Fortis Benefits
Summary of Long Term Disability

This summary is intended to help understand the group insurance policy. It does not change any of its provisions.

The policy pays a monthly benefit designed to partly replace income lost during periods of disability that result from injury, sickness, or pregnancy.

A covered person who remains disabled during the qualifying period may become eligible to receive a monthly benefit based on monthly pay. These benefits are payable while the disability continues, or until the maximum benefit period ends. Both the qualifying period and the maximum benefit period are explained in the Schedule.

If a disabled person receives benefits from other sources, Fortis may reduce the benefits payable under the policy. There are also certain disabilities for which benefits are not payable or are limited.

Group Policy Schedule

Eligible Classes: Each active, regular, full-time employee of the EOC working in the United States of America, except any temporary or seasonal workers.

Entry Date: An eligible person will become insured on the first of the month occurring on or after the day all eligibility requirements are met.

Schedule

Schedule Amount: 66 2/3% of monthly pay subject to a maximum schedule Amount of $5,000 per month.

For each day of a period less than a full month, the Schedule Amount will be 1/30th of the amount determined above.

Monthly pay means your basic monthly pay form the EOC and is determined on the determination date occurring on or before the day the period of disability starts. Bonuses, overtime and other compensation not considered by Fortis as basic wages or salary are not included. However, a monthly average of any commissions received during the prior full calendar year will be included. If you have been eligible to receive commissions for less than a full calendar year, monthly pay will include a monthly average of commissions received during the time you were eligible to receive them.

If you are an hourly employee, monthly pay will be based on your hourly rate of pay, but not more than 40 hours per week.

The determination date is the first of the month occurring after you become insured under the policy. Before the first of the month, the determination date is your effective date of insurance.

Minimum Benefit: If a covered person normally works at least 30 hours per week before the period of disability starts, the minimum monthly benefit will be $100. For any part of a period of disability less than a full month, the minimum benefit is 1/30 of $100 for each day of disability after the qualifying period ends.

Qualifying Period: 180 days
Maximum Interruption During Qualifying Period: 15 days

Maximum Benefit Amount: Fortis will not pay benefits beyond the maximums sated below, based on the person’s age on the day the period of disability started.

Age	Maximum Benefit Period
Before 60	the day before retirement age*
60 but before 65	the day before retirement age* or 36 month of disability**
65 but before 68	24 months of disability**
68 but before 70	18 months of disability**
70 but before 72	15 months of disability**
72 or more	12 months of disability**

*Retirement age means the Social Security Normal Retirement Age as stated in the 1983 revision of the United States Social Security Act.
**following the end of the qualifying period.

This is a summary of benefits only.
Please refer to your plan's booklet or contact Human Resources for full details of coverage and eligibility.