Short-Term Disability Insurance in Pennsylvania | Qualifying

Does the Commonwealth of Pennsylvania offer short-term disability insurance? How long do the benefits last, and how much does it pay?

You determine the answer to the last set of questions because the state does not have a mandatory program for off-the-job (non-occupational) accidents, illnesses, and pregnancy.

To qualify, each individual has to first buy a new policy by showing evidence of good health. Only then can you file a claim for benefits for covered medical conditions.

On the other hand, PA laws open the door to related programs with mandatory participation that might help. You do not have to enroll in these in advance but do have to fit specific criteria.

Short-Term Disability in PA

Individuals employed in Pennsylvania need to purchase short-term disability insurance from a private company before becoming sick, hurt, or pregnant. The state does not have a mandatory program.

Once you have a pre-existing condition, it will be tough to qualify for coverage or file a claim for temporary non-occupational benefits and meet the eligibility criteria in each phase.

How to Apply

People employed in Pennsylvania face a two-step short-term disability application process. You must buy a new policy before filing a claim form.

New Policy

Request an individual short-term disability quote to start the process. An agent licensed in PA may contact you to review premium rates based on three feature choices.

  1. The benefit period determines how long claim payments last: 3, 6, 12, or 24 months
  2. The benefit amount determines how much the policy will pay monthly: up to 2/3 salary subject to a $7,500 limit
  3. The elimination period determines how quickly claim payments begin: 0,1,2,3,6, or 12 weeks

The agent can help you complete a new policy application and submit it to the insurance company for review. You must show evidence of good health to qualify.

File Claim

Apply for short-term disability benefits by filing a claim after suffering a covered accident or illness – provided you have the coverage already in force. Download the claim form from the company website.

  • A doctor must indicate the medical reason and sign where indicated
  • Your employer must signature-verify that you are no earning income

File the completed claim form with the issuing company. Log in to the web portal to track the status and respond to any clarifying questions.

How it Works

Short-term disability works the same way in Pennsylvania as it does across the country. An individual policy may replace a portion of income when you cannot perform your job duties due to a covered medical reason – with noted exceptions.

Pregnancy

Pennsylvania maternity leave laws do not include income replacement during your time off. Therefore, buying short-term disability before conception is the primary alternative.

However, the place where you enroll and the type of policy can impact how the coverage works.

  • Medical complications of pregnancy before your due date
    • All plan types may include
  • Recovery from labor and delivery after normal childbirth (two outcomes)
    • Individual plans bought outside of employers do not cover
    • Personal and group plans obtained at the worksite include coverage
      • Vaginal delivery: 6 weeks
      • C-section birth: 8 weeks
  • Postpartum disorders that delay your return
    • All plan types address postpartum medical issues
    • Only group plans include postpartum depression

Surgery

Short-term disability might cover your surgery. However, the coverage can work differently in two common scenarios.

  1. New policies will not cover surgery for a pre-existing health condition until the coverage has been in force for at least twelve months (knee replacement)
  2. All plans will not pay for cosmetic surgery, which enhances your appearance and is not medically necessary (breast enhancement)

COVID-19

Short-term disability may cover illnesses such as COVID-19. The Coronavirus pandemic provides an excellent opportunity to illustrate how the coverage works.

  1. Only the covered person qualifies to file claims when sick with COVID-19, not other family members requiring care or supervision at home during a lockdown
  2. Many people recover from the Coronavirus very quickly and can return to the job well before the elimination period ends
  3. People who have to quarantine to avoid infecting others may be ineligible if they can perform job duties from home

Taxation

Short-term disability claims payments may be income taxable. The way it works depends on how you fund the premium and varies for federal and PA income taxes.

PA Short-Term Disability Laws

The most critical Pennsylvania short-term disability insurance laws pertain to whether the state requires residents or employees to maintain a specific coverage type. You cannot file a claim unless you have a policy already in force.

The Commonwealth does not have a legal mandate for programs covering temporary income losses caused by off-the-job (non-occupational) injuries and illnesses.

However, the state does require related types of coverage.

Out-of-State Commuters

The most frequently enacted short-term disability law in Pennsylvania pertains to out-of-state commuters – in both directions.  Two neighboring states have legal mandates that apply based on where you work rather than where you live.

  • New Jersey has a required program. NJ residents commuting into Chester, Philadelphia, Levittown, Bethlehem, Easton, or Stroudsburg to the job lose the benefits. Conversely, PA residents traveling in the opposite direction gain.
  • New York has a mandatory program. NY residents commuting into Scranton, Sayre, Bradford, or Erie to their job lose benefits, while PA residents traveling in the opposite direction gain.

However, commuters to and from Delaware, Maryland, West Virginia, and Ohio find themselves in the same boat. These states also do not have mandatory coverage.

Unemployment Compensation

Pennsylvania unemployment compensation law does not permit individuals with a temporary disability to file a claim. Three universal provisions rule out qualifying for unemployment due to medical reasons.

  1. Physically able to work
  2. Available for employment
  3. Actively seeking a new job

However, related statutes make it possible to file a claim and win approval after recovering from your injury or illness and are ready to resume activities. You must have informed your employer of limitations before quitting due to health reasons.

”If the employer fails to offer suitable work, the claimant may be eligible.”

Social Security

The Commonwealth of Pennsylvania administers two Social Security disability programs that cover non-occupational (off-the-job) losses. By law, most residents fund the premiums automatically through mandatory FICA payroll taxes.

Therefore, almost everyone qualifies to file a claim without having to buy coverage in advance. However, two gaping holes remain.

Temporary Disability

Pennsylvania law requires employers to purchase Workers Compensation on behalf of employees, which provides temporary disability benefits for occupational (off-the-job) accidents and sicknesses.

The State Workers Insurance Fund (SWIF) oversees this mandatory coverage, which does far more than cover temporary income losses.

  • Services rendered by physicians or other health care providers
  • Reasonable surgical and medical care
  • Hospital treatment and supplies
  • Prescription medicines and supplies
  • Orthopedic appliances and supplies

Government Employees

The Commonwealth of Pennsylvania offers short-term disability to state government employees. However, there is no legal requirement for taxpayers to fund the premiums on behalf of public personnel.

State government wage-earners have the option to enroll and pay the premiums themselves via payroll deductions. Group policies like these typically have discounted rates, laxer underwriting standards, and better benefits for childbirth.

Therefore, state employees should sign up at work.