Date of Birth
Date of Hire
Annual Salary
Based on last year's W2 earning which includes commission and bonuses If earnings change prior to this year, calculated benefits and premiums are also subject to change
x
Age as of Enrollment Period
LTD
LTD Bi-Weekly Premium
$
VSTD
If You are disabled and unable to generate current earnings greater than 20% of your weekly earnings, STD will provide the following weekly benefit less other income benefits.
STD Weekly Benefit
$
STD Bi-Weekly Premium
$
Life
Increments of $10,000 up to $500,000 and cannot be more than 5X of employee salary. For first-time eligible employees, up to $150k is guaranteed without health questions.
Voluntary Life Election
Election
Bi-Weekly Premium
Voluntary Life
$
$
AD&D
$
$
Total
$
Voluntary Life (Spouse)
Increments of $5,000 up to $150,000 and cannot be more than 50% of employee election. For first-time eligible employees, up to $50k is guaranteed without health questions.
Spouse Life Election
Election
Bi-Weekly Premium
Voluntary Life
$
$
AD&D
$
$
Total
$
Voluntary Life (Children)
Children Life Election (per Child)
$
Please select...
10,000
Election
Bi-Weekly Premium
Voluntary Life
$
$
AD&D
$
$
Total
$
NYS Paid Family Leave (PFL)
This benefit is based on the last 8 weeks of gross pay. If this number has changed from above annual salary or you want additional information, go to
https://paidfamilyleave.ny.gov/PFLbenefitscalculator
PFL Weekly Wage Benefit
$
Contact Information