For more information about Domestic Partner (DP) rates, view the Domestic Partner After Tax Contributions and Imputed Income resource.
|
|
Total Cost |
Employer Cost |
Employee Cost |
Cigna OAP 750 Rate |
|
|
|
|
Employee Only |
$932.69 |
$796.69 |
$136.00 |
|
Employee and Spouse |
$2,051.93 |
$1,701.93 |
$350.00 |
|
Employee and Child(ren) |
$1,678.85 |
$1,382.85 |
$296.00 |
|
Employee and Family |
$2,891.35 |
$2,391.35 |
$500.00 |
|
|
Total Cost |
Employer Cost |
Employee Cost |
Cigna HDHP Rate |
|
|
|
|
Employee Only |
$770.55 |
$694.55 |
$76.00 |
|
Employee and Spouse |
$1,695.20 |
$1,482.20 |
$213.00 |
|
Employee and Child(ren) |
$1,386.99 |
$1,210.99 |
$176.00 |
|
Employee and Family |
$2,388.70 |
$2,091.70 |
$297.00 |
|
|
Total Cost |
Employer Cost |
Employee Cost |
Kaiser Traditional HMO (CA) Rate |
|
|
|
|
Employee Only |
$684.84 |
$614.84 |
$70.00 |
|
Employee and Spouse |
$1,506.64 |
$1,306.64 |
$200.00 |
|
Employee and Child(ren) |
$1,369.67 |
$1,199.67 |
$170.00 |
|
Employee and Family |
$2,054.52 |
$1,769.52 |
$285.00 |
|
|
Total Cost |
Employer Cost |
Employee Cost |
Kaiser Traditional HMO (CO) Rate |
|
|
|
|
Employee Only |
$564.21 | $499.21 |
$65.00 |
|
Employee and Spouse |
$1,241.27 |
$1,046.27 |
$195.00 |
|
Employee and Child(ren) |
$1,128.43 |
$963.43 |
$165.00 |
|
Employee and Family |
$1,692.64 |
$1,412.64 |
$280.00 |
|
|
Total Cost |
Employer Cost |
Employee Cost |
Cigna Dental PPO Base Plan Rate |
|
|
|
|
Employee Only |
$40.65 |
$30.65 |
$10.00 |
|
Employee and Spouse |
$81.17 |
$61.17 |
$20.00 |
|
Employee and Child(ren) |
$96.56 |
$73.56 |
$23.00 |
|
Employee and Family |
$137.09 |
$104.09 |
$33.00 |
|
|
Total Cost |
Employer Cost |
Employee Cost |
Cigna Dental PPO Buy-Up Plan Rate |
|
|
|
|
Employee Only |
$52.22 |
$36.22 |
$16.00 |
|
Employee and Spouse |
$104.04 |
$73.04 |
$31.00 |
|
Employee and Child(ren) |
$175.53 |
$122.53 |
$37.00 |
|
Employee and Family |
$175.53 |
$122.53 |
$53.00 |
|
|
Total Cost |
Employer Cost |
Employee Cost |
VSP Vision PPO Rate |
|
|
|
|
Employee Only |
$7.71 |
$6.17 |
$1.54 |
|
Employee and Spouse |
$13.22 |
$10.58 |
$2.64 |
|
Employee and Child(ren) |
$13.50 |
$10.80 |
$2.70 |
|
Employee and Family |
$21.78 |
$17.42 |
$4.36 |
Age Band |
EE only |
EE + Spouse |
EE + Child(ren) |
EE + Family |
<25 |
$1.65 |
$2.98 |
$1.65 |
$2.98 |
25-29 |
$2.16 |
$3.74 |
$2.16 |
$3.74 |
30-34 |
$3.09 |
$5.14 |
$3.09 |
$5.14 |
35-39 |
$4.48 |
$7.23 |
$4.48 |
$7.23 |
40-44 |
$6.74 |
$10.61 |
$6.74 |
$10.61 |
45-49 |
$9.32 |
$14.48 |
$9.32 |
$14.48 |
50-54 |
$13.86 |
$21.32 |
$13.86 |
$21.32 |
55-59 |
$19.93 |
$30.44 |
$19.93 |
$30.44 |
60-64 |
$29.29 |
$44.51 |
$29.29 |
$44.51 |
65-69 |
$40.15 |
$60.81 |
$40.15 |
$60.81 |
70+ |
$56.17 |
$84.87 |
$56.17 |
$84.87 |
Age Band |
EE only |
EE + Spouse |
EE + Child(ren) |
EE + Family |
<25 |
$3.27 |
$5.91 |
$3.27 |
$5.91 |
25-29 |
$4.25 |
$7.38 |
$4.25 |
$7.38 |
30-34 |
$6.09 |
$10.13 |
$6.09 |
$10.13 |
35-39 |
$8.84 |
$14.25 |
$8.84 |
$14.25 |
40-44 |
$13.31 |
$20.97 |
$13.31 |
$20.97 |
45-49 |
$18.41 |
$28.62 |
$18.41 |
$28.62 |
50-54 |
$27.42 |
$42.19 |
$27.42 |
$42.19 |
55-59 |
$39.44 |
$60.24 |
$39.44 |
$60.24 |
60-64 |
$58.00 |
$88.14 |
$58.00 |
$88.14 |
65-69 |
$79.52 |
$120.46 |
$79.52 |
$120.46 |
70+ |
$111.35 |
$168.25 |
$111.35 |
$168.25 |
|
Low Plan |
High Plan |
EE only |
$3.99 |
$5.38 |
EE + Spouse |
$7.98 |
$11.66 |
EE + Child(ren) |
$8.38 |
$12.25 |
EE + Family |
$12.36 |
$18.08 |
Employee and Spouse |
Age Band |
Rate per $1,000 of Coverage |
18-24 |
$0.04 |
25-29 |
$0.04 |
30-34 |
$0.05 |
35-39 |
$0.07 |
40-44 |
$0.10 |
45-49 |
$0.15 |
50-54 |
$0.23 |
55-59 |
$0.41 |
60-64 |
$0.66 |
65-69 |
$1.10 |
70-74 |
$1.81 |
75+ |
$2.06 |
Dependent Child |
$0.17 per $1,000 of Coverage |
|
Rate per $1,000 of Coverage* |
EE only |
$0.030 |
EE + Spouse |
$0.040 |
EE + Child(ren) |
$0.040 |
EE + Family |
$0.040 |
EE only |
$6.50 |
EE + Family |
$12.50 |