Life Insurance

Wachusett Regional School District life insurance is provided by Boston Mutual.

Boston Mutual -- Life and Optional Life Insurance Enrollment Form
Basic Life Insurance Information
Optional Voluntary Life Insurance Information
Optional Life Insurance -- Group Rate Chart
Beneficiary Change Form
Evidence of Insurability Form


Basic Life and AD&D Insurance Benefit
Policy #: G26673
Benefit Amount: $10,000
Maximum Benefit: $10,000
Accidental Death & Dismemberment: Included
Cost: 50% employer paid
Premium: $3.60 per month
Employee cost: $1.80 per month
District cost: $1.80 per month
Contact Information: Boston Mutual
120 Royall Street
Canton, MA 02021

www.bostonmutual.com

Voluntary Life and AD&D Insurance Plan
Policy #: G26673
Benefit Amount: Increments of $10,000
Maximum Benefit: $500,000 not to exceed 7 times your annual salary
Accidental Death & Dismemberment: Included
Non-Medical Maximum: Age / Employee / Spouse

Under 70 / $150,000 / $30,000
70 and Over / $20,000 / $1,000
Maximum Spouse Coverage:

Units of $5,000 to a maximum of $150,000 but not to

exceed 100% of the employee coverage amount.

Child(ren) Coverage:

Dependent children age one year to 19 years (to age 25 if

full-time student) are eligible for Life Insurance in the

amount $5,000 or $10,000 and children 14 days to one

year in the amount of $500 or $1,000.

Cost: 100% employee paid
Contact Information: Boston Mutual
120 Royall Street
Canton, MA 02021

www.bostonmutual.com
Available forms: New forms to be posted shortly

This site provides a brief summary of your plans; it is not a contract.
Please see insurance contracts (available from Human Resources) for complete policy details and limitations.