In the event you become disabled while covered under the LTD Plan, you may be eligible to receive a monthly benefit payment based on your elected coverage level in force at the time your disability begins. This benefit amount would be paid in conjunction (coordinated) with any disability benefits you receive from other sources—such as Workers' Compensation, Social Security, other disability plans, and state-mandated benefits—so that you receive no more than the stated plan benefits. For more information, see Other Income Benefits.
Your benefits will generally continue throughout your disability, though certain limitations will apply. Information about filing a claim for benefits is provided under Claim Procedures.
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When Benefits Begin
Eligibility for LTD benefits begins after 26 weeks (six months) of continuous total or partial disability. The first 26 weeks of disability are referred to as the "elimination period," during which time you may be eligible for sick leave (sick leave benefits are provided based on the policy in place at your location; contact your local Human Resources representative for details).
During the elimination period, if you return to work for 30 days or less and then cannot work due to the same or related condition, the elimination period will be extended by the number of days you worked. If you return to work for more than 30 days, you must satisfy a new elimination period starting from the date your disability resumes.
Disability Requirements
You do not have to be confined at home or in the hospital to receive LTD benefits, but you must be under the continuing care of a licensed physician who must certify that you are disabled (and provide appropriate documentation).
The LTD Plan will also pay a benefit if you return to limited duties or are participating in a vocational rehabilitative employment program (see the applicable sections under How Benefits Are Determined below for more details).
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How Benefits Are Determined
The amount of benefits you may receive in the event you become disabled is based on your FlexSolutions election and the salary in force at the time you become disabled.
The monthly LTD Plan benefit you receive will be reduced by an amount equal to any "other income benefits" you are eligible to receive. (See Other Income Benefits.)
The LTD Plan estimates benefits you are entitled to receive under "other income benefits"—even if you have not yet applied for these benefits or they have not been awarded to you—and will reduce the benefit amount payable by this estimated amount. Once you receive or are denied these "other income benefits," your LTD benefit amount will be adjusted as appropriate.
Monthly Benefit Calculation
To calculate the monthly benefit in the event you are disabled and have completed the elimination period, follow these four steps...
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Multiply your monthly pre-disability earnings by the coverage level you elected (50%, 60% or 70%, as outlined above), then
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Check the maximum benefits available under the coverage level you elected, then
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Compare the amounts in steps 1 and 2 above, and apply the lesser amount; lastly,
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Subtract any "other income benefits" to which you are entitled (see Other Income Benefits).
Because you pay for LTD coverage on a pre-tax basis (as explained under Pre-Tax Coverages), any LTD benefits you receive are taxable.
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Successive Periods of Disability
A "successive period of disability" is one that relates to an earlier disability for which you may have received benefits under this Plan, or for which you were in the elimination period. Successive periods of disability are disabilities related or due to the same cause. A successive period of disability will be treated as part of the prior disability if you...
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Return to your own occupation for less than six continuous months, and
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Perform all material and substantial duties of your own occupation during this period.
To qualify for a successive period of disability benefit, you must experience more than a 20% loss of pre-disability earnings. As used here, "period of disability" means a continuous length of time during which you are disabled (and eligible to receive benefits) under this Plan. You will also not be required to satisfy another elimination period.
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Cost-Of-Living Freeze
After the initial deduction for "other income benefits" (as explained previously), your monthly LTD benefits will not be reduced further due to any cost-of-living increases payable under these other income benefits.
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Returning To Work While Still Disabled
Under the LTD Plan, you may return to work assuming limited duties after completing the elimination period and receive partial disability benefits. During the first 24 months of a partial disability, the sum of your monthly benefit and your current monthly disability earnings may provide up to 100% of your pre-disability earnings. To determine your monthly partial disability benefit, follow these steps...
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Determine the monthly benefit that would be paid if you were totally disabled (see Monthly Benefit Calculation); then
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Add to the amount in step 1 the amount of any monthly current disability earnings; then
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If the amount determined from step 2 exceeds your level of pre-disability earnings, determine the excess amount by subtracting your pre-disability earnings from the amount determined from step 2; so that
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Your monthly benefit will not exceed 100% of your pre-disability earnings.
If you continue to be partially disabled after 24 months, your monthly partial disability benefit will be determined based on the following formula...
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Subtract your current monthly disability earnings received while partially disabled from your pre-disability earnings (this figure represents the amount of lost earnings);
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Multiply the amount of lost earnings by 75%;
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Multiply your pre-disability earnings by the benefit percentage elected (50%, 60% or 70%);
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Your gross monthly benefit will be the lesser of steps 2 or 3;
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Finally, deduct any Other Income Benefits amounts from the gross monthly benefit determined in step 4.
Note, however, that during this time your monthly partial disability benefit will not be less than the minimum monthly benefit of $100, nor will it be more than the disability benefit payable under the Plan.
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Vocational Rehabilitation
Vocational rehabilitation is a program of employment or service designed to prepare you, in the event you are disabled, for the resumption of gainful work. Under the LTD Plan, vocational rehabilitative services include, but are not limited to...
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Vocational testing
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Vocational training
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Workplace modification
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Prosthesis
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Job placement
Such services will only be adopted if appropriate, necessary and feasible.
Vocational rehabilitative employment, meanwhile, is employment that is part of a vocational rehabilitation program that has been approved, in writing, by the Insurance Company.
The sum of your monthly benefit and total income received under this provision may not exceed 100% of your pre-disability earnings. If it does, the monthly benefit you would otherwise receive will be reduced accordingly.
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How Long LTD Benefits Last
If you become disabled, your disability benefits will generally continue for as long as you are disabled. However, certain age-based limitations do apply, as outlined below.
| Duration of LTD Benefit Payments |
| If You Become Disabled At Age... |
Your LTD Benefits Will Continue For... |
|
59 or younger
|
Up to age 65
|
|
60
|
60 months
|
|
61
|
48 months
|
|
62
|
42 months
|
|
63
|
36 months
|
|
64
|
30 months
|
|
65
|
24 months
|
|
66
|
21 months
|
|
67
|
18 months
|
|
68
|
15 months
|
|
69 and older
|
12 months
|
Your monthly disability benefits will end when you reach the maximum age-based duration for benefits as outlined above, as well as when...
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You are no longer disabled
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The earnings you receive while partially disabled exceed 80% of your pre-disability earnings
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You fail to furnish required proof of your continued disability to the Insurance Company
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You refuse to be examined, if the Insurance Company requires an examination
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You die
... whichever occurs first.
Also, if you are disabled because of mental illness or drug or alcohol abuse, benefits will be payable only for as long as you are confined in a hospital or other place licensed to provide medical care for your disability. If you are not so confined, benefits will only be payable for a total of 24 months for all such disabilities during your lifetime.
For the purposes of this provision, mental illness or drug or alcohol abuse refers to any condition caused, contributed or made disabling by...
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A mental, nervous, or emotional disease or disorder
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Alcoholism
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The non-medical use of narcotics, sedatives, stimulants, hallucinogens, or any other such substance.
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Exclusions
The LTD Plan will not cover any disability caused by...
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Commission of (or an attempt to commit) an indictable offense,
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Intentionally self-inflicted injury, whether attempted while sane or insane,
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War or any act of war (declared or undeclared), or participation in a riot, or,
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A "pre-existing condition" as defined below.
In addition, no monthly benefit will be paid during any disability period in which you are not under the care of a licensed physician.
Pre-Existing Condition Exclusion
A "pre-existing condition" is an illness or injury for which you received medical treatment, services or supplies within 90 days before the coverage effective date under the LTD Plan. The LTD Plan will not cover a disability caused by, contributed to, or resulting from a pre-existing condition, unless the disability resulting from a pre-existing condition begins after the first 12 months you were covered under this LTD Plan.
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