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Eligibility
Requirements: You
must be enrolled in SAMBA’s Group Term
Life Insurance Plan. If you are requesting supplemental
benefits for your spouse, he or she must be enrolled in the Dependent
Group Term Life Insurance Plan. Evidence of insurability is
required.
Benefits
offered by the Plan:
•
Group Term Life Insurance: This plan supplements your Group
Term Life Insurance benefit amount with additional protection
— up to $300,000. (Your spouse may continue his/her
coverage should you die.)
•
Accelerated Death Benefit: If you have a Terminal Medical
Condition, the Accelerated Death Benefit can make a difficult
time a little easier for your family. The plan can make
available up to 75% of your Supplemental Group Term Life
insurance amount, up to a maximum of $250,000. This can be used
to help pay medical expenses or begin putting the family’s
financial affairs in order. A Terminal Medical Condition is one
that, with reasonable medical certainty will result in death
within 12 months and was diagnosed by a physician on or after
coverage became effective. The same benefit is available under
spouse’s coverage. This benefit terminates on the earlier of
the date this benefit is paid or the date the policy terminates.
•
Retirement Coverage: The Supplemental Plan may be continued
into retirement with no reduction in the amount of coverage.
Rates
effective January 1, 2004
|
Supplemental
Group Term Life Insurance
|
|
Age
|
Biweekly
Rates for Coverage Amounts
|
| $30,000 |
$60,000 |
$90,000 |
$120,000 |
$150,000 |
$180,000 |
$210,000 |
$240,000 |
$270,000 |
$300,000 |
| 18-24 |
$
0.90 |
$
1.80
|
$
2.70
|
$
3.60
|
$
4.50 |
$
5.40 |
$
6.30 |
$
7.20 |
$
8.10 |
$9.00
|
| 25-29 |
$
1.14 |
$
2.28
|
$
3.42
|
$
4.56
|
$
5.70 |
$
6.84 |
$
7.98 |
$
9.12 |
$10.26 |
$11.40
|
| 30-34 |
$
1.35 |
$
2.70 |
$
4.05 |
$
5.40 |
$
6.75 |
$
8.10 |
$
9.45 |
$10.80 |
$12.15 |
$13.50 |
| 35-39 |
$
1.65 |
$
3.30 |
$
4.95 |
$
6.60 |
$
8.25 |
$
9.90 |
$11.55 |
$13.20 |
$14.85 |
$16.50 |
| 40-44 |
$
2.25 |
$
4.50 |
$
6.75 |
$
9.00 |
$11.25 |
$13.50 |
$15.75 |
$18.00 |
$20.25 |
$22.50 |
| 45-49 |
$
5.25 |
$10.50 |
$15.75 |
$21.00 |
$26.25 |
$31.50 |
$36.75 |
$42.00 |
$47.25 |
$52.50 |
| 50-54 |
$
9.00 |
$18.00 |
$27.00 |
$36.00 |
$45.00 |
$54.00 |
$63.00 |
$72.00 |
$81.00 |
$90.00 |
| 55-59 |
$15.00 |
$30.00 |
$45.00 |
$60.00 |
$75.00 |
$90.00 |
$105.00 |
$120.00 |
$135.00 |
$150.00 |
| 60-64 |
$22.50 |
$45.00 |
$67.50 |
$90.00 |
$112.50 |
$135.00 |
$157.50 |
$180.00 |
$202.50 |
$225.00 |
| 65-69 |
$40.50 |
$81.00
|
$121.50
|
$162.00
|
$202.50 |
$243.00 |
$283.50 |
$324.00 |
$364.50 |
$405.00
|
Your
spouse's Term Life Insurance coverage under all policies
issued to SAMBA may not exceed 50% of your coverage.
Insured’s coverage terminates at age 70. Spouse’s coverage
terminates when the spouse reaches age 70.
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