Under the definition of total disability provision, total disability means that because of sickness or injury, the insured is not able to perform the material and substantial duties of his or her occupation(s). The insured's occupation means the regular occupation(s) in which he or she is engaged at the time he or she becomes disabled. The insured will be totally disabled even if he or she is at work in some other capacity so long as he or she is not able to work in his or her occupation(s). If the insured's occupation is limited to a single medical specialty certified by the American Board of Medical Specialties or a single dental specialty recognized by the American Dental Association, the company will deem the specialty to be the insured's occupation. The insured is protected in his or her occupation(s) for the entire benefit period.

Under the medical care requirement provision, no benefits will be paid under this policy for any period during which the insured is not under the care of a physician. Such care must be appropriate, according to generally accepted medical standards, for the condition, which is causing the disability, and must be provided by a physician whose specialty is appropriate for the insured's sickness or injury. The company will waive the medical care requirement during any claim under this policy upon reasonable proof that the insured's sickness or injury no longer requires the regular care of a physician under prevailing medical standards.

The total disability benefit is payable, even if the insured is at work, if a sickness or injury results in a total and complete presumptive loss. Unexpired parts of the elimination period will be waived from the date of such loss, and benefits are payable as long as the loss continues to the end of the benefit period.

There are two residual disability riders available: a residual disability rider and a two year residual disability rider. Under both optional residual disability riders, the insured is residually disabled if he or she is at work, but because of sickness or injury, the insured is not able to earn at a rate of at least 80% of his or her prior income. (Under the base policy medical care requirement provision, the insured must be under a physician's care unless the sickness or injury no longer requires a physician's care under prevailing medical standards.)

Under both residual disability riders, there is no specific loss of time or duties requirement or prior period of total disability required to qualify for residual benefits. Even if the insured has recovered from the sickness or injury that caused residual disability, he or she will continue to be considered residually disabled so long as the loss of income is still at least 20% of his or her prior income and the loss is the result of such sickness or injury. A loss of prior income greater than 75% will be deemed 100%.

Residual benefits will be paid until the first of the following occurs: the insured becomes totally disabled; the income loss is less than 20% of prior income or, if lower, the residual benefit drops below $500 per month; the benefit period ends; or the insured becomes age 65 in any claim which began before age 60. For the two year residual disability rider, in addition to the above, the residual indemnity will stop when residual indemnity has been paid for a total of 24 months in any one claim.

For the first 6 months of residual disability benefits after the elimination period is satisfied, the benefit is guaranteed to be at least 50% of the maximum monthly benefit, or the actual percentage income loss, if greater. Thereafter, benefits are paid according to the actual percentage income loss, which is computed using the average current income for the preceding 6 months.

Even if the insured has recovered from the sickness or injury that caused residual disability, he or she will continue to be considered residually disabled so long as the loss of income is still at least 20% of his or her prior income and the loss is the result of such sickness or injury. If the loss of income is less than 20% of prior income, the residual indemnity will continue to be paid so long as such indemnity is at least $500.

The optional Automatic Increase Rider provides a 4% automatic increase in benefits for each 5 years, compounded annually, at attained age premiums, despite any changes in the insured's health, income, or occupation. Increases apply to any disability that starts after the effective date of the increase. This rider may be renewed prior to age 60, subject to published rules in effect at that time.

Days of disability need not be consecutive to satisfy the elimination period. If the elimination period is 1, 2 or 3 months, the accumulation period is the elimination period times two, plus 1 month. If the elimination period is 6, 12 or 24 months, the accumulation period is the elimination period plus 6 months. The elimination period will be waived if the insured becomes disabled within 5 years after the end of a prior period of disability which lasted more than 6 months and for which benefits were paid.

Recurrent periods of disability will be considered to be one continuous period of disability if they result from the same cause or causes and are not separated by a recovery of more than 12 months if the benefit period is to age 65 or longer and recurrence occurs before age 60; or 6 months in all other instances, including recurrence at or after age 60.

If the insured enrolls in an approved rehabilitation program while totally disabled, a benefit will be paid to meet some costs incurred that are not otherwise covered by another plan or program.

A disability, which results from transplant or cosmetic surgery, will be considered the result of sickness and will be covered.

Under the optional Future Increase Option rider, additional purchase options are exercisable on each anniversary through age 55. Until the insured is age 45, the insured may purchase all or part of the total increase option on any one option date. On or after age 45, the maximum purchase amount on any one option date is one-third of the total increase option. Options may be exercised while the insured is on claim, and benefits will be effective when the elimination period on the option policy has been satisfied.

Under the optional Cost of Living Adjustment rider, at the end of each 12 months in a continuous claim before age 65 while the insured is disabled, benefits will be adjusted, at a compounded rate, to reflect changes in the CPI-U. Each adjustment cannot be more than the company would have paid if the CPI-U had increased each year exactly by the maximum increase percent as chosen by the insured (3% or 6%). Prior to age 65, there is no total limit on the amount of adjusted indemnity received. When the insured recovers, any increase in effect under this rider will remain to age 65 as a permanent increase at no extra premium cost. At age 65, the insured may choose to continue the increased indemnity or the original indemnity selected. The cost of living adjustment rider applies to the residual disability and the social insurance substitute riders, if selected.

Premiums will be waived after 3 months of total disability (or residual disability, if the residual disability rider is selected) or the length of the elimination period, if shorter. This benefit will also apply if the insured has met the requirements of Waiver of Elimination Period, Recurrent Periods of Disability, or Presumptive Total Disability benefit. Premiums will continue to be waived while the insured is continuously disabled or within 3 months after the insured recovers. The premium mode will be changed to annual during the disability but may be changed back after the insured recovers.

Class 6

Available to the following occupations, which have the most favorable experience: actuaries; architects; attorneys; CPAs; engineers (degreed -office and administrative duties only); and business owners or corporate executives who meet the following requirements:

• is employed full time in a business which is financially sound, has been in existence for five years, and has prospects for a stable future;
• works at a business location other than his or her personal residence;
• the business has 10+ full-time employees other than the owner, with at least five employees qualifying for occupation Class 5 or Class 4;
• daily duties are office, managerial, administrative, or technical; little or no sales or travel; no physical or manual duties; and
• salary of $75,000+ for the past two years.

Class 5

Class 5 includes those professional and executive occupations that qualify for preferential classification and underwriting limits because of stability of employment and income; the demand for their service, educational, training and experience qualifications; whose duties are primarily office only and who would not be totally disabled if unable to travel.

Class 4, 4P*

Those who do not qualify for Class 5 but are engaged in office, clerical, executive, professional or semi-professional occupations requiring a high degree of stability and responsibility. Duties generally limited to office, sales and travel with no manual duties involved.
* 4P is not eligible for move-up option. 4P is limited to medical and dental professionals.

Class 3

Includes occupations that require more physical activity than Class 4, plus certain occupations, which may not be hazardous, but where the claim experience has not been the same as Class 4. Examples are: automobile dealers and contractors.

Class 2

Includes occupations where light manual duties or skilled work are involved, including small businesses, where the proprietor has specialized skills. These are uninsurable except in employer-sponsored situations. Business owners who have owned the business for at least five years and whose income is at least $25,000. Included in this class would be watchmakers, upholsterers, etc.

Class 1

Includes occupations requiring heavy manual duties or where there are real accident or environmental hazards. These are uninsurable except in employer- sponsored situations. Examples include mechanics and plasterers.

Class U

Uninsurable. This class includes divers, structural iron and steel erection workers, steeplejacks, and persons handling explosives.