Helping to Protect your Future.

Disability

MIB Notice

To properly underwrite and administer your application for insurance coverage, we must collect certain information concerning your insurability. You are our most important source of information, but we may also contact other sources such as medical professionals and institutions, employers and other insurance companies. While all information regarding your insurability will be treated as confidential, in some situations, and in compliance with applicable law, we may disclose necessary items of information to third parties without your specific authorization.

INVESTIGATIVE CONSUMER REPORTS - NOT APPLICABLE TO RESIDENTS OF NEW YORK

As part of our procedure for processing your application, an investigative consumer report may be prepared by an outside insurance reporting organization. Personal information may be collected from others regarding your general reputation and lifestyle. If an interview is conducted with someone other than you, we will inform you of your right to be interviewed in connection with the preparation of the investigative consumer report. You have the right to send a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

PERSONAL HISTORY INTERVIEW

To provide you, our client, with the best possible service, we may also conduct what we call a personal history interview. This is a phone call placed from our underwriting office. Its purpose is to make sure that the application information is complete. Our interviewers are trained to conduct their calls in a friendly, professional manner. The nature of the information discussed is always treated as personal and confidential and will only be used to assess your eligibility for insurance.

MEDICAL INFORMATION BUREAU (MIB) PRE-NOTICE

Information regarding your insurability will be treated as confidential. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may, however, make a brief report thereon to the MIB, Inc., formerly known as Medical Information Bureau, a not-for-profit membership organization of insurance companies, which operates an information exchange on behalf of its members. If you apply to another MIB member company for life or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request, will supply such company, with the information about you in its file. Upon receipt of a request from you, MIB will arrange disclosure of any information in your file. Please contact MIB at (866) 692-6901 (TTY (866) 346-3642). If you question the accuracy of the information in MIB's file, you may contact MIB and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of MIB's information office is 50 Braintree Hill Park, Suite 400, Braintree, Massachusetts 02184-8734. Hartford Life Insurance Company, Hartford Life and Accident Insurance Company, or their reinsurers, may also release information from their files to other insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Information for consumers about MIB may be obtained on its website at www.mib.com.

ACCESS, CORRECTION AND DISCLOSURE

You can obtain access to personal information about you contained in our policy files by sending us a written request. You may also request any necessary corrections, amendments or deletion of any information in our files which you believe to be inaccurate or irrelevant. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may release information in their files to other life insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Also, please be advised that personal and confidential information collected by us may, in certain circumstances, be disclosed to third parties without authorization. A notice providing further description of the circumstances under which information about you may be disclosed and the types of persons and organizations to whom it may be disclosed will be sent to you upon your written request. If you desire further information or access to your personal information, please send your written request to: Hartford Life Insurance Company or Hartford Life and Accident Insurance Company, 200 Hopmeadow St., Simsbury, CT 06089

PA-9369

Disability Income Insurance FAQ

Policy AGP-5683


Is this coverage occupation specific?
Yes.

Do I need to be an ACEP member to apply?
Yes, you must be and remain an ACEP member to continue coverage.

What premium modes can I select from?
We offer Direct monthly ACH, Monthly, Quarterly, Semi-Annual and Annual.

Are the premiums level?
The premiums are level for five years and will change at the 0 or 5 birthdays (example: age 30, 35, 40, 45).

When applying for coverage will I need to get a physical?
Blood and urine tests may requested along with an attending physician statement (APS) and medical records.

If I go on disability, when does the Waiver of Premium begin?
The Waiver of Premium begins the first day of the month following the start of the payment period.

What is involved in submitting a claim?
Please contact HBI and a claim form will be mailed to you immediately. Once the claim form is completed, return to HBI and a claim representative from The Hartford1 will be assigned.

What's covered?
This plan provides monthly Disability Income benefits, including a Return to Work Incentive, Recurrent Disability Benefit, and Survivor Income Benefit! It covers most disability due to accidental Injuries, Sickness or disease.

Who's eligible?
As a member of the American College of Emergency Physicians, you're eligible to apply for coverage. Applicants must be under age 65, Actively-At-Work at the time of application, and residing within the United States. To qualify for benefits, a period of Total Disability must begin while you are covered under this policy, and you are under the regular care of a physician for that condition. The physician cannot be a family member.

When will my coverage become effective?
Your coverage will become effective on the first day of the month immediately following the date your application is approved by Hartford Life and Accident Insurance Company, provided you are Actively-At-Work and your initial premium payment has been received. If you are not Actively-At-Work on that date, your effective date will be postponed until you are Actively-At-Work for 3 months.

Can my coverage be canceled?
Your coverage can only be canceled if:

you are no longer a member of American college of Emergency Physicians;
you do not pay your premiums;
you cease to be Actively-At-Work (except by reason of disability covered by this plan);
you attain the policy age limit; or
the policy terminates.
What are the benefit and waiting periods?
You may apply for monthly benefits in $100 increments from $500 up to $10,000 per month. See the Disability calculator to calculate the amount of disability income insurance you're eligible to purchase.



ELIMINATION PERIODS:

Benefits begin after you have been totally disabled for 30, 90 or 180 days, depending on the plan you select. The Elimination Period is the number of consecutive days at the beginning of a period of Total Disability which must elapse before benefits are payable.

 

Payment Period Elimination Period

Plan 1- To Age 65 Plan:

For Total Disability beginning:

a. Before Age 63: To Age 65 90,180 or 365 days
b. Age 63 or over, but under 65: 2 Years 2 years, 90, 180 or 365 days

Plan 2- 5 Year Plan

For Total Disability beginning:

a. Before Age 63: 5 Years 90,180 or 365 days
b. Age 63, but under 65: 2 Years 30, 90, or 365 days


Is there any Waiver of Premium provision?
Yes - Future premiums will be waived beginning the first day of the month following the start of disability payments and for as long as disability benefits are payable.

What is a Total Disability?
A disability that results in a loss of earnings of 80% or more is considered to be a Total Disability. You'll continue to qualify for benefits up to Age 65 (Plan I), or for up to 5 years (Plan II), if you cannot: perform the substantial and material duties of your own regular occupation; are under the care of a licensed physician other than yourself; and, are not gainfully employed in any occupation for which you are or become reasonably suited in terms of education, training or experience.

What if you return to work after a disability but suffer a relapse?
Because disabilities don't always start and stop in easily defined time frames, we've developed a plan that is flexible enough to accommodate various disability durations and scenarios. If you return to work for fewer than 14 days during the elimination period and then relapse, you can qualify for benefits by satisfying the remainder of the elimination period. This provision relieves you of starting the entire elimination period again.

In addition, periods of disability due to the same or related medical causes and separated by fewer than six months while you are Actively-At-Work, are considered a single period of disability. This means you won't have to satisfy a new elimination period before qualifying for benefits should you relapse upon returning to active employment after receiving benefits for a disability. Actively-At-Work is defined as performing all the regular duties of an occupation for wage or profit on a full-time basis (at least 30 hours per week).

Does the plan pay for partial disability?
Yes, your American College of Emergency Physicians plan provides benefits for partial disabilities following the Elimination Period and a period during which Total Disability benefits were payable. Partial disability means you are gainfully employed in your regular occupation or specialty on a partial and/or part-time basis, but continuously unable to perform your regular duties and you require the regular care of a physician.

What's not covered under this plan?
Benefits are not paid for losses due to war or acts of war, whether declared or not; intentionally self-inflicted Injury, suicide or attempted suicide, while sane or insane; pregnancy or childbirth, except Complications from Pregnancy; Injury sustained while committing or attempting to commit a felony; losses due to Sickness contracted or Injury sustained while on full-time active duty as a member of the armed forces of any country or international authority; or Injury or Sickness arising out of or in the course of employment which is compensable under any Workers' Compensation or Occupational Disease Act or Law.

This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York Department of Financial Services.

1The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford
Life and Accident Insurance Company

Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

Earnings Guard Insurance Plan

This insurance program is not available to residents in all states.

What is Earnings Guard Insurance Coverage?
Earnings Guard Coverage is a Guaranteed Issue Disability Income Insurance policy. It helps provide 24-hour-a-day protection worldwide for accident only disabilities. Benefits are paid regardless of any other insurance you may have, and is available to ACEP members, employees, spouses or domestic partners under age 65 who are actively working (25+ hours per week), and are residents of the United States.

Member Plan Option
Select the benefit amount and Waiting Period of your choice. Premiums are monthly.

 

  60 Day Waiting Period 90 Day Waiting Period
$2,000 Monthly Benefit $8.00 $6.00
$3,000 Monthly Benefit $12.00 $9.00


Spouse Plan Option
Select the benefit amount and Waiting Period of your choice. Premiums are monthly.

 

  60 Day Waiting Period 90 Day Waiting Period
$2,000 Monthly Benefit $8.00 $6.00
$3,000 Monthly Benefit $12.00 $9.00


Rates &/or benefits may be changed on a class basis. Billing Mode Options: Monthly, Quarterly, Semi-Annual or Annual

Offset Provision
Benefit cannot exceed 70% of Basic Monthly Pay.

Offset Provision Example
This example is for purposes of illustrating the effect of the benefit reductions and is not intended to reflect the situation of a particular claimant under the Policy.

Insured's Monthly Basic Monthly Pay  $3,000
Long Term Disability Benefits Percentage x70%
Unreduced Maximum Benefit $2,100
Total Amount of Long Term Disability Benefit Per Month  $2,100

Benefit Period

This plan will pay up to two years on a claim.

Waiting Period

Waiting Period means the number of consecutive days at the beginning of any on period of Total Disability which must elapse before benefits are payable. In this plan you can choose from a 60 or 90 day Waiting Period.

Policy Age Limit
Age 70

Effective Date

Your and your dependent's coverage will become effective the first day of the month on or next following the date we receive your Enrollment Form and premium payment. If you are not Actively-at-Work on that date, your coverage will only become effective when you are once again Actively-at-Work for three consecutive months.

Termination:

Your coverage will end once you reach age 70, cease to be Actively-at-Work - except due to disability under the Policy, or a member of ACEP or fail to pay your premiums when due.

This Policy does not cover:

Intentionally self inflicted Injury, suicide or attempted suicide, while sane or insane;
war or act of war, whether declared or not;
any Injury sustained while riding on, boarding or alighting from, any aircraft: as a pilot, crewmember or student pilot; 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 being used for tests, experimental purposes, stunt flying, racing or endurance tests;
the commission or attempted commission of a felony by you;
sickness or disease;
Injury sustained prior to the effective date of coverage;
Injury sustained while on full-time active duty as a member of the Armed Forces (land, water, air) of any country or international authority.
Injury:
Injury means bodily injury resulting directly from an accident and independently of all other causes which occurs while your coverage under this Policy is effective and which results in your Total Disability.

Total Disability:

Total Disability means a disability which wholly and continuously prevents you from performing the substantial and material duties of your usual occupation.

Basic Monthly Pay:

Basic Monthly Pay means the 12 month average of your regular monthly rate of pay, not including commissions, bonuses, overtime pay or any other fringe benefit or extra compensation, with such 12 month period ending on the last day of Active employment prior to becoming Disabled.

Successive Periods of Disability Limitation:

Periods of Disability a) due to the same or related medical causes; and b) separated by less than 6 months during which you are Actively-At-Work; will be considered one Period of Disability.

Periods of Disability separated by at least 6 months during which you are Actively-At-Work will be considered separate Periods of Disability.

Concurrent Disabilities:

Benefits during any Period of Disability as the result of more than one accident will be considered the same as if the disability resulted from only one cause.

THIS IS LIMITED TO ACCIDENT ONLY COVERAGE.

You have 30 days from your effective date of coverage to look over the program and discuss with your family and advisors. If you are not satisfied, you may return your Certificate within 30 days for a full premium refund, less any claims paid.

Print PDF and complete enrollment form & fax to 605-444-7017.

This website explains the general purpose of the insurance described, but in no way changes or affects the Master Policy AGP-5605 as actually issued. In the event of a discrepancy between this brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

This policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as by the New York State New York Department of Financial Services.

IMPORTANT NOTICE - THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS.

Underwritten by:
Hartford Life and Accident Insurance Company
Hartford, CT 06155

Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company

Simplified Issue Disability Income Insurance Plan

Free 30-day look!

Mail, Email or Fax!

ATTENTION: If applying for Life or Disability as a California or New York resident please contact HBI at 877-285-4445 or see the bottom of this page for a specified application.

This insurance program is not available to residents in all states.

You are Prepared to Practice ... But Are you Prepared for the Future?

Exclusive Simplified Issue Disability Income Insurance

Accidents can and do happen. If you suffer a disabling Injury, the financial security you've worked to build could be put at risk. As a member of ACEP, you are able to join an exclusive disability insurance program to help cover your income in the event a covered Injury or Sickness keeps you from working.

Simplified Issue Disability Insurance Features:

Up to $4,000 not to exceed 70% of Pre-Disability Earnings in $500 increments. The minimum benefit is $1,000
Available to members under age 60
Only 3 Medical Questions to apply
Minimum Monthly Benefit Amount: $1,000
Maximum Monthly Benefit Amount: $4,000

Eligibility

All Active ACEP Members who are under age 60 and citizens or legal residents of the United States, its territories and protectorates, and Actively-at-Work on a full-time basis (at least 30 hours per week) for four consecutive weeks and are not covered under a related ACEP disability policy with The Hartford1.

Policy Age Limit: Age 65

Maximum Payment Period:
-Up to age 65 for a covered Injury
-Up to three years for a covered Sickness
-Up to two years for Total Disability caused by Mental Illness, Alcoholism, or Substance Abuse

Two Options:

Option 1 Elimination Period: 60 days
Option 2 Elimination Period: 90 days

Offset Provision

This policy does contain an Offset Provision, which means the Total Disability benefit amount payable will be your selected Monthly Benefit minus any Other Income Benefits. In addition, your benefit cannot exceed 70% of your Pre-Disability Earnings.

Other Income Benefits includes any benefits you are eligible for or that are paid to you or a third party on your behalf, for: Workers’ Compensation, employer or government plan, “no-fault” automobile insurance or Social Security.

This example is for purposes of illustrating the effect of the benefit reductions and is not intended to reflect the situation of a particular claimant under the Policy:

Offset Provision Example:

Insured's Monthly Pre-Disability Earnings $3,000
Long Term Disability Benefits Percentage x70%
Unreduced Maximum Benefit Per Month $2,100
Less Social Security Disability Benefit Per Month $900
Less State Disability Income Benefit Per Month $300
Total Amount of Long Term Disability Benefit Per Month $900


Effective Date:

Your coverage will become effective the first of the month following receipt of your approved application and first premium payment. If evidence of insurability is required, your coverage will be effective on the first day of the month or next following the date we determine you are insurable.

Deferred Effective Date:

Coverage will not begin until the first day of the month on or next following the date you are Actively-at-Work for 3 month(s).

Explanation of Terms

Injury means bodily Injury that results directly and independently of all other causes from an accident within 180 days of accident.

Total Disability means a disability that prevents you from performing one or more of the duties of your usual occupation.

Elimination Period means the number of consecutive days at the beginning of any on period of Total Disability which must elapse before benefits are payable.

Pre-existing Condition means any Disability, diagnosed or undiagnosed, for which medical care is received by you within the 24 month(s) period prior to the date your insurance starts, or with respect to the limitation for any increase in coverage, within the 24 month(s) period prior to the effective date of your increase in coverage.

Pre-Disability Earnings means for self-employed physicians they are your average net monthly income (gross revenues less business expenses) from your practice or main business based on either 12 or 24 months average. Whichever produces the higher average. If you were self-employed for less than 12 months, it is based on the whole time you were self-employed. If your practice is incorporated, net income includes the cost to your company of fringe benefits and your share of the surplus. Income does not include investment returns, rents, royalties, and the like income which is not directly produced from your current work.
If you are not self-employed, Pre-disability Earnings means your regular monthly rate of pay, not counting commissions, bonuses, tips and tokens, overtime pay or any other fringe benefits or extra compensation, in effect on the date immediately prior to the last day you were actively at work before you became disabled.

Disabled and Working Benefits a Disability that continues while you are performing at least one of the material duties of your own occupation on either a full-time or part-time basis, causes a loss of earnings of at least 20% (and less than 80%), and requires the regular care of a Physician. A disability that causes a loss of earnings of 80% or more is considered to be a Total Disability and will be payable under the Total Disability Benefit.

If you are Disabled and Working, we will pay a Monthly Benefit for each month you are Disabled. The Disability must begin before you attain age 60 and while you are covered under this benefit. Payment will begin once you have been Disabled and Working and have satisfied the Elimination Period.

We will not pay for any part of a period that you are Disabled and Working that exceeds the Maximum Payment Period for this Benefit for any one Injury or any one Sickness.

Recurrent Disability:

If you cease to be Totally Disabled and return to work for a total of 14 days or less during the Elimination Period, the Elimination 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.

Periods of Disability:

Periods of disability due to the same or related medical causes and separated by fewer than six months while you are Actively-at-Work are considered a single period of disability. This means you won't have to satisfy a new elimination period before qualifying for benefits should you relapse upon returning to active employment after receiving benefits for a disability. You would only receive the remainder of the existing benefit period for that disability.

Benefits will not be paid during a period of Total Disability that is applied to the Elimination Period. The Elimination Period and Maximum Payment Period apply separately to each period of Total Disability.

Termination:

Your coverage will end on the day you attain age 65, cease to be an active member of ACEP, cease to be Actively-at-Work, except for Total Disability under the Policy, do not pay your premium when due or the Policy terminates.

Two Elimination Period Options: 60 Days and 90 Days.

Elimination Period means the number of consecutive days at the beginning of any period of Total Disability which must elapse before benefits are payable.

 

Individual Monthly Disability Premiums
$1,000 Monthly Benefit Amount
  60 Day Elimination Period 90 Day Elimination Period
Under 30 $11.15 $8.47
30-34 $12.43 $9.37
35-39 $15.26 $11.11
40-44 $19.78 $14.29
45-49 $25.28 $18.73
50-54 $33.74 $26.24
55-59 $42.21 $35.58
*60-64 $56.24 $49.95


*Renewal Premiums Only

Rates and/or benefits may be changed on a class basis. Rates are based on the attained age of the insured Person and increase as you enter each new age category.

Your rate may vary by a few cents due to rounding. Please refer to the Schedule of Benefits for your actual rate.

What are the Exclusions?

The Policy does not cover any Disability or loss caused by intentionally self inflicted Injury, suicide or attempted suicide, while sane or insane, or pregnancy or childbirth, except Complications of Pregnancy, or war or act of war, whether declared or not, or any Sickness or Injury for which workers' compensation benefits are paid, or may be paid, if duly claimed, or any Injury sustained while riding on, boarding or alighting from, any aircraft: a) as a pilot, crew member or student pilot; b) 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 c) being used for tests, experimental purposes, stunt flying, racing or endurance tests, or your commission or attempted commission of a felony, or Sickness contracted or Injury sustained while on full-time active duty as a member of the Armed Forces (land, water, 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.

Acceptance into this plan is subject to medical evidence of insurability as determined by The Hartford. Depending on your age, the amount of coverage you request, and your answers on the application, a medical examination, medical test(s), or other evidence of good health may be required. Any exams/tests requested by the company will be conducted at your convenience and at no expense to you.

This website explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

Need more coverage?

Call us today! 1-877-285-4445
You have 30 days from your effective date of coverage to look over the program and discuss with your family and advisors. If you are not satisfied, you may return your Certificate within 30 days for a full premium refund, less any claims paid.

Privacy Policy
MIB Notice

Print a PDF, complete application and fax to 605-444-7017.

Attention CA and NY residents: You cannot apply online, instead please utilize the following PDF applications:
California Residents: Click Here
New York Residents: Click Here

This policy provides disability income insurance only. It does NOT provide basic medical or major medical insurance as definced by the New York Department of Financial Services.

Underwritten by:
Hartford Life and Accident Insurance Company,
Hartford, CT 06155

Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

1The Hartford® is The Hartford Financial Services Group, Inc., and its
subsidiaries, including issuing company Hartford Life and Accident Insurance Company.

Disability Income Insurance Plan

Free 30-day look!

Questions?

Calculate Your Premium!

ATTENTION: If applying for Life or Disability as a California or New York resident please contact HBI at 877-285-4445 or see the bottom of this page for a specified application.

This insurance program is not available to residents in all states.

Help Protect Your Most Valuable Asset: Your Ability to Earn a Living

An Injury or Sickness that results in disability could keep you from working for months. Your major medical insurance may cover much of your hospital and physician expenses, but how would you replace your income? Disability Income Insurance can help protect your income so you can continue to pay bills for your home and your children's education.

Are you wondering when to purchase your Disability Income Insurance plan?
Today! Because premium and policy eligibility are based on age and health status, the best time to buy a Disability Income Insurance policy is when you're young and healthy. This policy includes a Pre-Existing Condition Limitation.

Eligibility

All members of ACEP under age 65, residing in the United States and Actively-at-Work at least 30 hours per week are eligible to apply for coverage.

Benefits

Thanks to your membership in the American College of Emergency Physicians, you now have the opportunity to apply for a Disability Income Insurance plan from Hartford Life and Accident Insurance Company at reasonable group rates. Disability Income Insurance will partially replace your income for a covered Sickness or Injury up to $10,000 a month depending on your Pre-Disability Earnings! Your plan will provide you with these valuable benefits:

Up to Age 65
$10,000 per monthly benefit
Occupation-specific
Affordable group rates
Partial Disability Benefit
Residual Disability Benefit
Waiver of Premium during Total Disability
Minimum Monthly Benefit Amount: $500
Maximum Monthly Benefit Amount: $10,000

Offset Provision

Offset Provision means that the benefit amount payable as the result of your Total Disability will be the lesser of the Monthly Benefit Amount or the Monthly Benefit Amount minus any Other Income Benefits. Other Income Benefits includes any benefits you are eligible for or that are paid to you or a third party on your behalf, for: Workers’ Compensation, employer or government plan, “no-fault” automobile insurance or Social Security.

Benefit cannot exceed 60% of Pre-Disability Earnings.

Offset Provision Example
This example is for purposes of illustrating the effect of the benefit reductions and is not intended to reflect the situation of a particular claimant under the Policy.onthly Rates per $100 of Monthly Benefit

Insured's Monthly Pre-Disability Earnings                 $3,000
Long Term Disability Benefits Percentage                 x60%
Unreduced Maximum Benefit                $1,800
Less Social Security Disability Benefit Per Month                $900
Less State Disability Income Benefit Per Month                $300
Total of Disability Income Benefit Per Month                $600
Plan I          Up to Age 65

 

Insured's Age 90-Day Elimination Period 180- Day Elimination Period 365 Day Elimination Period
Under 30 $1.02 $0.82 $0.70
30-34 $1.60 $1.28 $1.09
35-39 $2.19 $1.76 $1.49
40-44 $3.19 $2.56 $2.17
45-49 $3.92 $3.14 $2.67
50-54 $8.10 $6.28 $5.34
55-59 $9.56 $7.37 $6.26
60-64 $12.81 $9.97 $8.47

 

Elimination Periods
Elimination Period means the number of consecutive days at the beginning of any one period of Total Disability which must elapse before benefits are payable.


Payment Period Elimination Period
Plan I - To Age 65 Plan:
For Total Disability Beginning:
a. Before Age 63 To Age 65 90, 180 or 365 days
b. Age 63 or over, but under 65 2 Years 90, 180 or 365 days
Plan II - 5 Year Plan:
For Total Disability beginning:
a. Before Age 63 5 Years 30, 90 or 365 days
b. Age 63 or over, but under 65: 2 Years 30, 90 or 365 days
Rates are based on the attained age of the Insured person and increase as you enter each new age category.
Rates and/or benefits may be changed on a class basis

Explanation of Terms
Pre-Disability Earnings means the 12 month average of your regular monthly rate of pay, not including commissions, bonuses, overtime pay or any other fringe benefit or extra compensation, with such 12 month period ending on the last day of Active employment prior to becoming Disabled.
Injury means bodily Injury that results directly and independently of all other causes from an accident within 180 days of accident.
Total Disability means a disability that prevents you from performing one or more of the duties of your usual occupation.
Effective Date:
Your coverage will become effective on the first day of the month after your application is approved and you pay the first premium. If you are not Actively-at-Work on that date, your coverage will not become effective until you are once again Actively-at-Work.

Exclusions:

The Policy does not cover, and we will not pay a benefit for any Disability:

unless you are under the regular care of a Physician;
that is caused or contributed to by war or act of war (declared or not);
caused by your commission of or attempt to commit a felony;
caused or contributed to by your being engaged in an illegal occupation;
caused or contributed to by an intentionally self inflicted Injury; or
Sickness contracted or Injury sustained while on full-time active duty as a member of the Armed Forces (land, water, air) of any country or international authority.
Pre-Existing Condition Limitation:
Benefits are not paid for any Disability resulting from a Pre-Existing Condition until you have not received medical care for the condition for one year while covered under the plan, or you have been covered for two years.

Termination:

Your coverage will end on the day you attain age 65, cease to be an active member of ACEP, do not pay your premium when due, or the Policy terminates.

Waiver of Premium:
Once you have satisfied the Elimination Period and begin receiving Disability benefits, your premium will be waived for as long as your benefits are payable.

Print a PDF, complete application and mail to Hagan Barron Intermediaries P.O. Box 1889 Sioux Falls, SD 57101

Attention CA and NY residents: You cannot apply online at this time, instead please utilize the following PDF applications:

California Residents: Click Here
New York Residents: Click Here

Most people wouldn't dream of leaving their home, cars, boats or other valuables uninsured, but few think to insure their loss of income. It's too late to do anything about it once you've become disabled. That's why it's so important to safeguard your income now - while you're healthy and active.

You have 30 days from your effective date of coverage to look over the program and discuss with your family and advisors. If you are not satisfied, you may return your Certificate within 30 days for a full premium refund, less any claims paid.

Privacy Policy
MIB Notice

Acceptance into this plan is subject to medical evidence of insurability as determined by Hartford Life and Accident Insurance Company. Depending on your age, the amount of coverage you request, and your answers on the application, a medical examination, medical test(s), or other evidence of good health may be required. Any exams/tests requested by the company will be conducted at your convenience and at no expense to you.

This website explains the general purpose of the insurance described, but in no way changes or affects the Master Policy AGP-5683 as actually issued. In the event of a discrepancy between this website and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York Department of Financial Services.

 

 

Underwritten by:
Hartford Life and Accident Insurance Company
Hartford, CT 06155

Disability Form Series includes GBD-1000, GBD-1200, or state equivalent.

 

 

1The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.