Short Term Disability Benefit Summary

QVine Corporation pays 100% of the following benefits for all active, full-time employees working at least 30 hours per week.

Short Term Disability Benefits (STD)

• This benefit will pay 60% of the employee's basic weekly earnings up to a maximum benefit of $1,500 per week minus any income that is listed in the Benefit Reductions provisions.
  
• Benefits begin on the 1st day for an accident and or the 8th day for sickness/illness.
• In order to receive benefits, the Short Term Disability Claim Form that can be found on this website must be completed by you, your doctor and your employer.
  
• Short Term Disability benefits are paid on a weekly basis.
• Checks will be sent to your home address.
• If you are still disabled and incapable of working after 13 weeks, your Long Term Disability benefits, if approved, will begin.
• Claim forms should be filled out by the employee and submitted to Human Resources to be included with the employer portion of the claim information.

Can I return to work part-time and still receive a benefit?
Yes. The STD plan provides financial incentives for you to return to work, even on a part-time basis. You may receive up to 100% of your pre-disability earnings when combining Rehabilitation Incentives, Family Care Expense and Partial Disability Benefits.

Does the plan have Zero-Day Residual?
Yes, for example, if an employee becomes disabled, he/she can satisfy the waiting period while partially or totally disabled.

How is pregnancy handled?
Pregnancy benefits are determined on the same basis as sickness.

Limitations
Occupational Benefits Limitation
No benefits are payable for any disability: 1. which happens in the course of any work performed by the employee for wage or profit; or 2. for which the employee is eligible to receive benefits under any Workers' Compensation or any similar law.

Mandatory Rehabilitation
Benefit payments cease on the date an employee refuses to participate in an approved rehabilitation program in which the employee is capable of participating. (This limitation does not apply in NJ. In CT, this does not apply if the plan is contributory. In CT, if a plan is non-contributory, this provision will only apply if the insured's doctor approves the insured's participation in a rehabilitation program.)

Exclusions
This Plan does not cover any Disability which results from or is caused or contributed to by: war, insurrection, or rebellion; active participation in a riot; intentionally self-inflicted injuries or attempted suicide; committing a felony. The plan does not cover elective treatment or procedures such as, but not limited to: cosmetic surgery or treatment primarily to change appearance, invitro fertilization, embryo transfer procedure, artificial insemination, sex-change surgery, reversal of sterilization, liposuction and radial keratotomy (Please note: Certain states have specific requirements.)