You choose when you want your monthly benefits to begin – on the 31st, 91st, or 181st day of total disability. The longer you wait, the lower your premium.
How Total Disability Is Determined
You will be considered totally disabled as long as you are completely and continuously incapacitated and cannot perform the material and substantial requirements of your own occupation – not just any occupation you might be reasonably qualified to perform.
You must also be under the care of a qualified physician (not including yourself or a member of your family) and you may not be working in any occupation for wage or profit during disability. This coverage does not require hospital or home confinement to be eligible to receive benefits.
If you have successive periods of disability that are due to the same or related causes and are not separated by a return to full-time work for three months or more, this will be considered one period of disability. Additionally, all unrelated disabilities that are not separated by a return to full-time work will also be considered one period of disability. Those disabilities that meet these separation requirements will be treated as a new disability, subject to a new waiting period.
Exclusions and Limitations
Benefits are not provided for disability due to: injury or sickness which is not regularly treated by a physician other than you or a member of your family; war or military service; self-inflicted injury (while sane or insane); injury or sickness resulting from the committing of a felony, the attempted committing of a felony, or engaging in any illegal occupation or activity.
If New York Life places an Impairment Restriction on your coverage, benefits are not payable for the disability due to the condition(s) outlined in the Impairment Restriction.
Disabilities due to mental or nervous disorders, alcoholism, chemical dependency, or drug addiction will be subject to a two-year maximum benefit period.
Pre-Existing Condition Limitation
A pre-existing condition is any sickness, accidental injury, or related condition for which you consulted a doctor, received medical services or supplies, or took medication during the 90-day period immediately prior to the effective date of your coverage.
If you become totally disabled due to a pre-existing condition within one year after your coverage effective date, benefits will not be payable.
After you have been continuously insured under the policy for 12 months, pre-existing conditions will be covered unless specifically excluded by an Impairment Restriction on your Certificate of Insurance.
Maternity Coverage
Total disability due to pregnancy will be covered as any other sickness or accidental injury.
Rehabilitation Assistance
To help you to return to work, the insurance company may provide you with a rehabilitation professional to review your case history and determine the potential for returning to the workforce. If you are identified as a probable candidate for rehabilitation, you will have the option of participating in an approved program at no cost to you, and you will continue to receive monthly benefits during your rehabilitation.
Maximum Benefit Period
The Maximum Benefit Period for each Plan is shown the tables below.
PLAN 67 (Members Only)
For A Covered Disability Due To A Sickness,
Pregnancy, Or An Accidental Injury Starting | Maximum Benefit Period |
---|
Before Age 66 | To 67th Birthday |
Age 66 but before Age 70 | 1 Year |
PLAN 5 (Members & Employees)
For A Covered Disability Due To A Sickness,
Pregnancy, Or An Accidental Injury Starting | Maximum Benefit Period |
---|
Before Age 60 | 5 Years |
Age 60 but before Age 64 | To 65th Birthday |
Age 64 but before Age 70 | 1 Year |