1 For this plan year, the plan includes the following provisions, subject to change or discontinuation with or without notice at any time. This Summary Plan Description presents an overview of your Benefits. In the event of any discrepancy between this Summary Plan Description and the official Plan Document, the Plan Document shall govern. Table of Contents Overview of the Long-Term Disability Plan... 1 If the Plans Are Ended or Modified... 1 No Implied Promises... 1 Who Is Eligible for the Long-Term Disability Plan?... 1 Pre-Existing Condition Exclusion for Newly Eligible Employees... 1 Your Long-Term Disability Coverage Options... 2 Maximum Long-Term Disability Benefit... 2 Minimum Long-Term Disability Benefit... 2 Increasing Coverage... 2 Definition of Total Disability Under the Long-Term Disability Plan... 2 Services Not Covered Under the Long-Term Disability Plan... 3 Nervous/Mental or Substance Abuse Limit... 3 When Benefits Begin and End... 3 Long-Term Disability Claim Information... 4 How to File a Claim... 4 How Claims Are Paid... 5 Recovery of Overpayments... 5 What Happens to Your Long-Term Disability Plan Benefits When You Leave the Company?... 5 When Long-Term Disability Coverage Ends... 5 Guidelines Affecting Your Long-Term Disability Benefits... 6 Coordination of Benefits... 6 Social Security Disability Benefits... 6 Residual Benefits... 7 Lump Sum Payments... 7 Assumed Receipt of Benefits... 7 Work Incentive Benefit... 7 Rehabilitation during a Period of Disability... 7 Successive Periods of Disability... 8 Life Insurance Continuation... 8 Medical Insurance Continuation... 8 Use of Health Information... 8 Leave of Absence... 9 For More Information... 9 Page i
2 Overview of the Long-Term Disability Plan The purpose of the long-term disability plan is to provide financial protection against interrupted income due to a long-term illness or injury. The plan is designed to continue a portion of your salary for an extended period of time. When you join Deluxe and each year at annual enrollment you choose the long-term disability plan that best fits your needs. Your decision remains in effect for one calendar year, unless you experience a qualified change in status that changes your coverage needs. At that time, you may be able to change your original benefit elections. If you become disabled and cannot work for an extended period of time, you may receive a portion of your pay through the Deluxe long-term disability plan. Your long-term disability coverage begins after a waiting period of 26 weeks of total disability due to illness or injury unless mandated otherwise by the state in which case the state mandate applies. During the first 26 weeks of disability, you may be at least partially covered by a short-term disability plan or sick leave policy. Your employment with Deluxe will be terminated when or before long-term disability coverage becomes effective. Be sure to communicate with Cigna or your HR representative if you need reasonable accommodations including additional leave time. If the Plans Are Ended or Modified Deluxe reserves the right to amend, modify, suspend, or terminate any of its plans at any time, in whole or in part. If material changes that affect you are made in the future, you will be notified. No Implied Promises Nothing in this Web site says or implies that participation in the plans is a guarantee of continued employment with the company. Nor is it a guarantee that the plans or contribution levels will remain unchanged in future years. Who Is Eligible for the Long-Term Disability Plan? You are eligible to receive Deluxe long-term disability coverage if you are: An active, full-time employee; or A part-time employee who is regularly scheduled to work 20 or more hours per week. This does not include seasonal or temporary employees or independent contractors. Check with your Human Resources Representative to determine if you are eligible for this plan. To be eligible to receive long-term disability benefits, at the time you become disabled you must be at least age 18 and actively at work. You become eligible for the long-term disability plan the first of the month following your date of hire. You have 30 days to enroll. If you do not enroll within 30 days, you will default to 50% coverage and you will not be able to enroll again until the next annual enrollment period unless you experience a qualified change in status. If you have a qualified change in status and want to make a coverage change, you must call Your Benefits Resources (YBR) at U-ASK-DLX ( ) within 30 days of the qualifying event and talk with a YBR Customer Care Specialist to request a change. Pre-Existing Condition Exclusion for Newly Eligible Employees You will not be eligible for long-term disability benefits for a disability caused by or contributed to, by, or resulting from, a Pre-Existing Condition. A "Pre-Existing Condition" means any injury or illness for which medical treatment, care or services including diagnostic measures, prescription drugs or medicines was recommended or received from a licensed medical practitioner within 3 months of you becoming disabled. Page 1
3 The Pre-Existing Condition limitation will apply to any added benefits or increases in benefits. This limitation will not apply to a disability that begins after you have been actively at work for at least 12 consecutive months after becoming eligible for benefits or becoming eligible for an increased level of benefits. Your Long-Term Disability Coverage Options Disability benefits are adjusted on January 1 of each year. Benefits are based on your annualized base pay in effect at the time the wage information is extracted from payroll in the Fall prior to the January 1 effective date. If you are in a Deluxe sales position, have 15 percent or more of your pay at risk, and receive pay at risk more frequently than twice a year, your eligible pay is your base pay increased by an at-risk amount. Your long-term disability coverage options are: 50% of your eligible pay - Deluxe automatically provides you with and pays for this level of coverage. 66-2/3% of your eligible pay - You pay the difference between the 50% and 66-2/3% option with pre-tax contributions from your pay. Long-term disability coverage premiums paid by Deluxe will be listed as imputed income on your paystub and included in your earned income for tax premiums. If you buy-up to the 66-2/3% coverage level, payroll deductions will be made from your after-tax earnings. Consequently, any benefit you may receive if you become disabled will be exempt from income tax. Maximum Long-Term Disability Benefit The maximum long-term disability benefit available to eligible employees excluding Corporate Officers is $15,000 per month. The maximum long-term disability benefit available to eligible Corporate Officers (Executive Leadership Team) is $30,000 per month. Minimum Long-Term Disability Benefit There is no minimum benefit payable. Increasing Coverage When you elect to increase your coverage, you must be actively at work for one full day in the plan year in which the increase is to be implemented. In the event of a mid-year increase due to a qualified change in status, you must be actively at work one full day on the date when your increase would otherwise become effective, before the increase in coverage can take effect. If you are not actively at work for a full day on the date when your increased benefit amount would otherwise become effective, your increased benefit amount will become effective on the first day after you return to active work for at least one full day. Definition of Total Disability Under the Long-Term Disability Plan You are considered totally disabled if you are unable to perform the essential duties of your own occupation during the 26-week waiting period and for the next 24 months. After that time period, you are considered totally disabled if you cannot perform the duties of any occupation for which you may be qualified, educated, or trained. Although you do not have to be hospitalized, you must be under the continuous care of a legally qualified physician. Page 2
4 Services Not Covered Under the Long-Term Disability Plan The plan does not cover, and no benefit shall be paid for any disabilities: For which you are not under the regular care of a licensed physician; Resulting from active participation in a war, declared or undeclared, or any act of war; Resulting from active participation in a riot or in the commission of a felony; Caused or contributed to by an intentionally self-inflicted injury; Caused or contributed to by non-medically necessary cosmetic surgery; Caused by being engaged in an illegal act. Nervous/Mental or Substance Abuse Limit Benefits for nervous/mental or substance abuse disabilities are limited to 24 months of long-term disability coverage. When Benefits Begin and End You can apply for long-term disability benefits after a waiting period of 26 weeks of total disability. The waiting period begins on the date your doctor and the reviewing physician at CIGNA Group Insurance certify that you meet the applicable definition of total disability. While you meet the applicable definition of total disability, the length of time benefits continue is based on your age at the time the disability begins. If you become disabled: At or before age 62 At age 63 At age 64 At age 65 At age 66 At age 67 At age 68 At or after age 69 The maximum amount of time you will receive benefits is: To normal retirement age* or 42 months, if greater 36 months 30 months 24 months 21 months 18 months 15 months 12 months *Normal retirement age means the Social Security Normal Retirement Age as stated in the 1983 revision of the United States Social Security Act. It is determined by your date of birth. The table below shows the maximum duration for which benefits may be paid. All other limitations of the plan will apply. Page 3
5 Year of Birth Social Security Normal Retirement Age 1937 or before months months months months months 1943 thru months months months months months 1960 or after 67 Benefit payments will terminate on the first to occur of: The date you are no longer disabled; The date you fail to furnish proof of loss, when requested by the claims administrator; The date you are no longer under the regular care of a physician, or refuse the claims administrator's request that you submit to an examination by a physician; The date you refuse to participate in rehabilitation efforts as required by CIGNA; The date you refuse to participate in transitional work arrangements or other modified work arrangements; The date you die; The date your current monthly earnings exceed: o 80% of your Indexed pre-disability earnings if you are receiving benefits for being disabled; The date determined from the maximum duration of benefits table; or The date no further benefits are payable under any provision in this plan that limits benefit duration. Long-Term Disability Claim Information To receive long-term disability benefits, you must file a claim with CIGNA Group Insurance. How to File a Claim If you are receiving benefits through the Deluxe short-term disability plan administered by CIGNA Group Insurance, you and your doctor will continue to provide CIGNA Group Insurance with periodic medical updates as required by CIGNA Group Insurance. As you near the mid-point of your short-term disability benefit, your doctor and CIGNA Group Insurance will work with you to apply for long-term disability benefits if you are totally disabled and unable to return to work in your full-time capacity (work and hours). Page 4
6 If you are not receiving benefits through the Deluxe short-term disability plan, to apply for long-term disability benefits, call CIGNA at CIGNA Group Insurance will mail the necessary paperwork to you. Complete the paperwork, attach medical evidence of your disability, and mail all completed information to CIGNA Group Insurance (the address is listed on the claim forms). CIGNA Group Insurance must receive your claim no later than 90 days after the date your long-term disability benefit would otherwise begin. CIGNA Group Insurance reserves the right to visit you to confirm your disability and/or have you examined by a physician of its choice. During your disability, you may be required to provide proof of continuing disability. Eligibility to receive benefits is determined by CIGNA Group Insurance, the Deluxe long-term disability insurance provider. If you knowingly submit a false or fraudulent claim, you are guilty of a crime and may be subject to fines and prison confinement. How Claims Are Paid CIGNA Group Insurance mails benefit checks to you by the last working day of the month for that month's benefit. Recovery of Overpayments CIGNA Group Insurance has the right to collect overpayments from you, or from another insurance company, service plan, or organization that should have made payment. Coordination of Benefits applies to all benefit payments made to you. What Happens to Your Long-Term Disability Plan Benefits When You Leave the Company? When Long-Term Disability Coverage Ends Your eligibility for long-term disability coverage terminates when any of the following conditions occur: The date you cease to be an active, regular employee in an eligible class including: o Temporary layoff; o Leave of absence (including but not limited to a sabbatical approved by the Company and leave for military service); or o General work stoppage (including a strike or lock-out). The policy is terminated. You cease to be a member of the classes of employees eligible for this insurance. This does not include employees who are on an approved Family Medical Leave (FMLA). If you do not return to Deluxe in a benefits-eligible status at the end of your FMLA leave (up to 12 weeks, or 26 weeks for an approved military family medical leave), and you are not totally disabled, you are no longer eligible for long-term disability coverage. Deluxe reserves the right to amend or terminate any of its plans at any time without notice to, or the consent of, employees, retirees, or their dependents. Page 5
7 Guidelines Affecting Your Long-Term Disability Benefits Here are some guidelines that are important to know regarding your long-term disability benefits. Coordination of Benefits Deluxe long-term disability benefits are coordinated (reduced dollar for dollar) with those from the following sources: Social Security disability/retirement benefits to which you and your family are entitled. If your Social Security disability income changes after the Deluxe plan benefits begin, your adjusted monthly benefit from Deluxe is not affected. Disability benefits from Workers' Compensation, occupational disease, or similar law. Disability benefits from federal, state, county, or municipal government disability or retirement plans or laws. Disability benefits covered under the terms of any no-fault auto coverage, uninsured or underinsured motorist, or any other insurance policy or funds. The portion of a settlement or judgment minus associated costs of a lawsuit that represents or compensates for your loss of earnings. Any wage or salary for work performed. If Work Incentive Benefits apply to you, your disability benefits will be reduced as provided under the Work Incentive Benefit. Disability benefits from another Deluxe sponsored benefit plan such as short-term disability. If you are eligible for benefits from one of these other sources, you are required to apply, and reapply as necessary, for these benefits. You are responsible for supplying proof that you have applied for these benefits, and if you are denied, proof that you have appealed the decision. If you are approved, you must inform CIGNA Group Insurance of the benefit amount. If you receive benefits from CIGNA Group Insurance and are later approved by Social Security, Workers' Compensation, or another organization for benefits, any back benefits paid must be reimbursed to CIGNA Group Insurance for any amount that is paid in duplicate. Future benefits from another organization will offset future benefits that will be paid by CIGNA Group Insurance. Social Security Disability Benefits Based on your earnings history, you may be eligible for Social Security disability benefits. To qualify for Social Security disability benefits, your disability must prevent you from doing substantial gainful work and must last, or be expected to last, at least 12 months or result in death. Benefits may begin after five consecutive calendar months of disability and continue until: You recover; You are no longer eligible; or You die. Social Security disability benefits may be taxable depending on your total family income. It is to your advantage to apply for Social Security benefits since approval means you are eligible to receive: Medicare benefits; Cost-of-living Social Security benefit increases; Higher Social Security retirement benefits; and Family Social Security benefits. To apply for Social Security benefits, contact your local Social Security Administration office. Page 6
8 Residual Benefits You may be eligible to receive residual disability (partial disability) benefits if you have been receiving benefits through the Deluxe long-term disability plan and are able to perform some but not all of the essential duties of any occupation. For more information on residual benefits, call CIGNA Group Insurance at Lump Sum Payments Other income benefits or earnings that are paid in a lump sum will be prorated over the period for which the sum is given. If no time is stated, the lump sum will be prorated monthly over a five-year period. If no specific allocation of a lump sum payment is made, CIGNA will assume the total payment is an other income benefit. Assumed Receipt of Benefits CIGNA will assume you or your dependents, if applicable, are receiving other income benefits if you may be eligible for them. They will estimate the amount of these assumed benefits on the basis of what you may be eligible to receive and reduce your disability benefits as if you actually received them. Except for any wage or salary for work performed while disability benefits are payable, CIGNA will not assume your receipt of other income benefits if you provide them proof of the following events. 1. Application was made for these benefits. 2. Reimbursement Agreement is signed by you. 3. Any and all appeals were made for these benefits, or CIGNA has determined further appeals will not be successful. 4. Payments were denied. CIGNA will not assume you have received, nor will they reduce your disability benefits by any elective, actuarially reduced, or early retirement benefits under such laws until you actually receive them. Work Incentive Benefit If you return to work on a partial basis during the first 24 months of your disability benefit, your disability benefit will be adjusted. CIGNA will review the sum of your disability benefit, your current earnings, and any additional other income benefits. If the sum exceeds 100% of your indexed covered earnings, your disability benefit will be reduced by the excess amount. After the first 24 months, your disability benefit will be reduced by 50% of your current earnings received during any month you return to work. If the sum of your disability benefits, your current earnings, and any additional other income benefit exceeds 80% of your monthly indexed covered earnings, your disability benefit will be reduced by the excess amount. No disability benefits will be paid if CIGNA determines you are able to work under a transitional work arrangement or other modified work arrangement and you refuse to do so. Current earnings include any wage or salary you earn for work performed while disability benefits are payable. If you are working for another employer on a regular basis when your disability begins, your current earnings will include any increase in the amount you earn from this work during the period for which disability benefits are payable. CIGNA will, from time to time, review your status and will require satisfactory proof of earnings and continued disability. Rehabilitation during a Period of Disability If you are disabled and CIGNA determines that you are a suitable candidate for rehabilitation, you may participate in a Rehabilitation Plan. CIGNA must agree on the terms and conditions of the Rehabilitation Plan. They may require you to participate in a rehabilitation assessment, at their expense, and/or Rehabilitation Plan and will work with you, your physician, and others as appropriate, to develop a Rehabilitation Plan. If you refuse to participate in the rehabilitation efforts, disability benefits will not be payable. The Rehabilitation Plan may, at CIGNA s discretion, allow for payment of your medical expense, education expense, moving expense, accommodation expense or family care expense while you participate in the program. Page 7
9 A "Rehabilitation Plan" is a written agreement between you and CIGNA in which CIGNA agrees to provide, arrange or authorize vocational or physical rehabilitation services. Successive Periods of Disability Once you are eligible to receive disability benefits under the policy, separate periods of disability resulting from the same or related causes are a continuous period of disability unless you return to active service for more than 6 consecutive months. A period of disability is not continuous if separate periods of disability result from unrelated causes, or your later disability occurs after your coverage under the policy ends. Life Insurance Continuation If you become totally disabled while your life insurance is in force, you may be eligible to continue employee life insurance at no cost to you until: You are no longer receiving long-term disability benefits through the Deluxe sponsored long-term disability plan; The date you do not give Minnesota Life proof of total disability when required; or Coverage normally ends; To be eligible for the waiver of premium, you must follow these guidelines: You must be actively at work and have coverage on the date you become totally disabled and for 12 months just prior to becoming totally disabled. (This applies to both basic and optional coverage-you may have had one of the coverages for 12 months, but not the other. Only the coverage carried for at least 12 months just prior to the date you became totally disabled is eligible for waiver if approved by Minnesota Life.) You must provide the required proof of your total disability when requested by Minnesota Life. Medical Insurance Continuation When you become eligible for long-term disability benefits, you may become eligible to continue your medical coverage for up to 29 months under COBRA. To be eligible for this benefit you must be actively enrolled in medical coverage at the time of your employment termination and you must pay for your coverage as billed by Your Benefits Resources (YBR), the Deluxe benefits plan administrator. Medical coverage through Deluxe will stop after the 18 month period unless you are determined by Social Security to still be disabled under their guidelines. If this occurs, you are eligible to purchase COBRA coverage for an additional eleven months at 150% of the entire cost of coverage. Use of Health Information The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that, in part, requires group health plans to protect the privacy and security of your confidential health information. As an employee welfare benefit plan under ERISA, the Plan is subject to the HIPAA privacy rules. This means that the Plan will not use or disclose your protected health information without your authorization, except for purposes of treatment, payment, health care operation, or Plan administration, or as required or permitted by law. A description of the Plan s uses and disclosures of your protected health information and your rights and protections under the HIPAA privacy rules is set forth in the Deluxe Corporation Notice of Privacy Practices. Page 8
10 Leave of Absence Under the Family and Medical Leave Act of 1993, you may have the right to take a leave of absence to care for yourself or an ill family member, or following the birth or adoption of a child. When you take an eligible family leave, by law, your benefits may be continued during your leave as long as you pay the monthly premium as billed by Your Benefit Resources. This includes your long-term disability premium if you have elected 66 2/3% coverage. Upon your return to active service following a leave of absence that qualifies under the Family and Medical Leave Act of 1993, any canceled insurance will be reinstated as of the date of your return. For more information about the Family and Medical Leave Act, contact your local Human Resources Department. For More Information If you have specific questions about your long-term disability claim, call the CIGNA Group Insurance Customer Care Center at Page 9
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Massachusetts Teachers Association Your Group Short Term Disability Plan Policy No. 570975 011 Underwritten by Unum Life Insurance Company of America 8/4/2008 CERTIFICATE OF COVERAGE Unum Life Insurance
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Act Now! You must apply within 60 days of termination GIVE YOUR FAMILY PEAK PROTECTION Group Long Term Disability Insurance Conversion Plan Enrollment Kit Customer Service Center 888-262-6873 Monday through
Long-Term Disability Insurance Developed for Full-time Employees of Our Lady of Lourdes, Camden Protecting Your Family Securing Your Future As long as you've got your health. If you're physically healthy,
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Employee Group Benefits UNDERWRITTEN BY SUN LIFE ASSURANCE COMPANY OF CANADA Seton Hall University Core Plan / Buy-Up Plan: All Full-Time and Part-Time Active Faculty and Administrators Of Seton Hall University
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Release 9.1.0 YOUR GROUP VOLUNTARY LONG-TERM DISABILITY BENEFITS FOR EMPLOYEES OF: State of Nebraska CLASS(ES): All Eligible Employees EFFECTIVE DATE: July 1, 2013 PUBLICATION DATE: May 15, 2013 NOTICE(S)
Short Insurance Everyone understands the value of protecting your family by purchasing life insurance. But what about protecting your income? How would your bills get paid in the event that you were unable
HANFORD EMPLOYEE WELFARE TRUST SHORT AND LONG TERM DISABILITY PLAN AND DISABILITY EQUALIZER BENEFIT PLAN SUMMARY PLAN DESCRIPTION Amended and Restated January 1, 2014 TABLE OF CONTENTS Page ARTICLE 1 INTRODUCTION...
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