Page 16 - Palomar EE Guide 01-19 FINAL

Financial Wellness

Life/AD&D Insurance Overview of Supplemental Life Premiums
Cost to You (Per Pay Period)
How to Calculate Your Premiums
Palomar Health recognizes the importance of life insurance protection and

provides you with Basic Life and Accidental Death and Dismemberment (AD&D)
Employee: Current base annual salary x coverage
insurance coverage of 1x your annual salary at no cost to you.
selected (1, 2, 3 or 4), rounded to the next highest

$1,000 (x age reduction factor of 0.65, if employee’s
Supplemental Life/AD&D Insurance age is 65 or older, and 0.50 if 70 or older) x age rate
In addition to the 1x annual salary in basic life insurance provided to you, you from the table below.
may purchase additional life insurance protection up to 4x your base annual pay,
not to exceed the lesser of $1,250,000 or your total combined basic + Spouse: Coverage selected (x age reduction factor of
supplemental, so that you may choose the coverage you and your family need. 0.65, if spouse’s age is 65 or older and 0.5 if 70 or
Accidental Death and Dismemberment (AD&D) coverage is automatically included older) x spouse age rate from table below.

as part of your life insurance election. The cost of supplemental life insurance is Child(ren): See per pay period rate below.
determined using your current base salary and your age on your effective date
and will recalculate on January 1 each year. Age Age Rate

Employee
*Employee Supplemental Life Benefit (FT, PTII, and PTI) - Additional 1, 2, 3 <30 $0.0000198
or 4x base annual salary.
30-34 $0.0000240
35-39 $0.0000300
Annual Enrollment & Evidence of Insurability Requirements 40-44 $0.0000452
At your initial eligibility, you are guaranteed the full amount. Thereafter, you will 45-49 $0.0000812
be allowed to increase your amount each year at open enrollment by one benefit 50-54 $0.0001269
level (1x your salary). Any amounts over the one benefit level will require you to 55-59 $0.0002225
complete an Evidence of Insurability (EOI) form. 60-64 $0.0003295
65+ $0.0005589
Spouse Life/AD&D Insurance
Spouse
Employee life insurance protects your dependents in the event of your death. You <30 $0.0000212
can also elect Spouse Life and AD&D coverage, which protects you in the event of 30-34 $0.0000254
your spouse’s death. Spouse coverage may not exceed the lesser of 100% of your 35-39 $0.0000318
total coverage (basic life + supplemental life) or $250,000. The cost of spouse life 40-44 $0.0000485
insurance is determined using your spouse’s age on your effective date and will 45-49 $0.0000877
recalculate on January 1 each year. 50-54 $0.0001375

55-59 $0.0002414
Spouse Life Benefit (FT, PTII, and PTI) - Increments of $1,000 (minimum 60-64 $0.0003577
$10,000) up to the lesser of 100% of the employee’s combined basic + 65+ $0.0006069
supplemental life to a maximum of $250,000.
Child(ren)
Annual Enrollment & Evidence of Insurability Requirements $5,000 Coverage $0.48/pay period
$10,000 Coverage $0.95/pay period
At your initial eligibility, your spouse is guaranteed up to $100,000. You will also
$15,000 Coverage $1.43/pay period
be allowed to increase this amount each year at open enrollment by one benefit
$20,000 Coverage $1.90/pay period
level (up to $50,000). Any amounts over these limits will require your spouse to
complete an Evidence of Insurability (EOI) form. *Employee cannot cover a spouse if the spouse is also a
Palomar Health benefitted employee.
Child Life/AD&D Insurance
You may also purchase Child Life and AD&D insurance coverage on your eligible REMINDER - Beneficiary Designation
dependents up to age 26. The coverage you select will cover all eligible You must complete the Life Insurance Beneficiary Des-
dependent children for one cost. ignation online through Lawson Employee Self Service
• Child(ren) Life/AD&D FT, PTII, and PTI) - Available in increments of $5,000
after your effective date of coverage by clicking on the
up to a maximum of $20,000. All coverage is guaranteed.
Beneficiary link. This link is available to you at any
time for updates.

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