UT Southwestern Medical Center Faculty Long Term Disability Plan Features Faculty Plan The Standard Insurance Company Plan Provider 60% of monthly earnings Monthly Income Benefit Monthly Maximum $35,000 Elimination Period Choice of 90 or 180 days* Wait Period before benefits are payable* Duration of Benefits Age Disability Begins – Maximum Period Payable - 61 or younger – To age 65, or 3 years 6 months, if longer - 62 – 3 years 6 months - 63 – 3 years - 64 – 2 years, 6 months - 65 – 2 years - 66 – 1 year 9 months - 67 – 1 year 6 months - 68 – 1 year 3 months - 69 – 1 year 12 months Pre-Existing Condition Clause Inability to earn more than 80% of salary or Inability to perform job duties Definition of Disability Sub-specialty Protection** Yes Cost of Living Adjustment (COLA) Cost of Living Adjustment beginning 36 months after the date benefits are first payable for the term of disability. Inflation Protection Adjustment is equal to lesser of 3% or Consumer Price Index (CPI) Yes Conversion Benefit Offsets Reductions to monthly benefit for other sources of income Monthly Premium Rate Per $100 of monthly salary Benefits will reduce for sick leave, wages, Social Security benefits, retirement benefits that received employer contributions, workers compensation and unemployment benefits*** Selection Rate 90 Day Elimination Period with COLA 90 Day Elimination Period without COLA 180 Day Elimination Period with COLA 180 Day Elimination Period without COLA $0.955 $0.730 $0.827 $0.633 To calculate monthly premium, (monthly salary/100) times rate * Or exhaustion of sick leave, whichever is later ** As recognized by the American Board of Medical Specialties *** See Plan Certificate for a complete list of benefit offsets Fac LTD 12-13.doc 07-13-12:TL