About This Document About Portico Benefit Services About Our Plans

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1 SUMMARY PLAN DESCRIPTION EFFECTIVE JAN. 1, 2017

2 About This Document This plan summary, in conjunction with the ELCA Traditional Benefits Program Program Description, forms the summary plan description (SPD) for the ELCA Disability Benefits Plan, for members sponsored in the ELCA Traditional Benefits Program, effective Jan. 1, This plan summary describes plan rules and benefits, while the ELCA Traditional Benefit Program Program Description describes eligibility, enrollment, and how professional and life changes affect your benefits. Use these two documents together as a reference when you have questions about your ELCA disability benefits. Together, these documents replace and supersede all previous versions. The ELCA Traditional Benefit Program Program Description is available by signing in to myportico at myportico.porticobenefits.org/summaries or contacting the Portico Customer Care Center at mail@porticobenefits.org or The plan document of the ELCA Disability Benefits Plan is the full, legal description of the plan. Your rights under the plan are governed by the plan document. If this plan summary is found to be inconsistent with the plan document, the plan document will be considered the controlling document. A copy of the plan document is available from the Portico Customer Care Center. Portico reserves the right to change any term of the plan through the amendment or termination process described later in this summary. About Portico Benefit Services For over 25 years, Portico Benefit Services has offered health, retirement, and other benefits designed to enhance the well-being of those who serve. Because we focus on those who serve through the Evangelical Lutheran Church in America and other faith-based organizations, we can tailor our benefits to include advantages and options suited just for our membership. As part of the ministry community and as experienced professionals, we are qualified to design and manage all aspects of the ELCA s benefit plans. Portico serves more than 7,000 congregations and organizations, and more than 50,000 people across the ELCA during their working years and in retirement including rostered ministers, lay employees, retirees, and their family members. About Our Plans The ELCA Pension and Other Benefits Program provides health, flexible spending, retirement, disability, and survivor benefits presented as one comprehensive program to members. Benefit plans are governed and administered individually through separate plan documents. The Board of Pensions of the Evangelical Lutheran Church in America, doing business as Portico Benefit Services, maintains the following plans: ELCA Retirement Plan, ELCA Retirement Savings Plan (pilot), ELCA Disability Benefits Plan, ELCA Survivor Benefits Plan, ELCA Medical and Dental Benefits Plan (which includes the ELCA post-retirement medical benefits obligation), and ELCA Flexible Benefits Plan. We also maintain three group retirement plans for ELCA-affiliated social ministry organizations the ELCA Master Institutional Retirement Plan, the ELCA Retirement Plan for The Evangelical Lutheran Good Samaritan Society, and the ELCA 457(b) Deferred Compensation Plan. The assets of each plan are held in various trusts and therefore do not allow one plan to fund a shortfall of another plan. The plans are church plans, as defined in section 414(e) of the Internal Revenue Code and are not subject to the Employee Retirement Income Security Act (ERISA). The health and disability plans are self-insured and are not protected through any type of insurance program. Our ability to pay claims is dependent on continued contributions and market performance. The basic, supplemental, and dependent life insurance benefits are offered by Securian Life Insurance Company (Securian Life). Product guarantees are backed by the financial strength and claim paying ability of Securian Life. Premiums are not guaranteed to remain unchanged. Portico Benefit Services does not assume any responsibility or liability for the obligations of Securian Life under the insurance policies. Portico Benefit Services is not affiliated with Securian Life. We reserve the right to change any of the terms of the plans at any time through the amendment or termination process described in each plan s summary plan description.

3 Contents About the ELCA Disability Benefits Plan Traditional Benefits Program...4 What ELCA Disability Benefits Provide...4 Disability Benefits Eligibility...5 Disability Benefits Exclusions...5 Disability Benefits Administrator...6 Source of Disability Benefits...6 Applying for Disability Benefits...7 Pre-Existing Condition Period...7 Filing Your Claim...7 If Your Claim Is Denied...8 Receiving Benefits...9 Waiting Period...9 Payment of Benefits...9 Ongoing Review...9 Medical Treatment Guidelines...10 Clergy Housing Allowance...10 Total Disability...11 ELCA Total Disability Benefits...11 Working While Receiving Benefits...12 Social Security Disability Benefits...12 Benefits From Other Government Programs...13 Example: Total Disability Benefits...13 Partial Disability...14 ELCA Partial Disability Benefits...14 Example: Partial Disability Benefits...15 Duration of Benefits...16 Lifetime Maximum Benefit Period...16 Recurring Disability...16 Administrative and Miscellaneous Provisions...17 Glossary...22 Contact Information...24

4 About the ELCA Disability Benefits Plan Traditional Benefits Program The ELCA Disability Benefits Plan is part of the ELCA Traditional Benefits Program. Also called the ELCA benefit program, it includes: ELCA Medical and Dental Benefits Plan (ELCA Health Plan) ELCA Survivor Benefits Plan ELCA Disability Benefits Plan ELCA Retirement Plan Combined, these plans offer resources to help you and those you care about live well, so you re better able to enhance the lives of others. We also offer the ELCA Flexible Benefits Plan Tax-Advantaged Accounts. NOTE: If you have ELCA disability benefits through the ELCA Flexible Benefit Program, your disability benefits are described in the Summary Plan Description for the ELCA Disability Benefits Plan ELCA Flexible Benefits Program. Refer to that booklet for benefit information. What ELCA Disability Benefits Provide The ELCA Disability Benefits Plan provides generous financial and benefit assistance to help you adapt and recover from disabling illness and injury until you can return to meaningful work, if possible. Disability benefits provide monthly income, ELCA health and survivor coverage, and contributions to your ELCA Retirement Plan account if you become unable to work because of a disability. Generally, if you qualify for ELCA disability benefits, you receive: A monthly income benefit (referred to as your basic benefit) equal to two-thirds of your monthly benefit compensation (see Glossary), less severance payments, Social Security disability, workers compensation, or other government benefits you re receiving due to your disability (excluding veterans disability benefits), following a waiting period Health benefits for you and eligible family members Contributions to your retirement account at an amount based on your current basic benefit, multiplied by the minimum required employer retirement contribution rate (see Glossary), which may be less than your current rate Basic group life insurance Supplemental and dependent life insurance you purchased prior to your date of disability The option to contribute to a health flexible spending account (FSA) If you are partially disabled (see page 14), your benefits are reduced by the percentage of time you are able to work. Page 4

5 While receiving ELCA total disability benefits, you re not eligible to: Contribute to a dependent care FSA or health savings account (HSA) Purchase supplemental or dependent life insurance (also true for partial disability) Make pretax contributions toward retirement For the first two months of total disability, your sponsoring employer pays your salary and the contribution for your other benefits. Beginning with the third month, the contributions for these benefits are paid by the ELCA Disability Benefits Trust. If you re partially disabled (see page 14), your employer and the ELCA Disability Benefits Trust will split the contributions for your benefits. NOTE: Interim pastors or interim rostered laypersons under a call from a synod council who purchase disability coverage at their own expense will receive different benefits from the ELCA Disability Benefits Trust than those of sponsored members. See the ELCA Benefit Program Description section, If Your Interim Assignment Ends. Disability Benefits Eligibility In order to be eligible to receive ELCA disability benefits, all of the following must apply: The disabling condition must occur while you re sponsored in the plan and your first day absent due to disability must occur while you re still sponsored by an employer in the ELCA Traditional Benefits Program. Disability claimed for a date after termination of employment or end of call cannot be approved. You must apply for disability benefits within six months of becoming totally disabled. You must be under the regular care of a qualified health care provider for the disabling condition within the 31 days prior to the date of disability benefits. The disability must be substantiated by objective medical information from a qualified health care provider. The disability benefits administrator of the ELCA Disability Benefits Plan determines if you are disabled based on the information you provide when applying for benefits and periodically thereafter. Disability Benefits Exclusions You re not eligible to receive benefits under this plan if: Your total disability results from your willful and illegal participation in fights, riots, or civil insurrections, or occurs while you re committing a felony. You re incarcerated in a penal or correctional institution upon conviction of a felony. Your total disability results from a self-inflicted injury. Your disability is due to a cosmetic surgery, unless the surgery is covered under the ELCA Health Plan. Your disability is caused by a condition diagnosed or treated in the six-month period immediately before your enrollment date. You ve already received benefits for the plan s lifetime maximum benefit period (see page 16). The disability benefits administrator of the ELCA Disability Benefits Plan determines that you are not disabled based on the information you provide when applying for benefits and periodically thereafter. Page 5

6 The disability benefits administrator of the ELCA Disability Benefits Plan determines if you are not disabled based on the information you provide when applying for benefits and periodically thereafter. NOTE: If you re an interim pastor or interim rostered layperson serving under a term call from a synod council and between assignments after completing an interim or term call from your synod council, you can purchase up to 12 months of limited disability benefit coverage at your own expense. If purchasing disability coverage at your own expense, see the ELCA Benefit Program Description section, If Your Interim Assignment Ends. Disability Benefits Administrator The ELCA Disability Benefits Plan is administered by Liberty Mutual. As the disability benefits administrator, Liberty: Reviews all disability claims to determine initial eligibility Administers the claim filing processes Manages medical, psychological, educational, and vocational claim documentation Distributes all disability payments Verifies ongoing eligibility to receive benefits Answers questions you may have related to your disability Assesses current treatment plans Source of Disability Benefits The ELCA Disability Benefits Plan is funded by employer-paid contributions, calculated as a percentage of sponsored members defined compensation (see Glossary). These contributions are invested into the ELCA Disability Benefits Trust. All ELCA disability benefits are paid solely from the ELCA Disability Benefits Trust. Page 6

7 Applying for Disability Benefits You must apply for disability benefits within six months of becoming disabled. Liberty Mutual, the plan s disability benefits administrator, assigns a claims manager who reviews your disability claim to determine whether you meet the requirements of the plan. The claims manager will notify you if your claim is approved. Pre-Existing Condition Period The ELCA Disability Benefits Plan includes a pre-existing condition exclusion. During the pre-existing condition period, you aren t entitled to receive disability benefits if the disability is caused by a preexisting condition diagnosed or treated in the six-month period prior to the enrollment date. If you enroll in the ELCA Traditional Benefits Program within 60 days of becoming eligible or during Annual Enrollment, your six-month pre-existing condition period begins with your enrollment effective date. If you were diagnosed or treated for a condition in the six months prior to enrollment, and you become totally or partially disabled due to that condition within six months after becoming a sponsored member, you will not be eligible for disability benefits. If you enroll in the program more than 60 days after becoming eligible, you re subject to a pre-existing condition period of 18 months. If you were diagnosed or treated for a condition in the six months prior to enrollment, and you become totally or partially disabled due to that condition within 18 months after becoming a sponsored member, you will not be eligible for disability benefits. Exceptions The following individuals are not subject to the six-month or 18-month pre-existing condition exclusion period when enrolling (or re-enrolling) in the ELCA benefit program: Eligible pastors or rostered laypersons who continue ELCA health benefits while on leave from call Eligible called interim pastors or interim ELCA rostered laypersons who continue ELCA benefits at their own expense between assignments while serving under a term call from a synod council. NOTE: If you are an interim pastor, see the ELCA Benefit Program Description section, If Your Interim Assignment Ends for more information. Eligible employees who transfer from a non-elca church and were enrolled in that church s denominational disability coverage if that denomination has a reciprocity agreement with the ELCA, and if they become a sponsored member within 90 days after separation from service with the other church. These members will be given month-for-month credit for disability coverage for the time they participated in the other church plan. Filing Your Claim You become eligible to receive ELCA disability benefits at the start of the third consecutive month of disability. No disability benefits will be paid from the plan for two months immediately following your date of disability (see Glossary). File a claim by calling Liberty to apply for disability benefits (see Contact Information). You ll be asked questions about your current occupation, work history, education, income, health condition, and health Page 7

8 care providers. Provide the requested information to Liberty, including any required forms, by the specified deadline. Liberty will review information you provide, along with your medical records to determine whether you have a total disability as defined by the plan. If the review concludes that you are disabled, you will receive disability benefits. If it concludes that you are not disabled, you will not receive disability benefits. If Your Claim Is Denied If you ve submitted your disability claim and it is denied, Liberty will send you a letter that will include: The information collected to make the determination from you, your health care providers, and the administrator s reviewer Steps you can follow to appeal the denial If you believe you re entitled to receive disability benefits, follow the appeals procedure and deadline described in the letter from Liberty about the denial of disability benefits, or the termination of your benefits, or contact your Liberty claims manager. NOTE: Disability benefits are subject to the lifetime maximum benefit period. See page 16 for more information. Page 8

9 Receiving Benefits Once Liberty Mutual, the plan s disability benefits administrator, approves your claim, you will receive benefits following a waiting period. Waiting Period No disability benefits are paid from the plan for the two-month waiting period immediately following your date of disability (see Glossary). You can t work in any occupation during the first two months of total disability. During those two months, your employer is expected to pay your full salary and make contributions for your ELCA health, retirement, disability, and basic life insurance benefits. Payment of Benefits Beginning with the third consecutive month of disability, the contributions for your benefits will be paid by the ELCA Disability Benefits Trust. Your monthly disability benefit is mailed or electronically transferred on or about the first business day preceding the 21st of each month as long as you maintain eligibility. Your basic benefit may increase each Jan. 1, based on the annual increase factor (see Glossary). NOTE: If your disability started or terminated partway through the month, your monthly disability benefit will be prorated based on the number of days for which payment is due. Ongoing Review Liberty will periodically review your eligibility to continue to receive disability benefits. The frequency of review depends on many factors, including your age, medical condition, and treatment plan. Liberty will contact your health care provider(s) to request your medical records. Liberty may follow up with your providers to clarify questions about your medical status and treatment plan. Liberty will review your medical records, vocational skills, and potential job opportunities to help determine whether you continue to meet the plan s definition of total disability. If the review concludes you continue to be disabled, ELCA benefits will continue. Periodic reviews will continue. If the review concludes that you are no longer disabled, all ELCA benefits will end generally, immediately. If your benefits are terminated and you believe you re entitled to continue to receive disability benefits, follow the appeals procedure and deadline described in the letter from Liberty about the termination of your benefits, or contact your Liberty claims manager. IMPORTANT: When disability benefits end, all ELCA benefits paid by this plan will end, including monthly disability income, health benefits, retirement plan contributions, and basic group life insurance (as well as Medicare Part B premium reimbursement and flexible benefits, if applicable). You can continue health benefits at your own expense. NOTE: Disability benefits are subject to the lifetime maximum benefit period. See page 16 for more information. Page 9

10 Medical Treatment Guidelines While you re receiving disability benefits under this plan, you must be under the care of, and actively engaged in your care plan with providers qualified to treat your medical or psychological condition and receive medical or psychological treatment designed to restore or maintain your health and functionality. In addition, you must follow your qualified health care provider s treatment plan, including: Keeping appointments Taking medications, as prescribed Following recommended diet and exercise programs Refraining from the use of alcohol or illegal drugs, if so ordered Your disability benefits may be terminated if these guidelines aren t followed. Liberty may require that you receive an independent medical or psychological examination with a designated qualified provider to determine whether you are eligible to continue to receive disability benefits. The plan covers the cost of this required independent exam. Clergy Housing Allowance If you re an ELCA pastor and were serving under call on your date of disability, 100% of your disability payments will be designated as eligible for the housing allowance exclusion from federal gross income. Page 10

11 Total Disability The disability benefits administrator, Liberty Mutual, makes the determination of total disability as a direct result of physical or mental disorder, substantiated by objective medical information from a qualified health care provider, based on information you provided when you applied for benefits. Under this plan, you re considered to have a total disability if the disabling condition occurred while you were sponsored and your situation meets the following definitions: In the first 12 months of disability You are unable to perform the material duties of your normal occupation for any employer, as a direct result of injury or physical or mental disorder that occurred while sponsored in this plan. Your normal occupation is the occupation you performed immediately prior to your date of disability. After 12 continuous months of disability Liberty determines that you re totally disabled only if you re unable to perform the material duties of any occupation: - which you could reasonably undertake with education, training, or experience, and - in which you could reasonably expect to earn at least 70% of your benefit compensation ELCA Total Disability Benefits If you qualify for ELCA total disability benefits, you receive: Basic benefit Two-thirds of your benefit compensation (see Glossary), minus earnings in excess of one-third of your benefit compensation, any Social Security disability benefits for you and your family, and other governmental disability benefits such as workers compensation Health benefits ELCA-Primary Gold+ health benefit option* (or the ELCA Medicare- Primary Standard option if you re eligible for Medicare as your primary coverage) for you and eligible family members. If you have ELCA-Primary health benefits, you re still eligible to earn wellness dollars. Retirement contributions Employer contributions to your ELCA Retirement Plan account continue at the minimum required employer retirement contribution rate (see Glossary), which may be less than your current rate. Life insurance Basic group life and any supplemental and dependent life insurance you purchased prior to your date of disability will continue at no cost to you (premium waived by Securian Life Insurance Company). *If you become eligible for disability benefits while you have the Platinum+ health benefit option provided by your sponsoring employer, the ELCA Disability Benefits Trust will pay contributions for Platinum+ for the remainder of the year. If you chose it as a buy-up option, you continue to pay the difference between Gold+ and Platinum+ for the remainder of the year. You re also eligible to contribute to a health flexible spending account (FSA), which will be deducted from your basic benefit. While receiving total disability benefits, you can t purchase supplemental or dependent life insurance, and you re not eligible to make contributions to a: Dependent (day) care FSA (However, you can use available funds for eligible expenses incurred through the end of the calendar year. File your claims by April 30 of the following year.) Health savings account (HSA) (However, you can use available funds for eligible expenses.) ELCA Retirement Plan account Page 11

12 Working While Receiving Benefits Although you re not permitted to work during the first two months that you re totally disabled, following the two-month waiting period, you can earn up to one-third of your benefit compensation without a reduction in your monthly disability benefit. Earnings are monetary compensation you receive for work performed. Any earnings in excess of one-third will reduce your monthly disability benefit by 100% of the excess. It s your responsibility to notify Liberty of any earnings you receive while you re totally disabled. You may also be required to provide copies of your tax return or other earnings statements for accurate benefit calculation. If earnings statements are not provided as requested to Liberty in a timely manner, your monthly disability benefit may be delayed. Because it isn t always possible for Portico to reduce your monthly disability benefit in anticipation of earnings, you re obligated to reimburse the ELCA Disability Benefits Trust for any benefits paid (including interest) that shouldn t have been paid, based on your earnings and according to the terms of this plan. Social Security Disability Benefits While receiving ELCA total disability benefits, you may also be eligible for disability benefits from Social Security if you are unable to work due to a disability that is expected to last at least 12 months or result in death. You will be contacted by a company working with Liberty to assist you in applying for Social Security disability benefits at the appropriate time. You must apply for Social Security disability benefits as soon as you re eligible. Social Security disability benefits continue as long as you remain disabled as defined by the Social Security Administration, up to Social Security s full retirement age. (Thereafter, the benefit becomes a retirement benefit.) Social Security benefits may also be payable to your spouse if he or she is age 62 or over, or is caring for your child. Dependent children or grandchildren may also be eligible. If the Social Security Administration denies your claim, please send a copy of the denial notice to Liberty. If you don t apply for Social Security disability benefits, or if you don t participate in Social Security, your benefits will be reduced by an amount equal to the amount Social Security would have paid had you applied for benefits (or are deemed eligible to receive). For more information on Social Security disability benefits, see Contact Information and visit ssa.gov or call your local Social Security office. Social Security Offset Social Security disability benefits that you or your family members are eligible to receive will be subtracted from your ELCA monthly disability benefit payment. Between Social Security, other government programs including workers compensation (but excluding veterans disability benefits), and the ELCA disability benefit, you will receive at most two-thirds of your defined compensation (see Glossary). Page 12

13 All Social Security disability benefits reduce your ELCA monthly disability benefit. Therefore, if Social Security disability benefits are awarded retroactively, you must repay the ELCA Disability Benefits Trust any overpayment of benefits. Benefits From Other Government Programs Any income from other government disability programs (excluding veteran s disability benefits) to which you and your family are entitled during your disability, such as workers compensation, offsets your benefits under the ELCA disability plan. You must repay the ELCA Disability Benefits Trust for any benefits you receive or are entitled to receive. In the event of a lump-sum settlement, the disability benefits administrator, Liberty Mutual, may request repayment of the entire settlement or prorate the lump-sum settlement over the years it is estimated you will be entitled to receive disability benefits. Example: Total Disability Benefits Pastor Williams has monthly defined compensation of $6,000 prior to receiving disability benefits. For the first two months of her disability (waiting period), her employer pays Pastor Williams her salary and makes contributions for her benefits to Portico. Beginning with the third month, her total basic benefit is two-thirds of her benefit compensation before she became disabled in this case $4,000 less any Social Security or other government program benefits that may apply (in this example, all other benefits are assumed to be zero). For Pastor Williams, a total disability results in a monthly disability benefit of $4,000. While receiving total disability benefits, she ll also receive the following benefits, paid for through the ELCA Disability Benefits Trust: ELCA-Primary Gold+ health benefits for herself and eligible family members 10% of her defined compensation to her retirement account (the minimum required employer retirement contribution for pastors) Basic group life insurance Supplemental and dependent life insurance she purchased prior to her date of disability (premium waived by Securian Life Insurance Company; not paid by the ELCA Disability Benefits Trust) She s also eligible to contribute to a health FSA at her own expense. She s not eligible to: Make pretax retirement contributions to her ELCA retirement account Contribute to a dependent (day) care FSA Contribute to an HSA Purchase supplemental or dependent life insurance For information on FSA eligibility while receiving disability benefits, see the, If You Become Disabled section of the ELCA Benefit Program Description. Page 13

14 Partial Disability Under this plan, you re considered to have a partial disability when your physical capacity to perform full-time work at your normal occupation for your sponsoring employer is reduced by at least 20% due to a qualifying neurological disease (see Glossary). The following conditions are qualifying neurological diseases under this plan: Adult-onset muscular dystrophy Amyotrophic lateral sclerosis Huntington s disease Multiple sclerosis Myasthenia gravis Parkinson s disease This list of qualifying neurological diseases may be modified at any time. A qualified health care provider must provide the disability benefits administrator, Liberty Mutual, with objective medical information substantiating the partial disability and written verification of your reduced capacity for full-time work. If your disease progresses so that you can no longer work, you or your health care provider must notify Liberty of your change in status. Liberty will review your status to determine disability benefits. ELCA Partial Disability Benefits Upon approval by Liberty, you receive a basic monthly disability benefit (see Glossary) minus any Social Security and other government program payments, multiplied by the percentage of defined compensation (see Glossary) that you no longer receive due to the reduction in your normal workload. While receiving partial disability benefits, contributions for these benefits are split between your employer and the ELCA Disability Benefits Trust: Health benefits for yourself and eligible family members at the ELCA-Primary health benefit option you chose when you enrolled for the plan year Retirement contributions at the minimum required employer retirement contribution rate (see Glossary) Basic group life insurance You re eligible to contribute to health and dependent care flexible spending accounts (FSAs) at your own expense. For information on FSA eligibility while receiving disability benefits, see the If You Become Disabled section of the ELCA Benefit Program Description. You re not eligible to purchase supplemental or dependent life insurance. NOTE: If you re approved for partial disability benefits, you must notify the disability benefits administrator whenever your health or work status changes. Any change in status must be accompanied by a statement from a qualified health care provider. Your partial disability benefit will be redetermined whenever Liberty is notified of your change in status. Page 14

15 Example: Partial Disability Benefits Choir Director Anderson has a defined monthly compensation of $3,000 prior to receiving disability benefits and can now work only 75% of his previous workload. His employer continues to pay him 75% of his previous defined compensation ($2,250). His basic benefit is two-thirds of his benefit compensation before he became disabled in this case $2,000 less any Social Security or other government program payments that may apply (in this example, all offsets are assumed to be zero). The result is multiplied by the percentage of time he is unable to work. For Choir Director Anderson, a 25% partial disability results in a monthly partial disability benefit of $500 (25% of $2,000). In addition, the contributions are split 75% employer and 25% ELCA Disability Benefits Trust for these benefits he receives: The ELCA-Primary Gold+ health benefit option he chose when he enrolled, for himself and eligible family members 6% of his defined compensation to his retirement account (the minimum required employer retirement contribution for lay employees) Basic group life insurance Page 15

16 Duration of Benefits After your disability claim is approved, your benefits under this plan continue until the first of the following events: The date you re no longer considered by the disability benefits administrator, Liberty Mutual, to be disabled as defined by this plan The date the lifetime maximum benefit period ends (see table below) The date of your death Benefits under this plan may end earlier than noted above if you don t comply with plan terms, including the medical treatment guidelines described on page 10. Lifetime Maximum Benefit Period Disability benefits typically continue until you reach Social Security full retirement age. If you become disabled at age 63 or over while sponsored, you may receive disability benefits beyond Social Security full retirement age, up to a lifetime maximum benefit period. Age at Disability Under age 63 Lifetime Maximum Benefit Period To Social Security full retirement age 63 To Social Security full retirement age or 36 months, whichever is greater 64 To Social Security full retirement age or 30 months, whichever is greater months months months months 69 and over 12 months Recurring Disability If Liberty Mutual determines you can return to work following a partial or total disability, and you are again sponsored in the ELCA benefit program and are determined by Liberty Mutual to be disabled within the next six months for the same or a related condition, disability benefits will resume immediately. Benefits will be subject to the lifetime maximum benefit period. If the disability occurs more than six months after the prior disability, it will be treated as a new disability and you must reapply for disability benefits. Page 16

17 Administrative and Miscellaneous Provisions Third-Party Liability (Subrogation) Subrogation is a legal process that allows Portico to substitute itself in your place regarding a claim or legal right to compensation from a third party (person or entity) who was responsible for your injury or illness. Upon payment of benefits under the ELCA disability plan, Portico will be subrogated to your rights of recovery against any third party, including recoveries from: People who commit wrongful acts, injuries, or damages for which a civil action can be brought (tort-feasors) Underinsured/uninsured motorist coverage Employers and/or workers compensation insurers Other substitute coverage or any other right of recovery, whether based on tort or contract This applies to you and any person claiming benefits through you or on your behalf (trustee, personal representative, executors, next of kin, heirs, etc.). Non-assignability of rights Your rights to receive any reimbursement under this plan are not transferable through assignment or any other method and are not subject to claims by your creditors by any process whatsoever. Any attempt to do so will not be recognized by Portico, except as required by law. Reimbursed first Portico will be paid before any other claims are paid, including any claim by you for general damages. If you fail to remit to Portico any amount to which it is entitled, Portico may withhold future disability payments to satisfy your obligation. Government-mandated insurance If you fail to obtain any type of state or federal mandated insurance coverage, (workers compensation or no-fault insurance), Portico will be allowed to fully assert its subrogation rights. Lump-sum settlements If you voluntarily accept a lump-sum (or other) settlement without the consent of Portico and the settlement results in a waiver or abolishment of Portico s subrogation rights against the third party, Portico is relieved of any obligation to pay past, present, or future benefits or expenses relating to the illness or injury. Appeals Procedure Initial steps If you apply for a benefit under the plan and the benefit you receive isn t the benefit you expected, or the benefit is denied and you believe you re entitled to a benefit under the plan, follow the procedure outlined by the disability benefits administrator, Liberty Mutual, in your determination letter. Explain why you believe you re entitled to receive benefits and include additional medical documentation to substantiate your claim. Page 17

18 NOTE: Disability benefits are not paid during the appeals process. If you re found to be disabled, such benefits will be reinstated. Appeal to Portico s President If your claim isn t approved after exhausting the Liberty Mutual appeals procedure, you may file a written appeal with the president of Portico within 60 days of your receipt of an adverse appeal determination from Liberty. Include the facts of your case, any new or additional information not considered in the initial decision, and the outcome you desire. The president will review your claim with the advice and counsel of the internal appeals committee, which shall consist of at least three staff members who were not involved with the initial decision. The president will respond in writing within 30 days of receipt of your appeal and appropriate release of information authorization unless the president notifies you of the need for an additional 30 days. The president may approve an appeal only if one of the following is determined: An error was made in the initial benefit determination The appeal involves matters related to plan interpretation In the case of changing technology or circumstances, the president may recommend an expansion of benefit coverage requiring a plan amendment, which may or may not be retroactive. All plan amendments must be approved by the president, the Portico board of trustees, and/or the ELCA Church Council in accordance with the provisions described on page 20. Board of Trustees Appeals Committee An appeal may be filed with the appeals committee of the Portico board of trustees within 60 days of your receipt of the president s written response if you re dissatisfied with the decision of the president. The appeals committee will consist of five to seven members of the board of trustees, at least one of whom must be a participant in the ELCA benefit program. Additionally, the committee may include independent consultants with expertise in the area of the appeal to serve with voice but without vote. The appeals committee will schedule a meeting within 30 days of receiving your appeal and appropriate release of information authorization. The final decision of the appeals committee will be forwarded to you within 60 days of receipt of the appeal. All decisions of the appeals committee are final. Court system If you have exhausted the previously described appeals procedures and are dissatisfied with the final decision of the Portico appeals committee, you may initiate legal action in the Minnesota Fourth Judicial District Court, Hennepin County. Any removal of such action must be to the United States Court for the District of Minnesota. Legal action can t be taken more than three years after the date of the event on which the claim is based. Limitation of Liability Benefits under the ELCA Disability Benefits Plan will be paid solely from the ELCA Disability Benefits Trust. Neither Portico nor the disability benefits administrator, Liberty Mutual, is liable for the failure of any employer to enroll you as a sponsored member in the plan or for the failure of any employer to make contributions to the plan on your behalf. Also, Portico isn t liable to any member or other person or entity for any of its acts carried out in good faith and based upon information available at the time. Page 18

19 Correction of Errors It is recognized that in the operation and administration of the ELCA Disability Benefits Plan, certain mathematical and accounting errors may be made or mistakes may arise for various reasons, including factual errors in information supplied to Portico or its board of trustees. Portico has the power to make equitable adjustments to correct such errors as Portico, in its sole discretion, considers appropriate. Adjustments will be final and binding on all persons. Plan Information While every effort has been made to ensure the information contained in this communication is correct, if there is any omission or misstatement, the applicable legal plan document will control. The eligibility for any benefit will be governed by the terms of the applicable plan, program, or policy. Portico (and its designee or disability benefits administrator, as applicable) shall have the power, including, without limitation, discretionary power to make all determinations that the plan requires for its administration, and to construe and interpret the plan(s) for purposes of determining eligibility and benefits. Obligations of a Sponsored Member As a sponsored member of the ELCA Disability Benefits Plan, you agree to comply with all the Portico requirements regarding enrollment and administration of the plan. This includes, but is not limited to, providing your: Date of birth Disability status Family support obligations Marital status Social Security number If you don t comply with reasonable requirements or if you knowingly provide false, inaccurate, or misleading information, you must reimburse Portico or the disability benefits administrator, Liberty Mutual, for reasonable expenses and damages it incurs as the result of such failure. This includes, but is not limited to, the amount incurred by staff in discovering, correcting, or adjusting for such a failure. Liberty may reduce your future benefit payments under this ELCA Disability Benefits Plan, if any, by the additional expense. Obligations of a Participating Employer By sponsoring an eligible employee in the ELCA Disability Benefits Plan, the participating employer agrees to: Be bound by the terms of the ELCA Disability Benefits Plan, including future amendments and any rules or procedures adopted by Portico (such as paying full salary and contributions to the ELCA benefit program during the first two months of disability) Provide the necessary information to Portico for the administration of the ELCA Disability Benefits Plan Promptly notify Portico of any IRS audit or change in status that could cause the employer to cease to be eligible to participate in the plan Page 19

20 An employer may discontinue participating in the ELCA benefit program by notifying Portico and complying with any procedures established by Portico for discontinuing participation. Portico may discontinue the participation of an employer if Portico, in its sole discretion, determines the employer is no longer an eligible employer as defined by the program or if the employer has failed to comply with the provisions of the program. Self-Insured Plan The ELCA Disability Benefits Plan is a self-insured plan. Although Portico has contracted with Liberty Mutual to administer certain benefits of the plan, Liberty doesn t insure any part of the plan. All benefits to which a person becomes entitled hereunder shall be provided only out of the ELCA Disability Benefits Trust and only to the extent that the trust is able to cover expenses. Amendment to the Plan The ELCA Churchwide Assembly, the ELCA Church Council, or Portico may propose amendments to the plan. All proposed amendments must be submitted to Portico for recommendation before final action is taken by the Church Council. The president of Portico will approve amendments involving no change in policy and little or no change in cost or benefits. Amendments approved by the president will be reported to the Portico board of trustees. The Church Council will approve amendments involving a significant change in policy or a significant change in cost or benefits. The Church Council may, in its sole discretion, submit any proposed amendment to the Churchwide Assembly for final action. The board of trustees of Portico will approve all other amendments. Amendments approved by the board of trustees will be reported to the Church Council. No amendment will reduce the value of a benefit entitlement under the disability plan on the effective date of the amendment if you were disabled prior to that effective date. No Guarantee of Tax Consequences Portico makes no commitment or guarantee that any amount paid to or for your benefit under this plan will be excludable from your gross income for federal, state, or local income tax purposes. It is your responsibility to determine whether your payments are excludable from your gross income for income tax purposes. It is also your responsibility to notify Portico if you have any reason to believe a payment is not excludable for income tax purposes. If you re a pastor, you will receive information about the housing allowance designation prior to receiving your IRS Form W-2 each January. For federal income tax purposes, Portico designates your disability benefits as eligible for the housing allowance exclusion from federal gross income. However, it is up to you to justify to the IRS how much may be excluded as eligible for housing expenses (according to 107 tax code limits). Termination of the Plan The plan is designed, and contribution rates are established, to maintain long-term plan viability. However, the ELCA Church Council may terminate the ELCA Disability Benefits Plan by following the previously described amendment procedure. If the plan is terminated, the existing funds may be Page 20

21 distributed to you or your beneficiaries in such a manner as Portico, in its sole discretion, determines is fair and equitable. Funds may also be distributed to the ELCA if all members who became disabled prior to the termination date have received the present value of their benefit entitlement. If the funds are distributed, no future benefit payments will be made from the plan. Not a Party to Contracts You may have certain employment or contractual rights that may obligate your employer to make contributions to the ELCA Disability Benefits Plan on your behalf. Your employer is solely responsible for compliance with these provisions. Portico is not a party to these contracts. Portico won t provide coverage under this plan if it hasn t received contributions. No Legal Advice Portico does not provide legal advice. We provide members with certain written information of general application in order to help you understand the way in which we administer our plans. For legal questions or advice specific to you, you should consult with your own legal adviser. Page 21

22 Glossary Annual Increase Factor Monthly disability benefits may be increased each Jan. 1, based on the annual rate of increase in the average salary of ELCA pastors sponsored in the ELCA Retirement Plan, measured as of the preceding May 31. Basic Monthly Disability Benefit Two-thirds of your monthly benefit compensation (one-twelfth of the amount of defined compensation received during the 12 full months immediately preceding the disability) before you became disabled. Benefit Start Date Two months after your approved date of disability, when you begin receiving a benefit from the ELCA Disability Benefits Trust. Changes in Defined Compensation Portico must have the correct defined compensation on record for each sponsored member. When a member s defined compensation changes, the sponsoring employer should report the change to Portico. When Portico receives a change, we recalculate the contributions and make an adjustment to the billed amount. If we receive a change more than 60 days after the effective date, the billed amount will be adjusted only for the prior 60 days. Date of Disability The effective start date of your disability. The plan s disability benefit start date is two months after the date of disability as determined by the disability benefits administrator. Defined Compensation Defined compensation includes base salary before pretax benefit contributions are deducted. If you re a pastor, it includes Social Security tax allowance paid to you and one of the following: If housing isn t provided, the amount of cash housing allowance paid to you If housing is provided, an additional 30% of your base salary and Social Security tax allowance, plus any household furnishings or utilities allowance paid to you Defined compensation doesn t include: Utilities paid directly by your congregation or organization Employer contributions including clergy housing equity contributions made to the ELCA Retirement Plan or another eligible retirement plan Non-taxable reimbursements or expense allowances (auto and mileage, continuing education, books, or professional expenses) Disability Benefits Administrator Liberty Mutual, the entity contracted with Portico to administer disability benefits. Responsibilities include: Reviews all disability claims to determine initial eligibility Administers the claim filing processes Manages medical, psychological, educational, and vocational claim documentation Distributes all disability payments Verifies ongoing eligibility Answers questions you may have related to your disability Assesses current treatment plans Page 22

23 Minimum Required Employer Retirement Contribution Rate The employer contribution percentage may be different for each sponsored member, but if you are clergy or a rostered layperson, it can t be less than 10% of your defined compensation. If you are a lay employee of a participating congregation, it can t be less than 6% of your defined compensation. NOTE: If you participated in a predecessor plan on Dec. 31, 1987, were at least age 45 on that date, and have continuously participated in an ELCA retirement plan since Jan. 1, 1988, the total employer contribution must be at least 11%. If you are a lay employee of an ELCA institution or a non-elca organization, the employer contribution must be the same percentage for all non-clergy sponsored members and can t be less than 6% of defined compensation before disability, as determined by your employer. If you are an eligible selfsponsoring pastor, you pay the employer contribution of not less than 10% of your defined compensation. Monthly Benefit Compensation The amount used for calculating the basic monthly disability benefit one-twelfth of the amount of defined compensation you received during the 12 full months immediately preceding your disability. If your defined compensation decreased due to illness before you began receiving disability benefits, your compensation is considered one-twelfth of the defined compensation for the 12 full months preceding the decrease. If you have fewer than 12 months of service, your defined compensation will be based on the number of full months you were employed immediately preceding the disability. The basic monthly disability benefit is two-thirds of the monthly benefit compensation. Monthly Disability Benefit Offset The reduction in the monthly disability benefit if the member and family members are deemed eligible for Social Security disability benefits, receive income from certain government disability programs, such as workers compensation, or earn more than one-third of the member s monthly benefit compensation. Normal Occupation The occupation or work performed immediately prior to your date of disability. Pre-Existing Condition Exclusion Period An exclusion from coverage under the ELCA Disability Benefits Plan during the first six or 18 months of membership, due to a condition for which diagnosis or treatment was received within the six months prior to the member s most recent enrollment in the plan. Qualified Health Care Provider A qualified medical or mental health care provider must perform services within the scope of his or her license and be licensed by the state in which the services are performed. Qualifying Neurological Disease Certain neurological diseases may qualify a member for partial disability. A qualifying neurological disease is a progressive condition with insidious onset that gradually reduces your physical capacity for full-time work by at least 20%. Page 23

24 Contact Information Portico Benefit Services Portico Customer Care Center Call or with questions about your eligibility or contribution rates or if you have a change of family status, address, or coverage. Website Phone, fax Hours Mailing address myportico.porticobenefits.org F mail@porticobenefits.org 7:30 a.m. 6 p.m. (Central) Monday Friday Portico Benefit Services 800 Marquette Ave., Ste Minneapolis, MN Liberty Mutual Liberty Mutual The plan s disability benefits administrator. Contact Liberty for disability claims information or to apply for benefits. Phone, fax Hours F a.m. 4 p.m. (Central) Monday Friday Page 24

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26 Find the most current version of this document, other plan summaries, and the ELCA Benefit Program Description on myportico at (1/2017) Page 26