Ï㽶ÊÓƵChoice Plan Rates
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Medical plans
Review page 9 of the enrollment guide for more information.
| Plan coverage level | Premium plan | Copay plan | HDHP |
|---|---|---|---|
| Employee only | $163.20 | $58.94 | $78.28 |
| Employee and spouse | $367.75 | $131.15 | $172.23 |
| Employee and child(ren) | $252.23 | $87.07 | $111.77 |
| Employee and family | $494.06 | $171.62 | $213.60 |
| Plan coverage level | Premium plan | Copay plan | HDHP |
|---|---|---|---|
| Individual |
$1,400 |
$4,000 | $2,200 |
| Family | $4,200 | $8,000 | $4,400 |
| Coinsurance after deductible |
80% covered in-network 60% covered out-of-network |
80% covered in-network 60% covered out-of-network |
80% covered in-network 60% covered out-of-network |
| Plan coverage level | Premium plan | Copay plan | HDHP |
|---|---|---|---|
| Individual |
$5,000 |
$6,000 | $6,000 |
| Family | $10,000 | $12,000 | $8,150 |
Dental plans
Review page 17 of the enrollment guide for more information.
| Plan coverage level | Premium dental | Basic dental |
|---|---|---|
| Employee | $8.08 | $3.20 |
| Employee and spouse | $16.44 | $6.68 |
| Employee and child(ren) | $15.66 | $5.27 |
| Employee and family | $26.30 | $9.68 |
| Plan coverage level | Premium dental | Basic dental |
|---|---|---|
| Individual | $50 | $50 |
| Family | $150 | $150 |
| Plan coverage level | Premium dental | Basic dental |
|---|---|---|
| Per person | $3,500 | $2,000 |
Vision plans
Review page 18 of the enrollment guide for more information.
| Plan coverage level | Vision |
|---|---|
| Employee only | $.60 |
| Employee and spouse | $1.27 |
| Employee and child(ren) | $1.09 |
| Employee and family | $1.90 |
Supplemental life
Review page 25 of the enrollment guide for more information.
| Under 30 | 30-34 | 35-39 | 40-44 | 45-49 | 50-54 | 55-59 | 60-64 | 65+ | |
|---|---|---|---|---|---|---|---|---|---|
| $50k | $.65 | $1.02 | $1.18 | $1.66 | $2.49 | $4.06 | $7.57 | $10.15 | $21.97 |
| $100k | $1.29 | $2.03 | $2.35 | $3.32 | $4.98 | $8.12 | $15.14 | $20.31 | $43.94 |
| $150k | $1.94 | $3.05 | $3.53 | $4.98 | $7.48 | $12.18 | $22.71 | $30.46 | $65.91 |
| $200k | $2.58 | $4.06 | $4.71 | $6.65 | $9.97 | $16.25 | $30.28 | $40.62 | $87.88 |
| $250k | $3.23 | $5.08 | $5.88 | $8.31 | $12.46 | $20.31 | $37.85 | $50.77 | $109.85 |
| $300k | $3.88 | $6.09 | $7.06 | $9.97 | $14.95 | $24.37 | $45.42 | $60.92 | $131.82 |
| $350k | $4.52 | $7.11 | $8.24 | $11.63 | $17.45 | $28.43 | $52.98 | $71.08 | $153.78 |
| $400k | $5.17 | $8.12 | $9.42 | $13.29 | $19.94 | $32.49 | $60.55 | $81.23 | $175.75 |
| $450k | $5.82 | $9.14 | $10.59 | $14.95 | $22.43 | $36.55 | $68.12 | $91.38 | $197.72 |
| $500k | $6.46 | $10.15 | $11.77 | $16.62 | $24.92 | $40.62 | $75.69 | $101.54 | $219.69 |
| $550k | $7.11 | $11.17 | $12.95 | $18.28 | $27.42 | $44.68 | $83.26 | $111.69 | $241.66 |
| $600k | $7.75 | $12.18 | $14.12 | $19.94 | $29.91 | $48.74 | $90.83 | $121.85 | $263.63 |
Spouse/FIP supplemental life
Review page 25 of the enrollment guide for more information.
| Under 30 | 30-34 | 35-39 | 40-44 | 45-49 | 50-54 | 55-59 | 60-64 | 65+ | |
|---|---|---|---|---|---|---|---|---|---|
| $10k | $.13 | $.20 | $.24 | $.33 | $.50 | $.81 | $1.51 | $2.03 | $4.39 |
| $20k | $.26 | $.41 | $.47 | $.66 | $1.00 | $1.50 | $2.44 | $4.54 | $6.09 |
| $30k | $.39 | $.61 | $.71 | $1.00 | $1.50 | $2.44 | $4.54 | $6.09 | $13.18 |
| $40k | $.52 | $.81 | $.94 | $1.33 | $1.99 | $3.25 | $6.06 | $8.12 | $17.58 |
| $50k | $.65 | $1.02 | $1.18 | $1.66 | $2.49 | $4.06 | $7.57 | $10.15 | $21.97 |
| $60k | $.78 | $1.22 | $1.41 | $1.99 | $2.99 | $4.87 | $9.08 | $12.18 | $26.36 |
| $70k | $.90 | $1.42 | $1.65 | $2.33 | $3.49 | $5.69 | $10.60 | $14.22 | $30.76 |
| $80k | $1.03 | $1.62 | $1.88 | $2.66 | $3.99 | $6.50 | $12.11 | $16.25 | $35.15 |
| $90k | $1.16 | $1.83 | $2.12 | $2.99 | $4.49 | $7.31 | $13.62 | $18.28 | $39.54 |
| $100k | $1.29 | $2.03 | $2.35 | $3.32 | $498 | $8.12 | $15.14 | $20.31 | $43.94 |
| $110k | $4.42 | $2.23 | $2.59 | $3.66 | $5.48 | $8.94 | $16.65 | $22.34 | $48.33 |
| $120k | $1.55 | $2.44 | $2.82 | $3.99 | $5.98 | $9.75 | $18.17 | $24.37 | $52.73 |
| $130k | $1.68 | $2.64 | $3.06 | $4.32 | $6.48 | $10.56 | $19.68 | $26.40 | $57.12 |
| $140k | $1.81 | $2.84 | $3.30 | $4.65 | $6.98 | $11.37 | $21.19 | $28.43 | $61.51 |
| $150k | $1.94 | $3.05 | $3.53 | $4.98 | $7.48 | $12.18 | $22.71 | $30.46 | $65.91 |
Child(ren) supplemental life
Review page 25 of the enrollment guide for more information.
- $.462 per pay period up to age 26
- One election covers all dependent children
Monthly COBRA Rates
COBRA rates are monthly and include both the employee and employer contributions along with a 2% administrative fee.
| Tier | Premium Medical | Copay Medical | HDHP | Premium Dental | Basic Dental | Vision |
|---|---|---|---|---|---|---|
| Adult (Age 26 and Over) | $1,213.43 |
$1,015.41 |
$1,072.80 |
$66.05 |
$55.38 |
$7.00 |
| Children (Under Age 26) | $895.71 |
$749.53 |
$791.91 |
$75.39 |
$63.22 |
$7.98 |
| Adult Plus Children | $2,109.14 |
$1,764.94 |
$1,864.71 |
$141.44 |
$118.60 |
$14.98 |
| Two Adults | $2,426.86 |
$2,030.82 |
$2,145.60 |
$132.20 |
$110.85 |
$14.00 |
| Two Adults Plus Children | $3,397.60 | $2,843.14 | $3,002.33 | $226.08 | $189.37 | $23.95 |