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LONG-TERM DISABILITY AND SURVIVOR BENEFIT PLAN

LONG-TERM DISABILITY AND SURVIVOR BENEFIT PLAN. Presented By: Tammy Usher Chief Executive Office Risk Management Branch Long-Term Disability. County of Los Angeles “To Enrich Lives Through Effective and Caring Service”. Long-Term Disability.

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LONG-TERM DISABILITY AND SURVIVOR BENEFIT PLAN

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  1. LONG-TERM DISABILITY AND SURVIVOR BENEFIT PLAN Presented By: Tammy Usher Chief Executive Office Risk Management Branch Long-Term Disability County of Los Angeles “To Enrich Lives Through Effective and Caring Service”

  2. Long-Term Disability • The Long-Term Disability (LTD) Benefit provides a monthly income replacement to eligible participants when they are sick or disabled from work for more than six months.

  3. Long-Term Disability • An eligible County employee must be a General Member of Retirement Plan A, B, C, D, or E of the County of Los Angeles Employees Retirement Association (LACERA), and appointed to a County item as follows: “A,” “L,” “N,” or “D (with restrictions),” and “M (with restrictions)”.

  4. Authority, Eligibility & BenefitNon-MegaFlex Choices, Options and Flex (excluding Safety Retirement members) • The Non-MegaFlex LTD Plan is governed by section 5.38 of the County Code. • Employees must have five years of continuous County service or have an admitted worker’s compensation claim. • Employees are offered LTD benefits at 60% of their average basic monthly compensation (for the 12 months prior to the qualifying disability).

  5. Authority, Eligibility & BenefitMegaFlex Non-Represented and certain Management level Safety Classification Employees • The MegaFlex LTD Plan is governed by sections 5.27and 5.28 of the County Code. • Before the qualifying disability begins, a MegaFlex employee must have purchased LTD benefits at 40% or 60% of their average basic monthly compensation for the 12 months prior to the qualifying disability. MegaFlex employees in Retirement Plan E with five years of continuous County service or an admitted worker’s compensation claim qualify for a 40% LTD core benefit.

  6. LTD Application Process • An eligible employee must be disabled for six months or more with the qualifying disability approved by the County’s third-party administrator for LTD benefits. The six month waiting period is not extended if the employee returns to work for an aggregate of 29 days or less during the waiting period. But the six month waiting period will have to start over if the employee returns to work for an aggregate of 30 days or more.

  7. LTD Application Process • Employees absent from work for more than four months will receive an LTD Application form to apply for LTD benefits from Sedgwick CMS (Sedgwick), the County’s Third Party Administrator. • An employee must complete the “Employee’s Statement of Claim” form, and their physician must complete the “Attending Physician’s Statement” form. The completed LTD application forms must be returned to Sedgwick within one year from the first day of absence, otherwise, no benefits shall be paid under the LTD Plan.

  8. LTD Application Process • Within 30 days of filing an LTD application for benefits, employees must also apply for Social Security Disability (SSD) benefits under the Federal Social Security Act (FSSA), to complete the application process. • LTD Plan requires that employees provide Sedgwick with proof of their application for SSD benefits under the FSSA, regardless of whether or not they were found eligible to receive FSSA benefits.

  9. Duration of LTD Benefits • The first 24 months of benefit eligibility, an employee must be disabled and unable to perform the duties of their County position. • After 24 months of eligibility, an employee must be deemed totally disabled and unable to perform the duties of any occupation.

  10. Coordination of LTD Benefits • If an employee is entitled to other income replacement benefits as a result of their disability, their LTD benefit will be coordinated with these other benefits. • Employees who elect to use sick leave, vacation, annual leave, or other accrued time in lieu of LTD benefits, “Coordinated” means LTD benefits will be substituted on a day-for-day basis (not dollar-for-dollar basis), resulting in one day’s loss of LTD benefits for each day of substituted time. • Note: Employees on LTD cannot use paid leave or donated leave on a once-a-month frequency to maintain health care contributions or other cafeteria benefits.

  11. Long-Term Disability Health Eligibility & Benefit • An employee must be approved for LTD benefits, and also be enrolled in a County-sponsored medical plan to participate in the LTDH Plan. • The County LTDH Plan provides a “core” coverage of 75% County-sponsored medical premium while receiving LTD benefits. The employee will pay 25% of the monthly premium. • If an employee elects to “buy-up” with LTDH prior to the start of their disability, they will be covered for 100% of their health benefit while receiving LTD benefits.

  12. Long-Term Disability Health Eligibility & Benefit • The LTDH program is provided by the Department of Human Resources (DHR), Employee Benefits Division. Please contact DHR directly at (213) 388-9982 if you have questions about LTDH.

  13. Survivor Benefit & EligibilityNon-MegaFlex Choices, Options and Flex (excluding Safety Retirement members) • Survivors of Non-MegaFlex deceased employees who had five years or more of County Service qualify for Survivor Benefits (SB). For the life of the surviving spouse or domestic partner, SB pays 55% of the 60% LTD benefit, whether or not the employee was receiving LTD on the date of death.

  14. Survivor Benefit & EligibilityMegaFlex Non-Represented and certain Management level Safety Classification Employees • MegaFlex employees do not receive SB benefits, but MegaFlex Retirement Plan E employees may elect a separate Survivor Income Benefit (SIB) Plan. More information about SIB coverage may be found in the MegaFlex Summary Plan Description from the Department of Human Resources, Employee Benefits Division.

  15. Other Resources • Additional LTD information is available on the County Medical Provider Network website at: http://ceo.lacounty.gov/rtw/rtw_default.htm (click on the Return-To-Work Unit) • At the website you will find: • The LTD Booklets for MegaFlex, and Non-MegaFlex (Choices, Options, and Flex) • The LTD Pamphlet • Excerpt from the County Code that relates to LTD

  16. Other Resources • Contact Sedgwick @:(800) 786-8600 Fax – (818) 591-7644 Sedgwick CMS PO Box 9830 Calabasas, CA. 91372-0830

  17. LTD & Survivor Benefits This video is intended only as an overview of the LTD Plan. In the event that there are any discrepancies or inconsistencies between the information provided in this video and the provisions of the County Code, the County Code shall govern.

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