Historical Benefit Plan Premiums

State Group Health
EPIC Benefts+
Dental Insurance
Vision Insurance
Income Continuation Insurance
Life Insurance

Health Insurance

2015

Employee Contribution for the: 2015 Plan Year
Classified and Unclassified Employees 2015 HDHP · 2015 HMO/PPO
Employees Employed Less Than Half-Time (classified, unclassified) 2015 HDHP · 2015 HMO/PPO
Employer Contribution for Less than Full-Time Appointments
Craftsworkers 2015 HDHP · 2015 HMO/PPO
Graduate Assistants 2015
COBRA 2015 HDHP · 2015 HMO/PPO
Retirees 2015

2014

2013

2012

2011 (8/26/2011 - 12/31/2011)

2011 (1/1/2011 - 8/25/2011)

Non-Represented Employees Covered by WRS (Classified, Unclassified)

2010

Prior Years

Classified Employees
Non-Represented and Represented with Settled Contracts		Represented without Settled Contracts
Full Time	Less than Half Time	Full Time	Less than Half Time
2009	2009
2008 (1/1 - 7/31)	2008 (1/1 - 7/31)
2008 (8/1 - 12/31)	2008 (8/1 - 12/31)
2007	2007
2006	2006
2005	2005
2004	2004
2003	2003	2003	2003

Graduate Assistants and Short Term Academic Staff
Non-Represented and MGAA	TAA
2009	2009
2008 (1/1 - 7/31)	2008 (1/1 - 7/31)
2008 (8/1 - 12/31)	2008 (8/1 - 12/31)
2007	2007
2006	2006
2005
2004
2003	2003

EPIC Benefits+

Note: Beginning with the 2011 plan year, EPIC Dental and Excess Medical was renamed to EPIC Benefits+

EPIC Benefits+

2018 EPIC Benefits+ Insurance (Group #3180) - Active Employees
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
404	Active Employee Monthly Premium Without Vision Coverage	$21.38	$42.76	$42.76	$64.14
404	Active Employee Monthly Premium With Vision Coverage	$25.02	$49.16	$49.16	$73.58

2018 Monthly Rates for Annuitants
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
N/A	Annuitant Monthly Premium Without Vision Coverage	$28.74	$57.36	$66.58	$79.16
N/A	Annuitant Monthly Premium With Vision Coverage	$32.00	$63.22	$72.14	$87.64

2017 EPIC Benefits+ Insurance (Group #3180) - Active Employees
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
404	Active Employee Monthly Premium Without Vision Coverage	$21.56	$43.12	$43.12	$64.68
404	Active Employee Monthly Premium With Vision Coverage	$25.60	$50.24	$50.24	$75.16

2017 Monthly Rates for Annuitants
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
N/A	Annuitant Monthly Premium Without Vision Coverage	$28.90	$57.68	$66.96	$79.62
N/A	Annuitant Monthly Premium With Vision Coverage	$33.24	$65.50	$74.36	$90.92

2016 EPIC Benefits+ Insurance (Group #3180) - Active Employees
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
404	Active Employee Monthly Premium Without Vision Coverage	$19.77	$39.54	$39.54	$59.31
404	Active Employee Monthly Premium With Vision Coverage	$24.02	$47.04	$47.04	$70.34

2016 Monthly Rates for Annuitants
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
N/A	Annuitant Monthly Premium Without Vision Coverage	$26.69	$53.27	$61.90	$73.53
N/A	Annuitant Monthly Premium With Vision Coverage	$31.26	$61.51	$69.68	$85.43

2015 EPIC Benefits+ Insurance (Group #3180) - Active Employees
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
404	Active Employee Monthly Premium Without Vision Coverage	$19.77	$39.54	$39.54	$59.31
404	Active Employee Monthly Premium With Vision Coverage	$24.02	$47.04	$47.04	$70.34

2015 Monthly Rates for Annuitants
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
N/A	Annuitant Monthly Premium Without Vision Coverage	$26.69	$53.27	$61.90	$73.53
N/A	Annuitant Monthly Premium With Vision Coverage	$31.26	$61.51	$69.68	$85.43

2013 and 2014 EPIC Benefits+ Insurance (Group #3180) — Active Employees
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child	Family
404	Active Employee Monthly Premium Without Vision Coverage	$19.77	$39.54	$39.54	$59.31
404	Active Employee Monthly Premium With Vision Coverage	$24.02	$47.04	$47.04	$70.34

2013 and 2014 Monthly Rates for Annuitants
Deduction Code	Coverage Type	Employee	Employee + Spouse/Domestic Partner	Employee + Child	Family
N/A	Annuitant Monthly Premium Without Vision Coverage	$26.69	$53.27	$61.90	$73.53
N/A	Annuitant Monthly Premium With Vision Coverage	$31.26	$61.51	$69.68	$85.43

2012 EPIC Benefits+ Insurance (Group #3180) — Active Employees
Deduction Code	Coverage Type	Employee	Employee + Spouse / Domestic Partner	Employee + Child	Family
404	Active Employee Monthly Premium Without Vision Coverage	$18.99	$37.98	$37.98	$56.97
404	Active Employee Monthly Premium With Vision Coverage	$22.99	$45.05	$45.05	$67.36

2012 Monthly Rates for Non-Medicare Primary Annuitants
Deduction Code	Coverage Type	Annuitant	Annuitant + Spouse / Domestic Partner	Annuitant + Child	Family
N/A	Annuitant Monthly Premium Without Vision Coverage	$24.32	$48.53	$56.18	$66.90
N/A	Annuitant Monthly Premium With Vision Coverage	$28.63	$56.30	$63.52	$78.12

2011 EPIC Benefits+ Insurance (Group #3180)
Deduction Code	Coverage Type	Employee	Employee + Spouse or Domestic Partner	Employee + Child	Employee + 2 or more
404	Active Employee Monthly Premium Without Vision Coverage	$16.70	$33.40	$33.40	$50.10
404	Active Employee Monthly Premium With Vision Coverage	$20.70	$40.47	$40.47	$60.49
N/A	Retiree Monthly Premium Without Vision Coverage	$20.87	$41.64	$48.25	$57.43
N/A	Annuitant Monthly Premium With Vision Coverage	$25.18	$49.41	$55.59	$68.65

2009 Dental and Excess Medical (EPIC) Insurance (Group #3180)
Employee Type	Premium
Employee Type	Employee	Employee + Child	Employee + Spouse	Family
Active Employee	$16.70	$33.40	$33.40	$50.10
Retiree	$20.87	$48.25	$41.64	$57.43

2008 Dental and Excess Medical (EPIC) Insurance (Group #3180)
Employee Type	Premium
Employee Type	Employee	Employee + Child	Employee + Spouse	Family
Active Employee	$12.90	$25.80	$25.80	$38.70
Retiree	$16.85	$33.65	$33.65	$46.40

2006 Dental and Excess Medical (EPIC) Insurance (Group #3180)
Employee Type	Premium
Employee Type	Employee	Employee + Child	Employee + Spouse	Family
Active Employee	$12.90	$25.80	$25.80	$38.70
Retiree	$16.85	$33.65	$33.65	$46.40

2005 Dental and Excess Medical (EPIC) Insurance (Group #3180)
Employee Type	Premium
Employee Type	Employee	Employee + Child	Employee + Spouse	Family
Active Employee	$11.30	$22.60	$22.60	$33.90
Retiree	$13.15	$26.30	$30.45	$36.25

Anthem DentalBlue Insurance · Dental Wisconsin · Union Dental Plans

Anthem DentalBlue Insurance

Note: Effective January 1, 2011, only Classified Represented employees will be eligible to carry Anthem DentalBlue coverage. All other employees wishing to have dental coverage should enroll in the Dental Wisconsin plan. Premiums are deducted one month in advance of the month of coverage.

2012 DentalBlue Insurance — Monthly Premiums Effective for Coverage 1/1/2012
UW Deduction Codes	Plan	Employee	Employee + 1	Employee + 2 or more
467 Group Nos. 00166271 and 00166260	Anthem BCBS Dentacare HMO — Region 1 (Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties	$23.27	$46.55	$74.47
467 Group Nos. 00166271 and 00166260	Anthem BCBS Dentacare HMO — Region 2 (All other Wisconsin Counties)	$28.78	$57.56	$92.10
478 Group Nos. 00166270 and 00166212	Anthem BCBS Preferred PPO (Region 1 and Region 2)	$23.51	$47.01	$77.56
479 Group Nos. 00166272 and 00166261	Anthem BCBS Supplemental (Region 1 and Region 2)	$18.08	$36.17	$54.28

2010/2011 DentalBlue Insurance — Monthly Premiums Effective for Coverage 1/1/2010
UW Deduction Codes	Plan	Employee	Employee + 1	Employee + 2 or more
467 Group Nos. 00166271 and 00166260	Anthem BCBS Dentacare HMO — Region 1 (Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties	$23.27	$46.55	$74.47
467 Group Nos. 00166271 and 00166260	Anthem BCBS Dentacare HMO — Region 2 (All other Wisconsin Counties)	$28.78	$57.56	$92.10
478 Group Nos. 00166270 and 00166212	Anthem BCBS PPO (Region 1 and Region 2)	$23.51	$47.01	$77.56
479 Group Nos. 00166272 and 00166261	Anthem BCBS Supplemental (Region 1 and Region 2)	$16.59	$33.19	$49.80

2009 DentalBlue (Dentacare) — Monthly Premiums Effective for Coverage 01/01/2009
UW Deduction Codes	Plan	Employee	Employee + 1	Employee +2
467 Group Nos. 00166271 and 00166260	Anthem BCBS HMO — Region 1 (Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties	$23.27	$46.55	$74.47
467 Group Nos. 00166271 and 00166260	Anthem BCBS HMO — Region 2 (All other Wisconsin Counties)	$28.78	$57.56	$92.10
478 Group Nos. 00166270 and 00166212	Anthem BCBS PPO (Region 1 and Region 2)	$23.51	$47.01	$77.56
479 Group Nos. 00166272 and 00166261	Anthem BCBS Supplemental (Region 1 and Region 2)	$16.59	$33.19	$49.80

2008 DentalBlue (Dentacare) — Monthly Premiums Effective for Coverage 01/01/2008
UW Deduction Codes	Plan	Employee	Employee + 1	Employee +2
467 Group Nos. 00166271 and 00166260	Anthem BCBS HMO — Region 1 (Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties	$23.27	$46.55	$74.47
467 Group Nos. 00166271 and 00166260	Anthem BCBS HMO — Region 2 (All other Wisconsin Counties)	$28.78	$57.56	$92.10
478 Group Nos. 00166270 and 00166212	Anthem BCBS PPO (Region 1 and Region 2)	$21.70	$43.38	$71.58
479 Group Nos. 00166272 and 00166261	Anthem BCBS Supplemental (Region 1 and Region 2)	$14.28	$28.56	$42.86

2007 DentalBlue (Dentacare)
(Group #83445-7)
OSER Deduction Code	UW Deduction Code	Plan	Employee	Employee + 1	Employee + 2
484	467	Dentacare HMO—Region 1 (Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties	$19.12	$38.25	$61.19
484	467	Dentacare HMO—Region 2 (All other Wisconsin Counties)	$23.65	$47.30	$75.68
485	478	Preferred PPO	$19.38	$38.75	$63.94
486	479	Supplemental Plan	$11.48	$22.96	$34.45

2006 DentalBlue (Dentacare)
(Group #83445-7)
UW Deduction Codes	Plan	Employee	Employee + 1	Employee + 2
467	Dentacare HMO—Region 1 (Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties	$19.12	$38.25	$61.19
467	Dentacare HMO—Region 2 (All other Wisconsin Counties)	$23.65	$47.30	$75.68
478	Preferred PPO	$19.38	$38.75	$63.94
479	Supplemental Plan	$11.48	$22.96	$34.45

2005 DentalBlue (Dentacare)
(Group #83445-7)
UW Deduction Codes	Plan	Employee	Employee + 1	Employee + 2
467	Dentacare HMO—Region 1 (Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties	$17.40	$34.80	$55.68
467	Dentacare HMO—Region 2 (All other Wisconsin Counties)	$21.52	$43.04	$68.86
478	Preferred PPO	$17.94	$35.88	$59.20
479	Supplemental Plan	$9.95	$19.90	$29.85

Dental Wisconsin

2016 Dental Wisconsin Insurance (Group #31800D) — Active Employees
UW Deduction Codes	Plan	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
487	Preferred Provider Plan (PPO)	$25.49	$53.96	$60.34	$91.21
488	Select Plan	$20.52	$42.19	$48.68	$71.59

2015 Dental Wisconsin Insurance (Group #31800D) — Active Employees
UW Deduction Codes	Plan	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
487	Preferred Provider Plan (PPO)	$25.49	$53.96	$60.34	$91.21
488	Select Plan	$20.52	$42.19	$48.68	$71.59

2013 and 2014 Dental Wisconsin Insurance (Group #31800D) — Monthly Premiums Effective for Coverage 1/1/2013
UW Deduction Codes	Plan	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
487	Preferred Provider Plan (PPO)	$28.32	$59.96	$67.04	$101.34
488	Select Plan	$20.52	$42.19	$48.68	$71.59

2012 Dental Wisconsin Insurance (Group #31800D) — Monthly Premiums Effective for Coverage 1/1/2012
UW Deduction Codes	Plan	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
487	Preferred Provider Plan (PPO)	$26.82	$56.78	$63.49	$95.97
488	Select Plan	$17.84	$36.68	$42.32	$62.24

2011 Dental Wisconsin Insurance (Group #31800D) — Monthly Premiums Effective for Coverage 1/1/2011
UW Deduction Codes	Plan	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Family
487	Preferred Provider Plan (PPO)	$25.54	$54.08	$60.47	$91.41
488	Select Plan	$16.99	$34.93	$40.30	$59.28

Union Dental Plans

2011 Union Represented Dental Monthly Rates
Deduction Code	Plan Name	Bargaining Unit	Rate Effective Date	Premium
Deduction Code	Plan Name	Bargaining Unit	Rate Effective Date	Single	2 Person	Family
462	Care Plus Prepaid	WSEU 2,3,5,6,12	01/01/2011	$32.99	N/A	$81.07
463	DentalBlue	WSP 15	09/01/2005	$36.90	N/A	$99.62
464	DentaCare Smile Plus	UPQHC 11	07/01/2010	$42.05	N/A	$113.55
465	Freedom Advance	WEAC 13	09/01/2008	$56.21	$105.25	$176.50
466	Delta Exclusive Provider	WSEU 2,3,5,6,12	01/01/2010	$27.28	$53.87	$102.98
466	Delta Premier	WSEU 2,3,5,6,12	01/01/2010	$29.85	$58.83	$111.09
504	Freedom Basic	WPEC 7 PERSA 8 WSP 15	01/01/2011	$25.53	$52.87	$94.83
505	Freedom Advance	WPEC 7 PERSA 8 WSP 15	01/01/2011	$40.70	$81.23	$133.43

2009 Union Represented Dental Monthly Rates
Deduction Code	Plan Name	Bargaining Unit	Rate Effective Date	Premium
Deduction Code	Plan Name	Bargaining Unit	Rate Effective Date	Single	2 Person	Family
462	Care Plus Prepaid	WSEU 2,3,5,6,12	01/01/09	$30.50	N/A	$74.96
463	DentalBlue	WSP 15	09/01/05	$36.90	N/A	$99.62
464	DentaCare Smile Plus	UPQHC 11	07/01/09	$38.23	N/A	$103.23
465	Freedom Advance	WEAC 13	09/01/08	$56.21	$105.25	$176.50
466	Delta Exclusive Provider	WSEU 2,3,5,6,12	01/01/08	$27.28	$53.87	$102.98
466	Delta Premier	WSEU 2,3,5,6,12	01/01/08	$29.85	$58.83	$111.09
504	Freedom Basic	WPEC 7 PERSA 8 WSP 15	08/01/06	$24.32	$50.36	$90.32
505	Freedom Advance	WPEC 7 PERSA 8 WSP 15	08/01/06	$38.77	$77.37	$127.19
N/A	Madison Teachers Assistants Association	TAA	N/A	NONE	NONE	NONE

2006 Union Represented Dental Premiums
Deduction Code	Plan Name	Bargaining Unit	Rate Effective Date	Premium
Deduction Code	Plan Name	Bargaining Unit	Rate Effective Date	Single	2 Person	Family
462	Care Plus Prepaid	WSEU 2,3,5,6,12	01/01/06	$26.65	N/A	$65.50
462	Care Plus Prepaid	WSEU 2,3,5,6,12	01/01/08	$29.05	N/A	$71.39
463	DentalBlue	WSP 15	09/01/05	$36.90	N/A	$99.62
464	DentaCare Smile Plus	UPQHC 11	07/01/08	$36.07	N/A	$97.39
			07/01/07	$34.03	N/A	$91.88
			07/01/06	$32.10	N/A	$86.68
465	Freedom Advance	WEAC 13	08/01/07	$54.31	$101.70	$170.54
466	Delta Exclusive Provider	WSEU 2,3,5,6,12	01/01/07	$23.73	$46.85	$89.55
466	Delta Premier	WSEU 2,3,5,6,12	01/01/07	$26.67	$52.53	$99.03
504	Freedom Basic	WPEC 7 PERSA 8 WSP 15	08/01/06	$24.32	$50.36	$90.32
505	Freedom Advance	WPEC 7 PERSA 8 WSP 15	08/01/06	$38.77	$77.37	$127.19
N/A	Madison Teachers Assistants Association	TAA	N/A	NONE	NONE	NONE

2005 Union Represented Dental Premiums
Deduction Code	Plan Name	Bargaining Unit	Rate Effective Date	Premium
Deduction Code	Plan Name	Bargaining Unit	Rate Effective Date	Single	2 Person	Family
462	Care Plus Prepaid	WSEU 2,3,5,6,12	01/01/05	$26.65	N/A	$65.50
463	DentalBlue	WSP 15	09/01/03	$25.11	N/A	$67.80
464	DentaCare Smile Plus	UPQHC 11	07/01/04	$28.57	N/A	$77.14
465	Freedom Advance	WEAC 13	08/01/04	$36.25	$67.88	$113.83
466	Delta Care	WSEU 2,3,5,6,12	02/01/04	$16.87	$33.07	$57.76
466	Delta Preferred	WSEU 2,3,5,6,12	02/01/04	$17.22	$33.91	$58.74
466	Delta Premier	WSEU 2,3,5,6,12	02/01/04	$26.70	$51.80	$81.56
468	DentalBlue DentaCare HMO — Region 1 (Kenosha, Milwaukee, Ozaukee, Racine, Washington and Waukesha counties)	WSEU 2,3,5,6,12	01/01/05	$18.14	$35.47	$58.22
468	DentalBlue DentaCare HMO — Region 2 (All other Wisconsin counties)	WSEU 2,3,5,6,12	01/01/05	$22.49	$44.98	$71.95
469	DentalBlue Preferred PPO	WSEU 2,3,5,6,12	02/01/04	$16.97	$32.89	$57.98
480	DentalBlue Choice	WSEU 2,3,5,6,12	02/01/04	$42.50	$85.01	$123.55
481	DentalBlue Supplemental	WSEU 2,3,5,6,12	01/01/05	$12.07	$24.14	$37.34
504	Freedom Basic	WPEC 7 PERSA 8 WSP 15	08/01/02	$18.55	$38.41	$68.93
505	Freedom Advance	WPEC 7 PERSA 8 WSP 15	08/01/02	$29.57	$59.01	$97.01
N/A	Madison Teachers Assistants Association	TAA	N/A	NONE	NONE	NONE

Vision Insurance

VSP Vision Plan Monthly Premiums
Year	UW Deduction Code	Employee	Employee + Spouse/Domestic Partner	Employee + Child(ren)	Employee + Family
2019	411	$6.38	$12.76	$14.38	$22.98
2018	411	$6.54	$13.08	$14.73	$23.54
2017	411	$6.54	$13.08	$14.73	$23.54
2016	411	$6.54	$13.08	$14.73	$23.54
2015	411	$6.54	$13.08	$14.73	$23.54
2014	411	$6.35	$12.70	$14.30	$22.85
2013	411	$5.24	$10.49	$11.23	$17.93
2012	411	$5.24	$10.49	$11.23	$17.93
2011	411	$5.24	$10.49	$11.23	$17.93
2010	411	$5.24	$10.49	$11.23	$17.93
2009	410	$5.83	$11.34	$11.88	$17.82
2008	410	$5.83	$11.34	$11.88	$17.82
2007	410	$5.40	$10.50	$11.00	$16.50

Income Continuation Insurance (ICI)

For Coverage Effective 2/1/2019

For Coverage Effective 2/1/2018

For Coverage Effective 2/1/2017

For Coverage Before 2/1/2017

Effective Dates 2/1/2016 - 1/31/2017: Excel · PDF
Effective Dates 2/1/2015 - 1/31/2016: Excel · PDF
Effective Dates 2/1/2014 - 1/31/2015: Excel · PDF
Effective Dates 2/1/2013 - 1/31/2014: Excel · PDF
Effective Dates 2/1/2012 - 1/31/2013: Excel · PDF
Effective Dates 2/1/2010 - 1/31/2012: Excel · PDF
Effective Dates 2/1/2007 - 1/31/2010: Excel · PDF

Accidental Death & Dismemberment · Individual and Family Group Life Insurance · State Group Life · University Insurance Association (UIA) Life Insurance · UW Employees, Inc. Life

Accidental Death & Dismemberment

2016 AD&D Monthly Premium per Principal Sum Elected (Group #GTU 83-64-005)
Year	Principal Sum Elected	Employee Only Premium	Family Plan Premium
2019	25000	$0.73	$1.10
2019	50000	$1.45	$2.20
2019	100000	$2.90	$4.40
2019	150000	$4.35	$6.60
2019	200000	$5.80	$8.80
2019	250000	$7.25	$11.00
2019	300000	$8.70	$13.20
2019	350000	$10.15	$15.40
2019	400000	$11.60	$17.60
2019	450000	$13.05	$19.80
2019	500000	$14.50	$22.00
2018	25000	$0.65	$0.98
2018	50000	$1.30	$1.95
2018	100000	$2.60	$3.90
2018	150000	$3.90	$5.85
2018	200000	$5.20	$7.80
2018	250000	$6.50	$9.75
2018	300000	$7.80	$11.70
2018	350000	$9.10	$13.65
2018	400000	$10.40	$15.60
2018	450000	$11.70	$17.55
2018	500000	$13.00	$19.50
2017	25000	$0.65	$0.98
2017	50000	$1.30	$1.95
2017	100000	$2.60	$3.90
2017	150000	$3.90	$5.85
2017	200000	$5.20	$7.80
2017	250000	$6.50	$9.75
2017	300000	$7.80	$11.70
2017	350000	$9.10	$13.65
2017	400000	$10.40	$15.60
2017	450000	$11.70	$17.55
2017	500000	$13.00	$19.50
2016	25000	$0.73	$1.10
2016	50000	$1.45	$2.20
2016	100000	$2.90	$4.40
2016	150000	$4.35	$6.60
2016	200000	$5.80	$8.80
2016	250000	$7.25	$11.00
2016	300000	$8.70	$13.20
2016	350000	$10.15	$15.40
2016	400000	$11.60	$17.60
2016	450000	$13.05	$19.80
2016	500000	$14.50	$22.00
2015	25000	$0.73	$1.10
2015	50000	$1.45	$2.20
2015	100000	$2.90	$4.40
2015	150000	$4.35	$6.60
2015	200000	$5.80	$8.80
2015	250000	$7.25	$11.00
2015	300000	$8.70	$13.20
2015	350000	$10.15	$15.40
2015	400000	$11.60	$17.60
2015	450000	$13.05	$19.80
2015	500000	$14.50	$22.00
2014	25000	$0.73	$1.10
2014	50000	$1.45	$2.20
2014	100000	$2.90	$4.40
2014	150000	$4.35	$6.60
2014	200000	$5.80	$8.80
2014	250000	$7.25	$11.00
2014	300000	$8.70	$13.20
2014	350000	$10.15	$15.40
2014	400000	$11.60	$17.60
2014	450000	$13.05	$19.80
2014	500000	$14.50	$22.00
2013	25000	$0.73	$1.10
2013	50000	$1.45	$2.20
2013	100000	$2.90	$4.40
2013	150000	$4.35	$6.60
2013	200000	$5.80	$8.80
2013	250000	$7.25	$11.00
2013	300000	$8.70	$13.20
2013	350000	$10.15	$15.40
2013	400000	$11.60	$17.60
2013	450000	$13.05	$19.80
2013	500000	$14.50	$22.00
2012	25000	$0.73	$1.10
2012	50000	$1.45	$2.20
2012	100000	$2.90	$4.40
2012	150000	$4.35	$6.60
2012	200000	$5.80	$8.80
2012	250000	$7.25	$11.00
2012	300000	$8.70	$13.20
2012	350000	$10.15	$15.40
2012	400000	$11.60	$17.60
2012	450000	$13.05	$19.80
2012	500000	$14.50	$22.00
2011	25000	$0.73	$1.10
2011	50000	$1.45	$2.20
2011	100000	$2.90	$4.40
2011	150000	$4.35	$6.60
2011	200000	$5.80	$8.80
2011	250000	$7.25	$11.00
2011	300000	$8.70	$13.20
2011	350000	$10.15	$15.40
2011	400000	$11.60	$17.60
2011	450000	$13.05	$19.80
2011	500000	$14.50	$22.00

Life Insurance

Individual and Family Group Life Insurance

Cost per $1000 of Coverage for Employee and Spouse/Domestic Partner
Year	Employee Attained Age	Employee	Spouse/Domestic Partner
2019	27	0.023	0.036
2019	28	0.025	0.040
2019	31	0.032	0.050
2019	34	0.037	0.059
2019	37	0.045	0.072
2019	40	0.068	0.108
2019	43	0.108	0.171
2019	46	0.130	0.207
2019	49	0.181	0.288
2019	52	0.232	0.369
2019	55	0.323	0.513
2019	58	0.403	0.621
2019	61	0.556	0.774
2019	64	0.799	1.080
2019	67	1.117	1.503
2019	70	1.724	2.331
2019	73	2.466	3.330

2018	27	0.023	0.036
2018	28	0.025	0.040
2018	31	0.032	0.050
2018	34	0.037	0.059
2018	37	0.045	0.072
2018	40	0.068	0.108
2018	43	0.108	0.171
2018	46	0.130	0.207
2018	49	0.181	0.288
2018	52	0.232	0.369
2018	55	0.323	0.513
2018	58	0.403	0.621
2018	61	0.556	0.774
2018	64	0.799	1.080
2018	67	1.117	1.503
2018	70	1.724	2.331
2018	73	2.466	3.330

2017	27	0.023	0.036
2017	28	0.025	0.040
2017	31	0.032	0.050
2017	34	0.037	0.059
2017	37	0.045	0.072
2017	40	0.068	0.108
2017	43	0.108	0.171
2017	46	0.130	0.207
2017	49	0.181	0.288
2017	52	0.232	0.369
2017	55	0.323	0.513
2017	58	0.403	0.621
2017	61	0.556	0.774
2017	64	0.799	1.080
2017	67	1.117	1.503
2017	70	1.724	2.331
2017	73	2.466	3.330

2016	27	0.023	0.036
2016	28	0.025	0.04
2016	31	0.032	0.05
2016	34	0.037	0.059
2016	37	0.045	0.072
2016	40	0.068	0.108
2016	43	0.108	0.171
2016	46	0.13	0.207
2016	49	0.181	0.288
2016	52	0.232	0.369
2016	55	0.323	0.513
2016	58	0.403	0.621
2016	61	0.556	0.774
2016	64	0.799	1.08
2016	67	1.117	1.503
2016	70	1.724	2.331
2016	73	2.466	3.33

2015	27	0.023	0.036
2015	28	0.025	0.04
2015	31	0.032	0.05
2015	34	0.037	0.059
2015	37	0.045	0.072
2015	40	0.068	0.108
2015	43	0.108	0.171
2015	46	0.13	0.207
2015	49	0.181	0.288
2015	52	0.232	0.369
2015	55	0.323	0.513
2015	58	0.403	0.621
2015	61	0.556	0.774
2015	64	0.799	1.08
2015	67	1.117	1.503
2015	70	1.724	2.331
2015	73	2.466	3.33

2014	27	0.023	0.036
2014	28	0.025	0.04
2014	31	0.032	0.05
2014	34	0.037	0.059
2014	37	0.045	0.072
2014	40	0.068	0.108
2014	43	0.108	0.171
2014	46	0.13	0.207
2014	49	0.181	0.288
2014	52	0.232	0.369
2014	55	0.323	0.513
2014	58	0.403	0.621
2014	61	0.556	0.774
2014	64	0.799	1.08
2014	67	1.117	1.503
2014	70	1.724	2.331
2014	73	2.466	3.33

2013	27	0.023	0.036
2013	28	0.025	0.04
2013	31	0.032	0.05
2013	34	0.037	0.059
2013	37	0.045	0.072
2013	40	0.068	0.108
2013	43	0.108	0.171
2013	46	0.13	0.207
2013	49	0.181	0.288
2013	52	0.232	0.369
2013	55	0.323	0.513
2013	58	0.403	0.621
2013	61	0.556	0.774
2013	64	0.799	1.08
2013	67	1.117	1.503
2013	70	1.724	2.331
2013	73	2.466	3.33

2012	27	0.023	0.036
2012	28	0.025	0.04
2012	31	0.032	0.05
2012	34	0.037	0.059
2012	37	0.045	0.072
2012	40	0.068	0.108
2012	43	0.108	0.171
2012	46	0.13	0.207
2012	49	0.181	0.288
2012	52	0.232	0.369
2012	55	0.323	0.513
2012	58	0.403	0.621
2012	61	0.556	0.774
2012	64	0.799	1.08
2012	67	1.117	1.503
2012	70	1.724	2.331
2012	73	2.466	3.33

2011	27	0.023	0.036
2011	28	0.025	0.04
2011	31	0.032	0.05
2011	34	0.037	0.059
2011	37	0.045	0.072
2011	40	0.068	0.108
2011	43	0.108	0.171
2011	46	0.13	0.207
2011	49	0.181	0.288
2011	52	0.232	0.369
2011	55	0.323	0.513
2011	58	0.403	0.621
2011	61	0.556	0.774
2011	64	0.799	1.08
2011	67	1.117	1.503
2011	70	1.724	2.331
2011	73	2.466	3.33

Monthly Premium Table for Employee and Spouse/Domestic Partner Coverage (Deduction Code 428)
		Employee				Spouse/Domestic Partner
Year	Employee Attained Age	$5,000	$10,000	$15,000	$20,000	$5,000	$10,000
2019	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2019	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2019	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2019	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2019	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2019	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2019	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2019	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2019	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2019	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2019	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2019	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2019	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2019	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2019	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2019	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2019	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2019	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2019	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2019	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2019	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2019	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2019	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2019	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2019	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2019	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2019	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2019	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2019	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2019	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2019	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2019	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2019	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2019	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2019	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2019	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2019	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2019	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2019	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2019	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2019	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2019	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2019	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2019	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2019	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2019	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2019	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

2018	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2018	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2018	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2018	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2018	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2018	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2018	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2018	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2018	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2018	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2018	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2018	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2018	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2018	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2018	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2018	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2018	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2018	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2018	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2018	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2018	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2018	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2018	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2018	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2018	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2018	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2018	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2018	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2018	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2018	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2018	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2018	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2018	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2018	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2018	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2018	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2018	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2018	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2018	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2018	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2018	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2018	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2018	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2018	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2018	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2018	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2018	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

2017	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2017	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2017	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2017	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2017	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2017	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2017	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2017	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2017	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2017	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2017	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2017	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2017	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2017	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2017	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2017	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2017	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2017	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2017	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2017	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2017	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2017	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2017	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2017	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2017	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2017	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2017	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2017	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2017	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2017	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2017	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2017	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2017	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2017	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2017	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2017	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2017	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2017	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2017	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2017	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2017	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2017	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2017	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2017	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2017	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2017	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2017	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

2016	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2016	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2016	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2016	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2016	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2016	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2016	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2016	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2016	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2016	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2016	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2016	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2016	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2016	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2016	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2016	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2016	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2016	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2016	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2016	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2016	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2016	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2016	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2016	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2016	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2016	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2016	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2016	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2016	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2016	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2016	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2016	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2016	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2016	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2016	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2016	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2016	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2016	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2016	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2016	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2016	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2016	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2016	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2016	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2016	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2016	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2016	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

2015	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2015	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2015	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2015	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2015	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2015	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2015	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2015	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2015	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2015	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2015	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2015	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2015	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2015	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2015	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2015	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2015	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2015	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2015	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2015	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2015	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2015	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2015	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2015	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2015	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2015	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2015	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2015	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2015	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2015	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2015	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2015	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2015	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2015	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2015	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2015	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2015	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2015	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2015	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2015	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2015	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2015	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2015	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2015	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2015	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2015	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2015	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

2014	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2014	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2014	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2014	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2014	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2014	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2014	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2014	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2014	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2014	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2014	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2014	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2014	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2014	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2014	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2014	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2014	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2014	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2014	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2014	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2014	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2014	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2014	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2014	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2014	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2014	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2014	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2014	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2014	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2014	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2014	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2014	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2014	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2014	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2014	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2014	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2014	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2014	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2014	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2014	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2014	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2014	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2014	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2014	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2014	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2014	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2014	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

2013	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2013	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2013	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2013	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2013	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2013	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2013	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2013	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2013	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2013	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2013	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2013	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2013	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2013	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2013	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2013	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2013	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2013	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2013	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2013	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2013	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2013	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2013	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2013	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2013	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2013	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2013	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2013	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2013	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2013	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2013	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2013	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2013	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2013	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2013	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2013	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2013	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2013	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2013	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2013	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2013	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2013	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2013	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2013	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2013	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2013	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2013	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

2012	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2012	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2012	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2012	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2012	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2012	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2012	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2012	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2012	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2012	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2012	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2012	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2012	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2012	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2012	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2012	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2012	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2012	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2012	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2012	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2012	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2012	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2012	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2012	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2012	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2012	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2012	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2012	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2012	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2012	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2012	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2012	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2012	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2012	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2012	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2012	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2012	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2012	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2012	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2012	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2012	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2012	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2012	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2012	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2012	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2012	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2012	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

2011	27	$0.12	$0.23	$0.35	$0.46	$0.18	$0.36
2011	28	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2011	29	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2011	30	$0.13	$0.25	$0.38	$0.50	$0.20	$0.40
2011	31	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2011	32	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2011	33	$0.16	$0.32	$0.48	$0.64	$0.25	$0.50
2011	34	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2011	35	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2011	36	$0.19	$0.37	$0.56	$0.74	$0.30	$0.59
2011	37	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2011	38	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2011	39	$0.23	$0.45	$0.68	$0.90	$0.36	$0.72
2011	40	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2011	41	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2011	42	$0.34	$0.68	$1.02	$1.36	$0.54	$1.08
2011	43	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2011	44	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2011	45	$0.54	$1.08	$1.62	$2.16	$0.86	$1.71
2011	46	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2011	47	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2011	48	$0.65	$1.30	$1.95	$2.60	$1.04	$2.07
2011	49	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2011	50	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2011	51	$0.91	$1.81	$2.72	$3.62	$1.44	$2.88
2011	52	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2011	53	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2011	54	$1.16	$2.32	$3.48	$4.64	$1.85	$3.69
2011	55	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2011	56	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2011	57	$1.62	$3.23	$4.85	$6.46	$2.57	$5.13
2011	58	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2011	59	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2011	60	$2.02	$4.03	$6.05	$8.06	$3.11	$6.21
2011	61	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2011	62	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2011	63	$2.78	$5.56	$8.34	$11.12	$3.87	$7.74
2011	64	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2011	65	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2011	66	$4.00	$7.99	$11.99	$15.98	$5.40	$10.80
2011	67	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2011	68	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2011	69	$5.59	$11.17	$16.76	$22.34	$7.52	$15.03
2011	70	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2011	71	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2011	72	$8.62	$17.24	$25.86	$34.48	$11.66	$23.31
2011	73	$12.33	$24.66	$36.99	$49.32	$16.65	$33.30

Monthly Premium Table for Child Coverage
Year	Amount of Insurance	Monthly Premium
$2500 (Code Y)	$0.18
$5000 (Code A)	0.35
$7500 (Code B)	0.53
$10,000 (Code C)	0.70

State Group Life Insurance

Basic/Supplemental/Additional Coverage Monthly Premium Rates
(Deduction Codes: Basic=412, Basic Supplemental=414, Additional 1 Unit=419, Additional 2 Units=416, Additional 3 Units=417, Spouse & Dependent=420)
Year	Age as of April 1	Basic and Supplemental Rate per $1000	Additional Rate per $1000	Spouse and Dependent
2019	0 - 29	0.04	0.06	--
2019	30 - 34	0.06	0.04	--
2019	35 - 39	0.06	0.04	--
2019	40 - 44	0.09	0.06	--
2019	45 - 49	0.16	0.11	--
2019	50 - 54	0.25	0.17	--
2019	55 - 59	0.35	0.23	--
2019	60 - 64	0.47	0.32	--
2019	65 - 69	0.6	0.41	--

2018	0 - 29	0.06	0.04	--
2018	30 - 34	0.06	0.04	--
2018	35 - 39	0.06	0.04	--
2018	40 - 44	0.09	0.06	--
2018	45 - 49	0.15	0.10	--
2018	50 - 54	0.24	0.16	--
2018	55 - 59	0.33	0.22	--
2018	60 - 64	0.45	0.30	--
2018	65 - 69	0.39	0.59	--

2017	0 - 29	0.06	0.04	--
2017	30 - 34	0.06	0.04	--
2017	35 - 39	0.06	0.04	--
2017	40 - 44	0.09	0.06	--
2017	45 - 49	0.10	0.15	--
2017	50 - 54	0.16	0.24	--
2017	55 - 59	0.22	0.33	--
2017	60 - 64	0.30	0.45	--
2017	65 - 69	0.39	0.59	--

2016	0 - 29	0.04	0.06	--
2016	30 - 34	0.04	0.06	--
2016	35 - 39	0.06	0.04	--
2016	40 - 44	0.09	0.06	--
2016	45 - 49	0.15	0.10	--
2016	50 - 54	0.24	0.16	--
2016	55 - 59	0.33	0.22	--
2016	60 - 64	0.30	0.45	--
2016	65 - 69	0.39	0.59	--

2015	0 - 29	0.04	0.06	--
2015	30 - 34	0.04	0.06	--
2015	35 - 39	0.06	0.04	--
2015	40 - 44	0.09	0.06	--
2015	45 - 49	0.15	0.10	--
2015	50 - 54	0.24	0.16	--
2015	55 - 59	0.33	0.22	--
2015	60 - 64	0.45	0.30	--
2015	65 - 69	0.39	0.59	--

State Group Life Insurance

Basic/Supplemental/Additional Coverage Monthly Premium Rates
(Deduction Codes: Basic=412, Basic Supplemental=414, Additional 1 Unit=419, Additional 2 Units=416, Additional 3 Units=417, Spouse & Dependent=420)
Effective through 3/31/2016
Age As of April 1	Basic and Supplemental	Additional	Spouse & Dependent
Age As of April 1	2013/2014/2015 Rate per $1000	2013/2014/2015 Rate per $1000	Spouse & Dependent
Under age 30	$.04	$.06	One Unit of Coverage: $2.50 per $10,000 Spouse and $5000 for each dependent Two Units of Coverage: $5.00 per $20,000 Spouse and $10,000 for each dependent
30-34	.04	.06
35-39	.04	.06
40-44	.06	.09
45-49	.10	.15
50-54	.16	.24
55-59	.22	.33
60-64	.30	.45
65-69	.39	.59

Over Age 70 Additional Coverage (Deduction Code: 418)
Effective through 3/31/2016
Year	Age as of April 1	Rate per $1000
2019	70	1.00
2019	71	1.15
2019	72	1.25
2019	73	1.45
2019	74	1.6
2019	75	1.8
2019	76	1.95
2019	77	2.06

2018	70	1.00
2018	71	1.15
2018	72	1.25
2018	73	1.45
2018	74	1.60
2018	75	1.80
2018	76	1.95
2018	77	2.06

2017	70	1.00
2017	71	1.15
2017	72	1.25
2017	73	1.45
2017	74	1.60
2017	75	1.80
2017	76	1.95
2017	77	2.06

2016	70	1.00
2016	71	1.15
2016	72	1.25
2016	73	1.45
2016	74	1.60
2016	75	1.80
2016	76	1.95
2016	77	2.06

2015	70	1.00
2015	71	1.15
2015	72	1.25
2015	73	1.45
2015	74	1.60
2015	75	1.80
2015	76	1.95
2015	77	2.06

State Group Life Insurance Premiums Effective through 03/31/2013
Age As of April 1	Basic & Supplemental Per $1,000	Additional Per $1,000	Spouse & Dependent
Under age 30	$.04	$.06	One Unit of Coverage: $2.50 per $10,000 Spouse and $5,000 for each dependent Two Units of Coverage: $5.00 per $20,000 Spouse and $10,000 for each dependent
30-34	.04	.06
35-39	.05	.06
40-44	.06	.09
45-49	.10	.15
50-54	.16	.24
55-59	.22	.33
60-64	.30	.45
65-69	.39	.59

Over Age 70 Additional Coverage (Deduction Code: 418) — Effective through 03/31/2013
Age as of April 1	Rate per $1,000
70	$1.00
71	1.15
72	1.25
73	1.45
74	1.60
75	1.80
76	1.95
77+	2.06

State Group Life Insurance Premiums Effective through 03/31/2012
Age As of April 1	Basic & Supplemental Per $1,000	Additional Per $1,000	Spouse & Dependent
Under age 30	$.04	$.06	One Unit of Coverage: $2.50 per $10,000 Spouse and $5,000 for each dependent Two Units of Coverage: $5.00 per $20,000 Spouse and $10,000 for each dependent
30-34	.04	.07
35-39	.05	.07
40-44	.06	.09
45-49	.10	.15
50-54	.16	.24
55-59	.25	.37
60-64	.33	.50
65-69	.44	.66

Over Age 70 Additional Coverage (Deduction Code: 418) — Effective through 03/31/2012
Age as of April 1	Rate per $1,000
70	$1.00
71	1.15
72	1.25
73	1.45
74	1.60
75	1.80
76	1.95
77+	2.06

State Group Life Insurance Premiums Effective through 03/31/2011
Age As of April 1	Basic & Supplemental Per $1,000	Additional Per $1,000	Spouse & Dependent
Under age 30	$.05	$.07	One Unit of Coverage: $2.50 per $10,000 Spouse and $5,000 for each dependent Two Units of Coverage: $5.00 per $20,000 Spouse and $10,000 for each dependent
30-34	.05	.08
35-39	.05	.08
40-44	.07	.10
45-49	.11	.17
50-54	.18	.27
55-59	.28	.42
60-64	.38	.57
65-69	.50	.75

Over Age 70 Additional Coverage (Deduction Code: 418) — Effective through 03/31/2011
Age as of April 1	Rate per $1,000
70	$1.00
71	1.15
72	1.25
73	1.45
74	1.60
75	1.80
76	1.95
77	2.15
78	2.45
79	2.75
80	3.10
81	3.40
82	3.70
83	4.10
84	4.50
85	4.90
86	5.30
87	5.70
88	6.35
89	7.00
90+	Available upon request

University Insurance Association (UIA) Life Insurance

University Insurance Association Schedule of Benefits/Coverage Amounts (Group #32872-G)
Age as of Oct 1	Premium	Benefit Amount
Under 28	$2.00	$101000
28-30		98100
31-33		90900
34-36		78900
37-39		65000
40-42		50900
43-45		39100
46-48		30000
49-51		22600
52-54		17200
55-57		13100
58-60		10300
61-63		8200
64-66		6100
67-69		4500
70+		3400

University of Wisconsin Employees, Inc. Life Insurance

UW Employees, Inc. Monthly Premium Table — Premium and Coverage Amounts Effective 2014
Employee Age	Coverage Amount	Premium
under 35	$33,000	$1.00
35 - 39	28,000	1.25
40 - 44	25,000	1.60
45 - 49	18,000	2.00
50 - 54	15,000	2.40
55 - 59	13,000	3.80
60 - 64	12,000	4.35
65 and over	7,000	3.00

UW Employees, Inc. Monthly Premium Table — Premium and Coverage Amounts Effective 2019
Employee Age	Coverage Amount	Premium
under 35	$33,000	$0.75
35 - 39	28,000	0.94
40 - 44	25,000	1.20
45 - 49	18,000	1.50
50 - 54	15,000	1.80
55 - 59	13,000	2.85
60 - 64	12,000	3.26
65 and over	7,000	2.25

UW Employees, Inc. Monthly Premium Table — Premium and Coverage Amounts Effective October 1, 2011
Employee Age	Coverage Amount	Premium
under 35	$30,000	$1.00
35 - 39	25,000	1.25
40 - 44	22,000	1.60
45 - 49	15,000	2.00
50 - 54	12,000	2.40
55 - 59	10,000	3.80
60 - 64	9000	4.35
65 and over	4000	3.00

UW Employees, Inc. Monthly Premium Table — Premium and Coverage Amounts Effective January 1, 2010
Employee Age	Coverage Amount	Premium
under 35	$25,000	$1.00
35 - 39	21,000	1.25
40 - 44	18,000	1.60
45 - 49	12,000	2.00
50 - 54	9,000	2.40
55 - 59	7,500	3.80
60 - 64	7,000	4.35
over 64	3,000	3.00

Historical Benefit Plan Premiums

Health Insurance

EPIC Benefits+

EPIC Benefits+

Anthem DentalBlue Insurance

Dental Wisconsin

Union Dental Plans

Vision Insurance

Income Continuation Insurance (ICI)

Accidental Death & Dismemberment

Life Insurance

CONTACT US