Page 33 - SMS WV Overview.pdf

PLAN 1 - WEEKLY PREMIUMS PLAN 2 - WEEKLY PREMIUMS
$10,000 Basic Benefit Amount $20,000 Basic Benefit Amount
EE, EE + CH EE + SP, F EE, EE + CH EE + SP, F
AGE Non-Tobacco AGE Non-Tobacco
18-35 $1.92 $2.89 18-35 $3.35 $5.03
36-50 $4.49 $6.75 36-50 $8.50 $12.75
51-60 $9.31 $13.98 51-60 $18.14 $27.22
61-63 $14.58 $21.88 61-63 $28.67 $43.02
64+ $21.56 $32.36 64+ $42.64 $63.97
Tobacco Tobacco
18-35 $3.02 $4.55 18-35 $5.56 $8.35
36-50 $7.50 $11.26 36-50 $14.50 $21.77
51-60 $15.56 $23.36 51-60 $30.64 $45.97
61-63 $22.53 $33.80 61-63 $44.56 $66.86
64+ $33.41 $50.13 64+ $66.34 $99.52
PLAN 1 - MONTHLY PREMIUMS PLAN 2 - MONTHLY PREMIUMS
$10,000 Basic Benefit Amount $20,000 Basic Benefit Amount
EE, EE + CH EE + SP, F EE, EE + CH EE + SP, F
AGE Non-Tobacco AGE Non-Tobacco
18-35 $8.30 $12.51 18-35 $14.49 $21.79
36-50 $19.44 $29.23 36-50 $36.80 $55.24
51-60 $40.34 $60.56 51-60 $78.58 $117.92
61-63 $63.17 $94.81 61-63 $124.24 $186.41
64+ $93.43 $140.20 64+ $184.76 $277.19
Tobacco Tobacco
18-35 $13.09 $19.70 18-35 $24.07 $36.16
36-50 $32.48 $48.77 36-50 $62.82 $94.30
51-60 $67.43 $101.20 51-60 $132.75 $199.18
61-63 $97.60 $146.46 61-63 $193.09 $289.69
64+ $144.78 $217.23 64+ $287.44 $431.22
EE=Employee; EE + SP = Employee + Spouse;
EE + CH = Employee + Child(ren); F = Family

FOR HOME OFFICE USE ONLY - GVCIP2
Opt 1 - PX; 1.0U Base; CR; 2CIR; 2CR; SBR W/O; 2.0U WR;
Opt 2 - PX; 2.0U Base; CR; 2CIR; 2CR; SBR W/O; 2.0U WR;
ABQ V 09.09.2019 Rate Insert Creation Date: 10/1/2019

For use in enrollments sitused in: WV. This rate insert is part of the approved brochure for or form ABJ30427-1. It is not to be used on its own.
This material is valid as long as information remains current, but in no event later than October 1, 2022. Allstate Benefits is the marketing name used by
American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. ©2019 Allstate Insurance Company.
www.allstate.com or allstatebenefits.com.
ABJ30427-1 - Insert - 73611
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