Policy_Document_-_LTD_A_Amendment_3_CARPC_grandfather.pdf

This document is a Group Policy Amendment issued by Standard Insurance Company to the County of Dane, Wisconsin, specifically addressing the addition of an insured member to an existing disability insurance policy. The amendment, designated as Amendment No. 3 to Group Policy 163054-A, became effective June 1, 2021, and adds Nick Brower, a member of the Capital Area Regional Planning Commission (CARPC), as an insured under the group policy. The amendment specifies that Brower's coverage became active on June 1, 2021, with the notable provision that Evidence of Insurability was waived, meaning no medical underwriting or health screening was required for his enrollment.

The amendment was executed by Standard Insurance Company's Chairman and CEO and Corporate Secretary, establishing the formal authorization for the policy modification. This grandfather clause provision allowing waived insurability requirements suggests that Brower qualified for special enrollment status, potentially due to his affiliation with CARPC or a qualifying life event. The document serves as official notice of the coverage expansion within the County of Dane's group disability insurance program and represents a modification to the existing policy terms governing Short Term/Long Term Disability and Long Term Disability Only Services coverage.