Short Term Disability Insurance

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1 Short Insurance Everyone understands the value of protecting your family by purchasing life insurance. But what about protecting your income? How would your bills get paid in the event that you were unable to work due to a disability that lasted several days or several months? Short (STD) insurance pays you a portion of your lost earnings if you are unable to work due to a covered disability. CCSD offers a plan where you can choose a benefit level that will help you and your family the most depending on how many days of sick leave you already have accumulated but not used. or Disabled means that, due to sickness, pregnancy or accidental injury, you are unable to perform the essential duties of your own occupation for any employer in your local economy and as a result, your current weekly earnings are less than 80% of your pre-disability earnings. You must be under the regular care and treatment of a doctor to remain eligible for payments. Who is eligible to enroll in this plan? Is evidence of insurability required? You are eligible to enroll if you are an active full-time employee working at least 20 hours per week and you are a citizen or legal resident of the United States, its territories and protectorates. If you are a superintendent, temporary, leased or seasonal employee, you are not eligible to participate in this plan. If you are a newly eligible employee, evidence of insurability is not required to enroll. If you previously waived or declined to enroll in this coverage and are enrolling for the first time, you must submit a Personal Health Application and your coverage must be approved before it will become effective. You are responsible for ensuring that the application process is followed. What is the benefit amount? The STD insurance benefit can be found in the Core Plan and Buy Up plan charts. The benefit may replace up to 66 2/3% of your gross weekly earnings, less income you may receive from other sources. The STD Core Plan provides a benefit based on your accumulated sick leave (short term leave) days at the time of your disability. The STD Buy Up Plan is an enhancement which allows you to purchase a weekly benefit amount in addition to the Core Plan benefit. core STD coverage and your buy-up, when combined, cannot exceed 66 2/3% of your earnings. As 66 2/3% of your earnings is the plan s maximum, be sure not to elect an amount greater than that. Does the plan have limitations and exclusions? The plan pays a benefit for up to 4 weeks if your disability is due to a pre-existing condition. A preexisting condition is a condition for which you were diagnosed or received medical care in the 180 days prior to your effective date of coverage or the effective date of an increase in coverage. Medical Care includes consulting a physician or other medical provider who gives medical advice or prescribes treatment. Treatment includes medical exams, tests, observation, prescriptions, medicines, medical services, supplies or equipment. The pre-existing condition limitation does not apply after (a) you have been covered on the plan 180 days without treatment or (b) you have been covered on the plan for 365 days. s are not payable for the following exclusions: a disabling injury or sickness which happens in the course of any work performed by you for wage or profit, or for which you are eligible to receive benefits under any Workers Compensation or any similar law; disabilities caused by your commission of or attempt to commit a felony; if you are engaged in an illegal occupation; if your disability is caused or contributed to by war or act of war; or if your disability is caused by an intentionally self-inflicted injury. Am I only eligible to receive benefits if I am Totally Disabled? No, your plan includes a Disabled and Working benefit and a Rehabilitative Employment. The Short plan provides financial incentives for you to return to work, even on a part-time basis. You may receive up to 100% of your pre-disability earnings when combining Short benefits, rehabilitation incentives and part-time earnings.

2 When do Short benefits begin and how long do they continue? s are payable beginning on the 6 th day from your disability date. s continue for as long as you are disabled up to a maximum duration of 25 weeks. How does my accumulated sick leave impact my Short benefits? All sick leave days (sometimes referred to as short term leave days) must be used when you are on a medical leave of absence. The sick leave pay you receive while on a disability claim will reduce the amount of your Short benefit. This may result in a zero Short benefit during the time you are receiving short term leave pay. The Short benefit amount increases as the number of accumulated sick days increase to help offset this impact. Example #1: An employee earning $40,000 annually ($769 weekly) has 40 sick leave (short term leave) days accumulated. The employee s Core Plan benefit is $500 week. (This is approximately 65% of the employee s weekly earnings.) This employee becomes disabled, begins receiving short term leave pay and files a Short claim. The employee s Short claim is approved and Short benefits would start on the 6 th day of disability. However, no benefit is payable for the first 8 weeks. (Short benefits are reduced by short term leave pay. short term leave pay exceeds the Short benefits which results in no Short benefit payable for the first 8 weeks.) Once the short term leave pay is exhausted, the employee will receive a Core Plan benefit of $500 week, assuming no offsets for other income. Week Short Leave Pay Short s 1 Paid Waiting Period 2-8 Paid No 9-25 Not Paid $500 week less other income. If there is no other income and the employee remains disabled, a total benefit of $8,500 will be paid. Example #2: An employee earning $30,000 annually ($577 weekly) has 25 sick leave (short term leave) days accumulated. The employee s Core Plan benefit is $350 week. (This is approximately 61% of the employee s weekly earnings.) This employee becomes disabled, begins receiving short term leave pay and files a Short claim. The employee s Short claim is approved and Short benefits would start on the 6 th day of disability. However, no benefit is payable for the first 5 weeks during the time the employee is receiving short term leave pay. Once the short term leave pay is exhausted, the employee will receive a Core Plan benefit of $350 week, assuming no offsets for other income. Week Short Leave Pay Short s 1 Paid Waiting Period 2-5 Paid No 6-25 Not Paid $350 week less other income. If there is no other income and the employee remains disabled, a total benefit of $7,350 will be paid

3 How do I determine my Short benefit under the Core Plan and the Buy Up options that are available? 1. Review the chart below to determine your Core Plan benefit which is based on your accumulated short term leave days/work days. 2. Find your Total Short benefit if you elect Buy Up s 2, 3, 4 and Core Plan benefit plus your Buy Up Plan benefit cannot exceed 66.67% of your. This is referred to as the allowed on the policy. See chart for a quick reference or use the following formula: ( Annual divided by 52) times 66.67% = Enter your maximum here using the chart on the following page or using the formula above: Enter your Total Short here from the chart below: If the Total Short for a Buy Up option exceeds your, you cannot elect that Buy Up option. Short Core Plan Short Buy Up Plan Core Plan benefit plus an additional $115 per week Total Short (Core plus Buy Up) 3 - Core Plan benefit plus an additional $231 per week Total Short (Core plus Buy Up) 4 - Core Plan benefit plus an additional $345 per week Total Short (Core plus Buy Up) 5 - Core Plan benefit plus an additional $462 per week Total Short (Core plus Buy Up) Accumulated short term leave days at time of your disability Total Short (Core only) Under 15 work days $ $ $ $ $ to 24 work days $ $ $ $ $ to 34 work days $ $ $ $ $ to 44 work days $ $ $ $ $ to 59 work days $ $ $ $ $ to 89 work days $ $ $ $ $1, or more work days $ $ $ $1, $1,162.00

4 Short Chart Annual (Annual divided by 52 Weeks) 66 2/3% Annual (Annual divided by 52 Weeks) 66 2/3% $20,000 $385 $ $58,000 $1,115 $ $22,000 $423 $ $60,000 $1,154 $ $24,000 $462 $ $62,000 $1,192 $ $26,000 $500 $ $64,000 $1,231 $ $28,000 $538 $ $66,000 $1,269 $ $30,000 $577 $ $68,000 $1,308 $ $32,000 $615 $ $70,000 $1,346 $ $34,000 $654 $ $72,000 $1,385 $ $36,000 $692 $ $74,000 $1,423 $ $38,000 $731 $ $76,000 $1,462 $ $40,000 $769 $ $78,000 $1,500 $1, $42,000 $808 $ $80,000 $1,538 $1, $44,000 $846 $ $82,000 $1,577 $1, $46,000 $885 $ $84,000 $1,615 $1, $48,000 $923 $ $86,000 $1,654 $1, $50,000 $962 $ $88,000 $1,692 $1, $52,000 $1,000 $ $90,000 $1,731 $1, $54,000 $1,038 $ $92,000 $1,769 $1, $56,000 $1,077 $ $94,000 $1,808 $1, Instead of using the above chart to obtain an estimated, you may calculate your actual using the following formula. Enter your Annual : Divide your Annual by 52 to obtain your : Multiply this amount by 66.67% to obtain your :

5 Short Buy-up Chart STD is 66 2/3% of your. If the Core STD benefit exceeds this maximum, it will be reduced to your STD. The illustrative chart below indicates the maximum buy-up option available for these Annual Pre- amounts. Annual Predisability STD LESS THAN 15 Number of Short Leave Days LESS THAN DAYS DAYS $20,000 $256 1 $250 1 $256 $22,000 $282 1 $250 1 $282 $24,000 $308 1 $250 1 $300 $26,000 $333 1 $250 1 $300 $28,000 $359 1 $250 1 $300 $30,000 $385 2 $365 1 $300 $32,000 $410 2 $365 1 $300 $34,000 $436 2 $365 2 $415 $36,000 $462 2 $365 2 $415 $38,000 $487 3 $481 2 $415 $40,000 $513 3 $481 2 $415 $42,000 $538 3 $481 3 $531 $44,000 $564 3 $481 3 $531 $46,000 $590 3 $481 3 $531 $48,000 $615 4 $596 3 $531 $50,000 $641 4 $596 3 $531 $52,000 $667 4 $596 4 $646 $54,000 $692 4 $596 4 $646 $56,000 $718 5 $712 4 $646 $58,000 $744 5 $712 4 $646 $60,000 $769 5 $712 5 $762 $65,000 $833 5 $712 5 $762 $70,000 $897 5 $712 5 $762 $75,000 $962 5 $712 5 $762 $80,000 $1,026 5 $712 5 $762

6 Annual Predisability STD DAYS Number of Short Leave Days DAYS DAYS DAYS $20,000 $256 1 $256 1 $256 $22,000 $282 1 $282 1 $282 $24,000 $308 1 $308 1 $300 $26,000 $333 1 $333 1 $300 $28,000 $359 1 $350 1 $300 $30,000 $385 1 $350 1 $300 $32,000 $410 1 $350 1 $300 $34,000 $436 1 $350 1 $300 $36,000 $462 1 $350 1 $300 $38,000 $487 2 $465 1 $300 $40,000 $513 2 $465 1 $300 $42,000 $538 2 $465 2 $515 $44,000 $564 2 $465 2 $515 $46,000 $590 3 $581 2 $515 $48,000 $615 3 $581 2 $515 $50,000 $641 3 $581 3 $631 $52,000 $667 3 $581 3 $631 $54,000 $692 3 $581 3 $631 $56,000 $718 4 $696 3 $631 $58,000 $744 4 $696 3 $631 $60,000 $769 4 $696 4 $746 $65,000 $833 5 $812 4 $746 $70,000 $897 5 $812 5 $862 $75,000 $962 5 $812 5 $862 $80,000 $1,026 5 $812 5 $862

7 Annual Predisability STD DAYS Number of Short Leave Days DAYS DAYS DAYS $20,000 $256 1 $256 1 $256 $22,000 $282 1 $282 1 $282 $24,000 $308 1 $308 1 $308 $26,000 $333 1 $333 1 $333 $28,000 $359 1 $359 1 $359 $30,000 $385 1 $385 1 $385 $32,000 $410 1 $410 1 $410 $34,000 $436 1 $436 1 $436 $36,000 $462 1 $462 1 $462 $38,000 $487 1 $487 1 $487 $40,000 $513 1 $500 1 $513 $42,000 $538 1 $500 1 $538 $44,000 $564 1 $500 1 $564 $46,000 $590 1 $500 1 $590 $48,000 $615 2 $615 1 $600 $50,000 $641 2 $615 1 $600 $52,000 $667 2 $615 1 $600 $54,000 $692 2 $615 1 $600 $56,000 $718 2 $615 2 $715 $58,000 $744 3 $731 2 $715 $60,000 $769 3 $731 2 $715 $65,000 $833 3 $731 3 $831 $70,000 $897 4 $846 3 $831 $75,000 $962 5 $962 4 $946 $80,000 $1,026 5 $962 4 $946

8 Annual Predisability STD Number of Short Leave Days 90 DAYS OR MORE 90 DAYS OR MORE $20,000 $256 1 $256 $22,000 $282 1 $282 $24,000 $308 1 $308 $26,000 $333 1 $333 $28,000 $359 1 $359 $30,000 $385 1 $385 $32,000 $410 1 $410 $34,000 $436 1 $436 $36,000 $462 1 $462 $38,000 $487 1 $487 $40,000 $513 1 $513 $42,000 $538 1 $538 $44,000 $564 1 $564 $46,000 $590 1 $590 $48,000 $615 1 $615 $50,000 $641 1 $641 $52,000 $667 1 $667 $54,000 $692 1 $692 $56,000 $718 1 $700 $58,000 $744 1 $700 $60,000 $769 1 $700 $65,000 $833 2 $815 $70,000 $897 2 $815 $75,000 $962 3 $931 $80,000 $1,026 3 $931

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