Page 16 - NextCare Holdings 2021 Annual Benefits Enrollment
P. 16
Spouse Life Cost Per Pay Period
Important: Maximum Coverage is 50% of the Amount You Select for Yourself (use
employee’s age)
Coverage Less Than 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70+ Years
30 Years
Amount Old Years Old Years Old Years Old Years Old Years Old Years Old Years Old Years Old Old
$5,000 $0 .18 $0 .23 $0 .28 $0 .35 $0 .49 $0 .77 $1 .31 $1 .81 $3 .27 $5 .87
$10,000 $0 .36 $0 .46 $0 .56 $0 .69 $0 .99 $1 .54 $2 .63 $3 .62 $6 .54 $11 .75
$15,000 $0 .55 $0 .69 $0 .84 $1 .04 $1 .48 $2 .31 $3 .94 $5 .43 $9 .82 $17 .62
$20,000 $0 .73 $0 .91 $1 .13 $1 .38 $1 .98 $3 .08 $5 .25 $7 .25 $13 .09 $23 .49
$25,000 $0 .91 $1 .14 $1 .41 $1 .73 $2 .47 $3 .85 $6 .57 $9 .06 $16 .36 $29 .37
$30,000 $1 .09 $1 .37 $1 .69 $2 .08 $2 .96 $4 .62 $7 .88 $10 .87 $19 .63 $35 .24
$35,000 $1 .28 $1 .60 $1 .97 $2 .42 $3 .46 $5 .40 $9 .19 $12 .68 $22 .91 $41 .11
$40,000 $1 .46 $1 .83 $2 .25 $2 .77 $3 .95 $6 .17 $10 .50 $14 .49 $26 .18 $46 .98
$45,000 $1 .64 $2 .06 $2 .53 $3 .12 $4 .44 $6 .94 $11 .82 $16 .30 $29 .45 $52 .86
$50,000 $1 .82 $2 .28 $2 .82 $3 .46 $4 .94 $7 .71 $13 .13 $18 .12 $32 .72 $58 .73
$55,000 $2 .01 $2 .51 $3 .10 $3 .81 $5 .43 $8 .48 $14 .44 $19 .93 $36 .00 $64 .60
$60,000 $2 .19 $2 .74 $3 .38 $4 .15 $5 .93 $9 .25 $15 .76 $21 .74 $39 .27 $70 .48
$65,000 $2 .37 $2 .97 $3 .66 $4 .50 $6 .42 $10 .02 $17 .07 $23 .55 $42 .54 $76 .35
$70,000 $2 .55 $3 .20 $3 .94 $4 .85 $6 .91 $10 .79 $18 .38 $25 .36 $45 .81 $82 .22
$75,000 $2 .73 $3 .43 $4 .22 $5 .19 $7 .41 $11 .56 $19 .70 $27 .17 $49 .08 $88 .10
$80,000 $2 .92 $3 .66 $4 .50 $5 .54 $7 .90 $12 .33 $21 .01 $28 .98 $52 .36 $93 .97
$85,000 $3 .10 $3 .88 $4 .79 $5 .88 $8 .40 $13 .10 $22 .32 $30 .80 $55 .63 $99 .84
$90,000 $3 .28 $4 .11 $5 .07 $6 .23 $8 .89 $13 .87 $23 .64 $32 .61 $58 .90 $105 .72
$95,000 $3 .46 $4 .34 $5 .35 $6 .58 $9 .38 $14 .64 $24 .95 $34 .42 $62 .17 $111 .59
$100,000 $3 .65 $4 .57 $5 .63 $6 .92 $9 .88 $15 .42 $26 .26 $36 .23 $65 .45 $117 .46
$105,000 $3 .83 $4 .80 $5 .91 $7 .27 $10 .37 $16 .19 $27 .57 $38 .04 $68 .72 $123 .33
$110,000 $4 .01 $5 .03 $6 .19 $7 .62 $10 .86 $16 .96 $28 .89 $39 .85 $71 .99 $129 .21
$115,000 $4 .19 $5 .25 $6 .48 $7 .96 $11 .36 $17 .73 $30 .20 $41 .67 $75 .26 $135 .08
$120,000 $4 .38 $5 .48 $6 .76 $8 .31 $11 .85 $18 .50 $31 .51 $43 .48 $78 .54 $140 .95
$125,000 $4 .56 $5 .71 $7 .04 $8 .65 $12 .35 $19 .27 $32 .83 $45 .29 $81 .81 $146 .83
$130,000 $4 .74 $5 .94 $7 .32 $9 .00 $12 .84 $20 .04 $34 .14 $47 .10 $85 .08 $152 .70
$135,000 $4 .92 $6 .17 $7 .60 $9 .35 $13 .33 $20 .81 $35 .45 $48 .91 $88 .35 $158 .57
$140,000 $5 .10 $6 .40 $7 .88 $9 .69 $13 .83 $21 .58 $36 .77 $50 .72 $91 .62 $164 .45
$145,000 $5 .29 $6 .63 $8 .16 $10 .04 $14 .32 $22 .35 $38 .08 $52 .53 $94 .90 $170 .32
$150,000 $5 .47 $6 .85 $8 .45 $10 .38 $14 .82 $23 .12 $39 .39 $54 .35 $98 .17 $176 .19
$155,000 $5 .65 $7 .08 $8 .73 $10 .73 $15 .31 $23 .89 $40 .71 $56 .16 $101 .44 $182 .07
$160,000 $5 .83 $7 .31 $9 .01 $11 .08 $15 .80 $24 .66 $42 .02 $57 .97 $104 .71 $187 .94
$165,000 $6 .02 $7 .54 $9 .29 $11 .42 $16 .30 $25 .44 $43 .33 $59 .78 $107 .99 $193 .81
$170,000 $6 .20 $7 .77 $9 .57 $11 .77 $16 .79 $26 .21 $44 .64 $61 .59 $111 .26 $199 .68
$180,000 $6 .56 $8 .22 $10 .14 $12 .46 $17 .78 $27 .75 $47 .27 $65 .22 $117 .80 $211 .43
$185,000 $6 .75 $8 .45 $10 .42 $12 .81 $18 .27 $28 .52 $48 .58 $67 .03 $121 .08 $217 .30
$190,000 $6 .93 $8 .68 $10 .70 $13 .15 $18 .77 $29 .29 $49 .90 $68 .84 $124 .35 $223 .18
$195,000 $7 .11 $8 .91 $10 .98 $13 .50 $19 .26 $30 .06 $51 .21 $70 .65 $127 .62 $229 .05
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Important: Maximum Coverage is 50% of the Amount You Select for Yourself (use
employee’s age)
Coverage Less Than 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70+ Years
30 Years
Amount Old Years Old Years Old Years Old Years Old Years Old Years Old Years Old Years Old Old
$5,000 $0 .18 $0 .23 $0 .28 $0 .35 $0 .49 $0 .77 $1 .31 $1 .81 $3 .27 $5 .87
$10,000 $0 .36 $0 .46 $0 .56 $0 .69 $0 .99 $1 .54 $2 .63 $3 .62 $6 .54 $11 .75
$15,000 $0 .55 $0 .69 $0 .84 $1 .04 $1 .48 $2 .31 $3 .94 $5 .43 $9 .82 $17 .62
$20,000 $0 .73 $0 .91 $1 .13 $1 .38 $1 .98 $3 .08 $5 .25 $7 .25 $13 .09 $23 .49
$25,000 $0 .91 $1 .14 $1 .41 $1 .73 $2 .47 $3 .85 $6 .57 $9 .06 $16 .36 $29 .37
$30,000 $1 .09 $1 .37 $1 .69 $2 .08 $2 .96 $4 .62 $7 .88 $10 .87 $19 .63 $35 .24
$35,000 $1 .28 $1 .60 $1 .97 $2 .42 $3 .46 $5 .40 $9 .19 $12 .68 $22 .91 $41 .11
$40,000 $1 .46 $1 .83 $2 .25 $2 .77 $3 .95 $6 .17 $10 .50 $14 .49 $26 .18 $46 .98
$45,000 $1 .64 $2 .06 $2 .53 $3 .12 $4 .44 $6 .94 $11 .82 $16 .30 $29 .45 $52 .86
$50,000 $1 .82 $2 .28 $2 .82 $3 .46 $4 .94 $7 .71 $13 .13 $18 .12 $32 .72 $58 .73
$55,000 $2 .01 $2 .51 $3 .10 $3 .81 $5 .43 $8 .48 $14 .44 $19 .93 $36 .00 $64 .60
$60,000 $2 .19 $2 .74 $3 .38 $4 .15 $5 .93 $9 .25 $15 .76 $21 .74 $39 .27 $70 .48
$65,000 $2 .37 $2 .97 $3 .66 $4 .50 $6 .42 $10 .02 $17 .07 $23 .55 $42 .54 $76 .35
$70,000 $2 .55 $3 .20 $3 .94 $4 .85 $6 .91 $10 .79 $18 .38 $25 .36 $45 .81 $82 .22
$75,000 $2 .73 $3 .43 $4 .22 $5 .19 $7 .41 $11 .56 $19 .70 $27 .17 $49 .08 $88 .10
$80,000 $2 .92 $3 .66 $4 .50 $5 .54 $7 .90 $12 .33 $21 .01 $28 .98 $52 .36 $93 .97
$85,000 $3 .10 $3 .88 $4 .79 $5 .88 $8 .40 $13 .10 $22 .32 $30 .80 $55 .63 $99 .84
$90,000 $3 .28 $4 .11 $5 .07 $6 .23 $8 .89 $13 .87 $23 .64 $32 .61 $58 .90 $105 .72
$95,000 $3 .46 $4 .34 $5 .35 $6 .58 $9 .38 $14 .64 $24 .95 $34 .42 $62 .17 $111 .59
$100,000 $3 .65 $4 .57 $5 .63 $6 .92 $9 .88 $15 .42 $26 .26 $36 .23 $65 .45 $117 .46
$105,000 $3 .83 $4 .80 $5 .91 $7 .27 $10 .37 $16 .19 $27 .57 $38 .04 $68 .72 $123 .33
$110,000 $4 .01 $5 .03 $6 .19 $7 .62 $10 .86 $16 .96 $28 .89 $39 .85 $71 .99 $129 .21
$115,000 $4 .19 $5 .25 $6 .48 $7 .96 $11 .36 $17 .73 $30 .20 $41 .67 $75 .26 $135 .08
$120,000 $4 .38 $5 .48 $6 .76 $8 .31 $11 .85 $18 .50 $31 .51 $43 .48 $78 .54 $140 .95
$125,000 $4 .56 $5 .71 $7 .04 $8 .65 $12 .35 $19 .27 $32 .83 $45 .29 $81 .81 $146 .83
$130,000 $4 .74 $5 .94 $7 .32 $9 .00 $12 .84 $20 .04 $34 .14 $47 .10 $85 .08 $152 .70
$135,000 $4 .92 $6 .17 $7 .60 $9 .35 $13 .33 $20 .81 $35 .45 $48 .91 $88 .35 $158 .57
$140,000 $5 .10 $6 .40 $7 .88 $9 .69 $13 .83 $21 .58 $36 .77 $50 .72 $91 .62 $164 .45
$145,000 $5 .29 $6 .63 $8 .16 $10 .04 $14 .32 $22 .35 $38 .08 $52 .53 $94 .90 $170 .32
$150,000 $5 .47 $6 .85 $8 .45 $10 .38 $14 .82 $23 .12 $39 .39 $54 .35 $98 .17 $176 .19
$155,000 $5 .65 $7 .08 $8 .73 $10 .73 $15 .31 $23 .89 $40 .71 $56 .16 $101 .44 $182 .07
$160,000 $5 .83 $7 .31 $9 .01 $11 .08 $15 .80 $24 .66 $42 .02 $57 .97 $104 .71 $187 .94
$165,000 $6 .02 $7 .54 $9 .29 $11 .42 $16 .30 $25 .44 $43 .33 $59 .78 $107 .99 $193 .81
$170,000 $6 .20 $7 .77 $9 .57 $11 .77 $16 .79 $26 .21 $44 .64 $61 .59 $111 .26 $199 .68
$180,000 $6 .56 $8 .22 $10 .14 $12 .46 $17 .78 $27 .75 $47 .27 $65 .22 $117 .80 $211 .43
$185,000 $6 .75 $8 .45 $10 .42 $12 .81 $18 .27 $28 .52 $48 .58 $67 .03 $121 .08 $217 .30
$190,000 $6 .93 $8 .68 $10 .70 $13 .15 $18 .77 $29 .29 $49 .90 $68 .84 $124 .35 $223 .18
$195,000 $7 .11 $8 .91 $10 .98 $13 .50 $19 .26 $30 .06 $51 .21 $70 .65 $127 .62 $229 .05
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