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October 2000
MEMBERS' INSURANCE PROGRAMS
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| 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.
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.
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.
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.
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
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.
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 1-800-652-1772 for a quick quote.
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