Page 284 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat

STD Benefit: 70% of the first $4,807 of your Predisability Earnings,
reduced by Deductible Income.
Maximum: $3,365 before reduction by Deductible Income.
Minimum: $15
Benefit Waiting Period: The longer of (a) the period of sick leave for which you are
eligible under the Employer's sick leave plan, and (b) one
of the following:

For Noncontributory insurance,
Contributory insurance for Members
who apply during the Enrollment Period,
and for Members who were required to
submit Evidence Of Insurability to
become insured and it was approved:
For Disability caused by
accidental Injury: 7 days
For Disability caused by Physical
Disease, Pregnancy or Mental
Disorder: 7 days
For Contributory insurance for
Members who do not apply
during the Enrollment Period:

For Disability caused by
accidental Injury: 7 days
For Disability caused by Physical
Disease, Pregnancy or Mental
Disorder: During the 12-month period beginning on the date your
coverage becomes effective: 60 days; and
thereafter: 7 days
Enrollment Period for
Contributory insurance: The 31-day period beginning on the date you become
eligible.

Maximum Benefit Period: 90 days. However, STD Benefits will end on the date long
term disability benefits become payable to you under a
group plan provided by your Employer, even if that occurs
before the end of the Maximum Benefit Period.
If you are Disabled for less than one full week, we will pay one-seventh of the STD Benefit for each day
of Disability.

MEMBER CONTRIBUTIONS

Coverage is: Partners, Shareholders, L.L.C. Owner-Employees or Sole
Proprietors: Noncontributory (cost included)*
All other Members: Noncontributory (cost excluded)**
*Noncontributory (cost included) means that the cost of coverage is included in the Member's gross
earnings.

Revised 04/07/2015 - 2 - 751675-A