10/01/2017 to 09/30/2020Financial security X
for the long run. SECURIAN®
RATE CONFIRMATION
1. Policyholder: Monroe County BOCC
2. Policy Number(s): 34395
3. Insurance Product(s): Basic Term Life and AD &D, Employee and Spouse Supplemental Term Life
and AD &D and Child Life
4. The insurance rates included in this rate confirmation are net of commissions.
5. Rate Coverage Period: October 1, 2017 — September 30, 2020
Premium Rates:
Basic Life (Active and Retiree):
$0.400 / $1,000 / month
Basic AD &D: $0.020 / $1,000
/ month
Employee and Spouse Supplemental
Term Life:
Acme Rate / $1,000
/ Month
Under 25 $
0.050
25 -29 $
0.060
30 -34 $
0.080
35 -39 $
0.090
40-44 $
0.120
45 -49 $
0.210
50 -54 $
0.370
55 -59 $
0.610
60 -64 $
0.750
65 -69 $
1.310
70 -74 $
2.060
75* $
2.380
*Please note, rates increase past 75 and will be provided upon request
Employee and Spouse Supplemental AD &D: $0.020 / $1,000 / month
Child Life: $0.130 / $1,000 / month
MINNESOTA LIFE INSURANCE COMPANY
vl
By Date July 11, 2017
Susan Munson - Regala
Title 2 nd Vice President and Actua
ACKNOWLEDGEMENT BY AUTHORIZED REPRESENTATIVE OF POLICYHOLDER
This document confirms that the rates stated above are the agreed upon rates for the specified policy
numbers. These rates will be charged for coverage amounts effective during the Rate Coverage Period
listed above. Minnesota Life reserves the right to adjust the rates at any time in the event of plan design
changes, modifications to the definition of eligible employees, or significant demographic changes in the
group. We define significant changes to mean a change in the volume within a coverage or across
coverages of more than 15 %. Actives and retirees are considered independent coverages. The
baseline for calculating the total change in volume will be the volume provided in the 2017 RFP census.
By
Date 2 -1, z ° 1 7
George Neugent
Title
Mayor, Monroe County
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MONROE COUNTY ATTORNEY
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,TI CYNTHIA L. HALL
ASSISTANT COUNTY ATTORNEY
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Rate Confirmation Monroe County BOCC Page 2 of 2