Why Short-Term Disability Insurance? Short-Term Disability Insurance provides a source of income to people who are unable to work due to an accident or illness. Many do not have the means or cash to get through a period of 90 to 180 days when they cannot work and have no income due to an accident or illness. Short-Term Disability Insurance provides you a solution to protect against the loss of income when you cannot work due to an accident or illness.
Benefit Period: 6 Months
Accident Elimination Period: 0 Days
Sickness Elimination Period: 14 Days
Benefit Period: 12 Months
Accident Elimination Period: 0 Days
Sickness Elimination Period: 14 Days
Benefit Period: 24 Months
Accident Elimination Period: 180 Days
Sickness Elimination Period: 180 Days
Monthly Disability Benefit - Pays the selected benefit amount each month that an insured is totally disabled, not to exceed the monthly benefit percent shown on the Product Details page. Benefits do not begin until the applicable Elimination Period has been satisfied. Periods of disability lasting less than one month will be paid at 1/30th of the monthly benefit for each day of total disability. Benefits will stop once total disability ends or the end of the Benefit Period, whichever occurs first.
Waiver of Premium Provision - Premiums will be waived once an insured employee has been totally disabled for 90 days or met the elimination period, whichever is later. Premiums must continue to be paid until the waiver begins.
Partial Disability Benefit - Pays 50% of the Monthly Disability Benefit for up to 6 months when an insured employee returns to work on a limited basis following a total disability, assuming the partial disability is due to the same reason as the total disability.
Accelerated Benefit for Terminal Illness Rider (Rider Form Series) - Advances up to 12 months of Monthly Disability Benefits if the insured is diagnosed by a physician, for the first time on or after the effective date, as having a terminal illness.
Portability Option Benefit Rider (Rider Form Series CRDISB00) - Allows the employee to keep coverage if they leave the group or lose coverage for any reason other than nonpayment of premium.
The sum of the disability benefits paid to the insured together with the payments the insured is entitled to receive from the sources described below, may not exceed the monthly percent shown on the Product Details page:
With respect to items (b) and (f) only, unless we receive proof that payments under these applicable programs or acts have been applied for but will not be paid, we:
Benefits will not be reduced due to a cost of living increase in Social Security if the increase takes place while benefits are payable under the policy.
With respect to any and all of the above sources, if the insured or his or her dependent receives a lump sum payment for a period previously paid by us, any resulting overpayment must be repaid on a lump sum basis. If the insured has the option of taking retirement benefits on a monthly basis but chooses to receive retirement benefits in a lump sum, we may assume he or she is receiving retirement benefits based upon the lowest monthly retirement plan benefit available to the insured prior to lump sum withdrawal.
If the insured is totally disabled and receiving regular treatment due to a covered mental illness, regardless of the cause, monthly disability benefits will be paid for one-half (1/2) of the benefit. The lifetime maximum is 12 months of disability payments.
You authorize Enrollment123 dba Administration123 to charge the debit card, credit card or ACH bank account as indicated in this authorization on behalf of the Insurance Companies and benefit providers, and their respective plans which you have selected through this enrollment website. Furthermore, you acknowledge and agree that future payments may be charged to the debit card, credit card or ACH bank account you have provided on a recurring monthly basis with your full authorization for the amount associated with the products and services selected above.
Recurring monthly premium payments are billed in advance of the next coverage period, 25 calendar days after your effective date each month. If the recurring payment date falls on a weekend or holiday, you understand that the payment may be executed on the prior or next business day. You understand that this authorization will remain in effect until you cancel it in writing via email or mailed letter. You agree to make any account changes on with your secure online portal or notify Enrollment123 dba Administration123 in writing of any changes in your account information.
You certify that you are an authorized user of this debit card, credit card or bank account and that you will not dispute the scheduled payments with your Credit Card Company or bank provided the transactions correspond to the terms indicated in this authorization form.
You may cancel service at any time. All notices of cancellation must be submitted in writing only, via email or mailed letter. All cancellation notification must be made by the primary account holder. To avoid billing for unwanted services, all cancellation notices must be received no later than fifteen (15) calendar days prior to your next billing date. Upon receipt of your cancellation notice, coverage for the services/products listed will be terminated to the last day of the month of your coverage period. Cancellation notices received less than fifteen (15) days prior to the next billing date will result in cancellation of service postdated to the end of your next coverage period month.
Written notification may be sent via email to email@example.com
You may only receive a refund, if applicable, provided you have submitted a written notice of cancellation.
You may request a refund (refund requests MUST be made in writing) ONLY if you are cancelling your coverage within the first ten (10) calendar days following your product or policy effective date. If you are cancelling coverage for a product or policy and requesting a refund within the first ten (10) days following your effective date service; you are entitled to a full refund of the monthly premium or fee. Administration fees or enrollment fees ARE NOT refundable. You are not eligible for any refund if any claims have been filed by the policy holder or his/her dependents during the initial ten (10) days following the effective date.
Any questions regarding billing should be directed to firstname.lastname@example.org
You authorize Enrollment123 dba Administration123 to contact you via email and/or sms (text messaging) with regards to the policy(s) or benefit(s) which you have enrolled and updates regarding related products and services. You agree to provide Enrollment123 dba Administration123 with any updates/changes to your email address or phone number through the "Member Portal" or via email at email@example.com with these updates.
This authorization shall remain in effect until revoked by you in writing. You understand and agree that this authorization, an updated email address and phone number is required to receive important updates regarding your enrolled benefits and insurance coverage; and that revoking this authorization will result in missing important notification(s) that may adversely affect your coverage, including termination of benefits. Enrollment123 dba Administration123 shall not be held responsible or liable for any missed notifications due to incorrect contact mailing address, email address or phone number that results in a change to or loss of coverage or benefits.
The policy does not cover any loss, fatal or non-fatal, which results from:
There will be no disability benefit payable for a pre-existing condition until the insured has been continuously covered under the Policy for 12 consecutive months and has returned to performing the duties of his or her occupation for 30 continuous days after the first 12 months of coverage.
"Pre-Existing Condition" means sickness or physical condition for which the insured had treatment, incurred expense, took medication, or received a diagnosis or advice from a physician, during the 6-month period immediately before the effective date of coverage.
The term "Pre-Existing Condition" will also include a condition that manifests itself in a way that would cause an ordinarily prudent person to seek medical advice, diagnosis, care or treatment.
Employee coverage will terminate on the earliest of:
Termination will have no effect on payment of benefits for a total disability that begins before such termination. We will have the right to terminate the coverage of any covered person who submits a fraudulent claim under the policy.
I represent that all statements and answers made on or attached to this application are true to the best of my knowledge and belief, and realize that any false statements herein which materially affect the acceptance of the risk or the hazard assumed may result in loss of coverage under the policy/certificate to which this application is attached. I understand that any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. I also understand that coverage will become effective only after all of the following conditions have been met: a) I must be a member of an eligible class; b) I must have satisfied the policyholder waiting period; c) group must have met the Insurer’s minimum participation requirement; d) I must satisfactorily answer all questions on this form; e) I must be actively at work on the effective date (according to the Insurer’s rules); and f) the first month’s premium must have been received by the Insurer at its administrative office. Lastly, I understand that completion of this application in
no way implies that I will be accepted for insurance coverage.
I hereby authorize any licensed physician, medical practitioner, hospital, clinic or other medical or medically-related facility, insurance company, the Medical Information Bureau*, or other organization, institution or person, that has any records or knowledge of me or my health, to give to Insurer, or its reinsurers, any such information.
I understand the information obtained by use of this Authorization will be used by Insurer to determine eligibility for insurance. Any information obtained will not be released by Insurer to any person or organization except to reinsuring companies, the Medical Information Bureau*, or other persons or organizations performing business or legal services in connection with my application, claim, or as may be otherwise lawfully required or as I authorize. I know that I may request to receive a copy of this Authorization. I agree that a photographic copy of this Authorization shall be as valid as the original. I agree that this Authorization shall be valid for two years from the date shown below.
|Standard||1-5 business days||$7.95|
|Two Day||2 business days||$15|
|Next Day||1 business day||$30|
|* Free on orders of $50 or more|