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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.

MEMBER

  
 
 
  

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.

 
 
 
 
 
 
 
 
 

 

     

   Annual Basic Salary  
    
SPOUSE

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

   


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.

 
 
 
 


    

 

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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