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Please make your plan selection below and click Next  to continue.

Please note that Evidence of Insurability may be required.
The following questions must be answered prior to electing your life insurance plan.
Do you currently, or have you used tobacco in the past 12 months? No   Yes
Please enter your spouse's date of birth for spouse life insurance:  /  / 

  Choose Your Life Insurance Plan

Payroll Period View: 
Plan Choices Benefit Value Your
Contribution		 Employer
Contribution		 Total
Plan Cost
 
Basic, Life Insurance
  1X Salary $50,000 $0.00 $01.83 $01.83
 I choose to waive my Basic Life Insurance benefit.
Supplemental, Life Insurance
  1X Salary $50,000 $0.00 $01.53 $01.53
  2X Salary $100,000 $0.89 $01.53 $02.42
  3X Salary $150,000 $01.23 $01.53 $02.76
 Other Supplemental Amount
 I choose to waive my Supplemental Life Insurance benefit.
  Choose Your Dependent Life Insurance Plan

Payroll Period View: 
Choose your Dependent Life Insurance Plan(s)
Spouse - Dependent Life Insurance Plan
 Spouse 10K $10,000 $0.32 $0.00 $0.32
 Spouse 25K $25,000 $0.75 $0.00 $0.75
 Spouse 50K $50,000 $01.11 $0.00 $01.11
 Other Amount
 I choose to waive my Spouse - Dependent Life Insurance benefit.
Child(ren) - Dependent Life Insurance Plan
 Child 10K $10,000 $0.12 $0.00 $0.12
 I choose to waive my Child(ren) - Dependent Life Insurance benefit.


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