Feature The Standard (Protector Platinum) Berkshire Life's ProVider Plus Mass Mutual's Radius Northwestern Mutual's RR.DI Series

Transcription

1 Definition of Total Disability For all occupation classes, an insured is totally disabled if the insured is unable to perform the substantial and material duties of his or her own occupation. The own occupation definition of total disability is part of the base contract. If the insured's occupation is limited to a professionally recognized specialty in medicine or law, the specialty will be deemed to be the insured's own occupation. For all occupation classes, unable to perform major duties of own occupation (including recognized medical and dental specialties) and gainful employment in another occupation allowed. An insured is totally disabled if the insured is There is a choice of five different definitions of total disability and not all occupations are eligible for every unable to perform the main duties of his or definition: 1. Base definition of total disability option: her regular occupation and is not working in The insured is totally disabled if unable to perform the any other occupation. An own occupation principal duties of his or her regular occupation and is rider is available to select occupation classes. not gainfully employed in any occupation. 2. Any occupation definition of total disability option: During the first 24 months, the insured is totally disabled if unable to perform the principal duties of his or her regular occupation and is not gainfully employed in any occupation. After the first 24 months, the insured is totally disabled if unable to perform the principal duties of any occupation and is not gainfully employed in any occupation year initial period option: During the first 24 months, the insured is totally disabled when unable to perform the principal duties of his or her regular occupation but may be gainfully employed in a different occupation. After the first 24 months, the insured is totally disabled when unable to perform the principal duties of the regular occupation and not gainfully employed in any occupation. 4. Extended initial period option: The insured is totally disabled when unable to perform the principal duties of his or her regular occupation but may be gainfully employed in a different occupation. 5. Medical occupation definition of total disability: The insured is totally disabled if more than 50% of time was spent providing direct patient care, the insured is not employed in a different occupation, and the insured is not able to perform the procedures or duties of his or her medical specialty.

2 Definition of Partial/Residual Disability For the first six months partial disability benefits are payable, the benefit equals 100% of the basic monthly benefit regardless of earnings. Partial Disability means that an insured is not totally disabled, the insured is working his or her own occupation or any other occupation but, due to an injury or sickness, the insured has a 20% loss of duties, or a 20% loss of time, or a 20% loss of income. After six months, the definition is changed to mean that the insured is working in his or her occupation or any other occupation but, due to his or her injury or sickness, the insured has a loss of income of at least 20%. With the optional partial disability benefit rider, Under the Extended Partial Disability partial disability means that the insureds are Benefits Rider, the insured is partially gainfully employed, and solely due to injury or disabled if he or she is not working at his or sickness they are unable to perform one or more her occupation or another occupation, has but not all of the material and substantial duties an income loss of at least 20%, and can show of their occupation, or unable to perform the material and substantial duties of their a demonstrated relationship between the occupation for more than one half of the time loss of income and the current disability. normally required. An indemnity for partial disability is paid for a maximum of 6 months or if earlier, to the end of the benefit period. With the optional residual disability benefit rider, residual disability means that the insureds are gainfully employed in their occupation but because of sickness or injury their loss of income is at least 15% of their prior income. If the loss of income exceeds 75%, the full benefit is payable. For each of the first 12 months, a loss of income indemnity will be payable. For each of the first 12 months, a loss of income indemnity will be payable monthly and equal to the loss of income. If the insured continues to be residually disabled in the same claim after the loss of income indemnity has been paid for 12 months, a monthly residual indemnity is paid as a percentage of the monthly indemnity. During the first six months of residual disability the insured can choose to receive either 50% of the full benefit or the residual benefit. For the first six months, residual disability is defined as either: 1. the insured is unable to perform one or more principal duties which accounted for at least 20% of the time he or she spent at the regular occupation before the disability started, or 2. the insured has at least a 20% loss of time spent at his or her regular occupation. After the first six months, there must be an income loss of 20% for residual benefits to be payable.

3 Recovery Benefits A recovery benefit is paid if the insured is no longer disabled but continues to experience a loss of income and this loss is solely the result of the previous injury or sickness that caused the disability. The insured must be able to demonstrate that the loss of income continues to be solely the result of the previous injury or sickness for the recovery benefit to be payable as long as the conditions are met, subject to the policy's maximum benefit period. The loss of income must be at least 20%. Even if the insured has recovered from the sickness or injury that the previous disability, he or she will continue to be considered residually disabled so long as the loss of income is still at least 15% of his or her prior income and the loss is the result of such sickness or injury. Under the Extended Partial Disability Benefits Rider, the insured will receive monthly payments for 6 months following full recovery and return to his or her occupation, with at least a 20% loss of income and a demonstrated relationship between the insured's loss of income and the previous disability. After 6 months, subject to periodic review, monthly payments will continue up to max benefit period as long as 20% loss of income exists and a demonstrated relationship between the income loss and the previous disability continues. Under a transition benefit provision, if the insured demonstrated a 20% continued loss of earned income, a proportionate benefit will be paid for up to the first 12 months after the insured's recovery from a disability, provided: the insured was disabled until the beginning date of disability (end of the elimination period), the insured has returned to continuous full-time employment, and the month for which the transitional benefit is claimed is within the maximum benefit period.

4 Compassionate Care Benefit A Compassionate Care Benefit will be paid while the insured is working at least 20% fewer hours in order to care for a loved one who has a serious health condition, and the insured's monthly earnings are at least 20% less than pre-disability earnings due to that reduction in hours worked; and the insured is not disabled, and no other benefit is payable under this policy. The insured may claim the Compassionate Care Benefit up to two times while the policy is in force. The maximum amount of Compassionate Disability Benefit for all claims and all loved ones is a total amount equal to six times the basic monthly benefit. Any part of this total amount remaining after the first claim will be available for a second claim. Not available. Not available. Not available. Benefit Period 2,5,10 years, to age 65 and 67. 2,5, or 10 years, to age 65, to age 67, lifetime (with graded benefits). 2,5,10, to age 65, to age 67. 2,5, To age 65, to age 70. Elimination Periods (Days) 60,90,180,365 30,60,90,180,365, ,90,180,365, , 180, 365, 820 Coverage for Mental Disorder/Substance Abuse No time limitation on coverage for mental disorder and/or substance abuse in the base contract In most states there is no limitation or exclusion on MDSA coverage. Two-year limitation is applied to anesthesiologists, anesthetists and nurse anesthetists, pain management specialists, and ER physicians. A two-year MDSA limitation is applied for each separate period of disability. There is no lifetime limit on the number of two-year periods covered. There is a two-year MDSA limitation for all occupation classes in the base contract.

5 Indexed Cost of Living Rider Choice of three or six percent with Choice of 3%, 6% or four-year delayed compounded interest. CPI-U indexing options with compounded is used and an indexed cost of living interest.guaranteed minimum 3% for all benefit purchase is available following options. Four-year delayed rider delays a period of disability, allowing the COLA until after the 4th policy anniversary. insured to retain the benefit increase COLA benefit increases added at no charge in the event of a future claim. after a claim ends. A three percent rider indexed to the Consumer Price Index is offered with compounded interest. A cost of living benefit purchase is available. Choice of three or six percent with compounded interest. CPI-U indexing is used and an indexed cost of living benefit purchase is available. Automatic Increase Benefit The Automatic Increase Benefit increases the policy's basic monthly benefit by 4%, compounded each year, during a five-year increase period. The benefit is included in the base contract at no extra cost. Four percent automatic increase rider with compound interest and a five-year increase period offered at no cost at underwriting discretion. Additional benefits will be automatically added to the policy for five consecutive policy anniversaries provided the insured is not disabled. Each additional benefit will be equal to the greater of $50 or three percent simple interest of any fully underwritten monthly benefits. The insured may apply to renew this rider every fifth policy anniversary. CPI-U indexed with a maximum of six percent compounded annually for each of the first five years. Future Purchase Option Available through issue age 50 and Available through issue age 50 and exercisable to age 55. The option date exercisable to age 55. The option date each each year is the policy anniversary. year is the policy anniversay. Until the Until the insured is age 45, he or she insured is age 45, he or she may buy all or may buy all or part of the total part of the total incease option on any one increase option on any one option option date. On or after age 45, the insured date. On or after age 45, the insured may buy up to one third of the total may buy up to one third of the total increase option on any one option date. increase option on any one option date. The Future Insurability Option Rider is available through issue age 55. Each option allows the insured to purchase additional coverage of up to one times the base benefit plus the benefit from the Social Insurance Rider (SIR) through age 50, and one-half base of the benefit plus SIR after age 50. An option may be exercised once per year on an option date. Exercise available on every policy anniversary up to age 55. While this benefit is in effect, for each new policy: the minimum full benefit per month that may be purchased is $200; the maximum full benefit per month that may be purchased on each anniversary up to and including the policy anniversary nearest the insured's 45th birthday is the lesser of 50% of the initial pool amount or the remaining pool amount. The maximum full benefit per month that may be purchased on each policy anniversary after the policy anniversary nearest the insured's 45th birthday is the lesser of 25% of the initial poll amount or the remaining pool amount.

6 Presumptive Disability Benefits Lifetime benefits are payable for presumptive disability if the maximum benefit period is at least to age 65. Presumptive disability must be a total and permanent loss. Benefits are payable up to but not beyond the maximum benefit period. Presumptive disability does not need to be irrecoverable. Lifetime benefits are not payable for presumptive disabilities. Presumptive disability must be a total and permanent loss. Lifetime benefits are payable for all benefit periods for presumptive disabilities. If the insured experiences a presumptive disability before age 50, a 50% increased presumptive benenfit is payable. Catastrophic Disability Benefits Pays benefits if unable to perform two of six activities of daily living (ADL's), presumptively disabled, or cognitively impaired. Pays benefits if unable to perform two of six ADL's, presumptively disabled, or cognitively impaired. Pays catastrophic benefits to age 66/67 if unable to perform two of six ADL's, presumptively disabled, or cognitively imparied. Not available. Exclusions & Limitations Intentionally self-inflicted injury, sickness or injury due to war, committing or attempting to commit an assault or felony, actively participating in a violent disorder or riot, for the first 90 days of disability due to pregnancy or childbirth, while you are confined for any reason to a penal or correctional institution, loss or restriction of a professional license, occupation license or certification, and for more than 12 months for each period of continuous disability while the insured resides outside the United States or Canada. Incarceration; intentionally self-inflicted injury; suspension, revocation or surrender of professional license; 3 months normal pregnancy; active military service; incidental travel and vacation outside of the U.S. and Canada may not be for more than two non-consecutive months in a 12-month period. War (declared or undeclared); 90 days normal pregnancy or childbirth (multi-life cases only); active military service; preexisting condition limitation. War; incarceration; felony; loss of professional or occupational license or certificate; benefits payable for a maximum of 6 months for the life of the policy while insured is outside USA; 90 days normal pregnancy.