If you request a plan design change, you will receive new certificates, or the necessary pages to update those certificates you have distributed and those you have in supply. We will provide instructions with any new forms.

The list bill is the most commonly selected bill type. The list bill shows each employee and the amount of premium due for each applicable coverage. Any additions, terminations and changes that occur between billing periods will be reflected on your next invoice after the changes have been made; therefore, please pay premium as billed.

Link to sample of list bill

Access MetLink to accomplish your billing needs. MetLink users can view the following:

• Current bills
• Current invoices
• Billing history
• Payment inquiries

You can also print current invoices, receive email billing notifications, and suppress paper bills. Log into MetLink and click on the Billing section.

For further help navigating through the MetLink Billing section, access the Resources tab on MetLink to view your customized user guide.

If you are currently not a MetLink user, contact your MetLife Representative or broker.

If You Have Selected The Self-Administered Billing Option

With the self-administered bill option, you are responsible for tracking and reporting additions, terminations and changes that occur between billing periods. The self-administered bill reports premium due for the total number of insured lives for each coverage. You then make the appropriate adjustments in your totals for the month and mail the revised billing statement and premium to MetLife.

Link to sample of self-administered bill

Example Of How To Calculate STD Premium

Short Term Disability (STD):

Rate per $10 Weekly Benefit

Example: Monthly Earnings x 12 ÷ 52 = Weekly Earnings

Weekly Earnings ($461.54) x Benefit Percentage (60%) ÷ 10 x Rate (.40) = STD Premium Due ($11.08)

Example Of How To Calculate Voluntary STD Premium

Voluntary Short Term Disability (VSTD):

Age Rate per $10 Weekly Benefit

Example: Employee’s age = 30

Benefit Amount ($500) ÷ $10 X Rate (.28) = VSTD Premium Due ($14.00)

Age      Rate
<30      .25
30-34   .28
35-39   .31
40-44   .35
45-49   .40
50-54   .45
55-59   .50
60-64   .55
65+      .59

How to Read Your Billing Statement

To help you better understand MetLife's billing procedures, sample bill formats are included along with an item-by-item explanation of information it contains. Please contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638) if you have questions about an item or any aspect of our billing process.

MetLife reserves the right to audit your records periodically to ensure the accuracy of premium calculations.

Please note: There is a $25.00 fee for all premium checks returned due to insufficient funds.

Electronic Funds Transfer

• Authorization for Electronic Fund Transfer Form

Electronic Funds Transfer (EFT) provides a new payment option for list billed customers to remit premium electronically from your bank to ours, without the resources and costs associated with requesting and issuing a manual check each month.

You will continue to receive a List Billing statement. The last page will state “Amount To Be Drafted” instead of balance due. The premium will be drafted from your authorized bank account on each bill due date.

To implement the EFT payment option, complete the Authorization for Electronic Fund Transfer Form and attach a copy of a voided business check.

Remit the EFT form and voided check to:

MetLife Small Market
P.O. Box 14593
Lexington, KY 40512-4593

Or Fax to:

Attn: MetLife-Small Market
Subject: EFT Authorization Form
Fax: 1-888-505-7446

• Notify MetLife in writing. Notification should be sent to MetLife at least 60 days before your specified termination date. The policy will end on the later of the date stated in the notice; or the date MetLife receives the notice.
• Pay all unpaid premiums for the time your policy was in force. If MetLife receives a notice of termination request, all outstanding premiums must be paid in full before your request can be processed.

Please submit all request for termination to:

Fax 1-888-505-7446
Small Market Administration
PO Box 14593
Lexington, KY 40512-4593

• Enrollment Form (All Products)
• Statement of Health Form

Eligibility

Eligibility requirements and effective dates may vary by group and/or type of coverage.

Actively at Work Requirements

Actively at work requirements may vary by group and/or type of coverage. Generally, if the Employee is not actively at work on the day coverage would otherwise become effective because of layoff, leave of absence or disability, the coverage becomes effective on the date that the Employee returns to active work.

Generally, if the effective date of coverage falls on a day on which the Employee is not scheduled to work or during the Employee's vacation period or weekend, the Employee shall be considered to be actively at work, provided the Employee worked on the last scheduled work day or the day immediately preceding the vacation period.

Enrollment of New Employees for Contributory vs. Non-Contributory Coverages

Non-Contributory Coverage means the cost of the coverage is fully paid by the Employer.

• 100% of all eligible Employees must be enrolled.
• Eligible Employees cannot waive non-contributory coverage.

Contributory Coverage means the employee pays all or a portion of the cost of the coverage.

• Employees are not required to enroll for the coverage.

Enrollment of New Employees for Contributory Coverages

Once new employees have met the requirements for coverage, they have 31 days to enroll in your group plan. Employees who do not enroll within this 31-day period are considered late enrollees. Late enrollees may apply for coverage at any time, subject to certain restrictions. Please refer to the Late Enrollments section of this manual for more details. Any employee who chooses to waive coverage must complete the waiving coverage section and sign the Enrollment Form.

For all benefits, except dental, employees must complete a Statement of Health Form for coverage amounts in excess of the non-medical maximum that can be found in the Schedule of Benefits in your Certificate of Insurance.

Enrollment of New Employees for Non-Contributory Coverages

Once new employees have met the requirements for coverage, they have 31 days to enroll in your group plan. All employees are to be covered on the date they are eligible. There are no late enrollments for non-contributory benefits. Enrollments processed after the billing period has ended for the eligibility date will be back-billed on the first available billing after the enrollment has been received and processed. Any employee who chooses to waive coverage must complete the waiving coverage section and sign the Enrollment Form.

The completed Enrollment Form should be sent to MetLife. Keep a copy of the Enrollment Form in your files as evidence that the new employee was given the opportunity to enroll. All requested information is necessary to promptly and accurately enroll your employees.

For all benefits, except dental, employees must complete a Statement of Health Form for coverage amounts in excess of the non-medical maximum that can be found in the Schedule of Benefits in your Certificate of Insurance.

Checking Enrollment Applications

For List Billed Cases: Incomplete or missing information on the Enrollment Form may delay coverage for your employees. Please check to see that all required forms are completed before submitting them to MetLife. Keep a copy of the Enrollment Form for your files.

For Self-Administered Cases: Please check that all required forms are completed and signed. Keep these Enrollment Forms in your files. MetLife will use the information to determine eligibility for benefits at the time of claim.

On MetLink you can maintain employee and dependent eligibility.

You will have the ability to:

• Enroll new employees
• Terminate coverage
• Reinstate coverage
• Add/Change dependent status

For Group enrollment, you can view:

• Enrollment listings
• Plan structure

Log into MetLink and click on the Enrollment Services section.

For further help navigating through the MetLink Enrollment Services section, access the Resources tab on MetLink to view your customized user guide.

If you are currently not a MetLink user, contact your MetLife Representative or broker.

Domestic Partnership

• Domestic Partnership Declaration Form

Domestic Partner means each of two people, one of whom is insured under the Policy, who represent themselves publicly as each other's domestic partner and have satisfied certain conditions set-forth in the Certificate of Insurance. Review your Certificate of Insurance to verify if your plan provides Domestic Partnership benefits. A Domestic Partner can become a qualified dependent for Dental, Life and AD&D if the requirements listed in the Certificate of Insurance are met.

The insured and the declared domestic partner are required to fill out the appropriate Domestic Partnership Form. Retain the form in your files.

For more specific information concerning the Domestic Partnership option, please refer to your group Certificate of Insurance.

For more information, contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638).

Enrolling Rehired Employees

Any rehired employee should be enrolled as if he or she were a new employee regardless of whether or not this person was previously covered under your group plan. The only exception is if the employee is rehired within six (6) months of the date on which coverage terminated because employment ended.

Any rehired employee returning from the armed services does not have to meet the requirements for coverage of your group plan. Please note on the Enrollment Application that the employee is returning from the armed services and the date he or she returned to full-time employment.

Effective Dates For Absent Employees

Individual effective dates for an employee who becomes eligible for benefits after the initial effective date of the employer's plan may be delayed if the employee is out due to injury or sickness on the date that benefits would be effective.

At initial enrollment, eligible employees who are not at work due to injury or sickness on the day benefits would normally become effective, will have benefits delayed until they return to work. Refer to your prior carrier's Certificate of Insurance for the extension of benefits section.

• Enrollment Form (All Products)
• Statement of Health Form

Late Enrollments

A late enrollment occurs when an Employee:

• Has chosen not to enroll himself or herself for coverage within 31 days of the eligibility date (See the applicable Certificate or plan document for more details) and decides to do so when offered at a later date
  
• Reapplies after termination of coverage at the Employee's request
  
• Applies for reinstatement upon returning to work after termination of employment, lay-off or leave of absence
• Applies for coverage and was previously eligible for coverage under the prior insurance carrier but did not enroll

Late Enrollments For Contributory Coverage

Employees who do not complete and submit Enrollment Forms during their enrollment period, and employees requesting amounts over the non-medical maximum (found in your Certificate of Insurance) must submit Statement of Health Forms in addition to Enrollment Forms. Coverage is subject to approval by MetLife. Effective dates for approved enrollments are determined by MetLife. Please see your Certificate of Insurance for more details.

If employee coverage was terminated at the employee's request, and the employee wants to re-enroll for coverage, a Statement of Health Form will be required in addition to the Enrollment Form.

Late Enrollments For Voluntary Short Term Disability

Employees who do not enroll when first eligible must wait until the next annual enrollment period on your group's anniversary date. Enrollees are allowed to enroll for the maximum benefit level of $100.

During annual open enrollment, employees currently enrolled in the Voluntary Short Term Disability coverage, can elect an increase to one increment of $50.00.

Late Enrollments For Non-Contributory Coverage

All employees are to be covered on the date they are eligible. There are no late enrollments for non-contributory benefits.

Evidence of Good Health Requirements

With regard to Disability coverage, evidence of good health is required for late enrollments. Any proposed Insured can not receive coverage until proof of good health for himself or herself is approved. See Statement of Health Procedures in this section for instructions on completing and processing the required forms.

How to Submit Statement of Health Forms

Employers should treat all information in the Statement of Health Form as confidential. Information should not be discussed with, or disclosed to, others unless such discussion or disclosure is necessary to administer the MetLife coverage.

Review the Employee's Statement Section of the form to ensure that all required questions have been answered and complete the Employer Section of the form. The original copy should be sent to MetLife. You should keep a copy for your records, and the employee should retain a copy for his/her records.

The authorization to furnish medical information is incorporated into the Employee's Statement. If necessary, it allows MetLife to request a medical examination and/or additional information from the employee's attending physician for the purpose of underwriting the coverages involved. The signature of the employee who is applying for coverage is always required.

Mail Statement of Health Forms to:

MetLife Statement of Health
P.O. Box 14069
Lexington, KY 40512-4069

Once the completed Statement of Health is received and reviewed by MetLife, the employer will receive notification of approval or declination. If a status has not been received within three weeks of submitting the Statement of Health, contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638). Please do not have the employee call.

The Statement of Health Form may require employees to disclose sensitive medical information about themselves. This information is used exclusively for determination of insurability. It is not to be used or made available for any other purpose whatsoever.

• Change Request Form

Examples of Changes in Employee Status

Examples of changes that require notification include:

• Employee has a change in earnings or occupation that affects benefit amounts
• Employee cancellation of a contributory coverage
• Employee changes benefit class
• Employee changes name
• Employee divorce or legal separation
• Death of employee

MetLife must be notified of any change in employee classification or salary to ensure maximum benefits are paid at time of claim. You may indicate the changes on a written list or Change Request Form. The listing must include the employer name and group number, employee's name, effective date of the change and the employee’s Social Security number.

Employee Terminations

Examples of employee coverage terminations that require notification include:

• Employee has been terminated
• Employee no longer meets the definition of an eligible employee under the plan
• Employee stops making contributions

Notify MetLife by completing a Change Request Form.

An employee's coverage may be continued even though he or she may not be actively at work under the following conditions:

• During a temporary layoff; or
• During an authorized leave of absence.

Continuing coverage in these situations is an option you should consider only when the reasonable expectation exists that the employee will return to work.

To continue coverage, the same contribution must be paid as if the employee was at work. The termination date for any employee continuing coverage under these conditions is the date employment actually terminates. Please indicate the employee's name and the date employment terminated on your monthly statement or a separate attachment.

For more information on the requirements and time periods for this type of coverage to continue, please refer to your Certificate of Insurance.

Temporary Layoffs Or Leaves Of Absence

For an employee who has been laid off or who has taken a leave of absence, certain coverages such as Life/AD&D and Dental may be continued as determined by the rules and practices of the employer, however, continuance cannot be longer than 2 months. In the event the leave qualifies under the Family & Medical Leave Act of 1993 (FMLA), the period cannot be longer than 12 weeks following the date the leave of absence began.

Continuation of STD/LTD coverages for such an employee, however, is determined solely by MetLife and not by the employer. Refer to your Certificate of Insurance for any applicable rules.

If the employee does not return to work, submit a Change Request Form noting the date benefits terminate. Refer to your Certificate of Insurance for further information.

Most policies are renewed annually. Renewal underwriting and pricing typically occur before your group’s anniversary.

About four months before this date, MetLife will contact you to verify the accuracy of the insured data shown on your premium statement according to your records. We ask that you verify this information 90 days prior to your renewal date. If we have not received it, we will follow up with you.

Having a current history of covered insureds facilitates accurate pricing of your coverage.

Census Requirements For Self-Administered Bill Type Option

MetLife evaluates performance of each group plan once a year. These evaluations may or may not result in rate changes. We review covered lives and demographic information, and therefore require updated census.

For cases using the Self-Administered bill option MetLife does not maintain employee level data. At the time of renewal, you must provide MetLife with a detailed census of all insureds each year 90 days prior to your renewal date. In addition, provide the percentage of premium contributed by the employer for each line of coverage.

The census must include:

• name and/or Social Security Number;
• date of birth;
• gender;
• occupation (for LTD or STD);
• salary (for LTD, STD or Life);
• class information (eligibility according to the schedule of benefits);
• dependent coverage (indicate participants and whether spouse or child) for all insureds;
• number of hours worked per week (for hourly employees);
• amount of coverage (by line of coverage); and
• total number of employees eligible.

• participants;
• amount of coverage;
• amount or percentage contributed by employer; and
• total number of employees eligible.

Renewal Action Letter

MetLife sends a renewal action letter prior to your group’s anniversary. The letter states the status of your plan and any renewal changes.

When Your Group Falls Below Participation Requirements

Your group plan may terminate if the participation falls below the required participation percentage noted in your Certificate of Insurance.

Policy Changes

No changes can be made to your policy without advance approval from MetLife. To change your group policy, contact your group insurance representative or your local MetLife sales office. Be sure your request includes the proposed change, effective date and an authorized signature on company letterhead.

Once MetLife approves the change, you will receive an acknowledgment letter and, if needed, replacement policy and/or certificate forms.

Examples Of Policy Changes

Examples of policy modifications include changes in:

• Affiliates
• Class
• Employer contribution percentage
• Change of policy situs state
• Waiting period
• Elimination period
• Benefit level

• Change Request Form
• Disability Claim Form

When to File a Claim

Short Term Disability (STD) coverage is designed to provide replacement of income when accident or sickness has resulted in temporary or total short term disability. STD benefits are designed to be a partial replacement of income and do not equal the amount of the employee’s predisability wages.

When an employee is unable to work and earn the percentage of predisability earnings due to disability shown in the certificate of insurance, file a claim immediately to allow a timely claim decision. Early notice also allows the earliest possible claim management.

Claims for disability should be filed within 45 days of the disability date.

How to File a Claim

If you anticipate that an employee will be unable to work and earn the percentage of predisability earnings due to disability for the waiting period as specified in your Certificate of Insurance, a Disability Claim should be called into MetLife or a Disability Claim Form should be completed by the Employer, Employee and the Attending Physician.

For paper claim submission, the employer must complete the Employer portion of the Disability Claim Statement. We encourage employers to provide the completed Employer form to the employee so that, the Employer and Employee forms are submitted together. The employee will also need to arrange for his/her doctor to complete the Attending Physician's portion of the form.

The employee should mail the completed claim documents to:

MetLife Disability
P.O. Box 14590
Lexington, Kentucky 40511-4590

OR

Fax to: 1-800-230-9531

MetLink users can file and view claims. MetLink allows users to search claim information by employee name, employee social security number, claim status or claim number.

Log into MetLink and click on the Claims section.

For further help navigating through the MetLink Claims section, access the Resources tab on MetLink to view your customized user guide.

Employees can access their Disability claims on MyBenefits. MyBenefits allows employees to receive alerts on any processed claims, view claim status and payment issue dates; as well as, file a new claim within 5-10 minutes.

To view a demo of MyBenefits, contact your MetLife Representative or broker.

For New Mexico Residents Only:

New Mexico Notice of Confidential Abuse Practices This form permits victims of domestic violence to participate in a location confidentiality program as provided under the New Mexico Domestic Abuse Insurance Protection Act.

• New Mexico Domestic Abuse

Additional Information for Long Periods of Absence

When MetLife requires additional information for the disability claim, MetLife will make a telephonic contact with the treatment provider(s). Two telephonic attempts will be made within two business days. If telephonic attempts to obtain the information are unsuccessful, a fax request will be sent to the treatment provider(s). The employee will be contacted telephonically and advised that MetLife's attempts to contact the treatment provider were unsuccessful and that a written request was faxed. MetLife will ask that the employee contact their attending
physician(s) or treatment provider(s) to ensure that the additional information is provided to MetLife as requested.

Notification of Return to Work

When a disabled employee who has been on claim returns to work, it is important that you contact Customer Service 1-800-ASK-4-MET (1-800-275-4638) to notify MetLife as soon as possible.

Late notice of a disabled employee’s return to work may result in an overpayment of disability benefits.  If an employee has returned to work and benefits have been paid applicable to any days beyond the return to work date, the benefit check should be returned to MetLife for adjustment. The date through which benefits are paid is shown on each check.

Medical Confidentiality

With HIPAA regulations, medical professionals and treatment providers are required to guard the confidentiality of claim information. To do so, most treatment providers require an authorization signed by their patient before they will provide medical information requested by insurance companies for the purpose of claim evaluation.  Therefore, MetLife requires an up to date signed authorization from claimants so that, we may stay abreast of medical treatment and status relative to disability claim eligibility.

To protect confidentiality, the STD Claims office uses these guidelines:

• We consider all medical information confidential. We do not give this information to claimants, claimant representatives, or employers.
• We instruct claimants to contact their physicians whenever questions arise about a medical diagnosis.

Tax Information

For Details regarding Tax Information click here.

Reporting Requirements

The Internal Revenue Code (IRC) specifically addresses withholding and reporting of disability benefits paid by a "third party" (e.g., an insurer or 501(C)(g) trust). If the plan is contributory, the employer's report to the employee and to the IRS must show the portion of benefits attributable to employee contributions (i.e., included in gross income).

By law, the employer must report the amount of benefits paid attributable to employee/employer contributions to both the employee and the IRS. The employer is the only party in possession of sufficient information to ascertain not only the net premium or net cost of the Plan, but also the total employee contributions actually paid during the periods involved. As such, the responsibility for determining the allocation rests with the employer.

Premium payments required from the employee toward the cost of Short Term Disability coverage must continue during the Elimination Period and during the duration of the short term disability.

Should Short Term Disability benefits exhaust due to the maximum benefit duration being reached and the employee transitions into Long Term Disability (LTD) coverage with MetLife, premium payments will be waived during any period of disability for which a monthly LTD benefit is payable.

ERISA is an important federal law that governs most benefit plans established and maintained by employers. It imposes among other things certain participant reporting requirements on an employer. As a service to employers, MetLife can include an "ERISA Information" statement with the certificates of insurance issued to a group. This statement, combined with a certificate of insurance, is intended to assist you in meeting ERISA’s requirement to provide a summary plan description (SPD) to participants describing the insurance benefits provided by MetLife under the ERISA plan. If you want the ERISA Information for your plan sent to you, please send a written request to us. Your request must include your MetLife group number, the name, address, and phone number of the plan administrator of your plan, the employer identification number (which may be your Federal Tax Identification Number), and the beginning and end date of your Plan's fiscal year.

What Is ERISA?

ERISA is a federal law that governs most employer established welfare benefit plans (government and church plans are excluded as well as some employee pay all plans). It is the employer's responsibility to provide certain information to plan participants and the Department of Labor and comply with other requirements.

What types of employer groups are governed by ERISA?

This law generally applies to any employee welfare benefit plan that is established or maintained by:

• Any employer engaged in commerce or in any industry affecting commerce, or
• Any employee organization(s) representing employees engaged in commerce that provides certain benefits to their employees, participants, dependents, or beneficiaries.

Welfare benefit plans may include plans that provide the following types of benefits:

• medical, dental, disability income, or life benefits
• unemployment, vacation or severance benefits
• other types of employer sponsored benefits.

Is there a minimum number of employees below which ERISA does not apply?

No. ERISA governs all welfare benefit plans that have one or more employees, unless they are church or government groups.

What does ERISA require employers to do?

Generally, ERISA requires all employers (or plan administrators as an employer may contract with) to provide participants and beneficiaries with a summary plan description (SPD) describing in understandable terms their rights, benefits and responsibilities under the plan. Employers are also required to furnish participants with a summary of any material changes to the plan or changes to the information contained in the summary plan descriptions. These documents must be furnished to the Department of Labor on request.

Employers with 100 or more participants must file a Form 5500 annually. Employers with fewer than 100 participants must file Form 5500-C at least every third year and Form 5500-R in the two intervening years.

Where can I obtain additional information about ERISA?

You should contact your legal and tax counsel to advise you about your obligations as an employer under this law. You may also contact The Department of Labor or visit their web site at www.dol.gov for more information.

ERISA Plan Number

Welfare Benefit Plans must start with 501.

• Guaranty Association Notices