(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.
(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.
Disability Income Plan of North Carolina
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.
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.
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.
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.
TIAA Disability Income Plan
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.
Law Enforcement Officers' Supplemental Benefits Available
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:
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:
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:
Death Benefits Through TSERS
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.