What if I have medical insurance?
This is not “medical insurance,” which usually pays to doctors and medical providers. This kind of policy pays cash directly to the employee for covered accidents and injuries. It pays without regard to any other coverages you may have.
What is the maximum issue age for this coverage?
Age 69 for initial enrollment.
When will I get a policy?
You will receive a policy in the mail to your address of record about 2 weeks after enrollment.
Will I be able to keep the coverage after I leave the USPS?
The Disability portion (Accident or Illness) will stop at the sooner of age 70 or separation from USPS employment. The Accident portion will continue as long as premiums are paid.
Will prices ever go up or can I be canceled?
Prices for USPS are set as if the employee is 18 and will never go up. The policy only cancels when premiums are stopped.
What if I want to cancel my coverage?
You can stop the allotment, overwrite the allotment, or call the agent or the company to cancel. Any unused or excess premiums will be returned.
For All Disability Coverage (Only available for Primary Applicant). If the answer to any question is “Yes”, you are not eligible for any disability coverage.
In the past 5 years have you:
(a)been convicted of a felony,
(b)been charged with operating a vehicle under the influence of alcohol or drugs,
(c)been charged with three (3) or more moving violations,
(d)been incarcerated in a correctional institution or are currently on parole?
Are you covered under any other disability income insurance which is not ending and when combined with this application for insurance will exceed 66 2/3% of your monthly gross income (pre-tax)?
Are there any material or substantial job duties you are currently unable to perform due to sickness, maternity, or injury?
In the past 12 months have you been off work for 5 or more consecutive workdays due to illness or injury (other than for normal pregnancy)?
Are you currently or have you in the past 12 months been diagnosed with, treated for, had procedures related to, or prescribed medication for any of the following conditions
(a) any disease or disorder of the cartilage, bone, tendon, muscles or ligaments of the knee, back, discs of the spine, neck, joints, hip or ankle including but not limited to degenerative joint disease or osteoarthritis,
(b) carpal tunnel syndrome,
(c) psoriatic arthritis or rheumatoid arthritis
(d) radiculopathy or sciatica?
In the past 5 years have you been diagnosed with, treated for, or had procedures related to any of the following conditions: chronic fatigue syndrome or fibromyalgia?
For Sickness Disability Rider (Only available for Primary Applicant). If the answer to any question is “Yes”, you are not eligible for the Sickness Disability Rider.
In the past 10 years have you been treated for or diagnosed by a physician as having any of the following conditions or procedures?
Alzheimer’s Disease Cardiomyopathy
Chronic Hepatitis Chronic Liver Disease
Crohn’s Disease Cystic Fibrosis
Dementia Emphysema Heart Valve Replacement
Insulin Dependent Diabetes Diabetes Diagnosed Prior to age 40
Multiple Sclerosis Muscular Dystrophy
Parkinson’s Disease Pulmonary Fibrosis
Pulmonary Hypertension Regional Enteritis/Ileitis
Renal Hypertension Rheumatic Fever
Schizophrenia Systemic Lupus
Ulcerative Colitis Ulcerative Proctitis
Peripheral Vascular Disease (PVD) Venous Insufficiency
Chronic Obstructive Pulmonary Disease (COPD)
Stroke or Transient Ischemic Attack TIA (mini-stroke)
In the past 10 years have you been treated or diagnosed by a member of the medical profession as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) or tested positive for antibodies to Human Immunodeficiency Virus (HIV)?
In the past 5 years, did you seek medical advice about any symptom, illness or medical condition that has not yet been diagnosed by a medical professional?
In the past 5 years, have you had any medical condition(s) for which any medical or surgical procedure(s) (excluding cosmetic procedures) have been discussed, recommended, or planned with a medical professional, and are not yet completed?
In the past 5 years, have you been treated for or diagnosed by a physician or had surgery for any of the following conditions or procedures:
Angina and/or Chest Pain Atrial Fibrillation Bypass/Stents/Angioplasty
Cancer Congestive Heart Failure
Coronary Artery Disease (CAD) Diverticulitis
Drug or Alcohol Abuse Heart Disease or Disorder
Heart Attack Nephropathy
Sarcoidosis Implant of Pacemaker/Defibrillator
Heart Surgery (including valve replacement or correction)
Kidney Disease or Disorder (not including stones)
Liver Disease or Disorder (excluding Hepatitis A)
In the past 12 months, have you received medical treatment either as an inpatient or outpatient in a hospital, an emergency room, an observation room, or an ambulatory surgical center for a period of more than 24 hours for any reason other than normal childbirth?
LIMITATIONS AND EXCLUSIONS
The limitations and exclusions are standard in most states. State variations may apply.
We will not pay for loss contributed to, caused by or resulting from the insured:
- Being exposed to war or any act of war (declared or not)
- Participating in or contracting with the armed forces (including Coast Guard) of any country or international authority
- Committing or attempting to commit suicide, regardless of mental capacity
- Injuring or attempting to injure oneself intentionally, regardless of mental capacity
- Being in an accident more than 40 miles outside the territorial limits of the United States, Canada, Mexico, Puerto Rico, the Bahamas, Virgin Islands, Bermuda or Jamaica (except under the accidental death benefit)
- Riding in or driving any motor-driven vehicle in any race, stunt show or speed test or on any race course or speedway
- Operating, learning to operate, serving as a crew member on or jumping or falling from any aircraft, including those that are not motor-driven
- Hang-gliding, bungee jumping, parachuting, sail-gliding, parasailing, parakiting or mountaineering
- Being legally intoxicated or so intoxicated that mental or physical abilities are seriously impaired
- Being under the influence of any narcotic, unless such narcotic is taken under the direction of a physician
- Participating or attempting to participate in an illegal act
- Working at an illegal job
- Participating in any sporting event for pay or prize money
- having any disease, bodily or mental illness, or degenerative process.
- We also will not pay benefits for any related medical treatments or diagnostic procedures.
- Sickness Disability rider
- This rider does not cover any sickness or condition that was diagnosed by or for which an insured consulted a physician within 12 months prior to the effective date of the coverage
- Or for losses related to such sickness or condition that occur during the first 12 months after the effective date of coverage.
- The policy owner must be employed at least 18 hours per week at the time the sickness is diagnosed
- Be totally disabled
- Not be engaged in any employment or occupation for pay, benefit or profit
- And be cared for on a regular basis (at least monthly) by a physician.
- The same sickness occurring within six months of the end of the disability period will be treated as the same disability.
- A 14-day elimination period applies to each sickness.
- We will not pay for loss contributed to, caused by or resulting from an insured having a normal pregnancy
- Having a behavioral or psychological disorder, disease or syndrome without demonstrable organic origin
- And having alcoholism, drug abuse or chemical dependency.
- We will not pay for loss contributed to, caused by or resulting from an insured having a cosmetic/plastic surgery that is not for the diagnosis or treatment of a covered sickness based upon generally accepted medical practice and that is not considered medically necessary.
- The following procedures are not covered under any circumstances, even if performed for diagnosis or treatment of a covered sickness or considered medically necessary:
- abdominoplasty (tummy tuck)
- mammaplasty (breast enlargement)
- rhinoplasty (nose job)
- suction-assisted lipectomy (liposuction)
- Complications from any cosmetic/plastic surgery are not covered.
- We will not pay for loss contributed to, caused by, or resulting from an insured undergoing elective surgery that is not for the diagnosis or treatment of a covered sickness based upon generally accepted medical practice and that is not considered medically necessary.The following surgeries are not covered under any circumstances:
gastric bypass surgeries, even if performed for diagnosis or treatment of a covered sickness or medically necessary
voluntary abortion (except where the policy owner would be endangered if the fetus were carried to term or where medical complications have arisen from abortion)
and sex changes.
- Complications from any elective surgery are not covered.
- No postpartum benefits will be paid for any postpartum disability under the disability benefits.