Page 20 - Demo

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Benefit Contributions - Life Insurance and Critical Illness
FULL-TIME AND PART-TIME (30 OR 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 rate + age
rated for 1x 4x annual salary
2x 2x rate rate + age
rated for 2x 2x Rates for Employees Optional Group Term Life and and AD&D – 3 and 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
$25 000 000 000 $50 000 000 000 $100 000 000 000 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 is an an an an an an an independent company that provides optional legal benefits to Blue Blue Blue Blue Blue Blue Cross Cross Cross and and and Blue Blue Blue Blue Blue Blue Shield Shield Shield of of of Illinois Blue Blue Blue Blue Blue Blue Cross Cross Cross and and and Blue Blue Blue Blue Blue Blue Shield Shield Shield of of of Montana Blue Blue Blue Blue Blue Blue Cross Cross Cross and and and Blue Blue Blue Blue Blue Blue Shield Shield Shield of of of New Mexico and and Blue Blue Cross and and Blue Blue Shield of Texas employees LegalShield is an an an independent company that provides optional legal benefits to Blue Blue Cross and Blue Blue Shield Shield of Oklahoma employees