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Disability Insurance > Articles > Disability Insurance 101 > The 5 Core Essentials of Disability Insurance Available With Provider Choice

The 5 Core Essentials of Disability Insurance Available With Provider Choice

The Provider Choice individual disability insurance policy offered by Guardian through its wholly owned stock subsidiary Berkshire Life Insurance Company of America, is designed to be the most flexible disability insurance policy on the market. The Provider Choice policy was released for availability to the buying public in July of 2016 and is projected to be the one stop shop for individual disability insurance due to its flexible design. Buyers can now purchase a disability insurance policy with the most comprehensible terms available or dial back to keep within budget for disability insurance.


Comprehensive terms and provisions available with Provider Choice include (but are not limited to): 


1. Non-Cancellable and Guaranteed renewable. 

This will guarantee that your cost does not go up and the terms and provisions cannot be changed until the policy expiration date (to age 65/67) as long as premiums are paid on time. The price you pay today will be the same price you pay in the following years of your contract term if the level premiums structure is selected. 


2. True Own-Occupation definition of total disability. 

Under the True-Own-Occupation definition of total disability, totally disabled means that, solely due to injury or sickness, you cannot perform the material and substantial duties of your occupation, even if you are gainfully employed in another occupation. 


Provider Choice also has medical and dental specialty language for occupations 3M – 6M, and 3D-4D. If you are a physician or dentist, and have limited your occupation to the performance of the material and substantial duties of a single medical or dental specialty, that specialty will be recognized as your occupation. This is the default True Own-Occupation definition for dentists, or for physicians in the 3M-6M occupations class which have a lifetime rider attached or have no partial disability rider attached to the policy. 


The Provider Choice disability insurance policy has a special, even more comprehensive definition of total disability available for physicians that perform hands-on patient care. If your occupation is limited work as a Medical Doctor or Doctor of Osteopathy and you are deriving over 50% of your income from hands-on patient care, you are considered totally disabled even if you are gainfully employed in your practice or another occupation so long as, you are not able to provide hands–on patient care. 


Similarly, if you are a physician deriving over 50% of your income from performing surgical procedures, you are considered totally disabled even if you are gainfully employed in your practice or another occupation so long as, you are not able to perform surgical procedures. 


Provider Choice has other less comprehensive definition of total disability available also but not typically recommended unless the budget for disability insurance cannot afford one of the true Own-Occupation definitions of total disability. 


3. Waiver of Premium Benefit. 

With this benefit, your premiums will be waived while you are disabled and receiving benefits and for the following six months after you recover. The premiums that you paid that apply to the period of disability will also be refunded to you, even if paid prior to your disability. 


4. Waiver of Elimination Period. 

This built-in policy feature will waive the elimination period of a subsequent disability lasting at least 30 continuous days that follows within five years of a recovery of a previous disability that lasted more than six months and for which benefits were paid. 


5. Presumptive Total Disability Benefit. 

You will be considered totally disabled-even if you are still gainfully employed-if due to injury or sickness you suffer total and complete loss of 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. Your loss does not have to be irrevocable.


Provider Choice has flexible base policy provisions and optional riders customizable to individual need and budgets. Some of the configurations and optional riders of Provider Choice are:


  • Benefits for a disability due to a Mental and/or Substance-Related Disorders can be limited to 24 months for the lifetime of the policy unless you are confined to a hospital and under the regular medical care of a Physician. This option will reduce policy cost by limiting length of benefit paid for Mental and/or Substance-Related Disorders. This limitation is automatic for policies written for occupations that includes ER Physicians, Pain Management Physicians, Anesthetists, Anesthesiologists and nurse Anesthetists.
  • Unlimited benefits for Mental and/or Substance-Related Disorders.
  • Basic Residual Disability Benefit Rider requires a 20% loss of income due to injury or sickness. A loss of time performing duties or loss of ability to perform duties due to a sickness or injury is also required.
  • The Enhanced Partial Disability Benefit Rider only requires a 15% loss in income due to injury or sickness. No loss of time performing duties and no loss of ability to perform duties are required. Furthermore, for each of the first 12 months that you are eligible for partial disability benefits, you are eligible for an Enhanced Initial Monthly Benefit that is equal to the greater of 50% of your monthly indemnity or your actual loss of income ( up to the policy’s monthly indemnity) less any individual disability insurance benefits that you are receiving or are eligible to receive from all disability policies in force on or before the effective date of the Enhanced Partial Disability Benefit Rider.
  • The 3% Cost of Living Adjustments Riders also adjusts your monthly benefit and include compound annual adjustments. The 3% Compound COLA Rider increases your monthly benefit each year by a fixed 3%.
  • The 6% Maximum COLA Rider’s compounded increases will be no lower than 3% compounded and no higher than 6%. Increases with the 6% Maximum Cost of Living Adjustments Rider are tied to the Consumer Price Index.


When making a decision on which policy provisions to choose, note that the Provider Choice disability insurance policy offers you a plethora of options. If the budget for disability insurance becomes a financial challenge, it may make more sense to choose the less comprehensive riders and policy provisions available. There are no bad decision between the many choices available, the only bad decision may be not to choose. 


For additional information, request a disability insurance quote.



1. If you choose to have an optional rider on your policy your premium will increase. 
2. The limitation does not apply to policies issued as a result of a future increase option or future purchase option where the policy form which the option is exercised does not contain such a limitation. The limitation does not apply to any policies issued in the state of Vermont, regardless of occupation. 


Jack Le, CFP®, CLU® holds a Financial Representative contract with The Guardian Life Insurance Company of America based out of New York, NY. 

Individual disability insurance policy Forms 18ID, 18UD, and 18GI underwritten and issued by Berkshire Life Insurance Company of America, Pittsfield, MA, a wholly owned stock subsidiary of The Guardian Life Insurance Company of America, New York, NY. Product provision and availability may vary by state. In New York; These policies provide disability insurance only. They do not provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. For policy form 18ID, the expected benefit ratio is 50%. For policy forms 18UD, 18 GI, 18UD-F, the expected benefit ratio is 60%. The expected benefit ratio is the portion of future premiums that the company expects to return as benefits, when averaged over all people with these policy forms. Optional riders are available for an additional premium.

2018-63354 Exp 07/2020


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