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- Forms and Documents
This disability plan is specifically designed for IBEW Local 109 members to help them protect their income and assets in the event of a disability or illness.
Some Questions to Think About
- Could you afford to take a six-month vacation? If you can’t, do you think you could afford living through a six-month illness or injury?
- How would you and your family pay your bills without your income?
- How long would your savings last if you were unable to work because of an illness or accident and your income stopped?
- If you were sick or injured in an accident today, would your family’s standard of living be affected?
- What impact would a long-term illness or injury have on your ability to save for retirement?
- You must be actively at work to be eligible to enroll and maintain coverage.
- If you joined IBEW within the last 90 days, you are within your open enrollment window and can join with no medical questionnaire.
- If you have been a member of IBEW Local 109 for longer than 90 days, you are considered a late applicant and must complete a LATE APPLICANT ENROLLMENT FORM. You will receive a letter from the insurance carrier to advise if your enrollment has been accepted.
As a plan participant, you must notify Group Benefit Associates:
- Within 30 days of any layoff or work stoppage and again within 30 days of your return to work
- Immediately when your bank account or credit card information changes for the purpose of premium collection
- Immediately when your wage rate changes
- Within 30 days of any disability and 30 days of your return to work
- Within 30 days if you withdraw from the Union
- Within 30 days of your retirement
Failure to notify Group Benefit Associates in a timely manner of any of the above listed changes can affect your participation in the plan or the benefits that you are eligible to receive under the plan.
Group Benefit Associates has teamed together with Guardian Life Insurance Company of America to bring you this program. Guardian is the insurance carrier for the policy and processes all claims and Group Benefit Associates is the third-party administrator responsible for premium collection.
Short Term Disability (STD)
- Benefit Begins: 30th day non-occupational accidental injury, 30th day non-occupational sickness or pregnancy.
- Benefit Amount: $250 per week
- Benefit Period: 22 weeks
During the first 12 months of coverage, no STD benefits will be paid for a disability that is due to a pre-existing condition. A pre-existing condition is an injury or sickness for which you received medical treatment, consultation, diagnostic measures, prescribed drugs or medicines, or for which you followed treatment recommendations during the three months prior to your effective date of coverage. This provision also applies if you did not consult a physician when an ordinarily prudent person would have. Exclusions may vary by state.
The Short Term Disability (STD) Benefit will provide $250 per week tax free. That is in addition to any other benefit you may currently receive for a non-job related disability.
Your Monthly Cost is only $23.69 to participate in the supplemental Short Term Disability Program!
Cancellation Requests: Cancellation requests must be received in writing by mail, fax, or e-mail. Cancellations will become effective on the last day of the month in which they are received.
Premium Waived if Disabled: Premium will not need to be paid if you are receiving benefits. Please contact us within 30 days of your disability so that we may waive your premium while you are not working.
Premium Payments: Your initial premium due will be collected within 5 business days of your enrollment. Subsequent premiums will be collected automatically from a Visa, MasterCard or direct debit from a checking account on the 15th of each month. If the 15th falls on a weekend or holiday, the charge will occur on the next business day.
- If you have been a member of IBEW Local 109 for longer than 90 days, you are considered a late applicant and must complete a . You will receive a letter from the insurance carrier to advise if your enrollment has been accepted.
Disability Claim Form:
The disability income insurance claim form is composed of three separate sections that need to be completed by you, your physician and your employer.
- Employee Section: Please be sure to complete this part clearly and sign where indicated.
- Physician Section: Please have the physician that disabled you complete this part. If you have seen additional physicians, please also include their names, addresses, phone numbers and fax numbers on a separate sheet of paper.
- Employer Section: Even though your policy is purchased through the union, your benefit is based on the income you receive from your particular employer. Your employer assumes no liability or responsibility for your claim by completing this form for you.
Failure to provide proper information and documentation will delay your claim so it is very important the claim form is complete and clear. Once complete, forward the form to our office by mail or fax.
How Your Claim Will Be Handled:
Once received by Group Benefit Associates, we will begin waiving your premium as of the date of your disability. The processing of your claim will be handled by Guardian Life Insurance Company and therefore you may inquire with them regarding the status of your claim. Please note that Group Benefit Associates does not have access to information regarding claims determination or benefit payments. Guardian can be reached Monday through Friday from 8am to 5pm Eastern Standard Time at:
Short-Term Claims Department
800-268-2525 phone/ 610-807-8270 fax
Premium billing questions are handled by Group Benefit Associates at 800-450-1271.