| Coverage Level* | Member Under Age 70 | Member Age 70 and Over | Spouse** Under Age 70 | Spouse** Age 70 and Over | All Children** |
| $ 50,000 | $ 14.25 | $22.00 | $13.00 | $22.00 | $5.00 |
| 100,000 | 28.50 | 44.00 | 26.00 | 44.00 | |
| 150,000 | 42.75 | N/A | 39.00 | N/A | (For |
| 200,000 | 57.00 | N/A | 52.00 | N/A | $10,000 |
| 250,000 | 71.24 | N/A | 65.00 | N/A | coverage |
| 300,000 | 85.50 | N/A | N/A | N/A | for each |
| 350,000 | 98.50 | N/A | N/A | N/A | child) |
| 400,000 | 111.50 | N/A | N/A | N/A | |
| 450,000 | 124.50 | N/A | N/A | N/A | |
| 500,000 | 137.50 | N/A | N/A | N/A |
*
Coverage reduces to a maximum amount of $100,000 for members and/or
spouses on the premium due date coinciding with, or next following
member's attainment of age 70.
** Rates are based on
member's age.
Note: A $2.00 administrative fee is added for billing modes other than annual.
The premium contributions shown above reflect the 2013 rates and benefit structure. New York Life may change premium contributions on any premium due date but not more than once in any twelve-month period, and on any date on which benefits are changed. Your rate may change only if they are changed for all others in the same class of insureds under this group policy. For example, a class of insureds is a group of people with all the same issue age or benefit amount. Benefit option amounts are subject to change by agreement between New York Life and the Policyholder.