Long Term Disability Income Plan
Updated April 26, 2010
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.
|| 55 to 59
|| 60 to 64
|This Plans Maximum Issue Limit
|Maximum Participation Limit *
* Includes other disability insurance in force at time of application.
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
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
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
Successive disabilities will be considered as one unless separated
by at least two days of active, full-time work, or due to entirely unrelated
Residual Disability Benefits
You are eligible for residual disability income benefits if you return
to work after being totally disabled for at least three months or your
elimination period if longer, and if you return to work 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 percentof their average net 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
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
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.
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 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.
|Premium Per $100 Unit |
|<35||$ 4.88||$ 3.88||$ 3.00||$ 2.75||$ 2.38|
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
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
Affinity Insurance Services, Inc.
159 E. County Line Road
Hatboro, PA 19040-1218
(California License # 0795465)
(Massachusetts License #: 1554442)
(Louisiana License #: 192615)
Underwritten by: New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010
(NAIC # 66915)