The HealthChoice Disability Plan
The HealthChoice Disability Plan is designed to provide employees with partial replacement of income lost as a result of a disabling illness or injury. The Plan is not unemployment insurance, Workers’ Compensation, Social Security Disability, or disability retirement. Premiums are paid by your employer.
Disability benefits are limited to a maximum benefit period based on an employee’s disability, years of service, and age at the time of disability.
Before any benefits are paid by the Disability Plan, an employee must complete a 30-day elimination period. Benefits are calculated using the employee’s base salary at the time the disability began. Benefits are subject to state and federal taxes.
Plan benefits are reduced (offset) by other income the employee receives that is related to their disability. (See Benefit Offsets/Reductions in Benefits)
To remain eligible for disability benefits, an employee must provide proof of continuing disability as required, as well as participate in a rehabilitation program, as appropriate.
Disability benefits are divided into two types:
- Short-term disability benefits are paid for a maximum of 150 days (after the 30-day elimination period). The Plan pays a monthly benefit equal to 60% of the employee’s base salary less any offsets. The maximum monthly benefit is $2,500. There is no minimum monthly benefit.
- Long-term disability benefits begin after the 180 days of short-term disability ends. The Plan pays a monthly benefit equal to 60% of the employee’s base salary less any offsets. The maximum monthly benefit is $3,000, and the minimum monthly benefit is $50.
Any disability payments made for a partial month are prorated. (See OSEEGIB Rules 360:15-1-11)
Maximum Benefit Period
The maximum benefit period is based on the employee’s type of disability, years of service, and age at the time their disability occurred. Benefits end when the disability ends, when the employee reaches the end of the maximum benefit period, or when the employee dies. (See OSEEGIB Rules 360:15-1-19)
|Age at Disability
||Maximum Benefit Period
|Employees with less than one year of service
|Employees with less than five years of service
|Age 66 and younger
|69 and older
|Employees with five or more years of service
|Age 59 and younger
||Up to age 65
|69 and older
Benefit Offsets/Reduction in Benefits
Short-term and long-term disability benefits are offset, or reduced, by other benefits or payments the employee receives, or is eligible to receive, for any period of disability. (See OSEEGIB Rules 360: 15-1-12)
Offsets include but are not limited to:
- Available sick, annual, or shared leave
- Earnings the employee receives from any other employment; however, longevity pay and one-time bonuses are not considered offsets
- Unemployment compensation benefits
- Social Security benefits related to the disability, excluding:
- Social Security benefits unrelated to the current disability
- Social Security widow’s/widower’s benefits unrelated to the current disability
- Supplemental Security Income Program awards
- Benefits paid to the employee by State of Oklahoma or county retirement systems, except those benefits that began prior to the disability
- Disability related benefits paid under workers’ or workman’s compensation law, occupational disease law, or other similar act or law
- Fifty percent of any wages earned while partially disabled or during limited return to work (rehabilitative employment)
- Overpayment of disability payments including retroactive Social Security Disability awards
- Veterans Administration benefits
- Disability benefits paid by another group plan, except in the following conditions:
- Plans funded entirely by the employee’s contributions
- Plans where payment of benefits reduces benefits at retirement
- Benefits paid for conditions documented one year or more before the date of the disability claim
- Profit-sharing plans, 401K plans, thrift plans, individual retirement accounts, stock ownership plans, tax sheltered annuities, or benefits from non-qualified deferred compensation plans
Statutory or cost of living increases from pension or pension disability programs, Social Security, or workers’ compensation will not reduce monthly disability benefits.
If lump sum benefits are received, GHS Property & Casualty will prorate these benefits over the benefit period or the employee’s expected lifetime.
Benefit offsets can be estimated if they have not yet been awarded, denied, or if a denial is being appealed. Any overpayment or underpayment must be repaid by the responsible party once actual benefits are determined.
Returning to Work/Partial Disability
A time of partial disability may follow a period of total disability. An employee is considered partially disabled if they can perform at least one of the duties of any occupation, but earns less than 80% of their pre-disability gross base salary. If an employee is able to return to work, their disability benefits are reduced by 50% of any income earned from any other employment.
Partial disability must result from the same condition as the total disability. Proof of partial disability must be submitted within 31 days of the date the employee’s total disability period ends. (See OSEEGIB Rules 360:15-1-8)
Partial disability benefits are available for up to 24 months, or until the employee:
- Reaches the maximum benefit period
- Earns gross wages from any employment equal to 80% or more of their pre-disability gross base salary
A recurrent disability is when an employee has a relapse of a condition related to or caused by a prior disability for which they received benefits under the Plan. A recurrent disability is considered a continuation of the prior disability if the employee has been back to their regular full-time job for less than six months and performed all the assigned duties of that job. A recurrent disability does not alter the beginning date of a benefit period and does not require another 30-day elimination period.
If an employee has been back to their regular full-time job for more than six months, the recurrent disability is treated as a new disability. In this case, a new 30-day elimination period applies.
Multiple disabilities occur when an employee experiences a second, unrelated disability while already receiving disability benefits. If the second disability claim is eligible for benefits, the two claims are combined into one continuous disability period.
Participation in the HealthChoice Disability Plan is limited to state employees and participating county employees. Dependents are not eligible for disability insurance.
To participate in the Plan, employees must be actively at work and regularly scheduled to work at least 1,000 hours per year.
Enrollment in the Plan begins the first day of the month following the employment date, or the date the employee becomes eligible based on your employer’s rules.
To be eligible for disability plan benefits, an employee must:
- Be a covered employee of your participating employer
- Have been on duty at least 31 consecutive days
- Meet the Plan’s definition of a disabled individual
- Provide documentation of their medical condition
- File their claim within one year of the date of disability
An employee who is confined in a correctional institution for conviction of an offense is not eligible for disability plan benefits. (See OSEEGIB Rules 360:15-1-29)
An employee is considered disabled if, as a result of injury or illness, they are unable to perform the material duties of their occupation and the condition is expected to last 31 consecutive days or longer. A disability may or may not be related to the employee’s employment. After 24 months, a disability is defined as the employee’s inability to perform the material duties of any gainful occupation for which they are or may become reasonably qualified for by training, education, or experience. (See OSEEGIB Rules 360:15-1-2)
The disability must be documented and certified by a qualified physician and cannot be related to a preexisting condition.
A preexisting condition refers to an illness or injury for which the employee received medical care, diagnosis, consultation, treatment, or prescribed drugs or medicines during the 90-day period immediately preceding the employee’s employment date.
The elimination period is the first 30 days following the onset of an illness or an injury when no benefits are paid. An employee is eligible for disability benefits on the 31st day of disability.
The HealthChoice Disability Plan is only available to current employees.
If an employee leaves employment and continues to meet disability eligibility requirements, they can continue to receive disability benefits until their maximum benefit period is reached. (See Maximum Benefit Period)
Written notice of a claim for disability benefits should be provided to GHS Property & Casualty, the HealthChoice disability claims administrator, within 60 days following the beginning of the disability. GHS has the right to waive the 60-day notice requirement for good cause.
Disability claims are accepted only if they are filed within one year of the date of disability.
The disability benefit period begins after the 30-day elimination period, and employees are eligible for benefits beginning the 31st day of their disability.
Mental health and substance use disorder disability benefits have a maximum benefit period of 24 months from the date the employee becomes disabled. There is a lifetime benefit period of 60 months for mental health and substance abuse benefits.
Filing for Social Security Disability
To remain eligible for long-term disability benefits, an employee must apply for Social Security Disability benefits by the seventh month of their disability. If Social Security denies the employee’s application and the employee does not appeal the denial, plan benefits are terminated. If after 24 months of disability, Social Security has still not found the employee eligible for disability benefits the employee’s benefits under the Plan will be terminated. Exceptions to this rule may be granted by OSEEGIB on a case-by-case basis. (See OSEEGIB Rules 360: 15-1-11)
The HealthChoice Disability Plan provides assistance to employees through a company called Allsup, Inc. This service is provided at no cost to the employee; however, the employee is under no obligation to use Allsup’s services.
When appropriate, an employee is referred to Allsup by the HealthChoice disability claims administrator, GHS Property & Casualty. Have your employee contact GHS for more details. (See Contact Information for the Disability Plan)
Insurance Coordinator Training/Responsibilities
If you have employees receiving HealthChoice Disability Plan benefits, the disability claims administrator, GHS Property & Casualty, sends you a monthly Employer Report Form. To avoid delays or problems with your employees’ disability benefits, this form must be completed and returned to GHS Property & Casualty as quickly as possible.
The form requests the following employee information:
- Salary at onset of disability
- Present salary
- Employment status
- Insurance premiums deducted, if any
- Leave time used
- Any other financial compensation
The Employer Report Form cannot be used to make eligibility changes. Coverage changes must go through normal procedures.
If you feel you need additional training to administer your employees’ disability benefits, GHS Property & Casualty is available to assist you. GHS Property & Casualty can answer questions about how to complete forms, how the use of leave affects disability benefits, and how premium deductions are handled.
GHS Property & Casualty representatives can conduct training on-site or in their offices, whichever you prefer.
To request training, please contact GHS Property & Casualty at 1-405-316-7492 or toll-free 1-800-722-2567, extension 7492.
Contact Information for the Disability Plan
|OSEEGIB Member Services
www.sib.ok.gov or www.healthchoiceok.com
|Oklahoma City Area
|All Other Areas
|OSEEGIB Main Number
|GHS Property & Casualty
|Oklahoma City Area
|All Other Areas
GHS Property & Casualty Insurance Company
P.O. Box 660906
Dallas, TX 75266