Now that we’ve got that covered, I’m excited to welcome back Rocco. He’s a regular contributor to our webinar series, and today he’ll be leading a session on disability training. I hope you find it valuable and informative. With that, I’ll hand it over to Rocco so he can properly introduce himself.

Thank you, Elise. I appreciate the introduction. Good morning, everyone. My name is Rocco, and I’m with Mutual of Omaha. I’m excited to go through this presentation with you today. As I was just mentioning to Elise, we often conduct CE courses that come with specific content requirements, which can sometimes be a bit limiting. Today’s session, however, gives us the opportunity to really focus on what’s important in the marketplace—key insights that can help you in your role as a consultant, whether you're working with employers, HR managers, CFOs, or CEOs.

When you're presenting proposals and making recommendations, it's crucial to understand the impact that differences between carriers—especially when it comes to disability—can have on the claimant. That’s really the heart of what we do. It's easy to get caught up in the details of quoting and contracts, but at the end of the day, the goal is to help people when they’re hurt, sick, and unable to work—when they need financial support the most.

There are significant differences in provisions, contracts, and carriers that can make a big difference for the claimant. Honestly, I could talk about disability for 10 hours, but I won’t. For today’s presentation, I’ve narrowed it down to three major concepts. This will serve as the foundation, and as Elise mentioned, this is part of a series. If you find it valuable, we can definitely schedule future sessions to build on what we cover today.

I’ll start by giving a brief overview of Mutual of Omaha, and then we’ll move into those three key components of disability training.

Our Philadelphia-area office is located in Conshohocken. My manager and mentor, Mike Butler, has grown our office from $6 million to $10 million over the past 10 years, making us the fastest-growing ancillary carrier in our space. I work directly with brokers across Central and Eastern Pennsylvania, helping them with all ancillary benefits—everything outside of medical insurance. This includes life, short- and long-term disability, dental, vision, accident, critical illness, hospital indemnity, and absence management.

Our mission is to be the easiest carrier to work with. All our contracts—whether employee-paid or employer-paid—are consistent, and everything is consolidated on a single bill for the client. We serve all industries, and we’re competitive across the board, including with school districts and manufacturing groups. I work with groups of all sizes; there’s no need to go through different reps depending on group size. While our materials might say we serve groups from two to 100,000, I usually just say two to a million.

We offer voluntary or employee-paid benefits for groups with more than 10 eligible employees, and our sweet spot tends to be groups in the 25 to 500 life range. Many people recognize Mutual of Omaha for life and disability insurance, which is great because those are areas where we really excel. But what many don’t realize is that we also offer competitive dental products.

In fact, while we’re a major dental player nationwide, we’re not as well known for dental in Pennsylvania, Delaware, and New Jersey. That’s largely because Mike Butler was able to grow our office so significantly without needing to focus on dental in these regions. As a result, we have strong rates and a solid network, but lower name recognition compared to other carriers. That said, our dental offerings are just as flexible as any other major carrier. We can do MAC out-of-network plans, 90th percentile UCR, 95th, and even 99th percentile UCR. We also offer the option for a lifetime deductible—$100, for instance—which, once met, doesn’t reset annually. That’s not something we’re seeing from many other carriers. We also don’t include a missing tooth clause, which is a significant advantage compared to many of the big names in the market.

Again, this is just a quick overview of Mutual of Omaha before we dive into the core disability training content. Another area where we truly stand out is implementation. This is often a concern for employers and HR managers when considering switching carriers. They worry about the workload and the process of transition. We’ve made this as smooth as possible.

Once we receive confirmation that a group wants to move forward, we schedule a 30- to 45-minute welcome or implementation call. During that call, we go through all the paperwork together. In fact, we complete all the paperwork on our end and send it back for signatures only. It’s straightforward, efficient, and ensures that everyone is on the same page from the beginning. This approach significantly reduces the chances of issues arising six months, a year, or even two years down the line.

Finally, I want to highlight our strength in voluntary benefits. These employee-paid benefits are a key driver of our success. We have a wide range of resources and capabilities to create a seamless experience for both HR and employees, whether it’s through in-person, virtual, or hybrid enrollment methods.

We can create a custom app that employees can use to access all of their benefit summaries and enrollment platforms if they're enrolling online. We can also develop a microsite, fully branded to that employer. We've invested a significant amount of time, effort, and resources into voluntary benefits to ensure the process is simple and seamless. This approach not only improves the experience for employees but also helps reduce costs for employers on their employer-paid benefits.

There’s a lot to cover when it comes to disability differentiators in the marketplace. When we talk about ancillary benefits—everything that accompanies medical insurance aside from dental and vision—it often includes life and disability insurance. These are sometimes dismissed as commodity products, with the assumption that coverage is the same regardless of the carrier. You’ve probably heard that before, and maybe even said it yourself.

In the case of life insurance, that perception isn’t entirely wrong. If someone passes away, a benefit is paid—most carriers handle that similarly. However, disability insurance is a different story. There are many contractual provisions and differences that ultimately determine how much a claimant is paid, and for how long. Our focus is on supporting the claimant—that's the foundation of what we do.

In this session, I’ll walk you through three major components of disability insurance, how they work with Mutual of Omaha, and how they differ in the marketplace. These insights will help you become a more effective consultant and better explain to your clients exactly what they’re purchasing for their employees, especially when that coverage matters most.

The first concept is "No Loss, No Gain" for long-term disability (LTD), which is also referred to as individual continuity of coverage for future hires. When an employer moves from one carrier to another for their LTD policy, there’s an important provision that applies to existing employees. If those employees have been covered under the previous carrier’s LTD policy for at least a year, the new carrier typically honors that pre-existing condition period. This means the employee doesn't have to restart their pre-existing condition limitation with the new carrier.

This is standard practice across the industry—every carrier does this for existing employees. However, if a new hire joins the company, they are subject to the standard pre-existing condition limitation. In Pennsylvania, for example, the law mandates a 3/12 limitation. That means if a person receives medical advice or is prescribed medication for a condition within the three months prior to their effective date, they cannot file a claim for that condition until they’ve been covered under the plan for 12 months.

Now, here’s the critical difference: Mutual of Omaha is the only carrier in the marketplace that offers protection against this pre-existing condition limitation for new hires—through a specific provision designed for continuity of coverage. Let me share an example that illustrates this in real terms.

Imagine a tech company—ABC Company—is expanding and doing well. They're hiring a new executive and find Sally, who has nine years of experience at another tech firm, where she was covered by a group LTD plan. During the interview process, ABC Company tells her that her benefits will start on day one, just like at her current employer. Based on that assurance, she accepts the offer.

What ABC Company doesn’t know—due to HIPAA privacy rules—is that Sally was in a car accident a month prior. She’s okay and cleared to work, but the employer has no knowledge of her condition. Within the first 12 months at the new job, her back and neck begin to flare up due to the accident, and she needs to file an LTD claim.

With any other carrier, that claim would be denied. She’s a new hire, the injury occurred within the three-month pre-existing window, and she’s filing within the first 12 months of coverage. But with Mutual of Omaha, the claim is approved. She already satisfied her pre-existing condition period under her prior employer’s plan, and we honor that continuity of coverage.

This isn’t a hypothetical. This is based on an actual Mutual of Omaha case. And beyond supporting the claimant, this provision also protects the employer. Remember, they told Sally her benefits would begin on day one. If her claim were denied under another carrier, she could pursue legal action based on that promise. With Mutual of Omaha, that risk doesn’t exist.

So the employer avoids legal liability, the employee receives the benefits they were promised, and you, as the broker or consultant, become the hero for delivering a solution that truly protects your clients and their employees. If Sally were eligible for a $10,000 monthly LTD benefit and remained disabled for 10 years, that’s $1.2 million in benefits that would be paid with Mutual of Omaha—versus $0 with any other carrier.

Sometimes we hear, “It’s just $3,000 or $5,000 a month,” but this is long-term disability. These benefits can last for years—two, five, even ten years—and potentially until the claimant reaches their Social Security Normal Retirement Age, which is 67 for anyone born in 1960 or later.

That’s the first of the three key components I’ll cover today. I hope it’s a helpful tool for you when you're making recommendations and having conversations with clients. If you have questions at any point, feel free to drop them in the chat. I’m monitoring that as well.

I started with that example because it’s such a unique differentiator—Mutual of Omaha is the only carrier offering this kind of protection. But now I want to turn to arguably the most important and easily recognizable factor for both employers and employees: the definition of disability.

This is one of the most common questions we get, whether it's in enrollment meetings or proposal presentations. HR managers or employees might ask, “What actually qualifies as a disability? If someone’s in a car accident, does that count? Will it be approved?”

As consultants, we can’t always answer those questions definitively, because the outcome depends on how the carrier defines disability. And that definition varies from one carrier to another.

Let’s begin with short-term disability. At Mutual of Omaha, we define disability as the inability to perform at least one material duty of the employee’s own job, along with at least a 1% loss of earnings.

It’s important to distinguish between “own job” and “own occupation”—those are not interchangeable, and we’ll get into that more shortly.

You can typically find the definition of disability toward the end of a carrier’s contract. For convenience, I’ve included that definition here. “Own job” refers to the specific position the employee is regularly performing, as it is described by their employer. On the other hand, “own occupation” refers to the general job classification, as described by the Department of Labor in its Dictionary of Occupational Titles.

To make the distinction clear, let’s walk through an example. Imagine an employee at UPS. According to the company’s internal guidelines, all employees must be able to lift up to 60 pounds in order to meet the physical requirements of the job. Now suppose this employee suffers an injury, and their doctor tells them they can no longer lift more than 50 pounds. Based on UPS’s job description, the employee no longer meets the requirements and is therefore considered disabled under the definition of their “own job.” However, if the Department of Labor’s description of that occupation only requires the ability to lift 30 pounds, then under the broader “own occupation” definition, the employee is not considered disabled—because they are still capable of performing the general occupational duties as defined federally.

This distinction is important because Mutual of Omaha uses the “own job” definition for short-term disability. Under this definition, an employee is eligible for benefits if they experience just a one percent loss of income and can no longer perform at least one material duty of their job. Most other carriers are more restrictive. They typically require a loss of fifteen to twenty percent of income and the inability to perform some or most of the material duties of the job. That kind of language leaves room for subjective interpretation by the carrier, making the claims process more uncertain. Mutual of Omaha’s approach, by contrast, is objective and straightforward. If one material duty is lost and there is at least a one percent loss of income, the employee qualifies.

For long-term disability, the definition is nearly the same, except that it applies to “own occupation” rather than “own job.” This means that the employee is evaluated based on the general job description from the Department of Labor, not their specific employer’s version. This definition typically applies for the first twenty-four months of a claim. After that, the policy shifts to an “any occupation” definition. At that point, the employee must be unable to perform any occupation for which they are reasonably suited based on their education, experience, and training. For instance, someone who was a corporate executive wouldn’t be expected to take a job flipping burgers just because they are physically able. The role must be reasonably aligned with their background.

During this transition, the earnings threshold also changes. For the “own occupation” period, Mutual of Omaha requires only a one percent loss of income, but when the definition changes to “any occupation,” that threshold increases to fifteen percent. The employee must now be unable to perform all material duties of any occupation they are suited for.

It’s worth pointing out that many carriers include something called “gainful occupation” language. This is essentially a predictive clause that allows the carrier to terminate benefits early. If the carrier believes that the claimant will recover enough within the next twelve months to return to work in a gainful capacity, they can end benefits immediately—even if the person is still currently disabled. This is problematic because it forces claimants to stop receiving benefits based on a projection, not on their current state. Mutual of Omaha does not include this gainful occupation clause, offering more consistent and fair protection for claimants.

When we compare our standards with the broader market, the differences become even clearer. During the initial “own occupation” period, Mutual of Omaha only requires a one percent loss of income and the loss of one material duty. Most other carriers require a twenty percent loss and a broader inability to perform several duties. After the two-year mark, when the definition shifts to “any occupation,” we require a fifteen percent loss of income and the inability to perform all duties of any occupation. The market standard is significantly stricter, usually requiring a forty percent loss of income in addition to the inability to perform all duties. These differences can determine whether a claimant receives benefits or not.

During the presentation, a question came up about dentists. Yes, we do offer group disability coverage for dental offices. If the question is regarding individual disability insurance for a newly graduated dentist who just completed a residency, that’s a different product line outside of my department. I only handle group benefits here at Mutual of Omaha. However, another department may be able to help, and we’d be happy to connect you with the right contact.

Now, let's discuss the third part of the presentation: partial disability. This applies when an employee is still able to work but only on a part-time basis due to a medical condition. As long as there is at least a one percent loss of income and one material duty cannot be performed, the person remains eligible for benefits. This is another area where the specifics of the contract can significantly affect outcomes.

There are three primary methods that carriers use to calculate partial disability benefits. Most of this discussion focuses on long-term disability.

In one example, consider a long-term disability plan that pays sixty percent of pre-disability income, up to a maximum of six thousand dollars per month. Let’s assume the employee was earning nine thousand dollars per month before the disability, which qualifies them for a benefit of $5,400 if fully disabled. Now suppose they are able to return to work part-time and earn $3,000 per month.

Under the proportionate loss formula, we calculate the percentage of income lost. The person is earning $6,000 less than before, which is a sixty-six point seven percent loss. We apply that percentage to the full benefit amount, yielding a reduced benefit of $3,600. When combined with their part-time earnings, the employee now brings in $6,600 per month—roughly a seventy-three percent income replacement. Over five years, that adds up to a total of $396,000 in disability benefits.

A second method, known as the fifty percent offset formula, reduces benefits by half of the employee’s part-time earnings. In this case, half of $3,000 is $1,500, which is subtracted from the full $5,400 benefit, resulting in a $3,900 payout. When added to their part-time earnings, the employee now receives $6,900 per month, representing a seventy-seven percent income replacement. Over five years, that totals about $414,000 in benefits.

The third method—and the one used by Mutual of Omaha—is called the full work incentive or progressive partial formula. Under this method, benefits are not reduced at all unless the combined total of the disability benefit and part-time earnings exceeds 100 percent of pre-disability income. Since $5,400 in benefits plus $3,000 in part-time earnings adds up to $8,400, and the employee originally made $9,000, there is no reduction. The person receives the full benefit, achieving a ninety-three percent income replacement. Over five years, this equates to more than $500,000 in disability benefits—a significant difference.

Most carriers only allow the full work incentive model for the first twelve months, maybe twenty-four if you're lucky. After that, they switch to one of the less generous formulas. Imagine a person with MS who is fighting every day to remain active. They manage their symptoms, follow a routine, and push through to work part-time. For the first year, they’re supported financially. Then, one day, the benefit drops. Nothing has changed medically, but their income suddenly decreases. They ask HR what happened. HR has no idea. It comes to the broker. The broker checks with the carrier and is told, “Oh, that’s just how the contract works. It’s standard in the industry.” From the claimant’s perspective, that feels unfair. They're putting in the same effort but getting less support.

Mutual of Omaha doesn’t make that switch. We allow the full work incentive benefit to remain in place for the entire duration of the claim. As long as the claimant’s total income stays below their pre-disability earnings, their benefit isn’t reduced.

To wrap up, I hope this presentation helped clarify how the details of a disability policy—especially the definitions and calculation methods—can significantly impact the real-life experience of a claimant. Mutual of Omaha offers clear, consistent, and employee-friendly coverage that can make a real difference during difficult times.

At this point, we opened up the floor to questions. One came in about dental coverage, which I addressed earlier. Again, we offer group disability for dental offices, but if you're looking for individual coverage for a dentist, I’ll be happy to connect you with someone internally who specializes in that product.

Thanks again to everyone who joined. I appreciate your time and attention, and I hope you found this information useful. Elise, thank you as well for hosting.