TABLE A LIFE INSURANCE ONLY MONTHLY TERM RATES RATE SHEET Schedule of Monthly Portable Group Life 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 $0.334 = $16.70 + $1.00 = $17.70 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 $0.106 $0.106 37 $0.153 $0.153 59 $1.328 $1.328 16 $0.120 $0.120 38 $0.168 $0.168 60 $1.470 $1.470 17 $0.129 $0.129 39 $0.184 $0.184 61 $1.624 $1.624 18 $0.137 $0.137 40 $0.202 $0.202 62 $1.796 $1.796 19 $0.141 $0.141 41 $0.224 $0.224 63 $1.987 $1.987 20 $0.142 $0.142 42 $0.248 $0.248 64 $2.202 $2.202 21 $0.153 $0.153 43 $0.275 $0.275 65 $2.436 $2.436 22 $0.146 $0.146 44 $0.302 $0.302 66 $2.682 $2.682 23 $0.131 $0.131 45 $0.334 $0.334 67 $2.904 $2.904 24 $0.122 $0.122 46 $0.370 $0.370 68 $3.139 $3.139 25 $0.115 $0.115 47 $0.410 $0.410 69 $3.399 $3.399 26 $0.115 $0.115 48 $0.454 $0.454 70 $3.691 N/A 27 $0.107 $0.107 49 $0.500 $0.500 71 $4.022 N/A 28 $0.107 $0.107 50 $0.552 $0.552 72 $4.400 N/A 29 $0.107 $0.107 51 $0.610 $0.610 73 $4.828 N/A 30 $0.107 $0.107 52 $0.673 $0.673 74 $5.292 N/A 31 $0.107 $0.107 53 $0.743 $0.743 75 $5.785 N/A 32 $0.115 $0.115 54 $0.811 $0.811 76 $6.359 N/A 33 $0.115 $0.115 55 $0.896 $0.896 77 $6.958 N/A 34 $0.122 $0.122 56 $0.987 $0.987 78 $7.585 N/A 35 $0.131 $0.131 57 $1.091 $1.091 79 $8.262 N/A 36 $0.138 $0.138 58 $1.204 $1.204 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 $0.162 $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 1 of 2 EPORT (07/19)