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ATTACHMENT 1 – PRICING STRUCTURE
RFQ: 2031JW21Q00092
BASIC LIFE FOR ACTIVE EMPLOYEES
Base Six Months (July 1, 2021 through December 31, 2021)
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
Life coverage for employee (maximum coverage of $500,000)
Option Year 1 (January 1, 2022 through December 31, 2022)
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
Life coverage for employee (maximum coverage of $500,000)
Option Year 2 (January 1, 2023 through December 31, 2023)
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
Life coverage for employee (maximum coverage of $500,000)
Option Year 3 (January 1, 2024 through December 31, 2024)
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
Life coverage for employee (maximum coverage of $500,000)
Option Year 4 (January 1, 2025 through December 31, 2025)
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
Life coverage for employee (maximum coverage of $500,000)
BASIC LIFE FOR RETIREES
Base Year (July 1, 2021 through December 31, 2021)
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
| Life coverage for retirees |
| $________ |
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
| Life coverage for retirees |
| $________ |
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
| Life coverage for retirees |
| $________ |
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
| Life coverage for retirees |
| $________ |
| Type of Coverage |
| Biweekly Rate Per $1000 of Coverage |
| Life coverage for retirees |
| $________ |
OPTIONAL EMPLOYEE COVERAGE
| Age Brackets |
| Biweekly Rate Per $1000 (maximum coverage $500,000) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate Per $1000 (maximum coverage $500,000) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate Per $1000 (maximum coverage $500,000) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate Per $1000 (maximum coverage $500,000) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate Per $1000 (maximum coverage $500,000) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
OPTIONAL SPOUSE/DOMESTIC PARTNER COVERAGE
| Age Brackets |
| Biweekly Rate Per $1000 |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate Per $1000 |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate Per $1000 |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate Per $1000 |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate Per $1000 |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
OPTIONAL FAMILY COVERAGE
| Age Brackets |
| Biweekly Rate (per $5,000 spouse and $2,500 child) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate (per $5,000 spouse and $2,500 child) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate (per $5,000 spouse and $2,500 child) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate (per $5,000 spouse and $2,500 child) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
| Age Brackets |
| Biweekly Rate (per $5,000 spouse and $2,500 child) |
<35 35-39 40-44 45-49 50-54 55-59 60-64 65>
ANNUAL PRICE ESTIMATES
Base Year: July 1, 2021 – December 31, 2021
| Type of Coverage |
| Estimated Annual Price |
| Retiree Basic Life (excluding AD&D) |
| $ ________________ |
| Employee Basic Life (including AD&D) |
| $ ________________ |
| Employee Optional Life |
| $ ________________ |
| Spousal Optional Life |
| $ ________________ |
| Optional Family Life |
| $ ________________ |
| Total Estimated Price |
| $ ________________ |
Option Year 1: January 1, 2022 – December 31, 2022
| Type of Coverage |
| Estimated Annual Price |
| Employee Basic Life (including AD&D) |
| $ ________________ |
| Retiree Basic Life (excluding AD&D) |
| $ ________________ |
| Employee Optional Life |
| $ ________________ |
| Spousal Optional Life |
| $ ________________ |
| Optional Family Life |
| $ ________________ |
| Total Estimated Price |
| $ ________________ |
Option Year 2: January 1, 2023 – December 31, 2023
| Type of Coverage |
| Estimated Annual Price |
| Employee Basic Life (including AD&D) |
| $ ________________ |
| Retiree Basic Life (excluding AD&D) |
| $ ________________ |
| Employee Optional Life |
| $ ________________ |
| Spousal Optional Life |
| $ ________________ |
| Optional Family Life |
| $ ________________ |
| Total Estimated Price |
| $ ________________ |
Option Year 3: January 1, 2024 – December 31, 2024
| Type of Coverage |
| Estimated Annual Price |
| Employee Basic Life (including AD&D) |
| $ ________________ |
| Retiree Basic Life (excluding AD&D) |
| $ ________________ |
| Employee Optional Life |
| $ ________________ |
| Spousal Optional Life |
| $ ________________ |
| Optional Family Life |
| $ ________________ |
| Total Estimated Price |
| $ ________________ |
Option Year 4: January 1, 2025 – December 31, 2025
| Type of Coverage |
| Estimated Annual Price |
| Employee Basic Life (including AD&D) |
| $ ________________ |
| Retiree Basic Life (excluding AD&D) |
| $ ________________ |
| Employee Optional Life |
| $ ________________ |
| Spousal Optional Life |
| $ ________________ |
| Optional Family Life |
| $ ________________ |
| Total Estimated Price |
| $ ________________ |