- Forms & Docs
We are pleased to announce an open enrollment of the IUOE Local 399 endorsed Voluntary Group Short-Term and Long-Term Disability Insurance program administered by Group Benefit Associates and insured by The Hartford. Local 399 has a long-term business relationship with Group Benefit Associates and we are confident this voluntary program offers a good option for disability income at a reasonable cost.
This program provides the ability for you to meet your financial commitments to both you and your family in the event of disability of a non-work related illness or injury. Disability insurance allows you to protect your income if an illness or injury prevents you from performing your job. If your wages are your primary source of income, this benefit will help supplement the financial commitments you have to yourself and your family.
There are Two Optional Plans: (Both may be purchased.)
Short Term Plan - $250/week tax-free after 14 days of being unable to work due to a non-work related accident, injury, or illness up to a total of 26 weeks. This supplements the $250/week disability income benefit already in place if you are covered by Local 399´s Health & Welfare Plan.
Long Term Plan - After 180 days, the plan provides 60% of your income up to $4500 per month tax-free for an additional 5 years. This plan is intended for those members who have no other disability insurance.
You may enroll in the Short Term Disability plan, the Long Term Disability plan or both.
Open enrollment will begin on February 1, 2015 and will end on April 30, 2015. Coverage will become effective on May 1, 2015. During this time all enrollments will be accepted with no questions asked. This will be the ONLY opportunity to sign up for the disability coverage with NO medical questions asked. This is not a benefit derived from any collective bargaining agreement, any of our existing Local 399 plans or any employer sponsored plans.
This is strictly a voluntary program to our Local 399 members. There has not been an open enrollment period for some time and I encourage you to consider this voluntary disability income benefit program. The program is administered by Group Benefit Associates (GBA) and The Hartford, not Local 399. To review plan details and enroll, please visit www.groupba.com - select Union Members - then IUOE 399. Please direct questions to GBA at 1-800-450-1271. Detailed information about the program with be mailed to you within the next 10 days.
Brian E. Hickey
President & Business Manager
This disability plan is specifically designed for IUOE Local 399 members to help them protect their income and assets in the event of a disability.
Some Questions to Think About
- Could you afford to take a six-month vacation? If you can’t, do you think you could afford living through a six-month illness or injury?
- How would you and your family pay your bills without your income?
- How long would your savings last if you were unable to work because of an illness or accident and your income stopped?
- If you were sick or injured in an accident today, would your family’s standard of living be affected?
- What impact would a long-term illness or injury have on your ability to save for retirement?
- This plan is specifically designed to benefit the members of IUOE Local 399. As a current member, you are eligible to enroll in this group coverage.
You must be actively at work to be eligible to enroll.
As a plan participant, you must notify Group Benefit Associates:
Within 30 days of any layoff and again within 30 days of my subsequent return to work
Immediately when my bank account or credit card information changes for the purpose of premium collection
Immediately when my wage rate changes
Within 1 year of my date of disability if I become disabled
Within 30 days if I withdraw from the Union
I understand that failure to notify Group Benefit Associates in a timely manner of any of the above listed changes can affect my participation in the plan or the benefits I am eligible to receive under the plan.
Group Benefit Associates has teamed together with Hartford Life and Accident Insurance Company to bring you this program. The Hartford is the insurance carrier for the policy and processes all claims and Group Benefit Associates is the third-party administrator responsible for premium collection and remittance.
Short Term Disability (STD)
- Benefit Begins: 15th day non-occupational accidental injury, 15th day non-occupational sickness or pregnancy.
- Benefit Amount: $250 per week
- Benefit Period: 24 weeks
During the first 12 months of coverage, no benefits will be paid for a disability that is due to a pre-existing condition. A pre-existing condition is an injury or sickness for which you received medical treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for which you followed treatment recommendations during the three months prior to your effective date of coverage. This provision also applies if you did not consult a physician when an ordinarily prudent person would have. Exclusions may vary by state.
Long Term Disability (LTD)
- Benefit Begins: 180 days following non-occupational accidental injury, sickness or pregnancy
- Benefit Amount: 60% of monthly covered earnings
- Maximum Benefit: $4,500 per month less deductible sources of income and disability earnings.
- Minimum Benefit: $100 per month
- Benefit Period: Up to 5 years
- Limited Pay Periods:Disabilities due to mental illness and disabilities primarily based on self-reported symptoms are limited to 24 months of benefits during your lifetime.
Short-Term Disability (STD)
- For STD benefit of $250 per week, the monthly premium is $15.25.
Long-Term Disability (LTD)
Long Term Disability premiums are based on your age and wage rate. To calculate your LTD premium, enter your Birthdate and Wage Rate below. If you want to do a manual calculation, see the infomation at the bottom of this page.
**Please note that if you fall into a new age bracket as indicated above, your premium will increase. You will also experience a premium change if you have experienced a change in your pay rate.
Cancellation Requests: Cancellation requests must be received in writing by mail, fax, or e-mail. Cancellations will become effective on the last day of the month in which they are received.
Premium Waived if Disabled: Premium will not need to be paid if you are receiving benefits. Please contact us within 30 days of your disability so that we may waive your premium while you are not working.
Premium Payments: Your initial premium due will be collected within 5 business days of your enrollment. Subsequent premiums will be collected automatically from a Visa, MasterCard or direct debit from a checking account on the 15th of each month. If the 15th falls on a weekend or holiday, the charge will occur on the next business day.
LTD Manual Calculation
Please follow the steps below to manually calculate your LTD monthly premium:
|Enter your hourly wage rate||
|Multiply by 2080||
|Divide by 12||
|LTD Rate from Table Below||____.__||(B)|
|Monthly Earnings * LTD Rate (A)*(B)||
|Divide by 100||
*If your monthly earnings exceed $7,500 (maximum monthly covered earnings) then use $7,500 as your monthly earnings to calculate your premium.
LTD Rates per $100 of pre-disability earnings:
|Age||Rate per $100|
- If you prefer to complete a paper application, you may DOWNLOAD and print and mail or fax the application form
- President's Welcome Letter
- Summary of Benefits
- Late Applicant Enrollment Form
- New Member Enrollment Form
- Disability Policy Change Form
The disability income insurance claim form is composed of three separate sections that need to be completed by you, your physician and your employer.
- Employee Section: Please be sure to complete this part clearly and sign where indicated.
- Physician Section: Please have the physician that disabled you complete this part. If you have seen additional physicians, please also include their names, addresses, phone numbers and fax numbers on a separate sheet of paper.
- Employer Section: Even though your policy is purchased through the union, your benefit is based on the income you receive from your particular employer. Your employer assumes no liability or responsibility for your claim by completing this form for you.
Failure to provide proper information and documentation will delay your claim so it is very important the claim form is complete and clear. Once complete, forward the form to our office by mail or fax.
How Your Claim Will Be Handled:
Once received by Group Benefit Associates, we will begin waiving your premium as of the date of your disability. The processing of your claim will be handled by The Hartford and therefore you may inquire with them regarding the status of your claim. Please note that Group Benefit Associates does not have access to information regarding claims determination or benefit payments. However, the assistance of our office can be requested if you encounter difficulty in getting your claim processed.
The Hartford Claims Customer Support:
Premium billing questions are handled by Group Benefit Associates at 800-450-1271.