BENEFITS AT A GLANCE
Employees can choose to cover themselves with Income Replacement if they have a Short Term Disability. Choose from $500 to $6,000 subject to income requirements with $4,000 Guarantee Issue
Elimination Period (or waiting period before benefits are payable) is day 1 coverage for accident or 14 days for sickness
Payable for 3 months as long as still disabled.
COUNTING ON YOUR “SICK LEAVE” PLAN TO PROVIDE BENEFITS?
Employees have to be employed at least one full calendar year before they can be eligible to participate in the “Sick Leave Bank”. The Sick Leave Bank does not cover maternity or childbirth as a disability.
DISABILITY MATERNITY COVERAGE
Disability due to pregnancy and childbirth is payable to the same extent as a covered sickness, after the policy has been in force for ten months. The maximum benefit period allowed for childbirth is six weeks for non-cesarean delivery and eight weeks for cesarean delivery, less the elimination period of 14 days, unless you furnish proof that you remain disabled beyond these time frames.
COVERED BY WORKERS’ COMPENSATION?
Workers’ compensation provides benefits for only occupational related injuries or illnesses. About two thirds of disabling injuries occur off the job.
SHORT TERM DISABILITY BENEFITS
If you are working at a full-time job while coverage is in force and a covered sickness or covered off-the-job injury causes you to become totally disabled, we will pay you one-thirtieth of the benefit you selected for each day you remain totally disabled. A full-time job is defined as a job at which you work 19 hours or more per week. If you are not working at a full-time job while coverage is in force and you are unable to perform two or more ADLs (activities of daily living) resulting from a covered sickness are accident, as certified by a physician, and you require direct personal assistance to perform such ADLs, we will pay you one-thirtieth of the benefit you selected for each day you remain totally disabled.
PROVISIONS OF COVERAGE
Benefits will be paid for only one disability at a time, even if the disability is caused by more than one sickness, injury, or a sickness and an injury.
AFLAC reserves the reasonable right to meet with you during the pendency of a claim or to use an independent consultant and a physician’s statement to determine whether you are totally disabled, or whether you are unable to perform two or more ADLs and require direct personal assistance.
You must be under the care and attendance of a physician for benefits to be payable. Benefits will cease on the date of your death.
If you have any other disability benefit in force with AFLAC, only one disability benefit is payable under the policy.
Totally disabled is defined as your continuing inability to perform the material and substantial duties of your full-time job. You must also be under the care and attendance of a physician for your condition. If you are unable to perform the material and substantial duties of you full-time job but are able to work at any job, you will continue to be considered totally disabled as long as your earnings are less than 80 percent of your base pay earnings at the time you became totally disabled. If you return to work at any job and are earning 80 percent or more of your pre-disability base pay earnings, you will no longer be considered totally disabled.
Base pay earnings are your gross salary or wages for your full-time job, not including variable pay such as overtime (unless contractual), bonuses, or other incentives. If you are self-employed, base the allowable business deductions from that business. (For tax purposes, base pay earnings is referred to as net earnings.)
Successive periods of disability resulting from the same or a related condition, and not separated by 180 days or more, are considered a continuation of the prior disability. Separate periods of disability resulting from unrelated causes are considered a continuation of the prior disability unless they are separated by your returning to work at a full-time job for 14 working days, during which you are performing the material and substantial duties of this job and are no longer qualified to receive disability benefits.
ACTIVITIES OF DAILY LIVING
Continence: maintaining control of urination and bowel movements, including your ability to use ostomy supplies or other devices such as catheters
Transferring: moving between a bed and chair, or bed and a wheelchair
Dressing: putting on and taking off all necessary items of clothing, and/or medically necessary braces and artificial limbs usually worn
Toileting: getting to and from a toilet, getting on and off a toilet, and performing associated personal hygiene
Eating: performing all major tasks of getting food into the body
The effective date of the policy is the date shown in the Policy Schedule, not the date the application is signed.
|Age||Rate per $100|
|18 – 64||$2.08|
|65 – 74||$2.47|
Yes, guaranteed-issue! No medical underwriting is required for applicants who apply for a monthly benefit of $4,000 or less. Only the following eligibility rules must be met: (1) the applicant must be considered full-time and must be actively working, (2) the applicant must be earning at least $9,000 annually, and (3) the applicant must be working at least 19 hours per week.
Guaranteed-Issue policies are still subject to all policy provisions and definitions, such as waiting periods, pre-existing conditions language, and limitations and exclusions. We are simply waiving the medical underwriting questions so that eligible employees may qualify for a policy.
Disability caused by a pre-existing condition or re-injuries to a pre-existing condition will not be covered during the first 12 months after the effective date of coverage. A pre-existing condition is a sickness or an injury for which, within the 12 month period before the effective date of coverage, medical advice, consultation , or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.
A sickness is a disease, disorder, infection, or any other abnormal physical condition that is not caused by an injury and that is first manifested or treated more than 30 days after your effective date of coverage and while coverage is in force. Sickness includes diseases or conditions resulting from insect bites or infestations by micro-organisms. If the disease or disorder is first manifested or treated within the first 30 days after your effective date of coverage, any resulting disability will not be covered during the first 12 months after the effective date of coverage.
GUARANTEED-RENEWABLE TO AGE 75
You are guaranteed the right to renew the policy until the policy anniversary date following your 75th birthday by the payment of premiums at the rate in effect at the beginning of each term. You can never be singled out for a rate increase. Rates can be changed only if the rate is changed for all policies of this class. While the policy is in force, no change will be made in your class because of age, sex, or physical condition.
When you own AFLAC’s Personal Disability Income Protector you may choose to keep your policy regardless of job changes by continuing to pay premiums. The payroll rate may be retained after one month’s premium payment on payroll deduction.
WHAT IS NOT COVERED
Aflac will not pay benefits for a disability that is being treated outside the territorial limits of the United States or, if outside the United States, the territorial limits of the place where your policy was issued.
Aflac will not pay benefits for a disability that is caused by or occurs as a result of you:
Giving birth within the first ten months of the effective date of the policy as a result of a normal pregnancy, including cesarean (complication of pregnancy will be covered to the same extent as a sickness).
Being addicted to alcohol or drugs, unless administered by a physician and taken according to the physician’s instructions.
Participating in any activity or event, including the operation of a vehicle, while under the influence of a controlled substance (unless administered by a physician and take according to the physician’s instructions or while intoxicated (intoxicated means that condition as defined by the law of the jurisdiction in which the accident occurred).
Mountaineering using ropes and /or other equipment, parachuting, or hang gliding.
Participating in, or attempting to participate in, an illegal activity that is defined as a felony, whether charged or not (felony is as defined by the law of the jurisdiction in which the activity takes place), or being incarcerated in any type penal institution.
Intentionally self-inflicting a bodily injury or attempting suicide, while sane or insane.
Having cosmetic surgery or other elective procedures that are not medically necessary, or having dental treatment except as a result of injury.
Being exposed to war or any act of war, declared or undeclared.
Actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Army Reserve.
Participating in any form of flight aviation other than as a fare-paying passenger in a fully licensed, passenger-carrying aircraft.
Participating in any sport or sporting activity for wage, compensation, or profit, including officiating or coaching, or racing any type vehicle in an organized event.
Becoming totally disabled due to any of the following: bipolar affective disorder (manic depressive syndrome), delusional (paranoid) disorder, psychotic disorders, stomata disorders (psychosomatic illness), eating disorders, schizophrenia, anxiety disorders, depression, stress, or post-partum depression. (The policy will pay, however, for covered disabilities resulting from Alzheimer’s disease, or similar forms of senility or senile dementia, first manifested while coverage is in force.)
Donating an organ within the first 12 months of the effective date of the policy.
A physician does not include a member of your immediate family.
Benefits will be paid for only one disability at a time even if the disability is caused by more than one sickness, more than one injury, or a sickness and an injury.