Medical Plan |
Employee |
Employer |
Total |
Premium Medical
– Employee only
– Employee + spouse/domestic partner
– Employee + child(ren)
– Employee + family |
$240.00
$500.50
$435.50
$760.50
|
$160.00
$300.50
$265.50
$440.50
|
$400.00
$801.00
$701.00
$1,201.00
|
Standard Medical
– Employee only
– Employee + spouse/domestic partner
– Employee + child(ren)
– Employee + family |
$191.00
$401.50
$349.50
$612.50
|
$160.00
$300.50
$265.50
$440.50
|
$351.00
$702.00
$615.00
$1,053.00
|
Consumer Choice Medical / HSA
– Employee only
– Employee + spouse/domestic partner
– Employee + child(ren)
– Employee + family |
$127.00
$272.50
$235.50
$419.50
|
$160.00
$300.50
$265.50
$440.50
|
$287.00
$573.00
$501.00
$860.00
|
HMOs and Insured PPO Plans |
|
|
|
HMSA – HMO (Hawaii)
– Employee only
– Employee + one
– Employee + family |
$171.17
$356.84
$542.01
|
$114.17
$213.84
$314.01
|
$285.34
$570.68
$856.02
|
HMSA – PPO (Hawaii)
– Employee only
– Employee + one
– Employee + family |
$181.02
$377.54
$573.56
|
$121.02
$226.54
$332.56
|
$302.04
$604.08
$906.12
|
SelectHealth – HMO (Utah)
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$264.00
$549.50
$477.00
$835.50
|
$176.00
$329.50
$291.00
$483.50
|
$440.00
$879.00
$768.00
$1,319.00
|
SelectHealth – $1,000 Deductible HMO (Utah)
– Employee only
– Employee + spouse
– Employee + child(ren)
– Employee + family |
$130.00
$260.50
$228.50
$389.50 |
$130.00
$260.50
$228.50
$389.50 |
$260.00
$521.00
$457.00
$779.00 |
Dental Plan |
Employee |
Employer |
Total |
Basic Plan
– Employee only
– Employee + spouse/domestic partner
– Employee + child(ren)
– Employee + family |
$15.00
$33.00
$28.50
$50.50
|
$10.00
$18.00
$15.50
$25.50
|
$25.00
$51.00
$44.00
$76.00
|
Comprehensive Plan
– Employee only
– Employee + spouse/domestic partner
– Employee + child(ren)
– Employee + family |
$29.00
$59.00
$51.50
$90.50
|
$10.00
$18.00
$15.50
$25.50
|
$39.00
$77.00
$67.00
$116.00
|
Vision Plan |
Employee |
Employer |
Total |
VSP
– Employee only
– Employee + spouse/domestic partner
– Employee + child(ren)
– Employee + family |
$10.94
$17.18
$17.51
$28.25
|
$0.00
$0.00
$0.00
$0.00
|
$10.94
$17.18
$17.51
$28.25 |
| 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* |