TERMS AND CONDITIONS
This Policy does not cover Pre-Existing Conditions whether disclosed in the application or not, for any loss that occurs during the first 12 months beginning on the date that person becomes an Insured under the Policy or Rider. Any Disability Resulting from a Pre-Existing Condition will not be covered if it begins during the first 12 months after the Policy Effective Date. Refer to When a Recurrent Disability Becomes a New Disability section for a Recurrent Disability from a Pre-Existing Condition. By Pre-Existing Conditions, We mean a condition for which a Physician prescribed, recommended or gave to the Insured during the 12 months before the Insured’s Policy/Rider Effective Date: 1) treatment; or 2) medical advice; or 3) consultation; or 4) diagnosis or diagnostic tests; or 5) medication. For any person who was age 65 and over when they become an Insured under the Policy, Pre-Existing Conditions shall mean only those conditions specifically excluded in any part of the contract or attached endorsement. Conditions specifically named or described as excluded in any part of the Policy are never covered.
You can cancel at any time without any fees or charges
The Policy will end on the earliest of: a. the date You fail to pay Premiums within Your Grace Period; or b. The date You die; or c. the Policy Anniversary Date after You turn age 70; or d. the date You notify Us in writing to end the Policy. All coverage under the Policy and any attached Rider(s) will terminate when the Policy ceases to be in force. Coverage for an Insured Dependent will end on the date such Insured ceases to be an Eligible Dependent Child or Eligible Spouse. When an Insured Dependent’s coverage ends, We will: a. refund any Premium accepted for the period the Insured is not eligible; and b. Consider any claim that began before the insurance ended; and c. Allow a conversion policy as set forth in the Conversion Privilege provision of the Policy.
30 DAY RIGHT TO EXAMINE POLICY:
You have thirty (30) days to examine the policy. If you are not satisfied, you may return it to us and have your premiums refunded.
Your policy will be fully enforced once your first allotment is received. You can file a claim on any incident that happens on or after day 1 of your first payment being received.
Disability Benefit due to childbirth are only available if the inception of the pregnancy occurs after the Certificate Effective Date and coverage is in full force. This Policy allows up to 6 weeks for a natural birth and up to 8 weeks for a C-Section. All elimination periods are waved for maternity leave
CLAIMS PAY OUT:
This policy will pay out the monthly benefit, up to 12 months per incident.
Pays in addition to any other insurance, 50% if Worker’s Compensation or similar law pays.
LIMITATIONS & EXCLUSIONS:
The Policy (including any Rider(s) attached) does not cover losses sustained while caused by, contributed to or resulting from: a. being legally intoxicated as defined by State law where the loss occurred or being under the influence of any narcotic unless administered on the advice of a Physician; or b. alcoholism or Sickness or Injury resulting from being intoxicated as defined under the laws of the jurisdiction’ or c. the voluntary use of illegal drugs, the intention al taking of over the counter medication not in accordance with recommended dosage and warning instructions or intentional misuse of prescription drugs; or d. attempted suicide while sane or insane or intentionally self-inflicted Injury; or e. Mental or Nervous Disorders; or f. Being exposed to war or any act of war, declared or undeclared or while serving in the armed forces; or g. Engaging in an illegal activity; or h. Participation in any form of aviation other than as a fare-paying passenger in a fully licensed passenger carrying aircraft; or i. Voluntary inhalation of gas; or j. Mountaineering, sky diving, hang gliding or bungee jumping; or k. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test; or l. Conditions specifically excluded by Amendment or Endorsement; or m. Any Pre-Existing Conditions as defined in the policy. The Policy (including any Rider(s) attached) does not pay Benefits for: a. Care that is primarily for: 1) rest; or 2) convalescence; or 3) rehabilitation; or b. Treatment which is rendered outside the United States, its possessions, or Canada, except for emergency care for acute onset of Sickness or Injury sustained while traveling for business or pleasure; or c. Total or Partial Disability while You are outside of the United States, its possessions, or Canada; or d. Dental Treatment or plastic surgery for cosmetic purposes. This exclusion does not apply if the treatment or surgery is: 1) due to an Injury; or 2) to restore normal bodily functions; or e. Total or Presumptive Disability that begins while not Employed. We will not pay Benefits for any period the Insured is incarcerated in any type of penal institution.
ACTIVELY AT WORK means performing normal duties of Your principal occupation: 1. on a full-time basis (30 hours per week); and 2. at Your Employer’s usual place of business.
CALENDAR YEAR means a one-year period that begins on January 1 at 12:01 a.m., Standard Time and ends on January 1 at 12:01 a.m., Standard Time of the following year at the Employer’s address.
CERTIFICATE EFFECTIVE DATE means the date Your coverage becomes effective and is the Certificate Effective Date shown in the Schedule.
CLASSIFICATION means each classification of Employees eligible for Total Disability benefits as determined by the Employer.
COVERED INJURY means bodily injury or injuries caused by an accident and sustained by an Employee on or after the Certificate Effective Date that must result directly and independently of all other causes. The accident must occur while Your coverage is in force under this Certificate. A Covered Injury includes pyogenic infections incurred through an accidental cut or wound and all injuries as a result of one accident.
COVERED SICKNESS means illness or disease of an Employee that is diagnosed by a Physician or for which treatment was first recommended by a Physician after the Certificate Effective Date and occurs while Your coverage is in force. Covered Sickness includes inguinal, umbilical or post-operative hernia and bacterial infections. Normal pregnancy will be considered a Covered Sickness if the inception of the pregnancy occurs after the Certificate Effective Date and while Your coverage is in full force. The Company may require medical evidence to determine the inception date of the pregnancy.
EARNED INCOME means Your monthly rate of earnings from Your Employer in effect immediately prior to the date of the Covered Injury or Covered Sickness that causes You to be Totally Disabled. Earned Income includes all earnings before any reductions and includes Other Income Benefits. It does not include any bonuses, overtime pay, extra compensation and commissions.
ELIMINATION PERIOD means the number of consecutive days You must be Totally Disabled before We pay the Monthly Benefit for Total Disability. The Elimination Period is shown in the Schedule.
EMPLOYEE means a person who is directly employed by the Employer for pay in the conduct of the Employer’s regular business and who is Actively at Work and who is age 70 or less. Employee does not mean a part-time or temporary employee. The Employee insured under this Certificate is shown in the Schedule.
EMPLOYER means the person for whom You are directly employed. The Employer is shown in the Group Policy application.
MAXIMUM BENEFIT PERIOD means the number of months the Monthly Benefit for Total Disability is payable for any one Total Disability. The Maximum Benefit Period is shown in the Schedule.
If the Maximum Benefit Period shown in the Schedule is 24 months, the Maximum Benefit Period will be based on Your age as of the date Monthly Benefits for Total Disability begin as follows: 1. If You are younger than age 68, the Maximum Benefit Period is 24 months; 2. If You are older than age 68 but younger than age 69, the Maximum Benefit Period is until the date You reach age 70; 3. If You are age 69 or older, the Maximum Benefit Period is 12 months.
MENTAL OR NERVOUS DISORDERS means a neurosis, psychoneurosis, psychopathy, psychosis or mental or emotional disease or disorders of any kind.
MONTHLY BENEFIT means the Monthly Benefit for Total Disability shown in the Schedule.
OTHER INCOME BENEFITS means: 1. the amount of earnings You receive from any sick leave or formal salary continuation plan paid by Your Employer, or a pension plan to which Your Employer contributes or makes payroll deductions; 2. any amount of earnings You receive from any form of employment other than from the Employer to whom the Group Policy is issued; 3. any amounts You receive under the Federal Social Security Act, including benefits paid to Your dependents on account of Your Total Disability; 4. State or Federal government disability or retirement plan or increases which begin on or after the date of Your Total Disability; 5. Federal Old Age Benefits or increases which begin on or after the date of Your Total Disability under the Federal Social Security Act on Your behalf; and 6. any other disability income insurance You have that was not disclosed on Your application for this Certificate.
With respect to items 3 and 5 only, unless You show proof to Us that payments under these applicable programs or acts have been applied for but will not be paid, We: 1. will assume You are receiving such payments if You are covered under the Federal Social Security Act; and 2. may require You to apply (but not more frequently than annually) once a Social Security denial has been received and all appeals have been pursued. Failure to reapply for benefits when required by Us will result in Our estimation of payment under those acts.