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1 Gwinnett County Public Schools Short Term Disability Plan Document Effective September 1, 1989 Revised and Approved March 1998 Revised and Approved 2005 The Gwinnett County Board of Education provides as an employee benefit, a short term disability plan for the personal disabilities of employees only. The short term disability plan, hereinafter referred to as the Plan offers three benefit levels as follows: BENEFIT LEVEL ONE TWO THREE REFERRED TO AS BASIC PLAN A PLAN B The Plan provides financial protection for participating employees by paying a portion of their income while they are disabled. The Plan will pay a benefit over a maximum benefit period of twenty-six (26) weeks (180 days) per disability. The amount received is based on the amount earned before the disability began and the weekly benefit option chosen. Eligibility To be eligible to participate in the Plan, an employee must be a regular full-time or regular halftime (at least 20 hours per week) employee, working in a benefits eligible position. Application to Participate Eligible employees who wish to participate in the Plan must enroll in the Plan and complete the necessary paperwork within 31 days of being employed in a benefits eligible position. If an eligible employee does not enroll within the initial 31-day period, he or she will be considered a Late Applicant and cannot apply to participate in the Plan until the next open enrollment period. Late Applicants will have to provide satisfactory evidence of insurability, at their own expense, as part of the application process, and must be approved for participation in the Plan. Evidence of insurability requires that the employee provide medical history information, submit to a medical examination (if requested), and provide any additional information and medical documentation requested. A Late Applicant may be denied participation. Effective Date of Participation Provided the eligible employee enrolls within the initial 31-day eligibility period, participation begins on the first day of the month following completion of the 31-day eligibility period. An employee must participate and pay into the Plan for at least 6 full months before he or she can be considered for approval of an STD benefit, as explained in the next section. Approved benefit payments under this Plan will begin on the eighth day of disability whether the disability is due to an accident or illness. This is referred to as the Elimination Period. Participation for a Late Applicant will begin on the first day of the month following the date that he or she is provided written approval of his or her application to participate or the first day of the month of the new Plan year, whichever is later. If any employee is not actively at work on the day his or her participation is scheduled to begin, or if such day is not a normal work day for the employer, then participation shall not begin until the employee returns to active work for at least one regularly scheduled day. Eligible employees drawing pay as a result of approved sick leave will be considered to have been actively at work. Page 1 of 5

2 Short Term Disability Benefits After participation begins for an eligible employee, in order to be considered for approval of a short term disability payment, the employee must: 1. have participated in the Plan and paid into the Plan for the benefit level chosen, for at least six FULL months 2. have been actively at work on the business day that precedes the accident/illness that caused the disability; 3. become disabled after the six-month payment period; and 4. apply to receive a benefit within twelve (12) months of the accident/illness that caused the disability. In order to be considered disabled, an employee must be: 1. unable to perform the material and substantial duties of his/her job as a result of an accident/illness as approved by the Board (pregnancy and its complications will be treated as any other illness); and 2. under the appropriate and continuous care of a licensed physician who must provide a disability statement to the Benefits and Leave Administration Office. The statement must include the extent of disability, including restrictions and limitations preventing the employee from performing their regular occupation and the expected duration of their disability. STD claims will be paid or denied following a medical review. While a claim is pending, the Board, at its expense, has the right to request a medical evaluation of the employee by a physician of its choice. The Board may request that the employee have more than one evaluation. It is the responsibility of the employee to keep the Benefits and Leave Administration Office informed and updated of any and all changes in their medical condition for which they are receiving disability payments (including change in providers, treatment, appointment dates, etc.) Further, the employee must provide updated information upon request. The Board reserves the right to require repayment in the event benefits are paid to an employee who is no longer disabled. A participant may receive short term disability benefits and sick leave pay at the same time. Participants must continue to pay premiums while out on disability if they are receiving a paycheck from Gwinnett County Public Schools while receiving STD. Benefit Option Levels Basic Plan A Plan B Short-term disability benefits may be available for a work-related accident or illness incurred at Gwinnett County Public Schools (but not when incurred in connection with any other full or parttime employment). When available under these circumstances, the Plan will pay the difference, if any, between the Workers Compensation benefit level and the maximum benefit available under the Plan (66 2/3 percent of normal wages), provided that the Plan s maximum benefit is greater than the Workers Compensation benefit. If there is no excess above Workers Compensation, there is no short-term disability benefit. Page 2 of 5

3 Short term disability benefits will not be paid to an employee who is eligible to draw long term disability. Maximum Benefit Amount. No amount of benefit under the Plan will exceed 66 2/3 percent of the employee s normal wages earned during the pay period prior to the date the disability began. Normal wages do not include comp time, special wages, or overtime pay. Employees who have been released by a physician to return to work on a reduced work schedule and have been approved to return on a reduced work schedule by Human Resources and the principal or supervisor at their work locations, may receive a reduced short-term disability benefit for up to four weeks after returning to the reduced schedule. (Ex: An eight-hour employee who returns for four hours per day would receive 50% of his/her short-term disability benefit payment.) Second Occurrence Short-term disability benefits shall resume without having to satisfy another Elimination Period if a disabled employee returns to active work and again becomes disabled, if: 1. the employee is a participant in the Plan; 2. the first occurrence of the disability began within six (6) months prior to the second occurrence of the disability; 3. the first occurrence of the disability did not exhaust the maximum benefit period of twentysix (26) weeks; and 4. the employee is disabled again for the same illness/diagnosis. All prior days of disability and all monies previously paid under the first occurrence shall count toward maximum benefit period of 26 weeks (180 days) per disability. Once the maximum benefit period is exhausted, a participant can again become eligible to draw short term disability benefits for the same illness only after completing one full calendar year of full-time work (not less than 20 hours per week for this purpose), from the end of the previous illness. If the current disability meets the requirements above and is related to or due to the same cause(s) as the prior disability for which GCPS made a payment or if there is more than one illness and both run concurrently, GCPS will treat the current disability as part of your prior claim and another Elimination Period will not have to be completed. If you do not satisfy the above, your disability will be treated as a new claim and will be subject to all of the Plan provisions. Changes in Benefit Option Level Participants wishing to increase or decrease their Benefit Option Level can apply for a change, but only during the annual open enrollment period. Any application for an increased level of benefit must include the completion of forms showing satisfactory evidence of insurability, which must be provided at the participant s own expense. Evidence of insurability requires that the participant provide medical history information, submit to a medical examination (if requested), and provide any additional information and medical documentation requested. An application for an increased level of benefit may be denied, in which case the prior benefit option level will remain in force. If approved, the increased level will become effective on the first day of the month following the date that the participant is provided written approval of his or her application for an increased level of benefit, or the first day of the month of the new Plan year, whichever is later. However, in the case of an approved increase in the level of benefit, if the participant is not actively at work on the day his or her increased level is scheduled to begin, or if such day is not a Page 3 of 5

4 normal work day for the employer, then the increased benefit level shall not become effective until the participant returns to active work for at least one regularly scheduled day. Participants drawing pay as a result of approved sick leave will be considered to have been actively at work. If an increased level of benefit is approved, the participant will not be considered for a short-term disability payment under the increased level until the participant has paid into the Plan for at least six (6) full months for the increased benefit level. Until that time, any approved payment will be made under the participant s prior benefit option level. When Benefit Payments End Benefit payments will end on the earliest of: 1. The date employee is no longer disabled. 2. The date employee fails to furnish satisfactory proof that he/she continues to be disabled. 3. The date employee refuses to be examined if the Gwinnett County Public Schools Board requires an examination. 4. The last day of the maximum period for which benefits are payable. 5. The date employee failed to return to work when found fit by health care provider. 6. The date employee failed to return to work when found fit by independent physician. 7. The date medical documentation does not support claim of disability. 8. The date it is determined by the Board that employee is not under proper and adequate medical care or no longer is eligible for benefit payment for any reason. 9. The date employee left the state for a period exceeding 10 days without Board approval. Out of town travel will require a doctor s statement approving employee for travel. 10. The date the Board, despite reasonable efforts, has been unable to contact employee via phone and certified mail. (This date will be decided at the discretion of the Board.) 11. The day employee dies. 12. The day employment ends. 13. Other (as determined at the discretion of the Board, the Benefits and Leave Administration Office, or the disability manager). Benefits under this Plan shall not be payable for: 1. Any illness or injury which is not treated by a licensed physician or surgeon. 2. Any loss caused by war or act of war (declared or not) 3. Intentionally self-inflicted injury, whether employee is mentally competent or not. 4. Injury which occurs when employee commits or attempts to commit a felony. 5. Injury suffered in a fight in which employee is the aggressor. 6. The portion of the disability that employee is confined in a penal or correctional institution as a result of conviction for a criminal or other public offense. If employee s disability is the result of more than one cause, benefit payments will be made as if the disabilities were the same. Short term disability payments will end when both disabilities end, subject to the maximum benefit period of 26 weeks (180 days). Benefit levels will be announced and published in the Leave Handbook. Gwinnett County Public Schools reserves the right to designate the annual open enrollment period and can, at its discretion, declare more than one (1) per year. Gwinnett County Public Schools reserves the right to increase or decrease the benefit levels or premiums at any time. Should Gwinnett County Public Schools elect to change the benefit levels, the Plan will pay out the benefit currently being received by a disabled employee before adjusting the benefit to the new level. Page 4 of 5

5 Gwinnett County Public Schools reserves the right to amend or discontinue the Plan at its discretion. Should the Gwinnett County Public Schools ever decide to discontinue the Plan, it will pay out all the existing claims properly received on or before the date of discontinuance of the Plan, provided the claim for benefits is approved. Gwinnett County Public Schools (and the Board) has the final discretion and authority to interpret the Plan, including any ambiguous or uncertain terms, and to decide all questions of law and fact under the Plan. While the Board has final authority, others have the responsibility for the administration and operation of the Plan on a day to day basis. Page 5 of 5