Employee Costs (per pay period) | Cigna Full HMO | Cigna HMO Select | Cigna OAP | Cigna OAP with HSA |
---|---|---|---|---|
All Locations Except Indiana | ||||
Employee | $56.20 | $42.52 | $96.37 | $47.05 |
Employee + Spouse | $139.56 | $105.60 | $236.19 | $131.81 |
Employee + Child(ren) | $135.27 | $102.34 | $232.29 | $127.28 |
Family | $216.42 | $163.75 | $384.26 | $203.64 |
Indiana | ||||
Employee | Not Available | Not Available | $74.70 | $40.86 |
Employee + Spouse | Not Available | Not Available | $173.47 | $98.85 |
Employee + Child(ren) | Not Available | Not Available | $167.30 | $85.76 |
Employee + Family | Not Available | Not Available | $274.39 | $151.27 |
Employee Costs (per pay period) | DeltaCare USA HMO (CA only) | Dental PPO |
---|---|---|
Employee | $2.81 | $6.90 |
Employee + Spouse | $5.81 | $13.94 |
Employee + Child(ren) | $5.21 | $13.94 |
Family | $8.60 | $20.99 |
Employee Costs (per pay period) | Vision |
---|---|
Employee | $0.51 |
Employee + Spouse | $0.67 |
Employee + Child(ren) | $0.74 |
Employee + Family | $1.37 |
Optional Life Age Band | Monthly Rate (per $1,000 of covered volume) |
---|---|
Age 0-24 | $0.060 |
Age 25-29 | $0.071 |
Age 30-34 | $0.095 |
Age 35-39 | $0.107 |
Age 40-44 | $0.118 |
Age 45-49 | $0.178 |
Age 50-54 | $0.273 |
Age 55-59 | $0.510 |
Age 60-64 | $0.782 |
Age 65-69 | $1.504 |
Age 70+ | $2.439 |
Child(ren) life | $0.095 |
Optional AD&D | |
---|---|
Employee Only | $0.020 |
Spouse Only | $0.020 |
Child Only | $0.020 |
*Spouse coverage ends at age 70.
Every effort has been made to ensure this site accurately represents each benefit, however, should there be any discrepancy between the contents of this site and the terms in the plan document, the plan document will prevail.
Buy-Up STD Monthly Rates (per $10 of Weekly Benefit basis) | ||
---|---|---|
Age | CA Rate | Non-CA Rate |
Age 0-24 | $0.040 | $0.080 |
Age 25-29 | $0.040 | $0.080 |
Age 30-34 | $0.040 | $0.080 |
Age 35-39 | $0.040 | $0.080 |
Age 40-44 | $0.040 | $0.080 |
Age 45-49 | $0.045 | $0.095 |
Age 50-54 | $0.045 | $0.095 |
Age 55-59 | $0.060 | $0.120 |
Age 60-64 | $0.080 | $0.140 |
Age 65-69 | $0.100 | $0.160 |
Age 70+ | $0.100 | $0.160 |
LTD Buy-Up (per $100 of covered payroll)D Buy-Up (per $100 of covered payroll) | |
---|---|
Rate | $0.19 |