Short Term Disability Insurance Summary

Offered by Life Insurance Company of North America Short Term Disability Insurance Summary of Benefits Prepared for: Elkhart Community Schools class 1 Eligibility: All active Employees of the Employer classified as Administrator or Certified, regularly working a minimum of 20 hours per week in the United States, who are citizens or permanent resident aliens of the United States. Employee: You will be eligible for coverage the first of the month following the date of hire. Available Coverage: Maximum Benefit Gross Weekly Maximum Gross Benefit Waiting Period Disability Benefit Weekly Benefit Period (includes benefit waiting period) Employer Paid - Your 13 weeks for Employer provides 60% of your weekly 14 days for Accident Accident the following $1,000 covered earnings 14 days for Sickness 13 weeks for coverage at no cost Sickness to you. Employee Paid - 13 weeks for You have the option 60% of your weekly 30 days for Accident Accident to elect this plan to $1,000 covered earnings 30 days for Sickness 13 weeks for enhance what your Sickness Employer provides. Monthly Rate per $10 of Weekly Benefit = $0.440 Actual per pay period premiums may differ slightly due to rounding. Rates may be subject to change in the future. How to Calculate Your Monthly Cost: Step 1: Divide your annual salary by 52 to calculate your weekly earnings. Step 2: Multiply your weekly earnings by the benefit percentage defined above in the Available Coverage section. For example, 60% would be .60. Now, you have your Gross Weekly Benefit. Step 3: Use the chart above to find your Monthly rate. Multiply this rate by your Gross Weekly Benefit, or the Maximum Gross Weekly Benefit of $1,000, whichever is less. Step 4: Divide the total by 10. The result is your Monthly cost. Important Definitions and Policy Provisions: Disability -