close

Enter

Log in using OpenID

How to apply for State Disability - My Doctor Online - Kaiser

embedDownload
Are You Applying for
State Disability Insurance (SDI)?
FILING YOUR SDI CLAIM
There are two ways to file your State Disability Insurance claim Online or by mail using the new claim form.
REGISTER AND FILE A CLAIM ONLINE- 3 STEP PROCESS
• Log on the EDD’s website at http://www.edd.ca.gov/Disability/ and select SDI Online.
Choose SDI Online Registration and complete the questions
• Filing your claim online reduces processing time and provides immediate electronic
confirmation of your claim
1. TO REGISTER, YOU WILL NEED THE FOLLOWING INFORMATION:
• Legal name
• Valid e-mail address
• Date of birth
• Social Security number
• California driver’s license or state ID
• U.S. or International physical address
• Mailing address
• Valid phone number
2. TO FILE A DI OR PFL CLAIM ONLINE YOU WILL NEED:
• Your username and password
• For State government employees, bargaining unit number
• Date your disability began
• Last day worked for this employer prior to date disability began
• Classification and description of your job functions
• Sick, vacation, paid time off, annual or �other’ pay provided by your employer (if
applicable)
• Workers’ Compensation benefit information (if applicable)
• Last or current employer name and mailing address as found on W2 or paycheck stub
• Alcohol Recovery or Drug-Free facility information (if applicable)
• Document the receipt number that displays once your claim is submitted
• PFL claims require EDD Authorization 2501FC to be completed and sent to EDD
within 10 days. Claim will not be approved without required EDD authorization.
3. ONCE YOUR CLAIM HAS BEEN SUBMITTED ONLINE, PLEASE PROVIDE THE
RELEASE OF MEDICAL INFORMATION/MEDICAL SECRETARIES WITH THE
FOLLOWING:
• Your Patient Receipt Number should be R10000000XXXXXXX
• Name, Date of Birth and Kaiser Permanente Medical Record Number
• Before calling Release of Medical Information/Medical Secretaries staff please confirm with
your doctor that the Work Activity Status Form has been completed
• If filing for a PFL claim you must provider a copy of EDD authorization
This information may be provided via any of the following methods:
пѓј E-mail:
[email protected]
пѓј Phone:
925-817-5661
пѓј Fax:
877-883-5917
Are You Applying for
State Disability Insurance (SDI)?
COMPLETE AND MAIL A PAPER CLAIM TO EDD- 3 STEP PROCESS
To file a claim by mail, you must use the new RED claim form for Disability Insurance
(DI) Benefits, DE 2501 Rev. 78. EDD will not accept any other forms.
• Complete your paper claim form using the new RED DE 2501 Rev. 78
• After mailing your claim form to EDD, please allow 7 business days for mail, delivery
and processing before contacting Kaiser Permanente Release of Medical Information /
Medical Secretaries to have Kaiser Permanente submit the medical portion of the claim
1. IF YOU COMPLETE YOUR CLAIM BY MAIL, PLEASE:
• INITIAL EDD COMPLETE ONLY CLAIMANTS PART A, PAGES 1THROUGH 4.
• PFL COMPLETE ONLY CLAIMANTS PAGES 1 THROUGH 3
• Use only black ink to complete the paper form
• To ensure proper processing of your claim print legibly and inside the boxes provided.
• Forms can be obtained from:
 Kaiser Permanente Release of Medical Information / Medical Secretaries
Departments
 Local State Disability/Employment Development Department Offices
 Employers
 Telephone:
• 1-800-480-3287 in English
• 1-866-658-2246 en Español
2. ONCE CLAIM IS COMPLETED MAIL DIRECTLY TO DISABILITY INSURANCE
EDD Initial Claim Mail to:
PFL Claim Mail to:
State of California
Paid Family Leave
Employment Development Department
Employment Development Department
PO Box 989777
PO Box 997017
West Sacramento, Ca 95798-9777
Sacramento, Ca 95799-7017
3. ONCE YOUR CLAIM HAS BEEN MAILED AFTER SEVEN BUSINESS DAY, PLEASE
PROVIDE THE RELEASE OF MEDICAL INFORMATION/MEDICAL SECRETARIES STAFF
WITH THE FOLLOWING:
• Last four digits of your Social Security Number, Name, Date of Birth and Kaiser Medical
Record Number
• Before calling Release of Medical Information/Medical Secretaries please confirm with your
doctor that the Work Activity Status Form has been completed
This information may be provided via any of the following methods:
пѓј E-mail:
[email protected]
пѓј Phone:
925-817-5661
пѓј Fax:
877-883-5917
VOLUNTARY PLANS
If you are insured by a Voluntary Plan maintained by your employer, you will need to contact
your employer for information on the proper forms.
NON-INDUSTRIAL DISABILITY INSURANCE (NDI)
If you are a State government employee, please check with your personnel office for
instructions on filing an NDI or DI claim, or call EDD at 1-866-352-7675.
Document
Category
Education
Views
474
File Size
58 KB
Tags
1/--pages
Report inappropriate content