ProVider Plus & ProVider Plus Limited Comparison Insurance Proposal Policy Features and Key Differences Male, age 30, Rhode Island Proposed Coverage Details ProVider Plus ProVider Plus Limited Base Policy $1,000/mo. $1,000/mo. Optional Benefits Residual Disability Benefits Residual Disability Benefit Rider Inflation Protection* 3% Compound Cost of Living Adjustment Rider Future Insurability Coverage Future Increase Option Rider $2,000/mo. Basic Residual Disability Benefit Rider 3% Maximum Cost of Living Adjustment Rider Benefit Purchase Rider Extended Benefits Not Included Not Available with Provider Plus Limited Catastrophic Disability Benefit Rider Not Included Not Included Student Loan Protection Rider up to $2,000/mo. up to $2,000/mo. Unemployment Waiver of Premium Rider Not Included Not Included Proposed Policy Variables Discounts 24 Month Mental and/or Substance-Related Disorders Limitation Discount Elimination Period 90 Days 90 Days Benefit Period To Age 65 To Age 65 Premium Structure Level Level Not Available Included - 10% Discounted Monthly/GOM Premium $37.62 $29.17 Both policies illustrated are built upon our benefit-rich, Non-Cancellable & Guaranteed Renewable ProVider Plus base contract and includes these built in benefits: Waiver of Premium Benefit - We will waive any premiums that are due while you are disabled and receiving benefits, and for 6 months after you recover. Waiver of Elimination Period - We will waive the elimination period if you become totally disabled within five years after the end of a previous disability that lasted more than 6 months and for which we paid benefits. Occupational Rehabilitation Benefit - The insured may be eligible for an occupational rehabilitation benefit that is part of a mutually agreed-upon formal plan. Modification and Access Benefit - The insured may be eligible for reimbursement for the cost of workplace modifications that will help you return to gainful employment. Presumptive Total Disability - We will consider you totally disabled even if you are gainfully employed if you suffer total and complete loss of the sight in both eyes, hearing in both ears; speech; or the use of both hands, both feet, or one hand and one foot, in their entirety. Your loss does not have to be irrecoverable. Capital Sum Benefit - An additional lump sum benefit is payable for specified losses: total loss of sight in one eye, or loss of a hand or foot. This benefit equals 12 times your monthly indemnity. For a complete description of policy benefits and features, ask your representative for a copy of a sample policy. policy and riders, which may vary by state. Coverage is subject to our underwriting rules. Any policy issued may differ from this proposal and will constitute the contract between you and, Pittsfield, MA, a wholly owned stock subsidiary of The Guardian Life Insurance Company of America, New York, NY. Actual premiums may Page 1 of 2
ProVider Plus & ProVider Plus Limited Comparison Insurance Proposal Policy Features and Key Differences Policy Features Definition of Total Disability ProVider Plus Purposefully Engineered High-Performing Income Protection True Own-Occupation Totally disabled means that, solely due to Injury or Sickness, you can not perform the material and substantial duties of your occupation, even if you are gainfully employed in another occupation. Male, age 30, Rhode Island ProVider Plus Limited Selecting these reduced benefit options results in a premium savings of $8.45/month. True Own-Occupation Totally disabled means that, solely due to Injury or Sickness, you can not perform the material and substantial duties of your occupation, even if you are gainfully employed in another occupation. Maximum Benefit Period for Mental and/ or Substance- Related Disorders Residual Disability Benefits Inflation Protection* Future Insurability Coverage Extended Benefits Same as Policy Benefit Period Benefits for disabilities caused by mental and/or substance-related disorders are payable for the full length of the benefit period. Residual Disability Benefit Rider 15% loss of income threshold. No loss of time or duties required. 3% Compound Cost of Living Adjustment Rider Provides a fixed 3% annual compounded adjustment of the monthly indemnity while benefits are payable in the same claim. After recovery, increases remain at no extra charge to age 65. Future Increase Option Rider $2,000/mo. Increases may be applied for annually to age 55 and are subject to financial eligibility. Not Included Limited to 24 months Benefits for disabilities caused by mental and/or substance-related disorders are, under the policy, including any riders, only payable for up to 24 months over the lifetime of the policy, unless you are continuously confined to a hospital and under the regular medical care of a physician. Basic Residual Disability Benefit Rider 20% loss of income threshold. Loss of time or duties required. 3% Maximum Cost of Living Adjustment Rider Provides a maximum 3% annual compounded adjustment of the monthly indemnity while benefits are payable in the same claim. After recovery, increases remain at no extra charge to age 65. Benefit Purchase Rider Submission of financial documentation required every three years until age 55; an offer to increase coverage will be made when eligible. Not Available with Provider Plus Limited * Not necessarily protection against increases in the cost of living. Restrictions and limitations apply. Applications for additional coverage will be financially underwritten based on your then current income and all disability insurance then in force, applied for, or for which you are eligible to receive. Employment and occupational information also required for applications under the Benefit Purchase Rider. policy and riders, which may vary by state. Coverage is subject to our underwriting rules. Any policy issued may differ from this proposal and will constitute the contract between you and, Pittsfield, MA, a wholly owned stock subsidiary of The Guardian Life Insurance Company of America, New York, NY. Actual premiums may Page 2 of 2
ProVider Plus Disability Insurance Proposal Male, age 30 Issue State: RI 460 East Main Rd, Middletown, Rhode Island 02842 4016192686 Why Do You Need Disability Insurance? Your ability to earn an income is your most valuable asset and the foundation of any financial strategy. We know you work hard to support your lifestyle. Your income pays your expenses of daily living and enables you to build wealth for the future you desire. But what if illness or injury made it impossible for you to work? How long would your savings last? Would your spouse s or partner's income be sufficient to make up the shortfall? What lifestyle changes would you or your family need to make? What about your dreams for the future college for your children, travel, a comfortable retirement? What would happen to your credit rating? What Causes Most Disabilities? Accidents aren t the only cause of disability. In fact, the majority of all claims are due to illness. Are There Alternatives? It s important to think through each possible Plan B. However, are any of these really viable alternatives? Personal Assets Most financial advisors recommend counting on cash reserves only for the first few months. A long-term disability can rapidly erode assets. Social Security Given the stringent requirements to qualify for benefits, fewer than 30% of claims are approved at the initial level. After all appeals, only about half of claims are ultimately approved. (Source: Social Security Administration, 2006) Workers Compensation Benefits generally cover employees for job-related accidents and illness, not those suffered outside of the workplace. State Temporary Disability NY, NJ, CA, HI and RI provide a minimal level of shortterm coverage for employees. Other states offer no such coverage. Group LTD Employer and association long-term disability plans are highly variable, but rarely offer benefits like a guaranteed premium or cost of living adjustment. Benefits under employer plans are generally offset by Social Security and other government programs. Review your coverage carefully. Major Disablers % of New Claims Musculoskeletal/. connective tissue... 27.5% Cancer... 14.6% Cardiovascular... 9.1% Maternity-related... 5.1% Injuries/accidents... 10.3% Mental/psychiatric disorder... 9.1% Neurological... 6.9% Source: 2011 Long-Term Disability Claims Review, Council for Disability Awareness. For more information go to www.disabilitycanhappen.org. proposal and will constitute the contract between you and, Pittsfield, MA, a Page 1 of 9
ProVider Plus Disability Insurance Proposal Proposed Coverage If totally disabled and eligible for benefits, you will receive: Total Monthly Benefit $1,000 Total Annual Benefit $12,000 Potential Cumulative Benefit* $722,545 Benefits will become payable 90 days after you become totally disabled. Benefits continue while you remain totally disabled until Age 65. *Potential Cumulative Benefit includes 3% Compound Cost of Living Adjustment Rider. It assumes disability begins at your current age and continues until age 65. It is based on the monthly benefit illustrated above. The ProVider Plus policy is non-cancellable and guaranteed renewable to age 65. It provides true "own occupation" protection. Level Premium ProVider Plus Monthly/ GOM** Quarterly Semi Annual Annual Base Policy $1,000/mo. $17.01 $53.61 $105.11 $204.10 True Own-Occupation Optional Benefits Future Increase Option $2,000/mo. $4.00 $12.61 $24.72 $48.00 Residual Disability Benefit Rider $2.50 $7.88 $15.45 $30.00 Cost of Living Adj. 3% $2.95 $9.30 $18.23 $35.40 Student Loan Protection Rider $2,000/mo. $11.17 $35.20 $69.01 $134.00 Automatic Benefit Enhancement Rider $0.00 $0.00 $0.00 $0.00 Total Premium* $37.62 $118.59 $232.52 $451.50 *The total premium includes an annual policy fee of $30. **Refers to Guard-O-Matic--our automatic premium payment option. There is no service fee when your premium is automatically deducted each month from a checking or savings account. Next Steps Complete an Application Our underwriters need a complete and accurate picture of your health and financial status. Fulfill Underwriting Requirements Depending on coverage applied for, these may include: Financial documentation such as tax returns and financial statements. Private phone interview with one of our representatives to verify medical and financial information. Paramedical exam. Physician statements and medical records. Delivery and review of the above requirements typically take several weeks. proposal and will constitute the contract between you and, Pittsfield, MA, a Page 2 of 9
ProVider Plus Disability Insurance Proposal Student Loan Protection Rider If you re like most graduates, your student loans may be sizeable. Recent studies show that significant student loan debt can impact future plans and life s decisions such as: Employment Can you afford to buy a business or will you work in a corporate environment? Family Will marriage or starting a family need to be delayed? Home ownership Can you afford a new home and make your student loan payments? Protection for When You re Most Vulnerable The Student Loan Protection Rider can help provide peace of mind to those who are early in their professional careers. While your income may be on the rise, it could be several years before your yearly earnings exceed your loan balance a time when many professionals feel particularly vulnerable to a disability that could force them out of work or practice. Student Loan Protection is specifically designed to protect you during this time by providing an added layer of disability insurance, above and beyond what you might purchase to protect your income. Rider Term: 15 Years Maximum Reimbursement: $2,000 per month Total Student Loan Protection Available: $354,000 Do my Loans Already Have Disability Protection 1? Under current federal law federal student loans may be discharged for Total and Permanent Disabilities those that require you to be unable to engage in any substantial gainful activity and that are expected to last at least 5 years and result in death. Private loans may or may not include similar features. You could still be at risk as a professional's income is susceptible to many accidents and illnesses that won t qualify for this discharge. The Student Loan Protection rider protects you in your own occupation. 1 Please consult your legal or financial advisor if you have questions concerning the circumstances under which a federal student loan may be discharged for disabilities or other reasons. proposal and will constitute the contract between you and, Pittsfield, MA, a Page 3 of 9
ProVider Plus Disability Insurance Proposal Automatic Benefit Enhancement (ABE) Rider ABE is a no-cost rider that can help keep your disability insurance benefit aligned with normal, annual income increases you might experience when healthy. It provides an annual 4% benefit increase each year for up to six years, with no proof of income required. Each automatic increase will include an additional premium based on your then-current age. Potential Automatic Increases and Premiums* Each increase will grow your disability insurance benefit and will include an additional premium based on your then-current age as follows: Age Total Monthly Benefit without Automatic Increase Total Monthly Benefit with Automatic Increase** Annual Automatic Increase Premium Total Annual Premium with Automatic Increase 30 $1,000 $1,000 $0 $452 31 $1,000 $1,040 $10 $462 32 $1,000 $1,090 $13 $475 33 $1,000 $1,140 $14 $488 34 $1,000 $1,190 $14 $503 35 $1,000 $1,240 $15 $518 36 $1,000 $1,290 $16 $533 Renewability * Assumes the policy issued is identical to this illustration, includes the Automatic Benefit Enhancement (ABE) Rider and all available ABE increases are accepted when offered. Any differences between this illustration and any policy issued may impact both the availability of this rider and the potential increases resulting from the inclusion of this rider as well as premiums. ** The Automatic Increase does not increase the Social Insurance Substitute Indemnity. You may apply to renew the ABE rider on each six year review date. You must provide evidence of your medical insurability, income, occupation, employment and other insurance in force, applied for, or for which you are eligible. Your eligibility will be based on our underwriting rules in effect at the time of renewal. You will not be eligible to renew the ABE rider if you have been paid benefits under the same policy. Increases are available to a maximum of age 60 or until your monthly benefit equals the maximum allowed at that time. proposal and will constitute the contract between you and, Pittsfield, MA, a Page 4 of 9
ProVider Plus Disability Insurance Proposal Coverage and Monthly Premium Alternatives Elimination Period Benefit Period 60 Days 90 Days To Age 67 $58.57 $40.02 Base Policy $28.92 $18.40 Future Inc Option $7.48 $4.40 Residual $5.33 $2.74 COLA 3% $5.68 $3.32 SLP $11.17 $11.17 ABE Rider $0.00 $0.00 To Age 65 $54.48 $37.62 Base Policy $26.61 $17.01 Future Inc Option $6.80 $4.00 Residual $4.86 $2.50 COLA 3% $5.05 $2.95 SLP $11.17 $11.17 ABE Rider $0.00 $0.00 It is possible to adjust the monthly premium you pay by making changes to the quoted benefit and elimination periods. Your proposed coverage is highlighted at the left. Coverage Variables Elimination Period The number of days following disability before benefits become payable. Your choice of elimination period should be integrated with your short-term employer benefits and existing savings. Benefit Period The maximum time for which you can receive benefit payments for disability. A shorter benefit period means a lower premium, but may not provide sufficient coverage for an extended disability. Level and Graded Premiums Depending on your current situation, you can choose to pay a level fixed premium for the life of your policy, or choose a lower initial premium that increases annually (graded). proposal and will constitute the contract between you and, Pittsfield, MA, a Page 5 of 9
ProVider Plus Disability Insurance Proposal Graded and Level Premium Comparison Age Year Graded Annual Premium Level Annual Premium 1 Annual Premium Difference Cumulative Premium Difference Attained Age Level Premium 2 30 1 325 452-126 -126-31 2 333 452-118 -245 464 32 3 341 452-110 -355 478 33 4 348 452-103 -458 493 34 5 355 452-96 -555 507 35 6 364 452-87 -642 523 36 7 375 452-76 -718 536 37 8 387 452-65 -783 550 38 9 398 452-54 -836 565 39 10 411 452-41 -877 579 40 11 426 452-26 -903 595 41 12 442 452-10 -912 616 42 13 459 452 7-905 639 43 14 477 452 26-879 663 44 15 500 452 48-831 688 45 16 388 318 71-760 580 46 17 409 318 91-669 598 47 18 430 318 113-556 616 48 19 452 318 135-421 636 49 20 477 318 159-262 655 50 21 500 318 182-80 676 51 22 521 318 204 123-52 23 557 318 239 362-53 24 608 318 290 653-54 25 677 318 359 1,012-55 26 625 270 356 1,367-56 27 675 270 406 1,773-57 28 721 270 451 2,224-58 29 762 270 493 2,717-59 30 785 270 516 3,233-60 - 64 31-35 799 270 529 5,878-1. The level annual premium above is based on your age shown at the top-right of this proposal. 2. Clients who opt for a graded premium option may convert to a level premium on any policy anniversary through age 50. The Attained Age Level Premium represents the annual policy premium and is determined by your then current age at the time you convert. Should you change your coverage after a policy is issued, you should request a new proposal as your premium will likely vary from the amounts shown. proposal and will constitute the contract between you and, Pittsfield, MA, a Page 6 of 9
ProVider Plus Disability Insurance Proposal Policy Benefits Non-Cancellable and Guaranteed Renewable We cannot cancel your policy, increase your premiums or change policy provisions if you keep paying premiums due, until you reach age 65. After that you can renew your policy at rates then in effect as long as you continue to be gainfully employed full time for at least 10 months each year. Total Disability You will be considered totally disabled if, solely due to injury or sickness, you are not able to perform the material and substantial duties of your occupation, even if you are gainfully employed in another occupation. Your occupation means the occupation(s) in which you are gainfully employed during the 12 months prior to the time you became disabled. Waiver of Premium We will waive any premiums that are due while you are disabled and receiving benefits, and for 6 months after you recover. We will also refund any portion of premium you have paid that applies to the period after you first became disabled. Occupational Rehabilitation, Modification and Access Benefits The insured may be eligible for an occupational rehabilitation benefit that is part of a mutually agreed-upon formal plan, as well as reimbursement for the cost of workplace modifications that will help you return to gainful employment. Elimination Period The elimination period is the number of days that must elapse before benefits become payable. You may be disabled from the same or a different cause for this entire period. Days of disability need not be consecutive, but must occur within an accumulation period of 210 days. Waiver of Elimination Period We will waive the elimination period if you become totally disabled within five years after the end of a previous disability that lasted more than 6 months and for which we paid benefits. Benefit Period This is the longest period of time for which we will pay benefits for a continuous disability from the same cause. Recurrent Disability If, after a disability for which we paid benefits, you return to fulltime gainful employment but become disabled again within 12 months, the later period of disability will be considered a continuation of the previous one. The later period of disability must result from the same cause or causes as the previous disability. Benefits will resume with no new elimination period required. Presumptive Disability We will consider you totally disabled even if you are gainfully employed if you suffer total and complete loss of the sight in both eyes; hearing in both ears; speech; or the use of both hands, both feet, or one hand and one foot, in their entirety. Your loss does not have to be irrecoverable. Capital Sum Benefit An additional lump sum benefit is payable for specified losses: total loss of sight in one eye, or loss of a hand or foot. This benefit equals 12 times your monthly indemnity. For a complete description of policy benefits and features, ask your representative for a sample policy. Important Things To Know Exclusions We will not pay benefits during any period of time in which you are incarcerated, or for any disability caused by, contributed to or resulting from: Military training, action, conflict or war while you are serving in the military or an auxiliary unit or working for contracted military services. Commission of, or attempt to commit, a criminal offense. Being engaged in an illegal occupation. Suspension, revocation or surrender of your professional or occupational license or certification. An intentionally self-inflicted injury. Normal pregnancy or childbirth, during the first three months of disability or the elimination period, if longer. We will not pay benefits for any disability due to any loss we have excluded by name or specific description in your policy. Pre-Existing Conditions For the first two years of coverage, we do not cover disabilities caused by a preexisting condition that: Was misrepresented or not disclosed on your application; and For which you received professional medical advice, diagnosis or treatment within two years before coverage began; or caused symptoms within one year before coverage began for which a prudent person would usually seek medical advice, diagnosis or treatment. Benefits While Outside the United States or Canada You must be living in the U.S. or Canada in order to receive benefits (except for incidental travel or vacations). proposal and will constitute the contract between you and, Pittsfield, MA, a Page 7 of 9
ProVider Plus Disability Insurance Proposal Optional Benefits Your proposed policy includes the following riders: Residual Disability Benefit Rider At least a 15% income loss No specific loss of time or duties requirement Loss of income benefit for first 12 months Recovery benefit for up to the entire benefit period ProVider Plus Typical DI Policy Group LTD Not all disabilities are total. You may suffer a partial (or residual) disability that limits your ability to work and results in decreased income or an initial total disability may be followed by an extended period of residual disability. Under this important optional rider, you are considered residually disabled if solely because of sickness or injury, your loss of income is at least 15% of your prior income, and you are gainfully employed. No specific loss of time or duties is required. About the Automatic Benefit Enhancement Rider (ABE) ABE is a unique feature that provides automatic 4% compound increases to your policy s monthly indemnity. Increases occur each year for up to six years despite any change in health, income or occupation. You do not apply for the ABE rider; rather, your eligibility will be determined by us at the time of underwriting. There is no additional initial premium for this rider; each annual benefit increase will include a corresponding attained age premium increase, if you accept. Should you decline two consecutive increases, no future offers will be made and the rider will terminate. For each of the first 12 months that you are eligible for a residual disability benefit, we will pay a benefit equal to your loss of income (up to the policy s monthly indemnity) less any individual disability insurance benefits you are receiving or are eligible to receive from all disability policies in force before the effective date of the Residual Disability Benefit Rider. After that, the residual benefit is proportionate to your loss of income; we will consider a loss of income of more than 75% to be 100%. Even after you fully recover and return to gainful employment, we will continue residual benefits up to the end of the benefit period, as long as your loss of income is at least 15% of your prior income and solely the result of the injury or sickness that caused the disability. Are You A Business Owner? You should consider the following types of business coverage: Overhead Expense Reimburses monthly expenses like utilities, rent and staff salaries to keep your business running if you are disabled. Business Reducing Term Covers fixed financial obligations such as business loans, purchase agreements and salary guarantees. Disability Buy-Out Provides the funding for the disability provision of your firm s buy-sell agreement. proposal and will constitute the contract between you and, Pittsfield, MA, a Page 8 of 9
ProVider Plus Disability Insurance Proposal 3% Compound Cost of Living Adjustment Rider **While receiving disability benefit payments, we will adjust your monthly indemnity each year to help keep pace with inflation (3% compounded annually). Prior to policy expiration, if you are no longer disabled, prior increases to the monthly indemnity (if at least $200) will remain on the policy with no extra premium charge until age 65. Monthly benefit increases with COLA (For Illustrative Purposes) * Assumes you are eligible for benefits under the policy with payments beginning 30 days following the elimination period, with the monthly benefit adjusted annually at a compounded rate of 3%. This benefit is not necessarily protection against increases in the cost of living. **You have selected the 3% Compound Cost of Living Adjustment Rider. The potential cumulative benefit of $722,545 would be $417,000 if this rider were not selected. Future Increase Option Rider Obtaining coverage to protect a growing income often requires being medically underwritten for a new policy. With the Future Increase Option rider, you can apply for additional coverage each year until age 55 without additional medical underwriting. Financial eligibility is generally determined by your income, employment, and all other disability insurance that you own, have applied for, or for which you are eligible with all insurers. A special option date is available if you lose your employer-provided group long term disability coverage. Restrictions and limitations apply. For additional details, ask your representative for a sample policy. Student Loan Protection Rider See rider text with the ProVider Plus proposal (it is a separate page). proposal and will constitute the contract between you and, Pittsfield, MA, a Page 9 of 9
ProVider Plus Limited Disability Insurance Proposal Male, age 30 Issue State: RI 460 East Main Rd, Middletown, Rhode Island 02842 4016192686 Why Do You Need Disability Insurance? Your ability to earn an income is your most valuable asset and the foundation of any financial strategy. We know you work hard to support your lifestyle. Your income pays your expenses of daily living and enables you to build wealth for the future you desire. But what if illness or injury made it impossible for you to work? How long would your savings last? Would your spouse s or partner's income be sufficient to make up the shortfall? What lifestyle changes would you or your family need to make? What about your dreams for the future college for your children, travel, a comfortable retirement? What would happen to your credit rating? What Causes Most Disabilities? Accidents aren t the only cause of disability. In fact, the majority of all claims are due to illness. Are There Alternatives? It s important to think through each possible Plan B. However, are any of these really viable alternatives? Personal Assets Most financial advisors recommend counting on cash reserves only for the first few months. A long-term disability can rapidly erode assets. Social Security Given the stringent requirements to qualify for benefits, fewer than 30% of claims are approved at the initial level. After all appeals, only about half of claims are ultimately approved. (Source: Social Security Administration, 2006) Workers Compensation Benefits generally cover employees for job-related accidents and illness, not those suffered outside of the workplace. State Temporary Disability NY, NJ, CA, HI and RI provide a minimal level of shortterm coverage for employees. Other states offer no such coverage. Group LTD Employer and association long-term disability plans are highly variable, but rarely offer benefits like a guaranteed premium or cost of living adjustment. Benefits under employer plans are generally offset by Social Security and other government programs. Review your coverage carefully. Major Disablers % of New Claims Musculoskeletal/. connective tissue... 27.5% Cancer... 14.6% Cardiovascular... 9.1% Maternity-related... 5.1% Injuries/accidents... 10.3% Mental/psychiatric disorder... 9.1% Neurological... 6.9% Source: 2011 Long-Term Disability Claims Review, Council for Disability Awareness. For more information go to www.disabilitycanhappen.org. proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 1 of 9
ProVider Plus Limited Disability Insurance Proposal Proposed Coverage If totally disabled and eligible for benefits, you will receive: Total Monthly Benefit $1,000 Total Annual Benefit $12,000 Potential Cumulative Benefit* $722,545 Benefits will become payable 90 days after you become totally disabled. Benefits continue while you remain totally disabled until age 65 1. * Potential Cumulative Benefit includes 3% Maximum Cost of Living Adjustment Rider. It assumes disability begins at your current age and continues until age 65. It is based on the monthly benefit illustrated above. The ProVider Plus policy is non-cancellable and guaranteed renewable to age 65. It provides true "own occupation" protection. 1 Mental and/or Substance- Related Disorders Limitation For mental and/or substance related disorders, the policy, which includes any riders, only provides up to twenty four months of benefits during your lifetime, unless you remain continuously confined in a hospital for treatment. Level Premium ProVider Plus Limited Monthly/ GOM** Quarterly Semi Annual Annual Base Policy $1,000/mo. $17.01 $53.61 $105.11 $204.10 True Own-Occupation Optional Benefits Basic Residual Disability Benefit Rider $2.15 $6.78 $13.29 $25.80 Cost of Living Adj. 3% $2.09 $6.59 $12.93 $25.10 Student Loan Protection Rider $2,000/mo. $11.17 $35.20 $69.01 $134.00 Benefit Purchase Rider $0.00 $0.00 $0.00 $0.00 Automatic Benefit Enhancement Rider $0.00 $0.00 $0.00 $0.00 Total Premium* $32.42 $102.17 $200.34 $389.00 Discounts Applied Mental and/or Substance - Related Disorders Limitation Discount 10% $-3.24 $-10.22 $-20.03 $-38.90 Total Discounted Premium $29.17 $91.95 $180.30 $350.10 *The total premium includes an annual policy fee of $30. **Refers to Guard-O-Matic--our automatic premium payment option. There is no service fee when your premium is automatically deducted each month from a checking or savings account. Next Steps Complete an Application Our underwriters need a complete and accurate picture of your health and financial status. Fulfill Underwriting Requirements Depending on coverage applied for, these may include: Financial documentation such as tax returns and financial statements. Private phone interview with one of our representatives to verify medical and financial information. Paramedical exam. Physician statements and medical records. Delivery and review of the above requirements typically take several weeks. proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 2 of 9
ProVider Plus Limited Disability Insurance Proposal Student Loan Protection Rider If you re like most graduates, your student loans may be sizeable. Recent studies show that significant student loan debt can impact future plans and life s decisions such as: Employment Can you afford to buy a business or will you work in a corporate environment? Family Will marriage or starting a family need to be delayed? Home ownership Can you afford a new home and make your student loan payments? Protection for When You re Most Vulnerable The Student Loan Protection Rider can help provide peace of mind to those who are early in their professional careers. While your income may be on the rise, it could be several years before your yearly earnings exceed your loan balance a time when many professionals feel particularly vulnerable to a disability that could force them out of work or practice. Student Loan Protection is specifically designed to protect you during this time by providing an added layer of disability insurance, above and beyond what you might purchase to protect your income. Rider Term: 15 Years Maximum Reimbursement: $2,000 per month Total Student Loan Protection Available: $354,000 Do my Loans Already Have Disability Protection 1? Under current federal law federal student loans may be discharged for Total and Permanent Disabilities those that require you to be unable to engage in any substantial gainful activity and that are expected to last at least 5 years and result in death. Private loans may or may not include similar features. You could still be at risk as a professional's income is susceptible to many accidents and illnesses that won t qualify for this discharge. The Student Loan Protection rider protects you in your own occupation. 1 Please consult your legal or financial advisor if you have questions concerning the circumstances under which a federal student loan may be discharged for disabilities or other reasons. proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 3 of 9
ProVider Plus Limited Disability Insurance Proposal Automatic Benefit Enhancement (ABE) Rider ABE is a no-cost rider that can help keep your disability insurance benefit aligned with normal, annual income increases you might experience when healthy. It provides an annual 4% benefit increase each year for up to six years, with no proof of income required. Each automatic increase will include an additional premium based on your then-current age. Potential Automatic Increases and Premiums* Each increase will grow your disability insurance benefit and will include an additional premium based on your then-current age as follows: Age Total Monthly Benefit without Automatic Increase Total Monthly Benefit with Automatic Increase** Annual Automatic Increase Premium Total Annual Premium with Automatic Increase 30 $1,000 $1,000 $0 $350 31 $1,000 $1,040 $8 $359 32 $1,000 $1,090 $11 $370 33 $1,000 $1,140 $12 $381 34 $1,000 $1,190 $12 $393 35 $1,000 $1,240 $13 $406 36 $1,000 $1,290 $13 $419 Renewability * Assumes the policy issued is identical to this illustration, includes the Automatic Benefit Enhancement (ABE) Rider and all available ABE increases are accepted when offered. Any differences between this illustration and any policy issued may impact both the availability of this rider and the potential increases resulting from the inclusion of this rider as well as premiums. ** The Automatic Increase does not increase the Social Insurance Substitute Indemnity. You may apply to renew the ABE rider on each six year review date. You must provide evidence of your medical insurability, income, occupation, employment and other insurance in force, applied for, or for which you are eligible. Your eligibility will be based on our underwriting rules in effect at the time of renewal. You will not be eligible to renew the ABE rider if you have been paid benefits under the same policy. Increases are available to a maximum of age 60 or until your monthly benefit equals the maximum allowed at that time. proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 4 of 9
ProVider Plus Limited Disability Insurance Proposal Coverage and Monthly Premium Alternatives Elimination Period Benefit Period 90 Days To Age 67 $30.85 Base Policy $18.40 Basic Residual $2.36 COLA 3% $2.36 SLP $11.17 Benefit PR $0.00 ABE Rider $0.00 Total Discount $-3.43 To Age 65 $29.17 Base Policy $17.01 Basic Residual $2.15 COLA 3% $2.09 SLP $11.17 Benefit PR $0.00 ABE Rider $0.00 Total Discount $-3.24 It is possible to adjust the monthly premium you pay by making changes to the quoted benefit and elimination periods. Your proposed coverage is highlighted at the left. Coverage Variables Elimination Period The number of days following disability before benefits become payable. Your choice of elimination period should be integrated with your short-term employer benefits and existing savings. Benefit Period The maximum time for which you can receive benefit payments for disability. A shorter benefit period means a lower premium, but may not provide sufficient coverage for an extended disability. Level and Graded Premiums Depending on your current situation, you can choose to pay a level fixed premium for the life of your policy, or choose a lower initial premium that increases annually (graded). proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 5 of 9
ProVider Plus Limited Disability Insurance Proposal Graded and Level Premium Comparison Age Year Graded Annual Premium Level Annual Premium 1 Annual Premium Difference Cumulative Premium Difference Attained Age Level Premium 2 30 1 260 350-90 -90-31 2 266 350-84 -173 360 32 3 272 350-78 -252 369 33 4 277 350-73 -325 380 34 5 282 350-68 -393 390 35 6 289 350-62 -454 402 36 7 296 350-54 -508 411 37 8 304 350-46 -554 421 38 9 312 350-38 -592 431 39 10 322 350-29 -620 441 40 11 332 350-18 -639 452 41 12 344 350-7 -645 467 42 13 356 350 5-640 483 43 14 369 350 19-621 500 44 15 384 350 34-587 517 45 16 280 230 50-537 415 46 17 294 230 65-472 428 47 18 310 230 80-392 441 48 19 326 230 96-296 455 49 20 343 230 114-182 470 50 21 360 230 131-51 485 51 22 375 230 146 95-52 23 401 230 171 266-53 24 437 230 208 474-54 25 487 230 257 731-55 26 535 230 305 1,036-56 27 579 230 349 1,385-57 28 619 230 389 1,775-58 29 656 230 426 2,201-59 30 676 230 447 2,648-60 - 64 31-35 689 230 459 4,944-1. The level annual premium above is based on your age shown at the top-right of this proposal. 2. Clients who opt for a graded premium option may convert to a level premium on any policy anniversary through age 50. The Attained Age Level Premium represents the annual policy premium and is determined by your then current age at the time you convert. Should you change your coverage after a policy is issued, you should request a new proposal as your premium will likely vary from the amounts shown. proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 6 of 9
ProVider Plus Limited Disability Insurance Proposal Policy Benefits Non-Cancellable and Guaranteed Renewable We cannot cancel your policy, increase your premiums or change policy provisions if you keep paying premiums due, until you reach age 65. After that you can renew your policy at rates then in effect as long as you continue to be gainfully employed full time for at least 10 months each year. Total Disability You will be considered totally disabled if, solely due to injury or sickness, you are not able to perform the material and substantial duties of your occupation, even if you are gainfully employed in another occupation. Your occupation means the occupation(s) in which you are gainfully employed during the 12 months prior to the time you became disabled. Waiver of Premium We will waive any premiums that are due while you are disabled and receiving benefits, and for 6 months after you recover. We will also refund any portion of premium you have paid that applies to the period after you first became disabled. Occupational Rehabilitation, Modification and Access Benefits The insured may be eligible for an occupational rehabilitation benefit that is part of a mutually agreed-upon formal plan, as well as reimbursement for the cost of workplace modifications that will help you return to gainful employment. Elimination Period The elimination period is the number of days that must elapse before benefits become payable. You may be disabled from the same or a different cause for this entire period. Days of disability need not be consecutive, but must occur within an accumulation period of 210 days. Waiver of Elimination Period We will waive the elimination period if you become totally disabled within five years after the end of a previous disability that lasted more than 6 months and for which we paid benefits. Benefit Period This is the longest period of time for which we will pay benefits for a continuous disability from the same cause. Recurrent Disability If, after a disability for which we paid benefits, you return to fulltime gainful employment but become disabled again within 12 months, the later period of disability will be considered a continuation of the previous one. The later period of disability must result from the same cause or causes as the previous disability. Benefits will resume with no new elimination period required. Presumptive Disability We will consider you totally disabled even if you are gainfully employed if you suffer total and complete loss of the sight in both eyes; hearing in both ears; speech; or the use of both hands, both feet, or one hand and one foot, in their entirety. Your loss does not have to be irrecoverable. Capital Sum Benefit An additional lump sum benefit is payable for specified losses: total loss of sight in one eye, or loss of a hand or foot. This benefit equals 12 times your monthly indemnity. For a complete description of policy benefits and features, ask your representative for a sample policy. Important Things To Know Exclusions We will not pay benefits during any period of time in which you are incarcerated, or for any disability caused by, contributed to or resulting from: Military training, action, conflict or war while you are serving in the military or working for contracted military services. Commission of, or attempt to commit, a criminal offense. Being engaged in an illegal occupation. Suspension, revocation or surrender of your professional or occupational license or certification. An intentionally self-inflicted injury. Normal pregnancy or childbirth, during the first three months of disability or the elimination period, if longer. We will not pay benefits for any disability due to any loss we have excluded by name or specific description in your policy. Pre-Existing Conditions For the first two years of coverage, we do not cover disabilities caused by a preexisting condition that: Was misrepresented or not disclosed on your application; and For which you received professional medical advice, diagnosis or treatment within two years before coverage began; or caused symptoms within one year before coverage began for which a prudent person would usually seek medical advice, diagnosis or treatment. Benefits While Outside the United States or Canada You must be living in the U.S. or Canada in order to receive benefits (except for incidental travel or vacations). proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 7 of 9
ProVider Plus Limited Disability Insurance Proposal Optional Benefits Your proposed policy includes the following riders: Basic Residual Disability Benefit Rider Not all disabilities are total. You may suffer a partial (or residual) disability that limits your ability to work and results in decreased income or an initial total disability may be followed by an extended period of residual disability. Under this important optional rider, you will be eligible for a residual disability benefit when you are gainfully employed, but solely due to injury or sickness you experience a loss of income of at least 20% of your prior income and either you are unable to perform one or more of the material and substantial duties of your occupation; or, you are able to perform all of the material and substantial duties of your occupation but not for the length of time they normally require. The residual disability benefit is proportionate to your loss of income. During the first 6 months in which residual indemnity is payable, we will consider your loss of income to be 50% of your prior income or the actual percentage of loss, if greater. We will consider a loss of income of more than 75% to be 100% at any time while residual disability benefits are payable. A recovery benefit is payable if you are no longer disabled and you return to full time gainful employment immediately following a disability for which we paid benefits, yet you continue to suffer at least a 20% loss of income due to the injury or sickness that caused the disability. About the Automatic Benefit Enhancement Rider (ABE) ABE is a unique feature that provides automatic 4% compound increases to your policy s monthly indemnity. Increases occur each year for up to six years despite any change in health, income or occupation. You do not apply for the ABE rider; rather, your eligibility will be determined by us at the time of underwriting. There is no additional initial premium for this rider; each annual benefit increase will include a corresponding attained age premium increase, if you accept. Should you decline two consecutive increases, no future offers will be made and the rider will terminate. 3% Maximum Cost of Living Adjustment Rider **While you are receiving disability benefit payments, we will adjust your monthly indemnity each year to help keep pace with inflation. Adjustments are based upon changes in the Consumer Price Index (CPI-U), with a maximum 3% annual rate cap. When you recover, increases to the monthly indemnity (if at least $200) will remain on the policy with no extra premium charge until age 65. Monthly benefit increases with COLA (For Illustrative Purposes) Are You A Business Owner? You should consider the following types of business coverage: Overhead Expense Reimburses monthly expenses like utilities, rent and staff salaries to keep your business running if you are disabled. * Assumes you are eligible for benefits under the policy with payments beginning 30 days following the elimination period, with the monthly benefit adjusted annually at a maximum compounded rate of 3%. This 3% rate is for illustrative purposes only; actual rates will vary according to the CPI-U as stated above. This benefit is not necessarily protection against increases in the cost of living. **You have selected the 3% Maximum Cost of Living Adjustment Rider. The potential cumulative benefit of $722,545 would be $417,000 if this rider were not selected. Business Reducing Term Covers fixed financial obligations such as business loans, purchase agreements and salary guarantees. Disability Buy-Out Provides the funding for the disability provision of your firm s buy-sell agreement. proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 8 of 9
ProVider Plus Limited Disability Insurance Proposal Benefit Purchase Rider Obtaining additional coverage to protect a growing income often requires providing evidence of good health. This rider allows you to apply for increases in coverage every three years (in the form of a separate policy) until age 55 without additional medical underwriting. A special benefit purchase option is available outside of each three-year opportunity should you experience an increase in income of 50% or more or lose your employerprovided group long term disability coverage and it is not converted or replaced. The maximum amount of additional coverage available to you, if any, will be determined by your income, occupation, employment and all other disability insurance that you own, have applied for, or for which you are eligible with all insurers. There is no additional initial premium for this rider and rider eligibility will be determined by us at the time of underwriting. Student Loan Protection Rider See rider text with the ProVider Plus proposal (it is a separate page). proposal and will constitute the contract between you and, Pittsfield, MA, a Policy Form 1400 Page 9 of 9