Weekly Disability
Benefit
Your TeamstersCare Weekly Disability
Benefit is designed to pay you a weekly benefit while
you’re disabled. The disability must be caused by a sickness or injury that
is not related to your job. All
disabilities are subject to review by the TeamstersCare
Medical Review Committee.
The Weekly Disability Benefit also
includes maternity as an eligible disability for however
long it’s medically necessary. Generally,
“medically necessary” means your physician
determines that your pregnancy, or a condition arising
out of your pregnancy, prevents you from performing your
job.
FImportant
Note: If you are a UPS part-time benefit member, you are not eligible
for TeamstersCare weekly disability benefits, except when
you work 400 or more hours in an eligibility
determination period. (See UPS Part-time Benefit Members, click
here.)
Your Disability Coverage
If you have a disability not caused
by your job but which keeps you from working, the TeamstersCare
Weekly Disability Benefit pays you a benefit each week
for up to 26 weeks, after a seven-day waiting period. In order to be eligible,
you must submit the appropriate form (available from Charlestown
Member Services) completely filled out by you, your employer,
and your doctor.
You don’t have to be confined
to your home to receive benefits, but you
do have to be under the care of a medical doctor. (For
example, a chiropractor cannot sign your disability form.)
Also, during your disability, TeamstersCare may require
your physician to fill out an Extension of Benefits Form,
which will then be reviewed by the TeamstersCare Medical
Review Committee.
If approved by the Committee, your
weekly disability benefit equals 75% of your regular weekly
base pay, from a minimum of $300 per week up to a maximum
of $500 per week. In no event can this benefit be greater
than 100% of your average weekly pay. TeamstersCare uses
your most recent eligibility
determination period to calculate your base pay. (See “Eligibility Determination Period,” click here.)
The Government considers disability
benefits—to which you do not contribute—taxable
income. TeamstersCare deducts the appropriate FICA tax
from your check and mails you a W-2 form at the end of
the year.
Important Notes:
FIn no
event can your weekly disability benefit be more than your
weekly base pay. Also, your TeamstersCare disability benefit will be reduced
by any disability- related
payments you might receive from Workers’ Compensation,
state disability, or any other group plans.
FThe
Fund makes disability payments only so long as a member
remains eligible according to the eligibility and participation
provisions of the TeamstersCare Plan. Like other TeamstersCare
benefits, weekly disability payments are discontinued
when, for whatever reason, a member loses eligibility.
Disability Waiting
Period
After a seven-calendar-day “waiting
period,” your benefit payments start on the eighth
day you’re disabled and may be extended for up to
26 weeks with appropriate documentation of proof of disability.
The seven-day waiting period begins
on one of two days, depending on when you visit your doctor
and have your disability verified:
• If you visit
the doctor and receive verification anytime within the first
three days of the day you became disabled, the seven-day waiting
period begins on the first day you were disabled.
• If you do
not see your doctor and receive verification within three
days after you’re disabled, then your seven-day waiting
period starts three days before your first doctor’s
visit.
More Than One Period
of Disability
TeamstersCare pays benefits on a per-disability
basis. This means you can receive up to 26 weeks of benefits
each time you’re disabled. In order for two periods
of disability to be treated as separate, you must have actively,
physically returned to work for
at least two weeks between the end of the first period
of disability and the beginning of the second period of
disability. (So, for example, you could not use vacation
time or sick time to “bridge the gap” between
the two disability periods.)
If you go back to work for fewer than
two weeks after a disability ends, and you become disabled
again for the same or a related condition, then your second
period of disability will be considered an extension of
the first. However, you would not have to meet another
seven-day waiting period, and you could continue to receive
benefits for up to the remainder of the original 26-week
period.
Continuing TeamstersCare
Medical Coverage While Disabled
If you’re disabled and are
receiving either TeamstersCare Weekly Disability benefits (for a non-work-related disability) or Workers’ Compensation (for
a work-related disability),
you may be able to continue receiving TeamstersCare medical
benefits during the period of your disability. In either
case, you must meet all of the Plan’s eligibility
rules.
Non-Work Related Disability
If you’re disabled from
a non-work-related injury and are receiving TeamstersCare
Weekly Disability benefits, you may be eligible to continue
your TeamstersCare medical benefits.
After the seven-day waiting period,
for the first four weeks you’re disabled, your employer
must contribute to TeamstersCare at the rate of 32 hours
per week. After those four weeks, TeamstersCare will credit
you with hours toward continuing eligibility at a rate
of 32 hours per week, for up to 22 weeks. If you worked
an average of fewer than 32 hours per week during your
most recent eligibility determination period, TeamstersCare will credit you with the average number of
hours you worked per week.
You cannot be credited with a total
of more than 800 “disability” hours in any
consecutive three-year period.
Work-Related Disability
If you’re disabled from
a work-related injury and are receiving Workers’ Compensation,
you may be able to maintain your TeamstersCare medical
coverage so long as you meet all of the Plan’s eligibility
requirements and your employer continues to contribute to TeamstersCare
at a rate of 32 hours a week (17.31 hours for UPS part-timers)
for up to 12 months.
Disputed Work-Related Disability
If you’ve filed a Workers’
Compensation claim which is disputed by your employer
or the Workers’
Compensation carrier, then—during the period when
the claim is being adjudicated—TeamstersCare may
pay you a weekly disability benefit provided:
• you sign a notarized
agreement committing to repay any amounts you have received
from the Plan should you or your dependents: (1) become eligible
for Workers’ Compensation benefits or (2) receive proceeds
from a settlement of your Workers’ Compensation claim
• you provide
TeamstersCare with a copy of the Workers’ Compensation
denial
• you complete
a TeamstersCare Third-Party Questionnaire Form
FImportant
Note: During the period when you are disabled from a work-related
injury or illness and you’re receiving Workers’ Compensation,
TeamstersCare does not cover any medical expenses that are
attributable to the injury or illness. In addition, the maximum
benefit that you may collect is 26 weeks from the date of
injury. Any payments that you receive from Workers’ Compensation
count toward this 26-week maximum.
Continuing Life Insurance
While Disabled
If you become totally
and permanently disabled while
you’re covered by TeamstersCare life insurance, but
then lose your eligibility for benefits, your life insurance
may remain in effect for a certain period of time, provided
you continue to be totally disabled. There will be no cost
to you. TeamstersCare will pay the premiums on your behalf.
The length of time this extended coverage remains effective
depends on how old you are when disability begins. (See Life
Insurance Benefits If You’re Disabled, click
here.)
FImportant
Note: “Totally and permanently disabled” means that
your disability prevents
you from working at any kind of paying job you would normally
be qualified to do.
Disability TeamstersCare
Does Not Cover
TeamstersCare does not provide benefits
for job-related medical expenses or job-related disabilities
which are eligible for coverage by Workers’
Compensation, state disability laws, no-fault insurance,
or other group plans.
Disability Resulting
from Motor Vehicle and Motorcycle Accidents
If you have a disability claim related
to a motor vehicle or motorcycle
accident, you, or someone acting on your behalf, must
notify TeamstersCare as soon as possible. The Plan’s
coverage varies with a number of factors.
States Requiring Mandatory No-Fault
Insurance
If you live in Massachusetts,
or any other state with no-fault insurance, disability
claims resulting from a motor vehicle accident are covered
by mandatory no-fault insurance.
If you are covered by such insurance and you are in a motor vehicle accident, then TeamstersCare
will not pay weekly disability for any week in which you
also receive insurance payments. However, if you reach
the no-fault maximum before the 26th week that you’re
disabled, TeamstersCare may pay benefits for up to the
rest of the 26-week period.
If you have elected not to carry
no-fault coverage, and you
have a disability claim resulting from a motor vehicle
or motorcycle accident, TeamstersCare excludes from your
benefits all amounts that would have been covered had you
obtained no-fault insurance.
States Without No-Fault Insurance
If you live in a state that
does not require mandatory no-fault coverage, the Plan
will administer motor vehicle or motorcycle accident claims
in the same way as any other disability claim. However,
you’ll first have to sign a lien agreement which
says that if you receive any third-party settlements related
to the accident, you’ll be required to reimburse
TeamstersCare an amount equal to any payment the Plan may
have made on your behalf.
Note: For
coverage of medical claims resulting from motor vehicle accidents, see Medical Benefits for Motor Vehicle and Motorcycle Accidents, click here.
FImportant
Note: If you are denied benefits under your motor vehicle insurance
due to driving under the
influence, TeamstersCare excludes
from your benefits all amounts that would have been covered
by the insurance carrier.
Other Disability
Settlements
In general, if you receive a settlement
to compensate you for a disability, you must reimburse
TeamstersCare for any medical and disability benefits the
Plan may have paid you for that same disability.
If you’re disabled and are receiving
disability payments from a third party, your hours continue
to accrue towards your continuing eligibility for TeamstersCare
medical coverage—just as they would if TeamstersCare
were making your disability payments.
Filing a Weekly
Disability Claim
If you have a weekly disability claim,
call Charlestown Member Services for the appropriate Disability Claim Form. Fill out
your portion of the Form, then have your employer and medical doctor complete their respective
portions. You must return the completed Form to TeamstersCare within 90
days of the date your disability begins.
If you do not return the Form within 90 days of the date your disability begins,
you will not be eligible for coverage.
The TeamstersCare Medical Review Committee
will review the information you provide and contact you
if it needs any further information from you, your employer,
or medical doctor. (See Claims and Appeals, click
here.)
FImportant
Note: Disability payments cannot begin until you’ve
submitted a properly documented claim that’s been approved
by the TeamstersCare Medical Review Committee.
Information You
Must Provide to be Eligible for Weekly Disability Benefits
TeamstersCare cannot pay weekly disability
benefits without obtaining all the information it needs
to process your claim.
• When
you first have a claim, you
must, within 90 days: (1) submit the appropriate Disability
Claim Form, (2) sign a Release of Information Form, and
(3) provide TeamstersCare with a pay stub within 90 days
of the date your disability begins.
• In
order to begin or continue your weekly disability benefit, TeamstersCare may need to review certain documents related
to your disability. This could include such items as doctor’s
office notes and supporting data such as x-rays, MRI’s,
etc.
• For
prolonged periods of disability, TeamstersCare
may require your physician to fill out an Extension
of Benefits form, which
will then be reviewed by the TeamstersCare Medical Review
Committee.
• When
your disability is over and you return to work, you
must notify TeamstersCare immediately. Teamsters Union 25
Health Services & Insurance Plan will take all necessary
steps to recover any benefits it pays out because of late
or improper notification.
FImportant
Note: If you work while out on disability and you have not
been cleared to return to work by the doctor who treated
your disability, your TeamstersCare weekly disability benefits
end.
Life Insurance Benefit
The TeamstersCare Life Insurance Benefit
provides financial protection for your family or beneficiaries
in case of your death.
FImportant
Note: If you are a UPS part-time benefit member, you are not eligible
for TeamstersCare life insurance benefits, except when you
work 400 or more hours in an eligibility determination period.
(See UPS Part-time Benefit Members, click here.)
Your Life Insurance
Benefit Amount
If you die from any cause, on or off
the job, TeamstersCare pays your named beneficiary/beneficiaries
a benefit of $50,000.
Naming Your Beneficiary
So long as you comply with any state
or Federal mandates, you can designate anyone you choose
as your beneficiary—or you can name several people
as multiple beneficiaries.
You have to name your beneficiaries
when you complete your TeamstersCare Enrollment
Form, but you can change your designation at any time, provided
you do so on a form prescribed by the Plan. To change your
beneficiary, contact Charlestown Member Services, and we
will provide you with the appropriate form.
If you name more than one beneficiary
you can also specify how you wish your life insurance benefit
to be divided. TeamstersCare will pay death benefits to
the beneficiary or beneficiaries whom you have designated
and recorded with Charlestown Member Services.
FImportant
Note: Please note that you’re responsible for keeping your
beneficiary designation
current. At the time of your death, TeamstersCare will rely
only on the last beneficiary designation you submitted that
we have on file with Charlestown Member Services.
If you do not name
a beneficiary, or your beneficiary dies before you and there
is no current beneficiary designation on file, your life
insurance benefit will be paid to the first person in the
following order:
• your husband
or wife
• your children—insurance
amount distributed equally
• your parents—insurance
amount distributed equally
• your brothers
and sisters—insurance amount distributed equally
• the executor of your estate
Living Benefits
Option
TeamstersCare offers a special life
insurance option that applies if you are diagnosed with
a condition that is likely to result in your death within
12 or fewer months. Your doctor must certify in writing
that you are terminally ill and that your life expectancy
has been reduced to fewer than 12 months.
In this case, you are eligible to receive
up to 75% of your total $50,000 life insurance benefit
while living. There are no restrictions on how you use
this money, and the balance of your life insurance benefit
remains payable to your beneficiary upon your death.
If you live beyond the date of your
diagnosis, you are not required to repay any insurance
amounts you may have received under the living
benefits option. However, these payments will be deducted from any benefits
eventually paid to your beneficiaries and from the amount
you can convert to an individual policy.
Dependent Life Insurance
Benefit
TeamstersCare provides you with a
benefit that can help cover the unexpected expenses resulting
from the death of someone in your family.
TeamstersCare pays dependent life
benefits directly to you, as a lump sum, for these amounts:
• $5,000—death
of your spouse
• $2,000—death
of a dependent child (coverage begins at birth)
For the purpose of
this dependent life insurance benefit, a “dependent” child
is an unmarried child who depends on you for primary financial
support and:
• has not yet
reached December 31st of the year he or she turns age 19,
or
• has not yet
reached December 31st of the year he or she turns age 25
and is a regular, full-time student at a licensed academic
or trade school
Under the TeamstersCare Dependent
Life Insurance Benefit, dependent coverage includes life
insurance only, not accidental death & dismemberment.
The Plan does not pay benefits for the death of an ex-spouse.
Converting TeamstersCare
Life Insurance to an Individual Policy
If your TeamstersCare life insurance
coverage ends for any reason, you—and any of your
eligible dependents who wishes to do so—can “convert” from
TeamstersCare coverage to an individual policy. You—or
your dependent, as appropriate—will need to pay the
premiums for this continued coverage.
To convert, you do not need to show
proof of good health. However, you must apply for the conversion
and pay the first premium within 31 days after your TeamstersCare
coverage ends. Although the choice is yours, you must convert
in a timely fashion if you wish to exercise this option.You
(or your dependent) can select from whichever policies
are being offered by the insurance company at the time
you apply for conversion. And you can choose coverage amounts
up to your current TeamstersCare level.
In addition, if you should die anytime
during the 31-day conversion period, TeamstersCare will
pay to your designated beneficiary the full amount of insurance
you would otherwise have been entitled to convert.
If you (1) convert to an individual policy, then (2) regain TeamstersCare coverage,
then (3) subsequently lose your eligibility for a second time, you cannot convert
again to an individual policy. However, when you regain
TeamstersCare coverage, you are not required to terminate
the insurance you originally converted.
Life Insurance Benefits
If You’re Disabled
If you become totally
and permanently disabled
while you’re covered by TeamstersCare life insurance,
but then lose your eligibility for benefits, the life insurance
may remain in effect for a certain period of time, at no
cost to you, provided you continue to be totally disabled.
The length of time coverage remains
effective depends on how old you are when disability begins,
as shown in the following schedule:
To be eligible for extended life insurance
coverage, you have to be “totally and permanently”
disabled. This means your disability prevents you from working
at any kind of paying job you would normally be qualified
to do.
When you’re disabled, you have
to submit evidence of your disability to the insurance
company within 31 days of loss of eligibility. From that
time on, at reasonable intervals, you may be required to
submit medical proof that you continue to be totally disabled.
If you lose eligibility while you’re
disabled, you may wish to convert to individual coverage
until you’re notified that your extended coverage
has been approved. (See Converting TeamstersCare Life Insurance to an Individual Policy,
p. 62.) Once your extended coverage has been approved,
any premium you’ve paid for the converted coverage
will be returned to you.
If you become totally and permanently
disabled, contact Charlestown Member Services immediately
to discuss these options.
Filing a Life Insurance
Claim
To file a life insurance claim, you
or a family member must contact TeamstersCare and ask for
the appropriate claim form. TeamstersCare will send the
claim form to the designated beneficiary. The beneficiary
must complete and return the form to TeamstersCare within
12 months of the date of death. You or a family member
must provide TeamstersCare with a copy of the death certificate.
See also Claims
and Appeals, click
here.
Accidental Death &
Dismemberment Benefit
TeamstersCare’s Accidental Death
& Dismemberment (AD&D) Benefit provides you with
extra life and accident insurance protection. If you suffer
certain kinds of serious injury as the result of an accident,
TeamstersCare pays the AD&D benefit directly to you.
If you die within 365 days of an accident
and your death is a result of that accident, AD&D pays
a benefit to your designated beneficiary. The Plan makes
this AD&D payment in addition to your normal TeamstersCare
life insurance benefit.
FImportant
Note: If you are a UPS part-time benefit member, you are not eligible
for TeamstersCare AD&D benefits, except when you work
400 or more hours in an eligibility determination period. (See UPS
Part-time Benefit Members, click here.)
AD&D Benefit
If you die within 365 days of an accident,
or if you suffer one of the injuries listed below as the
result of an accident, TeamstersCare pays the following
benefits:
Important Notes:
FThe
Plan has certain technical definitions of the particular
losses, limbs, or faculties identified in this chart.
If you need specific information on any of the occurrences
described above, contact Charlestown Member Services.
FThe maximum
AD&D benefit from any one accident is $50,000.
Additional Coverage
for Using Seat Belts
In addition to the general $50,000
accidental death benefit, TeamstersCare makes a special
$5,000 payment to your beneficiary if you die as the result
of an automobile accident, and you were wearing a seat
belt when the accident occurred.
This applies whether you are the driver
or a passenger. In order for this special benefit to be
paid, certain certifications need to be made in the official
accident report regarding the proper positioning and fastening
of the belt and the sobriety of the driver. If you need
more specific information on any of the requirements for
this “seat belt coverage,”
please contact Charlestown Member Services.
Special Benefit for
Your Spouse
If you die as the result of an accidental
injury, TeamstersCare pays a special survivor’s benefit
of $500 per month for the six months following your death.
This benefit is paid to your spouse, if living. If your
spouse is not living, then the benefit is divided equally
among any dependent children you may have.
This benefit is in addition to the
general $50,000 accidental death benefit and recognizes
the extraordinary needs that may occur at such a time.
The benefit is paid directly to your spouse (or dependent
children) regardless of whom you have named as your beneficiary.
Special Coverage for
Felonious Assault Injuries
TeamstersCare pays a special AD&D
benefit if you die, or if you lose a limb or your sight,
as the result of what is legally called a “felonious
assault.” This occurs when you are the victim of
a criminal act such as kidnapping, robbery, assault and
battery, etc.
The special benefit is 10% added to
the amount you are otherwise entitled to receive,
as described in the AD&D basic benefit schedule. (See AD&D
Benefit, click here.) The assault must occur while
you are on the job, actively working for your employer.
Special Benefit for
Military Reserve or National Guard
TeamstersCare provides you with basic
AD&D coverage if you are a member of the U.S. Reserve
Corps or the National Guard, and if you are injured while:
• attending, or traveling to
or from, annual field training or any related training
activity that is not longer than a period of 60 days
• attending a service school—even
if the term of the school is longer than 60 days
• participating in any inactive
exercise, training, or assembly; or in a parade, exhibition,
or ceremony authorized by your unit
Naming Your Beneficiary
Unless you designate otherwise, the
beneficiaries for your AD&D benefit will be the same
person or persons you designate as beneficiaries for your
life insurance.
Losses AD&D Does
Not Cover
The AD&D Benefit does not cover
injuries resulting from:
• sickness or
disease
• intoxication
or the influence of drugs (unless taken under a doctor’s
direction)
• infection from
an accidental cut or wound
• intentionally
self-inflicted injury under any circumstances
• participating
in a crime
• participating
in a war or in military service during a war, declared or
undeclared
• police duty
as a member of any military organization
• certain kinds
of air travel—for more specific information, contact
Charlestown Member Services
How to File an AD&D
Claim
To file an AD&D claim, you or
a family member must:
• call Charlestown
Member Services and ask for an AD&D
Claim Form
• complete and
return the Form to TeamstersCare within
90 days of the date of the injury or death
• provide a copy
of the death certificate, as may be appropriate—or
proof of loss in the case of an accidental injury
See also Claims and Appeals, click
here.
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