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Supplemental Disability policy pre-existing condition
Jan 31, 2006

I have been HIV+ since 2000 and have been taking medications continuously since 2001. I am covered under my company's long term disability policy. The company is now offering a "supplemental individual income protection" plan from UnumProvident that would pay an additional 15% of monthly salary tax free, on top of the traditional 60% of monthly salary provided by the traditional LTD plan, should I become disabled. The initial enrollment is guaranteed standard issue.

Two questions:

1. I have not previously heard about this type of IIP policy. Are they a worthwhile investment (it would cost me $25 a month)?

2. Would I be covered under the pre-existing condition clause? The clause states:

"We will not pay benefits for a disability caused by a PEC that was not disclosed....PEC means a sickness or physical condition for which within the two-year period prior to the effective date...advice or treatment was recommended by or received from a Physician. PEC medical conditions play a limited role in applying for individual income protection insurance under a GSI offer. Our applications require that an applicant has been continuously at work on a full-time basis performing all the duties of their occupation without limitations due to injury or sickness for the period of time commencing 180 days prior to the date of application."

I satisfy the full-time for 180 days provision.

Thank you for the advice.

Response from Ms. Franzoi

To determine whether or not buying the additional coverage is a worthwhile investment or not, you should consider several things: (a) what is the cost per dollar of benefit; (b) how does that cost compare to your basic cost; (c) does it provide for benefits payable to age 65 based on disability from your own occupation or does it have a 2 year limit on your own occupation and then requires disability based on any occupation for which you are reasonably qualified thereafter; (d) is it portable if you were to leave your employer; (e) what offsets are there to your benefit such as offsets for Social Security disability, etc. After evaluating all of these factors, hopefully you can determine the value of this to you. Since you are HIV+, you should factor into your decision the fact that you would not be able to purchase a supplemental policy outside of a group arrangement.

With respect to your question on the pre-existing condition clause (PEC), that is more difficult to answer. Since the coverage is guaranteed issue, you shouldn't have to answer any medical questionnaire. Yet, based on the PEC definition you quoted, it sounds like you have to disclose that you have received treatment or seen a doctor for HIV-related health care, even if it is only bloodwork to check your viral load and T-cell count, in order not to have a PEC exclusion. Based on the quote above, disclosing your status would be the way around the PEC clause.

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