$5,000
Basic benefit amount: Primary insured or insured spouse - $5,000; dependent - $2,500.
| Age | Employee only | Employee + spouse | Employee + child(ren) | Family |
|---|---|---|---|---|
| 18-24 | $0.29 | $0.59 | $0.29 | $0.59 |
| 25-29 | $0.44 | $0.87 | $0.44 | $0.87 |
| 30-34 | $0.69 | $1.38 | $0.69 | $1.38 |
| 35-39 | $1.17 | $2.34 | $1.17 | $2.34 |
| 40-44 | $1.74 | $3.48 | $1.74 | $3.48 |
| 45-49 | $2.50 | $4.99 | $2.50 | $4.99 |
| 50-54 | $3.56 | $7.11 | $3.56 | $7.11 |
| 55-59 | $4.78 | $9.56 | $4.78 | $9.56 |
| 60-64 | $6.90 | $13.80 | $6.90 | $13.80 |
| 65-69 | $9.76 | $19.51 | $9.76 | $19.51 |
| 70-74 | $13.76 | $27.51 | $13.76 | $27.51 |
| 75-79 | $17.76 | $35.51 | $17.76 | $35.51 |
| 80+ | $22.08 | $44.16 | $22.08 | $44.16 |
$10,000
Basic benefit amount: Primary insured or insured spouse - $10,000; dependent - $5,000.
| Age | Employee only | Employee + spouse | Employee + child(ren) | Family |
|---|---|---|---|---|
| 18-24 | $0.55 | $1.10 | $0.55 | $1.10 |
| 25-29 | $0.82 | $1.64 | $0.82 | $1.64 |
| 30-34 | $1.30 | $2.61 | $1.30 | $2.61 |
| 35-39 | $2.21 | $4.42 | $2.21 | $4.42 |
| 40-44 | $3.29 | $6.58 | $3.29 | $6.58 |
| 45-49 | $4.72 | $9.44 | $4.72 | $9.44 |
| 50-54 | $6.71 | $13.42 | $6.71 | $13.42 |
| 55-59 | $9.03 | $18.04 | $9.03 | $18.04 |
| 60-64 | $13.07 | $26.15 | $13.07 | $26.15 |
| 65-69 | $18.50 | $37.00 | $18.50 | $37.00 |
| 70-74 | $26.18 | $52.37 | $26.18 | $52.37 |
| 75-79 | $34.01 | $68.04 | $34.01 | $68.04 |
| 80+ | $42.58 | $85.15 | $42.58 | $85.15 |
$15,000
Basic benefit amount: Primary insured or insured spouse - $15,000; dependent - $7,500.
| Age | Employee only | Employee + spouse | Employee + child(ren) | Family |
|---|---|---|---|---|
| 18-24 | $0.80 | $1.61 | $0.80 | $1.61 |
| 25-29 | $1.20 | $2.41 | $1.20 | $2.41 |
| 30-34 | $1.92 | $3.83 | $1.92 | $3.83 |
| 35-39 | $3.25 | $6.49 | $3.25 | $6.49 |
| 40-44 | $4.84 | $9.66 | $4.84 | $9.66 |
| 45-49 | $6.94 | $13.88 | $6.94 | $13.88 |
| 50-54 | $9.87 | $19.74 | $9.87 | $19.74 |
| 55-59 | $13.27 | $26.54 | $13.27 | $26.54 |
| 60-64 | $19.25 | $38.48 | $19.25 | $38.48 |
| 65-69 | $27.25 | $54.49 | $27.25 | $54.49 |
| 70-74 | $38.61 | $77.21 | $38.61 | $77.21 |
| 75-79 | $50.28 | $100.55 | $50.28 | $100.55 |
| 80+ | $63.07 | $126.15 | $63.07 | $126.15 |
$20,000
Basic benefit amount: Primary insured or insured spouse - $20,000; dependent - $10,000.
| Age | Employee only | Employee + spouse | Employee + child(ren) | Family |
|---|---|---|---|---|
| 18-24 | $1.07 | $2.13 | $1.07 | $2.13 |
| 25-29 | $1.59 | $3.18 | $1.59 | $3.18 |
| 30-34 | $2.54 | $5.07 | $2.54 | $5.07 |
| 35-39 | $4.29 | $8.58 | $4.29 | $8.58 |
| 40-44 | $6.39 | $12.76 | $6.39 | $12.76 |
| 45-49 | $9.16 | $18.32 | $9.16 | $18.32 |
| 50-54 | $13.03 | $26.06 | $13.03 | $26.06 |
| 55-59 | $17.52 | $35.05 | $17.52 | $35.05 |
| 60-64 | $25.42 | $50.83 | $25.42 | $50.83 |
| 65-69 | $35.99 | $71.99 | $35.99 | $71.99 |
| 70-74 | $51.03 | $102.07 | $51.03 | $102.07 |
| 75-79 | $66.54 | $133.08 | $66.54 | $133.08 |
| 80+ | $83.57 | $167.15 | $83.57 | $167.15 |