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Lafourche Summary of Benefits
1
Summary of Short Term Disability Benefits
Eligibility A regular employee of the Employer who is actively at work at least 25 hours each week or; an active bus driver or cafeteria worker employee of the Employer who is working at least 900 hour per year
Weekly Benefit Percentage -60%
Weekly Maximum Benefit $1,000 per week
Minimum Benefit $25 per week
Benefit Waiting Period 14 Days for Accident 14 Days for Sickness
Accumulated Sick Leave Included in Benefit Waiting Period
Work Days During the Benefit Waiting Period No limit on trial work days during benefit waiting period provided earnings received do not exceed the earnings test over the entire period
Definition of Disability Own Job
Earnings Test 80%
Definition of Covered Earnings Standard Wage includes the employee's wage or salary as reported by the employer but excludes overtime, bonuses or commissions.
Integration Type Full Family
Maximum Benefit Duration11 Weeks Accident and 11 Weeks Sickness
Pre-Existing Condition Limitation LATE ENTRANT 12 months prior/12 months Insured
This is a new provision which allows the Employee to come on the plan without EOI, however, they must be advised that a longer pre ex will need to be fulfilled.
Employer Contribution 0% Taxation of Benefits Non -Taxable
RATE: Monthly Rate per $10 of Weekly Covered Benefit $0.67
© Copyright Life Insurance Company of North America 2008
2
Pre Existing Condition Limitation Explained: STD Late Entrants should be advised that they will not have to complete a medical
underwriting questionnaire, however, they will have a longer pre ex applied to the policy. Benefits will not be paid for any period of Disability caused by or contributed to, or
resulting from an injury or sickness for which the Employee incurred expenses, received medical treatment, care or services including diagnostic means, took prescribed drugs or medicines ,or for which a reasonable person would have consulted a physician within 12 months before his or her most recent effective date of insurance. This limitation will not apply to a period of Disability that begins after an Employee is
covered for at least 12 months after his or her most recent effective date of insurance .
If a disability were to occur within 12 months of his or her most recent
effective date, and is not contributed to, or results from a pre existing condition, the policy would pay according the policy definitions as usual. © Copyright Life Insurance Company of North America 2008
3
Summary of Long Term Disability Benefits
Employer Contribution0%Taxation of Benefits Non-Taxable Return to Work Incentive Benefit Allows up to 100% income replacement for 24 months while
receiving benefits under this plan Rehabilitation Program Included Survivors Benefits 3 months lump sum with 3 months Benefit
Waiting Period Pre-Existing Condition Limitation NEW HIRE 3 months Prior/12 months Insured Pre-Existing Condition Limitation LATE ENTRANT 12 months prior/24 months Insured
This is a new provision which allows the Employee to come on the plan without EOI, however, they must be advised that a longer pre ex will need to be fulfilled. Mental Illness Limitation12 Month Lifetime Limitation Substance Abuse Limitation12 Month Lifetime Limitation Subjective Symptom Limitation No Limitation Catastrophic Disability Benefit (ADL Rider)15% Benefit$5,000 Monthly Maximum Amount Rate
Monthly Rate per $100 of Monthly Covered Payroll $0.40
© Copyright Life Insurance Company of North America 2008
4
Pre Existing Condition Limitation Explained: LTD Late Entrants should be advised that they will not have to complete a medical
underwriting questionnaire, however, they will have a longer pre ex applied to the policy. Benefits will not be paid for any period of Disability caused by or contributed to, or
resulting from an injury or sickness for which the Employee incurred expenses, received medical treatment, care or services including diagnostic means, took prescribed drugs or medicines, or for which a reasonable person would have consulted a physician within 12 months before his or her most recent effective date of insurance. This limitation will not apply to a period of Disability that begins after an Employee is
covered for at least 24 months after his or her most recent effective date of insurance .
If a disability were to occur within 24 months of his or her most recent
effective date, and is not contributed to, or results from a pre existing condition, the policy would pay according to the policy definitions as usual. © Copyright Life Insurance Company of North America 2008
6
1
Summary of Short Term Disability Benefits
Eligibility A regular employee of the Employer who is actively at work at least 25 hours each week or; an active bus driver or cafeteria worker employee of the Employer who is working at least 900 hour per year
Weekly Benefit Percentage -60%
Weekly Maximum Benefit $1,000 per week
Minimum Benefit $25 per week
Benefit Waiting Period 14 Days for Accident 14 Days for Sickness
Accumulated Sick Leave Included in Benefit Waiting Period
Work Days During the Benefit Waiting Period No limit on trial work days during benefit waiting period provided earnings received do not exceed the earnings test over the entire period
Definition of Disability Own Job
Earnings Test 80%
Definition of Covered Earnings Standard Wage includes the employee's wage or salary as reported by the employer but excludes overtime, bonuses or commissions.
Integration Type Full Family
Maximum Benefit Duration11 Weeks Accident and 11 Weeks Sickness
Pre-Existing Condition Limitation LATE ENTRANT 12 months prior/12 months Insured
This is a new provision which allows the Employee to come on the plan without EOI, however, they must be advised that a longer pre ex will need to be fulfilled.
Employer Contribution 0% Taxation of Benefits Non -Taxable
RATE: Monthly Rate per $10 of Weekly Covered Benefit $0.67
© Copyright Life Insurance Company of North America 2008
2
Pre Existing Condition Limitation Explained: STD Late Entrants should be advised that they will not have to complete a medical
underwriting questionnaire, however, they will have a longer pre ex applied to the policy. Benefits will not be paid for any period of Disability caused by or contributed to, or
resulting from an injury or sickness for which the Employee incurred expenses, received medical treatment, care or services including diagnostic means, took prescribed drugs or medicines ,or for which a reasonable person would have consulted a physician within 12 months before his or her most recent effective date of insurance. This limitation will not apply to a period of Disability that begins after an Employee is
covered for at least 12 months after his or her most recent effective date of insurance .
If a disability were to occur within 12 months of his or her most recent
effective date, and is not contributed to, or results from a pre existing condition, the policy would pay according the policy definitions as usual. © Copyright Life Insurance Company of North America 2008
3
Summary of Long Term Disability Benefits
Employer Contribution0%Taxation of Benefits Non-Taxable Return to Work Incentive Benefit Allows up to 100% income replacement for 24 months while
receiving benefits under this plan Rehabilitation Program Included Survivors Benefits 3 months lump sum with 3 months Benefit
Waiting Period Pre-Existing Condition Limitation NEW HIRE 3 months Prior/12 months Insured Pre-Existing Condition Limitation LATE ENTRANT 12 months prior/24 months Insured
This is a new provision which allows the Employee to come on the plan without EOI, however, they must be advised that a longer pre ex will need to be fulfilled. Mental Illness Limitation12 Month Lifetime Limitation Substance Abuse Limitation12 Month Lifetime Limitation Subjective Symptom Limitation No Limitation Catastrophic Disability Benefit (ADL Rider)15% Benefit$5,000 Monthly Maximum Amount Rate
Monthly Rate per $100 of Monthly Covered Payroll $0.40
© Copyright Life Insurance Company of North America 2008
4
Pre Existing Condition Limitation Explained: LTD Late Entrants should be advised that they will not have to complete a medical
underwriting questionnaire, however, they will have a longer pre ex applied to the policy. Benefits will not be paid for any period of Disability caused by or contributed to, or
resulting from an injury or sickness for which the Employee incurred expenses, received medical treatment, care or services including diagnostic means, took prescribed drugs or medicines, or for which a reasonable person would have consulted a physician within 12 months before his or her most recent effective date of insurance. This limitation will not apply to a period of Disability that begins after an Employee is
covered for at least 24 months after his or her most recent effective date of insurance .
If a disability were to occur within 24 months of his or her most recent
effective date, and is not contributed to, or results from a pre existing condition, the policy would pay according to the policy definitions as usual. © Copyright Life Insurance Company of North America 2008
6
