39
Team Member Spouse Dependent
$10,000
$10,000
N/A
N/A
*Enrollment and Statement of Health (SOH) forms must be submitted to Reliance Standard Life Insurance (RSLI) for approval
of coverage if you do not enroll when first eligible or if you request an amount above the guaranteed issue. Forms should be
submitted within 31 days of a Qualifying Event. Team Members will receive a letter from RSLI showing approval or denial of the
applied amount. If approved, premium deduction will come out of the first paycheck of the month.
Benefits Department • 800-562-6210, ext. 2495
Team Member-paid Term Life Insurance
Maximum Amount Available
Guaranteed Issue Amount
(no health questions required)
Statement of Health*
Age
Under 30
30-34
35-39
40-44
45-49
Age Reduction
reduces to 65% of original amount
reduces to 40% of original amount
reduces to 20% of original amount
Team Member Cost
$0.14
$0.18
$0.23
$0.35
$0.58
Up to 10x base salary to a
maximum of $500,000 in
increments of $10,000
Amount up to $500,000
when first eligible
Age 65
Age 70
Age 75+
You will need to submit a SOH
when enrolling after initial
eligibility.
Spouse (all ages) $0.35 per $10,000
Children (Birth – 26 years) $0.25 for $10,000
Up to 50% of Team Member coverage
to a maximum of $250,000 in
increments of $10,000
$50,000
The same age reduction amount
applies to spousal coverage.
Spousal Life can only equal
one-half of Team Member’s amount
and may reduce when Team Member
reaches one of the age reductions.
You will need to submit a SOH
when electing more than $50,000
when first eligible.
After-tax Team Member-paid Term Life Weekly Cost
Price per $10,000 of Coverage
After-tax Spousal and Dependent Term Life Weekly Cost
TERM LIFE INSURANCE
Additional Term Life insurance available for
purchase
Team Member, spouse and children
Description
Eligibility
Benefit amount
• Team Members who are married to each other cannot both carry coverage for their children
or carry coverage on each other as a dependent if already covered as a Team Member.
(14 days – age 26)
Age
50-54
55-59
60-64
65-69
70+
Team Member Cost
$0.92
$1.98
$3.53
$7.22
$8.68