Medical (Monthly)

January 1, 2023 – December 31, 2023

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
Aetna Open Choice PPO 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
Aetna Open Choice HDHP PPO 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	$617.13	$547.13	$70.00
	Employee and Spouse	$1,357.68	$1,157.68	$200.00
	Employee and Child(ren)	$1,234.26	$1,064.26	$170.00
	Employee and Family	$1,851.38	$1,566.38	$285.00

		Total Cost	Employer Cost	Employee Cost
Kaiser Traditional HMO (CO) Rate
	Employee Only	$566.75	$501.75	$65.00
	Employee and Spouse	$1,246.84	$1,051.84	$195.00
	Employee and Child(ren)	$1,133.49	$968.49	$165.00
	Employee and Family	$1,700.24	$1,420.24	$280.00

Dental (Monthly)

		Total Cost	Employer Cost	Employee Cost
Aetna Dental PPO Base Plan Rate
	Employee Only	$49.19	$39.19	$10.00
	Employee and Spouse	$98.22	$78.22	$20.00
	Employee and Child(ren)	$116.84	$93.84	$23.00
	Employee and Family	$165.89	$132.89	$33.00

		Total Cost	Employer Cost	Employee Cost
Aetna Dental PPO Buy-Up Plan Rate
	Employee Only	$63.19	$47.19	$16.00
	Employee and Spouse	$125.89	$94.89	$31.00
	Employee and Child(ren)	$149.66	$112.66	$37.00
	Employee and Family	$212.40	$159.40	$53.00

Vision (Monthly)

		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

Critical Illness — Low Plan $10,000 Coverage (Monthly)

Age Band	EE only	EE + Spouse	EE + Child(ren)	EE + Family
<20	$2.92	$5.44	$2.92	$5.44
20-24	$3.38	$6.14	$3.38	$6.14
25-29	$4.02	$7.10	$4.02	$7.10
30-34	$4.89	$8.40	$4.89	$8.40
35-39	$6.24	$10.44	$6.24	$10.44
40-44	$8.67	$14.08	$8.67	$14.08
45-49	$12.67	$20.09	$12.67	$20.09
50-54	$19.30	$30.03	$19.30	$30.03
55-59	$28.77	$44.24	$28.77	$44.24
60-64	$40.99	$62.57	$40.99	$62.57
65-69	$56.24	$85.46	$56.24	$85.46
70+	$70.88	$107.43	$70.88	$107.43

Critical Illness — High Plan $20,000 Coverage (Monthly)

Age Band	EE only	EE + Spouse	EE + Child(ren)	EE + Family
<20	$4.54	$8.16	$4.54	$8.16
20-24	$5.47	$9.55	$5.47	$9.55
25-29	$6.74	$11.46	$6.74	$11.46
30-34	$8.47	$14.07	$8.47	$14.07
35-39	$11.19	$18.14	$11.19	$18.14
40-44	$16.04	$25.43	$16.04	$25.43
45-49	$24.05	$37.44	$24.05	$37.44
50-54	$37.31	$57.34	$37.31	$57.34
55-59	$56.24	$85.75	$56.24	$85.75
60-64	$80.68	$122.41	$80.68	$122.41
65-69	$111.18	$168.19	$111.18	$168.19
70+	$140.47	$212.14	$140.47	$212.14

Accident Insurance (Monthly)

	Low Plan	High Plan
EE only	$6.00	$9.94
EE + Spouse	$10.72	$17.78
EE + Child(ren)	$11.55	$19.67
EE + Family	$15.69	$26.57

Supplemental Life Insurance (Monthly)

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

Supplemental AD&D Insurance (Monthly)

	Rate per $1,000 of Coverage*
EE only	$0.030
EE + Spouse	$0.040
EE + Child(ren)	$0.040
EE + Family	$0.040

* Total supplemental AD&D costs combined for employee, spouse, and/or child coverage as applicable.

Identity Theft (Monthly)

EE only	$6.50
EE + Family	$12.50