Forgot your password? First time user?
Request a Quote

Provider Choice




Provider Choice is a non-cancellable individual disability product offered through Berkshire Life Insurance Company of America, a Guardian Company.  Provider Choice replaces ProVider Plus in approved states.  This disability product offers some of the best policy language and flexibility in the industry through the three packages: Premier, Select, & Essential.   Berkshire is a leader in the IDI industry and is a benchmark for which all other company's disability products should be compared to.  

 

Provider Choice PackagesProvider Choice Package ChartNon-Can & Guar. RenewablePolicy Form Options: 18ID, 18UD, 18GI
Premium Structure: Level vs GradedOccupation Classes & What they MeanTiming of Disability BenefitsDefinition of Total Disability
Enhanced Medical Specialty DefinitionEnhanced Partial Rider and RecoveryBasic Partial Rider and RecoveryImportant Policy Features
Provider Choice Premium OptionsBerkshire Check By Phone Pay ServiceProvider Choice ExclusionsAvailability of Optional Riders
Future Increase Option (FIO) RiderBenefit Purchase Rider (BPR)Cost of Living Adjustment RidersEnhanced Catastrophic Rider (CAT)
Basic Catastrophic Rider (BCAT)Basic vs Enhanced CAT RidersGraded Lifetime Indemnity RiderLump Sum Disability Benefit Rider
Retirement Protection Plus RiderSocial Insurance Substitute RiderUnemployment Waiver of PremiumAutomatic Benefit Enhancement Rider
Student Loan Protection RiderSupplemental Term Benefit RiderShort Term Residual RiderSpecimen Policy: Provider Choice
Provider Choice Page Outline

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



Provider Choice Packages: Premier, Select, & Essential:

Provider Choice is available in three packages to best suit your needs and preferences. 

  • Provider Choice Premier Package offers some of the best riders and features in the industry and is a benchmark for quality IDI coverage. 

  • Provider Choice Select Package is designed for those budget minded to offer lower cost coverage while retaining some of the features available on Premier.   

  • Provider Choice Essential Package is designed for those that want coverage at the lowest possible cost while retaining all of the built in features of Provider Choice's base policy.  


Please see the Provider Choice Package Summary Chart to see a summary of what features are available which each package.  Note: specific provisions may vary from state to state.:

 

FEATURE/RIDER

 
PREMIER PACKAGESELECT PACKAGEESSENTIAL PACKAGE
Definition of DisabilityTrue Own Occ or Two Year True Own Occ
(Modified Thereafter)
True Own Occ or Two Year True Own Occ
(Modified Thereafter)
Two Year True Own Occ or Two Year Modified Own Occ
(Any Occupation Thereafter)
Premium StructureGraded or LevelGraded or LevelLevel only
Benefit Period OptionsAllAll2yr, 5yr, 10yr, to Age 65
Mental and/or Substance Related Disorder LimitationNo Limitation* 24 months6 months
Partial/Residual RiderEnhanced or Basic PartialBasic PartialShort-Term Residual
COLA RidersAvailableAvailableNot Available
Retirement Protection Plus Rider (RPP)AvailableAvailableNot Available
Lump Sum RiderAvailableAvailableNot Available
Catastrophic Rider (CAT)Enhanced or BasicEnhanced or BasicNot Available
Increase OptionFuture Increase Option (FIO) FIO or Benefit Purchase Rider (BPR)Not Available
Student Loan Rider (SLR)Available Available Not Available
Supplemental Term Rider (STR)AvailableAvailableNot Available
Automatic Benefit Enhancement (ABE)AvailableAvailableNot Available
Social Insurance Substitute Rider (SIS)AvailableAvailableAvailable
Unemployment Premium Waiver Rider (UPWR)AvailableAvailableNot Available
Serious Illness BenefitIncludedIncludedIncluded
Recurrent Disability Feature IncludedIncludedIncluded
Waiver of Elimination PeriodIncludedIncludedIncluded
Waiver of PremiumIncludedIncludedIncluded
Presumptive DisabilityIncludedIncludedIncluded
Hospice BenefitIncludedIncluded

Included

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   *All new policies issued in California will have the Mental and/or Substance-Related Disorder (MSRD) limitation. Policies issued to anesthesiologists/anesthetists, emergency room physicians, pain management physicians, and dentists will always have an MSRD limitation. Discounts are applied when there is an MSRD limitation. MSRD limitations do not apply to policies issued as the result of a future increase or future purchase option when exercised from a policy that did not have such a limitation.


return to top


Non-Cancellable & Guaranteed Renewable (Non-Can & GR):

Provider Choice is non-cancellable and guaranteed renewable to age 65 or age 67.  This means that the insurer cannot cancel the policy, change policy provisions, nor can we increase the policy premium after issue, as long as premium payments are made on a timely basis.

 
After age 65 or age 67 the Provider Choice is conditionally renewable for life. This means that coverage can be continued for life at rates then in effect based on the insured's age and class of risk; premiums can change on an annual basis. The insured must also be gainfully employed, defined as at least 30 hours per week, for at least 10 months each year.

This critical policy provision spells out the insured’s rights in keeping his or her protection in force. A disability contract may be guaranteed renewable only, or both non-cancellable and guaranteed renewable. Guaranteed renewable means that the insurance company agrees to renew the policy as long as premium payments are made on a timely basis. The insurer cannot change the provisions of the contract or single out an individual for premium increase, but it can increase premiums by state, occ class, policy form, etc. with prior notification

return to top



Policy Forms (18ID, 18UD, 18GI):

Provider Choice comes in three policy forms: 18ID, 18UD, 18GI. The 18ID policy is used for most individual sales (gender specific rates). Policy form 18UD is for employer sponsored situations where men and women are issued same rates.  Policy Form 18GI is used for guarantee issue scenarios.  For Associations, Student/Resident Discount Programs and the Professional Group Discount Programs, the 18ID series is used with a 10% discount. 

return to top


Premium Structure Options: Graded vs Level:

  • Level: Level premiums offers fixed premiums that never increase until the end of the Non-Cancellable & Guaranteed Renewal (Non-Can & GR) period which is age 65 or 67. 

  • Graded: Graded premiums offers a lower initial premium that annually increases according to a pre-determined (yet guaranteed) schedule.  With this option you can convert the policy rates to level on any policy anniversary date through age 50.  When a policy is converted to level the same exact policy remains inforce.  Only the premium structure changes to level.  With some carriers that offer a similar feature, you only get a new policy which is issued at that time.  This is an advantage of Provider Choice vs some other carriers. 

Note: All three forms of Provider Choice (18ID, 18UD, 18GI) can be issued level or graded premiums. Graded can be issued up to age 50.  The Provider Essential Package is level premium only.

return to top

 


Occupation Classes & What they Mean

Occupation plays a significant role in insurability and rates.   For example: Who do you think occupationally has a higher risk for disability?  An attorney or a welder.   Obviously the attorneys would likely become disabled less often because their occupation has no significant additional occupational hazards.     Below is a simple summary of where certain occupations fall in occupation class.   In general higher occupation class indicates a lower risk and a lower rate.

  • Class 6 & 6M: Lowest risk occupations such as actuaries, architects, attorneys, CPAs, and high income executives

  • Class 5 & 5M: Professional low risk occupations but not as low risk as 6 or 6M such as College Professors, computer engineers, Veterinarians, Bank officers, pharmacists.

  • Class 4 & 4M: Duties generally limited to office, sales and travel with no manual duties involved such as insurance agents, Computer analysts, general physicians, office managers. (most white collar occupations fall in this category.)

  • Class 3, 3M & 3D: Occupations that require some physical duties such as surgeons, dentists, registered nurses

  • Class 2 & 2M: Grey collar occupations such as plumbers, foreman, skilled machinists

  • Class 1 & 1M: Blue collar occupations that require heavy manual duties such as auto mechanics, installers, delivery drivers. 

Please contact us or your agent if you have any questions on what occupation class you may be classified under.

 


Timing of Disability Benefit Options:

  
Monthly Indemnity (Benefit):
A policy’s monthly indemnity benefit, or indemnity, is the dollar amount stated in the policy that is payable for total disability. The amount that a disability insurer will issue to an individual, if any, depends upon his or her earned income, occupation class, age, health, and other disability coverage in force (both individual & group LTD coverage).

return to top
 

Elimination Period (EP): A policy’s elimination period is the amount of time during which one must be disabled before starting to accrue Montlly benefits.  Provider Choice elimination periods are: 30, 60, 90, 180, 360*, and 720* days.  In order to satisfy the elimination period an individual may be disabled from either the same or different causes for the entire period.

return to top

 

Accumulation Period (AP): The days of disability do not have to be consecutive, but must occur during the accumulation period. Each elimination period has its own accumulation period, as follows:

 

Elimination Period

 
Accumulation Period 
30 days90 days
60 days150 days
90 days210 days
180 days360 days
360 days*540 days
720 days*900 days


 

 

 

 

 

*Not available in some states

return to top


Timing of First Benefit Payment at Start of Claim
 
Under any Disability Income (DI) policy, monthly benefits are not paid immediately at the end of the elimination period (waiting period) – they begin to accrue at that point. The first benefit check is paid after the insured has been disabled for a full month beyond the elimination period (EP)*.  Here is how it works for a disabled individual who has a policy with a 3 month EP who has satisfied all conditions necessary for receiving benefits.:

  • Months 1–3: Insured is disabled & elimination period is satisfied during this period of time.  Note the 90 day EP does not have to be continuous.  It can be satisfied in a 7 month time frame.  This is called the accumulation period. 
  • Month 4: Insured remains disabled & benefits begin to accrue 
  • Beginning of Month 5: Benefits paid for month 4 of disability 

*The date of actual payment may also vary dependent upon when the insured filed the claim with the carrier and whether the insured has satisfied all of the policy's terms and conditions for receiving benefits.  If insured recovers prior to accruing a full month of benefits, prorate benefits to the date of recovery are issued.

return to top



Benefit Period (BP):
The benefit period of a policy is the longest period of time for which benefits are payable for a covered disability.  Provider Choice premier and select packages offers these benefit periods:  2 year, 5 year, 10 year, to age 65, to age 67, and to age 70.   The Essential package is limited to just the following options: 2 years, 5 year, 10 year, & 65.   The benefit periods available depend on the insured’s occupation class and other factors including but not limited to health of the insured and product package.  Please reach out to your agent to see what benefit periods you may be eligible to purchase based on your occupation class.  Benefit Period availability by occupation class:

  • 3-6, 3M-6M:  2 years, 5 years, 10 years, to age 65, to age 67, to age 70
  • 2 & 2M:  2 years, 5 years
  • 1:  2 years

return to top



Definition of Total Disability:

Provider Choice offers three definitions of total disability:

  • Two Year True Own-Occupation, Modified Thereafter: This Definition of Disability is true own occupation for first two years of claim, followed by modified own occupation definition described in next section.   Modified own occupation means total disability benefits are paid when your client is unable to perform the material and substantial duties of their own occupation solely due to injury or sickness and they are not gainfully employed.  This definition is available to all packages.

    return to top


  • True Own Occupation (TOO): This Definition of Disability is the most sold definition of disability on Provider Choice policies.  This definition makes it possible for you to work in another occupation and still be eligible for total disability benefits.  With this option you are considered totally disabled if solely due to injury or sickness, if you are unable to perform the material and substantial duties of your own occupation.  The advantage of true own occupation is that you can pursue another occupation while receiving total disability benefits giving you the most freedom when on a total disability claim.  Additionally, dentists and physicians (ineligible for the New Enhanced Medical Specialty described below) that limit their occupation to the performance of the material and substantial duties of a single specialty and are unable to perform those duties solely due to disability will be considered totally disabled even if still working in a different specialty.  This specialty language is included on all dental classified occupations.  With Provider Choice Premier & Select packages, the length of true own-occupation protection is available for the entire benefit period, if selected, regardless of the occupation.  True own occupation definition beyond two years is not available for the Essential Package.  The True Own Occupation Definition of Disability is available to the Premier and the Select packages. 

    The additional cost for the True Own Occ definition of disability is not very costly.  When reducing the definition of disability from True Own occ to the Two Year True Own Occ, the rate only drops approximately 8% for a class 3/3M, 6% for a class 4/4M, 4% for a class 5/5M, and 2% for a class 6/6M.

    return to top



  • Enhanced Medical Specialty:  This definition is available to all medical occupations who have a partial rider and don't have the lifetime benefit period rider (Graded Lifetime Indemnity Rider). This adds the following to the True Own occupation Definition of disability: 

    If Your Occupation is limited to a Medical Doctor or Doctor of Osteopathy and more than 50% of Income is earned from Hands-On Patient Care, We will consider You to be Totally Disabled even if You are Gainfully Employed in Your practice or another occupation so long as, solely due to Injury or Sickness, You are not able to provide Hands-on Patient Care.

    OR 

    If Your Occupation is limited to a Medical Doctor or Doctor of Osteopathy and more than 50% of Income is earned from performing Surgical Procedures, We will consider You to be Totally Disabled even if You are Gainfully Employed in Your practice or another occupation so long as, solely due to Injury or Sickness, You are not able to perform Surgical Procedures.

    return to top



  • Lowest Cost Definition of Disability:  Two year modified own occupation followed by any occupation definition of disability.  This definition is available only with the Essential package as a way to further reduce cost as compared to the base definition of disability.
      
    return to top

 

Enhanced Partial Rider and Recovery Provision: 

This commonly sold rider (a must in our opinion when available) and the strongest partial rider available allows the policy to pay benefits while your condition worsens but not yet totally disabled as well as providing benefits to help you get back on your feet as while you are recovering from a disability.  The way the partial rider is structured it provides benefits: Sooner, More and sometimes Longer than other carriers. Here's how:

  • Sooner: The Provider Choice Partial Disability Benefit Rider has a 15% or more loss of income requirement.  Some other carriers pay partial benefits only when you show a minimum 20% loss. 

  • More: For the first 12 months that the insured is eligible for residual disability benefits, the Enhanced Partial Rider replaces lost income dollar-for-dollar up to the policy's monthly benefit or 50% of the policy benefit, whichever is greater.  Anyone would rather get all of their lost income as compared to just part of it.  This feature is payable in the first year of a partial claim.  Following the first year, partial disability benefits are paid in proportion to lost income.  If the loss is 75% or more, the loss will be considered 100%.  Some other carriers require an 80% loss to pay full benefits under the partial or residual rider/feature. 

    Note: The Enhanced Initial Monthly Benefit payable under the Enhanced Partial Rider may be reduced if other individual disability insurance policies are in force before the effective date of this rider.

  • Longer: The Enhanced Partial Rider pays benefits longer for two reasons:  First, the insured is eligible to receive benefits if, due to sickness or injury, they are experiencing a loss of income of 15%.  Some carriers take the insured off claim when they no longer show a 20% loss.  Second, the insured has the potential to receive benefits longer because the partial rider has what is called an unlimited recovery period.  This means that the insured will continue to be considered partially disabled and eligible for benefits if they continue to suffer at least a 15% loss of income solely due to their sickness or injury, even after they have medically recovered for up to the full benefit period.  This allows the insured to be eligible for benefits while they are building up their business and/or reputation for up to the policy benefit period.  Additionally, pre disability earnings are adjusted to reflect any changes in the cost of living tied to the Consumer Price Index for Urban Consumers (CPI-U), resulting in potentially higher benefits to be paid over a prolonged recovery.

The Enhanced Partial rider is only available with the Premier Package.

return to top


Basic Partial Rider & Recovery Provision: 
 

The Basic Partial Rider provides a benefit payable when the insured is gainfully employed (and not Totally Disabled under the terms of the policy), but solely due to illness or injury, they suffer a loss of income of at least 20% of their prior income and show a loss of time or duties.  This rider also includes the following features if the insured meets the policy's definition of residually disabled:

  • Minimum 50% of the total disability benefit during the first six months. 
  • If loss of income is more than 75% of prior income in any month while partial indemnity is payable, the company will consider such a loss to be 100%

Basic Partial Recovery Benefits: If following a partial disability the insured returns to full time work within 12 months of satisfying the elimination period the insured will receive a lump sum recovery benefit equal to two times the monthly indemnity.  

The Basic Partial rider is available with the Premier and the Select packages.

return to top


Short Term Residual Rider (STRR)

 

This rider is available on policies issued under the Essential package and is the lowest cost partial rider available under any of the packages. The short term residual benefit equals 50% of the total monthly indemnity and is payable for a period of up to six months.  The Short Term Residual rider pays a benefit following a period of total disability if: 

  • The insured is unable to perform one or more of the material and substantial duties of your occupation, or

  • The insured is unable to perform the material and substantial duties of your occupation for more than one-half of the time normally required.

 

return to top


Important Policy Features:

The following features are in all Provider Choice policies,  regardless of which package is selected.


Recurrent Disability: Separate disabilities normally require separate elimination periods. However, disability can be sporadic or recurrent. Under the Provider Choice policy, once the elimination period has been satisfied, recurrent periods of disability will be considered continuous, if the insured has returned to full time gainful employment for a period of less than 6 months, the more recent disability results entirely or in part from the same cause or causes of the previous disability, and benefits were paid for the prior disability. Should this be the case, no new elimination period will be required before benefits resume. A recurrent disability must be due to the same cause or causes.

return to top
 

Waiver of the Elimination Period:
 
The elimination period will be waived if the insured becomes disabled within five years after the end of a previous disability that lasted more than six months, satisfies 30 day continuous disability, and they received benefits under the policy for that prior disability.   

return to top


Waiver of Premium Benefit:
 
Just about all carriers waive the premium when on claim.  The Provider Choice waiver feature is a step above the rest.  After the elimination period has been satisfied, any premiums paid that apply to the period of disability are refunded and the premiums are waived not just when the insured is on claim, but for 6 months after the claim has ended as well.

return to top


Presumptive Total Disability Benefit:
With this feature the insured will be considered totally disabled, even if still working, if the insured suffers a total and complete loss of any of the following due to sickness or injury: total and complete loss of sight in both eyes, hearing in both ears, speech, or the entire use of both hands, both feet, or one hand and one foot.  With most other carriers that have a similar feature, the loss is required to be irrecoverable, meaning there must be no chance for you to recover for this benefit to be paid.  With this feature available through Berkshire, the cause need not be irrecoverable and you 
will have the elimination period waived and benefits will start to accrue from the date of your total disability.

return to top


Hospice Benefit:
  The insured will be considered Totally Disabled if, due to Injury or Sickness, the insured is under a physician-ordered plan of care for hospice services and receiving hospice services through a member of the National Hospice and Palliative Care Organization.  Any unexpired portion of the elimination period will be waived and benefits will start to accrue from the date the Plan of Care is initiated for hospice services.  Monthly Benefit will be paid as long as the Insured is Totally Disabled

return to top


Serious Illness Benefit Endorsement: 
  If totally disabled due to cancer, stroke or heart attack:  Pays additional 50% of monthly benefit at time of claim, payable to a maximum of 12 months during the life of the policy. 

Note: Not available on all states

return to top
 

Occupational Rehabilitation, Modification, & Access Benefits Endorsement:
  If the insured enrolls in a rehabilitation program while totally disabled, a benefit can be paid to meet some of the costs incurred.  The plan must be agreed to in writing before the insured enrolls, and the program must be a formal plan of retraining to help the insured return to work in their occupation.  The training program must be directed by an organization or individual licensed or accredited to provide vocational training/ education. The policy covers costs which are not otherwise covered by health insurance, workers’ compensation, or any other public program.

return to top


Cosmetic Surgery:  Provider Choice will pay disability benefits if, more than six months after the effective date of the policy, the insured becomes totally disabled because of complications of cosmetic surgery to improve appearance or correct a disfigurement.  

return to top

 


Provider Choice Premium Options:

The premium options available are Annual (once a year), Semi-Annual (twice a year), Quarterly (four times a year), Monthly Paper List Bill (3 or more insureds minimum) or GOM (Guard-O-Matic monthly Draft from your checking account).  The Semi-Annual, Quarterly, Monthly List Bill, & Monthly GOM options contain additional small fees for the convenience of not paying an annual premium upfront. 

return to top

 

Berkshire Check By Phone Pay Service:

This service can be used to get a payment to Berkshire quickly to keep a policy in force or can be used to make a payment to put a new policy in force.  When the client calls they will need to have their check book in hand:

   Berkshire Check By Phone Service: 888-482-7342 option 1,2
   Available 8:00 A.M.to 6:00 P.M. EST

This service is available only for Disability Income policies administered by Berkshire Life.

Note: The main DI Call center number is the same base number 888-482-7342

return to top

 


Provider Choice Exclusions & Limitations:

Provider Choice will not pay benefits during any time of incarceration or for disability resulting from suspension, revocation or surrender of the insured’s professional license. For normal pregnancy or childbirth* no benefits are payable until after three months of total disability, or the elimination period, if longer. Inured may not recover benefits that have ceased pursuant to this limitation.  Please see the specimen policy for the complete listing of the exclusions and limitations.  Exclusions and limitations may vary from state to state.

*Note: Any policy with employer sponsorship or endorsement does not contain this limitation.

CA Limitation: All new policies issued in California will have the Mental and/or Substance-Related Disorder (MSRD) limitation. Policies issued to anesthesiologists/anesthetists, emergency room physicians, pain management physicians, and dentists will always have an MSRD limitation. Discounts are applied when there is an MSRD limitation. MSRD limitations do not apply to policies issued as the result of a future increase or future purchase option when exercised from a policy that did not have such a limitation.

return to top



Mental and Nervous (M&N) Maximum Benefit Duration Options*:

Premier Package: Full Mental and Nervous Coverage*

Select Package: Two Year Maximum Mental and Nervous Coverage

Essential Package*: Twelve Month or Six Month Mental and Nervous Coverage depending on state.

*Note: Most states are compact states that have 12 month Mental and Nervous.   The following states are non compact and have a 6 month mental and nervous limitation on the Essential Package: CA, CT, DE, DC, FL, MT, NY, ND, & SD.  

*Note: All new policies issued in California will have the Mental and/or Substance-Related Disorder (MSRD) limitation. Policies issued to anesthesiologists/anesthetists, emergency room physicians, pain management physicians, and dentists will always have an MSRD limitation. Discounts are applied when there is an MSRD limitation. MSRD limitations do not apply to policies issued as the result of a future increase or future purchase option when exercised from a policy that did not have such a limitation.

return to top


Availability of Optional Riders By Package:

 

Premier Package*

Occupation Classes:

Available Riders:

3-6 (non medical or dental), 3M-6M (medical), 4D (dental specialty).

Note: 3D (general dentists) are ineligible for the FIO Rider but are eligible for the BPR rider noted in the Select Package below.

Enhanced Partial or Basic Partial
Cost of Living Adjustment (COLA): 3%, Max 6%, or Four Year Delayed 3%
Retirement Protection Plus Disability Benefit
Lump Sum Rider
Enhanced or Basic Catastrophic Disability Benefit
Future Increase Option
Graded Lifetime Indemnity for Total Disability 
Automatic Benefit Enhancement Rider
Student Loan Protection Rider
Supplemental Term Rider

Note: Graded Lifetime Indemnity for Total Disability rider not available with FIO Rider

1-2, 1M-2M (medical)

Enhanced or Basic Catastrophic Disability Benefit

All 

Social Insurance Substitute
Unemployment Waiver of Premium

 

 

 

 

 

 

 




 

 

 

 

Select Package*

Occupation Classes:

Available Riders:

3-6 (non medical or dental), 3M-6M (medical), 3D-4D (dental)

Basic Partial
Cost of Living Adjustment (COLA): 3%, Max 6%, or Four Year Delayed 3%
Retirement Protection Plus Disability Benefit
Lump Sum Rider
Enhanced or Basic Catastrophic Disability Benefit
Benefit Purchase Option
Graded Lifetime Indemnity for Total Disability 
Automatic Benefit Enhancement Rider
Student Loan Protection Rider
Supplemental Term Rider

Note: Future Increase Option (Not available for 3D)

1-2, 1M-2M (medical)

Enhanced or Basic Catastrophic Disability Benefit

All 

Social Insurance Substitute
Unemployment Waiver of Premium

 

 

 

 

 

 

 

 



 

 

 

 

Essential Package*

Occupation Classes:

Available Riders:

3-6 (non medical or dental), 3M-6M (medical), 3D-4D (dental)

Short Term Residual
Social Insurance Substitute 

1-2, 1M-2M (medical)

Short Term Residual
Social Insurance Substitute 

All 

Short Term Residual
Social Insurance Substitute 

 

 

 

 

 

 

 

 

*Note: specific provisions may vary from state to state.

return to top


Future Increase Option Rider (FIO):

This feature may be important to those who expect income increases in the future. The FIO rider allows you to apply for additional coverage in spite of any change in health or occupation.

  • Annual options effective the policy anniversary date until age 55 or the option has been used up if sooner.  The window to apply for the increase under this option is 31 days before and after the policy anniversary date.  Any increases exercised on claim will not be payable until a new and separate disability is payable.

  • Up to age 45 there is no limit on how much of the remaining pool option can be exercised provided the insured financially qualifies. 

  • After age 45 up to 1/3 of the remaining FIO option (or up to $1000 if the 1/3 is less than $1000) can be exercised on a policy anniversary date. 

  • Special Option Date:  This feature allows you to exercise of the FIO option off anniversary in the even the insured looses underlying group LTD coverage.  Typical examples of this would be completion of residency or change of employers.

The total amount of FIO coverage a client can purchase is equal to 2 times the base applied for, plus SIS and Guardian or Berkshire in-force coverage (3 times for Medical/Dental residents).  The total of all in-force coverage plus the applied for FIO cannot exceed the published IDI issue and participation limits.  Underlying group LTD is not considered in max I&P when issuing the FIO rider, but will be considered when exercised.  This is to allow additional FIO in the event underlying group LTD is lost or reduced.  The total amount of additional coverage that the insured is eligible to receive is based upon current earned income as well as disability insurance in-force, applied for, or for which the insured is eligible to receive from any insurer. 

Restrictions and limitations apply. While medical information is not required when exercising a future increase option, applications to exercise an increase option will be financially underwritten, taking into consideration both the applicant’s then current income, as well as all disability insurance which is then in force, or for which the insured has applied or is eligible to receive. This rider is not available to all occupations.

return to top


Benefit Purchase Rider (BPR):

This feature may be important to those who expect income increases in the future and do not wish to pay extra for the Future Increase Option Rider. The BPR allows you to purchase additional coverage every three years in the form of a separate policy with no evidence of insurability with just financial underwriting up to age 55.  Every three years the insured must provide income documentation and complete paperwork to determine eligibility for increased coverage.  If the insured fails to apply for any three year review or does not take at least 50% of the eligible additional coverage, then the future BPR options are forfeited.   The BPR also offers a special option date which can be exercised outside of the normal three year window for the loss of underlying group long term disability coverage (LTD). 

While medical information is not required when applying for additional coverage pursuant to the Benefit Purchase Rider, applications will be financially underwritten taking into consideration the insured’s then current income, occupation, and employment, as well as all disability insurance which is then in force, or for which the insured has applied or is eligible to receive.  Coverage may not be added while the insured is disabled, when benefits are payable, or during a suspension period.  Additional Restrictions and limitations apply.

return to top


Cost of Living Adjustment Riders (COLA)**:
 

The purpose of a COLA rider is to help protect you from the risk of having to live on a fixed benefit for an extended period of time. With each option below the increases are minimum 3%, are compound, have no cap, and incremental monthly benefit increases of at least $300 remain on the policy at no additional cost.  With some carriers, the increases are Consumer price index tied (CPI), subject to a cap of two times, and there may be additional premium to keep any increases in coverage upon recovery. 
There are three different optional COLA riders offered on Provider Choice:

  • 4 Year Delayed COLA Rider:  This is the lowest cost COLA option.  Increases begin on the fourth anniversary of the date you originally became disabled.

  • 3% Compound COLA Rider: The benefit increases annually 3% compound following a 12 month claim. (Most often Purchased COLA Rider)

  • 6% Compound COLA Rider: After you have been disabled for 12 months, the monthly benefit will be adjusted each year according to the changes in the Consumer Price Index for Urban Consumers (CPI-U). Compounded increases will be no lower than 3% compounded and no higher than 6%.

    **This benefit is not necessarily protection against increases in the cost of living. Optional riders are available for an additional premium.

return to top


Enhanced Catastrophic Rider (ECAT):

Provider Choice offers this enhanced catastrophic rider that provides an additional monthly benefit if you suffer from one of the following conditions:  

  • Loss of two of six Activities of Daily Living (bathing, dressing, eating, transferring, toileting, continence)

  • Cognitive impairment requiring substantial supervision (e.g. Alzheimer’s disease)

  • Irrecoverable disability. This type of disability is very similar to the Presumptive Total Disability definition (for complete loss of sight in both eyes, hearing in both ears, power of speech, use of two arms, two legs, or one arm and one leg). However, to qualify for payment under the Catastrophic Disability Benefit rider the loss must be irrecoverable.

Enhanced Catastrophic Disability Benefits are payable in addition to the regular monthly indemnity of the base disability income policy. We will issue up to $8,000 per month of Catastrophic Disability Benefit. Total coverage from all sources plus the Catastrophic Benefit cannot exceed 100% of the applicant’s income.

Unlike most similar riders on the market, this rider includes automatic 3% compound indexing of the Catastrophic Disability Benefit within the rider itself.  This means that even if you do not select any of the COLA riders, the benefit for this feature will increase 3% compound every year when payable. 

Note: This rider is not available in all states.

return to top


Severe Disability Rider/Basic Catastrophic Rider (BCAT):

Provider Choice offers this lower cost severe disability rider/catastrophic rider that provides an additional monthly benefit if you suffer one of the following conditions:  

  • Irrecoverable disabled. This type of disability is very similar to the Presumptive Total Disability definition (for complete loss of sight in both eyes, hearing in both ears, power of speech, use of two arms, two legs, or one arm and one leg). However, to qualify for payment under theis rider the loss must be irrecoverable

  • Functionally Impaired

Severe Disability Benefit/Basic Catastrophic Disability Benefits are payable in addition to the regular monthly indemnity of the base disability income policy. We will issue up to $8,000 per month of Basic Catastrophic Disability Benefit. Total coverage from all sources plus the Catastrophic Benefit cannot exceed 100% of the applicant’s income. 


Differences between the Enhanced and Severe Disability Benefit/Basic Catastrophic Riders:  The basic catastrophic rider eliminates the ADL & cognitive triggers and does not have the built in 3% compounding COLA feature.

return to top


Graded Lifetime Indemnity for Total Disability Rider (X45):

This rider provides a monthly lifetime indemnity for continuous total disabilities, payable after the policy's benefit period.  This optional rider is available to occupation classes: 3-6, 3M-6M up to age 45.  Note: the insured must remain totally and continuously disabled indefinitely for this policy benefit to be paid after policy's normal benefit period.  How much benefit will be paid monthly after the normal policy benefit period is determined by the onset age of the total disability.  Here is how it works:

  • If total and continuous disability starts prior to age 46 and remains to the end of the benefit period, then 100% of the policy's base benefit will be paid monthly for life.
  • For continuous total disabilities that began after age 46, the insured would be eligible to receive 100% of their policy's monthly benefit up to the benefit period, after which they would be eligible for the lifetime indemnity amount which is reduced (or graded) by 5% for each year.

  • For Example. If total and continuous disability starts at age 50, the insured would be eligible to receive 75% of the disability benefit every month for life after normal policy benefit period.  If disability starts at age 55, the insured would be eligible to receive 50% of the disability benefit every month for life after normal policy benefit period.  If disability starts at age 60, the insured would be eligible to receive 25% of the disability benefit every month for life after normal policy benefit period.  
  • Note:  There is no lifetime indemnity paid unless the insured remains totally and continuously disabled to policy normal benefit period.  In the above examples, no lifetime indemnity would be paid if the insured recovered at 64 even being on claim for many years.  We believe the patent pending Lump Sum Disability Benefit Rider below is a better and more economical option since it pays benefits in more situations and totally and continuously disability is not required.

If the Continuous Total Disability Started:

Lifetime Indemnity Percentage Is: 
Prior to Age 46100%
At or after Age 46, but before Age 4795%
At or after Age 47, but before Age 4890%
At or after Age 48, but before Age 4985%
At or after Age 49, but before Age 5080%
At or after Age 50, but before Age 5175%
At or after Age 51, but before Age 5270%
At or after Age 52, but before Age 5365%
At or after Age 53, but before Age 5460%
At or after Age 54, but before Age 5555%
At or after Age 55, but before Age 5650%
At or after Age 56, but before Age 5745%
At or after Age 57, but before Age 5840%
At or after Age 58, but before Age 5935%
At or after Age 59, but before Age 6030%
At or after Age 60, but before Age 6125%
At or after Age 61, but before Age 6220%
At or after Age 62, but before Age 6315%
At or after Age 63, but before Age 6410%
At or after Age 64, but before Age 655%
At or after Age 650%

Note: This is a very costly rider.  We often recommend that the lump sum is of better overall value as it pays benefits in many more situations and costs significantly less. 


Lump Sum Disability Benefit Rider*:


This rider takes a new unique approach that provides a potential lump sum benefit amount of 35% of all total and partial disability benefits paid over the lifetime of your policy. To qualify, the sum of total and/or partial disability benefits paid over the life of the policy must be equal to or greater than 12 times the monthly indemnity.  Unlike the Graded Lifetime Indemnity for Total Disability Rider, the great thing about this new option is that the insured does not need to be continuously and totally disabled for the lump sum additional benefit to be paid.  Here is an example of how this easy to understand rider works.:

  • Example: (Pub 5666):  You purchase a $10,000 month policy with the Lump Sum rider.  At age 47 you are in a serious car accident resulting in a total disability for three years ($360,000 in benefit)  followed by an additional two years of partial which totals another $140,000 in benefits, then return to work with no further claims.  The total benefits paid are $500,000.  At age 60 the Lump Sum rider kicks in.  Since you were paid $500,000 in total benefits, and that benefit paid exceeds 12 times the $10,000 monthly benefit of $120,000, you will be given a lump sum benefit check equivalent to 35% of what benefits were already paid.  You will receive a lump sum check of $175,000 ($500,000 x 35%).  View |a2274|Lump Sum Pub #5666 for more info on this example.
  • The Lump Sum rider is not available if a lifetime benefit from any carrier in force or if Retirement Protection Plus (or similar coverage) with any other carrier in force.

    Note:   This website is provided for informational purposes only and should not be considered tax or legal advice.  Please contact your tax or legal advisor regarding the tax treatment of the policy and policy benefits.  You should consult with your own independent tax and legal advisors regarding your particular set of facts and circumstances.  The information provided is not intended or written to be used, and cannot be relied upon, to avoid penalties imposed under the Internal Revenue Code or state and local tax law provisions.

return to top


Retirement Protection Plus Disability Benefit Rider (RPP):

This rider helps to ensure that you can continue to save for retirement in the event of total disability.  Here is how it works:  When you're totally disabled and not gainfully employed, a monthly benefit payment insuring up to 100% of your retirement contributions, including any employer-matched funds, will be paid into a trust established by you.  The trustee invests benefits at your client's direction.  This rider is also available as a stand alone policy.  For more information about this benefit: Retirement Protection Plus Product Page.

Retirement Protection Plus is not a pension plan, qualified retirement plan, qualified individual retirement account, or a substitute for one.

return to top


Social Insurance Substitute Rider (SIS):

The SIS benefit coordinates with social insurance (e.g., Social Security, any worker's compensation or benefits provided under any occupational disease law), in an amount up to $1,500 per month. The monthly indemnity will be offset dollar-for-dollar by the amount which is received through any of these sources. No refund of benefits paid is required if the first social insurance payment includes a retroactive benefit.
 
Note: In New York and New Jersey, no benefit will be paid under this rider if social insurance benefits are paid. 

return to top


Unemployment Waiver of Premium Rider (UPWR):

Do you know that you need Disability income protection but fear the loss of your job and being unable to continue paying for the policy? With this rider have no fear.  With this rider, if you become unemployed and receive unemployment compensation for at least 60 days, premiums are waived for twelve months, even if you return to work. Premiums can not be waived for a subsequent unemployment period until 48 months have elapsed from the end of the previous unemployment period. 

return to top
 


Automatic Benefit Enhancement Rider (ABE):

The ABE is a no cost rider designed to help them keep their coverage in line with an increasing income. It generates 4% increases of monthly benefit (compounded) each year for six years. These increases are provided despite any change in health, income or occupation. Note that ABE increases take place before any disability occurs; increases under the COLA rider begin after the insured becomes disabled.  You can choose to decline the increases in coverage, however any two consecutive years where this increase is refused, the rider will terminate.  This rider may be renewed subject to underwriting.  This rider is not applied for; rather it is included with the policy at underwriter discretion.  While the rider is provided at no cost, the insured is required to pay additional premiums for any coverage added by the rider.

return to top 


Student Loan Protection Rider (SLPP):

Many new professionals who hold or are obtaining an advanced degree have a significant amount of student loans.  If you are one of those individuals, will you have enough money if you became disabled to pay both living expenses and student loan payments?  
  
This rider now offers a solution to the student loan dilemma noted above for all individuals ages 18-45 who either hold or are pursuing an advanced degree and purchase a new Provider Choice policy.  The new Student Loan Protection Rider (SLPR) reimburses $500-$2500 a month toward student loan payments over and above the base policy benefits.  This leaves your clients with potentially more disability benefits to pay their normal living expenses.   This rider is available in all Provider Choice Approved states except FL, CT and NY.  

The Rider provides coverage for period of ten or fifteen years from the Policy Date.  When a qualifying total disability occurs, benefits are only payable during the remaining portion of the ten or fifteen-year term that has not elapsed when the disability begins.

return to top


Supplemental Term Benefit Rider (STBR):


The Supplemental Term Rider (STR) pays an additional $500-$2500 a month over and above the base policy benefits.     

The Rider provides coverage for period of ten or fifteen years from the Policy Date.  When a qualifying total disability occurs, benefits are only payable during the remaining portion of the ten or fifteen-year term that has not elapsed when the disability begins.

Combined the student loan rider plus the supplemental term rider can not exceed 2500 month. 

return to top


Short Term Residual Rider (STRR)

This rider is available on the Essential Package only. The partial benefit equals 50% of the total monthly indemnity (for non compact states: CA, CT, DE, DC, FL, MT, NY, ND & SD) and is payable for a period of up to six months following a period of total disability. For all other states there is a proportunate benefit paid for up to 6 months. The Short Term Residual Rider pays a benefit if sickness or injury causes a loss of: 

  • A: time at work of at least 50% of usual time in a work week, or

  • B: the ability to perform one or more of the material and substantial duties of the insured’s occupation.  

return to top


Provider Choice Specimen Policy: 

Provider Choice Annotated Compact State Specimen Contract 18ID Pub7534bl 4-2019

Note: Product may vary from state 



 
return to top


Provider Choice Consumer Page Outline:

Provider Choice State Availability
Provider Choice Packages: Premier, Select, and Essential
Provider Choice Package Feature and Rider Chart Summary
Non-Cancellable and Guaranteed Renewable (Non Can & GR)
Provider Choice Policy Form Options: 18ID, 18UD, and 18GI)
Premium Structure Options: Level vs Graded
Timing of Disability Benefits
     -Monthly Indemnity (Benefit)
     -Elimination Period (EP)
     -Accumulation Period (AP)
     -Timing of First Benefit Payment at Start of Claim
     -Benefit Period (BP)
Definition of Total Disability
     -Base Definition of Disability
     -True Own Occupation (TOO)
     -Medical/Dental Specialty Recognition 
     -
Enhanced Medical Definition
     -Lowest Cost Definition of Disability
Enhanced Partial Rider and Recovery Provision
Basic Partial Rider and Recovery Provision
Short Term Residual Rider (STRR)
Important Provider Choice Base Policy Features
     -Recurrent Disability
     -Waiver of Elimination Period
     -Waiver of Premium
     -Presumptive Total Disability Benefit
     -Hospice Benefit
     -Serious Illness Benefit Endorsement
     -Occupational Rehabilitation, Modification & Access Benefit
     -Transplant & Cosmetic Surgery
Provider Choice Premium Options
Provider Choice Exclusions & Limitations
Provider Choice Mental and Nervous (M & N) Maximum Benefit Duration Options
Provider Choice Availability of Optional Riders By Package
Provider Choice Future Increase Option (FIO) Rider
Provider Choice Benefit Purchase Rider (BPR) 
Provider Choice Cost of Living Adjustment (COLA) Riders:
     -4 Year Delayed COLA
     -3% Compound COLA Rider
     -6% Compound COLA Rider
Enhanced Catastrophic Rider (ECAT) 
Basic Catastrophic Rider (BCAT)
Provider Choice Graded Lifetime Indemnity Rider (X45)
Provider Choice Lump Sum Disability Benefit Rider
Provider Choice Retirement Protection Plus Rider (RPPR)
Social Insurance Substitute (SIS) Rider
Unemployment Waiver of Premium (UWPR)
Automatic Benefit Enhancement (ABE) Rider
Student Loan Protection Rider (SLPR)
Supplemental Term Benefit Rider (STBR)
Provider Choice Short Term Residual Rider (STRR)
Provider Choice Specimen Policy

return to top

Individual disability insurance policy Forms 18ID, 18UD, 18GI, 1400, 1500, and 1600 underwritten and issued by Berkshire Life Insurance Company of America (BLICOA), Pittsfield, MA. BLICOA is a wholly owned stock subsidiary of The Guardian Life Insurance Company of America (Guardian), New York, NY. Product provisions and availability may vary by state. In New York: These policies provide disability insurance only. They do not provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. For policy forms 18ID, 1400, 1500, and 1600 the expected benefit ratio is 50%. For policy forms 18UD, 18GI, 18UD-F, and 18GI-F, the expected benefit ratio is 60%. The expected benefit ratio is the portion of future premiums that the company expects to return as benefits, when averaged over all people with these policy forms.  Additional Riders available at an additional premium.

This website is provided for informational purposes only and should not be considered tax or legal advice.  Please contact your tax or legal advisor regarding the tax treatment of the policy and policy benefits.  You should consult with your own independent tax and legal advisors regarding your particular set of facts and circumstances.  The information provided is not intended or written to be used, and cannot be relied upon, to avoid penalties imposed under the Internal Revenue Code or state and local tax law provisions


Return to Home

Financial Representatives of the Guardian Life Insurance Company of America (Guardian), New York, New York.  First Financial Group is authorized to offer products of The Guardian Life Insurance Company of America (Guardian), New York, NY and its subsidiaries, and is not an affiliate or a subsidiary of Guardian. The GUARDIAN® Logo is a service mark of Guardian, used with permission. Important Disclosures:  www.guardianlife.com/disclosures  

2018-70474 Exp 01/2020