Extension of the Comprehensive Benefit

The term extension of benefits means that under certain circumstances some benefits will be paid for a totally disabled person for up to a maximum of 12 months after his coverage terminates. The extension of benefits rules apply separately to you and each of your dependents.

These extension of benefits provisions do not apply to any person who is covered under Medicare or under any other welfare fund, any group plan, or any plan sponsored by any employer at the time his eligibility under this Plan terminates.

Rules Governing an Extension of Benefits

  1. To qualify for an extension of benefits, a person must be totally and continuously disabled at the time his coverage terminates, the injury or sickness causing the total disability must have happened while the person was covered under the Plan, and the person must remain totally disabled (see page 81 for the definition of totally disabled).
  2. The person will be covered under an extension only as long as he has not received Comprehensive Benefits totaling his Comprehensive Benefit lifetime or calendar year maximum benefit; the Restoration of Lifetime Maximum Benefit provision does not apply to a person who is being covered under an extension of benefits; and benefits will be payable on behalf of the person only to the extent that benefits would have been payable on his behalf if his coverage had not terminated.
  3. The extension will apply only to expenses incurred for treatment of the sickness or injury (and related conditions) that was the primary cause of the person's total disability.
  4. An extension of benefits for a person will terminate on the first to occur of the following dates:
    1. The date the person is no longer totally disabled;
    2. The date the person has received his Comprehensive Benefit lifetime maximum benefit;
    3. The date the person becomes covered under Medicare or under any other welfare fund or any group plan or any plan sponsored by an employer; or
    4. The end of the 12-month period following the date his coverage terminated.