Long-Term Disability (LTD) Plan

Transcription

1 Long-Term Disability (LTD) Plan This document is a Summary Plan Description (SPD), as defined by the Employee Retirement Income Security Act of 1974 (ERISA), of the Toys R Us, Inc. Long-Term Disability (LTD) Plan. This SPD is a summary of the main features of the Plan in effect as of July 1, Details of the Plan are contained in the insurance contract that legally governs the Plan. If there is any discrepancy between the information contained in this document and the insurance contract, the insurance contract will always govern. If there are legal rules that require changes that are not yet written into the contract, the contract will be interpreted by the Plan Administrator as including those legal rules. Please note that nothing in this document is meant to imply a contract or guarantee of employment. Participation in the Plan does not preclude Toys R Us, Inc. from terminating your employment at any time, whether or not for cause, with or without notice. Please read this document carefully and share the information with your family. If you have any questions about this Plan, please contact Aetna Life Insurance Company This Summary Plan Description supersedes and replaces any previous SPDs you have received describing the Long-Term Disability Plan. Toys R Us, Inc. Long-Term Disability (LTD) Plan

2 Contents Long-Term Disability (LTD) Plan... 1 Your Long-Term Disability Plan at a Glance... 3 Benefit Amount... 4 Taxation of Benefits... 4 Social Security Benefits... 5 Duration of Benefits... 5 Mental and Nervous Conditions... 7 Extended Disability Benefit... 7 Rehabilitation... 7 Return to Work Incentive... 7 Recurring Disability... 7 Child Care Benefit... 8 Survivor Benefit... 8 Exclusions... 8 Claiming Benefits... 8 Recovery of Overpayment... 9 Other Benefits during Disability Returning to Work When Coverage Ends Glossary of Key Terms Toys R Us, Inc. Long-Term Disability (LTD) Plan

3 Your Long-Term Disability Plan at a Glance Here are the highlights of the Long-Term Disability Plan, which provides income protection if you are unable to work for an extended period of time due to illness or injury. Benefits may be subject to certain limits and restrictions. Be sure to review the rest of this Summary Plan Description (SPD) for a more complete description of Plan benefits. For information about participation requirements, see Eligibility and Enrollment; see Administrative and Legal Information for how to file a claim, legal notices and where to obtain additional information. Long-Term Disability Plan Benefits Begin Basic LTD Benefit Supplemental LTD Benefit Minimum Monthly Benefit After 180 days of disability 60% of covered monthly earnings, reduced by other disability income 60% of covered monthly earnings in excess of $200,000, reduced by other disability income 10% of the monthly benefit amount or $100, whichever is greater Maximum Monthly Benefit Basic LTD $10,000 Basic and Supplemental LTD combined $20,000 Maximum Benefit Period To age 67, or older if disabled after age 62 Toys R Us, Inc. Long-Term Disability (LTD) Plan

4 Benefit Amount To receive LTD benefits you must be under the regular and appropriate care and treatment of a physician. Basic LTD in combination with other disability income continues: 60% of your covered monthly earnings up to a Maximum monthly benefit of $10,000. In no case will you receive less than $100 a month or 10% of your gross monthly benefit from the LTD Plan alone, no matter how much other disability income you or your family get for that same disability. If your LTD benefit begins in the middle of the month, your LTD benefit for that month is based on 1/30 th of the monthly benefit for each day you are on LTD. Once your LTD benefit has been determined, cost of living adjustments made to any other income benefits you receive will not further reduce your Long-Term Disability benefits. Increases to your covered monthly earnings will be reflected in your LTD benefit amount on the day of the increase, provided you are actively at work on that day. Otherwise your benefit amount will increase on the day you return to active work. Supplemental LTD If you are eligible and enrolled, Supplemental LTD in combination with other disability income continues: 60% of your covered monthly earnings in excess of $200,000 up to a Combined maximum monthly benefit (Basic and Supplemental) of $20,000. Taxation of Benefits The Company provides Basic LTD coverage to all eligible team members, automatically and at no cost to you. Because you are not taxed on the premiums that Toys R Us, Inc. pays for this coverage, any Basic LTD benefits you receive are considered taxable income. If you are eligible for and elect Supplemental LTD, you pay the full cost of this coverage with after-tax dollars. This means that any Supplemental LTD benefits you receive are free from income tax. The Insurance company calculates the portion of your benefit that is taxable based on the percentage of the total cost paid by the Company (for team members in your employment class), as of the date immediately before your date of disability. Toys R Us, Inc. Long-Term Disability (LTD) Plan

5 Social Security Benefits In case of disability, you may be eligible for primary and/or family Social Security disability benefits. The amount of these benefits will vary depending on your salary, employment history, and the size of your family. When you become totally disabled, you are required to apply for Social Security benefits as soon as possible. If the Social Security Administration denies your claim, you must follow the Social Security Administration s claims appeal process. If the Insurance Company requires you to request a hearing before an Administrative Law Judge of the Office of Hearing and Appeals, the Insurance Company will pay your costs to attend the hearing. Your LTD benefits will be reduced by the amount of your Social Security disability benefits. If you do not apply for Social Security disability benefits, the Insurance company reserves the right to reduce your LTD benefits using an estimate of what you would have received from Social Security had you applied. If you are denied Social Security Disability Income (SSDI) and are in the process of appealing the denial, Aetna will not offset an estimated SSDI award as long as the appeal is in process. Duration of Benefits LTD benefits begin after you complete the benefit waiting period. In order to qualify for these benefits, you must be receiving regular and appropriate care from a licensed physician. You must also provide satisfactory evidence of continuing disability at the Insurance Company s request. Once they begin, LTD benefits continue for as long as you remain disabled (subject to any other Plan limits) up to the maximum payment period shown below. Age When Disability Starts Maximum Payment Period* Under age 62 To age months months months months months months months 69 or older 12 months * Benefits will continue up to your normal retirement age, if longer than the period listed. Toys R Us, Inc. Long-Term Disability (LTD) Plan

6 LTD payments stop on the date you: Are no longer disabled Reach the maximum payment period (or normal retirement age if later) Die or Fail to provide written proof of your disability acceptable to the Insurance Company. Toys R Us, Inc. Long-Term Disability (LTD) Plan

7 Mental and Nervous Conditions If your disability is due to a mental or nervous disorder, Plan benefits will be paid for a lifetime maximum of 24 months if you are not hospitalized. If you enter the hospital during this 24-month period, you will receive LTD benefits while hospital confined but not beyond the maximum benefit payment period. If you are hospitalized for at least 14 consecutive days and continue to be disabled after you are discharged, you will receive LTD benefits for the greater of: Any remaining portion of the 24-month period or 90 days, But not beyond the maximum benefit payment period. Extended Disability Benefit A reduced disability benefit may be payable for up to 60 months beyond the maximum duration if disabled team member is confined or receiving home health care and requires substantial assistance to perform 2 or more ADLs or substantial supervision due to cognitive impairment. Benefit is reduced to 85% of the monthly benefit, after offsets applied, up to $5,000/month. Rehabilitation If you are receiving a monthly benefit because you are considered totally disabled under the Plan you will continue to receive your monthly benefit plus if you participate in an approved rehabilitation program in an effort to return to work, you will receive an additional 10% of net monthly benefit after offsets subject to a $500 monthly maximum payable up to 6 consecutive months. Aetna includes worksite modifications within the rehabilitation program. You will be considered able to perform rehabilitative employment if a physician or licensed or certified rehabilitation specialist approved by the Insurance Company determines that you can perform such employment. Return to Work Incentive If you work while you are disabled, you are eligible for the return to work incentive. This Plan feature permits you to receive your earnings from your work in addition to your monthly LTD benefit for up to 12 months. In no case, however, can your LTD benefit plus your work earnings exceed 100% of your predisability earnings. If they do, your LTD benefit will be reduced by the amount of the excess (but not to less than the minimum monthly benefit). Recurring Disability LTD payments resume immediately if you had been receiving LTD benefits and the same or a related disability recurs within six months after you return to full-time work. Otherwise, the new disability is separate from the first. This means that you must meet the Plan s 180-day benefit waiting period before LTD benefits start again. Toys R Us, Inc. Long-Term Disability (LTD) Plan

8 Child Care Benefit If you are receiving LTD benefits, you may qualify for the child care benefit in addition to your regular monthly LTD Plan payment if you: Are receiving the return to work incentive benefit Have an eligible dependent child who requires child care because you are working and Obtain the services of a licensed child care provider who is not related to or living with you. You can receive an additional monthly amount equal to your actual child care expenses, up to a maximum of $250 total per month for children under age 15 or a handicapped dependent child of any age. In no case will the benefit exceed what you are paying for child care required because of any rehabilitative employment in which you are engaged, nor will it exceed $500 per month payable up to 12 months. Survivor Benefit If you die while receiving Plan payments, a survivor benefit equal to three times your monthly benefit (not reduced by any earnings from rehabilitative employment) will be paid to your eligible survivor. If you have no eligible survivor, payment will be made to your estate. Exclusions The LTD Plan covers most disabilities. Not covered are disabilities due to: Act of war Insurrection, riot, civil commotion Intentionally self-inflicted injury or illness Injury resulting from your participation in a felony Involvement in a fight in which you are the aggressor Driving while intoxicated Driving while under the influence of prescription drugs in excess of prescribed amounts Driving while under the influence of over-the-counter medications taken in excess of dosage instructed A pre-existing condition i.e., any condition for which you were treated within the three months immediately before you became a Plan member if that condition causes you to become totally disabled during the first 12 months coverage is in effect. Claiming Benefits You must file a claim to receive LTD benefits. Approval of your disability under your salary continuation (STD) plan benefit by the Insurance Company will suffice as claim filing on your behalf. Toys R Us, Inc. Long-Term Disability (LTD) Plan

9 Recovery of Overpayment If you receive a benefit payment for more than it should be, the Insurance company reserves the right to recover the full amount of the overpayment by: Requiring you to return the overpayment in one lump sum or Stopping benefits until the overpayment has been repaid. If you have not yet been approved for Social Security disability benefits, the Insurance Company may ask you to sign an agreement promising to reimburse the Plan for any overpayments before paying LTD benefits. Toys R Us, Inc. Long-Term Disability (LTD) Plan

10 Other Benefits during Disability If you are receiving disability benefits, your coverage under other Company-sponsored benefit plans may continue as described below. Your employment will terminate after you have exhausted your maximum leave time available. Benefit Plan Medical (including prescription drugs), Dental and Vision If your employment is not terminated Coverage continues as long as you pay your premiums timely If your employment is terminated You will be offered COBRA continuation coverage Health Savings Account Flexible Spending Accounts (FSAs) Basic Life and AD&D Insurance Supplemental Life and AD&D Insurance Spouse and Child Life Insurance Contributions will be suspended while you are on LTD. You will have to re-start your contributions upon return to work. Contributions will be suspended until you return to work Coverage continues Coverage continues as long as you pay your premiums timely Coverage continues as long as you pay your premiums timely Your Health Savings Account will become unaffiliated with Toys R Us and you will have to pay applicable account fees. You will be offered COBRA continuation coverage for the Limited Purpose FSA only; coverage under the Dependent Care FSA ends when your employment ends You will be offered the option to continue your Life Insurance coverage by converting it to individual insurance (AD&D cannot be converted) You will be offered the option to continue your Life Insurance coverage by converting it to individual insurance (AD&D cannot be converted) You will be offered the option to convert your coverage to individual insurance TRU Partnership Employees Savings and Profit Sharing Plan ( TRU Plan) You are 100% vested, and provided the Retirement Plan Committee approves your disability, you can receive payment of your accounts as provided under the TRU Plan Employee Assistance Program (EAP) Coverage continues COBRA continuation coverage applies Toys R Us, Inc. Long-Term Disability (LTD) Plan

11 Returning to Work If you plan to return to work following a disability, you must notify your supervisor and the Benefits Helpline ( ) at least two (2) weeks in advance that you intend to return to work. You will also be required to provide a statement from your health care provider that you are fit to return to work. The Company will make every reasonable attempt to place you in the same or an equivalent position when you return to work following a disability. However, there is no guarantee that a position at the Company will be available. When Coverage Ends LTD coverage stops on the earliest of the date: Your employment ends or you are transferred to an ineligible class of employment The Plan ends The Plan is amended to exclude the class of employees that includes you You are no longer eligible. Supplemental LTD also stops if you do not make the required contributions. If you become disabled while LTD coverage is in effect, your benefits will continue as long as you remain disabled up to the maximum benefit period, even if your coverage ends due to one of the events above. Toys R Us, Inc. Long-Term Disability (LTD) Plan

12 Glossary of Key Terms To help you understand how the Long-Term Disability (LTD) Plan works, you should familiarize yourself with the following key terms. Actively at work (Active work) Performing the essential duties of your position in the place where you normally work and in the manner in which the job is normally performed. You are considered actively at work during approved time off (for example, vacation, jury duty or bereavement leave), but not for time off due to an illness or injury. Activities of daily living (ADL) Includes bathing, dressing, eating and/or feeding, transferring (the ability to move in and out of a chair or bed) and toileting. Benefit waiting period The 180-day period that you must be continuously disabled before LTD benefits begin. It starts on the day you become disabled, as certified in writing by your doctor. If you are able to return to work during the benefit waiting period, you can do so for up to 30 days without having to begin a new waiting period if you again become disabled. However, any days that you return to work will not count toward meeting the waiting period. Cognitive impairment (Cognitively impaired) Confusion or disorientation due to organic changes in the brain that result in deterioration or loss of intellectual capacity. Company Toys R Us, Inc. Covered monthly earnings For: Management team members: Your monthly salary on the day before your total disability began prior to any deductions to a 401(k) or section 125 plan, not including commissions, overtime, bonuses (other than target bonus), or any other special compensation, plus 1/12 of your annual target bonus just prior to the date your total disability began Insured hourly team members: Your hourly rate of pay on the day before your total disability began multiplied by the number of standard hours worked during a regular work week, not to exceed 40 hours per week for Level IV 3+ positions and not to exceed 47.5 hours per week for grade M90 and assistant manager positions, multiplied by Dependent child An unmarried child under age 15, who resides in your home and is financially dependent on you for support and maintenance. Children include natural or adopted children, foster children, stepchildren or your domestic partner s children. Doctor (Physician) A state licensed, certified practitioner practicing within the scope of his or her license, and recognized by state law as qualified to treat the injury or sickness that is causing the disability. The doctor cannot be you, a member of your family or a team member of the Company. Toys R Us, Inc. Long-Term Disability (LTD) Plan

13 Domestic partner An individual of the same or opposite sex with whom you reside, provided you and that individual: Are not so closely related that marriage would otherwise be prohibited Are not legally married to each other or to any other person and are the sole partners of each other Have lived together for at least six (6) months in the same residence with the intention of residing together permanently Are both at least 18 years old and mentally competent to enter into a contract Are in a committed and mutually exclusive relationship, jointly responsible for each other s welfare and financial obligations and Are registered as domestic partners pursuant to a domestic partnership ordinance or law of a state or local government, or you have filed an Affidavit of Domestic Partnership with the Insurance Company. Eligible classes The following categories used by the Plan only when determining whether a covered team member is totally disabled: Class 1 team members active full-time directors, grade level D or above who are engaged in non-hazardous occupations and function primarily in an office environment Class 2 team members active full-time and part-time salaried/exempt management, active fulltime hourly team members in Level IV 3+ positions at R HQ and active full-time hourly nonexempt team members otherwise classified as management (including grade level M90 and California assistant managers), except those covered in Class 1. Eligible survivor Your spouse or domestic partner. If you have neither, your child(ren) under age 25. Children include natural or adopted children, stepchildren, or your domestic partner s children. Hospital A facility licensed to provide care and treatment for the condition causing the team member s total disability. Hospital confined A hospital stay of at least 24 hours. Insurance company Aetna Life Insurance Company. Mental or nervous disorder A disorder which is diagnosed to include a condition such as: Bipolar disorder (manic depressive syndrome) Schizophrenia Delusional (paranoid) disorders Psychotic disorders Depressive disorders Anxiety disorders Somatoform disorders (psychosomatic illness) Eating disorders or Mental illness. Toys R Us, Inc. Long-Term Disability (LTD) Plan

14 Normal retirement age Defined by the 1983 amendments to the United States Social Security Act and determined by your year of birth, as follows: Year of Birth 1937 or earlier 65 years Normal Retirement Age years and 2 months years and 4 months years and 6 months years and 8 months years and 10 months 1943 through years years and 2 months years and 4 months years and 6 months years and 8 months years and 10 months 1960 and later 67 years Other disability income Amounts you receive for a disability for which you also receive benefits under this Plan. They can be paid to you, your spouse, your children or a third party on your behalf and include benefits from primary and family Social Security benefits, Workers Compensation, the Jones Act, occupational disease or similar laws or any Company-sponsored plan that pays disability benefits. The Insurance company will assume that you are eligible for and receiving other disability income unless you notify them in writing that these benefits have been denied or are being contested. The Insurance Company may estimate the amount of other disability benefits and reduce the monthly LTD benefit accordingly. In this case, once the actual amount of the other disability benefit is determined (or if other disability benefits are denied), the monthly LTD benefit will be adjusted as necessary after written proof is provided. Other disability income does not include benefits from any individual disability insurance you may purchase on your own. Rehabilitative Employment Work in any gainful occupation for which your training, education or experience will reasonably allow. The work must be supervised by a physician or a licensed or certified rehabilitation specialist approved by the Insurance company. Rehabilitative employment includes work performed while you are partially disabled, but does not include performing all the material duties of your regular occupation on a full-time basis. Spouse The individual to whom you are legally married according to civil law in the jurisdiction in which the ceremony took place (including a common-law spouse if recognized by state law in your state of residence). Toys R Us, Inc. Long-Term Disability (LTD) Plan

15 Total Disability or Totally Disabled As a result of injury or sickness: Class 1 team members during the elimination period and thereafter you cannot perform the material duties of your regular occupation Class 2 team members during the elimination period and for the first 36 months for which a monthly benefit is payable, you cannot perform the material duties of your regular occupation; after a monthly benefit has been paid for 36 months, you cannot perform the material duties of any occupation. Toys R Us, Inc. Long-Term Disability (LTD) Plan