SELF-INSURED
SHORT TERM DISABILITY PLAN
For Eligible California
City College San
Francisco
Effective
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I. ELIGIBILITY
AND EFFECTIVE DATE OF COVERAGE
A. Eligibility
Certain
classified employees (not covered by SDI, which has its own State Disability
Plan) of the Employer are eligible for disability coverage.
B. Effective
Date of Coverage
An
individual in a covered class of employment on the effective date of this Plan
is immediately eligible for coverage. New employees in a covered class will become
eligible on the date of their employment.
Any
Employee who initially accepts coverage under this Plan may subsequently elect
to withdraw from the Plan within ten (10) days following the effective date of
any amendment to the Plan or, for any other reason, on the first (1st) day of
the first (1st) Calendar Quarter following the date of such election, by
notifying the Employer in writing. Any eligible Employee who has rejected
coverage or who has withdrawn from the Plan and who subsequently elects, in
writing, to be covered under the Plan, shall
be covered on the date the Employer receives written application.
II. DISABILITY
BENEFITS
Any
Employee covered under the Plan who becomes disabled by any physical or mental
illness or injury including pregnancy, childbirth or related medical
conditions, so as to prevent him or her from performing his or her regular or
customary work, will be paid benefits for the period of such disability as
follows, subject to the provisions of the "Limitations and
Exclusions" listed in Section III. For any Employee who participates in a
vocational rehabilitation plan in accordance with the California Labor Code,
regular or customary work will mean, upon completion of such rehabilitation
plan, only that employment for which the Employee has been retrained.
A. Amount of Benefits
The amount of
weekly benefit for which an Employee is covered under the Plan (subject to any
Plan Limitations and Exclusions) shall be equal to 55% of the Employee's
Regular Salary to a maximum of the California Workers’ Compensation temporary
disability indemnity weekly benefit amount in effect at the time of the
commencement of the Employee’s disability.
B. Benefits
for Less Than One (1) Week
For each day of any period of disability for which benefits are paid
and which is less than a full week, the amount of benefit payable shall be
one-seventh (1/7th) of the amount of the weekly benefit.
C. Maximum Benefit Period
The Maximum Benefit Period
payable for any one Disability Benefit Period shall be ninety (90) days.
D. Benefit Waiting Period
Benefits will begin on
the eighth (8th) consecutive day of disability, provided the employee has been
examined by or is under the care of a Physician during some portion of that
eight-day period of disability.
E. Reductions
Because of Other Benefits
The
benefit payments from this Plan will be reduced by the gross benefits, which
are paid from the following:
1. All wages (with the exception of vacation pay) that an Employee
receives from any employer or self-employment.
2. Workers’ compensation benefits for which the employee receives, or is
entitled to receive for: a) temporary or permanent disability indemnity, under
a workers' compensation or employer liability law of this state, or any other
state, or the federal government; or b) a maintenance allowance, except when
certain conditions are met. If such workers’ compensation benefits for a)
temporary or permanent disability or b) a maintenance allowance combined with
permanent disability indemnity, are less than the amount the Employee would
otherwise receive as benefits under this Plan, he/she shall be entitled to
receive for such day, if otherwise eligible, disability benefits, reduced by
the amount of such workers’ compensation benefits.
In the
case of an Employee who is receiving a maintenance allowance, benefits under
this plan will be reduced by the amount of both the maintenance allowance and
the maximum permanent disability indemnity pursuant to Section 2629 (d) (1) (2)
of the California Unemployment Code. In
the case of an employee who does not elect to receive an advance on his/her
permanent disability, the Plan benefits will also be reduced by the amount of
the permanent disability indemnity to which the Employee would have an
entitlement under the Labor Code had he/she requested same.
3. Any disability benefits
an Employee receives from any State Disability Plan
III. LIMITATIONS
AND EXCLUSIONS
A. No
Benefits Are Payable:
1. For any disability which is not supported by a certificate from a
treating Physician which contains a diagnosis and diagnostic code prescribed in
the International Classification of Diseases, or, where no diagnosis has yet
been obtained, a detailed statement of symptoms. The certificate must also contain a statement
of medical facts, including secondary diagnoses when applicable, within the
Physician’s knowledge, based on a physical examination and a documented medical
history of the claimant by the Physician, indicating his or her conclusion as
to the claimant’s disability, and a statement of his or her opinion as to the
expected duration of the disability.
However, as to any Employee who is hospitalized in or under the care of
any medical facility of the
a. If the Employee submits evidence of receipt
of temporary disability benefits under a workers' compensation law for any day
for which the Employee is entitled to receive Unemployment Compensation
Disability (UCD) benefits reduced by such temporary workers' compensation
disability benefits
b. If any Employee in good faith adheres to the
teachings of any bona fide church, sect, denomination or organization which
depends for healing entirely upon prayer or spiritual means, the certificate of
a duly authorized or accredited practitioner of such bona fide church, sect,
denomination or organization as to the disability of the Employee and the estimated
duration of such disability, will be accepted.
c. If an Employee has been referred or
recommended by competent medical authority to participate as a resident of an
approved alcoholism recovery home, and in the absence of any other disabling
condition, benefits while receiving alcoholism recovery treatment, while a
full-time resident in an approved recovery home, will be paid for a period not
to exceed thirty (30) days, and the Employee shall be eligible for disability
benefits for an additional period not in excess of sixty (60) days if the
referring Physician certifies to the need for continuing resident services.
d. If an Employee has been referred or
recommended by competent medical authority to participate in an approved
drug-free residential facility, and in the absence of any other disabling
condition, benefits while receiving such drug recovery treatment will be paid
for a period not to exceed forty-five (45) days, and the Employee shall be
eligible for disability benefits for an additional period not to exceed
forty-five (45) days if the referring Physician certifies to the need for
continuing resident services; or
e. If an Employee has been ordered not to work
by written order from a state or local health officer because the Employee is
infected with, or suspected of being infected with, a communicable disease.
Such written order shall be acceptable (for the period specified therein) in
lieu of a certificate.
2. If the Employee is involuntarily confined,
pursuant to commitment, court order, or certification, in an institution, or
other place, as a dipsomaniac, drug addict, or sexual psychopath.
3. For any period of disability for which
benefits are paid or payable under any unemployment compensation act of the
4. If any individual has filed with the Employer
a statement declaring the Employee's adherence to the faith or teaching of any
bona fide religious sect, denomination, or organization and in accordance with
its creed, tenets, or principles, depends for healing upon prayer in the
practice of religion, and the Employee's statement disclaims any disability
benefits based on Wages paid while such statement is in effect. This limitation is applicable during the period
when such exemption is in effect and for a period of three (3) months following
recession of such exemption certificate.
5. No benefits are payable to an individual who
is a) incarcerated in any federal, state, or municipal penal institution, jail,
medical facility, public or private hospital, or in any other place because of
a criminal conviction of a federal, state, or municipal law or ordinance or b)
who commits a crime and is disabled due to an illness or injury caused by, or
arising out of the commission of, arrest for, investigation of, or prosecution
of, any crime that results in a felony conviction.
V. CONTRIBUTIONS
Employees
will be notified of the Plan contribution rate, if any, for the next year, no
later than December 31st of the prior year.
VI. TERMINATION
OF INDIVIDUAL EMPLOYEE COVERAGE
An
Employee's coverage will terminate on the earliest of:
A. the date of termination of employment by
termination of the Employer-Employee relationship (including permanent layoff
or reduction in force); or at 12:00 midnight on the fifteenth (15th) day
following the commencement of an Employer approved leave of absence without pay
or a temporary layoff (eligible for recall), without pay, whichever occurs
first. A layoff with no definite return
to work date give by the Employer at the time of the layoff, shall be
considered a termination of the Employer/Employee relationship.
B. the date the individual ceases to be an
eligible Employee.
C. the beginning of the Calendar Quarter next
following the date the Employee has given
written notice of his or her intention to withdraw from the Plan.
D. the date of termination of the Plan by the
Employer.
VII. CLAIMS
Except for good cause, a claim must be filed within forty-one (41)
days from the first compensable day of unemployment and disability. However, an
extension will be granted for showing of good cause for late filing.
To Apply for benefits, telephone ICS at 800/965-1444. If you call between
The Claims
Administrator shall have the right to (A) require supplemental forms from the
Physician or those authorized to certify disabilities as often as deemed
necessary, and (B) examine any Employee claiming benefits under this Plan. Continued medical certification, signed by a
certified Physician or practitioner, must be submitted within twenty (20) days
of the date the Employee is issued a notice of final payment or the Employee
receives a request for additional medical certification, whichever is later.
Additional medical certification may be requested when and as often as may be
reasonably required during the period payments may be due under this Plan.
VIII. COMPLIANCE
The
Employer hereby guarantees that no Employee covered by this Plan, will be
excluded or restricted from this Plan due to age, sex, income or any
pre-existing health conditions.
IX. DEFINITIONS
A.
Claims
Administrator, as used herein, is Innovative Care Systems.
B.
Disability
Benefit Period, as used herein, means the continuous period of unemployment and
disability beginning with the first (1st) day with respect to which the
individual files a valid claim for benefits.
Two (2) consecutive periods of disability due to the same or related
cause or condition and separated by a period of not more than fourteen (14)
days shall be considered as one (1) Disability Benefit Period.
C.
Employer, as
used herein, means City college of San Francisco
D.
Leave of Absence, as used herein, shall mean
an absence from work that has been approved by the Employer under the
Employer’s leave of absence policy.
E.
Physician, as used herein, means any
physician, surgeon, optometrist, dentist, osteopath, qualified licensed
psychologist, accredited practitioner, chiropractor, or podiatrist who is duly
licensed and acting within the scope of his or her practice; or a licensed
midwife, licensed nurse-midwife or licensed nurse practitioner who may certify
only to normal pregnancy and childbirth related disabilities; or a duly
authorized medical officer of any facility of the United States government; or
a practitioner duly authorized and accredited by the Director of the California
Employment Development Department.
F.
Plan, as used
herein, means this Plan established by the Employer.
G.
Termination of
the Employer-employee relationship, means that employment ceases with no mutual
expectation or intention to continue the employment relationship. Reasons for termination of the
Employer-employee include but are not limited to, separation, dismissal,
resignation, and retirement.
H.
Wages, as used
herein, means all earnings received from the employer averaged over the twelve
(12) month period prior to the commencement of a period of disability.
X. OTHER
REQUIREMENTS
The
Plan shall continue in effect for a period of one (1) year form the effective
date and continuously thereafter. Termination shall be effective only on the
anniversary of the effective date of the Plan.