Your benefit plan has been designed to provide financial help for you when an insured loss occurs. The plan is established through a Group Policy issued by Principal Mutual Life Insurance Company to the Iowa State University of Science and Technology (the University).
As an insured Member of the plan, your rights and benefits are determined by the provisions of Group Policies GL 1460 and GLT 1460. A copy of each Group Policy is on file at the Office of Human Resource Services, 3750 Beardshear Hall, Suite 3350, Iowa State University. These copies are available for your inspection at the office during regular office hours. This booklet briefly describes those rights and benefits. It outlines what you must do to be insured. It explains how to file claims. It is your certificate while you are insured.
FUTURE OF PLAN. It is expected that this plan will be continued indefinitely. However, Iowa State University does reserve the right to change or terminate the plan on any July 1.
PLEASE READ YOUR BOOKLET CAREFULLY. It is
suggested that you start with a review of the terms listed in the DEFINITIONS
sections (Description of Benefits & Long
Term disability Insurance). The meanings of these terms will help you
understand the provisions of your plan.
PRINCIPAL MUTUAL
LIFE INSURANCE COMPANY
Des Moines, IA 50392-0001
LONG TERM DISABILITY INSURANCE AND T.I.A.A. WAIVER OF ANNUITY CONTRIBUTION BENEFIT
HOW TO BE INSURED
[HRS Home] [Employee Benefits - Merit]
LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
To be eligible for insurance you must be a Member.
Member means:
3. Any person who is retired, provided such person:
- was a staff member and was listed in the University's budget as being employed on a part-time basis (PTB).
Back to Supplemental Information
In some instances, proof of your good health will be required to place your insurance in force. The type and form of required proof will be determined by Principal Mutual Life Insurance Company. You will need to file proof of good health if you request insurance more than 31 days after the date you are eligible. You must pay the cost of obtaining proof.
EFFECTIVE DATE FOR INITIAL INSURANCE
If you elect to become insured, you must request initial insurance on a form provided by the University. You will furnish the information requested and agree to the required contribution which will be deducted from your salary.
Your insurance will normally be in force on:
- the first of the calendar month that next follows the date you are eligible, provided application is made within 31 days of the date of your employment.
However, if you are not Actively at Work on the date insurance would otherwise be effective, your insurance will not be in force until the day you return to Active Work.
You are required to contribute toward the cost of your Life Insurance. The contribution will be deducted from your pay at a rate established by the University. If you are employed on other than a 12 month basis, the necessary amount will be deducted from your last regular paycheck to maintain coverage for the off duty period. For example, if you are employed on a regular nine month basis, a deduction will be made from your May 31 paycheck to cover your insurance through July 31st.
Any change in the amount of Life Insurance will result in a corresponding change in your contribution.
You are not required to contribute toward the cost of your Accidental Death and Dismemberment Insurance. The entire cost is paid by the University.
EFFECTIVE DATE FOR BENEFIT CHANGES
A change in your benefit amount because of a change in your status (insurance class or compensation) will normally be effective on the date of the change.
However, if you are not Actively at Work on the date the change would otherwise be effective, the change will not be in force until the day you return to Active Work. Exception: decreases in Life and Accidental Death and Dismemberment Insurance Scheduled Benefit amounts are effective on the date noted above whether or not you are Actively at Work.
Your insurance will cease on the earliest of:
- the end of the calendar month in which you cease to belong to a class for which insurance is provided; or
- the end of the calendar month in which you cease to be a Member; or
- the end of the calendar month in which you cease Active Work.
If you cease Active Work because of sickness or injury, your plan might provide for limited continuation.
If you cease Active Work because of layoff or leave of absence, coverage may be continued on a limited basis.
If you arrange to take an approved leave of absence without pay, you will be eligible to keep your insurance in force during such leave of absence provided you pay all required premiums to continue the insurance. Arrangements for paying the premiums should be made in the Office of Human Resource Services, 3750 Beardshear Hall, Suite 3350, Iowa State University.
If you elect to discontinue your insurance while you are on an approved leave of absence, you may re-enroll within 31 days after the date of expiration of the leave of absence.
If you are covered under the terms of a collective bargaining agreement, you should refer to that contract for specific information regarding benefits during a leave without pay.
Your coverage may also be:
in accordance with the provisions of the Federal Family and Medical Leave Act (FMLA) and subject to the provisions of your Group Plan.
FEDERAL FAMILY AND MEDICAL LEAVE ACT (FMLA)
Continuation
Federal law requires that Eligible Employees be provided a continuation period in accordance with the provisions of the Federal Family and Medical Leave Act (FMLA).
This is a general summary of the FMLA and how it affects your Group Plan. See your employer for details on this continuation provision.
FMLA and Other Continuation Provisions
If your employer is an Eligible Employer and if the continuation portion of the FMLA applies to your coverage, these FMLA continuation provisions:
Eligible Employer
Eligible Employer means any employer who is engaged in commerce or in any industry or activity affecting commerce who employs 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year.
Eligible Employee
Eligible Employee means an employee who has worked for the Eligible Employer:
- for at least 1,250 hours (approximately 24 hours per week) during the year preceding the start of the leave; and
- at a work-site where the Eligible Employer employs at least 50 employees within a 75-mile radius.
Mandated Unpaid Leave
Eligible Employers are required to allow 12 workweeks of unpaid leave during any 12-month period to Eligible Employees for one or more of the following reasons:
- The placement of a child with the Eligible Employee for adoption or foster care.
- To care (physical or psychological care) for the spouse, child, or parent of the Eligible Employee, if they have a "serious health condition".
- A "serious health condition" that makes the Eligible Employee unable to perform the functions of his or her job.
An Eligible Employee's terminated coverage may be reinstated in accordance with the provisions of the Federal Family and Medical Leave Act (FMLA), subject to the Actively at Work requirements of the Group Plan.
See your employer for details on this reinstatement provision.
If you die while insured for Life Insurance, Principal Mutual Life Insurance Company will pay your beneficiary the Scheduled Benefit in force for you on the date of your death. If your beneficiary does not survive you, Principal Mutual Life Insurance Company will pay your estate, spouse, child(ren), parent(s) or other persons as provided in the Group Policy. The Scheduled Benefit is based on your Annual Budgeted Salary:
$6,500or more.................................................... The amount that is equal to 2 times your Annual Budgeted Salary (this amount will be rounded to the nearest $1,000, if it is not already an exact multiple of 1,000).
For the age(s) shown below, your amount of insurance will be the percentage of the Scheduled Benefit as shown below. Any reduction is effective on the first of the calendar month next following attainment of age 65:
ScheduledBenefit
All retired Members .................................$ 4,000 Upon your death, the Scheduled Benefit in force on the date of your death will be available to your beneficiary at any time, in total or in part, as provided in the Group Policy.You should name a beneficiary at the time you enroll for insurance. You may later change your beneficiary by filing a written request with the University. Change request forms are available at the office of Human Resource Services, 3750 Beardshear Hall, Suite 3350, Iowa State University. A change in your beneficiary will not be in force until the University records the change.
If you cease Active Work for any reason, your insurance will normally terminate. However, if you cease Active Work because you are Disabled, you may qualify to continue your Life Insurance. This continuation is called Coverage During Disability.
To be qualified for Coverage During Disability, you must:
- become Disabled before the June 30 coinciding with or next following the date you attain age 70; and
- remain Disabled continuously; and
- send proof of Disability to Principal Mutual Life Insurance Company within one year of the date Disability starts and as often thereafter as Principal Mutual Life Insurance Company may require; and
- return, without claim, any individual policy issued under your purchase rights as described below; and
- submit to examinations by a Physician when Principal Mutual Life Insurance Company requires (Principal Mutual Life Insurance Company will pay for these examinations and will choose the Physician).
- the exhaustion of your accumulated sick pay and vacation benefits;
If you are in the process of satisfying the qualification period specified above, recover from Disability for a short period of time, and then again become Disabled from the same or a related cause, the recovery from Disability will not interrupt satisfaction of the qualification period specified above, provided the recovery is not longer than ten* working days.
The period of recovery from Disability will not count toward the satisfaction of the qualification period specified above.
Coverage During Disability will cease on the earlier of the June 30 coinciding with or next following the date you attain age 70 or the date you no longer qualify.
If you die while Coverage During Disability is in force, or during the initial 90 day waiting period, Principal Mutual Life Insurance Company will pay your beneficiary the Life Insurance benefit, if any, that would have been paid had you remained insured under the benefit schedule in force on the date your Disability began. You will be considered to be a retired Member on the June 30 coinciding with or next following the date you attain age 70 if you are Disabled.
Note that Coverage During Disability will not be in force and NO BENEFIT WILL BE PAID if written proof of Disability is not sent to Principal Mutual Life Insurance Company within ONE YEAR of the date Disability starts.
*If you are a half-time employee and return to work for four hours, that will count as one of the ten days. If you are a full-time employee and return to work for four hours, that is to be counted as 1/2 day.
Recurring Disability
Your Coverage During Disability may be continued beyond the normal termination date if it is determined that a Recurring Disability exists. A Recurring Disability will exist if you become Disabled again, after returning to Active Work for less than six continuous months, provided you have already completed the Coverage During Disability qualification period and your current Disability and the Disability for which you completed the Coverage During Disability qualification period result from the same or a related cause.
All Recurring Disabilities will be treated as if your initial Disability had not ended. You will not need to complete a new Coverage During Disability qualification period for a Recurring Disability. Coverage During Disability will be in force immediately.
You will have the right to buy an individual life insurance policy without submitting proof of your good health:
- If the Group Policy terminates or is amended to exclude your insurance class after you have been insured for at least five years. In these instances, the maximum amount you may buy will be the smaller of: (1) $2,000; or (2) your Life Insurance amount in force on the date of termination, less any amount for which you become eligible under any Group Policy within 31 days.
- If your Coverage During Disability ceases because Disability ends and you do not then become insured under the Group Policy within 31 days. In this instance, the maximum amount you may buy will be the benefit amount in force on the date Disability ends, less any individual amount purchased earlier under these rights.
The individual policy will be for life insurance only (other than term insurance). No Disability or other benefits will be included. The premium you pay will be at Principal Mutual Life Insurance Company's normal rate for your age and for the risk class to which you belong on the individual policy's date of issue.
If you die within the 31-day purchase period, your beneficiary will be paid the life insurance amount, if any, you had the right to buy. This payment will be made whether or not you have applied for an individual policy.
If you are injured and all of the Benefit Qualifications listed below are met, Principal Mutual Life Insurance Company will pay the following percentages of your Accidental Death and Dismemberment Insurance Scheduled Benefit in force:
- 25% if the sight of one eye is permanently lost; or
- 50% if more than one of the listed losses occurs; or
- 100% if you lose your life.
Annual Budgeted Salary....................... Scheduled Benefit
$3,500 or more but less than$6,500....$ 22,000
The Scheduled Benefit is subject to the proof of good
health requirements shown in the group plan.
For the age(s) shown below, your amount of insurance will be the percentage of the Scheduled Benefit as shown below. Any reduction is effective on the first of the calendar month next following attainment of age 65:
Age ......................% of Scheduled Benefit
Age 65 and over ..........65%
To qualify for benefit payment, all of the following must occur:
- Your injury must be through external, violent, and accidental means.
- Your injury must be the direct and sole cause of a loss listed in the Summary of Benefits above.
- Your loss must occur within 90 days of your injury.
- You must satisfy the requirements listed in the CLAIM PROCEDURES section.
Payment will not be made for any loss to which a contributing cause is:
- disease or the treatment of disease; or
- voluntary participation in a riot, assault, felony or insurrection; or
- duty as a member of a military organization; or
- war or act of war; or
- the use of any drug, narcotic or hallucinogen not prescribed for you by a licensed Physician.
Claim Forms
The University will provide forms to assist you in filing claims.
Payment, Denial and Review
Federal law permits up to 90 days for processing claims and up to 60 days for reviewing denied claims. Both time limits may be extended if unusual factors exist.
In actual practice, most claims will be processed and paid within a few days after Principal Mutual Life Insurance Company receives a completed claim from the University. Once Principal Mutual Life Insurance Company has completed an investigation of an Accidental Death and Dismemberment Insurance claim, the claim will be paid promptly. Further, if a claim cannot be paid, Principal Mutual Life Insurance Company will promptly explain why.
If you disagree with a claim denial, a review may be requested. In order for Principal Mutual Life Insurance Company to review a denied claim, the University must receive a written request from you within 120 days of receipt of notice of the denial. All added facts should be given to the University within one year of receipt of notice of the denial. The University will send this information to Principal Mutual Life Insurance Company. Principal Mutual Life Insurance Company will then conduct the review. You will be advised of the final decision and the reasons.
Prompt Filing
Completed claim forms and other information needed to prove loss should be filed promptly. Claims should be sent to Iowa State University, Office of Human Resource Services, 3750 Beardshear Hall, Suite 3350, Iowa State University, Ames, IA 50011, within 90 days after the date of loss. Claims sent later will be accepted only if there is reasonable cause for the delay.
Medical Examinations
Principal Mutual Life Insurance Company may have the Member whose loss is the basis for claim examined by a Physician. Principal Mutual Life Insurance Company will pay for these examinations and will choose the Physician to perform them.
Legal Action
Legal action for a claim may not be started earlier than 60 days after a claim is filed. Further, no legal action may be started later than three years after proof is required to be filed.
Time Limits
All time limits listed in this section will be extended to meet any minimums required by law.
Federal law requires that this section be included in your booklet:
As a participant in this plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA).
ERISA provides that all plan participants shall be entitled to:
- Obtain copies of all plan documents and other plan information upon written request to the plan administrator. The administrator may make a reasonable charge for the copies.
- Receive a summary of the plan's annual financial report. The plan administrator is required by law to furnish each participant with a copy of this summary annual report.
Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials from the plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $100 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. If it should happen that fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, if, for example, it finds your claim is frivolous.
If you have any questions about your plan, you should contact the plan administrator. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest Area Office of the Pension and Welfare Benefits Administration, U.S. Department of Labor.
Active Work; Actively At Work means the active performance of all of a Member's normal job duties at the University's usual place or places of business.
Affiliates mean companies who delegate their payroll administration to the University, which provides these companies with the opportunity to participate in the University's group benefit plans.
Annual Budgeted Salary means the current salary amount appearing opposite your name in the University's budget and/or on your official Notice of Appointment. It is the salary amount for the academic year if payable during nine months or for the fiscal year if payable during 12 months. If you are paid on an hourly rate your Annual Budgeted Salary is determined by multiplying your budget hourly rate by your normal working hours in the fiscal year. Annual Budgeted Salary, for the purposes of this insurance, excludes:
- compensation in the form of non-cash items such as board, room, laundry, or premiums paid by the University for the benefit of any Member.
Disability/Disabled (for Life Insurance) means your inability, because of sickness or injury, to work:
- following the first 24 months, at any job that reasonably fits your background and training;
Member means:
- Any person who is employed by the Iowa State Memorial Union or the Iowa State University Press, appointed to a budgeted position, and regularly scheduled to work for 1/3 time or more for at least nine months; or
- Any person who is retired, provided such person:
- was a staff member and was listed in the University's budget as being employed on a part-time basis (PTB).
Physician means a licensed Doctor of Medicine or Osteopathy.
University means Iowa State University of Science and Technology and shall include any affiliate or subsidiary of the University participating in this plan.
The Employee Retirement Income Security Act (ERISA) requires that certain information be furnished to each participant in an employee benefit plan. Your booklet-certificate and this Supplement are the Summary Plan Description for purposes of ERISA. 1. Employer Identification Number: EIN: 42-6004224
LONG TERM DISABILITY INSURANCE AND T.I.A.A. Waiver of Annuity Contribution Benefit
HOW TO BE INSUREDTo be eligible for insurance you must be a Member.
Member means:
Coverage is available during the first year subject to an approved statement of good health. You pay the full cost of coverage until your regular effective date for coverage.
Back to Benfits Payable for Partial Disability with work Incentive benefits
Back to Supplementary Information
EFFECTIVE DATE FOR INITIAL INSURANCE
If you elect to become insured, you must request initial insurance on a form provided by the University. You will furnish the information requested and agree to the required contribution which will be deducted from your salary.
Your insurance will normally be in force on the first of the calendar month that next follows the date you complete one year of Active Work.
If coverage for the first year of employment is approved, your insurance will normally be in force on the first of the calendar month that next follows the date proof is approved by Principal Mutual Life Insurance Company.
However, if you are not Actively at Work on the date insurance would otherwise be effective, your insurance will not be in force until the day you return to Active Work.
You are not required to contribute toward the cost of your Long Term Disability Insurance (including T.I.A.A. Waiver of Annuity Contribution Benefit). The entire cost is paid by the University.
EFFECTIVE DATE FOR BENEFIT CHANGES
A change in your benefit amount because of a change in your status (insurance class or compensation) will normally be effective on the date of the change.
However, if you are not Actively at Work on the date the change would otherwise be effective, the change will not be in force until the day you return to Active Work.
Your insurance will cease on the earliest of: - the date the Group Policy terminates; or
- the end of the calendar month in which you cease to belong to a class for which insurance is provided; or
- the end of the calendar month in which you cease to be a Member; or
- the end of the calendar month in which you cease Active Work. If you cease Active Work because of sickness or injury, your plan might provide for limited continuation.
If you cease Active Work because of layoff or leave of absence, coverage may be continued on a limited basis.
If you arrange to take an approved leave of absence without pay, you will be eligible to keep your insurance in force during such leave of absence provided you pay all required premiums to continue the insurance. Arrangements for paying the premiums should be made in the Office of Human Resource Services, 3750 Beardshear Hall, Suite 3350, Iowa State University.
If you elect to discontinue your insurance while you are on an approved leave of absence, you may re-enroll within 31 days after the date of expiration of the leave of absence.
If you are covered under the terms of a collective bargaining agreement, you should refer to that contract for specific information regarding benefits during a leave without pay.
Your coverage may also be: - continued as described under the continuation provisions; and
- reinstated as described under the reinstatement provisions; in accordance with the provisions of the Federal Family and Medical Leave Act (FMLA) and subject to the provisions of your Group Plan.
If you are interested in continuing your insurance beyond the date it would normally terminate, you should consult with the Office of Human Resource Services before your insurance terminates.
FEDERAL FAMILY AND MEDICAL LEAVE ACT (FMLA)
Continuation
Federal law requires that Eligible Employees be provided a continuation period in accordance with the provisions of the Federal Family and Medical Leave Act (FMLA).
This is a general summary of the FMLA and how it affects your Group Plan. See your employer for details on this continuation provision.
FMLA and Other Continuation Provisions
If your employer is an Eligible Employer and if the continuation portion of the FMLA applies to your coverage, these FMLA continuation provisions:
Eligible Employer
Eligible Employer means any employer who is engaged in commerce or in any industry or activity affecting commerce who employs 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year.
Eligible Employee
Eligible Employee means an employee who has worked for the Eligible Employer: - for at least 12 months; and
- for at least 1,250 hours (approximately 24 hours per week) during the year preceding the start of the leave; and
- at a work-site where the Eligible Employer employs at least 50 employees within a 75-mile radius. For this purpose, "employs" has the meaning provided by the Federal Family and Medical Leave Act (FMLA).
Mandated Unpaid Leave
Eligible Employers are required to allow 12 workweeks of unpaid leave during any 12-month period to Eligible Employees for one or more of the following reasons: - The birth of a child of an Eligible Employee and in order to care for the child.
- The placement of a child with the Eligible Employee for adoption or foster care.
- To care (physical or psychological care) for the spouse, child, or parent of the Eligible Employee, if they have a "serious health condition".
- A "serious health condition" that makes the Eligible Employee unable to perform the functions of his or her job. Reinstatement
An Eligible Employee's terminated coverage may be reinstated in accordance with the provisions of the Federal Family and Medical Leave Act (FMLA), subject to the Actively at Work requirements of the Group Plan.
See your employer for details on this reinstatement provision.
BENEFITS PAYABLE FOR TOTAL DISABILITY
If you are Totally Disabled and all of the Benefit Qualifications listed below are met, benefits will be payable to you during each month of a Payment Period. The Benefit Payable to you for each full month of a Payment Period will be your Primary Monthly Benefit less Income From Other Sources, subject to the Disability Escalator.
The Benefit Payable for each day of any part of a Payment Period that is less than a full month will be the monthly benefit divided by 30.
The determination of Income From Other Sources will be subject to the requirements discussed in the CLAIM PROCEDURES Section.
BENEFITS PAYABLE FOR PARTIAL DISABILITY WITH WORK INCENTIVE BENEFIT
Subject to the Effective Date provisions and the Benefit Qualifications listed below:
- earnings from your regular job or any occupation; or
- your Income Loss Percentage.
You have multiple sclerosis. Because of your medical condition, you have had to reduce your work schedule from 40 hours per week to 16 hours per week. For the first 12 months of your Partial Disability, your monthly benefit will be calculated as follows:
Predisability Earnings:....................... $ 4,000
Monthly Disability Benefit
Income Loss Test ($1,600/$4,000):......... 40%
Less Current Part-time Earnings:... - $ 1,600
Work Incentive Benefit...................... $ 2,400
After the first 12 months of receiving Work Incentive Benefits, you continue to work part-time, 16 hours per week. Your monthly benefit will be calculated as follows:
Predisability Earnings:...................... $ 4,000
Monthly Disability Benefit
(Primary Monthly Benefit):...............$ 2,550
Income Loss Test ($1,600/$4,000): .......40%
Income Loss Percent
(Primary Monthly Benefit): ................$ 2,550
Total income replacement is $3,130 (Income loss benefit of $1,530 plus part-time earnings of $1,600).
INDEXED PREDISABILITY EARNINGS
For purposes of administering the Partial Disability benefit, your monthly Predisability Earnings will be adjusted to reflect changes in the cost of living based on the Consumer Price Index as published by the United States Department of Labor. The maximum adjustment made will be subject to an annual maximum of 10%. Adjustments made as a result of changes in the Index will be effective as of the anniversary date of Disability of each year.
If you have been Disabled for less than one year, the amount of increase will be determined by multiplying the ratio of:
The Disability Escalator applies to all Members who are Disabled and may be applied each year on the July 1 following completion of one year of continuous Disability. The Disability Escalator payments will be administered as follows:
- For Partial Disability Benefits, the Disability Escalator, if applicable, will be applied to the Primary Monthly Benefit less Income From Other Sources. Therefore, the Disability Escalator is applied prior to application of the Income Loss Percentage.
- The Disability Escalator will be based upon the annual Consumer Price Index (CPI), as determined by the United States Department of Labor. The amount of any increase will be determined by comparing the arithmetic mean of the CPI for January, February, and March of the current year to the corresponding period of the prior year.
- The amount of the Disability Escalator will equal the established Consumer Price Index (CPI) changes, but will not exceed 5% per year, except as may be modified by the "carry over provision" described in the following item.
- In those years when the Disability Escalator is less than 5%, the difference between the amount actually paid and 5% may be carried over and applied in future years in addition to the normal 5% increase. However, in no year may the increase exceed 10% regardless of the amount carried over. The increase, if any, will be effective on July 1 of each year.
- There will be no decrease in benefits at any time for any reason, unless the Group Policy is amended or terminated with respect to Escalator Benefits.
To qualify for benefit payment, all of the following must occur:
- Your Disability must not be subject to any of the limitations listed later in this section.
- You must complete a Benefit Waiting Period and establish a Payment Period.
- You must be under the regular care and attendance of a Physician.
- You must not be receiving sick pay benefits from the University, except as provided under Continued Payments.
- You must satisfy the requirements listed in the CLAIM PROCEDURES Section.
- the exhaustion of your accumulated sick pay benefits;
If you are in the process of satisfying a Benefit Waiting Period and recover from Disability for a short period of time, and then again become Disabled from the same or a related cause, the recovery from Disability will not interrupt satisfaction of the Benefit Waiting Period provided recovery is not longer than ten* working days.
A Payment Period will be established on the later of:
- the date six months before Principal Mutual Life Insurance Company receives written proof of your Disability.
During a Payment Period, all Social Security amounts included in your Income From Other Sources will be based on the provisions of the Social Security Act in force on your date of entitlement under that Act. Future adjustments during a Payment Period will be made only to reflect changes in Social Security amounts resulting from changes in the status of your Dependents. Social Security cost of living increases during a Payment Period will not be included in your Income From Other Sources.
Except as described below in Continued Payments, your Payment Period will end on the earliest of:
- the day before the date of your retirement; or
- the date your Disability ends; or
- the date you fail to provide any required proof of your Disability; or
- the date you fail to submit to any required medical examination; or
- the date you fail to report Income From Other Sources; or
- if your Disability begins before you are age 61, the later of the date five years after your Payment Period begins or the June 30th following the date you are age 65; or
- if your Disability begins on or after you are age 61 and before you are age 69, the earlier of the date five years after your Payment Period begins or the June 30th following the date you are age 70 (except that the Payment Period will not be less than 12 months); or
- if your Disability begins on or after you are age 69, the date 12 months after your Payment Period begins; or
- the date you cease to be under the regular care and attendance of a Physician.
In some instances your Payment Period may be continued beyond the normal termination date. These instances are discussed under these headings:
- Sick Pay Benefit Exceptions
A Recurring Disability will exist if you become Disabled again, after returning to Active Work for less than six continuous months, provided you already completed a Benefit Waiting Period and your current Disability and the Disability for which you completed the Benefit Waiting Period result from the same or a related cause.
All Recurring Disabilities will be treated as if your initial Disability had not ended, except that no benefits will be payable for the time between Disabilities. You will not need to complete a new Benefit Waiting Period for a Recurring Disability. Benefits will be payable immediately, but only for the remainder of the Payment Period you established for the initial Disability.
If you are receiving a sick pay benefit from the University, the Benefit Payable under this Long Term Disability Insurance will be payable if the sick pay benefit is interrupted by the summer break (the Benefit Payable under the Long Term Disability Insurance would only be continued in this situation until the sick pay benefit is resumed in the fall).
These continued payments will be subject to all of the other Payment Termination provisions and Benefit Qualification provisions listed earlier.
Benefits will not be paid for any Disability that:
- results from war or act of war; or
- results from voluntary participation in an assault or felony.
LONG TERM DISABILITY INSURANCE (T.I.A.A. WAIVER OF ANNUITY CONTRIBUTION BENEFIT)
BENEFITS PAYABLE FOR TOTAL DISABILITY
If you are Totally Disabled and all of the Benefit Qualifications listed below are met, benefits will be payable by Principal Mutual Life Insurance Company to the University during each month of a Payment Period. Benefits Payable to the University are for the explicit purpose of payment of your contributions under the University's retirement program with the Teachers Insurance and Annuity Association (T.I.A.A.). Principal Mutual Life Insurance Company is not responsible for the payment of your contributions to the Teachers Insurance and Annuity Association (T.I.A.A.). The Benefit Payable for each full month of a Payment Period will be your Primary Monthly Benefit, subject to the Disability Escalator.
The Benefit Payable for each day of any part of a Payment Period that is less than a full month will be the monthly benefit divided by 30.
BENEFITS PAYABLE FOR PARTIAL DISABILITY
If you are Partially Disabled and all of the Benefit Qualifications listed below are met, Partial Disability benefits will be payable by Principal Mutual Life Insurance Company to the University during each month of a Payment Period. Benefits Payable to the University are for the explicit purpose of payment of your contributions under the University's retirement program with the Teachers Insurance and Annuity Association (T.I.A.A.). Principal Mutual Life Insurance Company is not responsible for the payment of your contributions to the Teachers Insurance and Annuity Association (T.I.A.A.).
The Partial Disability Benefit Payable for each full month of a Payment Period will be your Primary Monthly Benefit less:
- the University's contributions based on your part-time earnings paid by the University.
The Disability Escalator applies to all Members who are Disabled and may be applied each year on the July 1 following completion of one year of continuous Disability. The Disability Escalator payments will be administered as follows:
- The Disability Escalator will be based upon the annual Consumer Price Index (CPI), as determined by the United States Department of Labor. The amount of any increase will be determined by comparing the arithmetic mean of the CPI for January, February, and March of the current year to the corresponding period of the prior year.
- The amount of the Disability Escalator will equal the established Consumer Price Index (CPI) changes, but will not exceed 5% per year.
- The increase, if any, will be effective on July 1 of each year.
- There will be no decrease in benefits at any time for any reason, unless the Group Policy is amended or terminated with respect to Escalator Benefits.
To qualify for benefit payment, all of the following must occur:
- You must be a participant in the Teachers Insurance and Annuity Association (T.I.A.A.); or the Civil Service Retirement System (C.S.R.S.); or the Federal Employees Retirement System (F.E.R.S.).
- Your Disability must not be subject to any of the limitations listed later in this section.
- You must complete a Benefit Waiting Period and establish a Payment Period.
- You must not be receiving sick pay benefits from the University, except as provided under Continued Payments.
- You must be under the regular care and attendance of a Physician.
- You must satisfy the requirements listed in the CLAIM PROCEDURES Section.
- the exhaustion of your accumulated sick pay benefits;
If you are in the process of satisfying a Benefit Waiting Period and recover from Disability for a short period of time, and then again become Disabled from the same or a related cause, the recovery from Disability will not interrupt satisfaction of the Benefit Waiting Period provided recovery is not longer than ten* working days.
A Payment Period will be established on the later of:
- the date six months before Principal Mutual Life Insurance Company receives written proof of your Disability.
Except as described below in Continued Payments, your Payment Period will end on the earliest of:
- the day before the date of your retirement; or
- the date your Disability ends; or
- the date you fail to provide any required proof of your Disability; or
- the date you fail to submit to any required medical examination; or
- if your Disability begins before you are age 61, the later of the date five years after your Payment Period begins or the June 30th following the date you are age 65; or
- if your Disability begins on or after you are age 61 and before you are age 69, the earlier of the date five years after your Payment Period begins or the June 30th following the date you are age 70 (except that the Payment Period will not be less than 12 months); or
- if your Disability begins on or after you are age 69, the date 12 months after your Payment Period begins; or
- the date you cease to be a participant in the Teachers Insurance and Annuity Association (T.I.A.A.); or the Civil Service Retirement System (C.S.R.S.); or the Federal Employees Retirement System (F.E.R.S.); or
- the date you cease to be under the regular care and attendance of a Physician.
In some instances your Payment Period may be continued beyond the normal termination date. These instances are discussed under these headings:
- Sick Pay Benefit Exceptions
A Recurring Disability will exist if you become Disabled again, after returning to Active Work for less than six continuous months, provided you already completed a Benefit Waiting Period and your current Disability and the Disability for which you completed the Benefit Waiting Period result from the same or a related cause.
All Recurring Disabilities will be treated as if your initial Disability had not ended, except that no benefits will be payable for the time between Disabilities. You will not need to complete a new Benefit Waiting Period for a Recurring Disability. Benefits will be payable immediately, but only for the remainder of the Payment Period you established for the initial Disability.
If you are receiving a sick pay benefit from the University, the Benefit Payable under this T.I.A.A. Waiver of Annuity Contribution Benefit will be payable if:
- the sick pay benefit is zero ($0.00) due to coordination with Social Security, Workers' Compensation and/or other integrated income.
Benefits will not be paid for any Disability that:
- results from war or act of war; or
- results from voluntary participation in an assault or felony.
Claim Forms
The University will provide forms to assist you in filing claims.
Payment, Denial and Review
Federal law permits up to 90 days for processing claims and up to 60 days for reviewing denied claims. Both time limits may be extended if unusual factors exist.
In actual practice, most claims will be processed by the day following completion of your Benefit Waiting Period, provided Principal Mutual Life Insurance Company receives a completed claim form from the University at least 30 days prior to this date. Further, if a claim cannot be paid, Principal Mutual Life Insurance Company will promptly explain why.
If you disagree with a claim denial, a review may be requested. In order for Principal Mutual Life Insurance Company to review a denied claim, the University must receive a written request from you within 120 days of receipt of notice of the denial. All added facts should be given to the University within one year of receipt of notice of the denial. The University will send this information to Principal Mutual Life Insurance Company. Principal Mutual Life Insurance Company will then conduct the review. You will be advised of the final decision and the reasons.
Prompt Filing
Completed claim forms and other information needed to prove loss should be filed promptly. Claims should be sent to Iowa State University, Office of Human Resource Services, 3750 Beardshear Hall, Suite 3350 . Room 100, Ames, IA 50011-1031, within 90 days after the date of loss. Written proof that Disability exists and has been continuous must be sent to Iowa State University, Office of Human Resource Services, 3750 Beardshear Hall, Suite 3350 , Ames, IA 50011-1031, within six months after you complete your Benefit Waiting Period. Claims sent later will be accepted only if there is reasonable cause for the delay.
Determination of Income From Other Sources
If you file a claim for Long Term Disability benefits, your Income From Other Sources will be determined in this way:
- If any income is payable to you in a lump sum, Principal Mutual Life Insurance Company will convert and apply that income on a monthly equivalent basis.
- Until exact amounts are known, Principal Mutual Life Insurance Company will estimate the Social Security benefits for which you and your Dependents are eligible and will include that estimate in your Income From Other Sources.
- give satisfactory proof within 30 days after receipt of Principal Mutual Life Insurance Company's notice that you have applied for these benefits within the ten-day period; and
- request reconsideration of the application for Social Security benefits if the original application is denied, and appeal any denial of reconsideration if an appeal appears reasonable.
If excess benefits are paid because your Income From Other Sources is understated, Principal Mutual Life Insurance Company will have the option to:
- recover the excess payment directly from you.
Long Term Disability benefits will be payable at the end of each month of a Payment Period, provided complete and proper proof of Disability has been received by Principal Mutual Life Insurance Company. Any unpaid balance that remains after a Payment Period ceases will be immediately payable.
Benefits will normally be paid directly to you. However, in the special instances listed below, payment will be as indicated:
- If Principal Mutual Life Insurance Company believes a person is not legally able to give a valid receipt for a benefit payment, and no guardian has been appointed, Principal Mutual Life Insurance Company may pay whoever has assumed the care and support of the person. Any payment due a minor will be at the rate of not more than $200 a month.
Principal Mutual Life Insurance Company may have the Member whose loss is the basis for claim examined by a Physician. Principal Mutual Life Insurance Company will pay for these examinations and will choose the Physician to perform them.
Legal Action
Legal action for a claim may not be started earlier than 60 days after a claim is filed. Further, no legal action may be started later than three years after proof is required to be filed.
Time Limits
All time limits listed in this section will be extended to meet any minimums required by law.
Federal law requires that this section be included in your booklet:
As a participant in this plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA).
ERISA provides that all plan participants shall be entitled to:
- Receive a summary of the plan's annual financial report. The plan administrator is required by law to furnish each participant with a copy of this summary annual report.
Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials from the plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $100 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. If it should happen that fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, if, for example, it finds your claim is frivolous.
If you have any questions about your plan, you should contact the plan administrator. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest Area Office of the Pension and Welfare Benefits Administration, U.S. Department of Labor.
Active Work; Actively At Work means the active performance of all of a Member's normal job duties at the University's usual place or places of business.
Affiliates mean companies who delegate their payroll administration to the University, which provides these companies with the opportunity to participate in the University's group benefit plans.
Annual Budgeted Salary means the current salary amount appearing opposite your name in the University's budget and/or on your official Notice of Appointment. It is the salary amount for the academic year if payable during nine months or for the fiscal year if payable during 12 months. If you are paid on an hourly rate your Annual Budgeted Salary is determined by multiplying your budget hourly rate by your normal working hours in the fiscal year. Annual Budgeted Salary, for the purposes of this insurance, excludes:
- compensation in the form of non-cash items such as board, room, laundry, or premiums paid by the University for the benefit of any Member.
Covered Leave of Absence means a Member's leave of absence where Long Term Disability Insurance and T.I.A.A. Waiver of Annuity Contributions benefits continue for that Member because the Member makes arrangements to pay the contributions during the leave.
Covered Monthly Earnings 1/12 of your Annual Budgeted Salary up to but not exceeding $150,000.
Dependent means your spouse and children if they qualify for benefits under the Federal Social Security Act as a result of your Disability.
Disability/Disabled means Total or Partial Disability as defined in this section.
Income From Other Sources will be the sum of:
- if you are age 65 or older, all retirement payments for the month that you and your Dependents receive (or would have received if complete and timely application had been made) under the Federal Social Security Act; and
- if you are less than age 65, all retirement payments for the month that you and your Dependents receive under the Federal Social Security Act; and
- all loss of wages payments for the month (other than payments from the Veterans' Administration) that you receive under a Workers' Compensation Act or other similar law; and
- all payments for the month that you receive from any salary continuance or pension plan sponsored by the University (including Federal Civil Service Disability benefits).
- your Indexed Predisability Earnings.
Member means:
- Any person who is employed by the Iowa State Memorial Union or the Iowa State University Press, appointed to a budgeted position, and regularly scheduled to work for 1/3 time or more for at least nine months.
Partial Disability means you are working on a limited or part-time basis and your inability, solely and directly because of sickness or injury:
- after completion of the Benefit Waiting Period and the two-year period immediately following the Benefit Waiting Period, to perform the majority of the material duties of any occupation for which you are or may reasonably become qualified based on your education, training or experience; and you are unable to earn more than 70% of your Indexed Predisability Earnings.
Predisability Earnings mean your Covered Monthly Earnings in effect on the date Disability begins.
FOR MEMBERS WHO HAVE COMPLETED LESS THAN FIVE YEARS OF ACTIVE WORK:
On any date the sum of:
On any date, 15% of your Covered Monthly Earnings as of the date Disability starts.
Primary Monthly Benefit (for other than T.I.A.A. Waiver of Annuity Contribution Benefit) means on any date:
- 60% of your Covered Monthly Earnings in excess of $1,000 as of the date Disability starts;
Back to Benefits payable for partial disablilty with work incentive benefit
Total Disability/Totally Disabled means you are not working for wage or profit and your inability, solely and directly because of sickness or injury:
SUPPLEMENT TO YOUR BOOKLET-CERTIFICATE
The Employee Retirement Income Security Act (ERISA) requires that certain information be furnished to each participant in an employee benefit plan. Your booklet-certificate and this Supplement are the Summary Plan Description for purposes of ERISA.