Sample Individual Disability Insurance Policies
Read the actual contracts behind the coverage. Each file below is a carrier’s specimen, labeled with its form number, for the carriers Set for Life Insurance works with.
What Does a Disability Insurance Policy Look Like?
A sample disability insurance policy, also called a specimen, is the contract wording a carrier publishes so a buyer can read the terms before applying. The files below are specimens of individual disability insurance (IDI) policies, the kind you own and keep when you change jobs. A group plan through an employer is a different product and is not shown here.
Set for Life Insurance is an independent brokerage with offices in Greenwood Village, Colorado and New York, New York. Each file opens as a PDF. Read the disclaimer at the bottom of this page before relying on any of them.
How to Read an IDI Sample Policy
A specimen shows the language a carrier uses. What you would be issued depends on your state, your underwriting and the options you choose, so treat each file as a reading copy, not as your contract. Several of these files say so on their first page.
When you open one, these are the parts worth reading first:
- The specifications or schedule page: where the monthly benefit, benefit period and elimination period appear.
- Definitions: how the contract defines total disability, and whether it applies an own occupation or any occupation test.
- Residual or partial benefit: what is paid when you return to work part time.
- Renewability: whether the coverage is non-cancellable and guaranteed renewable, and to what age.
- Exclusions and limitations: the wording on pre-existing conditions, war, self-inflicted injury and similar items.
- Riders and endorsements: optional provisions attached to the base contract.
For plain-language explanations of these provisions, see policy provisions that decide a disability claim.
Disability Insurance Specimen Policy PDFs
| IDI Insurance Carrier | Specimen IDI Policy | IDI Form | Disability Insurance Policy PDF |
|---|---|---|---|
| Guardian | Contract underwritten by Berkshire Life Insurance Company of America | ICC16 18ID | Guardian, form ICC16 18ID (PDF) |
| Principal | Annotated Income Protector contract | ICC22-800-IDI | Principal, form ICC22-800-IDI (PDF) |
| MassMutual | Radius Choice | ICC15-XLIS-RC | MassMutual, form ICC15-XLIS-RC (PDF) |
| The Standard | Platinum Advantage, annotated. Marked for use only in CT, DE, DC, FL, MT, ND and SD | B180 | The Standard, form B180 (PDF) |
| Ameritas | Disability income | 4501NC | Ameritas, form 4501NC (PDF) |
| Assurity | Disability income, accident and sickness | ICC24 I H2401 | Assurity, form ICC24 I H2401 (PDF) |
| Illinois Mutual | Disability income | DI105 | Illinois Mutual, form DI105 (PDF) |
| Lloyd’s of London, through Petersen International Underwriters | Personal disability, issued as a certificate | PDI111521 | Lloyd’s, form PDI111521 (PDF) |
Medical residents and fellows: the Guardian guaranteed standard issue program uses the same Guardian form shown above. See guaranteed standard issue disability insurance for residents.
Add-On Provisions in a Specimen IDI Policy
| IDI Insurance Carrier | Specimen IDI Policy | IDI Form | Disability Insurance Policy PDF |
|---|---|---|---|
| Principal | DI Retirement Security, which attaches to a Principal personal income contract and is not stand-alone | ICC22-800-DIRSE | Principal, form ICC22-800-DIRSE (PDF) |
Several of the contracts above also include the optional add-ons available with them.
Sample Business Overhead Expense Policy Files
This coverage pays a business owner’s covered operating expenses during a disability. The files below show the contract wording. For how it works and who it fits, see business overhead expense insurance.
| IDI Insurance Carrier | Specimen IDI Policy | IDI Form | Disability Insurance Policy PDF |
|---|---|---|---|
| Guardian | Contract underwritten by Berkshire Life Insurance Company of America | ICC18 18OE | Guardian, form ICC18 18OE (PDF) |
| Principal | Disability business overhead | ICC25 HH 801 OE | Principal, form ICC25 HH 801 OE (PDF) |
| MassMutual | Generic copy with no state-specific language | BOE99 | MassMutual, form BOE99 (PDF) |
| Ameritas | Form 4503NCBOE CA is the California-only version | 4503NCBOE | Ameritas, form 4503NCBOE (PDF) |
Sample Business Loan Protection Policy Files
Some carriers sell business loan coverage as a stand-alone contract and others as a rider. The two files below are stand-alone documents. For how it works, see business loan protection disability insurance.
| IDI Insurance Carrier | Specimen IDI Policy | IDI Form | Disability Insurance Policy PDF |
|---|---|---|---|
| Principal | Disability business loan expense | ICC24 HH 802 BLE | Principal, form ICC24 HH 802 BLE (PDF) |
| Lloyd’s of London, through Petersen International Underwriters | Loan indemnification, issued as a certificate | Loan020126 | Lloyd’s and Petersen, form Loan020126 (PDF) |
Quote the Coverage Behind These Sample Disability Insurance Policies
Personal Income Protection
An individual disability policy replaces a share of earned income when illness or injury stops work, and it stays with the owner when jobs change. Compare carrier quotes side by side.
Business Overhead Expense
This coverage reimburses a business owner’s fixed operating costs, such as rent, utilities and staff payroll, while the owner is disabled. Compare carrier quotes side by side.
Business Loan Protection
This coverage pays a business loan’s monthly installments while the owner is disabled, so the loan stays current. Compare carrier quotes side by side.
Sample Disability Policy FAQ
Important Disclaimer
For educational purposes only. This page is provided for educational purposes only.
These documents may not be current. Carriers revise their policy forms, riders and endorsements, and withdraw them, and the files above may not reflect the most recent version or the version available in your state. Confirm the current form, terms and availability with the carrier or a licensed agent before relying on anything in a specimen.
A specimen is not your policy. Each file is a sample or specimen provided for educational and informational purposes only. It contains placeholder values, may omit or differ from state-specific provisions, and is not a filed or issued contract. The coverage, terms, exclusions, limitations, riders and premiums in any policy actually issued depend on the carrier’s underwriting decision, your state, your answers on the application and the options selected. The issued policy controls, not the specimen.
Not legal, insurance, tax or financial advice. This page and the documents on it are provided for general information. Nothing here is legal advice, insurance advice, tax advice or financial advice, and nothing here is a recommendation to buy, keep or replace any coverage. Review the terms with a licensed insurance professional and, where needed, an attorney or tax advisor.
No offer, no guarantee. Nothing on this page is an offer of coverage or a guarantee that any carrier will issue a policy, that any product is available in your state or to your occupation, or that any benefit will be paid. Availability depends on carrier underwriting and eligibility rules.
Carrier documents. Each specimen is a document of the issuing carrier and is shown for reference. Form numbers, product names and company names belong to their owners. Set for Life Insurance does not write or alter these documents, and it does not guarantee that a file is complete, accurate or current.
Individual policies only. The policies shown are individual disability insurance policies (IDI policies), riders and business disability insurance policies. They do not describe group disability coverage offered through an employer, which has different terms.
Reading a sample shows the language. Seeing how carriers price and structure the same coverage takes a side by side quote.