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Voluntary Life and AD&D Insurance (Bi-Weekly Premiums, per $1,000 of coverage) AGE EMPLOYEE & SPOUSE/ AGE EMPLOYEE & SPOUSE/ DOMESTIC PARTNER* DOMESTIC PARTNER* Under 25 $0.027 55-59 $0.203 25-29 $0.031 60-64 $0.309 30-34 $0.040 65-69 $0.563 35-39 $0.044 70-74 $0.910 40-44 $0.051 75+ $0.955 45-49 $0.074 Children $0.026 Flat Rate 50-54 $0.111 *Premium based on team member’s age as of January 1, 2024 Hospital Indemnity Insurance EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE & SPOUSE/ FAMILY DOMESTIC PARTNER $9.39 $13.79 $18.20 $22.60 Accident Insurance EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE & SPOUSE/ FAMILY DOMESTIC PARTNER $4.69 $8.91 $7.70 $11.92 Legal Insurance & Identity Theft Protection $9.46 for employee and all dependents Critical Illness Insurance PREMIUMS - EMPLOYEE PREMIUMS - PREMIUMS - CHILD (BI-WEEKLY) SPOUSE/ DP (BI-WEEKLY) (BI-WEEKLY) $10,000 $20,000 $30,000 $10,000 $5,000 Age 29 $2.22 $4.43 $6.65 $2.68 Per Family Unit and under $1.41 Age 30-34 $2.77 $5.54 $8.31 $3.18 Age 35-39 $2.77 $5.54 $8.31 $3.18 Age 40-44 $5.22 $10.43 $15.65 $6.00 Age 45-49 $5.22 $10.43 $15.65 $6.00 Age 50-54 $10.15 $20.31 $30.46 $12.55 Age 55-59 $10.15 $20.31 $30.46 $12.55 Age 60-64 $14.68 $29.35 $44.03 $19.15 Age 65-70 $18.88 $37.75 $56.63 $21.92 Age 70+ $25.48 $50.95 $76.43 $33.05 | 47 |

May 2024 | UPC Physicians Benefit Guide - Page 49 May 2024 | UPC Physicians Benefit Guide Page 48 Page 50