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Life Insurance Plans 13

Basic Life and AD&D Insurance Plan

ABC Company provides employees with Basic Life and Accidental Death & Dismemberment (AD&D)
Insurance through Anthem. There is no cost to you for this benefit.

Basic Life Insurance
If your death occurs while you are covered under the plan, your beneficiary will receive a benefit amount
equal to two times your base salary to a maximum of $750,000.

Accidental Death & Dismemberment (AD&D) Insurance
If your death is the result of an accident, your survivors are entitled to an additional benefit equal to the
Basic Life Insurance amount. You are also eligible for partial benefits if you lose your eyesight or limb(s) as
the result of an accident.

Supplemental Life and AD&D Insurance Plan

Supplemental Life Insurance
You have the opportunity to supplement your Basic Life and AD&D Insurance by purchasing Supplemental
Life Insurance through Anthem for yourself and your eligible dependents.
For Employees
You may elect a coverage amount of up to five times your annual salary to a maximum of $500,000 in
increments of $10,000. Amounts over $150,000 require evidence of insurability.
For Your Spouse
You may purchase coverage for your spouse/domestic Rates for Supplemental Life Insurance
partner in increments of $5,000. Spouse coverage is Per $1,000 of Coverage Per Month
limited to the lesser of $100,000 or 50% of your elected
benefit amount. Amounts over $30,000 require Age Employee Spouse
evidence of insurability.
<29 $ 0.07 $ 0.05
Special Note: If you or your spouse/domestic partner do not enroll in
the Supplemental Life Insurance Plan when you are first eligible, you may 30 – 34 $ 0.08 $ 0.06
enroll at a later date. However, ALL Supplemental Life Insurance coverage 35 – 39 $ 0.10 $ 0.08
amounts will require proof of good health and are subject to approval by
Anthem. 40 – 44 $ 0.16 $ 0.14
For Your Child(ren) 45 – 49 $ 0.23 $ 0.21
You may purchase coverage for your child(ren) in 50 – 54 $ 0.35 $ 0.33
$2,500 increments to a maximum of $10,000. Children 55 – 59 $ 0.54 $ 0.52
age 15 days – 26 years are eligible for coverage.
60 – 64 $ 0.78 $ 0.76
Supplemental AD&D Insurance 65 – 69 $ 1.31 $ 1.29
When you purchase supplemental life insurance for 70 – 74 $ 2.92 $ 2.90
yourself, you are automatically covered for an 75+ $ 6.82 $ 6.80
additional benefit for supplemental AD&D equal to
your supplemental life insurance coverage amount. Children: $0.20