Employee Monthly Health Contribution
Step #1
Enter your annual salary:
Enter your age:
Choose Managed or Quality Care:
Employee Annual Salary Employee Monthly Health Contributions
Managed Care Quality Care
$29,500 & below
$47.00
$72.00
$29,501 - $44,600
$52.00
$77.00
$44,601 - $59,300
$54.50
$79.50
$59,301 - $74,200
$57.00
$82.00
$74,201 & above
$59.50
$84.50
Note: Certain annuitants/survivors may be required to pay a percentage of the cost for basic health coverage. Contact your retirement system for applicable premiums.
Dependent Monthly Health Premium
Monthly dependent premiums are in addition to employee health contributions. Dependents must be enrolled in the same plan as the Member.
Step #2
Indicate number of Dependents* enrolled:
* The listed dependent rates do not apply to dependents with Medicare. Please contact the Group Insurance Division, Medicare Coordination of Benefits (COB) Unit at (217) 782-7007 for the appropriate Medicare dependent rates.
Step #3
Click on the Cost button for your selected Dependent Health Plan:
Note: If you or your dependent(s) become eligible for Medicare, contact the Group Insurance Division, Medicare Coordination of Benefits (COB) Unit at (217) 782-7007.
Monthly Dental Premium (applicable only if Quality Care Dental Plan (QCDP))
Step #4
Select Dental:
Monthly Optional Term Life Insurance Rates
Step #5
Optional Term Life Insurance for Step #6
Select your desired Optional Life Level:
Step #7
Accidental Death & Dismemberment (AD&D) Option:
Step #8
Worksheet Totals
Step #9
Important! Completing this calculation worksheet does not change your carriers and/or benefit elections. You must request changes through your Group Insurance Representative [PDF, 245k] in order to make health, dental and/or life benefit changes.
