WHY WOULD I NEED IT? HOW MUCH DO I NEED?

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As you protect the health of others…we’ll help protect the health of your most vital asset:

your income.

Why would I need disability income protection?

As a physician, you’ve probably witnessed the

physical and financial effects of a disabling Sickness or Injury firsthand. It can happen to anyone, at anytime.

And if a sudden disability prevents you from working in your practice — for months or even years — your family’s financial future could be at risk.

Consider the statistics:

• Over 36 million Americans are classified as disabled; about 12% of the total population.

More than 50% of those disabled Americans are in their working years, from 18-64.*

• The average long-term disability claim duration is 31.2 months.*

• Three in 10 workers entering the work force today will become disabled before retiring.*

Why should I select this Plan?

The Wisconsin Medical Society Member Long-Term Disability Insurance Plan includes an important “Own Specialty Occupation” definition of disability. As a physician, your occupation means the general or sub- specialty in which you are practicing as recognized by the American Board of Medical Specialties. So if you became disabled and could not perform the essential duties of your specific area of practice, you are eligible to collect full benefits, even if you can practice another field of medicine or the duties of another job which is not part of your specialty.

Plus...the rates are very competitive!

The Wisconsin Medical Society Member Long-Term Disability Plan is underwritten by an industry leader: The Hartford1

This Program is underwritten by a leader in professional group coverage, The Hartford.

The Hartford has become known for its innovation in developing products for today’s insurance climate.

Your protection is administered by Nations Benefits and Financial Services Administration, (NBFSA), an administrator that serves the insurance needs of the professional association members nationwide. They have trained professional representatives available to assist with claims payment, or to answer any questions you may have. Just call 1-866-442-3810, 8:00 a.m. to 4:30 p.m. Monday to Friday, Central Time.

How much Disability Insurance would I need?

Depending on your own personal situation, many financial experts recommend that you have enough disability coverage to replace 60% of your income. This worksheet will help you calculate a monthly benefit that may be right for your family.

INTRODUCING THE

WISCONSIN MEDICAL SOCIETY MEMBER LONG-TERM DISABILITY INSURANCE PLAN

• Up to $10,000 of monthly benefits with Standard Issue coverage.

• Up to $6,000 of monthly benefits with Guaranteed Issue coverage for members under age 55.

• Includes “Own Specialty Occupation” definition of disability.

Especially for physicians

• Flexible coverage options can be tailored to your needs.

• Your spouse can also apply at same rates available to physician members.

• Monthly benefit payments can continue until retirement age.

Can we help you determine your needs, or provide you with

a no-obligation rate quote?

Contact Wisconsin Medical Society Insurance Services at 1-866-442-3810 for more information.

Definitions

Actively at Work means you or your Spouse are performing all the Essential Duties of Your Occupation for wage or profit on a full-time basis (at least 20 hours per week).

Pre-disability Earnings means, if you or your spouse are self-employed, your or your spouse’s average net monthly income (gross revenues less business expenses) from: 1) the personal practice of Your or Your Spouse’s profession; or 2) personal conduct of Your or Your Spouse’s main business.

This average is based on net income for: 1) 12 months; or 2) 24 months; whichever produces the higher average, before the determination is made. If You or Your Spouse have been self-employed for less than 12 months, it is based on the whole time You or Your Spouse were self-employed. If Your or Your Spouse’s practice is incorporated, net income includes the cost to Your or Your Spouse’s company of fringe benefits and Your or Your Spouse’s share of total surplus. Income does not include investment returns, rents, royalties, and the like income which is not directly produced from Your or Your Spouse’s current work.

Pre-disability Earnings means, if you or your Spouse are not self-employed, your or your spouse’s regular monthly rate of pay, not counting commissions, bonuses, tips and

tokens, overtime pay or any other fringe benefits or extra compensation, in effect on the date immediately prior to the last day you or your spouse were Actively at Work before you or your spouse became Disabled.

Disabled and Working means a Disability that: 1) continues while you are performing at least one of the material duties of Your Own Occupation on either a full- time or part-time basis; 2) causes a loss of earnings of at least 20% (and less than 80%); and 3) requires the Regular Care of a Physician.

Recurrent Disability: If you cease to be Disabled and return to work for a total of 14 days or less during the Elimination Period, the Elimination Period will not be interrupted. Except for the 14 days or less that you work, you must be Disabled by the same condition for the total Elimination Period.

Successive periods of Total Disability or Disabled and Working, which are 1) due to the same or related causes;

and not separated by a period of 6 months or longer; will be considered one period of Total Disability or Disabled and Working, and will be payable under the Plan.

Periods of Disability separated by at least 6 months during which you are Actively at Work, will be considered separate Periods of Disability.

1The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.

This brochure explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

Wisconsin Medical Society Insurance & Financial Services, Inc., is compensated for the placement of insurance and for the services it provides to customers on behalf of the insurance company, in addition to other compensation it may receive.

Nations Benefits and Financial Services Administration, LLC d/b/a NBFSA, LLC , is the Plan Administrator and Insurance broker that administers the insurance plan on behalf of the Hartford Life and Accident Insurance Company for the benefit of the Group Policyholder. Nations Benefits and Financial Services Administration, LLC d/b/a NBFSA, LLC & Wisconsin Medical Society Insurance & Financial Services, Inc., is compensated for the placement of insurance and for the services it provides to customers on behalf of the insurance company, in addition to other compensation it may receive.

Underwritten by Hartford Life and Accident Insurance Company, Simsbury, CT 06089.

Policy Form # GBD-1000 A (AGP-5858) WMSDI-B

Help protect the health of your most vital asset — your income — with coverage designed for the needs of physicians and spouses. Apply now.

Any Questions? Can we provide you with a no-obligation rate quote?

Contact Wisconsin Medical Society Insurance Services at 1-866-442-3810 for more information.

Category Monthly Expense Amount Mortgage or rent payment

(include property taxes and insurance

if paid separately) $

Food and Clothing Costs $

Child Care/Tuition Costs $

Auto &Transportation

(include auto payment, repairs, gas, public transportation costs, etc.) $ Loan Payments

(student loans, credit card payments,

personal loans, etc.) $

Utility Costs

(phone, heat, electric, gas, water, etc.) $ Living Expenses

(include home repairs, entertainment, vacations, memberships, etc.) $ Health, Life or Other Insurance Bills (include contributions to any health plan, prescription costs, life insurance

payments, etc.) $

Retirement & Other Contribution (include monthly contributions for meeting retirement and general savings goals, future education savings, etc.) $

Total Monthly Expenses $

Other disability insurance or salary that would continue even if you

couldn’t work:

Disability Income Protection Needed:

* As viewed at Council for Disability Awareness website on May 26, 2012, www. disabilitycanhappen.org

WHY WOULD I NEED IT?

HOW MUCH DO I NEED?

The results in this worksheet are for your information only and are not recommendations. Your individual needs may be different and you may wish to consult a qualified financial advisor for a detailed analysis of your financial needs.

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As you protect the health of others…we’ll help protect the health of your most vital asset:

your income.

Why would I need disability income protection?

As a physician, you’ve probably witnessed the

physical and financial effects of a disabling Sickness or Injury firsthand. It can happen to anyone, at anytime.

And if a sudden disability prevents you from working in your practice — for months or even years — your family’s financial future could be at risk.

Consider the statistics:

• Over 36 million Americans are classified as disabled; about 12% of the total population.

More than 50% of those disabled Americans are in their working years, from 18-64.*

• The average long-term disability claim duration is 31.2 months.*

• Three in 10 workers entering the work force today will become disabled before retiring.*

Why should I select this Plan?

The Wisconsin Medical Society Member Long-Term Disability Insurance Plan includes an important “Own Specialty Occupation” definition of disability. As a physician, your occupation means the general or sub- specialty in which you are practicing as recognized by the American Board of Medical Specialties. So if you became disabled and could not perform the essential duties of your specific area of practice, you are eligible to collect full benefits, even if you can practice another field of medicine or the duties of another job which is not part of your specialty.

Plus...the rates are very competitive!

The Wisconsin Medical Society Member Long-Term Disability Plan is underwritten by an industry leader: The Hartford1

This Program is underwritten by a leader in professional group coverage, The Hartford.

The Hartford has become known for its innovation in developing products for today’s insurance climate.

Your protection is administered by Nations Benefits and Financial Services Administration, (NBFSA), an administrator that serves the insurance needs of the professional association members nationwide. They have trained professional representatives available to assist with claims payment, or to answer any questions you may have. Just call 1-866-442-3810, 8:00 a.m. to 4:30 p.m. Monday to Friday, Central Time.

How much Disability Insurance would I need?

Depending on your own personal situation, many financial experts recommend that you have enough disability coverage to replace 60% of your income. This worksheet will help you calculate a monthly benefit that may be right for your family.

INTRODUCING THE

WISCONSIN MEDICAL SOCIETY MEMBER LONG-TERM DISABILITY INSURANCE PLAN

• Up to $10,000 of monthly benefits with Standard Issue coverage.

• Up to $6,000 of monthly benefits with Guaranteed Issue coverage for members under age 55.

• Includes “Own Specialty Occupation” definition of disability.

Especially for physicians

• Flexible coverage options can be tailored to your needs.

• Your spouse can also apply at same rates available to physician members.

• Monthly benefit payments can continue until retirement age.

Can we help you determine your needs, or provide you with

a no-obligation rate quote?

Contact Wisconsin Medical Society Insurance Services at 1-866-442-3810 for more information.

Definitions

Actively at Work means you or your Spouse are performing all the Essential Duties of Your Occupation for wage or profit on a full-time basis (at least 20 hours per week).

Pre-disability Earnings means, if you or your spouse are self-employed, your or your spouse’s average net monthly income (gross revenues less business expenses) from: 1) the personal practice of Your or Your Spouse’s profession; or 2) personal conduct of Your or Your Spouse’s main business.

This average is based on net income for: 1) 12 months; or 2) 24 months; whichever produces the higher average, before the determination is made. If You or Your Spouse have been self-employed for less than 12 months, it is based on the whole time You or Your Spouse were self-employed. If Your or Your Spouse’s practice is incorporated, net income includes the cost to Your or Your Spouse’s company of fringe benefits and Your or Your Spouse’s share of total surplus. Income does not include investment returns, rents, royalties, and the like income which is not directly produced from Your or Your Spouse’s current work.

Pre-disability Earnings means, if you or your Spouse are not self-employed, your or your spouse’s regular monthly rate of pay, not counting commissions, bonuses, tips and

tokens, overtime pay or any other fringe benefits or extra compensation, in effect on the date immediately prior to the last day you or your spouse were Actively at Work before you or your spouse became Disabled.

Disabled and Working means a Disability that: 1) continues while you are performing at least one of the material duties of Your Own Occupation on either a full- time or part-time basis; 2) causes a loss of earnings of at least 20% (and less than 80%); and 3) requires the Regular Care of a Physician.

Recurrent Disability: If you cease to be Disabled and return to work for a total of 14 days or less during the Elimination Period, the Elimination Period will not be interrupted. Except for the 14 days or less that you work, you must be Disabled by the same condition for the total Elimination Period.

Successive periods of Total Disability or Disabled and Working, which are 1) due to the same or related causes;

and not separated by a period of 6 months or longer; will be considered one period of Total Disability or Disabled and Working, and will be payable under the Plan.

Periods of Disability separated by at least 6 months during which you are Actively at Work, will be considered separate Periods of Disability.

1The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.

This brochure explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

Wisconsin Medical Society Insurance & Financial Services, Inc., is compensated for the placement of insurance and for the services it provides to customers on behalf of the insurance company, in addition to other compensation it may receive.

Nations Benefits and Financial Services Administration, LLC d/b/a NBFSA, LLC , is the Plan Administrator and Insurance broker that administers the insurance plan on behalf of the Hartford Life and Accident Insurance Company for the benefit of the Group Policyholder. Nations Benefits and Financial Services

Help protect the health of your most vital asset — your income — with coverage designed for the needs of physicians and spouses. Apply now.

Any Questions? Can we provide you with a no-obligation rate quote?

Contact Wisconsin Medical Society Insurance Services at 1-866-442-3810 for more information.

Category Monthly Expense Amount Mortgage or rent payment

(include property taxes and insurance

if paid separately) $

Food and Clothing Costs $

Child Care/Tuition Costs $

Auto &Transportation

(include auto payment, repairs, gas, public transportation costs, etc.) $ Loan Payments

(student loans, credit card payments,

personal loans, etc.) $

Utility Costs

(phone, heat, electric, gas, water, etc.) $ Living Expenses

(include home repairs, entertainment, vacations, memberships, etc.) $ Health, Life or Other Insurance Bills (include contributions to any health plan, prescription costs, life insurance

payments, etc.) $

Retirement & Other Contribution (include monthly contributions for meeting retirement and general savings goals, future education savings, etc.) $

Total Monthly Expenses $

Other disability insurance or salary that would continue even if you

couldn’t work:

Disability Income Protection Needed:

WHY WOULD I NEED IT?

HOW MUCH DO I NEED?

The results in this worksheet are for your information only

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Effective Date: Your coverage becomes effective for the Standard Issue Plan on the first of the month following our receipt of your approved application and first premium payment. For the Guaranteed Issue Plan, your coverage becomes effective the first of the month following our receipt of your enrollment form and first premium payment.

Deferred Effective Date: If you or your covered Spouse is not Actively-at-Work on the date, coverage will not become effective until the first day of the month on or next following the date he or she is Actively-at-Work for 3 months.

Termination: You may maintain your coverage as long as you remain a member; pay your premium on time and the Master Policy remains in force. Coverage terminates if you or your spouse attain the policy age limit; the date You or Your Spouse cease to be Actively at Work, except due to disability covered by the Policy or temporary lay-off, or leave of absence. Coverage for your spouse terminates when your coverage is no longer active, they are no longer eligible due to change in age, dependency or marital status.

However, if Your Spouse’s coverage would terminate because of your death, coverage will continue until the Premium Due Date on or next following your death unless continued in accordance with the Surviving Spouse Continuation provision.

Exclusions: The Policy does not cover any Disability or loss caused by: 1) intentionally self inflicted Injury, suicide

or attempted suicide, while sane or insane; or 2) war or act of war, whether declared or not; or 3) Your commission or attempted commission of a felony; or 4) Sickness contracted or Injury sustained while on full-time active duty as a member of the Armed Forces (land, water, air) of any country or international authority. We will refund the pro rata portion of any premium paid for You while You are in the Armed Forces on full-time active duty for a period of two months or more. Written notice must be given to Us within 12 months of the date You enter the Armed Forces.”

Limitations/Pre-Existing Condition Limitation: This means any injury or sickness, diagnosed or undiagnosed, for which medical care is received. Treatment in the 6 month period prior to the effective date of coverage will not be covered until 6 months ending on or after the effective date of coverage without medical advice or treatment for that condition, or until one (1) year after the effective date of coverage, whichever comes first.

Drug/Alcohol and Mental Nervous Limitation: If you are totally disabled due to mental or nervous disorders, alcoholism or drug abuse, the Maximum Payment Period will be reduced to 2 years during your lifetime unless you are confined in a hospital or other institution licensed to provide care and treatment for that disability.

Choose the waiting/elimination period that’s best for you.

You have a choice of two waiting periods: 90 or 180 days.

A waiting period (also known as an elimination period) is the period of time before your monthly benefits begin for a covered Disability. You can select the plan that works best your needs. The 180 period day plan is the most affordable. The 90 day plan may be a better fit for you if you would need more immediate funds in place for your living expenses.

Premiums waived while collecting benefits.

Premium payments are waived for the duration of your benefit period for any Total Disability which last six months or longer. This waiver of premium payment starts after you have been Totally Disabled for six months and ends when the Total Disability benefit is no longer payable.

How benefits are paid.

Benefits are tax-free when premium payments are made with after-tax dollars, so the monthly benefits under this plan may be exempt from federal income tax. You should consult your tax advisor for more information.

Here are some important benefits which are automatically included in your coverage:

Disabled and Working Benefit: If you become disabled and are still able to work, you can still receive a percentage of your selected benefit payment. If disabled and still working at your own occupation, you’re eligible to receive this benefit if earning more than 20% and less than 80% of your Pre-Disability Earnings, able to perform at least one of the duties of your job, and under the care of a physician.

This benefit is a percentage of your Disability benefit but would never be less than $50 a month.

Rehabilitative Employment Benefit: If you accept Rehabilitative Employment, while you are Disabled or

Disabled and Working, you can continue to receive monthly benefit payments equal to your Disability Monthly benefit, less 50% of any income received from the Rehabilitative Employment.

Workplace Modification Benefit: With this benefit, your employer can be reimbursed the cost of workplace modifications to accommodate your disability so that you are able to return to work, and perform the essential duties of your job. Benefits paid for workplace modifications cannot exceed the amount of your maximum monthly benefit. Payment of this benefit will not reduce or deny any benefit you are eligible to receive with this plan.

Survivor Income Benefit: This benefit provides a lump- sum payment equal to 3 times your last monthly benefit amount for Disability to your named beneficiary (or your surviving spouse or children) if you should die while receiving disability benefits.

Contagious and Infectious Disease Benefit: In the event that you contract an infectious and contagious disease – but are not Totally Disabled – you can receive a percentage of your monthly benefit payment. This benefit can begin once you have been covered by this benefit for a period of 12 months, and after conditions have been met which are proven to restrict your income and/or your ability to perform the Essential Duties of Your Occupation. This benefit can continue for up to two years, or until you qualify for full Disability benefits under the plan.

Family Care Credit Benefit: If you are working as part of a program of Rehabilitation, the benefit amount you receive can be adjusted by deducting the cost of Family Care from earnings received from a Rehabilitation Program.

This applies to the cost of providing care for children under age 13 or any member of your household who is mentally or physically handicapped and dependent upon you for support and maintenance. The maximum monthly deduction allowed for each qualifying child or family member is $300 during the first 6 months of Rehabilitation

Business Overhead Expense Benefit: This option provides a monthly benefit to help pay for your monthly office expenses, such as rent, employee salaries, mortgage and tax payments and more. You can receive an additional monthly benefit payment of up to 25% of your monthly Disability Benefit or $2,500, whichever is less. These benefits can continue for one year.

Cost of Living Adjustment (COLA) Benefit: If selected, you can receive an automatic increase in your monthly benefit amount on an annual basis. This can begin after being Disabled for 12 consecutive months.

The cost of living percentage increase is based on changes in the consumer price index. You can receive this annual adjustment up to 5 times.

Extended Earnings Protection Benefit: This optional benefit helps to protect your earnings level after you have returned to work following a period of disability.

You would be eligible to receive a monthly benefit for up to one full year, or until you earn at least 80% of your Pre-disability Earnings.

Progressive Illness Benefit: If you are diagnosed with a progressive noninfectious illness which causes you to gradually become Disabled (as the disease or disorder becomes more frequent and impacts your ability to perform your own occupation), you can begin collecting your monthly benefit payment.

The Wisconsin Medical Society Member Long-Term Disability Insurance Plan is designed especially for physicians.

It has flexible benefit options you can tailor to your specific needs.

You can consider adding these options to your coverage based on your specific needs.

(Simply check the appropriate boxes on the Application Form.) (If you or your spouse are in an occupation that requires either of you to maintain a license, your or your spouse’s failure to

pass a physical examination required to maintain that license does not alone mean that you or your spouse are disabled from your occupation.)

and $115 thereafter. It cannot exceed the amount of your monthly earnings, and Family Care Credits may not exceed a total of $2,500 during a calendar year.

You cannot be singled out for a rate increase.

You cannot be singled out for a rate increase because of your health status. In fact, rates and/or benefits may be changed for those in your same insured class only.

You can apply now with no obligation.

Your satisfaction is guaranteed.

You can rest assured by selecting your desired protection and applying now. Send no money now. Once coverage is approved, you will receive your Certificate of Insurance and you will have a full 30 days to review it. If you’re not 100% satisfied, simply return it within that time period without paying the premium. Your coverage will not be in force and you will be under no obligation.

Two Disability Benefit options are available to you:

Disability Benefit (Option 1)

MORE COMPREHENSIVE

Coverage for “Own Specialty Occupation”

This option is the most comprehensive, as it provides monthly benefit protection for any covered benefit period (until retirement age) for the “Own Specialty Occupation”

definition of a disability (any Disability which prevents you or your spouse from performing one or more of the essential duties of your specific area of practice). With this option, you are eligible to collect benefits until your Disability ends, even if you can practice another field of medicine or the duties of another job which is not part of your specialty.

Disability Benefit (Option 2)

MORE ECONOMICAL

24 Month Coverage for “Own Specialty Occupation”

With the Disability Benefit option 2, you would be covered for the “Own Specialty Occupation” definition of disability (any Disability which prevents you or your spouse from performing one or more of the essential duties of your specific area of practice) during the Waiting/Elimination Period and the first 24 months during which Disability Benefits are payable. After that, the definition of a

Disability would be expanded to include a Disability which continuously prevents you or your spouse from engaging in any occupation.

Member eligibility.

As an active Wisconsin Medical Society member under age 70 (under age 55 for Guarantee Issue Plan) you are eligible to apply for coverage as long as you are Actively at Work as a resident or physician at least 20 hours per week and performing all duties of your occupation. You must also be a citizen or legal resident of the United States and not be a full-time member of any country’s armed forces. The maximum amount of member coverage is $10,000, as long as it does not exceed 60% of your Pre-Disability Earnings.

Spouse eligibility. Your spouse can apply at same affordable rates available to physician members!

Your spouse is eligible for coverage as long as he or she is under age 70 (under age 55 for Guarantee Issue Plan) and Actively at Work at least 20 hours per week and performing all duties of his or her occupation. Your spouse must also be a citizen or legal resident of the United States and not be a full-time member of any country’s armed forces. The maximum amount of spouse coverage is $5,000, as long as it does not exceed 60% of Pre-Disability Earnings. Note:

The eligible member must apply for coverage in order to apply for coverage for his or her spouse. If a husband and wife are both eligible members, only one may apply for coverage as a member of the policyholder and the other may be covered as a spouse only.

Replace up to 60% of your basic monthly income if a disability strikes.

With the Standard Issue Plan or the Guarantee Issue Plan, you can select monthly benefits up to a full 60% of your Pre- Disability Earnings. These benefits are payable until Normal Retirement Age (age 65 to 67, based on your date of birth) and can be used to help replace your lost income if you should suffer a Disability due to any covered Sickness or Injury.

You are considered disabled if you are unable to perform one or more of the essential duties of the specialty you were practicing prior to your disability. Benefits don’t terminate solely because you can practice another field of medicine.

Standard Issue Plan – Monthly benefits of up to $10,000.

With the Standard Issue Plan, you can select monthly benefits from $500 to $10,000 per month, in $100

increments up to a full 60% of your Pre-Disability Earnings.

The Standard Issue Plan requires evidence of insurability and completion of the Application Form.

Guarantee Issue Plan* – Monthly benefits of up to $6,000 (for members under age 55).

With the Guarantee Issue Plan, members can select monthly benefits from $500 to $6,000 per month ($5,000 for spouses), in $100 increments up to a full 60% of your Pre-Disability Earnings. The Guarantee Issue Plan is available to members and spouses under age 55 who apply for coverage and are Actively at Work during the 90 consecutive day period immediately before the date of applying. It requires completion of the Enrollment Form.

* This means that although you will not be asked to take a medical exam or answer medical questions at the time of enrollment, insurance benefits payable are subject to your policy’s Pre-Existing Conditions Limitation.

No Disability Plan Offsets

Collect full monthly benefit payments regardless of any other benefits you may receive!

A “plan offset” means that the benefit amount payable as the result of the Insured Person’s Disability would be reduced, based upon other income such as Group Disability benefits, Workers’

Compensation, Social Security, etc. Some disability plans have offset provisions which can reduce the plan benefit payments. With the Wisconsin Medical Society Disability Plan there are no plan offsets.

So you can collect full monthly benefit payments from this plan regardless of any other benefits you may receive.

OPTIONAL BENEFITS

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Effective Date: Your coverage becomes effective for the Standard Issue Plan on the first of the month following our receipt of your approved application and first premium payment. For the Guaranteed Issue Plan, your coverage becomes effective the first of the month following our receipt of your enrollment form and first premium payment.

Deferred Effective Date: If you or your covered Spouse is not Actively-at-Work on the date, coverage will not become effective until the first day of the month on or next following the date he or she is Actively-at-Work for 3 months.

Termination: You may maintain your coverage as long as you remain a member; pay your premium on time and the Master Policy remains in force. Coverage terminates if you or your spouse attain the policy age limit; the date You or Your Spouse cease to be Actively at Work, except due to disability covered by the Policy or temporary lay-off, or leave of absence. Coverage for your spouse terminates when your coverage is no longer active, they are no longer eligible due to change in age, dependency or marital status.

However, if Your Spouse’s coverage would terminate because of your death, coverage will continue until the

or attempted suicide, while sane or insane; or 2) war or act of war, whether declared or not; or 3) Your commission or attempted commission of a felony; or 4) Sickness contracted or Injury sustained while on full-time active duty as a member of the Armed Forces (land, water, air) of any country or international authority. We will refund the pro rata portion of any premium paid for You while You are in the Armed Forces on full-time active duty for a period of two months or more. Written notice must be given to Us within 12 months of the date You enter the Armed Forces.”

Limitations/Pre-Existing Condition Limitation: This means any injury or sickness, diagnosed or undiagnosed, for which medical care is received. Treatment in the 6 month period prior to the effective date of coverage will not be covered until 6 months ending on or after the effective date of coverage without medical advice or treatment for that condition, or until one (1) year after the effective date of coverage, whichever comes first.

Drug/Alcohol and Mental Nervous Limitation: If you are totally disabled due to mental or nervous disorders, alcoholism or drug abuse, the Maximum Payment Period

Choose the waiting/elimination period that’s best for you.

You have a choice of two waiting periods: 90 or 180 days.

A waiting period (also known as an elimination period) is the period of time before your monthly benefits begin for a covered Disability. You can select the plan that works best your needs. The 180 period day plan is the most affordable. The 90 day plan may be a better fit for you if you would need more immediate funds in place for your living expenses.

Premiums waived while collecting benefits.

Premium payments are waived for the duration of your benefit period for any Disability which last six months or longer. This waiver of premium payment starts after you have been Disabled for six months and ends when the Disability benefit is no longer payable.

How benefits are paid.

Benefits are tax-free when premium payments are made with after-tax dollars, so the monthly benefits under this plan may be exempt from federal income tax. You should consult your tax advisor for more information.

Here are some important benefits which are automatically included in your coverage:

Disabled and Working Benefit: If you become disabled and are still able to work, you can still receive a percentage of your selected benefit payment. If disabled and still working at your own occupation, you’re eligible to receive this benefit if earning more than 20% and less than 80% of your Pre-Disability Earnings, able to perform at least one of the duties of your job, and under the care of a physician.

Disabled and Working, you can continue to receive monthly benefit payments equal to your Disability Monthly benefit, less 50% of any income received from the Rehabilitative Employment.

Workplace Modification Benefit: With this benefit, your employer can be reimbursed the cost of workplace modifications to accommodate your disability so that you are able to return to work, and perform the essential duties of your job. Benefits paid for workplace modifications cannot exceed the amount of your maximum monthly benefit. Payment of this benefit will not reduce or deny any benefit you are eligible to receive with this plan.

Survivor Income Benefit: This benefit provides a lump- sum payment equal to 3 times your last monthly benefit amount for Disability to your named beneficiary (or your surviving spouse or children) if you should die while receiving disability benefits.

Contagious and Infectious Disease Benefit: In the event that you contract an infectious and contagious disease – but are not Disabled – you can receive a percentage of your monthly benefit payment. This benefit can begin once you have been covered by this benefit for a period of 12 months, and after conditions have been met which are proven to restrict your income and/or your ability to perform the Essential Duties of Your Occupation. This benefit can continue for up to two years, or until you qualify for full Disability benefits under the plan.

Family Care Credit Benefit: If you are working as part of a program of Rehabilitation, the benefit amount you receive can be adjusted by deducting the cost of Family Care from earnings received from a Rehabilitation Program.

This applies to the cost of providing care for children

Business Overhead Expense Benefit: This option provides a monthly benefit to help pay for your monthly office expenses, such as rent, employee salaries, mortgage and tax payments and more. You can receive an additional monthly benefit payment of up to 25% of your monthly Disability Benefit or $2,500, whichever is less. These benefits can continue for one year.

Cost of Living Adjustment (COLA) Benefit: If selected, you can receive an automatic increase in your monthly benefit amount on an annual basis. This can begin after being Disabled for 12 consecutive months.

The cost of living percentage increase is based on changes in the consumer price index. You can receive this annual adjustment up to 5 times.

Extended Earnings Protection Benefit: This optional benefit helps to protect your earnings level after you have returned to work following a period of disability.

You would be eligible to receive a monthly benefit for up to one full year, or until you earn at least 80% of your Pre-disability Earnings.

Progressive Illness Benefit: If you are diagnosed with a progressive noninfectious illness which causes you to gradually become Disabled (as the disease or disorder becomes more frequent and impacts your ability to perform your own occupation), you can begin collecting your monthly benefit payment.

The Wisconsin Medical Society Member Long-Term Disability Insurance Plan is designed especially for physicians.

It has flexible benefit options you can tailor to your specific needs.

You can consider adding these options to your coverage based on your specific needs.

(Simply check the appropriate boxes on the Application Form.) (If you or your spouse are in an occupation that requires either of you to maintain a license, your or your spouse’s failure to

pass a physical examination required to maintain that license does not alone mean that you or your spouse are disabled from your occupation.)

and $115 thereafter. It cannot exceed the amount of your monthly earnings, and Family Care Credits may not exceed a total of $2,500 during a calendar year.

You cannot be singled out for a rate increase.

You cannot be singled out for a rate increase because of your health status. In fact, rates and/or benefits may be changed for those in your same insured class only.

You can apply now with no obligation.

Your satisfaction is guaranteed.

You can rest assured by selecting your desired protection and applying now. Send no money now. Once coverage is approved, you will receive your Certificate of Insurance and you will have a full 30 days to review it. If you’re not 100% satisfied, simply return it within that time period without paying the premium. Your coverage will not be in force and you will be under no obligation.

Two Disability Benefit options are available to you:

Disability Benefit (Option 1)

MORE COMPREHENSIVE

Coverage for “Own Specialty Occupation”

This option is the most comprehensive, as it provides monthly benefit protection for any covered benefit period (until retirement age) for the “Own Specialty Occupation”

definition of a disability (any Disability which prevents you or your spouse from performing one or more of the essential duties of your specific area of practice). With this option, you are eligible to collect benefits until your Disability ends, even if you can practice another field of medicine or the duties of another job which is not part of your specialty.

Disability Benefit (Option 2)

MORE ECONOMICAL

24 Month Coverage for “Own Specialty Occupation”

With the Disability Benefit option 2, you would be covered for the “Own Specialty Occupation” definition of disability (any Disability which prevents you or your spouse from performing one or more of the essential duties of your specific area of practice) during the Waiting/Elimination Period and the first 24 months during which Disability Benefits are payable. After that, the definition of a

Disability would be expanded to include a Disability which continuously prevents you or your spouse from engaging in any occupation.

Member eligibility.

As an active Wisconsin Medical Society member under age 70 (under age 55 for Guarantee Issue Plan) you are eligible to apply for coverage as long as you are Actively at Work as a resident or physician at least 20 hours per week and performing all duties of your occupation. You must also be a citizen or legal resident of the United States and not be a full-time member of any country’s armed forces. The maximum amount of member coverage is $10,000, as long as it does not exceed 60% of your Pre-Disability Earnings.

Spouse eligibility. Your spouse can apply at same affordable rates available to physician members!

Your spouse is eligible for coverage as long as he or she is under age 70 (under age 55 for Guarantee Issue Plan) and Actively at Work at least 20 hours per week and performing all duties of his or her occupation. Your spouse must also be a citizen or legal resident of the United States and not be a full-time member of any country’s armed forces. The maximum amount of spouse coverage is $5,000, as long as it does not exceed 60% of Pre-Disability Earnings. Note:

The eligible member must apply for coverage in order to apply for coverage for his or her spouse. If a husband and wife are both eligible members, only one may apply for coverage as a member of the policyholder and the other may be covered as a spouse only.

Replace up to 60% of your basic monthly income if a disability strikes.

With the Standard Issue Plan or the Guarantee Issue Plan, you can select monthly benefits up to a full 60% of your Pre- Disability Earnings. These benefits are payable until Normal Retirement Age (age 65 to 67, based on your date of birth) and can be used to help replace your lost income if you should

Standard Issue Plan – Monthly benefits of up to $10,000.

With the Standard Issue Plan, you can select monthly benefits from $500 to $10,000 per month, in $100

increments up to a full 60% of your Pre-Disability Earnings.

The Standard Issue Plan requires evidence of insurability and completion of the Application Form.

Guarantee Issue Plan* – Monthly benefits of up to $6,000 (for members under age 55).

With the Guarantee Issue Plan, members can select monthly benefits from $500 to $6,000 per month ($5,000 for spouses), in $100 increments up to a full 60% of your Pre-Disability Earnings. The Guarantee Issue Plan is available to members and spouses under age 55 who apply for coverage and are Actively at Work during the 90 consecutive day period immediately before the date of applying. It requires completion of the Enrollment Form.

* This means that although you will not be asked to take a medical exam or answer medical questions at the time of enrollment, insurance benefits payable are subject to your policy’s Pre-Existing Conditions Limitation.

No Disability Plan Offsets

Collect full monthly benefit payments regardless of any other benefits you may receive!

A “plan offset” means that the benefit amount payable as the result of the Insured Person’s Disability would be reduced, based upon other income such as Group Disability benefits, Workers’

Compensation, Social Security, etc. Some disability plans have offset provisions which can reduce the plan benefit payments. With the Wisconsin Medical Society Disability Plan there are no plan offsets.

OPTIONAL BENEFITS

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Effective Date: Your coverage becomes effective for the Standard Issue Plan on the first of the month following our receipt of your approved application and first premium payment. For the Guaranteed Issue Plan, your coverage becomes effective the first of the month following our receipt of your enrollment form and first premium payment.

Deferred Effective Date: If you or your covered Spouse is not Actively-at-Work on the date, coverage will not become effective until the first day of the month on or next following the date he or she is Actively-at-Work for 3 months.

Termination: You may maintain your coverage as long as you remain a member; pay your premium on time and the Master Policy remains in force. Coverage terminates if you or your spouse attain the policy age limit; the date You or Your Spouse cease to be Actively at Work, except due to disability covered by the Policy or temporary lay-off, or leave of absence. Coverage for your spouse terminates when your coverage is no longer active, they are no longer eligible due to change in age, dependency or marital status.

However, if Your Spouse’s coverage would terminate because of your death, coverage will continue until the Premium Due Date on or next following your death unless continued in accordance with the Surviving Spouse Continuation provision.

Exclusions: The Policy does not cover any Disability or loss caused by: 1) intentionally self inflicted Injury, suicide

or attempted suicide, while sane or insane; or 2) war or act of war, whether declared or not; or 3) Your commission or attempted commission of a felony; or 4) Sickness contracted or Injury sustained while on full-time active duty as a member of the Armed Forces (land, water, air) of any country or international authority. We will refund the pro rata portion of any premium paid for You while You are in the Armed Forces on full-time active duty for a period of two months or more. Written notice must be given to Us within 12 months of the date You enter the Armed Forces.”

Limitations/Pre-Existing Condition Limitation: This means any injury or sickness, diagnosed or undiagnosed, for which medical care is received. Treatment in the 6 month period prior to the effective date of coverage will not be covered until 6 months ending on or after the effective date of coverage without medical advice or treatment for that condition, or until one (1) year after the effective date of coverage, whichever comes first.

Drug/Alcohol and Mental Nervous Limitation: If you are disabled due to mental or nervous disorders, alcoholism or drug abuse, the Maximum Payment Period will be reduced to 2 years during your lifetime unless you are confined in a hospital or other institution licensed to provide care and treatment for that disability.

Choose the waiting/elimination period that’s best for you.

You have a choice of two waiting periods: 90 or 180 days.

A waiting period (also known as an elimination period) is the period of time before your monthly benefits begin for a covered Disability. You can select the plan that works best your needs. The 180 period day plan is the most affordable. The 90 day plan may be a better fit for you if you would need more immediate funds in place for your living expenses.

Premiums waived while collecting benefits.

Premium payments are waived for the duration of your benefit period for any Disability which last six months or longer. This waiver of premium payment starts after you have been Disabled for six months and ends when the Disability benefit is no longer payable.

How benefits are paid.

Benefits are tax-free when premium payments are made with after-tax dollars, so the monthly benefits under this plan may be exempt from federal income tax. You should consult your tax advisor for more information.

Here are some important benefits which are automatically included in your coverage:

Disabled and Working Benefit: If you become disabled and are still able to work, you can still receive a percentage of your selected benefit payment. If disabled and still working at your own occupation, you’re eligible to receive this benefit if earning more than 20% and less than 80% of your Pre-Disability Earnings, able to perform at least one of the duties of your job, and under the care of a physician.

This benefit is a percentage of your Disability benefit but would never be less than $50 a month.

Rehabilitative Employment Benefit: If you accept Rehabilitative Employment, while you are Disabled or

Disabled and Working, you can continue to receive monthly benefit payments equal to your Disability Monthly benefit, less 50% of any income received from the Rehabilitative Employment.

Workplace Modification Benefit: With this benefit, your employer can be reimbursed the cost of workplace modifications to accommodate your disability so that you are able to return to work, and perform the essential duties of your job. Benefits paid for workplace modifications cannot exceed the amount of your maximum monthly benefit. Payment of this benefit will not reduce or deny any benefit you are eligible to receive with this plan.

Survivor Income Benefit: This benefit provides a lump- sum payment equal to 3 times your last monthly benefit amount for Disability to your named beneficiary (or your surviving spouse or children) if you should die while receiving disability benefits.

Contagious and Infectious Disease Benefit: In the event that you contract an infectious and contagious disease – but are not Disabled – you can receive a percentage of your monthly benefit payment. This benefit can begin once you have been covered by this benefit for a period of 12 months, and after conditions have been met which are proven to restrict your income and/or your ability to perform the Essential Duties of Your Occupation. This benefit can continue for up to two years, or until you qualify for full Disability benefits under the plan.

Family Care Credit Benefit: If you are working as part of a program of Rehabilitation, the benefit amount you receive can be adjusted by deducting the cost of Family Care from earnings received from a Rehabilitation Program.

This applies to the cost of providing care for children under age 13 or any member of your household who is mentally or physically handicapped and dependent upon you for support and maintenance. The maximum monthly deduction allowed for each qualifying child or family member is $300 during the first 6 months of Rehabilitation

Business Overhead Expense Benefit: This option provides a monthly benefit to help pay for your monthly office expenses, such as rent, employee salaries, mortgage and tax payments and more. You can receive an additional monthly benefit payment of up to 25% of your monthly Disability Benefit or $2,500, whichever is less. These benefits can continue for one year.

Cost of Living Adjustment (COLA) Benefit: If selected, you can receive an automatic increase in your monthly benefit amount on an annual basis. This can begin after being Disabled for 12 consecutive months.

The cost of living percentage increase is based on changes in the consumer price index. You can receive this annual adjustment up to 5 times.

Extended Earnings Protection Benefit: This optional benefit helps to protect your earnings level after you have returned to work following a period of disability.

You would be eligible to receive a monthly benefit for up to one full year, or until you earn at least 80% of your Pre-disability Earnings.

Progressive Illness Benefit: If you are diagnosed with a progressive noninfectious illness which causes you to gradually become Disabled (as the disease or disorder becomes more frequent and impacts your ability to perform your own occupation), you can begin collecting your monthly benefit payment.

The Wisconsin Medical Society Member Long-Term Disability Insurance Plan is designed especially for physicians.

It has flexible benefit options you can tailor to your specific needs.

You can consider adding these options to your coverage based on your specific needs.

(Simply check the appropriate boxes on the Application Form.) (If you or your spouse are in an occupation that requires either of you to maintain a license, your or your spouse’s failure to

pass a physical examination required to maintain that license does not alone mean that you or your spouse are disabled from your occupation.)

and $115 thereafter. It cannot exceed the amount of your monthly earnings, and Family Care Credits may not exceed a total of $2,500 during a calendar year.

You cannot be singled out for a rate increase.

You cannot be singled out for a rate increase because of your health status. In fact, rates and/or benefits may be changed for those in your same insured class only.

You can apply now with no obligation.

Your satisfaction is guaranteed.

You can rest assured by selecting your desired protection and applying now. Send no money now. Once coverage is approved, you will receive your Certificate of Insurance and you will have a full 30 days to review it. If you’re not 100% satisfied, simply return it within that time period without paying the premium. Your coverage will not be in force and you will be under no obligation.

Two Disability Benefit options are available to you:

Disability Benefit (Option 1)

MORE COMPREHENSIVE

Coverage for “Own Specialty Occupation”

This option is the most comprehensive, as it provides monthly benefit protection for any covered benefit period (until retirement age) for the “Own Specialty Occupation”

definition of a disability (any Disability which prevents you or your spouse from performing one or more of the essential duties of your specific area of practice). With this option, you are eligible to collect benefits until your Disability ends, even if you can practice another field of medicine or the duties of another job which is not part of your specialty.

Disability Benefit (Option 2)

MORE ECONOMICAL

24 Month Coverage for “Own Specialty Occupation”

With the Disability Benefit option 2, you would be covered for the “Own Specialty Occupation” definition of disability (any Disability which prevents you or your spouse from performing one or more of the essential duties of your specific area of practice) during the Waiting/Elimination Period and the first 24 months during which Disability Benefits are payable. After that, the definition of a

Disability would be expanded to include a Disability which continuously prevents you or your spouse from engaging in any occupation.

Member eligibility.

As an active Wisconsin Medical Society member under age 70 (under age 55 for Guarantee Issue Plan) you are eligible to apply for coverage as long as you are Actively at Work as a resident or physician at least 20 hours per week and performing all duties of your occupation. You must also be a citizen or legal resident of the United States and not be a full-time member of any country’s armed forces. The maximum amount of member coverage is $10,000, as long as it does not exceed 60% of your Pre-Disability Earnings.

Spouse eligibility. Your spouse can apply at same affordable rates available to physician members!

Your spouse is eligible for coverage as long as he or she is under age 70 (under age 55 for Guarantee Issue Plan) and Actively at Work at least 20 hours per week and performing all duties of his or her occupation. Your spouse must also be a citizen or legal resident of the United States and not be a full-time member of any country’s armed forces. The maximum amount of spouse coverage is $5,000, as long as it does not exceed 60% of Pre-Disability Earnings. Note:

The eligible member must apply for coverage in order to apply for coverage for his or her spouse. If a husband and wife are both eligible members, only one may apply for coverage as a member of the policyholder and the other may be covered as a spouse only.

Replace up to 60% of your basic monthly income if a disability strikes.

With the Standard Issue Plan or the Guarantee Issue Plan, you can select monthly benefits up to a full 60% of your Pre- Disability Earnings. These benefits are payable until Normal Retirement Age (age 65 to 67, based on your date of birth) and can be used to help replace your lost income if you should suffer a Disability due to any covered Sickness or Injury.

You are considered disabled if you are unable to perform one or more of the essential duties of the specialty you were practicing prior to your disability. Benefits don’t terminate solely because you can practice another field of medicine.

Standard Issue Plan – Monthly benefits of up to $10,000.

With the Standard Issue Plan, you can select monthly benefits from $500 to $10,000 per month, in $100

increments up to a full 60% of your Pre-Disability Earnings.

The Standard Issue Plan requires evidence of insurability and completion of the Application Form.

Guarantee Issue Plan* – Monthly benefits of up to $6,000 (for members under age 55).

With the Guarantee Issue Plan, members can select monthly benefits from $500 to $6,000 per month ($5,000 for spouses), in $100 increments up to a full 60% of your Pre-Disability Earnings. The Guarantee Issue Plan is available to members and spouses under age 55 who apply for coverage and are Actively at Work during the 90 consecutive day period immediately before the date of applying. It requires completion of the Enrollment Form.

* This means that although you will not be asked to take a medical exam or answer medical questions at the time of enrollment, insurance benefits payable are subject to your policy’s Pre-Existing Conditions Limitation.

No Disability Plan Offsets

Collect full monthly benefit payments regardless of any other benefits you may receive!

A “plan offset” means that the benefit amount payable as the result of the Insured Person’s Disability would be reduced, based upon other income such as Group Disability benefits, Workers’

Compensation, Social Security, etc. Some disability plans have offset provisions which can reduce the plan benefit payments. With the Wisconsin Medical Society Disability Plan there are no plan offsets.

So you can collect full monthly benefit payments from this plan regardless of any other benefits you may receive.

OPTIONAL BENEFITS

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As you protect the health of others…we’ll help protect the health of your most vital asset:

your income.

Why would I need disability income protection?

As a physician, you’ve probably witnessed the

physical and financial effects of a disabling Sickness or Injury firsthand. It can happen to anyone, at anytime.

And if a sudden disability prevents you from working in your practice — for months or even years — your family’s financial future could be at risk.

Consider the statistics:

• Over 36 million Americans are classified as disabled; about 12% of the total population.

More than 50% of those disabled Americans are in their working years, from 18-64.*

• The average long-term disability claim duration is 31.2 months.*

• Three in 10 workers entering the work force today will become disabled before retiring.*

Why should I select this Plan?

The Wisconsin Medical Society Member Long-Term Disability Insurance Plan includes an important “Own Specialty Occupation” definition of disability. As a physician, your occupation means the general or sub- specialty in which you are practicing as recognized by the American Board of Medical Specialties. So if you became disabled and could not perform the essential duties of your specific area of practice, you are eligible to collect full benefits, even if you can practice another field of medicine or the duties of another job which is not part of your specialty.

Plus...the rates are very competitive!

The Wisconsin Medical Society Member Long-Term Disability Plan is underwritten by an industry leader: The Hartford1

This Program is underwritten by a leader in professional group coverage, The Hartford.

The Hartford has become known for its innovation in developing products for today’s insurance climate.

Your protection is administered by Nations Benefits and Financial Services Administration, (NBFSA), an administrator that serves the insurance needs of the professional association members nationwide. They have trained professional representatives available to assist with claims payment, or to answer any questions you may have. Just call 1-866-442-3810, 8:00 a.m. to 4:30 p.m. Monday to Friday, Central Time.

How much Disability Insurance would I need?

Depending on your own personal situation, many financial experts recommend that you have enough disability coverage to replace 60% of your income. This worksheet will help you calculate a monthly benefit that may be right for your family.

INTRODUCING THE

WISCONSIN MEDICAL SOCIETY MEMBER LONG-TERM DISABILITY INSURANCE PLAN

• Up to $10,000 of monthly benefits with Standard Issue coverage.

• Up to $6,000 of monthly benefits with Guaranteed Issue coverage for members under age 55.

• Includes “Own Specialty Occupation” definition of disability.

Especially for physicians

• Flexible coverage options can be tailored to your needs.

• Your spouse can also apply at same rates available to physician members.

• Monthly benefit payments can continue until retirement age.

Can we help you determine your needs, or provide you with

a no-obligation rate quote?

Contact Wisconsin Medical Society Insurance Services at 1-866-442-3810 for more information.

Definitions

Actively at Work means you or your Spouse are performing all the Essential Duties of Your Occupation for wage or profit on a full-time basis (at least 20 hours per week).

Pre-disability Earnings means, if you or your spouse are self-employed, your or your spouse’s average net monthly income (gross revenues less business expenses) from: 1) the personal practice of Your or Your Spouse’s profession; or 2) personal conduct of Your or Your Spouse’s main business.

This average is based on net income for: 1) 12 months; or 2) 24 months; whichever produces the higher average, before the determination is made. If You or Your Spouse have been self-employed for less than 12 months, it is based on the whole time You or Your Spouse were self-employed. If Your or Your Spouse’s practice is incorporated, net income includes the cost to Your or Your Spouse’s company of fringe benefits and Your or Your Spouse’s share of total surplus. Income does not include investment returns, rents, royalties, and the like income which is not directly produced from Your or Your Spouse’s current work.

Pre-disability Earnings means, if you or your Spouse are not self-employed, your or your spouse’s regular monthly rate of pay, not counting commissions, bonuses, tips and

tokens, overtime pay or any other fringe benefits or extra compensation, in effect on the date immediately prior to the last day you or your spouse were Actively at Work before you or your spouse became Disabled.

Disabled and Working means a Disability that: 1) continues while you are performing at least one of the material duties of Your Own Occupation on either a full- time or part-time basis; 2) causes a loss of earnings of at least 20% (and less than 80%); and 3) requires the Regular Care of a Physician.

Recurrent Disability: If you cease to be Disabled and return to work for a total of 14 days or less during the Elimination Period, the Elimination Period will not be interrupted. Except for the 14 days or less that you work, you must be Disabled by the same condition for the total Elimination Period.

Successive periods of Disability or Disabled and Working, which are 1) due to the same or related causes; and not separated by a period of 6 months or longer; will be considered one period of Disability or Disabled and Working, and will be payable under the Plan.

Periods of Disability separated by at least 6 months during which you are Actively at Work, will be considered separate Periods of Disability.

1The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.

This brochure explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

Wisconsin Medical Society Insurance & Financial Services, Inc., is compensated for the placement of insurance and for the services it provides to customers on behalf of the insurance company, in addition to other compensation it may receive.

Nations Benefits and Financial Services Administration, LLC d/b/a NBFSA, LLC , is the Plan Administrator and Insurance broker that administers the insurance plan on behalf of the Hartford Life and Accident Insurance Company for the benefit of the Group Policyholder. Nations Benefits and Financial Services

Help protect the health of your most vital asset — your income — with coverage designed for the needs of physicians and spouses. Apply now.

Any Questions? Can we provide you with a no-obligation rate quote?

Contact Wisconsin Medical Society Insurance Services at 1-866-442-3810 for more information.

Category Monthly Expense Amount Mortgage or rent payment

(include property taxes and insurance

if paid separately) $

Food and Clothing Costs $

Child Care/Tuition Costs $

Auto &Transportation

(include auto payment, repairs, gas, public transportation costs, etc.) $ Loan Payments

(student loans, credit card payments,

personal loans, etc.) $

Utility Costs

(phone, heat, electric, gas, water, etc.) $ Living Expenses

(include home repairs, entertainment, vacations, memberships, etc.) $ Health, Life or Other Insurance Bills (include contributions to any health plan, prescription costs, life insurance

payments, etc.) $

Retirement & Other Contribution (include monthly contributions for meeting retirement and general savings goals, future education savings, etc.) $

Total Monthly Expenses $

Other disability insurance or salary that would continue even if you

couldn’t work:

Disability Income Protection Needed:

WHY WOULD I NEED IT?

HOW MUCH DO I NEED?

The results in this worksheet are for your information only

Figure

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References

Related subjects :