INFORMATION ABOUT YOUR DISABILITY INSURANCE PLAN WITH LAFOURCHE PARISH SCHOOL BOARD

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1 INFORMATION ABOUT YOUR DISABILITY INSURANCE PLAN WITH LAFOURCHE PARISH SCHOOL BOARD Disability Insurance Benefits are designed to help you replace a portion of your income if you are disabled. Disability Insurance benefits will be offset or reduced by the amount you receive from other income. This is sometimes referred to as a coordinating benefit. Short-Term Disability coverage pays you for non-occupational disabilities only. Long-Term Disability coverage pays for occupational and non-occupational disabilities. EXAMPLE OF DISABILITY BENEFIT: Annual Salary - $35,000 Salary - $2,916 Disability Insurance % Payable 60% Disability Insurance Benefit - $1,750 Disability Insurance Benefits are TAX FREE (because you have paid the premium with after-tax dollars) The monthly Disability Insurance benefit is reduced by any other income you receive. Example: You cannot collect 100% of your salary (accumulated sick leave), extended sick leave (65% of your salary), workers compensation income, or donated sick leave days, and also receive a disability insurance benefit. Obviously, this would provide you with more income than you were making before the disability. If you are disabled and you have limited or no accumulated sick leave or you choose not to use your sick leave, you could then collect 60% of your salary TAX FREE under the disability insurance plan. Caution: If you choose not to go out on sick leave with pay, this would affect how long some of your insurance coverages will last. You will not be able to continue your insurance coverage under this option (unless you choose COBRA) for health, dental, and/or vision. If you have a large amount of accumulated sick leave with Lafourche Parish School Board and you intend to use it in the event of a disability, you should consider only purchasing the Long-Term Disability Insurance. This benefit will start paying you after your accumulated or extended sick leave pay stops. The Long-Term Disability Insurance plan pays to age 65 if you qualify after 90 days of disability. The benefit is TAX FREE (if paid with after-tax deductions). To collect Disability Benefits from the Short or Long-Term Disability Insurance plan, you must file a claim with the insurance company at the start of your disability. If you qualify, you will be eligible for benefits according to the insurance contract provisions. Should you have any questions about your benefits, please contact the Lafourche Parish School Board Insurance Department.

2 Lafourche Parish School Board Disability Coverage Employee Name: Employee# I am purchasing disability coverage during the Lafourche Parish School Board Open Enrollment period for an effective date of January 1, If I have a pre-existing condition, I understand that my pre-existing condition will not be covered for 12 months starting from January 1, 2015 under the short term disability plan. If I have a pre-existing condition, I understand that my pre-existing condition will not be covered for 24 months starting from January 1, 2015 under the long term disability plan. Employee Signature Date

3 Lf Lafourche Summary of fbenefits 1

4 Summary of Short Term Disability Benefits Eligibility A regular employee of the Employer who is actively at work at least 25 hours each week or; an active bus driver or cafeteria worker employee of the Employer who is working at least 900 hour per year Weekly Benefit Percentage -60% Weekly Maximum Benefit $1,000 per week Minimum Benefit $25 per week Benefit Waiting Period 14 Days for Accident 14 Days for Sickness Accumulated Sick Leave Included in Benefit Waiting Period Work Days During the Benefit Waiting Period No limit on trial work days during benefit waiting period provided earnings received do not exceed the earnings test over the entire period Definition of Disability Own Job Earnings Test 80% Definition of Covered Earnings Standard Wage includes the employee's wage or salary as reported by the employer but excludes overtime, bonuses or commissions. Integration Type Full Family Maximum Benefit Duration11 Weeks Accident and 11 Weeks Sickness Pre-Existing Condition Limitation LATE ENTRANT 12 months prior/12 months Insured This is a new provision which allows the Employee to come on the plan without EOI, however, they must be advised that a longer pre ex will need to be fulfilled. Employer Contribution 0% Taxation of Benefits Non -Taxable RATE: Rate per $10 of Weekly Covered Benefit $0.67 Copyright Life Insurance Company of North America

5 Pre Existing Condition Limitation Explained: STD Late Entrants should be advised that they will not have to complete a medical underwriting questionnaire, i however, they will have a longer pre ex applied to the policy. Benefits will not be paid for any period of Disability caused by or contributed to, or resulting from an injury or sickness for which the Employee incurred expenses, received medical treatment, care or services including diagnostic means, took prescribed drugs or medicines,or for which a reasonable person would have consulted a physician within 12 months before his or her most recent effective date of insurance. This limitation it ti will not apply to a period of Disability that t begins after an Employee is covered for at least 12 months after his or her most recent effective date of insurance. If a disability were to occur within 12 months of his or her most recent effective date, and is not contributed to, or results from a pre existing condition, the policy would pay according the policy definitions as usual. Copyright Life Insurance Company of North America

6 Summary of Long Term Disability Benefits Employer Contribution0%Taxation of Benefits Non-Taxable Return to Work Incentive Benefit Allows up to 100% income replacement for 24 months while receiving benefits under this plan Rehabilitation Program Included Survivors Benefits 3 months lump sum with 3 months Benefit Waiting Period Pre-Existing Condition Limitation NEW HIRE 3 months Prior/12 months Insured Pre-Existing Condition Limitation LATE ENTRANT 12 months prior/24 months Insured This is a new provision which allows the Employee to come on the plan without EOI, however, they must be advised that a longer pre ex will need to be fulfilled. Mental Illness Limitation12 Month Lifetime Limitation Substance Abuse Limitation12 Month Lifetime Limitation Subjective Symptom Limitation it ti No Limitationit ti Catastrophic Disability Benefit (ADL Rider)15% Benefit$5,000 Maximum Amount Rate Rate per $100 of Covered Payroll $0.40 Copyright Life Insurance Company of North America

7 Summary of Long Term Disability Benefits Eligibility regular employee of the Employer who is actively at work at least 25 hours each week or; an active bus driver or cafeteria worker employee of the Employer who is working at least 900 hour per year Benefit Percentage -60% Maximum Benefit $6,000 per month Minimum Benefit $100 Benefit Waiting Period 90 days Accumulated Sick Leave Included in Benefit Waiting Period Trial Work Days During the Benefit Waiting Period No limit on trial work days during benefit waiting period provided earnings received do not exceed the earnings test over the entire period. Definition of Disability 24 Months Own/Any Occupation Own Occupation Earnings Test 80% Any Occupation Earnings Test 80 % Definition of Covered Earnings Standard Wage includes the employee's wage or salary as reported by the employer but excludes overtime, bonuses or commissions. Benefit Reduction Schedule Traditional graded scale to 65 Integration Type Full Family Maximum Benefit Duration To Age 65 Copyright Life Insurance Company of North America

8 Pre Existing Condition Limitation Explained: Late Entrants should be advised that they will not have to complete a medical underwriting questionnaire, i however, they will have a longer pre ex applied to the policy. Benefits will not be paid for any period of Disability caused by or contributed to, or resulting from an injury or sickness for which the Employee incurred expenses, received medical treatment, care or services including diagnostic means, took prescribed drugs or medicines, or for which a reasonable person would have consulted a physician within 12 months before his or her most recent effective date of insurance. This limitation it ti will not apply to a period of Disability that t begins after an Employee is covered for at least 24 months after his or her most recent effective date of insurance. If a disability were to occur within 24 months of his or her most recent effective date, and is not contributed to, or results from a pre existing condition, the policy would pay according to the policy definitions as usual. Copyright Life Insurance Company of North America

9 Lafourche Parish School Board Disability Programs for Illustrative Purposes Only STD Weekly Benefit Salary Benefit Total Annual Earnings Earnings STD $5, $ $1.67 $5.55 $6, $ $2.00 $6.62 $6, $ $2.03 $6.72 $9, $ $3.20 $10.64 $10, $ $3.33 $11.04 $10, $ $3.40 $11.31 $12,700 1, $9.85 1, $4.23 $14.08 $13,200 1, $ , $4.40 $14.58 $13,100 1, $ , $4.37 $14.49 $13,200 1, $ , $4.40 $14.58 $13,500 1, $ , $4.50 $14.95 $13,700 1, $ , $4.57 $15.15 $14,200 1, $ , $4.73 $15.72 $14,300 1, $ , $4.77 $15.82 $14,400 1, $ , $4.80 $15.92 $14,500 1, $ , $4.83 $16.02 $14,700 1, $ , $4.90 $16.29 $14,750 1, $ , $4.92 $16.31 $14,800 1, $ , $4.93 $16.39 $14,850 1, $ , $4.95 $16.41 $14,900 1, $ , $4.97 $16.49 $14,950 1, $ , $4.98 $16.58 $15,000 1, $ , $5.00 $16.59 $15,100 1, $ , $5.03 $16.69 $15,200 1, $ , $5.07 $16.79 $15,300 1, $ , $5.10 $16.96 $15,400 1, $ , $5.13 $17.06 $15,500 1, $ , $5.17 $17.16 $15,600 1, $ , $5.20 $17.26 $15,700 1, $ , $5.23 $17.36 $15,800 1, $ , $5.27 $17.46 $15,900 1, $ , $5.30 $17.56 $16,000 1, $ , $5.33 $17.73 $16,500 1, $ , $5.50 $18.23 $17,000 1, $ , $5.67 $18.80 $17,500 1, $ , $5.83 $19.37 $18,000 1, $ , $6.00 $19.94 $18,500 1, $ , $6.17 $20.44 $19,000 1, $ , $6.33 $21.01 $19,500 1, $ , $6.50 $21.58 $20,000 1, $ , , $6.67 $22.15 $20,500 1, $ , , $6.83 $22.71 $21,000 1, $ , , $7.00 $23.21 $21,500 1, $ , , $7.17 $23.78 $22,000 1, $ , , $7.33 $24.35 $23,000 1, $ , , $7.67 $25.42 $24,000 2, $ , , $8.00 $26.56 $25,000 2, $ , , $8.33 $27.63

10 Lafourche Parish School Board Disability Programs for Illustrative Purposes Only STD Weekly Benefit Salary Benefit Total Annual Earnings Earnings STD $26,000 2, $ , , $8.67 $28.77 $27,000 2, $ , , $9.00 $29.90 $28,000 2, $ , , $9.33 $30.97 $29,000 2, $ , , $9.67 $32.11 $30,000 2, $ , , $10.00 $33.18 $31,000 2, $ , , $10.33 $34.32 $32,000 2, $ , , $10.67 $35.39 $33,000 2, $ , , $11.00 $36.53 $34,000 2, $ , , $11.33 $37.60 $35,000 2, $ , , $11.67 $38.74 $36,000 3, $ , , $12.00 $39.81 $37,000 3, $ , , $12.33 $40.94 $38,000 3, $ , , $12.67 $42.01 $39,000 3, $ , , $13.00 $43.15 $40,000 3, $ , , $13.33 $44.29 $41,000 3, $ , , $13.67 $45.36 $42,000 3, $ , , $14.00 $46.50 $43,000 3, $ , , $14.33 $47.56 $44,000 3, $ , , $14.67 $48.70 $45,000 3, $ , , $15.00 $49.77 $46,000 3, $ , , $15.33 $50.91 $47,000 3, $ , , $15.67 $51.98 $48,000 4, $ , , $16.00 $53.12 $49,000 4, $ , , $16.33 $54.19 $50,000 4, $ , , $16.67 $55.33 $55,000 4, $ , , $18.33 $60.88 $60,000 5, $ , , $20.00 $66.36 $65,000 5, $ , , $21.67 $71.92 $70,000 5, $ , , $23.33 $77.47 $75,000 6, $ , , $25.00 $82.96 $80,000 6, $ , , $26.67 $88.51 $85,000 7, $ , , $28.33 $94.06 $90,000 7, , $ , , $30.00 $97.00 $95,000 7, , $ , , $31.67 $98.67 $100,000 8, , $ , , $33.33 $ $105,000 8, , $ , , $35.00 $ $110,000 9, , $ , , $36.67 $ $115,000 9, , $ , , $38.33 $ $120,000 10, , $ , , $40.00 $107.00

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