Who Is Eligible?
ACP members and affiliate members, both physician and non-physician, under age 62 who are at FULL–TIME WORK are eligible to request coverage. Student members are not eligible unless working full–time.
"FULL–TIME WORK" means the active performance of the regular duties of your normal occupation for pay or profit on the basis of at least 20 hours per week at the place such duties are performed.
This coverage is only available to residents of the United States (except territories).
How The Plan Works
A Covered Disability, if such disability is not excluded in the Exclusions section, is as follows:
Covered Total Disability
The Plan pays monthly benefits if you are Totally Disabled. Benefits begin at the end of the waiting period, provided you are Totally Disabled.
"Totally Disabled" is defined as an incapacity from an illness or injury that you suffer while
insured under the Policy, but only if such incapacity continuously prevents you from doing the material and
substantial duties necessary to perform:
- For ACP Physician Affiliate Members: your regular occupation.
- For ACP Non-Physician Affiliate Members:
- during your selected waiting period and the following 24 months, your regular occupation;
- thereafter, any occupation for which you are qualified by reason of education, training or
- For all other ACP Members: your medical specialty or specialties.
To be considered Totally Disabled, you must not be working in any gainful occupation.
Long Term Disability benefits can be paid up to age 67 when you are Totally Disabled before age 60. Other monthly total disability/residual/partial disability benefits can be paid up to certain limits:*
|For Disability Beginning
||Monthly Benefits May Continue
|Before age 60
||Up to age 67
||Up to 5 years
||Up to 4 years
||Up to 3 years
||Up to 2 years
|Age 67** to termination age
||Up to 1 year
*See Exclusions and Limitations
Note: Benefits for disabilities due to mental disorders are limited to a maximum of 24 monthly payments. Benefits for any disability that is due or related to alcoholic intoxication or the use of stimulants, hallucinogens or other controlled substances unless prescribed by a physician other than you are limited to 12 monthly payments.
Choice of Monthly Benefit
You have a wide choice of monthly benefit options: from $500 to $12,500 (in $500 units); however, the option you choose, together with any other disability income insurance you may have, cannot exceed 66 2/3% of your AVERAGE MONTHLY INCOME.
This limitation is increased to 75% if your "other" disability insurance is paid for by your employer.
AVERAGE MONTHLY INCOME means, as of any date, a person's average monthly wages, salaries, commissions, fees and any other amounts received by such person for personal services, including the cost of his or her fringe benefits and share of total surplus; except that: For a person in military service, AVERAGE MONTHLY INCOME means, as of any date, the sum of such person’s Military Allowances and Special Pay, excluding basic pay. It does not include income from interest, dividends, rent, royalties, annuities, other insurance or other unearned income. AVERAGE MONTHLY INCOME is computed before deduction of any income taxes or social insurance taxes and after deduction of normal and usual business expenses that are deductible for income tax purposes.
Choice of Waiting Period
You also have a choice of four waiting periods before benefit payments begin: 30, 60, 90 or 180 days. A waiting period is the number of consecutive days that you must be disabled before benefits commence. Coverage with a longer waiting period is less expensive.
Waiver of Premium
After you have been Totally Disabled for 90 consecutive days or your waiting period, whichever is greater, and you begin to receive benefits for Total Disability, all future premium contributions under the Plan will be waived for as long as you receive benefits for that disability.
Benefits for Recurring Disability
Successive periods of disability, which are due to the same or related causes, will be considered a single period of disability unless separated by return to FULL–TIME WORK for six consecutive months or more.
This benefit is designed to help certain disabled individuals return to the work force. Under this provision, a professional rehabilitation staff reviews case histories and identifies those individuals who appear to have the greatest likelihood of rehabilitation. Individuals selected by New York Life Insurance Company will be offered the option of participating in a rehabilitation program at no cost to them. Participation is voluntary and benefits will not be reduced due to participation in the program.
Partial Disability and Residual Benefit
If a covered illness or injury prevents you from performing some but not all of the substantial duties of your medical specialty(ies), you may be eligible for a Partial Disability Benefit. If, while recovering from a Total Disability, you are able to resume some but not all of said duties, you may be eligible for a Residual Disability Benefit. These benefits are based on a percentage of your pre–disability earning. To qualify for either the Partial Disability or Residual Disability benefit, you may not be earning more than 80% of your pre–disability AVERAGE MONTHLY INCOME and you must not have reached the Maximum Benefit Period. Refer to your Certificate of Insurance for more information on these benefits.
Cost of Living Benefit (Optional Benefit)
This option offers disability benefits that help keep pace with the rate of inflation. Monthly benefits will be adjusted annually from the date the waiting period begins. Adjustments may be made to the monthly benefit paid in the second and each succeeding year. The adjustment amount will be based on the consumer price index for urban consumers (CPI–U) up to a maximum 6% increase per year and an overall maximum increase of one times the original benefit. Once you are no longer disabled and benefit payments stop, the monthly benefit returns to the original option amount. This benefit only applies to disabilities commencing before you reach age 65.
ADDITIONAL PLAN INFORMATION
You will become insured on the date specified by New York Life Insurance Company provided the first premium contribution is paid, satisfactory evidence of insurability is submitted, and you are at FULL-TIME WORK on that date. If you are not at FULL-TIME WORK coverage will not become effective until you return to FULL-TIME WORK for at least one full day, provided such day is within three months of the date insurance would have been 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 specified by New York Life Insurance Company.
Note: There are instances where New York Life Insurance Company may be able to offer insurance, at the same cost, by eliminating coverage for a specific impairment or disease.
When Coverage Ends
Once coverage is validly in force, it may be continued to the April 1st anniversary date on or immediately after you reach age 70. Coverage will end earlier if: you cease FULL–TIME WORK other than for reasons of disability, cease to be an ACP member, fail to pay premium contributions when due, or the group plan is modified or terminated by the policyholder or New York Life Insurance Company to end insurance on the group of insureds to which you belong.
Exclusions And Limitations
The Plan does not provide benefits for any disability that occurs during or is due or related to: intentionally self–inflicted injury while sane or insane, Missouri residents: the exclusion for intentionally self-inflicted injury is not applicable to injury caused by an attempted suicide while insane, declared or undeclared war or any act thereof; or incarceration for or participation in (except as a victim) an illegal occupation/activity or the commission of a crime; PRE–EXISTING YOUR CONDITION (except as noted below); or any impairment or disease specifically excluded from your coverage.
No benefits are payable for any disability for which you are not under the regular care of a licensed physician or surgeon other than yourself, your business associate, or member of your immediate family or household.
The Plan limits benefits for disabilities due to mental disorders to 24 months. Benefits for disabilities due to the voluntary intake of alcohol or narcotics/controlled substance (unless prescribed by a doctor other than yourself) are limited to 12 months.
A PRE–EXISTING CONDITION is an injury or illness for which you consulted a physician, took medication, or received medical services or supplies during the immediate 12–month period prior to becoming insured under this Plan. Benefits are not payable for a disability due to a PRE–EXISTING CONDITION until the end of the earlier of 12 consecutive months during which you have not consulted a physician, took medication, or received medical services or supplies, or; 24 months.
The insurance cost is based on the waiting Period, Monthly Benefit, and on your attained age when coverage becomes effective. Coverage increases on the April 1st anniversary date or immediately after the date you reach a higher age bracket. Premium contributions will vary depending upon the options and amounts chosen.
Current 2017 Semiannual Premium Rates per $1,000 Monthly Benefit
|Insured Member's Age
||30 Day Waiting Period
||60 Day Waiting Period
||90 Day Waiting Period
||180 Day Waiting Period
Cost Of Living Benefit Option — Semiannual Premium Rates Per $1,000 Monthly Benefit
|Insured Member's Age
+Renewal at age 62 and over.
The premium contributions shown reflect the current rate and benefit structure. 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. Benefit option amounts are not guaranteed and are subject to change by agreement between New York Life and the Trustees of the American College of Physicians, Inc. Insurance Trust.
30-DAY FREE LOOK
When you become insured, you will be sent a Certificate of Insurance, summarizing your coverage. This website is only a brief description of some of the plan’s principal provisions and features. The complete terms are set forth in the group policy issued by New York Life Insurance Company to the Trustees of the ACP, Inc. Insurance Trust.
If you’re not completely satisfied with the terms of your Certificate of Insurance, you may return it, without claim, within 30 days. Your coverage will be invalidated, and you will be sent a full refund, no questions asked!
How New York Life Insurance Company Obtains Information and Underwrites Your Request for Group Disability Income Insurance.
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 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 a 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
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
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 conceiving
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 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 chance to correct or complete the information in our files. Upon written request to New York Life Insurance 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 of the information provided by 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).
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 a 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 or 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
The ACP Insurance Trust incurs costs in connection with this sponsored program. To provide and maintain this valuable membership, it is reimbursed for these costs. ACP also receives a fee for this license of its name and logo for use in connection with this plan.
Underwritten by New York Life Insurance Company, under Group Policy No. G–29030–0 on Policy Form GMR.–FACE/G-29030-0