| 2007 PEBB Long Term Care Insurance |
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| How does the plan work? |
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Long term care insurance (LTC) covers care for substantial assistance with activities of daily living. Coverage is available for PEBB members and their enrolled family members. UnumProvident provides PEBB’s LTC. You must self pay for this coverage; the state does not contribute toward this benefit.
Coverage provides a monthly benefit based on the amount of coverage purchased. You use the money to meet the needs that you decide are most important. You never need to submit a record of your expenses, and you receive the full benefit payment even if it is larger than your expenses.
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| Who is eligible? |
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- Eligible employees
- Spouses or domestic partners
- Parents and grandparents of the employee or of the employee’s spouse or domestic partner
- Adult siblings or adult children of the employee or the employee’s spouse or domestic partner
- Non-Medicare eligible retirees and retirees’ spouse or domestic partner.
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| How do we enroll? |
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Applicants may enroll in, change or cancel long term care insurance at any time during the year; however:
- Newly eligible employees can enroll for a $4,000 monthly benefit with a benefit duration of six years as a guarantee issue within 60 days of their hire date. Application beyond this 60-day period requires submission of a medical history statement for review by the plan’s underwriting.
- For $5,000 or $6,000 monthly benefit or unlimited duration coverage, all individuals, including newly eligible employees, must complete a medical history statement.
- Family member enrollment is subject to medical underwriting at all times.
To obtain an enrollment kit, contact your agency or PEBB. Or visit the UnumProvident Web site for PEBB member enrollment.
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| When is coverage effective? |
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Newly eligible employees enrolling in guarantee issue within 60 days of their eligibility date will have an effective date of the first of the month following submission of the forms or the eligibility dates, whichever is later.
Enrollments requiring medical underwriting are effective the first of the month following approval by UnumProvident.
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| What is covered? |
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Base Plan
- Facility monthly benefit amount : $1,000 for three years
- Long term care in assisted living facility, adult foster care home and residential care facility at 60 percent of facility benefit amount
- Professional home care at 50 percent of facility benefit amount
- Elimination or waiting period: 90 days (satisfied only once per lifetime).
Additional Plan Options
- Facility monthly benefit amount: $2,000, $3,000, $4,000, $5,000* or $6,000*
- Benefit duration: three years, six years or unlimited*
- Total home care: 50 percent of facility benefit amount
- Inflation protection: Five percent simple uncapped yearly.
*Above the guarantee issue limits. Requires completion of UnumProvident’s medical underwriting process.
Lifetime Maximum:
The lifetime maximum is the maximum benefit dollar amount UnumProvident will pay over the life of your coverage. This dollar amount is based on the facility benefit amount and the benefit duration.
For example, if you choose $3,000 facility benefit amount and three-year duration, your lifetime maximum is calculated as follows: $3,000 per month x 12 months x 3 years = $108,000 Lifetime Maximum
Plan Features
- Guaranteed renewable for as long as you pay your premiums on time
- Waiver of premium: once you qualify for benefits, satisfy your elimination period, and are receiving benefits, your premium payments are waived
- Tax-free benefit: premium payments are not taxed.
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| When will I receive benefits? |
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You must meet one the following criteria:
Require substantial assistance with two out of six activities of daily living (ADLs) for more than 90 days (elimination period) (ADLs are bathing, toileting, dressing, transferring, continence, eating;
Or
Suffer severe cognitive impairment that requires substantial supervision
And
The ADL loss must be expected to last for a period of at least 90 days, as certified by a physician. (Recertification must occur every 12 months by a physician to confirm that the disability still exists.);
And
Care must be provided pursuant to a plan of care prescribed by a licensed healthcare practitioner.
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| How will I receive care? |
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In a long term care facility, an assisted living facility, an adult foster care home or a residential care facility with an Alzheimer’s care endorsement;
Or
At home, through professional home care, where care can be provided through a licensed home healthcare provider, or total home care, where care can be provided by anyone you choose, including family and friends.
The plan also covers respite care.
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| What about existing conditions |
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For guarantee issue coverage, the pre-existing condition exclusion applies. A pre-existing condition is any condition that exists for which you have received medical treatment, consultation, care or services (including diagnostic measures), or took drugs or medicines that were prescribed for the condition, during the six month period right before coverage begins.
UnumProvident will not make any payments to you for disability caused by, contributed to, or resulting from a pre-existing condition, and that begins during the first six months after your coverage begins.
For long term care definitions and more information go to UnumProvident's Web site.
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| What are the premium rates? |
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2004 Long-term Care Insurance Rates
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Rates shown are for $1,000 Monthly Faciity Benefit. You may choose from $1,000 - $6,000 in Facility monthly Benefit
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(monthly Premium = monthly rate for plan chosen X facility monthly benefit amount / 1,000)
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Plan 1
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Plan 2
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Plan 3
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Plan 4
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Long Term Care Facility
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Long Term Care Facility
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Long Term Care Facility
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Long Term Care Facility
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Professional Home Care
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Professional Home Care
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Professional Home Care
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Professional Home Care
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Total Home Care
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Simple Inflation Uncapped
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Total Home Care
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Simple Inflation Uncapped
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Benefit Duration
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3 YR
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6 YR
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Unlim
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3 YR
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6 YR
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Unlim
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3 YR
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6 YR
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Unlim
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3 YR
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6 YR
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Unlim
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AGE
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18-30
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2.20
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2.90
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4.00
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3.40
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4.50
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6.40
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3.70
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4.90
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6.80
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5.50
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7.40
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10.50
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31
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2.20
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3.00
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4.00
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3.40
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4.60
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6.50
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3.80
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5.00
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6.90
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5.60
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7.60
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10.70
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32
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2.20
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3.00
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4.20
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3.40
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4.70
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6.60
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3.80
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5.20
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7.20
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5.70
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7.80
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11.10
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33
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2.30
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3.10
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4.20
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3.50
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4.80
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6.70
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4.00
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5.50
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7.30
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6.00
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8.10
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11.40
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34
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2.40
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3.20
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4.30
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3.60
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4.90
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6.90
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4.20
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5.60
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7.60
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6.20
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8.40
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11.70
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35
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2.50
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3.30
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4.50
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3.70
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5.10
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7.10
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4.30
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5.90
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7.90
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6.40
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8.70
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12.20
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36
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2.50
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3.40
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4.60
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3.80
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5.20
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7.30
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4.50
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6.10
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8.10
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6.60
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9.00
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12.50
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37
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2.60
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3.60
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4.80
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3.90
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5.40
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7.60
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4.70
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6.40
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8.60
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6.90
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9.40
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13.10
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38
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2.80
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3.70
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4.90
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4.10
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5.60
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7.80
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5.00
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6.70
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8.80
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7.20
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9.80
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13.60
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39
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2.90
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3.80
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5.20
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4.30
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5.80
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8.20
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5.20
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6.90
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9.20
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7.50
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10.10
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14.10
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40
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3.00
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4.00
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5.40
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4.50
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6.10
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8.50
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5.40
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7.20
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9.60
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7.80
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10.50
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14.70
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41
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3.10
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4.10
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5.60
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4.70
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6.30
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8.90
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5.70
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7.50
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10.10
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8.20
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11.00
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15.30
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42
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3.30
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4.40
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5.80
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4.90
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6.60
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9.20
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5.90
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7.90
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10.50
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8.50
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11.60
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16.00
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43
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3.40
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4.60
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6.10
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5.10
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6.90
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9.60
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6.20
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8.20
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11.00
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8.90
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12.00
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16.60
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44
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3.60
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4.80
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6.40
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5.30
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7.20
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10.10
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6.50
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8.70
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11.50
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9.30
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12.70
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17.40
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45
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3.80
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5.10
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6.70
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5.60
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7.60
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10.60
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6.90
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9.10
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12.10
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9.80
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13.20
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18.30
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46
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3.90
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5.30
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7.10
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5.90
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8.00
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11.20
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7.10
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9.50
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12.50
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10.20
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13.80
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19.00
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47
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4.10
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5.60
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7.40
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6.20
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8.50
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11.80
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7.40
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9.90
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13.00
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10.60
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14.50
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20.00
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48
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4.40
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5.90
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7.80
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6.60
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9.00
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12.50
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7.80
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10.40
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13.70
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11.30
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15.30
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21.10
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49
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4.60
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6.10
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8.10
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6.90
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9.40
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13.10
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8.10
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10.80
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14.30
|
11.80
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16.00
|
22.10
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50
|
4.80
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6.40
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8.60
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7.30
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10.00
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14.00
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8.50
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11.30
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14.90
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12.40
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16.90
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23.30
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51
|
5.10
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6.80
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9.00
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7.80
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10.50
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14.80
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9.00
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11.90
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15.70
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13.10
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17.70
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24.60
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52
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5.40
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7.20
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9.50
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8.30
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11.20
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15.70
|
9.50
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12.50
|
16.40
|
13.80
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18.70
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25.80
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|
53
|
5.80
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7.60
|
10.10
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8.80
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11.90
|
16.70
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10.00
|
13.10
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17.20
|
14.60
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19.70
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27.40
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|
54
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6.10
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8.10
|
10.60
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9.30
|
12.70
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17.70
|
10.40
|
13.70
|
18.00
|
15.20
|
20.70
|
28.70
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|
55
|
6.50
|
8.60
|
11.10
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9.90
|
13.50
|
18.70
|
11.00
|
14.50
|
18.70
|
16.10
|
21.70
|
29.80
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|
56
|
6.90
|
9.10
|
11.90
|
10.50
|
14.40
|
20.00
|
11.60
|
15.30
|
19.90
|
16.90
|
23.00
|
31.80
|
|
57
|
7.40
|
9.80
|
12.70
|
11.30
|
15.40
|
21.40
|
12.40
|
16.30
|
21.00
|
18.00
|
24.40
|
33.70
|
|
58
|
7.90
|
10.50
|
13.60
|
12.10
|
16.50
|
23.00
|
13.10
|
17.20
|
22.20
|
18.90
|
25.80
|
35.60
|
|
59
|
8.60
|
11.20
|
14.60
|
13.00
|
17.70
|
24.60
|
14.00
|
18.40
|
23.50
|
20.30
|
27.50
|
37.90
|
|
60
|
9.30
|
12.10
|
15.60
|
13.90
|
18.90
|
26.40
|
15.00
|
19.40
|
25.00
|
21.60
|
29.10
|
40.20
|
|
61
|
10.10
|
13.20
|
17.00
|
15.00
|
20.70
|
28.80
|
16.20
|
21.10
|
27.10
|
23.10
|
31.60
|
43.50
|
|
62
|
11.10
|
14.50
|
18.60
|
16.40
|
22.50
|
31.30
|
17.70
|
22.90
|
29.20
|
25.00
|
34.10
|
46.90
|
|
63
|
12.20
|
15.90
|
20.30
|
17.80
|
24.50
|
34.10
|
19.10
|
24.90
|
31.60
|
26.90
|
36.80
|
50.70
|
|
64
|
13.40
|
17.40
|
22.10
|
19.40
|
26.70
|
37.10
|
20.80
|
27.00
|
34.10
|
29.00
|
39.60
|
54.40
|
|
65
|
15.30
|
19.80
|
25.00
|
21.70
|
29.80
|
41.50
|
23.50
|
30.30
|
38.20
|
32.20
|
43.90
|
60.40
|
|
66
|
16.90
|
21.90
|
27.80
|
23.60
|
32.60
|
45.40
|
25.80
|
33.30
|
41.90
|
34.80
|
47.70
|
65.70
|
|
67
|
18.90
|
24.30
|
30.70
|
25.90
|
35.70
|
49.50
|
28.30
|
36.40
|
45.70
|
37.60
|
51.50
|
70.80
|
|
68
|
20.90
|
26.90
|
34.00
|
28.20
|
38.90
|
54.10
|
30.80
|
39.60
|
49.80
|
40.60
|
55.70
|
76.60
|
|
69
|
23.20
|
29.70
|
37.50
|
30.90
|
42.50
|
59.00
|
33.70
|
43.10
|
54.30
|
43.80
|
59.90
|
82.40
|
|
70
|
25.70
|
32.90
|
41.40
|
33.70
|
46.50
|
64.50
|
36.80
|
47.20
|
59.20
|
47.30
|
64.80
|
89.10
|
|
71
|
28.50
|
36.50
|
46.00
|
37.00
|
51.00
|
70.70
|
40.50
|
51.80
|
64.90
|
51.50
|
70.60
|
97.10
|
|
72
|
31.60
|
40.50
|
50.80
|
40.50
|
55.90
|
77.20
|
44.60
|
57.00
|
71.20
|
56.00
|
76.80
|
105.00
|
|
73
|
35.10
|
44.70
|
55.90
|
44.50
|
61.30
|
84.30
|
48.80
|
62.10
|
77.50
|
60.80
|
83.30
|
113.80
|
|
74
|
38.80
|
49.50
|
61.60
|
48.70
|
67.10
|
91.90
|
53.60
|
68.20
|
84.60
|
66.00
|
90.40
|
122.80
|
|
75
|
46.80
|
59.50
|
74.00
|
58.10
|
80.10
|
109.40
|
63.80
|
80.80
|
100.20
|
77.90
|
106.60
|
144.50
|
|
76
|
51.40
|
65.30
|
81.20
|
63.20
|
87.20
|
119.10
|
69.10
|
87.60
|
108.70
|
83.80
|
114.70
|
155.60
|
|
77
|
56.40
|
71.70
|
89.10
|
68.70
|
94.90
|
129.50
|
75.30
|
95.40
|
118.20
|
90.50
|
123.90
|
168.00
|
|
78
|
61.90
|
78.60
|
97.40
|
74.80
|
103.30
|
140.70
|
81.50
|
103.10
|
127.50
|
97.20
|
133.30
|
180.30
|
|
79
|
68.00
|
86.10
|
106.60
|
81.40
|
112.40
|
152.80
|
88.70
|
112.20
|
138.60
|
104.90
|
144.00
|
194.50
|
|
80
|
74.70
|
94.50
|
116.70
|
88.60
|
122.30
|
165.90
|
96.00
|
121.20
|
149.40
|
112.80
|
154.60
|
208.50
|
|
81
|
82.30
|
103.80
|
128.00
|
96.80
|
133.50
|
180.50
|
105.10
|
132.20
|
162.70
|
122.30
|
167.50
|
225.20
|
|
82
|
91.30
|
115.00
|
141.40
|
106.60
|
146.90
|
198.00
|
114.70
|
144.20
|
177.00
|
132.70
|
181.90
|
243.80
|
|
83
|
100.90
|
126.80
|
155.50
|
117.20
|
161.30
|
216.70
|
125.80
|
157.80
|
193.10
|
144.90
|
198.20
|
264.70
|
|
84
|
111.20
|
139.40
|
170.30
|
128.40
|
176.70
|
236.10
|
136.40
|
170.90
|
208.40
|
156.50
|
214.10
|
284.70
|
|
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| Are there any exclusions? |
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UnumProvident will not make long term care payments to you for a disability caused by:
- War (declared or not) or any act of war
- Attempted suicide (while sane or insane) or self-destruction
- Commission of a crime for which you have been convicted under state or federal law or attempting to commit a crime under state or federal law; disability or confinement during which you are outside of the U.S., its territories or possessions for longer than 30 days
- Alcoholism or alcohol abuse; a disability caused by voluntary use of any controlled substance unless the controlled substance is prescribed for you by a physician
Or
- For a period in which you are confined in a hospital other than if you are confined in a nursing facility that is a distinctly separate part of a hospital (this exclusion does not apply to those periods covered under the bed reservation benefit
- Caused by psychological or psychiatric or mental conditions, regardless of cause, which include depression, generalized anxiety disorders, personality disorders, schizophrenia, manic-depressive disorders, adjustment disorders, and other conditions that are usually treated by a mental health provider or another qualified provider using psychotherapy, psychotropic drugs or similar methods of treatment.
However, UnumProvident will make payments to you for conditions that are not psychological, psychiatric, or mental in nature, including Alzheimer’s disease or similar forms of irreversible dementia.
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