Additional Term Life Coverage
Current & Former Employee Coverage & Rates for the 2020/21 Plan Year, effective 7/1/2020 through 6/30/2021

Contents
 》Resources
 》Age Banded Rates
 》Vendor
 》Employee Coverage
 》Spouse Coverage
 》Child Coverage
 》New Employer Group Enrollment
 》First Enrollment Opportunity
 》Later Enrollment Opportunities

Resources
 》Coverage Brochure PDF
 》YouTube Video Link
 》Additional Life Worksheet PDF
 》Additional Life Application Form PDF
 》Statement of Health Form PDF
 》Life Beneficiary Change Form PDF
 》Coverage Portability Application PDF
 》Life Conversion Request Form PDF
 》HIPAA Privacy Notice PDF

Age Banded Rates
 》Calculate rate using attained age of Employee or Spouse at coverage start date
 》Rates re-calculated annually using Employee or Spouse’s attained age each July 1st
 》Employees with in-force coverage with EGID, first $20,000 is $3.60 or $4.80 with AD&D regardless of age
 》Rate for each $5,000:
  18-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
   With AD&D 0.50 0.65 0.85 1.30 2.10 3.35 3.85 6.20 10.40 16.05
   Without AD&D 0.35 0.50 0.70 1.15 1.95 3.20 3.70 6.05 10.25 15.90

Vendor
 》The Standard
 》800.628.8600
 》www.standard.com Link

Employee Coverage
 》Minimum $20,000, and then in increments of $5,000 thereafter
 》Maximum $5x gross annual pay up to $500,000
 》Optional AD&D coverage available at $0.15 per $5,000

Spouse Coverage
 》Minimum $20,000, and then in increments of $5,000 thereafter
 》Maximum 50% of Employee’s approved coverage

Child Coverage
 》Option 1: $10,000 coverage at $2 per month
 》Option 2: $20,000 coverage at $4 per month
 》Child coverage requires Employee has approved coverage
 》One premium covers a Child up to the end of the month they turn 26

Coverage Approvals
New Employer Group Enrollment
 》Qualification is guaranteed and unconditionally approved for takeover of in-force coverage
 》Employees with in-force coverage with EGID, first $20,000 is $3.60 or $4.80 with AD&D regardless of age

First Enrollment Opportunity
 》Qualification is guaranteed and unconditionally approved for:
   》Employee up to $150,000
   》Spouse up to $50,000
   》Child coverage
 》Qualification is conditional and requires medical underwriting approval for coverage exceeding these amounts

Later Enrollment Opportunities
 》Qualification is conditional and requires medical underwriting approval for:
   》Enrollment in Employee, Spouse or Child coverage
   》Increases in coverage amounts of existing Employee, Spouse or Child coverage