SHORT-TERM DISABILITY (STD)

Transcription

1 SHORT-TERM DISABILITY (STD) Continuous Leave for an Employee s Own Illness or Injury Short-Term Disability (STD) provides benefits to qualifying employees who are disabled because of a non-work-related illness or injury by continuing a portion of the base pay for up to 25 weeks per illness or injury. STD begins paying benefits after a five-day waiting period and will pay benefits for up to the maximum benefit period (see below) if an employee is unable to work, as determined by the Leave Management Administrator. STD will run concurrently with Family and Medical Leave (FML) where applicable. Objective medical information supporting the employee s claim must be submitted by the employee s physician and approved by the Leave Management Administrator to receive STD benefits. Eligibility Full-time and regular part-time SunTrust employees are automatically eligible to participate in the STD plan on the day after completion of six months of service. Employees who are absent on the day following completion of six months of service become eligible to participate when they return to work. Full-time employees receive a combination of STD benefits paid at 100% and 60% of base pay for their first illness/injury occurrence in each calendar year. Once full-time employees have exhausted their 100% benefit they are eligible for 60% pay up to 25 weeks for each additional illness/injury occurrence in the calendar year. Regular part-time employees are eligible for 100% paid days only. The amount of STD benefits (100% pay portion) for which employees are eligible each year is based on their length of service and will be determined on the first business day of the calendar year. If the employee is on leave on the first working day of the calendar year, employees will continue under the prior year s STD benefit until they return to work. The benefit for the next year will be effective the first day the employee returns to work. Rehires Rehired employees are treated as a new hire for eligibility and for the determination of the number of weeks of 100% STD coverage during the year in which they are rehired. Provided that the break in service with SunTrust was less than five years, on the following January 1, the employee will receive credit for the prior SunTrust service to determine the number of weeks of 100% STD coverage. The 6- month waiting period must be satisfied before the employee is eligible for benefits. Transfers If employees transfer from an ineligible to an eligible status for example, from temporary to regular part-time they will be treated as new hires during the calendar year of the status change for eligibility and to determine the number of weeks of STD coverage. The following January 1, or once the 6-month waiting period is satisfied, the employee will receive credit for the prior service to determine the number of weeks of 100% STD coverage as long as the employee is not on a leave of absence on that date. If an employee transfers from part-time to full-time and has already satisfied the 6-month waiting period they will be immediately eligible for 60% STD coverage. If not, the eligibility requirement for 60% STD coverage will be met after meeting the 6-month waiting period.

2 Eligibility for coverage under STD ends when an employee: Terminates employment Retires; or Is no longer a full-time or regular part-time employee. Service STD Program Based on service as of year-end in current year Less than 6 months 7 months to 4 years 5-day waiting period Not Eligible 1 week (5 work days) FT/PT 100% pay FT Only 60% pay* 4 weeks 21 weeks Long-Term Disability for fulltime employees with six months of service who remain totally disabled 5+ years 1 week (5 work days) 8 weeks 17 weeks The amount of STD should replace the pay employees would have received had they worked their regular schedule; i.e., if the employee is regularly scheduled to work 4 hours on a day that qualifies, the employee should receive 4 hours of STD. *Full-time employees can elect to use vacation to supplement 60% pay *Full-time employees are eligible for 60% pay up to 25 weeks for each additional illness/injury occurrence approved by the Leave Management Administrator. Qualification for Benefits Medical review and approval is required for receipt of STD benefits. Your claim is not considered complete until objective medical documentation supporting your claim is submitted on your behalf by your physician. Benefits will be determined once an employee has been declared to be "disabled" for more than five consecutive business days by the Leave Management Administrator. An employee will be deemed to be disabled if they are not able, solely because of disease or injury to perform the material duties of their own occupation and are under the regular care of a physician. If an employee s own occupation requires a professional or occupational license or certification of any kind, they will not be deemed to be disabled solely because of loss of license or certification due to disease or injury. What Is Not Covered by STD No benefits are payable for any disability resulting from any of the following: War or any act of war that is declared or undeclared Service in the armed forces as an active member or as a reservist of any country; Illness or injury covered by Workers Compensation, occupational disease, or similar laws providing benefits; An employee's active participation in an insurrection, rebellion, riot, or criminal act; Intentionally self-inflicted injuries; or

3 Cosmetic or other surgery that is not medically necessary unless warranted as a result of an accident or illness (e.g., breast reconstruction post mastectomy). Complications arising from a noncovered cosmetic surgery are not excluded. Five-Day Waiting Period There is a five-day waiting period (five consecutive work days) before Short-Term Disability benefits begin. This waiting period applies to each leave. The first day of the waiting period is the first day an employee is absent from his or her position due to his or her own illness. Reinstatement Reinstatement following a leave involving receipt of STD benefits is not guaranteed unless the leave itself runs concurrently with Family and Medical Leave (FML). Generally, employees who return from FML are entitled to be reinstated to their former positions, or an equivalent position, as defined by law. SunTrust has the right to require employees to remain in contact during FML and to notify SunTrust when they intend to return to work. Employees will be notified if their position will not be held open because of ineligibility under FMLA or some other lawful reason. In this situation, generally employees will be given 60 unpaid calendar days to seek a new position with SunTrust once medically released to return to work, unless they are on probation or within 12 months from the date of a Final Warning, or their most recent job performance rating is below satisfactory standards. In such situation, consistent with SunTrust s Job Posting guidelines, employees will not be eligible to post for other positions, and employment will be terminated immediately. Recurrent Disability If employees return to work at SunTrust after receiving STD benefits but find they are unable to continue working within 30 calendar days of returning and go back on leave for the same condition, they will be under the same period of disability. There will be no requirement to satisfy a new five-day waiting period before STD benefit payments can resume. Additionally, if the employee satisfied the five-day waiting period but did not qualify for an STD benefit because he or she was not out beyond the waiting period, and has a recurring disability, the five-day waiting period will be considered satisfied. Employees who return to work in December and go back on leave for the same condition within 30 days in January will be considered to be on the same disability. If they have already received their allowed 100% days, they will continue to receive 60% pay until they are no longer disabled, or meet the waiting period for LTD. If employees return for fewer than 30 days and go back on leave for a new condition, it will be considered a new period of disability and will require a new waiting period. Employee Responsibilities Notify supervisor regarding each absence until leave has been approved. Please refer to the Attendance & Punctuality policy for complete notification guidelines. Contact the Leave Management Administrator, at , option #4. Notify the Leave Management Administrator (personally or through a representative) after becoming unable to work for three or more days to be eligible to receive benefit payments from the first date of disability. How the STD Benefit Is Determined The STD benefit will be paid as a percentage of an employee s eligible earnings as of the date just prior to the first date of the disability and based on their SunTrust service as of the end of the current year in which they become disabled. Eligible earnings means base salary, but excludes commissions, bonuses,

4 overtime pay, shift pay, and any other extra or non-recurring compensation received from SunTrust. For employees in a position with a benefits base eligible earnings means the benefits base in effect on the employee s last day of work. The benefit includes the STD benefit plus any other benefits the employee may receive from certain other sources of income, as described below. The benefit payment is subject to federal income taxes and state and city income taxes, if applicable. Offsets from Other Sources of Income If an employee qualifies for benefits from any of the following sources, the STD benefit will be reduced so that the total disability income from all sources will not exceed the amount of the employee s SunTrust STD benefit. Sources of income used as offsets to the STD benefit include the following: Disability income from any other group insurance plan for which an employee/spouse has not paid. Statutory disability payments. Any payment from a third party who is liable to pay for lost time due to the illness for which the employee is receiving STD benefits. If the other benefit is paid as a single lump-sum payment, that lump-sum will be converted to an actuarially equivalent semi-monthly benefit based on the payments for the employee s lifetime only the STD benefit will be reduced by that amount. If the total sum of the above offsets is larger than the STD benefit, the employee will not receive an STD benefit. Vacation pay is not an offset for STD benefits. In the event that an employee receives a benefit from STD to replace all or part of their lost wages due to an illness or injury and he or she recovers, or is entitled to recover, payments from a third party who may be liable for that illness or injury, SunTrust retains its right to subrogation and reimbursement. The policy requires the employee to repay SunTrust any wage replacement benefits they receive from the sources listed above if they result in duplicate or overlapping payments for the same time period. The purpose of the STD policy is to provide temporary financial assistance when an employee is unable to work. If the employee fails to reimburse SunTrust for any overpaid benefits within a month after they receive a retroactive award or any other form of duplicate payments from another source, the claims administrator has the right and obligation to pursue collection of the overpayment, including discontinuing future STD benefits until the overpayment is recovered in full on behalf of SunTrust. (Refer to the Reimbursement Subrogation topic in the Benefits Administration section of the SunTrust Health and Welfare Benefits Handbook on BENE Online.) In the event SunTrust discovers any error in the amount of any STD benefit paid to the employee, SunTrust will take appropriate action to correct the error. If the employee has not received the full benefit amount to which they are entitled, SunTrust will determine the underpaid amount which will be paid to the employee. If the benefit the employee received exceeds the amount to which they are actually entitled, SunTrust will notify the employee and plan to recover the overpayment. Taxes Because SunTrust pays the full cost of STD, under IRS rules, any STD benefits received by employees are taxable at the time they are paid.

5 Rehabilitation The Leave Management Administrator may require the employee to participate in a rehabilitative program approved by their physician or another physician selected by and paid by the claims administrator in order for the employee to continue to be eligible for STD benefits. When the STD benefit ends STD benefits will stop on the earliest of the following events: The date the employee is no longer disabled; The date the employee reaches the maximum benefit period; The date the employee fails to provide satisfactory proof of continuation of disability if requested by the Leave Management Administrator even if their physician has not released he or she to return to work; The date of the employee s death; The date the employee returns to work; The date the employee voluntarily elects to receive early retirement benefits from the SunTrust Retirement Plan; (Note: Retirement Plan elections cannot be rescinded.) The date the employee refuses to cooperate or participate in a program of rehabilitation; The date the employee fails to cooperate or participate in an independent medical examination as directed by the Leave Management Administrator. Initiating a Claim for STD Benefits How and When to File a Claim To initiate a claim for STD benefits, call BENE at and press 4 to speak to the Leave Management Administrator. Please note that an employee s medical information may be shared with certain employees at SunTrust or other third parties who need to know the information to perform their jobs, provide benefits, process your claim, respond to governmental inquiries, or other reasons. If the STD leave is not approved, the employee will not be paid for any days not covered by paid sick days or vacation time. Unapproved absences will be unpaid in accordance with the SunTrust payroll schedule. Vacation time can be used for this time away from work. (The five-day waiting period can be paid or unpaid based on available sick days or vacation days as it is in other situations.) The deadline for submitting a claim for STD benefits is 30 days from the first day of absence. Applications or claims received after 30 days from the first day of absence will be denied. If an employee is not able to meet the deadline because they are legally incapacitated, the employee or their legal representative must file the claim as soon as reasonably possible and attach proof of their legal incapacity. Approval of the Claim Once satisfactory proof of the employee s disability has been provided to the Leave Management Administrator and the application for STD benefits has been approved, the employee will receive a written notice of the claim approval and the date they will begin receiving STD benefits. Notice of Denial or Adverse Determination If a claim is denied, the employee or their authorized representative will receive a written notice of denial from the Leave Management Administrator, which will include the following:

6 The specific reason(s) for the denial. The specific policy provisions on which the denial is based. A description of any additional information (such as proper documentation from a medical provider) needed to reconsider the claim and an explanation of why this information is required. The steps to be taken to appeal the denial. A description of the policy review procedures and the applicable time limits. A copy of any rule, guideline, protocol, or other similar criterion that was relied on in deciding to deny the claim or a statement that such a rule was relied on in reaching the decision and that a copy will be provided to the employee free of charge upon request. Appealing a Denied Claim If a claim for benefits is denied, in whole or in part, the employee has 60 days after receiving the notice of denial to appeal the decision. The request for review should be sent in writing to the address specified in the notice of the denied claim. If the employee chooses to appeal, the Leave Management Administrator will evaluate all the information and advise the employee of its determination within 30 days after receiving written request for appeal. Revised: 01/01/2012