UFCW Midwest - Midwest Health and Pension Funds

United Food & Commercial Workers

Unions and Employers

Midwest Health and Pension Funds

Disability Income Protection

Your plan may not include every benefit mentioned. Refer to your plan booklet to verify which benefits are included in your plan.

Most people count on their wages to pay their everyday living expenses—the rent or mortgage, utility and car payments, plus food, clothing, and personal items for themselves and their families. These bills need to be paid even if you become totally disabled and can’t work. As a covered employee, the Income Protection Benefit helps replace part of your wages to help you pay your personal bills during your disability.

Income Protection

Income Protection, or Time-Loss, is income you receive if you become totally disabled while covered. This coverage does not apply to your dependents.

Total Disability

Total disability results from an accidental injury or illness that leaves you totally unable to do your job. In addition, to be considered totally disabled, you must be under the regular care and treatment of a doctor during the entire period of your disability. Examples of disabilities that would usually fit this definition are a heart attack, pregnancy or a serious car accident.

Any on-the-job injury or illness is not covered under the Plan. If you have an injury or illness which happened or is caused “on-the-job,” contact your employer immediately for claim information.

Eligibility for Income Protection

Under Plan D5 Rate-Per-Hour Eligibility, coverage begins after your Personal Health Coverage has been in effect for at least 4 calendar months. Also, you are covered for a specific disability only if your Personal Health Coverage continues and you have worked an average of at least 28 covered hours per week during weeks which end in 3 of the 4 months immediately before the month in which your disability occurs.

Under Plan D5 Flat-Rate Eligibility, coverage begins at the same time as your Personal Coverage as long as you worked enough hours to qualify for your employer’s regular full-time monthly health contributions; part-time contributions do not qualify. Your eligibility for the Income Protection Benefit terminates on the last day of the calendar month for which your employer last made a full-time monthly health contribution on your behalf.

Plan B5 does not include the Income Protection Benefit.

Benefit Amount

Your Income Protection benefit is equal to 55% of your basic weekly pay, up to a maximum benefit of $250 per week. This amount is figured using your average base weekly pay during the 4 weeks before the day you become totally disabled. Any overtime pay, bonuses, commissions, or other additional pay (such as sick pay) are not used in figuring this 4-week average—only your base or “set” hourly straight-time pay or salary. For partial weeks of disability, you receive one-seventh of the full weekly benefit for each day of absence, including Saturday and Sunday or scheduled day off.

Benefit Period

Income Protection Benefits are available for as long as 26 weeks if you remain totally disabled because of any one continuous illness or injury and remain continuously under your doctor’s regular care and treatment. (If after working less than 4 weeks your disability recurs, it is considered to be continuous.)

Income Protection Benefits will not be paid any longer than:

  • one 26-week period for all conditions related to the same injury, and
  • two 26-week periods for all conditions related to the same illness.

An important note: Benefits are not paid for any day you receive as a paid sick day from your employer.

When Benefits Begin

Income Protection Benefits begin on:

  • the 1st day of an accident
  • the 1st day of hospitalization
  • the 1st day of outpatient surgery
  • the 8th consecutive day of illness

Applying for Benefits

You apply for benefits by filing a Health Claim Form or an Income Protection Benefit Claim Form. The claim form is completed by you, your doctor and your employer.

You should contact the Fund Office as soon as you stop working! Since benefit payments are designed to help you during your disability, don’t wait until you return to work to file a claim. In fact, benefits may not be paid unless you notify the Fund Office within 2 weeks after your disability begins.

Besides filing your claim with the Fund Office, you must also notify your employer about your disability. Most often employers require that you request a medical leave of absence. Note that you are responsible for notifying both your employer and the Fund Office.

Protect Your Continuing Disability Benefits

The Trustees have ensured that the Fund is adequately financed to pay you the benefits that you have earned. However, to guard against disability claims that are not valid, all disabilities require a claim form signed by the physician and the employer. Timely filing of claims is important; it helps you receive your money quickly and it allows the Fund to fully review your medical status at the time you are missing work.

You can help protect your benefits by taking the following actions:

  • See your doctor! To receive benefits, you must be under the continued care of a qualified doctor. Stay in touch with your physician and keep your scheduled office visits. Lack of medical documentation can endanger your benefits.
  • File for benefits at least every three weeks! To process disability benefits, we must know if you are still off work and whether a doctor is certifying your disability. This is why a claim form is required. And if you don’t file for many weeks (or months), the Fund may not be in a position to validate your claim. This can result in a loss of benefits. If you remain off from work, file for benefits at least every three weeks.

Protect Your Continuing Medical Coverage

Your family’s medical coverage may be continued during your disability. The Plan provides for an extension of coverage for up to six months while you are disabled for any one medical condition. If you have previously been away from work due to the same medical condition, you may have less than six-months of extension remaining. Contact the Fund Office if you have any doubts as to how long your coverage will continue. If you remain disabled for a lengthy period, you may need to elect to make payment for your coverage under the Federal law commonly referred to as COBRA.
 

(Updated 03/17/10)