Employee Handbook Subject: Short and Long Term Disability Benefits STD: 1/1/91

Transcription

1 HANDBOOK STATEMENT Employee Handbook Subject: Short and Long Term Disability Benefits Approved By: Effective Date: Corporate STD: 1/1/91 Employee Benefits LTD: 8/1/96 Reviewed: January 19, 2016 The information that follows, along with the information contained in the General Information Section, are the Summary Plan Descriptions for the Huntington Bancshares Incorporated Short Term Disability Plan and the Huntington Bancshares Incorporated Long Term Disability Plan. SHORT AND LONG TERM DISABILITY BENEFITS When serious illness or injury strikes, your first concern may be the cost of the medical care you need. Serious illness or injury carries another price: the loss of income when health problems keep you from working. At Huntington, you have protection against this kind of loss from the Short-Term Disability Plan ( STD Plan ) and the Long-Term Disability Plan ( LTD Plan ). Quick Reference Guide Type of Plan Who Pays for Coverage Benefit Amount Huntington pays for the entire cost of your short-term disability ( STD ) and long-term disability ( LTD ) coverage. Benefits under the STD Plan are paid by Huntington and administered by Huntington s claims administrator CareWorks Absence Management. Benefits under the LTD Plan are paid through an insurance contract through Sun Life Assurance Company ( Sun Life ) 1

2 Type of Plan Benefit Amount Short-Term Disability Plan Benefits are payable after you have exhausted seven consecutive calendar days of non-work related disability as defined by the STD Plan. The amount of the benefit depends upon your length of service, as measured from your most recent hire date. The maximum period for reimbursement at 80% or 100% is eight weeks. After eight weeks, the reimbursement percentage is reduced to 60%. Benefits are payable for up to 173 calendar days. Long-Term Disability Plan Benefits are payable after you have been disabled, as defined by the LTD Plan s insurance contract. The amount of your benefit is 60% of base monthly earnings, minus any deductible sources of income. Benefits are payable for as long as you remain disabled, up to age 65 if the disability begins before age 60. For disabilities beginning after age 60, benefits are paid according to the schedule described in the LTD Plan s insurance contract. Short-Term Disability Benefits Who Is Eligible The STD Plan is for employees in fulltime and P-1 employment classifications with Huntington and related companies who adopt the plans ( Huntington ). Employees whose retirement benefits are subject to collective bargaining are not eligible. When Coverage Begins You are eligible for benefits under the STD Plan as of your date of employment (or the date you join an eligible class of employees), if you are actively at work. No enrollment is necessary. If you are not actively at work because of illness, injury or other leave of absence when coverage would normally begin, coverage will be delayed until you have been actively at work for at least one full day. 2

3 When Coverage Ends Coverage under the STD Plan ends on the date: Your employment with Huntington terminates; You go on a personal leave of absence and it extends past 90 days, you are temporarily laid off, or you become eligible for benefits under the Transition Pay Plan; You exhaust 180 days of medical leave available under Huntington s Medical Leave of Absence handbook statement; You retire; You no longer meet the STD Plan s eligibility requirements; or The STD Plan is terminated by Huntington Short-Term Disability (STD) Benefits Terms You Should Know Many terms used in this Summary for the STD Plan have special meaning. A list of these terms and their meaning follows: Basic weekly earnings For all eligible employees, except those in commissioned job codes, basic weekly earnings means the amount of regular weekly base salary paid by Huntington, excluding bonuses, commissions, overtime, incentive pay, other forms of special or non-recurring compensation or any other extra compensation. For employees in commissioned job codes, as designated by Huntington, basic weekly earnings include base salary, plus commissions, as determined by Huntington s Payroll department. Basic weekly earnings include any pretax contributions made for benefit coverage or contributed to a spending account or the Huntington Investment and Tax Savings Plan (the 401(k) Plan ). For P-1 employees, the weekly rate of pay will be the hourly rate multiplied by 35 hours per week. Claims administrator means CareWorks Absence Management Disability and disabled means that you are limited from performing the material and substantial duties of your regular occupation due to sickness or injury, and you are not working in any occupation. Material and substantial duties mean those duties normally required for the performance of your regular occupation that cannot be reasonably omitted or modified. Regular occupation means the occupation you are routinely performing when your disability begins. The claims administrator will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location. 3

4 You must be under the regular care and treatment of a licensed physician, who is practicing within the scope of his/her license during the entire period to be considered disabled. Elimination period means a period of seven consecutive calendar days of non-work related disability for which no short-term disability benefits are payable. The elimination period begins on the first day of disability. Injury means bodily injury resulting directly from an accident and independently of all other causes. The disability resulting from the injury must begin while you are covered under the STD Plan. Maximum benefit period means that following the expiration of your elimination period, benefits shall continue up to a maximum of 173 days. If a disability continues from one year to the next, benefits for the year in which your disability began will continue for the duration of the disability or until those days are used up, whichever comes first. Other income benefits means any of the following: Any amount you are entitled to, under any group insurance plan that provides disability income benefits, whether or not sponsored by Huntington; Any benefits you are entitled to receive under any salary continuation plan, whether or not sponsored by Huntington; Any benefits you are entitled to receive under the provisions of any retirement or pension plan, regardless of whether Huntington sponsored or maintained the plan; Any benefits payable under any state compulsory benefit act or law; Any benefits you or your dependents are eligible to receive because of your disability or age under the United States Social Security Act or similar plan or act. If benefits from these programs are denied for any reason (except your non-insured status), you will be required to appeal the denial to the full extent permitted. You will continue to be considered eligible to receive these benefits until all appeal processes are exhausted. Physician means a person (other than you, your spouse, child, brother, sister or parent, or the child, brother, sister or parent of your spouse) who is operating within the scope of his/her license, and is either: licensed to practice medicine and prescribe and administer drugs or to perform surgery; or legally qualified as a medical practitioner and required to be recognized according to the insurance statutes or the insurance regulations of the governing jurisdiction. 4

5 Short-term disability benefits means money that is paid as a benefit when your claim for benefits under the STD Plan has been approved. Sickness means an illness or disease. The disability resulting from the sickness must begin while you are covered under the STD Plan. When Benefits Begin Short-term disability benefits only begin after you have exhausted your elimination period. You must be continuously disabled during your elimination period. You must use available PTO during your elimination period. You may elect to use available Paid Time Off for Birth of a Child, Adoption or Foster Care Placement during your elimination period instead of available PTO. If you do not have enough PTO (or Additional Time Off for Birth of a Child, Adoption or Foster Care Placement, if applicable) to get through the elimination period, you may go for a period of time without pay. Pre-Existing Conditions The STD Plan will not pay benefits for a disability that begins during your first 12 months of coverage that result from a pre-existing condition. You have a pre-existing condition if you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage and the disability begins in the first 12 months after your effective date of coverage unless you have been treatment free for 3 consecutive months after your effective date of coverage. If You Return to Work and Become Disabled Again If you are disabled, return to work, and become disabled again due to the same or a related cause, the second disability will be considered a continuation of the first period of disability, as long as you had returned to work for less than 31 calendar days. If your second disability is unrelated to the first, or if you have returned to work for more than 30 calendar days, the second period of disability will be considered a separate claim and a new elimination period must be satisfied before benefits will become payable. When Benefits Under the STD Plan Become Payable You will be required to file a claim with the claims administrator no later than 15 days after your disability starts in order to be considered for benefits. The claims administrator approves payment of benefits under the STD Plan after the end of the elimination period and only when you and your physician provide proof that you: are disabled due to sickness or injury, and are under appropriate treatment and care of a physician. When the claims administrator receives satisfactory proof of claim, and your claim for disability benefits is approved, benefits payable under the STD Plan will be paid for any period that you remain disabled under the terms of the STD Plan. You will not receive 5

6 payment under the STD Plan until the claims administrator approves your claim for benefits under the STD Plan. This means that there may be a period where you go without pay. Payments will begin as of the payroll period as soon as administratively practicable following Huntington s receipt of notice from the claims administrator that your claim for benefits under the STD Plan has been approved. It is important for you and your physician to return your completed paperwork to the claims administrator as quickly as possible. Once Huntington receives notice that your claim has been approved, your first payment from the payroll system will include any payments for prior payroll periods for which you were entitled to benefits under the STD Plan. Conditions that Must be Met for Payments to Continue You will be paid short-term disability benefits as long as you remain disabled and are under the appropriate treatment and care of a physician. You will not be paid longer than the maximum benefit period. The claims administrator may require that an independent physician specialist examine you, at Huntington s expense. If you fail to comply with such a request, the result may be an interruption, suspension, or termination of benefits. Benefits may also be suspended or terminated if the results of the independent examination determine that you are not disabled under the definition of the STD Plan. In addition to filing a claim with the claims administrator, in order to be considered for benefits, you will also be required to give the claims administrator proof that your disability continues on a monthly basis. Such proof will be provided at your expense. The amount of your benefit under the Short Term disability plan will vary based upon your years of service, as measured from your most recent hire date with Huntington according to the following table: Your years of Huntington Service, as measured from your most recent hire date, on the date of disability Benefits Payable under the Short Term Disability Plan 5 years or less of service 60% of basic weekly earnings Between 5 years and less than 10 years 80% of basic weekly earnings, up to an annual maximum of eight weeks, and 60% of basic weekly earnings thereafter 10 years or more of service 100% of basic weekly earnings, up to an annual maximum of eight weeks, and 60% of basic weekly earnings thereafter This amount will be reduced by any other income benefits you are receiving or are entitled to receive. The amount you are actually paid for STD benefits is based on the number of standard hours for your employee classification. Full-time employees will be paid 8 hours per day and P-1 employees will be paid 7 hours per day times the appropriate percentage based on length of service from the table above. If you are receiving short-term disability benefits on the day before or after a holiday, the holiday will be forfeited and counted as a day of disability. 6

7 Partial STD Payments At times your physician may allow you to return to work, but not on your regular schedule. The STD Plan allows for partial short-term disability benefits under the following circumstances: (i) you have received benefits under the STD Plan for at least two consecutive weeks; (ii) you begin performing at least one of the material and substantial duties of your regular occupation or another occupation; and (iii) you have a 20% or more loss in your basic weekly earnings due to the same sickness or injury. The amount of your partial STD benefit is based on the difference between the number of hours you are regularly scheduled to work each day and the number of hours your physician will allow you to work. Termination of STD Benefits Benefits under the STD Plan will stop at the earliest of: The date you are determined to be no longer disabled The end of the STD Plan s maximum benefit period Termination of employment The date of your death Disabilities That Are Not Covered The STD Plan will not cover any disability due to: War or any act of war, declared or undeclared Intentionally self-inflicted injuries Active participation in a riot Loss of a professional license, occupational license or certification Cosmetic surgery, except surgery made necessary by accidental injury incurred while covered under the STD Plan Commission of a crime for which you have been convicted under state or federal law Periods of disability during which you are incarcerated Occupational illness or injury 7

8 Time Limits for Filing Claims under the STD Plan You must give the claims administrator proof of claim no later than 15 days after your disability starts. If that is not possible, you must notify the claims administrator as soon as you can. You must give the claims administrator proof of continued disability and regular treatment by a physician within 15 days of the date the claims administrator requests such proof. How to File A Claim You need to file a claim with the claims administrator before benefits may begin. Call the HR Service Center at to file a claim; additional information about filing an STD or LTD claim or a request for Medical or Family Leave can be found under the Human Resources tab on Essentials, that you will need to be aware of when filing an STD or LTD claim or a request for Medical Leave or Family Leave. In order for a claim to be processed, the claims administrator must receive your application for benefits, as well as sufficient medical evidence in support of your claim. Such evidence may consist of records from your physician, narrative reports, x-rays and any other medical records, as well as evidence that you continue to be under the appropriate care and treatment of a physician. In the absence of such proof, the claims administrator may elect to suspend benefits until such proof is received. Your disability must be supported by current medical evidence. You must be under the continuous care of a qualified physician, with a course of treatment that is appropriate for your condition. If your physician cannot substantiate your disability by objective findings, or if the claims administrator has any other questions regarding the medical substantiation for your disability you may be required to see a physician selected by the claims administrator for an independent evaluation. Failure to cooperate with such requests may result in denial or interruption in benefits. Appeal Procedures The claims administrator will provide you with notice of the STD claim decision no later than 45 days after you file your STD claim. This time period may be extended twice by 30 days if the claims administrator determines that such an extension is necessary due to matters beyond the control of the STD Plan and notifies you of the circumstances requiring the extension of time and the date by which the claims administrator expects to render a decision. If such an extension is necessary due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information you need to provide and you will be afforded at least 45 days from receipt of the notice within which to provide the specified information. If you deliver the requested information within the time specified, any 30 day extension period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, the claims administrator may decide your claim without that information. 8

9 If your claim for benefits is wholly or partially denied, any notice of adverse benefit determination under the STD Plan will: (a) state the specific reason(s) for the determination (b) reference specific STD Plan provision(s) for the determination (c) describe additional material or information necessary to complete the claim and why such information is necessary (d) describe STD Plan procedures and time limits for appealing the determination, and your right to obtain information about those procedures and the right to sue in federal court (e) disclose any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or upon request) You have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. You may file a written request for appeal of an adverse benefits determination with Huntington s claims administrator (at the following address). CareWorks Absence Management 5555 Glendon Court Dublin, OH Fax: A decision on your appeal will be made not later than 45 days following receipt of the written request for review. If the claims administrator determines that special circumstances require an extension of time for a decision on review, the review period may be extended by an additional 45 days (90 days in total). The claims administrator will notify you in writing if an additional 45 day extension is needed. If an extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days from receipt of the notice to provide the specified information. If you deliver the requested information within the time specified, the 45 day extension of the appeal period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, the claims administrator may decide your appeal without that information. You will have the opportunity to submit written comments, documents or other information in support of your appeal. You will have access to all relevant documents as defined by applicable U.S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination. 9

10 The claims administrator will conduct the review. In the case of a claim denied on the grounds of a medical judgment, the claims administrator will consult with a health professional with appropriate training and experience. The claims administrator will communicate the final decision on the part of Huntington. A notice that your request on appeal is denied will contain the following information: the specific reason(s) for the appeal determination a reference to the specific STD Plan provision(s) on which the determination is based a statement disclosing any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or a statement that such information will be provided free of charge upon request) a statement describing your right to bring a civil suit under federal law a statement that you are entitled to receive upon request, and without charge, reasonable access to or copies of all documents, records or other information relevant to the determination Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim. 10

11 Long-Term Disability Benefits For protection against the financial impact of an extended disability, Huntington provides you with LTD benefits. The LTD Plan pays a benefit for disabilities lasting 180 calendar days or longer. The elimination period may be satisfied with days of total disability, partial disability or a combination of both. Benefits under the LTD Plan are provided under a group insurance policy and a group certificate (the Sun Life Employee Group Benefits Booklet) issued by Sun Life Assurance Company of Canada, who is the claims administrator for the LTD Plan and is wholly responsible for the payment of benefits. In the event of a conflict between this Employee Handbook, on the one hand, and the group insurance policy and the Sun Life Employee Group Benefits Booklet, on the other hand, the terms of the group insurance policy and the Sun Life Employee Group Benefits Booklet shall prevail. The Sun Life Employee Group Benefits Booklet is included in this Handbook and is incorporated herein by this reference. The Sun Life Employee Group Benefits Booklet, together with the General Information Section of the Employee Handbook and this section on Long-Term Disability Benefits, constitute the summary plan description for benefits under the LTD Plan insured through Sun Life for disabilities beginning on and after July 1, For information about prior insurance carriers, please contact the HR Service Center ( or ). Posted January