DI Elective Coverage (DE 2565) 2565 De2565
User Manual: 2565
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STATE OF CALIFORNIA If you are a business owner or self-employed, then Disability Insurance Elective Coverage may be for you! LABOR AND WORKFORCE DEVELOPMENT AGENCY EMPLOYMENT DEVELOPMENT DEPARTMENT The EDD is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. Requests for services, aids, and/or alternate formats need to be made by calling 1-866-490-8879 (voice) or through the California Relay Service at 711. This pamphlet is for general information only and does not have the force and effect of law, rule, and regulation. DE 2565 Rev. 17 (5-17) (INTERNET) Page 1 of 2 CU/GA 894A DISABILITY INSURANCE ELECTIVE COVERAGE A SAFETY NET FOR THE BUSINESS OWNER OR SELF-EMPLOYED You must derive the major portion of your income from your trade, business, or occupation. You must be able to perform your normal duties on a full-time basis at the time you submit your application. Your business cannot be seasonal. You must stay in the program for two complete calendar years unless you discontinue your business or move out of California. Benefit Eligibility Generally, you must have this insurance coverage for at least six months before you are eligible to file a claim. If you are interested in more information about this program, call 916-654-6288. If you would like an application, call 916-554‑7104, complete and mail the attached form, or visit the EDD website at: www.edd.ca.gov DE 2565 Rev. 17 (5-17) (INTERNET) Page 2 of 2 State of California Employment Development Department DIEC Unit PO Box 826880, MIC 5 Sacramento, CA 94280-0001 For more information about DI, call 1-800-480-3287. For information about PFL, call 1-877-238-4373. You must possess a valid active license, if required by your occupation. Detach this portion and mail to the following address: Consider the Benefits Protection against loss of income due to injury, pregnancy, or illness whether or not it is work-related. Up to 39 weeks of benefits for your own disability. Automatic coverage in PFL, which provides up to six weeks of benefits to care for a seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner, or to bond with a new child. Please have someone call me at ___________________________________ A Financial Safety Net Disability Insurance Elective Coverage (DIEC) offers a safety net to business owners or self-employed individuals. Premiums are based on net profits as declared on the Internal Revenue Service Form 1040 (Schedule SE) or (Schedule C). For information regarding benefit amounts paid, view the Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts in Dollar Increments, DE 2589, at www.edd.ca.gov. You must be normally and continuously engaged in a regular trade, business, or occupation. Email Address _______________________________________________________________________________________________ Could you do without your income even temporarily? City _____________________________________________________________ State __________ ZIP Code _________________ You must have a minimum annual income of $4,600. Address _____________________________________________________________________________________________________ You were ill, injured, or pregnant and could not work. Your child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner needed your care due to a serious health condition. You would like to bond with your new child. Name _______________________________________________________________________________________________________ Major Requirements You must own your own business or be self-employed. Please send me more information and an application for DI Elective Coverage. Protect Your Most Valuable Asset: Your Ability to Earn an Income As someone whose livelihood depends on your ability to run a business, you should consider what would happen if your income stopped because:
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