Optional Dependent Life Insurance and AD&D Plan Summary and Premiums



Employees who are eligible for Basic Life Insurance may also purchase Optional Dependent Life Insurance coverage in an amount not to exceed the combined basic and optional coverage on themselves.

Spouse or Domestic Partner

Optional Dependent Life Insurance coverage for a spouse or domestic partner is available in the following amounts:







Coverage amounts of $10,000 and $20,000 are available on a guaranteed issue basis, as long as the application for the coverage is received within 60 days of the qualifying event (such as becoming eligible for basic coverage, getting married, etc.).

Dependent Children

Optional Dependent Life Insurance coverage for dependent children is available in the following amounts:






All of these coverage amounts for dependent children are available on a guaranteed issue basis.

Biweekly Deductions

The premium for Optional Life Insurance coverage is based on a rate (determined by the employee’s age) per $1,000 of coverage. The premium is paid through biweekly payroll deductions. The biweekly deduction amount is determined by multiplying the appropriate rate by the coverage amount. Two examples are provided at the end of this document.

Rates - Effective January 1, 2014

Biweekly deductions for spouse or domestic partner coverage are calculated using the following rates (rates include coverage for an equal amount of Accidental Death and dismemberment [AD&D] coverage) and can also be found in the Life Insurance Enrollment Kit:

Employee Age

Cost Per Thousand Dollars of Coverage

less than 25




















70 and above


Biweekly deductions for dependent child coverage are shown below (rates include coverage for an equal amount of AD&D coverage, and for an unlimited number of dependent children):

Employee Age

Cost for $2,000 Benefit

Cost for $4,000 Benefit

Cost for $6,000 Benefit

Cost for $8,000 Benefit

Cost for $10,000 Benefit

All ages






Enrollment Form

Please contact your operating location office responsible for benefits administration to complete an enrollment form indicating your Optional Dependent Life Insurance choice.

Examples of Biweekly Calculations for the Optional Life Insurance Plan (Effective January 1, 2014)

Example One


Employee Jones is 36 years old and his wife is 48 years old. They have no dependent children. Mr. Jones was hired seven months ago. Mr. Jones met the 6-month waiting period last month and is therefore automatically covered for $50,000 of Basic Life Insurance. He does not elect Optional Life coverage for himself.

Mr. Jones can only purchase $40,000 of coverage on his wife, because the next higher level of coverage would exceed his combined Basic and Optional Life Benefit ($50,000). However, since this amount is above the $20,000 guaranteed issue amount, his wife must complete a medical questionnaire for the additional $20,000. The first $20,000 she can get with no medical questions asked, since he is applying for the coverage within 60 days of eligibility. This example assumes she is approved for the full $40,000.

Optional Dependent Life Coverage Amount


Biweekly Deduction Calculation

$40,000 x .049 dollars per thousand = 40 x .049 = $1.96 biweekly deduction.

Note: The rate is based on the employee’s age (not the spouse’s age). Mr. Jones is still within his election period and if he purchases Optional Life coverage on himself, then he can get more coverage for his wife.

Example Two


Employee Doe is 39 years old, was hired two years ago, and therefore has the Basic Life insurance benefit for herself of $50,000. She has nine unmarried children under the age of 18. Since she waited too long to elect Optional Life coverage on herself and her spouse, she cannot get optional coverage for herself or her husband without submitting medical evidence of insurability to the insurance company, so she decides not to elect that coverage. However, she can still elect to purchase Optional Dependent life coverage for all her children with no need to provide evidence of insurability for any of them during open enrollment.

Ms. Doe has chosen the $10,000 benefit level. The benefit covers her nine children for $10,000 each, and includes an additional $10,000 in Accidental Death and Dismemberment (AD&D) benefits automatically.

Optional Dependent Life Coverage Amount


Biweekly Deduction

$0.44 according to the table above.

Change History



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