HealthChoice Disability Plan
- Disability plan benefits.
- More information about the disability plan.
Disability plan benefits
Oklahoma statutes limit participation in the HealthChoice Disability Plan to state employees and participating county employees (Education employers usually have disability plans through a third party. Consult administration for more information).
The HealthChoice Disability Plan is designed to provide employees with partial replacement of income lost as a result of a disabling illness or injury. The plan is not unemployment insurance, workers’ compensation, Social Security disability or disability retirement.
An employee is considered disabled if, as a result of injury or illness, they are unable to perform the material duties of their occupation and the condition is expected to last 31 consecutive days or longer. A disability may or may not be related to employment. After 24 months, a disability is defined as the employee’s inability to perform the material duties of any gainful occupation they are or may become reasonably qualified for by training, education or experience.
Disability benefits are limited to a maximum benefit period based on the employee’s disability, years of service and age at the time of disability. Refer to Maximum Benefit Period later in this section.
Before the plan pays any benefits, the employee must complete a 30-day elimination period. Benefits are calculated using the employee’s base salary at the time the disability began. Benefits are subject to state and federal taxes.
Plan benefits are offset, or reduced, by other income the employee receives that is related to their disability. Refer to Offsets/Reductions in Benefits later in this section.
To remain eligible for disability benefits, the employee must provide proof of continuing disability as required, as well as participate in a rehabilitation program as appropriate.
Disability benefits are divided into two types:
- Short-term disability benefits are paid for a maximum of 150 days (after the 30-day elimination period). The plan pays a monthly benefit equal to 60% of the employee’s base salary less any offsets. The maximum monthly benefit is $2,500. There is no minimum monthly benefit.
- Long-term disability benefits begin after the 180 days of short-term disability ends. The plan pays a monthly benefit equal to 60% of the employee’s base salary less any offsets. The maximum monthly benefit is $3,000, and the minimum monthly benefit is $50.
Any disability payments made for a partial month are prorated.
Maximum benefit period
The maximum benefit period is based on the employee’s disability, years of service and age at the time the disability occurred. Benefits end when the disability ends, when the employee reaches the end of the maximum benefit period or when the employee dies.
|AGE AT DISABILITY||MAXIMUM BENEFIT PERIOD|
|EMPLOYEES WITH LESS THAN ONE YEAR OF SERVICE|
|ANY AGE||6 months|
|EMPLOYEES WITH LESS THAN FIVE YEARS OF SERVICE|
|65 AND YOUNGER||24 months|
|69 AND OLDER||12 months|
|EMPLOYEES WITH FIVE OR MORE YEARS OF SERVICE|
|59 AND YOUNGER||Up to age 65|
|69 AND OLDER||12 months|
If an employee who is receiving disability benefits leaves employment and continues to meet disability eligibility requirements, they can continue to receive disability benefits until their maximum benefit period is reached.
Mental health and substance abuse disability benefits have a maximum benefit period of 24 months from the date the employee becomes disabled. There is a lifetime benefit period of 60 months for mental health and substance abuse benefits.
Offsets/reductions in benefits
Short-term and long-term disability benefits are offset, or reduced, by other benefits or payments the employee receives, or is eligible to receive, for any period of disability.
Offsets may include but are not limited to:
- Available sick, annual or shared leave.
- Earnings the employee receives from any other employment, excluding longevity pay and one-time bonuses.
- Unemployment compensation benefits.
- Social Security benefits related to the disability, excluding:
- Social Security widow’s/widower’s benefits unrelated to the current disability.
- Supplemental Security Income Program awards.
- Benefits paid to the employee by State of Oklahoma or county retirement systems, except those benefits that began prior to the disability.
- Disability related benefits paid under workers’ or workman’s compensation law, occupational disease law or other similar act or law.
- Fifty percent of any wages earned while partially disabled or during limited return to work (rehabilitative employment).
- Overpayment of previous disability payments, including retroactive Social Security disability awards.
- Veterans Affairs benefits.
- Disability benefits paid by another group plan, except for:
- Plans funded entirely by the employee’s contributions.
- Plans where payment of benefits reduces benefits at retirement.
- Benefits paid for conditions documented one year or more before the date of the current disability claim.
- Profit-sharing plans, 401K plans, thrift plans, individual retirement accounts, stock ownership plans, tax- sheltered annuities, or benefits from non-qualified deferred compensation plans.
Statutory or cost of living increases from pension or pension disability programs, Social Security or workers’ compensation do not reduce monthly disability benefits.
If lump sum benefits are received, offsets are prorated over the benefit period or the employee’s expected lifetime.
Benefit offsets can be estimated if they have not yet been awarded or denied, or if a denial is being appealed. The responsible party must repay any overpayment or underpayment once actual benefits are determined.
Returning to work/partial disability
A time of partial disability may follow a period of total disability. An employee is considered partially disabled if they can perform at least one of the duties of any occupation but earn less than 80% of their pre-disability gross base salary. If an employee is able to return to work, their disability benefits are reduced by 50% of any income earned from any other employment.
Partial disability must result from the same condition as the total disability. Proof of partial disability must be submitted within 31 days of the date the employee’s total disability period ends.
Partial disability benefits may be available for up to 24 months, or until the employee:
- Reaches the maximum benefit period.
- Earns gross wages from any employment equal to 80% or more of their pre-disability gross base salary.
A recurrent disability is related to or caused by a prior disability for which the employee received benefits under the plan. A recurrent disability is considered a continuation of the prior disability if the employee has been back to their regular full-time job for less than six months and performed all the assigned duties of that job. A recurrent disability does not alter the beginning date of a benefit period and does not require another 30-day elimination period.
If an employee has been back to their regular full-time job for more than six months, the recurrent disability is treated as a new disability. In this case, a new 30-day elimination period applies.
Multiple disabilities occur when an employee experiences a second, unrelated disability while already receiving disability benefits. If the second disability claim is eligible for benefits, the two claims are combined into one continuous disability period.
More information about the disability plan
To participate in the plan, employees must be actively at work and regularly scheduled to work at least 1,000 hours per year. Former employees are not eligible.
Enrollment in the plan begins the first day of the month following the employment date or the date the employee becomes eligible based on the employer’s rules.
To be eligible for disability plan benefits, an employee must:
- Be a covered employee of a participating employer.
- Be on duty at least 31 consecutive days.
- File their claim within one year of the date the disability began.
An employee who is confined in a correctional institution for conviction of an offense is not eligible for disability plan benefits.
The disability must be documented and certified by a qualified physician and cannot be related to a preexisting condition.
The elimination period is the first 30 days following the onset of an illness or an injury when no benefits are paid. An employee is eligible for benefits on the 31st day of their disability.
Written notice of a claim for disability benefits must be provided to the HealthChoice disability claims administrator within 60 days following the beginning of the disability. The claims administrator has the right to waive the 60-day notice requirement for good cause.
Filing for Social Security disability
To remain eligible for long-term disability benefits, an employee must apply for Social Security disability benefits by the seventh month of their disability. If Social Security denies the employee’s application and the employee does not appeal the denial, plan benefits are terminated. If after 24 months of disability, Social Security has still not found the employee eligible for disability benefits, the employee’s benefits under the plan will be terminated. Exceptions to this rule may be granted by EGID on a case-by-case basis.
The HealthChoice Disability Plan provides assistance to employees through a company called Allsup, Inc. This service is provided at no cost to the employee; however, the employee is under no obligation to use Allsup’s services.
When appropriate, an employee is referred to Allsup by the HealthChoice disability claims administrator. Have your employee contact the disability claims administrator for more details.
If an employee is receiving HealthChoice Disability Plan benefits, the claims administrator sends you a monthly Employer Report Form. To avoid delays or problems with your employees’ disability benefits, this form must be completed and returned as quickly as possible.
The form requests the following employee information:
- Salary at onset of disability.
- Present salary.
- Employment status.
- Insurance premiums deducted, if any.
- Leave time used.
- Any other financial compensation.
The Employer Report Form cannot be used to make eligibility changes. Coverage changes must go through normal procedures.
If you feel you need additional training, the HealthChoice disability claims administrator is available to assist you with completing forms and answering questions about how the use of leave affects disability benefits and how premium deductions are handled. Representatives can also conduct training onsite or in their offices, whichever you prefer. To request training, please contact the HealthChoice disability claims administrator at 855-262-0613.