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Spouse Non-Tobacco User Semi-Monthly Premiums Spouse Tobacco User Semi-Monthly Premiums

Employee Employee
$10,000 $15,000 $20,000 $10,000 $15,000 $20,000
Age Age
17 - 24 $0.56 $0.84 $1.13 17 - 24 $0.61 $0.91 $1.21
25 - 29 $0.86 $1.28 $1.71 25 - 29 $0.96 $1.45 $1.93
30 - 34 $1.16 $1.74 $2.32 30 - 34 $1.38 $2.06 $2.75
35 - 39 $1.60 $2.40 $3.21 35 - 39 $2.04 $3.06 $4.07
40 - 44 $2.45 $3.67 $4.90 40 - 44 $3.55 $5.33 $7.11
45 - 49 $3.81 $5.72 $7.63 45 - 49 $6.36 $9.54 $12.72
50 - 54 $5.42 $8.13 $10.83 50 - 54 $9.90 $14.8 $19.80
5
55 - 59 $7.27 $10.90 $14.54 55 - 59 $14.34 $21.5 $28.69
2
60 - 64 $10.24 $15.36 $20.48 60 - 64 $21.75 $32.6 $43.51
3
65 - 69 $14.31 $21.47 $28.62 65 - 69 $32.16 $48.2 $64.33
5
70 - 99 $27.58 $41.37 $55.16 70 - 99 $51.99 $77.9 $103.98
8

Dependent Children Semi-Monthly Premiums
Age Range $2,500 $5,000 $10,00
0
0 - 26 $0.48 $0.95 $1.91

EMPLOYEE SUPPLEMENTAL CRITICAL ILLNESS PLAN

COVERAGE SEMI-MONTHLY PREMIUM
EMPLOYEE ONLY $5.75
EMPLOYEE + SPOUSE $9.70
EMPLOYEE + CHILD(REN) $10.88
EMPLOYEE + FAMILY $14.71