Download Long-term disability - Professional Insurance Enrollers

Product specification
Disability insurance
Long-term disability
Long-term disability is a fully-insured group product with base disability income benefits as well as optional riders.
Long-term disability insurance provides long term income protection if an employee becomes disabled from a covered
accidental bodily injury, sickness or pregnancy. It replaces a percentage of income employees would have earned had
they been able to continue working. Benefits may be offset for other income and/or benefits received.
Plan options
Non-contributory – Premiums 100% employer paid and a minimum of 100 employees.
Contributory (voluntary) – Premiums wholly or partly paid by the employees. Greater of 25 lives or
25% of eligible group. Other options may be considered on a case by case basis.
Core and buy-up – Premiums on the base (core) plan are paid for by the employer and wholly or
partly by the employee on the buy-up plan.
Benefit
Income replacement percentages up to 66 ⅔% for non-contributory and up to 60% on
contributory/voluntary plans.
Eligibility
❯ Active full-time employees working 30 hours or more per week
❯ Part time employees and other eligibility hours will be considered on a case-by-case basis
Maximum benefit
duration
Range of graded duration maximum tables, from two- and five-year maximums to graded duration
to age 65 or normal Social Security retirement age.
Elimination period
Available options: 90, 120, 150, 180 and 365 days
Definitions of disability
❯ Disability or disabled means the employee is prevented from performing one or more of the
essential duties of their occupation during the elimination period; is prevented from performing
essential duties of their occupation and has a specified percentage loss of earnings for a period of
time known as the “own occupation” period; and, after the end of the “own occupation” period,
is prevented from performing essential duties of “any occupation;” to satisfy the elimination
period, a loss of earnings is not required; only a loss of duties is required
❯ Own occupation provision available for following time periods: one, two, three or five years, and
to the end of the benefit duration
Recurrent disability
❯ If the insured returns to work during the elimination period, the period of recovery will not
interrupt the elimination period as long as the period of recovery does not exceed a specified
number of days
❯ If the insured returns to work as an active full-time employee after the elimination period for up
to six months and then becomes disabled again, and the recurrent disability is due to the same (or
related) cause as the original disability, the insured will resume the original disability and not be
required to satisfy the elimination period again
Coverage basis
24-hour coverage is standard.
Maximum benefit
amounts
Up to $20,000 per month with $10,000 as the standard.
FOR AGENT USE ONLY
GN-05833-WB 11/09
Long-term disability
Long-term disability is a fully-insured group product with base disability income benefits as well as optional riders.
Long-term disability insurance provides long term income protection if an employee becomes disabled from a covered
accidental bodily injury, sickness or pregnancy. It replaces a percentage of income employees would have earned had
they been able to continue working. Benefits may be offset for other income and/or benefits received.
Pre-existing conditions
❯ Options (in months):
• Look back period/treatment free period/insured period: 3/3/12; 3/6/12; 6/6/12; 12/6/24;
and 12/12/24
• Look back period/insured period: 3/12, 6/12, 12/12 and 12/24
❯ Look back period – A specified amount of time, prior to the individual’s effective date, that helps
determine whether a medical condition is considered to be pre-existing; pertains to coverage or
an increase in coverage
❯ Treatment free period - A specified length of time, beginning with the individual’s effective date
of coverage, during which he/she received no medical treatment for the condition that caused
the disability; when using the look back period/insured period options, the treatment free period
equals the insured period
❯ Insured period – A specified length of time, beginning with the individual’s effective date of
coverage that is the maximum period of time to limit a condition to a pre-existing condition
Continuity of coverage
from a prior plan
This provision protects employees from losing coverage due to a change in insurance carriers.
Survivor benefit
Option of three or six month benefit.
Family care credit
This benefit is an incentive to the disabled insured who has family care responsibilities that need to be
addressed to enter a program of rehabilitative employment. The monthly income from rehabilitation
employment is reduced by up to $350 per dependent child for purposes of determining monthly
benefits. The credit is not to exceed $2,500 per calendar year.
Workplace Modification
benefit
This benefit may reimburse employers for expenses related to necessary modifications to help a disabled
employee return to work.
Mental illness &
substance abuse
limitation
Limitation options between 12-60 months for mental illness and/or alcoholism and substance abuse.
Mental illness and substance abuse may have different limitations.
FOR AGENT USE ONLY
GN-05833-WB 11/09
Long-term disability
Long-term disability is a fully-insured group product with base disability income benefits as well as optional riders.
Long-term disability insurance provides long term income protection if an employee becomes disabled from a covered
accidental bodily injury, sickness or pregnancy. It replaces a percentage of income employees would have earned had
they been able to continue working. Benefits may be offset for other income and/or benefits received.
Optional benefits
Infectious and Contagious Disease Benefit
❯ Covers loss of income caused by loss of license or reduced patronage because the employee is a
carrier of an infectious disease but is not disabled
Cost-of-Living Adjustment
❯ Totally disabled employees receive annual increases to monthly benefits by the lesser of (either
3% or 6%) or one half the percentage change in the Consumer Price Index; a maximum of ten
cost-of-living adjustments
Activities of Daily Living Benefit
❯ An additional benefit may be payable if there is a loss of two or more activities of daily living; the
benefit is between 10% and 40% of monthly income loss up to the lesser of maximum monthly
benefit or $5,000; a serious cognitive impairment may also qualify for benefits
Extended Earnings Protection Benefit
❯ Provides a benefit for a limited time to an insured who returns to full time work, but is earning
a reduced income; it is attractive to the insured who may lose his or her client base during an
extended disability
Pension Contribution Benefit
❯ Replaces a portion of lost pension contributions for employees who experience longer claims; the
employer’s pension plan must be able to accept outside contributions
Accidental Dismemberment and Loss of Sight Benefit
❯ Applies to certain dismemberments or loss of sight resulting from accidental injury; the monthly
benefit for disability will be paid for the number of months shown even if the insured returns to
work sooner
Return to work services
❯ Our team of professionals will actively guide and encourage the insured’s efforts to return to work, if
appropriate; we assess the disability and determine the appropriate resources and support services
❯ Support services may include: vocational testing and training, alternative treatment plans, workplace
modification and job placement; 100% return to work incentive that allows benefits plus earnings to
replace 100% of the pre-disability earnings for a specified amount of time
Insured by Kanawha Insurance Company, a Humana company.
FOR AGENT USE ONLY
GN-05833-WB 11/09
Long-term disability is Kanawha Insurance Company Policy Form 7111 9/05