Long Term Disability Insurance
Policy Number: GLT888163
Benefit: 60% of gross pay
Benefit Maximum: $7,500 per month
Elimination Period: 90 days
Cost: 100% employee paid
Available Forms:
LTD Enrollment Form
LTD Evidence of Insurability
LTD Claim Packet
LTD Benefit Highlights
LTD Rate Worksheet
Short Term Disability Insurance
Policy Number: 888163
Benefit: Income based scale
Elimination Period: 15 or 30 days
Cost: 100% employee paid
Available Forms:
STD Enrollment Form
STD Evidence of Insurability
STD Claim Packet
STD Benefit Highlights
STD Rate Worksheet
The Hartford Insurance Company
P.O. Box 14869
Lexington, KY 40512-4869
(800) 331-7234
www.thehartford.com