• Disability Intake Brochure
• Beneficiary Form
• Evidence of Insurability Form

• LTD Benefit Summary - Class 1
• LTD Benefit Summary - Class 2

California Law Enforcement (CLEA)

• Group LTD Plan A

Disability Plans

STATE DISABILITY INSURANCE (SDI)

Employees covered under AFSCME collective bargaining agreements are eligible for State Disability Insurance (SDI). SDI benefits are payable when an employee is off work for more than 7 days due to a personal disability. SDI benefits will be integrated with an employee’s sick leave hours in accordance with the following procedures:

1. When an employee is expected to be off work more than 7 calendar days, the employee may request a claim form from the Human Resources Department.
2. The employee will need to complete his/her section of the form and have the treating doctor complete the physician section of the forms. It is the employee’s responsibility to ensure the claim forms are returned to the State in a timely fashion.
3. In order to avoid an undue financial hardship, the City will use available sick hours to pay the employee 100% of his/her normal compensation until the employee sends the City confirmation that SDI benefits are being paid, or after being off of work for four weeks, whichever occurs first. Regardless of whether the employee is in fact collecting state disability after four weeks or not, the City will begin integration. The City will do this by estimating the State Disability Insurance benefit as published by the Employment Development Department (EDD) and reducing this amount from the employee’s normal compensation. The balance will be paid using available sick hours.
4. The employee submits his/her first state disability check payable to the City, whereupon the City will restore the sick hours reflected in the state disability pay. To determine the sick hours to be restored, the City will divide the state disability pay by the employee’s hourly rate.

Integration of sick leave with SDI will bring an employee to his/her full pay and is not intended to give an employee additional compensation. Additionally, integration of SDI benefits and sick leave is not intended to give additional leave time under the terms of any state or federally mandated leave programs.

LONG TERM DISABILITY INSURANCE (LTD)

If you continue to be disabled for 60 days, you may be eligible to receive a monthly benefit based on a percentage of your monthly salary. The amount of your benefit is based on your monthly income in effect just prior to your date of disability. Your monthly salary is defined as your base salary. The City of Burlingame provides LTD coverage at no cost to you.

The LTD plan does not cover any disabilities caused by or resulting from a pre-existing condition. You have a pre-existing condition if you received medical treatment, consultation, care, or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; or you had symptoms for which an ordinary prudent person would have consulted a health care provider in the 3 months just prior to your effective date of coverage; AND, disability begins in the first 12 months after your effective date of coverage.

Cigna

• www.mycigna.com
• 1-800-858-6843