World Bank Group Directive
|
|
- Lawrence Robertson
- 5 years ago
- Views:
Transcription
1 World Bank Group Directive Staff Rule Workers' Compensation Program Bank Access to Information Policy Designation Public Catalogue Number HRD3.03-DIR.114 Issued March 13, 2017 Effective October 1, 2011 Last Revised On March 13, 2017 Retired April 3, 2018 Content This Rule sets forth a workers' compensation program which provides staff members with compensation and other benefits in the event of illness, injury or death arising out of and in the course of employment with the Bank Group. Applicable to IBRD,IDA,IFC,MIGA,ICSID Issuer World Bank Group Human Resources Vice President, HRDVP Sponsor
2 Director, HR Compensation and Performance, HRDCP, HRDCP
3 01 Subject, Applicability and Definitions Subject and Policy Rationale 1.01 This Rule sets forth a workers' compensation program which provides staff members with compensation and other benefits in the event of illness, injury or death arising out of and in the course of employment with the Bank Group (sometimes called "work-related" below). This Rule is effective October 1, Applicability 1.02 Except where otherwise specified, this Rule applies to all staff members. Definitions 1.03 In addition to the definitions in Rule 1.01, "General Provisions," for purposes of this Rule, the following definitions apply: a. Child. The term "child" means the natural son or daughter of the staff member, or the staff member's spouse or registered domestic partner. Child also means a legally adopted son or daughter for whom the Bank Group has determined that a "bona fide" parental relationship exists. b. Claims Administrator. The term "claims administrator" refers to the third party administrator contracted by the World Bank Group to administer workers compensation claims in accordance with Annex A of this Rule. c. D.C. Act. The term "D.C. Act" means the District of Columbia Workers' Compensation Act of 1998 as amended from time to time. d. Social Security. The term "social security" means any national social security system. e. Wages. The term "wages" means: i. for staff paid a net salary, the net salary plus any tax allowance paid by the Bank Group in accordance with Rule 6.04, "Tax Allowance"; and ii. for staff paid a gross salary, the gross salary. f. Except for the definitions of "employer", "employee" and "wages", the definitions set forth in Section of the D.C. Act will apply. 02. Administration 2.01 The Claims Administrator will determine whether an injury, illness or death arises out of and in the course of employment and otherwise administer the workers' compensation program in accordance with the provisions of the D.C. Act specified in this Rule, except that where the provisions of this Rule differ from the provisions of the D.C. Act specified, the provisions of this Rule will govern. Provisions of the D.C. Act not specified in this Rule will not 1
4 apply. Except for para. (d) in Section and para. (a) in Section , where provisions of the D.C. Act specified in this Rule refer to the Mayor, this will be taken to mean the Claims Administrator A copy of the D.C. Act is available for inspection in the office of the Bank Group's Manager, Human Resources Service Center. 03. Claims 3.01 If a staff member's injury, illness or death is believed by a claimant to arise out of and in the course of employment, a claim for applicable workers' compensation benefits may be filed with the Claims Administrator by the staff member, a surviving spouse or domestic partner, a child, or an appointed guardian. A claim must be filed with the Claims Administrator within the timeline provided in Annex A, Claims Procedure, Paragraph No claim will be deemed compensable where the injury, illness or death was occasioned in a significant part by the staff member s intoxication or willful intention to injure or kill him/her or another. 04. Payment of Disability Benefits 4.01 Staff covered by Rule 6.22, "Disability Program" are eligible for dismemberment and permanent loss of use benefits payable under Section of the D.C. Act, but are not eligible for income replacement benefits under that Act Staff holding an Extended Term Consultant, Extended Term Temporary, Short Term Consultant, Short Term Temporary or Special Assignment (SPAS) appointment, who are unable to work by reason of a work-related injury or illness as determined by the Claims Administrator will be eligible for disability payments. Disability payments will be calculated in accordance with Sections and of the D.C. Act and paid to a claimant in accordance with Section of that Act, except that the wages of a staff member will be wages as defined in paragraph 1.03 (5). 05. Payment of Medical Expenses 5.01 When a claim has been determined to be compensable, the Claims Administrator will approve the appropriate course of medical treatment. The Bank Group will pay all reasonable medical, hospital, and medical rehabilitation costs causally related to the injury, illness, or death as approved by the Claims Administrator A staff member must seek the authorization of the Claims Administrator prior to an anticipated change in the course of treatment by the treating physician to ensure such treatment is eligible for continued payment. A staff member must seek the prior approval of the Claims Administrator for any change of treating physician, either at his/her own initiative or by referral from the original treating physician. Failure to seek such prior authorizations may result in the denial of a subsequent claim if the Claims Administrator determines that the treatment is unnecessary or unrelated to the covered condition. 2
5 06. Payment of Vocational Rehabilitation Expenses 6.01 In the event a staff member is not able to resume his/her previous job, but is determined by the Claims Administrator to be qualified for vocational rehabilitation, the Bank Group will bear the cost of and the Claims Administrator will arrange for, where available, appropriate vocational rehabilitation services During the period of rehabilitation, the injured person will continue to receive any compensation and medical benefits to which he/she is entitled under this Rule If an injured person declines to participate in an identified vocational rehabilitation program, the Claims Administrator may discontinue any and all benefits provided for under this Rule. 07. Payment of Death Benefits 7.01 In the event a compensable injury causes the death of a staff member, death benefits will be paid to the staff member's survivors and in amounts as specified in Section of the D.C. Act. Survivors are the staff member's spouse or registered domestic partner, and the children of the staff member and his/her spouse or registered domestic partner. 08. Supplemental Allowance 8.01 When the maximum amount of compensation payable for death or disability specified in the D.C. Act is adjusted upwards pursuant to Section of the D.C. Act, a supplemental allowance (also known as "cost-of-living adjustment") will automatically be paid in accordance with Section of that Act to claimants adjudged to be permanently and totally disabled who are already receiving disability benefits or to the claimants' survivors who are already receiving death benefits. 09. Recovery of Benefits Paid 9.01 A claimant receiving payment from a third party for the illness or injury or death for which a claim has been made under this Rule must reimburse the Bank Group to the full extent of benefits he/she has been paid or which have been paid by the Bank Group on his/her behalf under this Rule. In addition, the Bank Group will not be liable for additional benefits payable pursuant to the Workers' Compensation Program until the amount of the workers' compensation benefit due to the claimant exceeds the amount the claimant received from third party. 10. Coordination of Benefits Disability Pension Where a staff member is granted a disability pension under the Staff Retirement Plan by reason of a work-related illness or injury, the staff member will receive the workers' compensation disability benefits to which he/she is entitled under the D.C. Act plus a disability pension, provided that the total of the disability pension and the workers' compensation 3
6 disability benefit does not exceed 66 2/3 percent of the staff member's pensionable gross salary, adjusted by the same percentage that the maximum amount of compensation has been adjusted in Section 8 of this Rule. Funeral Expenses Funeral expenses that would otherwise be payable to survivors under Section of the D.C. Act will be reduced to the extent that a death benefit is paid pursuant to Rule 6.08, "Benefit on Death of a Staff Member in Active Service." Social Security Benefits payable under Section 4 of this Rule will be coordinated with and reduced by 50% of the benefits payable under social security. 11. Exclusive Remedy The claim for compensation which a claimant may file under this Rule constitutes an exclusive remedy against the Bank Group for any illness, injury or death arising out of and in the course of the staff member's employment, except to the extent that the other benefits specified in Section 10 of the Rule may also be paid. 12. Appeals A claimant who wishes to appeal the denial of a claim for workers' compensation benefits or a decision taken in connection with the administration of a compensable claim may, within 90 days of receiving notice of the final decision from the Claims Administrator, request administrative review of the decision from an Administrative Review Panel in accordance with Annex B, Appeals Procedure If a claimant, after receiving the final decision of the Administrative Review Panel, who wishes to pursue his/her complaint further, the claimant may then file an appeal with the World Bank Administrative Tribunal in accordance with the provisions of Rule 9.05, "The World Bank Administrative Tribunal." Annex A: Claims Procedure 1.0 Introduction 1.1 The purpose of this document is to detail the claims procedure for accessing workers compensation benefits under the Bank Group Workers Compensation Program. When an illness, injury, or death of a staff member is believed to arise out of and in the course of the staff member s work with the Bank Group, a claim for applicable workers compensation benefits may be submitted by the staff member, or his/her legal representative or guardian, or if the staff member is deceased by the surviving spouse, domestic partner, child, or estate. 1.2 The Bank Group authorizes a Claims Administrator to independently evaluate workers compensation claims and determine whether they are compensable. All benefits payable under this program are funded exclusively by the Bank Group upon approval by the Claims 4
7 Administrator. The authorized Claims Administrator is currently the Reed Group. Claimants can contact the Reed Group directly as follows. a. Dedicated toll-free number: b. Dedicated fax number: c. address: d. Physical address: Reed Group, PO Box 6248, Broomfield, CO, 80021, USA 2.0 Submission / Receipt of Initial Claim 2.1 Upon the claimant s initial contact with the Claims Administrator, the Claims Administrator will open a case file for the claimant and mail him/her a workers compensation information packet that includes and introductory letter as well as the following which also can be obtained from the Bank Group via the links provided. a. Workers Compensation Claim Form b. Attending Physician s Statement c. Release to Work Form d. Staff Rule 6.11, Workers Compensation 2.2 Claims must be submitted to the Bank Group s Claims Administrator within 12 months after the illness is diagnosed or the injury or death occurs, or if later, 12 months after the date when the claimant became aware, or by the exercise of reasonable diligence should have become aware, of the relationship between the staff member s employment and his/her illness, injury or death. 2.3 The claimant must ensure that the Workers Compensation Claim Form and the Attending Physician s Statement are substantially completed prior to consideration of the claim by the Claims Administrator; The claimant must also ensure that all relevant test results, office notes and/or discharge summaries completed by the attending physician are attached to the Attending Physician s Statement. The claimant must also ensure that any additional information requested pursuant to Paragraph 3.4 of this Annex has been provided to the Claims Administrator including the Release to Work Form, when appropriate. 2.4 Claims submitted on behalf of an impaired staff member by a guardian or other representative must be accompanied by a power of attorney, order establishing legal guardianship or other documentation evidencing the necessary authority to act on the staff member s behalf and to perform the duties required under the workers compensation claims procedure. 3.0 Determination of Compensability 3.1 Once the initial, completed claim is received, the Claims Administrator assigns a Claims Adjuster and a Case Manager to independently review each claim. The Claims Administrator will also notify the Bank Group s Insurance Unit and Health Services Department of the receipt of the claim. 5
8 3.2 The Claims Adjuster will: a. contact the claimant to provide an overview of the claim review process; b. review and clarify with the claimant all information relating to diagnosis and treatment; treatment providers; insurance claims previously submitted; relation of the condition to the staff member s work; events giving rise to claim; witnesses, observers, etc.; and c. obtain information, clarification and testimony directly from other relevant sources regarding how the illness, injury, or death occurred and how it related to the staff member s work. 3.3 The Case Manager will: a. contact the claimant for an Initial Clinical Interview during which he/she will review with the claimant information relating to diagnosis, treatment, or history of the injury, illness or death, as well as information relating to the attending physician, other medical treatment providers, or insurance claims previously submitted; and b. contact all medical provider(s) directly to obtain/confirm medical information; review prognosis for recovery and anticipated duration of condition; clarify relation of the condition to the staff member s work. 3.4 During the course of the reviews, the Claims Administrator may request additional information or documentation from the claimant. The claimant must provide additional information and documentation as needed on a timely basis in order to ensure a timely response to the claim by the Claims Administrator. Additionally, the Claims Administrator may require the claimant to undergo an Independent Medical Examination (IME) by an independent medical examiner, at the Bank Group s expense. The claimant will receive copy of the Independent Medical Examiner s finally report. The claimant must submit to the Independent Medical Examination, if so required. 3.5 When the Claims Administrator is in receipt of the completed and documented claim, along with any additional information and documentation that the Claims Administrator may request during the course of the review, the Claims Administrator shall promptly notify the claimant that his or her claim is deemed completed. Once the Claims Adjuster and the Case Manager have completed their independent reviews of the claim, they will agree on a determination to approve or deny the claim. The Claims Administrator will have 30 calendar days from the notification to the claimant of the receipt of the completed and documented claim to inform the claimant, the Bank Group s Insurance Unit, and Health Services Department of the decision to approve or deny the claim. 3.6 If the claim is approved, the Claims Administrator will define applicable benefits in accordance with Staff Rule 6.11and determine the compensability of the recommended course of treatment. The Claims Administrator may establish with the claimant a schedule of periodic, on-going reviews. At any time during the course of approved treatment and evaluation, the Claims Administrator may request additional medical examinations or documentation. 3.7 The Claim Administrator may request reinvestigation of the events giving rise to the workers compensation claim. 4.0 On-Going Treatment, Administration, and Review of Approved Claims 6
9 Payment of Medical Expenses 4.1 The staff member has the right to select an attending physician, as well as other medical services providers to carry out the appropriate medical treatment, subject to the approval of the Claims Administrator. 4.2 When an appropriate course of medical treatment has been approved by the Claims Administrator, the Bank Group will cover all reasonable medical, hospital, laboratory, and therapy expenses associated with the approved treatment. To that end, the claimant must complete and submit a Workers Compensation Medical Claim Form, which may be obtained from the Claims Administrator or from the Bank Group via the link provided. 4.3 When submitting claims for medical expenses, the claimant must complete a separate Workers Compensation Medical Claim for each medical treatment provider and list all services received from that provider as of the claim date, purpose of services, dates of services, charges, and amounts to be reimbursed. Proof of payment for all requested reimbursements must be attached to the completed Workers Compensation Medical Claim Form for submission. All claims for medical expenses must be submitted to the Claims Administrator within 30 calendar days of receipt of medical service. 4.4 The staff member must seek prior authorization from the Claims Administrator to change any element of the approved course of treatment, even when the changes are recommended by an attending physician. The staff member must seek prior authorization from the Claims Administrator to change the attending physician or add a treatment provider, even when the changes are recommended by the attending physician or another treatment provider. Only treatments and expenses authorized by the Claims Administrator will be covered for reimbursement. Failure to seek such prior authorizations may result in the denial of a claim if the claims administrator determines that the treatment is unnecessary or unrelated to the compensable condition. 4.5 Medical treatment approved under the Workers Compensation Program will not be covered by the Bank Group s Medical Insurance Plan (MIP) or Medical Benefits Program (MBP). 4.6 The Claims Administrator will review all claims for medical expenses and will have the authority to reject any expenses that do not comply with the approved treatment plan or are not deemed to be necessary and related to the compensable condition. The Claims Administrator may also authorize reimbursement on a provisional basis subject to further review. Claimants may appeal rejection of a medical expense claim in accordance with Annex B of Staff Rule Medical expense claims in full compliance with the approved medical treatment plan will be paid to claimant within 30 calendar days of receipt by the Claims Administrator. 4.8 The Claims Administrator may require the claimant to undergo an Independent Medical Examination (IME) at any time deemed necessary during the treatment period. In determining convenience of place of examination, the Claims Administrator shall consider the following with reasonable notice to the claimant. If the claimant unreasonably refuses such an examination, the benefits may be suspended by the Claims Administrator. a. the distance to be traveled b. the physical condition of the staff member; 7
10 c. the various modes of transportation available to the staff member; and d. the location of the qualified physicians who are available to conduct the examination 4.9 Fees and other charges for treatment or medical services shall be limited to those that are reasonable and customary charges prevailing in the local medical community as determined by the Claims Administrator. Examples include physician s charges, diagnostic and lab tests, and hospitalization expenses Reasonable transportation costs incurred to access treatment or to undergo examinations will be covered by the Bank Group. Mileage reimbursement will be assessed in accordance with the rates defined in the Workers Compensation Act of the District of Columbia. Vocational Rehabilitation 4.11 In the event a staff member is not able to resume his/her previous job, the Claims Administrator may prescribe a vocational rehabilitation program designed to return the staff member to work in a capacity that will provide a level of income that is as close as possible to the level of income earned by the staff at the time of injury. a. The Bank Group will bear the cost of and the Claims Administrator will arrange for, where available, appropriate vocational rehabilitation services. b. During the period of rehabilitation, the injured staff member will continue to receive any compensation and medical benefits to which he/she is entitled under this Rule. c. If an injured staff member declines to participate in an identified vocational rehabilitation program, the Claims Administrator may discontinue any and all benefits provided for under this Rule. Request for Reconsideration by the Claims Administrator 4.12 A claimant who wishes to contest the denial of a claim for workers' compensation benefits or a decision taken in connection with the administration of a compensable claim must request reconsideration of the decision by the Claims Administrator within 90 days of receiving notice of the decision The request for reconsideration shall include any new information not previously furnished with the initial application. If a claimant needs more than 90 days to prepare the request for reconsideration, the claimant may request, in writing, an extension of time from the Claims Administrator. The Claims Administrator will provide up to 30 additional days to file the request for reconsideration The Claims Administrator will render its decision within 60 days of receipt of the request for reconsideration. If the Claims Administrator requires more time to make a decision, the claimant will be provided notice in writing which will include an explanation of why more time is required. The additional time will not exceed 30 days, assuming the Claims Administrator has complete information to render its decision If upon reconsideration, the Claims Administrator upholds the denial of the claim; the claimant may appeal to the Administrative Review Panel at the Bank Group. 8
11 Disability Benefits / Income Replacement 4.16 The Claims Administrator will conduct on-going reviews of a staff member s general condition and response to treatment and will authorize continuation of eligibility for disability benefits or income replacement as necessary. Annex B: Appeals Procedure 1.0 Introduction The purpose of this document is to detail the process by which a staff member, the staff member s surviving spouse, domestic partner, or child, or the staff member s legally appointed guardian can appeal to the Bank Group s Administrative Review Panel for further review a final decision rendered by the Bank Group s Claims Administrator. 2.0 Administrative Review Panel 2.1 The Bank Group s Administrative Review Panel is composed of the following. a. The head of the Bank Group s Benefit unit responsible for the workers compensation program (Chair) b. A representative from the Bank Group s Health Services Department; and c. A representative of the Staff association appointed by the executive committee of the Bank Group s Staff Association 2.2 The Panel will review the decision under appeal on the basis of the written record as provided by the claimant, as well as the response provided by Claims Administrator. The Panel may request from the Worker s Compensation Administrator, the claimant or any other party additional information it deems necessary to reach a conclusion. 3.0 Request of Administrative Review 3.1 A claimant who wishes to appeal the Claims Administrator's denial of a claim for workers' compensation benefits or a decision taken in connection with the administration of a compensable claim may, within 90 days of receiving notice of final the decision on reconsideration from the Claims Administrator, request administrative review of the decision from the Administrative Review Panel by completing and submitting a Request for Administrative Review form. The form may be accessed via the links provided or from the Claims Administrator. 3.2 The appeal should be submitted to the Chair of the Administrative Review Panel. 3.3 The claimant s must ensure that the Request for Administrative Review form contains the following competed information. a. Claimant s full name, address, and telephone number b. Staff member s name and UPI number 9
12 c. Written notification of the decision against which the request is being made and the date on which the notification was received d. Grounds upon which the Appeal is made e. Statement of the relevant facts, together with supporting documentation and evidence f. The conclusion the appellant wishes the Panel to make; and g. Date of the Appeal and claimant s signature 3.4 In preparing an appeal, a claimant may request, and the Claims Administrator will furnish, copies of any medical reports, bills for medical treatment, vocational rehabilitation reports or official forms not already in the claimant's possession. When making his/her request to the Administrative Review Panel, the claimant must provide all necessary documentation, including relevant medical information. The claimant shall not include any new information not previously considered by the Claims Administrator in his/her appeal to the Administrative Review Panel. 3.5 Upon receipt of the appeal request, the Administrative Review Panel will provide a copy of the appeals request to the Claims Administrator who will prepare a written response within 60 days of receipt. The claimant will be provided a copy of the Claims Administrators written response and he/she will have 30 days to provide comments to the Administrative Review Panel on the response given by the Claims Administrator. 3.6 The Administrative Review Panel will review the decision being appealed based on the written record as supplied by the claimant and the response from the Claims Administrator. The Administrative Review Panel may request from the Claims Administrator, the claimant or any other party, additional information it deems necessary to reach a conclusion. 3.7 Within 90 days of receiving all requested documentation, the Panel will transmit a memorandum to the claimant and the Workers Compensation Administrator detailing its decision and the reasons for the decision on the Appeal. In the absence of receipt of requested documentation within a reasonable period of time as determined by the Panel, the Panel may proceed to issue its decision. 3.8 If a claimant, after receiving the final decision of the Administrative Review Panel wishes to pursue his/her complaint further, the claimant may then file an appeal with the World Bank Administrative Tribunal in accordance with the provisions of Staff Rule
Directive. Staff Rule 6.11, Workers' Compensation. Bank Access to Information Policy Designation Public. Catalogue Number. Issued
Directive Staff Rule 6.11, Workers' Compensation Bank Access to Information Policy Designation Public Catalogue Number Issued Effective October 1, 2011 Retired March 12, 2017 Content Applicable to Issuer
More informationWorld Bank Group Directive
World Bank Group Directive Staff Rule 6.22 Disability Insurance Program Bank Access to Information Policy Designation Public Catalogue Number HRD3.02-DIR.105 Issued October 12, 2016 Effective October 12,
More informationWorld Bank Group Directive
World Bank Group Directive Staff Rule 6.12 - Participation in the Medical Insurance Plan Bank Access to Information Policy Designation Public Catalogue Number HRD3.02-DIR.105 Issued October 13, 2016 Effective
More informationEMPLOYEE OCCUPATIONAL INJURY POLICY
I. Introduction EMPLOYEE OCCUPATIONAL INJURY POLICY The Alabama Workers' Compensation Act does not apply to employment with state agencies and institutions, such as the University. It is, however, the
More informationAdvocate Health Care Network Disability Income Protection Summary of Benefits
Advocate Health Care Network Disability Income Protection Summary of Benefits (Amended and Restated as of July 1, 2017) What s Inside Introduction...3 Disability Case Management...4 Disability Council...4
More informationShort Term Disability and Long Term Disability Insurance Plans
S U M M A R Y P L A N D E S C R I P T I O N L3 Technologies, Inc. Short Term Disability and Long Term Disability Insurance Plans Effective January 1, 2017 Table of Contents The Short Term Disability and
More informationShould you have any questions about any aspect of the Workers' Compensation Program, you may call the UNCG Benefits Office at extension
WORKER'S COMPENSATION MEMORANDUM Scope: All University Employees [Program Governed by North Carolina General Statutes Chapter 97] Effective: September 4, 1995 Revised: December 1, 2001 TO: All University
More informationBenefits. Long-Term Disability KPERS. Kansas Public Employees Retirement System. Summary Plan Description GLD 2006
Long-Term Disability Benefits Kansas Public Employees Retirement System Summary Plan Description GLD 2006 KPERS 2 Plan Sponsor Kansas Public Employees Retirement System 611 S. Kansas Ave., Suite 100 Topeka,
More informationWorld Bank Group Directive
World Bank Group Directive Staff Rule 6.19 Tax Supplements on Staff Retirement Plan Benefits Bank Access to Information Policy Designation Public Catalogue Number HRD3.09-DIR.105 Issued May 30, 2017 Effective
More informationGuide. to Recovery Under The Illinois Workers Compensation Act. The Injured Employee s
The Injured Employee s Guide to Recovery Under The Illinois Workers Compensation Act Prepared By: Romanucci & Blandin, LLC 33 North LaSalle Street, 20th Floor Chicago, Illinois 60602 Toll Free: 888.458.1145
More informationADOPTED REGULATION OF THE ADMINISTRATOR OF THE DIVISION OF INDUSTRIAL RELATIONS OF THE DEPARTMENT OF BUSINESS AND INDUSTRY. LCB File No.
ADOPTED REGULATION OF THE ADMINISTRATOR OF THE DIVISION OF INDUSTRIAL RELATIONS OF THE DEPARTMENT OF BUSINESS AND INDUSTRY LCB File No. R090-99 Effective October 28, 1999 EXPLANATION Matter in italics
More informationHome Office: Chicago, Illinois Administrative Office: Philadelphia, Pennsylvania
Home Office: Chicago, Illinois Administrative Office: Philadelphia, Pennsylvania TABLE OF CONTENTS Page SCHEDULE OF BENEFITS... 1.0 DEFINITIONS... 2.0 GENERAL PROVISIONS... 3.0 EFFECTIVE DATE AND TERMINATION...
More informationSURA/JEFFERSON SCIENCE ASSOCIATES, LLC
SURA/JEFFERSON SCIENCE ASSOCIATES, LLC COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN Summary Plan Description Amended and Restated Effective April 1, 2011 YOUR SUMMARY PLAN DESCRIPTION This document is
More informationGROUP LIFE INSURANCE PROGRAM. The Chenega Corporation Employee Benefits Trust
GROUP LIFE INSURANCE PROGRAM The Chenega Corporation Employee Benefits Trust CERTIFICATE OF INSURANCE We certify that you (provided you belong to a class described on the Schedule of Benefits and your
More informationNATIONAL ELEVATOR INDUSTRY HEALTH BENEFIT PLAN 19 Campus Boulevard Suite 200 Newtown Square, PA
NATIONAL ELEVATOR INDUSTRY HEALTH BENEFIT PLAN 19 Campus Boulevard Suite 200 Newtown Square, PA 19073-3288 800-523-4702 www.neibenefits.org Summary of Material Modifications February 2018 New Option for
More informationLONG TERM DISABILITY BENEFITS SUMMARY PLAN DESCRIPTION
LONG TERM DISABILITY BENEFITS SUMMARY PLAN DESCRIPTION August 1, 2009 TABLE OF CONTENTS DEFINITIONS...1 SCHEDULE OF BENEFITS...4 HOW TO FILE A CLAIM FOR BENEFITS...5 PAYMENT OF CLAIMS...5 REHABILITATION...5
More informationL-3 Communications Corporation. Long Term Disability Insurance Plan
S U M M A R Y P L A N D E S C R I P T I O N L-3 Communications Corporation Long Term Disability Insurance Plan Effective January 1, 2007 L - 3 C O M M U N I C A T I O N S Table of Contents The Long Term
More informationVISION CARE Plan Document
VISION CARE Plan Document February 1, 1984 With Revisions Effective January 1, 1985 May 1, 1986 January 1, 1988 September 16, 1988 March 17, 1989 January 1, 1990 January 1, 1992 July 1, 1992 September
More informationMARCH 5, Referred to Committee on Commerce and Labor. SUMMARY Revises provisions governing workers compensation.
A.B. ASSEMBLY BILL NO. COMMITTEE ON COMMERCE AND LABOR MARCH, 0 Referred to Committee on Commerce and Labor SUMMARY Revises provisions governing workers compensation. (BDR -) FISCAL NOTE: Effect on Local
More informationWorld Bank Group Directive
World Bank Group Directive Staff Rule 6.18 - Financial Assistance to Staff Members Bank Access to Information Policy Designation Public Catalogue Number HRD3.01-DIR.140 Issued October 19, 2017 Effective
More informationFIRE & POLICE PENSION PLANS TIERS 3, 4, 5, 6 DISABILITY RETIREMENT GENERAL INFORMATION SUMMARY BOOKLET. Application - Processing - Options
FIRE & POLICE PENSION PLANS TIERS 3, 4, 5, 6 DISABILITY RETIREMENT GENERAL INFORMATION SUMMARY BOOKLET Application - Processing - Options CITY OF LOS ANGELES Fire and Police Pension System Department of
More informationGROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PROGRAM. Rogers Public School District
GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PROGRAM Rogers Public School District CERTIFICATE OF INSURANCE We certify that you (provided you belong to a class described on the Schedule
More informationFIRE & POLICE PENSION PLAN TIER 5 (Administrative Code, Division 4, Chapter 20 et seq.) DISABILITY RETIREMENT GENERAL INFORMATION:
FIRE & POLICE PENSION PLAN (Administrative Code, Division 4, Chapter 20 et seq.) DISABILITY RETIREMENT GENERAL INFORMATION: Application - Processing - Options CITY OF LOS ANGELES Fire and Police Pension
More informationH 5889 SUBSTITUTE A AS AMENDED ======= LC02024/SUB A/2 ======= S T A T E O F R H O D E I S L A N D
01 -- H SUBSTITUTE A AS AMENDED LC00/SUB A/ S T A T E O F R H O D E I S L A N D IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 01 A N A C T RELATING TO LABOR AND LABOR RELATIONS -- TEMPORARY DISABILITY INSURANCE
More informationLong Term Disability, Life, Supplemental Life and Supplemental Dependent Life GROUP BENEFIT PLAN
Long Term Disability, Life, Supplemental Life and Supplemental Dependent Life GROUP BENEFIT PLAN TABLE OF CONTENTS Group Long Term Disability Benefits PAGE CERTIFICATE OF INSURANCE... 2 SCHEDULE OF INSURANCE...
More informationDisability Coverage. Disability benefits help protect your income if you have an illness or injury that keeps you from working.
Disability Coverage Disability benefits help protect your income if you have an illness or injury that keeps you from working. Plan Highlights If you enroll in the voluntary STD benefit, you will be eligible
More informationSELF-FUNDED EMPLOYEE BENEFIT PLAN SHORT TERM DISABILITY PLAN DOCUMENT YOSEMITE COMMUNITY COLLEGE DISTRICT. Restated January 1, 2007
SELF-FUNDED EMPLOYEE BENEFIT PLAN SHORT TERM DISABILITY PLAN DOCUMENT YOSEMITE COMMUNITY COLLEGE DISTRICT Restated January 1, 2007 License #0451271 Table of Contents I. DEFINITIONS II. III. IV. ELIGIBILITY
More informationYOUR BENEFIT PROGRAM TAYLOR CORPORATION. Full-time Employees. Salary Continuation
YOUR BENEFIT PROGRAM TAYLOR CORPORATION Full-time Employees Salary Continuation EMPLOYER: TAYLOR CORPORATION PROGRAM NUMBER: ASO-702684 PROGRAM EFECTIVE DATE: May 1, 2008 The benefits described herein
More informationClass 2 Disability Benefits Program 2014 Summary Plan Description
Montefiore Mount Vernon Hospital Montefiore New Rochelle Hospital Schaffer Extended Care Center Class 2 Disability Benefits Program 2014 Summary Plan Description Disability Disability benefits continue
More informationPenske Long-Term Disability Summary Plan Description
Penske Long-Term Disability Summary Plan Description Contents Program Highlights... 1 Coverage Available to You...1 Eligibility and Enrollment... 2 Eligibility... If You Are a New Hire... If You Transfer
More informationUtah Transit Authority Personal Injury Protection Information
Utah Transit Authority Personal Injury Protection Information Revised 11/2016 A passenger on a UTA bus or a pedestrian injured by a bus may be entitled to Personal Injury Protection benefits. To claim
More informationCITGO Petroleum Corporation Long Term Disability Program for Salaried Employees Summary Plan Description
CITGO Petroleum Corporation Long Term Disability Program for Salaried Employees Summary Plan Description as in effect January 1, 2013 TABLE OF CONTENTS PURPOSE... 1 ELIGIBILITY... 2 Who is Eligible...
More informationWorld Bank Group Directive
World Bank Group Directive Staff Rule 6.02 - Dependency (Tax Equivalency) Allowances Bank Access to Information Policy Designation Public Catalogue Number HRS3.01-DIR.03 Issued May 23, 2018 Effective May
More informationSUN LIFE ASSURANCE COMPANY OF CANADA
SUN LIFE ASSURANCE COMPANY OF CANADA Executive Office: One Sun Life Executive Park Wellesley Hills, MA 02481 (800) 247-6875 www.sunlife.com/us Sun Life Assurance Company of Canada certifies that it has
More informationHIGHLIGHTS OF THE NEW PERSONAL INJURY PROTECTION ( PIP ) STATUTE SIGNED INTO LAW ON MAY 04, 2012
HIGHLIGHTS OF THE NEW PERSONAL INJURY PROTECTION ( PIP ) STATUTE SIGNED INTO LAW ON MAY 04, 2012 By Travis L. Stock, Esq. May 14, 2012 On May 04, 2012, Governor Rick Scott signed legislation that purportedly
More informationVOLUNTARY TERM LIFE BENEFITS SUMMARY PLAN DESCRIPTION
VOLUNTARY TERM LIFE BENEFITS SUMMARY PLAN DESCRIPTION August 1, 2009 TABLE OF CONTENTS DEFINITIONS...1 SCHEDULE OF BENEFITS...4 HOW TO FILE A CLAIM FOR BENEFITS...6 ELIGIBILITY...6 GUARANTEED INCREASE
More informationDisability Income Salary Continuation Plan Resolution And Agreement
Disability Income Salary Continuation Plan Resolution And Agreement The sample resolution and agreement have been prepared as guides to assist attorneys. The agreement outlines the basic provisions which
More informationHome Office: Schaumburg, Illinois Administrative Office: Philadelphia, Pennsylvania
Home Office: Schaumburg, Illinois Administrative Office: Philadelphia, Pennsylvania POLICYHOLDER: Sedgwick County Area Educational Services POLICY NUMBER: GL 154255 EFFECTIVE DATE: September 1, 2015, as
More informationGROUP LIFE INSURANCE PROGRAM. Veolia North America, LLC
GROUP LIFE INSURANCE PROGRAM Veolia North America, LLC RELIANCE STANDARD LIFE INSURANCE COMPANY Home Office: Chicago, Illinois Administrative Office: Philadelphia, Pennsylvania CERTIFICATE OF INSURANCE
More informationVSP Plus. Plan Coverage Booklet
VSP Plus Plan Coverage Booklet The Blue Cross Blue Shield of Michigan benefits for which you are insured are set forth in the pages of this booklet. Consult these pages for a further description of the
More informationGROUP LIFE INSURANCE PROGRAM. Alden Management Services, Inc.
GROUP LIFE INSURANCE PROGRAM Alden Management Services, Inc. RELIANCE STANDARD LIFE INSURANCE COMPANY Home Office: Chicago, Illinois Administrative Office: Philadelphia, Pennsylvania CERTIFICATE OF INSURANCE
More informationGROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PROGRAM. Montgomery County Community College
GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PROGRAM Montgomery County Community College CERTIFICATE OF INSURANCE We certify that you (provided you belong to a class described on the Schedule
More informationThe Expanded Long-Term Disability Plan: LTD Coverage and Benefits
The Expanded Long-Term Disability Plan: LTD Coverage and Benefits M UNIVERSITY HUMAN RESOURCES BENEFITS OFFICE UNIVERSITY OF MICHIGAN Table of Contents The Expanded Long-Term Disability Plan... 1 Statement
More informationFebruary 1, Basic Long Term Disability MMC
February 1, 2008 MMC This plan provides you with income in case you can t work for an extended period of time because of an injury or illness. Effective January 1, 2007, benefits under MMC s Basic and
More informationThe Workers Advisers Office (WAO)
The Workers Advisers Office (WAO) This factsheet has been prepared for general information purposes. It is not a legal document. Please refer to the Workers Compensation Act and the Rehabilitation Services
More informationShort-Term Disability. Summary Plan Description
Short-Term Disability Summary Plan Description August 2016 Table of Contents INTRODUCTION... 1 ELIGIBILITY AND ENROLLMENT... 1 Eligibility... 1 Enrollment... 1 STD BENEFITS... 2 DURATION OF BENEFIT PAYMENTS...
More informationShort Term Disability
Short Term Disability General Information If you become ill or injured and are unable to work, the Hitachi Data Systems US Benefits Program can help protect you financially. The following plan has been
More informationYOUR SUMMARY PLAN DESCRIPTION
YOUR SUMMARY PLAN DESCRIPTION Richmond Public Schools All Regular Full-Time Hourly or Salaried Employees working at least 20 hours per week Income Coverage: Term Benefits Effective July 1, 2011 YOUR SUMMARY
More informationSTANDARD INSURANCE COMPANY
STANDARD INSURANCE COMPANY A Stock Life Insurance Company 900 SW Fifth Avenue Portland, Oregon 97204-1282 (503) 321-7000 GROUP LONG TERM DISABILITY INSURANCE CERTIFICATE POLICYHOLDER: University of Utah
More informationTABLE OF CONTENTS. Eligibility for Insurance 1 Effective Date of Insurance 1. Schedule of Benefits 2 Definitions 2 Insuring Provisions 6
TABLE OF CONTENTS ELIGIBILITY FOR INSURANCE PAGE Eligibility for Insurance 1 Effective Date of Insurance 1 LONG TERM DISABILITY INSURANCE Schedule of Benefits 2 Definitions 2 Insuring Provisions 6 PREMIUMS
More informationDefinitions for Key Terms can be found on page 4
THIS IS A STATEMENT OF COVERAGE FOR THE LA SIERRA UNIVERSITY CALIFORNIA VOLUNTARY PLAN. THE PROVISIONS OF THIS STATEMENT APPLY TO DISABILITY AND PAID FAMILY LEAVE BENEFIT PERIODS BEGINNING ON OR AFTER
More informationNorth Carolina State Government W O R K E R S C O M P E N S A T I O N E M P L O Y E E H A N D B O O K
North Carolina State Government W O R K E R S C O M P E N S A T I O N E M P L O Y E E H A N D B O O K NORTH CAROLINA OFFICE OF STATE HUMAN RESOURCES September 2016 PURPOSE The contents in this handbook
More informationWorkers Compensation Claim State Environmental Guide - Vermont
Workers Compensation Claim State Environmental Guide - Vermont VERMONT http://www.labor.vermont.gov/ Indemnity issues Temporary Total Benefits 21 V.S.A. 642 and Rule 15 Temporary Total: 2/3 (.667) of the
More informationLIFE INSURANCE PLAN TABLE OF CONTENTS
Life Insurance January 1, 2016 LIFE INSURANCE PLAN TABLE OF CONTENTS Life Insurance Plan Highlights... 1 Introduction... 2 Who is Eligible?... 2 How do I Enroll?... 3 When Can I Enroll?... 4 Assigning
More informationYOUR BENEFIT PLAN DIOCESE OF ST. PETERSBURG, INC. Short Term Disability
YOUR BENEFIT PLAN DIOCESE OF ST. PETERSBURG, INC. Short Term Disability EMPLOYER: DIOCESE OF ST. PETERSBURG, INC. PLAN NUMBER: GRH-697050 PLAN EFFECTIVE DATE: July 1, 2014 BENEFITS UNDER THE GROUP SHORT
More informationYOUR GROUP VOLUNTARY LONG-TERM DISABILITY BENEFITS. City of Tuscaloosa
YOUR GROUP VOLUNTARY LONG-TERM DISABILITY BENEFITS City of Tuscaloosa Effective October 1, 2009 HOW TO OBTAIN PLAN BENEFITS To obtain benefits see the Payment of Claims provision. Forward your completed
More informationSouth Dakota Workers Compensation System
An Employee s Guide to the South Dakota Workers Compensation System Division of Labor and Management 123 W. Missouri Ave. Pierre, SD 57501 Tel: 605.773.3681 sdjobs.org This booklet briefly outlines South
More informationWORKERS COMPENSATION HANDBOOK
WORKERS COMPENSATION HANDBOOK DEVELOPED BY RISK MANAGEMENT DEPARTMENT DIVISION OF BUSINESS AND FINANCE If you are injured on the job you have certain rights, benefits and responsibilities. Gwinnett County
More informationLPL Financial (herein called the Policyholder)
In Consideration of the Application for this Policy made by The Lincoln National Life Insurance Company A Stock Company Home Office Location: Fort Wayne, Indiana Group Insurance Service Office: 8801 Indian
More informationGROUP LIFE INSURANCE PLAN SUMMARY PLAN DESCRIPTION
GROUP LIFE INSURANCE PLAN SUMMARY PLAN DESCRIPTION As of January 1, 2018 1 WHO IS ELIGIBLE... 3 ENROLLING IN THE PLAN... 3 WHEN COVERAGE BEGINS... 3 COST OF COVERAGE... 3 BENEFITS... 3 BENEFICIARY DESIGNATIONS...
More informationYOUR GROUP LONG-TERM DISABILITY BENEFITS
YOUR GROUP LONG-TERM DISABILITY BENEFITS Cornerstone Systems, Inc. All other eligible employees Revised July 1, 2008 HOW TO OBTAIN PLAN BENEFITS To obtain benefits see the Payment of Claims provision.
More informationSUMMARY OF MATERIAL MODIFICATION AND AMENDMENT #1 TO THE BRAUN NORTHWEST, INC. HEALTH BENEFITS PLAN BASE PLAN GROUP NO
SUMMARY OF MATERIAL MODIFICATION AND AMENDMENT #1 TO THE BRAUN NORTHWEST, INC. HEALTH BENEFITS PLAN BASE PLAN GROUP NO. 15972 This Summary of Material Modification and Amendment describes changes to the
More informationSUN LIFE AND HEALTH INSURANCE COMPANY (U.S.)
SUN LIFE AND HEALTH INSURANCE COMPANY (U.S.) Executive Office: Home Office: One Sun Life Executive Park 201 Townsend Street, Suite 900 Wellesley Hills, MA 02481 Lansing, MI 48933 (800) 247-6875 www.sunlife.com/us
More informationPAN-AMERICAN LIFE INSURANCE COMPANY EMPLOYER ADMINISTRATIVE GUIDE FOR YOUR GROUP OCCUPATIONAL ACCIDENT PLAN
PAN-AMERICAN LIFE INSURANCE COMPANY EMPLOYER ADMINISTRATIVE GUIDE FOR YOUR GROUP OCCUPATIONAL ACCIDENT PLAN Toll Free: Phone: 855-837-1091 / Fax: 855-837-0380 1 This Administrative Guide has been provided
More informationUNITED COUNTY INDUSTRIES, COUNTY HEAT TREAT HEALTH REIMBURSEMENT ARRANGEMENT (HRA) PLAN SUMMARY PLAN DESCRIPTION
UNITED COUNTY INDUSTRIES, COUNTY HEAT TREAT HEALTH REIMBURSEMENT ARRANGEMENT (HRA) PLAN SUMMARY PLAN DESCRIPTION Effective: December 1, 2014 United County Industries, County Heat Treat Summary Plan Description
More informationMONTEFIORE MEDICAL CENTER
H52238 07/27/2009 GROUP BOOKLET-CERTIFICATE FOR MEMBERS OF MONTEFIORE MEDICAL CENTER ACTIVE MIDDLE MANAGEMENT, PHYSICAL THERAPISTS, CLERICAL EMPLOYEES, SECURITY STAFF OR HOUSE STAFF EMPLOYEES Group Long
More informationR LTD-0%-A. Michigan
GROUP INSURANCE POLICY NON-PARTICIPATING POLICYHOLDER: DEMONSTRATION COMPANY 032408 POLICY NUMBER: R0067363 LTD-0%-A POLICY EFFECTIVE DATE: February 1, 2008 POLICY ANNIVERSARY DATE: February 1 GOVERNING
More informationSB (b)(8) & (9) January 1, 2013 Minimum weekly benefit increased from $130 to $160 for injuries on/after January 1, 2013
SB863 The following is a quick summary sheet of changes with selected cited provisions of the Labor Code changes and amendments effectuated by the passage of SB 863 by the California Legislature. This
More informationHAWAII ADMINISTRATIVE RULES TITLE 12 DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS SUBTITLE 3 DISABILITY COMPENSATION DIVISION CHAPTER 10
HAWAII ADMINISTRATIVE RULES TITLE 12 DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS SUBTITLE 3 DISABILITY COMPENSATION DIVISION CHAPTER 10 WORKERS' COMPENSATION SUBCHAPTER 1 GENERAL PROVISIONS 12-10-1 Definitions.
More informationWorld Bank Group Directive
World Bank Group Directive Staff Rule 7.01 - Ending Employment Bank Access to Information Policy Designation Public Catalogue Number HRDVP3.09-DIR.70 Issued December 31, 2015 Effective January 1, 2016
More informationSTANDARD INSURANCE COMPANY
STANDARD INSURANCE COMPANY A Stock Life Insurance Company 900 SW Fifth Avenue Portland, Oregon 97204-1282 (503) 321-7000 People. Not just policies. GROUP LONG TERM DISABILITY INSURANCE CERTIFICATE POLICYHOLDER:
More informationEMPLOYEE INSTRUCTIONS FOR CLAIMS REPORTING
EMPLOYEE INSTRUCTIONS FOR CLAIMS REPORTING Please read the entire contents of the packet and follow directions below. 1. Call 1-800-445-6965 to report your work-related claim as soon as possible. 2. Advise
More informationTHE STANDARD LIFE INSURANCE COMPANY OF NEW YORK
THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK A Stock Life Insurance Company 360 Hamilton Avenue, Suite 210 White Plains, New York 10601-1871 (914) 989-4400 GROUP LONG TERM DISABILITY INSURANCE CERTIFICATE
More informationAccident Benefits Claim Instructions
Claim Instructions Your Accident Benefit Claim This packet contains the forms necessary to apply for. Every space on these forms should be filled in to avoid delay in processing your application. If a
More informationForest River, Inc. Your Group Long Term Disability Plan
Forest River, Inc. Your Group Long Term Disability Plan Policy No. 951840 011 Underwritten by Unum Life Insurance Company of America 3/2/2016 CERTIFICATE OF COVERAGE Unum Life Insurance Company of America
More informationLONG-TERM DISABILITY INCOME INSURANCE BENEFIT
LONG-TERM DISABILITY INCOME INSURANCE BENEFIT To be eligible for long-term disability benefits, employees must elect the benefit when they initially enroll for benefits with Allegiant Care or during a
More informationTable of Contents. 4. Appeals Contact Information...14
Disability Benefits Table of Contents 1. Disability Benefits Death and Disability Plan...1 Overview.... 1 Eligibility and Enrollment... 3 Disability Benefits.... 3 Factors that Affect Benefit Calculations...
More informationEmployee Group Benefits UNDERWRITTEN BY SUN LIFE ASSURANCE COMPANY OF CANADA
Employee Group Benefits UNDERWRITTEN BY SUN LIFE ASSURANCE COMPANY OF CANADA Mills Meyers Swartling GROUP POLICY NUMBER - 222551-001 BOOKLET EFFECTIVE DATE - April 1, 2012 BOOKLET AMENDMENT DATE - 93C-LH
More informationWhat Your Plan Covers and How Benefits are Paid BENEFIT PLAN. Prepared Exclusively for University of Hartford. Long Term Disability Coverage
BENEFIT PLAN Prepared Exclusively for University of Hartford What Your Plan Covers and How Benefits are Paid Long Term Disability Coverage Table of Contents Preface...1 Coverage for You...2 Long Term Disability
More informationSTANDARD INSURANCE COMPANY
STANDARD INSURANCE COMPANY A Stock Life Insurance Company 900 SW Fifth Avenue Portland, Oregon 97204-1282 (503) 321-7000 GROUP LONG TERM DISABILITY INSURANCE CERTIFICATE POLICYHOLDER: University of Utah
More informationIn addition there are several aspects of your disability claim that you should be aware of:
Dear Colleague: American Airlines has partnered with Harvey Watt and Company as the Claim Administrator for the Pilot Long Term Disability Plan (the Plan). We have enclosed the Claim Application along
More informationSELF-INSURED PAID FAMILY LEAVE Standard Operating Procedure
SELF-INSURED PAID FAMILY LEAVE Standard Operating Procedure Amended Effective January 1, 2015 Certain classified employees (not covered by SDI, which has its own Paid Family Leave Benefit) at City College
More informationGROUP BENEFIT PLAN MARVELL SEMICONDUCTOR, INC.
GROUP BENEFIT PLAN MARVELL SEMICONDUCTOR, INC. Long Term Disability, Life, Supplemental Life and Supplemental Dependent Life The following provisions are applicable to residents of Florida, Maryland and
More informationSUMMARY OF MARYLAND STATE EMPLOYEES & RETIREES BEHAVIORAL HEALTH PLAN
SUMMARY OF MARYLAND STATE EMPLOYEES & RETIREES BEHAVIORAL HEALTH PLAN 2012-2013 Call APS Healthcare Toll-Free: 1-877-239-1458 Website: www.apshelplink.com Company Code: SOM2002 1 of 8 Year 2012-2013 Summary
More informationNATIONAL RURAL ELECTRIC COOPERATIVE ASSOCIATION SHORT-TERM DISABILITY PLAN. A Constituent Plan of the NRECA Group Benefits Program
NATIONAL RURAL ELECTRIC COOPERATIVE ASSOCIATION SHORT-TERM DISABILITY PLAN A Constituent Plan of the NRECA Group Benefits Program As Amended and Restated January 1, 2012 TABLE OF CONTENTS Page SECTION
More informationCompBenefits Company A Prepaid Limited Health Service Organization Licensed Under Section 636 of the Florida Insurance Code.
CompBenefits Company A Prepaid Limited Health Service Organization Licensed Under Section 636 of the Florida Insurance Code. Agreement And Certificate of Benefits Provided that all Contributions and Copayments
More informationSUN LIFE AND HEALTH INSURANCE COMPANY (U.S.)
SUN LIFE AND HEALTH INSURANCE COMPANY (U.S.) Executive Office: Home Office: One Sun Life Executive Park 175 Addison Road Wellesley Hills, MA 02481 Windsor, CT 06095 (800) 247-6875 www.sunlife.com/us Sun
More informationTITLE 8. Industrial Relations. Division 1. Department of Industrial Relations. Chapter 4.5. Division of Workers Compensation
TITLE 8. Industrial Relations Division 1. Department of Industrial Relations Chapter 4.5. Division of Workers Compensation Subchapter 1. Administrative Director--Administrative Rules ARTICLE 3.5 Medical
More informationA-1 Contract Staffing, Inc.
A-1 Contract Staffing, Inc. Class II Short Term Disability Coverage Long Term Disability Coverage Benefit Highlights SHORT TERM DISABILITY PLAN This short term disability plan provides financial protection
More informationYOUR BENEFIT PROGRAM. For Exempt Staff. Short Term Income Replacement
YOUR BENEFIT PROGRAM For Exempt Staff Short Term Income Replacement EMPLOYER: UNIVERSITY OF NOTRE DAME DU LAC PROGRAM: STIR Exempt PROGRAM EFECTIVE DATE: July 1, 2016 THE INCOME REPLACEMENT PROGRAM DESCRIBED
More informationLife, Accident and Critical Illness Insurance Programs
Life, Accident and Critical Illness Insurance Programs Important Notice This Summary Plan Description (SPD) booklet, including any subsequent related Summaries of Material Modifications (SMMs), is intended
More informationINTERNATIONAL ASSOCIATION OF HEAT & FROST INSULATORS AND ASBESTOS WORKERS LOCAL UNION NO. 96 PENSION PLAN
INTERNATIONAL ASSOCIATION OF HEAT & FROST INSULATORS AND ASBESTOS WORKERS LOCAL UNION NO. 96 PENSION PLAN BE SURE TO NOTIFY THE FUND OFFICE OF YOUR CURRENT ADDRESS Most information about your plan and
More informationGROUP ACCIDENT INSURANCE. Claim Filing Instructions
Underwritten by: National Guardian Life Insurance Company Administered by: AlwaysCare Benefits, Inc. Claim Filing Instructions We understand an illness or injury creates emotional, physical and financial
More informationSUMMARY PLAN DESCRIPTION KAISER ALUMINUM SALARIED RETIREES VEBA PLAN
SUMMARY PLAN DESCRIPTION KAISER ALUMINUM SALARIED RETIREES VEBA PLAN January 1, 2017 NOTE: The information contained in this Summary Plan Description provides a limited description of the relevant provisions
More informationThis Policy will be construed in line with the law of the jurisdiction in which it is delivered.
A Control No. 474928 Blanket Student Accident and Sickness Insurance Policy a contract between Aetna Life Insurance Company (A Stock Company herein called Aetna) and Washington University in St. Louis
More informationAGREEMENT FOR WORKERS COMPENSATION PLAN ADMINISTRATION SERVICES
AGREEMENT FOR WORKERS COMPENSATION PLAN ADMINISTRATION SERVICES This agreement is made and entered into this 5 th day of May 2009 ( Effective Date ), by and between the City of Redlands, a municipal corporation
More informationLIFE INSURANCE CLAIM
LIFE INSURANCE CLAIM Life Insurance Claim - Instructions 1. For a Life Insurance Claim: The beneficiary (claimant) should complete the Beneficiary s (claimant s) Statement and submit the completed claim
More informationGroup Benefits Policy
Group Benefits Policy Policyholder: Policy Number: G0030630A Policy Effective Date: November 1, 2009 Policy Anniversary: Renewal Date: November 1st January 1st Table of Contents Group Benefits Schedule...1
More information**CONTINUATION COVERAGE RIGHTS UNDER COBRA**
**CONTINUATION COVERAGE RIGHTS UNDER COBRA** Federal law requires certain employers sponsoring group health plan coverage to offer their employees (and his or her enrolled family members) the opportunity
More informationSick Leave & Disability
In general, all full-time and part-time employees of the Company are eligible for the sick leave and disability plans described in this section. Interns, contract and agency workers and hiring hall employees
More information