BENEFITS SURVEY

DEATH BENEFIT PLANS

Basic Life Insurance Plan
Plan Existence
Type of Policy
Employee Eligibility
When Eligible
Basis of Coverage Amount
Cost Paid By
Premium Costs
Dependent Coverage

Supplemental Life Insurance Plan
Plan Existence
Type of Policy
Employee Eligibility
When Eligible
Basis of Coverage Amount
Cost Paid By
Premium Costs
Dependent Coverage

Accidental Death & Dismemberment Policy
Plan Existence
Employee Eligibility
Types of Coverage
Cost Paid By
Premium Costs
Dependent Coverage
Supplemental AD&D Plan
  (same details as Basic AD&D Plan immediately above)

Business Travel Insurance
Plan Existence
Medical Coverage
Disability Coverage
Cost Paid By

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