|Monthly Cost||$24.50 per month|
|100% of wages for Catastrophic Disabilities for up to 30 months – not to exceed maximum monthly benefit
80% of wages Non-Industrial Disability
70% of wages Industrial Disability (75% with deductible income)
(No reductions for Workers’ Compensation permanent disability settlements)
|Maximum Benefit||$10,000 per month, tax-free|
|Waiting Period||30 calendar days – Earlier reduced benefits may be payable based on lack of personal leave down to zero days. $750 per month Minimum Benefit after 60 days ($500 per month if Industrial caused), freeze of personal leave after 60 days. No benefits are payable if working full-time, light or modified duty.|
|Benefit Period||Lifetime Coverage of Sickness, Accident, & Pregnancy|
|Sick Leave Integration Benefit||After 60 days, you may use 50% sick leave and receive a 50% benefit from Plan or use 100% sick leave and receive $750 per month ($500 per month if Industrial caused).|
|Cost of Living Benefit (COLA)||4% compounded per year (years 2-7) thereafter, CPI increase to age 65 and then benefits continued lifetime.|
|Musculoskeletal & Connective Tissue Disorders||Covered, no restrictions lifetime Industrial and Non-Industrial causes.|
|Benefits Payable During Challenged Workers’ Compensation Cases||After 60 calendar days – 70% of wages or Maximum Benefit of $10,000 per month (repayable if settled in your favor).|
|Waiver of Payment||Waiver of Payment after no-pay status.|
|Minimum Monthly Benefit||$750 per month – paid in addition to personal leave after 60 calendar days ($500 per month if Industrial caused).|
|Pre-Existing Medical Condition Coverage||If you enroll during your initial enrollment period, all pre-existing medical conditions will be covered once you have been in the Plan for twenty-four (24) / forty-eight (48)*** months, unless you are eligible for the Prior Coverage Credit – otherwise, pre-existing medical conditions will not be covered.|
|Survivorship Benefit||Nine (9) months additional benefits to dependent beneficiary.|
|Death Benefit||$15,000 Death Benefit** on- or off-duty – natural, accidental or terminal illness (Payable and delivered usually within 24 hours of notification).|
* Maximum percentages reflect amount payable after completion of (a) waiting period, (b) freeze of sick leave option, or (c) sick leave integration. Offsetting Benefit/Income Amounts are applied to reduce amount from the Plan
** The Death Benefit for suicide is limited to $2,000 for the first 24 months of participation in the Plan.
*** Forty-eight months for Death Benefits and for HIV, AIDS, and ARC.
For illustration only. See the Summary Plan Description or the Plan Document provisions for a more complete description of coverage. CA Insurance Lic. #0544968.