Instructions to Complete Employer’s TDI Premium Statement 2018-2019

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These are the instructions to complete the Employer’s Temporary Disability Insurance (TDI) Premium Statement. If needed, they’re downloadable and printable.

Instructions for Filing Employer’s TDI Premium Statement for 2018-2019

Reporting Period
Include all information for the pay period stated on your billing/Employer’s Premium Statement form.

Section A
Enter the number of male and female employees for each month in the billing period.

Section B

  1. Total Wages
    This amount includes total of gross wages of all employees covered.
  2. Covered Wages
    This amount includes total of gross wages of all employees covered, up to, but not exceeding the maximum taxable wage PER PERSON. Use the following to determine the “Maximum Taxable Wage” per person.






    EXAMPLE: Employee “A” has an annual gross wage of $56,000. Since $56,000.00 exceeds the maximum covered wage of $55,568.24, you would use only $55,568.24 for employee “A.” Employee “B” has an annual gross wage of $30,000.00 Since this does not meet the maximum covered wage you will use $30,000.00 for employee “B.” So, the total on line 2 for the two employees will be $85,568.24. If all covered employees have the annual covered wage of $55,568.24 or less, the amount on line 2 will be the same as line 1.
  3. 2018 Premium
    The premium due is calculated by multiplying the covered wage by the rate. If the amount is less than the minimum annual premium due of $120.00, then the premium due will be the minimum of $120.00 per year or $10.00 per month.
  4. 2018 Estimated Premium Already Paid
    This amount was paid in January of 2018 and should be deducted from line 3.
  5. Subtotal
    This amount is the credit or balance due for 2018, after subtracting line 4 from line 3.
  6. 2019 Estimated Premium
    This amount should be the same as line 3, unless you began filing after January of 2018. Then this amount is calculated by estimating payroll from January 1 thru December 31, 2019, multiplied by the rate, but not less than the minimum annual premium of $120.00 or $10.00 per month. If you are filing for the complete year of 2018 and line 6 is less than line 3, give a brief explanation below line 8. (i.e. business closing, downsizing, etc.).
  7. Total Premium Due
    To calculate, add lines 5 and 6, and this is the amount due for 2018 premium and 2019 estimated premium.
  8. Amount of Premium Paid by:
    Enter amount of TDI contribution paid by employees, if any, but not more than one half of the premium cost.

    Enter amount of TDI contribution paid by employer.

    After completing the audit, please make a copy to keep for your records and send along with payment to Pacific Guardian Life. Please remit by January 31, 2019. Please make checks payable to: Pacific Guardian Life. To apply any payments received, ALL information must be completed. Thank you.