Question

Are you familiar with the difference between Berkshire’s Enhanced and Basic residual contract language and how material the language difference could be at claim time?

Asked on March 6th 2018 by Chris L.
I’m a physician resident researching to purchase an individual specialty specific disability policy and have a question about Berkshire. Berkshire has two contracts. 1. Provider Choice Premier and 2. Provider Choice Select. Both contract versions have exactly the same contract language for Total Disability that includes their “enhanced medical occupation definition”. The big difference appears to be in the residual definitions. The “Premier” contract provides access to their “Enhanced” residual definition. The “Select” contract only offers their “Basic” residual definition. I’m considering their Provider Choice Select version with Basic residual. One of my primary goals at this stage of my career is to protect future access to (top shelf) coverage by inclusion of their (no cost) Benefit Purchase Rider on the Select contract or Future Increase Option Rider on the Premier contract. If I go with the select contract version I can get a lower benefit amount (to supplement my group plan that is also with Guardian) and still protect future access to Berkshire’s issue limits without any future medical underwriting. This will keep cost down until I finish training and allow me the peace of mind to not have to worry about any potential medical exclusions or being declined. I realize I would have less coverage if something bad happened during residency, but the finances are really tight now. If I go with their Premier contract then I would need to purchase more coverage and therefore higher cost to accomplish the same objective. I’m wondering if you’re familiar with the difference between Berkshire’s Enhanced and Basic residual contract language and how material the language difference could be at claim time? Your perspective would be immensely appreciated.

Answer

Answered on March 7th 2018 by Attorney Gregory Dell

Chris, thank you for asking this important question. Without actually seeing the exact policies that you are reviewing, I am not able to provide an accurate opinion as to the difference in the language. The disability companies constantly offer new products with different language and I really need to see the definitions in order to answer your question. As a general answer I always tell people to buy as much coverage as you can possibly afford. I have represented numerous residents that unfortunately had a disability claim when they never thought they would. The other thing is that you Group coverage will only continue as long as you continue to work for your employer or the organization you bought it from continues to renew the contract. A group organization does not need to renew the policy whereas a private policy is guaranteed to be renewed each year. I know you finances are tight now, but they hopefully won’t be in the near future and you will really appreciate the piece of mind of having the highest possible coverage you are eligible for.