Short-Term Disability (STD)
What is Short-Term Disability?
STD insurance provides a weekly cash benefit after your claim is approved to help pay for expenses when you are out of work due to a covered STD benefit. You receive a weekly benefit once your claim is approved. STD benefits can continue for up to 26 weeks and are payable on the first day of a covered accident. When your claim is approved for an illness/sickness (including pregnancy), benefits are payable on the 8th day from the date of disability.
What are the most common Short-Term Disability claims?
- Pregnancies
- Musculoskeletal disorders affecting the bones, joints muscles, and connective tissues
- Injuries such as fractures, sprains, and strains of muscles and ligaments, as well as digestive disorders, and mental health issues including depression and anxiety
Can I collect a Short-Term Disability benefit if I am receiving other benefits or income?
Yes, the STD plan helps replace weekly earnings if you are disabled and cannot work due to a covered disability. STD is not reduced by any other income, by sick leave pay, or if you have other insurance coverage, or if you are collecting Workers’ Compensation.
If I collected on my Short-Term Disability, do I pay taxes on the funds I received?
STD benefit payments are not taxable when premium is paid by the member with post-tax dollars.
How Does Paid Parental Leave (PPL) Impact Short-Term Disability?
Paid Parental Leave provides eligible employees job-protected, paid time off (up to 12 weeks of fully paid leave without charge to accruals for parental leave completed within seven (7) months of the birth, adoption, or foster care placement of a child (“qualifying event”)).
Short-Term Disability insurance serves as a supplement to PPL for anyone who is having a baby. You must enroll in STD before becoming pregnant to benefit from the coverage. Combined with Paid Parental Leave, STD provides you and your family with extra cash to help you recover from the disability caused by childbirth and the costs associated with taking time to bond with a child.
Can I collect on Short-Term Disability after I give birth? And for how long?
Yes, you can collect for six (6) weeks for a normal delivery and eight (8) weeks for a C-section if you meet the definition of disability. Pregnancy falls under illness as defined by Sun Life. There is a one (1) week waiting period, after which actual payments received are five (5) weeks for a vaginal delivery, seven (7) weeks for a C-section.
If I have a pre-existing condition can I still enroll in Short-Term Disability?
Yes, but there are some limitations on the coverage. For the first 12 months following the effective date of insurance coverage or an increase in insurance coverage, benefits are not payable for disabilities caused by, contributed to by, or resulting from a pre-existing condition. A pre-existing condition is one for which an insured has received medical treatment, consultation, care or services, including diagnostic measures or prescribed drugs or medicine within the 3 months prior to his or her effective date of insurance or increase in insurance.
Do I have to provide Evidence of Insurability when I apply?
If you are a new employee (on the job less than 240 days) in the Professional, Scientific & Technical (PS&T) unit, you may apply with no medical questions asked¹, up to the $400 weekly benefit level. If we do not receive your insurance application(s) within 240 days of your date of hire with the PS&T unit, or if you want to elect coverage of $500, $600, or $700 when you first apply, you can still apply for the insurance, but you will also need to complete an Evidence of Insurability (EOI) form, which must be approved by Sun Life before coverage can begin.
EOI form
How can I cancel my Short-Term Disability insurance benefits?
If you would like to discontinue your coverage for STD, you may do so at any time by sending the PEF Membership Benefits Program (PEF MBP) a written request with your name, date, PEF Membership Identification Number (MIN), and signature to the address found on the bottom of pefmbp.com, or you may email your information to PEF MBP Insurance. Please make sure you are specific about which type of insurance you wish to cancel. Cancellations are effective the day PEF MBP receives your request and deductions will be stopped on the next available payroll. PEF MBP will mail an acknowledgement letter that will include the effective date of your cancellation. The online insurance application is not an acceptable way to cancel coverage. If you have questions, please contact PEF MBP at (800) 767-1840, or (518) 785-1900, ext. 243, opt. 2.
Long-Term Disability (LTD)
What is Long-Term Disability?
LTD insurance provides a monthly benefit if you are out of work longer than six (6) months, due to a covered disability that occurred on-the-job or off-the-job. All active, dues-paying members of PEF who work at least 17.5 hours per week on a regularly scheduled basis are eligible for this plan. The LTD plan offers two (2) levels of coverage: 50% or 60% of your monthly income, up to $7,500 a month. The LTD plan begins to pay benefits after a 6-month Elimination (waiting) Period. The LTD benefit is based on your base salary (excluding items like hazard pay and overtime) and does not take into account earnings from investments or savings plans. Once the Elimination Period ends and your claim is approved, you are eligible for monthly income for as long as you’re disabled, up to the normal retirement age under the 1983 amendments to the Social Security Act. Disabilities that start between the ages of 60 and 69 are covered from 1 to 5 years. Disabilities that start at or after age 69 are covered for 12 months. Consult your insurance certificate for details.
What are the most common Long-Term Disability claims?
- Musculoskeletal disorders affecting the bones, joints muscles, and connective tissues
- Cancer
- Injuries such as fractures, sprains, and strains of muscles and ligaments
- Mental health issues
- Circulatory issues such as a heart attack or a stroke
Are there offsets for Long-Term Disability insurance coverage?
The LTD benefit is reduced or offset by benefit payments by other sources of income for which you may receive, such as:
• Workers’ compensation
• Social Security (Primary and Family source)
• Disability pension or any New York state retirement payments
• Any other group benefits for disability, retirement, or unemployment
• Benefits from your sick pay program (these will offset benefits payable under this LTD program only when the combined benefits exceed 85% of income)
However, your LTD benefit payments will not be reduced if Social Security benefits increase for general cost-of-living adjustments. Regardless of how much in other benefits you may be eligible for, your LTD benefit will not be less than $200 a month. For a complete list of other income benefits, please refer to the plan certificate.
For more information on LTD and offsets, contact PEF MBP at (800) 767-1840, or (518) 785-1900, ext. 243, opt. 2.
Do I have to provide Evidence of Insurability when I apply for Long-Term Disability?
If you are a new employee (on the job less than 240 days) in the Professional, Scientific & Technical (PS&T ) unit, you may apply with no medical questions asked¹. If we do not receive your insurance application(s) within 240 days of your date of hire with the PS&T unit, you can still apply for the insurances, but you will also need to complete a Evidence of Insurability (EOI) form, which must be approved by Sun Life before coverage can begin.
EOI formIf I become disabled, how long will I have to wait before receiving Long-Term Disability benefits?
Payments start after you have been disabled for six (6) months and your claim is approved by Sun Life.
With Long-Term Disability, what happens if I go back to work, and then become disabled from the same cause?
If during the six (6) month Elimination Period, you return to work for less than 15 consecutive days and become disabled from the same cause, there is no interruption in calculating the Elimination Period. You can be partially disabled during the elimination period and still be working; however, benefits still will not be paid until after the Elimination Period. If after receiving benefits, you return to work for less than six (6) months only to become disabled again from the same cause, you do not have to go through another Elimination Period to resume benefit payments.
Does the Long-Term Disability cover illnesses that occur before the insurance goes into effect?
If you received treatment or took medication for a condition in the six (6) months before your effective date, benefits will not be payable for the first 12 months. This applies only to the first 12 months after your effective date.
Does Long-Term Disability cover mental and nervous illnesses?
Yes, but those benefits are limited to 24 months. This limitation does not apply to periods of confinement in a hospital, or another qualified institution, for treating mental and nervous disorders, alcoholism, and drug addiction.
What happens with my Long-Term Disability insurance coverage if I leave my present job and I am no longer a PEF member?
If you are no longer in a PEF-represented position or have left state service, you have the option to convert to an individual policy and keep your current coverage. (Only applicable to past PEF members with 12 consecutive months of employment before termination.)
How can I cancel my Long-Term Disability insurance benefits?
If you would like to discontinue your coverage for LTD, you may do so at any time by sending the PEF Membership Benefits Program (PEF MBP) a written request with your name, date, PEF Membership Identification Number (MIN), and signature to the address found on the bottom of pefmbp.com, or you may email your information to PEF MBP Insurance. Please make sure you are specific about which type of insurance you wish to cancel. Cancellations are effective the day PEF MBP receives your request and deductions will be stopped on the next available payroll. PEF MBP will mail an acknowledgement letter that will include the effective date of your cancellation. The online insurance application is not an acceptable way to cancel coverage. If you have questions, please contact PEF MBP at (800) 767-1840, or (518) 785-1900, ext. 243, opt. 2.
Group Term Life Insurance (GTL)
Do I have to provide Evidence of Insurability when I apply for Group Term Life insurance?
If you are a new employee (on the job less than 240 days) in the Professional, Scientific & Technical (PS&T) unit, you may apply with, no medical questions asked¹, for up to three times your Basic Annual Earnings. In addition, you may elect $20,000 of spouse/domestic partner coverage and $15,000 of coverage for each eligible dependent child. Coverage that does not require proof of good health will begin the day your enrollment form is received by the PEF MBP. If we do not receive your insurance application(s) within 240 days of your date of hire with the PS&T unit, you can still apply for the insurance(s), but you will also need to complete a Evidence of Insurability (EOI) form, which must be approved by Sun Life before coverage can begin.
Can I apply for Group Term Life insurance coverage on my dependents only?
No, you must have coverage on yourself to be eligible to apply for dependent coverage.
How much will my Group Term Life insurance premiums be for my dependent coverage?
Premiums are based on the member’s current age and are a flat bi-weekly rate. Spouse/domestic partner level of coverage cannot exceed the member’s coverage.
I’m retiring. Can I maintain my current Group Term Life insurance benefits?
Yes, but you must join PEF Retirees in order to maintain your current benefits. Failure to join PEF Retirees will result in you being in an ineligible class for this insurance, resulting in cancellation of your policy. PEF Retiree dues can be paid by either a flat rate of $41 per year, or by Pension Deduction at $3 per month ($36 per year). For further information, you may contact the PEF Retirees directly at: (800) 342-4306, ext. 288, or (518) 785-1900, ext. 288.
Who is my Group Term Life insurance beneficiary(ies)?
For privacy reasons, PEF MBP is unable to tell you over the phone who is listed as your beneficiary(ies). PEF MBP will mail a letter to the address on file stating who your current beneficiary(ies) is on your policy and PEF MBP will also include a Change of Beneficiary form that you can send back to PEF MBP if you would like to change your beneficiary(ies). Once PEF MBP receives the form, PEF MBP will send you a written confirmation of the change.
What is the Accidental Death & Dismemberment benefit with Group Term Life insurance?
If you apply for GTL insurance coverage for yourself or your dependents, you and your dependents are automatically covered for Accidental Death and Dismemberment (AD&D) coverage. Accidental Death coverage provides an additional benefit equal to the amount of your life insurance coverage and is payable if your death occurs as a direct result of a covered accidental bodily injury sustained while insured, provided death occurs within 365 days of the accident.
This plan pays a benefit if, while insured, you suffer a covered bodily injury caused by an accident and if, within 365 days after the accident, you lose, as a direct result of the injury, a hand, foot, or eye. The amount payable for any one loss is equal to one half the amount of your Accidental Death benefit. You may also be eligible for benefits ranging from 25% to 100% of your Accidental Death benefit for accidental losses that result in paraplegia, quadriplegia, or hemiplegia. However, no more than an amount equal to your full life insurance coverage is payable for all covered losses resulting from one accident.
• Loss of limb means severance of the hand or foot at or above the wrist or ankle joint.
• Loss of sight, speech, or hearing must be total and irrecoverable.
• Loss of thumb and index finger means severance through or above the metacarpophalangeal joints.
• Quadriplegia means the total and permanent paralysis of both upper and lower limbs.
• Paraplegia means the total and permanent paralysis of both lower limbs.
• Hemiplegia means the total and permanent paralysis of the upper and lower limbs on one side of the body.
What is the Group Term Life Insurance “Accelerated Death Benefits” (ADB)?
Should you or your spouse/domestic partner become diagnosed as terminally ill (certified with a 12-month-or-less life expectancy, the Accelerated Death Benefit (ADB) provides an accelerated payment of a portion of the terminally ill person’s life insurance proceeds. Your request cannot exceed 80% of the in-force amount of your GTL insurance and is subject to a minimum. See certificate details for more information.
How can I cancel my Group Term Life insurance benefits?
If you would like to discontinue your coverage for GTL, you may do so at any time by sending the PEF Membership Benefits Program (PEF MBP) a written request with your name, date, PEF Membership Identification Number (MIN), and signature to the address found on the bottom of pefmbp.com, or you may email your information to PEF MBP Insurance. Please make sure you are specific about which type of insurance you wish to cancel. Cancellations are effective the day PEF MBP receives your request and deductions will be stopped on the next available payroll. PEF MBP will mail an acknowledgement letter that will include the effective date of your cancellation. The online insurance application is not an acceptable way to cancel coverage. If you have questions, please contact PEF MBP at (800) 767-1840, or (518) 785-1900, ext. 243, opt. 2.
Accident Insurance
Can I get accident coverage for myself and my family?
Coverage is available for the PEF member, PEF Member and Spouse/Domestic Partner, the PEF member and any number of children, and the PEF member and the entire family. The bi-weekly cost reflects the coverage chosen.
Who do I call with questions about my claim?
If you have any questions regarding Accident insurance or existing coverage, please call PEF MBP Insurance at (800) 767-1840 or (518) 785-1900, ext. 243, opt. 2, before submitting a claim.
What happens once my claim is approved?
The benefit amount you receive will depend on your injury and/or the treatment provided. Remember, benefits are payable only once for each covered accident, unless noted otherwise in the benefit schedule.
Is there a time schedule that I need to follow?
Injuries and other related benefits due to a covered accident must be diagnosed or treated within a defined period of time from the date of your accident. This could be as few as three (3) days for certain benefits. Please refer to your Certificate for details.
Can I take my insurance with me if I leave my position with New York State?
If you leave your PEF position with the State, you cannot take your insurance with you.
Hospital Indemnity Insurance
Who do I call with questions about my claim?
If you have any questions regarding Hospital Indemnity insurance or existing coverage, please contact PEF MBP Insurance at (800) 767-1840 or (518) 785-1900, ext. 243, opt. 2, before submitting a claim application.
Do I need to file my claim within a certain timeframe?
You should file your claim within 30 days of a covered confinement or as soon as reasonably possible.
What if I have a pre-existing condition?
If your hospital stay is due to a pre-existing condition, benefits may not be payable if the diagnosis or treatment for your sickness was in:
- the first 12 months following your coverage effective date, or
- 12 months after any increase in your amount of coverage.
A pre-existing condition includes anything you have sought treatment for in the three (3) months prior to coverage becoming effective. Treatment can include consultation, advice, care, services, or a prescription for drugs or medicine.
How does Dependent Children Hospital Indemnity insurance apply to newborn children, newly placed foster children or newly adopted children?
If you are insured under the Policy, but do not have Dependent Children Hospital Indemnity insurance when a newborn child, newly placed foster child, or newly adopted child becomes one of your Dependent Children, then such child will automatically be covered for 31 days from the date he or she becomes your Dependent Child, provided you:
- enroll for Dependent Children Hospital Indemnity insurance within 31 days from the date the newborn child, newly placed foster child, or newly adopted child becomes your Dependent Child; and
- pay the required premium for your Dependent Children Hospital Indemnity insurance.
What benefits will I receive for my newborn child?
Benefits payable for your newborn child will depend on where their stay occurs. If your baby is receiving routine newborn nursery care, the regular hospital confinement benefits are payable. If your newborn stays in the Neonatal Intensive Care unit (NICU), the Intensive Care Unit (ICU) benefits will be paid.
Can I take my insurance with me if I leave my position with New York State?
If you leave your PEF position with the State, you cannot take your insurance with you.
Specified Disease Insurance
What if I have a pre-existing condition?
If your diagnosis is due to a pre-existing condition, benefits may not be payable if the diagnosis or treatment for your sickness was in:
- the first six (6) months following your coverage effective date, or
- six (6) months after any increase in your amount of coverage.
A pre-existing condition includes anything you have received treatment for in the six (6) months prior to coverage becoming effective. Treatment can include consultation, advice, care, services, or a prescription for drugs or medicine.
Who do I call with questions about my claim?
If you have any questions regarding Specified Disease insurance or existing coverage, please contact PEF MBP Insurance at (800) 767-1840 or (518) 785-1900, ext. 243, opt. 2, before submitting a claim.
How do I get the Wellness Screening Benefit?
You may be paid the benefit when you or a covered family member submits proof of a covered screening each year, like specific blood tests, cancer screenings, cardiac stress tests, immunizations, school sports exams, and more.
Can I receive benefits for more than one Specified Disease?
Yes. You can only claim benefits once for each covered condition unless a recurrence benefit is payable.
Can I take my insurance with me if I leave my position with the State of New York?
If you leave your PEF position at the State, you cannot take your insurance with you.
Military Leave
I’m going on Military leave. What happens to my insurance benefits?
Group Term Life
Group Term Life insurance coverage can be continued for up to 12 months at no charge to you for your approved military leave. A death claim would be eligible for payment if death occurs while covered. No benefits would be paid under the Accidental Death and Dismemberment (AD&D) feature of your coverage for a loss caused, or contributed to, by war or any act of war whether war is declared or not.
Short-Term Disability
Coverage cannot be maintained while on an approved leave of absence. The current contract specifically excludes disability caused by “war or act of war” and states that coverage will be terminated on the date you cease to be in an eligible class including leave for military service. When you return to active employment, you must notify PEF to initiate reinstatement of your coverage. You must request reinstatement of your coverage within 240 days of your return to active work.
Long-Term Disability
You may continue your coverage for six (6) months while on an approved leave of absence. The current contract specifically excludes disability caused by “war or act of war” and states that coverage will be terminated on the date you cease to be in an eligible class including leave for military service. If your leave extends beyond six (6) months, when you return to active employment with NYS, you must notify PEF MBP and request to reinstate your group LTD coverage. You may contact PEF MBP at: (800) 767-1840, or (518) 785-1900, ext. 243, opt. 2. To maintain your voluntary insurance benefits while on Military Leave, complete the application accessible below.
Have additional questions?
For additional questions, please contact PEF MBP at (800) 767-1840, or (518) 785-1900, ext. 243, opt. 2. You may also email PEF MBP insurance.
