RFP_21-057-DP_Appendix A - Part 2.xls
XLS spreadsheet 57 KB Posted
- Attached to
- Long Term and Short Term Disability Insurance
- Solicitation number
- RFP 680 21-057/DP 2
- Issued by
- Palm Beach County, Florida
About this file
This is a Long-Term Disability (LTD) and Short-Term Disability (STD) benefits questionnaire appendix documenting current employee benefit offerings for a state or local government entity. The document outlines three LTD benefit classes and one STD benefit category with detailed eligibility requirements, coverage parameters, and benefit structures. All eligible employees must be active, full-time workers regularly working a minimum of 30 hours per week, with coverage beginning on the first of the month coinciding with or next following 60 days of active service. The LTD Core plan provides 50% of monthly covered earnings with a maximum monthly benefit of $1,000, while the LTD Buy-Up plan offers 60% of monthly covered earnings up to $5,000 monthly. The LTD Voluntary plan, available to employees in the POS medical plan or those who opt out of coverage, provides 60% of monthly covered earnings with a $5,000 maximum. All plans include a 90-day elimination period and extend benefits based on age at time of disability onset, ranging from 12 to 60 monthly payments depending on the employee's age at disability onset.
The STD benefit provides the lesser of 67% of weekly covered earnings or a maximum weekly benefit of $1,200 with a minimum weekly benefit of $100 and a 14-day elimination period, with benefits payable through the date the 11th disability benefit is payable. All disability plans include provisions for partial disability, rehabilitation incentives, return-to-work incentives, waiver of premium, and portability options for eligible employees. Disability definitions vary between initial periods (24 months or less) and extended periods (beyond 24 months), with mental illness, self-reported symptoms, and drug and alcohol addiction subject to a 24-month limitation. Standard exclusions apply across all plans, including disabilities resulting from suicide, war, riot participation, felony commission, license revocation, incarceration, and for STD plans, non-medically necessary cosmetic surgery and workers' compensation-covered injuries. Pre-existing condition limitations apply for 12 months from the effective date of coverage or benefit addition, with survivor income benefits available when death occurs during active disability benefit periods.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP_21-057-DP_Attachment 4.pdf | ||
| RFP No. 21-057-DP_Appendix B1 LTD Price Proposal Pages.docx | DOCX document | |
| RFP No. 21-057-DP_Appendix B2_STD Price Proposal Pages.docx | DOCX document | |
| RFP_21-057-DP_1_Attachment-6.xlsx | XLSX spreadsheet | |
| RFP_21-057-DP_Attachment 5.xls | XLS spreadsheet | |
| RFP_21-057-DP.pdf | ||
| RFP_21-057-DP_1_7-20-21.pdf | ||
| RFP_21-057-DP_Appendix A - Part 1.docx | DOCX document | |
| RFP_21-057-DP_Attachment 3.pdf | ||
| RFP_21-057-DP_1_Attachment-7.xlsx | XLSX spreadsheet |
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Sheet1
| LTD Current Benefits | |||
| Benefits | Class I - Core | Confirm (Y/N) | Deviations |
| Eligible Employees | All active, full-time employees who are participating in the HMO medical plan or OAPIN medical plan, regularly working 30 hours per week, including employees classified as collective bargaining unit non-high risk Fire and Rescue employees | ||
| Benefit Amount | 50% of monthly covered earnings | ||
| Maximum Monthly Benefit | $1,000 | ||
| Minimum Monthly Benefit | $100 or 10% of monthly benefit | ||
| Eligibility Waiting Period | First of the month coinciding with or next following 60 days of active service | ||
| Elimination Period | 90 days | ||
| Disability Definition (less than or equal to 24 months) | Solely because of Injury or Sickness, you are either: |
1. unable to perform any or all of the material and substantial duties of your Regular Occupation; or
2. unable to earn 80% or more of your Indexed Earnings from working in your Regular Occupation.
Disability Definition (+24 months) After Disability Benefits have been payable for 24 months, you are considered Disabled if, solely due to Injury or Sickness, you are either:
1. unable to perform any or all of the material and substantial duties of any occupation for which you are, or may reasonably become, qualified based on education, training, or experience; or
2. unable to earn 60% or more of your Indexed Earnings.
| Partial Disability | After disability benefits are payable for 24 months, the monthly benefit payable is the Gross Disability Benefit reduced by Other Income Benefits and 50% of Disability Earnings |
| Rehabilitation Incentive | Yes, see Certificate of Insurance for specifics |
| Return-to-Work Incentive | Yes, see Certificate of Insurance for specifics |
| Rehabilitation Plan | A written plan designed to enable you to return to work. The Rehabilitation Plan will consist of one or more of the following phases: |
1. rehabilitation, under which we may provide, arrange or authorize education, vocational or physical rehabilitation or other appropriate services;
2. work, which may include modified work and work on a part-time basis Maximum Benefit Duration Age 59 or under - to age 65 but not less than 60 Monthly payments Age 60 to 64 - 60 monthly payments Age 65 to 69 - to age 70 but not less than 12 Monthly payments Age 70 or older - 12 monthly payments Recurrent Disability A separate period of Disability will be considered continuous:
1. if it results from the same or related causes as a prior Disability for which benefits were payable;
2. if, after receiving Disability Benefits, you return to work in your Regular Occupation for less than 6 consecutive months; and
3. if you earn less than the percentage of Indexed Earnings that would still qualify you to meet the definition of Disability/Disabled during at least one month.
| Mental Illness/ Self Reported Symptoms/ Drug & Alcohol Addiction | 24 months |
| Pre-Existing Condition Limitations | A Pre-Existing means any Injury or Sickness for which you incurred expenses, received medical treatment, care or services including diagnostic measures, took prescribed drugs or medicines, or for which a reasonable person would have consulted a Physician within 3 months before you most recent effective date of insurance. This limitation will not apply to a period of Disability that begins after you are covered for at least 12 months after your most recent effective date of insurance, or the effective date of any added or increased benefits. |
| Survivor Income | A Survivor Benefit if you die while Disability Benefits are payable and at least 3 Monthly Benefits have been payable to you for a continuous period of Disability. The Survivor Benefit will equal 100% of the sum of the last full Disability Benefit payable to you plus the amount of any Disability Earnings by which the benefit had been reduced for that month. A single lump sum payment equal to 3 monthly Survivor Benefits will be payable |
| Portability | You may request to continue your portability eligible disability income insurance if such insurance ends because you cease to be in an eligible class or your employments ends. In order to do so, the group policy must be in effect, a notice was not received from the policyholder of its intent to end the group policy, you reside in a jurisdiction that permits portability, you have been insured for at least 12 months prior to the date that your employment ends, your employment did not end as a result of your retirement, you are not disability, and you have not become insured under any other disability insurance plan within 31 days after the date your portability eligible disability income insurance ends under the group policy. |
| Waiver of Premium | Yes |
| Single Sum Payment in the Event of Your Death | Yes, see above Survivor Income |
| Exclusions | Disability Benefits will not be paid for a Disability that results, directly or indirectly, from: |
1. suicide, attempted suicide, or self-inflicted injury while sane or insane.
2. war or any act of war, whether or not declared
3. active participation in a riot.
4. commission of a felony.
5. the revocation, restriction or non-renewal of your license, permit or certification necessary to perform the duties of your occupation unless due solely to Injury or Sickness otherwise covered by the Policy.
In addition, we will not pay Disability Benefits for any period of Disability during which you are incarcerated in a penal or corrections institution.
| Please refer to the Certificates of Insurance for the full detail of benefits, and provide/list any of deviations from the certificate of insurance. | |||
| LTD Current Benefits | |||
| Benefits | Class I - Buy-Up | Confirm (Y/N) | Deviations |
| Eligible Employees | All active, full-time employees who are participating in the HMO medical plan or OAPIN medical plan, regularly working 30 hours per week, including employees classified as collective bargaining unit non-high risk Fire and Rescue employees | ||
| Benefit Amount | 60% of monthly covered earnings | ||
| Maximum Monthly Benefit | $5,000 | ||
| Minimum Monthly Benefit | $100 or 10% of monthly benefit | ||
| Eligibility Waiting Period | First of the month coinciding with or next following 60 days of active service | ||
| Elimination Period | 90 days | ||
| Disability Definition (less than or equal to 24 months) | Solely because of Injury or Sickness, you are either: |
1. unable to perform any or all of the material and substantial duties of your Regular Occupation; or
2. unable to earn 80% or more of your Indexed Earnings from working in your Regular Occupation.
Disability Definition (+24 months) After Disability Benefits have been payable for 24 months, you are considered Disabled if, solely due to Injury or Sickness, you are either:
1. unable to perform any or all of the material and substantial duties of any occupation for which you are, or may reasonably become, qualified based on education, training, or experience; or
2. unable to earn 60% or more of your Indexed Earnings.
| Partial Disability | After disability benefits are payable for 24 months, the monthly benefit payable is the Gross Disability Benefit reduced by Other Income Benefits and 50% of Disability Earnings |
| Rehabilitation Incentive | Yes, see Certificate of Insurance for specifics |
| Return-to-Work Incentive | Yes, see Certificate of Insurance for specifics |
| Rehabilitation Plan | A written plan designed to enable you to return to work. The Rehabilitation Plan will consist of one or more of the following phases: |
1. rehabilitation, under which we may provide, arrange or authorize education, vocational or physical rehabilitation or other appropriate services;
2. work, which may include modified work and work on a part-time basis Maximum Benefit Duration Age 59 or under - to age 65 but not less than 60 Monthly payments Age 60 to 64 - 60 monthly payments Age 65 to 69 - to age 70 but not less than 12 Monthly payments Age 70 or older - 12 monthly payments Recurrent Disability A separate period of Disability will be considered continuous:
1. if it results from the same or related causes as a prior Disability for which benefits were payable;
2. if, after receiving Disability Benefits, you return to work in your Regular Occupation for less than 6 consecutive months; and
3. if you earn less than the percentage of Indexed Earnings that would still qualify you to meet the definition of Disability/Disabled during at least one month.
| Mental Illness/ Self Reported Symptoms/ Drug & Alcohol Addiction | 24 months |
| Pre-Existing Condition Limitations | A Pre-Existing means any Injury or Sickness for which you incurred expenses, received medical treatment, care or services including diagnostic measures, took prescribed drugs or medicines, or for which a reasonable person would have consulted a Physician within 3 months before you most recent effective date of insurance. This limitation will not apply to a period of Disability that begins after you are covered for at least 12 months after your most recent effective date of insurance, or the effective date of any added or increased benefits. |
| Survivor Income | A Survivor Benefit if you die while Disability Benefits are payable and at least 3 Monthly Benefits have been payable to you for a continuous period of Disability. The Survivor Benefit will equal 100% of the sum of the last full Disability Benefit payable to you plus the amount of any Disability Earnings by which the benefit had been reduced for that month. A single lump sum payment equal to 3 monthly Survivor Benefits will be payable |
| Portability | You may request to continue your portability eligible disability income insurance if such insurance ends because you cease to be in an eligible class or your employments ends. In order to do so, the group policy must be in effect, a notice was not received from the policyholder of its intent to end the group policy, you reside in a jurisdiction that permits portability, you have been insured for at least 12 months prior to the date that your employment ends, your employment did not end as a result of your retirement, you are not disabled, and you have not become insured under any other disability insurance plan within 31 days after the date your portability eligible disability income insurance ends under the group policy. |
| Waiver of Premium | Yes |
| Single Sum Payment in the Event of Your Death | Yes, see above Survivor Income |
| Exclusions | Disability Benefits will not be paid for a Disability that results, directly or indirectly, from: |
1. suicide, attempted suicide, or self-inflicted injury while sane or insane.
2. war or any act of war, whether or not declared
3. active participation in a riot.
4. commission of a felony.
5. the revocation, restriction or non-renewal of your license, permit or certification necessary to perform the duties of your occupation unless due solely to Injury or Sickness otherwise covered by the Policy.
In addition, we will not pay Disability Benefits for any period of Disability during which you are incarcerated in a penal or corrections institution.
| Please refer to the Certificates of Insurance for the full detail of benefits, and provide/list any of deviations from the certificate of insurance. | |||
| LTD Current Benefits | |||
| Benefits | Class II - Voluntary | Confirm (Y/N) | Deviations |
| Eligible Employees | All active, full-time employees who participate in the POS medical plan, or Opt out of medical coverage, regularly working a minimum of 30 hours per week, excluding employees participating in the HMO plan and employees classified as collective bargaining union non-high risk Fire and Rescue employees | ||
| Benefit Amount | 60% of monthly covered earnings | ||
| Maximum Monthly Benefit | $5,000 | ||
| Minimum Monthly Benefit | $100 or 10% of monthly benefit | ||
| Eligibility Waiting Period | First of the month coinciding with or next following 60 days of active service | ||
| Elimination Period | 90 days | ||
| Disability Definition (less than or equal to 24 months) | Solely because of Injury or Sickness, you are either: |
1. unable to perform any or all of the material and substantial duties of your Regular Occupation; or
2. unable to earn 80% or more of your Indexed Earnings from working in your Regular Occupation.
Disability Definition (+24 months) After Disability Benefits have been payable for 24 months, you are considered Disabled if, solely due to Injury or Sickness, you are either:
1. unable to perform any or all of the material and substantial duties of any occupation for which you are, or may reasonably become, qualified based on education, training, or experience; or
2. unable to earn 60% or more of your Indexed Earnings.
| Partial Disability | After disability benefits are payable for 24 months, the monthly benefit payable is the Gross Disability Benefit reduced by Other Income Benefits and 50% of Disability Earnings |
| Rehabilitation Incentive | Yes, see Certificate of Insurance for specifics |
| Return-to-Work Incentive | Yes, see Certificate of Insurance for specifics |
| Rehabilitation Plan | A written plan designed to enable you to return to work. The Rehabilitation Plan will consist of one or more of the following phases: |
1. rehabilitation, under which we may provide, arrange or authorize education, vocational or physical rehabilitation or other appropriate services;
2. work, which may include modified work and work on a part-time basis Maximum Benefit Duration Age 59 or under - to age 65 but not less than 60 Monthly payments Age 60 to 64 - 60 monthly payments Age 65 to 69 - to age 70 but not less than 12 Monthly payments Age 70 or older - 12 monthly payments Recurrent Disability A separate period of Disability will be considered continuous:
1. if it results from the same or related causes as a prior Disability for which benefits were payable;
2. if, after receiving Disability Benefits, you return to work in your Regular Occupation for less than 6 consecutive months; and
3. if you earn less than the percentage of Indexed Earnings that would still qualify you to meet the definition of Disability/Disabled during at least one month.
| Mental Illness/ Self Reported Symptoms/ Drug & Alcohol Addiction | 24 months |
| Pre-Existing Condition Limitations | A Pre-Existing means any Injury or Sickness for which you incurred expenses, received medical treatment, care or services including diagnostic measures, took prescribed drugs or medicines, or for which a reasonable person would have consulted a Physician within 3 months before you most recent effective date of insurance. This limitation will not apply to a period of Disability that begins after you are covered for at least 12 months after your most recent effective date of insurance, or the effective date of any added or increased benefits. |
| Survivor Income | A Survivor Benefit if you die while Disability Benefits are payable and at least 3 Monthly Benefits have been payable to you for a continuous period of Disability. The Survivor Benefit will equal 100% of the sum of the last full Disability Benefit payable to you plus the amount of any Disability Earnings by which the benefit had been reduced for that month. A single lump sum payment equal to 3 monthly Survivor Benefits will be payable |
| Portability | You may request to continue your portability eligible disability income insurance if such insurance ends because you cease to be in an eligible class or your employments ends. In order to do so, the group policy must be in effect, a notice was not received from the policyholder of its intent to end the group policy, you reside in a jurisdiction that permits portability, you have been insured for at least 12 months prior to the date that your employment ends, your employment did not end as a result of your retirement, you are not disabled, and you have not become insured under any other disability insurance plan within 31 days after the date your portability eligible disability income insurance ends under the group policy. |
| Waiver of Premium | Yes |
| Single Sum Payment in the Event of Your Death | Yes, see above Survivor Income |
| Exclusions | Disability Benefits will not be paid for a Disability that results, directly or indirectly, from: |
1. suicide, attempted suicide, or self-inflicted injury while sane or insane.
2. war or any act of war, whether or not declared
3. active participation in a riot.
4. commission of a felony.
5. the revocation, restriction or non-renewal of your license, permit or certification necessary to perform the duties of your occupation unless due solely to Injury or Sickness otherwise covered by the Policy.
In addition, we will not pay Disability Benefits for any period of Disability during which you are incarcerated in a penal or corrections institution.
| Please refer to the Certificates of Insurance for the full detail of benefits, and provide/list any of deviations from the certificate of insurance. | |||
| STD Current Benefits | |||
| Benefits | All | Confirm (Y/N) | Deviations |
| Eligible Employees | All active, full-time employees regularly working 30 hours per week, including employees classified as collective bargaining unit non-high risk Fire and Rescue employees, but excluding employees classified as collective bargaining unit employees of Fire and Rescue | ||
| Benefit Amount | The lesser of 67% of your weekly covered earnings or your Maximum Disability Benefit | ||
| Maximum Weekly Benefit | $1,200 | ||
| Minimum Weekly Benefit | $100 | ||
| Eligibility Waiting Period | First of the month coinciding with or next following 60 days of active service | ||
| Elimination Period | 14 days | ||
| Disability Definition (less than or equal to 24 months) | Solely because of Injury or Sickness, you are either: |
1. unable to perform any or all of the material and substantial duties of your Regular Occupation; or
2. unable to earn 80% or more of your Covered Earnings from working in your Regular Occupation.
| Partial Disability | Yes, see Certificate of Insurance for specifics |
| Rehabilitation Incentive | Yes, see Certificate of Insurance for specifics |
| Return-to-Work Incentive | Yes, see Certificate of Insurance for specifics |
| Rehabilitation Plan | A written plan designed to enable you to return to work. The Rehabilitation Plan will consist of one or more of the following phases: |
1. rehabilitation, under which we may provide, arrange or authorize education, vocational or physical rehabilitation or other appropriate services;
2. work, which may include modified work and work on a part-time basis
| Maximum Benefit Duration | The date the 11th Disability Benefit is payable. |
| Recurrent Disability | A separate period of Disability will be considered continuous: |
1. if it results from the same or related causes as a prior Disability for which benefits were payable;
2. if, after receiving Disability Benefits, you return to work in your Regular Occupation for less than 14 days; and
3. if you earn less than the percentage of Indexed Earnings that would still qualify you to meet the definition of Disability/Disabled during at least one week.
Exclusions Disability Benefits will not be paid for a Disability that results, directly or indirectly, from:
1. suicide, attempted suicide, or self-inflicted injury while sane or insane.
2. war or any act of war, whether or not declared
3. active participation in a riot.
4. commission of a felony.
5. the revocation, restriction or non-renewal of your license, permit or certification necessary to perform the duties of your occupation unless due solely to Injury or Sickness otherwise covered by the Policy.
6. any cosmetic surgery or surgical procedure that is not Medically Necessary; "Medically Necessary" means the surgical procedure is a) prescribed by a Physician as required treatment of the Injury or Sickness; and b) appropriate according to conventional medical practice for the Injury or Sickness in the locality in which the surgery is performed. (We will pay benefits if your disability is caused by your donating an organ in a non-experimental organ transplant procedure.)
7. Injury or Sickness for which benefits are paid or payable to you from Workers' Compensation or occupational disease law.
In addition, we will not pay Disability Benefits for any period of Disability during which you are incarcerated in a penal or corrections institution.
Please refer to the Certificates of Insurance for the full detail of benefits, and provide/list any of deviations from the certificate of insurance.
&R&"Arial,Regular"&12APPENDIX A, QUESTIONAIRE PART 2 to RFP No. 15-065/SC LTD/STD Current Benefits &P of 4
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