Exhibit_1_-_Short-Term_Disability_Plan_Document_(1)_(1).pdf

11/2019

Exhibit 1 Short-Term

Disability Benefits

Employee Summary Plan Description (SPD)

Group Name: Collin County Government

Group Number: F024952

Class: Administrative Services Only (ASO)

SUMMARY PLAN DESCRIPTION

The Plan Sponsor, Collin County Government (referred to as the Employer) establishes this Short Term Disability Plan (referred to as the Plan) for certain Plan Participants (referred to as Employees) for injury and sickness while the employee is participating in the Plan. The Employer has full responsibility for payment of any benefits due according to the terms and conditions of the Plan.

Dearborn Life Insurance Company is the Claims Administrator under this arrangement. As the Claims Administrator, it administers the benefits under the Plan. The claims office address is:

Dearborn Life Insurance CompanyTM

701 East 22nd Street Lombard, Illinois 60148

1-800-348-4512

If you have any questions about your Plan, you should contact the Plan Administrator.

Benefit Booklet

Group Short Term Disability Plan

Group Name: Collin County Government

Group Number: F024952

Class: Administrative Services Only (ASO)

TABLE OF CONTENTS

SCHEDULE OF BENEFITS

ELIGIBILITY AND EFFECTIVE DATE PROVISIONS

SHORT TERM DISABILITY BENEFITS

EXCLUSIONS AND LIMITATIONS

TERMINATION OF PLAN PARTICIPATION

FILING A CLAIM

UNIFORM PROVISIONS

DEFINITIONS

SCHEDULE OF BENEFITS

Employer: Collin County Government

Group Number: F024952

Plan Effective Date: January 1, 2020 - Revised

Plan: Short Term Disability Plan

Eligible Class: All active, full-time Employees of the Policyholder who have completed the Waiting Period and are Actively at Work for the Employer and all Elected Officials during their term of office are eligible for participation. A full-time Employee is one who regularly works a minimum of 30 hours per week for the Employer. Part-time, seasonal, and temporary employees are not eligible.

Eligibility Waiting Period: First of the month coincident with or next following 90 days

STD Weekly Benefit: 67% of Your Weekly Earnings

Elimination Period: 14 days - Injury

14 days – Sickness

STD Benefits will begin the greater of: a.) The completion of the Elimination Period;

b.) When compensation payments from any Salary Continuation (including PTO), Sick Leave Benefits or Vacation Pay end.

Day Benefits Begin: Day 15 of Disability due to Injury

Day 15 of Disability due to Sickness

Maximum Period Payable: 26 weeks including the Elimination Period or until benefits become payable under the Long Term Disability plan, whichever occurs first

ELIGIBILITY AND EFFECTIVE DATE PROVISIONS

Who is eligible to participate in this Plan?

All Employees and Elected Officials who belong to an eligible class and work the minimum number of hours as set forth in the Schedule of Benefits in this booklet are eligible. An Employee must be Actively at Work to be eligible.

When does Your participation in the Plan become effective?

If You are an eligible Employee, Your participation will become effective on the date indicated in the Schedule of Benefits, provided You are Actively at Work on that day.

You must be Actively at Work for Your participation to become effective.

If You are not Actively at Work, when does participation become effective?

If You are absent from Active Work on the date Your participation would otherwise become effective; and Your absence is caused by an injury, illness or layoff, Your effective date for any initial participation will be deferred until the first day You return to Active Work.

However, You will be considered Actively at Work on any day that is not Your regularly scheduled work day (including but not limited to a weekend, vacation or holiday) if You were Actively at Work on the immediately preceding scheduled work day and You were:

1. not Hospital Confined; or

2. disabled due to an Injury or Sickness.

Who pays for Your participation?

The Employer pays the entire cost for Your participation.

Eligibility after You Terminate Employment

If Your participation ends due to termination of employment, You must meet all the requirements of a new Employee if You are rehired at a later date.

SHORT TERM DISABILITY BENEFITS

How is Disability defined?

Disability or Disabled means that You satisfy the definition of either Total Disability or Partial Disability and You are receiving Appropriate and Regular Care for Your condition from a Doctor.

Unless periods of Disability are separated by Your return to Active Work for at least 14 consecutive days, successive periods of Disability resulting from injuries received in any one Accident or from any one Sickness or related Sicknesses will be considered one period of Disability.

How is Total Disability defined?

Total Disability or Totally Disabled means that due to Sickness or Injury You are continuously unable to perform the Material and Substantial Duties of Your Regular Occupation, and Your Disability Earnings, if any, are less than 20% of Your pre-disability Weekly Earnings.

How is Partial Disability defined?

Partial Disability or Partially Disabled means that:

1. During the Elimination Period You are able to perform some but not all of the Material & Substantial Duties of Your Regular Occupation; and

2. After the Elimination Period, due to Injury or Sickness, You are able to perform some but not all of the Material and Substantial Duties of Your Regular Occupation, and Your Disability Earnings, if any, are at least 20% but less than or equal to 80% of Your pre-disability Weekly Earnings.

You will no longer be considered Partially Disabled when You are able to increase Your current earnings by increasing the number of hours You work or the number of duties You perform in Your Regular Occupation but You do not do so.

Loss of Professional License or Certification

If You require a professional license or certification for Your occupation, loss of that professional license or certification does not in and of itself constitute Disability.

What is the Elimination Period and how is it satisfied?

The Elimination Period is a period of continuous Disability which must be satisfied before You are eligible to receive benefits. It is shown in the Schedule of Benefits and begins on Your Date of Disability.

If You temporarily recover and return to work, Your Disability will be treated as continuous if You return to work for a period of less than or equal to one-half the Elimination Period rounded up to the next whole number, not to exceed 14 days. The days that You are not Disabled will not count toward Your Elimination Period.

If You return to work for a period greater than one-half the Elimination Period, or 14 days, whichever is less, and become Disabled again, You will have to begin a new Elimination Period.

Can You satisfy Your Elimination Period if You are working?

You can satisfy Your Elimination Period if You are working, provided You meet the definition of Disability.

What Disability Benefit are You eligible to receive?

If You are Disabled and receiving Appropriate and Regular Care for Your condition from a Doctor while participating in the Plan, You are eligible to receive one of the following at any given time:

1. an STD Weekly Benefit; or

2. a Work Incentive Benefit.

While You are Disabled, You might be eligible to receive one or the other of the above, but You cannot receive more than one of these benefits at the same time.

What is Your STD Weekly Benefit and how is it calculated?

Your STD Weekly Benefit will be based on Your Weekly Earnings as reported by Your Employer. An STD Weekly Benefit will be payable after the end of the Elimination Period if You are Disabled.

Your Net STD Weekly Benefit amount will be calculated as follows:

1. Multiply Your Weekly Earnings by 67%. This is Your Gross STD Weekly Benefit.

2. Subtract the Deductible Sources of Income from Your Gross STD Weekly Benefit. The resulting figure is Your Net STD Weekly Benefit.

If a benefit is payable for less than one week, STD Weekly Benefit payments will be made at a daily rate of 1/7th the weekly benefit.

If You are receiving any compensation from Your Employer, including, but not limited to:

1. Salary Continuation;

2. sick leave benefits; or

3. vacation pay.

STD Weekly Benefit payments will not begin until such compensation payments cease.

Can You work and still receive benefits?

While Partially Disabled, You may qualify for the Work Incentive Benefit.

What is the Work Incentive Benefit and how is it calculated?

You will receive a Work Incentive Benefit if You are Partially Disabled and Gainfully Employed after the end of the Elimination Period, or after a period during which You received STD Weekly Benefits.

The Work Incentive Benefit/Partial Disability Benefit will be the Employee's Pre-disability Earnings minus his Partial Disability income.

The payment of a Work Incentive Benefit, combined with Your STD Weekly Benefit, will not extend the Maximum Period Payable, as shown on the Schedule of Benefits.

What are the Deductible Sources of Income?

Your Gross STD Weekly Benefit will be reduced by:

1. Disability benefits paid, payable or for which You are eligible under:

a. any state compulsory disability benefit Act or Law.

b. any group insurance plan provided by or through the Employer.

c. any State Teachers Retirement System, Public Employees Retirement System or School Employees Retirement System not including Texas County and District Retirement System.

d. the Social Security Act, including any amounts for which Your dependents may qualify because of Your Disability.

e. the Canada Pension Plan, Quebec Pension Plan, or any other similar disability or pension plan or act.

f. the Canada Old Age Security Act.

g. any Workers’ Compensation or Occupational Disease Act or Law, or any other Law which provides compensation for an occupational Injury or Sickness.

Denial of Workers' Compensation will not result in the payment of benefits under the Plan if Your Disability resulted from an occupational Sickness or Injury. Benefits are also not payable under the Plan if You are entitled to participate in Workers' Compensation and choose not to do so.

2. Retirement benefits paid under the Social Security Act including any amounts for which Your dependents may qualify because of Your retirement;

3. Disability benefits paid under any No Fault Auto Motor Vehicle coverage;

4. Amounts received from a third party (after subtracting attorney’s fees) by judgment, settlement or otherwise, not to exceed 50% of the net settlement.

Act or Law means the original enactment of the law or act and all amendments.

Proration of Lump Sum Awards

If any Deductible Source of Income described above is paid in a single sum through compromise settlement or as an advance on future liability, We will determine the amount of reduction to Your Gross STD Weekly Benefit as follows:

1. We will divide the amount paid by the number of weeks for which the settlement or advance was provided; or

2. If the number of weeks for which the settlement or advance is made is not known, We will divide the amount of the settlement or advance by the expected remaining number of weeks for which We will provide benefits for Your Disability based on the Proof of Disability which We have, subject to a maximum of 26 weeks.

What other sources of income are not deductible?

Your Gross STD Weekly Benefit under the Plan will not be reduced by any of the following:

1. deferred compensation arrangements such as 401(k), 403(b) or 457 plans;

2. credit disability insurance;

3. pension plans for partners;

4. military pension and Disability income plans;

5. franchise disability income plans;

6. individual disability income plans;

7. a retirement plan from another employer;

8. profit sharing plans;

9. thrift or savings plans;

10. individual retirement account (IRA);

11. tax sheltered annuity (TSA);

12. stock ownership plan;

13. any amounts received by You from the Texas County and District Retirement System.

What happens if Your Deductible Sources of Income increase?

The Net STD Weekly Benefit will not be further reduced for subsequent cost-of-living increases which are paid, payable, or for which You or Your dependents are eligible under any Deductible Source of Income shown above.

How long will You receive benefits?

You will receive a payment for each week of Disability up to the Maximum Period Payable as shown in the Schedule of Benefits. Payment of benefits is also subject to any benefit duration limitation pertaining to Your Disability. Your benefits will cease on the earliest of:

1. the date this Plan terminates;

2. the date this Plan no longer available for Your class;

3. the date You are no longer Disabled;

4. the end of the Maximum Period Payable;

5. the date on which You return to work for the Employer in any capacity, unless as part of the Work Incentive Benefit;

6. the date on which You begin to receive benefits under any retirement plan sponsored by the Employer; or

7. the date You die.

What happens if Your Disability recurs?

If Disability for which benefits were payable ends but recurs due to the same or related causes less than 14 days after the end of a prior Disability, it will be considered a resumption of the prior Disability. Such recurrent Disability shall be subject to the provisions of the Plan that were in effect at the time the prior Disability began.

Disability which recurs more than 14 days after the end of a prior Disability is subject to:

1. a new Elimination Period;

2. a new Maximum Period Payable; and

3. the other provisions of the Plan that are in effect on the date the Disability recurs.

Disability must recur while You are participating in the Plan.

EXCLUSIONS AND LIMITATIONS

What are the exclusions and limitations under the Plan?

The Plan does not cover any loss or Disability caused by, resulting from, arising out of or substantially contributed to, directly or indirectly, by any one or more of the following:

1. loss of professional license, occupational license or certification;

2. commission of, participation in, or an attempt to commit an assault or felony;

3. intentionally self-inflicted injuries;

4. attempted suicide, regardless of mental capacity;

5. Cosmetic Surgery except when required due to Injury or Sickness;

6. Occupational Injury or Sickness;

7. participation in a war, declared or undeclared, or any act of war.

Furthermore:

1. Benefits are not payable if Your Disability Earnings exceed 80% of Your pre-disability Weekly Earnings.

2. Benefits are not payable if You are able to return to work in Your Regular Occupation on a part-time basis but You do not.

3. Benefits are not payable for any period during which You are confined to a penal or correctional institution if the period of confinement exceeds 30 days.

TERMINATION OF PLAN PARTICIPATION

When will Your participation in the Plan terminate?

Your participation will terminate on the earliest of the following dates:

1. the date on which the Plan is terminated; or

2. the date You:

a. are no longer a member of a class eligible to participate, or

b. are retired or pensioned, or

c. are no longer Actively at Work because of a leave of absence, furlough, layoff, or temporary work stoppage due to a labor dispute.

If you are no longer Actively at Work as a result of layoff or leave of absence and you are Totally Disabled on the date layoff or leave of absence begins, We will pay disability benefits up to the maximum period set forth in the Schedule of Benefits.

Termination of the Plan will not affect Your claim for a loss which began while the Plan was in force.

FILING A CLAIM

What are the Claim Filing Requirements?

Initial Notice of Claim

You should notify the Claims Administrator of Your claim as soon as possible, so that the Claims Administrator may make a timely decision on Your claim. Your Employer can assist You with the appropriate telephone number and address of the Claims Administrator’s Claim Department. You must send the Claims Administrator written notice of Your Disability within 30 days of the Date of Disability, or as soon as reasonably possible. Notice may be sent to the Claim Department at the address shown on the claim form.

Telephonic Claim Notification

In lieu of written Proof of Claim, the Claims Administrator may accept telephonic notice and Proof. All time limits applicable to the filing of Proof of Disability and commencement of Legal Actions shall apply to notice and proof filed by telephone or other means acceptable to the Claims Administrator.

Time Limit for Filing Your Claim

You must furnish the Claims Administrator with written proof of loss within 30 days after Your last day worked.

Proof of Disability

The following items, supplied at Your expense, must be a part of Your Proof of loss. Failure to provide complete Proof of loss may delay, suspend or terminate Your benefits.

1. The date Your Disability began;

2. The cause of Your Disability;

3. The prognosis of Your Disability;

4. Proof that You are receiving Appropriate and Regular Care for Your condition from a Doctor, who is someone other than You or a member of Your immediate family, whose specialty or expertise is the most appropriate for Your disabling condition(s) according to Generally Accepted Medical Practice.

5. Objective medical findings which support Your Disability. Objective medical findings include but are not limited to tests, procedures, or clinical examinations standardly accepted in the practice of medicine, for Your disabling condition(s).

6. The extent of Your Disability, including restrictions and limitations which are preventing You from performing Your Regular Occupation.

7. Appropriate documentation of Your Weekly Earnings.

8. If You were contributing to the premium cost, the Employer must supply proof of Your appropriate payroll deductions.

9. The name and address of any hospital or health care facility where You have been treated for Your Disability.

10. If applicable, proof of incurred costs covered under other benefit provisions under the Plan.

Continuing Proof of Disability

You may be asked to submit proof that You continue to be Disabled and are continuing to receive Appropriate and Regular Care of a Doctor. Requests of this nature will only be made as often as reasonably necessary. If required, this will be at Your expense and must be received within 45 days of the

Claims Administrator’s request. Failure to comply with such a request may delay, suspend or terminate Your benefits.

Examination

At the Plan Administrator’s expense, the Claims Administrator has the right to have You examined as often as reasonably necessary while the claim continues. Failure to comply with this examination may result in denial, suspension or termination of benefits, unless the Claims Administrator agrees You have a valid and acceptable reason for not complying.

Authorization and Documentation You will be asked to supply

You will be required to provide signed authorization for the Claims Administrator to obtain and release all reasonably necessary medical, financial or other non-medical information in support of Your Disability claim. Failure to submit this information may deny, suspend or terminate Your benefits.

You will be required to supply proof that You have applied for other Deductible Sources of Income such as Workers’ Compensation or Social Security Disability benefits, when applicable.

You will be required to notify the Claims Administrator when You receive or are awarded other Deductible Sources of Income. You must provide the nature of the Deductible Source of Income, the amount received, the period to which the benefit applies, and the duration of the benefit if it is being paid in installments.

Time of Payment of Claim

As soon as the Claims Administrator has all necessary substantiating documentation for Your Disability claim, Your benefit will be paid at least as frequently as once every two weeks, as long as You continue to qualify for it.

Benefits will be paid to You unless otherwise indicated. If You die while Your claim is open, any due and unpaid Disability benefit will be paid to the surviving person or persons in the first of the following classes of successive preference beneficiaries: Your: 1) Spouse; 2) children including legally adopted children; 3) parents; or 4) Your estate.

If any benefit is payable to an estate, a minor or a person not competent to give a valid release, the Plan may pay up to $1,000 to any relative or beneficiary of Yours whom may be entitled to this amount. The Plan will be discharged to the extent of such payment made in good faith.

Can You assign Your benefits?

Your benefits are not assignable, which means that You may not transfer Your benefits to anyone else.

What will happen if a claim is overpaid?

A claim overpayment can occur when You receive a retroactive payment from a Deductible Source of Income, when an error is inadvertently made in the calculation of Your claim; or if fraud occurs. The overpayment amount equals the amount paid in excess of the amount that should have been paid under the Plan.

The Plan has the right to recover from You any amount that is an overpayment of benefits under the Plan.

You must refund to the Plan the overpaid amount. The Plan may also, without forfeiting its right to collect an overpayment through any means legally available, recover all or any portion of an overpayment by reducing or withholding future benefit payments.

In an overpayment situation, the Plan Administrator will determine the method by which the repayment is made. You will be required to sign an agreement which details the source of the overpayment, the total amount that will be recovered and the method of recovery.

UNIFORM PROVISIONS

Clerical Error

Clerical error or omission by the Claims Administrator to the Plan Sponsor will not:

1. prevent You from receiving coverage, if You are entitled to coverage under the terms of the Plan;

or

2. cause coverage to begin or coverage to continue for You when the coverage would not otherwise be effective.

If the Plan Sponsor gives the Claims Administrator information about You that is incorrect, the Claims Administrator will use the facts to decide whether You have coverage under the Plan and in what amounts.

DEFINITIONS

The following are key words and phrases used in this certificate. When these words and phrases, or forms of them, are used, they are capitalized and italicized in the text. As You read this Benefit Booklet, refer to these definitions.

Accident or Accidental means a sudden, unexpected event that was not reasonably foreseeable.

Actively at Work or Active Work means that You must be:

1. An Employee at work on a full-time basis, either at Collin County's place of business or any other place Collin County may require them to go; or

2. An Employee in a paid status such as paid time off (PTO), catastrophic time off (CTO), jury duty, administrative leave, or compensatory leave; or

3. An Employee on an unpaid absence of one year or less in which the individual remains employed;

or

4. An Employee on family and medical leave; or

5. An Employee who has exhausted their Family and Medical Leave entitlement but is still receiving compensation from Collin County; or

6. An Employee who is on an approved leave of absence which may be paid or unpaid of six months or less; or

7. An Employee who is on leave through Workers' Compensation; or

8. An Employee who is utilizing 15 day required military leave; or

9. An Employee who did not continue coverage while on military or FMLA leave but has since returned to work; or

10. An Employee whose coverage is required by State or federal law.

For Elected Officials, Actively at Work means You are actively serving Your term in office.

Act or Law means the original enactment of the law or act and all amendments.

Appropriate and Regular Care means that You are regularly visiting a Doctor as frequently as medically required to meet Your basic health needs. The effect of the care should be of demonstrable medical value for Your disabling condition(s) to effectively attain and/or maintain Maximum Medical Improvement.

Cosmetic Surgery means any procedure which is directed at improving a person’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease.

Date of Disability means the date the Claims Administrator determines that You are Disabled.

Disability Earnings means the wage or salary You earn from Gainful Employment after a Disability begins.

Any lump sum payment will be prorated, based on the time over which it accrued or the period for which it was paid.

If Your Disability Earnings routinely fluctuate widely from week to week, the Claims Administrator may average Your Disability Earnings over the most recent three weeks to determine if Your claim should continue. If the Claims Administrator averages Your Disability Earnings, Your claim will not be terminated unless the average of Your Disability Earnings from the last three weeks exceeds 80% of Your Weekly Earnings.

Doctor means a person legally licensed to practice medicine, psychiatry, psychology or psychotherapy, who is neither You nor a member of Your immediate family. A licensed medical practitioner is a Doctor if applicable state law requires that such practitioners be recognized for purposes of certification of Disability, and the treatment provided by the practitioner is within the scope of his or her license.

Elimination Period means the number of calendar days at the beginning of a continuous period of Disability for which no benefits are payable. The Elimination Period is shown in the Schedule of Benefits.

Employee means an Actively at Work fullt-time employee whose principal employment is with the Employer, at the Employer’s usual place of business or such place(s) that the Employer’s normal course of business may require, who is Actively at Work for the minimum hours per week as stated in the Schedule of Benefits and is reported on the Employer’s records for Social Security and withholding tax purposes. The term Employee shall also include an Elected Official of the Policyholder.

Employer means the person, firm, or institution named in the Schedule of Benefits, including any covered subsidiaries or affiliates named in the Schedule of Benefits.

Gainful Employment or Gainfully Employed means the performance of any occupation for wages, remuneration or profit, for which You are qualified by education, training or experience on a full-time or part-time basis.

Generally Accepted Medical Practice means care and treatment which is consistent with relevant guidelines of national medical, research and health care coverage organizations and governmental agencies.

Gross STD Weekly Benefit means that benefit shown in the Schedule of Benefits which applies to You.

Hospital means either of the following:

1. A licensed hospital which

a. maintains on the premises all facilities necessary for major surgical treatment,

b. provides such treatment on an inpatient basis for compensation under the full-time supervision of licensed physicians, and

c. provides 24-hour service by registered graduate nurses.

2. A free-standing surgical facility which maintains on the premises all facilities necessary for major surgical treatment.

The term Hospital does not include an institution which is primarily a place for rest or convalescence, a place for the aged, a nursing home, a place for the treatment of alcohol or drug abuse or any facility primarily affording custodial, educational, or rehabilitative care.

Injury means bodily injury that is the direct result of an Accident and not related to any other cause. The Injury must occur, and Disability resulting from the Injury must begin while You are participation in the Plan. Injury that occurs before Your participation in the Plan will be treated as a Sickness.

Male pronoun, whenever used, includes the female.

Material and Substantial Duties means duties that:

1. are normally required for the performance of Your Regular Occupation; and

2. cannot be reasonably omitted or modified, except that if You are required to work on average in excess of 40 hours per week, the Claims Administrator will consider You able to perform that requirement if You have the capacity to work 40 hours.

Maximum Medical Improvement is the level at which, based on reasonable medical probability, further material recovery from, or lasting improvement to, an Injury or Sickness can no longer be reasonably anticipated.

Maximum Period Payable, as shown in the Schedule of Benefits, means the longest period of time that You will receive payments for any one period of Disability.

Net STD Weekly Benefit means the Gross STD Weekly Benefit less the Deductible Sources of Income.

Regular Occupation means the occupation that You are routinely performing when Your Disability begins. The Claims Administrator will look at Your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific Employer or at a specific location.

Schedule of Benefits means the schedule which is a part of this Benefit Booklet.

Sickness means sickness or disease causing Disability which begins while You are participating in the Plan.

Spouse means lawful spouse.

STD means Short Term Disability.

STD Weekly Benefit means the STD Weekly Benefit shown in the Schedule of Benefits which applies to You.

Waiting Period as shown in the Schedule of Benefits means the continuous length of time immediately before Your Effective Date during which You must be in an Eligible Class.

Weekly Earnings means Your gross weekly income from Your Employer in effect just prior to Your Date of Disability. It includes Your total income before taxes and any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It includes income actually received from commissions, but does not include overtime pay, shift differential, or any other extra compensation, or income received from sources other than Your Employer.

Commissions will be averaged for the lesser of:

1. the full 12 calendar month period of Your employment with Your Employer just prior to the date Disability begins; or

2. the period of actual employment with Your Employer.

You, Your and Yours means the Employee to whom this Benefit Booklet has been issued.

END OF

BENEFIT BOOKLET