Monthly Premiums and Coverage Levels
Employee’s Age (as of January 1) |
Employee | Spouse / Domestic Partner (based on employee’s age) |
||||
---|---|---|---|---|---|---|
$5,000 | $10,000 | $15,000 | $20,000 | $5,000 | $10,000 | |
27 or less | $0.12 | $0.23 | $0.35 | $0.46 | $0.18 | $0.36 |
28-30 | 0.13 | 0.25 | 0.38 | 0.50 | 0.20 | 0.40 |
31-33 | 0.16 | 0.32 | 0.48 | 0.64 | 0.25 | 0.50 |
34-36 | 0.19 | 0.37 | 0.56 | 0.74 | 0.30 | 0.59 |
37-39 | 0.23 | 0.45 | 0.68 | 0.90 | 0.36 | 0.72 |
40-42 | 0.34 | 0.68 | 1.02 | 1.36 | 0.54 | 1.08 |
43-45 | 0.54 | 1.08 | 1.62 | 2.16 | 0.86 | 1.71 |
46-48 | 0.65 | 1.30 | 1.95 | 2.60 | 1.04 | 2.07 |
49-51 | 0.91 | 1.81 | 2.72 | 3.62 | 1.44 | 2.88 |
52-54 | 1.16 | 2.32 | 3.48 | 4.64 | 1.85 | 3.69 |
55-57 | 1.62 | 3.23 | 4.85 | 6.46 | 2.57 | 5.13 |
58-60 | 2.02 | 4.03 | 6.05 | 8.06 | 3.11 | 6.21 |
61-63 | 2.78 | 5.56 | 8.34 | 11.12 | 3.87 | 7.74 |
64-66 | 4.00 | 7.99 | 11.99 | 15.98 | 5.40 | 10.80 |
67-69 | 5.59 | 11.17 | 16.76 | 22.34 | 7.52 | 15.03 |
70-72 | 8.62 | 17.24 | 25.86 | 34.48 | 11.66 | 23.31 |
73+ | 12.33 | 24.66 | 36.99 | 49.32 | 16.65 | 33.30 |
Child Coverage
Benefit Amount | Monthly Premium |
---|---|
$2,500 | $0.18 |
$5,000 | $0.35 |
$7,500 | $0.53 |
$10,000 | $0.70 |
$12,500 | $0.88 |
$15,000 | $1.05 |
$17,500 | $1.23 |
$20,000 | $1.40 |
$22,500 | $1.58 |
$25,000 | $1.75 |
For premiums use the Individual & Family Life Insurance Premium Calculator.
The Employer does not contribute towards the premium.
Eligibility
You must meet the following requirements to enroll in this plan:
- Eligible for State Group Health Insurance
- Not receiving a Wisconsin Retirement System (WRS) annuity
If an employee and their spouse/domestic partner are both eligible for this plan, the employee and their spouse/domestic partner may only be covered as an employee or a dependent—not both. This rule also applies to eligible children who are also eligible for this plan as an employee. Lastly, only one employee-parent in a family may carry children’s insurance.
Enrollment
- You have 30 days from the date employment begins to enroll
- Coverage begins on the first day of the month following 30 days from the date of hire
- You may also apply for coverage at any time through Evidence of Insurability (acceptance is not guaranteed)
- You may decrease or cancel coverage at any time
Coverage Levels
Coverage Type | Initial Enrollment Coverage Levels | Maximum Coverage Level |
---|---|---|
Employee | $5,000 $10,000 $15,000 $20,000 |
$300,000 |
Spouse / Domestic Partner | $5,000 $10,000 |
$150,000 |
Child(ren) | $2,500 $5,000 |
$25,000 |
The amount of Spouse/Domestic Partner and Child(ren) coverage may never exceed the amount of employee coverage in effect.
Employees must enroll in Employee coverage in order to enroll in Spouse/Domestic Partner and/or Child coverage.
Additional Benefits
- An annual opportunity to increase coverage level.
- If you are terminally ill with a life expectancy of 12 months or less, you may receive up to the full amount of your coverage prior to your death. This living benefit is also available for an insured spouse/domestic partners and child(ren).
- Conversion to an individual policy at the end of employment.
- Premiums may be waived to age 65 if you become totally disabled prior to age 60.
Beneficiary Information
Beneficiary designations can be made online or by paper.
- Once you enroll in coverage, Securian will send you login information so you can name your beneficiary online through the secure LifeBenefits portal OR
- Beneficiary Designation Form
- Mail completed form to: Securian Financial, PO Box 64546, St. Paul, MN 55164-0546
- Fax to:Â (651) 665-4827
- Attach and Submit on:Â www.LifeBenefits.com/filetransfer
Group Policy Number: 32871-G
You should review and update your Beneficiary Designation with each qualifying life event.
Forms
-
I&F Application/Change Form
Submit to your payroll and benefits office.
- Evidence of Insurability
- Beneficiary Designation
- Conversion Application
- Accelerated Benefit Claim Form
- Affidavit of Domestic Partnership
Publications
- I&F Fact Sheet
-
Certificate of Insurance
Details of services that will and will not be covered.
- Life Insurance Comparison Chart
- Conversion Information