Long Term Disability
Your Long Term Disability (LTD) coverage provides a benefit equal to 70% of your pre-disability monthly earnings if, after the first 150 calendar days of disability, you are unable to work due to illness or injury.
Participation in this plan is mandatory for all eligible employees.
A committee of LTD Trustees, made up of employee and employer representatives, oversees this plan. The Trustees are committed to ensuring that disability benefits remain available to health care workers.
Who is eligible for Long Term Disability coverage?
You are eligible if you are:
A permanent employee hired to work at least 28 hours every two weeks on a permanent basis, or
A permanent, part-time employee who is not regularly scheduled to work at least 28 hours every two weeks but who, over the course of the year, works on average 28 hours or more every two weeks. You become eligible for coverage on the first day of February in the year following the year you complete 12 months of continuous service.
Note: LTD coverage is not available for temporary and casual employees.
When does my LTD coverage become effective?
If you are a permanent employee hired to work at least 28 hours every two weeks, your coverage is effective after a three-month waiting period. So, if you are hired on May 12, your coverage becomes effective on August 12.
If you are a permanent part-time employee, hired to work less then 28 hours on a bi-weekly basis but who does work on average at least 28 hours bi-weekly for 12 continuous months, your coverage becomes effective on the first day of February in the year following.
How long will I be covered under the LTD plan?
Your LTD plan covers you until:
your employment terminates,
you are laid-off,
you reach age 65 (less the 150 consecutive day elimination period), or
you reach age 60 or greater and have 30 years of pensionable service in NSAHO's pension plan.
There is no conversion option when your Long Term Disability coverage ends.
Am I covered if I become disabled because of a medical condition I already had? (pre-existing condition limitation)
Yes, but not within the first 12 months of coverage under the plan for any disability that caused you to receive medical care, treatment or services or for which you took any prescribed medications during the 90-day waiting period prior to your coverage becoming effective.
If you are an employer and your facility is enrolling in the LTD plan as a group, please contact Group Benefits Solutions for more information on the pre-existing condition limitation.
What happens to my LTD coverage during a leave of absence?
If you are absent without pay, for reasons other than illness or injury, you may continue coverage under the LTD plan up to 24 months. Please contact your employer for payment arrangements.
If you decide not to continue coverage and your leave of absence is longer than 24 months, you will be subject to the pre-existing condition limitation as described above.
What happens to my LTD coverage when I retire?
When you retire, you are no longer covered under the Long Term Disability plan. There is no conversion option for LTD.
How much of a monthly benefit could I receive under the LTD plan?
You will be eligible to receive a monthly benefit equal to 70% of your monthly salary at the time of your disability.
The maximum monthly benefit is $20,000. You must provide proof of good health and be approved by the insurer for amounts over $15,000.
Please note that your monthly Long Term Disability (LTD) benefit is considered as taxable income. As well, the benefit paid is reduced by any benefit or income you receive from any of the following sources:
Canada Pension Plan, except dependent benefits.
Quebec Pension plan or US Social Security disability benefits
Any employer group or professional association disability plan.
Any employment income including sick leave, short-term disability benefits and vacation pay
Money received from a third party who caused or contributed to your disability (referred to as subrogation).
Income or benefits entitled to you under the Workers' Compensation Act, including lump-sum payments.
Any government disability or retirement pension plan.
Any income from a pension or retirement plan of an NSAHO member organization if this income became payable after the date you became disabled.
Any income received from a government legislated no-fault automobile insurance plan.
When do LTD benefits start?
After 150 consecutive days of disability, you may be eligible to receive monthly Long Term Disability benefits. This is often referred to as the elimination period.
Your disability must prevent you from performing your own occupation for an initial 30-month period (plus the 150 consecutive days off that make up the elimination period).
After 30 months, the definition of disability changes. At this point, you are considered disabled if your disability prevents you from performing any other occupation based on your education, training or experience.
How long will my Long Term Disability benefits continue?
Your LTD benefit payments continue until the earlier of when:
You recover from your disability and return to work as set out in the definition of disability.
You reach age 65.
You reach age 60 or greater with 30 years of pensionable service in the NSAHO Pension Plan.
You opt to take early retirement under the NSAHO Pension Plan.
The plan is terminated.
Are my LTD benefits considered taxable income?
Yes, because your employer pays a portion of the Long Term Disability premium, the benefit payment you receive is considered taxable income by the Canada Revenue Agency.
Will I still have to pay premiums if I'm receiving Long Term Disability benefits?
If you are a member of the Health Association Nova Scotia plans listed below, the following premiums are waived once you are approved for LTD benefits.
You will, however, need to pay premiums for your Health & Prescription Drug and Dental Plans if you are a member.
If you are not a member of the other Health Association Nova Scotia plans please contact your HR department for more information about your benefits while you are approved for LTD.
What happens to my NSAHO Pension Plan while I'm on LTD?
If you are disabled and in receipt of LTD benefits from an employer sponsored LTD plan:
you will remain a member of the pension plan but contributions will be waived, and
you will continue to earn pensionable service during your period of disability.
What if I return to work after a disability and become disabled again?
If you find yourself disabled again from the same disability within one year of returning to work after receiving disability benefits, benefits will continue immediately. You will not have to wait 150 consecutive days to qualify for benefits.
If you become disabled again more than 12 months after returning to work, you may be eligible for a reduced elimination period.
Long Term Disability – Claims Process
We strongly recommend that you send your Long Term Disability (LTD) application forms to your Benefits Administrator between four and six weeks before your Long Term Disability benefits are to begin. This will help speed up assessment of your claim and determine if participation in a rehabilitation program will help you.
There is a 150-day waiting (or elimination) period before you can receive LTD benefits. You must submit your application for LTD within seven months after the end of the elimination period. If your LTD application is submitted beyond this seven month time frame, benefits will be payable no earlier than the date we received the application. If your application is submitted more than 19 months after the expiry of the elimination period, no benefits will be paid to you.
The following forms must be fully completed and submitted to your Benefits Administrator to make an LTD claim:
- Employee/Member Statement
- Authorization and Consent Form
Canada/Quebec Pension Employee Agreement
Direct Deposit Application (including sample cheque marked VOID)
Workers' Compensation Benefits Employee Agreement
Attending Physician's Statement
Click here to go to Forms and Documents.
Additional required information
As well as the required forms, you'll need to send in the following with your application for Long Term Disability:
An up-to-date Job Description (ask your supervisor for a copy).
Copies of correspondence from the Workers' Compensation Board (WCB), indicating the status of a claim, if WCB is involved.
Copies of correspondence from Canada Pension Plan (CPP), indicating the status of a claim, if CPP is involved.
A copy of your Birth Certificate or valid Driver's License.
Additional optional information
If you have any of the following information available to you, we recommend that you send it along with your application:
Current copies of all medical reports and information about the illness or injury that led to your claim for LTD, such as:
Specialists' consult reports.
Results of investigative diagnostic procedures (such as X-rays, Blood work, Biopsy's, MRI's, CT Scan's, Bone Scan's, EKG reports, etc.).
Hospital Admission and Discharge summaries.
Operating Room reports.
Neuropsychological testing results.
Psychological Initial Assessment report and Progress reports.
Occupational Therapists Initial Assessment reports and Progress reports.
Physiotherapy Initial Assessment reports and Progress reports.
Functional Capacity Evaluation results.
Copies of clinical notes since the date your health became affected.
Current copies of all medical reports and information from the Occupational Health Department about the illness or injury that led to your LTD application. This includes information about any ongoing and/or attempted modified work or return to work programs.
It is vital that you provide the most current medical information available. Once you've filled in the forms and gathered the above information, give them to your Benefits Administrator. We realize this may seem like a cumbersome process and a lot of paperwork, but it will help ensure your application process is not delayed.
If I am declined or terminated for Long Term Disability benefits, can I appeal the decision?
Yes, you can. After the initial denial or termination, you can choose to participate in a claim review. You can submit other medical information that was not included with your original application. This new information will be reviewed and a decision will be made to approve benefits or uphold the denial or termination.
If the decision to deny or terminate is upheld, you can choose to request an appeal hearing based:
on medical evidence, or
on non-medical grounds.
An independent appeal board reviews all the medical information previously reviewed by the claims adjudicator. The Board's decision is based strictly on this medical information. An independent appeal board also reviews the process followed in appeals that are based on non-medical grounds.
If you wish to start an appeal, complete the required form provided by the claims adjudicator and send it to Group Benefits Solutions right away.
If you are taking legal action against the plan, you must start legal proceedings within one year of your LTD benefit being denied or terminated.
Long Term Disability – Exclusions
Long Term Disability benefits are not paid under the following circumstances:
For injuries received in a war or participating in a riot.
For injuries received while committing or attempting to commit a crime.
During a scheduled leave-of-absence without pay, initiated at your request, or to which you have a statutory or contractual right.
For an injury or illness for which you are not under the continuing medical care of a medical doctor or a medical specialist for the condition causing the total disability.
For any period during which you are not participating in a recognized therapeutic program if deemed appropriate by the Claims Adjudicator.
For a total disability due to an illness or injury that occurred after you were placed on lay-off status.
For any period after you fail to participate in an approved rehabilitation program.
- For any disability that starts within the first 12 months of being covered by the plan, if this disability is related to or caused by a disease or injury for which you received medical care, treatment or services, or took any prescribed medications during the 90-days before you became covered under the plan.
- For any disability that starts on or after the date a lay-off begins
- For any disability that starts on or after the date a strike or lockout begins, unless coverage has been continued (Article 6.09 of the Plan Text)
Long Term Disability – Rehabilitation
Are there any early rehabilitation programs to help me?
Yes, if you are enrolled in the Long Term Disability (LTD) plan and you are off work for 21 days or more due to a non-work related injury or illness, the Health Association offers a program called EASE (Early Assistance and Support for Employees).
EASE is a voluntary and confidential early intervention program funded through your LTD plan. EASE offeres a variety of tools to provide you with all the support you need to get back on your feet as soon as possible and to assist you in returning to work.
We recommend that if you're disabled and away from work for at least 21 days, that you assess your situation and consider whether EASE is for you. Visit the EASE page or call the EASE Program Manager toll-free at 1-888-824-EASE (or 3273) or in Metro at 832-8527 for more information.
Is there a rehabilitation component in this LTD plan once I'm receiving benefits?
Once your LTD benefits start, (after the 150-day waiting period), a rehabilitation consultant and a medical practitioner will assess your situation to see if you can participate in a rehabilitation program that should lead to a return to gainful employment. If so, you are obligated to participate.
Your personalized LTD rehabilitation program could include training, physiotherapy and/or other reasonable treatments to help you return to the workforce.
When you engage in rehabilitation employment in any occupation for which you are suited with any employer, your LTD benefit is reduced by 50% of your earnings, provided your earnings + monthly LTD benefit are not more than 100% of your earnings before you were disabled.
EASE (Early Assistance and Support for Employees)
EASE is sponsored by the Long Term Disability Plan Trustees (comprised equally of employee and employer representatives) as part of their commitment to creating a healthy workplace and ensuring that disability benefits remain available to health care workers in Nova Scotia at a reasonable cost. EASE is funded by the LTD Trust Fund.
If you would like to know more about EASE, please call toll free at 1-888-824-EASE (3273). Also, available at www.healthassociation.ns.ca/benefits, you can select EASE for further information.