Premium Policy Free! Recurrent Disability Enrollment Form Waiting Period Partial Disability Attending Physician’s Statement Evidence of Insurability Basic Compensation Elimination Period Grace Period Census Late Applicant Maximum Benefit Period Pending Claim Class Eligibility Open- Enrollment Period Proof of Loss Exclusion Eligibility Date Benefit Period Eligibility Period Non- Contributory Pre- Existing Condition Maximum Benefit Waiver of Premium Minimum Benefit Date of Disability Offset Amendment Prior Plan Contributory Effective Date Benefit Percentage Total Disability List Billed Short Term Disability (STD Self- Billed Premium Policy Free! Recurrent Disability Enrollment Form Waiting Period Partial Disability Attending Physician’s Statement Evidence of Insurability Basic Compensation Elimination Period Grace Period Census Late Applicant Maximum Benefit Period Pending Claim Class Eligibility Open- Enrollment Period Proof of Loss Exclusion Eligibility Date Benefit Period Eligibility Period Non- Contributory Pre- Existing Condition Maximum Benefit Waiver of Premium Minimum Benefit Date of Disability Offset Amendment Prior Plan Contributory Effective Date Benefit Percentage Total Disability List Billed Short Term Disability (STD Self- Billed
(Print)
Premium
Policy
Free!
Recurrent Disability
Enrollment Form
Waiting Period
Partial Disability
Attending Physician’s Statement
Evidence of Insurability
Basic Compensation
Elimination Period
Grace Period
Census
Late Applicant
Maximum Benefit Period
Pending Claim
Class
Eligibility
Open-Enrollment Period
Proof of Loss
Exclusion
Eligibility Date
Benefit Period
Eligibility Period
Non-Contributory
Pre-Existing Condition
Maximum Benefit
Waiver of Premium
Minimum Benefit
Date of Disability
Offset
Amendment
Prior Plan
Contributory
Effective Date
Benefit Percentage
Total Disability
List Billed
Short Term Disability (STD
Self-Billed
