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If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose. Accelerated Life Benefit: Guaranteed Issue: Employee: $250,000 Spouse: $25,000 Child: $10,000 What you need to know about your Voluntary Term Life and AD&D Benefits Employee: $10,000 to $500,000, in $1,000 increments, not to exceed 5 times your annual salary Flexible Options: Spouse under age 70: $5,000 to $50,000, in $500 increments, not to exceed 50% of the employee’s amount Dependent Life Coverage: Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren). Accidental Death and Dismemberment (AD&D): Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of insurability. Guaranteed Increase In Benefit: 70 75 65% 50% Age: Reduces To: Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent life insurance and dependent AD&D principal sum will reduce according to the employee's reduction schedule. Option 1: Child Options Child(ren) 6 months to age 19, or 25 if full-time student Child(ren) live birth to 6 months Deduction amount Child(ren) $10,000 $1,000 $2.53 Life & AD&D $15,000 Spouse Options $5,000 $10,000 Life & AD&D 0-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 $20,000 $25,000 $4.35 $6.70 $14.70 $.55 $.65 $.75 $1.15 $1.60 $2.55 $3.70 $8.70 $13.40 $29.40 $1.10 $1.30 $1.50 $2.30 $3.20 $5.10 $7.40 $13.05 $20.10 $44.10 $1.65 $1.95 $2.25 $3.45 $4.80 $7.65 $11.10 $17.40 $26.80 $58.80 $2.20 $2.60 $3.00 $4.60 $6.40 $10.20 $14.80 $21.75 $33.50 $73.50 $2.75 $3.25 $3.75 $5.75 $8.00 $12.75 $18.50 65-69 70-74 $14.70 $29.40 $44.10 $58.80 $73.50 75+ $.55 $1.10 $1.65 $2.20 $2.75 $.55 $1.10 $1.65 $2.20 $2.75 $30,000 Payroll Deduction Illustration: Employee Options $10,000 $20,000 Life & AD&D 0-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $8.70 $13.40 $29.40 $1.10 $1.30 $1.50 $2.30 $3.20 $5.10 $7.40 $17.40 $26.80 $58.80 $2.20 $2.60 $3.00 $4.60 $6.40 $10.20 $14.80 $26.10 $40.20 $88.20 $3.30 $3.90 $4.50 $6.90 $9.60 $15.30 $22.20 $34.80 $53.60 $117.60 $4.40 $5.20 $6.00 $9.20 $12.80 $20.40 $29.60 $43.50 $67.00 $147.00 $5.50 $6.50 $7.50 $11.50 $16.00 $25.50 $37.00 $52.20 $80.40 $176.40 $6.60 $7.80 $9.00 $13.80 $19.20 $30.60 $44.40 $60.90 $93.80 $205.80 $7.70 $9.10 $10.50 $16.10 $22.40 $35.70 $51.80 $69.60 $107.20 $235.20 $8.80 $10.40 $12.00 $18.40 $25.60 $40.80 $59.20 $78.30 $120.60 $264.60 $9.90 $11.70 $13.50 $20.70 $28.80 $45.90 $66.60 $87.00 $134.00 $294.00 $11.00 $13.00 $15.00 $23.00 $32.00 $51.00 $74.00 65-69 70-74 $23.30 $46.60 $69.90 $93.20 $116.50 $139.80 $163.10 $186.40 $209.70 $233.00 75+ $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $9.90 $11.00 $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $9.90 $11.00 City of Blackfoot Rate Effective Date: 10/1/2022 Class: 1 ® OneAmerica is the marketing name for the companies of OneAmerica. G 00619255-0000-000 Employee and Spouse premiums are based on your age as of 10/01 and amount of coverage chosen. Child premiums are for all eligible children combined. Note: