When You Are Eligible For a Monthly Benefit


You are eligible for a Monthly Benefit after:

A Monthly Benefit will become payable once all of these requirements are met.

The treatment and services you receive for you Disability must be provided pursuant to a written plan of care developed by a Licensed Health Care Practitioner.

If you have an existing loss of ADLs or Severe Cognitive Impairment on your effective date of coverage that loss or impairment will only be eligible for coverage if you recover from that loss or impairment. We must receive acceptable proof of your ADL or cognitive recovery, such as a Physician's statement or an assessment.

Amount of Monthly Benefit

The amount of your monthly benefit will be based on the coverage options you chose from the SUMMARY OF BENEFITS and the place of residence used for long term care. See your SCHEDULE OF LONG TERM CARE BENEFITS form to determine the amount we will pay you each month.

If your plan includes Professional Home Care Services, the benefit payment will be based on the number of days you receive these services each month.

A monthly benefit payable for less than one month will be paid at the rate of 1/30th of the monthly benefit amount for each day you are eligible for a monthly benefit.

When Monthly Benefits are Paid

Unum will send you a lump sum payment to cover the period between the day you became eligible for monthly payments and the day you were approved for these payments. Unum will then send you a payment each month for days you were eligible to receive benefits during the prior month.

When Monthly Benefit Payments End

We will continue monthly benefit payments until the earliest of the following dates:

Waiver of Premium

Once benefits become payable, there will be no more cost for your coverage as long as you are Disabled. If you do not receive Professional Home Care Services for a period of 30 consecutive days, premium payments will again become due. If benefits are no longer payable, you must resume premium payments to continue your coverage. Premiums are not waived while you are receiving a payment for Respite Care.

Recurrent Disability

You will not have to complete a new Elimination Period if you have become Disabled again after the date we stopped making monthly benefit payments to you for your previous Disability.

Respite Care Benefits

If you are eligible for a home care benefit but are not yet receiving monthly payments because you: ** have not yet completed the Elimination Period; or ** have completed the Elimination Period but have chosen to postpone receipt of benefits in order to preserve your Lifetime Maximum Amount

we will pay a benefit equal of 1/30th of your home care benefit for each day that you receive Respite Care up to a maximum of 15 days per calender year.

Payments made to you for Respite Care will reduce your Lifetime Maximum Amount.

Respite Care may be provided to you by: ** a formal caregiver, such as a Home Health Care Provider, an Adult Day Care Facility, a registered nurse, a licensed practical nurse, etc., or ** an informal caregiver such as your friends or relatives.

Bed Reservation Benefit

If you are receiving a Long Term Care Facility or Assisted Living Facility monthly benefit and your stay in the Facility is interupted because you are hospitalized, we will continue to pay the monthly benefit if a charge is made to reserve your accommadations in the Facility.

If your stay is interrupted because you are hospitalized while you are completing your Elimination Period, such days will be used to help satisfy this period.

Bed Reservation days will be limited to 15 days per calender year.

Inflation Protection

Uncapped Compound Growth Inflation Protetion Option

If you have chosen this option, your Monthly Benefit will increase each year on January 1st by 5% of the Monthly Benefit in effect on that date. As long as your coverage remains in effect, inflation increases will occur automatically for your Monthly Benefit Amount and Lifetime Maximum Amount as shown in the SUMMARY of BENEFITS, regardless of your health or whether or not you are Disabled. Your premium will not increase due to automatic increases in these amounts.

An example of a 5% uncapped compound growth inflation protection increase is:

An LTC Facility Monthly Benefit amount of $1,000 will be increased: ** by 5% to $1,050 on January 1st of the next calender year; ** by 5% of $1,050 to $1,102.50 on the next January 1st; and ** by 5% of the previous benefit amount on each following January 1st.

Contingent Nonforfeiture Benefit

If your premium rates increase to a level which results in a cumulative increase of your annual premium equal to or exceedng the percentage of your initial annual premium shown in the chart below, based on issue age, you may choose to do one of the following: ** continue to pay the required premium; ** reduce your benefits provided by the current coverage without a requiredment of underwriting so that your required premium payments are not increased; ** elect to convert your coverage within 120 days of the premium increase effective date to a paid-up status with the Contingent Nonforfeiture Benefit; or ** terminate your coverage within 120 days of the premium increase effective date and be automatically converted to the Contingent Nonforfeiture Benefit.

The percentage increase in premium does not include increases to premium due to changes to your Long Term Care insurance coverage.

If you stop making premium payments under items 3 or 4, this means that your coverage will continue automatically with the same level of benefits, except for a reduction in your Lifetime Maximum Amount. Your Lifetime Maximum Amount under this Contingent Nonforfeiture Benefit will be equal to the total premium paid up to the date you stopped paying premiums.

In no event will your Lifetime Maximum Amount: ** be less than one Long Term Care Facility Benefit payment amount; ** exceed that which you have been paid had you not stopped paying premiums.

If your coverage contains an inflation protection benefit and continues under the Contingent Nonforfeiture Benefit, no inflation protection increases will be made after the end of the period for which premiums were last remitted to Unum for your coverage.

Triggers for a Substantial Premium Increase

Issue Age Percent Increase Over Initial Premium
29 & under 200%
30-34 190%
35-39 170%
40-44 150%
45-49 130%
50-54 110%
55-59 90%
60 70%
61 66%
62 62%
63 58%
64 54%
65 50%
66 48%
67 46%
68 44%
69 42%
70 40%
71 38%
72 36%
73 34%
74 32%
75 30%
76 28%
77 26%
78 24%
79 22%
80 20%
81 19%
82 18%
83 17%
84 16%
85 15%
86 14%
87 13%
88 12%
89 11%
90 & over 10%