Page 39 - 2022 Insurity OE Guide FINAL

Voluntary Critical Illness Plan Premiums

Critical Illness is a 100% employee-paid benefit. Each eligible employee may elect for themselves and/or their eligible
spouse or dependents an amount of insurance shown in the table below.

Employee Monthly Premiums

BENEFIT AGE AGE AGE AGE AGE AGE AGE AGE AGE AGE AGE AGE AGE AGE AGE
AMOUNT 0–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+
$5,000 $2.70 $2.70 $3.05 $4.00 $5.50 $7.85 $11.00 $14.85 $20.20 $27.65 $36.05 $45.25 $45.25 $45.25 $45.25
$6,000 $3.24 $3.24 $3.66 $4.80 $6.60 $9.42 $13.20 $17.82 $24.24 $33.18 $43.26 $54.30 $54.30 $54.30 $54.30
$7,000 $3.78 $3.78 $4.27 $5.60 $7.70 $10.99 $15.40 $20.79 $28.28 $38.71 $50.47 $63.35 $63.35 $63.35 $63.35
$8,000 $4.32 $4.32 $4.88 $6.40 $8.80 $12.56 $17.60 $23.76 $32.32 $44.24 $57.68 $72.40 $72.40 $72.40 $72.40
$9,000 $4.86 $4.86 $5.49 $7.20 $9.90 $14.13 $19.80 $26.73 $36.36 $49.77 $64.89 $81.45 $81.45 $81.45 $81.45
$10,000 $5.40 $5.40 $6.10 $8.00 $11.00 $15.70 $22.00 $29.70 $40.40 $55.30 $72.10 $90.50 $90.50 $90.50 $90.50
$11,000 $5.94 $5.94 $6.71 $8.80 $12.10 $17.27 $24.20 $32.67 $44.44 $60.83 $79.31 $99.55 $99.55 $99.55 $99.55
$12,000 $6.48 $6.48 $7.32 $9.60 $13.20 $18.84 $26.40 $35.64 $48.48 $66.36 $86.52 $108.60 $108.60 $108.60 $108.60
$13,000 $7.02 $7.02 $7.93 $10.40 $14.30 $20.41 $28.60 $38.61 $52.52 $71.89 $93.73 $117.65 $117.65 $117.65 $117.65
$14,000 $7.56 $7.56 $8.54 $11.20 $15.40 $21.98 $30.80 $41.58 $56.56 $77.42 $100.94 $126.70 $126.70 $126.70 $126.70
$15,000 $8.10 $8.10 $9.15 $12.00 $16.50 $23.55 $33.00 $44.55 $60.60 $82.95 $108.15 $135.75 $135.75 $135.75 $135.75
$16,000 $8.64 $8.64 $9.76 $12.80 $17.60 $25.12 $35.20 $47.52 $64.64 $88.48 $115.36 $144.80 $144.80 $144.80 $144.80
$17,000 $9.18 $9.18 $10.37 $13.60 $18.70 $26.69 $37.40 $50.49 $68.68 $94.01 $122.57 $153.85 $153.85 $153.85 $153.85
$18,000 $9.72 $9.72 $10.98 $14.40 $19.80 $28.26 $39.60 $53.46 $72.72 $99.54 $129.78 $162.90 $162.90 $162.90 $162.90
$19,000 $10.26 $10.26 $11.59 $15.20 $20.90 $29.83 $41.80 $56.43 $76.76 $105.07 $136.99 $171.95 $171.95 $171.95 $171.95
$20,000 $10.80 $10.80 $12.20 $16.00 $22.00 $31.40 $44.00 $59.40 $80.80 $110.60 $144.20 $181.00 $181.00 $181.00 $181.00
$21,000 $11.34 $11.34 $12.81 $16.80 $23.10 $32.97 $46.20 $62.37 $84.84 $116.13 $151.41 $190.05 $190.05 $190.05 $190.05
$22,000 $11.88 $11.88 $13.42 $17.60 $24.20 $34.54 $48.40 $65.34 $88.88 $121.66 $158.62 $199.10 $199.10 $199.10 $199.10
$23,000 $12.42 $12.42 $14.03 $18.40 $25.30 $36.11 $50.60 $68.31 $92.92 $127.19 $165.83 $208.15 $208.15 $208.15 $208.15
$24,000 $12.96 $12.96 $14.64 $19.20 $26.40 $37.68 $52.80 $71.28 $96.96 $132.72 $173.04 $217.20 $217.20 $217.20 $217.20
$25,000 $13.50 $13.50 $15.25 $20.00 $27.50 $39.25 $55.00 $74.25 $101.00 $138.25 $180.25 $226.25 $226.25 $226.25 $226.25
$26,000 $14.04 $14.04 $15.86 $20.80 $28.60 $40.82 $57.20 $77.22 $105.04 $143.78 $187.46 $235.30 $235.30 $235.30 $235.30
$27,000 $14.58 $14.58 $16.47 $21.60 $29.70 $42.39 $59.40 $80.19 $109.08 $149.31 $194.67 $244.35 $244.35 $244.35 $244.35
$28,000 $15.12 $15.12 $17.08 $22.40 $30.80 $43.96 $61.60 $83.16 $113.12 $154.84 $201.88 $253.40 $253.40 $253.40 $253.40
$29,000 $15.66 $15.66 $17.69 $23.20 $31.90 $45.53 $63.80 $86.13 $117.16 $160.37 $209.09 $262.45 $262.45 $262.45 $262.45
$30,000 $16.20 $16.20 $18.30 $24.00 $33.00 $47.10 $66.00 $89.10 $121.20 $165.90 $216.30 $271.50 $271.50 $271.50 $271.50

Employee and Spouse Premiums Dependent Child(ren) Benefit Premiums

To calculate employee and spouse premiums: Dependent Child(ren) Benefit: Your dependent child(ren)
O Determine your age band: are eligible for a benefit amount of 25% of your Critical
Illness benefit election, limited to a maximum of $15,000.
– Your age = your age at your last birthday
– Spouse age = Spouse age at their last birthday Example: Employee Benefit Amount x 25% = Dependent
Child(ren) Benefit. No rounding needed.
O Select an employee and a spouse benefit from the
To calculate Dependent Child(ren) Premium: Dependent
table above
O Employee and spouse rates change as insured moves Child(ren) Benefit/1000 x 0.700. Please note: One rate and
benefit amount for all eligible children in family, regardless
from one age bracket to the next, based on the age
of number.
determination rules

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