Offered by Life Insurance Company of North America
Employee-Paid SHORT TERM DISABILITY INSURANCE
Summary of Benefits
Prepared for: AAA East Central
Eligibility: All active, Full-time Employees of the Employer regularly working a minimum hours as defined by the Employer. Employee: You will be eligible for coverage the first of the month on or after 30 days of active service. Available Coverage: Gross Weekly Benefit 1 Maximum Gross Weekly Benefit Benefit Waiting Period
Maximum Benefit Period
The later of any accumulated sick leave, accumulated paid time off or the time period shown below.
$1,500
26 Weeks for accident 25 Weeks for sickness
60% of your weekly covered earnings
0 Days for accident 7 Days for sickness
Employee’s Monthly Cost of Coverage: Monthly Rate Per $10 of Weekly Benefit = $0.420 Actual per pay period premiums may differ slightly due to rounding. Rates may be subject to change in the future. How to Calculate Your Monthly Cost: Step 1: Divide your annual salary by 52 to calculate your weekly earnings. Step 2: Multiply this amount by the benefit percentage defined above in the Available Coverage section. For example, 60% would be .60. Now, you have your gross weekly benefit. Step 3: Find the above Monthly rate. Multiply this rate by your gross weekly benefit, or the maximum gross weekly benefit, whichever is less.
Step 4: Divide the total by 10. The result is your Monthly cost. Important Definitions and Policy Provisions:
Disability - “Disability” or “Disabled” means if solely because of a covered injury or sickness, you are unable to perform the material duties of your regular job and you are unable to earn 80% or more of your covered earnings from working in your regular job. We will require proof of earnings and continued disability. Covered Earnings - “Covered Earnings” means your wages or salary, not including overtime pay, bonuses, commissions, and other extra compensation. When Benefits Begin - You must be continuously Disabled for the later of any accumulated sick leave, accumulated paid time off or 0 Days for an accident and 7 Days for a sickness before benefits will be paid for a covered Disability. How Long Benefits Last - Once you qualify for benefits under this plan, the maximum number of weekly Disability benefits is 26 Weeks for an accident and 25 Weeks for a sickness. Disability benefits will end sooner if you no longer qualify for benefits. When Coverage Takes Effect - Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form if required, or the date you authorize any necessary payroll deductions if applicable. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit proof of good health, your coverage takes effect on the date we agree, in writing, to cover you.
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