About Your Benefits:
You probably have insurance for your car or home, but what about the source of income that pays for it? You rely on your
paycheck for so many things, but what if you were suddenly unable to work due to an accident or illness? How will you put food
on the table, pay your mortgage or heat your home? Disability insurance can help replace lost income and make a difficult time a
little easier. Protect your most valuable asset, your paycheck-enroll today!
What Your Benefits Cover:
University of Massachusetts Medical School
University of Massachusetts Medical School Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
Short-Term Disability Benefit Summary
Group Number: 00549499
Benefit information illustrated within this material reflects the plan covered by Guardian as of 03/19/2018
Low Plan High Plan
.
Coverage amount
50% of salary to maximum
$1500/week
60% of salary to maximum
$1500/week
Maximum payment period: Maximum length of time you can
receive disability benefits.
11 weeks 11 weeks
Accident benefits begin: The length of time you must be disabled
before benefits begin.
Day 15 Day 15
Illness benefits begin: The length of time you must be disabled
before benefits begin.
Day 15 Day 15
Evidence of Insurability: A health statement requiring you to
answer a few medical history questions.
Health Statement not required Health Statement not required
Minimum work hours/week: Minimum number of hours you
must regularly work each week to be eligible for coverage.
20 20
Pre-existing conditions: A pre-existing condition includes any
condition/symptom for which you, in the specified time period prior
to coverage in this plan, consulted with a physician, received
treatment, or took prescribed drugs.
3 months look back; 12 months
after 2 week limitation
3 months look back; 12 months
after 2 week limitation
Premium waived if disabled: Premium will not need to be paid
when you are receiving benefits.
Yes Yes
UNDERSTANDING YOUR BENEFITS—DISABILITY (Some information may vary by state)
l Earnings definition: Your covered salary excludes bonuses and commissions.
1
Short-Term Disability Plan Bi-weekly Cost Illustration:
To determine the most appropriate level of coverage, you should consider your current basic monthly expenses. To help you assess
your needs, you can also go to Guardian Anytime and view a video:
https://www.guardiananytime.com/gafd/wps/portal/fdhome/employees/products-coverage/disability
University of Massachusetts Medical School Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
50% to $1,500 per week
Benefits Begin: 15 day accident, 15 day sickness
11 week benefit duration
Option 1
60% to $1,500 per week
Benefits Begin: 15 day accident, 15 day sickness
11 week benefit duration
Option 2
Policy amounts shown based on sample salary amounts only.
< 25 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+
Option 1 premium rate $0.330 $0.450 $0.620 $0.450 $0.320 $0.340 $0.380 $0.450 $0.530
Option 2 premium rate $0.340 $0.470 $0.650 $0.470 $0.330 $0.350 $0.400 $0.470 $0.550
Election Cost Per Age Bracket
< 25 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+
$20,000 Annual Salary
Option 1: $192 Weekly Benefit
Option 2: $231 Weekly Benefit
$2.92
$3.63
$3.99
$5.01
$5.49
$6.93
$3.99
$5.01
$2.84
$3.52
$3.01
$3.73
$3.37
$4.27
$3.99
$5.01
$4.70
$5.86
$30,000 Annual Salary
Option 1: $288 Weekly Benefit
Option 2: $346 Weekly Benefit
$4.39
$5.43
$5.98
$7.51
$8.24
$10.38
$5.98
$7.51
$4.25
$5.27
$4.52
$5.59
$5.05
$6.39
$5.98
$7.51
$7.05
$8.78
$40,000 Annual Salary
Option 1: $385 Weekly Benefit
Option 2: $462 Weekly Benefit
$5.86
$7.25
$8.00
$10.02
$11.02
$13.86
$8.00
$10.02
$5.69
$7.04
$6.04
$7.46
$6.75
$8.53
$8.00
$10.02
$9.42
$11.73
$50,000 Annual Salary
Option 1: $481 Weekly Benefit
Option 2: $577 Weekly Benefit
$7.33
$9.05
$9.99
$12.52
$13.76
$17.31
$9.99
$12.52
$7.10
$8.79
$7.55
$9.32
$8.44
$10.65
$9.99
$12.52
$11.77
$14.65
$60,000 Annual Salary
Option 1: $577 Weekly Benefit
Option 2: $692 Weekly Benefit
$8.79
$10.86
$11.98
$15.01
$16.51
$20.76
$11.98
$15.01
$8.52
$10.54
$9.05
$11.18
$10.12
$12.78
$11.98
$15.01
$14.11
$17.57
$70,000 Annual Salary
Option 1: $673 Weekly Benefit
Option 2: $808 Weekly Benefit
$10.25
$12.68
$13.98
$17.53
$19.26
$24.24
$13.98
$17.53
$9.94
$12.31
$10.56
$13.05
$11.80
$14.92
$13.98
$17.53
$16.46
$20.51
$80,000 Annual Salary
Option 1: $769 Weekly Benefit
Option 2: $923 Weekly Benefit
$11.71
$14.48
$15.97
$20.02
$22.01
$27.69
$15.97
$20.02
$11.36
$14.06
$12.07
$14.91
$13.49
$17.04
$15.97
$20.02
$18.81
$23.43
$90,000 Annual Salary
Option 1: $865 Weekly Benefit
Option 2: $1,038 Weekly Benefit
$13.18
$16.29
$17.97
$22.52
$24.75
$31.14
$17.97
$22.52
$12.78
$15.81
$13.57
$16.77
$15.17
$19.16
$17.97
$22.52
$21.16
$26.35
$100,000 Annual Salary
Option 1: $962 Weekly Benefit
Option 2: $1,154 Weekly Benefit
$14.65
$18.11
$19.98
$25.03
$27.53
$34.62
$19.98
$25.03
$14.21
$17.58
$15.10
$18.64
$16.87
$21.31
$19.98
$25.03
$23.53
$29.29
$110,000 Annual Salary
Option 1: $1,058 Weekly Benefit
Option 2: $1,269 Weekly Benefit
$16.11
$19.91
$21.97
$27.53
$30.28
$38.07
$21.97
$27.53
$15.63
$19.33
$16.60
$20.50
$18.56
$23.43
$21.97
$27.53
$25.88
$32.21
2
University of Massachusetts Medical School Benefit Summary
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004
< 25 25–29 30–34 35–39 40–44 45–49 50--54 55–59 60+
$120,000 Annual Salary
Option 1: $1,154 Weekly Benefit
Option 2: $1,385 Weekly Benefit
$17.58
$21.73
$23.97
$30.04
$33.02
$41.55
$23.97
$30.04
$17.04
$21.10
$18.11
$22.37
$20.24
$25.57
$23.97
$30.04
$28.23
$35.16
Manage Your Benefits: Need Assistance?
Go to www.GuardianAnytime.com to access secure information
about your Guardian benefits. Your on-line account will be set up
within 30 days after your plan effective date.
Call the Guardian Helpline (888) 600-1600, weekdays, 8:00
AM to 8:30 PM, EST. Refer to your member ID (social
security number) and your plan number: 00549499
A SUMMARY OF DISABILITY PLAN LIMITATIONS
AND EXCLUSIONS
n Evidence of Insurability is required on all late enrollees. This coverage will
not be effective until approved by a Guardian underwriter. This proposal is
hedged subject to satisfactory financial evaluation. Please refer to certificate
of coverage for full plan description.
n You must be working full-time on the effective date of your coverage;
otherwise, your coverage becomes effective after you have completed a
specific waiting period.
n Employees must be legally working in the United States in order to be
eligible for coverage. Underwriting must approve coverage for employees on
temporary assignment: (a) exceeding one year; or (b) in an area under travel
warning by the US Department of State. Subject to state specific variations.
n For Short-Term Disability coverage, benefits for a disability caused or
contributed to by a pre-existing condition are limited, unless the disability
starts after you have been insured under this plan for a specified period of
time. We do not pay short term disability benefits for any job-related or
on-the-job injury, or conditions for which Workers' Compensation benefits
are payable.
n We do not pay benefits for charges relating to a covered person: taking part
in any war or act of war (including service in the armed forces) committing a
felony or taking part in any riot or other civil disorder or intentionally
injuring themselves or attempting suicide while sane or insane. We do not
pay benefits for charges relating to legal intoxication, including but not
limited to the operation of a motor vehicle, and for the voluntary use of any
poison, chemical, prescription or non-prescription drug or controlled
substance unless it has been prescribed by a doctor and is used as
prescribed. We limit the duration of payments for long term disabilities
caused by mental or emotional conditions, or alcohol or drug abuse. We do
not pay benefits during any period in which a covered person is confined to
a correctional facility, an employee is not under the care of a doctor, an
employee is receiving treatment outside of the US or Canada, and the
employee’s loss of earnings is not solely due to disability.
n This policy provides disability income insurance only. It does not provide
"basic hospital", "basic medical", or "medical" insurance as defined by the
New York State Insurance Department.
n If this plan is transferred from another insurance carrier, the time an insured
is covered under that plan will count toward satisfying Guardian's
pre-existing condition limitation period. State variations may apply.
n When applicable, this coverage will integrate with NJ TDB, NY DBL, CA
SDI, RI TDI, Hawaii TDI and Puerto Rico DBA.
Contract # GP-1-STD-15-1.0 et al.
This document is a summary of the major features of the referenced insurance coverage. It is intended for illustrative purposes only and does not
constitute a contract. The insurance plan documents, including the policy and certificate, comprise the contract for coverage. The full plan description,
including the benefits and all terms, limitations and exclusions that apply will be contained in your insurance certificate. The plan documents are the final
arbiter of coverage. Coverage terms may vary by state and actual sold plan. The premium amounts reflected in this summary are an approximation; if
there is a discrepancy between this amount and the premium actually billed, the latter prevails.
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Thank you for choosing The Guardian Life Insurance Company of America (“Guardian”). This notice is
given to you at the time you apply for life or disability insurance to tell you about the kinds of information
we may obtain in connection with your application. Your personal information may be collected from a
person other than you. We will treat all personal information about you as confidential, except as
authorized by you, or as required by law. Such personal information as well as other personal or
privileged information subsequently collected by Guardian or our representatives may in certain
circumstances be disclosed to a third party without authorization.
You have a right of access and correction with respect to your personal information. If you wish a more
detailed explanation of our information practices, please send your written request to: The Privacy Office,
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004-4025.
MIB, Inc. Pre-Notice: Information regarding your insurability will be treated as confidential. Guardian, or
its reinsurers may, however, make a brief report thereon to MIB, Inc., a not-for-profit membership
organization of insurance companies, which operates an information exchange on behalf of its Members.
If you apply to another MIB, Inc. member company for life, health or disability insurance coverage, or a
claim for benefits is submitted to such a company, MIB, Inc., upon request, will supply such company with
the information about you in its file.
Upon receipt of a request from you, MIB, Inc. will arrange disclosure of any information it may have in
your file. Please contact MIB, Inc., at 866 692-6901 (TTY 866 346-3642). If you question the accuracy of
the information in your MIB, Inc. file, you may contact MIB, Inc., and seek a correction in accordance with
the procedures set forth in the federal Fair Credit Reporting Act. The address of MIB, Inc., information
office is 50 Braintree Hill Park, Suite 400, Braintree MA 02184-8734.
Guardian, or its reinsurers, may also release information in its file to other insurance companies to whom
you may apply for life, health, or disability insurance, or to whom a claim for benefits may be submitted.
Medical Records: We may request information from health care providers or others who have records of
your medical history, mental or physical condition, or treatment. Only qualified members of Guardian’s
staff will have access to your medical file to evaluate your eligibility for insurance or to service your claim
for benefits under a policy. Your authorization will govern our request for information and any later
disclosure of that information.
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