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