Page 289 - Aida Hovsepian Onboarding

Voluntary Life rates

Employee Voluntary Life
-
Participating Monthly Estimated Estimated
Age band em • lo ees rate monthly volume monthly premium
Under age 20 0 50.030 $0 $0
20-24 0 $0.030 SO $0
25-29 0 $0.030 $0 $0
30-34 4 50.040 $720,000 $29
35-39 3 $0.070 $130,000 $9
40-44 1 $0.120 $300,000 $36
45-49 2 $0.170 $320,000 $54
50-54 5 $0.350 $780,000 $273
55-59 6 $0.540 $430,000 $232
60-64 2 50.550 $270,000 $149
65-69 2 50.990 $159,500 $158
70-74 0 $2.640 $0 $0
75-79 0 52.640 $0 $0
80-84 0 $2.640 $0 $0
85 and over 0 $2.640 $0 $0
Rate basis: Per $1,000 of volume
Spouse Voluntary life
Participating Monthly Estimated Estimated
nd employees rate monthly volume monthly premium
Under age 20 0 $0.030 $0 $0
'-'—
A 20-24 0 $0.030 $0 $0
25-29 0 $0.030 $0 $0
30-34 3 50.040 $520,000 $21
35-39 2 $0.070 $120,000 $8
40-44 0 50.120 $01 50
45-49 2 $0.170 $260,000 $44
50-54 3 50.350 $60,000 $21
55-59 4 $0.540 $115,000 $62
60-64 0 50.550 $0 $0
65-69 2 50.990 $43,000 $43
_ Rate basis: Per $1,000 of volume

Included in ttiit" plan:

O 24-month rate guarantee from the Effective Date
O Employee age reductions: All coverage amounts reduce to 67% at age 70, 50% at age 75.
• Spouse age reductions: None
* Waiver of Premium: For employees with an approved disability prior to age 65, premium is waived until age 65 or for 12 months
(whichever is later). For employees disabled on or after age 65 but prior to age 70, premium is waived for 12 months. There is no
Elimination Period to satisfy before the Waiver of Premium begins. The definition of Total Disability is disabled from any
Group Voluntary Life coverage is underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) under Policy Form Series 15-GP-01
October 30, 2018

Proposal for Centralized Supply Chain Services LLC Case ID: 1208371

Page 9 of 39 rev. 0609061S GGOT-12.88