ENOUGH INFO, WHAT’S IT GOING TO COST ME?
SALARY RANGE: LESS THAN $35,000
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Plan 1 / Base H.S.A
Plan 2 / Mid Copay
Plan 3 / Premium Copay
Employee Only
$ 50.44 $ 141.29 $ 117.85 $ 185.77
$ 104.12 $ 238.93 $ 214.41 $ 338.09
$ 109.62 $ 251.80 $ 225.90 $ 356.23
EE
Employee + Spouse
ES
Employee + Child(ren)
EC
Employee + Family
FAM
SALARY RANGE: MORE THAN $35,000
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Plan 1 / Base H.S.A
Plan 2 / Mid Copay
Plan 3 / Premium Copay
Employee Only
$ 59.21 $ 168.39 $ 140.24 $ 221.60
$ 110.14 $ 257.51 $ 229.76 $ 362.66
$ 115.64 $ 270.39 $ 241.25 $ 380.80
EE
Employee + Spouse
ES
Employee + Child(ren)
EC
Employee + Family
FAM
REMINDER: If you sign up for the H.S.A eligible plan (only Plan 1 is H.S.A. eligible) AMIkids WILL GIVE YOU $500, pro-rated, in your open and active H.S.A. Of course you have to open the account and keep it open to get the money!
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