Cost of Coverage
Semi- Monthly Per Paycheck Cost
Semi- Monthly Per Paycheck Cost
Monthly Employee Cost
Monthly Employee Cost
Benefit Plan
Benefit Plan
Base Plan: PPO HSA - All States Employee Only
Dental “LOW” Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Dental “HIGH” Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Dental “PREMIUM” Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Vision “LOW” Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Vision “HIGH” Plan Employee Only Employee + Spouse Employee + Child(ren)
$0.00
$0.00
$0.00 $19.17 $29.36 $48.66
$0.00 $9.59
Employee + Spouse Employee + Child(ren) Employee + Family
$559.67 $301.36 $818.00
$279.84 $150.68 $409.00
$14.68 $24.33
Base Plan: Elements Choice HMO - CA Only Employee Only $0.00
$0.00
$0.00
$0.00 $17.26 $19.00 $36.25 $12.18 $38.50 $45.43 $71.71
Employee + Spouse Employee + Child(ren) Employee + Family
$763.76 $412.01 $1,117.86
$381.88 $206.01 $558.93
$34.52 $38.00 $72.50
Standard Plan: EPO - Non-CA Only Employee Only $35.37
$17.69
$24.35 $77.00 $90.85 $143.41
Employee + Spouse Employee + Child(ren) Employee + Family
$845.54 $471.61 $1,219.49
$422.77 $235.81 $609.75 $76.46 $557.68 $336.04 $780.79 $43.04 $481.09 $278.91
Standard Plan: Classic HMO - CA Only Employee Only $152.92
$0.00 $5.59 $5.87 $11.45
$0.00 $2.80 $2.94 $5.73 $0.00 $3.30 $3.46
Employee + Spouse Employee + Child(ren) Employee + Family
$1,115.36 $672.08 $1,561.57
Premium Plan: Classic PPO - All States Employee Only $86.08
$0.00 $6.59 $6.92
Employee + Spouse Employee + Child(ren)
$962.18 $557.82
Employee + Family $683.29 Basic Life Insurance, Short-Term Disability and Long-Term Disability Insurance are paid by the company if enrolled in a medical plan! $1,366.57
Employee + Family $6.76 Voluntary Life Insurance is based on age, covered dependents and coverage amount, therefore it will be calculated for you in the online enrollment system. $13.51
22 Benefits Guide 2025-26
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