Get the free SSQ Optional Life Insurance Application - Benefits by Design

REQUEST FOR OPTIONAL LIFE INSURANCE PLEASE COMPLETE THIS FORM IN BLOCK LETTERS USING INK A. EMPLOYER INFORMATION policyholder Name: SSR Group #: Division Name: Certificate #: B. PARTICIPANT INFORMATION

Plans can also choose to provide this benefit on an as needed basis to their members who choose to purchase it. D. INFORMATION FOR THE COVERAGE You do not have a premium for this plan and do not have to pay any additional deductible. Your monthly premiums are based on a percentage of a specific plan-matched amount (not your income). Your premium will be as follows: Basic Monthly Premium % for 1 Employee 50.00 20.00 2 Employees 68.00 30.00 3 or more Employees 90.00 35.00 Optional Insurance Monthly Premium % for 1 Employee 12.00 5.00 2 Employees 24.00 9.00 3 or more Employees 36.00 11.00 D. COSTS You will be notified of the monthly premiums for any available optional or basic benefits, as applicable. Benefits depend on the benefits selected and the plan coverage. Benefits which may be purchased with this benefit include: Emergency Medical Services — If you are eligible and your plan includes a medical emergency coverage option, emergency medical services will cost only the amount your plan matches if you are enrolled in the plan. This is in addition to your deductible up to the amount of your premium. Your emergency medical services coverage does not include the actual cost of traveling to a medical facility if you receive medical treatment at a hospital or medical center. In this scenario, the medical emergency cost would be a flat fee (for example, 100) and the actual medical facility cost would be the rate for that facility and your premium portion does not include any of those costs (even if you receive treatment at a hospital or medical center). — If you are eligible and your plan includes a medical emergency coverage option, emergency medical services will cost only the amount your plan matches if you are enrolled in the plan. This is in addition to your deductible up to the amount of your premium. Your emergency medical services coverage does not include the actual cost of traveling to a medical facility if you receive medical treatment at a hospital or medical center. In this scenario, the medical emergency cost would be a flat fee (for example, 100) and the actual medical facility cost would be the rate for that facility and your premium portion does not include any of those costs (even if you receive treatment at a hospital or medical center).

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What is ssq optional life insurance?

SSQ Optional Life Insurance is a type of life insurance offered by SSQ Insurance that provides additional coverage beyond basic life insurance. It allows policyholders to choose optional coverage amounts and beneficiaries.

Who is required to file ssq optional life insurance?

SSQ Optional Life Insurance is typically available to employees who are part of a group insurance plan offered by their employer. It is not required to be filed but can be purchased on a voluntary basis.

How to fill out ssq optional life insurance?

To fill out SSQ Optional Life Insurance, you will need to provide personal information such as your name, date of birth, and contact details. You will also need to select the coverage amount and beneficiaries. The application form can be obtained from SSQ Insurance or through your employer.

What is the purpose of ssq optional life insurance?

The purpose of SSQ Optional Life Insurance is to provide additional financial protection and support to policyholders and their designated beneficiaries in the event of death or critical illness. It can help cover expenses such as funeral costs, mortgage payments, or education expenses.

What information must be reported on ssq optional life insurance?

When filling out SSQ Optional Life Insurance, you will be required to report personal information including your name, address, date of birth, and contact details. You may also need to provide information about your current health status and any pre-existing medical conditions.

When is the deadline to file ssq optional life insurance in 2023?

The exact deadline to file SSQ Optional Life Insurance in 2023 may vary depending on the specific policy and employer's guidelines. It is recommended to consult with SSQ Insurance or your employer for the accurate deadline information.

What is the penalty for the late filing of ssq optional life insurance?

The penalty for the late filing of SSQ Optional Life Insurance may vary depending on the terms and conditions of your policy and the guidelines set by SSQ Insurance or your employer. It is advisable to refer to the policy documents or contact SSQ Insurance directly for information on penalties related to late filing.

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