Attachment_4__Technical_Attachment_4_of_the_PWS _5-Year_Rate_and_Premium_History.docx
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Attachment 4 Technical Attachment 4 of the PWS 5-Year Rate and Premium History
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Exhibit 4
Premium Rate History January 1, 2010 through June 30, 2015
24-Hour Personal Accident Insurance Rates and Premium Paid
Benefit Amount
| Biweekly Cost for Employee Only |
| Biweekly Cost for Employee & Family |
| $50,000 |
| $0.27 |
| $0.48 |
| $75,000 |
| $0.41 |
| $0.71 |
| $100,000 |
| $0.54 |
| $0.95 |
| $125,000 |
| $0.68 |
| $1.19 |
| $150,000 |
| $0.81 |
| $1.43 |
| $175,000 |
| $0.95 |
| $1.66 |
| $200,000 |
| $1.08 |
| $1.90 |
| $225,000 |
| $1.22 |
| $2.14 |
| $250,000 |
| $1.35 |
| $2.38 |
| $300,000 |
| $1.62 |
| $2.85 |
| $350,000 |
| $1.89 |
| $3.33 |
| $400,000 |
| $2.16 |
| $3.80 |
| $450,000 |
| $2.43 |
| $4.28 |
| $500,000 |
| $2.70 |
| $4.75 |
| Coverage Year |
| Total Premium Paid |
| 2010 |
| $ 70,335 |
| 2011 |
| $ 72,911 |
| 2012 |
| $ 81,274 |
| 2013 |
| $ 97,676 |
| 2014 |
| $105,312 |
| Thru Pay Period Ending 2/7/2015 |
| $ 11,818 |
| Total 24-HR PAI Premium Paid to Date |
| $439,326 |
Business Travel Accident Insurance Rates
| Year |
| Covered Group |
| Annual Premium |
| 2010 |
| OCC Employees |
| $16,093 |
| 2011 |
| OCC Employees |
OFR Employees (from 6/1/2011 through 12/31/2011) $16,093 $ 418
| 2012 |
| OCC Employees |
OFR Employees $16,808 $ 715
| 2013 |
| OCC Employees |
OFR Employees $16,808 $ 715
| 2014 |
| OCC Employees |
OFR Employees $16,808 $ 715
| 2015 |
| OCC Employees & OFR Employees combined |
| $ 9,888 |
| Total BTA Premium Paid to Date |
| $95,061 |
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