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Contact the BSC at 866-481-4922
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En Espanol blue2023 Plan Rates

Medical Rates

23 HSA OAP LP Rates

 LP_Premium_chart.png

23 Copay Rates 

 

*For coverage, Spouse also refers to Common Law

New Jersey state law no longer allows state gross income tax to include pretax contribution with the exception of contributions to your 401(k) account. Federal income taxes continue to include all pretax contributions. 

Medical Plan Surcharges

New enrollees to the company medical plan will be required to complete a biometric screening within 60 days of your benefit effective date to avoid a wellness surcharge. For additional details, visit the Biometrics & Coaching page.

Based on results, employees and/or covered spouses may be required to complete face-to-face, telephonic or online health coaching. Employees and covered spouses who choose not to work with a Healthy Life Team Navigator (HLN), do not make contact with their HLN or do not complete biometrics testing, will be charged an additional $28.85 per week or $125 per month as a surcharge on top of your medical plan premium.

If you enroll a spouse in the Company Medical Plan, they will be included in a spousal audit for other medical coverage. If your spouse’s employer offers insurance and you elect to cover him/her on Mohawk’s Medical Plan, you will pay an additional $125 per month in medical contributions.

*New hires and those new to the medical plan as a result of a Qualifying Life Event, please visit the Biometrics & Coaching page for details.

Surcharges:

The information below outlines ways in which medical surcharges will be applied. Keep in mind, the maximum surcharge is $57.70 per week or $250 per month in addition to your Medical plan contribution.

  • $28.85/wk or $125/mo:  If covered Employee does not complete a Biometric Screening when notified.
  • $28.85/wk or $125/mo:  If covered Spouse* does not complete a Biometric Screening when notified.
  • $28.85/wk or $125/mo:  If covered Employee requires Coaching based on biometric screening results and refuses to work with a health coach.
  • $28.85/wk or $125/mo:  If covered Spouse* requires Coaching based on biometric screening results and refuses to work with a health coach.
  • $28.85/wk or $125/mo:  If Spouse* enrolls in the Mohawk Medical plan and has access to other group medical coverage through their employer.

*For coverage, Spouse also refers to Common Law

Dental Rates

23 Dental Rates

*For coverage, Spouse also refers to Common Law

Vision Plan Rates

23 Vision Rates 

*For coverage, Spouse also refers to Common Law

Accident Insurance

Coverage Level

Weekly

Semi-
Monthly

Monthly

Employee Only

$2.61

$5.66

$11.31

Employee + Spouse

$3.75

$8.13

$16.25

Employee + Child(ren)

$5.55

$12.03

$24.05

Employee + Family

$6.69

$14.50

$28.99


Long-Term Disability

Pay Status Benefit Your Pay Period Cost
Hourly 50% of base monthly salary, up to $1,000/month for 5 years Your Pay Period Cost is determined based on your age. 
 
  Age Rate   Weekly Cost Monthly Cost
  0-19 0.75   $3.46 $15.00
  20-29 0.75   $3.46 $15.00
  30-39 0.79   $3.65 $15.80
  40-49 0.95   $4.38 $19.00
  50-59 1.85   $8.54 $37.00
  60-69 2.42   $11.17 $48.40
  70 + 1.11   $5.12 $22.20
Salaried  60% of base monthly salary, 
up to $10,000
Your Semi-Monthly Cost is determined based on your age and salary.
The below tool can provide an estimated amount of monthly premium
Semi-Monthly
  Age Rate    $50,000 annually   $60,000 annually   $70,000 annually 
  0-19 0.39   $8.13 $9.75 $11.38
  20-29 0.39   $8.13 $9.75 $11.38
  30-39 0.41   $8.54 $10.25 $11.96
  40-49 0.47   $9.79 $11.75 $13.71
  50-59 0.83   $17.29 $20.75 $24.21
  60-69 0.67   $13.96 $16.75 $19.54
  70 + 0.47   $9.79 $11.75 $13.71
             
Salaried  60% of base monthly salary,
up to $10,000
Your Semi-Monthly Cost is determined based on your age and salary.
The below tool can provide an estimated amount of monthly premium
Semi-Monthly
  Age Rate    $80,000 annually   $90,000 annually   $100,000 annually 
  0-19 0.39   $13.00 $14.63 $16.25
  20-29 0.39   $13.00 $14.63 $16.25
  30-39 0.41   $13.67 $15.38 $17.08
  40-49 0.47   $15.67 $17.63 $19.58
  50-59 0.83   $27.67 $31.13 $34.58
  60-69 0.67   $22.33 $25.13 $27.92
  70 + 0.47   $15.67 $17.63 $19.58
             
Salaried  60% of base monthly salary,
up to $10,000
Your Monthly Cost is determined based on your age and salary.
The below tool can provide an estimated amount of monthly premium
Monthly
  Age Rate    $50,000 annually   $60,000 annually   $70,000 annually 
  0-19 0.39   $16.25 $19.50 $22.75
  20-29 0.39   $16.25 $19.50 $22.75
  30-39 0.41   $17.08 $20.50 $23.92
  40-49 0.47   $19.58 $23.50 $27.42
  50-59 0.83   $34.58 $41.50 $48.42
  60-69 0.67   $27.92 $33.50 $39.08
  70 + 0.47   $19.58 $23.50 $27.42
             
Salaried  60% of base monthly salary, up to $10,000 Your Monthly Cost is determined based on your age and salary.  The below tool can provide an estimated amount of monthly premium
Monthly
  Age Rate    $80,000 annually   $90,000 annually   $100,000 annually 
  0-19 0.39   $26.00 $29.25 $32.50
  20-29 0.39   $26.00 $29.25 $32.50
  30-39 0.41   $27.33 $30.75 $34.17
  40-49 0.47   $31.33 $35.25 $39.17
  50-59 0.83   $55.33 $62.25 $69.17
  60-69 0.67   $44.67 $50.25 $55.83
  70 + 0.47   $31.33 $35.25 $39.17
 

Payroll Deductions for Supplemental Term Life

Please note: Supplemental Life Spouse rates are based on the age of the spouse.

MONTHLY RATES for SALES AND SALARIED EMPLOYEES

Child rate - $1.28 per month, per family unit

Employee's/Spouse's Age

Employee Monthly Cost per $10,000 Unit

Employee Semi-Monthly Cost per $10,000 Unit

Spouse Monthly Cost Per $5,000 Unit

Spouse Semi-Monthly Cost Per $5,000 Unit

Under 30

$0.60

$0.30

$0.30

$0.15

30 to 34

$0.80

$0.40

$0.40

$0.20

35 to 39

$0.90

$0.45

$0.45

$0.23

40 to 44

$1.44

$0.72

$0.72

$0.36

45 to 49

$2.26

$1.13

$1.13

$0.88

50 to 54

$3.80

$1.90

$1.90

$0.95

55 to 59

$6.26

$3.13

$3.13

$1.57

60 to 64

$7.82

$3.91

$3.91

$1.96

65 to 69

$13.49

$6.75

$6.75

$3.38

70 to 74

$22.00

$11.00

$11.00

$5.50

75 to 79

$33.40

$16.70

$16.70

$8.35

80 to 84

$54.10

$27.05

$27.05

$13.53

85 & Over

$87.60

$43.80

$43.80

$21.90

WEEKLY RATES FOR HOURLY EMPLOYEES (Units of $10,000)

Child rate - $1.28 per month, per family unit

Age

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Under 30

$0.14

$0.28

$0.42

$0.55

$0.69

$0.83

$0.97

$1.11

$1.25

$1.38

30 to 34

$0.18

$0.37

$0.55

$0.74

$0.92

$1.11

$1.29

$1.48

$1.66

$1.85

35 to 39

$0.21

$0.42

$0.62

$0.83

$1.04

$1.25

$1.45

$1.66

$1.87

$2.08

40 to 44

$0.33

$0.66

$0.99

$1.33

$1.66

$1.99

$2.32

$2.65

$2.98

$3.31

45 to 49

$0.52

$1.04

$1.56

$2.08

$2.61

$3.13

$3.65

$4.17

$4.69

$5.21

50 to 54

$0.88

$1.76

$2.63

$3.51

$4.39

$5.27

$6.14

$7.02

$7.90

$8.78

55 to 59

$1.45

$2.89

$4.34

$5.78

$7.23

$8.67

$10.12

$11.56

$13.01

$14.46

60 to 64

$1.80

$3.61

$5.41

$7.22

$9.02

$10.82

$12.63

$14.43

$16.23

$18.04

65 to 69

$3.11

$6.23

$9.34

$12.46

$15.57

$18.68

$21.80

$24.91

$28.03

$31.14

70 to 74

$5.08

$10.15

$15.23

$20.31

$25.38

$30.46

$35.54

$40.61

$45.69

$50.77

75 to 79

$7.71

$15.42

$23.12

$30.83

$38.54

$46.25

$53.95

$61.66

$69.37

$77.08

80 to 84

$12.48

$24.97

$37.45

$49.94

$62.42

$74.91

$87.39

$99.88

$112.36

$124.85

85 & Over

$20.22

$40.43

$60.65

$80.86

$101.08

$121.29

$141.51

$161.72

$181.94

$202.15


WEEKLY RATES FOR SPOUSE OF HOURLY EMPLOYEES (Units of $5,000)

Child rate - $1.28 per month, per family unit

Age

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000

Under 30

$0.07

$0.14

$0.21

$0.28

$0.35

$0.42

$0.48

$0.55

$0.62

$0.69

30 to 34

$0.09

$0.18

$0.28

$0.37

$0.46

$0.55

$0.65

$0.74

$0.83

$0.92

35 to 39

$0.10

$0.21

$0.31

$0.42

$0.52

$0.62

$0.73

$0.83

$0.93

$1.04

40 to 44

$0.17

$0.33

$0.50

$0.66

$0.83

$0.99

$1.16

$1.33

$1.49

$1.66

45 to 49

$0.26

$0.52

$0.78

$1.04

$1.30

$1.56

$1.82

$2.08

$2.35

$2.61

50 to 54

$0.44

$0.88

$1.32

$1.76

$2.19

$2.63

$3.07

$3.51

$3.95

$4.39

55 to 59

$0.72

$1.45

$2.17

$2.89

$3.61

$4.34

$5.06

$5.78

$6.50

$7.23

60 to 64

$0.90

$1.80

$2.71

$3.61

$4.51

$5.41

$6.31

$7.22

$8.12

$9.02

65 to 69

$1.56

$3.11

$4.67

$6.23

$7.79

$9.34

$10.90

$12.46

$14.01

$15.57

70 to 74

$2.54

$5.08

$7.61

$10.15

$12.69

$15.23

$17.77

$20.31

$22.84

$25.38

75 to 79

$3.85

$7.71

$11.56

$15.42

$19.27

$23.12

$26.98

$30.83

$34.68

$38.54

80 to 84

$6.24

$12.48

$18.73

$24.97

$31.21

$37.45

$43.70

$49.94

$56.18

$62.42

85 & Over

$10.11

$20.22

$30.32

$40.43

$50.54

$60.65

$70.75

$80.86

$90.97

$101.08


Critical Illness Rates

Rates are listed in Weekly, Semi-Monthly and Monthly formats.*

NON-TOBACCO Premium - WEEKLY

AGES $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

18-29

$0.37 $0.75 $1.12 $1.49 $1.87 $2.24 $2.62 $2.99 $3.36 $3.74

30-39

$0.59 $1.19 $1.78 $2.37 $2.96 $3.56 $4.15 $4.74 $5.34 $5.93

40-49

$1.37 $2.73 $4.10 $5.46 $6.83 $8.20 $9.56 $10.93 $12.29 $13.66

50-59

$2.35 $4.70 $7.05 $9.40 $11.76 $14.11 $16.46 $18.81 $21.16 $23.51

60-84

$4.53 $9.06 $13.59 $18.12 $22.65 $27.18 $31.70 $36.23 $40.76 $45.29

TOBACCO Premium - WEEKLY

AGES $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

18-29

$0.45 $0.91 $1.36 $1.82 $2.27 $2.73 $3.18 $3.64 $4.09 $4.54

30-39

$0.87 $1.74 $2.61 $3.48 $4.35 $5.22 $6.09 $6.96 $7.83 $8.70

40-49

$2.30 $4.60 $6.90 $9.20 $11.50 $13.80 $16.10 $18.40 $20.71 $23.01

50-59

$4.68 $9.36 $14.05 $18.73 $23.41 $28.09 $32.77 $37.46 $42.14 $46.82

60-84

$8.88 $17.76 $26.64 $35.52 $44.40 $53.28 $62.15 $71.03 $79.91 $88.79

NON-TOBACCO Premium - SEMI-MONTHLY

AGES $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

18-29

$0.80 $1.60 $1.20 $3.20 $4.00 $4.82 $5.60 $6.40 $7.20 $8.00

30-39

$1.28 $2.55 $1.91 $5.10 $6.38 $7.65 $8.93 $10.20 $11.48 $12.75

40-49

$2.95 $5.90 $4.43 $11.80 $14.75 $17.70 $20.65 $23.60 $26.55 $29.50

50-59

$5.10 $10.20 $7.65 $20.40 $25.50 $30.60 $35.70 $40.80 $45.90 $51.00

60-84

$9.83 $19.65 $14.74 $39.30 $49.13 $58.95 $68.78 $78.68 $88.43 $98.25

TOBACCO Premium - SEMI-MONTHLY

AGES $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

18-29

$0.98 $1.95 $2.93 $3.90 $4.88 $5.85 $6.83 $7.80 $8.78 $9.75

30-39

$1.88 $3.75 $5.63 $7.50 $9.38 $11.25 $13.13 $15.00 $16.88 $18.75

40-49

$4.98 $9.95 $14.93 $19.90 $24.88 $29.85 $34.83 $39.80 $44.78 $49.75

50-59

$10.15 $20.30 $30.45 $40.60 $50.75 $60.90 $71.05 $81.20 $91.35 $101.50

60-84

$19.25 $38.50 $57.75 $77.00 $96.25 $115.50 $134.75 $154.00 $173.25 $192.50

NON-TOBACCO Premium - MONTHLY

AGES $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

18-29

$1.60 $3.20 $4.80 $6.40 $8.00 $9.60 $11.20 $12.80 $14.40 $16.00

30-39

$2.55 $5.10 $7.65 $10.20 $12.75 $15.30 $17.85 $20.40 $22.95 $25.50

40-49

$5.90 $11.80 $17.70 $23.60 $29.50 $35.40 $41.30 $47.20 $53.10 $59.00

50-59

$10.20 $20.40 $30.60 $40.80 $51.00 $61.20 $71.40 $81.60 $91.80 $102.00

60-84

$19.65 $39.30 $58.95 $78.60 $98.25 $117.90 $137.55 $157.20 $176.85 $196.50

 TOBACCO Premium - MONTHLY

AGES $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

18-29

$1.95 $3.90 $5.85 $7.80 $9.75 $11.70 $13.65 $15.60 $17.55 $19.50

30-39

$3.75 $7.50 $11.25 $15.00 $18.75 $22.50 $26.25 $30.00 $33.75 $37.50

40-49

$9.95 $19.90 $29.85 $39.80 $49.75 $59.70 $69.65 $79.60 $89.55 $99.50

50-59

$20.30 $40.60 $60.90 $81.20 $101.50 $121.80 $142.10 $162.40 $182.70 $203.00

60-84

$38.50 $77.00 $115.50 $154.00 $192.50 $231.00 $269.50 $308.00 $346.50 $385.00


*
All Critical Illness policies are administered by MetLife. If you had a policy with Unum in 2013, MetLife took over that policy. You may have also enrolled in additional coverage through MetLife. The advantage to retaining the policy previously held with Unum, is that the rates will not increase as you age. The rates are locked in for the life of the policy, and are not reflected in the rates contained above. If you have any questions regarding your Critical Illness coverage, please contact the Benefits Service Center at 866.481.4922.