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Insurance Application and Brochure
Beneficiary Designation Form
Your rate for the entire term of your coverage is your rate for your age at the time coverage is issued.*
|
$50,000.00 |
$100,000.00 |
||
Age |
Non-Tobacco User |
Tobacco User |
Non-Tobacco User |
Tobacco User |
35 |
$2.30 |
$8.05 |
$4.60 |
$16.10 |
36 |
2.35 |
8.65 |
4.70 |
17.30 |
37 |
2.40 |
9.30 |
4.80 |
18.60 |
38 |
2.55 |
10.00 |
5.10 |
20.00 |
39 |
2.65 |
10.80 |
5.30 |
21.60 |
40 |
2.90 |
11.65 |
5.80 |
23.30 |
41 |
3.15 |
12.60 |
6.30 |
25.20 |
42 |
3.50 |
13.60 |
7.00 |
27.20 |
43 |
3.90 |
14.65 |
7.80 |
29.30 |
44 |
4.30 |
15.80 |
8.60 |
31.60 |
45 |
4.75 |
16.90 |
9.50 |
33.80 |
46 |
5.20 |
18.00 |
10.40 |
36.00 |
47 |
5.65 |
19.15 |
11.30 |
38.30 |
48 |
6.10 |
20.40 |
12.20 |
40.80 |
49 |
6.65 |
21.80 |
13.30 |
43.60 |
50 |
7.35 |
23.30 |
14.70 |
46.60 |
51 |
8.10 |
25.00 |
16.20 |
50.00 |
52 |
9.00 |
26.80 |
18.00 |
53.60 |
53 |
9.95 |
28.75 |
19.90 |
57.50 |
54 |
11.10 |
30.85 |
22.20 |
61.70 |
55 |
12.25 |
33.10 |
N/A |
N/A |
56 |
13.40 |
35.35 |
N/A |
N/A |
57 |
14.65 |
37.70 |
N/A |
N/A |
58 |
16.05 |
40.45 |
N/A |
N/A |
59 |
17.65 |
43.90 |
N/A |
N/A |
60 |
19.55 |
48.65 |
N/A |
N/A |
Rates shown are as of 9/1/2020.
*Premiums are based on your age at the date of issue and will not increase due to your age or health status. Premiums will only be increased for all insureds in the same age and rate class. The initial premium will not change for the first 10 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days advanced written notice.
**You will be billed just four times a year. If applicable, an additional $2.00 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.
Coverage will not be reduced during your level term period. The level term rate period begins on the effective date assigned by ReliaStar Life. Plan benefits are offered for amounts $50,000.00 to $100,000.00. If you are under age 55, you may select up to $100,000.00 of benefits (in $5,000.00 increments). You can apply for up to $50,000.00 in coverage if you are under age 60. To obtain a rate quote for other ages, benefit amounts, or additional information on the plan, call toll-free 1-800-247-7988.
For members and spouses¹, beginning on and after the 70th birthday, ReliaStar Life decreases the amount of your insurance. ReliaStar Life pays a percentage of the amount otherwise payable:
For members and spouses¹, insurance terminates on the Group Policy anniversary date on or after your 75th birthday.
A decrease in the amount of insurance due to age will take effect on the later of your attainment of any of the specified birthdays, or at the end of a level term rate period. Your amount of insurance will not decrease due to age during a level term rate period.
All members and spouses¹ must complete an application form for any new coverage or to increase coverage (including dependent coverage) or to begin an initial or subsequent 10-year Level Term Rate Period when proof of good health is required.
If there is an increase in the amount of your insurance, the increase will take effect on the first day of the month on or next following the date of the increase. If you are in a Level Term Rate Period, premiums for the increased amount of insurance will be based on your attained age on the effective date of the increase.
Your ROA Level Term Life Plan will start on the first day of the month after your application has been approved by ReliaStar Life and your first premium has been paid.
¹In OR, spouse includes domestic partner.
*Premiums are based on your age at date of issue and will not increase due to your age or health status. The initial premium will not change for the first 10 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days advance written notice.
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 documents will govern. Group Term Life Insurance is underwritten by ReliaStar Life Insurance Company. Policy form LP08GP.
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 to ROA as the policyholder. The group policy is sitused in the state of North Dakota and is governed by its laws. The group life insurance policy is issued by ReliaStar Life Insurance Company, Minneapolis, Minnesota. The policy is administered on behalf of ReliaStar Life Insurance Company by Mercer Consumer, an insurance administrator licensed in the state of North Dakota.
This is a paid endorsement. ROA receives a fee from the insurance broker and/or the insurer for its endorsement of this plan.
We're here to help! Please contact us in whatever manner is most convenient for you.
Administered by:
Address Mercer Consumer 12421 Meredith Drive Urbandale, IA 50398 |
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Phone 1-800-247-7988 |
Hours M-F 7:30a-5p CT |
Email roa.service@mercer.com |
Underwritten by:
Address ReliaStar Life Insurance Company Minneapolis, MN |
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Can my spouse¹ obtain separate coverage?
Yes, a spouse1 can obtain separate coverage.
1In OR, spouse includes domestic partner.
Do I have to take a medical exam, blood test, etc.?
No! Fill out the Simplified Application Form to apply for up to $100,000.00 (under age 55) or $50,000.00 (under age 60) in coverage without submitting to a full medical exam or providing blood work.
How long does the application process take? When will my coverage become effective?
The application process depends on many factors: the number of persons to be insured, their ages, the amount of coverage for which you apply, your medical history and that of your family members (if requesting dependent coverage), and the type of coverage requested.
Who is Mercer Consumer, the Administrator of the Program?
Mercer Consumer is the company contracted to manage the Group Insurance Program. Mercer Consumer is not affiliated with the insurance companies that underwrite each plan.
Who is the current insurance carrier and what is its rating?
ReliaStar Life Insurance Company is the insurance carrier for the ROA Simplified Issue Level Group Term Life Plan. ReliaStar Life is rated A Excellent by A.M. Best. This is the third highest of 15 ratings. A.M. Best company assigns ratings from A++ to F based on a company's financial strength and ability to meet obligations to contract holders.
Mercer Consumer, a service of Mercer Health & Benefits Administration LLC ("Mercer"), makes no representations or warranties, expressed or implied, concerning the financial condition or solvency of any insurers. A.M. Best’s Ratings are under continuous review and subject to change and/or affirmation. For the latest Best’s Ratings and Best’s Company Reports (which include Best’s Ratings), visit the A.M. Best website at http://www.ambest.com. See Guide to Best’s Ratings for explanation of use and charges. Best’s Ratings reproduced herein appear under license from A.M. Best and do not constitute, either expressly or impliedly, an endorsement of Mercer or its recommendations, formulas, criteria or comparisons to any other ratings, rating scales or rating organizations which are published or referenced herein. A.M. Best is not responsible for transcription errors made in presenting Best’s Ratings. Best’s Ratings are proprietary and may not be reproduced or distributed without the express written permission of A.M. Best Company.