| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | |
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1 | BRIDGEWATER RAYNHAM RSD - STD GRID | |||||||||||||||||||||||||
2 | * No Health Questions Required During This Enrollment Only | |||||||||||||||||||||||||
3 | Monthly Rates | |||||||||||||||||||||||||
4 | Rate | $ 0.52 | $ 0.54 | $ 0.56 | $ 0.63 | $ 0.81 | $ 0.96 | $ 1.12 | $ 1.51 | $ 1.93 | $ 2.21 | |||||||||||||||
5 | ||||||||||||||||||||||||||
6 | Weekly Benefit | Age <24 | 25-29 | 30-34 | 35-39 | 40-44 | 45-49 | 50-54 | 55-59 | 60-64 | 65 & Older | |||||||||||||||
7 | $ 100 | $5.20 | $5.40 | $5.60 | $6.30 | $8.10 | $9.60 | $11.20 | $15.10 | $19.30 | $22.10 | |||||||||||||||
8 | $ 110 | $5.72 | $5.94 | $6.16 | $6.93 | $8.91 | $10.56 | $12.32 | $16.61 | $21.23 | $24.31 | |||||||||||||||
9 | $ 120 | $6.24 | $6.48 | $6.72 | $7.56 | $9.72 | $11.52 | $13.44 | $18.12 | $23.16 | $26.52 | |||||||||||||||
10 | $ 130 | $6.76 | $7.02 | $7.28 | $8.19 | $10.53 | $12.48 | $14.56 | $19.63 | $25.09 | $28.73 | |||||||||||||||
11 | $ 140 | $7.28 | $7.56 | $7.84 | $8.82 | $11.34 | $13.44 | $15.68 | $21.14 | $27.02 | $30.94 | |||||||||||||||
12 | $ 150 | $7.80 | $8.10 | $8.40 | $9.45 | $12.15 | $14.40 | $16.80 | $22.65 | $28.95 | $33.15 | |||||||||||||||
13 | $ 160 | $8.32 | $8.64 | $8.96 | $10.08 | $12.96 | $15.36 | $17.92 | $24.16 | $30.88 | $35.36 | |||||||||||||||
14 | $ 170 | $8.84 | $9.18 | $9.52 | $10.71 | $13.77 | $16.32 | $19.04 | $25.67 | $32.81 | $37.57 | |||||||||||||||
15 | $ 180 | $9.36 | $9.72 | $10.08 | $11.34 | $14.58 | $17.28 | $20.16 | $27.18 | $34.74 | $39.78 | |||||||||||||||
16 | $ 190 | $9.88 | $10.26 | $10.64 | $11.97 | $15.39 | $18.24 | $21.28 | $28.69 | $36.67 | $41.99 | |||||||||||||||
17 | $ 200 | $10.40 | $10.80 | $11.20 | $12.60 | $16.20 | $19.20 | $22.40 | $30.20 | $38.60 | $44.20 | |||||||||||||||
18 | $ 210 | $10.92 | $11.34 | $11.76 | $13.23 | $17.01 | $20.16 | $23.52 | $31.71 | $40.53 | $46.41 | |||||||||||||||
19 | $ 220 | $11.44 | $11.88 | $12.32 | $13.86 | $17.82 | $21.12 | $24.64 | $33.22 | $42.46 | $48.62 | |||||||||||||||
20 | $ 230 | $11.96 | $12.42 | $12.88 | $14.49 | $18.63 | $22.08 | $25.76 | $34.73 | $44.39 | $50.83 | |||||||||||||||
21 | $ 240 | $12.48 | $12.96 | $13.44 | $15.12 | $19.44 | $23.04 | $26.88 | $36.24 | $46.32 | $53.04 | |||||||||||||||
22 | $ 250 | $13.00 | $13.50 | $14.00 | $15.75 | $20.25 | $24.00 | $28.00 | $37.75 | $48.25 | $55.25 | |||||||||||||||
23 | $ 260 | $13.52 | $14.04 | $14.56 | $16.38 | $21.06 | $24.96 | $29.12 | $39.26 | $50.18 | $57.46 | |||||||||||||||
24 | $ 270 | $14.04 | $14.58 | $15.12 | $17.01 | $21.87 | $25.92 | $30.24 | $40.77 | $52.11 | $59.67 | |||||||||||||||
25 | $ 280 | $14.56 | $15.12 | $15.68 | $17.64 | $22.68 | $26.88 | $31.36 | $42.28 | $54.04 | $61.88 | |||||||||||||||
26 | $ 290 | $15.08 | $15.66 | $16.24 | $18.27 | $23.49 | $27.84 | $32.48 | $43.79 | $55.97 | $64.09 | |||||||||||||||
27 | $ 300 | $15.60 | $16.20 | $16.80 | $18.90 | $24.30 | $28.80 | $33.60 | $45.30 | $57.90 | $66.30 | |||||||||||||||
28 | $ 310 | $16.12 | $16.74 | $17.36 | $19.53 | $25.11 | $29.76 | $34.72 | $46.81 | $59.83 | $68.51 | |||||||||||||||
29 | $ 320 | $16.64 | $17.28 | $17.92 | $20.16 | $25.92 | $30.72 | $35.84 | $48.32 | $61.76 | $70.72 | |||||||||||||||
30 | $ 330 | $17.16 | $17.82 | $18.48 | $20.79 | $26.73 | $31.68 | $36.96 | $49.83 | $63.69 | $72.93 | |||||||||||||||
31 | $ 340 | $17.68 | $18.36 | $19.04 | $21.42 | $27.54 | $32.64 | $38.08 | $51.34 | $65.62 | $75.14 | |||||||||||||||
32 | $ 350 | $18.20 | $18.90 | $19.60 | $22.05 | $28.35 | $33.60 | $39.20 | $52.85 | $67.55 | $77.35 | |||||||||||||||
33 | $ 360 | $18.72 | $19.44 | $20.16 | $22.68 | $29.16 | $34.56 | $40.32 | $54.36 | $69.48 | $79.56 | |||||||||||||||
34 | $ 370 | $19.24 | $19.98 | $20.72 | $23.31 | $29.97 | $35.52 | $41.44 | $55.87 | $71.41 | $81.77 | |||||||||||||||
35 | $ 380 | $19.76 | $20.52 | $21.28 | $23.94 | $30.78 | $36.48 | $42.56 | $57.38 | $73.34 | $83.98 | |||||||||||||||
36 | $ 390 | $20.28 | $21.06 | $21.84 | $24.57 | $31.59 | $37.44 | $43.68 | $58.89 | $75.27 | $86.19 | |||||||||||||||
37 | $ 400 | $20.80 | $21.60 | $22.40 | $25.20 | $32.40 | $38.40 | $44.80 | $60.40 | $77.20 | $88.40 | |||||||||||||||
38 | $ 410 | $21.32 | $22.14 | $22.96 | $25.83 | $33.21 | $39.36 | $45.92 | $61.91 | $79.13 | $90.61 | |||||||||||||||
39 | $ 420 | $21.84 | $22.68 | $23.52 | $26.46 | $34.02 | $40.32 | $47.04 | $63.42 | $81.06 | $92.82 | |||||||||||||||
40 | $ 430 | $22.36 | $23.22 | $24.08 | $27.09 | $34.83 | $41.28 | $48.16 | $64.93 | $82.99 | $95.03 | |||||||||||||||
41 | $ 440 | $22.88 | $23.76 | $24.64 | $27.72 | $35.64 | $42.24 | $49.28 | $66.44 | $84.92 | $97.24 | |||||||||||||||
42 | $ 450 | $23.40 | $24.30 | $25.20 | $28.35 | $36.45 | $43.20 | $50.40 | $67.95 | $86.85 | $99.45 | |||||||||||||||
43 | $ 460 | $23.92 | $24.84 | $25.76 | $28.98 | $37.26 | $44.16 | $51.52 | $69.46 | $88.78 | $101.66 | |||||||||||||||
44 | $ 470 | $24.44 | $25.38 | $26.32 | $29.61 | $38.07 | $45.12 | $52.64 | $70.97 | $90.71 | $103.87 | |||||||||||||||
45 | $ 480 | $24.96 | $25.92 | $26.88 | $30.24 | $38.88 | $46.08 | $53.76 | $72.48 | $92.64 | $106.08 | |||||||||||||||
46 | $ 490 | $25.48 | $26.46 | $27.44 | $30.87 | $39.69 | $47.04 | $54.88 | $73.99 | $94.57 | $108.29 | |||||||||||||||
47 | $ 500 | $26.00 | $27.00 | $28.00 | $31.50 | $40.50 | $48.00 | $56.00 | $75.50 | $96.50 | $110.50 | |||||||||||||||
48 | $ 510 | $26.52 | $27.54 | $28.56 | $32.13 | $41.31 | $48.96 | $57.12 | $77.01 | $98.43 | $112.71 | |||||||||||||||
49 | $ 520 | $27.04 | $28.08 | $29.12 | $32.76 | $42.12 | $49.92 | $58.24 | $78.52 | $100.36 | $114.92 | |||||||||||||||
50 | $ 530 | $27.56 | $28.62 | $29.68 | $33.39 | $42.93 | $50.88 | $59.36 | $80.03 | $102.29 | $117.13 | |||||||||||||||
51 | $ 540 | $28.08 | $29.16 | $30.24 | $34.02 | $43.74 | $51.84 | $60.48 | $81.54 | $104.22 | $119.34 | |||||||||||||||
52 | $ 550 | $28.60 | $29.70 | $30.80 | $34.65 | $44.55 | $52.80 | $61.60 | $83.05 | $106.15 | $121.55 | |||||||||||||||
53 | $ 560 | $29.12 | $30.24 | $31.36 | $35.28 | $45.36 | $53.76 | $62.72 | $84.56 | $108.08 | $123.76 | |||||||||||||||
54 | $ 570 | $29.64 | $30.78 | $31.92 | $35.91 | $46.17 | $54.72 | $63.84 | $86.07 | $110.01 | $125.97 | |||||||||||||||
55 | $ 580 | $30.16 | $31.32 | $32.48 | $36.54 | $46.98 | $55.68 | $64.96 | $87.58 | $111.94 | $128.18 | |||||||||||||||
56 | $ 590 | $30.68 | $31.86 | $33.04 | $37.17 | $47.79 | $56.64 | $66.08 | $89.09 | $113.87 | $130.39 | |||||||||||||||
57 | $ 600 | $31.20 | $32.40 | $33.60 | $37.80 | $48.60 | $57.60 | $67.20 | $90.60 | $115.80 | $132.60 | |||||||||||||||
58 | $ 610 | $31.72 | $32.94 | $34.16 | $38.43 | $49.41 | $58.56 | $68.32 | $92.11 | $117.73 | $134.81 | |||||||||||||||
59 | $ 620 | $32.24 | $33.48 | $34.72 | $39.06 | $50.22 | $59.52 | $69.44 | $93.62 | $119.66 | $137.02 | |||||||||||||||
60 | $ 630 | $32.76 | $34.02 | $35.28 | $39.69 | $51.03 | $60.48 | $70.56 | $95.13 | $121.59 | $139.23 | |||||||||||||||
61 | $ 640 | $33.28 | $34.56 | $35.84 | $40.32 | $51.84 | $61.44 | $71.68 | $96.64 | $123.52 | $141.44 | |||||||||||||||
62 | $ 650 | $33.80 | $35.10 | $36.40 | $40.95 | $52.65 | $62.40 | $72.80 | $98.15 | $125.45 | $143.65 | |||||||||||||||
63 | $ 660 | $34.32 | $35.64 | $36.96 | $41.58 | $53.46 | $63.36 | $73.92 | $99.66 | $127.38 | $145.86 | |||||||||||||||
64 | $ 670 | $34.84 | $36.18 | $37.52 | $42.21 | $54.27 | $64.32 | $75.04 | $101.17 | $129.31 | $148.07 | |||||||||||||||
65 | $ 680 | $35.36 | $36.72 | $38.08 | $42.84 | $55.08 | $65.28 | $76.16 | $102.68 | $131.24 | $150.28 | |||||||||||||||
66 | $ 690 | $35.88 | $37.26 | $38.64 | $43.47 | $55.89 | $66.24 | $77.28 | $104.19 | $133.17 | $152.49 | |||||||||||||||
67 | $ 700 | $36.40 | $37.80 | $39.20 | $44.10 | $56.70 | $67.20 | $78.40 | $105.70 | $135.10 | $154.70 | |||||||||||||||
68 | $ 710 | $36.92 | $38.34 | $39.76 | $44.73 | $57.51 | $68.16 | $79.52 | $107.21 | $137.03 | $156.91 | |||||||||||||||
69 | $ 720 | $37.44 | $38.88 | $40.32 | $45.36 | $58.32 | $69.12 | $80.64 | $108.72 | $138.96 | $159.12 | |||||||||||||||
70 | $ 730 | $37.96 | $39.42 | $40.88 | $45.99 | $59.13 | $70.08 | $81.76 | $110.23 | $140.89 | $161.33 | |||||||||||||||
71 | $ 740 | $38.48 | $39.96 | $41.44 | $46.62 | $59.94 | $71.04 | $82.88 | $111.74 | $142.82 | $163.54 | |||||||||||||||
72 | $ 750 | $39.00 | $40.50 | $42.00 | $47.25 | $60.75 | $72.00 | $84.00 | $113.25 | $144.75 | $165.75 | |||||||||||||||
73 | ||||||||||||||||||||||||||
74 | * 22 Week Duration | |||||||||||||||||||||||||
75 | * 60% of Monthly Salary - Units of 10 | Formula: Weekly Benefit/10 X Rate | ||||||||||||||||||||||||
76 | * Maximum $1,150.00 per week | |||||||||||||||||||||||||
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79 | *This form is for informational purposes only, please refer to the contract for specific language. | |||||||||||||||||||||||||
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