Receiving Benefits
When Benefits Start
Provident will pay you a monthly benefit after the end of the elimination period
when it receives proof that you:
Are disabled due to sickness or injury; and
require the regular attendance of a physician.
Provident will pay you as long as you remain disabled and require the regular
attendance of a physician. But Provident will not pay any longer than the maximum
benefit period shown in the plan outline.
Also, you must give Provident proof of these facts, at your own expense, when
Provident asks for it.
Evident of insurability-a statement or proof of your medical history upon
which Provident will determine your acceptance for insurance.
Gross monthly benefit-your benefit amount before any reduction for other income
benefits and earnings. Hospital or institution-facilities licensed to provide care
and treatment for the condition causing your disability.
Indexed pre-disability earnings-your basic monthly earnings, in effect just
prior to the date your disability began, adjusted on the first anniversary of benefit
payments and each following anniversary. Each adjustment will be based on the lesser
of 10% or the current annual percentage increase in the Consumer Price Index.
Injury-bodily injury resulting directly from an accident and independent of
all other causes. The injury must occur and disability must begin while you are
insured under the policy.
Mental illness-mental, nervous or emotional diseases or disorders of any type.
Monthly benefit-the amount Provident will pay you when you are disabled.
Other income benefits-those benefits as follows:
Worker's or Workmen's Compensation Law;
Occupational disease law; or
Any other act or law of like intent,
Any other group insurance plan,
Any governmental retirement system as a result of your job with your employer.
Partial disability and partial disabled-means that because of injury or
sickness you, while unable to perform all the material duties of your regular
occupation on a full-time basis, are:
Performing at least one of the material duties of your regular occupation or
another occupation on a part-time basis; and
Currently earning at least 20% less per month than your indexed pre-disability
earnings due to that same injury or sickness.
Physician-a person who is:
- Operating within the scope of his license; and 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 policy for insurance statutes or the insurance regulations of the governing
jurisdiction.
It will not include you or your spouse, daughter, son, father, mother, sister or brother.
Recurrent Disability-a disability which is related to a prior disability for
which you received a monthly benefit.
Provident will treat a recurrent disability as part of the prior disability if,
after receiving disability benefits, you:
- Return to your regular occupation on a full-time basis for less than six months; and
- Perform all the material duties of your occupation.
Benefit payments will be subject to the terms of this plan for the prior disability.
If you return to your regular occupation on a full-time basis for six months or more,
a recurrent disability will be treated as a new period of disability. You must
complete another elimination period.
When Provident receives proof that you are partially disabled within 31 days of the
end of a period during which you received disability benefits, you will be paid a
monthly benefit. The partial disability must result from the injury or sickness that
caused disability.
When Benefits End
Disability benefits cease on the earliest of:
- The date you are not longer disabled
- The date you die
- The end of the maximum benefit period
- The date your current earnings exceed 80% of your indexed pre-disability earnings.
Premium payments during any period for which benefits are payable.
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