Group Business Overhead Expense

You will be covered if, due to a total disability, you’re completely unable to perform the material and substantial duties of your own occupation, not just any job. “Own Occupation” is the occupation in which you were regularly engaged, for a minimum of two years, at the time you became disabled.

This plan can pay up to $15,000 monthly during a covered disability. You may apply for monthly benefit levels from $1,000 to $15,000 per month, in $100 increments.

45-Day (benefits begin on the 46th day of total disability)

60-Day (benefits begin on the 61st day of total disability)

The Elimination (Waiting Period) is the duration of time between the onset of the disability and when you receive your first monthly benefit payment. A longer waiting period means a lower cost.

The Benefit Period is the amount of time disability benefits can continue following the waiting period if you remain totally disabled from a covered disability. The shorter the benefit period, the more economical the plan:

Semi-Annual Rates per $100 Covered Monthly Benefit

Rates are guaranteed from May 1, 2017 – April 30, 2020

*For renewal only.

The program will provide Business Overhead Expense benefits for each period of total disability which continues beyond the waiting period, subject to the Exclusions and Limitations. A waiting period is the number of days you must be continuously disabled by a covered illness or injury before benefits commence. Payment of benefits will begin after you have been disabled for your waiting period and then will be paid retroactive to the first day of disability.

Benefit payments will end on the earliest of: the end of the maximum benefit period; the date you are no longer disabled; the date you die; the date you fail to have a requested medical examination, functional capacity examination or in-home interview; the date for which you fail to provide required Proof of Loss; or the date you reach age 70.

Benefits paid will not exceed the lesser of 1) the actual monthly eligible expenses incurred, or 2) the monthly benefit level in force on the date the total disability began. The expenses to include in these figures are those which must be paid even when you’re away.

Covered monthly expenses include, but are not limited to, expenses incurred for:

• rent, electricity, heat, gas, telephone and water;
• employees’ salaries and payments for group insurance and pension plans;
• monthly pro-rata portion of annual contributions for professional membership fees and dues that you incur as part of your profession;
• accountants’ services;
• mortgage interest and principal on debt owed for business premises owned and used by you in your profession;
• interest and principal on debt owed incurred for business equipment used in your office;
• tax payments for real and personal property used in your business; and
• rental of business equipment (except automobiles, aircraft and other motor vehicles).

If your business is jointly owned, Business Overhead Expenses will mean your portion of such expenses. We will determine your portion of Business Overhead Expenses based on the business records for the six months before the start of your disability. If you have been liable for Business Overhead Expenses for less than six months, you must submit Proof of Loss of the expenses for the period of time for which you have been liable for prior to the start of your disability, along with Proof of Loss demonstrating the portion of the Business Overhead Expenses for which you are liable. For a disability of less than one month, we will prorate your benefit based on a 30-day month.

• income taxes;
• cost of goods;
• cost of implements you use in the performance of your job;
• payments on mortgage principal, or the principal of any other indebtedness;
• monthly expenses for which you were not normally and customarily liable for on a periodic basis prior to the start of your disability;
• personal expenses; or
• any expenses that would otherwise constitute Business Overhead Expenses that are reimbursed under another business expense type policy.

In addition, Business Overhead Expenses do not include salary, fees, drawing account or any other remuneration for: you; any partner, shareholder or member of your profession; any person sharing business expenses with you; any person employed to perform your duties; any person hired after your disability began; or any person to whom you are related by blood or marriage who is not a paid employee hired at least three months prior to the onset of your disability.

Total Disability means that, due to sickness as a direct result of accidental injury, you are unable to perform the material and substantial duties of your own occupation. You must be receiving appropriate care and treatment and must be complying with the requirements of treatment.

While you are receiving Business Overhead Expense benefits, premium payments for the cost of any insurance provided under this certificate are waived after you have received monthly benefits for six continuous months. When your disability ends, premiums must again be paid when due.

If, before completing your waiting period, you return to active work for a period of 90 days or less and then become disabled again due to the same or related sickness or injury, we will not require you to complete a new waiting period. We will count the days that you were disabled before returning to active work towards the completion of your waiting period.

If, before completing your waiting period, you return to active work for a period of more than 90 days and then become disabled again, you will have to complete a new waiting period.

If you return to active work after completing your waiting period, for a period of 90 days or less, and then become disabled again due to the same or related sickness or injury, we will not require you to complete a new waiting period. For the purpose of determining your benefits, we will consider such disability to be a part of the original disability and apply the same terms, provisions and conditions that were used for the original disability.

If, after completing your elimination period, you return to active work for a period of more than 90 days and then become disabled again, you will have to complete a new elimination period.

If you die while disabled and receiving the monthly benefits, we will continue the payment to your beneficiary after you have been continuously disabled for at least 12 months. This benefit will end when three monthly payments have been made to the beneficiary; or when the maximum benefit period ends, whichever happens first.

The benefits to be paid by this plan for a complication of pregnancy will be the same as those to be paid for a sickness. (See your Certificate of Insurance for details.)

Your insurance will take effect after you provide evidence of your insurability. If we determine that you are insurable, your insurance will take effect on the date we state in writing, provided you are actively at work on that date. If you are not actively at work on the date insurance would otherwise take effect, insurance will take effect on the day you resume active work. If the date insurance is to take effect is not a scheduled workday, insurance will take effect on the next scheduled work day that you are actively at work.

Your insurance will end on the earliest of: the date the Group Policy ends; the date insurance ends for your class; the end of the period for which the last premium has been paid for you; the date you cease to be actively at work for reasons other than disability; the date you cease to be a member; or the premium due date coinciding with or next following the date you attain age 70.

We will not pay benefits for any disability caused by: war, whether declared or undeclared, or act of war, insurrection, or rebellion; intentionally self-inflicted injury; attempted suicide; or commission of or attempt to commit a felony.

Benefits will not be paid while you are confined in a penal or correctional institution.

When you receive your Certificate of Insurance, examine it carefully. If you are not completely satisfied with your Business Overhead Expense Insurance coverage, simply return your certificate, without claim, within 30 days¹ with your request for a full refund of any premium paid.

No questions will be asked and there will be no further obligation.

¹20 days in North Dakota; 10 days in West Virginia.