DI Elective Coverage (DE 2565) 2565 De2565

User Manual: 2565

Open the PDF directly: View PDF PDF.
Page Count: 2

If you are a business owner or
self-employed, then
Disability Insurance Elective
Coverage may be for you!
STATE OF CALIFORNIA
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
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:
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.
Could you do without your income even
temporarily?
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.
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.
For more information about DI, call
1-800-480-3287. For information about PFL,
call 1-877-238-4373.
Major Requirements
You must own your own business or be
self-employed.
You must have a minimum annual income
of $4,600.
You must be normally and continuously
engaged in a regular trade, business,
or occupation.
You must possess a valid active license,
if required by your occupation.
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.
Please send me more information and an application for DI Elective Coverage.
Name ______________________________________________________________________________________________________
Address ____________________________________________________________________________________________________
City _____________________________________________________________ State __________ ZIP Code ________________
Email Address ______________________________________________________________________________________________
Please have someone call me at ___________________________________
Detach this portion and mail to the following address:
State of California
Employment Development Department
DIEC Unit
PO Box 826880, MIC 5
Sacramento, CA 94280-0001
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

Navigation menu