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EMPLOYEE
16
C O N T R I B U T I O N S
Supplemental Employee Life Insurance
Age as of 1/1/2016
<30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Coverage for your child
Supplemental Short-Term Disability Insurance
To calculate: (Weekly Earnings (not to exceed $1,500) X .6 X Premium) / 10 = Deduction per month
Age as of 1/1/16
<30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
$0.09
$0.12
Supplemental Dependent Life Insurance
$0.470
Rates are the same as the
Supplemental Employee Life
Insurance above using the Spouse's
age as of 1/1/2016 and the following
formula: (Coverage Amount/1,000) X
Premium=Deduction Per Month
$0.50 per $2,500 of coverage
cost per $1,000 of coverage
cost per $10 of weekly benefit
$0.325
$0.325
$0.20
$0.28
$0.57
$0.68
$1.27
$2.06
Formula for calculating the cost: (Annual Base Salary rounded to next highest $1,000)/$1,000 X Premium
= Deduction per month
$0.06
$0.08
$0.325
$0.325
$0.325
$0.325
$0.398
$0.515
Coverage for your spouse
(cannot exceed 50% of
employee election)
*All costs shown per month