Proprietary 8-22 Pre-existing condition clause Coverage under the LTD plan is subject to a 3/12 preexisting condition clause. This means that a pre-existing condition review will be conducted if you submit an LTD claim within the first 12 months of your coverage effective date. If it is determined that you received care, treatment, or consultation for the disabling condition within the three months prior to the effective date of your coverage, then this condition will not be covered under the policy. Benefits limitation In addition, benefit coverage for disabilities due to mental illness, alcoholism, drug abuse, neuromusculoskeletal/Soft Tissue Disorder and Chronic Fatigue Syndrome is limited to a maximum of two years, unless the patient is confined to a hospital. Benefits are not paid for disabilities resulting from intentionally self-inflicted injuries, active participation in a riot, loss of a professional license or certification, or commission of a crime for which you have been convicted under state or federal law. Your plan will not cover a disability due to war, declared or undeclared, or any act of war. Your LTD benefit will be reduced by any disability benefits you receive or are eligible to receive, including workers’ compensation, federal or state benefits, Social Security, other group disability plans, and by new business commissions and any service fees you receive from any Farmers carrier. Work incentive benefit For the first 12 months of being disabled and receiving a disability payment, your monthly disability payment will not be reduced as long as your new business commissions plus the gross disability payment do not exceed 100% of your pre-disability monthly new business commissions. The length of time LTD benefits can be paid depends on your age when you become disabled, as shown in the chart below. 9 Your Age at Disability Maximum Benefit Period Less than age 60 To age 65 Age 60 60 months Age 61 48 months Age 62 42 months Age 63 36 months Age 64 30 months Age 65 24 months Age 66 21 months Age 67 18 months Age 68 15 months Age 69 and over 12 months WHAT IS A PRE-EXISTING CONDITION? You have a pre-existing condition if: n You received medical treatment, care, or services for a diagnosed condition or took prescribed medication for a diagnosed condition in the three months immediately prior to the effective date of coverage; and n The Disability caused or substantially contributed to by the condition begins in the first 12 consecutive months after the effective date of coverage.
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