Bookmark & Share2010 Premiums
Part A Basic
| Employees |
| $5.07 (employer-paid) |
Part B Basic (for Dependents)
An employee pays $0.50 per family, regardless of the number of dependents.
Part B Supplemental, Part C Optional, and Part D Supplemental Insurance
Your premium rate changes to the next higher rate as you reach each new age bracket.| Employee's age |
Monthly cost for each
$1,000 of coverage |
|
| Non-smoker | Smoker | |
| Under 25 | $0.028 | $0.036 |
| 25-29 | 0.030 | 0.044 |
| 30-34 | 0.034 | 0.058 |
| 35-39 | 0.042 | 0.066 |
| 40-44 | 0.064 | 0.074 |
| 45-49 | 0.092 | 0.112 |
| 50-54 | 0.144 | 0.170 |
| 55-59 | 0.268 | 0.318 |
| 60-64 | 0.412 | 0.484 |
| 65-69 | 0.760 | 0.932 |
| 70+ | 1.134 | 1.514 |
Part E - Accidental Death and Dismemberment (Voluntary)
| Employee AD&D benefit | Cost to cover employee only |
Cost to cover employee
& dependents |
Coverage for spouse/Qualified Domestic Partner: | Coverage for children: | ||
| With no children | With children |
With spouse/
Qualified Domestic Partner |
With no spouse/
Qualified Domestic Partner |
|||
| $ 25,000 | $0.20 | $0.30 | $ 12,500 | $ 10,000 | $ 1,250 | $ 2,500 |
| 50,000 | 0.40 | 0.60 | 25,000 | 20,000 | 2,500 | 5,000 |
| 75,000 | 0.60 | 0.90 | 37,500 | 30,000 | 3,750 | 7,500 |
| 100,000 | 0.80 | 1.20 | 50,000 | 40,000 | 5,000 | 10,000 |
| 125,000 | 1.00 | 1.50 | 62,500 | 50,000 | 6,250 | 12,500 |
| 150,000 | 1.20 | 1.80 | 75,000 | 60,000 | 7,500 | 15,000 |
| 175,000 | 1.40 | 2.10 | 87,500 | 70,000 | 8,750 | 17,500 |
| 200,000 | 1.60 | 2.40 | 100,000 | 80,000 | 10,000 | 20,000 |
| 225,000 | 1.80 | 2.70 | 112,500 | 90,000 | 11,250 | 22,500 |
| 250,000 | 2.00 | 3.00 | 125,000 | 100,000 | 12,500 | 25,000 |
