Leave of Absence. Associate s Serious Health Condition - California. Leave of Absence Instructions and Information

Transcription

1 Leave of Absence Associate s Serious Health Condition - California Included Inside Leave of Absence Instructions and Information Instructions for Processing a Leave of Absence (LOA) and/or Family Medical Leave Act (FMLA) Leave/California Family Rights Act (CFRA) Leave Documents and Procedures to Process Request for LOA and/or FMLA Leave/CFRA Leave Leave of Absence Forms Certification of Health Care Provider for Associate s Serious Health Condition LOA/FMLA/CFRA Certification BB&T Return to Work Certification Leave of Absence Resources and Information Workday Leave of Absence Instructions Employee Rights and Responsibilities Under FMLA (FMLA Poster) Life Event Changes: Instructions for Changing Benefit Elections in Workday Benefit-Related Items to Consider Payroll-Related Items to Consider Other Items to Consider California State Disability Insurance Brochure Filing Disability Claims with The Hartford Important Please contact Benefits Administration at , option 3, for assistance in completing the information contained within this packet. All medical records and forms should be submitted with a bar-coded Medical Records Fax Cover Sheet (located on InSite > Human Systems Express > Associate Information > Medical Records Fax Cover Sheet) to: (if faxing within BB&T) (if faxing from outside BB&T)

2 Leave of Absence Instructions & Information Instructions for Processing LOA and/or FMLA/CFRA Leave Please read the following instructions and complete all of the necessary paperwork/procedures accordingly. Associates scheduled 19 hours or less are not entitled to pay under the Sick Pay Policy unless the associate works in a state or municipality whose laws provide for such benefits. Associates must consult with Benefits Administration for more specific guidelines. 1. The associate should complete the Request for Leave of Absence process through Workday prior to the anticipated leave. If the leave of absence process was not completed by the associate, then the manager MUST complete the Leave of Absence process through Workday. This process should include the associate s last day worked, first day of leave, estimated last day of leave and leave type. Failure to complete this process in a timely manner may result in an incorrect payment to the associate. 2. The manager or associate should print a copy of the appropriate Leave of Absence packet. Benefits Administration can provide guidance to the manager or associate in completing the appropriate documentation. The associate should be given the appropriate Certification of Healthcare Provider, FMLA Poster and LOA / FMLA/CFRA Certification. Benefits Administration will send the associate their Notice of Eligibility and Rights & Responsibilities. The associate should retain the Notice of Eligibility and Rights & Responsibilities and FMLA Poster for their records. The appropriate Certification of Health Care Provider must be completed by the attending physician. It is important that the Certification of Health Care Provider and the LOA / FMLA/CFRA Certification be faxed in with a barcoded Medical Records Fax Cover Sheet to (if faxing within BB&T) or (if faxing from outside of BB&T) upon completion. Information provided on the Certification of Health Care Provider will determine the length of time the leave is approved and for which an associate will be paid during the leave of absence. 3. Upon receipt of the Certification of Healthcare Provider and other forms, Benefits Administration will complete the Designation Notice and send it to the associate along with a Return to Work Certification, Disability Information (if appropriate) and a general LOA cover letter which explains the associate s pay while on leave. 4. For the first ten (10) days of absence, associates must use all available Sick Day pay. If the associate does not have any or enough Sick Day pay, the associate may use other paid time off (e.g. vacation) to cover the absence or take the day(s) unpaid. If taken unpaid, the associate may file a disability claim with The Hartford to cover the absence. On the 11th consecutive business day the associate is absent, the associate is placed on leave of absence and the associate may have up to an additional 30 Sick Leave of Absence days available while on leave. If the leave of absence time exceeds the available Sick Leave of Absence days, the associate must request from and submit to The Hartford their disability information. Upon approval by The Hartford, disability benefits will begin on the first day following the exhaustion of the associate s Sick Pay. It is important that the associate contact The Hartford at for information about submitting a disability claim. 5. In the State of California, California State Disability is primary for your short-term disability benefits. You will work with the State of California directly for this and information can be obtained online at Please note that even if you file for California State Disability, you must also file for Hartford Disability. Associate s Serious Health Condition - California LOA Packet 2

3 6. The Return to Work Certification must be received at least one business day before the associate can return to work. The Return to Work Certification must be submitted with a bar-coded Medical Records Fax Cover Sheet to (if faxing within BB&T) or (if faxing from outside of BB&T) at least one business day prior to the associate actually reporting to work. This will ensure that any requests for accommodations are reviewed and decided upon prior to the associate s arrival. 7. When the associate returns from leave of absence, the manager should process the return through the Workday System. It is important that the process be completed in a timely manner to ensure the associate is paid correctly. If there is a lapse in pay from BB&T, the associate is responsible for continuing payment of benefit premiums. (See HS Policy 7007 Families and Medical Leave and/or Military Family Leave). All information regarding leaves of absence can be found in HS Policy 7002 Sick Pay, 7003 Leaves of Absence, and 7007 Family and Medical Leave and/or Military Family Leave. If you have any questions concerning this information, please feel free to contact Benefits Administration at , option 3. Documents and Procedures to Process Request for LOA and/or FMLA/CFRA Leave The following documents and/or procedures may be required for a LOA request. Forms that need be sent to BB&T should be faxed with a bar-coded Medical Records Fax Cover Sheet to (if faxing within BB&T), or (if faxing outside of BB&T). If there are questions about any of these forms, please contact Benefits Administration at , option 3. To be completed by Associate & Manager 1. Request for Leave of Absence through Workday - Required to formalize the request for LOA for any reason. To be completed by Benefits Administration 1. Notice of Eligibility and Rights & Responsibilities - Required to be provided to the associate by BB&T to document whether the associate is eligible for FMLA/CFRA qualified leave entitlement. 2. Designation Notice - Required to be provided to the associate by BB&T to document whether the absence is or is not FMLA/CFRA leave qualified. To be completed as designated below 1. Certification of Health Care Provider for Associate s Serious Health Condition - Required for an associate s situation related to personal illness or injury. (To be completed by the manager and health care provider) 2. LOA / FMLA/CFRA Certification - Required as confirmation that the associate was provided the FMLA Poster and Notice of Eligibility and Rights & Responsibilities. (To be completed by the associate) 3. Return to Work Certification - Required as evidence of the associate s physical ability to return to work. (To be completed by the health care provider and signed by the associate) Associate s Serious Health Condition - California LOA Packet 3

4 Leave of Absence Forms Certification of Health Care Provider for Associate s Serious Health Condition The Certification of Health Care Provider for Associate s Serious Health Condition on the following pages requires completion by: Your manager Your health care provider Provide the form to your manager for completion of Section I before forwarding to your health care provider to complete. Notice to Provider of Health Care Information The Genetic Information Non-discrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or individual s family member, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. Genetic Information, as defined by GINA, includes an individual s family medical history, results of an individual s or family member s genetic test, knowledge that an individual or an individual s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services. Important Please contact Benefits Administration at , option 3, for assistance in completing the information contained within this packet. All medical records and forms should be submitted with a bar-coded Medical Records Fax Cover Sheet (located on InSite > Human Systems Express > Associate Information > Medical Records Fax Cover Sheet) to: (if faxing within BB&T) (if faxing from outside BB&T) Associate s Serious Health Condition - California LOA Packet 4

5 CERTIFICATION OF HEALTH CARE PROVIDER FOR S SERIOUS HEALTH CONDITION Family and Medical Leave Act (FMLA) & California Family Rights Act (CFRA) PURPOSE of FORM: The below-named associate has requested a leave of absence for his/her health condition which may qualify as a protected leave under the FMLA and/or CFRA. This medical certification form will provide BB&T with information needed to determine if the associate s requested leave is for a qualifying reason under the FMLA and/or CFRA. Section II must be fully completed by the health care provider. INSTRUCTIONS to : You are required to submit a timely, complete, and sufficient medical certification to support your request for FMLA and/or CFRA leave due to your own serious health condition. Providing this completed form is required to obtain (or retain) the benefit of FMLA and/or CFRA protections for your leave. Failure to provide a complete and sufficient medical certification to BB&T may result in a delay or denial of your leave request. This form should be completed and returned within 15 calendar days of BB&T s request for this information, or no later than. If you cannot return the completed form within the stated deadline, please contact Benefits Administration with the reasons for the delay and the date when the certification will be provided. You may return the form by fax to (252) (if faxing within BB&T) or (866) (if faxing from outside BB&T). SECTION I: To be completed by BB&T ASSOCIATE'S NAME ASSOCIATE'S JOB TITLE ASSOCIATE'S REGULAR WORK SCHEDULE NAME OF BB&T REPRESENTATIVE TELEPHONE ASSOCIATE'S ESSENTIAL JOB FUNCTIONS SECTION II To be completed by HEALTH CARE PROVIDER INSTRUCTIONS to the HEALTH CARE PROVIDER: Your patient (our associate) has requested leave under the FMLA and/or CFRA. Please answer, fully and completely, all applicable parts. Several questions seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the associate. Be as specific as you can; terms such as indefinite, unknown, or indeterminate may not be sufficient to determine FMLA/CFRA coverage. Limit your responses to the condition for which the associate is seeking leave. Be sure to sign and date the form on page 2. THE GENETIC INFORMATION NONDISCRIMINATION ACT OF 2008 (GINA): The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. Genetic information, as defined by GINA, includes an individual s family medical history, the results of an individual s or family member s genetic tests, the fact that an individual or an individual s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services. NOTE: DO NOT DISCLOSE THE ASSOCIATE S UNDERLYING DIAGNOSIS WITHOUT HIS/HER CONSENT.

6 PROVIDER'S NAME BUSINESS ADDRESS TELEPHONE FAX PART A: MEDICAL FACTS (1) Approximate date condition commenced: Probable duration of condition: (2) From: Page 3 describes what is meant by a serious health condition under both the FMLA and CFRA. Does the associate s condition qualify as one of the types of serious health conditions? If yes, which type of serious health condition listed on Page 3 applies: To: Yes No (3) Use the information provided by BB&T in Section I to answer these questions. If no job description has been provided, please answer these questions based upon the associate s own description of his/her job functions. Is the associate able to perform work of any kind? Yes No If yes, is the associate unable to perform one or more of the essential functions of his/her position due to the condition? (Answer yes if intermittent or reduced schedule leave is medically necessary.) PART B: AMOUNT OF LEAVE NEEDED (4) Will the associate be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery? If yes, estimate the beginning and ending dates for the period of incapacity: FROM TO Yes Yes No No Answer questions 5 and/or 6 only if the requires leave on an intermittent or reduced schedule basis. (5) Will it be medically necessary for the associate to leave work intermittently or work a reduced schedule as a result of the medical condition (other than for episodic flare-ups which are addressed in question #6 below)? Yes No If the associate needs reduced schedule leave, estimate the part-time or reduced work schedule the associate needs: Associate should work no more than: Hours per Day Days Per Week From: through: If the associate needs intermittent leave, estimate the frequency of need for intermittent leave and the duration of incapacity (e.g. 1 episode every 3 months lasting 1-2 days): Frequency: _ Times per week(s) month(s) Duration: Hours or Day(s) per episode (6) Will the medical condition cause episodic flare-ups that will make it medically necessary for the associate to leave work intermittently or work a reduced schedule? Yes No If yes, based upon the patient s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups, the likely duration of incapacity that the patient may have as a result, and the period during which the flare-ups may occur (e.g., 1 episode every 3 months lasting 1-2 days during the specified period): Frequency: _ Times per week(s) month(s) Duration: Hours or Day(s) per episode Flare-ups may occur from: through: Part C: SIGNATURE SIGNATURE OF HEALTH CARE PROVIDER DATE

7 Serious Health Conditions A serious health condition means an illness, injury, impairment, or physical or mental condition that involves one of the following: 1. Inpatient Care Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment in connection with or consequent to such inpatient care. 2. Incapacity of More Than 3 Consecutive Days Plus Continuing Treatment by a Health Care Provider A period of incapacity of more than three consecutive calendar days (including any subsequent treatment or period of incapacity relating to the same condition), that also involves: (a) Treatment two or more times by a health care provider, by a nurse or physician s assistant under direct supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under orders of, or on referral by, a health care provider; OR (b) Treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment under the supervision of the health care provider (e.g., a course of prescription medication, or therapy requiring special equipment, to resolve or alleviate the health condition). Note: This does not include taking over-the-counter medications or activities that can be initiated without a visit to a health care provider (e.g., bed rest, exercise, drinking fluids). 3. Pregnancy (only covered under FMLA) A period of incapacity due to pregnancy, childbirth, or related medical conditions. This includes severe morning sickness and prenatal care. 4. Chronic Conditions Requiring Treatment A chronic condition which: (a) Requires periodic visits for treatment by a health care provider, or by a nurse or physician s assistant under direct supervision of a health care provider; (b) Continues over an extended period of time (including recurring episodes of a single underlying condition); and (c) May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.). 5. Permanent/Long-Term Conditions Requiring Supervision A period of incapacity that is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider. Examples include Alzheimer s, a severe stroke, or the terminal stages of a disease. 6. Multiple Treatments (Non-Chronic Conditions) Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.) severe arthritis (physical therapy), or kidney disease (dialysis).

8 LOA/FMLA/CFRA Certification The associate should receive information that explains the provision of a Leave of Absence and the Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA). Once the associate has received that information, they should sign below to acknowledge receipt. Associates should complete this form if they are taking a leave of absence, requesting intermittent leave, or requesting FMLA/CFRA for any period of time. The signature below certifies that I have received the FMLA Poster and the Notice of Eligibility and Rights and Responsibilities, and that I have read and fully understand the enclosed leave of absence terms and instructions. Associate s Signature Associate s Name (Print) Date B/C/D Number Important This completed form should be submitted with a bar-coded Medical Records Fax Cover Sheet (InSite > Human Systems Express > Associate Information > Medical Records Fax Cover Sheet). Please submit all medical records and forms with a bar-coded Medical Records Fax Cover Sheet to: (if faxing within BB&T) (if faxing from outside BB&T) Please contact Benefits Administration at , option 3, for assistance in completing the information contained within this packet. Benefit-Related Items to Consider Your benefit premiums and 401(k) loan repayments, if applicable, will automatically be drafted from the same account that your BB&T pay was deposited. Your premiums will be drafted on the 15th of month and the last business day of each month. If the 15th of the month falls on a weekend or Holiday, your account will be drafted the business day prior. If your premium draft rejects, your benefits will be cancelled. Your next opportunity to reenroll for benefit coverage will be during annual enrollment for the next calendar year or when you return to active status. It will be your responsibility to request a benefit change by contacting Benefits Administration at , option 1, within 31 days of your return to active employment status. Associate s Serious Health Condition - California LOA Packet 8

9 BB&T Return to Work Certification Must be faxed at least ONE business day PRIOR to associate s return to work date to: (if faxing within BB&T) (if faxing from outside BB&T) All medical records and forms should be submitted with a bar-coded Medical Records Fax Cover Sheet (InSite > Human Systems Express > Associate Information > Medical Records Fax Cover Sheet). Associate should retain original documentation for their own record. Patient s Name: Patient is approved to return to work: Yes No Date patient is medically released to return to work: Restrictions: Yes No If yes, please describe each restriction specifically and indicate duration of restriction: Specific Description: Specific Duration: Signature of Health Care Provider Type of Practice Date Name of Health Care Provider (Print) Telephone Number Ext. Address City/State Zip Signature of BB&T Associate Name of Associate (Print) B/C/D Number Date Associate s Serious Health Condition - California LOA Packet 9

10 Leave of Absence Resources & Information WORKDAY GUIDE: REQUESTING AN ABSENCE ASSOCIATES Access Workday and click on the Absence Icon. 1 2 Access Workday and click on the Team Absence Icon. MANAGERS Click Request Absence. 3 Click Enter Absence. Click Select Date Range or click and drag to choose your date range on the calendar. 4 Choose the associate who will be absent. Choose the starting and ending date for the planned absence using the calendar icon. Next, choose the appropriate Absence Type from the drop-down menu. Click Next. 5 Type of Absence The chosen date range and type of absence will now be displayed. Click Done and then Submit.

11 EMPLOYEE RIGHTS AND RESPONSIBILITIES UNDER THE FAMILY AND MEDICAL LEAVE ACT Basic Leave Entitlement FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons: for incapacity due to pregnancy, prenatal medical care or child birth; to care for the employee s child after birth, or placement for adoption or foster care; to care for the employee s spouse, son, daughter or parent, who has a serious health condition; or for a serious health condition that makes the employee unable to perform the employee s job. Military Family Leave Entitlements Eligible employees whose spouse, son, daughter or parent is on covered active duty or call to covered active duty status may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings. FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered servicemember during a single 12-month period. A covered servicemember is: (1) a current member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness*; or (2) a veteran who was discharged or released under conditions other than dishonorable at any time during the five-year period prior to the first date the eligible employee takes FMLA leave to care for the covered veteran, and who is undergoing medical treatment, recuperation, or therapy for a serious injury or illness.* *The FMLA definitions of serious injury or illness for current servicemembers and veterans are distinct from the FMLA definition of serious health condition. Benefits and Protections During FMLA leave, the employer must maintain the employee s health coverage under any group health plan on the same terms as if the employee had continued to work. Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms. Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee s leave. Eligibility Requirements Employees are eligible if they have worked for a covered employer for at least 12 months, have 1,250 hours of service in the previous 12 months*, and if at least 50 employees are employed by the employer within 75 miles. *Special hours of service eligibility requirements apply to airline flight crew employees. Definition of Serious Health Condition A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee s job, or prevents the qualified family member from participating in school or other daily activities. Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than 3 consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment. Use of Leave An employee does not need to use this leave entitlement in one block. Leave can be taken intermittently or on a reduced leave schedule when medically necessary. Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer s operations. Leave due to qualifying exigencies may also be taken on an intermittent basis. Substitution of Paid Leave for Unpaid Leave Employees may choose or employers may require use of accrued paid leave while taking FMLA leave. In order to use paid leave for FMLA leave, employees must comply with the employer s normal paid leave policies. Employee Responsibilities Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer s normal call-in procedures. Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave. Employer Responsibilities Covered employers must inform employees requesting leave whether they are eligible under FMLA. If they are, the notice must specify any additional information required as well as the employees rights and responsibilities. If they are not eligible, the employer must provide a reason for the ineligibility. Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee s leave entitlement. If the employer determines that the leave is not FMLA-protected, the employer must notify the employee. Unlawful Acts by Employers FMLA makes it unlawful for any employer to: interfere with, restrain, or deny the exercise of any right provided under FMLA; and discharge or discriminate against any person for opposing any practice made unlawful by FMLA or for involvement in any proceeding under or relating to FMLA. Enforcement An employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit against an employer. FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights. FMLA section 109 (29 U.S.C. 2619) requires FMLA covered employers to post the text of this notice. Regulation 29 C.F.R (a) may require additional disclosures. For additional information: US-WAGE ( ) TTY: U.S. Department of Labor Wage and Hour Division WHD Publication 1420 Revised February 2013

12 Life Event Changes: Instructions for Changing Benefit Elections in Workday Important Facts The federal tax law says you cannot change your benefit elections during the calendar year unless you have a change in family or employment status. You have 31 days from the date of the Life Event to change your benefit coverage for: Marriage, divorce, or legal separation Death of a spouse or dependent Birth or adoption of a child of the associate Leave of absence by associate or spouse Termination or commencement of spouse s employment Dependent fulfills or ceases to fulfill eligibility requirements Read on for step-by-step instructions to complete your Life Event Change through the Workday system. You must follow all of the steps below in order to complete the change. Part One: Submitting Your Life Event Change 1. Access Workday from InSite or BBTBenefits.com. 2. Click the Benefits icon. 3. Click Benefits under Change. 4. Click the arrow beside the Benefit Event Type field. 5. Choose your Life Event from the Benefit Event Type drop-down menu. 6. Click the calendar symbol beside Benefit Event Date. 7. Select the Benefit Event Date from the calendar. 8. Click Submit. 9. Your Life Event Change has been submitted in the Workday system. Click Done. 10. You can submit your supporting documentation, including the effective date coverage began or ended, within Workday or send to BB&T Benefits Administration at: PO Box 1215 Winston- Salem, NC Fax: Interoffice Mail Code: Benefits@BBandT.com No documentation is required for the birth of a child. Associate s Serious Health Condition - California LOA Packet 12

13 Part Two: Changing Your Benefit Elections Once any documentation you submitted has been reviewed and approved, a task will be generated in your Workday Inbox. Below are instructions for you to complete your Benefit Change task through the Workday system. 1. Access Workday. 2. Click the Inbox button in the upper-right corner of the screen. 3. Click on the Inbox task to change your benefits. 4. Make your necessary changes on the next few screens. Your associate cost will be displayed across the top of your enrollment screens as you proceed. 5. Read through the final page that reviews your changes (use the scroll bar to see the entire page). 6. Check I Agree at the bottom of the page. This acts as your electronic signature. 7. Click Submit. 8. If you want to print a copy of your changes for your records, click Print. 9. When you are finished with the page, click Done. Your premiums will be adjusted for the Life Event Change, and you will receive a pay adjustment notification if applicable. For step-by-step instructions complete with images, please refer to the Life Event Changes Workday Guide available on BBTBenefits.com. Associate s Serious Health Condition - California LOA Packet 13

14 Benefit-Related Items to Consider Paying for Benefits or 401(k) Loans While On Leave Your benefit premiums and 401(k) loan repayments, if applicable, will automatically be drafted from the same account that your BB&T pay was deposited. Your premiums will be drafted on the 15th of month and the last business day of each month. If the 15th of the month falls on a weekend or Holiday, your account will be drafted the business day prior. You can print a copy of your current coverage elections and premiums from Workday. Depending on the timing of leave, your first premium draft may be adjusted based on your paid through date. You may contact Payroll at , option 2, for more details. If you are a current BB&T LifeForce participant and receive a medical credit, it will be payed to you from Payroll and is subject to federal, state and FICA taxes. Benefit premiums will be deducted from the medical credit, and any remaining benefit premiums or medical credit will be drafted, deposited directly to your account from Payroll or a combination of the two. If your life insurance coverage (basic plus supplemental) totals more than $50,000, federal tax laws specify that only the premiums for the first $50,000 can be paid for on a tax-free basis. Any cost exceeding $50,000 in coverage is taxable and the premium is subject to FICA taxes, which will be drafted. What happens if my premium draft is rejected due to non-sufficient funds? If your premium draft rejects, your benefits will be cancelled. Your next opportunity to reenroll for benefit coverage will be during annual enrollment for the next calendar year or when you return to active status. It will be your responsibility to request a benefit change by contacting Benefits Administration at , option 1, within 31 days of your return to active employment status. Payroll-Related Items to Consider Name, Home Address, State and Federal Tax Withholding and Direct Deposit Account Changes - Make any necessary changes on Workday. Hartford Disability - Payments will come direct deposit to the primary account on file with payroll. This is also the account that will be drafted for benefit premiums and/or 401(k) loan repayments. Please ensure this account is kept up to date. Other Items to Consider Associates on a non-fmla or State protected leave are not eligible to accrue vacation while on leave of absence, which in some circumstances, could cause a negative annual vacation balance. If this occurs, the negative balance will roll forward and reduce next year s annual vacation balance until you accrue enough time to pay back the vacation overusage. If your leave is FMLA or State protected, your vacation accrual will continue while on leave and not be impacted until you exhaust your FMLA/State protection. Associate s Serious Health Condition - California LOA Packet 14

15 Employee Assistance Program (EAP) - BB&T s EAP is a program designed to help you cope with a variety of life s challenges such as emotional health issues, family and other personal problems, and work-life balance difficulties. The EAP is available at no cost to BB&T associates and members of their households. For more information about the EAP, you may contact MHN at members.mhn.com, access code: bbt, or at John Hancock Long Term Care Insurance Policies - Set up alternate payment while on Leave of Absence. Contact Matt Lo or Angela Robinson-Burke Travelers Customer Service - Set up alternate payment while on Leave of Absence by calling AFLAC - Set up alternate payment while on Leave of Absence by calling Associate s Serious Health Condition - California LOA Packet 15

16 DI Office Locations & Mailing Addresses Chico Salem Street (PO Box 8190, Chico, CA ) Chino Hills Fairfield Ranch Road, Ste. 100 (PO Box 60006, City of Industry, CA ) Fresno Mariposa Mall, Rm. 1080A (PO Box 32, Fresno, CA ) Long Beach Long Beach Blvd., Ste. 600 (PO Box 469, Long Beach, CA ) Los Angeles S. Figueroa Street, Ste. 200 (PO Box , Los Angeles, CA ) Oakland Oakport Street (PO Box 1857, Oakland, CA ) Riverside Palmyrita Avenue, Ste. 100 (PO Box 59903, Riverside, CA ) Sacramento Broadway (PO Box 13140, Sacramento, CA ) San Bernardino West 3rd Street (PO Box 781, San Bernardino, CA ) San Diego Lightwave Avenue, Bldg. A, Ste. 300 (PO Box , San Diego, CA ) San Francisco Franklin Street, Rm. 300 (PO Box , San Francisco, CA ) San Jose West Hedding Street (PO Box 637, San Jose, CA ) Santa Ana West Santa Ana Blvd., Bldg. 28, Rm. 735 (PO Box 1466, Santa Ana, CA ) Santa Barbara East Ortega Street (PO Box 1529, Santa Barbara, CA ) Santa Rosa Healdsburg Avenue (PO Box 700, Santa Rosa, CA ) Stockton Transworld Dr., Ste. 150 (PO Box , Stockton, CA ) California State Government Employees (PO Box 2168, Stockton, CA ) Van Nuys Sherman Way, Rm. 500 (PO Box 10402, Van Nuys, CA ) This pamphlet is for general information only, and does not have the force and effect of the law, rule or regulation. The EDD is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. Requests for services, aids, and/or alternate formats need to be made by calling DI at (voice), or TTY , or PFL at or TTY DE 2515 Rev. 62 (6-15) (INTER NET) Page 1 of 2 CU DISABILITY INSURANCE PROVISIONS Disability is an illness or injury, either physical or mental, which prevents customary work. Disability includes elective surgery, pregnancy, childbirth, or related medical conditions. Disability Insurance (DI) is a component of the State Disability Insurance (SDI) program, designed to partially replace wages lost due to a non-workrelated disability (see Other Programs, for jobrelated disabilities). SDI contributions are paid by California workers covered by the SDI program. Contribution rates may vary from year to year. For current rates, visit the DI website at or contact the Employment Development Department (EDD) Disability Insurance Customer Service at or EDD Employment Tax Customer Service at DI Plans State Plan. The DI state plan is covered in this brochure. Voluntary Plan (VP). A private plan, approved by the Director of the EDD, which may be substituted for the State Plan. Voluntary plans may be established if the employer and majority of employees agree to do so. VP information and filing a claim may be done through your employer. If you are covered by a VP, the provisions of the brochure may not apply to you. Obtain information about your coverage and file a VP claim through your employer. Elective Coverage (EC). Employers and selfemployed persons, including general partners, may elect coverage. The method of computing benefits for EC participants is not the same as for mandatory rate payers. The cost of participating, which is set annually, can be obtained from your local EDD Employment Tax Customer Service Office. EC claims are filed in the same manner as State Plan claims; however, there are some differences in eligibility requirements from those listed in this pamphlet. For additional information or to apply for coverage, contact EDD DI Customer Service at , EDD Employment Tax Customer Service at , or visit our website at How to Claim State Plan Benefits 1. Use SDI Online to securely file for benefits or request a paper claim form. By Internet: By phone: By TTY (teletypewriter for deaf, hearingimpaired, and speech-impaired persons only) at: for DI or for PFL. By mail: EDD, Disability Insurance, PO Box 13140, Sacramento, CA In person by visiting any of the DI offices listed under DI Office Locations. California state government employees covered by SDI should call When filing SDI Online, complete all required fields. A receipt number will be generated when your claim is submitted. If using a paper claim form, complete and sign the Claim Statement of Employee. Print clearly, and verify your answers are complete and correct as errors delay payments. 3. Have your physician/practitioner complete the Physician/Practitioner Certification online or use the paper claim form. If filing online, your physician/practitioner will need your receipt number to complete the Physician/Practitioner Certification. Usually a claim cannot begin more than seven days before you were examined by or under the care of a physician/practitioner. Certification may be made by a licensed medical or osteopathic physician and surgeon, nurse practitioner, chiropractor, dentist, podiatrist, optometrist, designated psychologist, or an authorized medical officer of a United States government facility. Certification may also be made by a licensed nurse-midwife or licensed midwife for disabilities related to normal pregnancy or childbirth. 4. File online or submit your paper claim form within 49 days from the first day you were disabled. If your claim is late, you may lose benefits unless your explanation of the delay is accepted as reasonable. How Benefits Are Paid The SDI benefits are paid electronically or by mail. You do not need to appear in person to apply or receive benefits. Benefits are paid via the EDD Debit Card SM. The EDD Debit Card SM works like other debit cards, giving you access to funds 24 hours a day, 7 days a week, and can be used everywhere Visa debit cards are accepted. When your claim is received, you may be contacted through SDI Online, by phone, or by mail for additional information. Most properly completed claims are processed within 14 days. The first seven days of your DI claim are a non-payable waiting period. Benefits are paid as quickly as possible after all information to determine eligibility is received. If you meet all eligibility requirements, benefits will be authorized. If you are eligible for further benefits, you will be sent additional benefits electronically or sent a continued claim certification form for you to complete for the next benefit period. Usually these benefit periods will be in two-week intervals. However, DI pays benefits based on daily eligibility within a seven-day calendar week. Partial weeks are paid at a daily rate. This rate is one-seventh of your weekly benefit amount. Please allow 10 days from the date you mail a certification for receipt of payment. How Your Benefit Rate is Determined Benefit amounts are based on wages paid during a specific 12-month base period, determined by the date your claim begins. Consider when to start your claim since this may affect your weekly benefit rate, your maximum benefit amount, and the period of your benefit eligibility. Only base period wages subject to the SDI contributions can be used in computing your benefits. To qualify, you must have earned at least $300 during your base period. The month your claim begins determines which four consecutive quarters are used. If your claim begins in: January, February, or March, your base period is the 12 months ending last September 30. (Example: A claim beginning February 14, 2015, uses a base period of October 1, 2013, through September 30, 2014.) April, May, or June, your base period is the 12 months ending last December 31. (Example: A claim beginning June 20, 2015, uses a base period of January 1, 2014, through December 31, 2014.) July, August, or September, your base period is the 12 months ending last March 31. (Example: A claim beginning September 27, 2015, uses a base period of April 1, 2014, through March 31, 2015.) October, November, or December, your base period is the 12 months ending last June 30. (Example: A claim beginning November 2, 2015, uses a base period of July 1, 2014, through June 30, 2015.) Exceptions: If your claim is determined to be invalid, but you were unemployed and seeking work for 60 days or more in any quarter of your base period, you may be able to substitute wages paid in prior quarters. You may be entitled to substitute wages paid in prior quarters to either validate your claim or increase your benefit amount, if during your base period you: were in the military service. received workers compensation benefits. did not work because of a labor dispute. If your situation fits any of the above, include a note with your claim form. Wage Continuation. If your employer continues to pay you wages while you are disabled, your DI benefits may be affected. DI benefits plus wages cannot exceed your regular weekly wage. DI benefits are not affected by vacation pay you may receive. Maximum Benefits. The maximum benefit amount is 52 times the weekly rate, but not more than your total base period wages. Exception: For employers and self-employed individuals who elect SDI coverage, the maximum benefit amount is 39 times the weekly rate. Additionally, benefits are payable only for a limited period to a resident in an alcoholic recovery home or drug-free residential facility that is both licensed and certified by the state in which the facility is located. However, disabilities related to or caused by acute or chronic alcoholism or drug abuse, being medically treated, do not have this limitation. Pregnancy. As with any medical condition, your disability period begins the first day you are unable to do your regular or customary work. DI benefits are based on the period of time your physician/ practitioner certifies you are unable to do your regular or customary work. Do not send in your claim for pregnancy-related DI benefits until the date your physician/practitioner certifies you are disabled. NOTE: For information on Paid Family Leave (PFL) bonding benefits, see the Other Programs section of this brochure. You May Not be Eligible for Benefits If you are receiving Unemployment Insurance or PFL benefits. If you are not working or looking for work at the time you become disabled. If you are in custody due to conviction of a crime. If your full wages are paid. If you are receiving workers compensation at a weekly rate equal to or greater than the DI rate. If workers compensation benefits are paid at a lower rate than your DI rate, you may be paid the difference. For the amount of time a claim is late (without good cause). If you make a false statement or fail to report a material fact. (A 30 percent penalty may be assessed if benefits are overpaid because you willfully withheld a material fact or made a false statement.) If you fail to attend an independent medical examination when requested. (Fees for such examinations are paid by the EDD.) The California Unemployment Insurance Code provides for penalties consisting of fines, imprisonment, and loss of benefit rights for fraud against the SDI program. DE 2515 Rev. 62 (6-15) (INTERNET) Page 2 of 2 Your Rights. You are entitled to: Know the reason and basis for any decision that affects your benefits. Appeal any decision about your eligibility for benefits. (Appeals must be sent to the DI office in writing.) Request an appeal hearing before an Administrative Law Judge (ALJ). You may further appeal the ALJ s decision to the California Unemployment Insurance Appeals Board and the courts. Privacy all claim information will be kept confidential except for the purposes allowed by law. Your Obligations. Your responsibilities: Complete your claim and other forms correctly, completely, and truthfully. Submit your claim and other forms according to time limits on forms. If your claim is submitted late and you believe you have a good reason for being late, you should include a written explanation of the reason(s) with the form. Contact DI if you do not understand a question or how to answer it. Include your name and Social Security number on letters to DI. Contact DI By at By phone at: Press 1 for English. Press 2 for Spanish. By U.S. mail addressed to PO Box 13140, Sacramento, CA If you do not have a current claim, you may write to any DI office. By TTY (teletypewriter for deaf, hearingimpaired, and speech-impaired persons only) at In person by visiting any of the DI offices listed under DI Office Locations. Other Programs If you are injured on the job or become ill as a result of your occupation, notify your employer. If you are able and available to work but unemployed, contact the Unemployment Insurance program of the EDD through the website at or by phone at (TTY ). If you need help in finding work, job training, retraining, or other services in order to return to work, visit your local America s Job Center of California SM formerly known as One-Stop Career Centers listed at or in the white pages of your phone directory. If your disability is permanent or is expected to continue for a year or more, contact the U.S. Social Security Administration at or by phone at (TTY ). If you take time off work to care for a family member or if you take time off from work to bond with a new child, including newly adopted, newly placed foster children, or those of your registered domestic partner, contact the EDD PFL program at disability, or by phone at (TTY ). For questions relating to DI, contact the EDD through the website at disability or by phone at (TTY ). Note: A PFL bonding claim form will be sent automatically with the final benefit payment to new mothers receiving DI benefits. If you are a victim of a crime, contact the California Victim Compensation program at (TTY ). You may also contact your county Victim/Witness Assistance Center. Questions about spousal or parental support obligations should be directed to the district attorney s office for the county that issued the court order. Questions about child support obligations should be directed to the Department of Child Support Services at (TTY ). Associate s Serious Health Condition - California LOA Packet 16

17 CLAIMS file a claim with confidence Your disability program is managed by The Hartford, a leader in disability and leave services. It s a user-friendly benefit that helps provide essential support services while you re away from your workplace. BB&T Corporation Policy # The hartford makes it easy To file a claim. JusT follow These steps. step 1 Know when it s time to file If you re absent from work, we can advise you on when to file your claim. If your absence is scheduled, such as an upcoming hospital stay, call us 30 days prior to your last day of work. If unscheduled, please call us as soon as possible. step 2 Have this information ready Name, address, and other key identification information. Name of your department and last day of active fulltime work. Your manager s name and phone number. The nature of your claim. Your treating physician s name, address, and phone and fax numbers. To file a claim: :00am 9:00pm et, monday friday Policy # If you re absent from work, we can advise you on when to file your claim. If your absence scheduled, such as an upcoming hospital stay, Travel call us 30 Assistance days prior to your Identification last day of work. If Number: unscheduled, please call us as soon as possible 30 days prior GLD to your last day of work. (Please cut here and keep in your wallet.) step 3 Make the call or file online With your information handy, call The Hartford at #B# #B# Or file online at or by using the My Benefits at The Hartford mobile claims app (see more information on the next page). You ll be assisted by a caring professional who ll take your information, answer your questions and file your claim. continued Associate s Serious Health Condition - California LOA Packet 17

18 CLAIMS GeT supportive assistance Even after your claim has been filed, we may be in touch to check your progress, answer questions or obtain additional information from you. Our goal is to offer a smooth and hassle free experience until you return to work. Feel free to also call us with anything that s on your mind. We re here to help. relax and stay positive FILE YOUR CLAIM FASTER BY USING THE MOBILE APP! The My Benefits at The Hartford claims app allows you to file your claim faster from your mobile device. You can also view your status and payment details and more! Download the app for free today from Apple and Google Play stores. You have the assurance of our knowledge, experience and understanding of what you are going through. We re with you all the way, so you can receive the benefits you qualify for and get back to your life. Quick facts The Hartford s goal is to help get you through your time away from work with dignity and assist you in any way we can. Keep the card below in a safe place for future use. We ll be there when you need us. Prepare. Protect. Prevail. (Please cut here and keep in your wallet.) when you call The hartford will ask you To provide: Name, address, and other key identification information. Name of your department and last day of active full-time work. The Hartford is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home office is Hartford, CT NS 11/ The Hartford Financial Services Group, Inc. All rights reserved. Your manager s name and phone number. The nature of your claim. Your treating physician s name, address, and phone and fax numbers. Associate s Serious Health Condition - California LOA Packet 18