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| Annual Premium |
Individual Plan $130 |
Family Plan $165 |
| Option 1 Premium |
Individual Plan |
Family Plan |
Increase AD&D to: Amount of Coverage |
| $300,000 |
$30 |
N/A |
| $400,000 |
$60 |
N/A |
| $500,000 |
$90 |
N/A |
| $600,000(1) |
$120 |
N/A |
| $750,000(1) |
$165 |
N/A |
| $1,000,000(1) |
$270 |
N/A |
| Option 2 Premium |
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| Add Medical Coverage |
| $25,000 Medical Maximum |
$40 |
$50 |
| $100,000 Medical Maximum |
$56 |
$70 |
(1)For Option 1, AD&D amounts in excess of $500,000 require completion of a supplemental Application Form. Contact the Administrator for the required supplemental Application Form. Allow at least 5 business days from the date your supplemental Application Form is submitted to the Administrator for underwriting and approval by the insurance company. |
| Individual Plan |
$190 |
$380 |
| Family Plan |
$240 |
$480 |
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