Page 42 - ABC Company 2018 Open Enrollment Guide

Critical Illness Rate Schedule
Below is a schedule of semi-monthly payroll contributions for the following benefit: $15,000 Critical Illness
Critical Illness / Semi-Monthly Rates
$15,000 Employee & Spouse — $3,750 Children to age 26
Rate Calc
per1000
EE
EE+SP
EE+CH
FAM
Ages 0-29
0.25
$1.88
$3.75
$2.02
$3.89
Ages 30-34
0.404
$3.03
$6.06
$3.17
$6.20
Ages 35-39
0.59
$4.43
$8.85
$4.57
$8.99
Ages 40-44
0.904
$6.78
$13.56
$6.92
$13.70
Ages 45-49
1.39
$10.43
$20.85
$10.57
$20.99
Ages 50-54
2.089
$15.67
$31.34
$15.81
$31.48
Ages 55-59
3.005
$22.54
$45.08
$22.68
$45.22
Ages 60-64
4.375
$32.81
$65.63
$32.96
$65.77
Ages 65-69
6.681
$50.11
$100.22
$50.25
$100.36
Ages 70-74
9
$67.50
$135.00
$67.64
$135.14
Ages 75-79
14.3
$107.25
$214.50
$107.39
$214.64
Ages 80-84
17.81
$133.58
$267.15
$133.72
$267.29
Ages 85+
26.29
$197.18
$394.35
$197.32
$394.49
Accident Rate Schedule
Below is a schedule of semi-monthly payroll contributions for the following benefit: Accident Insurance
Accident Insurance
Tiers
Semi-Monthly
Employee
$7.19
Employee + Spouse
$11.89
Employee + Child(ren)
$14.975
Employee + Family
$19.84
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