This is the verbatim wording of the Sun Life group disability policy issued to Clinicians Care Association, the contract that defines coverage for 1099 clinicians enrolled through participating MSOs, physician groups and staffing companies. We have annotated every term that decides a claim, in plain English. Click any highlighted term to read what it means and why it matters.
This guide is a reading aid, not the policy itself. The official Sun Life policy document governs all claims and benefits. Download the sample policy →
This is a non-ERISA plan. It is governed by the insurance laws of the state of Arizona and is regulated by the Arizona Department of Insurance and Financial Institutions. Any references to ERISA or Department of Labor regulations in the underlying Sun Life policy language do not apply to this plan.
Specific situations should be discussed with a benefits advisor or, at claim time, directly with Sun Life.
The policy uses a specific formula. The terms matter, because each one is the gate for a dollar amount.
To determine the benefit we will pay each month you are we will subtract all from the lesser of:
the Benefit Percentage you elected multiplied by your ; or the Maximum Benefit you elected.
The result is your Total Disability benefit.
Two terms in Section 2 do almost all the work in a claim decision. Together they hold this policy to a much higher standard than most group disability plans.
Regular Occupation means the general or sub-specialty in which you are performing for your Employer immediately prior to the first date your Period of Disability commences for which there is a specialty or sub-specialty recognized by the . If the sub-specialty in which you are performing is not recognized by the American Board of Medical Specialties, you will be considered performing in the general specialty category.
Material and Substantial Duties means the actual procedures which you are during the 12 consecutive months immediately prior to the first date your Period of Disability commences.
Full-time Basis means you are or have the capacity to perform the Material and Substantial Duties of your Regular Occupation for the prior to your Disability.
An honest read of the limits matters more than a flattering one. Physicians ask about this provision, given clinical burnout rates, and seeing it explained plainly is part of why this guide exists.
If a if you are under the Continuing Care of a specialist in psychiatric care. Benefits will be paid beyond 24 months if:
you are Confined in a Hospital or institution licensed to provide psychiatric Treatment; or you continue to be Disabled when discharged from a Hospital or institution licensed to provide psychiatric Treatment, then we will continue your benefits for up to 90 days.
Most disability claims involve reduced work, not a full stop. The policy is designed to make partial work worthwhile during recovery, but only if you understand how the math works.
To determine the benefit we will pay for the first 24 months while you are , add your Deductible Sources of Income and your to your Gross Benefit for a Total Disability.
If the calculation above is 100% or less than your Indexed Total Monthly Earnings, your benefit for a Partial Disability is the same as your benefit for a Total Disability.
If you continue to be Partially Disabled after receiving Partial Disability benefits for 24 months, your Partial Disability benefit will be recalculated based on the .
This policy is designed to cover the income you earn as a 1099 contractor at the MSO that sponsors your CCA membership. It is one layer in what is typically a three-layer income protection picture for a 1099 clinician. Understanding the interaction matters, because some other coverage stacks on top of this policy, and some reduces it.
means 1/12 of the amount reported as non-employee compensation on your 1099-NEC tax form from your Employer for the previous calendar year.
includes Social Security disability and retirement benefits, workers' compensation, disability benefits under another group plan of your Employer, salary continuation, and any income you receive from a 1099-NEC other than from your Employer, or from any W-2 or 1099-MISC, or income for work performed from another Employer.
includes income from 401(k), 403(b), IRA, profit sharing, pension plans for partners, vacation pay, holiday pay, and any amount you receive under any individual or association disability income policy.
Benefits are not paid indefinitely. The policy ties duration to your age when disability begins and to Social Security retirement age. For most clinicians under 60, this means benefits last to age 65 at minimum. For clinicians over 60, the duration shortens.
Your Maximum Benefit Duration is the period shown below or your Normal Retirement Age under the 1983 amendments to the Federal Social Security Act, whichever is longer.
: Less than age 63: To age 65, but not less than 48 Months. Age 63: 48 Months. Age 64: 36 Months. Age 65: 30 Months. Age 66: 27 Months. Age 67: 24 Months. Age 68: 21 Months. Age 69 and over: 18 Months.
means your Normal Retirement Age based on your year of birth, ranging from age 65 (for births before 1938) to age 67 (for births after 1959).
Benefits also end on the earliest of certain events. .
The single most common reason a first-year disability claim gets denied is a pre-existing condition exclusion. The terms are narrower than most clinicians assume, and the protections that kick in after 12 months are stronger than most clinicians realize. This section explains both.
means during the 3 months prior to your effective date of insurance or the effective date of an increase in your amount of insurance, you sought medical Treatment, consultation, advice, care or services, including diagnostic measures for the condition, or symptoms related to the condition, regardless of whether the condition was diagnosed or suspected at that time; or took prescribed drugs or medicines for the condition.
No benefit is payable to you under the Policy for any Period of Disability or other loss for which benefits are payable that is caused by, contributed to in any way or resulting from a Pre-existing Condition; .
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Benefits do not begin the day you become disabled. The policy includes a waiting period, called the Elimination Period, during which no benefits are paid. The policy also includes a trial work days provision that protects you if you try to return to work during the waiting period and cannot sustain it.
means the number of consecutive days of Disability, shown in the Benefit Highlights, which must be completed before we will pay you the benefit. No benefits will be paid to you for any portion of your Disability that occurs during your Elimination Period.
The Elimination Period is 90 days or the end of your Basic Short Term Disability Maximum Benefit Duration, whichever is later.
During your Elimination Period, a Disability that is caused by the same or related Accident or Sickness will be considered as continuous even if you cease to be Disabled and return to work for a period not to exceed the Elimination Period. We will not count these toward satisfaction of your Elimination Period.
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The monthly disability benefit is the core of the policy, but it is not all of what you receive. Several additional benefits are included automatically. Each is a separate provision in Section 5 of the policy.
The following Additional Benefits are included with every enrolled tier: , , , , and .
The policy lists specific causes of disability that are excluded from coverage. The mental health limitation is covered separately in Section C. This section covers the rest. Most are standard across group disability policies. None are unusual in scope.
No benefit is payable to you under the Policy for any Period of Disability or other loss for which benefits are payable that is caused by, contributed to in any way or resulting from:
; ; a Pre-existing Condition (with the 12-month exception explained in Section G); your active ; your .
Some limitations appear in group disability policies but not in this one. Other limitations do appear, and this section is honest about both. The pattern below explains each limitation, then says what this policy does. The goal is to help you understand how this policy compares to the ones you may have seen elsewhere, in either direction.
Six common limitations in group disability policies. Some are present in this policy; some are not. Click any term to see what it means and what this policy does: , , , , , and .
If you ever need to file a claim, the timeline and the steps are spelled out in the policy. The deadlines are real and they are short. This section walks through what happens, in order.
must be given to Sun Life no later than 30 days before the end of your Elimination Period.
must be given to Sun Life no later than 90 days after the end of your Elimination Period.
Sun Life will send you a after receipt of the claim, with possible extensions of 30 days each.
If your claim is denied, you have .
Download a sample of the Sun Life group disability policy to keep, print, or review with an advisor. No email required.
Download sample policyThe official Sun Life policy document governs all claims and benefits. Back to the 1099 disability insurance program, or read more in the Hollowtree Briefing Center.
Last updated May 26, 2026
