Disability – Directors

Short-Term Disability 

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

HOW THE SHORT-TERM DISABILITY (STD) PLAN WORKS
In order to qualify for Core STD benefits, you must be continuously disabled for a period of at least 14 days due to sickness or injury. (This 14-day period is called the “elimination period.”) 

The elimination period for the optional STD benefit (buy-up) is 7 days. 

For STD Plan purposes, you are considered to be “disabled” if: 

  • you are unable to perform the material duties of your regular job due to a non-occupational sickness or injury, and:
  • you have a 20% or more loss in weekly earnings due to your inability to perform the above duties. 

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 details. 

Payment of Benefits
If you qualify for STD benefits, your benefit payments will begin after: 

  • your first 14 days of continuous disability for Core STD benefits; and
  • your first 7 days of continuous disability for optional STD benefits. 

The calculation of the amount payable is measured from: 

  • your 15th day of disability for Core STD benefits; and
  • your 8th day of disability for optional STD benefits. 

The STD Plan does not pay benefits during the elimination period (the first 14 days of disability for Core STD benefits, and the first 7 days of disability for optional STD benefits). 

STD benefit payments are made on a weekly basis. If your disability lasts for less than one week, you will receive 1/5 of your weekly payment for each day of disability. 

Maximum Benefit Period
The maximum benefit period for any one disability is 11 weeks for Core STD benefits, and 12 weeks for optional STD benefits. This period may be extended if you return to work and then become disabled again. For more information, refer to Recovery from Disability (below). 

Full-time employees who are still disabled after their Short-Term Disability Plan benefits end may be eligible for Long-Term Disability Plan benefits (see the Long-Term Disability section for more information).

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

60% of your weekly earnings up to a maximum of $2,500 per week

                                                                        less

Your Other Income Benefits

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

The amount of your weekly optional STD benefit is determined as follows: 

66.67% of your weekly earnings up to a maximum of $2,500 per week

                                                                        less

Your Other Income Benefits

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

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

OTHER INCOME BENEFITS
When your weekly STD 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; or
  • 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 consult the Short-Term Disability Insurance Certificate for more complete information about your Other Income Benefits and how they are determined (you can obtain this certificate by contacting Human Resources). You can also contact the Insurance Company at 1-866-779-1054 if you have any questions. 

STD PLAN BENEFIT: HERE ARE EXAMPLES
To illustrate how your weekly Short-Term Disability (STD) Plan benefit is calculated, assume that you are a full-time employee working 40 hours a week and are absent from work for four weeks (28 days) due to a covered sickness or injury. Also assume that: 

  • you have Core STD Plan coverage (as described above);
  • your weekly earnings (as defined above) are $3,500.00; and
  • you have no accumulated sick leave or Other Income Benefits (as explained above). 

In this case, you would receive a weekly STD Plan benefit of $2,100.00*, payable for your third and fourth weeks of disability (total STD benefit: $4,200.00). Since you had no accumulated sick leave, your first two weeks of disability would be unpaid.** 

*$3,500.00 x 60% = $2,100.00

**The Core STD Plan does not pay benefits for your first 14 days of disability (the elimination period). 

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

In this case, you would receive a weekly optional STD Plan benefit of $2,334.00*, payable for your second, third, and fourth weeks of disability (total STD benefit: $7,002). Since you had no accumulated sick leave, your first week of disability would be unpaid.** 

*$3,500.00 x 66.67% = $2,333.45; $2,333.45 rounded to the next higher dollar = $2,334.00.

**The optional STD Plan does not pay benefits for your first 7 days of disability (the elimination period). 

RECOVERY FROM DISABILITY
Your STD Plan benefits will end as of the date that you return to work. However, the following rules will apply if you become disabled again (i.e., after you return to full-time work): 

  • if your current disability is due to the same cause as your prior disability, your current disability will be treated as part of your prior claim, provided that you returned to full-time work for less than 14 days.
  • if your current disability is not related to your prior disability, your current disability will be treated as a new claim. 

Here is an Example: Assume that you have received 21 days of Core STD Plan benefits and then return to full-time work. Also assume that: 

  • you become disabled again after 12 days of full-time work; and
  • your second disability is due to the same illness or injury that caused your first disability. 

In the above case, both disabilities will be treated as part of your prior claim. Since you received 21 days of (Core) STD Plan benefits for your first disability, you will be eligible for up to 56 days of additional benefits for the second disability. In other words: 

        Maximum Benefit Period (Core Plan                                  First Disability Period                       Second Disability Period         
                      11 weeks (77 days)                             less                        21 days                        =                       56 days               

You can contact Human Resources if you have any questions about the STD Plan’s definition of disability, or the plan rules for recovery from disability. 

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 STD 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 STD Plan benefit payments. You can also contact Human Resources for additional information and assistance. 

HOW TO APPLY FOR BENEFITS
If you become disabled and cannot report to work, you should notify your supervisor and the Insurance Company immediately. 

It is your responsibility to initiate the STD Plan claim submission process by filing a claim within 31 days of the onset of your disability (or as soon as reasonably possible after the onset of your disability).

To file a claim, you can:

  1. complete an online claim form at www.unum.com/claims, click on Download a Form to search for the appropriate form and follow the online instructions;
  2. call Unum at 1-866-779-1054 (available 24 hours a day, 7 days a week); or
  3. provide written notice and send to:

Unum Life Insurance Company of America
2211 Congress Street
Portland, Maine 04122
Phone Number: 1-866-779-1054

Please make sure you can provide Unum with:

  • your name and address, phone number, birth date, social security number and e-mail address;
  • our employer's name (Tufts Associated Health Plan, Inc.);
  • the policy number (STD Plan: 425544 011);
  • employment information such as date hired and job title;
  • the reason for your claim – illness, injury, or pregnancy;
  • a description of your illness, symptoms, and/or diagnosis. Include the date the symptoms first appeared and if you have had these symptoms before;
  • the extent of your disability, including restrictions and limitations preventing you from performing your job;
  • information about any workers' compensation claims you have filed or plan to file;
  • details about all doctor, hospital or clinic visits, including dates and contact information; and
  • appropriate documentation of your monthly earnings.

If you call to report your claim, Unum will ask you for your permission to get your medical information. You can give this permission during the call, which will help to process your claim more quickly.

After you finish giving your claim information, the phone agent will transfer you to a recorded message. Listen to the recording and answer "yes" or "no" to the questions. At the end of the recording, say "yes" if you give permission or "no" if you do not.

After your call, Unum will send you a letter which will include a copy of the recorded message for your records. The letter will include a form for you to sign and return to Unum. Check with your doctor to see if he or she has any other forms you may need to sign to give permission to release medical records.

A Unum claim manager will call you and your employer for a list of your job requirements. The claim manager will call your doctor for your medical records. This information will help Unum determine how long you may be out of work and the benefits you may be able to receive.

See Filing Your Claim for additional information on filing your claim for STD Plan claims or contact Human Resources.

WHEN YOUR BENEFITS END
Your STD Plan benefit payments will end upon your recovery from a covered disability. Your STD Plan coverage will also end upon your termination of employment, loss of eligibility for coverage, or for the other reasons described in When Coverage Ends

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