 | | Hospital Deductible Insurance (HDI) Supplementary Group Coverage | Standard Benefit Options Available:
$1,000, $2,000, $3,000 and $5,000.
(Also available in $500 increments up to $5,000) |  | Plans can be offered two ways: - Blanket Basis - employer pays 100% of the premium for employee coverage and employees pay for dependents.
- Voluntary Basis - employees pay some or all of the premium for themselves and their dependents.
| Note: A modal billing fee of up to $9 depending on group size will be reflected on each bill. |
|
| | |
 | Blanket Basis: Employer pays 100% of Employee-Only rate for all eligible employees.
Employees pay the balance for family members through payroll deduction. | | | Monthly Rates | | | Benefit Level | $1,000 | $2,000 | $3,000 | $5,000 | | Employee Only | $10.00 | $19.00 | $29.00 | $48.00 | | Employee & Spouse | $21.00 | $42.00 | $63.00 | $105.00 | | Employee & Children | $16.00 | $32.00 | $48.00 | $81.00 | | Family | $28.00 | $56.00 | $84.00 | $140.00 |
|
| | |
 | Voluntary Basis: Employees pay some or all of the premium for themselves and their dependents through payroll deduction. | | | Monthly Rates | | | Benefit Level | $1,000 | $2,000 | $3,000 | $5,000 | | Employee Only | $13.00 | $25.00 | $38.00 | $63.00 | | Employee & Spouse | $27.00 | $55.00 | $82.00 | $137.00 | | Employee & Children | $21.00 | $42.00 | $63.00 | $105.00 | | Family | $37.00 | $73.00 | $110.00 | $183.00 |
|
| | |
|