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Group Benefits from The Hartford. Disability Claims Management. The Hartford’s Short & Long Term Disability Claim Process. Highlights of The Hartford STD program. Reduced Voluntary participation requirement 40% to 25% for individual participating employers
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Group Benefits from The Hartford Disability Claims Management The Hartford’s Short & Long Term Disability Claim Process
Highlights of The Hartford STD program • Reduced Voluntary participation requirement • 40% to 25% for individual participating employers • Open Enrollment for 1/1/2010 for current participating employers AND new STD employer implementations • Evidence of Insurability will not be required for voluntary elections • Clinical Telephonic Claim process • Paperless Process for Employee, Employer and Physician’s Office promoting faster claim decisions • Nurse intake of claim produces most effective claim management. Hartford Nurses average 20 years experience • Electronic Employer Reporting of claim filing and decisions • Electronic Funds Transfer (EFT) of weekly benefit payments • Seamless transition from STD to LTD coordinated by The Hartford
Clinical Claims Management for STD Virginia Bankers Association Employee The Hartford Your Employer will provide Telephonic brochure Employee will call The Hartford & report the STD claim to a Nurse Nurse immediately calls attending physician to gather more information, as needed VBA will receive an email requesting Eligibility Data Data will be collected in coordination with participating Employer Completed form to be returned to Hartford in 48 hours. Provides claim decision 3-5 days from complete claim Explanation of Benefits (EOB) email to VBA Coordinates with employee, his/her physician & employer to facilitate a faster, smoother return to work
Ongoing Case Management Support • The Hartford’s claims system automatically prompts review by case managers who are experts in nursing and behavioral health. They review claims, including: • All complex claims • Claims with no return-to-work or surgery date provided • Vague complaints with no real diagnosis • All behavioral health claims • Subjective pain claims • Co-morbid conditions that have negative impact on primary disabling condition • The result: The Hartford’s STD durations are, on average, four days shorter than the industry’s.1 6 1 JHA Disability Fact Book, Fifth Edition, 2008
Return-to-Work Coordinator On average, our STD return-to-work coordinators help employees return to productivity nearly nine days sooner than initially estimated by their physicians.2 Employer RTW Coordinator Employer RTW Coordinator STD RETURN-TO-WORK COORDINATORS: • Expert, knowledgeable resources • Stay in close contact with physicians • Focus on ability • Offer feasible return to work strategies 2The Hartford’s Internal Database Records, 2007 and 2008. 7
The Short Term Disability Model in Action EXAMPLE: “Nancy” has a fractured ankle that requires surgery. Nurse Intake Virginia Bankers Association Employee Nurse gathers information from Nancy and follows up with her physician Physician confirms diagnosis and expects recovery for return to work in 12 weeks Receives Coverage Certification via email. Coordinates with Employer to verify Date of Hire, Plan design, earnings, Job Description, etc. and returns form within 48 hours. VBA Receives EOB via email and shares approval w/ Employer Hartford works with employee & employer to facilitate modified return-to-work based on restrictions Assistance includes handicapped parking and wheelchair use to minimize walking Claimant returns to work eight weeks after surgery
Seamless STD to LTD • Clinical case managers review all claims with potential of becoming long-term. Claims transition to LTD ½ through the LTD Elimination Period. (For example: 60 day EP = 30 day transition, 90 day EP = 45 day transition & 180 day EP = 90 transition). • LTD Analyst will process STD benefits while collecting the data necessary to complete the LTD claim. Hartford does the outreach to Employee & Employer. • Employees have a single point of contact for both STD and LTD claims. • The Hartford’s Ability Contract creates positive outcomes for employers and employees with a focus on return-to-work initiative. • Single point of contact • Milestone reviews • Employees receive support or retraining • Help prevent fraud and abuse 9
Long Term Disability (stand-alone) DESTROY ALL OLD UNUM APPLICATIONS • For Employers that do not offer STD Coverage, the LTD claim will continue to be filed via the Paper Claim Form. • Virginia Bankers Association must be contacted in the event of a disabling event to initiate the LTD claim process. • All disabling events should be filed with The Hartford. Long Term Disability provides 24 hour coverage and Work related injuries should be filed. • All LTD payments will be made on a Semi-Monthly basis vs. the current Monthly basis. • The Hartford provides disabled employees guidance on when to apply for Social Security benefits and their partnership with highly qualified credentialed Social Security vendors makes transition to Social Security Disability Income (SSDI) hassle-free. DESTROY ALL OLD UNUM APPLICATIONS
Travel Assistance • The Hartford provides travel assistance services to your employees and their families at no additional cost, through a partnership with Europ Assistance USA. • When traveling 100 miles or more from home (national or international travel) for 90 days or less, employees and their dependents are eligible for three types of services: • Emergency Medical Assistance – medical referrals, medical monitoring, medical evacuation, medical repatriation, return of traveling companion, return of dependent children, visit from family member or friend, emergency medical payments, repatriation of remains, replacement of medications and eyeglasses. • Emergency Personal Services – sending and receiving messages, emergency travel arrangements, emergency cash, locating lost or stolen items, legal assistance / bail, interpretation / translation. • Pre-Trip Information – visa, passport, inoculation and immunization requirements, cultural information, temperature and weather conditions, embassy and consular referrals, foreign exchange rates, travel advisories, international hot spots. BROCHURES WILL BE DELIVERED TO YOU BY 12/15/09 *Travel Assistance is provided by Europ Assistance USA. Europ Assistance USA is not affiliated with The Hartford and is not a provider of insurance services.