Key Takeaways:
- What is a Future Purchase Option in disability insurance?
Future Purchase Options allow physicians to increase disability insurance coverage later as income grows without having to re-qualify medically. - What is a Future Increase Option or FIO rider?
An FIO allows a physician to purchase additional disability insurance in the future using financial documentation without new medical underwriting. - What is a Benefit Increase Rider or BIR?
A BIR also allows coverage to increase without medical underwriting, but increases are typically reviewed every three years depending on the contract. - What is the main difference between an FIO and BIR?
FIO opportunities are typically available annually around the policy anniversary, while a BIR commonly operates on a three-year schedule with certain exceptions. - Why are future increase options important for physicians?
They help protect future insurability by allowing physicians to increase benefits as income grows without having their health reevaluated.
What is the difference between a Future Increase Option (FIO) and a Benefit Increase Rider (BIR) in physician disability insurance?
Both are types of Future Purchase Options designed to let physicians increase disability insurance coverage as their income grows without going through medical underwriting again.
However, FIO and BIR riders work differently, making it important for residents, fellows, and early-career attending physicians to understand how each option can affect their future coverage.
What Is a Future Increase Option in Disability Insurance?
A Future Increase Option (FIO) rider allows physicians to purchase additional disability insurance in the future based on financial eligibility.
If income increases enough to create a coverage gap, the physician can provide financial documentation and potentially increase the monthly benefit without a new medical exam, labs, or medical underwriting review.
FIO requests are typically made around the policy anniversary and are generally limited to one increase request per year, although exceptions may apply.
Why Is an FIO Important for Physician Disability Insurance?
The primary benefit of an FIO rider is protecting future insurability.
Physicians often purchase disability insurance during residency or fellowship when their income is substantially lower than their future attending income.
An FIO provides a way for disability insurance coverage to grow alongside income without requiring the physician to re-qualify medically.
Certain career events may also create opportunities for an earlier increase, including a substantial income increase, graduating from residency or fellowship, or losing employer group disability insurance.
What Is a Benefit Increase Rider?
A Benefit Increase Rider (BIR) works toward the same goal as an FIO but is structured differently.
Depending on the contract, physicians typically have an opportunity to increase disability insurance benefits every three years.
Financial documentation may be required, and increases are subject to current issue and participation limits.
There may also be specific minimum and maximum increase requirements necessary to keep the rider active.
A significant feature of the BIR is that it is commonly included at no additional cost on many disability insurance policies issued to physicians early in their careers.
Can You Lose a Benefit Increase Rider?
Potentially. Physicians generally need to check in during the required policy anniversary window and submit the necessary documentation.
Failing to complete this process can result in forfeiting the free increase feature.
This makes regular disability insurance policy reviews and anniversary reminders particularly important.
Why Do Many Physicians Choose a BIR?
The episode explains that many residents, fellows, and early attendings currently use a Benefit Increase Rider rather than purchasing an FIO.
One reason is cost: the BIR may already be included in the physician disability insurance policy at no additional charge.
Employer disability insurance is another consideration.
Hospital and health system group disability benefits can limit how much additional private disability insurance a physician qualifies to purchase.
Because of these participation limits, some early-career physicians may not immediately qualify for large private coverage increases.
How Do Physicians Decide Between an FIO and BIR?
Choosing between an FIO vs. BIR depends on factors such as career stage, current income, employer disability insurance, anticipated income growth, and long-term financial planning.
Physicians who do not expect income to increase rapidly and are not production-based may find the Benefit Increase Rider sufficient.
Physicians in high-production specialties or private practice settings may want to consider an FIO because of the potential for faster income growth.
From Scott & Amber’s Desk
Future Purchase Options are an important component of physician disability insurance because a physician’s income can change substantially throughout a career.
Both the Future Increase Option (FIO) and Benefit Increase Rider (BIR) can allow disability insurance coverage to grow without new medical underwriting.
Understanding the differences between FIO and BIR can help residents, fellows, and attending physicians build disability insurance coverage that evolves alongside their income and career.
Every article in the MD Disability Quotes Knowledge Center is written with one purpose: to help physicians understand insurance contracts before they ever need to rely on them.
To take the next step and build a strategy that supports your career and financial future, download the FREE Medical Professionals Blueprint here.
About MD Disability Quotes
MD Disability Quotes is a nationwide disability insurance advisory firm specializing in income protection for physicians, dentists, business owners, and other high-income professionals.
Founded by Scott Nelson-Archer and Amber Stitt, the firm brings more than 45 years of combined experience helping clients evaluate disability insurance contracts, navigate underwriting, and design income protection strategies tailored to specialized careers.
Scott and Amber are the longest-tenured disability insurance experts featured by White Coat Investor. Their education-first approach has helped thousands of physicians better understand disability insurance throughout medical school, residency, fellowship, and practice.
Whether you’re reviewing an existing policy or exploring coverage for the first time, MD Disability Quotes is committed to helping you make informed decisions that protect your ability to earn an income.
If you would like to schedule a disability insurance strategy session, click here.
If you would like to request physician disability insurance quotes, click here.
You can email us: info@mddisabilityquotes.com
Call 713-966-3932 (9 AM-5 PM Central)
Text 281-770-8080 at your convenience.
Episode transcript
Published 25 May 2026. Transcript generated automatically from the episode audio; it may contain errors.
Read the full transcript (1,262 words)
Amber Stitt [0:00]:
Welcome to The Responsible Resident. I'm Amber Stitt. This podcast takes a common sense approach to financial decisions for physicians, breaking down complex topics into something clear, practical, and usable. Because you shouldn't have to have a finance degree to build financial freedom. Today's topic is an important one for residents, fellows, and early attendings reviewing disability insurance policies. Future purchase options. FPOs are another way to refer to these. This is the parent name of this type of feature. Specifically, we're going to break down the difference between two features physicians often see in disability insurance contracts. The future increase option, often called an FIO rider, and the benefit increase rider, sometimes called a BIR. Both features allow physicians to increase their coverage later without going through medical underwriting again. But they work differently, and understanding those differences can help you design a policy that grows with your career. Why future increase options exist was highlighted via the story in episode three about our surgeon client named Claire. Since physicians often purchase their first disability insurance policy during residency or early in their career, income may still be relatively modest compared to what it will be later. But over time, physician income tends to grow as you complete training, transition into attending roles, build production or partnership income, or grow your practice. Future purchase features exist so physicians can increase disability coverage as income grows without needing to re-qualify medically. That means if your health changes later in your career, you can still increase your coverage. What is a future increase option? FIO A Future Increase Option Rider allows a physician to purchase additional disability insurance in the future with financial documentation only. These options to increase are available one time a year around the policy anniversary. If there is a gap in coverage, you can prove the income change and then fill that gap. That means no new medical exam, no new labs, and no medical underwriting review. So if income has increased enough to justify more coverage, you may be able to increase the monthly benefit. How the FIO rider works. The future increase option typically allows physicians to increase their coverage over time, up to a predetermined maximum allowed by income rules. Some common characteristics include the ability to purchase up to several multiples of the original base benefit over time. Requests are typically made on policy anniversary dates. Increases are usually limited to one request per year, but there are some exceptions. Financial documentation is required to confirm the increased income. Certain career events may also trigger opportunities to increase coverage earlier, such as a substantial increase in income, graduating from residency or fellowship, or losing employer group disability coverage. The key benefit of the FIO rider is protecting your future insurability, meaning your health does not need to be reevaluated when increasing coverage later. I'd like to take a second to tell you about a free medical professionals blueprint that I created with you in mind. At some point in your career, you realize it's not just about making more money, it's about making decisions that actually support your life. That's exactly why I created the Pathways Perspective for Physicians. It's a simple, non-technical framework to help you think through your career, your money, your risk, and how everything connects as your life evolves. You shouldn't have to have a finance degree to build financial freedom. You don't need to have everything figured out. You just need a place to start. You can download the free Medical Professionals Blueprint at stittstrategies.com/Blueprint. What is a benefit increase rider? The benefit increase rider works toward the same goal, increasing coverage as income grows, but it is structured a bit differently. This rider allows physicians to increase coverage every three years, depending on the structure of the contract. There are also similar exceptions to the three-year rule, like with the FIO discussed earlier. How does the benefit increase rider work? The benefit increase rider typically includes features such as increasing benefits without medical underwriting, requiring financial documentation depending on the amount of increase requested, and allowing increases up to current issue and participation limits with a specific minimum and maximum allowed. To keep the rider active, physicians typically need to check in during the anniversary window by submitting documentation. Another important feature is that this rider is commonly included at no additional cost on many policies issued to physicians early in their careers. The trade-off here is that you have to submit documentation during your policy anniversary, or this free feature can be forfeited. Your advisor should be helping you with this into the future. They are compensated to help you with reminders and submitting paperwork when the time is right. What is most common now, present day? Today, many physicians, particularly residents, fellows, and early attendings, often choose the benefit increase rider rather than purchasing the future increase option rider. One reason is that the benefit increase rider is frequently included automatically on policies at no additional cost. Another factor relates to employer disability insurance. As we discussed in earlier episodes, many physicians working for hospitals or health systems receive disability insurance through their employer. That employer coverage can sometimes limit how much private disability insurance you are allowed to purchase, especially early in your career. Because of these participation limits, many physicians may not yet qualify for large increases in private coverage. For that reason, the free increase features built into many policies are often sufficient during the early years of practice. How do you decide between the FIO or the BIR for yourself personally? Both the future increase option and the benefit increase rider exist to solve the same problem. Your income will likely grow throughout your career. These riders allow your disability insurance coverage to grow with it, while protecting your ability to increase benefits without medical underwriting. The right structure often depends on factors such as career stage, current income, employer disability coverage, and long-term financial planning strategy. If you do not foresee income changing that rapidly as an attending, and if you are not production-based, the benefit increase rider could be a great fit for you. High production specialties and those that are in private practice settings may consider an FIO instead. Our team is always happy to help review which is the best for you. To wrap up this episode, future purchase options are one of the most important planning tools in disability insurance for physicians. Because your career and income are likely to change significantly over time, building flexibility into your coverage early can help protect your financial future. Understanding how these riders work allows physicians to design coverage that can evolve as their careers develop. In the next episode of The Responsible Resident, we'll cover another decision physicians often face when purchasing disability insurance. Should you buy a fixed premium or a graded premium? We'll break down how each pricing structure works and how physicians think about these options early in their careers. Stay tuned for more information-packed episodes to help you make the right decisions for your life and your financial future. If this episode helped you think a little more clearly about your next step, that's the goal. You don't need to have everything figured out, but you do need to take ownership and take a meaningful step forward today. Thanks for listening to The Responsible Resident. It is not legal, tax, or individualized financial advice, and coverage options will vary based on your personal situation.
