Page 10 - Alpine & Rafetto v.2

Non-Tobacco - SI

Horizon Payroll Term* (Includes Policy Fee)
FOR AGENT USE ONLY
Information for Payroll Deduction Quotations
The appropriate illustration certification form must be completed in states that have adopted the Life Insurance Illustration Regulation.
$25,000 Death Benefit $50,000 Death Benefit $75,000 Death Benefit $100,000 Death Benefit
Issue Issue
Current** Maximum‡ Current** Maximum‡ Current** Maximum‡ Current** Maximum‡
Age Age
Monthly Weekly Monthly Weekly Monthly Weekly Monthly Weekly Monthly Weekly Monthly Weekly Monthly Weekly Monthly Weekly
18 N/A† N/A† N/A† N/A† $ 11.60 $ 2.68 $ 13.64 $ 3.15 $ 15.12 $ 3.49 $ 18.19 $ 4.20 $ 18.64 $ 4.31 $ 22.73 $ 5.25 18
19 N/A† N/A† N/A† N/A† 11.60 2.68 13.64 3.15 15.12 3.49 18.19 4.20 18.64 4.31 22.73 5.25 19
20 N/A† N/A† N/A† N/A† 11.60 2.68 13.64 3.15 15.12 3.49 18.19 4.20 18.64 4.31 22.73 5.25 20
21 N/A† N/A† N/A† N/A† 11.60 2.68 13.64 3.15 15.12 3.49 18.19 4.20 18.64 4.31 22.73 5.25 21
22 N/A† N/A† N/A† N/A† 11.60 2.68 13.64 3.15 15.12 3.49 18.19 4.20 18.64 4.31 22.73 5.25 22
23 N/A† N/A† N/A† N/A† 11.60 2.68 14.00 3.23 15.12 3.49 18.73 4.33 18.64 4.31 23.46 5.42 23
24 N/A† N/A† N/A† N/A† 11.60 2.68 14.46 3.34 15.12 3.49 19.41 4.48 18.64 4.31 24.37 5.63 24
25 N/A† N/A† N/A† N/A† 11.60 2.68 15.00 3.47 15.12 3.49 20.23 4.67 18.64 4.31 25.46 5.88 25
26 N/A† N/A† N/A† N/A† 11.60 2.68 15.64 3.61 15.12 3.49 21.19 4.89 18.64 4.31 26.73 6.17 26
27 N/A† N/A† N/A† N/A† 11.60 2.68 16.37 3.78 15.12 3.49 22.28 5.15 18.64 4.31 28.19 6.51 27
28 N/A† N/A† N/A† N/A† 11.60 2.68 17.14 3.96 15.12 3.49 23.44 5.41 18.64 4.31 29.73 6.86 28
29 N/A† N/A† N/A† N/A† 11.60 2.68 18.05 4.17 15.12 3.49 24.80 5.73 18.64 4.31 31.55 7.28 29
30 N/A† N/A† N/A† N/A† 11.60 2.68 19.05 4.40 15.12 3.49 26.30 6.07 18.64 4.31 33.55 7.75 30
31 N/A† N/A† N/A† N/A† 12.10 2.80 20.14 4.65 15.87 3.67 27.94 6.45 19.64 4.54 35.73 8.25 31
32 N/A† N/A† N/A† N/A† 12.64 2.92 21.37 4.94 16.69 3.86 29.78 6.88 20.73 4.79 38.19 8.82 32
33 $ 8.89 $ 2.06 $ 13.64 $ 3.15 13.23 3.06 22.73 5.25 17.57 4.06 31.82 7.35 21.91 5.06 40.91 9.44 33
34 9.21 2.13 14.39 3.32 13.87 3.20 24.23 5.60 18.53 4.28 34.07 7.87 23.19 5.36 43.91 10.14 34
35 9.55 2.21 15.23 3.52 14.55 3.36 25.91 5.98 19.55 4.52 36.60 8.45 24.55 5.67 47.28 10.91 35
36 9.91 2.29 16.16 3.73 15.28 3.53 27.78 6.41 20.64 4.77 39.39 9.09 26.00 6.00 51.00 11.77 36
37 10.32 2.39 17.19 3.97 16.10 3.72 29.82 6.89 21.87 5.05 42.46 9.80 27.64 6.38 55.10 12.72 37
38 10.73 2.48 18.35 4.24 16.91 3.91 32.14 7.42 23.10 5.33 45.94 10.61 29.28 6.76 59.73 13.79 38
39 11.19 2.59 19.60 4.53 17.82 4.12 34.64 8.00 24.46 5.65 49.69 11.47 31.10 7.18 64.73 14.94 39
40 11.66 2.69 21.00 4.85 18.78 4.34 37.46 8.65 25.89 5.98 53.91 12.44 33.00 7.62 70.37 16.24 40
41 12.19 2.82 22.57 5.21 19.82 4.58 40.60 9.37 27.46 6.34 58.62 13.53 35.10 8.10 76.64 17.69 41
42 12.75 2.95 24.28 5.61 20.96 4.84 44.00 10.16 29.16 6.73 63.73 14.71 37.37 8.63 83.46 19.26 42
43 13.35 3.08 26.21 6.05 22.14 5.11 47.87 11.05 30.94 7.14 69.53 16.05 39.73 9.17 91.19 21.05 43
44 13.98 3.23 28.35 6.55 23.41 5.41 52.14 12.04 32.85 7.58 75.94 17.53 42.28 9.76 99.73 23.02 44
45 14.66 3.39 30.75 7.10 24.78 5.72 56.96 13.15 34.89 8.06 83.16 19.19 45.00 10.39 109.37 25.24 45
46 15.41 3.56 33.41 7.71 26.28 6.07 62.28 14.38 37.14 8.57 91.14 21.04 48.00 11.08 120.00 27.70 46
47 16.21 3.74 36.37 8.40 27.87 6.44 68.19 15.74 39.53 9.13 100.00 23.08 51.19 11.82 131.82 30.42 47
48 17.05 3.94 39.60 9.14 29.55 6.82 74.64 17.23 42.05 9.71 109.69 25.32 54.55 12.59 144.73 33.40 48
49 17.96 4.15 43.16 9.96 31.37 7.24 81.78 18.88 44.78 10.34 120.39 27.79 58.19 13.43 159.00 36.70 49
50 18.94 4.37 47.10 10.87 33.32 7.69 89.64 20.69 47.71 11.01 132.19 30.51 62.10 14.33 174.73 40.33 50
51* 19.98 4.61 49.25 11.37 35.41 8.18 93.96 21.69 50.85 11.74 138.66 32.00 66.28 15.30 183.37 42.32 51*
52* 21.12 4.88 51.55 11.90 37.69 8.70 98.55 22.75 54.25 12.52 145.55 33.59 70.82 16.35 192.55 44.44 52*
53* 22.39 5.17 53.98 12.46 40.23 9.29 103.41 23.87 58.07 13.40 152.85 35.28 75.91 17.52 202.28 46.68 53*
54* 23.75 5.48 56.55 13.05 42.96 9.92 108.55 25.05 62.16 14.35 160.55 37.05 81.37 18.78 212.55 49.05 54*
55* 25.25 5.83 59.30 13.69 45.96 10.61 114.05 26.32 66.66 15.39 168.80 38.96 87.37 20.17 223.55 51.59 55*
56* 26.87 6.20 62.21 14.36 49.19 11.36 119.87 27.67 71.50 16.50 177.53 40.97 93.82 21.65 235.19 54.28 56*
57* 28.62 6.61 65.30 15.07 52.69 12.16 126.05 29.09 76.75 17.72 186.80 43.11 100.82 23.27 247.55 57.13 57*
58* 30.50 7.04 68.55 15.82 56.46 13.03 132.55 30.59 82.41 19.02 196.55 45.36 108.37 25.01 260.55 60.13 58*
59* 32.55 7.52 71.96 16.61 60.55 13.98 139.37 32.17 88.55 20.44 206.78 47.72 116.55 26.90 274.19 63.28 59*
60* 34.80 8.03 75.50 17.43 65.05 15.02 146.46 33.80 95.30 22.00 217.41 50.18 125.55 28.98 288.37 66.55 60*
61* 37.23 8.60 78.96 18.23 69.91 16.14 153.37 35.40 102.60 23.68 227.78 52.57 135.28 31.22 302.19 69.74 61*
62* 39.85 9.20 82.57 19.06 75.14 17.34 160.60 37.07 110.44 25.49 238.62 55.07 145.73 33.63 316.64 73.07 62*
63* 42.62 9.84 86.39 19.94 80.69 18.62 168.23 38.83 118.75 27.41 250.07 57.71 156.82 36.19 331.91 76.60 63*
64* 45.53 10.51 90.41 20.87 86.50 19.97 176.28 40.68 127.48 29.42 262.14 60.50 168.46 38.88 348.00 80.31 64*
65* 48.57 11.21 99.46 22.96 92.60 21.37 194.37 44.86 136.62 31.53 289.28 66.76 180.64 41.69 384.19 88.66 65*
* The Horizon Payroll Term (P20RCT) provides a level death benefit for the lesser of 20 years or to age 70. After the initial term period, the policy can be renewed for successive term periods prior to
age 70.
** Current Premiums are guaranteed for the first 5 policy years. After 5 years, we may increase or decrease the premium, but it will never exceed the maximum premium.
‡ This is the maximum premium for the initial term period. The maximum premium for subsequent term periods is based on the attained age of the insured at the time of renewal.
† Premium is less than the required minimum premium amount of $2.00 weekly or $8.66 monthly.
This rate card is for form P20RCT or state variations thereof and is incomplete without a corresponding brochure that describes the benefits, exclusions, and limitations
of the form. The policy is issued by American Heritage Life Insurance Company. Allstate Benefits is the marketing name used by American Heritage Life Insurance
Company (Home Office: Jacksonville, FL), a subsidiary of The Allstate Corporation. © 2018 Allstate Insurance Company
This rate card is approved for use in: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MN, MS, MO,
MT, NE, NV, NH, NJ, NM, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VI, VA, WA, WV, WI, WY
This rate card expires and is no longer valid after 12/31/2019 or the expiry date of the corresponding brochure(s), if earlier.
(Rev. 12/18)
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