Your per-pay-period contributions are shown below.
| Benefit Plan | Team Member Only | Team Member + Spouse / Domestic Partner | Team Member + Child(ren) | Team Member + Family |
|---|---|---|---|---|
| Medical | ||||
| Cigna HSA | $38.00 | $152.00 | $74.00 | $190.00 |
| Cigna PPO | $86.00 | $228.00 | $161.00 | $298.00 |
| Cigna PPO High | $137.00 | $309.00 | $226.00 | $390.00 |
| Dental | ||||
| Delta Dental PPO Low | $5.00 | $12.00 | $14.00 | $21.00 |
| Delta Dental PPO High | $15.00 | $30.00 | $34.00 | $51.00 |
| Vision | ||||
| VSP Low | $2.38 | $4.74 | $5.08 | $8.11 |
| VSP High | $3.94 | $7.89 | $8.48 | $13.48 |
| Coverage Options | Per Pay Period Rate |
|---|---|
| LegalShield Only | $7.98 |
| Identity Theft Only | $6.48 |
| Identity Theft Only (TM + Family) | $6.98 |
| Combo: Legal & Identity Theft | $12.95 |
| Pet Discount Plan | Per Pay Period Rate |
|---|---|
| PETplus (Single Pet) | $3.50 |
| PETplus (Unlimited Pets) | $5.00 |
| Pet Assure (Single Pet) | $2.25 |
| Pet Assure (Unlimited Pets) | $4.25 |
| Long Term Disability (LTD) | ||
|---|---|---|
| Team Member Age | Rates per $100 of Covered Base Pay (50%) | Rates per $100 of Covered Base Pay (60%) |
| <25 | $0.031 | $0.037 |
| 25-29 | $0.039 | $0.061 |
| 30-34 | $0.074 | $0.103 |
| 35-39 | $0.117 | $0.187 |
| 40-44 | $0.191 | $0.339 |
| 45-49 | $0.269 | $0.460 |
| 50-54 | $0.351 | $0.587 |
| 55-59 | $0.429 | $0.665 |
| 60-64 | $0.420 | $0.647 |
| 65-69 | $0.303 | $0.641 |
| 70-74 | $0.243 | $0.429 |
| Voluntary Life and AD&D Rates based on Team Members age (FYI: this is inclusive of Spouse rates as well) |
|||
|---|---|---|---|
| Rates Per $1,000 of Covered Base Pay | |||
| Age | Team Member | Age | Spouse |
| <25 | $0.04 | <25 | $0.03 |
| 25-29 | $0.04 | 25-29 | $0.03 |
| 30-34 | $0.05 | 30-34 | $0.03 |
| 35-39 | $0.06 | 35-39 | $0.04 |
| 40-44 | $0.06 | 40-44 | $0.05 |
| 45-49 | $0.09 | 45-49 | $0.07 |
| 50-54 | $0.12 | 50-54 | $0.11 |
| 55-59 | $0.22 | 55-59 | $0.16 |
| 60-64 | $0.31 | 60-64 | $0.26 |
| 65-69 | $0.54 | 65-69 | $0.45 |
| 70-74 | $0.86 | 70-74 | $0.45 |
| 75+ | $0.86 | 75+ | $0.45 |
| Child Supplemental Life and AD&D | Rate Per $1,000 of Covered Pay |
|---|---|
| Covers all Children | $0.08 |
| Unum Accident Insurance | Per Pay Period Rate |
|---|---|
| Team Member Only | $2.73 |
| Team Member + Spouse | $4.69 |
| Team Member + Child(ren) | $4.72 |
| Family | $6.68 |
| Chubb Critical Illness Insurance | ||||
|---|---|---|---|---|
| Per Pay Period Rate for $10,000 Benefit | ||||
| Age | Team Member | Team Member + Spouse | Team Member + Child(ren) | Team Member + Family |
| 18-25 | $1.26 | $1.49 | $1.26 | $1.49 |
| 26-30 | $1.69 | $2.14 | $1.69 | $2.14 |
| 31-35 | $2.00 | $2.60 | $2.00 | $2.60 |
| 36-40 | $2.58 | $3.46 | $2.58 | $3.46 |
| 41-45 | $3.54 | $4.91 | $3.54 | $4.91 |
| 46-50 | $5.17 | $7.35 | $5.17 | $7.35 |
| 51-55 | $7.26 | $10.49 | $7.26 | $10.49 |
| 56-60 | $10.01 | $14.62 | $10.01 | $14.62 |
| 61-65 | $13.56 | $19.95 | $13.56 | $19.95 |
| 66-70 | $16.85 | $24.88 | $16.85 | $24.88 |
| 71-75 | $19.12 | $28.28 | $19.12 | $28.28 |
| 76-80 | $23.45 | $34.82 | $23.45 | $34.82 |
| 81+ | $35.73 | $53.25 | $35.73 | $53.25 |
| Chubb Critical Illness Insurance | ||||
| Per Pay Period Rate for $20,000 Benefit | ||||
| Age | Team Member | Team Member + Spouse | Team Member + Child(ren) | Team Member + Family |
| 18-25 | $1.81 | $2.28 | $1.81 | $2.28 |
| 26-30 | $2.67 | $3.58 | $2.67 | $3.58 |
| 31-35 | $3.30 | $4.50 | $3.30 | $4.50 |
| 36-40 | $4.45 | $6.22 | $4.45 | $6.22 |
| 41-45 | $6.37 | $9.11 | $6.37 | $9.11 |
| 46-50 | $9.63 | $14.00 | $9.63 | $14.00 |
| 51-55 | $13.82 | $20.28 | $13.82 | $20.28 |
| 56-60 | $19.32 | $28.54 | $19.32 | $28.54 |
| 61-65 | $26.42 | $39.19 | $26.42 | $39.19 |
| 66-70 | $32.99 | $49.05 | $32.99 | $49.05 |
| 71-75 | $37.52 | $55.85 | $37.52 | $55.85 |
| 76-80 | $46.19 | $68.93 | $46.19 | $68.93 |
| 81+ | $70.76 | $105.79 | $70.76 | $105.79 |
| Chubb Critical Illness Insurance | ||||
| Per Pay Period Rate for $30,000 Benefit | ||||
| Age | Team Member | Team Member + Spouse | Team Member + Child(ren) | Team Member + Family |
| 18-25 | $2.36 | $3.06 | $2.36 | $3.06 |
| 26-30 | $3.66 | $5.02 | $3.66 | $5.02 |
| 31-35 | $4.59 | $6.40 | $4.59 | $6.40 |
| 36-40 | $6.32 | $8.98 | $6.32 | $8.98 |
| 41-45 | $9.19 | $13.31 | $9.19 | $13.31 |
| 46-50 | $14.09 | $20.65 | $14.09 | $20.65 |
| 51-55 | $20.37 | $30.07 | $20.37 | $30.07 |
| 56-60 | $28.63 | $42.46 | $28.63 | $42.46 |
| 61-65 | $39.27 | $58.43 | $39.27 | $58.43 |
| 66-70 | $49.13 | $73.22 | $49.13 | $73.22 |
| 71-75 | $55.93 | $83.42 | $55.93 | $83.42 |
| 76-80 | $68.93 | $103.03 | $68.93 | $103.03 |
| 81+ | $105.79 | $158.33 | $105.79 | $158.33 |
