Page 22 - National Billing

Critical Illness Insurance (GVCIP2)
from Allstate Benefits

BENEFIT AMOUNTS
†Covered dependents receive 50% of your benefit amount
INITIAL CRITICAL ILLNESS BENEFITS† PLAN 1 PLAN 2 See reverse for premiums
Heart Attack (100%) $10,000 $20,000
Stroke (100%) $10,000 $20,000
Major Organ Transplant (100%) $10,000 $20,000
End Stage Renal Failure (100%) $10,000 $20,000
Coronary Artery Bypass Surgery (25%) $2,500 $5,000
Waiver of Premium (employee only) Yes Yes
CANCER CRITICAL ILLNESS BENEFITS† PLAN 1 PLAN 2
Invasive Cancer (100%) $10,000 $20,000
Carcinoma in Situ (25%) $2,500 $5,000
SECOND EVENT BENEFITS† PLAN 1 PLAN 2
Second Event Initial Critical Illness Yes Yes
(same amount as Initial Critical Illness)
Second Event Cancer Critical Illness Yes Yes
(same amount as Cancer Critical Illness)
SUPPLEMENTAL CRITICAL ILLNESS BENEFITS II† PLAN 1 PLAN 2
Advanced Alzheimer’s Disease (25%) $2,500 $5,000
Advanced Parkinson’s Disease (25%) $2,500 $5,000
Benign Brain Tumor (100%) $10,000 $20,000
Coma (100%) $10,000 $20,000
Complete Blindness (100%) $10,000 $20,000
Complete Loss of Hearing (100%) $10,000 $20,000
Paralysis (100%) $10,000 $20,000
OPTIONAL/ADDITIONAL BENEFIT PLAN 1 PLAN 2
Wellness Benefit (per year) $50 $50

ABJ30427-1 - Insert - 08333
PLAN 1 - WEEKLY PREMIUMS PLAN 2 - WEEKLY PREMIUMS
GVCIP2BFL 4 POD86608
$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
18-24 $1.08 $1.58 18-24 $1.73 $2.54
25-29 $1.12 $1.66 25-29 $1.78 $2.62
30-35 $1.42 $2.11 30-35 $2.34 $3.45
36-39 $1.87 $2.80 36-39 $3.24 $4.82
40-44 $2.49 $3.74 40-44 $4.46 $6.65
45-50 $3.53 $5.27 45-50 $6.52 $9.72
51-54 $4.91 $7.33 51-54 $9.30 $13.84
55-60 $6.60 $9.86 55-60 $12.69 $18.93
61-70 $8.96 $13.34 61-70 $17.42 $25.93
71+ $13.30 $19.83 71+ $26.12 $38.94
Tobacco Tobacco
18-24 $1.45 $2.13 18-24 $2.48 $3.64
25-29 $1.50 $2.21 25-29 $2.53 $3.73
30-35 $1.95 $2.90 30-35 $3.39 $5.03
36-39 $2.81 $4.18 36-39 $5.11 $7.58
40-44 $3.84 $5.76 40-44 $7.16 $10.70
45-50 $5.63 $8.42 45-50 $10.72 $16.00
51-54 $7.60 $11.36 51-54 $14.67 $21.89
55-60 $10.57 $15.89 55-60 $20.63 $31.00
61-70 $13.27 $19.98 61-70 $26.04 $39.21
71+ $18.66 $28.30 71+ $36.83 $55.86
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
18-24 $4.67 $6.81 18-24 $7.50 $10.97
25-29 $4.85 $7.17 25-29 $7.68 $11.35
30-35 $6.14 $9.11 30-35 $10.12 $14.92
36-39 $8.09 $12.10 36-39 $14.03 $20.88
40-44 $10.77 $16.18 40-44 $19.30 $28.82
45-50 $15.26 $22.84 45-50 $28.22 $42.09
51-54 $21.27 $31.73 51-54 $40.27 $59.96
55-60 $28.58 $42.70 55-60 $54.96 $82.02
61-70 $38.80 $57.79 61-70 $75.48 $112.35
71+ $57.63 $85.93 71+ $113.19 $168.71
Tobacco Tobacco
18-24 $6.28 $9.20 18-24 $10.73 $15.76
25-29 $6.47 $9.58 25-29 $10.93 $16.15
30-35 $8.43 $12.53 30-35 $14.69 $21.76
36-39 $12.14 $18.08 36-39 $22.14 $32.85
40-44 $16.63 $24.95 40-44 $30.99 $46.33
45-50 $24.38 $36.47 45-50 $46.45 $69.31
51-54 $32.93 $49.21 51-54 $63.57 $94.86
55-60 $45.79 $68.86 55-60 $89.38 $134.30
61-70 $57.48 $86.57 61-70 $112.82 $169.88
71+ $80.84 $122.60 71+ $159.60 $242.03
EE=Employee; EE + SP = Employee + Spouse;
EE + CH = Employee + Child(ren); F = Family