Group Disability Income Insurance

Group Disability Income Insurance  

Overview

Member Benefits Up to $10,000 a Month Available!

 

Your Passport to Income Protection. If you’ve never considered disability income insurance before, you may wonder why you may need it now, especially if you’re young and healthy. But most professionals, at all stages, at all income levels, may want to consider solid disability income protection. The Academy–sponsored Group Disability Income Plan can help you protect your earning capacity.

 

Chances are, you already protect your important assets such as your house. Your health insurance can only cover your medical expenses; it can’t provide a regular source of income. Why not help protect the most important asset you have: your ability to earn an income?

 

Practical Help

  • Designed to provide a substitute source of income if you are totally disabled and cannot work.
  • Can provide monthly benefit options to aid in paying bills when disabled.
  • Offers two plans: a Career Plan and a Two–Year Plan—to help meet your needs and budget.
Enrollment Forms

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

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Valuable Benefits

  • Members Under Age 64 Are Eligible to Apply
  • Your Choice of Monthly Benefit Options 
    You may apply for up to $10,000 in coverage, in $100 increments.
  • Your Choice of Waiting Periods (90 or 180 days)
    A waiting period is the number of consecutive days you must be totally disabled before benefit payments begin.
  • Your Choice of Plans:
    Career Plan 
    Two–Year Plan
  • Preferred Definition of Disability Protects You as a Specialist in Ophthalmology
  • Premium Payments Waived During Total Disability
  • Rehabilitation Benefit
  • Residual Disability Benefit

 

Helps Protect You as a Specialist in Ophthalmology

A reliable source of disability protection may be your own disability income insurance such as this Group Disability Income Insurance Plan designed for members of the Academy. It helps provide an income when you’re "Totally Disabled" as defined below.

 

See How These Valuable Features can help Protect You

  • Monthly Benefit Options—up to $10,000
  • Flexible Waiting Periods—Choose 90 or 180 days before benefits begin
  • Choice of Plans—Choose the Two–Year Plan or Career Plan to best fit your needs and budget
  • Cost of Living Option (COLA)

 

ELIGIBILITY

Members of the Academy who are under age 64 and at FULL–TIME WORK can request this coverage, provided they reside in the United States (except TN, VT, WA, and territories) and Puerto Rico and have an ANNUAL NET EARNED INCOME of at least $20,000. Members on active duty in the Armed Forces and full–time students are not eligible.
 

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

"ANNUAL NET EARNED INCOME" means your wages, salaries, commissions, fees, and other amounts received for personal services—before deduction of income or social insurance taxes and after the deduction of normal and usual business expenses that are deductible for income tax purposes.—for any 12–month period. Annual Net Earned Income does not include income from interest, dividends, rent, royalties, annuities, other insurance and other unearned income.

 

HOW THE PLAN WORKS

Choose From Two Plan Options

Both plans are designed to pay monthly benefits while you are Totally Disabled. "Totally Disabled" is defined in the group policy as your being prevented by accident or sickness from performing the material and substantial duties of your regular occupation, as a specialist in ophthalmology, provided: (a) ophthalmology was your primary occupation at the time of disability, and (b) you are not otherwise working (at any occupation) for pay or profit.

 

Career Plan

Benefits are payable to age 65 for Total Disabilities beginning before age 64. Benefits are payable up to one year for Total Disabilities beginning at age 64 but before age 70.

 

Two–Year Plan

Benefits are payable for up to two years for Total Disabilities starting before age 64. For Total Disabilities starting at ages 64 but before age 70, benefits are payable for up to one year.

 

Choose Your Monthly Benefit

You may choose a Monthly Benefit Option from $500 to $10,000 (in $100 units). The option you choose, together with all other disability income insurance you have or for which you are applying, cannot exceed 60 percent of your AVERAGE MONTHLY INCOME. Depending upon your state of residence, you may be eligible to receive benefits under a state plan. You should check to see whether your state offers this.

 

Note: Under the Two–Year Plan, Monthly Benefit Options are available up to $4,000. Upon specific request, and with underwriting approval, of course, higher options may be available.

 

AVERAGE MONTHLY INCOME means, as of any date, the greater of: 

(a) your ANNUAL NET EARNED INCOME for the preceding 12–month period, divided by 12; or 

(b) your ANNUAL NET EARNED INCOME for the preceding 24–month period, divided by 24.

 

Choose Your Waiting Period

The Academy–sponsored Group Disability Income Plan offers a choice of two waiting periods: 90 or 180 days. (Note: the 180–day waiting period is available under the Career Plan only.) A waiting period is the number of consecutive days you must be Totally Disabled before benefits begin. For those members looking to pay a lower premium contribution, you can choose the 180–day waiting period.

 

FEATURES OF THE PLAN

Cost of Living Adjustment (COLA)

If Requesting coverage under the Career Plan, you can, for an additional premium, request the Cost of Living Adjustment (COLA) benefit. This benefit allows you to keep pace with the rate of inflation. If you become Totally Disabled before age 64, monthly benefits will be adjusted annually, beginning in the second year of disability. (Years are measured from the start of the Waiting Period). The adjustment is based on a formula reflecting changes in the Consumer Price Index for Urban Consumers (CPI-U) up to a maximum of 5%. Once you are no longer disabled and benefit payments stop, the Monthly benefit returns to its original amount.

 

Rehabilitation Benefit

This benefit is designed to help certain disabled members return to the work force. Under this provision, a professional rehabilitation staff reviews case histories and identifies individuals who appear to have the greatest likelihood of rehabilitation. Individuals selected by New York Life are offered the chance to participate in a rehabilitation program at no cost to them. Participation is optional, and benefits are not reduced due to participation in this program.

 

Residual Benefits

If you return to work after a Total Disability that began before age 65, and which lasted for at least 30 consecutive days, you may be eligible for a Residual Benefit, provided your current average earnings do not exceed 75 percent of AVERAGE MONTHLY INCOME for the period before your accident. The benefit payable is a percentage of your Monthly Benefit Option equal to the percentage reduction in your monthly earnings. (See the Certificate of Insurance for conditions and limitations.)

 

Premium Payments Waived During Disability

After you have been Totally Disabled for six months, all future premium contributions under the Plan will be waived for as long as you receive benefits for that disability, provided the disability began before age 60.

 

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 of 180 days or more. (Unrelated disabilities not separated by a return of FULL–TIME WORK will also be considered a single period of disability.)

 

YOUR COST

Current 2020 Monthly Premium Contributions

Cost is based on the Waiting Period, Plan and Monthly Benefit Option selected, and on your age and smoking status when coverage becomes effective. The cost increases on the premium contribution due date on or immediately after your reach a higher age bracket. Premium contributions will vary depending upon the options and amount chosen.

                                        

Career Plan — Current 2020 Quarterly Premium Contributions
 
 
 
Member
Age
Smoker $1,000 Monthly Benefit Option
Waiting Period
 
Non-Smoker $1,000 Monthly Benefit Option
Waiting Period
  90 days 180 days 90 days 180 days
Under 35 $40.70 $35.70 $34.40 $30.00
35-39 50.00 45.00 42.50 38.20
40-44 68.80 62.50 58.80 53.20
45-49 90.70 81.30 76.90 69.40
50-54 123.80 108.80 105.00 92.30
55-69** 157.50 141.80 133.90 120.80
Member
Age
Smoker $2,500 Monthly Benefit Option
Waiting Period
Non-Smoker $2,500 Monthly Benefit Option
Waiting Period
  90 days 180 days 90 days 180 days
Under 35 $101.75 $89.25 $86.00 $75.00
35-39 125.00 112.50 106.25 95.50
40-44 172.00 156.25 147.00 133.00
45-49 226.75 203.25 192.25 173.50
50-54 309.50 272.00 262.50 230.75
55-69†* 393.75 354.50 334.75 302.00
Member
Age
Smoker $5,000 Monthly Benefit Option
Waiting Period
Non-Smoker $5,000 Monthly Benefit Option
Waiting Period
  90 days 180 days 90 days 180 days
Under 35 $203.50 $178.50 $172.00 $150.00
35-39 250.00 225.00 212.50 191.00
40-44 344.00 312.50 294.00 266.00
45-49 453.50 406.50 384.50 347.00
50-54 619.00 544.00 525.00 461.50
55-69† 787.50 709.00 669.50 604.00
Member
Age
Smoker $7,500 Monthly Benefit Option
Waiting Period
Non-Smoker $7,500 Monthly Benefit Option
Waiting Period
  90 days 180 days 90 days 180 days
Under 35 $305.25 $267.75 $258.00 $225.00
35-39 375.00 337.50 318.75 286.50
40-44 516.00 468.75 441.00 399.00
45-49 680.25 609.75 576.75 520.50
50-54 928.50 816.00 787.50 692.25
55-69†* 1,181.25 1,063.50 1,004.25 906.00
Member
Age
Smoker $10,000 Monthly Benefit Option
Waiting Period
Non-Smoker $10,000 Monthly Benefit Option
Waiting Period
  90 days 180 days 90 days 180 days
Under 35 $407.00 $357.00 $344.00 $300.00
35-39 500.00 450.00 425.00 382.00
40-44 688.00 625.00 588.00 532.00
45-49 907.00 813.00 769.00 694.00
50-54 1,238.00 1,088.00 1,050.00 923.00
55-69†* 1,575.00 1,418.00 1,339.00 1,208.00

 

†Benefits are payable to age 65 for covered disabilities commencing before age 64, and benefits are payable up to one year for covered disabilities commencing at age 64 but before age 70.
*Renewal only for ages 65-69. Coverage terminates at age 70.
The premium contributions shown reflect the current rate and benefit structure. Benefit option amounts are not guaranteed and are subject to chance by agreement between New York Life and the Trustees of the Ophthalmologists Insurance Trust.
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.

 

Two-Year Benefit Plan — Current 2020 Quarterly Premium Contributions
 
Member
Age
Smoker $500 Monthly Benefit Option
Waiting Period 90 days
Non-Smoker $500 Monthly Benefit Option
Waiting Period 90 days
Under 35 $6.35 $5.35
35-39 7.25 6.20
40-44 8.95 7.65
45-49 11.85 10.00
50-54 21.70 18.40
55-61 45.70 38.85
62 60.65 51.50
63-69†* 78.75 66.95
Member
Age
Smoker $1,000 Monthly Benefit Option
Waiting Period 90 days
Non-Smoker $1,000 Monthly Benefit Option
Waiting Period 90 days
Under 35 $12.70 $10.70
35-39 14.50 12.40
40-44 17.90 15.30
45-49 23.70 20.00
50-54 43.40 36.80
55-61 91.40 77.70
62 121.30 103.00
63-69†* 157.50 133.90
Member
Age
Smoker $2,000 Monthly Benefit Option
Waiting Period 90 days
Non-Smoker $2000 Monthly Benefit Option
Waiting Period 90 days
Under 35 $25.40 $21.40
35-39 29.00 24.80
40-44 35.80 30.60
45-49 47.40 40.00
50-54 86.80 73.60
55-61 182.80 155.40
62 242.60 206.00
63-69†* 315.00 267.80
Member
Age
Smoker $3000 Monthly Benefit Option
Waiting Period 90 days
Non-Smoker $3000 Monthly Benefit Option
Waiting Period 90 days
Under 35 $38.10 $32.10
35-39 43.50 37.20
40-44 53.70 45.90
45-49 71.10 60.00
50-54 130.20 110.40
55-61 274.20 233.10
62 363.90 309.00
63-69†* 472.50 401.70
Member
Age
Smoker $4000 Monthly Benefit Option
Waiting Period 90 days
Non-Smoker $4000 Monthly Benefit Option
Waiting Period 90 days
Under 35 $50.80 $42.80
35-39 58.00 49.60
40-44 71.60 61.20
45-49 94.80 80.00
50-54 173.60 147.20
55-61 365.60 310.80
62 485.20 412.00
63-69†* 630.00 535.60

 

† Benefits are payable up to one year for covered disabilities commencing at age 64 but before age 70.
*Renewal only for ages 65-69. Coverage terminates at age 70.
The premium contributions shown reflect the current rate and benefit structure. Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life and the Trustees of the Ophthalmologists Insurance Trust. 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.
Please Note: This rate chart is based on quarterly rates. However, you may also select a semi-annual or annual premium payment schedule. Simply multiply the quarterly amount by 2 or 4,respectively.

 

Member
Age
Additional Premium for COLA 
(Career Plan only) Per $100 Monthly Benefit Option
Under 35 $1.88
35-39 2.50
40-44 3.83
45-49 5.10
50-54 4.55
55-59 4.23
60-64 1.88

 

How To Determine Your Cost For Other Options

If you wish to request a Monthly Benefit Option (in $100 units) other than those shown above, please contact the Administrator for assistance. The minimum monthly benefit is $500.

 

ADDITIONAL PLAN PROVISIONS

Exclusions And Limitations

The Plan does not provide benefits for any disability that 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] declared or undeclared war or any act thereof; military service; pregnancy or childbirth (except complications thereof) a PRE-EXISTING CONDITION (see below); or any impairment or disease specifically excluded from your coverage.
 

This Plan limits benefits for disability due to Mental Illness and Chemical Dependency to a maximum of 24 monthly benefit payments.
 

No more than six monthly benefits will be paid if you are outside the U.S. when these benefits are payable.
 

No benefit will be paid unless the disability occurs while you are insured under the Plan and you are under the care of a licensed physician or surgeon, other than yourself or member of your immediate family or household during the period of disability.
 

PRE-EXISTING CONDITION LIMITATION

PRE-EXISTING 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 PRE-EXISTING CONDITION until the end 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; or 24 consecutive months during which you have been insured under the Plan.

 

Effective Date

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 actively 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.
 

There are instances where New York Life may be able to offer insurance, at the same cost, by eliminating coverage for a specific condition or impairment.

 

When Coverage Ends

Your insurance can remain in force until you reach age 70. Coverage will end earlier if: you cease to be a member of the American Academy of Ophthalmology; you fail to make premium payments when due; you begin full-time active duty in the Armed Forces; you cease FULL-TIME WORK (other than for disability); or the group policy is terminated or modified by the Trustees or New York Life to end coverage for the group of insureds to which you belong.

 

Renewal Payments and Claims

Once you are accepted into the Plan, you will have a 31-day grace period for your payment of renewal premium contributions. When you want to submit a claim, call or write the Administrator for claim forms.

 

30-Day Free Look

When you become insured you will be sent a Certificate of Insurance summarizing your insurance coverage. If you are not completely 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 not-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 1-866-692-6901 (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 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-14308-0, on Policy Form GMR-FACE/G-14308-0.
 

About New York Life Insurance Company
 

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Contacts

We're here to help! Please contact us in whatever manner is most convenient for you.

 

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 #1700371
Mercer's Role & Compensation

Details of Mercer disclosure of the compensation.