How the Plan Works
This coverage is designed to pay you $1,000 in monthly benefits (not to exceed 75% of your AVERAGE MONTHLY INCOME4 when combined with other insurance) if you suffer a TOTAL DISABILITY5 while insured under the policy. You must be under the care of a licensed physician for your covered disability and not engaged in any occupation for pay or profit and have completed the 90-Day Waiting Period6. Benefits are paid regardless of other insurance coverage you may have, and this coverage automatically renews for all insured persons, as long as applicable terms and conditions are met. If your disability is the result of an injury, said injury must occur while you are covered under the Policy and result in a Total Disability within 365 days.
Your Benefit Period
For a Total Disability incurred due to a covered illness or accident, benefits are payable for two years or to age 70, whichever is later. At age 65, your monthly benefit amount is reduced to 50% of the before-age-65 benefit, whether you are disabled or not. Premiums do not reduce. The benefit period for disabilities that are due to mental disorders and/or chemical dependency is limited to two years.
Own Occupation Coverage
This plan pays monthly benefits directly to you if you are unable to perform the material and substantial duties of your profession during the Waiting Period and for the first 60 consecutive months of a claim. You may not engage in any occupation for pay or profit.
Tax-Free Benefits
The benefits paid to you are tax-free, as long as you pay your own premiums with after-tax dollars. This is different than employer-paid coverage, which is considered earned income and is taxable at your normal tax rate. You should consult with your personal tax advisor for further information.
Survivor Benefit
Your beneficiary will receive a Survivor Benefit of up to three months of payment of your monthly benefit, if you should die after receiving at least 12 consecutive months of benefits for a Total Disability.
Worldwide, Portable Coverage
This coverage goes with you! Unlike an employer-based plan, you’re covered when you travel, if you move, or if you change jobs3. Simply maintain your U.S. residency and your AAP membership to retain coverage.
Residual Disability Benefit
If you return to your practice after a covered disability that began before age 65 for which you received benefits, you may be entitled to the Residual Disability Benefit , provided you are not earning more than 80% of your AVERAGE MONTHLY INCOME, for the six-month period before your Total Disability. This benefit is a percentage of the Total Disability Benefit, and it equals the percentage reduction in your monthly earnings. However, for each month that that your income is reduced by 75% or more, this plan will pay the full Total Disability Benefit. Please refer to your Certificate of Insurance for applicable conditions.
Waiver of Premium
It’s good to know that your insurance will continue should you become totally disabled. Premium payments for your coverage will be waived if you become totally disabled for a period of at least six months. Please refer to your Certificate of Insurance for applicable conditions.
Additional Benefits
This plan also includes Residual Disability Benefits for Communicable Diseases, Recurring Disability Benefits, and Organ Transplant Donation Benefits. More about these plan features can be found in your Certificate of Insurance. Just like with the Group Term Life Plan, you have a 30-Day Free Look.
Summary of Terms and Conditions
When Coverage Begins: Coverage becomes effective on the first day of the month following the date the application is approved, provided the initial premium is paid within 31 days after billing and you are at FULL-TIME WORK. If you are not at FULL-TIME WORK as required, coverage will not become effective until the first of the month on or after the day you return to FULLTIME WORK. Payment of a premium contribution does not mean coverage is in- force. When Benefits End: Benefits will cease at the earlier of the following: a) your covered disability ends; b) the maximum benefit period ends; or c) if required proof of continuing disability is not provided. When Coverage Ends: Coverage will remain in force until the earlier of: a) you reach age 70; b) failure to pay premiums when due; c) you discontinue your membership in the association; d) you enter into military service; e) the Group Policy is modified to exclude the class of insured in which you belong; f) you are no longer at FULL-TIME WORK; g) or you elect to end coverage. Coverage Exclusions: Once you reach age 65 or begin full-time active duty in the military, your total in-force coverage will reduce to a maximum of $100,000. Benefit amounts are not guaranteed. Your premiums do not reduce. Coverage Exclusion: Benefits are not payable for disability for any of the following losses: due to war or any act of war, whether declared or undeclared; due to any act of international armed conflict or conflict involving the armed forces of any international authority; incurred while the insured individual is in the armed services of any country or international authority; due to the insured individual’s attempted suicide while sane or insane*; resulting from the insured individual’s intentionally self-inflicted illness whether sane or insane*; resulting from the insured individual’s committing of or the attempting to commit, a felony or any type of assault or battery; resulting from the insured individual’s participation in a riot or insurrection; resulting from the insured individual engaging in (except as a victim) an illegal activity or occupation; resulting from a normal pregnancy or a normal childbirth or a related medical condition except for certain complications of pregnancy as defined in the Certificate of Insurance; incurred while riding in any vehicle or device for aerial navigation, except: a) as a fare-paying passenger in a licensed passenger aircraft which is being operated at the time upon a regular schedule between established airports; or b) while traveling in a civil aircraft having a current and valid “Standard Federal Aviation Agency Airworthiness Certificate” and piloted by a person with a valid and current pilot’s certificate with the proper ratings for the type of flight and aircraft involved; resulting from any impairment or limitation specifically excluded from coverage; a disability that does not require the regular care of a doctor (“doctor” does not include yourself or a member of your immediate family). A Pre-Existing Condition: an injury or sickness for which you consulted a doctor, received any medical services or supplies, or took any medication during the 6 months immediately before becoming insured under this Plan. Benefits are not payable for a disability which is classified as a Pre-Existing Condition until the end of the earlier of 12 consecutive months during which you have not consulted a doctor, received medical services or supplies, or taken any medication for the condition; 24 consecutive months during which you have been insured under this Plan.
*MISSOURI RESIDENTS: the exclusion for self-inflicted injuries is not applicable to injuries caused by an attempted suicide while insane.
The benefit period for disabilities in connection with mental disorders and/or chemical dependency is limited to two years.
Underwritten by New York Life Insurance Company, 51 Madison Ave., New York, NY 10010 under Group Policy G-50861-0 on Policy Form GMR-FACE/G50861-0