TABLE A LIFE INSURANCE ONLY MONTHLY TERM RATES RATE SHEET Schedule of Monthly Portable Group Life and AD&D Insurance Term Rates For Insured and Dependents Rates (cost per $1,000 of coverage per month) are based on the Insured’s age and Dependent Spouse/Domestic Partner’s age as of the first of the month following the insured’s birthday. Rates are subject to change. An administrative fee may also apply. Sample monthly premium calculation for an insured age 45, electing $50,000 of portable coverage $50,000 ÷ $1,000 = 50 x $0.369 = $18.45 + $1.00 = $19.45 Amount of ÷ $1,000 = # of units x Rate based on = Monthly + Admin fee = Monthly coverage age 45 insurance total due selected premium DEPENDENT DEPENDENT DEPENDENT INSURED SPOUSE/ INSURED SPOUSE/ INSURED SPOUSE/ AGE RATE DOMESTIC AGE RATE DOMESTIC AGE RATE DOMESTIC PARTNER PARTNER PARTNER RATE RATE RATE 15 $0.141 $0.131 37 $0.188 $0.178 59 $1.363 $1.353 16 $0.155 $0.145 38 $0.203 $0.193 60 $1.505 $1.495 17 $0.164 $0.154 39 $0.219 $0.209 61 $1.659 $1.649 18 $0.172 $0.162 40 $0.237 $0.227 62 $1.831 $1.821 19 $0.176 $0.166 41 $0.259 $0.249 63 $2.022 $2.012 20 $0.177 $0.167 42 $0.283 $0.273 64 $2.237 $2.227 21 $0.188 $0.178 43 $0.310 $0.300 65 $2.471 $2.461 22 $0.181 $0.171 44 $0.337 $0.327 66 $2.717 $2.707 23 $0.166 $0.156 45 $0.369 $0.359 67 $2.939 $2.929 24 $0.157 $0.147 46 $0.405 $0.395 68 $3.174 $3.164 25 $0.150 $0.140 47 $0.445 $0.435 69 $3.434 $3.424 26 $0.150 $0.140 48 $0.489 $0.479 70 $3.726 N/A 27 $0.142 $0.132 49 $0.535 $0.525 71 $4.057 N/A 28 $0.142 $0.132 50 $0.587 $0.577 72 $4.435 N/A 29 $0.142 $0.132 51 $0.645 $0.635 73 $4.863 N/A 30 $0.142 $0.132 52 $0.708 $0.698 74 $5.327 N/A 31 $0.142 $0.132 53 $0.778 $0.768 75 $5.820 N/A 32 $0.150 $0.140 54 $0.846 $0.836 76 $6.394 N/A 33 $0.150 $0.140 55 $0.931 $0.921 77 $6.993 N/A 34 $0.157 $0.147 56 $1.022 $1.012 78 $7.620 N/A 35 $0.166 $0.156 57 $1.126 $1.116 79 $8.297 N/A 36 $0.173 $0.163 58 $1.239 $1.229 TABLE B TABLE C LIFE INSURANCE ONLY VAD&D LIFE INSURANCE ONLY MONTHLY TERM RATES MONTHLY TERM RATES AGE DEPENDENT CHILD(REN) VAD&D EMPLOYEE VAD&D FAMILY RATE RATE ONLY RATE N/A $0.209 $0.035 $0.05 Please Note: The Dependent Child(ren) Rate is based on a flat monthly rate. Each child is covered for the same amount regardless of the number of children covered under the policy EPORT RATE SHEET Page 2 of 2 EPORT (07/19)