on behalf
of the Employee to the Insurance company at its Home Office, or
to any authorized agent of the Insurance Company, with
particulars sufficient to identify the Employee, will be
considered notice to the Insurance Company. Failure to give
written notice within the time provided in this Policy will
neither invalidate nor reduce any claim if it can be shown that
it was not reasonably possible to give written notice within that
time and that written notice was given as soon as was reasonably
possible.
CLAIM FORMS. The Insurance company, when it
receives the notice of claim, will furnish to the Employee or to
UCAR for delivery to the Employee, the claim forms which it
usually furnishes for filing proofs of loss. If the Employee does
not receive these claim forms within 15 days after receipt by the
Insurance Company of the notice of claim, the Employee will be
considered to have complied with the requirements of this Policy
as to proof of loss upon submitting, within the time fixed in
this Policy for filing proofs of loss, written proof covering the
occurrence, character and extent of the loss for which claim is
made.
PROOFS OF LOSS. Written proof of loss must be
furnished to the Insurance Company at its Home Office within 90
days after the date of the loss for which claim is made. Failure
to furnish written proof of loss within the time provided in this
Policy will neither invalidate nor reduce any claim if it can be
shown that it was not reasonably possible to furnish written
proof of loss within that time and that written proof of loss was
furnished as soon as was reasonably.
LEGAL ACTIONS. No action at law or in equity
will be brought to recover on this Policy to the expiration of 60
days after proof of loss has been filed in accordance wit the
requirements of this Policy, nor will any action be brought at
all unless brought within 3 years from the expiration of the time
within which proof of loss is required by this Policy.
TIME LIMITATIONS. If any time limitation
provided in this Policy for giving notice of claims, for
furnishing proof of loss, or for bringing any action at law or in
equity is less than that permitted by the law of the state in
which the Employee resides at the time this policy is issued,
then the time limitation provided in this Policy is hereby
extended to agree with the minimum permitted by the law of that
state.
TERMS AND CONDITIONS. Payment of any benefits under this Policy is subject to the
definitions and all other terms and conditions oft his Policy pertinent to the benefit.
PHYSICIAN-PATIENT RELATIONSHIP. The Employee will have free choice of any doctor
practicing legally. The Insurance Company will in no way disturb the physician-patient
relationship.
PHYSICAL EXAMINATION. The Insurance Company, at its own expense, will have the right
and opportunity to examine any individual for whom claim is pending under this policy
when and so often as it may reasonably required and to make an autopsy
in case of death where it is not prohibited by law.
TIME OF PAYMENT OF BENEFITS. Upon receipt of
due proof, disability income benefits will be paid by the
Insurance Company at regular intervals occurring at least as
often as once a month, and any balance remaining unpaid at the
end of any period for which Insurance company is liable will be
paid at that time.
PAYMENT OF BENEFITS. All benefits will be payable to the Employee.
WORKERS COMPENSATION. This Policy is not to be construed as satisfying
any requirement for coverage by workers compensation insurance.
ASSIGNMENT. The insurance and any benefits provided hereunder are not assignable.
March 1998
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