Summary of Coverage
|Benefit Plan||Who Pays for Coverage||Coverage Amount||Waiting Period|
|Short Term Disability||You||60% of your base pay up to $1,700 per week||14 days or 30 days|
How it Works
Short Term Disability (STD)* through Prudential (Sedgwick) will pay benefits if you are unable to perform the essential duties of your occupation because of an illness, injury, or pregnancy. After the waiting period, STD will pay benefits for eligible disabilities for the duration of your disability (as deemed by your doctor) up to 180 days from the date of disability. Your benefit amount is based on your rate of base pay in the payroll system on the day before your disability.
You may receive Paid Time Off (PTO) or benefits from the Sick Leave Bank/EIB while receiving STD benefits, up to a combined total of 100% of your base pay. After meeting the waiting period, you may only receive a PTO amount (40%) that, when combined with STD benefit, does not exceed 100% of your pre-disability earnings.
You must have active disability coverage on the date you become disabled to receive benefits. If you are absent from work due to illness or injury during the date your STD or LTD coverage would otherwise become effective, coverage becomes effective after you are actively at work for one full day. The requirement to be actively at work also applies to increases in coverage. Any changes to STD or LTD coverage would take effect upon your return to work.
Getting STD payments started
Contact Prudential at 1-844-223-4398 to begin the process of setting up your disability payments.
When to report a claim
When you know you will be out for more than seven days in a row, contact our vendor no later than your seventh day out of work so they can begin reviewing your claim.
How to report a claim
- See your physician or medical care provider.
- Contact your supervisor and IDM to report your absence.
- Contact Prudential at 1-844-223-4398.
- Before you call or fill out the claim form, please make sure you can provide:
- Your name, address, birth date, social security number, and e-mail address.
- Employment information, such as date hired and job title.
- The reason for your claim- illness, injury, or pregnancy.
- A description of your illness, symptoms and/or diagnosis.
- Information about any workers’ compensation claims you have filed or plan to file.
- Details about all doctor, hospital or clinic visits, including dates and contact information.
Pre-Existing Conditions Under STD The Texas Health STD plan does not require evidence of insurability. However, it does have certain limitations and exclusions for pre-existing conditions when you enroll for the plan during open enrollment or add the benefit after a status change. (New hire enrollment isn’t subject to pre-existing condition limitations). Examples of pre-existing conditions include illness, chronic medical conditions, pregnancy, mental health conditions, etc. If you have a disability that is caused by, contributed to, or the result of a pre-existing condition within the first 12 months after your coverage becomes effective under the disability plan, your benefits will be limited to 4 weeks (if you were not covered by STD within 12 months before your disability began).
NOTE: If you elected the 30-day waiting period in 2022 and changed to the 14-day waiting period in 2023, your 2023 benefits for a pre-existing condition will be subject to the 30-day waiting period. If you become disabled in 2023 due to a condition that is not a pre-existing condition, the 14-day waiting period will apply.
Who do I contact with questions?
- Call IDM at 1-877-MyTHRLink (1-877-698-4754) prompt 6, then 1
- Email IDM at THRIDM@texashealth.org
- Contact Prudential at 1-844-223-4398 (telephone) or 1-855-800-5116 (fax)
*Executives are not eligible for the STD plan.