Today’s guest post comes from Larry Keller CFP®, CLU®, ChFC®, RHU®, LUTCF, a well-known disability insurance expert and long-time advocate for physicians’ financial literacy. Larry breaks down one of the most misunderstood options for doctors in training, the Guaranteed Standard Issue (GSI) disability policy.

If you’ve ever wondered what GSI is or whether GSI coverage is only for residents or fellows with medical issues, this one’s for you.

The Misconception

A common misconception among medical trainees is that Guaranteed Standard Issue (GSI) disability insurance exists mainly for residents or fellows with health conditions who wouldn’t qualify for traditional, medically underwritten coverage.

That’s simply not true.

These programs exist because insurance companies recognize the value, earning potential, and demanding schedules of medical professionals in training. They also aim to reward the agents or brokers who generate consistent, high-quality business at specific institutions (See also: How Insurance Brokers Get Paid & Why Doctors Need to Care).

Since GSI plans are exclusive to certain brokers, residents may sometimes be steered away from them by “non-endorsed” agents, only to apply through traditional underwriting and later find themselves ineligible for the GSI program altogether.

What Is a Guaranteed Standard Issue (GSI) Plan?

A Guaranteed Standard Issue (GSI) plan is an individual disability insurance policy that does not require medical underwriting.

That means:

• No medical questions
• No prescription drug checks
• No review of medical records

As a result, there are no ratings, no exclusion riders, and no modifications to your policy.

When structured similarly, the cost of a GSI policy is often the same or less than a fully underwritten policy. This makes it a smart choice, even for healthy residents and fellows. Once you apply for medically underwritten coverage and are declined, postponed, modified, or withdraw your application, you usually lose access to any special GSI offer.

Why Healthy Residents and Fellows Still Choose GSI

Leading insurers like Berkshire (Guardian) developed GSI programs to help physicians in training lock in high-quality coverage early, at a time when they have limited time, tighter budgets, and less awareness of how unpredictable underwriting can be.

Here’s why even healthy trainees often opt for GSI:

1. $15,000 Maximum Monthly Benefit
   Covers an annual income of roughly $350,000, often sufficient for many specialties.
   
2. Convenience and Speed
   Traditional underwriting involves detailed health questions, prescription checks, and medical record reviews, often taking weeks or months. GSI policies are usually approved within 24–48 hours.
   
3. Mental Health and Substance Use Disorder Coverage
   In certain specialties (e.g., Emergency Medicine, Anesthesiology, Pain Management), underwritten policies automatically include a 24-month limitation for mental/nervous or substance use disorder claims. GSI policies carry the same limitation, meaning these physicians receive equivalent protection without medical underwriting.
   
4. No Pre-Existing Condition Limitation
   Guardian’s GSI policies don’t require medical questions. Since no medical information is requested, claims can’t be denied for misrepresented or undisclosed medical history.
   
5. Permanent Premium Discounts
   Residents and fellows lock in lifetime savings, not just short-term convenience.

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The Truth About Underwriting

There’s a big difference between medical management and probability underwriting. What seems minor to a physician, like an old injury, mild anxiety, or a one-time medication, can derail eligibility in the eyes of an insurance underwriter.

According to the Milliman 2024 Annual Survey of the U.S. Individual Disability Income Insurance Market, 53% of disability insurance policies are either modified (34%) or declined (19%).

That’s why GSI programs matter: they balance both “good” and “bad” risks by offering group-based access. If GSI plans become overloaded with only uninsurable applicants, insurers will discontinue them, hurting future trainees. Broad participation helps keep these valuable options available.

Unfortunately, some agents discourage GSI participation, often because they lack access or would earn lower commissions. This can lead residents to worse outcomes after adverse underwriting decisions.

Combining GSI and Fully Underwritten Coverage

For residents who apply for a medically underwritten policy and receive modifications, a combination approach can work well using both GSI and fully underwritten coverage.

This is available through Guardian and Standard, but not Ameritas, unless the GSI policy is purchased first.

Example using Berkshire (Guardian):

1. GSI Plan

• $4,500/month base benefit
• 90-day elimination period, payable to age 65
• Includes Enhanced Partial Disability Benefit, 3% Compound COLA Rider, and $10,500 Future Increase Option (FIO) Rider
• Total potential benefit: $15,000/month ($4,500 base + $10,500 FIO)

2. Fully Underwritten Plan

• $500/month base benefit (Guardian minimum)
• 90-day elimination period, payable to age 65
• Includes Enhanced Partial Disability Benefit, 3% Compound COLA, and an additional FIO or Benefit Purchase Rider (BPR)
• Total potential coverage: $20,000–$30,000/month depending on rider structure

The GSI plan includes no exclusion riders, while the underwritten policy remains subject to Guardian’s standard underwriting guidelines.

Final Thoughts from Larry

Guaranteed Standard Issue (GSI) disability insurance isn’t a backup plan or a “lesser” version of coverage. It’s a high-quality, convenient, and often equally priced alternative that helps residents and fellows secure critical protection early in their careers.

If a GSI plan is available through your institution, it should almost always be your first choice regardless of the insurer offering it.

My Thoughts

First, big thank you to Larry for breaking this down so clearly. I see far too many residents delay applying for disability coverage only to face exclusions or higher premiums later.

My training program, NYU, now offers a GSI that would have been a huge advantage for me if available at the time I finished training. If your institution offers a GSI program, it’s worth a serious look, no matter how healthy you are today. Interested in learning more? Fill out the form here!

These resources can also help you navigate the insurance terrain for doctors:

• When Should Doctors Get Life & Disability Insurance?
• Why Disability Insurance Is a Must-Have for Doctors—Even If You Never Use It
• A Disability Insurance Do-Over?: Case Studies and A Word of Caution
• Cover Your Assets: Umbrella Insurance for Physicians

What do you think? Do you have GSI? Was it an option for you? Why did you choose to pursue it or not? Do you see any advantages or disadvantages? Let me know in the comments below!