19 Del. Admin. Code § 2007-8.0

Current through Reigster Vol. 28, No. 6, December 1, 2024

Section 2007-8.0 - STD Benefit Payment

8.1 STD benefit wage payments are paid by the employing organization to employees whose STD claims have been approved or extended.

8.2 The DIP insurance carrier or third-party administrator will notify the employee and the employee's Human Resource Benefits Office of the initial determination of the employee's eligibility for STD benefits in writing by certified mail, return receipt requested within 10 days of the determination.

8.3 STD benefits will be payable at a rate of up to 75% of the employee's creditable compensation not to exceed the plan maximum during the period the employee has a disability.

8.4 In accordance with 29 Del.C. § 5253(b)(3), creditable compensation during periods an employee receives STD benefits will include general salary increases awarded or reductions in salary instituted during the period of STD coverage.

8.5 Creditable compensation during the period an employee has a disability also includes hazardous duty pay if applicable. No other additional types of pay are included in the payment of STD benefits.

8.6 The amount of a benefit for loss of income provided to an employee or to an employee's family as a result of a period of disability for which the employee is claiming STD benefits will be an offset to the employee's STD benefit payment. This includes those benefits for which the employee or the employee's family is eligible or is paid to the employee, the employee's family, or to a third party on behalf of the employee. This includes the amount of a benefit for loss of income from:

8.6.1 The United States Social Security Act, the Civil Service Retirement System, the Railroad Retirement Act, the Jones Act, the Canada Pension Plan, the Quebec Pension Plan, or similar plan or act that a claimant, a claimant's spouse, or a claimant's child are eligible to receive because of the employee's disability;

8.6.2 A plan or arrangement of coverage, whether insured or not, as a result of employment by or association with the State of Delaware, or as a result of membership in or association with a group, association, union or other organization;

8.6.3 The Veteran's Administration or another foreign or domestic governmental agency for the disability;

8.6.4 A governmental law or program that provides disability or unemployment benefits as a result of the employee's job with the State of Delaware;

8.6.5 An individual insurance policy where the premium is wholly or partially paid by the State of Delaware;

8.6.6 A temporary or permanent disability benefits under a Workers' Compensation law, occupational disease law, or similar law including the Salary Supplement;

8.6.7 Compulsory "no-fault" (or PIP) automobile insurance; or

8.6.8 The portion of a settlement or judgment of a lawsuit that represents or compensates for the employee's loss of earnings for the disability.

8.6.9 Payment for Rehabilitative employment by the State of Delaware or other employer. Income received from the State of Delaware or other employer must immediately be reported to the DIP insurance carrier or third-party administrator.

8.7 A general increase in benefits required by law that a claimant is entitled to receive under the Federal Law will not reduce the STD Benefit payable for a period of Total Disability that began before the date of the increase. IMPORTANT NOTE: Other Income Benefits also mean payments that are made to the employee, the employee's family, or to a third party on behalf of the employee, in response to:

8.7.1 Disability benefit under the Employer's Retirement Plan;

8.7.2 Permanent disability or impairment benefits under a Workers' Compensation Law, the Jones Act, occupational disease law, similar law or substitutes or exchanges of the benefits;

8.7.3 Portion of a settlement or judgment, of a lawsuit that represents or compensates for the claimant's loss of earnings; retirement benefit from a Retirement Plan that is wholly or partially funded by employer contributions, unless:

8.7.3.1 the claimant was receiving it before becoming Disabled; or

8.7.3.2 the claimant immediately transfers the payment to another plan qualified by the United States Internal Revenue Service for the funding of a future retirement.

8.8 Employees enrolled in and receiving STD compensation will receive up to a maximum of 100% of pre-disability base pay from other sources, including parental leave. If the employee is otherwise eligible for holiday pay or a paid leave other than sick leave, annual leave, compensatory time or donated leave, the employee will be granted 100% pay on the day in question without a residual. Leave supplements will be calculated on a per pay basis.

8.9 Calendar days used to satisfy the STD elimination period for employees who work alternate schedules are converted to a Monday through Friday schedule as STD benefit payments are calculated using a 5 day work week. Once the employee has satisfied the calendar day elimination period, the STD program will pay 1/5 of the weekly amount for each weekday the employee is disabled during a pay period.

8.10 The minimum weekly STD benefit will be the greater of $25.00 or 10% of the gross STD benefit before the deduction of other income benefits. If the employee is receiving 100% of the pre-disability pay from another source which is an offset, a minimum STD benefit will not be paid.

8.11 If while covered under this program an employee develops a partial or residual disability and works on a part-time or limited duty basis, the employee will be entitled to a residual (partial) disability benefit. The employing organization is required to report hours worked by the employee to the DIP insurance carrier or third-party administrator on a weekly basis. The DIP insurance carrier or third-party administrator will calculate residual disability benefits for each claimant and promptly provide the results of the calculation to the employing organization. Income or benefit received from the State of Delaware or other employer must immediately be reported to the DIP insurance carrier or third-party administrator by the employee.

8.12 In accordance with 29 Del.C. § 5253(b)(5), if an employee returns to the employee's position on a full-time basis for 15 consecutive calendar days or longer, the succeeding period of disability for which the employee will be approved for STD benefits will be a new period of STD with a new corresponding calendar day elimination period. A new period of STD will not be granted if an employee returns to work on a part-time basis. If recurrent periods of disability are due to the same or a related cause; and separated by less than 15 consecutive days of work as an active full-time employee, this will be considered to be the same period of disability.

8.13 If while receiving STD benefits an employee should have another disability due to a new cause, the 182nd calendar day associated with the first disability will not be extended and the plan's exclusions will apply to the new disability. The employee is immediately required to report the new disability to the employee's supervisor, Human Resource Benefits Office and to the DIP insurance carrier or third-party administrator.

8.14 The DIP insurance carrier or third-party administrator will provide the employing organization with a wage report on each claimant illustrating the following information:

8.14.1 approval dates;

8.14.2 payment amount, and;

8.14.3 offset information.

8.15 It is the employing organization's responsibility to promptly pay STD benefits to employees. Overpayment and underpayment amounts must be immediately reported to the DIP insurance carrier or third-party administrator and to the current or former employee by the employing organization. In the event of an overpayment or underpayment, the DIP insurance carrier or third-party administrator will provide the employing organization with a report listing each claimant who receives or has received Other Income Benefits awarded as defined in subsections 8.6 and 8.7 of this regulation during the approved STD benefit period or who has been underpaid STD benefits as a result of a change in the member's claim. The report will also illustrate the additional following information:

8.15.1 Gross overpayment or underpayment amount;

8.15.2 Reason for the recalculation;

8.15.3 Recalculation period;

8.15.4 Amount of the claimant's Other Income Benefits award. Other Income Benefits are defined in subsections 8.6 and 8.7 of this regulation.

8.16 Overpayments must be immediately collected by the current or former employing organization and returned to the Office of Pensions via the State's payroll system (PHRST) or other accepted payroll process for tax reporting purposes.

8.17 It is the current or former employing organizations responsibility to promptly notify the DIP insurance carrier or third-party administrator of retroactive awards from other programs awarded to STD claimants.

8.18 It is the current or former employee's responsibility to promptly notify and repay the State of Delaware or the DIP insurance carrier or third-party administrator for overpayments including income paid as an offset during the STD or LTD benefit period.

19 Del. Admin. Code § 2007-8.0

19 DE Reg. 78 (7/1/2015)
20 DE Reg. 70 (7/1/2016)
22 DE Reg. 861 (4/1/2019)
28 DE Reg. 57 (7/1/2024) (Final)