Cost of Coverage
Medical Cost of Coverage
| Bronze | Silver (HSA) | Gold (HSA) | Platinum | |||||
|---|---|---|---|---|---|---|---|---|
| Bronze | Silver (HSA) | Gold (HSA) | Platinum | |||||
| Monthly Premiums | ||||||||
| Employee | $30 | $60 | $90 | $150 | ||||
| Employee + Child(ren) | $60 | $120 | $180 | $300 | ||||
| Employee + Spouse | $90 | $180 | $270 | $450 | ||||
| Family | $120 | $240 | $360 | $600 | ||||
Dental Cost of Coverage
| Dental Plan Highlights | Dental Low Plan | Dental High Plan | ||
|---|---|---|---|---|
| Dental Plan Highlights | Dental Low Plan | Dental High Plan | ||
| Monthly Premiums | ||||
| Employee | $24.12 | $45.56 | ||
| Employee + Child(ren) | $61.10 | $97.04 | ||
| Employee + Spouse | $48.72 | $82.64 | ||
| Family | $91.46 | $139.10 | ||
Vision Cost of Coverage
| Vision Plan Highlights | In-Network | Out-of-Network | ||
|---|---|---|---|---|
| Vision Plan Highlights | In-Network | Out-of-Network | ||
| Monthly Premiums | ||||
| Employee | $5.82 | |||
| Employee + Child(ren) | $12.80 | |||
| Employee + Spouse | $11.64 | |||
| Family | $18.62 | |||
Life Cost of Coverage
| Monthly Premium | |
|---|---|
| Monthly Premium | |
| Life & AD&D | $.066 per $1,000 of coverage |
Voluntary Life Cost of Coverage
| Monthly Premium* per $1,000 of coverage, based on age | Employee & Spouse | |
|---|---|---|
| Monthly Premium* per $1,000 of coverage, based on age |
Employee & Spouse | |
| <25 | $0.070 | |
| 25-29 | $0.070 | |
| 30-34 | $0.090 | |
| 35-39 | $0.130 | |
| 40-44 | $0.170 | |
| 45-49 | $0.250 | |
| 50-54 | $0.410 | |
| 55-59 | $0.70 | |
| 60-64 | $1.040 | |
| 65-69 | $1.680 | |
| 70-99 | $5.360 | |
| Child | ||
|
Child Life for $5,000 benefit (regardless of # of children) |
$0.40 | |
Disability Cost of Coverage
| Monthly Premiums | |
|---|---|
| Monthly Premiums | |
| Short-Term Disability | $.21 per $10 of weekly benefit |
| Long-Term Disability | $.13 per $100 of covered salary |
Voluntary Benefits Cost of Coverage – Accident
| Monthly Premiums | |
|---|---|
| Monthly Premiums | |
| Employee only | $9.52 |
| Employee + Child(ren) | $18.10 |
| Employee + Spouse | $15.44 |
| Family | $24.02 |
Voluntary Benefits Cost of Coverage – Hospital Indemnity
| Monthly Premiums | |
|---|---|
| Monthly Premiums | |
| Employee only | $20.42 |
| Employee + Child(ren) | $35.08 |
| Employee + Spouse | $43.12 |
| Family | $57.78 |
Voluntary Benefits Cost of Coverage – Critical Illness
| Monthly Premium* per $1,000 of coverage, based on employee’s age | Non-Tobacco User | Tobacco User | ||
|---|---|---|---|---|
| Monthly Premium* per $1,000 of coverage, based on employee’s age | Non-Tobacco User | Tobacco User | ||
| <25 | $.44 | $.46 | ||
| 25-29 | $.48 | $.50 | ||
| 30-34 | $.56 | $.62 | ||
| 35-39 | $.74 | $.90 | ||
| 40-44 | $1.00 | $1.32 | ||
| 45-49 | $1.34 | $1.98 | ||
| 50-54 | $1.90 | $3.06 | ||
| 55-59 | $2.44 | $4.20 | ||
| 60-64 | $2.86 | $5.20 | ||
| 65-69 | $3.68 | $7.12 | ||
| 70-74 | $4.92 | $9.36 | ||
| 75+ | $6.94 | $11.78 | ||
| Child | ||||
|
Child Benefit per $1,000 (regardless of # of children) |
$.10 | |||
