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SCHEDULE OF BENEFITS
$16 VOLUNTARY LIFE PLAN
| SCHEDULE OF BENEFITS - $16 MONTHLY CONTRIBUTION |
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MEMBER |
DEPENDENT |
| Member's Age at Time of Claim |
Group Term Life Insurance 1 |
Group Accidental Death & Dismemberment Insurance |
Total Benefit for Accidental Death |
Group Term Life Insurance |
| Spouse/ Domestic Partner |
Child(ren) |
| Less than 25 |
$225,000 |
$100,000 |
$325,000 |
$20,000 |
$4,000 |
| 25 - 29 |
$170,000 |
$100,000 |
$270,000 |
$20,000 |
(Age 14 days, but less than 21 years) |
| 30 - 39 |
$100,000 |
$100,000 |
$200,000 |
$20,000 |
| 40 - 44 |
$65,000 |
$100,000 |
$165,000 |
$18,000 |
| 45 - 49 |
$40,000 |
$100,000 |
$140,000 |
$15,000 |
| 50 - 54 |
$30,000 |
$100,000 |
$130,000 |
$10,000 |
| 55 - 59 |
$18,000 |
$100,000 |
$118,000 |
$7,000 |
| 60 - 64 |
$12,000 |
$100,000 |
$112,000 |
$5,000 |
| 65 and over |
$7,500 |
$7,500 |
$15,000 |
$4,000 |
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The total cost of coverage for the Member, their Spouse/Domestic Partner and eligible Children is $16 per month. Payment is made by payroll deduction.
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1 Total coverage purchased by premiums plus Accumulated Dividends
Payment Examples (applicable to $16 plan only): If an insured member age 38 dies of natural causes, the beneficiary would receive $100,000. If death is due to a covered accident, $200,000 would be payable. If the spouse or domestic partner of a 42 year-old member dies, the member would receive $18,000. If a dependent child less than age 21 dies, the payment to the member would be $4,000.
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