Benefit Rates

Benefit Rates

Medical

	$1,000 Deductible	$3,000 Deductible HRA	$4,000 Deductible HRA
Employee Only	$185.48	$75.89	$60.52
Employee + Spouse^*	$434.54	$153.62	$124.51
Employee + Child(ren)	$387.83	$128.05	$99.94
Family^*	$554.04	$212.25	$168.93

*A surcharge of $60 per pay for Medical insurance will apply for those covering spouses/domestic partners who have coverage available through their employer or through Medicare.

Vision

	Rate
Employee Only	Free
Employee + Spouse	$3.23
Employee + Child(ren)	$3.59
Family	$6.97

Dental

	Rate
Employee Only	Free
Employee + Spouse	$14.74
Employee + Child(ren)	$21.44
Family	$41.35

Legal Insurance ARAG

	Per Pay Rate
Basic Coverage	$9.58
Expanded Coverage	$11.19

Voluntary Life and AD&D

per $1,000

Age	Life	AD&D
Under 20	$0.025	$0.009
20-24	$0.025	$0.009
25-29	$0.025	$0.009
30-34	$0.033	$0.009
35-39	$0.050	$0.009
40-44	$0.075	$0.009
45-49	$0.145	$0.009
50-54	$0.245	$0.009
55-59	$0.399	$0.009
60-64	$0.594	$0.009
65-69	$0.910	$0.009
70-74	$1.333	$0.009
75-79	$2.438	$0.009
80-84	$2.438	$0.009
85-89	$2.438	$0.009
90-94	$2.438	$0.009
95-99	$2.438	$0.009
Dependent Child	$0.078	$0.009

All costs are per pay bi-weekly