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Frequently Asked Questions

What is the purpose of this plan?

A. The purpose of the Long Term Disability Program is to provide financial assistance should you lose your income due to a disabling illness or injury

Who is eligible to enroll?

A. You may apply for coverage if you are a permanent active, full-time federal employee and you are under age 62. Retirees, part-time or temporary employees are not eligible. Evidence of insurability is required.

What kind of disabilities are covered?

A. “Disability” or “Disabled” means that because of injury, sickness, or mental and nervous disorders, you are not engaged in any occupation or employment for wage or profit for which you are reasonably qualified by education, training, or experience, and:

  • During the first 24 months of disablility, you cannot perform all of the material and substantial duties of your regular occupation; and
  • After 24 months of disability, you are completely unable to perform the material and substantial duties of any occupation for which you are reasonably fit by education, training, and experience.

You must also be under the regular care of a physician.

Can I collect benefits for a work-related injury?

A. Yes. However, if you receive or are eligible to receive compensation under any Workers´ Compensation Law, Occupational Disease Law, or similar law, your SAMBA benefits will be offset by the amount you receive from the other source.

What are benefit offsets?

A. Generally, any amount of money you receive from another source because of your disability will be used to offset your SAMBA disability payment. Benefit offset examples include Workers’ Compensation, federal retirement programs, social security, or legal settlements from lawsuits related to an injury/illness.

My doctor says I will not be able to work for six months. How do I start collecting disability benefits?

A. Contact SAMBA as soon as you can by calling 1-800-638-6589. We will provide you with the necessary claim forms to file for compensation. You, your physician, and your employer will need to complete the forms and return them to us so that we can review and make a determination on your request for benefits. Your claim must be filed within 12 months of the onset date of the disability in order for the claim to be considered for compensation.

If I am out on disability, do I still have to pay my plan premiums?

A. No. If you are receiving disability benefits from us, we waive your disability premium following the Elimination Period for as long as benefits continue to be paid. You would however be responsible to pay the premiums for any other coverage you may have with SAMBA.

What is the Elimination Period?

A. This is 60 continuous days of disability which must be satisfied before you begin to receive benefits under the Program. A new Elimination Period is applied to each period of disability.

What is my Covered Salary Amount?

A. This is the amount of coverage that you are enrolled under the plan. The Covered Salary Amount cannot exceed your Eligible Salary Amount.

How are my monthly disability benefits calculated?

A. The benefit is 65% of your Covered Salary Amount.

For example:
Covered Salary Amount – $43,000.00
Multiply by 65% – $27,950.00
Divide by 12 – $2,329.17
Your Monthly Benefit Amount (before offsets) – $2,329.17

My salary has increased over time, but my Covered Salary Amount has stayed the same. Why?

A. After your initial enrollment in the Program, you must notify SAMBA of any increase in your salary. There are two reasons for this:

1) SAMBA has no way of knowing when your pay increases occur or how much your pay increases are, and
2) As there will be a change to your premium, you need to authorize the increase. Click here to access the Enrollment Center to make your change.

Do I have to fill out a Health Statement to increase my Covered Salary Amount?

A. You will not be required to complete a Health Statement if:
1) you apply within 90 days of the effective date of the salary increase; and
2) your Covered Salary Amount was equal to your Eligible Salary Amount immediately prior to the increase.

How can I cancel my coverage?

A. We need written documentation from you before we will cancel your coverage. If you pay your premium by payroll allotment, you need to complete Payroll Allotment Form 299 and write in the name of the plan you wish to cancel at box #6. Sign and date the form and mail it to:

SAMBA
11301 Old Georgetown Rd
Rockville, MD 20852

or fax it to SAMBA at 301-816-0191.

If you are billed other than through payroll allotment, write a short note requesting that the coverage be cancelled. You can e-mail us using the Contact Us website page. We will notify you once the coverage has been cancelled.

Available only to full-time active federal employees.

You are eligible to enroll if you are under age 62, are actively at work* as a permanent full-time employee of a federal agency, and reside in the U.S. at the time of enrollment.

 

*If your regular place of employment is your home or other residence, you would not be considered actively at work.

Enrollment Center

Monthly Benefit

The plan will pay up to 65% of your insured salary.

Survivor Benefit

If you die while collecting monthly benefits, a survivor benefit will be paid to your beneficiary.

Return to Work Incentive

Benefits continue if you return to work on a reduced schedule.

In-Hospital Benefit

For each day you or a covered family member is confined in a hospital, the plan pays a daily benefit.

Enrollment Center

Coverage is based on your salary.
Biweekly premium
Monthly premium

Claims Center