Short-Term Disability Q&A
Q. I’m not signed up for Short-Term Disability. Can I enroll now? A. Yes! Whether you’ve just become eligible for this coverage or didn’t sign up in the past, now is the time to enroll. You won’t need to answer any health questions to join the plan, but a pre-existing conditions limitation will apply. Your benefit election will be effective on the entry date specified in your group policy, provided you’re at active work on that date. Otherwise, your coverage becomes effective on the day you return to full-time duties. Q. How do I qualify for benefits? A. You’ll start receiving disability payments if you satisfy the qualifying period and meet the definition of disability. You’re considered disabled if either of the following apply: • You’re under the regular care and attendance of a doctor, and an injury, sickness or pregnancy prevents you from performing at least one of the material duties of your job; OR • An injury, sickness or pregnancy prevents you from earning more than 80% of your covered pre-disability pay. Q. When would I start receiving benefits and how long could I receive them? A. Your benefits begin on the 14th day of disability for accidents or injuries, and on the 14th day of disability for sickness or pregnancy. Your benefits can continue for up to 13 weeks. Q. What’s a pre-existing conditions limitation? A. A pre-existing condition is one for which you’ve seen a medical practitioner or taken medication in the 6 months before your coverage effective date. If your disability begins in the first 12 months of your coverage and is due to a pre-existing condition, full benefits are not payable. This limitation no longer applies after the earlier of 12 consecutive months ending on or after the effective date of coverage during which you have not consulted with or seen a medical practitioner or received treatment or medication for that condition or 12 consecutive months of coverage under this plan. If you become disabled, but there is a question about whether the disability is caused by a pre-existing condition, we will pay 25% of your gross benefit for up to 4 weeks. This provides you with a financial bridge while we conduct our claims investigation. If we conclude your claim is due to a pre-existing condition, no further payment will be made. If your disability is not due to a pre-existing condition and your claim is approved, you will receive the balance of any benefit due.
Q. Will benefits or payments I receive from other sources affect the amount of benefit I receive under this plan? A. Yes. Your benefit may be reduced by disability benefits from retirement or government plans, other group disability
plans, no-fault benefits, salary continuance or sick leave, and return-to-work earnings. Q. What happens if I can work, but only on a limited basis? Can I still receive a benefit?
A. Yes, provided you meet the definition of disability. If you’re performing limited work, you’ll receive your full benefit unless the combination of your benefit and your new earnings is more than your covered pre-disability weekly pay.
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