Medical Life Insurance Company

Voluntary Short Term Disability

Eligibility

You are eligible to enroll if you work the minimum number of hours

per week required by your employer, and you have satisfied any waiting period.

Benefit Schedule

15th Day Accident 15th Day Sickness 13 Week Maximum Duration

You select a weekly benefit amount ranging from $100 to $750

per week in $50 increments not to exceed 70% of basic weekly income*.

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Monthly Premium Cost

(based on 12 payroll deductions per year)

If your
Annual salary / You may
Select a weekly / Your Attained Age
is at least: / Benefit of: / Under 40 / 40 - 49 / 50 – 59 / 60+
$ 7,430 / $100 / 9.30 / 8.40 / 11.20 / 15.90
$11,143 / $150 / 13.95 / 12.60 / 16.80 / 23.85
$14,860 / $200 / 18.60 / 16.80 / 22.40 / 31.80
$18,572 / $250 / 23.25 / 21.00 / 28.00 / 39.75
$22,286 / $300 / 27.90 / 25.20 / 33.60 / 47.70
$26,000 / $350 / 32.55 / 29.40 / 39.20 / 55.65
$29,715 / $400 / 37.20 / 33.60 / 44.80 / 63.60
$33,430 / $450 / 41.85 / 37.80 / 50.40 / 71.55
$37,143 / $500 / 46.50 / 42.00 / 56.00 / 79.50
$40,860 / $550 / 51.15 / 46.20 / 61.60 / 87.45
$44,572 / $600 / 55.80 / 50.40 / 67.20 / 95.40
$48,286 / $650 / 60.45 / 54.60 / 72.80 / 103.35
$52,000 / $700 / 65.10 / 58.80 / 78.40 / 111.30
$55,715 / $750 / 69.75 / 63.00 / 84.00 / 119.25

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*Basic weekly income means the weekly compensation you earn from your normal occupation with your employer. It does not include earnings from overtime, bonuses, or any other form of pay. However, if your compensation is based in whole or in part on commissions, basic weekly income will include the weekly average paid in commissions during the preceding 12-month period.

This Premium Cost Chart is for illustrative purposes only; your monthly premium cost may be slightly higher or lower due to rounding.

The information provided is only a summary of the benefits available. Refer to a certificate for details and limitations of coverage. (Policy series ML2200)

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