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2017 Benefits Book

You can purchase Supplemental TermLife if you want additional coverage for you and your family. Benefits Costs 1. You may purchase in increments of $10,000 up to $300,000. 2. You may elect to purchase

1. Participation in this program is voluntary; therefore the cost of this benefit will be paid by the employee. See the chart below. 2. Dependent coverage is $4.60 per month regardless of the number of dependents covered.

dependent coverage of $10,000 for your spouse and $5,000 for your children up to age 26, if you purchase supplemental life insurance for yourself. 3. Electionstoparticipatecanbemade within 30 days of employment or at Open Enrollment. 4. Proof of insurability will be required for new hires for coverage over $20,000 and increases made at Open Enrollment for amounts over $100,000. Supplemental termlife insurancemay bepurchased throughTheStandard Insurance. Effective date: Coverage will be effective upon receipt of The Standard Insurance’s underwriters’ approval. Claims: In the event of death, contact an HR Benefits Specialist in the Human Resources Department as soon as possible, in order to have the claim processed within the applicable time limit.

Employee Age

Taxable Monthly Income per $1,000 of Coverage

< = to 29

$ 0.099 $ 0.104 $ 0.128 $ 0.187 $ 0.301 $ 0.443 $ 0.724 $ 0.819 $ 1.497 $ 2.442 $ 7.995

30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 – 74

75 and above

Portability: This coverage is portable within 30 days of termination and coverage must have been in effect for at least one year to be eligible for porting.

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