Page 17 - 2021 Sample Benefit Booklet

VOLUNTARY LIFE/AD&D COVERAGE

UNUM

Eligible employees are given the option to purchase additional Life and Accidental Death & Dismemberment
(AD&D) Insurance coverage at an additional cost. Benefit amounts over the guaranteed issue limits are re-
quired to complete and Evidence of Insurability (EOI) questionnaire and are subject to medical and underwriting
approval.

You should designate a beneficiary for your Life, AD&D and, if applicable, you may change your beneficiaries at
any time. Simply request the appropriate form from the HR Representative for yourprogram.

Voluntary Life/AD&D InsuranceCoverage
Benefits Voluntary Employee Life Voluntary SpouseLife Voluntary ChildLIfe
Voluntary Life Benefit $10,000 Increments $5,000 Increments 0-6 Months:$1,000
6 Mo to 26yrs: $2,000Incre-
ments
Basic AD&D Benefit Benefit matches lifebenefit Benefit matches lifebenefit Benefit matches lifebenefit

Minimum Benefit $10,000 $15,000 $1,000
Maximum Benefit $500,000, not to exceed5x $500,000 not to exceed $10,000
Earnings 100% of employee’samount
Guaranteed Issue $50,000 $5,000 $10,000

Age Based BenefitRe- To 65% at age 65;. 50% at To 65% at age 65;. 50% at N/A
duction age 70; 25% at age 75; and age 70; 25% at age 75; and
10% at age 80 10% at age 80

Term Life Coverage MonthlyRates AD&D Coverage Monthly Rates

Age Employee Spouse/DP Child AD&D Cost Per: Monthly Rate:
Band per $10,000 per $5,000 per $2,000 Employee: $10,000 $.314
Spouse/DP: $5,000 $.165
$.839 Child: $2,000 $.060
- 24 $.510 $.275
25-29 $.560 $.300 NOTE: The NOTE:
30-34 $.760 $.400 premium paid Rates shown are your monthlydeduction.
35-39 $1.120 $.575 for child
40-44 $1.710 $.865 coverage is Your rate is based on your actual age as of the effective
45-49 $2.670 $1.350 based on the date.
50-54 $3.930 $2.005 cost of Your spouse’s age is based on their age as of the effective
55-59 $5.630 $2.960 coverage for date.
60-64 $7.250 $4.100 one child, Your rate will increase as you age and move to the nextage
65-69 $10.310 $5.840 regardless of band.
70-74 $19.500 $11.050 how many
75+ $60.270 $34.160 children you
have.

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