4.1 26PAYPERIOD FY 2022-23 VOLUNTARY INSURANCE EXHIBIT A RATES.PDF

Employee Benefits – Plan Year 2023 Premium Rates - Exhibit A 
 
FY 22-23 Short Term Disability – Pay Period 
Pay Period Premium = (Multiplier X Annual Base Salary) /26 pay periods 
 Employee Only  
 Multiplier  
40% 
0.0018 
50% 
0.0029 
60% 
0.0055 
 
FY 22-23 Employee Assistance Program – Pay Period 
 Pay Period 
Total Premium  
 Pay Period 
Employer 
Premium  
 Pay Period 
Eligible 
Participant 
Premium  
Employee Assistance 
1.62 
1.62 
0.00 
FY 22-23 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 
  
0.360 
  
0.360  
Basic AD&D 1X Salary 
  
0.180 
  
0.180  
Employee Additional ADD 1X Salary/$1000 
0.024  
0.24 
 
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 
3.36 
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