Page 21 - 2022 Drive Open Enrollment Guide - Non Union

Monthly, Bi-Weekly & Weekly Employee Contributions:

Hospital Indemnity and Accident

Accident and Hospital Indemnity Premium Rates
Hospital Indemnity Plan Monthly Cost Bi-Weekly Cost Weekly Cost

Employee $10.99 $5.07 $2.54
Employee + 1 / Spouse $23.57 $10.88 $5.44
Employee + Children $15.76 $7.27 $3.64
Employee + Family $28.34 $13.08 $6.54

Accident Plan Monthly Cost Bi-Weekly Cost Weekly Cost
Employee $7.91 $3.65 $1.83
Employee + 1 / Spouse $13.63 $6.29 $3.15
Employee + Children $19.23 $8.88 $4.44

Family $24.95 $11.52 $5.76

Monthly, Bi-Weekly & Weekly Employee Contributions:

Critical Illness

$15,000 Employee & Child(ren) Cost; $15,000 Spouse Cost; $30,000 Employee & Child(ren) Cost; $30,000 Spouse
$50 Be Well Benefit Cost; $50 Be Well Benefit
Age Monthly Cost Bi-Weekly Cost Weekly Cost Age Monthly Cost Bi-Weekly Cost Weekly Cost
<25 $3.29 $1.52 $0.76 <25 $4.34 $2.00 $1.00
25-29 $3.89 $1.80 $0.90 25 - 29 $5.54 $2.56 $1.28
30 - 34 $4.94 $2.28 $1.14 30 - 34 $7.64 $3.53 $1.76
35 - 39 $6.44 $2.97 $1.49 35 - 39 $10.64 $4.91 $2.46
40 - 44 $8.84 $4.08 $2.04 40 - 44 $15.44 $7.13 $3.56
45 - 49 $12.59 $5.81 $2.91 45 - 49 $22.94 $10.59 $5.29
50 - 54 $18.14 $8.37 $4.19 50 - 54 $34.04 $15.71 $7.86
55 - 59 $25.34 $11.70 $5.85 55 - 59 $48.44 $22.36 $11.18
60 - 64 $36.44 $16.82 $8.41 60 - 64 $70.64 $32.60 $16.30
65 - 69 $52.34 $24.16 $12.08 65 - 69 $102.44 $47.28 $23.64
70 - 74 $76.79 $35.44 $17.72 70 - 74 $151.34 $69.85 $34.92
75 - 79 $102.89 $47.49 $23.74 75 - 79 $203.54 $93.94 $46.97
80 - 84 $130.79 $60.36 $30.18 80 - 84 $259.34 $119.70 $59.85
85+ $186.89 $86.26 $43.13 85+ $371.54 $171.48 $85.74

Please note:
- Rates shown above are per employee & child(ren), if you enroll your spouse, the rates above are doubled.
- Critical Illness spouse rate is based of the employee’s age.

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