Life and AD&D
 

Disability and Terminal Illness Benefits 

A portion of your Basic and Optional Employee Term Life Insurance coverage may be continued if you become totally disabled. You may also be eligible for an accelerated death benefit if you become terminally ill while covered by the plan.

TOTAL DISABILITY EXTENSION
Your Basic and Optional Employee Term Life Insurance coverage may be extended at no cost to you if: 

  • you become totally disabled; and
  • your total disability starts before you reach age 60. 

This total disability coverage is provided for covered Tufts Health Plan employees only. It is not available to your dependents. 

Extension Period
The coverage extension period will end one year after your total disability started, unless you provide the Insurance Company with written proof that: 

  • you have been totally disabled for a continuous period of at least 9 months; and
  • you provide the insurance company with proof of your total disability within 12 months of the date that your disability began. 

If you meet the above conditions, the Insurance Company will extend your life insurance coverage for successive one year periods, beginning on the date that you provide the Insurance Company with the written proof described above. You can obtain the required disability extension request forms from Human Resources. 

Total Disability: For purposes of determining your eligibility for this coverage extension, you are considered to be “totally disabled” if you are unable to perform all the material duties of your regular occupation. 

Continued Extension: In order to qualify for the continued extension of your coverage, you must provide the Insurance Company with written proof of your continued total disability. This proof may be required once each year. 

Death Benefit
In the event of your death during the coverage extension period, the plan will pay a death benefit to your beneficiary that is equal to the amount of life insurance coverage that you had in effect at the time you became totally disabled (subject to any applicable reduction because of age, retirement, payment of an accelerated benefit, or change in class). 

Total Disability: For purposes of determining your eligibility for this death benefit, you are considered to be “totally disabled” if, due to sickness and/or injury, you are unable to perform all the material duties of your regular occupation, or are receiving disability benefits under another Company-sponsored plan. 

Termination of Coverage
Your extended coverage will end on the earliest of the date that: 

  • your total disability ends;
  • you reach age 65;
  • you fail to provide any required proof of your total disability; or
  • you fail to submit to a medical examination required by the Insurance Company.          
All requests for total disability benefits are subject to approval by the Insurance Company. You will be provided with a written notice of the Insurance Company’s decision.

TERMINAL ILLNESS BENEFIT
A terminal illness benefit may be payable if you contract a terminal illness while covered by Basic and Optional Employee Term Life Insurance. This benefit may also be payable for your spouse or domestic partner who contracts a terminal illness while covered by Optional Employee Term Life Insurance. 

Terminal Illness
For plan purposes, a covered person is considered to be terminally ill if he or she is diagnosed by a physician to have a prognosis of 12 months or less to live. The plan also requires that the following proof of terminal illness be submitted: 

  • written diagnosis and prognosis by two physicians licensed to practice in the United States; and
  • supporting evidence satisfactory to the Insurance Company, including (but not limited to) radiological, histological, or laboratory reports. 

Amount of Benefit
The amount of the terminal illness benefit is 75% of the life insurance benefit in effect for you or your spouse/domestic partner as of the date that you or your spouse/domestic partner is determined by the Insurance Company to be terminally ill.

The terminal illness benefit: 

  • is payable only once in an insured person’s lifetime;
  • will reduce the death benefit otherwise payable for life insurance; and
  • is subject to a $250,000 maximum 

Following the covered person’s death, the remaining amount of that person’s life insurance coverage will be paid to his or her beneficiary. 

If you wish to apply for the total disability extension or the terminal illness benefit, you can obtain the necessary application forms by calling Tufts Health Plan Human Resources at 617-972-9400 or writing to: 

Cigna Group Insurance
Pittsburgh Claims Office
1600 West Carson Street
Suite 300
Pittsburgh, PA 15219
Toll-Free Phone Number: 1-800-238-2125