Cost of coverage

Medical – Monthly Rates

The rates shown here do not include a tobacco surcharge or working spouse surcharge. If you qualify for either surcharge, your rates will be higher than indicated in the table.

Cigna900 Deductible Plan1850 Deductible Plan w/HSA2850 Deductible Plan w/HSA
Employee Only$202.26$118.03$59.40
Employee + Spouse$484.51$309.96$186.83
Employee + Child(ren)$440.55$282.8$171.41
Employee + Family$682.60$432.47$256.58

Kaiser900 Deductible Plan1850 Deductible Plan w/HSA2850 Deductible Plan w/HSA
Employee Only$163.90$84.26$43.33
Employee + Spouse$392.65$221.08$136.19
Employee + Child(ren)$357.02$202.134125.20
Employee + Family$553.16$306.57$185.87
*Different rates apply for Hawaii.

Dental – Monthly Rates

 EnhancedBasic PlusDHMO
Employee Only$29.91$23.52$9.04
Employee + Spouse$59.82$47.05$17.70
Employee + Child(ren)$71.79$56.45$20.68
Employee + Family$101.70$79.98$32.15
*Different rates apply for Hawaii.

Vision – Monthly Rates

 EnhancedMaterials Only
Employee Only$12.68$6.00
Employee + Spouse$20.21$9.56
Employee + Child(ren)$20.36$9.62
Employee + Family$33.37$15.75

Voluntary Life – Monthly Rates

 Monthly Rate Per $1,000 of Coverage
Employee Age-BandEmployeeSpouse
<=24$0.040$0.050
25 - 29$0.048$0.060
30 - 34$0.056$0.080
35 - 39$0.072$0.090
40 - 44$0.080$0.100
45 - 49$0.120$0.150
50 - 54$0.184$0.230
55 - 59$0.344$0.430
60 - 64$0.520$0.660
65 - 69$0.776$1.270
70 - 74$0.968$2.060
75 - 79$1.623$2.060
>= 80$1.623$2.060
Child$0.110

Voluntary AD&D – Monthly Rates

 Monthly Rate Per $1,000 of coverage
Coverage Tier:Employee OnlyEmployee Plus Family
Monthly Rate:$0.022$0.034
Note that rates will be higher than what is shown if you qualify for the tobacco surcharge.

Critical Illness – Monthly Rates

Monthly
Rate
Employee amount: $10,000 Spouse amount: $5,000 Child amount: $2,500Employee amount: $20,000 Spouse amount: $10,000 Child amount: $5,000
EEEE + SPEE + ChildEE + FamEEEE + SPEE + ChildEE + Fam
0-24$3.77$6.66$4.10$6.99$5.77$9.78$$6.35$10.36
25-29$4.22$7.36$4.55$7.69$6.67$11.18$7.25$11.76
30-34$5.32$9.05$5.65$9.38$8.87$14.55$9.45$15.13
35-39$6.92$11.84$7.25$12.17$12.06$20.14$12.64$20.72
40-44$8.82$14.86$9.15$15.19$15.87$26.18$16.45$26.76
45-49$12.65$20.90$12.98$21.23$23.53$38.25$24.11$38.83
50-54$18.35$29.60$18.68$29.93$34.93$55.66$35.51$56.24
55-59$25.30$40.57$25.63$40.90$48.83$77.60$49.41$78.18
60-64$33.62$53.26$33.95$53.59$65.47$102.98$66.05$103.56
65-69$40.19$64.66$40.52$64.99$78.60$125.78$79.18$126.36
70-74$57.17$90.36$57.50$90.69$112.57$177.18$113.15$177.76
75-79$70.89$117.17$71.22$117.5$140.00$230.79$140.58$231.37
80-84$85.76$141.93$86.09$142.26$169.74$280.32$170.32$280.90
85+$120.78$199.02$121.12$199.35$239.80$394.50$240.38$395.08

Accident – Monthly Rates

 Standard (Low)Enhanced (High)
TierMonthly Employee RateMonthly Employee Rate
Employee$6.34$12.27
Employee & Spouse$10.81$20.94
Employee & Child(ren)$10.99$21.30
Family$14.82$28.75

Hospital Indemnity – Monthly Rates

 StandardEnhanced
TierMonthly Employee RateMonthly Employee Rate
Employee$9.22$14.55
Employee & Spouse$19.83$31.57
Employee & Child(ren)$17.23$26.82
Family$27.83$43.84

Hyatt Legal – Monthly Rates

TierMonthly Employee rate
Employee & Family$18.00

Allstate Identity Protection – Monthly Rates

TierMonthly Employee Rate
Employee$9.95
Employee & Family$17.95