Thank you for your interest! Please provide a little information so we can help you. THIS IS FOR POSTAL EMPLOYEES ONLY. IF YOU DO NOT WORK FOR THE POST OFFICE YOU ARE NOT ELIGIBLE. Which coverage are you interested in?(Required) Short Term Disability Life Insurance Cancer/Stroke Heart Attack Please tell us your USPS income last year (you can include overtime if you get it consistently): $ Based on your income, you would qualify for up to $0.00 /month disability Benefit. Please review the rate and waiting period options below. The waiting period is how long you have to be out unable to work due to an injury or illness before you can START the claim process. This field is hidden when viewing the formUsps IncomeWho are you wanting to cover with the life insurance?(Required) Myself Spouse Children under 26 How much of coverage do you want?(Required)Employee Age:(Required)Select2526272829303132333435363738394041424344454647484950515253545556575859606162636465Do you or anyone you want to cover smoke or use tobacco??(Required) Yes No Spouse Age:(Required)Dependent Children Ages (Under 26):(Required)Waiting PeriodSelect14 Day Waiting Period30 Day Waiting PeriodMonthly Benefit (14-Day Wait)Select$1,500 Benefit/Month cost per pay period = $40.44$1,600 Benefit/Month cost per pay period = $43.00$1,700 Benefit/Month cost per pay period = $45.56$1,800 Benefit/Month cost per pay period = $48.12$1,900 Benefit/Month cost per pay period = $50.68$2,000 Benefit/Month cost per pay period = $53.24$2,100 Benefit/Month cost per pay period = $55.80$2,200 Benefit/Month cost per pay period = $58.36$2,300 Benefit/Month cost per pay period = $60.92$2,400 Benefit/Month cost per pay period = $63.48$2,500 Benefit/Month cost per pay period = $66.04$2,600 Benefit/Month cost per pay period = $68.60$2,700 Benefit/Month cost per pay period = $71.16$2,800 Benefit/Month cost per pay period = $73.74$2,900 Benefit/Month cost per pay period = $76.30$3,000 Benefit/Month cost per pay period = $78.86$3,100 Benefit/Month cost per pay period = $81.42$3,200 Benefit/Month cost per pay period = $83.98$3,300 Benefit/Month cost per pay period = $86.54$3,400 Benefit/Month cost per pay period = $89.10$3,500 Benefit/Month cost per pay period = $91.66$3,600 Benefit/Month cost per pay period = $94.22$3,700 Benefit/Month cost per pay period = $96.78$3,800 Benefit/Month cost per pay period = $99.34$3,900 Benefit/Month cost per pay period = $101.90$4,000 Benefit/Month cost per pay period = $104.46$4,100 Benefit/Month cost per pay period = $107.04$4,200 Benefit/Month cost per pay period = $109.60$4,300 Benefit/Month cost per pay period = $112.16$4,400 Benefit/Month cost per pay period = $114.72$4,500 Benefit/Month cost per pay period = $117.28$4,600 Benefit/Month cost per pay period = $119.84$4,700 Benefit/Month cost per pay period = $122.40$4,800 Benefit/Month cost per pay period = $124.96$4,900 Benefit/Month cost per pay period = $127.52$5,000 Benefit/Month cost per pay period = $130.08Monthly Benefit (30-Day Wait)Select$1,500 Benefit/Month cost per pay period = $33.50$1,600 Benefit/Month cost per pay period = $35.60$1,700 Benefit/Month cost per pay period = $37.70$1,800 Benefit/Month cost per pay period = $39.80$1,900 Benefit/Month cost per pay period = $41.90$2,000 Benefit/Month cost per pay period = $44.00$2,100 Benefit/Month cost per pay period = $46.10$2,200 Benefit/Month cost per pay period = $48.20$2,300 Benefit/Month cost per pay period = $50.30$2,400 Benefit/Month cost per pay period = $52.40$2,500 Benefit/Month cost per pay period = $54.50$2,600 Benefit/Month cost per pay period = $56.60$2,700 Benefit/Month cost per pay period = $58.70$2,800 Benefit/Month cost per pay period = $60.80$2,900 Benefit/Month cost per pay period = $62.90$3,000 Benefit/Month cost per pay period = $65.00$3,100 Benefit/Month cost per pay period = $67.10$3,200 Benefit/Month cost per pay period = $69.20$3,300 Benefit/Month cost per pay period = $71.30$3,400 Benefit/Month cost per pay period = $73.40$3,500 Benefit/Month cost per pay period = $75.50$3,600 Benefit/Month cost per pay period = $77.60$3,700 Benefit/Month cost per pay period = $79.70$3,800 Benefit/Month cost per pay period = $81.80$3,900 Benefit/Month cost per pay period = $83.90$4,000 Benefit/Month cost per pay period = $86.00$4,100 Benefit/Month cost per pay period = $88.10$4,200 Benefit/Month cost per pay period = $90.20$4,300 Benefit/Month cost per pay period = $92.30$4,400 Benefit/Month cost per pay period = $94.40$4,500 Benefit/Month cost per pay period = $96.50$4,600 Benefit/Month cost per pay period = $98.60$4,700 Benefit/Month cost per pay period = $100.70$4,800 Benefit/Month cost per pay period = $102.80$4,900 Benefit/Month cost per pay period = $104.90$5,000 Benefit/Month cost per pay period = $107.00Are you actively at work for the last 30 days? Yes No Which one of the following best describes your reason for needing disability insurance?SelectJust in caseI have a current medical condition that I am concerned aboutPick your Age Range(Required)18-2930-3940-4950-5960+Pick your plan(Required)$10,000$20,000$30,000$40,000 Age Group 40-49 (Dropdown) $10,000 Plan Employee and Child (under 26) $0.00 Employee + Spouse and Family $0.00 Coverage Type Benefit Amount Disability Waiting Period Bi-weekly Cost Disability Coverage $0.00 14 $0.00 Who's Covered Critical Illness Coverage (Employee Child or Family) $0.00 Employee + Child $0.00 Employee + Spouse $0.00 Total Bi-weekly cost: $0.00 Continue with Disability Coverage Only: Continue with Disability Coverage and Critical Illness: This field is hidden when viewing the formContinue withName(Required) First Last Phone(Required)Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Job Title(Required)SelectRural CarrierCity CarrierMail HandlerPSE ClerkRural Carrier AssociateSupervisorPostmasterClerkMaintenanceTractor Trailer DriverCustodianOtherMay we Text you to set up a time to talk by phone?(Required) Yes No Which time of day typically is best to reach you?(Required)SelectBefore NoonAfternoonEveningWhat day of the week do your typically have off?SelectSundayMondayTuesdayWednesdayThursdayFridaySaturdayHow did you hear about us?(Required)SelectGoogle SearchFacebookTikTokGoogle AdsReferralCall inFlyer at my officeReceived flyer at workReceived flyer at homeOtherPhoneThis field is for validation purposes and should be left unchanged.
