| 2009 Spouse/Domestic Partner Life Ins. |
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| Notice |
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This Web page presents summary information only. Any error or omission here is unintentional and will be resolved in favor of plan documents or applicable federal or state law or rule. See plan documents for details.
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| Eligibility |
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All PEBB-eligible employees may enroll in life insurance coverage for their spouse or domestic partner. Some coverage amounts may require approval of a medical history statement by the insurance carrier.
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| Premium Rates |
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| Age > |
Thru 24 |
25-29 |
30-34 |
35-39 |
40-44 |
45-49 |
50-54 |
55-59 |
60-64 |
65-69 |
70& up |
| Rate Per $10,000 > |
$0.44 |
$0.52 |
$0.67 |
$0.74 |
$0.81 |
$1.26 |
$1.85 |
$3.48 |
$5.40 |
$10.36 |
$16.80 |
| AMOUNT |
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| $20,000 |
0.89 |
1.04 |
1.33 |
1.48 |
1.63 |
2.52 |
3.70 |
6.96 |
10.80 |
20.72 |
33.60 |
| $40,000 |
1.78 |
2.07 |
2.66 |
2.96 |
3.26 |
5.03 |
7.40 |
13.91 |
21.61 |
41.44 |
67.19 |
| $60,000 |
2.66 |
3.11 |
4.00 |
4.44 |
4.88 |
7.55 |
11.10 |
20.87 |
32.41 |
62.16 |
100.79 |
| $80,000 |
3.55 |
4.14 |
5.33 |
5.92 |
6.51 |
10.06 |
14.80 |
27.82 |
43.22 |
82.88 |
134.38 |
| $100,000 |
4.44 |
5.18 |
6.66 |
7.40 |
8.14 |
12.58 |
18.50 |
34.78 |
54.02 |
103.60 |
167.98 |
| $120,000 |
5.33 |
6.22 |
7.99 |
8.88 |
9.77 |
15.10 |
22.20 |
41.74 |
64.82 |
124.32 |
201.58 |
| $140,000 |
6.22 |
7.25 |
9.32 |
10.36 |
11.40 |
17.61 |
25.90 |
48.69 |
75.63 |
145.04 |
235.17 |
| $160,000 |
7.10 |
8.29 |
10.66 |
11.84 |
13.02 |
20.13 |
29.60 |
55.65 |
86.43 |
165.76 |
268.77 |
| $180,000 |
7.99 |
9.32 |
11.99 |
13.32 |
14.65 |
22.64 |
33.30 |
62.60 |
97.24 |
186.48 |
302.36 |
| $200,000 |
8.88 |
10.36 |
13.32 |
14.80 |
16.28 |
25.16 |
37.00 |
69.56 |
108.04 |
207.20 |
335.96 |
| $220,000 |
9.77 |
11.40 |
14.65 |
16.28 |
17.91 |
27.68 |
40.70 |
76.52 |
118.84 |
227.92 |
369.56 |
| $240,000 |
10.66 |
12.43 |
15.98 |
17.76 |
19.54 |
30.19 |
44.40 |
83.47 |
129.65 |
248.64 |
403.15 |
| $260,000 |
11.54 |
13.47 |
17.32 |
19.24 |
21.16 |
32.71 |
48.10 |
90.43 |
140.45 |
269.36 |
436.75 |
| $280,000 |
12.43 |
14.50 |
18.65 |
20.72 |
22.79 |
35.22 |
51.80 |
97.38 |
151.26 |
290.08 |
470.34 |
| $300,000 |
13.32 |
15.54 |
19.98 |
22.20 |
24.42 |
37.74 |
55.50 |
104.34 |
162.06 |
310.80 |
503.94 |
| $320,000 |
14.21 |
16.58 |
21.31 |
23.68 |
26.05 |
40.26 |
59.20 |
111.30 |
172.86 |
331.52 |
537.54 |
| $340,000 |
15.10 |
17.61 |
22.64 |
25.16 |
27.68 |
42.77 |
62.90 |
118.25 |
183.67 |
352.24 |
571.13 |
| $360,000 |
15.98 |
18.65 |
23.98 |
26.64 |
29.30 |
45.29 |
66.60 |
125.21 |
194.47 |
372.96 |
604.73 |
| $380,000 |
16.87 |
19.68 |
25.31 |
28.12 |
30.93 |
47.80 |
70.30 |
132.16 |
205.28 |
393.68 |
638.32 |
| $400,000 |
17.76 |
20.72 |
26.64 |
29.60 |
32.56 |
50.32 |
74.00 |
139.12 |
216.08 |
414.40 |
671.92 |
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| Premium Rate Increases |
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The life insurance premium rate will increase when age moves your spouse or domestic partner into a new tier. The tier rate increases on January 1 of the year following the birthday.
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| Description of Benefit |
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This is term life insurance. Term life insurance means that the insurance benefit is payable only if the insured person dies during a specified period. The beneficiary receives the benefit payment if the insured person dies while covered under the policy. In this case, that is while the employee who purchases the coverage is a PEBB-eligible state employee and premium payments for the coverage are current.
The carrier pays the benefit upon death from any cause, excluding suicide during the first two years of coverage. If the covered individual dies by suicide during the first two years of coverage, the insurance carrier will not pay the benefit but will refund the premiums paid during that period.
This insurance does not accumulate any kind of cash value.
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| Coverage Amounts |
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Guarantee Issue
You may enroll in $20,000 of spouse or domestic partner life insurance coverage as guarantee issue within 60 days of your hire date or your initial eligibility. Guarantee issue means your spouse or domestic partner will not have to give a medical history, and the insurance carrier cannot deny the coverage.
Additional Coverage
You may enroll or increase spouse or domestic partner life insurance coverage (in $20,000 increments to the $400,000 coverage limit) during Open Enrollment or when you experience a qualified status change. Enrolling or adding coverage during Open Enrollment requires insurance-carrier review of your spouse's or domestic partner's medical history.
Coverage Limit
The coverage limit for spouse or domestic partner life insurance is $400,000.
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| Medical History Statement |
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If you want to enroll for certain levels of coverage, you may have to submit a medical history statement to the insurance carrier. The carrier will base approval or denial of the coverage request based on review of your medical history.
The carrier requires a medical history statement if you
- Enroll for spouse or domestic partner life insurance coverage after 60 days from your date of eligibility
- Request spouse or domestic partner coverage of more than $20,000 (if you are enrolling during your initial period of eligibility)
- Want to increase your existing spouse or domestic partner coverage.
Your may download a medical history form, or you can provide the information to the carrier online.
NOTE: Applications for coverage of $100,000 or more may require physical and laboratory exams coordinated by the insurance carrier at the carrier's expense.
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| Effective Date |
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If you enroll for $20,000 in coverage within 60 days of your hire date or date of eligibility, the coverage becomes effective the first of the following month.
If you enroll during Open Enrollment, the coverage becomes effective January 1 of the new plan year (after approval by the insurance carrier).
If you enroll outside of Open Enrollment, your coverage becomes effective the first of the month following approval by the carrier.
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| Tax Treatment |
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Payroll deducts the premium for spouse or domestic partner life insurance from you pay post tax.
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| Beneficiaries |
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You choose the beneficiaries of this life insurance coverage. If you do not name the beneficiaries, the designation reverts to the standard designation established by Oregon law.
The standard designation pays benefits according to the chain of family beneficiaries. It automatically accounts for such life changes as marriage, divorce, death, birth or adoption within your family.
You can make your beneficiary designations online. You will need to enter:
- The person’s (or trust’s) legal name and relationship to you
- The whole-number percentage you wish the person to receive from your benefit
- Whether the person is a primary or a contingent beneficiary.
This designation will not change until you change it.
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| Portability, Conversion, Premium Waiver, Terminal Illness |
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Portability
If you lose eligibility for this coverage, you may continue the coverage through portability. Portability rates are based on the employee rate you pay at the time you lose eligibility.
You must apply for portability directly to the insurance carrier within 60 days of the date your coverage ends.
Conversion
If you become disabled, you may convert this coverage to a whole life individual policy. A whole life policy provides coverage for the individual's whole lifetime (as long as premiums are current) rather than a specified term. You can apply for an individual policy of whole life insurance without submitting a medical history statement.
You must apply for conversion directly to the insurance carrier within 60 days of the date your coverage ends.
Waiver of Premium on Disability
The insurance carrier may waive your premium payment and continue this coverage if you become totally disabled from all occupations before age 60. This waiver will end if
- Your disability ends
- You fail to provide ongoing proof that you are eligible for the waiver
- You fail to cooperate with the insurance carrier
- You convert your coverage.
Terminal Illness
If your spouse or domestic partner becomes terminally ill and is expected to life less than 12 months, you may elect a one-time, lump-sum benefit payment.
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