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This plan language is intended to be used with the state and local income continuation insurance manuals.

Income Continuation Insurance (ICI) is an optional insurance that provides a replacement income for disabilities that are considered short-term in nature, as well as those which may last for extended periods.

Local employers, complete to report monthly premiums for group income continuation insurance.

This application allows you to apply to enroll in the Income Continuation Insurance (ICI) Program if you did not enroll when originally eligible or if coverage was canceled.

State employers, complete to report monthly premiums for group income continuation insurance.

Complete and then submit to your employer to apply for income continuation insurance.

Use this form to file a paper income continuation insurance (ICI) claim.

Physician report to verify eligibility for an income continuation insurance claim.

Resolution for employers to join the ICI Program.

Employer report to verify eligibility for an income continuation insurance claim.