Assurant Employee Benefits Link

Transcription

1 Assurant Employee Benefits Link Group DISABILITY

2 Short-Term Disability Insurance Assurant Employee Benefits * Link coverage can provide financial protection to your employees when a disability strikes. No one plans on becoming disabled, but within a year nearly one in thirteen working people will suffer a short-term disability lasting more than a week. 1 Our Link Short-Term Disability (STD) insurance can protect your employees with valuable financial support when a disability occurs. The strength of our Link coverage comes from our commitment to rapid claim response and timely payment. Link includes many of the features in our Long-Term Disability (LTD) coverage which encourage return to productive work. For instance, our formalized vocational rehabilitation program shows our commitment to early claim intervention, helping to produce better results. Our STD and LTD coverage linked Assurant Employee Benefits Link may be purchased as a standalone product or with our LTD coverage. When purchased together, the result is: more simplified claim filing for you and your employees. One claim form initiates the claim for both short-term and longtermbenefits; and one bill for both coverages. Our contract In an effort to provide a financial safety net for your employees, we have built the following protections into our Link contract: Unlike other carriers, we offer a regular job test that is more liberal than an occupation test. An employee is disabled if an injury, sickness or pregnancy prevents him or her from per forming one of the material duties of his or her regular job. * Disability products marketed by Assurant Employee Benefits are underwritten by Union Security Insurance Company Commissioners Group Disability Table, Society of Actuaries

3 The Dual Definition of Disability qualifies employees for disability benefits by meeting either a job test or an earnings test -- not both as some carriers require. The earnings test qualifies an employee for disability benefits if an injury, sickness or pregnancy prevents him or her from earning more than 80% of pre-disability pay. The earnings test may be especially beneficial in situations where a disability may adversely affect a professional s ability to rebuild a client base. If the earnings test is being met, our zero-day residual stipulates that full-time work in which the employee is performing all of the material duties of his or her regular or some other occupation will not interrupt the qualifying (elimination) period or the period of disability. Under unlimited partial disability, if a disabled employee meets the job test only, works on less than a full-time basis or works full time but doesn t perform all of the material duties of his or her regular job, then the qualifying period and the period of disability will not be interrupted. The qualifying period also will not be interrupted if a disabled person returns to active work on a full-time basis at his or her regular occupation for a limited period and becomes disabled again from the same cause. The number of return-to-work days allowed is based on the selected qualifying period (QP). 0 day QP 0 return-to-work days allowed 7 day QP 1 return-to-work days allowed 14 day QP 2 return-to-work days allowed Our help in overcoming a disability Assurant Employee Benefits believes in helping our disabled insureds return to productive work when they can, thus attempting to improve our clients overall productivity. We put this belief into action by employing a staff of doctors, nurses and vocational rehabilitation specialists. When an employee follows an agreed upon vocational rehabilitation plan, we provide the following incentives and assistance to you and your employees. Assurant Employee Benefits incentives to employers may include: Paying to a maximum of 100% of an employee s first four weeks pay when the individual returns to limited work. Assisting an employer in satisfying the requirements of the Americans with Disabilities Act (ADA) by reimbursing an employer for worksite expenses incurred to accommodate an employee s dis ability to a maximum of $3,000. Assistance and incentives to employees may include: Increasing an employee s Schedule Amount of Benefit by 10% of weekly pay, up to $230. Payment of educational expenses for training in another occupation, as well as moving expenses if a claimant must move more than 35 miles because of employment or education needs. Up to 13 weeks of additional benefits and job search assistance if an employee in an agreed upon rehabilitation plan is unemployed when he or she recovers from a disability. We will provide a family care expense credit of $80 per week per eligible dependent for employees who are engaged in a vocational rehabilitation plan. We also provide the following incentive for all disabled employees to encourage them to return to limited work when possible: No benefit reduction, unless the sum of our benefit plus any other income exceeds 100% of an employee s pre-disability monthly earnings.

4 Our help when a return to work isn t possible Social Security Assistance While our main goal is helping disabled employees return to productive work, we realize that in some situations the disabled employee will not be able to do so. In those cases, our Social Security Assistance provision supports an individual s efforts to obtain Social Security disability benefits. If an individual s Social Security application is denied and we consider the person a good candidate, we may: offer the disabled employee a list of Social Security Assistance representatives and pay for the services of a Social Security Assistance representative chosen from the list or reimburse a disabled employee the amount charged for services, up to the amount approved by the Social Security Administration, if the claimant chooses a Social Security Administration representative not on our list. Employers can tailor Assurant Employee Benefits Link to their specific needs With Link coverage through Assurant Employee Benefits, employers can choose options to meet their own individuals needs and budget. Link plans are easy to design by choosing from the options listed below. A plan design can also be customized to meet your individual needs. Participation requirements 100% if employer paid 75% if employee and employer paid Benefit commencement dates 1st day accident / 8th day sickness or pregnancy 1st day accident / 15th day sickness or pregnancy 8th day accident / 8th day sickness or pregnancy 8th day accident / 15th day sickness or pregnancy Rate of benefit options 50% to 70% of weekly earnings standard Flat amounts limited to 70% of weekly earnings 66.67% limit for groups of less than 10 lives Maximum weekly benefit options $1,385 maximum when Assurant Employee Benefits Link is purchased with Assurant Employee Benefits Long-Term Disability coverage $600 maximum when Assurant Employee Benefits Link is not purchased with Assurant Employee Benefits Long-Term Disability coverage Maximum benefit duration options 13 weeks 26 weeks Offset Social Security integration Full Family Benefits as a Direct Offset (FFD) Full Family Benefits as an Indirect Offset (FFMPL) Primary Only Benefits as a Direct Offset (PDO) (only available to groups of ten or more lives) Non-occupational and 24-hour coverage is available. The Link product through Assurant Employee Benefits is also available in approved cash sickness states.

5 Other plan features Amount of benefit The amount of benefit payable is the scheduled weekly benefit amount minus the applicable Offset amount.* However, if the schedule amount plus the amount of benefits and payments from Other sources is more than 70% of the insured s weekly pay, the benefit will be furthered reduced by the excess. * Note: If the Full Family Benefits (FFMPL) Social Security offset integration option is chosen, there is no Offset amount and the benefits listed under the Offset amount will be included under the Other sources of income. Example 1: If the employer has chosen a 60% rate of benefit and the FFD - Social Security offset integration option, the calculation to determine the amount of benefit payable is as follows: $800 Covered weekly pay x.60 Rate of benefit $480 Schedule amount of benefi If the employee is eligible to receive a $200 Workers Compensation disability benefit per week, the benefit is further reduced. $480 Schedule amount of benefit -200 Workers compensation benefit offset $280 Weekly benefi Example 2: If an employer has chosen a 60% rate of benefit and the FFD - Social Security offset integration option, the calculation is as follows: The employee returned to work part time and is earning $500 weekly. The Link policy includes a 100% return-to-work provision for the first 12 months of a return to limited work. The combination of all sources of income in this example is capped, therefore, at 100% of pre-disability covered weekly pay. So, first the amount by which all sources of income exceeds 100% of pre-disability covered weekly pay is determined. $480 Schedule Amount of Benefit +$500 New Earnings while Disabled $980 -$800 Covered Weekly Pay $180 Excess The excess is then subtracted from our schedule amount of benefit to determine the amount paid. $480 Schedule Amount of Benefit -$180 Excess over $800 $300 New Benefit Payable The sum of our benefit ($300) plus new earnings while disabled ($500) equals and does not exceed the pre-disability covered weekly pay ($800). Extended benefits If a covered employee is disabled on the same day our Link coverage terminates, we will pay benefits as though coverage had not terminated. $800 Covered weekly pay x.60 Rate of benefit $480 Schedule amount of benefit The examples above are for illustrative purposes only.

6 Successive periods of disability provision A disability due to the same or a related cause is considered to have occurred during a single disability period if not separated by: one month or more with a 26-week maximum benefit period or two weeks or more with a 13-week maxi-mum benefit period of active full-time work. ( Full-time means working at least 30 hours per week.) In this event, the qualifying period does not have to be satisfied again. However, the individual must have remained insured with us throughout this period. Continuance of insurance Groups subject to the Family and Medical Leave Act may continue coverage for up to 12 weeks subject to the provisions of that Act. Minimum benefit The minimum benefit is $25 per week (if the claimant worked 30 hours or more per week). For any period of disability less than a week, the minimum benefit is 1/7th of $25 for each day of disability after the qualifying period ends. Offset amount Where chosen by the employer, the total of any benefits from the following sources for which an employee is eligible will be subtracted from the schedule amount: Disability benefits from: any other group disability plan; Social Security, including dependent benefits payable because of the covered person s disability (dependent benefits not included if Primary Only Benefit Offset is chosen); state temporary disability benefits; or any other government plan. Any benefits (except medical or death benefits) or any amount received in a settlement or compromise of the person s rights under any Workers Compensation Act or similar law or the Maritime Doctrine of Maintenance, Wages or Cure. Retirement benefits from a government plan or retirement benefits, disability benefits or similar benefits from a retirement plan sponsored by the employer. Other sources of income Salary continuance, sick leave or partial disability earnings in excess of 100% of weekly pay when combined with the schedule amount and benefits from other sources below (the excess, if any, is subtracted directly from the schedule amount in determining the amount payable); Any group disability insurance benefit, except from an employer-sponsored plan; and Benefits from any no-fault motor vehicle coverage, unless (i) prohibited by law; (ii) it determines its benefits after benefits have been paid under the STD plan; or (iii) the benefits are provided under optional coverage. Additional options Employee Assistance Program If you choose this option, your employees will have confidential assistance with personal problems. This service, provided by New Directions Behavioral Health, Inc., is a short-term counseling and referral service to help employees deal with family, legal or financial problems.

7 Survivor Benefit If an insured dies while receiving or being entitled to receive disability benefits for 14 days prior to death, the survivor benefit provides an income safety net while survivors are in the process of settling the estate. We will pay to the survivors an amount equal to the weekly benefit times the number of weekly payments remaining from the time of the claimant s death to the end of the maximum weekly benefit period. Exclusions No Link benefits are payable for any disability caused by: war, or any act of war, whether declared or not; intentionally self-inflicted injury, while sane or insane; or taking part in or the result of taking part in committing an assault or felony. No benefits are payable for any time the covered person is confined to any facility because he or she was convicted of a crime or public offense. In addition, we will not pay benefits if: the covered person s employer, the policy holder or an associated company has offered him or her the opportunity to return to limited work while disabled; the covered person is functionally capable of performing the limited work which is offered; and Benefits will end as of the date the covered person was first scheduled to return to work. Subject to the terms of the policy, benefits will recommence on the earlier date he or she returns to such work, if the covered person remains disabled, or the date disability worsens so that he or she is no longer capable of such work. When non-occupational coverage is selected by the employer, no benefits are payable for any disability caused by an injury occurring while working for pay or profit; or a sickness that entitles the covered person to benefits under any Workers Compensation Act or similar law (non-occupational policies only). Limitations Although not a standard feature of our Link coverage, a pre-existing conditions limitation may be imposed on amounts over the standard maximum. Plans comply with all applicable state laws. Not all plan provisions or options are available in all states. This brochure is an outline and summary of the plan provisions. The employer will be given certificates for distribution to each insured employee which describe the specific provisions of their plan in detail. This brochure is not the summary plan description required by ERISA. Assurant Employee Benefits Link is used throughout this brochure as a descriptive term for a Short-Term Disability policy offered through Assurant Employee Benefits. the covered person does not return to work when and as scheduled.

8 Assurant Employee Benefits specializes in quality employee benefits and services including long-term and short-term disability, life and accidental death and dismemberment insurance, dental coverage and disability reinsurance management services. Assurant Employee Benefits also offers voluntary (employee-paid) disability, life and dental plans. Underwriting flexibility allows Assurant Employee Benefits to market tailor-made benefit plans for groups of most any size. Assurant Employee Benefits is located in Kansas City, Missouri. Assurant Employee Benefits 2323 Grand Boulevard Kansas City, MO T F Assurant KC3485 (5/2006)