Long-Term Disability (LTD) insurance is designed to provide you with income if you are absent from work for six consecutive months or longer due to an eligible illness or injury. If elected, a participant may be eligible to receive benefits through LTD insurance after 180 days of disability. Employees pay the full cost of coverage on an after-tax basis.
In some states, LTD benefits may be paid at the same time as STD benefits. When this occurs, benefits will be integrated with other sources (refer to your LTD evidence of coverage for more information).
If you choose to waive LTD insurance when first eligible, you may be subject to medical underwriting if you decide to elect coverage at a later time, even if enrollment is due to a qualifying life event. If medical underwriting applies, you will receive a notification and the link to complete an electronic Evidence of Insurability (EOI).
For more information, download the Evidence of Coverage document.
Below are some important terms used in describing how a participant is eligible to receive benefits through the LTD Plan:
- Qualified Disability — One where a participant cannot perform his or her own occupation in the first two years of disability. After two years of disability, a qualified disability is one where a participant is unable to perform any occupation that he or she is reasonably qualified to hold. Refer to the LTD evidence of coverage, issued by Life Insurance Company of North America (LINA), a New York Life company, for more information on criteria for "own occupation" versus "any occupation." The participant will be required to provide objective medical evidence to LINA, the claims administrator, to qualify for benefits. The plan administrator will determine the types of medical documentation needed and how frequently the documentation must be updated.
- Claims Administrator — Life Insurance Company of North America (LINA), a New York Life company.
- Claims Fiduciary — Life Insurance Company of North America (LINA), a New York Life company.
The plan administrator has appointed Life Insurance Company of North America (LINA), a New York Life company, as the claims fiduciary for adjudicating claims for benefits under the Plan, and for deciding any appeals of denied claims. The Insurance Company shall have the authority, in its discretion, to interpret the terms of the Plan, to decide questions of eligibility for coverage or benefits under the Plan, and to make any related findings of fact. LINA, at its expense, has the right to examine, as often as reasonably required, any participant with a pending claim. LINA may also require an autopsy, at its expense, unless prohibited by law. All decisions made by the Insurance Company shall be final and binding on Participants and Beneficiaries to the full extent permitted by law. If a participant disagrees with the determination, there is a formal appeal process. For more information on the appeal process, refer to the plan's Evidence of Coverage.
Important: This document provides only a summary of general plan provisions. A separate evidence of coverage is available from LINA, which serves as the legal document that governs the plan.
If a participant is unable to work after 180 days of continuous disability, the participant may be eligible to receive LTD benefits if elected.
Employees who elect coverage will be eligible to receive up to 60% of his or her monthly base salary up to a maximum monthly benefit of $14,500, minus any reductions for other income benefits (state disability, Social Security disability, etc.).
Employees enrolled in LTD pay 100% of the cost on an after-tax basis thereby providing a tax-free benefit when received.
LTD is underwritten by LINA (a New York Life company), and a participant must meet the plan's criteria for disability to qualify for income replacement under this program. Refer to the plan's Evidence of Coverage for more information about qualifying for income replacement.
The following maximum benefit periods apply:
AGE WHEN PARTICIPANT'S DISABILITY BEGINS MAXIMUM BENEFIT PERIOD Age 62 or under The employee's 65th birthday or the date the 42nd monthly benefit is payable, whichever is later Age 63 The date the 36th monthly benefit is payable Age 64 The date the 30th monthly benefit is payable Age 65 The date the 24th monthly benefit is payable Age 66 The date the 21st monthly benefit is payable Age 67 The date the 18th monthly benefit is payable Age 68 The date the 15th monthly benefit is payable Age 69 or older The date the 12th monthly benefit is payable
Definition of Disability/Disabled
A participant is disabled if, because of injury or illness:
- The participant is unable to perform all the duties of his or her regular occupation, or unable to earn more than 80% of indexed covered earnings;
- The participant has been paid disability benefits for 24 months and unable to perform all the duties of any occupation for which he or she may reasonably become qualified based on education, training or experience, or unable to earn more than 80% of his or her indexed covered earnings. Refer to the evidence of coverage for more information about indexed covered earnings.
To assist the employee in transitioning from short term to long term disability claim with LINA, the following will occur at week 17 of an employee's disability:
- For participants who elect LTD, Sedgwick will send all open STD claims to LINA via an electronic file. LINA plan administrators will also have access to the Sedgwick system to view pertinent claims information.
- Sedgwick will send a letter notifying the claimant that the claim was referred to LINA for evaluation of LTD Benefits.
- LINA will acknowledge receipt of claim by sending out a confirmation letter to the employee once the online submission is completed.
- Within 10 days a dedicated claim manager will contact the employee via telephone to introduce themselves and notify the employee of the process. A follow up letter will be sent following this conversation to notify the claimant of any outstanding information and all applicable policy provisions.
If the participant is receiving benefits from the LTD plan:
- Disability benefits are paid once a month;
- Benefits can be sent through the mail, or electronically deposited;
- If not directed otherwise, a check will be mailed to the participant's home or address of record from the insurance company; and
- There are no deductions other than applicable taxes and offsets (see the evidence of coverage for more details).
Leidos requires that all participants returning from LTD provide a "fitness for duty" or "doctor's release" prior to returning to work. This document is usually a note from the health care provider clearly stating that the participant is not considered to be disabled, as well as the date the participant is able to return. If the health care provider is requesting modified duty or limited hours, this should be discussed with LINA and the workplace in advance of the participant's return to work. A participant who does not present a release may not be allowed to work until the release is presented.
LTD benefit payments end on the earliest of the following dates:
- The date the participant earns more than the percentage of indexed covered earnings which is used to determine if the participant is disabled;
- The date the claims administrator determines the participant is no longer disabled;
- The date the maximum benefit period ends;
- The date the participant dies;
- The date the participant refuses to participate in rehabilitation efforts;
- The date the participant is no longer receiving appropriate care.
If a participant’s disability started prior to termination of employment, disability benefits will continue to be paid up to the maximum duration approved under the Plan.
For collectively bargained participants, disability benefits will continue to be paid if a strike occurs and the disability started prior to the strike. Benefits will be paid up to the maximum duration approved under the Plan.
For more information about when LTD benefits end, refer to the plan's evidence of coverage.
LTD coverage ends:
- When the participant is eligible for coverage under a plan intended to replace this coverage;
- When the insurance policy is terminated;
- At the end of the pay period in which the participant is no longer in an eligible class;
- At the end of the last pay period for which premiums are paid; or
- When the participant dies.
LTD benefits will not be paid for any disability caused by, contributed to or resulting from a pre-existing condition that is diagnosed or treated within a three month period before the LTD coverage effective date. For this policy, a "pre-existing condition" means any injury or illness for which the participant:
- Received medical treatment, care or services including diagnostic measures;
- Took prescribed drugs or medicines; or
- Incurred expenses
The pre-existing condition limitation will apply to any added benefits or increases in benefits. It will not apply to a period of disability that begins after you are in active service for at least 12 months after your most recent effective date of insurance or the effective date of any added or increased benefits.
The pre-existing condition limitation will not apply to a participant covered under a prior plan who satisfied that plan's pre-existing condition limitation, if any. It will still apply to any benefit amount greater than that of the prior plan. If the participant did not completely satisfy the pre-existing condition limitation of the prior plan, the participant will receive credit for any time that was satisfied. For any person who becomes an employee of the employer as a part of an acquisition, the pre-existing condition limitation will not apply.
Time will not be credited for any day a participant is not actively at work due to his or her injury or illness. The pre-existing condition limitation will be extended by the number of days the participant is not actively at work due to injury or illness.
Employees who choose to waive LTD coverage when first eligible, and later choose to elect coverage will be required to complete EOI.
LTD benefits will not be paid for a disability that result, directly or indirectly, from:
- Suicide, attempted suicide, or whenever a participant injures himself or herself on purpose;
- War or any act of war, whether or not declared (For Class 1 employees only);
- Serving on full-time active duty in any armed forces. If the participant sends proof of military service, the plan will refund the portion of the premium paid to cover the participant during a period of such service;
- Active participation in a riot;
- Commission of a felony; or
- Revocation, restriction or non-renewal of a participant's license, permit or certification necessary to perform the duties of his or her occupation unless that is due only to covered injuries or illnesses.
LTD benefits will not be paid for any period of disability during which the participant:
- Is incarcerated in a penal or corrections institution;
- Is not receiving appropriate care under a licensed physician;
- Fails to cooperate with the plan in the administration of the claim, such as providing any information or documents needed to determine whether benefits are payable or the actual benefit amount due;
- Refuses to participate in rehabilitation efforts as required by the plan; or
- Refuses to participate in a Transitional Work Arrangement or other modified work arrangement. "Transitional Work Arrangement" means any work offered to the participant by Leidos or an affiliated company while the participant is disabled and which may be his or her own or any occupation. The term includes but is not limited to reassigned duties, work site modification, flexible work arrangements, job adaptation or special equipment.
For more information about what the LTD Plan does not cover, refer to the plan's certificate of coverage.
LTD benefits will be paid on a limited basis during a participant's lifetime for a disability caused by, or contributed to by, any of the following conditions. Once 24 monthly disability benefits have been paid, no further benefits will be paid for any of the following conditions:
- Anxiety disorders
- Delusional (paranoid) disorders
- Depressive disorders
- Drug addiction or abuse
- Eating disorders
- Mental illness
- Somatoform disorders (psychosomatic illness)
If before reaching the lifetime maximum of 24 monthly benefits, a participant is confined in a hospital for more than 14 consecutive days for the appropriate care of any of the conditions listed above, that period will not count against the lifetime limit.
For a complete list of the LTD plan's limitations and exclusions, refer to the plan's evidence of coverage.
The LTD plan will require that the participant cooperate in collecting the medical information necessary to review the claim and make a benefit determination. The most common reason that claim payments are delayed is the failure of the participant's health care provider to return calls, return forms or otherwise provide medical documentation. A participant can help the plan administrators make more timely decisions by:
- Explaining to the health care provider that the administrator will be contacting them;
- Following up with the health care provider's office after a request for information has been made to ensure that the information is being collected and sent to the administrator; and
- Notifying LINA immediately if the participant's return-to-work plans change, or if the health condition significantly changes (for example, if a surgery is needed). This will allow the plan administrator to help the employee file for an extension of benefits, if appropriate.
When a participant is unable to work for an extended period of time, the participant may be eligible for Social Security Disability Income (SSDI). SSDI allows an employee to receive income.
A participant who is disabled should apply for SSDI as soon as it is clear that the duration of the disability will be longer than six months. When the participant applies for LTD benefits, LINA will require that the participant apply for SSDI benefits, and will offer assistance throughout the SSDI application process.
If the participant is eligible for Social Security disability benefits, any such payment will be subtracted from disability benefits the participant receives from the disability plans.
It is not uncommon for the SSDI application and approval process to take several months, and for benefits paid to be retroactive back to a certain date of disability. A participant receiving LTD benefits will be asked by LINA to sign an Overpayment Reimbursement Agreement stating that the participant will reimburse LINA for any Social Security benefits received for the same period of time the participant was receiving disability benefits.
The LTD plan is designed to provide a certain degree of income protection if a participant is unable to work for long periods of time. However, the plan may reduce the disability benefit paid if, while a participant is disabled, he or she may be eligible for benefits from other income sources. If so, benefits may be reduced by the amount of these other income benefits, including:
- Any amounts which the participant or any dependents receive (or are assumed to receive) under:
- the Canada and Quebec Pension Plans;
- the Railroad Retirement Act;
- any local state, provincial or federal government disability or retirement plan or law as it relates to the participant;
- any employer sick leave plan;
- any work loss provision in mandatory "No-Fault" auto insurance;
- any Workers' Compensation, occupational disease, unemployment compensation law or similar state or federal law, including all permanent as well as temporary disability benefits. This includes any damages, compromises or settlement paid in place of such benefits, whether or not liability is admitted;
- Any Social Security disability benefits the participant or any third party receives (or are assumed to receive) on the participant's behalf or for his or her dependents; or, which his or her dependents receive (or are assumed to receive) because of the participant's entitlement to such benefits;
- Any employer-funded retirement plan benefits. "Retirement plan" means any defined benefit or defined contribution plan sponsored or funded by a participant's employer. It does not include:
- an individual deferred compensation agreement;
- a profit sharing or any other retirement or savings plan maintained in addition to a defined benefit or other defined contribution pension plan;
- any participant savings plan including a thrift, stock option or stock bonus plan, individual retirement account or 401(k) plan;
- Any proceeds payable under any franchise or group insurance or similar plan. If there is other insurance that applies to the same disability claim, and which contains the same or a similar provision for reduction because of other insurance, the plan will pay a pro rata share of the total claim. “Pro rata share” means the proportion of the total benefit that the amount payable under one policy, without other insurance, bears to the total benefits under all such policies;
- Any amounts paid because of lost earnings or loss of earning capacity through settlement, judgment, arbitration or otherwise, where a third party may be liable, regardless of whether liability is determined;
- Any wage or salary for work performed. If a participant is covered for Work Incentive Benefits, the plan will only reduce disability benefits to the extent provided under the Work Incentive Benefit in the Schedule of Benefits.
Although this coordination of benefits may reduce the amount received from the LTD plan, all benefits together will still equal the total amount the participant is eligible for under the LTD plan.
- Any amounts which the participant or any dependents receive (or are assumed to receive) under:
If the plan determines that a disabled participant is a suitable candidate for rehabilitation, a rehabilitation plan may be put in place. The terms and conditions of the rehabilitation plan must be mutually agreed upon by the participant and the plan.
The plan may require a participant to participate in a rehabilitation assessment or a rehabilitation plan at its expense. The plan will work with the participant, the employer and the participant's physician and others, as appropriate, to develop a rehabilitation plan. Disability benefits will not be paid if the participant refuses to participate in the rehabilitation efforts.
The rehabilitation plan may, at the plan's discretion, allow payment of the participant's medical expense, education expense, moving expense, accommodation expense or family care expense while he or she participates in the program.
A "rehabilitation plan" is a written agreement between the participant and the plan in which the plan agrees to provide, arrange or authorize vocational or physical rehabilitation services.
For the first 12 months the participant is eligible for a disability benefit, the disability benefit is determined based on the minimum and maximum disability benefit. If for any month during this period, the sum of the participant's disability benefit, current earnings and any additional other income benefits exceeds 100% of his or her indexed covered earnings, the disability benefit will be reduced by the excess amount.
After the first 12 months, the disability benefit is determined based on the minimum and maximum disability benefit, reduced by 50% of current earnings received during any month the participant returns to work. If the sum of the participant's current earnings and any additional other income benefits exceeds 80% of the participant's monthly indexed covered earnings, the disability benefit will be reduced by the excess amount figured above. No benefits will be paid if the plan determines the participant is able to work and refuses to do so under a transitional work arrangement or other modified work arrangement.
Current earnings include any wage or salary for work performed while disability benefits are payable. If participant is working for another employer on a regular basis when disability begins, current earnings will include any increase in the amount the participant earns from this work during the period for which disability benefits are payable.
Once a participant is eligible to receive LTD benefits, separate periods of disability resulting from the same or related causes are considered a continuous period of disability unless the participant returns to active service with Leidos for more than six consecutive months. A period of disability is not continuous if separate periods of disability result from unrelated causes or the later disability occurs after coverage ends.
If a participant is eligible for coverage under a plan that replaces this disability plan, the successive periods of disability provision will not apply.
For more information about what happens when a participant becomes disabled again, refer to the plan's evidence of coverage.
If the employee is on STD or not actively at work at the time of enrollment, LTD coverage will not be effective until the employee returns from leave. Premiums will not be charged until the coverage is active.
Disability insurance continues if a participant's active service ends because of a disability for which covered benefits are or may become payable. Premiums for the participant will be waived while disability benefits are payable. If the participant does not return to active service, this insurance ends when the disability ends or when benefits are no longer payable, whichever occurs first.
If a participant's active service ends due to an employer-approved unpaid leave of absence, insurance for that participant will continue for up to 24 months if the required premium is paid.
If a participant's active service ends due to family medical leave of absence, insurance for that participant will continue for up to 12 weeks if the required premium is paid.
If a participant's coverage ends because employment with Leidos ends, or a participant is laid off or on an uninsured leave of absence, the participant may be eligible for long term disability conversion insurance. To be eligible, a participant must have been insured for disability benefits and actively at work for at least 12 months. A participant must apply for conversion insurance within 62 days after coverage ends. The benefits of the conversion plan will be those benefits offered at the time a participant applies. The premium will be based on the rates in effect for conversion plans at that time.
Conversion insurance is not available if any of the following conditions apply:
- A participant is retired or age 70 or older;
- A participant is not in active service because of disability; or
- The insurance policy is canceled for any reason.
- LTD Conversion Form
This form needs to be completed if an employee wishes to continue long term disability coverage upon termination of employment.
The plan will pay a survivor benefit if a participant dies while monthly benefits are payable. The benefit will equal 100% of the sum of the last full disability benefit payable to the participant plus any current earnings by which the disability benefit was reduced for that month. A single lump sum payment equal to 6 monthly survivor benefits will be payable.
Benefits will be paid to the participant's spouse or registered domestic partner. If there is no spouse or registered domestic partner, benefits will be paid in equal shares to the participant's surviving children. If there is not a spouse/registered domestic partner and no children, no benefits will be paid.
"Spouse" means a participant's lawful spouse. "Registered Domestic Partner" is defined in the Eligibility section. "Children" means a participant's unmarried children under age 26 who are primarily dependent upon the participant for support and maintenance. The term includes a stepchild living with the participant at the time of his or her death.