July 21, 2009 (formerly 50.33)
A. General. If an employee who participates in the University of Idaho Group Benefit Programs becomes disabled while actively at work, one or more of the following benefits may be available for wage replacement and/or health coverage: short and long-term disability insurance, workers compensation, continued medical program benefits, life insurance, and/or disability retirement.
B. Wage Replacement.
B-1. Short and Long Term Disability. Employees participating in the University of Idaho Group Life and Disability Plan are covered by short-term and long-term disability income protection plan, provided at no cost to the employee.
B-2. Process. Application for benefits should be made if an employee anticipates any possibility that absence for non work-related conditions may last for 30 calendar days or longer. Accumulated sick leave must be exhausted before benefits are payable. However, application should be made before sick leave has been exhausted and as early as possible to avoid undue delays. Long-term disability benefits may be available at the expiration of short-term disability. Qualified conditions, duration of benefits, benefit amounts; benefit maximums and other information regarding these programs are governed by the institution’s contract. Employees may view the Plan Booklet at Benefits Website.
B-3. Disability Retirement. An employee who becomes permanently disabled, including diagnosis of a terminal condition under certain circumstances may be eligible for disability retirement. The retirement program for accelerated vesting and qualifying disability rules govern. A disabled employee should contact the program administrator for requirements, benefits, application procedures and other information. Contacts include:
AIG VALIC 1-800-892-5558
B-4. Disability Wage Replacement. Disability wage replacement benefits that are related to a qualified condition that occurred for a qualified individual while actively at work will continue to be paid in accordance with the disability program guidelines. In many cases, when disability is from any occupation and not related to mental health, benefits may continue until the employee is no longer disabled or until attaining age 65. Any new disabling condition that is not related to the condition that first qualified the employee to receive benefits will typically not be covered.
C. Workers Compensation.
C-1. Workers Compensation. Benefits may be available for work related conditions to include medical payments and wage replacement. See APM 55.32 for detailed information and procedures. [ed. 7-09]
D. Health and Life Insurance Benefits.
D-1. Health Benefits. Health benefits for this section typically include medical and dental coverage. Health benefits and life insurance for an employee who becomes disabled and/or his or her covered dependents continue during an employee’s disability.
i) Continuation of Benefits During Leave of Absence. When leave of absence is compensated through paid time off such as sick or annual leave or while on paid or unpaid family medical leave, medical, dental and life benefits are afforded on the same basis as working employees. In the instance of unpaid family medical or any other approved leave without pay with benefits, medical, dental and life benefits are also continued. Once pay status ends during leave of absence, the employee must make arrangements to make monthly payments to cover the costs of medical, dental, life coverage or any other costs for his or her dependents that would otherwise have been taken by payroll deduction.
ii) Continuation of Health Benefits for Disabled Employees Unable to Work. If employment ends while an employee is disabled, continuation of medical and dental coverage may be available for up to 30 months from the date in which the disability first began (last day worked). Such coverage will be provided through COBRA if the employee and /or his dependents meet and continue to meet the COBRA eligibility regulations. COBRA coverage is not available when the member has access to any other coverage under a group plan or Medicare. The University will pay the cost of the employee’s coverage for the first 30 months of disability. Coverage for dependents may also be continued for up to 30 months. However, the employee must make arrangements with Benefit Services to pay the cost of coverage that would have otherwise been deducted from pay.
iii) Continuation of Health Benefits for Disabled Retirees. In the event that an employee qualifies for disability retirement as discussed in B-4 above, medical and dental, (if eligible) benefits may be continued as a disabled retiree. A disabled retiree must be currently enrolled and have had coverage at least 10 years in the University medical plan. A disabled retiree pays a share of the retiree costs and 100% of the cost of qualified dependents covered by the program. A disabled retiree and all covered dependents must accept Medicare when first eligible. If a disabled retiree is an honored emeritus or honored staff and qualifies for the UI Retiree Health Program (see FSH 3730), coverage under the UI Retiree Health Program with honored/emeritus status will take precedence.
D-2. Basic Life Insurance Benefits. Basic life insurance benefits continue throughout an employee’s disability and once qualified by the carrier, can be provided at a waiver of premium. A waiver of premium will keep benefits in force at no cost to the employee even after separation from employment. Continuation of benefits and waiver of premium are not automatic; the employee must submit an application and acceptable documentation. Contact Benefit Services for assistance.
D-3. Supplemental Life Insurance. Supplemental Life Insurance can be continued through self-payment of the premium throughout an employee’s paid status, an employee may also qualify for waiver of premium, or have rights to conversion of coverage to an individual policy within 30-days of loss of coverage.
E. Procedures for Disability Benefits.
E-1. Employee Responsibilities.
i) Employees who anticipate more than 4 weeks of lost time should contact Benefit Services immediately to request a disability application form. The employee completes the application, which includes obtaining a physician's statement of disability, and returns the forms to Benefit Services. Once Benefit Services has received the employee’s application they will send the request to the Principal for processing.
ii) Claims processing begins when both the employer statement and the employee application are filed with the Principal. Notification letters are sent from the Principal acknowledging the receipt of the application and the status of the claim.
iii) Employees should submit timesheets documenting their use of paid leave time to their timekeeper, Benefit Services, and if necessary, the insurer.
iv) The employee is also responsible for completing other paperwork that may be applicable, such as family medical leave application, shared leave, etc, maintaining contact with their department supervisor, submitting continuing evidence of medical conditions affecting their return to work, and submitting time sheets as appropriate.
E-2. University Responsibilities (Department and HR).
i) Departments will record the employee's sick leave until all sick leave has been used.
ii) Departments who anticipate having an employee on extended sick leave or an employee, who will be off work more than 4 weeks, are asked to call Benefit Services. Doing this will ensure that Benefit Services is aware that the employee will probably be transferring to disability status, enabling Benefit Services to monitor the situation and assure a smoother transition for the employee.
iii) When the employee has used all available sick leave, the employee has the option of, (1) being placed on leave without pay from the university and drawing only disability income benefits, leaving annual leave balances “on the books,” or, (2) reducing the appointment percentage to 40% and using any accrued annual leave balances to supplement his or her disability payments until annual leave is exhausted. (The second option would continue income levels for an approved claim temporarily at 100% of pre-disability level until the annual leave balance is exhausted.)
iv) If the employee notifies Benefit Services and their department that he or she chooses to supplement the disability payment with annual leave allowances, the department/timekeeper will need to submit an Electronic Personnel Action (EPAF) form [See 50.03] reducing the employee's percentage of paid time to the appropriate level. Comments should be made on the EPAF that the reduction in percent time is due to a disability claim so benefits are not reduced.
E-3. Information. The disability benefits application form is available from Benefit Services. Short and long-term disability benefits are coordinated with workers compensation benefits. Long-term disability benefits are also coordinated with social security disability benefits and retirement disability benefits and are subject to a $700 weekly maximum benefit. (Note: “Coordination of benefits” means the employee will receive an amount which is equivalent to the larger of one or more benefits, but will generally not receive an amount from all employer-provided sources which is greater than the largest single benefit.) For further information or questions regarding eligibility, limitations, the application process or benefits, call Benefit Services (208) 885-3697.