short term disability - companion life

SHORT TERM DISABILITY

benefits for employees that benefit employers

®

PROTECT YOUR WORKFORCE A 2012 Social Security fact sheet predicts almost 1-in-4 of

today’s 20-year-olds will be disabled before age 67.1 According to the Integrated Benefits

Institute, research repeatedly shows that absenteeism, disability, employee performance and

lost productivity have a greater negative impact than medical and prescription drug costs

combined.2 So when you consider the relatively low cost of voluntary disability plans, the real

question is: Why wouldn’t you offer this option to your employees?

VOLUNTARY SHORT TERM DISABILITY INCOME COVERAGE Companion Life gives your employees the peace of mind that a protected paycheck brings. A program designed to help maintain a family’s current lifestyle and its plans for the future if the employee is disabled off the job. A plan with the flexibility to meet an employee’s individual needs. A program that

provides a significant enhancement to an employer’s benefit portfolio at no additional cost!

COVERAGES This Voluntary Short Term Disability Income insurance plan pays disability benefits for covered non-occupational injuries and illnesses. Maternity, alcoholism and drug addiction, and mental or nervous conditions are covered the same as any other illness. A partial disability benefit is included to support a recovering employee’s return to full potential through part-time work.

EVIDENCE OF INSURABILITY No evidence of insurability is required if the employee is at work on the effective date of coverage. Evidence of insurability is required if employees enroll after their initial eligibility period.

PARTICIPATION A minimum of three eligible employees must enroll for groups of 3-9 lives. A minimum of five eligible employees must enroll for groups of 10 or more lives.

ENROLLMENT AGE FREEZE When an employee enrolls for coverage, as long as he or she remains enrolled, the premium payable for the selected insurance coverage will always be based upon the employee’s age at the time of original enrollment.

EMPLOYER ELIGIBILITY An employer group is eligible for coverage:

n If the group is not heavily financed by federal, state or local government entities, or heavily dependent on the procurement of government contracts; and

n If it is not a union, health and welfare fund, or similar entity; and

n If 50 percent or more of the group is not in commissioned sales; and

n If 50 percent or more of the group is not related by blood or marriage; and

n If the group is not subject to seasonal fluctuations; and

n If the group has been in business more than six months.

EMPLOYEE ELIGIBILITY Employees meeting all of the following are eligible for coverage:

n Full-time employment (working 30 or more hours weekly)

n Actively at work on effective date of coverage

n Employees pay 100 percent of the premium.

Short Term Disability VOLUNTARY

1 Social Security Administration, Fact Sheet, January 2012 2 “Do Bleak Economic Times Mean Tougher Times for Employer Benefits Programs?,” IBI Quick Study, August 2011

PRE-EXISTING CONDITIONS We will not cover a disability that begins in the first 12 months after the effective date. A pre-existing condition means a condition result-ing from an injury that occurred or a sickness that began before your effective date of coverage under the policy; and for which medical treatment or advice was received or recommended no more than 12 months before the effective date of your coverage under the policy that causes total disability while you are insured under the policy.

WAIVER OF PRE-EXISTING CONDITIONS LIMITATION The Pre-existing Condition Limitation will not apply if the insured was covered under the prior carrier’s Short Term Disability policy on the policy’s termination date, and if the insured was responsible for paying the entire premium for his/her coverage under the prior carrier’s plan. See policy for further details.

ABOUT COMPANION LIFECompanion Life Insurance Company has specialized in group benefits for more than 40 years. It has earned an A.M. Best rating of A+ (Superior)*. We’ve earned these high marks due to our fis-cal strength, investment practices and sound management. Now, we want to earn your trust by giving you the highest level of service and responsiveness possible. Talk with your Companion Life agent today. See for yourself how the Companion Life Voluntary Short Term Disability Plan is a benefit plan that benefits you.

PLAN DESIGNS The employer may select one of the following eight plan designs to offer employees. Employers with 100 or more eligible employees may offer two plan designs for the employee group.

Plan number Benefits Begin Duration Accident Sickness Plan 1 1st Day 8th Day 13 Weeks Plan 2 8th Day 8th Day 13 Weeks Plan 3 15th Day 15th Day 13 Weeks

Plan 4 1st Day 8th Day 26 Weeks Plan 5 8th Day 8th Day 26 Weeks Plan 6 15th Day 15th Day 26 Weeks

Plan 7 15th Day 15th Day 52 Weeks Plan 8 30th Day 30th Day 52 Weeks

BENEFITS Employees may choose one of 13 weekly benefit payments, from $150 to $1,250, not to exceed 66 percent of basic weekly earnings.

employee Selection for the Benefit Annual Salary must Be at Least:

Benefit Level A $150 per Week $11,700 Benefit Level B $200 per Week $15,600 Benefit Level C $250 per Week $19,500 Benefit Level D $300 per Week $23,400 Benefit Level E $350 per Week $27,300 Benefit Level F $400 per Week $31,200 Benefit Level G $450 per Week $35,100 Benefit Level H $500 per Week $39,000 Benefit Level I $550 per Week $42,900 Benefit Level J $600 per Week $46,800 Benefit Level K $650 per Week $50,700 Benefit Level L $700 per Week $54,600 Benefit Level M $750 per Week $58,500 Benefit Level N $800 per Week $62,400 Benefit Level O $850 per Week $66,300 Benefit Level P $900 per Week $70,200 Benefit Level Q $950 per Week $74,100 Benefit Level R $1,000 per Week $78,000 Benefit Level S $1,050 per Week $81,900 Benefit Level T $1,100 per Week $85,800 Benefit Level U $1,150 per Week $89,700 Benefit Level V $1,200 per Week $93,600 Benefit Level W $1,250 per Week $97,500

All plans include a $10,000 Accidental Death and Dismemberment (AD&D) benefit for each insured employee. *Rating as of Jan. 23, 2013. For the latest rating, access ambest.com.

Apparel (2311-2399)Business Services (7311-7359, 7371-7379, 7383-7389)Communications (4812-4899)Drugs (2833-2836)Educational Services, Schools (8211-8299)Electric, Gas & Sanitary Services (4911-4971)Electronics & Other Electrical equipment (3612-3699)Engineering & Management (8711-8748)Finance, Insurance & Real Estate (6011-6799)Flooring & Special Product Saw Mills (2426-2429)Food Products (2011-2099)Furniture (2511-2599)Industrial Machinery (3511-3599)

Instruments (3812-3873)Legal Services (8111)Millwork, Wood Containers, Buildings, Products (2431-2499)Miscellaneous Manufacturing (3911-3999)Motion Pictures & Video Rental (7812-7841)Museums, Gardens (8412-8422)Printing & Publishing (2711-2796)Repair Services (7622-7699)Retail Trade (5211-5736, 5912-5999)Textile Mill Products (2211-2299)Veterinary Services (0741-0742)Wholesale Trade (5012-5199)

Agriculture, Services (0711-0724, 0751-0783)Automotive Repair, Rentals, Parking (7513-7549)Bowling Centers & Dance Studios (7911, 7933)Chemical Products (2812-2824, 2841-2869, 2893-2899)Construction (1521-1799)Courts & Public Safety (9211, 9222-9223, 9229)Employment & Help Agencies (7361-7363)Government, Legislative, General & Finance (9111-9199, 9311)Hotels & Other Lodging Places (7011-7041)Leather Products (3131-3199)Logging & Saw Mills (2411-2421)Mineral Products (3295-3299)National Security & International Affairs (9711-9721)

Organizations, Membership (8611-8699)Personal Services, Taxes, Photos (7211-7299)Petroleum & Coal Products (2911-2999)Pipelines, except Natural Gas (4612-4619)Public Administration (9411-9661)Retail trade, Drinking Places (5813)Rubber & Plastic Products (3011-3089)Security Systems (7382)Social Services (8322-8399)Stone, Clay & Glass Products (3211-3291)Tobacco Products (2111-2141)Transportation Equipment (3711-3799)Transportation Services, Freight, Cargo, Passengers (4724-4789)

ELIGIBLE INDUSTRIES FOR VOLUNTARY SHORT TERM DISABILITY COVERAGE

SOME PRODUCTS NOT AVAILABLE IN ALL STATES95960 Rev. 4/13

P.O. Box 100102 n Columbia, SC 29202-3102 n 800-753-0404 phone n 800-836-5433 [email protected] n CompanionLife.com

This brochure contains only a brief description of the benefits. It is not the contract. Rates and provisions are subject to change. Actual coverage is subject to the terms and conditions of the contract when it becomes effective, and actual contract language will be reflected in each employee’s Certificate of Coverage.

This list is not all-inclusive. Companion Life reserves the right to reject any business or industry which does not, in our opinion, represent a sound underwriting risk.

FOR A PROPOSAL, CONTACT:

SEE FOR YOURSELF HOW COMPANION LIFE VOLUNTARY GROUP PLANS ARE BENEFITS THAT BENEFIT YOUCompanion Life offers a full portfolio of Voluntary Group Benefits for employees:

n Voluntary Group Long Term Disability Insurance n Voluntary Group Dental Insurance n Voluntary Group Short Term Disability Insurance n Voluntary Group AD&D n Voluntary Group Life Insurance

®

PreferreD InDuSTrIeS

STAnDArD InDuSTrIeS

Agriculture, Crops & Livestock (0111-0291)Air, Bus, Rail, Trucking, Water Transportation (4011-4581)Chemicals, Agriculture (2873-2891)Fabricated Metal Products (3411-3479, 3491-3499)Fishing, Hunting,Trapping (0912-0971)Forestry (0811-0851)

Health Services (8011-8099)Leather Tanning & Finishing (3111)Paper Products (2611-2679)Steel Works, Foundries & Smelting (3312-3399)

non-STAnDArD InDuSTrIeS

Ammunition (3482-3483)Amusement Parks, Clubs, Sports, Other Recreational Services (7941-7999)Asbestos Products (3292)Detective, Guard, and Armored Car Services (7381)Eating Places (5812)Explosives (2892)Fire Protection (9224)

Metal & Coal Mining (1011-1241)Oil & Gas Extraction, Mining & Quarrying (1311-1499)Police Protection (9221)Private Households (8811)Small Arms, Ordnance and Accessories (3484-3489)Theatrical Producers, Bands, Entertainers (7922-7929)

non-eLIGIBLe InDuSTrIeS for VoLunTAry ShorT Term DISABILITy CoVerAGe

95961-Preferred (Rates effective 05/10) Rev. 12/12

Plan 1 1-8-13

To determine your initial monthly premium within your age category, simply find your age bracket on the left side and follow the line to the right.This premium cost chart is for illustrative purposes only; your monthly premium cost may be slightly higher or lower due to rounding. The information provided is only a summary of the benefits available. Refer to your certificate for details and limitations of coverage.

Companion Life reviews premiums annually and rates are subject to change.

the premiums shown above apply to the following preferred industries with 3-99 employeesFor rates on groups of 100+ lives, please contact Underwriting at 800-753-0404 or email [email protected].

ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 9.68 12.90 16.13 19.35 22.58 25.80 29.03 32.25 35.48 38.70 41.93 45.1530 - 34 9.96 13.28 16.60 19.92 23.24 26.56 29.88 33.20 36.52 39.84 43.16 46.48 35 - 39 9.96 13.28 16.60 19.92 23.24 26.56 29.88 33.20 36.52 39.84 43.16 46.4840 - 44 9.96 13.28 16.60 19.92 23.24 26.56 29.88 33.20 36.52 39.84 43.16 46.48 45 - 49 10.52 14.02 17.53 21.03 24.54 28.04 31.55 35.05 38.56 42.06 45.57 49.07 50 - 54 12.63 16.84 21.05 25.26 29.47 33.68 37.89 42.10 46.31 50.52 54.73 58.94 55 - 59 14.73 19.64 24.55 29.46 34.37 39.28 44.19 49.10 54.01 58.92 63.83 68.7460 - 64 17.25 23.00 28.75 34.50 40.25 46.00 51.75 57.50 63.25 69.00 74.75 80.50 65 - 69 22.73 30.30 37.88 45.45 53.03 60.60 68.18 75.75 83.33 90.90 98.48 106.05 70 - 74 30.57 40.76 50.95 61.14 71.33 81.52 91.71 101.90 112.09 122.28 132.47 142.6675+ 38.57 51.42 64.28 77.13 89.99 102.84 115.70 128.55 141.41 154.26 167.12 179.97

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 48.38 51.60 54.83 58.05 61.28 64.50 67.73 70.95 74.18 77.40 80.6330 - 34 49.80 53.12 56.44 59.76 63.08 66.40 69.72 73.04 76.36 79.68 83.00 35 - 39 49.80 53.12 56.44 59.76 63.08 66.40 69.72 73.04 76.36 79.68 83.0040 - 44 49.80 53.12 56.44 59.76 63.08 66.40 69.72 73.04 76.36 79.68 83.00 45 - 49 52.58 56.08 59.59 63.09 66.60 70.10 73.61 77.11 80.62 84.12 87.63 50 - 54 63.15 67.36 71.57 75.78 79.99 84.20 88.41 92.62 96.83 101.04 105.25 55 - 59 73.65 78.56 83.47 88.38 93.29 98.20 103.11 108.02 112.93 117.84 122.7560 - 64 86.25 92.00 97.75 103.50 109.25 115.00 120.75 126.50 132.25 138.00 143.75 65 - 69 113.63 121.20 128.78 136.35 143.93 151.50 159.08 166.65 174.23 181.80 189.38 70 - 74 152.85 163.04 173.23 183.42 193.61 203.80 213.99 224.18 234.37 244.56 254.7575+ 192.83 205.68 218.54 231.39 244.25 257.10 269.96 282.81 295.67 308.52 321.38

SIC Code Industry SIC Code Industry0741-0742 Veterinary Services 4812-4899 Communications2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services2211-2299 Textile Mill Products 5012-5199 Wholesale Trade2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services2511-2599 Furniture 7371-7379, 7383-7389 Business Services2711-2796 Printing & Publishing 7622-7699 Repair Services2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental3511-3599 Industrial Machingery 8111 Legal Services3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools3812-3873 Instruments 8412-8422 Museums, Gardens3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management

preferred industries — monthly premium Costweekly benefit amount and monthly premium

voluntary short term disability



Plan 2 8-8-13



the premiums shown above apply to the following preferred industries with 3-99 employees For rates on groups of 100+ lives, please contact Underwriting at 800-753-0404 or email [email protected].

ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 8.70 11.60 14.50 17.40 20.30 23.20 26.10 29.00 31.90 34.80 37.70 40.6030 - 34 8.97 11.96 14.95 17.94 20.93 23.92 26.91 29.90 32.89 35.88 38.87 41.86 35 - 39 8.97 11.96 14.95 17.94 20.93 23.92 26.91 29.90 32.89 35.88 38.87 41.8640 - 44 8.97 11.96 14.95 17.94 20.93 23.92 26.91 29.90 32.89 35.88 38.87 41.86 45 - 49 9.39 12.52 15.65 18.78 21.91 25.04 28.17 31.30 34.43 37.56 40.69 43.82 50 - 54 11.36 15.14 18.93 22.71 26.50 30.28 34.07 37.85 41.64 45.42 49.21 52.99 55 - 59 13.32 17.76 22.20 26.64 31.08 35.52 39.96 44.40 48.84 53.28 57.72 62.1660 - 64 15.57 20.76 25.95 31.14 36.33 41.52 46.71 51.90 57.09 62.28 67.47 72.66 65 - 69 20.48 27.30 34.13 40.95 47.78 54.60 61.43 68.25 75.08 81.90 88.73 95.55 70 - 74 27.50 36.66 45.83 54.99 64.16 73.32 82.49 91.65 100.82 109.98 119.15 128.3175+ 34.64 46.18 57.73 69.27 80.82 92.36 103.91 115.45 127.00 138.54 150.09 161.63

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 43.50 46.40 49.30 52.20 55.10 58.00 60.90 63.80 66.70 69.60 72.5030 - 34 44.85 47.84 50.83 53.82 56.81 59.80 62.79 65.78 68.77 71.76 74.75 35 - 39 44.85 47.84 50.83 53.82 56.81 59.80 62.79 65.78 68.77 71.76 74.7540 - 44 44.85 47.84 50.83 53.82 56.81 59.80 62.79 65.78 68.77 71.76 74.75 45 - 49 46.95 50.08 53.21 56.34 59.47 62.60 65.73 68.86 71.99 75.12 78.25 50 - 54 56.78 60.56 64.35 68.13 71.92 75.70 79.49 83.27 87.06 90.84 94.63 55 - 59 66.60 71.04 75.48 79.92 84.36 88.80 93.24 97.68 102.12 106.56 111.0060 - 64 77.85 83.04 88.23 93.42 98.61 103.80 108.99 114.18 119.37 124.56 129.75 65 - 69 102.38 109.20 116.03 122.85 129.68 136.50 143.33 150.15 156.98 163.80 170.63 70 - 74 137.48 146.64 155.81 164.97 174.14 183.30 192.47 201.63 210.80 219.96 229.1375+ 173.18 184.72 196.27 207.81 219.36 230.90 242.45 253.99 265.54 277.08 288.63





Plan 3 15-15-13




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 7.44 9.92 12.40 14.88 17.36 19.84 22.32 24.80 27.28 29.76 32.24 34.7230 - 34 7.58 10.10 12.63 15.15 17.68 20.20 22.73 25.25 27.78 30.30 32.83 35.35 35 - 39 7.58 10.10 12.63 15.15 17.68 20.20 22.73 25.25 27.78 30.30 32.83 35.3540 - 44 7.58 10.10 12.63 15.15 17.68 20.20 22.73 25.25 27.78 30.30 32.83 35.35 45 - 49 8.00 10.66 13.33 15.99 18.66 21.32 23.99 26.65 29.32 31.98 34.65 37.31 50 - 54 9.54 12.72 15.90 19.08 22.26 25.44 28.62 31.80 34.98 38.16 41.34 44.52 55 - 59 11.22 14.96 18.70 22.44 26.18 29.92 33.66 37.40 41.14 44.88 48.62 52.3660 - 64 13.19 17.58 21.98 26.37 30.77 35.16 39.56 43.95 48.35 52.74 57.14 61.53 65 - 69 17.25 23.00 28.75 34.50 40.25 46.00 51.75 57.50 63.25 69.00 74.75 80.50 70 - 74 23.28 31.04 38.80 46.56 54.32 62.08 69.84 77.60 85.36 93.12 100.88 108.6475+ 29.31 39.08 48.85 58.62 68.39 78.16 87.93 97.70 107.47 117.24 127.01 136.78

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 37.20 39.68 42.16 44.64 47.12 49.60 52.08 54.56 57.04 59.52 62.0030 - 34 37.88 40.40 42.93 45.45 47.98 50.50 53.03 55.55 58.08 60.60 63.13 35 - 39 37.88 40.40 42.93 45.45 47.98 50.50 53.03 55.55 58.08 60.60 63.1340 - 44 37.88 40.40 42.93 45.45 47.98 50.50 53.03 55.55 58.08 60.60 63.13 45 - 49 39.98 42.64 45.31 47.97 50.64 53.30 55.97 58.63 61.30 63.96 66.63 50 - 54 47.70 50.88 54.06 57.24 60.42 63.60 66.78 69.96 73.14 76.32 79.50 55 - 59 56.10 59.84 63.58 67.32 71.06 74.80 78.54 82.28 86.02 89.76 93.5060 - 64 65.93 70.32 74.72 79.11 83.51 87.90 92.30 96.69 101.09 105.48 109.88 65 - 69 86.25 92.00 97.75 103.50 109.25 115.00 120.75 126.50 132.25 138.00 143.75 70 - 74 116.40 124.16 131.92 139.68 147.44 155.20 162.96 170.72 178.48 186.24 194.0075+ 146.55 156.32 166.09 175.86 185.63 195.40 205.17 214.94 224.71 234.48 244.25





Plan 4 1-8-26




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 11.36 15.14 18.93 22.71 26.50 30.28 34.07 37.85 41.64 45.42 49.21 52.9930 - 34 11.78 15.70 19.63 23.55 27.48 31.40 35.33 39.25 43.18 47.10 51.03 54.95 35 - 39 11.78 15.70 19.63 23.55 27.48 31.40 35.33 39.25 43.18 47.10 51.03 54.9540 - 44 11.78 15.70 19.63 23.55 27.48 31.40 35.33 39.25 43.18 47.10 51.03 54.95 45 - 49 13.61 18.14 22.68 27.21 31.75 36.28 40.82 45.35 49.89 54.42 58.96 63.49 50 - 54 16.28 21.70 27.13 32.55 37.98 43.40 48.83 54.25 59.68 65.10 70.53 75.95 55 - 59 19.22 25.62 32.03 38.43 44.84 51.24 57.65 64.05 70.46 76.86 83.27 89.6760 - 64 22.44 29.92 37.40 44.88 52.36 59.84 67.32 74.80 82.28 89.76 97.24 104.72 65 - 69 29.60 39.46 49.33 59.19 69.06 78.92 88.79 98.65 108.52 118.38 128.25 138.11 70 - 74 40.25 53.66 67.08 80.49 93.91 107.32 120.74 134.15 147.57 160.98 174.40 187.8175+ 50.21 66.94 83.68 100.41 117.15 133.88 150.62 167.35 184.09 200.82 217.56 234.29

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 56.78 60.56 64.35 68.13 71.92 75.70 79.49 83.27 87.06 90.84 94.6330 - 34 58.88 62.80 66.73 70.65 74.58 78.50 82.43 86.35 90.28 94.20 98.13 35 - 39 58.88 62.80 66.73 70.65 74.58 78.50 82.43 86.35 90.28 94.20 98.1340 - 44 58.88 62.80 66.73 70.65 74.58 78.50 82.43 86.35 90.28 94.20 98.13 45 - 49 68.03 72.56 77.10 81.63 86.17 90.70 95.24 99.77 104.31 108.84 113.38 50 - 54 81.38 86.80 92.23 97.65 103.08 108.50 113.93 119.35 124.78 130.20 135.63 55 - 59 96.08 102.48 108.89 115.29 121.70 128.10 134.51 140.91 147.32 153.72 160.1360 - 64 112.20 119.68 127.16 134.64 142.12 149.60 157.08 164.56 172.04 179.52 187.00 65 - 69 147.98 157.84 167.71 177.57 187.44 197.30 207.17 217.03 226.90 236.76 246.63 70 - 74 201.23 214.64 228.06 241.47 254.89 268.30 281.72 295.13 308.55 321.96 335.3875+ 251.03 267.76 284.50 301.23 317.97 334.70 351.44 368.17 384.91 401.64 418.38





Plan 5 8-8-26




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 10.38 13.84 17.30 20.76 24.22 27.68 31.14 34.60 38.06 41.52 44.98 48.4430 - 34 10.94 14.58 18.23 21.87 25.52 29.16 32.81 36.45 40.10 43.74 47.39 51.03 35 - 39 10.94 14.58 18.23 21.87 25.52 29.16 32.81 36.45 40.10 43.74 47.39 51.0340 - 44 10.94 14.58 18.23 21.87 25.52 29.16 32.81 36.45 40.10 43.74 47.39 51.03 45 - 49 12.48 16.64 20.80 24.96 29.12 33.28 37.44 41.60 45.76 49.92 54.08 58.24 50 - 54 14.87 19.82 24.78 29.73 34.69 39.64 44.60 49.55 54.51 59.46 64.42 69.37 55 - 59 17.54 23.38 29.23 35.07 40.92 46.76 52.61 58.45 64.30 70.14 75.99 81.8360 - 64 20.61 27.48 34.35 41.22 48.09 54.96 61.83 68.70 75.57 82.44 89.31 96.18 65 - 69 27.21 36.28 45.35 54.42 63.49 72.56 81.63 90.70 99.77 108.84 117.91 126.98 70 - 74 36.89 49.18 61.48 73.77 86.07 98.36 110.66 122.95 135.25 147.54 159.84 172.1375+ 46.01 61.34 76.68 92.01 107.35 122.68 138.02 153.35 168.69 184.02 199.36 214.69

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 51.90 55.36 58.82 62.28 65.74 69.20 72.66 76.12 79.58 83.04 86.5030 - 34 54.68 58.32 61.97 65.61 69.26 72.90 76.55 80.19 83.84 87.48 91.13 35 - 39 54.68 58.32 61.97 65.61 69.26 72.90 76.55 80.19 83.84 87.48 91.1340 - 44 54.68 58.32 61.97 65.61 69.26 72.90 76.55 80.19 83.84 87.48 91.13 45 - 49 62.40 66.56 70.72 74.88 79.04 83.20 87.36 91.52 95.68 99.84 104.00 50 - 54 74.33 79.28 84.24 89.19 94.15 99.10 104.06 109.01 113.97 118.92 123.88 55 - 59 87.68 93.52 99.37 105.21 111.06 116.90 122.75 128.59 134.44 140.28 146.1360 - 64 103.05 109.92 116.79 123.66 130.53 137.40 144.27 151.14 158.01 164.88 171.75 65 - 69 136.05 145.12 154.19 163.26 172.33 181.40 190.47 199.54 208.61 217.68 226.75 70 - 74 184.43 196.72 209.02 221.31 233.61 245.90 258.20 270.49 282.79 295.08 307.3875+ 230.03 245.36 260.70 276.03 291.37 306.70 322.04 337.37 352.71 368.04 383.38





Plan 6 15-15-26



the premiums shown above apply to the following preferred industries with 3-99 employees For rates on groups of 100+ lives, please contact Underwriting at 800-753-0404 or email [email protected].

ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 8.97 11.96 14.95 17.94 20.93 23.92 26.91 29.90 32.89 35.88 38.87 41.8630 - 34 9.39 12.52 15.65 18.78 21.91 25.04 28.17 31.30 34.43 37.56 40.69 43.82 35 - 39 9.39 12.52 15.65 18.78 21.91 25.04 28.17 31.30 34.43 37.56 40.69 43.8240 - 44 9.39 12.52 15.65 18.78 21.91 25.04 28.17 31.30 34.43 37.56 40.69 43.82 45 - 49 10.80 14.40 18.00 21.60 25.20 28.80 32.40 36.00 39.60 43.20 46.80 50.40 50 - 54 12.90 17.20 21.50 25.80 30.10 34.40 38.70 43.00 47.30 51.60 55.90 60.20 55 - 59 15.29 20.38 25.48 30.57 35.67 40.76 45.86 50.95 56.05 61.14 66.24 71.3360 - 64 17.81 23.74 29.68 35.61 41.55 47.48 53.42 59.35 65.29 71.22 77.16 83.09 65 - 69 23.57 31.42 39.28 47.13 54.99 62.84 70.70 78.55 86.41 94.26 102.12 109.97 70 - 74 31.98 42.64 53.30 63.96 74.62 85.28 95.94 106.60 117.26 127.92 138.58 149.2475+ 39.83 53.10 66.38 79.65 92.93 106.20 119.48 132.75 146.03 159.30 172.58 185.85

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 44.85 47.84 50.83 53.82 56.81 59.80 62.79 65.78 68.77 71.76 74.7530 - 34 46.95 50.08 53.21 56.34 59.47 62.60 65.73 68.86 71.99 75.12 78.25 35 - 39 46.95 50.08 53.21 56.34 59.47 62.60 65.73 68.86 71.99 75.12 78.2540 - 44 46.95 50.08 53.21 56.34 59.47 62.60 65.73 68.86 71.99 75.12 78.25 45 - 49 54.00 57.60 61.20 64.80 68.40 72.00 75.60 79.20 82.80 86.40 90.00 50 - 54 64.50 68.80 73.10 77.40 81.70 86.00 90.30 94.60 98.90 103.20 107.50 55 - 59 76.43 81.52 86.62 91.71 96.81 101.90 107.00 112.09 117.19 122.28 127.3860 - 64 89.03 94.96 100.90 106.83 112.77 118.70 124.64 130.57 136.51 142.44 148.38 65 - 69 117.83 125.68 133.54 141.39 149.25 157.10 164.96 172.81 180.67 188.52 196.38 70 - 74 159.90 170.56 181.22 191.88 202.54 213.20 223.86 234.52 245.18 255.84 266.5075+ 199.13 212.40 225.68 238.95 252.23 265.50 278.78 292.05 305.33 318.60 331.88





Plan 7 15-15-52




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 10.10 13.46 16.83 20.19 23.56 26.92 30.29 33.65 37.02 40.38 43.75 47.1130 - 34 10.52 14.02 17.53 21.03 24.54 28.04 31.55 35.05 38.56 42.06 45.57 49.07 35 - 39 10.52 14.02 17.53 21.03 24.54 28.04 31.55 35.05 38.56 42.06 45.57 49.0740 - 44 10.52 14.02 17.53 21.03 24.54 28.04 31.55 35.05 38.56 42.06 45.57 49.07 45 - 49 12.06 16.08 20.10 24.12 28.14 32.16 36.18 40.20 44.22 48.24 52.26 56.28 50 - 54 14.45 19.26 24.08 28.89 33.71 38.52 43.34 48.15 52.97 57.78 62.60 67.41 55 - 59 17.12 22.82 28.53 34.23 39.94 45.64 51.35 57.05 62.76 68.46 74.17 79.8760 - 64 20.06 26.74 33.43 40.11 46.80 53.48 60.17 66.85 73.54 80.22 86.91 93.59 65 - 69 26.37 35.16 43.95 52.74 61.53 70.32 79.11 87.90 96.69 105.48 114.27 123.06 70 - 74 35.76 47.68 59.60 71.52 83.44 95.36 107.28 119.20 131.12 143.04 154.96 166.8875+ 44.75 59.66 74.58 89.49 104.41 119.32 134.24 149.15 164.07 178.98 193.90 208.81

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 50.48 53.84 57.21 60.57 63.94 67.30 70.67 74.03 77.40 80.76 84.1330 - 34 52.58 56.08 59.59 63.09 66.60 70.10 73.61 77.11 80.62 84.12 87.63 35 - 39 52.58 56.08 59.59 63.09 66.60 70.10 73.61 77.11 80.62 84.12 87.6340 - 44 52.58 56.08 59.59 63.09 66.60 70.10 73.61 77.11 80.62 84.12 87.63 45 - 49 60.30 64.32 68.34 72.36 76.38 80.40 84.42 88.44 92.46 96.48 100.50 50 - 54 72.23 77.04 81.86 86.67 91.49 96.30 101.12 105.93 110.75 115.56 120.38 55 - 59 85.58 91.28 96.99 102.69 108.40 114.10 119.81 125.51 131.22 136.92 142.6360 - 64 100.28 106.96 113.65 120.33 127.02 133.70 140.39 147.07 153.76 160.44 167.13 65 - 69 131.85 140.64 149.43 158.22 167.01 175.80 184.59 193.38 202.17 210.96 219.75 70 - 74 178.80 190.72 202.64 214.56 226.48 238.40 250.32 262.24 274.16 286.08 298.0075+ 223.73 238.64 253.56 268.47 283.39 298.30 313.22 328.13 343.05 357.96 372.88




Plan 8 30-30-52




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 7.44 9.92 12.40 14.88 17.36 19.84 22.32 24.80 27.28 29.76 32.24 34.7230 - 34 7.71 10.28 12.85 15.42 17.99 20.56 23.13 25.70 28.27 30.84 33.41 35.98 35 - 39 7.71 10.28 12.85 15.42 17.99 20.56 23.13 25.70 28.27 30.84 33.41 35.9840 - 44 7.71 10.28 12.85 15.42 17.99 20.56 23.13 25.70 28.27 30.84 33.41 35.98 45 - 49 8.84 11.78 14.73 17.67 20.62 23.56 26.51 29.45 32.40 35.34 38.29 41.23 50 - 54 10.67 14.22 17.78 21.33 24.89 28.44 32.00 35.55 39.11 42.66 46.22 49.77 55 - 59 12.48 16.64 20.80 24.96 29.12 33.28 37.44 41.60 45.76 49.92 54.08 58.2460 - 64 14.73 19.64 24.55 29.46 34.37 39.28 44.19 49.10 54.01 58.92 63.83 68.74 65 - 69 19.35 25.80 32.25 38.70 45.15 51.60 58.05 64.50 70.95 77.40 83.85 90.30 70 - 74 26.22 34.96 43.70 52.44 61.18 69.92 78.66 87.40 96.14 104.88 113.62 122.3675+ 32.82 43.76 54.70 65.64 76.58 87.52 98.46 109.40 120.34 131.28 142.22 153.16

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 37.20 39.68 42.16 44.64 47.12 49.60 52.08 54.56 57.04 59.52 62.0030 - 34 38.55 41.12 43.69 46.26 48.83 51.40 53.97 56.54 59.11 61.68 64.25 35 - 39 38.55 41.12 43.69 46.26 48.83 51.40 53.97 56.54 59.11 61.68 64.2540 - 44 38.55 41.12 43.69 46.26 48.83 51.40 53.97 56.54 59.11 61.68 64.25 45 - 49 44.18 47.12 50.07 53.01 55.96 58.90 61.85 64.79 67.74 70.68 73.63 50 - 54 53.33 56.88 60.44 63.99 67.55 71.10 74.66 78.21 81.77 85.32 88.88 55 - 59 62.40 66.56 70.72 74.88 79.04 83.20 87.36 91.52 95.68 99.84 104.0060 - 64 73.65 78.56 83.47 88.38 93.29 98.20 103.11 108.02 112.93 117.84 122.75 65 - 69 96.75 103.20 109.65 116.10 122.55 129.00 135.45 141.90 148.35 154.80 161.25 70 - 74 131.10 139.84 148.58 157.32 166.06 174.80 183.54 192.28 201.02 209.76 218.5075+ 164.10 175.04 185.98 196.92 207.86 218.80 229.74 240.68 251.62 262.56 273.50




95961-Standard (Rates effective 05/10) Rev. 12/12

standard industries — Monthly PreMiuM Costweekly benefit amount and monthly premium

Plan 1 1-8-13



the PreMiuMs shown above aPPly to the following standard industries with 3-99 eMPloyeesFor rates on groups of 100+ lives, please contact Underwriting at 800-753-0404 or email [email protected].

ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 11.39 15.18 18.98 22.77 26.57 30.36 34.16 37.95 41.75 45.54 49.34 53.1330 - 34 11.72 15.62 19.53 23.43 27.34 31.24 35.15 39.05 42.96 46.86 50.77 54.67 35 - 39 11.72 15.62 19.53 23.43 27.34 31.24 35.15 39.05 42.96 46.86 50.77 54.6740 - 44 11.72 15.62 19.53 23.43 27.34 31.24 35.15 39.05 42.96 46.86 50.77 54.67 45 - 49 12.38 16.50 20.63 24.75 28.88 33.00 37.13 41.25 45.38 49.50 53.63 57.75 50 - 54 14.85 19.80 24.75 29.70 34.65 39.60 44.55 49.50 54.45 59.40 64.35 69.30 55 - 59 17.33 23.10 28.88 34.65 40.43 46.20 51.98 57.75 63.53 69.30 75.08 80.8560 - 64 20.30 27.06 33.83 40.59 47.36 54.12 60.89 67.65 74.42 81.18 87.95 94.71 65 - 69 26.73 35.64 44.55 53.46 62.37 71.28 80.19 89.10 98.01 106.92 115.83 124.74 70 - 74 35.97 47.96 59.95 71.94 83.93 95.92 107.91 119.90 131.89 143.88 155.87 167.8675+ 45.38 60.50 75.63 90.75 105.88 121.00 136.13 151.25 166.38 181.50 196.63 211.75

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 56.93 60.72 64.52 68.31 72.11 75.90 79.70 83.49 87.29 91.08 94.8830 - 34 58.58 62.48 66.39 70.29 74.20 78.10 82.01 85.91 89.82 93.72 97.63 35 - 39 58.58 62.48 66.39 70.29 74.20 78.10 82.01 85.91 89.82 93.72 97.6340 - 44 58.58 62.48 66.39 70.29 74.20 78.10 82.01 85.91 89.82 93.72 97.63 45 - 49 61.88 66.00 70.13 74.25 78.38 82.50 86.63 90.75 94.88 99.00 103.13 50 - 54 74.25 79.20 84.15 89.10 94.05 99.00 103.95 108.90 113.85 118.80 123.75 55 - 59 86.63 92.40 98.18 103.95 109.73 115.50 121.28 127.05 132.83 138.60 144.3860 - 64 101.48 108.24 115.01 121.77 128.54 135.30 142.07 148.83 155.60 162.36 169.13 65 - 69 133.65 142.56 151.47 160.38 169.29 178.20 187.11 196.02 204.93 213.84 222.75 70 - 74 179.85 191.84 203.83 215.82 227.81 239.80 251.79 263.78 275.77 287.76 299.7575+ 226.88 242.00 257.13 272.25 287.38 302.50 317.63 332.75 347.88 363.00 378.13

SIC Code Industry SIC Code Industry0711-0724, 0751-0783 Agriculture, Services 5813 Retail trade, Drinking Places1521-1799 Construction 7011-7041 Hotels & Other Lodging Places2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos2411-2421 Logging & Saw Mills 7361-7363 Employment & Help Agencies2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios3131-3199 Leather Products 8322-8399 Social Services3211-3291 Stone, Clay & Glass Products 8611-8699 Organizations, Memberships3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration4724-4789 Transportation Services, Freight, Cargo, Passengers 9711-9721 National Security & International Affairs

voluntary short terM disability



Plan 2 8-8-13




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 10.23 13.64 17.05 20.46 23.87 27.28 30.69 34.10 37.51 40.92 44.33 47.7430 - 34 10.56 14.08 17.60 21.12 24.64 28.16 31.68 35.20 38.72 42.24 45.76 49.28 35 - 39 10.56 14.08 17.60 21.12 24.64 28.16 31.68 35.20 38.72 42.24 45.76 49.2840 - 44 10.56 14.08 17.60 21.12 24.64 28.16 31.68 35.20 38.72 42.24 45.76 49.28 45 - 49 11.06 14.74 18.43 22.11 25.80 29.48 33.17 36.85 40.54 44.22 47.91 51.59 50 - 54 13.37 17.82 22.28 26.73 31.19 35.64 40.10 44.55 49.01 53.46 57.92 62.37 55 - 59 15.68 20.90 26.13 31.35 36.58 41.80 47.03 52.25 57.48 62.70 67.93 73.1560 - 64 18.32 24.42 30.53 36.63 42.74 48.84 54.95 61.05 67.16 73.26 79.37 85.47 65 - 69 24.09 32.12 40.15 48.18 56.21 64.24 72.27 80.30 88.33 96.36 104.39 112.42 70 - 74 32.34 43.12 53.90 64.68 75.46 86.24 97.02 107.80 118.58 129.36 140.14 150.9275+ 40.76 54.34 67.93 81.51 95.10 108.68 122.27 135.85 149.44 163.02 176.61 190.19

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 51.15 54.56 57.97 61.38 64.79 68.20 71.61 75.02 78.43 81.84 85.2530 - 34 52.80 56.32 59.84 63.36 66.88 70.40 73.92 77.44 80.96 84.48 88.00 35 - 39 52.80 56.32 59.84 63.36 66.88 70.40 73.92 77.44 80.96 84.48 88.0040 - 44 52.80 56.32 59.84 63.36 66.88 70.40 73.92 77.44 80.96 84.48 88.00 45 - 49 55.28 58.96 62.65 66.33 70.02 73.70 77.39 81.07 84.76 88.44 92.13 50 - 54 66.83 71.28 75.74 80.19 84.65 89.10 93.56 98.01 102.47 106.92 111.38 55 - 59 78.38 83.60 88.83 94.05 99.28 104.50 109.73 114.95 120.18 125.40 130.6360 - 64 91.58 97.68 103.79 109.89 116.00 122.10 128.21 134.31 140.42 146.52 152.63 65 - 69 120.45 128.48 136.51 144.54 152.57 160.60 168.63 176.66 184.69 192.72 200.75 70 - 74 161.70 172.48 183.26 194.04 204.82 215.60 226.38 237.16 247.94 258.72 269.5075+ 203.78 217.36 230.95 244.53 258.12 271.70 285.29 298.87 312.46 326.04 339.63






Plan 3 15-15-13




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 8.75 11.66 14.58 17.49 20.41 23.32 26.24 29.15 32.07 34.98 37.90 40.8130 - 34 8.91 11.88 14.85 17.82 20.79 23.76 26.73 29.70 32.67 35.64 38.61 41.58 35 - 39 8.91 11.88 14.85 17.82 20.79 23.76 26.73 29.70 32.67 35.64 38.61 41.5840 - 44 8.91 11.88 14.85 17.82 20.79 23.76 26.73 29.70 32.67 35.64 38.61 41.58 45 - 49 9.41 12.54 15.68 18.81 21.95 25.08 28.22 31.35 34.49 37.62 40.76 43.89 50 - 54 11.22 14.96 18.70 22.44 26.18 29.92 33.66 37.40 41.14 44.88 48.62 52.36 55 - 59 13.20 17.60 22.00 26.40 30.80 35.20 39.60 44.00 48.40 52.80 57.20 61.6060 - 64 15.51 20.68 25.85 31.02 36.19 41.36 46.53 51.70 56.87 62.04 67.21 72.38 65 - 69 20.30 27.06 33.83 40.59 47.36 54.12 60.89 67.65 74.42 81.18 87.95 94.71 70 - 74 27.39 36.52 45.65 54.78 63.91 73.04 82.17 91.30 100.43 109.56 118.69 127.8275+ 34.49 45.98 57.48 68.97 80.47 91.96 103.46 114.95 126.45 137.94 149.44 160.93

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 43.73 46.64 49.56 52.47 55.39 58.30 61.22 64.13 67.05 69.96 72.8830 - 34 44.55 47.52 50.49 53.46 56.43 59.40 62.37 65.34 68.31 71.28 74.25 35 - 39 44.55 47.52 50.49 53.46 56.43 59.40 62.37 65.34 68.31 71.28 74.2540 - 44 44.55 47.52 50.49 53.46 56.43 59.40 62.37 65.34 68.31 71.28 74.25 45 - 49 47.03 50.16 53.30 56.43 59.57 62.70 65.84 68.97 72.11 75.24 78.38 50 - 54 56.10 59.84 63.58 67.32 71.06 74.80 78.54 82.28 86.02 89.76 93.50 55 - 59 66.00 70.40 74.80 79.20 83.60 88.00 92.40 96.80 101.20 105.60 110.0060 - 64 77.55 82.72 87.89 93.06 98.23 103.40 108.57 113.74 118.91 124.08 129.25 65 - 69 101.48 108.24 115.01 121.77 128.54 135.30 142.07 148.83 155.60 162.36 169.13 70 - 74 136.95 146.08 155.21 164.34 173.47 182.60 191.73 200.86 209.99 219.12 228.2575+ 172.43 183.92 195.42 206.91 218.41 229.90 241.40 252.89 264.39 275.88 287.38




Plan 4 1-8-26




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 13.37 17.82 22.28 26.73 31.19 35.64 40.10 44.55 49.01 53.46 57.92 62.3730 - 34 13.86 18.48 23.10 27.72 32.34 36.96 41.58 46.20 50.82 55.44 60.06 64.68 35 - 39 13.86 18.48 23.10 27.72 32.34 36.96 41.58 46.20 50.82 55.44 60.06 64.6840 - 44 13.86 18.48 23.10 27.72 32.34 36.96 41.58 46.20 50.82 55.44 60.06 64.68 45 - 49 16.01 21.34 26.68 32.01 37.35 42.68 48.02 53.35 58.69 64.02 69.36 74.69 50 - 54 19.14 25.52 31.90 38.28 44.66 51.04 57.42 63.80 70.18 76.56 82.94 89.32 55 - 59 22.61 30.14 37.68 45.21 52.75 60.28 67.82 75.35 82.89 90.42 97.96 105.4960 - 64 26.40 35.20 44.00 52.80 61.60 70.40 79.20 88.00 96.80 105.60 114.40 123.20 65 - 69 34.82 46.42 58.03 69.63 81.24 92.84 104.45 116.05 127.66 139.26 150.87 162.47 70 - 74 47.36 63.14 78.93 94.71 110.50 126.28 142.07 157.85 173.64 189.42 205.21 220.9975+ 59.07 78.76 98.45 118.14 137.83 157.52 177.21 196.90 216.59 236.28 255.97 275.66

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 66.83 71.28 75.74 80.19 84.65 89.10 93.56 98.01 102.47 106.92 111.3830 - 34 69.30 73.92 78.54 83.16 87.78 92.40 97.02 101.64 106.26 110.88 115.50 35 - 39 69.30 73.92 78.54 83.16 87.78 92.40 97.02 101.64 106.26 110.88 115.5040 - 44 69.30 73.92 78.54 83.16 87.78 92.40 97.02 101.64 106.26 110.88 115.50 45 - 49 80.03 85.36 90.70 96.03 101.37 106.70 112.04 117.37 122.71 128.04 133.38 50 - 54 95.70 102.08 108.46 114.84 121.22 127.60 133.98 140.36 146.74 153.12 159.50 55 - 59 113.03 120.56 128.10 135.63 143.17 150.70 158.24 165.77 173.31 180.84 188.3860 - 64 132.00 140.80 149.60 158.40 167.20 176.00 184.80 193.60 202.40 211.20 220.00 65 - 69 174.08 185.68 197.29 208.89 220.50 232.10 243.71 255.31 266.92 278.52 290.13 70 - 74 236.78 252.56 268.35 284.13 299.92 315.70 331.49 347.27 363.06 378.84 394.6375+ 295.35 315.04 334.73 354.42 374.11 393.80 413.49 433.18 452.87 472.56 492.25





Plan 5 8-8-26




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 12.21 16.28 20.35 24.42 28.49 32.56 36.63 40.70 44.77 48.84 52.91 56.9830 - 34 12.87 17.16 21.45 25.74 30.03 34.32 38.61 42.90 47.19 51.48 55.77 60.06 35 - 39 12.87 17.16 21.45 25.74 30.03 34.32 38.61 42.90 47.19 51.48 55.77 60.0640 - 44 12.87 17.16 21.45 25.74 30.03 34.32 38.61 42.90 47.19 51.48 55.77 60.06 45 - 49 14.69 19.58 24.48 29.37 34.27 39.16 44.06 48.95 53.85 58.74 63.64 68.53 50 - 54 17.49 23.32 29.15 34.98 40.81 46.64 52.47 58.30 64.13 69.96 75.79 81.62 55 - 59 20.63 27.50 34.38 41.25 48.13 55.00 61.88 68.75 75.63 82.50 89.38 96.2560 - 64 24.26 32.34 40.43 48.51 56.60 64.68 72.77 80.85 88.94 97.02 105.11 113.19 65 - 69 32.01 42.68 53.35 64.02 74.69 85.36 96.03 106.70 117.37 128.04 138.71 149.38 70 - 74 43.40 57.86 72.33 86.79 101.26 115.72 130.19 144.65 159.12 173.58 188.05 202.5175+ 54.12 72.16 90.20 108.24 126.28 144.32 162.36 180.40 198.44 216.48 234.52 252.56

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 61.05 65.12 69.19 73.26 77.33 81.40 85.47 89.54 93.61 97.68 101.7530 - 34 64.35 68.64 72.93 77.22 81.51 85.80 90.09 94.38 98.67 102.96 107.25 35 - 39 64.35 68.64 72.93 77.22 81.51 85.80 90.09 94.38 98.67 102.96 107.2540 - 44 64.35 68.64 72.93 77.22 81.51 85.80 90.09 94.38 98.67 102.96 107.25 45 - 49 73.43 78.32 83.22 88.11 93.01 97.90 102.80 107.69 112.59 117.48 122.38 50 - 54 87.45 93.28 99.11 104.94 110.77 116.60 122.43 128.26 134.09 139.92 145.75 55 - 59 103.13 110.00 116.88 123.75 130.63 137.50 144.38 151.25 158.13 165.00 171.8860 - 64 121.28 129.36 137.45 145.53 153.62 161.70 169.79 177.87 185.96 194.04 202.13 65 - 69 160.05 170.72 181.39 192.06 202.73 213.40 224.07 234.74 245.41 256.08 266.75 70 - 74 216.98 231.44 245.91 260.37 274.84 289.30 303.77 318.23 332.70 347.16 361.6375+ 270.60 288.64 306.68 324.72 342.76 360.80 378.84 396.88 414.92 432.96 451.00





Plan 6 15-15-26




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 10.56 14.08 17.60 21.12 24.64 28.16 31.68 35.20 38.72 42.24 45.76 49.2830 - 34 11.06 14.74 18.43 22.11 25.80 29.48 33.17 36.85 40.54 44.22 47.91 51.59 35 - 39 11.06 14.74 18.43 22.11 25.80 29.48 33.17 36.85 40.54 44.22 47.91 51.5940 - 44 11.06 14.74 18.43 22.11 25.80 29.48 33.17 36.85 40.54 44.22 47.91 51.59 45 - 49 12.71 16.94 21.18 25.41 29.65 33.88 38.12 42.35 46.59 50.82 55.06 59.29 50 - 54 15.18 20.24 25.30 30.36 35.42 40.48 45.54 50.60 55.66 60.72 65.78 70.84 55 - 59 17.99 23.98 29.98 35.97 41.97 47.96 53.96 59.95 65.95 71.94 77.94 83.9360 - 64 20.96 27.94 34.93 41.91 48.90 55.88 62.87 69.85 76.84 83.82 90.81 97.79 65 - 69 27.72 36.96 46.20 55.44 64.68 73.92 83.16 92.40 101.64 110.88 120.12 129.36 70 - 74 37.62 50.16 62.70 75.24 87.78 100.32 112.86 125.40 137.94 150.48 163.02 175.5675+ 46.86 62.48 78.10 93.72 109.34 124.96 140.58 156.20 171.82 187.44 203.06 218.68

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 52.80 56.32 59.84 63.36 66.88 70.40 73.92 77.44 80.96 84.48 88.0030 - 34 55.28 58.96 62.65 66.33 70.02 73.70 77.39 81.07 84.76 88.44 92.13 35 - 39 55.28 58.96 62.65 66.33 70.02 73.70 77.39 81.07 84.76 88.44 92.1340 - 44 55.28 58.96 62.65 66.33 70.02 73.70 77.39 81.07 84.76 88.44 92.13 45 - 49 63.53 67.76 72.00 76.23 80.47 84.70 88.94 93.17 97.41 101.64 105.88 50 - 54 75.90 80.96 86.02 91.08 96.14 101.20 106.26 111.32 116.38 121.44 126.50 55 - 59 89.93 95.92 101.92 107.91 113.91 119.90 125.90 131.89 137.89 143.88 149.8860 - 64 104.78 111.76 118.75 125.73 132.72 139.70 146.69 153.67 160.66 167.64 174.63 65 - 69 138.60 147.84 157.08 166.32 175.56 184.80 194.04 203.28 212.52 221.76 231.00 70 - 74 188.10 200.64 213.18 225.72 238.26 250.80 263.34 275.88 288.42 300.96 313.5075+ 234.30 249.92 265.54 281.16 296.78 312.40 328.02 343.64 359.26 374.88 390.50





Plan 7 15-15-52




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 11.88 15.84 19.80 23.76 27.72 31.68 35.64 39.60 43.56 47.52 51.48 55.4430 - 34 12.38 16.50 20.63 24.75 28.88 33.00 37.13 41.25 45.38 49.50 53.63 57.75 35 - 39 12.38 16.50 20.63 24.75 28.88 33.00 37.13 41.25 45.38 49.50 53.63 57.7540 - 44 12.38 16.50 20.63 24.75 28.88 33.00 37.13 41.25 45.38 49.50 53.63 57.75 45 - 49 14.19 18.92 23.65 28.38 33.11 37.84 42.57 47.30 52.03 56.76 61.49 66.22 50 - 54 17.00 22.66 28.33 33.99 39.66 45.32 50.99 56.65 62.32 67.98 73.65 79.31 55 - 59 20.13 26.84 33.55 40.26 46.97 53.68 60.39 67.10 73.81 80.52 87.23 93.9460 - 64 23.60 31.46 39.33 47.19 55.06 62.92 70.79 78.65 86.52 94.38 102.25 110.11 65 - 69 31.02 41.36 51.70 62.04 72.38 82.72 93.06 103.40 113.74 124.08 134.42 144.76 70 - 74 42.08 56.10 70.13 84.15 98.18 112.20 126.23 140.25 154.28 168.30 182.33 196.3575+ 52.64 70.18 87.73 105.27 122.82 140.36 157.91 175.45 193.00 210.54 228.09 245.63

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 59.40 63.36 67.32 71.28 75.24 79.20 83.16 87.12 91.08 95.04 99.0030 - 34 61.88 66.00 70.13 74.25 78.38 82.50 86.63 90.75 94.88 99.00 103.13 35 - 39 61.88 66.00 70.13 74.25 78.38 82.50 86.63 90.75 94.88 99.00 103.1340 - 44 61.88 66.00 70.13 74.25 78.38 82.50 86.63 90.75 94.88 99.00 103.13 45 - 49 70.95 75.68 80.41 85.14 89.87 94.60 99.33 104.06 108.79 113.52 118.25 50 - 54 84.98 90.64 96.31 101.97 107.64 113.30 118.97 124.63 130.30 135.96 141.63 55 - 59 100.65 107.36 114.07 120.78 127.49 134.20 140.91 147.62 154.33 161.04 167.7560 - 64 117.98 125.84 133.71 141.57 149.44 157.30 165.17 173.03 180.90 188.76 196.63 65 - 69 155.10 165.44 175.78 186.12 196.46 206.80 217.14 227.48 237.82 248.16 258.50 70 - 74 210.38 224.40 238.43 252.45 266.48 280.50 294.53 308.55 322.58 336.60 350.6375+ 263.18 280.72 298.27 315.81 333.36 350.90 368.45 385.99 403.54 421.08 438.63





Plan 8 30-30-52




ageCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 8.75 11.66 14.58 17.49 20.41 23.32 26.24 29.15 32.07 34.98 37.90 40.8130 - 34 9.08 12.10 15.13 18.15 21.18 24.20 27.23 30.25 33.28 36.30 39.33 42.35 35 - 39 9.08 12.10 15.13 18.15 21.18 24.20 27.23 30.25 33.28 36.30 39.33 42.3540 - 44 9.08 12.10 15.13 18.15 21.18 24.20 27.23 30.25 33.28 36.30 39.33 42.35 45 - 49 10.40 13.86 17.33 20.79 24.26 27.72 31.19 34.65 38.12 41.58 45.05 48.51 50 - 54 12.54 16.72 20.90 25.08 29.26 33.44 37.62 41.80 45.98 50.16 54.34 58.52 55 - 59 14.69 19.58 24.48 29.37 34.27 39.16 44.06 48.95 53.85 58.74 63.64 68.5360 - 64 17.33 23.10 28.88 34.65 40.43 46.20 51.98 57.75 63.53 69.30 75.08 80.85 65 - 69 22.77 30.36 37.95 45.54 53.13 60.72 68.31 75.90 83.49 91.08 98.67 106.26 70 - 74 30.86 41.14 51.43 61.71 72.00 82.28 92.57 102.85 113.14 123.42 133.71 143.9975+ 38.61 51.48 64.35 77.22 90.09 102.96 115.83 128.70 141.57 154.44 167.31 180.18

ageCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 43.73 46.64 49.56 52.47 55.39 58.30 61.22 64.13 67.05 69.96 72.8830 - 34 45.38 48.40 51.43 54.45 57.48 60.50 63.53 66.55 69.58 72.60 75.63 35 - 39 45.38 48.40 51.43 54.45 57.48 60.50 63.53 66.55 69.58 72.60 75.6340 - 44 45.38 48.40 51.43 54.45 57.48 60.50 63.53 66.55 69.58 72.60 75.63 45 - 49 51.98 55.44 58.91 62.37 65.84 69.30 72.77 76.23 79.70 83.16 86.63 50 - 54 62.70 66.88 71.06 75.24 79.42 83.60 87.78 91.96 96.14 100.32 104.50 55 - 59 73.43 78.32 83.22 88.11 93.01 97.90 102.80 107.69 112.59 117.48 122.3860 - 64 86.63 92.40 98.18 103.95 109.73 115.50 121.28 127.05 132.83 138.60 144.38 65 - 69 113.85 121.44 129.03 136.62 144.21 151.80 159.39 166.98 174.57 182.16 189.75 70 - 74 154.28 164.56 174.85 185.13 195.42 205.70 215.99 226.27 236.56 246.84 257.1375+ 193.05 205.92 218.79 231.66 244.53 257.40 270.27 283.14 296.01 308.88 321.75

SIC Code Industry SIC Code Industry0711-0724, 0751-0783 Agriculture, Services 5813 Retail trade, Drinking Places1521-1799 Construction 7011-7041 Hotels & Other Lodging Places2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos2411-2421 Logging & Saw Mills 7361-7363 Employment & Help Agencies2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios3131-3199 Leather Products 8322-8399 Social Services3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration4724-4789 Transportation Services, Freight, Cargo, Passengers 9711-9721 National Security & International Affairs


AgeCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 13.67 18.22 22.78 27.33 31.89 36.44 41.00 45.55 50.11 54.66 59.22 63.7730 - 34 14.06 18.74 23.43 28.11 32.80 37.48 42.17 46.85 51.54 56.22 60.91 65.59 35 - 39 14.06 18.74 23.43 28.11 32.80 37.48 42.17 46.85 51.54 56.22 60.91 65.5940 - 44 14.06 18.74 23.43 28.11 32.80 37.48 42.17 46.85 51.54 56.22 60.91 65.59 45 - 49 14.85 19.80 24.75 29.70 34.65 39.60 44.55 49.50 54.45 59.40 64.35 69.30 50 - 54 17.82 23.76 29.70 35.64 41.58 47.52 53.46 59.40 65.34 71.28 77.22 83.16 55 - 59 20.79 27.72 34.65 41.58 48.51 55.44 62.37 69.30 76.23 83.16 90.09 97.0260 - 64 24.36 32.48 40.60 48.72 56.84 64.96 73.08 81.20 89.32 97.44 105.56 113.68 65 - 69 32.07 42.76 53.45 64.14 74.83 85.52 96.21 106.90 117.59 128.28 138.97 149.66 70 - 74 43.17 57.56 71.95 86.34 100.73 115.12 129.51 143.90 158.29 172.68 187.07 201.4675+ 54.45 72.60 90.75 108.90 127.05 145.20 163.35 181.50 199.65 217.80 235.95 254.10

95961-Non-Standard (Rates effective 03/12) Rev. 12/12

NoN-staNdard iNdustries — MoNthly PreMiuM Costweekly benefit amount and monthly premium

PlAn 1 1-8-13

To determine your initial monthly premium within your age category, simply find your age bracket on the left side and follow the line to the right.

This premium cost chart is for illustrative purposes only; your monthly premium cost may be slightly higher or lower due to rounding. The information provided is only a summary of the benefits available. Refer to your certificate for details and limitations of coverage.


the PreMiuMs showN above aPPly to the followiNg NoN-staNdard iNdustries with 3-99 eMPloyeesFor rates on groups of 100+ lives, please contact Underwriting at 800-753-0404 or email [email protected].

AgeCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 68.33 72.88 77.44 81.99 86.55 91.10 95.66 100.21 104.77 109.32 113.8830 - 34 70.28 74.96 79.65 84.33 89.02 93.70 98.39 103.07 107.76 112.44 117.13 35 - 39 70.28 74.96 79.65 84.33 89.02 93.70 98.39 103.07 107.76 112.44 117.1340 - 44 70.28 74.96 79.65 84.33 89.02 93.70 98.39 103.07 107.76 112.44 117.13 45 - 49 74.25 79.20 84.15 89.10 94.05 99.00 103.95 108.90 113.85 118.80 123.75 50 - 54 89.10 95.04 100.98 106.92 112.86 118.80 124.74 130.68 136.62 142.56 148.50 55 - 59 103.95 110.88 117.81 124.74 131.67 138.60 145.53 152.46 159.39 166.32 173.2560 - 64 121.80 129.92 138.04 146.16 154.28 162.40 170.52 178.64 186.76 194.88 203.00 65 - 69 160.35 171.04 181.73 192.42 203.11 213.80 224.49 235.18 245.87 256.56 267.25 70 - 74 215.85 230.24 244.63 259.02 273.41 287.80 302.19 316.58 330.97 345.36 359.7575+ 272.25 290.40 308.55 326.70 344.85 363.00 381.15 399.30 417.45 435.60 453.75

SIC Code Industry SIC Code Industry0111–0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing0811–0851 Forestry 3312–3399 Steel Works, Foundries & Smelting0912–0971 Fishing, Hunting, Trapping 3411–3479, 3491–3499 Fabricated Metal Products2611–2679 Paper Products 4011–4581 Air, Bus, Rail, Trucking, Water Transportation2873–2891 Chemicals, Agriculture 8011–8099 Health Services

voluNtary short terM disability

PlAn 2 8-8-13





AgeCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 12.27 16.36 20.45 24.54 28.63 32.72 36.81 40.90 44.99 49.08 53.17 57.2630 - 34 12.68 16.90 21.13 25.35 29.58 33.80 38.03 42.25 46.48 50.70 54.93 59.15 35 - 39 12.68 16.90 21.13 25.35 29.58 33.80 38.03 42.25 46.48 50.70 54.93 59.1540 - 44 12.68 16.90 21.13 25.35 29.58 33.80 38.03 42.25 46.48 50.70 54.93 59.15 45 - 49 13.26 17.68 22.10 26.52 30.94 35.36 39.78 44.20 48.62 53.04 57.46 61.88 50 - 54 16.04 21.38 26.73 32.07 37.42 42.76 48.11 53.45 58.80 64.14 69.49 74.83 55 - 59 18.81 25.08 31.35 37.62 43.89 50.16 56.43 62.70 68.97 75.24 81.51 87.7860 - 64 21.98 29.30 36.63 43.95 51.28 58.60 65.93 73.25 80.58 87.90 95.23 102.55 65 - 69 28.91 38.54 48.18 57.81 67.45 77.08 86.72 96.35 105.99 115.62 125.26 134.89 70 - 74 38.81 51.74 64.68 77.61 90.55 103.48 116.42 129.35 142.29 155.22 168.16 181.0975+ 48.90 65.20 81.50 97.80 114.10 130.40 146.70 163.00 179.30 195.60 211.90 228.20

AgeCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 61.35 65.44 69.53 73.62 77.71 81.80 85.89 89.98 94.07 98.16 102.2530 - 34 63.38 67.60 71.83 76.05 80.28 84.50 88.73 92.95 97.18 101.40 105.63 35 - 39 63.38 67.60 71.83 76.05 80.28 84.50 88.73 92.95 97.18 101.40 105.6340 - 44 63.38 67.60 71.83 76.05 80.28 84.50 88.73 92.95 97.18 101.40 105.63 45 - 49 66.30 70.72 75.14 79.56 83.98 88.40 92.82 97.24 101.66 106.08 110.50 50 - 54 80.18 85.52 90.87 96.21 101.56 106.90 112.25 117.59 122.94 128.28 133.63 55 - 59 94.05 100.32 106.59 112.86 119.13 125.40 131.67 137.94 144.21 150.48 156.7560 - 64 109.88 117.20 124.53 131.85 139.18 146.50 153.83 161.15 168.48 175.80 183.13 65 - 69 144.53 154.16 163.80 173.43 183.07 192.70 202.34 211.97 221.61 231.24 240.88 70 - 74 194.03 206.96 219.90 232.83 245.77 258.70 271.64 284.57 297.51 310.44 323.3875+ 244.50 260.80 277.10 293.40 309.70 326.00 342.30 358.60 374.90 391.20 407.50





PlAn 3 15-15-13





AgeCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 10.50 14.00 17.50 21.00 24.50 28.00 31.50 35.00 38.50 42.00 45.50 49.0030 - 34 10.70 14.26 17.83 21.39 24.96 28.52 32.09 35.65 39.22 42.78 46.35 49.91 35 - 39 10.70 14.26 17.83 21.39 24.96 28.52 32.09 35.65 39.22 42.78 46.35 49.9140 - 44 10.70 14.26 17.83 21.39 24.96 28.52 32.09 35.65 39.22 42.78 46.35 49.91 45 - 49 11.28 15.04 18.80 22.56 26.32 30.08 33.84 37.60 41.36 45.12 48.88 52.64 50 - 54 13.47 17.96 22.45 26.94 31.43 35.92 40.41 44.90 49.39 53.88 58.37 62.86 55 - 59 15.84 21.12 26.40 31.68 36.96 42.24 47.52 52.80 58.08 63.36 68.64 73.9260 - 64 18.62 24.82 31.03 37.23 43.44 49.64 55.85 62.05 68.26 74.46 80.67 86.87 65 - 69 24.36 32.48 40.60 48.72 56.84 64.96 73.08 81.20 89.32 97.44 105.56 113.68 70 - 74 32.87 43.82 54.78 65.73 76.69 87.64 98.60 109.55 120.51 131.46 142.42 153.3775+ 41.39 55.18 68.98 82.77 96.57 110.36 124.16 137.95 151.75 165.54 179.34 193.13

AgeCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 52.50 56.00 59.50 63.00 66.50 70.00 73.50 77.00 80.50 84.00 87.5030 - 34 53.48 57.04 60.61 64.17 67.74 71.30 74.87 78.43 82.00 85.56 89.13 35 - 39 53.48 57.04 60.61 64.17 67.74 71.30 74.87 78.43 82.00 85.56 89.1340 - 44 53.48 57.04 60.61 64.17 67.74 71.30 74.87 78.43 82.00 85.56 89.13 45 - 49 56.40 60.16 63.92 67.68 71.44 75.20 78.96 82.72 86.48 90.24 94.00 50 - 54 67.35 71.84 76.33 80.82 85.31 89.80 94.29 98.78 103.27 107.76 112.25 55 - 59 79.20 84.48 89.76 95.04 100.32 105.60 110.88 116.16 121.44 126.72 132.0060 - 64 93.08 99.28 105.49 111.69 117.90 124.10 130.31 136.51 142.72 148.92 155.13 65 - 69 121.80 129.92 138.04 146.16 154.28 162.40 170.52 178.64 186.76 194.88 203.00 70 - 74 164.33 175.28 186.24 197.19 208.15 219.10 230.06 241.01 251.97 262.92 273.8875+ 206.93 220.72 234.52 248.31 262.11 275.90 289.70 303.49 317.29 331.08 344.88





PlAn 4 1-8-26





AgeCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 16.04 21.38 26.73 32.07 37.42 42.76 48.11 53.45 58.80 64.14 69.49 74.8330 - 34 16.64 22.18 27.73 33.27 38.82 44.36 49.91 55.45 61.00 66.54 72.09 77.63 35 - 39 16.64 22.18 27.73 33.27 38.82 44.36 49.91 55.45 61.00 66.54 72.09 77.6340 - 44 16.64 22.18 27.73 33.27 38.82 44.36 49.91 55.45 61.00 66.54 72.09 77.63 45 - 49 19.20 25.60 32.00 38.40 44.80 51.20 57.60 64.00 70.40 76.80 83.20 89.60 50 - 54 22.97 30.62 38.28 45.93 53.59 61.24 68.90 76.55 84.21 91.86 99.52 107.17 55 - 59 27.12 36.16 45.20 54.24 63.28 72.32 81.36 90.40 99.44 108.48 117.52 126.5660 - 64 31.68 42.24 52.80 63.36 73.92 84.48 95.04 105.60 116.16 126.72 137.28 147.84 65 - 69 41.78 55.70 69.63 83.55 97.48 111.40 125.33 139.25 153.18 167.10 181.03 194.95 70 - 74 56.82 75.76 94.70 113.64 132.58 151.52 170.46 189.40 208.34 227.28 246.22 265.1675+ 70.89 94.52 118.15 141.78 165.41 189.04 212.67 236.30 259.93 283.56 307.19 330.82

AgeCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 80.18 85.52 90.87 96.21 101.56 106.90 112.25 117.59 122.94 128.28 133.6330 - 34 83.18 88.72 94.27 99.81 105.36 110.90 116.45 121.99 127.54 133.08 138.63 35 - 39 83.18 88.72 94.27 99.81 105.36 110.90 116.45 121.99 127.54 133.08 138.6340 - 44 83.18 88.72 94.27 99.81 105.36 110.90 116.45 121.99 127.54 133.08 138.63 45 - 49 96.00 102.40 108.80 115.20 121.60 128.00 134.40 140.80 147.20 153.60 160.00 50 - 54 114.83 122.48 130.14 137.79 145.45 153.10 160.76 168.41 176.07 183.72 191.38 55 - 59 135.60 144.64 153.68 162.72 171.76 180.80 189.84 198.88 207.92 216.96 226.0060 - 64 158.40 168.96 179.52 190.08 200.64 211.20 221.76 232.32 242.88 253.44 264.00 65 - 69 208.88 222.80 236.73 250.65 264.58 278.50 292.43 306.35 320.28 334.20 348.13 70 - 74 284.10 303.04 321.98 340.92 359.86 378.80 397.74 416.68 435.62 454.56 473.5075+ 354.45 378.08 401.71 425.34 448.97 472.60 496.23 519.86 543.49 567.12 590.75





PlAn 5 8-8-26





AgeCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 14.66 19.54 24.43 29.31 34.20 39.08 43.97 48.85 53.74 58.62 63.51 68.3930 - 34 15.45 20.60 25.75 30.90 36.05 41.20 46.35 51.50 56.65 61.80 66.95 72.10 35 - 39 15.45 20.60 25.75 30.90 36.05 41.20 46.35 51.50 56.65 61.80 66.95 72.1040 - 44 15.45 20.60 25.75 30.90 36.05 41.20 46.35 51.50 56.65 61.80 66.95 72.10 45 - 49 17.63 23.50 29.38 35.25 41.13 47.00 52.88 58.75 64.63 70.50 76.38 82.25 50 - 54 20.99 27.98 34.98 41.97 48.97 55.96 62.96 69.95 76.95 83.94 90.94 97.93 55 - 59 24.75 33.00 41.25 49.50 57.75 66.00 74.25 82.50 90.75 99.00 107.25 115.5060 - 64 29.10 38.80 48.50 58.20 67.90 77.60 87.30 97.00 106.70 116.40 126.10 135.80 65 - 69 38.42 51.22 64.03 76.83 89.64 102.44 115.25 128.05 140.86 153.66 166.47 179.27 70 - 74 52.08 69.44 86.80 104.16 121.52 138.88 156.24 173.60 190.96 208.32 225.68 243.0475+ 64.95 86.60 108.25 129.90 151.55 173.20 194.85 216.50 238.15 259.80 281.45 303.10

AgeCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 73.28 78.16 83.05 87.93 92.82 97.70 102.59 107.47 112.36 117.24 122.1330 - 34 77.25 82.40 87.55 92.70 97.85 103.00 108.15 113.30 118.45 123.60 128.75 35 - 39 77.25 82.40 87.55 92.70 97.85 103.00 108.15 113.30 118.45 123.60 128.7540 - 44 77.25 82.40 87.55 92.70 97.85 103.00 108.15 113.30 118.45 123.60 128.75 45 - 49 88.13 94.00 99.88 105.75 111.63 117.50 123.38 129.25 135.13 141.00 146.88 50 - 54 104.93 111.92 118.92 125.91 132.91 139.90 146.90 153.89 160.89 167.88 174.88 55 - 59 123.75 132.00 140.25 148.50 156.75 165.00 173.25 181.50 189.75 198.00 206.2560 - 64 145.50 155.20 164.90 174.60 184.30 194.00 203.70 213.40 223.10 232.80 242.50 65 - 69 192.08 204.88 217.69 230.49 243.30 256.10 268.91 281.71 294.52 307.32 320.13 70 - 74 260.40 277.76 295.12 312.48 329.84 347.20 364.56 381.92 399.28 416.64 434.0075+ 324.75 346.40 368.05 389.70 411.35 433.00 454.65 476.30 497.95 519.60 541.25





PlAn 6 15-15-26





AgeCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 12.68 16.90 21.13 25.35 29.58 33.80 38.03 42.25 46.48 50.70 54.93 59.1530 - 34 13.26 17.68 22.10 26.52 30.94 35.36 39.78 44.20 48.62 53.04 57.46 61.88 35 - 39 13.26 17.68 22.10 26.52 30.94 35.36 39.78 44.20 48.62 53.04 57.46 61.8840 - 44 13.26 17.68 22.10 26.52 30.94 35.36 39.78 44.20 48.62 53.04 57.46 61.88 45 - 49 15.24 20.32 25.40 30.48 35.56 40.64 45.72 50.80 55.88 60.96 66.04 71.12 50 - 54 18.21 24.28 30.35 36.42 42.49 48.56 54.63 60.70 66.77 72.84 78.91 84.98 55 - 59 21.59 28.78 35.98 43.17 50.37 57.56 64.76 71.95 79.15 86.34 93.54 100.7360 - 64 25.14 33.52 41.90 50.28 58.66 67.04 75.42 83.80 92.18 100.56 108.94 117.32 65 - 69 33.27 44.36 55.45 66.54 77.63 88.72 99.81 110.90 121.99 133.08 144.17 155.26 70 - 74 45.15 60.20 75.25 90.30 105.35 120.40 135.45 150.50 165.55 180.60 195.65 210.7075+ 56.24 74.98 93.73 112.47 131.22 149.96 168.71 187.45 206.20 224.94 243.69 262.43

AgeCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 63.38 67.60 71.83 76.05 80.28 84.50 88.73 92.95 97.18 101.40 105.6330 - 34 66.30 70.72 75.14 79.56 83.98 88.40 92.82 97.24 101.66 106.08 110.50 35 - 39 66.30 70.72 75.14 79.56 83.98 88.40 92.82 97.24 101.66 106.08 110.5040 - 44 66.30 70.72 75.14 79.56 83.98 88.40 92.82 97.24 101.66 106.08 110.50 45 - 49 76.20 81.28 86.36 91.44 96.52 101.60 106.68 111.76 116.84 121.92 127.00 50 - 54 91.05 97.12 103.19 109.26 115.33 121.40 127.47 133.54 139.61 145.68 151.75 55 - 59 107.93 115.12 122.32 129.51 136.71 143.90 151.10 158.29 165.49 172.68 179.8860 - 64 125.70 134.08 142.46 150.84 159.22 167.60 175.98 184.36 192.74 201.12 209.50 65 - 69 166.35 177.44 188.53 199.62 210.71 221.80 232.89 243.98 255.07 266.16 277.25 70 - 74 225.75 240.80 255.85 270.90 285.95 301.00 316.05 331.10 346.15 361.20 376.2575+ 281.18 299.92 318.67 337.41 356.16 374.90 393.65 412.39 431.14 449.88 468.63





PlAn 7 15-15-52





AgeCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 14.25 19.00 23.75 28.50 33.25 38.00 42.75 47.50 52.25 57.00 61.75 66.5030 - 34 14.85 19.80 24.75 29.70 34.65 39.60 44.55 49.50 54.45 59.40 64.35 69.30 35 - 39 14.85 19.80 24.75 29.70 34.65 39.60 44.55 49.50 54.45 59.40 64.35 69.3040 - 44 14.85 19.80 24.75 29.70 34.65 39.60 44.55 49.50 54.45 59.40 64.35 69.30 45 - 49 17.03 22.70 28.38 34.05 39.73 45.40 51.08 56.75 62.43 68.10 73.78 79.45 50 - 54 20.40 27.20 34.00 40.80 47.60 54.40 61.20 68.00 74.80 81.60 88.40 95.20 55 - 59 24.15 32.20 40.25 48.30 56.35 64.40 72.45 80.50 88.55 96.60 104.65 112.7060 - 64 28.32 37.76 47.20 56.64 66.08 75.52 84.96 94.40 103.84 113.28 122.72 132.16 65 - 69 37.23 49.64 62.05 74.46 86.87 99.28 111.69 124.10 136.51 148.92 161.33 173.74 70 - 74 50.49 67.32 84.15 100.98 117.81 134.64 151.47 168.30 185.13 201.96 218.79 235.6275+ 63.17 84.22 105.28 126.33 147.39 168.44 189.50 210.55 231.61 252.66 273.72 294.77

AgeCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 71.25 76.00 80.75 85.50 90.25 95.00 99.75 104.50 109.25 114.00 118.7530 - 34 74.25 79.20 84.15 89.10 94.05 99.00 103.95 108.90 113.85 118.80 123.75 35 - 39 74.25 79.20 84.15 89.10 94.05 99.00 103.95 108.90 113.85 118.80 123.7540 - 44 74.25 79.20 84.15 89.10 94.05 99.00 103.95 108.90 113.85 118.80 123.75 45 - 49 85.13 90.80 96.48 102.15 107.83 113.50 119.18 124.85 130.53 136.20 141.88 50 - 54 102.00 108.80 115.60 122.40 129.20 136.00 142.80 149.60 156.40 163.20 170.00 55 - 59 120.75 128.80 136.85 144.90 152.95 161.00 169.05 177.10 185.15 193.20 201.2560 - 64 141.60 151.04 160.48 169.92 179.36 188.80 198.24 207.68 217.12 226.56 236.00 65 - 69 186.15 198.56 210.97 223.38 235.79 248.20 260.61 273.02 285.43 297.84 310.25 70 - 74 252.45 269.28 286.11 302.94 319.77 336.60 353.43 370.26 387.09 403.92 420.7575+ 315.83 336.88 357.94 378.99 400.05 421.10 442.16 463.21 484.27 505.32 526.38







PlAn 8 30-30-52





AgeCategory

$150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

< - 30 10.50 14.00 17.50 21.00 24.50 28.00 31.50 35.00 38.50 42.00 45.50 49.0030 - 34 10.89 14.52 18.15 21.78 25.41 29.04 32.67 36.30 39.93 43.56 47.19 50.82 35 - 39 10.89 14.52 18.15 21.78 25.41 29.04 32.67 36.30 39.93 43.56 47.19 50.8240 - 44 10.89 14.52 18.15 21.78 25.41 29.04 32.67 36.30 39.93 43.56 47.19 50.82 45 - 49 12.48 16.64 20.80 24.96 29.12 33.28 37.44 41.60 45.76 49.92 54.08 58.24 50 - 54 15.05 20.06 25.08 30.09 35.11 40.12 45.14 50.15 55.17 60.18 65.20 70.21 55 - 59 17.63 23.50 29.38 35.25 41.13 47.00 52.88 58.75 64.63 70.50 76.38 82.2560 - 64 20.79 27.72 34.65 41.58 48.51 55.44 62.37 69.30 76.23 83.16 90.09 97.02 65 - 69 27.33 36.44 45.55 54.66 63.77 72.88 81.99 91.10 100.21 109.32 118.43 127.54 70 - 74 37.02 49.36 61.70 74.04 86.38 98.72 111.06 123.40 135.74 148.08 160.42 172.7675+ 46.34 61.78 77.23 92.67 108.12 123.56 139.01 154.45 169.90 185.34 200.79 216.23

AgeCategory

$750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250

< - 30 52.50 56.00 59.50 63.00 66.50 70.00 73.50 77.00 80.50 84.00 87.5030 - 34 54.45 58.08 61.71 65.34 68.97 72.60 76.23 79.86 83.49 87.12 90.75 35 - 39 54.45 58.08 61.71 65.34 68.97 72.60 76.23 79.86 83.49 87.12 90.7540 - 44 54.45 58.08 61.71 65.34 68.97 72.60 76.23 79.86 83.49 87.12 90.75 45 - 49 62.40 66.56 70.72 74.88 79.04 83.20 87.36 91.52 95.68 99.84 104.00 50 - 54 75.23 80.24 85.26 90.27 95.29 100.30 105.32 110.33 115.35 120.36 125.38 55 - 59 88.13 94.00 99.88 105.75 111.63 117.50 123.38 129.25 135.13 141.00 146.8860 - 64 103.95 110.88 117.81 124.74 131.67 138.60 145.53 152.46 159.39 166.32 173.25 65 - 69 136.65 145.76 154.87 163.98 173.09 182.20 191.31 200.42 209.53 218.64 227.75 70 - 74 185.10 197.44 209.78 222.12 234.46 246.80 259.14 271.48 283.82 296.16 308.5075+ 231.68 247.12 262.57 278.01 293.46 308.90 324.35 339.79 355.24 370.68 386.13



affordable options!Companion Life’s Buy-Up Plan is an economical, simple solution that provides both employers and

employees an array of options. By combining a core level of income protection with the opportunity

to purchase additional coverage, both employers and employees benefit.

As an employer, you may offer $100/week in coverage, which allows employees to select weekly benefit payments from $50 to $1,150, not to exceed 66O% of basic weekly earnings. Please see our Voluntary Short Term Disability brochure for specific plan designs and benefit levels.

Maternity, alcoholism and drug addiction, and mental or nervous conditions are covered the same as any other illness. Disabilities which begin in the first 12 months after the effective date which are the result of a pre-existing condition are not covered. A pre-existing condition is defined as a condition with treatment (or symptoms for which an ordinarily prudent person would seek treatment) within 12 months prior to the effective date. The exclusion may vary in certain states as required.

Included at no additional cost is $10,000 of Accidental Death and Dismemberment coverage.

We look forward to assisting you in offering these affordable, comprehensive benefit options to your employees.

ContaCt Group MarketinG or Your aGent todaY for a proMpt, professional proposal!

Buy-Up Plan voluntarY short terM disabilitY

Companion Life Series (VSTD 808/809)

P.O. Box 100102 n Columbia, SC 29202-3102

800-753-0404 phone n 800-836-5433 fax

[email protected] n CompanionLife.com

®

flexibilitY for You and Your eMploYees!Help your employees protect one of their most valuable assets... their paycheck! Companion Life is

pleased to offer an innovative solution to employers — our Voluntary Short Term Disability Buy-Up Plan.

This versatile plan allows you to offer $100/per week in short term disability insurance while giving employees the option to purchase supplemental coverage. The additional benefit purchased by employees, added to the $100/per week benefit purchased by you, will allow employees to protect up to 66O% of their salary for a disability which occurs off the job. A minimum of five employees must enroll in the Buy-Up portion of the program.

Our Voluntary Short Term Disability Buy-Up Plan assists employers in providing their staff the peace of mind that a protected paycheck brings. After all, statistics show that the majority of American families would be bankrupt if they missed more than three consecutive paychecks. And 48% of all home foreclosures are the direct result of a disability.1

enhanCe Your voluntarY short terM disabilitY insuranCe todaY With our Buy-Up Plan you may choose from any one of the eight plan designs available under Companion Life’s Voluntary Short Term Disability product line. Employees can then select additional coverage from the same employer sponsored plan in order to “buy up.”

This adaptable program offers the following benefits:

eMploYer

n

Provides basic financial protection to disabled employees, increasing employee peace of mind, satisfaction and morale. No contribution requirement on the Buy-Up feature.

n

Offers a broad array of waiting periods and benefit durations.n

Proposal provided by Companion Life using an employee census.

eMploYee

n

Provides $100/per week in income. Taxes are not applicable to additional disability insurance coverage purchased by employees.

n

Offers the flexibility to purchase additional coverage to meet individual needs.n

Convenient, no-hassle payroll deduction.

Buy-Up Plan voluntarY short terM disabilitY

1 Housing and Home Finance Agency of the U.S. Government.

Rev. 3/1295963®

short term disability - companion life

Documents