Short-Term Disability (STD) Coverage

The Short-Term Disability Plan provides financial protection for you by paying a portion of your income while you are disabled.  The amount you receive is based on the amount you earned before your disability began.  In some cases, you can receive disability payments even if you work while you are disabled.

Short-Term Disability is a voluntary plan that you pay for through payroll deduction.

How Much the Plan Pays

The STD benefits you receive are based on your weekly earnings before your disability began and pays 60% of weekly earnings to a maximum benefit of $1,500 per week.

Your benefits may be reduced by the amount of other income replacement benefits you receive for the same disability. For more information, see “Other Sources of Income” within this section.

Once your coverage begins, any increased or additional coverage due to a change in your weekly or monthly earnings or due to a plan change requested by MPTN will take effect immediately if you are actively employed or on a covered leave of absence. If you are not actively employed due to illness or injury, any increased or additional coverage will begin on the date you return to active employment.

If you become disabled while you are on a covered leave of absence, your weekly earnings from MPTN in effect on the day before the date your absence began will be used to calculate your weekly payment. For more information about leaves of absence, contact Human Resources.

Benefits are paid for as long as you remain disabled as defined by the STD Plan, up to a maximum of 12 weeks.

What are your Weekly Earnings?

Your usual weekly rate of pay from the Employers as of your last day worked plus the tips and tokes, as determined by Employer, as of the date of disability.  It includes income actually received from commissions, but does not include:

• bonuses,
• overtime pay, shift differential or
• any other fringe benefit or extra compensation.

Commissions will be average for the lesser of:

• the 52 full calendar week period of your employment with your Employer just prior to the date of disability begins; or
• the period of actual employment with your Employer.

Taxes on STD Benefits

Because payments are made on an after-tax basis, any monies received due to a short-term disability are not taxable.

With the STD option, you pay the premium for benefits coverage of 60% of your weekly earnings. Because you pay on an after-tax basis, the benefits you receive from that portion generally are not subject to income and Social Security (FICA) taxes.

STD Benefit Example
This example shows how your weekly benefit is calculated. All amounts used are before taxes and any other deductions. Assume that your weekly earnings are $1,000.

Other Sources of Income

You may still receive income from other sources while you are disabled. Depending on the source of income, your benefits may be reduced.

Return to Work

The plan has provisions that can help you return to work. See “Rehabilitation Service” within this section.

For a list of income that does not reduce your STD benefits, see “Income that Doesn’t Reduce Your Benefits” in the Rules and Regulations section. For information on how benefit reductions are managed, see “How Your Benefits Are Reduced” in the Rules and Regulations section.

Income that Reduces Your STD Benefits

Income from the following sources will be subtracted from your gross disability benefit:

• The amount that you receive or are entitled to receive as disability income payments under any:
  • state compulsory benefit act or law
  • automobile liability insurance policy
  • other group insurance plan

• The amount that you receive:
  • under an accumulated sick leave plan
  • under The Jones Act (Title 46, U.S.C. Section 688)
  • from a third party (after subtracting attorney’s fees) by judgment, settlement or otherwise
• The amount that you, your spouse, and your children receive or are entitled to receive as disability payments because of your disability under:
  • the U.S. Social Security Act
  • any similar plan or act.

Only income that is payable as a result of the same disability will be subtracted from your gross disability payment.

The plan administrator may apply this amount toward any outstanding overpayment.

If You Are Disabled and Working

If you are continuously partially disabled and are able to work, you may have “disability earnings” from rehabilitative, transitional or part-time work. Your weekly disability earnings may affect your STD benefits.

Filing a Claim

Call the plan administrator
toll-free at 1-855-212-7102 or 1-866-562-8421 (Espanol), Monday through Friday, 8 a.m. to 8 p.m., Eastern Time, to begin filing a claim.

You will not receive a weekly STD benefit for any week during which your disability earnings are more than 80% of your pre-disability weekly earnings.

• If your disability earnings are less than 20% of your pre-disability weekly earnings, you will continue to receive the full STD weekly benefit.
• If you are continuously partially disabled and your weekly disability earnings are from 20% to 80% of your pre-disability weekly earnings, you will receive the lesser of:
  • 50% of your STD weekly benefit, or
  • your STD weekly benefit, less
  • what you earned while partially disabled, and
  • any other income that is subtracted from your STD benefit.

Your weekly benefit will be adjusted as described above based on your disability earnings. You may be required to send proof of your disability earnings each week to the plan administrator, including appropriate financial records that are necessary to substantiate your income.

If your disability earnings fluctuate widely from week to week on a regular basis, the plan administrator may average your disability earnings over the most recent three weeks to determine whether your benefits should continue. If your disability earnings are averaged, your benefits will not be terminated unless your average weekly disability earnings from the last three weeks exceed 80% of your pre-disability weekly earnings.

Time Limits on STD Claims

To initiate your STD claim, you must call the plan administrator within 10 days of the first day you are disabled. You must also send written proof of your claim, as described below, no later than 90 days after the seven day elimination period. If it is impossible to give proof within 90 days, you must send such proof no later than one year after the time that proof is otherwise required. There is an exception to this time limit if you are considered legally incapacitated.

For more information on how to submit a claim, contact Human Resources or the plan administrator.

Payment of STD Benefits

If you are absent from work due to an illness, injury or hospitalization lasting fewer than seven days, you must notify your supervisor to report an absence. You do not receive STD benefits for absences lasting seven days or less.

If you are absent due to an illness, injury or hospitalization that lasts more than seven working days, call the plan administrator to initiate STD benefits, as described below. You must call the plan administrator within 10 days of the first day you are disabled.

How to File an STD Claim

You can file your claim for STD benefits by telephone by calling the plan administrator toll-free at 1-855-212-7102 or 1-866-562-8421 (Espanol), Monday through Friday, 8 a.m. to 8 p.m. Eastern Time. You should call:

• when you have any absence from work due to illness or injury, or
• up to two weeks in advance of a planned disability absence, such as a disability due to pregnancy or surgery.

Your enrollment materials include a brochure called “Filing Your Short- Term Disability Claim by Telephone.” It includes an authorization for your health care provider to send medical information about your claim directly to the plan administrator and a list of the information you will need to provide. Be sure to make copies of this reference card so you can use it with any health care provider.

If you are not well enough to call the plan administrator yourself, someone else that you authorize can make the call on your behalf.

Proof of Your Disability

After you file a claim, you will need to provide proof of your disability, at your own expense, including all the following information:

• Evidence that you are under the regular care of a doctor,
• The appropriate documentation of your weekly earnings, such as a pay stub,
• The date your disability began,
• The cause of your disability,
• The extent of your disability, including any restrictions and limitations that prevent you from performing your regular job, and
• The name and address of any hospital or institution where you received treatment, including all attending physicians.

You may be required to provide proof of continuing disability indicating that you are under the regular care of a physician. This proof, provided at your expense, must be received within 45 days of such a request.

In some cases you will be required to give the plan administrator authorization to obtain additional medical information and to provide nonmedical information as part of your proof of claim or proof of continuing disability. The plan administrator will deny your claim or stop sending your payments if the appropriate information is not submitted when requested.

If you are not satisfied with the outcome of your claim for disability benefits, you may appeal the decision. For more information on how to appeal a claim decision, see “Claims Review and Appeals Procedures” in the Rules and Regulations section.

Pre-Existing Conditions

No STD Plan benefits will be paid for disabilities resulting from a pre-existing condition.

The pre-existing condition exclusion applies only to the 12-month period following your effective date of coverage or increase in coverage.

Receiving STD Benefits

After you complete the elimination period and your STD claim is approved, you will receive weekly benefits for up to a maximum of 12 weeks for one continuous period of disability.

If you are disabled for less than one week, you will receive one-seventh (1/7) of your payment for each day of disability.

Your STD benefits end on the earliest of the following dates:

• After four consecutive weeks of payments, if you are able to return to work in your regular occupation on a part-time basis but you choose not to,
• The end of the maximum period of payment,
• The date you are no longer disabled under the terms of the plan,
• The date you fail to submit proof of continuing disability,
• The date your disability earnings exceed the amount allowable under the plan, or
• The date you die.

Recurring Disabilities

If you return to work on your regular work schedule, whether full-time or part-time, for 14 consecutive days or less, and you become disabled again because of the same or a related condition, your recurring disability is considered one period of disability and you will not have to complete another elimination period. Your STD benefits resume on the day after your recurrence, taking into account STD benefits already received.

If you return to work on your regular work schedule for less than one day, whether full-time or part-time, and become disabled again because of a new disability that is unrelated to the original one, your current disability is treated as part of your earlier claim and you will not have to complete another elimination period. Your STD benefits resume on the day after your recurrence, taking into account STD benefits already received.

In all other cases, if you return to work on your regular work schedule and you become disabled again, your disability will be considered a new period of disability and you will have to complete another elimination period before receiving STD benefits.

If you become entitled to payments under any other group Short-Term Disability Plan, you will not be eligible for payments under the MPTN Plan.