Reliance Standard Voluntary Plans Voluntary Group Term Life Insurance ...

Reliance Standard Voluntary Plans Voluntary Group Term Life Insurance

Premium Table Plan Holder: Generic Company - VG # 999999

Scheduled Benefit: Each eligible employee may elect for himself and/or his eligible spouse an amount of insurance shown in the Table below. For employees age 75 and older: Benefit amounts are reduced according to the age-based reduction chart shown in the Voluntary Term Life brochure. When selecting an amount of insurance, you must select a pre-age 75 benefit amount. Employee/Spouse Premiums:

To find you and your spouse's premium -

l Determine your age band: Your age = your age at your last birthday. l Select a benefit amount (employees age 75 and older: see above comment - do not select a calculated

reduced amount). l Spouse premium: Repeat the steps above for your spouse at his/her age at his/her last birthday. Your

spouse must be under age 70 to be enrolled. l Employee and spouse rates change as insured moves from one age bracket to the next.

Semi-Monthly Premiums

Benefit Amount $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000 $190,000 $200,000 $210,000 $220,000 $230,000 $240,000 $250,000

Age -19

$0.31 $0.62 $0.93 $1.24 $1.55 $1.86 $2.17 $2.48 $2.79 $3.10 $3.41 $3.72 $4.03 $4.34 $4.65 $4.96 $5.27 $5.58 $5.89 $6.20 $6.51 $6.82 $7.13 $7.44 $7.75

Age 20-24

$0.31 $0.62 $0.93 $1.24 $1.55 $1.86 $2.17 $2.48 $2.79 $3.10 $3.41 $3.72 $4.03 $4.34 $4.65 $4.96 $5.27 $5.58 $5.89 $6.20 $6.51 $6.82 $7.13 $7.44 $7.75

Age 25-29

$0.31 $0.62 $0.93 $1.24 $1.55 $1.86 $2.17 $2.48 $2.79 $3.10 $3.41 $3.72 $4.03 $4.34 $4.65 $4.96 $5.27 $5.58 $5.89 $6.20 $6.51 $6.82 $7.13 $7.44 $7.75

Age 30-34

$0.31 $0.61 $0.92 $1.22 $1.53 $1.83 $2.14 $2.44 $2.75 $3.05 $3.36 $3.66 $3.97 $4.27 $4.58 $4.88 $5.19 $5.49 $5.80 $6.10 $6.41 $6.71 $7.02 $7.32 $7.63

Age 35-39

$0.44 $0.88 $1.32 $1.76 $2.20 $2.64 $3.08 $3.52 $3.96 $4.40 $4.84 $5.28 $5.72 $6.16 $6.60 $7.04 $7.48 $7.92 $8.36 $8.80 $9.24 $9.68 $10.12 $10.56 $11.00

Age 40-44

$0.73 $1.45 $2.18 $2.90 $3.63 $4.35 $5.08 $5.80 $6.53 $7.25 $7.98 $8.70 $9.43 $10.15 $10.88 $11.60 $12.33 $13.05 $13.78 $14.50 $15.23 $15.95 $16.68 $17.40 $18.13

Age 45-49

$1.23 $2.46 $3.69 $4.92 $6.15 $7.38 $8.61 $9.84 $11.07 $12.30 $13.53 $14.76 $15.99 $17.22 $18.45 $19.68 $20.91 $22.14 $23.37 $24.60 $25.83 $27.06 $28.29 $29.52 $30.75

Age 50-54

$2.03 $4.05 $6.08 $8.10 $10.13 $12.15 $14.18 $16.20 $18.23 $20.25 $22.28 $24.30 $26.33 $28.35 $30.38 $32.40 $34.43 $36.45 $38.48 $40.50 $42.53 $44.55 $46.58 $48.60 $50.63

Age

Age

Age

Age

55-59 60-64 65-69

70+

$3.46 $6.92 $10.38 $13.84 $17.30 $20.76 $24.22 $27.68 $31.14 $34.60 $38.06 $41.52 $44.98 $48.44 $51.90 $55.36 $58.82 $62.28 $65.74 $69.20 $72.66 $76.12 $79.58 $83.04 $86.50

$4.20 $8.40 $12.60 $16.80 $21.00 $25.20 $29.40 $33.60 $37.80 $42.00 $46.20 $50.40 $54.60 $58.80 $63.00 $67.20 $71.40 $75.60 $79.80 $84.00 $88.20 $92.40 $96.60 $100.80 $105.00

$6.27 $12.53 $18.80 $25.06 $31.33 $37.59 $43.86 $50.12 $56.39 $62.65 $68.92 $75.18 $81.45 $87.71 $93.98 $100.24 $106.51 $112.77 $119.04 $125.30 $131.57 $137.83 $144.10 $150.36 $156.63

$11.94 $23.87 $35.81 $47.74 $59.68 $71.61 $83.55 $95.48 $107.42 $119.35 $131.29 $143.22 $155.16 $167.09 $179.03 $190.96 $202.90 $214.83 $226.77 $238.70 $250.64 $262.57 $274.51 $286.44 $298.38

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Semi-Monthly Premiums

Benefit Amount $260,000 $270,000 $280,000 $290,000 $300,000 $310,000 $320,000 $330,000 $340,000 $350,000 $360,000 $370,000 $380,000 $390,000 $400,000 $410,000 $420,000 $430,000 $440,000 $450,000 $460,000 $470,000 $480,000 $490,000 $500,000

Age -19

$8.06 $8.37 $8.68 $8.99 $9.30 $9.61 $9.92 $10.23 $10.54 $10.85 $11.16 $11.47 $11.78 $12.09 $12.40 $12.71 $13.02 $13.33 $13.64 $13.95 $14.26 $14.57 $14.88 $15.19 $15.50

Age 20-24

$8.06 $8.37 $8.68 $8.99 $9.30 $9.61 $9.92 $10.23 $10.54 $10.85 $11.16 $11.47 $11.78 $12.09 $12.40 $12.71 $13.02 $13.33 $13.64 $13.95 $14.26 $14.57 $14.88 $15.19 $15.50

Age 25-29

$8.06 $8.37 $8.68 $8.99 $9.30 $9.61 $9.92 $10.23 $10.54 $10.85 $11.16 $11.47 $11.78 $12.09 $12.40 $12.71 $13.02 $13.33 $13.64 $13.95 $14.26 $14.57 $14.88 $15.19 $15.50

Age 30-34

$7.93 $8.24 $8.54 $8.85 $9.15 $9.46 $9.76 $10.07 $10.37 $10.68 $10.98 $11.29 $11.59 $11.90 $12.20 $12.51 $12.81 $13.12 $13.42 $13.73 $14.03 $14.34 $14.64 $14.95 $15.25

Age 35-39

$11.44 $11.88 $12.32 $12.76 $13.20 $13.64 $14.08 $14.52 $14.96 $15.40 $15.84 $16.28 $16.72 $17.16 $17.60 $18.04 $18.48 $18.92 $19.36 $19.80 $20.24 $20.68 $21.12 $21.56 $22.00

Age 40-44

$18.85 $19.58 $20.30 $21.03 $21.75 $22.48 $23.20 $23.93 $24.65 $25.38 $26.10 $26.83 $27.55 $28.28 $29.00 $29.73 $30.45 $31.18 $31.90 $32.63 $33.35 $34.08 $34.80 $35.53 $36.25

Age

Age

Age

Age

Age

Age

45-49 50-54 55-59 60-64 65-69

70+

$31.98 $33.21 $34.44 $35.67 $36.90 $38.13 $39.36 $40.59 $41.82 $43.05 $44.28 $45.51 $46.74 $47.97 $49.20 $50.43 $51.66 $52.89 $54.12 $55.35 $56.58 $57.81 $59.04 $60.27 $61.50

$52.65 $54.68 $56.70 $58.73 $60.75 $62.78 $64.80 $66.83 $68.85 $70.88 $72.90 $74.93 $76.95 $78.98 $81.00 $83.03 $85.05 $87.08 $89.10 $91.13 $93.15 $95.18 $97.20 $99.23 $101.25

$89.96 $93.42 $96.88 $100.34 $103.80 $107.26 $110.72 $114.18 $117.64 $121.10 $124.56 $128.02 $131.48 $134.94 $138.40 $141.86 $145.32 $148.78 $152.24 $155.70 $159.16 $162.62 $166.08 $169.54 $173.00

$109.20 $113.40 $117.60 $121.80 $126.00 $130.20 $134.40 $138.60 $142.80 $147.00 $151.20 $155.40 $159.60 $163.80 $168.00 $172.20 $176.40 $180.60 $184.80 $189.00 $193.20 $197.40 $201.60 $205.80 $210.00

$162.89 $169.16 $175.42 $181.69 $187.95 $194.22 $200.48 $206.75 $213.01 $219.28 $225.54 $231.81 $238.07 $244.34 $250.60 $256.87 $263.13 $269.40 $275.66 $281.93 $288.19 $294.46 $300.72 $306.99 $313.25

$310.31 $322.25 $334.18 $346.12 $358.05 $369.99 $381.92 $393.86 $405.79 $417.73 $429.66 $441.60 $453.53 $465.47 $477.40 $489.34 $501.27 $513.21 $525.14 $537.08 $549.01 $560.95 $572.88 $584.82 $596.75

DEPENDENT CHILD(REN) Semi-Monthly PREMIUMS:

Benefit Amount

Premium

$2,500 $0.21

$5,000 $0.41

$7,500 $0.61

$10,000 $0.81 (One rate for all eligible children in family, regardless of number)

PREMIUM CALCULATION (Add your elections here): Employee Premium Spouse Premium Dependent Children Premium Total Premium (Rates are calculated as of coverage effective date and are based on insured's age in relation to Plan anniversary date. Billed rates may be higher if, at application, the person is at the highest age in an age band).

Please read this important information:

l You may not have coverage as both an employee and as a dependent. l Only one insured spouse may cover the eligible dependent children. l Neither you nor your spouse may hold more than a total of $500,000 of group term life insurance with Reliance Standard under the master

Group Policy. Insurance over that amount will be void and the premium refunded. Rates are subject to change.

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