DISABILITY INCOME PROTECTION PLAN. Your Partner in Protecting Your Income. American Association of Nurse Anesthetists

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1 Your Partner in Protecting Your Income. TM Your ability to earn an income may be your most valuable asset. Your lifestyle, your home, your children s education and your retirement may ALL hinge on your ability to work. American Association of Nurse Anesthetists DISABILITY INCOME PROTECTION PLAN G

2 LIKE MOST PEOPLE, YOUR ABILITY TO EARN AN INCOME MAY BE YOUR MOST VALUABLE ASSET. Without an income, years of hard-earned savings could evaporate in a matter of months, even weeks. Still, no one really expects to become disabled, especially for a period of months or even years. But the fact is, it happens. That s why the American Association of Nurse Anesthetists wants to help you protect your income and your family s financial security with disability income protection insurance. What Disability Income Benefits Are Available To You? Thanks to your membership in the American Association of Nurse Anesthetists you now have the opportunity to apply for a valuable income protection plan from New York Life Insurance Company at reasonable group rates. Disability Income Protection helps replace your income if you re sick or injured and can t work. Valuable Coverage This group insurance plan covers most disabilities due to accidental injuries, sickness or disease, including complications of pregnancy. To qualify for benefits, a period of Total Disability must begin while you are covered under this policy and you are under the regular care of a physician (the physician cannot be a family member) for the condition. IMPORTANT BENEFITS Guaranteed Renewable As the only group accident and sickness disability income program sponsored by AANA, New York Life Insurance Company cannot cancel the Master Policy under which this valuable coverage is afforded. Additionally, once you have been accepted in the Plan, your coverage cannot be cancelled because of your health. Automatic Benefit Increase This feature gives you the opportunity to increase your monthly benefit amount by 10% of the amount of coverage in force on the day before the date of your first increase option every three years up to a maximum of four times and all without submitting medical evidence of insurability. Benefits cannot be higher than the maximum benefit amount of $12,000. This feature is available if you are under age 50 at the time of application and are not Totally or Residually Disabled on the date the increase would take effect. You will not be charged for this benefit until the increase goes into effect. Should you decline an Automatic Benefit Increase, no future increases will be available. Residual Disability Benefit is INCLUDED A Residual Disability Benefit is paid if you receive Total Disability benefits, but are then able to perform at least one of the substantial and material duties of your regular occupation, either part-time or full-time. You must suffer an income loss of between 20% and 80% and be under the regular care of a physician. (See your Certificate of Insurance for details.) The Residual Disability Benefit lets you rebuild your income to its predisability level as you return to full time employment. This provision is especially important for professionals or small business owners who must rebuild a professional practice or business after becoming disabled. no one really expects to become disabled, especially for a period of months or even years. But the fact is, it happens.

3 If you suddenly became too sick or hurt to work, how would you continue your lifestyle? Vocational Rehabilitation Benefit is INCLUDED Anyone who earns an income by delivering medical services each day needs to return to work as soon as possible from a disability. This Plan s Vocational Rehabilitation benefit can help make that happen. Your Certificate of Insurance will have all the details on this important benefit. Cost of Living Adjustment (COLA) Option This feature can provide you with increased monthly benefits should you remain disabled after 12 consecutive months. The COLA feature is based on a rise in the U.S. Consumer Price Index and benefits could be increased as long as you remain Totally Disabled, to a maximum of 2 times your original monthly benefit. The adjustment, which will be made on January 1 each year, will equal the percentage change in the Consumer Price Index to a maximum of 6%. Communicable Disease Benefit is INCLUDED If you contract a covered communicable disease (as defined in your Certificate of Insurance) and, as a result, are unable to earn more than 75% of your monthly income, you will receive residual disability benefits - without a waiting period - provided you are under age 65. Continuous Benefits at No Cost to you Future premiums will be waived for as long as benefits are payable after you have been Totally Disabled for six months. SELECT FROM GOLD OR PLATINUM PLANS AANA s Disability Income Protection Program offers two plans from which to choose, the Gold Plan and the Platinum Plan. You also have a choice of two waiting periods - either 60 or 90 days - to suit your benefit needs. The waiting period is the number of consecutive days that elapse after you have become Totally Disabled before benefits begin. Your disability benefits will be paid directly to you following this waiting period. The Gold Plan and the Platinum Plan provide benefits for as long as you are Totally Disabled, to a maximum age of 65. For Total Disabilities beginning before age 63, the payment period is to age 65. After age 63, but under age 70, the payment period is 2 years. The Gold Plan For the Gold Plan, a Total Disability is one that wholly and continuously prevents you from performing your substantial and material duties as a Nurse Anesthetist (or your current occupation) for pay or profit during the waiting period and the own occupation payment period which, under the Gold Plan, is 10 years. After that, a Total Disability is one that wholly and continuously prevents you from performing in an occupation for pay or profit for which you are reasonably suited by education, training and experience. The Platinum Plan For the Platinum Plan a Total Disability is defined as one that wholly and continuously prevents you from performing your substantial and material duties as a Nurse Anesthetist (or your current occupation) for pay or profit during the waiting period to age 65 (or two years, if disability occurs between age 63 and 70). Who is Eligible to Apply? As an active AANA member under age 60 (and a U.S. resident), working at least 20 hours a week practicing as a Nurse Anesthetist (or your current occupation), you may apply for coverage under this valuable AANA Plan. A member s spouse may apply for coverage. The spouse must be a U.S. resident, under age 60, employed full-time, and not legally separated or divorced from the AANA member. It s too late to do anything about it once you become disabled. That s why it s so important to shield your income now.

4 A M E R I C A N A S S O C I A T I O N O F N U R S E A N E S T H E T I S T S D I S A B I L I T Y I N C O M E P R O T E C T I O N P L A N F R O M N EW Y O R K L I F E How Much Can I Apply For? As an eligible AANA member, you may apply for a monthly benefit of up to 70% of your monthly earnings from $1,000 up to $12,000 in $100 increments ($1000 to $5,000 in $100 increments if practicing as a CRNA, or your current occupation, for less than 1 year). Monthly earnings are your average gross (pre-tax) income from salary, wages, fees, commissions, and any other amounts received for personal services, including the cost of your fringe benefits and share of total surplus; however, it does not include income from interest, dividends, rent, royalties, annuities, other insurance and other unearned income. The total monthly disability income insurance amount placed with all companies may not be greater than $20,000. If your disability benefits under this insurance, plus all other disability income benefits from government, government agencies, insurance companies, organizations or funds, are more than your maximum amount allowed (70% of your average monthly earnings when you experience a covered Total Disability), the benefits under this plan will be reduced. Of course, any premiums you may have paid for the excess insurance will be refunded retroactively for up to two years. At age 65, your monthly benefit, if greater than $1,000, will be reduced to $1,000. (This reduction will NOT apply if you are receiving benefits.) Convenient Coverage Effective Date Your insurance will take effect on the first day of the month following the date your application is approved and your premium is paid. If you re not working full-time on that day, your effective date will be postponed until the first day of the month following your return to full-time work for 90 consecutive days. Full-time work is defined as performing all the regular duties of your own occupation for pay or profit for at least 20 hours per week at a place where such duties are normally performed. Coverage Continuation Your coverage will continue as long as your premiums are paid, you continue in your practice as a Nurse Anesthetist, (or other occupation) working full-time at least 20 hours a week (except for covered disabilities); you are under age 70, and you remain a member (or lawful spouse of a member) of AANA, you do not begin active duty in the Armed Forces, and AANA continues to sponsor this insurance plan. What If I ReturnTo Work After A Disability, But Suffer a Relapse? AANA s Disability Income Protection Program recognizes that disabilities don t always start and stop in easily defined time frames. Therefore, periods of disability, if due to the same or related medical causes, and separated by fewer than 90 days while you are actively at fulltime work, are considered a single period of disability. This means you won t have to satisfy a new waiting period before qualifying for benefits should you suffer a relapse upon returning to active employment after receiving benefits for a disability. Exclusions and Limitations Disability Benefits are not payable for the following: a loss sustained as a result of service in the military, naval or air force of any country, alliance or international organization or in a civilian unit which serves such force other than active duty for training periods of two months or less*; a loss due to war, an act of war whether declared or not or an armed conflict which involves the armed forces of one or more countries; a loss due to self inflicted injury or that occurs while intentionally injuring oneself while sane or insane (in Missouri, while sane); a loss due to pregnancy**, childbirth or related medical conditions, except for a complication of pregnancy; a loss sustained as a result of travel in, on or a fall from or descent from any aircraft in flight unless traveling solely as a fare paying passenger on licensed, commercial, regularly scheduled, non military aircraft; in a civil aircraft having a current and valid Standard Federal Aviation Agency Airworthiness Certificate and piloted by a person with a current and valid pilot s Certificate with proper ratings for the type of flight and aircraft involved; or in a transport type of aircraft operated by the Military Airlift Command (MAC) or its successor organization of the United States of similar air service of any country; a loss as the result of participation in or incarceration resulting from the commission of a felony, an illegal occupation or activity, an insurrection, terrorist activity or a riot in a role other than as a victim; a loss as the result of the use of drugs, intoxicants, narcotics, barbiturates or hallucinogenic agents unless such use is prescribed by a doctor or accidentally administered or the illegal use of drugs, AANA s Disability Income Protection Program recognizes that disabilities don t always start and stop in easily defined time frames.

5 intoxicants, narcotics, barbiturates or hallucinogenic agents; a loss as a result of a condition which has an impairment restriction; a loss for which a doctor s care or attention is not required or any period of disability for which you are not under the regular care and attendance of a doctor who is not a member of your own family. A loss of license, in and of itself, does not constitute an incapacity that prevents an insured member from doing the material and substantial duties of his or her occupation and will not be deemed a Covered Total Disability. NOTE: The maximum benefit period for all covered disabilities due to or related to Mental Disorders and/or Chemical Dependency cannot exceed 12 months while insured under the policy; however, this limitation will not apply if the insured person is confined in a hospital or other institution licensed to provide care and treatment for that disability. The Maximum Benefit Period for all Covered Disabilities due or related to Self-Reported Symptoms may not exceed the lesser of 24 months or the Maximum Benefit Period of a Covered Disability. See your Certificate for details. Pre-Existing Conditions Limitations Any condition (diagnosed or undiagnosed) for which you received medical treatment or took medication within the 12 months preceding the effective date of your insurance is a pre-existing condition. Any period of disability due to a preexisting condition that begins within the first two years of your insurance will not be covered. This does not apply to disability periods beginning after you ve been without medical care for the condition for 12 consecutive months ending on or after your effective date of coverage. *Any unearned premium for the period for which no coverage has been provided will be refunded on a pro-rata basis. **Pregnancy covered in CA, MN and MT. TA K E T H I S You Have Too Much At Stake To Delay O P P O RT U N I T Y T O H E L P P R O T E C T YO U R I N C O M E Most people wouldn t dream of leaving their home, cars, boats or other valuables unprotected by insurance. But few think to protect the one asset that makes all of these others possible -- the ability to work and earn an income. It s too late to do anything about it once you become disabled. That s why it s so important to shield your income now -- while you re healthy and active. Take the first step towards protecting yourself from the devastating financial effects of a disability by filling out the enclosed application today. HERE S HOW TO APPLY 1. Complete the enclosed application, answering all questions in full. Your application is subject to approval by New York Life Insurance Company. 2. Mail your application in the enclosed, self-addressed envelope today. Please call us if you have ANY questions, or need help regarding your particular situation. We ll be happy to help you any way we can! :00 am to 5:00 pm Central Time Every Business Day. Fax Enjoy a 30-Day Free Look If you re not completely satisfied with your coverage, you can return your Certificate of Insurance without claim for a full refund within 30 days of the effective date of coverage. This brochure 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 brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the New York Life Insurance Company detail exclusions, limitations, reduction 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. Administered by: AANA Group Insurance Administrator The Princeton Corporation 600 Princeton Parkway Kentland, Indiana Underwritten by: New York Life Insurance Company 51 Madison Avenue New York, New York POLICY FORM: GMR FACE Princeton.

6 Semi-Annual Premiums Per $100 of Monthly Benefits Gold Plan Coverage for both accident & sickness, payable to age 65, with a 10 year own occupation benefit period If you wish to include the Cost of Living Adjustment (COLA) Benefit with your coverage, the total semi-annual premiums per $100 of monthly benefits are as follows: $ x 40 $ Figuring Your Rate is Simple (from the Gold Plan chart above) (This is the number of $100 increments for $4,000. {4, = 40}) Platinum Plan Coverage for both accident & sickness with an own occupation benefit period to age Day 60 Day 90 Day 60 Day Waiting Period Waiting Period Waiting Period Waiting Period Age Female Male Female Male Female Male Female Male under 30 $ 6.06 $ 4.13 $ $ 8.27 $ 6.79 $ 4.63 $ $ * * Gold Plan & Platinum Plan With Cost of Living Adjustment (COLA) Benefit Gold Plan W/COLA Coverage for both accident & sickness, payable to age 65, with a 10 year own occupation benefit period Platinum Plan W/COLA Coverage for both accident & sickness with an own occupation benefit period to age Day 60 Day 90 Day 60 Day Waiting Period Waiting Period Waiting Period Waiting Period Age Female Male Female Male Female Male Female Male under 30 $ 7.70 $ 5.25 $14.53 $ $ 8.62 $ 5.87 $ $ * * To determine your semi-annual premium, multiply the appropriate rate from above, times the number of $100 increments of monthly benefit for which you are applying. EXAMPLE WITHOUT COLA Gold Plan Female Day Waiting Period $4,000 Monthly Benefit No COLA Benefit EXAMPLE WITH COLA Gold Plan Female Day Waiting Period $4,000 Monthly Benefit COLA Benefit Included $ x 40 $ Rates current as of June 1, Rates current as of June 1, (from the Gold Plan chart above) (This is the number of $100 increments for $4,000. {4, = 40}) Premium you pay just twice a year. Premium you pay just twice a year. The premium rates shown in the chart above are based on the benefit plan you select, the waiting period you select, and your age at the time you apply (up to age 60). The premium rates shown above reflect the current rate and benefit structure and will increase on the due date immediately following your birthday as you enter a new age bracket. Premium rates may be changed by New York Life Insurance Company on any premium due date and on any date when benefits are changed. However, your rates may change only if they are changed for all others in the same class of insured. For example, a class of insureds is a group of people with the same issue age and gender. Benefits are subject to change by agreement between New York Life and AANA. AANA incurs costs in connection with providing oversight and administrative support for this sponsored plan. To provide and maintain this valuable membership benefit, AANA is reimbursed for these costs. *Renewal rates only G Licensed Agent: Jim Jelinek: AR Lic# CA Lic# 0G Princeton. All Rights Reserved. V2GP