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2015 Benefits Guide
12
VOLUNTARY LIFE AND
ACCIDENTAL DEATH &
DISMEMBERMENT
INSURANCE
ABC Employer
will continue to offer you the option of
purchasing Voluntary Life/AD&D insurance for yourself,
your spouse and your child(ren). This coverage will be
provided to you through
XXXX
. You, the employee,
must purchase Voluntary Life/AD&D in order to
purchase for your spouse and dependent children. If
you are currently enrolled in the Voluntary Life/AD&D
plan, and you do not wish to make any changes, your
current election will rollover to
XXXXX
. Your per
paycheck contribution will not change.
Employees can purchase up to 5 times their salary, with
a minimum of $10,000 in $10,000 increments up to a
maximum of $500,000(anything over $100,000, will be
subject to medical questions). Spousal coverage can
be purchased in increments of $5,000 up to 50% of the
employees election, with a minimum of $5,000 to a
maximum of $250,000. (anything over $25,000 will be
subject to medical questions). The spousal maximum
has increased this year. Dependent children coverage
can be purchased up to $10,000 ($1,000, $2,000,
$4,000, $5,000, $10,000) if age 6 months to age 26
(regardless of student status). In addition, the voluntary
life benefit carries and equal benefit of accidental death
and dismemberment coverage (AD&D) for the
employee and their dependents.
Please note: If you did not enroll during your initial
enrollment period in the Voluntary Life/AD&D you
will be required to complete an Evidence of
Insurability (EOI) form and be approved by
XXXX
before you are able to obtain coverage.
Should you decide to leave
ABC Employer
have elected
this coverage, you may have the option to convert
your Voluntary Life/AD&D policy to an individual policy.
VOLUNTARY LIFE/AD&D
EMPLOYEE CONTRIBUTION
(Rates are per month)
Age Band
Employee/Spouse Rate per
$1,000*
Under 25
$.060
25-29
$.060
30-34
$.080
35-39
$.095
40-44
$.129
45-49
$.197
50-54
$.318
55-59
$.527
60-64
$.795
65-69
$1.277
70-74
$2.413
75+
$2.413
AD&D (employee)
$0.029
AD&D (spouse)
$0.029
Child Life
$0.240
Child AD&D
$0.0510
*Spouse rates are based on the employees age.
HOW TO CALCULATE VOLUNTARY PREMIUM
$50,000
Elected
Coverage
÷ 1,000
=
50
Units
X
$0.197
Rate
* See
Note
=
$9.85
Monthly
Cost
*The premium calculation is based upon the life rate for an
employee age 45.