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An Introductory Overview

Guardian DI: Protection for Individuals and Small Businesses. An Introductory Overview. For producer use only. Not for use with the general public. Product provisions and features may vary from state to state. Disability income insurance underwritten and issued by

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An Introductory Overview

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  1. Guardian DI:Protection for Individuals and Small Businesses An Introductory Overview For producer use only. Not for use with the general public. Product provisions and features may vary from state to state. Disability income insurance underwritten and issued by Berkshire Life Insurance Company of America, Pittsfield, MA a wholly owned stock subsidiary of The Guardian Life Insurance Company of America, New York, NY or provided by Guardian. 8542--05-08

  2. Disability Insurance Products • Personal DI • ProVider Plus (Policy Forms 1400 & 1500) • The use of ProVider Plus in our marketing programs • Business DI • Overhead Expense (Policy Form 4100; NC82 in Montana) • Business Reducing Term (Policy Form AH55-A) • Disability Buy-Out (Policy Form 3100; AH84 in Montana)

  3. A Word About Guardian& Berkshire • Berkshire Life • Wholly owned stock subsidiary • DI and LTCI products • A. M. Best rating: A+

  4. Why Is DI Important? • Your client… • Income is your client’s most valuable and vulnerable asset. • You… • Professional responsibility • Market alignment & access • Profit

  5. Why ProVider Plus? • Disability is unpredictable • The best policy… • provides the most comprehensive protection • tailored to specific needs

  6. Evaluating a Disability Policy • Renewability • Definition of total disability • Strong policy provisions & safeguards • Optional benefits

  7. Renewability • Non-cancellable and guaranteed renewable until the expiration date (age 65 or 67) • We cannot… • cancel the policy • change policy provisions • increase the policy premium after issue (as long as premium payments are made on a timely basis) • After expiration date, conditionally renewable for life

  8. Total Disability: True “Own-Occ” • “unable to perform the material and substantial duties of your occupation…” • The insured can be gainfully employed in another occupation and still be considered totally disabled • True “own-occ” protection for the entire benefit period – all occupation classes

  9. Specialty Language • Medical & dental specialists • “If you have limited your occupation to the performance of the material and substantial duties of a single medical or dental specialty, we will consider that specialty to be your occupation.”

  10. Occupation Class • One of the primary determinants of risk • Occ classes based on claims experience • Determines pricing & benefits available

  11. Occupation Classes • Class 6-3: white collar professionals, executives, managers • Classes 2-1*: occupations with primarily manual duties • Classes 6M-1M: medical & dental occupations * Available only in employer-sponsored plans; Class 2 also available to business owners who have owned the business for at least 5 years. Class 1 is not available in Florida.

  12. Move Up Option • Many occupations can “move up” in class. • Criteria include: • income level & stability • experience • amount of travel • characteristics of the business organization

  13. Monthly Indemnity • Amount payable for total disability • Primary determinants of issue amount: • earned income • occupation class • other disability coverage in force (individual and group) • who pays the premium (individual vs. employer pay)

  14. Maximum Issue Limits* * For issue ages 18 – 55. Limits vary for medical and dental professionals, depending on the use of the TeleMed underwriting process. Limits also vary in Florida.

  15. Elimination Period • Elimination periods available: 30, 60, 90, 180, 360, 720* days • To satisfy the EP, must be disabled from the same or different causes. • Days of disability don’t have to be consecutive, but must occur during the accumulation period. • Example: 90 day EP – 210 day AP • Example: 180 month EP – 360 day AP * Not available in some states

  16. Elimination Period • Benefits begin to accrue after theelimination period has been satisfied. • Elimination period waived if you becomedisabled again within 5 years after theend of a prior disability… • which lasted more than 6 months • for which we paid benefits

  17. Benefit Periods • 2 years, 5 years, 10 years, to age 65, to age 67 • Flexibility to meet your clients’ needs • Graded lifetime benefits* available by rider (see details on the following slide)

  18. Graded Lifetime Indemnity for Total Disability Rider • For disability prior to age 46, full monthly indemnity payable after age 65 (or 67) • For disability at age 46 or after, benefit after age 65 (or 67) is a percentage of the monthly indemnity • decreases 5% for each year beyond age 45 that disability occurs • Examples: • For disability at age 46: 95% of monthly indemnity • For disability at age 50: 75% of monthly indemnity Note: Availability of this rider is limited in Florida.

  19. Recurrent Disability • No new elimination period if a disability occurs within 12 months of a previous disability. • To be considered recurrent, the later disability must be due to the same cause or causes as the previous disability.

  20. Presumptive Total Disability • Total disability presumed, even if at work, for total and complete loss of: • sight, hearing, speech • use of both hands, both feet, or one hand and one foot • Elimination period is waived • Benefit paid as long as loss continues during the benefit period • Loss does not have to be irrecoverable

  21. Capital Sum Benefit • Lump sum benefit paid for: • Total and irrecoverable loss of sight in one eye or • complete loss of a hand or foot by severance • Capital Sum = 12 X monthly indemnity • Payable in addition to any other policy benefit

  22. Rehabilitation Benefit • Helps to meet the costs of a rehabilitation program while totally disabled. • We must agree to the program in writing before enrollment. • A formal program of retraining to help the client return to work in his or her occupation.

  23. Modification and Access Benefit • Reimburses appropriate and reasonable costs incurred by the client • For a modification designed to assist in a return to work in his or her occupation.

  24. Transplant & Cosmetic Surgery • Benefits payable for total disability due to • transplant of a part of your body to another person or • complications of cosmetic surgery • Must become totally disabled more than 6 months after the policy’s effective date.

  25. Waiver of Premium • Waives premium while your client is disabled and receiving benefits • Continues to waive premium for six months following recovery. • Refunds any premium paid that is attributable to the period of disability – even if paid before the disability began.

  26. Exclusions & Limitations* • No benefits payable… • during incarceration • for disability caused by, contributed to or resulting from: • military training, action, conflict or war while serving in the military or working for contracted military services. • commission of, or attempt to commit, a criminal offense. • being engaged in an illegal occupation. • suspension, revocation or surrender of professional or occupational license or certification. • an intentionally self-inflicted injury. • any loss excluded by name or specific description. * Exclusions & limitations may vary by state.

  27. Exclusions & Limitations* • Normal pregnancy or childbirth are not covered during the first 90 days of disability or the elimination period, if longer.** • Foreign Residency Limitation - The insured must be living full time in the U.S. or Canada in order to receive benefits (except for incidental travel or vacations). * Varies by state ** Policy Form 1400 only

  28. Exclusions & Limitations • Mental Disorder and/or Substance Abuse limitation.* • monthly benefits are limited to an aggregate total of 24 months • Does not apply while continuously confined as an inpatient in a hospital and under care of physician. * Applies to all policies issued in Florida. It also applies in all states to anesthetists, anesthesiologists, ER physicians, pain management physicians, and CRNAs.

  29. ProVider Plus:Optional Benefits

  30. Optional Benefits • Classes 6 – 3, 6M – 3M • Residual Disability Benefit Rider • Cost of Living Adjustment Rider • Graded Lifetime Indemnity for Total Disability Benefit Rider • Future Increase Option Rider • Automatic Benefit Enhancement Rider • Catastrophic Disability Benefit Rider • Retirement Protection Plus Disability Benefit Rider • All Classes: • Social Insurance Substitute Rider • Unemployment Waiver of Premium Rider • Classes 2, 1: • Partial Disability Rider

  31. Residual Disability Benefit Rider • Requires loss of income of at least 15% of prior income. • Specific loss of time or duties are not required. • Elimination period can be satisfied by total or residual disability. • First 12 months – dollar-for-dollar loss of income benefit, up to the monthly indemnity* * Coordinates with benefits payable from any other disability insurance policies the client may already have.

  32. Residual Disability Benefit Rider • After the first 12 months, benefits are proportionate to the loss of income. • If income loss is 75% or more, we consider the loss to be 100%. • Residual benefits payable for entire period. • Recovery: residual benefits will continue up to the end of the benefit period, as long as the loss of income is at least 15%.

  33. Cost of Living Adjustment Riders • Fixed 3%: The monthly benefit increases each year during disability by 3% • 6% Maximum: The monthly benefit increases each year during disability according to changes in the CPI-U. • Increases will be no lower than 3% and no higher than 6% • For these options, increases begin after the insured has been disabled for 12 months Note: All COLA increases are calculated on a compound interest basis.

  34. Cost of Living Adjustment Riders • Four-Year Delayed: Increases begin on the fourth anniversary of disability. • The monthly benefit increases each year during disability by 3% • Economical option for obtaining long term cost of living protection Note: All COLA increases are calculated on a compound interest basis.

  35. Cost of Living Adjustment Riders • No cap on increases before the expiration date • After recovery, indexing increases remain part of the policy’s base benefit • until the expiration date • no extra premium

  36. Future Increase Option Rider • Allows for the purchase of additional coverage in spite of any change in healthor occupation • Total increase option: up to 2 times the base policy plus total in-force with Guardian and Berkshire* • Annual option dates to age 55 • Special option date: • For loss of Group LTD coverage or • On a date declared by the company Note: State variations may apply.

  37. Future Increase Option Rider • Until age 45, insured can exercise up to the total increase option. • Afterwards, up to 1/3 of the available option amount each year, or the remaining option amount, if less than $1,000. • May exercise an option if disabled on an option date • increased benefit available for a subsequent disability only

  38. Automatic Benefit Enhancement Rider • Attached to policy at underwriter’s discretion • 4% compound annual increases for 5 years • Increases provided despite any change in health, income or occupation • If the insured declines two consecutive increases, no future offers • Before age 60, insured may apply to extend the rider for additional 5-year periods.

  39. Catastrophic Disability Benefit Rider • Pays additional monthly benefit for • Loss of 2 of 6 ADLs • Cognitive impairment • Irrecoverable disability

  40. Catastrophic Disability Benefit Rider • Benefit amount: • up to $8,000 per month • total coverage not to exceed 100% of applicant’s income • Built-in annual 3% fixedcompounded adjustments • maximum benefit = two times the original benefit

  41. Social Insurance Substitute Rider • Coordinates with social insurance • Dollar-for-dollar offset • Issue amounts: up to $1500 per month • Required for policies issued to classes 2 – 1 and 2M – 1M. Note: In New York and New Jersey, if the insured receives any social insurance benefits, no benefits are payable under the rider.

  42. Unemployment Waiver of Premium Rider • Premiums waived if insured becomes unemployed • Must receive unemployment compensation for at least 60 consecutive days. • Premiums waived for 12 months, even if insured returns to work. • Renewable to age 60 or until the date option is exercised.

  43. Partial Disability* • Benefit is payable if sickness or injury causes a loss of • the ability to perform one or more of the material and substantial duties of the insured’s occupation, or • the ability to perform these duties for more than one-half the time normally required. • Elimination period must be satisfied by total disability • Benefit = 50% of the monthly indemnity • Payable for up to 6 months * Available to classes 2 – 1 and 2M – 1M.

  44. Premium Options • Level • Premiums remain the same until age 65 or 67. • Graded • Low initial rate, with annual increases. • Can be converted to a level premium (at attained age rates) until age 50. • Step-rate • Premium increases once to a level premium • At the later of age 35 or five years after purchase

  45. Premium Payment Modes • Annual, Semi-annual, quarterly, monthly • Monthly Guard-O-Matic – no service fee

  46. Risk Classes • Preferred • Select • Standard

  47. Employer-Sponsored Plans • Gender-distinct pricing (Policy Form 1400) used for policies issued in • Individual sales • Voluntary Income Protection programs • Association programs • Unisex pricing (Policy Form 1500) used for policies issued in • Qualified Sick Pay Plans • Executive Bonus Plans

  48. Discounts • Multi-policy discount • 5% on the first year premium • Employer-sponsored discount: 10% • Groups of 2+ lives • Groups of 3+ lives if one of the participants is in class 6M – 1M • Association discount: 10%* • For 10+ lives in approved associations

  49. Business Products • Overhead Expense • Business Reducing Term • Disability Buy-Out

  50. Overhead Expense* • Protects the business if the owner is disabled • Reimburses covered expenses incurred in the daily operation of the business • Excellent sequential sale to personal DI or… • Lead with Overhead Expense * Policy Form 4100; NC82 in Montana

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