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Employee Contributions (2017)

Your cost for coverage depends on how many eligible dependents you enroll and what benefit choices you make.

The Company pays the full cost of long term disability, basic life, basic AD&D and EAP.

Medical (Monthly Contributions)
Plan
Employee
Only
Employee
+ Spouse/DP
Employee
+ Child(ren)
Employee
+ Family
Option 1 PPO (Plan 494)
$366.28
$1,069.85
$912.17
$1,370.50
Option 2 PPO (Plan 521)
$362.02
$1,057.40
$901.56
$1,354.57
Option 3 HDHP HSA (Plan 557)
$291.67
$851.89
$726.34
$1,091.29
Option 4 HDHP HSA (Plan 552)
$289.49
$845.52
$720.90
$1,083.13
Option 5 HMO Value Network (Plan 66/39N)
$78.68
$399.93
$316.20
$587.30
Option 6 HMO Full Network (Plan 62/39N)
$364.41
$1,073.08
$864.89
$1,540.76

Dental (Monthly Contributions)
Plan
Employee
Only
Employee
+ Spouse/DP
Employee
+ Child(ren)
Employee
+ Family
Option 1 PPO Low Plan
$3.18
$11.92
$15.27
$25.52
Option 2 PPO Medium Plan
$5.92
$20.56
$28.76
$45.73
Option 3 PPO High Plan
$7.47
$25.75
$36.12
$57.25
Option 4 Dental HMO Plan
$2.72
$8.79
$12.12
$19.64

Vision (Monthly Contributions)
Plan
Employee
Only
Employee + Spouse/DP
Employee + Child(ren)
Employee
+ Family
Option 1 Exam Plus Allowance (Davis Network)
$1.47
$4.40
$3.12
$8.71
Option 2 Exam Plus Allowance (VSP Network)
$1.36
$4.08
$2.89
$8.08
Option 3 Full Feature (Davis Network)
$2.03
$6.08
$4.31
$12.04
Option 4 Full Feature (VSP Network)
$2.25
$6.76
$4.78
$13.37

Short Term Disability (Monthly Cost Per $10 of Weekly Benefit)
Option 1 (20%; max $1,000/week)
$0.983

Optional Life and Dependent Life
(Monthly Cost Per $1,000 of Coverage)
 Optional AD&D
(Monthly Cost Per $1,000 of Coverage)
Age
Employee
Spouse/DP*
Dependent Child(ren)
Employee
Spouse/DP
Dependent  Child(ren)
<25
$0.06
$0.06
$0.205 Regardless of the number of children covered
$0.02
$0.02
$0.02 Regardless of the number of children covered
25 – 29
$0.06
$0.06
30 – 34
$0.06
$0.06
35 – 39
$0.08
$0.08
40 – 44
$0.11
$0.11
45 – 49
$0.17
$0.17
50 – 54
$0.28
$0.28
55 – 59
$0.49
$0.49
60 – 64
$0.81
$0.81
65 – 69
$1.35
$1.35
70+
$2.70
N/A

* The cost for Spouse/DP coverage is based on the Spouse/DP age.
Voluntary Critical Illness Insurance (VCII) - Employees
(Monthly Cost)
Employee Age
Non-Tobacco
Tobacco
$5,000
$10,000
$15,000
$5,000
$10,000
$15,000
<25
$5.30
$8.20
$11.10
$6.75
$11.10
$15.45
25-29
$5.55
$8.70
$11.85
$7.65
$12.90
$18.15
30-34
$6.55
$10.70
$14.85
$9.80
$17.20
$24.60
35-39
$8.05
$13.70
$19.35
$13.25
$24.10
$34.95
40-44
$10.40
$18.40
$26.40
$18.35
$34.30
$50.25
45-49
$13.40
$24.40
$35.40
$24.40
$46.40
$68.40
50-54
$16.90
$31.40
$45.90
$31.80
$61.20
$90.60
55-59
$21.50
$40.60
$59.70
$39.85
$77.30
$114.75
60-64
$26.85
$51.30
$75.75
$47.25
$92.10
$136.95
65-69
$29.90
$57.40
$84.90
$49.15
$95.90
$142.65
70+
$51.70
$101.00
$150.30
$77.75
$153.10
$228.45

* Attained age of covered person as of effective date of coverage. Once enrolled, cost does not increase on account of age.

Voluntary Critical Illness Insurance (VCII) - Spouse/DP
(Monthly Cost)
Spouse/DP
Non-Tobacco
Tobacco
$5,000
$5,000
<25
$5.30
$6.75
25-29
$5.55
$7.65
30-34
$6.55
$9.80
35-39
$8.05
$13.25
40-44
$10.40
$18.35
45-49
$13.40
$24.40
50-54
$16.90
$31.80
55-59
$21.50
$39.85
60-64
$26.85
$47.25

* Attained age of covered person as of effective date of coverage. Once enrolled, cost does not increase on account of age.

Voluntary Accident Insurance (VAI)
(Monthly Cost)
Employee Only
Employee + Spouse/DP
Employee + Child(ren)
Employee + Family
$16.29
$26.34
$30.42
$40.47

LegalGUARD and Identity Theft
(Monthly Cost)
Plan
Employee Only
Employee + Spouse
LegalGUARD
$19.78
$19.78
InfoArmor
$8.45
$13.25
LegalGUARD and InfoArmor
$26.63
$32.03