Contract - Madison National Life Insurance Company - 12/4/2025 (2) Madison National
Life Insurance Company
RATE CONFIRMATION
1. Policyholder: City of Round Rock
2. Group Number: 25660
3. Insurance Product: Short Term Disability
4. Rate Coverage Period: January 1, 2026—December 31, 2027
Short Term Disability
Premium Rates:
Current Rates Renewal Rates
Coverage Rate per$10 of weekly benefit Rate per$10 of weekly benefit
per month per month
Short Term $0.340 $0.255
Disability
ACKNOWLEDGEMENT BY AUTHORIZED REPRESENTATIVE OF POLICYHOLDER
This document confirms that the rates stated above are the agreed upon rates for the specified policy numbers.
These rates will be charged for coverage amounts effective during the Rate Coverage Period listed above.
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