Voluntary Payroll Deduction Insurance PAYROLL DEDUCTION TERM LIFE INSURANCE Policy Form CLI-157 Term 10 Life Insurance Policy Form CLI-142 Term 20 Life Insurance cinfin.com Form CLI-20082 (11/16) Page 1 of 4
The Cincinnati Life Insurance Company PAYROLL DEDUCTION TERM LIFE INSURANCE Term life insurance provides guaranteed protection for a specified term or period of time and generally pays a benefit only if you die during that period. During this period, premiums are guaranteed to remain level. If you are still living at the end of the guaranteed term period, protection ceases unless the policy is renewed. You choose to participate The Payroll Deduction Term Life Insurance program is voluntary. It offers flexibility to build an insurance program that meets your needs and budget. Your spouse, children and grandchildren are also eligible for insurance coverage. Your premiums are conveniently deducted from your paycheck You pay your premiums through the convenience of payroll deduction, so you won't have to worry about remembering to write checks or mail payments. You own the policy Cincinnati Life s Term 10 and Term 20 life insurance policies provide individual coverage. You are the owner of your policy and it is portable. If you leave your employer or retire, you may continue coverage by paying the scheduled premiums directly to Cincinnati Life at the same premium with no change in coverage. Cost-effective life insurance protection Consider the following nonsmoker rate examples on how much coverage you can purchase for a few dollars a week. Age Life insurance 10-Year Premium 20-Year Premium 35 45 55 $50,000 $100,000 $50,000 $100,000 $10,000 $50,000 $100,000 $2.72 4.96 $5.22 9.96 $2.96 12.86 25.23 $3.42 6.36 $6.54 12.60 N/A $15.46 30.44 Give your family the added financial protection they may need in the event that something unexpected happens. Cover your children, stepchildren and legally adopted children, ages 15 days through 18 years, for an additional $1 per week with the Children s Term Life Insurance Rider. Each child is insured with $10,000 of life insurance. Conditional coverage the day you sign Your coverage becomes effective on the date you sign the payroll deduction authorization and the application, provided all persons to be insured are acceptable under Cincinnati Life s underwriting guidelines. Issuance of the policy may depend on the answers to the health questions in the application. Form CLI-20082 (11/16) Page 2 of 4
Valuable coverage Cincinnati Life s term life insurance policies are designed to enhance group life coverage by offering additional financial protection for your family during your working years. Premiums are guaranteed for the first 10 or 20 years of the policy, depending on the term period you choose. After the end of the term period, premiums will increase annually through age 100. Your insurance needs may change in the future. That s why your term life insurance policy provides you with an option to convert, without evidence of insurability, to one of Cincinnati Life s currently marketed, individual, permanent life insurance policies. You may convert your policy at any time prior to the end of the 10- or 20-year guaranteed term period or the policy anniversary following your 70 th birthday, whichever comes first, provided premiums are not being waived under the Disability Waiver of Premium Rider. You can cover your entire family Several options are available to help protect your family. You choose who to cover and how much coverage is necessary. You are not required to purchase a policy on yourself in order to cover your spouse or dependents. Coverage for you and your spouse You may apply for a term life insurance policy on you and your spouse. Available issue ages for Term 10 are 18 through 70. Available issue ages for Term 20 are 18 through 60. Coverage for children and grandchildren Cincinnati Life offers two ways to cover children. You may insure them under their own separate policy or a rider that is added to your policy or your spouse s policy. Individual life insurance You may apply for a Whole Life policy for your children, stepchildren, legally adopted children and grandchildren, ages 15 days through 18 years. You may also apply for Whole Life, Term or Term ROP for your children, stepchildren and legally adopted children ages 18-25 who are full-time students, unmarried and not in military services. Children s Term Life Insurance Rider (CLI-671)* This rider is available to cover your children, stepchildren and legally adopted children when attached to either your policy or your spouse s policy. One premium covers all children, each with a death benefit of $10,000. To apply for this rider, you or your spouse must be ages 18 through 60, and the children must be ages 15 days through 18 years. Insurance on each child continues to age 25, even if the child marries or enters the military service. All covered children can purchase up to five times the amount of their rider coverage as they reach age 25, regardless of their health or occupation at the time they convert to their own policy. You can customize your policy to meet your needs Accidental Death Benefit Rider (01901)* This rider is available to you and your spouse ages 18 through 60. It provides an additional death benefit equal to the initial amount of insurance. This benefit is payable if the insured dies before age 70 as the result of an accident. Accelerated Benefit Rider (CLI-680-T)* This rider is available to you, your spouse, children and grandchildren ages 18 through age 70 at no additional charge. It allows the policyowner to request up to 50 percent of the policy s face amount if the insured has been diagnosed by a physician with a terminal illness that is reasonably expected to result in death within 24 months or has been confined continuously for 90 days in a nursing home and is reasonably expected to remain there for the duration of the insured s life. One advanced payment is allowed per calendar year. The maximum lifetime benefit available is lesser of 50 percent of the death benefit or $250,000. The minimum benefit which can be advanced is $2,500. Disability Waiver of Premium Rider (01900)* This rider is available to you and your spouse ages 18 through 60. After four consecutive months of total disability, it waives the entire policy premium in the event that the insured is totally disabled. Therefore, insurance coverage continues during a time when paying premiums may be a hardship. All premiums you paid from the first day of total disability are returned to you. * Rider eligibility subject to issue age limitations of the base policy. Form CLI-20082 (11/16) Page 3 of 4
Employee and dependent coverage work sheet Employee coverage Spouse coverage Name Name Date of birth SS # Date of birth SS # Term 10 Term 20 Term 10 Term 20 Benefit amount Premium amount Benefit amount Premium amount Term death benefit $ $ Term death benefit $ $ Accidental Death Benefit $ Accidental Death Benefit $ Children s Term* $ Children s Term* $ Waiver of Premium $ Waiver of Premium $ Total premium $ Total premium $ Individual policy for children and/or grandchildren Name Name Date of birth SS # Date of birth SS # Whole Life Whole Life Benefit amount Premium amount Benefit amount Premium amount Death benefit $ $ Death benefit $ $ Accidental Death Benefit $ Accidental Death Benefit $ Waiver of Premium $ Waiver of Premium $ Total premium $ Total premium $ Name Name Date of birth SS # Date of birth SS # Whole Life Whole Life Benefit amount Premium amount Benefit amount Premium amount Death benefit $ $ Death benefit $ $ Accidental Death Benefit $ Accidental Death Benefit $ Waiver of Premium $ Waiver of Premium $ Total premium $ Total premium $ * The Children s Term Life Insurance Rider may be added to either the employee or spouse policy, not both. This is not a policy. For a complete statement of the coverages and exclusions, please see the policy contract. All applicants are subject to eligibility requirements. Product and riders are available in most states. Some riders may not be available to all employer groups. Copyright 2016 The Cincinnati Life Insurance Company. All rights reserved. Do not reproduce or post online, in whole or in part, without written permission. 6200 S. Gilmore Road, Fairfield, OH 45014-5141. Mailing address: P.O. Box 145496, Cincinnati, OH 45250-5496. cinfin.com Form CLI-20082 (11/16) Page 4 of 4 (7/14)
Payroll Deduction Term 20 Life Insurance TERM 20 NONSMOKER WEEKLY Level Amounts of Insurance Weekly Premium Policy Form CLI-142 Age at contract date $25,000 $50,000 $75,000 $100,000 18 $ 1.57 $ 2.66 $ 3.75 $ 4.85 19 1.57 2.66 3.75 4.85 20 1.57 2.66 3.75 4.85 21 1.57 2.66 3.75 4.85 22 1.57 2.66 3.75 4.85 23 1.57 2.66 3.75 4.85 24 1.57 2.66 3.75 4.85 25 1.57 2.66 3.75 4.85 26 1.59 2.69 3.80 4.90 27 1.60 2.72 3.84 4.96 28 1.62 2.75 3.88 5.02 29 1.63 2.79 3.94 5.10 30 1.66 2.84 4.02 5.19 31 1.69 2.90 4.11 5.33 32 1.74 2.99 4.25 5.50 33 1.79 3.11 4.42 5.73 34 1.86 3.25 4.63 6.02 35 1.95 3.42 4.89 6.36 36 2.05 3.62 5.18 6.75 37 2.14 3.80 5.46 7.11 38 2.24 4.00 5.76 7.52 39 2.35 4.22 6.09 7.96 40 2.48 4.47 6.47 8.46 41 2.62 4.76 6.90 9.04 42 2.79 5.10 7.42 9.73 43 3.00 5.51 8.02 10.54 44 3.23 5.98 8.73 11.48 45 3.51 6.54 9.57 12.60 46 3.74 6.99 10.24 13.50 47 4.01 7.54 11.07 14.60 48 4.34 8.19 12.05 15.90 49 4.71 8.93 13.16 17.38 50 5.13 9.78 14.43 19.08 51 5.61 10.73 15.86 20.98 52 6.14 11.80 17.46 23.11 53 6.72 12.95 19.19 25.42 54 7.33 14.18 21.03 27.88 55 7.97 15.46 22.95 30.44 56 8.59 16.69 24.80 32.90 57 9.18 17.88 26.58 35.29 58 9.83 19.18 28.53 37.88 59 10.62 20.77 30.91 41.06 60 11.62 22.77 33.91 45.06 Form CLI-20082-20-A (6/16) Page 1 of 2
Payroll Deduction Term 20 Life Insurance TERM 20 SMOKER WEEKLY Level Amounts of Insurance Weekly Premium Policy Form CLI-142 Age at contract date $25,000 $50,000 $75,000 $100,000 18 $ 2.06 $ 3.64 $ 5.22 $ 6.81 19 2.08 3.67 5.27 6.87 20 2.10 3.71 5.33 6.94 21 2.13 3.77 5.41 7.06 22 2.16 3.85 5.53 7.21 23 2.20 3.92 5.64 7.37 24 2.25 4.02 5.79 7.56 25 2.31 4.14 5.96 7.79 26 2.36 4.24 6.12 8.00 27 2.41 4.35 6.28 8.21 28 2.46 4.44 6.42 8.40 29 2.52 4.56 6.60 8.64 30 2.58 4.68 6.78 8.88 31 2.66 4.85 7.03 9.21 32 2.76 5.05 7.33 9.62 33 2.89 5.30 7.71 10.11 34 3.04 5.61 8.17 10.73 35 3.24 5.99 8.74 11.50 36 3.44 6.40 9.36 12.33 37 3.66 6.84 10.01 13.19 38 3.88 7.29 10.69 14.10 39 4.13 7.78 11.43 15.08 40 4.40 8.33 12.25 16.17 41 4.72 8.95 13.19 17.42 42 5.07 9.66 14.25 18.84 43 5.48 10.48 15.48 20.48 44 5.95 11.42 16.89 22.36 45 6.49 12.50 18.51 24.52 46 7.09 13.70 20.31 26.92 47 7.74 15.00 22.26 29.52 48 8.44 16.40 24.36 32.33 49 9.19 17.89 26.60 35.31 50 9.99 19.50 29.01 38.52 51 10.84 21.19 31.55 41.90 52 11.74 23.00 34.26 45.52 53 12.69 24.89 37.10 49.31 54 13.69 26.89 40.10 53.31 55 14.73 28.99 43.24 57.50 56 15.96 31.44 46.92 62.40 57 17.28 34.08 50.89 67.69 58 18.69 36.90 55.11 73.32 59 20.20 39.91 59.63 79.34 60 21.79 43.10 64.41 85.73 Copyright 2016 The Cincinnati Life Insurance Company. All rights reserved. Do not reproduce or post online, in whole or in part, without written permission. 6200 S. Gilmore Road, Fairfield, OH 45014-5141. cinfin.com Form CLI-20082-20-A (6/16) Page 2 of 2 (7/14)
Payroll Deduction Term 10 Life Insurance TERM 10 NONSMOKER WEEKLY Level Amounts of Insurance Weekly Premium Policy Form CLI-157 Age at contract date $10,000 $25,000 $50,000 $75,000 $100,000 18 $ 1.26 $ 2.04 $ 2.82 $ 3.60 19 1.27 2.06 2.85 3.63 20 1.28 2.08 2.88 3.67 21 1.30 2.12 2.93 3.75 22 1.32 2.15 2.99 3.83 23 1.35 2.23 3.11 3.98 24 1.39 2.31 3.22 4.14 25 1.45 2.42 3.39 4.37 26 1.47 2.45 3.44 4.42 27 1.48 2.48 3.48 4.48 28 1.50 2.51 3.52 4.54 29 1.51 2.54 3.57 4.60 30 1.52 2.57 3.61 4.65 31 1.54 2.60 3.65 4.71 32 1.55 2.62 3.70 4.77 33 1.57 2.65 3.74 4.83 34 1.59 2.69 3.80 4.90 35 1.60 2.72 3.84 4.96 36 1.69 2.89 4.10 5.31 37 1.78 3.09 4.39 5.69 38 1.89 3.29 4.69 6.10 39 1.99 3.50 5.01 6.52 40 2.11 3.74 5.37 7.00 41 2.24 3.99 5.74 7.50 42 2.37 4.27 6.16 8.06 43 2.52 4.56 6.60 8.64 44 2.68 4.87 7.07 9.27 45 2.85 5.22 7.59 9.96 46 3.09 5.70 8.31 10.92 47 3.35 6.22 9.09 11.96 48 3.64 6.80 9.96 13.11 49 3.96 7.44 10.92 14.40 50 $ 2.01 4.31 8.14 11.97 15.81 51 2.17 4.70 8.91 13.13 17.34 52 2.34 5.12 9.76 14.40 19.04 53 2.52 5.59 10.69 15.80 20.90 54 2.73 6.10 11.72 17.34 22.96 55 2.96 6.67 12.86 19.04 25.23 56 3.20 7.28 14.09 20.89 27.69 57 3.47 7.96 15.43 22.91 30.38 58 3.77 8.70 16.92 25.14 33.36 59 4.10 9.52 18.56 27.60 36.63 60 4.46 10.42 20.35 30.29 40.23 61 4.85 11.40 22.33 33.25 44.17 62 5.28 12.49 24.50 36.51 48.52 63 5.76 13.68 26.88 40.08 53.29 64 6.29 15.00 29.51 44.02 58.54 65 6.86 16.44 32.39 48.35 64.31 66 7.52 18.07 35.66 53.25 70.84 67 8.24 19.87 39.27 58.66 78.06 68 9.03 21.86 43.24 64.62 86.00 69 9.91 24.05 47.61 71.18 94.75 70 10.87 26.46 52.44 78.42 104.40 Form CLI-20082-10-A (4/16) Page 1 of 2 (7/14)
Payroll Deduction Term 10 Life Insurance TERM 10 SMOKER WEEKLY Level Amounts of Insurance Weekly Premium Policy Form CLI-157 Age at contract date $10,000 $25,000 $50,000 $75,000 $100,000 18 $ 1.79 $ 3.11 $ 4.42 $ 5.73 19 1.82 3.16 4.50 5.85 20 1.85 3.22 4.59 5.96 21 1.89 3.30 4.71 6.12 22 1.92 3.36 4.81 6.25 23 1.96 3.43 4.91 6.39 24 1.99 3.50 5.01 6.52 25 2.02 3.57 5.11 6.65 26 2.07 3.66 5.25 6.85 27 2.12 3.75 5.38 7.02 28 2.17 3.86 5.54 7.23 29 2.22 3.95 5.69 7.42 30 2.27 4.06 5.85 7.63 31 2.32 4.16 6.00 7.85 32 2.38 4.28 6.18 8.08 33 2.43 4.38 6.34 8.29 34 2.49 4.50 6.51 8.52 35 2.55 4.62 6.70 8.77 36 2.73 4.98 7.23 9.48 37 2.92 5.37 7.81 10.25 38 3.13 5.79 8.44 11.10 39 3.36 6.24 9.12 12.00 40 3.61 6.74 9.87 13.00 41 3.87 7.27 10.66 14.06 42 4.17 7.86 11.54 15.23 43 4.49 8.49 12.49 16.50 44 4.83 9.17 13.52 17.86 45 5.20 9.92 14.64 19.36 46 5.66 10.84 16.01 21.19 47 6.16 11.85 17.53 23.21 48 6.72 12.95 19.19 25.42 49 7.32 14.16 21.00 27.84 50 $ 3.48 7.98 15.49 22.99 30.50 51 3.77 8.71 16.94 25.17 33.40 52 4.09 9.51 18.55 27.58 36.61 53 4.44 10.39 20.30 30.21 40.11 54 4.83 11.35 22.22 33.09 43.96 55 5.25 12.41 24.33 36.26 48.19 56 5.67 13.46 26.44 39.42 52.40 57 6.13 14.61 28.73 42.85 56.98 58 6.63 15.85 31.22 46.59 61.96 59 7.17 17.20 33.92 50.64 67.36 60 7.76 18.68 36.87 55.07 73.27 61 8.40 20.28 40.08 59.87 79.67 62 9.10 22.02 43.56 65.11 86.65 63 9.86 23.92 47.36 70.80 94.25 64 10.68 25.99 51.50 77.01 102.51 65 11.58 28.24 56.00 83.76 111.51 66 12.55 30.66 60.83 91.01 121.19 67 13.60 33.29 66.09 98.90 131.71 68 14.75 36.15 71.82 107.48 143.15 69 15.99 39.26 78.03 116.81 155.59 70 17.34 42.64 84.79 126.95 169.11 Copyright 2016 The Cincinnati Life Insurance Company. All rights reserved. Do not reproduce or post online, in whole or in part, without written permission. 6200 S. Gilmore Road, Fairfield, OH 45014-5141. cinfin.com Form CLI-20082-10-A (4/16) Page 2 of 2 (7/14)