Voluntary Long Term Disability Insurance Standard Insurance Company has developed this document to provide you with information about the optional insurance coverage you may select. Written in non-technical language, this is not intended as a complete description of the coverage. If you have additional questions, please refer to the Your Choice Group Voluntary Long Term Disability Insurance brochure included in your packet or check with your Standard Insurance Company Onsite Representative. Plan Effective Date A minimum number of eligible employees must apply and qualify for the proposed plan before Voluntary LTD coverage can become effective. This level of participation has been agreed upon by your employer and The Standard. Eligibility To become insured, you must be: A regular, full-time employee of, excluding temporary or seasonal employees, full-time members of the armed forces, leased employees or independent contractors Actively at work at least 20 hours each week A citizen or resident of the United States or Canada Employee Coverage Effective Date Please contact your Standard Insurance Company Onsite Representative for more information regarding the following requirements that must be satisfied for your insurance to become effective. You must satisfy: Eligibility requirements An eligibility waiting period An evidence of insurability requirement, if applicable An active work requirement. This means that if you are not actively at work on the day before the scheduled effective date of insurance, your insurance will not become effective until the day after you complete 1 day of active work as an eligible employee. Benefit Amount You may select a monthly benefit amount in increments of $100, from $200 to $10, 000, based on the tables and guidelines presented in the Rates section of these Coverage Highlights. The monthly benefit amount must not exceed 60 percent of your monthly earnings. Plan Maximum Benefit: 60 percent of predisability earnings Plan Minimum Benefit: $100 Benefit Waiting Period The benefit waiting period is the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period. The benefit waiting period option associated with your plan include: Accidental Injury Other Disabilities 180 days 180 days SI 14493-649116 1 of 6 (10/12)
Preexisting Condition Exclusion A general description of the preexisting condition exclusion is included in the Your Choice Group Voluntary Long Term Disability Insurance brochure. If you have questions, please check with your Standard Insurance Company Onsite Representative. Preexisting Condition Period: The 180-day period just before your insurance becomes effective Exclusion Period: 12 months Own Occupation Period For the plan s definition of disability, as described in your brochure, the own occupation period is the first 24 months for which LTD benefits are paid. Any Occupation Period The any occupation period begins at the end of the own occupation period and continues until the end of the maximum benefit period. Maximum Benefit Period The maximum benefit period is the period for which benefits are payable. The maximum benefit period associated with your plan options are shown below: If you become disabled before age 65, LTD benefits may continue during disability for 2 years. If you become disabled at age 65 or older, the benefit duration is determined by your age when disability begins: Age Maximum Benefit Period 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months 69+ 1 year If you become disabled before age 62, LTD benefits may continue during disability for 5 years. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins: Age Maximum Benefit Period 62 3 years 6 months 63 3 years 64 2 years 6 months 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months 69+ 1 year] If you become disabled before age 62, LTD benefits may continue during disability until you reach the Social Security Normal Retirement Age (SSNRA). If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins: Age Maximum Benefit Period 62 To SSNRA or 3 years 6 months, whichever is longer 63 To SSNRA or 3 years, whichever is longer 64 To SSNRA or 2 years 6 months, whichever is longer 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months 69+ 1 year SI 14493-649116 2 of 6 (10/12)
When Benefits End LTD benefits end automatically on the earliest of: The date you are no longer disabled The date your maximum benefit period ends The date you die The date benefits become payable under any other LTD plan under which you become insured through employment during a period of temporary recovery The date you fail to provide proof of continued disability and entitlement to benefits Rates Employees can select a monthly LTD benefit ranging from a minimum of $200 to a maximum amount based on how much they earn. Referencing the appropriate attached charts, follow these steps to find the monthly cost for your desired level of monthly LTD benefit and benefit waiting period: 1. Find the maximum LTD benefit by locating the amount of your earnings in either the Annual or column. The LTD benefit amount shown associated with these earnings is the maximum amount you can receive. If your earnings fall between two amounts, you must select the lower amount. 2. Select the desired monthly LTD benefit between the minimum of $200 and the determined maximum amount, making sure not to exceed the maximum for your earnings. 3. In the same row, select the desired benefit waiting period to see the monthly cost for that selection. If you have questions regarding how to determine your monthly LTD benefit, the benefit waiting period, or the premium payment of your desired benefit, please contact your Standard Insurance Company Onsite Representative. Group Insurance Certificate If you become insured, you will receive a group insurance certificate containing a detailed description of the insurance coverage. The information presented above is controlled by the group policy and does not modify it in any way. The controlling provisions are in the group policy issued by Standard Insurance Company. SI 14493-649116 3 of 6 (10/12)
Maximum Benefit to SSNRA both Accident and Sickness Annual Disability Benefit Cost per Month 2 Year 5 Year SSNRA 4,000 333 200 2.12 2.96 4.12 6,000 500 300 3.18 4.44 6.18 8,000 667 400 4.24 5.92 8.24 10,000 833 500 5.30 7.40 10.30 12,000 1000 600 6.36 8.88 12.36 14,000 1167 700 7.42 10.36 14.42 16,000 1333 800 8.48 11.84 16.48 18,000 1500 900 9.54 13.32 18.54 20,000 1667 1,000 10.60 14.80 20.60 22,000 1833 1,100 11.66 16.28 22.66 24,000 2000 1,200 12.72 17.76 24.72 26,000 2167 1,300 13.78 19.24 26.78 28,000 2333 1,400 14.84 20.72 28.84 30,000 2500 1,500 15.90 22.20 30.90 32,000 2667 1,600 16.96 23.68 32.96 34,000 2833 1,700 18.02 25.16 35.02 36,000 3000 1,800 19.08 26.64 37.08 38,000 3167 1,900 20.14 28.12 39.14 40,000 3333 2,000 21.20 29.60 41.20 42,000 3500 2,100 22.26 31.08 43.26 44,000 3667 2,200 23.32 32.56 45.32 46,000 3833 2,300 24.38 34.04 47.38 48,000 4000 2,400 25.44 35.52 49.44 50,000 4167 2,500 26.50 37.00 51.50 52,000 4333 2,600 27.56 38.48 53.56 54,000 4500 2,700 28.62 39.96 55.62 56,000 4667 2,800 29.68 41.44 57.68 58,000 4833 2,900 30.74 42.92 59.74 60,000 5000 3,000 31.80 44.40 61.80 62,000 5167 3,100 32.86 45.88 63.86 64,000 5333 3,200 33.92 47.36 65.92 66,000 5500 3,300 34.98 48.84 67.98 68,000 5667 3,400 36.04 50.32 70.04 70,000 5833 3,500 37.10 51.80 72.10 72,000 6000 3,600 38.16 53.28 74.16 74,000 6167 3,700 39.22 54.76 76.22 76,000 6333 3,800 40.28 56.24 78.28 78,000 6500 3,900 41.34 57.72 80.34 80,000 6667 4,000 42.40 59.20 82.40 82,000 6833 4,100 43.46 60.68 84.46 84,000 7000 4,200 44.52 62.16 86.52 86,000 7167 4,300 45.58 63.64 88.58 SI 14493-649116 4 of 6 (10/12)
Maximum Benefit to SSNRA both Accident and Sickness Annual Disability Benefit Cost per Month 2 Year 5 Year SSNRA 88,000 7333 4,400 46.64 65.12 90.64 90,000 7500 4,500 47.70 66.60 92.70 92,000 7667 4,600 48.76 68.08 94.76 94,000 7833 4,700 49.82 69.56 96.82 96,000 8000 4,800 50.88 71.04 98.88 98,000 8167 4,900 51.94 72.52 100.94 100,000 8333 5,000 53.00 74.00 103.00 102,000 8500 5,100 54.06 75.48 105.06 104,000 8667 5,200 55.12 76.96 107.12 106,000 8833 5,300 56.18 78.44 109.18 108,000 9000 5,400 57.24 79.92 111.24 110,000 9167 5,500 58.30 81.40 113.30 112,000 9333 5,600 59.36 82.88 115.36 114,000 9500 5,700 60.42 84.36 117.42 116,000 9667 5,800 61.48 85.84 119.48 118,000 9833 5,900 62.54 87.32 121.54 120,000 10000 6,000 63.60 88.80 123.60 122,000 10167 6,100 64.66 90.28 125.66 124,000 10333 6,200 65.72 91.76 127.72 126,000 10500 6,300 66.78 93.24 129.78 128,000 10667 6,400 67.84 94.72 131.84 130,000 10833 6,500 68.90 96.20 133.90 132,000 11000 6,600 69.96 97.68 135.96 134,000 11167 6,700 71.02 99.16 138.02 136,000 11333 6,800 72.08 100.64 140.08 138,000 11500 6,900 73.14 102.12 142.14 140,000 11667 7,000 74.20 103.60 144.20 142,000 11833 7,100 75.26 105.08 146.26 144,000 12000 7,200 76.32 106.56 148.32 146,000 12167 7,300 77.38 108.04 150.38 148,000 12333 7,400 78.44 109.52 152.44 150,000 12500 7,500 79.50 111.00 154.50 152,000 12667 7,600 80.56 112.48 156.56 154,000 12833 7,700 81.62 113.96 158.62 156,000 13000 7,800 82.68 115.44 160.68 158,000 13167 7,900 83.74 116.92 162.74 160,000 13333 8,000 84.80 118.40 164.80 162,000 13500 8,100 85.86 119.88 166.86 164,000 13667 8,200 86.92 121.36 168.92 166,000 13833 8,300 87.98 122.84 170.98 168,000 14000 8,400 89.04 124.32 173.04 170,000 14167 8,500 90.10 125.80 175.10 SI 14493-649116 5 of 6 (10/12)
Maximum Benefit to SSNRA both Accident and Sickness Annual Disability Benefit Cost per Month 2 Year 5 Year SSNRA 172,000 14333 8,600 91.16 127.28 177.16 174,000 14500 8,700 92.22 128.76 179.22 176,000 14667 8,800 93.28 130.24 181.28 178,000 14833 8,900 94.34 131.72 183.34 180,000 15000 9,000 95.40 133.20 185.40 182,000 15167 9,100 96.46 134.68 187.46 184,000 15333 9,200 97.52 136.16 189.52 186,000 15500 9,300 98.58 137.64 191.58 188,000 15666 9,400 99.64 139.12 193.64 190,000 15833 9,500 100.70 140.60 195.70 192,000 16000 9,600 101.76 142.08 197.76 194,000 16166 9,700 102.82 143.56 199.82 196,000 16333 9,800 103.88 145.04 201.88 198,000 16500 9,900 104.94 146.52 203.94 200,000 16666 10,000 106.00 148.00 206.00 SI 14493-649116 6 of 6 (10/12)