Voluntary benefits are becoming increasingly important to employees as they focus on their physical, mental, social and financial health. As a result, many employers have expanded their voluntary benefits offerings to address employees’ needs and improve their attraction and retention efforts.
Because some of these offerings are disability benefits, it’s more important than ever to understand the differences between short- and long-term disability insurance and COBRA.
What are disability benefits?
Disability benefits provide guaranteed income or job protection to employees who are unable to work due to serious illness or injury. The most common disability benefits are STD and LTD insurance.
However, understanding the differences between short- and long-term benefits and other laws, such as the Consolidated Omnibus Budget Reconciliation Act, can be complicated and difficult for employers to navigate. This article provides a general overview of STD, LTD and COBRA and explores how both types of disability insurance differ from COBRA.
What are STD and LTD?
STD and LTD insurance are the most common forms of disability benefits.
Short-term disability insurance
STD insurance replaces a portion of an employee’s income due to a temporary disability. Under STD plans, employees receive a percentage of their income, typically 40% to 70% of their base pay, but employers can allow employees to supplement their STD benefits with paid sick leave or other benefits. An STD insurance policy is paid either fully or partially by the employer. The median length of STD insurance coverage is 26 weeks, according to the U.S. Bureau of Labor Statistics.
To qualify for STD insurance, an employee files a claim under their insurance policy. The employee must prove their illness or injury qualifies as a disability under the plan’s terms. STD insurance generally requires employees to wait for a short period before they start receiving benefits. On average, the wait is around seven days.
STD insurers do this to discourage abuse since many employers’ paid-time-off benefits cover shorter absences than those covered by STD insurance. While STD insurance plans do not guarantee job protection, employees may be entitled to it through their employers’ policies or under state and federal laws, such as the Family and Medical Leave Act.
Employers offer STD insurance because it helps employees as they recover from an illness or injury. This allows them to stay productive and focused when they’re physically able to return to work.
Since the income employees receive under STD insurance is paid by insurance companies, employers have greater financial resources and flexibility to, for example, hire temporary or contract workers to fill workforce gaps. This helps avoid high labor costs. In states that don’t require employers to participate in disability income plans, employers can offer full, partial or non-contributor STD insurance plans.
Long-term disability insurance
LTD insurance provides employees with income for long-term illnesses and injuries. Employees generally receive 60% to 66% of their base pay. However, some employers’ LTD plans offer more limited income replacement benefits. This is one of the key differences between short- and long-term disability insurance.
Similar to STD, employees receive income benefits until they are able to return to work or have exhausted policy limits. LTD benefits requirements tend to be more rigorous than STD because workers need to demonstrate they’re unable to perform any job, not just the job they were working before the illness or injury.
These plans often work together with STD, so when an employee exhausts their STD benefits, LTD benefits continue to provide the employee with income. As with STD benefits, LTD does not provide workers with job protection. Employees who become permanently disabled may continue to receive LTD benefits through their retirement date or until they’re eligible for Social Security disability benefits. Most LTD plans have age reduction provisions.
What is COBRA?
COBRA allows individuals to continue their group health plan coverage and other qualified benefits, e.g., dental and vision, in certain situations. This law requires group health plans maintained by private-sector employers with at least 20 employees to offer continuation coverage to covered employees and dependents when coverage would otherwise be lost due to certain specific events. These events include:
- death;
- termination;
- reduction in employment hours below the plan’s eligibility requirements;
- divorce or legal separation;
- Medicare eligible; and
- child’s loss of dependent status under the plan’s rules.
COBRA sets rules for how and when continuation coverage must be offered. It also covers how employees and their families may elect continuation coverage and when this coverage may be terminated. Employers may require individuals to pay for COBRA coverage. Group health coverage for COBRA participants is usually more expensive than coverage for active employees because many employers pay a portion of the premium for active employees. Learn more about COBRA guidelines.
COBRA continuation applies to plans that qualify as group health plans as defined by the Employee Retirement Income Security Act. Under ERISA, a group health plan must be a plan, fund or program that is established or maintained by an employer for the purpose of providing medical care. Health insurance plans, self-funded health plans, health maintenance organizations and prescription drug plans generally meet ERISA’s criteria for a group health plan. Medical care is defined as care for the diagnosis, cure, mitigation, treatment or prevention of disease and any other undertaking affecting any structure or function of the body.
The differences between short- and long-term disability insurance and COBRA
An employer is not required to offer COBRA continuation on a voluntary benefits plan if the plan does not qualify as a group health plan and the plan is considered completely voluntary. STD and LTD benefits generally provide income replacement for individuals who must take a leave of absence from work due to a qualifying condition instead of medical care.
Because STD and LTD typically do not provide medical care, they’re not subject to COBRA and would not be required to continue under COBRA. However, although uncommon, if an STD or LTD insurance provided medical care, it may be considered a group health plan under COBRA and subject to continuation coverage.
While STD and LTD benefits are generally not subject to continuation coverage under COBRA, an employee’s disability can initiate COBRA requirements if it produces a qualifying event. For example, if an employee becomes disabled and doesn’t return to work at the end of their disability leave or notifies their employer of their intent not to return, the employer’s plan will determine whether this is a qualifying event.
If this is determined a qualifying event, COBRA requires the employer to notify the employee of their COBRA rights and provide the employee with the option to continue group health insurance coverage. COBRA-qualified events and timelines of notification are important in this process.
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STD and LTD benefits can assist sick and injured employees when they’re unable to work. By understanding how these types of disability insurance differ from COBRA, employers can stay compliant and ensure employees have the benefits they need.
Contact HANYS Benefit Services for further guidance on voluntary benefits. Our team of experts can give you the resources needed to implement STD and LTD benefits. Check out our employee benefits consulting and start expanding your voluntary benefits.
This Benefits Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice. © 2023 Zywave, Inc. All rights reserved.