New Mexico Public Schools Insurance Authority Standard NMPSIA LTD...Slide17 Advantages for Older...
Transcript of New Mexico Public Schools Insurance Authority Standard NMPSIA LTD...Slide17 Advantages for Older...
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New Mexico Public Schools
Insurance AuthorityDisability Service OverviewStandard Insurance Company
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Long Term Disability (LTD) Claim Administration
Slides 4-11
LTD Terminology Definitions
Slides 12-14
Benefit Calculation Example
Slide 15
Benefits During School Vacations
Slide 16
Social Security Assistance
Slide17
Advantages for Older Employees
Slides 18-19
AdminEASESM LTD Online Reports
Slides 21-23
Table of Contents
The information contained in this presentation is only a
brief description of the group LTD insurance policy
sponsored by New Mexico Public Schools Insurance
Authority (NMPSIA). The controlling provisions will be in
the group policy issued by Standard Insurance Company
(The Standard). The group policy contains a detailed
description of the limitations, reductions in benefits,
exclusions and when The Standard and NMPSIA may
increase the cost of coverage, amend or cancel the
policy. A group certificate of insurance that describes the
terms and conditions of the group policy is available for
those who become insured according to its terms.
For answers to commonly asked questions, costs,
exclusions, limitations and reductions, please review the
Group Long Term Disability Insurance Booklet
(https://www.standard.com/eforms/10386d_645549.pdf)
and Certificate of Insurance
(https://www.standard.com/eforms/16928_645549.pdf) for
more detailed information.
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Long Term Disability Claim Administration
Collectively doing the right thing to manage absence and disability.
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Disability intake capabilities provide
increased efficiency
Our flexible claims submission methods (mail, e-mail or fax) offer consistent customer
experiences across submission channels.
Mail to:
Standard
PO Box 2800
Portland, OR 97208
Increased efficiency
and consistent
customer experience
Fax to:
1.800.378.5740
Claim intakeEmail to:
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Claim Intake
Employee’s
Statement
Employer’s
Statement
Attending
Physician’s
Statement
Complete claim
assigned to team
• Claim forms or web address provided by
Employer or posted on intranet site (employee
packet includes employee’s statement, attending
physician’s statement and authorization)
• Employee completes their portion and submits to
The Standard via mail or fax
• Employee receives confirmation letter and
regular follow-up letters for missing forms
• Employee gives Attending Physician’s Statement
to treating physician
• Treating physician completes form and returns to
The Standard via mail or fax
• Employer completes their portion of the claim
form (via paper claim form or AdminEASE)
• Employer provides any additional information (i.e.
job description, enrollment verification, payroll)
• Employer submits Employer portion to Standard
• Employer can check the status of the claim on
Reports Online via AdminEASE
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Eight full-time mental health specialist
Our psychologists and counselors assist employees who are experiencing mental health
issues. They offer support and guidance, encouragement in following recommended
treatment and medication regimens and referrals to appropriate care.
Claim intakeShorter duration
LTD claim
Longer duration
LTD claim
Mental health
claim
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LTD Claim Decision
Claim assigned
Our LTD analysts, with an average of 9 years at The Standard, review claims information,
interview employees and manage duration of the claim. Your employees receive a thorough
explanation of the claims process. If they have any questions, they speak directly to the
claim decision-maker, not a call center generalist.
If denied
Analyst interviews
employee
Initial claim review
and determination
made within 7 days
If pended
If approved
Mental health
claim
Additional information
is needed in order to
make a decision
We will request
information directly
and follow up routinely
until received
Status letters every 15
days
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LTD Claim Decision
Claim assigned
If denied
If pended
If approved
Analyst interviews
employee
Initial claim review
and determination
made within 7 days
Employee advised of
approval by mail and
phone
Employer notification are
emailed and viewable on
Reports Online
Benefit will coordinate
with other income such as
Workers’ Comp, PERS or
Social Security
Life Waiver of Premium
claim reviewed in
conjunction with LTD
Vocational resources help
employees return to work,
when appropriate
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LTD Claim Decision
Claim assigned
If pended
If approved
Analyst interviews
employee
Initial claim review
and determination
made within 7 days
If the information supports
a denial, a letter will be
sent to the employee
providing a detailed
explanation of the denial,
as well as the process for
requesting a review
We will also send a letter
to the policyholder
outlining the general
reason for the denial
If denied
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LTD Claim ManagementOnce a claim is approved, a claim management plan is created based on the anticipated
outcome of the claim. Whether the claimant is expected to return to work, needs assistance
in returning to work or is not expected to recover or return to work, our claim management
activities are specifically focused on each claim situation.
Recovery not
expected
Recovery with
assistance
Condition is expected to resolve,
leading to return to work
Condition requires close medical
and/or vocational monitoring to
ensure proper treatment and timely
recovery and/or return to work.
May require medical and/or
vocational rehabilitation
assistance and intervention.
Claim Management focuses on SS
assistance, offsets and monitoring
changes in medical condition
Recovery
expected
Claim
approved
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LTD Claim Management
Claim approved
Resources and
provisions to
promote RTW
On-site Social
Security Advocacy
Early review of Any
Occupation and
limitations
Mandatory review
dates
Offset pursuit and
resolution
Policy limitations
asserted
Stable claim
Management
Continued
maintenance until
duration end
Own Occupation
Period
Any Occupation
Period
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Predisability Earnings (PDE) – Gross base monthly earnings that exclude:
Bonuses, commissions, overtime, stipends for extracurricular activities, any other
extra pay and employer pension contributions.
Examples of stipend pay: Professional development, building support, athletics
support, coaching, cheerleading, lunch duties, extracurricular activities sponsor,
any duty preformed outside the scope of the job and beyond the scheduled work
day.
The Standard will request a copy of the employee contract and payroll data to
verify earnings.
If an employee has exceeded the employer’s salary schedule and you must
record the balance under the “Stipend” pay category to pay the employee
contract, please advise The Standard of this practice at point of claim.
Predisability Earnings
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If you are paid on an annual contract basis, your monthly rate of earnings is one-twelfth (1/12th) of
your annual contract salary.
If you are regularly scheduled to work a partial year, your monthly rate of earnings is a) the hours you
are regularly scheduled to work per month, times b) the number of months you are regularly
scheduled to work, divided by 12. For example, working 9 months per year, earning $18,000 per
year, divided by 12 = $1,500.
If you are paid hourly, your monthly rate of earnings is based on your hourly pay rate multiplied by the
number of hours you are regularly scheduled to work per month, but not more than 173 hours. For
example, working 9 months per year, earning $10.75 per hour, times 6 hours per day, times 182 days
= $11,739/12 = $978.25.
If you do not have regular work hours, your monthly rate of earnings is based on the average number
of hours you worked per month during the preceding 12 calendar months (or during your period of
employment if less than 12 months), but not more than 173 hours.
More than 95% of members are paid via an annual contract. What this means is that your annual pay
will be calculated in 12 equal increments to determine your Predisability Earnings.
Predisability Earnings Calculation
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Deductible income includes but is not limited to benefits you receive or are
eligible to receive from statutory plans like Social Security amounts you, your
spouse, or your children under age 18 receive because of your disability or your
retirement.
For example, benefits from Social Security Disability, Social Security Retirement,
ERB pension, ERB disability pension, worker's compensation, unemployment
and sick pay.
All other sources of income, other than employer paid earnings, are deductible
dollar for dollar.
Your LTD benefit plus you employer paid earnings (including other employment),
if earning less than 80% of Predisability Earnings, cannot exceed your Indexed
Predisability Earnings.
Deductible Income
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Benefits Calculation Example
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If you cease to be a Member because of a school break or vacation, your insurance will be continued
during that period.
Summer Claim Example:
Annual contract salary = $12,000
Monthly rate of earnings = $1,000 ($12,000/12)
LTD benefit = $1,000 x 66.67 = $666.70 (before deductible income)
Non-Educator: Paid July through June in 12 equal increments including insurance deduction.
Educator: Paid August through May; Pay summer months in June (balance of contract);
Payments include 12 months of insurance deductions as well as 12 months of pay.
This is considered Deductible Income.
LTD Benefits During School Vacations
Last Day of Active Work Friday, June 5th
Benefits become payable after 30-day Benefit Waiting Period Monday, July 6th
Claim Approval Wednesday July 8th
Claim closed because employee returned to work Thursday, August 6th
Benefit Payment: 7/6 through 8/5 (if received full summer pay) Minimum benefit of $100
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• Full-time, in-house Social Security coordinators
• Screens appropriate newly-approved LTD claims
• Completes all necessary paperwork for the employee
• Works closely with the employee and The Standard from initial application to award
• Challenges denied claims that appear to meet Social Security criteria
• 99% award rate for The Standard’s customers
• 95% of awards occur within 2 years
• Assists in recovery of overpayments as a result of an award
Social Security Assistance
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If you become disabled before age 62, then LTD benefits may continue during disability
until you reach age 65, or to Social Security Normal Retirement Age (SSNRA), or 3 years 6
months, whichever is longest. If you become disabled at age 62 or older, the benefit
duration is determined by your age when disability begins as indicated in the table below.
Social Security Normal Retirement Age (SSNRA) means your normal retirement age under
the Federal Social Security Act, as amended.
Advantages for Older Employees
Age when disability begins Maximum benefit period
62 To SSNRA, or 3 years 6 months, whichever is longer
63 To SSNRA, or 3 years, whichever is longer
64 To SSNRA, or 2 years 6 months, whichever is longer
65 2 years
66 1 year 9 months
67 1 year 6 months
68 1 year 3 months
69 and above 1 year
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• Standard helps you file for Social Security Disability for free, which could
save on doctors and attorney’s fees.
• Keep in mind Social Security Disability will pay only up to 50% of your salary.
• When you can’t return to your own occupation, you will typically get approved for
Social Security Disability.
• If you chose a disability retirement you may gain more income.
• If you are already receiving Social Security Retirement prior to your date of
disability, your Social Security Retirement Benefits are not considered
Deductible Income.
• If you are receiving a regular retirement pension from ERB prior to date of
disability and qualified for LTD benefits, ERB pension payment is not
considered deductible income.
Advantages for Older Employees
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AdminEASESM
Reports OnlineSM for Long Term Disability
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Products:
LTD
Available to:
Insured and self-funded
customers
Frequency:
Updated daily
Lists all incomplete,
pending and active
claims, plus claims
denied or closed within
the last 90 days
Claim Status Reports
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Products:
LTD
Available to:
Insured customers
Frequency:
Updated daily
Lists all active claims
and the time period
for which benefits are
due for a rolling
seven-day period
Recent Checks Reports
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Products:
LTD
Available to:
Insured customers
Frequency:
Updated daily
Shows benefit
calculation detail for
all active claims
Benefit Calculation Reports
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Thank you.
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