This plan is convenient for all married ROA Members because it can provide up to $100,000 of group term life insurance for both you and your spouse¹ in one plan for the cost of one affordable premium. Often called the "first-to-die" plan, it pays benefits for whoever dies first, you or your spouse1.
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Insurance Application and Brochure
Beneficiary Designation Form
The ROA 1 Plan is a joint term “first-to-die” life plan. You and your spouse1 are both covered for the same benefit amount – it pays the benefit you select on whoever dies first – you or your spouse1.
You and your spouse1 under age 65 can apply for $25,000, $50,000, or $100,000 of coverage. The choice is yours.
You can apply for a $5,000 benefit for your unmarried, dependent children age 6 months to age 19 (or 25 if they are full-time students). ($500 for children age 14 days to 6 months.)
Your monthly rate depends on three factors: the benefit amount you select; the tobacco user status of you and your spouse1; and the age difference between you and your spouse1.
NON-TOBACCO USERS: If you and your spouse1 are not tobacco users and the difference between your ages is 5 years or less, refer to TABLE A for our affordable monthly rate. If you’re more than 5 years in age apart, refer to TABLE B.
TOBACCO USERS: If either you or your spouse1 use tobacco and the difference between your ages is 5 years or less, refer to TABLE C. If you’re more than 5 years in age apart, refer to TABLE D.
Monthly Group Rates |
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Table A: Non-Tobacco User (Age difference is five years or less) |
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Oldest Spouse’s1 Age |
$25,000 Benefit |
$50,000 Benefit |
$100,000 Benefit |
Under 30 |
$3.02 |
$6.04 |
$12.08 |
30-34 |
$3.23 |
$6.46 |
$12.92 |
35-39 |
$3.88 |
$7.75 |
$15.50 |
40-44 |
$5.71 |
$11.42 |
$22.83 |
45-49 |
$8.98 |
$17.96 |
$35.92 |
50-54 |
$13.71 |
$27.42 |
$54.83 |
55-59 |
$20.44 |
$40.88 |
$81.75 |
60-64 |
$30.94 |
$61.88 |
$123.75 |
65-69 |
$66.31 |
$132.63 |
$265.25 |
Table B: Non-Tobacco User (Age difference is greater than five years) |
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Oldest Spouse’s1 Age |
$25,000 Benefit |
$50,000 Benefit |
$100,000 Benefit |
Under 30 |
$2.96 |
$5.92 |
$11.83 |
30-34 |
$3.13 |
$6.25 |
$12.50 |
35-39 |
$3.79 |
$7.58 |
$15.71 |
40-44 |
$5.13 |
$10.25 |
$20.50 |
45-49 |
$7.71 |
$15.42 |
$30.83 |
50-54 |
$11.71 |
$23.42 |
$46.83 |
55-59 |
$17.71 |
$35.42 |
$70.33 |
60-64 |
$26.98 |
$53.96 |
$107.92 |
65-69 |
$59.85 |
$119.71 |
$239.42 |
Table C: Tobacco User (Age difference is five years or less) |
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Oldest Spouse’s1 Age |
$25,000 Benefit |
$50,000 Benefit |
$100,000 Benefit |
Under 30 |
$3.67 |
$7.33 |
$14.67 |
30-34 |
$3.90 |
$7.79 |
$15.58 |
35-39 |
$4.69 |
$9.38 |
$18.75 |
40-44 |
$6.90 |
$13.79 |
$27.58 |
45-49 |
$10.85 |
$21.71 |
$43.42 |
50-54 |
$16.60 |
$33.21 |
$66.42 |
55-59 |
$24.73 |
$49.46 |
$98.92 |
60-64 |
$37.44 |
$74.88 |
$149.75 |
65-69 |
$80.21 |
$160.42 |
$320.83 |
Table D: Tobacco User (Age difference is greater than five years) |
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Oldest Spouse’s1 Age |
$25,000 Benefit |
$50,000 Benefit |
$100,000 Benefit |
Under 30 |
$3.58 |
$7.17 |
$14.33 |
30-34 |
$3.77 |
$7.54 |
$15.08 |
35-39 |
$4.58 |
$9.17 |
$18.33 |
40-44 |
$6.21 |
$12.42 |
$24.83 |
45-49 |
$9.33 |
$18.67 |
$37.33 |
50-54 |
$14.17 |
$28.33 |
$56.67 |
55-59 |
$21.42 |
$42.83 |
$85.67 |
60-64 |
$32.65 |
$65.29 |
$130.58 |
65-69 |
$72.42 |
$144.83 |
$289.67 |
Rates shown are guaranteed until 10/31/2024.
If applicable, an additional $2 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option.
Children’s Coverage $5,000 Benefit : 95 cents per month covers all eligible children.
The rates provided will not be changed unless rates change for all insureds in your classification. Your rates are based on the older spouse’s1 attained age and increase as the older spouse1 enters a higher age bracket. You will be billed quarterly for your convenience.
Your coverage continues as long as :
Coverage for your children continues as long as yours does, so long as they remain eligible.
If you die first, then your spouse1 will automatically collect the benefits. If your spouse1 dies first, then you collect the benefits. If both of you die from the same accident, the benefits will be paid to your surviving children. If you have no children, the benefits will be paid to your parents, siblings and then estate in this order. Your children’s beneficiary will be the member first, then your spouse1, your child’s siblings, then your parents, then your siblings, then estate, in this order. (If you wish to designate another beneficiary, please contact the Plan Administrator in writing.)
If you or your spouse1 die, then the surviving spouse1 and covered children can elect coverage under the ROA Term Life Plan, Group Policy No. GL-31816-7, (provided a request for coverage is made within 31 days after you or your spouse’s1 death and you or your spouse1 continue to pay your premiums).
Once your application is approved by the insurer, your coverage will start on the first of the month following the approval date of your application and the receipt of your first premium payment. (If you or your spouse1 are hospitalized at this time, then coverage will begin the day after you’re released.) Your children’s coverage begins on the latest day of the date you become insured, the date the dependent is eligible, or the date ReliaStar Life approves satisfactory evidence that your children are insurable and you pay your premium. (If dependent is hospitalized at this time, then coverage will begin the day after dependent is released.)
This coverage is available only to residents of the United States and may not be available in all states. Please contact the administrator for details.
ReliaStar Life Insurance Company (ReliaStar Life) is the insurance company for the ROA 1 Plan. ReliaStar Life Insurance Company is a member of the Voya® family of companies.
We're here to help! Please contact us in whatever manner is most convenient for you.
| Address AMBA 4050 114th Street Urbandale, Iowa 50322 |
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| Phone 1-800-247-7988 |
| Hours M-F 7:30a-5p CT |
| Email [email protected] |
Insurance Company
| ReliaStar Life Insurance Company Minneapolis, MN |
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Answers about the program, including eligibility, options, customer service and more.
How do I learn more about this insurance plan?
1 In OR, spouse includes domestic partner.
This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of coverage. All coverage is subject to the terms of the group policy. If there is any discrepancy between this document and the group policy documents, the policy document will govern.
Life Insurance coverage is provided under the terms of a group life insurance policy, Group Policy GL-31816-7, issued and delivered in the state of North Dakota, and governed by its laws, to ROA as the policyholder. The group life insurance policy is issued by ReliaStar Life Insurance Company, Minneapolis, Minnesota. The policy is powered on behalf of ReliaStar Life Insurance Company by AMBA, an insurance manager licensed in the state of North Dakota. Policy form LP08GP.
This is a paid endorsement. ROA receives a fee from the insurance broker and/or the insurer for its endorsement of this plan.