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Answers to frequently asked questions

I already have disability insurance through my employer. Should I still consider this insurance?

Yes, for three reasons:

  1. As a Resident, the level of protection you now carry may not be enough to help cover the living expenses that you would have should you become disabled. Using this plan to increase your total coverage can help you avoid having to deplete savings and investments intended for other purposes.
  2. The monthly benefit amount paid through employer-sponsored disability insurance is likely to be taxable, reducing the true amount of protection that coverage provides. In contrast, the benefits of this plan could be free of income tax when you pay the premiums with your own after-tax dollars. Consult your tax advisor.
  3. Unlike many employer-provided plans, this coverage is yours to keep without interruption, even if you change jobs or become self-employed. This plan adds an extra layer of protection that you control, and it will move with you throughout your career.

Why is “own specialty” coverage so important?

Some disability plans limit their definition of “total disability” to the inability to work in any occupation. This means you might not be eligible for benefits if you are sick or injured but still able to work in another profession.

Other plans may include an own occupation definition of disability, meaning that you might not be eligible for benefits if you were able to perform any physician job in the field of medicine, even though you were no longer able to carry out the duties and responsibilities of your medical specialty.

This plan contains a preferred definition of disability, called own specialty, which is so important for physicians. It means you are eligible to receive benefits if you’re unable to perform the duties of your own medical specialty – not just any job or some other job in the medical profession.

How does this plan define “total disability”?

You will be considered totally disabled if you are unable to perform the material and substantial duties of your medical specialty due to accident, illness, or organ donation*. House or hospital confinement is not required to be eligible for benefits, but you must be under the care of a physician.

*Note: for organ donation, the waiting period is waived as long as insurance has been in effect for at least six months.

Total disability is presumed, and the waiting period waived, if you experience total and irrecoverable loss of speech, hearing in both ears, sight of both eyes or loss of both hands or feet.

What does “waiting period” mean?

The waiting period is defined as the period of time from the start of total disability during which no benefits are payable. This offer comes with a choice of waiting periods, including a 60-day period to help conserve your personal savings and other financial assets. The waiting period is only satisfied if you are not working in any occupation.

How does the medical school loan payment benefit work?

If you are insured prior to age 40, this insurance could pay up to $200,000 of your eligible student loan debt if you are totally and permanently disabled before age 45. This benefit is paid in addition to your monthly disability benefit, and it’s included in your coverage at no additional charge.

Why are rates so affordable?

As a physician, you’re part of a large group of people nationwide, so you’re not only eligible to receive exclusive offers for coverage tailored to meet the unique needs of professionals, you also enjoy group purchasing power, which helps keep your cost competitive.

As a physician, you’re part of a large group of people nationwide, so you’re not only eligible to receive exclusive offers for coverage tailored to meet the unique needs of professionals, you also enjoy group purchasing power, which helps keep your cost competitiveca.

All insured physicians receive a 15% rate reduction for at least the first year of coverage. AMA Members receive a 35% reduction. Rate reductions are reviewed annually and have lowered the cost of AMA-sponsored disability insurance since 2006.

What if my health declines? Will my rates go up?

No. You can never be singled out for a rate increase or have your coverage cancelled due to your health. You are also assured that your rates will never increase as a result of the number of claims you’ve made. Rate increases occur as you move from one age bracket to the next. Additionally, the insurance company can only change premium rates for the group.

What other additional benefits are included at no extra charge?

Future Benefit Increase Option — If you are under age 40, you may be eligible for a future benefit amount increase with no health questions or medical exams required if your income increases and you remain actively at work. This one-time option must be exercised within the first three years of your original effective date or before your 40th birthday, whichever comes first.

Rehabilitation benefit — To help you recover, you may also qualify for rehabilitation benefits in addition to your monthly disability benefit if you participate in an approved accredited occupational rehabilitation program while you are disabled.

Residual benefits for part-time work — This plan allows you to make a gradual transition back to full-time employment following a covered total disability for which you receive benefits. You can receive a residual benefit when you return to work on a part-time basis in your own specialty, or any other specialty or occupation. The amount of the residual benefit is based upon a percentage of your total monthly disability benefit.

Communicable Disease Benefit — If you contract a Communicable Disease* before age 67, you may qualify for coverage without the requirement that you suffer a covered total disability. You’ll be eligible for this benefit if the illness causes you to earn less than 75% of your average monthly income for the period before your practice was limited and/or condition was disclosed as a result of contracting the disease.

*Communicable Disease means any of the following conditions, but only if: (a) the medical profession recommends; or (b) an appropriate governmental agency requires; the disclosure of the diagnosis of the Communicable Disease and/or a limitation of his or her practice due to contracting the Communicable Disease: Acute Viral Hepatitis of a non A type, Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS) or tuberculosis.

Family Care Benefit — We’ll pay up to one basic monthly benefit to you to care for a close family member with a Serious Health Condition.* Your spouse or domestic partner; child, including a step-child, adopted child or child of your domestic partner; or your parents, are considered “close family members.” The health condition must be certified by the family member’s licensed attending physician.

You must be working at least 20% fewer hours and have a loss of 20% or more of your average monthly income, due to the time off to qualify. The monthly benefit is the amount payable in proportion to the loss of monthly income up to a maximum of one basic monthly benefit:

0% -19%:No benefit
20% - 25%:25% of the Basic Monthly Benefit is payable
26% - 50%:50% of the Basic Monthly Benefit is payable
51% - 75%:75% of the Basic Monthly Benefit is payable
76% - 100%:100% of the Basic Monthly Benefit is payable

*Serious Health Condition is a condition that causes the family member: to be unable to complete, without substantial supervision, two of six “activities of daily living,” including bathing, dressing, toileting, transferring, (e.g., in and out of bed), eating and continence; to require substantial supervision due to severe cognitive impairment; to be hospitalized; or to become terminally ill with a condition that is reasonably expected to result in death within 12 months.

Lay Off or Leave of Absence Benefit — Your insurance can continue beyond the end date of the coverage if you cease to be employed full-time due to lay-off, leave of absence, or a leave of absence required by state law or by the Family and Medical Leave Act of 1993 (FMLA). Your coverage will continue for up to 90 days during a temporary lay-off or a leave of absence other than state mandated leave or FMLA; or the greater of the period required by state law or by FMLA provided the leave authorization is in writing and the required premium is paid.

The insurance will then end on the earliest of 90 days after the temporary lay-off or leave of absence (other than state mandated leave or FMLA) began; the date the layoff becomes permanent; the date the state mandated leave or FMLA leave ends; or the date insurance would otherwise end.

Are there additional optional riders?

Cost of Living Adjustment (COLA) Option — For just 15% additional premium you may add the COLA option. With it, the monthly benefit payable for a covered total disability may be adjusted annually to reflect changes in the cost of living based on the CPI-U.* Years are measured from the start of the waiting period. In the first year, no adjustment will be made. Adjustments may be made to the monthly benefit paid in the second and each succeeding year. Note: If you choose this option in addition to the Catastrophic Disability Rider below, the cost of the COLA option will be an additional 1.5% in premium for a total of 16.5% (or an additional 3% in premium for a total of 18% if age 60 and above).

*“CPI-U” means the Consumer Price Index for All Urban Consumers, All items, as published by the Bureau of Labor Statistics. If the CPI-U, in New York Life's opinion, is no longer a valid index for the purpose of the Automatic Benefit Increase Option, or is no longer published by the Bureau of Labor Statistics, we will use a new index.

Catastrophic Disability Rider — The Catastrophic Disability Rider provides extra benefits for disabling conditions that require extended care. Should you become totally disabled and lose the ability to perform two of the six activities of daily living — bathing, dressing, toileting, transferring (e.g., in and out of bed), eating or continence — you can receive this monthly benefit in addition to your base monthly disability benefit. By adding this optional benefit, you will receive a 30% increase (up to $4,500) in your total monthly benefit for only 10% additional premium, up to age 60 (or 20% additional premium if age 60 and above). You must have a minimum of $3,000 in base disability benefits to qualify.

How long will my benefits last?

That depends on your age at the time the disability begins. If you are disabled before age 62, benefits under this plan are payable up to age 67. If you are disabled between the ages of 62 and 63, benefits are payable for up to 60 months. From age 63 to 69, the benefit period is reduced in six-month increments, depending upon your age at the time the disability begins. From age 70 to 75, benefits are payable up to 12 months.

If you are disabled due to a mental, nervous or emotional disorder before age 69, benefits under this plan are limited to 24 months. At ages 69 and 70, benefits for such disability are limited to 18 and 12 months, respectively. (If such disability begins before age 65, benefits are payable to age 67, if you are confined to a hospital at the end of two years, and such confinement has been continuous for the immediately preceding 12 months.)

When does waiver of premium apply?

Once benefit payments begin, your premium payments will be waived for as long as you are totally disabled.

How often can I renew my coverage?

Your coverage will be effective on the 1st of the month following the date your application is approved by New York Life Insurance Company.

Coverage may be continuously renewed until your certificate anniversary following attainment of age 75, as long as you are actively employed full-time as a physician and pay your premiums when due, the group policy remains in force, and the AMA continues to sponsor this plan.

Coverage will be terminated upon the suspension or revocation, or voluntary surrender in any state, of your license to practice medicine as a result of a criminal act, ethical violation or gross malpractice.

Do I need to be a member of the American Medical Association?

You’re eligible to apply for this plan if you’re a physician age 40 or younger and actively engaged full-time in the duties of your medical profession. Membership in the American Medical Association is not required.

Why should I get my coverage through AMA Insurance?

Since 1988, AMA Insurance has been offering high quality, economical coverage designed to meet the unique needs of physicians nationwide. We can take advantage of the buying power available to large groups to secure competitive rates and physician-focused coverage you won't find anywhere else.

In addition, this disability plan has provided physician-exclusive rate reductions since 2006, helping keep the cost economical, even for significant amounts of coverage. AMA-sponsored disability insurance has been protecting physicians for five decades with solid, dependable coverage at competitive pricing.

Do I have to pay my first premium when I apply?

No. You don’t need to send any money until you’ve reviewed your Certificate of Insurance and confirmed that it meets your needs. Your first premium notice will be enclosed with your Certificate of Insurance.

Is there a free review period?

Yes. You must be completely satisfied with your coverage. Once your application is approved and coverage issued, you'll receive a Certificate of Insurance. Take up to 30 days to review it. If it meets your needs, pay your first premium. If it doesn't, return your certificate within that 30-day period and you'll be under no further obligation.

 

Rate details

All physicians save 15%, and AMA Members save 35%, for at least the first year of coverage. These savings are reflected in your personal rate quote and are based on your membership status. Physician savings and state surcharges apply to the full premium amount.

Attention residents of AK, AL, AZ, CA, FL, GA, HI, LA, MS, NM, OR, SC, TX and WA: Due to claims experience higher than the national average, rates are 40% higher in California and Florida, and 20% higher in Alaska, Alabama, Arizona, Georgia, Hawaii, Louisiana, Mississippi, New Mexico, Oregon, South Carolina, Texas and Washington. If you live in one of these states, the personal rate quote includes these state-specific variations.

Non-member physicians will be assessed an annual administrative fee of $55. Rates are based on your age on the effective date of coverage and your attained age on each renewal date. Depending on plan experience, rates and rate reductions may change on the plan anniversary date (July 1) or your annual renewal date, whichever is later.

To calculate your annual cost, divide the monthly rate by .083. If you prefer to pay semi-annually, multiply the annual rate by .52. Rates may vary due to rounding.

 

Limitations and exclusions

No monthly benefit will be paid for disability due to intentionally self-inflicted injury or attempted suicide, while sane or insane; a declared or undeclared war or an act of war; or the use of any narcotic drug or other substance which is (a) subject to federal or state controlled substances acts, unless the prescription shall have been written by an attending physician other than you, or (b) required by law to be dispensed by prescription only and used for other than a bonafide medical purpose as it relates to you or for other than the treatment of an existing medical condition. Benefits will not be paid or accrued for any period of time while you are incarcerated. Benefits will be paid either for injury or for sickness, but not for both, during any concurrent period of disability.

Coverage will terminate upon the suspension, revocation or voluntary surrender in any state of an insured’s license to practice medicine as a result of a criminal act, ethical violation or gross malpractice.

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