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Disability

What You Need to Know…

  • The Health Plan does not offer disability insurance. In addition, the Health Plan does not endorse any outside insurance firms or coverage.
  • If you or a dependent are totally disabled on the date your coverage expires, your coverage for the disabling condition will be extended until the earliest of the following:
    • 12 months from the date premium payment ceased for you or your dependent;
    • the date that you or your dependent ceases to be disabled;
    • the date that coverage for you or your dependent becomes effective under any replacement policy which does not exclude the disabling condition.
  • In addition, if you or a qualified beneficiary become disabled during your initial 18-month COBRA self-pay period, you will be eligible for an 11-month extension of your COBRA self-pay coverage, provided that you or a qualified beneficiary are determined by the Social Security Administration (SSA) to be disabled at any time during the first 60 days of COBRA coverage.

  • A copy of your Social Security Administration (SSA) determination letter will be required to establish eligibility for the Health Plan’s 11-month extension of your COBRA self-pay coverage (see above). The Health Plan must receive this letter within 60 days of the later of:
    • the date of the determination letter
    • loss of earned coverage and within the initial 18-month COBRA period
  • Alternative documentation will be required to establish eligibility for disabled children age 18 and over who do not meet the resource limit or residency requirements to qualify for Social Security disability benefits. Refer to page 28 of the March 2020 Health Plan Summary Plan Description for details.

  • The Health Plan has special criteria for disabled dependent children who do not meet Social Security resource limit or residency requirements. Refer to page 28 of the March 2020 Health Plan Summary Plan Description for details.
  • Disabled dependent children under age 18 and who are under earned coverage, COBRA coverage or Extended Self-Pay coverage do not need to submit proof of disability to determine dependent eligibility.
  • Disabled dependent children under age 18 and who are under Retiree Self-Pay coverage will need to submit documentation on an annual basis demonstrating continued mental or physical disability to determine dependent eligibility. This documentation will be reviewed by the Health Plan’s medical review firm.
  • The information on this page is only a summary of Health Plan rules. For detailed information, please refer to:

  • Disability benefits from the Pension Plans are available regardless of your age.
    • Under the Basic Plan, you must be 10-year vested and have accrued at least 12 Credited Service Months in the 36 months immediately prior to the disability onset date to receive disability benefits. If you are eligible for early retirement, a conversion option may be available. Please contact the Pension Plan at (877) 866-2200, Ext. 404 or pension@dgaplans.org for more information.
    • Under the Supplemental Plan, your Individual Account will be payable to you prior to age 60 after providing the Pension Plans Office with proof that you are totally disabled.
  • If you decide to apply for disability benefits, the Pension Plans can commence your pension benefits on the first of any month.
  • If you are going to apply for disability benefits with the Social Security Administration, you should review pages 14-16 of the March 2020 Pension Plans Summary Plan Description to review the Plans’ provisions, regarding disability benefits.

  • Notice of Award from the Social Security Administration – To apply for a disability benefit from the Basic and/or Supplemental Pension Plan, a copy of this notice must be provided to show that you are entitled to a disability benefit in connection with the Social Security Administration Retirement, Survivors and Disability Insurance. While you are not required to do so, you should notify the Plans within 90 days of your receipt of the Social Security award.
  • A Benefit Application Request Form, written request for a benefit application or signed letter of instruction must be received at least 60 days prior to the date on which you wish to start disability benefits.