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Rates
2022/23 Plan Year

Contents
 》All-in-One Rate Sheet PDF
 》Health
 》Dental
 》Vision
 》Group Life
 》Additional Life

Health
Health Coverage Details
  Diamond Platinum Gold Silver Bronze
Member 674.16 633.72 600.00 573.04 539.32
Child 322.08 302.76 286.66 273.76 257.66
Children 524.32 492.86 466.64 445.68 419.46
Spouse 788.22 740.92 701.52 669.98 630.58
Spouse & Child 1,110.30 1,043.68 988.18 943.74 888.24
Spouse & Children    1,312.54 1,233.78 1,168.16 1,115.66 1,050.04


Dental
Dental Coverage Details
Coverage Tier Enhanced Standard
Member 43.20 38.88
Child 22.82 20.54
Children 36.28 32.66
Spouse 53.36 48.02
Spouse & Child 76.18 68.56
Spouse & Children 89.64 80.68

Vision
Vision Coverage Details
Coverage Tier Enhanced Standard
Member 7.74 6.28
Child 7.22 5.82
Children 7.22 5.82
Spouse 6.80 5.50
Spouse & Child 18.44 14.92
Spouse & Children     18.44 14.92

Group Life
Group Life Coverage Details
Death Benefit          Rate
20,000 6.00
30,000 9.00
40,000 12.00
50,000 15.00


Additional Life
Additional Life Coverage Details
Per $5,000 of Coverage
         18-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
With AD&D 0.50 0.65 0.85 1.30 2.10 3.35 3.85 6.20 10.40 16.05
Without AD&D 0.35 0.50 0.70 1.15 1.95 3.20 3.70 6.05 10.25 15.90