Group Long Term Disability Insurance

The CSEA Group Long-Term Disability Income Insurance benefit pays valuable benefits if a covered injury or illness leaves you totally disabled and unable to perform the material and substantial duties of your occupation. Please refer to the Terms tab for more information on exclusions and limitations.

Probably not. Unlike sick leave, in California, your employer isn’t required to provide benefits for long term disabilities. Long term disability insurance generally takes over after sick leave ends and lasts for extended periods of time, such as two or five years.

The CSEA endorsed Group Long Term Disability coverage starts paying benefits after twelve months. Benefits are paid for covered disabilities due to injury, sickness or pregnancy. The CSEA endorsed Group Long Term Disability Benefits are designed to pay benefits equal to 60% of your monthly earning.

The CSEA Long-Term Disability Income Insurance continues based on which option you choose:

For 2 Year Coverage: If you are disabled before age 68 – benefits are paid for 2 years. If you are disabled after age 68-benefits are paid for the greater of: One year or to age 70.

For 5 Year Coverage: If you are disabled before age 60 – benefits are paid for 5 years. If you are disabled between ages 60 through 63, you can collect benefits until age 65. If you are disabled on or after age 64, benefits are payable for up to one year.

No. Under current tax laws, you collect tax-free coverage. That means you will receive the coverage amount you applied for in the event of a covered disability.

Yes. Apply for benefits as long as you work 20 hours a week for at least 20 consecutive service days with the State of California or any allied organization.

YES, as long as you continue to work for the state of California and remain a CSEA Affiliate member. Refer to the “Benefits” tab for additional eligibility requirements.

Accidents are one of the leading reasons for disabilities. That’s why the CSEA GROUP Long Term Disability coverage pays up to $5,000.00 – on top of any other disability benefit – for death and certain physical injuries caused by a covered accident*. The Certificate of Insurance includes specific details.

*This coverage does not pay benefits if the insured is receiving Worker’s Compensation Benefits.

This coverage will help to take care of your family. First, you don’t pay premiums while you’re disabled and collecting CSEA disability benefits. Plus, the CSEA Group Long Term Disability coverage adds two extra monthly payments if you die while receiving benefits for a covered disability that lasted 30 days or longer.

For easy budgeting, premiums are deducted from your paycheck.

After you’re approved for coverage, you’ll receive a Certificate of Insurance. Take up to 30 days to decide if this protection is right for you. If you change your mind, your premiums will be promptly refunded and your coverage invalidated, provided there have been no claims.

Your coverage will begin on the first of the month following the date your application is approved, provided you are actively-at-work full-time on the date, meet required evidence of insurability requirements and the premium is paid. If you are not Actively-At-Work, the insurance will not take effect until you return to full-time work for at least 10 consecutive workdays, if such day is within three months of the date insurance would otherwise have taken effect and the insured member is still eligible to obtain the insurance on that day. Benefits will begin on the first day of a covered total disability after completion of the applicable Waiting Period. Benefits will continue until the earlier of (a) the day the insured ceases to be totally disabled or (b) the end of the maximum benefit period.

This coverage ends at age 70 or when you are no longer at full-time work, you are no longer a CSEA Affiliate member, you stop paying your premiums when due, when you receive covered total disability benefits for the maximum benefit period, when you begin active duty in the armed forces, or the date the group policy ends.

Average Monthly Income means a person’s average monthly wages, salaries, commissions, fees and any other amounts received by such person for personal services, including the cost of his or her fringe benefits and share of total surpluses. It does not include income from interest, dividends, rent, royalties, annuities, other insurance and other unearned income.

Covered Total Disability is an incapacity that completely and continuously prevents the insured member from doing the material and substantial duties of his/her regular occupation. Such covered disability must begin while the insured member is insured under the Policy and be the result of: (1) an injury. For a covered disability to be considered to have resulted from an injury, the covered total disability must begin within 90 days after an accident, if the accident occurs while the insured member is insured under the policy. If more than 90 days has elapsed, such covered disability will be considered to have resulted from an injury sickness; (2) a sickness; or (3) an organ donation that an insured member makes, provided he/she has been insured under the Policy for at least six consecutive months on the day of such donation.

A loss of license, in and of itself, does not constitute an incapacity that prevents the insured member from doing the material and substantial duties of his or her regular occupation and will not be deemed a Covered Total Disability.

Mental Disorder means a condition due to or resulting from psychiatric or psychological conditions, regardless of cause, such as: (a) schizophrenia; (b) depression; (c) manic depressive or bipolar illness; (d) anxiety; (e) personality disorders; and/or (f) adjustment disorders or other conditions, usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs or other similar modalities used in the treatment of the above conditions. This limitation does not apply to dementia, if due to: (a) stroke; (b) trauma; (c) viral infection; (d) Alzheimer’s disease; or (e) other conditions not listed above which are not usually treated by a mental health provider using psychotherapy, psychotropic drugs or other modalities.

Chemical Dependency means the abuse of or psychological or physical dependency on or addiction to alcohol or a controlled substance. For purposes of this definition, “controlled substance” means a toxic inhalant, a volatile chemical, abusable glue or aerosol paint, or a substance designated as or considered a controlled substance under applicable federal, state or local authority.

Successive Periods of Disability will be considered one period of disability if such disabilities are due to the same or related causes, and which are separated by less than six months of return to continuous full-time work during which you are not totally disabled or different or unrelated causes are not separated by return to full-time work.

Waiting Period is the initial, continuous period of a Covered Total Disability which must be completed before such Covered Total Disability benefits become initially payable.

Note: The Maximum Benefit Period for all Covered Disabilities of an insured which are due to or related to Mental Illness and/or Chemical Dependency while such person is insured under the Policy, whether insurance has been continuous or interrupted, cannot exceed the lesser of: (a) 24 months; or (b) the Maximum Benefit Period for a Covered Disability due to an injury, sickness or organ donation. This limitation does not apply to any period during which such insured is institutionalized.

The CSEA Group Long-Term Disability Income Insurance does not cover and we will not pay a benefit for any loss or disability: Due to Crime/Illegal Occupation/Illegal Activity: Participation in or incarceration resulting from any of the following in a role other than as a victim: (a) the commission of a felony; (b) an illegal occupation or activity; (c) an insurrection; (d) terrorist activity; or (e) a riot. Intentional self-inflicted injury or an attempt at intentionally injuring oneself; while sane. Engagement in any of the following in a role other than a victim: (a) in war, (b) an act of war, or (c) an armed conflict which involves the armed forces of one or more countries; a pre-existing condition; an impairment restriction; a disability that is due to or related to service in the military, naval or air force of any country, alliance or international organization or in a civilian unit which serves such force. A disability that is due to a pregnancy or childbirth or a related medical condition, except for complications of pregnancy; Regular Care that does not require a doctor’s regular care of, or attendance to, the insured; or for any period of disability for which the insured is not under the regular care and attendance of a doctor, except that: This requirement will not apply if such care is no longer required for prudent medical management of the injury, sickness or organ donation. For the purpose of satisfying the requirement that the insured be under the “regular care” of a doctor, doctor does not include the insured or a member of his or her immediate family. Occurs during, is due to, or is related to the insured member’s travel in, travel on, fall from or descent from any aircraft when the aircraft is used to train, test, or experiment or is part of any military, naval or air force. Additional exclusions or limitations may apply as a condition of approval of your application for coverage.

Mental Disorder and Chemical Dependency Limitation: If you are disabled due to mental illness or substance abuse, the maximum benefit period for total and residual disability benefits is the lesser of: 1) the maximum benefit period shown on your schedule; or 2) 24 months during your lifetime. We will continue to pay benefits beyond the limited pay period if you are an inpatient under a physician’s care in either a hospital or an institution which treats and cares for mental illness or substance abuse. In no case will benefits be paid beyond the maximum benefit period.

Pre-Existing Condition Limitation: Pre-existing Condition means an injury or sickness or any condition related to such injury or sickness for which a person consults a doctor, receives medical services or supplies or takes any medication during the 12-month period immediately before the insured’s initial insurance date. Pre-existing Condition does not include: (a) any such injury or sickness or condition after such person has been continuously insured under the Policy for 12 months; or (b) an injury or sickness or condition classified as an Impairment Restriction.

Impairment Restriction – A disability that is due to or related to a condition which has an Impairment Restriction. Impairment Restriction means an exclusion or limitation of insurance on an INSURED MEMBER. An Impairment Restriction will be: (a) established by New York Life; and (b) continued by New York Life if it is in effect on the day before: (1) the INSURED MEMBER becomes insured under the Policy; or (2) a change in insurance takes effect; whether or not satisfactory medical evidence of insurability is furnished or medical evidence of insurability is required. All Impairment Restrictions are stated in the certificate. Insurance with such Impairment Restrictions is subject to the APPLICANT’S acceptance. Payment of one CONTRIBUTION after the INSURED MEMBER is advised of the Impairment Restriction will establish such acceptance.

Endorsed by: California State Employees Association

CSEA incurs certain administrative expenses in connection with this sponsored program. To provide and maintain this valuable membership benefit it is reimbursed for such expenses.

California State Employees Association
Administered by A.G.I.A., Inc.
PO Box 9997 Phoenix, AZ 85068-0997

A.G.I.A, Inc. is licensed and authorized to transact business in all 50 United States and the District of Columbia. Their state of domicile is California.

Joseph Guerrero CA Insurance License #0B54298. Joseph Guerrero AR Insurance License #766720.

AGIA Insurance Services, Inc.
P.O. Box 26860
Phoenix, AZ 85068

A.G.I.A., Inc., is licensed/authorized to transact business in all 50 United States, and the District of Columbia. Their state of domicile is California. Joseph Guerrero California Agent Insurance license number is 0B54298. Joseph Guerrero Arkansas Agent Insurance license number is 766720.