Your Choice Voluntary Long Term Disability Coverage Highlights Texas Voluntary Long Term Disability Insurance Standard Insurance Company has developed this document to provide you with information about the optional insurance coverage you may select through Northside ISD. Written in non-technical language, this is not intended as a complete description of the coverage. If you have additional questions, please check with your Benefits and Risk Management Department. Eligibility To become insured, you must be: A regular, full-time employee of, excluding temporary or seasonal employees, full-time members of the armed forces, leased employees or independent contractors Actively at work at least 20 hours each week A citizen or resident of the United States or Canada Employee Coverage Effective Date Please contact your Benefits and Risk Management Department for more information regarding the following requirements that must be satisfied for your insurance to become effective. Eligibility requirements. You must meet all eligibility requirements listed above. An eligibility waiting period. You will complete the eligibility waiting period on the first day of the calendar month coinciding with or next following the date you become an eligible employee described above. For employees electing this coverage during the 2011 annual enrollment period, the effective date will be January 1, 2012. For employees hired between October 1, 2011 and December 31, 2011 that elect this coverage, the effective date will be January 1, 2012. For employees hired after January 1, 2012 that elect this coverage, the effective date will be the first day of the first full month of employment. An evidence of insurability requirement, if applicable. An active work requirement. This means that if you are not actively at work on the day before the scheduled effective date of insurance, your insurance will not become effective until the day after you complete one day of active work as an eligible employee. Benefit Amount You may select a monthly benefit amount in $100 increments from $200 to $10,000; based on the tables and guidelines presented in the Rates section of these Coverage Highlights. The monthly benefit amount must not exceed 66 2/3 percent of your monthly earnings. Benefits are payable for non-occupational disabilities only. Occupational disabilities are not covered. Plan Maximum Gross Benefit: 66 2/3 percent of predisability earnings Plan Minimum Gross Benefit: 10 percent of your Long Term Disability benefit before reduction by deductible income SI 14494-648736 1 of 7 (7/11)
Benefit Waiting Period and Maximum Benefit Period The benefit waiting period is the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period. The maximum benefit period is the period for which benefits are payable. The benefit waiting period and maximum benefit period associated with your plan options are shown below: Benefit Waiting Period Accidental Injury Other Disability 0 days 3 days 14 days 14 days 30 days 30 days 60 days 60 days 90 days 90 days 180 days 180 days Maximum Benefit Period To Age 65 for Sickness and Accident If you become disabled before age 62, Long Term Disability benefits may continue during disability until you reach age 65. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins: Age Maximum Benefit Period 62 3 years 6 months 63 3 years 64 2 years 6 months 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months 69+ 1 year First Day Hospital Benefit With this benefit, if an insured employee is admitted as a hospital inpatient for at least four hours during the benefit waiting period, the benefit waiting period will be satisfied. Benefits become payable on the date of hospitalization; the maximum benefit period also begins on that date. This feature is included only on Long Term Disability plans with benefit waiting periods of 30 days or less. Preexisting Condition Exclusion A general description of the preexisting condition exclusion is included in the Group Voluntary Long Term Disability Insurance Certificate. Upon enrollment you will be provided a certificate. If you have questions, please check with your Benefits and Risk Management Department. Preexisting Condition Period: The 90-day period just before your insurance becomes effective Exclusion Period: 12 months Preexisting Condition Waiver For the first 90 days of disability, The Standard will pay full benefits even if you have a preexisting condition. After 90 days, The Standard will continue benefits only if the preexisting condition exclusion does not apply. SI 14494-648736 2 of 7 (7/11)
Definition of Disability Own Occupation. During the benefit waiting period and the own occupation period, you are considered disabled if, as a result of physical disease, injury, pregnancy or mental disorder: You are unable to perform with reasonable continuity the material duties of your own occupation, and You suffer a loss of at least 20 percent of your indexed predisability earnings when working in your own occupation. The own occupation period for the Voluntary LTD coverage is the first 24 months for which LTD benefits are paid. You are not disabled merely because your right to perform your own occupation is restricted, including a restriction or loss of license. You may work in another occupation while you are disabled from your own occupation, however, you will not be considered disabled when your work earnings from another occupation exceed 80 percent of your indexed predisability earnings. Any Occupation. After the own occupation period, you are considered disabled if, as a result of physical disease, injury, pregnancy or mental disorder, you are unable to perform with reasonable continuity the material duties of any occupation that you are able to perform, whether due to education, training or experience: Which is available at one or more locations in the national economy, and In which you can be expected to earn at least 60 percent of your indexed predisability earnings within 12 months following your return to work, regardless of whether you are working in that or any other occupation. The any occupation period continues until the end of the maximum benefit period. Other Long Term Disability Features Employee Assistance Program (EAP) This program offers support, guidance and resources that can help an employee resolve personal issues and meet life s challenges. Dependent Education Benefit Assists an employee s dependents with higher education costs. Family Care Expense Adjustment Disabled employees faced with the added expense of family care when returning to work may receive combined income from Long Term Disability benefits and work earnings in excess of 100 percent of indexed predisability earnings during the first 12 months immediately after a disabled employee s return to work. Reasonable Accommodation Expense Benefit Subject to The Standard s prior approval, this benefit allows us to pay up to $25,000 of an employer s expenses toward work-site modifications that result in a disabled employee s return to work. Survivors Benefit A Survivors Benefit may also be payable. This benefit can help to address a family s financial need in the event of the employee s death. Return to Work (RTW) Incentive The Standard s RTW Incentive is one of the most comprehensive in the employee benefits industry. For the first 12 months after returning to work, the employee s Long Term Disability benefit will not be reduced by work earnings until work earnings plus the Long Term Disability benefit exceed 100 percent of predisability earnings. After that period, only 50 percent of work earnings are deducted. Rehabilitation Plan Provision Subject to The Standard s prior approval, rehabilitation incentives may include training and education expense, family (child and elder) care expenses, and job-related and job search expenses. When Benefits End Long Term Disability benefits end automatically on the earliest of: The date you are no longer disabled The date your maximum benefit period ends The date you die The date benefits become payable under any other Long Term Disability plan under which you become insured through employment during a period of temporary recovery The date you fail to provide proof of continued disability and entitlement to benefits SI 14494-648736 3 of 7 (7/11)
Rates Employees can select a monthly Long Term Disability benefit ranging from a minimum of $200 to a maximum amount based on how much they earn. Referencing the appropriate attached charts, follow these steps to find the monthly cost for your desired level of monthly Long Term Disability benefit and benefit waiting period: Step 1. Find the maximum Long Term Disability benefit by locating the amount of your earnings in either the Annual or column. The Long Term Disability benefit amount associated with these earnings is shown in the Disability Benefit column and is the maximum amount you can receive. If your earnings fall between two amounts, you must select the lower amount. Step 2. Select the Disability Benefit you desire between the minimum of $200 and the determined maximum amount for your earnings. Step 3. In the same row as the selected the Disability Benefit, select the desired benefit waiting period to see the monthly cost for that selection. If you have questions regarding how to determine your monthly Long Term Disability benefit, the benefit waiting period, or the premium payment of your desired benefit, please contact your Benefits and Risk Management Department. Group Insurance Certificate If you become insured, you will receive a group insurance certificate containing a detailed description of the insurance coverage. The controlling provisions are in the group policy issued to the District by Standard Insurance Company. The information presented above is controlled by the group policy and does not modify it in any way. SI 14494-648736 4 of 7 (7/11)
Annual Disability Benefit Accident/Sickness Benefit Waiting Period Cost Per Month 0-3 14-14 30-30 60-60 90-90 180-180 3,600 300 200 8.32 7.30 3.46 2.42 2.38 2.06 5,400 450 300 12.48 10.95 5.19 3.63 3.57 3.09 7,200 600 400 16.64 14.60 6.92 4.84 4.76 4.12 9,000 750 500 20.80 18.25 8.65 6.05 5.95 5.15 10,800 900 600 24.96 21.90 10.38 7.26 7.14 6.18 12,600 1,050 700 29.12 25.55 12.11 8.47 8.33 7.21 14,400 1,200 800 33.28 29.20 13.84 9.68 9.52 8.24 16,200 1,350 900 37.44 32.85 15.57 10.89 10.71 9.27 18,000 1,500 1,000 41.60 36.50 17.30 12.10 11.90 10.30 19,800 1,650 1,100 45.76 40.15 19.03 13.31 13.09 11.33 21,600 1,800 1,200 49.92 43.80 20.76 14.52 14.28 12.36 23,400 1,950 1,300 54.08 47.45 22.49 15.73 15.47 13.39 25,200 2,100 1,400 58.24 51.10 24.22 16.94 16.66 14.42 27,000 2,250 1,500 62.40 54.75 25.95 18.15 17.85 15.45 28,800 2,400 1,600 66.56 58.40 27.68 19.36 19.04 16.48 30,600 2,550 1,700 70.72 62.05 29.41 20.57 20.23 17.51 32,400 2,700 1,800 74.88 65.70 31.14 21.78 21.42 18.54 34,200 2,850 1,900 79.04 69.35 32.87 22.99 22.61 19.57 36,000 3,000 2,000 83.20 73.00 34.60 24.20 23.80 20.60 37,800 3,150 2,100 87.36 76.65 36.33 25.41 24.99 21.63 39,600 3,300 2,200 91.52 80.30 38.06 26.62 26.18 22.66 41,400 3,450 2,300 95.68 83.95 39.79 27.83 27.37 23.69 43,200 3,600 2,400 99.84 87.60 41.52 29.04 28.56 24.72 45,000 3,750 2,500 104.00 91.25 43.25 30.25 29.75 25.75 46,800 3,900 2,600 108.16 94.90 44.98 31.46 30.94 26.78 48,600 4,050 2,700 112.32 98.55 46.71 32.67 32.13 27.81 50,400 4,200 2,800 116.48 102.20 48.44 33.88 33.32 28.84 52,200 4,350 2,900 120.64 105.85 50.17 35.09 34.51 29.87 54,000 4,500 3,000 124.80 109.50 51.90 36.30 35.70 30.90 55,800 4,650 3,100 128.96 113.15 53.63 37.51 36.89 31.93 57,600 4,800 3,200 133.12 116.80 55.36 38.72 38.08 32.96 59,400 4,950 3,300 137.28 120.45 57.09 39.93 39.27 33.99 61,200 5,100 3,400 141.44 124.10 58.82 41.14 40.46 35.02 63,000 5,250 3,500 145.60 127.75 60.55 42.35 41.65 36.05 64,800 5,400 3,600 149.76 131.40 62.28 43.56 42.84 37.08 66,600 5,550 3,700 153.92 135.05 64.01 44.77 44.03 38.11 68,400 5,700 3,800 158.08 138.70 65.74 45.98 45.22 39.14 70,200 5,850 3,900 162.24 142.35 67.47 47.19 46.41 40.17 72,000 6,000 4,000 166.40 146.00 69.20 48.40 47.60 41.20 SI 14494-648736 5 of 7 (7/11)
Annual Disability Benefit Accident/Sickness Benefit Waiting Period Cost Per Month 0-3 14-14 30-30 60-60 90-90 180-180 73,800 6,150 4,100 170.56 149.65 70.93 49.61 48.79 42.23 75,600 6,300 4,200 174.72 153.30 72.66 50.82 49.98 43.26 77,400 6,450 4,300 178.88 156.95 74.39 52.03 51.17 44.29 79,200 6,600 4,400 183.04 160.60 76.12 53.24 52.36 45.32 81,000 6,750 4,500 187.20 164.25 77.85 54.45 53.55 46.35 82,800 6,900 4,600 191.36 167.90 79.58 55.66 54.74 47.38 84,600 7,050 4,700 195.52 171.55 81.31 56.87 55.93 48.41 86,400 7,200 4,800 199.68 175.20 83.04 58.08 57.12 49.44 88,200 7,350 4,900 203.84 178.85 84.77 59.29 58.31 50.47 90,000 7,500 5,000 208.00 182.50 86.50 60.50 59.50 51.50 91,800 7,650 5,100 212.16 186.15 88.23 61.71 60.69 52.53 93,600 7,800 5,200 216.32 189.80 89.96 62.92 61.88 53.56 95,400 7,950 5,300 220.48 193.45 91.69 64.13 63.07 54.59 97,200 8,100 5,400 224.64 197.10 93.42 65.34 64.26 55.62 99,000 8,250 5,500 228.80 200.75 95.15 66.55 65.45 56.65 100,800 8,400 5,600 232.96 204.40 96.88 67.76 66.64 57.68 102,600 8,550 5,700 237.12 208.05 98.61 68.97 67.83 58.71 104,400 8,700 5,800 241.28 211.70 100.34 70.18 69.02 59.74 106,200 8,850 5,900 245.44 215.35 102.07 71.39 70.21 60.77 108,000 9,000 6,000 249.60 219.00 103.80 72.60 71.40 61.80 109,800 9,150 6,100 253.76 222.65 105.53 73.81 72.59 62.83 111,600 9,300 6,200 257.92 226.30 107.26 75.02 73.78 63.86 113,400 9,450 6,300 262.08 229.95 108.99 76.23 74.97 64.89 115,200 9,600 6,400 266.24 233.60 110.72 77.44 76.16 65.92 117,000 9,750 6,500 270.40 237.25 112.45 78.65 77.35 66.95 118,800 9,900 6,600 274.56 240.90 114.18 79.86 78.54 67.98 120,600 10,050 6,700 278.72 244.55 115.91 81.07 79.73 69.01 122,400 10,200 6,800 282.88 248.20 117.64 82.28 80.92 70.04 124,200 10,350 6,900 287.04 251.85 119.37 83.49 82.11 71.07 126,000 10,500 7,000 291.20 255.50 121.10 84.70 83.30 72.10 127,800 10,650 7,100 295.36 259.15 122.83 85.91 84.49 73.13 129,600 10,800 7,200 299.52 262.80 124.56 87.12 85.68 74.16 131,400 10,950 7,300 303.68 266.45 126.29 88.33 86.87 75.19 133,200 11,100 7,400 307.84 270.10 128.02 89.54 88.06 76.22 135,000 11,250 7,500 312.00 273.75 129.75 90.75 89.25 77.25 136,800 11,400 7,600 316.16 277.40 131.48 91.96 90.44 78.28 138,600 11,550 7,700 320.32 281.05 133.21 93.17 91.63 79.31 140,400 11,700 7,800 324.48 284.70 134.94 94.38 92.82 80.34 142,200 11,850 7,900 328.64 288.35 136.67 95.59 94.01 81.37 144,000 12,000 8,000 332.80 292.00 138.40 96.80 95.20 82.40 SI 14494-648736 6 of 7 (7/11)
Annual Disability Benefit Accident/Sickness Benefit Waiting Period Cost Per Month 0-3 14-14 30-30 60-60 90-90 180-180 145,800 $12,150 8100 336.96 295.65 140.13 98.01 96.39 83.43 147,600 $12,300 8200 341.12 299.30 141.86 99.22 97.58 84.46 149,400 $12,450 8300 345.28 302.95 143.59 100.43 98.77 85.49 151,200 $12,600 8400 349.44 306.60 145.32 101.64 99.96 86.52 153,000 $12,750 8500 353.60 310.25 147.05 102.85 101.15 87.55 154,800 $12,900 8600 357.76 313.90 148.78 104.06 102.34 88.58 156,600 $13,050 8700 361.92 317.55 150.51 105.27 103.53 89.61 158,400 $13,200 8800 366.08 321.20 152.24 106.48 104.72 90.64 160,200 $13,350 8900 370.24 324.85 153.97 107.69 105.91 91.67 162,000 $13,500 9000 374.40 328.50 155.70 108.90 107.10 92.70 163,800 $13,650 9100 378.56 332.15 157.43 110.11 108.29 93.73 165,600 $13,800 9200 382.72 335.80 159.16 111.32 109.48 94.76 167,400 $13,950 9300 386.88 339.45 160.89 112.53 110.67 95.79 169,200 $14,100 9400 391.04 343.10 162.62 113.74 111.86 96.82 171,000 $14,250 9500 395.20 346.75 164.35 114.95 113.05 97.85 172,800 $14,400 9600 399.36 350.40 166.08 116.16 114.24 98.88 175,600 $14,633 9700 403.52 354.05 167.81 117.37 115.43 99.91 176,400 $14,700 9800 407.68 357.70 169.54 118.58 116.62 100.94 178,200 $14,850 9900 411.84 361.35 171.27 119.79 117.81 101.97 180,000 $15,000 10000 416.00 365.00 173.00 121.00 119.00 103.00 SI 14494-648736 7 of 7 (7/11)