Advocate Health Care Network Disability Income Protection Summary of Benefits

Transcription

1 Advocate Health Care Network Disability Income Protection Summary of Benefits (Amended and Restated as of July 1, 2017)

2 What s Inside Introduction...3 Disability Case Management...4 Disability Council...4 Disability Certification...4 Case Management Services...4 Plan Participation...5 Eligibility...5 When Your Eligibility to Participate Will End...5 Enrollment...5 Short Term Disability (STD) Benefits...7 When STD Benefits Begin...7 What the STD Benefits Pay...7 Paying the Cost of Your STD Coverage...8 Filing a Claim for STD Benefits...8 If You Become Disabled Again...9 Long Term Disability (LTD) Benefits...10 When LTD Benefits Begin...10 What the LTD Benefits Pay...10 How Long Your LTD Benefits Continue...12 Paying the Cost of Your LTD Coverage...12 How Social Security Affects Your LTD Benefits...12 Taxes on Your LTD Benefits...13 Filing a Claim for LTD Benefits...13 If You Become Disabled Again...13 Transitional Work Program...14 Seeking Alternative Employment with Restrictions...15 Other Important Provisions...16 Disabilities Extending Beyond 12 Months...16 Lump Sum Payment...16 Disabilities Not Covered...16 Benefit Limitations...16 Pre-Existing Conditions...17 Offsets to Your Disability Benefits...17 When Your Benefits Will End...17 Benefits for Disabled Team Members as of December 31, Impact on Other Benefits...18 Appeal of a Denied Claim...18 Recovery of Benefits Paid or Payable...19 Subrogation...20 Reimbursement...21 Recovery of Overpayments

3 Plan and Administrative Information Terms to Know Any Occupation...25 Base Pay...25 BroMenn Team Member...25 Disability or Disabled...25 Disability Council...25 Material Duties...25 Medical Treatment...25 Mental Illness or Injury...25 Non-Work Related Illness...25 Non-Work Related Injury...25 Other Limited Conditions...26 Physician...26 Regular Care of a Physician...26 Temporary Disability...26 Total Disability

4 Introduction Advocate Health Care Network ( Advocate ) has established this disability plan, the Advocate Health Care Network Disability Income Protection Plan (Amended and Restated as of January 1, 2016) (the Plan ), to provide eligible team members employed by Advocate and certain of its affiliated employers that participate in the Plan ( Advocate Companies ) with a level of replacement income during a period when a certified disability prevents you from being able to work. This Plan is made up of two parts: Short Term Disability (STD) benefits which provide continuing income benefits for you during a temporary disability for up to five months, and Long Term Disability (LTD) benefits which provide continuing income benefits for you after you ve been disabled for five months (as long as you are totally disabled and meet the eligibility requirements of the Plan) for the period of time applicable to you under the chart in the How Long Your LTD Benefits Continue section of this summary (see page 11). The terms that are in italics throughout this summary are defined in the Terms to Know section on page 25. Key features of the Plan include: 12 to 16-day elimination period STD benefits that last up to your recovery or five months, whichever occurs first For eligible team members, LTD benefits begin after receiving STD benefits for five months Competitively-priced buy-up options to increase your basic STD and LTD benefits that you may elect This is a summary of the benefits available through the Plan. While this is not the official plan document for the Plan, it is intended to provide details regarding how the Plan works. In the event of a discrepancy between the information contained in this summary and the official plan document for the Plan, the Plan document will always govern. Advocate intends to continue the Plan at this time. However, no benefits under this Plan are vested or otherwise guaranteed to any person for any period of time, and Advocate reserves the right to amend, modify or terminate this benefit, in whole or in part, at any time for any reason. If the Plan is terminated, your disability coverage will end. The Plan Administrator and the Disability Council have absolute discretionary authority to determine eligibility for benefits and to construe the terms of the Plan. The Disability Council also has complete discretionary authority to certify disabilities and determine initial claims and appeals of denied claims for benefits under the Plan. Benefits under the Plan will be paid only if the Plan Administrator or Disability Council, as applicable, decides in its discretion that an individual is entitled to them. Except as otherwise set forth herein or required by law, the decisions of the Plan Administrator and the Disability Council shall be final and conclusive with respect to all questions relating to the Plan. This Plan summary is not a contract of employment. Nothing in the Plan gives any team member the right to be retained in the service of Advocate or any of its affiliated companies. 3

5 Disability Case Management Disability Case Management ensures that eligible participants: Receive the appropriate benefit, and Return to work as quickly as possible. This process is managed through the Disability Council. Disability Council The Disability Council is a group of health care providers, nurses and vocational rehabilitation professionals who can provide a range of services to you during your disability. These services can help you receive efficient and quality medical treatment so you can return to work as soon as appropriate. Disability Certification If you are absent from work for more than 5 consecutively scheduled work days, you must contact HR Direct no later than the sixth day of your absence. Your case will then be managed by a member of the Disability Council who works with an occupational health provider to determine the appropriate time off for your nonwork related injury or illness. In order to be eligible for STD or LTD benefits under the Plan, the Disability Council must certify your disability. This means that a clinical decision will be made regarding your non-work related injury or illness. Case Management Services The Disability Council also provides additional disability management services and may: Assist you in arranging medical services (such as therapy or home health care), Provide personal support during your disability, and Determine work modifications or vocational rehabilitation services as necessary. The Disability Council may ask a disabled team member to undergo independent medical exams on an as-needed basis, and may also request team member assistance program, integrated health advocacy program or functional capacity evaluation assessments by a licensed health care professional selected by the Disability Council. Your STD and LTD benefit payments under the Plan will end if you refuse an independent medical examination or any assessment or other testing requested by the Disability Council. Failure to provide medical updates within the 14 calendar days of the request or to undergo medical examination, testing or other assessments may result in your termination of employment on the basis of a voluntary resignation (unless your absence is approved under the Family Medical Leave Act ( FMLA ). Important! Remember, it is the Disability Council not your physician that determines your eligibility for benefits under the Plan by certifying your disability. Your case will be continuously reviewed to determine if additional time off is necessary and if you are eligible for benefits. The Disability Council will also be in contact with your physician to make sure you are following all recommended treatment plans. Your benefits under the Plan will cease if you are not under the regular care of a physician or are not following your physician s medical treatment program. 4

6 Plan Participation Eligibility If you are a regular Full-Time team member, a Part-Time A team member (who is regularly scheduled to work at least 32 hours per week) or a Part-Time B team member (who is regularly scheduled to work 20 to 31 hours per week) who is employed by an Advocate Company, you are eligible to participate in the Plan on the first day you are actively at work after you have worked for 6 continuous months without a leave of absence as a regular Full-Time, Part-Time A, or Part-Time B team member. Temporary and leased team members and independent contractors who are performing services for an Advocate Company are not eligible to participate in the Plan. If your employment with the Advocate Companies terminates and you are re-employed by an Advocate Company within 30 calendar days as a regular Full-Time, Part-Time A or Part- Time B team member you will again be eligible to participate in the Plan on the date you are re-employed. Your benefit elections, if any, under the Plan will be reinstated. If your employment with the Advocate Companies terminates and you are re-employed by an Advocate Company as a regular Full-Time, Part-Time A or Part-Time B team member more than 30 calendar days later, you must satisfy the six-month waiting period (as described above) before you become eligible to participate in the Plan. You will not receive credit under the Plan for any prior period of employment with an Advocate Company unless you were receiving severance pay from an Advocate Company immediately before you were re-employed. Once you have satisfied the 6-month waiting period, your eligibility under the Plan will continue while you are on an authorized leave of absence. If you exhaust your STD and LTD benefits under the Plan and then become Actively at Work as a regular Full-Time, Part-Time A or Part-Time B team member for an Advocate Company, you will again become eligible to participate in the Plan after you have completed 6 months of continuous employment (without a leave of absence). When Your Eligibility to Participate Will End Your eligibility to participate in the Plan ends as of the earliest of the following: You change to an ineligible employment status or terminate employment with the Advocate Companies (unless you are receiving benefits under the Plan at the time of your termination), Your death, You no longer reside in the United States for at least 6 months of the year, or The Plan terminates. 5

7 Enrollment Eligible team members (other than Part-Time B team members) are automatically enrolled in the Plan, and individuals whose annual base pay exceeds $150,000 will be offered the opportunity to elect the buy-up option (see the What the STD Benefits Pay and the What the LTD Benefits Pay sections of this summary) upon hire or entry to a new eligible status or during open enrollment. Note: Although Full-Time and Part-Time A team members of the Advocate Companies are automatically enrolled in the Plan, they must nevertheless satisfy the 6-month waiting period (described above) to be eligible to participate in the Plan. Any applicable deductions for contributions under the Plan will begin after you satisfy the 6-month waiting period for eligibility. Any changes in your elections under the Plan will be permitted only to the extent allowed under the terms of the Advocate Health Care Network Welfare Benefits Plan. Part-Time B Team Members: Part-Time B team members will be offered the opportunity to enroll in the Plan upon hire or entry to a new eligible status or during open enrollment. Any applicable deductions for contributions under the Plan will begin after you satisfy the 6-month waiting period (described above). Any changes in your elections under the Plan will be permitted only to the extent allowed under the terms of the Advocate Health Care Network Welfare Benefits Plan. 6

8 Short Term Disability (STD) When STD Benefits Begin If you are unable to substantially perform the material duties of your job because of a non-work related illness or injury requiring the regular care of a physician, you may be eligible to receive STD benefits under the Plan if the Disability Council certifies you as having a temporary disability. However, you will not be eligible for short-term disability benefits if you are receiving severance pay from your employer or under any Advocate severance policy, program or agreement. STD benefits cannot begin until after the elimination period, which is the earlier of the date: You have been absent from work for 12 or more consecutively scheduled work days, or You have been absent from work for at least 16 consecutive calendar days. If you work less than half of your scheduled hours and go home sick, that day still counts toward your first 12 days of absence. You must use paid time off (PTO) to replace your income until the short-term disability benefits or transitional work begins. PTO also must be used to supplement your disability income, but your total income during a disability period may not exceed 100% of your base pay. Notwithstanding the foregoing, you are not required to use PTO to supplement any disability income payment during an absence which is also covered by the Family and Medical Leave Act. STD benefits will begin the first pay period following the later of the certification of your temporary disability by the Disability Council and the end of the elimination period. STD benefits under the Plan will continue for 5 months, unless you recover from your disability or your benefits must end according to the terms of the Plan (see the When Your Benefits Will End section of this summary on page 17). Furthermore, STD benefits will end 6 weeks after a natural childbirth, and 8 weeks after a C-section. What the STD Benefits Pay Basic STD benefits equal 60% of your base pay, up to a maximum monthly benefit of $7,500 ($3, per pay period). Effective as of January 1, 2014, if you are an Executive, your basic STD benefits equal 100% of your base pay. If your annual base pay exceeds $150,000, you may increase the STD benefits you will receive by selecting a buy-up option. The value of this buy-up option is 10% or 15% of base pay, depending on your work location and when you elect this supplemental benefit. Unless you had satisfied the eligibility requirements under the Plan or were receiving benefits under the Plan as of December 31, 2014 and you elected the buy-up option prior to December 31, 2014, you must satisfy any applicable underwriting requirements for the buy-up benefit. Note: If you were receiving benefits under the Plan as of December 31, 2010, any buy-up option you elect applies only to benefits payable for any future disability under the Plan and not to the disability benefits you were then receiving. 7

9 If you are... A regular Full-Time or Part-Time A team member Part-Time B team member A team member whose annual base pay exceeds $150,000 and you elect the buy-up option And, you elected the buy-up option prior to December 31, 2010 Your percentage of benefit amount is increased by 15% - from 60% to 75%, up to a maximum monthly benefit of $7,500 Ineligible for the Buy-Up Option Maximum monthly benefit shall be $20,000 (Part-Time B team member were ineligible) STD Buy-Up Option Or, you elected the buy-up option on or after January 1, 2011 and before December 31, 2014 Your percentage of benefit amount is increased by 10% - from 60% to 70%, up to a maximum monthly benefit of $7,500 Ineligible for the Buy-Up Option Maximum monthly benefit shall be $20,000 (Part-Time B team member were ineligible) You elected the buy-up option after December 31, 2014 You can elect the buyup option only if your base pay exceeds $150,000 You can elect the buy-up option only if your base pay exceeds $150,000 Maximum monthly benefit shall be $20,000 For example... Let s take a look at an example to see what the value of your STD benefit will be with and without the buy-up option. For purposes of this example, let s assume: You have annual base pay of $40,000 based on an hourly rate of $19.23, and Your pay each bi-weekly pay period is $1, (80 hours x $19.23). Your basic STD benefit (60% of base pay) will be... Your basic STD benefit + the 10% buy-up option (70% of base pay) will be... Your basic STD benefit + the 15% buyup option (75% of base pay) will be... $ $1, $1, Note: $ base benefit is based on bi-weekly pay of $1, x.60 Important! Your STD Benefits will still be subject to all your regular deductions, including taxes. Paying the Cost of Your STD Coverage Advocate will pay the full cost of your basic STD coverage unless you are a Part-Time B team member. If you are a Part-Time B team member, you pay the entire cost of your coverage. You will pay the full cost of any additional buyup coverage that you elect, regardless of your work location. These costs will be deducted from your pay on a pre-tax basis. Filing A Claim for STD Benefits If you are absent from work for more than 5 consecutively scheduled work days, you must contact HR Direct no later than the sixth day of your absence. It is also your responsibility to request a leave of absence on advocatebenefits.com. The necessary forms will be sent to you and you will be notified of any other actions you need to take or information you need to provide in order for the Disability Council to consider whether to certify your non-work related illness or injury as a temporary disability. The forms you will receive include a Medical Certification, Authorization for Release of Information, Reimbursement Agreement, Subrogation Questionnaire and other additional forms. These forms must be completed by 8

10 you and your physician. Failure to return the completed forms by the deadlines established by the Disability Council will result in denial of benefits. A member of the Disability Council will make the determination as to whether to certify your disability and you will be notified of the approval or denial of your claim within 90 days of the Disability Council s receiving your request for STD benefits. As part of making its determination, the Disability Council may call you and/or your physician to discuss your case, ask you to undergo independent medical exams on an as-needed basis, and request team member assistance program, integrated health advocacy program or functional capacity evaluation assessments by a licensed health care professional selected by the Disability Council. The failure to undergo medical examination, testing or other assessments may result in your termination of employment on the basis of a voluntary resignation (unless your absence is approved under FMLA) and may also prevent your condition from being certified as a disability. Retroactive benefit payments will not be made for any period of time prior to the date you contact HR Direct requesting STD benefits. Even if you have completed the elimination period for STD benefits, you will forfeit any benefits that would have been paid for the days preceding your call to HR Direct. In addition, there is no precertification process for STD benefits under the Plan. It is your responsibility to call HR Direct once you are absent from work to request STD benefits and to begin the process for the Disability Council to certify your non-work related injury or illness, including maternity leaves and elective surgeries. Important! If you do not fill out the required forms (or have them filled out by your physician on your behalf) and return them to the Disability Council, STD benefits will not be paid and you will also be considered to have voluntarily resigned (unless your absence is approved under FMLA). Disability benefit payments are processed through Advocate s payroll system. Checks are processed and issued according to Advocate s regular pay period schedule. Any benefit payment delayed due to missing or late medical documentation or required paperwork will be issued in the next scheduled pay period. If You Become Disabled Again If you return to work after receiving STD benefits and become disabled again, you must call HR Direct to certify your non-work related illness or injury. Your period of disability will be considered: The same period of disability if: Your disability is based on the same or related injury or illness, and You have been back to work no more than 10 consecutively scheduled work days or 14 consecutive calendar days (whichever is earlier). A new period of disability if: You have been back to work for more than 10 consecutively scheduled work days or 14 consecutive calendar days (whichever is earlier), or Your disability is based on a cause unrelated to your previous disability and you return to active work for at least one day. 9

11 Long Term Disability (LTD) Benefits When LTD Benefits Begin If you are unable to substantially perform the material duties of your job for which you are qualified based on your education, experience or training because of a non-work related illness or injury requiring the regular care of a physician, you may be eligible to receive LTD benefits under the Plan if the Disability Council certifies you as having a total disability. However, you will not be eligible for LTD benefits if you are receiving severance pay from an employer or under any Advocate severance policy, program or agreement. LTD benefits cannot begin until the first day of your sixth month of receiving benefits under the Plan for your disability. You must use Paid Time Off (PTO) days to supplement your LTD benefits (not to exceed 100 percent of base pay), provided that you are not required to use PTO to supplement disability benefits during any leave of absence covered by the FMLA. Contact the Disability Council for more information. If your annual base pay exceeds $150,000, you may increase the LTD benefits you will receive by selecting a buy-up option. The value of this buy-up option is 10% of base pay, based on your work location and when you elect this supplemental benefit. Unless you had satisfied the eligibility requirements under the Plan or were receiving benefits under the Plan as of December 31, 2014 and you elected the buy-up option prior to December 31, 2014, you must satisfy any applicable underwriting requirements for the buy-up benefit. Note: If you were receiving benefits under the Plan as of December 31, 2010, any buy-up option you elect applies only to benefits payable for any future disability under the Plan and not the disability benefits you were then receiving. What the LTD Benefits Pay Basic LTD benefits equal 50% of your base pay, up to a maximum monthly benefit of $7,500 ($3, per pay period). However, if you are not a BroMenn team member and were receiving benefits under the Plan as of December 31, 2010, your basic LTD benefits equal 60% of your base pay, up to a maximum monthly benefit of $7,500 for the same or related injury or illness. The minimum benefit payable is $25.00 per pay period. 10

12 If you are... And, you elected the buy-up option prior to December 31, 2010 Or, you elected the buy-up option on or after January 1, 2011 and before December 31, 2014 You elected the buy-up option after December 31, 2014 A regular Full-Time or Part-Time A team member No change. Your percentage of benefit amount is increased by 10% - from 50% to 60%, up to a maximum monthly benefit of $7,500 You can elect the buyup option only if your base pay exceeds $150,000 Part-Time B team member Ineligible for the Buy-Up Option Ineligible for the Buy-Up Option You can elect the buyup option only if your base pay exceeds $150,000 A BroMenn team member Your percentage benefit amount is increased by 10% - from 50% to 60%, up to a maximum monthly benefit of $7,500 ($20,000 if base pay exceeds $150,000 per year) Your percentage benefit amount is increased by 10% - from 50% to 60%, up to a maximum monthly benefit of $7,500 ($20,000 if base pay exceeds $150,000 per year) You can elect the buyup option only if your base pay exceeds $150,000 A team member whose annual base pay exceeds $150,000 and you elect the buy-up option Maximum monthly benefit shall be $20,000 (Part-Time B team member were ineligible) Maximum monthly benefit shall be $20,000 (Part-Time B team member were ineligible) Maximum monthly benefit shall be $20,000 For example... Let s look at an example to see what the value of your LTD benefit will be. For purposes of this example, let s assume: You have annual base pay of $40,000 based on an hourly rate of $19.23 Your pay each bi-weekly pay period is $1, (80 hours x $19.23), and You are eligible to receive a Social Security disability benefit of $400 a month. Your bi-weekly LTD benefit if 50% of base pay will be... 50% of your bi-weekly eligible base pay: $1, x.50 = $ minus Your Social Security benefit: $400 x = $ Net LTD benefit per pay period: $ $ = $ Your bi-weekly LTD benefit if 60% of base pay will be... 60% of your bi-weekly eligible base pay: $1, x.60 = $ minus Your Social Security benefit: $400 x = $ Net LTD benefit per pay period: $ $ = $ $ $

13 How Long Your LTD Benefits Continue If you are entitled to receive LTD benefits under the Plan, how long you receive such benefits depends on your age when you are certified as disabled (unless your benefits end earlier (see the When Your Benefits Will End section of this summary on page 17 for more information)). Age at Initial Determination of Temporary Disability 61 or younger Up to age 65 Maximum Benefit Duration 62 Up to 42 months 63 Up to 36 months 64 Up to 30 months 65 Up to 24 months 66 Up to 21 months 67 Up to 18 months 68 Up to 15 months 69 and over Up to 12 months Paying the Cost of Your LTD Coverage If you are a regular Full-Time or Part-Time A team member Advocate will pay the full cost of your basic LTD coverage. If you are a Part-Time B team member, you will pay the full cost of your LTD coverage. Eligible team members will pay the full cost of any additional buy-up coverage that you elect, regardless of your work location. These costs will be deducted from your pay on a pre-tax basis. Important! If your disability lasts longer than five months, all payroll deductions for the cost of your disability coverage under the Plan will be waived for as long as your disability continues. How Social Security Affects Your LTD Benefits Your LTD benefits will be reduced by any Social Security benefits you receive beginning after the 11th month of receiving disability benefits under the Plan. If however, you do not authorize Allsup (or such other organization as is retained by Advocate specializing in Social Security Disability representation) to represent you in applying for Social Security benefits, then your STD and LTD benefits will be immediately reduced by the amount the Disability Counsel estimates as the offset for Social Security benefits. See 5.1(b) of the Plan. You must apply for federal Social Security disability benefits after receiving 90 days or more of STD benefits under the Plan and exhaust all appeal rights thereto by authorizing Allsup (or such other organization as is retained by Advocate specializing in Social Security Disability representation) to represent you in applying for Social Security benefits and in any required appeals. You must also provide the Disability Council with evidence of your application for Social Security benefits and evidence of any denial, appeal and/or award letters. If you fail to apply for federal Social Security benefits, or if you do not provide satisfactory proof of the application and any denials, appeals and/ or award letters to the Disability Council within 30 days of each such communication, your LTD benefits will end, and if you do not return to work, you will be considered to have voluntarily resigned. Note: Social Security has its own procedures, including time periods, for applying for disability benefits and appealing denials of benefits. You must also comply with these application and appeal procedures, including any timing requirements, for federal Social Security benefits in order to satisfy the requirements of this section. If you fail to do so, your LTD benefits under the Plan will nevertheless be offset by an estimated amount of federal Social Security benefits (as described in the next paragraph below) and you may lose any rights you have to federal Social Security benefits and/ or your LTD benefits under this Plan. 12

14 The benefits payable under the Plan will be reduced by the amount of benefits available under the federal Social Security Act and such offset shall apply regardless of whether such amount is paid periodically or commuted. The offset shall not include any cost-of-living increases in Social Security benefits payable to you. Taxes on Your LTD Benefits The first 30 days of LTD benefits are subject to FICA taxes. Benefits paid after the 30th day will be exempt from FICA taxes. However, the benefits are still subject to federal, state and local income taxes. Filing A Claim for LTD Benefits At the beginning of your third month of receiving STD benefits under Plan, the Disability Council will provide you with the forms you need to apply for LTD benefits. These forms include a Long-Term Disability Benefit Application, Attending Physician s Statement, Reimbursement Agreement and Social Security Status Form. The forms must be completed and returned to the Disability Council within 30 days after they are sent to you. Be sure to have your physician fill out the physician section of the forms. Failure to timely complete and return the forms may result in denial of your claim for LTD benefits. You also must contact your local Social Security Administration office to apply for federal Social Security disability benefits (see the How Social Security Affects Your LTD Benefits section of this summary on page 12). You must provide proof of your application for Social Security benefits to the Disability Council at least 30 days before your LTD benefits are scheduled to start. The Disability Council can direct you to the Social Security office nearest you. A team member who receives an award of Social Security benefits after or while receiving disability benefits under the Plan shall either pay the Plan the amount of any retroactive federal Social Security benefits award immediately upon receipt or shall authorize Allsup (or such other organization as is retained by Advocate specializing in Social Security Disability representation) to withdraw the Social Security benefit payment from the Claimant s personal account to repay the Plan on the Claimant s behalf. A member of the Disability Council will make the determination regarding the certification of your disability and you will be notified within 90 days of the Disability Council s receiving your request for LTD benefits of the approval or denial of your claim. The Disability Council may call you and/or your physician to discuss your case (see the Disability Case Management section of this summary on page 4 for more Information). Disability benefit payments are processed through Advocate s payroll system. Checks are processed and issued according to Advocate s regular pay period schedule. Any benefit payment delayed due to missing or late medical documentation or required paperwork will be issued in the next scheduled pay period. Remember! it is the Disability Council not your physician that determines your eligibility for benefits under the Plan. If You Become Disabled Again If you return to work and become disabled again you must call HR Direct to certify your disability. Your period of disability will be considered: The same period of disability If your disability is based on the same or related diagnosis and you have been back to work for no more than 180 days. You will begin to receive LTD benefits immediately. A new period of disability If you have been back to work for no more than 180 days but your disability is based on a diagnosis unrelated to your previous disability OR if you have been back to work for more than 180 days. You must first qualify for five months of STD benefits before becoming eligible to receive LTD benefits. 13

15 Transitional Work Program and Vocational Rehabilitation Program If you are disabled and unable to perform all the essential functions of your regular job because of that disability, the Transitional Work Program can provide you an opportunity to return to work while continuing to receive your pre-disability pay. A Transitional Work Program assignment is intended to be temporary in nature in general, no more than 60 days, though an extension of up to 30 additional days may be granted-and is intended to help you: Maintain a connection to the workplace Retain your skills Recover from your disability, and Return to work as soon as possible. To participate in the program, you must be eligible to receive benefits under the Advocate Disability Plan. You may apply for the Transitional Work Program or be selected for participation by the Disability Council. In general, you will be accepted into the program and given a Transitional Work assignment ONLY if your condition or prognosis is such that your return to your job within a 60 to 90-day period is likely. Note: If your condition is such that you are unable to transition back to your former job, you will not be eligible to participate in the Transitional Work Program. toward a full release to return to work. While on assignment, you will receive your full predisability pay (pro-rated if the assignment calls for you to work fewer than 40 hours per week) and you will be able to accrue paid time off (PTO). Decline the assignment you will no longer be eligible to receive disability benefits. If you do not have leave available under the FMLA, you will be considered to have voluntarily resigned your employment. If you accept an assignment and the assignment is discontinued before you are able to return to full-time work, you will (in most cases) resume disability benefits in accordance with the terms of the Plan. Vocational Rehabilitation Program If the Disability Council determines that you are permanently restricted from performing the work at the time your disability commenced, you may be required to participate in the Vocational Rehabilitation Program as may be established by the Disability Council. If you qualify for the program but fail to participate you will no longer be eligible to receive disability benefits. If you do not have leave available under the FMLA, you will be considered to have voluntarily resigned your employment. Once you have been approved to participate in the program and a suitable work assignment has been identified, you will receive a written Transitional Work Agreement. This agreement will outline the offer to participate in the Transitional Work Program and specify the details of your work assignment. (The assignment will be consistent with any medical restrictions that may apply and will generally be within your home department.) If you: Accept the assignment you will begin working under the Transitional Work Program on the date specified in the agreement. The Disability Council will carefully monitor your progress 14

16 Seeking Alternative Employment with Restrictions Seeking Alternative Employment with Restrictions Team members receiving STD or LTD benefits under the Plan are encouraged to: Discuss with their physician their ability to return to work with or without restrictions, and Seek alternative employment to obtain a permanent position that accommodates short- or long-term restrictions Important! Before interviewing for positions or accepting a job, you must notify the Disability Council. If you do not notify the Disability Council, your benefits under this Plan will end. 15

17 Other Important Provisions Disabilities Extending Beyond 12 Months After you have been disabled and have not returned to work for 12 months, your employment will be terminated unless the Disability Council determines that it would be reasonable to continue your employment for an additional limited period as an accommodation because, for example, you have a reasonably certain return-to-work date. However, even though your employment has ended, you will continue to receive disability benefits according to the terms of this Plan for such period as your disability continues to be certified by the Disability Council (see also the Impact on Other Benefits section of this summary on page 18 for more information on the continuation of other welfare benefits). Lump Sum Payment If you are receiving monthly benefit payments under the Plan that are $ per pay period or less, the Disability Council may determine, in its sole discretion, to pay you a lump sum payment in settlement your benefit payments for that disability. Disabilities Not Covered This Plan does not pay any STD or LTD benefits for disabilities caused or contributed to by or resulting from: A non-work related illness or injury for which you are not under regular care of a physician; Your commission of a felony, An injury or illness incurred during or caused or contributed to by war or any act of war (declared or undeclared), insurrection, rebellion or terrorism while you are or were a member of the armed forces of any country (except for any periods of duty with the United States armed forces of 30 days or less), Intentionally self-inflicted injuries or illness (regardless of your mental competency), Active participation in a riot, An injury or illness incurred during the performance of services of any job with any employer or an injury or illness covered by workers compensation, Fraud or misrepresentation, Pre-existing condition (see the Pre-Existing Conditions section of this summary), or Cosmetic surgery, except surgery made necessary by an injury or illness incurred while covered under the Plan. Benefit Limitations If your disability results from or if you receive any medical or surgical treatment for a mental illness or injury or other limited conditions you will be eligible to receive LTD benefits for a combined maximum period of 24 months in your lifetime. If your period of disability relates to a disability not subject to the benefit limitation for mental illness or injury or other limited conditions but during such period of disability you are diagnosed with a mental illness or injury or other limited conditions any period of disability relating to such subsequent condition shall be limited to a maximum lifetime period of disability of 24 months beginning as of the date of the physician s diagnosis of such mental illness or injury or other limited conditions. If your benefits under the Plan are limited by this 24-month limitation or if you have exhausted your benefits under this 24-month lifetime limit, you are not eligible to receive LTD benefits under this Plan with respect to any subsequent mental illness or injury or other limited conditions that would be covered by this 24-month limitation. If it has been determined that your injury or illness is compensable under any state workers compensation law, you will not be eligible for benefits related to the injury or illness under this Plan. 16

18 Pre-Existing Conditions Plan benefits will not be paid for a disability if: STD You have a condition for which you received medical treatment within 30 days immediately prior to the date you become eligible under the Plan, and you become disabled as a result of that condition during your first 5 days of Plan eligibility. LTD You have a condition for which you received medical treatment during the three calendar months immediately before you become eligible under this Plan and the condition recurs within a 12-month period immediately following the date you became eligible for coverage under this Plan. Offsets to Your Disability Benefits Other sources of income that are payable to you because of your disability will reduce the amount of the STD or LTD benefit payments you will receive from this Plan (regardless of whether you are made whole from these other sources of income). These other sources of income may include any income or benefits paid or payable from: Federal Social Security disability benefits (see the How Social Security Affects Your LTD Benefits section of this summary on page 12 for more information), Federal Social Security retirement benefits, A mandatory state disability law or any similar compulsory benefit law, Any other group insurance or benefit plan of an employer or former employer, Compulsory no fault automobile insurance, The Transitional Work Program (see page 14 for more information), Any damages recovered due to an act or omission of a third party or any judgment, settlement (including workers compensation settlement) or otherwise, Any type of state or federal unemployment benefits paid or payable during your period of disability, and Sick bank hours. If you are paid from any such other income sources in a lump sum payment, for purposes of determining the amount of the offset, the lump sum will be prorated over the period of time it would have been paid if not in a lump sum or if such period cannot be determined, over a period of 60 months. Your benefits will not be reduced by amounts received under any plan, policy or program for which you pay a premium or other amount for the ability to receive replacement income or any retirement plan that is sponsored by Advocate or one of its affiliated companies. When Your Benefits Will End Your benefits will end as of the earliest of the following (determined by the Disability Council in its sole discretion): You cease to have a certified disability, You are not following your physician s recommended medical treatment plan, You are not under the regular care of a physician, You no longer reside in the United States for at least 6 months of the year, Your employment with Advocate and its affiliated companies is terminated for any reason (other than because you have received disability benefits under the Plan for 12 months), You have exhausted all benefits payable under the Plan, The Plan is terminated or you are no longer eligible for coverage under the Plan, You commit or partake in any actions of fraud or dishonesty against the Plan or an Advocate Company, You qualify for the Transitional Work Program or Vocational Rehabilitation Program See 6.3(l) (see page 14), but refuse to participate, 17

19 You are offered an employment opportunity with an Advocate Company for which you are qualified, including restrictions related to your disability, other than employment through the Transitional Work Program or the Vocational Rehabilitation Program, You become eligible for long-term disability benefits under the Advocate Health Care Network Executive Long-Term Disability Plan, You fail to apply for Social Security benefits or to provide evidence of your application, any denials and appeals and award letters for Social Security benefits, You fail to timely submit evidence of your disability, fail to submit this evidence in accordance with the specified procedures, refuse an independent medical examination or testing requested by the Disability Council, refuse to cooperate with the Plan s subrogation, reimbursement or overpayment provisions and rights, or you do not otherwise cooperate with the Disability Council, You become employed (including contract or temporary employment) with any employer or become self-employed You fail to notify the Disability Council that you are interviewing for a job or have accepted a job with any employer including an Advocate Company, You fail to make any required contribution to the Plan (except that a failure to pay any required contribution for a buy-up option will result in only the termination of the benefits under such buy-up option), You are incarcerated, or Your death. Upon leaving employment, you may not convert your disability coverage to individual coverage. Benefits for Disabled Team Members as of December 31, 2010 If you were receiving LTD benefits under this Plan as of December 31, 2010, your LTD benefits equal 60% of your base pay or 50% of base pay for BroMenn team members. Impact on Other Benefits For information regarding participation in other welfare benefit plans, you should refer to the Welfare Plan document. Any required contributions will be deducted automatically from your disability benefit payments under this Plan. Beginning the 13th month of your disability, you will be required to pay 102% of the actual cost (i.e., employer and team member cost) of any medical, dental and vision benefits for which you may be eligible (unless you reached the end of your first 12 months of disability benefits prior to January 1, 2011) as described more fully in the Welfare Plan document. Appeal of a Denied Claim Within 180 days after receiving a notification denying your claim (in whole or in part) for STD or LTD benefits under the Plan, you may request, in writing, a review by the Executive Director of Welfare Plans and Absence Management. During this 180-day period, you may review pertinent documents and submit issues and comments to the Executive Director of Welfare Plans and Absence Management. Your request for review must state all of the grounds on which your request is based, all facts in support of your request and any other matters which you consider pertinent to the Executive Director of Welfare Plans and Absence Management review of your claim. The Executive Director of Welfare Plans and Absence Management or such appeals administrator as it may designate will make the determination of your claim on appeal and may require that you submit additional facts, documents, or other material as may be necessary or appropriate to make the determination. 18

20 Typically, the Executive Director of Welfare Plans and Absence Management or appeals administrator will provide written notice of the review decision within 60 days after receipt of your request for review, unless special circumstances require an extension of the time for processing. The review request and any legal processing relating to a claim that has been denied should be addressed to: Disability Plan Administrator 3075 Highland Parkway Suite 600 Downers Grove, IL You may not bring a legal or equitable action for benefits under this Plan unless and until you have exhausted your rights under the Plan and any such action must be brought in the time period between 60 days and 12 months after the date of the written decision on appeal. If you file a lawsuit in violation of these rules, you will be liable for and agree to pay any costs and fees (including reasonable attorneys fees) due to the litigation s being filed outside the requirements of the Plan. Recovery of Benefits Paid or Payable The Plan does not pay expenses for disability or other wage replacement payments or benefits paid to you that are the obligation or liability of another party and are due to injuries allegedly caused by another party, or that are covered by other insurance policies such as, but not limited to, auto insurance policies, including uninsured or underinsured auto coverage. The following rules apply to the payment of benefits under the Plan and are designed to avoid overpaying benefits, paying duplicate benefits, and paying benefits when disability benefits also are paid from another source or are otherwise determined not to be your responsibility. By accepting benefits under the Plan, you agree to the following recovery terms and you agree to assist Advocate in the Plan s recovery. All references in this Recovery of Benefits Paid or Payable section to you or your include your guardian, estate or other legal representative. Immediately upon paying any benefit, the Plan, as applicable, shall be subrogated to all rights of recovery you have against a third party, to the extent of the benefits provided under the Plan. In addition, if you receive any disability or other wage replacement payment from any third party as a result of an injury or illness, the Plan has the right to recover from you all amounts the Plan has paid as a result of that injury, up to the amount you have received from all third parties in regard to disability payments, and the Plan shall have a first priority claim on the settlement or judgment for that purpose. You shall do nothing to prejudice the payments or reimbursement rights of the Plan and shall, when requested, cooperate with the efforts of the Plan to recover benefits paid under the Plan. The Plan has the right to initiate legal action in your name against the third party to recover expenses, the Plan, as applicable, has paid. Recovery may include other reasonable expenses including legal expenses of the Plan. However, the Plan is not required to participate in or pay attorney fees, court costs or expenses to the attorney hired by you to pursue your damage claim. The Plan shall be entitled to full reimbursement first from third-party payments even if the remainder is insufficient to make you whole or compensate you in part or in whole for the damages sustained. The Plan has the right to initiate legal action against you if you fail to turn over the amounts you receive from the third party and otherwise due the Plan. The entire subrogation and reimbursement provision of the Plan will apply regardless of whether liability for payment is admitted by the third party and regardless of whether the settlement or judgment received by you identifies the benefits the Plan provided. 19

21 Subrogation If the Plan pays benefits for a disability that was caused by an act or omission of a third party, the Plan will be subrogated to all of your rights of recovery. Subrogated or Subrogation means the Plan may take your place (or stand in your shoes ) in pursuing your legal rights or a legal claim against the third party or your right to any recovery pursued on your behalf by the Plan or anyone else. If you receive benefits under the Plan for a disability that was caused by an act or omission of a third party, you must immediately notify the Disability Council of the name of any third party against whom you might have a claim as a result of your disability. A third party includes any person or organization (including an insurance company) that is not the sick or injured Plan participant. For example, if you are injured in an automobile accident and the person who hit you was at fault, the person who hit you is the third party whose act or omission caused your disability. Additionally, the insurance company of the person who hit you is a third party that may be liable for the act or omission that caused your disability. The following entities or forms of insurance are examples of third parties that may be responsible for making payment: Any no-fault insurance. Medical benefit coverage under any automobile liability plan. This includes your or any third party s policy under which you are entitled to benefits. Under-insured and uninsured motorist coverage. Any automobile medical payments and personal injury protection benefits. Any third-party liability insurance. Any workers compensation insurance. By accepting benefits under the Plan, you agree to this subrogation provision (as well as the other provisions of the Plan), including that you: Automatically assign to the Plan (you subrogate ) any right to recover payments and any actual recovery from any third party. Agree to notify the Disability Council when a third party may be liable for a disability covered under the Plan. You further agree to immediately notify the Disability Council of making any claim relating to that third party s liability. Failure to notify the Disability Council will suspend benefit payments for the applicable disability. Such suspension will be lifted when you sign the agreement discussed below. Recognize the Plan s right to recover its payment for Plan expenses from the third party who caused and/or is liable for the disability related to the Plan s benefit payments. Agree to cooperate with the Plan to provide information about your disability and otherwise do whatever is necessary to secure the Plan s subrogation right, including signing any necessary documents for the Plan to fully subrogate your claim. Agree to cooperate fully with the Plan in collecting from the person who caused the disability. (If a claim is settled without protecting the Plan s interests, your rights to full compensation may be lost.) Agree that no settlement proceeds will be distributed unless and until the Plan s interest has been paid to the satisfaction of the Plan s fiduciaries. Agree to refrain from any action or inaction that may prejudice the Plan s ability to obtain recovery from you or the third party. After you notify the Disability Council that a third party may be liable for expenses, or if the Disability Council believes a third party may be completely or partially liable for your disability, the Plan will require you to sign a statement evidencing your agreement with these provisions and to cooperate with Advocate in pursuing its subrogation rights. To exercise its subrogation rights, the Plan may: (1) place a lien against a third party to the extent 20