Office of Medical Education

Long Term Disability Insurance Plan

The Hartford Insurance Group website

LSU Booklet

The Hartford

Group Benefits Division, Customer Service

P.O. Box 2999

Hartford, CT 06104-2999

1-800-523-2233

Policyholder: LSU HEALTH SCIENCES CENTER - NEW ORLEANS

Policy Number: GLT-715924

SCHEDULE OF INSURANCE

LSU Health partners with The Hartford to provide Long Term Disability (LTD) coverage. The Policy of long term Disability insurance provides You with long term income protection if You become Disabled from a covered injury, sickness or pregnancy.

Cost of Coverage:

You are not required to contribute toward the cost of coverage.

Eligible Class(es) For Coverage:

All Full-time Active Employees who are house officers who are citizens or legal residents of the United States, its territories and protectorates; excluding temporary, leased or seasonal employees.

Full-time Employment: at least 40 hours weekly

Eligibility Waiting Period for Coverage:

None

Elimination Period:

90 day(s)

Maximum Monthly Benefit: $5,000

Minimum Monthly Benefit: The greater of:

1. $100; or

2. 10% of the benefit based on Monthly Income Loss before the deduction of Other Income Benefits.

Benefit Percentage: 60%

Maximum Duration of Benefits

Maximum Duration of Benefits Table

Age When Disabled                                                         Benefits Payable

Prior to Age 63                                                                     To Normal Retirement Age or 48 months, if greater

Age 63                                                                                   To Normal Retirement Age or 42 months, if greater

Age 64                                                                                   36 months

Age 65                                                                                   30 months

Age 66                                                                                   27 months

Age 67                                                                                   24 months

Age 68                                                                                   21 months

Age 69 and over                                                  18 months

Normal Retirement Age means the Social Security Normal Retirement Age as stated in the 1983 revision of the United States Social Security Act. It is determined by Your date of birth as follows:

Year of Birth                                                                       Normal Retirement Age

1937 or before                                                                    65

1938                                                                                       65 + 2 months

1939                                                                                       65 + 4 months

1940                                                                                       65 + 6 months

1941                                                                                       65 + 8 months

1942                                                                                       65 + 10 months

1943 thru 1954                                                                   66

1955                                                                                       66 + 2 months

1956                                                                                       66 + 4 months

1957                                                                                       66 + 6 months

1958                                                                                       66 + 8 months

1959                                                                                       66 + 10 months

1960 or after                                                                        67

Additional Benefit:

Family Care Credit Benefit

see benefit

Survivor Income Benefit

see benefit

Workplace Modification Benefit

see benefit

ELIGIBILITY AND ENROLLMENT

Eligible Persons: Who is eligible for coverage?

All persons in the class or classes shown in the Schedule of Insurance will be considered Eligible Persons.

Eligibility for Coverage: When will I become eligible?

You will become eligible for coverage on the later of:

1. the Policy Effective Date; or

2. the date on which You complete the Eligibility Waiting Period for Coverage shown in the Schedule of Insurance, if applicable.

Enrollment: How do I enroll for coverage?

All eligible Active Employees will be enrolled automatically by the Employer.

Forms