If an employee, while insured under the Plan and as a result of sickness or injury, becomes totally disabled, the Plan will pay biweekly benefits to the employee for the period of such disability. Such benefits are payable in an amount of sixty-five (65) percent of the employee’s basic daily earnings at the date of disability. Benefits are payable from the first benefit day of any one continuous period of disability up to a maximum of one year (364 days) subject to the following:
    (1) The “”first benefit day”” shall be the later of:
    (a) The thirty-first (31st) day of continuous disability,
    (b) The date following the day that an employee exhausts all accumulated leave credits including annual leave, sick leave, sick pool leave and personal holiday leave.
    (2) Benefits paid under the Plan will be reduced by any benefits paid or payable:
    (a) Under any Workers’ Compensation Act or similar legislation; and
    (b) As primary and family benefits under the Social Security Act; and
    (c) As regular or disability retirement benefits under the State of Florida Retirement System.
    (3) Successive periods of disability separated by less than one work week of continuous active work with the employer will be considered one continuous period of disability unless the later disability is due to causes entirely unrelated to the causes of the previous disability and commences after return to active work for at least one full day.
    (4) Plan benefits will be suspended at the employees’ anniversary date and will recommence on the date following the day that an employee exhausts all accumulated leave credits including annual leave, sick leave, sick pool leave and personal holiday leave.
    (5) Any claim files must contain the following information:
    (a) Employee information including the employee’s full name, Social Security number, address, telephone number, date of birth, signature of compliance and medical release, sex, occupation, marital status, spouse’s name and date of birth, children’s names and dates of birth, a description of the disability, date of the disability, date first treated for the disability, date of the last day worked due to disability, date returned to work full or part time, and any benefits paid or payable under Workers’ Compensation, Florida Retirement or Social Security and the employee’s signature.
    (b) Employer information including the employee hire date, certification of last day worked and date returned to work, salary at time of disability, accumulated leave balances, agency name, SAMAS organizational code, address and telephone number, and authorized personnel signature.
    (c) Attending physicians’ statement including a physical history, diagnosis, dates of treatment, nature of treatment, progress notes, impairment levels, prognosis, rehabilitation remarks, and the physician’s name, address, telephone number, licenses and signature.
Specific Authority 110.123(5) FS. Law Implemented Florida Statutes § 110.123. History-New 8-26-96, Repromulgated 1-31-02.