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Inv# Jan2025 Life Ins - LIFE INSURANCE COMPANY OF NORTH AMERICA - 01/28/2025
City of Dania Beach MONTHLY PREMIUM STATEMENT Cigna New York Life BILLING PERIOD:January-2025 COVERAGE COVERED LIVES RATE VOLUME MONTHLY PREMIUM ADJUSTMENTS ADJUSTED MONTHLY PREMIUM BASIC LIFE INSURANCE 169 0.180$ $24,234,500.00 $4,362.21 $0.00 $4,362.21 TOTAL BASIC AND AD&D LIFE 169 $24,234,500.00 $4,362.21 BASIC AD&D INSURANCE 169 0.020$ $24,234,500.00 $484.69 $0.00 $484.69 TOTAL BASIC AND AD&D LIFE 169 $24,234,500.00 $484.69 RETIREE BASIC LIFE INSURANCE 114 0.200$ $435,000.00 $87.00 $0.00 $87.00 TOTAL RETIREE BASIC LIFE 114 $435,000.00 $87.00 VOLUNTARY EMPLOYEE LIFE 0-29 1 0.090$ $40,000.00 $3.60 $0.00 $3.60 30-34 6 0.100$ $580,000.00 $58.00 $0.00 $58.00 35-39 11 0.140$ $1,220,000.00 $170.80 $0.00 $170.80 40-44 8 0.210$ $710,000.00 $149.10 $0.00 $149.10 45-49 13 0.380$ $1,570,000.00 $596.60 $0.00 $596.60 50-54 8 0.580$ $930,000.00 $539.40 $0.00 $539.40 55-59 4 0.940$ $420,000.00 $394.80 $0.00 $394.80 60-64 3 1.070$ $200,000.00 $214.00 $0.00 $214.00 65-69 3 1.510$ $120,000.00 $181.20 $0.00 $181.20 70-74 1 3.520$ $20,000.00 $70.40 $0.00 $70.40 75+0 3.520$ $0.00 $0.00 $0.00 $0.00 TOTAL VOLUNTARY EMPLOYEE LIFE 58 $5,810,000.00 $2,377.90 VOLUNTARY SPOUSE LIFE 0-29 0 0.090$ $0.00 $0.00 $0.00 $0.00 30-34 0 0.100$ $0.00 $0.00 $0.00 $0.00 35-39 3 0.140$ $85,000.00 $11.90 $0.00 $11.90 40-44 4 0.210$ $115,000.00 $24.15 $0.00 $24.15 45-49 6 0.380$ $215,000.00 $81.70 $0.00 $81.70 50-54 4 0.580$ $160,000.00 $92.80 $0.00 $92.80 55-59 2 0.940$ $40,000.00 $37.60 $0.00 $37.60 60-64 3 1.070$ $60,000.00 $64.20 $0.00 $64.20 65-69 2 1.510$ $65,000.00 $98.15 $0.00 $98.15 70-74 0 3.520$ $0.00 $0.00 $0.00 $0.00 75+0 3.520$ $0.00 $0.00 $0.00 $0.00 TOTAL VOLUNTARY SPOUSE LIFE 24 $740,000.00 $410.50 VOLUNTARY CHILD(REN) LIFE $5,000 29 0.170$ $145,000.00 $24.65 $0.00 $24.65 TOTAL VOLUNTARY CHILD(REN) LIFE 29 $145,000.00 $24.65 LONG TERM DISABILITY INSURANCE 164 0.320$ $992,214.48 $3,175.20 $0.00 $3,175.20 TOTAL LONG TERM DISABILITY 164 $992,214.48 $3,175.20 TOTAL PREMIUM DUE $32,356,714.48 $10,437.46 1/28/25