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GROUP UNIVERSAL LIFE INSURANCE WORKSHEET FOR THE PRUDENTIAL PLAN

- For illustrative purposes, please enter the requested information below to calculate your GUL premiums.
- Use the TAB key or mouse to move within the worksheet.
- Do not use the ENTER key as a way to navigate through this worksheet or to complete your calculation.

Effective April 1, 2019

MEMBER

  Non-smoker  Smoker  

Select a coverage level based upon either a multiple of your salary, or an increment of $10,000. Minimum coverage is $10,000. Maximum coverage is up to the lesser of 8 times your annual basic salary or $1,000,000.

1x Salary
2x Salary
3x Salary
4x Salary
5x Salary
6x Salary
7x Salary
8x Salary
An increment of $10,000 up to $100,000

$

 

   Member Age  

   Annual Basic Salary  
   $ 
SPOUSE

A member must elect coverage for himself/herself in order for his/her spouse to be covered.

   Spouse Age


Select a coverage amount for your spouse in increments of $10,000 ( Up to 5 times of Member's Salary; $250,000 maximum).
DEPENDENT CHILDREN

A member must elect coverage for himself/herself in order for his/her unmarried eligible dependent children to be covered.
Dependent children must be between the ages of 15 days and 26 years.
Select coverage for your dependent children. Each of your dependent children can be covered for $10,000 for a flat rate of per month.

$10,000
$15,000
$20,000
No Coverage


    

 

YOUR CONTRIBUTIONS
Contributions Bi-Weekly Contribution
 Yearly Contribution
Member Life Insurance Coverage
 $ $
Spouse Life Insurance Coverage
 $ $
Dependent Children Life Insurance Coverage
 $ $
TOTAL
 $ $
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