New Mexico Public Schools

Insurance AuthorityDisability Service OverviewStandard Insurance Company

Long Term Disability (LTD) Claim Administration

Slides 4-11

LTD Terminology Definitions

Slides 12-14

Benefit Calculation Example

Slide 15

Benefits During School Vacations

Slide 16

Social Security Assistance

Slide17

Advantages for Older Employees

Slides 18-19

AdminEASESM LTD Online Reports

Slides 21-23

Table of Contents

The information contained in this presentation is only a

brief description of the group LTD insurance policy

sponsored by New Mexico Public Schools Insurance

Authority (NMPSIA). The controlling provisions will be in

the group policy issued by Standard Insurance Company

(The Standard). The group policy contains a detailed

description of the limitations, reductions in benefits,

exclusions and when The Standard and NMPSIA may

increase the cost of coverage, amend or cancel the

policy. A group certificate of insurance that describes the

terms and conditions of the group policy is available for

those who become insured according to its terms.

For answers to commonly asked questions, costs,

exclusions, limitations and reductions, please review the

Group Long Term Disability Insurance Booklet

(https://www.standard.com/eforms/10386d_645549.pdf)

and Certificate of Insurance

(https://www.standard.com/eforms/16928_645549.pdf) for

more detailed information.

2

Long Term Disability Claim Administration

Collectively doing the right thing to manage absence and disability.

Disability intake capabilities provide

increased efficiency

Our flexible claims submission methods (mail, e-mail or fax) offer consistent customer

experiences across submission channels.

Mail to:

Standard

PO Box 2800

Portland, OR 97208

Increased efficiency

and consistent

customer experience

Fax to:

1.800.378.5740

Claim intakeEmail to:

NEWCLM@standard.com

4

Claim Intake

Employee’s

Statement

Employer’s

Statement

Attending

Physician’s

Statement

Complete claim

assigned to team

• Claim forms or web address provided by

Employer or posted on intranet site (employee

packet includes employee’s statement, attending

physician’s statement and authorization)

• Employee completes their portion and submits to

The Standard via mail or fax

• Employee receives confirmation letter and

regular follow-up letters for missing forms

• Employee gives Attending Physician’s Statement

to treating physician

• Treating physician completes form and returns to

The Standard via mail or fax

• Employer completes their portion of the claim

form (via paper claim form or AdminEASE)

• Employer provides any additional information (i.e.

job description, enrollment verification, payroll)

• Employer submits Employer portion to Standard

• Employer can check the status of the claim on

Reports Online via AdminEASE

5

Eight full-time mental health specialist

Our psychologists and counselors assist employees who are experiencing mental health

issues. They offer support and guidance, encouragement in following recommended

treatment and medication regimens and referrals to appropriate care.

Claim intakeShorter duration

LTD claim

Longer duration

LTD claim

Mental health

claim

6

LTD Claim Decision

Claim assigned

Our LTD analysts, with an average of 9 years at The Standard, review claims information,

interview employees and manage duration of the claim. Your employees receive a thorough

explanation of the claims process. If they have any questions, they speak directly to the

claim decision-maker, not a call center generalist.

If denied

Analyst interviews

employee

Initial claim review

and determination

made within 7 days

If pended

If approved

Mental health

claim

Additional information

is needed in order to

make a decision

We will request

information directly

and follow up routinely

until received

Status letters every 15

days

7

LTD Claim Decision

Claim assigned

If denied

If pended

If approved

Analyst interviews

employee

Initial claim review

and determination

made within 7 days

Employee advised of

approval by mail and

phone

Employer notification are

emailed and viewable on

Reports Online

Benefit will coordinate

with other income such as

Workers’ Comp, PERS or

Social Security

Life Waiver of Premium

claim reviewed in

conjunction with LTD

Vocational resources help

employees return to work,

when appropriate

8

LTD Claim Decision

Claim assigned

If pended

If approved

Analyst interviews

employee

Initial claim review

and determination

made within 7 days

If the information supports

a denial, a letter will be

sent to the employee

providing a detailed

explanation of the denial,

as well as the process for

requesting a review

We will also send a letter

to the policyholder

outlining the general

reason for the denial

If denied

9

LTD Claim ManagementOnce a claim is approved, a claim management plan is created based on the anticipated

outcome of the claim. Whether the claimant is expected to return to work, needs assistance

in returning to work or is not expected to recover or return to work, our claim management

activities are specifically focused on each claim situation.

Recovery not

expected

Recovery with

assistance

Condition is expected to resolve,

leading to return to work

Condition requires close medical

and/or vocational monitoring to

ensure proper treatment and timely

recovery and/or return to work.

May require medical and/or

vocational rehabilitation

assistance and intervention.

Claim Management focuses on SS

assistance, offsets and monitoring

changes in medical condition

Recovery

expected

Claim

approved

10

LTD Claim Management

Claim approved

Resources and

provisions to

promote RTW

On-site Social

Security Advocacy

Early review of Any

Occupation and

limitations

Mandatory review

dates

Offset pursuit and

resolution

Policy limitations

asserted

Stable claim

Management

Continued

maintenance until

duration end

Own Occupation

Period

Any Occupation

Period

11

Predisability Earnings (PDE) – Gross base monthly earnings that exclude:

Bonuses, commissions, overtime, stipends for extracurricular activities, any other

extra pay and employer pension contributions.

Examples of stipend pay: Professional development, building support, athletics

support, coaching, cheerleading, lunch duties, extracurricular activities sponsor,

any duty preformed outside the scope of the job and beyond the scheduled work

day.

The Standard will request a copy of the employee contract and payroll data to

verify earnings.

If an employee has exceeded the employer’s salary schedule and you must

record the balance under the “Stipend” pay category to pay the employee

contract, please advise The Standard of this practice at point of claim.

Predisability Earnings

12

If you are paid on an annual contract basis, your monthly rate of earnings is one-twelfth (1/12th) of

your annual contract salary.

If you are regularly scheduled to work a partial year, your monthly rate of earnings is a) the hours you

are regularly scheduled to work per month, times b) the number of months you are regularly

scheduled to work, divided by 12. For example, working 9 months per year, earning $18,000 per

year, divided by 12 = $1,500.

If you are paid hourly, your monthly rate of earnings is based on your hourly pay rate multiplied by the

number of hours you are regularly scheduled to work per month, but not more than 173 hours. For

example, working 9 months per year, earning $10.75 per hour, times 6 hours per day, times 182 days

= $11,739/12 = $978.25.

If you do not have regular work hours, your monthly rate of earnings is based on the average number

of hours you worked per month during the preceding 12 calendar months (or during your period of

employment if less than 12 months), but not more than 173 hours.

More than 95% of members are paid via an annual contract. What this means is that your annual pay

will be calculated in 12 equal increments to determine your Predisability Earnings.

Predisability Earnings Calculation

13

Deductible income includes but is not limited to benefits you receive or are

eligible to receive from statutory plans like Social Security amounts you, your

spouse, or your children under age 18 receive because of your disability or your

retirement.

For example, benefits from Social Security Disability, Social Security Retirement,

ERB pension, ERB disability pension, worker's compensation, unemployment

and sick pay.

All other sources of income, other than employer paid earnings, are deductible

dollar for dollar.

Your LTD benefit plus you employer paid earnings (including other employment),

if earning less than 80% of Predisability Earnings, cannot exceed your Indexed

Predisability Earnings.

Deductible Income

14

Benefits Calculation Example

15

If you cease to be a Member because of a school break or vacation, your insurance will be continued

during that period.

Summer Claim Example:

Annual contract salary = $12,000

Monthly rate of earnings = $1,000 ($12,000/12)

LTD benefit = $1,000 x 66.67 = $666.70 (before deductible income)

Non-Educator: Paid July through June in 12 equal increments including insurance deduction.

Educator: Paid August through May; Pay summer months in June (balance of contract);

Payments include 12 months of insurance deductions as well as 12 months of pay.

This is considered Deductible Income.

LTD Benefits During School Vacations

Last Day of Active Work Friday, June 5th

Benefits become payable after 30-day Benefit Waiting Period Monday, July 6th

Claim Approval Wednesday July 8th

Claim closed because employee returned to work Thursday, August 6th

Benefit Payment: 7/6 through 8/5 (if received full summer pay) Minimum benefit of $100

16

• Full-time, in-house Social Security coordinators

• Screens appropriate newly-approved LTD claims

• Completes all necessary paperwork for the employee

• Works closely with the employee and The Standard from initial application to award

• Challenges denied claims that appear to meet Social Security criteria

• 99% award rate for The Standard’s customers

• 95% of awards occur within 2 years

• Assists in recovery of overpayments as a result of an award

Social Security Assistance

17

If you become disabled before age 62, then LTD benefits may continue during disability

until you reach age 65, or to Social Security Normal Retirement Age (SSNRA), or 3 years 6

months, whichever is longest. If you become disabled at age 62 or older, the benefit

duration is determined by your age when disability begins as indicated in the table below.

Social Security Normal Retirement Age (SSNRA) means your normal retirement age under

the Federal Social Security Act, as amended.

Advantages for Older Employees

Age when disability begins Maximum benefit period

62 To SSNRA, or 3 years 6 months, whichever is longer

63 To SSNRA, or 3 years, whichever is longer

64 To SSNRA, or 2 years 6 months, whichever is longer

65 2 years

66 1 year 9 months

67 1 year 6 months

68 1 year 3 months

69 and above 1 year

18

• Standard helps you file for Social Security Disability for free, which could

save on doctors and attorney’s fees.

• Keep in mind Social Security Disability will pay only up to 50% of your salary.

• When you can’t return to your own occupation, you will typically get approved for

Social Security Disability.

• If you chose a disability retirement you may gain more income.

• If you are already receiving Social Security Retirement prior to your date of

disability, your Social Security Retirement Benefits are not considered

Deductible Income.

• If you are receiving a regular retirement pension from ERB prior to date of

disability and qualified for LTD benefits, ERB pension payment is not

considered deductible income.

Advantages for Older Employees

19

AdminEASESM

Reports OnlineSM for Long Term Disability

Products:

LTD

Available to:

Insured and self-funded

customers

Frequency:

Updated daily

Lists all incomplete,

pending and active

claims, plus claims

denied or closed within

the last 90 days

Claim Status Reports

21

Products:

LTD

Available to:

Insured customers

Frequency:

Updated daily

Lists all active claims

and the time period

for which benefits are

due for a rolling

seven-day period

Recent Checks Reports

22

Products:

LTD

Available to:

Insured customers

Frequency:

Updated daily

Shows benefit

calculation detail for

all active claims

Benefit Calculation Reports

23

Thank you.