Page 17 - Sample Life STD LTD Enrollment kit

Maximum Coverage Period
• This is the number of weeks you can collect disability benefits (also known as the benefit duration).
• [The 00-week coverage period is for the occupation in which you were employed at the time of your
disability (also known as your own occupation).]
No Health Examination Required
• You can take advantage of this important coverage now, without a health examination, if you are a
[full-time Sample employee].
• If you decline this coverage now and wish to enroll later, a health examination may be required.

[Pre-existing Condition]

• [ If you have a medical condition that begins before your coverage takes effect, and you receive
treatment for this condition within the [six months] leading up to your coverage start date, you may
not be eligible for benefits for that condition until you have been covered by the plan for [12 months].]

Additional Plan Benefits

Additional Plan Benefits

[Benefits Integration] Included
[Rehabilitation Assistance Benefit] Included
[Family Income Benefit] Included
[Portability] Included
[Premium Waiver] Included

[Benefits Integration]

• You can coordinate your short-term disability benefits with income from your employer (such as sick
pay) during your disability.

• This allows you to receive up to 100% of your pre-disability income.
[Rehabilitation Assistance Benefit]

• This benefit provides an additional [0]% to you each week if you participate in an approved
rehabilitation program while you are out of work.
— Approved rehabilitation programs are designed to help those who qualify for short-term disability
benefits get back to work.
— Additional training and school programs are available to those who are not able to return to their
own occupation.

[Family Income Benefit]
• An additional benefit paid to your family if you die while receiving benefits.

[Form Filing Number] Short-term Disability Insurance Plan Summary of Benefits