Plateau Casualty Insurance Company
Home Office: 2701 North Main Street, Crossville, TN 38555
Administrative Office: P.O. Box 7001, Crossville, TN 38557-7001
931-484-8411 800-752-8328
| INVOLUNTARY UNEMPLOYMENT INSURANCE CERTIFICATE SCHEDULE OF INSURANCE | |
Certificate Number: | {{certificateNumber}} |
Covered Person’s Name: | {{fullName}} |
Covered Person’s Address: | {{fullAddress}} |
| Effective Date: {{formattedEffectiveDate}} Expiration Date: Continuing until Cancelled. Monthly; subject to the terms and conditions stated herein. 12:01 a.m. local standard time at the address of the Covered Person. | |
| Group Policyholder Name: | Alliance of Well-Being Associations |
Group Policy Number: | {{groupPolicyNumber}} |
| MONTHLY BENEFIT AMOUNT | {{monthlyBenefitAmount}} |
| MAXIMUM BENEFIT AMOUNT | {{maximumBenefitAmount}} |
| MAXIMUM BENEFIT PERIOD | 1 Month |
| MONTHLY PREMIUM | Non-Contributory |
| BENEFIT OPTIONS | BENEFIT OPTIONS DAYS / MONTHS |
| Vesting Period | 90 Days |
| Re-Eligibility Period | 11 Months |
| Elimination Period | 30 Days (retro-active) |
| Non-Contributory Period | Continuing until cancelled |
CERTIFICATE CANCELABLE BY THE COMPANY RENEWABLE AT THE OPTION OF THE COMPANY
RIGHT TO EXAMINE
If You, the Covered Person, are not satisfied with this insurance after You receive it, You may cancel this Certificate of Insurance (hereinafter referred to as “Certificate”).
To cancel this Certificate, contact Us at Our Administrative Office at 1-800-752-8328 between 9:00 a.m. and 6:00 p.m. Eastern Time, Monday through Friday or by mail at P.O. Box 7001, Crossville, TN 38557-7001.
Coverage is available to eligible persons of the Group Policyholder.
Benefit amounts shown above are payable directly to You. We have no contractual obligation to make payments to other payees on Your behalf. You will not be eligible for benefits until the Vesting Period and Elimination Period has been satisfied, if any.
CERTIFICATE OF INSURANCE
This Certificate of Insurance, together with the Application for Insurance, the Certificate Schedule of Insurance, any insurance coverage riders, and any endorsements make up the entire contract of insurance. YOU SHOULD CAREFULLY READ THE ENTIRE CONTRACT FOR ADDITIONAL TERMS AND CONDITIONS THAT MAY PREVENT YOU FROM RECEIVING BENEFITS.
Your coverage and the Effective Date Your coverage begins are shown in the Schedule.
Plateau Casualty Insurance Company (herein called “We,” “Us,” or “Our”) has issued the Policy
to the Group Policyholder shown in the Schedule.
This Certificate is subject to the terms of the Policy and is made part of the contract between the Group Policyholder and Us. Involuntary Unemployment insurance and any insurance coverage riders are made available by Us to eligible persons in the Group Policyholder’s group.
We agree to pay the benefits described subject to all terms and conditions of this Certificate. Any conflict between the terms and conditions provided in this Certificate and the Policy shall be decided in favor of the Policy.
You may qualify for only one (1) Involuntary Unemployment Certificate under the Policy with Us. If We discover You are insured under more than one (1) Certificate, We will provide written notification of the duplication to You. You must contact Us at Our Administrative Office by mail or by phone to provide Us with the Certificate You request Us to cancel and We will refund any premiums paid for the coverage it provided.
The records maintained by Us and by the Group Policyholder shall determine the insurance provided under the Policy for any Covered Person.
GROUP INVOLUNTARY UNEMPLOYMENT INSURANCE CERTIFICATE OF INSURANCE
CONTENTS
| DEFINITIONS | Page 3-4 |
| ELIGIBILITY | Page 4 |
| BENEFITS | Page 4-5 |
| EXCLUSIONS | Page 5 |
| RENEWAL CONDITION | Page 5 |
| INDIVIDUAL TERMINATION OF INSURANCE | Page 5-6 |
| PREMIUMS | Page 6 |
| CLAIM PROVISIONS | Page 6 |
| GENERAL PROVISIONS | Page 7 |
DEFINITIONS
When used in this Certificate, the following words and phrases have the meaning given.
ADMINISTRATIVE OFFICE means P.O. Box 7001, Crossville, TN 38557-7001,
1-800-752-8328.
BENEFIT PERIOD means the period of consecutive days of Loss for which a benefit is payable.
The Benefit Period will begin on the first day of the Loss after the Elimination Period has been satisfied and will end on the first of the following:
(1) the date You are no longer incurring the Loss; or
(2) when the Maximum Benefit Period shown in the Schedule has been reached. The same continuous Loss is eligible for only one (1) Benefit Period.
COVERED PERSON means the Covered Person named in the Schedule.
EFFECTIVE DATE means the date coverage becomes effective as shown in the Schedule.
EMPLOYMENT means working at least thirty (30) hours per week for salary or wages during the ninety (90) day period immediately preceding the date of Loss.
GROUP POLICYHOLDER means the legal entity named in the Policy Schedule of Insurance and for whom the
Policy has been issued.
INVOLUNTARY UNEMPLOYMENT means the total and continuous Loss of Your non-seasonal, full-time
Employment resulting from one or more of the following:
(1) an individual layoff not due to willful or criminal misconduct: means an ending of employment at the will of the employer;
(2) a mass layoff: means an ending of employment at the will of the employer;
(3) a general strike: means a strike against all the employers in an industry or a territory; a simultaneous cessation or quitting of work by a body of workers acting in combination for the purpose of obtaining for themselves more desirable terms of employment;
(4) a unionized labor dispute: means a trade or labor union, through the coalition of its members, has authorized a strike to obtain higher wages, shorter hours of employment, better working conditions, or some other concession from the employer by the employees stopping work at a predetermined time,
and it involves a combination of persons and not a single individual;
(5) a lockout: means an employer’s discharge of his employees, because of a labor dispute or because of his dislike of his employees’ activities as a union; the temporary closing of the place of employment by the employer without formally discharging the employees, the object being to discourage union activities or to gain acceptance of his views or compromise, which is more favorable to him than the demands made by his employees; or
(6) an involuntary termination of Employment not due to willful or criminal misconduct: means a
transgression of some established and definite rule of action, a forbidden act, a dereliction of duty,
willful in character, improper, or wrong behavior but not negligence or carelessness and unlawful behavior as determined by local, state, or federal law.
LOSS means an event of Involuntary Unemployment. For additional insurance coverage riders, loss is defined as provided by those riders.
MAXIMUM BENEFIT AMOUNT means the benefit amount shown in Your Schedule. In the event of a Loss, the Maximum Benefit Amount is payable to You. Benefit payments are subject to all terms and conditions of this Certificate.
NON-CONTRIBUTORY PERIOD means a period of consecutive days/months after the Effective Date of coverage as shown in the Declarations of the Policy and the Covered Person’s Certificate Schedule of Insurance during which the Group Policyholder provides coverage to the Covered Person at no charge. The Group Policyholder is responsible for the premium during this period. Once the Non-Contributory Period ends, the Covered Person’s Certificate of Insurance is terminated.
POLICY means the contract issued to the Group Policyholder providing the coverages described.
RE-ELIGIBILITY PERIOD means a specified time period as shown in the Schedule following the end of a
Benefit Period.
If a claim for Involuntary Unemployment occurs within this specified Re-Eligibility Period during which You have returned to active full-time employment, the benefit is subject to the remaining benefits of the previous period of unemployment and will be considered a continuation of the previous claim. A new Elimination Period will not apply.
If a claim for Involuntary Unemployment occurs after the specified Re-Eligibility Period during which You have returned to active employment for ninety (90) consecutive days at least thirty (30) hours per week for salary or wages, the Loss will be considered a new claim and a new Elimination Period will apply.
SEASONAL EMPLOYMENT means Employment that can only be carried on during certain seasons or during definite times of the year and where the customary period of Employment is less than 1,000 hours during a consecutive twelve (12) month period.
VESTING PERIOD, if any, means a period of consecutive time following the Effective Date of coverage shown in Your Schedule during which You are ineligible to file a claim or to receive benefits even if a Loss occurs. The Vesting Period for each coverage is shown in Your Schedule.
ELIMINATION PERIOD means a period of consecutive time after a date of Loss during which no benefit is payable. The Elimination Period will not begin until the Vesting Period has been satisfied and You are eligible for benefits. The Elimination Period for each coverage is shown in Your Schedule.
WE, US and OUR means the insurer, Plateau Casualty Insurance Company.
YOU, YOUR and YOURS means the Covered Person.
ELIGIBILITY
Individuals who are part of the Group Policyholder’s group are eligible to apply for coverage.
Self-employed individuals and independent contractors may be eligible for Involuntary Unemployment Insurance coverage provided they meet all other eligibility requirements including qualifying for and receiving state unemployment benefits.
BENEFITS
Benefits are subject to all terms and conditions described in this Certificate.
INVOLUNTARY UNEMPLOYMENT BENEFIT. Upon Our receipt of satisfactory written proof of Loss from You, and after any Vesting Period and Elimination Period has been satisfied, We will pay benefits according to the terms and conditions of this Certificate and the coverage selected. If, after satisfaction of the Elimination Period, the period of Involuntary Unemployment is less than a full month, We will pay 1/30th of
the monthly benefit for each day of that period.
You:
(1) are required to provide Us written proof of Loss of Your continuing Involuntary Unemployment on a monthly basis or at any time upon Our request.
(2) must register with Your state unemployment office for unemployment benefits, must be receiving those benefits and must continue to actively seek Employment through Your state employment office or a recognized employment agency beginning no later than thirty (30) days after loss of Employment.
(3) must remain actively registered with Your state unemployment office to remain eligible for benefits under this Certificate.
Benefit payments will cease when You are no longer Involuntarily unemployed or when benefits reach the maximum limits shown in the Schedule, whichever occurs first.
Any change to Your Employment status including, but not limited to, retirement, may result in ineligibility for Involuntary Unemployment coverage under this Certificate. If You become ineligible as a result of a change in Employment status, You should contact Us at Our Administrative Office.
EXCLUSIONS
No benefit shall be paid if You are currently receiving benefits for any other Loss under this Certificate, or if the Loss was caused by, resulted from, or was contributed to by:
(1) voluntary forfeiture of Employment salary, wages, or other Employment income; (2) resignation of Employment;
(3) retirement from Employment;
(4) termination of Employment due to willful or criminal misconduct; (5) Scheduled termination of Employment contract;
(6) termination of Seasonal Employment;
(7) a reduction in number of hours worked not resulting in total elimination of Employment income;
(8) having received notice, either orally or in writing, of pending unemployment within ninety (90) days prior to enrollment date;
(9) the failure of self-employed individuals and independent contractors to meet all eligibility requirements including qualifying for and receiving state unemployment benefits; or
(10) a Loss of Employment commencing before satisfaction of the Vesting Period.
RENEWAL CONDITION
You may renew this Certificate, subject to the Individual Termination of Insurance and Premiums section. If We elect not to renew this Certificate, We will provide advance written notice of nonrenewal to the Covered Person at the last mailing address known to Us at least sixty (60) days prior to the effective date of nonrenewal. The notice will state the reason(s) for nonrenewal; proof of mailing will be sufficient proof of notice.
We do not have the right to refuse a premium paid on or before the date due or within the Grace Period. Your
coverage will expire if the premium is not paid by the last day of the Grace Period.
You may cancel this Certificate at any time by providing written notice to Us at Our Administrative Office. Coverage will remain in force until the premium due date immediately following the date of Your cancellation.
INDIVIDUAL TERMINATION OF INSURANCE
This Certificate may be terminated by You by providing Us at Our Administrative Office advance written notice of termination.
Coverage under this Certificate automatically ends on the premium due date immediately following: (1) the date this Certificate is terminated by You;
(2) the date You or the Group Policyholder’s fail to pay the required premium by the date due, except as
provided for in the grace period;
(3) the date You cease to participate in the Group Policyholder’s plan of insurance;
(4) discovery of fraud or material misrepresentation by You in the procurement of the insurance or with
respect to any claims submitted hereunder; or
(5) the date of Your death.
If We terminate this Certificate or the Policy. We will provide advance written notice of termination to You at least sixty (60) days prior to the date coverage will end. The notice will state the reason(s) for the proposed
action and the effective date of termination; coverage will end on that date. Proof of mailing will be sufficient proof of notice.
Upon termination of coverage, premiums paid monthly have been fully earned and are non-refundable; coverage will continue until the next monthly premium due date. Termination of this Certificate will not prejudice any claim originating prior its termination subject to all other terms and conditions contained herein.
PREMIUMS
PAYMENT OF PREMIUM. All premiums shall be paid to Us on or prior to the due date as stated in the
Schedule. You are required to pay the premium shown in the Schedule to keep Your coverage in force.
PREMIUM CHANGES. We have the right to change the premium rates under this Certificate by giving You and the Group Policyholder at least thirty (30) days’ advance written notice. Premium rates may also change at any time the Group Policyholder makes a coverage change request that We agree to accept.
GRACE PERIOD. If premium is not paid by the due date, the insurance shall be in default. After the first premium has been paid, We will allow a thirty (30) day Grace Period for future payments as allowed by the insurance laws in the state where coverage is issued. Coverage under this Certificate will terminate if the premium is not paid by the end of the Grace Period.
CLAIM PROVISIONS
TO REPORT A CLAIM AND TO OBTAIN A CLAIM FORM. Contact Our Administrative Office at
1-800-752-8328, between 9:00 a.m. and 6:00 p.m. Eastern Time, Monday through Friday or mail Your request to Our Administrative Office. We will mail forms for filing proof of Loss to You within ten (10) business days. If these forms are not delivered to You within ten (10) days, You may meet the Proof of Loss requirements by providing Us a written statement of the nature and extent of the Loss as stated in the Proof of Loss provision.
NOTICE OF CLAIM. Written Notice of Claim must be provided to Us within thirty (30) days after the date of Loss or as soon thereafter as is reasonably possible. Failure to give such notice within the time frame specified will not invalidate or reduce the claim unless this failure operates to prejudice Our rights. The Notice of Claim should include the Covered Person’s name, the Certificate Number, the Group Policyholder’s name, the Effective Date of coverage, and should be mailed to Our Administrative Office.
All proof of Loss forms must be completed by the Covered Person and such other persons or officials as may be required. A claim will be activated when all proof of Loss forms have been properly completed by all required parties and are received by Our Administrative Office.
PROOF OF LOSS. In the case of involuntary termination or layoff, satisfactory written evidence that You are receiving state unemployment benefits and have registered for work with Your state employment office or a recognized employment agency within thirty (30) days after Loss of Employment is required. Furthermore, written evidence that You remain registered and are actively seeking new Employment while benefits are being paid is also required.
In the case of a strike or lockout, satisfactory written evidence of Involuntary Unemployment, which may include a statement signed by a union officer, is required.
You must provide satisfactory written evidence of continuing Involuntary Unemployment on a monthly basis or any time upon Our request.
We may require the Covered Person to provide additional documents in order to satisfy proof of Loss and to determine Our liability. Additional documents must be provided no later than one (1) year from the time proof is otherwise required. .
PAYMENT OF CLAIMS. Upon Our receipt of satisfactory written proof of Loss and determination of Our
liability, benefits payable under the terms and conditions of this Certificate will be paid within thirty (30) days. All benefits are paid directly to You. If You become deceased, benefits will be payable to Your estate.
GENERAL PROVISIONS
CONFORMITY TO LAW. Any provision of this Certificate, which, on its Effective Date, is in conflict with the insurance laws of the state in which You reside, shall be amended to conform to the laws of that state.
ENTIRE CONTRACT. This Certificate of Insurance, together with the Application for Insurance, the Certificate Schedule of Insurance, any insurance coverage riders, and any endorsements make up the entire contract of insurance. This Certificate of Insurance may be revised only by written agreement between the You, the Group Policyholder, and Us.
Only Our authorized officer(s) have authority to waive or otherwise revise any provision of this Certificate or Our rights hereunder. Any action, statement, or agreement made in writing by any person(s) other than Our authorized officer(s), shall in no way bind or estop Us from enforcing the provisions of this Certificate or Our rights hereunder. A written agreement which modifies, extends, or is in conflict with this Certificate shall be invalid unless such written agreement is signed by Our authorized officer(s) and is made part of this Certificate. An agent or broker cannot change or waive provisions within the entire contract.
MATERIAL MISREPRESENTATION, FRAUD, OUR RIGHT TO RESCIND. If You have concealed or misrepresented any material fact in the application for insurance or in the submission of any claim, or if You have attempted fraud, or false swearing and coverage was issued or benefits were paid in reliance upon those statements, We may deny the claim and, if applicable, rescind coverage. Our liability will be limited to the return of premiums paid, less any benefits paid.
INCONTESTABILITY. After two (2) years from the Effective Date of this Certificate, no misstatements, except fraudulent misstatements made by You, in the application for this Certificate shall be used to void the Certificate or deny a claim for Loss incurred commencing after the expiration of such two (2) year period. After this Certificate has been in force for a period of two (2) years during Your lifetime, it shall become incontestable as to the statements contained in the application.
RIGHT OF RECOVERY. If payments for claims exceed the maximum amount payable under the terms and conditions of Involuntary Unemployment Insurance coverage or insurance coverage riders under this Certificate, We have the right to recover the excess of such payments within eighteen (18) months from the date the claim was paid.
LEGAL ACTIONS. No action can be brought to recover under this Certificate until at least sixty (60) days after We have received satisfactory written proof of Loss. No such action shall be brought more than ten (10) years after the date We receive satisfactory proof of Loss.
INCOME TAXATION. Benefits paid do not include provisions for any income tax that may be owed by You or Your estate. You should consult Your own tax advisor regarding any tax consequences of benefits received under this Certificate.
Authorized Officer
Authorized Officer