Cost of Coverage 2021/2022

This guide is intended to provide a brief summary of your benefits costs. If there is a discrepancy between this guide and the official plan documents, the plan documents will govern.

Medical

Anthem Bronze Plan

Medical Plans Community/Hospice/Home Office
Semi-Monthly Deductions
Associate Only $59.84
Associate + Spouse or Domestic Partner** $210.22
Associate + Child(ren) $182.37
Associate + Family $291.80

Anthem Consumer Choice Plan* (with HSA)

Medical Plans Community/Hospice/Home Office
Semi-Monthly Cost
Associate Only $78.86
Associate + Spouse or Domestic Partner** $255.67
Associate + Child(ren) $221.81
Associate + Family $354.90

Anthem Gold PPO

Medical Plans Community/Hospice/Home Office
Semi-Monthly Cost
Associate Only $155.39
Associate + Spouse or Domestic Partner** $589.27
Associate + Child(ren) $385.50
Associate + Family $817.99

Kaiser Permanente – California, Washington & Virginia ONLY

Medical Plans Community/Hospice/Home Office
Semi-Monthly Deductions
Associate Only $123.54
Associate + Spouse or Domestic Partner** $332.94
Associate + Child(ren) $298.04
Associate + Family $472.56

 


*When you enroll in the Consumer Choice medical plan, the company will help boost your health savings account with a company contribution of $50 per month.

**Cost of coverage for a Domestic Partner and/or a Domestic Partner’s children is subject to federal and state taxes.

Dental

Dental HMO

Dental Plan Options Community/Hospice/Home Office
Semi-Monthly Deductions
Associate Only $5.31
Associate + Spouse or Domestic Partner** $10.46
Associate + Child(ren) $8.85
Associate + Family $14.73

Dental PPO

Dental Plan Options Community/Hospice/Home Office
Semi-Monthly Deductions
Associate Only $10.08
Associate + Spouse or Domestic Partner** $20.09
Associate + Child(ren) $26.69
Associate + Family $36.58

**Cost of coverage for a Domestic Partner and/or a Domestic Partner’s children is subject to federal and state taxes.

Vision

Vision Service Plan (VSP) Community/Hospice/Home Office
Semi-Monthly Deductions
Associate Only $2.07
Associate + Spouse or Domestic Partner** $4.14
Associate + Child(ren) $4.43
Associate + Family $7.09

**Cost of coverage for a Domestic Partner and/or a Domestic Partner’s children is subject to federal and state taxes.

Voluntary Life & Accident Death & Dismemberment (AD&D)

Provides financial protection in the event that the policyholder dies.

Silverado provides Basic Life and AD&D insurance of 1X’s your annual salary. You may purchase additional life and AD&D insurance as indicated below. The cost for child life insurance coverage is $0.72 per month. This rate covers all eligible children. From birth – 6 months have a max benefit of $500. Children 6 months – 26 have a max benefit of $5000. *Guarantee issue, age and maximums may apply.

Associate or Spouse Life Insurance Rate (rates per $1,000 of coverage)

Associate or Spouse Age Community/Hospice/Home Office
Semi-Monthly Cost
<29 $0.024
30 to 34 $0.031
35 to 39 $0.035
40 to 44 $0.050
45 to 49 $0.075
50 to 54 $0.115
55 to 59 $0.215
60 to 64 $0.328
65 to 69 $0.550
*70 to 74 $0.851
75+ $1.030

Associate and Spouse Life Insurance:

  • Supplemental Life (Associate): One to five times base annual earnings to a maximum of $1,000,000. Guarantee Issue: $250,000
  • Supplemental Life (Spouse): Units of $10,000; not to exceed 50% of your coverage amount to a maximum of $100,000. Guarantee Issue: $50,000.

Associate must enroll in supplemental life to purchase dependent life

AD&D Coverage

You may purchase additional AD&D coverage. Associate only coverage cost is $0.015 per $1000 of coverage per month. Associate + Family coverage cost is $0.026 per $1000 of coverage per month.

  • Supplemental AD&D (Associate): One to ten times base annual earnings, rounded to the next $1,000 (Maximum: $1,000,000)
  • Supplemental AD&D (Spouse): 50% of the Associate’s Principal Amount if no dependent children are insured; 40% of the amount if one or more dependent children are insured
  • Supplemental AD&D (Dependent): 10% of the Associate’s Principal Amount if spouse is insured; 15% of the amount if no spouse is insured (Maximum: $10,000)

To calculate the cost of your voluntary life coverage:

  1. Find your age tier (or your spouse’s age)
  2. Determine your coverage amount
  3. Multiply your coverage amount by the age rate to get your per-pay-period deduction amount

Example of a 30 year old electing $150,000:

  1. Age 30 rate = $0.031 (semi-monthly)
  2. $0.031 x 150 = $4.65 semi-monthly

Voluntary Long-Term Disability (LTD) Insurance

Silverado provides Long-Term Disability coverage of 40% of eligible salary. You can choose to purchase additional coverage up to 60% of salary up to a maximum of $5,000 per month. Buy up cost is $0.368 per $100 of covered salary per month.

Voluntary Short-Term Disability (LTD) Insurance

You may purchase Voluntary Short-Term Disability coverage for yourself. Associates in California are not eligible.

Associate or Spouse Age Community/Hospice/Home Office
Semi-Monthly Cost
<25 $0.671
25 to 29 $0.784
30 to 34 $0.959
35 to 39 $0.722
40 to 44 $0.624
45 to 49 $0.630
50 to 54 $0.760
55 to 59 $0.902
60 to 64 $1.067
65+ 1.162

To calculate the cost of your voluntary life coverage:

  1. Find your age tier (or your spouse’s age)
  2. Determine your coverage amount
  3. Multiply your coverage amount by the age rate to get your per-pay-period deduction amount

Example of a 40 year old with a $25,000 annual income:
Weekly benefit $480.77, 50% benefit amount $240.38

  1. Age 40 rate = $0.624 (semi-monthly)
  2. $0.624 x 24.038 = $15 semi-monthly

Critical Illness Insurance

Pays cash directly to you after diagnosis of a covered critical illness to use any way you choose.

Semi-monthly Premium for $10,000 of Coverage (non-tobacco)

Issue Age Associate Only Associate + Spouse Associate + Child(ren) Associate + Family
<25 $1.65 $2.95 $3.15 $4.50
25 – 29 $1.70 $3.15 $3.25 $4.70
30 – 34 $2.20 $4.00 $3.75 $5.50
35 – 39 $3.20 $5.55 $4.70 $7.10
40 – 44 $4.90 $8.15 $6.45 $9.70
45 – 49 $6.60 $11.20 $8.15 $12.75
50 – 54 $9.70 $16.20 $11.20 $17.70
55 – 59 $12.45 $21.50 $13.95 $23.05
60 – 64 $16.85 $29.85 $18.35 $31.40
65 – 69 $23.90 $42.95 $25.40 $44.45
70+ $36.25 $63.65 $37.75 $65.15

Weekly Premium for $10,000 of Coverage (non-tobacco)

Issue Age Associate Only Associate + Spouse Associate + Child(ren) Associate + Family
<25 $0.76 $1.36 $1.45 $2.08
25 – 29 $0.78 $1.45 $1.50 $2.17
30 – 34 $1.02 $1.85 $1.73 $2.54
35 – 39 $1.48 $2.56 $2.17 $3.28
40 – 44 $2.26 $3.76 $2.98 $4.48
45 – 49 $3.05 $5.17 $3.76 $5.88
50 – 54 $4.48 $7.48 $5.17 $8.17
55 – 59 $5.75 $9.92 $6.44 $10.64
60 – 64 $7.78 $13.78 $8.47 $14.49
65 – 69 $11.03 $19.82 $11.72 $20.52
70+ $16.73 $29.38 $17.42 $30.07


Semi-monthly Premium for $20,000 of Coverage (non-tobacco)

Issue Age Associate Only Associate + Spouse Associate + Child(ren) Associate + Family
<25 $3.30 $5.90 $6.30 $9.00
25 – 29 $3.40 $6.30 $6.50 $9.40
30 – 34 $4.40 $8.00 $7.50 $11.00
35 – 39 $6.40 $11.10 $9.40 $14.20
40 – 44 $9.80 $16.30 $12.90 $19.40
45 – 49 $13.20 $22.40 $16.30 $25.50
50 – 54 $19.40 $32.40 $22.40 $35.40
55 – 59 $24.90 $43.00 $27.90 $46.10
60 – 64 $33.70 $59.70 $36.70 $62.80
65 – 69 $47.80 $85.90 $50.80 $88.90
70+ $72.50 $127.30 $75.50 $130.30

Weekly Premium for $10,000 of Coverage (non-tobacco)

Issue Age Associate Only Associate + Spouse Associate + Child(ren) Associate + Family
<25 $1.52 $2.72 $2.91 $4.15
25 – 29 $1.57 $2.91 $3.00 $4.34
30 – 34 $2.03 $3.69 $3.46 $5.08
35 – 39 $2.95 $5.12 $4.34 $6.55
40 – 44 $4.52 $7.52 $5.95 $8.95
45 – 49 $6.09 $10.34 $7.52 $11.77
50 – 54 $8.95 $14.95 $10.34 $16.34
55 – 59 $11.49 $19.85 $12.88 $21.28
60 – 64 $15.55 $27.55 $16.94 $28.98
65 – 69 $22.06 $39.65 $23.45 $41.03
70+ $33.46 $58.75 $34.85 $60.14


Semi-monthly Premium for $30,000 of Coverage (non-tobacco)

Issue Age Associate Only Associate + Spouse Associate + Child(ren) Associate + Family
<25 $4.95 $8.85 $9.45 $13.50
25 – 29 $5.10 $8.85 $9.45 $13.50
30 – 34 $6.60 $12.00 $11.25 $16.50
35 – 39 $9.60 $16.65 $14.10 $21.30
40 – 44 $14.70 $24.45 $19.35 $29.10
45 – 49 $19.80 $33.60 $24.45 $38.25
50 – 54 $29.10 $48.60 $33.60 $53.10
55 – 59 $37.35 $64.50 $41.85 $69.15
60 – 64 $50.55 $89.55 $55.05 $94.20
65 – 69 $71.70 $128.85 $76.20 $133.35
70+ $108.75 $190.95 $113.25 $195.45

Weekly Premium for $30,000 of Coverage (non-tobacco)

Issue Age Associate Only Associate + Spouse Associate + Child(ren) Associate + Family
<25 $2.28 $4.08 $4.36 $6.23
25 – 29 $2.35 $4.36 $4.50 $6.51
30 – 34 $3.05 $5.54 $5.19 $7.62
35 – 39 $4.43 $7.68 $6.51 $9.83
40 – 44 $6.78 $11.28 $8.93 $13.43
45 – 49 $9.14 $15.51 $11.28 $17.65
50 – 54 $13.43 $22.43 $15.51 $24.51
55 – 59 $17.24 $29.77 $19.32 $31.92
60 – 64 $23.33 $41.33 $25.41 $43.48
65 – 69 $33.09 $59.47 $35.17 $61.55
70+ $50.19 $88.13 $52.27 $90.21

▪Tobacco users are subject to higher premiums.

Accident Insurance

Pays cash directly to you after a covered accident occurs to use any way you choose.

Coverage Level Community/Hospice/Home Office
Semi-Monthly Deductions
Associate Only $5.39
Associate + Spouse or Domestic Partner** $9.29
Associate + Child(ren) $9.52
Associate + Family $11.70

Hospital Indemnity Insurance

Pays cash directly to you after a covered accident occurs to use any way you choose.

Coverage Level Community/Hospice/Home Office
Semi-Monthly Deductions
Associate Only $16.24
Associate + Spouse or Domestic Partner** $30.55
Associate + Child(ren) $25.21
Associate + Family $41.67

Legal Insurance

Coverage Level Community/Hospice/Home Office
Semi-Monthly Deductions
Covers Associate, Spouse and Dependents $9.00