Explanation Of Terms
|The accumulation period is shown in the schedule page. It is an uninterrupted period of consecutive days that begins on the first day that you are disabled and during which the elimination period must be satisfied.|
|Berkshire has one of the top disability insurance policies in the industry right now for professionals. Many professional associations throughout the country have endorsed the ProVider Plus policy for their membership. If an association has sponsored the company, any member of that association may purchase a disability insurance policy with a 10% discount. There are many state and local medical and dental associations throughout the United States that have endorsed the Company. However there are endorsements in a variety of professions, it is not limited to medical and dental associations. The Company has endorsements from such professional associations as accounting, film, optometric, and public relations. The agents in our office will work with you to identify whether or not an association you are affiliated with has an endorsement you can use to obtain a discounted premium.|
|Automatic Benefit Enhancement Rider|
|This rider is usually added to a disability insurance policy automatically by the underwriting department if there is no adverse medical history and you are not at the maximum amount of coverage for your occupation. It cannot be used if you choose a graded premium policy, and the future increase option rider and SIS benefit cannot take you above your maximum level of coverage either. The policy size must also be more than $1,000.
It provides a 4% annual benefit increase with premiums adjusted at attained age rates for five years. You have the ability to refuse any increase to keep your premiums level. If you refuse two increases inside of five years the rider will be removed from the policy. It is an excellent way to make sure your disability insurance benefits continue to grow with your income over the years. After five years you can apply to have the rider renewed for another five years with full underwriting.
|The benefit period is shown in the schedule page. It is the longest period of time for which Berkshire will pay benefits for a continuous disability from the same cause. Available benefit periods are 2 years, 5 years, 10 years, to age 65, and to age 67.|
|Catastrophic Rider (CAT)|
|This rider can provide a monthly benefit in addition to any other disability benefit payments under the policy if you are catastrophically disabled.
Catastrophic Disability or Catastrophically Disabled
Catastrophic Disability or Catastrophically Disabled means that, due to injury or sickness, you are:
• Unable to perform two or more of the activities of daily living without human standby assistance; or
• Cognitively impaired; or
• Irrecoverably disabled
Cognitive Impairment or Cognitively Impaired means you suffered a severe deterioration or loss in your cognitive capacity which requires Substantial Supervision to protect you or others from threats to health and safety.
Substantial supervision means the continual supervision by another person that may include physical assistance, cueing by verbal prompting, gestures, or other similar demonstrations.
Activities of Daily Living (ADL's) include:
|Cost of Living Adjustment Rider (COLA)|
|This is an optional rider you can choose to apply for with your policy. If you become disabled without this rider, your monthly benefit would never grow to keep pace with inflation. If your disability was resolved within a year, this would not be an issue. If your disability lasted longer than a year, then you would most likely want to have a COLA rider on your policy to make sure the monthly benefit continued to grow with inflation.
You can choose from one of three options, all of which have a guaranteed minimum adjustment of 3%; 3% Compound, 6% Maximum Compound, or the 4-Year Delayed COLA. Our agency is a proponent of the 4-Year Delayed COLA rider. It is the least expensive, and still provides excellent protection against inflation for a long term claim.
|Think of the elimination period as a deductible. It is the period of time that must elapse from the onset of a disability, before you are eligible to receive monthly benefits. The vast majority of disability insurance policies sold today use a 90 day elimination period; it has almost become an industry standard.
However, there are often good reasons to go with some of the other available choices. If you have short term disability protection already with a 6 month benefit, then you may want a 6 month elimination period on your person long term disability insurance policy so when one ends, the other begins. You may also not have enough savings to last 90 days until benefits begin, in which case you may want to go with a shorter elimination period like 30 or 60 days (even though it will be much more expensive to do so.).
Berkshire offers the following elimination period choices, just know the longer your elimination period is, the less expensive the policy is, and the more money you will need to risk with self insurance: 30 days, 60 days, 90 days, 180 days, 360 days and 720 days.
|Future Increase Option Rider|
|The Future Increase Option Rider allows you to apply for additional coverage each year until age 55 without additional medical underwriting. Financial eligibility will be determined by your income, employment, and all other disability insurance with any insurer that you own, have applied for, or for which you are eligible.|
|Graded Lifetime Indemnity for Total Disability Rider|
|This rider is available on policies that include a To Age 65 or To Age 67 benefit period. It may provide a monthly benefit that starts when the benefit period ends. If you are totally disabled at the end of the policy benefit period, the lifetime indemnity amount will be determined by your age when the last continuous, total disability began in the same claim.|
|Medical Specialty Language|
|The policy includes “specialty language” for physicians and dentists.
Your occupation is defined as the occupation, or occupations if more than one, in which you are engaged in at the time of disability.
If you have limited your occupation to the performance of the material and substantial duties of a single medical specialty, or to a single dental specialty, we will deem that specialty to be your occupation.
|It is the amount we will pay for each month of total disability.|
|Non-Cancellable & Guaranteed Renewable To The Expiration Date|
|You may renew this policy at the end of each premium term until the expiration date. During that time, We cannot change the premium or cancel the policy.|
|Own-Occupation (Definition of Total Disability or Totally Disabled)|
|Total Disability or Totally Disabled means that, solely due to injury or sickness, you are not able to perform the material and substantial duties of your occupation.
You will be totally disabled even if you are gainfully employed in another occupation so long as, solely due to injury or sickness, you are not able to work in your occupation.
Working an average of more than 40 hours in a week, in itself, is not a material and substantial duty.
Your Occupation means the occupation (or occupations, if more than one) in which you are gainfully employed during the 12 months prior to the time you become disabled.
If you have limited your occupation to the performance of the material and substantial duties of a single medical specialty or to a single dental specialty, we will deem that specialty to be your occupation.
Total Disability Benefit
When you are totally disabled, we will pay the monthly indemnity as follows:
- You must become totally disabled while the policy is in force.
- You must satisfy the elimination period
- After you have satisfied the elimination period, monthly indemnity will be payable at the end of the month while you remain totally disabled.
- Monthly indemnity will stop at the end of the benefit period or, if earlier, on the date you are no longer totally disabled.
We will not increase the monthly indemnity because you are totally disabled from more than one cause at the same time.
|Presumptive Total Disability Benefit|
|We will always consider you to be totally disabled even if you are gainfully employed, if injury or sickness results in your total and complete loss of:
- the sight in both eyes;
- hearing in both ears;
- speech; or
- the use of both hands, both feet, or one hand and one foot, in their entirety.
If your injury or sickness results from one of these conditions, we will waive the unexpired portion of the elimination period and benefits start to accrue from the date of your total disability. Monthly indemnity will be paid for as long as your total disability continues, but not longer than the benefit period.
|As provided in the Residual Disability Benefit Rider, even if you have recovered from the sickness or injury that caused residual disability, Berkshire will continue to consider you residually disabled so long as your loss of income is still at least 15% of your prior income and such loss of income is solely because of sickness or injury.|
|Residual Disability Benefit Rider|
|Residual disability or residually disabled means that you are gainfully employed and are not totally disabled under the terms of the policy but, solely because of sickness or injury, your loss of income is at least 15% of your prior income.
Residual Disability Benefit
When you are residually disabled, we will pay a monthly benefit as follows:
- You must become disabled while the policy is in force.
- You must satisfy the elimination period.
- After you have satisfied the elimination period, a residual disability benefit will be payable at the end of each month while you are residually disabled.
For each of the first 12 months that you are eligible for a residual disability benefit in the same claim, we will pay a loss of income indemnity. The loss of income indemnity is equal to your loss of income less any individual disability insurance benefits you are receiving, or that you are eligible to receive from us and all other insurance companies on policies that are in force on or before the effective date of this rider. In no event will the loss of income indemnity exceed your monthly indemnity.
If you continue to be residually disabled in the same claim after the loss of income indemnity has been paid for 12 months, we will pay a residual indemnity. The residual indemnity will be payable monthly and will be a percentage of the monthly indemnity.
Residual indemnity will be determined by the formula (a) divided by (b) multiplied by (c) where:
(a) is your loss of income for the month in which you are residually disabled; and
(b) is your prior income; and
(c) is the monthly indemnity.
If your loss of income is more than 75% of prior income in any month of residual disability while residual indemnity is payable, we will deem such loss to be 100%.
We will not increase the residual disability benefit because you are disabled from more than one cause at the same time.
|Retirement Protection Plus (RPP) Disability Benefit Rider|
|This rider provides an additional benefit in the event of a total disability. It is designed to help replace contributions made toe defined contribution retirement plans by you and your employer. The RPP monthly indemnity will be paid to the trust for you while you are totally disabled and not gainfully employed.|
|Social Insurance Substitute Rider|
|This rider may provide an additional benefit that is coordinated with benefits you may receive from certain guaranteed social insurance programs or workers compensation.
|Disability Insurance Quotes|