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SUPPLEMENTAL LIFE FOR ELIGIBLE EMPLOYEES AND DEPENDENTS - MUTUAL OF OMAHA
Voluntary Life is available at a cost to the employee through payroll deduction. The employee and/or dependents may
need to qualify for benefits. (Children up to age 19 - 23 if full time student)
Employee Only: $20,000
up to 5x annual salary up to $500,000 - *
Guarantee Issue:
5x annual salary up to
$130,000
Spouse: $5,000
up to
$50,000
not to exceed 100% of employee benefit - *
Guarantee Issue: $50,000
Child(ren): $2,000
up to
$10,000
not to exceed 50% of employee benefit - *
Guarantee Issue: $10,000
*Guarantee Issue Amount means the amount of life insurance Mutual of Omaha will issue without requiring Evidence of Insurability.
EMPLOYEE PER PAYCHECK PREMIUM RATE TABLE
$20,000 $30,000
$40,000 $50,000 $60,000
$70,000
$80,000
$90,000 $100,000 $110,000 $120,000 $130,000
<25
0.80
1.20
1.60
2.00
2.40
2.80
3.20
3.60
4.00
4.40
4.80
5.20
25-29
0.80
1.20
1.60
2.00
2.40
2.80
3.20
3.60
4.00
4.40
4.80
5.20
30-34
0.90
1.35
1.80
2.25
2.70
3.15
3.60
4.05
4.50
4.95
5.40
5.85
35-39
1.10
1.65
2.20
2.75
3.30
3.85
4.40
4.95
5.50
6.05
6.60
7.15
40-44
1.70
2.55
3.40
4.25
5.10
5.95
6.80
7.65
8.50
9.35
10.20 11.05
45-49
2.60
3.90
5.20
6.50
7.80
9.10
10.40 11.70
13.00
14.30 15.60 16.90
50-54
3.80
5.70
7.60
9.50
11.40
13.30
15.20 17.10
19.00
20.90 22.80 24.70
55-59
6.40
9.60
12.80 16.00
19.20
22.40
25.60 28.80
32.00
35.20 38.40 41.60
60-64
10.40
15.60 20.80 26.00
31.20
36.40
41.60 46.80
52.00
57.20 62.40 67.60
65-69
16.50
24.75 33.00 41.25
49.50
57.75
66.00 74.25
82.50
90.75 99.00 107.25
70-74
25.70
38.55 51.40 64.25
77.10
89.95 102.80 115.65 128.50 141.35 154.20 167.05
75-100
44.00
66.00 88.00 110.00 132.00 154.00 176.00 198.00 220.00 242.00 264.00 286.00
SPOUSE PER PAYCHECK PREMIUM RATE TABLE
$5,000
$10,000 $15,000 $20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
<25
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
2.00
25-29
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
2.00
30-34
0.23
0.45
0.68
0.90
1.13
1.35
1.58
1.80
2.03
2.25
35-39
0.28
0.55
0.83
1.10
1.38
1.65
1.93
2.20
2.48
2.75
40-44
0.43
0.85
1.28
1.70
2.13
2.55
2.98
3.40
3.83
4.25
45-49
0.65
1.30
1.95
2.60
3.25
3.90
4.55
5.20
5.85
6.50
50-54
0.95
1.90
2.85
3.80
4.75
5.70
6.65
7.60
8.55
9.50
55-59
1.60
3.20
4.80
6.40
8.00
9.60
11.20
12.80
14.40
16.00
60-64
2.60
5.20
7.80
10.40
13.00
15.60
18.20
20.80
23.40
26.00
65-69
4.13
8.25
12.38 16.50
20.63
24.75
28.88
33.00
37.13
41.25
70-74
6.43
12.85 19.28 25.70
32.13
38.55
44.98
51.40
57.83
64.25
75-100
11.00
22.00 33.00 44.00
55.00
66.00
77.00
88.00
99.00 110.00
ALL CHILDREN PER PAYCHECK PREMIUM RATE TABLE*
RATE
$2,000
$3,000
$4,000
$5,000 $6,000 $7,000 $8,000
$9,000
$10,000
$0.06
$0.09
$0.12
$0.15
$0.18
$0.21
$0.24
$0.27
$0.30
* Regardless of how many children you have, the premium is not a per child premium and is the same for one or all children.
Employee Premium Spouse Premium
Child(ren) Premium
Total Semi-Monthly Premium
+
+
=
Life and Disability Plans
LIFE INSURANCE PLAN/AD&D – MUTUAL OF OMAHA 100% COMPANY PAID
West Yavapai Guidance Clinic will continue to provide for all employees working 30 hours or more weekly, 100% company
paid life insurance of $50,000 through Mutual of Omaha. Please refer to the Mutual Certificate of Coverage for detailed
plan information. Coverage is automatic for all, benefits eligible employees who have met the eligibility waiting period.
Important to note: You should have a completed beneficiary form on file with Human Resources.