Supplemental AD&D Coverage (optional) Administered by Standard Insurance Co. 1-800-759-8702; www.standard.com/mybenefits/mus
Optional Supplemental AD&D Insurance eligibility: This is an Employee only benefit. If you enroll for Optional Supplemental Accidental Death & Dismemberment (AD&D) Insurance, your cost depends on the amount of coverage you select, as shown in the following table. No evidence of insurability is required for optional supplemental AD&D coverage at any level. The cost of this benefit is paid on an after-tax basis. • • • • •
If you are a new employee, you may elect any supplemental AD&D coverage amount during your initial enrollment. If you are enrolling for the first time and did not elect supplemental AD&D coverage during your new employee initial enrollment and want to add coverage, you may elect $25,000 in supplemental AD&D coverage at annual enrollment. If you are not enrolling for the first time, you may increase one level of coverage (increments of $25,000) during annual enrollment. Employees may decrease their coverage to any level or drop completely during annual enrollment. Employees may increase or decrease their coverage one level or drop completely due to a qualifying event, as long as the change is consistent with the event (such as increase coverage one level (such as birth of a child, coverage may be increased one level).
“The controlling provisions will be in the group policy issued by Standard Insurance Company. Neither the certificate nor the information presented in this booklet modifies the group policy or the insurance coverage in any way.”
Optional Supplemental AD&D Monthly Rates (after-tax) -Employee Benefit $25,000
$50,000
$.56
$1.12
$75,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $1.68
$2.24
$2.80
$3.36
$3.92
$4.48
5.04
$5.60
6.16
6.72
$325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $525,000 $550,000 $575,000 $600,000 $7.28
$7.84
$8.40
$8.96
$9.52
$10.08
$10.64
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$11.20
11.76
$12.32
12.88
Bob Marshall, MT
13.44
