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Long-Term Disability (LTD)

                                               

 

 


 

Plan Details

Long-Term Disability (LTD) insurance is designed to provide you with income if you are absent from work for six consecutive months or longer due to an eligible illness or injury. If elected, a participant may be eligible to receive benefits through LTD insurance after 180 days of disability. Employees pay the full cost of coverage on an after-tax basis.

The long term disability plan provides a monthly benefit of up to 60 percent of an employee's base monthly salary, not to exceed $13,890 per month. In some states, LTD benefits may be paid at the same time as STD benefits. When this occurs, benefits will be integrated with other sources (refer to your LTD evidence of coverage for more information).

If you choose to waive LTD insurance, you may be subject to medical underwriting if you decide to elect coverage at a later time, even if enrollment is due to a qualifying life event. The plan’s underwriter will request that you complete an Evidence of Insurability (EOI) form. Completed EOI forms should be submitted to the ESS HR Benefits Service Desk.

For more information, download the Evidence of Coverage document.

Below are some important terms used in describing how a participant is eligible to receive benefits through the LTD plan:

  • Qualified Disability — One where a participant cannot perform his or her own occupation in the first two years of disability. After two years of disability, a qualified disability is one where a participant is unable to perform any occupation that he or she is reasonably qualified to hold. Refer to the LTD evidence of coverage, issued by Life Insurance Company of North America (LINA), a CIGNA company, for more information on criteria for "own occupation" versus "any occupation."

    The participant will be required to provide objective medical evidence to CIGNA, the claims administrator, to qualify for benefits. The plan administrator will determine the types of medical documentation needed and how frequently the documentation must be updated.

  • Claims AdministratorLife Insurance Company of North America (LINA), a CIGNA company.
  • Claims FiduciaryLife Insurance Company of North America (LINA), a CIGNA company.

    The plan administrator has appointed Life Insurance Company of North America (LINA), a CIGNA company, as the claims fiduciary for adjudicating claims for benefits under the Plan, and for deciding any appeals of denied claims. The Insurance Company shall have the authority, in its discretion, to interpret the terms of the Plan, to decide questions of eligibility for coverage or benefits under the Plan, and to make any related findings of fact. All decisions made by the Insurance Company shall be final and binding on Participants and Beneficiaries to the full extent permitted by law.

This document provides only a summary of general plan provisions. A separate evidence of coverage is available from CIGNA, which serves as the legal document that governs the plan.


 

Overview

If a participant is unable to work after 180 days of continuous disability, he or she may become eligible to receive LTD benefits if elected.

Employees who elect coverage will be eligible to receive up to 60% of his or her monthly base salary up to a maximum monthly benefit of $13,890, minus any reductions for other income benefits (state disability, Social Security disability, etc.).

LTD is underwritten by LINA (a Cigna company), and a participant must meet the plan's criteria for disability to qualify for income replacement under this program. Refer to the plan's evidence of coverage for more information about qualifying for income replacement.

The following maximum benefit periods apply:

AGE WHEN PARTICIPANT'S DISABILITY BEGINS MAXIMUM BENEFIT PERIOD

Age 62 or under

The employee's 65th birthday or the date the 42nd monthly benefit is payable, whichever is later

Age 63

The date the 36th monthly benefit is payable

Age 64

The date the 30th monthly benefit is payable

Age 65

The date the 24th monthly benefit is payable

Age 66

The date the 21st monthly benefit is payable

Age 67

The date the 18th monthly benefit is payable

Age 68

The date the 15th monthly benefit is payable

Age 69 or older

The date the 12th monthly benefit is payable

What to Do in Case of a Long-Term Disability

If a participant is unable to work due to a qualified disability lasting more than 180 days, he or she may be eligible for LTD benefits.

To assist the employee in transitioning from short term to long term disability claim with Cigna, 45 days prior to STD maximum duration:

  1. Sedgwick will submit the claim to Cigna.
  2. Sedgwick will copy and send by overnight mail the medical records, job description, and payment history from the disability claim file. In addition, the Examiner will complete the form "Integrated Disability Management Transition Information" and send to Cigna.
  3. Sedgwick will send a letter to the claimant notifying them that they referred the claim to Cigna for evaluation of LTD Benefits.
  4. Cigna will acknowledge receipt of claim by sending out a confirmation letter to the employee once the online submission is completed.
  5. Within 10 days a dedicated claim manager will contact the employee via telephone to introduce themselves and notify them of the process. A follow up letter will be sent following this conversation to notify the claimant of any outstanding information and all applicable policy provisions.

Definition of Disability/Disabled

A participant is disabled if, because of injury or illness:

  • He or she is unable to perform all the duties of his or her regular occupation, or only because of the injury or illness he or she is unable to earn more than 80% of his or her indexed covered earnings; and
  • After disability benefits have been paid for 24 months, he or she is unable to perform all the duties of any occupation for which he or she may reasonably become qualified based on education, training or experience, or only because of the injury or illness he or she is unable to earn more than 80% of his or her indexed covered earnings. Refer to the evidence of coverage for more information about indexed covered earnings.

If the participant is receiving benefits from the LTD plan:

  • Disability benefits are paid once a month;
  • Benefits can be sent through the mail, or electronically deposited;
  • If not directed otherwise, the participant will receive a check mailed to his or her home or address of record from the insurance company; and
  • There are no deductions other than applicable taxes and offsets (see the evidence of coverage for more details).

Limitations and Exclusions

LTD benefits are provided based on certain maximums and exclusions. For more information, participants can also refer to What the LTD Plan Does Not Cover.

Pre-Existing Conditions

LTD benefits will not be paid for any disability caused by, contributed to or resulting from a pre-existing condition. A "pre-existing condition" means any injury or illness for which the participant:

  • Incurred expenses;
  • Received medical treatment, care or services including diagnostic measures;
  • Took prescribed drugs or medicines; or
  • For which a reasonable person would have consulted a physician within three months before his or her most recent effective date of insurance.

The pre-existing condition limitation will not apply to a participant covered under a prior plan who satisfied that plan's pre-existing condition limitation, if any. It will still apply to any benefit amount greater than that of the prior plan. If the participant did not completely satisfy the pre-existing condition limitation of the prior plan, he or she will receive credit for any time that was satisfied.

Time will not be credited for any day a participant is not actively at work due to his or her injury or illness. The pre-existing condition limitation will be extended by the number of days the participant is not actively at work due to his or her injury or illness.

Benefit Maximums for Certain Conditions

LTD benefits will be paid on a limited basis during a participant's lifetime for a disability caused by, or contributed to by, any of the following conditions. Once 24 monthly disability benefits have been paid, no further benefits will be paid for any of the following conditions:

  • Alcoholism
  • Anxiety disorders
  • Delusional (paranoid) disorders
  • Depressive disorders
  • Drug addiction or abuse
  • Eating disorders
  • Mental illness
  • Somatoform disorders (psychosomatic illness)

If before reaching the lifetime maximum of 24 monthly benefits, a participant is confined in a hospital for more than 14 consecutive days for the appropriate care of any of the conditions listed above, that period will not count against the lifetime limit.

For a complete list of the LTD plan's limitations and exclusions, refer to the plan's evidence of coverage.

The Plan Determines Eligibility and Certifies Disability

The plan's claims administrator, Cigna, determines eligibility and makes a determination of disability.

Cigna, at its expense, has the right to examine, as often as reasonably required, any participant with a pending claim. Cigna may also require an autopsy, at its expense, unless prohibited by law.

There is a formal appeal process if the participant disagrees with the determination of the claims administrator. For more information on the appeal process, refer to the plan's evidence of coverage.

Confidentiality

All medical information that a participant and his or her physician supply to the LTD plan is kept confidential and will be protected from unauthorized use. Certain claims for non-occupational disability benefits may require the use of a special, written authorization form. If a participant receives one of these forms, he or she will need to sign and return it as soon as possible so there is no delay in processing the claim.

Claims Management

The LTD plan will require that the participant cooperate in collecting the medical information necessary to review the claim and make a benefit determination. The most common reason that claim payments are delayed is the failure of the participant's health care provider to return calls, return forms or otherwise provide medical documentation. A participant can help the plan administrators make more timely decisions by:

  • Explaining to the health care provider that the administrator will be contacting them;
  • Following up with the health care provider's office after a request for information has been made to ensure that the information is being collected and sent to the administrator; and
  • Notifying Cigna immediately if the participant's return-to-work plans change, or if the health condition significantly changes (for example, if a surgery is needed). This will allow the plan administrator to help the employee file for an extension of benefits, if appropriate.

Continuation of Insurance

Disability insurance continues if a participant's active service ends because of a disability for which covered benefits are or may become payable. Premiums for the participant will be waived while disability benefits are payable. If the participant does not return to active service, this insurance ends when the disability ends or when benefits are no longer payable, whichever occurs first.

If a participant's active service ends due to an employer-approved unpaid leave of absence, insurance for that participant will continue for up to 24 months if the required premium is paid. If a participant's active service ends due to family medical leave of absence, insurance for that participant will continue for up to 12 weeks if the required premium is paid.

Rehabilitation During a Period of Disability

If, while a participant is disabled, the plan determines that he or she is a suitable candidate for rehabilitation, he or she may participate in a rehabilitation plan. The terms and conditions of the rehabilitation plan must be mutually agreed upon by the participant and the plan.

The plan may require a participant to participate in a rehabilitation assessment or a rehabilitation plan at its expense. The plan will work with the participant, the employer and the participant's physician and others, as appropriate, to develop a rehabilitation plan. Disability benefits will not be paid if the participant refuses to participate in the rehabilitation efforts.

The rehabilitation plan may, at the plan's discretion, allow payment of the participant's medical expense, education expense, moving expense, accommodation expense or family care expense while he or she participates in the program.

A "rehabilitation plan" is a written agreement between the participant and the plan in which the plan agrees to provide, arrange or authorize vocational or physical rehabilitation services.

Work Incentive Benefits

For the first 12 months the participant is eligible for a disability benefit, the disability benefit is determined based on the minimum and maximum disability benefit. If for any month during this period, the sum of the participant's disability benefit, current earnings and any additional other income benefits exceeds 100% of his or her indexed covered earnings, the disability benefit will be reduced by the excess amount.

After the first 12 months, the disability benefit is determined based on the minimum and maximum disability benefit, reduced by 50% of his or her current earnings received during any month he or she returns to work. If the sum of the participant's current earnings and any additional other income benefits exceeds 80% of his or her monthly indexed covered earnings, the disability benefit will be reduced by the excess amount figured above. No benefits will be paid if the plan determines the participant is able to work under a transitional work arrangement or other modified work arrangement and he or she refuses to do so.

Current earnings include any wage or salary for work performed while disability benefits are payable. If participant is working for another employer on a regular basis when disability begins, current earnings will include any increase in the amount he or she earns from this work during the period for which disability benefits are payable.

Survivor Benefit

The plan will pay a Survivor Benefit if a participant dies while monthly benefits are payable. The participant must have been continuously disabled for the survivor benefit waiting period before the first benefit is payable. These benefits will be payable for the maximum benefit period for Survivor Benefits.

Benefits will be paid to the participant's spouse or registered domestic partner. If there is no spouse or registered domestic partner, benefits will be paid in equal shares to the participant's surviving children. If there are no spouse/registered domestic partner and no children, no benefits will be paid.

"Spouse" means a participant's lawful spouse. "Registered Domestic Partner" is defined in the Eligibility section. "Children" means a participant's unmarried children under age 21 who are primarily dependent upon the participant for support and maintenance. The term includes a stepchild living with the participant at the time of his or her death.


 

Social Security Disability Benefits

When a participant is unable to work for an extended period of time, he or she may be eligible for Social Security Disability Income (SSDI). SSDI allows an employee to receive income.

A participant who is disabled should apply for SSDI as soon as it is clear that the duration of the disability will be longer than six months. When the participant applies for LTD benefits, CIGNA will require that the participant apply for SSDI benefits, and will offer assistance throughout the SSDI application process.

If the participant is eligible for Social Security disability benefits, any such payment will be subtracted from disability benefits he or she receives from the disability plans.

It is not uncommon for the SSDI application and approval process to take several months, and for benefits paid to be retroactive back to a certain date of disability. A participant receiving LTD benefits will be asked by CIGNA to sign an Overpayment Reimbursement Agreement stating that he or she will reimburse CIGNA for any Social Security benefits received for the same period of time he or she was receiving disability benefits.

Other LTD Benefits

The LTD plan is designed to provide a certain degree of income protection if a participant is unable to work for long periods of time. However, the plan may reduce the disability benefit paid if, while a participant is disabled, he or she may be eligible for benefits from other income sources. If so, benefits may be reduced by the amount of these other income benefits, including:

  • Any amounts which the participant or any dependents receive (or are assumed to receive) under:
    • the Canada and Quebec Pension Plans;
    • the Railroad Retirement Act;
    • any local state, provincial or federal government disability or retirement plan or law as it relates to the participant;
    • any employer sick leave plan;
    • any work loss provision in mandatory "No-Fault" auto insurance;
    • any Workers' Compensation, occupational disease, unemployment compensation law or similar state or federal law, including all permanent as well as temporary disability benefits. This includes any damages, compromises or settlement paid in place of such benefits, whether or not liability is admitted;
  • Any Social Security disability benefits the participant or any third party receives (or are assumed to receive) on the participant's behalf or for his or her dependents; or, which his or her dependents receive (or are assumed to receive) because of the participant's entitlement to such benefits;
  • Any employer-funded retirement plan benefits. "Retirement plan" means any defined benefit or defined contribution plan sponsored or funded by a participant's employer. It does not include:
    • an individual deferred compensation agreement;
    • a profit sharing or any other retirement or savings plan maintained in addition to a defined benefit or other defined contribution pension plan;
    • any participant savings plan including a thrift, stock option or stock bonus plan, individual retirement account or 401(k) plan;
  • Any proceeds payable under any franchise or group insurance or similar plan. If there is other insurance that applies to the same disability claim, and which contains the same or a similar provision for reduction because of other insurance, the plan will pay the proportion of the total benefit payable under the policy, without other insurance, as it applies to the total benefits under all such policies;
  • Any amounts paid because of lost earnings or loss of earning capacity through settlement, judgment, arbitration or otherwise, where a third party may be liable, regardless of whether liability is determined;
  • Any wage or salary for work performed. If a participant is covered for Work Incentive Benefits, the plan will only reduce disability benefits to the extent provided under the Work Incentive Benefit in the Schedule of Benefits.

Although this coordination of benefits may reduce the amount received from the LTD plan, all benefits together will still equal the total amount the participant is eligible for under the LTD plan.


 

When Benefit Payments End

LTD benefits end:

  • When the participant is eligible for coverage under a plan intended to replace this coverage;
  • When the insurance policy is terminated;
  • When the participant is no longer eligible;
  • On the day after the period for which premiums are paid; or
  • When the participant dies.

For more information about when LTD benefits end, refer to the plan's evidence of coverage.

Returning to Work

Leidos requires that all participants returning from LTD provide a "fitness for duty" or "doctor's release" when he or she returns to work. This document is usually a note from the health care provider clearly stating he or she is not considered to be disabled, as well as the date he or she is able to return, as well as the date of release that the participant may return to full duty. If the health care provider is requesting modified duty or limited hours, this should be discussed with CIGNA and the workplace in advance of the participant's return to work. A participant who does not present a release may not be allowed to work until the release is presented.


 

If the Participant Becomes Disabled Again

Once a participant is eligible to receive LTD disability benefits, separate periods of disability resulting from the same or related causes are considered a continuous period of disability unless the participant returns to active service with Leidos for more than six consecutive months.

A period of disability is not continuous if separate periods of disability result from unrelated causes or the later disability occurs after coverage ends.

If a participant is eligible for coverage under a plan that replaces this disability plan, the successive periods of disability provision will not apply.

For more information about what happens when a participant becomes disabled again, refer to the plan's evidence of coverage.


What is Not Covered

LTD benefits will not be paid for a disability that result, directly or indirectly, from:

  • Suicide, attempted suicide, or whenever a participant injures himself or herself on purpose;
  • War or any act of war, whether or not declared (For Class 1 employees only);
  • Serving on full-time active duty in any armed forces. If the participant sends proof of military service, the plan will refund the portion of the premium paid to cover the participant during a period of such service;
  • Active participation in a riot;
  • Commission of a felony; or
  • Revocation, restriction or non-renewal of a participant's license, permit or certification necessary to perform the duties of his or her occupation unless that is due only to covered injuries or illnesses.

LTD benefits will not be paid for any period of disability during which the participant:

  • Is incarcerated in a penal or corrections institution;
  • Is not receiving appropriate care under a licensed physician;
  • Fails to cooperate with the plan in the administration of the claim, such as providing any information or documents needed to determine whether benefits are payable or the actual benefit amount due;
  • Refuses to participate in rehabilitation efforts as required by the plan; or
  • Refuses to participate in a Transitional Work Arrangement or other modified work arrangement.

    "Transitional Work Arrangement" means any work offered to the participant by Leidos or an affiliated company while the participant is disabled and which may be his or her own or any occupation. The term includes but is not limited to reassigned duties, work site modification, flexible work arrangements, job adaptation or special equipment.

For more information about what the LTD Plan does not cover, refer to the plan's certificate of coverage.


 

Conversion Privilege

If a participant's coverage ends because employment with Leidos ends, or a participant is laid off or on an uninsured leave of absence, he or she may be eligible for long term disability conversion insurance. To be eligible, a participant must have been insured for disability benefits and actively at work for at least 12 months. A participant must apply for conversion insurance within 62 days after coverage ends. The benefits of the conversion plan will be those benefits offered at the time a participant applies. The premium will be based on the rates in effect for conversion plans at that time.

Conversion insurance is not available if any of the following conditions apply:

  • A participant is retired or age 70 or older;
  • A participant is not in active service because of disability; or
  • The insurance policy is canceled for any reason.

 

  • LTD Conversion Form (Except NY)

    This form needs to be completed if an employee (not a New York resident) wishes to continue long term disability coverage upon termination of employment.

  • LTD Conversion Form (NY only)

    This form needs to be completed by an employee residing in New York wishes to continue long term disability coverage upon termination of employment.