AICPA Insurance Programs

Group Elite Long Term Disability
Provisions and Exclusions

PLAN PROVISIONS

Maximum Benefit Duration

After a covered accident or illness, monthly disability income benefits will continue until the employee returns to work, is no longer disabled, reaches the maximum benefit duration, the employee fails to submit proof of continued disability, the employee's disability earnings exceed those allowed by the plan, or the employee dies. The maximum amount of time benefits will be payable is based on the insured's age at the time of the claim.

*Your normal retirement age is your retirement age under the Social Security Act where retirement age depends on your year of birth

For a covered claim due to a mental/nervous disorder or drug/alcohol addiction the maximum benefit period is 24 months.

Survivor Benefit

In the event the insured passes away after a covered disability claim, the Plan will pay a survivor benefit equal to three times their gross monthly benefit. The benefit is payable to the insured's spouse, if living, otherwise to their children under age 25, unless they have chosen another eligible survivor. The survivor benefit will be paid if, on the date of your death:

• your disability had continued for 180 or more consecutive days; and
• you were receiving or were entitled to receive payments under the Plan.

When the Insurance Terminates

The insurance for an individual will automatically terminate when he or she is no longer a covered individual or actively engaged in work full-time with the contributing employer, the firm ceases to be a contributing employer, or the group policy terminates. If a firm chooses to have 100% Employee paid coverage, the insurance will terminate when the employee stops paying premiums.

Minnesota Residents Only: If employment is terminated, either voluntarily or involuntarily, or if the individual is laid off and the group policy is still in force with the firm, coverage may be continued by the individual until coverage is obtained under another group policy or until a return to work from lay off; however, the maximum period that coverage may be continued is 18 months. Minnesota law allows the individuals to elect such coverage by the later of (a) 60 days from the date the notice of continuation is received from the firm; or (b) 60 days from the date coverage would otherwise have terminated.

Partial Disability

Monthly disability income benefits are provided for owners and employees who become partially disabled. Eligibility is based on the definition of disability applicable at the time the insured becomes disabled and when the decrease in the insured's earnings was effective.

• Regular Occupation of Disability - insured must lose at least 20% of pre-disability earnings.
• Gainful Occupation of Disability - insured must lose at least 40% of pre-disability earnings.

No benefits are paid if the insured owner or employee is employed and working 40 hours per week or has the capacity to be employed and working 40 hours per week.

Other Disability Benefits

In order to avoid the overpayment of benefits during a period of disability and to provide an incentive for an insured to return to work, monthly disability benefits are reduced by payments from the following:

• Benefits received from other group disability insurance programs, if premiums are paid by the employer.
• Social Security Disability and/or retirement payments for the insured and his or her family.
• Salary continuation plans, sick leave arrangements, employer retirement programs, unemployment benefits and similar types of payments that may be received by a disabled insured.

See certificate for additional details.

EXCLUSIONS AND NOTICES

The insurance does not cover a disability caused by or contributed by: any war or act of war (including undeclared war), intentionally self-inflicted bodily injury or attempted suicide; active participation in a riot; commission or attempt to commit a felony, or pregnancy, except complications of pregnancy will be treated as any other sickness.

The plan does not cover a disability due to a pre-existing condition during the 12 months after your effective date of coverage. See certificate for details.

Employment Waiting Period

If elected by the firm, the Employment Waiting Period is the period extending from the employee's date of employment to the completion of six months of continuous full-time service with the employer, or a total of six months of service on a full-time basis with one or more employers, provided that this service was completed within the twelve month period immediately preceding the employee's date of employment with the current employer.

Important Notice

The Certificate of Insurance that insured firms receive describes the benefits and other provisions more fully. The complete terms of the Master Group Insurance Policy governs at all times.

*Disabilities due to mental illness, nervous diseases, alcoholism, or drug addiction have a limited pay period of 24 months during your lifetime.