Medical Plan |
Employee |
Employer |
Total |
Premium Medical
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$48.00
$158.00
$131.00
$269.00
|
$319.00
$577.00
$512.00
$833.00
|
$367.00
$735.00
$643.00
$1,102.00
|
Standard Medical
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$ 3.00
$67.00
$52.00
$133.00
|
$319.00
$577.00
$512.00
$833.00
|
$322.00
$644.00
$564.00
$966.00
|
Consumer Choice Medical / HSA
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$(56).00
$(51).00
$(52).00
$(44).00
|
$319.00
$577.00
$512.00
$833.00
|
$263.00
$526.00
$460.00
$789.00
|
| HMO |
Employee |
Employer |
Total |
Blue Cross CaliforniaCare - HMO (California)
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$96.00
$277.00
$232.00
$458.00
|
$508.00
$930.00
$825.00
$1,354.00
|
$604.00
$1,207.00
$1,057.00
$1,812.00
|
HMSA – HMO (Hawaii)
– Employee only
– Employee + one
– Employee + family |
$30.00
$113.00
$195.00
|
$245.76
$438.52
$632.28
|
$275.76
$551.52
$827.28
|
HMSA – PPO (Hawaii)
– Employee only
– Employee + one
– Employee + family |
$35.00
$125.00
$215.00
|
$264.72
$474.44
$684.16
|
$299.72
$599.44
$899.16
|
SelectHealth – HMO (Utah)
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$53.00
$170.00
$140.00
$286.00
|
$336.00
$608.00
$540.00
$881.00
|
$389.00
$778.00
$680.00
$1,167.00
|
SelectHealth – $1,000 Deductible HMO (Utah)
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$0.00
$0.00
$0.00
$0.00
|
$230.00
$461.00
$404.00
$689.00
|
$230.00
$461.00
$404.00
$689.00
|
Dental Plan |
Employee |
Employer |
Total |
Basic Plan
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$5.00
$15.00
$12.00
$25.00
|
$20.00
$34.00
$31.00
$49.00
|
$25.00
$49.00
$43.00
$74.00
|
Comprehensive Plan
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$18.00
$42.00
$35.00
$65.00
|
$20.00
$34.00
$31.00
$49.00
|
$38.00
$76.00
$66.00
$114.00
|
Vision Plan |
Employee |
Employer |
Total |
VSP
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$10.76
$16.90
$17.22
$27.78
|
$0.00
$0.00
$0.00
$0.00
|
$10.76
$16.90
$17.22
$27.78
|
Flexible Spending Accounts |
Employee |
Employer |
Total |
Health Care Contributions
($5,000 maximum)
Dependent Day Care Contributions
($5,000 maximum)
|
A minimum of $5.00 per pay period and maximum of $208.00 per pay period (Health Care and Dependent Care) |
|
Up to the annual maximum of $5,000 per FSA plan. Note: If you elect the Consumer Choice plan, you can only contribute to the dependent care account |
| Limited Purpose Contributions |
|
$0.00 |
Up to the annual maximum of $2,500 for Limited Purpose |
| Heatlh Savings Account |
Employee |
Employer |
Total |
HSA maximum contribution amount
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$2,900
$5,800
$5,800
$5,800
|
$(56.00)
$(51.00)
$(52.00)
$(44.00)
|
Contribution maximums |
Basic Employee Term Life and AD&D Insurance |
Employee |
Employer |
Total |
Employer-provided Coverage
– 1 x Total Compensation |
$0.00 |
Life Insurance –
$0.12 per $1,000
AD&D Insurance –
$ 0.015 per $1,000 |
$0.135 per $1,000
($0.12 per $1,000 Life + $0.015 per $1,000 AD&D) |
Optional Basic Employee Term Life and AD&D Insurance |
Employee |
Employer |
Total |
1 x Total Compensation
|
$0.145 |
$0.00 |
$0.145 per $1,000
($0.13 per $1,000 Life + $0.015 per $1,000 AD&D) |
Voluntary AD&D Insurance |
Employee |
Employer |
Total |
Minimum $25,000 up to 10 x base salary for maximum of $750,000 |
Employee Only –
$0.021/$1,000
Employee + Family –
$0.032/$1,000 |
$ 0.00
$0.00
|
Employee Only –
$0.021/$1,000
Employee + Family –
$0.032/$1,000
|
Group Universal Life |
Employee |
Employer |
Total |
Employee
Spouse
Child(ren)
($0.12 per $1,000) |
Age Rate per $1,000
Employee & Spouse –
<30 $0.038
30-34 $0.045
35-39 $0.050
40-44 $0.075
45-49 $0.105
50-54 $0.165
55-59 $0.270
60-64 $0.420
65-69 $0.683
70-74 $1.665
75 + $2.530
Child(ren) –
$5,000 $0.60
$10,000 $1.20
$15,000 $1.80
$20,000 $2.40
$25,000 $3.00 |
$0.00 |
Age Rate per 1,000
Employee & Spouse –
30 $0.038
30-34 $0.045
35-39 $0.050
40-44 $0.075
45-49 $0.105
50-54 $0.165
55-59 $0.270
60-64 $0.420
65-69 $0.683
70-74 $1.665
75 + $2.530
Child(ren) –
$5,000 $0.60
$10,000 $1.20
$15,000 $1.80
$20,000 $2.40
$25,000 $3.00 |
Business Travel Accident Insurance |
Employee |
Employer |
Total |
Employer-provided Coverage -
3x Total Compensation |
$0.00 |
Premium determined by number of employees |
Employer-specific |
Long-term Disability- Class 1(For employees participating in a defined benefit pension plan) |
Employee |
Employer |
Total |
Employer-provided Coverage (66-2/3%) up to $20,000 monthly maximum |
$0.00
|
$0.26 per $100
|
$0.26 per $100 |
Long-term Disability- Class 2 (For employees not participating in a defined benefit pension plan) |
Employee |
Employer |
Total |
Employer-provided Coverage (66-2/3%) up to $20,000 monthly maximum |
$0.00
|
$0.31 per $100
|
$0.31 per $100 |
Cancer and Dread Disease (AFLAC) |
Employee |
Employer |
Total |
– Single
– 1 Parent + child(ren)
– Family
* Premium rates may vary in some states |
$21.50*
$25.90*
$36.40* |
$0.00
$0.00
$0.00 |
$21.50*
$25.90*
$36.40* |