Cost of Coverage
Per Paycheck Cost (Semi- Monthly)
Per Paycheck Cost (Semi- Monthly)
Per Paycheck Cost (Bi-Weekly)
Per Paycheck Cost (Bi-Weekly)
Benefit Plan
Benefit Plan
Base Plan: PPO HSA - All States Employee Only
Dental Low Plan
$0.00
$0.00
Employee Only
$0.00 $9.59 $14.68 $24.33 $0.00 $17.26 $19.00 $36.25 $0.00 $3.49 $3.67 $7.16 $0.00 $4.12 $4.33 $8.45
$0.00 $8.85 $13.55 $22.46 $0.00 $15.93 $17.54 $33.46 $0.00 $3.22 $3.38 $6.60 $0.00 $3.80 $3.99 $7.80
Employee + Spouse Employee + Child(ren) Employee + Family
$279.84 $150.68 $409.00
$258.31 $139.09 $377.54
Employee + Spouse Employee + Child(ren) Employee + Family
Base Plan: Elements Choice HMO - CA Only Employee Only $0.00
Dental High Plan
$0.00
Employee Only
Employee + Spouse Employee + Child(ren) Employee + Family
$381.88 $206.01 $558.93
$352.50 $190.16 $515.94
Employee + Spouse Employee + Child(ren) Employee + Family
Standard Plan: EPO - Non-CA Only Employee Only
Vision Low Plan
$17.69
$16.32
Employee Only
Employee + Spouse Employee + Child(ren) Employee + Family
$422.77 $235.81 $609.75
$390.25 $217.67 $562.84 $70.58 $514.78 $310.19 $720.72
Employee + Spouse Employee + Child(ren) Employee + Family
Standard Plan: Classic HMO - CA Only Employee Only $76.46
Vision High Plan
Employee Only
Employee + Spouse Employee + Child(ren) Employee + Family
$557.68 $336.04 $780.79
Employee + Spouse Employee + Child(ren) Employee + Family
Premium Plan: Classic PPO - All States Employee Only $43.04
$39.73
Employee + Spouse Employee + Child(ren)
$481.09 $278.91 $683.29
$444.08 $257.46
Employee + Family $630.72 Basic Life Insurance, Short-Term Disability, and Long- Term Disability are paid for by the company, if enrolled in a medical plan!
Benefits Guide 2024-25 21
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