CCCCD Medical/Dental Premiums
Effective 09/01/2009
|
HealthSelect |
Monthly |
State |
Employee |
|
Medical
Insurance |
Premium |
Pays |
Pays |
|
Employee Only |
$385.38 |
$385.38 |
$0.00 |
|
Employee & Spouse |
$826.02 |
$605.70 |
$220.32 |
|
Employee & Child(ren) |
$680.42 |
$532.90 |
$147.52 |
|
Employee & Family |
$1,121.06 |
$753.22 |
$367.84 |
|
Dental Plan |
Monthly |
State |
College |
Employee |
|
Premium |
Pays |
Pays |
Pays |
|
|
Dental Choice
Plan/GEHA |
|
|
|
|
|
Employee Only |
$22.46 |
$0.00 |
$22.46 |
$0.00 |
|
Employee & Spouse |
$44.92 |
$0.00 |
$22.46 |
$22.46 |
|
Employee & Child(ren) |
$53.90 |
$0.00 |
$22.46 |
$31.44 |
|
Employee & Family |
$76.36 |
$0.00 |
$22.46 |
$53.90 |
|
Dental HMO/Aetna |
|
|
|
|
|
Employee Only |
$8.52 |
$0.00 |
$8.52 |
$0.00 |
|
Employee & Spouse |
$17.05 |
$0.00 |
$8.52 |
$8.53 |
|
Employee & Child(ren) |
$20.45 |
$0.00 |
$8.52 |
$11.93 |
|
Employee & Family |
$28.98 |
$0.00 |
$8.52 |
$20.46 |
Optional Coverage Rates-Employees
All premiums are monthly
|
Optional Term Life*
Premiums |
|
|||||
|
Election I=1X annual salary Election II=2X annual salary NOTE:
After the first 31 days of employment, Election I and II require approval
through evidence of insurability. |
Rate per $1000 of
Annual Salary |
|
||||
|
Age |
Election
I |
Election
II |
Election
III |
Election
IV |
||
|
15-19 |
$0.06 |
$0.12 |
$0.18 |
$0.24 |
||
|
20-24 |
$0.06 |
$0.12 |
$0.18 |
$0.24 |
||
|
25-29 |
$0.06 |
$0.12 |
$0.18 |
$0.24 |
||
|
30-34 |
$0.07 |
$0.14 |
$0.21 |
$0.28 |
||
|
35-39 |
$0.07 |
$0.14 |
$0.21 |
$0.28 |
||
|
40-44 |
$0.09 |
$0.18 |
$0.27 |
$0.36 |
||
|
45-49 |
$0.13 |
$0.26 |
$0.39 |
$0.52 |
||
|
50-54 |
$0.21 |
$0.42 |
$0.63 |
$0.84 |
||
|
55-59 |
$0.37 |
$0.74 |
$1.11 |
$1.48 |
||
|
60-64 |
$0.63 |
$1.26 |
$1.89 |
$2.52 |
||
|
65-69 |
$1.03 |
$2.06 |
$3.09 |
$4.12 |
||
|
70-74 |
$1.64 |
$3.28 |
$4.92 |
$6.56 |
||
|
75-79 |
$2.68 |
$5.36 |
$8.04 |
$10.72 |
||
|
80-84 |
$4.36 |
$8.72 |
$13.08 |
$17.44 |
||
|
85-89 |
$7.54 |
$15.08 |
$22.62 |
$30.16 |
||
|
90+ |
$11.74 |
$23.48 |
$35.22 |
$46.96 |
||
|
Dependent Term Life |
Short & Long
term Disability Income Premiums |
|
$1.38/month (includes $5,000 term life with AD&D
coverage per dependent) |
Short-term
Disability Income $0.29/$100
of monthly salary Long-term
Disability Income $0.70/$100 of monthly salary |
|
Voluntary
Accidental Death and Dismemberment (Voluntary AD&D) Premiums |
|||||
|
You
may apply for Voluntary AD&D coverage according to the following table: |
|
||||
|
Employee's Age |
Minimum Coverage |
Maximum Coverage |
Minimum Increments |
Employee
Only-$0.02/$1000 of coverage
Employee & Family-$0.04/$1000 of coverage For more detailed information
about optional coverage benefits, see the benefits books available online at
the ERS website. |
|
|
Under age 70 |
$10,000 |
$200,000 |
$5,000 |
||
|
70-74 |
$6,500 |
$130,000 |
$3,250 |
||
|
75-79 |
$4,000 |
$80,000 |
$2,000 |
||
|
80-84 |
$2,500 |
$50,000 |
$1,250 |
||
|
85-89 |
$1,500 |
$30,000 |
$750 |
||
|
90+ |
$1,000 |
$20,000 |
$500 |
||