Simplified Issue Disability Income Insurance Plan

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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


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  x 70%
Unreduced Maximum Benefit   $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.


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.

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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.