Long-term Disability Benefits - Mosers

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LONG-TERM DISABILITY BENEFITSCoverage Available to Eligible Employees

November 2021LONG-TERM DISABILITY BENEFITSCoverage Available to Eligible EmployeesThis handbook provides a description of your long-term disability insurance benefits pursuant to Chapter 104, RSMo,and The Standard Group Insurance Policy Number 604201 or successors thereto, issued to the Trustees of the MissouriState Employees’ Retirement System (MOSERS). If there is a discrepancy between this handbook and the statute orinsurance contract, the statute or insurance contract will prevail.

LTD INSURANCE BENEFITSWe Are Here to HelpBenefit counselors are a valuable sourceof information regarding your benefitsand are available to assist you.Schedule an AppointmentSpeak with a benefit counselor by phoneor make an appointment to visit ouroffice. Our phones tend to be least busybetween 8:00 am and 9:00 am.Call Center HoursMonday Friday8:00 am–12:00 pm1:00 pm–4:30 pmContact UsToll Free: (800) 827-1063In Jefferson City: (573) 632-6100Fax: (573) 632-6103Visit Us907 Wildwood DrJefferson City, MOMailing AddressPO Box 209Jefferson City, MO 65102-0209Websitewww.mosers.orgLog in to myMOSERS to access yourpersonal information, submit forms,and more.Connect with Us on Social MediaBe sure to follow us on social media. It’s a greatway to stay informed and learn about your MOSERSbenefits. Invite your coworkers to join us, too!2The Group PolicyProvided by The Standard Insurance CompanyThe MOSERS long-term disability (LTD) program is providedunder Group Policy Number 604201, issued by The StandardInsurance Company to the Trustees of the Missouri StateEmployees’ Retirement System (MOSERS). The StandardInsurance Company hereby certifies that you will be insuredunder the terms of the group policy during the time, in themanner, and for the amount(s) set forth in the group policy,provided you meet the eligibility requirements that have beenestablished for participation in the plan.If you become disabled while insured under this group policy,The Standard Insurance Company will pay LTD benefitsaccording to the terms of the group policy after they receivesatisfactory proof of loss.Certificate of InsuranceGroup Policy Number604201Name and Address of Insurance CarrierThe Standard Insurance CompanyGroup Benefits DepartmentP. O. Box 2800 Portland, OR 97208-2800(844) 505-6026Name and Address of PolicyholderBoard of TrusteesMissouri State Employees’ Retirement System (MOSERS)907 Wildwood Drive Jefferson City, MO 65109(573) 632-6100 or (800) 827-1063The group policy is held by MOSERS.All claims must be filed through MOSERS.Claims are subject to the terms of the group policy.As long as you meet the eligibility requirementsset forth in group policy number 604201,you will have long-term disability coverage through MOSERS.Effective date January 1, 2021

Table of ContentsLTD INSURANCE BENEFITSSummary of LTD Insurance BenefitsProvisions.4LTD Insurance CoverageEligibility for Coverage.5Enrollment & Premiums.5Exclusions & Limitations .6Social Security Benefits .6Benefits Upon Becoming DisabledIncome Replacement .7For information about eligibility forApplying for LTD Benefitssee page 5.The Claims Process.9The Approval Process.9Denial, Suspension, or Termination of LTD Claim. 10MOSERS long-term disability insurance,Easily locate information by topic orreview definitions of the terminologyMaintaining Your Benefits.10used by referring to theCareer & Life Events That MayAffect LTD Insurance Benefitsback of this handbook.Approved Leave of Absence or Layoff.12Death and Your LTD Benefits.12Temporary Recovery.12New Disabilities.13Life Insurance .13Medical Benefits.13glossary and index in theIf you are viewing a PDF of this handbook,use the links provided in blue to quicklylocate relevant or additional informationabout a topic. Click on any topic in the tableof contents to go directly to that page.Retirement.13Return to WorkReturn to Work Responsibility.14Return to Work Incentive.14Workplace Possibilities Program.15GlossaryTerms.17IndexTopics.193

LTD INSURANCE BENEFITSSummary of LTD Insurance BenefitsThe following summary highlights the major provisions ofyour long-term disability (LTD) insurance benefits. For moreinformation on a particular provision, please refer the toindex located in the back of this handbook.Provisions Coverage Cost ‒ There is no cost to you for LTDinsurance. Your employer pays your premiums as longas you are an active employee (unless on a leave ofabsence). Income Replacement ‒ LTD benefits can replaceup to 60% of your pre-disability earnings less anydeductible income. Creditable Service ‒ You will continue to earn creditableservice toward your retirement for each month youreceive disability benefits. Waiver of Premium ‒ If you become disabled, you maybe eligible to continue your life insurance coverage andnot pay the premium. Workplace Possibilities Program ‒ The ability to performyour work duties can be difficult if you have a medicalcondition. The Workplace Possibilities Program providesaccommodations or services as an alternative to LTD. Survivor Benefits ‒ Your spouse or child(ren) mayqualify for survivor benefits if you die while receivingLTD benefits.4 Waiting Period ‒ Your LTD benefit payments will begin atthe end of the benefit waiting period—90 days after yourlast day on the job or the period of sick leave you areentitled to through your employer’s sick leave program,whichever is longer. Taxes ‒ Your LTD benefit may be subject to certain federaland state taxes. Return to Work Incentive ‒ If eligible, the return to workincentive allows you to work and still receive LTD benefitswith some limitations. Own Occupation ‒ Disability benefits will end ifyou are able to work in your own occupation, orany other reasonable occupation, but do not acceptavailable employment. Retirement ‒ LTD benefit payments will end when youbegin receiving early retirement benefits from MOSERSor when you become eligible for normal retirement.

LTD Insurance CoveragePeople insure their lives, health, homes, and otherpossessions, but often overlook their most importantasset—their ability to earn an income. If you face a lengthyillness or suffer from an accident that leaves you unable towork, you have resources. LTD insurance provides partialincome replacement if you are unable to work for anextended period. This benefit also includes a program thatmay assist in making workplace changes so you can avoidgoing or staying on LTD.Eligibility for CoverageEligible EmployeesYou are eligible for MOSERS LTD insurance coverageif you are: Working in a permanent position normally requiring atleast 1,040 hours per year as an employee of the state ofMissouri, and you are a member of any of the followingplans:– Missouri State Employees’ Plan (MSEP, MSEP 2000,and MSEP 2011)– Judicial Plan (Judicial Plan and Judicial Plan 2011)– Administrative Law Judges and Legal Advisors’ Plan(ALJLAP) An active member of the General Assembly who is amember of MOSERS. A member of the Public School and Education EmployeeRetirement System of Missouri (PSRS/PEERS) who isemployed full-time by a state agency, and is a citizen orresident of the United States or Canada. A member working in an MSEP, MSEP 2000, or MSEP2011 position at Lincoln University or State TechnicalCollege of Missouri.LTD INSURANCE BENEFITSNon-eligible EmployeesCertain groups of MOSERS members are not eligible toparticipate in the LTD plan. These include the following: Uniformed Water Patrol Officers who have qualified,or who qualify for receiving other disability benefits orretirement benefits due to disability, under the statutoryoccupational disability plan. Members of MOSERS who have another disability planprovided by their employer (i.e. universities not listedabove). A member of the College and University Retirement Plan(CURP). Members eligible for normal (unreduced) retirementfrom MOSERS. Missouri State Highway Patrol employees (exceptUniformed Water Patrol Officers electing MOSERSbenefits under the provisions of House Bill 1868). A retired member of the MoDOT and Patrol Employees’Retirement System (MPERS) re-employed in a benefiteligible position covered by MOSERS.Enrollment & PremiumsEnrollmentAs a new employee, LTD insurance coverage is automatic.Your coverage begins on the first day you become a stateemployee and meet the active-work requirement.PremiumsYour employer pays your monthly LTD insurance premiums,unless you are on a leave of absence. (see page 12) A Uniformed Water Patrol Officer electing MOSERSbenefits under the provisions of House Bill 1868.RSMo: 104.410.65

LTD INSURANCE BENEFITSExclusions & LimitationsSocial Security BenefitsExclusionsGenerally, if your application for Social Security DisabilityInsurance (SSDI) is approved, you must wait five monthsbefore you can receive your first SSDI benefit payment. Thismeans you would receive your first payment in the sixth fullmonth after the date we find that your disability began.Your LTD benefit is subject to certain exclusions andlimitations. You are not covered for a disability caused orcontributed to by: A pre-existing condition or the medical or surgicaltreatment of a pre-existing condition, unless, on the dateyou become disabled, you:– have been continuously insured by The StandardInsurance Company for 12 months (exclusion period),and– have been actively at work for at least one full dayafter the end of those 12 months. An intentionally self-inflicted injury, while sane or insane. War, or any act of war. Example: Your disability began on June 15, 2020 and youapplied on July 1, 2020. Your first benefit would be paidfor the month of December 2020, the sixth full month ofdisability.*Social Security cost-of-living adjustments (COLAs) will notreduce the amount of your MOSERS LTD benefit.* Social Security Administration Publication No. 05-10153 April 2021What You Need to Know When You Get Social Security Disability Benefitswww.ssa.gov/pubs/EN-05-10153.pdf Loss of license or certification. A disability caused or contributed to by your committingor attempting to commit an assault or felony, or activeparticipation in a violent disorder or riot.The payment of benefits is limited to 12 months for eachperiod of continuous disability while you reside outside theUnited States or Canada.LimitationsLTD benefits are not payable for: Any period of disability when you are not under thecontinuous care of a physician in the appropriatespecialty as determined by The Standard InsuranceCompany. More than 24 months during your lifetime for a disabilitycaused or contributed to by use of alcohol, alcoholism,use of any drug, including hallucinogens, or drugaddiction. Foreign residency beyond 12 months. Electing not to work when you are able to do so (seeReturn to Work Responsibility on page 14). Any period of disability when you are not participating ingood faith in a rehabilitation program, medical treatment,or vocational training approved by The StandardInsurance Company unless your disability prevents youfrom participating.6MOSERS’ LTD benefits and Social Security benefits areindependent of each other. Approval for one does not guaranteeapproval of the other.

LTD INSURANCE BENEFITSBenefits Upon Becoming DisabledIncome ReplacementMonthly Disability BenefitIf you are disabled, have been approved for LTD by TheStandard Insurance Company, and have completed thebenefit waiting period, your monthly disability benefit willequal 60% of: (1) your monthly salary on your last full dayof active work, or (2) the average monthly salary for yourhighest consecutive 36 months of employment (whicheveramount is greater).LTD insurance is intended to replace a percentage ofyour income lost as a result of disability. In replacing thepercentage of lost wages, The Standard Insurance Companyalso takes into account certain other sources of incomeyou may be eligible to receive as a result of your disability.These other sources of income are called “deductibleincome,” because they are deducted from your LTDbenefit. Your LTD benefit will be reduced by the followingtypes of deductible income: Primary Social Security benefits paid because of yourretirement or disability (Social Security cost-of-livingadjustments [COLAs] will not reduce the amount ofyour disability benefit). Amounts received or amounts eligible to be receivedfrom any workers compensation law as a result ofyour disability. Any wages earned while employed on a part-time basis. Any other benefits received under another groupdisability insurance plan. Any sick leave or salary continuation received whileeligible for LTD benefits.Minimum Disability BenefitThe gross amount of your LTD benefit payments will neverbe less than 100 per month or 15% of the maximummonthly LTD benefit otherwise payable, whichever amountis greater.Monthly Disability Benefit CalculationNow that you’re familiar with the criteria that can determineyour maximum and minimum monthly LTD benefit, let’slook at an example of how an LTD benefit payment iscalculated and how it can be impacted by potential sourcesof deductible income. To determine your pre-disabilityearnings, MOSERS will use the greater of (1) your currentmonthly compensation, or (2) the average monthlycompensation for your highest 36 consecutive months todetermine your pre-disability earnings.ExampleFor this example, all dollar amounts are pre-tax (gross) andthe following assumptions have been made:Pre-disability Earnings (current monthlycompensation was greater). 2,000 per monthLTD Replacement.60% (.60)Deductible Income (Social Security). 625 per monthMaximum Disability Benefit CalculationYour LTD plan provides a benefit equal to 60% of yourpre-disability earnings (offset by deductible earnings)xPre-disability EarningsLTD Replacement 2,000 Maximum Monthly Disability Benefit 1,200.60Deductible Income CalculationThe next step is to determine any sources of deductibleincome and calculate the reduction. See above for sourcesof deductible income.Maximum Disability Benefits-Deductible Income Monthly Disability Benefit 1,200 625 575Cost-of-Living AdjustmentsYour LTD benefit is NOT eligible for cost-of-livingadjustments. Once the amount of your disability benefitis determined, it will not increase. However, when youbecome eligible to retire, the calculation of your benefit willinclude annual cost-of-living adjustments applied to yourmonthly salary, as of your date of disability through yourretirement date.RSMo: 104.410.6, 104.10427

LTD INSURANCE BENEFITSDual Employment ProvisionIf you work at more than one full-time position for the stateof Missouri and become disabled, the following will apply: If you are disabled from all your positions, your predisability earnings will be based on your earnings for allyour positions. If you are disabled from one of your positions and youcontinue to work in the others, your work earnings will beconsidered deductible income as described in the Returnto Work Incentive section (see page 14). If you are disabled from one of your positions andyou elect not to work in the others, your pre-disabilityearnings will be based only on your earnings for theposition from which you are disabled.When Your Monthly Benefit Payments Will BeginYour LTD benefit payments will begin at the end of thebenefit waiting period—90 days after your last day on thejob or the period of sick leave you are entitled to throughyour employer’s sick leave program, whichever is longer.LTD benefits will be issued on the first day of the monthafter your approval date. For example, if you are approvedfor disability on March 19, your first benefit payment wouldbe issued on April 1. All future benefit payments will bemade on the first day of each month.Once you begin receiving benefits, your employer mayterminate your employment with the state. Contact aMOSERS benefit counselor and your employer to getdetails about how these provisions are administered inyour agency.When Monthly Benefit Payments Will EndLTD monthly benefit payments will end when you: Are no longer disabled. Begin receiving early (reduced) retirement benefits. Are eligible to receive normal (unreduced) retirementbenefits. Begin receiving benefits under any other group longterm disability policy. Return to full-time active employment. Are able to work, but do not accept availableemployment. Die.8Overpayment of BenefitsTo provide you with an income as soon as possible, monthlydisability benefits may be paid before a Social Security orworkers’ compensation monthly benefit is determined.This may result in an overpayment. You must notify TheStandard Insurance Company if you begin receivingbenefits from workers’ compensation or Social Securitywhile receiving your LTD benefits.Duty to Pursue Deductible IncomeAccording to the terms of the policy, you may be asked topursue deductible income for which you may be eligible,including Social Security and workers’ compensationbenefits. The Standard Insurance Company may ask youto provide written documentation that you are activelypursuing these or other applicable benefits.Your are also required to report other deductible income. Toreport additional income such as Social Security disability,worker’s compensation, or part-time employment, submita copy of your Social Security notification letter, workers’compensation settlement, or current pay stub to TheStandard Insurance Company.If you receive payment (including any retroactive payments),from Social Security, workers’ compensation, or a parttime job, you must promptly refund any overpayment fromyour LTD benefit to The Standard Insurance Company. Ifyou do not, The Standard Insurance Company may reduceor withhold future benefits until the overpayment hasbeen repaid.TaxesYour LTD benefit is an employer-paid benefit, and isconsidered to be income similar to receiving a wage orsalary. Therefore, your LTD benefit is subject to certainfederal and state taxes. Medicare and Social Security taxeswill also be deducted from your LTD benefits. You may wantto consult a tax advisor to see how you may be affected.If you wish to have taxes withheld from your monthly LTDbenefit, The Standard Insurance Company will provide youwith the necessary forms. Each year, The Standard InsuranceCompany will also send you a W-2 for use in preparing yourincome tax return.For more information regarding tax implications onyour LTD benefit, please contact The Standard InsuranceCompany at (844) 505-6026 or contact a local tax advisor.

LTD INSURANCE BENEFITSApplying for LTD BenefitsThe Claims ProcessThe easiest and most preferred way to file a long-termdisability claim is by phone. Simply contact The Standard’sIntake Service Center at (844) 505-6026.You will be asked to provide the following information, inaddition to other questions about your absence: Employer name: Trustees of the Missouri StateEmployees’ Retirement System (MOSERS) Human resources contact: (Name/Phone Number) Group policy number: 604201 Your name and Social Security number Last day you were at work Nature of claim/medical information Physician’s contact information: (name, address, phoneand fax number)You may also file your claim at www.standard.com (click Filea Claim to begin the process), or download and completethe Long-Term Disability Benefits Claim Packet (mail orfax required forms listed below to The Standard InsuranceCompany).Employee’s Statement– You, the member, are responsible for completingthis form.Required Filing DatesFile a claim as soon as possible once you become disabled.We also encourage you to report a claim as soon as youbelieve you will be absent from work beyond 90 calendardays. If you are uncertain about how long you will be absentor whether you should file a claim or not, we suggest thatyou file your claim. This offers you some peace of mind andallows for The Standard Insurance Company to begin itsreview and issue a timely payment if appropriate.You must provide proof of loss to The Standard InsuranceCompany within 90 days after the end of the benefit waitingperiod. If you cannot do so, you must provide it as soon asreasonably possible, but not later than one year after that90-day period. If you file proof of loss outside these timelimits, your claim will be denied. These time limits do notapply if you legally lack the capacity to perform the filingprocedure.Cost to Apply for BenefitsYou will be responsible for paying any costs associated withthe completion of the Attending Physician’s Statement.If requested by The Standard Insurance Company, you maybe required to provide evidence of continuing disabilityat your expense. In some cases, The Standard InsuranceCompany may hire and pay for a physician to examine youto determine disability. Employer’s Statement– HR representative is responsible for completingthis form Attending Physician’s Statement– Part A: Member is responsible for completingthis form.– Part B: Physician is responsible for completingthis form.Once you have filed for disability, notify your HRrepresentative right away. This notification will trigger HRto submit information directly to The Standard InsuranceCompany, which is necessary to review your claim.For additional information, see Frequently Asked QuestionsAbout Filing a Long-Term Disability Claim available onour website.9

LTD INSURANCE BENEFITSThe Approval ProcessA disability analyst from The Standard InsuranceCompany will begin reviewing your disability claim oncethey have received all of the forms and authorizationscompleted in the claims process. Based on the specificnature of your case, your claim may also be evaluated byadditional experts.Depending on your individual situation, the approvalprocess may take anywhere from one week to four months.In some cases, The Standard Insurance Company mayrequire additional medical information in order to make adetermination. If additional information is necessary, youwill be informed in writing of what is needed, and why it isrelevant.You will be notified in writing of the evaluation outcome,and the reason for approval or denial of your claim. In somecases, you may choose to receive text messages regardingyour claim status, Text STATUS to 53284 to enroll. Thefrequency and number of message will vary based on theclaim. Message and data rates my apply. Please review TextMessage Terms and Conditions from The Standard on theirwebsite. Text STOP to 53284 to unsubscribe.Denial, Suspension, orTermination of an LTD ClaimThe Standard Insurance Company will notify you in writingif your disability claim is denied, suspended, or terminated.The company will outline the reason why, and refer to thegroup policy provisions on which the denial, suspension, ortermination is based.Appeal ProceduresYou will be informed by The Standard Insurance Companyof the steps you can take to resubmit your claim for reviewand reconsideration if your claim is denied, suspended,or terminated.You may ask for a review and submit any additionalinformation you think may be helpful in order to reevaluateyour claim if your claim is denied, suspended, or terminatedor if you disagree with the amount of LTD benefits beingpaid. You must make your request in writing to TheStandard Insurance Company within 180 days after youreceive notice. If additional information is needed toprocess your appeal, it will be promptly requested.10The Standard Insurance Company will notify you in writingof the decision on any review of your appeal. The reasonsfor the decision will be fully explained, with reference to theapplicable provisions of the group policy.Ordinarily, a decision on your appeal will be reached within45 days after the receipt of your review request. However,in special circumstances, an additional 45 days may benecessary to reach a final decision.The obligation to provide disability benefits is primarily thatof the insurance carrier (The Standard Insurance Company)and secondarily that of the MOSERS Board of Trustees. Ifyou are denied disability benefits after following the appealprocedures listed above, you may appeal the decision byfiling a petition against the insurance carrier in a court oflaw in your county of residence.Neither MOSERS nor our Board of Trustees is liable for thedisability benefits provided by the insurance carrier and arenot subject to litigation with regard to disability benefitsunless you obtain a judgement against the insurance carrierand it is unable to satisfy your judgement.Maintaining Your BenefitsThe Standard Insurance Company will periodically send youinformation regarding the status of your disability claim.During the first 24 months of your disability benefit (ownoccupation disability period), your claim will be reviewedto determine if you are disabled from any occupationthat fits within your education, training or experience. If adetermination is made that you are not disabled from anyoccupation, your LTD claim will be terminated at the end ofyour own occupation disability period. In addition, duringthe own occupation disability period, The Standard InsuranceCompany will continue to gather medical evidence insupport of your inability to perform your own occupation.For payments to continue through the end of the first24-month period, the medical evidence must continue tosupport your disability under the own occupation disabilityperiod.You may be eligible for certain rehabilitation programs as aresult of your disability. You may speak with your disabilityanalyst at The Standard Insurance Company regardingpossible rehabilitation programs suited for you.

LTD INSURANCE BENEFITSNotable LTD DatesDate ofDisability90-Days6-Months24-MonthsBenefitWaiting Period*Social Security BenefitWaiting Period**DisabilityChanges fromOwn Occupationto Any OccupationEarlyRetirementNormalRetirement* Working full-time or receiving full salary during the 90-day benefit waiting period coulddelay payment of or eligibility for LTD benefits.** An overpayment may exist if Social Security makes a lump-sum payment.If this occurs, you are required to reimburse The Standard Insurance Companyper the signed agreement.LTD benefit payments will start on the latter of: The end of the benefit waiting period When your sick leave expiresLTD benefit payments will stop when you: Are no longer disabled Begin receiving early (reduced) retirement benefits Are eligible to receive normal (unreduced) retirement benefits Begin receiving benefits under another group long-term disability policy Return to full-time active employment Are able to work, but do not accept available employment Die11

LTD INSURANCE BENEFITSCareer & Life Events That MayAffect LTD Insurance BenefitsApproved Leave of Absence or LayoffAs long as you remain in active pay status, your employerwill pay your LTD premiums.If you take an approved leave of absence or are laid offand wish to continue your LTD coverage, you may do so forup to one year. At the end of the 12-month period, yourcoverage will terminate.If you choose to continue LTD coverage, we will transferpremium payments electronically each month from achecking or savings account you designate. To make thisdesignation, request an Autopay Authorization form from aMOSERS benefit counselor. You must sign, date, and returnthe completed form to MOSERS along with a voided checkor a deposit slip. You may upload the form and a scan orphoto of your voided check or deposit slip on myMOSERS.We will debit direct bill payments directly from your accounton the 14th of each month, or the next business day. Pleaseallow 10 business days for initial processing.If you choose to terminate your LTD coverage while on anapproved leave of absence, your coverage will begin againon the date you return to work.Death and Your LTD BenefitsDeath Before Approval of Disability BenefitsYour long-term disability claim will continue through thereview process if you die after the benefit waiting period,Survivor BenefitsThe Standard Insurance Company will pay a survivor benefitif you die while receiving LTD benefits. This benefit is a lumpsum equal to three times your monthly LTD benefit withoutreduction by deductible income. The survivor’s benefit isintended to meet a portion of your family’s financial needsin the event of your death. The benefit will be paid to yoursurviving spouse or your unm

LONG-TERM DISABILITY BENEFITS Coverage Available to Eligible Employees November 2021 This handbook provides a description of your long-term disability insurance benefits pursuant to Chapter 104, RSMo, and The Standard Group Insurance Policy Number 604201 or successors thereto, issued to the Trustees of the Missouri

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