Long Term Disability Income Plan
Updated August 15, 2013
Who May Apply
All CAP Junior Members and Fellows of the College residing in the U.S. and Puerto Rico (except TN, VT, WA, and territories) 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, waiting 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) depending on your “average monthly income.” “Average monthly income” is defined as: 1/24th of your wages, salaries, commissions, fees and other amounts received for personal services including the cost of fringe benefits and share of total surplus—before deduction of income or social insurance taxes and after deduction of normal business expenses which are deductible for income tax purposes—for the immediately preceding 24 month period. It does not include income from interest, dividends, rent, loyalties, annuities, other insurance or unearned income. The amount of coverage you choose, combined with any other disability income insurance you may have, cannot exceed 60 percent of your ‘average monthly income.’
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 60 percent of your earned income, less other disability income insurance in force, subject to the participation limits shown below.
|Member’s Age At Issue
| ||54||55 to 59||60 to 64|
|This Plan’s Maximum Issue Limit||$10,000||$4,000||$1,500|
|Maximum Participation Limit *||$10,000||$4,000||$1,500|
* Includes other disability insurance in force at time of application.
The waiting period is the number of days you must be totally disabled from a covered accident or illness before benefits can be paid. You can choose from 5 different waiting periods.
- PLAN 2: 30 Day Waiting Period
- PLAN 3: 60 Day Waiting Period
- PLAN 4: 90 Day Waiting Period
- PLAN 5: 180 Day Waiting Period
- PLAN 6: 365 Day Waiting Period
Benefits commence on the day following the waiting period you choose. The longer the waiting period, the more affordable the premiums can be.
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
be 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
Total Disability means a disability that continuously disables you
so that you are unable to perform the substantial and material duties
of your own occupation. Also you must be under the care of a legally qualified
physician and not working at any gainful occupation.
Should you return to work part-time or work at another occupation,
you may be eligible for continued benefits. (See Residual
Disability Benefits below.)
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
You may be eligible for residual disability income benefits if you return to work after being totally disabled for at least three months (or waiting period, if longer) and your current earnings are less than 75 percent of your pre-disability earnings. The reduction of earnings must be a consequence of your total disability.
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 member who contracts a “communicable disease” may be eligible for residual
disability benefits even though they are not totally disabled. In order
to be eligible for the residual disability benefits the insured must be
under age 65 and earning less than 75 percent of their “average monthly
income“ due to contracting the communicable disease. Benefits will not
begin until the applicable waiting period has been satisfied. The benefit
amount and duration will be determined in the same manner as the residual
disability benefit as previously described above.
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
After an insured member has been totally disabled for six continuous
months (for Plan 6 insureds, 12 months) disability income premiums due
thereafter will be waived during the remainder of the disability, up to
the date benefits are no longer paid, provided the disability began before
the insured’s 60th birthday.
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.
If you suffer a Covered Disability as a result of an organ donation, your Waiting Period will be 0 days for that Covered Disability. 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 underwriting approval. Approved coverage will be effective on the first day of the month coinciding with or next 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 Waiting Period applicable to your plan. Complete details will be described in your Certificate of Insurance.
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.
You may continue your insurance until the December 31 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.
|Premium Per $100 Unit |
|Age||Plan 2||Plan 3||Plan 4||Plan 5||Plan 6|
Premiums are based on attained age and increase as you get older. For the purpose of calculating premium, age means a person’s attained age on the immediately preceding January 1, except that: if a person’s birthday is January 1, age means the person’s attained age on his or her birthday. New York Life reserves the right to change premiums and benefit provisions but only on a class-wide basis. For example, a class is a group of insureds with the same age and waiting period.
Certificate of Insurance
Once insured, you will be issued a Certificate of insurance evidencing your benefits under the plan.
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 application form (PDF, 273 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 information is only a brief description of the principal provisions and features of the plan. The complete terms and conditions are set forth in master policy GMR-FACE/G-5388-0 issued to the College of American Pathologists. For details, see your certificate of insurance.
Sponsored and Approved by the College of American Pathologists
- Affinity Insurance Services, Inc.
- 159 E. County Line Road
- Hatboro, PA 19040-1218
- (California License # 0795465)
- (Massachusetts License #: 1554442)
- (Louisiana License #: 192615)
Aon Affinity is the brand name for the brokerage and program administrator operations of Affinity Insurance Services, Inc. (AR 244489): in CA, MN, & OK, AIS Affinity Insurance Agency, Inc. (CA 0795465), Aon Affinity Insurance Services, Inc. (OG94493), Aon Direct Insurance Administrator and Berkely Insurance Agency in NY and NH, AIS Affinity Insurance Agency.
- New York Life Insurance Company
- 51 Madison Avenue
- New York, NY 10010
- (policy form GMR)
New York Life’s state of domicile is New York (NAIC #66915). New York Life is licensed/authorized to transact business in all of the 50 United States, the District of Columbia, Puerto Rico, and Canada. However, not all group plans it underwrites are available in all jurisdictions. See eligibility for details.