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Employee Group Benefits
SUN LIFE ASSURANCE COMPANY OF CANADA
GROUP POLICY NUMBER – 55555
POLICY EFFECTIVE DATE – January 1, 2000
93C-LH
Welcome to Sun Life Assurance Company of
Canada ("Sun Life"). Sun Life is pleased to be your Employer’s
insurance carrier for the benefits provided in the Group Policy. The description
of Eligible Classes in the Benefits Highlights will help you determine what
benefits apply to you.
The booklet is intended to provide a
summarized explanation of the current Group Policy Benefits. However, the Group
Policy is the Document which forms Sun Life’s contract to provide benefits. If
the terms of the booklet and the Group Policy differ, the Group Policy will
govern. A complete copy of the Group Policy is in the possession of your
Employer and is available for your review. In the event of any changes in
benefits or Group Policy provisions, you will be provided with a new booklet or
a supplement which describes any changes.
Possession of this booklet does not
necessarily mean you are insured under the Group Policy. The requirements for
becoming eligible for insurance and the dates your insurance begins or ceases
are explained within this booklet.
This booklet uses insurance terms and phrases
that are listed in the Definitions Section.
For information, call the Sun Life Group
Customer Service Center toll free at 1-800-247-6875.
Employee Life and Accidental Death and
Dismemberment
Insurance ……………………………………………….
4
Eligibility and Effective
Dates
Employee
………………………………………………………
6
Employee
……………………………………………………..
7
Life Insurance
………………………………………………..
9
Employee
………………………………………………..
9
Accidental Death and Dismemberment Insurance (AD&D)
16
Notice of Claim
……………………………………………….
19
Proof of Claim ………………………………………………..
19
Payment of Claims …………………………………………..
20
Change in Beneficiary ……………………………………….
21
General Provisions
………………………………………….
22
General
………………………………………………………
24
Employee Life ……………………………………………….
26
Accidental Death and Dismemberment …………………..
27
AND
DISMEMBERMENT INSURANCE
All Full-Time Union Hourly Employees of
Mountain Adventures, working a minimum of 30 hours a week
AMOUNT OF INSURANCE
ACTIVE EMPLOYEES
LIFE
AD&D
$22,000
$22,000
Your Amount of Life and Accidental Death and
Dismemberment Insurance reduces to 65% when you reach age 65 and to 50% when you
reach age 70. Your Accidental Death and Dismemberment Insurance cancels at your
retirement.
RETIRED EMPLOYEES (Life
Insurance Only)
Applicable to all Employees who have
retired from active service and who have commenced a benefit under the
Retirement Income Plan for Hourly Rated Employees.
$3,500
Your amount of Life Insurance at retirement
will reduce to 65% when you reach age 65 and to 50% when you reach 70.
BENEFIT HIGHLIGHTS
WAITING PERIOD
- 90 days
CONTRIBUTIONS
The cost of your Life and Accidental Death
and Dismemberment Insurance is paid for entirely by your Employer. This is your
non-contributory insurance.
The following Questions and Answers will help
you to better understand your benefits.
Please read them carefully and refer any
questions to your Employer or call the Sun Life Group Service Center free at
1-800-247-6875.
ELIGIBILITY AND EFFECTIVE DATE
OF EMPLOYEE INSURANCE
When am I eligible for
insurance?
If you are in an Eligible Class shown in the
Benefit Highlights, you are eligible on the later of:
·
October 1, 1999; or
·
the day after you complete your
Waiting Period.
When does my insurance
start?
Your insurance starts on the date you are
eligible, if you are Actively at Work on that date.
What if I am not Actively
at Work on that date?
If you are not Actively at Work because of
injury, sickness, layoff or leave of absence on the date your insurance would
normally start, your insurance will not start until you are Actively at Work.
When do changes in my
amount of insurance occur?
If your amount of insurance increases due to
a change in your salary or election, your increase will take effect on the first
of the following month, as long as you are Actively at Work on that date.
If your amount of insurance decreases due to
a change in your salary, election or age, the decrease will take effect on the
first of the following month.
If you are not Actively at Work because of
injury, sickness, layoff or leave of absence on the date an increase in your
insurance would normally start, the increase in your insurance will not start
until you are Actively at Work.
TERMINATION OF EMPLOYEE INSURANCE
Your insurance ceases on the earliest of:
·
the date the Group policy
terminates;
·
the date you are no longer in an
Eligible Class;
·
the date your class is no longer
included for insurance;
·
the last day any required premium
has been paid for your insurance;
·
the date you request in writing to
terminate your insurance;
·
the date you enter active duty in
any armed service during a time of war (declared or undeclared);
·
the date your employment
terminates;
·
the date you cease to be Actively
at Work.
Are there any conditions
under which my insurance can continue?
Yes.
If you are on temporary layoff, leave of
absence or vacation, your Employer may continue your insurance by paying the
required premium for the length of time specified below.
Layoff – for up to 1 month
Leave of Absence – for up to 1 month
Vacation – for up to 3 months
If you are absent from work due to an injury
or sickness, your Employer may continue your Life Insurance, by paying the
required premium, for up to 12 months.
TERMINATION OF EMPLOYEE INSURANCE
If you are "Totally Disabled" you
may be eligible for a longer continuation of Life Insurance. Refer to "What
is the Waiver of Premium Provision" in the Life Benefits Section. Please
note you need to apply for continued benefits under the Waiver of Provision
within 12 months after you cease to be Actively at Work.
If your coverage terminates and you are not
eligible for any of the described continuations, you may be eligible for a
Conversion Privilege. Refer to the "Conversion Privilege" in the Life
Benefit section. Please note that you need to apply for the conversion and pay
the required premium within 31 days following your termination of insurance.
You may be eligible to continue your
insurance pursuant to the Family and Medical Leave Act of 1993. You should
contact your Employer for more details.
You may be eligible to continue your
insurance coverage pursuant to the Uniformed Services Employment and
Reemployment Rights Act (USERRA). You should contact your Employer for more
details.
What is the Life
Insurance Benefit?
If you die while insured, your Beneficiary
will receive the amount of your Life Insurance in force when Sun Life receives
written Notice and Proof of Claim.
What is the amount of my
Life Insurance?
The amount of your Life Insurance is shown in
the Benefit Highlights.
Your amount of Life Insurance is subject to
any age reductions or terminations shown in the Benefits Highlights.
What is the Waiver of
Premium Provision?
If you become Totally Disabled while insured,
The Waiver of Premium Provision may continue your Life Insurance without any
further payment of premiums by you or your Employer.
When am I eligible for
the Waiver of Premium Provision?
You are eligible if Sun Life receives Notice
and Proof of Claim that you became Totally Disabled:
·
While insured: and
·
Before your 60th
birthday; and
·
Before you retire.
What is the amount of
Life Insurance that is continued under the Waiver of Premium Provision?
Sun Life will continue the amount of your
Life insurance in force on the last day you were Actively at Work. This amount
is subject to the same reductions or terminations that would have been
applicable had you not become Totally Disabled.
BENEFIT PROVISIONS
If you have converted your Life Insurance to
an individual policy, the continued insurance will be reduced by that converted
amount unless you exchange that individual policy for a full refund of premiums
paid.
When does my Waiver of
Premium cease?
Your Waiver of Premium ceases on the earliest
of:
·
the date you are no longer Totally
Disabled;
·
the date you do not provide Proof
that you continue to be Totally Disabled;
·
the date you do not submit to an
Examination by a physician of Sun Life’s choice;
·
the date you are no longer under
the regular and continuing care of a Physician providing appropriate treatment
by means of examination and testing in accordance with your disabling condition.
For the purposes of this Waiver of Premium
Provision, you are considered retired when you receive any compensation from a
retirement or pension plan of your Employer, or when you reach age 70, whichever
is earlier.
If your Waiver of Premium ceases and you do
not return to work with your Employer, your Life Insurance will terminate. You
may be eligible to convert your Life Insurance under the Conversion Privilege.
What is the Accelerated
Benefit?
If Sun Life receives satisfactory
Certification that you are Terminally Ill, part of your Life Insurance may be
payable to you while you are still living.
When am I eligible for an
Accelerated Benefit?
(Applicable if you were employed on or before
January 1, 1999)
You are eligible if:
·
you were Actively at Work on
January 1, 1999 and have been insured for Life Insurance for at least 60 days.
(This includes any period of time you were insured under the prior insurer’s
group life policy); and
BENEFIT PROVISIONS
EMPLOYEE LIFE INSURANCE
(Applicable if you were employed after
January 1, 1999)
You are eligible if:
·
you have been insured for Life
Insurance for at least 60 days; and
(Applicable to All Employee)
·
you are Certified as Terminally
Ill with a life expectancy of 12 months or less; and
·
you are insured for at least
$20,000 of Life Insurance.
How do I receive an
Accelerated Benefit?
You need to submit a written request to Sun
Life.
If you have assigned your Life Insurance,
named an irrevocable Beneficiary or have a former spouse named as Beneficiary as
part of a divorce decree, you must have a signed agreement from those parties.
What is the amount of
Accelerated Benefit?
You can request up to 75% of the amount of
your Life Insurance currently in force. The maximum amount you can request is
$500,000. The minimum amount you may request is $10,000.
If you have received an Accelerated Benefit
under the prior insurer’s group life policy, you can request up to 75% of your
Life Insurance currently in force reduced by the amount of the Accelerated
Benefit you have previously received.
How is the Accelerated
Benefit paid?
The Accelerated Benefit is paid in a single
lump sum amount.
BENEFIT PROVISIONS
EMPLOYEE LIFE INSURANCE
Can I receive more than
one Accelerated Benefit?
You may request the Accelerated Benefit only
once under Sun Life’s Group Policy.
Are there any charges if
I request an Accelerated Benefit?
No.
What happens to my Life
Insurance if I receive an Accelerated Benefit?
If you have received an Accelerated Benefit
from Sun Life or the prior insurer’s group life policy, your Life Insurance
will be reduced by an amount equal to the Accelerated Benefit paid by Sun Life
and an amount equal to the Accelerated Benefit paid by the prior insurer’s
group life policy.
Some Important Notes
about your Accelerated Benefit
Your Accelerated Benefit is not a long term
care policy. The amount your Accelerated Benefit would pay may not be enough to
cover nursing home expenses or other bills. You may use the money received from
the Accelerated Benefits for any purpose.
Receipt of your Accelerated Benefit may
affect your Medicaid eligibility.
No Accelerated Benefit payment will be
processed if you are required to request it by a third party, including any
creditor, government agency, trustee in bankruptcy or any other person, or as
the result of a court order.
Benefit payable under this provision MAY be
taxable. You should consult your tax advisor. Sun Life does not give tax or
legal advice.
BENEFIT PROVISIONS
EMPLOYEE LIFE INSURANCE
What is the Conversion
Privilege?
If your Life Insurance ceases, you may be
able to convert your Life Insurance to an individual policy. You need to apply
for the Conversion Privilege within 31 days. See question "How do I convert
my Life Insurance?’
When can I convert my
Life Insurance?
1.
You can convert if all or part of your Life Insurance ceases or reduces
due to:
·
termination of your employment
·
termination of your membership in
an Eligible Class;
·
your retirement;
·
your reaching a specified age; or
·
your changing to a different
Eligible Class; or
·
termination of your Waiver of
Premium continuation; or
·
your continuation period ending
during your layoff or leave of absence.
2.
You can convert if you have been continuously insured for 5 or more years
under Sun Life’s Group Policy and all or part or your Life Insurance ceases or
reduces due to:
·
termination of the Life Insurance
Benefit Provision;
·
termination of the Group Policy;
·
an amendment to the Group Policy
to reduce the amount of Life Insurance in your Eligible Class; or
·
an amendment to the Group Policy
to terminate your Eligible Class.
BENEFIT PROVISIONS
EMPLOYEE LIFE INSURANCE
What amount of Life
Insurance can I convert?
The amount of Life Insurance you can convert
depends on the reason your Life Insurance ceases.
If your amount of Life Insurance ceased or
reduced for the reasons stated in #1 "When can I convert my Life
Insurance?", you can convert up to the amount that ceased or reduced. If
your Amount of Life Insurance that ceased is $10,000 or more, the minimum amount
of your individual policy must be $ 10,000.
If your amount of Life Insurance ceased or
reduced for the reason stated in #2 "When can I convert my Life
Insurance?", you can convert up to the lesser of:
·
$2,000; or
·
the amount that ceased or reduced
less any amount of group life insurance you may become eligible for within 31
days after your Life Insurance ceased or reduced.
How do I convert my Life
Insurance?
You convert by applying to Sun Life for an
individual policy along with sending payment of the first premium within 31 days
after any part of your Life Insurance ceases or reduces. This is your 31 day
conversion period.
What type of individual
policy is available?
You can convert to any plan of whole Life
Insurance available by Sun Life for conversion. The individual policy will not
include any additional benefits or accidental death and dismemberment benefits.
You do not have to submit Evidence of
Insurability to convert to an individual policy.
When does my individual
policy start?
If your application for the individual policy
is received and the first premium is paid when due, your individual policy
starts on the day after the 31 day conversion period.
BENEFIT PROVISIONS
EMPLOYEE LIFE INSURANCE
What happens if I die
during the 31 day conversion period?
If Sun Life receives Notice and Proof of
Claim, a death benefit is payable to your Beneficiary whether or not you had
applied got an individual policy or had paid the first premium.
The death benefit is the amount of Life
Insurance you would have been eligible to convert.
What happens when my
Employer transfers Insurance Carriers to Sun Life?
In order to prevent losing your insurance,
Sun Life will provide the following coverage.
If you are not Actively at Work on January 1,
1999, you will be insured if:
1.
you were insured under the prior insurer’s group Life policy on the
date of termination of that policy; and
2.
you are a member of an Eligible Class; and
3.
premiums for you are paid to date; and
4.
you are not receiving or eligible to receive benefits under the prior
insurer’s group Life policy.
Any Life benefit payable will be lesser of:
·
the Life benefit payable under the
Group Policy; or
·
the Life benefit payable under the
prior insurer’s group life policy had it remained in force.
All other provisions of Sun Life’s Group
policy will apply.
If Sun Life receives written Notice and Proof
of Claim that:
an Accidental Death and Dismemberment benefit
may be payable to you or to your Beneficiary.
What is the amount of my
Accidental Death and Dismemberment Benefit?
Your benefit is a percentage of the amount of
Accidental Death and Dismemberment Insurance in force for your class shown in
the Benefit Highlights on the date of your loss. The following is a list of
percentages payable for your applicable loss.
Life………………………………………………………………………..100%
Sight of one eye
……………………………………………………….. 50%
One limb
………………………………………………………………... 50%
Speech and hearing
……………………………………………………100%
Speech or hearing
..…………………………………………………… 50%
Thumb and index finger
BENEFIT PROVISIONS
ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
Quadriplegia
…………………………………………………………….100%
Paraplegia
……………………………………………………………… 75%
Hemiplegia
……………………………………………………………... 50%
The maximum amount of Accidental Death and
Dismemberment Benefit payable for your losses resulting from any one accident is
100%.
Loss of Limb means severance of your hand or
foot at or above the wrist or ankle joint. Loss of your sight must be total and
irrecoverable. Loss of your speech means the total and irrecoverable loss of
speech. Loss of your hearing means the total and irrecoverable loss of hearing.
Loss of your thumb and index finger means severance through or above the
metacarpophalangeal joints.
Quadriplegia means the total and permanent
paralysis of both your upper and lower limbs. Paraplegia means the total and
permanent paralysis of both your lower limbs. Hemiplegia means the total and
permanent paralysis of your upper and lower limbs on one side of your body.
If your loss of life occurs as a result of an
automobile accident, an additional Accidental Death Benefit is payable if you
were wearing a seat belt at the time of the accident. This Seat Belt Benefit
equals $50,000, or the amount of Accidental Death Benefit payable, whichever is
less.
Sun Life must receive satisfactory written
proof that your death resulted from an automobile accident and that you were
wearing a seat belt at the time of the accident. A copy of the police report is
required.
Seat Belt means a properly installed seat
belt, lap and shoulder restraint, or other restraint approved by the National
Highway Traffic Safety Administration.
Automobile means a motor vehicle licensed for
use on public highways.
Any Accidental Death and Dismemberment
Benefit payable is subject to the Exclusions.
BENEFIT PROVISIONS
ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
What are the Exclusions?
No AD&D benefit will be payable for your
loss that is due to or results from:
What happens when my
Employer transfers Insurance Carriers to Sun Life?
In order to prevent losing your insurance,
Sun Life will provide the following coverage.
If you are not Actively at Work on January 1,
1999, you will be insured if:
Any AD&D benefit payable will be lesser
of:
All other provisions of Sun Life’s Group
policy will apply.
How is a claim submitted?
To submit a claim, you or someone on your
behalf must send Sun Life written Notice and Proof of Claim within the time
limits specified. Your Employer has the Sun Life Notice and Proof of Claim
forms.
When does written Notice
of Claim have to be submitted?
for a Death Claim
(accidental or otherwise) – written notice of claim must be given to Sun Life
no later than 30 days after date of death.
for Life Waiver of Premium
– Written notice of claim must be given to Sun Life no later than 12 months
after you cease to be Actively at Work.
for Accidental Dismemberment
– written notice of claim must be given to Sun Life no later than 12 months
after the date of your loss.
If notice cannot be given within the
applicable time period, Sun Life must be notified as soon as it is reasonably
possible.
When Sun Life has received written notice of
claim, Sun Life will send the forms for proof of claim. If the forms are not
received within 15 days after written notice of claim is sent, proof of claim
may be sent to Sun Life without waiting to receive the proof of claim forms.
When does written Proof
of Claim have to be submitted?
for a death claim
(accidental or otherwise) – proof of claim must be given to Sun Life no later
than 90 days after date of death.
for Life Waiver of Premium
– proof of claim must be given to Sun Life no later that 15 months after you
cease to be Actively at Work.
for Accidental Dismemberment
– proof of claim must be given to Sun Life no later than 15 months after the
date of your loss.
CLAIM PROVISIONS
If proof cannot be given within these time
limits, proof must be given as soon as reasonably possible. Proof of claim may
not be given later than one year after the time proof is otherwise required
unless the individual is legally incompetent.
What is considered Proof
of Claim?
Proof of Claim consists of at least the
following information:
·
what the loss or disability is;
·
the date the loss or disability
occurred; and
·
the cause of the loss or
disability.
(For example: a Death Claim would include at
least the Death Certificate for Proof of Claim)
Sun Life may require as part of the proof,
authorization to obtain medical and non-medical information.
Proof of your continued Total Disability and
regular and continuous care by a Physician must be given to Sun Life within 30
days of the request for proof.
Proof must be satisfactory to Sun Life.
When are benefits
payable?
Benefits are payable when Sun Life receives
satisfactory Proof of Claim.
Who are benefits payable
to?
Benefits payable upon your death are payable
to your Beneficiary living at the time (other than your Employer). Unless you
otherwise specify, if more than one Beneficiary survives you, all surviving
Beneficiaries will share equally. If no Beneficiary is alive on the date of your
death, payment will be made to your estate.
All other benefits payable during your
lifetime are payable to you.
If a benefit is payable to your estate, if
you are a minor, or you are not competent, Sun Life has the right to pay an
amount of the benefit up to $5,000 to any of your relatives that Sun Life
considers entitled. If Sun Life pays benefits in good faith to a relative, Sun
Life will not have to pay those benefits again.
If your Beneficiary is a minor or is not
competent, Sun Life has the right to pay up to $1,000 to the person or
institution that appears to have assumed custody and main support for the minor,
until the appointed legal representative makes a formal claim. If Sun Life pays
benefits in good faith to a person or institution, Sun Life will not have to pay
those benefits again.
You can change your Beneficiary at any time
on the form provided by Sun Life, unless you have stated your choice of
Beneficiary is irrevocable or you have assigned your interest in you Life
Insurance to another person. Any request for change of Beneficiary must be in
written form and will take effect on the date you sign and file the change with
your Employer. If Sun Life has taken any action or made payment before receiving
notice of that change, your change of Beneficiary will not affect any action or
payment made by Sun Life. The consent of you Beneficiary is not required to
change any Beneficiary.
Can I assign my Life
Insurance?
You can transfer ownership of your Life
Insurance under the Group Policy by means of an absolute assignment. You cannot
make an absolute assignment to your Employer. All your rights and duties as
owner are transferred to the new owner. The new owner can make any change the
Group Policy allows, such as a change of Beneficiary.
Any assignment must be in a written form and
will take effect on the date you sign and file the assignment with your
Employer. If Sun Life has taken any action or made payment before receiving
notice of that change, the assignment will not affect any action or payment made
by Sun Life. Sun Life will not be responsible for the legal, tax or other
effects of any assignment.
How can statements made
in any application for insurance be used?
All statements made in any application are
considered representations and not warranties. No representation by you in
applying for insurance under the Group Policy will be used to reduce or deny a
claim unless a copy of your written application for insurance is or has been
given to you or to your Beneficiary, if any.
No statement made by you or any of your
Dependents, relating to Evidence of Insurability for an initial, increased or
additional amount of insurance, will be used in contesting the validity of that
insurance, after such initial, increased or additional amount of insurance has
been in force for a period of two years during that individual’s lifetime.
This statement must be contained in a form signed by that individual.
What happens if facts are
misstated?
If relevant facts about you or any one of
your Dependents are not accurate:
If the amount of benefit depends on your age,
the benefit will be the amount you would have been entitled to if your correct
age were known.
What are Sun Life’s
examination and autopsy rights?
Sun Life, at its own expense, has the right
to have any person, whose Injury or Sickness is the basis of a claim:
This right may be used as often as reasonably
required.
GENERAL PROVISIONS
Sun Life has the right, in the case of death,
to request an autopsy.
What are the time limits
for legal proceedings?
No legal action may start:
·
until 60 days after Proof of Claim
has been given; nor
·
more than 3 years after the time
Proof of Claim is required.
Do these group benefits
affect Workers’ Compensation?
The Group Policy is not in lieu of, and does
not affect, any requirement for coverage by Workers’ Compensation Insurance.
Can the Policyholder act
as a Sun Life agent?
For all purposes of the Group Policy, the
policyholder acts on its own behalf or as your agent. Under no circumstances
will the Policyholder be deemed a Sun Life agent.
These are some of the
general terms you need to know.
Actively at Work
means that you perform all the regular duties of your job for a full work day
scheduled by your Employer at your Employer’s normal place of business or a
site where your Employer’s business requires you to travel.
You are considered Actively at Work on any
day that is not your regular scheduled work day (i.e., you are on vacation,
layoff or an approved leave of absence) as long as you:
·
are not hospital confined; or
·
are not disabled due to an injury
or sickness; and
·
were Actively at Work on your
immediately proceeding scheduled work day.
You are considered Actively at Work if you
usually perform the regular duties of your job at your home as long as you;
·
are not hospital confined; or
·
are not disabled due to an injury
or sickness; and
·
can perform all the regular duties
of your job for a full work day and can do so at your Employer’s normal place
of business, if required.
Eligibility Date
means the date or dates you become eligible for insurance under the Group
Policy. Classes eligible for insurance are shown in the Benefit Highlights.
Employee (You)
means a person who is employed by the Employer working at least the number of
hours shown in the Benefit Highlights, and paid regular earnings.
Employer means
Mountain Adventures, and includes any Subsidiary, Affiliated or Associated
company insured under the Group Policy.
Evidence of Insurability
means a statement or proof of your or your Dependent’s medical history upon
which acceptance for insurance will be determined by Sun Life.
Injury means bodily impairment resulting directly from an accident and
independently of all other causes. Any Injury must occur and Disability must
begin while you are insured under the Group Policy.
DEFINITIONS
Physician
means an individual who is operating within the scope of his license and is
either:
·
licensed to practice medicine and
prescribe and administer drugs or to perform surgery; or
·
legally qualified as a medical
practitioner and required to be recognized, under the Group Policy for insurance
purposes, according to the insurance regulations of the governing jurisdiction.
The Physician cannot be you, your spouse or
the parents, brothers, sisters or children of you or your spouse.
Pregnancy means
childbirth, miscarriage, abortion or any disease resulting from or aggravated by
the pregnancy.
Sickness
means illness, disease or pregnancy. A disability, because of sickness, must
begin while you are insured under the Group Policy.
Waiting Period
means the continuous length of time immediately before your Eligibility Date
during which you must be Actively at Work for your Employer before you can apply
for benefits. Any period of time before the Group Policy Effective Date that you
were Actively at Work for your Employer as a full-time Employee will count
towards completion of your Waiting Period. The Waiting Period is shown in the
Benefit Highlights.
DEFINITIONS
These are Life Insurance
terms you need to know.
Beneficiary
means the person (it cannot be your Employer) who is entitled to receive death
benefit proceeds as they become due under the Group Policy. A person becomes
your Beneficiary only if you have named that person on a signed form acceptable
to Sun Life.
Certified or Certification
means a written statement made by a Physician, on a form provided by Sun Life,
as to your Terminal Illness.
Retired Employee
means you are a former Employee of your Employer, you have retired on or after
January 1, 1999 and prior to your retirement you:
·
worked as a full-time Employee;
and
·
were insured as an active
Employee.
To be considered a retired employee, you must
be receiving pension from your Employer or receiving a pension as a result of
employment with your Employer.
Retirement for
the purposes of your being considered retired means the first of the following
dates to occur:
1.
the effective date of your retirement benefits under:
a.
any plan of a federal, state, county, municipal or an association
retirement system which you are eligible as a result of your employment with
your Employer;
b.
any plan your Employer sponsors; or
c.
any plan your Employer makes or has made contributions to.
2.
The effective date of your retirement benefits under the Social Security
Act or any similar plan or act. However, if you meet the definition of an
Employee Actively at Work and you are receiving retirement benefits under Social
Security Act or similar plan or act, you will not be considered retired.
Terminally Ill or Terminal Illness
means your Sickness or physical condition that is Certified by a Physician to
reasonably be expected to result in your death within twelve months or less.
Total Disability or Totally Disabled
means because of your Injury or Sickness, you are unable to perform the material
and substantial duties of any occupation for which you are or become reasonably
qualified for by education, training or experience.
DEFINITIONS
This is an Accidental
Death and Dismemberment Insurance term you need to know.
Accidental Bodily Injury
means bodily harm caused solely by external, violent and accidental means which
is sustained directly and independently of all other causes.
Mountain Adventures Employee
Benefit Plan (The Plan) has been established to provide welfare benefits for its
employees.
The Employee Retirement Income Security Act
of 1974 (ERISA) requires that the Plan Administrator provide you with a Summary
Plan Description which discloses required information about the employee benefit
plan. The following section entitled "Summary Plan Description" is not
part of the Group Insurance Policy. The Information in the Summary Plan
Description is provided by the Policyholder and is included in this
Booklet/Certificate for your convenience for the accuracy or sufficiency of the
information in the Summary Plan Description.
SUMMARY PLAN DESCRIPTION
Plan Sponsor: Mountain Adventures
P.O. Box 123
Coeur d’Alene, Idaho 83816
Plan Administrator: Mountain Adventures
P.O. Box 123
Coeur d’Alene, Idaho 83816
The Plan Administrator has authority to
control and manage the operation and administration of the Plan.
Agent for Service of
Legal Process: Mountain Adventures
P.O. Box 123
Coeur d’Alene, Idaho 83816-0316
Employer Identification Number (EIN):
12-3456789
Plan Number:
101
End of Plan Year: December 31st
Type of Administration:
The Plan is administered by the Plan Administrator. The benefits provided
by the Group Insurance Policy issued by Sun Life Assurance Company of Canada are
included in the Plan.
Participants:
The Insured employees described in the Sun Life Assurance Company of Canada
Booklet/Certificate.
Plan Changes and Termination:
The Plan Administrator may amend, modify or terminate the Plan.
Contributions:
The cost of your benefits under the Plan is paid for by your employer and (if
applicable) include the cost of any insurance premiums contributed by you.
Funding:
Sun Life provides the Plan Administrator with certain insurance benefits in
connection with the Plan. Those insurance benefits are described in your
Booklet/Certificate.
Claim Procedure:
When you or your beneficiary wish to file a claim under the Plan, you should
contact your personnel office for claim forms and instructions for filing. Your
Booklet/Certificate explains the procedure for filing a claim under the Group
Insurance Policy.
If your claim for benefits is denied in whole
or in part, you will receive a written notice within 90 days from the date you
filed your claim, stating the reasons why your claim was denied. You will then
have the right, upon written notice from you or your authorized representative,
to review that claim denial. The claim denial notice will include the name and
address of the person you may ask for such a review. Additional information
about claims submitted and review procedures may be obtained by contacting your
Plan Administrator.
ERISA Rights: As
a participant in the plan, you are entitled to certain rights and protections
under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA
provides that all plan participants shall be entitled to:
Examine, without charge, at the Plan
Administrator’s office, all Plan documents filed by the Plan with the U.S.
Department of Labor, such as detailed annual reports and plan descriptions.
Obtain copies of all Plan documents and other
information upon written request to the Plan Administrator. The Administrator is
required under ERISA to furnish each participant with a copy of this summary
annual report.
In addition to creating rights for Plan
participants, ERISA imposes duties upon the people who are responsible for the
operation of the Plan. The people who operate your plan, called
"Fiduciaries" of the Plan, have a duty to act prudently, in your
interest and that of the other Plan participants and Beneficiaries.
No one, including your employer, may
terminate you or otherwise discriminate against you in any way to prevent you
from obtaining a benefit or exercising your rights under ERISA. If your claim
for a benefit is denied in whole or in part, you must receive a written
explanation of the reason for the denial. You have the right to have the Plan
Administrator review and reconsider your claim.
Under ERISA, there are steps you can take to
enforce the above rights.
For instance, if you request materials from
the Plan and do not receive them within 30 days, you may file suit in a federal
court. In such a case, the court may require the Plan Administrator to provide
the materials and pay you up to $110 a day until you receive the materials,
unless the materials were not sent because of reasons beyond the control of the
Plan Administrator.
If you have a claim for benefits which is
denied or ignored, in whole or in part, you may file suit in a state or federal
court. If it should happen that Plan Fiduciaries misuse the Plan’s money, or
if you are discriminated against for asserting your rights, you may seek
assistance of the U.S. Department of Labor, or you may file suit in a federal
court. The court will decide who should pay court costs and legal fees. If you
are successful the court may order the person you have sued to pay these costs
and fees. If you lose, the court may order you to pay these costs and fees, for
example, if it finds your claim is frivolous.
If you have questions about your Plan, you
should contact the Plan Administrator. If you have any questions about your
rights under ERISA, you should contact the nearest office of the Pension and
Welfare Benefits Administration, U.S. Department of Labor, listed in your
telephone directory of the Division of Technical Assistance and Inquiries,
Pension and Welfare Benefits Administration, U. S. Department of Labor, 200
Constitution Avenue, N.W., Washington, DC 20210.
Disclaimer. Privacy Policy. ©1999-2002 Instant Benefits Network, Inc.
All Rights Reserved.
