2019 Employee Benefit Plans

Rev1 Energy 9950 Princess Palm Avenue, Suite 330 Tampa, FL 33619 Tel: (813)657-2404 | Fax: (813)- 413-4333

REV 1 Employee Benefit Plan Rates: March 1, 2019 AETNA – Medical Coverage Only

Plans #1

Aetna OAMC550 HSA

Employer Contribution to HSA Weekly (on an active plan)

Weekly Rates

Employee Only Employee & Spouse Employee & Children

$35.12 $156.82 $109.20 $222.08

$30 $30 $30 $30

Family

Plans #2

Aetna OAMC 5000 70/50 Weekly Rates

Employee Only Employee & Spouse Employee & Children

$53.23 $199.94 $142.53 $278.61

Family

Plan #3

Aetna OAMC 2000 Weekly Rates

Employee Only Employee & Spouse Employee & Children

$83.02 $270.84 $197.34 $371.55

Family

Principal - Dental Coverage

Principal

Plans

Weekly Rates

Employee Only Employee & Spouse Employee & Children

$2.00 $5.00 $4.00 $8.00

Family

Principal - Vision Coverage

Principal

Plans

Weekly Rates

Employee Only Employee & Spouse Employee & Children

$2.01 $4.04 $4.21 $6.79

Family

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