Limited Monthly Benefits to be Paid
For Mental, Nervous or Emotional Disorders, Alcoholism or Drug addiction
If total disability is due to a mental, nervous or emotional disorder, alcoholism
or drug addiction, a maximum of 12 monthly benefits will be paid while such
disability continues.
Integration
- Your monthly income benefit is reduced by any benefits available from any
government plans. (i.e. Social Security benefits, Workers’ Compensation, etc.)
- Then, if any benefits are available from other group Disability and Retirement
plans, or any other income from employment, the benefit is reduced so that the
total income from such sources does not exceed 70% of your pre-disability
earnings. Benefit integration does not apply to individual policies.
If: the monthly benefit to be paid
under this plan, before reduction, plus the other income benefits, equals 70% or
less of the member’s basic monthly pay...
Then: no reduction will be made under
this plan.
If: the monthly benefit to be paid
under this plan, before reduction, plus the other income benefits, exceeds 70%
of the member’s basic monthly pay.
Then: a reduction will be made, but
will be limited to the amount by which the total income benefit exceeds such
70%.
Limited Monthly Benefits
to be Paid for Pre-existing Conditions
Pre-existing Condition means an injury or sickness for which the member: incurred
charges, received medical treatment, consulted a physician, or, took
prescription drugs, within 12 months before he became insured by this plan.
If total disability is due to a pre-existing condition and it begins within 24
months of the date the member becomes insured by this plan, no benefits will be
paid unless the member has not: incurred charges, received medical treatment,
consulted a physician, or, taken prescribed drugs, for such condition, or any
complication of it, for 12 continuous months, while insured.
Successive Periods of Disability
Successive periods of disability will be considered one period of disability
unless they are: due to unrelated causes, or, separated by a return to full-time
work for 6 or more continuous months. A separate waiting period will apply for
each separate period of total disability.
If the member receives long term disability benefits from another group plan
which replaces this plan, this provision will not apply to him.
Exclusions
The Policy does not cover any Disability or loss caused by:
- intentionally self inflicted Injury, suicide or attempted suicide, while sane
or insane; or
- pregnancy or childbirth, except Complications of Pregnancy; or
- war or act of war, whether declared or not; or
- Your commission or attempted commission of a felony.
Termination
Your coverage and Your Spouse's coverage will end on the earliest of:
- the date The Policy terminates;
- the date the Policyholder withdraws its sponsorship of, or cancels, The Policy;
- the Premium Due Date on or next following the date You or Your Spouse attain The
Policy Age Limit;
- the date You or Your Spouse cease to be Actively at Work, except due to
disability covered by The Policy as described herein;
- the Premium Due Date any required premium contribution is not made, subject to
the Individual Grace Period; or
- with respect to Your Spouse's coverage, the Premium Due Date he or she is
legally separated or divorced from You.
However, if Your Spouse's coverage would terminate because of Your death,
coverage will continue until the Premium Due Date on or next following Your
death unless continued in accordance with the Surviving Spouse Continuation
provision.
Eligibility
- All members who are under age 60 who are actively at work 30 or more hours
per week.
- All spouses of members who are under age 60 who are actively at work 30 or more
hours per week.
Note: For the purpose of this proposal, references to
member will mean spouse, as appropriate.
Evidence of Insurability
A medical application with MIB authorization is required for all monthly benefit
amounts and benefit periods, lab work may be required in some cases.
Actively at Work Requirement
The member must be actively at work on the date insurance is to take effect. If
he or she is not, insurance will not take effect until the date the member
resumes such work.
Definitions
Total Disability: during the waiting period and next 24
months, the member’s complete inability to perform the material duties of his
regular job; “his regular job” is that which he was performing on the day before
total disability began; after such 24 months, the member’s complete inability to
perform the material duties of any gainful job for which he is reasonably fit by
training, education or experience.
The total disability must be a result of an injury or sickness. To be considered
totally disabled, the member must also be under the regular care of a physician,
and must not be performing the duties of any gainful job.
Pre-disability Earnings: means if You or Your Spouse
are self-employed, You or Your Spouse's average new monthly income (gross
revenues less business expenses) from:
- the personal practice of Your or Your Spouse's profession; or
- personal conduct of Your or Your Spouse's main business.
This average is based on net income for:
- 12 months; or
- 24 months;
whichever produces the higher average, before the determination is made. If You
or Your Spouse have been self-employed for less than 12 months, it is based on
the whole time You or Your Spouse were self-employed. If Your or Your Spouse's
practice is incorporated, net income includes the cost to Your or Your Spouse's
company of fringe benefits and Your or Your Spouse's share of total surplus.
Income does not include investment returns, rents, royalties, and the like
income which is not directly produced from Your or Your Spouse's current work.
Pre-disability Earnings means, if You or Your Spouse are not self-employed, Your
or Your Spouse's regular monthly rate of pay, includes Commissions, but not
bonuses, tips and tokens, overtime pay or any other fringe benefits or extra
compensation, in effect on the date immediately prior to the last day You or
Your Spouse were Actively at Work before You or Your Spouse became Disabled.
Waiting Period: a period of consecutive days of total
disability for which no benefit is payable.
Medical Information Bureau Disclaimer:
Acceptance into this plan is subject to medical evidence of insurability as
determined by The Hartford. Depending on your age, the amount of coverage you
request, and your answers on the application, a medical examination, medical
test(s), or other evidence of good health may be required. Any exams/tests
requested by the company will be conducted at your convenience and at no expense
to you.
Notice of Insurance Information Practices
To properly underwrite and administer your application for insurance coverage, we
must collect certain information concerning your insurability. You are our most
important source of information, but we may also contact other sources such as
medical professionals and institutions, employers and other insurance companies.
While all information regarding your insurability will be treated as
confidential, in some situations, and in compliance with applicable law, we may
disclose necessary items of information to third parties without your specific
authorization.
INVESTIGATIVE CONSUMER REPORTS
As part of our procedure for processing your application, an
investigative consumer report may be prepared by an outside insurance reporting
organization. Personal information may be collected from others regarding your
general reputation and lifestyle. If an interview is conducted with someone
other than you, we will inform you of your right to be interviewed in connection
with the preparation of the investigative consumer report. You have the right to
send a written request within a reasonable period of time to receive additional
detailed information about the nature and scope of this investigation.
PERSONAL HISTORY INTERVIEW
To provide you, our client, with the best possible service, we
may also conduct what we call a personal history interview. This is a phone call
placed from our underwriting office. Its purpose is to make sure that the
application information is complete. Our interviewers are trained to conduct
their calls in a friendly, professional manner. The nature of the information
discussed is always treated as personal and confidential and will only be used
to assess your eligibility for insurance.
MEDICAL INFORMATION BUREAU (MIB) PRE-NOTICE
Information regarding your insurability will be treated as
confidential. Hartford Life Insurance Company or Hartford Life and Accident
Insurance Company or its reinsurer(s) may, however, make a brief report thereon
to the MIB, Inc., formerly known as Medical Information Bureau, a not-for-profit
membership organization of insurance companies, which operates an information
exchange on behalf of its members. If you apply to another MIB member company
for life or health insurance coverage, or a claim for benefits is submitted to
such a company, MIB, upon request, will supply such company, with the
information about you in its file. Upon receipt of a request from you, MIB will
arrange disclosure of any information in your file. Please contact MIB at (866)
692-6901 (TTY (866) 346-3642). If you question the accuracy of the information
in MIB's file, you may contact MIB and seek a correction in accordance with the
procedures set forth in the Federal Fair Credit Reporting Act. The address of
MIB's information office is 50 Braintree Hill Park, Suite 400, Braintree,
Massachusetts 02184-8734. Hartford Life Insurance Company, Hartford Life and
Accident Insurance Company , or their reinsurers, may also release information
from their files to other insurance companies to whom you may apply for life or
health insurance, or to whom a claim for benefits may be submitted. Information
for consumers about MIB may be obtained on its website at www.mib.com.
ACCESS, CORRECTION AND DISCLOSURE
You can obtain access to personal information about you contained
in our policy files by sending us a written request. You may also request any
necessary corrections, amendments or deletion of any information in our files
which you believe to be inaccurate or irrelevant. Hartford Life Insurance
Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may
release information in their files to other life insurance companies to whom you
may apply for life or health insurance, or to whom a claim for benefits may be
submitted. Also, please be advised that personal and confidential information
collected by us may, in certain circumstances, be disclosed to third parties
without authorization. A notice providing further description of the
circumstances under which information about you may be disclosed and the types
of persons and organizations to whom it may be disclosed will be sent to you
upon your written request. If you desire further information or access to your
personal information, please send your written request to: Hartford Life
Insurance Company or Hartford Life and Accident Insurance Company, 200 Hopmeadow
St., Simsbury, CT 06089.
The Hartford is The Hartford Financial Services Group, Inc., and its
subsidiaries, including issuing company Hartford Life and Accident Insurance
Company.
PA-9369
This website explains the general purpose of the insurance described, but in no
way changes or affects the policy as actually issued. In the event of a
discrepancy between this website and the policy, the terms of the policy apply.
All benefits are subject to the terms and conditions of the policy. Policies
underwritten by Hartford Life and Accident Insurance Company detail exclusions,
limitations, reductions of benefits and terms under which the policies may be
continued in full or discontinued. Complete details are in the Certificate of
Insurance issued to each insured individual and the Master Policy issued to the
policyholder. This program may vary and may not be available to residents of all
states.
Once you receive your certificate of insurance, if you’re not 100% satisfied
within the first 30 days, we’ll send you a full refund of any premiums paid
during that period and your certificate will be considered never issued. You
will be under no further obligation.
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