NOT INTENDED FOR CURRENTLY EMPLOYED PERSONNEL.

FOR USE ONLY BY QUIT OR TERMINATED EMPLOYEES.

PLEASE READ and REVIEW THE REQUIREMENTS OF ELIGIBILITY FOR A SUB DISTRIBUTION AFTER YOU HAVE QUIT or WERE TERMINATED

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Employees are valued at all companies, and we hope that the employment relationship with your previous employer was rewarding. Unfortunately, you are reviewing this notice and completing the electronic form because you were either laid off, quit or were terminated. These instructions are intended to assist you with obtaining the Supplemental Unemployment Compensation Benefits ("SUB") in addition to your state unemployment benefits.

Requirements to be eligible for a SUB Distribution:

You MUST be eligible to receive state unemployment benefits based on full or partial unemployment and experienced a shortage of hours of at least 4 hours (8 hours in California) during a 40-hour workweek.

You must meet the eligibility requirements of state unemployment insurance benefits in the state you file for unemployment benefits and have amounts credited to your account.

You also may receive SUB Plan benefit payments if you do not qualify for state unemployment insurance benefits because of one of the three permitted exceptions:

1. you have not compiled sufficient wage credits under state law; or
2. you have exhausted your unemployment insurance benefits; or
3. you have not met the state's eligibility waiting period for unemployment insurance benefits.

You are required to attach to this application, proof of eligibility, such as documentation from your state's unemployment office or an unemployment payment receipt. Additional documentation will be required if you qualify under one or more of the state's exceptions as outlined above under Mandatory Qualifications.

DISTRIBUTIONS WILL NOT BE CONSIDERED UNLESS ALL REQUIRED DOCUMENTATION IS RECEIVED BY NEUBRIDG, INC.

Unfortunately, your request for a SUB distribution cannot be processed at this time because you do have not obtained all of the required documentation or have submitted the documentation to NeuBridg, Inc.

 

If you have the documentation but answered the previous question incorrectly, please press the BACK button and start the form over.

If you do not have the documentation, please gather the required documentation and reapply.

 

Thank you.

• Amounts requested for eligible distributions will be processed in 40-hour increments ONLY.
• No Lump Sum distributions shall be allowed.
• At no time will a distribution be greater than the amount in your account.
• It shall be YOUR responsibility to request eligible distributions and notify NeuBridg when you are no longer eligible for unemployment or become employed.
• Enter dollars requested or hours, depending on how your previous company requested submission. 

I, hereby attest and under the penalties of perjury, and do hereby affirm that I am eligible for state unemployment as required and a NeuBridg SUB distribution. I hold NeuBridg, Inc., Midwest Group Benefits, and my employer harmless and will defend them against all actions brought against them should the information I provide be not true or fraudulent.