Page 16 - 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.

TOBACCO
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 This rate card expires and is no longer valid on 12/31/2021.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 Issue age 18 will always be issued Nontobacco. 50 $113.32³ $136.00³ $181.32³ $226.64³
19 $19.24³ $23.08³ $30.78³ $38.46³ 51 $123.70³ $148.46³ $197.92³ $247.42³
20 $20.20³ $24.24³ $32.32³ $40.40³ 52 $133.80³ $160.56³ $214.08³ $267.60³
21 $21.16³ $25.40³ $33.86³ $42.32³ 53 $144.28³ $173.14³ $230.86³ $288.56³
22 $22.12³ $26.54³ $35.40³ $44.24³ 54 $154.48³ $185.38³ $247.16³ $308.96³
23 $23.08³ $27.70³ $36.94³ $46.16³ 55 $163.80³ $196.56³ $262.08³ $327.60³
24 $24.04³ $28.86³ $38.46³ $48.08³ 56 $176.98³ $212.38³ $283.16³ $353.96³
25 $25.00³ $30.00³ $40.00³ $50.00³ 57 $189.62³ $227.54³ $303.40³ $379.24³
26 $25.96³ $31.16³ $41.54³ $51.94³ 58 $201.94³ $242.32³ $323.08³ $403.86³
27 $26.92³ $32.32³ $43.08³ $53.86³ 59 $214.58³ $257.50³ $343.32³ $429.14³
28 $27.90³ $33.46³ $44.62³ $55.78³ 60 $227.08³ $272.50³ $363.32³ $454.14³
29 $28.86³ $34.62³ $46.16³ $57.70³ 61 $245.68³ $294.82³ $393.08³ $491.36³
30 $29.82³ $35.78³ $47.70³ $59.62³ 62 $264.04³ $316.86³ $422.46³ $528.08³
31 $30.78³ $36.94³ $49.24³ $61.54³ 63 $281.84³ $338.20³ $450.94³ $563.66³
32 $31.74³ $38.08³ $50.78³ $63.46³ 64 $299.24³ $359.08³ $478.78³ $598.48³
33 $32.70³ $39.24³ $52.32³ $65.40³ 65 $315.54³ $378.64³ $504.86³ $631.06³
34 $33.66³ $40.40³ $53.86³ $67.32³ 66 $346.20³ $415.46³ $553.94³ $692.42³
35 $34.62³ $41.54³ $55.40³ $69.24³ 67 $376.16³ $451.40³ $601.86³ $752.32³
36 $38.14³ $45.76³ $61.00³ $76.26³ 68 $405.40³ $486.46³ $648.62³ $810.78³
37 $41.50³ $49.80³ $66.40³ $82.98³ 69 $434.00³ $520.80³ $694.40³ $868.00³
38 $45.00³ $54.00³ $72.00³ $90.00³ 70 $461.78³ $554.14³ $738.86³ $923.56³
39 $48.70³ $58.46³ $77.92³ $97.42³ 71 ^ $537.16 $644.60 $859.48 $1,074.34
40 $52.18³ $62.60³ $83.46³ $104.34³ 72 ^ $561.78 $674.14 $898.86 $1,123.56
41 $57.60³ $69.12³ $92.16³ $115.20³ 73 ^ $588.86 $706.62 $942.16 $1,177.70
42 $63.14³ $75.76³ $101.00³ $126.26³ 74 ^ $619.24 $743.08 $990.78 $1,238.46
43 $68.56³ $82.28³ $109.70³ $137.12³ 75 ^ $653.46 $784.16 $1,045.54 $1,306.94
44 $74.10³ $88.92³ $118.54³ $148.18³ 76 ^ $693.56 $832.28 $1,109.70 $1,387.12
45 $79.38³ $95.26³ $127.00³ $158.76³ 77 ^ $718.28 $861.94 $1,149.24 $1,436.54
46 $85.82³ $103.00³ $137.32³ $171.64³ 78 ^ $744.52 $893.44 $1,191.24 $1,489.04
47 $92.60³ $111.12³ $148.16³ $185.20³ 79 ^ $772.22 $926.66 $1,235.54 $1,544.44
48 $99.58³ $119.50³ $159.32³ $199.14³ 80 ^ $801.36 $961.62 $1,282.16 $1,602.70
49 $106.54³ $127.86³ $170.46³ $213.08³

° 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 2 of 2 Printed 11/22/2021 7:17 PM