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2018 Benefits Guide
16
VOLUNTARY LIFE ENROLLMENT WORKSHEET
Employee
$__________
÷ 1,000 X ($__________
= $___________
(AD&D
+ .031)
Amount of
Coverage
Unit Cost from
Rate Table
Employee Monthly
Cost
Spouse
$__________
÷ 1,000 X ($__________
= $___________
(AD&D
+ .030)
Amount of
Coverage
Unit Cost from
Rate Table
Spouse Monthly
Cost
Child(ren)
$__________
÷ 1,000 X $__________
= $___________
(AD&D
+ .041)
Amount of
Coverage
Unit Cost from
Rate Table
Child(ren) Monthly
Cost
Employee Monthly Rate/$10,000
Non-Tobacco User
Tobacco User
$1.280
$1.280
$2.080
$3.370
$5.190
$8.460
$13.290
$18.450
$34.060
$54.210
$0.690
$0.770
$1.150
$1.860
$2.870
$4.670
$7.340
$10.190
$18.800
$31.540
Under 29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
$.350
$.390
$.580
$.930
$1.440
$2.340
$3.670
$5.100
$9.400
$15.77
*Spouse Monthly Rate/
$5,000