CSEA Group 6-Month Short Term Disability Insurance

Benefits

Help Protect Your Paycheck with CSEA benefits

Do you depend on your income to pay day-to-day bills? The CSEA endorsed benefits help replace more of your paycheck if you can't work. If you are Disabled*, you will be paid a Monthly Benefit, which is based on your Income and will not exceed $5,000. (You'll be informed of your Monthly Benefit upon approval of your application.) The Monthly Benefit will be automatically adjusted each January 1, if necessitated by changes to your income. The Monthly Benefit payable, combined with Other Income* you receive or for which you are entitled, will not exceed 75% of your Basic Monthly Earnings*.

*As defined in the "Terms" tab.

Waiting Period

The CSEA endorsed Group Short Term Disability starts paying benefits as soon as you complete your Waiting Period: for a covered injury, day one or the end of your accumulated sick leave, whichever is greater, or; for a covered illness or pregnancy, the 31st day. And benefits continue as long as you're disabled — up to six months.

See "When Coverage Ends" in the "Terms" tab.

Collect up to an EXTRA $5,000 Benefit for Accidents

The CSEA endorsed Short Term Disability Plan includes an Accidental Death and Dismemberment (AD&D) benefit, that can pay up to $5,000.00 – on top of any other disability benefit – for death and certain physical injuries caused by a covered accident. Injuries must occur within 90 days after the date of the accident. The Certificate of Insurance includes specific details.

Owe Nothing While Collecting Benefits

As long as you're paid CSEA disability benefits, the plan waives your premium – making it easier for you to get back on your feet.

Get Peace of Mind — 2 Added Payments for Loved Ones

The CSEA Plan pays your family two extra monthly payments if you die while receiving benefits for a covered disability that lasted 30 days or longer. It's our way of making sure your loved ones are taken care no matter what happens.

Exclusions and Limitations

See the "Terms" tab for which disabilities are not covered.

Eligibility

You're eligible for coverage if you work for CSEA or any participating group such as ACSS or CSUEU, under age 70 and actively employed on a full-time basis (for at least 20 consecutive days and must be working at least 20 hours per week) with the State of California or any allied organization, and you are a U.S. resident. You must reside in the state of California and are not on active duty with the military.

You're Under No Obligation

If you decide your CSEA endorsed Group Short Term Disability Protection isn't for you, just let us know in the first 30 days. We'll promptly refund your premiums and invalidate your coverage, provided there have been no claims... No questions. No obligation.

Rates

Check Out The Current 2019 Monthly Payroll-Deducted* Premiums – Easy to Budget!

As a CSEA member, you qualify for group rates for the 6-Month Short Term Disability Plan.

6-Month Short Term Disability Rate Chart: View Rate Chart

* Payroll deduction is only available for SEIU, ACSS, CSUEU. All other groups utilize automatic bank deduction or credit card.

FAQs

Am I at risk of becoming disabled?

People with disabilities comprised 13.2 percent of the US population¹.

Sources:

¹https://disabilitycompendium.org/sites/default/files/user-uploads

How can the CSEA endorsed Group Short Term Disability insurance plan help replace a portion of my salary?

Disability insurance by design helps to replace part of your monthly income. In the event of a covered disability, the CSEA endorsed Group Short Term Disability pays benefits in accordance with your approved Monthly Benefit. However, the benefit payable will not exceed 75% of your basic monthly salary (as described in the "Benefits" tab) and start as soon as your first day of disability if due to an accident or 31st day if disabled due to illness or pregnancy.

What is the difference between short term benefits and long term disability insurance?

The waiting period for short-term disability insurance is usually under 14 days. Long-term policy waiting periods range from 30 days to two years, but the most common is 90 days. Short-term disability benefits typically last between three to six months. Long-term benefits are measured in years; you can apply for a benefit period that lasts two, five, or 10 years, or until retirement age. If you are interested in reading supporting information, please click on the link below.

Source:

https://www.policygenius.com/disability-insurance/short-term-disability-vs-long-term-disability-insurance/

Am I eligible for coverage if I work less than 40 hours a week?

Yes. Apply for benefits as long as you work 20 hours a week for at least 20 consecutive service days with the State of California or any allied organization.

Can I keep CSEA endorsed Short Term Disability Coverage if I change my job?

YES, as long as you continue to work for the state of California and remain a CSEA member. Refer to the "Benefits" tab for additional eligibility requirements.

Will my family be taken care of?

This plan will help to take care of your family. First, you don't pay premiums while you're disabled and collecting CSEA disability benefits. Plus, the CSEA endorsed Short Term Disability Plan adds two extra monthly payments if you die while receiving benefits for a covered disability that lasted 30 days or longer.

What if my disability is due to an accident?

Accidents are one of the leading reasons for disabilities. That's why the CSEA endorsed Short Term Disability Plan pays up to $5,000.00 – on top of any other disability benefit – for certain physical injuries caused by a covered accident. See Exclusions & Limitations under the "Term" tab.

How do I pay my premiums?

For easy budgeting, premiums are deducted from your paycheck*. 

* Payroll deduction is only available for SEIU, CSUEU, ACSS. All other groups leverage auto-renewal through automatic bank deduction or credit card.

What if I change my mind after I apply?

After you're approved for coverage, you'll receive a Certificate of Insurance. Take up to 30 days to decide if this protection is right for you. If you change your mind, your premiums will be promptly refunded and your coverage invalidated, provided there have been no claims.

 

Terms

Your CSEA Group Short Term Disability benefits can begin following approval from New York Life. Your coverage will take effect on the first day of the month after your application has been approved, and your first payment has been received. Once approved you will receive a Certificate of Insurance describing the terms and conditions of your coverage. If you are not working full-time on the date your insurance is scheduled to become effective, your insurance will not become effective until you return to full-time work. However, if you are not actively working due to a non-working day, you will still become insured on the scheduled effective date provided you would have been able to do your regular job on that non-working day. If you become disabled as a result of a covered accidental injury, sickness or pregnancy, benefits will be paid during the continuance of your disability. Benefits begin with the first day of a covered accident, 31st day for a sickness or pregnancy, or at the end of your sick leave, whichever is later.

Premiums are subject to change by agreement between New York Life Insurance Company and the CSEA, but not more than twice in any twelve-month period. Your rates may change only if they are changed for others in the same class of insured under this group policy. For example, a class of insured is a group of people with the same age and gender. For SEIU, ACSS, and CSUEU premium for this plan is deducted from payroll or PERS for Retirees with an authorization from each individual member. All other groups leverage auto-renewal through automatic bank deduction or credit card. Future benefits are subject to change by agreement between New York Life and the CSEA.

IMPORTANT INFORMATION

Definition of "total disability" or "totally disabled"

Means an injury, sickness or pregnancy that you incur while insured under the Policy which prevents you from performing with reasonable continuity the substantial and material acts necessary to perform your usual occupation. If you voluntarily decide to work at any occupation, you would no longer be considered disabled.

Definition of "Monthly Income"

MONTHLY INCOME means a person's basic monthly pay from the State Of California or any allied organization determined on his or her initial INSURANCE DATE and thereafter on each October 1. MOTHLY INCOME for hourly employees will be based on the hourly rate of pay, but not on more than 40 hours per week.

Definition of "Other Income":

1. 50% of any salary, wages, partnership or proprietorship draw, commissions, or similar pay from Rehabilitative Employment
2. Any salary or other compensation you receive for work performed while disabled and the amount of any income payment under a salary continuance or sick leave plan
3. Income payments, other than unearned income, from a professional corporation, partnership or other group practice arrangement. Income payments include the cost of your fringe benefits and the share of the total contributions to corporate surplus
4. Income payments under a retirement plan, other than a government pension plan, which starts on or after the date of disablement for which Covered Disability benefits become payable;
5. Income payments under a government pension plan which starts on or after the date of disablement for which Covered Disability benefits become payable. Any increase in such payments that occurs after the waiting period is excluded from the determination of such benefits
6. Benefits for loss of time from employment which is provided for a disability under: (a) any plan arranged by any employer, union or association; (b) any fund or other arrangement pursuant to any compulsory disability benefit act or law; or (c) an individual disability income policy
7. Benefits in the form of periodic cash payments for a disability, excluding any benefits for a disability starting before the effective date, which is provided: (a) under any group life insurance plan; (b) by any federal, state, provincial, municipal or other governmental agency, or pursuant to the Federal Railroad Retirement Act; or (c) under the Federal Social Security Act, Canada Pension Plan or Quebec Pension Plan on the basis of your record of wages and self - employment income and payable to your spouse or child, without regard to any deductions from such benefits which can be made: (1) on account of work; (2) because of your refusal to accept rehabilitation; or (3) because your spouse or child has elected to be paid benefits under the Federal Social Security Act, Canada Pension Plan or Quebec Pension Plan on the basis of the spouse's or child's own record of wages and self-employment income. In determining the amount of such benefits, however, there will be excluded the amount of any increase therein which occurs after the waiting period; and/or;
8. Benefits under any work loss provision in the mandatory part of any "no-fault" auto insurance policy.

Successive periods of disability

Disabilities that are due to the same or related cause will be considered as one period of disability unless separated by a 3-month period during which you return to full-time work with the employer. Disabilities which meet these separation measurements will be treated as a new disability, subject to a new waiting period.

Pre-existing conditions

Benefits will not be paid for disabilities due to non-disclosed pre-existing conditions, as defined below until the end of the earlier of (1) 12 consecutive months after the effective date of coverage during which the covered person has had no treatment or medical advice for that condition or (2) 24 consecutive months during which the person has been insured under the policy. "Pre-Existing Condition" means any injury, sickness, mental, emotional or nervous disorder or related illness for which a person consulted a doctor, received any medical services or supplies or took any medication during the 12 months immediately before becoming covered under this plan and which was not disclosed on the person's request for coverage. A condition which was fully disclosed on the application for insurance is not considered a Pre-Existing Condition.

Rehabilitative employment

If you are disabled from your regular job but accept rehabilitative employment within 31 days after a period of disability for which a monthly benefit is payable, 50% of any salary, wages, partnership or proprietorship draw, commissions, or similar pay received from rehabilitative employment will be considered along with your other sources of income and benefits when determining the monthly benefit payable.

What is not covered under this Disability plan (Exclusions and limitations)

This plan does not pay benefits for a disability and/or confinement that began before a person becomes an insured member; a disability, confinement and/or injury that: occurs during or is due or related to incarceration for or participation in (except as a victim) the commission of a felony, an illegal occupation or activity, an insurrection, terrorist activity or a riot; any disability, confinement or injury caused by war or any act of war or an armed conflict which involves the armed forces of one or more countries, whether declared or not; intentionally self-inflicted injury, while sane or insane; A disability, confinement or injury that occurs or is due or related to duty in the military, naval or air service of any country; a disability that is due to a Preexisting condition, as defined above; a disability that no longer requires the regular care and attendance of a doctor or any period of disability for which insured member is not under regular care and attendance of a doctor; an injury that is due or related to or occurs during the course of any occupation for pay or profit; or a sickness that entitles the insured member to benefits under a Worker's Compensation Act or similar Act. AD&D Coverage: No benefits are payable for losses due or related to: serving as a pilot, crew or training instructor of any aircraft; disease or bodily infirmity, or medical or surgical treatment thereof; bacterial infections due to an accidental cut or wound; illegal use of drugs; use of alcohol, and; accidental ingestion of contaminated material. All other exclusions noted above also apply except those for: Preexisting Condition, and; regular doctor care.

When Coverage Ends

Coverage under the Policy will end upon the earliest of the following occurrences:

1. the insured member retires or ceases active full time work of at least 20 hours per week (other than for reason of disability)
2. membership in the California State Employees Association ends; (3) active duty in the armed forces (except for training purposes of 2 months or less) begins; (4) premium contributions are not paid when due; (5) the Group Policy is terminated by the policyholder or New York Life; (6) the member is no longer a permanent resident of the United States, District of Columbia, Puerto Rico or Canada.

 

(Please read and retain for your records)

IMPORTANT NOTICE:

How New York Life Obtains Information and Underwrites Your Request for Group Disability Income Insurance

In this notice, references to "you" and "your" include any person proposed for insurance. Information regarding insurability will be treated as confidential. In considering whether the person(s) in your request for insurance qualify for insurance , we will rely on the medical information you provide, and on the information you AUTHORIZE us to obtain from your physician, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB, Inc. ("MIB"). MIB is a not-for-profit organization of insurance companies, which operates an information exchange on behalf of its members. If you apply for life or health insurance coverage, a claim for benefits is submitted to an MIB member company, medical or non-medical information may be given to MIB, and such information may then be furnished by MIB, upon request, to a member company.

Your AUTHORIZATION may be used for a period of 24 months from the date you signed the application for insurance, unless sooner revoked. The AUTHORIZATION may be revoked at any time by notifying New York Life in writing at the address provided. Your revocation will not be effective to the extent New York Life or any other person already has disclosed or collected information or taken other action in reliance on it, or to the extent that New York Life has a legal right to contest a claim under an insurance certificate or the certificate itself. The information New York Life obtains through your AUTHORIZATION may become subject to further disclosure. For example, New York Life may be required to provide it to insurance, regulatory or other government agencies. In this case, the information may no longer be protected by the rules governing your AUTHORIZATION.

MIB and other insurance companies may also furnish New York Life, its subsidiaries or the Plan Administrator with non-medical information (such as driving records, past convictions, hazardous sport or aviation activity, use of alcohol or drugs, and other applications for insurance). The information provided may include information that may predate the time frame stated on the medical questions section, if any, on this application. This information may be used during the underwriting and claims processes, where permitted by law.

New York Life may release this information to the Plan Administrator, other insurance companies to which you may apply for life and health insurance, or to which a claim for benefits may be submitted and to others whom you authorize in writing, however, this will not be done in connection with test results concerning Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV). We may also make a brief report of your protected health information to MIB, but we will not disclose our underwriting decision.

New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. Information in our files may be seen by New York Life and Plan Administrator employees, but only on a "need to know" basis in considering your request. Upon receipt of all requested information, we will make a determination as to whether your request for insurance can be approved.

If we cannot provide the coverage you requested, we will tell you why. If you feel our information is inaccurate, you will be given a chance to correct or complete the information in our files. Upon written request to New York Life or MIB, you will be provided with non-medical information. Generally, medical information will be given either directly to the proposed insured or to a medical professional designated by the proposed insured. Your request is handled in accordance with the Federal Fair Credit Reporting Act procedures. If you question the accuracy of the information provided by MIB, you may contact MIB and seek a correction. MIB's information office is: MIB, Inc., 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734, telephone +1-866-692-6901 (TTY 866 346-3642). For Canadian residents, the address is: MIB Information Office, 330 University Avenue, Suite 501, Toronto, Ontario, Canada M5G 1R7, telephone +1-416-597-0590. Information for consumers about MIB may be obtained on its website at www.mib.com.

For NM Residents: Protected persons1 have a right of access to certain Confidential abuse information2 we maintain in our files and they may choose to receive such information directly. You have the right to register as a Protected person by sending a signed request to the Administrator at the address listed on the application. Please include your full name, date of birth and address.

¹Protected person means a victim of domestic abuse: who has notified us that he/she is or has been a victim of domestic abuse; and who is an insured person or prospective insured person.

²Confidential abuse information means information about: acts of domestic abuse or abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant or insured as family member, employer or associate of a victim of domestic abuse or a person with whom an applicant or insured is known to have a direct, close, personal, family or abuse-related relationship.

New York Life Insurance Company 7.15 ed.

Endorsed by: California State Employees Association

CSEA incurs certain administrative expenses in connection with this sponsored program. To provide and maintain this valuable membership benefit it is reimbursed for such expenses.

California State Employees Association
Administered by A.G.I.A., Inc.
PO Box 9997
Phoenix, AZ 85068-0997

A.G.I.A, Inc. is licensed and authorized to transact business in all 50 United States and the District of Columbia. Their state of domicle is California. J. Christopher Burke California Insurance License # 0F70947. J. Christopher Burke AR Insurance License #8876308.

Underwritten by:
New York Life Insurance Company
51 Madison Avenue
New York, NY 10010

Under Group Policy G-29115-1 on Policy Form GMR-FACE/G-29115-1, New York Life is licensed/authorized to transact business in all 50 United States, District of Columbia, Puerto Rico and Canada. However, not all plans it underwrites are available in all jurisdictions. Please check plan details for current availability.

New York Life Insurance Company's state of domicile is New York and their NAIC ID# is 55915.

This is not a policy or Certificate of Insurance. It merely summarizes the principal features and is for informational purposes only. The complete terms and provisions of coverage and the conditions under which it may be kept in force are contained in the group Master Policy issued by New York Life Insurance to the California State Employees Association.

*Payroll deduction is only available for SEIU, CSUEU, ACSS, and Retirees. All other groups leverage auto-renewal through automatic bank deduction or credit card.

 

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