Coordination with Other Paid Does employer require EE Time Off- Self Insured Only to either exhaust or have choice to utilize Sick Days or EIB (Extended Illness Bank) during the EP? If Yes: Elimination Period must be based on the of” Sick Days or 14 “greater days, for example. Upon EP satisfaction: For ASO, ATP (non check cutting clients) Employer may apply offsets as desired. For checking cutting clients, offsets will be determined by the client. Day Hospital Are Accident and Sickness – Confinement Elimination Periods waived for hospital confinement? (Yes/No) First Day Hospital Are Accident and Sickness – Outpatient benefits payable from first day outpatient, provided the (Note: Benefit basis only) employee is disabled on the day following the Elimination Period? (Yes/No) Benefit Duration Indicate the total number of weeks of the Benefit Duration. (ie. Number of weeks benefits are payable) Benefit Duration Look Back For most a Benefit Period Duration Look Back Period Example: If EE has a disability is not applicable. However, if the plan contains this within a rolling calendar year from current disability, we provision, indicate the look must deduct the previous back period of time and if it disability from their current is in days, weeks or years. disability. Example: Disability For example, 26 weeks. If there is a look back period, eff 5/1/13. Matrix checks to see if EE went out of work a history file must be from 5/1/12 up until 5/1/13. If provided. yes, Matrix deducts the # of days that EE was previously on disability from current disability that began 5/1/13. If the lookback reveals that the EE was on disability from 7/1/12 thru 7/30/12, Matrix would deduct 30 days from current disability that began 5/1/13. Note: Applies to ASO STD Only
Coordination with Other Paid Time Off- Self Insured Only Does employer require EE to either exhaust or have choice to utilize Sick Days or EIB (Extended Illness Bank) during the EP? If Yes: Elimination Period must be based on the “greater of” Sick Days or 14 days, for example. Upon EP satisfaction: For ASO, ATP (non check cutting clients) Employer may apply offsets as desired. For checking cutting clients, offsets will be determined by the client. Day Hospital – Confinement Are Accident and Sickness Elimination Periods waived for hospital confinement? (Yes/No) First Day Hospital – Outpatient (Note: Benefit basis only) Are Accident and Sickness benefits payable from first day outpatient, provided the employee is disabled on the day following the Elimination Period? (Yes/No) Benefit Duration Indicate the total number of weeks of the Benefit Duration. (ie. Number of weeks benefits are payable) Benefit Duration Look Back Period Example: If EE has a disability within a rolling calendar year from current disability, we must deduct the previous disability from their current disability. Example: Disability eff 5/1/13. Matrix checks to see if EE went out of work from 5/1/12 up until 5/1/13. If yes, Matrix deducts the # of days that EE was previously on disability from current disability that began 5/1/13. If the lookback reveals that the EE was on disability from 7/1/12 thru 7/30/12, Matrix would deduct 30 days from current disability that began 5/1/13. Note: Applies to ASO STD Only For most a Benefit Duration Look Back Period is not applicable. However, if the plan contains this provision, indicate the look back period of time and if it is in days, weeks or years. For example, 26 weeks. If there is a look back period, a history file must be provided.
COP%20-%20STD%20FINAL%20082017.docx