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| Insured by: Life Insurance Company of North America |
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| Spouse coverage (not to exceed member insured’s amount) is available on the same basis using the rates below. Rates are subject to change. |
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| SOMA NON-TOBACCO USER ANNUAL PREMIUMS | | Attained Age* | $50,000 | $100,000 | $150,000 | $200,000 | $250,000 | | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | | 18-24 | 21.36 | 62.88 | 42.72 | 125.76 | 64.08 | 188.64 | 85.44 | 251.52 | 106.80 | 314.40 | | 25-34 | 26.40 | 43.92 | 52.80 | 87.84 | 79.20 | 131.76 | 105.60 | 175.68 | 132.00 | 219.60 | | 35-44 | 61.44 | 100.32 | 122.88 | 200.64 | 184.32 | 300.96 | 245.76 | 401.28 | 307.20 | 501.60 | | 45-54 | 311.28 | 560.40 | 622.56 | 1120.80 | 933.84 | 1681.20 | 1245.12 | 2241.60 | 1556.40 | 2802.00 |
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| * Premiums increase as you move to each new age bracket. |
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| SOMA TOBACCO USER ANNUAL PREMIUMS | | Attained Age | $50,000 | $100,000 | $150,000 | $200,000 | $250,000 | | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | | 18-24 | 29.04 | 85.44 | 58.08 | 170.88 | 87.12 | 256.32 | 116.16 | 341.76 | 145.20 | 427.20 | | 25-34 | 43.44 | 72.00 | 86.88 | 144.00 | 130.32 | 216.00 | 173.76 | 288.00 | 217.20 | 360.00 | | 35-44 | 120.96 | 197.52 | 241.92 | 395.04 | 362.88 | 592.56 | 483.84 | 790.08 | 604.80 | 987.60 | | 45-54 | 513.12 | 924.00 | 1026.24 | 1848.00 | 1539.36 | 2772.00 | 2052.48 | 3696.00 | 2565.60 | 4620.00 |
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Dependent children from age 6 months to 19 years (23 if a full-time student) can be insured. |
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| SOMA Children's Premiums (covers all eligible children) | | | $2,500 | $5,000 | $7,500 | $10,000 | | Semi-Annual | $4.38 | $8.76 | $13.14 | $17.52 | | Annual | $8.76 | $17.52 | $26.28 | $35.04 |
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| Payment can be made by debit or credit cards (contact AGU for alternate methods of payment). There is a separate $1.00 administrative fee charged with each payment. |
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| Rev. 03/2016 |