1. Claim Processing steps The Standard Insurance Company (The Standard) is Stafford County School Board’s Third Party Administrator for the Short-term (STD) and Long- term Disability Program (LTD) 1

2. Questions to ask yourself- 1. Have I been employed under a full-time contract with the school division for twelve (12) consecutive months? 2. Am I a VRS Hybrid member? 3. Is the short-term disability for myself? 4. Will I be out for more than seven (7) calendar days? 5. Am I under a Doctor’s care? If you answer “Yes” to all the questions, you may be eligible for VRS Hybrid Short-term Disability. 2

3.  Inform building level administrator of absence  Coordinate FMLA paperwork with Human Resources.  Complete the Standard Benefit Administrator’s Disability Insurance Claim Packet (Pages 3 thru 7, including Physician section). The Standard claim form may be found at the VaCoRP website: https://www.vacoins.org/vacorp/HybridDisability//%5E %5EDisability%20Claim%20Form%5E%5E.pdf. https://www.vacoins.org/vacorp/HybridDisability//%5E %5EDisability%20Claim%20Form%5E%5E.pdf  Employee will complete employee section using the on-line fillable form, print, sign and forwarded onto Attending Physician for completion. Instructions can be found on page 1 under “How To Apply for Benefits”.  Forward completed forms to The Standard Benefit Administrators either via USPS to The Standard Benefit Admin. PO Box 5031 White Plains, NY 10602 or to fax # 1- 800-378-8361. Note : The Standard will only accept claim forms no more than 90 day before the beginning of the short-term disability period. Employees are advised to make a copy of completed claim form for their records as the school division will not have access to the original claim form. 3

4.  Once the completed claim form is received by the Standard, a decision or request for further information will be made within one week. The decision will arrive either by email or USPS.  If approved, the first seven (7) calendar days of absence will be charged to your current sick leave. If no available leave, leave without pay will prevail.  Your sick leave accrual will then be frozen.  Ongoing approved disability days will be paid according to appropriate chart (non-work or work related) on page 5 or 6.  Payments will range from 60% - 100% depending on your length of service with the school division. 4

5. Days of Income Replacement: Non-Work Related Short-Term Disability (STD) Months of Service 100% Income 80% Income 60% Income Replacement Replacement Replacement  0-12 0 0 0  13-59 0 0 125  60-119 25 25 75  120-179 25 50 50  180 or more 25 75 25 Read chart from Left to Right. http://www.varetire.org/pdf/publications/vldp-handbook.pdf 5

6. Days of Income Replacement: Work Related Short- Term Disability (STD)* Months of Service 100% Income 80% Income 60% Income Replacement Replacement Replacement  < 60 0 0 125  60 - 119 85 25 15  > 120 85 40 0 *If an employee experiences a work related injury or illness and believes he or she will out of work for more than 7 days, the employee must file both a Standard and a Worker Compensation claim. Approvals and payments will be coordinated between companies. Employee’s STD and Worker Compensation will never exceed employee’s current salary compensation. Employees with less than sixty (60) months of service and awarded Worker Compensation payments may not see additional compensation from the Standard. Employees with over sixty month of service, the STD benefit could exceed the Worker Compensation amount and a STD benefit might remain payable on these claims. Read chart from Left to Right. Http://www.varetire.org/pdf/publications/vldp-handbook.pdf 6

7.  The Standard makes all decisions regarding the short-term disability period and the approved time period.  Approved time will only be adjusted in certain documented events.  Coordination of adjustment to leave time will be between the employee, their physician and the Standard. 7

8. The VRS Hybrid Short-term disability handbook http://www.varetire.org/pdf/publications/vldp-handbook.pdf The Standard Insurance Company (The Standard) 800-426-4332 800-378-8361 Fax Stafford County Public School’s VACorp Member Number with the Standard # 086B Questions: Human Resources - FMLA – Mary Ford 540-658-6566 Payroll – Wendi Martin 540-658-6591 Benefits – Cynthia Fortin 540-658-6669 May 2015 8