GROUP TERM LIFE INSURANCE
DEPENDENT GROUP TERM LIFE INSURANCE
Issued by the Prudential Insurance Company of America
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NOTICE
Enrollment in the SAMBA Group Term Life Insurance and Dependent Group Term Life Insurance Plans is no longer being offered as of July 1, 2009. Active
employees who are under age 62 on July 1, 2009 may retain this coverage until they reach age 62, even if they retire in the interim.
If you were enrolled in the Supplemental Group Term Life Insurance Plan for yourself or your spouse, this coverage was converted to our new SAMBA Term
Life Insurance Plan.
CLICK HERE to access information about the new SAMBA Term Life Insurance Plan.
If you are under age 62 and therefore are still enrolled in the Group Term Life/Dependent Group Term Life Insurance plans, you were notified that you
may experience an increase in premium.
Please refer to the charts below.
Contact SAMBA if you have questions or need assistance by calling (800) 638-6589 or by
email at Insurance@sambaplans.com.
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Rate and Coverage Charts for Group Term Life and Dependent Group Term Life Plans
Note:Please read the heading of each chart below to find the one that pertains to your coverage. Some of the charts reflect
the premium changes of April 2002, since some members elected at that time not to take the rate increase.
Group Term Life Insurance
| Group Term Life Insurance for Active Members who elect to pay
increased premium and keep current coverage |
(applies to members who participated after 4/1/2002 and prior to 7/1/2009) |
| Job Classification |
Amount of Insurance * |
Biweekly Premium per member |
Monthly Premium per member |
Biweekly Premium eff 7/1/2009 |
Monthly Premium eff 7/1/2009 |
| GS-5 & below |
80,000 |
6.00 |
13.00 |
7.00 |
15.17 |
| GS-6 thru GS-9 |
100.000 |
8.00 |
17.33 |
10.00 |
21.67 |
| GS-10 thru GS-12 |
140,000 |
13.00 |
28.17 |
16.00 |
34.67 |
| GS-13 thru GS-14 |
175,000 |
17.00 |
36.83 |
20.00 |
43.33 |
| GS-15 |
200,000 |
20.00 |
43.33 |
24.00 |
52.00 |
| SES & SL |
250,000 |
23.00 |
49.83 |
28.00 |
60.67 |
* Includes AD&D equal to the face amount of life insurance plus 50% line of duty benefit.
| Group Term Life Insurance for Active Members who elect to retain the pre-7/1/09 contribution rate with reduced coverage |
(applies to members who participated after 4/1/02 prior to 7/1/2009) |
| Job Classification |
Amount of Insurance prior to 7/1/09 * |
Biweekly Premium per member |
Monthly Premium per member |
Amount of Insurance eff 7/1/2009 * |
Biweekly Premium eff 7/1/2009 |
Monthly Premium eff 7/1/2009 |
| GS-5 & below |
80,000 |
6.00 |
13.00 |
65,000 |
6.00 |
13.00 |
| GS-6 thru GS-9 |
100,000 |
8.00 |
17.33 |
80,000 |
8.00 |
17.33 |
| GS-10 thru GS-12 |
140,000 |
13.00 |
28.17 |
115,000 |
13.00 |
28.17 |
| GS-13 thru GS-14 |
175,000 |
17.00 |
36.83 |
145,000 |
17.00 |
36.83 |
| GS-15 |
200,000 |
20.00 |
43.33 |
165,000 |
20.00 |
43.33 |
| SES & SL |
250,000 |
23.00 |
49.83 |
200,000 |
23.00 |
49.83 |
* Includes AD&D equal to the face amount of life insurance plus 50% line of duty benefit.
| Group Term Life Insurance for Active Employees who elected to
retain the Pre-4/1/02 Contribution Rate and agree to the new 7/1/09 Contribution Rate |
| Job Classification |
Amount of Insurance* |
Biweekly Premium per member |
Monthly Premium per member |
Biweekly Premium eff 7/1/2009 |
Monthly Premium eff 7/1/2009 |
| GS-5 & below |
65,000 |
5.00 |
10.83 |
6.00 |
13.00 |
| GS-6 thru GS-9 |
85,000 |
7.00 |
15.17 |
8.00 |
17.33 |
| GS-10 thru GS-12 |
110,000 |
10.00 |
21.67 |
12.00 |
26.00 |
| GS-13 thru GS-14 |
140,000 |
13.00 |
28.17 |
16.00 |
34.67 |
| GS-15 |
155,000 |
15.00 |
32.50 |
18.00 |
39.00 |
| SES & SL |
180,000 |
18.00 |
39.00 |
22.00 |
47.67 |
* Includes AD&D equal to the face amount of life insurance plus 50% line of duty benefit.
| Group Term Life Insurance for Active Employees who elected to
retain the Pre-4/1/02 Contribution Rate and also elected to retain the old rate on 7/1/09 - coverage reduced |
| Job Classification |
Amount of Insurance prior to 7/1/09 * |
Biweekly Premium per member |
Monthly Premium per member |
Amount of Insurance eff 7/1/2009 * |
Biweekly Premium eff 7/1/2009 |
Monthly Premium eff 7/1/2009 |
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under age 62 |
under age 62 |
| GS-5 & below |
65,000 |
5.00 |
10.83 |
55,000 |
5.00 |
10.83 |
| GS-6 thru GS-9 |
85,000 |
7.00 |
15.17 |
70,000 |
7.00 |
15.17 |
| GS-10 thru GS-12 |
110,000 |
10.00 |
21.67 |
90,000 |
10.00 |
21.67 |
| GS-13 thru GS-14 |
140,000 |
13.00 |
28.17 |
115,000 |
13.00 |
28.17 |
| GS-15 |
155,000 |
15.00 |
32.50 |
130,000 |
15.00 |
32.50 |
| SES & SL |
180,000 |
18.00 |
39.00 |
150,000 |
18.00 |
39.00 |
* Includes AD&D equal to the face amount of life insurance plus 50% line of duty benefit.
Dependent Group Term Life
| Dependent Group Term Life Coverage for Active Members who elect
to pay increased premium |
(applies to members who participated after 4/1/02 and prior to 7/1/2009) |
| Job Classification |
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Spouse Insurance Amount |
Child Insurance Amount |
Biweekly Premium per member |
Monthly Premium per member |
Biweekly Premium eff 7/1/2009 |
Monthly Premium eff 7/1/2009 |
| GS-9 & below |
If eligible children |
20,000 |
10,000 |
3.00 |
6.50 |
4.00 |
8.67 |
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If no eligible children |
25,000 |
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3.00 |
6.50 |
4.00 |
8.67 |
| GS-10 thru GS-15 & below |
If eligible children |
30,000 |
10,000 |
4.00 |
8.67 |
5.00 |
10.83 |
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If no eligible children |
35,000 |
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4.00 |
8.67 |
5.00 |
10.83 |
| SES & SL |
If eligible children |
45,000 |
10,000 |
5.00 |
10.83 |
6.00 |
13.00 |
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If no eligible children |
50,000 |
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5.00 |
10.83 |
6.00 |
13.00 |
| Dependent Group Term Life Coverage for Active Members who elect
to retain pre-7/1/09 contribution rate with reduced coverage |
(applies to members who participated prior to 7/1/2009) |
| Job Classification |
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Spouse Insurance Amount |
Child Insurance Amount |
Biweekly Premium per member |
Monthly Premium per member |
Spouse Insurance Amount eff 7/1/2009 |
Child Insurance Amount eff 7/1/2009 |
Biweekly Premium eff 7/1/2009 |
Monthly Premium eff 7/1/2009 |
| GS-9 & below |
If eligible children |
20,000 |
10,000 |
3.00 |
6.50 |
15,000 |
8,000 |
3.00 |
6.50 |
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If no eligible children |
25,000 |
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3.00 |
6.50 |
20,000 |
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3.00 |
6.50 |
| GS-10 thru GS-15 & below |
If eligible children |
30,000 |
10,000 |
4.00 |
8.67 |
25,000 |
8,000 |
4.00 |
8.67 |
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If no eligible children |
35,000 |
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4.00 |
8.67 |
30,000 |
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4.00 |
8.67 |
| SES & SL |
If eligible children |
45,000 |
10,000 |
5.00 |
10.83 |
35,000 |
8,000 |
5.00 |
10.83 |
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If no eligible children |
50,000 |
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5.00 |
10.83 |
40,000 |
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5.00 |
10.83 |
| Dependent Group Term Life Coverage for Active Employees who
elected to retain the Pre-4/1/02 Contribution Rate and agreed to the new 7/1/09 contribution rate |
| Job Classification |
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Spouse Insurance Amount |
Child Insurance Amount |
Biweekly Premium per member |
Monthly Premium per member |
Biweekly Premium eff 7/1/2009 |
Monthly Premium eff 7/1/2009 |
| GS-9 & below |
If eligible children |
14,000 |
10,000 |
3.00 |
6.50 |
4.00 |
8.67 |
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If no eligible children |
17,500 |
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3.00 |
6.50 |
4.00 |
8.67 |
| GS-10 thru GS-15 & below |
If eligible children |
20,000 |
10,000 |
4.00 |
8.67 |
5.00 |
10.83 |
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If no eligible children |
25,000 |
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4.00 |
8.67 |
5.00 |
10.83 |
| SES & SL |
If eligible children |
30,000 |
10,000 |
5.00 |
10.83 |
6.00 |
13.00 |
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If no eligible children |
35,000 |
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5.00 |
10.83 |
6.00 |
13.00 |
| Dependent Group Term Life Coverage for Active Employees who
elected to retain the Pre-4/1/02 Contribution Rate and also elected to retain that rate on 7/1/09 |
| Job Classification |
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Spouse Insurance Amount |
Child Insurance Amount |
Biweekly Premium per member |
Monthly Premium per member |
Spouse Insurance Amount eff 7/1/2009 |
Child Insurance Amount eff 7/1/2009 |
Biweekly Premium per member |
Monthly Premium per member |
| GS-9 & below |
If eligible children |
14,000 |
10,000 |
3.00 |
6.50 |
10,000 |
8,000 |
3.00 |
6.50 |
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If no eligible children |
17,500 |
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3.00 |
6.50 |
15,000 |
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3.00 |
6.50 |
| GS-10 thru GS-15 & below |
If eligible children |
20,000 |
10,000 |
4.00 |
8.67 |
15,000 |
8,000 |
4.00 |
8.67 |
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If no eligible children |
25,000 |
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4.00 |
8.67 |
20,000 |
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4.00 |
8.67 |
| SES & SL |
If eligible children |
30,000 |
10,000 |
5.00 |
10.83 |
25,000 |
8,000 |
5.00 |
10.83 |
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If no eligible children |
35,000 |
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5.00 |
10.83 |
30,000 |
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5.00 |
10.83 |
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