Enriched DBL Coverage 50-99 Employees 52-Week Benefits
(New York)

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Enriched DBL Coverage¹

52-Week Enriched Benefits

Maximum Weekly Benefit	Monthly Rate per $100 of Covered Monthly Payroll1
Industry Class2	50% Plan		60% Plan
Industry I	Males	Females	Males	Females
$170	$0.223	$0.453	$0.268	$0.544
$200–$349	$0.284	$0.520	$0.328	$0.599
$350–$749	$0.329	$0.576	$0.394	$0.679
Industry II	Males	Females	Males	Females
$170	$0.297	$0.602	$0.356	$0.722
$200–$349	$0.371	$0.695	$0.443	$0.795
$350–$749	$0.439	$0.761	$0.523	$0.902
Industry III	Males	Females	Males	Females
$170	$0.381	$0.773	$0.457	$0.927
$200–$349	$0.478	$0.898	$0.556	$1.014
$350–$749	$0.557	$0.980	$0.672	$1.151
Industry IV	Males	Females	Males	Females
$170	$0.447	$0.906	$0.536	$1.088
$200–$349	$0.563	$1.039	$0.651	$1.227
$350–$749	$0.659	$1.150	$0.787	$1.374

* Rating as of March 23, 2011 (3rd highest of 16 A.M. Best categories).
¹ The minimum premium is $45 for any policy year.
² See download link below for Industry Classification Table. SIC categories exclude
   Leasing or Temporary Agencies.

Enriched DBL Coverage 50-99 Employees:

All Fields Required Otherwise State N/A

Broker Name
Email
Name of Insured
Doing Business As
Location Address
Mailing Address
City
State
Zip
Select an Industry	Administration of Human Resources Adminstration of Human Resources Agricultural Production- Crops Agricultural Production- Livestock Agricultural Services Amusement and Recreation Services Anthracite Mining Apparel and Accessory Stores Apparel and Other Textile Products Auto Repair, Services and Parking Automotive Dealers and Service Stations Building Materials and Garden Supplies Business Services Chemicals and Allied Products Coal Mining Communications Depository Institutions Eating and Drinking Places Educational Services Electric, Gas, and Sanitary Services Electronic and Other Engineering and Management Services Environment Quality and Housing Executive, Legislative, and General Government Fabricated Metal Products Finance, Taxation and Monetary Policy Fishing, Hunting, and Trapping Food and Kindred Products Food Stores Forestry Furniture and Fixtures Furniture and Home Furnishings Stores General Building Contractors General Merchandise Stores Health Services Heavy Construction, Except Building Holding and Other Investment Offices Hotels and Other Lodging Places Industrial Machinery Equipment Instruments and Related Products Insurance Agents, Brokers and Service Insurance Carriers Justice, Public Order and Safety Leather and Leather Products Legal Services Local and Inter-urban Passenger Transit Logging and Sawmills Membership Organizations Metal Mining Miscellaneous Manufacturing Industries Miscellaneous Repair Services Miscellaneous Retail Motion Pictures Museum, Botanical, Zoological Gardens National Security and International Affairs Non Classifiable Non-Depository Institutions Nonmetallic Minerals, Except Fuels Oil and Gas Extraction Paper and Allied Products Personal Services Petroleum and Coal Products Pipelines, Except Natural Gas Primary Metal Industries Printing and Publishing Private Households Railroad Transportation Real Estate Rubber and Miscellaneous Plastics Products Security and Commodity Brokers Services, NEC Social Services Special Trade Contractors Stone, Clay and Glass Products Textile Mill Products Tobacco Products Transportation by Air Transportation Equipment Transportation Services Trucking and Warehousing U.S. Postal Service Water Transportation Wholesale Trade- Durable Goods Wholesale Trade- Non-durable Goods
Please enter a 52 Week Benefit
52 Week Benefit Duration Enter dollar amount ($170 min. – $749 max.)
Monthly Rate per $100 of Covered Monthly Payroll: Please select a monthly rate
50% Plan 60% Plan
Total # of Males	Total # of Females
Please enter the total number of males Please enter the total number of females
W2 Service or ER FICA Match: Yes No This field is required
Enhanced Disability coverage is based on an employee's estimated annual wage. By clicking submit, your information will be directed to both The Hartford and their partnering General Agency. A member of our staff will contact you directly to go over the details of your proposal."

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Policies sold in New York are underwritten by Hartford Life Insurance Company. Home Office of both companies is Simsbury, CT. This is a summary only; providing general information on the services described. It is not a contract. All benefits are subject to the terms and conditions of the policy as issued. Exclusions, limitations, reduction of benefits, and terms of coverage apply as pursuant to NY Disability Benefits Law. Rates are set by the New York Workers' Compensation Board and are subject to change.

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