ELIGIBILITY REQUIREMENTS
1. Who is eligible to participate?
AAPA Fellow members, in good standing with the American Academy of PA's, working at least 24 hours or more per week in the medical services industry.
You must maintain your membership to participate in this plan. Failure to notify us of a lapse in membership will render your coverage terminated at the end of the month prior to your membership lapse date.
If you have ever applied medically for these plans, and you were declined, medical underwriting is required to apply for this plan even during an open enrollment period.
Disability benefits received from other group LTD and/or STD plans (such as an employer sponsored plan) could reduce the benefits you receive from the AAPA plan. If you are paying for other group coverage please contact us before you apply for this coverage.
Not a member? Click Here to join AAPA or go to www.aapa.org/join.aspx
2. What is required to apply?
If you are a new AAPA Fellow member you have 60 days from your original date of membership to apply for the STD, LTD or both, guaranteed acceptance. No medical questions or exams are required. The application will ask contact information, membership date, monthly income, and bank account information for the monthly premium debit. The application is secure and encrypted. If you are eligible (see #1 above) you will be accepted based on the date of your membership and you will receive an email confirmation. Your premiums will start the following month.
STD- New eligible members applying for coverage within the first 60 days of membership will be approved and can use the insurance upon the effective date.
Short-Term Disability plan benefits will begin after 14 days of disability and will continue to pay as long as you remain disabled; up to 76 days.
The benefit period for a pregnancy with no complications is as follows:
LTD-Members longer than 60 days must go through medical underwriting for the LTD coverage only.
STD- Members longer than 60 days do not have to go through medical underwriting but will be subject to the "Extended Benefit Waiting Period".
Important information regarding STD coverage for members longer than 60 days
STD-If you are a member for longer than 60 days you will be accepted for short term disability coverage with no underwriting required but an STD Extended Benefit Waiting Period will apply. This states that the benefit waiting period for any condition (pregnancy), other than an accident, will be 60 days for the first 12 months of coverage. Once the 12 months has been satisfied you will be eligible for the 14 day benefit waiting period.
STD DEDUCTIBLE INCOME - Income that would offset with any STD benefits you could receive.
Deductible Income means:
Short Term and Long Term Disability General Questions
1. Should I cancel any individual or group disability policies I currently have once I have applied for this group disability insurance?
This plan will not offset benefits with those received from an individually owned DI policy. It is recommended that you keep your individual plan and use this as a supplemental disability insurance.
2. Will this plan reduce by other group disability benefits I may receive at claim time?
Disability benefits received from other group STD/LTD plans (such as an employer, association or State sponsored group plan) will reduce the benefits you receive from these plans. If you are paying for other group coverage that you intend to keep please contact us to discuss your options.
Definition of Disability
You are Disabled if you meet the following Own Occupation definition of Disability. You are required to be Disabled only from your Own Occupation. You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder:
1. You are unable to perform with reasonable continuity the Material Duties of your Own
Occupation; and
2. You suffer a loss of at least 20% in your Predisability Earnings when working in your Own Occupation.
Note: You are not Disabled merely because your right to perform your Own Occupation is restricted, including a restriction or loss of license. You may work in another occupation while you meet the Own Occupation definition of Disability. However, you will no longer be Disabled when your Work Earnings from another occupation exceed 80% of your Predisability Earnings. Your Work Earnings may be Deductible Income.
Own Occupation means any employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as the occupation you are regularly performing for your Employer when Disability begins. In determining your Own Occupation, we are not limited to looking at the way you perform your job for your Employer, but we may also look at the way the occupation is generally performed in the national economy. If your Own Occupation involves the rendering of professional services and you are required to have a professional or occupational license in order to work, your Own Occupation is as broad as the scope of your license.
Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation, that cannot be reasonably modified or omitted. In no event will we consider working an average of more than 40 hours per week to be a Material Duty.
3. How long must I be disabled in order to receive benefits?
14 days of Total or Partial disability for the Short-Term Disability plan.
90 days of Total or Partial disability for the Long-Term Disability plan.
4. How long can benefits be paid?
Long-Term Disability plan benefits will begin after the 90 day waiting period and will continue to pay as long as you remain disabled or until your Social Security Normal Retirement Age.
Short-Term Disability plan benefits will begin after 14 days of disability and will continue to pay as long as you remain disabled; up to 76 days. Unless you are under the "Extended Benefit Waiting Period". No benefits will be approved for pregnancy because of the 60 day waiting period.
IMPORTANT: Benefit period paid for pregnancy?
5. Does the LTD plan have a pre-existing conditions clause?
Yes, but it only applies to Long-Term Disability. The pre-existing condition exclusion does not apply to Short-Term Disability. The LTD plan has a 3/12 pre-existing condition clause. This means if you’ve received care or consultation for any condition within the 3 months just prior to being insured, a disability caused by the condition will not be covered if it occurs within the first 12 consecutive months of being insured under the plan. After being insured under the plan for 12 consecutive months, the pre-existing condition clause no longer applies.
6. Will my personal information listed on the application be kept in the strictest confidence and security?
YES. All information entered on your electronic application is secured. All information gathered is used solely for the purpose of plan enrollment and ongoing services and will not be used for any other purpose.
7. How do I pay my premiums?
Funds will be deducted automatically, from the bank account of your choice, on the 17th of each month (or next banking day). The deduction will be listed on your statement as "Association DI Plans, LLC AAPA". Monthly bank draft is the only method of payment.
Note: Premiums are in 5 year age brackets (Age 40-44, 45-49, etc.). Your premiums will be adjusted the month following any birthday that moves you into the next bracket. You can use the "Calculate Benefits and Apply Now " to see how premiums will adjust over time, based on current rates.
8. Does the policy have a conversion option?
Yes. Up to $4,000/mo of benefit can be converted to an individual plan without medical underwriting. You must be on the plan at least one year prior to termination to be eligible for conversion. It is your responsibility to notify us of any change in your eligibility.
9. How much monthly benefit can I purchase?
There are two plan options; Group Long-Term Disability (LTD) and Group Short-Term Disability (STD).
10. Can I choose the Group Long-Term Disability only and/or the Group Short Term Disability only or both?
Yes. You can choose one plan only or both. By choosing both plans, there will be a 20% discount applied to the Short-Term Disability premium.
11. What if I choose Short-term disability and want to switch to Long-term disability later?
You can choose the STD standalone. If you decide to enroll in the LTD at a later date, and you are outside of the open enrollment period or past the 60 day new member window, you will be subject to medical underwriting and risk being declined for the LTD plan.
12. How do I calculate my monthly disability benefits and premiums, and enroll?
Once you have decided on the group LTD, STD, or both, click the link to “Calculate Benefits” if you want to get an idea of your premium cost. You can also access the application from this form.
13. How does Standard Insurance Company define earnings?
Your monthly salary (averaged over the last 12 months) and any contributions to tax qualified retirement accounts. Do not include bonuses, overtime pay or contributions to qualified plans made by your employer. If you are self-employed, use your gross work earnings net of business expenses.
14. What type of financial documentation do I need to show to purchase benefits?
There is no financial underwriting at the time of application. If you have a claim, Standard Insurance Company will require proof of income, such as your prior year's tax return.
15. Can I apply for coverage that is less than 60% of my earnings?
No. Due to the possible risk of anti-selection, and since Standard Insurance Company has created a group premium structure for this plan, you are required to input your full average monthly income and generate the appropriate benefit and premium.
16. Are my benefits locked in at the time of enrollment?
No. Your benefits are always based on your pre-disability Income. Each year you are required to report your income (based on your prior year’s tax return) and adjust your benefits and premium accordingly. This will keep your benefits at 60% of earnings (subject to the benefit maximum of the plan). You will not be required to submit any financial documentation when you make this report.
You will receive an emailed Statement of Benefits and reminder to report your income in the first quarter of each year.
17. If a new member wants to apply but does not have the prior year’s income as a Physician Assistant, can they still apply
Yes. Those newly employed can use their current rate of pay.
Policy Limitations and Exclusions
18. Can the policy be cancelled or can the rates increase and or decrease?
Yes. Standard Insurance or AAPA can cancel these plans. However, it is far more likely that The Standard would announce a premium rate increase rather than cancel the plans outright. It is also more likely that AAPA would not cancel these plans unless new plans were offered as a replacement. The plan rates can increase or decrease depending on the experience of the group. An increase would be issued to keep the plans viable.
19. Are certain disabilities subject to limited pay periods?
The plan includes a 24-month lifetime combined duration for Mental Disorder, Substance Abuse, and Other Limited Conditions limitations.
20. What type of disabilities are excluded from coverage?
Disabilities resulting from war, self-inflicted injuries, pre-existing conditions (see question 6 in FAQ), being unable to work because of loss of professional license or criminal act, etc. are the most common exclusions.
1. Who is eligible to participate?
AAPA Fellow members, in good standing with the American Academy of PA's, working at least 24 hours or more per week in the medical services industry.
You must maintain your membership to participate in this plan. Failure to notify us of a lapse in membership will render your coverage terminated at the end of the month prior to your membership lapse date.
If you have ever applied medically for these plans, and you were declined, medical underwriting is required to apply for this plan even during an open enrollment period.
Disability benefits received from other group LTD and/or STD plans (such as an employer sponsored plan) could reduce the benefits you receive from the AAPA plan. If you are paying for other group coverage please contact us before you apply for this coverage.
Not a member? Click Here to join AAPA or go to www.aapa.org/join.aspx
2. What is required to apply?
If you are a new AAPA Fellow member you have 60 days from your original date of membership to apply for the STD, LTD or both, guaranteed acceptance. No medical questions or exams are required. The application will ask contact information, membership date, monthly income, and bank account information for the monthly premium debit. The application is secure and encrypted. If you are eligible (see #1 above) you will be accepted based on the date of your membership and you will receive an email confirmation. Your premiums will start the following month.
STD- New eligible members applying for coverage within the first 60 days of membership will be approved and can use the insurance upon the effective date.
Short-Term Disability plan benefits will begin after 14 days of disability and will continue to pay as long as you remain disabled; up to 76 days.
The benefit period for a pregnancy with no complications is as follows:
- Normal pregnancy birth- STD benefits will pay 4 weeks
- C-section birth -STD benefits will pay 6 weeks
LTD-Members longer than 60 days must go through medical underwriting for the LTD coverage only.
STD- Members longer than 60 days do not have to go through medical underwriting but will be subject to the "Extended Benefit Waiting Period".
Important information regarding STD coverage for members longer than 60 days
STD-If you are a member for longer than 60 days you will be accepted for short term disability coverage with no underwriting required but an STD Extended Benefit Waiting Period will apply. This states that the benefit waiting period for any condition (pregnancy), other than an accident, will be 60 days for the first 12 months of coverage. Once the 12 months has been satisfied you will be eligible for the 14 day benefit waiting period.
STD DEDUCTIBLE INCOME - Income that would offset with any STD benefits you could receive.
Deductible Income means:
- Your Work Earnings, as described in the Return To Work Provisions. (see Policy Certificate)
- Any amount you receive or are eligible to receive because of your disability under a state disability income benefit law or similar law. States with DI covered include; NJ, CA, RI, HI, NY, PR.
- Any amount you receive or are eligible to receive because of your disability under another group insurance coverage.
- Any disability or retirement benefits you receive or are eligible to receive under your Employer's retirement plan, including a public employee retirement system, a state teacher retirement system, and a plan arranged and maintained by a union or employee association for the benefit of its members. You and your Employer's contributions will be considered as distributed simultaneously throughout your lifetime, regardless of how funds are distributed from the retirement plan. If any of these plans has two or more payment options, the option which comes closest to providing you a monthly income for life with no survivors benefit will be Deductible Income, even if you choose a different option.
- Any earnings or compensation included in Predisability Earnings which you receive or are eligible to receive while STD Benefits are payable.
- Any amount you receive or are eligible to receive under any unemployment compensation law or similar act or law.
- Any amount you receive by compromise, settlement, or other method as a result of a claim for any of the above, whether disputed or undisputed.
- Care Of A Physician - You must be under the ongoing care of a Physician in the appropriate specialty as determined by us during the Benefit Waiting Period. No STD Benefits will be paid for any period of Disability when you are not under the ongoing care of a Physician in the appropriate specialty as determined by us.
- Occupational Benefits- No STD Benefits will be paid for any period when you are eligible to receive benefits for your Disability under a workers' compensation law or similar law. If your claim for these benefits is accepted, compromised or settled (whether disputed or undisputed), you must repay us for the full amount of any payments we make to you while your claim for occupational benefits is pending.
- Paid Sick Leave Or Other Salary Continuation- No STD Benefits will be paid for any period when you are receiving paid sick leave pay, annual or personal leave pay, or other salary continuation, including donated amounts, (but not vacation pay) from your Employer.
- Imprisonment- No STD Benefits will be paid for any period of Disability when you are confined for any reason in a penal or correctional institution.
- Return To Work Responsibility- No STD Benefits will be paid for any period of Disability when you are able to work in your Own Occupation and able to earn at least 20% of your Predisability Earnings, but you elect not to work.
- Rehabilitation Program - No STD Benefits will be paid for any period of Disability when you are not participating in good faith in a plan, program or course of medical treatment or vocational training or education approved by us unless your Disability prevents you from participating.
Short Term and Long Term Disability General Questions
1. Should I cancel any individual or group disability policies I currently have once I have applied for this group disability insurance?
This plan will not offset benefits with those received from an individually owned DI policy. It is recommended that you keep your individual plan and use this as a supplemental disability insurance.
2. Will this plan reduce by other group disability benefits I may receive at claim time?
Disability benefits received from other group STD/LTD plans (such as an employer, association or State sponsored group plan) will reduce the benefits you receive from these plans. If you are paying for other group coverage that you intend to keep please contact us to discuss your options.
Definition of Disability
You are Disabled if you meet the following Own Occupation definition of Disability. You are required to be Disabled only from your Own Occupation. You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder:
1. You are unable to perform with reasonable continuity the Material Duties of your Own
Occupation; and
2. You suffer a loss of at least 20% in your Predisability Earnings when working in your Own Occupation.
Note: You are not Disabled merely because your right to perform your Own Occupation is restricted, including a restriction or loss of license. You may work in another occupation while you meet the Own Occupation definition of Disability. However, you will no longer be Disabled when your Work Earnings from another occupation exceed 80% of your Predisability Earnings. Your Work Earnings may be Deductible Income.
Own Occupation means any employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as the occupation you are regularly performing for your Employer when Disability begins. In determining your Own Occupation, we are not limited to looking at the way you perform your job for your Employer, but we may also look at the way the occupation is generally performed in the national economy. If your Own Occupation involves the rendering of professional services and you are required to have a professional or occupational license in order to work, your Own Occupation is as broad as the scope of your license.
Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation, that cannot be reasonably modified or omitted. In no event will we consider working an average of more than 40 hours per week to be a Material Duty.
3. How long must I be disabled in order to receive benefits?
14 days of Total or Partial disability for the Short-Term Disability plan.
90 days of Total or Partial disability for the Long-Term Disability plan.
4. How long can benefits be paid?
Long-Term Disability plan benefits will begin after the 90 day waiting period and will continue to pay as long as you remain disabled or until your Social Security Normal Retirement Age.
Short-Term Disability plan benefits will begin after 14 days of disability and will continue to pay as long as you remain disabled; up to 76 days. Unless you are under the "Extended Benefit Waiting Period". No benefits will be approved for pregnancy because of the 60 day waiting period.
IMPORTANT: Benefit period paid for pregnancy?
- Normal pregnancy birth- STD benefits will pay 4 weeks
- C-section birth -STD benefits will pay 6 weeks
5. Does the LTD plan have a pre-existing conditions clause?
Yes, but it only applies to Long-Term Disability. The pre-existing condition exclusion does not apply to Short-Term Disability. The LTD plan has a 3/12 pre-existing condition clause. This means if you’ve received care or consultation for any condition within the 3 months just prior to being insured, a disability caused by the condition will not be covered if it occurs within the first 12 consecutive months of being insured under the plan. After being insured under the plan for 12 consecutive months, the pre-existing condition clause no longer applies.
6. Will my personal information listed on the application be kept in the strictest confidence and security?
YES. All information entered on your electronic application is secured. All information gathered is used solely for the purpose of plan enrollment and ongoing services and will not be used for any other purpose.
7. How do I pay my premiums?
Funds will be deducted automatically, from the bank account of your choice, on the 17th of each month (or next banking day). The deduction will be listed on your statement as "Association DI Plans, LLC AAPA". Monthly bank draft is the only method of payment.
Note: Premiums are in 5 year age brackets (Age 40-44, 45-49, etc.). Your premiums will be adjusted the month following any birthday that moves you into the next bracket. You can use the "Calculate Benefits and Apply Now " to see how premiums will adjust over time, based on current rates.
8. Does the policy have a conversion option?
Yes. Up to $4,000/mo of benefit can be converted to an individual plan without medical underwriting. You must be on the plan at least one year prior to termination to be eligible for conversion. It is your responsibility to notify us of any change in your eligibility.
9. How much monthly benefit can I purchase?
There are two plan options; Group Long-Term Disability (LTD) and Group Short-Term Disability (STD).
- For group STD, your monthly benefits are equal to 60% of your average prior year earnings, up to the $1,000.00 weekly benefit maximum.
- For group LTD, your monthly benefits are equal to 60% of your average prior year earnings, up to the $8,000.00 monthly benefit maximum.
10. Can I choose the Group Long-Term Disability only and/or the Group Short Term Disability only or both?
Yes. You can choose one plan only or both. By choosing both plans, there will be a 20% discount applied to the Short-Term Disability premium.
11. What if I choose Short-term disability and want to switch to Long-term disability later?
You can choose the STD standalone. If you decide to enroll in the LTD at a later date, and you are outside of the open enrollment period or past the 60 day new member window, you will be subject to medical underwriting and risk being declined for the LTD plan.
12. How do I calculate my monthly disability benefits and premiums, and enroll?
Once you have decided on the group LTD, STD, or both, click the link to “Calculate Benefits” if you want to get an idea of your premium cost. You can also access the application from this form.
13. How does Standard Insurance Company define earnings?
Your monthly salary (averaged over the last 12 months) and any contributions to tax qualified retirement accounts. Do not include bonuses, overtime pay or contributions to qualified plans made by your employer. If you are self-employed, use your gross work earnings net of business expenses.
14. What type of financial documentation do I need to show to purchase benefits?
There is no financial underwriting at the time of application. If you have a claim, Standard Insurance Company will require proof of income, such as your prior year's tax return.
15. Can I apply for coverage that is less than 60% of my earnings?
No. Due to the possible risk of anti-selection, and since Standard Insurance Company has created a group premium structure for this plan, you are required to input your full average monthly income and generate the appropriate benefit and premium.
16. Are my benefits locked in at the time of enrollment?
No. Your benefits are always based on your pre-disability Income. Each year you are required to report your income (based on your prior year’s tax return) and adjust your benefits and premium accordingly. This will keep your benefits at 60% of earnings (subject to the benefit maximum of the plan). You will not be required to submit any financial documentation when you make this report.
You will receive an emailed Statement of Benefits and reminder to report your income in the first quarter of each year.
17. If a new member wants to apply but does not have the prior year’s income as a Physician Assistant, can they still apply
Yes. Those newly employed can use their current rate of pay.
Policy Limitations and Exclusions
18. Can the policy be cancelled or can the rates increase and or decrease?
Yes. Standard Insurance or AAPA can cancel these plans. However, it is far more likely that The Standard would announce a premium rate increase rather than cancel the plans outright. It is also more likely that AAPA would not cancel these plans unless new plans were offered as a replacement. The plan rates can increase or decrease depending on the experience of the group. An increase would be issued to keep the plans viable.
19. Are certain disabilities subject to limited pay periods?
The plan includes a 24-month lifetime combined duration for Mental Disorder, Substance Abuse, and Other Limited Conditions limitations.
20. What type of disabilities are excluded from coverage?
Disabilities resulting from war, self-inflicted injuries, pre-existing conditions (see question 6 in FAQ), being unable to work because of loss of professional license or criminal act, etc. are the most common exclusions.