18- Pay Voluntary Critical Illness Premium Table

Reliance Standard Voluntary Plans Critical Illness Insurance Premium Table Plan Holder: Goshen Community Schools Scheduled Benefit: Each eligible employee may elect for himself and/or his eligible spouse an amount of insurance shown in the table below. Employee/Spouse Premiums: To find you and your spouse's premium -  Determine your age band: o Your age = your age at your last birthday. o Spouse age = your age at your last birthday. o When selecting an amount of insurance you must select at pre-age 70 benefit amount.  Select a benefit from: o Select an employee and spouse benefit from the table below.  Employee and spouse rates change as insured moves from one age bracket to the next, based on the age determination rules. Employee and Spouse 18 Payment Premiums Benefit Age Age Age Age Age Age Amount 0-29 30-39 40-49 50-59 60-69 70+ $10,000 $2.53 $4.53 $8.53 $15.33 $23.47 $46.13 $20,000 $5.07 $9.07 $17.07 $30.67 $46.93 $92.27 $30,000 $7.60 $13.60 $25.60 $46.00 $70.40 $138.40 Dependent Child(ren): Your dependent child(ren) is eligible for a benefit amount of 50% of your Critical Illness benefit election, limited to a maximum of $15,000 To calculate Dependent Child(ren) Benefit: Employee Benefit Amount x 50% = Dependent Child(ren) Benefit. No rounding needed. Dependent Child(ren) Rate is included in the Employee Premium. Please Note: One rate and benefit amount for all eligible children in family, regardless of number. Please read this important information - You may not have coverage as both an employee and as a dependent. - Employee must have coverage in order for spouse and dependent children to be covered. Please note, these rates are approximate and subject to change.