Life and AD&D Benefit Summary

How much coverage can I get?

Calculate your costs

1

2

3

4

1. Enter the coverage amount you want. 2. Divide by the amount shown. 3. Multiply by the rate. Use the rate table (at right) to find the rate based on age. (Choose the age you will be when your coverage becomes effective. See your plan administrator for your plan effective date. To determine your spouse rate, choose the age the employee will be when coverage becomes effective. See your plan administrator for your plan effective date.)

Employee

$______,000

÷ $1,000 = $________

X $______

= $_______

Spouse

$______,000

÷ $1,000 = $________

X $______

= $_______

Child

$______,000

÷ $1,000 = $________

X $______

= $_______

Total cost

Employee monthly rate

Spouse monthly rate Per $ 1,000 of coverage Cost

Child monthly rate $0.120 per $1,000 of coverage

Per $1,000 of coverage Cost

Age

15-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

$0.063 $0.063 $0.080 $0.099 $0.144 $0.225 $0.387 $0.702 $1.053 $1.986 $3.096 $3.096

$0.063 $0.063 $0.080 $0.099 $0.144 $0.225 $0.387 $0.702 $1.053 $1.986 $3.096 $3.096

4. Enter your cost.

75+

1. Enter the AD&D coverage amount you want. 2. Divide by the amount shown. 3. Multiply by the rate. Use the AD&D rate table (at right) to find the rate. 4. Enter your cost.

AD&D

1

2

3

4

Employee

$______,000

÷ $1,000 = $________

X $0.020

= $_______

Spouse

$______,000

÷ $1,000 = $________

X $0.030

= $_______

Child

$______,000

÷ $1,000 = $________

X $0.030

= $_______

Total cost

AD&D monthly rates

Coverage amount

Rate

Employee

per $1,000 of coverage

$0.020

Spouse

per $1,000 of coverage

$0.030

Child

per $1,000 of coverage

$0.030

Billed amount may vary slightly. If you apply for coverage above the guaranteed issue amount, you may be subject to medical underwriting which may affect your ability to get the larger coverage amount. In order to purchase coverage for your dependents, you must buy coverage for yourself. Coverage amounts for your dependents cannot exceed 50% of your coverage amounts.

Unum | Term Life Insurance

EN-1976 EN-449408

FOR EMPLOYEES

FOR EMPLOYEES

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(6-22)

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