State Life Insurance Fund - Wisconsin

State Life Insurance Fund

State of Wisconsin

Office of the Commissioner of Insurance

P.O. Box 7873 ? Madison WI 53707-7873 ? (608) 266-0107 or 1-800-562-5558

oci.slif.htm

HISTORY OF THE FUND

The State Life Insurance Fund (Fund) is a state-sponsored

life insurance program for the benefit of residents of

Wisconsin.

The Fund is a nonprofit organization and receives no subsidies from the state. It is not permitted to use commissioned

agents, does not advertise, and is exempt from federal

income tax. As a result, overhead expenses are minimal.

The Fund was established in 1911 in response to a national

scandal over the improper practices of some life insurance

companies.

According to the Insurance Commissioner at the time, the

Fund was set up ¡°. . . to give the people of the state the

benefit of the best old-line insurance on a mutual plan at

the lowest possible cost.¡±

Originally the maximum level of coverage available to each

policyholder was $1,000. This maximum is now $10,000.

TYPES OF LIFE INSURANCE POLICIES

The Fund pays dividends on all the life insurance it issues.

The two types are:

TERM INSURANCE

A Term to Age 65 policy is offered by the Fund. The

premiums for these policies remain the same until the policy

terminates. Term to Age 65 may be converted to any type

of whole life insurance prior to age 55. (The Fund does

not offer decreasing or annually renewable term policies.)

Term insurance provides death protection for a specific

period. Death benefits are paid only if you die within that

period. People usually buy term insurance to get the most

death protection for their money.

WHOLE LIFE INSURANCE

The Fund offers four different whole life policies. An

Ordinary Life policy has premiums paid throughout the life

of the policyholder. A Life Paid Up at Age 65 policy has

OCI 42-571 (R 8/2021)

premiums payable to age 65. A 20-Payment Life policy is

paid for 20 years. A Single Premium Life policy has one

premium paid at the time of issue.

Whole life insurance has lifetime insurance protection for

the insured provided the premium is paid.

Whole life policies accumulate a cash value which is

returned to you if you surrender the policy. You may borrow

against the policy¡¯s cash value. If you do, the policy¡¯s net

value will be reduced proportionately.

Whole life insurance is sometimes bought as an investment.

However, very little of your premium will be returned to you

if you surrender your policy in the early years. For the

first several years, the rate of return on the cash value is

low. You should not consider any whole life policy as an

investment unless you intend to keep it for twenty years

or longer.

APPLICATION PROCESS

ELIGIBILITY

Life insurance policies are only available to persons who

are residents of the state of Wisconsin at the time the

application is submitted. Proposed insureds must be at

least 14 days old.

All five different policies are available to residents who are

standard risks. Residents who are substandard risks are

only eligible for an Ordinary Life policy.

Underwriting of the applications of substandard risks may

require the Fund to seek information from the Medical

Information Bureau and/or an investigative consumer

report. This information will only be obtained if necessary.

The Fund is not required to provide insurance to all

residents who apply. Consequently some substandard

risks may not be eligible for insurance from the Fund. The

Fund is required to operate in a manner consistent with

private insurers with regard to policy coverage, medical

examinations, and underwriting procedures.

MEDICAL EXAMINATIONS

The Fund requires a medical exam for applicants who are

55 years of age or older. The Fund may request exams on

other applicants. If a medical exam is required or requested,

the applicant will be required to see a licensed physician.

The Fund will pay a set fee toward the exam cost.

LIFE INSURANCE COSTS

PREMIUM TABLES

The premiums for the standard policies offered by the

Fund are given on the following page. To determine your

premium, look at your age, sex, and the policy you wish to

buy. The rates indicate the cost per $1,000 of insurance.

Multiply this rate by the amount of insurance you are buying

to determine the actual premium you will pay. If you pay

quarterly or semiannually, costs will be somewhat higher.

If you can afford to pay premiums annually, you can save

this cost.

WAIVER OF PREMIUM BENEFIT

Standard risks who buy life insurance through the Fund

automatically have a waiver of premium benefit. This

means if total and permanent disability of the insured

occurs, premium payments are paid by the Fund and the

policy remains in force.

This benefit expires when the insured reaches age 60

unless the insured is disabled.

CASH SURRENDER VALUE

The cash surrender value is the guaranteed amount of

cash available in the policy. Cash surrender values are

important to policyholders who wish to borrow money or

build an asset fund.

Cash surrender values may be borrowed. If you borrow the

cash surrender value and die, this amount will be deducted

from the benefits paid. The Fund currently charges 8%

interest on outstanding loans. If you terminate the policy,

you will receive the net cash surrender value. If you would

like a printout of cash values for a desired plan, contact

the Fund.

OTHER CONSIDERATIONS

Cost is only one consideration in buying life insurance.

Consumers should also be concerned about the provisions

of the policy contract, the stability of the insurer, and the

service received.

APPLICATION INSTRUCTIONS

Instructions for completing the Fund application form are included on the form. However, five important instructions

should be noted:

1. All questions in the application must be answered. The processing of the insurance will be delayed with incomplete

responses.

2. Enter the total annual premium on the application. For a $5,000 policy, the annual premium will be five times the rate

per $1,000, etc. This must be entered on the application form even if you are paying quarterly or semiannually.

3. State the full name of all beneficiaries. Do not list beneficiaries as ¡°my wife,¡± ¡°my spouse,¡± or ¡°Mrs. Brown.¡±

4. If the person to be covered by the insurance is under age 18, an owner must be designated.

5. Mail the application form and premium to:

State Life Insurance Fund

P.O. Box 7873

Madison, WI 53707-7873.

PRE NOTICE¡ªDISCLOSURE OF

INFORMATION

State Life Insurance Fund

P.O. Box 7873

Madison, WI 53707-7873

(608) 266-0107 or 1-800-562-5558

Fax: (608) 264-6220

ocislif@

oci.slif.htm

We, or our reinsurers, may make a brief report to the MIB, Inc. MIB, Inc., is a not-for-profit membership organization of

insurance companies that operates an information exchange on behalf of its members. If you apply to another MIB member

company for life or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request

will supply the company with the information in its file. At your request, MIB will arrange disclosure of any information it may

have in your file. If you question the accuracy of the information in MIB¡¯s file, you may contact MIB and seek correction

in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of MIB¡¯s information

office is 50 Braintree Hill Park, Suite 400, Braintree, Massachusetts 02184-8734. The telephone number is 866-692-6901.

Information for consumers about MIB, Inc., may be obtained on its website at .

LIFE INSURANCE ANNUAL PREMIUMS PER $1,000

INCLUDES WAIVER OF PREMIUM BENEFIT AT APPLICABLE AGES

MALE PREMIUMS

Issue

Age

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

OL

Ordinary

Life

20P

Twenty

Pay Life

L65

Life

Paid Up

at Age 65

T65

Term to

Age 65

8.26

8.37

8.47

8.57

8.67

8.77

8.89

9.02

9.15

9.27

9.39

9.56

9.72

9.88

10.03

10.17

10.35

10.52

10.70

10.87

11.04

11.25

11.46

11.67

11.88

12.10

12.36

12.63

12.91

13.21

13.50

13.86

14.23

14.60

14.98

15.38

15.84

16.31

16.80

17.31

17.83

18.34

18.88

19.44

20.02

20.64

21.29

21.97

22.69

23.45

24.25

25.07

25.93

26.83

27.78

28.77

29.68

30.63

31.61

32.64

33.70

35.29

36.97

38.75

40.65

42.67

45.15

47.83

50.73

53.86

57.24

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

10.68

10.85

11.03

11.21

11.39

11.57

11.79

12.01

12.22

12.44

12.67

12.93

13.20

13.46

13.71

13.96

14.24

14.51

14.78

15.05

15.32

15.63

15.94

16.25

16.57

16.89

17.26

17.64

18.03

18.43

18.84

19.31

19.78

20.26

20.75

21.24

21.80

22.37

22.94

23.53

24.12

24.74

25.38

26.04

26.72

27.44

28.15

28.89

29.67

30.48

31.32

32.13

32.97

33.84

34.75

35.70

36.46

37.24

38.05

38.90

39.78

41.18

42.65

44.21

45.87

47.65

49.76

52.06

54.55

57.29

60.28

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

8.39

8.50

8.62

8.73

8.84

8.95

9.10

9.24

9.39

9.53

9.67

9.86

10.05

10.24

10.42

10.59

10.81

11.02

11.24

11.45

11.67

11.93

12.20

12.48

12.76

13.06

13.41

13.77

14.16

14.56

14.99

15.49

16.01

16.56

17.14

17.75

18.45

19.19

19.97

20.81

21.71

22.67

23.70

24.83

26.07

27.44

28.95

30.64

32.52

34.63

37.01

39.67

42.74

46.29

50.46

55.43

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

7.19

7.26

7.30

7.34

7.37

7.40

7.45

7.50

7.54

7.58

7.63

7.69

7.76

7.83

7.91

7.99

8.11

8.22

8.32

8.43

8.52

8.65

8.76

8.87

8.97

9.06

9.18

9.30

9.42

9.56

9.71

9.85

10.00

10.18

10.37

10.58

10.88

11.21

11.56

11.93

12.33

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

SP

Single

Premium

Life

120.67

123.07

125.65

128.30

131.00

133.76

136.78

139.86

143.01

146.22

149.48

153.10

156.77

160.49

164.22

167.92

171.95

175.90

179.74

183.65

187.63

191.99

196.44

200.98

205.63

210.37

215.56

220.91

226.43

232.14

238.02

244.33

250.79

257.37

264.10

270.95

278.15

285.47

292.90

300.46

308.15

316.04

324.09

332.31

340.78

349.49

358.45

367.68

377.17

386.95

397.00

407.39

418.03

428.90

440.00

451.33

462.98

474.85

486.90

499.12

511.49

524.22

537.06

550.00

563.01

576.09

589.58

603.18

616.88

630.67

644.51

659.39

674.26

689.05

703.73

718.26

733.92

749.50

765.00

780.42

795.73

INCLUDES WAIVER OF PREMIUM BENEFIT AT APPLICABLE AGES

FEMALE PREMIUMS

Issue

Age

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

OL

Ordinary

Life

7.89

7.98

8.07

8.16

8.25

8.33

8.45

8.56

8.67

8.78

8.89

9.03

9.17

9.32

9.45

9.58

9.74

9.90

10.06

10.23

10.39

10.59

10.79

11.00

11.20

11.41

11.66

11.91

12.17

12.43

12.70

13.02

13.34

13.68

14.02

14.37

14.77

15.20

15.63

16.07

16.54

17.01

17.51

18.02

18.56

19.12

19.73

20.36

21.02

21.71

22.42

23.16

23.93

24.74

25.58

26.46

27.26

28.09

28.96

29.85

30.78

32.09

33.47

34.93

36.48

38.11

40.24

42.52

44.96

47.58

50.40

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

20P

Twenty

Pay Life

9.99

10.15

10.30

10.47

10.62

10.78

10.97

11.16

11.36

11.55

11.74

11.97

12.21

12.44

12.67

12.89

13.15

13.40

13.66

13.92

14.19

14.49

14.80

15.11

15.42

15.73

16.09

16.45

16.83

17.20

17.59

18.01

18.45

18.90

19.35

19.81

20.32

20.84

21.37

21.92

22.48

23.08

23.70

24.34

25.00

25.68

26.39

27.11

27.85

28.62

29.42

30.18

30.97

31.79

32.63

33.50

34.20

34.91

35.65

36.41

37.20

38.35

39.56

40.83

42.17

43.60

45.42

47.38

49.48

51.76

54.23

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

L65

Life

Paid Up

at Age 65

8.01

8.11

8.21

8.31

8.41

8.51

8.64

8.77

8.90

9.02

9.15

9.31

9.48

9.65

9.81

9.97

10.17

10.37

10.57

10.77

10.98

11.24

11.50

11.76

12.03

12.31

12.65

12.99

13.35

13.73

14.12

14.57

15.05

15.55

16.08

16.63

17.27

17.95

18.67

19.44

20.27

21.17

22.16

23.23

24.40

25.69

27.13

28.72

30.49

32.47

34.70

37.24

40.16

43.54

47.51

52.24

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

T65

Term to

Age 65

SP

Single

Premium

Life

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

6.66

6.70

6.73

6.76

6.80

6.83

6.88

6.94

6.98

7.02

7.05

7.11

7.18

7.24

7.30

7.35

7.44

7.52

7.60

7.67

7.73

7.82

7.89

7.96

8.03

8.09

8.18

8.27

8.36

8.47

8.57

8.74

8.91

9.08

9.26

9.44

9.72

10.01

10.31

10.63

10.97

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

110.58

112.61

114.86

117.22

119.62

122.06

124.74

127.46

130.25

133.08

135.96

139.14

142.38

145.71

149.08

152.44

156.12

159.80

163.53

167.35

171.27

175.53

179.91

184.39

188.94

193.57

198.61

203.77

209.07

214.49

220.04

225.96

232.01

238.20

244.53

250.96

257.74

264.65

271.68

278.84

286.17

293.86

301.76

309.87

318.20

326.75

335.67

344.79

354.12

363.65

373.39

383.49

393.82

404.35

415.08

426.02

437.34

448.85

460.56

472.45

484.52

496.89

509.41

522.06

534.83

547.69

560.88

574.14

587.46

600.83

614.23

628.45

642.73

657.05

671.40

685.76

701.37

716.96

732.51

748.00

763.39

State of Wisconsin

Office of the Commissioner of Insurance

State Life Insurance Fund

P.O. Box 7873

Madison, WI 53707-7873

(608) 266-0107 or 1-800-562-5558

APPLICATION FOR INSURANCE

Ref: Ch. 607, Wis. Stat.

For office use only:

Cash with Application $

Date Received

Policy Number

INSTRUCTIONS: Print in ink or type all information, sign form, and forward to above address. All questions must be answered. Only

Wisconsin residents are eligible to apply for this insurance. The Fund is NOT required to provide insurance to all applicants.

A. Proposed Insured Information

1. Proposed Insured¡¯s Name First

Middle

2. Resident Address

3. Sex

Male

Female

Last

City

4. Age

8. Social Security # of Insured

State

5. State of Birth

Date of Birth

9. Occupation

6. Phone

Zip Code

7. Email

10. Employer

11. Employer Address

City

State

12. Who will be paying for this policy? Name

Zip Code

Last 4 digits of SSN

Address

City

State

Zip Code

B. New Business Product and Benefit Information

1. Complete the amount of coverage and premium for the plan of

3. Amount of premium enclosed $

Premium method may be changed only on the policy anniversary

date. The Automatic Premium Loan provision is effective on all Fund

policies.

4. Dividends are to be:

insurance you desire. Maximum coverage amount is $10,000.

Face Amount of Insurance

Annual Premium

$

Ordinary Life

$

Premium Amount

$

20-Payment Life

$

Premium Amount

$

Life Paid Up at Age 65

$

Premium Amount

$

Term to Age 65

$

Premium Amount

$

Single Premium Life

$

Applied to reduce premium

Left to accumulate interest

Paid in cash

Unless otherwise specified, dividends will be applied to reduce

the premium.

Total Premium

2. How do you wish to pay premium? (Not applicable to Single Premium

Life) If amount is less than $10, you MUST pay annually.

Annually

Semiannually (Annual x .51)

Quarterly (Annual x .26)

C. Ownership Information

A minor (under age 18) may not be the owner.

1. Will the Proposed Insured be the Sole Owner of the new policy? [ ] Yes

If yes, proceed to Section D, Beneficiary Information.

[ ] No

2. Policy Owner

First Name

Middle Initial

Last Name

Address

City

State

Relationship to Insured

Date of Birth

Social Security # of Owner

OCI 42-511 (R 8/2021)

Zip Code

1

 ................
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