Untitled Document


DISABILITY iNSURANCE

Professional Insurance Company

Step 1 BENEFITS AND RATES

Review Benefits

Determine amount of coverage you are eligible to purchase by taking 40% of your gross monthly income(before deductions). The 40% represents the maximum(though you may select a lesser amount) benefit amount you are eligible to purchase. The overall maximum offered in the program is a benefit of $2,000 monthly.

Example:

Monthly income- $3000
Times 40% - X .40
Equals- = $ 1200

$1200 is the maximum monthly amount availible in this example.

Click here for calculator

PLAN DESCRIPTION

Circle the amount of benefit you would like to purchase on the rate sheet. This sheet should be returned with your application.
RATE SHEET

Step 2 APPLICATION

Print application and complete sections A & C , sign and date.

Application

Proceed to next step..

Step 3 CAFCC

(you must do this step regardless of application method).

You must be a member of the CAFCC(California Association for Family Child Care) for $20 a year.

If you are a member already, proceed to next step.

If you are not a member, print out the CAFCC application, complete and attach a $20 check made out to CAFCC.

Proceed to next step.

Step 4 PAYMENT METHOD

The payment option is auto deduction directly from your checking account. Print out this form, complete and sign. Attach a VOID check.

PAYMENT FORM

Provide a check for the 1st month's premium made out to P I C. After the first month the preimum will be automatically deducted from your account.

Proceed to next step.

Step 5 FINAL CHECKLIST AND MAILING

Put the following into an envelope to mail to Vantage:

___ Completed application.
___ Complete Authoriz Draft Form.
___ Void Check.
___ Premium Check
___ Rate Sheet (with benefits amount circled)

Mail to:

Vantage Business Support & Insurance Services
Attn: Childcare Program
2363 Mariner Square Dr., Ste. 240
Alameda, CA 94501