ADA LEVEL TERM LIFE - ADA-Sponsored Insurance Plans

ADA LEVEL TERM LIFE INSURANCE PLAN

s

2021 Premiums for Males

Help give your loved ones the protection they need

Member Coverage

? Exclusive, low ADA member premiums

? Up to $3,000,000 in death benefit

Spouse Coverage

? Same low rates as member coverage ? Coverage available up to $1,000,000*

Dependent Coverage

? One flat premium provides coverage for all your eligible dependent children

? $15,000 of coverage for children ages 15 days?21 (to age 27 if full-time student)

Choices of Coverages

? 10 years of guaranteed rates4

? 20 years of guaranteed rates5

? M ay roll coverage into annually renewable Term Life Insurance before the end of the term2

*Cannot exceed member coverage amount.

1Premiums are fixed based on the selected duration of 10 or 20 years, are effective as of 1/1/21 with a semi-annual billing frequency. Must maintain ADA membership throughout selected Term.

2After ages 59 for 20-year term and 64 for 10-year term, coverage amounts can no longer be increased. Participant may roll coverage into annually renewable Term Life before the end of the term, which is renewable up to the age of 81.

3Preferred rates are available to the healthiest individuals who have low-risk health and lifestyle characteristics. Your eligibility will be determined through medical underwriting. You must be a non-smoker and have normal blood pressure (without medication) and normal cholesterol, plus meet all other health-related underwriting criteria. You must also have low-risk lifestyle characteristics that include non-hazardous avocations and travel, and a good driving record.

4Eligible to apply for coverage up to age 65.

5Eligible to apply for coverage up to age 60.

Effective June 1, 2019, certain insurance company members of the Protective Life group assumed administrative responsibilities for the ADA Members Insurance Plans issued by Great-West Financial?.

This material is not a contract. Benefits are provided through a group policy (No. 104LTLP Level Term Life) filed in the State of Illinois in accordance with and governed by Illinois law, issued to the American Dental Association by Great-West Financial?. The ADA is entitled to receive royalties from the group policies issued to the ADA by Great-West Financial. Coverage is available to eligible ADA members in all fifty states and US territories under the aforementioned group policy. Each Plan participant will receive a Certificate of Insurance explaining the terms and conditions of the policy. Great-West Financial? is a marketing name of Great-West Life & Annuity Insurance Company, Corporate Headquarters: Greenwood Village, CO; Great-West Life & Annuity Insurance Company of New York, Home Office: NY, NY, and their subsidiaries and affiliates. GWL&A is not licensed in New York, but eligible members residing in New York may apply for coverage under the aforementioned group policy. ?2020 Great-West Life & Annuity Insurance Company. All Rights Reserved. RO1395113-1120

ADA? is a registered trademark of the American Dental Association and Great-West Financial? is a registered trademark of GWL&A.

ADA LEVEL TERM LIFE INSURANCE PLAN

Semi-Annual Premiums per $100,000 of Coverage1 for Males

Insured

Member's Issue Age2

10-YEAR TERM

Preferred3

Standard

Semi-Annual Rates Semi-Annual Rates

20-YEAR TERM

Preferred3

Standard

Semi-Annual Rates Semi-Annual Rates

20

$11.86

21

$11.86

22

$11.86

23

$11.86

24

$11.86

25

$11.86

26

$11.86

27

$11.86

28

$11.86

29

$11.86

30

$11.86

31

$11.86

32

$11.86

33

$11.86

34

$11.86

35

$11.86

36

$12.37

37

$12.89

38

$13.92

39

$15.46

40

$17.01

41

$19.07

42

$21.13

43

$23.71

44

$27.32

45

$30.41

46

$33.51

47

$37.11

48

$41.24

49

$45.88

50

$50.52

51

$55.15

52

$60.31

53

$66.49

54

$72.68

55

$79.90

56

$86.60

57

$93.81

58

$103.09

59

$113.92

60

$127.32

61

$143.30

62

$162.37

63

$184.54

64

$210.31

$21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.65 $22.68 $24.23 $25.77 $28.35 $30.93 $34.02 $37.63 $41.24 $45.88 $50.52 $55.67 $61.34 $68.04 $74.74 $81.96 $88.66 $95.88 $104.64 $113.40 $123.71 $134.54 $146.39 $160.82 $177.32 $196.91 $220.10 $247.42 $278.35 $313.40

$21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.65 $22.16 $22.68 $23.71 $24.74 $26.80 $28.35 $30.41 $32.99 $36.08 $40.21 $45.36 $50.52 $56.19 $62.89 $69.07 $75.77 $84.02 $91.75 $101.03 $110.82 $121.65 $134.54 $147.94 $164.43 $182.47 $202.06 $224.74 $250.00 $278.87

-- -- -- --

$32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $33.51 $34.02 $34.54 $35.05 $35.57 $36.08 $36.60 $37.11 $38.66 $40.21 $42.78 $46.39 $50.00 $54.12 $59.28 $65.46 $72.16 $79.90 $88.14 $96.91 $106.70 $118.04 $129.38 $142.78 $156.70 $171.65 $188.14 $206.70 $227.84 $252.06 $280.41 $312.37 $348.45 $389.18 $435.57

-- -- -- --

Just $29.46 semi-annually provides $15,000 of ADA Level Term Life coverage for all of your eligible dependent children.

Visit insurance. to apply online or call 866.607.5338

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