Your CSEA Group Long Term Disability benefits can begin following approval from New York Life. Your coverage will take effect on the first day of the month after your application has been approved and first payment has been received. Once approved you will receive a Certificate of Insurance describing the terms and conditions of your coverage. If you are not working full-time on the date your insurance is scheduled to become effective, your insurance will not become effective until you return to full-time work. However, if you are not actively working due to a non-working day, you will still become insured on the scheduled effective date provided you would have been able to do your regular job on that non-working day.
Definition of "total disability" or "totally disabled"
means an injury, sickness or pregnancy requires that prevents you from performing your usual occupation. If you voluntarily decide to work at any occupation, you would no longer be considered totally disabled.
Definition of "Other Income":
(1.)50% of any salary, wages, partnership or proprietorship draw, commissions, or similar pay from Rehabilitative Employment (2.) any salary or other compensation you receive for work performed while disabled and the amount of any income payment under a salary continuance or sick leave plan; (3.) income payments, other than unearned income, from a professional corporation, partnership or other group practice arrangement. Income payments include the cost of your fringe benefits and the share of the total contributions to corporate surplus; (4.) income payments under a retirement plan, other than a government pension plan, which starts on or after the date of disablement for which Covered Disability benefits become payable; (5.) income payments under a government pension plan which starts on or after the date of disablement for which Covered Disability benefits become payable. Any increase in such payments that occurs after the waiting period is excluded from the determination of such benefits; (6.) 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; (7.) benefits in the form of periodic cash payments for a disability, excluding any benefits for a disability starting before the effective 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 your record of wages and self-employment income and payable to your spouse or child, without regard to any deductions from such benefits which can be made: (1) on account of work; (2) because of your refusal to accept rehabilitation; or (3) because your spouse or child 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; and/or (8.) benefits under any work loss provision in the mandatory part of any "no-fault" auto insurance policy.
Means a person's basic monthly pay from the State of California or any allied organization determined on his or her initial INSURANCE DATE and thereafter on each October 1. MONTHLY INCOME for hourly employees will be based on the hourly rate of pay, but not on more than 40 hours per week.
Successive periods of disability
Disabilities that are due to the same or related cause will be considered as one period of disability unless separated by a 3-month period during which you return to full-time work with the employer. Disabilities which meet these separation measurements will be treated as a new disability, subject to a new waiting period.
Benefits will not be paid for disabilities due to non-disclosed pre-existing conditions, as defined below until the end of the earlier of (1) 12 consecutive months after the effective date of coverage during which the covered person has had no treatment or medical advice for that condition or (2) 24 consecutive months during which the person has been insured under the policy. "Pre-Existing Condition" means any injury, sickness, pregnancy, mental, emotional or nervous disorder or related illness for which a person consulted a doctor, received any medical services or supplies or took any medication during the 12 months immediately before becoming covered under this plan and which was not disclosed on the person's request for coverage. A condition which was fully disclosed on the application for insurance is not considered a Pre-Existing Condition.
If you are disabled from your regular job but accept rehabilitative employment within 31 days after a period of disability for which a monthly benefit is payable, 50% of any salary, wages or similar pay received from rehabilitative employment will be considered along with your other sources of income and benefits when determining the monthly benefit payable.
What is not covered under this Disability plan (Exclusions and Limitations)
This plan does not pay benefits for a disability and/or confinement that began before a person becomes an insured member; a disability, confinement and/or injury that: occurs during or is due or related to incarceration for or participation in (except as a victim) the commission of a felony, an illegal occupation or activity, an insurrection, terrorist activity or a riot; any disability, confinement or injury caused by war or any act of war or an armed conflict which involves the armed forces of one or more countries, whether declared or not; intentionally self-inflicted injury, while sane or insane; A disability, confinement or injury that occurs or is due or related to duty in the military, naval or air service of any country; a disability that is due to a Preexisting condition as defined above; and specifically excluded from coverage; a disability that no longer requires the regular care and attendance of a doctor or any period of disability for which insured member is not under regular care and attendance of a doctor. AD&D Coverage: No benefits are payable for losses due or related to: serving as a pilot, crew or training instructor of any aircraft; disease or bodily infirmity, or medical or surgical treatment thereof; bacterial infections due to an accidental cut or wound; illegal use of drugs; use of alcohol, and; accidental ingestion of contaminated material. All other exclusions noted above also apply except those for: Preexisting Condition, and; regular doctor care.
When Coverage Ends
(1) the insured member retires or ceases active fulltime work of at least 20 hours per week (other than for reason of disability); (2) membership in the California State Employees Association ends; (3) active duty in the armed forces (except for training purposes of 2 months or less) begins; (4) premium contributions are not paid when due; (5) the Group Policy is terminated by the policyholder or New York Life; (6) the member is no longer a permanent resident of the United States, District of Columbia, Puerto Rico or Canada.
(Please read and retain for your records)
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, Inc. ("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, Inc., 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734, telephone +1-866-692-6901 (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 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.
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.
2 Confidential 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 7/15
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 85068-0997
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. J. Christopher Burke AR Insurance License #8876308.
This Group Whole Life Insurance Plan is underwritten by:
New York Life Insurance Company
51 Madison Avenue
New York, NY 10010
Under Group Policy G-29115-0 on Policy Form GMR-FACE/G-29115-0, New York Life is licensed/authorized to transact business in all 50 United States, District of Columbia, Puerto Rico and Canada. However, not all plans it underwrites are available in all jurisdictions. Please check plan details for current availability.
New York Life Insurance Company's state of domicile is New York and their NAIC ID# is 55915.
This is not a policy or Certificate of Insurance. It merely summarizes the principal features and is for informational purposes only. The complete terms and provisions 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 to the California State Employees Association.