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EMPLOYEE SEMI-MONTHLY PREMIUM RATE TABLE
$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000
0-24
$0.43
$0.85
$1.28
$1.70
$2.13
$2.55
$2.98
$3.40
$3.83
$4.25
25-29
$0.43
$0.85
$1.28
$1.70
$2.13
$2.55
$2.98
$3.40
$3.83
$4.25
30-34
$0.43
$0.85
$1.28
$1.70
$2.13
$2.55
$2.98
$3.40
$3.83
$4.25
35-39
$0.58
$1.15
$1.73
$2.30
$2.88
$3.45
$4.03
$4.60
$5.18
$5.75
40-44
$0.83
$1.65
$2.48
$3.30
$4.13
$4.95
$5.78
$6.60
$7.43
$8.25
45-49
$1.33
$2.65
$3.98
$5.30
$6.63
$7.95
$9.28 $10.60
$11.93
$13.25
50-54
$1.88
$3.75
$5.63
$7.50
$9.38 $11.25 $13.13 $15.00
$16.88
$18.75
55-59
$2.73
$5.45
$8.18
$10.90
$13.63 $16.35 $19.08 $21.80
$24.53
$27.25
60-64
$4.43
$8.85
$13.28
$17.70
$22.13 $26.55 $30.98 $35.40
$39.83
$44.25
65-69
$7.93
$15.85
$23.78
$31.70
$39.63 $47.55 $55.48 $63.40
$71.33
$79.25
70-74
$11.13
$22.25
$33.38
$44.50
$55.63 $66.75 $77.88 $89.00 $100.13
$111.25
75-79
$23.88
$47.75
$71.63
$95.50 $119.38 $143.25 $167.13 $191.00 $214.88
$238.75
80+
$23.88
$47.75
$71.63
$95.50 $119.38 $143.25 $167.13 $191.00 $214.88
$238.75
SPOUSE SEMI-MONTHLY PREMIUM RATE TABLE
5,000
$10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000
$50,000
0-24
$0.21
$0.43
$0.64
$0.85
$1.06
$1.28
$1.49
$1.70
$1.91
$2.13
25-29
$0.21
$0.43
$0.64
$0.85
$1.06
$1.28
$1.49
$1.70
$1.91
$2.13
30-34
$0.21
$0.43
$0.64
$0.85
$1.06
$1.28
$1.49
$1.70
$1.91
$2.13
35-39
$0.29
$0.58
$0.86
$1.15
$1.44
$1.73
$2.01
$2.30
$2.59
$2.88
40-44
$0.41
$0.83
$1.24
$1.65
$2.06
$2.48
$2.89
$3.30
$3.71
$4.13
45-49
$0.66
$1.33
$1.99
$2.65
$3.31
$3.98
$4.64
$5.30
$5.96
$6.63
50-54
$0.94
$1.88
$2.81
$3.75
$4.69
$5.63
$6.56
$7.50
$8.44
$9.38
55-59
$1.36
$2.73
$4.09
$5.45
$6.81
$8.18
$9.54 $10.90
$12.26
$13.63
60-64
$2.21
$4.43
$6.64
$8.85
$11.06 $13.28 $15.49 $17.70
$19.91
$22.13
65-69
$3.96
$7.93
$11.89
$15.85
$19.81 $23.78 $27.74 $31.70
$35.66
$39.63
ALL CHILDREN SEMI-MONTHLY PREMIUM RATE TABLE*
$1,000
$2,000
$3,000
$4,000
$5,000 $6,000 $7,000 $8,000
$9,000
$10,000
RATE
$0.10
$0.20
$0.30
$0.40
$0.50
$0.60
$0.70
$0.80
$0.90
$1.00
* Regardless of howmany children you have, they are included in the all children premium amounts listed in the above table
Employee premium Spouse Premium
Child(ren) Premium
Total Semi-Monthly Premium
Mutual of Omaha Voluntary Life/AD&D
Voluntary Life is available at a cost to the employee through payroll deduction. The employee and/or dependents may
need to qualify for benefits. (Children up to age 19 - 23 if full time student). Guarantee Issue means if you sign up when you
are newly hired, you automatically receive the Guarantee Issue amount without completing a health history form.
Employee Only:
$10,000 up to 7x annual salary up to $350,000 -
Guarantee Issue:
Up to $100,000 (at initial eligibility)
Spouse:
$5,000up to$100,00not toexceed50%of employeebenefit -
Guarantee Issue:
Up to$30,000 (at initial eligibility)
Child(ren):
$2,000 up to $10,000 -
Guarantee Issue:
Up to $10,000 (at initial eligibility)
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+
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Reminder
Notify your HR Department with name, address, dependent age, adding or updating your beneficiary records.