|AGE OF RETIREE, SPOUSE, WIDOW/ER, FORMER SPOUSE (Premiums shown are per person)||HIGH OPTION II PLAN||ACTIVE DUTY PLAN|
Each Child of Retiree*
|SPOUSE OF ACTIVE DUTY MEMBER
EACH CHILD OF ACTIVE DUTY MEMBER
|* Newborn children not named on your
enrollment form are automatically covered from birth for injury or sickness, including
treatment of congenital defects and birth abnormalities, for 31 days. You must notify the
Plan Administrator in writing and pay the additional premium due within 31 days of birth for coverage
to continue beyond this period. Insured children who are incapable of self-sustaining
employment because of mental retardation or physical disability - and who are unmarried and
chiefly dependent on the insured member for support and maintenance - may continue
coverage past policy age limits, with required proof. Otherwise, each dependent child's
insurance terminates on the premium due date following the date he or she is no longer a
Premiums shown are PER PERSON. Premiums increase based on your effective date of coverage as you move from one age bracket to another. The insurance company reserves the right to change premiums on a group-wide basis.
Note: To pay premiums semi-annually or annually, just multiply your quarterly premium by 2 or 4 respectively.
(This product is currently unavailable in ME, MT, NH and VT)