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Computing Your Monthly Costs for Supplemental Life Insurance

The monthly cost for supplemental life insurance for you and your dependents is based on age, amount of coverage you select and whether or not you or your spouse use tobacco products. Use this worksheet and the rate chart to determine your monthly contributions.

Number of $10,000 Units of Coverage:

                         
Total Amount
of Coverage
÷
$10,000
=
                         
Number of $10,000
Units of Coverage
 
Your Cost:

                         
# of $10,000 Units
of Coverage (above)
X
$                         
Life Rate
from chart
=
                          (A)
Your Monthly
Cost
 
Your Spouse's Cost:

  1, 2, 3 or 4 Units  
# of $10,000 Units
of Coverage
X
$                         
Life Rate
from chart
=
                          (B)
Your Spouse's
Monthly Cost
 
Your Dependent Children's Cost:

           $.72           
Coverage
(Rate for $5,000
Insurance for Each
Covered Child)
=
                          (C)
(Fill in $.72 if you are electing Dependent
Children's Supplemental Life Insurance)
 
TOTAL MONTHLY COST = (A) + (B) + (C)
=
                         
 070606
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