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The cost of coverage depends on the amount of monthly benefit you elect and for which you are eligible. You can calculate your Maximum Monthly Benefit Amount by taking your annual salary multiplied by 66-2/3 percent; divided by 12 (months), then rounded down to the nearest $100. You may select any benefit amount shown up to the lesser of your Maximum Monthly Benefit Amount or $5,000. You pay the full rate.
| Monthly Benefit | 2013 Rate per Pay Period |
|---|---|
| $ 300 | $1.75 |
| 400 | 2.33 |
| 500 | 2.92 |
| 600 | 3.50 |
| 700 | 4.08 |
| 800 | 4.66 |
| 900 | 5.25 |
| 1,000 | 5.83 |
| 1,100 | 6.41 |
| 1,200 | 7.00 |
| 1,300 | 7.58 |
| 1,400 | 8.16 |
| 1,500 | 8.75 |
| 1,600 | 9.33 |
| 1,700 | 9.91 |
| 1,800 | 10.49 |
| 1,900 | 11.08 |
| 2,000 | 11.66 |
| 2,100 | 12.24 |
| 2,200 | 12.83 |
| 2,300 | 13.41 |
| 2,400 | 13.99 |
| 2,500 | 14.58 |
| 2,600 | 15.16 |
| 2,700 | 15.74 |
| 2,800 | 16.32 |
| 2,900 | 16.91 |
| 3,000 | 17.49 |
| 3,100 | 18..07 |
| 3,200 | 18.66 |
| 3,300 | 19.24 |
| 3,400 | 19.82 |
| 3,500 | 20.41 |
| 3,600 | 20.99 |
| 3,700 | 21.57 |
| 3,800 | 22.15 |
| 3,900 | 22.74 |
| 4,000 | 23.32 |
| 4,100 | 23.90 |
| 4,200 | 24.49 |
| 4,300 | 25.07 |
| 4,400 | 25.65 |
| 4,500 | 26.24 |
| 4,600 | 26.82 |
| 4,700 | 27.40 |
| 4,800 | 27.98 |
| 4,900 | 28.57 |
| 5,000 | 29.15 |