HOW DOES AN INDIVIDUAL BECOME ELIGIBLE
TO RECEIVE STD COVERAGE/BENEFITS?
An individual must be enrolled in the Short Term Disability
(STD) plan to have coverage. They must remain an active
full-time employee up until the time the disability begins and
meet the contractual definition of disability and all other plan
provisions.
HOW SHOULD A CLAIM BE SUBMITTED?
Guardian
®
provides different methods for submitting an
STD claim. An individual should contact his/her employer
resource to determine the preferred method for filing a claim.
WHEN SHOULD A CLAIM BE SUBMITTED?
A claim should be submitted after the disability has begun,
and when it has been determined that the disability will be
long enough in duration to qualify for STD benefits. Each
STD plan has an elimination period which must be satisfied
before benefits commence.
WHAT IS AN ELIMINATION PERIOD?
The unpaid period of time (specific to each plan) that must be
satisfied prior to the commencement of benefits.
WHAT CAN BE EXPECTED AFTER A CLAIM IS
SUBMITTED?
An assigned STD Case Manager will review all information
that is supplied. If additional information is needed, the Case
Manager will make contact with the appropriate party to
obtain that information. If the Case Manager determines that
there could be a delay in reaching a decision, they will contact
the individual to advise of the potential delay.
HOW LONG DOES IT TAKE TO REACH A
DECISION ON A CLAIM?
Each claim is evaluated based on its own merit, and as a result,
timeframes for reaching a decision could vary depending on
the quality of the information supplied. Most claim decisions
are made within 5 to 7 business days, provided all information
is supplied timely and we are successful in obtaining any
information that might be lacking. Assuming the claim is
approved, and a benefit check is issued, mail delivery could
vary depending upon where a claimant is located. We ask that
claimants allow for ample mail delivery time.
HOW OFTEN ARE BENEFIT CHECKS ISSUED AND
WHERE ARE THEY MAILED?
Benefit checks are issued either weekly or bi-weekly and
typically mailed to the individual’s home address. An employer
elects the payment frequency at the time the coverage first
becomes effective with Guardian. Payments may be interrupted
while we are awaiting additional information. The individual
will be notified of these potential interruptions. For pregnancy
claims, benefits may be issued in a lump sum payment.
GROUP SHORT TERM DISABILITY
Frequently Asked Questions
The Guardian Life Insurance
Company of America
7 Hanover Square
New York, NY 10004-4025
www.guardiananytime.com
DISABILITY & ABSENCE MANAGEMENT
Guardian’s Group Short Term Disability Insurance are underwritten and issued by The
Guardian Life Insurance Company of America, New York, NY. Products are not available
in all states. Policy limitations and exclusions apply. Optional riders and/or features may
incur additional costs. This policy provides disability income insurance only. It does NOT
provide basic hospital, basic medical or major medical insurance as dened by the New
York State Department of Financial Services. Plan documents are the nal arbiter of
coverage. Policy Forms #GP-1-STD-15.
2018-58246 (04-20)
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This is provided for informational purposes only and does not serve as a
guarantee of payment. Please refer to your contract/certicate booklet for all
applicable plan provisions.
IS DIRECT DEPOSIT FOR BENEFIT PAYMENTS
AVAILABLE?*
Disability benefits can typically be automatically deposited
into either a savings or checking account for quick access
to funds and no postal delays. Processing of a new Direct
Deposit request will take up to 10 days after we receive the
Direct Pay Enrollment and Authorization Form. Once the
Enrollment is approved, benefit payments can be expected
to be in an account approximately 2 business days after the
payment issue date. Enrollment is easy. Download the form
from www.GuardianAnytime.com. Click on “Find a Form”
located on the top left hand side of the screen. In the Keyword
field enter “Direct Pay” and click search.
HOW ARE DISABILITY BENEFITS EXTENDED?
If an individual’s disability lasts longer than expected,
additional medical information may be needed. As each claim
is unique, the medical information needed would vary from
claim to claim. A physician simply stating that an individual is
disabled may not be sufficient to extend benefits.
WHEN DOES THE INDIVIDUAL’S DISABILITY
AND/OR BENEFITS END?
Benefits may end when we determine the individual is able
to perform the major duties of his/her regular job, even if
the individual chooses not to. Benefit payments may also end
if the individual returns to work; the end of the maximum
payment period; the individual fails to provide continued
proof of loss; the individual is no longer under a doctor’s
regular care; or the individual passes away.
DO WE OFFSET OR INTEGRATE WITH OTHER
SOURCES OF INCOME?
Most STD plans will deduct other sources of income for
which an individual may be entitled. Some common ones
are: State Disability, No-Fault, Social Security, Retirement,
and other group disability benefits. An individual is required
to make application for any sources of income to which they
may be entitled and should advise Guardian immediately of
the status of their application.
WHICH STATES HAVE MANDATED STATE
DISABILITY PROGRAMS?
New York, New Jersey, California, Rhode Island, Hawaii,
and Puerto Rico have state mandated disability programs.
Individuals working in these states should consult with their
employer to determine how and where a state disability
claim should be filed. The individual should notify Guardian
immediately of the status of his or her application for state
disability benefits, as the outcome could have a direct impact
on the STD benefit amount.
HOW ARE BENEFITS PAID FOR MATERNITY
CLAIMS?
Maternity claims are handled the same as claims for any
other illness. Benefits commence after the elimination period
has been satisfied. Following delivery, continued benefits
would depend on the type of delivery and taking into
consideration reasonable recovery periods. The American
Medical Association (AMA) has determined that 6 weeks
is a reasonable recovery period following an uncomplicated
vaginal delivery, and 8 weeks following an uncomplicated
cesarean section. However, benefits can only be considered
for the period of time for which we have medically supported
limitations and restrictions preventing the individual from
performing his/her job duties. If the individual experiences
complications before or after delivery, we may require
additional medical documentation to substantiate any
excessive periods of disability. As indicated previously,
benefits may be issued in a lump sum payment.
ARE THERE ANY BENEFIT EXCLUSIONS UNDER
THIS PLAN?
Yes. These would be specific to the plan in question.
ARE DISABILITY BENEFITS TAXABLE?**
Disability benefits may be considered taxable and would
depend on how the disability premiums are paid. If taxable,
FICA (Social Security and Medicare) tax withholding may
be required. The individual may also elect to have Federal
Income Tax (FIT) tax withheld. Guardian is not required to
withhold State and Federal Unemployment Tax Act
(FUTA) taxes.
DISABILITY & ABSENCE MANAGEMENT
*Not available on all plan designs. **Please contact your tax or legal advisor regarding the tax treatment of the policy and
policy benets. You should consult with your own independent tax and legal advisors regarding your particular set of facts
and circumstances. The information provided is not intended or written to be used, and cannot be relied upon, to avoid
penalties imposed under the Internal Revenue Code or state and local tax law provisions.
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HOW DOES GUARDIAN COMMUNICATE THE
BENEFIT AMOUNTS FOR TAX REPORTING?
Explanation of Benefits (EOB’s) are typically mailed with
every check and would indicate the benefits paid and taxes
withheld. Guardian also provides the employer with quarterly
and year-end tax reports. This information is also available
through Guardian’s web portal — www.guardiananytime.com.
Each employer can choose from one of Guardian’s three STD
tax reporting options. If an employer determines that the tax
option assigned to their plan is incorrect, or the taxation of
the benefit is inaccurate, they should contact us immediately
to make the necessary changes.
WHAT IS A PRE-EXISTING CONDITION AND
HOW DOES IT AFFECT ELIGIBILITY FOR
BENEFITS?
Some STD plans include a pre-existing condition provision.
If applicable, disabilities for a condition(s) that is treated
within a specified timeframe prior to an individual’s STD
coverage effective date may be considered pre-existing. We
may limit or exclude benefits for disabilities caused by a
pre-existing condition(s) unless the individual was insured for
12 (typically) consecutive months.
ARE EMPLOYEE ASSISTANCE PROGRAM (EAP)
SERVICES INCLUDED?
Some plans may include our WorkLifeMatters
1
program —
check with a Guardian benefits advisor or employer resource
to see if this applies. With WorkLifeMatters, an individual
has access to a confidential employee assistance program
through Guardian and Integrated Behavioral Health (IBH),
ensuring they do not have to face life’s challenges alone.
WorkLifeMatters provides support and guidance for matters
that range from personal issues an individual might face,
to providing information on everyday topics that affect an
individual’s life.
Connect to a counselor for free support services:
1-800-386-7055 (Available 24 hours a day, 7 days a week)
Visit www.ibhworklife.com
(User name: “Matters”; Password: “wlm70101”) .
HOW DOES AN INDIVIDUAL CONTACT
GUARDIAN WITH BENEFIT OR CLAIM
QUESTIONS?
For claim questions or status, an individual has the option of
calling us toll-free at 800-268-2525, or visiting Guardian’s web
portal — www.guardiananytime.com. If an individual would
like to submit claim information, it can be faxed to
610-807-8270, sent via email to “[email protected]”,
or it can be submitted securely through www.
guardiananytime.com. Our regular business hours are
Monday through Friday, 8:00 AM to 8:00 PM (EST). When
contacting Guardian, be sure to have the individual’s name,
plan number, claim number and any contact information
included.
DISABILITY & ABSENCE MANAGEMENT
1. WorkLifeMatters Program services are provided by Integrated Behavioral Health, Inc., and its contractors. Guardian does not provide any
part of WorkLifeMatters program services. Guardian is not responsible or liable for care or advice given by any provider or resource under
the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide the actual
terms, services, limitations and exclusions. Guardian and IBH reserve the right to discontinue the WorkLifeMatters program at any time
without notice. Legal services provided through WorkLifeMatters will not be provided in connection with or preparation for any action
against Guardian, IBH, or your employer. WorkLifeMatters Program services is not an insurance benet and may not be available in all states.
WWW.GUARDIANANYTIME.COM
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