CHART D Age Rate Chart Age Rated Contributions and Premium Chart assuming 72.14 % employer contribution.
EE Cost
ER Cost
Total Premium
EE Cost
ER Cost
Total Premium
Age
Age
14 (and under)
$111.97 $121.93 $125.73 $129.54 $133.64 $137.73 $141.98 $146.37 $146.37 $146.37 $146.37 $146.96 $149.88 $153.40 $159.11 $163.79 $166.13 $169.65 $173.16 $175.35 $177.69 $178.86 $180.04 $181.21 $182.38 $184.72
$289.95 $315.71 $325.57 $335.42 $346.03 $356.65 $367.64 $379.01 $379.01 $379.01 $379.01 $380.52 $388.11 $397.20 $411.98 $424.11 $430.18 $439.27 $448.36 $454.06 $460.12 $463.15 $466.18 $469.21 $472.24 $478.31
$401.92 $437.64 $451.30 $464.96 $479.67 $494.38 $509.62 $525.38 $525.38 $525.38 $525.38 $527.48 $537.99 $550.60 $571.09 $587.90 $596.31 $608.92 $621.52 $629.41 $637.81 $642.01 $646.22 $650.42 $654.62 $663.03
40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
$187.06 $190.57 $193.94 $198.63 $204.48 $211.36 $219.56 $228.78 $239.32 $249.71 $261.42 $272.98 $285.72 $298.60 $312.50 $326.41 $341.48 $356.71 $372.95 $381.00
$484.38 $493.47 $502.19 $514.31 $529.48 $547.29 $568.51 $592.39 $619.68 $646.59 $676.91 $706.85
$671.44 $684.04 $696.13 $712.94 $733.96 $758.65 $788.07 $821.17 $859.00 $896.30 $938.33 $979.83
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
$739.82 $1,025.54 $773.18 $1,071.78 $809.19 $1,121.69 $845.19 $1,171.60 $884.23 $1,225.71 $923.64 $1,280.35 $965.72 $1,338.67 $986.56 $1,367.56
$397.25 $1,028.63 $1,425.88 $411.30 $1,065.02 $1,476.32 $420.52 $1,088.90 $1,509.42 $432.09 $1,118.83 $1,550.92 $439.11 $1,137.03 $1,576.14 $439.11 $1,137.03 $1,576.14
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