Frequently Asked Questions - Carrier Specific Information
To be eligible for coverage, you must apply under this Policy, and be an Eligible Person of an Eligible Class. The Eligible Class is defined in your Schedule of Insurance; an Eligible Person is:
- An Employee Actively at Work for the Employer;
- Regularly scheduled to work at least 30 hours per week;
- A citizen or legal resident of the United States, its territories, or Canada;
- Not a temporary or seasonal employee;
- And not a full-time member of the armed forces of any country.
To be a Covered Person, you must be an Eligible Person, accepted for coverage under the Policy, make premium payments when they become due, complete the Eligibility Waiting Period, and fulfill the Actively at Work requirements and any Evidence of Insurability required.
If you are applying for coverage under Late Enrollment, you are required to provide Evidence of Insurability, which may include a physical examination if required by us, as will be required as well should you apply for reinstatement, or if you were not covered under the prior plan. Evidence of insurability will not be required for employees returning from a Family or Medical Leave.
Your monthly benefit amount is the calculation of your earnings multiplied by the Benefit Percentage (66 2/3rds% of your basic monthly earnings), to a stated maximum, before Benefit Offsets. Benefit Offsets are those amounts to which you are eligible through Workers’ Compensation, any state disability income program, any state unemployment benefit law, and similar programs, as applicable.
If you return temporarily to active work, the allowable period of a temporary return is 12 months, and if you become disabled again within that period, the prior days of disability will apply towards satisfying the elimination period, and your disability will be considered a continuation of the benefit period.
If you die while LTD benefits are payable, the policy provides for a Survivor Benefit Amount as shown in your Schedule of Insurance, presently 6 times the Monthly Benefit Amount, to be paid to your surviving spouse; to your surviving children if you have no surviving spouse; or to your estate if you have no surviving children.
After you have been disabled and received LTD benefits for 12 months, your Monthly Benefit Amount will receive a Cost of Living Adjustment as shown on the Schedule of Insurance on each anniversary of the date LTD benefits began.
The elimination period, or the time you must be disabled, is 90 days. Claims should be filed on the insurer’s forms, and Proof of Loss should be filed within 90 days after the satisfaction of the elimination period.
Your coverage will continue without payment of premiums while LTD Monthly Benefits are payable. Your status as a Covered Person will continue while you are disabled, during any Lay-Off Period or Leave of Absence Period shown in your Schedule of Insurance, during the first six months of a labor dispute or strike, or while you are on a leave of absence under any state or federally mandated family or medical leave act.
Generally, if your age at disability is under 61, benefits will be paid to age 65; at age 61, the duration of benefits is graded according to the information provided in your Schedule of Insurance. However, 24 months of benefits only are provided for those disabilities arising from Mental and Nervous Disorders, or from Drug and Alcohol Disorders. Your Schedule of Insurance describes these limitations in greater detail.
No benefits will be payable for disabilities caused by war or any act of war, declared or undeclared, civil or international, or any substantial armed conflict between organized forces of a military nature; nor during periods of incarceration exceeding 90 days; nor for pre-existing conditions that existed in the three months prior to the effective date of the coverage.