HUMAN RESOURCES

Effective Date: 07/01/95

Policy Statement 10: Insurance Benefits


Hospitalization Insurance

  1. The State of North Carolina offers a self-insured health insurance program and several Health Maintenance Organization Plans (HMO) for State Employees. Choice of HMO Plans for ECU employees are Healthsource, Inc., and Personal Care Plan with Blue Cross and Blue Shield. Coverage for the employee is free provided he/she is employed in a permanent position 75% to 100% with the self-insured plan. There is an additional charge to the employee when joining one of the HMO's. There is a charge to cover dependents with all the plans. Employees working in part-time permanent positions 50% to 74% may purchase coverage by paying the full expense.

    1. An overview of the State of North Carolina Comprehensive Health Benefit Plan (self-insured plan) is described below:

      (1) Benefits are subject to the deductible and co-payments. Payments are based on the Plan's Usual, Customary and Reasonable (UCR) allowance.

      (2) The maximum benefit for lifetime is $1,000,000.

      (3) $250 deductible per year for the individual and a family deductible of $750.

      (4) You pay 20% of the first $5,000 (after deductible) of allowable benefits.

      (5) This plan is comprehensive and includes physician care, hospital care, outpatient care and coverage for prescription drugs. The handbook for the State of North Carolina Teachers and State Employees' Comprehensive Major Medical Plan should be consulted for specifics on the coverage. This plan provides coverage in-state, out-of-state, and out of United States.

      (6) The employee and eligible dependents may go to the physician of their choice.

    2. An overview of the HMO Plans (Healthsource and Personal Care Plan) is described below:

      (1) Benefits are generally not subject to co-payments or deductibles unless specified by the plan certificate.

      (2) There is no maximum benefit for lifetime unless specified by the plan certificate.

      (3) Coverage is generally for a specific area and emergency treatment is provided as outlined in the specific plan for services provided for outside of the service area.

      (4) A prescription card will be provided to allow the employee to pay a flat fee for prescriptions.

      (5) The plan is a comprehensive plan for physician visits, hospitalizations, outpatient care and prescription drugs. The physicians you see must be on the approved list from the HMO you chose to enroll in.

      (6) The individual plan certificate should be studied for specific details on each plan.

    3. The new employee may gain coverage on the first of the month following the date he or she begins work or on the first of any succeeding month. The exception to this would be nine month faculty beginning in August. They do not receive their first salary until the end of September and therefore health insurance coverage would be effective October 1. Faculty are given the option to pay the full cost to begin coverage effective September 1. If enrolled when first eligible for coverage, there is no waiting period for basic coverage. The only exception is when an employee is rehired as a State Employee within 12 months and did not continue coverage with the health insurance coverage from previous employer if eligible. This would apply to dependents also.

    4. If the employee terminates employment and the last workday occurs before half of the month has been obtained (this calculation includes workdays and holidays), hospitalization coverage will cease at the end of that same month. If the employee works as many as half or more of the workdays including holidays of a month that termination of employment occurs, hospitalization coverage may be extended through the following month.

    5. Employees on approved leave of absence without pay may continue their hospitalization coverage up to one year provided the premiums are paid in advance by the employee to the Human Resources Department. If the employee chooses not to continue coverage while on leave, he/she will need to re-enroll in the health insurance plan upon return to work. This individual and previously eligible dependents would be subject to a 12 month pre-existing clause (anything that existed prior to the effective date of coverage whether diagnosed or not would not be covered under the plan for a 12 month period).

    6. Annually employees are given the opportunity to switch health insurance carriers. This would change coverage effective October 1 of each year. Notification is sent from the State Health Office in Raleigh to all employees outlining their choices and giving the details of each plan.


    Disability Income Plan of North Carolina

    1. The purpose of this plan is to provide equitable replacement income for eligible state teachers and state employees who become temporarily or permanently disabled for the performance of their duty prior to retirement and to encourage disabled state teachers and state employees who are able to work to seek gainful employment after a reasonable period of rehabilitation. The plan further provides for the accrual of retirement and other benefits to the date the eligible state teacher or state employee meets the requirements for an unreduced retirement under the Teachers' and State Employees' Retirement System.

    2. You are a covered participant if you are a state teacher or state employee in service and a member of the Teachers' and State Employees' Retirement System or participant of the University Optional Retirement Program on January 1, 1988, or become a state teacher or state employee or re-enter service as a state teacher or state employee and you are in service and a member of the Teachers' and State Employees' Retirement System or a participant of the University Optional Retirement Program after January 1, 1988. If you meet these requirements, you will automatically become a participant of the Disability Income Plan of North Carolina. Your participation in the Plan is free to you. ECU will make the necessary contributions on your behalf to provide for coverage.

    3. Under the provisions of the plan, disability means:

      The mental or physical incapacity for the further performance of duty (the usual occupation of a participant); provided that such disability was not the result of war, whether declared or not, armed or unarmed military or paramilitary conflict, terrorist activity, active participation in a riot, committing or attempting to commit a felony, or an intentional self-inflicted injury.

    4. A participant is not entitled to receive any benefits from the plan for a period of 60 continuous calendar days from the onset of disability. The 60day waiting period is determined from the last actual day of service, the day of the disabling event if the disabling event occurred on a day other than a normal workday, or the day succeeding at least 365 calendar days after service as a state teacher or state employee, whichever is later. During this waiting period you may be paid such continuation of compensation by exhausting accumulated sick leave, vacation leave or some other salary continuation as provided by your employer. During the waiting period, you may return to service for trial rehabilitation for period of not more than five continuous days of service. Such a return to service will not cause a new waiting period to begin but will extend the waiting period by the number of days of the return to service. Trial rehabilitation during the waiting period is defined as a return to service in any capacity.

    5. Short-term disability benefits are payable after the conclusion of the waiting period, for a period of 365 calendar days provided you meet the following requirements:

      1. You must have at least one year of contributing membership service in the Retirement System earned within 36 calendar months preceding the disability,

      2. You must be found to be mentally or physically disabled for the further performance of your usual occupation, and

      3. Your disability must have been continuous and incurred at the time of active employment.

      The monthly short-term benefit will equal 50% of 1/12 of your annual base rate of compensation last payable to you prior to the beginning of the short-term benefit period (for teachers, annual base rate of compensation includes any local supplement or coaches supplement) plus 50% of 1/12 of your annual longevity payment, if any, to a maximum of $3,000 per month. The monthly benefit will be reduced by any monthly payments you receive for Workers' Compensation (excluding permanent partial Workers' Compensation awards). For the first six months after the beginning of the disability, any benefits payable under the plan will be subject to FICA (Social Security) taxes. Short-term benefits, however, will not be offset by any primary social security benefits you may be receiving. Earnings are permitted during the short-term disability period up to the amount of the short term benefit without reduction in the benefit. If your earnings exceed the amount of the short-term benefits your short-term benefit will be reduced on a dollar-for-dollar basis by the amount your earnings exceed the short-term benefit.

      If you are in receipt of short-term disability benefits, you may return to service for trial rehabilitation for periods of not more than 40 continuous days of service without causing a new waiting period to begin, unless a different disability occurs. Trial rehabilitation during the short-term period is defined as a return to service in the same capacity that existed prior to the disability. The period of rehabilitation employment will not extend the short-term disability period.

      In lieu of short-term disability benefits, you may elect to continue to exhaust any accumulated sick leave, vacation leave, or any other salary continuation as provided by your employer. Such an election will not extend the 365 days duration of the short-term benefit period. An election to receive salary continuation for any part of a given day is in lieu of any short-term benefit otherwise payable for that day. An election to receive a lump sum payout of vacation leave is treated as if you had exhausted the leave and is in lieu of any short-term benefit otherwise payable.

      Short-term disability benefits may be extended for as many as 365 days beyond the short-term period in cases where the Medical Board finds that the disability continues to be temporary and is likely to end during the extended period.

      Employees wanting to apply for benefits under this plan should contact the Benefits Section in Human Resources Department at the end of the waiting period to complete the required forms.

    6. Long-term disability benefits are payable after the conclusion of the short-term disability period or after salary continuation payments cease, whichever is later, for as long as you are permanently disabled but not after you become eligible for an unreduced service retirement, provided you meet the following requirements:

      1. You must have at least five years of contributing membership service in the Retirement System earned within 96 calendar months prior to the end of the short-term disability period.

      2. You must make application to receive long-term benefits within 180 days after the conclusion of the short-term disability period or after salary continuation payments cease, whichever is later.

      3. You must be certified by the Medical Board to be mentally or physically disabled for the further performance of your usual occupation.

      4. Your disability must have been continuous, likely to be permanent, and incurred at the time of active employment.

      5. You are not eligible to receive an unreduced retirement benefit from the Teachers' and State Employees' Retirement System or if you were a participant of the Optional Retirement Program, you must not meet the age and service requirements to qualify for an unreduced benefit from the Teachers' and State Employees' Retirement System.

      The determination of disability and eligibility for long-term benefits will be made by the Plan's Medical Board. The Medical Board may not determine any person to be eligible for long-term benefits who is in receipt of any payments on account of the same disability that existed upon entrance into membership in the Retirement system.

      During the first 36 months of the long-term disability period, the monthly long-term benefit will equal 65% of 1/12th of your annual base rate of compensation that was last payable to you prior to the beginning of the short-term benefit period (for teachers, annual base rate of compensation includes any local supplement or coaches supplement) plus 65% of 1/12th of your annual longevity payment, if any, to a maximum of $3,900 per month. The monthly benefit will be reduced by any monthly payments you receive for Workers' Compensation (excluding permanent partial Workers' Compensation awards) and by any primary Social Security benefits you may be receiving; however, the benefit payable will be no less than ten dollars a month. Earnings are permitted during the first 36 months of the long-term disability period but if the earnings plus the net long-term benefits exceed 100% of your compensation, your long-term benefit will be reduced on a dollar-for-dollar basis.

      After the first 36 months of the long-term disability period, the long-term benefit is calculated in the same manner as described above except that the benefit is reduced by an amount equal to a primary Social Security disability benefit to which you might be entitled had you been awarded Social Security disability benefits. Also, after the first 36 months of the long-term disability period, earnings are permitted equal to the amount of your net long-term benefit without reduction in the benefit. If your earnings exceed the amount of your long-term benefit, your benefit will be reduced by $1 for each $3 of monthly earnings in excess of the net benefit until the sum of the monthly net benefit plus earnings reach 100% of your compensation prior to the disability, at which time your benefit will be reduced on a dollar-for-dollar basis.

      In lieu of long-term disability benefits, you may elect to continue to exhaust any accumulated sick leave, vacation leave or any other salary continuation as provided by ECU. Such an election will not extend the first 36 consecutive months of the long-term disability period. An election to receive salary continuation for any part of a given day is in lieu of any long-term benefit otherwise payable for that day. An election to receive a lump sum payment for vacation leave is treated as if you had exhausted the leave and is in lieu of any long-term benefit otherwise payable.

      When a person receiving long-term disability benefits reaches the age and/or service requirements to qualify for an unreduced service retirement allowance from the Retirement System, the benefits payable from the Plan will cease and the person will commence retirement under the Retirement System. Persons in receipt of benefits under the Plan, who were participants of the University Optional Retirement Program, will receive long-term benefits until the time they would have qualified for an unreduced service retirement allowance from the Retirement System had they elected to be a member of the State Retirement System.

    7. A person receiving benefits under the Plan will earn creditable service in the Retirement System for each month the individual is eligible for and is paid a benefit under the Plan. The only exceptions are that creditable service under this provision will not be earned if the individual is in service and earning creditable service for the same month in any State-administered retirement system or if the individual was a participant of the University Optional Retirement Program.

    8. A person in receipt of benefits under the Plan is covered under the Teachers' and State Employees' Comprehensive Major Medical Plan, with the State contributing toward the cost, provided the person has contributed to the Retirement System at least 5 years as a teacher or state employee at the time of disability. A person in receipt of benefits under the Plan who did not meet these requirements at the time of disability may elect to continue coverage under the Major Medical Plan by paying the full premium required.

    9. A person in receipt of benefits under the Plan, who is a member of the Teachers' and State Employees' Retirement System is considered to be in service and covered by the Survivor's Alternate Benefit under the Retirement System provided the person meets the age and/or service requirements as follows:

      1. Reaching age 60 with 5 years of creditable service (age 55 with 5 years of creditable service as a law enforcement officer), or

      2. Completing 20 years of creditable service, regardless of age, or

      3. Reaching age 50 with 15 years of creditable service as a law enforcement officer.

      The beneficiary named to receive a refund of your contributions and interest under the Retirement System (provided you have named only one principal beneficiary who is living at the time of your death) may choose to receive a monthly benefit for life instead of a refund. If you have named two or more persons or your estate as principal beneficiary, the Survivor's Alternate Benefit does not apply. The benefit equals the same monthly amount you would have been entitled to under Option 2 (100% Joint and Survivorship) had you retired on the first of the month following your death. If you do not want your beneficiary to have this choice, you should so indicate in writing to the Retirement System.

    10. A State teacher or State employee is not covered under the provisions of the Plan during any period while on leave of absence without pay. Therefore, no benefits are payable for any period of disability that begins while an employee is on leave without pay.

    11. Claim forms may be obtained from Benefits Section in the Human Resources Department.


    TIAA Disability Income Plan

    1. This is a disability income plan offered by the Teachers Insurance and Annuity Association (TIAA) only to employees with academic rank who are members of the Optional Retirement Program. The employee may subscribe voluntarily and make payment of the premium through payroll deduction. The computation of premium will be based upon total monthly compensation used for deduction of Optional Retirement Program retirement contributions to include summer school pay.

    2. The plan provides benefits which begin on the first of the month following three consecutive months of total disability and continue during such disability until you reach age 65. However, for a period of total disability beginning after age 60 benefits continue during such disability until you have been totally disabled for a period of 5 years; if such disability occurs at or after age 65, the benefits continue until you reach age 70.

      The monthly income benefit, including any income benefits payable from Social Security for yourself or for your dependents, Workers' Compensation, and any disability benefits payable under any insurance or retirement plan for which contributions are made by the University, or any benefits payable under the Disability Income Plan of North Carolina, is equal to 66-2/3% of your covered monthly salary as of the date the disability began, but not to exceed $10,000 monthly. In no event will the TIAA monthly income benefit be less than $100, even though this amount may bring your total disability income to more than 66-2/3% of your salary.

      Credit will continue to the retirement annuity account with a total contribution of what ECU and the employee would have contributed had the employee remained on the payroll as long as a monthly benefit is being received under the TIAA Disability Income Plan.

    3. Total disability under this program is for the first 12 months of such total disability, the complete inability of the employee, by reason of sickness, bodily injury, or pregnancy, to perform any occupation for which the employee is reasonably suited by education, training or experience.

    4. Provides survivor income for continuation of the monthly income benefit payment for three months after the death of the disabled employee, payable to the surviving dependent.

    5. Provides a conversion privilege to a participant who terminates employment to continue disability coverage if no other coverage is available. A conversion application must be completed by the participant and submitted to TIAA within 31 days from the date of termination of employment.

    6. Enrollment and claim forms may be obtained from the Benefits Section in Human Resources Department.


    Law Enforcement Officers' Supplemental Benefits Available

    1. Supplemental Retirement Income Plan: Once a law enforcement officer has been sworn in for duties, he should complete the enrollment form for Supplemental Retirement Income Plan. ECU pays an amount equal to 5% of your salary into your account in the Plan and you may elect to make additional contributions on a tax-deferred basis. You decide how the contributions in the account are invested and also how you want to receive the contributions when you separate from employment. This is known as the 401(k) Plan.

    2. Separate Insurance Benefits Plan: This provides certain temporary disability and death benefits to qualified active and retired participants.

      You are eligible to become a participant on your date of hire if you are a law enforcement officer employed by the State or any political subdivision of the State and have the full power of arrest with the primary duty of enforcing criminal laws or the detection and prevention of crime, or serving civil processes.

      The benefits under the Plan are:

      1. Accident and sickness insurance,

      2. A death benefit of $5,000 for participants in active service (while being paid salary),

      3. A death benefit of $4,000 for participants who are eligible former officers,

      4. Accidental line-of-duty death benefit of $2,100.

      Payments on account of accidental injury or sickness shall be payable to a participant or his legal representative. Payments on account of death shall be payable to the surviving spouse, if any, or otherwise to the estate of the participant unless the participant had designated in writing since January 1, 1986, another person or persons as beneficiaries and had filed such designation with the Retirement System.

      When you stop work as a law enforcement officer, you will end your participation in the plan unless you:

      1. Have 20 or more years or service as a law enforcement officer, or

      2. Are receiving disability retirement benefits from any State administered retirement system.

      Contact the Benefits Section in Human Resources for claim forms.


    ECU Group Life Policy

    ECU Group Life Insurance Program is with Investors Consolidated Insurance Company. The value of the policy is determined by age and salary. All new employees are required to enroll in the plan as part of their employment contract. A new employee may cancel within 60 days of effective date of coverage and receive a full refund of premiums submitted. Cancellation after that date is possible but no refund of premiums is allowed. Annually in November all policies are reviewed to determine if premiums should increase and employees are given an opportunity at that time to increase coverage if desired.


    State Employee Group Insurance Plan

    There is available to ECU employees who hold a probationary or permanent position at least 50% and above various types of group insurance that may be subscribed to on a voluntary basis by payment of premium through payroll deduction. These plans are underwritten by the Jefferson-Pilot Life Insurance Company, Investors Consolidated Insurance Company and by Transamerica Insurance through the State Employees' Association. The Human Resources Department is responsible for coordination of insurance plans offered to University employees as underwritten by these companies. Anyone who may be interested in any of these plans should visit or contact the Human Resources Department for more information. The various group plans are identified as follows:

    1. Life Insurance - This includes a variety of group life insurance plans such as:

      1. Level Term,
      2. Decreasing Term,
      3. Permanent Cash Value, and
      4. Accidental Death and Dismemberment.

    2. Disability Income Insurance

    3. Cancer Insurance

    4. Intensive Care Insurance

    5. Major Injury Insurance

    6. Individual Hospital Indemnity Insurance


    Death Benefits Through TSERS

    1. University employees who are members of the Teachers' and State Employees' Retirement System (TSERS) and death occurs while still in active service (while being paid salary) after one year as a contributing member, your beneficiary will receive a single lump sum payment. The payment equals the highest 12 months' salary in a row during the 24 months before you die, but no less than $25,000 and no more than $50,000. This benefit is also paid if you die within 180 days of the last day for which you received paid salary.

    2. The Benefits Section in Human Resources can assist in processing all claims for the death benefit. In all cases, it will require that the claim be supported by a certified copy of the death certificate.


    Retiree Hospitalization Insurance Benefits

    One who retires with the Teachers' and State Employees' Retirement System or one who retires with the Optional Retirement Plan with at least five years of state service in a permanent position will be eligible to participate in the State Health Plan or HMO. Application may be obtained from the Benefits Section in Human Resources Department. Any premium due for coverage of dependents may be deducted from the monthly retirement benefit check for those who are members of the Teachers' and State Employees' Retirement System and those enrolled in the Optional Retirement Plan will be billed by the insurance company.