Income Protection Plan An Accident-Only Disability Income Insurance Plan

Transcription

1 Income Protection Plan An Accident-Only Disability Income Insurance Plan Income Protection Plus Plan An Accident & Illness Disability Income Insurance Plan M IP_P IP B 110_110 HealthMarkets is the brand name for products underwritten and issued by the insurance subsidiaries of HealthMarkets, Inc. The Chesapeake Life Insurance Company, Mid-West National Life Insurance Company of Tennessee SM and The MEGA Life and Health Insurance Company ṢM

2 The only thing worse than being disabled is not being able to afford it. Accidents and illnesses can unexpectedly prevent you from earning a living. Have you ever thought about what you would do if you were unable to work because you were totally disabled due to an injury or illness? What are the chances that you may suffer a disabling injury? Unintentional-injury deaths were up 2% in 2006 compared to the revised 2005 estimate.* Unintentional-injury deaths were estimated to total 120,000 in 2006 and 118,000 in 2005.* About 28.4 million were treated in hospital emergency departments and about 5.4 million visits to hospital outpatient departments were for unintentional injuries.* About 40.9 million visits to physicians offices were for unintentional injuries.* Where will your paycheck come from if you are disabled? *National Safety Council Injury Facts, 2008 Edition ( )

3 Flexible Protection MEGA's Commitment MEGA has long recognized the need for flexible insurance coverage and is committed to making such insurance coverage available to you. As part of that commitment, you are provided access to insurance coverage through The MEGA Life and Health Insurance Company SM (MEGA). MEGA Provides: Flexible insurance options A dedicated field force to explain the coverage face-to-face with members A portfolio of health and ancillary insurance products

4 Table of Contents Benefit Descriptions 1 Income Protection Plan 2 Income Protection Plus Plan 3 Additional Information on Income Protection & Income Protection Plus Plans 4 Other Important Information & State Variations 5 Acknowledgement of Receipt This brochure provides only summary information. Benefits may vary by state. The information contained in this brochure is accurate at the time of printing. These plans are not intended as a replacement for health coverage and should not be construed as such. For a complete listing of benefits, exclusions and limitations please refer to the Policy schedule. In the event of any discrepancy contained in this brochure, the terms and conditions contained in the Policy documents shall govern.

5 Income Protection Plan - An Accident-Only Disability Income Insurance Plan Benefit paid directly to you Provides protection on and off the job Use benefit as you choose Benefits The Income Protection Plan provides a monthly total disability benefit if you become totally disabled, due to an accident only, while you are insured under the plan and are actively employed. Your monthly total disability benefit will begin on the first day following the elimination period. CHOOSE YOUR MONTHLY INDEMNITY BENEFIT 1 $1,000 per person $1,500 per person The monthly indemnity benefit will be the lesser of the amount chosen or your prior monthly income (as defined in the Policy). MAXIMUM PERIOD PAYABLE 12 months for each period of total disability CHOOSE YOUR ELIMINATION PERIOD 2 14 days 30 days The elimination period is the consecutive period of time beginning on the date you are considered totally disabled before the monthly indemnity benefit is payable. Total disability must begin within 30 days of the injury which caused your total disability. 1 Benefit cannot exceed 60% of gross monthly earnings, including other disability income benefits. 2 The elimination period begins on the date you are considered totally disabled. This plan cannot be sold with the Income Protection Plus plan. Form IP, or its state variation M IP_P IP B 110 1

6 Income Protection Plus Plan - An Accident & Illness Disability Income Insurance Plan Benefits The monthly total disability benefit will be the lesser of $600 or your prior monthly income (as defined in the Policy). The 30-day elimination period is the consecutive period of time before the monthly indemnity benefit is payable. The total disability must commence within 30 days of the illness or injury that caused your total disability. Your monthly total disability benefit will begin on the first day following the elimination period. MONTHLY INDEMNITY AMOUNTS 1 $600 per person $700 per person $800 per person $900 per person $1,000 per person $1,100 per person $1,200 per person $1,300 per person $1,400 per person $1,500 per person MAXIMUM PERIOD PAYABLE 2 24 months for each period of total disability The elimination period will be waived if you are hospitalized for more than 7 days. ELIMINATION PERIOD 30 days The elimination period is the consecutive period of time beginning on the date you are considered totally disabled before the monthly indemnity benefit is payable. Total disability must begin within 30 days of the injury which caused your total disability. Optional Benefits Return of Premium Benefit (25918-IR) This optional rider is available to age 50. This optional rider returns your disability income insurance premiums, less any claims paid for you, if the rider is continuously in force from the effective date until age 65. Depending on the number of years the rider is in force, partial refunds, less any claims paid, may be claimed after only five years. Example: Assume an insured is paying $75 a month in disability income insurance premium. If disability income insurance premiums remain level, $22,500 in disability income insurance premiums will have been paid by age 65; a) If the insured had no claims, we would refund a total of $22,500 at 65; b) If we had paid $5,000 in claims over this 25-year period, we would still refund $17,500 at age 65; c) If we had paid for a lengthy disability or many disability claims ($25,000 for example), there would be no refund at age 65. Waiver of Premium Benefit Rider (25917-IR) This optional rider will waive disability income insurance premiums on a monthly basis during the period that total disability benefits are payable, after you have been continuously totally disabled for a period of 90 days. Your coverage and its benefits will continue during the benefit period. When you are no longer eligible for the waiver of premium, you can continue your coverage in force by resuming premium payments within 31 days of the date you become ineligible for this benefit. 1 Benefits cannot exceed 60% of gross monthly earnings, including other disability income benefits. 2 Benefit is payable if you become totally disabled while you are covered under the Policy and are actively at work. This plan cannot be sold with the Income Protection plan. Form IP, or its state variation 2 M IP_P IP B 110

7 Additional Information for Income Protection and Income Protection Plus Commonly Asked Questions What if I m totally disabled for less than a full month? We will pay 1/30th of the monthly indemnity benefit otherwise payable for each day of a period of total disability that is less than a full month. What if I have a recurrent disability? After a period of total disability for which we paid benefits ends, if you become totally disabled again within 12 months from the same or related cause, we will consider it a continuation of the previous period of total disability. If you have been actively at work for more than 12 consecutive months between those two periods of total disability, then we will consider it a new period of total disability. Plan Terms Actively at Work: 1) working on a permanent basis at least 25 hours per week; and 2) performing the material and substantial duties of your regular job or any other job for which you are qualified by reason of education, training or experience. Injury: Bodily harm caused by an accident resulting in unforeseen trauma requiring immediate medical attention and is not contributed to, directly or indirectly, by disease. The injury must occur after your coverage becomes effective and while coverage is in force. Prior Monthly Income: Your average monthly income over the last 12 months or the last calendar year, whichever is greater. Sickness (for Income Protection Plus Only): An illness or disease which first manifests itself after your coverage becomes effective and while the coverage is in force. Total Disability or Totally Disabled: Due to an injury (or sickness, applies to Income Protection Plus only) you are under a physician's care and unable to engage in any employment or occupation for which you are qualified by reason or education, training or experience, and are not in fact actively at work, as certified by a physician upon our request. Exclusions and Limitations (may vary by state) We may require information regarding pre-tax personal income, allowable business expenses, and other plans, including income tax returns, for periods before and after the start of a period of total disability. Failure to provide such information may result in disqualification for benefit payment under the Policy. Benefits are subject to coordination with other compensation. We will not provide any benefits for any loss caused by or resulting from: Sickness (for Income Protection Plan Only) Any act of war, declared or undeclared Pregnancy or childbirth Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane Mental or nervous disorders Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics, or hallucinogens, unless taken as prescribed by a physician An overdose of drugs, being intoxicated or under the influence of intoxicants, hallucinogens, narcotics or other drugs, unless taken as prescribed by a physician Engaging in an illegal occupation or illegal activity or your being incarcerated Travel in or descent from any vehicle or device for aerial navigation, except as a fare paying passenger in an aircraft operated by a commercial airline (other than a charter airline) on a regularly scheduled passenger trip Any condition excluded from coverage by name or specific description. Pre-Existing Condition (for Income Protection Plus Only) The plan will not cover a pre-existing condition, as defined, unless the loss is incurred at least one year after your effective date of coverage. A pre-existing condition means a medical condition, sickness or injury not excluded by name or specific description for which: 1) Medical advice, consultation or treatment was recommended by or received from a physician within the two year period before the effective date of coverage; or 2) Symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the two year period before the effective date of coverage. Termination of Coverage Your coverage will terminate and no benefits will be payable under the Policy and the attached riders, if any: 1) at the end of the period for which premium has been paid, subject to the grace period; 2) at the end of the period through which premium has been paid following our receipt of your written request of termination; 3) on the date of fraud or misrepresentation by you; 4) on the date we elect to discontinue this plan or type of coverage; 5) on the date we elect to discontinue all coverage in your state; 6) on the date an insured person is no longer a permanent resident of the United States; or 7) upon your attainment of age 65. Form IP and IP, or their state variations M IP_P IP B 110 3

8 Other Important Information & State Variations When does coverage begin? Once MEGA has approved your application, and you have paid your premium, coverage will begin on the Policy date shown in the Policy schedule. What about premium changes? We reserve the right to change the table of premiums, on a class basis, becoming due under the Policy at any time and from time to time; provided we have given the policyholder written notice of at least 31 days prior to the effective date of the new rates. Such changes will be on a class basis. The premium for the Policy may change by reason of an increase in your attained age or change in your occupation. What about renewability? Your Policy is guaranteed renewable, to age 65 subject to the company s right to discontinue or terminate the coverage as provided in the termination of coverage section of the Policy. State Variations The information provided below summarizes the major variations in coverage by state from those described in this brochure. The exclusions and limitations of the Policy also apply. Please refer to your Policy, upon receipt for complete details. Georgia For both plans, the "actively at work" requirement is replaced with: "and under the regular care of a licensed physician and the disability is not excluded under the exclusions and limitations section." The "What about premium changes?" section is revised by changing "31 days" to "60 days". Under the Termination of Coverage section, provision # 3 is revised to read: "On the date of fraud or misrepresentation by You, subject to the Incontestability provision appearing under the General Provisions section of the Policy," for the Income Protection Plan, and revised to "If you perform an act or practice that constitutes fraud or intentional misrepresentation of material fact in applying for or procuring coverage, subject to the Incontestability provision appearing under the General Provisions section of this Policy," for the Income Protection Plus Plan. For the Income Protection Plus plan, the Return of Premium Rider is not available. Maine For Income Protection Plus Plan, the definition of Sickness is replaced with: "Sickness means an illness or disease". New Hampshire For both plans, a $500 monthly indemnity benefit is also available. For both plans, exclusion number 6 regarding an overdose of drugs, the word "intoxicants" is deleted. Under the Recurrent Disability section, "12 months" is revised to "6 months". The "What about premium changes?" section is revised to read: "We reserve the right to change the table of premiums, on a class basis, becoming due under the Policy at any time and from time to time; provided, we have given the insured person written notice of at least 31 days prior to the effective date of the new rates, unless otherwise provided on the Policy Schedule. The premium for this Policy may change in amount by reason of an increase in your attained age or occupation. Premium rates will be guaranteed for six months. The Termination of Coverage Section is deleted and replaced with: "Your coverage will terminate and no benefits will be payable under the Policy and any attached Riders: 1) at the end of the period for which premium has been paid (subject to the Grace Period); 2) if your mode of premium is monthly, at the end of the period through which premium has been paid following our receipt of your request of termination; 3) If your mode of premium is other than monthly, upon the next monthly anniversary day following our receipt of Your request of termination. Premium will be refunded for any amounts paid beyond the termination date; 4) On the date we elect to discontinue this plan or type of coverage. We will give you at least 90 days written notice before the date coverage will be discontinued. You will be offered an option to purchase any other coverage that we offer without regard to health status; 5) On the date we elect to discontinue all coverage in your state. We will give you and the proper state authority at least 180 days written notice before the date coverage will be discontinued; or 6) on the date an insured person: 4 M IP_P IP B 110

9 State Variations (continued) a) performs an act or practice that constitutes fraud; or b) has made an intentional misrepresentation of material fact, relating in any way to the coverage provided under the Policy, including claims for benefits under the Policy; 7) on the date an insured person is no longer a permanent resident of the United States; or 8) on the date you reach the age of 65, or become eligible for Medicare, whichever comes first. For the Income Protection Plus plan, the Return of Premium Rider is not available. Oregon For both plans, the definition for Total Disability or Total Disabled is replaced with: "you are unable to engage in any employment or any occupation which you reasonably qualify in your local geographic area or national economy considering your education, training, experience, and mental and physical abilities." The "What about premium changes?" section is revised to read: "Subject to prior approval by the Oregon Insurance Division, We reserve the right to change the table of premiums becoming due under this Policy as often as permitted by applicable law. Such change will be on a class basis. We will provide You with written notice at least 31 days prior to the effective date of the new rates. The premium for the Policy may change in amount by reason of a change in your occupation." Under the Termination of Coverage section, provision #2 has been deleted and replaced with: "if your mode of premium is monthly, at the end of the period through which premium has been paid following our receipt of your request of termination; if your mode of premium is other than monthly, upon the next monthly anniversary day following our receipt of your request of termination. Premium will be refunded for any amounts paid beyond the termination date;" provision #4 is revised to read: "on the date we elect to discontinue all policies of the same type and form as the Policy;" and the following paragraph is added to the end: "Termination of coverage will be without prejudice to any claim arising prior to the date of termination. If we accept any premium for coverage extending beyond the date for termination, coverage will continue during the period for which a premium has been accepted, except as provided in the Age or Occupation Misstatement provision." For both plans, a $500 monthly indemnity benefit is also available. For both plans, exclusion number 6 regarding an overdose of drugs is deleted in its entirety. The following exclusion has been added: "Intoxicants and Controlled Substances- We shall not be liable for any loss sustained or contracted in consequence of an Insured Person being legally intoxicated or under the influence of any controlled substance, unless administered on the advice of a Doctor." 5 M IP_P IP B 110

10 Acknowledgement of Receipt (Retain for your records) If you have any questions about your application, insurance coverages, need any assistance with claims or other matters, please contact: The MEGA Life and Health Insurance Company SM Administrative Office: 9151 Boulevard 26 North Richland Hills, TX Home Office: Oklahoma City, OK Toll-Free: Received from: The following payment will be deposited upon receipt by the company. Please note, acceptance of this payment does not constitute coverage. Insurance is not effective until the coverage applied for has been approved and issued by The MEGA Life and Health Insurance Company SM. The amount of $ for the initial insurance premium and application fee, with application for enrollment in the following plan: Income Protection Plan; or Income Protection Plus Plan The agent does not have the authority on behalf of The MEGA Life and Health Insurance Company SM to accept risks; to make, alter or amend any Policy; or to extend the time for making any payment due under such Policy. Agent Number Licensed Insurance Agent Date Phone Number of Licensed Insurance Agent This brochure is a brief description of the coverage offered under: the Income Protection Plan (Form IP, or its state variation); and the Income Protection Plus Plan (Form IP, or its state variation). Your Policy, which should be read immediately upon receipt, describes in detail the rights and obligations of both you and The MEGA Life and Health Insurance Company SM under the Policy. Specific coverages available in your state may vary The MEGA Life and Health Insurance Company SM

11 Administrative Office: 9151 Boulevard 26 North Richland Hills, Texas HealthMarkets is the brand name for insurance products underwritten and issued by insurance subsidiaries of HealthMarkets, Inc. The Chesapeake Life Insurance Company, Mid-West National Life Insurance Company of Tennessee SM and The MEGA Life and Health Insurance Company. SM Products provided under the HealthMarkets brand are designed to provide personalized protection to individuals, families, the self-employed and small businesses. Our sales agents work closely with individuals and families to develop personalized coverage solutions that meet each customer s specific needs and budget. As those circumstances change, licensed and trained agents representing our insurance products are there to offer guidance and information that can help our customers make appropriate changes to their health coverage. Our knowledgeable agents, responsive claim specialists and customer support teams all clearly demonstrate our commitment to developing and providing health insurance protection that fits our customers various lifestyles through every stage of their lives. The products offered by our companies vary by region and state, and not all are available in all states. Each underwriting company is financially responsible for its own insurance products. Association group plans, where available, require association membership. Certain exclusions and limitations may apply depending on the product chosen. For further information on HealthMarkets products, visit HealthMarkets, Inc. was founded in 1985 and its underwriting companies administrative offices are located in North Richland Hills, Texas. Products are marketed through independent agents in sales offices across the country. For more information about our company, visit

12 megainsurance.com M IP_P IP B 110_110 The M ANC MA 1009_1009