Insurance products issued by Dearborn Life Insurance Company, 701 E. 22nd St. Suite 300, Lombard, IL 60148.
Voluntary Long-Term
Disability Insurance
for Employees of the University of Texas System
EFFECTIVE SEPTEMBER 1, 2021
Group disability insurance pays a percentage of your salary when you are
unable to work full time because of a covered illness or injury. These
benets can be used to help pay your everyday expenses when you are
without a paycheck.
LONG-TERM DISABILITY (LTD)
All benets-eligible, active employees may elect to enroll for
voluntary long-term disability. For questions on eligibility, please
refer to the Oce of Employee Benets’ active employee web
page or contact your institution’s benets oce.
• The monthly benet is 60% of your monthly earnings up to a
maximum of $15,000 per month.
• You pay 100% of the premium for the voluntary LTD.
LTD benets will begin after you have been disabled for 90 days
and may continue until you reach age 60 or beyond as indicated
in the chart below.
Age at Disability Maximum Period Payable
Less than 60 To age 65, but not less than 60 months
60 – 64 60 months
65 – 69 To age 70, but not less than 12 months
70 and over 12 months
MONTHLY PAYROLL DEDUCTIONS
The monthly premium is based on your salary. To calculate
your premium cost, follow this simple formula.
Divide your annual salary by 12. Then round to the nearest
whole dollar (this number is capped at 25,000). Then multiply
by $0.0034 (the rate).
The following example assumes a salary of $50,000.
50,000 / 12 = 4,166.67, rounded to the nearest whole dollar =
4,167 x .0034 = $14.17 of monthly premium
ELIGIBILITY AND ENROLLMENT
Eligible employees may enroll for voluntary benets. If you are
eligible and you do not apply during the initial enrollment period
or within 31 days of your eligibility date, you must wait until the
next annual enrollment period or a qualied change in family
status event to elect voluntary benets.
We will require satisfactory evidence of insurability for applicants
who did not enroll during the initial enrollment period (or when
they were rst eligible to do so).
DEFINITION OF EARNINGS
Your earnings will be the greater of your earnings from UT
System immediately preceding your date of disability or your
earnings on September 1 immediately prior to your disability.
Earnings consist of your total income before taxes, including:
• hazardous duty pay
• longevity pay
• employee contributions made through a salary reduction
agreement with your employer to an IRC Section 401(k),
403(b), 501(c)(3), 457 deferred compensation plan, or any
other qualied or non-qualied employee retirement plan or
deferred compensation agreement
• amounts contributed to your fringe benets according to a
salary reduction arrangement under an IRC Section 125 plan
Earnings do not include:
• commissions
• bonuses
• overtime pay
• UT System’s contribution on your behalf to a retirement plan
or deferred compensation arrangement
• any other extra compensation
DEFINITION OF DISABILITY
You may be totally or partially disabled under this plan. Total
disability means that during the rst 24 consecutive months of
benet payments due to sickness or injury you are continuously
unable to perform the material and substantial duties of your
regular occupation and your disability earnings, if any, are less
than 20% of your pre-disability indexed monthly earnings.
After the LTD monthly benet has been paid for 24 consecutive
months, total disability means that due to sickness or injury you
are continuously unable to engage in any gainful occupation and
your disability earnings, if any, are less than 20% of your pre-
disability indexed monthly earnings
Partial disability means that during the elimination and
maximum period payable due to sickness or injury you are able
to work in any gainful occupation and you are able to earn at
least 20% of your pre-disability indexed monthly earnings.
Note: If you become disabled when school is not in session,
disability will be based on whether or not you would be able
to perform the material and substantial duties of your regular
occupation if school were in session
PRE-EXISTING CONDITION EXCLUSION
Benets may not be payable for a condition that existed prior
to you enrolling for coverage. A pre-existing condition means
a condition that was caused by or results from a sickness or
injury for which you received medical treatment or advice was
rendered, prescribed or recommended, whether or not the
sickness was diagnosed at all or was misdiagnosed within 3
months prior to your eective date, and results in a disability
that begins in the rst 12 months after your eective date. Time
enrolled with the prior carrier does count toward satisfying the
pre-existing condition.
EFFECTS OF OTHER INCOME WHILE DISABLED
Disability insurance is designed to help you meet your nancial
obligations by replacing some of your lost earnings if you cannot
work due to a disability. The benet amount may be reduced by
other sources of income you receive while disabled. Other income
sources that will reduce your benets under this plan are:
1. Disability benets paid, payable or for which you are eligible:
i. occupational accident coverage provided by or through
UT System
ii. any Statutory Disability Benet Law
iii. the Railroad Retirement Act
iv. Title 46, United States Code Section 688 et seq (The Jones Act)
v. Title 33, United States Code Section 901 et seq
(Longshore and Harbor Workers’ Compensation Act)
a.
Any group insurance plan provided by or through UT System
b. Any sick leave or salary continuance plan provided by or
through UT System
c. The Social Security Act, including any amounts for which
your dependents may qualify because of your disability
d. The Canada Pension Plan, Quebec Pension Plan or any
other similar disability or pension plan or act
e. The Canada Old Age Security Act
f. Any Workers’ Compensation or Occupational Disease Act
or Law, or any other law that provides compensation for an
occupational injury or sickness
2. Retirement benets paid under the Social Security Act,
including any amounts for which your dependents may
qualify because of your retirement
3. Retirement and disability benets paid under a retirement
plan provided by UT System except for amounts attributable
to your contributions
4. Disability benets paid under any No-Fault Auto Motor Vehicle
coverage
5. Amounts received from a third party (after subtracting attorney’s
fees) by judgment, settlement or otherwise, not to exceed 50%
of the net settlement
6. Any Public Employee Retirement System Plan or any State
Teachers’ Retirement System Plan or any plan provided as an
alternative to any of the above acts or plans
WORK INCENTIVE
This benet provides partially disabled employees who are
working with the full monthly benet amount, not to exceed
100% of the pre-disability earnings when combined with current
earnings, for up to 24 months. After 24 months, the benet will
be based on a proportional loss of earnings.
REHABILITATIVE INCENTIVE INCOME
If we identify a partially disabled employee as a candidate for
a rehabilitation program, we will work with them to structure
a voluntary rehabilitation plan that assists the employee in
returning to employment. The Plan details the vocational
rehabilitation services available to the employee.
While the employee is participating in a voluntary rehabilitation
plan and continues to the meet the obligations of the program,
we will allow the employee to retain a combination of benets
and disability income in excess of 100% of their indexed pre-
disability income for 12 months. After 12 months we will oset
the Voluntary LTD benet by multiplying the benet times the
adjusted loss of salary ratio.
While disabled, employees cannot receive more than one of the
following benets at the same time: an LTD Monthly Benet, a
Work Incentive Benet, or a Rehabilitative Incentive Income.
DAY CARE EXPENSE BENEFIT
To assist employees taking advantage of our Rehabilitative
Incentive Income feature, we oer Day Care Expense Benets.
This benet reimburses claimants for any day care expenses
they may incur for children under age 13 while participating in
the rehabilitation program. The benet pays up to $350 per child
for up to 12 months, not to exceed an overall monthly maximum
of $1,000.
TRIAL WORK DAYS
If you are receiving disability benets and you return full time,
the plan allows you to attempt to return to work without having
to start a new elimination period. You may attempt to return to
work for up to 6 months.
If you were able to return to work for more than 6 months
and become disabled again, the disability will be treated as a
new disability and will be subject to a new elimination period,
maximum period payable and any policy provisions in eect on
the date the disability recurs.
SURVIVOR INCOME BENEFIT
If you die while you are receiving disability benets and received
benets for 12 or more consecutive months, we will pay a
benet to your eligible survivor. The benet will be equal to 3
times the last monthly benet you received.
WORKSITE MODIFICATION
We will assist you and UT System in identifying modications that
are likely to help you remain at work or return to work.
For employee use only. For illustrative purposes only. May not be available in all jurisdictions. Coverage may be subject to limitations, exclusions and other coverage conditions contained in the issued policy. Please
consult the policy for the actual terms of coverage.
CONVERSION
The conversion privilege allows you to convert your LTD insurance
coverage to an individual policy if your coverage terminates.
ACCIDENTAL DISMEMBERMENT BENEFIT
If you suer paralysis or a loss of hand, foot, sight or thumb
and index nger on the same hand due to an accidental injury,
we will pay a monthly benet. The benet will be 60% of your
monthly earnings minus any deductible sources of income.
You do not have to be disabled in order to receive this benet.
Please refer to the benet book for a list of losses and number
of monthly benet payments.
EDUCATION BENEFIT
For any disabled employee who has received Voluntary LTD
benets for at least six months and has a dependent child under
age 23 attending a school of higher learning on a full-time basis,
an Education Benet is payable. The monthly benet is $300 and
is for each child who qualies.
REHABILITATION BENEFIT
If the disabled employee is participating in a formal rehabilitation
plan approved by us while receiving benets, we will pay an
additional monthly benet equal to the lesser of 5% of their
Gross LTD Monthly Benet or $1,000. The Rehabilitation Benet
is payable for a maximum of 12 months.
CATASTROPHIC DISABILITY BENEFIT
If you are not working and catastrophically disabled due to
illness or injury, this benet provides an additional monthly
benet while you are receiving monthly LTD benets or
accidental dismemberment benets. A catastrophic disability
is one that either prevents you from being able to perform at
least 2 of the activities of daily living without the assistance/
supervision of another person or renders you cognitively
impaired. This benet is 10% of your pre-disability monthly
earnings up to a maximum of $5,000.
CAREGIVER RESPITE
If you are receiving the catastrophic disability benet, we may pay
a caregiver respite benet for each day of an informal caregiver’s
respite intervals. The benet is payable for medically necessary
companion care you receive during the caregiver’s respite.
CAREGIVER TRAINING
As part of the catastrophic disability benet, we may also pay a
benet if your informal caregiver incurs expenses to be trained to
provide informal home care to you during your disability. This benet
will pay a maximum of $500.
EMERGENCY ALERT SYSTEM
While you are receiving catastrophic disability benets, we may
reimburse you the cost of renting or leasing an emergency alert
system that allows you to remain in your home alone. In order to
qualify for this benet, the system must be medically necessary
and your condition is such that you cannot be left alone unless you
have an alert system. The benet is limited to $25 per month.
EXCLUSIONS AND LIMITATIONS
The plan does not cover any loss or disability caused by,
resulting from, arising out of or substantially contributed to,
directly or indirectly, by any one or more of the following:
1. a pre-existing condition
2. commission of, participation in or an attempt to commit an
assault or felony, including participation in a riot
3. intentionally self-inicted injuries
4. attempted suicide, regardless of mental capacity
5.
participation in a war, declared or undeclared, or any act of war
During a period of LTD, the plan has limitations on:
• Mental disorders—disability beyond 24 months after the
elimination period if it is due to a mental disorder of any type.
Connement in a hospital or institution licensed to provide
care and treatment for mental illness will not be counted as
part of the 24-month limit.
• Substance Abuse—a substance abuse (drug or alcohol)
related disability unless you are participating in a substance
abuse treatment program approved by the State where the
treatment program is provided. The cost of the treatment
program must be borne by you or another group plan of UT
System (such as a group health plan or Employee Assistance
Program) if one is available and covers this type of treatment.
Except as specically stated above, in no event will LTD monthly
benets for a mental disorder or substance abuse be paid
beyond the earliest of the date:
1. 24 LTD monthly benet payments have been made; or
2. the maximum period payable is reached; or
3. you refuse to participate in an appropriate, available
treatment program, or you leave the treatment program
before completion; or
4. you are no longer following the requirements of your
treatment plan under the program; or
5. you complete the initial treatment plan, exclusive of any
aftercare or follow-up services.
The lifetime cumulative maximum period payable for all
disabilities due to a mental disorder and substance abuse is
24 months. Only 24 months of benets will be paid for any
combination of such disabilities, even if the disabilities are not
continuous and/or are not related.
Blue Cross and Blue Shield of Texas is the trade name of Dearborn Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. BLUE CROSS
®
, BLUE SHIELD
®
and the Cross
and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
753122.0621
