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2023-2024 Benefits Guide
HOWTOENROLLYouwillbeabletocompleteyourenrollmentbyfollowingthestepslistedbelow. ENROLLMENTOPTIONS 01You canenrollindependently throughouronline EnrollmentPlatform. Logininstructionsareincludedon the nextpage.
_________________________________EMPLOYEE BENEFITS: HOWTO LOGINTOBERNIE PORTALACCOUNTBelow are the instructions for how to login both with and without an email address:How to login with email:Go to: https://www.bernieportal.com/en/loginEmployee default logins:Username: email addressPassword: Selecttheforgotpasswordoption ifyou donotrememberorhavenotsetoneupbefore.ORHow to login without email:https://www.bernieportal.com/en/emplovercode/loginEmployee code logins:2-digit code: 2-digit birth month (Example:March=03)4-digit code: last 4 of socialEmployer code:____________Grace Funeral Home8518f0
____________________________________________thrivesonbalance–balancingprofessionalandpersonalworlds–balancingworkandrest–whilealwaysbalancingcostandvalue.Wealsounderstandthatbalancemustbeindividualized.Whatisrightforonepersonmaynotbeappropriateforanother.Itisourgoaltoofferchoicesallowingyoutotailoryourbenefitsplanspecificallytowhatisbestforyouandyourfamilymembers.YourChoices___ Providesacompletepackageofbenefitsaimedatprovidingflexibleinsuranceprotectionandprogramstomeetyourever-changingneeds.___ sharesthecostofsomebenefitswithyou,whilemakingadditionalbenefitsavailablethatyoupayforifyouchoosetoenroll.Thepartofthebenefitcoststhatyouareresponsibleforwillbeautomaticallydeductedfromyourpaycheck,eitherbeforeorafteryourtaxesarecalculated.BenefitPre-TaxorPostTaxWhopaysthecost?WhydoIpayforsomebenefitswithbefore-taxmoney?Whilenotallbenefitsqualifyforpre-taxcontribution,thereisadefiniteadvantagetopayingforthosethatdo:Takingthemoneyoutbeforeyourtaxesarecalculatedlowerstheamountofyourtaxableincome.Therefore,youpaylessintaxes.HowYourBenefitsWorkFull-timeemployeesareeligibleformostbenefitson_____________________________________ofhire.MakingChangesGenerally,youcanonlychangeyourbenefitschoicesduringtheannualBenefitsEnrollmentPeriod.However,youcanchangeyourbenefitschoicesduringtheyearifyouhavealifeeventchange.Lifeeventchangesincludebutarenotlimitedto:· Marriage· Divorce· Birth,adoption,orplacementforadoptionofaneligiblechild· Deathofyourspouseorcoveredchild· Changeinyouoryourspouse’sworkstatusthatresultsincancellationofyourbenefits· BecomingeligibleforMedicareorMedicaidduringtheyearIfyouhavealifeeventchange,youmustnotifyHumanResourceswithin31daysofthechange(forexample,amarriageorbirthcertificate).Ifyoudo notnotifyHumanResourceswithin31days,youwillhavetowaituntilthenextannualOpenEnrollmentperiodtomakebenefitschangesunlessyouhaveanotherlifeeventchange.Anychangesyoumaketoyourbenefitchoicesmustbedirectlyrelatedtothelifeeventchange.Grace Funeral HomeGrace Funeral HomeGrace Funeral Homethe first day of the month following 60 daysGrace Funeral HomePre-Tax Employer SharedPre-Tax Employee PaidPre-Tax Employee PaidPost-Tax Employee PaidPost-TaxPost-TaxEmployee PaidPost-Tax Employee PaidEmployee PaidPost-Tax Employee PaidEmployee PaidPost-TaxN/A Employer PaidHealth InsuranceShort Term DisabilityDental InsuranceLong Term DisabilityVision InsuranceER Paid Life InsuranceHospital InsuranceCritical IllnessVoluntary Life InsuranceAccident
PortabilityIfyouleavethecompany,someofyourbenefitsendandsomeofyourbenefitsareportable.Thismeansyoucantakethemwithyouifyouleave,aslongasyoucontinuetopaythepremiumsyourself.Onceterminated,youwillbenotifiedthroughthemailifanyofyourbenefitsareportable.WhenCoverageEndsBenefitsendonthelastdayofthemonthfollowingterminationorwhenyouceasetomeeteligibilityguidelines. Lookingahead……Nowlet’slookateachbenefitthatmakesupthebenefitsprogram.Inthefollowingpages,you’lllearnmoreaboutthevaluablebenefitsyouremployeroffers.You’llalsoseehowchoosingtherightcombinationofbenefitscanhelpprotectyouandyourfamily’shealth.NOTES:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Continuing Your CoverageUndercertaincircumstances,youmay continue yourhealthcarecoveragewhenitwouldotherwiseend.ThisiscalledCobraappliestotheseplans:· HealthInsurance· DentalInsurance· VisionInsuranceWhencan I continue coverage under____________________?Youand/oryourdependentsareeligibletocontinuehealthcarecoverageunder________________________If coverageislostbecause:· Your employment endsforanyreasonother than“grossmisconduct”.· Yourworkhours are significantlyreduced.· Youdie.· Youbecome entitled toandenrollinMedicarepriortolosingcoverage.· Youdivorceorbecomelegallyseparatedfromyourspouse.· Yourdependentlosesdependentstatus.________________CobraCobraCobraGrace Funeral Home
DeductibleFamily DeductibleCoinsuranceOut-Of-PocketOffice VisitSpecialty Doctor Office VisitInpatient Hospital ServicesPreventative Lab & X-RayAdvanced ImaginingUrgent CareEmergency RoomRXPCPEmployees Bi-Weely Rate Employees Semi-Monthly Rate Employees Bi-Weely Rate Employees Semi-Monthly RateEmployee Only $146.92$159.16$192.38$208.41Employee + Spouse $440.75$477.48$531.67$575.98Employee + Child(ren) $440.75$477.48$531.67$575.98Employee + Family $734.58$795.80$870.97$943.55HMOG9E5ADTHMOS9J5ADTYES YES80% After Ded.80% After Ded.80% After Ded.80% After Ded.80% After Ded.5/15/50/100/250/350 After Ded.In$1,250$3,75080%$5,250 ($10,500)$45 Copay$90 Copay$300 Copay + 80% After Ded.$150 Copay + 80% After Ded.$250 Copay + 80% After Ded.$75 Copay$600 Copay + 80% After Ded.0/10/50/100/150/250In$3,000$6,00080%$6,900 ($13,800)$35 Copay after Ded.$70 Copay after Ded.
In Out In OutDeductible$5,000 $10,000 $1,500 $3,000Family Deductible$10,000 $20,000 $4,500 $9,000Coinsurance100% 100% 80% 60%Out-Of-Pocket$5,000 ($10,000) $10,000 ($20,000) $6,000 ($12,000) UnlimitedOffice Visit100% After Ded. 100% After Ded. $40 Copay 60% After Ded.Specialty Doctor Office Visit100% After Ded. 100% After Ded. $80 Copay 60% After Ded.Inpatient Hospital Services100% After Ded. 100% After Ded. 80% After Ded. 60% After Ded.Preventative Lab & X-Ray100% After Ded. 100% After Ded. $50 Copay + 80% After Ded. 60% After Ded.Advanced Imagining100% After Ded. 100% After Ded. $100 Copay + 80% After Ded. 60% After Ded.Urgent Care100% After Ded. 100% After Ded. $75 Copay 60% After Ded.Emergency Room100% After Ded. 100% After Ded. $500 Copay + 80% After Ded. As INNRX100% After Ded. 100% After Ded. 0/10/50/100/150/250 60% After Ded.PCPEmployees Bi-Weely Rate Employees Semi-Monthly Rate Employees Bi-Weely Rate Employees Semi-Monthly RateEmployee Only $290.38$314.58$347.12$376.05Employee + Spouse $727.67$788.31$841.15$911.25Employee + Child(ren) $727.67$788.31$841.14$911.24Employee + Family $1,164.96$1,262.05$1,335.19$1,446.46NoG653CHCPPONoS662CHCPPO
EN-2026 FOR EMPLOYEES (06-21) Unum | Dental InsuranceGrace Funeral Home IncorporatedWhat else is included?Pregnancy benefitAn extra cleaning for expecting mothers in their 2nd or 3rd trimester.Wellness benefitsOral cancer screenings for patients 40 and older with high risk factors.Unumdentalcare.comUse unumdentalcare.com and the mobile app search for providers, manage your benefits and learn about good dental health. Features include easy access to ID Cards, claims history and coverage information.Carryover benefitsMembers who take care of their teeth, but use only part of their annual maximum benefit during a benefit period are rewarded with extra benefits in future years! Carryover benefits will be accrued and stored in the insured’s carryover account to be used in the next benefit year.The limits for this policy/certificate are:Passive PPOCarryover benefit $350Threshold limit $700Carryover account limit$1,250Unum Dental™ Dental Insurance can help you pay for dental exams, cleanings and other services.Why is this coverage so valuable?Routine dental care keeps your mouth and whole body healthy.Your plan is backed by Unum’s commitment to excellence in customer service.Personalized website and mobile app to manage your benefits including claims information, ID cards and more.There’s no waiting period for preventive and basic services.How does it work?Good dental care is critical to your overall well-being. With Unum Dental insurance, you can get the attention your teeth need — at a cost you can afford.Unum Dental allows you to see any dentist you choose. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards. You can find in-network providers at unumdentalcare.com.
EN-2026 FOR EMPLOYEES (06-21) Unum | Dental InsuranceDental carryover benet and how it worksEach benefit year a member must have: •One cleaning, •One regular exam, and •Total dental claims for preventive, basic and major covered procedures paid during the year below the threshold limit. •If all three criteria above are met, a portion of the annual maximum will carry over to the next year.Other Specifications: •Each covered family member receives their own carryover benefit. •Group carryover benefit rider must be in effect for one benefit year before any members can utilize carryover benefits. •A member must be on the plan for a minimum of three months before accruing carryover benefits. •Carryover benefit may be used toward preventive, basic and major covered services only •A member’s carryover account will be eliminated, and the accrued carryover benefits lost if the insured has a break in coverage for any length of time or any reason.Dependent childrenDependent age guidelines vary by state. Please refer to your policy certificate or contact customer service at (888) 400-9304.Services not listedIf you expect to require a dental service not included on this brochure, it may still be covered. Please contact customer service at (888) 400-9304 to confirm your exact benefits.Alternate treatmentUnum covers the least expensive most commonly used and accepted American Dental Association treatments. Plan members may elect a more expensive treatment, but will be responsible for the cost difference resulting from the more expensive procedure.Coverage details and costsOverview Passive PPOBenefit Year Maximum*$1,500Deductible**$25 per benefit yearMaximum 3 per familyPlan Coinsurance In-network Non-networkClass A Preventive100% 100%Class B Basic80% 80%Class C Major 50% 50%*Applies to Class A, B and C Services, if applicable **Waived for Class A (applies to Class B and C Services) Dental CoveragePassive PPOSemi-monthly cost†YouYou + 1Family†Rates guaranteed for 12 months from the effective date.$14.81$28.65$51.24
EN-2026 FOR EMPLOYEES (06-21) Unum | Dental InsuranceCovered Procedures & Waiting PeriodsPassive PPOCLASS A PREVENTIVE SERVICESWaiting Period: None •Routine exams (2 per 12 months) •Prophylaxis (2 per 12 months) – (1 additional cleaning or periodontal maintenance per 12 months, if member is in 2nd or 3rd trimester of pregnancy) •Bitewing x-rays (maximum of 4 films; 1 per 12 months) •Fluoride treatment for children up to age 16 (1 per 12 months) •Sealants for children up to age 16 (permanent molars, 1 per 36 months) •Space MaintainersCLASS B BASIC SERVICESWaiting Period: None •Emergency Treatment (1 per 12 months) •Full mouth/panoramic x-rays (1 per 36 months) •Simple restorative services (fillings) – Posterior composite restorations •Simple extractionsCLASS C MAJOR SERVICESWaiting Period: None •Oral Surgery (extractions and impacted teeth) •Anesthesia (subject to review, covered with complex oral surgery) •Repair of crown, denture or bridge •Inlays and onlays •Non-Surgical periodontics •Surgical periodontics (gum treatments) •Periodontal maintenance (2 per 12 month in combination with prophylaxis) •Endodontics (root canals) •Crowns, bridges, dentures and implantsRefer to your certificate of coverage for the services covered under your plan.
Exclusions and LimitationsThe following dental services are not covered unless stated otherwise in the Certificate of Coverage:• any treatment which is elective or primarily cosmetic in nature and not generally recognized as a generally accepted dental practice by the American Dental Association, as well as any replacement of prior elective or cosmetic restorations;• replacement of a removable device or appliance that is lost, missing or stolen, and for the replacement of removable appliances that have been damaged due to abuse, misuse, or neglect. This may include but not be limited to removable partial dentures or dentures;• replacement of any permanent or removeable device or appliance unless the device or appliance is no longer functional and is older than the limitation in the Schedule of Covered Procedures. This may include but not be limited to bridges, dentures and crowns;• any appliance, service, or procedure performed for the purpose of splinting, to alter vertical dimension or to restore occlusion;• any appliance, service or procedure performed for the purpose of correcting attrition, abrasion, erosion, abfraction, bite registration, or bite analysis;• charges for implants (except noted above), removal of implants, precision or semi-precision attachments, denture duplication, or dentures and any associated surgery, or other customized services or attachments;• services provided for any type of temporomandibular joint (TMJ) dysfunction, muscular, skeletal deficiencies involving TMJ or related structures, myofascial pain.Limitations:• Multiple restorations on one surface are payable as one surface. Multiple surfaces on a single tooth will not be paid as separate restorations. On any given day, more than 8 periapical x-rays or a panoramic film in conjunction with bitewings will be paid as a full mouth radiograph. Pre-estimates are recommended for any treatment expected to exceed $300.Takeover benefits:Takeover benefits apply if we are taking over a comparable benefits plan from another carrier and only if there is no break in coverage between the original plan and the takeover date. Takeover is available to those individuals insured under the employer’s dental plan in effect at the time of the employer’s application. If takeover benefits are included in your benefits, then waiting periods for service will be waived for the individuals currently insured under the employer’s previous plan during the month prior to coverage moving to us. Application of takeover benefits is subject to Underwriting review and approval. New hires with prior-like dental coverage (lapse in coverage must be less than 63 days) will receive takeover credit for the length of time they had with the prior carrier and must provide proof of coverage (including coverage dates) to receive takeover credit (i.e. one page benefit summary, Certificate of Creditable Coverage, etc.). A Network Access plan is available. THIS POLICY PROVIDES LIMITED BENEFITS This brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series Dental 20-GDN or contact your Unum Dental representative. Underwriten by Starmount Life Insurance Company, Baton Rouge, LA.© 2021 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-2026 FOR EMPLOYEES (06-21)unum.com
EN-376255 FOR EMPLOYEES (4-21) Grace Funeral Home IncorporatedUnum Vision® Quality eye care meets convenienceHow much does it cost? Semi-monthly premiumYou You and your spouse Family Plan features:• Our network offers members access to a large national network, including independent optometrists and retail stores like Walmart, Sam’s Club, Target Optical, America’s Best and many more.• Find an in-network provider at unumvisioncare.com• Manage benefits online with AlwaysAssist.com and on-the-go with the AlwaysAssist mobile app.Covered benefits:Exam: Each member is entitled to a comprehensive vision exam. An exam co-pay applies and is outlined in the grid at right.Materials: Each member has coverage for covered services and materials. Purchases are subject to benefit frequencies and co-pays. Plan features include:• Frame benefit: You may choose any frame within a provider’s collection, subject to the retail frame allowance listed at right. If the cost is greater than the plan’s benefits, you are responsible for the difference.• Eyeglass lens benefit: Standard plastic (CR-39 Plastic Material) single vision, bifocal, trifocal, and specialty lenses are generally covered after any applicable materials copay. If covered by plan allowance, you are responsible for any cost greater than the plan’s benefit.• Contact lens benefit: Members electing contact lenses instead of eye glass lenses may apply the contact lens allowance to any lenses in the provider’s collection. If the cost is greater than the plan’s benefits, you are responsible for the difference. Laser vision correction: Discounts are available with participating surgery providers across the country. (not an insured benefit)Unum Vision benefits:Vision Care ServicesIn-network ProvidersOut-of-network AllowancesExam (1 per 12 months)$10 co-pay Up to $35Materials$10 co-paySee allowances belowStandard Plastic Lenses (1 per 12 months)Single VisionCovered by co-payUp to $25BifocalCovered by co-payUp to $40TrifocalCovered by co-payUp to $50Lenticular$80 allowanceUp to $50Progressive $70 allowanceUp to $40Lens OptionsScratch Resistant CoatingCovered by co-pay (at Walmart only)Not coveredPolycarbonate Lenses for children to age 19Covered by co-payNot coveredFrames (1 per 24 months)Members choose from any frame available at provider locations.$175 allowance Up to $50Contact Lenses (1 per 12 months) In lieu of eyeglass lenses and frames (Includes fit*,follow-up and materials)$10 co-paySee allowances belowElective$175 allowance Up to $100Medically Necessary$210 allowance Up to $210*Some providers, such as Walmart, may charge for a contact lens fit and evaluation separately from your contact lens allowance, leaving the entire allowance for materials.$3.59$6.00$11.86
EN-376255 FOR EMPLOYEES (4-21) Vision InsuranceLaser Vision Correction Network Membership provides access to preferred pricing. Transactions are handled directly between members and providers. Refractive surgery is an elective procedure and may involve potential risks to patients. This is not an insured benefit. Unum cannot and does not guarantee the outcome of any refractive surgical procedure or a total elimination of the need for glasses or contacts. Providers may not be available in all metropolitan areas. Login to www.alwaysassist.com for a list of participating laser vision correction providers.Hearing Savings Plan Unum offers a Hearing Savings Plan at no additional cost, to all of its Unum Dental and Unum Vision members. Partnering with EPIC Hearing Healthcare, the Hearing Savings Plan provides:• 30-60% discounts off MSRP on name brand hearing instruments.• 40% savings on hearing aid batteries shipped directly to members’ homes.• On-call support for member questions, managed by professional hearing counselors.Other Unum Vision SpecificationsDependent children: Dependent age guidelines vary by state. Please refer to your policy certificate or contact customer service at 888-400-9304.Services not listed: If you expect to require a vision service not included on this brochure, it may still be covered. Please contact customer service at 888-400-9304, to confirm your exact benefits.This is a primary vision care benefit and is intended to cover only eye examinations and corrective eyewear. Medical or surgical treatment of eye disease or injury is not provided under this plan. Coverage may not exceed the lesser of actual cost of covered services and materials or the limits of the policy.Some providers at optical and/or retail chains, such as Walmart, may charge for a contact lens fit and evaluation separately and apart from your contact lens allowance, leaving the entire allowance for materials.Covered materials that are lost or broken will be replaced only at normal service intervals indicated in the Plan Design; however, these materials and any items not covered below may be purchased at Preferred Pricing from a Participating Provider. In addition, benefits are payable only for expenses incurred while the Group and individual Member coverage is in force.This plan will not cover:Orthoptics or vision training and any supplemental testing; Plano (non-prescription) lenses; or two pair of eyeglasses in lieu of bifocals or trifocals; Medical or surgical treatment of the eyes; An eye exam or corrective eye wear required by an employer as a condition of employment; Any injury or illness covered under Workers’ Compensation or similar law, or which is work related; Plain or prescription sunglasses or tinted lenses, and no-line bifocals and blended lenses (subject to allowance); Sub-normal vision aids; Services rendered or materials purchased outside the U.S. or Canada, unless: the insured resides in the U.S. or Canada, and the charges are incurred while on a business or pleasure trip; Charges in excess of Usual and Customary for services and materials; Experimental or non-conventional treatments or devices; Safety eyewear; Spectacle lens styles, materials, treatments or “add-ons” not shown in the Schedule of Benefits.A Network Access plan is available.THIS POLICY PROVIDES LIMITED BENEFITSThis brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series VI-2002, VI-2007 and VI-2019 or contact your Unum Vision representative.Starmount Life Insurance Company8485 Goodwood Boulevard • Baton Rouge, LA 70806PH: (888) 400-9304Vision plans are marketed by Unum, administered and underwritten by Starmount Life Insurance Company, Baton Rouge, LA.© 2021 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
EN-2046 (10-19) FOR EMPLOYEES1 Unum internal data, 2017Grace Funeral Home IncorporatedTerm Life with Accidental Death & Dismemberment (AD&D) Insurance can provide money for your family if you die or are diagnosed with a terminal illness.How does it work?You keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.AD&D Insurance is also available, which can pay a benefit if you survive an accident but have certain serious injuries. It can pay an additional amount if you die from a covered accident.Why choose Unum?Your employer is offering you this coverage at no cost to you. Unum is the leading provider of employee benefits, with more than 165 years of experience.1 We’ll be there to back our benefits and provide you with the support you need.What else is included? A “Living” Benefit If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit and may be taxable. Waiver of premium Your cost may be waived if you are totally disabled for a period of time.Portability You may be able to keep coverage if you leave the company, retire or change the number of hours you work.Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.Who can get Term Life coverage?If you are actively at work at least 30 hours per week, you can receive coverage for:You: You can receive a benefit amount of $15,000. You can get up to $15,000 with no health questions.Who can get Accidental Death & Dismemberment (AD&D) coverage?You: You can receive an AD&D benefit amount of $15,000.No questions or health exams required for AD&D coverage.
EN-2046 (10-19) FOR EMPLOYEESExclusions and limitationsActively at workEligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage.Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.Exclusions and limitationsLife insurance benefits will not be paid for deaths that are caused by suicide occurring within 24 months after the effective date of coverage or the date that increases to existing coverage becomes effective. This exclusion standardly applies to all medically written amounts and contributory amounts that are funded by the employee including shared funding plans.AD&D specific exclusions and limitations:Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:• Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)• Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane• War, declared or undeclared, or any act of war• Active participation in a riot• Committing or attempting to commit a crime under state or federal law• The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your doctor. This exclusion does not apply to you if the chemical substance is ethanol.• Intoxication – “Being intoxicated” means your blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.Delayed effective date of coverage Employee:Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.Age reductionCoverage amounts for Life and AD&D Insurance for you will reduce to 65% of the original amount when you reach age 65, and will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.Termination of coverageYour coverage under the policy ends on the earliest of:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverageThis 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 C.FP-1 et al or contact your Unum representative.Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.Underwritten by:Unum Life Insurance Company of America, Portland, Maine© 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.Term Life with Accidental Death & Dismemberment (AD&D) Insurance
EN-1976 FOR EMPLOYEES (4-21) Grace Funeral Home IncorporatedTerm Life and Accidental Death & Dismemberment (AD&D) Insurancecan provide money for your family if you die or are diagnosed with a terminal illness.Who can get Term Life coverage?If you are actively at work at least 30 hours per week, you may apply for coverage for:You: Choose from $10,000 to $500,000 in $10,000 increments, up to 5 times your earnings.You can get up to $50,000 with no health questions. This is your guaranteed issue amount.Your spouse:Get up to $500,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.Your spouse can get up to $15,000 with no health questions, if eligible (see delayed effective date). This is their guaranteed issue amount.Your children:Get up to $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.The maximum benefit for children live birth to 6 months is $1,000.How does it work?You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.Why is this coverage so valuable?If you buy a minimum of $10,000 of coverage now, you can increase your coverage in the future up to $50,000 to meet your growing needs. You won’t have to answer any health questions or take a health exam.What else is included? A ‘Living’ Benefit — If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit, and may be taxable. These benefit payments may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlements, and may be taxable. Recipients should consult their tax attorney or advisor before utilizing living benefit payments.Waiver of premium — Your cost may be waived if you are totally disabled for a period of time.Portability — You may be able to keep coverage if you leave the company, retire or change the number of hours you work.Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.Who can get Term Life coverage?If you are actively at work at least 30 hours per week, you may apply for coverage for:You: Choose from $10,000 to $500,000 in $10,000 increments, up to 5 times your earnings.You can get up to $50,000 with no health questions. This is your guaranteed issue amount.Your spouse:Get up to $500,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.Your spouse can get up to $15,000 with no health questions, if eligible (see delayed effective date). This is their guaranteed issue amount.Your children:Get up to $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.The maximum benefit for children live birth to 6 months is $1,000.Who can get Accidental Death & Dismemberment (AD&D) coverage?You: Get up to $500,000 of AD&D coverage for yourself in $5,000 increments to a maximum of 5 times your earnings.Your spouse:Get up to $500,000 of AD&D coverage for your spouse in $5,000 increments, if eligible (see delayed effective date).Your children:Get up to $10,000 of coverage for your children in $2,000 increments if eligible (see delayed effective date).No questions or health exams required for AD&D coverage.
EN-1976 FOR EMPLOYEES (4-21) Term Life and Accidental Death & Dismemberment (AD&D) InsuranceHow much coverage can I get?1. Enter the coverage amount you want.2. Divide by the amount shown.3. Multiply by the rate. Use the rate table (at right) to find the rate based on age.(Choose the age you will be when your coverage becomes effective. See your plan administrator for your plan effective date. To determine your spouse rate, choose the age the employee will be when coverage becomes effective. See your plan administrator for your plan effective date.)4. Enter your cost.Billed amount may vary slightly.If you apply for coverage above the guaranteed issue amount, you will be asked health-related questions which may affect your ability to get the larger coverage amount. In order to purchase coverage for your dependents, you must buy coverage for yourself. Coverage amounts cannot exceed 100% of your coverage amounts. Calculate your costs1 2 3 4Employee $______,000 ÷ $1,000 = $________ X $______ = $_______Spouse $______,000 ÷ $1,000 = $________ X $______ = $_______Child $______,000 ÷ $1,000 = $________ X $______ = $_______Total costSpouse semi-monthly ratePer $1,000 of coverageCost$0.045$0.045$0.060$0.095$0.135$0.220$0.330$0.475$0.610$0.795$1.455$4.890Employee semi-monthly rateAgePer $1,000 of coverageCost15-24 $0.04525-29 $0.04530-34 $0.06035-39 $0.09540-44 $0.13545-49 $0.22050-54 $0.33055-59 $0.47560-64 $0.61065-69 $0.79570-74 $1.45575+ $4.890Child semi-monthly rate$0.200 per $1,000 of coverage1. Enter the AD&D coverage amount you want.2. Divide by the amount shown.3. Multiply by the rate. Use the AD&D rate table (at right) to find the rate.4. Enter your cost.AD&D semi-monthly ratesCoverage amount RateEmployee per $1,000 of coverage $0.025Spouse per $1,000 of coverage $0.025Child per $1,000 of coverage $0.040AD&D1 2 3 4Employee $______,000 ÷ $1,000 = $________ X $0.025 = $_______Spouse $______,000 ÷ $1,000 = $________ X $0.025 = $_______Child $______,000 ÷ $1,000 = $________ X $0.040 = $_______Total cost
EN-1976 FOR EMPLOYEES (4-21) Exclusions and limitationsActively at workEligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.An unmarried handicapped dependent child who becomes handicapped prior to the child’s attainment age of 26 may be eligible for benefits. Please see your plan administrator for details on eligibility.Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.Exclusions and limitationsLife insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits. AD&D specific exclusions and limitations:Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:• Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)• Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane• War, declared or undeclared, or any act of war• Active participation in a riot• Committing or attempting to commit a crime under state or federal law• The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol.• Intoxication – ‘Being intoxicated’ means your or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.Delayed effective date of coverageInsurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.Delayed Effective Date: if your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.Age ReductionCoverage amounts for Life and AD&D Insurance for you and your dependents will reduce to 65% of the original amount when you reach age 65, and will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.Termination of coverageYour coverage and your dependents’ coverage under the policy ends on the earliest of:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverageIn addition, coverage for any one dependent will end on the earliest of:• The date your coverage under a plan ends• The date your dependent ceases to be an eligible dependent• For a spouse, the date of a divorce or annulment• For dependents, the date of your deathUnum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.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 C.FP-1 et al or contact your Unum representative.Term Life and Accidental Death & Dismemberment (AD&D) InsuranceLife Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.Unum complies with state civil union and domestic partner laws when applicable.Underwritten by: Unum Life Insurance Company of America, Portland, Maine© 2021 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
EN-1977 (6-20) FOR EMPLOYEESGrace Funeral Home IncorporatedGrace Funeral Home IncorporatedShort Term Disability Insurance can pay you a weekly benefit if you have a covered disability that keeps you from working.How does it work?If a covered illness or injury keeps you from working, Short Term Disability Insurance can replace part of your income while you recover. As long as you remain disabled, you can receive payments for up to 11 weeks. You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result. Why is this coverage so valuable?You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.What’s covered? This insurance may cover a variety of conditions and injuries. Here are Unum’s top reasons for short term disability claims:1 • Normal pregnancy• Injuries (excluding back)• Joint disorders• Cancer• Digestive disordersThis plan does not cover pre-existing conditions. See the disclosure section to learn more.1 Unum internal data, 2018. Note: Causes are listed in ranked order.Cesarean section benefit If you have a Cesarean section, you will be considered disabled for a minimum period of eight weeks unless you return to work before the end of the time.Consider your weekly expensesFood $_______Transportation _______ (gas, car payments, repairs)Child care/elder care _______Mortgage/rent _______Utilities _______ (electric, water, cable, phone)Medical costs _______ (co-pays, medications)Insurance _______ (health, life, car, home)Total weekly expenses $_______
EN-1977 (6-20) FOR EMPLOYEESShort Term Disability InsuranceHow much coverage can I get?! Coverage is guaranteed as long as a certain number of employees purchase coverage. If you don’t sign up now but decide to apply later, you may have to answer medical questions.Elimination period (EP)This is the number of days that must pass between your first day of a covered disability and the day you can begin to receive your disability benefits.Your benefits would begin after you become disabled for 14 days.Benefit duration (BD)The maximum number of weeks you can receive benefits while you’re disabled. You have a 11 week benefit duration.Calculate your costYou*You are eligible for coverage if you are an active employee in the United States working a minimum of 30 hours per week.Coverage amounts Cover 60% of your weekly income, up to a maximum benefit of $1,000 per week. The weekly benefit may be reduced or offset by other sources of income. *See the Legal Disclosures for more information• For step 2:Enter your rate from the Rate Chart, based on your age.(Choose the age you will be when your coverage becomes effective. See your plan administrator for your plan effective date.)Billed amount may vary slightly. Your rate is based on your age and will increase as you move to the next age band. * The maximum covered annual income is $86,666.Age Rates15-2425-2930-3435-3940-4445-4950-5455-5960-6465+Disability worksheet1Calculate your weekly disability benefit.$________ ÷ 52 = $________ x 60% =$__________Max weekly benefit available (if the amount exceeds the plan max of $1,000, enter $1,000.Your annualearningsYour weeklyearnings(Max % ofincome covered)2Calculate your cost per paycheck.$________÷ 10 = $________ x $_______ = $________ x 12 = $_______ ÷ 24 = $__________Your weeklybenefit amountYour rate Your monthly costYour annual costNumber of paychecks per yearYour cost per paycheck$0.975$1.321$1.278$0.910$0.715$0.780$0.932$1.278$1.473$1.777
EN-1977 (6-20) FOR EMPLOYEESExclusions and limitationsActive employeeYou are considered in active employment, if on the day you apply for coverage, you are being paid regularly by Grace Funeral Home Incorporated for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.Delayed effective date of coverageInsurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.Definition of disabilityYou are considered disabled when Unum determines that, due to sickness or injury:• You are limited from performing the material and substantial duties of your regular occupation; and• You have a 20% or more loss in weekly earningsYou must be under the regular care of a physician in order to be considered disabled. The loss of a professional or occupational license or certification does not, in itself, constitute disability. ‘Substantial and material acts’ means the important tasks, functions and operations generally required by employers from those engaged in your usual occupation that cannot be reasonably omitted or modified.Unless the policy specifies otherwise, as part of the disability claims evaluation process, Unum will evaluate your occupation based on how it is normally performed in the national economy, not how work is performed for a specific employer, at a specific location or in a specific region.Pre-existing conditionsYou have a pre-existing condition if: • You received medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it in the 3 months just prior to your effective date of coverage; and• The disability begins in the first 12 months after your effective date of coverage. Deductible sources of incomeYour disability benefit may be reduced by deductible sources of income and any earnings you have while you are disabled, including such items as group disability benefits or other amounts you receive or are entitled to receive:• Workers’ compensation or similar occupational benefit laws• State compulsory benefit laws• Automobile liability insurance policy• Motor vehicle insurance policy or plan• No fault motor vehicle plan• Legal judgments and settlements• Salary continuation or sick leave plans, if applicable• Other group or association disability programs or insurance• Social Security or similar governmental programs Exclusions and limitationsBenefits will not be paid for disabilities caused by, contributed to by, or resulting from:• War, declared or undeclared or any act of war• Active participation in a riot• Intentionally self-inflicted injuries;• Loss of professional license, occupational license or certification;• Commission of a crime for which you have been convicted;• Any period of disability during which you are incarcerated;• Excluded pre-existing conditions (see definition).The loss of a professional or occupational license does not, in itself, constitute disability.Termination of coverageYour coverage under the policy ends on the earliest of the following:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are in active employment except as provided under the covered layoff or leave of absence provision.Unum will provide coverage for a payable claim that occurs while you are covered under the policy or plan.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 C.FP-1 et al., or contact your Unum representative.Short Term Disability InsuranceUnderwritten by:Unum Life Insurance Company of America, Portland, Maine© 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
EN-1978 (6-20) FOR EMPLOYEESGrace Funeral Home IncorporatedLong Term Disability Insurance can replace part of your income if a disability keeps you out of work for a long period of time.How does it work?This coverage can pay a monthly benefit if you have a covered illness or injury and you can’t work for a few months — or even longer.You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result. Why is this coverage so valuable?You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.What else is included?Work-life balance EAP Get access to professional help for a range of personal and work-related issues, including counselor referrals, financial planning and legal support.Worldwide emergency travel assistance One phone call gets you and your family immediate help anywhere in the world, as long as you’re traveling 100 or more miles from home. However, a spouse traveling on business for his or her employer is not covered.Survivor benefit If you die while you’ve been disabled and receiving benefits for at least 180 days, your family could get a benefit equal to 3 months of your gross disability payment. Waiver of premium If you’re disabled and receiving benefit payments, Unum waives your cost until you return to work.1 Unum internal data, 2018. Note: Causes are listed in ranked order.What’s covered? This insurance may cover a variety of conditions and injuries. Here are Unum’s top reasons for long term disability claims:1 • Cancer• Back disorders• Injuries• Cardiovascular• Joint disordersThis plan does not cover pre-existing conditions. See the disclosure section to learn more.Consider your monthly expensesFood $_______Transportation _______ (gas, car payments, repairs)Child care/elder care _______Mortgage/rent _______Utilities _______ (electric, water, cable, phone)Medical costs _______ (co-pays, medications)Insurance _______ (health, life, car, home)Total monthly expenses $_______
EN-1978 (6-20) FOR EMPLOYEESLong Term Disability InsuranceHow much coverage can I get?! Coverage is guaranteed as long as a certain number of employees purchase coverage. If you don’t sign up now but decide to apply later, you may have to answer medical questions. Elimination period (EP)Your elimination period is 90 days. This is the number of days that must pass after a covered accident or illness before you can begin to receive benefits.Benefit duration (BD)This is the maximum length of time you can receive benefits while you’re disabled. You can receive benefits up to the Social Security (SS) normal retirement age.Billed amount may vary slightly. Your rate is based on your age and will increase as you move to the next age band. • Use $100,000 if your annual earnings exceed this amount. This is the maximum coverage amount offered in this plan. • Multiply by your rate.Use the rate table to find the rate based on your age. (Choose the age you will be when your coverage becomes effective. See your plan administrator for your plan effective date.)Calculate your costYou*You are eligible for coverage if you are an active employee in the United States working a minimum of 30 hours per week. Coverage amounts Cover 60% of your monthly income, up to a maximum payment of $5,000. The monthly benefit may be reduced or offset by other sources of income. *See the Legal Disclosures for more information.Age Rates15-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970+Disability worksheet1Enter your annual earnings and calculate your maximum monthly benefit available.$________ ÷ 12 = $_______ x 60% = $__________Your annual earningsYour monthly earnings(Max % of income covered) Max monthly benefit available 2Calculate your cost per paycheck $_______÷ 100 = $_______ x $_____ = $_______ ÷ 24 = $__________Your annual earningsRate Number of paychecks per yearTotal cost per paycheck$0.070$0.105$0.180$0.280$0.450$0.605$0.740$0.935$0.910$0.880$0.750
EN-1978 (6-20) FOR EMPLOYEESExclusions and limitationsActive employeeYou are considered in active employment, if on the day you apply for coverage, you are being paid regularly by Grace Funeral Home Incorporated for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.Delayed effective date of coverageInsurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.Benefit duration (BD)The duration of your benefit payments is based on your age when your disability occurs. Your Long Term Disability benefits are payable while you continue to meet the definition of disability. Please refer to your plan document for the duration of benefits under this policy.Definition of disabilityYou are considered disabled when Unum determines that you are under the regular care of a physician, and:• You are limited from performing the duties required of your regular occupation due to sickness or injury and are not working; or• You are working and you have a 20% or more loss in monthly earnings due to sickness or injury.After benefits have been paid for 24 months, your plan’s definition of disability changes. At that time you are considered disabled when Unum determines that, due to the same sickness or injury, you cannot perform the duties of any occupation that you are qualified to do based on your education, training or experience.You must be under the regular care of a physician in order to be considered disabled.The loss of a professional or occupational license or certification does not, in itself, constitute disability.“Substantial and material acts” means the important tasks, functions and operations that are generally required by employers from those engaged in your usual occupation and that cannot be reasonably omitted or modified.Unless the policy specifies otherwise, as part of the disability claims evaluation process, Unum will evaluate your occupation based on how it is normally performed in the national economy, not how work is performed for a specific employer, at a specific location or in a specific region.Recovery Income BenefitUnum will send you the monthly payment if you have been disabled and you satisfy each of the following:• You have satisfied the elimination period for that disability;• You return to your regular occupation full time with the Employer on the earlier of the date your disability ends or the date your benefits cease;• you have a 20% or more loss in your indexed monthly earnings due to the same disability; and• You have received at 3 months of disability payments for that disability under the plan.Recovery income protection benefit payments will end on the earliest of the following:• The date months recovery income protection benefits have been paid; or• The date your current earnings exceed 80% of your indexed monthly earnings.Pre-existing conditionsYou have a pre-existing condition if:• You received medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it in the 3 months just prior to your effective date of coverage; and• The disability begins in the first 12 months after your effective date of coverage.Deductible sources of incomeYour disability benefit may be reduced by deductible sources of income and any earnings you have while you are disabled, including such items as group disability benefits or other amounts you receive or are entitled to receive:• Workers’ compensation or similar occupational benefit laws, including a temporary disability benefit under a workers’ compensation law• State compulsory benefit laws• Automobile liability insurance policy• No fault motor vehicle plan• Third-party settlements• Other group insurance plans• A group plan sponsored by your employer• Governmental retirement system• Salary continuation or sick leave plans, if applicable• Retirement payments• Social Security or similar governmental programsLong Term Disability InsuranceExclusions and limitationsBenefits will not be paid for disabilities caused by, contributed to by, or resulting from:• Intentionally self-inflicted injuries;• Active participation in a riot;• War, declared or undeclared or any act of war;• Commission of a crime for which you have been convicted;• Loss of professional license, occupational license or certification; or• Pre-existing conditions (See the disclosure section to learn more).The loss of a professional or occupational license does not, in itself, constitute disability.Unum will not pay a benefit for any period of disability during which you are incarcerated.The lifetime cumulative maximum benefit for all disabilities due to mental illness is 24 months. Disabilities based primarily on self-reported symptoms are limited to 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments can continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability.Termination of coverageYour coverage under the policy ends on the earliest of the following:• The date the policy or plan is cancelled• The date you no longer are in an eligible group• The date your eligible group is no longer covered• The last day of the period for which you made any required contributions• The last day you are in active employment except as provided under the covered layoff or leave of absence provision.Unum will provide coverage for a payable claim that occurs while you are covered under the policy or plan.Social Security advocacy services are provided by GENEX Services, Inc. or The Advocator Group, LLC. Referral to one of our advocacy partners is determined by Unum.Worldwide emergency travel assistance services are provided by Assist America, Inc. Work-life balance employee assistance program services are provided by HealthAdvocate. Services are available with select Unum insurance offerings. Terms and availability of service are subject to change and prior notification requirements. Service providers do not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.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 C.FP-1 et al. or contact your Unum representative.Underwritten by:Unum Life Insurance Company of America, Portland, Maine© 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
EN-2073 FOR EMPLOYEES (10-22) Unum | Accident InsuranceGrace Funeral Home IncorporatedWho can get coverage? Accident InsuranceHow does it work?Accident Insurance pays a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur off the job. And it includes a range of incidents, from common injuries to more serious events.Why is this coverage so valuable?It can help you with out-of-pocket costs that your medical plan doesn’t cover, like co-pays and deductibles. You’ll have base coverage without medical underwriting. The cost is conveniently deducted from your paycheck. You can keep your coverage if you change jobs or retire. You’ll be billed directly.You If you’re actively at work*Your spouseCan get coverage as long as you have purchased coverage for yourself.Your childrenDependent children from birth until their 26th birthday, regardless of marital or student status.*Employees must be legally authorized to work in the United States and actively working at a U.S. location to receive coverage. See Schedule of benefits for a complete listing of what is covered. What’s included?Be Well BenefitEvery year, each family member who has Accident coverage can also receive $50 for getting a covered Be Well screening test, such as: •Annual exams by a physician include sports physicals, well-child visits, dental and vision exams •Screenings for cancer, including pap smear, colonoscopy •Cardiovascular function screenings •Screenings for cholesterol and diabetes •Imaging studies, including chest X-ray, mammography •Immunizations including HPV, MMR, tetanus, influenzaOrganized Sports BenefitEach family member that has Accident coverage is eligible for a 10% increase in payable benefits within the Injury and Treatment schedule of benefit categories. See disclosures and schedule of benefits for more information.How much does it cost?Your semi-monthly premium Option 1You$5.21You and your spouse$9.63You and your children $13.62Family $18.04
Unum | Accident InsuranceEN-2073 FOR EMPLOYEES (10-22)SCHEDULE OF BENEFITSHospitalizationAdmission $1,000Admission – Hospital ICU (added to Admission)$1,000Daily Stay $300Daily Stay – Hospital ICU (added to Daily Stay)$300Short Stay $200InjuryInjury due to felony & sexual assault$150Organized Sports 10%Burns2nd Degree Burns - At least 5%, but less than 20% of skin surface$5002nd Degree Burns - 20% or greater of skin surface$1,0003rd Degree Burns - Less than 5% of skin surface$2,0003rd Degree Burns - At least 5%, but less than 20% of skin surface$5,0003rd Degree Burns - 20% or greater of skin surface$10,000ConcussionConcussion $200Connective Tissue DamageOne Connective Tissue (tendon, ligament, rotator cuff, muscle)$90Two or more Connective Tissues (tendon, ligament, rotator cuff, muscle)$150DislocationsKnee joint (other than patella)$1,650Ankle bone or bones of the foot (other than toes)$1,650Hip joint $3,375Collarbone (sternoclavicular)$825Elbow joint $500Hand (other than Fingers) $500Lower Jaw $500Shoulder $500Wrist joint $500Collarbone (acromioclavicular and separation)$325Finger or Toe (Digit) $150Kneecap (patella) $500Incomplete Dislocation - Payable as a % of the applicable Dislocations benefit25%Eye InjuryEye Injury $200InjuryFracturesSkull (except bones of Face or Nose), Depressed$4,500Hip or Thigh (femur) $3,375Skull (except bones of Face or Nose), Non-depressed$2,250Vertebrae, body of (other than Vertebral Processes)$1,350Leg (mid to upper tibia or fibula)$1,350Pelvis $1,350Bones of the Face or Nose (other than Lower Jaw, Mandible or Upper Jaw, Maxilla)$675Upper Arm between Elbow and Shoulder (humerus)$675Upper Jaw, Maxilla (other than alveolar process)$675Ankle (lower tibia or fibula)$450Collarbone (clavicle, sternum) or Shoulder Blade (scapula)$450Foot or Heel (other than Toes)$450Forearm (olecranon, radius, or ulna), Hand, or Wrist (other than Fingers)$450Kneecap (patella) $450Lower Jaw, Mandible (other than alveolar process)$450Vertebral Processes $450Rib $450Tailbone (coccyx), Sacrum $450Finger or Toe (Digit) $225Chip Fracture - Payable as a % of the applicable Fractures benefit25%Same bone maximum incurred per accident1 FractureMaximum payable multiplier for multiple bones2 TimesInternal InjuriesInternal Injuries $200LacerationsNo Repair $50Repair Less than 2 inches $150Repair At least 2 inches but less than 6 inches$300Repair 6 inches or greater $600Loss of a DigitOne Digit (other than a Thumb or Big Toe)$750One Digit (a Thumb or Big Toe)$1,125Two or more Digits $1,500InjuryKnee CartilageKnee Cartilage (Meniscus) Injury$150Ruptured or Herniated DiscOne Disc $150Two or more Discs $250RecoveryAcquired Brain Injury $25At-Home Care $100Physician Follow-Up Visits $75Physician Follow-Up Maximum Visits2 VisitsPrescription Drug $25Prescription Benefit Incidence per covered accident1 Per InsuredRehabilitation or Subacute Rehabilitation Unit$100Behavior Health Therapy $20Behavior Health Therapy visits15 DaysTelehealth Service $25Telemedicine Medical Service$25Therapy Services (chiro, speech, PT, occ, acupuncture/alternative)$20Therapy Services Maximum Days15 DaysSurgeryDislocationsDislocation, Surgical Repair - Payable as a % of the applicable Injury benefit100%AnesthesiaEpidural or Regional Anesthesia$100General Anesthesia $250Connective TissueExploratory without Repair $100Repair for One Connective Tissue$800Repair for Two or more Connective Tissues$1,200Eye SurgeryEye Surgery, Requiring Anesthesia$300FracturesFractures, Surgical Repair - Payable as a % of the applicable Injury benefit100%Surgical Repair same bone maximum incurred per accident1 Fracture
Unum | Accident InsuranceEN-2073 FOR EMPLOYEES (10-22)SCHEDULE OF BENEFITSSurgerySurgical Repair same bone maximum payable multiplier for multiple bones2 TimesGeneral SurgeryAbdominal, Thoracic, or Cranial$1,500Exploratory $150Incidence per covered accident1 Per InsuredHernia SurgeryHernia Surgery $150Knee CartilageKnee Cartilage (Meniscus) Exploratory without Repair$150Knee Cartilage (Meniscus) with Repair$750Outpatient Surgical FacilityOutpatient Surgical Facility$300Ruptured or Herniated Disc SurgeryExploratory without Repair $125One Disc $675Two or more Discs $1,000TreatmentOrganized Sports 10%AmbulanceAir $1,000Ground $300Durable Medical EquipmentTier 1 (arm sling, cane, medical ring cushion)$50Tier 2 (bedside commode, cold therapy system, crutches)$100Tier 3 (back brace, body jacket, continuous passive movement, electric scooter)$200Emergency Dental RepairDental Crown $350Dental Extraction $115Filling or Chip Repair $90ImagingTier 1: X-rays or Ultrasound$50Tier 2: Bone Scan, CAT, CT, EEG, MR, MRA, or MRI$200Medical Imaging Incidence allowance covered accident per Tier1 Per Insured Per TierLodgingLodging (per night) $150Prosthetic DeviceOne Device or Limb $750TreatmentTwo or more Devices or Limbs$1,500Skin GraftsFor Burns - Payable as a % of the applicable Burn benefit50%Not Burns - Less than 20% of skin surface$250Not Burns - 20% or greater of skin surface$500TreatmentEmergency Room Treatment $100Injections to Prevent or Limit Infection (tetanus, rabies, antivenom, immune globulin)$50Pain Management Injections (epidural, cortisone, steroid)$100Transfusions $400Transportation (per trip) $100Family Care $50Pet Boarding (per day) $30Treatment in a Physician’s Office or Urgent Care Facility (initial)$75•
EN-2073 FOR EMPLOYEES (10-22)Unum | Accident InsuranceOrganized Sports BenefitThis increased benefit payment will be applied if the covered Accident occurs while playing an organized sport that required formal registration to participate and is officiated by someone certified to act in that capacity. Active employmentYou are considered in active employment if, on the day you apply for coverage, you are being paid regularly for the required minimum 20 hours each week and you are performing the material and substantial duties of your regular occupation. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. New employees have a 30 day waiting period to be eligible for coverage. Please contact your plan administrator to confirm your eligibility date. If enrolling, and eligible for Medicare (age 65+; or disabled) the Guide to Health Insurance for People with Medicare is available at www.medicare.gov/sites/default/files/2022-03/02110-medigap-guide-health-insurance.pdf.Effective date of coverageCoverage becomes effective on the first day of the month in which payroll deductions begin.Exclusions and limitations We will not pay benefits for a claim that is caused by, contributed to by, or occurs as the result any of the following:• committing or attempting to commit a felony;• being engaged in an illegal occupation or activity;• injuring oneself intentionally or attempting or committing suicide, whether sane or not;• active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, Injury as an innocent bystander, or Injury for self-defense;• participating in war or any act of war, whether declared or undeclared;• combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations;• a Covered Loss that occurs while an Insured is legally incarcerated in a penal or correctional institution;• elective procedures, cosmetic surgery, or reconstructive surgery unless it is a result of trauma, infection, or other diseases;• an occupational injury; • any Sickness, bodily infirmity, or other abnormal physical condition or Mental or Nervous Disorders, including diagnosis, treatment, or surgery for it;• Infection. This exclusion does not apply when the infection is due directly to a cut or wound sustained in a Covered Accident;• experimental or investigational procedures;• operating any motorized vehicle while intoxicated;• operating, learning to operate, serving as a crew member of any aircraft or hot air balloon, including those which are not motor-driven, unless flying as a fare paying passenger;• jumping, parachuting, or falling from any aircraft or hot air balloon, including those which are not motor-driven;• travel or flight in any aircraft or hot air balloon, including those which are not motor-driven, if it is being used for testing or experimental purposes, used by or for any military authority, or used for travel beyond the earth’s atmosphere;#practicing for or participating in any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received;• riding or driving an air, land or water vehicle in a race, speed or endurance contest; and• engaging in hang-gliding, bungee jumping, sail gliding, parasailing, parakiting, or BASE jumping.Additionally, no benefits will be paid for a Covered Loss that occurs prior to the Coverage Effective Date.Termination of employee coverageIf you choose to cancel your coverage your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage ends on the earliest of the:• the date this policy is canceled by Unum or your employer;• the date you are no longer in an eligible group;• the date your eligible group is no longer covered;• the date of your death;• the last day of the period any required premium contributions are made;• the last day you are in active employment. However, as long as premium is paid as required, coverage will continue• in accordance with the Continuation of your Coverage during Absences provision; or• if you elect to continue coverage for you, your Spouse, and Children under Portability of Accident Insurance. We will provide coverage for a Payable Claim that occurs while you are covered under this certificateAccident InsuranceTHIS IS A LIMITED BENEFITS POLICYThis 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 certificate form GAC16-1 et al. and GAC16-2, GAC16-2-IL, GAC16-3-NH, GAC16-2-OH, and GAC16-2-UT. Policy Form GAP16-1 et al. in all states, GAP16-3-NH in New Hampshire or contact your Unum representative.Unum complies with state civil union and domestic partner laws when applicable.Underwritten by: Unum Insurance Company, Portland, Maine© 2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
Unum | Critical Illness Insurance EN-2050 FOR EMPLOYEES (8-22) Grace Funeral Home IncorporatedWhy should I buy coverage now? • It’s more affordable when you buy it through your employer and the premiums are conveniently deducted from your paycheck. • Coverage is portable. You may take the coverage with you if you leave the company or retire. You’ll be billed at home. Be Well BenefitEvery year, each family member who has Critical Illness coverage can also receive a payment for getting a covered Be Well Benefit screening test, such as:• Annual exams by a physician include sports physicals, well-child visits, dental and vision exams• Screenings for cancer, including pap smear, colonoscopy• Cardiovascular function screenings• Screenings for cholesterol and diabetes• Imaging studies, including chest X-ray, mammography• Immunizations including HPV, MMR, tetanus, influenzaWho can get coverage?You:Choose $15,000 or $30,000 of coverage with no medical underwriting to qualify if you apply during this enrollment.Your spouse:Spouses can only get 50% of the employee coverage amount as long as you have purchased coverage for yourself.Your children:Children from live birth to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. The diagnosis must occur after the child’s coverage effective date.How does it work?If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want.Why is this coverage so valuable? • The money can help you pay out-of-pocket medical expenses, like co-pays and deductibles. • You can use this coverage more than once. Even after you receive a payout for one illness, you’re still covered for the remaining conditions and for the reoccurrence of any critical illness with the exception of skin cancer. The reoccurrence benefit can pay 100% of your coverage amount. Diagnoses must be at least 180 days apart or the conditions can’t be related to each other.What’s covered?Critical illnesses• Heart attack• Stroke• Major organ failure• End-stage kidney failure• Coronary artery disease Major (50%): Coronary artery bypass graft or valve replacement Minor (10%): Balloon angioplasty or stent placementCancer conditions• Invasive cancer — all breast cancer is considered invasive• Non-invasive cancer (25%)• Skin cancer — $500Progressive diseases Supplemental conditions• Amyotrophic Lateral Sclerosis (ALS)• Dementia, including Alzheimer’s disease• Multiple Sclerosis (MS)• Parkinson’s disease• Functional loss• Loss of sight, hearing or speech• Benign brain tumor• Coma• Permanent Paralysis• Occupational HIV, Hepatitis B, C or D• Infectious Diseases (25%)Please refer to the certificate for complete definitions about these covered conditions. Coverage may vary by state. See exclusions and limitations. Critical Illness Insurance
Unum | Critical Illness Insurance EN-2050 FOR EMPLOYEES (8-22) Active employment: You are considered in active employment if, on the day you apply for coverage, you are being paid regularly for the required minimum 20 hours each week and you are performing the material and substantial duties of your regular occupation. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. New employees have a 30 day waiting period to be eligible for coverage. Please contact your plan administrator to confirm your eligibility date.If enrolling, and eligible for Medicare (age 65+; or disabled) the Guide to Health Insurance for People with Medicare is available at www.medicare.gov/sites/default/files/2022-03/02110-medigap-guide-health-insurance.pdf. Semi-monthly costsAgeEmployee coverage: $15,000 Spouse coverage: $7,500 Be Well benefit: $50Employee Spouseunder 25 $2.59 $1.8725 - 29 $3.26 $2.2130 - 34 $4.09 $2.6235 - 39 $5.51 $3.3440 - 44 $7.31 $4.2345 - 49 $9.64 $5.4050 - 54 $13.24 $7.2055 - 59 $18.18 $9.6760 - 64 $25.91 $13.5465 - 69 $37.83 $19.5070 - 74 $57.71 $29.4375 - 79 $82.84 $42.0080 - 84 $117.41 $59.2985+ $186.94 $94.05Semi-monthly costsAgeEmployee coverage: $30,000 Spouse coverage: $15,000 Be Well benefit: $100Employee Spouseunder 25 $5.17 $3.7525 - 29 $6.52 $4.4230 - 34 $8.17 $5.2535 - 39 $11.02 $6.6740 - 44 $14.62 $8.4745 - 49 $19.27 $10.8050 - 54 $26.47 $14.4055 - 59 $36.37 $19.3560 - 64 $51.82 $27.0765 - 69 $75.67 $38.9970 - 74 $115.42 $58.8775 - 79 $165.67 $84.0080 - 84 $234.82 $118.5785+ $373.87 $188.10
Unum | Critical Illness Insurance EN-2050 FOR EMPLOYEES (8-22) Your paycheck deduction will include the cost of coverage and the Be Well Benefit. Actual billed amounts may vary.Pre-existing conditionsWe will not pay benefits for a claim when the Covered Loss occurs in the first 12 months following an Insured’s Coverage Effective Date and the Covered Loss is caused by, contributed to by or occurs as the result of any of the following:•a Pre-existing Condition; or•complications arising from treatment or surgery for, or medications taken for, a Pre-existing Condition.An Insured has a Pre-existing Condition if, within the 12 months just prior to their Coverage Effective Date, they have an injury or sickness, whether diagnosed or not, for which:•medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;•drugs or medications were taken, or prescribed to be taken during that period; or•symptoms existed. The Pre-existing Condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage Effective Date refers to the date any initial coverage or increases in coverage become effective.Pre-existing Condition requirements are not applicable to children who are newly acquired after your Coverage Effective Date.Date of diagnosis must be after the coverage effective date.Exclusions and limitationsWe will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following: •committing or attempting to commit a felony; being engaged in an illegal occupation or activity; injuring oneself intentionally or attempting or committing suicide, whether sane or not; active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or injury for self-defense; participating in war or any act of war, whether declared or undeclared; combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations; voluntary use of or treatment for voluntary use of any prescription or non-prescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician; being intoxicated; and a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution.Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the Coverage Effective Date.End of employee coverageIf you choose to cancel your coverage your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage ends on the earliest of the: date this policy is canceled by Unum or your employer; date you are no longer in an eligible group; date your eligible group is no longer covered; date of your death; last day of the period any required premium contributions are made; or last day you are in active employment. However, as long as premium is paid as required, coverage will continue in accordance with the Continuation of your Coverage during Absences provision or if you elect to continue coverage for you, your Spouse, and Children under Portability of Critical Illness Insurance.Unum will provide coverage for a payable claim that occurs while you are covered under this certificate.THIS INSURANCE PROVIDES LIMITED BENEFITSThis 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 imitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 or the Certificate Form GCIC16-1 or contact your Unum representative.Underwritten by: Unum Insurance Company, Portland, Maine© 2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
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EN-372230 FOR EMPLOYEES (10-22) Unum | Hospital Insurance Grace Funeral Home IncorporatedWho can get coverage?You:If you’re actively at work.Your spouse:Can get coverage as long as you have purchased coverage for yourself.Your children:Dependent children newborn until their 26th birthday, regardless of marital or student statusEmployee must purchase coverage for themselves in order to purchase spouse or child coverage. Employees must be legally authorized to work in the United States and actively working at a U.S. location to receive coverage. Please refer to the certificate for complete definitions about these covered conditions. Coverage may vary by state. See exclusions and limitations.This plan has a pre-existing condition limitation. See the disclosures for more information.If enrolling, and eligible for Medicare (age 65+; or disabled) the Guide to Health Insurance for People with Medicare is available at www.medicare.gov/sites/default/files/2022-03/02110-medigap-guide-health-insurance.pdfHow does it work?Hospital Insurance helps covered employees and their families cope with the financial impacts of a hospitalization. You can receive benefits when you’re admitted to the hospital for a covered accident, illness or childbirth.Why is this coverage so valuable? •The money is paid directly to you — not to a hospital or care provider. The money can also help you pay the out-of-pocket expenses your medical plan may not cover, such as co-insurance, co-pays and deductibles. •You get affordable rates when you buy this coverage at work. •The cost is conveniently deducted from your paycheck. •The benefits in this plan are compatible with a Health Savings Account (HSA). •You may take the coverage with you if you leave the company or retire, without having to answer new health questions. You’ll be billed directly.Be Well BenefitEvery year, each family member who has Hospital coverage can also receive $50 for getting a covered Be Well screening test, such as: •Annual exams by a physician include sports physicals, wellchild visits, dental and vision exams •Screenings for cancer, including pap smear, colonoscopy •Cardiovascular function screenings •Screenings for cholesterol and diabetes •Imaging studies, including chest X-ray, mammography •Immunizations including HPV, MMR, tetanus, influenzaSince our founding in 1848, Unum has been a leader in the employee benefits business. Innovation, integrity and an unwavering commitment to our customers has helped us become a global leader in financial protection benefits.Hospital InsuranceHospital Insurance can pay benefits that help you with the costs of a covered hospital visit.How much does it cost?Your semi-monthly premiumYou $15.07You and your spouse$29.59You and your children $19.24Family $33.76
EN-372230 FOR EMPLOYEES (10-22)Unum | Hospital Insurance HospitalHospital AdmissionPayable for a maximum of 1 day per year$1,500Hospital Daily StayPayable per day up to 365 days $100Other BenefitsWell Child BenefitPayable for maximum of 4 days per child before child reaches age 1$50Exclusions and LimitationsHospital insurance filed policy name is Group Hospital Indemnity Insurance PolicyActive employmentYou are considered in active employment if, on the day you apply for coverage, you are being paid regularly for the required minimum 20 hours per week and you are performing the material and substantial duties of your regular occupation. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. New employees have a 30 day waiting period to be eligible for coverage. Please contact your plan administrator to confirm your eligibility date.Pre-existing ConditionWe will not pay benefits for a claim when the Covered Loss occurs in the first 12 months following an Insured’s Coverage Effective Date and the Covered Loss is caused by, contributed to by, or resulting from any of the following:• a Pre-existing Condition; or• complications arising from treatment or surgery for, or medications taken for, a Pre-existing Condition.An Insured has a Pre-existing Condition if, within the 12 months just prior to their Coverage Effective Date, they have a a disease or physical condition whether diagnosed or not, for which:• medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; or• drugs or medications were taken, or prescribed to be taken during that period; or• symptoms existed.Pre-existing Condition requirements are not applicable to:• Children who are newly acquired after your Coverage Effective Date.The Pre-existing Condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage Effective Date refers to the date any initial coverage or increases in coverage become effective.Exclusions and limitationsWe will not pay benefits for a claim that is caused by, contributed to by, or resulting from any of the following:• participation in a felony ;• being engaged in an illegal occupation;• injuring oneself intentionally or attempting or committing suicide, whether sane or not;• participation in a riot, or insurrection. This does not include civil commotion or disorder, Injury as an innocent bystander, or Injury for self-defense;• participating in war or any act of war, whether declared or undeclared;• combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations while coverage is suspended and no premiums are collected;• being legally intoxicated;• a Covered Loss that occurs while an Insured is legally incarcerated in a penal or correctional institution;• elective procedures, cosmetic surgery, or reconstructive surgery unless it is a result of organ donation, trauma, infection, gender identity disorders, or other diseases;• treatment for dental care or dental procedures, unless treatment is the result of a Covered Accident; • any Admission of a newborn Child immediately following Childbirth unless the newborn is Injured or Sick;• voluntary use of illegal drugs; and • Mental or Nervous Disorders. This exclusion does not include dementia if it is a result of:• stroke, Alzheimer’s disease, trauma, viral infection; or• other conditions which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment.Additionally, no benefits will be paid for a Covered Loss that occurs prior to the Coverage Effective Date.End of employee coverageIf you choose to cancel your coverage under this certificate, your coverage will end on the first of the month following the date you provide notification to your Employer.Otherwise, your coverage under this certificate ends on the earliest of:• the date the Policy is cancelled by us or your Employer;• the date you are no longer in an Eligible Group;• the date your Eligible Group is no longer covered;• the date of your death;• the last day of the period any required premium contributions are made; or• the last day you are in Active Employment.However, as long as premium is paid as required, coverage will continue in accordance with the Continuation of your Coverage During Absences provision or if you elect to continue coverage for you under Portability of Hospital Indemnity Insurance.We will provide coverage for a Payable Claim that occurs while you are covered under this certificate.THIS INSURANCE PROVIDES LIMITED BENEFITSThis coverage is a supplement to health insurance. It is not a substitute for comprehensive health insurance and does not qualify as minimum essential health coverage as defined in federal law. Some states may require individuals to have comprehensive medical coverage before purchasing hospital insurance.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 definitions of coverage and availability, please refer to Certificate Form GHIC16-1 and policy form GHIP16-1 or contact your Unum representative.Unum complies with all state civil union and domestic partner laws when applicable.Underwritten by: Unum Insurance Company, Portland, Maine© 2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.