Benefits At a Glance

Each employee has the option of selecting additional Group Life insurance on their Dependent Children for $5,000 or $10,000.

Below are the payroll deduction costs per $5,000 of coverage.

Option Weekly Semi-monthly
$5,000 $.15 $.33
$10,000 $.30 $.65

Payroll deduction will be adjusted due to changes in age on the date of the event.

Plan Design

Regardless of the amount selected the amount of Optional Dependent Child life insurance for a child under 14 days is NONE, and for a child age 14 days but under 6 months is $250.00.

The Optional Dependent Child life insurance continues to age 19, or to age 25 if the child is enrolled as a full-time student and depends on the Employee for 50% or more for support.

Benefit Summary

Plan Details

Evidence of Insurability: If the Dependent Life coverage is enrolled within 31 days of their initial eligibility date, coverage is issued on a guarantee issue basis.

EOI Instructions

Certificate of Coverage

Class 1- Voluntary Life Certificate of Coverage includes Dependent Life