This includes premium changes due to age for cases that are step-rated. Effective Date of Premium Choices: Changes due to change in Age -the date (i.e., EE moves into next age -first of the month coinciding band category with new rate) w/next following - Policy Ann Date - Specific Month/Date w/next following - Other define Earnings Definition See below for a description of the Earnings Definitions. For choices 6) or 7): What is (Please indicate the number included in the W2? and the details of the definition.) For choices 3), 4), or 7): What is the time period for averaging? 2 Choices: years, 3 years? Standard Standard & Hourly For choices 3) or 4): What is Standard & Average averaged and who does it apply Standard, Hourly & to? Average Not Applicable Prior Year W2 Average W2 Other Enter based on Earnings Earnings based on: Definition. Note: Earnings definition may or Choices: may not always match the - Scheduled Hours Minimum Hours Requirement on - Actual Hours Worked Page 1 regarding Scheduled or Actual. Earnings Determination "The Day" for the "Earnings (determination date must be the Determination". This means that the employee's benefit same as the EARNINGS CHANGE) will be determined by his/her wages on the day just before the date of the loss. Choices: the date first of the month following Policy Anniversary Date Specific MM/DD Other (provide details) Premium Grace Period Enter the Premium Grace Default: 60 Days Period: - 60 days (Default) EOI Approval Effective Date Required to match the Individual Effective Date on the plan. There are to be "No" variations.
Effective Date of Premium Changes due to change in Age (i.e., EE moves into next age band category with new rate) This includes premium changes due to age for cases that are step-rated. Choices: -the date -first of the month coinciding w/next following - Policy Ann Date - Specific Month/Date w/next following - Other define Earnings Definition For choices 6) or 7): What is included in the W2? For choices 3), 4), or 7): What is the time period for averaging? 2 years, 3 years? For choices 3) or 4): What is averaged and who does it apply to? See below for a description of the Earnings Definitions. (Please indicate the number and the details of the definition.) Choices: Standard Standard & Hourly Standard & Average Standard, Hourly & Average Not Applicable Prior Year W2 Average W2 Other Earnings based on: Note: Earnings definition may or may not always match the Minimum Hours Requirement on Page 1 regarding Scheduled or Actual. Enter based on Earnings Definition. Choices: - Scheduled Hours - Actual Hours Worked Earnings Determination (determination date must be the same as the EARNINGS CHANGE) "The Day" for the "Earnings Determination". This means that the employee's benefit will be determined by his/her wages on the day just before the date of the loss. Choices: the date first of the month following Policy Anniversary Date Specific MM/DD Other (provide details) Premium Grace Period Enter the Premium Grace Period: - 60 days (Default) Default: 60 Days EOI Approval Effective Date Required to match the Individual Effective Date on the plan. There are to be "No" variations.
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