Long-term Disability Summary Plan Description

If you are working for your Employer in a covered class, the date you are eligible for coverage is the plan’s program date.

Covered class means your class as determined by the Contract Holder. This will be done under the Contract Holder’s rules, on dates the Contract Holder sets. The Contract Holder must not discriminate among persons in like situations. You cannot belong to more than one class for insurance on each basis, Contributory or Non-contributory Insurance, under a plan. “Class" means covered class, benefit class or anything related to work, such as position or earnings, which affects the insurance available. If you are an employee of more than one Employer included under the Group Contract, for the insurance you will be considered an employee of only one of those Employers. Your service with the others will be treated as service with that one.

When your Employer pays the entire cost of your coverage under a plan, you will be covered at 12:01 a.m. on the later of:

• the date you are eligible for coverage; and
• the date you are in active employment. If you are not in active employment on the date your coverage would normally begin, it will begin on the date you return to active employment.

When you and your Employer share the cost of your coverage under a plan, you will be covered at 12:01 a.m. on the latest of:

• the date you are eligible for coverage, if you enroll for it on or before that date;
• the date you enroll for coverage, if you enroll for it within 31 days after the date you are eligible for coverage;
• the date Prudential approves your application, if evidence of insurability is required; or
• the date you are in active employment. If you are not in active employment on the date your coverage would normally begin, it will begin on the date you return to active employment.

The Contract Holder may not waive an evidence of insurability requirement for any reason.

Evidence of insurability means a statement of your medical history which Prudential will use to determine if you are approved for coverage.

In any of these situations, you must give evidence of insurability, provided at your expense. This requirement will be met when Prudential decides the evidence is satisfactory.

• When you and your Employer share the cost of your coverage under a plan, you enroll for coverage more than 31 days after the date you are eligible for it.
• You re-enroll for coverage after you voluntarily cancelled it.
• You enroll after any coverage ends because you did not pay a required contribution.
• You have not met a previous evidence requirement to become covered under any plan the Employer has with Prudential.

An evidence of insurability form can be obtained from your Employer.

You must enroll on a form approved by Prudential and agree to pay the required contributions.

Once your coverage begins, any increased or additional coverage will take effect on the latest of:

1. the effective date of the change, if you are:
   • in active employment;
   • on a temporary layoff;
   • on leave of absence; or
   • working reduced hours, for reasons other than disability.
2. the date Prudential approves your application, if evidence of insurability is required; or
3. the date you return to active employment, if you are not in active employment due to injury or sickness.

An increase in your long term disability coverage may be subject to a pre-existing condition limitation as described in the plan. Any decrease in coverage will take effect immediately upon the effective date of the change. Neither an increase nor a decrease in coverage will affect a payable claim that occurs prior to the increase or decrease.

Reduced hours means you are working less than the number of hours required to be considered in active employment.

Payable claim means a claim for which Prudential is liable under the terms of the Group Contract.

If you are on a temporary layoff, and if premium is paid, you will be covered to the end of the month following the month in which your temporary layoff begins.

If you are on a sabbatical leave of absence, and if premium is paid, you will be covered for up to 24 months following the date in which your sabbatical leave begins.

If you are on a personal leave of absence, and if premium is paid, you will be covered for up to 3 months following the date your personal leave begins.

For all other leaves of absence, and if premium is paid, you will be covered to the end of the month following the month in which your leave of absence begins. But, with respect to leave of absence under the federal Family and Medical Leave Act of 1993 (FMLA) or similar state law, if it is your employer’s policy to allow a longer period of continued coverage for FMLA leaves, this policy will be used to determine the period of continued coverage for your FMLA leave. Continuation of such coverage pursuant to this provision is contingent upon Prudential’s timely receipt of premium payments and written confirmation of your FMLA leave by your Employer.

If you are working reduced hours, for reasons other than disability, and if premium is paid, you will be covered to the end of the month following the month in which your reduced hours begin.

Temporary layoff means you are temporarily absent from active employment for a period of time that has been agreed to in advance in writing by your Employer, other than for reasons in connection with any severance or termination agreement. Your normal vacation time, any period of disability or FMLA leave is not considered a temporary layoff.

Leave of absence means you are temporarily absent from active employment for a period of time that has been agreed to in advance in writing by your Employer, other than for reasons in connection with any severance or termination agreement. Your normal vacation time or any period of disability is not considered a leave of absence.

Your coverage under the Group Contract or a plan ends on the earliest of:

• the date the Group Contract or a plan is canceled;
• the date you are no longer a member of the covered classes;
• the date your covered class is no longer covered;
• the last day of the period for which you made any required contributions;
• the last day you are in active employment except as provided under the Once Your Coverage Begins, What Happens If You Are Temporarily Not Working Or If You Are Working Reduced Hours? section; or
• the date you are no longer in active employment due to a disability that is not covered under the plan. The disabilities that are not covered are shown in the What Disabilities Are Not Covered Under Your Plan? section of the Long Term Disability Coverage Benefit Information pages.

The coverage under a plan does not replace or affect the requirements for coverage by workers’ compensation or state disability insurance.

For purposes of the Group Contract, your Employer acts on its own behalf. Under no circumstances will your Employer be deemed the agent of Prudential.

This certificate sets forth only the terms and conditions for coverage and receipt of benefits for Long Term Disability. It does not address and does not confer any rights, or take away any rights, if any, to other benefits or employment with your Employer. Your rights, if any, to other benefits or employment are solely determined by your Employer. Prudential plays no role in determining, interpreting, or applying any such rights that may or may not exist.

Prudential considers any statements you or your Employer make in a signed application for coverage a representation and not a warranty. If any of the statements you or your Employer make are not complete and/or not true at the time they are made, we can:

• reduce or deny any claim; or
• cancel your coverage from the original effective date.

If a statement is used in a contest, a copy of that statement will be furnished to you or, in the event of your death or incapacity, to your eligible survivor or personal representative.

A statement will not be contested after the amount of insurance has been in force, before the contest, for at least two years during your lifetime.

We will use only statements made in a signed application as a basis for doing this.

If the Employer gives us information about you that is incorrect, we will:

• use the facts to decide whether you have coverage under the plan and in what amounts; and
• make a fair adjustment of the premium.

You are disabled when Prudential determines that:

• you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
• you are under the regular care of a doctor; and
• you have a 20% or more loss in your monthly earnings due to that sickness or injury.

After 24 months of payments, you are disabled when Prudential determines that due to the same sickness or injury:

• you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience; and
• you are under the regular care of a doctor.

The loss of a professional or occupational license or certification does not, in itself, constitute disability.

Prudential will assess your ability to work and the extent to which you are able to work by considering the facts and opinions from:

• your doctors; and
• doctors, other medical practitioners or vocational experts of our choice.

When we may require you to be examined by doctors, other medical practitioners or vocational experts of our choice, Prudential will pay for these examinations. We can require examinations as often as it is reasonable to do so. We may also require you to be interviewed by an authorized Prudential Representative. Refusal to be examined or interviewed may result in denial or termination of your claim.

Material and substantial duties means duties that:

• are normally required for the performance of your regular occupation; and
• cannot be reasonably omitted or modified.

Regular occupation means the occupation you are routinely performing when your disability begins. Prudential will look at your occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location.

Sickness means any disorder of your body or mind, but not an injury; pregnancy including abortion, miscarriage or childbirth. Disability must begin while you are covered under the plan.

Injury means a bodily injury that:

• is the direct result of an accident;
• is not related to any cause other than the accident; and
• results in immediate disability.

Disability must begin while you are covered under the plan.

Regular care means:

• you personally visit a doctor as frequently as is medically required, according to generally accepted medical standards, to effectively manage and treat your disabling condition(s); and
• you are receiving the most appropriate treatment and care, which conforms with generally accepted medical standards, for your disabling condition(s) by a doctor whose specialty or experience is the most appropriate for your disabling condition(s), according to generally accepted medical standards.

Doctor means a person who is performing tasks that are within the limits of his or her medical license; and

• is licensed to practice medicine and prescribe and administer drugs or to perform surgery; or
• has a doctoral degree in Psychology (Ph.D. or Psy.D.) whose primary practice is treating patients; or
• is a legally qualified medical practitioner according to the laws and regulations of the governing jurisdiction.

Monthly earnings means your gross monthly income from your Employer in effect as of January 1 of each year. It does not include income received from commissions, bonuses, overtime pay, any other extra compensation, or income received from sources other than your Employer.

If you become disabled while you are on a covered layoff or leave of absence, we will use your monthly earnings from your Employer in effect just prior to the date your absence begins.

Gainful occupation means an occupation, including self employment, that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds:

• 80% of your indexed monthly earnings, if you are working; or
• 60% of your monthly earnings, if you are not working.

But, if you enrolled for Option 2, it means an occupation, including self employment, that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds:

• 80% of your indexed monthly earnings, if you are working; or
• 70% of your monthly earnings, if you are not working.

Indexed monthly earnings means your monthly earnings as adjusted on each July 1 provided you were disabled for all of the 12 months before that date. Your monthly earnings will be adjusted on that date by the lesser of 10% or the current annual percentage increase in the Consumer Price Index. Your indexed monthly earnings may increase or remain the same, but will never decrease.

The Consumer Price Index (CPI-W) is published by the U.S. Department of Labor. Prudential reserves the right to use some other similar measurement if the Department of Labor changes or stops publishing the CPI-W.

Indexing is only used to determine your percentage of lost earnings while you are disabled and working.

You must be continuously disabled through your elimination period. Prudential will treat your disability as continuous if your disability stops for 30 consecutive days or less during the elimination period. The days that you are not disabled will not count toward your elimination period.

Your elimination period is 180 days.

Elimination period means a period of continuous disability which must be satisfied before you are eligible to receive benefits from Prudential. If you become covered under a group long term disability plan that replaces this plan during your elimination period, your elimination period under this plan will not be met.

Yes, provided you meet the definition of disability.

You will begin to receive payments when we approve your claim, providing the elimination period has been met. We will send you a payment each month for any period for which Prudential is liable.

We will follow this process to figure out your monthly payment:

1. If you are enrolled for Option 1, multiply your monthly earnings by 60%. But, if you are enrolled for Option 2, multiply your monthly earnings by 70%.
2. If you are enrolled for Option 1, the maximum monthly benefit is $7,000.00. But, if you are enrolled for Option 2, the maximum monthly benefit is $10,000.00.
3. Compare the answer in item 1 with the maximum monthly benefit. The lesser of these two amounts is your gross disability payment.
4. Subtract from your gross disability payment any deductible sources of income.

That amount figured in item 4 is your monthly payment.

After the elimination period, if you are disabled for less than 1 month, we will send you 1/30th of your payment for each day of disability.

Monthly payment means your payment after any deductible sources of income have been subtracted from your gross disability payment.

Maximum monthly benefit means the maximum benefit amount for which you are insured under this plan.

Gross disability payment means the benefit amount before Prudential subtracts deductible sources of income and disability earnings.

Deductible sources of income means income from deductible sources listed in the plan that you receive or are entitled to receive while you are disabled. This income will be subtracted from your gross disability payment.

We will send you the monthly payment if you are disabled and your monthly disability earnings, if any, are less than 20% of your indexed monthly earnings due to the same sickness or injury.

If you are disabled and your monthly disability earnings are 20% or more of your indexed monthly earnings, due to the same sickness or injury, Prudential will figure your payment as follows:

During the first 12 months of payments, while working, your monthly payment will not be reduced as long as disability earnings plus the gross disability payment does not exceed 100% of indexed monthly earnings.

1. Add your monthly disability earnings to your gross disability payment.
2. Compare the answer in item 1 to your indexed monthly earnings.

If the answer from item 1 is less than or equal to 100% of your indexed monthly earnings, Prudential will not further reduce your monthly payment.

If the answer from item 1 is more than 100% of your indexed monthly earnings, Prudential will subtract the amount over 100% from your monthly payment.

After 12 months of payments, while working, you will receive payments based on the percentage of income you are losing due to your disability.

1. Subtract your disability earnings from your indexed monthly earnings.
2. Divide the answer in item 1 by your indexed monthly earnings. This is your percentage of lost earnings.
3. Multiply your monthly payment by the answer in item 2.

This is the amount Prudential will pay you each month.

If your monthly disability earnings exceed 80% of your indexed monthly earnings, Prudential will stop sending you payments and your claim will end.

Prudential may require you to send proof of your monthly disability earnings on a monthly basis. We will adjust your payment based on your monthly disability earnings.

As part of your proof of disability earnings, we can require that you send us appropriate financial records, including copies of your IRS federal income tax return, W-2’s and 1099’s, which we believe are necessary to substantiate your income

Disability earnings means the earnings which you receive while you are disabled and working, plus the earnings you could receive if you were working to your greatest extent possible. This would be, based on your restrictions and limitations:

• During the first 24 months of disability payments, the greatest extent of work you are able to do in your regular occupation, that is reasonably available.
• Beyond 24 months of disability payments, the greatest extent of work you are able to do in any occupation, that is reasonably available, for which you are reasonably fitted by education, training or experience.

Salary continuance paid to supplement your disability earnings will not be considered payment for work performed.

If you are receiving payments for your disability under the plan and have been continuously disabled for at least 180 days, you may be eligible to receive a supplemental payment equal to 12% of your monthly pre-disability earnings to a maximum of $1,000 paid to the trustee or administrator of your pension plan if you were hired prior to January 1, 2006 or 14% of your monthly pre-disability earnings paid to the trustee or administrator of your pension plan if you were hired on or after to January 1, 2006. If you are working while you are disabled, your supplemental payments will be multiplied by your percentage of lost income as determined above to calculate the amount.

Pension plan means a plan which provides retirement benefits and which is not wholly funded by employee contributions. The term shall not include a profit sharing plan, a thrift plan, an individual retirement account (IRA), a tax sheltered annuity plan (TSA), a stock ownership plan or a non-qualified plan of deferred compensation.

If your disability earnings are expected to fluctuate widely from month to month, Prudential may average your disability earnings over the most recent 3 months to determine if your claim should continue subject to all other terms and conditions in the plan.

If Prudential averages your disability earnings, we will terminate your claim if the average of your disability earnings from the last 3 months exceeds 80% of indexed monthly earnings.

We will not pay you for any month during which disability earnings exceed the above amounts.

Prudential will deduct from your gross disability payment the following deductible sources of income:

1. The amount that you receive as loss of time benefits under:
   • a workers’ compensation law;
   • an occupational disease law; or
   • any other act or law with similar intent.
2. The amount that you receive or are entitled to receive as loss of time disability income payments under any:
   • state compulsory benefit act or law.
   • automobile liability insurance policy other than mandated no-fault coverage.
   • group insurance or self-insured plans where the Employer, directly or indirectly, has paid all or part of the cost or made payroll deductions.
   • governmental retirement system as the result of your job with your Employer.
3. The gross amount that you, your spouse and children receive or are entitled to receive as loss of time disability payments because of your disability under:
   • the United States Social Security Act;
   • the Railroad Retirement Act;
   • the Canada Pension Plan;
   • the Quebec Pension Plan; or
   • any similar plan or act.
   Amounts paid to your former spouse or to your children living with such spouse will not be included.
4. The gross amount that you receive as retirement payments or the gross amount your spouse and children receive as retirement payments because you are receiving payments under:
   • the United States Social Security Act;
   • the Railroad Retirement Act;
   • the Canada Pension Plan;
   • the Quebec Pension Plan; or
   • any similar plan or act.
   Benefits paid to your former spouse or to your children living with such spouse will not be included.
5. The Amount That You:
   • receive as disability payments under your Employer’s retirement plan;
   • voluntarily elect to receive as retirement or early retirement payments under your Employer’s retirement plan; or
   • receive as retirement payments when you reach normal retirement age, as defined in your Employer’s retirement plan.

   Amounts under (b) above do not include early retirement payments if the payments reduce the retirement benefits under your Employer’s retirement plan.

   Disability payments under a retirement plan will be those benefits which are paid due to disability and do not reduce the retirement benefits which would have been paid if the disability had not occurred.

   Retirement payments will be those benefits which are paid based on your Employer’s contribution to the retirement plan. Disability benefits which reduce the retirement benefits under the plan will also be considered as a retirement benefit.

   Amounts received do not include amounts rolled over or transferred to any eligible retirement plan. Prudential will use the definition of eligible retirement plan as defined in Section 402 of the Internal Revenue Code including any future amendments which affect the definition.

6. The amount you receive under the maritime doctrine of maintenance, wages and cure. This includes only the “wages” part of such benefits.
7. The amount of loss of time benefits that you receive or are entitled to receive under any salary continuation.
8. The amount that you receive or are entitled to receive under any unemployment income act or law due to the end of employment with your Employer.

With the exception of retirement payments, Prudential will only subtract deductible sources of income which are payable as a result of the same disability.

We will not reduce your payment by your Social Security retirement payments if your disability begins after age 65 and you were already receiving Social Security retirement payments.

Law, plan or act means the original enactment of the law, plan or act and all amendments.

Retirement plan means a defined contribution plan or defined benefit plan. These are plans which provide retirement benefits to employees and are not funded entirely by employee contributions.

Salary continuation means continued payments to you by your Employer of all or part of your monthly earnings, after you become disabled as defined by the Group Contract. This continued payment must be part of an established plan maintained by your Employer for the benefit of an employee covered under the Group Contract. Salary continuation does not include compensation paid to you by your Employer for work you actually perform after your disability begins. Such compensation is considered disability earnings, and would be taken into account as such, in calculating your monthly payment.

Prudential will not deduct from your gross disability payment income you receive from, but not limited to, the following sources:

• 401(k) plans;
• profit sharing plans;
• thrift plans;
• tax sheltered annuities;
• stock ownership plans;
• non-qualified plans of deferred qualifications;
• pension plans for partners;
• military pension and disability income plans;
• credit disability insurance;
• franchise disability income plans;
• individual disability income plans;
• a retirement plan from another employer;
• Medicaid;
• mandated no-fault automobile liability insurance policy;
• individual retirement accounts (IRA).

The minimum monthly payment is the greater of (a) 10% of the gross disability payment otherwise payable and (b) $100.

Prudential may apply this amount toward an outstanding overpayment.

Once Prudential has subtracted any deductible source of income from your gross disability payment, Prudential will not further reduce your payment:

• due to a cost of living increase from that source,
• by the amount of any increase in your Social Security income.

If we determine that you may qualify for benefits under item 1, 2, or 3 in the deductible sources of income section, we will estimate your entitlement to these benefits. We can reduce your payment by the estimated amount if such benefits have not been awarded.

However, we will NOT reduce your payment by the estimated amount under item 1, 2, or 3 in the deductible sources of income section if you:

• apply for the benefits;
• appeal any denial to all administrative levels Prudential feels are necessary; and
• sign Prudential’s Reimbursement Agreement form. This form states that you promise to pay us any overpayment caused by an award.

If your payment has been reduced by an estimated amount, your payment will be adjusted when we receive proof:

• of the amount awarded; or
• that benefits have been denied and all appeals Prudential feels are necessary have been completed. In this case, a lump sum refund of the estimated amount will be made to you.

If we determine that you may qualify for benefits under item 7, 8 or 10 in the deductible sources of income section, we will estimate your entitlement to these benefits. We can reduce your payment by the estimated amount if such benefits have not been received.

If your payment has been reduced by an estimated amount, your payment will be adjusted when we receive proof:

• of the amount received
• that benefits have been denied. In this case, a lump sum refund of the estimated amount will be made to you.

If you receive a lump sum payment from any deductible source of income, the lump sum will be pro-rated on a monthly basis over the time period for which the sum was given. If no time period is stated, we will use a reasonable one.

Prudential will send you a payment each month up to the maximum period of payment. Your maximum period of payment is:

We will stop sending you payments and your claim will end on the earliest of the following:

1. During the first 24 months of payments, when you are able to work in your regular occupation on a part-time basis but you choose not to; after 24 months of payments, when you are able to work in any gainful occupation on a part-time basis but you choose not to.
2. The end of the maximum period of payment.
3. The date you are no longer disabled under the terms of the plan.
4. The date you fail to submit proof of continuing disability satisfactory to Prudential.
5. The date your disability earnings exceed the amount allowable under the plan.
6. The date you die.

Maximum period of payment means the longest period of time Prudential will make payments to you for any one period of disability.

Part-time basis means the ability to work and earn 20% or more of your indexed monthly earnings.

Disabilities which, as determined by Prudential, are due in whole or part to mental illness have a limited pay period during your lifetime.

The limited pay period for mental illness is 24 months during your lifetime.

Prudential will continue to send you payments for disabilities due in whole or part to mental illness beyond the 24 month period if you meet one or both of these conditions:

1. If you are confined to a hospital or institution at the end of the 24 month period, Prudential will continue to send you payments during your confinement.

   If you are still disabled when you are discharged, Prudential will send you payments for a recovery period of up to 90 days.

   If you become reconfined at any time during the recovery period and remain confined for at least 14 days in a row, Prudential will send payments during that additional confinement and for one additional recovery period up to 90 more days.

2. In addition to item 1, if, after the 24 month period for which you have received payments, you continue to be disabled and subsequently become confined to a hospital or institution for at least 14 days in a row, Prudential will send payments during the length of the confinement.

Prudential will not pay beyond the limited pay period as indicated above, or the maximum period of payment, whichever occurs first.

Prudential will not apply the mental illness limitation to dementia if it is a result of:

• stroke;
• trauma;
• viral infection;
• Alzheimer's disease;
• other conditions not listed which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment as standardly accepted in the practice of medicine.

Mental illness means a psychiatric or psychological condition regardless of cause. Mental illness includes but is not limited to schizophrenia, depression, manic depressive or bipolar illness, anxiety, somatization, substance related disorders and/or adjustment disorders or other conditions. These conditions are usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment as standardly accepted in the practice of medicine.

Confined or confinement for this section means a hospital stay of at least 8 hours per day.

Hospital means a short-term, acute, general hospital that:

1. is primarily engaged in providing, by or under the continuous supervision of Doctors, to inpatients, diagnostic services and therapeutic services for diagnosis, treatment and care of injured or sick persons;
2. has organized departments of medicine and major surgery;
3. has a requirement that every patient must be under the care of a Doctor or dentist;
4. provides 24-hour nursing service by or under the supervision of a registered professional nurse (R.N.);
5. if located in New York State, has in effect a hospitalization review plan applicable to all patients which meets at least the standards set forth in section 1861(k) of United States Public Law 89-97 (42 USCA 1395x(k));
6. is duly licensed by the agency responsible for licensing such hospitals; and
7. is not, other than incidentally, a place of rest, a place primarily for the treatment of tuberculosis, a place for the aged, a place for drug addicts, alcoholics, or a place for convalescent, custodial, educational, or rehabilitory care.

Your plan does not cover any disabilities caused by, contributed to by, or resulting from your:

• intentionally self-inflicted injuries;
• active participation in a riot; or
• commission of a felony for which you have been convicted under state or federal law.

Your plan does not cover a disability due to a pre-existing condition during the 12 months after your effective date of coverage.

Your plan does not cover a disability due to war, declared or undeclared, or any act of war. But this does not apply if a disability due to an act of war occurs while you are required to travel on business for the Employer outside the Continental United States.

Your plan does not cover a disability treated by any relative including, but not limited to, you, your spouse, or a child, brother, sister, or parent of you or your spouse as a doctor for a claim that you send to us.

You have a pre-existing condition if you received medical treatment, consultation, care or services, including diagnostic measures, or took prescribed drugs or medicines, or followed treatment recommendation in the 3 months just prior to your effective date of coverage or the date an increase in benefits takes effect.

If you become covered for an increase in your benefits due to an amendment of the plan or your enrollment in another plan option, a benefit limit will apply if:

• your disability begins during the 12 months just after the date the increase in benefits takes effect; and
• your disability is due to a pre-existing condition.

You will be limited to the benefits you had on the day before the effective date of the increase. The benefit limit will end and the increase will apply to your disability on the date 12 months after the effective date of the increase in benefits.

Special rules apply to the pre-existing condition provisions under this plan if:

• you were covered under a previous long term disability plan;
• the previous coverage was continuous to a date not more than 60 days prior to the date you became covered under this plan; and
• that coverage or level of benefits was determined by Prudential to be substantially similar to coverage or level of benefits under this plan.

The special rules are:

• if the previous coverage was coverage under Employer’s prior plan, and this plan replaces your Employer’s prior plan, then the pre-existing condition limits that apply to you are the lesser of those provided under your Employer’s prior plan or those provided under this plan.
• if the previous coverage was coverage under a plan other than your Employer’s prior plan which this plan replaced, then the pre-existing condition limits that apply to you under this plan will be reduced to the extent you met those limits under the previous plan.

If you have a recurrent disability, as determined by Prudential, we will treat your disability as part of your prior claim and you will not have to complete another elimination period if:

• you were continuously insured under this plan for the period between your prior claim and your current disability; and
• your recurrent disability occurs within 6 months of the end of your prior claim.

Your recurrent disability will be subject to the same terms of the plan as your prior claim. Any disability which occurs after 6 months from the date your prior claim ended will be treated as a new claim. The new claim will be subject to all of the plan provisions.

If you become covered under any other group long term disability plan, you will not be eligible for payments under the Prudential plan.

Recurrent disability means a disability which is:

• caused by a worsening in your condition; and
• due to the same cause(s) as your prior disability for which Prudential made a Long Term Disability payment.

When Prudential receives proof that you have died, we will pay a survivor benefit equal to 3 months of your gross disability payment.

The survivor benefit will be paid to your spouse, if living, otherwise, to your children under age 25, unless you have chosen another eligible survivor.

The survivor benefit will be paid if, on the date of your death:

• your disability had continued for 180 or more consecutive days; and
• you were receiving or were entitled to receive payments under the plan.

If a benefit is payable to a person who is a minor or not capable of giving a valid release for any payment due, Prudential may, at its option, pay the amount payable to that person or to any person or institution that appears to Prudential to have assumed the custody and main support of that person. If any amount is so paid, Prudential will not have to pay that amount again.

If you have no eligible survivors, payment will be made to your estate.

However, we will first apply the survivor benefit to any overpayment which may exist on your claim.

Eligible survivor means a person you have chosen, on a form approved by Prudential, to receive the survivor benefit. But, if you have not chosen such a person, your eligible survivor will be your spouse, if living; otherwise, your children under age 25.

You may change the eligible survivor at any time without the consent of the present eligible survivor. The eligible survivor change form must be filed through the Contract Holder. The change will take effect on the date the form is signed. But it will not apply to any amount paid by Prudential before it receives the form.

Portable adaptive equipment might be what is needed to allow you to perform the material and substantial duties of your regular occupation with your Employer. At your option, one of our designated professionals will assist you and your Employer to identify portable adaptive equipment we agree is likely to help you remain at work or return to work. This agreement will be in writing and must be signed by you, your Employer and Prudential.

When this occurs, Prudential will reimburse you for the cost of the portable adaptive equipment up to the greater of:

• $1000;
• the equivalent of two months of your gross disability payment.

The portable adaptive equipment provided under this coverage is not the property of your Employer. It is your property.

This benefit is available to you on a one time only basis.

Prudential can arrange for expert advice regarding your Social Security disability benefits claim and assist you with your application or appeal, if you are disabled under the plan.

Receiving Social Security disability benefits may enable:

• you to receive Medicare after 24 months of disability payments;
• you to protect your retirement benefits; and
• your family to be eligible for Social Security benefits.

We can assist you in obtaining Social Security disability benefits by:

• helping you find appropriate legal representation;
• obtaining medical and vocational evidence; and
• reimbursing pre-approved case management expenses.

Prudential has a rehabilitation program available.

As your file is reviewed, medical and vocational information will be analyzed to determine if rehabilitation services might help you return to work.

Once the initial review is completed by our rehabilitation program specialists working along with your doctor and other appropriate specialists, Prudential may elect to offer you and pay for a rehabilitation program. If the rehabilitation program is not developed by Prudential’s rehabilitation program specialists, you must receive written approval from Prudential for the program before it begins.

The rehabilitation program may include, but is not limited to, the following services:

• coordination with your Employer to assist you to return to work;
• vocational evaluation to determine how your disability may impact your employment options;
• job placement services;
• resume preparation;
• job seeking skills training;
• retraining for a new occupation; or
• assistance with relocation that may be part of an approved rehabilitation program.

Rehabilitation program means a program designed to assist you to return to work.

We encourage you to notify us of your claim as soon as possible, so that a claim decision can be made in a timely manner. Written notice of a claim should be sent within 30 days after the date your disability begins. However, you must send Prudential written proof of your claim no later than 90 days after your elimination period ends. If it is not possible to give proof within 90 days, it must be given as soon as reasonably possible.

The claim form is available from your Employer, or you can request a claim form from us. If you do not receive the form from Prudential within 15 days of your request, send Prudential written proof of claim without waiting for the form.

You must notify us immediately when you return to work in any capacity.

You and your Employer must fill out your own section of the claim form and then give it to your attending doctor. Your doctor should fill out his or her section of the form and send it directly to Prudential.

Your proof of claim, provided at your expense, must show:

• That you are under the regular care of a doctor.
• Appropriate documentation of your monthly earnings.
• The date your disability began.
• Appropriate documentation of the disabling disorder.
• The extent of your disability, including restrictions and limitations preventing you from performing your regular occupation or any gainful occupation.
• The name and address of any hospital or institution where you received treatment, including all attending doctors.
• The name and address of any doctor you have seen.

For your Long Term Disability claim, we may request that you send proof of continuing disability, satisfactory to Prudential, indicating that you are under the regular care of a doctor. In some cases, you will be required to give Prudential authorization to obtain additional medical information, and to provide non-medical information (e.g., copies of your IRS federal income tax return, W-2’s and 1099’s) as part of your proof of claim, or proof of continuing disability. This proof, provided at your expense, must be received within 30 days of a request by us. Prudential will deny your claim or stop sending you payments if the appropriate information is not submitted.

Regular care means:

• you personally visit a doctor as frequently as is medically required, according to generally accepted medical standards, to effectively manage and treat your disabling condition(s); and
• you are receiving the most appropriate treatment and care, which conforms with generally accepted medical standards, for your disabling condition(s) by a doctor whose specialty or experience is the most appropriate for your disabling condition(s), according to generally accepted medical standards.

Doctor means a person who is performing tasks that are within the limits of his or her medical license; and

• is licensed to practice medicine and prescribe and administer drugs or to perform surgery; or
• has a doctoral degree in Psychology (Ph.D. or Psy.D.) whose primary practice is treating patients; or
• is a legally qualified medical practitioner according to the laws and regulations of the governing jurisdiction.

Hospital means a short-term, acute, general hospital that:

1. is primarily engaged in providing, by or under the continuous supervision of Doctors, to inpatients, diagnostic services and therapeutic services for diagnosis, treatment and care of injured or sick persons;
2. has organized departments of medicine and major surgery;
3. has a requirement that every patient must be under the care of a Doctor or dentist;
4. provides 24-hour nursing service by or under the supervision of a registered professional nurse (R.N.);
5. if located in New York State, has in effect a hospitalization review plan applicable to all patients which meets at least the standards set forth in section 1861(k) of United States Public Law 89-97 (42 USCA 1395x(k));
6. is duly licensed by the agency responsible for licensing such hospitals; and
7. is not, other than incidentally, a place of rest, a place primarily for the treatment of tuberculosis, a place for the aged, a place for drug addicts, alcoholics, or a place for convalescent, custodial, educational, or rehabilitory care.

Prudential will make payments to you for all benefits except survivor benefits payable upon your death.

Prudential will make payments to your eligible survivor for survivor benefits payable upon your death.

Prudential has the right to recover any overpayments due to:

• fraud;
• any error Prudential makes in processing a claim; and
• your receipt of deductible sources of income.

You must reimburse us in full. We will determine the method by which the repayment is to be made.

Prudential will not recover more money than the amount we paid you.

You can start legal action regarding your claim 60 days after proof of claim has been given and up to 3 years from the time proof of claim is required, unless otherwise provided under federal law.

Prudential wants to ensure you and your Employer do not incur additional insurance costs as a result of the undermining effects of insurance fraud. Prudential promises to focus on all means necessary to support fraud detection, investigation and prosecution.

In some jurisdictions, if you knowingly and with intent to defraud Prudential, file an application or a statement of claim containing any materially false information or conceal for the purpose of misleading, information concerning any fact material thereto, you commit a fraudulent insurance act, which is a crime and subjects you to criminal and civil penalties. These actions will result in denial or termination of your claim, and, where such laws apply, are subject to prosecution and punishment to the full extent under any applicable law. Prudential will pursue all appropriate legal remedies in the event of insurance fraud.