| Long Term Disability Income Plan |  |
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| Long Term Disability |
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| Why Is This Plan Important to You? |
| How Will You Benefit? |
| Lifetime Benefits May Be Paid for Disabilities Beginning Before Age 50 |
| When Do Benefits Begin? |
| Maximum Issue and Participation Limits |
| What Is the Future Purchase Option? |
| How Does the Cost of Living Adjustment (COLA) Option Work? |
| Definitions |
| What Are Residual Benefits? |
| How Long Is This Benefit Paid? |
| How Is My Pre-Disability Income Determined? |
| How Can Inflation Guard Help You? |
| What About the Residual Disability Benefit for Communicable Diseases? |
Features of the Plan
Waiver of Premium |
| Organ Transplant Donor |
| Terminal Disability Benefit |
| Rehabilitation Provision |
| Who Is Eligible? |
| When Does Coverage Become Effective? |
| Evidence of Insurance |
| What Is Disability Income Over-Insurance? |
| When Coverage Ends |
| Long Term Disability Income Annual Premium Rates |
| Exclusions and Limitations |
| IMPORTANT NOTICE - How New York Life Underwrites Your Request for Insurance |
| For More Information |
| Administered by |
| Underwritten by |
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| Why Is This Plan Important to You? |
As an orthodontist, you've spent considerable time, money and effort to get where you are today. If a sudden injury or illness causes you to be unable to practice, your financial losses could be devastating. Thankfully it doesn't have to be this way. One of your greatest assets is your ability to earn an income. Help protect it with the AAO endorsed Disability Income Plan. Disability from a long term illness or injury also poses more of a threat than most people realize. At age 35, for instance, being disabled for 90 days or longer is 3 times more likely to occur than death before age 65.* Through the group purchasing power of your Association, you can apply for protection in the event of a covered disability. Because your personal needs will vary, this plan was designed to provide you with a variety of options. Since no one knows your income replacements needs like you do, simply select the options that work best for you.
*Society of Actuaries, 1989.
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| How Will You Benefit? |
How much you benefit is up to you. The Monthly Benefit Amount you may apply for ranges from $1,000 to $12,500 in $100 units. When applying for Disability Insurance the amount applied for may not exceed 60% of the net income (before taxes) plus pension contributions, less other disability benefits you would be eligible to receive from Social Security and all other disability insurance in force.
You also choose the Waiting Period. Benefit payments start after a 30, 90 or 180 day waiting period provided you have been disabled continuously through this period.
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| Lifetime Benefits May Be Paid for Disabilities Beginning Before Age 50 |
Disability benefits may be paid during a covered total disability, as defined further on, up to these limits:
Disabilities
Beginning | Monthly Benefits
Continue |
Before Age 50 |
As long as Lifetime* | | 50-63 | Up to age 65* | | 64 and Older | Up to one year |
*Benefits will be limited to a maximum benefit period of 24 months for disabilities that are the result of psychiatric or psychological disorder and/or substance abuse.
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| When Do Benefits Begin? |
Simply choose between the following waiting periods:
Plan 1
Benefits start on the 31st day of covered disability.
Plan 2
Benefits start on the 91st day of covered disability.
Plan 3
Benefits start on the 181st day of covered disability.
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| Maximum Issue and Participation Limits |
Member's Age
at Issue | Maximum Issue
Limit | Participation
Limit* |
Before Age 55 |
$12,500 |
$15,000 | | 55-59 | $4,000 | $10,000 | | 60-64 | $1,500 | $1,500 |
*Including other disability income insurance in force
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| What Is the Future Purchase Option? |
This option makes it possible, if you are under age 50, to increase disability income coverage in the future without medical underwriting at that time, even if you are no longer in good health. This low-cost coverage makes it possible for you to increase your long term disability monthly benefits as your earnings grow. Amounts ranging from $500 to $2,500 per month in the $100 units are available. However, the amount applied for may not exceed the amount of long term monthly disability income for which you are insured. Also, the combination of Future Purchase Option plus Long Term Disability Income cannot exceed the $12,500 monthly maximum.
All or a portion of the Future Purchase Option may be converted to long term disability income coverage in $100 units on October 1st, coinciding with or next following the insured's 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48 and 50th birthdays. The Option can't be exercised if you are disabled on a conversion date, and you must have sufficient earned income to qualify for the amount of Future Purchase Option coverage being converted.
The premium for the Future Purchase Option is based on your age at issue and increases with age. When you convert all or a portion of the Future Purchase Option the premium is based on your age on the conversion date. The Future Purchase Option premium charge is reduced when an option is exercised, and the premium is discontinued when any remaining options terminate at age 50. You must satisfy new York Life's insurability requirements at the time you apply for this feature.
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| How Does the Cost of Living Adjustment (COLA) Option Work? |
Inflation doesn't stop when you're disabled. This feature is intended to help Long Term Disability Monthly Benefits adjust for inflation. On each anniversary of a continuing disability, your monthly benefit for the next 12 months is adjusted to reflect any changes in the CPI-U during the last 12 months. The maximum yearly increase is 8%, and the overall maximum increase for a single disability is 100%. Since the residual benefit is a percentage of your Long Term Disability Benefit, it also reflects any COLA change. COLA contains a "catch up" feature witch can allow an annual increase greater than 8% in a year when the CPI-U is higher. This will occur if a lower rate of inflation is applied to an earlier year(s) of disability. In this event, a higher percentage of increase will be allowed except the adjusted benefit cannot be greater than the original 8# a year, compounded annually. Upon recovery, the monthly benefit for new disabilities will match the original issued Long Term Disability Benefit amount 100%.
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| Definitions |
Definition of Disability - You are totally disabled if, due to a covered illness or injury, you are unable to perform the substantial duties of your own occupation as a specialist in orthodontics for which you have been specifically educated and trained. You must also be under a physician's care and not working at any gainful occupation to be considered totally disabled.
If you cannot practice your orthodontic specialty, and voluntarily decide to go into another profession, then you would no longer be classified as "totally" disabled and the "residual" benefit might apply if you're working part-time or experiencing a loss of income because of the occupational change (see Residual Benefits).
Definition of Successive Disability - Successive Disabilities are considered as on continuous disability unless separated by 180 days of active full-time work or due to entirely unrelated causes.
Definition of Earned Income - If you are self-employed, earned income is net monthly earnings after business expenses, before taxes. If you have incorporated, earned income includes the cost to the corporation of your fringe benefits and the share of total contributions to corporate surplus for the preceding 12 months. Income from investments, royalties, etc., or other income is not included in earned income. Otherwise, earned income means the basic rate of compensation from your employer, excluding overtime, commissions, bonuses and the like.
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| What Are Residual Benefits? |
If you return to work after a covered disability which began before age 64 and lasted for at least 30 consecutive days, you may be entitled to a Residual Benefit if: (1) a total disability income benefit was paid for the disability or you have satisfied the applicable waiting period through a combination of total disability & residual disability days, (2) you did not receive your benefit for the full maximum period applicable to the disability, and (3) your current average earnings during the most recent 6 months after the total disability ends are no more than 75% of your pre-disability average earnings.
The Residual Benefit is a percentage of your total disability benefit equal to the percentage reduction of monthly earnings. For every month that the percentage reduction is 75% or more, the plan will pay the full total disability benefit.
For example, if your last monthly total disability income benefit was $2,000 and you have a 40% reduction in current earnings, your Residual Benefit would be 40% of $2,000 or $800 a month. No Residual Benefit will be payable until the waiting period has been satisfied.
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| How Long Is This Benefit Paid? |
The Residual Benefit will be paid for as long as the total disability benefit would have been paid if the underlying total disability had continued, or until you go for 6 consecutive months without qualifying for Residual Benefits, if this sooner.
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| How Is My Pre-Disability Income Determined? |
Your pre-disability income is your average net monthly earnings for the 12 or 14 months prior to onset of total disability, whichever is higher.
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| How Can Inflation Guard Help You? |
To help prevent inflation from artificially increasing post-disability earnings and thereby reducing benefits, the Plan will increase prior earnings up to 8% per year for the purpose of Residual Benefits calculations. Your certificate will provide details.
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| What About the Residual Disability Benefit for Communicable Diseases? |
If you contract a "communicable disease" and therefore are unable to treat patients, you may be eligible for residual disability benefits even though you are not totally disabled. In order to be eligible for the residual disability benefits, you must be under age 65 and earning less than 75% of your monthly net income due to contracting the communicable disease. Benefits will not begin until the applicable waiting period has been satisfied. The benefit amount and duration will be determined in the same manner as described above.
A "communicable disease" means any of the following conditions, but only if the applicable medical and/or dental profession or appropriate governing agency recommends the disclosure of the diagnosis of the "communicable disease" and it results in a limitation of your practice due to contracting the "disease": viral hepatitis of a non-A type, Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS) or tuberculosis.
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Features of the Plan
Waiver of Premium |
If you become totally disabled while insured before age 60 and remain so for 3 consecutive months, you will not have to pay further premiums to continue your coverage while staying disabled.
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| Organ Transplant Donor |
If you donate an organ after coverage has been in force for at least 6 months, benefits will be paid from the first day of the resulting disability.
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| Terminal Disability Benefit |
If you should die on a day for which a total disability benefit is payable for a total disability which lasted at least 30 days, immediately preceding the day of death, the Plan will pay a final benefit equal to 30 times the benefit for that day.
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| Rehabilitation Provision |
This feature can pay the expenses of a personalized rehabilitation plan, including the costs of retraining, additional education, medical assessment and modifications to your practice. Regular plan benefits would continue during the rehabilitation plan.
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| Who Is Eligible? |
If you are an orthodontist under age 65 residing in the U.S. or Canada and an AAO member who regularly works at least 20 hours a week or a full-time student member, then you're eligible for coverage. All coverage is subject to approval by new York Life.
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| When Does Coverage Become Effective? |
In order to become insured, you must provide satisfactory evidence of insurability and pay the required premium. Insurance will take effect on the first of the month following the date your coverage is approved by New York Life provided the initial premium deposit is paid to the Plan Administration Office within 31 days of that date. You must be performing the normal activities of a person in good health of like age and sex on the later of the date of approval and the date the premium is paid.
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| Evidence of Insurance |
Once you've been approved you will receive a Certificate describing your coverage issued under the policy form GMR.
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| What Is Disability Income Over-Insurance? |
New York Life limits the amount of Disability Income benefits it will approve, based on your age, earnings, Social Security eligibility and all other disability insurance you may have an intend to continue. If you wish to know your maximum issue limits, please refer to the chart entitled Maximum Issue and Participation Limits in this brochure. When applying for Disability Income Insurance, you should limit the amount requested to 60% of net income (before taxes) plus pension contributions, less other disability benefits you would be eligible to receive from Social Security and all other disability insurance in force. The tax-free nature of most disability benefits is often over-looked and members sometimes apply for more than is necessary to replace lost income. In the interest of safety and stability, the AAO Disability Plans have issue limits at time of application.
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| When Coverage Ends |
New York Life cannot change benefits, terminate coverage or change premiums on an individual basis; it may do so on a class-wide basis. The benefits provided under the group-wide policy may be changed upon agreement with New York Life and AAO. New York Life has agreed not to exercise its right to terminate the group policy as long as AAO continues to endorse only the New York Life Plan. While the group policy continues in force, you may renew your coverage until age 70. But coverage will terminate earlier if you cease active full-time work (at least 20 hours per week) before that time. You must continue to be an AAO member and pay your premium to time to renew your coverage.
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| Long Term Disability Income Annual Premium Rates |
Click here for Long Term Disability Income Annual Premium Rates.
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| Exclusions and Limitations |
Benefits are not paid for disabilities resulting from: war or military service, self-inflicted injuries (unless the injuries are caused by attempted suicide while insane); pregnancy, except for specific complications; or specific conditions for which an impairment restriction has been placed on your coverage.
Benefits are not paid during the 30, 90 or 180 day waiting period for the plan selected.
Benefits will be limited to a maximum benefit period of 24 months for disabilities that are the result of psychiatric or psychological disorder and/or substance abuse.
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| IMPORTANT NOTICE - How New York Life Underwrites Your Request for Insurance |
Information regarding insurability will be treated as confidential. In considering your request for insurance, we will rely on the medical information you provide and on the information you authorize us to obtain from you doctor, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB, Inc. (Medical Information Bureau), New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. We may make a brief report to MIB; however we will not disclose our underwriting decision. Information in our files may be seen by New York Life and Plan Administrator employees, but only on a "need to know" basis in considering your request. Upon receipt of all requested information we will make a determination as to whether your request for insurance can be approved.
MIB is a non-profit, membership organization of life insurance companies, which operates an information exchange on behalf of its members. When you apply for insurance or submit a claim for benefits to a MIB member company, medical or non-medical information may be given to the Bureau, which may then be furnished to member companies.
If we cannot provide the coverage you requested, we will tell you why. If you feel our information is inaccurate, you will be given a chance to correct or complete the information in our files. Upon written request to New York Life or MIB, you will be provided with non-medical information, generally medical information will be given either directly to the proposed insured or to a medical professional designated by the proposed insured. Your request is handled in accordance with the Fir Credit Reporting Act procedures. If you question the accuracy of the information provided by MIB, you may contact MIB and seek a correction. MIB's information office P.O. Box 105, Essex Station, Boston, MA 02112, telephone 617-426-3660. For Canadian residents, the address is 330 University Avenue, Suite 403, Toronto, Canada M5G 1R7, telephone (416) 597-0590.
For NM residents, PROTECTED PERSONS (1) have a right of access to certain CONFIDENTIAL ABUSE INFORMATION (2) we maintain in our files and they may choose to receive such information directly. You have the right to register as a PROTECTED PERSON by sending a signed request to the Administrator at the address listed on the application. Please include your full name, date of birth and address.
(1) PROTECTED PERSON means a victim of domestic abuse: who has notified us that he/she is or has been a victim of domestic abuse; and who is an insured or prospective insured.
(2) CONFIDENTIAL ABUSE INFORMATION means information about: acts of domestic abuse or abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant or insured as family member, employer or associate of a victim of domestic abuse or a person with whom an applicant or insured is known to have a direct, close personal, family or abuse-related counseling relationship.
If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage by effective prior to t his date. Payment of a premium contribution with your application does not mean there is any insurance in force before the effective date is determined by New York Life.
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| For More Information |
Please contact us at the Plan Administration Office, 159 E. County Line Road, Hatboro, PA 19040-1218 or call toll-free: 1-800-622-0344 or fax us at: 1-800-527-8930.
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| Administered by |
Affinity Insurance Services, Inc.
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| Underwritten by |
New York Life Insurance Company, New York, NY 10010
This brochure briefly describes the general highlights of the Insurance Plan, and is for illustrative purposes only. Please consult the policy for complete details of all terms, conditions and exclusions.
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  Find out more about your member benefits today! |
Administered by:
Affinity Insurance Services, Inc.
Michael Loughran licensed in Arkansas (License#: 233963)
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