Highlight_Sheet_-_LTD_Only.pdf

Standard Insurance Company

Voluntary Long Term Disability Coverage Highlights – LTD Only County of Dane

163054-NONCOMBO

SI 12501 1 of 6 (9/21)

Voluntary Long Term Disability (LTD) Insurance Long Term Disability insurance is designed to pay a monthly benefit to you in the event you cannot work because of a covered illness or injury. This benefit replaces a portion of your income, thus helping you to meet your financial commitments in a time of need. Standard Insurance Company (The Standard) has developed this document to provide you with information about the optional coverage you may select through County of Dane.

Eligibility Requirements Employee • A regular employee of County of Dane, other than a Capital Area Regional

Planning Commission employee

• Actively working at least 20 hours each week

• A citizen or resident of the United States or Canada

• Temporary and seasonal employees, full-time members of the armed forces, leased employees and independent contractors are not eligible Premium • Insurance is contributory. The following factors determine the taxability of the benefit amount:

Employer contribution level;

Whether premiums are included or excluded from a member’s gross wages; and Pre-tax and post-tax contributions, if any, by the member

Benefit Amount Benefit Percentage Your monthly benefit is the lesser of:

Formula 1: 65 percent of the first $6,154 of your monthly insured predisability earnings; and

Formula 2: 70 percent of your monthly predisability earnings, reduced by deductible income

Plan Maximum Monthly Benefit

$4,000

Plan Minimum Monthly Benefit

$50

Note:

• All late applications (applying 31 days after becoming eligible), requests for coverage increases and reinstatements are subject to medical underwriting approval.

• To submit a medical history statement online, visit: http://www.standard.com/mhs.

Disability Needs Calculator Your family has a unique set of circumstances and financial demands. To help you figure out the amount of Disability insurance you may need if you become unable to work, The Standard has created a Disability Needs Calculator found at: http://www.standard.com/disability/needs.

Employee Coverage Effective Date To become insured, you must satisfy the eligibility requirements listed above, serve an eligibility waiting period*, receive medical underwriting approval (if applicable), and be actively at work (able to perform all normal duties of your job) on the day before the scheduled effective date of insurance. 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 full day of active work as an eligible employee.

Please contact your benefits representative for more information regarding the requirements that must be satisfied for your insurance to become effective.

* You are eligible on the first day of the calendar month that follows or coincides with 6 consecutive months as a member.

http://www.standard.com/mybenefits/mhs_ho.html http://www.standard.com/calculators/dineeds.html

Standard Insurance Company Voluntary LTD Coverage Highlights – LTD Only

County of Dane

SI 12501 2 of 6 (9/21)

Understanding Your Plan Design Benefit Waiting Period

If your claim for LTD benefits is approved by The Standard, benefits become payable after you have been continuously disabled for 90 days and remain disabled. Benefits are not payable during the benefit waiting period.

Own Occupation Definition of Disability

For the benefit waiting period and the first 12 months for which LTD benefits are paid, you are considered disabled when you are unable as a result of physical disease, injury, pregnancy or mental disorder to perform with reasonable continuity the material duties of your own occupation AND are suffering a loss of at least 20 percent of your indexed predisability earnings when working in your own occupation. You are not disabled merely because your right to perform your own occupation is restricted, including a restriction or loss of license.

Any Occupation Definition of Disability

After the own occupation period of disability, you will be considered disabled if you are unable as a result of physical disease, injury, pregnancy or mental disorder to perform with reasonable continuity the material duties of any occupation.

Maximum Benefit Period

If you become disabled before age 63, LTD benefits may continue during disability until Social Security Normal Retirement Age (SSNRA) or 4 years, whichever is longer.

If you become disabled at age 63 or older, the benefit duration is determined by the age when disability begins:

Age Maximum Benefit Period 63 To SSNRA, or 3 years 6 months, whichever is longer 64 3 years 65 2 years 6 months 66 2 years 3 months 67 2 years 68 1 year 9 months 69+ 1 year 6 months

Deductible Income Deductible income is income you receive or are eligible to receive while LTD benefits are payable. Deductible income includes, but is not limited to:

• Benefits under any workers’ compensation law or similar law

• Amounts under unemployment compensation law

• Social Security disability or retirement benefits, including benefits for your spouse and children

• Disability benefits from any other group insurance

• Disability or retirement benefits under your employer’s retirement plan

• Benefits under any state disability income benefit law or similar law

• Earnings from work activity while you are disabled, plus the earnings you could receive if you work as much as your disability allows

• Amounts due from or on behalf of a third party because of your disability, whether by judgment, settlement or other method

• Any amount you receive by compromise, settlement or other method as a result of a claim for any of the above

SI 12501 3 of 6 (9/21)

Benefit Calculation Example The LTD benefit amount is determined by multiplying your insured predisability earnings by the specified benefit percentage. This amount is then reduced by deductible income. In the example below, the LTD benefit amount is 65 percent of insured predisability earnings. If your monthly earnings before becoming disabled were $4,500, and you now receive a monthly Social Security disability benefit of $1,200 and a monthly retirement benefit of $900, your monthly LTD benefit would be calculated as follows:

Insured predisability earnings $4,500 LTD benefit percentage X 65% $2,925 Less Social Security disability benefit -$1,200 Less retirement benefit -$900 Amount of LTD benefit $825

Additional Features Please see your benefits representative for additional information about the features and benefits below.

24 Hour Coverage 24-hour LTD plans provide coverage for disabilities occurring on or off the job.

Rehabilitation Plan If you are participating in an approved Rehabilitation Plan, The Standard may include payment of some of the expenses you incur in connection with the plan including but not limited to; training and education expenses, family (child and elder) care expenses, job related expenses and job search expenses.

Reasonable Accommodation Expense Benefit

If your employer makes an approved work-site modification that enables you to return to work while disabled, The Standard will reimburse your employer up to a pre-approved amount for some or all of the cost of the modification.

Rehabilitation Incentive Benefit

If you agree to participate in a rehabilitation plan that prepares you to return to work (plan must be approved by The Standard), you may be eligible to receive an additional benefit equal to 10 percent of your predisability earnings. When added to any other amount you receive from The Standard, your total benefit cannot exceed the maximum benefit allowed by the policy.

Employee Assistance Program

Includes an Employee Assistance Program and WorkLife Services to offer support, guidance and resources to help you and your household members resolve personal issues.

Survivors Benefit If you die while LTD benefits are payable, and on the date you die you have been continuously disabled for at least 180 days, a survivors benefit equal to three time your unreduced LTD benefit may be payable (any survivors benefit payable will first be applied to any overpayment of your claim due to The Standard).

Family Care Expense Benefit

Applies when a disabled employee has returned to work and continues to receive LTD benefits. For 24 months, a portion of expenses (up to $250 per dependent, per month) is deducted from the amount of your work earnings.

Travel Assistance1 Available 24 hours a day, this service connects you to resources when you’re traveling at least 100 miles from home or in a foreign country for up to 180 days.

1 Travel Assistance is provided through an arrangement with an entity that is not affiliated with The Standard. Travel Assistance is not an insurance product in all states except Oregon. For more information, visit www.standard.com/travel-info.

http://www.standard.com/travel-info

SI 12501 4 of 6 (9/21)

Exclusions Subject to state variations, you are not covered for a disability caused or contributed to by any of the following:

• Your committing or attempting to commit an assault or felony, or your active participation in a violent disorder or riot

• An intentionally self-inflicted injury, while sane or insane

• War or any act of war (declared or undeclared, and any substantial armed conflict between organized forces of a military nature)

• The loss of your professional or occupational license or certification

Limitations LTD benefits are not payable for any period when you are:

• Not under the ongoing care of a physician in the appropriate specialty as determined by The Standard

• Not participating in good faith in a plan, program or course of medical treatment or vocational training or education approved by The Standard, unless your disability prevents you from participating

• Confined for any reason in a penal or correctional institution

• Able to work and earn at least 20 percent of your indexed predisability earnings, but you elect not to work throughout the own occupation period; thereafter, the responsibility to work includes work in any occupation

In addition, payment of LTD benefits is limited in duration:

• If you reside outside the United States or Canada

• If your disability is caused or contributed to by mental disorder

When Benefits End LTD 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 LTD disability insurance 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

When Insurance Ends Insurance ends automatically on the earliest of the following:

• The last day of the last period for which you make a premium contribution (except if premiums are waived while disabled)

• The date your employment terminates

• The date the group policy terminates

• The date you cease to be a member (insurance may continue for limited periods under certain circumstances)

Group Insurance Certificate If coverage becomes effective, and you become insured, you may receive a group insurance certificate containing a detailed description of the insurance coverage including the definitions, exclusions, limitations, reductions and terminating events. The controlling provisions will be in the group policy. Neither the information presented in this summary, nor the certificate modifies the group policy or the insurance coverage in any way.

SI 12501 5 of 6 (9/21)

Rates If you have questions regarding how to determine your earnings, please contact your benefits representative.

Premiums for this coverage will be deducted directly from your paycheck.

To calculate your monthly payroll deduction, use the formula indicated below:

1. Enter your average monthly earnings, not to exceed $6,154, on Line 1. Line 1:

2. Rate of 0.38 divided by 100. Line 2: 0.0038

3. Multiply Line 1 by the amount shown on Line 2. Line 3:

The amount shown on Line 3 is your estimated monthly payroll deduction.

SI 12501 6 of 6 (9/21)

For more than 100 years we have been dedicated to our core purpose: to help people achieve financial well-being and peace of mind. We have earned a national reputation for quality products and superior service by always striving to do what is right for our customers.

Headquartered in Portland, Oregon, The Standard is a nationally recognized provider of group Disability, Life, Dental and Vision insurance and Individual Disability insurance. We provide insurance to more than 24,800 groups, covering over 8 million employees nationwide.* Our first group policy, written in 1951 and still in force today, stands as a testament to our commitment to building long-term relationships.

To learn more about products from The Standard, Contact your human resources department or visit us at www.standard.com.

* As of June 30, 2013, based on internal data developed by Standard Insurance Company.

1100 SW Sixth Avenue Portland OR 97204

GP190-LTD/S399, GP399-LTD/TRUST, GP899-LTD,

GP209-LTD, GP608-LTD, GP190-LTD/ASSOC/S399,

GP190-LTD/TRUST/S399, GP491-LTD/TRUST/S399