2020-2021 Benefits Guide rev 6.22.2021

of $110,000.00 in increments of $10,000 not to exceed $200,000. Insurance coverage over the Guarantee Issue amount will be subject to Evidence of Insurability. Employees who do not enroll within 31 days of eligibility, may enroll during the annual Open Enrollment, but will be required to complete an evidence of insurability form. How Much Coverage Can I Get?

To calculate your cost for optional life insurance, follow the directions below and the premium amounts on the age band table to the right. The example below can be used as a reference. • Enter the Term Life coverage amount you want. • Divide by 10,000. • Multiple by the rate based by your age. Use the Term Life rate table to find the rate based on your age (choose the age that was in effect as of 10/01 of the current plan year. Example: Plan year 10/01/2020-09/30/2021. The employees date of birth is 10/17/1988. The correct rate to use is .730 since the employee was 29 years old on 10/01). • Your rate will increase to the next age band each October 1. • Enter your monthly cost • Divide the monthly cost by 2 to determine your cost per pay period. • See the example below for refence. Example (100,000 coverage, age 40)

Age Band Table

Age

Per $10,000

15-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

$.680 $.730 $.970

$1.420 $2.170 $3.400 $5.010 $7.200 $9.300 $13.210 $24.990 $77.230

75+

$21.70/ month

$10.85/ Pay period

$100,000

÷ $10,000

X

$2.170

Calculate your cost using the table below.

Rate (determined by age band table)

Monthly Cost

Pay Period Amount (divide by 2)

Coverage Amt Increment

Times

$ ___________ ÷ $10,000

X

$ _________________ $ _________ $ _______________

Choosing a Beneficiary In the event of your death, life insurance benefits are paid to your eligible named beneficiary or beneficiaries, unless prohibited by law. Accelerated Benefit If you become terminally ill and are not expected to live beyond a certain time as stated in the employee’s certificate booklet, the employee may request up to 50% of their life insurance amount up to $750,000, without fees or present value adjustments. A doctor must certify the condition to qualify for this benefit. Upon the employee’s death, the remaining benefit will be paid to the employee’s designated beneficiary(ies). Portability/Conversion Allows an insured employee to take this coverage with them according to the terms outlined in the contract. However, if the employee has a medical condition which has a material effect on life expectancy, the employee will

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