Long Term Disability (LTD) TABLE OF CONTENTS (Click on any item below to go to that section) Overview LTD Coverage Benefit Payment of LTD Benefit Other Income Benefits Defining Disabled Recurrent disability What Is Not Covered Disabilities that are not covered Pre-existing conditions exclusion Mental illness limitation Filing a Claim If Your Claim Is Denied End of Coverage LTD Benefit Claims Administrator Overview Fortunately, long-term disabilities are rare. But when they do happen, the result could be financial disaster. This Long-Term Disability plan is offered to protect you and your family against the catastrophic loss that disability can cause. This plan can be a way to provide financial protection in the event of disability. As a member of the FlexAbility benefits plan you automatically receive core coverage under the long-term disability plan at no cost to you. This plan is meant to protect you against loss of income if you are disabled. Any payments that are paid under this policy are subject to the actual insurance policy. This section is a summary of information contained in the group insurance certificate. To obtain a copy of the certificate, please contact your local Human Resources department. If you are unable to return to your job after 90 days of disability, long-term disability (LTD) benefits will replace a portion of your income. LTD Coverage Benefit Your LTD benefit is coordinated with other income benefits. This means that the total amount you
would receive from the combination of other income benefits and the LTD benefit is 60 percent of your base pay. The most that you can receive from the LTD benefit is 60 percent of your base pay or $5,000 per month, whichever is less, minus other income benefits. The least you can receive per month is the greater of $100 or 10 percent of the monthly benefit before deductions for other income benefits. "Base pay" means your rate of earnings from your employer just prior to the date the disability begins. It doesn't include commissions, bonuses, call pay, overtime, or other compensation. Payment of LTD Benefit If you are totally or partially disabled by illness or injury, whether on the job or off, long-term disability benefits begin after you have been disabled for 90 consecutive days. You must notify the Claims Administrator of your disability in order to receive benefits. As long as you remain disabled and require the care of a physician, monthly benefits are paid according to this schedule. Age of disability Maximum benefit period Prior to age 62 To age 65 or 48 months if greater 62 48 months 63 42 months 64 36 months 65 30 months 66 27 months 67 24 months 68 21 months 69 and over 18 months Benefit payments stop when the maximum benefit period is reached or on the date one of the following conditions is met: The date you are no longer disabled or fail to furnish Proof of Loss The date you die The date your current earnings exceed 80 percent of your indexed pre-disability earnings Other Income Benefits The other income benefits that would reduce your benefits from this plan include: Payments you receive from: Your employer's retirement program
Retirement benefits for you or your dependents from Social Security or the Railroad Retirement Act Disability income you are eligible for under: Any other group insurance or association plan A governmental law or program that provides disability or unemployment benefits as a result of your job with your employer Workers' or Workmen's Compensation law, occupational disease law, or any compulsory benefit act or law Social Security or the Railroad Retirement Act These other payments, except retirement benefits or increases in a disability benefit from the Department of Veterans Affairs or other governmental agency, must be payable as a result of the same disability for which we pay a benefit. Defining Disabled You are considered disabled if because of injury or sickness: You are prevented from performing one or more of the Essential Duties of your occupation during the elimination period; and, For the 24 months following the Elimination Period, as a result Your Current Monthly earnings are less than 80% of your Indexed Pre-disability Earnings; AND After benefits have been paid for 24 months, you are prevented from performing one or more of the Essential Duties of any occupation for which you are qualified by training, education, or experience; and As a result your Current Monthly Earnings are less than 80% of your Indexed Pre-disability Earnings While you are receiving disability benefits, you may be asked to provide proof of your disability to continue being eligible to receive benefits. You must be under the regular care of a physician during your entire disability, or your benefits will stop. Recurrent disability A recurrent disability is a disability that is related to or due to the same cause as a prior disability for which you have satisfied the elimination period. A recurrent disability is considered either a continuation of the prior disability or a new disability. If you become disabled due to a recurrent disability less than 6 months after you return to your regular occupation on a full-time basis, the disability would be considered as part of the prior disability. If you return to work as an Active Employee after 6 months or more, a recurrence of the
disability would be considered a new disability and would be subject to a new Elimination Period and a new Maximum Duration of Benefits. Benefits payable under the recurrent disability provision are discontinued if benefits are payable under any other group long-term disability policy. What Is Not Covered Disabilities that are not covered Any disabilities due to the following are not covered: Caused or contributed by war, declared or undeclared, or any act of war. Intentionally self-inflicted injuries. Not under the regular care of a Physician. Caused by your commission of or attempt to commit a felony. Caused or contributed by your being engaged in an illegal occupation. Pre-existing conditions exclusion Your long-term disability plan does not cover any disability that begins in the first 12 months after your effective date of coverage if it is caused by, contributed to, or results from a preexisting condition. For this plan, pre-existing condition means a sickness or injury for which you received medical treatment, consultation, care, or services including diagnosis, or for which you took prescribed drugs or medicines in the 3 months prior to your effective date. Mental illness limitation If you have a disability due to mental illness, benefits are paid for a maximum of 24 months during your lifetime. The benefits may be extended for as long as you are confined in a hospital or other place licensed to provide medical care for the disabling condition. Benefits are not paid beyond the maximum benefit period defined by your age at the time of disability. Filing a Claim To file a claim, contact Human Resources to obtain Long-Term Disability claim forms. Within 30 days of when the disability started, fill out the forms and return them to your local Human Resources department. If you notify the department in writing without using the form, be sure to include: The date the disability started The cause of the disability How serious the disability is
You must send your Human Resources department a proof of claim no later than 180 days from the date of the disability. If Your Claim Is Denied If you have any questions, contact Human Resources or your Claims Administrator for this plan. If your claim is denied, either in full or in part, and you do not agree with the reason, you should write to your Claims Administrator within 60 days of receiving the denial. Contact your Human Resources department for the address. State why you believe the claim should not have been denied, and submit any data, questions, or comments you think are appropriate. You will receive a written response confirming that your appeal is being reviewed. Your Claims Administrator will review your claim and give a final decision on the review no later than 60 days from when they received your request. If there are any special circumstances, you will be notified and the final decision on the review will be made no later than 120 days from when your request for a review was received. End of Coverage Coverage under this plan ends on the earliest of the following dates: The date the policy terminates The date you are no longer eligible The date your employment terminates If you take a leave of absence or are temporarily laid off, coverage continues through the end of the month following the date in which you begin your layoff or leave of absence. You may be eligible for additional coverage if your leave qualifies under the Family and Medical Leave Act. Contact your Human Resources Department for more information. If the insurer ends the plan or if your employer ends the insurance contract, coverage would end on the date the plan or insurance contract is ended. LTD Benefit Claims Administrator We encourage suggestions from our members. Call or write your Claims Administrator: The Hartford P.O. Box 13829 Sacramento, CA 95853 (800) 523-2233