A Special Lloyd s of London Lump Sum Disability Program

Transcription

1 A Special Lloyd s of London Lump Sum Disability Program

2 How the Plan Works You will be paid up to $1,000,000 in lump sum cash if an accident or illness prevents you from performing the substantial and material duties of your regular occupation or specialty for 12 months and you are not expected to be able to perform those duties in the future.* After 12 months of total disability $1,000,000 Your bank account *See the Q&A for all of the details. 1

3 Other Important Features and Benefits You can buy your benefit without a medical examination or the need to answer medical questions if you have been actively at work for the past 180 days and have not received disability benefits in the past five years. You can buy your benefit in addition to your in-force disability insurance and it will not be offset or reduced by payments from that insurance. Your premiums are guaranteed for five years. You can purchase either a $500,000, $750,000 or $1,000,000 benefit. The $1,000,000 benefit is underwritten by Lloyd s of London which has exceptionally high Financial Ratings. Standard & Poor s A+ Excellent Fitch A+ Excellent A.M. Best A Excellent 2

4 Questions and Answers 1. What is the purpose of the Lump Sum Plan? The purpose of the Plan is to provide you with up to an additional $1,000,000 of disability insurance benefits to help you maintain your standard of living and that of your family if you become disabled, and to enable you to continue contributions to your retirement programs. 2. How much can I purchase? $500,000, $750,000 or $1,000,000 of lump sum benefits. 3. When is the benefit payable? When you are Permanently and Totally Disabled and the 12-month Elimination Period has been met. 4. What does Permanently and Totally Disabled mean? That as a result of a covered injury or sickness, you are permanently and totally unable to perform the substantial and material duties of your practice or specialty, as shown on your policy certificate for 12 months; you are not expected to be able to perform those same duties for the remainder of your lifetime; and you are under the regular care of a physician that is appropriate for the condition causing the disability. 5. What happens if there is a claims dispute? As part of the proof of Permanent Total Disability there must be included a certification from a physician that the Insured Person has suffered Permanent Total Disability as defined in the Certificate. In the event that Underwriters determine that it has not been demonstrated the Insured Person is Permanently Totally Disabled, then the question of Permanent Total Disability will be subject to the approval of two independent referees. One referee shall be an independent legally qualified physician or surgeon, chosen by the Underwriters, and the second referee shall be an independent expert of recognized standing in the occupation (as stated in the Schedule) of the Insured Person and shall be chosen by the Assured. The referees shall have the authority to decide solely whether the Insured Person s Total Disability is Permanent as defined in this Certificate. The referees are not to decide any other aspect concerning the validity of the claim. The decision of the two referees will be binding upon all parties. In the event that the two referees fail to agree, then they will appoint an Umpire whose decision will be final and binding upon all parties. 3

5 6. What are some examples of how the definition of disability works? A physician has Parkinson s and can no longer conduct the daily activities of his practice. The claim will be paid as it is not expected he will be able to continue his practice due to the effects of the disease. A dermatologist has a serious stroke and can no longer practice. If the residual effects of the stroke such as a partial paralysis of an arm or leg, or the inability to speak clearly are expected to prevent her from ever performing the substantial and material duties of her specialty, the claim will be paid. A surgeon loses the use of his hand in an accident. He will be paid because he will never be able to perform the duties of a surgeon. A surgeon suffers from Multiple Sclerosis and is no longer able to operate, but can still teach and provide cognitive professional services. She will be paid because she is not expected to be able to practice in her specialty as a surgeon even though she can work in another occupation. These are hypothetical claims examples to demonstrate what Permanently and Totally Disabled means. All claims will be decided in terms of their actual conditions and circumstances. 7. Will the $1,000,000 benefit be reduced or offset by payments I may receive from other disability insurance policies that I own? No. 8. Can I buy my benefit in addition to the disability insurance I now own? Yes. 9. Should I replace any of my existing disability with this policy? No, the policy is designed to be used to supplement your existing coverage, not replace it. 10. How do I qualify for guaranteed issue? To qualify for guaranteed issue, you must have been actively at work full-time in your practice for 180 days preceding the open enrollment period, have annual net earnings of at least $100,000, and have not been paid disability benefits in the past five years. 4

6 11. Do I have to be U.S. Citizens to be eligible for this coverage? No. 12. If I am disabled outside of the continental United States am I covered? Yes, protection is worldwide, 24/ Are premiums waived after I become disabled? Premiums are due during the 12-month period after the start of a disability. At the end of the 12 months when you have been paid your lump sum benefit, all of the premiums paid during this 12-month elimination period will be refunded to you. 14. Who is the insurer? Lloyd s of London. Its current financial ratings are: Standard and Poor s Fitch A.M. Best A+ (Excellent) A+ (Excellent) A (Excellent) 15. How long are premiums and coverage guaranteed? For five years. 16. At the end of the five-year period is it possible that the premium schedule can be changed or that the insurance company will not renew the policy? The policy is written on a group basis for a term of five years and premiums are guaranteed for that time. At the end of the term, the insurance company has the option to renew the policy and to adjust the rates based on new census population and experience. 17. Are benefits paid if the disability was caused by war, acts of foreign enemies, hostilities or warlike operations, civil war, rebellion, revolution, insurrection, uprising, or any act of terrorism provided that I was not taking an active part in them? Yes, with the exception of nuclear, chemical, or biological terrorism. 5

7 18. What conditions are not covered by the policy? If the loss is caused by, or the result of: Being under the influence of narcotics or intoxicants. Any psychosis, neurosis, or neuropsychiatric illness including, but not limited to any emotional anxiety or depression illness. Attempted suicide or an intentionally self-inflicted injury. Travel on aircraft for test purposes, on military aircraft, serving as a pilot or crewmember or taking a flying lesson. Participation in a riot, service in the military, or committing or attempting to commit a felony. Losses from any act of nuclear, chemical, or biological terrorism. Nuclear reaction, radiation, or contamination (not related to occupation). A pre-existing condition. 19. What is a pre-existing condition and how might it affect the coverage? A pre-existing condition is one for which (1) an insured received medical advice, or treatment was recommended or received from a physician during the 12-month period before the effective date of your coverage, or (2) had symptoms that were present during this 12-month period that would cause a reasonably prudent person to seek advice or treatment from a physician. The policy certificate does not provide benefits for a loss due to a pre-existing condition unless the loss begins more than one year after the effective date of your policy certificate, or the insurance company has agreed to cover it. 20. When will the insurance be effective? The effective date is shown on the policy certificate. 21. If I have not been actively at work for the past 180 days or have received disability benefits in the past five years, will I be denied coverage? Not necessarily. It depends upon the condition that caused the interruption in work or the disability. 22. What happens if I apply for coverage and then decide I don t want it? You can return your certificate within ten days of receiving it and receive a full refund of your premium payment. 6

8 23. Where can I view my premium rates and how do I enroll? Enrolling is simple and takes less than five minutes with no paper applications. Log onto our special website and enter your birthday to view your individual rates. Choose your benefit amount and follow the prompts through our simple three step enrollment process. You will sign electronically and will be able to print your application for your records once it is submitted. Approval takes on average 7-10 business days and once approved, we will notify you by mail or at which time the premium will be due. Once the premium is paid, you will receive your policy certificate. You have a 10-day money back guarantee review period. This Questions and Answers material is a summary of important policy provisions. It is not a contract or proposal. In all cases, the actual terms and provisions of the policy will govern. 7