Cost of Coverage
Medical Coverage
| 2023 Semi-Monthly Contributions | CDHP Employee Cost | PPO Employee Cost |
|---|---|---|
| Employee Only | $53.37 | $91.40 |
| Employee + Spouse | $126.03 | $203.81 |
| Employee + Child(ren) | $117.52 | $192.46 |
| Employee + Family | $171.45 | $299.76 |
Dental Coverage
| 2023 Semi-Monthly Contributions | Preventive Plan | Comprehensive Plan |
|---|---|---|
| Employee Only | $3.18 | $7.50 |
| Employee + Spouse | $6.36 | $15.00 |
| Employee + Child(ren) | $8.40 | $20.00 |
| Employee + Family | $12.63 | $30.00 |
Vision Coverage
| 2023 Semi-Monthly Contributions | Employee Pays |
|---|---|
| Employee Only | $2.71 |
| Employee + Spouse | $5.42 |
| Employee + Child(ren) | $5.48 |
| Employee + Family | $8.74 |
Voluntary Benefits
Voluntary Life Semi-Monthly Rates
| Prudential Voluntary Life | ||
|---|---|---|
| Age | Employee Rate per $1,000 | Spouse Rate per $1,000 |
| Under 25 | $0.025 | $0.025 |
| 25-29 | $0.030 | $0.030 |
| 30-34 | $0.040 | $0.040 |
| 35-39 | $0.045 | $0.045 |
| 40-44 | $0.050 | $0.050 |
| 45-49 | $0.075 | $0.075 |
| 50-54 | $0.115 | $0.115 |
| 55-59 | $0.215 | $0.215 |
| 60-64 | $0.330 | $0.330 |
| 65-69 | $0.635 | $0.635 |
| 70-74 | $1.030 | $1.030 |
| 75+ | $1.030 | $1.030 |
| Child(ren) Rate Per $1,000 | $0.147 | |
Voluntary AD&D Semi-Monthly Rates
| Prudential Voluntary AD&D | |
|---|---|
| Rate per $1,000 | |
| Employee | $0.009 |
| Spouse | $0.009 |
| Child | $0.009 |
Critical Illness Semi-Monthly Costs
| Employee Only | Employee + Spouse | Employee + Child(ren) | Employee + Family | |
|---|---|---|---|---|
| Age | Rate Per $10,000 | Rate Per $10,000 | Rate Per $10,000 | Rate Per $10,000 |
| Under 30 | $2.03 | $3.44 | $2.03 | $3.44 |
| 30-39 | $3.01 | $5.44 | $3.01 | $5.44 |
| 40-49 | $4.75 | $8.22 | $4.75 | $8.22 |
| 50-59 | $8.76 | $14.26 | $8.76 | $14.26 |
| 60-69 | $16.60 | $26.12 | $16.60 | $26.12 |
| 70-79 | $27.18 | $44.06 | $27.18 | $44.06 |
| 80+ | $27.18 | $44.06 | $27.18 | $44.06 |
Accidental Injury Semi-Monthly Costs
| Accidental Injury Coverage | Semi-Monthly Rates |
|---|---|
| Employee Only | $3.11 |
| Employee + Spouse | $5.34 |
| Employee + Child(ren) | $5.99 |
| Employee + Family | $8.41 |
Hospital Care Semi-Monthly Costs
| Hospital Care Coverage | Semi-Monthly Rates |
|---|---|
| Employee Only | $4.26 |
| Employee + Spouse | $8.66 |
| Employee + Child(ren) | $8.28 |
| Employee + Family | $12.68 |