Short-Term Disability

Transcription

1 Effective: American Fidelity Assurance Company s Short-Term Disability Income Insurance Plan Designed Specifically For: Certificated, Administrative and Clerical Employees - Classic

2 Plan Highlights Benefits are paid directly to you, not to a doctor or your employer. Benefits are payable year-round. Convenient payroll deduction. Benefit payments may be directly deposited into your bank account. Benefits are paid due to a covered Injury or Sickness. Several benefit plan options are available. Optional Riders available: Accident Only Spousal Rider and Hospital Indemnity Rider. IMPORTANT Benefits include: Donor Benefit Worksite Accommodation Evaluation Physician Expense Benefit Accidental Death Benefit Waiver Of Premium (Plans V-VII only) Choose The Plan That s Right For You Plan I - On the 1st day of Disability due to a covered Injury and on the 8th day of Disability due to a covered Sickness. Plan II - On the 15th day of Disability due to a covered Injury or Sickness. Plan III - On the 1st day of Disability due to a covered Injury and on the 8th day of Disability due to a covered Sickness. Plan IV - On the 15th day of Disability due to a covered Injury or Sickness. Plan V - On the 1st day of Disability due to a covered Injury and on the 8th day of Disability due to a covered Sickness. Plan VI - On the 1st day of Disability due to a covered Injury and on the 8th day of Disability due to a covered Sickness. Plan VII - On the 15th day of Disability due to a covered Injury or Sickness. benefits are payable Plan I - Up to 60 days for a covered Injury or Sickness. Plan II - Up to 60 days for a covered Injury or Sickness. Plan III - Plan IV - Up to 90 days for a covered Injury or Sickness. Up to 90 days for a covered Injury or Sickness. Plan V - Up to 120 days for a covered Injury or Sickness. Plan VI - Plan VII - Up to 180 days for a covered Injury or Sickness. Up to 1 year for a covered Injury or Sickness.

3 Plan Features ACCIDENTAL DEATH BENEFIT A lump sum of $10, will be paid if you die as the direct result of an Injury and death occurs within 365 days after the Injury. The benefit will be increased 1% for each full month that your Certificate was continuously in force just prior to death. The total increase shall not be more than 60% of the benefit amount. Physician expense benefit Injury - $ per Injury If you need personal treatment by a Physician due to an Injury, we will pay the amount shown above provided no other claim has been paid under the Policy. You are not required to miss one full day of work in order to receive the Injury benefit. This benefit will be limited to 8 payments per calendar year. Donor benefit If you are Disabled as a result of being an organ or tissue donor, we will pay your benefit as any other Sickness under the terms of the plan. worksite accommodation If worksite modifications may assist your return to work, we will evaluate your claim for appropriate action. Direct deposit disability benefits In the event you choose the direct deposit option on an approved claim, we will deposit your benefits directly into your bank account at no additional cost. This can accelerate access to your benefits by several days. We also have a toll-free fax that allows you instant transmission of your claim forms to our Benefits Department. Waiver of premium (Plans v-vii only) No premium payments are required while you are receiving payments under the plan after Disability Payments have been received under the plan for 90 consecutive days. We will require proof on an annual basis that you remain Disabled during this time. Successive Disabilities Disabilities which result from the same or related causes will be considered one period of Disability unless the Disabilities are separated by your return to Active Employment or any other gainful occupation for at least 6 consecutive months. Definitions ACTIVE EMPLOYMENT: Means you are doing in the usual manner all of the regular duties of your employment on a full-time basis on a scheduled work day and these duties are being done at one of the places of business where you normally do such duties or at some location to which your employment sends you. You will be said to be on Active Employment on a day which is not a scheduled work day only if you are not Disabled and would be able to perform in the usual manner all the regular duties of your employment if it were a scheduled work day. Disability: Disability or Disabled means you are unable to perform the material and substantial duties of your Regular Occupation. Disability Payment: Means your Disability Benefit minus Deductible Sources of Income. Hospital: The term Hospital shall not include an institution used by you as: a place for rehabilitation; a place for rest or for the aged; a nursing or convalescent home; a long-term nursing unit or geriatrics ward; or as an extended care facility for the care of convalescent, rehabilitative, or ambulatory patients. MONTHLY COMPENSATION: Means for contracted employees, one-twelfth (1/12) of your contract salary through your Employer; or for non-contracted employees, one-twelfth (1/12) of your annual salary through your Employer, in effect on the date Disability began. It excludes any additional compensation including but not limited to, overtime pay, weekend or summer work compensation, bus or other allowances, bonuses or district-funded fringe benefits. If you become Disabled while on an approved leave of absence, we will use your gross Monthly Compensation from your Employer in effect just prior to the date your absence began. Pre-existing Condition: The term Pre-Existing Condition means a disease, Injury, Sickness, physical condition or mental illness for which you: had treatment; incurred expense; took medication; received care or services including diagnostic testing or related measures; or received a diagnosis or advice from a Physician, during the 12-month period immediately before your Effective Date of coverage. The term Pre-Existing Condition will also include conditions which are related to such disease, Injury, Sickness, physical condition, or mental illness.

4 Important Policy Provisions Eligibility All active full-time certificated, administrative, and clerical employees of the school district working 17.5 hours or more per week. Proof of good health may be required by us in order to be eligible for disability coverage. We will rely on answers given on your application to determine if coverage can be issued. Regardless of your health at the time of application, if coverage is approved and issued, claims incurred while coverage is in force will be subject to all terms of the Policy including any Pre-Existing Condition limitation. When coverage begins Certificates will become effective on the requested effective date following the date we approve the application, providing you are on Active Employment and premium has been paid. IF YOU ARE DISABLED DUE TO A COVERED DISABILITY AND NOT WORKING plan i - vi only Your Disability Payment will be the lesser of: the Disability Benefit described in the Benefit Schedule; or 70% of your Monthly Compensation less any Deductible Sources of Income you receive or are entitled to receive. plan vii Your Disability Payment will be the Disability Benefit described in the Benefit Schedule less any Deductible Sources of Income you receive or are entitled to receive. Offsets with Other Sources of Income Deductible Sources of Income include: Other group disability income. Governmental or other retirement system, whether due to Disability, normal retirement or voluntary election of retirement benefits. United States Social Security Act or similar plan or act, including any amounts due your dependent(s) on account of your Disability. State Disability. Unemployment compensation. Sick leave or other salary or wage continuance plans provided by the Employer which extend beyond 30 calendar days from the Date of Disability. We reserve the right to estimate these Deductible Sources of Income that you may receive as defined in your Certificate. MINIMUM DISABILITY BENEFIT The minimum Monthly Disability Benefit is 10% of the Monthly Disability Benefit or $100.00, whichever is greater. INCREASE OF INCOME DUE TO COST OF LIVING ADJUSTMENTs The Disability Payment will not be reduced due to a cost of living increase if the increase from a Deductible Source of Income takes effect after the onset of Disability and while benefits are payable under the Policy Pre-existing condition limitation No Disability Benefit will be payable if Disability is caused by or resulting from a Pre-Existing Condition and begins before you have been continuously covered under the Policy for 12 months. This provision will not apply if you have: gone treatment-free; incurred no expense; taken no medication; and received no diagnosis or advice from a Physician for 12 consecutive months for such condition(s). This limitation will not apply to a Disability resulting from a Pre- Existing Condition that begins after you have been continuously covered under the Policy for 12 months. Any increase in benefits will be subject to this Pre-Existing Condition limitation. A new Pre-Existing Condition period must be satisfied with respect to any increase applied for and approved by us. EXCLUSIONS The Policy does not cover any loss, fatal or non-fatal, resulting from: Intentionally self-inflicted injury while sane or insane. An act of war, declared or undeclared. Injury sustained or Sickness contracted while in the service of the armed forces of any country. Committing a felony. Penal incarceration. We will not pay benefits for Disability or any other loss during any period for which you are incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer. Injury or Sickness arising out of and in the course of any occupation for wage or profit or for which you are entitled to Workers Compensation*. *The term entitled to Workers Compensation shall also include Workers Compensation claim settlements that occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which you are entitled to Workers Compensation benefits.

5 Leave of Absence Your coverage may be continued for 1 year during a Leave of Absence approved in writing by your Employer. Termination of insurance Your insurance coverage will end on the earliest of these dates: the date you do not meet the Eligibility requirements as defined in the Eligibility paragraph in this brochure; the date you retire; the date you cease to be on Active Employment, except as provided for under the Leave of Absence provision; the end of the last period for which premium has been paid; the date the Policy is discontinued; or the date your employment terminates. If: your coverage ends as a result of your termination of Active Employment; such termination is caused by an Injury or Sickness for which Disability Benefits would be payable; and Disability is established prior to the termination of Active Employment, then: Disability Benefits will be paid as if such termination had not occurred. Termination of the Policy will have no affect on Disability Payments which began before termination. We may end your coverage if you submit a fraudulent claim.

6 Accident Only Spousal Rider Consider The Facts On average, one out of every 11 Americans suffered a disabling injury in National Safety Council, Injury Facts, 2009 Edition, p. 2 Total costs of accidental injuries averaged $26,023 per injury in National Safety Council, Injury Facts, 2009 Edition, p. 4 Monthly Indemnity Amount Accident Only Spousal rider Annual Salary Monthly Premium $ $10, $4.00 $1, $10, $20, $8.01 $1, $20, $30, $12.00 $2, $30, and over. $16.00 We will pay a monthly indemnity amount to you for your spouse who is disabled as a result of a non-occupational accident. Benefits will begin on the 31st consecutive day after the Injury and will continue for 2 years. Coverage under this Rider will begin on the later of the requested Effective Date or the date we approve the written application, provided that your spouse has no other group disability income coverage in force; is less than age 70; is engaged in Full Time Employment on the date this Rider becomes effective; and is able to perform the material and Hospital Indemnity Rider Consider The Facts The average charge for a hospital stay is $26,100. HCUP Facts and Figures, 2007: Statistics on Hospital-based Care in the United States; Agency for Healthcare Research and Quality, % of total healthcare costs are paid out-of-pocket. Kaiser Family Foundation: Trends in Health Care Costs and Spending; March 2009 The average length of a hospital stay is 4.6 days. HCUP Facts and Figures, 2007: Statistics on Hospital-based Care in the United States; Agency for Healthcare Research and Quality, We will pay a daily benefit amount for an Inpatient Hospital confinement a maximum of 90 days. Inpatient means you are admitted as a resident patient to a Hospital for at least 18 continuous hours and are being charged for room and board facilities. substantial duties of his or her occupation on the date this Rider becomes effective, and; your coverage under the Policy is in force and you are on Active Employment; and the required premium has been paid. FULL TIME EMPLOYMENT (or Full Time) means your Spouse is employed an average of 25 or more hours per week for pay or benefits. Full Time Employment does not include any hours your Spouse is working while self-employed. Accident Only Spousal Rider Limitations This Rider does not provide benefits for your Spouse for any Disability, fatal or non-fatal, which results from any of the following: (a) Intentionally self-inflicted Injury while sane or insane; (b) An act of war, declared or undeclared; (c) Injury sustained or contracted while in the service of the armed forces of any country; (d) Committing a felony; (e) Penal incarceration. We will not pay benefits during any period for which your Spouse is incarcerated in a penal or correctional institution or for any Injury that occurs while your Spouse is incarcerated in a penal or correctional institution; (f) Injury arising out of and in the course of any occupation for wage or profit or for which your Spouse is entitled to Workers Compensation. The term entitled to Workers Compensation shall also include Workers Compensation claim settlements which occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which your Spouse is entitled to Workers Compensation benefits; (g) Participation in any sport for wage or profit; (h) Participation in any contest of speed in a power driven vehicle for wage or profit. Spouse means the person you are lawfully married to who is less than age 70. No benefits are payable for your Spouse under this Rider for a Disability from an Injury that occurred outside of the United States or its territories. No benefit will be provided for any period in which your Spouse is not under the Regular and Appropriate Care of a Physician. No benefits will be paid for any Injury to your Spouse which is caused by or resulting from spousal abuse. Hospital Indemnity rider Daily Benefit Amount Monthly Premium $ $6.01 $ $9.00 Hospital Indemnity Rider Limitations The Hospital Confinement Benefit will not be payable for an Injury or Sickness incurred in the first 12 months of coverage if the Injury or Sickness is caused by or resulting from a Pre-Existing Condition as defined in the Policy. In addition to the Exclusions listed in the Policy, no benefits will be payable under this Rider for any Hospital Confinement that is caused by or resulting from Mental Illness or Drug or Alcohol Abuse. Benefits are reduced by 50% at age 70. Successive Hospital stays will be considered as one confinement if they are separated by less than 90 days of confinement to a Hospital.

7 Disability Insurance Needs Worksheet Use this worksheet to get a general estimate of how much Disability Income Protection insurance you need. However, you should consult with a financial advisor before buying any insurance products. Monthly Income Your Income Total Monthly Income Monthly Expenses Mortgage/Rent Car Payment Utilities Loan/Credit Card Payments Insurance (Home, Auto, Health, Life, etc.) Food/Clothing Child Care/Education Other Expenses Total Monthly Expenses Are You Covered? $ $

8 Benefit Schedule Several benefit options are available to you. You may participate in the Plans under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 66⅔% of your Monthly Compensation. If your gross annual salary is at least: You are eligible for a maximum Monthly Disability Benefit of: Plan I 60 days Monthly Premiums Rates deductions per year. Plan II (15th) 60 days Plan III 90 days Plan IV (15th) 90 days Plan V 120 days Plan VI 180 days $3, $ $4.46 $3.87 $4.91 $4.27 $5.43 $6.13 $5, $ $6.58 $5.81 $7.30 $6.42 $8.06 $9.22 $7, $ $8.83 $7.74 $9.73 $8.54 $10.70 $12.30 $9, $ $10.96 $9.66 $12.05 $10.67 $13.33 $15.39 $11, $ $13.02 $11.62 $14.43 $12.80 $15.99 $18.49 $13, $ $15.26 $13.55 $16.81 $14.94 $18.55 $21.51 $15, $ $17.39 $15.49 $19.10 $17.07 $21.25 $24.65 $17, $ $19.64 $17.42 $21.57 $19.20 $23.95 $27.79 $23, $1, $26.28 $23.23 $28.81 $25.61 $31.89 $36.99 $29, $1, $32.86 $29.04 $36.05 $32.01 $39.86 $46.23 $32, $1, $35.85 $31.66 $39.32 $34.92 $43.48 $50.46 $34, $1, $37.76 $33.44 $41.49 $36.86 $45.82 $53.29 $36, $2, $39.84 $35.22 $43.70 $38.80 $48.33 $56.05 $37, $2, $41.73 $36.94 $45.86 $40.74 $50.64 $58.90 $39, $2, $43.82 $38.72 $48.05 $42.68 $53.17 $61.66 $41, $2, $44.79 $40.48 $49.23 $44.62 $54.55 $63.42 $43, $2, $46.75 $42.24 $51.36 $46.56 $56.94 $66.18 $44, $2, $48.68 $44.02 $53.51 $48.50 $59.30 $68.94 $46, $2, $50.48 $45.76 $55.65 $50.44 $61.42 $71.74 $48, $2, $52.42 $47.52 $57.79 $52.38 $63.79 $74.53 $50, $2, $54.36 $49.30 $59.93 $54.32 $66.17 $77.26 $52, $2, $56.30 $51.04 $62.07 $56.26 $68.50 $80.02 $53, $3, $58.23 $52.78 $64.20 $58.20 $70.88 $82.80 $55, $3, $60.19 $54.56 $66.35 $60.14 $73.24 $85.54 $57, $3, $62.13 $56.32 $68.49 $62.08 $75.61 $88.34 $59, $3, $64.07 $58.08 $70.62 $64.02 $77.96 $91.09 $61, $3, $66.01 $59.84 $72.77 $65.96 $80.32 $93.85 $62, $3, $67.95 $61.64 $74.91 $67.90 $82.69 $96.58 $64, $3, $69.89 $63.38 $77.05 $69.84 $85.05 $99.37 $66, $3, $71.83 $65.12 $79.21 $71.78 $87.41 $ $68, $3, $73.79 $66.88 $81.33 $73.71 $89.77 $ $70, $3, $75.72 $68.64 $83.47 $75.66 $92.14 $107.66

9 Benefit Schedule (con t) Several benefit options are available to you. You may participate in the Plans under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 66⅔% of your Monthly Compensation. If your gross annual salary is at least: You are eligible for a maximum Monthly Disability Benefit of: Plan I 60 days Monthly Premiums Rates deductions per year. Plan II (15th) 60 days Plan III 90 days Plan IV (15th) 90 days Plan V 120 days Plan VI 180 days $71, $4, $77.65 $70.44 $85.60 $77.60 $94.49 $ $73, $4, $79.60 $72.16 $87.75 $79.54 $96.88 $ $75, $4, $81.54 $73.94 $89.89 $81.48 $99.22 $ $77, $4, $83.48 $75.68 $92.03 $83.42 $ $ $79, $4, $85.42 $77.44 $94.17 $85.36 $ $ $80, $4, $87.37 $79.14 $96.31 $87.30 $ $ $82, $4, $89.31 $80.96 $98.45 $89.24 $ $ $84, $4, $91.25 $82.72 $ $91.18 $ $ $86, $4, $93.19 $84.48 $ $93.12 $ $ $88, $4, $95.13 $86.24 $ $95.06 $ $ $89, $5, $97.06 $88.04 $ $97.00 $ $ $91, $5, $99.01 $89.76 $ $98.94 $ $ $93, $5, $ $91.52 $ $ $ $ $95, $5, $ $93.28 $ $ $ $ $97, $5, $ $95.08 $ $ $ $ $98, $5, $ $96.78 $ $ $ $ $100, $5, $ $98.56 $ $ $ $ $102, $5, $ $ $ $ $ $ $104, $5, $ $ $ $ $ $ $106, $5, $ $ $ $ $ $ $107, $6, $ $ $ $ $ $ $109, $6, $ $ $ $ $ $ $111, $6, $ $ $ $ $ $ $113, $6, $ $ $ $ $ $ $115, $6, $ $ $ $ $ $ $116, $6, $ $ $ $ $ $ $118, $6, $ $ $ $ $ $ $120, $6, $ $ $ $ $ $ $122, $6, $ $ $ $ $ $ $124, $6, $ $ $ $ $ $ $125, $7, $ $ $ $ $ $ $127, $7, $ $ $ $ $ $ $129, $7, $ $ $ $ $ $ $131, $7, $ $ $ $ $ $ $133, $7, $ $ $ $ $ $ $134, $7, $ $ $ $ $ $207.02

10 Benefit Schedule Several benefit options are available to you. You may participate in the Plan under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 66⅔% of your Monthly Compensation. Monthly Salary Monthly Disability Benefit Monthly Premiums Plan VII (15th) 1 year $ $ $ $4.32 $ $ $ $6.48 $ $ $ $8.64 $ $ $ $10.80 $ $1, $ $12.96 $1, $1, $ $15.12 $1, $1, $ $17.28 $1, $1, $ $19.44 $1, $1, $1, $21.60 $1, $1, $1, $23.79 $1, $1, $1, $25.92 $1, $2, $1, $28.08 $2, $2, $1, $30.24 $2, $2, $1, $32.40 $2, $2, $1, $34.56 $2, $2, $1, $36.76 $2, $2, $1, $38.88 $2, $2, $1, $41.04 $3, $3, $2, $43.20 $3, $3, $2, $45.42 $3, $3, $2, $47.54 $3, $3, $2, $49.68 $3, $3, $2, $51.84 $3, $3, $2, $54.02 $3, $4, $2, $56.16 $4, $4, $2, $58.32 $4, $4, $2, $60.46 $4, $4, $2, $62.64 $4, $4, $3, $64.84 $4, $4, $3, $66.96 $4, $4, $3, $69.12 $4, $5, $3, $71.26 $5, $5, $3, $73.46 $5, $5, $3, $75.60 $5, $5, $3, $77.75 $5, $5, $3, $79.92 $5, $5, $3, $82.08

11 Benefit Schedule (con t) Several benefit options are available to you. You may participate in the Plan under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 66⅔% of your Monthly Compensation. Monthly Salary Monthly Disability Benefit Monthly Premiums Plan VII (15th) 1 year $5, $5, $3, $84.24 $6, $6, $4, $86.40 $6, $6, $4, $88.56 $6, $6, $4, $90.72 $6, $6, $4, $92.88 $6, $6, $4, $95.02 $6, $6, $4, $97.18 $6, $7, $4, $99.36 $7, $7, $4, $ $7, $7, $4, $ $7, $7, $4, $ $7, $7, $5, $ $7, $7, $5, $ $7, $7, $5, $ $7, $8, $5, $ $8, $8, $5, $ $8, $8, $5, $ $8, $8, $5, $ $8, $8, $5, $ $8, $8, $5, $ $8, $8, $5, $ $9, $9, $6, $ $9, $9, $6, $ $9, $9, $6, $ $9, $9, $6, $ $9, $9, $6, $ $9, $9, $6, $ $9, $10, $6, $ $10, $10, $6, $ $10, $10, $6, $ $10, $10, $6, $ $10, $10, $7, $ $10, $10, $7, $ $10, $10, $7, $ $10, $11, $7, $ $11, $11, $7, $ $11, And Over $7, $162.00

12 Underwritten by: Plan Sponsored By: WEA Plan Consultants: P.O. Box 9100 Federal Way, Washington Spokane Branch Office 621 W. Mallon Suite 301 Spokane, WA (509) (877) Tukwila Branch Office 565 Andover Park West Suite 102 Tukwila, WA (206) (866) Fifth Avenue Suite 1200 Seattle, WA (206) FAX (206) SB G MCH# , , , , , , , R1, R1