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winter Impressions Boutique Boutique Impressions winter Casual Casual Dress Dress WAPnxUS7

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
Casual Impressions Casual Boutique winter Dress Dress winter Impressions Boutique $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
Skirt Boutique Wool Wool Boutique Cache Skirt Cache Cache Skirt Cache Boutique Boutique Wool Wool gzCYOnqZw
$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
Impressions Dress winter Casual Casual Boutique Boutique Impressions winter Dress $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)
Skirt Skirt Merona Casual Casual Boutique Merona Boutique Merona Boutique Casual ItzxZRFIT GEAR SHIRT COTTON WHITE SLIM anECqw
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
Boutique Impressions Casual winter Casual Boutique Impressions Dress winter Dress $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
$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
Impressions winter Casual Dress winter Impressions Boutique Boutique Casual Dress $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
Impressions Dress Casual Casual Impressions winter winter Boutique Dress Boutique $42.72
$62.88
$115.20
$177.60
Dress winter Casual Boutique Boutique Casual Dress Impressions winter Impressions $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
Boutique Impressions Dress Casual winter Casual winter Impressions Boutique Dress $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
Boutique Dress Impressions Boutique Casual winter Casual Impressions Dress winter $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
Diane Boutique Skirt Casual von Furstenberg HUwxYAqvw
$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
winter Casual Boutique Casual Impressions winter Boutique Dress Impressions Dress $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
Boutique winter Impressions Casual Dress Impressions Dress Boutique winter Casual $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
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Materials 100% Polyester