Page 23 - 2019 Dawson Benefits Guide

Rates apply to both employee and spouse—spouse rate based on spouse
age Children under 26 $0.29/$1,000 per month

The ADP/WFN enrollment system will automatically calculate the cost
per pay period of your elected voluntary life and AD&D coverage as
follows.

1. Determine the amount of insurance you want to purchase
2. Using the table, determine the rate based on your age

3. Use the following formula to calculate your monthly premium
amount:
Y Coverage amount/1,000 × rate = monthly premium

X Example: 45 year old elects to purchase $100,000 of voluntary
life insurance
X $100,000/1,000 × $0.14 = $14.00; the amount of premium
equals $14.00 per month. The bi-weekly per pay period cost is
$7.00. The weekly pay period cost is $3.50.

Your premium is paid for on an after-tax basis. If you have a birthday
during the plan year which takes you to a higher rate, your premium rate
will not change until January 1 following your birthday.

Evidence of Insurability

If you do not elect coverage, during the 2019 Open Enrollment period,
and want to elect coverage at a later date, you will be required to complete
evidence of insurability (EOI). If you do not elect coverage for your
children during this Open Enrollment, you will be required to complete
EOI to elect coverage at a later date.

If you elect coverage for yourself and/or your spouse, each year at open
enrollment, you may increase your coverage by $10,000 and your spouse’s
coverage by $5,000 without completing EOI.

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