Short-Term Disability
A昀氀ac Group Disability Advantage INSURANCE PLAN — NONOCCUPATIONAL A disabling illness or injury may be unpredictable. We'll help make sure they don't affect your 昀椀nancial plans, too. AG500751IN R1 IV (2/16)
AFLAC GROUP DISABILITY G INSURANCE PLAN Policy Series C50000IN DI A昀氀ac can help you protect one of your most important assets. Your income. All too often when we hear the words disability and insurance together, it conjures up an image of a catastrophic condition that has left an individual in an incapacitated state. Be it an accident or a sickness, that’s the stereotype of a disabling injury that most of us have come to expect. What most of us don’t realize is that in addition to accidental injuries, conditions such as arthritis, heart disease, diabetes, and even pregnancy are some of the leading causes of disability that can keep you out of work and affect your income. That’s where A昀氀ac group disability insurance can help. Our A昀氀ac group disability plan can help protect your income by offering disability bene昀椀ts to help you make ends meet when you are out of work. Our plan was created with you in mind and includes: • Off-job only coverage. • Bene昀椀ts that help you maintain your standard of living. Understanding the facts can help you decide if the Aflac group Disability Plan makes sense for you. FACT NO. 1 FACT NO. 2 DISABILITIES ACCOUNT FOR % $400 22 BILLION 1 2 PER YEAR IN HEALTHCARE EXPENDITURES. OF ADULTS IN THE UNITED STATES HAVE SOME TYPE OF DISABILITY. 1 Disability Impacts ALL of US., Centers for Disease Control and Prevention, 2015 2“Prevalence of Disability and Disability Type Among Adults,” Morbidity and Mortality Weekly Report, CDC, 2015. Underwritten by Continental American Insurance Company (CAIC) A proud member of the A昀氀ac family of insurers
Here’s why the For more than 60 years, A昀氀ac has been dedicated to helping provide A昀氀ac group individuals and families peace of mind and 昀椀nancial security when they’ve disability plan needed it most. Our group disability plan is just another innovative way to is right for you. help make sure you’re well protected under our wing. But it doesn’t stop there, having group short-term disability insurance from A昀氀ac means that you will have added 昀椀nancial resources to help with medical costs or ongoing living expenses such as rent, mortgage or car payments. The A昀氀ac group disability plan bene昀椀ts: • Bene昀椀ts are paid when you are sick or hurt and unable to work, up to 60 percent of your salary (up to 40% in states with state disability). • Minimum and Maximum Total Monthly Bene昀椀t – $300 to $6,000. • Premium payments are waived after 90 days of total disability (not available on 3 month bene昀椀t period). • Partial Disability Bene昀椀t. Features: • Bene昀椀ts are paid directly to you unless you choose otherwise. • Coverage is portable. That means you can take it with you if you change jobs (with certain stipulations). • Payroll Deduction – Premiums are paid through convenient payroll deduction. • Fast claims payment. Most claims are processed in about four days. How it works A昀氀ac Group Disability Plan pays the certi昀椀cate holder A昀氀ac Group The certi昀椀cate A physician Disability Advantage holder hurts his The determines the Nonoccupational back helping his certi昀椀cateholder certi昀椀cateholder coverage is selected friend move over visits the doctor. will be out of work 60% for 1 month while with a 60% the weekend. of his salary for the length of disability after of salary bene昀椀t recovering. the elimination period. The plan has limitations and exclusions that may affect bene昀椀ts payable. This brochure is for illustrative purposes only. Refer to your certi昀椀cate for complete details, de昀椀nitions, limitations, and exclusions. For more information, ask your insurance agent/producer, call 1.800.433.3036, or visit a昀氀acgroupinsurance.com.
Bene昀椀ts Overview TOTAL DISABILITY This convenient, affordable disability income plan will help provide needed income if you become Totally Disabled and are unable to work due to a covered injury or illness. Total disability bene昀椀ts will be payable monthly once the elimination period has been satis昀椀ed. PARTIAL DISABILITY The Partial Disability Bene昀椀t helps you transition back into full-time work after suffering a disability. If you remain partially disabled and are only able to work earning less than 80 percent of your pre-disability income at any job, this plan will still pay you 50 percent of your selected monthly bene昀椀t for up to the maximum partial disability bene昀椀t period of 3 months after the elimination period. You do not have to have received the Total Disability bene昀椀t to receive the Partial Disability bene昀椀t. WAIVER OF PREMIUM Premiums are waived after 90 days of Total Disability. After Total Disability bene昀椀ts end, any premiums which become due must be paid in order to keep your insurance in force. This bene昀椀t is not available on plans with a 3-month bene昀椀t period. PORTABILITY If you cease employment with your employer, you may elect to continue your coverage. In order to continue your coverage you must meet all of the requirements listed below. • You must work full-time for another employer. • You must make a written application and pay the required premium to us within 31 days after the date your insurance would otherwise terminate. • You must continue to pay any required premiums. The coverage you may continue is that which you had on the date your employment terminated. If you qualify for this portability privilege as described, then the same bene昀椀ts, plan provisions, and premium rate shown in your certi昀椀cate as previously issued will apply. Coverage may not be continued if you fail to pay any required premium or if the master policy terminates. Instructions for continuing coverage will be provided within your certi昀椀cate of coverage. What you need, when you need it. Group disability insurance pays cash bene昀椀ts that you can use any way you see 昀椀t when you are unable to work due to an accident or sickness.
LIMITATIONS AND EXCLUSIONS DISABILITY INSURANCE WHAT IS NOT COVERED, AND TERMS YOU NEED TO KNOW
LIMITATIONS AND EXCLUSIONS LIMITATIONS AND EXCLUSIONS Treatment or Medical Treatment is the consultation, care, or services If this coverage will replace any existing individual policy please be aware provided by a Doctor. This includes receiving any diagnostic measures and that it may be in your best interest to maintain their individual guaranteed- taking prescribed drugs and medicines. renewable policy. We will not pay bene昀椀ts for any Disability resulting from or affected by a We will not pay bene昀椀ts for loss caused by Pre-Existing Conditions (except Pre-existing Condition if the Disability was diagnosed within the 12-month as stated in the provision below). period after the Effective Date. We will not pay bene昀椀ts whenever coverage provided by this Policy is in We will not reduce or deny a claim for bene昀椀ts for any Disability due to a violation of any U.S. economic or trade sanctions. If the coverage violates pre-existing condition that was diagnosed more than 12 months after the U.S. economic or trade sanctions, such coverage shall be null and void. Effective Date. We will not pay bene昀椀ts whenever fraud is committed in making a claim PREGNANCY LIMITATION under this coverage or any prior claim under any other A昀氀ac coverage for Within the 昀椀rst nine months of the Effective Date of coverage, we will not which you received bene昀椀ts that were not lawfully due and that fraudulently pay bene昀椀ts for a Disability that is caused by, or occurs as a result of, your induced payment. Pregnancy or childbirth. Disability due to Complications of Pregnancy will We will not pay bene昀椀ts for a Disability that is caused by or occurs as a be covered to the same extent as a covered Sickness. result of: 1. Any act of war, declared or undeclared; insurrection; rebellion; After this coverage has been in force for nine months from the Effective or act of participation in a riot; 2. Actively serving in any of the armed Date of coverage, Disability bene昀椀ts for childbirth will be payable. The forces, or units auxiliary thereto, including the National Guard or Reserve; maximum Period of Disability allowed for Disability due to childbirth is six 3. An intentionally self-in昀氀icted Injury; 4. A commission of a crime for which weeks for noncesarean delivery and eight weeks for cesarean delivery, the Insured has been convicted; we will not pay a bene昀椀t for any Period of less the Elimination Period, unless you furnish proof that your Disability Disability during which the Insured is incarcerated; 5. Travel in, or jumping continues beyond these time frames due to Complications of Pregnancy. or descent from any aircraft, except when a fare-paying passenger in a TERMS YOU NEED TO KNOW licensed passenger aircraft; 6. Mental Illness as de昀椀ned; 7. Alcoholism or Actively at Work refers to your ability to perform your regular employment drug addiction; 8. An Injury that arises from any employment; 9. Injury or duties for a full normal workday. You may perform these activities either at Sickness that is covered by Worker’s Compensation. your employer’s regular place of business or at a location where you may be PRE-EXISTING CONDITION LIMITATION required to travel to perform the regular duties of your employment. Pre-existing Condition is a disease or physical condition of a person that Bene昀椀t Period is the maximum number of days after the Elimination Period, existed within the 12-month period before your effective date. For a if any, for which you can be paid bene昀椀ts for any period of disability. Each condition to have been Pre-existing a Doctor must have advised, diagnosed, new Bene昀椀t Period is subject to a new Elimination Period. or treated the covered employee, or symptoms existed that would ordinarily cause a prudent person to seek medical advice or treatment.
Complications of Pregnancy refers to: Mental Illness is de昀椀ned as a Total Disability resulting from psychiatric Conditions requiring Medical Treatment that comes before or comes after or psychological conditions, regardless of cause. Mental Illnesses and the termination of a pregnancy. The diagnoses for this Medical Treatment Emotional Disorders includes but are not limited to the following: bipolar must be distinct from pregnancy but either adversely affected by pregnancy affective disorder (manic-depressive syndrome), delusional (paranoid) or caused by pregnancy. For a condition to be a Complication of Pregnancy, disorders, psychotic disorders, somatoform disorders (psychosomatic it must constitute a classi昀椀ably distinct pregnancy complication. Examples illness), eating disorders, schizophrenia, anxiety disorders, depression, of such Complications of Pregnancy are: 1. Acute nephritis; 2. Nephrosis; stress, post-partum depression, personality disorders and adjustment 3. Cardiac decompensation; 4. Missed abortion; 5. Disease of the vascular, disorders or other condition usually treated by a mental health provider or hemopoietic, nervous, or endocrine systems; and 6. Similar medical and other quali昀椀ed provider using psychotherapy, psychotropic drugs or other surgical conditions of comparable severity. similar modalities used in the treatment of the above conditions. Further Complications of Pregnancy include: Partial Disability refers to your being under the care and attendance of a 1. Hyperemesis gravidarum and pre-eclampsia requiring hospital Doctor due to a condition that causes your inability to perform the material con昀椀nement; 2. Ectopic pregnancy that is terminated; and 3. Spontaneous and substantial duties of your Full-Time Job. To qualify as Partial Disability, termination of pregnancy that occurs during a period of gestation in which a you are able to work at any job earning less than 80 percent of the Annual viable birth is not possible. Income of your Full-Time Job at the time you became disabled. Complications of Pregnancy do not include the following conditions: Sickness refers to a covered illness, disease, infection, or any other abnormal physical condition that is not caused by an injury and any 1. Multiple gestation pregnancy; 2. false labor; 3. occasional spotting; and 4. resulting covered period of disability must occur on or after the effective morning sickness. date of coverage and while coverage is in force. Other similar conditions associated with the management of a dif昀椀cult Termination Coverage will terminate on the earliest of: (1) the date the pregnancy are not considered Complications of Pregnancy. Cesarean master policy is terminated, (2) the 31st day after the premium due date if deliveries are not considered Complications of Pregnancy. the required premium has not been paid, (3) the date you cease to meet the Effective Date is the date shown on the Certi昀椀cate Schedule, provided you de昀椀nition of an employee as de昀椀ned in the master policy, (4) the date you no are actively at work, or if not, it is the date you are actively at work as an longer belong to an eligible class, (5) age 75. eligible employee Total Disability refers to your being under the care and attendance of a Elimination Period is the number of continuous days at the beginning of Doctor due to a condition that causes your inability to perform the material your Period of Disability for which no bene昀椀ts are payable. Each new Bene昀椀t and substantial duties of your Full-Time Job. To qualify as Total Disability, Period is subject to a new Elimination Period. you may not be working at any job. Injury refers to a bodily injury that is not otherwise excluded that is directly You and Your refers to an employee as de昀椀ned in the Plan. caused by a covered accident, not caused by sickness, disease, bodily in昀椀rmity, or any other cause, and any resulting covered period of disability must occur on or after the effective date of coverage and while coverage is in force.
AFLAC GROUP DISABILITY ADVANTAGE INSURANCE G Policy Series C50000 DI PRE-EXISTING CONDITIONS BENEFIT During the first 12 months of coverage, this benefit pays 50% of the covered employee’s applicable monthly disability benefit for a pre-existing condition, including pregnancy. Benefits begin following the expiration of an applicable Elimination Period. Disability Benefits will end when: · You are cleared by the doctor and return to your full-time job, or · You earn 80% or more of pre-disability income working at any job, or · You reach the end of the maximum disability benefit period. For a complete list of limitations and exclusions please refer to the brochure. This benefit supersedes the pre- existing conditions limitation listed in the brochure. Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. Continental American Insurance Company • Columbia, South Carolina The certificate to which this sales material pertains is written only in English; the certificate prevails if interpretation of this material varies. This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. This brochure is subject to the terms, conditions, and limitations of Policy Form Series C50000. AG50084P R1 IV (2/16)
a昀氀acgroupinsurance.com 1.800.433.3036 Continental American Insurance Company (CAIC), a proud member of the A昀氀ac family of insurers, is a wholly-owned subsidiary of A昀氀ac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. Continental American Insurance Company • Columbia, South Carolina The certificate to which this sales material pertains is written only in English; the certificate prevails if interpretation of this material varies. This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. This brochure is subject to the terms, conditions, and limitations of Policy Form Series C50000IN.
