TWU Summer 2014 Benefits MeetingAugust 19, 2014

Company confidential 2

• Introductions– Arleen Tesoriero, Account Manager

• Account Management • Experience Review• STD Claim Form Review• STD Claim Process• Questions

Agenda

Experience01/01/2011 through 07/31/2014

• Total number of claims since 01/01/2011: 313 claims• 2011-61 claims 2013-103 claims• 2012-115 claims 2014( through July)-34 claims• Average duration of claims:• 2011- 93 days 2013-109 days• 2012- 118 days 2014- 97 days• Average paid per claim• 2011-$5730.96 2013-$6921.50• 2012-$6768.47 2014-$5588.79

Claim Duration by Diagnosis01/01/2013 through 12/31/2013

Diagnosis Approved Claims % Average Duration

Bone, Joint, Muscle 26 25 97

Back Conditions 19 18 121

Circulatory/Heart 12 12 114

Misc/Unclassified 7 7 54

Fracture 5 5 106

Cancer 5 5 165

Digestive 6 6 80

Reproductive/Urinary

6 6 84

Mental Disorders 6 6 155

All others including Respiratory, Maternity,,ENT

11 10 130

Claim Duration by Diagnosis01/01/2014 through 07/31/2014

Diagnosis Approved Claims % Average Duration

Bone, Joint Muscle 9 26 106

Back Conditions 7 21 90

Fracture 4 12 138

Misc/Unclassified 3 9 39

Reproductive/Urinary

3 9 99

Eye, Ear, Nose,throat

2 6 34

Mental Disorders 2 6 151

Suppressed 4 23 100

STD Benefits

• Benefit percentage-Weekly STD benefit is 50% of the first $8,000 of your weekly insured pre-disability earnings, reduced by deductible income

• Plan Maximum-$4,000• Plan Minimum-$15• Maximum Benefit Period-26 weeks. STD benefits end,

though, upon payment of Long Term disability benefits payable under a group plan provided by the employer

• Benefit Waiting period-The longer of the period of sick leave to which you are entitled or 7 days of disability

STD Benefits Cont.

• Definition of disability-You will be considered disabled if, as a result of physical disease ,injury, pregnancy or mental illness:

• You are unable to perform with reasonable continuity the material duties of your own occupation, and

• You suffer a loss of at least 20 percent in your pre-disability earnings when working in your own occupation

• Rehabilitation Plan• Reasonable Accommodation Expense Benefit• Exclusions/Limitations

Intake Method Paper/Fax Web

Cost of Service No additional cost No additional cost

High-level Claim Submission Process

Employee and employer complete paper packet of forms and submits the completed form to us by mail or fax. Claim packet includes an Employee Statement, Employer Form, Attending Physician Statement and Authorization.

Completed claim forms may be scanned and e-mailed to:NYDBSR@standard.com or faxed to:

1-800-378-8361

Claimant logs onto our website to submit information for the Employee Statement. The claimant then prints off the remaining forms (Employer Statement, Attending Physician Statement, and Authorization) for completion.

Claim Intake

Company Confidential

Check List for Filing STD ClaimEmployer Statement

Employee/Attending Physician

Statement

Authorization to Obtain and Release

Information

Pay Stub & Identification

Page 2 of 7 Page 4 of 7 Page 6 of 7

To be filled out by Benefit Coordinator or Local Union Representative.

Top portion to be completed by employee. Physician Statement must be completed by the physician certifying disability.

To be completed by employee. This form authorizes The Standard to obtain necessary medical information.

Employee to provide most recent pay stub from prior to last day worked and copy of drivers license. If claiming benefits for overtime, employee must provide pay stubs from 52 weeks prior to last day worked.

Company Confidential

Employer Statement Elements• EIN and Date Employed are

important in determining eligibility

• LTD enrollment information needed to determine when STD benefits end

• Other benefits and workers’ compensation

• Predisability Earnings • Sick leave pay and other

compensation• Local Number: drop down box to

chose Local Union #• Include all contact information

for representative completing the form

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Employee/Attending Physician Statement• Employee section must be fully

completed• Employee must sign and date the

form• The Physician Statement must be

completed by the health care provider certifying disability and be signed by a licensed practitioner or his representative

Company Confidential

Authorization

• Authorization needs to be signed and dated by the employee and should be included with initial claim submission

• This form authorizes The Standard to obtain necessary medical documentation to assist in claim adjudication.

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Fast Track Claims· Pregnancies· Short recovery surgeries· Employee has returned to work· Death

Short Duration Claims· Hypertension· Diabetes· Mental Health· Migraine· Foot Disorders

Long Duration/Complex Claims· Disability expected to exceed STD

maximum benefit period· Complex / multiple diagnoses· Preexisting condition claims· Claim filed late

Claim Review· Claim information reviewed by Benefits Examiner with additional information confirmed with treating physician or employee as needed· Claim decision is made· Duration managed by Benefits Examiner with input from The Standard’s Integrated Disability Management team which includes Nurse and

Vocational Case Managers and Physician Consultants as needed

Completed STD claim transitions from Intake team· Claim assigned to Benefits Examiner to review eligibility for STD benefits· Claim information updated in AdminEase ReportsOnline – claim status will change to Pending· Employee is sent a letter every 15 business days while the claim remains pending

Disability Specialist Triage· Claims assigned based on complexity with most complex cases

assigned to Disability Benefits Specialists

STD Claim Review

Appropriate resources

applied to every claim

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Wrap Up

Questions/Comments?

Thank you for having us!

We value your business and look forward to a successful 2014!