CPA Long Term Disability Insurance

CPA Long Term Disability Insurance - Let's Get Started

Earnings Calculation

Monthly Earning ($)

Total Monthly Earning ($)

*65% ($)

This is the maximum disability income amount for which you qualify ($)

Deduct other Monthly Disability Income Coverage Amounts ($)

Member Information

Email Address *

Zip Code *

Are you a member of the AICPA? *

Yes No

AICPA Membership#

First Name *

Gender *

Male Female

Date of Birth *

State of Residence *

Are you a member of a State Society of CPAs or other eligible organization? *

Yes No

Select State for State Society

Last Name *

Are you now actively at work full-time?(At least 17-1/2 hours per week is required) *

Yes No

Coverage Information

Select a Monthly Coverage Amount *

Select the type of coverage you would like a quote for *

Please Note:

If you are requesting $6,000 or more of monthly disability income coverage, you must complete the Earnings Calculation below to determine the maximum monthly coverage amounts for which you are eligible.

Monthly Benefit Amount	Minimum monthly Earnings Requirement
$5,000 or less	No Minimum
6,000	$9,231
7,000	$10,770
8,000	$12,308
9,000	$13,846
10,000	$15,385
12,000	$18,463

To maintain a benefit amount of $6,000, $7,000, $8,000, $9,000, $10,000 or $12,000, your benefit amount may not exceed 65% of your earnings.

Earnings Calculation

Monthly Earning ($) *

*65% ($)

Deduct other Monthly Disability Income Coverage Amounts ($)

Rate Information

	Product Name	Coverage Amount	Coverage Type	Waiting Period	Monthly Contribution	Net Monthly Rate *

* The Net Monthly Rate represents your monthly rate minus the Annual Cash Refund.

Cash refunds paid by the Trust can lower your annual cost of insurance. Although they can’t be guaranteed, participants in all AICPA Insurance Trust Life Plans have received cash refunds from the Trust every year without fail since each Plan’s inception.

The rates reflected above are based on the information you provided as of . Complete underwriting of your full medical history and other factors will be required to determine whether you are eligible for coverage. Your actual rate will be based on your age as of the date of your application’s approval.