Voluntary Life Insurance
Coverage Amounts
Spouse Monthly Life Rates
25,000 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000
Under age 30 $ 1.20 $ 2.40 $ 4.80 $ 7.20 $ 9.60 $ 12.00 $ 14.40 $ 16.80 $ 19.20 $ 21.60 $ 24.00 Ages 30- 34 $ 1.30 $ 2.60 $ 5.20 $ 7.80 $ 10.40 $ 13.00 $ 15.60 $ 18.20 $ 20.80 $ 23.40 $ 26.00 Ages 35- 39 $ 1.80 $ 3.60 $ 7.20 $ 10.80 $ 14.40 $ 18.00 $ 21.60 $ 25.20 $ 28.80 $ 32.40 $ 36.00 Ages 40- 44 $ 2.20 $ 4.40 $ 8.80 $ 13.20 $ 17.60 $ 22.00 $ 26.40 $ 30.80 $ 35.20 $ 39.60 $ 44.00 Ages 45- 49 $ 4.20 $ 8.40 $ 16.80 $ 25.20 $ 33.60 $ 42.00 $ 50.40 $ 58.80 $ 67.20 $ 75.60 $ 84.00 Ages 50- 54 $ 5.10 $ 10.20 $ 20.40 $ 30.60 $ 40.80 $ 51.00 $ 61.20 $ 71.40 $ 81.60 $ 91.80 $ 102.00 Ages 55- 59 $ 8.10 $ 16.20 $ 32.40 $ 48.60 $ 64.80 $ 81.00 $ 97.20 $ 113.40 $ 129.60 $ 145.80 $ 162.00 Ages 60- 69 $ 13.70 $ 27.40 $ 54.80 $ 82.20 $ 109.60 $ 137.00 $ 164.40 $ 191.80 $ 219.20 $ 246.60 $ 274.00
Coverage Amounts
After age 69, rates remain constant and coverage amount change
12,500 25,000 50,000 7,500 100,000 125,000 150,000 175,000 200,000 225,000 250,000
Ages 70- 74 $ 13.70 $ 27.40 $ 54.80 $ 82.20 $ 109.60 $ 137.00 $ 164.40 $ 191.80 $ 219.20 $ 246.60 $ 274.00
Coverage Amounts
6,250 12,500 25,000 37,500 50,000 62,500 75,000 87,500 100,000 112,500 125,000
75 and over $ 13.70 $ 27.40 $ 54.80 $ 82.20 $ 109.60 $ 137.00 $ 164.40 $ 191.80 $ 219.20 $ 246.60 $ 274.00
Dependent Children Coverage
Coverage Amount
5,000 10,000 15,000 Monthly Cost $ 0.52 $ 1.04 $ 1.56
Voluntary AD & D Insurance
Insured by PEHP
AD & D provides benefits for death, loss of use of limbs, speech, hearing, or eye sight due to an accident. You can select a coverage amount ranging from $ 25,000 to $ 250,000. When you elect coverage, your spouse and dependents will automatically be covered as follows:
» Your spouse will be insured for 40 % of your coverage amount. If you have no dependent children, your spouse’ s coverage increases to 50 % of yours.
» Each dependent child is insured for 15 % of your coverage amount. If you have no spouse, each eligible dependent child’ s coverage increases to 20 % of yours.
Coverage Amount
Additional AD & D Monthly Rates
Individual Plan
Family Plan
$ 25,000 $ 0.50 $ 0.00 $ 50,000 $ 1.00 $ 1.50 $ 75,000 $ 1.50 $ 2.25 $ 100,000 $ 2.00 $ 3.00 $ 125,000 $ 2.50 $ 3.75 $ 150,000 $ 3.00 $ 4.50 $ 175,000 $ 3.50 $ 5.25 $ 200,000 $ 4.00 $ 6.00 $ 225,000 $ 4.50 $ 6.75 $ 250,000 $ 5.00 $ 7.50
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