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C97-101 Provident Life and Accident
PROVIDENT0CCWlo145LIFEANDACCIDENTINSURANCECOMPANY1FOUNTAiNSQUARECHATTANOOGATN37402October17,1996Ms.SueEatonHumanResourcesDirectorEagleCountyGovernment500BroadwayEagle,CO81631SUBJECT:LETTEROFCONTRACTACCEPTANCEAsacceptanceofthedeliveryandtermsofthisLTDPolicy,theundersignedPolicyholderandProvidentLifeandAccidentInsuranceCompanyagreetothefollowing:1.ThePolicyisissuedbyProvidentLifeandAccidentInsuranceCompanyinaccordancewiththetermsoftheApplicationforGroupLongTermDisabilityInsurance;2.ThePolicyholderagreestopaythepremiumsdueunderthegroupinsuranceplantotheProvidentatitsHomeOfficewhenduebythetermsandconditionssetforthinthisPolicy;3.ThePolicyholderunderstandsandagreestobeboundbytheterms,provisions,conditions,andlimitationsofthePolicyandalllawfulamendmentsthereto;and4.ProvidentLifeandAccidentInsuranceCompanyunderstandsandagreestobeboundbytheterms,provisions,conditions,andlimitationsofthePolicyandalllawfulamendmentsthereto.Acceptanceofthetermssetforthaboveareherebynotedbythesignaturesbelow,withanexecutedcopybeingreturnedbythePolicyholdertoProvidentLifeandAccidentInsuranceCompanyintheenclosedself-addressed,postage-paidreturnenvelopeorbyfaxtotheGroupUnderwriting,CorporateRiskManagement(423)755-5003.PROVIDETLWENDACCIDENTINSURAECO_____EagleCountyGovernment_____bCC—NameofPolicyholderaturVicePresident,GroUnderwritingCorporateRiskManagementSignature/Chairperson,BoardofCcuntyCommissionersTitleFebruary25,1997Dateneg PROVIDENTLIFEANDACCIDENTINSURANCECOMPANY433EASTLASCOLINASBLVD.(214)401-8000OFFICESUITE1300(214)401-3493FAXIRVING,TX75039(800)275-3143November13,1996Mr.BillDenman,PresidentDenman,GrayandCompany13901E.ExpositionAvenueAurora,CO.80012RE:EagleCountyGovernment/AnnualAppropriationDearBill:ThislefteristoconfirmProvidentLife&Accidentdoesagreetoabidebythefollowingclause,whichweunderstandisrequiredbyColoradolawtobepartofanymultiple-fiscal-yearCountycontract:AnnualAppropriation.Notwithstandinganythinghereincontainedtothecontrary,theClientsobligationsunderthisAgreementareexpresslysubjecttoanannualappropriationbeingmadebytheBoardofCountyCommissionersinanyamountsufficienttopayforsumsduehereunder.Intheeventsufficientfundsshallnotbeappropriatedforthepaymentofsumsduehereunder,thisAgreementmaybeterminatedbyeitherpartywithoutpenally;provided,however,thatintheeventofsuchtermination_____________shallbepaidforallworkperformedunderthisAgreementuptothedateoftermination,TheClient’sobligationshereundershallnotconstituteageneralobligationindebtednessormultipleyeardirectorindirectdebtorotherfinancialobligationwhatsoeverwithinthemeaningoftheConstitutionorlawsoftheStateofColorado.Thisshouldbeputwiththeircontractasourlefterofagreement.Pleasecallifyouhaveanyquestions.erney,URegionalSalesDirector/rj CaPROVIDENTLIFEANDACCIDENTINSURANCECOMPANY1FountainSquareChattanooga,Tennessee37402(423)755-7077GROUPLONGTERMDISABILITYINSURANCEPOLICYPOLICYHOLDEREagleCountyGovernment500BroadwayEagle,CO81631POLICYNUMBER122743-01EFFECTIVEDATESeptember1,1996PLANANNIVERSARYDATEEachSeptember1stJURISDICTIONColoradoTheconsiderationforthisPolicyistheapplicationofthePolicyholderandthepaymentofpremiumsasprovidedherein.ForpurposesofeffectivedatesandendingdatesunderthisPolicy,alldaysbeginandendat12:01A.M.StandardTimeatthePolicyholder’saddress.ThisPolicyisgovernedbythelawsofthejurisdictioninwhichitisdelivered.InthisPolicy“we,”‘us,’and“our”meanProvidentLifeandAccidentInsuranceCompany.Otherdefinedtermsappearwiththeirinitialletterscapitalized.Sectionheadingsandreferencestothemappearinboldfacetype.SECRETARYPRESIDENTANDCHIEFEXECUTIVEOFFICERITflfl7fl1-flfl TABLEOFCONTENTSC.SECTIONI-INSURINGCLAUSE3SECTIONII-SCHEDULEOFINSURANCE3Eligibility3CoveredPerson3EligibilityWaitingPeriod3EvidenceofInsurabilityRequirements4PremiumRatesandRenewals4DisabilityBenefitsandRequirements4OtherBenefits5Exclusions5Limitations6SECTIONIII-DEFINEDTERMS7ListofDefinedTerms7DefinitionsofDisability9SECTIONIV-BENEFITPROVISIONS10LTDMonthlyBenefitAmount70WhenLTDMonthlyBenefitsBegin70MinimumLTDMonthlyBenefitAmount70WhenLTDMonthlyBenefitsEnd11BenefitsAfterCoverageEndsorIsChanged17EliminationPeriod11BenefitPeriod11TemporaryReturntoActiveWork11BenefitOffsets12ExceptionstoBenefitOffsets13RulesforBenefitOffsets13SurvivorBenefit74WaiverofPremium15SECTIONV-EXCLUSIONSANDLIMITATIONS16Exclusions16Limitations16SECTIONVI-COVERAGEPROVISIONS18ActiveWorkProvisions18WhenCoverageBecomesEffective18CoverageSubjecttoEvidenceofInsurability78WhenCoverageEnds19ReinstatementofCoverage19ReplacementofPriorPlans19SECTIONVII-CLAIMPROVISIONS21GeneralClaimProvisions21SECTIONVIII-POLICYHOLDERPROVISIONS23PremiumRatesandRenewals23GracePeriodandTerminationforNonpayment23TerminationforOtherReasons24GeneralPolicyProvisions24LTD83701-CO2 SECTIONI-INSUJGCLAUSEThisPolicyprovidesincomereplacementbenefitswhentheCoveredPersonbecomesDisabled.TheDisabilitymustcommencewhilethisPolicyisineffect.WhenwereceivesatisfactoryProofofLoss,wewillpaylongtermdisability(LTD)monthlybenefitsaccordingtothetermsofthisPolicy.SECTIONII-SCHEDULEOFINSURANCEThisScheduleofInsurancehighlightsmanyofthefeaturesofthis(LTD)insuranceplan.Pleaserefertothetextofeachsectionforfulldetailsofcoverage.ThefollowinginformationdescribesallcovetedEmployetsandsubsidiariesandidentifiestheclass(es)andschedule(s)ineffectunderthisPolicy.EMPLOYEREagleCountyGovernmentSUBSIDIARYNAMENoneELIGIBILITYTobeeligibleforcoverage,theemployeemust(a)applyforcoverageunderthisPolicy;(b)beanEligiblePerson;and(C)beamemberofanEligibleClass.TobeanEligiblePerson,theemployeemustmeetthefollowingrequirements:1.beanemployeeActivelyatWorkfortheEmployer;2.beregularlyscheduledtoworkatleast30hoursperweek;3.beacitizenorlegalresidentoftheUnitedStates,itsterritories,orCanada;4.notbeatemporaryorseasonalemployee;and5.notbeafull-timememberofthearmedforcesofanycountry.ELIGIBLECLASS(ES)AllActivefull-timeemployeesCLASSDESCRIPTION(S)1:AllActivefull-timeemployeesCOVEREDPERSONTobeaCoveredPersonunderthePolicy,anemployeemust(a)beanEligiblePerson;(b)beacceptedforcoverageunderthePolicy;(C)makepremiumpaymentswhendue;(d)completetheEligibilityWaitingPeriod;andfe)meettherequirementsofActiveWorkandWhenCoverageBecomesEffectiveinSectionVI-CoverageProvisions.ELIGIBILITYWAITINGPERIODEligiblePersonsbecomecoveredunderthisPolicyonthisPolicy’seffectivedateiftheyareEligiblePersonsonthatdate.OtherwisetheywillbecomeeligibleonthefirstdayofthecalendarmonthcoincidingwithornextfollowingthedatetheybecomeEligiblePersons.IfthisPolicyisareplacementforaPriorPlan,administrationoftheEligibilityWaitingPeriodwillbemodifiedaccordingtGReplacementofPriorPlansinSectionVI-CoverageProvisions.IfCoveedPersons’coverageends,theymayrequestreinstatementoftheircoverageunderthisPolicywithouthavingtosatisfytheEligibilityWaitingPeriodif:1.theywerepreviouslycoveredunderthisPolicy;2.theircoverageendedwhentheirlay-offorleaveofabsenceextendedbeyondtheLay-offorLeaveofAbsencePeriod;and3.theyrequestreinstatementwithin72monthsofthedateonwhichtheircoverageended.LTD83701-CO3 SECTIONII-SCh)ULEOFINSURANCE(Conjed)EVIDENCEOFINSURABILITYREQUIREMENTSEmployeesarerequiredtoprovideEvidenceofInsurabilitywhen:1.theyapplyforcoverageunderLateEnrollment;2.theircoverageunderthePolicyceasesandtheyapplyforreinstatement;or3.theywereeligiblebutnotcoveredunderthePriorPlan.EvidenceofInsurabilitywillnotberequiredforemployeesreturningfromafamilyormedicalleave.PREMIUMRATESANDRENEWALSSubjecttoitstermsandconditions,thisPolicyisissuedfortheInitialRateGuaranteePeriodshownbelow.Coveragemaybecontinuedbythepaymentofpremiumssetbyus.AftertheInitialRateGuaranteePeriod,thepremiumratewillnotbechangedmorethanonceinany12-monthperiodunlessmutuallyagreedtobythePolicyholderandus.PREMIUMDUEDATESOntheEffectiveDateshownonthePolicyfacepageandVthefirstdayofeachcalendarmonththereafterGRACEPERIOD31daysINITIALRATE$0.28per$100ofCoveredMonthlyEarningsINITIALRATEGUARANTEEPERIOD2yearsfromeffectivedateNoTICEOFRATECHANGE60daysvPREMIUMCONTRIBUTIONNoncontributoryMINIMUMPARTiCIPATIONNUMBER25CoveredPersons”MINIMUMPARTICIPATIONPERCENTAGE100%ofEligiblePersons-DISABILITYBENEFITSANDREQUIREMENTSLTDBENEFITAMOUNTEarningsmultipliedbytheLTDBenefitPercentage,nottoexceedtheMaximumLTDMonthlyBenefitAmount,minusBenefitOffsetsLTDBENEFITPERCENTAGE60%SeeDisabilityBenefitsProvisionforMoreinformation.EARNINGSEarningsmeansbasemonthlysalarybutexcludescommissions,bonuses,overtimepay,andanyotherextracompensationreceivedfromtheEmployer.EarningsaredeterminedasofthedatejustpriortotheDateofDisability.MAxIMUMLTDMONTHLY/BENEFrrAMOUNT$5,000beforereductionbyBenefitOffsetsMINIMUMLTDMONTHLY/BENEFITAMOUNTThelesserof$100or10%oftheLTDMonthlyBenefitAmountbeforereductionforBenefitOffsetsELIMINATIONPERIOD6monthsLTD83701-CO4 SECTIONII-SCtJULEOFINSURANCE(Contied)BENEFITOFFSETSMAXIMUMBENEFITPERIODGRADEDDURATIONOWNOCCUPATIONPERIODANYOCCUPATIONPERIODOWNOCCUPATIONINCOMELEVELANYOCCUPATIONINCOMELEVELCOVERAGEINCLUDESLAY-OFFORLEAVEOFABSENCEPERIODCOVERAGECONTINUEDDURINGFAMILYORMEDICALLEAVEOTHERBENEFITSSURVIVORBENEFITAMOUNTEXCLUSIONSPREEXISTINGCONDITIONEXCLUSIONPREEXISTINGCONDITIONPERIODPREEXISTINGCONDITIONEXCLUSIONPERIODDirectFamily/SeeBenefitOffsetsProvisionforMoreInformation.DeterminedbyyourageontheDateofDisability:AGEATDISABILITYMAXIMUMBENEFITPERIOD61oryounger6263646566676869orolder3years-“FromtheendoftheOwnOccupationPeriodbutnotexceedingtheMaximumBenefitPeriod80%ofIndexedEarnings50%ofIndexedEarningsfromanyoccupationCoveredPersonsarereasonablyfittedbyeducation,training,orexperienceResidual/Nottoexceed2Weeks.7Alumpsumpaymentequalto3timestheLTDMonthly’BenefitAmountnotreducedbyBenefitOffsets.Yes;whenfirstcoveredThe3monthspriortotheCoveredPersonscoverageeffectivedateThefirst12monthsasaCoveredPersonSeeExclusionsProvisionforMoreInformation.toage653years6months3years2years6months2years1year9months1year6months1year3months1yearYesLTD83701-CO5 SECTIONII-SCh.JULEOFINSURANCE(Cont,ied)LIMITATIONSMENTALANDNERVOUSDISORDERSLIMITATIONSYes;24monthsofbenefitsDRUGANDALcohoLDISORDERSLIMITATIONSYes;24monthsofbenefitsSeeLimitationsProvisionforMoreInformation.LTD83701-CO6 SECTIONIII-DElEDTERMSLISTOFDEFINEDTERMSCThepagenumbersshownbelowarewhereeachtermisdefined.Fortermsdefinedbyanentiresection,thepagenumbersbelowarethoseonwhichthesectionbegins.CONTRIBUTORYINSURANCEmeansthatcoveragepurchasedunderthisPolicyispaidforinfullorinpartbytheCoveredPersons.CPI-WmeanstheConsumerPriceIndexforUrbanWageEarnersandClericalWorkerspublishedbytheUnitedStatesDepartmentofLabor.IftheCPI-Wisdiscontinuedorchanged,wemayuseacomparableindex.Whenrequired,wewillobtainpriorstateapprovalofthenewindex.ELIGIBILITYWAITINGPERIODmeanstheperiodEligiblePersonsmustwaitbeforecoveragebecomeseffectiveunderthisPolicy.(SeeSectionII-ScheduleofInsurance.)EMPLOYERmeansthePolicyholderandallsubsidiariesnamedontheScheduleofInsurance.EVIDENCEOFINSURABILITYmeansemployeesmust:1.completeandsignourhealthandmedicalhistoryform(s);2.signourformauthorizingustoobtaininformationabouttheirhealthandmedicalhistory;3.attheirexpense,undergoaphysicalexamination,ifrequiredbyus,whichmayincludeb1oodtesting;and4.attheirexpense,provideanyadditionalinformationabouttheirinsurabilitythatwemayreasonablyrequire.HosPImLmeansalegallyoperatedinstitutionorfacilityprovidingfull-timemedicalcareandtreatmentunderthedirectionofafull-timestaffoflicensedphysiciansandregisterednurses.Nursinghomes,resthomes,convalescenthomes,homesfortheaged,andfacilitiesprimarilyprovidingcustodial,educational,orrehabilitativecarearenotHospitals.ActiveWorkorActivelyatWork,18AnyOccupationDisability,9AnyOccupationPeriod,9BenefitOffsets,12BenefitPeriod,11ContributoryInsurance,7CPI-W,7DateofDisability,9Disability,Disabled,9DrugandAlcoholDisorders,17EligibilityWaitingPeriod,7EligiblePerson,3EliminationPeriod,11Employer,7EvidenceofInsurability,7GracePeriod,23Hospital,7IndexedEarnings,8Injury,8LateEnrollment,8LTDMonthlyBenefit,8,MaximumBenefitPeriod,8MaximumCoveredMonthlyEarnings,8MentalandNervousDisorders,17NoncontributoryInsurance,8OwnOccupationDisability,9OwnOccupationPeriod,9PensionPlans,RetirementPlans,andRetirementBenefits,8Physician,9Policy,9Policyholder,9PreexistingCondition,16PriorPlan,9ProofofLoss,21Sickness,9SurvivingChildren,14SurvivingSpouse,14War,16WorkEarnings,9LTD83701-CO7 SECTIONIII-DElEDTERMS(Continued)CINDEXEDEARNINGSmeansCoveredPersons’EarningsadjustedbytherateofincreaseintheCPI-W.DuringthefirstyearofDisability,theCoveredPersons’IndexedEarningsarethesameastheirEarnings.Afterthat,theIndexedEarningsaredeterminedoneachanniversaryoftheirDateofDisabilitybyincreasingthepreviousyear’sIndexedEarningsbytherateofincreaseintheCPI-Wforthepriorcalendaryear.Themaximumadjustmentinanyyearis70%.IndexedEarningswillnotdecreaseeveniftheCPI-Wdecreases.INJURYmeansanaccidentalbodilyinjuryrequiringtreatmentbyaPhysician.LATEENRoLLMENTmeansanEligiblePersonhasappliedforContributorycoverage31daysormoreafterfirstbecominganEligiblePerson.LTDMONTHLYBENEFITmeansthemonthlybenefitpayableunderthetermsofthisPolicy.MAXIMUMBENEFITPERIODmeansthelongestperiodforwhichLTDMonthlyBenefitsarepayableforanyoneperiodofcontinuousDisability.TheMaximumBenefitPeriodwillbegintoaccruewhentheEliminationPeriodends.LTDMonthlyBenefitsarenotpayableaftertheendoftheMaximumBenefitPeriodeveniftheCovetedPersonsarestillDisabled.(SeeSectionII-ScheduleofInsurance.)MAXIMUMCOVEREDMONTHLYEARNINGSmeanstheMaximumLTDMonthlyBenefitdividedbytheLTDBenefitPercentage.N0Nc0NTRIBUTORYINSURANCEmeansthatcoveragepurchasedunderthisPolicyispaidforinfullbythePolicyholder.PENSIONPLANS,RETIREMENTPLANS,ANDRETIREMENTBENEFITSmeanmoneypaidtoafundbytheEmployeronbehalfofCoveredPersonsandisreceivedbythematthetimeoftheirretirementand1.isestablishedforthepurposeofprovidingasourceofretirementincome;and2.doesordoesnotresultinareductionoftheamountofmoneyCoveredPersonswouldreceivewhenDisabledundertheplanattheirnormalretirementage.ThetermsRetirementPlanandPensionPlanincludeanyRetirementBenefit:1.thatispartofanyfederal,state,county,municipal,orassociationretirementsystem;and2.forwhichCoveredPersonsareeligibleasaresultofemploymentwiththeEmployer.ThetermsRetirementPlanorPensionPlandonotinclude:1.aprofit-sharingplan;2.athriftplan;3.anindividualretirementaccount(IRA);4.atax-shelteredannuity(TSA);5.astock-ownershipplan;or6.anon-qualifiedplanofdeferredcompensation.RegardlessoftheCoveredPersons’retirementdate,DisabledCoveredPersonsmaybereceivingRetirementBenefits.RetirementBenefitswillbetreatedasaBenefitOffsetonthelaterofthefollowing:1.whenCoveredPersonsattainage62;or2.whenCoveredPersonsattaintheirnormalretirementdate.RetirementBenefitsreceivedvoluntarilybyDisabledCoveredPersonspriortotheirnormalretirementdatewillbetreatedasaBenefitOffsetatthetimetheyarereceived.TheBenefitOffsetwillnotexceedthepercentagebeingcontributedtotheCoveredPersonsRetirementorPensionPlanbytheEmployerimmediatelypriortotheDateofDisability.RetirementBenefitsmaybepaidineitheralumpsumorinperiodicpayments.CoveredPersons’BenefitOffsetswillbeadjustedaccordingtothemannerinwhichtheirRetirementBenefitsarepaid.(SeeBenefitOffsetsinSectionIV-BenefitProvisions.)LTD83701-CO8 SECTIONIII-DELlEDTERMS(Continued)(PHYsIcIANmeansalicensedmedicalprofessional,diagnosingandtreatingCoveredPersonswithinthescopeotthephysician’smedicallicense.APhysiciandoesnotincludetheCovetedPersonoranyonerelatedtotheCovetedPersonbyblood,marriage,oradoption.POLICYmeansthegroupLTDInsurancePolicyissuedbyustothePolicyholderandidentifiedbythepolicynumber.PoLIcYHoLDERmeanstheentitynamedonthefacepageofthisPolicy.PRIORPLANmeanstheEmployer’sgrouplongtermdisabilityinsurancepolicyineffectonthedaybeforetheeffectivedateofthereplacementcoverageunderthisPolicy.SICKNESSmeansanillnessordisease,includingpregnancyorcomplicationsofpregnancy,requiringtreatmentbyaPhysician.WORKEARNINGSmeanstheCoveredPersons’earningsfromself-employmentorearningsfromworkperformedfortheEmployeroranyotheremployerwhileDisabled.DEFINITIONSOFDISABILITYCoveredPersonsareDisabledifduetotheirSicknessorInjurytheymeetthefollowingdefinition(s)ofDisability:OWNOCCUPATIONDIsABILITYDEFINITIONDuringtheOwnOccupationPeriod,CoveredPersonsareDisabledfromtheirownoccupationifduetotheirSicknessorInjurythey:1.areunabletoearnatleasttheOwnOccupationIncomeLevel;or2.areunabletoperformeachofthematerialdutiesoftheoccupationthattheyregularlyperformfortheEmployeror,ifaphysicianoranattorney,unabletoperformeachofthematerialdutiesoftheirspecialtyinthepracticeofmedicineorlaw.CoveredPersonswillnotbeconsideredDisablediftheyhaveWorkEarningsinexcessoftheOwnOccupationIncomeLevelshowninSectionII-ScheduleofInsurance.ANYOCCUPATIONDIsABILITYDEFINITIONDuringtheAnyOccupationPeriod,CoveredPersonsareDisabledfromAnyOccupationifduetotheirSicknessorInjurythey:1.areunabletoearnatleasttheAnyOccupationIncomeLevelwhileworkinginanyoccupation;or2.areunabletoperformeachofthematerialdutiesofanyoccupationforwhichtheyarereasonablyfittedbyeducation,training,orexperience.CoveredPersonswillnotbeconsideredDisablediftheyhaveWorkEarningsinexcessoftheAnyOccupationIncomeLevelshowninSectionII-ScheduleofInsurance.TheDateofDisabilityisthedateonwhichCoveredPersonsfirstmeettheOwnOccupationorAnyOccupationDisabilityDefinition.OWNOCCUPATIONPERIODTheOwnOccupationPeriodstartsonthedatethatLTDBenefitsbecomepayableandcontinuesuntilCoveredPersonshavebeenDisabledforthedurationshownunderOwnOccupationPeriodinSectionII-ScheduleofInsurance.ANYOCCUPATIONPERIODTheAnyOccupationPeriodstartsonthedayfollowingexpirationoftheOwnOccupationPeriodandcontinuesupto,butnotinexcessof,theMaximumBenefitPeriod.LTD83701-CO9 SECTIONIV-BEkFITPROVISIONS(,LTDMONTHLYBENEFITAMOUNTBENEFITSPAYABLEWHENDISABLEDANDNorWORKINGWhenCoveredPersonsareDisabledanddonothaveWorkEarnings,theirLTDMonthlyBenefitAmountwillbethelesserof:1.EarningsmultipliedbytheLTDBenefitPercentage;or2.theMaximumLTDMonthlyBenefitAmountshowninSectionII-ScheduleofInsurance.TheapplicableamountabovewillthenbereducedbyBenefitOffsets.BENEFITSPAYABLEWHENDISABLEDANDWORKINGWhenCoveredPersonsareDisabledandhaveWorkEarnings,theirLTDMonthlyBenefitwillbecalculatedasfollows:LTDMonthlyBenefitAmountxIndexedEarnings-WorkEarningsIndexedEarningsAnyLTDMonthlyBenefitpaidforaperiodoflessthanafullmonthwillbetheamountoftheLTDMonthlyBenefitAmountmultipliedbythenumberofdaysDisabledanddividedby30.TheLTDMonthlyBenefitAmount,MaximumLTDMonthlyBenefitAmount,andMinimumLTDMonthlyBenefitAmountareshowninSectionIi-ScheduleofInsurance.TheLTDMonthlyBenefitAmountwillbedeterminedaccordingtobenefitamountsinforceunderthisPolicyforCoveredPersonsasoftheDateofDisability.(SeeSectionII-ScheduleofInsurance.)TheLTDMonthlyBenefitAmountwillnotbepaid:1.inexcessoftheMaximumLTDMonthlyBenefitAmount;2.inanamountlessthantheMinimumLTDMonthlyBenefitAmount;3.duringtheEliminationPeriod;4.foranyperiodinexcessoftheMaximumBenefitPeriod;or5.whenCoveredPersonsareDisabledandearningmorethantheoccupationincomelevel(s)showninSectionII-ScheduleofInsurance.IfthisPolicyisareplacementforaPriorPlan,administrationofthisLTDMonthlyBenefitAmountprovisionmaybemodifiedaccordingtoReplacementofPriorPlansinSectionVI-CoverageProvisions.WHENLTDMONTHLYBENEFITSBEGINLTDMonthlyBenefitswillbepayableonthefirstdayaftersatisfactionoftheEliminationPeriod.MINIMUMLTDMONTHLYBENEFITAMOUNTWhenbenefitsarepayable,theLTDMonthlyBenefitAmountwillnotbelessthantheMinimumLTDMonthlyBenefitAmountshowninSectionII-ScheduleofInsurance.LTD83701-CO10 SECTIONIV-BEI,1TPROVISIONS(ContinueC‘WHENLTDMONTHLYBENEFITSENDLTDMonthlyBenefitswillautomaticallyendontheearliestofthefollowingwhenCoveredPersons:1.arenolongerDisabled;2.failtoprovidesatisfactoryproofofcontinuingDisability;3.continuetobeDisabledbeyondtheMaximumBenefitPeriod;4.refusetocooperateortoparticipateinaprogramotrehabilitationapprovedbyus;5.die;or6.temporarilyreturntoActiveWorkandarecoveredoreligibleforcoverageunderanyothergroupLTDpolicy.(SeeEffectofaTemporaryReturntoActiveWorkinthisSectionIV-BenefitProvisions.)BENEFITSAFTERCOVERAGEENDSORISCHANGEDCovetedPersons’righttoreceiveLTDMonthlyBenefitsforaDisabilitythatbeginswhiletheyarecovetedisnotaffectedby:1.terminationofthisPolicyafterCoveredPersonsbecomeDisabled;2.terminationofCoveredPersons’coveragewhilethisPolicyremainsinforce;or3.adoptionofamendment(s)approvedaftertheirDateofDisability.ELIMINATIONPERIODTheEliminationPeriodisthelengthoftimepriortobenefitsbeingpayableduringwhichCoveredPersonsarecontinuouslyDisabled.TheEliminationPeriodstartsontheDateofDisabilityandcontinuesforthedurationshowninSectionII-ScheduleofInsurance.TheEliminationPeriodmaybesatisfiedwhileCoveredPersonsareDisabledandworking.AnewEliminationPeriodwillbeappliedtoeachDisability,IfCoveredPersonsarenotcontinuouslyDisabledduringtheEliminationPeriod,theTemporaryReturntoActiveWorkprovisionunderthisSectionIV-BenefitProvisionsmayapply.BENEFITPERIODTheBenefitPeriodisthelengthoftimeduringwhichbenefitsarepayable.CoveredPersonsmustbecontinuouslyDisabledduringtheBenefitPeriodtoreceivebenefitsunderthisPolicy.TEMPORARYRETURNTOACTIVEWORKIfCovetedPersonstemporarilyreturntoActiveWorkwhileDisabled,thefollowingprovisionswillapply:TEMPORARYRETURNTOAcTIvEWORKALLOWABLEPERIODS1.IfCoveredPersonstemporarilyreturntoActiveWorkwhilesatisfyingtheirEliminationPeriod,thefollowingwillapply:a.theallowableperiodofatemporaryreturntoActiveWorkwillbecalculatedas5daysforeach30daysofrequiredEliminationPeriod;b.theallowableperiodofatemporaryreturntoActiveWorkmaynotexceed30days;andc.ifafterhavingreturnedtoActiveWork,theybecomeDisabledagainandthereturntoActiveWorkdidnetexceedtheallowableperiodspreviouslydescribed,thentheywillnotbesubjecttotherequirementsofanewEliminationPeriod.LTD83707-CO11 SECTIONIV-BEt?ITPROVISIONS(Continuet)2.IfCoveredPersonstemporarilyreturntoActiveWorkduringaBenefitPeriod,thefollowingwillapply:a.theallowableperiodofatemporaryreturntoActiveWorkmaynotexceedatotalof180days;andb.ifafterhavingreturnedtoActiveWork,theybecomeDisabledagainfromthesameorrelatedcauseorcausesandtheirreturntoActiveWorkdidnotexceedtheallowableperioddescribedabove,thentheirDisabilitywillbeconsideredacontinuationoftheBenefitPeriod.EFFECTOFATEMPORARYRETURNTOACTIVEWORKIfCoveredPersonstemporarilyreturntoActiveWorkanddonotexceedtheallowableperiod,thefollowingwillapplytothepaymentofbenefits:1.thedurationoftheCoveredPersons’temporaryreturntoActiveWorkwillnotbeusedtosatisfytheEliminationPeriodoranyoftheoccupationalperiodsdescribedintheDefinitionsofDisabilityinSectionIII-DefinedTerms;2.theLTDMonthlyBenefitAmountwillnotbepayableduringatemporaryreturntoActiveWork;3.duringaperiodinwhichCoveredPersonstemporarilyreturntoActiveWork,coverageunderthisPolicywillautomaticallyendonthedatetheybecomecovetedoreligiblefotcoverageunderanyothergrouppolicy;4.theprovisionsofthisPolicywillbeappliedtobenefitsinthesamemannerastheywouldhavebeenappliedhadtherebeennointerruptionintheEliminationPeriodorBenefitPeriod;and5.anychangeintheirEarningsduringthetimeCoveredPersonstemporarilyreturntoActiveWorkwillnotbeusedtodeterminetheirLTDMonthlyBenefitAmountiftheirBenetitPeriodresumes.BENEFITOFFSETSBenefitOffsetsmeansthefollowing:1.sickpayfromtheEmployer;2.salarycontinuationorseverancepayfromtheEmployer,excludingvacationpay;3.anyamountCoveredPersonsreceiveorareeligibletoreceivebecauseoftheirDisabilityunderanyWorkers’Compensationlaworsimilarlaw,includingamountsforvocationaltherapyorforpartialortotaldisability,whetherpermanentortemporary;4.anyamountCoveredPersonsreceiveorareeligibletoreceivebecauseofDisabilityunderanystatedisabilityincomebenefitlaworsimilarlaw;5.anyamountCoveredPersonsreceiveorareeligibletoreceivebecauseofDisabilityunderanygroupinsurancecoverage;6.anyDisabilityorRetirementBenefits,sponsoredorcontributedtobytheEmployeronCoveredPersons’behalf,thatarereceivedundertheEmployer’sRetirementPlan(inaddition,seePensionPlans,RetirementPlans,andRetirementBenefitsinSectionIII-DefinitionsandListofDefinedTerms);7.anyamountCovetedPersonsreceiveorareeligibletoreceivethroughtheVeteransAdministration(exceptfromaNationalServiceLifeInsurancePolicy)becauseoftheirDisability;8.anyamountCoveredPersonsreceivebycompromise,settlement,orothermethodresultingfromaclaimforanyoftheabove,whetherdisputedorundisputed;9.iftheBenefitOffsetsareshownasDirectPrimatyontheScheduleofInsurance,thenanyamounttheCovetedPersonsreceiveorareeligibletoreceivebecauseoftheirDisabilityorretirementunderanyFederalActorPlan;10.iftheBenefitOffsetsareshownasDirectFamilyontheScheduleofInsurance,thenanyamountCoveredPersons,theirspouses,orchildrenunderage18receiveorareeligibletoreceivebecauseofCoveredPersons’DisabilityorretirementunderanyFederalActorPlan;andLTD83701-CO12 SECTIONIV-BEFITPROVISIONS(Continue11.iftheBenefitOffsetsareshownasAllSourcesontheScheduleofInsurance,theLTDMonthlyBenefitAmountequalsthelesserof:a.EarningsmultipliedbytheLTDBenefitPercentagebeforereductionforBenefitOffsets;b.theLTDMaximumMonthlyBenefitAmount;orc.theAllSourcespercentagemultipliedbyCoveredPersons’EarningslessBenefitOffsets.FederalActsandPlansmeananyofthefollowing:a.theFederalSocialSecurityAct;b.theCanadaPensionPlan;c.theQuebecPensionPlan;d.theRailroadRetirementAct;e.theJones’Act;orf.anysimilarplanoract.EXCEPTIONSTOBENEFITOFFSETSBenefitOffsetsdonotincludethefollowing:1.anycostoflivingincreaseinanyBenefitOffsetiftheincreasebecomeseffectivewhileCoveredPersonsareDisabtedandeligibleforthatBenefitOffset;2.reimbursementforhospital,medical,orsurgicalexpense;3.reimbursementforreasonableattorney’sfeesincurredduetoaclaimforBenefitOffsets;4.earlyRetirementBenefitsundertheFederalSocialSecurityActthatarenotreceived;5.iftheBenefitOffsetsareshownasDirectPrimaryontheScheduleofInsurance,thenbenefitsreceivedundertheFederalSocialSecurityActbyCoveredPersons’spousesorchildrenunderage18;6.groupcreditormortgagedisabilityinsurancebenefits;7.thefollowingamountsundertheEmployer’sRetirementPlan:a.anyamountthatisattributabletoCoveredPersons’contributionstotheplan;orb.anyamountCoveredPersonsreceiveuponterminationofemploymentwithoutbeingdisabledorretired;and8.benefitsfrom(a)through(h)asfollows:a.profit-sharingplan;b.thriftorsavingsplan;c.deferredcompensationplan;U.plansunderIRCSection401(k)or457;e.individualretirementaccount(IRA);f.tax-shelteredannuity(ISA)underIRCSection403(b);g.nofaultautoinsurance;orh.individualdisabilityinsurance.RULESFORBENEFITOFFSETSLUMPSUMPAYMENTSWhenCoveredPersonsnegotiatealumpsumsettlementunderanyactorlawreferredtointhisBenefitOffsetprovision,wewilldividethelumpsumsettlementbythelesserofthescheduleunderstate!awortheremainingnumberofmonthsundertheMaximumBenefitPeriod.SeePensionPlans,RetirementPians,andRetirementBenefitsinL3eiinitions,SectionIll-DefinedTermsforfurtherinformation.LTD83701-CO13 SECTIONIV-EELFITPROVISIONS(ContinueNPENDINGBENEFITOFFSETSDuringtheperiodbetweenthedateCoveredPersonsapplyforSocialSecuritybenefitsandthedatesuchbenefitsareactuallygrantedordenied,CoveredPersonsmustselectoneofthefollowingoptions:1.electtohavetheLTDMonthlyBenefitAmountreducedbyanestimateoftheirexpectedSocialSecuritybenefit;or2.electtohavenoreductionmadeuntilthedateSocialSecuritybenefitsareactuallygranted.ItCoveredPersonselectoption1,theirLTDMonthlyBenefitAmountwillbeadjustedafterSocialSecuritybenefitsaredetermined.Iftheyelectoption2,theymustsignanagreementpromisingtorepayanyoverpaymentcausedbySocialSecuritybenefitsbeingpaid.ThisoverpaymentmustbereimbursedtousonthedateSocialSecuritybenefitsareactuallypaid.ItbenefitsaredeniedundertheSocialSecurityAct,RailroadRetirementAct,oranyplanoractoflikeintentofaforeignnation,CoveredPersonsmustfileforarequestforreconsideration.Ifdeniedagain,theymustrequestaheatingbeforeanAdministrativeLawJudgeunlesswaivedinwritingbyus.CoveredPersons’LTDMonthlyBenefitAmountwillbeadjustedasiftheyhadelectedoption1whentheydonot:1.electoneoftheaboveoptions;2.filearequestforreconsideration;or3.requestahearingbeforeanAdministrativeLawJudge.OvERPAYMENTOFCLAIMSItafterhavingmadeoneormorepaymentsunderthisPolicy,wefindthattheamountofbenefitsorpaymentsfromothersourcesthatweshouldhaveconsideredincomputingtheamountoftheCoveredPersons’claimisgreaterorlessthanwhatwasconsidered,wewilladjustclaimpaymentsinthefollowingmanner:1.ifwehaveunderpaidbenefits,wewillpaytheamountnecessarytoadjustthetotalpaymentstotheamountthatweshouldhavepaid;or2.ifwehaveoverpaidbenefits,theoverpaymentmustberefundedtousbytheCovetedPersons.Wemayreduceoreliminatefuturepaymentsinsteadofrequitingrepaymentinonesum.TheMinimumLTDMonthlyBenefitwillnotbepaidwhiletheoverpaymentisbeingrepaid.SURVIVORBENEFITIfCoveredPersonsdiewhileLTDMonthlyBenefitsarepayable,wewillpayaSurvivorBenefit.TheSurvivorBenefitwillbepaidaccordingtothefollowing:1.theSurvivorBenefitamountshownontheScheduleofInsurancewillbepaidtotheCoveredPersons’SurvivingSpouses;2.ifCoveredPersonsdonothaveSurvivingSpouses,butdohaveSurvivingChildren,wewillpaythisbenefittotheCovetedPersons’estates;3.theSurvivorBenefitwillnotbepaidifCoveredPersonsdonothaveSurvivingSpousesorSurvivingChildren;and4.SurvivorBenefits,itpayable,willfirstbeappliedtoreduceanyclaimoverpayments.SurvivingSpousemeansalegalspouseoftheCoveredPersonwhomeetsallrequirementsforavalidlegalmarriageintheCoveredPerson’sandtheSurvivingSpouse’sstateofresidence.SurvivingChildrenmeansnaturaloradoptedchildrenwhoare:1.unmarried;and2.undertheageoftwenty-five(25).LTD83701-CO14 SECTIONIV-BEt9TPROVISIONS(Continue’WAIVEROFPREMIUMCoveragewillcontinueforCoveredPersonswithoutpaymentofpremiumswhileLTDMonthlyBenefitsarepayable.LTD83701-CO15 SECTIONV-EXCJSIONSANDLIMITATIONS0EXCLUSIONSWARCoveredPersonsarenotcoveredforDisabilitiescausedorcontributedtobyWaroranyactofWar.WarmeansdeclaredorundeclaredWar,whethercivilorinternational,andanysubstantialarmedconflictbetweenorganizedforcesofamilitarynature.INTENTiONALLYSELF-INFLICTEDINJURYCoveredPersonsarenotcoveredforDisabilitiescausedorcontributedtobyanintentionallyself-inflictedInjury,whilesaneorinsane.RIOTORCIVILINSURRECTIONCoveredPersonsarenotcoveredforDisabilitiescausedorcontributedtobytheiractiveparticipationinaninsurrection,rebellion,orriot.CoMMissioNOFAFELONYCoveredPersonsarenotcoveredforDisabilitiescausedorcontributedtobytheircommissionoforattempttocommitfelonies.INCARCERATIONBenefitsunderthisPolicywillnotbepayablewhenCovetedPersonsareincarceratedforanyperiodexceeding90days.ARMEDFORCESCoveredPersonsarenotcoveredforDisabilitiescausedorcontributedtobyserviceinthearmedforcesasactivemembersorasreservistsofanycountry.PREExIsTINGCONDITIONADisabilitycausedorcontributedtobyaPreexistingConditionisnotcoveredunderthisPolicyunlesstheDateofDisabilityoccursafterthePreexistingConditionExclusionPeriodshowninSectionII-ScheduleofInsurance.PreexistingConditionmeansamentalorphysicalconditionforwhichCoveredPersonshave(a)consultedaPhysician;(b)receivedmedicaltreatmentorservices;or(c)takenprescribeddrugsormedicationsduringthePreexistingConditionPeriodshownintheSectionII-ScheduleofInsurance.IfthisPolicyisareplacementforaPriorPlan,administrationofthisPreexistingConditionprovisionmaybemodifiedaccordingtoReplacementofPriorPlansinSectionVI-CoverageProvisions.LTD83707-CO16 SECTIONV-EXC.]SIONSANDLIMITATIONS(ntinued)LIMITATIONSFOREIGNMEDICALTREATMENTCoveredPersonsarenoteligibleforbenefitsduringanyperiodofDisabilityinwhichtheyarehospitalizedorreceivingmedicaltreatmentoutsidetheUnitedStates,itsterritories,orCanada.MENTALANDNERVOUSDISORDERSPaymentofLTDMonthlyBenefitsislimitedtothedurationshowninSectionII-ScheduleofInsuranceforeachDisabilitycausedorcontributedto,directlyorindirectly,byaMentalorNervousDisorder.IfCoveredPersonsareconfinedinaHospitalattheendoftheduration,thislimitationwillnotapplywhiletheyarecontinuouslyconfined.MentalandNervousDisordersmeanphysical,mental,emotional,behavioral,orstress-relateddisorderscausedorcontributedto,directlyorindirectly,byamentalornervousconditionasclassifiedintheDiagnosticandStatisticalManualoftheAmericanPsychiatricAssociation(DSM)ineffectasoftheDateofDisability.DRUGANDALCOHOLDISORDERSPaymentofLTDMonthlyBenefitsislimitedtothedurationshowninSectionII-ScheduleofInsuranceforeachDisabilitycausedorcontributedto,directlyorindirectly,byaDrugorAlcoholDisorder.IfCoveredPersonsareconfinedinaHospitalattheendoftheduration,thislimitationwillnotapplywhiletheyarecontinuouslyconfined.DrugorAlcoholDisordersmeanphysical,mental,emotional,behavioral,orstress-relateddisorderscausedorcontributedto,directlyorindirectly,bysubstanceabuseordependencyasclassifiedintheDiagnosticandStatisticalManualoftheAmericanPsychiatricAssociation(DSM)and/ortheInternationalClassificationofDiseases(lCD)ineffectasoftheDateofDisability.InnocasewillLTDMonthlyBenefitsbepaidbeyondtheoriginalMaximumBenefitPeriodshowninSectionII-ScheduleofInsurance.LTD83701-CO17 SECTIONVI-CLERAGEPROVISIONSCACTIVEWORKPROVISIONSACTIVEWORKORACTIVELYATWORKDEFINITIONActiveWorkandActivelyatWorkmeanthatemployeesoftheEmployerorCoveredPersonsareperformingeachofthematerialdutiesoftheoccupationthattheyregularlyperformfortheEmployerattheEmployer’susualplaceofbusiness.ACTIVEWORKREQUIREMENTSIfemployeeswereabsentfromActiveWorkbecauseofSicknessorInjuryonthedaybeforethescheduledeffectivedateoftheircoverage,theircoveragewillnotbecomeeffectiveuntiltheycompleteonefulldayofActiveWorkasEligiblePersons.CHANGESINBENEFITSThisActiveWorkrequirementalsoappliestoanychangeinbenefits.IfCoveredPersonsreturntoActiveWorkduringaBenefitPeriod(SeeBenefitPeriodsinSectionIV-BenefitProvisions),theywillnotqualifyforanychangeinbenefitscausedwhen:1.theirclassstatuschanges;2.theirEarningschange;or3.thetermsofthisPolicychange.EXCEPTIONSTheActiveWorkRequirementwillbewaivedwhenCoveredPersons:1.areabsentfromActiveWorkbecauseofaregularlyscheduleddayoff,holiday,orvacationday;2.wereActivelyatWorkontheirlastscheduledworkdaybeforethedateoftheirabsence;and3.werecapableofActiveWorkonthedaybeforethescheduledeffectivedateoftheircoverage.WHENCOVERAGEBECOMESEFFECTIVEPremiumRatesandRenewalsinSectionII-ScheduleofInsurancestateswhetherthecoverageisContributoryorNoncontributory.N0Nc0NTRIBuT0RYINSURANCESubjecttotheActiveWorkProvisions,NoncontributoryInsurancebecomeseffectiveonthedatetheemployeebecomeseligibleforcoverageunderthisPolicy.CONTRIBUTORYINSURANCEIfEligiblePersonsapplyforContributoryInsurancewithin31daysofbecomingeligible,theywillnotberequiredtoprovideEvidenceofInsurability.However,iftheyapplyafterthefirst31daysinwhichtheybecomeeligible,theymustprovideEvidenceofInsurability.SubjecttotheActiveWorkprovisions,theirContributoryInsurancewillbecomeeffectiveononeofthefollowingdates:1.thedatetheybecomeeligibleiftheyapplyonorbeforethatdate;2.thedatetheyapplyiftheyapplywithin31daysaftertheybecomeeligible;or3.thedateweapprovetheirEvidenceofInsurabilityiftheyapplymorethan31daysaftertheybeccmeeligible.COVERAGESUBJECTTOEVIDENCEOFINSURABILITYCoveragesubjecttoEvidenceofInsurabilitybecomeseffectiveonthelaterof:7.theEligiblePersons’effectivedatesatcoverage;or2.thedateweapprovetheirEvidenceofInsurability.CoveragesubjecttoEvidenceofInsurabilityisalsosubjecttotheActiveWorkProvisionsinthisSectionVI-CoverageProvisions.LTD83701-CO18 SECTIONVI-C.ERAGEPROVISIONS(Cont.ied)WHENCOVERAGEENDSTERMINATIONOFSTATUSASCOVEREDPERSONSCoveredPersons’coveragewillautomaticallyceaseunderthisPolicyontheearliestofthefollowing:1.thedatetheyceasetomakepremiumcontributionsiftheircoverageisContributory;2.thedatethisPolicyterminates;3.thedatetheiremploymentwiththeEmployerterminates;4.thedateonwhichtheyceasetomeettheCovetedPersonrequirementsshowninSectionII-ScheduleofInsurance;5.thedateonwhichtheyceasetobeamemberofanEligibleClass;6.thedateonwhichtheirlay-offorleaveofabsenceexceedstheperiodshownintheScheduleofInsuranceunderLay-offorLeaveofAbsencePeriod;or7.iftheyarelegalresidents,thedateonwhichtheyhavebeenresidingoutsidetheUnitedStates,itsterritoriesorCanadaforaperiodof6ormoreconsecutivemonths.CONTINUATIONASACOVEREDPERSONStatusasaCoveredPersonandcoverageunderthePolicywillcontinue:7.whiletheCoveredPersonisDisabled;2.whiletheCoveredPersonisonaleaveofabsenceunderthetermsofanystateorfederallymandatedfamilyormedicalleaveactorlaw;or3.duringtheLay-offorLeaveofAbsencePeriodshownintheScheduleofInsuranceforanyotherleaveofabsence.REINSTATEMENTOFCOVERAGECoveredPersonsmayrequestreinstatementiftheircoverageunderthisPolicyendedduetoanyofthefollowingreasons:1.theywereunabletomeettheeligibilityrequirementsoftheirinsuredclass;2.theytailedtomakearequiredpremiumcontribution;or3.theircoverageendedduringaleaveofabsenceunderthetermsofanystateorfederallymandatedfamilyormedicalleaveactorlaw.PreviouslyCoveredPersonsmustrequestreinstatementwithin90daysofceasingtobeCoveredPersons.EvidenceofInsurabilitywillnotberequiredforreinstatementsfollowingCoveredPersons’returnfromafamilyormedicalleave.EvidenceofInsurabilityisrequiredforallotherreinstatementrequests.Ifcoverageisreinstated,thefollowingwillapply:7.theEligibilityWaitingPeriodwillbewaived;and2.theapplicablePreexistingConditionprovisioninSectionV-ExclusionsandLimitationswillbeappliedasiftherewerenointerruptionincoverage.REPLACEMENTOFPRIORPLANS7ReplacementofaPriorPlanwiththisPolicymayresultinsomeofourprovisionsbeingmodified.WhenthisPolicyreplacesaPriorPlan,wewillmodifyourprovisionsasindicatedinthefollowingdescriptionofeffects.Theprovisionsaffectedbythesemodificationsincludebutarenotlimitedtothefollowing:EFFECTONELGIB!LITYWAITINGPERIODIfCoveredPersonswerecoveredunderthePriorPlanonthedaybeforetheeffectivedateofthisPolicy,theirEligibilityWaitingPeriodmaybewaived.IftheywerepreviouslydeclinedforLTDinsurance,theymustsubmitEvidenceofInsurabilitysatisfactorytousbeforetheycanbecomecoveredunderthisPolicy.(SeeSectionII-ScheduleofInsuranceandSectionIII-Definitions.)LTD83701-CO19 t_-SECTIONVI-CLERAGEPROVISIONS(Conth.ed)EFFECTONPREExIsTINGCONDITIONSItCovetedPersons’DisabilitiesaresubjecttothePreexistingConditionExclusionorLimitationinSectionV-ExclusionsandLimitations,LTDMonthlyBenefitswillbepayableif:1.CoveredPersonswerecoveredunderthePriorPlanonthedaybeforetheeffectivedateoftheircoverageunderthisPolicy;2.CoveredPersonswerecontinuouslycoveredunderthisPolicyfromtheeffectivedateoftheEmployer’scoverageunderthisPolicythroughthedatetheybecameDisabled;and3.benefitswouldhavebeenpayableunderthePriorPlanifithadremainedinforce,takingintoaccountthepreexistingconditionlimitationorexclusion,itany,ofthePriorPlan.EFFECTONLTDMONTHLYBENEFITSTheLTDMonthlyBenefitwillbethelesserof:1.themonthlybenefitthatwouldhavebeenpayableunderthetermsofthePriorPlanifithadremainedinforce;or2.theLTDMonthlyBenefitamountpayableunderthisPolicy.EFFECTONWHENLTDMONTHLYBENEFITSENDIfthisPolicyisareplacementofaPriorPlan,thenLTDMonthlyBenefitswillautomaticallyendwhentheearlierofthefollowingoccurs:1.theeventslistedunderWhenLTDMonthlyBenefitsEndinSectionIV-BenefitsProvisionofthisPolicy;or2.thedateonwhichtheCoveredPersons’benefitsunderthePriorPlanwouldhaveendeditithadremainedinforce.LTD83701-CO20 SECTiONVII-CLMPROViSiONS0GENERALCLAIMPROVISIONSFILINGACLAIMClaimsshouldbetiledonourforms.ItCovetedPersonsdonotreceiveourformswithin15daysaftertheyaskforthem,theymaysubmittheirclaimsinalettertous.ThelettershouldincludetheDateofDisabilityandthecauseandnatureoftheDisability.PRooFOFLossProofotLossmeanswrittenevidencesatisfactorytousthatCoveredPersonsareDisabledandentitledtoLTDMonthlyBenefits.ProofofLossmustbeprovidedattheirexpense.TIMELIMITsONFILINGPROOFOFLossCoveredPersonsmustgiveusProofofLosswithin90daysaftertheendoftheEliminationPeriod.Iftheycannotdoso,theymustgiveittouswhenreasonablypossible,butnolaterthan1yearafterthat90-dayperiod.ItProofofLossisfiledoutsidethesetimelimits,theirclaimwillbedenied.TheselimitswillnotapplywhileCoveredPersonslacklegalcapacity.DOCUMENTATIONAtCoveredPersons’expense,theymustsubmitcompletedclaimstatements,asignedauthorizationforustoobtaininformation,andanyotheritemswemayrequireinsupportoftheirclaim.Iftheydonotprovidethedocumentationwithin60daysafterwemailthemourrequest,theirclaimsmaybedeniedorsuspended.INvESTIGATIONOFCLAIMWemayinvestigateCoveredPersons’claimsatanytime.Atourexpense,wemayhavethemexaminedatreasonableintervalsbyspecialistsofourchoiceincludingphysicians,psychologists,psychiatrists,orvocationalevaluators.WemaydenyorsuspendLTDMonthlyBenefitsifCoveredPersonsfailtoattendanexaminationorcooperatewiththeexaminer.TIMEOFPAYMENTWewillpayLTDMonthlyBenefitswithin60daysandaftertheProofofLosshasbeensatisfied.LTDMonthlyBenefitswillbepaidtoCoveredPersonsattheendofeachmonthduringwhichtheyqualifyforthem.LTDMonthlyBenefitsremainingunpaidatthetimeofCovetedPersons’deathwillbepaidtotheirestate.NOTICEOFDECISIONONCLAIMCoveredPersonswillreceivewrittendecisionontheirclaimwithinareasonabletimeafterwereceivetheirclaim.Iftheydonotreceiveourdecisionwithin90daysafterwereceivetheirclaim,theywillhaveanimmediaterighttorequestareviewasiftheirclaimhadbeendenied.Ifwedenyanypartoftheirclaim,theywillreceiveawrittennoticeofdenialcontainingthefollowinginformation:1.thereasonforourdecision;2.referencetothepartsofthisPolicyonwhichourdecisionisbased;3.adescriptionofanyadditionalinformationneededtosupporttheirclaim;and4.informationconcerningtheirrighttoareviewofourdecision.REv:EwPROCEDURESCoveredPersonsmayrequestinwritingreviewofadenialoftheirclaimwithin60daysaftertheyreceivenoticeofdenial.Whentheyrequestareview,theymaysenduswrittencommentsorotheritemstosupporttheirclaim.CoveredPersonsmayreviewanynonprivilegedinformationthatrelatestotheirrequestforreview.WewillreviewCoveredPersons’claimspromptlyafterwereceivetheirrequest.Wewillsendthemanoticeofourdecisionwithin60daysafterwereceivetheirrequest,orwithin120daysifspecialcircumstancesrequireanextension.WewillstatethereasonsforourdecisionandreferthemtotherelevantpartsofthisPolicy.LTD83701-CO21 SECTIONVII-CLMPROVISIONS(Continued,TIMELIMITSONLEGALACTIONSNoactionatlaworinequitymaybebroughtuntil60daysafterCoveredPersonshavegivenusProofofLossandhaveexhaustedallappeals.Suchactionmaynotbebroughtmorethan3yearsaftertheearlierof:1.thedatewereceiveProofofLoss;or2.theendoftheperiodwithinwhichProofofLossisrequiredtobegiven.LTD83701-CO22 SECTIONVIII-PLJCYHOLDERPROVJSIONSCPREMIUMRATESANDRENEWALSPREMIUMSThepremiumdueoneachpremiumduedateisthesumofthepremiumsforallpersonsthencoveredunderthisPolicy.CONTRIBUTIONSFROMCOVEREDPERSON(S)ThePolicyholderdeterminestheamount,ifany,ofeachCoveredPerson’scontributiontowardthecostofcoverage.CHANGESINPREMIUMRATESWemaychangepremiumrateswhenanyofthefollowingoccur:1.achangeinlaworgovernmentalregulationaffectstheamountpayableunderthisPolicy(anysuchchangeinpremiumrateswillreflectonlythechangeinourobligations);2.thenumberofCoveredPersonschangesby25%ormore;or3.thePolicyholderandwemutuallyagreetochangepremiumrates.Exceptasprovidedabove,premiumrateswillnotbechangedduringtheInitialRateGuaranteePeriodshowninSectionII-ScheduleofInsurance.AfterthatwemaychangepremiumratesuponadvancewrittennoticetothePolicyholder.Thepremiumratewillnotbechangedmorethanonceinany12monthsunlessmutuallyagreeduponbyusandthePolicyholder.(SeePremiumRatesandRenewalsinSectionII-ScheduleofInsurance.)PREMIUMCALCULATIONANDPAYMENTPremiumforeachCoveredPersoniscalculatedbymultiplyingthepremiumratebytheCoveredPerson’sEarningsuptobutnotexceedingtheMaximumCoveredMonthlyEarnings.Thetermpremiumincludesanychangeintheamountowedduetoachangeinthepremiumrate.Premiumsaredueonthedatecoveragebecomeseffectiveandonorbeforeeachsuccessiveduedate.ThepaymentofpremiumwhenduemaintainsthisPolicyinforceuntilthenextpremiumduedate.(SeePremiumRatesandRenewalsinSectionII-ScheduleofInsurance.)PREMIUMAuoTlNGWereservetherighttoauditpremiumrecordsofthePolicyholderatanytimewithoutpriornotice.ThePolicyholderisrequiredtocooperatefullyinresolvinganyoutstandingissuesrelatedtopremiumamountspaidorowing.Fullcooperationincludes,butisnotlimitedto,thefulfillmentofanyrequestfordatarequiredbyustomakeadetermination.Ifwedeterminethatanoverpaymenthasoccurred,apremiumcreditintheamountoftheoverpaymentwillbeappliedtothePolicyholder’sfuturepremiums.Ifwedeterminethatanunderpaymenthasoccurred,apremiumbillingintheamountoftheunderpaymentwillbemailedtothePolicyholder.Paymentofanypremiumsowedduetoanunderpaymentarepayableuponreceiptoftheunderpaymentbilling.IfthePolicyholderdoesnotreimburseuswithin30daysofreceiptoftheunderpaymentbilling,thisPolicywillbecancelledattheexpirationoftheGracePeriod.Inanyevent,thePolicyholderisliabletousforfullreimbursementoftheunderpayment.GRACEPERIODANDTERMINATIONFORNONPAYMENTIfapremiumisnotpaidonorbeforeapremiumduedate,itmaybepaidduringtheGracePeriod.ThelengthoftheGracePeriodisshowninSectionII-ScheduleofInsurance.ThisPolicywillremaininforceduringtheGracePeriod.ItthepremiumisnotpaidduringtheGracePeriod,thisPolicywillterminateautomaticallywhentheGracePeriodends.ThePolicyholderisliableforthepaymentofpremiumforcoverageduringtheGracePeriod.LTD83701-CO23 SECTIONVIII-PLJCYHOLDERPROVISIONS(ntinued)TERMINATIONFOROTHERREASONSTERMINATIONBYTHEPoLIcYHoLDERThePolicyholdermayterminatethisPolicybygivingusa31-dayadvancewrittennotice.Theeffectivedateofterminationwillbethelaterofthefollowing:1.thedatestatedinthenotice;or2.thedatewereceivethenotice.TERMINATIONBYUsWemayterminatethisPolicywithadvancewrittennotice.TheminimumadvancenoticeofterminationshallbethesameperiodastheNoticeofRateChangestatedinPremiumRatesandRenewalsinSectionII-ScheduleofInsurance.Failuretoreceivethewrittennoticewillnotwaiveourrightsunderthisprovision.GENERALPOLICYPROVISIONSALLOCATIONOFAUTHORITYExceptforthosefunctionsthatthisPolicyspecificallyreservesforthePolicyholder,thePolicyholderdelegatesandagreesthatweshallhavefull,exclusive,anddiscretionaryauthoritytocontrol,manage,andadministerclaims,andtointerpretandresolveallquestionsarisingoutoftheadministration,interpretation,andapplicationofthisPolicy.Ourauthorityincludes,butisnotlimitedto,thefollowing:1.thetighttoresolveallmatterswhenareviewhasbeenrequested;2.therighttoestablishandenforcerulesandproceduresfortheadministrationofthisPolicyandanyclaimunderit;and3.therighttodetermine:a.eligibilityforcoverage;b.entitlementtobenefits;c.amountofbenefitspayable;andd.thesufficiencyandamountofinformationwemayrequiretodeterminea,b,orc.SubjecttothereviewproceduresofthisPolicy,anydecisionwemakeintheexerciseofourauthorityisconclusiveandbinding.CERTIFICATESWewilldelivercertificatesunderthisPolicytothePolicyholderwhoisresponsiblefordistribution.Weshallnotberesponsibleorbearanyliabilityforcertificatesnotdistributed,ormaterialsusedinlieuof,orinadditionto,thecertificatesunlesssuchmaterialsareapprovedbyus.RECORDSANDREPoRTsThePolicyholderwillfurnishonourformsallinformationnecessarytoadministerthisPolicy.WehavetherightatallreasonabletimestoinspectthepayrollandotherrecordsofthePolicyholderrelatingtocoverageunderthisPolicy.ClericalerrorbythePolicyholderwillnotresultinthefollowing:1.causeapersontobecomecovered;2.invalidatecoverageotherwisevalidlyinforce;or3.continuecoverageotherwisevalidlyterminated.MISSTATEMENTOFAGEIfapersonsagehasbeenmisstated,wewillequitablyadjustpremiums,benefits,orboth.Theadjustmentwillbebasedonthefollowing:1.theamountofcoveragebasedonthecorrectage;and2.thedifferencebetweenthepremiumspaidandthepremiumsthatwouldhavebeenpaidiftheagehadbeencorrectlystated.LTD83701-CO24 SECTIONVIII-P.JCYHOLDERPROVISIONS(ntinued)ENTIRECoNTRAcT,CHANGESThisPolicyandtheapplicationofthePolicyholderconstitutetheentirecontractbetweentheparties.AcopyofthePolicyholder’sapplicationisattachedtothisPolicywhenissued.TheplanofinsuranceprovidedbythisPolicyshallbeadministeredaccordingtothetermsandconditionsofthedocumentslistedinthisprovisionandnotaccordingtoanyplansummary,bywhatevernamecalled,usedbytheEmployerandwhichhasnotbeenapprovedbyus.OtherthanchangesthatateallowedbyprovisionofthisPolicy,wemaychangethisPolicywhenthatchangeisapprovedinwritingbymutualagreementbetweenusandthePolicyholder.AchangeinthisPolicywillnotbevalidunlessitisrequestedoracceptedbythePolicyholder.AgentsdonothaveauthoritytochangethisPolicyortowaiveanyofitsprovisions.EFFECTONWORKERS’COMPENSATIONORSTATEDISABILITYINSURANCEThecoverageprovidedunderthisPolicyisnotasubstituteforcoverageunderWorkers’Compensationorstatedisabilityincomebenefitlawsanddoesnotrelieveanemployerofanyobligationtoprovidesuchcoverage.INCONTESTABILITYOFCOVEREDPERSON’SINSURANCEAnystatementthatismadebythePolicyholder,Employer,orCoveredPersontoobtaininsuranceisarepresentationandnotawarranty.Misrepresentationbythesepartieswillnotbeusedtoreduceordenyaclaimorcontestthevalidityofcoverageunlessanyofthefollowingapply:1.coveragewouldnothavebeenapproved;or2.wehavegiventheproperpartiesacopyofawritteninstrumentsignedbythatpersonthatcontainsthematerialmisrepresentation.AftercoverageunderthisPolicyhasbeenineffectfor2years,wewillnotuseamaterialmisrepresentationbythePolicyholder,Employer,orCoveredPersontoreduceordenyaclaim,unlessitwasafraudulentmisrepresentation.INCONTESTABILITYOFPOLICYAnystatementmadebythePolicyholdertoobtainthisPolicyisarepresentationandnotawarranty.MaterialmisrepresentationbythePolicyholderwillnotbeusedtodenyaclaimortodenythevalidityofthisPolicyunless:1.thisPolicywouldnothavebeenissued;and2.wehavegiventhePolicyholderacopyofawritteninstrumentsignedbythePolicyholderthatcontainsthemisrepresentation.ThevalidityofthisPolicywillnotbecontestedafterithasbeeninforcefor2years,exceptfornonpaymentofpremiumsorfraudulentmisrepresentations.ASSIGNMENTTherightsandbenefitsunderthisPolicymaynotbeassigned.0045NEGLTD83701-CO25 APPLICATIONFORGROUPDISABILITYINSURANCEPolicyholder/ApplicantEagleCountyGovernmentLTDCoverageflSTDCoverageVLTDCoverageAddress500Broadway(ExactlegalnameasitshouldappearonPolicy)(Street)EagleCO81631(City)(State)(Zip)CoveredSubsidiariesand/orAffiliatedCompanies:n/a(Name)(City)(State)REQUESTEDEFFECTIVEDATE—itisrequestedthatthecoverageappliedforbecomeeffectiveSeptember1,1996ThecoverageappliedforwilltakeeffectasoftheRequestedEffectiveDateprovidedthisapplicationisapprovedattheHomeOfficeoftheProvident.Theapplicantagreesthatitsacceptanceofthepolicyandcontinuedpaymentofpremiumwillconstituteanagreementtothepolicyterms.Acopyofthisapplicationwillbeattachedtoandmadeapartofthepolicy.GENERALAGREEMENTS—TheapplicantagreestotransmitthetotalpremiumsundertheplantotheProvidentatitsHomeOfficewhendue.NoagentorotherpersonexceptanofficercanmakeorchangeanycontractoragreementonbehalfortheProvident.DatedatEagle,CO(City,State)thisl9thdayofAugust1996PROVIDENLIFEANDACCIDENTINSURAr\COMPANYCHATTANOOGA,TENNESSEE(HereincalledtheProvident)ApplicantEagleCountyGovernment(EmployerName)STD—83703
