If you are an Eligible Employee, coverage is available to you. Coverage is not available for your Spouse/Domestic Partner or dependents.

To qualify for benefits under this plan, you must be disabled as a result of a covered injury or sickness, and you must be under the appropriate care of a U.S. licensed doctor of your choosing who is qualified to treat your disability.

 

Elimination Period

Before collecting benefits, you must satisfy a 14 day waiting period following your date of disability. The waiting period is referred to as the “elimination period”.

 

Weekly Benefit

If you are determined to be disabled, you may receive up to 60% of your weekly Covered Earnings to a weekly maximum of $2,308 during the first 24 weeks of disability payments.

 

Monthly Benefit:

After your weekly benefits stop, you may receive monthly benefits up to 60% of your monthly Covered Earnings, to a monthly maximum of $10,000.

 

Benefit Period

Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit period, or until you no longer qualify for benefits, whichever occurs first. (We will ask you to periodically furnish proof of your continuing disability.) Short-term disability benefits will generally be paid weekly – there may be some instances where it is paid as a lump-sum. Long-term disability benefits will be paid monthly.

 

Your benefit period begins on the first day after you complete your elimination period. Should you remain disabled, your benefits continue in accordance with the following maximum benefit period schedule, depending on your age at the time you become disabled.

 

Age at commencement of disability	Duration of benefit period
Age 62 or younger	To age 65 or the date the 42nd monthly benefit is payable, if later.
63 years	36 monthly payments
64 years	30 monthly payments
65 years	24 monthly payments
66 years	21 monthly payments
67 years	18 monthly payments
68 years	15 monthly payments
69 years or older	12 monthly payments

 

Benefits payable under this plan will terminate on the earliest of any date indicated below:

• The date we determine you are no longer disabled.
• The date you refuse to participate without good cause in a transitional work arrangement or other modified work arrangement. (Benefits may be resumed if you begin to cooperate in the rehabilitation plan or transitional work arrangement within 30 days of the date benefits terminated.)
• The date the maximum benefit period ends.
• The date you cease to get appropriate care.
• The date you die.
• The date you refuse to participate without good cause in all required phases of the rehabilitation plan. (Benefits may be resumed if you begin to cooperate in the rehabilitation plan within 30 days of the date benefits terminated.)
• The date you fail to cooperate with us in the administration of the claim.

Disability insurance premiums are paid for with after-tax dollars. You pay your premiums through payroll deduction unless you are on an unpaid leave of absence, in which case you will be required to pay via check. The total depends on your age and the amount of your monthly Covered Earnings. Rates are subject to change.

 

If you are between these ages	Your cost per $100 of monthly covered earnings
18-29	$0.234
30-34	$0.383
35-39	$0.542
40-44	$0.748
45-49	$1.038
50-54	$1.337
55-59	$1.496
60-64	$1.178
65-69	$0.926
70+	$0.673

 

*Your age for calculating monthly cost of insurance will be updated on each January 1.

Return-to-work incentive benefit

You may continue to receive benefits if you return to work but continue to meet the definition of disability. While weekly benefits are payable throughout the first 30 months of disability, benefits will be reduced so that the combination of this program’s benefit, work earnings and other income benefits do not exceed 100% of your pre-disability indexed Covered Earnings. After the first 30 months of disability, benefits payable under this program are reduced by 50% of your actual work earnings.

 

If you return to work while disability benefits are payable, but are not performing to the level of your optimum ability in that work—as determined by independent medical specialists qualified to make such an evaluation—the benefits payable under this program will be reduced by the difference between what you actually earn and what you would be earning if working to the level considered by those specialists to be your optimum ability.

 

Survivor income benefit

The plan also includes a family survivor benefit feature. With this feature, if you die while collecting disability benefits, we will pay a survivor benefit based on 100% of the total of your last month’s benefit, plus the amount of any disability earnings by which this benefit had been reduced for that month. This plan pays a single lump-sum, equal to 6 months of benefits.

 

Rehabilitation services

If you are offered a rehabilitative assistance program, we will work with you during the course of your elimination period or while benefits are payable. You will be expected to cooperate with the implementation of that assistance program.

 

If you refuse such assistance without good cause (e.g., a medically substantiated reason), disability benefits will not be payable and coverage under this plan will end. Coverage may be reinstated, and benefits resumed, if, within 30 days of the termination date, you agree to participate in the rehabilitation efforts.

 

Spouse/Domestic Partner rehabilitation services

While you’re disabled, your Spouse/Domestic Partner may (at NYL GBS’s option) be eligible to participate in a rehabilitation plan. The Spouse’s/Domestic partner’s rehabilitation plan may include payment of your Spouse’s/Domestic Partner’s education expenses, reasonable job placement expenses and moving expenses. It may also include family care expenses, if necessary for your Spouse/Domestic Partner to be retrained under the rehabilitation plan.

 

To be eligible, you must be continuously disabled for 12 months, your Spouse’s/Domestic Partner’s earnings must be 60% or less than your earnings and NYL GBS must determine your Spouse/Domestic Partner to be a suitable candidate for rehabilitation. Your Spouse/Domestic Partner must be living with you on the date your disability begins.

 

Your monthly benefits will be reduced by 50% of your Spouse’s/Domestic Partner’s earnings from rehabilitative work. If your Spouse/Domestic Partner was working before the rehabilitation plan began, monthly benefits will be reduced by 50% of the increase in income that results from a Spouse’s/Domestic Partner’s participation in the program.

 

Recurrent disability feature

If you return to work after receiving benefits under this program, and then become disabled again from the same or a related cause, you will not have to fulfill another elimination period, unless you have worked six or more consecutive months during which you earn 80% or more of your indexed Covered Earnings. The disability would be considered a continuation of your initial claim. If the second disability recurs beyond these limits or results from a cause unrelated to the first, you must file a new claim and fulfill a new elimination period.

If you apply within 30 days of your Benefits Eligibility Date, coverage will begin on the later of: your Benefits Eligibility Date or the date NYL GBS receives your completed online or paper insurance application.

 

If you apply more than 30 days after your Benefits Eligibility Date, proof of good health is required. If your application is approved, coverage will begin on the date the application approved by NYL GBS.

This coverage will end on the earliest of any of the following dates:

• The date you are no longer an Eligible Employee.
• The date the policy is terminated by Insperity.
• The day after the last date for which premium has been paid.
• The date you become eligible for a plan of benefits intended to replace this coverage.
• The date benefits end because you did not comply with the terms and conditions of the policy.

 

If you are receiving disability benefits when the policy terminates, disability benefits will continue if you remain disabled and meet the requirements for the insurance. Any later period of disability, regardless of cause, that begins when you are eligible under another disability coverage provided by any employer, will not be covered.

This plan provides only limited benefits for some conditions and excludes others from coverage, as listed below.

Pre-existing conditions (applicable to Long Term Disability only)

Pre-existing conditions are those for which you have incurred expenses, taken prescription drugs or medicines, received medical treatment, care or services (including diagnostic measures) or for which a reasonable person would have consulted a physician during the three months immediately prior to the most recent effective date of insurance.

 

This plan does not pay benefits for any disability resulting from a pre-existing condition, unless the disability occurs after you have been insured under this plan for 12 consecutive months. If you were insured under an employer-sponsored disability plan with a pre-existing condition limitation (immediately prior to the effective date of this plan), credit for the time you were insured may apply toward the 12 consecutive month limitation period under this plan.

 

Coverage limitations

This plan limits benefits for disabilities caused by or contributed to by any one or more of the following conditions:

• Alcoholism
• Anxiety disorders
• Delusional (paranoid) or depressive disorders
• Drug addiction or abuse
• Eating disorders
• Mental illness
• Somatoform disorders (including disorders psychosomatic illnesses)

 

Benefits for these conditions have a lifetime limit of 24 months for outpatient treatment. The plan also pays benefits during periods of hospital confinement for these conditions, as long as hospitalization lasts for more than 14 consecutive days and occurs before the 24-month lifetime outpatient limit is exhausted. Once the 24-month outpatient benefits are exhausted, the plan pays no further benefits for these conditions.

 

Coverage exclusions

This plan does not pay benefits for a disability which results, directly or indirectly, from any of the following:

• Suicide, attempted suicide, or whenever you injure yourself on purpose while sane or insane.
• War or any act of war, whether or not declared.
• Active participation in a riot.
• Commission of a felony.
• The revocation, restriction or non-renewal of your license, permit or certification necessary for you to perform the duties of your occupation, unless solely due to injury or sickness otherwise covered by the policy.
• Any cosmetic surgery or surgical procedure that is not medically necessary. “Medically necessary” means the surgical procedure is: (a) prescribed by a Physician as required treatment of the Injury or Sickness; and (b) appropriate according to conventional medical practice for the Injury or Sickness in the locality in which the surgery is performed. (Benefits will pay if the disability is caused by the Employee donating an organ in a non-experimental organ transplant procedure.)

 

In addition, we will not pay disability benefits for any period of disability during which you are incarcerated in a penal or corrections institution for any reason.

Continuation

Your disability insurance will continue if your Active Service ends because of a disability for which benefits under the Policy are or may become payable. Your premiums will be waived while disability benefits are payable. If you do not return to Active Service, this insurance ends when your disability ends or when benefits are no longer payable, whichever occurs first.

 

If your Active Service ends due to any other excused short term absence from work that is reported to the Employer timely in accordance with the Employer’s reporting requirements for such short term absence, your insurance will continue until the earlier of:

• The date your employment relationship with the Employer terminates;
• The date premiums are not paid when due;
• The end of the 30 day period that begins with the first day of such excused absence;
• The end of the period for which such short term absence is excused by the Employer.

 

Conversion

In addition, this program includes a long-term disability conversion privilege feature. Under this feature, you may be eligible to become insured under a separate disability policy if you should leave your current employment with Insperity or if your coverage ends as the result of an approved leave of absence exceeding 12 weeks (or any longer period required by applicable state or federal law).

 

Conversion is not available in certain situations that include:

• when you are retired;
• when you reach age 70;
• when you are not in active service because of disability; or,
• if you have not been covered under the policy for 12 consecutive months.

 

Contact NYL GBS directly for additional information at 800.231.1193. 

Understanding these words and phrases may be helpful as you read through the information about Disability insurance.

 

Active Service

An Employee will be considered in Active Service on a day which is a scheduled workday if any of the following conditions are met:

1. The Employee is actively at work performing his or her regular occupation.
2. The Employee is on a holiday, vacation day, or a day which is not a scheduled workday and was performing his or her regular occupation on the preceding scheduled workday.
3. The Employee is on an approved leave of absence for a period of no longer than 12 weeks (or any longer period by state or federal law).

 

Employees of a new Client Company who fall into one of the categories above (as of the effective date of the co-employment agreement between Employer and a Client Company) will be treated as being in Active Service for purposes of this Policy.

 

Affordable Care Act (ACA)

The federal health care reform legislation that was enacted in 2010, as amended.

 

Applicable Large Employer (ALE)

An employer that employed, on average, at least 50 full-time employees (including full-time equivalent employees), as defined by the ACA, on business days during the preceding calendar year. Contact Insperity if you have questions concerning ALE determinations and whether you are an employee subject to these rules.

 

Appropriate care

The determination of an accurate and medically supported diagnosis of your disability, or ongoing medical treatment and care of your disability by a physician that conforms to generally accepted medical standards, including frequency of treatment and care.

 

Covered Earnings

For Full-time Employees, Covered Earnings means an Employee's base annual salary, plus actual earnings for the previous 12 months derived from (i) commissions, (ii) piece work, (iii) fee-based work, and (iv) for ordained, commissioned, or licensed ministers only, any housing allowance paid by the Employer, as reported by the Employer to New York Life on the eligibility file. Amounts attributable to actual earnings will be annualized if the Employee has been employed by the Employer for less than 12 months. In no event will Covered Earnings include bonuses, overtime pay, special pay or any other form of extra compensation.

For part-time Employees, Covered Earnings means actual earnings for the previous 12 months derived from (i) salary (including hourly wages), (ii) commissions, (iii) piece work, (iv) fee-based work, and (v) for ordained commissioned or licensed ministers only, any housing allowance paid by the Employer, as reported by the Employer to New York Life on the eligibility file. Any such amount will be annualized if the Employee has been employed by the Employer for less than 12 months. In no event will Covered Earnings include bonuses, overtime pay, special pay or any other form of extra compensation.

For Employees on a Leave of Absence (whether paid or unpaid), Covered Earnings will be the amount in effect (as calculated above) immediately prior to going on an approved Leave of Absence. The Covered Earnings amount will remain frozen until the Employee returns to work.

 

Domestic Partner

Domestic Partner means any of the following:

1. A person with whom the Employee or Former Employee has a registered civil union or domestic partnership under state law which imposes legal obligations on the parties substantially similar to marriage.
   
   Such person will continue to be recognized as a Domestic Partner unless and until: (1) the civil union or domestic partnership is dissolved under applicable law; or (2) either the Employee or Former Employee or the Domestic Partner marries another person.


2. A person meeting all of the following requirements, with respect to an Employee or Former Employee:
   1. Shares a permanent residence with the Employee or Former Employee;
   2. Has resided with the Employee or Former Employee for at least 12 months.
   3. Has not been legally married to any other person within the previous 12 months, and has no Domestic Partner other than the Employee or Former Employee during the previous 12 months, and is the Employee’s or Former Employee sole Domestic Partner;
   4. Is interdependent with the Employee or Former Employee in two of the following ways:
      1. Both partners are registered under any municipal ordinance as domestic partners.
      2. Both partners are jointly parties to a lease, mortgage or deed.
      3. Both partners jointly own one or more motor vehicles.
      4. Both partners jointly own one or more bank or credit accounts.
      5. The Employee or Former Employee has named the Domestic Partner as attorney-in-fact under a durable power of attorney with authority over health care decisions.
      6. The Employee or Former Employee has designated the Domestic Partner as a beneficiary under a retirement plan or a life insurance policy.
      7. The Employee or Former Employee has designated the Domestic Partner as a beneficiary of the Employee’s will.
      
      
   5. Is not so closely related by blood to the Employee or Former Employee as to prohibit legal marriage in their state of residence.
   6. Is no less than 18 years of age.

All references in the policy to “Spouse” shall be changed to read “Spouse and Domestic Partner" except as follows:

1. The definition of “Spouse” remains unchanged.
2. A child of a Domestic Partner may only be eligible to be insured if:
   1. the child is primarily dependent on the Employee for financial support; or
   2. the Employee has a legal obligation of support of the child; or
   3. the Employee is the child’s legal guardian.

 

Important Note: In order to file a claim for benefits, proof of the domestic partnership as indicated above must be furnished the same as proof of a marriage.

 

Disabled

If, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 30 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 80% or more of your indexed earnings. We will require proof of earnings and continued disability.

 

Eligible Employees

The Plan administers two sets of eligibility rules – one for employees of a non-ALE company and one for employees of an ALE company, as described below and in the SPD.

 

Employees of a Non-ALE Company

You are an Eligible Employee if your benefits package from Insperity includes coverage under the Plan and you are:

• A Full-Time Employee. A full-time employee of Insperity who is working 30 hours or more per week (20 hours in Hawaii) on average.
• A Full-Time Employee on a Leave of Absence. A full-time employee of Insperity who meets the requirements for continuing eligibility during an approved leave of absence.

 

Employees of an ALE Client Company

You are an Eligible Employee if your benefits package from Insperity includes coverage under the Plan and if you are:

• A Full-Time Employee. A full-time employee of Insperity who is working 30 hours or more per week (20 hours in Hawaii) on average.
• A Part-Time or Seasonal Benefits Eligible Employee. A part-time or seasonal employee of Insperity who is also employed by an ALE Client Company and has been determined to be eligible for benefits as described below.
• An Employee on a Leave of Absence. An employee in either of the two categories described above, who meets the requirements for continuing eligibility during an approved leave of absence.

 

Eligibility for employees of an ALE Client Company will be determined based on hours worked during the employee’s Measurement Period. Once the employee is determined by Insperity to be eligible for benefits, eligibility will be retained during the Stability Period associated with that Measurement Period (regardless of any changes in hours worked during the Stability Period).

 

Certain exclusions may apply. Please see the Certificate for more information.

 

Indexed earnings

Indexed earnings are the same as Covered Earnings for the first 12 months of benefit payments. After the 12th month of benefit payments, we apply an increase to your Covered Earnings amount, and refer to this as “indexed earnings,” in order to calculate the maximum benefit payable under this plan when combined with other income benefits you may be eligible to receive. The amount of the increase we apply is the lesser of either 10% or the rate specified in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPIW) for the preceding calendar year. We do not reduce indexed earnings if the CPIW drops. If the CPIW is ever discontinued, we will use a comparable national index to calculate indexed earnings.

 

Injury

Any accidental loss or bodily harm that results directly and independently of all other causes from an accident.

 

Regular occupation

The occupation you routinely perform at the time your disability begins. In evaluating your disability, NYL GBS will consider the duties of your occupation as it is normally performed in the general labor market in the national economy, and not work tasks performed for a specific employer or at a specific location.

 

Sickness

Any physical or mental illness.

You can apply For Disability Insurance Online by using the "Apply Now" button to the right. Or, you can Complete An Application and submit to NYL GBS.

 

Important Tips For Applying For Coverage With NYL GBS Trusted Advisor

• Online applications for each voluntary benefits program will open in separate browser windows.
• Online applications for each voluntary benefits program will need to be completed, electronically signed and submitted individually.
• Once an application has been submitted, close the application window and start the next application by clicking “Apply Now” below.
• For your protection, an online application will time out after 30 minutes of inactivity; any un-submitted applications will NOT be saved.
• Do not use the “Back” button in your browser; you will have the option to edit your application when you see the “Edit Application” button before each application is completed.
• In the event you need to access Insperity Premier^TM, it will remain open in a separate Internet browser window (you may be asked to log in again, depending upon the length of inactivity).

You can report your claim by phone, fax, web or mail. However, when you report your claim via the phone, this allows our intake specialists to obtain relevant information in a single phone call, get verbal authorization to obtain your medical information, which allows for quicker access to medical information from your treating physician—this helps to speed up the claim decision process.

 

To file a disability claim by phone please call 800.362.4462.

You may check the status of your claim by logging into www.myNYLGBS.com. If you do not have a registration ID and password, you will need to register for one before accessing your claim information. Please wait 48 hours from the time you file your claim before checking the status of your claim.

 

You can check the status of your disability claim by phone at 800.362.4462

 

Yes. If you are able to return-to-work after a disabling injury or accident, NYL GBS has a team of dedicated vocational rehabilitation counselors who will support your to return-to-work efforts and they will develop a personalized plan for you and recommend assistive equipment as needed.

 

Yes. Our expert resources help qualified individuals apply and be approved for Social Security Disability Insurance and also represent them at Social Security hearings.

 

Yes. Our Disability insurance plan includes many value-added programs, offered at no additional cost, to help you and your family maintain your health, well-being and sense of security throughout your lifetime. To see which programs are available to you select Value-Added Programs from the menu above.