Underwritten by ReliaStar Life Insurance Company

Coverage options allow employees to design their own plan. For questions about enrollment and administration, contact your personnel, payroll, or benefits office. For additional information, you may contact the plan.

Part A: Basic Term Life and Accidental Death and Dismemberment Insurance for Employees

$25,000 Basic Life insurance for death from any cause and $5,000 Basic Accidental Death and Dismemberment insurance.

Your employer provides Part A coverage through the PEBB full benefits package at no cost to you.

Part B: Basic Dependent Term Life Insurance

$2,500 spouse or qualified domestic partner and $2,500 each eligible unmarried dependent child. If you apply within 60 days of eligibility, your spouse, qualified domestic partner, or other eligible dependent may obtain coverage without providing evidence of insurability. After 60 days, he or she must provide evidence of insurability (except for dependent children). Part B Basic covers death from any cause.

You pay $0.67 per family, regardless of the number of dependents.

Part B: Supplemental Spouse Term Life Insurance

If you have enrolled in Part B Basic Dependent Term Life Insurance, you may apply for additional amounts for your spouse or qualified domestic partner in $1,000 increments up to one-half of the amount of life insurance you obtain for yourself under Part C and Part D combined (rounded up to the next $1,000). If you apply within 60 days of eligibility, your spouse or qualified domestic partner may have up to $25,000 of coverage without providing evidence of insurability. After 60 days, or for coverage in excess of $25,000, it is necessary to provide evidence of your spouse's or qualified domestic partner's good health at the carrier's expense. Part B Supplemental covers death from any cause.

Review the rate sheet for monthly costs.

Part C: Optional Term Life Insurance for Employees

You may choose any amount in $1,000 increments from half of your annual salary up to the amount of your annual salary (both rounded up to the next $1,000). If you apply within 60 days of your eligibility date, you may obtain coverage without providing evidence of insurability. After 60 days, you must provide evidence of insurability. Part C covers death from any cause.

Review the rate sheet for monthly costs.

Part D: Supplemental Term Life Insurance for Employees

You may apply for additional amounts in $1,000 increments up to $350,000. If you apply within 60 days of your eligibility date, you may obtain up to $50,000 of coverage without evidence of insurability. After 60 days, or for coverage in excess of $50,000, it is necessary for you to provide evidence of insurability. Part D covers death from any cause.

Review the rate sheet for monthly costs.

Part E: Voluntary Accidental Death and Dismemberment Insurance

You may enroll in Part E Accidental Death and Dismemberment (AD&D) coverage in multiples of $25,000 ($25,000 minimum) up to $250,000 for covered accidental death or covered accidental dismemberment. Deaths and dismemberments from other causes are not covered under Part E.

If you select voluntary dependents' AD&D coverage in addition to your own, your spouse or qualified domestic partner will be insured for 50 percent of your benefit if you have no dependent children. If you have children, your spouse or qualified domestic partner will be insured for 40 percent and each dependent child for 5 percent of your benefit. If there is no spouse or qualified domestic partner, each dependent child will be insured for 10 percent of your benefit. This dependent coverage will not reduce your coverage.

Review the rate sheet for monthly costs.