PART-TIME HOURLY DISABILITY PLAN QUICK FACTS AND QUICK LINKS

Transcription

1 PART-TIME HOURLY DISABILITY PLAN QUICK FACTS AND QUICK LINKS Your Part-time Hourly Disability Option Short-term Disability A Quick Look at the Disability Plan Short-term disability When benefits begin: After an illness or injury has kept you unable to work for 14 consecutive calendar days Your disability benefit is:* 50% of your current weekly base pay (up to $125 per week) for an approved disability up to 26 weeks (your 14-day elimination period plus your 24 weeks of coverage) * Short-term disability benefits are reduced by any other income you receive (such as Social Security and Workers Compensation) while you are disabled. Part-time Hourly Disability Plan Contacts Important Enrollment Information New Associates Enrolling for the First Time: You are automatically enrolled in the Short-term Disability Plan. If you do not want this coverage, you must decline it before your 91st day of employment or payroll deductions will begin. To decline, call the Benefits Choice Center at All Other Associates: You can enroll in the disability plan once during any 12-month rolling period or when you experience a life event. To enroll, call the Benefits Choice Center at Quick Links to Frequently Used Disability Info How do I qualify for short-term disability benefits? What s not covered under the disability plan? How do I file a claim for benefits? U.S. VIRGIN ISLANDS PART-TIME HOURLY ASSOCIATES 77

2 DISABILITY U.S. Virgin Islands Part-Time Hourly Associates CHAPTER CONTENTS 79 Short-Term Disability Coverage 79 Enrolling in STD Coverage 79 Paying for Your Coverage 79 How the Short-term Disability Plan Works 79 Qualifying for Benefits 80 How the Plan Pays Benefits 80 Recurring Disabilities 80 Total Disability 80 What s Not Covered Under the Disability Plan 80 Termination of Benefits 80 Filing Claims for Benefits 81 Information Checklist 81 How Your Claims Are Handled 81 Appealing a Claim Note: The Disability Plan is not available to THD At-Home Services 100% commission associates with under one year of service. U.S. VIRGIN ISLANDS PART-TIME HOURLY ASSOCIATES 78

3 GET THE MOST VALUE FROM YOUR PLAN What do you need? File an STD claim Find it here... Lexington, KY Check the status of an STD or LTD claim Call Short-Term Disability Coverage To help your financial protection if you become disabled and are unable to work because of illness or injury, the Company offers you the Short-term Disability (STD) Insurance Plan. You can find information related to your Disability plan benefits, exclusions and limitations and other important information in your Plan Documents. Your Plan Documents are available 24 hours a day, 7 days a week on livetheorangelife.com. To access your Plan Documents, go to Enrolling in STD Coverage You are automatically enrolled in the Short-term Disability coverage after completing your 90th day of service. Payroll deductions begin with your first paycheck after you complete your 90th day. If you do not want the coverage, you must opt out through or by calling the Benefits Choice Center. If you opt out of the Plan, you may enroll in STD once during any rolling 12- month period and/or upon a qualified status change. You may only opt out if you have not filed a claim for a disability benefit with Aetna within the prior 12 months. If you have filed a claim for a benefit, you may opt out of coverage during your next rolling 12-month period following your return from medical leave. Depending on your personal circumstances, the benefits you may receive from sources other than the STD coverage may significantly reduce any benefit that the Company s STD coverage might provide. Paying for Your Coverage Since you pay the premium for short-term disability coverage with after tax dollars, you do not have to pay federal income and FICA taxes on the benefits you receive. How the Short-term Disability Plan Works After 14 consecutive calendar days of an illness or injury during which you are unable to work, the Short-term Disability coverage will pay 50% of your covered weekly base, up to a maximum of $125 per week for an approved period of disability, not to exceed 26 weeks (your 14-day elimination period plus your 24 weeks of coverage). The 14-day elimination period is waived if you are confined to a hospital at any time during the elimination period. Base pay means your regular hourly pay rate in effect as of the date of disability and does not include overtime, bonuses, premiums, incentive pay or any other form of pay from the Company. These benefits are paid on a weekly basis, and you do not pay federal income or FICA taxes on the benefits received. Qualifying for Benefits You must be actively at work on the day your coverage begins. If you become disabled during the first seven consecutive calendar days of coverage under the Short-term Disability Plan, you must have been actively working your normally scheduled hours during the seven calendar days immediately before the disability occurred to qualify for benefits. In addition, to qualify for short-term disability benefits, you must meet all of the following requirements: The disability period must be expected to last more than 14 consecutive calendar days; You must be under the care of a qualified doctor (qualified doctors include legally licensed physicians and practitioners who are not related to you and are performing services within the scope of their licenses); U.S. VIRGIN ISLANDS PART-TIME HOURLY ASSOCIATES 79

4 You must not be able to perform the material and substantial duties of your regular occupation; and Aetna must receive certification accompanied by appropriate medical documentation of a disability from your attending doctor before benefits are considered for payment. How the Plan Pays Benefits During the first 14 consecutive calendar days that you are disabled, you can use any sick or vacation days you have available to receive pay for normally scheduled hours. After the first 14 consecutive calendar days, if approved, you will receive 50% of your base pay up to a maximum of $125 per week for the period of short-term disability, not to exceed 26 weeks (14 day elimination period plus 24 weeks of coverage). Recurring Disabilities If you have been receiving disability benefits and return to work for less than 14 days, and then go out on disability again for the same or related cause, the disability, if approved, is considered to be recurring. In this case, the benefit continues through the balance of the 26-week period, from the original date of disability (the 14-day waiting period plus the approved period of disability of up to 24 weeks). You do not have to complete another 14-day waiting period. If you have been receiving disability benefits and return to work for 14 days or more, and then go out on disability again, regardless of the disability reason, a new 26-week period (the 14-day waiting period plus the approved period of disability up to 24 weeks) begins, if approved. You must satisfy the 14-day waiting period before the benefit payment would begin. If you have been receiving disability benefits and return to work for at least one day, and become disabled due to a different or unrelated cause, the disability is considered to be different. If approved, a new 26-week period (the 14-day waiting period plus the approved period of disability up to 24 weeks) begins. You must satisfy the 14-day waiting period before the benefit payment can begin. Total Disability You are disabled when Aetna determines that you are unable to perform all of the material and substantial duties of your regular occupation due to your sickness or injury. What s Not Covered Under the Disability Plan The Short-term Disability Plan does not cover a disability caused by or resulting from: An act or accident of war, declared or undeclared; Attempted suicide; Intentionally self-inflicted injuries (while sane or insane); Insurrection, rebellion or active participation in a riot; Committing or attempting to commit a criminal act; An occupational sickness or injury except in the case of sole proprietors or partners who cannot be covered by worker's compensation; Operating a motor vehicle under the influence of alcohol; or Is caused by alcoholism, drug abuse or substance abuse. Termination of Benefits Your payments and your claim will end on the earliest of: The date you are no longer disabled according to the terms of the Plan; The date you reach the end of the maximum benefit period; The date you fail to provide proof of continuing disability; The date you are able to increase your disability earnings by increasing the number of hours you work or the number of duties you perform, but choose not to do so; The date you refuse to be examined by a physician, if such an exam is requested by the Plan; The date you refuse to be interviewed by a Plan representative; The date you cease to be under the regular care of a physician or refuse recommended treatment designed to cure, correct or limit your disability; or The date you die. Filing Claims for Benefits If you are out of work for more than four days and expect your disability to last more than 14 days, or if you know in advance that you will be out of work for more than 14 days due to an injury, illness or pregnancy (e.g., a scheduled surgery), call Aetna Voluntary immediately. How do I file a claim? Obtain a claim form by: U.S. VIRGIN ISLANDS PART-TIME HOURLY ASSOCIATES 80

5 Logging on to Log In in the center of the page Enter the 6-digit group ID number and password: User ID: Password: AAHC Click on Document Library on the left Calling Claims Customer Service at Monday through Friday, 8:00 a.m. to 8:00 p.m. ET Writing to: Lexington, KY These claim forms contain instructions on how to fill them out. Send completed forms to,,, Lexington, KY If you have a claim, you must send in a signed claim form of the type utilized by this plan. This will help ensure prompt processing of your claim. For Customer Service call , Monday through Friday, 8:00 a.m. to 6:00 p.m. Information Checklist You will need to provide the following information when you call Aetna: Employer s name and location group number, which is Policy number, which is ASA Name and Social Security number Complete address and phone number Date of birth Marital status and number of dependents Occupation (or job title) Supervisor s name and phone number Physician's name, address and phone number Date and description of injury (if applicable) A brief description of your medical condition Cause of your medical condition (illness, injury, whether it is work related) Dates of your first visit, your most recent visit and your next scheduled visit with your physician for this condition Last day you worked and first day you were absent from work due to this condition Date you expect to return to work (if you know) or the actual date (if you have already returned to work at the time you call) Please Note: Any person who knowingly, and with intent to injure, defraud or deceive an insurance company, files a statement of claim containing any false, incomplete or misleading information, may be subject to legal action. In certain states, other consequences may apply. How Your Claims Are Handled Aetna disability claims management unit will handle all STD claims for the Company associates. Here is a quick summary of important numbers and addresses: If you need to Check the status of an existing claim Send a fax to the claims unit Mail information to Aetna Appealing a Claim Contact If your claim is denied as described in the Claims and Appeals chapter, you will receive a formal letter that states the reasons for the denial and outlines the process you must follow if you choose to appeal the denial. To appeal, you must request a review of the claim in writing to: Attn: Appeals Resolution Team PO Box Lexington, KY Lexington, KY For more information, see the Claims and Appeals chapter. U.S. VIRGIN ISLANDS PART-TIME HOURLY ASSOCIATES 81