Insurance FAQs

INSURANCE**

Short-Term Disability

What is the difference between Short-Term Disability and Long-Term Disability insurance?

The Short-Term Disability (STD) plan helps supplement your weekly earnings if you’re disabled and cannot work. STD benefits can continue for up to 26 weeks and are payable on the first day of a covered accident. When your claim is approved for an illness/sickness (including pregnancy), benefits are payable on the 8th day from the date of disability. For the first 12 months following the effective date of insurance or an increase in insurance, benefits are not payable for disabilities caused by, contributed to by, or resulting from a pre-existing condition. A pre-existing condition is one for which an insured has received medical treatment, consultation, care or services, including diagnostic measures or prescribed drugs or medicine within the 3 months prior to his or her effective date of insurance or increase in insurance. Please refer to your certificate for additional details.

Long-Term Disability (LTD) insurance provides a monthly benefit to someone who, due to a covered on-the-job or off-the-job illness or injury, is unable to work for an extended period of time. All active, dues-paying members of PEF who work at least 17.5 hours per week on a regularly scheduled basis are eligible for this plan. The LTD plan offers 2 levels of coverage: 50% or 60% of your monthly income, up to $7,500 a month. The LTD plan begins to pay benefits after a 6-month Elimination (waiting) Period. Once the Elimination Period ends and your claim is approved, you are eligible for monthly income for as long as you’re disabled, up to age 65. (Disabilities that start between the ages of 62 and 69 are covered from 1 to 3.5 years. Disabilities that start at or after age 69 are covered for 12 months. Consult your insurance certificate for details.) The LTD benefit is based on your base salary (excluding items like hazard pay and overtime) and does not take into account earnings from investments or savings plans.

The LTD benefit is reduced or offset by your benefit payments from other sources of income for which you may be eligible, such as:
• Workers’ compensation
• Social Security (Primary and Family source)
• Disability pension or any New York state retirement payments
• Any other group benefits for disability, retirement, or unemployment
• Benefits from your sick pay program (these will offset benefits payable under this LTD program only when the combined benefits exceed 85% of income).

However, your LTD benefit payments will not be reduced if Social Security benefits increase for general cost-of-living adjustments. Regardless of how much in other benefits you may be eligible for, your LTD benefit will not be less than $200 a month. For a complete list of other income benefits, please refer to the plan certificate.

If you enroll within 120 days of the date you were first eligible to become a member of PEF, your application will automatically be approved. After 120 days, you will have to complete an Evidence of Insurability application that must be approved by Sun Life before coverage can begin.

Can I collect a Short-Term Disability benefit if I am receiving other benefits or income?

Yes, your Short-Term Disability plan helps replace your weekly earnings if you are disabled and cannot work due to a disability. Short-Term Disability is not reduced by any other income, by sick leave pay, or if you have other insurance coverage or if you are collecting workers’ compensation.

If I collected on my Short-Term Disability, do I pay taxes on the funds I received?

Benefit payments are not subject to federal income tax.

Can I collect on Short-Term Disability after I give birth? And for how long?

Yes, you can collect for 6 weeks for a normal delivery and 8 weeks for a C-section if you meet the definition of disability. For the first 12 months following the effective date of insurance or an increase in insurance, benefits are not payable for disabilities caused by, contributed to by, or resulting from a pre-existing condition. A pre-existing condition is one for which an insured has received medical treatment, consultation, care or services, including diagnostic measures or prescribed drugs or medicine within the 3 months prior to his or her effective date of insurance or increase in insurance.

Do I have to provide Evidence of Insurability when I enroll?

If you enroll within 120 days of the date you were first eligible to become a member of PEF, your application will automatically be approved for increments of $100, $200, and $300. After 120 days, or for all elections of $400 or $500, you will have to complete an Evidence of Insurability form, which must be approved by Sun Life before coverage can begin. Download the EOI form.

How can I cancel my Short-Term Disability insurance benefits?

If you would like to discontinue your coverage for Short-Term Disability, you may do so at any time by sending us a written request with your name, date, PEF Membership Identification Number (MIN), and signature to: PEF Membership Benefits Program, PO Box 12414, Albany, NY 12212-2414.

Please make sure you are specific about which type of insurance you wish to cancel. Cancellations are effective the day we receive your request and deductions will be stopped on the next available payroll. We will mail an acknowledgement letter that will include the effective date of your cancellation.

Long-Term Disability

Do I have to provide Evidence of Insurability when I enroll?

If you enroll within 120 days of the date you were first eligible (120 days from date of hire) to become a member of PEF, your application will automatically be approved. After 120 days, you will have to complete an Evidence of Insurability (EOI) application, which must be approved by Sun Life before coverage can begin. Download the EOI form.

If I become disabled, how long will I have to wait before receiving Long-Term Disability benefits?

Payments start after you have been disabled for 6 months and your claim is approved by Sunlife.

What if I go back to work after being disabled, and then get sick again?

If during the Elimination Period, you return to work for less than 15 consecutive days and become disabled from the same cause, there will be no interruption in calculating the Elimination Period. You can be partially disabled during the elimination period and still be working; however, benefits still will not be paid until after the Elimination Period. If after receiving benefits, you return to work for less than 6 months only to become disabled again from the same cause, you will not have to go through another Elimination Period to resume benefit payments.

Does this plan cover illnesses that occur before the insurance goes into effect?

If you received treatment or took medication for a condition in the 6 months before your effective date, benefits will not be payable for the first 12 months. This applies only to the first 12 months after your effective date.

Does this plan cover mental and nervous illnesses?

Yes, but those benefits are limited to 24 months. This limitation does not apply to periods of confinement in a hospital, or another qualified institution, for treating mental and nervous disorders, alcoholism, and drug addiction.

What happens if I leave my present job and I am no longer a PEF member?

If you are no longer in a PEF-represented position or have left state service, you have the option to convert to an individual policy and keep your current coverage.

How can I cancel my Long-Term Disability insurance benefits?

If you would like to discontinue your coverage for Long Term Disability, you may do so at any time by sending us a written request with your name, date, PEF Membership Identification Number (MIN), and signature to: PEF Membership Benefits Program, PO Box 12414, Albany, NY 12212-2414.

Please make sure you are specific about which type of insurance you wish to cancel. Cancellations are effective the day we receive your request, and deductions will be stopped on the next available payroll. We will mail an acknowledgement letter regarding your cancellation, which will include the effective date of your cancellation.

Group Term Life Insurance

Do I have to provide Evidence of Insurability when I enroll?

If you enroll within 120 days of the date you first become eligible (120 days from date of hire) to become a member of PEF, coverage will automatically be approved for up to three times your Basic Annual Earnings. In addition, you may elect $20,000 of spouse coverage and $4,000 of coverage for each eligible dependent child. Coverage that does not require proof of good health will begin the day your enrollment form is received by the PEF Membership Benefits Program. If you request coverage after the 120-day period, you will be required to complete and submit an Evidence of Insurability application, and coverage will begin on the date Sun Life approves your application.

Can I apply for Group Term Life insurance coverage on my dependents only?

No, you must have coverage on yourself to be eligible to apply for dependent coverage.

How much will my premiums be for my dependent coverage?

Premiums are based on the member’s current age and are a flat bi-weekly rate. Spouse/Domestic partner level of coverage cannot exceed the member’s coverage.

I’m retiring. Can I maintain my current benefits?

Yes, but you must maintain your membership in the PEF Retirees. Failure to maintain your membership in the PEF Retirees will result in you being in an ineligible class for this insurance, resulting in cancellation of your policy. PEF Retiree dues can be paid by either a flat rate of $21.00 per year, or by Pension Deduction at $1.50 per month ($18.00 per year). For further information, you may contact the PEF Retirees directly at: (800) 342-4306, ext. 289, or (518) 785-1900, ext. 289.

Who is my beneficiary?

For privacy reasons, we are unable to tell you over the phone who your beneficiary is. We will mail a letter to the address we have on file stating who your current beneficiary is on your policy and we will include a Change of Beneficiary form that you can send back to us if you would like to change your beneficiary. Once we receive the form, we will then send you a written confirmation of the change.

What is the Group Term Life Insurance “Accelerated Death Benefits (ADB)”?

Should you or your spouse/domestic partner become diagnosed as terminally ill (certified with a 12-month-or-less life expectancy, the Accelerated Death Benefit (ADB) provides an accelerated payment of a portion of the terminally ill person’s life insurance proceeds. Your request cannot exceed 80% of the amount of their Group Term Life insurance in force.

How can I cancel my Group Term Life insurance benefits?

If you would like to discontinue your coverage for Group Term Life insurance, you may do so at any time by sending us a written request with your name, date, PEF Membership Identification Number (MIN), and signature to: PEF Membership Benefits Program, PO Box 12414, Albany, NY 12212-2414.

Please make sure you are specific about what type of the insurance you wish to cancel. Cancellations are effective the day we receive your request and deductions will be stopped on the next available payroll. We will mail an acknowledgement letter that will include the effective date of your cancellation.

DISCLAIMER: These questions and answers explain the general purpose of the insurance described but in no way change or affect the policy as issued. In the event of any discrepancy between this information and the policy, the terms of the policy apply. Complete details are in the certificate of insurance issued to each insured individual**

 


MILITARY LEAVE

I’m going on Military leave. What happens to my benefits?

Group Term Life

Group Term Life insurance coverage can be continued for up to 12 months at no charge to you for your approved military leave. A death claim would be eligible for payment if death occurs while covered under this policy. No benefits would be paid under the Accidental Death and Dismemberment (AD&D) feature of your policy for a loss caused, or contributed to, by war or any act of war whether war is declared or not.

Short-Term Disability

Coverage cannot be maintained while on an approved leave of absence. The current contract specifically excludes disability caused by “war or act of war” and states that coverage will be terminated on the date you cease to be in an eligible class including leave for military service. When you return to active employment, you must notify PEF to initiate reinstatement of your coverage. You must request reinstatement of your policy within 120 days of your return to active work.

Long-Term Disability

You may continue your coverage for 6 months while on an approved leave of absence. When you return to active employment with NYS, you must notify the PEF Membership Benefits Program and request to reinstate your group LTD policy. You may contact the PEF Membership Benefits Program at: (518) 785-1900, ext. 243 or (800) 342-4306, ext. 243. Download the application to maintain your voluntary insurance benefits while on Military Leave.


FREE BENEFITS

Are there any FREE benefits I receive just for being a PEF member?


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