Medical Plan |
Employee |
Employer |
Total |
Premium Medical
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$207.50
$446.50
$387.00
$685.50
|
$159.50
$288.50
$256.00
$416.50
|
$367.00
$735.00
$643.00
$1,102.00
|
Standard Medical
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$162.50
$355.50
$308.00
$549.50
|
$159.50
$288.50
$256.00
$416.50
|
$322.00
$644.00
$564.00
$966.00
|
Consumer Choice Medical / HSA
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$103.50
$237.50
$204.00
$372.50
|
$159.50
$288.50
$256.00
$416.50
|
$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 |
$350.00
$742.00
$644.50
$1,135.00
|
$254.00
$465.00
$412.50
$677.00
|
$604.00
$1,207.00
$1,057.00
$1,812.00
|
HMSA – HMO (Hawaii)
– Employee only
– Employee + one
– Employee + family |
$152.88
$332.26
$511.14
|
$112.88
$219.26
$316.14
|
$275.76
$551.52
$827.28
|
HMSA – PPO (Hawaii)
– Employee only
– Employee + one
– Employee + family |
$167.36
$362.22
$557.08
|
$132.36
$237.22
$342.08
|
$299.72
$599.44
$899.16
|
SelectHealth – HMO (Utah)
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$221.00
$474.00
$410.00
$726.50
|
$168.00
$304.00
$270.00
$440.50
|
$389.00
$778.00
$680.00
$1,167.00
|
SelectHealth – $1,000 Deductible HMO (Utah)
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$115.00
$230.50
$202.00
$344.50
|
$115.00
$230.50
$202.00
$344.50
|
$230.00
$461.00
$404.00
$689.00
|
Dental Plan |
Employee |
Employer |
Total |
Basic Plan
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$15.00
$32.00
$27.50
$49.50
|
$10.00
$17.00
$15.50
$24.50
|
$25.00
$49.00
$43.00
$74.00
|
Comprehensive Plan
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$28.00
$59.00
$50.50
$89.50
|
$10.00
$17.00
$15.50
$24.50
|
$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) |
$0.00 |
Up to the annual maximum of $5,000 per FSA plan for Health Care and Dependent Care. 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 |
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 / $1,000 |
$0.00 |
$0.145 / $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* |