Employee Contribution
Medical, Dental & Vision Cost of Coverage
| Medical Plans | ||||
|---|---|---|---|---|
| Rates Per Pay Period | ||||
| Core Plan | ||||
| Coverage Options | Wellness | Standard | ||
| Employee Only | $104.00 | $142.50 | ||
| Employee + Spouse | $225.50 | $276.50 | ||
| Employee + Child(ren) | $165.00 | $213.50 | ||
| Family | $319.50 | $370.50 | ||
| Buy Up Plan | ||||
| Coverage Options | Wellness | Standard | ||
| Employee Only | $112.50 | $159.50 | ||
| Employee + Spouse | $256.50 | $307.50 | ||
| Employee + Child(ren) | $197.00 | $222.50 | ||
| Family | $333.50 | $384.00 | ||
| Limited Plan | ||||
| Coverage Options | Wellness | Standard | ||
| Employee Only | $91.50 | $117.00 | ||
| Employee + Spouse | $193.50 | $244.50 | ||
| Employee + Child(ren) | $163.50 | $189.00 | ||
| Family | $276.00 | $327.00 | ||
| HSA Plan | ||||
| Coverage Options | Wellness | Standard | ||
| Employee Only | $85.50 | $111.00 | ||
| Employee + Spouse | $180.00 | $231.00 | ||
| Employee + Child(ren) | $137.00 | $180.00 | ||
| Family | $256.00 | $307.00 | ||
| Dental Plans | ||||
| Rates Per Pay Period | ||||
| Coverage Options | Core | Buy Up | ||
| Employee Only | $6.46 | $13.85 | ||
| Employee + Spouse | $13.38 | $26.31 | ||
| Employee + Child(ren) | $14.77 | $29.08 | ||
| Family | $22.62 | $40.15 | ||
| Vision Plan | ||||
| Rates Per Pay Period | ||||
| Coverage Options | ||||
| Employee Only | $3.50 | |||
| Employee + Spouse | $6.91 | |||
| Employee + Child(ren) | $6.28 | |||
| Family | $10.32 | |||
Voluntary Critical Illness Cost of Coverage
| Col1 | Col2 | Col3 | ||
|---|---|---|---|---|
| Employee Coverage | ||||
| Bi-Weekly Rates (26 Pay Periods) Includes Wellness Benefit Rider Uni.Tobacco |
||||
| Attained Age | $10,000 | $20,000 | ||
| Under 25 | $1.06 | $2.12 | ||
| 25-29 | $1.52 | $3.05 | ||
| 30-34 | $1.89 | $3.78 | ||
| 35-39 | $2.58 | $5.17 | ||
| 40-44 | $4.02 | $8.03 | ||
| 45-49 | $6.51 | $13.02 | ||
| 50-54 | $9.32 | $18.65 | ||
| 55-59 | 12.74 | $25.48 | ||
| 60-64 | $19.71 | $39.42 | ||
| 65-69 | $25.71 | $51.42 | ||
| 70+ | $30.18 | $60.37 | ||
| Spouse Coverage* | ||||
| Bi-Weekly Rates (26 Pay Periods) Includes Wellness Benefit Rider Uni.Tobacco |
||||
| Attained Age | $5,000 | $10,000 | ||
| Under 25 | $0.55 | $1.11 | ||
| 25-29 | $0.74 | $1.48 | ||
| 30-34 | $0.97 | $1.94 | ||
| 35-39 | $1.32 | $2.63 | ||
| 40-44 | $1.98 | $3.97 | ||
| 45-49 | $2.93 | $5.86 | ||
| 50-54 | $4.04 | $8.08 | ||
| 55-59 | $5.24 | $10.48 | ||
| 60-64 | $6.78 | $13.57 | ||
| 65-69 | $9.90 | $19.80 | ||
| 70+ | $15.09 | $30.18 | ||
| *Spouse rate is based on spouse's age | ||||
| Children Coverage | ||||
| Bi-Weekly Rates (26 Pay Periods) Includes Wellness Benefit Rider |
||||
| Coverage Amount | Rate | |||
| $5,000 | $0.18 | |||
| $10,000 | $0.37 | |||
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