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What would happen if your income stopped tomorrow?
Your ability to earn an income may be your most valuable asset. Your family's lifestyle, your home, your children's education and your retirement may all hinge on your ability to work and earn an income. What if you suddenly became too sick or hurt to work, how would you continue your lifestyle? Without an income, years of hard-earned savings could evaporate in a matter of months, even weeks. That's why your association wants to help you to protect your income and your family's financial security with Disability Income Protection insurance.
Benefits for Mental, Nervous or Emotional Disorder, Alcoholism or Drug Addiction |
If disability is due to alcoholism, drug addiction or a mental, nervous or emotional disorder, or any combination of these, a maximum of 12 monthly benefits will be paid while such disability continues. Limited benefits may be paid beyond this 12 month period if you are confined in a hospital on the last day of the month for which the 12th monthly benefit is to be paid, but no beyond the maximum benefit period or the date you are discharged from the hospital.
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Benefits for Self-Reported Symptoms and Musculoskeletal and Connective Tissue Disorder
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A maximum of 12 monthly payments will be paid while under this plan for all disabilities resulting from, or caused by self-reported symptoms or musculosketal and connective tissue disorders of the neck and back as described in your group certificate.
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| Reduction of Benefits |
The amount of monthly benefit selected is the maximum benefit you will receive under the group policy. The benefit will be reduced by any other benefits you are entitled to receive that month from:
- an employer or self-employment
- an employer retirement plan, if such plan is elected by the member
- the retirement system of any government agency
- the Federal Social Security Act, the Railroad Retirement Act, the Canada Pension Plan or the Quebec Pension Plan
- an employer benefit plan providing disability income benefits, if such benefits do not reduce the member's life insurance amount or if such plan is elected by the member
- a benefit plan providing short term disability income benefits, if any, offered by the Policyholder
- the Veterans Administration or any other government agency
- a worker's compensation or similar law.
In no event will the monthly benefit paid under the group policy exceed 66 2/3% of your basic monthly salary or be less than $100.
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When Coverage Ends
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Your Long Term Disability protection is renewable through age 70 provided the group policy remains inforce. Earlier termination can only occur if (1) you fail to pay the required premium when due (2) you retire or cease to be actively engaged in full time employment of at least 20 hours per week in your profession for reasons other than total disability (3) your disability benefits have been paid for the maximum benefit period, or (4) you are no longer a Member of APWU.
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| Exhaustion Of Benefits |
Once you have received benefits under the plan for one disability, coverage will automatically terminate once the benefits are exhausted. Additional injuries or sickness contracted during the disability will not extend the coverage beyond the benefit duration. You may reapply for coverage, once you have returned to active employment for at least 30 days.
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| Successive Disability |
Successive periods of total disability from the same or related causes, will be considered one period of total disability, unless separated by at least 6 continuous months or more of active employment or due to entirely unrelated causes..
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| Partial Disability |
| Partial Disability means one that you cannot perform the material duties of your regular occupation but you are able to perform at least one of these duties on a part-time basis or at least one but not all of these duties on a full-time basis. Your regular occupation is the job you were performing on the day before disability began. Partial disability benefits are payable only if you are earning less than 80% of your basic monthly pay at the time partial disability employment begins. To be considered partially disabled, you must be under the regular care of a physician. Partial disability must begin within 31 days after a period of total disability for which monthly benefits are payable and must be a result of the injury or sickness that caused the total disability. The monthly benefit amount for partial disability is your monthly benefit for total disability less the wages you earn while partially disabled.
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What's a Total Disability
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Total Disability means one that continuously disables you so that you are unable to perform the material duties of your regular occupation for the first 24 months following the 12 month disability waiting period. Once benefits are paid for 24 months, total disability means the complete inability to perform the material duties of any gainful job for which you are reasonably fit by training, education or experience. You need not be confined to a hospital or your home, but you must be under a doctors regular care to receive benefits and must not be working at a gainful occupation.
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Additional Survivor Benefits |
If you are totally or partially disabled for at least 90 consecutive days and die while receiving benefits for such disability, an amount equal to 2 times your last monthly benefit will be paid to your spouse or children.
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| What's A Disability |
| During the waiting period and next 24 months, total disability means the inability to perform the material duties of your regular occupation that you were performing on the day before total disability begins. Once benefits are paid for 24 months, total disability means the inability to perform the material duties of any gainful job for which you are reasonably fit by training, education or experience. You need not be confined to a hospital or your home, but you must be under a doctor's regular care to receive benefits.
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| Benefit Duration |
Benefits are not payable for any time during the 12 month waiting period. Once the 12 month waiting period has been satisfied, benefits for a total disability which begins prior to age 61 are payable to age 65. However, if your disability begins between ages 61 and 69, the following schedule applies.
| Age at Disability |
Benefit Period |
| 61 |
48 months |
| 62 |
42 months |
| 63 |
36 months |
| 64 |
30 months
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| 65 |
24 months
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| 66 |
21 months
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| 67 |
18 months
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| 68 |
18 months
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| 69 |
12 months |
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| Exclusions |
Disabilities are not covered if they result from: war or acts of war; intentionally self-inflicted injuries, committing a crime or an attempt to do so; pregnancy (complications of pregnancy will be covered) or any impairment or disease specifically excluded from the insured's coverage.
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| Premium Waived |
Once you qualify for total disability you will not be required to pay any premiums for the Long Term Disability coverage while you are receiving benefits. Once the disability ends and you return to full-time work, you may keep the coverage in force by resuming premium payments.
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| Pre-existing Condition Limitation |
Pre-existing condition limitations are defined as an injury or sickness for which a person incurred charges, received medical treatment, consulted a physician or took prescribed drugs within 12 months prior to the date his or her insurance took effect. Disabilities resulting from pre-existing conditions are not covered under this plan until the person has not incurred charges, received medical treatment, consulted a physician or taken prescribed drugs for such conditions, or any complication of it for 12 continuous months or the person stays insured under the plan for 24 continuous months.
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| How To Determine Your Benefit Amount And Cost |
- To determine your maximum monthly benefit amount, multiply your basic monthly postal salary by .667 to equal $_____________. Round this number down to the nearest $100.
- From the rate chart Click here to view, locate your current age and benefit amount from step 1 above. The corresponding amount will be your bi-weekly premium amount that will be deducted from your paycheck upon receipt and approval of your application. You may, of course, apply for an amount equal to or lower than the amount in step 1.
- Complete and sign the application and return it. It's that easy!
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| When Coverage Begins |
All coverage is subject to approval by New York Life. Once approved your coverage will become effective on the first payday the premium is deducted form your paycheck. You must be actively at work on that day, otherwise coverage is effective the day you return to full-time work.
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| Who May Apply For The Plan |
You are eligible if:
- You are an active APWU Member in good standing
- You have been working full time (at least 20 hours per week) for at least 90 consecutive days
- You are not yet age 65
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| Here's How To Apply |
- Complete the application which includes medical questions and authorizes payroll deductions. Click here for an application form .Please make sure you complete all the information requested. An incomplete application will be returned, resulting in a delay in processing your application. Send no money.
- Return your application to: The Voluntary Benefits Plan, P.O. Box 1471, Waterbury, CT 06721 or fax to 1-203-754-7847.
Once you receive your certificate of insurance, if you're not 100% satisfied within the first 30 days, we'll send you a full refund of any premiums paid during that period and your certificate will be considered never issued. You will be under no further obligation.
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| Advantages To You |
- Can pay up to 66 2/3% of your basic monthly pay, to a maximum of $3,000 a month, $36,000 a year for a covered disability
- For Members totally disabled prior to age 61, benefits may continue to age 65
- Benefits may start after a 12 month waiting period (which may be paid by the Voluntary Benefits Plan Short Term Disability Plan if you have that coverage)
- Economical APWU Rates are payable through payroll deduction
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| What Are The Benefits? |
You may select a monthly benefit amount from $500 to $3000 in $100 increments. Benefits you will be paid cannot exceed 66 2/3% of your basic monthly pay when combined with all other Income Benefits you are entitled to from any other source. See the Reduction of Benefits Section.
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| Basic Monthly Pay |
Basic Monthly Pay is the monthly rate of pay from your employer. The rate will be that in effect on the day before total disability begins. Basic monthly pay does not include overtime pay, bonuses, or other extra compensation.
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Your Evidence of Insurance
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Once insured, you will receive a Certificate of Insurance evidencing coverage which is provided under Group Policy G-29315-2 (Policy form GMR) (Long Term Disability).
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| Incontestibility |
The validity of any amount of insurance which has been in force for two years during the insured’s life will not be contested except for non-payment of premium contributions.
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| Any Questions? |
Call the following toll-free number 1-800-422-4492
• TDD 1-203-754-4410
Please Note: You must notify the Voluntary Benefits Plan of any address change, employment status change, change in union membership status, life status change (i.e., marriage, divorce, beneficiary or name change) or benefit changes requested. Notice must be in writing.
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| Administered By |
The Voluntary Benefits Plan
P.O. Box 1471
Waterbury, CT 06721
Phone: 1-800-422-4492
Fax: 1-203-754-7847
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Right To Change Benefits Or Rates
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Future benefits are subject to change by agreement between New York Life and the group policyholder. Rates can be changed by New York Life on any premium due date and on any date in which benefits are changed.
This is a summary of the benefits available under the Group Insurance Policy issued ot the voluntary Benefits PlanTM Trust (underwritten by New York Life). For specific provisions please refer to your Certificate of Insurance.
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| Underwritten By |
| New York Life Insurance Company 
New York Life has been awarded an A++ (Superior) rating from A.M. Best. This rating reflects United States Life's superior overall financial strength and operating performance when compared to A.M. Best's standards. The rating is current as of June 11, 2009. For the latest A.M. Best's Ratings and A.M. Best's Company Reports, please visit the A.M. Best Web site at www.ambest.com.
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IMPORTANT NOTICE:
How New York Life Obtains Information and Underwrites Your Request For Group Short and Long Term Disability Insurance
Information regarding insurability will be treated as confidential. In considering your request 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, Inc. (formerly known as Medical Information Bureau). 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.
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 the Administrator 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.
New York Life may release this information to the plan administrator, MIB, other insurance companies to whom you may apply for insurance, or to whom a claim for benefits may be submitted and to others whom you authorize in writing. However, this will not be done in connection with information concerning Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV).
New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. We may make a brief report to MIB; however, we will not disclose our underwriting decision. 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.
MIB is a not-for-profit organization of insurance companies, which operates an information exchange on behalf of its members. When you apply for insurance or submit a claim for benefits to a MIB member company, medical or non-medical information may be given to the Bureau, which may then be furnished to member companies.
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, Inc., 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734, telephone (866) 692-6901 (TTY 866-346-3642). 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 PERSONS 1 have a right of access to certain CONFIDENTIAL ABUSE INFORMATION 2 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.
1 PROTECTED 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.
New York Life Insurance Company 02.09 ed(s)
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FRAUD NOTICE – For Residents of all states except those listed below: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which may be a crime and may subject such person to criminal and civil penalties. RESIDENTS OF CO, the following also applies: Any insurance company or agent who defrauds or attempts to defraud an insured shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.
RESIDENTS OF AR/LA/MD/RI: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
FOR RESIDENTS OF D.C., WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant.
RESIDENTS OF FL: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
RESIDENTS OF KS: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance may be guilty of insurance fraud as determined by a court of law.
RESIDENTS OF ME: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.
RESIDENTS OF NJ: WARNING: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.
RESIDENTS OF NY: Any person who knowingly and with intent to defraud any insurance company or any other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.
RESIDENTS OF OK: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
RESIDENTS OF PUERTO RICO: Any person who, knowingly and with the intent to defraud, presents false information in an insurance request form, or who presents, helps or has presented a fraudulent claim for the payment of a loss or other benefit, or presents more than one claim for the same damage or loss, will incur a felony, and upon conviction will be penalized for each violation with a fine no less than five thousand (5,000) dollars nor more than ten thousand (10,000) dollars, or imprisonment for a fixed term of three (3) years, or both penalties. If aggravated circumstances prevail, the fixed established imprisonment may be increased to a maximum of five (5) years; if attenuating circumstances prevail, it may be reduced to a minimum of two (2) years.
RESIDENTS OF TN/WA: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.
RESIDENTS OF VA: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing false or deceptive statements may have violated state law.
G-29315-1,G-29315-2
GPA-DI-EZ-2
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