Frequently Asked Questions About Disability Benefits

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1 Frequently Asked Questions About Disability Benefits The following information is a brief synopsis of frequently asked questions regarding Prince Willam County School Board Long Term Disability (LTD) benefit programs, administered by Standard Insurance Company (The Standard). This information is in no way a complete review of the benefit policies nor is it meant to replace the Certificate of Insurance outlining your benefits. If you do not have a Certificate of Insurance please contact your Human Resources Department. Policy Provisions and Definitions: 1. What is the Definition of Disability? The LTD policy defines disability as: During the Benefit Waiting Period (BWP) and the Own Occupation Period (first 24 months after the Benefit Waiting Period) you are required to be Disabled only from your Own Occupation. The BWP is the length of time you must be Disabled before benefits become payable. See below for more information regarding the BWP. You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of your Own Occupation; and you suffer a loss of at least 20% of your Indexed Predisability Earnings when working in your Own Occupation. Own Occupation means any employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as your regular and ordinary employment with the Employer. Your Own Occupation is not limited to the way you perform your job with your Employer. The Standard may also look at the way the occupation is generally performed in the national economy. If your Own Occupation involved the rendering of professional services and you are required to have a professional or occupational license in order to work, your Own Occupation is as broad as the scope of your license. Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted. Working an average of more than 40 hours per week is not considered to be a Material Duty. Prince William County School Board Page 1 of 6

2 For benefits to continue after 24 months of disability, you must be disabled from all occupations. You are Disabled from all occupations if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of any occupation for which you are reasonably fitted by education, training and experience. 2. How long will I receive benefits? The maximum period benefits are payable is defined in the LTD group plan. If you are disabled in your own occupation, you will receive disability benefits for a period of 24 months. If you are disabled in all occupations you will be paid to age 65. No LTD benefits are payable after you are no longer disabled as defined by the policy or reach the maximum benefit period. 3. Are there any limitations or exclusions to the policy? Yes, below are examples of some of the limitations in the LTD group policy. Please refer to your Certificate of Coverage for a complete list of limitations and exclusions. No LTD Benefits will be paid for any period of Disability when you are not under the ongoing care of a Physician in the appropriate specialty as determined by The Standard. Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused or contributed to by a Mental Disorder, Substance Abuse, or Other Limited Conditions as defined by the LTD group policy. Other Limited Conditions include, but are not limited to chronic fatigue conditions sensitivity to chronic pain conditions, see your policy for a complete listing. You are not covered for a Disability caused or contributed to by a Preexisting Condition or medical or surgical treatment of a Preexisting Condition unless on the date you become Disabled you have been continuously insured under the Group Policy for 12 months. Please refer to your Certificate of Insurance for a full description a Preexisting Condition. Payment of LTD Benefits is limited to 12 months for each period of continuous Disability while you reside outside of the United States or Canada. No LTD Benefits will be paid for any period of Disability when you are confined for any reason in a penal or correctional institution. Prince Willam County School Board Page 2 of 6

3 Benefits: 1. How much will I get paid if1 am disabled? Long Term Disability For employees participating in the Employer's sick leave plan (Plan B), the LTD policy provides a benefit equal to 60% of your monthly Predisability Earnings. The maximum monthly benefit payable under the LTD policy is $7,500. It should also be noted that both LTD benefits may be reduced by Deductible Income (see below for a description of Deductible Income). 2. When do my benefits become payable? The benefit waiting period (period of time you must be disabled before benefits become payable) for the LTD is 180 days. How often will I receive checks? LTD benefits are paid on a monthly basis, at the end of the benefit month. Your disability date and benefit waiting period will determine your benefit month. For LTD benefits you also have the option of having your benefit payments direct deposited into your bank account or transferred to a Securecard (similar to a debit card) provided by The Standard and U.S. Bank. Please contact the benefits analyst administering your claim for details on these options. Deductible Income: 1. How will Workers' Compensation affect my disability claim? If you are receiving or are eligible to receive Workers' Compensation (WC) benefits, they will be deducted from LTD benefits. Any amount you receive or are eligible to receive because of your disability, including amounts for partial or total disability, whether permanent, temporary, or vocational are considered to be Deductible Income. 2. I have disability benefits through another policy, how will these benefits affect my disability benefits through The Standard? Benefits you receive through another group insurance plan will be considered Deductible Income. If your other benefit plan deducts the benefits you receive from The Standard, we will coordinate benefits with the other plan administrator so that you receive the amount of benefits payable under the greater plan, with payment from both entities. For example, if you are to receive 60% of your predisability earnings from The Standard and 50% of your predisability earnings from the other plan, you will receive a total of 60% between both plans. Prince Willam County School Board Page 3 of 6

4 3. What if1 choose not to apply for deductible income? The Prince Willam County School Board LTD group disability policies require that you apply for Deductible Income you may be eligible to receive. If you do not apply for other income you are eligible to receive, The Standard has the right to deduct the amount we estimate you would be eligible to receive if you had applied for the deductible income in a timely manner. 4. What if1 receive Deductible Income for a retroactive period of time? You may receive a Deductible Income award that pays you retroactively (an earlier period of timelpast benefits) for a period of time you were also receiving benefits from The Standard. If you were already paid LTD benefits for the same period of time you have now received retroactive Deductible Income, there will be an overpayment on your claim. This is because the combined amount of income you received from The Standard and another source (Deductible Income) exceed the maximum benefit level provided in the group policies. For example, if you had been receiving a maximum monthly LTD benefit of $1,500, which represented 60% of your predisability earnings and then received a retroactive Deductible Income award of $500 per month, your LTD claim will have been overpaid by $500 per month. This is because your combined income of $2,000 ($1,500 LTD + $500 Deductible Income) per month would equal 89% of your predisability earnings. This exceeds your maximum monthly benefit level of 60% provided by the group policy. You will be asked to immediately repay The Standard for any overpayment occurring on your claim. You will not receive any additional benefits until The Standard has been repaid in full. Return to Work: 1. What if1 return to work to a modified duty or on a part time basis? If the medical information provided by your doctor continues to support that you are unable to work full time in your Own Occupation, you may be entitled to continued benefits while working on a part-time or modified basis. Long Term Disability The LTD policy has a provision called the Return to Work Incentive. For the first 12 months following the date you return to work, while disabled, you are eligible to receive 100% of your Predisability Earnings between work earnings and disability benefits combined After the first 12 months following your initial return to work date, one-half of your work earnings will be used to reduce your disability benefit. For example: If your disability benefit is $2,000, work earnings are $1000, $500 is Prince Willam County School Board Page 4 of 6

5 Deductible Income. Therefore, your total income equals $2,500 ($1,500 LTD benefit + $1,000 work earnings). When Benefits End: When will my benefits end? LTD benefits will automatically end the earliest of: The date you are no longer Disabled The date your maximum benefit period ends The date you die The date benefits become payable under any other LTD plan under which you become insured through employment during a period of Temporary Recovery The date you fail to provide proof of continued Disability and entitlement to LTD benefits Am I responsible for providing medical documentation to support my claim? The Standard will periodically provide you with a medical statement or questionnaire for your doctor to complete. The timing of these requests will vary, depending on the reason for your disability, and when it would be reasonable to expect a change or improvement in your condition. It is your responsibility to ensure that these forms are completed and returned to The Standard. The Standard may also contact your doctor directly for information regarding your medical condition. Although The Standard has initiated this request and will follow though, you may be asked to assist if your doctor does not respond. 3. How will I be notified if my claim is denied, closed, or limited? You will be notified in writing of any determination to deny, close, or limit payment on your claim. This letter will provide a summary of the decision, including a description of the information used to reach the decision, copies of applicable policy provisions, and a description of your right to appeal the decision. Additionally, when appropriate, this letter may also contain condition specific medical questionnaires to be completed by your doctor or a description of other information that may be helpful if you request a review. 4. Can I appeal a decision to deny, close, or limit my claim? Yes. As noted above, claim denial, closure, or payment limitation notification letters will provide a description of your right to appeal the decision. You have a right to request a review of the claim within 180 days following the receipt of the decision letter. This request for review must be submitted in writing to The Standard and should include any information you, your authorized representative, or your doctor feel would be helpful to a reconsideration of your claim. You are not required to submit additional information to exercise your review rights. You also have the right Prince Willam County School Board Page 5 of 6

6 to review pertinent claim documents and may submit comments in writing for The Standard to review. Taxability: 1. Are my disability benefits taxable? If premiums are deducted from your paycheck on a post tax basis, your benefits are not taxable. Contact Information: 1. Who should I contact $I have questions about my disability policy? If you have questions regarding your disability policy, please contact The Standard. Lisa Jacobson at x 4470 will be happy to answer your questions regarding the provisions of the policy. 2. Who do I contact $I need to submit a claim? If you need to submit a claim please contact your Human Resources Department at Prince Willam County School Board. 3. Who should I contact $1 have questions about my disability claim? If you have questions regarding a disability claim that you have submitted please contact your benefits analyst or examiner. If you do not know the name of your benefits analyst or examiner, contact The Standard's customer contact center at and they will be happy to assist you. Prince Willam County School Board Page 6 of 6