Page 12 - NextCare Holdings 2022 Benefits Guide
P. 12
Additional Voluntary Life Details
Should you wish to enroll in an amount greater than $150,000 for yourself or greater than $30,000 for your
spouse, you will be required to complete an evidence of insurability application.
If you decline this coverage when irst eligible, you may join at the next open enrollment period but will be
subject to completing the personal health application for any amount of coverage elected. A personal health
application will be required for any change in coverage once elected also.
Please see the NextCare Intranet beneits page for more details.
Conversion Benefit
If you are an active employee, terminated employee, retiree, or dependent who may be faced with losing all
coverage or even a portion of your coverage under NextCare’s Group life plan(s), you and/or your dependents
may be eligible to continue the lost amount of coverage without submitting evidence of good health.
You have 31 days from the date of your termination to participate in life insurance and long term disability
conversion. If your employment is terminating because you are disabled, you will need to convert your life
insurance coverage to be eligible for Waiver of Premium.
Please contact Michelle Geeve to obtain the Notice of Conversion and/or Portability Rights Form. This form
must be completed and submitted to New York Life within 91 days of the date of your coverage change.
VOLUNTARY RATES
Employee Supplemental Life/AD&D Cost Per Pay Period
Important: Maximum Coverage is Five (5) Times Your Current Annual Pay
Less Than
Coverage 30 Years 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70+ Years
Amount Old Years Old Years Old Years Old Years Old Years Old Years Old Years Old Years Old Old
$10,000 $0.36 $0.46 $0.56 $0.69 $0.99 $1.54 $2.63 $3.62 $6.54 $11.75
$20,000 $0.73 $0.91 $1.13 $1.38 $1.98 $3.08 $5.25 $7.25 $13.09 $23.49
$30,000 $1.09 $1.37 $1.69 $2.08 $2.96 $4.62 $7.88 $10.87 $19.63 $35.24
$40,000 $1.46 $1.83 $2.25 $2.77 $3.95 $6.17 $10.50 $14.49 $26.18 $46.98
$50,000 $1.82 $2.28 $2.82 $3.46 $4.94 $7.71 $13.13 $18.12 $32.72 $58.73
$60,000 $2.19 $2.74 $3.38 $4.15 $5.93 $9.25 $15.76 $21.74 $39.27 $70.48
$70,000 $2.55 $3.20 $3.94 $4.85 $6.91 $10.79 $18.38 $25.36 $45.81 $82.22
$80,000 $2.92 $3.66 $4.50 $5.54 $7.90 $12.33 $21.01 $28.98 $52.36 $93.97
$90,000 $3.28 $4.11 $5.07 $6.23 $8.89 $13.87 $23.64 $32.61 $58.90 $105.72
$100,000 $3.65 $4.57 $5.63 $6.92 $9.88 $15.42 $26.26 $36.23 $65.45 $117.46
$110,000 $4.01 $5.03 $6.19 $7.62 $10.86 $16.96 $28.89 $39.85 $71.99 $129.21
$120,000 $4.38 $5.48 $6.76 $8.31 $11.85 $18.50 $31.51 $43.48 $78.54 $140.95
$130,000 $4.74 $5.94 $7.32 $9.00 $12.84 $20.04 $34.14 $47.10 $85.08 $152.70
$140,000 $5.10 $6.40 $7.88 $9.69 $13.83 $21.58 $36.77 $50.72 $91.62 $164.45
$150,000 $5.47 $6.85 $8.45 $10.38 $14.82 $23.12 $39.39 $54.35 $98.17 $176.19
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Should you wish to enroll in an amount greater than $150,000 for yourself or greater than $30,000 for your
spouse, you will be required to complete an evidence of insurability application.
If you decline this coverage when irst eligible, you may join at the next open enrollment period but will be
subject to completing the personal health application for any amount of coverage elected. A personal health
application will be required for any change in coverage once elected also.
Please see the NextCare Intranet beneits page for more details.
Conversion Benefit
If you are an active employee, terminated employee, retiree, or dependent who may be faced with losing all
coverage or even a portion of your coverage under NextCare’s Group life plan(s), you and/or your dependents
may be eligible to continue the lost amount of coverage without submitting evidence of good health.
You have 31 days from the date of your termination to participate in life insurance and long term disability
conversion. If your employment is terminating because you are disabled, you will need to convert your life
insurance coverage to be eligible for Waiver of Premium.
Please contact Michelle Geeve to obtain the Notice of Conversion and/or Portability Rights Form. This form
must be completed and submitted to New York Life within 91 days of the date of your coverage change.
VOLUNTARY RATES
Employee Supplemental Life/AD&D Cost Per Pay Period
Important: Maximum Coverage is Five (5) Times Your Current Annual Pay
Less Than
Coverage 30 Years 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70+ Years
Amount Old Years Old Years Old Years Old Years Old Years Old Years Old Years Old Years Old Old
$10,000 $0.36 $0.46 $0.56 $0.69 $0.99 $1.54 $2.63 $3.62 $6.54 $11.75
$20,000 $0.73 $0.91 $1.13 $1.38 $1.98 $3.08 $5.25 $7.25 $13.09 $23.49
$30,000 $1.09 $1.37 $1.69 $2.08 $2.96 $4.62 $7.88 $10.87 $19.63 $35.24
$40,000 $1.46 $1.83 $2.25 $2.77 $3.95 $6.17 $10.50 $14.49 $26.18 $46.98
$50,000 $1.82 $2.28 $2.82 $3.46 $4.94 $7.71 $13.13 $18.12 $32.72 $58.73
$60,000 $2.19 $2.74 $3.38 $4.15 $5.93 $9.25 $15.76 $21.74 $39.27 $70.48
$70,000 $2.55 $3.20 $3.94 $4.85 $6.91 $10.79 $18.38 $25.36 $45.81 $82.22
$80,000 $2.92 $3.66 $4.50 $5.54 $7.90 $12.33 $21.01 $28.98 $52.36 $93.97
$90,000 $3.28 $4.11 $5.07 $6.23 $8.89 $13.87 $23.64 $32.61 $58.90 $105.72
$100,000 $3.65 $4.57 $5.63 $6.92 $9.88 $15.42 $26.26 $36.23 $65.45 $117.46
$110,000 $4.01 $5.03 $6.19 $7.62 $10.86 $16.96 $28.89 $39.85 $71.99 $129.21
$120,000 $4.38 $5.48 $6.76 $8.31 $11.85 $18.50 $31.51 $43.48 $78.54 $140.95
$130,000 $4.74 $5.94 $7.32 $9.00 $12.84 $20.04 $34.14 $47.10 $85.08 $152.70
$140,000 $5.10 $6.40 $7.88 $9.69 $13.83 $21.58 $36.77 $50.72 $91.62 $164.45
$150,000 $5.47 $6.85 $8.45 $10.38 $14.82 $23.12 $39.39 $54.35 $98.17 $176.19
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