Health 10

Many insurance companies offer a short-term additional benefit in the form of a rider. The rider normally covers the first 6 to 12 months of a disability. Some insurers refer to the rider as a Social Security Rider as it pays benefits while the insured is awaiting Social Security Benefits. The rider is not related to Social Security and, therefore, an AMB Rider is used to define the benefit. The short-term benefit could supplement either a government or private benefit plan. Unlike the SIS, this rider (AMB) does not consider the amount of a Social Security Benefit. It is strictly in addition to all other disability benefits.

Additional Monthly Benefit (AMB) Rider

The benefit amount is subject to maximum and minimum weekly limits.

Total disability

When an insured is totally disabled because of the transplant of an organ to another individual, the insurer will deem the insured to be disabled as a result of sickness.

Transplant Donor Benefit

______________ _____________ benefits are mandated by state (or federal) law, they are primary to any other insurance benefits.

Workers' Compensation

The total dollar limit is ____-____% of the employee's disability benefits.

150-180%

Benefit amounts are usually limited to typically _______ of the participant's LTD policy

2/3

How long is the waiting period for social security?

5 Full months

A spouse and other dependents (parents or children) may be eligible for up to ____% of the amount of the disability benefit received by the disabled individual.

50%

A spouse caring for the worker's unmarried child who is under age 16 or was disabled before age 22 also receives a benefit equal to ___% of the employee's PIA. Unmarried children under age 18 (or 19 if still in high school) or if disabled prior to age 22 are also eligible for a benefit equal to 50% of the employee's PIA. The total dollar limit is 150-180% of the employee's disability benefits.

50%

Unmarried children under age 18 (or 19 if still in high school) or if disabled prior to age 22 are also eligible for a benefit equal to ___% of the employee's PIA. The total dollar limit is 150-180% of the employee's disability benefits.

50%

The elimination period may be as short as ______ days for accident and ___ days for sickness but is rarely more than ___ or ___ days. Benefits are typically paid weekly and range from ___% to ____% of the individual's income.

0,7 days,15,30 50% to 100%

Group short-term disability benefits are payable for 13, 26, or 52 weeks typically, but never longer than 2 years. The elimination period is usually 0-7 days but rarely longer than 15-30 days. Benefits are typically paid weekly and can be as high as ______% of wages.

100%

If the total of SSDI, Workers' Compensation, and other public disability benefits exceeds ____% of the worker's pre-disability earnings, the SSDI benefit will be reduced dollar-for-dollar until the ____% limitation is reached.

80%, 80%

Some companies will allow an insured to add a life insurance rider to a disability income policy in the form of __________ ___________ _________ rider . This provides additional death benefits if the insured dies due to a disability.

Annual renewable term rider

Some policies are stricter and require the insured to be unable to perform the duties of any occupation for which he/she is reasonably suited by education, training, and experience. This definition is more restrictive and harder to qualify for benefits.

Any occupation

The time period the insured is eligible to receive payments after the elimination period has been met.

Benefit period

Provides the funds to cover the overhead expenses of a business when the owner becomes disabled. The benefits include expenses such as office rent, utilities, and employee labor. However, the owner cannot collect for loss of income under this policy.

Business overhead expense

Pays a lump sum, enabling a partnership or business to buy out the totally disabled principle's interest in the business.

Buy-sell agreement

This form of a return of premium begins building values equal to a percentage of premiums paid for a disability policy. The values start building around the third year and build to 100 percent at age 65, which can be returned to the insured at that time, less any claims.

Cash surrender rider

Automatically increases monthly benefits after the onset of a disability, as the Consumer Price Index (CPI) increases. An adjustment in benefits is made on each anniversary while the disability continues and protects the insured against inflation.

Cost of living rider

To collect Social Security disability benefits, an employee must be unable to engage in any substantial gainful activity due to a medically determined physical or mental condition that has lasted or is expected to last at least 12 months or result in an early death.

Definition of Disability

Based on the employee's average indexed monthly earnings on which Social Security taxes have been paid. This is referred to as the Primary Insurance Amount (PIA).

Disability Income Benefits

__________ _____________ _________ helps a small business that has long-term financial commitments requiring regular monthly payments to meet its obligations. The amount of the benefit remains the same monthly, but the benefit period reduces.

Disability Reducing Term

Helps a small business that has long-term commitments requiring monthly or other regular payments meet their obligations. The amount of coverage remains the same monthly, but the benefit period reduces as the debt reduces.

Disability Reducing term

Pays an income benefit when the insured is unable to work due to illness or injury (even if injured on vacation). Benefits are paid weekly or monthly and determined as a flat benefit or a percentage of the insured's current earnings, normally 60% - 70%.

Disability income policy

is the time period an individual must be disabled before benefits become payable. This waiting period for a disability due to an illness is usually longer than for an injury due to an accident. For example, a policy may have a 6-month elimination period for loss due to a sickness and waive the elimination period to provide immediate coverage in case of an accident.

Elimination Period

Guarantees that on specified dates, ages, or occurrences, such as marriage, birth of a child, etc., the insured may purchase additional monthly benefits, if income justifies it, without proof of insurability. Rates are based on attained age. Some insurers refer to this as a Future Increase Option (FIO).

Guaranteed Purchase Option rider

Waives the elimination period if insured is hospitalized during the period of elimination, but only pays when being treated as an inpatient.

Hospital Confinement Rider

Eliminates coverage for preexisting conditions, such as back injuries. Attaching this rider excludes coverage for a condition that would otherwise be covered. The use of this rider may make insurance obtainable for an otherwise uninsurable person.

Impairment rider

Pays a benefit to the business when a key employee becomes disabled by helping pay for a replacement, train a new employee, or replace loss of revenue due to the disabled employee's lack of ability to work.

Key employee insurance

Extends the benefits for life if total disability begins before a specified age. If disability begins when the insured is older than the age specified, the rider is not in effect.

Lifetime benefit rider

This coverage is often characterized by benefit periods of 2 years, 5 years, to age 65, or lifetime. The elimination period will most commonly be either 30, 60, 90 or 180 days. It may be possible to obtain a __________-_________ __________ policy with a two-year elimination period, to be used in conjunction with a short term disability policy that pays benefits for 2 years.

Long-term disibility

The policy covers a disability due to injury and sickness which occurs off the job only.

Non occupational

Does not pay disability income, but pays the medical expenses that are related to an injury that does not result in total disability (such as Emergency Room, x-rays, durable medical equipment, etc.). It is a limited form of medical expense coverage added to a disability income policy.

Non-Disabling Injury Rider

The policy covers a disability due to injury and sickness which occurs either on or off the job.

Occupational

some policies require the insured's inability to perform the main duties of his/her own occupation. The own occupation definition often applies for the first 2 years of a disability, then changes to any occupation. This definition is the least restrictive and is easier to qualify for benefits.

Own occupation

Benefits restore a percentage of lost wages.

Partial disability

Disability resulting in an inability to perform 1 or more of the regular duties of an occupation. The benefit usually pays up to 50% of a total disability benefit for 3 to 6 months.

Partial disability

n the event total disability continues beyond a specified period, future premiums will be waived by the insurer for the duration of the disability.

Waver of premium rider

A total disability that reduces or eliminates the insured's ability to work again.

Permanent disability

Loss is presumed to be total and permanent due to the loss of sight, hearing, speech, or the loss of 2 limbs. Benefits paid under presumptive disability are usually paid in a LUMP SUM.

Presumptive Disability

The employee is eligible for 100% of the _______________ _______________ ____________.

Primary Insurance Account

A __________ __________ may be included in some disability income policies to protect the insurer from immediate claims. The insurer may have a 15-30 day waiting period before losses due to a pre-existing condition.

Probationary period

Under this policy, the insured will receive benefits if loss of income is due to a covered accident or sickness, even if the insured is able to work full-time doing all the same duties as before the loss occurred. (injured densist)

Pure loss of income policy

When a second disability is suffered due to the same cause within a certain period of time (usually 6 months), the elimination period will not apply and the disability will be considered continuous.

Recurrent disability

Paid while the insured is totally disabled and receiving benefits, if the insured elects to participate in some form of vocational rehabilitation approved by the insurer. Total disability benefits will be continued as long as the insured is actively participating in the training program and remains totally disabled.

Rehab benefits

recognizes one's ability to continue to work, but at a reduction of earnings.

Residual disability

At specified policy years (typically after 10 years) the insurer will provide a refund of 80% of premiums paid in to that point less any dollar amounts paid out in claims. This optional rider has a premium requirement which can be an additional 40-60% of the base policy's premium.

Return of premium rider

There is a schedule of benefits for specific permanent partial injuries, such as a specific amount for loss of an eye or a specific amount for loss of a hand

Scheduled income

__________- _________ _________ _________ plans are characterized by maximum benefits for periods of rather short duration, such as 13, 26, or 52 weeks. Often, benefit periods are coordinated with the employer's "sick pay plan." __________- _________ _________ _________ will not pay benefits for disabilities lasting longer than 2 years.

Short-Term Disability Income, Short-Term Disability Income

Pays in addition to regular disability policies until Workers' Compensation or Social Security payments begin. It is also designed to provide benefits if social security is declined. If either benefit stops, the SIS will pay benefits. The SIS, which was developed by private insurers to reduce over insurance by matching Social Security as closely as possible, is normally written for a specified period of time.

Social Insurance Supplement (SIS) Rider

"currently" insured (a sliding scale based on age, beginning with 6 credits in the past 13 quarters for persons age 21 to 24), and satisfying the waiting period.

Social Security Disability Insurance

An insured is able to continue to work at reduced efficiency or reduced hours, but is expected to fully recover.

Temporary disability

affects both the short- and long-term group disability benefits for the people employed after age 65. This, in turn, will have some effect on premium determination by the insurer when underwriting a particular group.

The Age Discrimination in Employment Act (ADEA)

Individual and group disability benefits will be reduced by the amount of ____________ _____________ benefits. ___________ _____________ is always the primary payor when applicable.

Worker's compensation, Worker's compensation

___________ ___________ coverage applies to bodily injury and or occupational diseases that arise from and in the course of employment. There are 4 "statutory claims" for benefits under most states' Workers' Compensation laws: Disability Income, Rehabilitation (job retraining), Medical Expenses, and Survivors' Income (including a burial benefit).

Workers' Compensation

The individual or group benefit will be reduced dollar-for-dollar by the amount of _________ _________ benefits paid, so that the total disability income benefit payable from all sources combined will _____ __________ the amount that would be payable by the individual or group disability policy on its own.

Workers' Compensation, not exceed

The more _______________ the occupation, the _________ benefit and/or the ___________ the premium. Consideration is also given to any hazardous hobbies, such as bull riding, skydiving, and bungee jumping, which would affect the rating or require an exclusion rider.

dangerous, less, higher

Benefits do not include ________ ________ and each state sets the eligibility requirements for Workers' Compensation benefits.

extra income

Group disability income insurance is usually offered only on a ________________________ basis, which will not cover work-related disabilities. Work-related injuries are usually covered under ______________ _____________ Insurance.

nonoccupational,Workers' Compensation

In underwriting disability income, the insured's _____________ is the single most important rating factor because a worker in America is more likely to suffer a disability than die prior to age 65.

occupation

The change of ______________ provision in a disability income policy could result in a change of benefits depending on the new occupation, or the insurer could change the amount of premium to fit the occupational rating for the current level of benefit.

occupation

_________ and _________ disability benefits are referred to as "at-work" benefits since the insured is able to work and continue to receive benefits. All other disability benefits are considered "24 hour" benefits.

partial, residual

In order to qualify for disability benefits, it may be required that the insured be under the care of a ____________, regardless of the definition used in the policy.

physician