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Active Employee
An Employee means an Employee as defined in the Act.
Approved Practitioner
A person who provides medical service and care within the scope of his or her licensure and training which is consistent with national and community medical practice standards and acting within the scope of his or her license (other than a hospital resident or intern), who is a Doctor of Medicine or Doctor of Osteopathy. The term "approved practitioner" shall not be deemed to include a Doctor of Chiropractic, a Doctor of Dentistry, a Doctor of Optometry, a Doctor in Psychology, a Licensed Audiologist, a Licensed Master Social Worker-Advanced Clinical Practitioner, a Licensed Chemical Dependency Counselor, a Licensed Hearing Instrument Fitter and Dispenser, a Licensed Dietitian, a Licensed Marriage and Family Therapist, a Licensed Professional Counselor, a Licensed Speech-Language Pathologist, a Doctor of Podiatry, an Advanced Practice Nurse, a Physician Assistant, a Licensed Occupational Therapist, a Licensed Physical Therapist, a Licensed Acupuncturist, a Licensed Psychological Associate or a Licensed Surgical Assistant. An acute and temporary total disability may be certified or attested to by a Doctor of Podiatry licensed by the Texas State Board of Podiatric Medical Examiners if the acute and temporary total disability is caused by a sickness or injury that may be treated within the scope of the license of such Doctor of Podiatry. Such terms shall have the meaning assigned to them by the Texas Insurance Code. |
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Disability Evidence of Insurability
Evidence of Insurability (EOI) means such evidence, provided at no expense to ERS or Dearborn National, including medical records and a physical examination, as may be required by Dearborn National, to determine that the individual for whom coverage is sought is an acceptable risk for issuance of new coverage or for increases in existing coverage, required pursuant to the Rules of the Board of Trustees of the Employees Retirement System of Texas.
Dearborn National must review the EOI and approve coverage before such coverage becomes effective. The effective date of coverage will be later than the approval date.
Disability EOI applications are located in the Forms section of this website. Completion and filing Instructions are also located on this page.
Employee
Employee means an individual eligible to participate in the Group Benefits Program under Chapter 1551, Texas Insurance Code, as provided in Section 1551.101 in that chapter.
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Initial Period of Eligibility
The first 31 days of employment a person is eligible to enroll in Short-term Disability and Long-term Disability. Those persons who decide to enroll in disability insurance coverages or increase some optional coverages after those first 31 days, will be required to provide evidence of insurability (EOI) which is acceptable to Dearborn National.
Integration
The reduction of your Short-term Disability or Long-term Disability monthly income benefit due to other sources of income such as Workers' Compensation, ERS or TRS disability retirement benefits, social security (for Long-term Disability) and other group disability benefits, is called Integration. If Integration is used to reduce your Short-term Disability or Long-term Disability monthly income benefit, 70% of your insured monthly salary is used in the calculation of your benefit. |
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Long-Term Disability
Long-term Disability insurance pays a monthly benefit to replace a portion of your income for an extended period of time if you are totally disabled and unable to work. |
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Monthly Income Benefit
The amount of any Short-term Disability or Long-term Disability payment that will be made on a monthly basis as the payment of an approved claim for such Short-term or Long-term Disability plan benefits. |
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Qualifying Life Event
A qualifying life event allows you to apply for or change coverages outside of Annual Enrollment. This includes a change in marital status, a change in dependent status, a change in employment status, a change of address that results in loss of benefits eligibility, a change in Medicare or Medicaid status, a significant cost of benefit or coverage change imposed by a third party provider, or a change in coverage ordered by a court. |
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Short-Term Disability
Short-term Disability insurance pays a benefit to replace a portion of your income for up to five months if you are totally disabled and unable to work.
Social Security Disability
Social Security Disability insurance pays benefits to you if you are "insured," meaning that you worked long enough and paid Social Security taxes. For more information regarding Social Security Disability Insurance, visit Social Security Online.
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Total Disability or Totally Disabled (for the Short-term and Long-term Disability Income Benefit)
For the first 24 months benefits are payable, this means the inability of the covered Employee, because of an injury or sickness established by medical evidence based on objective clinical findings using current American Medical Association guidelines and certified by an approved practitioner operating within the scope of his or her licensure and practice, to perform the usual tasks of his or her occupation in such a way as to procure or retain employment.
After benefits have been paid for 24 months of continuous disability, Total Disability will mean the inability of the covered Employee, because of an injury or sickness established by medical evidence based on objective clinical findings using current American Medical Association guidelines certified by an approved practitioner operating within the scope of his or her licensure and practice, to perform the usual tasks of any compensated occupation for which the covered Employee is reasonably suited by training, education or experience, in such a way as to procure or retain employment. Inability to pass a periodic physical examination required by flight personnel or having a temporary impairment does not constitute Total Disability. The Employee will be conclusively deemed not to be disabled if employed and compensated in any manner.
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Waiting Period
The number of consecutive days of total disability in which no insurance benefits are paid, beginning at any one period of disability. After the Employee has stopped working, the waiting period begins the date total disability is established by medical proof which must include but is not limited to certification by an Approved Practitioner. |
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