SiteImpact • 2023-2024 Benefits Guide
BI-WEEKLY PAYROLL CONTRIBUTIONS
Medical/Rx
HSA 3500
HMO 5000
HMO 1500
PPO 1500
Employee
$3.49
$31.33
$67.98
$88.96
Employee + Spouse (Domestic Partner)
$258.15
$324.91
$394.82
$430.57
Employee + child(ren)
$147.31
$198.02
$277.02
$294.56
Employee + Family
$387.70
$446.46
$543.54
$592.75
Dental
DHMO
PPO
Employee
$2.15
$12.39
Employee + Spouse (Domestic Partner)
$6.98
$31.79
Employee + child(ren)
$9.67
$42.80
Employee + Family
$13.44
$57.81
Vision
Vision
Employee
$1.41
Employee + Spouse (Domestic Partner)
$4.93
Employee + child(ren)
$6.91
Employee + Family
$9.64
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