Features & Provisions

Monthly Benefits

The total disability benefit will begin to accrue on the day after the waiting period ends.

The total disability benefit will be paid in the amount elected and approved, reduced by other income benefits as described below.

Limited benefits will be paid for:
Total disability due to mental, nervous or emotional disorders, alcoholism and drug addiction, and pre-existing conditions.

Benefit for Part of a Month:
To determine the benefit to be paid for a period of less than a full month: divide the benefit by 30 and multiply the result by the number of days in such period.

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

1. Your monthly income benefit is reduced by any benefits available from any government plans. (i.e. Social Security benefits, Workers’ Compensation, etc.)
2. 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

No monthly benefit will be paid for disability due to; intentionally self-inflicted injury; a war or an act of war; committing a crime or an attempt to do so, or; pregnancy, except benefits for complications of pregnancy, as defined by the group policy, are paid for as a sickness.

Termination

A member’s insurance will end at the earliest of:

1. the date the group policy ends
2. the end of the period for which the last premium has been paid by the member
3. the date the member attains age 70; or
4. the date employment ends for reasons other than total disability for which benefits are payable under the group policy.

Eligibility

1. All members who are under age 60 who are actively at work 30 or more hours
   per week.
2. 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.

Basic Monthly Pay: the member’s monthly rate of pay from his employer or self-employment. Such rate will be that in effect on the day before total disability begins. “Basic monthly pay” includes commissions, but not bonuses, overtime pay or other extra compensation. Commissions will be averaged for the lesser of: the 24 month period of employment before the date total disability begins, or; the period of employment.

Waiting Period: a period of consecutive days of total disability for which no benefit is payable.

The brochure is a summary of benefits only and is subject to the terms, conditions exclusions and limitations of Group Policy No. G-174,371, Form No. G-19000.

Underwritten by: The United States Life Insurance Company in the City of New York (called United States Life). A member company of American International Group, Inc. A copy of this application will be attached and become part of your Certificate of Insurance, upon approval.

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.

Disability Benefits received from coverage paid for by the insured are normally TAX-FREE.
Consult your tax advisor for specific details.

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