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1st Financial Federal Credit Union -
Executives
7
EMPLOYEE COST—Semi Monthly
Medical
Base
Per Pay
Buy Up
Per Pay
Employee
$36.00
$40.00
Employee & Spouse
$241.00
$267.00
Employee & Child(ren) $190.00
$210.00
Family
$395.00
$437.00
ENROLLMENT WORKSHEET
Employee
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Employee
Monthly Cost
Spouse
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Spouse Monthly
Cost
Child(ren)
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Child(ren)
Monthly Cost
Dental
Cost Per Pay
Employee
$2.50
Employee & Spouse
$17.50
Employee & Child(ren)
$22.00
Family
$36.50
VOLUNTARY LIFE/AD&D
EMPLOYEE CONTRIBUTION
(Rates are per month)
AGE BAND
Cost/$1,000*
Under 29
$.078
30-34
$.083
35-39
$.126
40-44
$.203
45-49
$.341
50-54
$.602
55-59
$.998
60-64
$1.330
65-69
$2.073
70-74
$3.639
75 +
5.942
Child Life Rate
$2.00/$10,000
AD&D: Employee/Spouse
$0.02
Child
$0.04
*
Spouse rates are based on the employees age.