Page 5 - PWH 2018 Plan Documents

Short Term Disability

Elect One: This Benefit Program will be offered under the
Cafeteria Plan Arrangement; OR

This Benefit Program will not be offered under
the Cafeteria Plan Arrangement (or the Cafeteria
Plan Arrangement does not apply).

The documents that govern the operation and administration of the Benefit
Program include:

• Principal Group Policy – Short Term Disability Insurance
• Principal Group Booklet – Certificate for Members
• Principal Summary of Benefits
Claims Fiduciary: Principal Life Insurance Company
Claims Administrator: Principal Life Insurance Company
Benefit Program Year: January 1st through December 31st
List all Employers whose Employees participate in this Benefit
Program: Positrol Workholding

Long Term Disability

Elect One: This Benefit Program will be offered under the
Cafeteria Plan Arrangement; OR

This Benefit Program will not be offered under
the Cafeteria Plan Arrangement (or the Cafeteria
Plan Arrangement does not apply).

The documents that govern the operation and administration of the Benefit
Program include:

• Principal Group Policy – Long Term Disability Insurance
• Principal Group Booklet – Certificate for Members

Claims Fiduciary: Principal Life Insurance Company
Claims Administrator: Principal Life Insurance Company
Benefit Program Year: January 1st through December 31st
List all Employers whose Employees participate in this Benefit
Program: Positrol Workholding