zipcode gender dob doh annualsalary basic life …...zipcode gender dob doh annualsalary...

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ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_Volum Spouse_Optional_Life_Option Spouse_Optional_Life_Approved_Volume Child_Optional_Life_Option Child_Optional_Life_Approved_Volume 64151 F 9/23/1957 8/9/2013 21,463.89 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage 64157 M 3/19/1964 11/1/1999 73,548.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64152 M 12/25/1975 2/3/2014 37,252.80 Yes 50,000.00 Yes with ADD 120,000.00 Waive Coverage Waive Coverage 64118 F 8/3/1966 8/18/2008 21,843.36 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64119 F 7/14/1979 8/7/2015 19,020.54 Yes 50,000.00 Yes with ADD 100,000.00 Yes 50,000.00 Waive Coverage 64116 F 8/10/1988 8/3/2011 58,991.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64118 M 8/6/1979 8/3/2005 58,179.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64151 M 11/8/1977 7/10/2002 60,745.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes 10,000.00 64118 F 4/9/1983 7/2/2002 45,198.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64118 M 5/10/1981 1/6/2016 62,222.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00 64152 M 5/10/1951 8/12/2011 25,102.96 Yes 50,000.00 Yes 40,000.00 Yes 40,000.00 Waive Coverage 64152 F 9/12/1972 8/20/1997 67,426.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage 64153 M 11/21/1959 4/22/2003 45,364.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64155 F 9/6/1989 8/2/2012 44,380.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64154 F 12/29/1960 3/1/2005 19,170.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64155 M 5/26/1977 8/8/2017 21,775.60 Yes 50,000.00 Yes with ADD 110,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00 64154 F 7/11/1982 8/28/2017 19,852.56 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64154 F 7/23/1972 8/16/2006 28,537.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64117 M 6/5/1974 8/1/2016 39,145.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64109 F 12/2/1992 2/3/2014 39,341.00 Yes 50,000.00 Yes 200,000.00 Yes 50,000.00 Waive Coverage 64152 M 8/28/1976 7/16/2012 38,334.40 Yes 50,000.00 Yes 200,000.00 Yes 30,000.00 Yes 10,000.00 64116 M 5/19/1990 7/31/2014 51,624.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64151 F 4/3/1981 8/2/2007 72,135.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64153 F 10/7/1960 5/5/1997 26,112.52 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage 64151 F 5/11/1962 7/27/2015 36,712.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage 64154 F 6/26/1991 8/3/2017 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64152 M 1/9/1986 8/4/2009 68,606.57 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes 5,000.00 64152 F 8/2/1988 8/3/2017 51,026.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64150 F 5/27/1970 9/18/2017 19,020.54 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64154 F 12/22/1957 10/2/2000 66,486.00 Yes 50,000.00 Yes with ADD 30,000.00 Yes 30,000.00 Waive Coverage 64156 F 1/24/1990 8/1/2016 54,329.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage 66207 F 11/4/1970 7/31/2008 70,508.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64151 F 10/18/1962 10/4/2010 22,278.34 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes 10,000.00 64152 F 9/30/1970 2/12/2013 25,859.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64152 F 2/21/1979 8/7/2002 63,332.59 Not Eligible Waive Coverage Waive Coverage Waive Coverage 64151 M 2/12/1984 8/2/2012 55,612.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00 66205 F 6/20/1985 8/3/2015 45,345.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64152 F 4/21/1965 8/21/1992 71,102.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64153 M 11/18/1965 10/21/2013 37,793.60 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Yes 10,000.00 64089 F 5/3/1958 7/28/2014 50,502.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64153 F 11/14/1954 1/18/1994 73,957.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64089 F 9/2/1974 3/31/2005 50,502.40 Yes 50,000.00 Yes with ADD 200,000.00 Yes 30,000.00 Yes with ADD 10,000.00 66202 F 1/8/1978 8/9/2001 66,943.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64152 F 6/9/1961 9/6/2011 45,011.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64151 F 1/17/1979 8/11/2014 60,745.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64068 F 2/10/1991 12/7/2015 40,000.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64024 M 5/13/1969 9/10/2002 43,659.20 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage 64154 F 7/23/1963 7/20/2009 36,133.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64153 F 4/1/1979 1/2/2002 69,160.00 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage 66207 F 9/13/1970 8/3/2015 67,515.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64152 M 8/4/1954 9/1/1980 149,645.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64151 F 10/7/1960 8/2/2012 59,107.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64106 F 8/14/1990 8/1/2013 41,385.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64118 F 9/20/1992 11/28/2016 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64154 M 9/21/1973 10/10/2017 27,077.33 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64089 F 1/9/1975 7/31/2014 40,487.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64123 M 9/28/1990 8/11/2014 25,383.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64153 F 10/19/1963 8/19/1999 87,854.63 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64152 M 10/20/1994 4/17/2017 35,672.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64151 M 3/2/1966 8/20/1997 76,418.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64157 F 10/28/1984 8/3/2015 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64117 F 9/7/1994 1/5/2017 25,667.59 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage 64152 F 4/13/1970 8/15/2012 16,442.94 Yes 50,000.00 Yes with ADD 30,000.00 Yes with ADD 50,000.00 Yes 10,000.00 64155 M 12/2/1981 12/16/2002 65,643.92 Yes 50,000.00 Yes 200,000.00 Waive Coverage Yes 10,000.00 64155 F 8/20/1966 8/19/1999 72,328.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage 64156 F 9/29/1972 8/4/2010 66,131.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64106 F 4/9/1982 8/1/2013 67,031.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage 64118 M 5/1/1979 7/31/2014 68,747.71 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage 64114 F 1/18/1974 7/16/2012 38,334.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64154 F 12/18/1967 2/1/2017 23,274.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64151 F 4/9/1979 8/11/2017 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage 64152 F 4/29/1957 8/21/1992 63,566.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

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Page 1: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option Spouse_Optional_Life_Approved_Volume Child_Optional_Life_Option Child_Optional_Life_Approved_Volume

64151 F 9/23/1957 8/9/2013 21,463.89 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64157 M 3/19/1964 11/1/1999 73,548.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 12/25/1975 2/3/2014 37,252.80 Yes 50,000.00 Yes with ADD 120,000.00 Waive Coverage Waive Coverage

64118 F 8/3/1966 8/18/2008 21,843.36 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 7/14/1979 8/7/2015 19,020.54 Yes 50,000.00 Yes with ADD 100,000.00 Yes 50,000.00 Waive Coverage

64116 F 8/10/1988 8/3/2011 58,991.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 8/6/1979 8/3/2005 58,179.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 11/8/1977 7/10/2002 60,745.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes 10,000.00

64118 F 4/9/1983 7/2/2002 45,198.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 5/10/1981 1/6/2016 62,222.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

64152 M 5/10/1951 8/12/2011 25,102.96 Yes 50,000.00 Yes 40,000.00 Yes 40,000.00 Waive Coverage

64152 F 9/12/1972 8/20/1997 67,426.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64153 M 11/21/1959 4/22/2003 45,364.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 9/6/1989 8/2/2012 44,380.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 12/29/1960 3/1/2005 19,170.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 5/26/1977 8/8/2017 21,775.60 Yes 50,000.00 Yes with ADD 110,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64154 F 7/11/1982 8/28/2017 19,852.56 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 7/23/1972 8/16/2006 28,537.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64117 M 6/5/1974 8/1/2016 39,145.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64109 F 12/2/1992 2/3/2014 39,341.00 Yes 50,000.00 Yes 200,000.00 Yes 50,000.00 Waive Coverage

64152 M 8/28/1976 7/16/2012 38,334.40 Yes 50,000.00 Yes 200,000.00 Yes 30,000.00 Yes 10,000.00

64116 M 5/19/1990 7/31/2014 51,624.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/3/1981 8/2/2007 72,135.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 10/7/1960 5/5/1997 26,112.52 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64151 F 5/11/1962 7/27/2015 36,712.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64154 F 6/26/1991 8/3/2017 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 1/9/1986 8/4/2009 68,606.57 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes 5,000.00

64152 F 8/2/1988 8/3/2017 51,026.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64150 F 5/27/1970 9/18/2017 19,020.54 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 12/22/1957 10/2/2000 66,486.00 Yes 50,000.00 Yes with ADD 30,000.00 Yes 30,000.00 Waive Coverage

64156 F 1/24/1990 8/1/2016 54,329.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

66207 F 11/4/1970 7/31/2008 70,508.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/18/1962 10/4/2010 22,278.34 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes 10,000.00

64152 F 9/30/1970 2/12/2013 25,859.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 2/21/1979 8/7/2002 63,332.59 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64151 M 2/12/1984 8/2/2012 55,612.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00

66205 F 6/20/1985 8/3/2015 45,345.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/21/1965 8/21/1992 71,102.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 11/18/1965 10/21/2013 37,793.60 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Yes 10,000.00

64089 F 5/3/1958 7/28/2014 50,502.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 11/14/1954 1/18/1994 73,957.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 9/2/1974 3/31/2005 50,502.40 Yes 50,000.00 Yes with ADD 200,000.00 Yes 30,000.00 Yes with ADD 10,000.00

66202 F 1/8/1978 8/9/2001 66,943.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/9/1961 9/6/2011 45,011.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/17/1979 8/11/2014 60,745.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 2/10/1991 12/7/2015 40,000.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64024 M 5/13/1969 9/10/2002 43,659.20 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64154 F 7/23/1963 7/20/2009 36,133.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 4/1/1979 1/2/2002 69,160.00 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

66207 F 9/13/1970 8/3/2015 67,515.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 8/4/1954 9/1/1980 149,645.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/7/1960 8/2/2012 59,107.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64106 F 8/14/1990 8/1/2013 41,385.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 9/20/1992 11/28/2016 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 9/21/1973 10/10/2017 27,077.33 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 1/9/1975 7/31/2014 40,487.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64123 M 9/28/1990 8/11/2014 25,383.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 10/19/1963 8/19/1999 87,854.63 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 10/20/1994 4/17/2017 35,672.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 3/2/1966 8/20/1997 76,418.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 10/28/1984 8/3/2015 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64117 F 9/7/1994 1/5/2017 25,667.59 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64152 F 4/13/1970 8/15/2012 16,442.94 Yes 50,000.00 Yes with ADD 30,000.00 Yes with ADD 50,000.00 Yes 10,000.00

64155 M 12/2/1981 12/16/2002 65,643.92 Yes 50,000.00 Yes 200,000.00 Waive Coverage Yes 10,000.00

64155 F 8/20/1966 8/19/1999 72,328.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64156 F 9/29/1972 8/4/2010 66,131.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64106 F 4/9/1982 8/1/2013 67,031.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64118 M 5/1/1979 7/31/2014 68,747.71 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage

64114 F 1/18/1974 7/16/2012 38,334.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 12/18/1967 2/1/2017 23,274.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/9/1979 8/11/2017 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/29/1957 8/21/1992 63,566.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 2: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64150 F 1/9/1978 8/6/2004 61,951.00 Yes 50,000.00 Yes 200,000.00 Yes 50,000.00 Yes 10,000.00

64114 F 8/6/1990 8/2/2012 49,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 3/3/1985 8/3/2015 56,128.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64110 F 9/27/1989 1/3/2014 40,869.00 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Yes 10,000.00

64151 F 2/26/1966 8/2/2007 32,407.92 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/25/1973 12/1/2016 24,080.42 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64151 F 10/21/1974 8/20/1997 75,432.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Yes 10,000.00

64116 F 1/19/1963 7/17/2017 34,153.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 7/25/1986 7/31/2008 61,181.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64105 F 9/7/1992 1/14/2016 20,925.10 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64151 F 7/15/1977 9/1/2001 65,833.00 Yes 50,000.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage

64154 F 11/8/1979 8/3/2006 63,163.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64157 F 6/30/1979 8/3/2015 45,345.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/13/1968 7/31/2014 46,628.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00 Yes with ADD 10,000.00

64119 F 2/16/1993 8/3/2015 40,105.00 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64111 F 8/13/1967 8/1/2016 60,745.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 11/8/1973 8/9/2001 61,951.00 Yes 50,000.00 Yes with ADD 80,000.00 Waive Coverage Yes with ADD 10,000.00

64151 M 10/15/1959 7/28/2017 32,687.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64477 F 3/21/1961 11/1/2013 40,872.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 4/8/1977 10/23/2014 53,561.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 2/23/1952 8/13/2008 22,929.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64150 F 6/18/1984 8/3/2015 62,106.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes with ADD 10,000.00

64068 F 4/11/1990 8/7/2015 24,433.92 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/31/1961 8/26/2005 60,149.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

66202 F 4/12/1982 8/16/2012 47,912.00 Yes 50,000.00 Yes 200,000.00 Yes 30,000.00 Waive Coverage

64068 M 1/10/1986 10/29/2012 36,940.80 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

64152 F 4/1/1987 3/9/2007 45,345.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 8/24/1990 3/13/2014 40,289.60 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64152 M 8/16/1968 8/6/2004 74,367.20 Yes 50,000.00 Yes with ADD 30,000.00 Yes with ADD 0.00 Waive Coverage

64068 M 11/22/1974 8/16/2000 70,250.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 9/23/1954 6/8/1998 49,275.20 Yes 50,000.00 Yes with ADD 90,000.00 Waive Coverage Waive Coverage

64151 F 10/14/1961 8/1/2011 25,760.28 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 9/17/1966 1/12/2009 27,977.70 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes 10,000.00

64152 F 3/31/1970 8/3/2016 121,739.38 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64152 F 7/16/1973 9/22/2014 42,621.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 7/28/1987 8/3/2015 62,669.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/5/1952 9/8/1998 74,916.00 Yes 50,000.00 Yes with ADD 80,000.00 Yes 50,000.00 Waive Coverage

64151 F 7/28/1964 1/10/2005 23,268.21 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 10/14/1981 8/3/2006 70,611.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64030 M 7/11/1972 8/26/1996 63,236.80 Yes 50,000.00 Yes with ADD 80,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64154 M 9/22/1981 8/6/2004 87,250.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64152 M 3/19/1945 6/16/2008 40,622.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/13/1981 9/17/2014 42,149.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64111 M 8/22/1994 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/8/1989 8/1/2016 45,345.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64152 F 4/23/1983 8/3/2005 61,295.00 Yes 50,000.00 Yes 200,000.00 Yes 10,000.00 Yes 10,000.00

64152 F 9/7/1974 8/12/2011 47,912.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64079 M 10/20/1956 7/11/2011 38,896.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/30/1982 8/3/2006 57,927.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/15/1966 2/2/2015 23,613.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 2/9/1968 3/28/2016 38,022.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/20/1994 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

62812 F 2/13/1971 7/31/2008 79,663.51 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Waive Coverage

64155 F 7/26/1966 9/13/1989 78,232.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/16/1984 7/20/2015 56,128.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64152 F 1/14/1965 8/11/2014 21,225.82 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/15/1965 10/15/2003 55,784.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 6/22/1965 8/14/2002 55,784.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 F 4/22/1969 8/17/1998 76,418.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64109 M 2/5/1980 7/31/2008 69,712.12 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

64157 M 2/15/1978 8/1/2016 66,391.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 9/9/1985 8/1/2013 62,121.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Yes 10,000.00

64154 F 4/29/1980 8/4/2003 70,508.00 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Yes 10,000.00

66062 F 1/4/1981 7/1/2017 91,411.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64152 M 12/14/1964 8/29/1989 88,959.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/19/1958 9/19/1996 31,718.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/14/1970 10/13/2004 69,537.29 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64106 M 5/22/1967 8/3/2005 90,797.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 M 5/3/1990 10/23/2017 29,083.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/14/1965 8/3/2005 77,212.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64154 F 2/26/1967 11/5/2012 25,327.75 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66208 F 3/23/1988 8/2/2012 53,148.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

66018 M 2/3/1958 8/1/2013 64,657.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 6/12/1977 9/8/2014 25,490.92 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Yes with ADD 10,000.00

Page 3: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64079 M 2/17/1984 1/4/2016 46,259.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64109 F 3/25/1994 8/10/2017 21,775.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 4/13/1990 8/8/2016 24,080.42 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64111 F 6/1/1991 10/5/2015 42,882.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/18/1959 8/13/2012 34,548.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 1/20/1962 1/2/2008 40,622.40 Yes 50,000.00 Yes with ADD 50,000.00 Yes with ADD 30,000.00 Yes 10,000.00

64110 M 1/1/1988 11/12/2012 60,698.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 8/25/1957 1/6/2004 44,553.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 11/30/1990 8/11/2016 40,869.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64119 F 5/5/1964 9/24/2007 38,896.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 2/11/1991 12/4/2017 34,153.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 8/1/1970 8/10/2006 44,963.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes 10,000.00

64477 F 2/19/1968 9/8/1992 54,267.20 Yes 50,000.00 Yes 140,000.00 Waive Coverage Yes 10,000.00

66109 F 6/23/1962 7/25/2016 44,200.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes with ADD 50,000.00 Waive Coverage

64151 F 6/13/1959 8/13/2001 49,134.08 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 M 6/10/1991 12/4/2017 34,153.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 6/15/1972 8/9/2001 68,345.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/17/1976 8/3/2017 61,951.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 50,000.00 Waive Coverage

64154 F 3/12/1992 9/5/2017 27,077.33 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66216 M 7/19/1957 8/1/2016 76,046.86 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/25/1968 8/18/2008 22,817.13 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64113 F 3/10/1975 7/6/1999 96,110.00 Yes 50,000.00 Yes 200,000.00 Yes 0.00 Yes 10,000.00

64156 F 6/22/1979 8/3/2006 65,203.29 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

64152 F 8/20/1981 8/12/2013 31,418.80 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

64151 F 8/20/1956 9/11/1998 14,797.04 Yes 50,000.00 Yes with ADD 80,000.00 Yes with ADD 50,000.00 Waive Coverage

66046 F 1/14/1966 1/21/2014 21,651.84 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 6/15/1969 8/17/1998 91,049.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 10/25/1990 8/8/2016 45,593.60 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64155 F 2/27/1996 1/2/2018 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64057 M 3/24/1990 1/4/2016 45,593.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 11/22/1982 2/23/2015 27,107.72 Yes 50,000.00 Yes with ADD 30,000.00 Yes with ADD 20,000.00 Yes with ADD 10,000.00

64152 F 3/25/1970 8/1/2016 42,607.38 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64152 M 3/30/1976 8/9/2001 100,348.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64152 F 1/27/1980 9/12/2016 49,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 9/7/1978 8/4/2003 69,676.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64068 M 6/24/1986 8/3/2015 50,496.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/18/1982 8/13/2014 27,976.05 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 3/31/1993 8/3/2015 40,105.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 M 4/25/1962 6/30/2000 59,945.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 M 5/5/1971 5/3/2001 50,627.20 Yes 50,000.00 Yes with ADD 150,000.00 Yes 30,000.00 Waive Coverage

64157 F 8/21/1959 8/15/1995 47,842.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/8/1964 8/15/2002 64,440.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/8/1982 2/22/2016 45,489.60 Yes 50,000.00 Yes 100,000.00 Waive Coverage Yes 10,000.00

66212 F 2/18/1984 8/3/2006 56,895.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 8/19/1991 8/3/2017 42,916.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64151 F 8/25/1989 8/3/2015 48,640.98 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 11/12/1987 9/5/2017 60,218.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 F 7/7/1983 8/3/2015 67,827.25 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 3/7/1985 7/31/2014 54,329.00 Yes 50,000.00 Yes with ADD 100,000.00 Yes 30,000.00 Yes 10,000.00

64114 F 10/10/1983 7/31/2008 69,414.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64151 F 10/20/1980 8/1/2013 54,845.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/15/1956 8/7/2002 81,966.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 M 2/2/1984 7/31/2014 47,144.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64155 F 8/1/1954 8/2/2007 70,744.09 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 6/21/1967 9/13/2010 22,165.57 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/23/1963 6/21/1990 80,473.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 4/24/1970 8/22/1995 75,175.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 2/9/1982 8/3/2011 60,393.78 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 4/29/1987 2/1/2018 21,737.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 12/9/1987 8/2/2012 53,183.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 4/16/1971 8/3/2015 54,329.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 3/24/1981 8/3/2015 59,462.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 10/7/1977 1/9/2001 66,743.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64157 F 11/15/1972 8/21/1996 77,174.35 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66218 M 8/20/1942 12/21/2004 39,603.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 1/21/1984 8/2/2007 62,538.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/28/1974 8/9/2017 27,077.33 Yes 50,000.00 Yes with ADD 140,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 11/10/1964 7/20/2009 36,291.92 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

64152 F 5/9/1973 8/12/2013 23,658.18 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64024 M 6/6/1954 8/2/2005 44,075.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/7/1969 8/15/2007 25,140.92 Yes 50,000.00 Yes with ADD 40,000.00 Yes with ADD 25,000.00 Waive Coverage

64151 M 5/15/1977 7/31/2014 60,705.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 11/15/1976 8/16/2006 24,346.14 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 11/15/1955 11/17/2014 39,707.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 4: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64110 F 6/4/1958 8/3/2006 81,452.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64015 F 2/13/1968 7/1/2010 113,434.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes 30,000.00 Yes 10,000.00

64153 M 9/11/1975 8/3/2005 61,055.00 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage

64153 F 2/21/1985 8/9/2007 60,889.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/16/1956 8/20/1997 80,418.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64152 F 2/11/1975 8/3/2005 48,110.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 8/27/1971 8/3/2015 61,181.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 7/31/1972 8/17/2010 56,078.80 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64152 F 10/14/1976 8/4/2003 71,024.00 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

64152 F 1/5/1980 8/15/2012 16,840.32 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64151 F 12/14/1957 8/6/2004 77,457.48 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/30/1986 5/12/2016 46,924.80 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64155 F 7/31/1984 8/3/2006 70,611.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 10/12/1963 9/2/2008 40,040.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66061 F 10/20/1978 8/6/2004 61,301.00 Yes 50,000.00 Yes with ADD 170,000.00 Waive Coverage Yes with ADD 10,000.00

64151 F 12/10/1969 8/7/2002 68,203.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64118 F 9/27/1985 3/26/2018 21,775.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 8/27/1992 8/3/2015 44,529.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/12/1986 8/4/2009 64,924.00 Yes 50,000.00 Yes 30,000.00 Waive Coverage Waive Coverage

64151 M 3/1/1979 8/7/2002 77,698.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64118 M 11/30/1974 8/4/2009 62,257.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/18/1981 8/6/2004 75,730.24 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64477 M 2/16/1961 8/26/2002 83,750.00 Yes 50,000.00 Yes with ADD 120,000.00 Waive Coverage Waive Coverage

64154 F 4/23/1964 8/2/2007 34,570.95 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 5/23/1961 8/20/1997 77,193.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 8/16/1965 8/9/2001 77,153.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 6/21/1965 3/23/2015 38,584.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 11/6/1976 8/16/2000 68,928.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/18/1977 8/7/2017 39,540.80 Yes 50,000.00 Yes 100,000.00 Yes 50,000.00 Yes 10,000.00

64152 F 9/19/1980 8/2/2007 69,497.12 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 4/21/1972 8/20/1997 77,225.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes with ADD 10,000.00

64151 F 7/4/1981 8/1/2016 46,728.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 3/26/1976 8/16/2011 33,763.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64057 M 9/11/1971 7/31/2014 47,912.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64157 M 4/12/1988 8/9/2013 21,965.09 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66212 F 4/27/1975 8/9/2001 68,540.86 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64154 F 7/25/1967 6/8/1989 78,426.83 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 7/25/1970 8/1/2016 65,320.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64114 M 5/2/1965 6/21/1990 77,195.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

64153 F 7/18/1967 9/6/2005 59,028.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 12/22/1977 8/9/2001 73,312.00 Yes 50,000.00 Yes with ADD 140,000.00 Waive Coverage Yes 10,000.00

64118 F 2/21/1976 8/17/2010 25,748.94 Yes 50,000.00 Yes 70,000.00 Waive Coverage Waive Coverage

64152 F 9/2/1987 8/1/2013 48,779.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 5/26/1988 8/16/2011 31,349.50 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes 10,000.00

64157 F 10/26/1990 8/1/2013 49,558.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/6/1948 8/15/2007 18,096.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/1/1961 1/28/2013 33,142.08 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

64155 M 10/6/1960 10/6/2003 45,198.40 Yes 50,000.00 Yes with ADD 60,000.00 Yes 30,000.00 Waive Coverage

64151 M 1/11/1977 8/1/2013 69,590.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/6/1975 7/28/2016 40,847.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 3/9/1970 8/19/1999 79,689.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 4/8/1981 9/19/2005 67,563.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/26/1989 8/1/2016 46,628.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Yes with ADD 10,000.00

64079 F 7/30/1972 8/3/2006 63,926.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 3/24/1973 8/7/2002 74,786.46 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 10/7/1976 8/16/2000 75,227.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 7/14/1977 10/24/2002 64,128.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66061 F 6/30/1969 7/31/2008 89,536.41 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 7/26/1982 10/19/2010 30,506.63 Yes 50,000.00 Yes with ADD 100,000.00 Yes with ADD 0.00 Yes with ADD 10,000.00

64068 F 2/21/1959 9/15/2008 28,828.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/18/1961 8/2/2007 43,742.40 Yes 50,000.00 Yes 20,000.00 Yes 10,000.00 Yes 10,000.00

64114 F 3/27/1968 8/17/1994 75,693.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

64157 F 8/13/1966 3/14/2016 38,584.00 Yes 50,000.00 Yes with ADD 30,000.00 Yes 30,000.00 Yes 10,000.00

64118 F 10/4/1982 8/17/2010 53,740.45 Yes 50,000.00 Yes 160,000.00 Waive Coverage Waive Coverage

64151 F 6/8/1955 8/9/2001 79,571.75 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/4/1957 7/24/2006 37,738.56 Yes 50,000.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage

64151 F 3/18/1959 8/19/2002 23,819.53 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 12/24/1960 8/6/2004 67,488.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64079 F 6/28/1958 7/1/2014 73,456.00 Yes 50,000.00 Yes with ADD 80,000.00 Yes with ADD 50,000.00 Waive Coverage

64154 M 11/21/1967 8/31/1992 76,677.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 11/29/1965 8/10/2005 23,606.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 M 9/20/1967 7/1/2010 111,857.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 11/21/1972 8/21/1996 64,597.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64152 M 6/20/1981 1/25/2006 49,982.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 5: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64155 F 7/5/1979 9/27/2002 67,254.00 Yes 50,000.00 Yes 220,000.00 Waive Coverage Yes 10,000.00

64153 M 2/22/1977 8/3/2011 69,187.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 1/31/1986 8/2/2012 54,466.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 2/8/1952 3/27/2017 29,083.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/28/1955 8/10/2009 31,033.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 7/19/1951 29,083.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/21/1957 1/30/2002 51,742.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/4/1958 4/9/1990 77,317.00 Yes 50,000.00 Yes with ADD 100,000.00 Yes 50,000.00 Waive Coverage

64154 M 7/26/1973 8/7/2002 69,653.00 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes with ADD 10,000.00

64154 F 7/19/1967 8/9/2001 74,045.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64153 F 10/6/1967 8/24/1990 80,512.05 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66223 M 8/22/1973 8/3/2006 72,843.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

66211 F 10/13/1978 7/20/2017 74,595.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64018 F 7/26/1979 8/3/2005 61,261.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 5/23/1981 8/3/2017 64,240.00 Yes 50,000.00 Yes with ADD 20,000.00 Yes with ADD 10,000.00 Waive Coverage

66109 F 4/3/1990 8/2/2012 43,004.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/2/1975 8/11/2008 23,481.22 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 8/10/1962 8/23/1991 80,473.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 10/31/1967 8/7/2002 75,751.25 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 F 3/22/1989 8/2/2012 56,403.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 12/15/1988 8/21/2017 40,105.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/3/1987 8/4/2010 58,694.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 1/21/1987 8/1/2013 52,278.00 Yes 50,000.00 Yes 70,000.00 Waive Coverage Yes 10,000.00

64153 F 4/27/1989 10/9/2012 49,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/22/1989 2/17/2009 41,767.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 6/9/1986 8/3/2015 55,337.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/23/1987 8/3/2011 60,411.10 Not Eligible Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64118 F 5/10/1991 8/11/2014 22,651.84 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64154 M 4/11/1991 7/31/2014 47,877.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/29/1991 8/1/2013 47,912.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 7/13/1985 6/1/2016 49,004.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/21/1992 8/1/2016 45,345.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64030 F 9/1/1988 3/28/2016 37,086.40 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Waive Coverage

64119 F 8/9/1994 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 9/5/1994 1/8/2018 17,592.12 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/22/1994 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/11/1976 1/24/2013 25,473.42 Yes 50,000.00 Yes with ADD 120,000.00 Yes 0.00 Yes 10,000.00

64068 M 7/8/1945 1/16/2013 18,945.36 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 M 3/24/1963 7/31/2008 94,193.34 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 8/28/1954 3/16/2016 39,540.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/24/1963 3/19/2001 27,417.46 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/27/1959 8/5/2013 65,718.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/4/1959 8/16/2000 65,718.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 2/21/1966 7/22/1985 65,353.60 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Waive Coverage

64152 F 2/22/1956 2/28/2000 34,729.43 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/8/1962 8/6/2004 70,508.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Yes 10,000.00

64151 M 6/27/1968 8/26/1992 82,279.30 Yes 50,000.00 Yes 250,000.00 Yes 50,000.00 Waive Coverage

64118 M 6/23/1968 8/1/1993 66,742.00 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

64151 F 4/14/1963 8/2/2007 73,568.00 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64153 M 6/10/1962 2/28/2000 43,659.20 Yes 50,000.00 Yes with ADD 30,000.00 Yes 20,000.00 Yes 10,000.00

64151 F 4/16/1966 8/3/2005 59,737.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage Yes 10,000.00

64118 F 1/6/1974 7/13/2015 75,210.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 8/6/1964 8/17/2010 17,334.36 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/27/1965 9/1/2001 70,282.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64485 F 1/26/1969 8/3/2015 44,016.35 Yes 50,000.00 Yes with ADD 200,000.00 Yes 30,000.00 Waive Coverage

64152 F 3/9/1964 8/8/2002 67,612.00 Yes 50,000.00 Yes 30,000.00 Waive Coverage Yes 10,000.00

64152 M 4/29/1967 12/3/2003 43,035.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 11/6/1970 7/25/2005 50,502.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 8/21/1969 10/14/2013 45,011.20 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Yes with ADD 10,000.00

64118 M 11/20/1976 8/4/2009 70,084.00 Yes 50,000.00 Yes 100,000.00 Yes 50,000.00 Yes 10,000.00

64154 F 2/6/1982 8/4/2010 84,920.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/8/1976 1/2/2015 54,329.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64117 F 11/6/1975 1/2/2003 42,882.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/9/1979 8/3/2005 67,529.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/9/1973 8/20/1997 78,593.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 1/15/1985 7/20/2017 74,595.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Yes with ADD 10,000.00

64154 F 5/20/1985 8/2/2012 63,496.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 2/28/1973 1/21/2014 32,334.80 Yes 50,000.00 Yes with ADD 50,000.00 Yes 30,000.00 Yes with ADD 10,000.00

64118 F 2/13/1987 8/3/2015 59,604.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64081 F 6/20/1985 8/4/2010 42,882.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 2/2/1984 7/31/2008 54,329.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 7/20/1975 8/14/2002 54,561.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 6/25/1982 8/1/2013 68,844.00 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes 10,000.00

66210 F 6/13/1974 12/19/1996 75,691.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 6: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64116 F 11/21/1978 8/3/2017 54,466.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 4/4/1974 8/1/2013 61,523.00 Yes 50,000.00 Yes with ADD 20,000.00 Yes 30,000.00 Yes 10,000.00

64465 F 9/26/1983 12/8/2014 25,490.92 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes with ADD 10,000.00

64154 F 9/22/1980 8/3/2011 75,509.00 Yes 50,000.00 Yes with ADD 80,000.00 Waive Coverage Waive Coverage

64155 F 6/16/1977 8/14/2002 66,040.37 Yes 50,000.00 Yes 300,000.00 Waive Coverage Yes 10,000.00

64060 F 4/23/1973 7/31/2012 28,161.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 4/28/1987 8/4/2009 53,561.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 1/13/1984 7/28/2016 27,398.35 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 5/23/1989 8/23/2016 45,593.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64117 F 6/3/1989 8/6/2012 21,852.32 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 6/6/1989 8/2/2012 50,995.00 Yes 50,000.00 Yes 150,000.00 Waive Coverage Yes 10,000.00

64153 F 7/1/1989 8/3/2015 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 6/1/1968 8/14/2002 66,360.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 7/26/1988 7/31/2014 50,459.00 Yes 50,000.00 Yes 110,000.00 Waive Coverage Waive Coverage

64116 F 4/10/1990 8/1/2016 49,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64439 F 2/7/1986 7/31/2008 63,076.38 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64154 F 12/11/1985 1/20/2009 53,045.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes with ADD 0.00 Waive Coverage

64154 F 6/24/1991 7/31/2014 51,408.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 6/1/1984 11/5/2012 46,259.20 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64050 M 1/6/1993 4/4/2016 26,626.92 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64151 F 11/21/1992 8/3/2017 40,105.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Yes 10,000.00

64079 F 1/5/1993 8/1/2016 41,308.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 6/17/1983 8/14/2017 26,066.76 Yes 50,000.00 Yes 50,000.00 Yes 40,000.00 Yes 10,000.00

64118 F 9/1/1994 10/6/2015 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 9/26/1994 2/3/2016 20,432.30 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 10/14/1959 1/12/2001 63,612.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 11/19/1970 1/5/1998 65,823.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 12/31/1962 8/25/2003 45,198.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 7/8/1958 1/21/1998 60,611.20 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64089 M 9/5/1963 10/1/2013 53,435.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 1/9/1969 8/19/1999 88,838.82 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 6/28/1965 6/20/2016 49,004.80 Yes 50,000.00 Yes 150,000.00 Waive Coverage Waive Coverage

64060 F 5/23/1960 9/25/1989 51,438.40 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Yes 10,000.00

64118 M 7/11/1962 10/18/2017 34,153.60 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes 10,000.00

64153 F 6/17/1974 8/20/1997 74,657.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 8/12/1964 8/6/2004 77,797.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 1/11/1965 8/28/1996 18,590.03 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Yes 10,000.00

64150 F 8/24/1977 8/3/2005 76,687.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Waive Coverage

64157 M 10/9/1979 8/3/2011 52,258.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

64153 F 9/19/1976 8/19/1999 74,657.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/29/1981 7/17/2017 37,481.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 6/7/1982 8/8/2016 24,080.42 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 11/18/1980 8/6/2004 63,679.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64163 M 7/12/1968 10/9/2012 24,744.96 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/17/1969 8/21/1992 125,559.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64060 M 5/24/1982 9/6/2012 72,621.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 M 6/9/1983 5/18/2015 62,473.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 2/23/1972 11/27/2000 21,737.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

74434 F 9/25/1984 8/3/2017 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/25/1972 9/1/2006 17,581.38 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 7/11/1970 8/21/1992 72,844.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes with ADD 10,000.00

64157 F 2/20/1973 8/3/2006 66,912.00 Yes 50,000.00 Yes 110,000.00 Waive Coverage Waive Coverage

64152 F 5/13/1970 8/1/2013 48,428.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/4/1985 8/4/2009 60,149.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64081 F 12/23/1986 8/1/2016 44,062.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64113 F 2/13/1985 8/4/2010 61,326.84 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 2/16/1987 8/1/2013 53,045.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64055 F 9/7/1979 8/1/2013 40,869.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage Yes 10,000.00

64152 M 2/11/1984 8/2/2007 70,635.65 Yes 50,000.00 Yes 60,000.00 Waive Coverage Waive Coverage

64089 M 7/12/1977 8/3/2006 61,777.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 5/26/1977 8/3/2017 65,271.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64151 F 12/18/1971 8/17/1998 78,434.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 2/26/1983 10/15/2013 97,217.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 6/9/1986 8/8/2005 28,476.50 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64050 F 12/30/1978 1/15/2008 17,839.14 Yes 50,000.00 Yes with ADD 80,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 6/6/1974 10/19/2010 17,087.34 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64048 F 3/11/1988 8/3/2011 50,479.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 8/29/1975 8/3/2005 76,538.47 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64152 F 2/29/1988 8/2/2012 42,149.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 8/21/1983 8/28/2008 50,479.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66109 F 11/11/1988 8/10/2015 27,465.76 Yes 50,000.00 Yes 140,000.00 Waive Coverage Yes 10,000.00

64157 F 9/14/1986 8/18/2004 53,591.96 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 F 4/26/1989 8/3/2016 25,028.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 6/30/1989 11/1/2017 21,464.52 Yes 50,000.00 Yes 110,000.00 Waive Coverage Waive Coverage

Page 7: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64118 F 5/20/1985 8/19/2010 67,065.00 Yes 50,000.00 Yes 130,000.00 Yes 50,000.00 Waive Coverage

64150 F 7/5/1991 8/1/2016 47,912.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 7/25/1991 12/1/2014 41,308.00 Yes 50,000.00 Yes with ADD 20,000.00 Yes with ADD 0.00 Waive Coverage

64152 F 8/12/1991 8/1/2016 39,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66223 M 8/12/1991 1/25/2010 44,948.80 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

64118 F 2/13/1993 9/23/2013 16,604.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 1/11/1990 8/11/2014 18,368.98 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/2/1994 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 2/27/1949 8/17/1998 68,508.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 M 3/23/1954 7/24/2006 41,204.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64056 M 2/10/1962 2/2/2015 44,844.80 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64151 M 10/18/1955 2/8/1999 57,470.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 4/4/1958 8/16/2000 76,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/3/1967 10/13/2011 22,165.57 Yes 50,000.00 Yes 50,000.00 Waive Coverage Yes 10,000.00

64119 F 6/27/1958 8/24/1998 42,480.96 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/3/1960 7/23/2002 51,230.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 2/4/1955 8/10/2012 22,368.32 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/13/1960 4/10/2007 54,074.91 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 7/20/1963 8/10/2016 36,192.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/5/1958 9/7/1999 25,235.42 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 6/14/1961 8/26/1998 24,175.74 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64152 F 2/8/1974 11/5/2014 23,613.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/20/1962 8/23/1991 77,452.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Yes 10,000.00

64118 F 2/26/1976 1/31/2011 24,850.35 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/29/1968 9/28/1993 74,036.00 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage

64151 M 5/28/1971 8/19/1999 83,908.71 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 6/4/1972 7/31/2014 53,045.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 11/27/1971 8/9/2001 66,889.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Yes 10,000.00

64152 F 7/13/1964 8/16/1990 55,681.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66208 M 6/29/1972 8/3/2017 73,993.15 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/30/1963 8/16/2005 59,737.60 Yes 50,000.00 Yes 250,000.00 Yes 250,000.00 Yes 10,000.00

64152 F 12/1/1970 7/30/2015 42,020.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes 30,000.00 Yes 10,000.00

64151 F 4/6/1964 6/9/1988 78,232.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64024 F 7/5/1965 8/14/2017 22,737.12 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/23/1978 8/3/2015 68,391.00 Yes 50,000.00 Yes 200,000.00 Yes 0.00 Yes 10,000.00

64119 M 1/15/1975 10/10/1996 56,076.80 Yes 50,000.00 Yes with ADD 90,000.00 Waive Coverage Waive Coverage

64155 M 4/5/1973 7/1/2012 132,351.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes with ADD 10,000.00

64157 F 7/5/1980 7/31/2008 61,055.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 5/27/1966 8/26/1994 63,566.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 11/12/1965 10/19/1993 63,348.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 2/4/1978 8/3/2017 60,727.16 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64105 F 2/26/1969 8/25/1997 77,548.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 8/25/1968 8/16/2000 72,328.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/12/1974 8/3/2006 62,257.00 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 11/13/1975 8/19/1999 68,928.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64151 M 3/11/1969 7/1/2012 162,724.00 Yes 100,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/17/1971 1/8/2008 17,839.14 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64117 F 6/8/1977 8/31/2016 64,386.00 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

64152 M 8/21/1980 8/3/2006 66,581.90 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64151 F 6/19/1973 8/19/1999 79,654.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 M 11/10/1975 8/7/2002 70,012.00 Yes 50,000.00 Yes 200,000.00 Yes 100,000.00 Yes 10,000.00

64152 F 8/5/1972 4/2/2018 80,826.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/12/1971 8/19/1999 78,693.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 9/17/1982 6/16/2000 55,598.40 Yes 50,000.00 Yes 180,000.00 Waive Coverage Waive Coverage

64068 M 4/14/1983 8/2/2012 62,441.00 Yes 50,000.00 Yes 110,000.00 Waive Coverage Waive Coverage

64155 F 3/17/1972 8/9/2017 24,364.96 Yes 50,000.00 Yes with ADD 130,000.00 Waive Coverage Waive Coverage

64153 F 11/27/1971 9/1/1994 46,259.20 Yes 50,000.00 Yes 70,000.00 Yes 50,000.00 Yes 10,000.00

64155 F 5/24/1984 7/31/2008 55,612.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 1/12/1977 8/16/2000 79,557.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/14/1982 8/2/2007 62,318.06 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64105 F 3/3/1981 8/3/2017 71,324.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/12/1979 8/1/2016 56,757.44 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64152 F 7/19/1979 8/14/2002 36,067.20 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Yes 10,000.00

64152 F 6/2/1986 8/4/2009 53,045.00 Yes 50,000.00 Yes 120,000.00 Waive Coverage Yes 10,000.00

64154 M 9/9/1984 8/2/2007 69,878.70 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 F 4/4/1986 8/4/2009 58,728.50 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64444 M 8/12/1988 1/22/2018 34,153.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64507 M 8/22/1989 3/1/2016 55,598.40 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64108 F 5/12/1984 8/2/2007 55,612.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 6/17/1990 8/2/2012 49,711.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64063 M 9/24/1991 1/9/2017 73,080.00 Yes 50,000.00 Yes 200,000.00 Yes 50,000.00 Yes 10,000.00

64154 F 9/21/1991 8/1/2013 47,912.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/10/1993 8/3/2017 47,774.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/23/1993 1/5/2016 24,080.42 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 8: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64155 M 11/9/1994 11/17/2015 36,712.00 Yes 50,000.00 Yes 30,000.00 Waive Coverage Waive Coverage

64154 F 1/18/1995 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/18/1980 8/4/2014 30,097.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/7/1962 8/9/2007 28,537.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 11/10/1962 8/26/1997 26,069.58 Yes 50,000.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage

64152 F 9/29/1970 7/31/2017 39,147.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 5/15/1955 6/8/1989 80,180.35 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 1/28/1962 4/5/2002 28,537.60 Yes 50,000.00 Yes 50,000.00 Waive Coverage Yes 10,000.00

64024 M 11/21/1965 8/21/1992 75,912.30 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/26/1959 8/24/1999 21,451.36 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 7/6/1973 1/21/1997 84,720.30 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/6/1963 7/30/2007 20,035.47 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 6/18/1971 8/3/2005 79,726.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 2/25/1960 3/9/2009 71,697.60 Yes 50,000.00 Yes with ADD 130,000.00 Waive Coverage Waive Coverage

64152 F 6/18/1972 8/9/2013 21,965.09 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

64118 F 3/8/1959 3/5/2018 30,825.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/19/1973 8/6/2004 69,653.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/2/1953 8/23/1999 44,928.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64151 F 11/30/1958 11/1/2004 18,462.06 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64439 F 10/10/1964 5/19/2008 40,622.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 12/21/1973 8/4/2009 53,561.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 4/14/1979 3/6/2013 52,665.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 2/11/1965 7/31/2008 65,318.72 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 10/12/1969 8/4/2015 24,433.92 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 10/13/1977 8/16/2000 73,568.00 Yes 50,000.00 Yes 200,000.00 Yes 30,000.00 Waive Coverage

64157 F 7/30/1981 8/1/2016 54,329.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64106 F 2/11/1967 1/22/2013 23,613.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 9/27/1967 8/15/2007 49,774.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/6/1976 8/1/2016 50,995.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/13/1966 9/5/2001 73,936.00 Yes 50,000.00 Yes with ADD 170,000.00 Waive Coverage Yes 10,000.00

64157 F 9/19/1983 8/3/2006 56,895.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/10/1983 12/11/2017 39,704.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 1/14/1970 8/31/2009 25,833.28 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/8/1984 8/3/2011 61,424.80 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64016 F 3/31/1970 8/3/2006 69,045.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 11/26/1977 8/4/2010 76,620.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 1/23/1975 8/7/2002 68,249.00 Yes 50,000.00 Yes with ADD 40,000.00 Yes 20,000.00 Yes 10,000.00

64068 F 5/9/1974 8/3/2015 40,105.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 M 4/11/1969 7/31/2008 72,711.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/18/1971 8/17/1998 75,689.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 3/10/1971 8/10/2016 23,953.16 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/18/1971 8/23/1994 106,268.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 9/8/1976 8/9/2001 77,557.90 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes 10,000.00

64152 F 12/2/1970 3/2/2015 41,251.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64018 F 7/14/1982 8/25/2008 38,584.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/20/1987 8/2/2012 54,466.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 12/9/1982 2/10/2014 21,651.84 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 M 6/9/1980 8/2/2007 68,726.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 3/26/1988 11/5/2013 37,793.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 9/23/1982 11/4/2002 25,373.25 Yes 50,000.00 Yes 200,000.00 Yes 0.00 Yes 10,000.00

64151 M 9/11/1989 8/1/2016 48,414.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66218 F 6/17/1990 8/1/2013 54,639.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 F 10/13/1991 1/5/2015 40,621.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 9/17/1991 9/8/2014 27,276.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/27/1991 7/31/2014 46,096.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 11/5/1991 9/29/2014 25,383.80 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64118 F 4/16/1993 8/10/2015 38,545.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64079 M 5/10/1993 2/27/2017 23,699.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 5/17/1993 8/8/2016 36,192.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64112 F 4/6/1993 8/3/2015 41,308.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/30/1993 8/3/2015 40,105.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64089 F 6/3/1993 8/1/2016 40,621.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 1/9/1995 2/11/2013 24,306.66 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 12/16/1959 7/1/2006 122,689.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64151 F 11/24/1961 9/13/1980 51,438.40 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

64158 F 8/17/1965 7/7/2017 30,825.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 11/2/1973 8/19/1999 81,484.06 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 11/12/1969 8/3/2005 72,344.30 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64151 F 2/7/1962 8/28/1995 28,537.60 Yes 50,000.00 Yes with ADD 30,000.00 Yes 30,000.00 Yes 10,000.00

64152 F 3/22/1974 8/3/2011 62,473.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 3/30/1969 3/1/2005 38,584.00 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64152 M 7/2/1968 8/1/2016 69,002.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/21/1976 7/31/2014 79,596.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64133 M 7/10/1975 10/10/2002 43,659.20 Yes 50,000.00 Yes with ADD 90,000.00 Yes 40,000.00 Yes 10,000.00

Page 9: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64154 F 12/23/1964 8/3/2005 79,693.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 4/2/1971 1/9/1995 75,434.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

64151 F 7/1/1965 6/25/1987 79,996.00 Yes 50,000.00 Yes with ADD 160,000.00 Waive Coverage Yes 10,000.00

64152 F 7/6/1964 9/15/2005 20,546.07 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 4/29/1976 8/3/2009 46,259.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/17/1967 8/15/2007 70,518.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 11/25/1978 8/3/2006 72,881.00 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Yes 10,000.00

64152 F 10/23/1971 8/9/2001 71,153.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 11/27/1981 8/1/2013 60,253.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Yes 10,000.00

64152 M 6/27/1983 10/11/2001 62,121.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 5/8/1982 4/20/2015 88,573.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 30,000.00 Yes with ADD 10,000.00

64153 M 6/3/1981 10/24/2012 50,627.20 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Waive Coverage

64079 F 6/15/1970 8/11/2014 27,206.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 8/26/1982 8/1/2016 56,895.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 7/12/1981 11/13/2017 20,135.36 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64113 F 6/28/1982 8/4/2010 69,013.95 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64058 M 11/1/1982 1/9/2012 52,665.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 1/11/1971 4/18/2011 40,872.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64152 F 7/23/1970 8/3/2005 72,911.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64110 F 1/18/1985 7/31/2008 60,149.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 1/7/1979 9/30/2013 21,539.07 Yes 50,000.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage

64155 M 3/20/1976 8/16/2000 119,474.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64157 F 3/23/1976 10/16/2003 67,426.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64155 F 8/19/1980 8/14/2017 19,020.54 Yes 50,000.00 Yes 100,000.00 Waive Coverage Yes 10,000.00

64152 F 10/25/1987 8/3/2011 50,479.00 Yes 50,000.00 Yes 500,000.00 Waive Coverage Yes 10,000.00

64157 F 12/28/1974 8/19/1999 67,733.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 6/28/1988 8/1/2016 51,762.00 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 9/12/1989 8/2/2012 45,379.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64118 F 10/27/1987 8/2/2012 50,479.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64133 F 1/8/1985 8/3/2017 63,199.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 2/15/1988 9/21/2015 46,259.20 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64118 M 7/31/1990 8/1/2016 43,670.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 8/26/1990 8/1/2013 49,711.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 7/31/1990 8/22/2017 21,775.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/9/1990 8/3/2017 54,329.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 7/27/1990 6/1/2015 44,012.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 11/25/1991 7/31/2014 48,393.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 F 6/11/1993 8/3/2017 42,778.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/1/1995 8/3/2017 40,264.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/20/1971 8/14/2017 21,464.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/20/1982 7/31/2014 49,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/3/1958 9/6/1988 31,486.77 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/23/1959 12/8/1998 25,736.62 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/10/1972 8/20/1997 61,295.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64152 F 5/20/1962 8/19/2002 19,450.14 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/23/1960 2/22/2000 42,520.72 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/24/1967 1/27/1992 81,672.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 F 11/4/1977 7/31/2014 66,227.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64152 F 7/6/1977 8/7/2002 70,596.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 F 5/30/1978 7/31/2008 73,510.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64075 M 10/19/1965 8/7/2002 107,993.00 Yes 50,000.00 Yes with ADD 300,000.00 Yes 50,000.00 Yes 10,000.00

64152 F 6/11/1980 8/3/2006 57,682.73 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64079 F 1/7/1966 8/2/2007 55,612.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 8/4/1981 8/1/2016 55,784.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64152 M 8/14/1974 8/1/2013 68,969.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes 30,000.00 Yes 10,000.00

64153 F 6/5/1979 8/4/2003 79,764.05 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64060 F 3/26/1982 8/2/2012 74,272.90 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00

64082 M 1/31/1972 8/1/2013 81,987.34 Yes 50,000.00 Yes 200,000.00 Yes 50,000.00 Yes 10,000.00

64152 F 1/2/1972 1/6/2014 21,225.82 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 11/1/1983 7/31/2014 56,895.00 Yes 50,000.00 Yes 200,000.00 Yes 200,000.00 Yes 10,000.00

64151 F 2/16/1970 8/2/2012 56,842.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64113 F 11/29/1968 3/23/1992 64,821.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64105 M 8/15/1982 8/2/2007 62,116.96 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 F 4/20/1973 8/3/2005 71,526.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

65321 F 3/17/1981 8/3/2006 67,942.00 Yes 50,000.00 Yes 40,000.00 Yes 20,000.00 Waive Coverage

66213 M 7/3/1975 8/17/1998 82,925.28 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64158 F 8/30/1975 10/10/2016 20,624.38 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Waive Coverage

64157 F 9/13/1972 8/20/1997 74,916.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/20/1976 8/1/2013 60,410.87 Yes 50,000.00 Yes with ADD 190,000.00 Yes 50,000.00 Yes 5,000.00

64150 F 8/16/1982 8/16/2005 67,529.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/5/1977 8/4/2003 96,031.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

64068 F 11/9/1979 7/24/2017 37,481.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64108 F 12/24/1974 8/6/2004 66,339.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64151 F 5/10/1973 7/19/2016 91,996.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 10: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64151 F 7/11/1977 8/15/2013 24,140.34 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Waive Coverage

64024 F 11/1/1974 11/16/1993 54,100.80 Yes 50,000.00 Yes 200,000.00 Yes 110,000.00 Yes 10,000.00

64152 F 8/15/1975 11/16/1998 46,212.00 Yes 50,000.00 Yes with ADD 80,000.00 Yes 50,000.00 Yes 10,000.00

64155 F 5/19/1988 9/26/2011 49,195.00 Yes 50,000.00 Yes 40,000.00 Waive Coverage Waive Coverage

64152 F 8/14/1988 8/2/2012 79,553.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64152 F 9/21/1988 8/2/2016 24,850.35 Yes 50,000.00 Yes with ADD 90,000.00 Waive Coverage Yes 10,000.00

64068 F 1/6/1978 8/11/2014 44,535.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 10/13/1989 8/1/2013 62,333.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/12/1989 1/24/2013 33,571.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 10/13/1989 8/15/2012 37,252.80 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage

64117 F 7/9/1986 8/2/2012 54,466.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64114 F 10/24/1985 8/3/2017 53,996.10 Yes 50,000.00 Yes with ADD 120,000.00 Yes 50,000.00 Waive Coverage

64151 F 6/19/1992 8/21/2017 21,464.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 7/16/1993 8/3/2017 44,062.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 4/12/1995 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/22/1972 8/13/2010 22,929.90 Yes 50,000.00 Yes with ADD 70,000.00 Yes with ADD 0.00 Yes with ADD 10,000.00

64152 F 3/6/1954 8/30/1993 89,387.00 Yes 50,000.00 Yes 30,000.00 Yes 30,000.00 Yes 10,000.00

64152 F 10/20/1952 7/27/2015 41,420.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 10/22/1954 2/3/1992 46,212.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/20/1959 8/31/1992 41,204.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 3/13/1954 5/17/1999 44,928.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 4/27/1955 8/1/2016 64,657.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 7/27/1969 8/3/2015 61,301.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 1/10/1965 6/28/2010 40,040.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64429 M 9/15/1966 8/16/2000 85,601.81 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66018 F 2/7/1959 7/31/2014 64,657.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 11/5/1962 1/21/2014 44,844.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 9/30/1962 8/31/2010 41,454.40 Yes 50,000.00 Yes with ADD 70,000.00 Yes 30,000.00 Yes 10,000.00

64155 F 8/29/1971 8/26/1996 74,916.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 10/2/1964 9/26/2016 36,192.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/8/1970 8/19/1993 81,706.68 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

64154 M 1/25/1977 9/17/2002 45,572.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 7/5/1964 8/21/1992 82,283.65 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/16/1966 8/17/1998 64,373.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 3/28/1972 1/11/2018 34,153.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 10/9/1970 8/19/1993 76,418.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 9/25/1978 8/3/2015 72,796.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 3/9/1978 8/26/1999 25,235.42 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 12/6/1968 8/19/1993 77,452.00 Yes 50,000.00 Yes with ADD 120,000.00 Waive Coverage Yes with ADD 10,000.00

66215 F 6/29/1977 8/16/2000 71,590.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 M 12/18/1968 8/21/1996 87,564.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66208 F 6/15/1979 8/3/2005 62,522.16 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64151 F 6/29/1971 8/1/2002 51,230.40 Yes 50,000.00 Yes with ADD 40,000.00 Yes with ADD 40,000.00 Yes with ADD 10,000.00

64138 F 7/14/1986 8/14/2017 21,464.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/20/1981 8/4/2010 58,710.58 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 7/8/1981 8/2/2007 65,810.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/4/1986 1/11/2010 52,278.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64056 M 2/25/1987 9/5/2017 44,948.80 Yes 50,000.00 Yes 100,000.00 Yes 50,000.00 Waive Coverage

64119 F 3/12/1983 7/31/2014 55,612.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 10/30/1987 7/1/2017 21,464.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66061 F 6/24/1986 9/20/2004 54,845.00 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64157 F 6/8/1988 8/3/2015 49,711.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/2/1986 8/12/2011 41,701.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes with ADD 10,000.00

64118 M 6/12/1985 2/23/2009 59,603.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 M 8/23/1988 7/20/2017 78,595.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 50,000.00 Waive Coverage

64114 M 11/8/1985 7/31/2008 58,271.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/12/1989 8/2/2012 60,692.51 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 10/25/1989 8/23/2013 27,276.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 M 8/22/1990 8/8/2016 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 9/24/1990 7/13/2015 62,473.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64116 M 10/31/1990 9/5/2017 34,153.60 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Waive Coverage

64116 M 1/15/1992 8/1/2016 51,123.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64151 F 2/7/1992 8/3/2015 50,850.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 6/8/1993 8/3/2017 42,778.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 8/2/1993 9/1/2016 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64132 M 10/15/1993 2/1/2016 36,192.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64118 F 9/13/1993 8/3/2017 44,062.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 9/14/1993 8/1/2016 39,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 9/15/1993 11/16/2017 34,153.60 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64154 M 10/18/1993 8/14/2017 24,673.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 7/24/1995 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/31/1980 10/8/2007 41,204.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 10/2/1950 10/31/2005 41,808.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 8/19/1956 8/16/2000 68,674.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 11: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64152 M 3/14/1955 12/6/2010 25,876.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 4/26/1957 8/17/1998 74,657.00 Yes 50,000.00 Yes 70,000.00 Waive Coverage Waive Coverage

64155 M 5/14/1958 4/14/2008 59,092.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 1/22/1959 2/20/2013 40,705.60 Yes 50,000.00 Yes with ADD 20,000.00 Yes 20,000.00 Yes 10,000.00

64150 M 1/27/1958 12/8/2008 59,092.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 11/11/1968 8/23/1991 89,528.91 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64116 F 5/19/1973 7/1/2014 107,502.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00

64151 F 4/10/1962 3/28/2003 56,895.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64119 F 7/6/1957 8/17/2004 65,405.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Waive Coverage

64152 F 12/9/1960 8/4/2009 73,338.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/19/1959 11/8/2010 22,165.57 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/8/1963 11/23/1998 64,149.00 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64153 F 4/16/1970 8/31/1992 70,377.00 Yes 50,000.00 Yes with ADD 40,000.00 Yes with ADD 30,000.00 Waive Coverage

64118 M 10/24/1964 1/15/1999 46,696.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/20/1969 8/14/2006 50,502.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 M 4/19/1965 8/3/2006 76,680.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/6/1967 8/19/1993 76,418.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/31/1973 8/16/2000 75,175.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 11/1/1979 8/6/2004 78,913.95 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64151 M 1/31/1972 8/16/2000 72,405.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/28/1975 7/31/2008 62,257.00 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage

64152 F 2/11/1975 7/17/2012 40,872.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64063 M 10/21/1982 8/1/2016 69,242.00 Yes 50,000.00 Yes with ADD 100,000.00 Yes 50,000.00 Waive Coverage

64153 F 12/7/1966 1/26/2009 42,057.60 Yes 50,000.00 Yes with ADD 200,000.00 Yes 40,000.00 Yes 10,000.00

64152 M 7/20/1968 8/21/1996 72,793.30 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 12/11/1983 12/5/2011 50,479.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64117 F 10/14/1968 8/9/2001 61,301.00 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64152 F 8/5/1977 8/16/2000 73,568.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/25/1968 8/7/2002 63,566.00 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Yes 10,000.00

64152 M 10/8/1981 7/31/2008 65,047.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 6/9/1983 8/8/2012 55,612.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64153 F 3/5/1968 8/30/1994 68,674.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes with ADD 10,000.00

64119 F 4/23/1978 8/8/2002 64,908.80 Yes 50,000.00 Yes 150,000.00 Yes 50,000.00 Waive Coverage

64155 F 9/14/1971 8/2/2012 84,512.15 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes with ADD 10,000.00

64154 F 12/8/1983 7/31/2008 79,872.98 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 8/14/1979 8/7/2002 59,462.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/13/1986 8/2/2012 49,711.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/5/1971 8/9/2017 17,592.12 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 5/9/1981 3/1/2016 37,627.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 5/29/1977 8/3/2006 46,212.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/31/1976 1/28/2013 44,948.80 Yes 50,000.00 Yes with ADD 190,000.00 Yes 50,000.00 Yes with ADD 10,000.00

66205 F 4/12/1982 8/3/2006 61,467.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 8/5/1971 9/1/2011 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/31/1979 8/9/2001 72,796.00 Yes 50,000.00 Yes with ADD 160,000.00 Waive Coverage Yes 10,000.00

64151 F 5/26/1977 8/16/2000 72,796.00 Yes 50,000.00 Yes 150,000.00 Yes 50,000.00 Waive Coverage

64151 F 2/8/1973 8/12/2002 59,092.80 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64151 F 1/29/1987 10/4/2010 64,467.00 Yes 50,000.00 Yes 80,000.00 Waive Coverage Waive Coverage

66217 F 11/15/1990 8/1/2016 47,912.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64465 M 12/26/1988 12/6/2010 53,435.20 Yes 50,000.00 Yes 30,000.00 Waive Coverage Waive Coverage

64117 F 8/9/1988 8/3/2017 50,995.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 1/30/1990 7/31/2014 57,489.45 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64108 F 10/28/1991 8/3/2017 44,062.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 2/20/1981 5/2/2011 52,665.60 Yes 50,000.00 Yes with ADD 250,000.00 Waive Coverage Yes 10,000.00

64151 M 3/6/1992 8/3/2017 42,778.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 3/14/1992 8/14/2017 19,852.56 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64151 F 2/18/1992 8/3/2017 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 2/29/1992 2/1/2018 34,153.60 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64151 F 10/5/1993 8/1/2016 39,341.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64113 F 10/15/1993 2/1/2016 43,670.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 5/18/1995 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64112 F 5/18/1995 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 7/9/1995 9/8/2014 16,604.04 Yes 50,000.00 Yes with ADD 80,000.00 Waive Coverage Waive Coverage

64152 M 7/10/1995 3/14/2016 29,501.52 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64116 F 7/4/1995 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 12/27/1956 1/2/2007 29,660.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64150 F 11/15/1954 8/19/1998 39,247.20 Yes 50,000.00 Yes with ADD 170,000.00 Yes with ADD 50,000.00 Waive Coverage

64151 F 2/1/1956 6/6/2001 43,659.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 8/31/1957 9/25/2006 41,204.80 Yes 50,000.00 Yes 30,000.00 Waive Coverage Yes 10,000.00

64154 M 6/30/1969 1/18/2011 38,896.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64492 F 9/5/1971 8/17/1998 83,106.00 Yes 50,000.00 Yes with ADD 250,000.00 Yes 0.00 Yes with ADD 10,000.00

64154 F 11/3/1961 8/14/2017 19,020.54 Yes 50,000.00 Yes with ADD 100,000.00 Yes with ADD 50,000.00 Waive Coverage

64157 F 8/20/1976 7/31/2008 75,359.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 2/19/1976 2/1/2010 49,195.00 Yes 50,000.00 Yes 200,000.00 Yes 50,000.00 Yes 10,000.00

64151 F 3/13/1962 8/27/1984 66,389.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Waive Coverage

Page 12: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64153 F 8/24/1971 8/1/2016 80,832.00 Yes 50,000.00 Yes with ADD 20,000.00 Yes 20,000.00 Yes 10,000.00

64152 M 7/18/1975 8/9/2001 64,585.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 7/8/1967 8/20/1997 72,328.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/26/1979 1/7/2013 59,978.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 12/2/1979 8/20/2012 80,826.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64154 M 1/17/1970 8/19/1999 84,957.20 Yes 50,000.00 Yes 150,000.00 Waive Coverage Yes 10,000.00

64151 F 9/27/1978 8/3/2015 58,179.00 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

64111 F 9/22/1976 8/2/2012 51,888.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64152 F 7/28/1969 10/23/2017 17,592.12 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66213 F 1/3/1966 9/13/1990 73,948.60 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64079 F 11/26/1968 8/21/1996 71,377.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/12/1966 8/11/2014 57,866.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00

64158 F 12/19/1968 12/7/2017 38,417.60 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64151 F 9/11/1980 1/25/2016 15,970.38 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 8/3/1972 10/25/2004 85,629.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 7/19/1972 8/20/1997 74,916.00 Yes 50,000.00 Yes with ADD 180,000.00 Yes 50,000.00 Yes 10,000.00

64155 F 3/13/1971 8/16/2000 78,916.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 4/21/1968 8/9/2001 73,926.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 6/20/1968 8/3/2017 80,155.00 Yes 50,000.00 Yes 150,000.00 Waive Coverage Waive Coverage

64152 M 4/27/1982 8/3/2015 72,658.71 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 30,000.00 Yes with ADD 10,000.00

64151 F 4/23/1982 8/2/2012 57,411.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/7/1967 8/13/2014 16,206.66 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64150 F 3/19/1968 9/14/1992 75,693.00 Yes 50,000.00 Yes with ADD 100,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64079 F 8/21/1973 8/20/1997 66,085.05 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Yes 10,000.00

64118 M 1/14/1984 9/11/2017 34,153.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 10/22/1979 8/15/2012 44,880.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 3/9/1971 9/5/2017 30,521.12 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 11/2/1974 8/17/1998 74,657.00 Yes 50,000.00 Yes 110,000.00 Waive Coverage Waive Coverage

64154 F 12/28/1980 8/3/2005 69,087.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 M 6/26/1975 8/4/2003 68,115.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/4/1987 8/4/2009 53,045.00 Yes 50,000.00 Yes 30,000.00 Waive Coverage Waive Coverage

64118 F 8/22/1986 9/1/2014 47,500.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64133 M 8/15/1979 10/13/2014 69,551.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 7/15/1977 8/1/2016 68,949.55 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64506 F 11/10/1975 8/1/2016 72,111.00 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64151 F 12/11/1980 8/1/2016 59,210.00 Yes 50,000.00 Yes with ADD 20,000.00 Yes 20,000.00 Yes 5,000.00

64152 M 7/28/1976 10/19/2007 68,056.45 Yes 50,000.00 Yes with ADD 40,000.00 Yes with ADD 40,000.00 Yes with ADD 10,000.00

64079 M 11/2/1987 8/3/2011 54,989.80 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64157 M 6/10/1983 8/3/2017 49,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/19/1983 9/16/2002 63,498.25 Yes 50,000.00 Yes with ADD 40,000.00 Yes with ADD 20,000.00 Yes with ADD 10,000.00

66204 F 5/3/1983 8/31/2007 23,606.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 10/4/1986 8/10/2012 19,204.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 5/31/1987 10/8/2015 31,418.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 6/11/1985 8/3/2015 61,575.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64154 M 7/5/1984 7/31/2014 63,317.45 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 10/17/1989 9/1/2015 24,433.92 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 10/13/1988 8/1/2016 50,730.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 12/4/1979 8/7/2002 63,141.00 Yes 50,000.00 Yes 110,000.00 Yes 50,000.00 Waive Coverage

64501 F 7/28/1988 8/10/2015 40,487.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes 30,000.00 Yes 10,000.00

64152 M 3/5/1992 7/31/2014 53,821.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64110 F 3/23/1992 8/3/2015 55,722.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64136 M 4/24/1992 7/8/2015 38,584.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 11/7/1993 8/1/2016 39,857.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64057 F 10/20/1993 8/1/2016 39,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 9/21/1944 33,087.12 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/28/1963 8/3/2006 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64167 F 11/4/1952 2/4/2008 48,360.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/8/1966 8/14/2013 26,969.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 2/28/1961 8/10/2015 36,712.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64110 F 2/7/1956 8/17/1998 42,851.03 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64152 M 11/8/1967 8/21/1992 169,631.00 Yes 100,000.00 Waive Coverage Waive Coverage Waive Coverage

66226 F 11/30/1971 8/9/2001 79,175.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 9/24/1957 5/1/1995 48,568.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64117 F 1/21/1959 9/9/1998 32,344.00 Yes 50,000.00 Yes with ADD 20,000.00 Yes 20,000.00 Waive Coverage

64151 F 9/4/1961 8/25/1997 42,149.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/5/1975 8/9/2001 75,088.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64152 M 5/1/1963 9/8/2015 39,707.20 Yes 50,000.00 Yes with ADD 150,000.00 Yes 50,000.00 Yes 10,000.00

64157 M 1/19/1976 8/2/2007 66,142.15 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64152 M 10/21/1963 3/16/2009 57,408.00 Yes 50,000.00 Yes with ADD 170,000.00 Waive Coverage Waive Coverage

64154 F 2/18/1977 8/1/2013 60,745.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64089 F 9/19/1961 5/1/2017 36,940.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 5/31/1974 8/29/2016 48,140.10 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64114 F 5/24/1973 8/3/2015 44,647.00 Yes 50,000.00 Yes 150,000.00 Yes 30,000.00 Yes 10,000.00

64155 F 12/7/1979 12/18/2002 68,881.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 13: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64154 F 10/10/1964 8/25/1997 80,277.90 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

64151 F 6/23/1965 9/9/2013 21,855.90 Yes 50,000.00 Yes 20,000.00 Yes 20,000.00 Yes 10,000.00

64152 F 4/17/1970 8/21/1992 95,636.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/30/1970 7/1/2005 58,105.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 10/11/1967 3/2/2005 41,620.80 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64089 F 1/5/1966 8/13/2008 22,278.34 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/30/1977 7/1/2014 130,082.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 8/17/1970 5/7/2012 16,840.32 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64057 F 4/8/1967 8/26/1992 65,270.00 Yes 50,000.00 Yes with ADD 100,000.00 Yes 30,000.00 Yes 10,000.00

64156 F 10/30/1971 8/8/2002 46,728.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Yes 10,000.00

64151 M 5/27/1981 8/1/2016 66,138.75 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 8/22/1983 6/1/2001 17,141.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64133 F 5/6/1985 7/31/2008 56,300.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 4/1/1985 7/1/2016 45,593.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 12/2/1979 8/6/2004 77,602.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/17/1977 8/3/2015 46,628.00 Yes 50,000.00 Yes with ADD 80,000.00 Waive Coverage Yes with ADD 10,000.00

64155 F 6/1/1976 7/20/2015 112,481.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 M 12/1/1977 8/3/2006 68,881.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/31/1979 11/1/2005 43,742.40 Yes 50,000.00 Yes with ADD 250,000.00 Yes with ADD 250,000.00 Yes with ADD 10,000.00

64153 F 10/15/1983 8/2/2007 57,239.01 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64157 M 6/17/1982 8/3/2017 46,726.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 8/25/1979 8/3/2017 60,745.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64112 F 6/12/1978 8/9/2001 67,869.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 4/8/1984 8/11/2014 50,291.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 7/8/1986 8/3/2015 56,091.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 7/1/1985 8/2/2012 54,329.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 30,000.00 Yes with ADD 10,000.00

64506 F 11/7/1980 7/1/2017 118,000.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 9/29/1977 8/1/2016 68,940.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64114 F 9/13/1988 1/29/2015 49,674.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 1/6/1988 8/4/2010 64,280.74 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 8/22/1987 8/2/2012 51,835.07 Yes 50,000.00 Yes 40,000.00 Yes 30,000.00 Yes 10,000.00

64118 F 12/7/1990 8/1/2014 25,952.64 Yes 50,000.00 Yes with ADD 60,000.00 Yes 50,000.00 Yes 10,000.00

64154 F 12/4/1990 8/22/2011 43,714.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/2/1992 10/3/2016 38,545.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64112 F 4/29/1992 7/31/2017 46,909.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/1/1992 11/27/2017 21,464.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 11/6/1988 9/7/2011 50,479.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64112 F 12/28/1993 8/3/2017 44,062.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 F 1/10/1994 8/3/2017 42,778.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64151 M 5/28/1991 8/12/2011 25,381.30 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/1/1994 8/1/2016 39,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/20/1958 8/19/2002 29,298.78 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 3/31/1956 10/30/2017 39,147.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64474 F 9/9/1961 8/15/2002 28,981.89 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 M 5/7/1965 8/4/2003 69,160.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 1/27/1974 12/1/2014 46,924.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/19/1961 7/1/2003 51,979.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64150 F 6/21/1961 7/1/2007 116,232.00 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64152 F 10/11/1969 8/7/2002 87,744.70 Yes 50,000.00 Yes 60,000.00 Yes 50,000.00 Waive Coverage

64152 F 10/7/1964 8/21/1991 74,437.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 12/5/1969 8/20/1997 79,983.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64444 F 7/30/1963 1/14/2002 43,118.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/12/1965 11/6/2017 19,020.54 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 6/1/1979 8/3/2005 58,179.00 Yes 50,000.00 Yes with ADD 160,000.00 Waive Coverage Waive Coverage

64118 F 3/12/1978 8/2/2012 75,863.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00

64151 F 10/19/1972 8/17/1999 74,395.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/5/1970 8/24/1993 81,916.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64157 F 4/3/1967 8/3/2005 66,409.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/8/1968 7/24/1990 77,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 M 8/9/1981 10/28/2002 63,593.50 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Yes with ADD 10,000.00

64151 F 9/30/1978 2/1/2010 47,912.00 Yes 50,000.00 Yes 150,000.00 Yes 0.00 Yes 10,000.00

64152 F 8/16/1979 8/7/2002 64,269.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes with ADD 10,000.00

64492 F 3/6/1984 8/2/2007 62,419.00 Yes 50,000.00 Yes 30,000.00 Waive Coverage Waive Coverage

64154 F 9/14/1972 8/9/2001 70,169.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 M 8/29/1977 8/2/2012 71,153.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64131 F 7/19/1982 8/3/2017 47,912.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 8/10/1973 8/21/1996 73,982.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/23/1976 8/19/1999 76,911.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 4/22/1974 8/26/1996 78,305.92 Yes 50,000.00 Yes with ADD 280,000.00 Yes 50,000.00 Yes 10,000.00

64119 M 10/8/1969 8/3/2005 74,135.60 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Yes with ADD 10,000.00

64157 M 3/25/1981 8/3/2011 68,335.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64156 F 7/31/1972 8/20/1997 70,541.00 Yes 50,000.00 Yes 100,000.00 Yes 100,000.00 Waive Coverage

64152 F 7/1/1976 9/20/1999 50,336.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 9/22/1983 8/1/2013 57,411.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

Page 14: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64152 F 11/27/1980 7/28/2016 39,104.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes with ADD 10,000.00

64150 M 3/14/1980 8/3/2015 53,561.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes with ADD 30,000.00 Yes with ADD 10,000.00

64155 F 2/12/1985 8/9/2013 21,539.07 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/28/1984 7/31/2014 58,658.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64110 F 12/2/1988 1/4/2016 47,586.56 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66109 F 12/19/1973 8/16/2000 74,916.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 12/31/1981 8/4/2009 73,293.84 Yes 50,000.00 Yes with ADD 110,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64152 F 4/19/1984 7/31/2008 64,550.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/3/1987 3/1/2016 28,715.96 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes with ADD 10,000.00

64015 F 4/25/1986 8/9/2017 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 8/29/1973 8/16/2006 37,354.48 Yes 50,000.00 Yes with ADD 110,000.00 Yes with ADD 50,000.00 Waive Coverage

66208 F 4/22/1985 8/1/2013 65,066.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 1/13/1991 8/3/2015 48,428.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 11/24/1986 1/4/2012 24,346.14 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 8/11/1988 7/31/2014 52,533.50 Yes 50,000.00 Yes 30,000.00 Waive Coverage Waive Coverage

64152 F 4/25/1987 9/14/2007 37,793.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 7/29/1992 9/20/2016 24,080.42 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 2/15/1994 3/20/2017 26,887.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 1/22/1994 8/1/2016 39,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 3/6/1994 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 M 11/13/1995 9/26/2016 44,948.80 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64154 F 2/18/1984 8/3/2015 61,570.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 7/7/1953 7/16/2000 52,561.60 Yes 50,000.00 Yes with ADD 30,000.00 Yes 30,000.00 Waive Coverage

64151 F 11/5/1954 8/1/1998 41,131.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 M 5/10/1956 5/14/2012 46,155.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/27/1959 8/18/2004 43,908.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/28/1967 9/1/2001 55,612.00 Yes 50,000.00 Yes 70,000.00 Waive Coverage Waive Coverage

64151 F 7/16/1973 8/14/2002 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 2/27/1976 1/1/1997 61,692.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64081 M 12/27/1961 2/2/2015 36,712.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 1/8/1977 8/4/2010 74,114.96 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 2/13/1974 8/7/2017 44,948.80 Yes 50,000.00 Yes with ADD 150,000.00 Yes 50,000.00 Yes 10,000.00

66086 F 9/26/1976 7/30/2009 90,243.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/29/1981 12/9/2003 61,201.65 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64079 F 4/16/1974 8/1/2012 59,568.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 M 10/9/1969 8/10/2012 63,131.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64151 M 7/29/1981 8/10/2006 71,481.10 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage

64151 F 1/6/1972 1/19/2010 41,003.00 Yes 50,000.00 Yes 100,000.00 Yes 50,000.00 Yes 10,000.00

66106 F 7/3/1968 7/31/2017 54,774.08 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Yes with ADD 10,000.00

64154 F 7/27/1983 8/4/2009 70,493.00 Yes 50,000.00 Yes with ADD 100,000.00 Yes 100,000.00 Yes 10,000.00

64089 F 6/6/1968 8/3/2005 75,434.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66210 F 7/24/1985 8/3/2011 60,521.44 Yes 50,000.00 Yes 200,000.00 Yes 30,000.00 Yes 10,000.00

64152 F 10/1/1969 8/20/1997 62,695.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 3/24/1972 8/17/1994 87,432.51 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64029 F 7/24/1980 8/2/2012 50,513.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/6/1979 8/9/2001 70,718.28 Yes 50,000.00 Yes 170,000.00 Waive Coverage Waive Coverage

64151 F 11/12/1981 8/15/2005 38,771.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 10/12/1977 3/12/2015 24,433.92 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 1/17/1979 8/1/2013 68,662.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64151 F 8/22/1982 1/13/2006 64,515.00 Yes 50,000.00 Yes 110,000.00 Waive Coverage Yes 10,000.00

64152 F 8/14/1972 9/4/2007 66,533.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 10/28/1973 8/3/2015 62,695.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes 10,000.00

64089 F 10/5/1978 8/14/2013 33,287.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 12/20/1989 8/1/2013 47,912.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64138 F 1/11/1990 8/1/2016 41,385.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 1/28/1991 7/31/2014 47,912.00 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage

64151 F 2/15/1991 7/31/2014 49,642.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 8/4/1992 9/10/2012 38,334.40 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64116 F 7/16/1992 8/3/2015 42,511.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 1/26/1984 7/17/2012 43,742.40 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Yes 10,000.00

64116 M 8/17/1950 2/18/2014 21,225.82 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 4/3/1955 10/15/2008 22,473.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 8/31/1953 8/16/2006 18,354.66 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 M 2/11/1957 7/20/1998 43,659.20 Yes 50,000.00 Yes with ADD 70,000.00 Yes 0.00 Waive Coverage

64152 M 8/16/1954 5/7/2007 43,284.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 2/14/1954 8/23/2000 28,582.72 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 6/7/1958 2/1/2015 27,077.33 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 6/26/1956 8/23/2000 28,582.72 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66018 F 4/28/1956 7/1/2005 247,400.00 Yes 100,000.00 Waive Coverage Waive Coverage Waive Coverage

64485 F 2/26/1973 8/1/2013 78,482.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 6/30/1967 8/19/1999 84,177.11 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 6/29/1963 1/10/1996 41,131.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/12/1957 10/29/1997 40,139.12 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 3/22/1970 9/5/2006 41,204.80 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Yes 10,000.00

Page 15: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64151 M 1/29/1974 8/4/2003 77,040.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64152 M 9/3/1962 11/4/1996 75,693.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 8/23/1963 9/5/2007 67,267.20 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes with ADD 10,000.00

64155 F 6/1/1974 9/8/1997 22,278.34 Yes 50,000.00 Yes with ADD 110,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64454 F 10/11/1976 9/21/2009 27,385.96 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/18/1980 6/1/2015 24,433.92 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64152 F 5/29/1982 8/3/2017 53,045.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 2/14/1968 8/22/1995 73,023.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 11/28/1980 8/4/2009 59,462.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64150 M 3/30/1971 7/21/1997 45,572.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/8/1970 9/1/1993 75,434.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 10/30/1982 8/3/2006 64,515.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64152 F 7/2/1968 8/21/1996 73,023.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64089 F 4/24/1969 8/4/2009 68,078.00 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes 10,000.00

64152 M 5/29/1976 8/12/2014 40,869.00 Yes 50,000.00 Yes 200,000.00 Yes 30,000.00 Yes 10,000.00

64152 F 5/25/1985 8/1/2016 53,558.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 6/28/1982 8/2/2012 61,295.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66109 F 1/1/1984 7/31/2008 54,845.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 2/24/1971 8/11/2003 28,537.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 9/8/1979 6/19/2017 44,948.80 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64152 F 12/12/1980 8/1/2013 66,039.00 Yes 50,000.00 Yes with ADD 80,000.00 Yes with ADD 50,000.00 Waive Coverage

64151 F 5/20/1982 7/23/2007 37,904.08 Yes 50,000.00 Yes with ADD 190,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 4/22/1980 8/6/2004 72,396.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 11/7/1984 2/5/2007 25,074.16 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 9/6/1972 8/26/1996 78,566.00 Yes 50,000.00 Yes with ADD 290,000.00 Yes with ADD 30,000.00 Yes with ADD 10,000.00

64154 F 1/22/1979 8/1/2016 60,488.70 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes 10,000.00

66202 F 5/29/1974 8/14/2002 56,128.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 2/12/1989 8/14/2017 21,464.52 Yes 50,000.00 Yes with ADD 50,000.00 Yes 40,000.00 Yes 10,000.00

66207 F 2/14/1986 8/4/2009 66,561.70 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 3/4/1982 8/3/2011 62,647.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/10/1991 8/1/2016 43,420.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 3/11/1991 8/3/2015 44,131.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64110 F 3/6/1991 7/31/2014 47,877.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64151 F 8/10/1992 8/8/2017 49,272.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 9/1/1992 5/6/2015 25,028.90 Yes 50,000.00 Yes with ADD 130,000.00 Waive Coverage Waive Coverage

64152 F 5/5/1994 9/4/2012 26,127.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64057 F 5/26/1994 8/3/2017 38,545.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64068 M 5/25/1994 8/1/2016 39,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/15/1994 8/1/2016 39,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 2/13/1996 1/29/2018 29,011.43 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 2/14/1996 3/5/2018 19,852.56 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64152 F 7/24/1963 7/24/1990 79,896.52 Yes 50,000.00 Yes with ADD 20,000.00 Yes 20,000.00 Yes 10,000.00

64151 M 1/29/1959 2/1/2010 39,457.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 3/8/1960 7/12/2010 39,457.60 Yes 50,000.00 Yes with ADD 80,000.00 Waive Coverage Waive Coverage

64079 F 5/10/1973 8/17/1998 74,657.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64060 F 1/20/1958 10/10/2016 40,247.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/21/1973 5/1/2008 57,220.80 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Yes 10,000.00

64151 F 1/7/1959 5/8/2017 38,584.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 3/26/1972 8/20/2004 56,621.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/5/1960 11/6/2006 56,659.20 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64152 F 3/9/1959 2/17/1998 40,693.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 12/4/1974 8/3/2015 76,229.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/18/1962 8/18/2004 26,880.14 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 10/17/1978 2/2/1998 41,385.00 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes with ADD 10,000.00

64648 M 12/27/1967 3/25/2013 39,707.20 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Yes 10,000.00

64118 F 8/22/1968 9/1/2000 30,588.39 Yes 50,000.00 Yes with ADD 160,000.00 Waive Coverage Yes 10,000.00

64157 F 11/23/1971 8/16/2000 67,733.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64112 M 4/27/1966 1/2/2003 48,193.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64113 F 3/30/1979 8/3/2006 74,619.19 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 5/8/1984 8/1/2016 66,661.00 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Waive Coverage

64118 M 9/15/1983 8/10/2015 68,549.00 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Yes 10,000.00

64152 F 4/20/1970 11/22/1999 26,266.32 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 12/4/1969 8/4/2009 66,306.21 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66202 M 1/5/1984 8/1/2016 70,228.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 11/30/1959 5/23/2007 41,204.80 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64152 F 9/16/1978 9/16/2013 47,912.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes with ADD 10,000.00

64154 F 6/7/1971 8/4/2003 82,734.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64108 M 3/9/1981 5/15/2014 36,192.00 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Waive Coverage

64154 F 8/14/1980 7/14/2014 48,817.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 4/14/1982 8/3/2006 71,178.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 3/9/1986 8/1/2013 57,137.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64151 M 1/5/1977 8/2/2012 49,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66007 F 2/23/1989 8/1/2013 50,479.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 1/30/1978 8/3/2006 67,945.05 Yes 50,000.00 Yes 180,000.00 Yes 30,000.00 Waive Coverage

Page 16: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64150 M 2/13/1990 6/19/2014 39,707.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 2/18/1990 8/1/2017 38,547.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/22/1986 8/4/2009 53,045.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 10/31/1987 8/4/2010 56,336.60 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64106 F 7/21/1988 8/9/2017 20,135.36 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64086 F 10/30/1986 7/31/2014 54,535.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 2/25/1991 7/31/2014 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 4/24/1991 7/31/2014 48,428.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 10/8/1992 8/10/2017 44,948.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 F 10/9/1992 12/19/2014 27,206.40 Yes 50,000.00 Yes with ADD 100,000.00 Yes with ADD 30,000.00 Waive Coverage

64155 M 9/22/1992 9/21/2015 55,598.40 Yes 50,000.00 Yes with ADD 140,000.00 Yes 50,000.00 Waive Coverage

64154 F 11/7/1992 8/13/2015 40,105.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 6/9/1952 2/27/2003 43,035.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 9/18/1971 5/1/2015 36,712.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage Yes 10,000.00

64117 F 7/9/1952 6/18/2015 40,705.60 Yes 50,000.00 Yes with ADD 20,000.00 Yes 10,000.00 Waive Coverage

64152 F 11/15/1963 8/7/2017 34,153.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/20/1956 8/28/1996 41,204.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/7/1956 9/20/2004 21,965.09 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 10/18/1961 8/1/2013 67,597.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/21/1969 8/21/1992 75,057.91 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 3/7/1968 8/13/2010 41,251.00 Yes 50,000.00 Yes 50,000.00 Yes 50,000.00 Yes 10,000.00

64155 F 12/14/1962 8/19/1999 76,418.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/7/1959 8/23/1991 76,936.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 9/14/1962 10/1/2012 60,991.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Yes 10,000.00

64155 F 5/16/1960 8/13/2014 24,140.34 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 10/15/1972 8/2/2007 68,928.00 Yes 50,000.00 Yes with ADD 220,000.00 Waive Coverage Yes with ADD 10,000.00

64151 F 9/30/1965 8/21/1992 77,195.00 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Waive Coverage

64151 F 6/9/1968 8/17/2010 22,165.57 Yes 50,000.00 Yes with ADD 40,000.00 Yes with ADD 0.00 Yes with ADD 10,000.00

64153 F 10/6/1977 8/1/2013 53,045.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/10/1962 10/12/1995 28,070.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 4/18/1966 8/1/2013 77,387.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage Yes 10,000.00

64133 M 4/7/1980 1/11/2016 36,192.00 Yes 50,000.00 Yes with ADD 90,000.00 Waive Coverage Waive Coverage

64151 F 10/5/1976 8/9/2001 67,869.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64156 F 8/10/1965 8/4/2010 111,947.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/25/1968 8/3/2015 31,418.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64477 F 11/22/1969 8/8/2011 29,725.20 Yes 50,000.00 Yes with ADD 30,000.00 Waive Coverage Waive Coverage

64448 M 7/21/1981 7/31/2008 60,987.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/8/1964 8/21/1996 68,630.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/24/1967 8/17/2009 49,711.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 2/22/1970 12/4/2017 34,153.60 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64154 F 12/14/1966 8/3/2015 74,138.00 Yes 50,000.00 Yes with ADD 170,000.00 Waive Coverage Yes with ADD 10,000.00

64079 F 1/2/1981 8/26/1999 28,298.97 Yes 50,000.00 Yes with ADD 90,000.00 Waive Coverage Yes with ADD 10,000.00

64157 F 8/9/1969 8/27/2012 24,346.14 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/17/1968 8/15/2012 39,956.80 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes 10,000.00

64151 F 1/29/1969 1/26/2009 30,521.12 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64110 M 5/24/1984 8/4/2010 53,045.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes with ADD 50,000.00 Yes with ADD 5,000.00

64152 F 5/7/1971 8/14/2003 34,652.80 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64152 F 3/21/1971 4/13/2016 31,418.80 Yes 50,000.00 Yes with ADD 50,000.00 Yes 50,000.00 Yes 5,000.00

64154 F 6/7/1974 8/29/1996 77,661.79 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 10/8/1983 8/3/2015 47,912.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66202 F 2/9/1977 7/31/2008 66,383.06 Not Eligible Yes with ADD 50,000.00 Yes with ADD 50,000.00 Waive Coverage

64152 F 1/17/1977 8/4/2009 61,295.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 6/14/1986 8/9/2013 21,965.09 Yes 50,000.00 Yes 70,000.00 Waive Coverage Waive Coverage

64155 M 6/16/1977 8/4/2003 83,932.20 Yes 50,000.00 Yes 220,000.00 Waive Coverage Waive Coverage

64138 M 12/28/1981 8/3/2017 52,290.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64157 F 4/5/1975 8/9/2001 62,257.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64117 M 10/30/1983 8/9/2013 31,746.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 8/2/1977 8/9/2001 81,471.32 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 9/30/1973 8/19/2002 18,318.86 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 12/25/1977 8/7/2002 80,004.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 9/10/1982 8/3/2005 77,432.75 Yes 50,000.00 Yes 110,000.00 Waive Coverage Yes 10,000.00

64154 F 1/14/1979 8/9/2001 69,510.00 Yes 50,000.00 Yes with ADD 140,000.00 Waive Coverage Yes 10,000.00

64151 F 2/20/1973 8/21/1996 119,919.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64138 F 8/18/1987 8/4/2010 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 8/25/1988 1/22/2007 42,778.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64106 F 4/10/1989 8/2/2012 63,076.10 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 3/31/1989 9/7/2016 46,924.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 2/14/1989 10/1/2013 55,722.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 3/23/1989 9/13/2017 46,909.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 6/11/1986 6/20/2016 41,121.60 Yes 50,000.00 Yes with ADD 150,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64155 F 8/16/1991 8/10/2015 40,105.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 4/29/1970 8/17/1998 82,137.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 5/31/1982 8/3/2005 71,063.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 10/12/1975 8/4/2010 77,957.73 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 17: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64151 F 10/23/1981 8/3/2006 63,163.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66050 F 3/28/1986 9/13/2010 69,329.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64116 F 7/18/1964 8/7/2017 15,078.96 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/3/1965 1/1/1989 79,072.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66209 F 9/27/1977 8/9/2001 64,585.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 6/1/1984 7/31/2008 65,547.00 Yes 50,000.00 Yes 250,000.00 Waive Coverage Yes 10,000.00

64153 M 7/6/1983 8/2/2007 63,060.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 M 8/27/1979 7/31/2008 70,234.00 Yes 50,000.00 Yes 40,000.00 Waive Coverage Waive Coverage

64154 M 3/13/1973 8/19/1999 75,441.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64105 M 6/15/1988 8/2/2012 64,053.50 Yes 50,000.00 Yes with ADD 130,000.00 Waive Coverage Waive Coverage

64130 F 7/13/1988 12/20/2010 25,013.66 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 5/17/1983 7/31/2014 61,761.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/5/1989 8/2/2012 41,767.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64119 F 7/14/1985 8/2/2007 58,890.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 8/20/1979 8/1/2016 55,612.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 M 10/3/1977 7/31/2014 76,155.75 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 9/18/1983 8/3/2017 41,633.00 Yes 50,000.00 Yes with ADD 100,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64156 F 1/7/1987 8/4/2009 53,045.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64118 F 5/5/1977 7/31/2008 65,951.00 Yes 50,000.00 Yes 50,000.00 Waive Coverage Yes 10,000.00

64157 F 4/10/1990 8/2/2012 49,195.00 Yes 50,000.00 Yes with ADD 170,000.00 Waive Coverage Yes with ADD 10,000.00

64151 F 4/4/1990 8/3/2015 67,715.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 6/25/1992 8/1/2016 44,062.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/23/1963 9/3/1991 125,559.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 10/25/1963 8/20/1997 79,737.05 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/19/1970 8/13/2014 23,274.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 9/15/1980 8/6/2004 61,055.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 30,000.00 Yes with ADD 10,000.00

64152 M 9/5/1973 8/21/1996 45,895.00 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Yes with ADD 10,000.00

64079 M 9/8/1974 8/24/1998 79,486.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 1/17/1982 8/6/2004 61,055.00 Yes 50,000.00 Yes 500,000.00 Yes 200,000.00 Yes 10,000.00

64151 M 2/26/1973 8/20/1997 77,389.00 Yes 50,000.00 Yes 500,000.00 Waive Coverage Yes 10,000.00

64152 F 10/10/1975 8/25/1999 61,951.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/3/1994 2/21/2017 23,953.16 Yes 50,000.00 Yes with ADD 120,000.00 Waive Coverage Waive Coverage

66218 M 6/22/1955 8/2/2016 77,843.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 6/13/1958 8/19/1999 79,677.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/11/1976 8/16/2000 62,475.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/10/1971 8/3/2015 70,169.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/21/1963 8/3/2017 62,257.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 9/27/1982 8/2/2007 103,320.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 8/19/1976 10/3/2013 64,958.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Yes 10,000.00

64152 F 12/25/1970 8/10/2006 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 7/19/1985 7/31/2008 89,618.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/3/1986 10/22/2013 21,965.09 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66208 F 8/8/1979 8/4/2003 84,040.30 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 5/9/1983 4/1/2015 60,239.00 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Waive Coverage

64154 M 6/26/1978 8/4/2003 60,745.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 1/30/1985 8/1/2016 53,276.37 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64105 F 12/30/1991 8/3/2015 45,345.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/30/1963 2/12/1988 82,232.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 11/7/1977 8/9/2001 72,796.00 Yes 50,000.00 Yes 60,000.00 Waive Coverage Yes 10,000.00

64111 M 11/10/1987 6/12/2017 21,232.98 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Waive Coverage

64151 F 4/15/1991 8/3/2017 47,912.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64157 F 7/14/1992 8/1/2016 47,144.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 3/6/1962 3/19/2001 18,999.06 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66086 M 1/30/1957 8/3/2017 19,020.54 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

64153 F 9/20/1974 8/6/2004 83,468.00 Yes 50,000.00 Yes with ADD 260,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64157 M 11/20/1966 8/16/2000 69,350.65 Yes 50,000.00 Yes with ADD 200,000.00 Yes 100,000.00 Yes 10,000.00

64155 M 7/30/1962 11/10/2008 29,212.80 Yes 50,000.00 Yes with ADD 80,000.00 Yes with ADD 20,000.00 Yes with ADD 10,000.00

64119 F 8/5/1979 7/31/2014 64,956.77 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 9/6/1969 8/4/2003 76,374.61 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 5/10/1982 8/2/2012 57,618.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 5/24/1978 8/2/2007 67,259.00 Yes 50,000.00 Yes 70,000.00 Yes 40,000.00 Yes 10,000.00

66203 F 9/6/1969 8/27/2007 23,142.91 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/25/1975 10/2/2017 39,147.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 5/13/1985 7/1/2016 92,948.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/14/1969 8/4/2010 73,338.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00

64079 F 4/4/1984 8/3/2006 61,057.56 Yes 50,000.00 Yes with ADD 160,000.00 Yes 50,000.00 Yes 10,000.00

66202 M 8/25/1980 8/3/2017 45,345.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64118 F 9/30/1976 7/1/2016 37,481.60 Yes 50,000.00 Yes with ADD 100,000.00 Waive Coverage Yes 10,000.00

66109 F 8/24/1979 8/3/2017 67,527.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes 50,000.00 Waive Coverage

64152 F 10/23/1980 8/3/2015 56,895.00 Yes 50,000.00 Yes with ADD 150,000.00 Yes with ADD 10,000.00 Yes with ADD 10,000.00

64079 F 11/8/1970 4/1/2006 21,464.52 Yes 50,000.00 Yes 110,000.00 Waive Coverage Waive Coverage

64105 F 2/20/1984 8/3/2015 51,831.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66218 F 3/29/1977 8/16/2000 66,931.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 2/24/1981 8/3/2015 59,462.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 18: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

66048 F 7/29/1989 9/14/2015 37,627.20 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes with ADD 10,000.00

64117 F 4/30/1990 8/1/2013 45,063.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 9/28/1992 8/3/2015 41,308.00 Yes 50,000.00 Yes with ADD 150,000.00 Yes with ADD 50,000.00 Waive Coverage

66202 F 11/2/1992 8/3/2017 40,105.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 1/29/1956 7/31/2008 56,895.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 7/25/1956 7/27/2001 60,611.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 9/28/1972 8/19/1999 83,683.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64164 F 11/21/1963 8/4/2003 27,265.28 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64079 F 8/19/1968 8/17/2000 63,273.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 7/27/1961 2/1/2000 32,414.20 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64155 M 4/9/1974 8/1/2013 74,657.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 9/7/1965 8/3/2006 62,475.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 4/24/1980 1/20/2004 69,603.00 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Yes with ADD 10,000.00

64152 F 12/5/1968 8/14/2013 23,658.18 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 6/22/1966 11/14/2011 17,087.34 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 M 12/24/1974 8/6/2004 62,695.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64111 M 7/6/1982 8/15/2016 136,802.00 Yes 50,000.00 Yes with ADD 500,000.00 Yes with ADD 250,000.00 Yes with ADD 10,000.00

66207 F 9/16/1985 8/1/2013 45,270.00 Yes 50,000.00 Yes with ADD 80,000.00 Waive Coverage Waive Coverage

64151 F 5/11/1976 3/9/2015 15,970.38 Yes 50,000.00 Yes with ADD 80,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64151 M 12/26/1981 8/2/2007 63,576.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 8/30/1980 8/7/2002 62,775.31 Not Eligible Waive Coverage Waive Coverage Waive Coverage

64151 F 4/18/1977 7/31/2008 63,766.45 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 11/14/1974 8/19/1999 76,524.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 8/6/1982 7/1/2012 125,661.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/30/1980 8/3/2006 84,193.00 Yes 50,000.00 Yes with ADD 250,000.00 Waive Coverage Yes with ADD 10,000.00

64153 F 7/1/1988 8/8/2016 27,371.34 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Waive Coverage

64111 F 10/25/1988 8/2/2012 53,531.00 Yes 50,000.00 Yes 70,000.00 Waive Coverage Waive Coverage

64111 F 10/7/1989 8/1/2013 47,912.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 10/6/1988 8/3/2011 50,479.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 11/19/1987 9/22/2015 26,205.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/13/1973 8/1/2013 60,745.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes with ADD 10,000.00

64111 F 6/8/1987 8/18/2016 24,080.42 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64098 M 3/27/1990 12/7/2015 86,736.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 9/8/1991 7/31/2014 45,379.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66008 M 8/13/1991 6/22/2016 60,448.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66212 F 9/6/1991 8/3/2015 46,794.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66210 M 1/22/1993 8/10/2015 68,549.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64111 F 7/9/1991 8/3/2017 40,869.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64117 M 7/4/1955 9/15/1998 44,928.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66085 M 12/3/1953 8/3/2017 81,760.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Yes 10,000.00

64152 F 1/17/1958 3/7/2007 48,442.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 7/17/1958 8/19/2013 21,965.09 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64151 F 8/23/1959 1/28/1998 83,685.12 Yes 50,000.00 Yes with ADD 160,000.00 Yes 40,000.00 Waive Coverage

64155 F 8/20/1973 8/21/1996 69,653.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64150 F 11/20/1967 9/2/2009 40,872.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 5/8/1974 8/20/1997 66,053.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 1/23/1976 8/19/1999 73,879.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

66109 F 5/29/1963 8/24/1998 52,728.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66102 F 9/16/1973 10/23/2014 21,651.84 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes 10,000.00

66112 F 12/5/1976 8/3/2017 78,284.00 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Waive Coverage

66109 M 3/2/1976 5/26/2015 81,870.00 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Yes with ADD 10,000.00

64119 F 10/23/1975 1/21/2014 65,229.00 Yes 50,000.00 Yes 150,000.00 Waive Coverage Waive Coverage

64151 F 10/3/1974 8/19/1999 67,204.00 Yes 50,000.00 Yes with ADD 240,000.00 Yes 100,000.00 Yes 10,000.00

64152 F 2/27/1980 8/3/2017 59,462.00 Yes 50,000.00 Yes with ADD 150,000.00 Waive Coverage Yes with ADD 10,000.00

64151 F 12/10/1971 8/4/2009 84,152.35 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 12/24/1985 8/24/2016 29,479.96 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

64154 F 6/7/1977 8/4/2010 55,753.28 Yes 50,000.00 Yes 50,000.00 Waive Coverage Waive Coverage

66202 F 5/19/1987 3/14/2016 49,152.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 7/7/1978 8/4/2003 62,372.00 Yes 50,000.00 Yes 130,000.00 Waive Coverage Waive Coverage

66218 F 1/10/1979 7/30/2009 97,479.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 6/6/1982 9/21/2010 46,529.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/23/1980 8/3/2005 65,624.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66202 F 3/7/1987 8/4/2010 45,796.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 2/29/1972 8/3/2015 65,919.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes with ADD 10,000.00

64068 M 10/4/1985 7/31/2008 71,600.23 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Waive Coverage

64118 M 9/1/1987 8/4/2015 24,433.92 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/9/1980 11/14/2011 16,442.94 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66086 F 10/21/1989 8/1/2013 48,428.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66211 F 11/16/1989 8/1/2013 48,428.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64055 M 9/30/1986 5/18/2016 45,593.60 Yes 50,000.00 Yes with ADD 110,000.00 Yes 20,000.00 Waive Coverage

66007 F 9/28/1990 8/8/2017 21,464.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 12/4/1991 8/10/2015 33,855.92 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 F 2/24/1993 12/18/2014 20,624.38 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66202 M 2/16/1993 3/7/2017 65,647.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 50,000.00 Waive Coverage

Page 19: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64151 M 10/27/1973 12/21/2001 45,364.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 1/18/1950 8/1/1990 89,387.00 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64152 M 6/6/1968 5/25/1990 147,839.00 Yes 50,000.00 Yes with ADD 350,000.00 Yes with ADD 110,000.00 Yes with ADD 10,000.00

66085 F 2/25/1953 8/3/2017 78,232.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64157 F 8/16/1958 9/8/2009 26,328.75 Yes 50,000.00 Yes 20,000.00 Waive Coverage Yes 10,000.00

64151 F 1/1/1972 9/14/2015 36,712.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 8/8/1969 3/26/2018 21,737.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/13/1971 8/7/2002 121,269.00 Yes 50,000.00 Yes with ADD 80,000.00 Yes 50,000.00 Yes 10,000.00

64089 F 8/1/1961 8/25/1997 67,733.00 Yes 50,000.00 Yes with ADD 50,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64079 M 8/7/1965 8/4/2015 38,538.40 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes with ADD 10,000.00

64068 F 6/27/1978 1/2/2001 61,301.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 12/9/1964 6/23/1988 43,398.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64106 F 8/25/1980 8/1/2016 60,991.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66109 M 5/1/1968 4/25/2016 36,192.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64443 M 11/22/1985 9/15/2014 57,220.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66104 M 6/21/1979 7/1/2017 84,920.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

64154 F 3/11/1978 8/4/2003 64,000.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 1/23/1988 6/13/2016 49,004.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64110 M 3/11/1983 8/3/2017 44,497.00 Yes 50,000.00 Yes with ADD 20,000.00 Yes with ADD 20,000.00 Waive Coverage

64152 F 3/28/1981 8/3/2017 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 12/12/1989 8/6/2015 42,095.00 Yes 50,000.00 Yes 100,000.00 Waive Coverage Waive Coverage

64153 F 3/28/1988 8/2/2012 49,195.00 Yes 50,000.00 Yes 200,000.00 Yes 50,000.00 Yes 10,000.00

66215 F 11/26/1990 8/1/2013 41,385.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 5/12/1993 8/3/2017 40,105.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64168 F 11/16/1948 11/6/2006 41,204.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 3/23/1961 4/4/2016 36,192.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 6/6/1953 8/13/2012 22,278.34 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 6/13/1977 8/4/2009 113,443.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/11/1961 9/30/1996 66,858.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/8/1959 10/20/1999 32,344.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64151 M 12/27/1965 10/15/2014 38,168.00 Yes 50,000.00 Yes with ADD 20,000.00 Yes with ADD 0.00 Yes 5,000.00

64151 M 1/13/1959 3/1/2012 38,334.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/26/1976 7/31/2008 61,301.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 4/13/1962 8/14/2002 96,681.48 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 M 2/11/1975 8/16/2000 71,909.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 2/14/1974 8/1/2016 69,106.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66012 M 3/14/1962 5/6/2015 36,712.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64151 F 1/19/1978 8/7/2002 65,892.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/22/1964 8/21/1996 91,980.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 3/28/1969 11/14/2016 17,842.72 Yes 50,000.00 Yes with ADD 70,000.00 Yes with ADD 50,000.00 Waive Coverage

64155 F 8/3/1983 8/2/2007 57,102.00 Yes 50,000.00 Yes 250,000.00 Yes 0.00 Yes 10,000.00

64157 F 3/7/1981 8/6/2004 79,386.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes 30,000.00 Yes 10,000.00

64151 F 12/24/1985 8/1/2013 47,912.00 Yes 50,000.00 Yes with ADD 40,000.00 Waive Coverage Waive Coverage

64014 M 9/26/1974 7/1/2013 111,947.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64150 F 5/2/1975 8/19/1999 67,260.00 Yes 50,000.00 Yes with ADD 200,000.00 Yes with ADD 0.00 Waive Coverage

64068 F 1/25/1989 9/5/2017 25,755.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64055 M 2/18/1989 2/3/2014 46,259.20 Yes 50,000.00 Yes with ADD 120,000.00 Waive Coverage Waive Coverage

64153 F 5/18/1987 8/4/2010 51,762.00 Yes 50,000.00 Yes 130,000.00 Waive Coverage Waive Coverage

64151 F 12/19/1989 8/3/2017 46,628.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 10,000.00

64151 M 7/19/1983 8/1/2013 69,365.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 M 12/31/1990 5/16/2016 48,140.10 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66106 M 12/12/1990 1/3/2017 45,593.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 M 11/21/1996 3/7/2016 20,135.36 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 3/9/1965 8/17/1998 74,660.35 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 1/13/1957 1/19/2017 37,086.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 M 2/1/1969 8/16/2000 81,425.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/8/1969 8/12/2010 25,373.25 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 11/2/1957 10/28/1992 51,814.30 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 8/6/1974 12/2/2015 20,925.10 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64492 F 12/23/1960 9/5/1995 29,124.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 10/8/1979 8/7/2002 60,991.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 6/13/1970 2/5/1992 76,418.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66208 F 7/8/1982 8/2/2012 54,466.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 7/17/1986 8/4/2009 87,411.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64152 M 2/26/1975 7/1/2010 139,406.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 1/16/1982 8/4/2009 68,881.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66102 M 6/3/1987 2/3/2014 38,168.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 7/31/1971 7/31/2014 75,170.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 7/20/1979 8/3/2006 60,745.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 M 8/7/1979 8/12/2003 119,032.52 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64154 F 11/2/1986 8/4/2010 58,864.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 8/20/1988 8/13/2013 44,547.00 Yes 50,000.00 Yes with ADD 200,000.00 Waive Coverage Yes with ADD 5,000.00

66208 F 5/8/1987 8/13/2010 52,278.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66048 M 3/12/1991 12/8/2014 46,259.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 20: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64152 M 3/6/1947 12/11/2006 41,204.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 F 6/21/1995 1/2/2018 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/7/1963 8/11/2003 33,803.44 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 11/19/1958 7/1/2005 122,573.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 M 12/26/1955 7/1/1998 129,770.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Waive Coverage

64151 M 5/2/1955 3/27/2017 29,083.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/16/1959 10/8/2001 39,963.84 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 6/9/1964 8/19/1993 89,188.40 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Yes with ADD 10,000.00

64151 M 6/10/1967 7/1/2008 117,968.00 Yes 50,000.00 Yes with ADD 100,000.00 Yes with ADD 30,000.00 Yes with ADD 10,000.00

64152 F 2/9/1963 2/16/2016 24,080.42 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64133 M 8/10/1966 9/21/2015 39,540.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 9/17/1980 8/2/2012 68,439.00 Yes 50,000.00 Yes 60,000.00 Waive Coverage Waive Coverage

64152 M 6/9/1977 6/9/2014 37,252.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 7/25/1970 8/9/2001 75,950.00 Yes 50,000.00 Yes 200,000.00 Waive Coverage Waive Coverage

64152 F 8/2/1981 1/10/2018 37,481.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 8/7/1986 7/23/2012 100,057.00 Yes 50,000.00 Yes with ADD 70,000.00 Yes 30,000.00 Yes 10,000.00

64151 F 4/21/1970 9/23/2013 24,787.42 Yes 50,000.00 Yes 50,000.00 Waive Coverage Yes 10,000.00

64089 F 3/12/1975 8/17/1998 75,214.28 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66025 F 7/24/1987 8/1/2016 54,713.25 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/14/1968 11/16/2006 22,982.96 Yes 50,000.00 Yes with ADD 120,000.00 Yes with ADD 50,000.00 Yes with ADD 10,000.00

66217 F 6/22/1974 8/3/2005 68,012.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64112 F 2/22/1993 8/1/2016 41,701.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 2/27/1971 8/9/2001 70,136.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/18/1967 8/17/1998 70,861.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64113 M 12/10/1974 7/31/2008 69,018.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 5/22/1990 8/3/2015 47,877.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 M 3/2/1957 3/18/2002 73,798.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 6/11/1973 8/16/2000 74,657.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 M 11/11/1980 8/3/2017 65,970.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66203 F 7/16/1991 8/3/2017 51,762.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 11/26/1962 11/26/2002 65,892.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 1/8/1967 8/24/1989 73,535.90 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/12/1969 8/19/1993 78,418.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 1/12/1973 1/5/2012 25,460.96 Yes 50,000.00 Yes with ADD 110,000.00 Waive Coverage Yes with ADD 10,000.00

64155 F 7/24/1980 8/1/2016 39,341.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64155 F 1/21/1983 8/26/2009 56,895.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64158 F 4/13/1988 8/2/2012 44,963.00 Yes 50,000.00 Yes with ADD 20,000.00 Waive Coverage Yes with ADD 10,000.00

64151 F 12/21/1967 8/16/2000 80,209.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66061 F 8/2/1955 8/2/2012 81,337.95 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 12/27/1956 12/1/2008 44,366.40 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 F 5/25/1985 8/2/2012 44,535.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64118 M 7/23/1961 7/1/2014 37,252.80 Yes 50,000.00 Yes 30,000.00 Waive Coverage Waive Coverage

66203 F 7/13/1958 8/26/1996 15,078.96 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/11/1968 1/9/2008 27,763.76 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 8/30/1966 8/17/2009 25,212.60 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes 10,000.00

64079 F 8/5/1980 1/20/2009 53,045.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 11/28/1967 12/2/2013 22,790.88 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/15/1978 8/1/2013 69,510.00 Yes 50,000.00 Yes 20,000.00 Waive Coverage Waive Coverage

64151 F 8/16/1965 8/2/2007 65,718.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 3/14/1957 8/14/2017 21,464.52 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 M 3/3/1949 7/21/2014 41,288.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64439 M 6/17/1949 3/26/2012 31,692.72 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 12/13/1973 8/13/2008 45,435.00 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Yes 10,000.00

64151 M 12/3/1958 6/10/1997 45,572.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/1/1975 8/16/2001 22,278.34 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 1/4/1970 5/5/2005 23,944.83 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 9/10/1951 1/25/1993 41,059.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 2/16/1958 10/15/1998 41,311.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 5/12/1953 9/9/2013 21,539.07 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 9/23/1958 9/18/2000 24,506.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 2/19/1960 8/26/1998 28,704.69 Yes 50,000.00 Yes with ADD 20,000.00 Yes with ADD 20,000.00 Waive Coverage

66205 F 4/27/1977 8/1/2013 68,411.65 Yes 50,000.00 Yes 70,000.00 Waive Coverage Waive Coverage

64151 F 2/19/1965 5/28/1987 78,022.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64153 F 12/31/1972 8/17/1998 75,742.60 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 M 7/4/1974 7/1/2002 162,724.00 Yes 100,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 9/11/1971 8/21/2013 24,787.42 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 6/14/1971 8/3/2017 47,912.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 F 3/27/1985 8/1/2014 51,762.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 M 2/6/1990 8/3/2015 58,195.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64089 F 12/6/1977 8/11/2011 49,980.04 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64156 F 8/25/1983 9/8/2015 28,195.93 Yes 50,000.00 Yes with ADD 60,000.00 Waive Coverage Waive Coverage

64152 F 2/11/1989 8/9/2017 19,852.56 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Yes 10,000.00

64154 F 8/27/1977 9/9/2013 31,418.80 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64119 F 5/24/1980 8/12/2011 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

Page 21: ZipCode Gender DOB DOH AnnualSalary Basic Life …...ZipCode Gender DOB DOH AnnualSalary Basic_Life_Option Basic_Life_Volume Employee_Optional_Life_Option Employee_Optional_Life_Approved_VolumeSpouse_Optional_Life_Option

64152 F 4/15/1970 7/17/2012 41,891.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 10/13/1989 8/25/2015 26,811.20 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 11/18/1992 8/21/2015 40,105.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64068 F 5/11/1991 7/28/2016 38,545.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64060 M 8/29/1968 8/3/2006 77,563.15 Yes 50,000.00 Yes with ADD 500,000.00 Yes 200,000.00 Yes 10,000.00

64152 F 3/17/1983 7/31/2014 59,978.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 12/2/1982 8/3/2006 62,647.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64111 M 3/4/1989 11/28/2016 60,698.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64151 M 4/26/1987 7/5/2017 34,153.60 Yes 50,000.00 Yes with ADD 150,000.00 Yes with ADD 50,000.00 Waive Coverage

64118 F 8/4/1987 8/12/2011 24,433.92 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64118 F 4/8/1993 8/3/2015 45,045.50 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64079 M 5/2/1982 6/20/2016 36,192.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64154 F 2/24/1981 8/9/2013 21,539.07 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64439 M 2/4/1984 11/2/2015 36,712.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64152 F 4/25/1990 7/31/2014 46,628.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

63055 F 12/10/1964 8/3/2017 69,087.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64116 F 10/1/1985 8/1/2016 53,045.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

66212 F 7/31/1984 7/31/2008 70,101.40 Yes 50,000.00 Yes with ADD 70,000.00 Waive Coverage Waive Coverage

78249 F 8/25/1988 8/3/2017 41,633.00 Yes 50,000.00 Waive Coverage Waive Coverage Waive Coverage

64157 F 2/14/1976 8/4/2010 60,991.00 Yes 50,000.00 Yes with ADD 50,000.00 Waive Coverage Waive Coverage

64151 F 6/8/1990 8/3/2015 43,714.00 Yes 50,000.00 Yes 220,000.00 Yes 0.00 Waive Coverage