Page 15 - Guide

Monthly Cost of Coverage

You pay a monthly premium for each $1,000 of coverage. Your premium for
yourself and your spouse is based on your age as of December 1 and will not
increase until the next December 1 regardless of having a birthday which takes you
to the next age band.

In order for coverage to be effective for yourself, your spouse and/or dependent
children, you must be actively at work on December 1. Your spouse and dependent
child(ren) must be performing the task of a similarly situated spouse (children). If
not, coverage will not be effective until you return to active employment or your
spouse and/or children are performing normal duties.

Employee Life Monthly Spouse Life Monthly Step
Age Step Rates per $10,000 Rates per $5,000 Child Life Monthly Rate
< 25 $0.726 $0.400
25–29 $0.795 $0.440
30–34 $1.063 $0.595
35–39 $1.572 $0.855
40–44 $2.393 $1.290
45–49 $3.741 $2.010 $0.748 per $2,000
50–54 $5.512 $2.985
55–59 $7.897 $4.395
60–64 $10.187 $6.080
65–69 $14.472 $8.670
70–74 $27.380 $16.395
75+ $84.637 $50.685

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