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Medical/Dental/Vision
Life Insurance
Long Term Disability Insurance
VEBA
Medical/Dental/Vision:
What plans are available?
The HCA offers a total of 6 medical plans and
3 dental plans. Not all the
plans area available in every county. In most cases, you must live in the plan’s
service area to join the plan. The plans available in Whatcom County are: Group Health Classic/Value,
Aetna Public Employees Plan and Uniform for Medical; Uniform, Willamette, and
DeltaCare for Dental.
How do I select the best plan for me and my
family?
Only you can decide which plan makes the most
sense for you and your family. If you cover eligible dependents, they must be
covered under the same medical and dental plan you choose. As you review the
plans, some things you may want to consider are: geography, cost, unique medical
needs, coinsurance vs. co-pay, deductible, out-of-pocket maximum, referral
procedures, your provider, paperwork and coordination with your other benefits.
How do the plans differ?
All medical plans offer the same basic benefits,
although benefit enhancements, limitations, payroll deductions and out-of-pocket
maximums may vary. For more information, call
the plans directly or review the plan’s benefits booklet.
How do I know if my doctor or hospital belongs
to a plan?
Simply ask your doctor or hospital, or call the
plan directly at the telephone number listed in the “PEBB Plan Telephone
Directory.” Be sure you let them know you are a PEBB state of Washington
enrollee. Chances are that your provider or hospital participates in one or more
of the PEBB plans.
May I change providers after I have joined a
plan?
Rules vary from plan to plan, but all plans provide a process for making
changes. Check with your plan for more information.
Do all members of my family have to use the same
provider?
They may select the same provider but it’s not
required. Each member of your family may select his or her own medical provider
available through the plan. Some dental plans require selection of one dentist
for the entire family.
Life
Insurance:
When am I covered under this plan?
You are covered under Part A (Basic Life,
$25,000 and AD&D, $5,000):
PERMANENT EMPLOYEES, SEASONAL EMPLOYEES, CAREER
SEASONAL/INSTRUCTIONAL EMPLOYEES: Coverage begins on the first day of the month
following the date of employment. If the date of employment is the first working
day of a month, coverage begins on the date of employment.
NONPERMANENT EMPLOYEES: Coverage for
nonpermanent employees begins on the first day of the seventh calendar month
following the date of employment.
PART-TIME FACULTY: Coverage for part-time
faculty begins on the first day of the month following the beginning of the
second consecutive quarter/semester of half-time or more employment. If the
first day of the second consecutive quarter/semester is the first working day of
the month, coverage begins at the beginning of the second consecutive
quarter/semester.
Parts B, C, D, and E If you enroll within 60
days of eligibility, you may elect Part B Basic, Part B Supplemental Spouse up
to $25,000, Part C Optional, and Part D Supplemental Life up to $50,000 without
providing evidence of good health and these coverages will become effective the
first of the month following the signature date on the enrollment form. If you
apply more than 60 days after your initial eligibility, evidence of good health
is required by the insurance company for Parts B Basic (except for children), B
Supplemental, C, and D and coverage becomes effective on the first of the month
following the insurance company’s approval of your application. Voluntary AD&D
(Part E) coverage does not require evidence of good health and becomes effective
on the first of the month after your application is submitted.
Any increase in the amount of insurance for a
dependent who is confined in a hospital on a date when the increase would
otherwise become effective will be deferred until the dependent’s discharge from
the hospital.
Note: If you are not actively at work on such
date, the insurance will become effective the first of the month following the
date you return to active work. If the date that your insurance would otherwise
become effective falls on a non-working day, such insurance shall nevertheless
become effective if you were actively at work on the last preceding work day,
provided that you would have been able to work had the effective date been a
work day.
How much does this insurance cost?
Part A is provided by your employer through the
PEBB at no cost to you. The cost of Part B Basic is $.67 per family per month
regardless of the number of dependents. The cost of Part B Supplemental, Part C,
and Part D coverage is determined by your age, the amount of insurance you
choose, and whether or not you or your spouse (if he/she is covered under Part B
Basic and Spouse Supplemental) smoke. Part E Voluntary AD&D coverage you choose
and whether or not you cover dependents for voluntary AD&D coverage. You can
find rates at:
http://pebb.hca.wa.gov/rates/life.shtml
Does a salary increase affect my life insurance?
Yes. If you enroll in Part C and select the
maximum allowable based on your salary, you may also elect automatic increases.
When your salary increases, your Part C coverage will automatically be increased
to your new maximum on the first of the month following your salary increase.
However, you may voluntarily reduce or freeze your Part C coverage at any time
by completing a new enrollment form. If you reduce your Part C coverage below
the maximum allowable or if you initially enroll in Part C for less than your
maximum allowable, proof of good health will be required to increase Part C
coverage. There is no automatic increase provision for Part B Supplemental
Spouse Insurance. If your salary decreases, you can retain the amount of your
Part C coverage in effect immediately prior to the salary decrease.
Who must complete an enrollment form?
All eligible employees must complete an
enrollment form even if they only want Part A. This is important to assure that
your beneficiary is properly named. Be sure to check the boxes declining
coverages you don’t want and sign and date the form. Name a beneficiary and
indicate that individual’s relationship to you. Since the insurance in this
pamphlet is the only life or AD&D program sponsored and approved by the PEBB,
you should carefully consider your options.
When is my enrollment period?
Your enrollment period ends 60 days from your
initial eligibility date. This period is set to allow you to:
Enroll yourself in Part C to the maximum
allowable and Part D to $50,000 without furnishing evidence of good health.
Enroll your dependents in Part B Basic and up to
$25,000 in Part B Supplemental spouse coverage without furnishing evidence of
good health for your spouse.
Who is the beneficiary for my dependent’s
insurance?
You are automatically the beneficiary for your
enrolled dependent’s insurance if you are living at the time of the dependent’s
death. If you are not living at that time, payment will be made to your
surviving spouse, children, or parents in that order. If none survive, payment
will be made to your estate.
Who is my beneficiary?
You may name any beneficiary you wish when you
complete the enrollment form. If you should die with no named living
beneficiary, payment will be made in this order to your survivors: (1) spouse,
(2) children, (3) parents, or (4) estate.
All eligible employees will be covered for
$25,000 employer-provided Life and $5,000 AD&D Insurance under Part A of the
PEBB program. For that reason, everyone must complete an enrollment form to
designate a beneficiary. If you are married and wish to name someone other than
your spouse as beneficiary, or if you have special estate planning needs, or
wish to assign ownership of your Life Insurance to another person, you should
seek legal/tax advice before completing your beneficiary designation. If your
beneficiary is a minor (under age 18) benefits may be paid to the child’s
court-appointed legal guardian or proceeds may be held in an interest-bearing
account by the Company. The payment method is determined by the legal guardian.
What happens if I retire or otherwise leave
employment with the state?
Your Life Insurance (not AD&D Insurance)
continues for 31 days (60 days for persons retiring) beyond the date your
employer-provided and employee-paid coverages terminate. (See the next question
for these termination dates.) During that 31/60 days, you have the right to
convert any amount of your Life Insurance (subject to a minimum of $1,000) to an
individual permanent whole life policy at the conversion rates for your age at
that time. ReliaStar Life Insurance Company must accept you for the conversion
benefit regardless of your health. Should death occur during the 31/60 day
conversion period, a death benefit in the maximum amount for which an individual
policy could have been issued will be paid, whether or not the application for
conversion had been made. You may also convert Life Insurance on your
dependents. Conversion is not available for any AD&D Insurance.
Note: If you are in good health when your
coverage ends, it may be to your advantage to apply for a lower cost type of
Life Insurance which would not be available under the conversion option. You
should discuss this with a Relistar Life agent or a life insurance agent of your
choice during the 31/60 day conversion period.
Most retirees will be eligible for Retiree Term
Life Insurance if they apply for coverage within 60 days of their date of
retirement. A description of coverage and an enrollment form will be furnished
by their Retirement Office at the time of final application for retirement. If
you do not enroll in the retiree life insurance within your initial 60 day
enrollment period, you will be required to provide evidence of good health,
subject to approval by the underwriter, to enroll at a later date. Coverage
would become effective the first of the month following approval.
When does my insurance terminate?
The day on which your insurance terminates is
different for employer-provided coverage then for the employee-paid optional
coverages.
Employer-provided Part A coverage terminates at
the end of the month in which your pay status ends or following an approved
leave of up to 12 weeks under the Family and Medical Leave Act.
Employee-paid coverages, Parts B, C, D, E (and
Part A coverage which you may continue on a self-pay basis when not in pay
status) terminate at the end of the month in which your employment terminates,
you begin full military service, you voluntarily cancel your insurance, or
following an approved leave of up to 12 weeks under the Family and Medical Leave
Act. (However, you may continue to self-pay your insurance up to 29 months
during any authorized leave without pay, while receiving time loss benefits
under Workers’ Compensation, during a layoff [reduction-in-force], or while
awaiting hearing for a dismissal action.)
Note: Coverage for dependents terminates on the
earliest of the following dates: (1) at the end of the month in which a
dependent ceases to be an eligible dependent or you voluntarily cancel your
dependent’s insurance, (2) for Life Insurance (not AD&D), five months (subject
to self-payment of premium) after the date of death of the employee, or (3) on
the date employee coverage ends for reasons other than death.
Do I have a choice of benefits?
Yes. You are automatically covered under Part A
which is provided by your employer. You may also choose to apply for one or more
of the optional coverages (Parts B, C, D, and E at the prescribed premium rates)
subject to the enrollment requirements previously stated. By examining your
options carefully, you can tailor your coverage to your own needs.
How much life insurance should I have?
This is largely a matter of individual estate
planning. However, the minimum amount should be enough to cover funeral expenses
when you die. The Basic Life Insurance coverage is designed to help toward these
costs.
The optional plan (Part C) is similar to private
industry plans which usually provide at least one year’s salary in life
insurance benefits. This allows a deceased employee’s family time to adjust to
the loss.
Supplemental Insurance (Part D) is available to
provide higher amounts of inexpensive life insurance for employees with large
financial needs in the event of premature death or for other estate planning
reasons. Part B Supplemental Spouse Insurance is available for similar reasons.
Voluntary Accidental Death and Dismemberment
Insurance (Part E) is also available to supplement any life insurance you may
choose. It allows you to provide a type of “double indemnity” if you or your
enrolled dependents die from a covered accident. It also provides dismemberment
coverage for the loss of hands, feet, or eyesight as a result of a covered
accident.
Will coverage reduce as I get older?
No, except in the case of total disability as
indicated under Question 21.
When should I answer the health questions on the
enrollment form?
The Medical Questionnaire section of the
enrollment form must be complete and approved to become insured in the following
cases:
When applying for Part B Basic, Part B
Supplemental (spouse only), Part C, and Part D after your 60-day eligibility
enrollment period.
When applying for Part B Supplemental over
$25,000 and Part D over $50,000.
How
much supplemental insurance (Part D) may I apply for?
You may apply for any amount of
insurance in $1,000 increments up to $350,000 under Part D Supplemental.
How much supplemental spouse insurance (Part B)
may I apply for?
If you have enrolled your spouse in Part B Basic
Dependents Insurance, you may apply for additional insurance for your spouse in
$1,000 increments up to one half of the amount of life insurance you obtain for
yourself under Part C and Part D combined. The cost for Supplemental Spouse
Insurance will be based on your age (not the age of your spouse) and whether or
not you or your spouse smoke.
If I acquire dependents after I am enrolled, how
may I enroll them?
Under Part B Basic and Part E, if you already
have one dependent child enrolled, it is not necessary to tell us about
newly-eligible children; they will be automatically covered. A newly-acquired
spouse must be enrolled through your Benefits office within 31 days of marriage
to be covered without furnishing evidence of good health.
Under Part B Supplemental, new spouse coverage
does not require approval up to $25,000 if application is made within 31 days of
marriage. Otherwise, it always requires approval of evidence of good health by
application through your payroll office.
What coverage is provided if both husband and
wife are eligible employees of the state?
Each will be covered under Part A and both are
eligible for Parts B, C, D, and E. They may insure each other and both cover
their dependent children.
When one spouse terminates coverage, the
actively employed spouse may apply for transfer of the terminated spouse’s
employee or Dependent Life Insurance up to the maximum allowed under the active
employee’s coverages. Application for transfer must be made within 31 days of
the date the first spouse terminates employment.
How are claims filed?
In the event of death, your Benefits office
should be notified immediately. That office will have instructions for
submitting claims. They will need a certified death certificate and the
beneficiary’s Social Security number to submit a claim. For claims of $5,000 or
more, the beneficiary must sign the death claim form.
How are payments made?
Beneficiaries with a life claim benefit of
$5,000 or more receive a personal checkbook. They can obtain their full benefit
or less amounts at any time by simply writing a check. The account balance earns
a competitive rate of interest until it is withdrawn.
What if I become totally disabled?
If you become totally disabled prior to age 60
and the disability continues at least six months, your life insurance (Basic,
Optional, and Supplemental) can be continued without premium payments while
disabled (waiver of premium) up to specified limits (see pages 20-21). Premiums
for Dependent Life Insurance will also be waived as long as you remain totally
disabled and the master policy with the insurance company remains in force. Your
dependents will be eligible to exercise the Life Insurance conversion option in
the event waiver of dependent premium is discontinued due to termination of the
employee’s waiver of premium benefit (or termination of the master policy).
If you believe you qualify for this benefit,
promptly contact the Benefits office who will submit the claim for you. Premiums
must be continued (subject to refund if the claim is approved) until you are
terminated by our employer or until your claim has been approved by the
insurance company, whichever occurs first. If you are terminated before the
waiver of premium claim is approved, you must apply for conversion within 31
days of your date of termination to protect your life insurance conversion
rights in the event the claim is disapproved.
The waiver of premium provision is for Life
Insurance only. AD&D coverage cannot be continued beyond the month in which your
disability waiver of premium claim is approved or you are terminated by your
employer, whichever occurs first.
Note: If your Optional Life Insurance premiums
are waived due to disability and you return to work, you must complete a new
enrollment form within 31 days of your return-to-work date, and resume paying
the required contribution, to reinstate your optional coverages.
How long can I continue PEBB life insurance when
I am not actively at work?
I f you self-pay the premiums through your
payroll or insurance office, you may continue Life Insurance for yourself and
your dependents under the following conditions:
Up to 18 months between periods of employer paid
coverage, if you are a part-time faculty or seasonal employee;
Up to 29 months during any authorized leave
without pay, while receiving time loss benefits under Workers’ Compensation,
during a layoff (reduction-in-force), or while awaiting hearing for a dismissal
action;
Up to 18 months if you are a reverted employee
and not successful in regaining pay status.
If you self-pay premiums while you are off work
and complete an enrollment form within 31 days of your return to work, you will
not be required to furnish evidence of good health to reinstate your optional
coverages.
Note: AD&D coverages, Part A and Part E, can be
continued for the same period as Life Insurance, except in the case of total
disability (see Question 21).
If you choose not to self-pay the premiums, your
coverage will terminate (see Question 9 for the termination dates). When you
return to active work, you must provide evidence of good health to reinstate
Parts B Basic Spouse, B Supplemental, C, and D of your coverage.
If you are on an approved leave of up to 12
weeks under the Family and Medical Leave Act, your employer will continue
providing Part A coverage for you without cost. If you choose not to self pay
premiums for optional coverage during that time period, your optional coverage
will be reinstated to the amounts you had under this plan immediately prior to
your leave on the date you return. Your return must be within the period
authorized by your employer but not longer than 12 weeks. You must complete an
enrollment form within 31 days of your return to work and also resume paying the
required contribution at that time.
What is Accidental Death and Dismemberment
Insurance?
Accidental Death and Dismemberment (AD&D)
Insurance provides extra benefits for certain injuries or death resulting from
an accident. If you die from a covered accidental bodily injury, the full amount
of AD&D benefits (Principal Sum) for which you are enrolled will be paid to your
beneficiary in addition to any life insurance you have under the PEBB program.
For covered accidental losses, loss of both
hands, both arms, both feet, both legs, or loss of sight in both eyes, the AD&D
coverage pays you the full amount of benefits (Principal Sum) for which you are
enrolled.
I f you should lose one hand, one arm, one foot,
one leg, or the sight of one eye as a result of a covered accident, AD&D
benefits equal to half of the amount of your AD&D coverage (Principal Sum) will
be paid to you.
Why is AD&D coverage so much less expensive than
life insurance (which pays for death from any cause)?
Actuarial studies indicate that only about one
in 12 deaths are caused by accidents. The loss of hands, feet, arms, legs, or
eyesight as a result of an accident is also a relatively rare occurrence. Since
the risk is low, you can obtain AD&D coverage to supplement your Life Insurance
for a relatively small additional premium.
How do I drop or reduce coverage for myself or
my dependents?
You may drop or reduce optional coverages at any
time, subject to the minimum for continued enrollment in Part C. Complete a new
enrollment form and give it to your payroll office. Your change in coverage will
take effect on the last day of the calendar month in which you elect to drop
coverage. Of course, all employees remain in Part A as long as they are
eligible.
If you drop or reduce coverage on yourself or
your spouse, evidence of good health will be required to re-enroll at a later
date.
Who answers questions about life insurance
benefits?
For questions about enrollment and
administration, contact the Benefits office or the Health Care Authority, 676
Woodland Square Loop S.E., P. O. Box 42682, Olympia, WA 98504-2682, (800)
700-1555 or (360) 412-4200.
Does this life insurance program have a
provision to pay benefits while I am living?
Yes. Terminally ill employees and spouses who
meet specific eligibility rules may be able to collect a portion of their Life
Insurance benefit during the last six months of life. (See the Accelerated Life
Benefit)
Long Term Disability Insurance:
Why is Long Term Disability (LTD) Insurance
important?
Your continued ability to pay for food, shelter,
and other commitments is probably dependent upon your receiving a paycheck. Six
out of ten people between ages 20 and 60 will be disabled for some period of
time before age 65. If you are between the ages of 35 and 65, you are six times
more likely to become disabled than to die. The PEBB-sponsored Long Term
Disability Insurance Plan is designed to help protect you from the financial
risk of loss of earnings due to serious injury or illness. Basic LTD Plan
coverage is provided at no cost to you. If you meet the eligibility
requirements, you may also enroll in Optional LTD Plan insurance at your
expense. LTD benefits are coordinated with other sources of replacement income
available to you during periods of Disability (such as Workers’ Compensation,
Social Security, and Retirement Plan benefits) to provide valuable protection of
your earnings while controlling your premium cost.
What are the LTD benefits?
The PEBB-sponsored LTD plan has 2 parts: the
Basic Plan and the Optional Plan. The Basic Plan The Basic LTD Plan provides a
benefit of 60% of the first $400 of Predisability Earnings, reduced by any
deductible Income (see Question 11). The maximum benefit payable is $240 per
month. The minimum benefit is $50 per month. Benefits begin after 90 days of
Disability or after the period of your accumulated sick leave, whichever period
is longer, and continue during your Disability up to the Maximum Benefit Period.
The Optional Plan This plan allows most
employees eligible for the Basic LTD Plan to apply for additional benefits. When
combined with Basic benefits, the Optional Plan will pay 60% of the first
$10,000 of your Predisability Earnings, reduced by any Deductible Income. The
minimum combined benefit is $100 per month. The Optional Plan benefit will
increase in accordance with the Cost of Living Adjustment (COLA) provision as
explained in Question 3. Optional Plan benefits begin after the end of the
Benefit Waiting Period (see Question 6) and continue during Disability up to the
Maximum Benefit Period. Employees enrolled in the Optional Plan are also covered
under the Retirement Supplement benefit.
Here are examples of how LTD works:
Mr. Smith is age 27, has been in state service
for four years, and his current salary is $1,000 per month. He has 20 days of
accumulated sick leave and elected the 90-day Benefit Waiting Period under the
Optional Plan. Mr. Smith’s disability does not qualify for Social Security or
other disability benefits: $1,000 Predisability Earnings x60 % $ 600 Maximum
benefit* from all sources, beginning after 90 days of Disability
*Plus any benefit payable under the Cost of
Living Adjustment provision or the Retirement Supplement.
Ms. Jones is age 50 and has been in state
service for 16 years. Her current salary is $2,000 per month. She has 135 days
of accumulated sick leave which is the calendar day equivalent of 189 days. Ms.
Jones elected the 180-day Benefit Waiting Period under the Optional Plan. Since
accumulated sick leave (189 calendar days) exceeds the 180-day Benefit Waiting
Period, benefits begin after 189 days of Disability. $2,000 Predisability
Earnings x60 % $1,200 Maximum benefit from all sources
$ 400 Social Security (assuming disability to
last a year or more) $ 400 Retirement Disability Benefit $ 240 Basic Plan
Benefit $ 160 Optional Plan Benefit* $1,200
*Plus any benefit payable under the Cost of
Living Adjustment provision or the Retirement Supplement.
Mr. Brown is age 55 and has been in state
service for 25 years. His current salary is $2,200 per month. He has 175 days of
accumulated sick leave, the calendar day equivalent of 245 days. Mr. Brown
elected the 240-day Benefit Waiting Period under the Optional Plan. Benefits
begin after 245 days of Disability. $2,200 Predisability Earnings x60 % $1,320
Maximum benefit from all sources
$ 400 Social Security (assuming disability to
last a year or more) $ 1,000 Retirement Disability Benefit
$ 1,400 Total Deductible Benefit Income (exceeds
60% of Predisability Earnings) $ 100 Minimum Plan Benefit ($50 Basic plus $50
Optional*)
This example is given to illustrate that because
of the disability benefits available from other sources, Mr. Brown will receive
only the minimum benefit of $100 per month.
*Plus any Retirement Supplement benefit
Will my Optional Plan benefit increase if the
cost of living increases?
Yes. The Optional Plan includes a Cost of Living
Adjustment (COLA) provision which increases the Optional benefit annually, based
on increases in the Consumer Price Index. This adjustment is made each March 1
for employees who have received Optional Plan benefits for at least three months
during the preceding 12 months. The benefit increase will be equal to one-half
of the rate of increase in the Consumer Price Index for Urban Wage Earners and
Clerical Workers during the preceding calendar year, up to a maximum increase of
6%.
This COLA provision does not apply when the
minimum benefit is being paid. Also, the COLA provision does not apply to Basic
and Retirement Supplement benefits.
Does the Optional Plan provide a supplement to
my retirement income?
Yes. Employees enrolled in the Optional Plan who
are eligible to be covered under Teacher’s Insurance Annuity Association and
College Retirement Equities Fund (TIAA-CREF) or a Higher Education Academic
Retirement Plan have the following type of retirement supplement:
The amount paid to your pension plan on your
behalf will be equal to the sum of (1) the contribution you are required to make
to TIAA-CREF or a Higher Education Academic Retirement Plan, and (2) the
contribution made by the Employer to TIAA-CREF or a Higher Education Academic
Retirement Plan on your behalf, not to exceed 15% of the first $10,000 of your Predisability Earnings.
All other employees enrolled in the Optional
Plan who have at least five years of employment with the state have a retirement
supplement monthly benefit, which is determined as follows:
Two percent (2%) of the first $10,000 of the
Predisability Earnings at the time of Disability times the number of "qualifying
years of Disability," not to exceed 60%. (In case of a duty disability for
employees covered under PERS 1, the benefit will be 1% of the first $10,000 of
Predisability Earnings times the number of "qualifying years of Disability," not
to exceed 30%).
However, no benefit is payable if the amount
determined above is less than $50 per month.
"Qualifying years of Disability" means the
number of years for which regular Optional Plan benefits are paid.
The retirement supplement monthly benefit begins
when the scheduled Maximum Benefit Period for Disability benefits ends, and the benefit continues until the date of the employee’s death.
The Cost of Living Adjustment and
Deductible Income provisions do not apply to these retirement
supplement benefits. For more details, refer to the certificate language.
Which employees are eligible to enroll in the
Public Employees Benefits Board Long Term Disability Insurance Plan?
The following state, school district and
educational service district, and participating governmental subdivision
employees are covered under the Basic Plan and are eligible to enroll in the
Optional Plan:
Permanent employees: Those who work at least
half-time per month and who are expected to be employed for more than six
months. Such employees shall be eligible to apply for coverage on their first
day of employment.
Nonpermanent employees: Those who work at least
half-time and are expected to be employed for no more than six months. Such
employees shall be eligible to apply for coverage on the first day of the
seventh month of employment.
Career seasonal/instructional employees:
Employees who work half-time or more on an instructional year (school year) or
equivalent nine-month seasonal basis are eligible to apply for coverage on their
first day of employment and are eligible to receive the Employer contribution
for insurance during the off-season following each period of seasonal
employment.
What is the Benefit Waiting Period?
The Benefit Waiting Period is the period you
must be continuously Disabled before LTD benefits become payable. The Benefit
Waiting Period under the Basic Plan is the first 90 days of Disability or the
period of your accumulated sick leave, whichever is longer. You choose the
length of your Benefit Waiting Period under the Optional Plan at the time you
enroll. The Benefit Waiting Period for Optional Plan benefits is either 30, 60,
90, 120, 180, 240, 300, or 360 days of each period of Disability, depending upon
your choice, or the period of your accumulated sick leave, whichever is longer.
LTD Benefits are paid at the end of each month you qualify for them. Why does
the Optional Plan have several Benefit Waiting Periods from which to select? The
choice of Benefit Waiting Periods under the Optional Plan allows you to select
the Benefit Waiting Period which best fits your needs. The longer the Benefit
Waiting Period, the lower the premium cost to you. Since no plan benefits are
payable during a period when you are eligible to receive sick leave, the Benefit
Waiting Period you select should take into consideration the amount of your
accumulated sick leave. For example, an employee who has accumulated 26 weeks
(130 days) of sick leave may wish to select the 180-day Benefit Waiting Period
so that benefits could begin at about the same time as sick leave pay is
exhausted. A new employee or an employee with no sick leave accumulation may
wish to select a shorter Benefit Waiting Period.
Can I change my Benefit Waiting Period under the
Optional Plan once enrolled? Yes. You may lengthen your Optional Plan Benefit
Waiting Period at any time, but you may reduce it only by furnishing evidence of
good health satisfactory to the insurance company. To maintain the lowest
premium cost possible, you may contact your insurance, personnel or payroll
office to lengthen your Benefit Waiting Period when your sick leave accumulation
exceeds the Benefit Waiting Period you have selected.
How much does the Optional Plan cost?
The cost of the Optional Plan depends upon the
Benefit Waiting Period you select as shown on page 39. It is calculated as a
percent of your Predisability Earnings up to $120,000 per year (i.e. up to
$10,000 per month for persons paid 12 months per year or up to $12,000 per month
for those paid 10 months per year, etc.).
What are considered Predisability Earnings?
For benefit calculation purposes, Predisability
Earnings are determined by dividing your basic annual earnings from state
employment by 12 (not including overtime, shift differential, standby pay,
bonuses, commissions, supplemental stipends, and other extra compensation).
Position stipends are considered part of Predisability Earnings. However, for
premium calculation (payroll deduction) purposes, basic monthly earnings do not
include days/hours of unpaid leave.
What is Deductible Income?
Deductible Income includes: Sick pay, shared
leave, and other salary continuation paid to you by your Employer, but not
including vacation pay or annual leave. Your Work Earnings as described in the
Return to Work Incentive. Any amount you receive or
are eligible to receive because of your disability under any Workers’
Compensation law or similar law, including amounts for partial or total
disability, whether permanent, temporary, or vocational. Any amount you, your
spouse, or your children under age 18 receive or are eligible to receive because
of your disability or retirement under the Federal Social Security Act, Canada
Pension Plan, Quebec Pension Plan, or any similar plan or act. Any amount you
receive or are eligible to receive because of your disability under any state
disability income benefit law or similar law. Amounts you receive or are
eligible to receive because of your disability under any other group disability
insurance coverage. Your Deductible Income from your Employer’s retirement plan. Any amount you receive by compromise, settlement, or
other method as a result of a claim for any of the above, whether disputed or
undisputed. Exceptions: Deductible Income does not include:
Any cost of living increase in any Deductible
Income other than Work Earnings, if the increase becomes effective while you are
disabled and while you are eligible for the Deductible Income. Reimbursement for
hospital, medical, or surgical expense. Reasonable attorneys’ fees incurred in
connection with a claim for Deductible Income. Benefits from any individual
disability insurance policy. California Workers’ Compensation benefits for
permanent total or permanent partial disability. Early retirement benefits under
the Federal Social Security Act which are not actually received. Group credit or
mortgage disability insurance benefits. Vacation pay ("annual leave"). Military
retirement or disability benefits.
When am I covered under the Basic Plan?
Your insurance under the Basic Plan becomes
effective on the first day of the month following the date you become eligible. Evidence of good health is not required for the
Basic Plan.
When am I covered under the Optional Plan?
If you apply for the Optional Plan within 31
days from the date you first become eligible for PEBB-sponsored benefits (not as
a transfer to a new agency, school district, or ESD), evidence of good health
will not be required, and your insurance becomes effective on the first day of
the month following the date you apply. If you
apply for the Optional Plan more than 31 days after your initial eligibility
date, evidence of good health will be required, at your expense, and coverage
does not become effective until the first of the month after your application
has been approved by the insurance company.
Upon return to work from an unpaid leave, if you
were covered under the Optional Plan in the month immediately preceding the
unpaid leave, or if you return within the first 12 weeks of approved family
leave, you may reinstate your Optional coverage without furnishing evidence of
good health only if you notify the Benefits office in writing within 31 days of
your return to your predisability work schedule. Your Optional coverage then
reinstates on the first of the month following your return to your predisability
work schedule. Application must be within 31 days of reinstatement and mailed
directly to your personnel/payroll officer.
Note: If sickness, injury, or pregnancy prevents
you from working the day before the scheduled effective date of your Optional
insurance, your Optional insurance will not become effective until the day after
the complete one full day of active work.
What is the definition of Disability?
During the Benefit Waiting Period and for the
next 24 months, Disability means you are unable, as a result of sickness,
injury, or pregnancy, to perform with reasonable continuity the Material Duties
of your Own Occupation. After that, Disability means you are not unable, as a
result of sickness, injury, or pregnancy, to perform with reasonable continuity
the Material Duties of any gainful occupation for which you are reasonably able
through education, training, or experience. Partial Disability is also covered.
What are the Exclusions and Limitations?
Benefits are not paid for disability resulting
from war, intentionally self-inflicted injuries while sane or insane), or a
"pre-existing condition" as defined by the plan.
What is a pre-existing condition? A pre-existing
condition is defined as a mental or physical condition for which you received
medical treatment, took prescribed drugs, or consulted a physician, in the 90
days preceding the effective date of your insurance under the group policy.
Is a pre-existing condition covered?
In general, the plan does not provide benefits
for any disability caused or contributed to by a pre-existing condition, unless
the disability begins after you have been insured for 12 consecutive months
after the effective date of your insurance. The 12-month period applies
separately to Basic and Optional coverages. However, the pre-existing condition provision will be
waived for you if you furnish evidence of good health which is approved by the
insurance company. If you return to pay status after a period of non-pay status
resulting from the termination of employment, the pre-existing condition
provision will apply to any condition which is pre-existing on the date you
become insured again.
Coverage for all other covered conditions begins
immediately when you become insured.
Are mental disorders covered? Yes. Benefits for
mental disorders are limited to 24 months. However, if you are continuously
hospitalized at the end of such period, benefits will continue while you are
hospitalized if you are otherwise eligible. All benefits are subject to the
Maximum Benefit Period. What if both husband and wife are
eligible employees? Both may enroll without regard to marital status. Must I be
continuously Disabled to satisfy the Benefit Waiting Period? No, you may return
to your predisability work schedule for up to five days for each 30 days of the
Benefit Waiting Period without starting the Benefit Waiting Period over again.
Days that you work will not be counted as part of the Benefit Waiting Period. If
I receive benefits and then recover from Disability, must I serve another
Benefit Waiting Period before receiving benefits again? No. If your second
Disability for the same cause occurs within 180 days, you will be eligible for
benefits without satisfying the Benefit Waiting Period again.
What is the Maximum Benefit Period?
The Maximum Benefit Period depends on your age
at the beginning of Disability, as shown in the following table: Age at
Beginning of Disability Duration of Benefits 61 or younger 62 63 64 65 66 67 68
69 and older To age 65, but not less than 42 months 42 months 36 months 30
months 24 months 21 months 18 months 15 months 12 months
Exception: The Retirement Supplement monthly
benefit for employees not covered under the TIAA-CREF or a Higher Education
Academic Retirement Plan begins at the end of the above Maximum Benefit Period,
and is payable until the date of the employee’s death.
What happens if I should die while Long Term
Disability insurance benefits are payable? Should you die while receiving
benefits, a lump sum equal to three times your LTD benefit is payable to your
surviving spouse or dependent child(ren). However, no survivorship benefit will
be payable under either Retirement Supplement plan. Do I have to pay premiums
while I am Disabled? Premium payments are not required once your benefit begins
or while you are completing the Benefit Waiting Period if your pay status ends.
Does this coverage continue while I am on paid leave? Yes, provided you continue
any required payroll deductions. For employers who work in an institutional year
or career seasonal position, coverage continues between periods of active
employment.
Does this coverage continue while I am on unpaid
leave or reduced pay?
Coverage ceases on the day your pay status
ceases, except under the following conditions:
Basic and Optional coverages last to the end of
the month in which pay status ends due to approved leave, reduction in force or
reversion.
If you are on approved family leave, Basic
coverage is continued up to the first 12 weeks. You may also self-pay Optional
coverage during this time.
Your coverage may be continued for up to 24
months provided you are on an approved sabbatical or educational leave.
Your coverage will be continued for up to 30
days without additional cost to you during a continuous period of unpaid
approved leave which is taken immediately following the annual paid leave.
What is the Return to Work Incentive?
The Return to Work Incentive offers a financial
incentive for you to return to work to the extent of your ability. You are
eligible for the Return to Work Incentive on the first day you work after the
Benefit Waiting Period if LTD Benefits are payable on that date.
You also may serve your Benefit Waiting Period
while working if you meet the plan’s definition of Disability or Partial
Disability.
How does the Return to Work Incentive affect my
Long Term Disability benefit?
During the first 12 months after the first day you
work following completion of the Benefit Waiting Period, your Work Earnings will
be Deductible Income as determined below:
Determine the amount of your LTD Benefit as if
there were no Deductible Income, and add your Work Earnings to that amount.
Determine 100% of your Indexed Predisability Earnings. If A. is greater than B.,
the difference will be Deductible Income. After those first 12 months, one half
of your Work Earnings will be Deductible Income.
If I leave public employment, may I take my Long
Term Disability insurance with me?
No. Neither the Basic nor Optional Plans may be
converted to individual polices. Group Long Term Disability insurance is
designed to provide coverage only while you are working for a specific Employer,
and benefits are designed to fit the specific needs of the group.
When does my insurance terminate?
Your insurance automatically terminates on the
earliest of the following dates:
The date of termination of your status as an
eligible employee (the last day you were in pay status, except as stated
otherwise; The date you become a full-time member of the military forces
(land, sea, or air) of any country; For the Optional Plan only, the end of the
last month for which you were eligible and made a required contribution; or The
date of discontinuance of the group policy. (This will NOT affect continuance of
disability benefits if you have an active claim. Please refer to Benefits After
Insurance Ends or Is Changed on page 34.)
When should I file a claim?
You should file a claim as soon as you or your
doctor believe you will be disabled for a period longer than your Benefit
Waiting Period. Approximately 30 days after a claim is filed, Standard will send
you a written decision on your claim. If your claim is approved, the notice will
advise you when the first monthly benefit payment will be made. In some cases,
additional investigation is required before a decision can be made on a claim.
Standard will notify you in writing if additional time is required.
How do I file a claim?
Report your claim to the Benefits office. They
will help you complete the necessary paperwork to file a claim.
Who is the insurance company?
The Public Employees Benefits Board has
contracted with Standard Insurance Company of Portland, Oregon to provide this
coverage.
If I complete the "Statement of Health" form, am
I protected under the Federal Fair Credit Reporting Act?
Yes. Information regarding your insurability
will be treated as confidential. Standard Insurance Company may, however, make a
brief report to the Medical Information Bureau, a non-profit membership
organization of life insurance companies, which operates an information exchange
on behalf of its members. If you apply to another Bureau member company for life
or health insurance coverage, or a claim for benefits is submitted to such a
company, the Bureau, upon request, will supply such company with the information
in its file.
Upon receipt of a request from you, the Bureau
will arrange disclosure of any information it may have in your file. (Medical
information will be disclosed only to your attending physician.) If you question
the accuracy of information in the Bureau’s file, you may contact the Bureau and
seek a correction in accordance with the procedures set forth in the Federal
Fair Credit Reporting Act. The address of the Bureau’s information office is 160
University Avenue, Westwood, Massachusetts 02090, telephone number (617)
329-4500.
Standard Insurance Company may also release
information in its file to other life insurance companies to whom you may apply
for life or health insurance, or to whom a claim for benefits may be submitted.
If I have a question about the Long Term
Disability Insurance Plan, who can answer it for me?
For questions about enrollment and
administration, contact the Benefits office. You may also contact the Health
Care Authority, 676 Woodland Square Loop S.E., P. O. Box 42682, Olympia, WA
98504-2682, telephone 1-800-700-1555 or, if you are calling from the Olympia
area, (360) 412-4200.
VEBA:
What is a VEBA and what are the tax objectives
of the Plan?
A VEBA is a tax-exempt trust authorized by the
Internal Revenue Code Section 501(c)(9). The tax objectives of this type of plan
are to enable your employer to make tax-free deposits on your behalf to the
Plan, for your account to be credited with tax-free investment earnings, and to
enable you to obtain tax-free reimbursements for your medical expenses and
insurance premiums payments. VEBA-MEP contributions will not be reported on your
W-2.
Why should I participate in the VEBA-MEP?
The VEBA-MEP account provides a source of funds
to pay for the cost of health care expenses for you, your spouse, and your
qualified dependents. A VEBA-MEP account may be used to pay any qualified
post-retirement medical, dental, or vision out-of-pocket expenses (deductibles,
co-payments, co-insurance, etc.), plus post-retirement medical, dental, or
vision insurance premiums, Medicare Part B premiums, Medicare deductibles,
Medicare Supplement Plans, and long term care insurance premiums.
How much sick leave cash-out will be contributed
to the VEBA-MEP at retirement?
When you retire, the total amount equivalent to
your sick leave cash-out, based on your salary at the time of retirement, will
be contributed to your VEBA-MEP account. Your cash-out amount is calculated at ¼
of your accumulated unused sick leave balance.
Can annual sick leave cash-out be contributed to
the VEBA-MEP?
No. State law does not provide the authority for
annual January cash-out funds to be contributed to VEBA-MEP. However, you may
choose to not cash-out your unused sick leave annually, and instead accumulate
more sick leave days which will increase your retirement cash-out amount.
Do VEBA contributions reduce my State of
Washington pension benefits?
No. VEBA contributions do not reduce the wage
base reported to the Department of Retirement Systems which is used to calculate
your pension.
When and how do I get money out of my VEBA-MEP?
Your VEBA-MEP is opened when your Employer sends
sick leave cash-out funds to the VEBA Plan Administrator. You will be mailed a
Welcome Packet and then you may submit a VEBA Medical Claim Form for your
qualified out-of-pocket medical, dental or vision expenses incurred by yourself,
your spouse, and/or your qualified dependents. Claims payment is efficient and
hassle free.
You may file claims for any amount. Benefits
will be paid until your account is used up. You may also arrange to have monthly
insurance premiums paid by using the VEBA Systematic Payment Form. If your
spouse or dependents are covered by different medical plans, their insurance
premiums can also be paid out of this account.
Can the cost of any qualified retiree medical
plan be paid from my VEBA-MEP?
Yes. The cost of any qualified medical plan you
elect to use after retirement can be paid out of this account, including PEBB
plans, Medicare Supplement Plans, etc. If you join the PEBB Retiree Medical
Plan, you can authorize the Department of Retirement Systems to deduct your
medical premium from your defined benefit pension check (PERS/TRS retirement
plan members). You can then arrange with the VEBA Plan Administrator to directly
reimburse you from your VEBA account by using the VEBA Systematic Payment Form.
Direct deposit is available.
What happens if I die before my VEBA-MEP is used
up?
If you are survived by a spouse or dependent
children (or other dependents as defined by the IRS) they may submit requests
for medical expense reimbursements until your account is used up. If you have no
eligible dependent(s), the funds remaining in your account will be paid as
medical expense reimbursements to the heir(s) of your estate.
Who is the VEBA Plan Administrator?
Rehn & Associates in Spokane is the VEBA
Administrator. Rehn is an experienced employee benefits administrator
specializing in the administration of ERISA health and welfare plans. Rehn
provides all correspondence, accounting, and benefit payment services.
Who is responsible for developing and managing
this Plan?
The VEBA Trust was developed and sponsored by
the Association of Washington School Principals (AWSP), Washington Association
of School Administrators (WASA), and the Washington Association of School
Business Officials (WASBO). It is managed by six Trustees appointed by the
sponsoring organizations. Over 25,000 employees have participated in the VEBA
Trust since its inception in 1984.
What are the Trustee’s responsibilities?
The Trustees are fiduciaries and have a duty to
act prudently and in the best interest of all the Plan participants and
beneficiaries.
Will I receive a statement of my account?
You will receive a semi-annual statement
detailing all activity in your account. You may also call and request additional
statements at any time.
Will my account grow?
The net investment earnings or losses (after
expenses are deducted) are credited tax-free to your account on a monthly basis.
How is the VEBA money invested?
The Trust offers you three fund options. You may
choose to have all or a portion of your VEBA account in any or all of the
following funds:
• Stable Value Fund
• Balanced Fund
• Growth Fund
Investments in the Balanced and Growth Funds
will fluctuate in value. VEBA is not meant to be a long term investment account.
Its purpose is to hold funds that are distributed for medical expenses; hence
the higher administration fee.
How are expenses paid?
All expenses of administering the Plan are paid
by reductions of investment earnings, or, if there are no earnings, charged as a
deduction to a participant’s account.
I am grandfathered in to the 180-day med plan.
Why do I get to vote on VEBA?
As an employee grandfathered into the 180-day
med plan you have a vote regarding VEBA because every year you may elect to
switch over to the accrual method. Although the 180-day med plan is NOT
cashable, if you were to switch over to the accrual method, your previous hours,
plus any new accruals would be cashable and part of the VEBA plan. This decision
can be made any year (only once) up until retirement.
Why can’t people decide if they want to
participate individually in the VEBA plan, instead of forcing everyone into the
plan?
The "all or none" comes from IRS rules. VEBA
Medical Expense Plans were created by the governing bodies, but they must comply
with tax laws. The IRS very clearly states that if you give employees the choice
of receiving cash or having a benefit, then that benefit/cash must be taxable as
income. The only way to protect the tax status of the VEBA account is to make it
such that employees don't have the option and/or choice to receive cash.
Therefore, we can create a VEBA MEP, and allow people to vote participation in
(or out), but once it's voted in, all employees must participate. In other
words, you cannot provide a tax free benefit without making everyone
participate.
The whole benefit of the VEBA-MEP is the tax
protection. In the past, if you were to retire from the University, you could
cash out your sick leave, but it would be taxed at 25%. So, you lose 25% of the
25% cash out. The VEBA MEP accounts were created, because it was presumed that
the majority of people who were retiring from the University would have some
sort of health care costs during their retirement years. Specifically, costs
associated with premiums for retiree health care coverage and/or Medicare, or
costs associated with keeping themselves healthy in old age. This tax protection
would allow people 25% more money to spend on what is pretty much a guaranteed
need.
Is it a huge hassle to request reimbursement?
Similar to the FSA (Flexible Savings Account),
you must fill out a reimbursement form, along with appropriate documentation. If
there is a question about the documentation or medical necessity, there may be
additional steps. For the majority of claims the process is very simple. There
is also an option to set up automatic premium payment from your VEBA-MEP for
regular medical expenses such as your Retiree health insurance premiums. That
way, the VEBA administrator automatically sends payment to the WA State Health
Care Authority for your retiree medical premiums.
Can employees contribute additional money to
their VEBA account?
No. Additional contributions are not allowed at
this time. However, congress is considering legislation that would allow for the
creation of a Health Savings Account. This account would be similar to the
University’s Flexible Savings Account or a Personal IRA. It would allow
taxpayers to put aside money on a tax free basis to cover health care related
expenses. This is something to watch for in the future.
Is there a maximum allowed cash-out?
No, whatever your sick leave balance is, it will
be cashed out at 25% upon retirement.
If I am a member of the State’s retirement plan
(PERS, TRS, LEOFF) will the cash out value be added to my annual income?
The cash out value of sick leave is not added to
your W-2 income or applied to your retirement.
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