Glossary | MetLife

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 an injury or illness. This is used to calculate how much disability income a policyholder will qualify for in the case of an 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 cannot perform the duties of your Own Job and cannot earn more than 80% of your Pre-Disability Salary. You will need to receive Appropriate Care and Treatment from a doctor and comply with this treatment.

Disability Insurance: An insurance product that provides 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 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 example, working at least 30 hours per week. For State of Tennessee, 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.

M

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

Minimum Weekly Benefit (STD): The lower-end limit of how much STD 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 predisability 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 State of Tennessee plans are calculated monthly. Please refer to the “Rates” tab at the top of this page to calculate premiums.

S

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