
(per month)
Base Plan Rate:
|
See rates below.
|
Age Band Structure
|
Coverage Rates
|
0-14
|
$2
|
15-19
|
$2
|
20-24
|
$2
|
21-29
|
$2
|
30-34
|
$2
|
35-39
|
$2
|
40-44
|
$2
|
45-49
|
$2
|
50-54
|
$2
|
55-59
|
$2
|
60-64
|
$2
|
65 and over
|
$2
|
|
Base Rate Type:
|
Per $100 of monthly benefit
|
Base Plan Contribution:
|
Employee contributes 5% per month.
|
Buy-up Plan Rate:
|
See rates below.
|
Buy-up Age Band Structure
|
Coverage Rates
|
Male
|
Female
|
Smoker
|
Non-Smoker
|
Smoker
|
Non-Smoker
|
0-14
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
15-19
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
20-24
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
21-29
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
30-34
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
35-39
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
40-44
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
45-49
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
50-54
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
55-59
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
60-64
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
65-69
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
70-74
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
75 and over
|
$2.00
|
$2.00
|
$2.00
|
$2.00
|
|
Buy-up Plan Rate Type:
|
Per $100 of monthly benefit
|
Buy-up Plan Contribution:
|
Employee contributes 5% per month.
|
|