Benefits Plans - Long-Term Disability Plans: Expanded Long-Term Disability -
Plan Provisions

How do I qualify for disability benefits?

You must become totally disabled (see Definitions of Terms), and apply for disability benefits before retirement, termination of employment, Workers' Compensation redemption, reduction in force, educational or military leave of absence without pay, or termination of coverage for nonpayment while you are on a leave of absence.

If you are on a leave of absence during which you continue to be eligible for disability, you are responsible for paying your share of the cost, if any, for continuing disability coverage on that portion of your salary.

Are there any pre-existing condition exclusions or limitations?

No. The Expanded Long-Term Disability Plan pays benefits regardless of any pre-existing conditions.

Are there any exclusions?

Yes. The Plan will not pay benefits if your disability occurs:

  • due to an intentionally self-inflicted injury or illness;
  • due to war or acts of war, declared or undeclared;
  • while you are committing or attempting to commit a crime;
  • while participating in a riot;
  • while you are in jail or in prison.

See the Plan Limitations and Interpretations section for more information.

Who determines if I am disabled?

The Claims Administrator determines whether you meet the definition of disability.

What is the basis for determining disability?

The Claims Administrators make disability determinations at their sole discretion based on medical information, which must include objective clinical findings. You must provide medical information that the Claims Administrator, at its sole discretion, accepts as evidence of your total disability as defined in Definition of Terms.

The Claims Administrator bases its determination of disability—and the effective date of the disability—on the information you provide when you apply for benefits and additional information the university may require. The university reserves the right to reject any information provided after the determination is made.

All medical information must document your health condition during the period of time that your LTD coverage is in force. In no case will the University accept medical information that documents your health condition during a time when you are not covered by this LTD plan.

Length of Time of Disability

If it is determined that your total disability is not expected to last more than 12 months, your application will be denied.

If it is uncertain whether your disability will last a year or more, determination of disability may be delayed until you have shown that you were totally disabled for 12 consecutive months.

Note: Being out of work for 12 continuous months does not necessarily qualify you as being totally disabled.

When will disability benefits begin?

If your claim is approved, your disability benefits will begin on the latest of the following dates:

  • the day after you have used up all your sick time pay (including extended sick time), vacation accrual, and/or PTO accrual as defined in the Definition of Terms; or
  • after the waiting period, or
  • after your leave has ended (see Coverage During Leaves of Absence).

What disability benefits will I receive?

If your claim is approved, the Expanded Long-Term Disability Plan replaces up to 65% of your base salary minus any disability income you receive from other public sources, such as Workers' Compensation, Social Security disability and/or retirement benefits, or Veterans Administration benefits. (See "Other disability income" in the Definition of Terms section.) If you receive other disability income—or if the Claims Administrator determines that you are eligible to receive other disability income—the Plan will pay you the difference between that income and 65% of your base salary (or the maximum benefit, if that is less). If your other disability income exceeds 65% of your base salary, the Expanded Long-Term Disability Plan makes no payments.

If you receive no other disability income, the Plan will pay you the full 65% of your base salary up to the maximum benefit.

Disability benefits are paid monthly on the last working day of each month. The maximum annual base salary covered is $424,615. The Plan's maximum benefit is $23,000 per month.

Reduced Appointment—If your appointment is reduced—voluntarily or involuntarily—while you are covered by this Plan, your disability benefits will be calculated using the base salary for your reduced appointment. There is one exception, however. Your disability benefits will be calculated using your base salary prior to the reduction in appointment, if:

  • There is satisfactory evidence that your appointment and/or base salary were reduced because of your disability, and
  • You are approved for benefits within two years of such reduction. The approval date for benefits under the Plan is the date the Claims Administrator (ManageAbility or UNUMProvident) provides written approval.

Less than Two Years of Service—If you have less than two years of service and did not earn at least 75% of your total base salary during the full period of employment, the Plan will not pay disability benefits based on your full salary. This means that you must earn at least 75% of your annual salary as of your last day of work.

For example, if your annual salary is $100,000, 75% of this amount is $75,000. In order to receive disability benefits based on your full salary, you must earn at least $75,000 as of your last day of work. If you do not earn at least 75% of your annual base salary as of your last day of work, benefits will be based on the salary that was earned.

Extended Sick Pay—If you are on extended sick pay, the Plan will not consider a salary increase of more than your average increase over your last three years of work (or, if it is greater, the average increase in your department during the current year). Retroactive salary adjustments will be considered only if the salary was proposed in writing to Human Resources before your last day of work.

Retirement, Retirement Furlough, and Sabbatical—Expanded Long-Term Disability benefits will not be paid if you apply for disability benefits after you are scheduled to retire or take retirement furlough, or during scheduled retirement furlough or sabbatical.

What other benefits will I receive?

If you are approved for disability benefits under this Plan, you will continue any university benefits in which you were participating as of your last day of pay, or the date disability payments begin.

Note: If you do not elect to continue these benefits when you go on disability—or if you elect these benefits and then opt out of them at a later date—you will not be eligible to re-enroll in them at a later date.

Other Benefits

Benefit

What to Consider

Health Plan
Dental Plan Option 1
Group Term Life Insurance
Prescription Drug

Your coverage will continue at no cost to you. You may continue dependent coverage only for those named dependents who are enrolled as of your last day of pay. Note: You cannot add dependents to your coverage while you are on disability unless dependents qualify under the provisions of the university's commercial transfer policy. If you remove dependents from your coverage, you will not be eligible to re-enroll them at a later date.

University Basic Retirement Savings Plan

If you are enrolled in the Basic Retirement Savings Plan or if you are a compulsory Basic Retirement Savings Plan participant, the Plan will provide Basic Retirement Savings Plan contributions as a percentage of your covered base salary at the time of your disability, to the extent it is legally permitted. Additional contributions cannot be made under the provisions of this Plan.

Dental Option 2 and 3
Group Legal
Vision

You are eligible to continue these benefits and must pay the full employee contribution for them yourself; however, if you withdraw from these benefits, you may not be able to re-enroll at a later date.

Taxes and premiums

If a new federal or state law requires the university to pay taxes or premiums to the federal or state government (or another entity) for hospital or medical benefits, the university may make any necessary adjustments to avoid duplicating benefits and may adjust taxable income as needed to comply with such laws.

Medical Leave of Absence

If your Expanded Long-Term Disability benefits are not approved before your last day of pay, you must ask your supervisor and your Campus Employment Office to place you on a medical leave of absence. (For further information, see Standard Practice Guide 201.30, "Leaves of Absence.")

If your disability benefits are approved later, any benefits plans you discontinued will be restored retroactive to your last date of pay—or the date your disability payments begin—whichever occurs later except in cases where the health plan contract does not permit. In these cases, health plan contract language will prevail in determining the retro benefit effective date. You will be reimbursed for any benefits covered under the plan that you continued at your own expense (except for coverage during the Plan's waiting period).

How will the University know if I am eligible for other disability income?

It is your responsibility to inform the university that you and/or your dependents are eligible for other disability income such as Social Security disability or retirement benefits, Workers' Compensation, or Veterans Administration benefits. If you qualify for disability income under this Plan, you must pursue the possibility of receiving disability income from all other sources. See "Other disability income" in the Definition of Terms section. You must promptly provide updated information as may be requested from time to time by the university to evaluate the continued eligibility of you and/or your dependents.

You must notify the Benefits Office in writing promptly whenever you are awarded—or denied—disability income from any other source. At the time you and your dependents are awarded disability income from another source, you must reimburse the university for any advances or overpayments immediately out of any retroactive lump-sum benefit.

In addition, you are responsible for notifying the Long-Term Disability Coordinator immediately when your spouse and/or children are no longer eligible for Social Security, Veterans Administration, or other benefits. Your Expanded Long-Term Disability Plan benefits will be adjusted accordingly.

If you fail to apply for other disability income, fail to provide updated information on request, fail to inform the Benefits Office of all awards and denials, or fail to repay any overpayment, the university has the right to:

  • withhold or discontinue all payments and benefits under the Expanded Long-Term Disability Plan, or
  • reduce your Plan benefits by the amount of other disability income that you and your dependents are eligible to receive, or
  • see termination of your employment status.

When must I apply for Social Security disability benefits?

You must apply for Social Security disability benefits for you and your eligible dependents immediately upon approval for disability benefits under this Plan. You can apply online at ssa.gov or by calling Social Security's toll-free number 1-800-772-1213.

If your claim for Social Security disability benefits is denied, you must request an immediate reconsideration of that decision. If your claim is denied again, within 60 days you must file for a hearing with a Social Security Administration law judge.

If you do not apply for Social Security disability benefits, do not follow the full appeal process, or are denied Social Security disability benefits because you refuse to accept rehabilitation, the University has the right to:

  • withhold or discontinue all benefits under the Expanded Long-Term Disability Plan, or
  • reduce your Plan benefits by the amount of other disability income you and your dependents are eligible to receive, or
  • seek termination for your employment status.

If you retain an attorney for assistance with Social Security disability claims, the Long-Term Disability program will reimburse your attorney fees up to the legal limit, which is currently 25% of the retroactive benefit but not more than $6,000, provided you reimburse the university in full within 30 days of receiving a retroactive payment from Social Security.

When must I enroll in Medicare?

If you are enrolled in a university health care plan, you must enroll in Medicare Parts A and B as soon as you become eligible (usually 24 months after you begin receiving Social Security disability benefits). All dependents who are covered on your university health plan must also enroll in Medicare Parts A and B upon becoming eligible for coverage. It is your responsibility to notify the Benefits Office and provide proof of enrollment in Medicare for you and any eligible dependents.

When do Plan benefits end?

Your Expanded Long-Term Disability Plan benefits end on the earliest of the following dates:

  • the day you are no longer totally disabled as determined by the Claims Administrator at its sole discretion and are able to return to work at least half time;
  • the end of the month in which you retire (in most cases, age 65; refer to the chart below);
  • the end of the month in which your university employment is terminated;
  • your scheduled retirement date;
  • the date you go to jail or prison;
  • the end of the month in which you die.
LTD Benefit Duration Chart
Age LTD Benefits Schedule
Under 62 Until age 65

62

3.5 yrs/42 mos.

63

3 yrs/36 mos.

64

2.5 yrs/30 mos.

65

2 yrs/24 mos.

66

1.75 yrs/21 mos.

67

1.5 yrs/18 mos.

68

1.25 yrs/15 mos.

69

1 yr/12 mos.

Over 69

1 yr/12 mos.

However:

  • If you are disabled and meet the requirements for age and years of continuous service under the Retirement Plan, you may retire at any time.
  • Your participation in the Expanded Long-Term Disability Plan will end at the time of retirement.

Your Plan benefits may end if:

  • You fail to provide documents or medical information requested by the Plan;
  • You fail to follow reasonable medical advice;
  • You fail to cooperate in obtaining rehabilitation or employment;
  • You otherwise fail to abide by the terms of the Plan.

In each of the above cases, your employment with the university will terminate on the same date your Expanded Long-Term Disability benefits end.

 

Next: Claims

Limitations
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.