A

Adjusted Disability Benefits
A reduced benefit due to a claimant earning partial income, such as through part time work.

Annual Predisability Salary
The annual base salary that a disability insurance policyholder was earning before a covered injury or illness. This is used to calculate how much disability income a policyholder will qualify for in the case of a covered injury or illness. Annual salary will be based on your salary as of September 1, effective October 1. See FAQs for new hire and annual adjustment information.

B

Benefit Period
The period of time during which disability benefits are payable (providing the claimant has exhausted all accrued paid leave). The benefit period starts on the day after the elimination period has been satisfied and extends for the length of time approved by MetLife, not to exceed the maximum benefit period outlined in the plan.

C

Certificate of Insurance
This plan document is the agreement between MetLife and individuals enrolled in disability insurance. Please view the Certificate in the Documents tab.

Claimant
A disabled member that has submitted a claim or is drawing a disability benefit.

D

Disability

For short-term disability: “Disabled” or “Disability” means that, due to sickness or as a direct result of accidental injury, you are unable to earn more than 80% of your pre-disability salary at your own job at the State of Tennessee and are receiving and complying with requirements of appropriate care and treatment.

For long-term disability: “Disabled” or “Disability” means that, due to sickness or as a direct result of accidental injury, you are, during the elimination period and the next 36 months of sickness or accidental injury, unable to earn more than 80% of your pre-disability salary at your own occupation for any employer in the local economy, and are receiving and complying with requirements of appropriate care and treatment. To continue to meet the definition after such period, you must be unable to earn more than 60% of your pre-disability salary at any gainful occupation for any employer in the local economy or unable to perform the duties of any gainful occupation for any employer in the local economy for which you are reasonably qualified taking into account your training, education, and experience.

Disability Insurance
An insurance product that provides a portion of an individual’s pre-disability income to help maintain an individual’s or family's standard of living in the event that the insured is unable to continue working due to a covered injury or illness.

Disability Member Handbook
This document explains key features of the disability insurance plan, like certain rules, limitations and how to file a claim.

Disability Period
The period of time the claimant is deemed disabled per the plan definition. The disability period begins on the date of disability and includes the elimination period and the benefit period.

E

Effective date
This is the date that marks the beginning of your coverage, once you enroll.

Eligibility
Meeting the necessary requirements for coverage. For Partners for Health, this is defined as all employees working not less than 30 hours/week; seasonal employees hired prior to July 1, 2015 with 24 months of service and certified by their appointing authority to work at least 1,450 hours per fiscal year (July-June); or deemed eligible by applicable federal law, state law, or action of the State Insurance Committee.

Elimination Period
The period of disability during which MetLife does not pay benefits. The elimination period begins on the date of disability and continues for the period of time outlined in the plan in which the member is enrolled.

Evidence of Insurability
An application process in which you provide information on the condition of your health in order to be considered for certain types of insurance coverage.

Exclusions
An item or risk specifically not covered by an insurance policy. These include suicide, act of war, participation in a riot, commission of a felony, cosmetic or elective surgery. Please see the Certificate of Insurance for details.

G

Guaranteed Issue
A period of time when insurance coverage is offered to eligible employees without having to answer health questions.

L

Limitations
A restriction placed on certain situations, such as a disability due to mental, nervous conditions or substance abuse. Please see Certificate for details.

Long-Term Disability Insurance
An insurance product that replaces a portion of the insured's income during an extended period of a covered disabling illness or accident.

M

Maximum Monthly Benefit

The upper-end limit of how much long-term disability will pay out. For example, if you enrolled in long-term disability and if you earned $17,000 per month ($204,000 per year) before your covered accident or illness and file a claim for long-term disability: 63% of $17,000 is $10,710. Since there is a maximum benefit of $10,000 per month, long-term disability insurance will only pay out $10,000 per month.

Maximum Weekly Benefit
The upper-end limit of how much short-term disability will pay out. For example, if you enrolled in short-term disability insurance and if you earned $4,500 per week ($234,000 per year) before your covered accident or illness, and file a claim for short-term disability: 60% of $4,500 is $2,700. Since there is a maximum benefit of $2,500 per week, short-term disability insurance will only pay out $2,500 per week.

Minimum Monthly Benefit
The lower-end limit of how much long-term disability will pay out under certain circumstances. The minimum is the greater of 10% of benefit or $100 per month. The minimum benefit will not apply if you receiving 100% of your pre-disability salary under the Policyholder (the State’s) paid leave policy

Minimum Weekly Benefit
The lower-end limit of how much long-term disability will pay out under certain circumstances. The minimum STD benefit is $25 per week. The minimum benefit will not apply if you receiving 100% of your pre-disability salary under the Policyholder (the State’s) paid leave policy.

O

Own Occupation
The essential functions a member regularly performs that provide their primary source of earned income.

P

Pre-Existing Condition
A medical condition that started before a person's disability insurance went into effect.

Premium
What you would pay for disability insurance if you enroll. Premiums for the Partners for Health plans are calculated monthly. Please refer to the “Rates” tab at the top of this page to calculate premiums.

S

Short-Term Disability Insurance
An insurance product that replaces a portion of the insured's income during the initial weeks of a covered disabling illness or accident.