Semi-monthly Rates
| Benefit plan options | Employee | Employee + Spouse/DP |
Employee + Child(ren) |
Family |
|---|---|---|---|---|
| Medical | ||||
| Cigna PPO 1000 | $83.32 | $304.87 | $282.73 | $456.67 |
| Cigna PPO 2000 | $32.18 | $218.67 | $202.81 | $330.84 |
| Cigna HDHP | $21.32 | $171.45 | $157.48 | $245.75 |
| Dental | ||||
| Dental High Plan | $10.32 | $29.62 | $35.46 | $55.20 |
| Dental Low Plan | $0.90 | $8.98 | $10.77 | $17.06 |
| Vision | ||||
| Vision | $0.25 | $3.00 | $3.25 | $5.00 |
| Voluntary Life (rate per $1,000 based on employee’s age) | ||||
| <20 | 0.025 | |||
| 20-24 | 0.025 | |||
| 25-29 | 0.025 | |||
| 30-34 | 0.025 | |||
| 35-39 | 0.040 | |||
| 40-44 | 0.065 | |||
| 45-49 | 0.095 | |||
| 50-54 | 0.150 | |||
| 55-59 | 0.240 | |||
| 60-64 | 0.350 | |||
| 65-69 | 0.600 | |||
| 70-74 | 1.365 | |||
| 75-79 | 2.890 | |||
| 80-84 | 2.890 | |||
| 85-89 | 2.890 | |||
| 90-94 | 2.890 | |||
| 95-99 | 2.890 | |||
| Supplemental Benefits | ||||
| Accident | $2.85 | $4.95 | $6.53 | $8.64 |
| Critical Illness (rates based on employee’s age) | ||||
| 0-24 | $1.27 | $2.17 | $2.02 | $2.92 |
| 25-29 | $1.41 | $2.39 | $2.16 | $3.14 |
| 30-34 | $1.75 | $2.94 | $2.50 | $3.69 |
| 35-39 | $2.30 | $3.88 | $3.05 | $4.62 |
| 40-44 | $2.89 | $4.85 | $3.64 | $5.60 |
| 45-49 | $4.09 | $6.72 | $4.83 | $7.47 |
| 50-54 | $5.68 | $9.22 | $6.43 | $9.97 |
| 55-59 | $7.80 | $12.45 | $8.54 | $13.20 |
| 60-64 | $9.61 | $15.44 | $10.36 | $16.19 |
| 65-69 | $12.50 | $19.17 | $13.25 | $19.92 |
| 70-74 | $16.30 | $25.88 | $17.05 | $26.63 |
| 75-79 | $21.77 | $34.08 | $22.51 | $34.82 |
| 80-84 | $26.18 | $40.91 | $26.93 | $41.66 |
| 85+ | $34.80 | $54.18 | $35.55 | $54.93 |
