Earnings based on: Enter based on Earnings Definition. Note: Earnings definition may or Choices: may not always match the - Scheduled Minimum Hours Requirement on Page 1 regarding Scheduled or - Actual Hours Worked 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 will be determined by his/her CHANGE) wages on the day just before the date of the loss. Choices: the date 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 (if Required to match the applicable) Individual Effective Date on the plan. There are to be "No" variations. Waiver of Premium Provide all of the following: Elimination = 9 or 6 Months Eligibility= Disability Occurred Under Age 60 Waiver of Premium Duration = Age 65 or 70 Benefit Coverage Amount Times Salary or Flat Benefit? List by Class, if different Rounding Rule Are benefit amounts rounded? Choices: - up or down to nearest $100, $1000, etc.? Reminder: When figuring coverage amount and rates, multiply salary before or after rounding? RSL Standard: Multiply before rounding Maximum Benefit Maximum Benefit Amount. List by if different Minimum Benefit Minimum Benefit Amount, if applicable. List by Class, if different
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 - 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 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 (if applicable) Required to match the Individual Effective Date on the plan. There are to be "No" variations. Waiver of Premium Provide all of the following: Elimination = 9 or 6 Months Eligibility= Disability Occurred Under Age 60 Waiver of Premium Duration = Age 65 or 70 Benefit Coverage Amount Times Salary or Flat Benefit? List by Class, if different Rounding Rule Are benefit amounts rounded? Choices: - up or down to nearest $100, $1000, etc.? Reminder: When figuring coverage amount and rates, multiply salary before or after rounding? RSL Standard: Multiply before rounding Maximum Benefit Maximum Benefit Amount. List by if different Minimum Benefit Minimum Benefit Amount, if applicable. List by Class, if different
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