Page 16 - 2019 Benefit Guide Non-CA

BASIC LIFE AND VOLUNTARY LIFE INSURANCE PLANS

Employees must enroll in employee coverage for dependents to be eligible for this benefit.
Your spouse’s rate is based on your age. The premium amount is found in the box where the row (your age) and
the column (benefit amount) intersect. Spouse coverage ends at the age of 70.

SPOUSE PREMIUM TABLE (PER PAYCHECK)
$5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

0-29 $0.28 $0.55 $0.82 $1.10 $1.38 $1.65 $1.92 $2.20 $2.48 $2.75
30-34 $0.30 $0.60 $0.90 $1.20 $1.50 $1.80 $2.10 $2.40 $2.70 $3.00

35-39 $0.35 $0.70 $1.05 $1.40 $1.75 $2.10 $2.45 $2.80 $3.15 $3.50

40-44 $0.48 $0.95 $1.42 $1.90 $2.38 $2.85 $3.32 $3.80 $4.28 $4.75
45-49 $0.75 $1.50 $2.25 $3.00 $3.75 $4.50 $5.25 $6.00 $6.75 $7.50

50-54 $1.18 $2.35 $3.52 $4.70 $5.88 $7.05 $8.22 $9.40 $10.58 $11.75
55-59 $1.78 $3.55 $5.32 $7.10 $8.88 $10.65 $12.42 $14.20 $15.98 $17.75

60-64 $2.72 $5.45 $8.18 $10.90 $13.62 $16.35 $19.08 $21.80 $24.52 $27.25
65-69 $4.82 $9.65 $14.48 $19.30 $24.12 $28.95 $33.78 $38.60 $43.42 $48.25

ALL CHILDREN PREMIUM TABLE (PER PAYCHECK)
$2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000

$0.18 $0.27 $0.36 $0.45 $0.54 $0.63 $0.72 $0.81 $0.90
If you wish to calculate the total semi-monthly premium for your Voluntary Term Life and AD&D benefits for your
own information, enter the appropriate amounts below:

Employee Premium + Spouse Premium + Children Premium = Semi-Monthly Premium

+ + =
Employee Premium Spouse Premium Children Premium Semi-Monthly Premium

Please note that you must enroll in the Voluntary Life benefits to add coverage for your spouse and/or children.

*Not all employment categories are eligible for voluntary life insurance.
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