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.
Plan Documents
Eligibility & Effective Dates
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 Standard.
If
you enroll for $20,000 in coverage within 30 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 Standard.
Description of Benefits
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
Standard 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.
Coverage Limit
The coverage limit for spouse or domestic partner life insurance is $400,000.
Guarantee Issue
You
may enroll in $20,000 of spouse or domestic partner life insurance
coverage as guarantee issue within 30 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.
Medical History Statement
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
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.
Premium Rates
You must self pay for this coverage. The state does not provide a benefit amount for optional employee life insurance coverage.
This
life insurance is tobacco rated annually. The life insurance premium
rate is higher in the next Plan Year for covered individuals who have
used tobacco products in the 12 months prior to enrollment. The premium
rate increase when covered individuals' ages move them into a new tier.
The tier rate increase goes into effect on January 1 of the year
following a covered individual's birthday.
Spouse/Domestic
Partner Optional Life Insurance Monthly Premium Rates (Non-Tobacco)
Rate per $10,000 by Age
Band
|
Age band
|
Thru 24
|
25-29
|
30-34
|
35-39
|
40-44
|
45-49
|
50-54
|
55-59
|
60-64
|
65-69
|
70-74
|
75 & up
|
Rate per
$10,000
|
$0.40
|
$0.48
|
$0.62
|
$0.69
|
$0.75
|
$1.18
|
$1.74
|
$3.30
|
$5.13
|
$9.95
|
$16.30
|
$16.40
|
Calculated Rate by Age Band
|
$20,000
|
$0.80
|
$0.96
|
$1.24
|
$1.38
|
$1.50
|
$2.36
|
$3.48
|
$6.60
|
$10.26
|
$19.90
|
$32.60
|
$32.80
|
$40,000
|
$1.60
|
$1.92
|
$2.48
|
$2.76
|
$3.00
|
$4.72
|
$6.96
|
$13.20
|
$20.52
|
$39.80
|
$65.20
|
$65.60
|
$60,000
|
$2.40
|
$2.88
|
$3.72
|
$4.14
|
$4.50
|
$7.08
|
$10.44
|
$19.80
|
$30.78
|
$59.70
|
$97.80
|
$98.40
|
$80,000
|
$3.20
|
$3.84
|
$4.96
|
$5.52
|
$6.00
|
$9.44
|
$13.92
|
$26.40
|
$41.04
|
$79.60
|
$130.40
|
$131.20
|
$100,000
|
$4.00
|
$4.80
|
$6.20
|
$6.90
|
$7.50
|
$11.80
|
$17.40
|
$33.00
|
$51.30
|
$99.50
|
$163.00
|
$164.00
|
$120,000
|
$4.80
|
$5.76
|
$7.44
|
$8.28
|
$9.00
|
$14.16
|
$20.88
|
$39.60
|
$61.56
|
$119.40
|
$195.60
|
$196.80
|
$140,000
|
$5.60
|
$6.72
|
$8.68
|
$9.66
|
$10.50
|
$16.52
|
$24.36
|
$46.20
|
$71.82
|
$139.30
|
$228.20
|
$229.60
|
$160,000
|
$6.40
|
$7.68
|
$9.92
|
$11.04
|
$12.00
|
$18.88
|
$27.84
|
$52.80
|
$82.08
|
$159.20
|
$260.80
|
$262.40
|
$180,000
|
$7.20
|
$8.64
|
$11.16
|
$12.42
|
$13.50
|
$21.24
|
$31.32
|
$59.40
|
$92.34
|
$179.10
|
$293.40
|
$295.20
|
$200,000
|
$8.00
|
$9.60
|
$12.40
|
$13.80
|
$15.00
|
$23.60
|
$34.80
|
$66.00
|
$102.60
|
$199.00
|
$326.00
|
$328.00
|
$220,000
|
$8.80
|
$10.56
|
$13.64
|
$15.18
|
$16.50
|
$25.96
|
$38.28
|
$72.60
|
$112.86
|
$218.90
|
$358.60
|
$360.80
|
$240,000
|
$9.60
|
$11.52
|
$14.88
|
$16.56
|
$18.00
|
$28.32
|
$41.76
|
$79.20
|
$123.12
|
$238.80
|
$391.20
|
$393.60
|
$260,000
|
$10.40
|
$12.48
|
$16.12
|
$17.94
|
$19.50
|
$30.68
|
$45.24
|
$85.80
|
$133.38
|
$258.70
|
$423.80
|
$426.40
|
$280,000
|
$11.20
|
$13.44
|
$17.36
|
$19.32
|
$21.00
|
$33.04
|
$48.72
|
$92.40
|
$143.64
|
$278.60
|
$456.40
|
$459.20
|
$300,000
|
$12.00
|
$14.40
|
$18.60
|
$20.70
|
$22.50
|
$35.40
|
$52.20
|
$99.00
|
$153.90
|
$298.50
|
$489.00
|
$492.00
|
$320,000
|
$12.80
|
$15.36
|
$19.84
|
$22.08
|
$24.00
|
$37.76
|
$55.68
|
$105.60
|
$164.16
|
$318.40
|
$521.60
|
$524.80
|
$340,000
|
$13.60
|
$16.32
|
$21.08
|
$23.46
|
$25.50
|
$40.12
|
$59.16
|
$112.20
|
$174.42
|
$338.30
|
$554.20
|
$557.60
|
$360,000
|
$14.40
|
$17.28
|
$22.32
|
$24.84
|
$27.00
|
$42.48
|
$62.64
|
$118.80
|
$184.68
|
$358.20
|
$586.80
|
$590.40
|
$380,000
|
$15.20
|
$18.24
|
$23.56
|
$26.22
|
$28.50
|
$44.84
|
$66.12
|
$125.40
|
$194.94
|
$378.10
|
$619.40
|
$623.20
|
$400,000
|
$16.00
|
$19.20
|
$24.80
|
$27.60
|
$30.00
|
$47.20
|
$69.60
|
$132.00
|
$205.20
|
$398.00
|
$652.00
|
$656.00
|
$20,000
|
$0.80
|
$0.96
|
$1.24
|
$1.38
|
$1.50
|
$2.36
|
$3.48
|
$6.60
|
$10.26
|
$19.90
|
$32.60
|
$32.80
|
$40,000
|
$1.60
|
$1.92
|
$2.48
|
$2.76
|
$3.00
|
$4.72
|
$6.96
|
$13.20
|
$20.52
|
$39.80
|
$65.20
|
$65.60
|
$60,000
|
$2.40
|
$2.88
|
$3.72
|
$4.14
|
$4.50
|
$7.08
|
$10.44
|
$19.80
|
$30.78
|
$59.70
|
$97.80
|
$98.40
|
$80,000
|
$3.20
|
$3.84
|
$4.96
|
$5.52
|
$6.00
|
$9.44
|
$13.92
|
$26.40
|
$41.04
|
$79.60
|
$130.40
|
$131.20
|
$100,000
|
$4.00
|
$4.80
|
$6.20
|
$6.90
|
$7.50
|
$11.80
|
$17.40
|
$33.00
|
$51.30
|
$99.50
|
$163.00
|
$164.00
|
$120,000
|
$4.80
|
$5.76
|
$7.44
|
$8.28
|
$9.00
|
$14.16
|
$20.88
|
$39.60
|
$61.56
|
$119.40
|
$195.60
|
$196.80
|
$140,000
|
$5.60
|
$6.72
|
$8.68
|
$9.66
|
$10.50
|
$16.52
|
$24.36
|
$46.20
|
$71.82
|
$139.30
|
$228.20
|
$229.60
|
$160,000
|
$6.40
|
$7.68
|
$9.92
|
$11.04
|
$12.00
|
$18.88
|
$27.84
|
$52.80
|
$82.08
|
$159.20
|
$260.80
|
$262.40
|
$180,000
|
$7.20
|
$8.64
|
$11.16
|
$12.42
|
$13.50
|
$21.24
|
$31.32
|
$59.40
|
$92.34
|
$179.10
|
$293.40
|
$295.20
|
$200,000
|
$8.00
|
$9.60
|
$12.40
|
$13.80
|
$15.00
|
$23.60
|
$34.80
|
$66.00
|
$102.60
|
$199.00
|
$326.00
|
$328.00
|
Spouse/Domestic
Partner Optional Life Insurance Monthly Premium Rates (Tobacco)
Rate per $10,000 by Age
Band
|
Age band
|
Thru 24
|
25-29
|
30-34
|
35-39
|
40-44
|
45-49
|
50-54
|
55-59
|
60-64
|
65-69
|
70-74
|
75 & up
|
Rate per
$10,000
|
$0.64
|
$0.74
|
$0.96
|
$1.06
|
$1.16
|
$1.78
|
$2.62
|
$4.80
|
$7.40
|
$13.90
|
$22.00
|
$21.50
|
Calculated Rate by Age Band
|
$20,000
|
$1.28
|
$1.48
|
$1.92
|
$2.12
|
$2.32
|
$3.56
|
$5.24
|
$9.60
|
$14.80
|
$27.80
|
$44.00
|
$43.00
|
$40,000
|
$2.56
|
$2.96
|
$3.84
|
$4.24
|
$4.64
|
$7.12
|
$10.48
|
$19.20
|
$29.60
|
$55.60
|
$88.00
|
$86.00
|
$60,000
|
$3.84
|
$4.44
|
$5.76
|
$6.36
|
$6.96
|
$10.68
|
$15.72
|
$28.80
|
$44.40
|
$83.40
|
$132.00
|
$129.00
|
$80,000
|
$5.12
|
$5.92
|
$7.68
|
$8.48
|
$9.28
|
$14.24
|
$20.96
|
$38.40
|
$59.20
|
$111.20
|
$176.00
|
$172.00
|
$100,000
|
$6.40
|
$7.40
|
$9.60
|
$10.60
|
$11.60
|
$17.80
|
$26.20
|
$48.00
|
$74.00
|
$139.00
|
$220.00
|
$215.00
|
$120,000
|
$7.68
|
$8.88
|
$11.52
|
$12.72
|
$13.92
|
$21.36
|
$31.44
|
$57.60
|
$88.80
|
$166.80
|
$264.00
|
$258.00
|
$140,000
|
$8.96
|
$10.36
|
$13.44
|
$14.84
|
$16.24
|
$24.92
|
$36.68
|
$67.20
|
$103.60
|
$194.60
|
$308.00
|
$301.00
|
$160,000
|
$10.24
|
$11.84
|
$15.36
|
$16.96
|
$18.56
|
$28.48
|
$41.92
|
$76.80
|
$118.40
|
$222.40
|
$352.00
|
$344.00
|
$180,000
|
$11.52
|
$13.32
|
$17.28
|
$19.08
|
$20.88
|
$32.04
|
$47.16
|
$86.40
|
$133.20
|
$250.20
|
$396.00
|
$387.00
|
$200,000
|
$12.80
|
$14.80
|
$19.20
|
$21.20
|
$23.20
|
$35.60
|
$52.40
|
$96.00
|
$148.00
|
$278.00
|
$440.00
|
$430.00
|
$220,000
|
$14.08
|
$16.28
|
$21.12
|
$23.32
|
$25.52
|
$39.16
|
$57.64
|
$105.60
|
$162.80
|
$305.80
|
$484.00
|
$473.00
|
$240,000
|
$15.36
|
$17.76
|
$23.04
|
$25.44
|
$27.84
|
$42.72
|
$62.88
|
$115.20
|
$177.60
|
$333.60
|
$528.00
|
$516.00
|
$260,000
|
$16.64
|
$19.24
|
$24.96
|
$27.56
|
$30.16
|
$46.28
|
$68.12
|
$124.80
|
$192.40
|
$361.40
|
$572.00
|
$559.00
|
$280,000
|
$17.92
|
$20.72
|
$26.88
|
$29.68
|
$32.48
|
$49.84
|
$73.36
|
$134.40
|
$207.20
|
$389.20
|
$616.00
|
$602.00
|
$300,000
|
$19.20
|
$22.20
|
$28.80
|
$31.80
|
$34.80
|
$53.40
|
$78.60
|
$144.00
|
$222.00
|
$417.00
|
$660.00
|
$645.00
|
$320,000
|
$20.48
|
$23.68
|
$30.72
|
$33.92
|
$37.12
|
$56.96
|
$83.84
|
$153.60
|
$236.80
|
$444.80
|
$704.00
|
$688.00
|
$340,000
|
$21.76
|
$25.16
|
$32.64
|
$36.04
|
$39.44
|
$60.52
|
$89.08
|
$163.20
|
$251.60
|
$472.60
|
$748.00
|
$731.00
|
$360,000
|
$23.04
|
$26.64
|
$34.56
|
$38.16
|
$41.76
|
$64.08
|
$94.32
|
$172.80
|
$266.40
|
$500.40
|
$792.00
|
$774.00
|
$380,000
|
$24.32
|
$28.12
|
$36.48
|
$40.28
|
$44.08
|
$67.64
|
$99.56
|
$182.40
|
$281.20
|
$528.20
|
$836.00
|
$817.00
|
$400,000
|
$25.60
|
$29.60
|
$38.40
|
$42.40
|
$46.40
|
$71.20
|
$104.80
|
$192.00
|
$296.00
|
$556.00
|
$880.00
|
$860.00
|
$20,000
|
$1.28
|
$1.48
|
$1.92
|
$2.12
|
$2.32
|
$3.56
|
$5.24
|
$9.60
|
$14.80
|
$27.80
|
$44.00
|
$43.00
|
$40,000
|
$2.56
|
$2.96
|
$3.84
|
$4.24
|
$4.64
|
$7.12
|
$10.48
|
$19.20
|
$29.60
|
$55.60
|
$88.00
|
$86.00
|
$60,000
|
$3.84
|
$4.44
|
$5.76
|
$6.36
|
$6.96
|
$10.68
|
$15.72
|
$28.80
|
$44.40
|
$83.40
|
$132.00
|
$129.00
|
$80,000
|
$5.12
|
$5.92
|
$7.68
|
$8.48
|
$9.28
|
$14.24
|
$20.96
|
$38.40
|
$59.20
|
$111.20
|
$176.00
|
$172.00
|
$100,000
|
$6.40
|
$7.40
|
$9.60
|
$10.60
|
$11.60
|
$17.80
|
$26.20
|
$48.00
|
$74.00
|
$139.00
|
$220.00
|
$215.00
|
$120,000
|
$7.68
|
$8.88
|
$11.52
|
$12.72
|
$13.92
|
$21.36
|
$31.44
|
$57.60
|
$88.80
|
$166.80
|
$264.00
|
$258.00
|
$140,000
|
$8.96
|
$10.36
|
$13.44
|
$14.84
|
$16.24
|
$24.92
|
$36.68
|
$67.20
|
$103.60
|
$194.60
|
$308.00
|
$301.00
|
$160,000
|
$10.24
|
$11.84
|
$15.36
|
$16.96
|
$18.56
|
$28.48
|
$41.92
|
$76.80
|
$118.40
|
$222.40
|
$352.00
|
$344.00
|
$180,000
|
$11.52
|
$13.32
|
$17.28
|
$19.08
|
$20.88
|
$32.04
|
$47.16
|
$86.40
|
$133.20
|
$250.20
|
$396.00
|
$387.00
|
$200,000
|
$12.80
|
$14.80
|
$19.20
|
$21.20
|
$23.20
|
$35.60
|
$52.40
|
$96.00
|
$148.00
|
$278.00
|
$440.00
|
$430.00
|
Contact The Standard
(800) 628-8600