PEBB - Life Insurance Supplemental Plan Premiums

Basic Life and AD&D Insurance for Employees

$4.02 per month (employer-paid)

Supplemental Life Insurance for Employees and Supplemental Spouse1 Life Insurance

(Premiums increase as you reach each new age bracket.)

Employee's Age Cost per $1,000 per month
Non-tobacco user Tobacco user
Under 25 $0.029  $0.038  
25-29 0.032 0.045
30-34 0.035 0.059
35-39 0.044 0.068
40-44 0.066 0.076
45-49 0.095 0.115
50-54 0.148 0.176
55-59 0.277 0.328
60-64 0.425 0.499
65-69 0.784 0.961
70+ 1.170  1.562
 
1or registered domestic partner

Basic Life Insurance for Dependents​

$0.62 per family per month, regardless of the number of dependents. ​  

Supplemental Accidental Death and Dismemberment Insurance

Employee
AD&D benefit
Cost to cover
only yourself
Cost to cover
you and your dependents
Coverage your spouse1 would have Coverage your children would have
With no children With children If you have a spouse1 If you have no spouse1
$ 25,000   $0.48   $0.73   $12,500    $10,000   $1,250   $2,500  
50,000 0.95 1.45 25,000 20,000 2,500 5,000
75,000 1.43  2.18 37,500 30,000 3,750 7,500
100,000 1.90  2.90 50,000 40,000 5,000 10,000
125,000 2.38  3.63 62,500 50,000 6,250 12,500
150,000 2.85  4.35 75,000 60,000 7,500 15,000
175,000 3.33  5.08 87,500 70,000 8,750 17,500
200,000 3.80  5.80 100,000 80,000 10,000 20,000
225,000 4.28  6.53 112,500 90,000 11,250 22,500
250,000 4.75  7.25 125,000 100,000 12,500 25,000

1or registered domestic partner
 
Premiums are guaranteed through December 31, 2015.
 
Policy Form #LP00GP.