Important Information Regarding Group Short Term Disability Benefit

Please read through the policy information below.The bold text should be understood completely.

 

EXTENDED BENEFIT WAITING PERIOD

Does not apply to members that enrolled during an open enrollment period or that are within the first 60 days of membership.

  •  
  • For Disability caused by accidental Injury: 14 days
  • For Disability caused by Physical Disease, Pregnancy or Mental Disorder: 60 days.

 

The Extended Benefit Waiting Period applies only for the 12-month period beginning on the most recent date your insurance becomes effective. Thereafter for any period of continuous coverage only the Benefit Waiting Period will apply.

 

DEDUCTIBLE INCOME

Subject to Exceptions To Deductible Income, Deductible Income means:

1. Your Work Earnings, as described in the Return To Work Provisions.

 

2. Any amount you receive or are eligible to receive because of your disability under a state disability income benefit law or similar law. States with DI covered include; NJ, CA, RI, HI, NY, PR

 

3. Any amount you receive or are eligible to receive because of your disability under another group insurance coverage.

 

4. Any disability or retirement benefits you receive or are eligible to receive under your Employer's retirement plan, including a public employee retirement system, a state teacher retirement system, and a plan arranged and maintained by a union or employee association for the benefit of its members. You and your Employer's contributions will be considered as distributed simultaneously throughout your lifetime, regardless of how funds are distributed from the retirement plan. If any of these plans has two or more payment options, the option which comes closest to providing you a monthly income for life with no survivors benefit will be Deductible Income, even if you choose a different option.

 

5. Any earnings or compensation included in Predisability Earnings which you receive or are eligible to receive while STD Benefits are payable.

 

6. Any amount you receive or are eligible to receive under any unemployment compensation law or similar act or law.

 

7. Any amount you receive by compromise, settlement, or other method as a result of a claim for any of the above, whether disputed or undisputed.

 

LIMITATIONS

A. Care Of A Physician You must be under the ongoing care of a Physician in the appropriate specialty as determined by us during the Benefit Waiting Period. No STD 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 us.

 

B. Occupational Benefits No STD Benefits will be paid for any period when you are eligible to receive benefits for your Disability under a workers' compensation law or similar law. If your claim for these benefits is accepted, compromised or settled (whether disputed or undisputed), you must repay us for the full amount of any payments we make to you while your claim for occupational benefits is pending.

 

C. Paid Sick Leave Or Other Salary Continuation No STD Benefits will be paid for any period when you are receiving paid sick leave pay, annual or personal leave pay, or other salary continuation, including donated amounts, (but not vacation pay) from your Employer.

 

D. Imprisonment No STD Benefits will be paid for any period of Disability when you are confined for any reason in a penal or correctional institution.

 

E. Return To Work Responsibility No STD Benefits will be paid for any period of Disability when you are able to work in your Own Occupation and able to earn at least 20% of your Predisability Earnings, but you elect not to work.

 

F. Rehabilitation Program No STD Benefits will be paid for any period of Disability when you are not participating in good faith in a plan, program or course of medical treatment or vocational training or education approved by us unless your Disability prevents you from participating.

 

For additional questions please feel free to contact us.