Medical Plans (PPO) |
Employee |
Employer |
Total |
Premium Medical Plan |
|
|
|
|
|
Employee only |
$298.50 |
$178.50 |
$ 477.00 |
Employee + spouse |
$647.50 |
$353.50 |
$1,001.00 |
Employee + domestic partner |
Pre-tax
$298.50 |
Post-tax
$349.00 |
$353.50 |
$1,001.00 |
Employee + child(ren) |
$599.50 |
$329.50 |
$ 929.00 |
Employee + family |
$950.00 |
$504.00 |
$1,454.00 |
Employee + family / domestic partner |
Pre-tax
$601.00 |
Post-tax
$349.00 |
$504.00 |
$1,454.00 |
Standard Medical Plan |
Employee only |
$218.50 |
$178.50 |
$ 397.00 |
Employee + spouse |
$480.50 |
$353.50 |
$ 834.00 |
Employee + domestic partner |
Pre-tax
$218.50 |
Post-tax
$262.00 |
$353.50 |
$ 834.00 |
Employee + child(ren) |
$444.50 |
$329.50 |
$ 774.00 |
Employee + family |
$707.00 |
$504.00 |
$1,211.00 |
Employee + family / domestic partner |
Pre-tax
$445.00 |
Post-tax
$262.00 |
$504.00 |
$1,211.00 |
Consumer Choice Medical Plan (high deductible health plan) |
Employee only |
$148.50 |
$178.50 |
$327.00 |
Employee + spouse |
$331.50 |
$353.50 |
$685.00 |
Employee + domestic partner |
Pre-tax
$148.50 |
Post-tax
$183.00 |
$353.50 |
$685.00 |
Employee + child(ren) |
$306.50 |
$329.50 |
$636.00 |
Employee + family |
$490.00 |
$504.00 |
$994.00 |
Employee + family / domestic partner |
Pre-tax
$307.00 |
Post-tax
$183.00 |
$504.00 |
$994.00 |
Dental Plans |
Employee |
Employer |
Total |
Basic Dental Plan |
Employee only |
$14.00 |
$ 9.00 |
$23.00 |
Employee + spouse |
$30.50 |
$15.50 |
$46.00 |
Employee + domestic partner |
Pre-tax
$14.00 |
Post-tax
$16.50 |
$15.50 |
$46.00 |
Employee + child(ren) |
$37.00 |
$19.00 |
$56.00 |
Employee + family |
$53.00 |
$26.00 |
$79.00 |
Employee + family / domestic partner |
Pre-tax
$36.50 |
Post-tax
$16.50 |
$26.00 |
$79.00 |
Comprehensive Dental Plan |
Employee only |
$27.50 |
$ 8.50 |
$36.00 |
Employee + spouse |
$56.00 |
$15.00 |
$71.00 |
Employee + domestic partner |
Pre-tax
$27.50 |
Post-tax
$28.50 |
$15.00
|
$71.00 |
Employee + child(ren) |
$67.00 |
$19.00 |
$86.00 |
Employee + family |
$96.00 |
$26.00 |
$122.00 |
Employee + family / domestic partner |
Pre-tax
$67.50 |
Post-tax
$28.50 |
$26.00 |
$122.00 |
VSP Vision Plan |
Employee |
Employer |
Total |
Employee only |
$10.94 |
$0.00 |
$10.94 |
Employee + spouse |
$17.18 |
$0.00 |
$17.18 |
Employee + domestic partner |
Pre-tax
$10.94 |
Post-tax
$6.24 |
$0.00
|
$17.18 |
Employee + child(ren) |
$17.51 |
$0.00 |
$17.51 |
Employee + family |
$28.25 |
$0.00 |
$28.25 |
Employee + family / domestic partner |
Pre-tax
$22.01 |
Post-tax
$6.24 |
$0.00 |
$28.25 |
Tax Advantage Accounts |
Employee |
Employer |
Total |
| Health Savings Account |
Minimum: $5.00/pay period |
Employer rebate will be deposited to HSA |
Individual - $3,100/yr
Family - $6,250/year
$1,000 catch-up 55 & over |
Health Care Flexible Spending Account Contributions |
Minimum:
$5.00/ pay period*
Maximum:
$208.34/ pay period* |
$0.00 |
$5,000/year |
Dependent Day Care Flexible Spending Account Contributions |
Minimum:
$5.00/ pay period*
Maximum:
$208.34/ pay period* |
$0.00 |
$5,000/year |
Limited Purpose Health Care Flexible Spending Account Contributions |
Minimum:
$5.00/ pay period*
Maximum:
$104.17/ pay period* |
$0.00 |
$2,500/year |
*There are 24 Pay Periods each year. |
Benefit Plan |
Employee |
Employer |
Total |
Basic Employee Term Life and AD&D Insurance |
1 x Total Compensation* |
$0.00 |
Life Insurance: |
$0.095/ $1,000 |
$0.11 per $1,000 |
AD&D
Insurance: |
$0.015/ $1,000 |
(*Defined as current base salary plus prior year’s variable compensation – i.e. Bonus, incentives, etc.) |
Board of Directors: AD&D Insurance |
$100,000
|
$0.00 |
$0.015 per $1,000 |
$18.00 per year |
Optional Basic Employee Term Life and AD&D Insurance |
1 x Total Compensation* |
Life Insurance: |
$0.13/ $1,000 |
$0.00 |
$0.145 per $1,000 |
AD&D Insurance: |
$0.015/ $1,000 |
(*Defined as current base salary plus prior year’s variable compensation – i.e. Bonus, incentives, etc.) |
Voluntary AD&D Insurance |
Minimum $25,000 purchased in $25,000 increments up to 10 x Total Compensation* for maximum of $750,000 |
Employee: |
$0.021/ $1,000 |
$0.00 |
N/A |
Employee + Family: |
$0.032/ $1,000 |
Change: This is a change to be consistent with all other pay related insurance benefits:
(*Defined as current base salary plus prior year’s variable compensation – i.e. Bonus, incentives, etc.) |
Group Universal Life Insurance Plan (GUL) |
Employee & Spouse |
Age |
Rate per $1,000 |
$0.00 |
N/A |
| Under 30 |
$0.038 |
| 30-34 |
$0.045 |
| 35-39 |
$0.050 |
| 40-44 |
$0.075 |
| 45-49 |
$0.105 |
| 50-54 |
$0.165 |
| 55-59 |
$0.270 |
| 60-64 |
$0.420 |
| 65-69 |
$0.683 |
| 70-74 |
$1.665 |
| 75+ |
$2.530 |
Life Insurance – Child(ren)
($0.12 per $1,000) |
Amount |
Rate |
$0.00 |
N/A |
| $5,000 |
$0.60 |
| $10,000 |
$1.20 |
| $15,000 |
$1.80 |
| $20,000 |
$2.40 |
| $25,000 |
$3.00 |
Business Travel Accident Insurance (BTA) |
Employees
3x Total Compensation*
|
$0.00 |
$4.09 / employee /year
Aircraft: $3,797/year |
N/A |
(*Defined as current base salary plus prior year’s variable compensation – i.e. Bonus, incentives, etc.)
Premium determined by number of employees / directors on 08/01/09 |
Board of Directors
$100,000
|
$0.00 |
$1.68/director/year |
N/A |
Long-term Disability- Class 1
(For employees participating in a defined benefit pension plan) |
66-2/3% of Total Compensation* up to $20,000/month maximum
|
$0.00
|
$0.234 per $100
|
N/A |
(*Defined as current base salary plus prior year’s variable compensation – i.e. Bonus, incentives, etc.) |
Long-term Disability- Class 2
(For employees not participating in a defined benefit pension plan) |
66-2/3% of Total Compensation* up to $20,000/month maximum
|
$0.00
|
$0.279 per $100
|
N/A |
(*Defined as current base salary plus prior year’s variable compensation – i.e. Bonus, incentives, etc.) |