SHORT TERM DISABILITY
The plan provides for short-term income continuation if you become disabled due to non-occupational injury or sickness. Benefits commence the 15 th day after the onset of an illness or injury. Your benefit will be 60% of your basic weekly salary to a max of $1,500. The maximum duration is 11 weeks. If elected, the employee pays 100% of the Short Term Disability premium.
Voluntary STD Premium Calculation Worksheet
You may elect 60% of your covered weekly earnings to a maximum of $1,500 per week. Your weekly earnings amount is your basic weekly pay. Overtime pay or other compensation that is not considered as basic income should not be included. To calculate your approximate STD bi-weekly premium, follow these steps:
STEP 1 Enter your basic weekly pay (divide your annual pay by 52) rounded to the nearest dollar. STEP 2 Multiply the amount in Step 1 by 60% and enter the result (rounded to the next higher dollar). This is your weekly benefit. Do not enter more than $1,500.
1. _________
2. _________
STEP 3 Divide the amount in Step 2 by 10 and enter that amount.
3. _________
STEP 4 Enter the rate for your age from the chart below. The rate is
4. _________
determined by your age and will be reevaluated on each subsequent coverage policy anniversary.
STEP 5 Multiply the amount in Step 3 by the amount in Step 4 and then enter it here. This is your approximate monthly premium. STEP 6 Multiply the amount in Step 5 by 12 and then divide by 26 and then enter it here. This is your approximate bi-weekly premium.
5. _________
6. _________
Monthly Rate per $10 of Weekly Benefit
AGE
24 and younger
0.87
25-29
0.87
30-34
0.87
35-39
0.88
40–44
0.63
45-49
0.61
50–54
0.72
55-59
0.92
60–64
1.23
65-69
1.36
70+
1.36
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