Voluntary Plan Claim Eligibility and Benefits
Your employee can find out if they are covered by a Voluntary Plan (VP) or State Disability Insurance (SDI) by checking with you, their employer. You should maintain records on VP and SDI coverage for all eligible employees.
Most VP coverage starts the first day of employment for existing voluntary plans, or the date the employee chooses to be covered by a new voluntary plan. The employee has the option to opt out of the VP and use SDI instead.
Note: Some VP may require the employee to work for the company for a period of time before the VP coverage becomes effective. In this situation, SDI will cover the employee for this period.
When the VP chooses to cover all employees, a signed rejection slip must be on file for any employee who chooses to be covered by SDI instead. If automatic coverage is not in effect, an enrollment sheet or other documentation, must confirm each employee’s coverage choice.
An employee can submit a claim for VP Disability Insurance if they are unable to work due to a non-work-related illness, injury, or pregnancy.
Determining eligibility must be based on the date that the:
- Disability began.
- Condition reached a point where the employee was unable to perform their normal or usual work.
This date may be different from the claim start date or the first day that the employee is able to receive benefits.
Chronic health conditions may require further review. Personnel records, attendance information, and discussion with the employee’s supervisor may be needed to identify when the condition became disabling. A medical condition can exist for some time without preventing an employee from doing their normal or usual work. That same condition can worsen and the employee becomes eligible for disability benefits.
Employees covered by a VP are also covered for Voluntary Plan Family Leave (VPFL). If a VP insurer provides VPDI coverage, then it must also provide coverage.
An employee can submit a claim for VP Paid Family Leave benefits for these reasons:
- To care for a seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner.
- To bond with a minor child entering the family through birth, adoption, or foster care placement.
- To participate in a qualifying event because of an eligible family member’s (spouse, registered domestic partner, parent, or child) military deployment to a foreign country.