Basic Life and AD&D
Life and AD&D coverage helps protect your loved ones in the event of your death or serious injury. Even if you’re single, your beneficiary can use your Life insurance benefits to pay off your debts, such as credit cards, mortgages, and other final expenses.
Basic Life insurance – You receive Basic Life insurance coverage at no cost to you, and you do not need to enroll in any other health and protection program. Basic Life insures you for 2 times your basic annual earnings, up to a maximum of $500,000.
Basic AD&D is included with your Basic Life coverage and provides you specified benefits for a covered accidental bodily injury that directly causes dismemberment (i.e., the loss of a hand, foot or eye). If death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies).
Imputed Income: Under current tax laws, imputed income is the value of your Basic Life insurance that exceeds $50,000 and is subject to federal income, Social Security and state income taxes, if applicable. This imputed income amount will be included in your paycheck and shown on your W-2 statement.
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Eligibility
All Active Full-Time Employees working 30 hours or more per week, except for any person working on a temporary or seasonal basis.
Benefit Amount
Basic Life and AD&D: 2.0 times earnings, rounded to the next higher $1,000, subject to a maximum of $500,000.
Guaranteed Issue
$500,000
Contribution Requirements
Coverage is 100% Employer Paid.
AD&D Schedule
For Accidental Loss of
Life
Both Hands
Both Feet
Sight of Both Eyes
One Hand and One Foot
One Hand and Sight of One Eye
One Foot and Sight of One Eye
Speech and Hearing
One Hand
One Foot
Sight of One Eye
Speech
Hearing
For Total Loss of
Both Arms and Both Legs
Both Arms and One Leg
Both Legs and One Arm
Both Arms
Both Legs
One Arm and One Leg
One Arm or One Leg
Amount Payable
100%
100%
100%
100%
100%
100%
100%
100%
50%
50%
50%
50%
50%
Amount Payable
100%
75%
75%
67%
67%
67%
50%
Benefit Reduction Due to Age
- At age 65, original benefit is reduced to 65%.
- At age 70, original benefit is reduced to 40%.
- At age 75, original benefit is reduced to 20%.
Features
- Accelerated Death Benefit
- Air Bag Benefit
- Conversion Privilege
- FMLA/MSLA Extension
- Portability
- Seat Belt Benefit
- Waiver of Premium
Value Added Services
- Bereavement Counseling Services
- Travel Assistance Services
Voluntary Life and AD&D
In addition to Basic Life and AD&D, eligible employees may purchase additional Voluntary Life and AD&D insurance at favorable group rates. Participants pay 100% of the premium. Note: It is important to provide beneficiary information during the enrollment process and keep this information up to date. If you decline Voluntary Life insurance when first eligible or if you elect coverage and wish to increase your benefit amount at a later date, evidence of insurability may be required before coverage is approved.
Employee/Spouse Cost per $10,000 of Coverage
Employee Age
<25:
25-29:
30-34:
35-39:
40-44:
45-49:
50-54:
55-59:
60-64:
65-69:
70-74:
75+:
Child Life Rate per $10,000:
Employee/Spouse Rate
$0.75
$0.85
$1.05
$1.45
$2.05
$2.95
$4.25
$6.45
$10.15
$16.75
$28.25
$45.25
$0.13
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Eligibility
All Active Full-Time Employees working 30 hours or more per week, except for any person working on a temporary or seasonal basis. Dependents: You must be insured for your Dependents to be covered. Dependents are:
- Your legal spouse who is not legally separated or divorced from you;
- Your unmarried financially dependent children birth to 21 years (to 26 years if full‐time student);
- A person may not have coverage as both an Employee and Dependent;
- Only one insured spouse may cover dependent children;
Benefit Amount
Supplemental Life: Choose from a minimum of $10,000 to a maximum of $500,000 in $10,000 increments.
Spouse: Choose from a minimum of $5,000, a maximum of $250,000 in $2,000 increments, not to exceed 50.00% of employee amount.
Child(ren): Birth to age 21 years: $1,000 to $20,000 in increments of $1,000 (up to age 26 if a full-time student).
Guaranteed Issue
Initial eligibility period only
Employee: $200,000
Spouse: $25,000
Child(ren): $20,000
Contribution Requirements
Coverage is 100% Employee Paid.
AD&D Schedule
For Accidental Loss of
Life
Both Hands
Both Feet
Sight of Both Eyes
One Hand and One Foot
One Hand and Sight of One Eye
One Foot and Sight of One Eye
Speech and Hearing
One Hand
One Foot
Sight of One Eye
Speech
Hearing
For Total Loss of
Both Arms and Both Legs
Both Arms and One Leg
Both Legs and One Arm
Both Arms
Both Legs
One Arm and One Leg
One Arm or One Leg
Amount Payable
100%
100%
100%
100%
100%
100%
100%
100%
50%
50%
50%
50%
50%
Amount Payable
100%
75%
75%
67%
67%
67%
50%
Benefit Reduction Due to Age
- At age 65, original benefit is reduced to 65%.
- At age 70, original benefit is reduced to 40%.
- At age 75, original benefit is reduced to 20%.
Features
- Accelerated Death Benefit
- Air Bag Benefit
- Conversion Privilege
- Education Benefit
- FMLA/MSLA Extension
- Portability
- Seat Belt Benefit
- Waiver of Premium
- Common Carrier Benefit
- Day Care Benefit
- Exposure & Disappearance
Value Added Services
- Travel Assistance Services
Employee/ Spouse Amount by Employee Age
<25: $0.75
25-29: $0.85
30-34: $1.05
35-39: $1.45
40-44: $2.05
45-49: $2.95
50-54: $4.25
55-59: $6.45
60-64: $10.15
65-69: $16.75
70-74: $28.25
75+: $45.25
Child Life Rate per $10,000: $0.13