Group Office Overhead Expense Insurance

Group Office Overhead Expense Insurance  

OVERVIEW

Member Benefits Up To $12,500 a Month Available!

 

Your Passport to Protecting Your Livelihood.

 

When you’re in practice for yourself, you have a special need: to protect your practice in the event you become Totally Disabled by an accident or illness. Not only does your income stop when you’re not working, but the expenses continue—your rent, employee salaries, utilities, taxes, maintenance and depreciation of equipment, interest on loans, and so on.

 

Disability insurance helps replace your loss of income without damaging your standard of living, but you still need to protect your practice. Even if you share offices or have partners, you may have to pay pro–rata expenses. Help protect your practice today with the Academy Group Office Overhead Expense Insurance Plan.

 

Practical Help

  • Helps provide a means of continuing to meet the overhead expenses of your practice when a disabling illness or injury puts a stop to your income.
  • Can provide monthly benefits to pay your pro–rata share of expenses when disabled.
  • Helps keep your practice going while you are disabled.

 

 

Enrollment Forms

These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.

Tell Me More

Valuable Benefits

  • Members Under Age 60 Are Eligible to Apply
  • Your Choice of Monthly Benefits
    You may apply for up to $12,500 in coverage, in $100 increments.
  • Choice of 30- or 90-Day Waiting Period
    The waiting period is the number of consecutive days you must be Totally Disabled before benefit payments begin.
  • Benefits Payable Up to 24 Months
    Benefits begin after the waiting period, and are payable for up to 24 months during Total Disability.
  • Helps Cover Fixed Expenses of Operating Your Practice
  • Preferred Definition of Totally Disability Protects You as a Specialist in Ophthalmology
  • Premiums Waived If You Are Totally Disabled

 

ELIGIBILITY

 

If you are an Academy member under age 60 and at FULL-TIME WORK, you may apply for the Academy Group Office Overhead Expense Plan, provided you are a resident of the United States (except FL, IN, MN, NC, TX, TN, VT, WA and territories) and Puerto Rico.

 

"FULL-TIME WORK" means actively performing the regular duties of your normal occupation for pay or profit on the basis of at least 20 hours each week at the place such duties are normally performed or other location to which travel is required.

 

Note: Coverage may not be available in all states at this time; contact the Administrator for current information.

 

For some benefit amounts requested, a financial questionnaire may be required as evidence of insurability.

 

HOW THE PLAN WORKS

 

The Plan is designed to pay Monthly Benefits when you are Totally Disabled. Totally Disabled is defined in the group policy as being prevented by illness or injury from performing the material and substantial duties of your regular occupation as a specialist in ophthalmology, provided (a) that was your primary occupation at the time of disability; and (b) you are not otherwise working (at any occupation) for pay or profit.

 

Choice of Waiting Periods

A waiting period is the number of consecutive days you must be Totally Disabled before benefits can begin. The longer the waiting period, the lower your cost. You have a choice of 30 or 90 days.

 

Choice of Monthly Benefit

You may apply for a Monthly Benefit of $1,500 to $12,500 per month (in $100 units). The actual monthly benefit payable will be the lesser of:  a) the Monthly Benefit in force; b) the Eligible Expenses incurred for that month and; c) the average of monthly Eligible Expenses incurred during the six month period immediately preceding your Total Disability. To find the amount that's appropriate, check your records for your actual expenses and calculate your average monthly expenses for the past twelve months. (See worksheet section that follows.)

 

24-Month Benefit Period

Benefits begin following the end of the applicable waiting period and are payable up to 24 months during Total Disability.

 

Eligible Overhead Expenses

This Plan provides coverage for the normal operating expenses of your current practice which are incurred while you are Totally Disabled. Eligible Overhead Expenses include, but are not limited to:

  • Office rent
  • Interest payments on outstanding business debts
  • Utilities (heat, water, telephone, electricity, etc.)
  • Employees' salaries and payroll taxes
  • Postage and stationery
  • Equipment maintenance
  • Rental, lease or depreciation of office equipment
  • Monthly average of taxes on the premises
  • Insurance premiums
  • Accounting fees, to the extent that such expenses are normal and customary in the conduct and operations of the business
  • Professional membership and/or subscription dues
  • Such other fixed expenses as are normal and customary in the conduct and operation of your office

 

If you're incorporated, a partner or joint tenant, Eligible Overhead Expenses include only your share of overhead expenses.

 

Eligible Overhead Expenses do not include: the salary, fees, drawing accounts, profits, or any compensation for you, your partner or any member of your profession employed by or working for you; any individual hired after the date your disability begins (except your temporary replacement); income taxes; personal expenses; charitable contributions; the cost of the purchase of office equipment, goods or merchandise; or the payment of principal on any indebtedness.

 

FEATURES OF THE PLAN

 

Waiver of Premium Contributions

If you have been Totally Disabled for six consecutive months, premium contributions due thereafter will be waived for as long as benefits are payable for that Total Disability, provided the disability began before age 60.

 

Benefits for Recurring Disability

Successive periods of disability that are due to the same or related causes will be considered a single period of disability unless separated by a return to FULL-TIME WORK for six months or more. (Unrelated disabilities not seperated by a return of FULL-TIME WORK will also be considered a single period of disability.) Disabilities which meet these requirements will be treated as a new disability, subject to a new benefit period and waiting period.

 

Tax-Deductible Premium Contributions

The IRS currently recognizes Office Overhead Expense Insurance as a legitimate business expense and allows deductions of its premium contributions as a business expense under Rev. Rul. 55-264, 1955-IC.B11. This aspect should be discussed with your financial advisor.

 

YOUR COST

 

Cost is based on the Waiting Period, Monthly Benefit selected, your age and usage of tobacco/nicotine products when coverage becomes effective and increases on the premium due date on or immediately after you reach a higher age bracket.

 

CURRENT 2020 QUARTERLY PREMIUM CONTRUBUTIONS FOR NON-SMOKER

$1,000 Monthly Benefit

CURRENT 2020 QUARTERLY PREMIUM CONTRUBUTIONS FOR SMOKER

$1,000 Monthly Benefit

Member's Age 30-Day Waiting period 90-Day Waiting Period Member's Age 30-Day Waiting period 90-Day Waiting Period
Under 40 $13.90 $8.50 Under 40 $16.40 $10.00
40-49 24.80 14.30 40-49 29.20 16.80
50-59† 41.50 24.70 50-59† 48.80 29.00

$5,000 Monthly Benefit

$5,000 Monthly Benefit

Member's Age 30-Day Waiting period 90-Day Waiting Period Member's Age 30-Day Waiting period 90-Day Waiting Period
Under 40 $69.50 $42.50 Under 40 $82.00 $50.00
40-49 124.00 71.50 40-49 146.00 84.00
50-59† 207.50 123.50 50-59 244.00 145.00

$10,000 Monthly Benefit

$10,000 Monthly Benefit

Member's Age 30-Day Waiting period 90-Day Waiting Period Member's Age 30-Day Waiting period 90-Day Waiting Period
Under 40 $139.00 $85.00 Under 40 $164.00 $100.00
40-49 248.00 143.00 40-49 292.00 168.00
50-59† 415.00 247.00 50-59† 488.00 290.00

 

†Contact the Administrator for renewal rates at ages 60 and over. Coverage terminates at age 70.

 

The premium contributions shown reflect the current rate and benefit structure. Benefit amounts are not guaranteed and are subject to change by agreement between New York Life Insurance Company and the Trustees of the Ophthalmologists Insurance Trusts. Premium contributions may be changed by New York Life Insurance Company on any premium due date and any date on which benefits are changed. However, your rates may change only if they are changed for all others in the same class of insureds. For example, a class of insureds is a group of people with the same issue age.

 

How To Determine Your Cost for Other Monthly Benefits

If you wish to request a Monthly Benefit (in $100 units)
for an amount not shown, please contact the Administrator for assistance.

 

Note: If you prefer to pay annually, the cost is four times the quarterly cost; if you prefer to pay semiannually, the cost is twice the quarterly cost. Please indicate your choice on the application.

 

ADDITIONAL PLAN PROVISIONS

Exclusions And Limitations

The Plan does not provide benefits for any disability that is due or related to: chemical dependency or ingestion of a narcotic (unless prescribed or administered by a doctor other than you or your close relative); declared or undeclared war or any act thereof; military service; pregnancy or childbirth (except complications thereof), any impairment or disease specifically excluded from your coverage; or occurs during or is due or related to intentionally self-inflicted injury while sane or insane, [Missouri Residents: This exclusion is not applicable to injury caused by an intentionally self-inflicted injury while insane] operating, riding in or descending from any aircraft except when traveling solely as a passenger on a licensed aircraft piloted by a licensed pilot; a PREEXISTING CONDITION (see below) or your incarceration for participation in (except as a victim) an illegal occupation/activity or the commission of a crime.

 

No benefits will be paid if you are outside the U.S, Puerto Rico or the Virgin Islands when benefits are payable.

 

In addition, no benefits will be paid unless the disability occurs while you are insured under this Plan and you are under the care of a licensed physician other than yourself (or immediate family/household member) during the period of disability.

 

PREEXISITING CONDITION is an injury or sickness for which you consulted a doctor, received any medical services or supplies, or took any medication during the 12 months immediately before becoming insured under this Plan.
Benefits are not payable for a disability which is classified as a PREEXISITING CONDITION until the end of the earlier of: 12 consecutive months during which you have not consulted a doctor, received any medical services or supplies, or taken any medication for the condition; and 24 consecutive months during which you have been insured under the Plan.

 

Effective Date of Coverage

You will become insured on the date specified by New York Life provided the first premium contribution has been paid, satisfactory evidence of insurability has been submitted, and you are at FULL-TIME WORK on that date. If you are not at FULL-TIME WORK as required, coverage will not become effective until the day you are at FULL-TIME WORK provided such date is within three months of the date insurance would have become effective and you are still eligible for insurance. Payment of a premium contribution for insurance does not mean there is any coverage in force before the effective date as specified by New York Life Insurance Company.

 

There are instances where New York Life Insurance Company may be able to offer insurance (at the same premium contribution) by eliminating coverage for specific impairments or diseases.

 

When Coverage Ends

Your insurance can remain in force until you reach age 70, provided: you do not cease FULL-TIME WORK (other than for reason of disability); Academy membership is maintained; premium contributions are paid when due; full time active duty in the armed forces is not begun; and the group policy is not terminated, or modified, by the Policyholder or New York Life Insurance Company to end coverage for the group of insureds to which you belong.

 

Renewal Payments and Claims

Once you are accepted into this Plan, you will have a 31-day grace period for your payment of renewal premiums. When you need to submit a claim, contact the Administrator for the proper forms.

 

30-Day Free Look

When you are approved for coverage, you'll be sent a Certificate of Insurance summarizing the provisions of your coverage. If you are not fully satisfied with the terms of your Certificate, you may return it without claim within 30 days. Your coverage will be invalidated and you will receive a full refund no questions asked.

 

IMPORTANT NOTICE

 

How New York Life Obtains Information and Underwrites Your Request For The

 

Group Disability Income Insurance Plan

 

In this notice, references to "you" and "your" include any person proposed for insurance. Information regarding insurability will be treated as confidential. In considering whether the person(s) in your request for the insurance qualify for insurance, we will rely on the medical information you provide, and on the information you AUTHORIZE us to obtain from your physician, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB, Inc. ("MIB"). MIB is a non-for-profit organization of insurance companies, which operates an information exchange on behalf of its members. If you apply for life or health insurance coverage or claim for benefits is submitted to an MIB member company, medical or non-medical information may be given to MIB and such information may then be furnished by MIB, upon request, to a member company.

 

Your AUTHORIZATION may be used for a period of 24 months from the date you signed the application for insurance, unless sooner revoked. The AUTHORIZATION may be revoked at any time by notifying New York Life in writing at the address provided. Your revocation will not be effective to the extent New York Life or any other person already has disclosed or collected information or taken other action in reliance on it, or to the extent that New York Life has a legal right to contest a claim under an insurance certificate or the certificate itself. The information New York Life obtains through your AUTHORIZATION may become subject to further disclosure. For example, New York Life may be required to provide it to insurance, regulatory or other government agencies. In this case, the information may no longer be protected by the rules governing your AUTHORIZATION.

 

MIB and other insurance companies may also furnish New York Life, its subsidiaries or the Plan Administrator with non-medical information (such as driving records, past convictions, hazardous sport or aviation activity, use of alcohol or drugs, and other application for insurance). The information provided may include information that may predate the time frame stated on the medical questions section, if any, on this application. This information may be used during the underwriting and claims processes, where permitted by law.

 

New York Life may release this information to the Plan Administrator, other insurance companies to which you may apply for life and health insurance, or to which a claim for benefits may be submitted and to others whom you authorize in writing. However, this will not be done in connection with test results concerning Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV). We may also make a brief report of your protected health information to MIB, but we will not disclose our underwriting decision.

 

New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. 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.

 

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 change 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 Federal Fair Credit Reporting Act procedures. If you question the accuracy to the information provided by the MIB, you may contact MIB and seek a correction. MIB's information office is: MIB,Inc.50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734 telephone 866-692-6901 (TTY 866 346-3642)

 

Information for consumers about MIB may be obtained on its Web site at http://www.mib.com/

 

For NM Residents: PROTECTED PERSONS1 have a right of access to certain CONFIDENTIAL ABUSE INFORMATION2 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.

 

1PROTECTED PERSON means 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 person.

 

2CONFIDENTIAL ABUSE INFORMATION means information about: acts of domestic abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant or insured family member, employer or associate of a victim of domestic abuse or a person with whom the applicant or insured is known to have a direct, close, personal, family or abuse-related relationship.

New York Life Insurance Company
 

8/12 ed.

This section is only a brief description of the principal provisions and features of the Plan. The complete terms and conditions are set forth in the group policy issued by New York Life to the Trustees of the Ophthalmologists Insurance Trust.

 

The Academy incurs costs in connection with this sponsored Program. To provide and maintain this valuable membership benefit, it is reimbursed for these costs. The Academy also receives a fee for the license of its name and logo for use in connection with this Plan.

 

Underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010 under Group Policy G-14308-1, on Policy Form GMR-FACE/G-14308-1.

 

About New York Life Insurance Company

 

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Program Administrator

 Address
Mercer Consumer
12421 Meredith Drive
Urbandale , IA 50398
 Phone
1-888-424-2308
 Hours
 M-F 7:30a-5p CT
 Email
customerservice.service@mercer.com
 Website
http://www.mercer-web.com/products/mercerhealthbenefits.html

 

Insurance Company

 Address
New York Life Insurance Company
51 Madison Avenue
New York , NY 10010
SMRU #1700505