Sample Life Insurance Policy Details

Sample_Documents

DISCLAIMER: This is a sample template provided for informational purposes only. It does not constitute legal, tax, or financial advice. Organizations should consult their own legal and tax advisors and tailor this document to reflect their specific business needs, geographies, and applicable laws.

Life Insurance Policy Details

Document Title	Life Insurance Policy Details
Document Type	Life Insurance Policy Details
Category	Benefits & Wellness
Company	<Company Name>
Policy Sponsor	<Company Name> Total Rewards
Vendor/Carrier	<Vendor Name>
Policy Number(s)	<Policy Number>
Version	<Version Number>
Effective Date	<Date>
Last Reviewed	<Date>
Next Scheduled Review	<Date> (e.g., annually in <Month>)
Document Owner	<Owner Name/Title>
Approver(s)	<Approver Name/Title>
Applicable Geographies	<Country>, <Country/Region>

Document Purpose and Objectives

Provide a comprehensive, configurable framework describing <Company Name>’s life insurance programs, including eligibility, coverage, costs, administration, governance, and communication.
Enable consistent implementation across <Country/Region> while allowing local adaptation to comply with applicable law.
Clarify roles, responsibilities, and processes for Total Rewards, Payroll, HR Operations, Legal, and the external vendor(s).
Support equitable, competitive, and compliant life insurance benefits aligned with <Company Name>’s Total Rewards strategy.

Policy Statement

<Company Name> offers life insurance benefits to provide financial protection to beneficiaries of eligible employees in the event of an employee’s death, subject to the terms, exclusions, and limitations of the policy.
Where required by law, statutory life insurance benefits will be provided at or above mandated levels.
This document summarizes plan design and administrative practices. In case of conflict, the insurance certificate/policy and applicable law govern.

Scope and Applicability

In Scope

Employer-paid basic life insurance (also called core life) for eligible employees
Employee-paid supplemental life insurance
Dependent life insurance for spouse/domestic partner and eligible children
Accidental Death and Dismemberment (AD&D), if applicable
Enrollment, evidence of insurability (EOI), and late entrant rules
Beneficiary designation and claims processes
Imputed income and taxation treatment per <Country> law
Portability and conversion options, where provided by <Vendor Name>
Global framework with country-specific schedules and exceptions

Out of Scope

Short-term or long-term disability insurance (see separate policy)
Business travel accident coverage (see separate policy)
Workers’ compensation benefits
Executive supplemental death benefits outside standard plans (unless noted)
Retiree life insurance, unless explicitly listed in a country appendix

Employee Populations and Eligibility Scope

Regular full-time employees working >= <Hours> hours per week
Regular part-time employees working >= <Hours> hours per week
Temporary/contingent workers, interns, and contractors are generally ineligible unless required by <Country> law or stated in a local appendix
Eligibility begins after completion of a waiting period of <Days> days from date of hire or as required by local law

Plan Overview

Plan Types Offered

Basic Life Insurance funded by <Company Name> at <Multiple of Pay> x base pay or a flat amount of <Amount>.
Supplemental Employee Life paid by the employee, available in increments of <Multiple of Pay> x pay, up to a maximum of <Amount> or <Multiple of Pay>.
Spouse/Domestic Partner Life paid by the employee, available in increments of <Amount> up to <Amount> (not to exceed 100% of employee’s coverage).
Child Life paid by the employee, flat benefit of <Amount> per eligible child.
AD&D (if offered) mirroring elected life amounts or provided as a standalone schedule.

Salary Definition and Coverage Rounding

Salary for life insurance purposes includes <Components Included> and excludes <Components Excluded>.
Annual base pay is rounded to the next higher <1,000/500/100> for coverage calculations.
Coverage amounts are rounded to the next higher <1,000/500/100> as specified by the policy.
Currency is determined by the local payroll currency unless otherwise stated.

Guaranteed Issue (GI) and Evidence of Insurability (EOI)

GI is available up to <Amount> or <Multiple of Pay> for timely new hires and during special enrollment events.
EOI is required for elections above GI, late entrants, or increases exceeding <Amount>/<Percentage> during annual enrollment.
EOI is administered by <Vendor Name> according to underwriting rules and privacy standards.

Waiting Periods and Effective Dates

Coverage is effective on the first day of the month following <Days> days of continuous employment, or as of date of hire if required by <Country> law.
Elections made during annual enrollment are effective on <Date> following approval of any required EOI.

Coverage Details

Basic Life Insurance

Coverage level: <Multiple of Pay> x eligible pay or flat <Amount>.
Minimum: <Amount>; Maximum: <Amount>.
Employer-paid, with imputed income applied where required by <Country> tax law.
Reduces by age per schedule below.

Supplemental Employee Life

Available in increments of <Multiple of Pay> up to <Multiple of Pay> x pay or <Amount> maximum.
GI for new hires: <Amount> or <Multiple of Pay>; post-GI amounts subject to EOI.
Annual enrollment increases limited to <Amount> or <Multiple of Pay> without EOI, subject to GI.

Spouse/Domestic Partner Life

Available in increments of <Amount> up to <Amount>; cannot exceed 100% of employee’s combined basic and supplemental life coverage.
EOI required above <Amount> GI or for late entrants.
Domestic partner eligibility requires an affidavit and compliance with <Country/Region> law.

Child Life

Flat coverage amount of <Amount> per eligible child.
Eligible children are defined as natural, adopted, step, or foster children from <Age> days up to <Age> years (or <Age> if a full-time student), subject to policy terms and local law.

Accidental Death and Dismemberment (AD&D)

AD&D pays an additional benefit for covered losses due to qualifying accidents, per the schedule in the certificate.
Common exclusions include illness, suicide, war, and participation in hazardous activities not covered by the policy.

Age Reduction Schedule

Attained Age	Percentage of Original Coverage In Force
<Age>	100%
<Age>	65%
<Age>	50%
<Age>	35%

Maximums, Minimums, and Combined Limits

Combined life insurance coverage may not exceed <Amount> across basic and supplemental policies.
For executives in grade <Grade> and above, an enhanced maximum of <Amount> may apply with <Approval Body> approval.

Portability and Conversion

Portability allows eligible individuals to continue coverage at group rates upon separation, subject to age and minimum coverage requirements.
Conversion allows conversion to an individual policy without EOI when coverage ends or reduces due to qualifying events.
Election window: <Days> days from the date of coverage termination or notification, whichever is later.
Contact <Vendor Name> at <Phone/Portal> for forms and rates.

Evidence of Insurability (EOI) Process

Employee submits EOI through <Vendor Name> portal within <Days> days of election.
Vendor conducts underwriting and may request additional information.
Vendor notifies employee and <Company Name> of approval, denial, or pending status.
Payroll deductions for the elected amount begin after approval; interim coverage is limited to GI amount if applicable.

Premiums and Contributions

Employer and Employee Cost Allocation

Basic Life: 100% employer-paid, up to <Amount> or <Multiple of Pay>.
Supplemental/Dependent Life: 100% employee-paid via payroll deduction.

Pretax, Post-tax, and Imputed Income

In <Country>, employer-paid life insurance above <Local Threshold> may be subject to imputed income, added to taxable wages.
Employee-paid premiums for life insurance are generally post-tax unless local law permits pretax.
Consult <Country> tax rules and <Company Name> payroll guidelines.

Premium Rate Structures

Basic Life: <Flat Rate> per <1,000> of coverage, paid by employer.
Supplemental Life: Age-banded rates per <1,000> of coverage, updated annually.
Spouse Life: Age-banded based on spouse age; Child Life: flat rate per family.

Sample Age-Banded Rate Table (Illustrative)

Age Band	Employee Rate per 1,000	Spouse Rate per 1,000
<Under Age>	<Amount>	<Amount>
<Age>-<Age>	<Amount>	<Amount>
<Age>-<Age>	<Amount>	<Amount>
>= <Age>	<Amount>	<Amount>

Calculation Examples (Illustrative)

Employee age <Age> elects <Multiple of Pay> x pay; annual base pay = <Amount>; coverage = <Amount> after rounding; monthly premium = (coverage/1,000) x age-banded rate.
Imputed income applies on employer-paid coverage exceeding <Local Threshold>; imputed monthly value = ((coverage - threshold)/1,000) x imputed rate per <Country> tables; included in taxable wages.

Payroll and Finance Controls

Payroll codes configured for each product and country: <Code>.
Monthly reconciliation of vendor premium bill vs. payroll deductions and employer costs.
General ledger mapping and cost center allocation reviewed monthly by <Finance Team>.

Enrollment and Changes

New Hire Enrollment

Employees must enroll within <Days> days of eligibility to receive GI without EOI.
If no action is taken, default enrollment is <Default Coverage> basic life, beneficiary defaults to <Default Rule>.

Annual Enrollment

Employees may increase or decrease coverage during annual enrollment.
Increases beyond <Amount> or <Multiple of Pay> require EOI; decreases are always permitted down to plan minimums.

Qualified Life Events (QLEs)

Marriage, divorce, birth/adoption, loss/gain of other coverage, death of a dependent, change in domestic partner status.
Changes must be consistent with the event and requested within <Days> days of the event.
Spouse/partner and child coverage may be added with proof of eligibility; EOI rules still apply.

Late Entrants and Reinstatements

Employees who enroll after the initial window are late entrants and must provide EOI for any coverage.
Reinstatement after unpaid leave or LOA follows the same or modified rules per <Country> law and policy terms.

Beneficiary Designation

Employees must designate primary and contingent beneficiaries via <HRIS/Portal>.
Beneficiary changes take effect upon submission and confirmation; state or country laws may impose restrictions for spouses.
If no beneficiary is on file, benefits are paid per the policy’s default hierarchy or applicable law.

Claims and Beneficiary Management

Claims Initiation

Beneficiaries or managers notify HR or file directly with <Vendor Name> within <Days> days of death.
Required documentation typically includes a certified death certificate, claim form, and any additional evidence as requested.

Payment of Claims

Benefits are paid to the designated beneficiary(ies) or per policy defaults if none.
Benefits for minors may be paid to a legal guardian, trust, or per jurisdictional requirements.

AD&D Claims

Additional documentation such as police reports or medical examiner reports may be required for accidental death or dismemberment claims.

Appeals and Disputes

Claim determinations may be appealed within <Days> days from adverse determination.
Appeals are reviewed by <Vendor Name> according to policy and local law; <Company Name> does not decide medical underwriting or claim outcomes.

Privacy and Data Handling

Personal data shared for EOI and claims is processed by <Vendor Name> per its privacy policy and by <Company Name> under <Company Privacy Policy> and applicable law.
Access to beneficiary data is restricted to authorized personnel.

Exclusions and Limitations

Common Exclusions

Suicide exclusion for <Months/Years> from policy effective date for voluntary coverage, as permitted by law.
Death resulting from war or participation in a felony may be excluded if allowed by law.
Misstatement of age or smoking status may adjust benefits or premiums.

Contestability and Fraud Prevention

The insurer may contest coverage within <Years> of the effective date based on misrepresentation.
False statements may result in rescission, denial of benefits, and disciplinary action pursuant to <Company Name> policy.

Maximum Payouts and Coordination

Total benefits paid under basic and supplemental life cannot exceed the policy maximum.
Statutory coordination applies where government benefits are mandated.

Governance and Compliance

Policy Governance

Owned by Total Rewards with oversight by <Benefits Governance Committee>.
Changes to plan design require approval from <Approval Body> and Legal review.

Legal and Regulatory Compliance

Compliant with applicable <Country/Region> employment, insurance, and tax laws.
Statutory benefits will be met or exceeded; deviations documented in country appendices.

Risk Management and Controls

Quarterly audit of eligibility, coverage, and premiums.
Annual SOC 2 or equivalent assurance review of <Vendor Name>.
Documented segregation of duties for enrollment, billing, and payments.

Record Retention

Maintain enrollment elections, beneficiary designations, EOI outcomes, and claim records for <Years> or as required by law.

Roles and Responsibilities

Total Rewards

Define plan design, set eligibility, coverage, and contribution strategy.
Maintain vendor relationship, monitor SLAs, and oversee plan performance.
Lead annual enrollment strategy and approve communications.

HR Operations/Benefits Administration

Process enrollments, changes, and terminations.
Maintain accurate data feeds to <Vendor Name> and ensure timely EOI routing.
Support employees and managers with process guidance.

Payroll

Configure payroll codes, apply imputed income, and process deductions.
Reconcile vendor invoices and resolve discrepancies.

Legal/Compliance

Review policy documents, rider updates, and country-specific variations.
Advise on domestic partner tax treatment, beneficiary rules, and privacy requirements.

Finance

Budget for employer costs, analyze trend, and allocate expenses to cost centers.
Validate accruals and premium true-ups.

Vendor/Carrier (<Vendor Name>)

Underwrite EOI, adjudicate claims, issue certificates, and provide billing.
Provide service-level reporting and data security assurances.

Employees and Managers

Employees maintain accurate beneficiary information and initiate claims.
Managers notify HR promptly upon a death and support the family with available resources.

Implementation Guidelines

Program Design and Configuration Steps

Confirm plan design, eligibility, GI amounts, and age reductions per <Country>.
Finalize rates and underwriting with <Vendor Name>.
Configure HRIS and payroll with coverage rules, rounding, and deductions.
Build and test data feeds to <Vendor Name>.
Prepare communications and FAQs; align with annual enrollment timelines.
Train HR, managers, and Helpdesk on processes and escalation paths.

Data Integration and Feeds

Eligibility file to <Vendor Name> includes employee identifiers, demographics, salary, coverage elections, smoker status, and beneficiaries.
Frequency: <Daily/Weekly/Monthly>; format: <File Format>.
Error handling: daily reject report reviewed by <Team>; corrections within <Days>.

Payroll Setup and Testing

Deduction codes: <Code> for supplemental, <Code> for spouse/child, and <Code> for AD&D.
Employer-paid GL account: <Account>; employee-paid GL account: <Account>.
Test scenarios include new hire GI, mid-year QLE increase with EOI, late entrant, age-band move, and age reduction triggers.

EOI and Late Entrant Processing

HRIS flags coverage above GI and triggers EOI packet.
Coverage above GI is pending until approval; partial coverage in force at GI.
If EOI denied, coverage remains at approved level; employees may reapply at next annual enrollment or after <Months>.

Portability and Conversion Administration

HRIS generates separation report with coverage amounts.
<Vendor Name> sends portability/conversion kits within <Days> of termination.
Employer responsibilities end after timely notification; employees interact directly with the vendor thereafter.

International and Local Variations

Local appendices document statutory requirements, tax treatment, and currency.
Any deviations from global standards require approval by <Approval Body> and Legal.

Plan Performance, Metrics, and Reporting

Key Performance Indicators (KPIs)

Participation rate for supplemental life: target <Percentage>%.
Percentage of employees with a current beneficiary on file: target <Percentage>%.
EOI decline rate: target <Percentage>% or lower.
Claims cycle time: average <Days> from complete claim to payment.
Billing accuracy: variance <Percentage>% or less.

Reporting Cadence

Monthly billing reconciliation report
Quarterly participation and EOI outcomes
Annual plan design review with claims and cost trend analysis

Vendor Management

Service-level agreements with <Vendor Name> include timeliness of claim processing, EOI turnaround, and data accuracy thresholds.
Annual operational review and benchmarking against market.

Review and Approval Process

Review Cycle

This policy is reviewed at least annually, or upon material legal or market changes.
Proposed changes are documented in a change memo and submitted to <Approval Body>.

Approvals and Effective Dates

Total Rewards drafts revision and consults Legal and Payroll.
Benefits Governance Committee reviews and approves.
Executive sponsor <Title> provides final approval.
Effective date set to <Date> allowing <Weeks> for system and communication updates.

Exceptions Process

Exceptions to standard limits require a documented business case and approvals from Total Rewards and Legal.
Approved exceptions are time-bound and recorded in the exceptions log.

Glossary of Terms and Definitions

Accidental Death and Dismemberment (AD&D)

Insurance that pays additional benefits for accidental death and specified injuries, subject to exclusions.

Basic Life Insurance

Employer-paid coverage provided automatically to eligible employees.

Beneficiary

The person(s) or entity designated to receive life insurance benefits upon the insured’s death.

Conversion

Option to convert group coverage to an individual policy when eligibility ends.

Evidence of Insurability (EOI)

Health questionnaire or underwriting required to obtain coverage above GI or as a late entrant.

Guaranteed Issue (GI)

Maximum amount of coverage available without EOI for timely enrollments.

Imputed Income

The taxable value of employer-provided life insurance over a threshold under local tax law.

Portability

Option to continue group coverage at group rates when employment ends, if eligible.

Salary for Coverage Purposes

The definition of pay used to calculate coverage; may include base salary and exclude variable pay per policy.

Suicide Exclusion

A policy provision limiting payment if death occurs by suicide within a specified period.

Appendices and Examples

Example Coverage Schedule (Configurable)

Coverage Type	Increments	Minimum	Maximum	GI Amount
Basic Life	<Multiple of Pay> x pay or flat	<Amount>	<Amount>	n/a
Supplemental Employee Life	1x pay increments	<Amount>	<Amount> or <Multiple of Pay>	<Amount> or <Multiple of Pay>
Spouse/Domestic Partner Life	<Amount> increments	<Amount>	<Amount> and not > employee coverage	<Amount>
Child Life	flat per child	<Amount>	<Amount>	n/a
AD&D	mirrors life or standalone	<Amount>	<Amount>	n/a

Sample Process Controls Checklist

Eligibility audit completed monthly
Billing reconciliation completed monthly
EOI pending report reviewed weekly
Beneficiary completion reminders sent quarterly
Vendor SLA review conducted quarterly
Annual plan design benchmark completed by <Date>

Communication to Employees and Managers

Overview Message

Your life insurance benefits at <Company Name> are designed to provide financial protection for your loved ones. As an eligible employee, you receive company-paid basic life insurance and may purchase additional coverage for yourself and your eligible dependents. This section explains what you get, your choices, how much it costs, and what actions you need to take to keep your coverage up to date.

What You Receive Automatically

Company-paid basic life insurance of <Multiple of Pay> times your base pay (or flat <Amount>). This coverage starts after you meet your eligibility waiting period. No action is required from you to receive basic coverage, but you must name your beneficiary.

Your Options to Personalize Coverage

Supplemental life insurance lets you increase your protection in increments of your pay, up to a maximum. You can usually enroll up to <GI Amount> without answering health questions if you act during your initial enrollment window. Higher amounts may require a short health questionnaire through <Vendor Name>.
Spouse or domestic partner life insurance provides coverage for your partner in fixed dollar amounts. Some amounts are available without health questions if you enroll on time.
Child life insurance offers a flat benefit per eligible child for a low monthly rate that covers all eligible children in your household.
If offered, AD&D pays an additional benefit for covered accidental deaths or serious accidental injuries.

How Much It Costs

<Company Name> pays the full cost of basic life insurance up to <Local Threshold>, as required by local tax rules. When the company pays for coverage above a certain threshold, the value of that extra coverage may be taxable to you under local law. This is called imputed income and will appear on your pay statement.
The cost of supplemental, spouse/partner, and child life insurance is based on age and the amount of coverage you choose. Rates are provided during enrollment and may change each year.

How and When to Enroll

New hires: You have <Days> days from your eligibility date to enroll. If you enroll within this window, you can choose up to <GI Amount> without answering health questions.
Annual enrollment: Each year, you can review and change your coverage. Increases above certain amounts may require health questions.
Life events: If you get married, have a child, or experience other qualifying events, you can update coverage within <Days> days of the event. Some changes may still require health questions.

Naming a Beneficiary

Please name your beneficiary as soon as possible in <HRIS/Portal>. This tells us who should receive the benefit if you pass away. You can name more than one person and assign percentages. You can also change your beneficiary at any time. If you do not name a beneficiary, benefits are paid according to the policy and local law, which may delay payment to your family.

What Happens If You Leave <Company Name>

When your employment ends, your life insurance coverage usually ends on your last day or at the end of that month. You may be able to continue your coverage by converting it to an individual policy or by porting it at group rates, if available in your area. You typically have <Days> days to act, so watch for mailed or emailed instructions from <Vendor Name> and contact them promptly if you are interested.

How to File a Claim

In the event of a death, your family or beneficiary should contact <Vendor Name> at <Phone/Portal> or reach out to <Company Name> Benefits at <Email>. They will be guided through the process and required documents, such as a certified death certificate. Our goal is to support your family with compassionate, timely service.

Important Limitations and Exclusions

Life insurance policies include standard exclusions. For example, some plans have a suicide exclusion for a limited time for newly purchased coverage. Accidental death benefits have rules about what is considered an accident. Full details are in the insurance certificate. If you have questions, contact <Company Name> Benefits.

Support and Resources

Enroll or update beneficiaries in <HRIS/Portal>
View your current coverage and costs in <HRIS/Portal>
Contact <Vendor Name> at <Phone/Portal> for coverage and claim questions
Contact <Company Name> Benefits at <Email/Phone> for help with enrollment or life events

Final Note

Your life insurance is an important part of your Total Rewards at <Company Name>. Review your coverage annually, keep your beneficiary up to date, and reach out if you need help choosing the right amount for your situation.

Employee-Focused Disclaimer

This is a summary. The insurance certificate and the policy issued by <Vendor Name> control in all cases. Benefits, rates, and eligibility are subject to change and to applicable law in <Country/Region>.

Document Information:

Document Type: Life Insurance Policy Details
Category: Benefits & Wellness
Generated: August 25, 2025
Status: Sample Template
Next Review: <Insert Review Date>

Usage Instructions:

Replace all text in angle brackets < > with your company-specific information
Review all sections for applicability to your organization
Customize content to reflect your company's policies and local regulations
Have legal and HR leadership review before implementation
Update document header with your company's version control information
At bottom of the document you find a short example on how the content could be communicated to end-users, for instance employees.

This sample document is provided for reference only and should be customized to meet your organization's specific needs and local legal requirements.