Page 20 - HCSC2019EG

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Benefit Contributions - Life Insurance and Critical Illness
FULL-TIME AND PART-TIME (30 OR MORE HOURS PER WEEK)
Life and AD&D*
Coverage
Employee Monthly Cost
Options
1x annual salary
$0.15 per $1,000 of coverage
2x annual salary
$0.15 per $1,000 of coverage
3x annual salary
2x rate + age rated for 1x
4x annual salary
2x rate + age rated for 2x
Rates for Employees Optional Group Term Life and AD&D – 3 and 4 Times Annual Salary Options
Your Age:
Cost per Thousand:
Your Age:
Cost per Thousand:
Under 30
$0.05
50 – 54
$0.28
30 – 34
$0.07
55 – 59
$0.47
35 – 39
$0.08
60 – 64
$0.55
40 – 44
$0.13
65 – 69
$1.00
45 – 49
$0.18
70 – 74
$1.70
Dependent Life
Coverage
Employee Monthly Cost
Dependent Spouse Rates per $1,000 of coverage
$10,000 for spouse only
$ 2.50
Age 0 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 +
Rate/$1,000 $0.05 $0.07 $0.08 $0.16 $0.23 $0.37 $0.66 $0.78 $1.43 $2.46
$25,000, $50,000, $100,000 or $200,000 for spouse only
Age rated
$5,000 for children only
$ 0.75
$10,000 for children only
$ 1.50
Long-Term Disability – Employee Buy-Up
$0.30 per $100 covered salary
Hyatt Group Legal
Monthly Contribution
$18
LegalShield® Monthly Contributions (OK Only)
Legal Only
$15.95
Legal and Identity Theft
$25.90
Identity Theft Only
$14.95
Critical Illness Monthly Contribution
Age
Employee Rate (per $1,000 monthly)
Spouse Rate (per $1,000 monthly)
Below 30
$0.407
$0.626
30-39
$0.571
$0.801
40-49
$1.072
$1.320
50-59
$2.058
$2.318
60-64
$3.369
$3.632
65+
$4.744
$5.167
Dependent Child(ren) Rates per $1,000: $0.267
* Hyatt Legal Plans is an independent company that provides optional legal benefits to Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico and Blue Cross and Blue Shield of Texas employees.
LegalShield is an independent company that provides optional legal benefits to Blue Cross and Blue Shield of Oklahoma employees.