Our disability insurance is intended to “fill the gaps” in your leave and disability retirement benefits. To see a detailed financial impact exhibit on how our program enhances your existing benefits complete the following information and we’ll send it over to you

All Fields Required

Your Name:

Phone: xxx-xxx-xxxx

Email:

Date of Birth: mm/dd/yyyy

Base Annual Salary: $ddd,ddd

Are you currently enrolled under the The Standard disability insurance plan?:

Yes No

Special Group Qualification please check if covered

I am a Law Enforcement Officer, Firefighter, or Air TrafficController covered under the "Special Groups" retirement provisions of FERS?

I am currently receiving LEAP (Availability Pay).

How many 'Years of Service' do you have?

How much leave (hours) do you have saved?

What is your current 'High 3' salary?

Enter code above in box below: