HCA Short-Term Disability Plan

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1 HCA Short-Term Disability Plan As part of the HCA Health and Welfare Benefits Plan, short-term disability insurance coverage through The Prudential Life Insurance Company of America (Prudential or insurance carrier) helps protect you from the financial consequences of a disability if you are an eligible employee. The short-term disability insurance benefit option provides you with coverage to replace all or part of your income if a serious accident or illness leaves you unable to work for a short period of time. Benefitseligible full-time and part-time employees at participating facilities will be automatically enrolled in the short-term disability benefit option. If you report to a participating facility but you work at a facility in California, you are not eligible for this plan. Benefits-eligible full-time and part-time employees at participating facilities will be automatically enrolled in the short-term disability benefit option. If you are an employee at a facility with a collective bargaining agreement or a facility that mirrors the benefits of a facility with a collective bargaining agreement, this information may not apply to you or it may apply to you in a modified manner. If you have questions, please contact your facility s Human Resources office. If you are a new hire and you have not completed your benefits waiting period on the effective date of the plan, you will be eligible once you meet your benefits waiting period, provided you are actively at work as of the date your waiting period ends. Employees who are on leave for their own medical conditions that start before the effective date of the plan, and who continue on leave past the effective date of the plan, will continue on the locally managed Extended Illness Bank (EIB) until they return from leave. Every effort has been made to accurately describe the short-term disability benefit option in this SPD; however, these benefits are offered and controlled by a group insurance contract with Prudential. The insurance contract is the plan document for the short-term disability insurance benefit option and if there is a discrepancy between this SPD and the insurance contract, the terms of the insurance contract will control. A certificate of insurance is available upon written request to HCA Inc., Corporate Benefits, One Park Plaza, P.O. Box 550, Nashville, TN Prudential is the insurance carrier for the short-term disability benefit option. Sedgwick is assisting Prudential with administering the short-term disability benefit option and operating the Time Away From Work Service Center. If you have questions relating to this short-term disability benefit option call the Time Away From Work Service Center at Important note for employees working in Hawaii, New Jersey, New York and Rhode Island: As an employee working in one of these states, you may be eligible for a state disability income plan. Because you are eligible for the state-sponsored plan, the short-term disability benefit option described in this SPD may not be of any value to you. This does not affect your ability to participate in the short-term disability benefit option. To learn more about your state s plan, contact your state s disability department. Employees working in California are not eligible for this plan. Plan Overview: What are the benefit levels? Years of Service Benefit Level *60% of pre-disability pay *80% of pre-disability pay 100% of pre-disability pay Who pays the cost? What is the maximum period of short-term disability benefits? Your facility provides this coverage at no cost to you. 21 weeks (including seven-day elimination period) for each event. This includes any period when 100% Pay Replacement Hours have been used. *After any 100% Pay Replacement Hours have been used. Cost of Coverage Your facility provides this coverage at no cost to you. Note: This document describes changes to the HCA Benefit Plans Summary Plan Descriptions (SPD) originally published in February It is important that you keep this summary with your SPD since this material plus the SPD and any other applicable Summaries of Material Modifications comprise your complete SPD. You can access the most up-to-date SPD at HCArewards.com. If you have questions, call BConnected at (800) HCA-G96 / 2012 HCA Short-Term Disability Plan SPD Page 1

2 The Benefits If you are eligible for short-term disability benefits, you may receive 60%, 80% or 100% of your pre-disability pay depending on your years of service, after you have been disabled continuously for seven calendar days (or five work days). The sevenday period is your elimination period. After your elimination period, short-term disability benefits will be paid while you are disabled. The maximum period of short-term disability benefits for each event is 21 weeks (including the elimination period) from the date you are disabled. If you had a balance of hours in an Extended Illness Bank (EIB) provided by your facility as of the plan s effective date, you will be credited with 100% Pay Replacement Hours equal to those EIB hours as part of your short-term disability benefit. If you become disabled, after your elimination period, the short-term disability benefit option will first pay as your short-term disability benefit any of your 100% Pay Replacement Hours until exhausted. After your 100% Pay Replacement Hours are depleted, your short-term disability benefit will be 60%, 80% or 100% of your pre-disability pay depending upon your years of service. For employees with less than five years of service, please refer to the CorePlus Supplemental Short-Term Disability Benefits option for information on the supplemental option of 20% of pre-disability pay. Your short-term disability benefit will be reduced by any other income you are entitled to receive on the date you became disabled, such as state mandated disability benefits or disability Social Security. See the Other Sources of Income section. Disabled During the elimination period, you are disabled when the insurance carrier determines that: you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; you are under the regular care of a doctor; and you are not working at any job for which you are reasonably fitted by your education, training or experience. After the elimination period, you are disabled when the insurance carrier determines that: you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and you are under the regular care of a doctor; and you have a 20% or more loss in pre-disability pay due to the same sickness or injury. The loss of a professional or occupational license or certification does not, in itself, constitute disability. Disability must begin while you are covered under the plan. A determination of disabled status under this Plan does not constitute a determination that an individual is disabled for any other purpose. The insurance carrier will assess your ability to work and the extent to which you are able to work by considering the facts and opinions from: your doctors; and doctors, other medical practitioners or vocational experts of the insurance carrier s choice. Material and substantial duties means duties that are normally required for the performance of your regular occupation; and cannot be reasonably omitted or modified. Regular occupation means the occupation you are routinely performing when your disability begins. The insurance carrier will look at your occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location. Sickness means any disorder of your body or mind, but not an injury. Sickness includes pregnancy, abortion, miscarriage, childbirth, and any complication related to pregnancy. Injury means a bodily injury that is the direct result of an accident; is not related to any cause other than the accident; and results in immediate disability. Regular care means: you personally visit a doctor as frequently as is medically required, according to generally accepted medical standards, to effectively manage and treat your disabling condition(s); and you are receiving the most appropriate treatment and care, which conforms with generally accepted medical standards, for your disabling condition(s) by a doctor whose specialty or experience is the most appropriate for your disabling condition(s), according to generally accepted medical standards. HCA-G96 / 2012 HCA Short-Term Disability Plan SPD Page 2

3 Doctor means a person who is performing tasks that are within the limits of his or her medical license; and is licensed to practice medicine and prescribe and administer drugs or to perform surgery; or has a doctoral degree in Psychology (Ph.D. or Psy.D.) whose primary practice is treating patients; or is a legally qualified medical practitioner according to the laws and regulations of the governing jurisdiction. The insurance carrier will not recognize any relative including, but not limited to, you, your spouse, or a child, brother, sister, or parent of you or your spouse as a doctor for a claim that you send to us. Drug / Alcohol If your disability is the result of a drug and alcohol illness, you will be entitled to the same short-term disability benefits as for any other disability. However, you must be actively supervised by a physician and receiving continuing treatment. Mental / Emotional If your disability is the result of a mental or emotional disorder, you will be entitled to the same short-term disability benefits as for any other disability. However, you must be under appropriate Psychiatric care within 30 days of your first day of disability for any condition with a mental health or emotional diagnosis. Psychiatric care must involve direct treatment by a psychiatrist or treatment by a licensed, registered psychologist who is working under the supervision of a psychiatrist or your treating physician. When Benefits Are Paid Short-term disability benefits are paid when the insurance carrier determines that you are and continue to be disabled continuously for a period of seven calendar days. This is your elimination period and it is counted toward the 21 week maximum duration of the short-term disability benefit. No short-term disability benefit payments are made during your elimination period. During your elimination period, you can use Paid Time Off (PTO) or take the time off without pay. You must be actively at work for some or all of your regularly scheduled work hours as of the last regularly scheduled workday preceding the start of the elimination period. Active employment means you are working for your employer for earnings that are paid regularly and that you are performing the material and substantial duties of your regular occupation. You must be working at least the minimum number of hours as designated by your HCA-affiliated facility. A period of disability starts on the first day you are disabled. You must be under the care of a doctor during this period. In addition, as proof of your continuing disability, you may be asked to have a medical examination from time to time by a doctor selected and paid for by the insurance carrier. Short-term disability benefit payments may begin the day after the elimination period is completed. How Benefits Are Paid Short-term disability benefits are paid on your regular pay schedule and mailed directly to you, unless you have direct deposit. In which case, your short-term disability benefits will be deposited directly to your designated bank account. If a benefit is payable for less than a full pay period, the plan will pay 1/5th of the weekly benefit for each day you were disabled. If you work a variable schedule, such as (3) 12 hour shifts weekly and your benefit is payable for less than a full pay period, the plan will pay based upon your regular schedule and hours. If your short-term disability benefit is overpaid, your future benefits will either be reduced to recover the overpayment or you will be asked to repay the overpayment in a lump-sum payment. How Benefits Are Calculated 100% Pay Replacement Hours Employees who had EIB hours under the EIB policies in effect as of the plan s effective date, will have a bank of 100% Pay Replacement Hours equal to the value of their EIB hours. If you have 100% Pay Replacement Hours, your short-term disability benefit will be equal to your 100% Pay Replacement Hours until those 100% Pay Replacement Hours are exhausted. HCA-G96 / 2012 HCA Short-Term Disability Plan SPD Page 3

4 Benefit Level After your 100% Pay Replacement Hours are depleted, your short-term disability benefit will depend on your years of service. The amount of your short-term disability benefit will be 60%, 80%, or 100% of your pre-disability pay. Years of Service Benefit Level 60% of pre-disability pay 80% of pre-disability pay 100% of pre-disability pay For employees with less than five years of service, please refer to the CorePlus Supplemental Short-Term Disability Benefits option for information on the supplemental option of 20% of pre-disability pay. Year of Service A year of service means a 12-month period of service commencing on your employment date (i.e. anniversary date). Pre-disability Pay Pre-disability pay is your regular benefit pay for the last full pay period just before the period of disability begins. It does not include bonuses, overtime and any other extra compensation, nor does it include income received from sources other than an HCA-affiliated facility. If you re a commissioned salesperson, your pre-disability pay includes income you actually receive from commissions, but it does not include renewal commissions, bonuses, overtime pay and any other extra compensation, nor does it include income received from sources other than an HCA-affiliated facility. If you are disabled and return to work after your elimination period on a reduced schedule, your short-term disability benefit may be reduce by the insurance carrier when your disability earnings exceed 20% of your pre-disability pay. Short-Term Disability Benefit Payment Examples Example 1: If the effective date of the plan is April 1, 2012, and you have six years of service and 40 hours of 100% Pay Income Replacement Hours, what would your short-term disability benefit be if you become disabled after April 1, 2012? Example 2: If the effective date of the plan is April 1, 2012, and you have one year of service, work three 12-hour days (36 hours) and have 36 hours of 100% Pay Income Replacement Hours, what would your short-term disability benefit be if you become disabled after April 1, 2012? Day Example 1 Short-Term Disability Benefit Level Example 2 Short-Term Disability Benefit Level 1-7 0% This is your elimination period. You may use PTO for these days or take them without pay % of pre-disability pay The short-term disability benefit option would first pay the 40 hours of 100% Pay Income Replacement Hours % of pre-disability pay After all the 100% Pay Income Replacement Hours are used, you would receive 80% of pre-disability based upon your six years of service. 0% This is your elimination period. You may use PTO for these days or take them without pay. 100% of pre-disability pay The short-term disability benefit option would first pay the 36 hours of 100% Pay Income Replacement Hours. 60% of pre-disability pay After all the 100% Pay Income Replacement Hours are used, you would receive 60% of pre-disability based upon your six years of service. Last day of 21 week period of disability Your short-term disability benefit payments would end on the last day of the 21-week disability period starting on the first day you were disabled, which includes your elimination period, as long as you remain disabled through this disability period. Your short-term disability benefit payments would end on the last day of the 21-week disability period starting on the first day you were disabled, which includes your elimination period, as long as you remain disabled through this disability period. HCA-G96 / 2012 HCA Short-Term Disability Plan SPD Page 4

5 If You Become Disabled Again If your current disability is related or due to the same cause(s) as your prior disability for which the insurance carrier made a payment, the insurance carrier will treat your current disability as part of your prior claim, and you will not have to complete another elimination period, if you return to active employment for your Employer on a full time basis for 30 days or less. Your disability will be subject to the same terms of the plan as your prior claim. If your current disability is unrelated to your prior disability for which the insurance carrier made a payment, the insurance carrier will treat your current disability as a new claim and you will have to complete another elimination period. Your disability will be subject to all of the plan provisions. If you become covered under any other group short term disability plan, you will not be eligible for payments under this shortterm disability benefit option. Taxes on Benefits Because your facility pays for the cost of this short-term disability insurance coverage and you do not include the value of the coverage in your taxable income (i.e. imputed income) each pay period, the IRS considers the short-term disability benefit payments to be taxable income. However, the Time Away from Work Service Center generally does not withhold taxes from your benefit, unless you request otherwise. As a result, you will need to pay taxes on the benefits when you file your federal income tax return. You may request the insurance carrier to withhold taxes as you receive your short-term disability payments. You can make this request when you file your disability claim. Other Sources of Income If you become disabled, you may be entitled to benefits or sources of income from other company- and government-sponsored plans. Your short-term disability income benefits will be reduced by the other sources of income that you receive or are entitled to receive while you are disabled. What are deductible sources of income? The Time Away from Work Service Center will deduct from your gross disability payment the following deductible sources of income: 1. The amount that you receive or are entitled to receive as loss of time disability income payments under any state compulsory benefit act or law. Amounts you receive or are entitled to receive under any blanket group or franchise school accident policy will not be included. 2. The gross amount that you, your spouse and children receive or are entitled to receive as loss of time disability payments because of your disability under: a. the United States Social Security Act; b. the Railroad Retirement Act; c. the Canada Pension Plan; d. the Quebec Pension Plan; or e. any similar plan or act. Amounts paid to your former spouse or to your children living with such spouse will not be included. 3. The gross amount that you receive as retirement payments or the gross amount your spouse and children receive as retirement payments because you are receiving payments under: a. the United States Social Security Act if attributable to your retirement from HCA; b. the Railroad Retirement Act; c. the Canada Pension Plan; d. the Quebec Pension Plan; or e. any similar plan or act. Benefits paid to your former spouse or to your children living with such spouse will not be included. 4. The amount that you: a. receive as disability payments under your Employer s retirement plan; b. voluntarily elect to receive as retirement or early retirement payments under your Employer s retirement plan; or c. receive as retirement payments when you reach normal retirement age, as defined in your Employer s retirement plan. Disability payments under a retirement plan will be those benefits which are paid due to disability and do not reduce the retirement benefits which would have been paid if the disability had not occurred. HCA-G96 / 2012 HCA Short-Term Disability Plan SPD Page 5

6 Retirement payments will be those benefits which are paid based on your Employer s contribution to the retirement plan. Disability benefits which reduce the retirement benefits under the plan will also be considered as a retirement benefit. Amounts received do not include amounts rolled over or transferred to any eligible retirement plan. Prudential will use the definition of eligible retirement plan as defined in Section 402 of the Internal Revenue Code including any future amendments which affect the definition. 5. The amount that you receive, due to your disability, from a third party (after subtracting attorney s fees) by judgment, settlement or otherwise. 6. The amount that you receive or are entitled to receive under any unemployment income act or law due to the end of employment with your Employer. 7. The amount that you are entitled to receive from any other short term disability benefit. With the exception of retirement payments, the Time Away from Work Service Center will only subtract deductible sources of income which are payable as a result of the same disability. The Time Away from Work Service Center will not reduce your payment by your Social Security retirement payments if your disability begins after age 65 and you were already receiving Social Security retirement payments. Law, plan or act means the original enactment of the law, plan or act and all amendments. Retirement plan means a defined contribution plan or defined benefit plan. These are plans which provide retirement benefits to employees and are not funded entirely by employee contributions. What Are Not Deductible Sources of Income? The Time Away from Work Service Center will not deduct from your gross disability payment income you receive from, but not limited to, the following sources: 401(k) plans; Profit sharing plans; Thrift plans; Tax sheltered annuities; Stock ownership plans; Non-qualified plans of deferred compensation; Pension plans for partners; Military pension and disability income plans; Credit disability insurance; Franchise disability income plans; Automobile liability insurance; A retirement plan from another Employer; Individual retirement accounts (IRA). It is your responsibility to contact the Time Away from Work Service Center if there is any change in your disability income from other sources or if your dependent's benefits change. If you receive other income benefits in a lump-sum payment, the amount you receive will be prorated on a weekly basis over a reasonable period of time. The other sources of income will reduce the amount you receive as the short-term disability benefits, if you receive any retroactive benefits, you must notify the insurance carrier. You will be required to repay the amount you received from the short-term disability benefit option that was more than the maximum benefit you should have received. The insurance carrier will notify you of the amount you will be required to repay. When Benefits End Short-term disability benefits will end on the earliest date that one of the following events occurs: The date you are no longer disabled under the terms of the plan, You are able to work in your regular occupation on a part-time basis but you choose not to, The date you die, The date you fail to submit proof of continuing disability, If you are working, the date your disability earnings exceed the amount allowed under the plan, or The end of the maximum period of short-term disability benefit payments (e.g., 21 weeks from the date of your disability). HCA-G96 / 2012 HCA Short-Term Disability Plan SPD Page 6

7 When Coverage Ends Your coverage under the plan will end on the day the first of one of the following occurs: You no longer meet the eligibility requirements You cease employment with the Company You stop active work with the Company for any reason other than becoming totally disabled The date your covered class is no longer covered You retire The plan ends The end of the month in which you are out of work on a leave of absence Disabilities Not Covered Short-term disability benefits will not be paid for disabilities caused by, contributed to by or resulting from your: Intentionally self-inflicted injuries, while sane or insane, Active participation in a riot, Commission of a crime for which you have been convicted under state or federal law, Occupational sickness or injury, Attempted suicide, while sane or insane, Cosmetic Procedures (except reconstruction after illness, like cancer, or complications from a cosmetic procedure) In addition, no benefits will be paid for: A disability due to war, declared or undeclared, or any act of war, Any period of disability during which you are incarcerated, or Any disability caused by, contributed to by, or resulting from your loss of a professional license, occupational license or certification. How to Use the Benefits How to File a Claim 1. Notify your supervisor that you are unable to work as the result of a non-work related illness or injury. 2. File a claim by calling the Time Away From Work Service Center if you will be absent from work for any non-work related illness or injury for more than two days. The telephone number for the Time Away From Work Service Center is The claim must be filed as soon as possible and no later than 30 days after the beginning of your disability. 3. Submit medical proof of the disability before benefits start. You may be required to show proof of your continuing disability from time to time. 4. Notify the Time Away from Work Service Center if you, your spouse or your dependents have been approved for Social Security disability benefits, Workers Compensation, occupational disease awards or any other federal or state disability benefits. 5. If applicable, provide insurance carrier with any documents that would help the Time Away from Work Service Center to recover payment from a third party. The insurance carrier has the right to recover short-term disability payments when a third party is found to be responsible for your disability. For example, you could be in an automobile accident caused by another person, and the courts could find that person responsible for your disability. 6. Notify the Time Away From Work Service Center prior to your return to work in any capacity. 7. If you have questions about your claim or short-term disability benefit check, contact the Time Away From Work Service Center at Delay of Benefits The following situations could result in a delay of your benefits: You fail to apply for benefits within 20 days of becoming disabled or fail to provide the information required on claim forms, You change your address while receiving benefits and fail to provide the Time Away from Work Service Center with your new address, or You fail to inform the Time Away from Work Service Center that you were approved (or not approved) for Social Security benefits. HCA-G96 / 2012 HCA Short-Term Disability Plan SPD Page 7

8 When Insurance Carrier May Recover Payment In some situations, a third party, such as another person or insurance company, may be legally responsible for your disability. This may happen, for example, in an automobile accident. When this occurs, the insurance carrier is entitled to be reimbursed for all short-term disability benefits that have been paid under the program. The insurance carrier may take any actions necessary to enforce its rights to be reimbursed. When you accept payment from the short-term disability program, you agree to provide any documents that would help Prudential recover payments it has made on your behalf. The legal term for this right of recovery is subrogation. In situations where your program has a subrogation interest, you may be asked to sign certain documents acknowledging the insurance carrier s rights. The insurance carrier is entitled to subrogation even if you fail to sign the requested documents. Proof of Disability The insurance carrier may require you to provide proof that your disability continues and that you are receiving regular medical treatment from a doctor. In addition, the insurance carrier may require you to have an independent medical examination, from time to time, to verify a continuing disability. Failure to appear for an independent medical examination may cause you to lose your benefits. Appealing a Claim Denial If your disability claim is denied or your benefit payments are terminated, you will receive a written explanation of the reason for the denial or termination. You have the right to have your claim reviewed and reconsidered. All claims and appeals are handled by the Time Away from Work Service Center. The Time Away from Work Service Center has absolute discretion in deciding claims and appeals. HCA does not decide claims or appeals. See the Administrative Information section for information regarding claim denials and appeals. What Else You Should Know Attachment of Benefits To the extent permitted by law, your short-term disability benefits may not be attached, garnished or subject to other legal processes for your debts or liabilities. Conversion of Coverage Short-term disability cannot be converted to an individual policy when your coverage ends. HCA-G96 / 2012 HCA Short-Term Disability Plan SPD Page 8

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