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Group Life Ins.

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What is Group Life Insurance?

Group Life Insurance is purchased by employers on behalf of employees to provide benefits coverage to employees and their dependents. Employers are required to participate at a minimum rate of 50% of the cost of the program chosen. Insurance companies require a high percentage of participation among employees in order to make programs feasible.

What are the benefits of Group Life Insurance?

Group Life Insurance provides employees with the opportunity to access insurance coverage that could otherwise be prohibitive by cost. Many coverage's are also available without having to provide medical history. Premiums paid by the employer on behalf of employees are tax deductible. The security provided to employees by benefit packages helps to encourage a productive atmosphere in the workplace.

What Benefits Can Be Included?

Group Life Insurance provides either a flat benefit, such as $25,000 or a percentage of the employee salary, depending on the plan chosen.

Accidental Death & Dismemberment benefit provides coverage as specified in the plan chosen. The amount of coverage usually corresponds to the amount reflected by the Group Life Insurance plan.

Dependent Life Insurance provides coverage for spouses and dependent children.

 

 

Policyholder Name:
Contact Name:
City:
State:
ZIP Code:
Phone:
FAX:
E-mail Address:
Current Carrier:
Current Plan Design:
Effective Date: / /
Renewal Date: / /
Current Rates:
Employee:
Family:
AD&D Rate::
Contributions: Employer Paid
Employee Paid
Employer and Employee Paid

For groups over 5 employees, please fax your census to 201-703-0045!!

Employee #1

DOB: / /
Sex: Male
Female
Coverage: Single
Husband/Wife
Parent/Child
Family

Employee #2
(if applicable)

DOB: / /
Sex: Male
Female
Annual Salary:
Coverage: Single
Husband/Wife
Parent/Child
Family

Employee #3
(if applicable)

DOB: / /
Sex: Male
Female
Annual Salary:
Coverage: Single
Husband/Wife
Parent/Child
Family

Employee #4
(if applicable)

DOB: / /
Sex: Male
Female
Annual Salary:
Coverage: Single
Husband/Wife
Parent/Child
Family

Employee #5
(if applicable)

DOB: / /
Sex: Male
Female
Annual Salary:
Coverage: Single
Husband/Wife
Parent/Child
Family