Never Include These 10 Features
Selling in the physician insurance marketplace can be challenging in today’s highly competitive environment. It’s important to recognize that some commercial carriers may use cost containment provisions – in the form of subjective and restrictive contract language – to enable aggressive pricing for physician group LTD plans. These contract provisions can:
- Prematurely terminate a claim
- Reduce the expected benefit amount
Keep in mind, when a physician buys LTD, they are buying their next paycheck. For a doctor who experiences a disabling event, nothing is worse than discovering that the claim experience and benefits they receive are vastly different than what they expected.
Comparisons of physician group LTD contracts from different carriers can help identify the difference between what a physician group thought they bought and what they actually bought. While sufficient for other workers and professions, these ten traditional features are harmful to doctors at claim time, and should never be included in a group LTD contract for physicians.
- Non-specific definition of occupation and duties
- Offsets for lagged income
- International travel/residency restrictions
- Part-time work requirement
- Maximum capacity language
- Mandatory rehabilitation
- 40-hour work week limit
- Self-reported symptom limitations
- 24-month lifetime aggregate mental illness & substance abuse limits
- Recommended treatment requirement
A good practice is to provide an audit of client or prospect contracts to identify whether or not they contain these detrimental provisions. If you find your client needs better specialized protection, MGIS IncomeProtect provides Individual Disability supplement coverage fine-tuned to doctors’ unique needs.
Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 93P-LH, 12- GP-01, and 12-DI-C-01. In New York, group insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 13-GP-LH-01, 13-LTD-C-01-MGIS, 13-STD-C-01-MGIS, 13-ADD-C-01-MGIS, 13-GP-LF-01, 13-LF-C-01-MGIS.
The disability policies provide disability income insurance only. They do NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Insurance Department.
This coverage does not constitute comprehensive health insurance (often referred to as “major medical coverage”) and does not satisfy the requirement for Minimum Essential Coverage under the Affordable Care Act.
Administration for physician products is provided by Medical Group Insurance Services, Inc. (MGIS), in all states, except as follows: in CA by MGIS Insurance Agency, Inc.; in NY by MGIS Insurance Agency. Product offerings may not be available in all states and may vary depending on state laws and regulations.
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