Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 4423 Life Insurance is provided through Metropolitan Life Insurance Company www.metlife.com, (800) 638-6420 n  BASIC LIFE INSURANCE •  Basic Life Insurance is a term insurance policy WSSC provides for every permanent employee, at no cost to the employee. Enrollment is automatic. •  Basic Life Insurance is valued at 2 times Your Basic Annual Earnings (including longevity pay if applicable), rounded to the next higher $1,000. The maximum Basic Life Benefit is $400,000. Coverage is pro-rated for part- time employees. n  ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (AD&D) •  WSSC also provides AD&D for every permanent employee, at no cost to the employee. AD&D is the value of your Basic Life Insurance. The maximum AD&D Benefit is $400,000. Enrollment is automatic. n  SUPPLEMENTAL LIFE INSURANCE •  Supplemental Life Insurance is an optional term insurance policy that permanent employees may purchase to provide extra coverage above and beyond the amount provided through the WSSC’s Basic Life and AD&D insurance package. •  Supplemental Life Insurance coverage is an amount, elected by you, which is a multiple of $10,000 with a maxi- mum supplemental life benefit of $200,000. The cost of this coverage is based on your age and coverage amount. •  Employees already enrolled in Supplemental Life who wish to increase their benefit amount by more than $20,000 must complete a Statement of Health form. See the Statement of Health section on next page. •  Employees who are not currently enrolled in Supplemental Life Insurance but wish to enroll during Open Enrollment for the 2017 Plan year, must complete a Statement of Health. See the Statement of Health section on next page. •  Free will preparation service available to enrolled employees. •  Enrollment in Supplemental Life is not automatic. You must elect Supplemental Life and the coverage amount in One-Source. Age Semi-monthly rate per $10,000 in coverage Age Semi-monthly rate per $10,000 in coverage under 30 $0.24 55-59 $1.84 30-34 $0.32 60-64 $3.04 35-39 $0.36 65-69 $5.32 40-44 $0.40 70-74 $8.80 45-49 $0.64 75-79 $17.76 50-54 $0.96 80-84 $28.76           Life Insurance: Basic, Supplemental & Dependent