DB101 California - Short Term Disability Insurance: Frequently Asked Questions

Disability Benefits 101: working with a disability in California

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1) What is Short Term Disability (STD) coverage?

2) How do you obtain STD coverage?

3) Who is eligible for STD coverage?

4) How soon will I be eligible to enroll in benefits from STD coverage?

5) How much income replacement will I receive from STD coverage?

6) Why should I enroll in group STD coverage during the initial enrollment period?

7) What is a pre-existing condition exclusionary period in STD coverage?

8) How do I meet a pre-existing condition exclusionary period?

9) How long does a pre-existing condition exclusionary period last in STD coverage?

10) Does STD coverage provide health coverage too?

11) How much does STD coverage cost and who pays for it?

12) How long does STD coverage last?

13) How do I stay enrolled/eligible for STD coverage?

14) Does what I have in the bank or what I own affect my eligibility for STD coverage?

15) What is the difference between STD coverage and state and federal disability programs, such as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI)?

16) Are there immigration rules to qualify for STD insurance program?

17) Can I keep my group short term disability (STD) coverage if I no longer belong to the group that provided the benefit?

18) What other benefit programs are available to me and how will they work with STD coverage?

19) What else should I know about STD coverage?

1) What is Short Term Disability (STD) coverage?
Short term disability coverage provides wage replacement to individuals who experience wage loss due to a disability. STD coverage lasts for up to one year.

2) How do you obtain STD coverage?
Short term disability coverage can be obtained either through a group or individually. Group coverage can be offered by an employer, professional group or association. Individual coverage can be purchased directly from an insurance broker based upon medical underwriting.

3) Who is eligible for STD coverage?

If short term disability coverage is offered from an employer, the individual must work for a specified period of time - known as a service wait - prior to becoming eligible for benefits. For professional or association-affiliated STD coverage, the individual must be a member of the group for a set period of time. Individual policies may be purchased directly from an insurance broker based upon medical underwriting. Individual policies are usually available if you have not had any medical treatment for a potentially disabling medical condition during the past 10 years. Medical treatment includes prescription medications and physician consultations.

4) How soon will I be eligible to enroll in benefits from STD coverage?
If you have employer-sponsored STD coverage, you must meet the active work requirement in order to be eligible to enroll in benefits. For professional or association-affiliated STD coverage, you must meet their specific requirements to be eligible to enroll in coverage. See the summary plan description for further details.

5) How much income replacement will I receive from STD coverage?
Short term disability coverage provides monthly income replacement that is either a percentage of gross pre-disability earnings or a specified dollar amount. Benefit variations do exist, so be sure to check the summary plan description for details.

6) Why should I enroll in group STD coverage during the initial enrollment period?
The initial enrollment period is the best time to enroll if you have a pre-existing condition. During the initial enrollment period, your medical history is not subject medical underwriting. However, pre-existing condition exclusions may limit or delay the use of coverage.

7) What is a pre-existing condition exclusionary period in STD coverage?

A pre-existing condition is any medical condition for which “medical care” was received three to six months prior to the coverage effective date. STD plans may have pre-existing conditions exclusionary periods. During this period of time, an individual's prior medical condition(s) will not be covered by the policy. However, after the pre-existing exclusionary period expires, the condition becomes covered under STD coverage.

8) How do I meet a pre-existing condition exclusionary period?

To meet the pre-existing conditions exclusionary period for short term disability coverage:

Enroll during initial enrollment;
Continue membership in the group (employer, professional group, association); and
Remain enrolled in coverage during both the service wait and pre-existing conditions exclusionary period.

Once the exclusionary period has passed, you will then be covered for any pre-existing disability.

9) How long does a pre-existing condition exclusionary period last in STD coverage?
In short term disability coverage, a pre-existing condition exclusionary period can last between 6 to 12 months.

10) Does STD coverage provide health coverage too?
No. STD coverage only provides wage replacement. In employer-sponsored STD coverage, the employer may use your eligibility for STD to determine continued eligibility for other benefits such as health and life coverage.

11) How much does STD coverage cost and who pays for it?

If you have individual STD coverage, you will be responsible for all costs.

If you have group STD coverage, you may be responsible for no cost, a percentage of the cost, or a set premium. With employer-sponsored STD coverage, you may be responsible for the amount that is above what the employer elects to pay. This is determined by employer agreements with their insurance companies. Your employer, Human Resources Department, or personnel staff can explain these benefit details.

12) How long does STD coverage last?
STD coverage can last up to 12 months.

13) How do I stay enrolled/eligible for STD coverage?

Enrollment and eligibility requirements depend on the type of short term disability coverage you have - group (employer, professional group, association) or individual. For example, if you have employer-sponsored STD coverage, you will need to meet the active work requirements, which entails working a minimum number of hours per week. If you are unable to meet the active work requirements due to a disability, and you have passed the service wait and pre-existing condition exclusionary periods, STD coverage may be used to replace a portion of your wages. If you have STD coverage through a professional group or association, you will need to maintain membership to continue eligibility for benefits.

14) Does what I have in the bank or what I own affect my eligibility for STD coverage?
No. There are no income or assets restrictions for STD coverage.

15) What is the difference between STD coverage and state and federal disability programs, such as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI)?

STD coverage is private insurance offered through individual or group (employer, professional group or association) plans. STD coverage does not have income and assets restrictions. Coverage varies between insurance policies. Some employers may provide this coverage instead of California State Disability (SDI). State and federal wage replacement programs - Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) - are public benefits. To be eligible for public income replacement, an individual does not have to belong to a group but must meet specific requirements.

16) Are there immigration rules to qualify for STD insurance program?
No. Immigration rules that should be considered relate to your legal residency status and whether you are legally authorized to work in California.

17) Can I keep my group short term disability (STD) coverage if I no longer belong to the group that provided the benefit?
Yes. Some group STD plans are portable if you are not disabled when you leave the group. Be sure to check your summary plan description to see if the plan has a portability option. If the STD policy does not allow portability, you must re-enroll during the initial enrollment period and complete both the service wait and pre-existing condition exclusionary period again.

18) What other benefit programs are available to me and how will they work with STD coverage?

Many additional benefits programs may be available to you depending on your work history and what benefits an employer has provided. They may include California State Disability Insurance (SDI), privately sponsored long term disability, or Social Security Disability Insurance (SSDI). You may also be eligible to continue private health coverage continuation (COBRA, OBRA, Cal-COBRA, HIPAA ). In certain circumstances, you may be eligible for Medi-Cal (Medicaid) or, after waiting periods have been satisfied, for Medicare.

19) What else should I know about STD coverage?

If you reduce hours or leave work due to a disability, you may be eligible to receive partial benefits if this provision is included in your policy. Check the summary plan description for details. Also, you may want to consider consulting a benefits planner about State Disability Insurance (SDI) or Social Security disability programs such as Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

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