Page 15 - MOMS NEW ALLSTATE GROUP VOLUNTARY BENEFITS

GI° Group Term to Age 100 Life Insurance, Biweekly Premium² Quotes
For Eligible EMPLOYEES of 1000+ life Employer Groups. GI° Max. $100,000.

NONTOBACCO
This rate card is for groups sitused in Virginia. This rate card expires and is no longer valid on 12/31/2021.
The appropriate Illustration Certification must be completed in all states.
Biweekly Premium for Biweekly Premium for
Issue Group Term to 100 Initial Death Benefit¹ of: Issue Group Term to 100 Initial Death Benefit¹ of:
Age $125,000 $150,000 $200,000 $250,000 Age $125,000 $150,000 $200,000 $250,000
18 $25.00³ $30.00³ $40.00³ $50.00³ 50 $67.84³ $81.42³ $108.54³ $135.68³
19 $17.32³ $20.78³ $27.70³ $34.62³ 51 $74.86³ $89.84³ $119.78³ $149.72³
20 $17.32³ $20.78³ $27.70³ $34.62³ 52 $81.94³ $98.32³ $131.08³ $163.86³
21 $17.32³ $20.78³ $27.70³ $34.62³ 53 $88.96³ $106.74³ $142.32³ $177.90³
22 $17.32³ $20.78³ $27.70³ $34.62³ 54 $95.98³ $115.16³ $153.54³ $191.92³
23 $17.32³ $20.78³ $27.70³ $34.62³ 55 $108.18³ $129.82³ $173.08³ $216.36³
24 $17.32³ $20.78³ $27.70³ $34.62³ 56 $117.94³ $141.52³ $188.70³ $235.88³
25 $17.32³ $20.78³ $27.70³ $34.62³ 57 $127.70³ $153.24³ $204.32³ $255.40³
26 $17.60³ $21.12³ $28.16³ $35.20³ 58 $137.46³ $164.96³ $219.94³ $274.92³
27 $17.90³ $21.46³ $28.62³ $35.78³ 59 $147.22³ $176.66³ $235.54³ $294.44³
28 $18.18³ $21.82³ $29.08³ $36.36³ 60 $156.88³ $188.26³ $251.00³ $313.76³
29 $18.46³ $22.16³ $29.54³ $36.94³ 61 $171.98³ $206.38³ $275.16³ $343.96³
30 $18.76³ $22.50³ $30.00³ $37.50³ 62 $187.08³ $224.50³ $299.32³ $374.14³
31 $19.72³ $23.66³ $31.54³ $39.44³ 63 $202.22³ $242.66³ $323.54³ $404.44³
32 $20.68³ $24.82³ $33.08³ $41.36³ 64 $217.32³ $260.78³ $347.70³ $434.62³
33 $21.64³ $25.96³ $34.62³ $43.28³ 65 $232.42³ $278.90³ $371.86³ $464.82³
34 $22.60³ $27.12³ $36.16³ $45.20³ 66 $255.68³ $306.82³ $409.08³ $511.36³
35 $23.56³ $28.28³ $37.70³ $47.12³ 67 $278.90³ $334.68³ $446.24³ $557.80³
36 $24.58³ $29.50³ $39.32³ $49.14³ 68 $302.18³ $362.60³ $483.46³ $604.34³
37 $26.68³ $32.02³ $42.70³ $53.38³ 69 $325.40³ $390.46³ $520.62³ $650.78³
38 $28.72³ $34.46³ $45.94³ $57.42³ 70 $348.62³ $418.34³ $557.78³ $697.22³
39 $30.72³ $36.88³ $49.16³ $61.46³ 71 ^ $410.30 $492.36 $656.46 $820.58
40 $32.74³ $39.30³ $52.40³ $65.50³ 72 ^ $425.82 $511.00 $681.32 $851.64
41 $35.92³ $43.10³ $57.46³ $71.84³ 73 ^ $442.60 $531.12 $708.16 $885.20
42 $39.04³ $46.86³ $62.46³ $78.08³ 74 ^ $466.78 $560.14 $746.86 $933.56
43 $42.16³ $50.60³ $67.48³ $84.34³ 75 ^ $495.68 $594.82 $793.08 $991.36
44 $45.34³ $54.42³ $72.54³ $90.68³ 76 ^ $611.26 $733.50 $978.00 $1,222.50
45 $48.46³ $58.16³ $77.54³ $96.94³ 77 ^ $648.14 $777.76 $1,037.00 $1,296.26
46 $52.42³ $62.90³ $83.86³ $104.82³ 78 ^ $677.94 $813.52 $1,084.70 $1,355.88
47 $56.30³ $67.56³ $90.08³ $112.60³ 79 ^ $704.52 $845.44 $1,127.24 $1,409.04
48 $60.16³ $72.18³ $96.24³ $120.30³ 80 ^ $732.70 $879.24 $1,172.32 $1,465.40
49 $64.00³ $76.80³ $102.40³ $127.98³
° Guarantee Issue (GI) underwriting limits are subject to account specific offer. Quotes denoted † or ³ require EOI.
¹ Initial Death Benefit is guaranteed level for the first five (5) years. After the first five years, the death benefit may decrease, but it will never
be less than the minimum guaranteed in the policy. The current, non-guaranteed death benefit is projected to be level to age 100.
² Premium is level to age 100. BIWEEKLY means 26 times per year.
³ Quote does not meet the minimum size requirement, i.e. the greater of $5,000 or the amount purchased by $2/week
without regard to riders, or it exceeds the CGI/GI Maximum (requires Evidence of Insurability).

^ Evidence of insurability (EOI) is required for ages 71-80 and quotes in excess of U/W offer (³).

For Agent Use Only. Not for use with consumer sales. Not to be disseminated to the public.
This rate card is for certificate form GPTLC, or state variation thereof, underwritten by American Heritage Life Insurance Company. Refer to the state specific brochure or
policy form for exact benefits, limitations, exclusions, and other provisions applicable to the state of solicitation. Allstate Benefits is the marketing name for American
Heritage Life Insurance Company, Home Office, Jacksonville, FL, a subsidiary of The Allstate Corporation. ©2021 Allstate Insurance Company.

FOR HOME OFFICE USE ONLY: Settings were Virginia-Employee-BIWEEKLY-CGI/GI-REGV-1001-TRUE-0-0-N-Initial Death Benefit-125000-150000-200000-250000

Version 5.0 (Rev. 4/15/2021) Page 1 of 2 Printed 11/22/2021 7:17 PM