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Optional Long-Term Disability (LTD) Insurance
Public Employee’s Benefits Board (PEBB) ProgramOutreach & Training
February 2019
One-time Open Enrollment
Overview of PEBB LTD Insurance
One-time Enrollment Process
Resources
Review
1
2
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4
5
6
Topics We’ll Cover
Questions
One-time open enrollment opportunity
Optional LTD Insurance
Key Elements: One-time enrollmentEvidence of Insurability (EOI) not required to:
Enroll in optional LTD coverage, or
Decrease benefit waiting period (BWP)
Enrollment PeriodMarch 1 through 31, 2019
Effective Date May 1, 2019
PEBB LTD Insurance
Long-term DisabilityBenefit Overview
Basic LTD Coverage
All PEBB benefits eligible employees enrolled
Does not require EOI
Employer paid
Monthly Benefit
Minimum $50
Maximum $240
BWP 90 days
Optional LTD CoverageEnrollment
Voluntary election
Employee paid
EOI RequiredIf outside 31 days of initial eligibility
When decreasing BWP
EOI Not RequiredIf within 31 days of initial eligibility
When increasing BWP
EOI not required during 2019 one-time enrollment
Claim ExampleBill’s monthly earnings insured before the disability $5,125
Benefit percentage 60%
Monthly benefit amount payable $3,075
Social Security disability income -$1,450
Monthly benefit amount $1,625
Length of disability 3 years, 8 months*
Optional LTD CoverageMonthly Benefit
60% of pre-disability earningsMaximum $6,000
Reduced by deductible incomeSocial Security, sick pay, etc.
* This example only. Length of disability will vary.
Benefit Waiting Period (BWP)
Benefit waiting period:The period you must be continuously disabled before LTD benefits become payable.
Benefit Waiting Period (BWP)Basic Coverage
90 days, orPeriod of sick leave(Whichever is longer)
Optional CoverageEmployee selects from:
90, 120, 180, 240, 300, 360 daysPeriod of sick leave(Whichever is longer)
Benefit Waiting Period (BWP)BWP impacts the premium for optional coverage.
Rates vary by retirement plan
0.25%300 days$12.81
Benefit Waiting Period (BWP)Decreasing the BWP increases the rate.
0.36%120 days
$18.45
Benefit Waiting Period (BWP)
0.28%300 days$14.35
BWP impacts the premium for optional coverage.
Rates vary by retirement plan
Benefit Waiting Period (BWP)
0.42%120 days
$21.53
Decreasing the BWP increases the rate.
PEBB LTD Insurance
Review ofPreexisting Condition &
Exclusion Periods
Exclusion Period
Continuously insured for 12 months and actively at work for 1 full day after those 12 months.
Exclusion period = 12 months + 1 full day
Applies to basic & optional coverage
Preexisting ConditionA mental or physical condition for which you have done any of the following during the preexisting condition period:
Consulted a physician
Received medical treatment or services; or
Taken prescriptions drugs or medications
Preexisting Condition Period
90 days prior to most recent effective date
2019 One-time Enrollment effective date is May 1, 2019
Applies to basic & optional coverage
LTD Timeline
90-day preexisting condition period
Effective date of LTD
coverage
Potential exclusion period:12 months continuously insured and 1 day actively at work
January 31 - April 302019
May 1 2019
June-December2019
January – April2020
May 2 2020
How the exclusion and 90-day preexisting condition periods align with the effective date of coverage.
January 31 - April 302019
May 1 2019
June-December2019
January – April2020
May 2 2020
90-day preexisting condition period
Potential exclusion period:12 months continuously insured and 1 day actively at work
Effective date of LTD
coverage
Outcome: If a disability is found to have been caused or contributed to by a preexisting condition, then that disability is not covered.
BecomesDisabled
Scenario: Bill enrolls in optional LTD effective May 1, 2019, and then becomes disabled in December 2019.
YES
January 31 - April 302019
May 1 2019
June-December2019
January – April2020
May 2 2020
90-day preexisting condition period
Potential exclusion period:12 months continuously insured and 1 day actively at work
BecomeDisabledNO
Outcome: If a disability is not found to have been caused or contributed to by a preexisting condition, then that disability is covered.
Scenario: Bill enrolls in optional LTD effective May 1, 2019, and then becomes disabled in December 2019.
Effective date of LTD
coverage
90-day preexisting condition period
Potential exclusion period:12 months continuously insured and 1 day actively at work
Effective date of LTD
coverage
January 31 - April 302019
May 1 2019
June-December2019
January – April2020
May 2 2020
BecomeDisabledYES
Outcome: If a disability is found to have been caused or contributed to by a preexisting condition, then that disability is covered, but the previous BWP applies (300 days).
Scenario: Karen decreases optional LTD BWP from 300 to 120 days, effective May 1, 2019, and then becomes disabled in April 2020.
90-day preexisting condition period
Potential exclusion period:12 months continuously insured and 1 day actively at work
January 31 - April 302019
May 1 2019
June-December2019
January – April2020
May 2 2020
BecomeDisabledNO
Outcome: If a disability is not found to have been caused or contributed to by a preexisting condition, then that disability is covered bythe new BWP (120 days).
Scenario: Karen decreases optional LTD BWP from 300 to 120 days, effective May 1, 2019, and then becomes disabled in April 2020.
Effective date of LTD
coverage
90-day preexisting condition period
Potential exclusion period:12 months continuously insured and 1 day actively at work
Effective date of LTD
coverageBecomeDisabled
January 31 - April 302019
May 1 2019
June-December2019
January – April2020
May 2 2020
Outcome: Once outside the exclusion period, the preexisting condition period does notapply.
Scenario: Bill or Karen makes a change effective May 1, 2019, and becomes disabled in July 2020.
PEBB LTD Insurance
2019 Enrollment Form
2019 LTD Enrollment Form
PEBB LTD Insurance
One-time Enrollment Form
LTD One-time Enrollment/Change Form
300
xxxxxxxxxx xxx-xxx 5,125
Xxxxx Xxxxx 03-29-2019
PEBB LTD Insurance
One-time Open Enrollment Process
One-time Enrollment ProcessEmployers who key in PAY1
Employee submits form to personnel, payroll or benefits office
Review one-time enrollment form
Completeness Signed & datedDate stamp
Complete employer section on form
Place in employee file after keying
EOI form not sent to Standard
One-time Enrollment ProcessEmployers who key in PAY1
Employers who update monthly salary in Pay1
Update A.41 screen
Update A. 46 screen
Pending not required
No approval needed from Standard
Pay1
Enroll in Optional LTD A.46 ScreenExamples
Step 1
Step 2
Step 1
Step 3
Pay1
Decrease BWPA.46 ScreenExamples
Step 1
Step 2
Step 1
Step 3
One-time Enrollment ProcessHigher Ed
Employee submits form to personnel, payroll or benefits office
Review one-time enrollment formCompleteness Signed & datedDate stamp
Complete employer section on form
Enter enrollment via current process
Place in employee file
EOI form not sent to Standard
One-time Enrollment ProcessEmployers who O&T keys for
Employee submits form to personnel, payroll or benefits office
Review one-time enrollment formCompleteness Signed & datedDate stamp
Complete employer section on form
Send form to O&T via FUZE
Place in employee file
EOI form not sent to Standard
PEBB LTD Insurance
Resources
Employee ResourcesPostcard mailed on January 28th
Article in February’s For Your Benefits newsletterMail & Email February 7th
Emails to employees who subscribe to PEBB email notificationsFebruary 19th
March 1st
March 27th
SmartHealth Wellness LTD activity – 100 ptsGovDelivery messages from O&T
Can be forwarded to employees
PEBB Continuation Coverage (Unpaid Leave)Employees who will be on PEBB Continuation Coverage (Unpaid Leave) in March 2019 should contact the PEBB Program at 1-800-200-1004 for more information.
Employer ResourcesEnrollment Materials
Long-Term Disability One-time Enrollment/Change Form https://www.standard.com/eforms/7533_377661oe.pdf
Long-Term Disability Plan booklet (certificate of coverage)https://www.standard.com/eforms/14249_377661.pdf
See Page #2 for SOE information
Decision support tool https://www.standard.com/wa-pebb
LTD One-Time Open Enrollment
Review
One-time Open EnrollmentEnrollment period
March 1 through 31, 2019
Effective Date May 1, 2019
Unique enrollment formhttps://www.standard.com/eforms/7533_377661oe.pdf
EOI Not Required
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