Disability – Full-Time and Part-Time
 

Long-Term Disability 

Eligible full-time employees of the Tufts Health Plan are provided with Core Long-Term Disability (LTD) Plan coverage, which is entirely paid for by the Company. You also have the option of electing increased LTD coverage at your own expense. 

Note: Part-time employees are not eligible for Long-Term Disability (LTD) Plan coverage. 

HOW THE LONG-TERM DISABILITY (LTD) PLAN WORKS 

Definition of Disability
In order to qualify for LTD Plan benefits, you must meet the plan’s definition of disability. For LTD Plan purposes, you are considered to be “disabled” if you are incapacitated due to a non-occupational sickness or injury, and you meet the following requirements: 

First 24 Months: During your first 24 months of LTD Plan payments:       

  • you are unable to perform the material duties of your regular occupation; and
  • you are unable to earn 80% or more of your Indexed Earnings (as defined below). 

After 24 Months: After 24 months of LTD Plan payments: 

  • you are unable to perform the duties of any occupation for which you are suited by education, training, or experience; and
  • you are unable to earn 80% or more of your Indexed Earnings. 

The Insurance Company may require that you be examined by a doctor or vocational expert to verify your disability. This examination will be conducted at the Insurance Company’s expense. 

Certain types of disabilities are not covered by the plan. See Exclusions and Limitations for more information. 

Payment of Benefits
LTD Plan benefit payments are made on a monthly basis. These payments will begin after you have been continuously disabled for 90 days (the "elimination period").

If you qualify for LTD benefits, your benefit payments will begin as of the first day of the month following the end of the elimination period described above. 

The minimum monthly benefit payable under the plan is the greater of $100 or 10$ of your gross LTD Plan benefit. The maximum monthly benefit payable under the plan is $10,000.

The maximum period for payment of LTD Plan benefits depends on your age at the time you become disabled. The rules for continuation of LTD Plan benefit payments and the plan’s maximum payment period are explained in the Continuation of Benefit Payments section. 

PRE-EXISTING CONDITION
The LTD Plan does not cover a disability which: 

  • began within 12 months of the date that your coverage became effective; and
  • is due to a pre-existing condition. 

For plan purposes, you have a "pre-existing condition" if: 

  • you have an injury or sickness for which you incurred expenses, received medical treatment, care, or services (including diagnostic measures) or took prescribed drugs or medicines; and
  • you received the above care or treatment within the 3-month period immediately before the most recent effective date of your insurance. 

You can contact Human Resources if you have any questions concerning the LTD Plan’s pre-existing condition exclusion. 

CORE COVERAGE
The Company pays the full cost of your Core LTD Plan coverage. The amount of your monthly Core LTD benefit is determined as follows: 

60% of your monthly earnings up to a maximum of $10,000 per month

                                                                     less

Your Other Income Benefits

OPTIONAL COVERAGE
You have the option of increasing your LTD Plan coverage (the “buy-up” option). You pay for this increased coverage through after-tax payroll deduction contributions. 

The amount of your monthly optional LTD benefit is determined as follows: 

66.67% of your monthly earnings up to a maximum of $10,000 per month

                                                                     less

Your Other Income Benefits

DEFINITION OF MONTHLY EARNINGS
Your “monthly earnings” means your monthly base pay that was in effect immediately before your date of disability. For plan purposes, your covered monthly earnings do not include: 

  • commissions;
  • bonuses;
  • overtime pay;
  • income received from sources other than the Company; or
  • any other extra compensation. 

Indexed Earnings
Your Indexed Earnings are used to determine whether you meet the LTD Plan’s definition of disability, as described under How the Long-Term Disability (LTD) Plan Works (above). 

Indexed Monthly Earnings means your monthly earnings adjusted on each anniversary of benefit payments by the lesser of 10% or the current annual percentage increase in the Consumer Price Index (CPI-U). Your indexed monthly earnings may increase or remain the same, but will never decrease.

The CPI-U is published by the U.S. Department of Labor. Unum reserves the right to use some other similar measurement if the department of Labor changes or stops publishing the CPI-U. Indexing is only used as a factor in the determination of the percentage of lost earnings while you are disabled and working.

OTHER INCOME BENEFITS
When your monthly LTD benefit is calculated, it will be offset (reduced) by your other sources of disability income. These “Other Income Benefits” include any amounts that: 

  • you receive (or are eligible to receive) under any salary continuation or accumulated sick leave benefit sponsored by the Company;
  • you receive (or are eligible to receive) for injury or sickness under any local, state, or federal law;
  • you receive from a retirement plan sponsored by the Company (except for 401(k) or other employee savings plan);
  • you receive under any franchise, group insurance, or similar plan;
  • you receive through settlement, judgment, or arbitration where a third party may be liable;
  • you receive under any work loss provision in mandatory “no fault” auto insurance; or
  • you, your spouse/domestic partner, and children receive (or are eligible to receive) as retirement income or loss of time disability income under Social Security, the Railroad Retirement Act, or other similar law (including Canadian law). 

You should contact the Insurance Company at 1-866-779-1054 if you have any questions about your Other Income Benefits and how they are determined. 

Exceptions
Payments from the following are not considered Other Income Benefits, and will not be deducted from your LTD benefit calculation: 

  • 401(k) plans, thrift plans, or profit-sharing plans;
  • tax-sheltered annuities;
  • stock ownership plans;
  • non-qualified plans of deferred compensation;
  • a retirement plan sponsored by another employer; or
  • Individual Retirement Accounts (IRA). 

LTD PLAN BENEFITS: HERE IS AN EXAMPLE
To illustrate how your Long-Term Disability (LTD) Plan benefit is calculated, assume that you become disabled under the terms of the plan, and: 

  • you have Core LTD Plan coverage (as described above);
  • your monthly earnings (as defined above) are $4,000.00; and
  • you have no Other Income Benefits (see above for examples). 

In this case, you would receive a monthly LTD Plan benefit of $2,400.00*. These payments will continue until the earlier of: 

  • the end of your maximum benefit period; or
  • the date that your benefits end for other reasons specified by the plan.

*$4,000.00 x 60% = $2,400.00 

Optional Coverage Example
Assume that all the facts in the above example apply, except that you have purchased optional LTD Plan coverage (as described above). 

In this case, you would receive a monthly LTD Plan benefit of $2,667.00*. These payments will continue until the earlier of: 

  • the end of your maximum benefit period; or
  • the date that your benefits end for other reasons specified by the plan. 

*$4,000.00 x 66.67% = $2,666.80; $666.80 rounded to the next higher dollar = $2,667.00 

See Continuation of Benefit Payments for an explanation of the maximum benefit period and other circumstances under which your LTD Plan payments will end. 

Other Income Benefits
It is important to remember that your monthly LTD Plan benefit will be offset (reduced) by your Other Income Benefits as described above. For example, assume that the same assumptions used in the above optional LTD Plan example apply, except that you are entitled to a Social Security disability benefit of $967.00 per month. 

Your monthly optional LTD Plan benefit would be determined as follows:

               66.67% x $4,000.00                             =         $2,667.00

                             less                        

       Social Security Disability Benefit                =          ($967.00)

            Amount Paid by LTD Plan                     =          $1,700.00

In this case, you would receive a $1,700.00 monthly benefit from the LTD Plan. 

SUCCESSIVE DISABILITY
Your LTD Plan benefits will end as of the date that you are no longer disabled, as defined by the plan (see How the Long-Term Disability (LTD) Plan Works above for a definition). However, a special rule applies if you return to work in your regular occupation and suffer a successive disability. For plan purposes, a “successive disability” is a disability which results from the same or related causes as a prior disability for which you received LTD Plan benefits. 

If you have a successive disability, the plan will treat this disability as part of your prior claim if: 

  • you were continuously covered under the LTD Plan for the period between your prior claim and your successive disability; and
  • you returned to work in your regular occupation for less than 6 consecutive months.

Any disability which occurs more than 6 months after the end of a prior claim will be treated as a new disability. In addition, you will not be eligible for payments under the LTD Plan if you become covered by any other group long-term disability plan (for example, a plan sponsored by a new employer). 

RETURN TO WORK WHILE DISABLED
There may be circumstances in which you return to work while you are still disabled. If this applies to you, the amount of your continued LTD Plan benefit payment (if any) will depend on the amount you earn after you return to work. 

If you return to work while you are still disabled, you should contact the Insurance Company for additional information concerning your eligibility for continued LTD Plan benefit payments. You can also contact Human Resources for additional information and assistance. 

REHABILITATION BENEFITS AND RETURN TO WORK ASSISTANCE PROGRAM
If you are medically able, this benefit provides services and benefits to assist you and your employer in making accommodations to allow you to work.

While you are participating in the program, you can receive an additional disability benefit of 10% of your LTD benefit, up to $1,000 per month.

You may be eligible for an additional dependent care expense benefit of $350 per month, per dependent (up to a maximum of $1,000 per month) if you are incurring expenses to provide care for a child under the age of 15, and/or you start incurring expenses to provide care for a child age 15 or older, or a family member who needs personal care assistance. To submit a claim to participate in a rehabilitation program, contact the Insurance Company.

Depending on the nature of your disability, the Insurance Company may ask you to participate in a rehabilitation program. If you refuse this participation, your LTD Plan benefits may be terminated.

Work Life Assistance Program concerning the additional benefits and covered services that may be available to you.

This benefit provides you and your dependents with access to a work life assistance program to help with problems of daily living, including help with finding day care or transportation for an elderly parent, college research, stress management and crisis support.

For more information, you can contact the Insurance Company by calling 1-800-854-1446 or by going to www.unum.com/LifeBalance.

Worksite Modification Program
This benefit provides a payment to your employer of up to the greater of $1,000 or the equivalent of 2 months of your monthly LTD benefit for workplace modifications to help you remain or return to work. The Insurance Company will work with you and your employer to identify the modifications.

Benefits will cease when you are able to work in your regular occupation on a part-time basis, but you do not.

For those covered under the 2 Years' Own Occupation definition of disability, benefits will cease if, after 24 months of payments, you are able to work in any gainful occupation on a part-time basis, but do not.

Social Security Claimant Advocacy Program
This benefit provides you, while you are receiving LTD benefits, with expert advice regarding a Social Security Disability application or appeal.

HOW TO APPLY FOR BENEFITS
If you continue to be disabled and cannot return to work, it is your responsibility to work with Unum as your claim transitions from STD to LTD. You will receive notification directly from Unum regarding this process.

WHEN YOUR BENEFITS END
Your LTD Plan benefit payments will end upon your recovery from disability (see Continuation of Benefit Payments for details). Your LTD Plan coverage will also end upon your termination of employment, loss of eligibility for coverage, or for the other reasons described under When Coverage Ends.                                     

TAX CONSIDERATIONS
Your Core (Company-paid) LTD Plan benefit payments are taxable to you. The portion of your optional LTD Plan benefit payments which is attributable to your own contributions is not taxable to you. 

SURVIVOR BENEFIT
The LTD Plan will pay a lump sum benefit equal to 3 months of your gross disability payment to your eligible survivor if: 

  • your death occurs while you are receiving LTD Plan payments; and
  • your disability continued for 180 or more consecutive days. 

If you do not have any eligible survivors, the survivor benefit will be paid to your estate. If there is no estate, no payment will be made.