Eligibility 1
The date the Employer's policy for coverage begins.
Policy Effective Date
Maximum length of time benefits will be paid. Standard period covers disabled employees until they reach Social Security Normal Retirement Age (SSNRA), which is determined by the employee's date of birth or the age they were when they became disabled.
Maximum Benefit Period
Means the usual and customary employment, business, trade, profession or vocation that the Employee performed as it is generally recognized in the national economy immediately prior to the first date Total or Partial Disability began.
Own Occupation
Limited conditions are typically payable for a period of _______ months.
24
If the Employee stopped working within a specified period of time after becoming eligible for coverage and received medical treatment, had symptoms, took medication, etc. during a specified period of time prior to their effective date of insurance with Sun Life.
Pre-Existing Condition
The number of days an employee must be disabled before benefits begin to be paid.
Elimination Period
Describes situations where no benefit would be paid.
Exclusions
A written agreement between the Employee and Sun Life in which Sun Life agrees to provide, arrange, or authorize vocational, physical, or psychiatric rehabilitation services to help the Employee return to work.
Rehabilitation Program
Limits benefits payable due to conditions such as bipolar affective disorder, schizophrenia, psychotic illness, manic depressive illness, depression and depressive disorders, anxiety and anxiety disorders.
Mental Illness Limitation
Describes benefits/income an Employee could be receiving that can be deducted from LTD benefits to prevent over-insurance.
Other Income
A standard feature that refers to the length of time an employee must work for the employer before being eligible for coverage.
Waiting Period
The date or dates an Employee in an Eligible Class becomes eligible for insurance under the policy.
Effective Date of Insurance
Policy definition that describes how the Employee's pre-disability earnings will be calculated.
Total Monthly Earnings
Limits benefits payable due to illness which results from the abuse of alcohol, drugs or derivatives.
Drug and Alcohol Illness
If an Employee is claiming disability due to a car accident in which the Employee was driving and it was determined that they were _________, LTD benefits may not be payable.
Intoxicated
This is a group in which an Employee must fall in order to be eligible for coverage.
Eligible Class
Explains how a person must be disabled before being qualified for benefits and how long a person’s condition will be evaluated against their ability to perform their own occupation versus any occupation
Total Disability or Totally Disabled
The provision provides employees with protection from a major loss of income. This provides a strong incentive for employees to return to work and does not force them back to work earning less than what they were receiving while on disability.
Gainful Occupation
Limits benefits payable due to disease or disorder of the neck and back and sprains and strains of joints and adjacent tissues.
Musculoskeletal and Connective Tissue Illness
The employment income an Employee receives while Partially Disabled or income and Employee receives while participating in an approved Rehabilitation Program.
Disability Earnings
Explains how often and where an employee must be working or scheduled to work in order to be eligible for coverage.
Actively at Work
Means a statement or proof of an Employee’s medical history upon which acceptance for insurance will be determined by Sun Life.
Required if the employee elects insurance or an increase in insurance outside of the enrollment period.
Evidence of Insurability
Documented physical or mental impairments, or a necessary medical program, which prevent the Employee from participating in, or completing, the Rehabilitation Program.
Good Cause
Limits benefits payable due to conditions such as environmental allergies, sick building syndrome, multiple chemical sensitivity syndrome, and chronic toxic encephalopathy
Chemical and Environmental Illness
Protects employees from losing disability coverage when their employer changes insurance companies
Continuity of Coverage