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Benefits and Policy Features*
Noncancelable and Guaranteed Renewable to Age 65: Until Age 65, the policy cannot be canceled, premiums cannot be increased and restrictions cannot be added, as long as premiums are paid as due.
Guaranteed Renewable to Age 65: Until Age 65, the policy cannot be canceled and restrictions cannot be added, as long as premiums are paid as due. The company reserves the right to change the premium rates; however, the change will apply to all policies of this form and class in each state. The new premium will be based on original issue age and occupation.
Conditionally Renewable for Life: The policy may be renewed beyond Age 65 for life on each policy anniversary provided insured is actively working at least 30 hours each week, is not receiving a benefit under the policy or any attached rider and the policy is in force with no premium in default. When renewing the policy, current income documentation is required and insured must pay the premium due for his/her age at the time of renewal.
Base Monthly Benefit: The Company will pay the base monthly benefit for each month the insured is totally disabled, under the terms of the policy, due to accident or sickness. Benefits begin after the elimination period is satisfied. Benefits continue as long as total disability continues or to the end of the benefit period, if sooner.
Benefit Periods: Available benefits periods are 2, 5 and 10-years, to Age 65, to Age 67 and to Age 70.
Elimination Periods: Available elimination periods are 30, 60, 90, 180, 365 and 730 days.
Occupational Classes: Available non-medical occupational classes are 6A, 5A, 4A, 3A, 2A, A and B. Available medical occupational classes are 6M, 5M, 4M, 3M, 2M and M.
Waiving Physician’s Care: While disabled, insured must be under the regular care and treatment of a physician appropriate for the condition causing disability. The company will waive this requirement if, in the opinion of that physician, continued medical treatment will not improve the condition.
Successive Periods of Total Disability: Successive periods of total disability will be considered as one period if: (a) they are caused by the same or related conditions; (b) they are separated by less than 365 days (Noncancelable policy) or 180 days (Guaranteed Renewable policy); and (c) each begins while the policy is in force. The elimination period and benefit period will not restart.
Exceptions and Limitations: Benefits will not be paid: (a) for a disability caused or contributed by war, declared or undeclared, or any act or incident of war, or as a result of military service when scheduled active duty is more than three months, (b) for a disability resulting from an intentionally self-inflicted injury, (c) during any period insured is incarcerated, (d) except as a direct result of sickness or injury, if the insured is prevented from engaging in his/her occupation as a result of suspension, revocation or surrender of his/her professional license or certification, (e) for normal pregnancy or childbirth until after 90 days, (f) for more than 24 months during the lifetime of the policy for total disability caused by a mental/nervous disorder and/or drug alcohol abuse, or (g) for more than 12 months during the lifetime of the policy, if you reside outside of the United States.
Choice of 2 Definitions of Total Disability is available:
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True Own Occupation for the Length of the Benefit Period: Total disability means that, due to a sickness or injury, in and of itself, the insured is unable to perform the material and substantial duties of his/her occupation. Occupation means the occupation or occupations being performed at the time disability began. If the insured is not employed at that time, occupation means any occupation he/she is able to do based on education, training and experience.
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Own Occupation and Not Working for the Length of the Benefit Period: Total disability means that, due to a sickness or injury, in and of itself, the insured is unable to perform the material and substantial duties of his/her occupation and he/she is not working in any occupation for wage or profit. It is the insured’s choice whether or not to work in another occupation, if in fact he/she can. Occupation means the occupation or occupations being performed at the time disability began. If insured is not employed at that time, occupation means any occupation he/she is able to do based on education, training and experience.
Nondisabling Injury Benefit: If the insured suffers an injury requiring medical treatment prescribed by a physician or the repair to natural teeth prescribed by a dentist, the company will pay the expense of such treatment, not to exceed the lesser of 50% of the base monthly benefit or $3,000.
COBRA Premium Benefit: If the insured becomes unemployed due to disability and, as a result, is paying COBRA medical coverage premiums, the company will reimburse for those premiums up to $1,000 per month, beginning with the first premium due after the elimination period is satisfied on this policy, but not to exceed 18 months. Reimbursement is also available for those who continue their employer-provided group medical plan under the provisions of a state continuation plan. The company will not pay more than 100% of the COBRA premium expense incurred monthly, under all policies.
Survivor Benefit: Should the insured die after satisfying the elimination period and while monthly disability benefits are being paid under this policy, the company will pay an additional three months of base monthly benefit to the designated beneficiary, if any, otherwise to the insured’s estate.
Presumptive Total Disability: The insured will be considered totally disabled if he/she sustains the complete loss of hearing in both ears, sight in both eyes, speech, the loss of use of both hands, both feet, or one hand and one foot. The elimination period will be waived and benefits are payable for as long as the presumptive total disability continues, even if he/she is working in an occupation. The loss is not required to be permanent or irrecoverable.
Surgical Transplant Benefit: While this policy is in force, if a total disability results from the insured being a transplant donor, the company will consider him/her totally disabled due to sickness, provided the transplant occurs more than six months after the issue date of the policy. The elimination period will be waived.
Good Health Benefit: For every consecutive policy year the insured completes without receiving monthly disability benefits under this policy, the company will reduce the elimination period by two days. In no case will the elimination period be reduced to less than 30 days.
Cosmetic Surgery Benefit: While this policy is in force, if a total disability results from cosmetic surgery to correct a disfigurement or to improve the insured’s appearance, the company will consider his/her totally disabled due to sickness, provided the cosmetic surgery occurs more than six months after the issue date of the policy. The elimination period must be satisfied before benefits are payable.
Rehabilitation: The insured may participate in an occupational rehabilitation program without being considered “recovered” from the disability. Moreover, if the company approves the program, it will pay for the reasonable expenses of the program, subject to mutual agreement in writing.
Waiver of Premium: After 90 days and once a claim is approved, the company will begin waiving premiums for as long as the insured is disabled, even beyond the benefit period. The company will refund the premiums paid during the elimination period.
Optional Benefit Riders
Enhanced Residual Disability Rider: We will pay you a residual benefit while you are residually disabled if you suffer a loss of at least 15% of your net earned income, and you are able to perform one or more, but not all, of the material and substantial duties of your occupation or you are unable to engage in your occupation for more than 80% of the time as was usual prior to the start of your disability.
Enhanced Residual Disability Rider: A residual benefit is payable if the insured suffers a loss of at least 15% of net earned income and is unable to perform one or more, but not all, of the material and substantial duties of his/her occupation or is unable to engage in his/her occupation for more than 80% of the time as was usual prior to the start of disability. Benefit is based on the loss of earned income. If loss of earned income is 75% or more, the full monthly disability benefit is payable.
Recovery Benefit: Built into the Enhanced Residual Disability Rider. In the month immediately following a period for which disability benefits have been paid, upon recovery and return to full-time work, a residual benefit is payable if the insured maintains a loss of at least 15% of net earned income and that loss is a direct result of the previous disability.
Basic Residual Disability Rider: A residual benefit is payable is the insured suffers loss of at least 15% of net earned income and is able to perform one or more, but not all, of the material and substantial duties of his/her occupation or is unable to engage in his/her occupation for more than 80% of the time as was usual prior to the start of disability. Benefit is based on the loss of earned income, up to a maximum of 50% of the base monthly benefit.
Partial Disability Benefit: This benefit is built into the Guaranteed Renewable policy only. After a period of disability for which monthly benefits were paid, the insured may be eligible for partial benefits if, due to sickness or injury, he/she is able to do one or more, but not all, of the material and substantial duties of his/her occupation or can only perform all of the main duties for 50% or less of the time normally required. While partially disabled, the company will pay one-half of the base monthly benefit for a period not to exceed the lesser of 12 months or any unused portion of your maximum benefit period for total disability. If the insured elects either the Enhanced or Basic Residual Disability Rider on his/her policy, the Partial Disability benefit is not included.
Social Insurance Substitute (SIS) Rider: Following the elimination period for this rider, the company will pay the SIS benefit amount for each month the insured is totally disabled due to injury or sickness. This amount will be reduced if the insured is receiving any Social Insurance benefits. Social Insurance benefits are those payable under Social Security, Worker’s Compensation, occupation disease or employer liability laws and similar Federal, state or local laws or acts.
Cost of Living Adjustment Rider – 6% Compounded: As long as the insured remains disabled, the base monthly benefit will be increased by the lesser of 6% compounded annually or the change in the Consumer Price Index (CPI-U), on each anniversary of the date of disability. Benefits will not be increased by this rider after Age 65, but will remain at the same level as applicable at Age 65, until benefits cease. The insured has a qualified right to purchase the increase amount under this rider upon his/her recovery and return to full-time work.
Cost of Living Adjustment Rider – 3% Simple: As long as the insured remains disabled, the base monthly benefit will be increased by a flat 3% simple interest increase on each anniversary of the date of disability. Benefits will not be increased by this rider after Age 65, but will remain at the same level as applicable at Age 65 until benefits cease.
Automatic Increase Rider: This rider is designed to provide for a 4% simple automatic increase in the base monthly benefit on each policy anniversary, for up to five years. This increase will be made without evidence of insurability and will also apply to the Residual and Cost of Living Adjustment Riders (if part of the insured’s policy). One refusal to increase the monthly benefit will forfeit remaining options during any five-year period and will forfeit an insured’s right to reapply for a new five-year option.
Future Increase Option (FIO) Rider: This rider permits the insured to purchase additional coverage with only financial evidence of insurability. During the first three years after issue, on any given policy anniversary, the insured can exercise up to the entire benefit under this rider, provided he/she qualifies financially and is not disabled. On each subsequent anniversary date, up to and included age 55, the insured may purchase up to 50% of the base monthly benefit, provided he/she qualifies financially. The total of all increases may never exceed the amount purchased under the rider.
Catastrophic Disability (CAT) Rider: Following the elimination period for this rider, the company will pay Catastrophic Disability (CAT) benefits for each month that the insured is catastrophically disabled due to injury or sickness. Catastrophically disabled means that the insured is unable to perform two or more Activities of Daily Living without standby assistance or requires substantial supervision due to severe cognitive impairment. Activities of Daily Living are: dressing, toileting, transferring, continence, eating and bathing. Benefits will continue as long as the insured remains catastrophically disabled or to the end of the Catastrophic Disability maximum benefit period, if sooner.
*Subject to state approval and variations.
Disability Income insurance (Forms 4501NC, 4502GR and 4503BOE) is issued by Ameritas Life Insurance Corp. in approved states. In New York, Disability Income insurance (Forms 5501-NC, 5502-GR and 5503-BOE) is issued by Ameritas Life Insurance Corp. of New York.
This information is provided by Ameritas Life Insurance Corp. (not licensed in New York) and Ameritas Life Insurance Corp. of New York. Each Company is responsible for its own financial condition and contractual obligations. For more information about Ameritas®, visit www.ameritas.com
Ameritas® is a registered service mark of Ameritas Mutual Holding Company.
© 2012 Ameritas Mutual Holding Company