Group Long Term Disability Insurance Policy Information, Forms & Claims

Coverage Termination

Coverage for you and your spouse will end 1) on the earliest of policy cancellation (including class of insureds), 2) when you cease to be an eligible member, 3) at the attainment of age 70, 4) when you stop actively working (except due to a disability covered by the policy), or 5) when you stop paying your premiums. Coverage for your spouse will also end when he/she is no longer your lawful spouse or domestic partner.

Exclusions and Limitations

If you are totally disabled due to mental or nervous disorders, alcoholism, or drug abuse, the maximum payment period will be reduced to two years during your lifetime unless you are confined in a hospital or other institution licensed to provide care and treatment for that disability.

A total disability is an injury or illness which, during the waiting period and the following 24 months, wholly and continuously prevents you from performing the essential duties of your occupation; and after that, wholly and continuously prevents you from engaging in any occupation for which you are reasonably qualified by reason of education, training, or experience.

If you cease to be totally disabled and return to work for a total of 14 days or less during the elimination period, the waiting period will not be interrupted. Except for the 14 days or less that you work, you must be totally disabled by the same condition for the total elimination period.

The policy does not cover any disability or loss caused by:

1. Intentionally self-inflicted injury, suicide or attempted suicide, 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); or
2. Pregnancy or childbirth, except complications of pregnancy; or
3. War or act of war, whether declared or not; or
4. Any injury sustained while riding on, boarding, or alighting from any aircraft:
   
   1. As a pilot, crew member, or student pilot;
   2. Operated by any military authority (land, sea, or air), unless it is a Military Transport Aircraft used for transport and operated by the United States Military Air Mobility Command (AMC) or an AMC type service of a national government recognized by the United States; or
   3. Being used for test, experimental purposes, stunt flying, racing or endurance tests; or
5. Your commission or attempted commission of a felony, an illegal occupation/activity, an insurrection, or a riot; or
6. Sickness contracted or injury sustained while on full-time active duty as a member of the Armed Forces (land, sea, or air) of any country or international authority. We will refund the pro-rata portion of any premium paid for you while you are in the Armed Forces on full-time active duty for a period of two months or more. Written notice must be given to us within 12 months of the date you enter the Armed Forces; or
7. Any impairment or disease specifically excluded from your coverage.
8. A disability that does not require a doctor’s regular care.

IMPORTANT NOTICE: How New York Life Obtains Information and Underwrites Your Request For Group Long Term Disability 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, LLC. (“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, a claim for benefits is submitted to a 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 applications 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 concerning 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 we 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 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 Canadian residents, the address is: MIB Information Office, 330 University Avenue, Suite 501, Toronto, Ontario, Canada M5G 1R7, telephone 416-597-0590. Information for consumers about MIB may be obtained on its website at www.mib.com.

For NM Residents: 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 address.

1) PROTECTED 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 person or prospective insured person.

2) CONFIDENTIAL 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 as a 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 relationship.