The Long Term Disability Benefit

What the Benefit Is

If you are unable to work because of a long-term disability, the Disability Policy purchased by the Health and Welfare Fund will pay, monthly, 60% of your basic monthly earnings.  Your monthly income under this benefit will be reduced by certain types of other income (PSERS and Social Security disability). The Social Security disability payment offsets the basic payment only once. There is a maximum monthly limit of $2500. This benefit starts either 365 days after you have become disabled or after you have exhausted your health insurance, whichever is longer. In years in which a state contribution penalty would not be applied (such as "30 and out"), the 365 day wait may be waived.  It continues until age 65 if you begin to collect the benefit prior to reaching age 62. If you begin to collect the benefit at ages 62, 63, or 64, you may collect for a maximum of thirty-six months. If you begin to collect the benefit at ages 65, 66, or 67, you may collect for a maximum of twenty-four months. If you begin to collect at ages 68 or 69, you may collect for a maximum of twelve months. If your disability is the result of an accident, payment will be made for life.

Exclusions and Limitations

Your monthly income under this benefit is reduced by the total of all other income you receive for that month from any other source of benefits (e.g., Social Security, government disability or retirement coverage, Worker's Compensation, and the Retirement System). Social Security benefits and PSERS benefits will be subtracted automatically unless you can demonstrate that you have applied for those benefits and have been denied them.

Example: If you are entitled to a total disability payment of $1200 per month and you are already receiving $200 per month  from Social Security and $300 per month  from the Retirement System, you will collect $700 a month under the Long Term Disability Benefit Program. Social Security is a one-time only offset.

Benefits will not be paid under the following circumstances:

• Self-inflicted injuries.
• Disability caused by war or war-like acts.
• Illness or injury for which you were already being treated during the 6 months before you were eligible for coverage under this benefit. (However, such pre-existing conditions are covered if your Disability starts up again 12 months or more after you are eligible for this benefit).

If a person collecting this benefit engages in rehabilitative work, the monthly income from this benefit will be reduced.

For mental disability (i.e., caused or contributed to by a mental illness or nervous disorder) your Long Term Disability benefits will be paid for 24 months (2 years). However, if after the 2-year period you are confined in a mental hospital for 14 days or more, you will receive payments during the hospital stay and the 3 months following the stay.

SOME SPECIAL QUESTIONS

What about Dependents? Dependents are not covered under this benefit.

Who determines what disability is? A legally qualified physician or surgeon must be treating you and must say you are disabled. The insurance company selected by the Fund will also want its own doctor to confirm this; they have that right. The insurance company must approve the benefit.

What are those "Basic Monthly Earnings" on which this benefit is based? The benefit is based on the gross salary before any deductions shown on your last paycheck prior to the time the disability started. NOTE: The benefit does not include extracurricular, staff development, or any other additional compensation.

What about successive disabilities? Your benefits depend upon the cause of the successive disability or disabilities. If the cause of your second disability leave is the same as the cause of the first one, the two leaves will be considered as one unless you have been back on the job for 3 months. On the other hand, if your second disability leave is caused by something other than the cause of your first disability leave, then the second one is treated as a new disability and there is another waiting period.

When are you eligible? You are protected as soon as you have satisfactorily completed 1 day of the appointment for which you were hired, on a scheduled work day. To receive the benefit you must:

• be so disabled that you are completely prevented from engaging in your occupation;

• have been disabled for at least 365 continuous days;

• have exhausted your health insurance; and

• be less than 70 years old.

How to Use the Benefit

Secure information and forms from the Health and Welfare Fund Office. It is requested that claim forms be returned within a reasonable amount of time. It is recommended that a member make an appointment for long-term disability counseling with the retirement coordinators at the Fund Office.

Special Benefits Under Long Term Disability

If you are a recipient of Long Term Disability payments, you are entitled to a prescription benefit. Only you are covered, not your spouse or dependents. To receive the benefit, do the following:

• Complete a Retiree Enrollment form, which is available from the Health and Welfare Fund Office.
• Send the completed enrollment form to the Health and Welfare Fund Office located at 1816 Chestnut Street, Philadelphia, Pennsylvania.