State of Michigan
Employee Benefits Division – Civil Service Commission
Long-Term Disability Insurance Income Protection Plan
Rev. 2/2024
ENROLLMENT
Employees may enroll in the Long-Term Disability (LTD) Insurance Plan within the first
31
days as a new hire OR enroll in the Plan during the annual Benefits Open
Enrollment period. Placement in LTD Plan I or Plan II is based
on sick leave balance at
the time the enrollment takes effect.
PLAN I BENEFIT
PERIOD
Employees who have 183 or fewer hours of accumulated sick leave may be eligible for
LTD payments up to 24 months. If you are already age 65 or older (age 70 or older for
UAW) on the date of total disability, your eligibility for LTD payments ends after 12
months following the waiting period explained below.
PLAN II BENEFIT
PERIOD
Employees who have 184 hours or more of accumulated sick leave may be eligible for
LTD payments to age 65 (age 70 for UAW represented employees enrolled in the LTD
plan). Plan II employees will not be reclassified to Plan I if their sick leave balance falls
below 184 hours as long as they remain continuously enrolled in the LTD Plan. If you
are already age 65 or older (age 70 or older for UAW) on the date of total disability, your
eligibility for LTD payments ends after 12 months following the waiting period explained
below.
PREMIUM RATE
CHANGE
Premium rates are provided annually for Plan I and Plan II classes. Plan and
premium class rate changes take place at the beginning of the pay period following
the
pay period in which 184 or 528 sick leave hours are accumulated, or sick leave
balance
falls below 184 hours.
WHEN TO FILE A
CLAIM
LTD claims should be filed within 90 days of the date of disability, by contacting Sedgwick,
the LTD Plan Third Party Administrator (TPA) for claim filing
information. Submitting a
medical statement does not
constitute the filing of an LTD claim. The LTD Plan TPA will
send employees an
initial claim packet containing the forms that must be completed and
returned. The
LTD Plan TPA will determine whether the medical documentation
submitted
supports a total disability.
WAITING PERIOD
Employees must wait 14 calendar days (30 days for MSPTA represented employees) from
the date of disability or the date their sick leave is exhausted, whichever comes
later,
before LTD payments begin.
PRE-EXISTING
CONDITION RULE
The LTD Plan does not cover pre-existing conditions in the first year of coverage.
A pre-existing condition is an illness, injury or pregnancy for which the employee
was
seen by a physician, received medical treatment or services from a physician,
or was
prescribed medication by a physician during the 6 months immediately
before the date
the employee enrolled in the LTD Plan. After continuous
enrollment in the Plan for
more than 1 year, this rule does not apply.
TOTAL
DISABILITY
A “period of total disability” starts when the employee becomes totally disabled, but
not
earlier than 31 days before the date they were personally treated by a “licensed
physician”.
During the first 24 months, Plan I and Plan II employees must be totally disabled
from
their “usual occupation”. After the first 24 months, Plan II employees must be
totally
disabled from working at any “reasonable occupation”.
State of Michigan
Employee Benefits Division – Civil Service Commission
Long-Term Disability Insurance Income Protection Plan
Rev. 2/2024
BEHAVIORAL
HEALTH
DIAGNOSIS
Only a psychiatrist or a behavioral health care provider, as determined by the LTD
plan TPA, can evaluate, provide treatment, and submit documentation of a behavioral
health condition. LTD payments for these conditions will terminate at the end of 24
months of disability benefits. This limitation is not applicable to Plan II UAW
represented employees.
LTD PAYMENT
During the first 6 months of disability, employees will receive LTD payments twice
each
month. During the 7th and subsequent months of disability, the LTD payment
is received
near the last day of the month.
LTD PAYMENT
AMOUNT
For full-time employees, the gross monthly payment before deductions and offsets
is
66.67% of their monthly rate of basic earnings (capped at $5,000 per month; $3,000
per month for MSPTA represented employees). Bonuses, overtime pay and
other
extra compensation are not included. For seasonal and less than full-time employees,
the
gross monthly payment is based on the number of basic hours paid in the prior
fiscal year.
The monthly LTD payment is subject to a monthly maximum and is reduced by any
other
income payable for the same month as provided in the LTD Plan. The most
common
sources of “other income” are Social Security Disability Insurance (SSDI)
benefits, State
of Michigan Retirement income and an employee’s post injury work
earnings.
HEALTH
INSURANCE AND
LTD RIDER
If an LTD claim is approved and the employee is enrolled in a health plan through the
State, the State will pay both the employee’s and employer’s share of
the health
insurance premium for the period of disability for up to 6 months. This
provision is
called the LTD Rider. An application to enroll with the LTD Rider must be received by
EBD for this to be in effect.
Dental and vision premiums are not paid by the LTD Rider. Contact the Civil
Service
Commission Employee Benefits Division for information about continuing
dental, vision
or life insurances while on LTD and continuing health insurance after
the LTD Rider
expires.
RETURNING TO
WORK
Employees released to return to work must submit written authorization or a
release to
return to work without restrictions to DMO, DMU or their HR Office respectively, and the
LTD Plan TPA. Any request to return to work with restrictions must be submitted to
the
appropriate State office (DMO, DMU or HR Office).
RETURNING TO
WORK ON
REDUCED HOURS
Partial LTD payments are calculated by subtracting 80% of the gross pay for hours
worked from the employee’s gross LTD payment.
UNABLE TO
RETURN TO WORK
The LTD Plan TPA will assist employees who are permanently unable to return to work
at
their “usual” or a “reasonable occupation” with applying for Social Security Disability
benefits.
Employees must contact the Office of Retirement Services to inquire if they
are
eligible for any type of State retirement benefit.
*Nothing contained in this information shall be construed to modify the Long-Term Disability Income
Protection Plan.
