Standard Policy Limitations and Exclusions (Form No. I H0920)
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 monthly benefits.
Mental/Nervous Disorders; Substance Abuse – A maximum of 24 disability monthly benefits will be paid during the insured’s lifetime for disabilities due to mental/nervous disorders and 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 monthly 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.
Foreign Travel and Residency – A maximum of three disability monthly benefits will be paid for any disability sustained or continued outside the United States 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, experiencing childbirth or having an elective abortion (Complication of pregnancy is deemed to be a sickness);
- losing an occupational or professional license or certification;
- being exposed to war or any act of war, declared or undeclared;
- engaging in an illegal occupation;
- participating in or attempting to commit a felony;
- intentionally self-inflicting a sickness or injury;
- committing or attempting to commit suicide, while sane or insane;
- being incarcerated or is caused while incarcerated in a penal institution or government detention facility;
- being intoxicated (as determined by the laws governing the operation of motor vehicles in the jurisdiction where the disability occurs) or under the influence of an illegal substance or a narcotic (except for narcotics used as prescribed by a Physician); or
- actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Reserves, except during the active duty training of less than 60 days.
Residual Disability Benefit Rider Standard Limitations and Exclusions (Form No. R I1602)
Any benefit payments under this rider require proof of prior monthly income and current monthly income, including items such as Federal Income Tax Return(s) as filed with the Internal Revenue Service, monthly profit and loss statements, and earnings statements.
Supplemental Disability Income Rider Standard Limitations and Exclusions (Form No. R I0929)
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;
- written proof is provided that the insured has applied for social insurance benefits along with the amount qualified to receive;
- written permission is provided to obtain information on the insured’s application, reapplication or appeal for social insurance benefits;
- all appeal procedures available are actively pursued by the insured in a timely manner if denied social insurance benefits;
- reapplication for social insurance benefits is done by the insured upon request if there is a change in circumstances or in the law; and
- written proof is provided by the insured of any award or payment of social insurance benefits as soon as they are received, in addition to any change in benefit eligibility or payment status.