ESBD_503812_1775238485584_Rate History.pdf

This is a Rate History document for employee and retiree life insurance coverage in Texas, detailing premium rates across fiscal years 2022 through 2025. The document outlines pricing structures for Basic Life insurance, Optional Life insurance, Dependent Life insurance plans, and Accidental Death and Dismemberment (AD&D) coverage. Basic Life coverage for employees and retirees is provided at a fixed monthly rate of $4.70 for $7,500 in coverage, while certified other health coverage is offered at $.626 per $1,000 of coverage. The contract encompasses multiple plan options including Plan A for spouse coverage, Plan B with flat-rate spouse and child options, and Plan C with alternate premium calculations based on employee or retiree status and family composition.

Optional Life and Dependent Life premiums are structured by age brackets and tobacco use status, with rates per $1,000 of monthly coverage ranging from $0.05 to $4.00 depending on age and smoking status. Dependent Life coverage for children is available at $.06 per $1,000 of coverage under Plan A, while Plan B offers flat-rate spousal coverage of $1.05 and child coverage of $0.32, each for $5,000 in combined Dependent Life and AD&D benefits. Plan C premiums are calculated as one-half of the Alternate Basic Life premium for employee-only coverage at $0.10 monthly and employee-and-family coverage at $0.24 monthly, with retiree rates at $0.28 and $0.46 respectively. Accidental Death and Dismemberment coverage is provided at a monthly rate per $10,000 of coverage as specified in the rate schedule.