On the following pages, you will find an overview of the Unum Individual Short Term Disability Insurance product and plan design.

Transcription

1 Voluntary Individual Short Term Disability Insurance PRODUCT OVERVIEW FOR VOLUNTARY BENEFITS This customized overview has been prepared for: SAIF Corporation Overview presented by: The Partners Group On the following pages, you will find an overview of the Unum Individual Short Term Disability Insurance product and plan design. Note that we have also included an overview of standard underwriting limits based on predefined enrollment methods. This overview is similar to what you might expect to receive as a result of a formal underwriting offer. Unum would be pleased to provide a formal underwriting offer upon receipt of a Request for Case Approval that includes benefit communication, enrollment strategy and an overview of the payroll deduction/billing and collection arrangement of the corporate prospect. This document does not constitute an offer or an acceptance of risk by Unum

2 Unum s Voluntary Individual Short Term Disability Income Protection Insurance (ISTD) is designed to help replace a portion of the employee s income while encouraging timely return to work, and promote employee sharing of the employer s benefit costs. The chart below outlines how likely a disability can be for individuals. Plan Features Non-occupational plan provides monthly benefits for disabilities due to a covered sickness or off-job accidents. Pays benefits for disabilities resulting from a covered accidents or covered sicknesses. Voluntary, individual coverage for eligible employees only. Minimum monthly benefit of $400 and maximum monthly benefit of up to 60% of gross monthly salary, not to exceed $5,000 (subject to salary requirements). 1 Premiums are based on the insured s age at policy issue, in bands of and (64 in CA) and will not increase as the insured moves into a new age band (rates may only change on a class basis). A variety of elimination and benefit period combinations are available. Coverage is guaranteed renewable to age 72. A Waiver of Premium provision is automatically included in the policy at no additional premium. Expanded geographical boundaries providing coverage when the insured is traveling outside the United Sates. Premiums are paid through payroll deduction. The employee can continue coverage at the same face amount and premium if he/she retires or leaves the company. 1 The available monthly benefit amount may be reduced by existing group account and individual plans owned by the employee. Offset or reduction of monthly benefit must be taken based on inforce individual or group coverage. State Cash Sickness plans must be offset from the monthly benefit election on all plans. In CA, HI, NJ and RI, coverage is limited to 40%.

3 Elimination & Benefit Periods Benefit Period Elimination Periods (accident/sickness) 3 Months* 0/7, 7/7, 0/14, 14/14 days 6 Months 0/7, 7/7, 0/14, 14/14, 0/30, 30/30 days 12 Months 0/7, 7/7, 0/14, 14/14, 0/30, 30/30, 60/60, 90/90 days 24 Months 0/7, 7/7, 0/14, 14/14, 0/30, 30/30, 60/60, 90/90, 180/180 days 60 Months 14/14, 30/30, 60/60, 90/90, 180/180 days *Three-month benefit period is not available in NJ. Three and 60 month benefit periods are not available in VT. Policy Features and Riders Waiver of Premium Provision Waives premiums while disability benefits are paid to the insured as a result of a covered accident or sickness. Automatically included in the base policy at no additional premium. Payment of premiums will be waived after 90 days of total disability (or after the elimination period if longer than 90 days). Premiums are waived as long as the disability continues as defined in the policy, up to the maximum benefit period. Mental Illness Rider Once chosen by the employer, the insured must select this benefit. This rider provides a disability benefit due to mental illness equal to 50% of the policy benefit amount, up to a maximum benefit period of 24 months. There is an additional premium applied for this rider. Due to Vermont regulations, all Vermont policies will automatically receive this rider. Coverage will be provided at 100% of the base benefit amount and Vermont rates will reflect the inclusion of this benefit. The maximum benefit period is 24 months. Policy Terms & Provisions Rates Unisex, unitobacco Age last birthday Rate Classes - AAA, AA, A, B - See the Industry Rate Classification Manual for specific rate class assignment. - One rate class assigned per account based on Industry. Eligibility Full time employees, working at least 20 hours per week. Must be actively at work at the time of application 2. 2 Being actively at work means that on the day the employee applies for coverage, he/she is working at one of your company s business locations, or is working at a location where he/she is required to represent your company. If the employee is applying for coverage on a day that is not one of their scheduled workdays, then the employee will be considered actively at work if he/she meets this definition as of their last scheduled workday. Employees are not considered actively at work if their normal duties are limited or altered due to health, or if they are on a leave of absence.

4 Employee issue ages (64 in CA). The length of time an employee must be employed to be eligible for coverage will be defined at time of case approval, based on the turnover ratio. Coverage Effective Date Coverage is effective on the first day of the month in which payroll deductions begin. The employee will receive the plan and coverage amount applied for on the application, unless it is determined to be unacceptable under Unum s rules, limits or standards. In such event, the plan and coverage amount may be modified or declined. Definition of Total Disability During the first two years of disability you are unable to perform the duties of your occupation, not engaged in any occupation and under the care of a physician. After the second year of disability, if applicable, you are unable to perform the duties of any occupation for which you are fitted by education, training or experience, not engaged in any occupation and under the care of a physician. Maternity Claims Pregnancy is considered as any other covered sickness nine months after coverage becomes effective. The available monthly benefits will be paid upon fulfillment of the elimination period. Benefits will not be paid if you give birth within nine months after coverage becomes effective. However, medical complications of pregnancy may be considered as any other covered sickness subject to the pre-existing condition provision described below. Employer verification for maternity claims is required and a standard claim form will be accepted to process the claim. Pre-Existing Conditions Benefits for a pre-existing condition (defined as a sickness or physical condition for which within 12 months before the coverage effective date symptoms existed that would cause a person to seek treatment or; the insured was treated, received medical advice from a Physician or had taken medicine) will not be paid during the first 12 months the policy is in force.

5 State Exceptions State Exception California, Hawaii, New Jersey and Limited to 40% of income Rhode Island California, Michigan, New Hampshire Special rates California New York Kansas, Montana and Oklahoma Idaho and Nevada New Jersey and Vermont Vermont Residents of CA will always receive a CA policy regardless of enrollment state. Issue ages See ISTD-NY Product Overview No nine-month giving birth exclusion; Maternity claims covered as any other sickness subject to pre-existing condition provision 6/12 pre-existing condition period NJ: No three month benefit period VT: No three month or 60 month benefit period To comply with Vermont regulations, all Vermont policies will automatically include the Mental Illness Rider which will provide coverage for 100% of the base benefit amount. Vermont rates will reflect the inclusion of the required Mental Illness benefit. Enrollment Guidelines Pre-Tax Capability Unum does not support the sale of its Voluntary Benefits on a pre-tax basis. Minimum Case Size to Establish Case: Simply Unum: eligible lives require 2 approved adult lives per VB product eligible lives require 5 approved adult lives per VB product. To offer this product in Simply Unum, please refer to the Simply Unum Product Proposal for additional details. Classic Business: A minimum of 10 adult applications at the employer level must be submitted in order to establish the billing for the account. Individual Underwriting Coverage is available on either Modified Issue or Simplified Issue. May be available on a Guaranteed Issue basis for employees, subject to: Formal Case Underwriting approval Minimum of 70% of the eligible employee base must be seen on a face-toface basis to be considered for a Guaranteed Issue offer Participation of 20% of the total eligible employee population Enrollment Methodologies Face-to-Face Enrollment - Assumes a benefit counselor is conducting the benefit communication and enrollment process at the worksite in a face-to-face meeting with eligible employees

6 - Minimum of 70% of the eligible employee base must be seen on a face-toface basis to be considered for a Guaranteed Issue offer Non Face-to-Face Enrollment - Benefit communication and enrollment processes including, but not limited to: 1) call center; 2) web: 3) self-enrolled kit Underwriting Guidelines Underwriting Levels Level of Underwriting Face-to-Face Enrollment Non-Face-to-Face Enrollment Guaranteed Issue Available Not available* Modified Issue Required until minimum Required* participation level for GI is achieved Simplified Issue Available and required for Available and required for levels of coverage above GI levels of coverage above MI Guaranteed Issue (GI) / Modified Issue (MI) - Must meet the actively at work definition - MI requires completion of three basic health questions - GI available if a minimum of 20% participation of the total eligible employee population is achieved Simplified Issue (SI) - Must meet the actively at work definition - Five additional basic health questions *Enrollment will be conducted on an MI basis. However, if 20% participation of the total eligible employee population is achieved, GI will be available on a retroactive basis. Underwriting Limits Guaranteed Issue*/ Modified Issue Simplified Issue Non- Up to 60% of monthly salary, not Up to 60% of monthly salary, not to Occupational to exceed $3,000 exceed $5,000 Select 24-Hour** Up to 60% of monthly salary, not Up to 60% of monthly salary, not to to exceed $3,000 exceed $5,000 Up to 40% of monthly salary, not Up to 60% of monthly salary, not to to exceed $5,000 exceed $5,000 Underwriting Limits for CA, HI, NJ and RI Guaranteed Issue*/Modified Issue Non- Occupational Up to 40% of salary, not to exceed $5,000

7 *Subject to minimum participation requirements 20% Employee participation must be achieved **24 Hour Plan is not available with Worker s Compensation plans Offsets Case Level offsets - Advanced Underwriting will consider any group STD coverage as an offset to the proposed STD coverage. The offset amount(s) may be a percentage of the employee s salary or a flat dollar amount. No offsets will be applied at the time of claim. Individual offsets - All in force disability coverage with Unum will be offset against the STD coverage applied for. - No offsets will apply to benefit amounts up to the GI/MI limits (as listed above). State Cash Sickness - For California, Hawaii, New Jersey and Rhode Island, the maximum percentage of salary coverage allowed will be limited to 40% not to exceed $5,000 for the plans with elimination periods of less than six months. Pre-Existing Condition Waiver Rider The rider is only available for accounts with 100+ eligible lives with case underwriting approval. The availability of this rider is limited to employer-paid group -or- group voluntary replacements when the employee cannot continue or convert existing coverage. The rider is not available when replacing another carrier s individual voluntary coverage. Exclusions We will not pay benefits for losses that are caused by or occur as the result of: War or act of war, whether declared or undeclared; Riding in or driving any motor-driven vehicle in a race, stunt show or speed test; Operating, learning to operate, serving as a crewmember of or jumping or falling from any aircraft, including those which are not motor-driven. This does not include flying as a fare paying passenger; Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing or parakiting or any similar activities; Participating or attempting to participate in an illegal activity and/or being incarcerated in a penal institution; Committing or trying to commit suicide or injuring yourself intentionally, whether you are sane or not; Addiction to alcohol or drugs, except for drugs taken as prescribed by your Physician; Having a Pre-Existing Condition as described and limited in this policy; Practicing for or participating in any semi-professional or professional competitive athletic contest for which you receive any type of compensation or remuneration; Having a psychiatric or psychological condition including but not limited to affective disorders, neuroses, anxiety, stress and adjustment reactions.

8 However, Alzheimer s disease and other organic senile dementias are covered under this policy; Having a work-related Injury, unless an On-Job Total Disability benefit is shown on the Policy Schedule; Giving birth within the first nine months after the Coverage Effective Date as the result of a normal pregnancy, including Cesarean. Complications of a pregnancy will be covered to the same extent as any other Covered Sickness. Terminations The policy will terminate on the earliest of the following: Written request by the insured to terminate the policy; Failure to pay the premiums for the policy, subject to the grace period allowed; The policy anniversary on or following the insured s 72nd birthday; or Death of the insured. Sample Rates for Individual Short Term Disability For rate information on Individual Short Term Disability Income Protection Insurance, contact your Unum representative. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form L or contact your Unum representative. Underwritten by: Provident Life and Accident Insurance Company, 1 Fountain Sq. Chattanooga, TN unum.com 2010 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. VB-721 (8/10)