FAQ | MetLife

1. What is Disability Insurance?

It is insurance to protect your income when you cannot work due to illness or injury.

2. Is Disability Insurance right for me?

Disability insurance might be right for you if you..

Have little or no annual or sick leave saved up
Don’t have much in the way of savings or an emergency fund
Take part in high-risk activities, for example sky diving, etc.

3. What is Short-Term Disability (STD) Insurance?

Short-Term Disability Insurance replaces a portion of your income during the initial weeks of a disability.

4. When am I eligible to enroll in Short-Term Disability plan?

You will be eligible to enroll in the STD plan on the first day of the calendar month following the date you complete a waiting period of 1 full calendar month if you are an employee working not less than 30 hours per week, or a seasonal employee 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. You then have 30 days of becoming eligible to enroll. The State of TN does not offer Long-Term Disability (LTD) to Higher Ed employees. For details regarding Long-Term Disability and how it coordinates with Short-Term Disability, please consult with your Agency Benefits Administrator.

5. What do the terms “Disabled” and “Disability” mean? How are they defined under the Short-Term Disability plan?

“Disabled” or “Disability” means that, due to sickness, or as a direct result of accidental injury:

You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and
You are unable to earn more than 80% of Your Predisability Salary at Your Own Job at the State of Tennessee.

For purposes of determining whether a Disability is the direct result of an accidental injury, the Disability must have occurred within 90 days of the accidental injury and resulted from such injury independent of other causes.

If Your occupation requires a license, the fact that You lose Your license for any reason will not, in itself, constitute Disability.

6. What is my Pre-Disability Salary and when is it determined?

Your gross base annual salary is defined as your Pre-Disability Salary. The gross base annual salary you make on September 1 of each calendar year determines the benefit you are eligible for beginning October 1 of each calendar year.

For new hires, Pre-Disability Salary will be based on your date-of-hire salary, and coverage will be effective after you complete one full calendar month of employment.
Annually, there will be a benefit and premium level adjustment. If your salary has changed from the prior year, your benefit and premium will change accordingly using the gross base annual salary you make on September 1. This adjustment will become effective on October 1.

7. What is the Short-Term Disability benefit, and what amount will I receive?

There are two benefit options from which to choose:

Option A: Pays 60% of your Pre-Disability Salary, up to a maximum of $2,500 per week with an Elimination Period of 14 days.
Option B: Pays 60% of your Pre-Disability Salary, up to a maximum of $2,500 per week with an Elimination Period of 30 days.

Example: if a person’s Annual Pre-Disability Salary equals $65,000, simply divide by 52 (weeks,) and multiply by the benefit percentage of 60% to find out your weekly benefit.

$65,000 / 52 x .60 = $750.00 per week of STD benefit

8. How long can I receive benefits under Short-Term Disability Insurance?

The maximum Benefit Period for Short-Term Disability is 26 weeks and begins on the benefit start date, which is the day after you satisfy the Elimination Period of either 14 days or 30 days. Please note – because every disability is different, not every disability may last for the entire maximum Benefit Period.

MetLife will use information submitted by your treating physician to determine your approvable Disability Period. The Disability Period is 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. Benefits are only payable during the Benefit Period and only after the claimant has exhausted all accrued paid leave. The length of the Disability Period and Benefit Period depends on your specific disability, and every disability is different.

9. What is the Elimination Period, and why is it important?

The Elimination Period means “the period of your disability during which MetLife does not pay benefits.” It’s your waiting period. The Elimination Period starts on the day you become disabled and runs concurrently with any pay received for Accrued Annual Leave, Sick Leave and Compensatory Leave or pay withdrawn from the Sick Leave Bank.

For Short-Term Disability, there are two elimination period options available to employees:

Option A has an Elimination Period of 14 days for both accident and sickness.
Option B has an Elimination Period of 30 days for both accident and sickness.

The length of the Elimination Period affects the premium rate. A shorter Elimination Period means your monthly premium will be higher. A longer Elimination Period means you pay a lower monthly premium because you wait longer to receive a benefit.

10. When will I receive my disability benefit payment?

Short-Term Disability benefits are issued weekly. MetLife will process claims within five (5) business days of receiving all required information. Once an approval decision is rendered by MetLife and you satisfy the Elimination Period and no longer have Accrued Annual Leave, Sick Leave and Compensatory Leave, benefit payments will be issued weekly each Tuesday for the prior week’s benefit period. Payments are issued via paper check and mailed to you at your address on file with MetLife. Direct Deposit/EFT is also available and once registered, payments will be deposited into the designated bank account within three (3) business days of being issued. The weekly benefit checks cannot be sent to your employer, a doctor, or hospital.

11. Will I have to pay my Short-Term Disability Insurance premiums while I am disabled?

Yes. You are required to pay your STD premiums while you are out on disability to keep your STD insurance inforce. You will be direct billed for Short-Term Disability premiums just as you are for other benefits such as Medical and Dental.

12. If I am currently disabled, and my Short-Term Disability (STD) Insurance coverage ends, will my current claim benefits stop?

No. If you were eligible for STD coverage on your date of disability, then your current claim benefits will not be impacted and will continue to be administered according to the rules outlined in the plan.

13. Can I receive Short-Term Disability benefits if I return to work part-time?

Maybe. MetLife will work with you to determine if you qualify to receive any benefits and what those benefits are.

14. What happens if my Short-Term Disability is longer than the maximum benefit period of 26 weeks?

Short-Term Disability Benefit payments will stop. The State of Tennessee does not administer Long-Term Disability benefits for Higher Education employees. You must consult with your Agency Benefits Coordinator to determine how and when Long-Term Disability benefits would start.

15. Are there any income sources I might receive while I am disabled which will NOT reduce my Short-Term Disability Benefit?

Yes. The following income sources will not reduce your Disability benefit:

Early retirement benefits that have not been voluntarily taken by you.
Veteran’s benefits.
Individual disability income insurance policies.
Benefits received from an accelerated death benefit payment.

The above list is not all inclusive. Please read the Short-Term Disability Certificate of Insurance for the full legal details. Click here to view the Certificate.

16. Are there any income sources I might receive while I am disabled which will reduce my Short-Term Disability benefit?

Yes. The following income sources will reduce your Disability benefit

Any Sick Leave, Accrued Leave, Compensatory Leave or other salary continuation that the Policyholder (the State) pays to you.
Any disability or retirement benefits which you receive because of your disability or retirement under a Railroad Retirement Act or any state or public employee retirement or disability plan.
Any income received for disability or retirement under the Policyholder’s Retirement Plan, to the extent that it can be attributed to the Policyholder’s (the State’s) contributions.
Any income received for disability under another Group Insurance Policy (for example, if you are a member of TSEA and have a group disability policy so are covered under both Disability plans).
Any income received for workers’ compensation.

The above list is not all inclusive. Please read your Short-Term Disability Certificate of Insurance for the full legal details. Click here to view the Certificate.

17. Am I allowed to have both a Workmen’s Compensation (WC) claim and Short-Term Disability (STD) at the same time?

Yes. The STD claim will run concurrently with the WC claim and any income payments received from WC would be an offset to the STD benefit payments.

18. I have “Leave” time accrued. Does this affect my Short-Term Disability benefit?

Yes.

You ARE required to use all of your accrued leave before your disability payments begin. This includes Sick Leave, Annual Leave, and Compensatory Leave. Any accrued leave that extends beyond the STD benefit start date will be on offset to the STD benefit. You will not be paid from two different sources for your disability. Your disability benefit payment from MetLife will begin after your pay from any accrued leave ends.

Every Employee’s situation is different. Consider how much accrued sick and annual leave you have when deciding whether to purchase Short-Term and/or Long-Term Disability Insurance.

19. Will using days from the “Sick Leave Bank” impact my STD benefit payment?

You are NOT required to use days from the Sick Leave Bank. However, if you withdraw days from your Sick Leave Bank, any Sick Leave Bank days that extend beyond the STD benefit start date will be an offset to the STD benefit. You will not be paid from two different sources for your disability. Your disability benefit payment from MetLife will begin after your pay from the Sick Leave Bank ends.

20. How does Short-Term Disability work with FMLA?

If you are on FMLA due to your own disability you may be eligible to receive disability benefits if you meet the definition of disability per the plan. If you are on FMLA for any other reason, such as care of a family member for example, you are not eligible to receive disability benefits. While on FMLA leave, you will be billed for Disability coverage just as you are for other benefits, such as Medical and Dental.

You can take FMLA leave when your child is born, and therefore, you can use disability benefits due to the birth of a child. If you use FMLA for any reason other than a disability related to you, let’s say you need to care for a family member, then you may continue your STD coverage while you are on leave. You will be billed for Disability premiums just as you are with other benefits offered such as Dental or Life.

21. What happens to my Short-Term Disability insurance coverage if I quit (lose) my job?

Your disability insurance coverage will end at midnight on the date you terminate employment. A member enrolled in the State’s disability insurance program for at least 12 calendar months whose employment ends due to a reason other than disability may convert their coverage to an individual disability policy or a non-state sponsored group disability plan. They must do so within 30 days of the end of their Disability insurance coverage. MetLife will mail the eligible member an enrollment packet which includes an enrollment form, plan summary and premium rate sheet. This option is not available to a member whose coverage ends due to non-payment of premiums.

22. When can I cancel or change my Short-Term Disability coverage?

You may cancel coverage during the Annual Enrollment Period or by giving at least 30 days advance written notice. You may change your coverage option during the Annual Enrollment Period or when you experience a Special Qualifying Event; however, if currently enrolled and increasing coverage, you will be required to submit an Evidence of Insurability application.

23. Can my spouse sign up for Short-Term Disability insurance?

No. The disability insurance program is for active and eligible employees only. If your spouse is also an active and eligible employee, he or she may apply as an employee.

24. Are there any exclusions to my Short-Term Disability Insurance coverage?

Yes. Short-Term Disability insurance typically does not cover any disability caused or contributed to by any of the following means:

Acts of War, Insurrections, Riots, Rebellion(s) or Terrorist acts.
Intentionally self-inflicted injuries or attempted suicides.
Commission of or attempt to commit a felony.
Disability(ies) caused or contributed to by elective treatments or procedures include items such as Cosmetic Surgery(ies), Liposuction, or Visual correction surgery.

Click here to view the Certificate.

25. Are there any limitations to my Short-Term Disability Insurance coverage?

There are no limitations to STD.

26. Are there any exclusions for Pre-Existing Conditions?

There are no exclusions for Pre-Existing Conditions.

27. Am I required to enroll in the Short-Term Disability plan?

No. However, if you think that enrolling in the STD plan may be an option you may consider later, be aware of the following.

If you do not enroll during your initial 30 day eligibility enrollment period , you cannot enroll until the Annual Enrollment Period, except in cases of a Special Qualifying Event. During the Annual Enrollment Period, or when you experience a Special Qualifying Event, you will have to provide evidence of insurability by answering certain health related questions and providing other information, if required. Coverage is not guaranteed.

Here are two examples that will show you how your initial 30 day eligibility enrollment period will differ from future Annual Enrollment Periods:

Example 1: Employee is currently pregnant and elects Short-Term Disability Insurance during her initial 30 day eligibility enrollment period. She can enroll in Short-Term Disability insurance. When her baby is born, she is eligible for Short-Term Disability benefits if she was Actively at Work on the date her insurance became effective.

Example 2: Employee is currently pregnant and waived coverage during her initial 30 day eligibility enrollment period. She now wants to enroll during a future Annual Enrollment Period. She would need to submit an application to MetLife to be reviewed for medical Evidence of Insurability (EOI) . A question on the EOI form is ‘Are you now pregnant?’ Since she would answer ‘yes’ to this question, her EOI would be denied and therefore she would not be allowed to enroll for STD coverage.

28. Can I enroll for both Short-Term Disability and Long-Term Disability? How does this work?

Yes, you may enroll in Short-Term Disability (STD) separately from Long-Term Disability (LTD) insurance. The State of TN does not offer Long-Term Disability (LTD) to Higher Education employees. For details regarding Long-Term Disability and how it coordinates with Short-Term Disability, please consult with your Agency Benefits Coordinator.

29. What are the rules of enrollment for newly eligible employees (new hire or transfer)?

Newly eligible employees have 30 days after their initial eligibility date to enroll and will not be required to answer health questions. If you do not enroll during your initial 30 day eligibility enrollment period, you must wait until the next Annual Enrollment Period, or when you experience a Special Qualifying Event. Then, if you decided to enroll, you will have to answer questions about your health. If an employee changes within 30 calendar days from an agency of the Policyholder (the State)to another agency of the Policyholder (the State)where coverage had not been available before, so this is the first opportunity to enroll in STD, then he/she will be treated as a new hire. If the employee is already enrolled in STD, then the employee may transfer the STD coverage.

30. If I sign up for Disability Insurance when will my coverage be effective?

If enrolled timely, as a newly eligible employee, coverage is effective on your eligibility date, if you are actively at work on the effective date. If you are not actively at work on the effective date, then coverage will be effective on the first day you return to active work. This means there is no coverage for a disability already in progress on your normal effective date.
If enrolled timely, with a Special Qualifying Event (within 60 days of the event), you will be required to answer medical questions and coverage will be effective the first day of the calendar month following the date MetLife approves the medical request if approval is made before the 15th of the month, or the first day of the second calendar month following the date MetLife approves the medical request if approval is made on/after the 15^th of the the month, if you are actively at work on the effective date. If you are not actively at work on the effective date, then coverage will be effective on the first day you return to active work. This means there is no coverage for a disability already in progress on your normal effective date.
If enrolled during the Annual Enrollment Period, you will be required to answer medical questions. If MetLife approves your medical request, coverage will be effective the later of: the first day of the calendar year following the Annual Enrollment Period, or the first day of the calendar month following the date MetLife approves the medical request if approval is made before the 15th of the month, or the first day of the second calendar month following the date MetLife approves the medical request if approval is made on/after the 15^th of the month, if you are actively at work on the effective date. If you are not actively at work on the effective date, then coverage will be effective on the first day you return to active work. This means there is no coverage for a disability already in progress on your normal effective date.

31. How much does Short-Term Disability Insurance cost?

Rates for your plan(s) can be found on the following websites, as well as in the Member Handbook.

Microsite https://www.metlife.com/StateofTN
ParTNers for Health website https://www.tn.gov/content/dam/tn/finance/fa-benefits/documents/premium_std_2019.pdf

32. Do I have to pay through payroll deductions?

Yes. Deductions will be made with “After-Tax” dollars which means the STD benefits will not be taxable. Deductions are taken in advance just as they are for other benefits, such as Medical and Dental.

33. I am interested in Short-Term Disability Insurance. How do I enroll in coverage?

Enroll in Short-Term Disability Insurance online in ESS during your initial 30 day eligibility enrollment period. If you are enrolling (or changing benefit plans) during the next Annual Enrollment Period or within 60 days from a Qualifying Life Event, then complete a paper Enrollment Change Application and follow further instructions provided by your Agency Benefits Coordinator. If you are newly eligible, then no health questions will be asked. If you are enrolling during the next Annual Enrollment Period or with a Special Qualifying Event, then health questions will be asked. If an employee changes within 30 calendar days from an agency of the Policyholder (the State) to another agency of the Policyholder (the State) where coverage had not been available before, this is the first opportunity to enroll in STD, so he/she will be treated as a new hire. If the employee is already enrolled in STD, then the employee may transfer the STD coverage.

34. I enrolled for disability insurance and I think I have become Disabled, what do I need to do?

You will need to file a Disability claim with MetLife.

35. How do I file a claim?

There are three (3) ways to file a claim

1. Call the MetLife Claims Center at 1-855-700-8001 from 7:00 am – 10:00 pm CT, Monday – Friday

2. File a claim online at www.metlife.com/mybenefits

3. File a Paper Claim by downloading a form from www.metlife.com/mybenefits. Send your completed claim form to the MetLife Claim’s office address and or fax number below:

Metropolitan Life Insurance Company
PO Box 14590
Lexington, KY 40512
Fax: 1-800-230-9531

Whether you file by phone, online or by paper, you can track the status of your claim online or through MetLife’s “My Benefits” site www.metlife.com/mybenefits, or via the MetLife US App. Simply search for "MetLife" on iTunes® App Store or Google Play to download the app. For more information on filing a claim, watch the following video.

36. What information will I need to provide to MetLife when submitting a disability claim?

Name
Social Security Number
Contact Phone Number
Job Title
Supervisor’s Name
Contact Information
Reason for your absence

37. Who decides if I am disabled?

A MetLife Claim Manager will be assigned to your claim. He or she will review the information on your claim. This includes medical reports from your doctors, information from your employer, and other sources necessary to make a determination of your claim. The frequency of the medical and information being requested will vary depending on the circumstances of the claim.

38. What happens if my request for Short-Term Disability benefit is denied? Is there an appeal process?

If MetLife denies your claim, you may appeal the decision. Upon your written request, MetLife will provide you with copies of documents, records and other information relevant to your claim. You must submit your appeal to MetLife at the address on the claim form within 180 days of receiving MetLife's decision.

Please read the Short-Term Disability Certificate of Insurance for more information. Click here to view the Certificate.

39. How will Short-Term Disability be listed on the timesheet?

Time away from work for Short-Term Disability will be coded as “Leave Without Pay”.

40. Will leave time or service credits continue to accrue while on Short-Term Disability?

No, time away from work for Short-Term Disability will be coded as “Leave Without Pay” which does not allow for accrual of leave time or service credit.

41. How does MetLife’s Rehabilitation Program help employees return to work safely and effectively?

The MetLife Rehabilitation Program supports an employee with returning to work safely by providing resources to assist where appropriate. The Rehabilitation Program plan is managed as a team effort and involves the employee, the State of TN, the employee’s treating provider(s) and MetLife clinical and return-to-work consultants. Each Rehabilitation Program is customized to meet the needs of the employee and is based on an assessment of the employee’s capabilities and medical condition. The State of TN’s Disability plan is designed to provide advantages and financial incentives for participating in MetLife’s Rehabilitation Program. Participation in the State of TN Rehabilitation Program is mandatory when MetLife deems is mandatory, and benefits will end on the date the employee ceases or refuses to participate in the program.

The Rehabilitation Program may include, but is not limited to, an employee’s participation in one or more of the following activities:

return to work on a modified basis with a goal of resuming employment for which you are reasonably qualified by training, education, experience and past earnings;
on-site job analysis;
job modification/accommodation;
training to improve job-seeking skills;
vocational training; or
restorative therapies to improve functional capacity to return to work.

42. What if I am unable to contact MetLife to report my claim?

If you experience a disability that prevents you from calling MetLife to report your claim, someone can call MetLife (1-855-700-8001) and report the claim on your behalf. This can be someone from the State of TN HR team, a family member or other individual who is aware of your situation. They should be prepared to provide as much information as possible about your current condition, treating physicians, and/or hospital name/location including any relevant contact phone numbers that would be helpful for claims administration.

43. How does MetLife manage my Short-Term Disability claim for a pregnancy diagnosis?

When MetLife receives a claim for a pregnancy diagnosis, they will review the details to determine the appropriate approval Disability Period for both ante-partum (prior to delivery) and post-partum (after delivery) following the below guidelines:

Normal Vaginal Delivery is approvable for 6 weeks from and including actual delivery date. Cesarean Delivery (C-Section) is approvable for 8 weeks from and including actual delivery date. If you require additional time beyond the standard 6 or 8 weeks post-partum (after delivery), then detailed medical documentation must be submitted to MetLife. A pregnancy claim is also approvable for up to 2 weeks ante-partum (prior to delivery) which does not require that detailed medical documentation be submitted. However, if your first day absent exceeds the delivery date by more than 2 weeks ante-partum (prior to delivery), then detailed medical documentation must be submitted to MetLife.