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     Home → Welfare→ SPD → 14.1 EXTENDED BENEFITS FOR TOTAL DISABILITY


14.1 EXTENDED BENEFITS FOR TOTAL DISABILITY

If a Participant is Totally Disabled and under the care of a Physician at the time coverage ends due to loss of eligibility, limited health care benefits will be extended for Covered Expenses incurred by that Participant. Health care coverage will be extended for treatment of the disabling condition subject to the same terms that would have applied to the condition if the Participant had not been disabled. NOTE: This disability provision does not apply to Retired Participants or their Dependents.

For the purposes of these extended benefits, “Total Disability” or “Totally Disabled” means that as a result of an Injury or Illness, a Participant is absent from work and unable to engage in the duties of his/her customary occupation, and is performing no work of any kind for wage or profit. If the Participant has no occupation, “Total Disability” or “Totally Disabled” means that the Participant is unable to engage in the normal activities of a person of similar age and gender in good health.

Extended Benefits for Total Disability are available only for the disabled Participant, for Covered Expenses incurred:

  • for treatment of the specific Illness or Injury that caused Total Disability;
  • while the Participant remains Totally Disabled;
  • for a period not to exceed 29 months from the date that the Participant’s disability began.
Extended Benefits for Total Disability are provided until the first of the following occurs:
  • the disabled Participant becomes eligible for coverage under another health care plan;
  • the date the disabled Participant becomes eligible for Medicare;
  • 29 months from the date that the Participant’s disability began; or
  • This Extended Benefit runs concurrently with COBRA coverage.


 

 
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