The file's text, extracted by GovTribe without its formatting.
Base Year
| | | Base Year | 1/1/2021 - 12/31/2021 | |
| | Type of Insurance | | | |
| | Basic Insurance | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| | Basic Life | $157,655,920.00 | | $0.00 | $0.00 |
| | Basic AD&D | $157,655,920.00 | | $0.00 | $0.00 |
| | Total Basic Life + AD&D | $157,655,920.00 | $0.000 | $0.00 | $0.00 |
| | Note: CFPB will pay Contractor based on total combined Basic Life & AD&D Rate. | | | | |
| | Optional Employee Life | | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium | |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | | |
(Column E multipled by 26)
| Under 35 | $4,600,000 | $0.00 | $0.00 |
| 35-39 | $16,450,000 | $0.00 | $0.00 |
| 40-44 | $16,600,000 | $0.00 | $0.00 |
| 45-49 | $17,500,000 | $0.00 | $0.00 |
| 50-54 | $14,700,000 | $0.00 | $0.00 |
| 55-59 | $12,475,000 | $0.00 | $0.00 |
| Age 60 and older | $10,300,000 | $0.00 | $0.00 |
| | Optional Spouse Life | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| Under 35 | $938,000 | $0.00 | $0.00 |
| 35-39 | $5,961,500 | $0.00 | $0.00 |
| 40-44 | $6,159,000 | $0.00 | $0.00 |
| 45-49 | $7,023,000 | $0.00 | $0.00 |
| 50-54 | $6,987,000 | $0.00 | $0.00 |
| 55-59 | $5,620,000 | $0.00 | $0.00 |
| Age 60 and older | $3,645,000 | $0.00 | $0.00 |
| | Optional Family Life | | | |
| | Age Ranges | Number of units – one unit equals $5,000 for spouse plus $2,500 per child | Bi-Weekly Life Rate per Unit/Multiple | Bi-Weekly Premium |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | |
(Column E multiplied by 26)
| | Under 35 | 29 | | $0.00 | $0.00 |
| | 35-39 | 154 | | $0.00 | $0.00 |
| | 40-44 | 137 | | $0.00 | $0.00 |
| | 45-49 | 202 | | $0.00 | $0.00 |
| | 50-54 | 129 | | $0.00 | $0.00 |
| | 55-59 | 135 | | $0.00 | $0.00 |
| | Age 60 and older | 79 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Self | | | | |
| | Benefit Amount | Number of employees - only elections | Self Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| | $50,000 | 18 | | $0.00 | $0.00 |
| | $75,000 | 2 | | $0.00 | $0.00 |
| | $100,000 | 13 | | $0.00 | $0.00 |
| | $125,000 | 1 | | $0.00 | $0.00 |
| | $150,000 | 8 | | $0.00 | $0.00 |
| | $175,000 | 1 | | $0.00 | $0.00 |
| | $200,000 | 21 | | $0.00 | $0.00 |
| | $225,000 | 0 | | $0.00 | $0.00 |
| | $250,000 | 17 | | $0.00 | $0.00 |
| | $300,000 | 10 | | $0.00 | $0.00 |
| | $350,000 | 4 | | $0.00 | $0.00 |
| | $400,000 | 5 | | $0.00 | $0.00 |
| | $450,000 | 1 | | $0.00 | $0.00 |
| | $500,000 | 44 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Family | | | | |
| | Benefit Amount | Number of employee + family elections | Family Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| $50,000 | 12 | | $0.00 | $0.00 |
| $75,000 | 3 | | $0.00 | $0.00 |
| $100,000 | 24 | | $0.00 | $0.00 |
| $125,000 | 6 | | $0.00 | $0.00 |
| $150,000 | 9 | | $0.00 | $0.00 |
| $175,000 | 2 | | $0.00 | $0.00 |
| $200,000 | 16 | | $0.00 | $0.00 |
| $225,000 | 1 | | $0.00 | $0.00 |
| $250,000 | 18 | | $0.00 | $0.00 |
| $300,000 | 16 | | $0.00 | $0.00 |
| $350,000 | 1 | | $0.00 | $0.00 |
| $400,000 | 4 | | $0.00 | $0.00 |
| $450,000 | 2 | | $0.00 | $0.00 |
| $500,000 | 158 | | $0.00 | $0.00 |
| | Base Year Total (Sum of all Sub-Totals, above) | | $0.00 |
Option Year 1
| | | Option Year 1 | 1/1/2022 - 12/31/2022 | |
| | Type of Insurance | | | |
| | Basic Insurance | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| | Basic Life | $162,385,597.60 | | $0.00 | $0.00 |
| | Basic AD&D | $162,385,597.60 | | $0.00 | $0.00 |
| | Total Basic Life + AD&D | $162,385,597.60 | $0.000 | $0.00 | $0.00 |
| | Note: CFPB will pay Contractor based on total combined Basic Life & AD&D Rate. | | | | |
| | Optional Employee Life | | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium | |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | | |
(Column E multipled by 26)
| Under 35 | $4,600,000 | $0.00 | $0.00 |
| 35-39 | $16,450,000 | $0.00 | $0.00 |
| 40-44 | $16,600,000 | $0.00 | $0.00 |
| 45-49 | $17,500,000 | $0.00 | $0.00 |
| 50-54 | $14,700,000 | $0.00 | $0.00 |
| 55-59 | $12,475,000 | $0.00 | $0.00 |
| Age 60 and older | $10,300,000 | $0.00 | $0.00 |
| | Optional Spouse Life | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| Under 35 | $938,000 | $0.00 | $0.00 |
| 35-39 | $5,961,500 | $0.00 | $0.00 |
| 40-44 | $6,159,000 | $0.00 | $0.00 |
| 45-49 | $7,023,000 | $0.00 | $0.00 |
| 50-54 | $6,987,000 | $0.00 | $0.00 |
| 55-59 | $5,620,000 | $0.00 | $0.00 |
| Age 60 and older | $3,645,000 | $0.00 | $0.00 |
| | Optional Family Life | | | |
| | Age Ranges | Number of units – one unit equals $5,000 for spouse plus $2,500 per child | Bi-Weekly Life Rate per Unit/Multiple | Bi-Weekly Premium |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | |
(Column E multiplied by 26)
| | Under 35 | 29 | | $0.00 | $0.00 |
| | 35-39 | 154 | | $0.00 | $0.00 |
| | 40-44 | 137 | | $0.00 | $0.00 |
| | 45-49 | 202 | | $0.00 | $0.00 |
| | 50-54 | 129 | | $0.00 | $0.00 |
| | 55-59 | 135 | | $0.00 | $0.00 |
| | Age 60 and older | 79 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Self | | | | |
| | Benefit Amount | Number of employees - only elections | Self Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| | $50,000 | 18 | | $0.00 | $0.00 |
| | $75,000 | 2 | | $0.00 | $0.00 |
| | $100,000 | 13 | | $0.00 | $0.00 |
| | $125,000 | 1 | | $0.00 | $0.00 |
| | $150,000 | 8 | | $0.00 | $0.00 |
| | $175,000 | 1 | | $0.00 | $0.00 |
| | $200,000 | 21 | | $0.00 | $0.00 |
| | $225,000 | 0 | | $0.00 | $0.00 |
| | $250,000 | 17 | | $0.00 | $0.00 |
| | $300,000 | 10 | | $0.00 | $0.00 |
| | $350,000 | 4 | | $0.00 | $0.00 |
| | $400,000 | 5 | | $0.00 | $0.00 |
| | $450,000 | 1 | | $0.00 | $0.00 |
| | $500,000 | 44 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Family | | | | |
| | Benefit Amount | Number of employee + family elections | Family Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| $50,000 | 12 | | $0.00 | $0.00 |
| $75,000 | 3 | | $0.00 | $0.00 |
| $100,000 | 24 | | $0.00 | $0.00 |
| $125,000 | 6 | | $0.00 | $0.00 |
| $150,000 | 9 | | $0.00 | $0.00 |
| $175,000 | 2 | | $0.00 | $0.00 |
| $200,000 | 16 | | $0.00 | $0.00 |
| $225,000 | 1 | | $0.00 | $0.00 |
| $250,000 | 18 | | $0.00 | $0.00 |
| $300,000 | 16 | | $0.00 | $0.00 |
| $350,000 | 1 | | $0.00 | $0.00 |
| $400,000 | 4 | | $0.00 | $0.00 |
| $450,000 | 2 | | $0.00 | $0.00 |
| $500,000 | 158 | | $0.00 | $0.00 |
| | Option Year 1 Total (Sum of all Sub-Totals, above) | | $0.00 |
Option Year 2
| | | Option Year 2 | 1/1/2023 - 12/31/2023 | |
| | Type of Insurance | | | |
| | Basic Insurance | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| | Basic Life | $167,257,165.53 | | $0.00 | $0.00 |
| | Basic AD&D | $167,257,165.53 | | $0.00 | $0.00 |
| | Total Basic Life + AD&D | $167,257,165.53 | $0.000 | $0.00 | $0.00 |
| | Note: CFPB will pay Contractor based on total combined Basic Life & AD&D Rate. | | | | |
| | Optional Employee Life | | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium | |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | | |
(Column E multipled by 26)
| Under 35 | $4,600,000 | $0.00 | $0.00 |
| 35-39 | $16,450,000 | $0.00 | $0.00 |
| 40-44 | $16,600,000 | $0.00 | $0.00 |
| 45-49 | $17,500,000 | $0.00 | $0.00 |
| 50-54 | $14,700,000 | $0.00 | $0.00 |
| 55-59 | $12,475,000 | $0.00 | $0.00 |
| Age 60 and older | $10,300,000 | $0.00 | $0.00 |
| | Optional Spouse Life | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| Under 35 | $938,000 | $0.00 | $0.00 |
| 35-39 | $5,961,500 | $0.00 | $0.00 |
| 40-44 | $6,159,000 | $0.00 | $0.00 |
| 45-49 | $7,023,000 | $0.00 | $0.00 |
| 50-54 | $6,987,000 | $0.00 | $0.00 |
| 55-59 | $5,620,000 | $0.00 | $0.00 |
| Age 60 and older | $3,645,000 | $0.00 | $0.00 |
| | Optional Family Life | | | |
| | Age Ranges | Number of units – one unit equals $5,000 for spouse plus $2,500 per child | Bi-Weekly Life Rate per Unit/Multiple | Bi-Weekly Premium |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | |
(Column E multiplied by 26)
| | Under 35 | 29 | | $0.00 | $0.00 |
| | 35-39 | 154 | | $0.00 | $0.00 |
| | 40-44 | 137 | | $0.00 | $0.00 |
| | 45-49 | 202 | | $0.00 | $0.00 |
| | 50-54 | 129 | | $0.00 | $0.00 |
| | 55-59 | 135 | | $0.00 | $0.00 |
| | Age 60 and older | 79 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Self | | | | |
| | Benefit Amount | Number of employees - only elections | Self Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| | $50,000 | 18 | | $0.00 | $0.00 |
| | $75,000 | 2 | | $0.00 | $0.00 |
| | $100,000 | 13 | | $0.00 | $0.00 |
| | $125,000 | 1 | | $0.00 | $0.00 |
| | $150,000 | 8 | | $0.00 | $0.00 |
| | $175,000 | 1 | | $0.00 | $0.00 |
| | $200,000 | 21 | | $0.00 | $0.00 |
| | $225,000 | 0 | | $0.00 | $0.00 |
| | $250,000 | 17 | | $0.00 | $0.00 |
| | $300,000 | 10 | | $0.00 | $0.00 |
| | $350,000 | 4 | | $0.00 | $0.00 |
| | $400,000 | 5 | | $0.00 | $0.00 |
| | $450,000 | 1 | | $0.00 | $0.00 |
| | $500,000 | 44 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Family | | | | |
| | Benefit Amount | Number of employee + family elections | Family Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| $50,000 | 12 | | $0.00 | $0.00 |
| $75,000 | 3 | | $0.00 | $0.00 |
| $100,000 | 24 | | $0.00 | $0.00 |
| $125,000 | 6 | | $0.00 | $0.00 |
| $150,000 | 9 | | $0.00 | $0.00 |
| $175,000 | 2 | | $0.00 | $0.00 |
| $200,000 | 16 | | $0.00 | $0.00 |
| $225,000 | 1 | | $0.00 | $0.00 |
| $250,000 | 18 | | $0.00 | $0.00 |
| $300,000 | 16 | | $0.00 | $0.00 |
| $350,000 | 1 | | $0.00 | $0.00 |
| $400,000 | 4 | | $0.00 | $0.00 |
| $450,000 | 2 | | $0.00 | $0.00 |
| $500,000 | 158 | | $0.00 | $0.00 |
| | Option Year 2 Total (Sum of all Sub-Totals, above) | | $0.00 |
Option Year 3
| | | Option Year 3 | 1/1/2024 - 12/31/2024 | |
| | Type of Insurance | | | |
| | Basic Insurance | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| | Basic Life | $172,274,880.49 | | $0.00 | $0.00 |
| | Basic AD&D | $172,274,880.49 | | $0.00 | $0.00 |
| | Total Basic Life + AD&D | $172,274,880.49 | $0.000 | $0.00 | $0.00 |
| | Note: CFPB will pay Contractor based on total combined Basic Life & AD&D Rate. | | | | |
| | Optional Employee Life | | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium | |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | | |
(Column E multipled by 26)
| Under 35 | $4,600,000 | $0.00 | $0.00 |
| 35-39 | $16,450,000 | $0.00 | $0.00 |
| 40-44 | $16,600,000 | $0.00 | $0.00 |
| 45-49 | $17,500,000 | $0.00 | $0.00 |
| 50-54 | $14,700,000 | $0.00 | $0.00 |
| 55-59 | $12,475,000 | $0.00 | $0.00 |
| Age 60 and older | $10,300,000 | $0.00 | $0.00 |
| | Optional Spouse Life | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| Under 35 | $938,000 | $0.00 | $0.00 |
| 35-39 | $5,961,500 | $0.00 | $0.00 |
| 40-44 | $6,159,000 | $0.00 | $0.00 |
| 45-49 | $7,023,000 | $0.00 | $0.00 |
| 50-54 | $6,987,000 | $0.00 | $0.00 |
| 55-59 | $5,620,000 | $0.00 | $0.00 |
| Age 60 and older | $3,645,000 | $0.00 | $0.00 |
| | Optional Family Life | | | |
| | Age Ranges | Number of units – one unit equals $5,000 for spouse plus $2,500 per child | Bi-Weekly Life Rate per Unit/Multiple | Bi-Weekly Premium |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | |
(Column E multiplied by 26)
| | Under 35 | 29 | | $0.00 | $0.00 |
| | 35-39 | 154 | | $0.00 | $0.00 |
| | 40-44 | 137 | | $0.00 | $0.00 |
| | 45-49 | 202 | | $0.00 | $0.00 |
| | 50-54 | 129 | | $0.00 | $0.00 |
| | 55-59 | 135 | | $0.00 | $0.00 |
| | Age 60 and older | 79 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Self | | | | |
| | Benefit Amount | Number of employees - only elections | Self Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| | $50,000 | 18 | | $0.00 | $0.00 |
| | $75,000 | 2 | | $0.00 | $0.00 |
| | $100,000 | 13 | | $0.00 | $0.00 |
| | $125,000 | 1 | | $0.00 | $0.00 |
| | $150,000 | 8 | | $0.00 | $0.00 |
| | $175,000 | 1 | | $0.00 | $0.00 |
| | $200,000 | 21 | | $0.00 | $0.00 |
| | $225,000 | 0 | | $0.00 | $0.00 |
| | $250,000 | 17 | | $0.00 | $0.00 |
| | $300,000 | 10 | | $0.00 | $0.00 |
| | $350,000 | 4 | | $0.00 | $0.00 |
| | $400,000 | 5 | | $0.00 | $0.00 |
| | $450,000 | 1 | | $0.00 | $0.00 |
| | $500,000 | 44 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Family | | | | |
| | Benefit Amount | Number of employee + family elections | Family Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| $50,000 | 12 | | $0.00 | $0.00 |
| $75,000 | 3 | | $0.00 | $0.00 |
| $100,000 | 24 | | $0.00 | $0.00 |
| $125,000 | 6 | | $0.00 | $0.00 |
| $150,000 | 9 | | $0.00 | $0.00 |
| $175,000 | 2 | | $0.00 | $0.00 |
| $200,000 | 16 | | $0.00 | $0.00 |
| $225,000 | 1 | | $0.00 | $0.00 |
| $250,000 | 18 | | $0.00 | $0.00 |
| $300,000 | 16 | | $0.00 | $0.00 |
| $350,000 | 1 | | $0.00 | $0.00 |
| $400,000 | 4 | | $0.00 | $0.00 |
| $450,000 | 2 | | $0.00 | $0.00 |
| $500,000 | 158 | | $0.00 | $0.00 |
| | Option Year 3 Total (Sum of all Sub-Totals, above) | | $0.00 |
Option Year 4
| | | Option Year 4 | 1/1/2025 - 12/31/2025 | |
| | Type of Insurance | | | |
| | Basic Insurance | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| | Basic Life | $177,443,126.91 | | $0.00 | $0.00 |
| | Basic AD&D | $177,443,126.91 | | $0.00 | $0.00 |
| | Total Basic Life + AD&D | $177,443,126.91 | $0.000 | $0.00 | $0.00 |
| | Note: CFPB will pay Contractor based on total combined Basic Life & AD&D Rate. | | | | |
| | Optional Employee Life | | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium | |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | | |
(Column E multipled by 26)
| Under 35 | $4,600,000 | $0.00 | $0.00 |
| 35-39 | $16,450,000 | $0.00 | $0.00 |
| 40-44 | $16,600,000 | $0.00 | $0.00 |
| 45-49 | $17,500,000 | $0.00 | $0.00 |
| 50-54 | $14,700,000 | $0.00 | $0.00 |
| 55-59 | $12,475,000 | $0.00 | $0.00 |
| Age 60 and older | $10,300,000 | $0.00 | $0.00 |
| | Optional Spouse Life | | | |
| | Age Ranges | Estimated Monthly Volume | Bi-Weekly Life Rate per $1,000 | Bi-Weekly Premium |
| ((Column C/$1,000) multiplied by Column D) | Yearly Premium | | | | |
(Column E multipled by 26)
| Under 35 | $938,000 | $0.00 | $0.00 |
| 35-39 | $5,961,500 | $0.00 | $0.00 |
| 40-44 | $6,159,000 | $0.00 | $0.00 |
| 45-49 | $7,023,000 | $0.00 | $0.00 |
| 50-54 | $6,987,000 | $0.00 | $0.00 |
| 55-59 | $5,620,000 | $0.00 | $0.00 |
| Age 60 and older | $3,645,000 | $0.00 | $0.00 |
| | Optional Family Life | | | |
| | Age Ranges | Number of units – one unit equals $5,000 for spouse plus $2,500 per child | Bi-Weekly Life Rate per Unit/Multiple | Bi-Weekly Premium |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | |
(Column E multiplied by 26)
| | Under 35 | 29 | | $0.00 | $0.00 |
| | 35-39 | 154 | | $0.00 | $0.00 |
| | 40-44 | 137 | | $0.00 | $0.00 |
| | 45-49 | 202 | | $0.00 | $0.00 |
| | 50-54 | 129 | | $0.00 | $0.00 |
| | 55-59 | 135 | | $0.00 | $0.00 |
| | Age 60 and older | 79 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Self | | | | |
| | Benefit Amount | Number of employees - only elections | Self Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| | $50,000 | 18 | | $0.00 | $0.00 |
| | $75,000 | 2 | | $0.00 | $0.00 |
| | $100,000 | 13 | | $0.00 | $0.00 |
| | $125,000 | 1 | | $0.00 | $0.00 |
| | $150,000 | 8 | | $0.00 | $0.00 |
| | $175,000 | 1 | | $0.00 | $0.00 |
| | $200,000 | 21 | | $0.00 | $0.00 |
| | $225,000 | 0 | | $0.00 | $0.00 |
| | $250,000 | 17 | | $0.00 | $0.00 |
| | $300,000 | 10 | | $0.00 | $0.00 |
| | $350,000 | 4 | | $0.00 | $0.00 |
| | $400,000 | 5 | | $0.00 | $0.00 |
| | $450,000 | 1 | | $0.00 | $0.00 |
| | $500,000 | 44 | | $0.00 | $0.00 |
| | 24-Hour Personal Accident | | | | |
| | Optional Family | | | | |
| | Benefit Amount | Number of employee + family elections | Family Bi-Weekly Unit Price | Bi-Weekly Premium | |
| (Column C multiplied by Column D) | Estimated Annual Premium | | | | | |
(Column E multiplied by 26)
| $50,000 | 12 | | $0.00 | $0.00 |
| $75,000 | 3 | | $0.00 | $0.00 |
| $100,000 | 24 | | $0.00 | $0.00 |
| $125,000 | 6 | | $0.00 | $0.00 |
| $150,000 | 9 | | $0.00 | $0.00 |
| $175,000 | 2 | | $0.00 | $0.00 |
| $200,000 | 16 | | $0.00 | $0.00 |
| $225,000 | 1 | | $0.00 | $0.00 |
| $250,000 | 18 | | $0.00 | $0.00 |
| $300,000 | 16 | | $0.00 | $0.00 |
| $350,000 | 1 | | $0.00 | $0.00 |
| $400,000 | 4 | | $0.00 | $0.00 |
| $450,000 | 2 | | $0.00 | $0.00 |
| $500,000 | 158 | | $0.00 | $0.00 |
| | Option Year 4 Total (Sum of all Sub-Totals, above) | | $0.00 |
Total Evaluated Price
| | Base Year Total | $0.00 |
| | Option Year 1 Total | $0.00 |
| | Option Year 2 Total | $0.00 |
| | Option Year 3 Total | $0.00 |
| | Option Year 4 Total | $0.00 |
| | Total Evaluated Price | |
| (Sum of all Five Years) | $0.00 | | |