MERITAIN MEDICAL PLANS
Bi-weekly Payroll Contributions
|
HDHP Base Plan |
|
|
Employee Only |
$17.53 |
|
Employee + Child(ren) |
$69.23 |
|
Employee + Spouse |
$89.14 |
|
Family |
$120.47 |
|
Meritain Low EPO Plan |
|
|
Employee Only |
$53.31 |
|
Employee + Child(ren) |
$151.70 |
|
Employee + Spouse |
$204.76 |
|
Family |
$275.06 |
|
Meritain High POS Plan |
|
|
Employee Only |
$96.92 |
|
Employee + Child(ren) |
$217.38 |
|
Employee + Spouse |
$292.86 |
|
Family |
$394.19 |
KAISER MEDICAL PLANS
CA employees only
Bi-weekly Payroll Contributions
|
Kaiser HDHP Base Plan |
|
|
Employee Only |
$13.85 |
|
Employee + Child(ren) |
$80.15 |
|
Employee + Spouse |
$94.70 |
|
Family |
$114.57 |
|
Kaiser HMO Low Plan |
|
|
Employee Only |
$57.35 |
|
Employee + Child(ren) |
$127.01 |
|
Employee + Spouse |
$170.76 |
|
Family |
$230.73 |
|
Kaiser HMO High Plan |
|
|
Employee Only |
$111.90 |
|
Employee + Child(ren) |
$200.71 |
|
Employee + Spouse |
$269.85 |
|
Family |
$364.62 |
DELTA DENTAL PLANS
Bi-Weekly Payroll Contributions
|
Bi-Weekly Deductions |
DHMO Plan |
DPPO Plan |
|
Employee Only |
$0.64 |
$6.38 |
|
Employee + Child(ren) |
$5.90 |
$18.50 |
|
Employee + Spouse |
$2.01 |
$13.00 |
|
Family |
$10.15 |
$24.97 |
DELTA VISION PLAN
Bi-weekly Payroll Contributions
|
Essential Plan |
|
|
Employee Only |
$0.00 |
|
Employee + Child(ren) |
$2.72 |
|
Employee + Spouse |
$2.41 |
|
Family |
$5.11 |
|
Platinum Choice Plan |
|
|
Employee Only |
$2.64 |
|
Employee + Child(ren) |
$8.38 |
|
Employee + Spouse |
$7.69 |
|
Family |
$14.16 |
PRUDENTIAL WORKSITE BENEFITS
Bi-weekly Payroll Contributions
|
Accident |
|
|
Employee Only |
$5.63 |
|
Employee + Child(ren) |
$9.38 |
|
Employee + Spouse |
$8.84 |
|
Family |
$13.72 |
|
Hospital Indemnity Insurance |
|
|
Employee Only |
$4.01 |
|
Employee + Child(ren) |
$8.23 |
|
Employee + Spouse |
$7.43 |
|
Family |
$11.66 |
Critical Illness - Non Smokers & Monthly Rate per $1,000 of coverage
|
Age Bands |
Employee + Child(ren) |
Spouse |
|
Age <30 |
$0.214 |
$0.215 |
|
Age 30-39 |
$0.378 |
$0.313 |
|
Age 40-49 |
$0.595 |
$0.530 |
|
Age 50-59 |
$1.143 |
$1.155 |
|
Age 60-69 |
$1.968 |
$2.184 |
|
Age 70+ |
$3.332 |
$3.695 |
Critical Illness - Smokers & Monthly Rate per $1,000 of coverage
|
Age Bands |
Employee + Child(ren) |
Spouse |
|
Age <30 |
$0.239 |
$0.240 |
|
Age 30-39 |
$0.474 |
$0.406 |
|
Age 40-49 |
$0.896 |
$0.829 |
|
Age 50-59 |
$1.954 |
$2.022 |
|
Age 60-69 |
$3.458 |
$3.841 |
|
Age 70+ |
$5.580 |
$6.189 |
PRUDENTIAL VOLUNTARY LIFE
Monthly Payroll Rates
|
Age Bands |
Employee Rates per $1,000 of coverage: |
Spouse Rates per $1,000 of coverage based on spouse’s age: |
|
Age <30 |
$0.110 |
$0.110 |
|
Age 30-34 |
$0.150 |
$0.150 |
|
Age 35-39 |
$0.190 |
$0.190 |
|
Age 40-44 |
$0.260 |
$0.260 |
|
Age 45-49 |
$0.370 |
$0.370 |
|
Age 50-54 |
$0.570 |
$0.570 |
|
Age 55-59 |
$0.840 |
$0.840 |
|
Age 60-64 |
$1.170 |
$1.170 |
|
Age 65-69 |
$2.010 |
$2.010 |
|
Age 70-74 |
$3.460 |
$3.460 |
|
Age 75+ |
$12.670 |
$12.670 |