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Life and AD&D Insurance

Medex® Travel Assist Needs Estimator Premium Calculator

Continued Benefits

Conversion and Portability Waiver of Premium
Employee Forms -Provide Evidence of Insurability- Medical History Statement -To Apply for Benefits- Accelerated Benefits Accidental Dismemberment Benefits Accidental Death Higher Education Benefit Life Insurance Benefits -To Continue Your Coverage- Group Life Insurance Portability Application Request for Life Conversion Materials Waiver of Premium Claim Packet Booklet/Brochure Group Additional Life and Voluntary AD&D Insurance Medex® Travel Assist Certificates AD&D Insurance Certificate Life Insurance Certificate Human Resources Forms -Claim Forms- Accelerated Benefits Accidental Death Higher Education Benefit Accidental Dismemberment Benefits Life Insurance Benefits -Coverage Continuation- Group Life Insurance Portability Application Waiver of Premium Claim Packet



Premium Calculators

Use the calculators below to determine the monthly and annual premiums for insurance coverage that you may elect.

Additional Life Insurance - Active Employee
Enter Your Age as of January 1:
Enter Your Annual Earnings*:


* Minimum salary is $1,000. Salary will be rounded to the next higher multiple of $1000.


Dependents Life - Spouse of Active Employee
Your Spouse's Age as of January 1:
Amount of Additional Life coverage I'd like my spouse to apply for:
(Note: The Spouse maxiumum coverage amount may not exceed 100% of the total Member Basic Life and Additional Life.)



Estimated monthly premium:


Dependents Life - Dependent Children
Please select one of the Dependent Life Insurance options below:

(Note: The maxiumum coverage amount per child may not exceed 100% of the total Member Basic Life and Additional Life.)



Estimated monthly premium:


Voluntary AD&D - Employee and/or Family
Enter Your Annual Earnings*:


* Minimum salary is $1,000. Salary will be rounded to the next higher multiple of $1000.