Employee Cost Use this chart to find your current age and the monthly premium for Employee Only coverage. This is your cost after Ten Key’s employer contribution. Plan 2: G746ADT $2,100 Plan | Monthly Payroll | Plan 2: PPO $2,100 Plan (G746ADT) | | Deduction | Employee Premiums | | Age | Rate | Age | Rate | Age | Rate | Age | Rate | Age | Rate | | <15 | $143.88 | 25 | $188.83 | 36 | $231.33 | 47 | $293.96 | 58 | $479.22 | | 15 | $156.67 | 26 | $192.60 | 37 | $232.84 | 48 | $307.50 | 59 | $489.56 | | 16 | $161.56 | 27 | $197.10 | 38 | $234.34 | 49 | $320.86 | 60 | $510.43 | | 17 | $166.45 | 28 | $204.43 | 39 | $237.35 | 50 | $335.90 | 61 | $528.49 | | 18 | $171.72 | 29 | $210.46 | 40 | $240.36 | 51 | $350.76 | 62 | $540.34 | | 19 | $176.98 | 30 | $213.47 | 41 | $244.87 | 52 | $367.13 | 63 | $555.20 | | 20 | $182.43 | 31 | $217.99 | 42 | $249.20 | 53 | $383.68 | 64+ | $564.23 | | 21 | $188.08 | 32 | $222.49 | 43 | $255.22 | 54 | $401.54 | | 22 | $188.08 | 33 | $225.32 | 44 | $262.75 | 55 | $419.41 | | 23 | $188.08 | 34 | $228.33 | 45 | $271.59 | 56 | $438.78 | | 24 | $188.08 | 35 | $229.82 | 46 | $282.12 | 57 | $458.35 | Use this chart to calculate the monthly premium deduction for any dependents you wish to add to your plan. Premiums are age-rated and per person so you must look up your spouse’s age and each child’s age, then add all premiums together (including your premium for Employee Only coverage). For children, you are charged for the 3 oldest children only. | Monthly Payroll | Plan 2: PPO $2,100 Plan (G746ADT) | | Deduction | Dependent Premiums | | Age | Rate | Age | Rate | Age | Rate | Age | Rate | Age | Rate | | <15 | $227.75 | 25 | $298.90 | 36 | $366.17 | 47 | $465.30 | 58 | $758.54 | | 15 | $247.99 | 26 | $304.85 | 37 | $368.55 | 48 | $486.74 | 59 | $774.91 | | 16 | $255.73 | 27 | $311.99 | 38 | $370.94 | 49 | $507.88 | 60 | $807.96 | | 17 | $263.47 | 28 | $323.60 | 39 | $375.70 | 50 | $531.69 | 61 | $836.54 | | 18 | $271.81 | 29 | $333.13 | 40 | $380.46 | 51 | $555.21 | 62 | $855.30 | | 19 | $280.14 | 30 | $337.89 | 41 | $387.61 | 52 | $581.12 | 63 | $878.82 | | 20 | $288.77 | 31 | $345.04 | 42 | $394.46 | 53 | $607.31 | 64+ | $893.10 | | 21 | $297.70 | 32 | $352.18 | 43 | $403.98 | 54 | $635.59 | | 22 | $297.70 | 33 | $356.65 | 44 | $415.89 | 55 | $663.87 | | 23 | $297.70 | 34 | $361.41 | 45 | $429.89 | 56 | $694.53 | | 24 | $297.70 | 35 | $363.79 | 46 | $446.56 | 57 | $725.50 | 14 |