April 4, 2012
Employee Name and Address
Dear______:
On behalf of the staff, we send our best wishes to you for a comfortable and quick recovery.
In order to claim short term disability benefits, the attached forms must be completed and forwarded to The Lincoln National Life Insurance Company at your earliest opportunity. Please complete the (1) Authorization for Release of Information, the (2) Group Short-Term Disability Statement of Employee andforward the(3) Attending Physician’s Statement of Short-Term Disability to your doctor. All forms must be faxed to The Lincoln National Life Insurance Company: 877-843-3950.
You are eligible to receive short term disability payments after a seven consecutive day waiting period and approval of the physician’s statement by Lincoln National Life Insurance Company. Since your last day was Monday, April 2, the seven day waiting period is fromTuesday, April 3 through Monday, April 9. Onceshort term disability is approved, payment willbeginTuesday, April 10. Short term disability benefits are paid seven days a week and are 66 2/3% of your current salaryup to twenty-six weeks. Lincoln Financial Group does not deduct for medical and dental premiums, 401(k) contributions,loan payments or AFLAC. It is the employee’s responsibility to pay the medical and dental premiums directly to NCHC. Your bi-weekly medical deduction is:$42.19 and Dental is $8.33. You may pay either bi-weekly or monthly.
The employer’s notification of disability was submitted to Lincoln Financial Group today,
April 4th. A short term disability benefits representative will call you soon.
If you plan to add your newborn to the medical plan, please complete the enclosed form and return it to my attention at your earliest opportunity, but no later than 30 days from date of birth.
Please feel free to contact me if you have any questions concerning the attached forms. My number is: 899-1770 ext. 8000
Sincerely,
Jane Graham
Executive Assistant/HR
cc: J. Centore/Payroll
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