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Life and Accidental Death and Dismemberment Premium Rates

2010 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