FOR THE EMPLOYEES OF HUTTO INDEPENDENT SCHOOL DISTRICT

Transcription

1 VOLUNTARY LONG-TERM DISABILITY INSURANCE FOR THE EMPLOYEES OF HUTTO INDEPENDENT SCHOOL DISTRICT If you were disabled due to an Injury Sickness Pregnancy Would you still need a paycheck? How would you pay the expenses that continue? Mortgage Groceries Insurance Car Payments Sign up today and let Assurant Employee Benefits help protect your most valuable asset your paycheck! PLANS CONTAIN LIMITATIONS AND EXCLUSIONS USIC-GRPDI-SUM W2 1 5/2/2011

2 VOLUNTARY LONG TERM DISABILITY INSURANCE SUMMARY OF BENEFITS FOR THE EMPLOYEES OF HUTTO INDEPENDENT SCHOOL DISTRICT This summary provides a brief description of the Long Term Disability benefits available to all eligible employees. This is not a Certificate of Coverage. Nothing contained herein will guarantee, waive or alter any terms of any subsequently issued plan. The provisions of such actually issued plan will be based on the insurance applied for by your employer and agreed upon by Union Security Insurance Company. Further, depending on the governing jurisdiction, the actual text of provisions and availability of either the product or product feature(s) may differ from what is presented in this summary of benefits. ELIGIBILITY You are eligible for coverage if you are an employee, in an eligible class, in active employment, working at least the minimum number of hours required under the plan, and you have satisfied any applicable waiting periods. When you first become eligible for coverage, you can enroll for coverage within 30 days of the date you become eligible, subject to any plan benefit maximums. If you do not apply within the 30 day period, Evidence of Insurability will be required to enroll for any amount of coverage. BENEFIT AMOUNT You may participate in the plan under any one of the benefit levels outlined in the Rate Schedule, provided the monthly benefit level you selected does not exceed 66 2/3% of your monthly earnings from your employer. If, at any time, the monthly benefit you have chosen exceeds 66 2/3% of your monthly earnings, your benefit amount will be reduced to the highest benefit level for which you are eligible. USIC-GRPDI-SUM W2 2 5/2/2011

3 ELIMINATION PERIOD If you elect or apply for Long Term Disability coverage, you may select from the following elimination period options: 1. 0 days for injury, 7 days for sickness* days for injury, 14 days for sickness* days for injury, 30 days for sickness* days for injury, 90 days for sickness * If you are hospital confined as an in patient because of your disability, and have selected an elimination period of 30 days or less, benefits begin immediately. In patient means you are physically confined for an overnight stay, as a registered bed patient in a hospital, health facility, or institution, as defined in the plan. MAXIMUM PERIOD OF PAYMENT If you elect or apply for Long Term Disability coverage, the following is your maximum period of payment option: During a continuous period of disability... For disabilities due to Injury that begin prior to age 60, Long Term Disability benefits are payable for up to Social Security Normal Retirement Age*. For disabilities due to Injury that begin on or after you reach age 60, a reducing benefit duration or SSNRA will apply. For disabilities due to Sickness that begin prior to age 64, Long Term Disability benefits are payable for up to 36 months. For disabilities due to Sickness that begin on or after age 64, a reducing benefit schedule will apply. *Social Security Normal Retirement Age ranges from age 65 to age 67, depending on the year in which you were born. For additional information about the Maximum Period of Payment provision, please contact your agent. USIC-GRPDI-SUM W2 3 5/2/2011

4 DEDUCTIBLE SOURCES OF INCOME Deductible Sources of Income (also referred to as offsets or integration ) is income from Deductible Sources listed in the plan that the insured may receive or may be eligible to receive while disabled. To avoid over insurance, income for these sources may reduce the disability benefit payable. (Refer to a Sample Certificate for complete details regarding the Deductible Sources of Income provision.) For the first 6 months of benefit payments, the amount of benefit you receive, or are eligible to receive, from Workers Compensation, an occupational disease law or any other act or law of similar intent will be subtracted from your monthly benefit. After 6 months of benefit payments, the amount of benefit you receive, or eligible to receive, from Social Security, Workers Compensation or other sources will be subtracted from your monthly benefit. Income received from salary continuation or accumulated sick leave plans will not be deducted from your monthly benefit. The minimum monthly benefit amount payable under the plan is 25% of your monthly benefit, regardless of the amount of income you receive from other sources. PORTABILITY Portability may allow you to continue coverage if your employment ends. If allowed, the insurance continued is 50% of the monthly benefit in force on the date employment ends. The maximum benefit duration will be the lesser of 12 months or the plan maximum period of payment in force on the date your employment ends. You will be eligible to apply for ported coverage if you have been covered under the plan for 12 consecutive months before your employment ends and met the eligibility requirements as outlined in your Certificate of Coverage. DEFINITION OF DISABILITY TOTAL DISABILITY Benefits for Total Disability are paid if you are disabled and not working, or have returned to work and, due to your disability, are earning less than 20% of monthly earnings. USIC-GRPDI-SUM W2 4 5/2/2011

5 PARTIAL DISABILITY Depending on the Maximum Period of Payment, if you are disabled and working and your monthly disability earnings are between 20% and 80% of your monthly earnings prior to disability, you are eligible for partial disability benefits. For the first 12 months of payments, your monthly payment will not be reduced by your disability earnings unless the total of your monthly payment, income from other sources, and disability earnings exceeds 100% of your monthly earnings. If the total exceeds 100%, your monthly payment will be reduced by the excess amount. After 12 months of monthly payments, 50% of your monthly disability earnings will be subtracted form any further payments you are eligible to receive. TOTAL AND PARTIAL DISABILITIES Depending on the benefit duration, you will continue to receive payments beyond 24 months of disability if you are: 1. working in any occupation and continue to have a 20% or more loss in monthly earnings due to your sickness or injury; 2. not working, and due to your sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably qualified based on education, training or experience. When determining eligibility for Total or Partial Disability benefits if school is not in session, your work capacity is measured by determining whether you would be able to perform your work if school were in session. The loss of a professional or occupational license or certification does not, in itself, constitute disability. WAIVER OF PREMIUM Premium payments are not required for your coverage beginning the first of the month following the elimination period and thereafter while you are receiving Long Term Disability payments under this plan. USIC-GRPDI-SUM W2 5 5/2/2011

6 EVIDENCE OF INSURABILITY Evidence of Insurability will be required if: 1. you are a late applicant, which means you apply for coverage more than 30 days after your eligibility date; 2. you voluntarily cancel your coverage and are re applying; 3. you apply for a monthly benefit amount greater than the annual increase amount without Evidence of Insurability during the annual enrollment period; 4. you increase your monthly benefit amount by any amount during the plan year. Evidence of Insurability may also be required if an employee elects a change in coverage that impacts when or for how long benefits are payable. Increases or additional coverage will be subject to the pre existing condition limitation. SURVIVOR BENEFIT A lump sum benefit equal to three times your monthly benefit will be paid to your eligible survivor upon your death, if you were receiving, or were eligible to receive, payments under the plan for 180 or more consecutive days. ADVANCED SURVIVOR BENEFIT You may receive an Advanced Survivor Benefit prior to your death if you have been diagnosed with a Terminal Illness. We will pay you a lump sum amount equal to three times the monthly benefit without reduction for deductible sources of income if: 1. your disability had continued for 180 or more consecutive days, 2. you have been diagnosed with a Terminal Illness as defined by the plan, 3. you elect the Advanced Survivor benefit in writing, and 4. your doctor has certified, in writing, that you have a Terminal Illness. USIC-GRPDI-SUM W2 6 5/2/2011

7 This benefit is available to you on a voluntary basis and will be payable one time only under the plan. If you receive this benefit prior to your death, the Survivor Benefit will not be payable upon your death. WORKPLACE MODIFICATION If you are disabled and are receiving a monthly payment under the plan, an additional Workplace Modification Benefit may be payable to your Employer for your benefit. We may reimburse your Employer for up to 100% of the reasonable costs your Employer incurs through modifications to the workplace to accommodate your return to work, and to assist you in remaining at work. The amount we may pay will not exceed the greater of three times your last monthly payment; or $5,000. This benefit is available to you on a one time basis. AD&D BENEFIT This plan will pay an additional lump sum Accidental Death and Dismemberment (AD&D) Benefit if you have an injury which, within 90 days of the injury, is the direct and only cause of one of the following losses: For loss of: Life Loss of both hands Loss of both feet Loss of sight in both eyes One hand or one foot Sight of one eye AD&D Benefit The AD&D Principal sum The AD&D Principal sum The AD&D Principal sum The AD&D Principal sum One half the AD&D Principal sum One half the AD&D Principal sum The AD&D Principal sum is equal to 15 times the monthly benefit. The AD&D Benefit is payable for the greatest single loss resulting from any one injury. For any combination of covered losses resulting from any one injury, the maximum AD&D Benefit payable is the AD&D Principal sum. The AD&D Benefit will not be reduced by income or payments you receive from other sources. USIC-GRPDI-SUM W2 7 5/2/2011

8 EXCLUSIONS AND LIMITATIONS The plan does not cover any disabilities caused by, contributed to by or resulting from: 1. loss of professional license, occupational license, or certification; 2. participation in a felony; 3. intentionally self inflicted injuries; 4. attempted suicide, regardless of mental capacity; 5. being legally intoxicated or being under the influence of any narcotic, unless the narcotic is taken under the direction of and as directed by a doctor; 6. participation in a war, declared or undeclared, or any act of war; 7. active military duty; 8. active participation in a riot; 9. engaging in any illegal or fraudulent occupation, work, or employment; 10. commission of a crime for which you have been convicted; 11. participation in autoerotic asphyxiation; 12. elective surgery except when required for your appropriate care as a result of your injury or sickness; 13. traveling or flying on any aircraft operated by or under authority of military or any aircraft being used for experimental purposes. DISABILITIES WITH A LIMITED PAY PERIOD Disabilities due to mental illness, alcoholism or drug abuse have a limited pay period up to 12 months. Disabilities due to Special Conditions have a limited pay period up to 12 months. USIC-GRPDI-SUM W2 8 5/2/2011

9 PRE EXISTING CONDITIONS (State Variations may apply) Benefits will not be paid if your disability begins in the first 12 months following the effective date of your coverage; and your disability is caused by, contributed to by, or the result of a condition, whether or not that condition is diagnosed at all or is misdiagnosed, for which: 1. you received medical treatment, consultation, care or services, including diagnostic measures, or were prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; or 2. you had symptoms for which an ordinarily prudent person would have consulted a doctor in the 3 months just prior to your effective date of coverage. Increases or additional coverage are also subject to the pre existing condition limitation, as of the effective date of the increase or additional coverage. USIC-GRPDI-SUM W2 9 5/2/2011

10 For claims service, please contact: Claims Office One Riverfront Plaza Westbrook, Maine Toll free: Fax: For all other customer service inquiries, please contact: This Summary of Benefits is not complete without the Product Overview Brochure (form series USIC GRPDI EE) or (form series USIC GRPDI FDH) and the Rate Schedule(s) (form series USIC GRPDI RSA, USIC GRPDI RSB and USIC GRPDI RSC), including state variations where used Union Security Insurance Company USIC-GRPDI-SUM W2 10 5/2/2011