Page 27 - QSC Benefits Guide 7-17 COLORADO

YOUR COST FOR COVERAGE - PER MONTH

This is a sample of the monthly Voluntary Life and AD&D rates. If elected, you will pay for this coverage with after-tax dollars
through convenient payroll deductions. Additional coverage options are available up to $500,000. Please contact the Human
Resources Department for additional rate calculations.

Employee: Voluntary Life
Age Band: $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000
25-29 $0.60 $1.20 $1.80 $2.40 $3.00 $3.60 $4.20 $4.80 $5.40 $6.00
30-34 $0.70 $1.40 $2.10 $2.80 $3.50 $4.20 $4.90 $5.60 $6.30 $7.00
35-39 $0.90 $1.80 $2.70 $3.60 $4.50 $5.40 $6.30 $7.20 $8.10 $9.00
40-44 $1.40 $2.80 $4.20 $5.60 $7.00 $8.40 $9.80 $11.20 $12.60 $14.00
45-49 $2.40 $4.80 $7.20 $9.60 $12.00 $14.40 $16.80 $19.20 $21.60 $24.00
50-54 $3.90 $7.80 $11.70 $15.60 $19.50 $23.40 $27.30 $31.20 $35.10 $39.00
55-59 $6.10 $12.20 $18.30 $24.40 $30.50 $36.60 $42.70 $48.80 $54.90 $61.00
60-64 $9.50 $19.00 $28.50 $38.00 $47.50 $57.00 $66.50 $76.00 $85.50 $95.00
65-69 $17.00 $34.00 $51.00 $68.00 $85.00 $102.00 $119.00 $136.00 $153.00 $170.00
70-74 $30.40 $60.80 $91.20 $121.60 $152.00 $182.40 $212.80 $243.20 $273.60 $304.00
75+ $50.10 $100.20 $150.30 $200.40 $250.50 $300.60 $350.70 $400.80 $450.90 $501.00
Spouse: Voluntary Life
Age Band: $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000
25-29 $0.30 $0.60 $0.90 $1.20 $1.50 $1.80 $2.10 $2.40 $2.70 $3.00
30-34 $0.35 $0.70 $1.05 $1.40 $1.75 $2.10 $2.45 $2.80 $3.15 $3.50
35-39 $0.45 $0.90 $1.35 $1.80 $2.25 $2.70 $3.15 $3.60 $4.05 $4.50
40-44 $0.70 $1.40 $2.10 $2.80 $3.50 $4.20 $4.90 $5.60 $6.30 $7.00
45-49 $1.20 $2.40 $3.60 $4.80 $6.00 $7.20 $8.40 $9.60 $10.80 $12.00
50-54 $1.95 $3.90 $5.85 $7.80 $9.75 $11.70 $13.65 $15.60 $17.55 $19.50
55-59 $3.05 $6.10 $9.15 $12.20 $15.25 $18.30 $21.35 $24.40 $27.45 $30.50
60-64 $4.75 $9.50 $14.25 $19.00 $23.75 $28.50 $33.25 $38.00 $42.75 $47.50
65-69 $8.50 $17.00 $25.50 $34.00 $42.50 $51.00 $59.50 $68.00 $76.50 $85.00
70-74 $15.20 $30.40 $45.60 $60.80 $76.00 $91.20 $106.40 $121.60 $136.80 $152.00
75+ $25.05 $50.10 $75.15 $100.20 $125.25 $150.30 $175.35 $200.40 $225.45 $250.50
Child(ren): Voluntary Life
# of Children: $2,000 $4,000 $6,000 $8,000 $10,000
Cost for All Children $0.40 $0.80 $1.20 $1.60 $2.00

Employee: Voluntary AD&D
Age Band: $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000
All Ages $0.32 $0.64 $0.96 $1.28 $1.60 $1.92 $2.24 $2.56 $2.88 $3.20
Spouse: Voluntary AD&D
Age Band: $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000
All Ages $0.16 $0.32 $0.48 $0.64 $0.80 $0.96 $1.12 $1.28 $1.44 $1.60
Child(ren): Voluntary AD&D
# of Children: $2,000 $4,000 $6,000 $8,000 $10,000
Cost for All Children $0.064 $0.128 $0.192 $0.256 $0.320

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