A person must be Actively-at-Work on the date insurance is to take effect. If not, such insurance will take effect on the day the person resumes such work. Coverage will begin on the 1st of the month, following the receipt of your approved application and payment.
Total Disability means disability which: during the Waiting Period and first 24 months when Total Disability benefits are payable, prevents you from performing the substantial and material duties of your usual occupation; and after that, wholly and continuously prevents you from engaging in any and every occupation or employment for which you are reasonably suited by training, education or experience.
Waiting Period means the number of consecutive days at the beginning of a period of Total Disability which must elapse before benefit are payable.
Actively-at-Work means You performing all the regular duties of an occupation for wage or profit on a Full-time basis (at least 20 hours a week).
Basic Monthly Pay means: a) if self-employed, your net income after the deduction of business expenses for the calendar year immediately preceding the Total Disability, or b) if not self-employed, your average monthly salary or rate of pay (not counting commissions, bonuses, overtime pay or any other fringe benefit or extra compensation) for the 12 months immediately preceding the Total Disability.
Exclusions and Limitations
The plan does not cover: intentionally self-inflicted Injury, suicide or attempted suicide, while sane or insane; pregnancy or childbirth, except Complications of Pregnancy; any Sickness contracted or Injury sustained as the result of war or act of war, whether declared or not; any Injury sustained while riding on, boarding or alighting from, any aircraft: (a) as a pilot, crew member or student pilot; (b) operated by an military authority (land, sea or air), unless it is a Military Transport Aircraft used for transport and operated by the United States Military Air Mobility Command (AMC) or an AMC type service of a national government recognized by the United States; or (c) being used for tests, experimental purposes, stunt flying, racing or endurance tests; any Sickness contracted or Injury sustained as the result of commission or attempted commission of a felony by you; Sickness contracted or Injury sustained while on full-time active duty as a member of the Armed Forces (land, water, air) of any country or international authority. We will refund the pro rata portion of any premium paid for you while you are in the Armed Forces on full-time active duty for a period of two months or more. Written notice must be given to us within 12 months of the date you enter the Armed Forces.
Pre-Existing Condition Limitation: Any loss or period of Total Disability which: begins during the first 12 months of your insurance; and is a result of a Pre-Existing Condition; will not be covered.
Pre-Existing Condition means any Injury or Sickness, diagnosed or undiagnosed, for which medical care is received by you: within the 12-month period prior to your effective date of insurance, or prior to any increase in coverage.
Termination: Your coverage terminates on the earliest to occur of:
• the date the policy is cancelled; or
• the premium due date on or next following the date you:
• cease to be an active member of the policyholder; or
• attain the policy age limit shown in the schedule; or
• the date you cease to be Actively-at-Work, except due to disability covered by this policy; or
• the premium due date the required premium contribution is not made, subject to the grace period; or
• with respect to a Spouse or Domestic Partner, the premium due date on or next following the date that he or she no longer qualifies as an eligible Spouse or Domestic Partner. Termination will be without prejudice to any claim which began prior to the effective date of termination.
Successive Periods of Disability Limitation: Periods of Disability:
• due to the same or related medical causes; and
• separated by less than 6 months during which You are Actively-at-Work;
• will be considered one Period of Disability. Periods of Disability separated by at least 6 months during which You are Actively-at-Work will be considered separate Periods of Disability.
Concurrent Disabilities: Benefits during any Period of Disability as the result of: a) more than one Sickness; or b) more than one Injury; or c) both Sickness and Injury; will be considered the same as if the Disability resulted from only one cause.
NY: This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York Department of Financial Services.
This website explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this website and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder.
This program may vary and may not be available to residents of all states.
Acceptance into this plan is subject to medical evidence of insurability as determined by The Hartford.1
Depending on your age, the amount of coverage you request, and your answers on the application, a medical examination, medical test(s), or other evidence of good health may be required. Any exams/tests requested by the company will be conducted at your convenience and at no expense to you.
A.G.I.A, Inc., is the Plan Administrator who administers the insurance plan on behalf of Hartford Life and Accident Insurance Company. A.G.I.A, Inc., is also the Insurance Broker who is compensated for the placement of insurance.
1The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.
NOTICE OF INSURANCE INFORMATION PRACTICES
To properly underwrite and administer your application for insurance coverage, we must collect certain information concerning your insurability. You are our most important source of information, but we may also contact other sources such as medical professionals and institutions, employers and other insurance companies. While all information regarding your insurability will be treated as confidential, in some situations, and in compliance with applicable law, we may disclose necessary items of information to third parties without your specific authorization.
INVESTIGATIVE CONSUMER REPORTS NOT APPLICABLE TO RESIDENTS OF NEW YORK
As part of our procedure for processing your application, an investigative consumer report may be prepared by an outside insurance reporting organization. Personal information may be collected from others regarding your general reputation and lifestyle. If an interview is conducted with someone other than you, we will inform you of your right to be interviewed in connection with the preparation of the investigative consumer report. You have the right to send a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.
PERSONAL HISTORY INTERVIEW
To provide you, our client, with the best possible service, we may also conduct what we call a personal history interview. This is a phone call placed from our underwriting office. Its purpose is to make sure that the application information is complete. Our interviewers are trained to conduct their calls in a friendly, professional manner. The nature of the information discussed is always treated as personal and confidential and will only be used to assess your eligibility for insurance.
MEDICAL INFORMATION BUREAU (MIB) PRE-NOTICE
Information regarding your insurability will be treated as confidential. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may, however, make a brief report thereon to the MIB, Inc., formerly known as Medical Information Bureau, 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 member company for life or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request, will supply such company, with the information about you in its file. Upon receipt of a request from you, MIB will arrange disclosure of any information in your file. Please contact MIB at (866) 692-6901 (TTY (866) 346-3642). If you question the accuracy of the information in MIB's file, you may contact MIB and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of MIB's information office is 50 Braintree Hill Park, Suite 400, Braintree, Massachusetts 02184-8734. Hartford Life Insurance Company, Hartford Life and Accident Insurance Company, or their reinsurers, may also release information from their files to other insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Information for consumers about MIB may be obtained on its website at www.mib.com.
ACCESS, CORRECTION AND DISCLOSURE
You can obtain access to personal information about you contained in our policy files by sending us a written request. You may also request any necessary corrections, amendments or deletion of any information in our files which you believe to be inaccurate or irrelevant. Hartford Life Insurance Company or Hartford Life and Accident Insurance Company or its reinsurer(s) may release information in their files to other life insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted. Also, please be advised that personal and confidential information collected by us may, in certain circumstances, be disclosed to third parties without authorization. A notice providing further description of the circumstances under which information about you may be disclosed and the types of persons and organizations to whom it may be disclosed will be sent to you upon your written request. If you desire further information or access to your personal information, please send your written request to: Hartford Life Insurance Company or Hartford Life and Accident Insurance Company, 200 Hopmeadow St., Simsbury, CT 06089.
AMTA Optional Insurance Program
Hartford Life and Accident Insurance Company
One Hartford Plaza, Hartford, CT 06155
Policy # AGP-5667 Form # SRP-1311 A (HLA)(5667)
A.G.I.A., Inc., is licensed/authorized to transact business in all 50 United States, and the District of Columbia. Their state of domicile is California. John Wigle California Insurance license number is 0482924. John Wigle Arkansas Insurance license number is 46424.
AMTA Group Insurance Program Administered by:
PO BOX 26860, Phoenix, AZ 85068
Questions? Call toll-free 1-866-803-6773
Download printable application for California residents
Download printable application for New York residents