4.1 PY 2024 VOLUNTARY INSURANCE RATES EXHIBIT A.PDF

Voluntary Benefits – Premium Rates - Exhibit A 
Plan Year 1/1/2024 to 12/31/2024 
 
Short Term Disability 
Pay Period Premium = (Multiplier X Annual Base Salary) /26 pay periods 
 Employee Only  
 Multiplier  
40% 
0.0018 
50% 
0.0029 
60% 
0.0055 
 
Voluntary Programs 
 Monthly Total 
Premium  
 Monthly 
Employer 
Premium  
 Monthly Eligible 
Participant 
Premium  
Group Legal 
15.75 
0.00 
15.75 
Employee Assistance 
3.50 PEPM 
3.50 PEPM 
0.00 
 
Life Insurance – Annual Rate 
 Life Insurance  
  
 Annual Total 
Premium per 
$1000  
 Annual Employee 
Premium Per 
$1000  
 Annual Employer 
Premium Per 
$1000  
Basic Life 1X Salary 
  
.0360 
  
0.360  
Basic AD&D 1X Salary 
  
0.180 
  
0.180  
Employee Additional ADD 1X Salary/$1000 
0.240 
0.240 
  
Family Additional ADD 2X Salary/$1000 
0.420 
0.420 
  
Dependent Child Life /$5,000 
1.200 
1.200 
  
Additional - Non-Smoker 
Under 25 
0.348 
0.348 
  
Additional - Non-Smoker 
25-29 
0.420 
0.420 
  
Additional - Non-Smoker 
30-34 
0.552 
0.552 
  
Additional - Non-Smoker 
35-39 
0.612 
0.612 
  
Additional - Non-Smoker 
40-44 
0.804 
0.804 
  
Additional - Non-Smoker 
45-49 
1.308 
1.308 
  
Additional - Non-Smoker 
50-54 
2.004 
2.004 
  
Additional - Non-Smoker 
55-59 
3.408 
3.408 
  
Additional - Non-Smoker 
60-64 
5.760 
5.760 
  
Additional - Non-Smoker 
65-69 
8.304 
8.304 
  
Additional - Non-Smoker 
70 and older 
15.372 
15.372 
  
Additional - Smoker 
Under 25 
0.564 
0.564 
  
Additional - Smoker 
25-29 
0.612 
0.612 
  
Additional - Smoker 
30-34 
0.696 
0.696 
  
Additional - Smoker 
35-39 
1.188 
1.188 
  
Additional - Smoker 
40-44 
1.692 
1.692 
  
Additional - Smoker 
45-49 
3.360 
3.360 
  
Additional - Smoker 
50-54 
6.192 
6.192 
  
Additional - Smoker 
55-59 
6.312 
6.312 
  
Additional - Smoker 
60-64 
9.780 
9.780 
  
Additional - Smoker 
65-69 
11.964 
11.964 
  
Additional - Smoker 
70 and older 
19.656 
19.656