Disability Income Insurance
Standard Policy Limitations and Exclusions (Form No. I H2016)
Note: Limitations and Exclusions may vary by state. The state specific policy form is the ultimate authority for any questions about this product.
Pre-existing Condition - If disability is within two years from the issue date and is due to a pre-existing condition, no benefits will be paid unless the condition was disclosed and not misrepresented on the application and is not excluded by a policy amendment rider.
Elimination Period – This policy includes an elimination period which is the amount of time the insured must be continuously, totally disabled before eligible to receive weekly benefits.
Mental/Nervous Disorders - A maximum of 104 disability weekly benefits will be paid during the insured's lifetime for disabilities due to mental/nervous disorders.
Substance Abuse - A maximum of 104 disability weekly benefits will be paid during the insured's lifetime for disabilities due to substance abuse.
Guaranteed Renewable. This policy form is guaranteed renewable, meaning the policyowner may continue the coverage provided through the end of the renewal period by payment of the required premiums when they are due. Terms of the policy cannot be changed while it is in force. Premiums for the policy may change, but any changes require prior regulatory approval and can be done on an insured class basis only.
Misstatement of Age and/or Gender - If age and/or gender is misstated, an adjustment in premiums, coverage, or both, will be made based on the correct age and/or gender. If, according to the correct age, the coverage provided by this policy would not have become effective, or would have ceased, the only liability during the period in which the insured was not eligible for coverage, shall be limited to the refund of premiums paid for such period.
Misstatement of Income - If annual income was overstated at the time of policy application, an adjustment in both coverage and premiums may be made. If, according to the correct income, the coverage provided by the policy would not have become effective, liability shall be limited to the refund of premiums paid.
Misstatement of Tobacco Use - If, during the first two years of this policy, the tobacco status has been misstated, an adjustment in policy and rider benefit amounts will be made based on the amount the premium paid would have purchased using the correct tobacco status on the Issue Date.
Foreign Travel and Residency - A maximum of 52 disability weekly benefits will be paid for any disability sustained while residing outside the United States, its territories or possessions, or Canada.
Military Service - The policy may be suspended if the insured enters active military service.
Benefits will not be paid for conditions that are caused by or the result of the insured:
- being pregnant or having an elective abortion (as applies to Accident and Sickness policy type) (complication of pregnancy is deemed to be a sickness);
- war or any act of war, declared or undeclared;
- actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve, except during the active duty training of less than 60 days;
- committing or attempting to commit a felony;
- being legally incarcerated in a penal or correctional institution for more than seven days or during a period of legal detainment of more than seven days where the period of legal incarceration or legal detainment results in the insured person's inability to meet any work requirements in the definition of total disability;
- participating in a riot, insurrection or rebellion;
- intentionally self-inflicting an injury or attempting to commit suicide, while sane or insane;
- engaging in an illegal occupation;
- having an illness, disease or infection, other than infection from an injury received while this policy is in force (as applies to Accident-Only policy type);
- having a mental and/or nervous disorder, subject to the applicable law in the state where this policy was delivered or issued for delivery (as applies to Accident-Only policy type);
- being addicted to drugs or suffering from alcoholism, subject to the applicable law in the state where this policy was delivered or issued for delivery (as applies to Accident-Only policy type);
- being under the influence of an illegal substance, excitant, depressant, hallucinogen, narcotic, or any other drug or intoxicant, unless administered on the advice and as directed by a physician, subject to the applicable law in the state where this policy was delivered or issued for delivery;
- being intoxicated (as determined by the laws governing the operation of motor vehicles in the state where this policy was delivered or issued for delivery); or
- having cosmetic surgery, except for reconstructive surgery when the surgery is incidental to or follows surgery resulting from trauma, infection, or other diseases of the involved part, and reconstructive surgery because of congenital disease or anomaly resulting in a functional defect.
Social Insurance Offset Benefit
Any benefit payments under this rider are subject to the following conditions:
- The insured applies for any Social Insurance Benefits for which they are eligible in a timely manner;
- The insured provides written proof they have applied for Social Insurance Benefits along with the amount they are qualified to receive;
- The insured provides written permission to obtain information on their application, reapplication or appeal for Social Insurance Benefits;
- The insured actively pursues all appeal procedures available in a timely manner if denied Social Insurance Benefits;
- The insured reapplies for Social Insurance Benefits upon request, if there is a change in circumstances or in the law; and
- The insured provides proof of any award or payment of Social Insurance Benefits as soon as they are received and notification of any change in benefit eligibility or payment status in a timely manner.