Employee Contributions
2025 BI-WEEKLY CONTRIBUTION RATES
IN-NETWORK ONLY – EPO ZERO DEDUCTIBLE PLAN
Managed Choice (Out-o-Network)
Elect Choice (In-Network)
Coverage Tier
Dental
Vision
Employee Only
$90.00
$23.08
$0.00
$0.00
Employee + Spouse / Domestic Partner** Employee + Child(ren)
$55.38 $294.12**
$462.56
$22.88
$2.85
$392.61
$41.54
$23.62
$2.99
Family
$683.68
$78.46
$46.49
$7.16
**If your spouse or domestic partner is employed and has medical coverage available through their employer, a spousal surcharge of $294.12/bi-weekly will be added if you elect to cover your spouse or domestic partner under your medical plan **Imputed Income & after tax deductions may apply to those enrolling domestic partners **Spouse/D/P must provide proof they are NOT offered coverage
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CONTRIBUTIONS I
Callen Lorde BENEFITS GUIDE
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