LTD Change and Enrollment Form

The monthly premium of the LTD insurance selected will vary based on age, salary, and the coverage option selected. The premiums will automatically be deducted from payroll. Employees can estimate how much the monthly premium will be by using the table below.

HOW TO CALCULATE MONTHLY PREMIUMS:
       1. Choose the option you want.
       2. Locate your age.
       3. Find the corresponding rate in the column of the option you selected.

Option A: 180-day Benefit Waiting Period
Option B: 90-day Benefit Waiting Period
Option C: 180-day Benefit Waiting Period with the Annuity Contribution Benefit (retirement protection)
Option D: 90-day Benefit Waiting Period with the Annuity Contribution Benefit (retirement protection)