Arizona individual Disability Income (DI) insurance limitations and exclusions

Eligibility, benefits, and related limitations, exclusions, and reductions

Eligibility

To be eligible for coverage, employees must be actively at work on a full-time basis for at least 20 hours per week; residing in the United States; US citizens or legally working in the United States at the time of application. Part-time under 20 hours per week and seasonal are not eligible. Proof of good health and financials may be required. The type and form of proof is determined by Principal.

Benefit qualification

All conditions have requirements to qualify. The disability must begin while insured is covered under this policy. Written notice of claim, proof of loss and any additional information need to process are required. Claim procedures must be satisfied. Documentation must be provided within the timelines established in the policy, and all claims requirements must be met.

Elimination period

The policy includes an elimination period, which is a set number of days of disability from the start of a continuous disability for which no benefits will be paid.

Benefit period

The period starts after the satisfaction of the elimination period and is the longest time for which benefits will be paid for any one continuous disability.

Recurring disability

A continuation of a prior disability when the recurrence of disability occurs while the policy is in force and results from the same or directly related cause as the prior disability for which benefits were paid or provided the waiver of premium benefit unless after the prior disability ends they return to work for at least 40 hours per week in any occupation for at least 6 consecutive months. No new elimination period is required and benefits will be paid during the recurring disability for the remainder of the benefit period.

Preexisting condition limitation

A preexisting condition is a condition for which medical treatment, testing or medication was recommended by a doctor or received from a doctor within the 2 year period prior to the effective date of coverage or which has caused symptoms within the 2 year period prior to the effective date of coverage which would have caused an ordinarily prudent person to seek diagnosis, care or treatment.

Claims for a disability or loss which begins within 2 years after the effective date of coverage and results from a pre-existing condition which was not disclosed or was misrepresented on the application may be excluded.

General limitations and exclusions

No benefits will be paid for an injury or sickness due to an intentional self-inflicted injury; commission of or attempt to commit a criminal act, or involvement in an illegal occupation or activity; suspension, revocation or surrender of your professional or occupational licenses or certification; active military service during a military action or conflict; loss that was excluded by name or specific description in any rider or endorsement. No benefits are payable for any period during a continuous disability when incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer.

Benefit payments may be limited to 12 months during a continuous disability while residing outside of the US or Canada if not residing in the US or Canada for at least 6 consecutive months each calendar year.

Limitation of benefits for mental, nervous, and substance abuse for a total of 24 months during the life of the policy. If the elimination period is less than 90 days, then normal pregnancy and normal childbirth are not covered sicknesses. If the elimination period is greater than 90 days, then normal pregnancy and normal childbirth are covered sicknesses subject to the definition of disability.

Refer to the policy for definitions applicable to all terms used in this document, and for other applicable terms and conditions. Proof of disability, documentation of loss, submission of medical records, and proof of income are required. Claim procedures must be satisfied. Documentation must be provided within the timelines established in the policy. Limitations and exclusions must not apply for benefits to be payable.

Principal has discretion to construe or interpret the provisions of this policy, to determine eligibility for benefits, and to determine the type and extent of benefits, if any, to be provided. The decisions of Principal in such matters shall be controlling, binding, and final.