LONG TERM DISABILITY BENEFITS SUMMARY PLAN DESCRIPTION

Transcription

1 LONG TERM DISABILITY BENEFITS SUMMARY PLAN DESCRIPTION August 1, 2009

2 TABLE OF CONTENTS DEFINITIONS...1 SCHEDULE OF BENEFITS...4 HOW TO FILE A CLAIM FOR BENEFITS...5 PAYMENT OF CLAIMS...5 REHABILITATION...5 ELIGIBILITY...5 LONG TERM DISABILITY BENEFIT...6 EXCLUSIONS AND LIMITATIONS...7 TIC/A/UAS 0809 i

3 The Company provides Long-Term Disability (LTD) insurance to eligible Employees under Group Policy Number AULtimate LTD1F, Participating Unit Number G issued by American United Life Insurance Company, One American Square, P.O. Box 6123, Indianapolis, IN (herein called the Insurance Company). The Plan Administrator is: TIC International Corporation North Meridian Street, Suite 600 Carmel, IN The policy provides non-contributory Employee only LTD insurance (non-contributory insurance is fully paid for by the Company). Any information pertaining to benefits, including the information contained herein, is controlled and superseded by the policy. The policy may be amended or terminated by the Company at any time. Employees will be advised of significant changes. To examine the policy, please send a written request, in advance, to the Plan Administrator. Certificate of Insurance: An Employee who becomes insured under the policy will receive a Certificate of Insurance issued by the Insurance Company that summarizes the provisions, limitations and exclusions of the policy. The Certificate of Insurance is subject to the terms of the policy and is not a contract for insurance. DEFINITIONS The terms listed below apply to LTD Insurance only. If a term's definition is different from its definition in the policy, the definition in the policy shall prevail. Active Work and Actively At Work mean the use of time and energy in the services of the Company at the regular place of employment by a person who is physically and mentally capable of performing each of the main duties of his or her regular job for a minimum of 30 hours per week. This includes time off for vacation, jury duty and funeral leave where the person could otherwise have been at Active Work. It also includes time off under the Family and Medical Leave Act and certain other periods of employer approved leave and lay-off during which the policy allows insurance to be continued. This does not include time off as a result of an Injury or Sickness; leave or layoff, except as otherwise specifically allowed under the policy; strike; or lockout. Basic Monthly Earnings means monthly pay, before taxes, received from the Company not to exceed the Employee s normal work schedule. Earnings do not include income received from commissions, bonuses or expense accounts. Child means: 1. Any Child born of the Employee, and 2. Any legally adopted Child of the Employee from the time of placement in the Employee s home with the intent to adopt, and 3. Any stepchild who lives with the Employee, and 4. Any Child for whom the Employee has legal guardianship. Company means United Actuarial Services, Inc. Covered Monthly Earnings means the amount of earnings that is insured by the policy. This will be the lesser of: a) the Basic Monthly Earnings or b) the Maximum Monthly Benefit divided by the benefit percentage show in the Schedule of Benefits. Disability and Disabled mean either Total Disability and Totally Disabled or Partial Disability and Partially Disabled. UAS

4 DEFINITIONS (continued) Eligible Survivor means the Employee's legal spouse or unmarried Child under the age of 23 if the Child: 1. Is dependent upon the Employee for principal financial support or is claimed as a dependent on the Employee s federal income tax return, or 2. Is registered in and attending an accredited educational institution on a full-time basis as defined in the regulation of the institution. Elimination Period means a period of 180 continuous days of Total Disability, Partial Disability, or a combination of both for which no benefit is payable. For purposes of satisfying the Elimination Period, the cessation of Disability for not more than 30 days will be treated as continuous Disability. Employee means a person whose employment with the Company constitutes his or her principal occupation and who regularly works at that occupation 30 or more hours per week. Employee does not include a person who is temporarily or seasonally employed by the Company. Employer s Retirement Plan means a plan that provides retirement benefits to Employees and is not funded wholly by Employee contributions. Family Social Security Benefits means benefits that the Employee and/or the Employee s spouse or child(ren) are entitled to receive as a result of the Employee s eligibility for disability insurance benefits or old age insurance benefits under Social Security. Gross Monthly Benefit means the Employee's monthly benefit amount prior to any reduction for Other Income Benefits and earnings. Indexed Pre-Disability Earnings means the Employee s Pre-Disability Earnings increased by the Consumer Price Index. The increase will be effective on July 1 following the first 12 consecutive months of receiving Disability benefits and on each subsequent July 1. Injury means bodily injury resulting directly from an accident and independently of all other causes. Loss with regard to: a) hand and foot means complete severance through or above the wrist or ankle joint, b) sight means total and irrevocable loss of sight, and c) thumb and index finger means complete severance at or above the knuckles joining each to the hand. Maximum Monthly Benefit means the maximum benefit payable to an Employee on a monthly basis as shown in the Schedule of Benefits. Mental Illness means any condition classified as a mental disorder in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, as published from time to time, excluding mental retardation. Monthly Benefit means the Gross Monthly Benefit reduced by Other Income Benefits. Other Income Benefits means any: a) amount payable under a Worker s or Workmen s Compensation Law, Occupational Disease Law or other similar act or law, b) disability benefits payable under a Compulsory Benefit Act or Law, c) disability benefits payable under another Company provided group insurance plan, d) disability benefits payable under the Employer s Retirement Plan that do not reduce the amount of money that the plan would have paid as retirement benefits at the normal retirement age and e) lump sum or periodic retirement benefits under the Employer s Retirement Plan that do not represent contributions by the Employee and are payable on early or normal retirement or for disability, if such payment does not reduce the benefit that would have been paid at the normal retirement age if the disability had not occurred, f) disability or retirement benefits payable under the United States Social Security Act based on Family Social Security Benefits, g) disability or retirement benefits under the Railroad Retirement Act or other similar act or law provided in any jurisdiction, h) Salary continuance, sick pay or other Covered Monthly Earnings received from the Company after the Elimination Period has been completed and i) earnings the Employee receives from any other occupation or employment TIC/A/UAS

5 DEFINITIONS (continued) while the Employee is Disabled and receiving a Monthly Benefit under the policy (this does not include earnings of the spouse or child, if any). Partial Disability and Partially Disabled mean that because of Injury or Sickness the Employee, while unable to perform every material and substantial duty of his or her regular occupation on a full-time basis, is performing at least one (1) of the material and substantial duties of his or her regular occupation or another occupation on a part-time or full-time basis, and earning less than 80% of his or her Indexed Pre-Disability Earnings due to the same Injury or Sickness. Physician means a qualified, licensed doctor of medicine or osteopathy and any other licensed health care provider that state law requires to be recognized as a Physician who is practicing within the scope of his or her license. This does not include the Employee, or the Employee s spouse, parent, son, daughter, brother or sister. Pre-Disability Earnings means the Employee s Covered Monthly Earnings in effect immediately prior to his or her date of Disability. Pre-Existing Condition means any Injury or Sickness for which the Employee received medical treatment, services, or incurred expenses during the three (3) months immediately prior to the date the Employee s insurance became effective or the date the Employee s Maximum Monthly Benefit increased by $1,000 or more. Sickness means illness, bodily disease, Mental Illness, or pregnancy. Social Security means the United States Social Security Act or any similar law, plan or act including the initial enactment and all amendments. Social Security Normal Retirement Age means the normal retirement age under the latest amendment to the Social Security Act. Total Disability and Totally Disabled mean that because of Injury or Sickness the Employee cannot perform the material and substantial duties of his or her regular occupation and, after benefits have been paid for 36 months, the material and substantial duties of any gainful occupation for which he or she is reasonably fitted by training, education or experience. If the Employee s regular occupation requires a license, loss of this license for any reason does not in itself constitute Total Disability. TIC/A/UAS

6 SCHEDULE OF BENEFITS Classification Monthly Benefit All eligible Employees... 60% of Covered Monthly Earnings not to exceed a Maximum Monthly Benefit of $5,000 then reduced by Other Income Benefits Elimination Period: 180 days. Minimum Monthly Benefit: The greater of 10% of the Gross Monthly Benefit or $100. Social Security Integration: Direct Primary Social Security Incentive: The Monthly Benefit will not be reduced by Social Security benefits for three (3) months unless the combined income from all sources, including the Monthly Benefit, exceeds 100% of Pre- Disability Earnings in which case the Monthly Benefit will be reduced by the amount in excess of Pre-Disability Earnings. Survivor Benefit: 3 months Benefit Duration: The maximum benefit duration will be the greater of the Social Security Normal Retirement Age or: Age When Disability Begins Maximum Benefit Duration Less than to age years years years years years years months months months 69 and over months TIC/A/UAS

7 HOW TO FILE A CLAIM FOR BENEFITS Written notice of Disability must be given to the Insurance Company during the Elimination Period or as soon thereafter as reasonably possible. The notice should contain sufficient information to identify the Employee. Upon receipt of written notice, the Insurance Company will provide claim forms for the Employee to complete and return. If the Employee does not receive the claim forms from the Insurance Company within 15 days, the Employee may submit a claim by sending the Insurance Company written proof of Disability showing the Employee s name and address, group policy number, date of Disability, cause of Disability and the nature and extent of Disability. The claim forms (or proof of Disability) must be signed by a Physician and sent to the Insurance Company within 90 days of the end of the Elimination Period or as soon as reasonably possible, but under no circumstances more than one (1) year after it is otherwise required. To maintain benefit payments, additional claim forms will be periodically required by the Insurance Company. These forms must be completed and returned to the Insurance Company within 30 days of the date requested by the Insurance Company. Claim forms may be obtained from the Insurance Company or the Plan Administrator. The Insurance Company may have the insured examined by a Physician, of its choice as often as necessary to determine the extent of any Disability for which claim has been made. PAYMENT OF CLAIMS Upon submission of proof of Disability acceptable to the Insurance Company, benefits will be paid monthly in accordance with the Schedule of Benefits. All benefits, other than survivor benefits, are payable to the Employee. If a benefit becomes payable to the Employee's estate and no estate has been established, the Insurance Company may pay up to $1,000 to any of the Employee s relatives whom it considers to be entitled to such benefits. If a benefit is payable to a minor or a person who is not competent, the Insurance Company may pay the benefit to the person s guardian. Once the Insurance Company pays benefits to a person it considers entitled to such benefits, the Insurance Company has no obligation to pay benefits again. REHABILITATION An Employee receiving benefits may choose to join a vocational rehabilitation program to enable a return to work. Subject to the Insurance Company s prior approval, such participation will not, by itself, be deemed recovery from Disability. By mutual agreement, the Insurance Company may help pay the expenses for the program. There is no penalty for refusal to participate in a vocational rehabilitation program. ELIGIBILITY Employees will become eligible for LTD insurance on the date next following completion of 30 days of Active Work. Enrollment: To become insured, an eligible Employee must give the Plan Administrator a written request for coverage on a form satisfactory to the Insurance Company within 31 days from the Employee s eligibility date. A form may be obtained by contacting the Plan Administrator. Effective Date of Insurance: Insurance will be effective for Employees who are Actively At Work on the eligibility date. If an Employee is not Actively At Work on the date insurance would otherwise be effective, the effective date will be the date of return to Active Work. Termination of Insurance: LTD insurance will terminate on the earliest of the following: 1. The date the policy terminates, or 2. The date the insured is no longer eligible for insurance, or TIC/A/UAS

8 ELIGIBILITY (continued) 3. The date for which a required contribution is not paid, or 4. The date the insured enters active military service for any country except for temporary duty of 30 days or less, or 5. The date employment terminates. Cessation of Active Work will be deemed termination of employment except that insurance will be continued during a Disability Elimination Period, any period that premiums are being waived by the Insurance Company, an approved leave of absence under the Family and Medical Leave Act, any employer-approved leave of 180 days or less or any temporary lay-off of 90 days or less. LONG TERM DISABILITY BENEFIT On receipt of satisfactory proof that an insured Employee is Disabled due to Injury or Sickness that requires the regular attendance of a Physician, the Insurance Company will pay the Employee the Monthly Benefit shown in the Schedule of Benefits. Benefits will start after the Elimination Period ends and will continue, subject to acceptable proof of continued Disability and regular attendance of a Physician, up to the maximum benefit period shown in the Schedule of Benefits. Monthly Benefit: The Monthly Benefit will equal the lesser of: 1. 60% of the Employee's Basic Monthly Earnings less Other Income Benefits or 2. The Maximum Monthly Benefit shown in the Schedule of Benefits. The Monthly Benefit will never be less than the greater of $100 or 10% of the Gross Monthly Benefit. Partial Disability: A Return to Work Benefit will apply during the first 12 month period for which a Monthly Benefit is payable for Partial Disability. During this period, the Monthly Benefit will not be reduced by earnings unless such earnings combined with income from all other sources, including the Monthly Benefit, exceeds 100% of Pre-Disability Earnings. The Monthly Benefit will be reduced by any amount in excess of 100% of the Pre- Disability Earnings. After the Return to Work Benefit period is completed, the Monthly Benefit for Partial Disability will equal A x B x 70%, where: A = Basic Monthly Earnings less the income from earnings and Other Income Benefits received while Partially Disabled, and B = Covered Monthly Earnings divided by Basic Monthly Earnings. Benefits under the Return to Work and Partial Disability provisions will never exceed the Maximum Monthly Benefit nor be less than the Minimum Monthly Benefit shown in the Schedule of Benefits. Application for Other Income Benefits: An Employee claiming LTD benefits must apply for Other Income Benefits for which the Employee or a family member becomes eligible and appeal any denial that appears unreasonable. Recurrent Disability: If Disability reoccurs within six (6) months after the end of a related Disability for which a Monthly Benefit was paid, a new Elimination Period will not be applied and the Monthly Benefit will be based on Covered Monthly Earnings prior to the related Disability. Any Disability that occurs six (6) months or more after a prior Disability will be considered a new Disability and will be subject to the Elimination Period. Benefits payable under this provision will stop if the Employee becomes eligible for benefits under any other group long-term disability policy. TIC/A/UAS

9 LONG-TERM DISABILITY BENEFIT (continued) Termination of Monthly Benefits: Disability benefits will cease on the earliest of: 1. The date the insured is no longer Disabled or under the regular care of a Physician, or 2. The date the insured dies, or 3. The end of the maximum benefit period, or 4. The date earnings from any occupation or employment equal or exceed 80% of Indexed Pre-Disability Earnings. 5. The date the insured fails to provide proof of Disability acceptable to the Insurance Company. 6. The date the insured refuses to allow an examination requested by the Insurance Company. 7. The date the insured, if a foreign national, leaves the United States or Canada and establishes a domicile in any other country. Monthly Benefit for Accidental Dismemberment and Loss of Sight: If an insured Employee has an accidental Injury that results in Loss within 100 days of the date of Injury, the Insurance Company will pay the Monthly Benefit as follows: For Loss of: Number of Monthly Benefit Payments Sight of Both Eyes 46 Both Hands 46 Both Feet 46 One Hand and One Foot 46 One Hand and Sight of One Eye 46 One Foot and Sight of One Eye 46 One Hand or One Foot 23 Sight of One Eye 15 Thumb and Index Finger of Either Hand 12 The maximum number of payments for all Losses suffered in any one (1) Injury will be limited to the Loss for which the greatest number of monthly payments is provided. Survivor Benefit: If an Employee who is receiving a Monthly Benefit dies, the Employee's Eligible Survivor will receive a lump sum Survivor Benefit equal to three (3) times the Employee's Gross Monthly Benefit. If there is no Eligible Survivor, no lump sum benefit will be paid. The policy does not cover any disability due to: EXCLUSIONS AND LIMITATIONS 1. War, declared or undeclared, or any act of war, or 2. Active participation in a riot, or 3. Intentionally self-inflicted injuries, or 4. Commission of an assault or a felony. TIC/A/UAS

10 EXCLUSIONS AND LIMITATIONS (continued) Pre-Existing Condition Exclusion: During the first 12 months of coverage, the policy does not cover Disability caused by, contributed to by or resulting from a Pre-Existing Condition. With regard to an increase in the Maximum Monthly Benefit of $1,000 or more, the policy does cover the increased amount for any Disability that begins during the first 12 months the increase is in effective that is caused by, is contributed to by or results from a Pre-Existing Condition. Mental Illness/Drug and Alcohol Abuse Limitation: Disabilities resulting from mental or nervous conditions or drug or alcohol abuse will be limited to 24 months of benefit payments unless the Employee is confined in a hospital-or institution at the end of the 24-month benefit period and: a) the confinement began during the Elimination Period or the 24 months next following the Elimination Period and b) the confinement is for at least 14 consecutive days. When benefits are payable beyond 24 months because of confinement, the Monthly Benefit will be paid until the Employee is discharged from the hospital or institution and, if the same Disability continues following discharge, for a recovery period not to exceed 90 days. If, due to the same Disability, the Employee is re-confined during the recovery period to a hospital or institution for at least 14 consecutive days, the Monthly Benefit will be paid during the re-confinement. If Disability continues after the Employee is discharged from such re-confinement, the Monthly Benefit will be payable for a final recovery period not to exceed 90 days. The Monthly Benefit will be paid during subsequent periods of confinement lasting 14 consecutive days or more as long as Disability is continuous subject to the maximum benefit period shown in the Schedule of Benefits. To be covered, confinement must be in a facility licensed to provide care and treatment for the disabling condition due to Mental Illness, drug or alcohol abuse. TIC/A/UAS