Page 32 - Apricity Benefits Guide
P. 32
2020
Apricity Benefits Overview
Critical Illness—Employee Contributions
Monthly Rate For $1,000 of Coverage (Non-Smoker)
Age Band Employee Spouse
<25 $0.18 $0.13
25-29 $0.19 $0.13
30-34 $0.27 $0.17
35-39 $0.39 $0.24
40-44 $0.60 $0.35
45-49 $0.90 $0.52
50-54 $1.29 $0.79
55-59 $1.78 $1.14
60-64 $2.55 $1.65
65-69 $3.83 $2.52
70 + $5.82 $3.65
Monthly Rate for $1,000 of Coverage (Smoker)
Age Band Employee Spouse
<25 $0.25 $0.16
25-29 $0.27 $0.17
30-34 $0.42 $0.24
35-39 $0.64 $0.35
40-44 $1.01 $0.54
45-49 $1.56 $0.88
50-54 $2.26 $1.33
55-59 $3.15 $1.96
60-64 $4.55 $2.90
65-69 $6.87 $4.50
70 + $10.46 $6.55
Child(ren)
Age Band Unismoker monthly rate
per $5,000 coverage
Up to 26 $0.65
Note: Same monthly rate for children will apply for amount chosen regardless of the
number of children enrolled.
Table of Contents Your Quick Guide to Savings and Group Auto and Home Insurance .33
About Your Beneits Program. . . . . . .2 Spending Accounts .............16 Group Legal Services ............33
Beneits Basics ...................3 Dental Beneits .................18 Employee Assistance Program ....34
Medical/Prescription Drugs Beneits . 6 Dental Plan Summary ............20 Medicare Part D Creditable
Comparing Medical Plan Options ..7 Vision Beneits ..................21 Coverage Notice ...............35
First Stop Health ................11 Voluntary Disability Insurance .....22 Premium Assistance Under Medicaid
Medical Plan Summary ..........12 Life and AD&D Insurance ........25 and the Children’s Health Insurance
Program (CHIP) .................42
Pharmacy Plan Summary .........13 Voluntary Accident Insurance ....29 Contact Information .............46 32
Flexible Spending Accounts ......14 Voluntary Critical Illness Insurance . 31
Apricity Benefits Overview
Critical Illness—Employee Contributions
Monthly Rate For $1,000 of Coverage (Non-Smoker)
Age Band Employee Spouse
<25 $0.18 $0.13
25-29 $0.19 $0.13
30-34 $0.27 $0.17
35-39 $0.39 $0.24
40-44 $0.60 $0.35
45-49 $0.90 $0.52
50-54 $1.29 $0.79
55-59 $1.78 $1.14
60-64 $2.55 $1.65
65-69 $3.83 $2.52
70 + $5.82 $3.65
Monthly Rate for $1,000 of Coverage (Smoker)
Age Band Employee Spouse
<25 $0.25 $0.16
25-29 $0.27 $0.17
30-34 $0.42 $0.24
35-39 $0.64 $0.35
40-44 $1.01 $0.54
45-49 $1.56 $0.88
50-54 $2.26 $1.33
55-59 $3.15 $1.96
60-64 $4.55 $2.90
65-69 $6.87 $4.50
70 + $10.46 $6.55
Child(ren)
Age Band Unismoker monthly rate
per $5,000 coverage
Up to 26 $0.65
Note: Same monthly rate for children will apply for amount chosen regardless of the
number of children enrolled.
Table of Contents Your Quick Guide to Savings and Group Auto and Home Insurance .33
About Your Beneits Program. . . . . . .2 Spending Accounts .............16 Group Legal Services ............33
Beneits Basics ...................3 Dental Beneits .................18 Employee Assistance Program ....34
Medical/Prescription Drugs Beneits . 6 Dental Plan Summary ............20 Medicare Part D Creditable
Comparing Medical Plan Options ..7 Vision Beneits ..................21 Coverage Notice ...............35
First Stop Health ................11 Voluntary Disability Insurance .....22 Premium Assistance Under Medicaid
Medical Plan Summary ..........12 Life and AD&D Insurance ........25 and the Children’s Health Insurance
Program (CHIP) .................42
Pharmacy Plan Summary .........13 Voluntary Accident Insurance ....29 Contact Information .............46 32
Flexible Spending Accounts ......14 Voluntary Critical Illness Insurance . 31
