READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and Standard Insurance Company. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland, Oregon 97204 000-000-0000 xxx.xxxxxxxx.xxx STANDARD INSURANCE COMPANY By J. Xxxx Xxxx Xxxxxx X. Xxxxxxxx President Corporate Secretary ICC17-B180(07/17) TABLE OF CONTENTS Assignment 19 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 Total Disability 4 Claims Claim Forms 11 Notice of Claim 11 Payment of Claims 13 Proof of Loss 11 Time of Payment 12 Concurrent Disability 9 DEFINITIONS 20 Exclusions and Limitations 8 Pre-Existing Conditions 10 General Provisions 17 Grace Period 14 Owner 22 Policy Data 3 Policy Termination 15 Premiums Schedule of 3 In General 14 Recurrent Disability 9 Reinstatement 14 Renewal Option After The Termination Date 16 Suspension During Military Service 15 Time Limit On Certain Defenses 18 This refers to the number of days after the start of your disability before you are eligible to receive a disability payment. POLICY DATA Insured Policy Effective Date Owner at Issue [XXXX XXX] [July 2, 2016] [The Insured] [00C9999990][35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Gender PREMIUM SUMMARY Annual Premium Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.50] Riders $[988.51] Net Annual Premium: $[2,280.61]{*} [Mode of Premium Payment: [Special Monthly] Amount: $199.55] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.60] Difference between net annual premium and total [Special Monthly] payments: $[113.99]] {*The Net Annual Premium reflects the following discount(s): [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 10%]} [NONCANCELABLE / GUARANTEED RENEWABLE POLICY] BASIC POLICY BENEFITS ([To Age 67]) Commencement Date [91st] day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17) Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection are available through our wide range of optional riders. Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months] ADDED BENEFITS Amount Annual Premium Rider Of Benefits Prior to Age [67] Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] [$293.24] Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026] Basic Residual Disability Rider [$185.40] Enhanced Residual Disability Benefit Rider [$xx.xx] Short Term Residual Disability Benefit Rider [$xx.xx] Own Occupation Benefit Rider [$160.97] {Total Premium for Riders [$988.51]} {* Premium included in base policy premium and any applicable rider premium.} {** Payable to expiration date.} If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers to your occupation at the time you become disabled. This section also defines regular occupation for specialized physicians and dentists. For example, a presumptive disability could be the total and permanent loss of hearing in both ears. You don’t have to satisfy a benefit waiting period before receiving benefits for a presumptive disability. As you’re recuperating from a disability, you can receive help to return to work full-time. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expenses.
Appears in 2 contracts
Samples: www.standard.com, www.doctordisability.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and The Standard Life Insurance CompanyCompany of New York. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland000 Xxxxxxxxxxx Xxxxxx Xxxx Xxxxxxxx, Oregon 97204 Xxxxx 000 Xxxxx Xxxxxx, Xxx Xxxx 00000 (000-) 000-0000 xxx.xxxxxxxx.xxx THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK By J. Xxxx Xxxx Xxxxxx X. Xxxxxxxx XxXxxxxx President and CEO Xxxxxxx Xxxxxx Corporate Secretary ICC17-B180(07/17) B180GSI(9/16)NY TABLE OF CONTENTS Assignment 19 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 6 Total Disability 4 Claims Claim Forms 11 9 Notice of Claim 11 9 Payment of Claims 13 11 Proof of Loss 11 9 Time of Payment 12 10 Concurrent Disability 9 8 DEFINITIONS 20 18 Exclusions and Limitations 8 Pre-Existing Conditions 10 7 General Provisions 17 15 Grace Period 14 12 Owner 22 19 Policy Data 3 Policy Termination 15 13 Premiums Schedule of 3 In General 14 12 Recurrent Disability 9 8 Reinstatement 14 12 Renewal Option After The Termination Date 16 Date. 14 Suspension During Military Service 15 13 Time Limit On Certain Defenses 18 This refers to the number of days after the start of your disability before you are eligible to receive a disability payment. POLICY DATA 16 B180GSI(9/16)NY Insured Policy Effective Date Owner at Issue [XXXX XXX] [July 2, 2016] [The Insured] [00C9999990][3500C9999990] [35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Neutral Gender PREMIUM SUMMARY Annual Premium Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.50] Riders $[988.51] Net Annual Premium: $[2,280.61]{*} [Mode of Premium Payment: [Special Monthly] Amount: $199.55] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.60] Difference between net annual premium and total [Special Monthly] payments: $[113.99]] {*The Net Annual Premium reflects the following discount(s): [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 10%]} [NONCANCELABLE / GUARANTEED RENEWABLE POLICY] BASIC POLICY BENEFITS ([To Age 67]) Commencement Date [91st] day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17) Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection are available through our wide range of optional riders. Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months] ADDED BENEFITS Amount Annual Premium Rider Of Benefits Prior to Age [67] Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] [$293.24] Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026] Basic Residual Disability Rider [$185.40] Enhanced Residual Disability Benefit Rider [$xx.xx] Short Term Residual Disability Benefit Rider [$xx.xx] Own Occupation Benefit Rider [$160.97] {Total Premium for Riders [$988.51]} {* Premium included in base policy premium and any applicable rider premium.} {** Payable to expiration date.} If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers to your occupation at the time number of days that you become disabledmust be disabled before you are eligible to receive a disability benefit. This section also defines regular occupation for specialized physicians and dentists. For example, a presumptive disability could be the total and permanent loss of hearing in both ears. You don’t have to satisfy a benefit waiting period before receiving benefits for a presumptive disability. As you’re recuperating from a disability, you can receive help to return to work full-time. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expenses.PREMIUM SUMMARY
Appears in 1 contract
Samples: www.standard.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and The Standard Life Insurance CompanyCompany of New York. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland000 Xxxxxxxxxxx Xxxxxx Xxxx Xxxxxxxx, Oregon 97204 000Xxxxx 000 Xxxxx Xxxxxx, Xxx Xxxx 00000 (914) 989-000-0000 xxx.xxxxxxxx.xxx 4400 By THE STANDARD LIFE INSURANCE COMPANY By J. Xxxx Xxxx Xxxxxx X. Xxxxxxxx President Corporate Secretary ICC17-B180(07/17) OF NEW YORK B180AMR(9/16)NY TABLE OF CONTENTS Assignment 19 18 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 6 Total Disability 4 Claims Claim Forms 11 10 Notice of Claim 11 10 Payment of Claims 13 12 Proof of Loss 11 10 Time of Payment 12 11 Concurrent Disability 9 8 DEFINITIONS 20 19 Exclusions and Limitations 8 7 Pre-Existing Conditions 10 8 General Provisions 17 16 Grace Period 14 13 Owner 22 18 Policy Data 3 Policy Termination 15 14 Premiums Schedule of 3 In General 14 13 Recurrent Disability 9 8 Reinstatement 14 13 Renewal Option After The Termination Date 16 Date. 15 Suspension During Military Service 15 14 Time Limit On Certain Defenses 18 This refers to the number of days after the start of your disability before you are eligible to receive a disability payment. POLICY DATA 17 B180AMR(9/16)NY Insured Policy Effective Date Owner at Issue [XXXX XXX] [July 2, 2016] [The Insured] [00C9999990][3500C9999990] [35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Gender PREMIUM SUMMARY Annual Premium Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.50] Riders $[988.51] Net Annual Premium: $[2,280.61]{*} [Mode of Premium Payment: [Special Monthly] Amount: $199.55] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.60] Difference between net annual premium and total [Special Monthly] payments: $[113.99]] {*The Net Annual Premium reflects the following discount(s): [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 10%]} [NONCANCELABLE / GUARANTEED RENEWABLE POLICY] BASIC POLICY BENEFITS ([To Age 67]) Commencement Date [91st] day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17) Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection are available through our wide range of optional riders. Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months] ADDED BENEFITS Amount Annual Premium Rider Of Benefits Prior to Age [67] Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] [$293.24] Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026] Basic Residual Disability Rider [$185.40] Enhanced Residual Disability Benefit Rider [$xx.xx] Short Term Residual Disability Benefit Rider [$xx.xx] Own Occupation Benefit Rider [$160.97] {Total Premium for Riders [$988.51]} {* Premium included in base policy premium and any applicable rider premium.} {** Payable to expiration date.} If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers to the number of days after the start of your occupation at the time disability before you become disabledare eligible to receive a disability payment. This section also defines regular occupation for specialized physicians and dentists. For example, a presumptive disability could be the total and permanent loss of hearing in both ears. You don’t have to satisfy a benefit waiting period before receiving benefits for a presumptive disability. As you’re recuperating from a disability, you can receive help to return to work full-time. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expenses.PREMIUM SUMMARY
Appears in 1 contract
Samples: www.standard.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and The Standard Life Insurance CompanyCompany of New York. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland000 Xxxxxxxxxxx Xxxxxx Xxxx Xxxxxxxx, Oregon 97204 000Xxxxx 000 Xxxxx Xxxxxx, Xxx Xxxx 00000 (914) 989-000-0000 xxx.xxxxxxxx.xxx 4400 By THE STANDARD LIFE INSURANCE COMPANY By J. Xxxx Xxxx Xxxxxx X. Xxxxxxxx President Corporate Secretary ICC17-B180(07/17) OF NEW YORK B180GSI(9/16)NY We want you to be satisfied with the policy we deliver to you. If you decide within 30 days that you don’t want the policy, we’ll cancel it with no questions asked and refund your premium. TABLE OF CONTENTS Assignment 19 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 6 Total Disability 4 Claims Claim Forms 11 9 Notice of Claim 11 9 Payment of Claims 13 11 Proof of Loss 11 9 Time of Payment 12 10 Concurrent Disability 9 8 DEFINITIONS 20 18 Exclusions and Limitations 8 Pre-Existing Conditions 10 7 General Provisions 17 15 Grace Period 14 12 Owner 22 19 Policy Data 3 Policy Termination 15 13 Premiums Schedule of 3 In General 14 12 Recurrent Disability 9 8 Reinstatement 14 12 Renewal Option After The Termination Date 16 Date. 14 Suspension During Military Service 15 13 Time Limit On Certain Defenses 18 16 B180GSI(9/16)NY This refers to the number of days after the start of your disability that you must be disabled before you are eligible to receive a disability paymentbenefit. POLICY DATA Insured Policy Effective Date Owner at Issue [XXXX XXX] [00C9999990] Policy Number Policy Effective Date [July 2, 2016] [35] Issue Age Owner at Issue [The Insured] [00C9999990][35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Neutral Gender PREMIUM SUMMARY Annual Premium Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.501,960.50] Riders $[988.511,201.00] Net Annual Premium: $[2,280.612,371.13]{*} * [Mode of Premium Payment: [Special Monthly] Amount: $199.55[ 207.47] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.602,489.64] Difference between net annual premium and total [Special Monthly] payments: $[113.99[ 118.51]] {*The Net Annual Premium reflects a discount of [25]%. This is the following discount(s): [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 10%]} maximum amount of time we will pay benefits under your policy. [NONCANCELABLE / GUARANTEED RENEWABLE POLICY] BASIC POLICY BENEFITS ([To Age 67]) Commencement Date [91st] day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17) B180GSI(9/16)NY Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection are available through our wide range of optional riders. POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months 68 24 months 69 21 months 70 18 months 71 16months 72 15 months 73 14 months 74 13 months 75 or older 12 months] ADDED BENEFITS Amount Annual Premium Rider Of Benefits Prior to Age [67] Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] [$293.24428.66] Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026166.00] Basic Residual Disability Rider [$185.40235.26] Enhanced Residual Disability Benefit Rider [$$ xx.xx] Short Term Residual Disability Benefit Rider [$xx.xx] Own Occupation Benefit Rider [$160.97371.08] Regular Occupation Extension Rider [$xx.xx] OTHER {Mental Disorder/Substance Abuse Limitation * } {Total Premium for Riders and Other [$988.511,201.00]} {* Premium included in base policy premium and any applicable rider premium.} {** Payable to expiration date.} If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers to your occupation at the time you become disableddisabled as stated in the policy. This section also defines regular occupation for specialized physicians and dentists. For exampleIf you are presumptively disabled, a presumptive you can continue to work and earn an income and still be eligible for disability could be benefits. Presumptively disabled may refer to the total and permanent loss of hearing in both ears, for example. You don’t have to satisfy a benefit waiting period before receiving benefits for a presumptive disability. As you’re recuperating from a disability, you can receive help to return to work full-timetime by participating in a rehabilitation program that is approved by us. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expenses. Specialists (AOABOS) or American Dental Association (ADA), then that specialty will be deemed your Regular Occupation. If you are unemployed at the time Disability begins, then the last occupation in which you worked at least 30 hours per week will be deemed your Regular Occupation. If you are retired at the time Disability begins, then being retired will be deemed your Regular Occupation.
Appears in 1 contract
Samples: www.standard.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and Standard Insurance Company. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland, Oregon 97204 000800-000247-0000 6888 xxx.xxxxxxxx.xxx STANDARD INSURANCE COMPANY By J. Xxxx Xxxx Xxxxxx X. Xxxxxxxx President Corporate Secretary ICC17-B180(07/17) TABLE OF CONTENTS Assignment 19 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 Total Disability 4 Claims Claim Forms 11 Notice of Claim 11 Payment of Claims 13 Proof of Loss 11 Time of Payment 12 Concurrent Disability 9 DEFINITIONS 20 Exclusions and Limitations 8 Pre-Existing Conditions 10 General Provisions 17 Grace Period 14 Owner 22 Policy Data 3 Policy Termination 15 Premiums Schedule of 3 In General 14 Recurrent Disability 9 Reinstatement 14 Renewal Option After The Termination Date 16 Suspension During Military Service 15 Time Limit On Certain Defenses 18 This refers to the number of days after the start of your disability before you are eligible to receive a disability payment. POLICY DATA Insured Policy Effective Date Owner at Issue [XXXX XXX] [July 2, 2016] [The Insured] [00C9999990][35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Gender PREMIUM SUMMARY Annual Premium Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.50] Riders $[988.51] Net Annual Premium: $[2,280.61]{*} [Mode of Premium Payment: [Special Monthly] Amount: $199.55] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.60] Difference between net annual premium and total [Special Monthly] payments: $[113.99]] {*The Net Annual Premium reflects the following discount(s): [Multi-Life Discount 10%] [Preferred Occupation Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 10%]} [NONCANCELABLE / GUARANTEED RENEWABLE POLICY] BASIC POLICY BENEFITS ([To Age 67]) Commencement Date [91st] day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17) Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection are available through our wide range of optional riders. Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months] ADDED BENEFITS Amount Annual Premium Rider Of Benefits Prior to Age [67] Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] [$293.24] Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 1,500 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026] Basic Residual Disability Rider [$185.40] Enhanced Residual Disability Benefit Rider [$xx.xx] Short Term Residual Disability Benefit Rider [$xx.xx] Own Occupation Benefit Rider [$160.97] {Total Premium for Riders [$988.51]} {* Premium included in base policy premium and any applicable rider premium.} {** Payable to expiration date.} If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers to your occupation at the time you become disabled. This section also defines regular occupation for specialized physicians and dentists. For example, a presumptive disability could be the total and permanent loss of hearing in both ears. You don’t have to satisfy a benefit waiting period before receiving benefits for a presumptive disability. As you’re recuperating from a disability, you can receive help to return to work full-time. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expenses.
Appears in 1 contract
Samples: www.standard.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and Standard Insurance Company. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland, Oregon 97204 000800-000247-0000 xxx.xxxxxxxx.xxx 6888 xxx.xxxxxxxx.xxx] STANDARD INSURANCE COMPANY By J. Xxxx Xxxx FL: (Noncancelable policy): For a noncancelable policy, this section will be replaced with new language that states the policy is noncancelable and guaranteed renewable to age 65 or 67. We can’t change the policy or its premium. FL: (Guaranteed Renewable policy): Before that date we can change the premium only if the change applies to all policies with like benefits insuring the same risk class. We will notify you in writing at least 45 days prior to any change in premium. MT: (Guaranteed Renewable policy): We will not increase the premium more than once during any 12-consecutive- month period, except as allowed by state law. Xxxxxx X. Xxxxxxxx XxXxxxxx President and CEO Xxxxxxxxx X. Xxxxx Corporate Secretary ICC17-B180(07/17B180GSI(7/17) TABLE OF CONTENTS Assignment 19 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 Total Disability 4 Claims Claim Forms 11 Notice of Claim 11 Payment of Claims 13 Proof of Loss 11 Time of Payment 12 Concurrent Disability 9 DEFINITIONS 20 Exclusions and Limitations 8 Pre-Existing Conditions 10 General Provisions 17 Grace Period 14 Owner 22 Policy Data 3 Policy Termination 15 Premiums Schedule of 3 In General 14 Recurrent Disability 9 Reinstatement 14 Renewal Option After The Termination Date Date. 16 Suspension During Military Service 15 Time Limit On Certain Defenses 18 B180GSI(7/17) Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. This refers to the number of days after the start of your disability that you must be disabled before you are eligible to receive a disability paymentbenefit. This is the maximum amount of time we will pay benefits under your policy. POLICY DATA Insured Policy Effective Date Owner at Issue [XXXX XXX] [00C9999990] Policy Number Policy Effective Date [July 2, 2016] [35] Issue Age Owner at Issue [The Insured] [00C9999990][35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Neutral Gender PREMIUM SUMMARY Annual Premium Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.501,960.50] Riders $[988.511,201.00] Net Annual Premium: $[2,280.612,371.13]{*} * [Mode of Premium Payment: [Special Monthly] Amount: $199.55[ 207.47] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.602,489.64] Difference between net annual premium and total [Special Monthly] payments: $[113.99[ 118.51]] {*The Net Annual Premium reflects the following discount(s): a discount of [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 10%]} 25]%. [NONCANCELABLE / GUARANTEED RENEWABLE POLICY] BASIC POLICY BENEFITS ([To Age 67]) Commencement Date [91st] day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17B180GSI(7/17) Page 3 Many additional forms of income protection are available through our wide POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection are available through our wide range of optional riders. Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months 68 24 months 69 21 months 70 18 months 71 16months 72 15 months 73 14 months 74 13 months 75 or older 12 months] ADDED BENEFITS range of optional riders. Rider Amount Annual Premium Rider Of Benefits Prior to Age [67] FL: Noncancelable policy provisions are incorporated Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] [$293.24428.66] Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026166.00] Basic Residual Disability Rider [$185.40235.26] Enhanced Residual Disability Benefit Rider [$$ xx.xx] Short Term Residual Disability Benefit Rider [$xx.xx] Own Occupation Benefit Rider [$160.97371.08] Regular Occupation Extension Rider [$xx.xx] OTHER {Mental Disorder/Substance Abuse Limitation * } {Total Premium for Riders and Other [$988.511,201.00]} {* Premium included in base policy premium and any applicable rider premium.} {** Payable to expiration date.} If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. into the base policy form rather than attached as a rider. FL: For the first 12 months of disability, you may be engaged in another job or occupation for wage or profit and still be considered totally disabled. After the first 12 This refers to your occupation at the time you become disableddisabled as stated in the policy. This section also defines regular occupation for specialized physicians and dentists. For exampleIf you are presumptively disabled, a presumptive you can continue to work and earn an income and still be eligible for disability could be benefits. Presumptively disabled may refer to the total and permanent loss of hearing in both ears, for example. You don’t have to satisfy a benefit waiting period before receiving benefits for a presumptive disability. As you’re recuperating from a disability, you can receive help to return to work full-timefull- time by participating in a rehabilitation program that is approved by us. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expenses. Specialists (AOABOS) or American Dental Association (ADA), then that specialty will be deemed your Regular Occupation. If you are unemployed at the time Disability begins, then the last occupation in which you worked at least 30 hours per week will be deemed your Regular Occupation. If you are retired at the time Disability begins, then being retired will be deemed your Regular Occupation.
Appears in 1 contract
Samples: www.standard.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and Standard Insurance Company. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland, Oregon 97204 000800-000247-0000 xxx.xxxxxxxx.xxx 6888 xxx.xxxxxxxx.xxx] STANDARD INSURANCE COMPANY By J. Xxxx Xxxx Xxxxxx X. Xxxxxxxx XxXxxxxx President and CEO ICC17-B180GSI(07/17) Xxxxxxxxx X. Xxxxx Corporate Secretary ICC17-B180(07/17) We want you to be satisfied with the policy we deliver to you. If you decide within 30 days that you don’t want the policy, we’ll cancel it with no questions asked and refund your premium. TABLE OF CONTENTS Assignment 19 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 Total Disability 4 Claims Claim Forms 11 Notice of Claim 11 Payment of Claims 13 Proof of Loss 11 Time of Payment 12 Concurrent Disability 9 DEFINITIONS 20 Exclusions and Limitations 8 Pre-Existing Conditions 10 General Provisions 17 Grace Period 14 Owner 22 Policy Data 3 Policy Termination 15 Premiums Schedule of 3 In General 14 Recurrent Disability 9 Reinstatement 14 Renewal Option After The Termination Date 16 Suspension During Military Service 15 Time Limit On Certain Defenses 18 ICC17-B180GSI(07/17) This refers to the number of days after the start of your disability that you must be disabled before you are eligible to receive a disability paymentbenefit. POLICY DATA Insured Policy Effective Date Owner at Issue [XXXX XXX] [00C9999990] Policy Number Policy Effective Date [July 2, 2016] [35] Issue Age Owner at Issue [The Insured] [00C9999990][35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Neutral Gender PREMIUM SUMMARY Annual Premium Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.501,960.50] Riders $[988.511,201.00] Net Annual Premium: $[2,280.612,371.13]{*} * [Mode of Premium Payment: [Special Monthly] Amount: $199.55[ 207.47] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.602,489.64] Difference between net annual premium and total [Special Monthly] payments: $[113.99[ 118.51]] {*The Net Annual Premium reflects a discount of [25]%. This is the following discount(s): [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 10%]} maximum amount of time we will pay benefits under your policy. [NONCANCELABLE / GUARANTEED RENEWABLE POLICY] BASIC POLICY BENEFITS ([To Age 67]) Commencement Date [91st] day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17B180GSI(07/17) Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection are available through our wide range of optional riders. POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months 68 24 months 69 21 months 70 18 months 71 16months 72 15 months 73 14 months 74 13 months 75 or older 12 months] ADDED BENEFITS Rider Amount Of Benefits Annual Premium Rider Of Benefits Prior to Age [67] Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] [$293.24428.66] Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026166.00] Basic Residual Disability Rider [$185.40235.26] Enhanced Residual Disability Benefit Rider [$$ xx.xx] Short Term Residual Disability Benefit Rider [$xx.xx] Own Occupation Benefit Rider [$160.97371.08] Regular Occupation Extension Rider [$xx.xx] OTHER {Mental Disorder/Substance Abuse Limitation * } {Total Premium for Riders and Other [$988.511,201.00]} {* Premium included in base policy premium and any applicable rider premium.} {** Payable to expiration date.} If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers ICC17-B180GSI(07/17) Page 3A INTRODUCTION We agree to your occupation at pay benefits according to the time terms of this policy if you become disabled. This section also defines regular occupation Disabled while this policy is in force and you give us Proof Of Loss for specialized physicians and dentists. For example, a presumptive disability could be the total and permanent loss of hearing in both ears. You don’t have to satisfy a benefit waiting period before receiving any benefits for which you submit a presumptive disabilityclaim. As In this policy you’re recuperating from a disability, /your mean the Insured; we/us/our mean Standard Insurance Company. Other defined terms have initial capital letters and are defined in the DEFINITIONS section or in the provisions in which they first appear and to which they primarily pertain. Disability/Disabled means that you can receive help to return to work full-timeare Totally Disabled. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expensesDisability Benefit / Disability Benefits means any benefit payment or payments for Total Disability that are made under this policy.
Appears in 1 contract
Samples: www.standard.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and The Standard Life Insurance CompanyCompany of New York. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland000 Xxxxxxxxxxx Xxxxxx Xxxx Xxxxxxxx, Oregon 97204 000Xxxxx 000 Xxxxx Xxxxxx, Xxx Xxxx 00000 (914) 989-000-0000 xxx.xxxxxxxx.xxx 4400 THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK By J. Xxxx Xxxx Xxxxxx X. Xxxxxxxx XxXxxxxx President and CEO Xxxxxxx Xxxxxx Corporate Secretary ICC17-B180(07/17) B180AMR(9/16)NY TABLE OF CONTENTS Assignment 19 18 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 6 Total Disability 4 Claims Claim Forms 11 10 Notice of Claim 11 10 Payment of Claims 13 12 Proof of Loss 11 10 Time of Payment 12 11 Concurrent Disability 9 8 DEFINITIONS 20 19 Exclusions and Limitations 8 7 Pre-Existing Conditions 10 8 General Provisions 17 16 Grace Period 14 13 Owner 22 18 Policy Data 3 Policy Termination 15 14 Premiums Schedule of 3 In General 14 13 Recurrent Disability 9 8 Reinstatement 14 13 Renewal Option After The Termination Date 16 Date. 15 Suspension During Military Service 15 14 Time Limit On Certain Defenses 18 This refers to the number of days after the start of your disability before you are eligible to receive a disability payment. POLICY DATA 17 B180AMR(9/16)NY Insured Policy Effective Date Owner at Issue [XXXX XXX] [July 2, 2016] [The Insured] [00C9999990][3500C9999990] [35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Gender PREMIUM SUMMARY Annual Premium Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.50] Riders $[988.51] Net Annual Premium: $[2,280.61]{*} [Mode of Premium Payment: [Special Monthly] Amount: $199.55] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.60] Difference between net annual premium and total [Special Monthly] payments: $[113.99]] {*The Net Annual Premium reflects the following discount(s): [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 10%]} [NONCANCELABLE / GUARANTEED RENEWABLE POLICY] BASIC POLICY BENEFITS ([To Age 67]) Commencement Date [91st] day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17) Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection are available through our wide range of optional riders. Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months] ADDED BENEFITS Amount Annual Premium Rider Of Benefits Prior to Age [67] Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] [$293.24] Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026] Basic Residual Disability Rider [$185.40] Enhanced Residual Disability Benefit Rider [$xx.xx] Short Term Residual Disability Benefit Rider [$xx.xx] Own Occupation Benefit Rider [$160.97] {Total Premium for Riders [$988.51]} {* Premium included in base policy premium and any applicable rider premium.} {** Payable to expiration date.} If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers to the number of days after the start of your occupation at the time disability before you become disabledare eligible to receive a disability payment. This section also defines regular occupation for specialized physicians and dentists. For example, a presumptive disability could be the total and permanent loss of hearing in both ears. You don’t have to satisfy a benefit waiting period before receiving benefits for a presumptive disability. As you’re recuperating from a disability, you can receive help to return to work full-time. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expenses.PREMIUM SUMMARY
Appears in 1 contract
Samples: www.standard.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and Standard Insurance Company. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland, Oregon 97204 000800-000247-0000 6888 xxx.xxxxxxxx.xxx STANDARD INSURANCE COMPANY By J. Xxxx Xxxx FL: (Noncancelable policy): For a noncancelable policy, this section will be replaced with new language that states the policy is noncancelable and guaranteed renewable to age 67. We can’t change the policy or its premium. Xxxxxx X. Xxxxxxxx XxXxxxxx President and CEO Xxxxxxxxx X. Xxxxx Corporate Secretary ICC17-B180(07/17B180(7/17) TABLE OF CONTENTS Assignment 19 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 Total Disability 4 Claims Claim Forms 11 Notice of Claim 11 Payment of Claims 13 Proof of Loss 11 Time of Payment 12 Concurrent Disability 9 DEFINITIONS 20 Exclusions and Limitations 8 Pre-Existing Conditions 10 General Provisions 17 Grace Period 14 Owner 22 Policy Data 3 Policy Termination 15 Premiums Schedule of 3 In General 14 Recurrent Disability 9 Reinstatement 14 Renewal Option After The Termination Date Date. 16 Suspension During Military Service 15 Time Limit On Certain Defenses 18 This refers to the number of days after the start of your disability before you are eligible to receive a disability payment. POLICY DATA Insured Policy Effective Date Owner at Issue [XXXX XXX] [July 2, 2016] [The Insured] [00C9999990][35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Gender PREMIUM SUMMARY Annual Premium B180(7/17) Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. This refers to the number of days that you must be disabled before you are eligible to receive a Insured Policy Effective Date Owner at Issue Termination Date Benefit Waiting Period POLICY DATA [XXXX XXX] [July 2, 2016] [ The Insured] [July 2, 2048] [90 Days] [0000000000] Policy Number [Non-Smoker] Risk Class [3P] Occupation Class [Female] Gender disability benefit. PREMIUM SUMMARY Annual Premium Base Policy $[1,545.501,553.06] Riders $[988.511,303.84] Net Annual Premium: $[2,280.61]{2,856.90*} [] Mode of Premium Payment: [Special Monthly] Amount: [$199.55249.98] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.602,999.76] Difference between net annual premium and total [Special Monthly] payments: $[113.99142.86]] {*The Net Annual Premium reflects the following discount(s): [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 15% 10%]} [% NONCANCELABLE / GUARANTEED RENEWABLE POLICY] POLICY BASIC POLICY BENEFITS ([To Age 67]) TO AGE 67 Commencement Date [91st] 91st day of Disability This is the maximum Basic Monthly Benefit $[5,000] amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] 67 – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17B180(7/17) Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C99999900000000000] Policy Number Many additional forms of income protection Some added benefits are available through our wide range of optional ridersincluded automatically under the GME program. Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months] months ADDED BENEFITS Others, such as the Student Loan Rider, are optional. Amount Annual Premium Rider Of Benefits Annual Premium Prior to Age [67] 67 FL: Noncancelable policy Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2October 13, 20362043] Automatic Increase Benefit Rider 0 Indexed Cost of Living Rider [3%] [6%] % [$293.24371.46] provisions are incorporated into the base policy form rather than attached as a rider. Catastrophic Disability Benefit Rider $[5,000.00] Per Month [$207.50174.04] Student Loan Rider [$141.40]** Maximum Monthly Student Loan Benefit: $[ 2,000 ] 2,500.00 [$225.37]** Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026] Basic Residual 90 days 10/13/2031 Applicants may choose to add a Student Loan Rider and/or Catastrophic Disability Rider [$185.40] Benefit Rider. Enhanced Residual Disability Benefit Rider Own Occupation Rider OTHER Pre-existing Conditions Limitation [$xx.xx280.23] Short Term Residual Disability Benefit Rider [$xx.xx252.74] Own Occupation Benefit Rider [$160.97] {* Total Premium for Riders and Other [$988.51]} {1,303.84] * Premium included in base policy premium and any applicable rider premium.} {. ** Payable to expiration date.} . If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers B180(7/17) Page 3A INTRODUCTION We agree to your occupation at pay benefits according to the time terms of this policy if you become disabled. This section also defines regular occupation Disabled while this policy is in force and you give us Proof Of Loss for specialized physicians and dentists. For example, a presumptive disability could be the total and permanent loss of hearing in both ears. You don’t have to satisfy a benefit waiting period before receiving any benefits for which you submit a presumptive disabilityclaim. As In this policy you’re recuperating from a disability, /your mean the Insured; we/us/our mean Standard Insurance Company. Other defined terms have initial capital letters and are defined in the DEFINITIONS section or in the provisions in which they first appear and to which they primarily pertain. Disability/Disabled means that you can receive help to return to work full-timeare Totally Disabled. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expensesDisability Benefit / Disability Benefits means any benefit payment or payments for Total Disability that are made under this policy.
Appears in 1 contract
Samples: www.standard.com
READ THIS POLICY CAREFULLY. It is a legal contract between the Owner and Standard Insurance Company. Pre-existing Condition limitations or exclusions and other limitations or exclusions may apply. The telephone number for the [XYZ] Department of Insurance is [xxx-xx-xxxx]. Signed at our Home Office 1100 S.W. Sixth Avenue Portland, Oregon 97204 000800-000247-0000 6888 xxx.xxxxxxxx.xxx STANDARD INSURANCE COMPANY By J. Xxxx Xxxx Xxxxxx X. Xxxxxxxx XxXxxxxx President Corporate Secretary and CEO ICC17-B180(07/17) Xxxxxxxxx X. Xxxxx Corporate Secretary TABLE OF CONTENTS Assignment 19 Benefits Family Care 6 Premium Waiver 6 Presumptive Disability 5 Rehabilitation Program 5 Survivor 8 Total Disability 4 Claims Claim Forms 11 Notice of Claim 11 Payment of Claims 13 Proof of Loss 11 Time of Payment 12 Concurrent Disability 9 DEFINITIONS 20 Exclusions and Limitations 8 Pre-Existing Conditions 10 General Provisions 17 Grace Period 14 Owner 22 Policy Data 3 Policy Termination 15 Premiums Schedule of 3 In General 14 Recurrent Disability 9 Reinstatement 14 Renewal Option After The Termination Date 16 Suspension During Military Service 15 Time Limit On Certain Defenses 18 Insured Policy Effective Date Owner at Issue [XXXX XXX] [July 2, 2016] [The Insured] [00C9999990][28] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4P] Occupation Class Benefit Waiting Period [90 days] [Male] Gender POLICY DATA This refers to the number of days after the start of your disability before you are eligible to receive a disability payment. POLICY DATA Insured Base Policy Effective Date Owner at Issue [XXXX XXX] [July 2, 2016] [The Insured] [00C9999990][35] [Non-Smoker] Policy Number Issue Age Risk Class Termination Date [July 2, 2048] [4A] Occupation Class Benefit Waiting Period [90 days] [Male] Gender Riders PREMIUM SUMMARY Annual Premium $[1,349.82] $[1,386.22] Our underwriting experts use risk and occupation class as factors in determining terms of coverage and premium rates. Base Policy $[1,545.50] Riders $[988.51] Net Annual Premium: $[2,280.61]{*} [Mode of Premium Payment: [Special Monthly] $[2,093.09]* Amount: $199.55183.15] There are four premium modes available. The total amount due over a policy year varies by the mode selected. The mode you chose is noted above. The total due over the policy year for this mode and the difference between that total and the net annual premium payment are noted below: Total of [Special Monthly] Premium Payments: $[2,394.602,197.80] Difference between net annual premium and total [Special Monthly] payments: $[113.99104.71]] {*The Net Annual Premium reflects the following discount(s): [Multi-Life Discount 10%] [Student/Resident Discount 10%] [Graduate Medical Education Discount 15%] [Business Owner Discount 10%] [Multi-Product Discount 5%] [Mental Disorder/Substance Abuse Limitation 15% 10%]} [% NONCANCELABLE / GUARANTEED RENEWABLE POLICY] POLICY BASIC POLICY BENEFITS ([To Age 67]) 67 Commencement Date [91st] 91st day of Disability This is the maximum amount of time we will pay benefits under your policy. Basic Monthly Benefit $[5,000] Maximum Benefit Period: [To Age 67] 67 – Determined by Your age when Disability begins; see Schedule of Maximum Benefit Periods on the next page. ICC17-B180(07/17) Page 3 POLICY DATA (CONTINUED) Insured [XXXX XXX] [00C9999990] Policy Number Many additional forms of income protection Some added benefits are available through our wide range of optional ridersincluded automatically under the GME program. Schedule of Maximum Benefit Periods Age When Disability Begins Maximum Benefit Period [61 or younger To age 67 62 60 months 63 48 months 64 42 months 65 36 months 66 30 months 67 24 months] ADDED BENEFITS Amount Annual Premium Others, such as the Student Loan Rider, are optional. Rider Of Benefits Prior to Age [67] Noncancelable Policy Rider * Benefit Increase Rider 0 Expiration Date: [July 2, 2036] Automatic Increase Benefit Rider 0 [Indexed Cost of Living Rider 3% ] Amount Of Benefits Annual Premium Prior to Age 67 * 0 [3%$364.04] [6%] [$293.24] Catastrophic Disability Benefit Rider $[5,000.00] Per Month Month] [$207.50198.50] [Student Loan Rider [$141.40205.74]** Maximum Monthly Student Loan Benefit: $[ 2,000 2,500 ] Student Loan Benefit Waiting Period: [ 90 ] days Student Loan Benefit Expiration Date: [July 2, 2026] Basic Residual Disability Rider [$185.40]] Enhanced Residual Disability Benefit Rider [$xx.xx284.84] Short Term Residual Disability Benefit Own Occupation Rider [$xx.xx183.75] Own Occupation Benefit Rider [$160.97] {OTHER Pre-existing Conditions Limitation * Total Premium for Riders and Other [$988.51]} {1,386.22] * Premium included in base policy premium and any applicable rider premium.} {. ** Payable to expiration date.} . If this policy was issued with an increased premium, exclusion or other modification, you may contact us if there are any changes to your health, occupation, avocation or other risk factor that might allow coverage to be continued without the modification. We will review the information you provide plus any other information available to us regarding all risk factors associated with you as of the time of our review. Using our underwriting rules and guidelines then in effect, we reserve the right to offer any change that we think is most appropriate, as well as the right to decline to make any change, regardless of whether the change in risk factor(s) is directly related to the reason for the policy modification. This refers ICC17-B180(07/17) Page 3A Applicants may choose to your occupation at the time you become disabled. This section also defines regular occupation for specialized physicians and dentists. For example, add a presumptive disability could be the total and permanent loss of hearing in both ears. You don’t have to satisfy a benefit waiting period before receiving benefits for a presumptive disability. As you’re recuperating from a disability, you can receive help to return to work full-time. We’ll pay the reasonable costs of a voluntary rehabilitation program, which may include workplace modifications, training and family care expensesStudent Loan Rider and/or Catastrophic Disability Benefit Rider.
Appears in 1 contract
Samples: www.standard.com
