Long-Term Disability Q&A
Q. I’m not signed up for Long-Term Disability. Can I sign up 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. During the qualifying period and the next 24 months of disability, you’re considered disabled if injury, sickness or pregnancy prevents you from performing at least one of the material duties of your regular occupation. After the qualifying period and the first 24 months of disability, you’re considered disabled if you’re unable to perform at least one of the material duties of any gainful occupation for which you are qualified by education, training or experience, and which provides as much income as the amount of coverage for which you enrolled. Q. When would I start receiving benefits? A. Your benefits begin after 90 days of disability. Q. How long can benefits continue? A. For most conditions, benefits are payable up to age 65 (or two years, if later), as long as you remain disabled under the policy. However, we may limit benefit payments to 12 months for disabilities due to chronic fatigue syndrome, fibromyalgia, carpal tunnel syndrome, environmental allergic illness, certain subjective musculoskeletal and connective tissue disorders, mental illnesses, alcoholism, and drug or chemical abuse. 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 coverage and is due to a pre-existing condition, no benefits are 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. 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, sick leave pay or 50% of return-to-work earnings. Q. What happens if I can work on a limited basis? Can I still receive benefits? A. Yes, provided you meet the definition of disability. This policy encourages return to work, during the qualifying period or after you have begun to receive payments. In fact, you never have to be totally disabled to receive a benefit under this plan. Your plan also includes rehabilitation benefits that provide services and support initiatives to help you return to active work. Q. Can I take my insurance with me if I leave my employer? A. If your coverage ends after you have been insured under this plan for at least a year, you may be able to convert your coverage to a plan that would be billed to you directly.
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