Benefits are not payable during the 60-day waiting period. This policy does not provide benefits for disabilities due or related to routine pregnancy (complications of pregnancy are covered); or declared or undeclared war or any act thereof; or specific conditions for which an impairment restriction has been placed on your coverage or any pre-existing conditions (conditions for which you received medical advice or treatment within 12 months of coverage becoming effective) until 12 treatment-free months have passed or until the coverage has been in effect for 1 year. This 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*; or incarceration or participation in a crime or illegal activity. No benefits are payable for any period during which you are incarcerated. Also, to be considered disabled, the disability must occur while you are insured under the policy and you must be under the regular care of a licensed physician.

*For Missouri residents only: The exclusion for intentionally self-inflicted injury is not applicable to injuries caused by an attempted suicide while insane.

Military Service - A disability that is due to or related to service in the military, naval or air force of any country, alliance or international organization or in a civilian unit which serves such force.

Air Travel - Injury sustained while riding on, boarding, or alighting from any aircraft: as pilot, crew member, or student pilot, unless the insured person is flying on his or her employer's business in an aircraft certified as airworthy by the appropriate authority; the commission or attempted commission of a felony by you.

 

Definition of Total Disability - A disability that completely and continuously prevents you from doing the material and substantial duties of your regular occupation during the Waiting Period and during the next 24 consecutive months. After which, you are considered to be totally disabled if you cannot perform any occupation for which you are or may become qualified by reason of education, training or experience.

Total Disability - If you become totally disabled as the result of an injury or sickness while covered under the policy, we will pay the monthly benefit amount due for the period of total disability. The period of total disability must require the regular care of a physician.

Successive Periods of Disability - Periods of disability due to the same or related medical causes and separated by less than 6 months during which you are actively-at-work will be considered one period of disability.

Period of Disability means a continuous length of time during which you are disabled under this plan.

Pre-existing Condition means an injury or sickness or any condition related to such injury or sickness for which a person consults a doctor, receives medical services or supplies or takes any medication during the 12 month period immediately before the insured member's insurance date. Pre-existing Condition does not include: (a) any such injury or sickness or condition after such person has been continuously insured under the Policy for 12 month; or (b) an injury or sickness or condition classified as an Impairment Restriction.

Maximum Payment Period: For total disability beginning before age 61: to age 62. Age 61 and over: 12 months.

If you are totally disabled due to mental or nervous disorders, alcoholism, or drug 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.

Actively-at-work means you are performing the regular duties of your normal occupation for wage or profit on a full-time basis (at least 17.5 hours a week).

The plan has an offset provision which means benefits payable as a result of your total disability will be the lesser of the monthly benefit amount or the monthly benefit amount minus any other income benefits. However, if your monthly benefit amount would reduce to less than $200 per month due to other income benefits, then the minimum monthly benefit amount under this benefit will be $200 per month.

Other Income Benefits include, but are not limited to (See Certificate for details) 1. benefits for loss of time from employment which is provided for a disability under: (a) any plan arranged by any employer, union or association; (b) any fund or other arrangement pursuant to any compulsory disability benefit act or law; or (c) an individual disability income policy; 2. benefits in the form of periodic cash payments for a disability, excluding any benefits for a disability starting before the insured member's insurance date, which is provided: (a) under any group life insurance plan; (b) by any federal, state, provincial, municipal or other governmental agency, or pursuant to the Federal Railroad Retirement Act; or (c) under the Federal Social Security Act, Canada Pension Plan or Quebec Pension Plan on the basis of the insured member's record of wages and self-employment income and payable to the insured member or a spouse or child of the insured member, without regard to any deductions from such benefits which can be made: (1) on account of work; (2) because of the insured member's refusal to accept rehabilitation; or (3) because a spouse or child of the insured member has elected to be paid benefits under the Federal Social Security Act, Canada Pension Plan or Quebec Pension Plan on the basis of the spouse's or child's own record of wages and self-employment income. In determining the amount of such benefits, however, there will be excluded the amount of any increase therein which occurs after the waiting period 3. benefits under a Workers' Compensation Act or similar act.

The example in the table directly below is for purposes of illustrating the effect of benefit reductions and is not intended to reflect the situation of a particular claimant under the policy.

Insured's monthly [Basic Monthly Insured Salary]	$3,000
Long term disability benefits percentage	x 65%
Unreduced maximum benefit	$1,950
Less Social Security disability benefit per month	- $900
Less state disability income benefit per month	- $300
The total amount of long term disability benefit per month	$750

 

Coverage End Date - Once approved, you can continue your coverage to as long as you pay all premium contributions when due, you remain at Full-Time Work, the group policy remains in force, and you do not enter active duty in the Armed Forces. There is no policy age limit under the plan.

Average Monthly Insured Income means your regular monthly rate of pay including Administratively Uncontrollable Overtime (AUO) or Availability Pay, but not counting commissions, bonuses, other overtime pay or any fringe benefit or extra compensation, in effect on the last day of active employment prior to becoming Disabled, and upon which the required premium has been paid. If your rate of pay changes, your benefit amount will be adjusted on the premium due date you pay the premium applicable to the new rate of pay and benefit amount.

This plan has a Survivorship Benefit. If you die: a.) After completing the waiting period; or b.) while receiving a monthly benefit; under the total disability benefit we will pay a Benefit. The benefit amount will be based on the covered person's age at the time of death as follows: If the covered person dies prior to attaining age 60, the benefit will be the lesser of: twenty-four times the covered person's monthly benefit amount payable after offsets including assumed benefits; or, $30,000. If the covered person dies on or after attaining age 60, the benefit amount will be the lesser of: a.) twelve times the covered person's monthly benefit amount payable after offsets, including assumed benefits; or b.) $15,000. The Benefit will be paid: a.) to the beneficiary designated by you; or, b.) if no beneficiary has been designated: 1.) to your surviving spouse; 2.) if no surviving spouse, in equal shares to your surviving children; 3.) if no surviving spouse or surviving children, to your estate.

This is a brief description of the features of the plan. It is not a contract. Complete terms and conditions of coverage are set forth in the Group Policy G-30305-0/FACE issued by New York Life Insurance Company to the Civil Service Employee Benefit Association.

The Association incurs costs in connection with providing oversight and administrative support for the sponsored plan. To provide and maintain this valuable membership benefit, they are reimbursed for these costs. The Association may also receive a fee in connection with the plan.

New York Life Insurance Company is licensed/authorized to transact business in all of the 50 United States, District of Columbia, Puerto Rico and Canada. However, not all group plans it underwrites are available in all jurisdictions. New York Life Insurance Company's state of domicile is New York and NAIC ID# is 66915.

Administered by NBFSA | P.O. Box 24279 Winston-Salem, NC 27114 | Phone: 844-746-1452
Insurance License Numbers: CA: 0B75061, AR: 166052

New York Life Insurance Company | 51 Madison Avenue New York, NY 10010 | on Policy Form GMR

This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York Department of Financial Services. Other Plan Features included at no additional cost (See Certificate for full description):

• Catastrophic Disability Benefit - Pays a benefit 9.75% of your monthly income loss if you cannot perform 2 of the 6 Activities of Daily Living (ADL) or suffer Cognitive Impairment
• Vocational Rehabilitative Benefit - If you participate in a rehabilitation program approved by New York Life and without any reduction in benefits.

Effective Date - Coverage becomes effective first of the month on or following approval of your application and the required premium is paid when due.

Certificate of Insurance - This information is only a brief description of the principal provisions and features of the plan. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to the Civil Service Employee Benefit Association. When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the Plan.

30 Day Free Look - When you receive your Certificate of Insurance, read it carefully. If you are not completely satisfied with the terms of your new insurance, simply return your Certificate, without claim, within 30 days and your premium will be promptly refunded. Your insurance will then be invalidated.

Please Note: This website explains the general purpose of the insurance described, but in no way changes or affects the policy Master Policy G-30305-0 as actually issued. In the event of a discrepancy between this website and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies are underwritten by New York Life Insurance Company detail exclusions, limitations, 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.