1 IBM Short-Term Disability Income Plan A Self-Insured Voluntary Disability Plan Part 2 For Non-Regular California Employees of International Business Machines Corporation and all Designated Subsidiaries Plan Restatement for Disabilities Commencing on or after January 1, 2010 I. ELIGIBILITY AND EFFECTIVE DATE OF COVERAGE A. Eligibility All Non-Regular California Employees, in Active Employment, as designated by the Employer, are eligible for coverage under this Plan. B. Effective Date of Coverage Eligible individuals employed by the Employer prior to the effective date of the Plan shall be eligible for coverage on the effective date of the Plan Individuals employed by the Employer on or after the effective date of the Plan, who have signed enrollment cards on or prior to the date they become eligible, will be covered under the Plan as of the first day of the calendar quarter next following the date they complete three (3) months of Active Employment. Employees who sign enrollment cards within 31 days from the date they became eligible will be covered on the first day of the calendar quarter next following completion of three months of Active Employment after the date they enroll. Any Employee who initially accepts coverage under this Plan may subsequently elect to withdraw from the Plan within ten (10) days following the effective date of any amendment to the Plan or, for any other reason, on the first (1st) day of the first (1st) Calendar Quarter following the date of such election, by notifying the Employer in writing. Any Employee who has filed with the Employer a written rejection of the Plan and who at some later date elects to be again included in the Plan will be treated as a new Employee with the date of his or her election to be covered considered to be his or her date of employment. II. DISABILITY BENEFITS Any Employee covered under the Plan who becomes disabled, on or after the effective date of this Plan restatement show above, by any physical or mental illness or injury including pregnancy, childbirth or related medical conditions, so as to prevent him or her from performing his or her regular or customary work, will be paid benefits for the period of such disability as follows, subject to the provisions of the "Limitations and Exclusions" listed in Section IV. For any Employee who participates in a vocational rehabilitation plan in accordance with the California Labor Code, regular or customary work will mean, upon completion of such rehabilitation plan, only that employment for which the Employee has been retrained. IBM California Non-Regular Voluntary Plan 1
2 A. Amount of Benefits The amount of weekly benefit for which an Employee is covered under this Plan shall be equal to 70% of the Employee's Regular Salary to the maximum of the California Workers Compensation temporary disability indemnity weekly benefit amount in effect at the time of the commencement of the Employee s disability, subject to a Gross Minimum Weekly Benefit of Fifty Dollars ($50.00). B. Benefits for Less Than One (1) Week For each day of any period of disability for which benefits are paid and which is less than a full week, the amount of benefit payable shall be one-seventh (1/7th) of the amount of the weekly benefit. C. Benefit Waiting Period Benefits will begin on the earliest of: 1. the eighth (8th) consecutive day of disability, provided the employee has been examined by or is under the care of a Physician during some portion of that eight-day period of disability; 2. the first (1st) full day of Hospital Confinement; or 3. the first (1st) day of treatment in a Surgical Clinic or Surgical Unit of a hospital, or ambulatory surgical centers" approved by the Federal Medicare program) provided the employee is disabled for a period of at least eight days as a result of the condition for which treatment was rendered. In the event that an employee s disability extends beyond fourteen (14) days during any one Disability Benefit Period, the waiting period, if any, will be waived. D. Maximum Total Benefit The maximum benefit payable for any one Disability Benefit Period shall be fifty-two (52) times the applicable amount of weekly benefits as determined in paragraph II. A., above. E. Reductions Because of Other Benefits The benefit payments from this Plan will be reduced by the gross benefits, which are paid from the following: 1. All wages (with the exception of vacation pay) that an Employee receives from any employer or self-employment. Except, an employee who is working while disabled under this Plan, shall be entitled to receive, from his employment, self-employment and the Plan benefit, for any sevenday week or partial week, an amount equal to 100% of Salary (exclusive of overtime) immediately prior to the commencement of disability. The Plan benefit, after reduction for all wages, will not exceed the Employee s maximum weekly amount provided by this Plan. 2. Workers compensation benefits for which the employee receives, or is entitled to receive for: a) temporary or permanent disability indemnity, under a workers' compensation or employer liability law of this state, or any other state, or the federal government; or b) a maintenance allowance, except when certain conditions are met. If such workers compensation benefits for a) temporary or permanent disability or b) a maintenance allowance combined with permanent disability indemnity, are less than the amount the Employee would otherwise receive as benefits under this Plan, he/she shall be entitled to receive for such day, if otherwise eligible, disability benefits, reduced by the amount of such workers compensation benefits. IBM California Non-Regular Voluntary Plan 2
3 In the case of an Employee who is receiving a maintenance allowance, benefits under this Plan will be reduced by the amount of both the maintenance allowance and the maximum permanent disability indemnity pursuant to Section 2629 (d) (1) (2) of the California Unemployment Code. In the case of an Employee who does not elect to receive an advance on his/her permanent disability, the Plan benefits will also be reduced by the amount of the permanent disability indemnity to which the Employee would have an entitlement under the Labor Code had he/she requested same. III. LIMITATIONS AND EXCLUSIONS A. No Benefits Are Payable: 1. for any disability which is not supported by a certificate from a treating Physician which contains a diagnosis and diagnostic code prescribed in the International Classification of Diseases, or, where no diagnosis has yet been obtained, a detailed statement of symptoms. The certificate must also contain a statement of medical facts, including secondary diagnoses when applicable, within the Physician s knowledge, based on a physical examination and a documented medical history of the claimant by the Physician, indicating his or her conclusion as to the claimant s disability, and a statement of his or her opinion as to the expected duration of the disability. However, as to any Employee who is hospitalized in or under the care of any medical facility of the United States government, a certificate as to the Employee s disability, signed by any duly authorized medical officer of such facility, will be acceptable for the period of such hospitalization. With respect to an Employee who is hospitalized in a county hospital, or hospitalized by said county hospital in another hospital, a certificate stating the date that the Physician ordered the confinement of the Employee and the duration of such confinement, signed by the registrar of the hospital shall satisfy the requirement of this part for the period of such hospitalization. However, such certificate is not required: a. if the Employee submits evidence of receipt of temporary disability benefits under a workers' compensation law for any day for which the Employee is entitled to receive Unemployment Compensation Disability (UCD) benefits reduced by such temporary workers' compensation disability benefits; or b. if any Employee in good faith adheres to the teachings of any bona fide church, sect, denomination or organization which depends for healing entirely upon prayer or spiritual means, the certificate of a duly authorized or accredited practitioner of such bona fide church, sect, denomination or organization as to the disability of the Employee and the estimated duration of such disability, will be accepted; or c. if an Employee has been referred or recommended by competent medical authority to participate as a resident of an approved alcoholism recovery home, and in the absence of any other disabling condition, benefits while receiving alcoholism recovery treatment, while a full-time resident in an approved recovery home, will be paid for a period not to exceed thirty (30) days, and the Employee shall be eligible for disability benefits for an additional period not in excess of sixty (60) days if the referring Physician certifies to the need for continuing resident services; or d. if an Employee has been referred or recommended by competent medical authority to participate in an approved drug-free residential facility, and in the absence of any other disabling condition, benefits while receiving such drug recovery treatment will be paid for a period not to exceed forty-five (45) days and the Employee shall be eligible for disability benefits for an additional period not to exceed forty-five (45) days if the referring Physician certifies to the need for continuing resident services; or IBM California Non-Regular Voluntary Plan 3
4 e. if an Employee has been ordered not to work by written order from a state or local health officer because the Employee is infected with, or suspected of being infected with, a communicable disease. Such written order shall be acceptable (for the period specified therein) in lieu of a certificate. 2. if the Employee is involuntarily confined, pursuant to commitment, court order, or certification, in an institution, or other place, as a dipsomaniac, drug addict, or sexual psychopath; or 3. for any period of disability for which benefits are paid or payable under any unemployment compensation act of the United States or of any other country; or 4. if any individual has filed with the California Employment Development Department, and each of his or her employers, a statement declaring the Employee's adherence to the faith or teaching of any bona fide religious sect, denomination, or organization and in accordance with its creed, tenets, or principles, depends for healing upon prayer in the practice of religion, and the Employee's statement disclaims any disability benefits based on Wages paid while such statement is in effect. This limitation is applicable during the period when such exemption is in effect and for a period of three (3) months following recession of such exemption certificate; or 5. to an individual who is a) incarcerated, in any federal, state, or municipal penal institution, jail, medical facility, public or private hospital, or in any other place because of a criminal conviction of a federal, state, or municipal law or ordinance or b) who commits a crime and is disabled due to an illness or injury, caused by, or arising out of the commission of, arrest for, investigation of, or prosecution of any crime that results in a felony conviction; or B. Benefits payable under this Plan will be limited to the State Plan Rate plus one dollar for the following disabilities: 1. any period that an employee is disabled so as to be unable to perform his or her regular and customary work, but is not wholly disabled so as to be prevented from engaging in any occupation or employment for remuneration or profit; or 2. any disability for which an employee is entitled to benefits under any workers compensation or employer's liability law. IV. PRORATION OF BENEFITS In case of any period of disability for which an Employee entitled to benefits hereunder is simultaneously covered by one (1) or more other plans (including Voluntary Plans and the State Disability Plan) and accordingly is entitled to other Unemployment Compensation Disability (UCD) benefits on account of the same disability, the amount payable under this Plan for such period of disability shall be: A. the amount, if any, by which the basic benefits to which the Employee otherwise would have been entitled under this Plan exceeds the benefits to which he or she would have been entitled under the California Unemployment Insurance Code if the Employee were not covered by any Voluntary Plan; plus B. the quotient of the amount of basic benefits to which the Employee would have been entitled under the California Unemployment Insurance Code if he or she were not covered by any Voluntary Plan divided by the number of plans (including Voluntary Plans and the State Disability Plan) under which the Employee is simultaneously entitled to benefits. IBM California Non-Regular Voluntary Plan 4
5 V. CONTRIBUTIONS Employee contributions to the Plan, if any, shall be an amount equal to or less than the contribution rate established by the California Employment Development Department for the California State SDI Plan each year. Employees will be notified of the Plan contribution rate, if any, for the next year, no later than December 31st of the prior year. VI. TERMINATION OF INDIVIDUAL EMPLOYEE COVERAGE An Employee's coverage will terminate on the earliest of: A. the date of termination of employment by termination of the Employer-Employee relationship (including permanent layoff or reduction in force); or at 12:00 midnight on the fifteenth (15th) day following the commencement of a Leave of Absence without pay or a temporary layoff (eligible for recall), without pay, whichever occurs first. B. the date the individual ceases to be an eligible Employee. C. the beginning of the next Calendar Quarter following the date the Employee has given written notice of his or her intention to withdraw from the Plan. D. the date of termination of the Plan. VII. CLAIMS Except for good cause, a claim must be filed within Forty-One (41) days from the first compensable day of unemployment and disability. An individual eligible to receive benefits under this plan may choose to redirect a portion of his or her weekly benefits to cover all or part of the cost of Employee paid benefits. In order to allow the Employer to redirect a portion of the Voluntary Plan benefit, the Employee must give permission, in writing, for the weekly amounts to be redirected for payment of the Employee paid benefits. This redirection may be initiated at the time the Employee applies for Voluntary Plan benefits. The Employee may terminate or change the terms of the Voluntary Plan redirection of benefits at any time while receiving benefits under this Plan. In the event that the calculation of a benefit under the Voluntary Plan results in an overpayment to the Employee for any reason, the Employee shall be required to repay such overpayment to the Plan only to the extent permitted under the California Unemployment Insurance Code and the California Code of Regulations. The Plan will make reasonable arrangements with the Employee or his or her legal representative for the repayment to the Plan of such overpayment, including, but not limited to, the reduction of future benefits under the Plan or the reduction of future pay from the Company as allowed under the California Unemployment Insurance Code and the California Code of Regulations. Under the provisions of the California Unemployment Insurance Code, the Employer or its authorized Claims Administrator shall have the right to (A) require supplemental forms from the Physician or those authorized to certify disabilities as often as deemed necessary, and (B) examine any Employee or family member claiming benefits under this Plan. The Plan shall have the sole authority to select the examining physician. Failure of the Employee or family member to attend any medical examination, or cooperate with the examiner, without good cause, can result in loss of benefits. Continued medical certification, signed by a certified Physician or practitioner, must be submitted within twenty (20) days of the date the Employee is issued a notice of final payment or the Employee receives a request for additional medical certification, whichever is later. Additional medical certification may be requested when and as often as may be reasonably required during the period payments may be due under this Plan. An Employee covered IBM California Non-Regular Voluntary Plan 5
6 under a Voluntary Plan may appeal the denial of a claim to the California Employment Development Department. Appeals may be made in person or in writing at any office of the Employment Development Department within twenty (20) days from the date the notice of denial was mailed. Written appeals must be signed and shall include the Employee's name and Social Security number, as well as the name of the Employer and the reason for filing the appeal. VIII. COMPLIANCE The Employer hereby guarantees that each Employee covered by this Plan will in all respects be afforded rights at least equal to those afforded by the State Disability Plan and will receive a weekly rate and maximum amount and duration of benefits at least equal to those which the Employee would have received from the State Disability Plan but for coverage by this Plan. Except as otherwise provided, this Plan will be administered in conformity with all applicable rules and regulations governing the State Disability Plan. If an invalid State Disability Plan award is received due to insufficient qualifying earnings, the Employee may be entitled to further benefit considerations under the benefit rights of the long-term unemployed. If during the Base Period, the Employee was in military service, received workers' compensation benefits, or did not work due to a trade dispute, the Employee may be able to substitute Wages paid in prior Calendar Quarters to establish or increase the Employee's benefit amount. The Employee can contact the Claims Administrator or the State Disability Insurance field office in his or her local area for further information. IX. PAID FAMILY LEAVE Paid Family Leave is unemployment compensation disability insurance paid to workers who suffer a wage loss when they take time to care for a seriously ill family member, such as a parent, child, spouse or domestic partner, or to bond with a new child. Eligibility for Paid Family Leave will be based on the current earnings. Employees may receive up to six weeks of benefits that may be paid over a 12-month period. The weekly benefit is equal to 55% of current earnings up to a maximum of the California workers compensation temporary disability rate. To qualify for Paid Family Leave compensation, you must meet the following requirements: Must be covered by the Voluntary Plan Complete your claim forms accurately, completely, truthfully, and timely Supply medical information that supports your claim that the care recipient is in need of your care Provide documentation to support a claim for bonding with a new child Serve a 7-day unpaid waiting period before benefits begin Paid Family Leave does not provide job protection or return rights. Your job may be protected if you are eligible for the federal Family Medical Leave Act and the California Family Rights Act. You must notify Human Resources of your reason for taking leave in a manner consistent with the company s leave policy. You may not be eligible for benefits if: You receive State Disability Insurance, Unemployment Compensation Insurance, or Workers Compensation You are not working or looking for work at the time you begin your family leave You are not suffering a loss of wages You do not have a qualifying event because the need for care is not supported by the certificate of a treating physician or practitioner You are in custody due to conviction of a crime IBM California Non-Regular Voluntary Plan 6
7 If you have any questions you may contact Human Resources. IX. DEFINITIONS A. Active Employment, as referred to herein, means those work duties that an Employee was hired by the Employer to perform on a regularly scheduled work week (including regularly scheduled days off, holidays or vacation days, so long as the Employee is capable of working on those days.) B. Calendar Quarter, as used herein, means a period of three (3) consecutive months commencing with the first (1st) day of January, April, July or October. C. Claims Administrator, as used herein, is MetLife. D. Designated Subsidiaries, as used herein, means International Business Machines Credit Corporation, Inc., E. Disability Benefit Period, as used herein, means the continuous period of unemployment and disability beginning with the first (1st) day with respect to which the individual files a valid claim for benefits. Two (2) consecutive periods of disability due to the same or related cause or condition and separated by a period of not more than fourteen (14) days shall be considered as one (1) Disability Benefit Period. F. Employee, as used herein, shall mean any individual whose service with the Employer is considered employment within the meaning of the California Unemployment Insurance Code, and such person is not excluded from coverage under this Plan. G. Employer, as used herein, refers to International Business Machines, Inc., and any of its subsidiaries that participate in the Plan H. Gross Minimum Weekly Benefit, as used herein, shall mean the disability benefit amount prior to reduction by any benefits for which the Employee is paid, or is eligible to receive, from any other sources (such as, but not limited to, Workers Compensation) allowable under this Plan. I. Leave of Absence, as used herein, shall mean any absence from work that has been approved by the Employer under the Employer s leave of absence policy. J. Non-Regular Employee, as used herein, shall mean an Employee, designated by the Employer, who is working a temporary, limited-term employment arrangement and can work any part of a regularly scheduled work period. Non-Regular Employees include temporary/supplemental employees, regular full-time and regular part-time employees who are working while on a leave of absence, fixed term contract employees, students, interns, etc. K. Physician, as used herein, means any physician, surgeon, optometrist, dentist, osteopath, qualified licensed psychologist, accredited practitioner, chiropractor, or podiatrist who is duly licensed and acting within the scope of his or her practice; or a licensed midwife, licensed nurse-midwife or licensed nurse practitioner who may certify only to normal pregnancy and childbirth related disabilities; or a duly authorized medical officer of any facility of the United States government; or a practitioner duly authorized and accredited by the Director of the California Employment Development Department. L. Plan, as used herein, means a Voluntary Plan established by the Employer pursuant to Part 2 of the California Unemployment Insurance Code relating to Unemployment Compensation Disability benefits. IBM California Non-Regular Voluntary Plan 7
8 M. State Plan Rate, as referred to herein, means the weekly benefit amount and the maximum benefit amount payable from the State Disability Fund pursuant to Part 2 of the California Unemployment Insurance Code. N. Salary or Regular Salary, as used herein, means regular weekly compensation for regularly scheduled hours, not over 40 hours a week. For Employees under commission or incentive plans, regular weekly compensation is defined as base compensation plus on-target earnings X. OTHER REQUIREMENTS A. Security, as required by the Employment Development Department, will be deposited to secure the operation of the Plan. The amount of the deposit shall be determined by the Department and shall be deposited with the State Treasurer for the purpose herein specified. B. The Employer agrees to furnish to the Department the information, reports, and records as are required by law. C. The Employer agrees to pay all valid assessments or charges levied by the Employment Development Department in accordance with the California Unemployment Insurance Code. All State assessments and administrative expenses may be paid for directly from the Voluntary Plan Fund established for this Plan. D. The Plan shall continue in effect for a period of one (1) year form the effective date and continuously thereafter unless thirty (30) days advance written notice is given of the termination of the Plan. Termination shall be effective only on the anniversary of the effective date of the Plan next following the filing of the notice; except that the Plan may be terminated on the operative date of any law increasing the benefit amounts provided by Sections 2653 and 2655 or the operative date of any change in the rate of worker contribution as determined by Section 984, if notice of the termination of the Plan is transmitted to the Director of Employment Development not less than thirty (30) days prior to the operative date of such law or change. If the Plan is not terminated on such thirty (30) day notice because of the enactment of a law increasing benefits or because of a change in the rate of worker contributions as determined by Section 984, the Plan shall be amended to conform to such increase or change on the operative date of the increase or change. IBM California Non-Regular Voluntary Plan 8
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YOUR GROUP WEEKLY DISABILITY INCOME INSURANCE PLAN For Employees of Valley Schools Employee Benefit Trust 6CC000 Balsz Elementary School District B-14166 (9-13) E-Book CONTENTS CERTIFICATION PAGE.............................................
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