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 |
|
|
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 |
|
|
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 |
<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 |
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 |
|
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 |
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 |