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NYSSCPA
Member Insurance Plans
October
2000
The
Society offers the following insurance plans as a special
benefit to members. The insurance programs are monitored and
supervised by the Society's Members Insurance Committee. All
programs, except GEICO automobile and CAMICO professional
liability insurance, are administered by Seabury & Smith.
Members
may contact the NYSSCPA account coordinator at Seabury & Smith
for plan details and application materials by calling the
exclusive toll-free number (800) 342-6501. For automobile
insurance, members may contact GEICO at (800) 368-2734. For
professional liability, contact CAMICO Mutual at (800) 652-1772.
Members may also contact Paul Sinegal, the NYSSCPA's Manager,
Members Insurance, at (212) 719-8419 or by e-mail: psinegal@nysscpa.org.
Automobile
Insurance
The GEICO
Auto Insurance Program offers NYSSCPA members quality car
insurance with complete 24-hour sales, policy, and claim service.
As a NYSSCPA member, you may also qualify for a Member Discount,
in addition to GEICO's already low rates. The discount is
available in most states. Call GEICO today for a free rate
quote at 1-800-368-2734.
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$1,000,000
Catastrophe Major Medical Insurance (with Nursing Home and
Home Health Care Benefits) For New York Residents
Some
accidents or illnesses can leave a person so severely injured
that he or she may require extensive surgery, long-term hospitalization
and perhaps home health care before the individual is fully
recovered. Most basic health insurance plans have a limit
or "cap" on the total lifetime benefits available to an insured—and
a catastrophic illness or accident can quickly add up to meet
that "cap" and exceed it, too.
Today,
the medical costs of a serious illness or accident are often
far beyond the benefits provided by the average hospitalization
or major medical insurance policy. Rising hospital and nursing
home costs, escalating doctors' fees, expensive medication,
home health care costs, specialized surgical procedures and
new sophisticated equipment can push your expenses far over
the limit that basic insurance was ever designed to handle.
Even if a basic health insurance policy may have a large lifetime
maximum benefit, benefits may be restricted per year as to
what will and won't be covered.
When
health care bills go beyond that cap, then it's up to the
patient to pay the remainder. The catastrophe major medical
insurance plan helps Society members by paying those costs
that are in excess of a basic health plan, including Medicare.
The
Society’s $1,000,000 catastrophe major medical insurance plan
helps take over when a member’s basic health insurance (including
Medicare) runs short. This plan helps cover the rising cost
of extensive medical care.
The
plan helps pay up to 100 percent of all eligible expenses
including:
- Daily Hospital Room and Board charges - up to $400 per day
if you Medicare eligible. Up to $150 per day if you are not
eligible for Medicare; however, your deductible will be reduced
by $2,000 for each day of hospital confinement.
- Miscellaneous
Hospital Services.
- Intensive Care up to $800 per day.
- Doctor bills; physicians, surgeons and licensed physiotherapists.
- Private duty nursing services of registered or licensed
practical nurses where medically necessary.
- Up to $300 per day - maximum $30,000 per benefit period.
- Oxygen; rental of equipment for its administration and rental
of wheelchairs or hospital beds.
- Prescription drugs and medications.
- Surgery; anesthetic and its administration.
- Ambulance service up to $2,000 per benefit period.
- Blood and blood plasma; artificial limbs and eyes; surgical
dressings, casts, splints, braces, trusses, crutches.
- Diagnostic tests, x-rays and laboratory fees; radiation
and chemotherapy.
- Dental treatment if natural teeth are injured by a covered
non-job related accident.
- Home Health Care up to 100 visits per benefit period.
- Hospice Health Care up to 210 days confinement per benefit
period.
- Psychiatric, mental, nervous or emotional illness. Diagnosis
and treatment while hospitalized - up to 30 days per calendar
year. Up to 30 outpatient visits per calendar year - maximum
benefit $50 per visit. Up to 3 emergency visits per calendar
year - maximum benefit $60 per visit.
- Alcoholism, alcohol abuse, substance abuse and substance
dependency. Diagnosis and treatment while hospitalized. Inpatient
rehabilitation in an alcohol or substance abuse treatment
center - up to 30 days per calendar year. Up to 60 outpatient
visits per calendar year in an alcohol or substance abuse
treatment center - 20 of which may be for family members of
the alcohol or substance abuser.
- PLUS: Nursing/Convalescent home benefit up to $300 per week
for confinement beginning within 14 days after hospital confinement;
lifetime maximum $46,800. (Nursing/Convalescent Home Definition:
A licensed institution that has -- organized facilities to
care for and treat its patients; a physician on staff to supervise
such care and treatment; and a registered nurse on duty at
all times. A Nursing Home, or Convalescent Home, DOES NOT
mean a place or part of one, which is used mainly for the
aged; alcoholics; drug addicts; or persons with mental, nervous
or emotional disorders.).
HOW
THE PLAN WORKS -- This Plan has a $25,000 deductible
feature to help keep the premiums for members affordable.
Benefits paid by a member’s insurance plan or Medicare are
used to satisfy the deductible. It applies separately to each
person for each sickness or injury. Each member has up to
24 consecutive months to satisfy the deductible and you may
use all eligible expenses.
IF
YOU ARE MEDICARE ELIGIBLE -- After satisfying the
$25,000 deductible for each sickness or injury the Plan pays
up to 100 percent of the additional eligible expenses for
that sickness or injury for the three year benefit period
- up to the aggregate lifetime maximum of $1,000,000.
IF
YOU ARE UNDER AGE 65 AND NOT MEDICARE ELIGIBLE --
After satisfying the $25,000 deductible (which will be reduced
by $2,000 for each day of hospital confinement) for each sickness
or injury the Plan pays up to 100 percent of the additional
eligible expenses for that sickness injury for the three-year
benefit period. Hospital benefits are calculated as follows
for those under age 65 and not eligible for Medicare:
|
The first thirty days of hospital confinement in a benefit
period: |
$ 75.00 |
|
Next 100 days: |
$100.00 |
|
Thereafter: |
$150.00 |
These
benefits will be paid regardless of any reimbursement received
from any underlying basic coverage. This only applies to charges
made by a hospital while the insured is confined as an inpatient.
TERMS
OF COVERAGE -- Once the benefit period begins, all
eligible expenses due to the same recurrent sickness or injury
are covered until either the $1,000,000 maximum is reached
or the three-year benefit period ends. If no expenses are
incurred for that sickness or injury for 12 months, it will
be treated as a new sickness or injury with a new deductible
and benefit period.
RENEWABILITY
– Members can continue their coverage for as long as they
want, regardless of age, as long as premiums are paid when
due and the Group Policy remains in force. Coverage for dependant
children will continue until the child reaches age 19 (25
if a full-time student), marries or becomes self-sufficient,
whichever occurs first. Even if the member dies, the insured
spouse and dependant children can continue coverage as long
as they remain eligible and pay premiums when due.
COMMON
DISASTER BENEFIT -- If more than one insured family
member is injured in the same accident, only one deductible
will be applied and each insured family member will then be
eligible for benefits during the benefit period.
SURVIVOR
CLAUSE -- Coverage for the insured’s dependents may
continue after the insured dies, as long as they remain eligible,
the premiums are paid when due and the Group Policy remains
in force.
EXCLUSIONS
-- No benefit is payable unless the expense is incurred while
the member is insured, and upon the recommendation of a legally
qualified physician who is treating the sickness or injury.
No benefit is payable for expenses which the insured is not
legally obligated to pay.
Eligible
medical expenses do not include charges incurred as a result
of: war or act of war; intentionally self-inflicted injury;
treatment which would be given free of charge if the person
was not insured; losses for which benefits are payable under
any Worker's Compensation Law or similar legislation; routine
nursery care for a newborn child; treatment given by a member
of the insured's immediate family or by an employee of the
insured's employer. Eligible expenses also do not include
charges incurred in connection with dental work, vision care,
hearing aids, cosmetic surgery, mental disorders, alcoholism
or drug addiction, except to the extent, if any, described
within.
PRE-EXISTING
CONDITIONS -- Any injury or sickness for which an
ordinarily prudent person would have sought medical advice,
diagnosis, care or treatment within six months prior to the
effective date of coverage, or any injury or sickness for
which medical advice, diagnosis, care or treatment was recommended
or received within 6 months prior to the effective date is
a pre-existing condition. Pregnancy that exists on the effective
date is also a pre-existing condition. Pre-existing conditions
are not covered unless the insured person has been covered
under the Group Policy for 12 consecutive months. ALL covered
injuries and sicknesses which occur AFTER the effective date
of insurance are covered immediately.
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Accidental
Death and Dismemberment
In recent
years, Accidental Death & Dismemberment Insurance has become
one of the more important types of insurance coverage recommended
for professionals like CPAs and accountants. Many professionals
find it vital to have adequate insurance protection that will
provide for themselves and their loved ones in the event of
an accident that causes death or severe injuries. NYSSCPA's
Accidental Death & Dismemberment Insurance provides the financial
protection needed by its members. This NYSSCPA Plan is underwritten
by the United States Life Insurance Company in the City of
New York.
An accidental
injury can be severe enough to prevent a Society member from
doing everyday work. Unfortunately such an injury can easily
happen to anyone.
The
Accidental Death and Dismemberment insurance, underwritten
by the United States Life Insurance Company in the City of
New York, provides Society members with a benefit for a covered
accidental injury or accidental death. This benefit is paid
in addition to any health insurance benefits the insured might
receive.
This
plan provides worldwide, around-the-clock protection for all
accidents, whether they happen on or off the job. This is
complete coverage.
All
NYSSCPA members and their spouses under age 70 are eligible
for coverage. Members and their spouses may apply for benefits
ranging from $50,000 to $500,000.** [FOOTNOTE: **the spouse's
benefit may not exceed the amount the member has selected]
When injury results within 365 days of an accident, or when
death occurs, this plan will pay the selected benefit. (See
the payment schedule below.)
Benefit
Features:
- Choice of benefit options
- 24-hour coverage—at economical group rates—anywhere in the
world, work-related or not
- Benefits paid directly to the insured or their chosen beneficiary
(the member is the beneficiary of a spouse's coverage)
- Coverage also available for dependent children
This
insurance is an economical way to have that extra coverage
for the unexpected. Moreover, this plan will remain in force
as long as the premiums are paid when due, and the insured
remains a NYSSCPA member in good standing and the Master Group
Policy remains in force.
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Long-Term
Disability Income Insurance
This
plan is designed to safeguard one of the members' most valuable
assets: earning ability. All members and employees of members
under age 70 and actively working with an employer on a full-time
basis (20 hours per week) are eligible for disability benefits.
Members under the age of 60 are eligible for up to $5,000
($3,200 under Plan Two) per month in benefits. Members between
the ages of 60 and 69 are eligible for a $500 per month benefit.
Plus, the Disability Plan includes a number of important features,
including:
*Choices
to cater coverage to meet individual needs. Members can pick
between two plans:
-
Plan One provides benefits to age 70 (with the length of benefits
being determined based on the age at disability)
- Plan Two provides benefits for two years.
*Both plans have a choice of monthly benefit amounts.
*Plan One also allows a choice of waiting periods so members
can cater their coverage to combine these benefits with benefits
from other sources of income.
WHO
IS ELIGIBLE FOR THIS PLAN -- Members of the NYSSCPA,
or the employee of a member, under age 70 and actively at
work with an employer on a full-time basis (20 hours per week),
are eligible to apply for this coverage.
Eligible
enrollees under the age of 60 may apply for the plan of their
choice and select their monthly benefit, as well as selecting
a waiting period for coverage to begin. This choice allows
enrollees to cater coverage to meet individual needs.
Eligible
enrollees over the age of 60 may apply for a $500 monthly
benefit under the plan of their choice.
THE
DEFINITION OF TOTAL DISABILITY
Total
Disability is defined as the complete inability of a person
to perform the material duties of his regular occupation or
profession during the waiting period and during the next 60
months. "His regular occupation or profession" is that which
the person was performing on the day before the total disability
began.
After
60 months, total disability is the complete inability of the
person to perform the material duties of any gainful job for
which he is reasonably fit by training, education or experience.
The
total disability must be a result of an injury or sickness
and a person must also be under the regular care of a physician.
WAITING
PERIOD means a period of consecutive days of total disability
for which no benefits are paid. The waiting period begins
on the first day of total disability occurring after the effective
date of a person's insurance. Members may choose and extended
waiting period to coordinate with other sources of short-term
disability benefits they may already be able to receive.
IMPORTANT:
The total benefit amount selected under this plan, when added
to any other disability benefits the member may have in effect
or may be eligible for, may not exceed 60 percent of the member's
or employee's regular monthly earnings.
Benefits
for Plan I will be coordinated with other income benefits
received from other sources. More details are available in
the Certificate of Insurance.
Benefit
Features:
- Elect monthly benefits to suit needs and lifestyle
- 24-hour protection—on or off the job—anywhere in the world
- Spouse may also apply for coverage
IMPORTANT
PLAN BENEFITS
Whether
Plan 1 or Plan 2, Disability coverage includes a number of
important additional plan features. These features include:
Partial
Disability Benefits -- After completing the waiting
period, and 31 days of total disability as defined by the
policy, a benefit is payable for partial disabilities if the
member is unable to work more than four hours per day. The
benefit is payable at the rate of 50 percent of the total
disability benefit, for up to three months.
Residual
Disability Benefit – Society members are eligible
to receive a residual disability benefit if totally disabled
and collecting benefits under this plan for no more than five
years (two years for Plan 2); plus, the member’s earnings
after returning to work must be less than 75 percent of your
pre-disability earnings. The residual benefit will be equal
to a chosen monthly benefit, less 60 percent of the member’s
monthly earnings.
As an
example:
Monthly earnings = $3,000 (before disability)
Monthly earnings = $1,000 (after disability)
Monthly disability benefit = $1,500 (from this Plan)
$1,500
- ($1,000 x ..60 = $600)
$1,500 - $600 = $900
Your
residual disability benefit would be $900
Cost
Of Living Benefit -- A cost-of-living adjustment will
be paid every January 1st following each completed calendar
year that the member has been totally disabled. The adjustment
to the monthly benefit amount will be the lesser of (1) two-thirds
of the percentage increase in the Consumer Price Index for
the previous year, or (2) five percent.
The
cost-of-living adjustment will continue to the member’s monthly
benefit until the amount payable is 125 percent higher than
it would have been without this benefit.
Survivor's
Benefit -- If an insured member dies while receiving
a monthly total disability benefit, a one-time benefit payment,
equal to three times the last net monthly benefit paid to
the insured, would be made if there is one or more eligible
surviving dependent.
Exclusions
-- No monthly benefit will be paid for disability due to intentionally
self-inflicted injury, a war or act of war, committing a crime
or an attempt to do so.
The
maximum benefit duration applies to all types of benefits,
including total disability benefits, rehabilitation benefits,
partial disability benefits and residual disability benefits.
Only one of these types of benefits is payable during any
given period of time.
If a
total disability is due to mental, nervous or emotional disorder,
alcoholism or drug addiction, a maximum of 24 monthly benefits
will be paid while such disability continues.
Limited
monthly benefits will be paid for pre-existing conditions
(an injury or sickness for which the person incurred charges,
received medical treatment, consulted a physician, or took
prescription drugs within 12 months before he or she became
insured by this policy). If a disability is due to a pre-existing
condition and it begins within 12 months of the date the person
becomes insured by this policy, no benefits will be paid.
If a disability is due to a pre-existing condition and it
begins more than 12 months after the date the person became
insured by this policy, benefits will be paid as they accrue.
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Supplemental
Hospital Indemnity Insurance
This
plan provides Society members and their families with additional
funds to protect against the rising costs of hospital stays.
Hospital
stays are expensive. An additional daily benefit can help
defray that expense, especially if your basic medical plan
has a high deductible, so it takes time before those benefits
even begin.
The
benefits from the Hospital Indemnity Plan are paid directly
to you to use anyway you decide. With these benefits, out-of-pocket
hospital expenses don't have to be paid out of your own pocket.
Benefit
Features:
- Select amount of daily benefit
- Benefit paid directly to you or anyone you assign
- Family coverage available
- Supplement your basic health plan with the Hospital Indemnity
Plan that provides a daily benefit directly to you.
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Term
Life Insurance (underwritten by United States Life Insurance
Company in the City of New York)
Research
shows that basic life insurance coverage should be equal to
six times an annual income.People with several children or
large financial obligations may need even more.
A supplemental
plan like the Group Term Life Insurance Plan lets Society
members add to their existing life insurance at economical
group rates for $50,000 or $1,000,000 in coverage.
The
NYSSCPA Sponsored Term Life Insurance Plan gives its members
a choice and is an ideal way to add to existing life insurance
coverage, keeping it up to date with current living expenses
and needs.
It's
available to you as an NYSSCPA member under age 70 and your
spouse any employees who meet the same acceptance requirements.
Cover
to age 75
Society
members can keep this coverage until the premium due date
on or next following the 75th birthday. Coverage will continue
as long as the group master policy is in force, the insured
remains a NYSSCPA member in good standing, and the member
pays the premiums on time.
One
Exclusion
Members
are covered for death from any cause, anywhere in the world.
Suicide, however, is not covered during the first two years
that coverage is in force.
Premium
Waiver
If the
insured should become totally disabled prior to age 60, coverage
continues without further premium payment for as long as the
disability continues or until the premium due date following
the 70th birthday. A member must be disabled for at least
six consecutive months and the insurance company must approve
this disability claim.
Benefits
During Terminal Illness
With
this feature, members are eligible to receive 60 percent of
selected life insurance benefit prior to death when they are
diagnosed with a terminal illness (as defined by the policy).
Members are allowed to use these benefits in any way you wish.
Members may need them to cover medical expenses or perhaps
use them for a personal wish. At the time of death, the beneficiary
will receive the remainder of the benefits.
Eligibility
During
this limited-time offer, all NYSSCPA members under age 70,
who are actively performing the duties of their occupation
(at least 20 hours a week) are eligible to apply for either
$50,000 or $100,000 of Term Life Insurance. Spoises imder
the age of 70 may also apply In addition, employees meeting
the same eligibility requirements are also eligible to apply.
Benefit
Features:
- Choice of benefits
- Economical group rates
- Accelerated Benefits Provision allows you to use a portion
of your benefit if a terminal illness is diagnosed
- Choice of beneficiary
- Spouse and children eligible for coverage
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Professional
Liability Insurance
CAMICO
Mutual Insurance Company knows that risk management involves
sharing a great deal of knowledge - like how to control exposure
to risk while growing a business.To that end the Society is
offering direct access to CAMICO’s experienced loss prevention
and tax experts who deal exclusively with the needs of CPAs.
Go to http://www.camico.com/website/services.asp
for complete information on our loss prevention services.
Toll-Free
Advisory Hotline
Specialized,
detailed advice is available through CAMICO’s toll-free hotline
on topics such as:
Arbitration/Mediation
Client Selection/Screening/Service
Employment Practices
Engagement and Disengagement Letters
Fraud & Defalcation
Internal Controls
Practice Management
Risk Evaluation
Splits/Mergers/Dissolution/Retirement
Subpoenas/Summonses/Depositions
CAMICO’s
loss prevention specialists review engagement letters, counsel
policyholders on issues such as fee structuring and collection,
and help you navigate through difficult situations.
'All
Professional Services' Covered
CAMICO
has developed a new policy form to better reflect the new
world of accounting. For instance, the definition of covered
services has been expanded to include "all professional services"
-- not just accounting services.
The
new form also covers your firm, no matter what professional
services it provides. A broad range is thereby covered, including:
- specific
investment advice
- computer/IT consulting
- business valuation
- litigation support
- trustee/executor
- assurance services
Call
CAMICO at (800) 652-1772 for a quick quote.
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