Member Benefits Up to $5,000 a Month Available!

Your Passport to Income Protection. If you’ve never considered disability income insurance before, you may wonder why you may need it now, especially if you’re young and healthy. But most professionals, at all stages, at all income levels, may want to consider solid disability income protection. The AJLI–sponsored Group Disability Income Insurance can help you protect your earning capacity.

Chances are, you already protect your important assets such as your house. Your health insurance can only cover your medical expenses; it can’t provide a regular source of income. Why not help protect the most important asset you have: your ability to earn an income?

Practical Help

• Designed to provide a substitute source of income if you are totally disabled and cannot work.
• Can provide monthly benefit options to aid in paying bills when disabled.
• Offers two waiting periods to help meet your needs and budget.

Valuable Benefits

• Members Under Age 60 Are Eligible to Apply
• Your Choice of Monthly Benefit Options
  You may apply for up to $5,000 in coverage, in $100 increments.
• Your Choice of Waiting Periods (Plan A, 180-day or Plan B, 90-day)
  A waiting period is the number of consecutive days you must be totally disabled before benefit payments begin.

ELIGIBILITY

Members of the AJLI who are under age 60 and at FULL–TIME WORK can request this coverage, provided they reside in the United States (excluding AK, DE, FL, LA, ME, MD, MO, MT, NV, NH, NM, NC, OR, SD, TX, VT, UT, WA, WY and territories) and have an ANNUAL NET EARNED INCOME of at least $20,000. Members on active duty in the Armed Forces and full–time students are not eligible.

"FULL–TIME WORK" means the active performance of regular duties of your normal occupation for pay or profit on the basis of at least 30 hours per week at the place where such duties are normally performed or other location to which travel is required.

"ANNUAL NET EARNED INCOME" means your wages, salaries, commissions, fees, and other amounts received for personal services—before deduction of income or social insurance taxes and after the deduction of normal and usual business expenses that are deductible for income tax purposes.—for any 12–month period. Annual Net Earned Income does not include income from interest, dividends, rent, royalties, annuities, other insurance and other unearned income.

HOW IT WORKS

Choose Your Monthly Benefit

You may choose a Monthly Benefit Option from $500 to $5,000 (in $100 units). The option you choose, together with all other disability income insurance you have or for which you are applying, cannot exceed 60 percent of your AVERAGE MONTHLY INCOME. Depending upon your state of residence, you may be eligible to receive benefits under a state Policy. You should check to see whether your state offers this.

Choose Your Waiting Period

The AJLI–sponsored Group Disability Income Policy offers a choice of two waiting periods: 180-day or 90-day. A waiting period is the number of consecutive days you must be Totally Disabled before benefits begin. For those members looking to pay a lower premium contribution, you can choose the 180–day waiting period.

FEATURES

Premium Payments Waived During Disability

If you are Totally Disabled and have been receiving benefits for six months, all future premium contributions under the Policy will be waived for as long as you receive benefits for that disability.

Recurring Disability

Successive periods of disability that are due to the same or related causes will be considered a single period of disability unless separated by a return to FULL–TIME WORK of 180 days or more. (Unrelated disabilities not separated by a return of FULL–TIME WORK will also be considered a single period of disability.)

YOUR COST

Current 2024 Monthly Premium Contributions

Cost is based on the Waiting Period and Monthly Benefit Option selected, and on your age when coverage becomes effective. The cost increases on the premium contribution due date on or immediately after your reach a higher age bracket. Premium contributions will vary depending upon the options and amount chosen.

Current 2024 Quarterly Premium Contributions

180-Day Waiting Period

90-Day Waiting Period

*Renewal only

These rates increase on the next premium due date following your attainment of ages 30, 40, 50 and 60. Your monthly benefit amount will be limited to a maximum of $2,000 on the premium due date coinciding with or next following the date you attain age 60. This reduction applies to the monthly benefit amount payable for total disability that commences prior to age 60 as well as total disability that commences after age 60. Coverage terminates upon attainment of age 65. The Company reserves the right to change premiums based on the experience of the group as a whole.

If applicable, an additional $2 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option as well as paying annually.

ADDITIONAL PROVISIONS

Effective Date

You will become insured on the date specified by New York Life provided the first premium contribution has been paid, satisfactory evidence of insurability has been submitted, and you are actively at FULL-TIME WORK on that date. If you are not at FULL-TIME WORK as required, coverage will not become effective until the day you are at FULL-TIME WORK provided such date is within three months of the date insurance would have become effective and you are still eligible for insurance. Payment of a premium contribution for insurance does not mean there is any coverage in force before the effective date as specified by New York Life.

There are instances where New York Life may be able to offer insurance, at the same cost, by eliminating coverage for a specific condition or impairment.

When Coverage Ends

Your insurance can remain in force until you reach age 65. Coverage will end earlier if: you cease to be a member of the AJLI; you fail to make premium payments when due; you begin full-time active duty in the Armed Forces; you cease FULL-TIME WORK (other than for disability); or the group policy is terminated or modified by the Trustees or New York Life to end coverage for the group of insureds to which you belong.

Renewal Payments and Claims

Once your application is approved, you will have a 31-day grace period for your payment of renewal premium contributions. When you want to submit a claim, call or write the Administrator for claim forms.

30-Day Free Look

When you become insured you will be sent a Certificate of Insurance summarizing your insurance coverage. If you are not completely satisfied with the terms of your Certificate, you may return it, without claim, within 30 days. Your coverage will be invalidated and you will receive a full refund—no questions asked.

IMPORTANT NOTICE

How New York Life Obtains Information and Underwrites Your Request For The

Group Disability Income Insurance Plan

In this notice, references to "you" and "your" include any person proposed for insurance. Information regarding insurability will be treated as confidential. In considering whether the person(s) in your request for the insurance qualify for insurance, we will rely on the medical information you provide, and on the information you AUTHORIZE us to obtain from your physician, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB, LLC. ("MIB"). MIB is a not-for-profit organization of insurance companies, which operates an information exchange on behalf of its members. If you apply for life or health insurance coverage or claim for benefits is submitted to an MIB member company, medical or non-medical information may be given to MIB and such information may then be furnished by MIB, upon request, to a member company.

Your AUTHORIZATION may be used for a period of 24 months from the date you signed the application for insurance, unless sooner revoked. The AUTHORIZATION may be revoked at any time by notifying New York Life in writing at the address provided. Your revocation will not be effective to the extent New York Life or any other person already has disclosed or collected information or taken other action in reliance on it, or to the extent that New York Life has a legal right to contest a claim under an insurance certificate or the certificate itself. The information New York Life obtains through your AUTHORIZATION may become subject to further disclosure. For example, New York Life may be required to provide it to insurance, regulatory or other government agencies. In this case, the information may no longer be protected by the rules governing your AUTHORIZATION.

MIB and other insurance companies may also furnish New York Life, its subsidiaries or the Plan Administrator with non-medical information (such as driving records, past convictions, hazardous sport or aviation activity, use of alcohol or drugs, and other application for insurance). The information provided may include information that may predate the time frame stated on the medical questions section, if any, on this application. This information may be used during the underwriting and claims processes, where permitted by law.

New York Life may release this information to the Plan Administrator, other insurance companies to which you may apply for life and health insurance, or to which a claim for benefits may be submitted and to others whom you authorize in writing. However, this will not be done in connection with test results concerning Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV). We may also make a brief report of your protected health information to MIB, but we will not disclose our underwriting decision.

New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. Information in our files may be seen by New York Life and Plan Administrator employees, but only on a "need to know" basis in considering your request. Upon receipt of all requested information, we will make a determination as to whether your request for insurance can be approved.

If we cannot provide the coverage you requested, we will tell you why. If you feel our information is inaccurate, you will be given a change to correct or complete the information in our files. Upon written request to New York Life or MIB, you will be provided with non-medical information. Generally, medical information will be given either directly to the proposed insured or to a medical professional designated by the proposed insured. Your request is handled in accordance with the Federal Fair Credit Reporting Act procedures. If you question the accuracy to the information provided by the MIB, you may contact MIB and seek a correction. MIB's information Office is: MIB, LLC. 50 Braintree Hill Park, Suite 400,Braintree, MA 02184-8734, telephone 866-692-6901 (TTY 866 346-3642)

Information for consumers about MIB may be obtained on its Web site at http://www.mib.com/

For NM Residents: PROTECTED PERSONS¹ have a right of access to certain CONFIDENTIAL ABUSE INFORMATION² we maintain in our files and they may choose to receive such information directly. You have the right to register as a PROTECTED PERSON by sending a signed request to the Administrator at the address listed on the application. Please include your full name, date of birth and address.

¹PROTECTED PERSON means victim of domestic abuse; who has notified us that he/she is or has been a victim of domestic abuse; and who is an insured or prospective insured person.

²CONFIDENTIAL ABUSE INFORMATION means information about: acts of domestic abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant or insured family member, employer or associate of a victim of domestic abuse or a person with whom the applicant or insured is known to have a direct, close, personal, family or abuse-related relationship.

New York Life Insurance Company

8/12 ed.

This section is only a brief description of the principal provisions and features of the Policy. The complete terms and conditions are set forth in the group policy issued by New York Life to the Trustees of Ophthalmologists Insurance Trust.

AJLI incurs costs in connection with this sponsored program. To provide and maintain this valuable membership benefit, it is reimbursed for these costs. AJLI also receives a fee for the license of its name and logo for use in connection with this coverage.

Underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010, under Group Policy G-30713-0, on Policy Form GMR-FACE/G-30713-0.

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About New York Life Insurance Company