Page 15 - EMSAR 2022 Benefits Guide
P. 15
2022
Benefits Guide
Disability Benefits
BlueCross BlueShield of Texas/Dearborn National | Group Number: F025112
Voluntary Short Term Voluntary Long Term
Disability Disability
Group Voluntary Short Term Disability plans help Group Voluntary Long Term Disability plans provide
replace lost income should an insured Associate long term income replacement security. Programs
become disabled due to an accident or sickness, feature return to work claim management programs
including pregnancy or complications from focused on personalized claim service.
pregnancy.
Voluntary Long Term Beneits
Voluntary Short Term Beneits Disability
Disability Elimination Period 90 days
7 days sickness or 7 days Beneit Percentage 60% of basic monthly earnings
Elimination Period
accident Maximum Monthly Beneit $5,000
Beneit Percentage 60% of basic weekly earnings Minimum Monthly Beneit $100
Maximum Weekly Beneit $1,000 Social Security Normal
Minimum Weekly Beneit $25 Beneit Duration Retirement Age
Maximum Beneit Duration 12 weeks Pre-Existing Limitation 3/12*
Pre-Existing Limitation 3/12*
Age Rates (monthly rates)
Monthly Premium Rate Monthly Monthly
Per $10 Weekly Beneit $0.38 per $10 of weekly beneit Premium Premium
Age Age
($100 covered ($100 covered
monthly salary) monthly salary)
Calculation
Monthly Premium Weekly salary × 60%/10 × $0.38 <20 $0.11 45-49 $0.61
Example 20-24 $0.12 50-54 $0.93
Associate Earns $500 × 60% = $300 weekly beneit/10 = 25-29 $0.17 55-59 $1.14
$500/Week 30 × $0.38 = $11.40 per month 30-34 $0.26 60-64 $1.19
35-39 $0.33 65-69 $1.25
* A pre-existing condition is a sickness or injury for which you have 40-44 $0.43 70+ $1.32
received treatment within 3 months prior to your efective date. Any
disability contributed to or caused by a pre-existing condition within
the irst 12 months of your efective date will not be covered. Calculation
Monthly Premium Annual Salary/12/100 × Age Rate
Example
Age 35: Earning $40,000/12 = $3,333.33 per month/100 =
$40,000 Per Year 33.33 × $0.33 = $11.00 per month
15
Benefits Guide
Disability Benefits
BlueCross BlueShield of Texas/Dearborn National | Group Number: F025112
Voluntary Short Term Voluntary Long Term
Disability Disability
Group Voluntary Short Term Disability plans help Group Voluntary Long Term Disability plans provide
replace lost income should an insured Associate long term income replacement security. Programs
become disabled due to an accident or sickness, feature return to work claim management programs
including pregnancy or complications from focused on personalized claim service.
pregnancy.
Voluntary Long Term Beneits
Voluntary Short Term Beneits Disability
Disability Elimination Period 90 days
7 days sickness or 7 days Beneit Percentage 60% of basic monthly earnings
Elimination Period
accident Maximum Monthly Beneit $5,000
Beneit Percentage 60% of basic weekly earnings Minimum Monthly Beneit $100
Maximum Weekly Beneit $1,000 Social Security Normal
Minimum Weekly Beneit $25 Beneit Duration Retirement Age
Maximum Beneit Duration 12 weeks Pre-Existing Limitation 3/12*
Pre-Existing Limitation 3/12*
Age Rates (monthly rates)
Monthly Premium Rate Monthly Monthly
Per $10 Weekly Beneit $0.38 per $10 of weekly beneit Premium Premium
Age Age
($100 covered ($100 covered
monthly salary) monthly salary)
Calculation
Monthly Premium Weekly salary × 60%/10 × $0.38 <20 $0.11 45-49 $0.61
Example 20-24 $0.12 50-54 $0.93
Associate Earns $500 × 60% = $300 weekly beneit/10 = 25-29 $0.17 55-59 $1.14
$500/Week 30 × $0.38 = $11.40 per month 30-34 $0.26 60-64 $1.19
35-39 $0.33 65-69 $1.25
* A pre-existing condition is a sickness or injury for which you have 40-44 $0.43 70+ $1.32
received treatment within 3 months prior to your efective date. Any
disability contributed to or caused by a pre-existing condition within
the irst 12 months of your efective date will not be covered. Calculation
Monthly Premium Annual Salary/12/100 × Age Rate
Example
Age 35: Earning $40,000/12 = $3,333.33 per month/100 =
$40,000 Per Year 33.33 × $0.33 = $11.00 per month
15
