Long Term Disability Income Plan

Updated April 26, 2010

• Insurance Enrollment Form (PDF, 159 K)
• Who May Apply
• Amounts of Coverage
• Elimination Period
• Benefit Duration
• Total Disability Defined
• Residual Disability Benefits
• Residual Disability Benefit for Communicable Diseases
• Waiver of Premium
• Rehabilitation
• Organ Transplant
• Terminal Disability Benefit
• Effective Date of Coverage
• Exclusions
• Limitations
• Termination
• CAP Disability Semi-Annual Premiums
• Certificate of Insurance
• Multi-Coverage Discount
• How to File a Claim
• The 30 Day Free Look
• How to Apply
• Important Notice

Who May Apply

All CAP Junior Members and Fellows of the College residing in the U.S. or Canada (except Quebec), under age 65, and actively engaged in their profession at least 20 hours per week are eligible to apply for coverage.

When you are insured under this plan and you suffer a covered total disability that lasts for the applicable, elimination period, you will receive benefits while you remain totally disabled thereafter, up to the benefit duration period.

Amounts of Coverage

You may apply for $400 to $10,000 per month (in $100 increments).

To determine the maximum issue limits at the time of application, New York Life limits the amount of disability income benefits it will approve, based on your age, earnings and all other disability insurance you have in force and intend to continue. New York Life will issue up to 60percent of your earned income, less other disability income insurance in force, subject to the participation limits shown in the chart at the top of the next page. Earned income is equal to net monthly income after business expenses and before taxes. Income from investments, rent, or royalties is not included in earned income.

* Includes other disability insurance in force at time of application.

Elimination Period

The elimination period is determined by the plan you choose:

PLAN 2: 30 Day Waiting Period

Benefits commencing on the 31st day of total disability due to accident or sickness; or

PLAN 3: 60 Day Waiting Period

Benefits commencing on the 61st day of total disability due to accident or sickness; or

PLAN 4: 90 Day Waiting Period

Benefits commencing on the 91st day of total disability due to accident or sickness; or

PLAN 5: 180 Day Waiting Period

Benefits commencing on the 181st day of total disability due to accident or sickness; or

PLAN 6: 365 Day Waiting Period

Benefits commencing on the 366th day of total disability due to accident or sickness

Benefit Duration

While you remain totally disabled from a covered accident or illness, monthly benefits are payable as follows.

For total disability commencing before age 64, benefits can be payable up to age 65 *

For total disability commencing at ages 64 through 69, benefits can he payable for up to one year *

* Benefits will be limited to no more than two years for disabilities that are due to mental and nervous disorders and/or substance abuse.

Total Disability Defined

Should you return to work part-time or work at another occupation, you may be eligible for continued benefits. (See Residual Disability Benefits.)

Successive disabilities will be considered as one unless separated by at least two days of active, full-time work, or due to entirely unrelated conditions.

Residual Disability Benefits

Pre-disability earnings means your average monthly earnings for the 12 or 24 months prior to the onset of your disability, whichever period produces the higher average. To help prevent inflation from artificially increasing post-disability earnings, New York Life will increase pre-disability income upward to reflect increases in the Consumer Price Index (CPI-U) up to eight percent compounded annually.

When computing any earnings loss, earnings received after resuming employment will be averaged up to six months for the period immediately following total disability.

The residual benefit is a percentage of your total disability benefit equal to the percentage reduction of monthly earnings. It will be paid as long as total disability benefits would have been paid if the underlying total disability had continued or until current income exceeds 75 percent of pre-disability average earnings, if sooner.

No residual disability income benefit is payable following a total disability unless it begins while insured and before your 65th birthday.

Residual Disability Benefit for Communicable Diseases

A communicable disease means any of the following conditions, but only if the applicable medical profession or appropriate governmental agency requires the disclosure of the diagnosis of the communicable disease and it results in a limitation of his or her practice due to contracting the disease;

Acute viral hepatitis (hepatitis B or C virus), human immunodeficiency virus, acquired immune deficiency syndrome (AIDS), or tuberculosis.

Waiver of Premium

Rehabilitation

If, while you are disabled, you wish to enter into a rehabilitation program, New York Life will review, at their expense, the feasibility of that program. If you and New York Life agree on a rehabilitation program, New York Life will state in writing which expenses of the program it will pay. Any payment by New York Life toward a rehabilitation program will be in addition to the disability income benefit to which you are entitled.

Organ Transplant

If you donate an organ for transplant, your resulting disability will be considered as being caused by sickness and you will be considered to have a zero-day sickness elimination period. New York Life will pay benefits for this type of disability only on amounts of coverage in force for more than six consecutive months.

Terminal Disability Benefit

Should death occur on a day for which a total disability benefit is payable, and during a disability which lasted for at least 30 days before death, New York Life will pay a final benefit of 30 times the daily benefit otherwise payable for that day.

Effective Date of Coverage

All coverage is subject to New York Life's approval. Approved coverage will be effective on the first day of the month following the date the request for coverage is approved provided the initial contribution for insurance is paid within 31 days of your billing date and the member is performing the normal activities of a person in good health of like age and sex on the later of the date of approval and the date the contribution is paid.

Benefits will not be payable for disabilities caused, or contributed to, directly or indirectly, by war or military service, self-inflicted injuries (intentional or while insane), undisclosed pre-existing conditions, or pregnancy, or any condition excluded by rider attached to the member's certificate. Benefits are not payable during the elimination period applicable to your plan.

Limitations

Benefits will be limited to a maximum benefit period of 24 months for disabilities that are the result of psychiatric or psychological disorder or substance abuse.

Termination

You may continue your insurance until the January 1 coinciding with or next following your 70th birthday.

Otherwise your coverage cannot be terminated as long as (1) you continue to pay premiums when due, (2) continue membership in CAP, (3) the group master policy is not terminated or amended, (4) you do not go on active duty in the armed forces, and (5) you continue to work at least 20 hours per week.

All premiums are payable semi-annually each January 1 and July 1. Premiums are based on members who attained age on the January 1st proceeding the date of the application and increases each subsequent January 1st as they attain a new age bracket. New York Life reserves the right to change premiums and benefit provisions on a class-wide basis. Premiums may also be paid annually. For annual premiums double the amount shown above.

Certificate of Insurance

Once insured, you will be issued a certificate evidencing your coverage.

Members who are insured in both the CAP-endorsed Term Life Insurance and Long Term Disability Income Plans at the same time can receive a five percent discount off the premium for both plans as long as they retain coverage in both plans. If you drop one of the plans, the discount ceases. This discount applies to member rates only.

How to File a Claim

The plan administrator will furnish claim forms upon request with instructions for their completion.

The 30 Day Free Look

The College of American Pathologists has thoroughly analyzed this plan and monitors its administration. When you receive your certificate examine it carefully. If you are not completely satisfied with your CAP Long Term Disability Income coverage, simply return your certificate within 30 days without claim, with your request for a full refund. No questions will be asked, and there will be no further obligation.

How to Apply

• Simply indicate the disability income plan you want on the enrollment form (PDF, 264 K).
• Complete, date and sign, then return the application to the Plan Administrator. Send no money now. You will be billed once coverage has been approved.
• Send to:
  Affinity Insurance Services, Inc.
  159 E. County Line Road
  Hatboro, PA 19040-1218

This brochure briefly describes the provisions of master Policy G-5388-0 (Policy Form GMR) issued to the College of American Pathologists. For details, see your certificate of insurance.

Important Notice: How New York Life Underwrites Your Request for CAP Coverage

Information regarding insurability will be treated as confidential. In considering whether the persons in your request for insurance qualify for coverage, we will rely on medical information you provide and on the information you authorize us to obtain from your doctor, other medical practitioners and facilities, other insurance companies for which you applied for insurance, and MIB, Inc. (Medical Information Bureau). New York Life will not disclose such information to anyone except those you authorize or where required by law. We may make a brief report to MIB; however, we will not disclose our underwriting decision. 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.

MIB is a non-profit membership organization of life insurance companies which operates an information exchange on behalf of its members. When you apply for insurance or submit a claim for benefits to an MIB member company, medical or non-medical information may be given to the bureau, which may then be furnished to member companies. Upon written request, MIB will arrange disclosure of any information it may have about you in its file. MIB's information office is PO Box 105, Essex Station, Boston, MA 02112; phone 617-426-3660.

If we cannot provide the coverage you requested, we will tell you why. In all cases medical records information will be given to a medical professional designated by you (except for certain types of medical information in specified jurisdictions you may choose to receive such information directly). If you feel our information is inaccurate, you will be given a chance to correct or complete the information in our files.

For New Mexico residents, in addition, protected persons* have a right of access to certain confidential abuse information** 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 current address.

For U.S. residents, your request is handled in accordance with the Fair Credit Reporting Act procedures. If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage be effective prior to this date.

Payment of premium contribution with your application does not mean that there is any insurance in force before the effective date is determined by New York Life.

*Protected person means a victim of domestic abuse who has notified us that he or she is or has been a victim of domestic abuse and who is an insured or prospective insured.

**Confidential abuse information means information about acts of domestic abuse status, the work or home address or telephone number of a victim of domestic abuse or the status of an applicant or insured as family member, employer or associate of a victim of domestic abuse or a person with whom an applicant or insured is known to have a direct, close personal, family or abuse-related counseling relationship. New York Life Insurance Company 7/99 ed.

Sponsored and Approved by the College of American Pathologists

Plan Administrator:

1-800-509-6023

Underwritten by: New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010
(NAIC # 66915)