2022/23 Plan Year Rates
for Current & Former Employees

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  

		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  

		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  

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