Benefit Policy Schedule (continued) Several benefit options are available to you. You may participate in the Plan under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 66 2/3% of your Monthly Compensation. Plan II - Per Pay Period Monthly Salary Monthly Disability Benefit 26 Pay 24 Pay 22 Pay 21 Pay 20 Pay 19 Pay 18 Pay 17 Pay Monthly $300.00 - $449.99 $200.00 $1.78 $1.92 $2.10 $2.20 $2.31 $2.43 $2.56 $2.71 $3.84 $450.00 - $599.99 $300.00 $2.66 $2.88 $3.14 $3.29 $3.46 $3.64 $3.84 $4.07 $5.76 $600.00 - $749.99 $400.00 $3.54 $3.84 $4.19 $4.39 $4.61 $4.85 $5.12 $5.42 $7.68 $750.00 - $899.99 $500.00 $4.44 $4.80 $5.24 $5.49 $5.76 $6.07 $6.40 $6.78 $9.60 $900.00 - $1,049.99 $600.00 $5.32 $5.76 $6.29 $6.59 $6.91 $7.28 $7.68 $8.13 $11.52 $1,050.00 - $1,199.99 $700.00 $6.20 $6.72 $7.33 $7.68 $8.07 $8.49 $8.96 $9.49 $13.44 $1,200.00 - $1,349.99 $800.00 $7.10 $7.68 $8.38 $8.78 $9.22 $9.70 $10.24 $10.84 $15.36 $1,350.00 - $1,499.99 $900.00 $7.98 $8.64 $9.43 $9.88 $10.37 $10.92 $11.52 $12.20 $17.28 $1,500.00 - $1,649.99 $1,000.00 $8.86 $9.60 $10.48 $10.97 $11.52 $12.13 $12.80 $13.55 $19.20 $1,650.00 - $1,799.99 $1,100.00 $9.76 $10.56 $11.52 $12.07 $12.67 $13.34 $14.08 $14.91 $21.12 $1,800.00 - $1,949.99 $1,200.00 $10.64 $11.52 $12.57 $13.17 $13.83 $14.55 $15.36 $16.26 $23.04 $1,950.00 - $2,099.99 $1,300.00 $11.52 $12.48 $13.62 $14.27 $14.98 $15.77 $16.64 $17.62 $24.96 $2,100.00 - $2,249.99 $1,400.00 $12.42 $13.44 $14.66 $15.36 $16.13 $16.98 $17.92 $18.97 $26.88 $2,250.00 - $2,399.99 $1,500.00 $13.30 $14.40 $15.71 $16.46 $17.28 $18.19 $19.20 $20.33 $28.80 $2,400.00 - $2,549.99 $1,600.00 $14.18 $15.36 $16.76 $17.56 $18.43 $19.40 $20.48 $21.68 $30.72 $2,550.00 - $2,699.99 $1,700.00 $15.06 $16.32 $17.81 $18.65 $19.59 $20.62 $21.76 $23.04 $32.64 $2,700.00 - $2,849.99 $1,800.00 $15.96 $17.28 $18.85 $19.75 $20.74 $21.83 $23.04 $24.40 $34.56 $2,850.00 - $2,999.99 $1,900.00 $16.84 $18.24 $19.90 $20.85 $21.89 $23.04 $24.32 $25.75 $36.48 $3,000.00 - $3,149.99 $2,000.00 $17.72 $19.20 $20.95 $21.95 $23.04 $24.26 $25.60 $27.11 $38.40 $3,150.00 - $3,299.99 $2,100.00 $18.62 $20.16 $22.00 $23.04 $24.19 $25.47 $26.88 $28.46 $40.32 $3,300.00 - $3,449.99 $2,200.00 $19.50 $21.12 $23.04 $24.14 $25.35 $26.68 $28.16 $29.82 $42.24 $3,450.00 - $3,599.99 $2,300.00 $20.38 $22.08 $24.09 $25.24 $26.50 $27.89 $29.44 $31.17 $44.16 $3,600.00 - $3,749.99 $2,400.00 $21.28 $23.04 $25.14 $26.33 $27.65 $29.11 $30.72 $32.53 $46.08 $3,750.00 - $3,899.99 $2,500.00 $22.16 $24.00 $26.18 $27.43 $28.80 $30.32 $32.00 $33.88 $48.00 $3,900.00 - $4,049.99 $2,600.00 $23.04 $24.96 $27.23 $28.53 $29.95 $31.53 $33.28 $35.24 $49.92 $4,050.00 - $4,199.99 $2,700.00 $23.94 $25.92 $28.28 $29.63 $31.11 $32.74 $34.56 $36.59 $51.84 $4,200.00 - $4,349.99 $2,800.00 $24.82 $26.88 $29.33 $30.72 $32.26 $33.96 $35.84 $37.95 $53.76 $4,350.00 - $4,499.99 $2,900.00 $25.70 $27.84 $30.37 $31.82 $33.41 $35.17 $37.12 $39.30 $55.68 $4,500.00 - $4,649.99 $3,000.00 $26.58 $28.80 $31.42 $32.92 $34.56 $36.38 $38.40 $40.66 $57.60 $4,650.00 - $4,799.99 $3,100.00 $27.48 $29.76 $32.47 $34.01 $35.71 $37.59 $39.68 $42.01 $59.52 $4,800.00 - $4,949.99 $3,200.00 $28.36 $30.72 $33.51 $35.11 $36.87 $38.81 $40.96 $43.37 $61.44 $4,950.00 - $5,099.99 $3,300.00 $29.24 $31.68 $34.56 $36.21 $38.02 $40.02 $42.24 $44.72 $63.36 $5,100.00 - $5,249.99 $3,400.00 $30.14 $32.64 $35.61 $37.31 $39.17 $41.23 $43.52 $46.08 $65.28 $5,250.00 - $5,399.99 $3,500.00 $31.02 $33.60 $36.66 $38.40 $40.32 $42.44 $44.80 $47.44 $67.20 $5,400.00 - $5,549.99 $3,600.00 $31.90 $34.56 $37.70 $39.50 $41.47 $43.66 $46.08 $48.79 $69.12 $5,550.00 - $5,699.99 $3,700.00 $32.80 $35.52 $38.75 $40.60 $42.63 $44.87 $47.36 $50.15 $71.04 $5,700.00 - $5,849.99 $3,800.00 $33.68 $36.48 $39.80 $41.69 $43.78 $46.08 $48.64 $51.50 $72.96 $5,850.00 - $5,999.99 $3,900.00 $34.56 $37.44 $40.85 $42.79 $44.93 $47.30 $49.92 $52.86 $74.88 *Higher benefit amounts available, up to $7,500, based on your Monthly Salary.
Short Term Disability Indiana Page 4 Page 6