When Coverage Begins: Your coverage will begin on the first of the month following the date your application is approved, provided you are actively-at-work full-time on the date, meet required evidence of insurability requirements and the premium is paid. If you are not Actively-At-Work, the insurance will not take effect until you return to full-time work for at least 10 consecutive workdays, if such day is within three months of the date insurance would otherwise have taken effect and the insured member is still eligible to obtain the insurance on that day. Benefits will begin on the first day of a covered total disability after completion of the applicable Waiting Period. Benefits will continue until the earlier of (a) the day the insured ceases to be totally disabled or (b) the end of the maximum benefit period.
When Coverage Ends: This coverage ends at age 70 or when you are no longer at full-time work, you stop paying your premiums when due, when you receive covered total disability benefits for the maximum benefit period, when you begin active duty in the armed forces, or the date the group policy ends.
Average Monthly Income means a person's average monthly wages, salaries, commissions, fees and any other amounts received by such person for personal services, including the cost of his or her fringe benefits and share of total surpluses. It does not include income from interest, dividends, rent, royalties, annuities, other insurance and other unearned income.
Covered Total Disability is an incapacity that completely and continuously prevents the insured member from doing the material and substantial duties of his/her regular occupation. Such covered disability must begin while the insured member is insured under the Policy and be the result of: (1) an injury. For a covered disability to be considered to have resulted from an injury, the covered total disability must begin within 90 days after an accident, if the accident occurs while the insured member is insured under the policy. If more than 90 days has elapsed, such covered disability will be considered to have resulted from an injury sickness; (2) a sickness; or (3) an organ donation that an insured member makes, provided he/she has been insured under the Policy for at least six consecutive months on the day of such donation.
A loss of license, in and of itself, does not constitute an incapacity that prevents the insured member from doing the material and substantial duties of his or her regular occupation and will not be deemed a Covered Total Disability.
Mental Disorder means a condition due to or resulting from psychiatric or psychological conditions, regardless of cause, such as: (a) schizophrenia; (b) depression; (c) manic depressive or bipolar illness; (d) anxiety; (e) personality disorders; and/or (f) adjustment disorders or other conditions, usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs or other similar modalities used in the treatment of the above conditions. This limitation does not apply to dementia, if due to: (a) stroke; (b) trauma; (c) viral infection; (d) Alzheimer's disease; or (e) other conditions not listed above which are not usually treated by a mental health provider using psychotherapy, psychotropic drugs or other modalities.
Chemical Dependency means the abuse of or psychological or physical dependency on or addiction to alcohol or a controlled substance. For purposes of this definition, "controlled substance" means a toxic inhalant, a volatile chemical, abusable glue or aerosol paint, or a substance designated as or considered a controlled substance under applicable federal, state or local authority.
Successive Periods of Disability will be considered one period of disability if such disabilities are due to the same or related causes, and which are separated by less than six months of return to continuous full-time work during which you are not totally disabled or different or unrelated causes are not separated by return to full-time work.
Waiting Period is the initial, continuous period of a Covered Total Disability which must be completed before such Covered Total Disability benefits become initially payable.
Note: The Maximum Benefit Period for all Covered Disabilities of an insured which are due to or related to Mental Illness and/or Chemical Dependency while such person is insured under the Policy, whether insurance has been continuous or interrupted, cannot exceed the lesser of: (a) 24 months; or (b) the Maximum Benefit Period for a Covered Disability due to an injury, sickness or organ donation. This limitation does not apply to any period during which such insured is institutionalized.
The CSEA Group Long-Term Disability Income Insurance does not cover and we will not pay a benefit for any loss or disability: Due to Crime/Illegal Occupation/Illegal Activity: Participation in or incarceration resulting from any of the following in a role other than as a victim: (a) the commission of a felony; (b) an illegal occupation or activity; (c) an insurrection; (d) terrorist activity; or (e) a riot. Intentional self-inflicted injury or an attempt at intentionally injuring oneself; while sane. Engagement in any of the following in a role other than a victim: (a) in war, (b) an act of war, or (c) an armed conflict which involves the armed forces of one or more countries; a pre-existing condition; an impairment restriction; 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. A disability that is due to a pregnancy or childbirth or a related medical condition, except for complications of pregnancy; Regular Care that does not require a doctor's regular care of, or attendance to, the insured; or for any period of disability for which the insured is not under the regular care and attendance of a doctor, except that: This requirement will not apply if such care is no longer required for prudent medical management of the injury, sickness or organ donation. For the purpose of satisfying the requirement that the insured be under the "regular care" of a doctor, doctor does not include the insured or a member of his or her immediate family. Occurs during, is due to, or is related to the insured member's travel in, travel on, fall from or descent from any aircraft when the aircraft is used to train, test, or experiment or is part of any military, naval or air force. Additional exclusions or limitations may apply as a condition of approval of your application for coverage.
Mental Disorder and Chemical Dependency Limitation: If you are disabled due to mental illness or substance abuse, the maximum benefit period for total and residual disability benefits is the lesser of: 1) the maximum benefit period shown on your schedule; or 2) 24 months during your lifetime. We will continue to pay benefits beyond the limited pay period if you are an inpatient under a physician's care in either a hospital or an institution which treats and cares for mental illness or substance abuse. In no case will benefits be paid beyond the maximum benefit period.
Pre-Existing Condition Limitation: 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's initial 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 months; or (b) an injury or sickness or condition classified as an Impairment Restriction.
Impairment Restriction - A disability that is due to or related to a condition which has an Impairment Restriction. Impairment Restriction means an exclusion or limitation of insurance on an INSURED MEMBER. An Impairment Restriction will be: (a) established by New York Life; and (b) continued by New York Life if it is in effect on the day before: (1) the INSURED MEMBER becomes insured under the Policy; or (2) a change in insurance takes effect; whether or not satisfactory medical evidence of insurability is furnished or medical evidence of insurability is required. All Impairment Restrictions are stated in the certificate. Insurance with such Impairment Restrictions is subject to the APPLICANT'S acceptance. Payment of one CONTRIBUTION after the INSURED MEMBER is advised of the Impairment Restriction will establish such acceptance.
Important Information from New York Life Insurance Company
New York Life Insurance Company reserves the right to request medical information to determine applicant's medical eligibility for coverage. Based on the age of the person proposed for insurance and the amount of coverage requested, a physical examination, EKG, blood test or other information may be required. Not all applicants will have to supply additional information. However, if it is required, New York Life will arrange for an independent professional paramedic to contact you to perform these simple tests at your convenience. The exam and blood test are free-of-charge. If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage be effective prior to this date. Payment of a premium contribution with your application does not mean that there is any insurance in force before the effective date as determined by New York Life.
How New York Life Obtains Information and Underwrites Your Request for the CSEA Group Long Term Disability Income 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 application 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, Inc., 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.
New York Life Insurance Company 8.12 ed.
If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage be effective prior to this date. Payment of a premium contribution with your application does not mean that there is any insurance in force before the effective date as determined by New York Life.
Questions? Please call +1-800-296-2732.
Administrative expenses incurred by the CSEA to provide the valuable membership benefits resulting from these sponsored insurance programs are reimbursed from available program dividends. New York Life may also, out of premium, pay a reasonable fee to the CSEA for making the CSEA assets available to it to promote these programs to the membership. These assets include the CSEA Intellectual Property Rights and mailing lists of eligible members.
Endorsed by: California State Employees Association
CSEA incurs certain administrative expenses in connection with this sponsored program. To provide and maintain this valuable membership benefit it is reimbursed for such expenses.
California State Employees Association
Administered by A.G.I.A., Inc.
PO Box 9997
Phoenix, AZ 85068-9954
A.G.I.A, Inc. is licensed and authorized to transact business in all 50 United States and the District of Columbia. Their state of domicile is California. J. Christopher Burke California Insurance License # 0F0947.
This Group Long Term Disability Insurance is underwritten by:
New York Life Insurance Company
51 Madison Avenue
New York, NY 10010
NEW YORK LIFE and the NEW YORK LIFE Box Logo are trademarks of New York Life Insurance Company
Under Group Policy G-30389-0 on Policy Form GMR-FACE/G-30389-0, New York Life is licensed/authorized to transact business in all 50 United States, District of Columbia, Puerto Rico and Canada. However, not all policies it underwrites are available in all jurisdictions. Please check benefit details for current availability.
New York Life Insurance Company's state of domicile is New York and their NAIC ID# is 66915.
This is not a policy or Certificate of Insurance. It merely summarizes the principal features and is for informational purposes only. The complete exclusions and limitations of coverage and the conditions under which it may be kept in force are contained in the group Master Policy issued by New York Life Insurance Company to the California State Employees Association.