Group Office Overhead Expense Insurance
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Helps You Maintain Your Practice While You Are Disabled

Office expenses need to be met, even if you aren’t around to pay them. The ACP Group Overhead Expense Insurance Plan can help you keep your practice running by providing financial coverage for your normal operating expenses while you are recovering from a disability. You will be able to take the time needed to recuperate while finding comfort in knowing that your office and staff will be ready and waiting for your return.

  1. Click on and print the applicable application located to the right.
  2. Be sure to read the information in this brochure carefully. Choose the Monthly Benefit you wish to request.
  3. Complete, sign and date the application. It is extremely important that you answer fully the questions about medical history on this form. New York Life Insurance Company will rely upon your answers, and failure to provide complete and truthful information may invalidate coverage.
    If you choose the Electronic Funds Transfer (EFT) Option, be sure to include a voided check, as applicable, in addition to the check for the first payment due.
    If a Domestic Partner Form is required, please print and include with your application. The form can be located on the “Forms” tab.
  4. Mail the Application together with your check made payable to:

    Administrator

    ACP Group Insurance Program
    P.O. Box 10374
    Des Moines, IA 50306

    Residents Of Puerto Rico:

    Please send your completed application and check for the initial premium to:
    Global Insurance Agency, Inc.
    P.O. Box 9023918
    San Juan, PR 00902-3918

Medical Requirements

New York Life Insurance Company reserves the right to request medical information needed to determine an applicant’s eligibility for coverage. Based upon the age of the person proposed for insurance and the amount of coverage requested, a physical exam, EKG, blood test or other medical information may be required.

Not all applicants will have to supply additional information. However, if required, we will arrange for an independent professional paramedic to contact you to perform these simple tests at your convenience. The exam and blood test will be free of charge.

Requests for insurance will be processed promptly and coverage will be issued for members whose evidence of insurability has been found to be satisfactory.

How To File A Claim

To file a claim, call or write the Administrator for claim forms.

30-Day FREE Look

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 your premium refunded — no questions asked!

Who Is Eligible?

Eligibility

If you are an ACP member, Physician Affiliate or Non-Physician Affiliate under age 60 and at FULL–TIME WORK, you may apply for the Group Office Overhead Expense Insurance Plan.

“FULL–TIME WORK” means actively performing the regular duties of your normal occupation for pay or profit on the basis of at least 20 hours each week at the place such duties are normally performed.

This offer is available only to residents of the United States and Puerto Rico.

How The Plan Works

The Plan is designed to pay Monthly Benefits when you are Totally Disabled. Totally Disabled means an incapacity from an injury or sickness that completely and continuously prevents you from doing the material and substantial duties of your medical specialty or specialties, provided you are not working in any gainful occupation.

Choice of Monthly Benefit

You may apply for a Monthly Benefit of $500 to $15,000 per month (in $500 increments). However, the actual monthly benefit payable will not exceed the lesser of the Eligible Expenses incurred for that month and the average of monthly Eligible Expenses incurred during the six month period immediately preceding your Total Disability. To find the amount that’s appropriate, check your records for your actual expenses and calculate your average monthly expenses for the past twelve months.

For some benefit amounts requested, a financial questionnaire may be required as evidence of insurability.

Choice of Waiting Periods

A waiting period is the number of consecutive days you must be Totally Disabled before benefits can begin. You have a choice of 30 or 60 days.

Choice of Benefit Periods

A Benefit Period is the duration of how long monthly benefits will be paid after you have satisfied your chosen waiting period. This plan offers you a choice of benefit periods: 1, 2, or 3 years.

Regardless of which Benefit Period you choose, for Total Disabilities commencing after you turn age 64, benefits are payable for up to 1 year.

Eligible Overhead Expenses

This Plan provides coverage for the normal operating expenses of your current practice which are incurred while you are Totally Disabled. Eligible Overhead Expenses include, but are not limited to:

  • Office rent
  • Interest payments on outstanding business debts
  • Utilities (heat, water, telephone, electricity, etc.)
  • Employees’ salaries and payroll taxes
  • Postage and stationery
  • Equipment maintenance
  • Rental, lease or depreciation of office equipment
  • Monthly average of taxes on the premises
  • Insurance premiums
  • Accounting fees, to the extent that such expenses are normal and customary in the conduct and operations of the business
  • Professional membership and /or subscription dues
  • Such other fixed expenses as are normal and customary in the conduct and operation of your office

If you’re incorporated, a partner or joint tenant, Eligible Overhead Expenses include only your share of overhead expenses.

Eligible Overhead Expenses do not include: the salary, fees, drawing accounts, profits, or any compensation for you, your partner or any member of your profession employed by or working for you; any individual hired after the date your disability begins (except your temporary replacement); income taxes; personal expenses; charitable contributions; the cost of the purchase of office equipment, goods or merchandise; or the payment of principal on any indebtedness.

Your Cost

Cost is based on the Waiting Period, Monthly Benefit, Benefit Period and your age when coverage becomes effective.

Cost increases on the premium due date on or immediately after you reach a higher age bracket.

Current 2018 Semi–Annual Premium Rates Per $1,000 Monthly Benefit
30–Day Waiting Period
Age 3–Year Benefit Period 2–Year Benefit Period 1–Year Benefit Period
Under age 30 $22.00 $20.00 $17.00
30–34 28.00 24.00 20.00
35–39 32.00 27.00 21.00
40–44 40.00 32.00 25.00
45–49 60.00 47.00 35.00
50–54 80.00 62.00 44.00
55–59 110.00 90.00 65.00
*60–64 160.00 135.00 105.00
*65–69 200.00 200.00 200.00
60–Day Waiting Period
Age 3–Year Benefit Period 2–Year Benefit Period 1–Year Benefit Period
Under age 30 $18.00 $15.00 $13.00
30–34 24.00 19.00 15.00
35–39 28.00 21.00 17.00
40–44 36.00 26.00 20.00
45–49 55.00 40.00 29.00
50–54 74.00 53.00 37.00
55–59 100.00 75.00 55.00
*60–64 150.00 125.00 95.00
*65–69 180.00 180.00 180.00

*Applicable to renewal only. Maximum benefit duration of 1 year ages 64 to over. Premium rates for MONTHLY BENEFITS or modes of payment not shown are exact multiples of the applicable premium rates shown.

Coverage terminates at age 70.

How To Determine Your Cost for Other Monthly Benefits
If you wish to request a Monthly Benefit (in $500 increments) for an amount not shown, please contact the Administrator for assistance.

When Coverage Ends

Insurance can remain in force until you reach age 70, provided: you do not cease FULL–TIME WORK (other than for reason of disability); ACP membership is maintained; premium contributions are paid when due; active duty in the armed forces (except for training purposes of two months or less) is not begun; and the group policy is not terminated or modified by the policyholder or New York Life Insurance Company to end insurance for the group of insureds to which you belong.

Your Effective Date

Insurance will take effect on the date specified by New York Life Insurance Company, provided the initial contribution has been paid and you are 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 coverage.

Payment of a premium contribution for insurance does not mean that there is any coverage in force before the effective date as specified by New York Life Insurance Company.

There are instances where New York Life Insurance Company may be able to offer insurance (at the same premium contribution) by eliminating coverage for specific impairments or diseases.

Plan Features

Waiver of Premium Contributions

If you have been Totally Disabled for six consecutive months, premium contributions due thereafter will be waived for as long as benefits are payable for that Total Disability, provided the disability began before age 60.

Benefits for Recurring Disability

Successive periods of disability which are due to the same or related causes and are not separated by return to FULL–TIME WORK for at least six consecutive months will be considered as one period of disability, as will unrelated disabilities that are not separated by return to FULL–TIME WORK of at least one day. Disabilities which meet these separation requirements will be treated as a new disability, subject to a new benefit and waiting period.

Business Estate Settlement Benefit

If you die while receiving benefits or during your waiting period, the plan will pay a benefit for covered expenses incurred in closing your office. The benefit will be paid to your estate or to the corporation if your practice is incorporated up to a maximum of four times the monthly benefit selected.

Tax–Deductible Premium Contributions

The IRS currently recognizes “Office Overhead Expense Insurance” as a legitimate business expense and allows deductions of its premium contributions as a business expense under Rev. Rul. 55–264, 1955–IC.B11. This aspect should be discussed with your financial advisor.

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, military service, or incarceration for or participation in (except as a victim) an illegal occupation activity or the commission of a crime; Pre–Existing 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 alcoholic intoxication and drug use (unless prescribed by a physician other than yourself) 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 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.

IMPORTANT NOTICE:

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 qualifies 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 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 containing 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 8/12ed.

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 American College of Physicians, 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!

Underwritten by New York Life Insurance Company, under Group Policy No. G–29030–1 on Policy Form GMR–FACE/G–29030–1

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.

Answers about the plan, including eligibility, options, enrollment, customer service and more.

"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 experience.
  • For all other ACP Members: your medical specialty or specialties.

To be considered Totally Disabled, you must not be working in any gainful occupation.

Not all applicants will have to supply additional information. However, if required, we will arrange for an independent professional paramedic to contact you to perform these simple tests at your convenience. The exam and blood test will be free of charge.

Insurance will take effect on the date specified by New York Life Insurance Company, provided the initial contribution has been paid and you are at FULL-TIME WORK (as defined in Tell Me More) on that date.

Insurance can remain in force until you reach age 70, provided: you do not cease FULL-TIME WORK (other than for reason of disability); ACP membership is maintained; premium contributions are paid when due; active duty in the armed forces (except for training purposes of two months or less) is not begun; and the group policy is not terminated or modified by the policyholder or New York Life Insurance Company to end insurance for the group of insureds to which you belong. Coverage will also end when the maximum benefit payable for a disability has been reached.
This plan is underwritten by New York Life Insurance Company, under Group Policy No. G-29030-1 on Policy Form GMR.–FACE/G-29030-1.

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Program Administrator, ACP Group Insurance Program

Mercer Consumer
P.O. Box 10374
Des Moines, IA 50306
Phone: 1-888-643-0323
Email: ACPgroupins@marshpm.com

Insurance Company

New York Life Insurance Company
51 Madison Avenue
New York, NY 10010

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