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HomeMy Public PortalAbout16-9231 Enter into Agreement w/Avmed Health Plan Sponsored by: City Manager RESOLUTION NO. 16-9231 A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF OPA-LOCKA, FLORIDA, AUTHORIZING THE CITY MANAGER TO ENTER INTO AGREEMENTS WITH AVMED HEALTH PLAN AS THE PROVIDER FOR THE CITY OF OPA- LOCKA'S HEALTH PLAN, METLIFE AS THE PROVIDER FOR THE CITY OF OPA-LOCKA'S DENTAL AND VISION PLAN, AND AMERICAN PUBLIC LIFE AS THE PROVIDER FOR THE CITY OF OPA-LOCKA'S GAP PLAN, FOR THE BENEFIT YEAR BEGINNING OCTOBER 1, 2016 AND EXPIRING SEPTEMBER 30, 2017 ; PROVIDING FOR INCORPORATION OF RECITALS; PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, The City hired Sapoznik Insurance and Associates as its Agent of Record to facilitate the competitive bid process for the selection of a health plan provider, dental and vision plan provider, and gap plan provider; and WHEREAS, The City's staff has reviewed the bids and recommendations provided by the Agent of Record; and WHEREAS, The City's staff is recommending AVMED as the Health Plan provider, Metlife for the Dental and Vision plan provider, and American Public Life for the Gap plan provider for the City, for the benefit year beginning October 1, 2016 and expiring September 30, 2017; and NOW THEREFORE BE IT RESOLVED THAT THE CITY COMMISSION OF THE CITY OF OPA LOCKA, FLORIDA: Section 1. The recitals to the preamble herein are incorporated by reference. Section 2. The City Commission hereby accepts staff's recommendation and authorizes the City Manager to enter into 1 Resolution No. 16-9231 agreements with AVMED as the Health Plan provider, Metlife for the Dental and Vision plan provider, and American Public Life as the Gap plan provider for the City, for the benefit year beginning October 1, 2016 and expiring September 30, 2017 . Section 3.This Resolution shall take effect immediately upon adoption. PASSED AND ADOPTED this 6th day of September, 2016. yra L. Taylor Mayor Attest to: Approved as to form and legal sufficiency: 11. 4421 -• Joa1 a Flores Vincent T. Brown, Esq. City Clerk The Brown Law Group, LLC City Attorney Moved by: COMMISSIONER RILEY Seconded by: COMMISSIONER KELLEY Commissioner Vote: 4-0 Commissioner Kelley: YES Commissioner Riley: YES Commissioner Santiago: NOT PRESENT Vice Mayor Holmes: YES Mayor Taylor: YES V D, AF'oa nteoi City of Opa-Locka Agenda Cover Memo City Manager: Yvette Harrell I CM Signature: Finance Director: Charmaine Parchment FD Si gnature: r7,,4 Department Kierra Ward • Director: Commission 9/6/2016 Item Type: Resolution Ordinance Other Meeting Date: X (EnterXin box) Fiscal Impact: Ordinance Reading: 1stReadiin 2nd (Enter X in box) Yes No (Enter X in box) g 2 Reading x Public Hearing: Yes No Yes No (Enter X in box) X X Funding Source: (Enter Fund Advertising Requirement: Yes &Dept) No P) (EnterXin box) - Ex: x Account# Various department line items Contract/P.O. Yes No RFP/RFQ/Bi#: Required: X (EnterXin box) Strategic Plan Yes No Strategic Plan Priority Area: Strategic Plan Ob . Strate (list Related X g 1/ gY: the specific objective/strategy this item will (EnterXin box) Enhance Organizational 0 address) Bus.&Economic Dev Public Safety See attached memorandum Quality of Education D Qual.of Life&City Image Communication Sponsor Name Department: City Manager City Manager Short Title: Insurance Renewal FY 16-17 Staff Summary: See attached Proposed Action: Staff recommends approval Attachment: Memorandum with Staff analysis. } ,figamagitnna ^ 4 r.G HAC-- Memorandum TO: Mayor Myra L. Taylor Vice-Mayor Timothy Holmes Commissioner Joseph L. Kelley Commissioner Luis B. Santiago Commissioner John Riley FROM: Yvette Harrell, City Manager DATE: August 26,2016 RE: Proposed Health,Dental,Vision, and GAP Carrier for Fiscal Year 2016/2017. Request: A RESOLUTION OF THE CITY OF OPA-LOCKA, FLORIDA AUTHORIZING THE CITY MANAGER TO SELECT AVMED HEALTH PLAN AS THE PROVIDER FOR THE CITY OF OPA-LOCKA HEALTH PLAN, METLIFE AS THE PROVIDER FOR THE CITY OF OPA-LOCKA'S DENTAL AND VISION GROUP PLANS, AND AMERICAN PUBLIC LIFE FOR THE CITY'S GAP PLAN FOR THE BENEFIT YEAR BEGINNING OCTOBER 1, 2016 EXPIRING SEPTEMBER 30, 2017. Description: The Human Resources Department has worked diligently with the City's Agent of Records, Sapoznik Insurance and Associates, Inc to assess the existing group insurance policies and proposed employee benefit rates. A resolution of the City Commission of Opa-locka, Florida authorizes the City Manager to enter into an agreement with AvMed and Metlife for the medical, dental, and vision group plans, respectively. Financial Impact: This item is estimated to present an annual cost of$772,532.64, and is subject to change upon employee dependant coverage election. This item is currently included in the proposed budget. Implementation Timeline: October 1, 2016-September 30, 2017 Legislative History: Resolution NO. 15-9052 Recommendation(s): This approval is based on staff's analysis of the proposed services, providers, and costs. Additionally, the City is proposing to renew the agreement with AvMed, MetLife and American Public Life for the FY 2016-17 Benefit Year. Analysis: Staff has analyzed the results of the competitive Bid Process for Insurance Carriers facilitated by the City's current Agent of Records Sapoznik Insurance and Associates. It has been determined that based on the current proposed budget and the City's obligation per union contract to offer City employees individual HMO coverage 100% and 50% of dependant coverage sponsored by the City, to recommend to renew the current policies. Sapoznik successfully negotiated the initial proposed renewal of 11.66% HMO and 12.31% PPO increase to 5.73% HMO and 6.45% PPO increase for the current plan being offered for medical insurance. The City obtained a rate pass for the GAP insurance provided by American Public Life, and has also confirmed that the plans are being utilized by employees, confirming that employees are taking advantage of the benefit and minimizing out of pocket costs. Metlife, the current dental and vision plan provider has issued a rate pass for the DHMO plan (the plan that is sponsored by the City). The DPPO renewal was negotiated from 18% to 12.5% dental plans. Metlife has also offered a rate pass for the City's Vision renewal. Employees are responsible for 100% of their vision coverage. Attachments: Plan design and Insurance Bid Results PREPARED BY: Kierra Ward, MBA Human Resources Director co m a N U O m n u6 V1 to co co t c U 00 n OI 000 V ? 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W O ,NO. O n 0 A O U N u >- >- rt W N E C O O W W ? VR 6N4 ! O1 w * Ce * V L J } J r J r w + U a 1k c * w * YZ 0a 0a ja � U OM W w W OL C v .ti Z . u .. 0 vmi QO ZO ZO ZO v+Q tnZ¢ o O `� Y Jw W C ¢ Q Q a -I a � IN0 j �O_ o Z a ¢ a ¢ a ¢ o ¢ o 4 G N a a .- N o rn Cr a 02 ^ m 'a9 8 .0 z a) .t In F.5 uf .o.) aii c d� ' 2 E ? * a t0 .{yZJ� W U C N Z O N V T N C N N N I)CO EM w ut B li 2 E o o _o' o f E C d E x 0 41 c c $4 C a s n a E a� 0 W W E ER W J {d - V IL W w W W U H — T L o�g E O = W o 8 w z a Q� a s M t ry p 0 aC 0 K Q) 2p 0 o c t a a P. O "' in.- y F L O oo a w w v:, 0 ON" z Wd' in C7 m m J' 2p y y a Op M J W ~ ~ .y N a g N 0 O N Z Uj U Z if OO U U W a W E IX 0 a s w CO Q U U .:4 Ai p 0 Z V 0 u r:,', w ¢ 7 C Z O J .t' in tn d C 0 N ` g E E a 0 i Humana kiturr:,�a, Inc. .E‘n F SW're. zwer+tue l3uiltiioxq A, Floor 2 MMMirdnriar, FL 331)27 www.Iiurnaria.com July 13, 2016 Linda Jamen Sapoznik Insurance 1100 NE 163 Street 2nd Floor North Miami Beach, FL 33162 Re: City of Opa-Locka (Dental and Vision) Dear Linda, Humana thanks you for the opportunity to prepare a proposal for your client, City of Opa-Locka. Unfortunately, we are unable to issue a proposal at this time. In reviewing the submitted information, Humana believes that the risk associated with insuring City of Opa-Locka for dental and vision coverage outweighs the premium we would be able to generate. The main factor leading to this decision is: • Uncompetitive Rates Thank you for your confidence and trust in Humana and our family of health benefit solutions. We look forward to serving you and your valuable clients in the future and hope that you keep us in mind for following years. If you have any questions or if I can be of any further assistance please do not hesitate to contact me. Sincerely, Logan Mondshein Sales Executive, Large Group Commercial Sales Humana, Inc. 305.609.3836 Cell Phone 305.626.5084 Direct Line Lmondshein @humana.com The information transmitted is intended only for the person or entity to which it is addressed and may contain CONFIDENTIAL material. If you receive this material/information in error, please contact the sender and delete or destroy the material/information. MEDlink® Prime Series Supplemental Limited Benefit Medical Expense Insurance it, P for the Employees of City of Opa Locka Summary of Benefits In-Hospital Policy Plan 1 Maximum In-Hospital Benefits $3,000 per covered person per calendar year.Maximum of$9,000 per calendar year for all covered persons combined. In-Hospital Ambulance Benefit Up to$350 per trip for ground transportation or up to$1,000 per trip for air transportation where a covered person is confined as an inpatient.Limited to one trip per day. Outpatient Policy Maximum Outpatient Benefits $1,000 per covered person per calendar year for covered outpatient services.Maximum of$3,000 per calendar year for all covered persons combined. Outpatient Ambulance Benefit Up to$350 per trip for ground transportation or up to$1,000 per trip for air transportation where a covered person resides less than 18 hours.Limited to one trip per day. Emergency Room Deductible $300 per covered person per occurrence Covered Outpatient Services Hospital Emergency Room Payable up to the maximum outpatient benefit,subject to the emergency room per occurrence deductible,as shown above. Urgent Care Facility Payable up to the maximum outpatient benefit,after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Outpatient Surgery Outpatient surgery in a hospital outpatient facility or freestanding outpatient surgery center. Payable up to the maximum outpatient benefit,after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Diagnostic Testing Diagnostic testing in a hospital outpatient facility or MRI facility.Payable up to the maximum outpatient benefit,after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Physical Therapy Facility Payable up to the maximum outpatient benefit,after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Outpatient Treatment for a Mental or Emotional Maximum of 30 days of treatment per covered person per calendar year.Payable up Disorder in a Hospital Outpatient Facility to the maximum outpatient benefit,after satisfaction of any applicable outpatient deductible as stated in the out•atient.olic above. Additional Rider Benefits Physician or Specialist Outpatient Treatment Benefits Physician-$25 per visit Specialist-$50 per visit For treatment in a hospital outpatient facility or physician's office Total Monthly Premiums by Plan* Issue Ages Employee Employee&Spouse Employee&Child Employee&Family Plan 1 18+ $41.23 $74.21 $75.41 $108.40 *Total premium includes the Plan selected and any applicable rider premium.The premium and amount of benefits vary dependent upon the Plan selected at time of application. APSB-22380(FL)-Over 51 Page 1 of 2 MEDlink® Prime Series Supplemental Limited Benefit Medical Expense Insurance Definitions Premium Changes Hospital - is not an institution, or part thereof, used as a place for The premium rates may be changed by APL at the first anniversary date rehabilitation,a place for rest or for the aged,a nursing or convalescent of the policy or any premium due date thereafter. No such increase in home,a long-term nursing unit or geriatrics ward,or an extended care rates will be made unless 60 days prior notice is given to the policyholder. facility for the care of convalescent,rehabilitative or ambulatory patients. Premiums will not increase during the initial 12 months of coverage.If we fail to provide the 60-day notice,the coverage will remain in force with In-Hospital Policy and Outpatient Policy Limitations the existing rates until after the 60-day notice is given. and Exclusions Termination of Certificate No benefits will be payable for expenses incurred during any period the Insurance coverage under the certificate and any attached riders will covered person does not have coverage under your other medical plan, end on the earliest of these dates:the date this policy terminates;the except as provided in the absence of your other medical plan provision, end of the grace period if the premium remains unpaid;the date you no described in the policy. longer qualify as an insured;the date your coverage under your other Exclusions medical plan ends;or the date of your death. No benefits are payable for any loss resulting from or caused,whether Termination of Coverage directly or indirectly, by: war or any act of war, whether declared or Insurance coverage under the certificate and any attached riders for a undeclared,or active service in the armed forces;(This exclusion includes covered person will end as follows:the date this policy terminates;the accident sustained or sickness contracted while in the service of any date the certificate terminates;the end of the policy month in which we military,naval,or air force of any country engaged in war. If coverage is receive a written request from the policyholder to terminate the covered suspended for any covered person during a period of military service, person's coverage;the date a covered person no longer qualifies as an insured or eligible dependent;or the date of the covered person's death. APL will refund the pro-rata portion of any premium paid for any such We may end your coverage if you submit a fraudulent claim. covered person upon receipt of your written request.); an intentionally self-inflicted injury or sickness;suicide or attempted suicide,while sane or COBRA Continuation of Coverage insane;rest care or rehabilitative care and treatment(this does not include This plan may be continued in accordance with the Consolidated rehabilitation for treatment of physical disability); routine newborn care, Omnibus Reconciliation Act of 1986. including routine nursery charges;voluntary abortion except,with respect to you or your covered eligible dependent spouse: where you or your Optionally Renewable dependent spouse's life would be endangered if the fetus were carried to The policyholder has the right to terminate the policy on any premium term or where medical complications have arisen from abortion;pregnancy due date after the first anniversary following the policy effective date. of an eligible dependent child;participating in a riot,insurrection,rebellion, We must give at least 60 days written notice to the policyholder prior civil commotion,civil disobedience or unlawful assembly(This does not to cancellation.We cannot cancel your coverage under this certificate include a loss which occurs while acting in a lawful manner within the because of change in your age or health.We can change your premiums scope of authority.);committing,or attempting to commit,an illegal act for this certificate if we change premiums for all similar certificates issued that is defined as a felony(Felony is as defined by the law of the jurisdiction under the policy.We must give you at least 60 days written notice before in which the act takes place.);participation in a contest of speed in power we change your premiums. driven vehicles,parachuting or hang gliding;air travel,except as a fare- Termination of Physician or Specialist Outpatient paying passenger on a commercial airline on a regularly scheduled route or as a passenger for transportation only and not as a pilot or crew member; Treatment and Rider Benefit(s) being intoxicated or under the influence of any narcotic unless administered Insurance coverage for a covered person under applicable riders will end by a physician or taken according to the physician's instructions(Intoxication on the earliest of:the date the policy terminates;the date the certificate means that which is determined and defined by the laws and jurisdiction of terminates;the date the rider terminates;the end of the grace period if the premium remains unpaid;the end of the certificate month in which the geographical area in which the event that caused the loss occurred.); the policyholder requests to terminate the coverage for an eligible alcoholism or drug addiction;sex changes;experimental treatment,drugs dependent;the date a covered person no longer qualifies as an insured or surgery (bone marrow transplants are not considered experimental); or eligible dependent;or the date of the covered person's death.We have accident or sickness arising out of,and in the course of,any occupation the right to terminate your certificate and any attached riders if a covered for compensation,wage or profit for which benefits are paid by workers' person makes a fraudulent claim. compensation(This does not apply to those sole proprietors or partners not covered by workers'compensation.);dental or vision services,including treatment,surgery,extractions or x-rays,unless resulting from an accident occurring while the covered person's coverage is in force and if performed within 12 months of the date of such accident or due to congenital disease or anomaly of a covered newborn child; routine examinations, such as health exams, periodic check-ups or routine physicals;elective cosmetic surgery; drugs (prescription and non-prescription for use outside of a covered facility as defined in this policy or any attached rider);sterilization Underwritten by: and reversal of sterilization;an expense that does not meet the definition of covered charges;an expense or service that exceeds any of the maximum American Public Life benefits,as shown in the schedule of benefits;or any expense for which z P Insurance Company benefits are not payable under your other medical plan. • 2305 Lakeland Drive I Flowood,MS I 39232 ampublic.com 1800.256.8606 This is a brief description of the coverage.For actual benefits,limitations,exclusions and other provisions,please refer to the policy and riders.This coverage does not replace Workers'Compensation Insurance.This product is inappropriate for people who are eligible for Medicaid coverage. I Policy Form MEDlink•Series I FL I Supplemental Limited Benefit Medical Expense Insurance (10/14) APSB-22380(FL)-Over 51 Page 2 of 2 Vol untary Life Insurance nline coi1 with Accidental Death and Dismemberment (AD&D) Financial Group® SUMMARY OF BENEFITS Sponsored by: City of Opa Locka Life Benefit Employee Spouse Dependent Employee must elect coverage for Spouse or dependents to be eligible. Amount Choice of$10,000 increments Choice of$5,000 increments Age 14 Days to 6 months: $250 6 months to age 19(to age 25 if full-time student): $10,000 Newborn children to age 14 days are not eligible for a benefit Minimum $10,000 $5,000 $10,000 Amount Maximum $300,000,limited to 5 times your annual $150,000, limited to 50%of $10,000 Amount salary employee amount Employees age 70 and older,maximum benefit is$50,000 Guarantee $150,000 $30,000 Issue for Newly Eligible Employee Current Eligible You or your Spouse may elect or increase insurance coverage equal to 2 Employees benefit levels on a guaranteed acceptance basis during your company's defined annual open enrollment period,provided that you or your Spouse •• have not been previously declined,withdrawn, or pending for coverage. AD&D Benefit Employee Spouse Amount Benefit amount equal to the life amount Same as employee elected by you. Cost included in the schedule. Benefit Employee Spouse Reduction Benefits will 35%at age 65; 35%at Employee Age 65 w: reduce: Additional 25%of original amount at age 70; Benefits terminate at Employee Additional 15%of original amount at age 75; Retirement Additional 15%of original amount at age 80; Benefits terminate at retirement Eligibility Employee Spouse and Dependents All employees in an eligible class. Cannot be in a period of limited activity on the day coverage takes effect. Additional Benefits See Definition: Accelerated Death Benefit See Definition: Portability See Definition: Conversion See Definition: Seat Belt,Airbag, and Common Carrier www.LincolnFinancial.com Definitions Accelerated Death Accelerated Death Benefit provides an option to withdraw a percentage of your life insurance Benefit coverage when diagnosed as terminally ill(as defined in the policy). The death benefit will be reduced by the amount withdrawn. To qualify,you have satisfied the Active Work rule and have been covered under this policy for the required amount of time as defined by the policy. Check with your tax advisor or attorney before exercising this option. AD&D Accidental Death and Dismemberment(AD&D)insurance provides specified benefits for a covered accidental bodily injury that directly causes dismemberment(e.g.,the loss of a hand,foot,or eye). In the event that death occurs from a covered accident, both the life and the AD&D benefit would be payable Conversion If you terminate your employment or become ineligible for this coverage,you have the option to convert all or part of the amount of coverage in force to an individual life policy on the date of termination without Evidence of Insurability. Conversion election must be made within 31 days of your date of termination. Guarantee Issue For timely entrants enrolled within 31 days of becoming eligible,the Guarantee Issue amount is available without any Evidence of Insurability requirement. Evidence of Insurability will be required for any amounts above this, for late enrollees or increase in insurance, and it will be provided at your own expense. Limited Activity A period when a Spouse or dependent is confined in a health care facility;or,whether confined or not, is unable to perform the regular and usual activities of a healthy person of the same age and sex. Portability If coverage has been in force for at least 12 months,you may continue coverage for a specified period of time after your employment by paying the required premium. Portability is available if you cease employment for a reason other than total disability or retirement at Social Security Normal Retirement Age. A written application must be made within 31 days of your termination. Seat Belt,Airbag, If you die as a result of a covered auto accident while wearing a seat belt or in a vehicle equipped with and Common an airbag,additional benefits are payable up to$10,000 or 10%of the principal sum,whichever is Carrier less. If loss occurs for you due to an accident while riding as a passenger in a common carrier, benefits will be double the amount that would otherwise apply as outlined in the certificate. Term Life Benefit provided to the designated beneficiary upon the death of the insured.The benefit is provided for the time period that you are eligible and premium is paid.There is no cash value associated with this product. Exclusion:Suicide Benefits will not be paid if the death results from suicide within 2 years after coverage is effective. May apply if employee contributes toward the premium. Additional Benefits LifeKeysSM Online will&testament preparation service, identity theft resources and beneficiary assistance support for all employees and eligible dependents covered under the Group Term Life and/or AD&D policy. Trave/Connect'sM Travel assistance services for employees and eligible dependents traveling more than 100 miles from home. For assistance or additional information Contact Lincoln Financial Group at (800) 423-2765; reference ID: CTYOPALOCK I www.LincolnFinancial.com Insurance products are issued by The Lincoln National Life Insurance Company(Fort Wayne, IN),which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. Not for use in New York. www.LincolnFinancial.com SS—CTYOPALOCK-6/14-Employee Choice-Increments—Employee Choice-Increments-AD&D on Group Level-Gen-8/25/2015 Semi-Monthly Employee Premium Life and Accidental Death and Dismemberment Premium for sample benefit amounts Employee and Spouse premiums are calculated separately. Refer to Program Specifications for your maximum benefit amounts. Benefits and premium amounts reflect age reductions. Semi-Monthly AGE $ 10,000 $ 20,000 $ 30,000 $ 40,000 $ 50,000 $ 60,000 $ 70,000 $ 80,000 $ 90,000 $ 100,000 Per$1000 0.0560 <25 $0.56 $1.12 $1.68 $2.24 $2.80 $3.36 $3.92 $4.48 $5.04 $5.60 0.0560 25-29 $0.56 $1.12 $1.68 $2.24 $2.80 $3.36 $3.92 $4.48 $5.04 $5.60 0.0610 30-34 $0.61 $1.22 $1.83 $2.44 $3.05 $3.66 $4.27 $4.88 $5.49 $6.10 0.0710 35-39 $0.71 $1.42 $2.13 $2.84 $3.55 $4.26 $4.97 $5.68 $6.39 $7.10 0.1060 40-44 $1.06 $2.12 $3.18 $4.24 $5.30 $6.36 $7.42 $8.48 $9.54 $10.60 0.1610 45-49 $1.61 _ $3.22 $4.83 $6.44 $8.05 $9.66 $11.27 $12.88 $14.49 $16.10 0.2860 50-54 $2.86 $5.72 $8.58 $11.44 $14.30 $17.16 $20.02 $22.88 $25.74 $28.60 0.4460 55-59 $4.46 $8.92 _ $13.38 $17.84 $22.30 $26.76 $31.22 $35.68 $40.14 $44.60 0.5210 60.64 $5.21 $10.42 $15.63 $20.84 $26.05 $31.26 $36.47 $41.68 $46.89 $52.10 0.9260 65-69 $4500 $13,000 $19,500 $26,000 _ $32,500 $39,000 $445,500 _ $552,000 $58,500 $55,000 $6.02 $1204 _ $18.06 $24.08 $30.10 $38.11 $4213 $48.15 _ $54.17 $60.19 1.7910 70-74 $4,000 $8,000 $12,000 $16,000 _ $20,000 N/A WA N/A WA N/A $7.16 $14.33 $21.49 $28.86 $35.82 WA N/A N/A _ N/A N/A 4.8010 75-79 _ $2,500 $5,000 $7,500 $10,000 $12,500 N/A WA WA N/A WA $12.00 $24.01 $38.01 $48.01 $60.01 WA N/A N/A WA N/A 10.9310 80-99 $1,000 $2,000 $3,000 _ $4000 $1,000 . N/A N/A WA _ WA N/A $10.93 $21.86 $32.79 $43.72 $54.88 N/A WA N/A N/A N/A This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency. Example: Use this formula to calculate premium for benefit amounts over $ 100,000 Semi- Rate Per X Benefit In$1,000'$ = Semi- Age Cost Monthly $1,000 Monthly Example: 35 0.0710 © 150 MEM $ 10.65 X = Dependent Children Benefit $ 10,000 Semi-Monthly Rate: $ 1.00 Premium covers all dependent children regardless of the number of children. Insurance products are issued by The Lincoln National Life Insurance Company(Fort Wayne, IN),which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. Not for use in New York. www.LincolnFinancial.com SS-CTYOPALOCK-6/14-Employee Choice-Increments-Employee Choice-Increments-ADO on Group Level-Gen-8/25/2015 Semi-Monthly Spouse Premium Life and Accidental Death and Dismemberment Premium for sample benefit amounts Employee and Spouse premiums are calculated separately. Spouse premiums will be calculated based on the Employee Age Refer to Program Specifications for your maximum benefit amounts. Benefits and premium amounts reflect age reductions. beml-monmIy RATE AGE $ 5,000 $ 10,000 $ 15,000 $ 20,000 $ 25,000 $ 30,000 $ 35,000 $ 40,000 $ 45,000 $ 50,000 Per$1000 0.0560 <25 $0.28 _ $0.56 $0.84 $1.12 $1.40 $1.68 $1.96 $2.24 $2.52 $2.80 0.0560 25-29 $0.28 $0.56 , $0.84 $1.12 $1.40 $1.68 $1.96 $2.24 $2.52 $2.80 0.0610 30-34 $0.31 $0.61 $0.92 $1.22 _ $1.53 $1.83 $2.14 $2.44 $2.75 $3.05 0.0710 35-39 $0.36 $0.71 $1.07 $1.42 _ $1.78 $2.13 $2.49 $2.84 $3.20 $3.55 0.1060 40-44 $0.53 $1.06 $1.59 $2.12 _ $2.65 $3.18 $3.71 $4.24 $4.77 $5.30 0.1610 45-49 $0.81 $1.61 $2.42 $3.22 $4.03 $4.83 $5.64 $6.44 $7.25 $8.05 0.2860 50-54 $1.43 $2.86 _ $4.29 $5.72 $7.15 - $8.58 $10.01 $11.44 $12.87 $14.30 0.4460 55-59 $2.23 $4.46 $6.69 _ $8.92 $11.15 $13.38 $15.61 $17.84 $20.07 $22.30 0.5210 60-64 $2.61 $5.21 $7.82 $10.42 $13.03 $15.63 _ $18.24 $20.84 $23.45 $26.05 0.9260 65-69 *250 _ $6,300 $9,750 $13,000 $14230 $19,500 , $23,750 $26,000 $29,250 $32,500 _ $3.01 _ $6.02 $9.03 $12.04 _ $15.05 $18.08 $21.07 $24.08 $27.09 $30.10 This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency. Example: Use this formula to calculate premium for benefit amounts over $ 50,000 Semi- Rate Per X Benefit In$1,000'$ = Semi- Age Cost Monthly $1,000 Monthly Example: 35 0.0710 X 75 = $ 5.33 X = Insurance products are issued by The Lincoln National Life Insurance Company(Fort Wayne, IN),which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. Not for use in New York. www.LincolnFinancial.com SS-CTYOPALOCK-6/14-Employee Choice-Increments-Employee Choice-Increments-AD&D on Group Level-Gen-8/25/2015