Page 249 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat

2 (additional) Dependents Life Insurance Benefit for your Spouse that exceeds the Guarantee
Issue Amount.
5. If your Child is eligible but not insured for additional Dependents Life Insurance, requirements
a. and c. above will be waived for your Child if you apply for additional Dependents Life Insurance
for your Child up to $10,000 during your Employer’s Annual Open Enrollment.
6. If your Child is insured for an amount of additional Dependents Life Insurance less than $10,000,
requirement f. above will be waived for your Child if you apply for an increase in additional
Dependents Life Insurance for your Child up to $10,000 during your Employer’s Annual Open
Enrollment.
Annual Enrollment Period means the period designated each year by your Employer when you may
change insurance elections.

PREMIUM CONTRIBUTIONS

Life Insurance: Plan 1: Noncontributory
Plan 2: Contributory

AD&D Insurance:
Member: Plan 1: Noncontributory
Plan 2: Contributory

Dependents Life Insurance:
Spouse: Plan 1: Noncontributory
Plan 2: Contributory

Child: Plan 1: Noncontributory
Plan 2: Contributory

SCHEDULE OF INSURANCE

SCHEDULE OF LIFE INSURANCE
For you:
Life Insurance Benefit:
You will become insured under Plan 1 if you meet the requirements to become insured under
the Group Policy.
If you are insured under Plan 1, you may also become insured under Plan 2 if you meet the
requirements to become insured under Plan 2 Life Insurance under the Group Policy. Plan 2 is
a Contributory plan requiring premium contributions from Members.

Plan 1 (basic): Class 1: 2 times your Annual Earnings, rounded to the next
higher multiple of $1,000, if not already a multiple of
$1,000. The maximum amount is $80,000.

Class 2: 2 times your Annual Earnings minus $20,000,
rounded to the next higher multiple of $1,000, if not already
a multiple of $1,000. The maximum amount is $80,000
when combined with the Minor League Health & Welfare
Plan Benefit.

Revised 08/10/2021 - 3 - 151138-D