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«Your Group Short Term Disability Plan Policy No. 415507 011 Underwritten by Unum Life Insurance Company of America 8/11/2015 CERTIFICATE OF COVERAGE ...»

-- [ Page 1 ] --

Enhanced Short-Term

Disability Insurance

Summary Plan Description

Vanderbilt University

Your Group Short Term Disability Plan

Policy No. 415507 011

Underwritten by Unum Life Insurance Company of America

8/11/2015

CERTIFICATE OF COVERAGE

Unum Life Insurance Company of America (referred to as Unum) welcomes you as a client.

This is your certificate of coverage as long as you are eligible for coverage and you become insured. You will want to read it carefully and keep it in a safe place.

Unum has written your certificate of coverage in plain English. However, a few terms and provisions are written as required by insurance law. If you have any questions about any of the terms and provisions, please consult Unum's claims paying office. Unum will assist you in any way to help you understand your benefits.

If the terms and provisions of the certificate of coverage (issued to you) are different from the policy (issued to the policyholder), the policy will govern. Your coverage may be cancelled or changed in whole or in part under the terms and provisions of the policy.

The policy is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments.

For purposes of effective dates and ending dates under the group policy, all days begin at 12:01 a.m. and end at 12:00 midnight at the Policyholder's address.

Unum Life Insurance Company of America 2211 Congress Street Portland, Maine 04122 CC.FP-1 CC.FP-1 (7/6/2015) 1

TABLE OF CONTENTS

BENEFITS AT A GLANCE

SHORT TERM DISABILITY PLAN

CLAIM INFORMATION

SHORT TERM DISABILITY

GENERAL PROVISIONS

SHORT TERM DISABILITY

BENEFIT INFORMATION

OTHER BENEFIT FEATURES

GLOSSARY

–  –  –

This short term disability plan provides financial protection for you by paying a portion of your income while you are disabled. The amount you receive is based on the amount you earned before your disability began and the weekly benefit option that you chose. In some cases, you can receive disability payments even if you work while you are disabled.

EMPLOYER'S ORIGINAL PLAN

EFFECTIVE DATE: January 1, 2014

PLAN YEAR:

January 1, 2014 to January 1, 2015 and each following January 1 to January 1

–  –  –

ELIGIBLE GROUP(S):

All full time employees and residents in active employment in the United States with the Employer, excluding faculty & temporary and seasonal employees

MINIMUM HOURS REQUIREMENT:

Employees must be working at least 30 hours per week.

WAITING PERIOD:

For employees in an eligible group on or before January 1, 2014: Effective date of coverage For employees entering an eligible group after January 1, 2014: First of the month following one year of active employment You must be in continuous active employment in an eligible group during the specified waiting period.

REHIRE:

If your employment ends and you are rehired within 12 months, your previous work while in an eligible group will apply toward the waiting period. All other policy provisions apply.

CREDIT PRIOR SERVICE:

Unum will apply any prior period of work with your Employer toward the waiting period to determine your eligibility date.

WHO PAYS FOR THE COVERAGE:

–  –  –

66.6667% of weekly earnings to a maximum benefit of $308 per week Your payment may be reduced by deductible sources of income and disability earnings.

Some disabilities may not be covered under this plan.

–  –  –

66.6667% of weekly earnings to a maximum benefit of $2,192 per week Your payment may be reduced by deductible sources of income and disability earnings.

Some disabilities may not be covered under this plan.

MAXIMUM PERIOD OF PAYMENT:

24 weeks (does not include elimination period)

For disabilities due to live birth only:

You will receive a minimum of 6 weeks of benefits. (does not include elimination period) Premium payments are required for your coverage while you are receiving payments under this plan.

Your Short Term Disability plan does not cover disabilities due to an occupational sickness or injury.

REHABILITATION AND RETURN TO WORK ASSISTANCE BENEFIT:

10% of your gross disability payment to a maximum benefit of $250 per week.

In addition, we will make weekly payments to you for 3 weeks following the date your disability

ends if we determine you are no longer disabled while:

- you are participating in the Rehabilitation and Return to Work Assistance program; and

- you are not able to find employment.

OTHER FEATURES:

–  –  –





The above items are only highlights of this plan. For a full description of your coverage, continue reading your certificate of coverage section.

The plan includes enrollment, risk management and other support services related to your Employer's Benefit Program.

–  –  –

We encourage you to notify us of a claim as soon as possible, so that a claim decision can be made in a timely manner. Telephonic notice as authorized by us or written notice of claim should be provided within 30 days after the date your disability begins. However, you must provide Unum written proof of your claim no later than 90 days after your elimination period. If it is not possible to give proof within 90 days, it must be given no later than 1 year after the time proof is otherwise required except in the absence of legal capacity.

If you choose to file a written notice of claim, the claim form is available from your Employer, or you can request a claim form from us. If you do not receive the form from Unum within 15 days of your request, send Unum written proof of claim without waiting for the form.

You must notify us immediately when you return to work in any capacity.

HOW DO YOU FILE A CLAIM?

You may file notice of claim by telephonic means. The telephone number is available through your Employer. You will be required to sign an authorization form in order for Unum to obtain medical information from your attending physician.

Should Unum be unable to obtain your medical information, we will send a letter and appropriate forms to you for completion to be returned to us by the date determined in the letter.

If you choose to file written notice of claim, you and your Employer must complete your own sections of the claim form and then give it to your attending physician.

Your physician should fill out his or her section of the form and send it directly to Unum.

WHAT INFORMATION IS NEEDED AS PROOF OF YOUR CLAIM?

Your proof of claim, provided at your expense, must show:

- that you are under the regular care of a physician;

- the appropriate documentation of your weekly earnings;

- the date your disability began;

- the cause of your disability;

- the extent of your disability, including restrictions and limitations preventing you from performing your regular occupation; and

- the name and address of any hospital or institution where you received treatment, including all attending physicians.

We may request that you send proof of continuing disability indicating that you are under the regular care of a physician. This proof, provided at your expense, must be received within 45 days of a request by us.

In some cases, you will be required to give Unum authorization to obtain additional medical information and to provide non-medical information as part of your proof of

–  –  –

TO WHOM WILL UNUM MAKE PAYMENTS?

Unum will make payments to you.

WHAT HAPPENS IF UNUM OVERPAYS YOUR CLAIM?

Unum has the right to recover any overpayments due to:

- fraud;

- any error Unum makes in processing a claim; and

- your receipt of deductible sources of income.

You must reimburse us in full. We will determine the method by which the repayment is to be made.

Unum will not recover more money than the amount we paid you.

–  –  –

This certificate of coverage is a written statement prepared by Unum and may

include attachments. It tells you:

- the coverage for which you may be entitled;

- to whom Unum will make a payment; and

- the limitations, exclusions and requirements that apply within a plan.

WHEN ARE YOU ELIGIBLE FOR COVERAGE?

If you are working for your Employer in an eligible group, the date you are eligible for

coverage is the later of:

- the plan effective date; or

- the day after you complete your waiting period.

WHEN DOES YOUR COVERAGE BEGIN?

When you become eligible for coverage under the plan, your Employer will automatically enroll you under Option 2 in the plan. Your coverage will begin at 12:01 a.m. on the date you are eligible for coverage. If you do not want Option 2 under the plan, you may choose to decline this coverage and you will be covered under the Employer paid Option 1 at 12:01 a.m. on the date you are eligible for coverage.

If you decline Option 2 coverage and later apply for Option 2 coverage, evidence of insurability will be required.

WHEN CAN YOU CHANGE YOUR COVERAGE BY CHOOSING ANOTHER

OPTION?

You can increase or decrease your coverage at any time during the plan year.

Evidence of insurability is required if you increase to Option 2. An evidence of insurability form can be obtained from your Employer.

An increase in coverage will begin at 12:01 a.m. on the first of the month following the date Unum approves your evidence of insurability form.

A decrease in coverage will begin at 12:01 a.m. on the day after you request the decrease.

If you end employment and are rehired within the same plan year, you may be insured on your eligibility date for the coverage that you had under the plan when you ended employment.

WHAT HAPPENS IF YOU RETURN TO AN ELIGIBLE GROUP?

If you return to an eligible group with 12 months from the date you became ineligible you will automatically be enrolled in the plan without evidence of insurability for the same amount of insurance you had just prior to the date you became ineligible.

–  –  –

If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will begin on the date you return to active employment.

ONCE YOUR COVERAGE BEGINS, WHAT HAPPENS IF YOU ARE TEMPORARILY

NOT WORKING?

If you are on a temporary layoff, and if premium is paid, you will be covered through the end of the month that immediately follows the month in which your temporary layoff begins.

If you are on a leave of absence, and if premium is paid, you will be covered for up to 24 months following the in which date your leave of absence begins.

ONCE YOUR COVERAGE BEGINS, WHAT HAPPENS IF YOU ARE NOT WORKING

DUE TO A PLANT CLOSING?

Massachusetts Residents Only If you are not working due to a plant closing (as defined in Section 71A of Chapter 151A of the Massachusetts Insurance Statutes), and if premium is paid, you will be covered up to 90 days from the day you were no longer in active employment. If you become covered under any other group disability plan, your coverage under this policy or plan will end.

WHEN WILL CHANGES TO YOUR COVERAGE TAKE EFFECT?

Once your coverage begins, any increased or additional coverage due to a change in your weekly earnings or due to a plan change requested by your Employer will take effect immediately if you are in active employment or if you are on a covered layoff or leave of absence. If you are not in active employment due to injury or sickness, any increased or additional coverage will begin on the date you return to active employment.

Any decrease in coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease.

WHEN DOES YOUR COVERAGE END?

Non-Massachusetts Residents Only

Your coverage under the policy or a plan ends on the earliest of:

- the date the policy or a plan is cancelled;

- the date you no longer are in an eligible group;

- the date your eligible group is no longer covered;

- the last day of the period for which you made any required contributions; or

- the last day you are in active employment except as provided under the covered layoff or leave of absence provision.

Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

–  –  –

- the date the policy or a plan is cancelled;

- the date you no longer are in an eligible group;

- the date your eligible group is no longer covered;

- the last day of the period for which you made any required contributions; or

- the last day you are in active employment except as provided under the covered layoff, leave of absence and plant closing provisions, or as noted below.

If you end employment, coverage will be extended for 31 days. But if you become eligible for any other group disability insurance or any other arrangement, this extension of coverage will end.



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