Extended Disability Benefits

ASEBP’s EDB is a Total Disability plan. It is designed to provide benefits and income for members who have a medically related illness or injury that prevents them from performing their occupational duties. To qualify for EDB, you must meet the following criteria:

• You are medically unable to perform the main duties (material and substantial duties) of your regular occupation for 90 consecutive days (known as the elimination period), and
• The disability is supported by medical information from health care providers.

To be eligible for EDB, you must be under the age of 65 and:

• Have ASEBP EDB coverage
• Fulfill the 90-day waiting (elimination) period, meaning you have been unable to work for 90 consecutive days.
• Have a 90-day waiting period that begins on the date the illness started or the injury occurred, which is usually the day after your last day worked.
  • If you are on a regularly scheduled school break (for example, summer or winter break), the 90-day period begins on the date you become totally disabled, not your scheduled return to work date. If you participated in ASEBP’s SLS program, the 90-day period may differ.
• Have continued ASEBP benefits during a leave of absence, if the illness or injury occurred during that leave.
• Have no pre-existing medical condition that would affect eligibility.

ASEBP will contact you to discuss the SLS program and EDB, and will provide you with the necessary application forms, if applicable. Your health-care providers must complete the required forms so ASEBP can review and adjudicate your claim. If your claim is approved, ASEBP will work with you and your health-care providers to support your recovery. During your recovery, you are responsible for:

• Completing required forms for SLS and EDB applications, including authorizations to release information needed to support the claim.
• Participating in treatment recommended by physicians and other health care providers.
• Actively participating in return-to-work (RTW) planning when medically cleared.
• Keeping ASEBP informed of changes to medical condition, work status, or RTW progress.
• Advising ASEBP of travel plans and providing medical documentation confirming fitness to travel and continuity of treatment.
• Attending medical assessments and treatments arranged or expedited by ASEBP.
• Paying costs associated with EDB application medical forms.

If you are disabled due to an accident, you may be entitled to additional benefits through your Accidental Death & Dismemberment coverage.

A pre-existing condition is an accidental injury or illness for which you received medical attention, consultation, diagnosis, or treatment during the 12 months before your benefits became active. No benefits will be payable if the disability is related to a pre-existing condition and Total Disability occurs within the applicable 26-week period following the start of your coverage or any subsequent re-start of coverage following a lapse greater than 90 days.

You may have a pre-existing condition if:

• You received medical care from a doctor or specialist for an accidental injury or illness in the 12 months before your ASEBP coverage began, or
• You received medical care for an accidental injury or illness during a period without coverage for more than 90 days in the 12 months of your leave, and
• You become Totally Disabled due to that condition within 26 weeks of enrolling or re-enrolling in EDB.

 

After you are approved for EDB:

• First 24 months: You must continue to be unable to perform your own occupation and experience a 30 percent or greater loss of income compared to your pre-disability earnings.

• After 24 months: ASEBP assesses whether you are medically able to perform any occupation for which you are reasonably suited based on education, training, or experience, and that could provide 60 percent or more of your pre-disability earnings.

In some circumstances, ASEBP may discuss vocational services with you to help prepare for the possibility of returning to work in another occupation, if medically appropriate. Please speak with your case manager if you have questions.

To support your recovery and help improve your ability to return to work, ASEBP may arrange for you to see a health-care provider who is not employed by ASEBP for an assessment and/or treatment.

If ASEBP determines that a medical assessment is required, you must participate in the assessment to continue receiving EDB payments. The results will help inform your support, recovery and/or RTW plan and will be shared with your health-care provider(s).

If you are eligible for EDB, you qualify for income replacement at the level stated in your plan. You can find which plan you are enrolled in by checking My ASEBP or the My ASEBP Mobile App.

Your benefit payment includes salary, administrative allowances, pay while on vacation, isolation pay, retroactive salary, and compensation for an acting assignment longer than three months. It does not include signing bonuses, overtime, car allowances, expense allowances or reimbursements, salary earned while teaching night or summer school classes, early retirement incentives, or pay in lieu of vacation.

EDB accrual and non-working months 

If you are paid over 10 or 11 months, EDB includes an accrual that helps maintain income during summer months when you are not working.

Each EDB claim is reviewed individually and administered according to the plan rules in place when your disability began. Your EDB benefit may be adjusted if you receive other income while on claim. You will receive a letter explaining how your payment is calculated and any adjustments that apply to your situation.

Benefits are paid monthly through direct deposit to the bank account you have identified on My ASEBP. You can find your EDB payment details, as well as T4As and other tax information, on My ASEBP under the Documents tab (Extended Disability Benefits and Tax Documents).

ASEBP will ask you to disclose any other income or benefits you receive, are eligible to receive, or may become entitled to receive while on EDB. You must notify your adjudicator or case manager of any alternate earnings or benefits.

Other income may reduce (offset) your EDB payments to ensure they are calculated accurately and to avoid overpayments, which would need to be repaid by you. Your adjudicator or case manager can explain how offsets apply to your specific situation and provide further details if needed.

When your medical condition has improved, and you are ready to participate in a gradual return to work (GRTW), a Rehabilitation Employment plan will be developed with input from your health care providers and implemented in consultation with your employer.

Rehabilitation Employment is a temporary program that supports your short-term transition back to work. Participation must be pre-approved by ASEBP and occurs while you are receiving EDB. The program allows you to work modified hours and perform alternate duties as part of your recovery and rehabilitation. Its goal is to support a gradual return to your pre-disability level of employment while maintaining a higher level of income than EDB alone provides.

While you are participating in Rehabilitation Employment, your monthly EDB benefit is reduced by 50 percent of the earnings you receive.

Example: If you receive $3,000 per month in EDB and earn $1,000 per month through Rehabilitation Employment, your EDB benefit will be reduced by $500. Your revised EDB payment would be $2,500 per month. When combined with the $1,000 earned from your employer, your new total monthly income would be $3,500—which is $500 more than receiving EDB alone.

What is a re-occurrence (successive disability)? 

If you return to work after an approved extended disability leave and must stop working again within six months due to the same disability or related causes, your disability may be considered a re-occurrence (also called a successive disability).

If you stop working within 30 days of returning to work due to a new, unrelated disabling condition, it may also be considered a successive disability.

Your disability will be considered a re-occurrence if all the following conditions are met:

• You received benefits for your first period of disability.
• You remained covered under ASEBP’s EDB plan after your first disability, with no break in coverage.
• Your successive period of disability began after you returned to active employment, or after you were medically cleared to return to work during a non‑working period (July–August for employees who work 10 months of the year).
• You apply within six months of stopping work due to illness or injury.

If all these conditions are met, your EDB coverage will begin immediately once your claim is approved, at the same benefit level as your previous disability claim. You must provide medical evidence to support your disabling condition.

What is Progressive Disability?

Progressive Disability provides income protection if you are unable to perform all of your regular job duties and must reduce your regular working hours due to a progressively debilitating illness that is expected to result in Total Disability.

This program may apply if you cannot continue working your regular hours because of a medical condition that is expected to worsen over time and eventually prevent you from performing the duties of any occupation at some point in the future (e.g., Parkinson’s disease, Amyotrophic Lateral Sclerosis [ALS]).

To be considered for Progressive Disability, all the following conditions must be met:

• Medical information supports the need to reduce your full-time equivalent (FTE) work hours.
• Total Disability is anticipated before age 65.
• Your employer submits an application within 90 days of your reduction in FTE.

ASEBP reviews each situation based on medical information to determine eligibility and assess the most appropriate program.

What happens if I disagree with the decisions throughout my EDB claim:

If your EDB application is declined or your claim is terminated, you may be eligible to request a Total Disability Appeal. Appeals focus on whether you meet the plan’s definition of Total Disability and are typically based on the interpretation of medical information.

You must submit a Total Disability Appeal Request within 60 calendar days of being notified of the decision. For details about the process and eligibility, visit Total Disability Appeals.

If you believe a policy was incorrectly applied or misinterpreted, or if you feel there are extenuating circumstances, you may be able to request a Policy Appeal.

Example (pre‑existing condition policy):

Your EDB application is declined because ASEBP determined that you received treatment, diagnosis, or consultation in the 12 months before your application and that there was a lapse in coverage of more than 90 days. However, you believe this did not occur and wish to appeal the decision on that basis.

If you are already receiving EDB payments as you approach age 65, your coverage will end on the last day of the month following the month in which you reach age 65. (e.g., if you turn 65 on December 1, 2024, your disability coverage would end on January 31, 2025.)

If you are not already receiving EDB payments as you approach age 65, your eligibility for EDB coverage ends three months (90 days) before your 65^th birthday. This is because EDB includes a 90‑day elimination period, and there is insufficient time to complete this waiting period before eligibility ends at age 65.