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Long Term Disability

Application procedures

No approval required:

Carrier approval is not required when the employee submits the Long-Term Disability Enrollment/Change Form (109.3 KB) within 31 days of initial eligibility, or when the employee requests to increase the waiting period. The employer will:

1. Review the LTD Enrollment/Change Form (109.3 KB) for accuracy. Ensure that the employee has completed the appropriate sections and has signed and dated the form.
   
   
2. Complete Section 4 of the form. Include the following information: Current Agency Hire Date, Employee's Monthly Earnings, Initial Eligibility Date, Employee's Current Coverage, and the Effective Date of Optional Coverage, when no approval is required.
   
   
3. Update the LTD Insurance screen with the requested coverage and effective date. Refer to the insurance system manual for instructions. (The effective date is the first of the month following the signature date on the form.)
   
   Note: Employer groups, who do not key updates, please send a copy of the form(s) to PEBB Outreach and Training. Keep the originals of all forms for the employee's file.
   
   
4. File the enrollment form in the employee's file (applications that do not require approval should not be forwarded to Standard Insurance Company.)

Approval required:

Carrier approval is required when the employee applies for coverage outside of the 31 days of initial eligibility or when the employee requests to decrease the waiting period. An Evidence of Insurability form (117.4 KB) must be submitted to Standard Insurance for approval. The employer will:

1. Review the LTD Enrollment/Change Form (109.3 KB) for accuracy. Ensure that the employee has completed the appropriate sections and has signed and dated the form.
   
   
2. Complete Section 4 of the form. Include the following information: Current Agency Hire Date, Employee's Monthly Earnings, Initial Eligibility Date, and the Employee's Current Coverage.
   
   
3. Update the LTD Insurance screen with the requested coverage and effective date. Refer to the insurance system manual for instructions. The coverage will pend for approval. If you are unable to key the pending coverage for any reason, please send a message to PEBB Outreach and Training through FUZE.
   
   Note: Employer groups, who do not key updates, please send a copy of the form(s) to PEBB Outreach and Training. Keep the originals of all forms for the employee's file.
   
   
4. Remind the employee to send the Evidence of Insurability form (117.4 KB) to Standard Insurance Company. If the employee submitted the form to you with the Enrollment/Change form, send the Evidence of Insurability form (117.4 KB) to the carrier.
   
   Note: Standard Insurance Company no longer requires a copy of the Enrollment/Change form for approval.
   
   
5. File the enrollment form in the employee's file.

After approval:

1. The employer and the employee will receive a Final Action Notice (FAN) from Standard Insurance Company when the underwriting of the application has been completed.
   
   
2. Review the FAN for accuracy, verify the coverage required approval. Verify the approved waiting period matches the waiting period on the employees enrollment/change form and the pending waiting period keyed into the insurance system. Contact Standard Insurance Company if approval was not required or the waiting period is incorrect.
   
   
3. Key the approval, denial or closure into the insurance system. Refer to the insurance system manual for instructions.
   
   
4. Once coverage has been keyed, attach the Employer copy of the FAN to the LTD Enrollment/Change Form (109.3 KB) and file in the employee's file.

Refer to the LTD Booklet "Enrollment Process/Changing Your Coverage" , for additional information concerning this procedure.

Claim procedures

LTD claims should be filed as soon as the employee's last day physically on the job is known. Do not wait for the waiting period or leave to be exhausted to file the claim. Standard Insurance Company does not require the employee exhaust their leave; however, leave balances are verified for purposes of determining when the benefit payment period begins. The employer will:

1. Complete the State of Washington Long-Term Disability Claim Employer's Statement (153.2 KB).
   
   
   • Complete the employee's personal information. Include the employee's job title and job classification. The job classification information should include whether the employee is full-time, part-time, permanent, temporary etc.
     
     
   • Date Employed – date employee began employment for a state agency, employer group, K-12 school district, educational service district, or higher education institution with no break in coverage.
     
     
   • Medical Carrier information and effective dates – list the most recent medical plan. If the employee has been enrolled in the medical plan for less than a year, provide previous plan information.
     
     
   • Last day of work before disability commenced – last day physically on the job.
     
     
   • Salary information – current salary, previous salary, and the effective date of the last increase.
     
     
   • Complete Section 4 – include banked sick leave, shared leave, and annual leave.
     
     
2. Send the completed Long-Term Disability Employer's Statement to Standard Insurance. Include: copies of the employee's LTD Enrollment/Change forms, employee's current Classification Questionnaire (CQ), and the requested documentation in section 7. In addition, Standard now requires earnings verification on all LTD claims as follows:
   
   
   • All LTD claims with PDE (predisability earnings) reported as less than $8,000 per month require information through the last day paid and the three previous calendar months prior to the date of disability.
     
     
   • All LTD claims with PDE (predisability earnings) reported as more than $8,000 per month require payroll information through the last day paid and the twelve previous calendar months prior to the date of disability, and the previous year's W-2 or other applicable tax form.
     
     Payroll information is defined as, payroll records, pay stubs, or other documents produced via a payroll software system. Payroll information needs to include year-to-date information, wherever available.
     
     
3. Send the Employee Long-Term Disability Claim Packet (available through the HCA warehouse) to the employee.
   
   The LTD Claim Packet includes:
   
   
   • Employer's Statement - An agency representative should complete this statement and mail it directly to The Standard Insurance Company.
     
     
   • Employee's Statement – The employee should complete and return this form to The Standard Insurance Company with attached copies of requested documents. (See the instructions on the first page of form). Included in the Employee’s Statement are:
     
     
     • Authorization to Obtain Information – Employee must sign and date this form and return with the Employee's Statement
       
       
     • Authorization to Obtain Psychotherapy Notes – Employee must sign and date this form and return with the Employee's Statement
       
       
     • Attending Physician's Statement – Part A is completed by the employee. Part B is completed by the employee's physician. The physician must return this to the Standard Insurance Company.
       
       
   • LTD Notification Form – This form should be given to the employee. This is a two part form, the top part is sent to Standard, by the employee, when they return to work and the bottom part is sent to ReliaStar (life insurance) only if the employee is under 60 years old, disabled, and has been or will be off work for six months or more.
     
     
4. Key the pending Waiver (W) into the insurance system (except Higher Education). The effective date is the first of the month following the last day worked. Refer to the insurance system manual for instructions.
   
   Note: Employer groups, who do not key updates, please send a copy of the form(s) to PEBB Outreach and Training. Keep the originals of all forms for the employee's file.
   
   
5. Continue to collect the optional premiums until you receive Standard Insurance Company's decision.

After decision:

1. Standard Insurance Company will send a copy of the Explanation of Benefits (EOB) to the employer and the employee. If approved, the employee will receive payment with the EOB. If the employee has both Basic and Optional coverage, two letters will be issued explaining the benefits.
   
   
2. Key the approval, denial, or closure into the insurance system. Refer to the insurance system manual for instructions.
   
   Note: Employer groups, who do not key updates, please send a copy of the form(s) to PEBB Outreach and Training. Keep the originals of all forms for the employee's file.
   
   
3. If the employee is still active, the employer will refund any premiums to the employee. If the employee is in self-pay status or no longer employed, HCA accounting will refund the premiums. Notify HCA accounting through FUZE of premium refunds for employees in self-pay status or employees no longer employed.

Return to work:

The employer must notify Standard Insurance Company anytime there is a change in work status of the employee.

• If the employee returns to work part-time, notify Standard immediately.
  
  
• If the employee returns to work part-time, notify Standard immediately. If the employee then returns to full-time, notify Standard again, immediately.
  
  
• If the employee returns directly to full-time, notify Standard immediately.
  
  

When the employee returns to work full-time, regular duties, the employer will reinstate optional coverage, effective the first of the month following the day the employee returns to work. Refer to the insurance system manual for instructions. If coverage is not re-keyed, premiums will not be deducted, and coverage will not be reinstated.

The Employee Enrollment/Change form is not required when the employee returns to work. Enroll the employee in the same coverage as before the claim. If the employee would like to change coverage, refer to the Application procedures section above. For additional information on LTD Claims, refer to the LTD booklet, "Coverage Provisions" beginning on page 24.