Age	Life Benefit Amount*
Band	$10,000	$20,000	$30,000	$40,000	$50,000	$60,000	$70,000	$80,000	$90,000	$100,000
Under 30	$0.70	$1.40	$2.10	$2.80	$3.50	$4.20	$4.90	$5.60	$6.30	$7.00
30-34	$0.80	$1.60	$2.40	$ 3.20	$4.00	$4.80	$5.60	$6.40	$7.20	$8.00
35-39	$1.20	$2.40	$3.60	$4.80	$6.00	$7.20	$8.40	$9.60	$10.80	$12.00
40-44	$1.50	$3.00	$4.50	$6.00	$7.50	$9.00	$10.50	$12.00	$13.50	$15.00
45-49	$2.70	$5.40	$8.10	$10.80	$13.50	$16.20	$18.90	$21.60	$24.30	$27.00
50-54	$4.60	$9.20	$13.80	$18.40	$23.00	$27.60	$32.20	$36.80	$41.40	$46.00
55-59	$7.50	$15.00	$22.50	$30.00	$37.50	$45.00	$52.50	$60.00	$67.50	$75.00
60-64	$11.70	$23.40	$35.10	$46.80	$58.50	$70.20	$81.90	$93.60	$105.30	$117.00
65-69	$12.10	$24.20	$36.30	$48.40	$60.50	$72.60	$84.70	$96.80	$108.90	$121.00
70+	$14.80	$29.60	$44.40	$59.20	$74.00	$88.80	$103.60	$118.40	$133.20	$148.00
Age	Life Benefit Amount*
Band	$110,000	$120,000	$130,000	$140,000	$150,000	$160,000	$170,000	$180,000	$190,000	$200,000
Under 30	$7.70	$8.40	$9.10	$9.80	$10.50	$11.20	$11.90	$12.60	$13.30	$14.00
30-34	$8.80	$9.60	$10.40	$11.20	$12.00	$12.80	$13.60	$14.40	$15.20	$16.00
35-39	$13.20	$14.40	$15.60	$16.80	$18.00	$19.20	$20.40	$21.60	$22.80	$24.00
40-44	$16.50	$18.00	$19.50	$21.00	$22.50	$24.00	$25.50	$27.00	$28.50	$30.00
45-49	$29.70	$32.40	$35.10	$37.80	$40.50	$43.20	$45.90	$48.60	$51.30	$54.00
50-54	$50.60	$55.20	$59.80	$64.40	$69.00	$73.60	$78.20	$82.80	$87.40	$92.00
55-59	$82.50	$90.00	$97.50	$105.00	$   112.50	$120.00	$   127.50	$135.00	$   142.50	$150.00
60-64	$   128.70	$   140.40	$   152.10	$   163.80	$   175.50	$   187.20	$   198.90	$   210.60	$   222.30	$234.00
65-69	$   133.10	$   145.20	$   157.30	$   169.40	$   181.50	$   193.60	$   205.70	$   217.80	$   229.90	$242.00
70+	$   162.80	$   177.60	$   192.40	$   207.20	$222.00	$   236.80	$   251.60	$   266.40	$   281.20	$296.00
	AD&D Benefit Amount*
	$10,000	$20,000	$30,000	$40,000	$50,000	$60,000	$70,000	$80,000	$90,000	$100,000
All ages	$       0.46	$       0.92	$       1.38	$       1.84	$2.30	$       2.76	$       3.22	$       3.68	$       4.14	$4.60
	$110,000	$120,000	$130,000	$140,000	$150,000	$160,000	$170,000	$180,000	$190,000	$200,000
All ages	$       5.06	$5.52	$5.98	$6.44	$6.90	$7.36	$7.82	$8.28	$8.74	$9.20
	*- These rates are to be used when purchasing Employee covg.  Additionally, use same rates to compute  Spouse Premium.
			Child(ren) Life Amount
			Age	$2,500	$5,000	$7,500	$10,000
			6 months- 19 (25, if full time student)	$       0.64	$1.28	$1.92	$2.56
Rev: 10/09/08                                 * Child(ren) coverage is $1,000 from live birth to 6 months.

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Evidence of Insurability Form (.pdf)