Simplified Disability Insurance

ATTENTION: If applying for Life or Disability as a California or New York resident please contact Hagan Benefits at 877-285-4445 or see the bottom of this page for a specified application.

You are Prepared to Practice ...
But Are you Prepared for the Future?

Exclusive Simplified Issue Disability Insurance

Accidents can and do happen. If you suffer a disabling Injury, the financial security you've worked to build could be put at risk. As a member of ACEP, you are able to join an exclusive disability insurance program to help cover your income in the event a covered Injury or Sickness keeps you from working.

Simplified Issued Disability Insurance Features:

Up to $4,000 not to exceed 70% of Pre-Disability Earnings in $500 increments. The minimum benefit is $1,000
Available to members under age 60
Only 3 Medical Questions to apply

Offset Provision

Benefit cannot exceed 60% of Basic Monthly Pay.

Offset Provision Example
Insured's Monthly Pre-Disability Earnings	$3,000
Long Term Disability Benefits Percentage	x 60%
Unreduced Maximum Benefit	$1,800
Less Social Security Disability Benefit Per Month	- $900
Less State Disability Income Benefit Per Month	- $300
Total Amount of Long Term Disability Benefit Per Month	$600

ELIGIBLE MEMBERS:

All Active ACEP Members who are under age 60 and citizens or legal residents of the United States, its territories and protectorates, and Actively-at-Work on a full-time basis (at least 30 hours per week) for four consecutive weeks and are not covered under a related ACEP disability policy with The Hartford.

Policy Age Limit: Age 65

You can enroll for a Monthly Benefit Up to $4,000 not to exceed 70% of Pre-disability Earnings in $500 increments while the minimum benefit is $1,000. The Maximum Payment Period for Total Disability caused by Injury is up to age 65 and for Total Disability caused by Sickness a payment of 3 years however, the Maximum Payment Period may be reduced due to Mental Illness, alcoholism or Substance Abuse as specified in the Total Disability Benefit.

Two Options:

Option 1 Elimination Period: 60 days
Option 2 Elimination Period: 90 days

Effective Date: Your coverage will become effective the first of the month following receipt of your approved application and first premium payment. If evidence of insurability is required, the first day of the month or next following the date we determine you are insurable.

Deferred Effective Date:

If on the date you are to become covered under the policy, for increased benefits or for a new benefit and you are not Actively-at-Work on that date, coverage will not begin until the first day of the month on or next following the date you are Actively-at-Work for 3 month(s).

Disability Benefit:

If You become Totally Disabled as the result of a covered Injury or Sickness while covered under The Policy, We will pay the Monthly Benefit due for the period of Total Disability. The period of Total Disability must require the Regular Care of a Physician.

Actively-at-Work means You are performing all the Essential Duties of Your Occupation for wage or profit on a full-time basis (at least 30 hours per week).

Total Disability:

Total Disability or Totally Disabled means disability which, during the Elimination Period during which Total Disability Benefits are payable, wholly and continuously prevents You from performing the Essential Duties of your Occupation.

Recurrent Disability:

If You cease to be Totally Disabled and return to work for a total of 14 days or less during the Elimination Period, the Elimination Period will not be interrupted. Except for the 14 days or less that You work, You must be Totally Disabled by the same condition for the total Elimination Period.

Periods of Disability:

Periods of disability due to the same or related medical causes and separated by fewer than six months while you are Actively-at-Work are considered a single period of disability. This means you won't have to satisfy a new waiting period before qualifying for benefits should you relapse upon returning to active employment after receiving benefits for a disability. You do not need to satisfy a new waiting period, the relapse does not entitle you to a new benefit period. You would only receive the remainder of the existing benefit period for that disability. Actively-at-Work is defined as performing all the regular duties of an occupation for wage or profit on a full-time basis (at least 30 hours per week).

Period of Disability means a continuous length of time during which You are disabled under The Policy.

Benefits will not be paid during a period of Total Disability that is applied to the Elimination Period or waiting period. (This is the amount of time from the date of a disabling Injury before your benefits are payable.) Or, that exceeds the Maximum Payment Period. However, if You are Totally Disabled due to Mental Illness, alcoholism or Substance Abuse, the Maximum Payment Period will be reduced to 2 years during Your lifetime unless You are confined in a hospital or other institution licensed to provide care and treatment for that disability. The Elimination Period and Maximum Payment Period apply separately to each period of Total Disability.

Termination:

Your coverage will end on the earliest of the date the Policy terminates or Policyholder withdraws its sponsorship, or cancels the Policy. Coverage will also terminate if the Premium Due Date on or next following the date you cease to be an active member of the Policyholder or you attain The Policy Age Limit or the date You cease to be Actively-at-Work, except due to disability covered by The Policy or temporary lay-off, leave of absence, or Family or Medical Leave, as described herein, or the Premium Due Date any required premium contribution is not made, subject to the Individual Grace Period.

What are Pre-disability Earnings?

For self-employed physicians they are your average net monthly income (gross revenues less business expenses) from your practice or main business based on either 12 or 24 months average. Whichever produces the higher average. If you were self-employed for less than 12 months, it is based on the whole time you were self-employed. If your practice is incorporated, net income includes the cost to your company of fringe benefits and your share of the surplus. Income does not include investment returns, rents, royalties, and the like income which is not directly produced from your current work.

Pre-disability Earnings that are not self employed physicians is your regular monthly rate of pay, not counting commissions, bonuses, tips and tokens, overtime pay or any other fringe benefits or extra compensation, in effect on the date immediately prior to the last day you were actively at work before you became disabled.

Disabled and Working Benefits:

If You are Disabled and Working, we will pay a Monthly Benefit for each month You are Disabled. The Disability must begin, before You attain age 60 and while You are covered under this benefit. Payment will begin on the first day following the day You have been Disabled and Working for as long as You would have been required to be Totally Disabled in order to have satisfied the Disability Elimination Period, whether or not You are Totally Disabled.

We will not pay for any part of a period that You are Disabled and Working that exceeds the Maximum Payment Period for this Benefit for any one Injury or any one Sickness.

To determine the Disabled and Working Monthly Benefit, use the following calculation: (A divided by B) x C = D

A = Your Pre-disability Earnings less Your Current Monthly Earnings.
B = Your Pre-disability Earnings.
C = The Monthly Benefit payable if You were otherwise Totally Disabled. (Disregard all other income from any employer or for any work when determining this figure).
D = The Disabled and Working Monthly Benefit payable.

Disabled and Working means a Disability that continues while You are performing at least one of the material duties of Your own occupation on either a full-time or part-time basis. And causes a loss of earnings of at least 20% (and less than 80%), and requires the Regular Care of a Physician. A disability that causes a loss of earnings of 80% or more is considered to be a Total Disability and will be payable under the Total Disability Benefit.

Two Elimination Period Options: 60 Days and 90 Days.

Individual Annual Disability Premiums
	$100 Monthly Benefit Amount
	60 DAY WP	90 DAY WP
Under 30	$13.38	$10.16
30-34	$14.92	$11.24
35-39	$18.31	$13.33
40-44	$23.73	$17.15
45-49	$30.33	$22.48
50-54	$40.49	$31.49
55-59	$50.65	$42.70
*60-64	$67.49	$59.94

*Renewal Premiums Only

Rates and/or benefits may be changed on a class basis. Rates are based on the attained age of the insured Person and increase as you enter each new age category.

Premiums are based on the Insured Person's:

Age on his or her effective date and on each premium due date thereafter, and Waiting Period options.

What are the Exclusions?

The Policy does not cover any Disability or loss caused by intentionally self inflicted Injury, suicide or attempted suicide, while sane or insane, or pregnancy or childbirth, except Complications of Pregnancy, or war or act of war, whether declared or not, or any Sickness or Injury for which workers' compensation benefits are paid, or may be paid, if duly claimed, or any Injury sustained while riding on, boarding or alighting from, any aircraft: a) as a pilot, crew member or student pilot; b) operated by any military authority (land, sea or air), unless it is a Military Transport Aircraft used for transport and operated by the United States Military Air Mobility Command (AMC) or an AMC type service of a national government recognized by the United States; or c) being used for tests, experimental purposes, stunt flying, racing or endurance tests, or Your commission or attempted commission of a felony, or Sickness contracted or Injury sustained while on full-time active duty as a member of the Armed Forces (land, water, air) of any country or international authority. We will refund the pro rata portion of any premium paid for You while You are in the Armed Forces on full-time active duty for a period of two months or more. Written notice must be given to Us within 12 months of the date You enter the Armed Forces.

Pre-Existing Conditions Limitation:

Conditions Prior to Effective Date: We will not pay a Benefit for any loss or period of Total Disability which begins during the first 24 month(s) of Your insurance, and is a result of a Pre existing Condition; unless such Total Disability begins after You have been free of Medical Care for the condition for a 24 month(s) period ending any time on or after Your effective date.

Treatment is recommended or prescribed by, or received from a Physician.

Treatment includes, but is not limited to:

Medical examination, test, attendance, or observation, medical services, supplies, or equipment, including their prescription or use, or prescribed drugs or medicines, including their prescription or use.

Pre-existing Condition means any Disability, diagnosed or undiagnosed, for which Medical Care is received by You within the 24 month(s) period prior to the date Your insurance starts, or with respect to the limitation for any increase in coverage, within the 24 month(s) period prior to the effective date of Your increase in coverage.

NOTICE OF INSURANCE INFORMATION PRACTICES

To properly underwrite and administer your application for insurance coverage, we must collect certain information concerning your insurability. You are our most important source of information, but we may also contact other sources such as medical professionals and institutions, employers and other insurance companies. While all information regarding your insurability will be treated as confidential, in some situations, and in compliance with applicable law, we may disclose necessary items of information to third parties without your specific authorization.

INVESTIGATIVE CONSUMER REPORTS

As part of our procedure for processing your application, an investigative consumer report may be prepared by an outside insurance reporting organization. Personal information may be collected from others regarding your general reputation and lifestyle. If an interview is conducted with someone other than you, we will inform you of your right to be interviewed in connection with the preparation of the investigative consumer report. You have the right to send a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

PERSONAL HISTORY INTERVIEW

To provide you, our client, with the best possible service, we may also conduct what we call a personal history interview. This is a phone call placed from our underwriting office. Its purpose is to make sure that the application information is complete. Our interviewers are trained to conduct their calls in a friendly, professional manner. The nature of the information discussed is always treated as personal and confidential and will only be used to assess your eligibility for insurance.

MEDICAL INFORMATION BUREAU (MIB) PRE-NOTICE

Information regarding your insurability will be treated as confidential. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may, however, make a brief report thereon to the MIB, Inc., formerly known as Medical Information Bureau, a not-for-profit membership organization of insurance companies, which operates an information exchange on behalf of its members. If you apply to another MIB member company for life or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request, will supply such company, with the information about you in its file. Upon receipt of a request from you, MIB will arrange disclosure of any information in your file. Please contact MIB at (866) 692-6901 (TTY (866) 346-3642). If you question the accuracy of the information in MIB's file, you may contact MIB and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of MIB's information office is 50 Braintree Hill Park, Suite 400, Braintree, Massachusetts 02184-8734. Hartford Life Insurance Company, Hartford Life and Accident Insurance Company , or their reinsurers, may also release information from their files to other insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Information for consumers about MIB may be obtained on its website at www.mib.com.

ACCESS, CORRECTION AND DISCLOSURE

You can obtain access to personal information about you contained in our policy files by sending us a written request. You may also request any necessary corrections, amendments or deletion of any information in our files which you believe to be inaccurate or irrelevant. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may release information in their files to other life insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Also, please be advised that personal and confidential information collected by us may, in certain circumstances, be disclosed to third parties without authorization.

A notice providing further description of the circumstances under which information about you may be disclosed and the types of persons and organizations to whom it may be disclosed will be sent to you upon your written request. If you desire further information or access to your personal information, please send your written request to: Hartford Life Insurance Company or Hartford Life and Accident Insurance Company, 200 Hopmeadow St., Simsbury, CT 06089.

The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company. PA-9199

Acceptance into this plan is subject to medical evidence of insurability as determined by The Hartford. Depending on your age, the amount of coverage you request, and your answers on the application, a medical examination, medical test(s), or other evidence of good health may be required. Any exams/tests requested by the company will be conducted at your convenience and at no expense to you.

This website explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

Need more coverage?

Call us today! 1-877-285-4445

You have 30 days from your effective date of coverage to look over the program and discuss with your family and advisors. If you are not satisfied, you may return your Certificate within 30 days for a full premium refund, less any claims paid.

Apply now

Attention CA and NY residents: You cannot apply online, instead please utilize the following PDF applications:
California Residents: Click Here
New York Residents: Click Here

Underwritten by:
Hartford Life and Accident Insurance Company,
Simsbury, CT 06089
Policy Form #GBD-1000 A (AGP-5837) (TX)

The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.