Wright USA's Disability Income Insurance Plan Rates shown below apply only to full or part-time Federal Employees. You must be a full or part-time Federal Employee to apply for Wright USA’s Disability Income Insurance Plan.

Premiums are based on a flat charge of $6.25 per month per $10,000 of annual base salary for full or part-time Federal Employees (up to a maximum salary of $166,000 per year) for all ages. Rates and/or benefits may be changed on a class basis.

Premium calculation details are as easy as the following four steps:

Step 1 – Determine your Annual Salary rounded to next highest $1,000.
Step 2 – Divide result from Step 1 by 10,000 (i.e., Income Units)
Step 3 – Multiply result of Step 2 by $6.25 (i.e., Rate per Month/per unit)
Step 4 – Multiply result of Step 3 by 12 to determine Annual Rate


Example

Step 1 – Annual Salary = $70,000
Step 2 - $70,000/10,000 = 7 Income Units
Step 3 - 7 x $6.25 = $43.75 per month
Step 4 – $43.75 x 12 = $525 annual premium

You may download, complete and return the application to the plan administrator at the address listed on the form. Be sure to answer all questions on the downloadable application and initial any changes.

If you are a New Hire (i.e., within 45 days of your Hire Date), you can Download, complete and return the application for our Guaranteed Acceptance plan (benefits subject to the policy's pre-existing condition limitation) to the plan administrator at the address listed on the form. Be sure to answer all questions on the application and initial any changes.

Send No Money Now. You will be billed once you are approved for coverage.

If you have any questions during the application process, please call 800-424-9801 for assistance.

California Residents Only: Click here to download your state’s application.

New York Residents Only: Click here to download your state’s application.

Residents of All Other States: Click the blue “Download Application” button immediately below.

If You Download the Application - Please Note: Your future Wright USA premiums can be paid automatically from your account at your financial institution on a Monthly, Quarterly, or Annual basis through Electronic Funds Transfer (EFT). To sign up for EFT: download, complete, and return our EFT Form along with your completed application.