Arizona short-term disability (STD) and long-term disability (LTD) insurance limitations and exclusions

Eligibility, benefits, and related limitations, exclusions, and reductions

Eligibility

To be eligible for coverage, employees must be actively at work on a full-time basis for at least 30 hours per week; residing in the United States; US citizens or legally working in the United States. Part-time, seasonal, temporary and contract are not eligible. In certain cases, eligibility hours of less than 30 hours per week may be available. Proof of good health may be required. The type and form of proof of good health is determined by Principal.

Benefit qualification

All conditions have requirements to qualify. The disability must begin while insured under this policy. Proof of disability, documentation of loss, submission of medical records, and proof of income are required. Claim procedures must be satisfied. Documentation must be provided within the timelines established in the policy, and all claims requirements must be met. The loss of a professional or occupational license or certification does not in itself constitute a disability. Benefits will be offset by other income sources.

Elimination period

The employer determines the length of the unpaid waiting period that must elapse after a disability is incurred before benefits begin. A member cannot satisfy any part of the elimination period with any period of disability that results from a cause for which Principal does not pay benefits.

Benefit payment period

Benefits are payable for a maximum duration stated in the policy. However, in no event will benefits continue beyond the date the member: dies; recovers from the disability; ceases to be under the regular and appropriate care of a physician; fails to provide any required proof of disability; fails to submit to a required medical examination; fails to report income from other sources or any other required earnings information; fails to pursue Social Security, Workers’ Compensation benefits or similar benefits within 10 days of receipt of notice from Principal; or ceases to be under the regular and appropriate care of a physician.

Recurring disability

Disabled employees who recover and return to work for 30 days or less during the benefit duration are not required to complete a new elimination period if they become disabled again due to the same or related cause. The policy pays benefits for the remainder, if any, of the original benefit payment period established for the initial disability.

Preexisting condition limitation

A preexisting condition is any sickness or injury, including all related conditions and complications, or a pregnancy, for which a covered person received medical treatment, consultation, care, or services, or was prescribed or took prescription medications for a defined number of months before they became insured under the policy. For policies with a preexisting condition limitation, no benefits will be paid for a disability caused or substantially contributed by a preexisting condition unless, on the date the member becomes disabled, they’ve been actively at work for one full day after being insured under the policy for a defined number of consecutive months.

General limitations and exclusions

No benefits will be paid for a disability resulting from: willful self-injury or self-destruction while sane or insane; war or an act of war; voluntary participation in an assault, felony, criminal activity, insurrection, or riot; a new or continuing disability that begins after an employee’s benefit payment period has ended, but the member has not returned to active work; a work-related sickness or injury; a cosmetic surgery or other elective procedures that are not medically necessary.

Optional limitations for LTD

Benefit payments may be limited to 12 months for each period of continuous disability while residing outside of the US. Benefits for disabilities resulting from drug, alcohol or chemical abuse, dependency, addiction, and mental health conditions may be limited to a maximum lifetime benefit period of 12-36 months. For disabilities due to special conditions that are self-reported and difficult to diagnose, such as chronic fatigue syndrome, carpal tunnel syndrome, headaches, or certain back conditions, benefits may be limited to a lifetime maximum of 12-36 months.