Member Benefits Up to $5,000 a Month Available!
Your Passport to Income Protection. If you’ve never considered disability income insurance before, you may wonder why you may need it now, especially if you’re young and healthy. But most professionals, at all stages, at all income levels, may want to consider solid disability income protection. The AJLI–sponsored Group Disability Income Plan can help you protect your earning capacity.
Chances are, you already protect your important assets such as your house. Your health insurance can only cover your medical expenses; it can’t provide a regular source of income. Why not help protect the most important asset you have: your ability to earn an income?
Members of the AJLI who are under age 60 and at FULL–TIME WORK can request this coverage, provided they reside in the United States (excluding AK, DE, FL, LA, ME, MD, MO, MT, NV, NH, NM, NC, OR, SD, TX, VT, UT, WA, WY and territories) and have an ANNUAL NET EARNED INCOME of at least $20,000. Members on active duty in the Armed Forces and full–time students are not eligible.
"FULL–TIME WORK" means the active performance of regular duties of your normal occupation for pay or profit on the basis of at least 30 hours per week at the place where such duties are normally performed or other location to which travel is required.
"ANNUAL NET EARNED INCOME" means your wages, salaries, commissions, fees, and other amounts received for personal services—before deduction of income or social insurance taxes and after the deduction of normal and usual business expenses that are deductible for income tax purposes.—for any 12–month period. Annual Net Earned Income does not include income from interest, dividends, rent, royalties, annuities, other insurance and other unearned income.
HOW THE PLAN WORKS
Choose Your Monthly Benefit
You may choose a Monthly Benefit Option from $500 to $5,000 (in $100 units). The option you choose, together with all other disability income insurance you have or for which you are applying, cannot exceed 60 percent of your AVERAGE MONTHLY INCOME. Depending upon your state of residence, you may be eligible to receive benefits under a state plan. You should check to see whether your state offers this.
Choose Your Waiting Period
The AJLI–sponsored Group Disability Income Plan offers a choice of two waiting periods: Plan A, 180-day or Plan B, 90-day. A waiting period is the number of consecutive days you must be Totally Disabled before benefits begin. For those members looking to pay a lower premium contribution, you can choose the 180–day waiting period.
FEATURES OF THE PLAN
Premium Payments Waived During Disability
After you have been Totally Disabled due to a covered injury or sickness for six months, all future premium contributions under the Plan will be waived for as long as you receive benefits for that disability, provided the disability began before age 60.
Successive periods of disability that are due to the same or related causes will be considered a single period of disability unless separated by a return to FULL–TIME WORK of 180 days or more. (Unrelated disabilities not separated by a return of FULL–TIME WORK will also be considered a single period of disability.)
Current 2019 Monthly Premium Contributions
Cost is based on the Waiting Period, Plan and Monthly Benefit Option selected, and on your age when coverage becomes effective. The cost increases on the premium contribution due date on or immediately after your reach a higher age bracket. Premium contributions will vary depending upon the options and amount chosen.
Current 2019 Quarterly Premium Contributions
PLAN A: Benefits begin on the 181st day of covered disability.
PLAN B: Benefits begin on the 91st day of covered disability.
These rates increase on the next premium due date following your attainment of ages 30, 40, 50 and 60. Your monthly benefit amount will be limited to a maximum of $2,000 on the premium due date coinciding with or next following the date you attain age 60. This reduction applies to the monthly benefit amount payable for total disability that commences prior to age 60 as well as total disability that commences after age 60. Coverage terminates upon attainment of age 65. The Company reserves the right to change premiums based on the experience of the group as a whole.
If applicable, an additional $2 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option as well as paying annually.
ADDITIONAL PLAN PROVISIONS
Exclusions And Limitations
The following situations will exclude you from approval for this Disability Insurance coverage as per the Master Policy. A Crime or Illegal Occupation; a Preexisting condition (explained in detail below); Pregnancy, Childbirth Or A Related Medical Condition except for a Complication of Pregnancy, as defined in the Certificate; Regular Care; a Self-Inflicted Injury; or a War Condition. For specific Information on any exclusion please contact the administrator prior to applying.
PRE-EXISTING CONDITION LIMITATION
Pre-existing Condition: means an INJURY or SICKNESS or any condition related to such INJURY or SICKNESS for which a person has been medically diagnosed or treated by a doctor, including taking any medications during the 12 month period immediately before the COVERED PERSON'S CERTIFICATE EFFECTIVE DATE. Preexisting Condition does not include: a) any such INJURY or SICKNESS or condition for which such person has not consulted a doctor, received medical services or supplies or taken any education during the 12 month period immediately after he or she first becomes a COVERED PERSON; b) any such INJURY or SICKNESS or condition after such person has been continuously insured under the Policy for 24 months; or c) an INJURY or SICKNESS or condition classified as an Impaired Restriction.
You will become insured on the date specified by New York Life provided the first premium contribution has been paid, satisfactory evidence of insurability has been submitted, and you are actively at FULL-TIME WORK on that date. If you are not at FULL-TIME WORK as required, coverage will not become effective until the day you are at FULL-TIME WORK provided such date is within three months of the date insurance would have become effective and you are still eligible for insurance. Payment of a premium contribution for insurance does not mean there is any coverage in force before the effective date as specified by New York Life.
There are instances where New York Life may be able to offer insurance, at the same cost, by eliminating coverage for a specific condition or impairment.
When Coverage Ends
Your insurance can remain in force until you reach age 65. Coverage will end earlier if: you cease to be a member of the AJLI; you fail to make premium payments when due; you begin full-time active duty in the Armed Forces; you cease FULL-TIME WORK (other than for disability); or the group policy is terminated or modified by the Trustees or New York Life to end coverage for the group of insureds to which you belong.
Renewal Payments and Claims
Once you are accepted into the Plan, you will have a 31-day grace period for your payment of renewal premium contributions. When you want to submit a claim, call or write the Administrator for claim forms.
30-Day Free Look
When you become insured you will be sent a Certificate of Insurance summarizing your insurance coverage. If you are not completely satisfied with the terms of your Certificate, you may return it, without claim, within 30 days. Your coverage will be invalidated and you will receive a full refund—no questions asked.
How New York Life Obtains Information and Underwrites Your Request For The
Group Disability Income Insurance Plan
In this notice, references to "you" and "your" include any person proposed for insurance. Information regarding insurability will be treated as confidential. In considering whether the person(s) in your request for the insurance qualify for insurance, we will rely on the medical information you provide, and on the information you AUTHORIZE us to obtain from your physician, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB, Inc. ("MIB"). MIB is a not-for-profit organization of insurance companies, which operates an information exchange on behalf of its members. If you apply for life or health insurance coverage or claim for benefits is submitted to an MIB member company, medical or non-medical information may be given to MIB and such information may then be furnished by MIB, upon request, to a member company.
Your AUTHORIZATION may be used for a period of 24 months from the date you signed the application for insurance, unless sooner revoked. The AUTHORIZATION may be revoked at any time by notifying New York Life in writing at the address provided. Your revocation will not be effective to the extent New York Life or any other person already has disclosed or collected information or taken other action in reliance on it, or to the extent that New York Life has a legal right to contest a claim under an insurance certificate or the certificate itself. The information New York Life obtains through your AUTHORIZATION may become subject to further disclosure. For example, New York Life may be required to provide it to insurance, regulatory or other government agencies. In this case, the information may no longer be protected by the rules governing your AUTHORIZATION.
MIB and other insurance companies may also furnish New York Life, its subsidiaries or the Plan Administrator with non-medical information (such as driving records, past convictions, hazardous sport or aviation activity, use of alcohol or drugs, and other application for insurance). The information provided may include information that may predate the time frame stated on the medical questions section, if any, on this application. This information may be used during the underwriting and claims processes, where permitted by law.
New York Life may release this information to the Plan Administrator, other insurance companies to which you may apply for life and health insurance, or to which a claim for benefits may be submitted and to others whom you authorize in writing. However, this will not be done in connection with test results concerning Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV). We may also make a brief report of your protected health information to MIB, but we will not disclose our underwriting decision.
New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. Information in our files may be seen by New York Life and Plan Administrator employees, but only on a "need to know" basis in considering your request. Upon receipt of all requested information, we will make a determination as to whether your request for insurance can be approved.
If we cannot provide the coverage you requested, we will tell you why. If you feel our information is inaccurate, you will be given a change to correct or complete the information in our files. Upon written request to New York Life or MIB, you will be provided with non-medical information. Generally, medical information will be given either directly to the proposed insured or to a medical professional designated by the proposed insured. Your request is handled in accordance with the Federal Fair Credit Reporting Act procedures. If you question the accuracy to the information provided by the MIB, you may contact MIB and seek a correction. MIB's information Office is: MIB,Inc. 50 Braintree Hill Park, Suite 400,Braintree, MA 02184-8734, telephone 866-692-6901 (TTY 866 346-3642)
Information for consumers about MIB may be obtained on its Web site at http://www.mib.com/
For NM Residents: PROTECTED PERSONS1 have a right of access to certain CONFIDENTIAL ABUSE INFORMATION2 we maintain in our files and they may choose to receive such information directly. You have the right to register as a PROTECTED PERSON by sending a signed request to the Administrator at the address listed on the application. Please include your full name, date of birth and address.
1PROTECTED PERSON means victim of domestic abuse; who has notified us that he/she is or has been a victim of domestic abuse; and who is an insured or prospective insured person.
2CONFIDENTIAL ABUSE INFORMATION means information about: acts of domestic abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant or insured family member, employer or associate of a victim of domestic abuse or a person with whom the applicant or insured is known to have a direct, close, personal, family or abuse-related relationship.
New York Life Insurance Company
This section is only a brief description of the principal provisions and features of the Plan. The complete terms and conditions are set forth in the group policy issued by New York Life to the Trustees of Ophthalmologists Insurance Trust.
AJLI incurs costs in connection with this sponsored program. To provide and maintain this valuable membership benefit, it is reimbursed for these costs. AJLI also receives a fee for the license of its name and logo for use in connection with this Plan.
Underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010, under Group Policy G-30713-0, on Policy Form GMR-FACE/G-30713-0.