If You Become Totally Disabled
Waiver of Premium While Receiving Disability Benefits
Paid leave provisions do not apply to substitute teachers.
If you, as the employee, are unable to work because of a total, ongoing disability, your coverage will continue until the earlier of:
-
Your recovery from the disability; or
-
The end of 30 calendar months from the date your total disability started.
Total disability is a covered employee's complete inability to perform the principal duties of his or her occupation. You will be required to provide a physician's certification of your disability.
Any of your dependents who were covered on the date your total disability started will continue to be covered while your coverage continues and they continue to meet the definition of an eligible dependent.
Extension of Coverage While Totally Disabled
If you, as the employee, or a covered dependent are receiving treatment for a totally disabling condition at the time your coverage ends, the plan will continue to provide medical coverage for treatment of that specific condition. To receive this extension of coverage, you must provide the Trust Office with proof of the continuing total disability within 90 days after your coverage ends. Call the Trust Office at (844) 203-0239 for instructions on how to submit this proof.
A covered employee is considered totally disabled if he or she is completely unable to perform the principal duties of his or her occupation or employment.
Dependents are considered totally disabled if illness or injury prevents them from engaging in all regular activities that are customary for their age.
The plan will provide these extended benefits for the lesser of:
-
The number of months you (or your dependent) were covered under the plan before your coverage ended; or
-
12 months for you (as the covered employee) or six months for any covered dependent.
However, extended coverage will stop before these time limits if you or your dependent ceases to be totally disabled.
Extension of coverage is not available if you elect to continue coverage through self-payment.
Note: Extension of coverage for total disability will not apply if the plan terminates within 31 days after your coverage ends.
|
