Page 17 - Hussmann- Chino Union OE Guide 2015 Plan Year
P. 17
Hussmann Corporation
Employee Monthly Cost Spouse Monthly
Employee Age per $1,000 Unit Cost per $10,000
Non-Tobacco User Tobacco User Unit Supplemental
Under 25 $0.045 $0.057 $0.44 Life Premiums
25 to 29 $0.054 $0.068 $0.47
30 to 34 $0.072 $0.090 $0.62
35 to 39 $0.081 $0.101 $0.71
40 to 44 $0.090 $0.112 $0.83
45 to 49 $0.134 $0.169 $1.26
50 to 54 $0.207 $0.258 $2.00
55 to 59 $0.388 $0.484 $3.62
60 to 64 $0.594 $0.743 $5.73
65 to 69 $1.141 $1.428 $11.02
70 to 74 $1.854 $2.316 $17.87
75 and Over $3.010 $3.762 $17.87
Supplemental Life Premiums for Children
$5,000 of coverage $0.39
$10,000 of coverage $0.77
One premium will insure all your eligible children, regardless of the number of children you
have. Costs are subject to change.
Calculating the Cost of Your Coverage
Step 1 $_________ Your Yearly Salary
x ________ 1, 2, 3, 4, 5, 6, 7, or 8 (salary multiples)
= $_________ Amount of Coverage You Want
Step 2 Round to the next higher $1,000, e.g., $214,300 becomes $215,000
Step 3 _________ รท 1,000 = ________
Your Coverage Amount Employee Units
Step 4 _________ x $_________ = $_________
Employee Units Employee Cost Per Unit
Step 5 _________ x $_________ = $_________ (+)
Spouse Units Spouse Cost Per Unit
Step 6 _________ x $_________ = $_________ (+)
Child(ren) Units Child(ren) Cost Per Unit
Step 7 = $_________
Total Monthly Cost
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Employee Monthly Cost Spouse Monthly
Employee Age per $1,000 Unit Cost per $10,000
Non-Tobacco User Tobacco User Unit Supplemental
Under 25 $0.045 $0.057 $0.44 Life Premiums
25 to 29 $0.054 $0.068 $0.47
30 to 34 $0.072 $0.090 $0.62
35 to 39 $0.081 $0.101 $0.71
40 to 44 $0.090 $0.112 $0.83
45 to 49 $0.134 $0.169 $1.26
50 to 54 $0.207 $0.258 $2.00
55 to 59 $0.388 $0.484 $3.62
60 to 64 $0.594 $0.743 $5.73
65 to 69 $1.141 $1.428 $11.02
70 to 74 $1.854 $2.316 $17.87
75 and Over $3.010 $3.762 $17.87
Supplemental Life Premiums for Children
$5,000 of coverage $0.39
$10,000 of coverage $0.77
One premium will insure all your eligible children, regardless of the number of children you
have. Costs are subject to change.
Calculating the Cost of Your Coverage
Step 1 $_________ Your Yearly Salary
x ________ 1, 2, 3, 4, 5, 6, 7, or 8 (salary multiples)
= $_________ Amount of Coverage You Want
Step 2 Round to the next higher $1,000, e.g., $214,300 becomes $215,000
Step 3 _________ รท 1,000 = ________
Your Coverage Amount Employee Units
Step 4 _________ x $_________ = $_________
Employee Units Employee Cost Per Unit
Step 5 _________ x $_________ = $_________ (+)
Spouse Units Spouse Cost Per Unit
Step 6 _________ x $_________ = $_________ (+)
Child(ren) Units Child(ren) Cost Per Unit
Step 7 = $_________
Total Monthly Cost
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