SHORT TERM DISABILITY benefits for employees that benefit employers
Short Term Disability VOLUNTARY PROTECT YOUR WORKFORCE A 2014 Social Security Fact sheet predicts that just over one in four of today s 20-year-olds will become disabled before reaching age 67. 1 According to the Integrated Benefits Institute, research repeatedly shows that absenteeism, disability, employee performance and lost productivity have a greater negative impact than medical and prescription drug costs combined. 2 So, when you consider the relatively low cost of voluntary disability plans, the real question is: Why wouldn t you offer this option to your employees? VOLUNTARY SHORT TERM DISABILITY INCOME COVERAGE Companion Life gives your employees the peace of mind that a protected paycheck brings. A program designed to help maintain a family s current lifestyle and its plans for the future if the employee is disabled off the job. A plan with the flexibility to meet an employee s individual needs. A program that provides a significant enhancement to an employer s benefit portfolio at no additional cost! COVERAGES This Voluntary Short Term Disability Income insurance plan pays disability benefits for covered non-occupational injuries and illnesses. Maternity, alcoholism and drug addiction, and mental or nervous conditions are covered the same as any other illness. A partial disability benefit is included to support a recovering employee s return to full potential through part-time work. EVIDENCE OF INSURABILITY No evidence of insurability is required if the employee is at work on the effective date of coverage. Evidence of insurability is required if employees enroll after their initial eligibility period. PARTICIPATION A minimum of three eligible employees must enroll for groups of 3-9 lives. A minimum of five eligible employees must enroll for groups of 10 or more lives. ENROLLMENT AGE FREEZE When an employee enrolls for coverage, as long as he or she remains enrolled, the premium payable for the selected insurance coverage will always be based upon the employee s age at the time of original enrollment. EMPLOYER ELIGIBILITY An employer group is eligible for coverage: n If the group is not heavily financed by federal, state or local government entities, or heavily dependent on the procurement of government contracts; and n If it is not a union, health and welfare fund or similar entity; and n If 50 percent or more of the group is not in commissioned sales; and n If 50 percent or more of the group is not related by blood or marriage; and n If the group is not subject to seasonal fluctuations; and n If the group has been in business more than six months. EMPLOYEE ELIGIBILITY Employees meeting all of the following are eligible for coverage: n Full-time employment (working 30 or more hours weekly) n Actively at work on effective date of coverage n Employees pay 100 percent of the premium 1 Social Security Administration, Fact Sheet, April 2014 2 Do Bleak Economic Times Mean Tougher Times for Employer Benefits Programs?, IBI Quick Study, August 2011
PLAN DESIGNS The employer may select one of the following eight plan designs to offer employees. Employers with 100 or more eligible employees may offer two plan designs for the employee group. Plan Number Benefits Begin Duration Accident Sickness Plan 1 1st Day 8th Day 13 Weeks Plan 2 8th Day 8th Day 13 Weeks Plan 3 15th Day 15th Day 13 Weeks Plan 4 1st Day 8th Day 26 Weeks Plan 5 8th Day 8th Day 26 Weeks Plan 6 15th Day 15th Day 26 Weeks Plan 7 15th Day 15th Day 52 Weeks Plan 8 30th Day 30th Day 52 Weeks BENEFITS Employees may choose one of 23 weekly benefit payments, from $150 to $1,250, not to exceed 662/3 percent of basic weekly earnings. Employee Selection For the Benefit Annual Salary Must Be at Least: Benefit Level A $150 per Week $11,700 Benefit Level B $200 per Week $15,600 Benefit Level C $250 per Week $19,500 Benefit Level D $300 per Week $23,400 Benefit Level E $350 per Week $27,300 Benefit Level F $400 per Week $31,200 Benefit Level G $450 per Week $35,100 Benefit Level H $500 per Week $39,000 Benefit Level I $550 per Week $42,900 Benefit Level J $600 per Week $46,800 Benefit Level K $650 per Week $50,700 Benefit Level L $700 per Week $54,600 Benefit Level M $750 per Week $58,500 Benefit Level N $800 per Week $62,400 Benefit Level O $850 per Week $66,300 Benefit Level P $900 per Week $70,200 Benefit Level Q $950 per Week $74,100 Benefit Level R $1,000 per Week $78,000 Benefit Level S $1,050 per Week $81,900 Benefit Level T $1,100 per Week $85,800 Benefit Level U $1,150 per Week $89,700 Benefit Level V $1,200 per Week $93,600 Benefit Level W $1,250 per Week $97,500 All plans include a $10,000 Accidental Death and Dismemberment (AD&D) benefit for each insured employee. PRE-EXISTING CONDITIONS We will not cover a disability that begins in the first 12 months after the effective date that is due to a pre-existing condition. A pre-existing condition means a condition resulting from an injury that occurred or a sickness that began before your effective date of coverage under the policy and for which medical treatment or advice was received or recommended no more than 12 months before the effective date of your coverage under the policy that causes total disability while you are insured under the policy. WAIVER OF PRE-EXISTING CONDITIONS LIMITATION The Pre-existing Condition Limitation will not apply if the insured was covered under the prior carrier s Short Term Disability policy on the policy s termination date and if the insured was responsible for paying the entire premium for his or her coverage under the prior carrier s plan. See policy for further details. ABOUT COMPANION LIFE Companion Life Insurance Company has specialized in group benefits for more than 40 years. We have earned an A.M. Best rating of A+ (Superior)*. We ve earned these high marks due to our fiscal strength, investment practices and sound management. Now, we want to earn your trust by giving you the highest level of service and responsiveness possible. Talk with your Companion Life agent today. See for yourself how the Companion Life Voluntary Short Term Disability Plan is a benefit plan that benefits you. *Rating as of Dec. 21, 2016. For the latest rating, access ambest.com. Opinion from the leading provider of insurer ratings of a company s financial strength and ability to meet its obligations to policyholders.
ELIGIBLE INDUSTRIES FOR VOLUNTARY SHORT TERM DISABILITY COVERAGE Apparel (2311-2399) Business Services (7311-7359, 7371-7379, 7383-7389) Communications (4812-4899) Drugs (2833-2836) Educational Services, Schools (8211-8299) Electric, Gas & Sanitary Services (4911-4971) Electronics & Other Electrical Equipment (3612-3699) Engineering & Management (8711-8748) Finance, Insurance & Real Estate (6011-6799) Flooring & Special Product Saw Mills (2426-2429) Food Products (2011-2099) Furniture (2511-2599) Industrial Machinery (3511-3599) Agriculture Services (0711-0724, 0751-0783) Automotive Repair, Rentals, Parking (7513-7549) Bowling Centers & Dance Studios (7911, 7933) Chemical Products (2812-2824, 2841-2869, 2893-2899) Courts & Public Safety (9211, 9222-9223, 9229) Employment & Help ncies (7361-7363) Government, Legislative, General & Finance (9111-9199, 9311) Hotels & Other Lodging Places (7011-7041) Leather Products (3131-3199) Logging & Saw Mills (2411-2421) Mineral Products (3295-3299) Organizations, Membership (8611-8699) Agriculture, Crops & Livestock (0111-0291) Air, Bus, Rail, Trucking, Water Transportation (4011-4581) Auto Dealers (5500-5599) Chemicals, Agriculture (2873-2891) Construction (1521-1799) Fabricated Metal Products (3411-3479, 3491-3499) PREFERRED INDUSTRIES Instruments (3812-3873) Legal Services (8111) Millwork, Wood Containers, Buildings, Products (2431-2499) Miscellaneous Manufacturing (3911-3999) Motion Pictures & Video Rental (7812-7841) Museums, Gardens (8412-8422) Printing & Publishing (2711-2796) Repair Services (7622-7699) Retail Trade (5211-5736, 5912-5999) Textile Mill Products (2211-2299) Veterinary Services (0741-0742) Wholesale Trade (5012-5199) STANDARD INDUSTRIES NON-STANDARD INDUSTRIES Personal Services, Taxes, Photos (7211-7299) Petroleum & Coal Products (2911-2999) Pipelines, except Natural Gas (4612-4619) Public Administration (9411-9661) Rubber & Plastic Products (3011-3089) Security Systems (7382) Social Services (8322-8399) Stone, Clay & Glass Products (3211-3291) Tobacco Products (2111-2141) Transportation Equipment (3711-3799) Transportation Services, Freight, Cargo, Passengers (4724-4789) Fishing, Hunting,Trapping (0912-0971) Forestry (0811-0851) Health Services (8011-8099) Leather Tanning & Finishing (3111) Paper Products (2611-2679) Steel Works, Foundries & Smelting (3312-3399) NON-ELIGIBLE INDUSTRIES FOR VOLUNTARY SHORT TERM DISABILITY COVERAGE Ammunition (3482-3483) Amusement Parks, Clubs, Sports, Other Recreational Services (7941-7999) Asbestos Products (3292) Detective, Guard and Armored Car Services (7381) Drinking Places (5813) Eating Places (5812) Explosives (2892) Fire Protection (9224) Metal & Coal Mining (1011-1241) National Security & International Affairs (9711-9721) Oil & Gas Extraction, Mining & Quarrying (1311-1499) Police Protection (9221) Private Households (8811) Small Arms, Ordnance and Accessories (3484-3489) Theatrical Producers, Bands, Entertainers (7922-7929) Wrecking & Demolition Work (1795) This list is not all-inclusive. Companion Life reserves the right to reject any business or industry that does not, in our opinion, represent a sound underwriting risk. SEE FOR YOURSELF HOW COMPANION LIFE VOLUNTARY GROUP PLANS ARE BENEFITS THAT BENEFIT YOU Companion Life offers a full portfolio of Voluntary Group Benefits for employees: n Voluntary Group Long Term Disability Insurance n Voluntary Group Short Term Disability Insurance n Voluntary Group Dental Insurance n Voluntary Group AD&D n Voluntary Group Life Insurance FOR A PROPOSAL, CONTACT: P.O. Box 100102 n Columbia, SC 29202-3102 n 800-753-0404 phone n 800-836-5433 fax proposals@companiongroup.com n CompanionLife.com This brochure contains only a brief description of the benefits. It is not the contract. Rates and provisions are subject to change. Actual coverage is subject to the terms and conditions of the contract when it becomes effective, and actual contract language will be reflected in each employee s Certificate of Coverage. SOME PRODUCTS NOT AVAILABLE IN ALL STATES 95960 Rev. 8/17
PREFERRED INDUSTRIES MONTHLY PREMIUM COST PLAN 1 1-8-13 < - 30 8.46 11.28 14.10 16.92 19.74 22.56 25.38 28.20 31.02 33.84 36.66 39.48 30-34 8.72 11.62 14.53 17.43 20.34 23.24 26.15 29.05 31.96 34.86 37.77 40.67 35-39 8.72 11.62 14.53 17.43 20.34 23.24 26.15 29.05 31.96 34.86 37.77 40.67 40-44 8.72 11.62 14.53 17.43 20.34 23.24 26.15 29.05 31.96 34.86 37.77 40.67 45-49 9.21 12.28 15.35 18.42 21.49 24.56 27.63 30.70 33.77 36.84 39.91 42.98 50-54 11.04 14.72 18.40 22.08 25.76 29.44 33.12 36.80 40.48 44.16 47.84 51.52 55-59 12.89 17.18 21.48 25.77 30.07 34.36 38.66 42.95 47.25 51.54 55.84 60.13 60-64 15.09 20.12 25.15 30.18 35.21 40.24 45.27 50.30 55.33 60.36 65.39 70.42 65-69 19.88 26.50 33.13 39.75 46.38 53.00 59.63 66.25 72.88 79.50 86.13 92.75 70-74 26.75 35.66 44.58 53.49 62.41 71.32 80.24 89.15 98.07 106.98 115.90 124.81 75+ 33.75 45.00 56.25 67.50 78.75 90.00 101.25 112.50 123.75 135.00 146.25 157.50 < - 30 42.30 45.12 47.94 50.76 53.58 56.40 59.22 62.04 64.86 67.68 70.50 30-34 43.58 46.48 49.39 52.29 55.20 58.10 61.01 63.91 66.82 69.72 72.63 35-39 43.58 46.48 49.39 52.29 55.20 58.10 61.01 63.91 66.82 69.72 72.63 40-44 43.58 46.48 49.39 52.29 55.20 58.10 61.01 63.91 66.82 69.72 72.63 45-49 46.05 49.12 52.19 55.26 58.33 61.40 64.47 67.54 70.61 73.68 76.75 50-54 55.20 58.88 62.56 66.24 69.92 73.60 77.28 80.96 84.64 88.32 92.00 55-59 64.43 68.72 73.02 77.31 81.61 85.90 90.20 94.49 98.79 103.08 107.38 60-64 75.45 80.48 85.51 90.54 95.57 100.60 105.63 110.66 115.69 120.72 125.75 65-69 99.38 106.00 112.63 119.25 125.88 132.50 139.13 145.75 152.38 159.00 165.63 70-74 133.73 142.64 151.56 160.47 169.39 178.30 187.22 196.13 205.05 213.96 222.88 75+ 168.75 180.00 191.25 202.50 213.75 225.00 236.25 247.50 258.75 270.00 281.25 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING PREFERRED INDUSTRIES WITH 3-99 EMPLOYEES 0741-0742 Veterinary Services 4812-4899 Communications 2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services 2211-2299 Textile Mill Products 5012-5199 Wholesale Trade 2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade 2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate 2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services 2511-2599 Furniture 7371-7379, 7383-7389 Business Services 2711-2796 Printing & Publishing 7622-7699 Repair Services 2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental 3511-3599 Industrial Machingery 8111 Legal Services 3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools 3812-3873 Instruments 8412-8422 Museums, Gardens 3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management 95961-Preferred (Rates effective 07/15) Rev. 7/15
PREFERRED INDUSTRIES MONTHLY PREMIUM COST PLAN 2 8-8-13 < - 30 7.61 10.14 12.68 15.21 17.75 20.28 22.82 25.35 27.89 30.42 32.96 35.49 30-34 7.86 10.48 13.10 15.72 18.34 20.96 23.58 26.20 28.82 31.44 34.06 36.68 35-39 7.86 10.48 13.10 15.72 18.34 20.96 23.58 26.20 28.82 31.44 34.06 36.68 40-44 7.86 10.48 13.10 15.72 18.34 20.96 23.58 26.20 28.82 31.44 34.06 36.68 45-49 8.22 10.96 13.70 16.44 19.18 21.92 24.66 27.40 30.14 32.88 35.62 38.36 50-54 9.95 13.26 16.58 19.89 23.21 26.52 29.84 33.15 36.47 39.78 43.10 46.41 55-59 11.66 15.54 19.43 23.31 27.20 31.08 34.97 38.85 42.74 46.62 50.51 54.39 60-64 13.62 18.16 22.70 27.24 31.78 36.32 40.86 45.40 49.94 54.48 59.02 63.56 65-69 17.91 23.88 29.85 35.82 41.79 47.76 53.73 59.70 65.67 71.64 77.61 83.58 70-74 24.06 32.08 40.10 48.12 56.14 64.16 72.18 80.20 88.22 96.24 104.26 112.28 75+ 30.30 40.40 50.50 60.60 70.70 80.80 90.90 101.00 111.10 121.20 131.30 141.40 < - 30 38.03 40.56 43.10 45.63 48.17 50.70 53.24 55.77 58.31 60.84 63.38 30-34 39.30 41.92 44.54 47.16 49.78 52.40 55.02 57.64 60.26 62.88 65.50 35-39 39.30 41.92 44.54 47.16 49.78 52.40 55.02 57.64 60.26 62.88 65.50 40-44 39.30 41.92 44.54 47.16 49.78 52.40 55.02 57.64 60.26 62.88 65.50 45-49 41.10 43.84 46.58 49.32 52.06 54.80 57.54 60.28 63.02 65.76 68.50 50-54 49.73 53.04 56.36 59.67 62.99 66.30 69.62 72.93 76.25 79.56 82.88 55-59 58.28 62.16 66.05 69.93 73.82 77.70 81.59 85.47 89.36 93.24 97.13 60-64 68.10 72.64 77.18 81.72 86.26 90.80 95.34 99.88 104.42 108.96 113.50 65-69 89.55 95.52 101.49 107.46 113.43 119.40 125.37 131.34 137.31 143.28 149.25 70-74 120.30 128.32 136.34 144.36 152.38 160.40 168.42 176.44 184.46 192.48 200.50 75+ 151.50 161.60 171.70 181.80 191.90 202.00 212.10 222.20 232.30 242.40 252.50 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING PREFERRED INDUSTRIES WITH 3-99 EMPLOYEES 0741-0742 Veterinary Services 4812-4899 Communications 2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services 2211-2299 Textile Mill Products 5012-5199 Wholesale Trade 2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade 2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate 2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services 2511-2599 Furniture 7371-7379, 7383-7389 Business Services 2711-2796 Printing & Publishing 7622-7699 Repair Services 2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental 3511-3599 Industrial Machingery 8111 Legal Services 3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools 3812-3873 Instruments 8412-8422 Museums, Gardens 3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management 95961-Preferred (Rates effective 07/15) Rev. 7/15
PREFERRED INDUSTRIES MONTHLY PREMIUM COST PLAN 3 15-15-13 < - 30 6.51 8.68 10.85 13.02 15.19 17.36 19.53 21.70 23.87 26.04 28.21 30.38 30-34 6.63 8.84 11.05 13.26 15.47 17.68 19.89 22.10 24.31 26.52 28.73 30.94 35-39 6.63 8.84 11.05 13.26 15.47 17.68 19.89 22.10 24.31 26.52 28.73 30.94 40-44 6.63 8.84 11.05 13.26 15.47 17.68 19.89 22.10 24.31 26.52 28.73 30.94 45-49 7.01 9.34 11.68 14.01 16.35 18.68 21.02 23.35 25.69 28.02 30.36 32.69 50-54 8.36 11.14 13.93 16.71 19.50 22.28 25.07 27.85 30.64 33.42 36.21 38.99 55-59 9.83 13.10 16.38 19.65 22.93 26.20 29.48 32.75 36.03 39.30 42.58 45.85 60-64 11.54 15.38 19.23 23.07 26.92 30.76 34.61 38.45 42.30 46.14 49.99 53.83 65-69 15.09 20.12 25.15 30.18 35.21 40.24 45.27 50.30 55.33 60.36 65.39 70.42 70-74 20.37 27.16 33.95 40.74 47.53 54.32 61.11 67.90 74.69 81.48 88.27 95.06 75+ 25.65 34.20 42.75 51.30 59.85 68.40 76.95 85.50 94.05 102.60 111.15 119.70 < - 30 32.55 34.72 36.89 39.06 41.23 43.40 45.57 47.74 49.91 52.08 54.25 30-34 33.15 35.36 37.57 39.78 41.99 44.20 46.41 48.62 50.83 53.04 55.25 35-39 33.15 35.36 37.57 39.78 41.99 44.20 46.41 48.62 50.83 53.04 55.25 40-44 33.15 35.36 37.57 39.78 41.99 44.20 46.41 48.62 50.83 53.04 55.25 45-49 35.03 37.36 39.70 42.03 44.37 46.70 49.04 51.37 53.71 56.04 58.38 50-54 41.78 44.56 47.35 50.13 52.92 55.70 58.49 61.27 64.06 66.84 69.63 55-59 49.13 52.40 55.68 58.95 62.23 65.50 68.78 72.05 75.33 78.60 81.88 60-64 57.68 61.52 65.37 69.21 73.06 76.90 80.75 84.59 88.44 92.28 96.13 65-69 75.45 80.48 85.51 90.54 95.57 100.60 105.63 110.66 115.69 120.72 125.75 70-74 101.85 108.64 115.43 122.22 129.01 135.80 142.59 149.38 156.17 162.96 169.75 75+ 128.25 136.80 145.35 153.90 162.45 171.00 179.55 188.10 196.65 205.20 213.75 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING PREFERRED INDUSTRIES WITH 3-99 EMPLOYEES 0741-0742 Veterinary Services 4812-4899 Communications 2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services 2211-2299 Textile Mill Products 5012-5199 Wholesale Trade 2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade 2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate 2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services 2511-2599 Furniture 7371-7379, 7383-7389 Business Services 2711-2796 Printing & Publishing 7622-7699 Repair Services 2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental 3511-3599 Industrial Machingery 8111 Legal Services 3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools 3812-3873 Instruments 8412-8422 Museums, Gardens 3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management 95961-Preferred (Rates effective 07/15) Rev. 7/15
PREFERRED INDUSTRIES MONTHLY PREMIUM COST PLAN 4 1-8-26 < - 30 9.95 13.26 16.58 19.89 23.21 26.52 29.84 33.15 36.47 39.78 43.10 46.41 30-34 10.32 13.76 17.20 20.64 24.08 27.52 30.96 34.40 37.84 41.28 44.72 48.16 35-39 10.32 13.76 17.20 20.64 24.08 27.52 30.96 34.40 37.84 41.28 44.72 48.16 40-44 10.32 13.76 17.20 20.64 24.08 27.52 30.96 34.40 37.84 41.28 44.72 48.16 45-49 11.91 15.88 19.85 23.82 27.79 31.76 35.73 39.70 43.67 47.64 51.61 55.58 50-54 14.24 18.98 23.73 28.47 33.22 37.96 42.71 47.45 52.20 56.94 61.69 66.43 55-59 16.82 22.42 28.03 33.63 39.24 44.84 50.45 56.05 61.66 67.26 72.87 78.47 60-64 19.64 26.18 32.73 39.27 45.82 52.36 58.91 65.45 72.00 78.54 85.09 91.63 65-69 25.89 34.52 43.15 51.78 60.41 69.04 77.67 86.30 94.93 103.56 112.19 120.82 70-74 35.22 46.96 58.70 70.44 82.18 93.92 105.66 117.40 129.14 140.88 152.62 164.36 75+ 43.94 58.58 73.23 87.87 102.52 117.16 131.81 146.45 161.10 175.74 190.39 205.03 < - 30 49.73 53.04 56.36 59.67 62.99 66.30 69.62 72.93 76.25 79.56 82.88 30-34 51.60 55.04 58.48 61.92 65.36 68.80 72.24 75.68 79.12 82.56 86.00 35-39 51.60 55.04 58.48 61.92 65.36 68.80 72.24 75.68 79.12 82.56 86.00 40-44 51.60 55.04 58.48 61.92 65.36 68.80 72.24 75.68 79.12 82.56 86.00 45-49 59.55 63.52 67.49 71.46 75.43 79.40 83.37 87.34 91.31 95.28 99.25 50-54 71.18 75.92 80.67 85.41 90.16 94.90 99.65 104.39 109.14 113.88 118.63 55-59 84.08 89.68 95.29 100.89 106.50 112.10 117.71 123.31 128.92 134.52 140.13 60-64 98.18 104.72 111.27 117.81 124.36 130.90 137.45 143.99 150.54 157.08 163.63 65-69 129.45 138.08 146.71 155.34 163.97 172.60 181.23 189.86 198.49 207.12 215.75 70-74 176.10 187.84 199.58 211.32 223.06 234.80 246.54 258.28 270.02 281.76 293.50 75+ 219.68 234.32 248.97 263.61 278.26 292.90 307.55 322.19 336.84 351.48 366.13 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING PREFERRED INDUSTRIES WITH 3-99 EMPLOYEES 0741-0742 Veterinary Services 4812-4899 Communications 2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services 2211-2299 Textile Mill Products 5012-5199 Wholesale Trade 2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade 2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate 2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services 2511-2599 Furniture 7371-7379, 7383-7389 Business Services 2711-2796 Printing & Publishing 7622-7699 Repair Services 2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental 3511-3599 Industrial Machingery 8111 Legal Services 3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools 3812-3873 Instruments 8412-8422 Museums, Gardens 3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management 95961-Preferred (Rates effective 07/15) Rev. 7/15
PREFERRED INDUSTRIES MONTHLY PREMIUM COST PLAN 5 8-8-26 < - 30 9.08 12.10 15.13 18.15 21.18 24.20 27.23 30.25 33.28 36.30 39.33 42.35 30-34 9.57 12.76 15.95 19.14 22.33 25.52 28.71 31.90 35.09 38.28 41.47 44.66 35-39 9.57 12.76 15.95 19.14 22.33 25.52 28.71 31.90 35.09 38.28 41.47 44.66 40-44 9.57 12.76 15.95 19.14 22.33 25.52 28.71 31.90 35.09 38.28 41.47 44.66 45-49 10.92 14.56 18.20 21.84 25.48 29.12 32.76 36.40 40.04 43.68 47.32 50.96 50-54 13.01 17.34 21.68 26.01 30.35 34.68 39.02 43.35 47.69 52.02 56.36 60.69 55-59 15.35 20.46 25.58 30.69 35.81 40.92 46.04 51.15 56.27 61.38 66.50 71.61 60-64 18.05 24.06 30.08 36.09 42.11 48.12 54.14 60.15 66.17 72.18 78.20 84.21 65-69 23.81 31.74 39.68 47.61 55.55 63.48 71.42 79.35 87.29 95.22 103.16 111.09 70-74 32.27 43.02 53.78 64.53 75.29 86.04 96.80 107.55 118.31 129.06 139.82 150.57 75+ 40.25 53.66 67.08 80.49 93.91 107.32 120.74 134.15 147.57 160.98 174.40 187.81 < - 30 45.38 48.40 51.43 54.45 57.48 60.50 63.53 66.55 69.58 72.60 75.63 30-34 47.85 51.04 54.23 57.42 60.61 63.80 66.99 70.18 73.37 76.56 79.75 35-39 47.85 51.04 54.23 57.42 60.61 63.80 66.99 70.18 73.37 76.56 79.75 40-44 47.85 51.04 54.23 57.42 60.61 63.80 66.99 70.18 73.37 76.56 79.75 45-49 54.60 58.24 61.88 65.52 69.16 72.80 76.44 80.08 83.72 87.36 91.00 50-54 65.03 69.36 73.70 78.03 82.37 86.70 91.04 95.37 99.71 104.04 108.38 55-59 76.73 81.84 86.96 92.07 97.19 102.30 107.42 112.53 117.65 122.76 127.88 60-64 90.23 96.24 102.26 108.27 114.29 120.30 126.32 132.33 138.35 144.36 150.38 65-69 119.03 126.96 134.90 142.83 150.77 158.70 166.64 174.57 182.51 190.44 198.38 70-74 161.33 172.08 182.84 193.59 204.35 215.10 225.86 236.61 247.37 258.12 268.88 75+ 201.23 214.64 228.06 241.47 254.89 268.30 281.72 295.13 308.55 321.96 335.38 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING PREFERRED INDUSTRIES WITH 3-99 EMPLOYEES 0741-0742 Veterinary Services 4812-4899 Communications 2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services 2211-2299 Textile Mill Products 5012-5199 Wholesale Trade 2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade 2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate 2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services 2511-2599 Furniture 7371-7379, 7383-7389 Business Services 2711-2796 Printing & Publishing 7622-7699 Repair Services 2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental 3511-3599 Industrial Machingery 8111 Legal Services 3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools 3812-3873 Instruments 8412-8422 Museums, Gardens 3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management 95961-Preferred (Rates effective 07/15) Rev. 7/15
PREFERRED INDUSTRIES MONTHLY PREMIUM COST PLAN 6 15-15-26 < - 30 7.86 10.48 13.10 15.72 18.34 20.96 23.58 26.20 28.82 31.44 34.06 36.68 30-34 8.22 10.96 13.70 16.44 19.18 21.92 24.66 27.40 30.14 32.88 35.62 38.36 35-39 8.22 10.96 13.70 16.44 19.18 21.92 24.66 27.40 30.14 32.88 35.62 38.36 40-44 8.22 10.96 13.70 16.44 19.18 21.92 24.66 27.40 30.14 32.88 35.62 38.36 45-49 9.45 12.60 15.75 18.90 22.05 25.20 28.35 31.50 34.65 37.80 40.95 44.10 50-54 11.30 15.06 18.83 22.59 26.36 30.12 33.89 37.65 41.42 45.18 48.95 52.71 55-59 13.38 17.84 22.30 26.76 31.22 35.68 40.14 44.60 49.06 53.52 57.98 62.44 60-64 15.59 20.78 25.98 31.17 36.37 41.56 46.76 51.95 57.15 62.34 67.54 72.73 65-69 20.61 27.48 34.35 41.22 48.09 54.96 61.83 68.70 75.57 82.44 89.31 96.18 70-74 27.99 37.32 46.65 55.98 65.31 74.64 83.97 93.30 102.63 111.96 121.29 130.62 75+ 34.86 46.48 58.10 69.72 81.34 92.96 104.58 116.20 127.82 139.44 151.06 162.68 < - 30 39.30 41.92 44.54 47.16 49.78 52.40 55.02 57.64 60.26 62.88 65.50 30-34 41.10 43.84 46.58 49.32 52.06 54.80 57.54 60.28 63.02 65.76 68.50 35-39 41.10 43.84 46.58 49.32 52.06 54.80 57.54 60.28 63.02 65.76 68.50 40-44 41.10 43.84 46.58 49.32 52.06 54.80 57.54 60.28 63.02 65.76 68.50 45-49 47.25 50.40 53.55 56.70 59.85 63.00 66.15 69.30 72.45 75.60 78.75 50-54 56.48 60.24 64.01 67.77 71.54 75.30 79.07 82.83 86.60 90.36 94.13 55-59 66.90 71.36 75.82 80.28 84.74 89.20 93.66 98.12 102.58 107.04 111.50 60-64 77.93 83.12 88.32 93.51 98.71 103.90 109.10 114.29 119.49 124.68 129.88 65-69 103.05 109.92 116.79 123.66 130.53 137.40 144.27 151.14 158.01 164.88 171.75 70-74 139.95 149.28 158.61 167.94 177.27 186.60 195.93 205.26 214.59 223.92 233.25 75+ 174.30 185.92 197.54 209.16 220.78 232.40 244.02 255.64 267.26 278.88 290.50 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING PREFERRED INDUSTRIES WITH 3-99 EMPLOYEES 0741-0742 Veterinary Services 4812-4899 Communications 2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services 2211-2299 Textile Mill Products 5012-5199 Wholesale Trade 2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade 2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate 2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services 2511-2599 Furniture 7371-7379, 7383-7389 Business Services 2711-2796 Printing & Publishing 7622-7699 Repair Services 2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental 3511-3599 Industrial Machingery 8111 Legal Services 3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools 3812-3873 Instruments 8412-8422 Museums, Gardens 3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management 95961-Preferred (Rates effective 07/15) Rev. 7/15
PREFERRED INDUSTRIES MONTHLY PREMIUM COST PLAN 7 15-15-52 < - 30 8.84 11.78 14.73 17.67 20.62 23.56 26.51 29.45 32.40 35.34 38.29 41.23 30-34 9.21 12.28 15.35 18.42 21.49 24.56 27.63 30.70 33.77 36.84 39.91 42.98 35-39 9.21 12.28 15.35 18.42 21.49 24.56 27.63 30.70 33.77 36.84 39.91 42.98 40-44 9.21 12.28 15.35 18.42 21.49 24.56 27.63 30.70 33.77 36.84 39.91 42.98 45-49 10.56 14.08 17.60 21.12 24.64 28.16 31.68 35.20 38.72 42.24 45.76 49.28 50-54 12.63 16.84 21.05 25.26 29.47 33.68 37.89 42.10 46.31 50.52 54.73 58.94 55-59 14.97 19.96 24.95 29.94 34.93 39.92 44.91 49.90 54.89 59.88 64.87 69.86 60-64 17.55 23.40 29.25 35.10 40.95 46.80 52.65 58.50 64.35 70.20 76.05 81.90 65-69 23.09 30.78 38.48 46.17 53.87 61.56 69.26 76.95 84.65 92.34 100.04 107.73 70-74 31.29 41.72 52.15 62.58 73.01 83.44 93.87 104.30 114.73 125.16 135.59 146.02 75+ 39.15 52.20 65.25 78.30 91.35 104.40 117.45 130.50 143.55 156.60 169.65 182.70 < - 30 44.18 47.12 50.07 53.01 55.96 58.90 61.85 64.79 67.74 70.68 73.63 30-34 46.05 49.12 52.19 55.26 58.33 61.40 64.47 67.54 70.61 73.68 76.75 35-39 46.05 49.12 52.19 55.26 58.33 61.40 64.47 67.54 70.61 73.68 76.75 40-44 46.05 49.12 52.19 55.26 58.33 61.40 64.47 67.54 70.61 73.68 76.75 45-49 52.80 56.32 59.84 63.36 66.88 70.40 73.92 77.44 80.96 84.48 88.00 50-54 63.15 67.36 71.57 75.78 79.99 84.20 88.41 92.62 96.83 101.04 105.25 55-59 74.85 79.84 84.83 89.82 94.81 99.80 104.79 109.78 114.77 119.76 124.75 60-64 87.75 93.60 99.45 105.30 111.15 117.00 122.85 128.70 134.55 140.40 146.25 65-69 115.43 123.12 130.82 138.51 146.21 153.90 161.60 169.29 176.99 184.68 192.38 70-74 156.45 166.88 177.31 187.74 198.17 208.60 219.03 229.46 239.89 250.32 260.75 75+ 195.75 208.80 221.85 234.90 247.95 261.00 274.05 287.10 300.15 313.20 326.25 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING PREFERRED INDUSTRIES WITH 3-99 EMPLOYEES 0741-0742 Veterinary Services 4812-4899 Communications 2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services 2211-2299 Textile Mill Products 5012-5199 Wholesale Trade 2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade 2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate 2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services 2511-2599 Furniture 7371-7379, 7383-7389 Business Services 2711-2796 Printing & Publishing 7622-7699 Repair Services 2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental 3511-3599 Industrial Machingery 8111 Legal Services 3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools 3812-3873 Instruments 8412-8422 Museums, Gardens 3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management 95961-Preferred (Rates effective 07/15) Rev. 7/15
PREFERRED INDUSTRIES MONTHLY PREMIUM COST PLAN 8 30-30-52 < - 30 6.51 8.68 10.85 13.02 15.19 17.36 19.53 21.70 23.87 26.04 28.21 30.38 30-34 6.75 9.00 11.25 13.50 15.75 18.00 20.25 22.50 24.75 27.00 29.25 31.50 35-39 6.75 9.00 11.25 13.50 15.75 18.00 20.25 22.50 24.75 27.00 29.25 31.50 40-44 6.75 9.00 11.25 13.50 15.75 18.00 20.25 22.50 24.75 27.00 29.25 31.50 45-49 7.73 10.30 12.88 15.45 18.03 20.60 23.18 25.75 28.33 30.90 33.48 36.05 50-54 9.33 12.44 15.55 18.66 21.77 24.88 27.99 31.10 34.21 37.32 40.43 43.54 55-59 10.92 14.56 18.20 21.84 25.48 29.12 32.76 36.40 40.04 43.68 47.32 50.96 60-64 12.89 17.18 21.48 25.77 30.07 34.36 38.66 42.95 47.25 51.54 55.84 60.13 65-69 16.94 22.58 28.23 33.87 39.52 45.16 50.81 56.45 62.10 67.74 73.39 79.03 70-74 22.95 30.60 38.25 45.90 53.55 61.20 68.85 76.50 84.15 91.80 99.45 107.10 75+ 28.71 38.28 47.85 57.42 66.99 76.56 86.13 95.70 105.27 114.84 124.41 133.98 < - 30 32.55 34.72 36.89 39.06 41.23 43.40 45.57 47.74 49.91 52.08 54.25 30-34 33.75 36.00 38.25 40.50 42.75 45.00 47.25 49.50 51.75 54.00 56.25 35-39 33.75 36.00 38.25 40.50 42.75 45.00 47.25 49.50 51.75 54.00 56.25 40-44 33.75 36.00 38.25 40.50 42.75 45.00 47.25 49.50 51.75 54.00 56.25 45-49 38.63 41.20 43.78 46.35 48.93 51.50 54.08 56.65 59.23 61.80 64.38 50-54 46.65 49.76 52.87 55.98 59.09 62.20 65.31 68.42 71.53 74.64 77.75 55-59 54.60 58.24 61.88 65.52 69.16 72.80 76.44 80.08 83.72 87.36 91.00 60-64 64.43 68.72 73.02 77.31 81.61 85.90 90.20 94.49 98.79 103.08 107.38 65-69 84.68 90.32 95.97 101.61 107.26 112.90 118.55 124.19 129.84 135.48 141.13 70-74 114.75 122.40 130.05 137.70 145.35 153.00 160.65 168.30 175.95 183.60 191.25 75+ 143.55 153.12 162.69 172.26 181.83 191.40 200.97 210.54 220.11 229.68 239.25 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING PREFERRED INDUSTRIES WITH 3-99 EMPLOYEES 0741-0742 Veterinary Services 4812-4899 Communications 2011-2099 Food Products 4911-4971 Electric, Gas & Sanitary Services 2211-2299 Textile Mill Products 5012-5199 Wholesale Trade 2311-2399 Apparel 5211-5736, 5912-5999 Retail Trade 2426-2429 Flooring & Special Product Saw Mills 6011-6799 Finance, Insurance & Real Estate 2431-2499 Millwork, Wood Containers, Buildings, Products 7311-7359, Business Services 2511-2599 Furniture 7371-7379, 7383-7389 Business Services 2711-2796 Printing & Publishing 7622-7699 Repair Services 2833-2836 Drugs 7812-7841 Motion Pictures & Video Rental 3511-3599 Industrial Machingery 8111 Legal Services 3612-3699 Electronics & Other Electrical equipment 8211-8299 Educational Services, Schools 3812-3873 Instruments 8412-8422 Museums, Gardens 3911-3999 Miscellaneous Manufacturing 8711-8748 Engineering & Management 95961-Preferred (Rates effective 07/15) Rev. 7/15
STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 1 1-8-13 VOLUNTARY SHORT TERM DISABILITY < - 30 9.96 13.28 16.60 19.92 23.24 26.56 29.88 33.20 36.52 39.84 43.16 46.48 30-34 10.25 13.66 17.08 20.49 23.91 27.32 30.74 34.15 37.57 40.98 44.40 47.81 35-39 10.25 13.66 17.08 20.49 23.91 27.32 30.74 34.15 37.57 40.98 44.40 47.81 40-44 10.25 13.66 17.08 20.49 23.91 27.32 30.74 34.15 37.57 40.98 44.40 47.81 45-49 10.83 14.44 18.05 21.66 25.27 28.88 32.49 36.10 39.71 43.32 46.93 50.54 50-54 12.99 17.32 21.65 25.98 30.31 34.64 38.97 43.30 47.63 51.96 56.29 60.62 55-59 15.17 20.22 25.28 30.33 35.39 40.44 45.50 50.55 55.61 60.66 65.72 70.77 60-64 17.76 23.68 29.60 35.52 41.44 47.36 53.28 59.20 65.12 71.04 76.96 82.88 65-69 23.39 31.18 38.98 46.77 54.57 62.36 70.16 77.95 85.75 93.54 101.34 109.13 70-74 31.47 41.96 52.45 62.94 73.43 83.92 94.41 104.90 115.39 125.88 136.37 146.86 75+ 39.71 52.94 66.18 79.41 92.65 105.88 119.12 132.35 145.59 158.82 172.06 185.29 < - 30 49.80 53.12 56.44 59.76 63.08 66.40 69.72 73.04 76.36 79.68 83.00 30-34 51.23 54.64 58.06 61.47 64.89 68.30 71.72 75.13 78.55 81.96 85.38 35-39 51.23 54.64 58.06 61.47 64.89 68.30 71.72 75.13 78.55 81.96 85.38 40-44 51.23 54.64 58.06 61.47 64.89 68.30 71.72 75.13 78.55 81.96 85.38 45-49 54.15 57.76 61.37 64.98 68.59 72.20 75.81 79.42 83.03 86.64 90.25 50-54 64.95 69.28 73.61 77.94 82.27 86.60 90.93 95.26 99.59 103.92 108.25 55-59 75.83 80.88 85.94 90.99 96.05 101.10 106.16 111.21 116.27 121.32 126.38 60-64 88.80 94.72 100.64 106.56 112.48 118.40 124.32 130.24 136.16 142.08 148.00 65-69 116.93 124.72 132.52 140.31 148.11 155.90 163.70 171.49 179.29 187.08 194.88 70-74 157.35 167.84 178.33 188.82 199.31 209.80 220.29 230.78 241.27 251.76 262.25 75+ 198.53 211.76 225.00 238.23 251.47 264.70 277.94 291.17 304.41 317.64 330.88 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0711-0724, 0751-0783 Agriculture, Services 7011-7041 Hotels & Other Lodging Places 2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos 2411-2421 Logging & Saw Mills 7361-7363 Employment & Help ncies 2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems 2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking 3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios 3131-3199 Leather Products 8322-8399 Social Services 3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships 3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance 3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety 4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration 4724-4789 Transportation Services, Freight, Cargo, Passengers 95961-Standard (Rates effective 07/15) Rev. 8/16
STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 2 8-8-13 VOLUNTARY SHORT TERM DISABILITY < - 30 8.96 11.94 14.93 17.91 20.90 23.88 26.87 29.85 32.84 35.82 38.81 41.79 30-34 9.24 12.32 15.40 18.48 21.56 24.64 27.72 30.80 33.88 36.96 40.04 43.12 35-39 9.24 12.32 15.40 18.48 21.56 24.64 27.72 30.80 33.88 36.96 40.04 43.12 40-44 9.24 12.32 15.40 18.48 21.56 24.64 27.72 30.80 33.88 36.96 40.04 43.12 45-49 9.68 12.90 16.13 19.35 22.58 25.80 29.03 32.25 35.48 38.70 41.93 45.15 50-54 11.70 15.60 19.50 23.40 27.30 31.20 35.10 39.00 42.90 46.80 50.70 54.60 55-59 13.71 18.28 22.85 27.42 31.99 36.56 41.13 45.70 50.27 54.84 59.41 63.98 60-64 16.02 21.36 26.70 32.04 37.38 42.72 48.06 53.40 58.74 64.08 69.42 74.76 65-69 21.08 28.10 35.13 42.15 49.18 56.20 63.23 70.25 77.28 84.30 91.33 98.35 70-74 28.31 37.74 47.18 56.61 66.05 75.48 84.92 94.35 103.79 113.22 122.66 132.09 75+ 35.66 47.54 59.43 71.31 83.20 95.08 106.97 118.85 130.74 142.62 154.51 166.39 < - 30 44.78 47.76 50.75 53.73 56.72 59.70 62.69 65.67 68.66 71.64 74.63 30-34 46.20 49.28 52.36 55.44 58.52 61.60 64.68 67.76 70.84 73.92 77.00 35-39 46.20 49.28 52.36 55.44 58.52 61.60 64.68 67.76 70.84 73.92 77.00 40-44 46.20 49.28 52.36 55.44 58.52 61.60 64.68 67.76 70.84 73.92 77.00 45-49 48.38 51.60 54.83 58.05 61.28 64.50 67.73 70.95 74.18 77.40 80.63 50-54 58.50 62.40 66.30 70.20 74.10 78.00 81.90 85.80 89.70 93.60 97.50 55-59 68.55 73.12 77.69 82.26 86.83 91.40 95.97 100.54 105.11 109.68 114.25 60-64 80.10 85.44 90.78 96.12 101.46 106.80 112.14 117.48 122.82 128.16 133.50 65-69 105.38 112.40 119.43 126.45 133.48 140.50 147.53 154.55 161.58 168.60 175.63 70-74 141.53 150.96 160.40 169.83 179.27 188.70 198.14 207.57 217.01 226.44 235.88 75+ 178.28 190.16 202.05 213.93 225.82 237.70 249.59 261.47 273.36 285.24 297.13 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0711-0724, 0751-0783 Agriculture, Services 7011-7041 Hotels & Other Lodging Places 2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos 2411-2421 Logging & Saw Mills 7361-7363 Employment & Help ncies 2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems 2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking 3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios 3131-3199 Leather Products 8322-8399 Social Services 3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships 3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance 3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety 4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration 4724-4789 Transportation Services, Freight, Cargo, Passengers 95961-Standard (Rates effective 07/15) Rev. 8/16
STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 3 15-15-13 < - 30 7.65 10.20 12.75 15.30 17.85 20.40 22.95 25.50 28.05 30.60 33.15 35.70 30-34 7.80 10.40 13.00 15.60 18.20 20.80 23.40 26.00 28.60 31.20 33.80 36.40 35-39 7.80 10.40 13.00 15.60 18.20 20.80 23.40 26.00 28.60 31.20 33.80 36.40 40-44 7.80 10.40 13.00 15.60 18.20 20.80 23.40 26.00 28.60 31.20 33.80 36.40 45-49 8.24 10.98 13.73 16.47 19.22 21.96 24.71 27.45 30.20 32.94 35.69 38.43 50-54 9.83 13.10 16.38 19.65 22.93 26.20 29.48 32.75 36.03 39.30 42.58 45.85 55-59 11.55 15.40 19.25 23.10 26.95 30.80 34.65 38.50 42.35 46.20 50.05 53.90 60-64 13.58 18.10 22.63 27.15 31.68 36.20 40.73 45.25 49.78 54.30 58.83 63.35 65-69 17.76 23.68 29.60 35.52 41.44 47.36 53.28 59.20 65.12 71.04 76.96 82.88 70-74 23.97 31.96 39.95 47.94 55.93 63.92 71.91 79.90 87.89 95.88 103.87 111.86 75+ 30.18 40.24 50.30 60.36 70.42 80.48 90.54 100.60 110.66 120.72 130.78 140.84 < - 30 38.25 40.80 43.35 45.90 48.45 51.00 53.55 56.10 58.65 61.20 63.75 30-34 39.00 41.60 44.20 46.80 49.40 52.00 54.60 57.20 59.80 62.40 65.00 35-39 39.00 41.60 44.20 46.80 49.40 52.00 54.60 57.20 59.80 62.40 65.00 40-44 39.00 41.60 44.20 46.80 49.40 52.00 54.60 57.20 59.80 62.40 65.00 45-49 41.18 43.92 46.67 49.41 52.16 54.90 57.65 60.39 63.14 65.88 68.63 50-54 49.13 52.40 55.68 58.95 62.23 65.50 68.78 72.05 75.33 78.60 81.88 55-59 57.75 61.60 65.45 69.30 73.15 77.00 80.85 84.70 88.55 92.40 96.25 60-64 67.88 72.40 76.93 81.45 85.98 90.50 95.03 99.55 104.08 108.60 113.13 65-69 88.80 94.72 100.64 106.56 112.48 118.40 124.32 130.24 136.16 142.08 148.00 70-74 119.85 127.84 135.83 143.82 151.81 159.80 167.79 175.78 183.77 191.76 199.75 75+ 150.90 160.96 171.02 181.08 191.14 201.20 211.26 221.32 231.38 241.44 251.50 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0711-0724, 0751-0783 Agriculture, Services 7011-7041 Hotels & Other Lodging Places 2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos 2411-2421 Logging & Saw Mills 7361-7363 Employment & Help ncies 2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems 2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking 3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios 3131-3199 Leather Products 8322-8399 Social Services 3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships 3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance 3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety 4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration 4724-4789 Transportation Services, Freight, Cargo, Passengers 95961-Standard (Rates effective 07/15) Rev. 8/16
STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 4 1-8-26 < - 30 11.70 15.60 19.50 23.40 27.30 31.20 35.10 39.00 42.90 46.80 50.70 54.60 30-34 12.14 16.18 20.23 24.27 28.32 32.36 36.41 40.45 44.50 48.54 52.59 56.63 35-39 12.14 16.18 20.23 24.27 28.32 32.36 36.41 40.45 44.50 48.54 52.59 56.63 40-44 12.14 16.18 20.23 24.27 28.32 32.36 36.41 40.45 44.50 48.54 52.59 56.63 45-49 14.01 18.68 23.35 28.02 32.69 37.36 42.03 46.70 51.37 56.04 60.71 65.38 50-54 16.76 22.34 27.93 33.51 39.10 44.68 50.27 55.85 61.44 67.02 72.61 78.19 55-59 19.79 26.38 32.98 39.57 46.17 52.76 59.36 65.95 72.55 79.14 85.74 92.33 60-64 23.10 30.80 38.50 46.20 53.90 61.60 69.30 77.00 84.70 92.40 100.10 107.80 65-69 30.47 40.62 50.78 60.93 71.09 81.24 91.40 101.55 111.71 121.86 132.02 142.17 70-74 41.43 55.24 69.05 82.86 96.67 110.48 124.29 138.10 151.91 165.72 179.53 193.34 75+ 51.69 68.92 86.15 103.38 120.61 137.84 155.07 172.30 189.53 206.76 223.99 241.22 < - 30 58.50 62.40 66.30 70.20 74.10 78.00 81.90 85.80 89.70 93.60 97.50 30-34 60.68 64.72 68.77 72.81 76.86 80.90 84.95 88.99 93.04 97.08 101.13 35-39 60.68 64.72 68.77 72.81 76.86 80.90 84.95 88.99 93.04 97.08 101.13 40-44 60.68 64.72 68.77 72.81 76.86 80.90 84.95 88.99 93.04 97.08 101.13 45-49 70.05 74.72 79.39 84.06 88.73 93.40 98.07 102.74 107.41 112.08 116.75 50-54 83.78 89.36 94.95 100.53 106.12 111.70 117.29 122.87 128.46 134.04 139.63 55-59 98.93 105.52 112.12 118.71 125.31 131.90 138.50 145.09 151.69 158.28 164.88 60-64 115.50 123.20 130.90 138.60 146.30 154.00 161.70 169.40 177.10 184.80 192.50 65-69 152.33 162.48 172.64 182.79 192.95 203.10 213.26 223.41 233.57 243.72 253.88 70-74 207.15 220.96 234.77 248.58 262.39 276.20 290.01 303.82 317.63 331.44 345.25 75+ 258.45 275.68 292.91 310.14 327.37 344.60 361.83 379.06 396.29 413.52 430.75 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0711-0724, 0751-0783 Agriculture, Services 7011-7041 Hotels & Other Lodging Places 2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos 2411-2421 Logging & Saw Mills 7361-7363 Employment & Help ncies 2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems 2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking 3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios 3131-3199 Leather Products 8322-8399 Social Services 3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships 3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance 3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety 4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration 4724-4789 Transportation Services, Freight, Cargo, Passengers 95961-Standard (Rates effective 07/15) Rev. 8/16
STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 5 8-8-26 < - 30 10.68 14.24 17.80 21.36 24.92 28.48 32.04 35.60 39.16 42.72 46.28 49.84 30-34 11.27 15.02 18.78 22.53 26.29 30.04 33.80 37.55 41.31 45.06 48.82 52.57 35-39 11.27 15.02 18.78 22.53 26.29 30.04 33.80 37.55 41.31 45.06 48.82 52.57 40-44 11.27 15.02 18.78 22.53 26.29 30.04 33.80 37.55 41.31 45.06 48.82 52.57 45-49 12.86 17.14 21.43 25.71 30.00 34.28 38.57 42.85 47.14 51.42 55.71 59.99 50-54 15.30 20.40 25.50 30.60 35.70 40.80 45.90 51.00 56.10 61.20 66.30 71.40 55-59 18.05 24.06 30.08 36.09 42.11 48.12 54.14 60.15 66.17 72.18 78.20 84.21 60-64 21.23 28.30 35.38 42.45 49.53 56.60 63.68 70.75 77.83 84.90 91.98 99.05 65-69 28.01 37.34 46.68 56.01 65.35 74.68 84.02 93.35 102.69 112.02 121.36 130.69 70-74 37.97 50.62 63.28 75.93 88.59 101.24 113.90 126.55 139.21 151.86 164.52 177.17 75+ 47.36 63.14 78.93 94.71 110.50 126.28 142.07 157.85 173.64 189.42 205.21 220.99 < - 30 53.40 56.96 60.52 64.08 67.64 71.20 74.76 78.32 81.88 85.44 89.00 30-34 56.33 60.08 63.84 67.59 71.35 75.10 78.86 82.61 86.37 90.12 93.88 35-39 56.33 60.08 63.84 67.59 71.35 75.10 78.86 82.61 86.37 90.12 93.88 40-44 56.33 60.08 63.84 67.59 71.35 75.10 78.86 82.61 86.37 90.12 93.88 45-49 64.28 68.56 72.85 77.13 81.42 85.70 89.99 94.27 98.56 102.84 107.13 50-54 76.50 81.60 86.70 91.80 96.90 102.00 107.10 112.20 117.30 122.40 127.50 55-59 90.23 96.24 102.26 108.27 114.29 120.30 126.32 132.33 138.35 144.36 150.38 60-64 106.13 113.20 120.28 127.35 134.43 141.50 148.58 155.65 162.73 169.80 176.88 65-69 140.03 149.36 158.70 168.03 177.37 186.70 196.04 205.37 214.71 224.04 233.38 70-74 189.83 202.48 215.14 227.79 240.45 253.10 265.76 278.41 291.07 303.72 316.38 75+ 236.78 252.56 268.35 284.13 299.92 315.70 331.49 347.27 363.06 378.84 394.63 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0711-0724, 0751-0783 Agriculture, Services 7011-7041 Hotels & Other Lodging Places 2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos 2411-2421 Logging & Saw Mills 7361-7363 Employment & Help ncies 2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems 2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking 3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios 3131-3199 Leather Products 8322-8399 Social Services 3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships 3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance 3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety 4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration 4724-4789 Transportation Services, Freight, Cargo, Passengers 95961-Standard (Rates effective 07/15) Rev. 8/16
STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 6 15-15-26 < - 30 9.24 12.32 15.40 18.48 21.56 24.64 27.72 30.80 33.88 36.96 40.04 43.12 30-34 9.68 12.90 16.13 19.35 22.58 25.80 29.03 32.25 35.48 38.70 41.93 45.15 35-39 9.68 12.90 16.13 19.35 22.58 25.80 29.03 32.25 35.48 38.70 41.93 45.15 40-44 9.68 12.90 16.13 19.35 22.58 25.80 29.03 32.25 35.48 38.70 41.93 45.15 45-49 11.12 14.82 18.53 22.23 25.94 29.64 33.35 37.05 40.76 44.46 48.17 51.87 50-54 13.29 17.72 22.15 26.58 31.01 35.44 39.87 44.30 48.73 53.16 57.59 62.02 55-59 15.74 20.98 26.23 31.47 36.72 41.96 47.21 52.45 57.70 62.94 68.19 73.43 60-64 18.33 24.44 30.55 36.66 42.77 48.88 54.99 61.10 67.21 73.32 79.43 85.54 65-69 24.26 32.34 40.43 48.51 56.60 64.68 72.77 80.85 88.94 97.02 105.11 113.19 70-74 32.93 43.90 54.88 65.85 76.83 87.80 98.78 109.75 120.73 131.70 142.68 153.65 75+ 41.01 54.68 68.35 82.02 95.69 109.36 123.03 136.70 150.37 164.04 177.71 191.38 < - 30 46.20 49.28 52.36 55.44 58.52 61.60 64.68 67.76 70.84 73.92 77.00 30-34 48.38 51.60 54.83 58.05 61.28 64.50 67.73 70.95 74.18 77.40 80.63 35-39 48.38 51.60 54.83 58.05 61.28 64.50 67.73 70.95 74.18 77.40 80.63 40-44 48.38 51.60 54.83 58.05 61.28 64.50 67.73 70.95 74.18 77.40 80.63 45-49 55.58 59.28 62.99 66.69 70.40 74.10 77.81 81.51 85.22 88.92 92.63 50-54 66.45 70.88 75.31 79.74 84.17 88.60 93.03 97.46 101.89 106.32 110.75 55-59 78.68 83.92 89.17 94.41 99.66 104.90 110.15 115.39 120.64 125.88 131.13 60-64 91.65 97.76 103.87 109.98 116.09 122.20 128.31 134.42 140.53 146.64 152.75 65-69 121.28 129.36 137.45 145.53 153.62 161.70 169.79 177.87 185.96 194.04 202.13 70-74 164.63 175.60 186.58 197.55 208.53 219.50 230.48 241.45 252.43 263.40 274.38 75+ 205.05 218.72 232.39 246.06 259.73 273.40 287.07 300.74 314.41 328.08 341.75 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0711-0724, 0751-0783 Agriculture, Services 7011-7041 Hotels & Other Lodging Places 2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos 2411-2421 Logging & Saw Mills 7361-7363 Employment & Help ncies 2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems 2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking 3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios 3131-3199 Leather Products 8322-8399 Social Services 3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships 3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance 3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety 4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration 4724-4789 Transportation Services, Freight, Cargo, Passengers 95961-Standard (Rates effective 07/15) Rev. 8/16
STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 7 15-15-52 < - 30 10.40 13.86 17.33 20.79 24.26 27.72 31.19 34.65 38.12 41.58 45.05 48.51 30-34 10.83 14.44 18.05 21.66 25.27 28.88 32.49 36.10 39.71 43.32 46.93 50.54 35-39 10.83 14.44 18.05 21.66 25.27 28.88 32.49 36.10 39.71 43.32 46.93 50.54 40-44 10.83 14.44 18.05 21.66 25.27 28.88 32.49 36.10 39.71 43.32 46.93 50.54 45-49 12.42 16.56 20.70 24.84 28.98 33.12 37.26 41.40 45.54 49.68 53.82 57.96 50-54 14.87 19.82 24.78 29.73 34.69 39.64 44.60 49.55 54.51 59.46 64.42 69.37 55-59 17.61 23.48 29.35 35.22 41.09 46.96 52.83 58.70 64.57 70.44 76.31 82.18 60-64 20.64 27.52 34.40 41.28 48.16 55.04 61.92 68.80 75.68 82.56 89.44 96.32 65-69 27.15 36.20 45.25 54.30 63.35 72.40 81.45 90.50 99.55 108.60 117.65 126.70 70-74 36.81 49.08 61.35 73.62 85.89 98.16 110.43 122.70 134.97 147.24 159.51 171.78 75+ 46.05 61.40 76.75 92.10 107.45 122.80 138.15 153.50 168.85 184.20 199.55 214.90 < - 30 51.98 55.44 58.91 62.37 65.84 69.30 72.77 76.23 79.70 83.16 86.63 30-34 54.15 57.76 61.37 64.98 68.59 72.20 75.81 79.42 83.03 86.64 90.25 35-39 54.15 57.76 61.37 64.98 68.59 72.20 75.81 79.42 83.03 86.64 90.25 40-44 54.15 57.76 61.37 64.98 68.59 72.20 75.81 79.42 83.03 86.64 90.25 45-49 62.10 66.24 70.38 74.52 78.66 82.80 86.94 91.08 95.22 99.36 103.50 50-54 74.33 79.28 84.24 89.19 94.15 99.10 104.06 109.01 113.97 118.92 123.88 55-59 88.05 93.92 99.79 105.66 111.53 117.40 123.27 129.14 135.01 140.88 146.75 60-64 103.20 110.08 116.96 123.84 130.72 137.60 144.48 151.36 158.24 165.12 172.00 65-69 135.75 144.80 153.85 162.90 171.95 181.00 190.05 199.10 208.15 217.20 226.25 70-74 184.05 196.32 208.59 220.86 233.13 245.40 257.67 269.94 282.21 294.48 306.75 75+ 230.25 245.60 260.95 276.30 291.65 307.00 322.35 337.70 353.05 368.40 383.75 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0711-0724, 0751-0783 Agriculture, Services 7011-7041 Hotels & Other Lodging Places 2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos 2411-2421 Logging & Saw Mills 7361-7363 Employment & Help ncies 2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems 2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking 3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios 3131-3199 Leather Products 8322-8399 Social Services 3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships 3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance 3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety 4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration 4724-4789 Transportation Services, Freight, Cargo, Passengers 95961-Standard (Rates effective 07/15) Rev. 8/16
STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 8 30-30-52 VOLUNTARY SHORT TERM DISABILITY < - 30 7.65 10.20 12.75 15.30 17.85 20.40 22.95 25.50 28.05 30.60 33.15 35.70 30-34 7.94 10.58 13.23 15.87 18.52 21.16 23.81 26.45 29.10 31.74 34.39 37.03 35-39 7.94 10.58 13.23 15.87 18.52 21.16 23.81 26.45 29.10 31.74 34.39 37.03 40-44 7.94 10.58 13.23 15.87 18.52 21.16 23.81 26.45 29.10 31.74 34.39 37.03 45-49 9.09 12.12 15.15 18.18 21.21 24.24 27.27 30.30 33.33 36.36 39.39 42.42 50-54 10.98 14.64 18.30 21.96 25.62 29.28 32.94 36.60 40.26 43.92 47.58 51.24 55-59 12.86 17.14 21.43 25.71 30.00 34.28 38.57 42.85 47.14 51.42 55.71 59.99 60-64 15.17 20.22 25.28 30.33 35.39 40.44 45.50 50.55 55.61 60.66 65.72 70.77 65-69 19.92 26.56 33.20 39.84 46.48 53.12 59.76 66.40 73.04 79.68 86.32 92.96 70-74 27.00 36.00 45.00 54.00 63.00 72.00 81.00 90.00 99.00 108.00 117.00 126.00 75+ 33.78 45.04 56.30 67.56 78.82 90.08 101.34 112.60 123.86 135.12 146.38 157.64 < - 30 38.25 40.80 43.35 45.90 48.45 51.00 53.55 56.10 58.65 61.20 63.75 30-34 39.68 42.32 44.97 47.61 50.26 52.90 55.55 58.19 60.84 63.48 66.13 35-39 39.68 42.32 44.97 47.61 50.26 52.90 55.55 58.19 60.84 63.48 66.13 40-44 39.68 42.32 44.97 47.61 50.26 52.90 55.55 58.19 60.84 63.48 66.13 45-49 45.45 48.48 51.51 54.54 57.57 60.60 63.63 66.66 69.69 72.72 75.75 50-54 54.90 58.56 62.22 65.88 69.54 73.20 76.86 80.52 84.18 87.84 91.50 55-59 64.28 68.56 72.85 77.13 81.42 85.70 89.99 94.27 98.56 102.84 107.13 60-64 75.83 80.88 85.94 90.99 96.05 101.10 106.16 111.21 116.27 121.32 126.38 65-69 99.60 106.24 112.88 119.52 126.16 132.80 139.44 146.08 152.72 159.36 166.00 70-74 135.00 144.00 153.00 162.00 171.00 180.00 189.00 198.00 207.00 216.00 225.00 75+ 168.90 180.16 191.42 202.68 213.94 225.20 236.46 247.72 258.98 270.24 281.50 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0711-0724, 0751-0783 Agriculture, Services 7011-7041 Hotels & Other Lodging Places 2111-2141 Tobacco Products 7211-7299 Personal Services, Taxes, Photos 2411-2421 Logging & Saw Mills 7361-7363 Employment & Help ncies 2812-2824, 2841-2869, 2893-2899 Chemical Products 7382 Security Systems 2911-2999 Petroleum & Coal Products 7513-7549 Automotive Repair, Rentals, Parking 3011-3089 Rubber & Plastic Products 7911, 7933 Bowling Centers & Dance Studios 3131-3199 Leather Products 8322-8399 Social Services 3211-3291 Stone, Clay & Glass Products 8611-8699 Organizxations, Memberships 3295-3299 Mineral Products 9111-9199, 9311 Government, Legislative, General & Finance 3711-3799 Transportation Equipment 9211, 9222-9223, 9229 Courts & Public Safety 4612-4619 Pipelines, except Natural Gas 9411-9661 Public Administration 4724-4789 Transportation Services, Freight, Cargo, Passengers 95961-Standard (Rates effective 07/15) Rev. 8/16
NON-STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 1 1-8-13 < - 30 11.96 15.94 19.93 23.91 27.90 31.88 35.87 39.85 43.84 47.82 51.81 55.79 30-34 12.30 16.40 20.50 24.60 28.70 32.80 36.90 41.00 45.10 49.20 53.30 57.40 35-39 12.30 16.40 20.50 24.60 28.70 32.80 36.90 41.00 45.10 49.20 53.30 57.40 40-44 12.30 16.40 20.50 24.60 28.70 32.80 36.90 41.00 45.10 49.20 53.30 57.40 45-49 12.99 17.32 21.65 25.98 30.31 34.64 38.97 43.30 47.63 51.96 56.29 60.62 50-54 15.59 20.78 25.98 31.17 36.37 41.56 46.76 51.95 57.15 62.34 67.54 72.73 55-59 18.20 24.26 30.33 36.39 42.46 48.52 54.59 60.65 66.72 72.78 78.85 84.91 60-64 21.32 28.42 35.53 42.63 49.74 56.84 63.95 71.05 78.16 85.26 92.37 99.47 65-69 28.07 37.42 46.78 56.13 65.49 74.84 84.20 93.55 102.91 112.26 121.62 130.97 70-74 37.77 50.36 62.95 75.54 88.13 100.72 113.31 125.90 138.49 151.08 163.67 176.26 75+ 47.64 63.52 79.40 95.28 111.16 127.04 142.92 158.80 174.68 190.56 206.44 222.32 < - 30 59.78 63.76 67.75 71.73 75.72 79.70 83.69 87.67 91.66 95.64 99.63 30-34 61.50 65.60 69.70 73.80 77.90 82.00 86.10 90.20 94.30 98.40 102.50 35-39 61.50 65.60 69.70 73.80 77.90 82.00 86.10 90.20 94.30 98.40 102.50 40-44 61.50 65.60 69.70 73.80 77.90 82.00 86.10 90.20 94.30 98.40 102.50 45-49 64.95 69.28 73.61 77.94 82.27 86.60 90.93 95.26 99.59 103.92 108.25 50-54 77.93 83.12 88.32 93.51 98.71 103.90 109.10 114.29 119.49 124.68 129.88 55-59 90.98 97.04 103.11 109.17 115.24 121.30 127.37 133.43 139.50 145.56 151.63 60-64 106.58 113.68 120.79 127.89 135.00 142.10 149.21 156.31 163.42 170.52 177.63 65-69 140.33 149.68 159.04 168.39 177.75 187.10 196.46 205.81 215.17 224.52 233.88 70-74 188.85 201.44 214.03 226.62 239.21 251.80 264.39 276.98 289.57 302.16 314.75 75+ 238.20 254.08 269.96 285.84 301.72 317.60 333.48 349.36 365.24 381.12 397.00 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING NON-STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0111 0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing 1521-1799 Construction 3312 3399 Steel Works, Foundries & Smelting 0811 0851 Forestry 3411 3479, 3491 3499 Fabricated Metal Products 0912 0971 Fishing, Hunting, Trapping 4011 4581 Air, Bus, Rail, Trucking, Water Transportation 2611 2679 Paper Products 5500-5599 Auto Dealers 2873 2891 Chemicals, Agriculture 8011 8099 Health Services 95961-Non-Standard (Rates effective 07/15) Rev. 8/17
NON-STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 2 8-8-13 < - 30 10.74 14.32 17.90 21.48 25.06 28.64 32.22 35.80 39.38 42.96 46.54 50.12 30-34 11.09 14.78 18.48 22.17 25.87 29.56 33.26 36.95 40.65 44.34 48.04 51.73 35-39 11.09 14.78 18.48 22.17 25.87 29.56 33.26 36.95 40.65 44.34 48.04 51.73 40-44 11.09 14.78 18.48 22.17 25.87 29.56 33.26 36.95 40.65 44.34 48.04 51.73 45-49 11.61 15.48 19.35 23.22 27.09 30.96 34.83 38.70 42.57 46.44 50.31 54.18 50-54 14.04 18.72 23.40 28.08 32.76 37.44 42.12 46.80 51.48 56.16 60.84 65.52 55-59 16.46 21.94 27.43 32.91 38.40 43.88 49.37 54.85 60.34 65.82 71.31 76.79 60-64 19.23 25.64 32.05 38.46 44.87 51.28 57.69 64.10 70.51 76.92 83.33 89.74 65-69 25.29 33.72 42.15 50.58 59.01 67.44 75.87 84.30 92.73 101.16 109.59 118.02 70-74 33.96 45.28 56.60 67.92 79.24 90.56 101.88 113.20 124.52 135.84 147.16 158.48 75+ 42.78 57.04 71.30 85.56 99.82 114.08 128.34 142.60 156.86 171.12 185.38 199.64 < - 30 53.70 57.28 60.86 64.44 68.02 71.60 75.18 78.76 82.34 85.92 89.50 30-34 55.43 59.12 62.82 66.51 70.21 73.90 77.60 81.29 84.99 88.68 92.38 35-39 55.43 59.12 62.82 66.51 70.21 73.90 77.60 81.29 84.99 88.68 92.38 40-44 55.43 59.12 62.82 66.51 70.21 73.90 77.60 81.29 84.99 88.68 92.38 45-49 58.05 61.92 65.79 69.66 73.53 77.40 81.27 85.14 89.01 92.88 96.75 50-54 70.20 74.88 79.56 84.24 88.92 93.60 98.28 102.96 107.64 112.32 117.00 55-59 82.28 87.76 93.25 98.73 104.22 109.70 115.19 120.67 126.16 131.64 137.13 60-64 96.15 102.56 108.97 115.38 121.79 128.20 134.61 141.02 147.43 153.84 160.25 65-69 126.45 134.88 143.31 151.74 160.17 168.60 177.03 185.46 193.89 202.32 210.75 70-74 169.80 181.12 192.44 203.76 215.08 226.40 237.72 249.04 260.36 271.68 283.00 75+ 213.90 228.16 242.42 256.68 270.94 285.20 299.46 313.72 327.98 342.24 356.50 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING NON-STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0111 0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing 1521-1799 Construction 3312 3399 Steel Works, Foundries & Smelting 0811 0851 Forestry 3411 3479, 3491 3499 Fabricated Metal Products 0912 0971 Fishing, Hunting, Trapping 4011 4581 Air, Bus, Rail, Trucking, Water Transportation 2611 2679 Paper Products 5500-5599 Auto Dealers 2873 2891 Chemicals, Agriculture 8011 8099 Health Services 95961-Non-Standard (Rates effective 07/15) Rev. 8/17
NON-STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 3 15-15-13 < - 30 9.18 12.24 15.30 18.36 21.42 24.48 27.54 30.60 33.66 36.72 39.78 42.84 30-34 9.36 12.48 15.60 18.72 21.84 24.96 28.08 31.20 34.32 37.44 40.56 43.68 35-39 9.36 12.48 15.60 18.72 21.84 24.96 28.08 31.20 34.32 37.44 40.56 43.68 40-44 9.36 12.48 15.60 18.72 21.84 24.96 28.08 31.20 34.32 37.44 40.56 43.68 45-49 9.89 13.18 16.48 19.77 23.07 26.36 29.66 32.95 36.25 39.54 42.84 46.13 50-54 11.79 15.72 19.65 23.58 27.51 31.44 35.37 39.30 43.23 47.16 51.09 55.02 55-59 13.86 18.48 23.10 27.72 32.34 36.96 41.58 46.20 50.82 55.44 60.06 64.68 60-64 16.29 21.72 27.15 32.58 38.01 43.44 48.87 54.30 59.73 65.16 70.59 76.02 65-69 21.32 28.42 35.53 42.63 49.74 56.84 63.95 71.05 78.16 85.26 92.37 99.47 70-74 28.77 38.36 47.95 57.54 67.13 76.72 86.31 95.90 105.49 115.08 124.67 134.26 75+ 36.21 48.28 60.35 72.42 84.49 96.56 108.63 120.70 132.77 144.84 156.91 168.98 < - 30 45.90 48.96 52.02 55.08 58.14 61.20 64.26 67.32 70.38 73.44 76.50 30-34 46.80 49.92 53.04 56.16 59.28 62.40 65.52 68.64 71.76 74.88 78.00 35-39 46.80 49.92 53.04 56.16 59.28 62.40 65.52 68.64 71.76 74.88 78.00 40-44 46.80 49.92 53.04 56.16 59.28 62.40 65.52 68.64 71.76 74.88 78.00 45-49 49.43 52.72 56.02 59.31 62.61 65.90 69.20 72.49 75.79 79.08 82.38 50-54 58.95 62.88 66.81 70.74 74.67 78.60 82.53 86.46 90.39 94.32 98.25 55-59 69.30 73.92 78.54 83.16 87.78 92.40 97.02 101.64 106.26 110.88 115.50 60-64 81.45 86.88 92.31 97.74 103.17 108.60 114.03 119.46 124.89 130.32 135.75 65-69 106.58 113.68 120.79 127.89 135.00 142.10 149.21 156.31 163.42 170.52 177.63 70-74 143.85 153.44 163.03 172.62 182.21 191.80 201.39 210.98 220.57 230.16 239.75 75+ 181.05 193.12 205.19 217.26 229.33 241.40 253.47 265.54 277.61 289.68 301.75 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING NON-STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0111 0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing 1521-1799 Construction 3312 3399 Steel Works, Foundries & Smelting 0811 0851 Forestry 3411 3479, 3491 3499 Fabricated Metal Products 0912 0971 Fishing, Hunting, Trapping 4011 4581 Air, Bus, Rail, Trucking, Water Transportation 2611 2679 Paper Products 5500-5599 Auto Dealers 2873 2891 Chemicals, Agriculture 8011 8099 Health Services 95961-Non-Standard (Rates effective 07/15) Rev. 8/17
NON-STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 4 1-8-26 < - 30 14.04 18.72 23.40 28.08 32.76 37.44 42.12 46.80 51.48 56.16 60.84 65.52 30-34 14.57 19.42 24.28 29.13 33.99 38.84 43.70 48.55 53.41 58.26 63.12 67.97 35-39 14.57 19.42 24.28 29.13 33.99 38.84 43.70 48.55 53.41 58.26 63.12 67.97 40-44 14.57 19.42 24.28 29.13 33.99 38.84 43.70 48.55 53.41 58.26 63.12 67.97 45-49 16.82 22.42 28.03 33.63 39.24 44.84 50.45 56.05 61.66 67.26 72.87 78.47 50-54 20.10 26.80 33.50 40.20 46.90 53.60 60.30 67.00 73.70 80.40 87.10 93.80 55-59 23.75 31.66 39.58 47.49 55.41 63.32 71.24 79.15 87.07 94.98 102.90 110.81 60-64 27.72 36.96 46.20 55.44 64.68 73.92 83.16 92.40 101.64 110.88 120.12 129.36 65-69 36.56 48.74 60.93 73.11 85.30 97.48 109.67 121.85 134.04 146.22 158.41 170.59 70-74 49.71 66.28 82.85 99.42 115.99 132.56 149.13 165.70 182.27 198.84 215.41 231.98 75+ 62.03 82.70 103.38 124.05 144.73 165.40 186.08 206.75 227.43 248.10 268.78 289.45 < - 30 70.20 74.88 79.56 84.24 88.92 93.60 98.28 102.96 107.64 112.32 117.00 30-34 72.83 77.68 82.54 87.39 92.25 97.10 101.96 106.81 111.67 116.52 121.38 35-39 72.83 77.68 82.54 87.39 92.25 97.10 101.96 106.81 111.67 116.52 121.38 40-44 72.83 77.68 82.54 87.39 92.25 97.10 101.96 106.81 111.67 116.52 121.38 45-49 84.08 89.68 95.29 100.89 106.50 112.10 117.71 123.31 128.92 134.52 140.13 50-54 100.50 107.20 113.90 120.60 127.30 134.00 140.70 147.40 154.10 160.80 167.50 55-59 118.73 126.64 134.56 142.47 150.39 158.30 166.22 174.13 182.05 189.96 197.88 60-64 138.60 147.84 157.08 166.32 175.56 184.80 194.04 203.28 212.52 221.76 231.00 65-69 182.78 194.96 207.15 219.33 231.52 243.70 255.89 268.07 280.26 292.44 304.63 70-74 248.55 265.12 281.69 298.26 314.83 331.40 347.97 364.54 381.11 397.68 414.25 75+ 310.13 330.80 351.48 372.15 392.83 413.50 434.18 454.85 475.53 496.20 516.88 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING NON-STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0111 0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing 1521-1799 Construction 3312 3399 Steel Works, Foundries & Smelting 0811 0851 Forestry 3411 3479, 3491 3499 Fabricated Metal Products 0912 0971 Fishing, Hunting, Trapping 4011 4581 Air, Bus, Rail, Trucking, Water Transportation 2611 2679 Paper Products 5500-5599 Auto Dealers 2873 2891 Chemicals, Agriculture 8011 8099 Health Services 95961-Non-Standard (Rates effective 07/15) Rev. 8/17
NON-STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 5 8-8-26 < - 30 12.81 17.08 21.35 25.62 29.89 34.16 38.43 42.70 46.97 51.24 55.51 59.78 30-34 13.52 18.02 22.53 27.03 31.54 36.04 40.55 45.05 49.56 54.06 58.57 63.07 35-39 13.52 18.02 22.53 27.03 31.54 36.04 40.55 45.05 49.56 54.06 58.57 63.07 40-44 13.52 18.02 22.53 27.03 31.54 36.04 40.55 45.05 49.56 54.06 58.57 63.07 45-49 15.42 20.56 25.70 30.84 35.98 41.12 46.26 51.40 56.54 61.68 66.82 71.96 50-54 18.36 24.48 30.60 36.72 42.84 48.96 55.08 61.20 67.32 73.44 79.56 85.68 55-59 21.66 28.88 36.10 43.32 50.54 57.76 64.98 72.20 79.42 86.64 93.86 101.08 60-64 25.47 33.96 42.45 50.94 59.43 67.92 76.41 84.90 93.39 101.88 110.37 118.86 65-69 33.60 44.80 56.00 67.20 78.40 89.60 100.80 112.00 123.20 134.40 145.60 156.80 70-74 45.56 60.74 75.93 91.11 106.30 121.48 136.67 151.85 167.04 182.22 197.41 212.59 75+ 56.82 75.76 94.70 113.64 132.58 151.52 170.46 189.40 208.34 227.28 246.22 265.16 < - 30 64.05 68.32 72.59 76.86 81.13 85.40 89.67 93.94 98.21 102.48 106.75 30-34 67.58 72.08 76.59 81.09 85.60 90.10 94.61 99.11 103.62 108.12 112.63 35-39 67.58 72.08 76.59 81.09 85.60 90.10 94.61 99.11 103.62 108.12 112.63 40-44 67.58 72.08 76.59 81.09 85.60 90.10 94.61 99.11 103.62 108.12 112.63 45-49 77.10 82.24 87.38 92.52 97.66 102.80 107.94 113.08 118.22 123.36 128.50 50-54 91.80 97.92 104.04 110.16 116.28 122.40 128.52 134.64 140.76 146.88 153.00 55-59 108.30 115.52 122.74 129.96 137.18 144.40 151.62 158.84 166.06 173.28 180.50 60-64 127.35 135.84 144.33 152.82 161.31 169.80 178.29 186.78 195.27 203.76 212.25 65-69 168.00 179.20 190.40 201.60 212.80 224.00 235.20 246.40 257.60 268.80 280.00 70-74 227.78 242.96 258.15 273.33 288.52 303.70 318.89 334.07 349.26 364.44 379.63 75+ 284.10 303.04 321.98 340.92 359.86 378.80 397.74 416.68 435.62 454.56 473.50 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING NON-STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0111 0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing 1521-1799 Construction 3312 3399 Steel Works, Foundries & Smelting 0811 0851 Forestry 3411 3479, 3491 3499 Fabricated Metal Products 0912 0971 Fishing, Hunting, Trapping 4011 4581 Air, Bus, Rail, Trucking, Water Transportation 2611 2679 Paper Products 5500-5599 Auto Dealers 2873 2891 Chemicals, Agriculture 8011 8099 Health Services 95961-Non-Standard (Rates effective 07/15) Rev. 8/17
NON-STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 6 15-15-26 < - 30 11.09 14.78 18.48 22.17 25.87 29.56 33.26 36.95 40.65 44.34 48.04 51.73 30-34 11.61 15.48 19.35 23.22 27.09 30.96 34.83 38.70 42.57 46.44 50.31 54.18 35-39 11.61 15.48 19.35 23.22 27.09 30.96 34.83 38.70 42.57 46.44 50.31 54.18 40-44 11.61 15.48 19.35 23.22 27.09 30.96 34.83 38.70 42.57 46.44 50.31 54.18 45-49 13.34 17.78 22.23 26.67 31.12 35.56 40.01 44.45 48.90 53.34 57.79 62.23 50-54 15.95 21.26 26.58 31.89 37.21 42.52 47.84 53.15 58.47 63.78 69.10 74.41 55-59 18.89 25.18 31.48 37.77 44.07 50.36 56.66 62.95 69.25 75.54 81.84 88.13 60-64 21.99 29.32 36.65 43.98 51.31 58.64 65.97 73.30 80.63 87.96 95.29 102.62 65-69 29.10 38.80 48.50 58.20 67.90 77.60 87.30 97.00 106.70 116.40 126.10 135.80 70-74 39.51 52.68 65.85 79.02 92.19 105.36 118.53 131.70 144.87 158.04 171.21 184.38 75+ 49.22 65.62 82.03 98.43 114.84 131.24 147.65 164.05 180.46 196.86 213.27 229.67 < - 30 55.43 59.12 62.82 66.51 70.21 73.90 77.60 81.29 84.99 88.68 92.38 30-34 58.05 61.92 65.79 69.66 73.53 77.40 81.27 85.14 89.01 92.88 96.75 35-39 58.05 61.92 65.79 69.66 73.53 77.40 81.27 85.14 89.01 92.88 96.75 40-44 58.05 61.92 65.79 69.66 73.53 77.40 81.27 85.14 89.01 92.88 96.75 45-49 66.68 71.12 75.57 80.01 84.46 88.90 93.35 97.79 102.24 106.68 111.13 50-54 79.73 85.04 90.36 95.67 100.99 106.30 111.62 116.93 122.25 127.56 132.88 55-59 94.43 100.72 107.02 113.31 119.61 125.90 132.20 138.49 144.79 151.08 157.38 60-64 109.95 117.28 124.61 131.94 139.27 146.60 153.93 161.26 168.59 175.92 183.25 65-69 145.50 155.20 164.90 174.60 184.30 194.00 203.70 213.40 223.10 232.80 242.50 70-74 197.55 210.72 223.89 237.06 250.23 263.40 276.57 289.74 302.91 316.08 329.25 75+ 246.08 262.48 278.89 295.29 311.70 328.10 344.51 360.91 377.32 393.72 410.13 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING NON-STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0111 0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing 1521-1799 Construction 3312 3399 Steel Works, Foundries & Smelting 0811 0851 Forestry 3411 3479, 3491 3499 Fabricated Metal Products 0912 0971 Fishing, Hunting, Trapping 4011 4581 Air, Bus, Rail, Trucking, Water Transportation 2611 2679 Paper Products 5500-5599 Auto Dealers 2873 2891 Chemicals, Agriculture 8011 8099 Health Services 95961-Non-Standard (Rates effective 07/15) Rev. 8/17
NON-STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 7 15-15-52 < - 30 12.48 16.64 20.80 24.96 29.12 33.28 37.44 41.60 45.76 49.92 54.08 58.24 30-34 12.99 17.32 21.65 25.98 30.31 34.64 38.97 43.30 47.63 51.96 56.29 60.62 35-39 12.99 17.32 21.65 25.98 30.31 34.64 38.97 43.30 47.63 51.96 56.29 60.62 40-44 12.99 17.32 21.65 25.98 30.31 34.64 38.97 43.30 47.63 51.96 56.29 60.62 45-49 14.91 19.88 24.85 29.82 34.79 39.76 44.73 49.70 54.67 59.64 64.61 69.58 50-54 17.84 23.78 29.73 35.67 41.62 47.56 53.51 59.45 65.40 71.34 77.29 83.23 55-59 21.14 28.18 35.23 42.27 49.32 56.36 63.41 70.45 77.50 84.54 91.59 98.63 60-64 24.77 33.02 41.28 49.53 57.79 66.04 74.30 82.55 90.81 99.06 107.32 115.57 65-69 32.58 43.44 54.30 65.16 76.02 86.88 97.74 108.60 119.46 130.32 141.18 152.04 70-74 44.18 58.90 73.63 88.35 103.08 117.80 132.53 147.25 161.98 176.70 191.43 206.15 75+ 55.26 73.68 92.10 110.52 128.94 147.36 165.78 184.20 202.62 221.04 239.46 257.88 < - 30 62.40 66.56 70.72 74.88 79.04 83.20 87.36 91.52 95.68 99.84 104.00 30-34 64.95 69.28 73.61 77.94 82.27 86.60 90.93 95.26 99.59 103.92 108.25 35-39 64.95 69.28 73.61 77.94 82.27 86.60 90.93 95.26 99.59 103.92 108.25 40-44 64.95 69.28 73.61 77.94 82.27 86.60 90.93 95.26 99.59 103.92 108.25 45-49 74.55 79.52 84.49 89.46 94.43 99.40 104.37 109.34 114.31 119.28 124.25 50-54 89.18 95.12 101.07 107.01 112.96 118.90 124.85 130.79 136.74 142.68 148.63 55-59 105.68 112.72 119.77 126.81 133.86 140.90 147.95 154.99 162.04 169.08 176.13 60-64 123.83 132.08 140.34 148.59 156.85 165.10 173.36 181.61 189.87 198.12 206.38 65-69 162.90 173.76 184.62 195.48 206.34 217.20 228.06 238.92 249.78 260.64 271.50 70-74 220.88 235.60 250.33 265.05 279.78 294.50 309.23 323.95 338.68 353.40 368.13 75+ 276.30 294.72 313.14 331.56 349.98 368.40 386.82 405.24 423.66 442.08 460.50 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING NON-STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0111 0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing 1521-1799 Construction 3312 3399 Steel Works, Foundries & Smelting 0811 0851 Forestry 3411 3479, 3491 3499 Fabricated Metal Products 0912 0971 Fishing, Hunting, Trapping 4011 4581 Air, Bus, Rail, Trucking, Water Transportation 2611 2679 Paper Products 5500-5599 Auto Dealers 2873 2891 Chemicals, Agriculture 8011 8099 Health Services 95961-Non-Standard (Rates effective 07/15) Rev. 8/17
NON-STANDARD INDUSTRIES MONTHLY PREMIUM COST PLAN 8 30-30-52 < - 30 9.18 12.24 15.30 18.36 21.42 24.48 27.54 30.60 33.66 36.72 39.78 42.84 30-34 9.53 12.70 15.88 19.05 22.23 25.40 28.58 31.75 34.93 38.10 41.28 44.45 35-39 9.53 12.70 15.88 19.05 22.23 25.40 28.58 31.75 34.93 38.10 41.28 44.45 40-44 9.53 12.70 15.88 19.05 22.23 25.40 28.58 31.75 34.93 38.10 41.28 44.45 45-49 10.91 14.54 18.18 21.81 25.45 29.08 32.72 36.35 39.99 43.62 47.26 50.89 50-54 13.17 17.56 21.95 26.34 30.73 35.12 39.51 43.90 48.29 52.68 57.07 61.46 55-59 15.42 20.56 25.70 30.84 35.98 41.12 46.26 51.40 56.54 61.68 66.82 71.96 60-64 18.20 24.26 30.33 36.39 42.46 48.52 54.59 60.65 66.72 72.78 78.85 84.91 65-69 23.91 31.88 39.85 47.82 55.79 63.76 71.73 79.70 87.67 95.64 103.61 111.58 70-74 32.40 43.20 54.00 64.80 75.60 86.40 97.20 108.00 118.80 129.60 140.40 151.20 75+ 40.53 54.04 67.55 81.06 94.57 108.08 121.59 135.10 148.61 162.12 175.63 189.14 < - 30 45.90 48.96 52.02 55.08 58.14 61.20 64.26 67.32 70.38 73.44 76.50 30-34 47.63 50.80 53.98 57.15 60.33 63.50 66.68 69.85 73.03 76.20 79.38 35-39 47.63 50.80 53.98 57.15 60.33 63.50 66.68 69.85 73.03 76.20 79.38 40-44 47.63 50.80 53.98 57.15 60.33 63.50 66.68 69.85 73.03 76.20 79.38 45-49 54.53 58.16 61.80 65.43 69.07 72.70 76.34 79.97 83.61 87.24 90.88 50-54 65.85 70.24 74.63 79.02 83.41 87.80 92.19 96.58 100.97 105.36 109.75 55-59 77.10 82.24 87.38 92.52 97.66 102.80 107.94 113.08 118.22 123.36 128.50 60-64 90.98 97.04 103.11 109.17 115.24 121.30 127.37 133.43 139.50 145.56 151.63 65-69 119.55 127.52 135.49 143.46 151.43 159.40 167.37 175.34 183.31 191.28 199.25 70-74 162.00 172.80 183.60 194.40 205.20 216.00 226.80 237.60 248.40 259.20 270.00 75+ 202.65 216.16 229.67 243.18 256.69 270.20 283.71 297.22 310.73 324.24 337.75 THE PREMIUMS SHOWN ABOVE APPLY TO THE FOLLOWING NON-STANDARD INDUSTRIES WITH 3-99 EMPLOYEES 0111 0291 Agriculture, Crops & Livestock 3111 Leather Tanning & Finishing 1521-1799 Construction 3312 3399 Steel Works, Foundries & Smelting 0811 0851 Forestry 3411 3479, 3491 3499 Fabricated Metal Products 0912 0971 Fishing, Hunting, Trapping 4011 4581 Air, Bus, Rail, Trucking, Water Transportation 2611 2679 Paper Products 5500-5599 Auto Dealers 2873 2891 Chemicals, Agriculture 8011 8099 Health Services 95961-Non-Standard (Rates effective 07/15) Rev. 8/17
Buy-Up Plan voluntary short term disability affordable options! Companion Life s Buy-Up Plan is an economical, simple solution that provides both employers and employees an array of options. By combining a core level of income protection with the opportunity to purchase additional coverage, both employers and employees benefit. As an employer, you may offer $100/week in coverage, which allows employees to select weekly benefit payments from $50 to $1,150, not to exceed 66O% of basic weekly earnings. Please see our Voluntary Short Term Disability brochure for specific plan designs and benefit levels. Maternity, alcoholism and drug addiction, and mental or nervous conditions are covered the same as any other illness. Disabilities which begin in the first 12 months after the effective date which are the result of a pre-existing condition are not covered. A pre-existing condition is defined as a condition with treatment (or symptoms for which an ordinarily prudent person would seek treatment) within 12 months prior to the effective date. The exclusion may vary in certain states as required. Included at no additional cost is $10,000 of Accidental Death and Dismemberment coverage. We look forward to assisting you in offering these affordable, comprehensive benefit options to your employees. Contact Group Marketing or Your nt Today for a Prompt, Professional Proposal! P.O. Box 100102 n Columbia, SC 29202-3102 800-753-0404 phone n 800-836-5433 fax C.life@companiongroup.com n CompanionLife.com Companion Life Series (VSTD 808/809)
Buy-Up Plan voluntary short term disability flexibility for you and your employees! Help your employees protect one of their most valuable assets... their paycheck! Companion Life is pleased to offer an innovative solution to employers our Voluntary Short Term Disability Buy-Up Plan. This versatile plan allows you to offer $100/per week in short term disability insurance while giving employees the option to purchase supplemental coverage. The additional benefit purchased by employees, added to the $100/per week benefit purchased by you, will allow employees to protect up to 66O% of their salary for a disability which occurs off the job. A minimum of five employees must enroll in the Buy-Up portion of the program. Our Voluntary Short Term Disability Buy-Up Plan assists employers in providing their staff the peace of mind that a protected paycheck brings. After all, statistics show that the majority of American families would be bankrupt if they missed more than three consecutive paychecks. And 48% of all home foreclosures are the direct result of a disability. 1 Enhance your voluntary short term disability insurance today With our Buy-Up Plan you may choose from any one of the eight plan designs available under Companion Life s Voluntary Short Term Disability product line. Employees can then select additional coverage from the same employer sponsored plan in order to buy up. This adaptable program offers the following benefits: EMPLOYER n Provides basic financial protection to disabled employees, increasing employee peace of mind, satisfaction and morale. No contribution requirement on the Buy-Up feature. n Offers a broad array of waiting periods and benefit durations. n Proposal provided by Companion Life using an employee census. EMPLOYEe n Provides $100/per week in income. Taxes are not applicable to additional disability insurance coverage purchased by employees. n Offers the flexibility to purchase additional coverage to meet individual needs. n Convenient, no-hassle payroll deduction. 95963 Rev. 3/12 1 Housing and Home Finance ncy of the U.S. Government.