Short Term Disability Insurance

Short Term Disability Insurance is an employee paid optional benefit for full time permanent staff.

1-800-627-3660

Short Term Disability Certificate of Insurance

Short Term Disability Enrollment Form

Eligible staff may enroll at anytime by completing the enrollment form and the evidence of insurability form below. If enrolling at the time of hire or initial eligibility AND enrolling in a weekly benefit of $301 or less you only need to complete the enrollment form. If enrolling in over $301 or anytime after the initial eligibility period please complete both the enrollment form and the evidence of insurability process below.

Evidence of Insurability

If you are electing a coverage higher than $301 or enrolling after your initial eligibility please complete the online evidence of insurability and the enrollment form.

Short Term Disability Claim Form

If you are enrolled in coverage and miss three days of work due to an illness or any work due to an injury please contact Human Resources to notify them of the need to file a claim, then complete the claim form Section II and Section III and send Section III and IV to your physician.

Why is Short Term Disability Important?

Please Note: Employees must complete all enrollment forms within 30 days of their effective date of employment or within 30 days from a qualifying event. For benefit questions please contact human resources at 715-738-2660 extension 1902