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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 your initial eligibility 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
spouse or children during this initial eligibility period, you will be required
to complete EOI to elect coverage at a later date.
If you elect coverage for yourself and your spouse during your new hire
eligibility period, each year at open enrollment, you may increase your
coverage by $10,000 and your spouse’s coverage by $5,000 (up to the GI
level shown on page 22), without completing EOI. Any increase above
$10,000 or $5,000 requires an evidence of insurability form.
Dawson 23
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 your initial eligibility 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
spouse or children during this initial eligibility period, you will be required
to complete EOI to elect coverage at a later date.
If you elect coverage for yourself and your spouse during your new hire
eligibility period, each year at open enrollment, you may increase your
coverage by $10,000 and your spouse’s coverage by $5,000 (up to the GI
level shown on page 22), without completing EOI. Any increase above
$10,000 or $5,000 requires an evidence of insurability form.
Dawson 23
