Page 13 - Polyventive 2022 Benefits Guide
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2022 Benefits Guide
Voluntary Life
Voluntary term life insurance through Anthem is available to Employees and their dependents.
■ Eligible Employees: $10,000 increments to a maximum of the lesser of ive (5) times earnings or $500,000.
(Health statements may be required for employees that did not previously enroll during their new hire
enrollment period or to increase their original beneit.)
■ Spouse coverage: $5,000 increments to a maximum of $100,000, not to exceed 50% of the Employee’s
Optional Life Beneit. (Health statements may be required for spouses if the spouse was not previously
enrolled during the employee’s new hire enrollment period or to increase the spouse’s original beneit.)
■ Child coverage: Employees may elect child optional life in the amount of $1,000, up to a maximum of
$10,000, not to exceed 50% of the Employee’s Optional Life Beneit. Children are eligible from 15 days to
26 years. The child beneit is per child unit; a unit can be one (1) or more children.
Monthly Voluntary Term Life Rates (Employee and Spouse) Voluntary Life Premiums
Age Band Rate per $1,000 (Monthly—Dependent Child(ren)
Under age 20 $0.060 Amount of Coverage Per Family
20-24 $0.060 Rate per $1,000 of beneit $0.21
25-29 $0.060
30-34 $0.080
35-39 $0.090
40-44 $0.105
45-49 $0.166
50-54 $0.265
55-59 $0.430
60-64 $0.660
65-69 $1.270
70-74 $2.060
75-79 $2.060
80+ $2.060
Voluntary AD&D
Voluntary Accidental Death & Dismemberment (AD&D) is available through Anthem to Employees and their
dependents. The AD&D beneit amount will be equal to the amount of optional life insurance purchased for
yourself, spouse, or child(ren).
Voluntary Rate per $1,000
Employee $0.017
Spouse $0.017
Child(ren) $0.051
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Voluntary Life
Voluntary term life insurance through Anthem is available to Employees and their dependents.
■ Eligible Employees: $10,000 increments to a maximum of the lesser of ive (5) times earnings or $500,000.
(Health statements may be required for employees that did not previously enroll during their new hire
enrollment period or to increase their original beneit.)
■ Spouse coverage: $5,000 increments to a maximum of $100,000, not to exceed 50% of the Employee’s
Optional Life Beneit. (Health statements may be required for spouses if the spouse was not previously
enrolled during the employee’s new hire enrollment period or to increase the spouse’s original beneit.)
■ Child coverage: Employees may elect child optional life in the amount of $1,000, up to a maximum of
$10,000, not to exceed 50% of the Employee’s Optional Life Beneit. Children are eligible from 15 days to
26 years. The child beneit is per child unit; a unit can be one (1) or more children.
Monthly Voluntary Term Life Rates (Employee and Spouse) Voluntary Life Premiums
Age Band Rate per $1,000 (Monthly—Dependent Child(ren)
Under age 20 $0.060 Amount of Coverage Per Family
20-24 $0.060 Rate per $1,000 of beneit $0.21
25-29 $0.060
30-34 $0.080
35-39 $0.090
40-44 $0.105
45-49 $0.166
50-54 $0.265
55-59 $0.430
60-64 $0.660
65-69 $1.270
70-74 $2.060
75-79 $2.060
80+ $2.060
Voluntary AD&D
Voluntary Accidental Death & Dismemberment (AD&D) is available through Anthem to Employees and their
dependents. The AD&D beneit amount will be equal to the amount of optional life insurance purchased for
yourself, spouse, or child(ren).
Voluntary Rate per $1,000
Employee $0.017
Spouse $0.017
Child(ren) $0.051
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