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