Frequently Asked Questions Regarding Claims Maternity Questions

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1 Maternity Questions MATERNITY QUESTIONS What is the duration for short-term disability benefits for maternity leave? Standard recovery time for maternity leave is six weeks including a Cesarean delivery. Benefits may be considered prior to delivery upon receipt of supporting medical documentation. Benefits could also be considered past the six-week benefit period with supporting medical documentation. Medical records must be submitted for consideration for any time other than the six weeks post delivery time frame. When can I file a claim for maternity benefits? A short-term disability claim may be filed any time during a pregnancy. Benefits may be approved prior to delivery if documentation is submitted that supports a totally disability status. Pregnancy in itself is not disabling until after delivery. How will benefits be paid for maternity leave? Benefits are considered for up to six-weeks after the delivery of a child, subject to the elimination period. Benefits will be paid in one lump sum for the time frame you are eligible. What is an elimination period? The elimination period is a period of time in which benefits are not payable but the employee must satisfy before becoming eligible for benefits. For example, a standard policy allows for a six-week maternity benefit. If your policy has a two-week elimination period, you will be paid for a total of four weeks (six weeks minus the two week elimination period). What happens if I become disabled early in my pregnancy and have to receive benefits for an extended period of time? If you become disabled prior to delivery and there is medical evidence to support disability, benefit checks will issue every two weeks until you deliver and are six weeks post delivery. If my baby is sick and needs care, can I draw disability during this time? No. Medical documentation needs to support disability for the insured only, not dependents.

2 Short Term Disability Questions SHORT TERM DISABILITY QUESTIONS How can I file a claim? Lincoln Financial Group offers three easy ways to file a claim: For Telephonic filing, please call a representative at toll free (866) to initiate your claim over the phone. Your employer can initiate the claim electronically via the web site. Fax or mail a completed claim form to us. Every claim has three portions that need to be completed: the employer section, the employee section and the attending physician's section. All three portions need to be completed for claim consideration and review. What will be my weekly benefit amount? Your benefit amount is a percentage of your weekly salary as stated in your certificate of insurance. Where will my benefit checks be mailed and how often? Our standard procedure is to issue short-term disability checks every other week. Unless otherwise indicated, all claim checks will be mailed directly to the employer. What is an elimination period? The elimination period is a period of time in which benefits are not payable but the employee must satisfy before becoming eligible for benefit payment. My employer does not have sick pay, how can I receive pay through my elimination period? If your employer does not have a sick pay program you may use vacation time or paid time off depending on what is available to you through your employer. Why does Lincoln Financial need updates from my physician? To be eligible for benefits, a person must be found to be totally disabled according to our contract. Objective documentation such as office and treatment records may be required to support the inability to perform one's occupation.

3 Short Term Disability Questions What are medical records? Medical records should include, but are not limited to, office and treatment notes, physical examination notes, progress notes, testing and/or laboratory results, consultations, operative reports, hospitalization records, all types of therapy notes, etc. What is needed to extend a claim? If you are unable to return to work by the date your benefits end, it is important for you to provide medical documentation of complications that have caused your disability to be extended beyond the normal recovery period. Medical documentation includes, but is not limited to, office and treatment notes, physical examination notes, progress notes, all types of testing and/or laboratory results, all types of therapy notes, consultations, operative reports, etc. This information may be obtained from your physician and should be provided at your own expense. A note from your physician without any supporting documentation may not be sufficient to consider benefits. What if I move while I m out on disability? Please call us at (800) , option 1 to report the change of address. You may also us your address change at claimservices@lfg.com Will I have to continue to pay premium while out on short-term disability? Please refer to your certificate of insurance or contact your employer. What does it mean if my claim status is showing pending? If the status of your claim is pending, please contact us at (800) , option 1 to determine what is required to continue processing the claim. What does it mean if my claim status is showing incomplete? If the status of your claim is incomplete, Lincoln Financial needs an Attending Physician's Statement (APS) and Authorization Statement. These forms can be located on under My Forms. If you have questions, please contact us at (800) , option 1 for assistance. Does Lincoln Financial Group integrate with state disability plans? Yes. In California, Hawaii, New Jersey, New York, Puerto Rico and Rhode Island, most employers are required to provide state mandated disability income coverage (the state TDI plan) for both full and part-time employees. The amount received through the state plan would be deducted from your benefit.

4 Short Term Disability Questions What do I do if the disability reoccurs once I am back to work? If you return to work for fewer than two weeks, this is considered the same disability. Your claim representative would reopen your claim and you would not be subject to a new elimination period. However, you would need to submit updated medical records for further review. A new claim form is not required. I m close to reaching my maximum benefit and I have long-term disability. What will happen to my short-term disability? Once the maximum benefit is paid out and if you are still unable to return to work, we link the short-term and long-term disability plans together provided your employer carries longterm protection and you are eligible for the coverage. You will receive an abbreviated longterm disability form from your claim representative. Your claim representative will request additional information from your employer. Lincoln Financial tries to make this process as seamless as possible for you and the employer. If your long-term disability is with another carrier please ask your employer for assistance with filing a claim with the other carrier. If you do not have long-term coverage, your benefits will end. Can I return to work part time and receive disability benefits? Partial disability provides benefits to an employee who returns to work on a part-time basis. The partial language states the amount of weekly partial disability benefit equals the lesser of: The insured person's basic weekly earnings multiplied by the benefit percentage (limited to the maximum weekly benefit); or The insured person's basic weekly earnings minus earnings received from any form of employment for that period of disability. My claim is due to a work related injury can I still file for benefits? When you have a work related injury, you must first file for benefits under Worker's Compensation. We do not pay benefits when you receive Worker's Compensation. If Worker's Compensation denies your claim for benefits, then you can file a claim for benefits with Lincoln Financial Group. Please include a denial from Worker's Compensation when filing the claim.

5 Short Term Disability Questions My employment was terminated while out on short-term disability. Will my benefits stop when my employment ends? If your employment is terminated while out on short-term disability, your benefits will continue as long as we have medical documentation to support ongoing disability or until you reach your maximum benefit duration. What are office and treatment notes or medical records? Office and treatment records are the records a physician creates following each visit. They include test results and x-rays. These are considered to be objective findings. Will short-term disability cover me if I have an elective procedure or a cosmetic procedure done? Short-term disability will pay benefits as long as you are medically unable to perform your job duties and are under the care and treatment of a physician.

6 Long Term Disability Questions LONG TERM DISABILITY QUESTIONS What is long-term disability? Long-term disability is coverage you would use if you become disabled and are unable to perform your job duties due to a medical condition. Long-term disability, with supporting documentation, will replace a percentage of your monthly wage while you are unable to work. How can I file a claim? We require a long-term disability claim form be completed. The claim form has three sections. The sections need to be completed by the employer, employee and doctor. All three sections must be received in order to make a claim determination. An insured going from short-term disability with us to long-term disability with us does not need to complete a new claim form. We link your short-term disability and long-term disability in an efficient and effective manner allowing for a smooth transition from the short-term to long-term coverage. You will be notified of this Links Process when you are close to exhausting your short-term disability benefits. What is an elimination period? The elimination period is a period of time in which benefits are not payable but the employee must satisfy before becoming eligible for benefit payments How will payments be issued to me? You have two options. You may choose to have payments received by check or directly deposited into your checking or savings account. For direct deposit, we require a voided check with your banking information and a direct deposit form. A direct deposit form may be obtained on or you can call us at (800) , option 1 or you may obtain one from your employer. What is a pre-existing condition? A pre-existing condition applies to a sickness or injury from which the employee received medical treatment, consultation, care or services including diagnostic measures or prescribed drugs or medicines during a specific period of time prior to the employee s effective date.

7 Long Term Disability Questions Will an illness always be considered pre-existing if I had been diagnosed prior to my employment? The pre-existing time frame is outlined in your certificate of coverage. The pre-existing exclusion only applies to claims incurred within a period of time specified by your contract, usually the first months following an employee s effective date. Will you require additional information from my doctor(s)? Information may be requested periodically. If updates are required you will be notified by written correspondence. If my claim is denied will I be able to appeal this decision? Yes. A written appeal, with supporting medical documentation, must be received in our office within 60 days of receipt of our decision letter. Will benefits be reduced when I start receiving Social Security benefits? Yes. Our contracts allow for integration of other income the employee received due to the disability. This means that the benefit amount will be reduced by the income received up to the minimum benefit. If the Social Security benefits are larger than the long-term disability benefits, you will still be entitled to the minimum benefit according to your contract. Example: long-term disability benefits are $1,100 per month and Social Security is $1,200 per month. The minimum benefit in the contract is $100 per month. You will receive $1,200 from Social Security and $100 from long-term disability. If your long-term disability benefits are greater than Social Security, you will receive the difference. Example: long-term disability benefit is $1,400 per month and Social Security benefit is $900 per month. You will receive $900 from Social Security and $500 from long-term disability for a total of the $1,400 allowable benefits. Once my claim has been filed, how long does it take to review? If all answers have been completed on your claim form, please allow 5-7 business days for review. A representative will contact you if we are missing or need additional information.

8 How often will my benefit payments be issued? Benefit payments for long-term disability are issued monthly. What is considered a partial disability? Frequently Asked Questions Long Term Disability Questions Partial Disability means as a result of sickness or injury, the insured employee is: Able to perform one or more, but not all of the main duties of his/her occupation or any occupation of a full or part-time basis; or Able to perform all of the main duties of his/her own occupation or any other occupation, but only on a part-time basis. If I return to work part-time will my benefits be reduced by any wages I receive? Long-term disability encourages you to return to work. If you return to work part-time, we will not offset your benefit. Example: You are working 20 hours per week and are also receiving a long-term disability benefit of 60% of your salary. If 20 hours per week equals 50% of your predisability wage, then your long-term disability benefit would be reduced from 60% to 50%. Combined, you would be able to receive 100% of your pre disability monthly salary. You will never receive more than 100% of your pre-disability wage. What happens if my employment is terminated while I am on long-term disability? If your employment terminates, your long-term disability will continue to pay benefits as long as you remain totally disabled or until the maximum benefit duration is met. What options do I have if I can't return to my occupation? We provide assistance to anyone who wishes to return to work but would not be able to return to his or her prior occupation. This is referred to as a Rehabilitation Benefit. Please contact your claim representative for more information. Will I be notified if my payments are stopped for any reason? You will be contacted if your claim representative requires updated medical records or any additional information.

9 Will my employer receive information on my claim? Frequently Asked Questions Long Term Disability Questions Due to privacy regulations, your employer will not have access to any of your medical information. Your employer will receive standard letters advising them if benefits are approved or if payments will end. Can my spouse or family member call and discuss my claim? Due to privacy, we cannot release information on your claim unless you have completed an authorization form. This form can be located on under My Forms. What do I do if my check was issued but not received? If you do not receive your check within 12 calendar days of the date the check was mailed, please call Claim Services at (800) , option 1 and a client service representative will assist you. Payment from direct deposit will appear in your account within three business days from the date issued. If your account does not reflect a deposit, please call our Claim Services at (800) , option 1. What is the difference between own occupation and any occupation? Own Occupation means the occupation, trade or profession: In which the you were employed with the employer prior to disability; and Which was your main source of earned income prior to disability It means a collective description of related jobs, as defined by the U.S. Department of Labor Dictionary of Occupational Titles. It includes any work in the same occupation for pay or profit, regardless of: Whether such work is with the employer or on a self-employed basis; or Whether a suitable opening is currently available with the employer or in the local labor market Any occupation means a position in which you have training, education or experience.

10 Life Contract Questions LIFE CONTRACT QUESTIONS What is Accidental Death or AD&D? Accidental Death and Dismemberment (AD&D) is a benefit tied to your life insurance plan. Accidental Death and Dismemberment could pay you or your beneficiary additional benefits if you lose your life in an accident or if you become dismembered due to an accident. Please refer to your certificate of insurance for specific amounts and details regarding the AD&D provisions. What is a beneficiary? The beneficiary is the person or persons you wish to leave your life insurance benefits upon your death. Please be sure to update your beneficiary whenever circumstances change due to marriage, divorce or death of the person named, etc. How do I change my beneficiary? To change your beneficiary, please go to "My Forms" on and select the "Beneficiary Designation" form. Please complete the form and fax or mail to us. The fax number and mailing information are on the form. You may also obtain this form from your employer. How do I complete the beneficiary designation form when I have more than one beneficiary? When listing more than one beneficiary, please list complete information for each person including the percentage of benefits each person should receive. The percentages should add to 100%. For example, your spouse will receive 50% of the benefit and your two children should each receive 25% of the benefit ( =100). What happens if I have a minor child as my beneficiary? According to state law a minor lacks capacity to sign a binding release of an insurance contract. Only the lawfully appointed representative of a minor may give release for the payment to a minor. Life insurance, therefore, cannot be paid to anyone who has not reached the age of majority. If guardianship documents are not secured, the proceeds will be held in trust until the beneficiary reaches the age of majority, unless state statutes (e.g. the Uniform Gifts/Transfer to Minors Act) in the appropriate jurisdiction allow for other payment provisions to be used.

11 What if I do not designate a beneficiary? Frequently Asked Questions Life Contract Questions Payment may be made to certain relatives or your estate. Please see the certificate of insurance for more information. How does the beneficiary receive the life benefit? The beneficiary will need to sign and complete the beneficiary portion of the life claim form. The employer section of the life claim form and a certified copy of the death certificate are also required. What happens to my life insurance policy if I terminate employment? Life insurance terminates when your employment ends. You may have the option of continuing the life coverage. Please refer to your certificate of insurance for continuation options. What happens if I become disabled? Would I be able to continue my life insurance coverage? If you are under the age of 60 and become totally disabled from all occupations for a period of six months, you may qualify for extension of death benefits or life waiver of premium. This means your coverage will continue as if you were still employed but no premium will be collected from you or your employer. If you happen to be over the age of 60 when you become disabled, you would not qualify for life waiver of premium. You can convert to an individual whole life policy or check with your Human Resource Department for options your certificate of coverage may contain.

12 Life Contract Questions What is the accelerated death benefit? The accelerated death benefit is also called the living benefit. This benefit allows advance payment of part (based on policy language) of the insured person's personal life insurance. It may be paid to a terminally ill insured person in a lump sum once in her/his lifetime. To qualify in most states, the insured person must: Satisfy the actively at work requirement under the policy. Be insured under the policy for at least twelve months (some states may vary check the policy to verify timeline). Have a minimum amount of personal life insurance under the policy on the date the living benefit is paid ($20,000 is standard check the specific policy to verify the amount). Be insured under the policy on the date the living benefit is to be paid. (Certain state requirements may vary. See your specific policy for details.) How do I apply for extension of death benefits (waiver of premium)? For life waiver of premium, there is a specific form, which must be completed to make application for these benefits. This form is the extension of death benefits form located on The employee must be totally disabled as defined by the policy from any occupation for at least six months and be under the age 60 at the time of disability (see your certificate of coverage for plan details as age and waiting period may vary). What happens if I am on life waiver of premium and I am able to return to work? When you return to work you are no longer eligible for life waiver of premium. Premium payments will resume upon your return to work What does it mean if a claim's status is showing incomplete? If a claim's status is Incomplete, in general, that means Lincoln Financial needs proof of claim. For Life claims, this consists of a completed claim form and a Certified Death Certificate. For Life Waiver, Living Benefit and AD&D claims, this consists of a completed claim form and Attending Physician's Statement (APS). If you have questions, please contact us at (800) , option 1 for assistance.

13 Dental Questions DENTAL QUESTIONS How do I know if my plan is a PPO plan? Please refer to your certificate of insurance to determine if your plan is PPO or please call us at , option one and a customer service representative will assist you. How do I find a participating dentist? Please use the "Participating Dentist Finder" tab on to search for a participating dentist in your zip code area or please call us at (800) , option 1 and a customer service representative will assist you. What is the difference between network providers (PPO) and nonparticipating providers? Using a network provider is a cost savings to you as the provider is under contract. If the fee they charge exceeds the contracted amount, the dentist will write this amount off your bill. Non-participating dental offices will bill a fee that is subject to usual and customary charges for the geographical area. If the fee exceeds usual and customary charges, you are responsible for the amount over the usual and customary amount. How do I file a claim? We accept the standard American Dental Association (ADA) forms that most dental offices use. You can also use our claim form that can be located under "My Forms." How will my dental office be able to verify eligibility and benefits? Your dental office can call our Claim Services at (800) , option 1 to receive a faxed detailed copy of your dental benefits. If my employment ends, will I have a coverage continuation option? Yes. You may elect COBRA coverage. You need to complete the dental COBRA election form within 60 days of the date of termination or qualifying event. The form must be completed, signed, dated and submitted to your employer. The form can be located on under "My Forms," or may be obtained from your employer or you can call Claim Services at (800) , option 1.

14 Dental Questions What is the turnaround time for dental claims? Claims are reviewed and processed within 5-7 business days from the date all requested information has been received. Can anyone call for information on my claim? Due to privacy regulations, protected health information is only shared with the dental office, the insured or the claimant. Will Lincoln Financial pay the lifetime max on orthodontia in a lump sum or over a period of time? Orthodontia claims are paid in installments based on dates of service. When should a pre-determination of benefits be requested? If you or your dentist anticipates the cost of treatment for dental expenses to exceed $300.00, a pre-determination is recommended. This will allow you and the dentist to find out before the work is done how the charges will be covered by the plan. What does "Alternate Benefits applied" mean? When there are two or more methods of treating a dental condition, the amount of the covered expense will be based on the charge for the least costly procedure that Lincoln Financial Group determines to be appropriate and adequate. This determination is based on current professional dental standards. At what age will my dependent child/children's' eligibility end? Your certificate of insurance will define the maximum age for which your child/children will be covered. How do I remove a dependent from my policy? Please contact your employer. How will I be reimbursed if I paid my dental office for services? Please indicate on the claim form that payment should go to the insured.

15 Dental Questions What is required to appeal a denied claim? In most instances, a written appeal must be received within 180 days from the date of denial to reconsider a denied claim. The appeal letter should include the reason the claim should be reconsidered and include: Employee's and patient's name Employee's Social Security number Dentist's name Date(s) of service Supporting documentation, i.e., x-rays, narrative, charting, when appropriate How can I determine what services are Type I, II or III? Please refer to your certificate of insurance for definitions and examples or call us at (800) , option 1. What is an indemnity plan? An indemnity plan allows you to see any provider of your choice. Will my dental policy cover whitening of my teeth? No. Whitening of the teeth is considered cosmetic and will not be covered under your dental policy. Please see your certificate of insurance for more details. What is a calendar year maximum? The calendar year maximum is the amount we will pay in the calendar year for covered dental services received per person. Is the calendar year maximum for my whole family? No. Each family member has an individual calendar year maximum. For example, if your maximum is $1,000 we will pay up to $1,000 per calendar year for each covered member of your family. What is a deductible? A one time per calendar year amount that applies to certain types of procedures. Please check your certificate of insurance for details.