Exclusions Example of standard Exclusion language: Note: Applies to ASO Only Intentionally self-inflicted illness or injury; the commission or attempted RSL has standard exclusions that differ from commission of a felony or engagement in an illegal ASO and cannot be occupation; an act of war; changed. not under the regular and continuous care of a physician; incarceration in any federal, state or municipal penal institution, jail, medical facility, hospital or in any other place because of a criminal conviction; employment of an employer other than the Policyholder, loss of a professional or occupation license or certification; an occupational injury or sickness and elective surgery Weekly Benefit Percentage Enter the benefit amount, for example: 60% of pay Maximum Weekly Benefit Enter the maximum benefit amount. Minimum Weekly Benefit the minimum benefit amount. Late Entrant Sample = N/A or EOI only if Voluntary STD. Plan Options are (Yes/No) Offsets Example of standard Offsets: Workers’ Note: Fully Insured STD compensation for lost time, standard offsets are Individual disability, Social Security, Disability Income (IDI), Formal federal or state Salary Continuance, Wages disability benefits, No fault auto insurance. Is offset on $ for $ or greater than 100%? Redirects Only available on Writing policies. Define the redirects (premium for Medical, Dental, etc.) available to be deducted from the benefits. Claims to set up the customer as the recipient of the redirects. Rate Per $10 of Weekly Employer paid rate Covered Benefit Note: On Fully Insured Voluntary STD there is no composite Rate.
Exclusions Note: Applies to ASO Only RSL has standard exclusions that differ from ASO and cannot be changed. Example of standard Exclusion language: Intentionally self-inflicted illness or injury; the commission or attempted commission of a felony or engagement in an illegal occupation; an act of war; not under the regular and continuous care of a physician; incarceration in any federal, state or municipal penal institution, jail, medical facility, hospital or in any other place because of a criminal conviction; employment of an employer other than the Policyholder, loss of a professional or occupation license or certification; an occupational injury or sickness and elective surgery Weekly Benefit Percentage Enter the benefit amount, for example: 60% of pay Maximum Weekly Benefit Enter the maximum benefit amount. Minimum Weekly Benefit the minimum benefit amount. Late Entrant Sample = N/A or EOI only if Voluntary STD. Plan Options are (Yes/No) Offsets Note: Fully Insured STD standard offsets are Individual Disability Income (IDI), Formal Salary Continuance, Wages Example of standard Offsets: Workers’ compensation for lost time, disability, Social Security, federal or state disability benefits, No fault auto insurance. Is offset on $ for $ or greater than 100%? Redirects Only available on Writing policies. Define the redirects (premium for Medical, Dental, etc.) available to be deducted from the benefits. Claims to set up the customer as the recipient of the redirects. Rate Per $10 of Weekly Covered Benefit Note: On Fully Insured Voluntary STD there is no composite Rate. Employer paid rate
COP%20-%20STD%20FINAL%20082017.docx