International Union of Elevator Constructors

Currently, as a member of International Union of Elevator Constructors, if you were to become disabled due to an accident, injury, or illness, off the job, you will receive $325 per week from the IUEC sickness benefit. This benefit is received for only 26 weeks. 

The IUEC Supplemental Disability Benefit Plan that is being offered by Group Benefit Associates will provide a benefit that will be paid to you in-addition to the Sickness Benefit. As you are aware, it is simply not possible to pay your bills on just the sickness benefit you currently receive.

Advantages of participating in the IUEC program include:

• Partial Income Replacement- Benefits provide partial income replacement when you are unable to work due to a sickness or injury.
• Assistance and support for your return to work efforts
  • Rehabilitation Program- Benefits may include vocational evaluation, job placement services, resume preparation, retraining for a new occupation, and assistance with relocation.
  • Work Site Modification- Hartford will work to find a modification that is likely to help you remain at work or return to work. We may reimburse your employer or make contributions towards its cost.
  • Benefits While Working- Hartford encourages you to stay at work or return to work when it's appropriate, and may pay benefits if you are working while disabled.
• Affordable Group Rates- Hartford's plan is available to you at group rates, which are typically lower than individual rates.
• Benefits Are Not Subject to Income Tax- When the cost of insurance is paid with after-tax dollars, benefits are not subject to income tax.

If you joined International Union of Elevator Constructors within the last 90 days, you are within your open enrollment window and can join with no medical questionnaire. If you elect not to enroll within your open enrollment period, you will have to complete a medical questionnaire and receive approval from the insurance company to join the plan in the future.

As a plan participant you must notify Group Benefit Associates:

• Within 60 days of any layoff and again within 60 days of my subsequent return to work
• Immediately when my bank account or credit card information changes for the purpose of premium collection
• Immediately when my wage rate changes
• Within 1 year of my date of disability if I become disabled

I understand that failure to notify Group Benefit Associates in a timely manner of any of the above listed changes can affect my participation in the plan or the benefits I am eligible to receive under the plan.

Short Term Disability (STD)

• Benefit Begins: 15th day non-occupational accidental injury, 15th day non-occupational sickness or pregnancy.
• Benefit Amount: $325 benefit per week
• Benefit Period: 24 weeks
• Pre-existing Conditions: Exclusions apply. Please refer to the Summary of Benefits for explanations.

During the first 12 months of coverage, no STD benefits will be paid for a disability that is due to a pre-existing condition. A pre-existing condition is an injury or sickness for which you received medical treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for which you followed treatment recommendations during the three months prior to your effective date of coverage. This provision also applies if you did not consult a physician when an ordinarily prudent person would have. Exclusions may vary by state.

Long Term Disability (LTD)

• Benefit Begins: 180 days following non-occupational accidental injury, sickness or pregnancy
• Benefit Amount: 60% of your monthly earnings up to $5,000 benefit per month. Minimum monthly benefit of $100
• Maximum Benefit Period: 5 years
• Limited Pay Periods:Disabilities due to mental illness and disabilities primarily based on self-reported symptoms are limited to 24 months of benefits during your lifetime.
• Survivor Benefits: In the event of your death, three times your gross disability payment is payable to your spouse or children under age 25.
• Pre-existing Conditions: Exclusions apply. Please refer to the Summary of Benefits for explanations.

Please follow the steps below to calculate your monthly premium:

Calculating your monthly long-term disability (LTD) cost:

Enter your hourly wage rate	$	____.__
Multiply by 2080	=	____.__
Divide by 12	=	____.__ Monthly Earnings*
Multiply by 0.00293	=	____.__
		LTD Premium

*If your monthly earnings exceed $8,333 (maximum monthly covered earnings) then use $8,333 as your monthly earnings to calculate your premium.

Add the short-term disability premium to determine your total monthly premium +$21.75= $_______._____ Total Premium

Termination Requests: Termination requests must be received in writing by mail, fax or e-mail within 30 days of the requested termination date. Terminations can only be processed on the first of the month, mid-month terminations are not allowable.

Premium Payments & Grace Periods: Premium must be paid via automatic ACH bank drafts of by credit card (Visa or Mastercard). Drafts occur on the 20th of the month for the following month (example, October 20th for November's coverage). If the 20th falls on a weekend or holiday, the draft occurs on the next business day. If a payment is declined or returned, a notice will be sent to your last known address. If payment is not received by the end of the month of which premium was returned, your policy will be canceled (example, the payment drafted on October 20th for November's coverage is declined. A notice will be sent and payment must be received by November 30 to avoid a lapse in coverage).

The PDF documents below are provided for your reference.

• Summary of Benefits
• Late Applicant Enrollment Form
• New Member Enrollment Form
• Disability Policy Change Form
• Short Term Disability Claim Form

Long Term Disability Claim Forms:

• Long Term Disability Claim Form (to be completed by you)
• Attending Physician's Statement of Disability (to be completed by your doctor)
• Physical Demands Job Description & Requirements (to be completed by your employer)

The disability income insurance claim form is composed of three separate sections that need to be completed by you, your physician and your employer.

• Employee Section: Please be sure to complete this part clearly and sign where indicated.
• Physician Section: Please have the physician that disabled you complete this part. If you have seen additional physicians, please also include their names, addresses, phone numbers and fax numbers on a separate sheet of paper.
• Employer Section: Even though your policy is purchased through the union, your benefit is based on the income you receive from your particular employer. Your employer assumes no liability or responsibility for your claim by completing this form for you.

Failure to provide proper information and documentation will delay your claim so it is very important the claim form is complete and clear.

How Your Claim Will Be Handled:

Group Benefit Associates will begin waiving your premium as of the date of your disability. The processing of your claim will be handled by The Hartford and therefore you may inquire with them regarding the status of your claim. Please note that Group Benefit Associates does not have access to information regarding claims determination or benefit payments. However, the assistance of our office can be requested if you encounter difficulty in getting your claim processed. The Hartford can be reached Monday through Friday from 8am to 6pm Eastern Time at:

Hartford Customer Service Department

Phone: 800-331-7234

Fax: 860-843-3221

www.TheHartfordAtWork.com

Premium billing questions are handled by Group Benefit Associates at 800-450-1271.