Apply for up to $10,000 Monthly Benefit
A total disability could stop your ability to earn an income in a split second. Make sure you have a reliable financial plan in place that includes long term disability income protection. Members can turn to the California Optometric Association sponsored Group Long Term Disability Income Insurance that protects members in their specialty as an optometrist.
Underwritten by: New York Life Insurance Company
51 Madison Ave., New York NY 10010
Under Group Policy number G-29322-0 on Policy form GMR-FACE/G-29322-0
Optional Catastrophic Benefit – If a benefit for total disability becomes payable, and you become cognitively impaired or unable to perform two or more Activities of Daily Living (ADL’s) as defined, you may be eligible to receive an additional monthly benefit of $1,000, $2,500 or $5,000 per month for a maximum of 24 months, subject to meeting qualifying criteria.
To learn more about this coverage—features, costs, eligibility, renewability, limitations, exclusions and underwriting insurance company continue scrolling.
Benefits Guide Information for California Optometric Association Members
"Stand alone" OR "Supplement"
This group coverage can be your sole, “stand-alone” disability insurance coverage. If you have some type of disability coverage through an employer, this plan can be an excellent supplement to it. That’s an approach some of our members take because these benefits are NOT taxable, unlike most employer plans—and the coverage is 100% portable, provided you pay the premiums.
As a member, you are eligible to request coverage under this group plan if you are:
* FULL-TIME work means the active performance of the regular duties of your normal occupation for pay or profit on the basis of at least 30 hours per week at the place such duties are performed.
** Not available in all states at this time. Contact the Administrator for current information
For rate information and to apply, click on the "Download Now" button.
Diagnostics: 3 Key Reasons Optometrists May Need Disability Coverage
1. Your income is substantial and your lifestyle is based on the assumption of that income stream
2. Your expenses are significant, including:
3. Your livelihood demands full use of your mind and body
Common Accidents & Medical Conditions Can Result in "Disability"
+ The policy limits benefits for Mental/Nervous disorders and Chemical Dependency.
Your benefit payments are TAX-FREE— you could collect 40% more each month
Under current tax laws, if you pay your own disability premiums, your benefits are tax-free. This means you’ll generally collect 40% higher benefit checks through this policy than you’d receive from a comparable program offered through an employer. Or, you may be able to claim part of your policy premiums as a tax deduction if you own your own practice. Consult with your tax advisor for more details.
Example: $10,000 monthly benefit taxed vs. tax-free:
(40% paid to state and federal income taxes)
Taxable Plan: pays $6,000.00 per month vs. Tax-Free CMA/County Plan: pays $10,000.00 per month (you net 40% more)
TAX-FREE benefit payments assume you don’t choose to take your insurance premiums as a tax deduction. Of course, always consult with your tax advisor for the best advice for your individual situation.
You can collect if you cannot work within YOUR specialty as an optometrist
As an optometrist, your occupation is highly specialized. And if you can’t perform the duties of your occupation due to a covered Total Disability, the policy will pay your monthly income benefits for up to 10 years after your disability begins.
Your coverage is portable—you can take this plan with you anywhere you go*
Unlike hospital, healthcare systems, or other employer-paid or sponsored policies, you own your group coverage. It can go wherever you go, as long as you remain an Association member. You don’t have to worry about losing your disability insurance because you change employers or if you strike out on your own as part of a practice or as a sole practitioner.
* Subject to policy terms and U.S. government regulations on restricted countries.
You pay group rates
This policy is only available to members. Rates have been specifically negotiated on your behalf. The policy pays monthly benefits if you are Totally Disabled.
Totally Disabled means an incapacity from an injury or sickness that completely and continuously prevents you from doing the material and substantial acts of your medical specialty, during the waiting period and the first 10 years thereafter. After this period, you will be considered Totally Disabled if you are unable to perform any occupation in which you can reasonably be expected to perform satisfactorily in light of age, education, training, experience, station in life and physical and mental capabilities.
Maximum Benefit period for disabilities beginning:
Before age 60 – To his or her normal retirement age (NRA)+
At age 60 but before age 63 – Five years
At age 63 but before age 65 – Two years
At age 65 but before age 70 – One year
Benefits for disabilities due to mental disorders and chemical dependency/alcoholism are limited to 24 months.
+ The Normal Retirement Age (NRA) will gradually increase to age 67 from age 65, depending on year of birth. For example, members born in 1948 have an NRA of 66 years. Members born in 1960 or later have an NRA of 67 years.
You collect benefits regardless of any other coverage
This policy will pay you in addition to whatever you may collect from any other disability coverage (private, group, employer, any type) OR from any Social Security or other government benefit. Your benefit payments under this policy are never reduced because of other insurance/disability funds you may be entitled to collect. However, please note that your coverage amount, together with any other disability coverage you may have, may not exceed 66 2/3% of your AVERAGE MONTHLY INCOME.
AVERAGE MONTHLY INCOME means, as of any date, your average monthly wages, salaries, commissions, fees and other amounts received for personal services—before deduction of income or social insurance taxes and after deduction of the normal business expenses that are deductible for income tax purposes—for the immediately preceding 12-month period. It does not include income from interest, dividend, rent royalties, annuities, other insurance or other unearned income.
You have a broad choice of monthly benefit options to fit your needs/budget—from $500 to $10,000
If you are under age 50, you may apply for up to $10,000 in Monthly Benefits (in $500 units). If you are between the ages of 50 and 59, you may apply for up to $6,000 in Monthly Benefits. However, the option you choose, together with any other disability income insurance you may have, cannot exceed 66 2/3% of your AVERAGE MONTHLY INCOME.
Starting at age 65, your Monthly Benefit amount is reduced 5% each year through age 69. Benefits will not be reduced while you are on a claim.
You have 100% freedom and control of your benefit payments—NO restrictions on how you use the money
All benefit payments are sent to you directly, by check. The benefit is never paid to any medical provider, mortgage company, or other person unless you specifically direct it. Use the money however you choose with no limitations or requirements.
Your premiums are waived during disability—you owe $0 premiums if you become Totally Disabled
The last thing you should worry about during a disability is paying for your coverage. So, we made sure you wouldn’t owe any premiums if you become Totally Disabled. After you have been Totally Disabled for at least six months, all future premium contributions will be waived for that disability. Please see your certificate for more detailed information.
You can collect “Residual Disability” benefits—helps you supplement lost income while recovering from a Total Disability
If, while recovering from a Total Disability, you are able to resume some but not all of said duties prior to age 65, you may be eligible for a Residual Disability Benefit. This benefit is based on a percentage of your pre-disability earnings. To qualify for the Residual Disability Benefit, you may not be earning more than 80% of your pre-disability AVERAGE MONTHLY INCOME and you must not have reached the Maximum Benefit Period. Refer to your Certificate of Insurance for more information on this benefit. This benefit will end if you return to work in an occupation other than your own specialty as an optometrist.
You have a choice of 3 waiting periods
Create custom coverage that suits your income needs and gives you the right benefit/price combination. Help replace your lost income so you can continue to pay your monthly expenses. You may select waiting periods of 90, 120 or 180 days. Coverage with a longer waiting period will be less expensive.
You can choose a “Cost-of-Living” Benefit—helps your benefit amount keep pace with inflation
This optional benefit offers disability coverage that, once benefits begin, can help keep pace with the rate of inflation. Monthly benefits will be adjusted annually beginning one year after the date the waiting period begins if you are Totally Disabled prior to age 65. Adjustments may be made to the monthly benefit paid in the second and each succeeding year up to a maximum of 10 adjustments. The adjustment amount will be based on the consumer price index for urban consumers (CPI-U) up to a maximum six percent increase per year and an overall maximum increase of one times the original benefit. Once you are no longer disabled and benefit payments stop, the monthly benefit returns to the original option amount.
Catastrophic Benefit Option
This option is designed to provide an additional layer of protection for severe disabilities. This benefit provides an additional $1,000, $2,500 or $5,000 monthly benefit while on disability if your Total Disability causes: a loss of the ability to perform, for at least 30 consecutive days, two or more ACTIVITIES OF DAILY LIVING; COGNITIVE IMPAIRMENT; or have a life expectancy of less than 12 months as described in the Certificate of Insurance. The benefit will be paid for a maximum of 24 months.
ACTIVITIES OF DAILY LIVING are: bathing, dressing, toileting, transferring, continence and eating.
COGNITIVE IMPAIRMENT means deterioration or irreversible loss of intellectual capacity, a deficiency in short or long term memory, orientation as to people, place or time, deductive or abstract reasoning, and judgment as it relates to safety awareness. Cognitive Impairment will be measured according to generally accepted medical standards.
You can receive a lump sum recovery benefit upon your return to FULL-TIME WORK following a Covered Total Disability for which you received a Total Monthly Benefit. The benefit payable will be ¼ of the Total Monthly Benefit amount received for each full month of Total Disability to a maximum of three times the last Total Monthly Benefit. For more information, please refer to your Certificate of Insurance.
You have a voluntary rehabilitation benefit—designed to help you return to the work force
This policy offers a Rehabilitation Benefit that is designed to help certain disabled individuals return to the work force. Under this benefit, a professional rehabilitation staff reviews case histories and identifies those individuals who appear to have the greatest likelihood of rehabilitation. Individuals selected by New York Life Insurance Company will be offered the OPTION of participating in a rehabilitation program at NO COST to them. Participation is VOLUNTARY and benefits will NOT be reduced due to participation in the program.
You can never be singled out for a rate increase
This is a group policy exclusively for COA members, which means you can never be singled out for a premium increase, even if there is a change in your health or where you reside.
When Coverage Starts (Effective Date)
You will become insured on the date specified by New York Life Insurance Company provided the first premium contribution is paid when due, satisfactory evidence of insurability has been submitted and you are at FULL-TIME WORK on that date.
If you are not at FULL-TIME WORK as required, coverage will not become effective until the day you are at FULL-TIME WORK provided such date is within six months of the date insurance would have been effective and you are still eligible for insurance.
Payment of a premium contribution for insurance does not mean there is any coverage in force before the effective date specified by New York Life Insurance Company.
When Coverage Ends
Once coverage is validly in force, it may be continued to the premium due date on or immediately after you reach age 70. Coverage will end earlier if: you cease FULL-TIME WORK other than for reasons of disability, cease to be an Association member, fail to pay premium contributions when due, enter full-time active duty in the armed forces (coverage may be restored upon termination of active duty status, subject to policy guidelines), group policy is terminated or modified to exclude coverage for the group of individuals to which you belong or the association sponsors a similar policy of disability income insurance for members.
Exclusions & Limitations
The policy does not provide benefits for any disability that occurs during or is due or related to: intentionally self-inflicted injury while sane or insane (Missouri Residents: This exclusion is not applicable to injury caused by an intentionally self-inflicted injury while insane.), declared or undeclared war or any act thereof, or incarceration or participation in (except as a victim) an illegal occupation/activity or the commission of a crime, flying in any aircraft, except as a fare-paying passenger on a licensed commercial carrier: PREEXISTING CONDITION (except as noted below) or any impairment or disease specifically excluded from your coverage.
No benefits are payable for any disability for which you are not under the regular care of a licensed physician or surgeon other than yourself, your business associate, or member of your immediate family or household.
The policy limits benefits for disabilities due to mental disorders to 24 months. Benefits for disabilities due to chemical dependency are limited to 24 months.
A PREEXISTING CONDITION is an injury or illness for which you consulted a physician, took medication, or received medical services or supplies during the immediate 12-month period prior to becoming insured under this plan. Benefits are not payable for a disability due to a PREEXISTING CONDITION until the end of the earlier of: 12 consecutive months during which you have not consulted a physician, taken medication, or received medical services or supplies; or 24 months.
New York Life reserves the right to request medical information needed to determine an applicant’s eligibility for coverage. Based upon the age of the person proposed for insurance and the amount of coverage requested, a physical exam, EKG, blood test or other medical information may be required.
Not all applicants will have to supply additional information. However, if required, we will arrange for an independent professional paramedic to contact you to perform these simple tests at your convenience. The exam and blood test will be paid for by the policy.
Request for insurance will be processed promptly and coverage will be issued for members whose evidence of insurability has been found to be satisfactory.
How New York Life Obtains Information and Underwrites Your Request For Group Disability Income Insurance
In this notice, references to “you” and “your” include any person proposed for insurance. Information regarding insurability will be treated as confidential. In considering whether the person(s) in your request for insurance qualify for insurance, we will rely on the medical information you provide, and on the information you AUTHORIZE us to obtain from your physician, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB, LLC. (“MIB”). MIB is a not-for-profit organization of insurance companies, which operates an information exchange on behalf of its members. If you apply for life or health insurance coverage, a claim for benefits is submitted to an MIB member company, medical or non-medical information may be given to MIB, and such information may then be furnished by MIB, upon request, to a member company.
Your AUTHORIZATION may be used for a period of 24 months from the date you signed the application for insurance, unless sooner revoked. The AUTHORIZATION may be revoked at any time by notifying New York Life in writing at the address provided. Your revocation will not be effective to the extent New York Life or any other person already has disclosed or collected information or taken other action in reliance on it, or to the extent that New York Life has a legal right to contest a claim under an insurance certificate or the certificate itself. The information New York Life obtains through your AUTHORIZATION may become subject to further disclosure. For example, New York Life may be required to provide it to insurance, regulatory or other government agencies. In this case, the information may no longer be protected by the rules governing your AUTHORIZATION.
MIB and other insurance companies may also furnish New York Life, its subsidiaries or the Plan Administrator with non-medical information (such as driving records, past convictions, hazardous sport or aviation activity, use of alcohol or drugs, and other applications for insurance). The information provided may include information that may predate the time frame stated on the medical questions section, if any, on this application. This information may be used during the underwriting and claims processes, where permitted by law.
New York Life may release this information to the Plan Administrator, other insurance companies to which you may apply for life and health insurance, or to which a claim for benefits may be submitted and to others whom you authorize in writing, however, this will not be done in connection with test results concerning Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV). We may also make a brief report of your protected health information to MIB, but we will not disclose our underwriting decision
New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. Information in our files may be seen by New York Life and Plan Administrator employees, but only on a "need to know" basis in considering your request. Upon receipt of all requested information, we will make a determination as to whether your request for insurance can be approved.
If we cannot provide the coverage you requested, we will tell you why. If you feel our information is inaccurate, you will be given a chance to correct or complete the information in our files. Upon written request to New York Life or MIB, you will be provided with non-medical information. Generally, medical information will be given either directly to the proposed insured or to a medical professional designated by the proposed insured. Your request is handled in accordance with the Federal Fair Credit Reporting Act procedures. If you question the accuracy of the information provided by MIB, you may contact MIB and seek a correction. MIB's information office is: MIB, LLC., 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734, telephone 866-692-6901. For Canadian residents, the address is: MIB Information Office, 330 University Avenue, Suite 501, Toronto, Ontario, Canada M5G 1R7, telephone 416-597-0590. Information for consumers about MIB may be obtained on its website at www.mib.com.
For NM Residents: PROTECTED PERSONS1 have a right of access to certain CONFIDENTIAL ABUSE INFORMATION2 we maintain in our files and they may choose to receive such information directly. You have the right to register as a PROTECTED PERSON by sending a signed request to the Administrator at the address listed on the application. Please include your full name, date of birth and address.
1PROTECTED PERSON means a victim of domestic abuse: who has notified us that he/she is or has been a victim of domestic abuse; and who is an insured person or prospective insured person.
2CONFIDENTIAL ABUSE INFORMATION means information about: acts of domestic abuse or abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant or insured as family member, employer or associate of a victim of domestic abuse or a person with whom an applicant or insured is known to have a direct, close, personal, family or abuse-related relationship.
100066 New York Life Insurance Company