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Voluntary Life and Accidental
2016–17 Beneits Enrollment
Death & Dismemberment Cost of
(AD&D) Coverage
Your individual premium rate will
We offer a voluntary life insurance option through The Hartford with depend on your age. View the age/
rate table to determine how much this
competitive group rates so you can purchase the additional inancial protection benefit will cost.
you need. 1. Determine the amount of
insurance you want to purchase
Employee Voluntary Life and AD&D Insurance 2. Using the table, determine the
rate based on your age
You are eligible to purchase voluntary life and AD&D insurance in increments 3. Use the following formula to
of $10,000 up to 5x your annual earnings up to a maximum of $500,000. calculate your monthly premium
amount.
Coverage amount/1,000 x rate =
Spouse Voluntary Life and AD&D Insurance monthly premium
If you elect voluntary life and AD&D coverage for yourself, you can also Example
elect voluntary life and AD&D coverage for your spouse. You can purchase 45 year old elects to purchase
coverage in increments $5,000. Your spouse’s coverage cannot exceed 50% of $100,000 of voluntary life insurance.
your elected amount up to a maximum of $30,000. Spousal rates are calculated $100,000/1,000 X 0.40= $40.00. The
amount of premium equals $40.00 per
based on the age of the employee. month.
Dependent Voluntary Life Insurance Rate per $1,000 of
Dependent child life coverage is available for a lat $10,000 beneit if the child Age Range Coverage
is 6 months to 19 years of age. If death occurs between 15 days and 6 months, Under 25 $0.16
25—29
$0.16
there is a lat beneit of $250. The cost for dependent child coverage is $2.00 30—34 $0.17
per family unit regardless of the number of children you are covering. All 35—39 $0.20
40—44
$0.28
dependent child elections are guaranteed issue without requiring EOI. 45—49 $0.43
50—54 $0.78
Evidence of Insurability (Personal Health Application) 55—59 $1.24
60—64 $1.54
Evidence of insurability (EOI) is an application process in which you provide 65—69 $2.62
$5.98
proof of good health standing to our insurance carrier. EOI is required under 70—74 $22.36
75+
the following circumstances. Child Rate per $2.00
Family Unit
X You are a late entrant; meaning you have previously waived the opportunity
to elect this coverage and are now electing coverage for the irst time * This beneit is subject to an age reduction
schedule. See certiicate of coverage for
X You are requesting over the guaranteed issue amount of $180,000 for details.
employee coverage or $30,000 for spouse coverage
X You are requesting an increase to your current elected coverage
Your elections are subject to approval from our insurance carrier before 15
considered inal.
2016–17 Beneits Enrollment
Death & Dismemberment Cost of
(AD&D) Coverage
Your individual premium rate will
We offer a voluntary life insurance option through The Hartford with depend on your age. View the age/
rate table to determine how much this
competitive group rates so you can purchase the additional inancial protection benefit will cost.
you need. 1. Determine the amount of
insurance you want to purchase
Employee Voluntary Life and AD&D Insurance 2. Using the table, determine the
rate based on your age
You are eligible to purchase voluntary life and AD&D insurance in increments 3. Use the following formula to
of $10,000 up to 5x your annual earnings up to a maximum of $500,000. calculate your monthly premium
amount.
Coverage amount/1,000 x rate =
Spouse Voluntary Life and AD&D Insurance monthly premium
If you elect voluntary life and AD&D coverage for yourself, you can also Example
elect voluntary life and AD&D coverage for your spouse. You can purchase 45 year old elects to purchase
coverage in increments $5,000. Your spouse’s coverage cannot exceed 50% of $100,000 of voluntary life insurance.
your elected amount up to a maximum of $30,000. Spousal rates are calculated $100,000/1,000 X 0.40= $40.00. The
amount of premium equals $40.00 per
based on the age of the employee. month.
Dependent Voluntary Life Insurance Rate per $1,000 of
Dependent child life coverage is available for a lat $10,000 beneit if the child Age Range Coverage
is 6 months to 19 years of age. If death occurs between 15 days and 6 months, Under 25 $0.16
25—29
$0.16
there is a lat beneit of $250. The cost for dependent child coverage is $2.00 30—34 $0.17
per family unit regardless of the number of children you are covering. All 35—39 $0.20
40—44
$0.28
dependent child elections are guaranteed issue without requiring EOI. 45—49 $0.43
50—54 $0.78
Evidence of Insurability (Personal Health Application) 55—59 $1.24
60—64 $1.54
Evidence of insurability (EOI) is an application process in which you provide 65—69 $2.62
$5.98
proof of good health standing to our insurance carrier. EOI is required under 70—74 $22.36
75+
the following circumstances. Child Rate per $2.00
Family Unit
X You are a late entrant; meaning you have previously waived the opportunity
to elect this coverage and are now electing coverage for the irst time * This beneit is subject to an age reduction
schedule. See certiicate of coverage for
X You are requesting over the guaranteed issue amount of $180,000 for details.
employee coverage or $30,000 for spouse coverage
X You are requesting an increase to your current elected coverage
Your elections are subject to approval from our insurance carrier before 15
considered inal.
