Page 20 - 2022 Chartwell Hospitality Managers

Dependent Children
- Dependent Coverage is only available if the employee is insured for voluntary coverage.
- This benefit provides coverage for all dependent children in the following amounts:
OPTION A OPTION B OPTION C OPTION D
$2,500 $5,000 $7,500 $10,000
$0.25 per paycheck $0.50 per paycheck $0.75 per paycheck $1.00 per paycheck

- From age 6 months to 19 years old (up to 25 years of age, if unmarried, & a full-time student)
- Age 14 days to 6 months $250; From birth to age 14 days No benefit
- Dependent Children coverage is $.50 per month for $2,500, $1.00 per month for $5,000, $1.50 per
month for $7,500 or $2.00 per month for $10,000, regardless of the number of children.

EMPLOYEE SHORT TERM DISABLITY
All employees will receive short-term disability insurance that will begin on the 1st day after an accident and the
15th day after an illness or accident. You would receive 60% of your weekly income payable up to 11 weeks. This
program is paid 100% by Chartwell Hospitality and provides coverage for non-job-related accidents and illnesses.

EMPLOYEE LONG TERM DISABILITY
All employees will receive long-term disability insurance that will begin after 13 weeks. You would receive 60% of
your income payable until age 65. This program is paid 100% by Chartwell Hospitality and provides coverage for
non-job-related accidents and illnesses.

EMPLOYEE SUPPLEMENTAL CRITICAL ILLNESS PLAN

Employee
- Coverage amounts available are $10,000/$15,000/$20,000
- Guarantee Issue (no medical questions) $20,000
Spouse
- Coverage amounts available are $5,000/$7,500/$10,000, not to exceed 50% of the employee's benefit amount
- Guarantee Issue (no medical questions) $10,000
- Spouse coverage is only available if the employee is insured for voluntary coverage.
- Spouse’s rate is based on Employee Age.
Child(ren)
- Coverage amounts available are $2,500/$5,000/$10,000
- Guarantee Issue (no medical questions) $10,000
- Child coverage is only available if the employee is insured for voluntary coverage.

Employee Non-Tobacco User Semi-Monthly Premiums Employee Tobacco User Semi-Monthly Premiums

Employee Employee
$10,000 $15,000 $20,000 $10,000 $15,000 $20,000
Age Age
17 - 24 $1.13 $1.69 $2.25 17 - 24 $1.21 $1.82 $2.43
25 - 29 $1.71 $2.57 $3.42 25 - 29 $1.93 $2.89 $3.86
30 - 34 $2.32 $3.48 $4.64 30 - 34 $2.75 $4.13 $5.50
35 - 39 $3.21 $4.81 $6.41 35 - 39 $4.07 $6.11 $8.15
40 - 44 $4.90 $7.34 $9.79 40 - 44 $7.11 $10.66 $14.21
45 - 49 $7.63 $11.44 $15.25 45 - 49 $12.72 $19.08 $25.44
50 - 54 $10.83 $16.25 $21.67 50 - 54 $19.80 $29.71 $39.61
55 - 59 $14.54 $21.81 $29.08 55 - 59 $28.69 $43.03 $57.37
60 - 64 $20.48 $30.71 $40.95 60 - 64 $43.51 $65.26 $87.01
65 - 69 $28.62 $42.93 $57.24 65 - 69 $64.33 $96.49 $128.6
70 - 99 $55.16 $82.75 $110.33 70 - 99 $103.98 $155.97 6
$207.9
6