Basic Life & Accident – Employee Coverage Only

Basic

Basic AD & D

$25,000

Coverage doubles if loss of life or limb resulting from an accident

Coverage is provided by the University, at no cost to you.

Supplemental Life & Accident – Employee Coverage Only

Supplemental

Supplemental AD&D (included)

You may purchase supplemental coverage equal to 1, 2, or 3 times your annual salary
---- rounded up to the next $1,000

Example: Salary = $41,390 / age 33

1x’s - $ 42,000 = $ 5.04 per month

2x’s - $ 84,000 = $10.08 per month

3x’s - $126,000 = $15.12 per month

AGE

RATE

<25

.09

25-29

.10

30-34

.12

35-39

.13

40-44

.15

45-49

.20

50-54

.29

55-59

.52

60-64

.80

65-69

$1.55

70+

$2.46

Dependent Life – Spouse and Children

Spouse

$10,000

$4.70 per month

Flat rate regardless of the number of dependents covered

Child

14 days but less than 6 month $2,000

6 months but less than 19 years $10,000

19 years but less than 25 years $10,000

Plan Features

• Your coverage amount automatically increases or decreases when a salary change occurs.
• Basic accidental death and dismemberment (AD&D) insurance is attached to your life insurance package.  Your AD&D insurance pays a benefit if you die or suffer certain permanent injuries due to a covered accident.
• Waiver of premium if you become totally and permanently disabled.

Additional information: http://www.usg.edu/employment/benefits/life

Enrollment form: http://www.gsu.edu/benefits/EnrollmentForms/BORLifeApplicationForm.pdf

Change form:   www2.gsu.edu/~wwwhre/benefits/EnrollmentForms/BORTermLifeChangeForm.pdf