School District of Philadelphia Human Resources Office of Employee Benefits Wage Continuation Short-Term Disability Insurance Summary Plan Description K:\9250 Employee Benefits Management\Wage Continuation\CASA NR 634\Plan Doc\Wage Continuation- Summary Plan Descriptionupdated053116.docx Last update: 5/31/2016
THE SCHOOL DISTRICT OF PHILADELPHIA WAGE CONTINUATION SUMMARY PLAN DESCRIPTION TABLE OF CONTENTS BENEFITS AT A GLANCE PAGE 3 CLAIM INFORMATION... PAGE 6 GENERAL PROVISIONS... PAGE 7-2 -
BENEFITS AT A GLANCE WAGE CONTINUATION Wage Continuation is a voluntary short term disability plan (also known as a Salary Continuance Program) offered by the School District of Philadelphia (SDP) that pays 75% of base pay to enrolled employees who are absent from work due to an extended approved illness.. EFFECTIVE DATE: March 17, 2014 PLAN YEAR: July 1, 2014 to June 30, 2015 and each following July 1 to June 30 ELIGIBLE GROUP(S): CASA Employees All full time employees who are active with the School District of Philadelphia shall have the opportunity to enroll in a Salary Continuance Program which would provide a uniform benefit duration with various waiting periods based on accumulated sick leave. Local 634 Employees All full time employees who are active with the School District of Philadelphia shall have the opportunity to enroll in a Salary Continuance Program which would provide a uniform benefit duration with various waiting periods based on accumulated sick leave. Local 634 employees will be eligible after employment probation. Non-Represented Employees All full time employees who are active with the School District of Philadelphia, excluding Non-Represented Directors, Officers, and Cabinet Level employees, shall have the opportunity to enroll in a Salary Continuance Program which would provide a uniform benefit duration with various waiting periods based on accumulated sick leave. ENROLLMENT PERIOD: All eligible employees must apply within 90 days of hire in an eligible position. Eligible employees who do not apply within the first 90 days of hire may enroll in the program during the School District of Philadelphia s annual Open Enrollment period, which is held from May 1 through May 31, effective July 1. WAITING PERIOD: For employees in an eligible group that apply within 90 days of hire of an eligible position: First of the month following 90 days of continuous active employment. For employees in an eligible group that apply during the Open Enrollment period: July 1 following the end of the Open Enrollment period. Twelve-month employees are eligible to use the benefit on July 1 and premium deductions for the program will begin in July. - 3 -
Ten-month employees are eligible to use the benefit as of September 1 and premium deductions will begin in September. Ten-month employees will not be charged during the summer months of July and August and are ineligible to use this benefit during this time. RESTORATION OF SERVICE: Employees rehired within 12 months from the last day of their active employment must re-enroll in the program within 30 days of hire date; otherwise, they must wait until the Open Enrollment period, as described above. If the employee does not re-enroll, it will be considered that they waived enrollment in the plan. Under no circumstances should repayment of premiums be considered as retroactive enrollment in the wage continuation plan for benefits. Employees rehired after 12 months from the last day of their active employment, must re-enroll in the program within 90 days of hire date; otherwise, they must wait until the Open Enrollment period, as described above. ELIMINATION PERIOD AND PREMIUMS: The chart below outlines the plan name, the associated accumulated sick leave, the waiting period and percentage of the premium paid by the School District of Philadelphia, as well as the employee. Accumulated Sick Leave (as of enrollment date) Waiting Period (Corridor Days) Plan Name Percentage of Premium Paid by the SDP Percentage of Premium Paid by the Employee Less than 10 7 WC7D 50% 50% 10 but less than 30 6 WC6D 50% 50% 30 or more 5 WC5D 65% 35% Premium amounts for the Salary Continuance Program shall be deducted from all pays, except for Summer Reserve pay for ten-month employees. Premiums are subject to change each year, effective July 1. Any changes in the premium will be communicated to all employees listed in the Eligible Groups section. At the commencement of each school year (September 1) and until the following August 31, the individual shall be placed in a category corresponding to his/her accumulated sick leave. BENEFIT AMOUNT AND MAXIMUM PERIOD OF PAYMENT: The Salary Continuance Program shall pay 75% of bi-weekly earnings for a maximum of 26 weeks within a 12 month period after the individual has utilized his/her accumulated sick leave plus waiting period. Premium payments are required for your coverage while you are receiving payments under this plan. Your Short Term Disability plan does not cover disabilities due to an occupational sickness or injury. - 4 -
The Family Medical Leave Act (FMLA) runs concurrently with any paid personal illness leave. Wage continuation may only be used when an employee has a serious health condition as certified by a physician. Wage Continuation cannot be used to care for a family member. REESTABLISHMENT PERIOD: The following process will apply to an employee who has been absent on Wage Continuation for an extended absence between six (6) weeks and three (3) months within any 12 month period: Employee must return to work on a continuous basis for 3 months to be eligible again for Wage Continuation benefits. During the 3-month period, employees are only permitted to take 4 days: Personal leave, Personal illness, and Illness in the family. The following process will apply to an employee who has been absent on Wage Continuation for an extended absence from 3 months to 6 months within any 12 month period: Employee must return to work on a continuous basis for 6 months to be eligible again for Wage Continuation benefits. During the 6-month period, employees are only permitted to take 6 days: Personal leave, Personal illness, and Illness in the family. If the employee uses more days that allotted during the reestablishment period, the reestablishment period will be extended until the employee completes it in full. The bi-weekly premium for the Wage Continuation program will continue until the employee has exhausted the full 26 weeks. Once exhausted, participation in the program will cease and the employee will no longer be eligible for the benefit. Employees who wish to re-enroll in the program will be required to submit an application during the Open Enrollment period. OTHER BENEFITS If you are approved for the use of the Salary Continuance Program, your District provided medical insurance will continue for you and any dependents, if applicable, for up to 26 weeks, to coincide with the length of the approved absence. CANCELLATION PERIOD: Employees can cancel participation in the Wage Continuation program during the following times only: Open Enrollment: The full month of May, effective July 1. TERMINATION OF COVERAGE Wage Continuation insurance plan will terminate the day an employee: Stops active service, Ceases to be physically active at work, Exhausts the full 26 weeks of the benefit within a 12 month period, - 5 -
Or voluntarily cancels the plan. If an employee is placed on temporary layoff or takes an approved leave of absence without pay, the plan will end on the last day of active employment. CLAIM INFORMATION WHEN DO YOU NOTIFY THE SDP OF A CLAIM? We encourage you to notify us of your claim as soon as possible so that a claim decision can be made in a timely manner. You must coordinate your absence with the Employee Health Services (EHS) department. Completing the following steps will ensure a smooth transition: For absences over 3 consecutive days, submit an Extended Illness Absence Card (Form SEH-3) to EHS. This form is available on their website, www.philasd.org/offices/healthservices/forms You will receive a letter from EHS scheduling an appointment for you to visit the SDP s physician for review of your absence. You will continue to use all accrued (banked) sick days until you have none left. Upon approval of your continued absence, you will have a waiting period between your last sick day and when Wage Continuation payments begin. Waiting periods are listed above in the Benefits at a Glance section and range between 5-7 work days. Wage Continuation payments continue until you are cleared to return to work. Payments may continue for up to 26 weeks in a 12 month period. You must contact Health Services at (215) 400-4660 or by e-mail at employeehealth@philasd.org. Their office is located at 440 North Broad Street, Room 134, Philadelphia, PA 19130. WHAT INFORMATION IS NEEDED AS PROOF OF YOUR CLAIM? Your proof of claim, provided at your expense, must show a detailed medical report from a qualified physician that includes the following: The name and address of any hospital or institution where you received treatment Diagnosis Prognosis Anticipated date of return The District will deny your claim, or stop sending you payments, if the appropriate information is not submitted. TO WHOM WILL THE SDP MAKE PAYMENTS? The District will make payments directly to you via paychecks issued through the Payroll Department as part of the regular payroll schedule. WHAT HAPPENS IF THE SDP OVERPAYS YOUR CLAIM? The SDP has the right to recover, in full, any overpayments due to: Fraud; and Any error the SDP makes in processing a claim - 6 -
The SDP will recover any amounts owed through payroll deductions. The SDP will not recover more money than the amount you were paid. GENERAL PROVISIONS WHEN DOES YOUR COVERAGE BEGIN? For employees in an eligible group that apply within 90 days of hire of an eligible position: First of the month following 90 days of continuous active employment For employees in an eligible group that apply during the Open Enrollment period: July 1 following the end of the Open Enrollment period. Twelve-month employees are eligible to use the benefit as of July 1 and charges for the program will begin in July. Ten-month employees are eligible to use the benefit as of September 1 and premium deductions will begin in September. Ten-month employees will not be charged during the summer months of July and August and are ineligible to use this benefit during this time. WHEN CAN YOU APPLY FOR COVERAGE IF YOU (1) DID NOT APPLY WITHIN 90 DAYS OF HIRE OF AN ELIGIBLE POSITION OR (2) IF YOU DID NOT APPLY DURING OPEN ENROLLMENT OR (3) IF YOU VOLUNTARILY CANCELLED YOUR COVERAGE? You can apply for coverage only during the annual Open Enrollment period. Open Enrollment is held during the month of May. Coverage applied for during the annual Open Enrollment period will begin on: July 1, for twelve-month employees September 1, for ten-month employees HOW WILL THE DISTRICT HANDLE INSURANCE FRAUD? It is a crime if you knowingly, and with intent to injure, defraud or deceive the District, or provide any information, including filing a claim that contains any false, incomplete or misleading information. These actions, as well as submission of materially false information, will result in denial of your claim, and are subject to prosecution and punishment to the full extent under state and/or federal law. The District will pursue all appropriate legal remedies in the event of insurance fraud. CAN I USE WAGE CONTINUATION FOR PREGNANCY? Medical leave resulting from pregnancy shall entitle employees to paid leave for up to six (6) weeks in the case of a normal delivery, and up to eight (8) weeks for a Caesarean Section. Such paid leave consists of sick leave and Wage Continuation, in that order. Ten-month employees will not be compensated through the Wage Continuation program during the summer months of July and August. DOES THE POLICY REPLACE OR AFFECT ANY WORKERS COMPENSATION OR STATE DISABILITY INSURANCE? The policy does not replace or affect the requirements for coverage by any Workers Compensation or state disability insurance. - 7 -
EMPLOYER S RIGHT TO AMEND THE PLAN The District reserves the rights, in its sole and absolute discretion, to amend or modify, in whole or in part, any or all provisions of this Plan (including any related documents and underlying policies), at any time for any reason or no reason. Any amendment must be in writing and communicated to all eligible employees. - 8 -